SSG Hospital Research Articles

Spectrum of exploratory laparotomy for acute abdomen in a central Gujarat tertiary care centre

Background: Exploratory laparotomy is one of commonest emergency surgeries performed in the world. Despite technological advance imaging, the fundamental technique of exploratory laparotomy has remained unchanged over years. Studies quantifying the spectrum of laparotomy in central Gujarat are lacking. Methods: A retrospective study of 249 patients of emergency exploratory laparotomy for acute abdomen in SSG Hospital Baroda from May 2022 to May 2024 was done and data involving clinical presentation, imaging, operative findings and post- operative course were studied and analysed. The cases were divided into gastro-intestinal perforation, gastro-intestinal obstruction and miscellaneous cause. Results: The most common cause of exploratory laparotomy in study was perforation peritonitis including 59 ileal, 16 jejunal, 49 pre-pyloric, 29 duodenal, 1 body of stomach, 17 appendicular and 8 colon. With post op major complications like burst-11%, leak-5%, pneumonia-5%, multi-organ failure-6.5% and ileus 5%, wound infection 18%. The overall mortality was 15%. Out of 58 cases of laparotomy for obstruction including adhesions (29.3%), obstructed inguinal hernia (12%), tuberculosis (32%), malignancy (13.8%), internal hernia (12.6%). The miscellaneous causes were ruptured liver abscess (9), rupture ectopic pregnancy (2), twisted ovarian tumour (1). Conclusions: Acute abdomen remains a significant surgical problem. Peptic perforation remains a common cause of acute abdomen with high morbidity and mortality, despite improves medical management, though there is a declining trend in incidence, tuberculosis remains an important cause.

Evaluation of all Medicolegal Cases Brought to Casualty of GMC and SSG Hospital Vadodara

Evaluation of all Medicolegal Cases Brought to Casualty of GMC and SSG Hospital Vadodara

Association of antenatal counselling with breastfeeding outcomes: a comparative analysis

Background: Breastfeeding is an art and a skill which needs to be learnt and mastered. Breastfeeding practice gets affected by many factors like Social, cultural, biophysical, demographic and psychological. One of the important factors for ineffective breastfeeding is the lack of adequate knowledge of women regarding breastfeeding, such as the time of initiation of feeding, feeding of colostrum and mother’s position while feeding the baby. Objective of the study was to find out association of antenatal counselling with the preference for breastfeeding positions, early initiation of breastfeeding and feeding of colostrum. Methods: This was a prospective cohort study where 120 primigravida who had taken structured counseling on breastfeeding during their antenatal period and ended up with vaginal delivery at labour room of SSG Hospital, Baroda were recruited. With every such mother, the next woman who delivers vaginally and has not taken structured counselling during ANC was taken as the control. After delivery, all the mothers were observed for early initiation of breastfeeding, feeding of colostrum and adoption of cross-cradle breastfeeding position in comparison with other positions. Results: The rate of early initiation of breastfeeding (EIBF) and number of mothers who fed colostrum to their babies was significantly higher in case group compared to the control group. The number of mothers preferring the cross cradle position was also higher in case group. Conclusions: Antenatal counseling on breastfeeding helps mothers to raise the rate of early initiation of breastfeeding and feeding of colostrum to babies. It also helped mothers to choose cross cradle position as their preferred method of breast feeding.

A Cohort Study to Evaluate the Effect of Nutritional Intervention on Severe Acute Malnutrition Children Admitted to A Nutritional Rehabilitation Centre in A Tertiary Care Hospital in Central Gujarat, India

Background: Undernutrition is one of the most concerning health and development issues in India as well as in the world. Nutritional rehabilitation centres (NRC) were started by Government of India to control severe acute malnutrition. The aim is to assess the effect of nutrition interventional measures for severe acute malnutrition (SAM) children admitted at NRC through selected anthropometric indicators. Methodology: A hospital-based prospective cohort study was conducted at NRC of SSG Hospital, Vadodara, Gujarat from April to September 2022, all children of 6-60 months of age admitted during this period were observed during their stay with three follow-ups after discharge at 15 days interval. The data was entered in Microsoft Excel and was analysed using Medcalc Software. Results: A total of 76 children were analysed for anthropometric indicators. A statistically significant difference was obtained between the weight of children at admission, discharge and 3 follow-ups (ANOVA=141, p<0.001); difference of mid upper arm circumference (MUAC) (ANOVA=84.2, p<0.001) and difference of height (ANOVA=43.3. p<0.001) at admission, discharge and follow-up were also statistically significant. Conclusions: NRCs have had a positive impact on the selected anthropometric indicators of severe malnourished children but lag behind proper follow-up visits.

