Government Medical College Research Articles

Concerns of Primary Caregivers of Children with Complex Chronic Conditions in Kerala: A Qualitative Analysis.

Exploring data on primary caregiver experiences of dealing with chronically ill children (CIC) strengthens the ability of paediatricians to improve the quality of care by detecting unmet needs in paediatric palliative care and understanding their original concerns instead of presumed needs. Hence, this study aims to identify and describe the primary concerns and challenges faced by caregivers of children with complex chronic conditions in a tertiary care hospital in Kerala. Primary caregivers of 25 children aged <13 years with non-malignant life-limiting illnesses, admitted to the paediatric department of a government medical college in Kerala between 1 July 2021 and 28 February 2022, underwent in-depth interviews to analyse their most worrisome issues. Thematic analysis was the method chosen for qualitative data analysis. The main themes identified were medical issues, unmet needs, caregiver health issues, and social and financial issues. Among the medical issues, poor seizure control and infected bedsores, sleep deprivation in both patient as well as caregivers, and difficulty in maintaining the personal hygiene of patients were the major issues. Parents of almost all the CICs reported that they required diapers more than any other material or device. Maternal depression was the major caregiver health issue. The unavailability of antiepileptic drugs in peripheral health centres resulted in missing doses and undue expenses for travel to tertiary centres to obtain the same. Caregivers reported their dismay when they finally realised that they were given false hopes of a cure by different systems of medicine. The challenges faced by caregivers of children with complex chronic conditions are multifaceted. Their most problematic issues related to medical issues are the occurrence of breakthrough seizures and development of infected bedsores. The most important material hardship reported was diaper needs. Caregiver issues such as sleep deprivation and maternal depression must be identified and addressed while providing comprehensive palliative care.

Perinatal Outcome of Twin Pregnancies in Relation to Chorionicity at a Tertiary Care Centre in Central Kerala, India: A Prospective Cohort Study

Introduction: In recent years, there has been a significant increase in the incidence of multiple births due to advanced maternal age at conception and the growing use of infertility treatment. Multiple pregnancies are associated with both maternal and perinatal complications. Maternal complications include anaemia, gestational hypertension, gestational diabetes, preterm labour, operative delivery and postpartum haemorrhage. Preterm birth, growth discordance and complications specific to monochorionic twins predispose these babies to adverse perinatal outcomes. Aim: To assess the perinatal outcomes of twin pregnancies and compare the outcomes of monochorionic and dichorionic pregnancies. Materials and Methods: The present prospective cohort study was conducted in the Department of Obstetrics and Gynaecology, Government Medical College (Tertiary care centre), Thrissur, Kerala, India, from September 2019 to August 2020. All twins who delivered at a gestational age of ≥28 weeks during the study period were recruited, totaling 76 twin pregnancies. A structured proforma was used to collect demographic and clinical details, including mode of conception, chorionicity, maternal complications, intrapartum events and neonatal outcomes. Data were analysed using Epi Info software. Results: The mean maternal age of the study participants was 28.39±6.29 years. The incidence of twin pregnancies delivering at ≥28 weeks at Government Medical College, Thrissur, during the study period was 2.8% (76 twins out of 2709 deliveries). Infertility treatment (ovulation induction alone or Assisted Reproductive Techniques (ART) was associated with dichorionic twinning in 19.7% (15 out of 76 twin pregnancies), with a p-value of 0.008. Maternal complications were similar in both dichorionic and monochorionic twins. Preterm Premature Rupture of Membranes (PPROM) occurred in 23 (28.75%) twin pregnancies, 19 (23.75%) had Gestational Diabetes Mellitus while 13 (16.25%) participants had anaemia. Foetal growth restriction, congenital anomalies, and discordant growth were more prevalent in monochorionic twin pregnancies compared to dichorionic twin pregnancies. Although the proportion of babies requiring Neonatal Intensive Care Unit (NICU) admission was higher in monochorionic twins (64% vs 53.9%), the proportion of neonatal deaths was nearly equal between monochorionic and dichorionic twins (10% vs 9.8%). Conclusion: In the present study, there was no statistical difference in maternal complications between monochorionic and dichorionic twins. However, monochorionic pregnancies had a poorer perinatal outcome compared to dichorionic pregnancies.

Impact of Tobacco Consumption During COVID-19 Lockdown: Insights from Employees at a Government Medical College in Gujarat

Background: Tobacco consumption is consistently harmful to one's well-being, and for individuals with respiratory conditions, it can elevate the likelihood of contracting infections, raise the potential for complications, and enhance the probability of transmission. In this study awareness about the association and the impact of the lockdown on tobacco use among current tobacco users of Government Medical College, Gujarat was assessed. Objectives: To evaluate the level of insight regarding the connection between COVID-19 and tobacco use and to assess the influence of COVID-19 related lockdown measures on the rate of tobacco consumption among current tobacco users at Government Medical College, Gujarat. Methods: A study was conducted among Class 3 &amp; Class 4 employees of Government Medical College using convenient sampling technique. Study population who was ready to participate in the study and had been actively engaged in the 10-month counselling program from January 2020 to November 2020. Data was gathered through a pre-tested closed-ended questionnaire. Statistical analysis was carried out using the SPSS software (version 22). Ethical approval was obtained from the Institute Ethical Committee, and written informed consent was acquired from all the participants. Results: A significant majority, comprising 68% of tobacco users, lacked awareness of the link between tobacco use and COVID-19. Among the 173 current tobacco users, 49 of them successfully abstained from tobacco use during the lockdown period. The primary reasons cited for this change were the unavailability and higher prices of tobacco products. Conclusions: The level of awareness regarding the connection between tobacco and COVID-19 played a crucial role in motivating tobacco users to discontinue their tobacco consumption.

