Mysore Medical College Research Articles

Paediatric Head Injury: Concordance between CT Findings and GCS Scores- A Retrospective Study in a Tertiary Care Hospital

Introduction: Computed Tomography (CT) remains the mainstay in the detection of traumatic brain injuries in children just as in the adult population. However, unnecessary and inadvertent use of CT in minor and less significant head injuries exposes children to harmful ionising radiation and subsequently increases the lifetime cancer risk. So, there is a need to use CT judiciously in cases of minor head injuries. The Glasgow Coma Score (GCS) can provide a comprehensive framework for proper stratification of neural impairment and head injury severity. Aim: To assess the concordance between CT scan findings and GCS scores in paediatric patients with acute Traumatic Brain Injury (TBI). Materials and Methods: This was a retrospective study of paediatric head injury cases who were referred to the Department of Radiodiagnosis, Mysore Medical College, Karnataka, India. from January 2021 to December 2021. The head CT of 110 patients was reviewed. Demographic details, mode of accident, CT findings, and GCS scores were collected from hospital records. Descriptive statistics were used and results were expressed in terms of frequency and percentages. Results: Out of 110 patients (mean age: 9.17±3.02 years) reviewed, males were 78 (71%) and females were 32 (29%). Road traffic accident was found to be the most common cause, i.e., in 71 patients (64.5%). The most common CT scan finding was fracture as seen in 12 cases. Out of 110 patients, 94 had mild injury according to GCS scores, 12 had a moderate head injury and four had a severe head injury. As the GCS scores decreased, the percentage of positive findings on CT increased. Conclusion: Percentage of positive CT findings was higher in the moderate and severe head injury category, where the role of CT scans in acute settings becomes valuable.

Stress, Anxiety, and Depression among Nursing Students at a Tertiary Teaching Hospital in Karnataka, India: A Cross-sectional Study

Introduction: Nursing students are valuable human resources in the health profession. During their student life, they face a great deal of stress, which can negatively affect their mental and physical health, as well as their academic performance. However, there is limited evidence regarding stress, anxiety, and depression among nursing students in Karnataka, India. Aim: To estimate the prevalence of stress, anxiety, and depression among nursing students and determine the factors associated with these conditions amongst them. Materials and Methods: A cross-sectional study was conducted at Department of Community Medicine, Mysore Medical College and Research Institute, Mysuru from March 2022 to August 2022, involving 200 undergraduate nursing students. The study included nursing students from the 1st year to the 4th year. Data was obtained using a predesigned and pretested questionnaire consisting of two parts: the first part collected details on sociodemographic and academic parameters, and the second part assessed psychological parameters using the Depression, Anxiety and Stress scale (DASS) 21 Scale. Data were entered into an excel spreadsheet and presented as frequencies and percentages using Statistical Package for Social Sciences (SPSS) software version 24.0. Factors associated with stress, anxiety, and depression were analysed using the Chi-square test, with a p-value <0.05 considered statistically significant. Results: A total of 200 nursing students participated in the study. The mean age of the participants was 20.22 years, with a standard deviation of 1.42. A total of 39 students (19.5%) reported moderate stress, while 26 (13%) reported severe to extremely severe stress. Approximately 35 (25%) participants experienced moderate to severe depression. Among the participants, 63 (31.5%) reported moderate anxiety, while 78 (39%) reported severe to extremely severe levels of anxiety. Factors such as academic year, lack of time for leisure activities, financial crisis in the family, and addiction to internet use were significantly associated with stress (p<0.05). Conclusion: The prevalence of depression, anxiety, and stress was high among nursing students in the study. These statistics can help nursing educators understand the challenges faced by nursing students and assist in promoting the quality of clinical practice.

