Bangalore Medical College Research Articles

Assessment of knowledge, attitude and practice regarding blood donation among the residents in the urban field practice area of Bangalore Medical College and Research Institute: a community based cross sectional study

Background: The act of donating blood is crucial for healthcare systems worldwide. Despite its significance, blood donation rates are sub-optimal in many regions, especially urban areas. This study aimed to assess the level of knowledge, attitudes, and practices related to blood donation among urban residents in Bangalore. The study also aimed to identify misconceptions, motivators and barriers for guiding public health strategies to promote blood donation. Methods: A community based cross sectional study was conducted in Urban field practice area of Bangalore Medical College and Research Institute, Bengaluru from May 2024 to July 2024. Sample size was calculated according to study done by Samreen et al. Data was collected using simple-random-sampling and analysed via SPSS 26.0. Results: The study investigated knowledge, attitude, and practice of blood donation among 148 participants. Findings showed 6% having good knowledge, 92% having fair knowledge, and 1.3% having poor knowledge about blood donation. 70.9% had favourable attitude, while 29.1% had unfavourable attitude. 14.2% of participants had donated blood despite a high level of favourable attitude. Barriers identified were fear of infections (21%), fear of needles (15%), and laziness along with lack of information (27.2%), ineligibility (17.6%) and fear for health (13.2%). Conclusions: This study indicated that while the population has fair knowledge and favourable attitude towards blood donation, very less proportion have actually donated blood. The study also identified misconceptions, motivations, and barriers to donation. Targeted measures are required to improve blood donation practices.

The effect of hygienic material use during menstruation on the prevalence of RTIs symptoms among women in India

Background: Every month, healthy adolescent girls and pre-menopausal adult women are impacted by the crucial topic of menstrual hygiene. Menstrual hygiene management is essential to women’s reproductive health. Menstrual product consumption, poor cleaning techniques, and material reuse are examples of suboptimal menstrual health and hygiene. So, the current study was planned to assess the impact of hygienic material use during menstruation on the prevalence of RTIs among women in India. Methods: A cross-sectional, comparative community-based study was conducted in urban and rural areas of Bangalore, India. Study was conducted from December 2023 to March 2024. All female patients in reproductive age group attending RHTC and UHTC OPD were included. Interview method was used to collect data from consented participants on socio demographic details, products used for menstrual hygiene and symptoms suggestive of RTI in last 6 months were collected. Results: A community-based study was conducted in rural and urban field practice area of a medical college in Bangalore. A total of 258 participants attending UHTC and RHTC centres were included from each area. The proportion of participants with RTI symptoms were 62.2%. In current study 20.3% participants reported lower abdominal pain and 18.6% of participants had pain during micturition in past 6 months. Conclusions: Our study’s findings show a direct link between subpar MHM procedures and RTI symptoms. Our results confirm international recommendations for a dual focus on providing suitable absorbent materials and making sure that ambient conditions allow associated hygiene, such as washing, safety, and dignity for women.

Assessment of frequency and factors associated with low back pain among undergraduate medical students in Bangalore Medical College and Research Institute: a cross-sectional study

Background: A large percentage of young adults suffer from low back pain. Due to their demanding curriculum, medical students are most susceptible. This study aims to assess the frequency and factors associated with low back pain among undergraduate medical students at a college in Bangalore. Methods: An online cross-sectional study using a questionnaire was conducted among undergraduate medical students at Bangalore Medical College and Research Institute. SPSS 26.0 was used to analyze the data with a significance level of p <0.05. Results: Of the 250 students enrolled, 45.6% had low back pain. Long hours of sitting were the common factor aggravating the pain. The logistic regression analysis revealed that Phase 3 (part 2) MBBS (OR=2.53, 95% CI: 1.34 - 4.66), overweight (BMI>25) (OR=3.03, 95% CI: 1.42-6.50), coffee consumption regularly (OR=1.761, 95% CI: 1.007-3.009), Family history of LBP (OR=5.900, 95% CI: 3.182-10.939), duration of exercise/sports 1-2 hours per week (OR=1.691, 95% CI: 1.023-2.794), spending >8 hours for electronic gadgets daily (OR=2.02, 95% CI: 1.14-3.59) were found to be independently associated with low back pain. These results demonstrate an increased risk of low back pain among medical students with high BMI, lack of physical activity and increased electronic device usage. Conclusions: It highlights the necessity of focused treatments to control stress, minimize extended periods of sitting, enhance physical activity, and support proper posture among medical students. By preventing and managing low back pain, medical students can improve overall performance and quality of life.

