King George's Medical University Research Articles

Morphological, Morphometric, and Histological Evaluation of the Placenta in Cases of Intrauterine Fetal Death.

Background The human placenta is a remarkable organ that develops during pregnancy and is crucial in supporting fetal growth and development. The placenta supplies oxygen and nutrients to the fetus and removes waste products from the fetal bloodstream. It also produces hormones that support pregnancy, such as human chorionic gonadotropin, progesterone, and estrogen. Placental insufficiency occurs when the placenta cannot deliver adequate nutrients and oxygen to the fetus. This can result in intrauterine fetal death (IUFD), stillbirth, intrauterine growth restriction, low birth weight, and premature birth. It can also be associated with developmental delays or long-term health issues for the baby. This study aimed to assess the morphologic, morphometric, and histologic changes in the placenta associated with IUFD and compare it with the placenta of live births. Methodology This study was conducted at the Department of Anatomy in collaboration with the Department of Obstetrics and Gynaecology, Integral Institute of Medical Sciences and Research and King George's Medical University Lucknow, where 60 placentas were studied. Placentas were further categorized into the following two groups: Group A, the study group in which placentas from IUFD were taken (n = 30), and Group B, the control group where placentas from live births were taken (n = 30). Morphological and morphometric features of both groups were recorded and compared. Histological features of placentas from IUFD (Group A) were examined after hematoxylin and eosin staining. Results A total of 60 placentas were observed (Group A and Group B). In Group A (IUFD) and Group B (control group), most pregnancies were multigravidas. Round-shaped placentas were the most common type in both groups (Group A = 46.67%, Group B = 66.67%). The average thickness of placentas from Group A (IUFD) cases was significantly reduced (mean thickness = 1.17 ± 0.07 cm) compared to controls in Group B (mean thickness = 2.04 ± 0.93 cm). The p-value obtained was significant at 0.0001. There was a notable reduction in the average placental diameter in Group A (mean diameter = 241.73 ± 65.54 cm) compared to Group B (mean diameter = 263.72 ± 162.67 cm). The p-value obtained was not significant at 0.49. On histopathological examination of the placentas of Group A (IUFD), perivillous fibrin deposition and high-grade calcification were seen in a significantly high number of placentas (70% and 60%, respectively). Conclusions The knowledge of the placenta's morphologic, morphometric, and histologic changes can be utilized to establish the cause of fetal death. In instances of fetal growth limitation and fetal demise that are clinically inexplicable, they can also explain the causes.

Comparison of flow-mediated dilation (FMD) of the brachial artery in normotensive versus preeclamptic pregnant females

ABSTRACT Introduction: Flow-mediated dilation (FMD) of the brachial artery is an ultrasonography test that assesses the endothelial response to reactive hyperemia. The aim of this study was to assess the changes in FMD in preeclamptic pregnant patients and compare them with normotensive pregnant females. Methods: An analytical cross-sectional comparative study was conducted in the Department of Obstetrics and Gynaecology at King George’s Medical University (KGMU) after obtaining ethical approval. A total of 110 normotensive and 100 preeclamptic patients were recruited for the study. Using a Toshiba Ultrasound Machine with a 7–12 MHz probe, the baseline diameter of the brachial artery D1 was measured. Afterward, the cuff of the sphygmomanometer was placed distally on the forearm and it was inflated up to ≥250 mm of Hg pressure and later slowly deflated. At 90th seconds after cuff deflation, the mean of three measurements of vessel caliber (D2) was obtained. The FMD% was obtained by the following equation: FMD (%) = [(D2 − D1)/D1] ×100, where D1 = basal diameter and D2 = post-occlusion diameter. All patients were followed till delivery for maternofetal outcome. Results: FMD% was significantly lower in the preeclampsia group, and it went on decreasing with increasing severity of preeclampsia. At the cutoff of 9.4 for FMD%, its sensitivity for the prediction of preeclampsia was 65.3%, specificity was 89.3%, positive predictive value (PPV) was 94%, and negative predictive value (NPV) was 50%. Discussion: FMD is a noninvasive test, and it gets decreased before clinical signs of preeclampsia, so it can be used as a predictor of preeclampsia.

RETROSPECTIVE PROSPECTIVE COMPARATIVE ANALYSIS OF RECONSTRUCTION OF ACL TEAR WITH QUADRUPLED HAMSTRING GRAFT VERSUS QUADRUPLED HAMSTRING GRAFT INTERNALLY BRACED WITH FIBERTAPE

