Medical Sciences Hospital Research Articles

A Study of Management of Adverse Reaction to Iodinated Contrast Media used in Computed Tomography at UCMS-TH

INTRODUCTION: Iodinated contrast media is used in computed tomography imaging to enhance the visibility of blood vessels and tissues. They have distinct clinical effectiveness and toxicity profiles. Although low osmolar contrast media have made iodinated contrast media safer in recent years, adverse reactions can sometimes occur. The management of adverse reactions to iodinated contrast media is an important aspect of patient care during computed tomography examinations. The purpose of this study was to evaluate the management of adverse reactions to iodinated contrast media during contrast-enhanced computed tomography examinations at Universal College of Medical Sciences and Teaching Hospital, Bhairahawa, Nepal. MATERIALS AND METHODS: A prospective, observational study was conducted on 323 patients at Department of Radiodiagnosis and Medical Imaging, Universal College of Medical Sciences and Teaching Hospital, Bhairahawa, Nepal, from December 15, 2022 to May 15, 2023. All data was obtained from the Department of Radiodiagnosis and Medical Imaging, as per the study inclusion criteria. The data were analyzed with statistical package for the social sciences version 20. RESULTS: The mean age of study participants was 48.49±19.78 years. There were 34.67% male and 65.33% female patients involved in this study. Universal College of Medical Sciences and Teaching Hospital favoured a more strict approach, to determine the normal renal function and withhold metformin before iodinated contrast media exposure. 36.84% of patients had a history of previous adverse reactions, before undergoing contrast-enhanced computed tomography scans. Following iodinated contrast media administration, 94.74% experienced nausea and vomiting which was followed by mild urticarial (88.54%) and dyspnea (19.81%). Premedication protocol was predominantly implemented with antihistamine, pheniramine (73.1%), and corticosteroid, hydrocortisone (26.9%). Mild urticaria was treated with pheniramine (87.1%), nausea and vomiting was treated with metoclopramide (83.01%), dyspnea was treated by epinephrine, hydrocortisone and oxygen (9.38%). CONCLUSIONS: Universal College of Medical Sciences and Teaching Hospital has established a standard protocol for the management of adverse reactions experienced by patients during iodinated contrast media administration. Premedication with antihistamines and corticosteroids was recommended for highrisk patients.

Clinico-histopathological evaluation of tonsillectomy specimens at a tertiary care hospital

Background: Tonsillar diseases are common in paediatric and adult otolaryngological practice and often require tonsillectomy and specimens are subjected to histopathological evaluation. Chronic tonsillitis is disease with repeated attacks of acute tonsillitis/ a sub-clinical form of a resistant or poorly treated infection. Aim of study was to determine the most common histopathological findings in patients presenting with clinical features of chronic tonsillitis. Methods: The present study is an observational study carried out at the Departments of Pathology and Otorhinolaryngology at Gujarat Adani Institute of Medical Sciences and GK General Hospital, Bhuj from January 2019 to April 2022. Results: A total of 35 cases of bilateral tonsillectomy were studied in a span of 40 months. There were 17 (49%) males and 18 (51%) females. The age ranges of the patients varied from 7 to 37 years with maximum number of cases less than 20 years of age. A total of 70 specimens obtained from 35 patients were studied. The most common clinical presentation was throat pain in 29 (83%) patients. The histopathological evaluation confirmed chronic tonsillitis in 40 (57%) specimens, followed by chronic lymphoid hyperplasia/ hypertrophy in 30 (43%) specimens, 14 specimens with chronic tonsilitis showed associated actinomycetes. Conclusions: Resected tonsillectomy specimens should be routinely evaluated by histopathological examination to know the cause of enlarged tonsils.

Outcomes of Pediatric Neurosurgical Cases Managed by General Neurosurgeons: A Retrospective Study from Eastern India