A questionnaire based study to assess knowledge, attitude and practice of pharmacovigilance among exam going second year undergraduate medical students in a South Indian teaching hospital

Background: Pharmacovigilance not only helps in the early detection of adverse drug reactions (ADRs) but also facilitates the identification of both, risk factors and the underlying mechanism. To increase the reporting rate, it is essential to improve the knowledge, attitude, and practices (KAP) of healthcare professionals regarding ADR reporting and pharmacovigilance, especially during undergraduate and postgraduate education. The objective of this study was to assess the KAP about pharmacovigilance among exam-going second-year undergraduate medical students.Methods: A cross-sectional questionnaire-based study was conducted among 150 exam-going second-year undergraduate students from Mysore Medical College and Research Institute, Mysore from April 2022 to June 2022. A validated questionnaire consisting of 22 questions divided into 3 sections; knowledge, attitude, and practice was used. Statistical analysis of data was done using an MS excel spreadsheet.Results: Out of the 150 participants 133 had good knowledge about ADR and pharmacovigilance. Majority of the students agreed that reporting of ADRs is necessary (95.3%), mandatory (95.3%), and should be included in pharmacology practicals (94.7%). Only 29.3% of the students had witnessed an ADR and none of the participants had ever reported an ADR indicating poor practice among the undergraduate students.Conclusions: Students had good knowledge and positive attitude towards ADR reporting and pharmacovigilance. Practice regarding pharmacovigilance was found to be poor, indicating the need for training the undergraduate students in ADR reporting by including ADR recognition and reporting as a part of clinical posting curriculum.

Epidemiology of Snake Bite in A Medical College in Karnataka

Snake bites are a cause of considerable morbidity and mortality worldwide. Out of 68 cases, the maximum was between the age group of 20 - 30 years (26%). 47 of 68 (69%) victims were male, and 31% of victims were female. More than half of the victims are farmers. 39 of 68 (>57%) victims belonged to a lower class of socioeconomic status. 24% were illiterates, and 76% were literates. Maximum victims, 91%, were from a rural region. A maximum number of victims, 68% had snake bites in the fields, followed by 19% snake bites at home. 56% of snake bites occurred in the rainy season and 26% in the winter season.

Study of polyps in female reproductive tract in a tertiary care centre

To study the clinical presentation, management of polyps of female reproductive tract. To know the correlation between ultrasonological finding and Histopathological findings. This was a retrospective hospital based observational study. It was conducted in Cheluvamba hospital, attached to Mysore Medical college and Research Institute, Mysore. Data was collected from hospital registers who underwent surgery for diagnosis of polyp from the year 2018 to 2021 were included in the study. There were 50 cases in the study. They were managed according to their symptoms, age, desire for fertility and type of polyp. Polyps are most common in the age group 31 to 40 years (42%) and in parous women. The most common presenting complaint was heavy menstrual bleeding (82%). Based on USG and HPE the most common type of polyp was leiomyomatous polyp. Heavy menstrual bleeding caused severe anaemia in 44% of women who required blood transfusion for correction anaemia. No cases of malignancy were diagnosed.Polyps are an important cause of AUB. The resulting heavy menstrual bleeding can cause severe anaemia requiring blood transfusion, leading to morbidity. Clinical examination and ultrasound diagnosis correlates with histopathological diagnosis. Using clinical examination and ultrasound one can identify the site and type of polyp and decide on further management.

Correlation of fasting and postprandial triglyceride levels and carotid artery intimal medial thickness in type 2 diabetic patients

Background: Although the prevalence of both type 1 and type 2 diabetes mellitus is increasing worldwide, the prevalence of type 2 DM is rising more rapidly, because of sedentary lifestyle, increasing obesity and increased life expectancy. Objectives: To study correlation between fasting and postprandial triglyceride levels and Carotid artery intimal medial thickness (CIMT) in Type 2 Diabetic Patients. Material and Methods: This cross sectional observation study was done in Department of General Medicine, Mysore Medical College and Research Institute, Mysore, Karnataka, India during January 2019 to June 2020. Sample size was 50 and Simple Random sampling method was used. Results: The mean carotid IMT of subjects with postprandial triglycerides < 200 with normal fasting triglyceride was 0.92±0.33. The mean carotid IMT of subjects with postprandial triglyceride 200-299 with normal fasting triglyceride was 1.52±0.57. The mean carotid IMT of subjects with postprandial triglycerides ≥300 with normal fasting triglycerides was 1.66±0.45. Conclusion: postprandial hypertriglyceridemia, despite normal fasting triglyceride levels, may be an independent risk factor for early atherosclerosis in type 2 diabetes. Hence evaluating not only for FTG but also PPTG level during clinical assessment of patients with type 2 diabetes is important.

