Shyam Shah Medical College Research Articles

Pattern of Medical Comorbidities among Patients of Postpartum Psychosis at a Tertiary Care Center of Central India

Abstract Background and Aim: The reproductive age group is vulnerable to various preexisting psychiatric disorders as well as newly diagnosed illnesses. The stress associated during pregnancy increases the likelihood of developing psychiatric comorbidities even more. Of importance are postpartum blues, depression, and psychosis. The presence of various medical comorbidities may be a contributing factor for the development of psychiatric illnesses. This study was done to find the pattern of medical comorbidities among patients of postpartum psychosis. Materials and Methods: The study was carried out at the Department of Psychiatry and Department of Obstetrics and Gynecology, Shyam Shah Medical College, Rewa (Madhya Pradesh). Total duration of the study was 1 year, all patients diagnosed with postpartum psychosis (n = 88) were segregated using simple random sampling and every 2nd patient was included in the study (n = 44). Further, necessary assessments were carried out and patients were discharged postrecovery. Results: In the present study, 59.09% of patients (26) belonged to the age group 25–35 years, 81.81% of patients (36) were from lower socioeconomic status, housewives 79.54% (35), and 36.36% (16) were middle school educated. About 63.63% of patients (28) females were nulliparous. About 59.09% of patients (26) were delivered through cesarean section. The most prevalent medical comorbidity was postpartum infection which was present in 50% of the patients (22), followed by hypothyroidism in 43.18% of patients (19). Conclusion: Various medical comorbidities may precipitate, maintain, or aggravate underlying postpartum psychosis which may alter their course progression and outcome.

Unveiling transfusions: Analyzing blood product utilization patterns in a leading tertiary care center in Madhya Pradesh, India

Background: Blood transfusions play a pivotal role in medical care, saving millions of lives annually. The timely provision of safe blood is critical in various clinical scenarios, necessitating a careful balance between supply and demand. Despite advanced blood banking facilities globally, challenges persist in ensuring appropriate blood component utilization, prompting a need for clinical audits and optimization strategies. Aims and Objectives: This study aims to analyze the patterns of blood product utilization in a tertiary care hospital in Madhya Pradesh over 1 year, focusing on transfusion requests, cross-match-to-transfusion (C/T) ratios, transfusion indices (TIs), and indications for transfusions. Materials and Methods: A retrospective study was conducted at Shyam Shah Medical College from January 01, 2023, to December 31, 2023. Data from transfusion and cross-match requests in various departments were collected. C/T ratios, TI, and non-usage probability were computed to assess blood utilization efficiency. Results: Out of 16,682 cross-matched units, 71.93% were transfused. The overall C/T ratio was 1.39. The department of medicine demonstrated the most efficient blood usage with a C/T ratio of 1.16. Obstetrics and gynecology had the highest TI (1.06), while surgery had the lowest (0.71). Indications for transfusion included anemia (29.9%), pre-operative (17.2%), intraoperative (21.8%), and post-operative (31.1%). Conclusion: This study provides valuable insights into blood utilization patterns, offering a foundation for refining transfusion practices and enhancing the efficiency of blood management in the studied tertiary care hospital.

Sociodemographic Profile of Animal Bite Cases Attending at a Tertiary Care Center, Rewa (M.P.)

Abstract Objective: The study’s objectives were to learn about the sociodemographic profile of animal bite cases in Madhya Pradesh’s Vindhya region while attending the Medicine Outpatient Department (OPD) at Shyam Shah Medical College in Rewa (M. P.). Materials and Methods: Between January 1, 2018, and December 31, 2018, this study was conducted in the Medicine OPD, Department of Medicine, at Shyam Shah Medical College in Rewa, Madhya Pradesh, India. A cross-sectional study was conducted. A total of 1440 cases of animal bites were included in the sample, and for each patient, a sociodemographic profile was obtained along with a comprehensive history of the animal’s category and type, bite type and site, duration of exposure, and category of exposure. Results: The majority of the 1440 animal bite cases were bitten by dogs 1198 (76.94%). There are 763 (52.98%) Category II bites, 605 (42.01%) Category III bites, and 72 (5%) Category I bite. Lower limbs were bitten 914 (63.47%), upper limbs 389 (27.01%), head and neck 67 (4.65%), and trunk 70 (4.86%). Conclusion: This study found that rural areas have a high number of dog bite cases, and adult males have a higher incidence of animal bites than adult females. The most common biting animal is the dog, and the most common site of bite in adults is the lower limbs.