Abstract Background India is home to almost 19% of the world's children. The burden of diseases in the pediatric age group is quite high and is just the tip of the iceberg. In India, there are very few neurosurgeons who deal with cases in the pediatric age group. Most parents avoid surgical management for their child due lack of confidence in the expertise of the neurosurgeon in handling pediatric cases. Many challenges are encountered in the pediatric population during the pre-, intra- and post-operative period. Objectives The aim of this study is to study the demographic profile and respective outcomes of pediatric neurosurgical cases (below 18 years of age). Methods A retrospective study of cases over a period of 1.5 years in the Department of Neurosurgery, Institute of Medical Sciences and Sum Hospital was done. The variables analyzed were age group, sex, diagnosis, elective or emergency, neurological examination, and outcome. Data analysis was done using Version 3.0.2; 2013-09-25 for Statistical Computing (IBM Corporation's SPSS programme, version 27.0, 2020). Literature review was done through the NCBI PubMed, Scopus, Embase, and Google Scholar databases. Quality of life was assessed by the disability-adjusted life years (DALY) score approved by the World Health Organization. Results The majority of the patients had significant improvement in achieving milestones with reduced morbidity and one case of mortality. Conclusion To conclude, we have managed all cases of pediatric age group in a general neurosurgery department with utmost skill and meticulous surgery, with less than 0.1% mortality. In the cases that pertain to low resourced centers, areas, and countries where general neurosurgeons are mandated and obliged to perform pediatric neurosurgical procedures, we general neurosurgeons should take it as a challenge to manage these pediatric cases as our study showed appreciable results although the need for specialized pediatric neurosurgical care cannot be overemphasized.

Role of Neck Vessel Doppler in Correlation with Coronary CT Angiography for Assessing Coronary Artery Disease Burden in Diabetic Women and Men

Objectives: With an incidence of 4.1 for women and 6.4 for men/1000 person-years, cardiovascular disease is the primary cause of morbidity and mortality for both men and women worldwide.[1] In asymptomatic patients, subclinical atherosclerosis has been detected utilising several non-invasive methods, such as computed tomography (CT) coronary angiography and Neck Vessel Doppler (NVD) to test coronary calcification. The goal of the present study was to assess the role of NVD in correlation with coronary CT angiography (CCTA) in assessing the coronary artery disease (CAD) burden in diabetic women and men patients. Materials and Methods: This study was conducted on 30 female patients and 30 male patients aged 40–60 years, who were referred for CCTA for suspected CAD at Nizam’s Institute of Medical Sciences Hospital, Hyderabad. This study was an observational and prospective study of diabetes mellitus patients. All subjects underwent NVD and CCTA scan on the same day. Carotid intimal media thickness (CIMT) was considered the largest of the two separate values (left and right CIMT). The analysis examined factors associated with coronary artery calcification defined as a coronary artery calcium (CAC) score >0. Results: The mean age at assessment was 52.6 years in the diabetic male group and 53.7 in the diabetic female group. 63% of the study population was also hypertensive in the male group and 77% of the study population was also hypertensive in the female group. Mean CIMT was 1.01 mm in the diabetic male group and 1.02 mm in the diabetic female group. Twenty-two (73.3%) patients in the diabetic male group had a CAC score >0, of which 4 (18.18%) had severe coronary artery calcification (CAC score >400 Au), 7 (31.81%) had moderate coronary artery calcification (CAC score 100–400 Au), 11 (50%) had mild coronary artery calcification (CAC score 1-99 Au), and 8 out of 30 (26.67%) had no coronary artery calcification (CAC score <0 Au). Twenty (66.67%) patients in the diabetic female group had a CAC score >0, of which 2 (10%) had severe coronary artery calcification (CAC score >400 Au), 7 (35%) had moderate coronary artery calcification (CAC score 100–400 Au), 11 (55%) had mild coronary artery calcification (CAC score 1-99Au) and 10 out of 30 (33.33%) had no coronary artery calcification (CAC score <0 Au). Mean CIMT and carotid plaque were significantly associated with CAC (P = 0.046 and P = 0.026, respectively, in the diabetic male’s group and P = 0.008 and P = 0.011, respectively, in the diabetic female’s group). The significance was more profound in the diabetic female group when compared to the diabetic male group. Conclusion: NVD giving various surrogate parameters such as CIMT and plaque, in correlation with CCTA (CAC score), can play a significant role in assessing the CAD burden in men and women with diabetes and hypertension, thereby helping the clinician to assess the future risk for stroke or myocardial ischemic events to take active interventions.

