Rural Hospital In Central India Research Articles

Analytical observational study of salmonella PCR and its comparison with routine laboratory parameters in cases of enteric fever in tertiary care hospital in central India

Background Enteric fever, predominantly caused by Salmonella enterica serotype Typhi, remains a significant global health concern, particularly in resource-limited settings. The diagnostic landscape for enteric fever relies on traditional methods such as the Widal test and blood culture, each with inherent limitations regarding sensitivity and turnaround time. Methods The study will employ an Analytical Observational Study design conducted at Acharya Vinoba Bhave Rural Hospital in central India over a two-year period. Participants will include adults above 18 years admitted to the ward or Intensive Care Unit (ICU) with acute febrile illnesses. Inclusion criteria encompass a wide age range, ensuring a diverse study population. Peripheral blood samples will be collected for Salmonella PCR, Widal testing, and blood culture. Dot-PCR for Typhi will be employed, and DNA extraction will follow strict protocols. Data will be systematically recorded, and statistical analyses, including sensitivity, specificity, and comparative assessments, will be conducted to evaluate diagnostic performance. Expected Outcome It is anticipated that Salmonella PCR will exhibit superior sensitivity and specificity compared to traditional diagnostic methods, offering a more rapid and accurate identification of enteric fever cases. The study aims to contribute valuable evidence supporting the incorporation of Salmonella PCR into routine diagnostic algorithms, potentially revolutionizing the approach to enteric fever diagnosis. Moreover, insights gained from the study are expected to inform clinical practices, enhance patient management, and potentially reduce the economic burden associated with misdiagnosis or delayed diagnosis of enteric fever. The outcomes of this research are poised to impact public health strategies, providing a foundation for more effective and efficient diagnostic protocols in the context of enteric fever.

MRI evaluation of trigeminal neuralgia patients in a rural hospital of central India

Background Trigeminal neuralgia is characterized by repetitive paroxysmal electric shock-like pain in the trigeminal nerve distribution. The most common cause implicated in this condition is neurovascular conflict, primarily by the superior cerebellar artery in the prepontine cistern. Other common causes include cerebellopontine angle tumours and aneurysms at the brainstem level. Magnetic resonance imaging (MRI) is the imaging modality of choice in evaluating trigeminal neuralgia, with 3D-FIESTA (Fast Imaging employing steady-state acquisition) being the mainstay for assessing neurovascular conflict. This study’s objective is to assess the role of MRI in evaluating trigeminal neuralgia and to study the spectrum of MRI findings associated with various causes. Methods The study type is a cross-sectional observational prospective study conducted at Acharya Vinoba Bhave Rural Hospital, Sawangi, on 41 patients coming to the Radiology department with clinical suspicion of trigeminal neuralgia. Descriptive statistics will summarize participants’ imaging characteristics. At the same time, comparison tests will be employed to assess the association between imaging features and diagnosis of MRI with the distribution of patient symptoms, laterality, aetiology, artery, and branch of trigeminal nerve involved. Considering ethical concerns, participants’ privacy will be protected, and all data will be handled with the utmost confidentiality.

Experience of Percutaneous Closure of Ventricular Septal Defects in 140 Patients With Different Duct Occluders in a Tertiary Care Rural Hospital in Central India.