An Observational Study on Impact of COVID-19 in Pregnancy: Clinical Profiles and Foetomaternal Outcomes in Caesarean Section Cases at a Tertiary Care Centre, Gujarat, India

Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, has resulted in a crippled healthcare system worldwide. In this unprecedented situation, it is important to analyse the impact on the vulnerable population of pregnant women, especially those with high-risk pregnancies and those undergoing a Caesarean section (CS). Aim: To analyse the clinical profile, foetomaternal outcomes, and co-morbidities in COVID-19-affected pregnancy cases undergoing a CS. Materials and Methods: This was a retrospective observational study conducted at the Department of Obstetrics and Gynaecology, Government Medical College, and New Civil Hospital in Surat, Gujarat, India during the first wave of the COVID-19 pandemic from April 2020 to December 2020. The study included a total of 65 cases of COVID-19-positive mothers undergoing a C-section. Demographic parameters such as age, obstetric history, details of the C-section (like gestational age at the time of the procedure, indication, and category of the C-section), associated co-morbidities, severity of COVID-19- related symptoms and treatment, neonatal parameters {such as birth weight, Appearance, Pulse, Grimace, Activity and Respiration (APGAR) score, and COVID-19 status of the baby at birth} were analysed. Additionally, a comparison of the C-section rate and complications such as the development of severe anaemia requiring blood transfusion, postoperative development of urinary tract infections, surgical site infections, and the association of hypertensive disorders of pregnancy was conducted between COVID-19-affected and unaffected pregnancies undergoing a C-section during the study period. Data on COVID-19 negative cases were obtained from the monthly labour room statistics submitted to the department. The Chi-square test and Fisher’sexact test were used to compare parameters of the COVID-19 positive and negative groups and a p-value of less than 0.05 was considered statistically significant. Results: Out of a total of 6246 deliveries conducted at the institute during the study period, the CS rate among affected and non affected women was 44.5% (65 out of 146) vs. 32.8% (2006 out of 6100) {p=0.003, Relative Risk (RR) 1.3, 95% Confidence Interval (CI) 1.12-1.62}. The mean age of women with COVID19 undergoing a CS was 25.3 years. The difference in the rate of blood transfusion requirement in COVID-19-affected cases was 9 out of 65 (13.8%) vs. 120 out of 2006 (6%) in COVID-19 negative pregnancies (RR 2.3, 95% CI: 1.2-4.3). The difference in the rate of urinary tract infections in the postoperative period was statistically significant in COVID-19-infected patients, 5 out of 65 (7.7%) vs. 58 out of 2006 (2.9%) in non infected patients (p=0.0451, RR 2.6, 95% CI 1.1-6.4). The prevalence of hypertensive disorders among COVID-19 positive and negative mothers undergoing CS was very high in the present study (16 out of 65, 24.6% vs. 160 out of 2006, 8.1%, RR 3.08, 95% CI 1.9-4.8). Neonatal parameters like low APGAR score at birth were seen in 5 cases (8%), low birth weight in 20 cases (30%), and 3 babies (4.5%) were COVID-19 positive at birth. Conclusion: Higher rates of caesarean sections, increased prevalence of hypertensive disorders of pregnancy, anaemia requiring blood transfusion, and postoperative development of urinary tract infections among COVID-19-affected mothers undergoing a caesarean section.

Clinicopathological Study of Mucormycosis in COVID-19: A Cross-sectional Study from a Tertiary Care Centre in North Kerala, India