Serum Amylase as a Prognostic Factor in Diabetic Ketoacidosis

Abstract Objective: The study’s objectives were to learn about the impact of serum amylase levels on morbidity and mortality of diabetic ketoacidosis (DKA) patients. Methodology: This is a single-center cross-sectional study of 100 patients admitted to the Medicine Intensive Care Unit at Shyam Shah Medical College and SGM Hospital Rewa between January 2021 and June 2022. Results: Mean duration of hospital stay in DKA patients with serum amylase level <140 U/L was 10.56± 5.04 days while DKA patients with serum amylase level ≥140 U/L was 23.75 + 1.66 Days. The mean amylase level in death cases of DKA was 198.32 IU/L and in recovered cases of DKA was 87.22 IU/L. Conclusion: In our study, we discovered that as serum amylase levels rise so does the length of hospital stay. Amylase levels were extremely high in death cases.

DENTAL IMPLANTS AS AN OPTION FOR MISSING TOOTH/TEETH REPLACEMENT: A STUDY ON PATIENT AWARENESS AND SOURCES OF INFORMATION

Objectives: This study was designed with an aim to assess the level of awareness regarding dental implant as a treatment modality for the replacement of missing teeth in the patients reporting to dental outpatient department and to determine their sources of information regarding implants. Methods: This was a questionnaire-based study to assess the awareness about dental implants and the related sources of information in 350 patients who reported to Department of Dentistry, Shyam Shah Medical College Rewa, Madhya Pradesh from 1st October 2022 to 31st December 2022. Results: Only 36.86% (n=129) of participants had heard of dental implants. Among these patients (N=129), only 30.23 % (n=39) received information about dental implants from dentists. Only 4 (3.10%) patients had themselves undergone treatment with dental implants. Awareness regarding implant composition was poor with only 6.98% (n=9) participants being aware that implants are made of titanium. Fear of surgery (33.33%) and high treatment cost (30.23%) were the most common limiting factors that governed the decision of patients regarding undergoing treatment with dental implants. Conclusion: The findings of the study indicate a low level of awareness about dental implants as a treatment option for replacing missing teeth. A very less number of participants received information from reliable sources. It is important to create awareness in general population regarding feasibility of implants for prosthetic rehabilitation and to make implant treatment easily accessible and affordable.

Rural-urban disparities in knowledge, attitude, and practice toward child oral health among mothers of 9-36-month-old children.

Objective: To assess and compare the knowledge, attitude, and practice of mothers of pre-school children in urban and rural areas toward maintaining child oral health. Materials and Methods: A cross-sectional comparative study was conducted in a convenient sample of 400 mothers of pre-school children (aged 9 months to 3 years) visiting the outpatient department of the Department of Dentistry, Shyam Shah Medical College, Rewa (M.P), India between February 1 and April 21, 2022. The study sample was divided into two groups based on whether they belonged to a rural area (Group A) or urban area (Group B). Group A included 236 participants, and Group B 186 participants. They were served a 24-item questionnaire to assess and compare their knowledge, attitude, and practice toward child oral health. The data were represented as mean and proportions, and a student t test and analysis of variance were performed. Results: In Group A and Group B, 93.64% and 98.17% mothers respectively had the knowledge of cariogenic food. While 66.10% of mothers in Group A and 73.78% in Group B were aware that regular cleaning of teeth protects against tooth decay, only 5.49% of mothers in Group B and none in Group A reported taking their children to routine dental visits; the majority (94.07% in Group A and 78.05% in Group B) had never taken their children to the dentist. Urban background was significantly associated with better knowledge, attitude, and practice scores. Mother's' age and education level were significantly associated with better Knowledge, Attitude, and Practice scores in both groups. Conclusion: Mothers can play an important role in promoting positive attitudes and healthy practices toward oral health care in children. Knowledge, attitude, and practice score were found to be significantly low in mothers who belonged to the rural subgroup.