Background Ventricular septal defects (VSDs) are the most common type of septal defects in early infants and are very complicated. This has paved the way for the development of new minimally invasive procedures for interventional cardiologists. This study presents our experience using duct occluders instead of conventional ventricular septal devices in the Department of Cardiology at Acharya Vinoba Bhave Rural Hospital (AVBRH) in central rural India. This study aimed to reviewsuccess and complications and assess safety and its relation to age, sex, size of the VSDs, type of VSD, and types of devices used after transcatheter closure of perimembranous and muscular VSDs using various types of duct occluders. Methodology This retrospective study included patients who underwent percutaneous VSD device closure at the AVBRH between July 2017 and December 2020. We reviewed the patients' medical records to recognize imaging, clinical, and interventional data pre- and post-procedure and at the last follow-up. Results The success rate of VSD closure was 98.6%, one (0.7%) out of 81 females developed a complication due to device dislodgement, and one male aged six years (0.7%) out of 59 developed a post-procedural complication; hence, the total failure rate was 1.4%. The perimembranous type had no complication, and the muscular type had two (14.3%) unsuccessful procedures. Conclusion This study has concluded an impressive percentage of VSD closure, showing no mortality and low morbidity, using a percutaneous approach with different duct occluders. As the type of device used is not correlated with device failure and failure rate, duct occluders will be financially helpful in the closure ofVSD in indicated patients.

Study of Polycystic Ovarian Syndrome in Infertile Women in a Rural Hospital in Central India, Prospective Design

Study of Polycystic Ovarian Syndrome in Infertile Women in a Rural Hospital in Central India, Prospective Design

Vestibular, Central, and Non-Vestibular Etiologies of Vertigo and Disequilibrium: A Rural Hospital-Based Cross-Sectional Comparative Analysis.

Vertigo/dizziness is defined as disturbed postural awareness and could range from a feeling of sensation of spinning of self or surrounding. Dizziness or disturbed postural awareness is a common presentation in varying age groups. Vertigo has varied clinical presentations. Classically, there are four vertigo syndromes: vertigo, imbalance/disequilibrium, presyncope/lightheadedness, and psychogenic dizziness. The present study was conducted to examine the various etiologies involved in these syndromes and to help unmask the overlaps between them. This study also aimed to further classify the etiologies underlying these vertigo syndromes and overlaps into peripheral or vestibular, central, and non-vestibular. This would help develop a comprehensive management protocol for vertigo of any origin. A prospective observational cross-sectional study was undertaken in a rural hospital in Central India. We studied patients with giddiness and categorized them into vertigo syndromes according to the site of origin of vertigo. We also compared overlaps in the presentation of vertigo. Out of the 80 patients that were studied, vertigo with disequilibrium was observed in 72.50% of the patients. Non-vestibular vertigo of cervicogenic origin was the common cause of vertigo seen in 36.25% of the patients occurring alone or in association with vestibular vertigo. Among patients with overlaps, vestibular vertigo with non-vestibular vertigo was the most common etiology observed in 89.65% of the patients with overlaps. The syndrome of "vertigo with disequilibrium" was the commonest presentation in the patients studied, followed by "vertigo syndrome" as an isolated symptom, not associated with "disequilibrium."Ours is probably the first study to report this observation of overlaps of two syndromes, with diagnostic implications.

Clinical Study and Profile of Ocular Trauma: Findings From a Rural Hospital in Central India.

