Karnataka Institute Of Medical Sciences Research Articles

COMPARISON OF LASER AND PNEUMATIC LITHOTRIPSY FOR MID AND LOWER URETERAL STONES: “AN ANALYTICAL REVIEW” AT TERTIARY CARE CENTER

Objectives: Management of large lower and mid ureteric stones represents a treatment challenge. The main objective of stone treatment is to achieve the highest stone-free rate with minimal morbidity. Available modalities are medical therapy, open surgery, laparoscopic surgery, endoluminal surgery and extracorporeal shock wave lithotripsy (ESWL). After the invention of uretero-renoscopy (URS) and ESWL in 1980s, there has been a paradigm shift in the treatment modality of ureteric calculus from open surgery to endoluminal and non-invasive method. There are various modalities for stone fragmentation in URS – electrohydrolic lithotripsy, pneumatic. Ultrasonic, laser and dual energy source (Ultrasound+Pneumatic) Lithotripsy. Both laser lithotripsy (LL) and pneumatic lithotripsy (PL) have favourable outcomes The aim of this study was to compare efficacy of pneumatic versus laser lithotripters for Mid and lower ureteric calculi in regional population at KIMS, Hubballi. Methods: This was a prospective comparative study done in 116 cases of mid and lower ureteric calculi (58 in PL and 58 in LL) at karnataka institute of medical sciences, Huballi from May 2022 to November 2022. Patients were randomly divided into two groups: Group 1 had PL, while Group 2 had lithotripsy using a laser energy source. For PL group, 0.8 and 1 mm probe was passed through working channel of URS. LL was performed using a 100- W holmium:yttriumaluminium-garnet (YAG)-pulsed laser machine, with 365 μm fibres. Complications were graded according to the Clavien-Dindo Grading System. Results: In all, 116 patients (78 male and 38 female) with a mean age of 36.21 years were included in the study, Varying from 18 to 75 years. In group one 58 patients under went PL out of which 41 were males and 17 were females. In group two 58 patients under went LL out of which 37 were males and 21 were females. In group one (PL) mean operative with SD was 42.10±(10.16) min, and in group two (LL). Mean operative with SD was 46.78±(9.36) min, with p=0.011, which was statistically significant. Mean hospital stay ±SD (days) in PL group was 2.69±(0.730) days, and in group two LL mean hospital stay ±SD (days) was 2.40±(0.591) with p=0.019, which was statistically significant. In group one out of 58 patients, 11 patients had stone migration with % of an 18.96% and in group two out of 58 patients 2 patient had stone migration of, with % of 3.44%, with p=0.008, which is statistically very significant. Post operatively 7 patients in group one needed auxillary procedures, 3 patients needed ESWL, 3 patients needed. Re URSL and one patient needed bladder clot evacuation with DJ stenting, In all these patients stone size was larger than 15 mm, In Group 2 no patient needed Auxillary procedure, with p=0.003 which is statistically significant. Conclusion: Both pneumatic and LL are standard and safe techniques for the management of lower and mid ureteric calculi. Our study showed LL had less stone migration, and no need for reintervention.

Serum Organophosphorus compound levels as a surrogate marker for severity assessment and management in Acute Organophosphorus Poisoning − A novel approach

Organophosphorus (OP) compounds are the most extensively used pesticides’ class worldwide; cause most self‑poisoning deaths especially in India. Thus, it is utmost important for early identification and aggressive management of OP poisoning from the clinical perspective to prevent serious complications by using sophisticated LC-MS/MS approach. This was a prospective study involving 103 patients of OP cases admitted to Karnataka Institute of Medical Sciences from June 2022 to May 2023, based on the inclusion and exclusion criteria patients were subjected to study. On admission, venous blood was collected from patient with Malathion and Profenofos OP poisoning history and subjected to serum biomarker and to LC-MS/MS analysis. Out of the 103 patients, 68 patients consumed Profenofos (66%) and 35 patients consumed Malathion (34%). Pseudocholinesterase levels among the of OP cases revealed that the 33 patients had mild toxicity, 40 patients had moderate toxicity and 30 patients had severe toxicity of OP poisoning. Subsequently LC-MS/MS analysis showed that the results obtained are not in correlation with indirect serum marker pseudocholinesterase levels. On the other side, LC-MS/MS results are in correlation with the clinical outcome of the patients with respect to morbidity and mortality. Thus, LC-MS/MS approach to assess the OP levels in patients could be used as potential diagnostic and prognostic marker for the absolute quantification of OP compounds compared to indirect OP levels estimation.