Introduction: Mucormycosis is an angioinvasive disease associated with high morbidity and mortality caused by fungi of the order Mucorales. The rise in the incidence of mucormycosis, along with the surge of Coronavirus Disease- 2019 (COVID-19), justifies reassessment of associated risk factors and the susceptible population. The present study aims to highlight the specific clinicopathological features and risk factors of mucormycosis in COVID-19 patients. Aim: To investigate the histopathological features, key clinical findings in mucormycosis, and the predisposing factors associated with mucormycosis in post-COVID-19 patients. Materials and Methods: This descriptive cross-sectional study was conducted at the Department of Pathology, Government Medical College, Manjeri, Malappuram, Kerala, India, in the Department of Pathology. It included all histopathologically proven Mucormycosis specimens from confirmed COVID-19 positive and post-COVID-19 cases in this Medical College from January 1, 2021, to December 31, 2021, amounting to a total of 30 cases. The type of tissue reaction, fungal hyphae, angioinvasion, necrosis, and fungal co-infections were assessed. Histopathologic analysis was performed using routine Haematoxylin and Eosin (H&amp;E) slides, followed by special stains such as Periodic Acid Schiff (PAS) and Grocott Methenamine Silver (GMS). Data was collected using a proforma, and the clinical details were obtained from the request form received along with the biopsy specimen and case sheets. Age, gender, site of involvement, and risk factors were assessed and subjected to descriptive tabulation and analysis. Results: The mean age was 49.5 years with a male-to-female ratio of 1.30:1. The major risk factors observed in the present study were Diabetes Mellitus (DM) and steroid therapy, 30 all cases (100%), along with others such as chronic kidney disease 2 cases (6.67%) immune disorders, and renal transplantation 1 case each (3.33%). The most commonly involved site was sinuses 27 cases (90.00%). Multiple sinuses were affected in 22 cases (73.33%), with the ethmoid sinus being the most common site 24 cases (80.00%), followed by the maxillary sinus 21 cases (70.00%). The most common reaction pattern observed was acute inflammation 15 cases (50.00%). Angioinvasion was noticed in 19 cases (63.33%) and necrosis was present in 28 cases (93.33%). Co-infection with fungal pathogens was observed in 8 cases (26.67%), with aspergillus being the most common co-infection in all except one of the eight cases. Fungal hyphae were visible on H&amp;E slides in 28 cases (93.33%), while the remaining cases were identified only through special stains (PAS and GMS). Conclusion: Mucormycosis infection is strongly associated with DM and steroid therapy. A more even distribution between males and females was noted, deviating from the male predominance described in most studies. The histopathological appearance of angioinvasion was less frequent compared to most studies, consistent with previous studies on the Indian population. Higher rates of co-infection and the presence of granulomatous inflammation were observed. Further studies are needed to explore the relationship between host immunity, morphological patterns, and their influence on prognosis.

A comparative study of low-pressure pneumoperitoneum versus standard-pressure pneumoperitoneum in laparoscopic cholecystectomy in tertiary care center

Background: Laparoscopic cholecystectomy is the gold standard management of symptomatic cholelithiasis. We try to use low-pressure pneumoperitoneum (LPP) to study the effect of pneumoperitoneum in the duration of surgery, field of visualization with providing sufficient work space for surgeon, and post-operative shoulder pain and hospital stay in laparoscopic cholecystectomy. Aims and Objectives: The aims and objectives of the study are to compare outcomes in LPP versus standard-pressure pneumoperitoneum (SPP) with respect to duration of surgery, CO2 consumption, field of visualization, and surgical difficulties to convert SPP or open cholecystectomy and post-operative shoulder pain and hospital stay. Materials and Methods: The prospective randomized study was conducted in tertiary care center, Government Medical College, Banda, Uttar Pradesh from July 2021 to October 2022. All consented 100 patients after randomization were allotted into two groups. Results: In our study, the mean duration of surgery surgical difficulties to convert open and standard pressure and difficulty in field visualization insignificant is more in LPP as compared to SPP but CO2 consumption, post-operative shoulder pain, and mean hospital stay is less in LPP as compared to SPP. Conclusion: Laparoscopic cholecystectomy in LPP is safe and feasible. Field visualization, conversion rate, and duration of surgery are affected non-significantly because depend on the expertise of surgeon but shoulder pain, CO2 consumption, and hospital stay are less in LPP.

Hepatitis B Vaccination Coverage among Healthcare Workers and Evaluation of Immune Response by Estimating Anti-HBs Antibody Titers over Time at a Tertiary Care Hospital: A Cross-sectional Study