Utility of automated cell counter histogram in diagnosis of thrombocytopenia and pseudothrombocytopenia

Background: Automated hematology analyzers have become mainstream of complete blood count (CBC) during the past two decades; they are potential, more accurate to produce results of CBCs. However, often automated analyzers can give false results too, specially, falsely low platelet count due to platelets aggregates, which have to be confirmed on peripheral smears. Aims and Objectives: The aim and objective of the study was to diagnose thrombocytopenia (TCP) cases and differentiate them from pseudothrombocytopenia (PTCP) cases by analyzing platelet histogram and to determine the sensitivity and specificity of platelet histograms for diagnosing TCP and PTCP. Materials and Methods: The present study was conducted in the Department of Pathology at Shyam Shah Medical College, Rewa, M.P., after obtaining ethical clearance from the Institutional Ethics Committee. It was prospective study conducted for a period of 15 months from January 2021 to May 2022 on 1000 samples. Results: The sensitivity and specificity of platelet histogram flags and presence of multiple peaks to diagnose TCP and PTCP cases were calculated as 73.60% and 93.60%, respectively. The present study also interpret that mean platelet volume and platelet distribution width cannot use as indicator to differentiate between TCP and PTCP. Conclusion: The present study concludes that analysis and interpretation of histogram more specifically platelet histogram flagging provide clue for early detection of PTCP cases prior peripheral smear examination and also helpful in differentiating them from true TCP cases. These platelet histogram flagging can be used as a screening parameter for the detection of PTCP and these are helpful in preventing unnecessary stress for clinician, patients, and their relatives. However, the peripheral smear examination will remain the gold standard to differentiate TCP from, PTCP.

Significance of levels of serum proteins and serum lipids as prognostic indicators in mortality of burn patients

Background: Burn mortality is significant because of the higher metabolic and physiological abnormalities; it causes more so than because of the actual injury. Since these abnormalities persist throughout the clinical course of burns, it is believed that both the trend of change and absolute values of the serum proteins and serum lipids have an impact on the prognosis and outcome. Aims and Objectives: This study aimed to find whether serum albumin, globulin, total protein, cholesterol, and triglyceride levels are clinically relevant to determine the mortality of a burn patient and thereby the patient’s outcome. Materials and Methods: The current prospective analytical study was carried out in patients who were admitted to the burn unit, Department of Surgery, Shyam Shah Medical College, and associated Sanjay Gandhi Memorial Hospital, Rewa (M.P.), during the period of April 1, 2021–June 30, 2022 (15 months), and the results were analyzed. Results: In the present study, a total of 112 patients were studied and followed up. Among them, 86% (96/112) of total patients were survivors who were discharged/DOR in stable condition and 14% (16/112) of total patients expired during the course of treatment. It could be statistically inferred that the increase in values of albumin, globulin, total protein, and cholesterol during the clinical course reduces mortality with serum albumin acting as the best predictor with the highest sensitivity of 100% and specificity of 100% and cholesterol the least. Conclusion: It could be statistically inferred that the increase in values of albumin, globulin, total protein, and cholesterol during the clinical course reduces mortality with serum albumin acting as the best predictor and cholesterol the least.

Comparative study of laparoscopic versus open surgery in cases of liver hydatid cysts

Background: Hydatidosis is a zoonotic infection, and treatment is mandatory to avoid complications. The infection can be asymptomatic or severe, causing extensive organ damage and even death of the patient. Aims and Objectives: The main aim of this study is to find out the merits and demerits of laparoscopy over that of open surgery in the treatment of hydatid cysts of liver. Materials and Methods: This prospective observational study was done on 50 patients who had liver hydatid disease admitted in the Department of Surgery, Shyam Shah Medical College Rewa (M.P.). Patients were divided into two groups consisting of 25 cases in each. Group A: managed by laparoscopic surgery and Group B: managed by open surgery. Results: The mean operative time in Group A was 99.6 min, while in Group B, it was 140.4 min. Group A patients were mobilized early and resumed duty very fast then Group B. The mean duration of stay in hospital was 8.64 days (range: 4–20 days) in Group A and 11.84 days (range: 4–12 days) in Group B. Wound infection seen in 9 patients in Group B and 0% in Group A. General complication rate was 32% in Group B and 8% in Group A. No recurrence noticed in either group during follow-up. Conclusion: Overall laparoscopic management of liver hydatid cyst is cost-effective in terms of early mobilization, early discharge, and early resumption of work along with cosmetic benefit.