Histopathological study of lungs, kidney and spleen in death due to burns

Burn injuries occur universally and have plagued mankind ever since antiquity till the present day. As burns continue to be a major problem, a prospective study of demographic and pathological profile in deaths due to burns was conducted at the Department of Pathology Karnataka Institute of Medical Sciences Hubballi. To study the demographic profile, histopathological changes in lungs, kidney and spleen and to find the cause of death in cases due to burns. : The present study was carried out in the Department of Pathology, Karnataka institute of medical sciences, Hubballi, during the period of one year from 1-11-2014 to 31-10-2015. Total of 44 cases with burn injuries were used as material for study purpose and the collection of tissues were done for histopathology examination. This study includes 44 autopsy cases of death due to burn, of which majority were females. The age of the subjects ranged from 13 years to 65 years. Maximum numbers of victims were found in the age group of 21-30 years were 22 cases (50.00%).Most of the female victims were married and housewives. Most common manner of the burn were said accidental burns in 27 cases (61.36%) and 13 cases (29.54%) were due to suicidal burns, 4 cases (9.09%) were homicidal burns.Burns were more common in females most were married. Age group most commonly found was between 21-30 years of age probably related to dowry related issues, inexperience in cooking styles, house hold works, and inability to bear stress. Most common place of burns were kitchen. Most common manner of burns were said accidental. Most common cause of burns was due to said kerosene spill over or self pouring. TBSA involved more than 76%, in maximum number of cases. Maximum finding were seen in lung. Most common findings were diffuse alveolar damage, acute tubular injury and congested splenomegaly.

A Descriptive Study of Nail Changes in Systemic Diseases

Abstract Background and Objectives: Nail findings may represent a part of the symptom complex that may be useful for the physical diagnosis. Thus, the present study was undertaken to know the nail changes in systemic diseases among patients attending the outpatient and inpatient departments of dermatology, medicine, nephrology, pulmonology, and surgery attached to Karnataka Institute of Medical Sciences (KIMS), Hubballi. Methodology: A hospital-based original study was conducted at KIMS, Hubballi. During January 1, 2021–January 30, 2023, data were collected by personal interview after obtaining informed consent from all eligible participants using a prestructured and pretested pro forma, among a convenient sample of 272 patients selected by the simple random sampling method. Results: Among 272 patients, 57.5% of the patients were young adults with male predominance (56.0%) and inpatients (66.0%) were more compared to outpatients (44%). Of the 272 patients, respiratory system (RS) (26%) was most common involved followed by hematology (21.0%), gastrointestinal tract (GIT) and liver (17%), cardiovascular system (CVS) and renal (12%), and clubbing was the most common nail change encountered (35.5%) followed by longitudinal ridging (33%) and pallor (31%) of the nail subsequently. RS was found as the common cause of clubbing followed by CVS and liver and GIT. Conclusion: RS (clubbing) was the most common system involved. Other systems involvement were renal system (half and half nail), liver, and GIT system (Terry’s nail) which are the specific nail changes that can lead us to the diagnosis. Thus, nails can serve as a window for the underlying systemic illness.

A prospective study of demographic, clinical profile, treatment of necrotizing fasciitis, and its consequences

Background: The infection that spreads along the fascial planes and causes widespread necrosis is known as necrotizing fasciitis (NF). An uncommon but potentially deadly infectious disease, NF places a significant financial strain on both individuals and the health-care system. There are four occurrences for every 100,000 person-years. Patients with type 1 (polymicrobial) NF are typically immune-compromised, whereas those with type 2 (monomicrobial) NF are typically immune-competent with a trauma history. Type 1 NF has a death rate of 21%, while Type 2 NF has a death rate of 14–34%. Furthermore, NF has the potential to significantly lower patients’ quality of life, especially for those who are having an amputation. Another significant issue for public health is the high death rate. Patients with advanced age, diabetes, smoking, immunosuppression, obesity, malnutrition, steroid therapy, and HIV are more likely to have the disease. Injury and diabetes are important factors. Only few studies have conducted to correlate demographic and clinical features treatment and its outcomes. Therefore, the study is conducted to correlate demographic and clinical features, treatment of NF, and its outcomes. Aims and Objectives: The aims of this study were as follows: (1) to study demographic, clinical profile of patients with NF and (2) to analyze the treatment and outcomes of NF. Materials and Methods: This cohort study was carried out for cases that were clinically diagnosed with NF in patients admitted under the Department of Surgery, Karnataka Institute of Medical Sciences, Hubli, from December 2019 to December 2021. After clearance from the Institutional Ethics Committee, 124 cases were selected based on the inclusion and exclusion criteria. Results: A total of 124 patients were enrolled and analyzed in this study. Most common age group to be affected was 51–60 years. One hundred were male and 24 were female, with male: female ratio of 4.2: 1. Lower limb 95 (76.61%) was the most common site to be involved. Most common risk/precipitating factor for developing NF is trauma 43 (34.65%) followed by diabetes 40 (32.25%). Most common antibiotic used in this study was piperacillin combined with tazobactum in 53 patients (43.54%). Total 124 patients, among them 25 patients underwent amputation, 33 patients were in septic shock and succumbed due to same, 13 patients ended up in skin grafting, the mean duration of hospital stay was 13.46 days, and mean number of debridement was 1.129. Conclusion: In this study, mortality was higher (53.23%), but there was a good improvement in all the surviving patients. Early surgical intervention (within 72 h) with broad spectrum antimicrobials has a favorable outcome. Prompt and early surgical intervention with holistic care helps in reducing morbidity and mortality.

