Lokmanya Tilak Municipal Research Articles

Perioperative Dysrhythmias in Adult Patients for Non Cardiac Surgery: A Prospective Cohort Study

Introduction: The vulnerable perioperative period is prone to the development of a heterogeneous group of conditions characterised by abnormal electrical activity in the heart, termed as cardiac dysrhythmias. Aim: To determine the incidence of dysrhythmias in the perioperative period, identify predisposing factors, evaluate the effect of anaesthesia, analyse haemodynamic consequences, and document the treatment provided. Materials and Methods: A prospective cohort study involving 9666 adult patients undergoing non cardiac surgery was conducted in the Department of Anaesthesiology at Lokmanya Tilak Municipal College and General Hospital, Sion, Mumbai, Maharsahtra, India from January 2012 to December 2013. Parameters studied included preoperative clinical data (history, examination, and relevant investigations), type of anaesthesia, occurrence of dysrhythmias, and clinical outcomes of persistent dysrhythmias or those requiring treatment. Data was collected prospectively and analysed using Statistical Package for Social Sciences (SPSS) software version 15.0. Results: The overall incidence of dysrhythmias was 1.2%. Consistent factors included age over 40 years (68.1%), male gender (52.59%), gastrointestinal and orthopaedic procedures (65.5%), preoperative hypertension (25%), and patients receiving general anaesthesia (61.2%). Most patients were classified as American Soceity of Anesthesiologists (ASA) Class-I and II (93.97%) and underwent elective surgery (61.21%). The majority (81.89%) of dysrhythmias occurred intraoperatively and were ventricular in origin (68.97%). Unstable haemodynamic conditions [Systolic Blood Pressure (SBP) <90 mmHg, Heart Rate (HR) <50 /min and/or Ventricular Premature Contraction (VPCs) >5/min or multifocal VPCs)] were observed in 56.9% of patients. Of patients with ventricular dysrhythmias, 57% exhibited unstable haemodynamics. Treatment was provided to 84.48% of patients, with 74.14% responding positively, leading to the termination of dysrhythmias. Anticholinergics were used in 40.52% of treatment modalities. The majority of dysrhythmias were transient 80 (68.9%) patients, and 83 of patients had a favourable outcome. Unfortunately, 5 (6.9%) of patients could not be revived, with three patients 3 (2.5%) succumbing in the operating room. Mortality was not directly linked to the dysrhythmia but was due to underlying causes. Conclusion: Transient intraoperative ventricular cardiac dysrhythmias are common in adult patients undergoing noncardiac surgeries. Therefore, it is crucial to identify highrisk patients, analyse contributing factors, and promptly correct issues under expert medical guidance.

Diagnostic Performance and Comparative Analysis of Conventional Drug Susceptibility Testing, Line Probe Assay, and GeneXpert in Extrapulmonary Tuberculosis Cases: A Cross-sectional Observational Study

Introduction: Tuberculosis (TB), a known threat to mankind for ages, causes a significant burden on healthcare worldwide. The alarming rise of Extrapulmonary Tuberculosis (EPTB) has led healthcare professionals to opt for molecular diagnostics. Despite the availability of rapid diagnostics, conventional culture Drug Susceptibility Testing (DST) is still considered the gold standard in diagnosing TB. Aim: To assess the diagnostic accuracy of culture DST which is considered the gold standard. Materials and Methods: This cross-sectional observational study included 150 suspected EPTB patients and was conducted over a period of one year (September 2018 to August 2019) at Lokmanya Tilak Municipal Medical College and Sion Hospital (LTMMC), a tertiary care hospital in central Mumbai, Maharashtra, India. The hospital is located adjacent to Dharavi, the largest slum area with a high population density, which contributes to the majority of patients attending clinics. Patients attending the pulmonary medicine Outpatient Department (OPD) with extrapulmonary manifestations and suspected cases of EPTB were enrolled in the study. Samples, excluding sputum, were sent to the Department of Microbiology, LTMMC, Sion Hospital for GeneXpert analysis. The samples were further evaluated by microscopy, GeneXpert, and culture DST to detect the presence of Mycobacterium tuberculosis (M. tuberculosis) and drug susceptibility, respectively. Patients positive for Pulmonary Tuberculosis (PTB) were excluded from the study. Categorical variables were described using percentages. A Chi-square test was applied, and a p-value of <0.05 was considered significant. All statistical analyses were performed using SPSS statistical software (IBM SPSS version 26.0, Armonk, N.Y.). Results: Out of the 150 extrapulmonary samples, 23 (15.33%) samples were culture positive for M. tuberculosis and were subjected to DST using the 1% proportion method and GeneXpert assay. The MDR isolates were tested using the firstline Line Probe Assay (LPA). Eleven (47.8%) showed resistance to first-line antitubercular drugs. Among the 12 new cases, only 2 (16.7%) showed resistance compared to 9 (81.8%) in previously treated cases. A discordance of 8.7% was observed between DST with GeneXpert and LPA. Additionally, a discordance of 8.7% was observed between DST and LPA for rifampicin resistance and 4.3% for isoniazid resistance. Conclusion: The paucibacillary nature of extrapulmonary samples contributes to the challenging diagnosis of EPTB cases, leading to increased drug resistance. Highlighting the importance of the conventional solid culture DST method, this study strongly recommends the use of conventional DST accompanied by LPA for extrapulmonary cases.