Clinical and Polysomnographic Profile of Patients with Sleep Disordered Breathing in a Tertiary Care Hospital

Background: Obstructive Sleep Apnea (OSA) is a prevalent sleep disorder associated with various health complications, yet it often remains undiagnosed. Understanding its clinical and polysomnographic profiles is crucial for effective management. Objective: To investigate the clinical characteristics, including demographic factors and comorbidities, of patients diagnosed with Obstructive Sleep Apnea (OSA). To analyze the polysomnographic profiles of individuals with OSA, focusing on respiratory events, sleep architecture alterations, and cardio metabolic parameters, to provide insights into the severity and manifestations of the disorder. Methodology: Data were collected from patients who underwent Level 1 polysomnography at a Sleep Laboratory in Bangalore Medical College And Research Institute from January 2021 to September 2023. Clinical profiles and polysomnographic data were analyzed using IBM SPSS software. Results: The study included 112 patients with a median age of 52 years and a high median BMI of 33.29. Polysomnographic analysis revealed a mean AHI of 36.709, indicating severe OSA. Respiratory events during REM and NREM sleep showed variations in apnea and hypopnea occurrences. Cardio metabolic parameters indicated potential subclinical cardiac dysfunction and dyslipidemia. Conclusion: In conclusion, our study demonstrates a strong correlation between Obstructive Sleep Apnea (OSA) and cardiovascular health, characterized by respiratory disturbances and obesity. Notably, elevated Pulmonary Artery Systolic Pressure (PASP) highlights the potential risk of pulmonary hypertension in this population, warranting close monitoring and targeted therapies. The findings underscore the importance of multidisciplinary management approaches in addressing OSA and its associated health conditions to improve patient outcomes and quality of life.

IJCM_357A: Smartphone addiction and physical activity among students of a Medical College in Bengaluru-a cross-sectional study

Background: Smartphones have become an indispensable necessity for medical students because of their various demands and comforts. The excessive use of smartphones may lead to addiction which can negatively affect physical and mental health including physical activity. The relationship between smartphone addiction and physical activity needs exploration. Hence this study was undertaken to assess the magnitude of smartphone addiction and to explore its association with physical activity among students of a medical college in Bengaluru. Objective: To assess smartphone addiction and its association with physical activity among students of a medical college in Bengaluru. Methodology: A cross-sectional study was conducted among students of Bangalore Medical College and Research Institute. Based on a study done in Maharashtra(p=46.15%), the sample size was calculated as 382. Study subjects were recruited by stratified random sampling and probability-proportional to size sampling was used to select study participants across various strata. Data was collected using a pretested semi-structured questionnaire. Smartphone addiction was assessed by smartphone addiction scale-short version (SAS-SV) and physical activity by international physical activity questionnaire-short form (IPAQ-SF). The data collected was entered in MS Excel and analyzed using SPSS 21.0. Results: Among 382 students 164(43%) were found to have smartphone addiction. The primary use of smartphones was for social networking. Physical activity, duration of smartphone usage, and use of the smartphone right before sleeping were associated significantly with smartphone addiction. Conclusion: The problem of smartphone addiction has reached an alarming level. There is a need to create awareness about the problem and plan effective strategies to address it.

IJCM_390A: A study to assess body weight perception, weight control practices, and their association with menstruation among adolescent girls in the rural field practice area of Bangalore medical college and research institute

Background: Adolescent girls are concerned about their weight, physical appearance, and how society perceives them. The identities they seek and create in this phase influence society and their peers. In this process, a lot of Emotional, Biological, and Social problems are faced by them. One such problem is Menstrual disorders. Keeping this rationale in mind, the above study was undertaken to Assess Body weight perception, Weight control practices, and their association with Menstruation among Adolescent girls. Objective: 1. To assess Body weight perception and Weight Control Practices, among Adolescent girls 2. To compare Body weight perception and Weight control practices among Adolescent girls with normal and abnormal Menstrual cycles Methodology: A Cross-sectional study was conducted among Adolescent girls residing in the rural field practice area of Bangalore Medical College and Research Institute, Bengaluru. A Sample size of 192 was determined based on a previous study done by Bhurtun DD et al, and Simple random sampling was used for participant recruitment. Data collection utilized a pre-tested structured questionnaire. Data analyzed using SPSS 21.0 Results: Among the 192 participants, based on Body mass index (BMI), 13(6.7%) were Overweight and the rest of the participants 135(70.3%) were of Normal weight. Out of 118(61.5%) respondents reported trying to lose weight, reducing fat intake 100(84.7%) was the most common method. The majority of the Adolescent girls had a positive perception of weight control but had problems accepting their body image as healthy. Body weight perception and Weight control practices affected normal menstrual cycles as well as girls with Menstrual disorders. Conclusion: The findings revealed Body weight perception affected the girls with Normal Menstruation as well as with Menstrual disorders. Therefore, Adolescent girls need to be educated on the need for a Healthy body image as well as a Healthy lifestyle.