ObjectiveIn this study, we aimed to examine the presence of visual damage due to ocular trauma and assess visual outcomes, and document the clinical spectrum and outcomes following ocular injuries among patients presenting to a tertiary care hospital in rural central India.MethodsThis was a hospital-based prospective interventional study conducted over a period of two years from August 2019 to August 2021. Patients with ocular injuries attending the casualty and the Ophthalmology department were included in the study after applying the inclusion and exclusion criteria. A detailed and comprehensive ophthalmic examination was performed and visual acuity was noted at the presentation and follow-ups. The patients were followed up at regular intervals, initially at one week and subsequently at three and six weeks.ResultsThe incidence of ocular trauma was highest in the age group of 31-40 years. There were only three patients aged more than 60 years; 15 were in the pediatric age group (1-20 years). The ocular trauma was highest in males (88.33%) than in females (11.67%). The majority of the patients were from rural areas (70%) and 30% were from urban areas. In this study, both eyes were equally involved. The right eye was involved in 45% of patients and the left eye was involved in 55%. Of note, 80% of the patients presented with closed globe injury, and 20% presented with open globe injury. On classifying the open and closed globe injuries into their subtypes, it was observed that the majority of the patients had lid laceration (n=43, 71.67%), followed by corneal penetration in 12 patients (20%), corneal abrasion in three patients (5%), and lid abrasion in two patients (3.33%). While 34 patients presented to the hospital with a history of road traffic accidents (56.67%), accidental trauma (by a wooden stick, hook of a blouse, bangle, etc.) was noted in 17 patients (28.33%), trauma by soil particle and hand pump in five patients (8.33%), and electrical trauma caused by the blast of capacitor in one patient (1.67%). One patient (1.67%) had sustained trauma from a piece of wood while working on the farm and two patients (3.33%) had a trauma because of assault. Thirty-four patients (66.67%) had a history of falls from bikes, and the next most common object causing trauma was a wooden piece/stick (four patients, 6.67%), followed by trauma caused by an iron particle in four patients (6.67%), trauma by stone in three patients (5%), and trauma by hand pump in two patients (3.33%).ConclusionRoad traffic accidents were the most common cause of ocular trauma in patients attending this rural hospital in central India. The ocular structures involved and types of ocular trauma play a significant role in determining the visual outcomes in these patients.

Role of Salivary Uric Acid Versus Serum Uric Acid in Predicting Maternal Complications of Pre-Eclampsia in a Rural Hospital in Central India: A Two-Year, Cross-Sectional Study.

BackgroundHypertensive disorders during pregnancy are an important topic of concern, specifically in rural and remote areas of India where there is a lack of awareness and it is difficult to maintain proper follow-up of pregnant females to screen them for complications developed during pregnancy. Gestational hypertension and pre-eclampsia result in the abruption of the placenta, hemolysis, elevated liver enzymes, low platelet count syndrome, eclampsia, and disseminated intravascular coagulation, which can be a serious threat to the health of the mother and the fetus. Therefore, it is important to identify biomarkers for diagnosing and predicting the complications of pre-eclampsia that may aid the obstetric high-dependency units based in rural areas to tackle this important health hazard during pregnancy.MethodologyA total of 180 singleton pregnant women of more than 34 weeks of gestational age were enrolled in this study. All women were divided into three groups (control group, severe pre-eclampsia, and non-severe pre-eclampsia) based on the severity of blood pressure and the presence of proteinuria (≥+1 by the dipstick method). Salivary and serum uric acid levels were measured through morning samples, and all patients were monitored for the development of complications and outcomes. Salivary uric acid and serum uric acid levels were correlated with each other and with maternal complications of pre-eclampsia.ResultsMean salivary uric acid (mg/dL) in severe pre-eclampsia was (6.72 ± 0.49) significantly higher compared to non-severe pre-eclampsia (4.75 ± 0.94) and control (3.13 ± 0.43). Mean serum uric acid (mg/dL) in severe pre-eclampsia was (8.13 ± 0.87) significantly higher compared to non-severe pre-eclampsia (6.23 ± 0.76) and control (3.85 ± 0.46).The lowest best cut-off value of maternal salivary uric acid was 5.06 mg/dL, above which one can predict maternal complications with a diagnostic accuracy of 78.33%.ConclusionsSalivary uric acid and serum uric acid levels are significantly raised in cases of pre-eclampsia in comparison to normal pregnancy. Salivary uric acid and serum uric acid are correlated significantly indicating that salivary uric acid can function as a cost-effective, novel marker to provide an idea about serum uric acid levels. The prognostic accuracy of salivary uric acid was good in predicting maternal complications among cases of pre-eclampsia (severe and non-servere) and early-onset maternal complications. Therefore, it may be utilized as a helpful marker to identify high-risk patients.

Role of Zinc and Clinicopathological Factors for COVID-19-Associated Mucormycosis (CAM) in a Rural Hospital of Central India: A Case-Control Study.