Introduction: Healthcare Workers (HCWs) are at a high-risk of acquiring Hepatitis B Virus (HBV) infection. However, this risk can be prevented through Hepatitis B vaccination. In some institutes, HCWs have a lower percentage of HBV vaccination, leading to a higher risk of HBV transmission. Therefore, the coverage of vaccination is an important point, along with the evaluation of protective immune status. Aim: To assess the vaccination coverage and evaluate the immune response post-vaccination through Anti-Hepatitis B surface Antibodies (Anti-HBs) titre. Materials and Methods: This cross-sectional study was conducted at Government Medical College, Pali, Rajasthan, India, over a period of one year from April 2021 to March 2022, following approval from the Institutional Ethics Committee (IEC). A total of 455 HCWs below 60 years of age were included in the study, and their demographic details such as age, gender, occupation, needle stick injury, blood exposure to mucous membranes and breached skin, hepatitis B vaccination status, and time duration since vaccination were noted. Additionally, their Anti-HBs titer was examined. The participants were initially classified into three groups: completely vaccinated, partially vaccinated, and non vaccinated. Among those who were vaccinated, they were further divided into two groups: vaccination ≤5 years (Group A) and &gt;5 years (Group B). Furthermore, those who received a booster dose were divided into Group I (≤1 year) and Group II (&gt;1 year). Blood samples were collected to assess the anti-HBs levels quantitatively in the sera using Enzyme Linked Immuno Sorbent Assay (ELISA). The data was entered into Microsoft Excel and later imported into Statistical Package for Social Sciences (SPSS) version 22.0 for statistical analysis. Results: Participants had a mean age of 29.65±9.603 years. Among them, 43 (30.1%) were doctors, and 37 (25.9%) were medical students who were found to be completely vaccinated. On the other hand, among other HCWs, 15 (10.5%) were nurses, 16 (11.2%) were nursing students, and 32 (22.4%) were lab technicians who were vaccinated. None of the support staff were vaccinated (p-value=0.0001). A total of 143 participants were completely vaccinated, and 97.9% (n=140) had protective immunity to Hepatitis B. The anti-Hbs titre was 567.32±434.494 in group A and 265.74± 211.80 in group B (p-value=0.0001). Similarly, it was 688.34±424.617 in group I and 221.14±141.221 in group II (p-value &lt;0.0001).The anti-Hbs titre did not significantly increase among the partially vaccinated participants (n=162). It was found to be 25.47±27.595 in group A and 14.60±19.939 in group B (p-value=0.004). There was no significant difference in the results between males and females (p-value=0.961). Conclusion: The coverage of complete vaccination among HCWs was significantly low, which is crucial for obtaining a protective Anti-Hbs titre. Incomplete vaccination does not result in a sufficient level of anti-Hbs titre, and there may be a significant decline in the immune response over time (p-value&lt;0.05). Therefore, it is essential to estimate the titre after 1-2 months of complete vaccination to ensure that individuals are fully protected against Hepatitis B.

A cross-sectional retrospective study comparing Alvarado and air scores in predicting accuracy of Appendicectomy: A study conducted at government medical college, Srikakulam

A cross-sectional retrospective study comparing Alvarado and air scores in predicting accuracy of Appendicectomy: A study conducted at government medical college, Srikakulam

Analysis of Trends in Dengue Infection among Patients Attending a Tertiary Care Teaching Hospital: A Retrospective Observational Study

Introduction: Dengue, a common mosquito-borne arboviral infection in tropical countries, presents cyclical epidemics and seasonal variations with diverse clinical outcomes. Over the past three decades, it has become endemic in India, leading to a rising mortality trend, primarily due to its severity and antibody-dependent enhancement in secondary dengue cases. Therefore, understanding the trend of dengue infection in specific geographical areas is crucial for more efficient prophylaxis. Aim: To provide a comprehensive overview of the seroprevalence of dengue virus infection in Surat district, including the trends in gender, age distribution, and seasonal variations of dengue infection from 2014 to 2021. Materials and Methods: The present retrospective observational analysis was conducted in the Department of Microbiology, Government Medical College (tertiary care teaching New Civil Hospital), Surat, Gujarat, India. A total of 31,683 blood samples were received from patients with clinical suspicion of dengue-like illness from January 2014 to December 2021. Data collection took place from March 2022 to May 2022, and the analysis was conducted in June and July 2022. All samples underwent dengue infection detection using the Enzyme-linked Immunosorbent Assay (ELISA) method by Non structural 1 (NS1) antigen detection and Immunoglobulin M (IgM) antibody detection by Mac capture ELISA. Demographic and clinical details were obtained and recorded from laboratory request forms using a structured data sheet in using Microsoft Excel software version 2013. The data were entered and analysed using EpiInfo software version 3.5.1. Results: Among the 31,683 blood samples tested, 5,994 (18.91%) cases were confirmed for dengue infection through ELISA testing. The highest number of positive cases (33.6%) was observed in the 20-29 years age group, with males outnumbering females in terms of dengue positivity at a ratio of 1.37:1. The maximum number of dengue cases occurred during the postmonsoon and early winter periods, with 96.5% of cases reported from Surat district, India. Conclusion: The rising trend of dengue infection in different age groups over the years underscores the need for continued implementation of surveillance and preventive strategies before the monsoon, aiming to reduce severe dengue infections in the future.

A cross-sectional comparative assessment of diabetic autonomic neuropathy using heart rate variability and galvanic skin response – Effect of disease progression

Background: Type 2 diabetes mellitus (T2DM) poses a significant health-care challenge and is a primary contributor to both mortality and morbidity. Diabetic autonomic neuropathy (DAN) is a frequently occurring complication associated with diabetes mellitus. Autonomic nerve damage leading to cardiac autonomic dysfunction and peripheral sympathetic neuropathy can lead to changes in heart rate variability (HRV) and galvanic skin resistance (GSR), respectively. Aims and Objectives: The study was designed and done to evaluate the impact of T2DM on HRV and GSR for assessing DAN. Materials and Methods: A total of 100 individuals diagnosed with T2DM (cases) and 100 healthy individuals (controls) participated in this study. Physio Pac (PC-2004) was used to record the necessary data. Statistical analysis was performed using the non-parametric Mann–Whitney test to see the comparison of the cases and controls. In addition, to measure the statistical relationship between the duration of the disease and the HRV and GSR parameters, Spearman’s rank correlation coefficient was utilized. The study received approval from the Ethical and Research Committee at the Government Medical College, Patiala. Results: Significant statistical differences were observed between the cases and controls in all time domain measures, as well as GSR and the majority of frequency domain measures of HRV. The correlation analysis revealed a strong association between the duration of T2DM and a decrease in HRV as well as an increase in GSR. Conclusion: The findings from the present study provide evidence that T2DM has an impact on HRV, which suggests the presence of cardiac autonomic neuropathy among diabetic patients, leading to an increased risk of cardiovascular morbidity. In addition, the study indicates that reduced sudomotor function, as assessed by Galvanic Skin Resistance (GSR), serves as a predictive measure for autonomic neuropathy. Therefore, these tests can serve as valuable tools in facilitating the assessment of DAN.