IJCM_124A: A cross sectional study to assess the prevalence, pattern and predictors of complementary and alternative medicine use among non – communicable disease patients in the urban field practise area of a Government Medical College, Bengaluru

Background: In the current century, a significant challenge is addressing the escalating global burden of Non-Communicable Diseases. Integrating Alternative and Complementary Medicine into the existing healthcare system is a major initiative to combat this issue. Despite increased access to free healthcare facilities, heightened disease awareness, and widespread exposure through electronic and print media, the popularity of unprescribed alternative medicine persists in India. Objectives: To assess the Prevalence, Patterns, and Predictors of Complementary and Alternative Medicine use among non-communicable disease patients in the urban field practice area of Bangalore Medical College and Research Institute, Bengaluru. Methodology: A cross-sectional study conducted among non-communicable disease patients residing in the urban field practice area of Bangalore Medical College and Research Institute, Bengaluru. A sample size of 250 was determined based on a pilot study and systematic random sampling used for participant recruitment. Data collection utilized a pre-tested structured questionnaire. Data analysed using SPSS 21.0 Results: Among the 250 participants, 55 (22%) used both Allopathic and Alternative medicines, only 11 (20%) exclusively relying on Alternative systems. Ayurveda was the most utilized alternative medicine 15(27.2%), followed by Sidda 8(14.5%). Statistically significant associations were observed between the usage of Alternative medicine and patients’ religion and education. Conclusion: A relatively small percentage of adults exclusively used Alternative systems of medicine in this study. Ayurveda emerged as the predominant alternative medicine, followed by Sidda. The prevalence of alternative medicine was higher among Hindus and participants with education below the primary level. These findings shed light on the complex dynamics of healthcare.

IJCM_10A: Role of male spouse in antenatal care of pregnant women in the urban field practice area of Bangalore Medical College and Research Institute, Bengaluru – A Cross-Sectional study

Background: The husband has a great role to play in the antenatal care of his wife during pregnancy. Male spouse involvement is crucial and essential in utilization of the services and benefits, antenatal services to the maximum by the woman. The male spouse involvement will have positive impact on reproductive and child health. The extent of involvement of male spouse depends on the gender role attitudes and the social network. Objective: To assess the involvement of Male spouse in Antenatal care. Methodology: A community based cross-sectional study was conducted in the month of June to November 2023 among 263 Male partners of parous women between the reproductive age 15-45yr, in the urban slum area of BMCRI, Bangalore through simple random sampling technique. A pre-tested, semi-structured, questionnaire was used to collect the data, to assess their involvement during antenatal care. Data collected was entered in MS Excel and analysis was done using SPSS version 21.0. Results: In our study, 84% were actually present at the hospital during the delivery and 82.5% had good practice of taking appointment for ANC visits of their wives. About 77.6% were aware of pregnancy related danger signs. But only 35% participants accompanied their wives to ANC visit at least four times. Conclusion: There is a need to recognize importance and positive impact of male participation in antenatal care. Knowledge and attitude of men are the prime determinants of their level of participation in antenatal care.

Serum Vitamin D Levels and Vascular Endothelial Growth Factor in Patients with Type 2 Diabetes Mellitus: A Cross-sectional Study

Introduction: Diabetes Mellitus (DM) is the most common noncommunicable disease and the fifth leading cause of death worldwide. Recent research has demonstrated that low Vitamin D levels and high Vascular Endothelial Growth Factor (VEGF) in middle-aged and elderly populations represent a risk factor for Type 2 Diabetes Mellitus (T2DM). Aim: To estimate the Vitamin D and VEGF levels in study subjects with T2DM and healthy controls and to correlate the Vitamin D level and VEGF with HbA1c % in study subjects with T2DM. Materials and Methods: A cross-sectional study was undertaken from October 2014 to November 2016 at the Department of Medicine in collaboration with the Department of Biochemistry, Bangalore Medical College and Research Institute, Bangalore. The study included 50 T2DM subjects on oral hypoglycaemic agents for five years and 50 age and sexmatched healthy controls selected randomly from the general population. In all the study subjects, Random Blood Glucose (RBG), LFT, Renal Function Test (RFT), HBA1c, serum Vitamin D, and serum VEGF were estimated. Student t-test and Chisquare/Fisher-Exact test were used to find the significance of study parameters between cases and controls. Multivariate logistic regression analysis was done to assess the risk factors for DM. Results: The mean age of the cases was 50.9±9.7 years and of controls was 49.76±7.7 years. Among the 50 cases, 19 (38%) were men and 31 (62%) were women. Among the 50 controls, 27 (54%) were men and 23 (46%) were women. The mean Body Mass Index (BMI) among cases was 27.21±4.59 and in controls was 24.82±2.63 (p-value=0.0016). The mean serum 25(OH) Vitamin D levels in cases were 11.39±3.32 ng/mL and in controls were 28.06±11.14 ng/mL (p-value <0.001). The mean serum VEGF levels in cases were 97.52±16.96 pg/mL and in controls were 56.37±17.74 pg/mL (p-value <0.001). Conclusion: The present study found that subjects with T2DM have lower serum 25(OH) Vitamin D levels and higher serum VEGF levels than those without T2DM. Serum Vitamin D decreases and serum VEGF-A levels increase with increasing HbA1c%, correlating with vascular complications.