Validation of the IAC Yokohama system for reporting breast fine-needle aspiration cytology categorization of breast lesions in Vindhya region population

Background: In 2016, International academy of cytology (IAC) has established a standardized approach for reporting breast fine-needle aspiration cytology (FNAC) by categorizing the lesions in five tier system from C1 to C5 to standardize reporting, which will enhance Breast fine-needle aspiration biopsy cytology performance, interpretation, and reporting. Aims and Objectives: The aim of the study was to categorize FNAC cases according to The IAC Yokohama System and evaluate the diagnostic ability of FNAC. Materials and Methods: The current prospective analytical study was carried out in the Department of Pathology, Shyam Shah Medical College, Rewa, Madhya Pradesh, for a period of 15 months from January 2021 to March 2022 (15 months). A total of 100 cases were included in the study based on inclusion criteria. The results were analyzed based on cytological reporting and P value calculated. Results: Among the 100 cases studied highest number of cases were from the age group of 21–30 years with 29% (n=29). The most common breast laterality affected was left with 69% of affected cases. The maximum number of cases, 69% (n=69) of the total, were found to be categorized under the category C2 (benign) which was followed by Category C5 (Malignant) seen in 13% (n=13). About 9% (n=9) of the total cases were categorized as suspicious of malignancy (C4). Atypical Lesion (C3) and Unsatisfactory Lesions (C1) were categorized in 5% (n=5) and 4% (n=4) of the total cases, respectively. Conclusion: FNAC is a minimally invasive, quick, and efficient pre-operative diagnostic tool that can also be used for postoperative breast lump follow-up to prevent recurrences. FNAC using IAC Yokohama system is a rapid and effective method for the primary categorization of palpable breast lumps and provides better clarity to the clinicians in the management of the patient and can reduce unnecessary surgeries.

VULVOVAGINAL CANDIDIASIS- PREVALENCE AND ANALYSIS OF ASSOCIATED RISK FACTORS AMONG WOMEN OF REPRODUCTIVE AGE GROUP IN VINDHYA REGION

Background: Although it can affect all groups, vaginitis remains one of the most common ambulatory problems to occur in women of reproductive age group. It accounts for 5-10 million office visits per year throughout world. In India prevalence of vaginitis is approximately 30%. Vaginitis has substantial impact on various aspects of female reproductive health, mental health, work ability and routine physical activity. It is also associated with various obstetrical and gynecological complications. Vulvovaginal candidiasis is common form of vaginitis. So, we aim to find out prevalence and analyze risk factors associated with vulvovaginal candidiasis at tertiary care hospital in Rewa, Madhya Pradesh India. Method: An observational cross-sectional study was conducted at Department of Obstetrics and Gynecology, Shyam Shah Medical College Rewa for 18 months from January 2021 to June 2022 on 1000 women of reproductive age group, visiting routine Gynae OPD of department of Obstetrics & Gynecology. Results: Prevalence of vulvovaginal candidiasis in present study was found to be 12%. Various associated risk factors were OCP use, use of cloth during menses, douching/cleanliness habit, rural area of residence, middle and lower socioeconomic class and various occupations like factory workers and farmers. Conclusion: As it is evident that vaginitis will never be completely prevented, but incidence can be reduced. Much of the morbidity and complications can be reduced by identification and prevention of modifiable risk factors and interventional strategies directed mainly on high-risk behaviors in day-to-day life.

Correlation of automated cell counter RBC histograms and peripheral smear in anemia typing