Diagnostic Accuracy of Ultrasonography Versus Magnetic Resonance Imaging in the Detection of Endometrial Carcinoma Keeping Histopathology as Gold Standard

Objective: To calculate the diagnostic accuracy of Ultrasonography versus Magnetic Resonance Imaging in detecting endometrial carcinoma with histopathology kept as a gold standard.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Department of Diagnostic Radiology, Pakistan Institute of Medical Sciences Hospital, Islamabad Pakistan, from Apr 2019 to Apr 2020.
 Methodology: This study included patients of perimenopausal and post-menopausal age groups with abnormal uterine bleeding having a high index of suspicion for endometrial malignancy referred from the Gynecology department for an ultrasound examination. Patients having high suspicion for malignancy or inconclusive evidence on ultrasound were considered for Magnetic Resonance Imaging(MRI). All of them were followed for histopathological reports after surgical exploration. Clinical, sonological and Magnetic Resonance Imaging (MRI) findings, along with histopathological diagnosis, were documented.
 Results: Mean age of the patients was 56.58±10.28. Of these eight patients, 8(21.1%) did not have carcinoma upon histopathology. The most common type of carcinoma was poorly differentiated endometrial adenocarcinoma. The diagnostic accuracy of ultrasound was found to be 47.35%, while that for Magnetic Resonance Imaging (MRI) was 71.05%. Sensitivity and specificity for Ultrasound versus Magnetic Resonance Imaging (MRI) were 53.33% versus 66.67% and 75% versus 87.50%, respectively. The mean endometrial thickness on ultrasound was 15.97±5.64 mm, while on MRI was 15.42±6.9 mm.
 Conclusion: Magnetic Resonance Imaging (MRI) is a more accurate and sensitive modality in detecting endometrial carcinoma in patients with abnormal uterine bleeding.

Study design and rationale of EXPLORER-CN: a phase III, randomised, double-blind, placebo-controlled clinical study to evaluate the efficacy and safety of mavacamten in Chinese adults with symptomatic obstructive hypertrophic cardiomyopathy

IntroductionHypertrophic cardiomyopathy (HCM) is a primary myocardial disease commonly caused by pathogenic genetic variants encoding sarcomere proteins. Mavacamten, a first-in-class allosteric inhibitor of cardiac-specific myosin, has demonstrated efficacy and safety...

Comorbidity of asthma in patients with attention-deficit/hyperactivity disorder (ADHD) aged 4-12 years in Iran: a cross-sectional study.

The present study was a cross-sectional analytical study conducted to investigate the incidence of asthma in ADHD patients aged 4-12 years who were referred to Urmia University of Medical Sciences clinics and hospitals. In this study, ADHD patients were diagnosed through a psychiatric interview and based on a paediatric asthma questionnaire (approved by asthma and allergy organizations and scientific institutions), and individuals with suspected asthma were selected. All 101 ADHD patients referred to these clinics during the specified period were examined. Five patients were excluded from the study because of lack of cooperation or incomplete information. Then, the selected subjects were divided into two age groups of less than 5 years and between 5 and 12 years. The final diagnosis of asthma was made by clinical findings and demographic questionnaire in subjects younger than 5 years, while it was made by spirometry in subjects between 5 and 12 years. Data analysis was conducted using SPSS software. The mean age of the 96 samples included in the study was 7.67 years with a standard deviation of 7.214. Sixteen of them (16.7%) were under 5 years of age and eighty of them (83.3%) were between 5 and 12 years of age. Asthma was diagnosed in 7 children under 5 years of age (7.3%) and in 14 children (14.6%) between 5 and 12 years of age. A total of 21 (21.9%) were diagnosed as having asthma after screening. On the basis of these results, the frequency of asthma according to classified age was significant (P=0.020). The frequency of asthma based on sex and birth rank was also examined, and none of these factors showed a significant association with asthma. Medications taken by the ADHD patients were also examined in this study. The most commonly used medications in both groups of patients with asthma and no asthmatic patients were a combination of risperidone and atomoxetine or risperidone alone. The prevalence of asthma in the target population was also assessed in terms of parental smoking. According to the results of this study, the incidence of asthma in ADHD patients aged 4-12 years is high, and this case is more frequent in subjects younger than 5 years than in subjects aged 5-12 years. It should be noted that according to the results of the present study, there was no significant association between birth rank, parental smoking, ADHD medication, and the frequency of asthma.

A randomized controlled trial to evaluate the impact of pharmacist-led clinical interventions on the health-related quality of life among TB patients.