Microbiological profile and role of streptokinase in empyema thoraces in children – A retrospective and observational study from a tertiary care teaching hospital from North Karnataka

Objectives: Paediatric empyema thoracis causes significant childhood morbidity and mortality over the years. The organisms causing empyema are varying. The role of streptokinase in management is still not clear. Hence, we undertook this study to find the profile of organisms and role of streptokinase in our cases. Materials and Methods: A retrospective study was conducted at the Department of Pediatrics, Karnataka Institute of Medical Sciences (KIMS), Hubli from 2017 to 2019. All children aged 2 months–12 years with empyema included. Case sheets were collected from medical records department. The detailed demographic, clinical history, examination findings and treatment received were recorded and entered in a pre-designed performa with a special emphasis on streptokinase usage including indications, dose and outcome. Institution ethical clearance was obtained from Institute Review Board (IRB). Results: Thirty-three children fulfilled inclusion criteria during the study period. Mean age was 5.25 ± 1.14 years with male to female ratio of 1.2:1. Most common age group was 1–5 years (39.39%). Clinical manifestations at presentation were fever 100% (33), cough 87.8% (29), dyspnoea 78.78% (26) and intercostal bulge 36.36% (12). Staphylococcus aureus (54.54%) and Streptococcus pneumonia (18.18%) were the most common organisms isolated in pleural fluid. However, blood culture was positive in only one child (non-fermenting Gram-negative bacilli). Fourteen (35%) children received streptokinase. Among those subjects who received streptokinase, 100% were improved as compared to who did not receive (11.5% mortality); however, there was no statistical significance. Although there was decreased duration of hospital stay in streptokinase group (13.79 ± 4.51 vs. 14.73 ± 8.26 days), again this was not statistically significant. Conclusion: The most common organism causing empyema was S. aureus. Although use of streptokinase showed better outcome and decreased duration of hospital stay, this was not statistically significant.

A clinical study to determine the early functional outcome of ACL injuries managed by arthroscopic reconstruction using four strand hamstring graft with interferrence screw

Anterior cruciate ligament is the most commonly injured ligament. Arthroscopic reconstruction of anterior cruciate ligament with aperture fixation of graft using the interference screw on the tibial side allows for early Firm fixation and healing with tight bone-tendon interface.Even after better surgical techniques and fixation devices many athletes retire early due to residual knee instability. Hence in this study, I am making an effort to assess the early clinical outcome of anterior Cruciate Ligament injuries managed with arthroscopic reconstruction using hamstring graft with Interference screw. Due to rise of RTAs need for study of function outcome of ACL injuries treated by arthroscopic reconstruction in non sports individuals. This prospective comparative observational study related data were captured between october 2020 to april 2022 in a Karnataka institute of medical sciences. About 35 patients with arthroscopic anatomic ACL reconstruction using hamstring tendon graft with interference screw were evaluated and followed up for functional outcome. Patients were evaluated for functional outcome and stability of knee using International knee documentation committee subjective score and Lysholm score over a period of 18 months. This prospective comparative observational study related data were captured between october 2020 to april 2022 in a Karnataka institute of medical sciences. About 35 patients with arthroscopic anatomic ACL reconstruction using hamstring tendon graft with interference screw were evaluated and followed up for functional outcome. Patients were evaluated for functional outcome and stability of knee using International knee documentation committee subjective score and Lysholm score over a period of 6 months.The larger percentage of cases was operated less than 6 months from the date of injury. On evaluation of the patients during the follow up by IKDC and LGS, 100% of the patients had excellent to good results, and were able to return to pre injury level of activity.The technique of arthroscopic ACL reconstruction offers an excellent knee function, knee stability and restoration of preoperative functional status with minimal complications.