Cardiopulmonary Involvement in Patients with Systemic Sclerosis: A Cross-sectional Study

Introduction: One of the most challenging aspects of systemic sclerosis is the potential involvement of the cardiopulmonary system, which can lead to significant morbidity and mortality if not detected and managed promptly. Aim: To assess the clinical characteristics and prevalence of specific cardiopulmonary involvement and to investigate its association with disease duration in patients with systemic sclerosis from South India. Materials and Methods: This cross-sectional, observational study was conducted at the Department of General Medicine, Government Medical College, Thrissur, India, between January 1, 2020, and December 31, 2020. Forty patients with systemic sclerosis were included according to the European Alliance of Associations for Rheumatology (EULAR) and the American College of Rheumatology classification criteria. Skin thickening was evaluated using the modified Rodnan Skin Score (mRSS). Investigations such as chest X-ray, echocardiogram, and antibody profiling were conducted to evaluate cardiopulmonary involvement. The data were analysed using Statistical Package for Social Sciences (SPSS) version 23.0, and the Chi-square test was used to compare qualitative variables between groups. Results: Sixteen patients (40%) had an mRSS score between 11 and 20, followed by 14 patients (35%) with mRSS scores between 21 and 30. The prevalence of Interstitial Lung Disease (ILD) was 50%. The echocardiogram findings showed mitral regurgitation and moderate Pulmonary Arterial Hypertension (PAH) in 30% (n=12) and 25% (n=10) of patients, respectively. High-Resolution Computed Tomography (HRCT) and pulmonary function tests were normal in 10 patients (25%). The duration of the disease was three to eight years in 14 patients and eight to 12 years in 12 patients. Both ILD and PAH were significantly associated with the duration of the disease (p&lt;0.05). Antiscleroderma-70 and anti-centromere were the most common antibodies present in patients with ILD and PAH, respectively. Conclusion: The study indicated a high prevalence of PAH and ILD in patients with systemic sclerosis. Moreover, both ILD and PAH were significantly associated with the duration of the underlying disease, with longer disease duration being associated with a higher likelihood of these conditions.

Histopathological Profile of Lung Lesions- An Autopsy Study at a Tertiary Care Centre, Kerala, India

Introduction: Autopsy plays a crucial role in understanding and identifying pulmonary pathology, encompassing non neoplastic lesions, neoplastic conditions and the secondary implications of the lungs in terminal events of cardiovascular diseases. Pathological analysis confirms diagnosis and identifies the prevalence of lesions, contributing significantly to medical understanding and patient care. Aim: To estimate the prevalence of lung pathology in autopsy specimens through Histopathological Examination (HPE). Materials and Methods: A cross-sectional one-year study was conducted to determine the histopathological alterations in 132 lung autopsy specimens from Medicolegal autopsies received in the Department of Pathology at a tertiary care centre in Government Medical College, Cochin, Kerala, India from January 2021 to December 2021. Autopsy specimens of the lung were fixed in 10% formalin. Following gross examination, tissue sections were processed with paraffin and subjected to staining, with microscopy findings recorded. The data was numerically coded and entered into a Microsoft Excel spreadsheet. Statistical Package for Social Sciences (SPSS) version 21.0 was used for descriptive statistics and graphical representations of findings. Results: The mean age of the study population, comprising 132 autopsy cases, was 49.41±52.12 years and the male-to- female ratio was 3.71:1. Most cases 97/132 (73.50%) involved sudden deaths where the cause remained unknown. Significant microscopic findings found in 117 (88.63%) cases were as follows: Pulmonary oedema and congestion: 61 (46.21%), Pneumonia: 17 (12.87%), Diffuse Alveolar Damage (DAD): 12 (9.09%), Chronic venous congestion: 8 (6.06%), Tuberculosis: 7 (5.30%), Emphysema: 7 (5.30%), Pulmonary fibrosis: 1 (0.75%), Fat embolism: 1 (0.75%) and Pulmonary arterial hypertension: 1 (0.75%). Neoplastic lesions were identified in 7 (5.30%) cases, with primary lung cancers accounting for 3 (2.27%) cases. There were 10 cases of Real-time Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR), positive Coronavirus Disease 2019 (COVID-19) autopsies, of which 6 (60%) exhibited DAD, while 4 (40%) showed changes of bronchopneumonia. Conclusion: Non neoplastic lesions such as pulmonary oedema, DAD and infections contributed to mortality in most cases. DAD was the most common lung finding in more than half of COVID- 19 deaths. The prevalence of pulmonary neoplastic lesions in autopsies underscores their epidemiological significance in a particular geographical area.