PANC-3 score in predicting the severity of acute pancreatitis

Background: Acute pancreatitis (AP) presents as acute abdomen, Inflammatory process of pancreas associated with local and systemic complications. Many scores (such as Ranson’s, APACHE II, and Bedside index for severity in AP) that help us in predicting severity at the time of admission, but these are time consuming and require complex calculation and are not economically cheap. Our aim here is to analyze the simplified stratification system of PANC3 SCORE and its assessment in predicting severity of AP as decided by Modified Marshall Score. Aims and Objectives: PANC-3 score in predicting the severity of acute pancreatitis. Materials and Methods: PANC3 Scoring system is simple, easy to access readily available and economic, as it involves these criteria (hematocrit, body mass index, and pleural effusion). It is a prospective study in which 100 patients were evaluated with PANC3 Scoring, who were diagnosed with AP and admitted to the department of general surgery, Mysore Medical College and Research Institute. Results: The results showed that PANC3 score had a 96.25% specificity, 70% sensitivity, 82.35% positive predictive value, and 92.77% negative predictive value. Conclusion: PANC3 SCORE is cost effective, can be determined at the time of admission, thus early prediction of disease severity and early referral to higher center.

A Cross-Sectional Study to Estimate the Proportion of Early Initiation and Exclusive Breastfeeding Practices in Rural Field Practice Area, Mysore

Introduction: Breastfeeding is the healthiest and easily accessible nutrient to the infants Malnutrition is more prevalentin India and inappropriate feeding practices are the one of the reason. So the current study is conducted to estimate theprevalence of early initiation and exclusive beastfeeding practices and factors influencing on these practices.Methods: A cross sectional study was conducted among 198 mothers of children less than 24 months in the field practicearea of Mysore Medical College and Research Institute, Mysore by using simple random sampling method during March2015 to August 2015 by using pretested and semi-structured questionnaire. In our study we found that 70.2% mothersinitiated breastfeeding within 1 hour of delivery, the most common reason for delay was LSCS, 14.6% mothers practicethe prelacteal feed, 92.9% mothers fed colostrum, exclusive breastfeeding(EBF) was practiced in 105 (53%) mothers themost common reason for non-EBF was lack of knowledge 78 (47.6%). Gender, fathers education, socio-economic statusand number of antenatal visits had an influence on breastfeeding practices.Conclusion: Majority of the women not practiced EBF. The knowledge regarding proper breastfeeding practices should beemphasized on each antenatal and postnatal visits. Improved socio-economic status can improve breastfeeding practices.

A study of splanchnic vein thrombosis in cases of acute pancreatitis and its outcome in a tertiary care center

Splanchnic veins thrombosis(SVT) is one of the rare but known complications of Acute Pancreatitis(AP). It mostly involves Splenic vein(SPV), Superior mes enteric vein(SMV) and often Portal vein(PV) either individually or in combination. Though the cause is thought to be multi-factorial, a direct inflammatory process is implicated in the pathogenesis of SVT in AP. SVT can be sometimes an incidental finding in the radiological evaluation, but it also presents with severe pain, portal hypertension, hepatic dysfunction and bowel ischemia in a life-threatening scenario. Present study aims at understanding incidence, pattern, therapy initiated, complications and outcome of SVT in AP.A serial study of 89 cases of acute pancreatitis who underwent Contrast Enhanced Computed Tomography was conducted at tertiary care centre, department of general surgery, Mysore Medical College and Research Institute, Mysore, Karnataka from the period of January 2021 to June 2021. Out of 89 cases studied, 62 were male, 27 were female with mean age of 39.5 years. Most common cause of AP was Ethanol abuse, followed by Gallstones, Main pancreatic duct (MPD) anamoly, Anamoly of duodenal papillae and idiopathic. 37(41.57%) Patients had SVT. 31(83.78%) were male, 6 (16.22%) were female. 29 patients received anti-coagulation therapy, out of which 24 showed good response. Out of 8 patients who didn’t receive therapy 3 showed reduction in size of clot by 75%. Hence, anticoagulation has a therapeutic role in treatment of SVT (p- 0.0157). SVT is one of the known complications in AP with increase in incidence severity and with presence of peripancreatic collection. Spontaneous resolution of SVT is seen in about 40% of patients whereas anticoagulation therapy has a good role.