IntroductionCoronavirus disease 2019 (COVID-19)has been a difficult enemy to beat for healthcare professionals around the world. However, even before the end of the COVID-19 pandemic, there has been an emergence of a new combatant in the form of opportunistic fungal infections with a high rate of morbidity and mortality, creating havoc throughout the globe.MethodsA case-control single-center study was conducted in Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra. All the subjects who were included in the study were tested positive for COVID-19 through the reverse transcriptase-polymerase chain reaction (RT-PCR) method and the cases were defined as patients with biopsy-proven mucormycosis, whereas control were subjects who did not develop mucormycosis. The duration of the study was three months, from June 2021 to August 2021.ResultA total of 55 cases and 50 controls were enrolled in the study. The use of zinc was found to be significantly associated with COVID-19-associated mucormycosis, with 89.1% of the cases having a history of zinc intake and only 52% of controls having a history of zinc intake( p-value <0.001). Diabetes mellitus was found to be significantly associated with COVID-19-associated mucormycosis with 83.6% of the cases and 16% of the controls having diabetes mellitus (p-value <0.001). Although the use of steroids in cases was more with 98.2% of the cases and 54% of the control receiving steroids; this difference was not significant statistically (p-value of 1.00).ConclusionWe conclude that apart from diabetes mellitus and other immunosuppressive states, zinc might be the hidden culprit behind the sudden surge of COVID-19-associated mucormycosis worldwide owing to the self-administration of zinc by the patients to acquire innate immunity and over-prescription of multivitamins by the treating clinicians. However, this association required further studies in order to be proved.

Prof M. Murugappan Poster Award

Background:Adverse childhood experiences (ACEs) like physical and emotional abuse or neglect are known to influence personality development and contribute to various psychopathologies, including depression.This study provides data on the presence of ACEs among patients of clinical depression with residual symptoms. Although this relationship has been studied worldwide, it has not been sufficiently explored among the Indian rural population.Objectives:The primary objective was to correlate the types of early life stressors with residual depressive symptoms.Method:Data was collected in the psychiatry OPD of a rural hospital in central India. 152 patients of depression on treatment were included. Adverse Childhood Experiences – International Questionnaire, the Hamilton Depression Rating Scale, and the Presumptive Stressful Life Event Scale were applied. According to the HAM-D scores, 64 participants were in clinical remission and 88 showed mild symptoms.Results:Among the participants, 52% were female, mean age was 38±14.71 years and 67.8% were married. An average of 3.78±2.2ACEs were endured by the participants. Significant correlations were seen between residual depressive symptoms and emotional abuse (OR=1.01, 95% CL=0.49-2.07), physical neglect (OR=1.17,95% CL=0.59-2.3) and substance abuse among household members (OR=1.21,95% CL=0.47-3.12) but the strongest association was shown with mothers being treated violently (OR=2.24,95% CL=1.08-4.67). Of the total sample population, 54% perceived themselves to be withstanding severe stress in the current day-to-day life.Discussion:Emotional abuse and physical neglect suffered in childhood are common findings among psychiatric patients, including those of depression. Similar results have been reflected in this study. Witnessing violence at home has shown great influence on this sample. Majority of study populations report experiencing at least one early life stressor. These circumstances influence their mental health in later life.Conclusion:This data strengthens the need to recognise and address these issues at the root. Evaluating ACEs in all individuals could help identify and treat patients sooner, hence reducing the overall burden of the disorder.