Background: The study was designed to evaluate the impact of pharmacist-led clinical interventions on the health-related quality of life among tuberculosis patients in Pakistan. Methods: A randomized, controlled prospective study was carried out in a Pakistan Institute of Medical Sciences hospital tuberculosis (TB) control center. Participants who visited the TB center between September 2020 and December 2021 were randomly assigned to two clusters, the usual care group (UC group) vs. the intervention group (pharmaceutical care group), in a 1:1 ratio by a simple envelope technique. In the intervention group, a patient received centered care that encompassed informed decision-making, which can increase the quality of care and monitoring of adverse drug events. However, the control group received routine TB treatment at the hospital. The EuroQol-5D-3L instrument was used to assess the health-related quality of life (HRQoL) at the baseline and in the third and sixth months of the treatment time period. Results: A total of 503 patients were eligible, of which only 426 patients were included in this study. At the end of the study, n = 205 of the patients in the intervention group and n = 185 of those in the control group were analyzed. In the intervention group, the EQ-5D-3L health utility score improved significantly (p < 0.001) (from the baseline mean ± SD, 0.40 ± 0.36, to 6months of treatment, 0.89 ± 0.09, while in the control group from 0.42 ± 0.35 to 0.78 ± 0.27). In multivariate regression analysis, the variables that remained statistically associated (p < 0.001) with the HRQoL (unstandardized β [95% confidence interval]) of the control group were as follows: gender, female vs. male (-0.039 [-0.076 to -0.003]); body weight, less than 40kg vs. more than 40kg (-0.109 [-0.195 to -0.024]); patients with any comorbidity vs. without comorbidity (-0.136 [-0.252 to -0.020]); and smokers vs. non-smokers (-0.204 [-0.291 to -0.118]). The study did not find any statistically significant associations between the intervention group's variables and the HRQoL. Conclusion: Patient-centered care interventions led by pharmacists as part of care coordination enhanced the HRQoL for TB patients significantly. According to this study, clinical pharmacists should be included in the interdisciplinary clinical staff for TB patient management.

Frequency of hepatocellular carcinoma in patients with hepatitis C receiving treatment with directly antiviral agents

Background and Aims: Hepatitis C infection is one of leading causes of liver cirrhosis and a considerable proportion of hepatocellular carcinoma worldwide. Despite the very high efficacy of Directly Acting Viral Agents (DAAs) on clearance of hepatitis C their role remains controversial on development of Hepatocellular Carcinoma. The Aim of this study is to analyze hepatocellular occurrence in hepatitis C patients after achieving Sustained virologic response on directly acting viral agent. Methods and Material: It is prospective study conducted on outpatients in the Hepato-gastroenterology department of Asian Institute of Medical Science Hospital Hyderabad from 21-10-2018 to 20-04-2019. All patients who fulfilled the criteria were enrolled, their baseline demographic characteristics, Child Pugh Class, MELD score, alpha-fetoprotein level and Ultrasound liver before and after treatment collected. Duration of DAAs treatment and type of DAAs used also noted. Hepatocellular carcinoma labelled when Triphasic CT scan liver shows typical characters of hepatocellular carcinoma i.e. arterial phase hyperenhancement and delayed washout on portal and venous phase or ultrasound liver shows focal liver lesion with alpha-fetoprotein level more than 300ng/ml. Results: One hundred fifty-seven patients of chronic hepatitis C enrolled in the study after exclusion criteria.

A comprehensive review of the epidemiology and clinical features of 91 cases with Buerger's disease.

Thromboangiitis Obliterans (TAO) is a disease of small and medium-sized arteries with an unclear natural course. This study aims to establish a national registry of the disease to gain a better understanding of its epidemiology and clinical course. This study was a cohort study of 242 patients with a high probability of TAO admitted to Mashhad University of Medical Sciences (MUMS) hospitals from 2000 to 2015. Of these, 91 patients with a confirmed diagnosis were included in the study (90 males and 1 female) with a mean age of 35 ± 7.8years. The most common symptom upon onset of the disease was paresthesia (29.7%), followed by cold sensitivity and paresthesia (93.4%) during the progression of the disease and Raynaud syndrome or vasospasm (93.9%) in the active phase. The right lower limb was the most commonly affected limb (46.2%), and presenting ischemic symptoms in 48.4%.Statistics indicated a positive correlation between the duration of Burger's disease and the number of affected limbs (p = 0.001). There was no effect of disease duration on the likelihood of amputations (p = 0.28). Some patients may experience mild, subtle symptoms for years before the initial signs and symptoms appear, which can be severe and rapidly progress to the point of requiring amputation.We suggest that the diagnostic criteria for Buerger's disease should be revised in light of the presence of atherosclerosis and its associated risk factors, which present a challenge in terms of diagnosis and treatment. Clinical experience will be of great importance in this regard.