Diphtheria Remains a Threat to the Health System Even in the Era of Vaccination: A Cross-sectional Observational Study from Karnataka, India

Introduction: Diphtheria is an infectious disease caused by a gram-positive facultatively anaerobic bacilli, Corynebacterium (C.) diphtheriae. The present health statistics and data from the few studies that have been carried out suggest that our war with this disease is still going on and is far from being over in spite of the vaccine that’s freely available. Aim: To study clinical profile, complications, and outcome of diphtheria in karnataka population and to correlate with immunisation status. Materials and Methods: This was a hospital-based prospective cross-sectional observational study done in the Department of Paediatrics, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India, from January 2018 to November 2018. Patients admitted with history suggestive of diphtheria were enrolled and categorised into probable and confirmed cases. The age, sex, area of residence, religion, immunisation status, mean time of presentation to hospital from onset of illness, use of inotropes and mechanical ventilation were recorded in a predesigned proforma. Throat swab smear for C.diphtheria and culture, complete blood count, Renal Function Tests (RFT) with serum electrolytes, chest radiograph, Electrocardiogram (ECG) and 2-Dimensional (2D) Echocardiogram (ECHO) were also recorded. Results: Out of total 28 cases, 18 fulfilled the inclusion criteria. Male to female ratio was 2:1 and the mean age of presentation was 9.7 years. Highest incidence (n=14, 77.8%) was seen in the age group of 09-11 years. Most common clinical presentation was fever and sore-throat present in all 18 (100%), neck swelling in 13 (72.2%), dysphagia in 05 (27.7%). Examination revealed tonsillar hypertrophy and pseudomembrane in 17 (94.4%) patients, whereas one patient had laryngeal diphtheria, which was diagnosed when swab was sent while intubating in view of membranous laryngitis. Mean time of presentation to hospital after the onset of symptoms was 5.65 days. All children received appropriate antibiotics and Antidiphtheritic Serum (ADS). Total of seven patients were ventilated, of which 5 (27.7%) succumbed, and two were extubated. Four (22.2%) patients developed myocarditis in the second week, and all succumbed to resistant arrhythmias. One patient developed sepsis with ventilator dependency, and succumbed to inotrope resistant septic shock. On follow-up, 5 (27.7%) developed palatal palsy among which three had associated polyneuropathy; all these children recovered with only supportive care. Conclusion: Diphtheria is down but not out, the present study unmasks the fact that the disease is equally prevalent in immunised and older children with the changing epidemiology of diphtheria in the era of vaccines.

Effect of Low T3 Syndrome on Severity of Coronary Artery Disease in Patients with Acute Coronary Syndrome: A Cross-sectional Study

Introduction: Low Triiodothyronine (T3) syndrome is a hormonal imbalance that significantly influences cardiovascular haemodynamics by altering the vascular endothelial function by influencing the Nitric Oxide (NO) production. In Acute Coronary Syndrome (ACS) inflammation disrupts plaque which stimulates thrombosis, coagulation, activation of sympathetic system and release of cytokines mainly Interleukin 6 (IL-6), which is a pleotropic and pro-inflammatory cytokine, which exerts inhibitory effect on thyroid axis function. Aim: To study the association of low T3 syndrome and severity of Coronary Artery Disease (CAD) in ACS. Materials and Methods: This cross-sectional study was conducted in the Intensive Critical Care Unit (ICCU)under the Department of Cardiology, Karnataka institute of Medical Sciences, Hubli, Karnataka, India, from July 2021 to August 2022. A total of 120 consecutive ACS patients were taken for the study and all underwent Coronary Angiography (CAG). Severity of CAD was assessed with the help of Gensini risk scoring system. The patients were divided based on thyroid function status. Low T3 syndrome was defined as <0.846 ng/ mL with normal values of Thyroxine (T4) and Thyroid Stimulating Hormone (TSH). Receiver operating characteristic curves were generated to correlate low T3 syndrome and angiographic severity of CAD. Multinominal logistic regression analysis demonstrated LT3S is an independent risk factor for CAD. The Chi-square test was used for ordered categorical data with the severity of coronary artery lesions. Results: The severity of coronary artery lesions in the low T3 syndrome group (n=29, 24.16%) and hypothyroidism (n=20, 16.6%) group was significantly greater than that of euthyroid group (n=71, 59.1%), with all the groups’ (p-value=0.047). Multinominal logistic regression analysis demonstrated that low T3 syndrome was an independent risk factor of CAD for moderate (Odds ratio=2.34, 95%CI: 0.47-11.39, p<0.02) and severe (Odds ratio=8.56, 95%CI: 1.52-47.9, p<0.015) lesions. Conclusion: The patients with low T3 syndrome are associated with more severe and diffuse CAD and low T3 syndrome is an independent risk factor for ACS.