Effect of handgrip exercise on QTc interval during different phases of menstrual cycle

Menopause is a major change in a women’s life, it refers to a permanent cessation of menstruation and fertility. The fast face of modern life has induced many problems like stress, anxiety, insomnia etc. associated with serious health problems. The most common disorders associated with menstruation among younger women are dysmenorrhea, pre-menstrual syndrome, menorrhagia, metrorrhagia. Aims and Objectives: To record the effect of handgrip exercise on QTc and RR interval in different phases of menstrual cycle and to compare with the baseline ecg values. The study was conducted on 40 medical (I MBBS) students from Mysore Medical College and Research Institute, Mysore. In this study a total of 40 female students aged between 17-19 years from 1st MBBS studying at Mysore Medical Collage and Research Institute, Mysore were selected as per the inclusion and exclusion criteria. Informed consent was obtained from each student. Data about the duration of previous two menstrual cycles and the days of menstrual bleeding were noted from the subjects statement. Subject monitored basal body temperature was used to identify phases of menstrual cycle. Ovulation was indicated by a sustained increase in the basal body temperature of at least 0.3°C after LH surge.

Effect of handgrip exercise on QTc interval during different phases of menstrual cycle

Introduction: Menopause is a major change in a women’s life, it refers to a permanent cessation of menstruation and fertility. The fast face of modern life has induced many problems like stress, anxiety, insomnia etc. associated with serious health problems. The most common disorders associated with menstruation among younger women are dysmenorrhea, pre-menstrual syndrome, menorrhagia, metrorrhagia. Aims and Objectives: To record the effect of handgrip exercise on QTc and RR interval in different phases of menstrual cycle and to compare with the baseline ecg values. Materials and Methods: The study was conducted on 40 medical (I MBBS) students from Mysore Medical College and Research Institute, Mysore. In this study a total of 40 female students aged between 17-19 years from 1st MBBS studying at Mysore Medical Collage and Research Institute, Mysore were selected as per the inclusion and exclusion criteria. Informed consent was obtained from each student. Data about the duration of previous two menstrual cycles and the days of menstrual bleeding were noted from the subjects statement. Subject monitored basal body temperature was used to identify phases of menstrual cycle. Ovulation was indicated by a sustained increase in the basal body temperature of at least 0.3°C after LH surge.

Post-operative complications rates in patients undergoing emergency laparotomy in tertiary care hospital

Background: Post-operative complication may occur after explorative laparotomy whether elective or emergency. This study was aimed to evaluate the cause in which emergency laparotomy has been done, the frequency of different types of surgical complications after laparotomy in KR hospital, Mysore Medical college and Research Institute, Mysore, Karnataka. Aims and Objective: This study aims to evaluate the post-operative complications in patients undergoing emergency laparotomies at K R Hospital, Mysore Medical College and Research Institute, Mysore. Materials and Methods: This prospective observational study was carried out at the Department of General Surgery in Mysore Medical College, Mysore, Karnataka, during the period of October 2020–June 2021. All the patients who underwent emergency laparotomy were included in the study. They were followed up in the post-operative period and all the complications/sequelae developed were recorded. Results: The primary indications for an exploratory laparotomy are perforation peritonitis constituted (58.8%) cases followed by intestinal obstruction (13%), gallbladder perforation (10%), blunt and penetrating trauma abdomen (9.2%), and appendicular abscess/perforation (4.8%). In this study, most of the patients (77.2%) were between 21 and 50 years of age. Out of these, maximum cases (age) were found in the 4th decade, that is, 107 cases (42.8%). In this study local complication, surgical site infection (47.2%) was the most common complication followed by respiratory infection (30%), fever (38%), nausea and vomiting (14%), paralytic ileus (12.8%), UTI (10%), and thrombophlebitis (10.8%). Mortality was 6%. Conclusion: Post-operative complications are more common after emergency laparotomy as compared to elective laparotomies. Post-operative surgical site infection, nausea and vomiting, and fever are the most common complications which need adequate management and post-operative care.