Background: Reconstruction of anterior cruciate ligament is a widely done surgery. The surgical outcome is dependent upon the strength of the graft used. Quadrupled hamstring graft is a commonly used graft as it provides good strength and functional outcomes. However graft re-rupture and laxity of the graftare amongst the known complications which lead to repeat surgeries and unsatisfactory outcomes. Various techniques have been described to strenghthen the graft. This study compares the cumulative effect of internally bracing quadrupled hamstring graft using fibertape with quadrupled hamstring graft alone in terms of functional outcome and laxity. Materials and Method:The study was done at the Department of Orthopaedics at King Georges Medical University in Lucknow on 60 patients with anterior cruciate ligament tears from October 2021 to October 2022. The patients were divided into two groups: Group 1 had quadrupled hamstring graft reconstruction done alone, and Group 2 had quadrupled hamstring graft reconstruction done with fibertapebracedinternally.Lysholm knee score was used as a measure of functional outcome along with standardized Pivot shift test, Lachman testand anterior drawer test to measure and compare the pre- and postoperative variation in laxity. Results:On comparing the improvement in grades at subsequent follow-up, group 2 showed significant improvement in functional outcomes in terms of Lysholm knee score . Conclusion:We concluded that reconstruction of anterior cruciate ligament using quadrupled hamstring graft internally braced with fiber tape gives a better functional outcome in form of Lysholm knee score although there was no significant improvement in grades of Anterior Drawer and Lachman test. Although follow up period of six months was a limiting factor . Further clinical evaluation over a longer period of follow up to evaluate the effect of fibertape on shielding and creeping of graft is essential and also to study the resultant collagen fibretapes clinical behavior.

An Analysis of the Anomalous Fissure of the Ligamentum Teres Hepatis: A Morphological Perspective in the North Indian Population.

Background The liver, being the largest internal organ of the body shows a variety of gross morphological variations about lobes, fissures and processes which may be clinically significant. Among various anatomical variations, the most found is the variant fissure for ligamentum teres hepatis.The present study was done to classify, review, compare and discuss the literature for anomalies in fissures for ligamentum teres hepatis. Methods A total of 100 formalin-preserved human livers were obtained from the Department of Anatomy of King George's Medical University, Lucknow, and studied for one year. Result In our study, 15% of the liver showed morphological variations in fissures for ligamentum teres hepatis. These were classified into four types. In type I (2%), the fissure was converted into a tunnel by pons hepatis. In type II (3%), there was an incomplete fissure for ligamentum teres hepatis extending into the diaphragmatic surface.In type III (4%), there was an incomplete fissure for ligamentum teres hepatis present only on the visceral surface. In type IV (6%), the fissure was covered by a thin membrane. Conclusion In this study of the North Indian population, 15% ofliver have gross morphological variations. So thorough anatomical knowledge of the existence of variant or abnormal surface features on the liver isimperativeto understanding the underlying pathology for radiologists and surgeons so that a favorable outcome can be achieved.

Chronomedicine Insights: Evaluating the Impact of Time-Restricted Meal Intake on Lipid Profile Parameters Among Individuals With Type 2 Diabetes in Northern India.

Time-restricted meal intake (TRM) has shown potential benefits such as enhanced insulin sensitivity, lowered blood sugar levels, and possible weight loss in individuals with type 2 diabetes mellitus (T2DM).Our study aimed to investigate the impact of TRM on lipid profile parameters such astotal cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL)in fasting conditionsin T2DM patients. In total, 400 patients from the endocrinology department at King George's Medical University (KGMU), Lucknow were enrolled in this study, adhering to the guidelines of the American Diabetes Association (ADA). Male and female patients with recently diagnosed T2DM (in the past five years), aged between 25 to 60 years, on oral anti-diabetic therapy excluding insulin, expressing willingness to provide written consent and to adhere to TRM were included in theTRM group. It was a longitudinal study asdiabetic dyslipidemia is primarily caused by insulin resistance and nutritional reasons and we wanted to assess the effect of TRM on lipid profile in T2DM patients. Patients were enrolled via simple random sampling using the random number table method (computerized). The TRM grouphad an early dinner at 7 pm whereasthe control group was of non-TRM/late-night eaters. TRM group was given comprehensive guidance including strategies to manage hunger, permissible beverage options (water and prescribed medication) during the fasting period, and daily maintenance of adiary documenting their timing, type, and quantity of food intake which they were requested to bring fortnightly. Emphasis was placed on recording even minor dietary items consumed throughout the day. The TRM group consumed food ad libitum during a 12-hour eating window from breakfast at 7 am to dinner at 7 pm. Data distribution was non-parametric. Mann-Whitney U test compared TRM and control groupusing mean values at baseline and follow-ups. Analysis used GraphPad Prism 9.2.0 software (GraphPad Inc., La Jolla, CA). A p-value less than 0.05 (p < 0.05) was considered statistically significant. A total of 127 patients were lost to follow-up, resulting in 273 patients who completed the study. The mean value of TC in the TRM and non-TRM groups using the Mann-Whitney U test registered a highly significant p-value <0.0001 at 18 months, with a decrease of 14.17% from baseline in the TRM group and a decrease of 1.53% from baseline in the non-TRM group. The TRM group had a decrease of 24.75%in TG from a baseline value of 145.4±41.9, whereasthe non-TRM group showed a decrease of 2.2% from a baseline value of 154.7±37.30 (p-value <0.0001). The TRM group showed an increase of 9.25%in HDLfrom a baseline value of 50.14±8.58; the non-TRM group showed an increase of0.82% from a baseline value of 48.62±9.31(p-value <0.0001). TRM group showed a decrease of 8.62%in LDLfrom a baseline value of 68.20±16.2 while the non-TRM group showed an increase of 1.54% from a baseline value of 65.38±19.3(p-value <0.0002). The TRM group showed a decrease of13.97%in VLDLfrom a baseline value of 32.20±18.7; the non-TRM group showed an increase of4% from a baseline value of 30.16±24.2 (p-value <0.0001). Our study's promising results underscore the potential of TRM as an effective strategy for managing dyslipidemia in individuals with T2DM, even over prolonged periods.