A Study of Clinical Profile and Outcome of Status Epilepticus in Children Aged 1 Month to 18 Years

Background: A common neurological emergency in children is Status epilepticus which, if not treated immediately, may trigger marked neuro morbidity and mortality and hence will need immediate and aggressive management. The neurological outcome worsens in a child as the time taken to control seizures increases and it becomes harder to terminate the seizures. This attempts to explain clinical profile and development of children with convulsive status epilepticus coming to rural hospital in central India and assess the effect of drugs used for treatment of status epilepticus.&#x0D; Methodology: This Prospective Cross-sectional Study will be conducted in the paediatric intensive care unit Department of Paediatrics, PICU, AVBRH, Wardha. Parameters like clinical presentations, clinical signs, duration and types of status epilepticus, investigations used to diagnose status epilepticus, drugs (anti-epileptic drugs), immediate outcome, effect of drugs used to control seizures will be recorded. Data will be analysed using Chi- square test and independent t-test as applicable. Univariate analysis will be used for testing the influence of different variables in the outcome of present study.&#x0D; Expected Results: Many factors like age, type and time period of status epilepticus, cause, treatment and corresponding comorbidities determine the end result in status epilepticus. From this study, we expect to get significant evidences to explain profile of cases of convulsive status epilepticus.&#x0D; Conclusion: Outcomes of status epilepticus are determined by factors like age, time period, cause, treatment and associated comorbidities.

Management of Bartholin Gland Adenocarcinoma in a Rural Hospital in Central India

Management of Bartholin Gland Adenocarcinoma in a Rural Hospital in Central India

Pattern of colorectal cancers at tertiary rural hospital in Central India

Background: In India the incidence of colorectal cancers is moderate to low but the five year survival of colorectal cancers in India is one of the lowest in the world. The poor survival rate warrants the assessment of reasons. Population based data is available only from few regions in India. Hospital based data may give a crude idea regarding the cancer distribution in the respective areas.Methods: The present study was carried out at a tertiary rural hospital in central India. A total of 216 cases of primary malignant tumors of colon and rectum presenting over a period of 10 year interval from 1994 to 2004 were analyzed for demographic and clinical presentation.ResultsThe peak incidence of cancer of colon and rectum was in 7th and 6th decade respectively. The M: F ratio was found to be 1.6: 1 for colorectal cancers combined. The mean age of presentation was 50.6 years. 25% patients with colorectal cancers were below age of 40 years. 48.3% patients with cancer of colon and 79.5% with cancer of rectum had locoregional disease, while 38.2% and 15.7% had distant spread respectively.Conclusions: Rectal cancer was found to be much commoner than colonic cancer supporting the case of independent etiologies. The incidence of colorectal cancer in young patients was high. Disease confined to the primary organ when the patient is first treated was very low.

Schizophrenia with Co-morbid Obsessive-Compulsive Disorder: A Case Series

The frequency of co-morbidities like Obsessive Compulsive Disorder (OCD) is common in schizophrenia. Some studies have reported earlier age of onset, more positive and negative symptoms, more depressive symptoms, and worse prognosis in such patients. The phenomenology and management of OCD in schizophrenia is understudied. Evidence claims that the course of illness of both schizophrenia and bipolar disorders may be affected by obsessive-compulsive disorder whereas in other cases antipsychotic induced obsessive-compulsive symptoms have been observed. A meta-analysis of of schizophrenia and its co-morbid psychiatric conditions, found a prevalence of 12.1% for obsessive compulsive disorder, 9.8% for panic disorders, 12.4% for post-traumatic stress disorder and 14.9% for social phobia. SGAs like amisulpride and aripiprazole are found to be useful in the treatment of comorbid OCD in schizophrenia due to their negligible serotonergic properties. A combination of selective serotonin reuptake inhibitors (SSRI) with antipsychotics has been recommended by the American Psychiatric Association (APA) for treatment of comorbid OCD in schizophrenia. Escitalopram at a dose of 20 mg/day has been found to be beneficial in such cases while psychosis worsened with the use of fluvoxamine and clomipramine. Below is a series of seven cases of schizophrenia with co-morbid obsessive-compulsive symptoms who are on treatment for their illness from the psychiatric outpatient department of a rural hospital in central India.