Continual Improvement in Clinical Bacteriology Laboratory with Quality Indicators: A Retrospective Observational Study

Introduction: Healthcare management is undergoing significant changes with the evolution of new and re-emerging infections. A clinical microbiologist plays an important role in giving an accurate and timely report to the clinicians. Quality Indicators (QIs) act as a measure of the quality of services offered by the laboratory and are tools to monitor and evaluate the laboratory’s performance throughout the Total Testing Process (TTP). Aim: To measure the performance of the clinical bacteriology laboratory using QIs. Materials and Methods: A retrospective study was conducted in the Department of Microbiology at Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India. The study evaluated QIs from the records of 94,624 samples received in the bacteriology section of the clinical Microbiology laboratory between January 2018 and March 2021. Data analysis was conducted over a six-month period from December 2021 to May 2022. In 2018, one QI was identified for each phase, with an additional QI added in each phase to the pre-existing QI in 2019. In 2020, a QI was added in the preanalytical phase only. In 2021, the acceptable limit for one preanalytical QI was reduced from 2% to 1%. Data analysis was performed using an Excel sheet. Results: Data from records of 94,624 clinical bacteriology samples collected over 39 months were analyzed retrospectively. The preanalytical indicators included the number of samples rejected (135, 0.14%) and the number of requisition forms with three patient identifiers (59,645, 93.95%). Analytical phase QIs consisted of the average External Quality Assurance Scheme (EQAS) performance score (97.44% from January 2018 to March 2021) and outliers in the Internal Quality Control (IQC) (25 from January 2019 till March 2021). Failures in the IQC were not assessed in 2018. Postanalytical phase QIs included Turnaround Time (TAT) (average of 2.55 days for aerobic growth) and reporting time for critical alerts, which was within 24 hours of alert finding (100% for smear and culture-positive results). Conclusion: Regular monitoring of QIs helps to identify potential errors. This laboratory chose to analyse and monitor its processes using practically feasible QIs. It was found that the laboratory consistently maintained its performance throughout the study period.

MULTIDETECTOR COMPUTED TOMOGRAPHY IN BLUNT CHEST TRAUMA SINGLE TERTIARY CARE TRAUMA CENTRE EXPERIENCE.

Thoracic injuries are signicant causes of morbidity and mortality in trauma patients, second only to head injuries. In addition to conventional radiography, multidetector computed tomography (CT) is increasingly being used, since it can quickly and accurately help diagnose a wide variety of injuries in trauma patients. Furthermore, multiplanar and MiNIP, volumetric reformatted CT images provide improved visualization of injuries, increased understanding of trauma-related diseases, and enhanced communication between the radiologist and the referring clinician. To identify and accurately a Aims: ssess variety of injuries in blunt thoracic trauma with multidetector Computed Tomography (MDCT). To nd commonest pattern of intrathoracic injury related to blunt chest trauma. This Method: retrospective observational study included 50 patients who underwent Multidetector CT examination during the period from November 2020 to April 2021 at tertiary care trauma centre, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai. Blunt chest Conclusion: trauma injuries were classied into pleural injury, lung parenchymal injury, bony thorax, tracheobronchial and vascular injuries. The commonest injury detected was pleural (70%) followed by lung parenchymal injury (52%) and bony thorax injury in 50% cases. 50% of the pleural injury cases were associated with rib fractures. Multiple injuries were seen in the 47 patients, stating the importance of a detail evaluation of all chest components. No oesophageal and cardiac injury was detected in our CT studies' with its multiplanar, MinIP and volume reconstruction images increases the condence in imaging diagnosis and play a critical role in understanding thoracic trauma related complications.