Background: Red blood cell (RBC) indices and histogram obtained from automated hematology gives an idea about the morphological changes in anemia and therefore forms the fundamental process for diagnosis of anemia. Along with the peripheral smear, they can be used for anemia typing and to interpret the cause of anemia. Aims and Objectives: (1) Interpretation of histograms in normal persons and patients with different types of anemia. (2) Anemia typing based on RBC histograms complemented with Peripheral smear examination. Materials and Methods: The present prospective study is conducted in Haematology section of Department of Pathology, Shyam Shah Medical College and Sanjay Gandhi Medical Hospital Rewa, Madhya Pradesh. A total of 1000 patients blood sample is collected for complete blood count and anemia typing irrespective of age and gender and examined over a period of 1 year from August 2021 to July 2022. The patient’s blood sample is collected in EDTA vacutainer and analyzed on the basis of histogram obtained and peripheral smear slide prepared. Results: In the present study, we noted that the predominant age group affected was 20–30 years. Peripheral smear finding shows normocytic normochromic anemia was seen in 6% cases (60/1000), microcytic hypochromic anemia seen in 24.2% cases (242/1000), macrocytic anemia seen in 14% cases (140/1000), dimorphic anemia seen in 50.2% cases (502/1000), and hemolytic anemia seen in 5.6% cases (56/1000). This peripheral smear finding shows well correlation with findings of histogram pattern and RBC indices, where normocytic normochromic seen in 6.4% of cases (64/1000), microcytic hypochromic anemia seen in 24.4% of cases (244/1000), macrocytic anemia seen in 13.8% of cases (138/1000), dimorphic anemia seen in 49.5% of cases (495/1000), and hemolytic anemia seen in 5.9% of cases (59/1000). The most common anemia is dimorphic anemia (combined nutritional deficiency) in 49.5% cases followed by microcytic hypochromic anemia in 24.4% of cases based on histogram findings along with RBC indices. Conclusion: Histogram guides a technologist about the cases that need actual detailed peripheral smear examination by experts. Our study shows a well correlation in findings of automated hematology analyzer with the microscopic examination. Histogram alone could be used as screening method and when combined with peripheral blood smear findings, they act as useful supplement and by correlating findings of both methods, we could diagnose majority of anemia.

Left Ventricular Diastolic Dysfunction in Patients with Type 2 Diabetes Mellitus and its Association with Age, Gender, Duration and Glycosylated Haemoglobin: A Cross-sectional Study

Introduction: Diabetes Mellitus (DM) is a group of metabolic disorders resulting in hyperglycaemia with disturbances in carbohydrate, fat, and protein metabolism. Hyperglycaemia when present for a long period of time leads to a host of metabolic abnormalities and also results in end organ damage. Diastolic dysfunction is an early sign of diabetic heart muscle disease preceding systolic and diastolic damage. Only a few studies have been conducted in central India to establish this prevalence and association in diabetic patients. Aim: To assess Left Ventricular Diastolic Dysfunction (LVDD) in diabetic patients and its association with age, gender, duration, and glycosylated haemoglobin (HbA1c). Materials and Methods: In this cross-sectional study, 150 normotensive patients with type 2 DM and no clinical evidence of cardiovascular disease were enrolled by simple random selection in the Department of General Medicine, Shyam Shah Medical College, Rewa, Madhya Pradesh, India. The sample size was calculated by standard formula with a confidence interval of 95% and an error margin of less than 5%. A semi-structured proforma was used to record the demographic profiles with full medication history, as well as, anthropometric measurements like height, weight, and waist circumference. Blood pressure was measured and blood was drawn for complete blood count, liver function test, renal function test, fasting and postprandial blood sugar, HbA1c, and lipid profile. Electrocardiographic and Echocardiographic studies were performed to assess LVDD. Data obtained by various methods was analysed statistically using Statistical Package for the Social Sciences (SPSS), version 20.0 and Chi-square test. Results: The present study showed that 85 out of 150 types 2 diabetic patients had diastolic dysfunction, out of which 80 had grade I diastolic dysfunction and, five of them had grade II diastolic dysfunction. The prevalence of diastolic dysfunction was increased with age, duration, and HbA1c (≥7%) and was not affected by gender. Conclusion: The study concluded that asymptomatic normotensive patients of type 2 DM have Heart Failure with preserved Ejection Fraction (HFpEF). LVDD were associated with age, gender, duration of diabetes, and HbA1c.

Impact of Electronic Gadgets Overuse on Myopia Progression among Young People: A Prospective Study