A clinical study to determine the functional outcome of distal end radius fracture managed with volar locking plate and screws

Background and Objective: Fracture of the distal radius is one of the most common skeletal injuries treated by orthopaedic surgeons. For a favourable functional outcome, radial length, radial tilt angle, and articular surface congruity must all be restored. Recognition of fracture patterns and fixation of fracture to maintain reduction is the key for successful management of complex fractures of distal radius. Volar locking plates allow improved fracture fixation without leading to soft tissue and vascular complications. They have been shown to provide excellent stability for an unstable fracture with volar Metaphyseal comminution. The objective of the study was to evaluate the clinical and functional outcome of fracture of distal end of radius treated by ORIF by Volar locking plate and screws using Criteria of Gartland and Werley Point System. Methods: Thirty patients with fracture of distal end radius were treated by ORIF by Volar locking plate and screws in Karnataka institute of medical sciences, hubballi. Between from November 2020 to September 2022. Results: The study included 30 patients, 27 male and 3 females aged from 21 to 69 years with mean of 33.53 years. The average duration of follow-up was 12 months. Using the Demerit scoring system of Gartland and Werley score, we had 20% excellent results, 50% good results, 16.67% fair results and 13.3% poor result. As per our results, excellent to good results were found in 70% of patients. Interpretation & Conclusion: ORIF by Volar locking plate and screws can be an alternative to other procedures in treating the extra-articular fracture with volar displacement and volar Barton’s fracture radius. Excellent to good results are produced by using volar locking plate for fixation of distal radius fractures.

Mucinous Carcinoma of Breast: A Histopathological and Immunohistochemical Study

Introduction: Mucinous Carcinoma (MC) is a special type of breast cancer. It comprises 4% (1-7%) of all invasive breast cancer. MC is also called colloid breast cancer characterised by nests of cells floating in lakes of mucin. It is divided into two subtypes Pure Mucinous Carcinoma (PMC) and Mixed Mucinous Carcinoma (MMC). PMC classified into two main types according to its structural and cytological features type A (paucicellular) the classical variant with a large amount of extracellular mucin, and type B (hypercellular) a hypercellular variant with less mucin and often with neuroendocrine differentiation. Hormone receptors, Human Epidermal growth factor Receptor-2 (HER2) and MUC2 status play an important role in prognosis and management. Aim: To study histopathological features of MC breast and Immunohistochemical (IHC) status. Materials and Methods: A retrospective study of patients who presented with breast cancer were studied at Department of Pathology, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India. The study was analysed in June 2002 and authors included data from January 2021 to June 2022. The data included the age at diagnosis, Tumour (T), Lymph Nodes (N), and Metastases (M) (TNM) stage, presence and number of Lymph Node (LN) metastases, Oestrogen Receptor (ER), Progesterone Receptor (PR), HER2 and MUC2 status. The patients in whom the diagnosis of MC of breast was given on histopathology were only included in the study. Patients of breast cancer of other pathological types were excluded from the detailed study. Descriptive statistics like mean, tables, and charts were used with the help of Microsoft office 2007 to interpret the results. Results: A total of 245 patients reported as invasive breast cancer during 18 months of study period, out of which 12 cases diagnosed as MC were taken in study. Amongst 12 cases, eight cases were PMC and four cases were MMC. The mean age at presentation was 63.37±16.38 years (eight PMC) and 60.0±19.30 years (four MMC). A total of 11 out of 12 cases were females and only one was male case (PMC). Majority of PMC 04 (50.0%) and MMC 03 (75.0%) were observed to be in TNM Stage 2, and four of 12 cases of MC had LN metastasis with no distant metastasis. MC showed higher expression of hormone receptors and lower expression of HER2/neu and MUC2 positivity, which corroborates with other studies and concluded that, MC with such an immunohistochemistry profile was prognostically better. Conclusion: Mucinous Breast Carcinoma (MBC) is a rare type of breast cancer accounting for about 4% of all diagnosed breast cancers. These are associated with a better long-term prognosis than other breast cancers. Hormone receptors and HER2 status play an important role in prognosis and management. MUC2 also plays a major role in mediating the proliferation, apoptosis, metastases of breast cancer cells and determining the use of chemotherapy drugs.

Abnormal Shape of Placenta as a Consequence of Maternal Thyroid Disorders-Does It Leave Any Microscopic Changes?

Introduction: Thyroid disorders are common in the reproductive age group of women and these can cause significant perinatal outcomes.Though the effect of abnormal thyroid hormones on the foetus and its development is established, their effect on the placenta and its contribution towards the effect is not elaborately studied. Aim: To compare the microscopic features of euthyroid placentae with those of mothers with thyroid dysfunction. Materials and Methods: This is prospective observational study wherein placentae received from October 1 ,2017 to March 31, 2019 in the Department of pathology, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India, were collected, processed and analysed. A total of 539 cases were received for histopathological examination during this period, of these 64 cases had abnormal antenatal thyroid profile. These were compared grossly and microscopically with the control group of 64 euthyroid cases. Results: The total sample of the study comprised of case group(n=64) and control group(n=64), mean age: mean age of the women 26.91±4.1 years. The case group samples included 3 hyperthyroid cases and 61 hypothyroid cases.In the control group, 3 (2.3%) foetuses were dead as compared to 6 (4.7%) foetuses in hypothyroid group and 3 (2.3% of total, 100% of hyperthyroid group) foetuses in hyperthyroid group (p< 0.001). Abnormal shape of the placenta was seen in 1 (0.8%) case in normal group as compared to 3 (2.3%) in hypothyroid group and 1 (0.8%) case in hyperthyroid group (p=0.018). However, there weren’t any significant microscopic changes. Conclusions: Maternal thyroid disorders result in abnormal shape of placenta and hence resulting in foeto-maternal insufficiency and subsequent foetal growth restriction and adverse foetal outcome.