Nagpur technique (triple wedge technique) for cleft lip repair in the first plastic surgery department of India: Principle and its evolution

ABSTRACT Background: Cleft lip chelioplasty can be approached with a wide array of different techniques. The ultimate goal of all techniques is to restore sphincter competence and aesthetically favorable outcome. Dr.C. Balakrishnan of Government medical college,Nagpur devised an original triple wedge technique,a form of three triangular flap,that was evolved independently of the triangular flap technique. Unfortunately he did not publish his technique,even today many of his 4th and 5th generation trainees perform triple wedge technique for cleft lip repair.[1-3] The history of cleft lip repair in Nagpur and it’s growth can not be dissociated from modern plastic surgery in India by the father of modern plastic surgery in India Dr. C.Balakrishnan himself,who established the first department of plastic surgery in India at GMC Nagpur,credited it with a new classification of cleft lip and palate, a new technique of cleft lip repair and propagated the principles of comprehensive cleft care. In our institute triple wedge repair for cleft lip is the repair of choice since 1950, although many modifications have been done in original technique since then. I was trained in KEM hospital,Mumbai and learned Millard’s repair there. After coming to Nagpur,I joined the department as lecturer under respected Dr S.M. Kale sir and I got the opportunity to learn triple wedge technique from him. Over the last 20 years I have added few modifications like changing the orientation of triangles,using the mucosal element for anterior palate repair which used to be discarded in original triple wedge technique and primary rhinoplasty. Aims and Objectives: In this original article we are describing the original triple wedge technique invented by father of modern plastic surgery in India Dr.C. Balakrishnan 2 and its evolution since then in the first department of plastic surgery in India. Materials and Methods: Patients operated in last 50 years at Government Medical college,Nagpur and data available in department. Results: Early and late postoperative pictures showing result of the technique. Conclusion: The purpose of this article is illuminating unpublished work of legend of plastic surgery in India Dr. C. Balakrishnan.

Declining Trend of HIV Seroprevalence in Pregnant Women: A Retrospective Observational Analysis of 12 Years’ Experience at a Tertiary Care Hospital in Central India

Introduction: Human Immunodeficiency Virus (HIV) infection among antenatal women has been reported throughout the country, with a relatively high prevalence in the state of Maharashtra. Data on HIV seroprevalence in antenatal women serve as an indirect indicator of the HIV epidemic's burden in the general population and aid in predicting the same in young children. Diagnostic and treatment services for HIV are concentrated in selected states and districts with high seroprevalence, making it necessary to accurately calculate the prevalence of HIV. Aim: To assess the effectiveness of Prevention of Parentto-Child Transmission (PPTCT) services and to study the effectiveness of the National Acquired Immunodeficiency Syndrome (AIDS) Control Programme (NACP) in the functioning of PPTCT services. Materials and Methods: A retrospective observational analysis of 12-year data, from January 2007 to December 2018, was conducted in the Department of Microbiology at the Government Medical College and Hospital, Nagpur, Maharashtra, representing Central India. Data collection took place from June 2019 to December 2019, and analysis occurred over the subsequent two months (January 2020 to February 2020). The total sample size was 101,865 patients. All pregnant women registered in the Antenatal Clinic (ANC) under the PPTCT Program were included in the present study, and Strategy III of the National HIV testing algorithm was followed. The women's ages, their partners' serostatus, and records of babies born to HIV seropositive mothers were obtained and analysed. The statistical analysis of the data was performed using Stata (version 10.4.2009, STATA Corp., Texas, USA) and Epi Info 7 (version 7.1.06, 2012, CDC, Atlanta, USA), employing the Chi-square test for linear trend (Extended Mantel-Haenszel). A p-value &lt;0.05 was considered significant. Results: The seroprevalence of HIV infection among pregnant women was 1.04% in 2007, decreasing to 0.23% by 2017. In 2009, 88.9% of women were counselled, and 100% were tested for HIV, with pretest counselling steadily increasing to 100% by 2012. The trend in HIV testing, however, remained at 100% over the span of 10 years. Post-test counselling varied from 89.6% to 99.9%, whereas the trend of HIV testing among partners fluctuated from 50% to 94.44%. The overall HIV positivity among babies, after 18 months of follow-up, was 4.77%. Conclusion: The HIV seroprevalence among the pregnant population is steadily declining. More and more women are availing themselves of the facilities at Integrated Counselling and Testing Centre (ICTC). Intensive health education and the availability of diagnostic and therapeutic services across the country have reduced the burden of the HIV/AIDS problem in the country

Diagnostic Stability of Single Spirometry Compared to Repeat Spirometry for Airway Obstruction in Suspected COPD Patients: A Cross-sectional Study