Prediction of In-Hospital Mortality in Spontaneous Bacterial Peritonitis Patients with Advanced Liver Disease

Introduction: Bacterial infections are known reason for morbidity and mortality in hospitalized patients with cirrhosis among which Spontaneous bacterial peritonitis (SBP) is most common, accounts for around 20% to 30% mortality rate. Objective: To evaluate the frequency of in-hospital mortality in SBP patients. Study Design: Descriptive case series. Setting: Asian Institute of Medical Sciences Hospital Hyderabad. Duration: From 1st January 2019 to 30th June 2019. Material and Methods: Adult patients diagnosed to have spontaneous bacterial peritonitis and followed for outcome. Results: 223 patients of spontaneous bacterial peritonitis I,e 165 (74%) male and 58 (26%) female fulfilling the inclusion criteria were enrolled in study. Mean age obtained was 47.56 ± 13.069 years and Hepatitis C with most common etiology for CLD was 128 (57.4%) followed by Hepatitis B 26 (11.7%), Hepatitis B + D 30 (13.5 %) and Alcohol 8 (3.6 %). Hepatocellular carcinoma in 70 (31.4 %) only. CTP (Child-Turcot-Pugh) score and MELD (Model for End-stage Liver Disease) score used to access stage of cirrhosis. 38 (17 %) patients with CTP class B and 185 (83 %) with CTP class C. The mean MELD score of all patients found to be 23.09 ± 15.686. Among 223 patients, in-hospital mortality was observed in 61 (27.4%), 115 (51.6%) were discharged with improvement and rest 47 (21.1%) discharged with no improvement. Practical Implication: This study's findings underscore the need for early detection and aggressive management of Spontaneous Bacterial Peritonitis in patients with advanced liver disease, especially those with CTP Class C and high MELD scores, to reduce the high in-hospital mortality rate. Conclusion: Significantly high in-hospital mortality was found to be associated with SBP, with CTP Class C, High MELD Score, increased creatinine, bilirubin, PT, INR and decreased albumin especially in females. Keywords: Cirrhosis; In-hospital mortality; Spontaneous bacterial peritonitis

The relationship between succession and intellectual capital with entrepreneurship in hospitals

BackgroundThe hospital environment is very dynamic and faces many internal and external changes. Healthcare knowledge and technology are developing at a swift pace. This study investigated the relationship between succession and intellectual capital with entrepreneurship at the Qazvin University of Medical Sciences hospital, Iran.MethodsThe number of employees working in six hospitals was 2256, and according to Morgan’s table, the required number of samples was 331. We distributed three hundred sixty-five questionnaires considering 10% of sample loss. We used a multi-stage stratified sampling method. In the first stage, each hospital was considered a stratum. After that, occupational groups were considered the next stratum within each hospital, and based on the ratio, the required number of samples for each occupational group was randomly selected. We used the Sobel test to investigate the mediating role of intellectual capital and the structural equation model to fit the research model.ResultsSuccession aspects, including culturalization, meritocracy, job promotion path, and the role of senior managers, have a positive and significant effect on intellectual capital. Succession is only effective on intellectual capital and does not affect the personnel’s entrepreneurship directly or through intellectual capital.ConclusionConducting training classes and intervention programs and using localized succession models can create a suitable platform for increasing organizational creativity and entrepreneurship, motivating the hospitals’ personnel, and increasing intellectual capital.

Association between treatment for retinopathy of prematurity and blood monocyte counts.

To investigate blood monocyte counts as a risk factor for retinopathy of prematurity (ROP) treatment. Retrospective cohort study. Infants who underwent ROP screening at Shiga University of Medical Science Hospital between January, 2011 and July, 2021 were included in this study. Screening criteria were a gestational age (GA) < 32 weeks or birth weight (BW) < 1500g. The week with the largest difference in monocyte counts between the infants with and without type 1 ROP determined based on the effect size. Multivariate logistic regression analysis was applied to investigate whether the monocyte counts constituted an independent risk factor for type 1 ROP. The objective variable was type 1 ROP, and the explanatory variables were GA, BW, infants' infection, and Apgar score at 1min and monocyte counts in the week with the largest monocyte-counts difference between the with- and without type 1 ROP groups. In total, 231 infants met the inclusion criteria. The monocyte counts in the fourth week after birth (4w MONO) exhibited the largest difference between infants with and without type 1 ROP. The analysis was performed on 198 infants, excluding 33 infants without 4w MONO data. Thirty-one infants had type 1 ROP, whereas 167 infants did not. BW and 4w MONO were significantly associated with type 1 ROP (odds ratio: 0.52 and 3.9, P < .001 and 0.004, respectively). The 4w MONO was an independent risk factor for type 1 ROP and may be useful in follow-up of infants with ROP.