Evaluation of neck swellings in a tertiary care hospital

Background: Patients presenting to the outpatient department with a neck swelling is of common occurrence which can pose a diagnostic dilemma to the head and neck surgeon. Most of the patients are worried about the possibility of a cancer. Objective: to study clinical presentation of various neck swellings and their management. Methods: Our study is a prospective study conducted in the department of surgical oncology and department of ENT in Karnataka institute of medical sciences, hubballi from July 2019 to December 2021. All patients presenting with a swelling in the head and neck region were included in the study. In the study period of 30 months, a total of 135 patients were included in the study. Results: In our study, out of 135 patients, 25 had swelling in the anterior triangle of neck of which 12 had nodular goitre of thyroid, 11 had papillary carcinoma of thyroid, 1 had medullary carcinoma and 1 had follicular carcinoma of thyroid. Of the 110 patients who had swelling in the posterior triangle of the neck, 60 had reactive lymphadenitis, 24 were due to tubercular lymphadenitis and 18 patients had swelling due to metastatic neck deposits.

A Comparative Study between Peptic Ulcer Perforation Score, Mannheim Peritonitis Index, ASA Score, and Jabalpur Score in Predicting the Mortality in Perforated Peptic Ulcers

Introduction Peptic ulcer disease continues to be a major public health in most developing countries despite the advances in medical management. The incidence of perforations remains high and has the highest mortality rate of any complication of ulcer disease. Risk stratification of cases will lead to better preoperative management and efficient utilization of intensive care unit resources. The purpose of the present study is to compare different existing scoring systems and identify the most accurate predictor of mortality in perforated peptic ulcer (PPU) cases. Materials and Methods This is an observational study conducted in Karnataka Institute of Medical Sciences, Hubli, India. All cases of PPU disease admitted from December 2017 to August 2019 who were treated surgically were included in the study. Demographic data were collected and peptic ulcer perforation (PULP) score, Mannheim peritonitis index (MPI), American Society of Anesthesiologists (ASA) score, and Jabalpur score (JS) were calculated for individual patient and compared. The patient was followed up during the postoperative period. Observation A total of 45 patients were included in the study with a mean age of 42.5 years. Most of the patients presented with 24 hours of the onset of symptoms. Nonsteroidal anti-inflammatory drug use was noted in 8.9% patients, and steroid use was present in 2.2% patients. Of the 45 patients, 7 deaths were reported. Between the various scoring systems, the MPI and JS were better predictors of mortality with a p -value of <0.001 and 0.007, respectively. In contrast, the PULP and ASA scores had p -value not statistically significant. However, the PULP score was a better predictor of postoperative complication with a p -value of 0.047. Conclusion Of the four scoring systems validated, the MPI and JS were better predictors of mortality in the given population. PULP score is a better predictor of postoperative complications in the present study.

COVID-19 Associated Mucormycosis (CAM): A Single Hospital-Based Study.

Background:Opportunistic fungal infections like Mucormycosis in Coronavirus Disease 2019 (COVID-19) patients have posed a great challenge to health care professionals, especially in developing countries like India. Hence, there is a need to understand the biological behaviour of COVID-19 associated Mucormycosis (CAM) to establish standard treatment Protocols and to reduce mortality.Aims:This study aims is to assess the type of Mucormycosis among COVID-19 patients in study population and compare the findings with clinical, radiological and haematological parameters along with treatment and surgical management.Methods and Material:This retrospective, observational study included 60 cases of CAM reported to the Department of Oral and Maxillofacial Surgery at the tertiary care centre, Karnataka Institute of Medical Sciences, Hubli. Data about various parameters were tabulated and analysed statistically.Statistical Analysis Used:Bivariate analysis was done using the Chi-Square test to assess the relationship between the type of Mucormycosis and other variables. Spearman's Correlation test was used to assess the correlation between types of Mucormycosis with the other variables. Linear regression analysis was performed to assess the response variable related to the type of Mucormycosis.Results:About 50% of subjects presented with “Rhino orbital” type of Mucormycosis. Palatal discoloration and palatal erosion was the most common oral manifestation among “only Sinus” and “Rhino orbital” types of Mucormycosis (P = 0.00). Significant association (P = 0.29) was found between the type of Diabetes mellitus and Mucormycosis.Conclusions:The study indicates that DM is the most commonly associated comorbidity in CAM patients. Hence, a thorough understanding of the underlying comorbidity and its close monitoring during and after COVID-19 infection is mandatory for successful treatment outcomes.