Comparison between Dexmedetomidine and Propofol for MRI Brain in Paediatric Patients- A Randomised Clinical Trial

Introduction: Dexmedetomidine is an a2 agonist that causes deep sedation after bolus, and can be given as infusion while performing Magnetic Resonance Imaging (MRI) brain in paediatric patients. There are reports of increased incidences of bradycardia and hypotension with prolonged recovery when it was used in high doses of 2-3 mcg/kg bolus. Lower dose of bolus may enhance the recovery profile and reduce the chances of bradycardia, while maintaining the efficacy of sedation. Aim: To compare the induction of sedation, haemodynamics stability, success rate of the scan, efficacy of the drug and recovery profile of low dose dexmedetomidine and propofol infusion for MRI brain in paediatric patients. Materials and Methods: This randomised clinical trial was conducted at Lokmanya Tilak Municipal General Hospital and Medical College, Sion Mumbai, Maharashtra, India, from November 2012 to April 2014. Total 70 American Society of Anesthesiologists (ASA) grade I and II children aged 1-7 years posted for elective MRI brain were included in the study. Patients were divided into two groups i.e, dexmedetomidine group (n=35) and propofol group (n=35). Intranasal midazolam 0.2 mg/kg was given. Children in dexmedetomidine group were induced with 1 mcg/kg dexmedetomidine given over 10 minutes and maintained with dexmedetomidine at 1 mcg/kg/hr. Patients in propofol group received propofol bolus 2 mg/kg and infusion at 100 mcg/kg/min. Results: The MRI scan was completed in 34 (97.1%) and 35 (100%) of children in dexmedetomidine and propofol group, respectively. Time for complete recovery was 68.9±31.5 and 40.1±23 minutes in the dexmedetomidine and propofol group, respectively. Time for induction was 12.4±3.53 and 6.46±1.9 minutes in the dexmedetomidine and propofol group, respectively. Bradycardia was observed in 8 (22.9%) patients in dexmedetomidine group. Heamodynamic parameters were with in 20% of baseline in both the groups. Conclusion: Propofol is a better anaesthetics in terms of recovery and induction time when used as an infussion for MRI brain in paediatric patients. Dexmedetomidine has a high incidence of bradycardia so requires a more vigilant monitoring.

COMPARATIVE STUDY OF CORNEAL ENDOTHELIAL CELL DENSITY, MORPHOLOGICAL FEATURES AND CENTRAL CORNEAL THICKNESS AMONG DIABETIC AND NON-DIABETIC PATIENTS

Introduction:Diabetes can cause a decrease in endothelial cell density and hexagonality, as well as increased polymegathism, pleomorphism and subsequently decrease in corneal endothelial function, corneal hydration and the increase in central corneal thickness. The cell density of endothelium is around 3500 cells /mm2 in young adults. Corneas with cell count < 1000 cells /mm2 poorly tolerate intraocular surgery. Coefficient Of Variation: The normal endothelium has a co-efcient of variance of 0.25. An increase in this value means that the cell size is variable and is known as polymegathism. Aims And Objectives 1. To compare corneal endothelial cell changes namely, endothelial cell density, morphological features and central corneal thickness between diabetics and nondiabetic subjects 2. To compare corneal endothelial cell changes namely, endothelial cell density, morphological features and central corneal thickness among diabetics in relation to their HbA1c levels and their grades of retinopathy. Materials And Methods: Analytical study in Ophthalmology OPD of Lokmanya Tilak Municipal Medical College, Mumbai Specular microscopy ndings of diabetics and nondiabetics were compared. Results And Conclusion: ECD of both eyes were reduced in cases as compared to the controls, CVand CCTwere increased in both eyes of cases as compared to that of the controls, these values were correlated to their HbA1c levels and grade of diabetic retinopathy except CCT which was increased in NPDR group. Hence regular specular microscopy evaluation prior to any ocular surgeries and use of dispersive viscoelastics in ocular surgeries are essential pre requisites in patients with diabetes mellitus.