Risk Factors for Stroke in Children with Tuberculous Meningitis: A Prospective Observational Study.

The purpose of the study is to establish the prevalence of stroke as well as the clinical and radiological correlates of stroke in children with tuberculous meningitis (TBM). A prospective observational study was conducted at the Pediatric Department, King George's Medical University (KGMU), Lucknow, Uttar Pradesh, India. Using a computed tomography (CT) scan/brain magnetic resonance imaging (MRI), patients were divided into stroke and non-stroke groups. Demographic characteristics, clinical presentations, cerebrospinal fluid examination, basal meningeal enhancement, hydrocephalus, tuberculoma, and clinical outcome were compared between the two groups. Seventy-eight TBM patients, aged between 6 months and 14 years, were included. Out of 78 enrolled patients, 3 (3.8%) had definite TBM, 73 (91%) had probable TBM, and 4 (5.1%) had possible TBM (LCS). As per the Medical Research Council (MRC) staging, 13% had Stage 1 TBM, 26% had stage 2, and 61% had stage 3 TBM. Out of 78 patients with chest X-ray findings, 42 (53%) had findings suggestive of tuberculosis (TB), which included 33 (42%) with hilar lymphadenopathy and 9 (11%) with a miliary pattern. On neuroimaging, hydrocephalous was seen in 62.8% of cases, basal meningeal enhancement in 64.1%, tuberculoma in 6.4% of cases, and infarction in 53.8% of cases. There was no statistically significant association found between the staging of TBM and the presence of infarction as the majority of cases involved were in stage 3 of the disease (61.5%). TBM patients with stroke had poor clinical outcomes. Age, altered sensorium, focal neurological deficits, vomiting, and basal meningeal enhancement can predict the occurrence of stroke in young adults with TBM.

The Impact of Time-Restricted Meal Intake on Glycemic Control and Weight Management in Type 2 Diabetes Mellitus Patients: An 18-Month Longitudinal Study.

This study aimed to investigate the impact of time-restricted meal intake (TRM) on anthropometric and biochemical parameters in patients with type 2 diabetes mellitus (T2DM). A total of 400 patients diagnosed with T2DM were selected from the Endocrinology Department at King George's Medical University (KGMU), Lucknow, based on the American Diabetes Association (ADA) guidelines and specific criteria. A total of 127 patients were lost to follow-up, resulting in 273 patients who completed the study. The patients were randomly assigned to two groups: the TRM group (consenting to have an early dinner at 7 pm) and the control group (non-TRM/late-night eater group). Baseline data were recorded, and follow-up assessments were conducted at six months, 12 months, and 18 months. Informed consent was obtained, and a diet chart was regularly maintained and updated. The TRM group experienced a significant weight loss of 3.88 kg (5.45%) and a substantial reduction in BMI by 1.5 units (5.26%). In contrast, the non-TRM/control group had smaller reductions in weight (1.36 kg, 1.77%) and BMI (0.5 units, 1.65%). TRM group showed significant reductions in fasting blood sugar levels by 33.9 mg/dl (21.17%), postprandial blood sugar levels by 94.6 mg/dl (38.88%), andglycosylated hemoglobin (HbA1c) levels by 1.37 (15.87%). These improvements were significantly greater than the reductions observed in the control group, which had decreases of 29.3 mg/dl (17.85%) in fasting blood sugar levels, 41.6 mg/dl (16.84%) in postprandial blood sugar levels, and 0.59 (6.89%) in HbA1c levels. Our findings underscore the potential of TRM as an effective strategy for weight management and glycemic control in patients with T2DM, even in a long-term context. These results supporttime-restricted eating as a sustainable lifestyle modification for managing chronic metabolic diseases.

Occurrence and determinants of seizures and their impact on tuberculous meningitis: a prospective evaluation.

To assess the incidence of seizures and the factors contributing to poor outcomes in patients with tuberculous meningitis (TBM). In this prospective observational study, 129 patients with TBM were enrolled at the Department of Neurology, King George's Medical University, Uttar Pradesh, India, from April 2021 to April 2023. Detailed clinical history, neurological examinations, baseline laboratory tests, contrast-enhanced Magnetic resonance imaging (MRI) and electroencephalography (EEG) were obtained for all patients. Patients received anti-tuberculous therapy and, if necessary, anti-epileptic treatment. Patients were followed for 6months, with outcomes evaluated using the Modified Rankin Scale (MRS). Of the 129 patients, 48 (37.2%) reported seizures. Advanced TBM stage (p = 0.040, OR = 2.50 95% CI:1.02-6.07), cortical involvement (p = .0.013, OR = 2.58 95% CI:1.20-5.51) and spike-wave discharges in the EEG (p = 0.001) were significantly associated with seizure occurrence. After multivariate analysis, only cortical involvement (p = 0.031, OR = 2.34, 95% CI:1.08-5.08) emerged as independent predictor of for seizures. Focal to bilateral seizures (p = 0.008, OR = 9.41, 95% CI: 1.76-74.04), status epilepticus (p = 0.002, OR = 8.00, 95% CI: 1.86-34.32), and rifampicin resistance (p = 0.022, OR = 9.25, 95% CI: 1.43-59.50) were significantly associated with poor outcomes at the 6-month mark. Seizures were significantly associated with advanced stage of the disease, cortical involvement on neuro-imaging and epileptiform pattern on EEG. Additionally, focal to bilateral seizures and status epilepticus adversely affected the outcome.