The Journey and Progress of the Department of Neurosurgery at the University College of Medical Sciences and Guru Teg Bahadur Hospital.

Guru Teg Bahadur Hospital (GTBH) associated with the University College of Medical Sciences (UCMS) is one of the largest hospitals associated with a medical college in the National Capital of Delhi, India. The Department of Neurosurgery was initially established here in 1997, but since its inception, has made rapid strides in terms of infrastructure and quality of patient care. The main objective of this article is to depict the history and path of progress of the Neurosurgery Department, from its inception to its present status, along with the inherent and existing challenges in running the department. A retrospective analysis from the time the department was established to its present status was done. The improvement of infrastructure, increase in patient inflow over the years, the number of procedures related to different subspecialties, and existing challenges along with the scope of further improvement were analyzed. There has been a significant upgradation of infrastructure more so in the last 5 years. Both indoor and outdoor patient attendance has increased over the years along with steady significant growth of the number of elective and emergency procedures. However, despite the progress, significant challenges hampering optimal patient care still remain to be overcome. The department right now is providing satisfactory patient care with absolutely no financial burden to the patients. Neurosurgery academic residency has recently resumed, and a wide range of neurosurgical conditions are being successfully treated. If the existing challenges are addressed in a timely manner, the coming years hold a bright future for the department.

Editorial introductions.

Editorial introductions.

A STUDY OF RISK FACTORS OF DELIRIUM TREMENS IN PERSONS WITH ALCOHOL USE DISORDER IN A TERTIARY CARE HOSPITAL.

Introduction: Delirium tremens is the severe form of alcohol withdrawal state that carries a certain degree of mortality. It is important to understand various risk factors associated with delirium tremens and compare with persons in alcohol withdrawal without delirium tremens. Objectives of the Study is to identify various risk factors associated with delirium tremens and to compare and identify any differences in risk factors for withdrawal syndrome in persons with alcohol use disorder with and without delirium tremens. This cross-sectional study Methodology: was conducted in the Department of Psychiatry at Hamdard Institute of Medical Science and HAHC Hospital, New Delhi on the patients with alcohol use disorder in withdrawal attending Department of Psychiatry, during period from January 2022 to June 2022. 75 patients with alcohol use disorder were taken. They were further categorised into 3 groups of patients which included patients with alcohol use disorder experiencing uncomplicated withdrawal, complicated withdrawal with or without delirium tremens. Patients with age range 18-60 years of either sex with illness of at least 12 months were taken. Severity of withdrawal was assessed by CIWA-Ar (Clinical Institute for Withdrawal of Alcohol scale containing ten items). Data was analysed using computer-based software (SPSS v16). Mean scores were calculated for both study populations for all the scales applied. Chi square test was used to make in between group comparisons for categorical variables with P value less than 0.05 was considered statistically signicant at 95 % condence level. Among the 75 patients Results: admitted for detoxication treatment during the period of January 2022- June 2023; 9 of the participants were suffering from uncomplicated withdrawal, 13 participants were suffering from complicated withdrawal without delirium tremens and 53 participants was suffering from complicated withdrawal with delirium tremens The factors signicantly associated with delirium tremens were previous history of DT (p=0.004**), binge drinking pattern (p=0.000**), history of morning alcohol consumption (p=0.000*), and delay in hospitalization (p=0.004**), and increased CIWA- AR score (p=0.001**). Patient admitted Conclusion: for detoxication should be carefully evaluated for these risk factors; and the vulnerable subjects with the presence of these risk factors should be cautiously managed and carefully monitored by the nurses taking care of these patients to prevent the occurrence of the fatal complication associated with alcohol withdrawal syndrome. Environmental manipulation, close observation and monitoring of vital signs, front loading dose of benzodiazepines are essential for preventing the occurrence of Delirium tremens during detoxication period.