Assessment of Postoperative Analgesic Efficacy of Ilioinguinal-Iliohypogastric Block as Compared to Caudal Block in Children Undergoing Inguinal Herniotomy: A Randomised Clinical Study

Introduction: An Inguinal herniotomy is most frequently performed surgery in children under general anaesthesia along with various regional anaesthesia techniques such as ilioinguinal-iliohypogastric block (hernia block) or caudal block. Aim: To compare postoperative analgesic efficacy of hernia block (anatomical landmark guided ilioinguinal- iliohypogastric block) versus caudal block using bupivacaine as a local anaesthetic in children undergoing inguinal herniotomy. Materials and Methods: This single-centre, randomised clinical study was conducted at tertiary medical college and hospital (Lokmanya Tilak Municipal Medical College and General Hospital), Mumbai, Maharashtra, India, from December 2016 to December 2018. The study included 100 children from age 6 months to 6 years with American Society of Anesthesiologists (ASA) grade I and II, posted for elective inguinal herniotomy (unilateral). All children were given either hernia block or caudal block, based on computerized randomisation method. Total 55 patients received hernia block (Group H) with 0.3 mL/kg of 0.25% concentration of bupivacaine and another 45 patients received caudal block (Group C) with 0.75 mL/kg of 0.25% bupivacaine. In the postoperative period, mean pain free period and total duration of rescue analgesia were recorded in both the groups. Chi-square test and Fisher’s-exact test. The p-value <0.05 was indicated as statistically significant. Results: Demographic data was comparable in two groups. The mean drug volume (bupivacaine 0.25%) used in group C was 8.44 ±3.46 mL and in group H was 4.24 ±1.6 mL. The mean pain free period, with in the first 24 hours, in group C was 8.80±6.43 hours and in group H, it was 11.77±8 hours. Rescue analgesia and FLACC score (the Face, Legs, Activity, Cry, Consolability scale) at 0 min, 15 min, 30 min and every hour upto 4 hours was comparable in both the groups. Mean time of discharge of patients receiving either of blocks, FLACC score at the time of discharge were comparable in both the groups. Conclusion: Hernia block was more effective than caudal block based on duration of postoperative analgesia. There was higher margin of safety with lower volume of local anaesthetic used.

Histomorphological Changes in Pancreas and Liver among Chronic AlcoholicsAn Autopsy Study

Introduction: The clinical and pathological association between pancreatitis and alcohol abuse is well recognised, however the concurrence of prevalence of alcoholic related pancreatitis and liver disease is less well studied. Aim: To evaluate frequency of histomorphological changes in pancreas and liver among patients with history of alcohol abuse and observe the prevalence of coexistence between chronic pancreatitis and liver cirrhosis. Materials and Methods: This was observational cross-sectional study conducted in Department of Pathology at Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India, from July 2013 to July 2018. The study included 1917 autopsies and 107 cases with a documented history of chronic alcohol abuse. Haematoxylin and Eosin (H&E) staining was done on all sections and special stain like Masson’s trichrome was performed as per indication. Gross and microscopy were studied under variable defined parameters. Data was entered in Microsoft Excel sheets. Results: Histomorphologically, 12 cases (11.21%) were diagnosed as pancreatitis; 10 cases (9.34%) were of acute pancreatitis and two cases (1.86%) were of chronic pancreatitis. Total 21 cases were diagnosed as liver cirrhosis. The most dominant pattern of fibrosis seen in pancreatitis was perilobular and interlobular periductal fibrosis. The frequency of pancreatitis (14.28%) and pancreatic fibrosis (38.09%) was found to be more in cirrhotics. Chronic pancreatitis was commonly seen in cirrhotics than in non cirrhotics. Similarly, liver cirrhosis was more commonly observed in cases of chronic pancreatitis. Conclusion: The frequency of histomorphological changes seen in pancreas and liver was observed considerably among patients giving history of alcohol abuse. The prevalence of co-existence of chronic pancreatitis and liver cirrhosis was 50%.