Pharmacovigilance Study of Anticancer Drugs in a Tertiary Care Rural Hospital in Central India

The present study has been undertaken to evaluate the pattern of adverse drug reactions (ADRs) of intravenous anticancer (i.v.) drugs with their causality and severity in a tertiary health care set up. The study was an observational cross-sectional survey over a period of 18 months. The indoor patients who were diagnosed to have cancer and receiving i.v. anticancer drugs were included in the study. The details of the patients and ADRs were recorded at the time of visit or within one-month of occurrence of ADRs using case record form and ADR reporting form. A total of 374 patients on cancer chemotherapy were included in the study and ADR was seen in 293(78.34%) patients. Out of total 812 number of ADRs, most ADRs (51.60%) were G.I. system related, followed by skin and appendages related ADRs (23.88%). The association of females in developing haematological ADRs is statistically significant (p&lt;0.05). Most common (19.80%) cause of ADRs was the use of combination of Cisplatin, Paclitaxel and 5 Fluorouracil. Most (90.02%) of the ADRs were categorized as ‘possible’ and the remaining (9.98%) as ‘probable/likely’. The maximum number of the ADRs were classified as ‘mild’(87.68%) followed by moderate (11.45%) and severe (0.86%). The mild reactions were more common as compare to moderate &amp; severe category in G.I &amp; haematology related ADRs (p&lt;0.05).

MRI Evaluation of Seizures in Pediatric Age Group Patients in a Rural Hospital of Central India

Background: Seizures are a common presenting complaint in pediatric patients. There are many underlying causes which may present as seizures in pediatric population, for example: febrile seizures, hypoxic ischemic encephalopathy, congenital malformations, certain neoplasms etc. Magnetic resonance imaging(MRI) plays a fundamental role in evaluation of these causes and is especially of use in identifying the structural lesions presenting as seizures.&#x0D; Objectives: To assess the role of MRI(1.5 Tesla) in evaluation pediatric seizures and to study spectrum of MRI findings associated with various causes.&#x0D; Methodology: A prospective study will be conducted at “Acharya Vinoba Bhave Rural Hospital, Sawangi”, involving 138 pediatric patients coming to Radiology department.&#x0D; Results: After statistical analysis, we expect to find effectiveness of MRI in evaluation of pediatric seizures.&#x0D; Conclusion: In this study we expect to find usefulness of MRI as a diagnostic tool in assessment of pediatric seizures especially in those with structural lesions.

Study of serum nitric oxide (no) in type 2 diabetes mellitus patients having normoalbuminuria and microalbuminuria in Central India

Introduction: Nitric oxide (NO) is known as a mediator in a broad cluster of biological systems. NO is the endothelium-derived relaxing factor, which causes vasodilation by relaxing vascular smooth muscle. This role of NO plays an important role of diabetic nephropathy in Type 2 Diabetes Mellitus (DM) Aims: To assess serum nitric oxide levels among type 2 diabetes mellitus patients having normoalbuminuria and microalbuminuria. Setting and Design: This cross sectional study was carried out at Department of Biochemistry in a tertiary care rural hospital in Central India with 200 diagnosed patients of type 2 diabetes mellitus. Materials and Methods: 24 hr urine albumin was done in all the patients. Based on the concentration of albumin in urine, patients were categorised in two groups, group 1 had normoalbuminuria (i.e. Urine Albumin 20 to

Impact of COVID 19 Pandemic on Tuerculosis

Covid19 or SARS COV 2 is the most dreaded pandemic of the century, causing widespread mortality and morbidity. On the other hand, tuberculosis is an age-old disease killing billions around the globe every year. Both the diseases have caused a significant loss of human lives along with socio-economic constraints. While SARS Cov 2 is a very new disease, tuberculosis is known to humanity for thousands of years. Tuberculosis is an airborne infection while Covid spreads via droplet spread and through fomite as well. Tuberculosis and complications related to it may lead to increased mortality due to poor lung compliance. Moreover, Tuberculosis control programmed may get affected due to the ongoing pandemic. To decrease the adverse outcome of Covid19 on Tb strict measures like proper social distancing, hand hygiene, compliance to Anti Tubercular drugs, domiciliary Tb care and strengthening immune system may prove important. Measures like the use of masks, proper cough hygiene and repeated washing of hands may play a role in decreasing the spread of tuberculosis as well and might also play a role in the elimination of tuberculosis. The article also highlights the measures taken in a rural hospital in central India for the management of COVID 19 and Tuberculosis and the possible difficulties faced in the management of tuberculosis during the Covid pandemic.