Factors associated with treatment outcome of multidrug-resistant tuberculosis patients co-infected with human immunodeficiency virus in a Drug Resistant Tuberculosis Centre

Background: Tuberculosis is one of the major public health problem, further complicated by the relentless spread of human immunodeficiency virus (HIV). The incidence of drug resistant TB among HIV patients is now increasing. Treatment outcomes in multidrug-resistant tuberculosis (MDR-TB) patients co-infected with HIV is poorly documented. Objectives: Assessed the treatment outcome of MDR-TB co-infected with HIV treated under programmatic management of drug resistant tuberculosis. Methods: The study was conducted in Department of Respiratory Medicine, Princess Krishnajammanni Tuberculosis and Chest Diseases (PK TB & CD) Hospital, Mysore Medical College and Research Institute (MMCRI), Mysore. It is a retrospective study done on patients who were admitted in DRTB center of PK TB & CD hospital, Mysore for initiation of treatment from January 2013 to December 2019. Results: Among the 63 patients studied, 26 patients (41.3%) had a favorable outcome with cure and treatment completed. 25 patients (39.7%) had an unfavorable outcome with death, 9 patients (14.3%) defaulted during the treatment and 2 patients (3.2%) had failure of therapy. Conclusion: Early recognition and treatment of HIV with ART and the clinical stage of the disease during presentation affect the treatment outcome in patients with MDR-TB. Keywords: tuberculosis; HIV; outcome; multidrug resistance; ART

Perceived Stress and Suicidal Ideation among the Farmers: A Cross Sectional Study from the Rural Field Practice Area of a Medical College in Karnataka

Introduction: Psychological Stress and other mental health problems are highly neglected in Indian farming Community. Changing climatic, weather and environmental conditions affected the growth of crops and yield. This has resulted in various stressful conditions faced by the farmers. The psychological stress leads to tensions in the family relationship, variations in their daily life, and poor operational decisions while farming and even may lead to farm accidents, suicides among them. Objectives: To study the Stress levels perceived by the farmers and the factors determining the stress among them and to study the suicidal ideation among farmers in the previous 6 months. Method: A Community based Cross sectional study was carried out in the villages of Kalghatagi taluk, among 324 marginal & small scale farmers of age group 18-60 years, using pretested semi-structured questionnaire comprising of socio-demographic details, occupational characteristics, perceived stress and the reasons for stress. The 4 item Perceived Stress Scale was used for the assessment of Stress levels. Higher Score indicates high levels of Stress. Results: Among 324 farmers, 69.8% of the farmers were males, majority of them belonged to 50-60 years, and most of them were small scale farmers. The mean perceived score was 6.29+4.38 SD. Majority of the farmers reported crop failure (35%) and debt (37%) as the reasons for stress. The major determinants of stress among farmers were crop failure, debt and family problems. Among 324 farmers 25.3% reported suicidal ideation in the previous 6 months. The Mean stress scores were high among those with suicidal ideation (12.69±1.12 SD). Conclusion: The study shows that stress levels were high among farmers and are related to the failure of crops, inability to pay the debts and other factors. The Mental health problems of the farmers should be addressed at early stages to reduce the burden of farmers’ suicides. Primary mental health care should be made available to the rural population.

Morphometric analysis of infraorbital foramen in human dry skull of south Indian population and its clinical implications