A Cadaveric Study on Incidence and Morphology of Psoas Minor Muscle in South Indian Population

Introduction: The muscles of posterior abdominal wall on each side of vertebral column include psoas group, quadratus lumborum and iliacus. The psoas muscle group comprises of major, minor and tertius. The psoas major is present in all individuals. Psoas minor is often absent in 40% of the cases. Psoas minor muscle has racial and morphometric variations. Aim: To find the incidence and morphology of psoas minor in south Indian population and discuss its clinical implications. Materials and Methods: The present observational cadaveric study was done on 30 embalmed cadavers for teaching purpose from November 2017 to December 2020 at Karnataka Institute of Medical Sciences, Hubli, Karnataka, India. Cadavers in the study were of the age group between 50-60 years. Out of 30 cadavers, five were females and 25 were males. In cadavers with presence of psoas minor muscle following parameters were photographed and studied: unilateral or bilateral, origin, insertion, nerve supply, total length of musculotendinous unit, length of muscle belly, length of tendon, width and circumference at its widest point. Vernier calipers, measuring tape, scale and inelastic thread were used to note various parameters and were tabulated. Results: Out of 30 cadavers, psoas minor was present in 10 cadavers (two female and eight male), bilateral in five; unilateral in five. The incidence of presence of psoas minor muscle in the present study is 33.33% (two female 6.67% and eight male 26.67%). Conclusion: The psoas minor muscle being vestigial and inconstant, its morphology is highly variable. But the incidence of psoas minor is quiet significant (33.33%). Hence knowledge of psoas minor is important to anatomists for academic purpose and to clinicians for proper diagnosis and treatment.

Placental Changes in Perinatal DeathAn Observational Study from a Tertiary Care Centre in North Karnataka

Introduction: Placenta is poetically described as a diary which bears the events of intrauterine life; hence examining them, especially in perinatal death can provide valuable information regarding the cause of death and sometimes gives an idea about recurrence of such events. Aim: To describe the various placental lesions in perinatal death and compare them with equal number of normal placentae. Materials and Methods: This prospective, comparative, crosssectional study was conducted in tertiary care centre, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India. All placentae, irrespective of the gestational age, received in the Department of Pathology, from October 1st 2017 to March 31st 2019 were collected after taking an informed consent. A total of 539 cases were received in this time frame, of which 121 (22.45%) were dead and included in the study and were compared with 121 normal placentae (alive), without any maternal co-morbidities. The placentae were grossed and assessed according to Amsterdam guidelines. The significance of the difference observed was established by Chi-square test using Statistical Package for Social Sciences software (SPSS) version 21.0. Results: Of these 121 cases, 89 (73.5%) cases had placental changes, whereas 32 (26.5%) cases were devoid of placental changes. Placental infarct and increased syncytial knots were seen contributing maximum to foetal death in 31 (25.6%) cases followed by chorioamnionitis. Rare cases like Twin Reversed Arterial Perfusion (TRAP) syndrome, Persistent Right Umbilical Vein (PRUV), maternal floor infarct were also reported. Conclusion: Despite many antenatal imaging advances, placental examination still remains valuable in diagnosing cause of death and growth restriction in the foetus especially recurrent causes, favouring clinical intervention in those cases.

Congenital Central Nervous System and Associated Systemic Anomalies in Foetal and Perinatal Autopsy- A Retrospective Study

Introduction: Congenital malformations in India accounts for 10-15% of perinatal deaths. Congenital Heart Defects (CHD) is most common congenital anomaly followed by Central Nervous System (CNS) anomalies, among which Neural Tube Defects (NTD) are most common. Folic acid deficiency can lead to NTDs and can be corrected by its supplementation in subsequent pregnancies, the authors analysed neurological anomalies in foetal and perinatal autopsies to ascertain distribution of various congenital neurological malformations and to classify those according to WHO classification system and their association with other systemic malformation. Aim: To study CNS anomalies in foetal autopsies. Materials and Methods: The present retrospective study conducted in Department of Pathology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India from July 2015 to June 2020 analysed 500 foetal autopsies retrospectively. Data regarding maternal age, parity, history of previous abortion, foetal birth weight, gestational age, gender and CNS and other systemic anomalies detected at autopsy were included from departmental autopsy database. Data was presented as frequencies and percentages using Microsoft Excel 2017. Results: In the study, 500 foetal autopsies were analysed, out of which 70 (14%) foetuses had CNS anomalies were included in study. Among 70 foetuses with CNS anomalies, anencephaly was most common 25 (35%) followed by meningomyelocele 19 (27%), Arnold chiari type 2 malformation 8 (11.4%), congenital hydrocephalus and encephalocele 5 (7%). Multiple neurological anomalies were observed in various combinations. Neurological with musculoskeletal anomalies were also observed in the present study. Conclusion: Foetal autopsy plays an important role in arriving at final diagnosis and detecting cause of death. Findings of autopsy are of practical significance to clinicians in the form of estimating risk of recurrence and genetic counselling.