Efficacy of Magnesium Sulfate and Dexmedetomidine as Adjuvants to Ropivacaine in Supraclavicular Brachial Plexus Block: A Randomised Clinical Study

Introduction: Peripheral nerve blocks have recently proven to be extremely promising in terms of patient satisfaction. In upper limb procedures, rapid and deep anaesthesia can be achieved with supraclavicular ultrasound-guided access to the brachial plexus. To improve the quality of local anaesthesia, adjuvants such as magnesium sulfate and dexmedetomidine have been added to the local anaesthetic. Aim: To evaluate the efficacy of magnesium sulfate and dexmedetomidine as adjuvants to ropivacaine in supraclavicular Brachial Plexus Blockade (BPB). Materials and Methods: A prospective randomised doubleblind study was conducted in the Department of Anaesthesiology from June 2016 to November 2017 ( 1 year and 6 months) at King George's Medical University, Lucknow, Uttar Pradesh, India. A total of 60 patients were divided into two groups using a computer-generated random number for upper limb surgeries (below the mid-humerus) under supraclavicular brachial plexus block. Group A (n=30) received ropivacaine 0.5% (30 mL) plus dexmedetomidine 50 µg for the supraclavicular block, and Group B received ropivacaine 0.5% (30 mL) plus magnesium sulfate 150 mg in 1 mL Normal Saline (NS) 0.9% for the same block. A comparison of these two groups was conducted for the time of onset, duration of sensory and motor block, haemodynamic stability, postoperative analgesia, and complications. Statistical analyses such as Student’s t-test, Chi-square test, and MannWhitney U-test were used. Results: The mean age of Group A was 28.03±5.86 years and Group B was 31.07±7.06 years. The sensory block and motor block onset were significantly faster among patients of Group A (6.47±1.43 min and 8.50±1.46 min) compared to Group B (9.57±1.22 min and 11.77±1.19 min). The mean duration of analgesia was significantly longer (p&lt;0.001) in Group A (1034.10±61.07 min) compared to Group B (460.00±35.82 min). The duration of sensory block and motor block was also significantly higher (p&lt;0.001) in Group A compared to Group B. Both groups were haemodynamically stable, but sedation was significantly higher in Group A. Conclusion: Dexmedetomidine 50 µg is a superior adjuvant compared to magnesium sulfate 150 mg with ropivacaine 0.5% in supraclavicular brachial plexus block as it significantly hastens onset time and prolongs the duration of sensory and motor blocks and the duration of analgesia.

Self-care Behaviour of Pregnant Women with Gestational Diabetes Mellitus at a Tertiary Care Hospital in Lucknow, India: A Quasi-experimental Study

Introduction: India is now the diabetes capital of the world. The rising burden of Gestational Diabetes Mellitus (GDM) adds to the existing diabetes burden. Euglycemia is achieved once the baby is delivered. The first line of management of GDM is mainly through lifestyle modification with diet and physical activity. There is a dearth of information from Lucknow city about how well pregnant women with GDM adhere to dietary changes and exercise recommendations, or how counselling helps them deal with their GDM. Aim: To assess the self-care behaviour related to diet, physical activity, and Self-Monitoring of Blood Glucose (SMBG) of pregnant women diagnosed with GDM. Materials and Methods: A total of 188 pregnant women diagnosed with GDM were selected for present quasiexperimental study. The study participants were recruited from the antenatal Outpatient Department (OPD) at the Department of Obstetrics and Gynaecology of Queen’s Mary Hospital, King George Medical University (KGMU), Lucknow, India. The total study duration was from November 2019 to November 2022. Pregnant women diagnosed with GDM according to Diabetes in Pregnancy Study Group in India (DIPSI) criteria, up to 28 weeks of gestation, who gave their written consent to participate in the study and were living within a 15-kilometer radius of the study Institute, were included in the study. One group of the study participants received one-to-one counselling, an individualised diet plan, along with usual GDM care, and the other group received usual GDM care during their antenatal visits. The summary of diabetes self-care was adapted to assess adherence to the recommended dietary and physical activity modifications, as well as self-monitoring of blood glucose. Data were analysed using R software version 4.1.1 (R Core Team, 2021). All categorical data were presented using frequency and percentages. The comparison of baseline demographic and clinical parameters of pregnant women between the two groups was done using the Chi-square test or Fisher’s-exact test for categorical observations based on the expected frequency. The independent sample t-test or Mann-whitney U test for continuous measurements was used after checking the normality assumption using the Shapiro-wilk test. The change in scores of general diet, specific diet, physical activity, and SMBG throughout all follow-ups was assessed by repeated measures Analysis of Variance (ANOVA). The change from the first follow-up visit to subsequent follow-up visit was compared using a mixed linear model with follow-up visits. The p-value was considered significant at a 5% level of significance for all comparisons. Results: The mean age of the pregnant women with GDM was 27.6±3.7 years in the intervention group and 27.9±3.9 years in the control group (p=0.451). The pregnant women with GDM in the two groups did not show significant differences in terms of socio-demographic variables such as age, religion, education, socio-economic status, occupation, type of family, and family history of diabetes mellitus. A significant difference was observed in the dietary and physical activity scores between the two groups of pregnant women with GDM. However, no difference was observed in the case of self-monitoring of blood glucose scores of the two groups. Conclusion: The study concluded that counseling plays an important role in helping pregnant women with GDM adhere to the recommended dietary modifications and physical activity.