Introduction: Myopia has a multifactorial aetiology, involving interplay between environmental, genetic and behavioural factors. In today’s times of digitalisation, young people are now more exposed to digital devices, which is another possible risk factor for myopia. Aim: To determine the effect of mobile and laptop overuse on progression of myopia in young people at three time points of six months interval. Materials and Methods: This prospective observational study was conducted in the Department of Ophthalmology, Shyam Shah Medical College and associated Gandhi Memorial Hospital, Rewa, Madhya Pradesh, India, from of January 2019 to September 2020. A total of 400 eyes of 200 myopic patients were included. All the eyes were categorised into three groups based upon degree of myopia at the time of presentation. Cycloplegic autorefraction followed by subjective refinement of refraction was done and Spherical Equivalent (SE) was calculated in time 1, time 2 and time 3. Progression of myopia was calculated as increase in myopic refraction of subject’s eye between time 1 and time 3. Questionnaire survey about amount of time spent on mobile and laptop and their working distance was done. Then task-specificdiopter-hours per day were calculated. Multivariate analysis was done to estimate the adjusted odds ratio for mobile and laptop use associated with myopia progression. Results: The present study was conducted on 200 patients having varying degree of myopia. Mean age of patients with low, moderate and high myopia was 18.62±3.18, 17.65±3.59 and 17.49±3.91 years, respectively. The male to female ratio was 1.04:1. This study documents task specific mobile and laptop diopter hours per day was significantly higher in eyes with progression as compared to no progression in low, moderate as well as in high myopes (p-value<0.05). Conclusion: In the present study, risk of progression of myopia was significantly higher in patients engaged for longer duration on mobile and laptop and at near distance. Thus, this study concludes that overuse of electronic gadgets has a significant adverse impact on myopia progression in young people.

Comparison of Percutaneous Cystolithotripsy and Transurethral Cystolithotripsy for Treatment of Medium Size Bladder Stone: A Retrospective Study

Introduction: Vesical calculus accounts for nearly 5% of urinary system calculi and is commonly seen in patients with Bladder Outlet Obstruction (BOO), chronic infection, and neurogenic bladder. Open cystolithotomy is an invasive surgery with a long postoperative period and with a high wound infection rate, so only best recommended for large stones. With recent advancements in endourological instruments, cystolithotripsy either by Percutaneous Cystolithotripsy (PCCL) or Transurethral Cystolithotripsy (TUCL) approach has become a safer treatment for medium size stone (2-4 cm). Aim: To compare the outcome of PCCL and TUCL for medium size bladder stones in adult patients. Materials and Methods: This retrospective study was conducted between January 2019 to December 2021 in the Department of Urology, Superspeciality Hospital, Shyam Shah Medical College, Rewa, Madhya Pradesh, India. Group I was PCCL (n=32) and group II was TUCL (n=30). PCCL group was compared with TUCL group II for age, stone size, number of stones, operative time, mean urethral entries, postoperative hospital stays, peri and postoperative complications. Statistical analysis was performed using Chi-square and t-test. Differences were accepted to be statistically significant at p-value≤0.05. Results: A total of 168 were treated for bladder stones in the Institute and 62 patients were included in the study. No residual stone was observed in any of the two groups. Complete stone clearance was achieved in both groups of patients. Mean operative time and the number of urethral entries were 46.75±2.45 min and 1.06±0.25 min in in the PCCL group, and 59.67±3.84 min and 2.87±0.82 min in in the TUCL group. (p-value-<0.001). Conclusion: PCCL appears to be a better technique and preferable over TUCL in bladder stones of size between 2-4 cm.

Clinicohaematological Study of Leukaemias at a Tertiary Care Centre, Vindhya Region of India: A Cross-sectional Study

Introduction: Leukaemia is characterised by widespread proliferation of leucocytes and their precursors in the body tissues and is usually associated with qualitative and quantitative changes in circulating white blood cells. The global burden of leukaemia is increasing. Aim: To study the morphology of leukaemia from Peripheral Blood Smears (PBS) and/or bone marrow smears and evaluate the clinical and haematological profile of leukaemia patients. Materials and Methods: This prospective observational study was conducted in a Tertiary Care Centre of the Vindhya region, in the Department of Pathology at Shyam Shah Medical College, Rewa, Madhya Pradesh, India. The study was carried out over a period of one year, from June 2019 to June 2020. A total of 90 newly diagnosed cases of all types of leukaemia during the study period. Detailed history, physical examination, complete blood counts, and bone marrow examinations were performed to confirm the diagnosis. Cytochemistry was used for the diagnosis and classification of acute leukaemia according to the French-American-British (FAB) classification. The data was compiled and analysed using appropriate statistical methods, and the mean was described with Standard Deviation (SD). Statistical significance was assessed using Analysis of Variance (ANOVA) test conducted with Statistical Package for Social Sciences (SPSS) version 22.0. Results: The study included 90 cases of all types of leukaemia, with a mean age of 36.5±22.5 years. There was a male preponderance in the study, with 65 (72.2%) males and 25 (27.8%) females, resulting in a male-to-female ratio of 2.6:1. Chronic Myeloid Leukaemia (CML) was the most common malignancy, accounting for total 40 (44.4%) cases. Non specific symptoms such as fever in 50 (55.6%), weight loss 49 (54.4%), and loss of appetite 42 (46.7%) cases were the most common symptoms across all types of leukaemia. Acute leukaemia also presented with leukopenia and normal leucocyte counts, while chronic leukaemia mostly showed markedly elevated Total Leucocyte Count (TLC) with a mean count of 1,30,912±63,792 per mm3. Conclusion: Light microscopic features of peripheral smear and bone marrow examination still play an important role in the diagnosis of leukaemia, especially in resource-poor health centres lacking immunotyping and cytogenetics.