Retrospective Cohort Study of Short- and Long-term Outcomes in Surgical Management of Adult Choledochal Cysts: Ten-year Experience of a Tertiary Care Centre in Karnataka, India

Introduction: Choledochal cysts in adults are rare, as most are diagnosed in childhood. The concern for malignancy in adults adds to the expenses associated with evaluation and management. A aetiology can be congenital or acquired. Acquired biliary wall thinning, caused by the reflux of pancreatic juice, can be a contributing factor in adults. Long-term follow- up after surgery is essential to optimise the treatment. However, not many studies have documented the long-term outcomes of surgery. Aim: To study the short- and long-term outcomes of patients undergoing surgery for adult choledochal cysts {choledochal cyst excision and Hepaticojejunostomy (HJ)}. Materials and Methods: This was a retrospective cohort study of patients aged 18 years and older with choledochal cysts who were diagnosed and operated on between 2012 and 2022 in the Department of Surgical Gastroenterology, Bangalore Medical College and Research Institute (BMCRI), Bengaluru, Karnataka, India. Patients were diagnosed using imaging and subjected to open choledochal cyst excision and HJ. Outcomes like morbidity and mortality associated with the procedure, both in the short- term and long-term, were studied. Continuous variables like age were represented as mean±standard deviation, while categorical variables (such as CBD diameter) were represented as percentages/proportions. Statistical Package for the Social Sciences (SPSS) (version 25.0) was used for statistical analyses. Results: A total of 128 patients were included in the study, with a mean age of 48.92±16.20 years. Type I cysts were seen in 61.72% of the cases, while Type IV A constituted 38.28%. The mean diameter of the Common Bile Duct (CBD) in the study sample was 23.13±14.88 mm, with fusiform dilatation. Endoscopic Retrograde Cholangiopancreatography (ERCP) with stenting/stone clearance was performed in 41 patients. Short-term complications occurred in 48 (37.5%) patients, with Surgical Site Infection (SSI) being the most common early complication. Early postoperative mortality was observed in one patient (0.78%), On long-term follow-up of 83 patients, mortality occurred in six patients. A total of 18 patients complained of abdominal pain during long-term follow-up. Conclusion: Choledochal cyst still remains a significant surgical disease in the adult population, especially in a tertiary care centre. Timely surgical intervention is essential to prevent the short- and long-term complications associated with this condition.

Detection of Human Adenovirus from Clinical Samples of Conjunctivitis by Real-time PCR: A Cross-sectional Descriptive Study

Introduction: Human Adenoviruses (HAdV) have been implicated in a variety of infections, including conjunctivitis, respiratory tract infections, genitourinary infections and gastroenteritis. Epidemic Keratoconjunctivitis (EKC) is a severe ocular surface infection strongly associated with HAdV, known to occur in widespread outbreaks. HAdV species B, D and E are associated with ocular manifestations ranging from simple follicular conjunctivitis (types 3, 4, 7) and pharyngoconjunctival fever (types 3, 7, 14) to the more severe EKC (types 8, 19, 37, 53, 54, 56 and 64). Viral cell cultures of conjunctival specimens help confirm adenovirus infection through the characteristic Cytopathic Effect (CPE) and Polymerase Chain Reaction (PCR) is the best standard method to diagnose viral conjunctivitis due to its sensitivity, accuracy and rapidity. Aim: To diagnose HAdV in clinically suspected cases of viral conjunctivitis using real-time PCR. To isolate HAdV in viral cell culture and confirm it by observing its characteristic CPE and performing adenoviral real-time PCR. Materials and Methods: A cross-sectional descriptive study was conducted from July 2023 to September 2023 at the state-level Virus Research and Diagnostic Laboratory (VRDL) at Bangalore Medical College and Research Institute (BMCRI), Bengaluru, Karnataka, India. A total of 45 conjunctival swab samples from patients with suspected viral conjunctivitis, who attended the Ophthalmology Outpatient Department (OPD) or were admitted to the wards, were included in the study. Conjunctival swab samples collected in Viral Transport Medium (VTM) were centrifuged at 3000 rpm for five minutes at 4°C. Real-time PCR was performed and samples positive for HAdV by real-time PCR were taken up for viral cell culture. Confirmatory PCR was conducted for samples showing CPEs in the cell line. The data collected were analysed using descriptive statistics. Results: The majority of patients in the present study were in the age group of 18-45 years, comprising 25 (56%) of the total patients. Out of 45 conjunctival samples tested, 8 samples were positive in adenovirus real-time PCR. All eight PCR-positive samples showed a CPE in viral cell culture on the A549 cell line. The study found PCR positivity in 8 samples (17.7%), while adenoviral recovery from cell culture was observed in 6 samples (13.3%). Conclusion: Real-time PCR has become the standard diagnostic procedure for detecting adenovirus conjunctivitis. Rapid and accurate diagnosis is key to interrupting the contagious spread of adenoviral conjunctivitis, along with timely treatment.