"Various factors affecting the success of the ETV procedure in infants"-an insight via a prospective study.

Congenital hydrocephalus in infants treated with ETV has variable results in literature. We studied some supposed clinicoradiological parameters which though are considered vital in deciding operative management and have never been thoroughly studied to establish a well-defined association. To evaluate the influence of clinicoradiological profile and intraoperative findings over the outcome of ETV done in infants for congenital hydrocephalus. All infants who underwent ETV in King George's Medical University, Lucknow, from January 2019 to February 2020 for congenital hydrocephalus were included. Their clinical, radiological, operative data was gathered. Infants were followed at 1, 3, and 6months after ETV. ETV success was defined as stabilization of abnormal head growth with resolution of symptoms of raised ICP and no requirement of shunt surgery 6months post-ETV. All the clinicoradiological and intraoperative factors were statistically correlated with the final outcome. Forty infants were operated for congenital hydrocephalus during the study period in our institution. Failure rate was higher in children younger than 3months (p value of 0.04). Increase in head size was present in all 40 cases and bulging anterior fontanelle in 95% cases. Success rate of ETV at 1, 3, and 6months was 62.5%, 40%, and 35%. Most of failure occurred within 3months after the procedure. Expiry rate at 1, 3, and 6month was 15%, 17.5%, and 17.5%. None of the intraoperative findings significantly correlated with the final outcome. ETV can be a luring treatment of congenital hydrocephalus in infants but has limited success rate because of the dependency of procedure on well-formed arachnoid villi for absorption. It also carries minimal risk of fatal complications like CSF leak and meningitis associated with it. Age is the only factor which truly reflects the outcome of the procedure.

Differences in the microanatomy of skin of sole and palm in humans

Background: The prevalence of skin diseases has increased over the last few decades and they contribute to a significant burden on the health-care systems all across the world. In some forms of reconstructive or plastic surgery, palm skin has successfully been replaced with sole skin, removed to form a full-thickness graft that covered almost the entire palm of the hand without impairing the weight-bearing areas of the feet or encumbering the gait. In cases such as these, the skin of the palm and sole is preferred for grafts. Aims and Objectives: The study was conducted to learn the microanatomy of palm and sole. Materials and Methods: The present observational study was carried out in the Department of Anatomy, King George Medical University, Lucknow, from the period of September 2017 to August 2018. Ethical clearance was obtained from Institutional Ethics Committee (Ref. code:63/Ethics/R-Cell-18). For the present study, skin was procured from the palm and sole of six freshly embalmed human cadavers (three males and three females). The mean age of the cadavers was 67 years. Tissues were preserved in 10% of formaldehyde for 48 h, fixed, Stained in H and E, and observed under light microscope. Results: The study showed that the thickness of epidermis and ratio of epidermis to stratum corneum (Edp: sc) of the sole are greater than palm, dermoepidermal junctions were more in sole. Thickness of dermis both papillary and reticular dermis was more in sole than palm. Conclusion: The values of thickness of skin of palm and sole region provide data for plastic surgeons to plan cosmetic surgeries.

Psychological Assessment and Treatment Effectiveness in Mastalgia: Developing a Treatment Algorithm.