Efficacy of Stroke Volume Variation-guided Fluid Management of Patients undergoing Off-pump Coronary Artery Bypass Grafting: An Observational Comparative Study between Open and Closed Chest

Introduction: Functional haemodynamic monitoring using dynamic parameter such as Stroke Volume Variation (SVV), based on pulse contour analysis, helps in predicting fluid responsiveness in off pump Coronary Artery Bypass Grafting (CABG) surgery. This allows adequate volume replacement to achieve optimal cardiac performance. Aim: To evaluate the efficacy of SVV in predicting volume responsiveness and effect on haemodynamic variable in patients undergoing off pump CABG in both closed and open chest. Materials and Methods: This single-centre, non randomised observational study was conducted at a tertiary medical college and hospital (LokmanyaTilak Municipal Medical College and General Hospital) Mumbai, Maharashtra, India, from December 2016 to December 2018. A total of 34 patients undergoing elective off pump CABG were included. Haemodynamic measurements Stroke Volume (SV), Cardiac Output (CO), Cardiac Index (CI), and SVV, were recorded with the transducer positioned at the level of midaxillary line. If the SVV was equal to or higher than 12, 100 mL fluid aliquot was given to patients. Endpoints for fluid aliquots was increase in CO by 15%, decrease in SVV of less than 12 or an increase Central Venous Pressure (CVP) upto 15 millimeter of mercury (mmHg). Number of times SVV above 12 during the procedure was recorded. SVV was considered as fluid responsive “if there was an increase in SV by 5%”. Statistical analysis was done using Student’s t-test (two tailed, dependent) on continuous parameters. The p-value <0.05, was considered significant. Results: Out of 103 events of rise in SVV, 65 (63.1%) occurred when chest was open and 38 (36.9%) while chest was closed. The SVV-guided fluid response was 76.3% in closed chest and 75.4% in open chest and there was no significant difference. (p-value=0.91). There was a significant increase in SV (p-value<0.01), CO (p-value=0.04), and significant decrease in SVV (p-value<0.01) and heart rate (p-value<0.01) after fluid loading in the responsive group when compared with non responsive group. There was no statistically significant difference between percentage change in SV, CO, CI, SBP, DBP, MAP and CVP between closed and open chest conditions after fluid replacement. Conclusion: SVV is not affected by open or closed chest conditions in mechanically ventilated patients undergoing CABG and can be used as a guide for fluid replacement. Weather open or closed chest conditions, few patients do not respond to fluid replacement when SVV are more than 12 by an increase in SV, cardiac output or CI, the cause of which remains to be determined.

Audit of Blood Utilization in a Tertiary Care Hospital

Context: Blood transfusion plays a vital role in saving lives. However, owing to its many side effects, it should be used judiciously. Aim: The aims of this study were: audit of blood utilization in our tertiary care set up, formulation of a maximum surgical blood ordering schedule (MSBOS) for procedures where a complete cross-match appears mandatory, and improvement in the efficiency of blood utilization in trauma care. Methods: All patients admitted to Lokmanya Tilak Municipal Medical College and General Hospital during the study period for whom cross-match requests were sent to blood bank were included in this study. They were divided into groups according to the departments under which they were admitted. Data were analyzed and cross-match to transfusion ratio (C/T ratio), transfusion index, and transfusion probability (%T) were calculated. C/T ratio was used as an index of the efficacy of blood ordering practice, and a ratio of >2.5 was considered an indication of the excess cross match. Results: The maximum C/T ratio of 34.11 was noted in the Department of Cardiology. Only three departments (Artificial Kidney Dialysis, Pediatrics, and Medical Intensive Care Unit) showed effective utilization of blood. Minimum C/T ratio of 1.34 observed in the Department of Artificial Kidney Dialysis. Conclusion: We found gross over-ordering of blood by different departments. Hence we propose the formulation of a blood ordering schedule. We drafted a MSBOS which provides guidelines for frequently performed elective surgical procedures by recommending the maximum number of units of blood to be cross-matched preoperatively, implementation of which will result in more efficient use of blood.