Serodiagnosis of Brucellosis in Patients with Fever of Unknown Origin at a Tertiary Care Hospital in Bangalore: A Cross-sectional Study

Introduction: Brucellosis is a zoonotic disease caused by bacteria of the genus Brucella. Although it is not commonly transmitted between humans, it can be transmitted through direct handling of cattle or their products, such as raw milk, unevenly heated milk, clotted cream, and cheese, for varying periods. Brucellosis is considered as one of the neglected zoonotic diseases worldwide, as it can cause debilitating acute infections and later become chronic with numerous complications. Aim: To determine the prevalence of brucellosis among patients with Pyrexia of Unknown Origin (PUO). Materials and Methods: This cross-sectional study was conducted in the Department of Microbiology at Ramaiah Medical College and Teaching Hospital in Bangalore, Karnataka, India, over a period of two years, from December 2019 to December 2021. The study included patients who visited the Outpatient Department (OPD) and those admitted to the hospital with fever persisting for more than 5-7 days and Fever of Unknown Origin (FUO). The total sample size was 180, and 5-10 ml of blood was collected from each patient under aseptic precautions from the median cubital vein for serological tests. The blood samples were stored at 2-8°C for the Rose Bengal Test (RBT) assay and Enzyme-Linked Immunosorbent Assay (ELISA). The demographic parameters considered included clinical history, age, gender, residency, and history of animal exposure. Data analysis was performed using the statistical software Statistical Package for the Social Sciences (SPSS) version 18.0, employing the Chi-Square test, Fisher’s-Exact test, and descriptive statistics. The significance level employed was set at p-value <0.05. Results: Among 180 samples, six (i.e., 3.3%) were positive for the Brucella RBT (BRBT), while 11 (i.e., 6.1%) were positive for the (ELISA IgM), and 17 (i.e., 9.4%) were positive for the (ELISA IgG). Additionally, 22 samples (i.e., 12.22%) tested positive for either ELISA of IgG or IgM (ELISA IgG/IgM). Conclusion: The present study identified 22 patients (12.22%) with Brucella-positive cases who presented with various clinical signs and symptoms, originating from different geographical locations and regardless of gender. These findings suggest that all cases of FUO presented to a clinician should be evaluated for Brucella infection.

Correlation of Cross-sectional Area of the Umbilical Cord on Antenatal Ultrasound with Neonatal Birth Weight in Pregnant Women with and without Gestational Diabetes Mellitus: A Prospective Cohort Study

Introduction: Many foetal and maternal complications, such as polyhydramnios, macrosomia, birth injuries, and operative interference, are linked with Gestational Diabetes Mellitus (GDM). Among these, macrosomia is particularly significant, as it increases the risk of shoulder dystocia, brachial plexus injury, birth asphyxia, and maternal complications, including emergency Lower Segment Caesarean Section (LSCS), Postpartum Haemorrhage (PPH), and perineal trauma. Therefore, one of the most essential perinatal goals in GDM is to predict macrosomia by estimating birth weight, thereby preventing adverse maternal and foetal outcomes. Aim: To evaluate whether there is a correlation between the cross-sectional area of the Umbilical Cord (UCA) and the Neonatal Birth Weight (NBW) in pregnant women with GDM. Materials and Methods: A prospective cohort study was conducted in the Departments of Radiology and Obstetrics Bangalore Medical College, Bengaluru, Karnataka, India. A total of 100 pregnant women (50 with GDM and 50 without GDM) were recruited from July 2021 to July 2022. Ultrasound examination (USG) was performed on pregnant women after 36 weeks of gestation. The UCA was measured in a free-floating loop, and the NBW was measured using a digital scale. The correlation coefficient was calculated to determine the degree of correlation between UCA and NBW. Results: The mean age of the subjects was 26.5±3.9 years. The frequency of macrosomia was higher in the GDM group (8%) compared to the control group (4%). A strong positive correlation was observed between UCA and NBW in both diabetics (r=0.819) and control groups (r=0.736). Conclusion: A strong positive correlation exists between UCA and NBW in women with GDM. Therefore, it should be estimated during routine antenatal USG for the prediction of birth weight in such women.