Background Mastalgia often impairs the physical, social, and sexual lives of women. It may manifest in both cyclical or acyclical patterns. The psychoneurotic association of mastalgia has been claimed for a long time in various available literature. Several treatment options have been used and are available in the market for mastalgia, but no specific guidelines are currently in place at the global or local levels. This study aims to evaluate the psychological status and effectiveness of various treatment options in women presenting with mastalgia. Methods This study was conducted in the General Surgery outpatient department from February 1 to November 30, 2021,at King George's Medical University, Lucknow, India. Females of all age groups presenting to the General Surgery outpatient department with unilateral/bilateral breast pain and/or chest wall pain were considered for this study. Pregnant patients, those with a history of allergy to drugs, or those who were lost to follow-upwere excluded from the study. The psychological status of patients was assessed using the Depression Anxiety and Stress Scale(DASS-42) scale. Pain assessment was performed using a visual analog scale (VAS). Patients were divided into five categories: (i) isolated chest wall pain, (ii) isolated breast pain, (iii) both chest wall and breast pain, (iv) pain with an associated lump(s), and (v) pain and tenderness isolated over the lump, and two groups: Group-A: VAS≤4, and Group-B: VAS>4. Group B patients in Category iv were randomized into two groups: topical non-steroidal anti-inflammatory drugs (NSAIDs) or evening primrose oil+vitamin E. The next line of treatment was tamoxifen 10mg followed by danazol 100mg followed by ormeloxifene 30mg. Results The mean age of 106 participants enrolled was 31.59±10.52 years. The mean scores,using the DASS-42 scale, for depression, anxiety, and stress were 7.31±8.53, 7.08±6.57, and 11.15±8.07, respectively. The depression, anxiety, and stress scores had no significant correlation with pain scores (p =0.84, 0.99, and 0.97 for depression, anxiety, and stress, respectively), or duration (p=0.69, 0.66, and 0.85 for depression, anxiety, and stress, respectively). Twenty-nine of 43 patients (67.44%) responded to topical NSAIDs as first-line treatment, and out of the remaining, 6.98% responded to evening primrose oil + vitamin E, 18.60% to tamoxifen, and 4.65% to danazol. Twenty-nine of 32 patients (90.63%) responded to evening primrose oil+vitamin E as first-line treatment, while 6.25% and 3.12% responded to tamoxifen and danazol, respectively. Conclusions Both topical NSAIDs and evening primrose oil + vitamin E were found effective first-line treatment options in the majority of patients. Hence, it is always advisable to start such patients on topical NSAIDs, or evening primrose oil + vitamin E, before switching over (if no resolution of pain is reported with these drugs) to higher and more severe treatment options. The duration or severity of pain did not correlate with the psychological condition of the patient.

Impact of Primary Tumor Variables on Predicting Nodal Metastasis in Lower Extremity Marjolin's Ulcer: A Retrospective Cohort Study.

Background Marjolin's ulcer or scar carcinoma is a rare disease arising from the conversion of chronic scar into malignancy. Studies show Marjolin's ulcer squamous cell carcinoma has more chances of lymph nodal metastasis and is more aggressive with a worse survival rate. To date, no established guidelines exist for managing regional lymph nodes in cases of Marjolin's ulcer with clinically N0 nodes. Observation vs elective node dissection remains an option. In developing countries, long-term follow-up is not consistently leading to the risk of patients being kept on observation for regional nodes; presenting late with inoperable regional nodes is possible. This study aims to identify clinicopathological factors of lower extremity Marjolin's ulcer, which are associated with a high risk of inguinal lymph node metastasis. Identifying such risk factors may help provide a rationale for performing elective nodal dissection instead of observation in high-risk cases. Material and methods All clinically N0 lower extremity Marjolin's ulcer cases, more than 3 cm in size, treated at King George's Medical University, India, during the last five years, have been included in this study. Demographic, clinical, and pathological data of eligible patients were retrieved from institutional records. Various clinical and pathological factors were studied and correlated with lymph node positivity, and the strength of the correlation was tested using statistical methods. Factors correlated strongly with inguinal lymph node positivity were identified as high-risk factors. Results A total of 66 patients with lower extremity Marjolin's ulcer had no preoperative pathologically confirmed inguinal lymph nodes documented by ultrasonography and fine needle aspiration cytology. All patients underwent surgery for primary, followed by elective, inguinal lymph nodal dissection. The majority were males (n=51/66; 71%), and the most common age group was 30-50 years (n=40/66; 60%). The leg was the most common site (n=31/66; 47%). The least common site was below the ankle (n=14/66; 22%). Maximum dimension ranged from 3 cm to >15 cm, with the majority between 6 and 10 cm (n=40/66; 56%). Extension beyond the scar site was present in 24% (n=15/66) of patients. Most of the lesions in this study were well differentiated, 85% (n=56/66), and moderately differentiated, 15% (n=10/66), and none of the lesions was poorly differentiated. Perineural invasion, lymphovascular invasion, tumor necrosis, and extension below subcutaneous tissue were present in 82%, 14%, 28%, and 26%, respectively. Of 66 patients, 21.2% (n=14/66) had pathological nodal disease after elective nodal dissection. Perineural invasion (p<0.0001), depth of lesion (p<0.0001), and tumor necrosis (p=0.0002) had a statistically significant correlation with node metastasis. On ROC curve analysis, 7.5 cm was the cut-off size, above which chances of nodal metastasis increased significantly. Conclusions Marjolin's ulcer patients with no preoperative positive nodes may be segregated into high-risk and low-risk groups as per their risk of harboring cancer cells in regional lymph nodes. Those having one or more of the following risk factors should be classified as high risk: dimension more than 7.5 cm, presence of perineural invasion, tumor necrosis, and deep tumors extending below subcutaneous tissue. We recommend that such patients undergo prophylactic regional lymph node dissection instead of observation during primary surgery.

Utility of bone marrow examination in retinoblastoma and their correlation with hematological features.