Infraorbital foramen,an important anatomical landmark in anaesthetic and surgical interventions of the maxillary region, transmits the infra orbital vessels and nerve. Infraorbital nerve block is commonly used in regional anaesthesia for the midface and paranasal surgeries. The purpose of our study to obtain detailed knowledge of the anatomical location and variations of IOF which is imminent for successful regional anaesthesia and endoscopic surgeries of the maxillary region. The study was conducted on 50 Human skull bones of unknown gender from the Department of Anatomy, Mysore Medical College and Research Institute, Mysore. Both side of skulls were visually observed for shape, direction of the infraorbital foramen and presence of accessory infraorbital foramina. 1. Sagittal Distance between the infraorbital margin to upper margin of infraorbital foramen were measured. 2. Transverse diameter from lateral margin of pyriform aperture to medial margin of IOF were measured. 3. Oblique distance from anterior nasal spine to inferior margin of IOF, were measured. 4. Vertical and transverse diameter of the IOF were measured. 50 skulls (100 sides – both right and left) were studied.Most commonly observed shape of IOF is semilunar 36% on right side, 40% on left side, transversely oval 20% on right side, 28% on left side, vertically oval 18% on right side, 12% on left side, circular 18% on right side, 8% on left side, triangular 8% on right side 12% on left side. Direction of IOF is 88% medially downwards, 12% downwards.The mean distance between IOM and IOF is 6.58±0.28 mm on the right side, 6.78 +0.233 mm on the left side. The mean distance between pyriform aperture to of IOF 16.88+3.7mm on the right side 16.46 +2.7 on the left side. The mean distance between ANS to inferior margin IOF on the 34.77+0.55 mm on right side 34.22+0.3 mm on the left side.Mean vertical diameter of IOF 3.76 mm on right side & 3.94 mm on left side. Mean transverse diameter of IOF 4.18 mm on right side & 4.32+15 mm on left side.Accessory IOF were present in 6% of skulls bilaterally. Our study results will be of immense help to the surgeons and anaesthetists, handling this region for operative procedures.

Evaluation of Cardiometabolic Markers in Helicobacter pylori Infection: A Case-control Study

Introduction: Helicobacter pylori (H. pylori) is a gram negative bacterium that naturally colonises the gastric epithelium and causes chronic gastritis. H. pylori infection affects gastric physiology and alters the lipid metabolism pathways. Highsensitivity CRP (hs-CRP) is a useful marker for risk assessment of future cardiovascular events. Many studies have proposed a link between cardiometabolic markers like lipid profile and hs-CRP with H. pylori infection but very limited studies are available to explain the effect of H. pylori infection on these cardiometabolic markers. Aim: To analyse the cardiometabolic markers (lipid profile, and hs-CRP) in H. pylori infection. Materials and Methods: This case-control study was conducted from November 2018 to June 2019 in the Department of Biochemistry in association with the Department of Surgery, Mysore Medical College and Research Institute, Mysore, Karnataka, India, 50 cases and 50 control subjects were enrolled. Fasting Total Cholesterol (TC), Triglycerides (TG), High Density Lipoprotein Cholesterol (HDL-C), Low Density Lipoprotein Cholesterol (LDL-C), Very Low Density Lipoprotein Cholesterol (VLDL-C), hs-CRP and atherogenic Index of Plasma (AIP) were analysed. Statistical analysis was performed using Student’s t-test. Results: The gender distribution was almost same in the two groups. The mean age in the case group was 47.34±12.08 years, while that in the control group was 46.2±14.8 years. There was an increase in TC, LDL, VLDL, and TG in cases`, but it was not statistically significant. Serum HDL level was 34.59±9.79 mg/ dL, and 41.62±10.29 mg/dL for cases and controls respectively and it was statistically significant. hs-CRP level was significantly increased in the case group (5.51±4.59 mg/L) when compared to the control (2.63±2.0 mg/L). AIP was also significantly high in the cases (0.246±0.219) than the controls (0.106±0.22). Conclusion: Significant decrease in HDL and increase in hsCRP levels in cases show evidence of dyslipidaemia and atherogenic risk. hs-CRP also showed a significant correlation with AIP. Hence, these cardiometabolic markers may have a role in identifying individuals at higher risk for cardiovascular diseases in cases.

Morphological Study of Left Ventricular False Tendons in Human Cadaveric Heart Specimens