A cross-sectional study to determine the potential drug–drug interactions in patients with alcoholic liver disease in a tertiary care hospital

Background: Alcoholic liver disease (ALD) is a major cause of chronic liver disease worldwide, and it significantly contributes to liver-related mortality on a global scale. These patients often require drug treatment either for liver disease and its complications or for other comorbid conditions. Due to compromised hepatic function and the prevalence of polypharmacy-associated comorbidities, liver disease significantly increases the risk of drug-drug interactions (DDIs) and adverse drug reactions (ADRs). Aims and Objectives: The aim of the study was to determine the potential drug interactions in the pharmacological management of patients with alcoholic liver disease undergoing conservative treatment. Materials and Methods: A descriptive and cross-sectional study was conducted at Victoria Hospital attached to Bangalore Medical College and Research Institute over a period of 3 months. The study analyzed 200 cases of alcoholic liver disease for the presence of potential drug interactions using the LEXICOMP computer program. Results: The study included 200 subjects with alcoholic liver disease. About 92% were males, and 35% were from the age group of 41 to 50 years followed by 28% from 31 to 40 years. Cirrhosis was identified in 53% of the cases. The median number of drugs per patient was 8.8. A total of 118 potential DDIs (pDDIs) were identified averaging 2.5 pDDIs per patient. The common pDDIs were seen with ondansetron, metronidazole, propranolol, rifaximin, and ranitidine. It was noted that polypharmacy exhibited a robust association with the occurrence of drug interactions. The findings highlight a significant association between polypharmacy and the incidence of pDDIs. Conclusion: The complexity of pharmacotherapy in alcoholic liver disease stems from compromised liver function. It is crucial for physicians to be cognizant of the significant DDIs associated with medications used in liver disease treatment, given the heightened susceptibility of these patients to ADRs.

Efficacy and safety of dexmedetomidine in attenuating stress response to skull pin holder application in patients undergoing craniotomy

Background: Skull pin holder application during craniotomy can evoke stress response, which might lead to sudden rise in blood pressure (BP), causing intracranial hemorrhage, cerebral edema, and prolonged hospital stay. Dexmedetomidine has been shown to blunt the sympathoadrenal response to surgery. Aims and Objectives: The present study was undertaken to assess the efficacy and safety of dexmedetomidine in attenuating stress responses to skull pin holder application as compared to normal saline. Materials and Methods: After obtaining approval from the institutional ethics committee and written informed consent, patients of either sex undergoing elective craniotomy at the attached hospitals of Bangalore Medical College and Research Institute, Bengaluru, India, were randomized in a 1:1 ratio to receive normal saline or dexmedetomidine as premedication. Hemodynamic parameters, i.e., heart rate (HR), systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP), were monitored at various time points until 30 min after skull pin application. Data were analyzed using the chi-squared test, repeated measure ANOVA, unpaired t-test, and Mann–Whitney U test, wherever applicable. Results: A total of 52 patients were included in the study, with 26 patients in each group. All the baseline parameters were matched. As a stress response, a significant increase in HR was seen after intubation (90.69 bpm) and skull pin insertion (87.92 bpm) in the normal saline group. However, there was no significant variation in HR in the dexmedetomidine group over 30 min (69.19 bpm–74.15 bpm). Dexmedetomidine reduced HR significantly as compared to normal saline after intubation (P = 0.03). Dexmedetomidine lowered SBP and DBP as compared to baseline throughout 30 min without any excursions during intubation and skull pin insertion. The SBP was significantly lower in the dexmedetomidine group after intubation as compared to saline (P = 0.02). Although a reduction in SBP was noted after skull pin insertion in the dexmedetomidine group, it was not statistically significant than saline. No significant difference was noted in DBP, MAP, or blood glucose between the two groups. No incidents of hypotension and bradycardia were noted. Conclusion: Dexmedetomidine maintained basal HR throughout 30 min without any variations in response to intubation and skull pin insertion. It also reduced SBP and DBP over 30 min. HR and SBP were significantly lower in the dexmedetomidine group as compared to saline after intubation. The same effect was noted in the dexmedetomidine group as compared to saline after skull pin insertion, but it was not statistically significant.

Analysis of chemotherapy-induced toxicity and its amelioration in patients with cancer in a tertiary care hospital