STUDY OF EFFICACY AND SAFETY OF BRONCHIALARTERY EMBOLIZATION IN CONTROLLING HAEMOPTYSIS

Hemoptysis can be dened as the coughing of blood or blood tinged sputum derived from the bronchial airways or lung parenchyma as a result of bronchial or pulmonary hemorrhage. Massive hemoptysis is an emergent and life-threatening condition with a broad range of underlying causes. Various treatment options for hemoptysis include conservative medical management, bronchial artery embolization and denitive surgical resection. Surgical resection is not possible in those patients associated with poor pulmonary reserve. Alone conservative management also carries higher risk of mortality rate in these cases. Early management with bronchial artery embolization can signicantly reduce the mortality in these patients. Proper techniques, results, and possible complications of BAE should be taken in mind and the same applies for the characteristics of the various embolic agents used in the procedure. In cases of recurrences, the procedure can be repeated effectively.This study done to know efcacy and safety of bronchial artery embolization in controlling hemoptysis. Study was done in Department of Radiology Lokmanya Tilak Medical College and Lokmanya Tilak Municipal General Hospital Sion Mumbai India over a period of 3 years. With its low recurrence rates and low procedure related complications BAE remains one of the best palliative and minimally invasive procedure for management of patients with hemoptysis including those who are unt to undergo or unwilling for more invasive managements such as surgery

Rapid volunteer-based SARS-Cov-2 antibody screening among health care workers of a hospital in Mumbai, India

Objectives:COVID-19 is highly contagious, and health care workers are at high risk of being infected. We carried out a rapid survey to estimate the proportion of HCWs who are serologically positive for SARS-CoV-2 in the Lokmanya Tilak Municipal General Hospital, Mumbai, India.Material and Methods:After the consent of the hospital authorities, volunteers were asked to report at a special booth set up in the hospital between May 1, 2020, and May 16, 2020. After consent, each worker was administered a questionnaire using a handheld computer which had questions on symptoms in the past 30 days, place of posting (COVID designated area or other), work category (doctor/nurse/others), use of personal protective equipment, smoking, comorbidity, and exposure followed by a test for COVID-19 using the STANDARD Q COVID-19 IgM/ IgG Duo Test of SD Biosensor. We estimated weighted seroprevalence with 95% confidence limits after adjusting for the work category. We calculated the adjusted odds ratio (aOR) using logistic regression with seropositivity as an outcome variable and others as independent variables.Results:The final sample included 501 and 1051 subjects working in the COVID area and non-COVID area, respectively, covering 35% of the total staff of the hospital. Overall, 6.9% (95% CI of 5.7–8.2) of the hospital staff was serologically positive for SARS-Cov-2, similar in the COVID area –5.7 (3.8–8.1) and non-COVID area –7.2 (5.7–9.0). Age more than 50 years (aOR 2.65; 1.45–4.85) and being in others work category 2.84 (1.34–6.02) were identified as significant predictors of being seropositive. Only 10% of the subjects reported COVID-like illness in the past 1 month.Conclusion:The overall modest prevalence of infection among the health care workers, especially non-doctors and nurses, and similarity of prevalence in COVID and non-COVID area staff indicate the possibility of non-hospital source of infection.

“Am I audible? Are my slides visible?” – Do we need to flatten the webinar curve?

“Am I audible? Are my slides visible?” – Do we need to flatten the webinar curve?

Foreign body in urinary bladder: our experience and review of literature

Background: The objective of the study was to study clinical presentation, mode of insertion, and management of intravesical foreign bodies in patients treated at our hospital.Methods: This was a retrospective study conducted between January 2018 to June 2019. Six patients underwent treatment for urinary bladder foreign body at Lokmanya Tilak Municipal Medical College and Sion Hospital, Mumbai, Maharashtra, India. Medical records were analyzed retrospectively with regard to nature of foreign body, each patient’s clinical presentation, the mode of insertion and how the foreign was managed.Results: A total of six foreign bodies were retrieved from patients’ urinary bladders. The patients range in age from 28 to 65 years (mean age was 45 years). The Clinical presentation includes Lower urinary tract symptoms. Four patients were male and two were female. Circumstance of insertion was iatrogenic in 5 patients and self-insertion in 1 patient. Five patients were treated endoscopically (cystoscopy retrieval with or without cystolithotrity) and one patient with supra pubic cystostomy. Post-operative hospital stay was of 1 to 2 days. Mean follow up period was 3 months. Psychiatric referral and counseling were done in patients with history of self-insertion of foreign body in urinary bladder.Conclusions: Foreign body in the urinary bladder remain a challenge to the urologist. Removal of the foreign body without injury to the urinary bladder or the urethra gives good outcome.