Comparing the Effects of Misoprostol/Letrozole and Misoprostol/Placebo on Medical Abortion Success Rate: A Randomized Clinical Trial

Background: Abortion is the medical or surgical termination of pregnancy before the 20th week. However, dilation and curettage have been associated with hazards such as uterine rupture, heavy bleeding, and infection. Therefore, in recent decades, pharmacological therapies have become more widely accepted. Objectives: This research compared the medical abortion success rates of misoprostol/letrozole versus misoprostol/placebo. Methods: This randomized clinical study was conducted at Mashhad University of Medical Sciences hospitals between 2018 and 2019, involving pregnant women who were candidates for medical abortion. The study population was divided into two groups based on whether they had undergone cesarean section (CS). Each group was randomly assigned to either a control or an intervention group. In the CS group, there were 52 patients in the intervention group and 52 in the control group. The control group received a regimen of misoprostol and placebo, while the intervention group received a combination of misoprostol and letrozole. Results: There was no statistically significant difference in age (31.59 ± 5.6 vs. 31.06 ± 4.6, P value = 0.605), gestational age by ultrasound (11.20 ± 3.3 vs. 10.29 ± 2.6, P value = 0.135), or blood pressure between the control and intervention groups. However, the analysis showed a statistically significant difference in the rate of complete abortion (12 (23.5%) vs. 28 (54.9%), P value = 0.001) between the two groups. In the non-CS group, there was a significant difference in age between the control and intervention groups. The study analyses also revealed a significant difference in the rate of complete abortion between the two groups (24 (46.2%) vs. 36 (72.0%), P value = 0.008). Conclusions: Letrozole is recommended in combination with misoprostol for medical abortions because it increases the likelihood of complete abortion and reduces the duration of the abortion process.

An in-depth appraisal of clinico-biochemical and radiological findings of COVID-19 patients during the COVID-19 pandemic in a dedicated COVID Care Hospital in Eastern India and its outcome in relation to the COVAXIN vaccination status: A 2-year study.

COVID-19 pandemic hit Odisha province from April 2020 to December 2020, then from April 2021 to August 2021 and from February 2022 to April 2022 as the first, second, and third waves, respectively, with the most severe form witnessed during the second wave. Kalinga Institute of Medical Sciences hospital in Odisha was declared a Dedicated COVID Hospital (DCH) during those three waves and witnessed 9485 cases of admissions among which there were 1214 deaths. COVAXIN vaccination of the vulnerable population was launched in February 2021 onwards. This study has been done to know the clinic-biochemical profiles, radiologic findings of COVID-19 admitted patients, the predictors of mortality in the second wave, and clinical outcomes in the three waves in relation to COVAXIN vaccination status. This was a serial three-round retrospective study from the electronic medical records using multistage random sampling where we collected and critically analyzed the demographic, and all the relevant possible health data of the cases that consist of 514 cases admitted in three waves. The data from death certificates among the 555 cases in the second wave have been analyzed to conclude predictors of mortality. Mortality increased with age, male gender, comorbidities, and raised C-reactive protein level. High NL ratio, extent of pulmonary involvement. There was a wide variation in incidence and spectrum of illness starting from 79% incidence of mild symptomatic in the initial and third wave, but remained in the range of 35-65% in the second wave, respectively, and the most noticeable symptomatic illness was that of the upper respiratory tract. In fulminant cases, the mode of presentations was severe pneumonia and acute respiratory distress syndrome. Males were more sufferers than females. Children had better outcomes compared to adults. COVID-associated coagulopathy had a normal platelet count. Subsequently, in 2021 year onwards vaccination of the vulnerable population was launched in a phased manner that changed the dynamics of the disease outcome by better survival chances despite intercurrent COVID infection by induction of herd immunity. On the contrary, there was a higher prevalence of serious illness among non-vaccinated individuals. While the cases continued during the second wave of the pandemic, long COVID became a clinical entity of symptomatic that persisted or recurred among the COVID illness recovered cases after reverse transcriptase polymerase chain reaction results for COVID-19 became negative. The symptoms consisted of fatigue, cough, dyspnea as pulmonary manifestations and extra-pulmonary involvement of the cardiac, renal, and central nervous systems and the pulmonary imaging features consisted of interstitial pneumonia, consolidation, cavity pattern, and prone to microbial infection. These events lead to morbidity and admission. Coinciding with the vaccination of all population of Odisha province with the first dose of the vaccine by around the period of the first quarter of 2022, there was a new variant named Omicron responsible in the third wave, in which the majority of the admitted cases had.mild upper respiratory illness. This was not as lethal as its predecessors due to its lower propensity to invade the lungs and blood vessels. Immune dysregulation plays a central role in the pathogenesis of the manifestations. Vaccine-induced protection and the induction of herd immunity played a proactive role in the waning of the severity of clinical presentations.