Early Electroencephalogram as Predictor of Neuromotor Outcome in a Term Newborn with Hypoxic Ischaemia Encephalopathy- A Prospective Cohort Study

Introduction: Birth asphyxia is the leading cause of neonatal morbidity and mortality globally. Early prediction of neuromotor problems in babies with Hypoxic Ischaemic Encephalopathy (HIE) allows parental counseling regarding treatment continuation, better utilisation of limited resources and prompt referral for early intervention services to so that the best possible outcomes can be achieved. Aim: To investigate the role of early Electroencephalogram (EEG) background activity in prediction of cerebral palsy, epilepsy and developmental delay in term newborn with HIE and also to check the association of EEG background activity with Hammersmith Neonatal Neurological Examination (HNNE), Hammersmith Infant Neurological Examination (HINE) score and various short-term and long-term outcome. Materials and Methods: This prospective clinical study was conducted in Neonatal Intensive Care Unit (NICU) of Department of Paediatrics, Shyam Shah Medical college and associated Gandhi Memorial Hospital, Rewa (MP) during April 2019 to June 2020. Total 81 term neonates with HIE underwent conventional EEG within six hours of birth using International 10-20 system, (modified for neonate) for electrode placement. At the time of discharge HNNE was performed. On follow-up (6 to 12 months), cerebral palsy was evaluated using HINE and modified Ashworth score, Developmental delay by Development Assessment Scale for Indian Infant (DASII) scale and for epilepsy by clinical history and EEG background activity. Association between EEG background activity, HNNE, HINE score and various short-term and long-term outcome was calculated using Chi-square test and Fisher’s-exact test. Results: In present study, out of 81 cases, 58 (71.6%) cases were male and 23 (28.4%) cases were female with mean Gestational Age (GA) of 39 weeks. A total of 57 neonates were discharged successfully after stay of mean duration 13.8 days in NICU. All neonates with normal/mildly abnormal EEG background activity had 100% survival rates whereas only 68.2% (15) and 37% (10) could be discharged from moderately abnormal and severely abnormal EEG background activity group. Out of discharged patients none with severely abnormal background had optimal HNNE whereas 75% (24) of mildly abnormal EEG had optimal HNNE score. Mean HNNE and HINE score was significantly lower in newborns with severely abnormal EEG (mean score 20.8) as compared to normal EEG group (mean score 30.3). Severely abnormal EEG at birth had significant association with cerebral palsy (p-value<0.0001), epilepsy (p-value= 0.003) and developmental delay (p-value<0.001) as compared to moderately and mildly abnormal EEG background activity in newborns with HIE. Conclusion: EEG within six hours of birth in term neonate with HIE has very high sensitivity and Negative Predictive Value (NPV) in predicting short-term outcome as death, poor neurological outcome and long-terms outcome as cerebral palsy, epilepsy and developmental delay.

Inter-observer Reliability in Reporting Complications of Transurethral Resection of the Prostate with Clavien-Dindo Classification: A Retrospective Observational Study