Introduction: Left Ventricular False Tendons (LVFT) is normal and common anatomical variants of the left ventricle. They may be associated with findings of cardiac pathology or they may be an isolated finding from 2D echocardiogram. These structures may mimic pathologic structures, such as intraventricular chorda rupture, vegetation or thrombus, but considered as false tendon. Aim: To study the morphology, age and gender specific proportions of false tendons in cadaveric heart specimens. Materials and Methods: A descriptive cross-sectional study was conducted in Mysore Medical College and Research Institute, Mysuru, Karnataka, India, from October 2015 to March 2017. A total of 100 human cadaveric heart specimens of both male and female (n=50) and female (n=50) aged 18-76 years were collected from Department of Anatomy and postmortem specimens from Department of Forensic Medicine. The morphology of tendons was studied regarding its location, gross appearance and parameters such as its length and width. The statistical analysis was done using Chi-square test and Analysis of Variance (ANOVA) test appropriately using the software Statistical Package for Social Service (SPSS), version 20.0 for windows. Results: False tendons were seen in 49 of heart specimens. Total 40 of the specimens showed one LVFT and nine showed two LVFT. Out of total 44 (58.67%) specimens aged 50 years or less had false tendons, while in older specimens, only 5 (20%) were found to have false tendon (p-value <0.05). The common location of false tendons was Posteromedial Papillary Muscle (PMPM) to mid interventricular septum 11 (18.9%), followed by PMPM to free wall 9 (15.5%). The tendons were fibrous in 53 (91.4%), fibromuscular in 4 (6.9%)and 1 (1.7%) was muscular in nature. Out of 50 female and 50 male heart specimens, 24 and 25 had LVFT, respectively (p-value=0.891). Conclusion: Sound knowledge of heart morphology can avoid false diagnosis in patients with false tendon, as it can simulate other pathological murmurs and structural heart disease in echocardiography.

Role of Multidetector Computed Tomography in Evaluation of Intestinal Obstruction with Surgical Correlation- A Prospective Cohort Study

Introduction: Intestinal obstruction is a common surgical emergency that is encountered in general surgery units and it contributes to substantial patient morbidity and healthcare costs. Computed Tomography (CT) has emerged as an invaluable diagnostic tool in the evaluation of bowel obstruction and helps in deciding early surgery. The CT gives information on the cause for obstruction, its location, and complications like closed loop obstruction, bowel ischaemia. Aim: 1. To evaluate the accuracy of CT in diagnosing the presence, level and cause of intestinal obstruction. 2. To detect the presence of complications and demonstrate threatening signs of bowel non-viability. 3. To relate CT findings with intraoperative findings. Materials and Methods: A prospective cohort study was done at the Department of Radiology, Mysore Medical College and Research Institute, Mysore, India from April 2021 to September 2021. A total of 40 patients, ≥18 years of age with clinical suspicion of intestinal obstruction, were subjected to Contrast- Enhanced Computed Tomography (CECT) of the abdomen. The sensitivity , specificity, positive and negative predictive values of Muti-detector Computed Tomography (MDCT) were calculated. Data analysis was carried out using Statistical Package for Social Science (SPSS) version 18.5 software. Results: Total of 40 patients were analysed (25 males and 15 females ; mean age: 50.5 years). Small bowel obstruction constituted 75% of cases and large bowel obstruction constituted 25% of the cases. Ileum was the most common site of obstruction. Adhesions were the leading cause seen. Closed loop obstruction with bowel ischaemia and gangrene were observed in five patients (12.5%). Comparison of CT and per-operative findings showed that CT has a high sensitivity, specificity, accuracy of 97.44%, 100%, 97.50%; 92.31%, 100%, 92.50% and 100%, 94.12%, 95%, respectively for determining the level, cause and complications of obstruction. Conclusion: The MDCT has high diagnostic accuracy in diagnosing the level, cause and complications of intestinal obstruction with the highest of 97.50% for identifying the cause of obstruction. CT is 100% sensitive in picking up complications like bowel ischemia. Thus, MDCT were in concordance with intra operative findings for the diagnosis of intestinal obstruction and can guide surgeons in the management of these patients.

Comparison between Dexamethasone Alone and its Combination with 5-Hydroxytryptamine Receptor Antagonist for Antiemesis during Laparoscopic Surgeries: A Double-blind Randomised Clinical Study