Depression, Anxiety and Stress among the general population in the time of COVID-19 lockdown: A cross-sectional study protocol

The incidence of Depression, Anxiety and stress among the general population is steadily increasing due to outbreak of COVID-19 across the globe. Beyond the risks of COVID-19, concerns have been expressed to have mental effect on the general population due to COVID-19 lock down. The emotional impact is more among individuals with pre-existing medical diseases like hypertension, Coronary Artery Disease, Diabetes (DM) and psychiatric illness. The lockdown results in health anxiety, this can manifest as maladaptive behaviours (repeated medical consultations, avoiding health care even if genuinely ill, hoarding particular items); at a broader societal level, it can lead to mistrust of public authorities and scapegoating of particular populations or groups. There are very few data from India studying mental impact of lockdown due to COVID 19 among general population. In our study, we will assess DAS among rural population who are accompanying the Non-COVID 19 patients at a tertiary care rural hospital of central India in the era of lock down.

Transvaginal laparoscopic appendectomy using innovative submucosal tunnels: a conducive modification for improving hybrid NOTES access and its critical appraisal.

Currently, transvaginal natural orifice transluminal endoscopic surgery (NOTES), the most minimally invasive option for laparoscopic surgery, suffers various technological restraints limiting its implementation. We discuss a simple modification for vaginal access to improve the existing hybrid NOTES technique. We retrospectively studied 18 women at our rural hospital in central India, who, under defined criteria, underwent transvaginal appendicectomy using innovative strategically designed submucosal tunnels. The procedure was successfully completed in all but the first three cases. None required additional abdominal trocar or analgesia beyond the first 6 h. The mean operative and hospitalisation times were 27.5 min and 18.5 h, respectively. We had no intraoperative complications and only one patient experienced postoperative self-limiting vaginal spotting. All patients were very pleased with the cosmetic results and sexual life as assessed by locally devised scales. On regular follow-up, all were progressing well. We recommend the method presented, as it is not only feasible and safe but has the potential to improve overall results. Clearly, a larger volume randomised trial would be optimal to confirm our conclusion.

Evaluation of the evan's and bicaudate index for rural population in central india using computed tomography

Introduction:Evans index (EI) and Bicaudate index (BCI) are practical markers of ventricular volume and are helpful radiological markers in the diagnosis of normal pressure hydrocephalus. Worldwide, variation exists in normative studies for both these indices. Most of the studies conducted for EI and BCI are based on the Western population data. No study has been performed on the rural population of Central India. The purpose of this study is to develop normative data on EI and BCI that can be extrapolated for future reference.Materials and Methods:This was a retrospective study conducted from December 2018 to May 2019 in MGIMS Hospital, Sevagram, Maharashtra, India, which is a rural hospital in Central India. All patients with either a head injury or neurological complaints although with normal computed tomography (CT) brain were included in the study. Patients with diagnosed neurological disorder, clinical features suggesting hydrocephalus, or intracranial pathology on CT brain were excluded from the study. Five hundred and eleven patients were selected for this study, and EI and BCI was calculated for them.Results:The mean value of EI and BCI in our study was 0.2707 and 0.1121, respectively. Both indices showed a statistically significant difference between males and females. The value of both indices increased with age.Conclusion:Although our study is in agreement with the cutoff value of EI to diagnose dilated lateral ventricles as 0.3 for age <70 years, cutoff value of EI for the older population should be reconsidered to 0.34.