Background: According to the World Health Organization, an adverse drug reaction (ADR) is any response to a medication that is unpleasant, unexpected, and occurs at recommended doses utilized in men for prevention, diagnosis, or therapy. Pharmacovigilance is of utmost importance to ensure safe and effective medications, especially in palliative health care services. ADRs associated with cancer chemotherapy in a hospital setup give insight into the causality, severity, and preventability of the identified ADRs. Hence, the study aims to analyze the various adverse effects of drugs used for cancer chemotherapy and the measures taken to ameliorate the toxicity of these drugs. Aims and Objectives: The objective of our study was to analyze the various adverse effects of drugs used for cancer chemotherapy and the measures taken to ameliorate the toxicity of these drugs. Materials and Methods: It was a cross-sectional study done from October 2021 to May 2022. The study was conducted in the Department of Medical Oncology at Victoria Hospital, attached to Bangalore Medical College and Research Institute, with 40 patients who were diagnosed with cancer and were undergoing chemotherapy. ADRs were recorded using the CDSCO–ADR form, graded according to severity, and uploaded to PVPI. Results: The data demonstrated that most of the patients who experienced ADR were females (75%) and in the age group of 18–60 years (70%). The most common chemotherapeutic agent was cisplatin and the most common ADR was anemia (42.5%) and nausea (27.5%). Out of the 21 types of adverse reactions, nine ADRs were treated with ameliorating therapy. Even though a number of adverse reactions were reported, only 43% of patients were treated with ameliorating therapy. Conclusion: Patients diagnosed with cancer and who are on chemotherapy are already in distress and experience a lot of ADRs. Identifying and treating these ADRs is quite challenging. These ADRs are inevitable, and in terms of the risk-benefit ratio, the benefit is greater than the risk due to therapy. So, we must create awareness about ameliorating toxicity to positively impact the quality of life. The study shows only some reactions are treated with ameliorating therapy for chemotherapy-induced toxicity.

Ocular Manifestations in Head and Neck Cancer: A Cross-Sectional Study from a Tertiary Care Centre from South India.

Introduction: Head and neck cancers (HNCs) present a significant global health burden, especially in India, where oral cavity cancers, notably affecting the tongue, are prevalent. A substantial portion of global HNCs (57.5%) is concentrated in Asia, India contributing with 30%. Despite advancements, challenges persist due to HNCs' invasive nature and metastatic potential. This study aims to explore the link between HNCs and ocular manifestations. Methods: A cross-sectional study was conducted at Bangalore Medical College and Research Institute involving 47 patients with diagnosed HNCs and ocular complaints. Clinical evaluations encompassed visual acuity, anterior and posterior segment examinations, and specialized investigations when necessary. Results: A diverse range of malignancies were observed, with SCC maxilla and xeroderma pigmentosa, each accounting for 10.63% of cases. Ocular examinations unveiled visual acuity challenges, anterior segment findings like masses, exotropia, pigmented lesions, and varied fundus abnormalities. The anterior segment findings encompassed masses often accompanied by protrusion or relative afferent pupillary defect (RAPD). Additionally, exotropia, pigmented lesions, and other conditions were observed. Fundus examination revealed a spectrum of findings, including media haziness (10.63%), lack of view (17.02%), and pale discs (6.38%). Treatment plans were diverse, including excision biopsies (42.55%), exenteration procedures, Mitomycin-C applications, and referrals for chemotherapy and radiotherapy. Conclusion: The present study underscores the significance of ophthalmological assessment and investigations in patients with diagnosed HNCs, emphasizing the value of early detection and intervention. Abbreviations: HNC = Head and Neck Cancer, OCT = Optical Coherence Tomography, WNL = Within Normal Limits, SCC = Squamous Cell Carcinoma, MRI = Magnetic Resonance Imaging, CT = Computed Tomography, RAPD = Relative Afferent Pupillary Defect, XP = Xeroderma Pigmentosa.

Lens induced glaucoma – Clinical profile and prognosis in tertiary care centre

Conditions in which cataractous lens and abnormalities of lens leads to elevated intra ocular pressure have been termed as Lens induced glaucoma (LIG). Objective of our study was to know the clinical profile of patients, describe management and visual outcome in lens induced glaucoma. Hospital based prospective study conducted on 40 patients of LIG from November 2016 to October 2018 attending the outpatient department of Ophthalmology at Minto Ophthalmic Hospital, Bangalore Medical College and Research Institute. After taking informed consent, detail history, detailed examination, IOP by Applanation tonometry, Gonioscopy, examination of posterior segment, patients diagnosed as lens induced glaucoma admitted and managed with medical and surgical treatment. Post operative day 1 visual acuity and IOP recorded and followed up on day 8 and 6 weeks for above. Data analyzed with descriptive statistics and chi square test. In our study mean age of presentation in phacomorphic glaucoma is 67.25 ± 6.58 years and phacolytic glaucoma mean age was 64.10years ± 9.78. Female to male ratio being 1.8 : 1. Phacomorphic glaucoma was found in 57% and phacolytic glaucoma in 43%. Mean IOP at presentation was 42.6mmHg ±5.36. Most of them underwent SICS + PCIOL (52.5%). Study showed that most of them had better visual acuity at the end of 6 weeks. Final IOP was 15.8 mmHg± 1.78.Our study demonstrated that lens induced glaucoma is still a challenging complication of cataract which can be prevented by early treatment of cataract. SICS is still gold standard that effectively controls IOP and gives better visual outcome.

To Determine the Efficacy of Pentoxifylline in the Management of Bell's Palsy.