Introduction: Obstructive airway diseases are a leading cause of respiratory morbidity and mortality worldwide, particularly Chronic Obstructive Lung Disease (COPD). The diagnosis of COPD is confirmed by a post-bronchodilator ratio of Forced Expiratory Volume in the first second (FEV1) to Forced Vital Capacity (FVC), i.e., FEV1/FVC &lt;0.7. A repeat spirometry shows variability in a significant population. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommends repeating spirometry on a separate occasion if the post-bronchodilator FEV1/FVC is between 0.6 and 0.8. Aim: To determine the proportion of patients with diagnostic stability in the FEV1/FVC ratio after two weeks. Materials and Methods: This study was a cross-sectional study conducted in the Department of Pulmonary Medicine, Government Medical College, Thiruvananthapuram, Kerala, India from January 2019 to December 2019. in which 155 clinically suspected COPD patients with an FEV1/FVC ratio between 0.6 and 0.8 were recruited. A repeat spirometry was conducted two weeks later. The two post-bronchodilator FEV1/FVC ratios were compared, and the proportion of patients with diagnostic stability was determined. Fisher’s-exact test and Pearson's Chisquare test were used to compare categorical variables between groups. The statistical significance of differences between means of variables among different independent groups was analysed using independent sample t-tests. A p-value &lt;0.05 was considered statistically significant. Results: The mean age of the study population was 63.02±9.80 years. In present study, 118 (76.13%) out of 155 patients had stability in diagnosis, while 37 (23.87%) patients experienced a change in their diagnosis after repeat spirometry. The use of Inhaled Corticosteroids (ICS) and a history of Coronary Artery Disease (CAD) were associated with diagnostic instability (p&lt;0.05). Conclusion: In present study, 23.87% experienced a change in their diagnosis after repeat spirometry. Hence, repeat spirometry should be done on a separate occasion as suggested by GOLD guidelines in patients with FEV1/FVC ratios between 0.6 and 0.8.

External Auditory Canal Granulations of Varying Aetiology Other than Cholesteatoma: A Series of Seven Cases

External Auditory Canal (EAC) granulations can occur due to various causes, each with different presenting features, treatment options, and prognoses. They can arise from trivial situations, such as a neglected Foreign Body (FB), or indicate serious pathology like squamous cell carcinoma. The most common causes of EAC granulations are otitis media, including squamous and mucosal types. However, clinical practice encounters numerous other rare and common causes. The present case series describes seven patients with EAC granulations resulting from different aetiologies apart from Chronic Suppurative Otitis Media (CSOM). The study was conducted over a six-month period at a Government Medical College (GMC) in North Odisha. It aims to assist clinicians in considering these situations when managing patients with EAC granulation. Proper diagnosis and treatment of these patients resulted in successful outcomes. Therefore, the author recommends considering these underlying causes whenever EAC granulations do not respond to appropriate medical treatment with antibiotics. Radiological imaging, fine needle aspiration cytology, and histopathological studies can help exclude many of these causes from the list of differential diagnoses.

Assessment of echocardiographic findings in patients of hypertension

Background: Long-term hypertension is a substantial risk factor for coronary artery disease, stroke, heart failure, peripheral vascular disease, vision loss, and chronic kidney disease. Not only is echocardiography the most adaptable imaging technique for the cardiovascular system but it is also the most comprehensive and dependable hemodynamic tool. Aim and Objective: The purpose of this study was to analyze echocardiographic results in hypertensive patients. Material and Methods: It was a cross-sectional study of hypertension patients admitted to the medicine wards of the civil hospital connected to the P.D.U. Government Medical College in Rajkot, Gujarat, India. After considering inclusion and exclusion criteria, hypertensive patients were chosen at random for enrollment in the study. A total of 50 patients with hypertension were investigated. A skilled cardiologist performed the echocardiographic examinations. To simplify the observations made in the study, patients were separated into four groups based on their wall motion score. Results: The number of patients with systolic blood pressure of 169–179 mmHg was 32% (16 patients), while the number of patients with 140 mmHg was 18% (9 patients). Systolic blood pressure of 140–159 mmHg has 28% (14 patients) and more than 180 mmHg has 22% (11 patients). The most prevalent diastolic hypertension group had 22 patients (44%), and it was also the most common group among both sexes. Males had 12 patients with 90–90 mmHg and females had 10 individuals with 90–99 mmHg. Out of 50 hypertension patients, 21 (42%) had aberrant regional wall motion, while the remaining patients had no abnormal regional wall motion. In terms of diastolic function, 42 of 50 patients (84%) had diastolic dysfunction. Conclusion: Echocardiography is a valuable tool for assessing the consequences of hypertension in patients. It is also a widely and most regularly utilized imaging modality in cardiology practice due to its non-invasiveness and ease of access.

Gender Inequity in Clinical Clerkships and its Influence on Career Selection: A Cross-Sectional Survey.