Clinico-aetiological Profile of Meningoencephalitis: A Prospective Observational Study in a Tertiary Care Centre, Hubli, Karnataka, India

Introduction: Meningoencephalitis is a syndrome leading to fatality and neurological damages. Worldwide, infection of the central nervous system is the most common cause of meningoencephalitis. In encephalitis, a leptomeningeal involvement along with inflammation of brain parenchyma is invariably present and the clinical symptoms reflect both diffuse and focal cerebral pathology as well as meningitis. Correct immediate diagnosis and introduction of early symptomatic and specific therapy has a dramatic influence upon survival and reduces the extent of permanent brain injury and also has major impact on the outcome. Aim: To study the clinical profile and aetiological causes of meningoencephalitis and also to analyse the mortality and morbidity due to meningoencephalitis in a tertiary care centre. Materials and Methods: It was a prospective observational study conducted between December 2018 to December 2020 in a tertiary care centre, Karnataka Institute of Medical Sciences, Hubali, Karnataka, in which 184 patients of meningoencephalitis who fulfilled inclusion criteria were included. Detailed history and clinical examination was done followed by laboratory investigations, complete hemogram, serum electrolytes, liver function tests, Fundoscopy, Electroencephalography (EEG). Cerebrospinal Fluid (CSF) analysis including CSF culture and Cartridge Based Nucleic Acid Amplification Test (CBNAAT), Computed Tomography (CT)/Magnetic Resonance Imaging (MRI) Brain were also done and results analyzed. Microsoft (MS) Excel and MS word was used to obtain various types of graphs such as bar diagram, pie diagram. Percentages, means were calculated using Statistical Package for Social Sciences (SPSS) statistics software version 22.0. Results: Out of 184 patients majority of patients were in the age group of 31 to 50 years accounting for 85 (46.2%) of cases. Majority of patients were males (n=113) than females (n=71). Tubercular aetiology was found in 51.6%, viral cause in 25%, bacterial cause in 21.2%, fungal cause in 2.17% of patients. Out of 184 patients of meningoencephalitis, 50% patients recovered, 27.17% patients recovered with residual neurological deficit, 11.95% patients died and 10.86% were discharged . Conclusion: Detailed history and clinical examination along with appropriate investigations are necessary to confirm the diagnosis of meningoencephalitis. The Tubercular (TB) Meningitis was common with high morbidity and mortality.

English

BACKGROUND Cardiovascular diseases are one of the leading causes of morbidity and mortality worldwide. High Ca levels and low Mg levels are associated with increased cardiovascular risk in the general population.1 The balance between Ca and Mg seems to play an important role in homeostasis since Mg is considered as physiologic antagonist of Ca.2 Hence Ca/Mg ratio was considered to study its association with acute coronary syndrome (ACS). METHODS This is a case control study conducted in Karnataka Institute of Medical Sciences, Hubli over a period of 2 years, February 2019 to December 2020. 200 cases and 150 controls were included in the study. The biochemical measurements including complete blood count (CBC), cardiac biomarkers, liver function tests, renal function tests (RFT), serum electrolytes and lipid profile were measured using standard laboratory methods. Student ‘t’ test was used to compare the data. Optimum cut-offs for diagnosis of acute myocardial infarction was calculated using receiver operating characteristics (ROC) analysis. The association among markers was established by calculating Pearson’s correlation. RESULTS Serum Ca/Mg ratio was significantly higher (p value &lt; 0.001) in ACS when compared to control groups. It was also found that Ca/Mg ratio was significantly lower (p value &lt; 0.001) in non-ST elevation myocardial infarction (NSTEMI) when compared to STEMI group. Serum Mg was significantly lower (p value &lt; 0.001) in ACS group when compared to control group. Significant correlation (p value &lt; 0.05) was found between serum Ca/Mg ratio and cardiac markers (CKMB, Troponin-I). ROC analysis of Ca/Mg (4.19) ratios showed optimum cut-offs in diagnosis of AMI. CONCLUSIONS Serum Ca/Mg could be useful adjuvant marker in diagnosis of AMI. The ratio is higher in ST-segment elevation myocardial infarction when compared to non-STsegment myocardial infarction, which could be due to greater decrease in Mg levels when compared Ca in ACS. KEYWORDS ST Elevation Myocardial Infarction (STEMI), Non ST Elevation Myocardial Infarction (NSTEMI), Calcium (Ca), Magnesium (Mg), Acute Coronary Syndrome (ACS), Creatine Kinase-MB (CK-MB).