ROLE OF SHATAVARI IN MANAGEMENT OF EARLY OSTEOARTHRITIS.

08Sep 2019 ROLE OF SHATAVARI IN MANAGEMENT OF EARLY OSTEOARTHRITIS. Pooja S.K.Rai , Kanchan Sonone and Pramod Ingale. Associate Professor, Department of Biochemistry, LokmanyaTilak Municipal Medical College & Hospital, Sion Mumbai. Assistant Professor, Department of Biochemistry, LokmanyaTilak Municipal Medical College & Hospital, Sion Mumbai. Professor & Head, Department of Biochemistry, LokmanyaTilak Municipal Medical College & Hospital, Sion Mumbai.

Management of Difficult Laryngeal Exposure During Suspension Microlaryngoscopy.

Difficult laryngeal exposure during suspension microlaryngoscopic surgeries is a common situation encountered by the phonosurgeons nowadays. It leads to unnecessary trauma, incomplete surgery and even abortion of the procedure. Although various methods have been described to counter the situation, they might not be adequate in some cases with very anteriorly placed larynx. This study is intended to determine the utility of angled rigid endoscope along with malleable endoscopic instruments to improve surgical access in cases with inadequate glottic exposure during suspension microlaryngoscopy. In this cross sectional study conducted at Lokmanya Tilak Municipal Medical College and General Hospital in Mumbai, 50 patients of voice disorders who underwent Suspension Microlaryngoscopy from July 2014 to December 2017 were included. Out of these patients, 5 patients (10%) presented with difficult laryngeal exposure that were operated using readily available angled rigid endoscope along with malleable endoscopic instruments, without requirement of any specially designed instruments. There was improvement in laryngeal exposure in all the cases following utilisation of angled endoscopes. The surgeries were carried out under video monitor guidance with complete excision of the vocal cord lesions. Our study concluded that the cases in which the laryngeal exposure cannot be improved even by various external procedures, can be enhanced by application of angled rigid endoscopes and the vocal cord lesions can be excised completely by using malleable endoscopic instruments.

Third Delay in TBI: Time to Management as a Predictor of Mortality

Background: Traumatic brain injury (TBI) is a global epidemic with an increasing incidence in low-and-middle income countries (LMICs). The time from arrival to the hospital to receiving appropriate treatment (third delay) can vary widely in LMICs, though its association with mortality in TBI remains unknown. Methods: A retrospective cohort analysis with multivariable logistic regression was conducted with the Towards Improved Trauma Care Outcomes in India database, which contains data from 4 urban trauma centers in India from 2013-2015. Findings: There were 6,278 TBIs included in the cohort. The median age was 39 (IQR 27-52) and 81% of patients were male. The most frequent mechanisms of injury were road traffic accidents (52%) and falls (34%). A majority of cases were transfers from outside facilities (79%). In-hospital 30-day mortality was 27%; of patients who died, 21% died within 24 hours of arrival. The median third delay was 10 minutes (IQR 0-60 minutes); 34% of cases had moderate third delay (10-60 minutes) and 22% had extended third delay (61 minutes). Overall 30-day mortality was associated with moderate third delay (OR 1·3, p = 0·001) and extended third delay (OR 1·3, p = 0·001) after adjustment by pertinent co-variates. This effect was pronounced for 24-hour mortality: moderate and extended third delay were independently associated with odds ratios of 3·4 and 3·8 for 24-hour mortality, respectively (both p < 0·001). Interpretation: Third delay is associated with early mortality in TBI and represents a target for process improvement in urban trauma centers. Funding Statement: This study was not funded. Declaration of Interests: All authors declare no financial or personal conflicts of interest. Ethics Approval Statement: Ethical approval, including a waiver of informed consent, was obtained by all hospitals that enrolled patients. These hospitals and their corresponding ethics committee reference numbers were the: All India Institute of Medical Sciences (EC/NP-279/2013 RP-Ol/2013), Jai Prakash Narayan Apex Trauma Center (IEC/279), Lokmanya Tilak Municipal General Hospital (IEC/11/13), and the Institute of Post-Graduate Medical Education and Research at the Seth Sukhlal Karnani Memorial Hospital (IEC/279).This study was exempt from formal Institutional Review Board review by Harvard Medical School (IRB 17-2035). All investigators who conducted data manipulation and analysis utilizing the de-identified and de-personalized TITCO data required approval by the TITCO consortium.