Retinoblastoma makes up about 3% of all childhood malignancies. The frequency of metastatic retinoblastoma ranges from 4.8 to 11%. Assessing the bone marrow status of newly diagnosed patients is crucial because of the advantages of autologous bone marrow transplants for high-risk patients. This study aimed to determine the utility of bone marrow examination in cases of retinoblastoma and its correlation with hematological findings. This retrospective study was conducted at the Department of Pathology, King George's Medical University, Lucknow, India. A total of 34 cases of retinoblastoma with bone marrow examination were included in the study. Bone marrow infiltration was present in 17.65% (6/34) cases of retinoblastoma. Bone marrow aspirate myelogram showed that marrow metastasis in retinoblastoma was significantly linked with a reduced percentage of total myeloid cells (p=0.001) and segmented cells (p=0.006). The present study demonstrated that 15% (3/20) of retinoblastoma patients previously classified as nonmetastatic before bone marrow examination (stages I to III based on histology, imaging, and bone scan) had bone marrow metastases following bone marrow examination and were upgraded to stage IV. To conclude, a diligent and exhaustive search for metastatic cells in bone marrow is advised if the myelogram shows a reduced percentage of total myeloid and segmented cells. All stage II and stage III cases of retinoblastoma must undergo bone marrow examination for early metastasis detection, as it may result in an upgrade to stage IV disease, impacting the prognosis and necessitating distinct treatment modalities.

Rajendra Jinjwaria quality of life-22 scale (RJQOL-22) scale

The Rajendra Jinjwaria quality of life-22 (RJQOL-22) scale will help assess the overall quality of life in various acute and chronic diseases such as rheumatoid arthritis, osteo arthritis, and other conditions that affect the quality of life such as cardiovascular, HIV, and cancer. The tool was developed from 29 January 2019 to 01 May 2023 by Rajendra Kumar Jinjwaria at King George's Medical University Lucknow and Banaras Hindu University, Uttar Pradesh, India. The validity of the RJQOL-22 scale was established as per the content validity index (CVI) 98% and validated by more than 100 expert faculty across the world. The scale is standardized and highly valid for assessing the quality of life in acute and chronic diseases. The overall reliability of the scale based on a study was estimated to be (&gt;0.983) through (Cronbach’s alpha value) and it indicates a highly reliable scale. While the individual reliability of group I and group II was 0.989 and 0.978 respectively. The acceptable cut-off value of coefficients was 0.7 for moderate and 0.8 for high reliability. This indicates that the tool used in the studies was highly reliable.

Out of pocket expenditure on cancer patients at a tertiary care hospital of Lucknow

The increasing cost of cancer diagnosis and its management has led to a huge financial burden and noticed to be one of the major contributors to poverty. Out-of-pocket expenses (OOPE) significantly impact patients households work as well as experience to cancer treatment. Understanding its nature of burden will guide us in formulation of plans to avoid financial distress among the cancer patients.A tertiary care hospital based cross-sectional observational and analytical study was conducted on 120 cancer patients attending surgical OPD at King Georges Medical University, Lucknow, from July 2020 to November 2021. Sociodemographic and economic variables, costs incurred under various headings and expenditure details of the subjects were obtained by pre-designed, pre-tested, semi-structured questionnaire. Direct medical and direct non-medical costs were calculated, and its total was used as the OOPE. Appropriate statistical tests were applied wherever applicable.Overall mean out-of-pocket expenditure by study participants was Rs 79925.5 (51776-121651). The expense on direct medical expenditure was Rs 45151(30051, 90051) and indirect non-medical expenditure was Rs 10000(5000,14000). We found significantly higher OOPE in subjects residing more than 100 km away from Lucknow (P = 0.017), with gall bladder cancer (P = 0.001), who were diagnosed with cancer while screening (P =0.034), who were diagnosed at Private clinic/hospital (P = &amp;#60; 0.001) and delayed treatment (P = 0.023). Cancer patients experience significant OOPE following their diagnosis. Its impact on patient wellbeing with their treatment decisions need to be further studied.

Limb Salvage Strategy Amendment for a Better Future in the Era of Bone Cancer Therapy: A Cross-Sectional Study in North India.

Bone tumors remain a formidable challenge for orthopedic surgeons. In developing countries, the challenge is exacerbated by limited diagnostic, therapeutic, and management facilitiesand ignorance. Patients with upper and lower-extremity muscle and skeletal tumors are candidates for amputation or surgical rescue of the limbs. Traditionally, limb rescue surgery by neo-adjuvant chemotherapy is the preferred surgery method for localized carcinoma. Amputations are usually reserved for patients with increased tumor size. The purpose of this study is to investigate health-related quality of life (HRQOL) and physical disability, focusing on surgical care, gender, and age, in adolescent and young adult survivors of malignant bone tumors treated surgically. This cross-sectional study consists of 38 long-term survivors who underwent amputation or limb-salvage surgery at King George's Medical University, Lucknow, from 2019 to 2022. After obtaining ethical clearance and informed consent, 38 patients which included 26 patients treated with limb salvage in Group A and 12 patients treated with amputation in Group B were included in the study. The SF-36 and HUI3 scores were used to assess the functional outcome and health-related QoL of these patients. After minimal six months of interventions, we have found a significant improvement in all the following factors: physical functioning (P=0.000), role limitations due to physical health (P=0.000) and emotional problems (P=0.001), energy/fatigue (P=0.000), emotional well-being (P=0.000), social functioning (P=0.000), pain (P=0.000), and general health (P=0.000). Group A showed a higher degree of significance than Group B through SF-36 (Short Form-36, patient-reported outcome), whereasHUI-3 did not show any significant outcomes (P=0.347). The overall quality of life of patients with salvaged limbs appears to be higher than that of the quality of life of amputee patients in tumor survivor patients. Further analyses must be carried out to verify the results and focus on areas that have a major impact on the overall quality of life using other assessmenttools. The impact of therapy on the quality of life depends on maintaining the necessary structures for functional functions, adjusting patient expectations to cancer treatments, and designing long-term rehabilitation programs to support functional functions.