The aim of this study was to identify the frequency, form, and underlying factors contributing to gender inequity experienced by medical undergraduates and assess its influence on their career choices. This was a cross-sectional, retrospective survey with a 100% response rate. This survey was distributed among medical students of clinical years in Karachi's private and government medical colleges from September 10th, 2021-March 30th, 2022. 430 participants were enrolled using a simple-random-sampling-technique. Chi-square/Fisher's Exact tests are employed to assess the relationships between gender and gender-based inequity in various specialties, including their characteristics, influence on career choices, adverse psychological effects, and potential mitigation strategies. Among 430 respondents, 28.6% were male, and 71.4% were female. 89.1% reported gender inequity, evenly distributed in government (80.4%) and private institutions (88.1%). The general surgery and gynecology disciplines stood out, each with a 56% prevalence. In gynecology and surgery clinical-clerkships, both genders experienced similar rates, with females at 54.5% and 42.3%, and males at 56.7% and 61.6%, respectively (P-value = .000*). Disrespect from staff/professors/patients (48.8%) was the most common manifestation, driven by factors like preferences (73.7%), gender superiority (62.6%), societal attitudes (54%), and cultural norms (50.9%). Furthermore, 82.6% of students reported that gender inequity had a negative impact on their career decision (Male = 82.9%;Female = 82.4%, P-value = .899). Additionally, gender inequity also caused demotivation (78.1%), poor self-esteem (67.2%), helplessness/hopelessness (48.6%), and frustration (45.8%). Gender inequity is widely prevalent in the clinical-clerkships, affecting medical students' career decisions and mental health, stressing the need to prioritize and implement solutions at the undergraduate clinical-clerkship level.

Autopsy Pathology of Heart and Coronary Vessels in Sudden Death: A Cross-sectional Study from Southern India

Introduction: Cardiac diseases emerge as the primary culprits behind sudden and unexplained deaths. Morphological evaluation through autopsy is invaluable in establishing the prevalence of cardiac lesions and coronary atherosclerosis within the general population. It provides healthcare researchers with valuable insights to develop preventive measures and early detection strategies crucial for improving survival rates. Aim: To estimate the prevalence of cardiac lesions in postmortem specimens of the heart from autopsies of sudden and unexplained deaths. Materials and Methods: The present cross-sectional study was conducted in the Department of Pathology, Government Medical College (a public sector hospital), Cochin, Kerala, India, from January to December 2021 on 140 specimens of the heart. Medicolegal autopsies were performed in the Department of Forensic Medicine, with specimens forwarded to the Pathology Department for histopathological examination. Hearts dissected by the modified Virchow’s method were examined for gross pathology in the cardiac wall, chambers, valves, coronaries and aorta. Microscopy findings were documented and the grading of coronary atherosclerosis was done using the Modified American Heart Association (AHA) criteria. Proportions were analysed from the compiled data using a Chi-square test. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software version 21.0 software. Results: In the study encompassing 140 adult autopsies, the mean age of the study population was 45.98 with a Standard Deviation (SD) of 15.82 years and the male to female ratio was 3.5:1. The prevalence of cardiac lesions was as follows: coronary artery atherosclerosis (80.70%), Ischaemic Heart Disease (IHD) (44.28%), cardiac hypertrophy and hypertension (10%), pericarditis (6.42%) and myocarditis (3.50%). The male- to-female ratio for coronary atherosclerosis was 4.4:1, with triple vessel disease observed in 42.90% of cases. Atherosclerosis severity grades included early non atheromatous lesions (19.3%), Pathological Intimal Thickening (PIT) (23.6%), and advanced atherosclerotic lesions (37.80%). Among cases associated with Coronavirus Disease 2019 (COVID-19)-related deaths (10.7%), changes noted included myocarditis, microhaemorrhages, oedema, capillary dilatation, fibrin deposition and inflammatory infiltrates. Conclusion: The present study revealed a high prevalence of coronary atherosclerosis affecting all three vessels, particularly among the younger population. This underscores the significance of screening for cardiovascular risk factors and implementing preventive measures from an early age.

A Study on Clinico Radiological Profile and Treatment Pattern of Patients Admitted with Mucormycosis in a Teaching Institution

Abstract Objectives: (1) Primary objective: To study the selected risk factors and clinical and radiological profiles of patients admitted with mucormycosis. (2) Secondary objective: To study the treatment pattern of patients admitted with mucormycosis. Materials and Methods: A descriptive cross-sectional study was conducted, which included the data of all patients admitted with the histopathological diagnosis of mucormycosis after undergoing surgery in the Otorhinolaryngology Department, Government Medical College, Thrissur, from January 2020 to September 2021. The risk factors, clinical and radiological profiles along with the treatment pattern of patients admitted with mucormycosis were analyzed. Results: Most of the cases belonged to the 40–50 age group, although the mean age was 52.24 with patients ranging from the age of 32–76. The male: female ratio was 2:1. All patients had diabetes mellitus. 89.7% had hypertension, and 76.9% had chronic kidney disease. Conclusion: Diabetes mellitus and COVID-19 cause a predilection for mucor to invade the paranasal sinuses and beyond. Aggressive treatment with amphotericin B along with surgical clearance aided by radiological investigation will help in decreasing the morbidity of the disease.