Bell's palsy is an acute, unilateral, lower motor neuron peripheral facial paralysis. It is the most common cause of facial paralysis in the ages ranging from 13 to 65 years. It not only causes physical disfigurement of face but is also associated with social stigma and psychological trauma to the patient. In Bell's Palsy, there is hypoxic damage to the nerve due to reduced blood flow and cellular injury to the capillaries. Pentoxifylline is a phosphodiesterase inhibitor that increases the cAMP and cGMP levels at the site of the RBC cell membrane thereby improving the dexterity of the cell membrane allowing the RBCs to pass through the damaged and narrowed blood vessels thereby improving the perfusion and oxygen delivery to the damaged tissues. Vasoactive agents are not routinely used as an active component in the treatment. Since vascular compromise plays a predominant role in the pathophysiology of Bell's palsy, it is proposed that the addition of a vasoactive agent like Pentoxifylline can improve the recovery rate and shorten the duration of treatment in the management of Bell's Palsy. The study was conducted in the Department of ENT, BMCRI, Bangalore during the period February 2021 to August 2022. This is a prospective randomized control study which included 70 patients attending the out-patient department of ENT, Bangalore Medical College and Research Institute, Bangalore. Written informed consent was taken from all patients included in the study. A detailed history, thorough clinical examination, and relevant investigations were done for these patients. Patients were randomly divided into Group A and Group B based on random numbers generated by the WINPEPI software version 11.65. The study group (Group A) received standard treatment in addition to Tab Pentoxifylline 400mg TID for 1 week. The control group (Group B) received only the standard treatment regimen. Patients were followed up on Days 5, 10, 15, and 6 months to assess recovery following treatment. The recovery of facial nerve function was evaluated as per the House-Brackmann Grading system for any improvement. Both pre-treatment and post-treatment HB grades were analyzed. The data collected were tabulated and subjected to statistical analysis using ANOVA. The age distribution of the patients showed that the most common age group affected in this study was 18-30 years. Males were affected more than females (1.2:1). The most common HB grade at presentation noted in this study was Grade 4 in both groups (54.2%). At the beginning of the treatment, in Group A, around 43% patients had HB grade of 3 and 57% patients had HB grade of 4. In Group B, around 20% patients had HB grade 2, 28.57% patients with grade 3 and 51.43% patients with grade 4. After a follow-up period of 6 months, in Group A, around 43% of patients achieved a HB grade of 1, 51% patients achieved a grade of 2 and about 6% patients had a grade of 3. In Group B after a follow up period of 6 months, 29% patients achieved HB grade of 1, 46% patients achieved grade of 2 and 26% patients had a grade of 3. It was observed that 42.86% of patients had better outcomes (Normal facial function) in Group A (Study group) compared to 28.57% of patients in Group B (Control group). It is evident that a patient who presented with HB grades of 2 or 3 and who presented within 5 days had better chances of recovery which was statistically significant (p = 0.001). From the present study, it may be concluded that Bell's palsy occurs in all age groups. It affects younger age groups more commonly (2nd decade) and affects males more than females. The study group who had received Tab Pentoxifylline along with standard treatment had better outcome. This highlights the benefit of vasoactive agent in the management of Bell's palsy by improving the oxygen delivery to the affected tissues. The online version contains supplementary material available at 10.1007/s12070-023-04298-9.

Factors Influencing Infant Morbidity in the Urban Field Practice Area of a Medical College in Bangalore

Background: Infants constitute 2.92% of the total population in India. Health of infants is considered as a sensitive indicator of health status and level of socio-economic development of a country. In India, the infant morbidity and mortality are in decline, but the pace of decline is not sufficient to attain the target goals of National Health Mission. Objective: To assess the factors influencing infant morbidity in the urban field practice area of a medical college in Bangalore. Methods and Material: This was a population based cross sectional study done at an urban poor locality in Bangalore. The study was conducted between April 2018 to September 2019 with a sample size of 300 after obtaining the approval from Institutional ethics committee. Population proportion to size was used to ensure equal representation. Data was collected using pre tested semi structured questionnaire & analysed using open epi like descriptive statistics with univariate & multi variate logistic regression were used. Results: Total of 165(55%) subjects were females, with majority 206(68.7%) Muslim by religion and 161(53.7%) lived in the nuclear family. The prevalence of morbidities among infants was 209(69.7%). The most common infant morbidities reported were 121(40.3%) ARI, 85(28.3%) fever and 45(15%) diarrhea. Infants with perinatal complications, faulty feeding practices like delayed initiation of breast feeding, bottle feeding and immunization had significant association with infant morbidities. Conclusions: To conclude there is a statistically significant association between perinatal complications, bottle feeding & partial immunization with infant morbidity. Keywords: Infant, Immunization, Breast feeding, Morbidity