To Study the β-Globin Haplotype Pattern of Descent of a Set of Linked Alleles Occurring on the Same Chromosome in the Northern Province of India.

To study the five mutations commonly prevalent in North India, i.e., IVS-I-5 (G→C), 619 bp deletion, IVS-I-1 (G→T), codon 41/42 (-TTCT), and codon 8/9 (+G), in the betathalassemia (β-thalassemia) major children. The specific β-thalassemia mutations of different haplotype patterns of the β-globin gene cluster will also be determined. A total of125 children diagnosed with β-thalassemia major visiting the Department of Pediatrics of King George's Medical University were involved in the study. As per the QIAamp (Qiagen, Hilden, Germany) manufacturer guidelines, genomic DNA was isolated from whole blood. To identify the haplotype pattern within the β-globin gene cluster, the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis was used. The respective restriction endonucleases used were Hind III/GƔ, Hinc II/Ψß, Hinf I/ß, Ava II/ß,and BamHI for the haplotype analysis in the β-globin pattern of descent of a set of linked alleles occurring on the same chromosome. Among the five common mutations, 73 patients had IVS-I-5 (G→C), 28 patients had 619 bp deletion, 17 patients had IVS-I-1 (G→T), five patients had Cd 41/42 (-TTCT), and two patients had Cd 8/9 (+G) mutations. Fifteen haplotypes (haplotypes 1-15) were identified in 125 β-thalassemia major children. Among the five haplotypes observed in the IVS-I-5 (G→C) mutation, the H1 haplotype was most predominant with a frequency of 27.2%, followed by the H2, H4, H3, and H10 haplotypes in the given population. In 619 bp deletion, IVS-I-1 (G→T), codon 41/42, and codon 8/9, haplotype H9, H12, H11, and H5were seen, respectively. β-thalassemia was found to be the most common in the northern province of Uttar Pradesh. The linkage of β-globin gene haplotypes with β-thalassemia mutations was explored in the northern provinceof Uttar Pradesh. The population of different natives is being mixed up due to migration and industrialization. These were some reasons for the occurrence of haplotypic heterogeneity. This haplotype heterogeneity was correlated with the origin of these mutations found to be unlike the origin of common ones from different provinces.

KGHeBTA (King George's Medical University Hepatitis B Therapeutic Algorithm): A New Diagnostic and Therapeutic Algorithm and Clinico-epidemiological Spectrum of Hepatitis B

Diagnostic and therapeutic algorithms given by various societies for hepatitis B are fragmented and complex. The clinico-epidemiologic spectrum of hepatitis B is not studied with large-scale data from our region. We aimed to develop a comprehensive algorithm for the treatment of hepatitis B and study its clinico-epidemiological spectrum. From 2014-2019, the clinico-laboratory data of hepatitis B surface antigen (HbsAg)-positive patients were prospectively recorded. King George's Medical University hepatitis B therapeutic algorithm (KGHeBTA) was developed on the basis of the standard existing guidelines. The prevalence of different clinical stages of HBsAg-positive patients was calculated and their treatment records reviewed. Testing circumstances and risk factors were noted. Among 1,508 data record sheets, 421 were complete. According to the KGHeBTA algorithm, 221 had detectable hepatitis B virus DNA. 21% were cirrhotic and 79% non-cirrhotic. 72% were incidentally detected asymptomatic hepatitis B, 7% were hepatitis B with acute symptoms, 0.7% were acute hepatitis B, and 22% were chronic hepatitis B. 20% patients were eligible for antivirals and 80% patients were not eligible. 32% patients were actually treated with antivirals due to the inclusion of some special indications as pregnancy and family history. Screening during various medical illnesses (40%) was the most common and during health camps (0.2%), the least common testing approach. Road-side shaving (52%) was the most common and intravenous drug abuse (0.2%) and the least common risk factor for the detection of hepatitis B in our data pool. HBsAg-positive patients can be easily worked up and treated based on the proposed algorithm (KGHeBTA). About one fourth to one fifth of all HBsAg-positive patients were eligible and treated with oral antivirals. Most of the patients were incidentally detected asymptomatic hepatitis B screened during medical illnesses. Roadside shaving and intravenous drug abuse were the most and the least common risk factors.