Study of prognostic factors affecting outcome of urosepsis in a tertiary care hospital in Mumbai

Background: Urosepsis implies clinically evident severe infection of the urinary tract and/or the male genital tract (e.g. prostate) with features consistent with systemic inflammatory response syndrome. This research was aimed at studying various prognostic factors of urosepsis and its outcome. Methods: We prospectively observed patients admitted at Lokmanya Tilak Municipal General Hospital (LTMGH), Mumbai with a confirmed diagnosis of urosepsis from January 1, 2014 to December 31, 2014. After collecting socio-demographic data, patients were worked up with blood culture, urine routine and culture and other relevant clinical data. Data were analyzed in SPSS statistical software (SPSS v20 Inc, Chicago, USA). Results: 100 patients were included in the final of which 51 were males and 43 were aged 40-60 years. 49 patients had diabetes mellitus, 24 had a history of urethral procedures. 39% of the patients had E.coli and 40% of the patients reported no organisms. Additionally, 50% of the patients reported shock as a complication. Presence of pus cells in urine showed statistically significant association with mortality, duration of hospital stay and residual renal impairment. Conclusions: Urosepsis is much prevalent but rarely studied disease. Various clinical and microbiological parameters of the patient are of prognostic value and can predict the clinical outcome.

Prognostic factors in perforative peritonitis: an observational study

Background: Perforative peritonitis is the most common surgical emergency in India that requires prompt and optimum surgical attention. Despite advances in surgical techniques, antimicrobial therapy and intensive care support, management of peritonitis continues to be highly demanding, difficult and complex. This study was aimed to identify factors in patients with peritonitis which have a significant bearing on morbidity and mortality. Methods: The study was a single center, prospective observational study conducted in Lokmanya Tilak Municipal Hospital, Sion, Mumbai. 50 patients with perforative peritonitis presented to the emergency were included in our study. Detailed history & clinical examination performed, routine blood investigation were done followed by the use of appropriate diagnostic procedures such as X-ray erect abdomen, with additional help of abdominal ultrasound and abdominal CT scan. Different parameters were studied and analyzed. Results: 50 patients studied with age range 18-60 years with mean age of presentation 36.80 years and mortality rate was 16%. Majority of cases were male 88%. Tuberculosis was the most common co-morbidity (16%), most common site of perforation was gastroduodenal perforation (61%) [duodenum (48.9%) gastric (12.8%)] with peptic ulcer as the most common histopathology. We found most of the patients having no growth in peritoneal contamination followed by E. coli (34%) highly sensitive to amikacin. Most common complication was wound infection. We found delayed presentation >24 hrs, blood pressure /=24/min, number of perforation, size of perforation >/=1 cm, site of perforation, amount of contamination >1000 ml and Mannheim’s peritonitis index were the prognostic factors associated with morbidity. We could not find association between older age, sex, creatinine and hemoglobin but they were associated morbidity. Conclusions: The late admission to the hospital a very important cause of adverse outcome, leads to deterioration of patients. Tachycardia, tachypnea, hypotension, anemia, renal failure and septicemia, amount of contamination, size and number of perforations are the factors significantly predicting death (each significant at 5%). Thus, if patients having above mentioned symptoms could be detected early and prompt treatment could be provided accordingly; mortality can be reduced.

Violent Asphyxial Death: Annual Retrospective Study at LTMMC &amp; LTMGH, Sion Hospital, Mumbai

The deaths due to asphyxia are so wide and varied that they are challenging the autopsy surgeons on many occasions. Therefore careful study and examination of every case is important to bring wide variety of observations in death by asphyxia. This study was aimed to evaluate Pattern of violent asphyxial deaths at Department of Forensic Medicine & Toxicology, Lokmanya Tilak Municipal Medical College & Lokmanya Tilak Municipal General Hospital, Sion, Mumbai. Total 2585 autopsies were analyzed during January 2013 to December 2013. Out of 2585 cases, 80 cases were of violent asphyxial deaths. Majority of the cases were of male (70%) and of hanging (91.25%).