Laparoscopic versus open pelvic exenteration for locally advanced rectal cancer: analysis of short- and long-term effects

Objective: To explore the feasibility, safety, and short- and long-term efficacy of laparoscopic pelvic exenteration (LPE) in treating locally advanced rectal cancer. Methods: The clinical data of 173 patients who had undergone pelvic exenteration (PE) for locally advanced rectal cancer that had been shown by preoperative imaging or intraoperative exploration to have invaded beyond the mesorectal excision plane and adjacent organs in the Cancer Hospital, Chinese Academy of Medical Sciences (n=64) and Peking University First Hospital (n=109) from 2010 January to 2021 December were collected retrospectively. Laparoscopic PE (LPE) had been performed on 82 of these patients and open PE (OPE) on 91. Short- and long-term outcomes (1-, 3-, and 5-year overall and disease-free survival and 1- and 3-year cumulative local recurrence rates) were compared between these groups. Results: The only statistically significant difference in baseline data between the two groups (P>0.05) was administration of neoadjuvant therapy. Compared with OPE, LPE had a significantly shorter operative time (319.3±129.3 minutes versus 417.3±155.0 minutes, t=4.531, P<0.001) and less intraoperative blood loss (175 [20-2000] ml vs. 500 [20-4500] ml, U=2206.500, P<0.001). The R0 resection rates were 98.8% and 94.5%, respectively (χ2=2.355, P=0.214). At 18.3% (15/82), and the incidence of perioperative complications was lower in the LPE group than in the OPE group (37.4% [34/91], χ2=7.727, P=0.005). The rates of surgical site infection were 7.3% (6/82) and 23.1% (21/91) in the LPE and OPE group, respectively (χ2=8.134, P=0.004). The rates of abdominal wound infection were 0 and 12.1% (11/91) (χ2=10.585, P=0.001), respectively, and of urinary tract infection 0 and 6.6% (6/91) (χ2=5.601, P=0.030), respectively. Postoperative hospital stay was shorter in the LPE than OPE group (12 [4-60] days vs. 15 [7-87] days, U=2498.000, P<0.001). The median follow-up time was 40 (2-88) months in the LPE group and 59 (1-130) months in the OPE group. The 1-, 3-, and 5-year overall survival rates were 91.3%, 76.0%, and 62.5%, respectively, in the LPE group, and 91.2%, 68.9%, and 57.6%, respectively, in the OPE group. The 1, 3, and 5-year disease-free survival rates were 82.8%, 64.9%, and 59.7%, respectively, in the LPE group and 76.9%, 57.8%, and 52.7%, respectively, in the OPE group. The 1- and 3-year cumulative local recurrence rates were 5.1% and 14.1%, respectively, in the LPE group and 8.0% and 15.1%, respectively, in the OPE group (both P>0.05). Conclusions: In locally advanced rectal cancer patients, LPE is associated with shorter operative time, less intraoperative blood loss, fewer perioperative complications, and shorter hospital stay compared with OPE. It is safe and feasible without compromising oncological effect.

Causes and treatment strategies of unilateral leaflet escape of bileaflet mechanical prosthetic heart valves after surgery: a case series

BackgroundDuring the eleven years from 2010 to 2021, preliminary statistics have shown that Fuwai Hospital completed 23,571 mechanical valve replacements for various types of valves, and 1139 mechanical valve replacements were performed in Guangyuan First People's Hospital. Only two patients developed valve leaflet escape, so valve leaflet escape is a rare postoperative complication.Case presentationIn 2010 and 2021, two patients were selected after they had unilateral leaflet escape after having mechanical valve replacements in Fuwai Hospital of Chinese Academy of Medical Sciences and Guangyuan First People's Hospital. Both patients underwent reoperations with the classic operation and the new bileaflet mechanical prosthetic heart valve was sutured. The treatment of detached single lobe and distal vessel was comprehensively determined, and the condition was treated according to the patient's symptoms, CT results, ultrasound results and other test results, as well as whether this detached lobe caused any abnormal hemodynamics of the distal vessel. The patient with mechanical aortic valve escape completed the 10-year follow-up, and patient with mechanical mitral valve escape completed the 3-month follow-up. there was no thrombosis or hematoma at the embolic site; the patient had no lower limb symptoms.ConclusionsThe reason for the leaflet escape may be related to the valve design and the leaflet material. If the detached leaflets are damaged and if the distal blood vessels are affected, simultaneous surgical treatment is required. Those patients whose vessels were not damaged by the valve lobe should be carefully monitored.