Introduction: Transurethral Resection of the Prostate (TURP) is a gold standard treatment for Benign Prostatic Hyperplasia (BPH). The Clavien classification system was proposed in 1992 to grade complications of general surgery, which was then modified in 2004 by Dindo. In 2017, the European Association of Urology (EAU) endorsed its use for reporting complications in urological procedures. However, the system relies on observers to grade complications, and different observers may assign different grades to the same negative outcome, highlighting the need for uniformity. Aim: To assess the inter-observer reliability and uniformity among urologists in reporting complications of TURP using the modified Clavien-Dindo classification system. Materials and Methods: A retrospective observational study was conducted at Department of Urology, Shyam Shah Medical College, Rewa, Madhya Pradesh, India, from January 2018 to May 2023. The study included symptomatic patients with BPH and prostate gland sizes greater than 40 cc. Negative outcomes were evaluated and complications were rated by nine different raters. Inter-observer reliability was tested using weighted kappa with Statistical Package for Social Sciences (SPSS) version 21.0 (Fleiss’s kappa test). Results: A total of 523 men with BPH who underwent TURP were evaluated, with a mean age of 66.7±5.2 years and a mean prostate volume of 62 cc. Adverse events occurred in 96 patients (18.36%), and these complications were classified according to the Clavien-Dindo System (CDS) by nine different blinded observers. The rating of these complications was then assessed for concordance. A concordance rate using weighted kappa of 0.847 was observed, indicating high inter-observer reliability for TURP. Conclusion: Clavien-Dindo’s system demonstrated good interobserver concordance and reliability. Some modifications to the grading system are needed, taking into account the impact of pre-existing co-morbidities and auxiliary procedures. Largescale prospective studies are recommended to further validate these findings.

Epidemiology, Pattern, and Management of Midsagittal and Parasagittal Palatal Fractures through Placement of Intra-arch Wire

Aim: The aim of this prospective study was to evaluate the epidemiology, pattern, and concomitant injuries associated with midsagittal and parasagittal palatal fractures and to assess the postoperative complications associated with treatment by placement of intra-arch wiring for their management. Materials and Methods: A prospective study was carried out on 22 patients of maxillofacial trauma who were diagnosed with midsagittal or parasagittal palatal fractures and were treated by placement of intra-arch wires during August 2020 to January 2022 in the Department of Dentistry, Shyam Shah Medical College Rewa. All the cases were treated with open reduction/closed reduction for the management of concomitant injury. Results: Out of a total of 31 cases diagnosed with palatal fractures during the study duration, the most common palatal fractures were parasagittal (41.93%) and sagittal fractures (29.03%), which met the inclusion criterion of the study (n = 22). Sagittal and parasagittal fractures of the palate were commonly seen in males with a male-to-female ratio of 10:1. The mean age of occurrence was 32.04 ± 11.29 years. The mean duration of surgery was 7.9 ± 2.28 min. Occlusal discrepancy requiring an orthodontic intervention for correction was seen in 1 (4.54%) patient. In 3 (13.63%) patients, occlusal discrepancy was managed by prolonging the duration of intermaxillary fixation. Conclusion: Intra-arch wiring is a simple, cost-effective, and quick method for the management of midsagittal and parasagittal fractures of palatal fractures. It eliminates the need of a second surgery for the removal of plates that are placed in open reduction of palatal fractures.

Study of histopathological spectrum of non-neoplastic lesions of the lung in autopsy specimen

Background: Lungs are the major organ involved in infectious and occupational diseases almost secondarily involved in all forms of terminal diseases. Autopsy plays an important role in identifying and understanding the pathology of various respiratory diseases and lung lesions to find out the parenchymal pathology. Aims and Objectives: This study aims to study the histopathological spectrum of non-neoplastic lung lesions in medicolegal autopsy and to assess the frequency of spectrum of lung lesions. Materials and Methods: The present retrospective study was carried out in the Department of Pathology, Shyam Shah Medical College, Rewa, M.P., for a period of 18 months from July 2020 to January 2022. All 98 consecutive specimens of medicolegal autopsy were included with age from newborn to 70 years irrespective of gender and cause of death. The results were analyzed based on gross and microscopic findings. Results: Among the 98 cases studied, 82 cases (84%) were of diseased and 16 cases (16%) were of non-diseased lung. The most common age group affected was 30–39 years with 30% of affected cases followed by 20–29 years with 21% of affected cases. Among 82 cases, the most common pulmonary lesion was pneumonia in 46% (45/98) of the total cases followed by congestion and edema seen in 22% (21/98) of the cases. Conclusion: Histopathological study of lung autopsy helps in providing information for clinical diagnosis of non-neoplastic lung lesions that act as a tool for better clinical assessment and help to establish a correct prophylactic measure. The histopathological examination (HPE) helps in establishing the final cause of death. The HPE helps in establishing the final cause of death. Therefore, autopsy study is very helpful in refining the vision and diagnostic setup for better evaluation.