Introduction: Post operative nausea and vomiting (PONV) are often associated with the laparoscopic surgeries under general anesthesia (GA). The PONV guidelines recommended the use of 5-hydroxytryptamine receptor antagonist (5-HT3RA) as the first-line prophylactic agents in patients categorised as high-risk for emesis perioperatively. There are very few studies comparing the efficacies of combinations of newer 5HT3 RA with dexamethasone. Aim: To compare the severity of emetic episodes as well as the complete response rate to antiemetics like dexamethasone or its combination with palonosetron or ramosetron during the first 48 hours after laparoscopic surgeries. Materials and Methods: This randomised clinical double-blind study Department of Anesthesiology at Mysore Medical College and Research Institute, Mysuru, Karnataka, India, from November 2014 to August 2016 among 90 patients, aged between 18 to 60 years belonging to the American Society of Anesthesiology (ASA) grade I and II scheduled for elective laparoscopic surgery under general anesthesia. They were randomly allocated into three equal groups. Group D received dexamethasone 8 mg, group RD received ramosetron 0.3 mg with dexamethasone 8 mg, and group PD received palonosetron 0.075 mg with dexamethasone 8 mg. Postoperative Nausea and Vomiting (PONV), retching were recorded via direct questioning or by the spontaneous complaints from the patients at 2, 6, 24, 48 hours. A scoring system was used to assess PONV. Complete response rate was also noted i.e, percentage of patients in a group with absence of nausea, retching, vomiting and no requirement of rescue antiemetic medications within postoperative 48 hours. Results: The baseline characteristics were similar in all three groups. Early and late PONV were significantly lesser with group-PD compared to group D (p-value=0.01) and group RD (p-value=0.007). The complete response rate in group PD (86.6%) was significantly highest compared to group D (40%) and group RD (76%). Rescue anlgesics required was nil in group PD compared to group D (36.3%), and group RD (10%) over 48 hours. Conclusion: Combination of palonosetron with dexamethasone is a better alternative to combination of ramosetron with dexamethasone in preventing PONV.

Comparing Clonidine and Fentanyl as Adjuvants to Intrathecal Hyperbaric Ropivacaine in Elective Infraumbilical Surgeries- A Randomised Clinical Study

Introduction: Ropivacaine is popular as a safe intrathecal anaesthetic drug due to its higher safety profile over bupivacaine. Intrathecal additives are known to increase the quality of anaesthesia and analgesic duration. Aim: To compare the effects of clonidine and fentanyl as intrathecal adjuvants to hyperbaric ropivacaine in elective infraumbilical surgeries. Materials and Methods: This randomized, double-blinded, clinical study was undertaken at Krishnarajendra hospital and Cheluvamba hospital, attached to Mysore Medical College and Research Institute, Mysuru, Karnataka, India, from January 2018 to June 2018. Total 60 adult patients aged between 18-60 years of age, American Society of Anesthesiologists (ASA) I and II status, and posted for infraumbilical surgeries, were randomized to two groups of 30 patients each i.e., group C patients receiving 2.5 mL of hyperbaric 0.42% ropivacaine and clonidine 15 mcg, and group F patients receiving 2.5 mL of hyperbaric 0.42% ropivacaine and fentanyl 25 mcg. The onset, extent and duration of sensory and motor blockade, heart rate, mean arterial pressure, prolongation of analgesia in the post operative period, and any complications were observed. Statistical analysis was done using student’s t-test, and Chi-square test to test significance of variables. The p-value <0.05 was taken as statistically significant. Results: Demographic characteristics were comparable in both the groups. The onset of sensory blockade and the maximum height of sensory blockade attained were similar in both groups i.e., group C-2.12±0.22 min vs group F-2.24±0.66 min, group C-4.94±0.91 min vs group F-5.12±1.38 min, respectively. The duration of sensory blockade was prolonged in group C (148.5±10.84 min vs 109.37±14.5 min), resulting in delayed demand for analgesic after surgery in this group. The onset of motor block and the complete motor blockade was prolonged in group C patients (3.22±1.01 min vs 1.16±0.3 min, 6.8±1.49 min vs 3.72±1.31min). The recovery from motor blockade was also significantly delayed in Group C (125.17±13.29 min vs 95.47±13.08 min). The incidence of hypotension was similar in both the groups. Conclusion: Clonidine, and fentanyl both provide early and adequate spinal anaesthesia, but the former (clonidine 15 mcg), prolongs the duration of spinal anaesthesia with Ropivacaine 0.42% hyperbaric solution, and significantly increases the time for the demand for analgesia in the recovery period, compared to fentanyl