Estimating Time Since Death From Post Mortem Lividity: An Autopsy Study Conducted in Government Medical College and Ssg Hospital ofCentral Gujarat State of India

Background: Evaluation and estimation of time since death is a fundamental part of medico-legal investigations. Post mortem lividity or post-mortem staining is a bluish or reddish-purple discoloration due to capillo-venous distension with blood, at the under surface of the skin on the dependant parts of the body, as a result of settling of blood in those areas following pulling by gravity, after circulation of the blood in motion ceases. A study was conducted in the department of forensic medicine, GovernmentMedical College and SSG hospital, Vadodara to evaluate time since death by method of studying post mortem lividity. This was prospective and observational study conducted on 256 dead bodies brought for post mortem examination from November 2021 to August 2022. It was observed that the Post mortem Lividity starts appearing as a patchy form by 1-7 hours and well develops by 7-13 hours. Post mortem Lividity gets fixed by 8-18 hours following death. It was concluded that compared to other methods, the post mortem lividity assessment can be used as the most conventional, easy and quicker method for estimating time since death

Association of Inflammatory Markers With Disease Progression and the Severity of COVID-19.

Introduction InDecember 2019, there was a massive outbreak of viral pneumonia, which had a high case fatality rate. Genetic sequencing of the virus showed similarity with severe acute respiratory syndrome coronavirus (SARS-CoV). It was later named novel coronavirus 2019 while the disease it caused was given the nomenclature of COVID-19. This deadly pneumonia outbreak was declared a pandemic by the World Health Organization (WHO). Aim To derive the strength of the correlation between blood levels of various inflammatory markers with the severity of COVID-19 pneumonia in patients affected with novel coronavirus 2019. Materials and methodology A prospective study was conducted on 300 confirmed cases of COVID-19 infection from August 2020 to July 2021 in SSG Hospital, Vadodara. Diagnosis of patients as confirmed cases of COVID-19 infection was done according to the WHO interim guidance for COVID-19. Their inflammatory markers were done for this study. All COVID-19-positive patients who had given negative consent for enrollment were excluded from the study. Patients were classified based on the severity of acute respiratory distress syndrome (ARDS). Comprehensive medical record information, encompassing biodata, clinical symptoms, comorbidities, and laboratory investigations, was systematically collected. Patients were given the standard treatment protocol as per guidelines. Patients were subjected to detailed investigations comprising complete blood counts and inflammatory markers like C-reactive protein (CRP), lactate dehydrogenase (LDH), serum ferritin, and D-dimer. Patients were further investigated by chest X-ray (posteroanterior view) or high-resolution computed tomography of the thorax. Results A total of 300 confirmed cases of COVID-19 infection were included in this study. Most of them were males (52%) with a mean age of 51 years and 48% were females with a mean age of 55 years. The majority of patients(40%) did not have ARDS, 23.3% of patients had mild, 16.7% of patients had moderate, and 20% of patients had severe ARDS. Higher CRP levels, serum ferritin, and serum D-dimer were significantly associated with the severity of COVID-19 infection as compared to those having no symptoms (p < 0.05). Increased levels were associated with severe clinical manifestations of COVID-19. The sensitivity of CRP is 69% and specificity is 100% as a diagnostic marker for COVID-19 pneumonia in terms of ARDS. The sensitivity of ferritin is 88% and specificity is 81% as a diagnostic marker for COVID-19 pneumonia in terms of ARDS. The sensitivity of D-dimer is 94% and specificity is 89% as a diagnostic marker for COVID-19 pneumonia in terms of ARDS. The sensitivity of LDH is 93% and specificity is 84% as a diagnostic marker for COVID-19 pneumonia in terms of ARDS. Conclusions Current evidence from our study showed that higher levels of inflammatory markers such as CRP, LDH, D-dimer, and ferritin are associated with the severity of COVID-19 in terms of ARDS and thus could be used as significant prognostic factors of the disease.These indicators might support clinical decisions to identify highfatality casesand poor diagnosis in the initial admission phase.

Microvascular decompression for trigeminal neuralgia: an experience of 84 operated cases

AimWe retrospectively analyse and review the results of microvascular decompression performed for trigeminal neuralgia. We also discuss the surgical nuances, complication avoidance and compare our results with other reported studies.Materials and methodsThis is a retrospective study in which the data of eighty-four patients who underwent microvascular decompression for trigeminal neuralgia in the last ten years from 2013 till May 2023 at our institute (Neuron hospital and SSG Hospital, Vadodara, India) was reviewed. The preoperative pain characteristics, radiology reports and the degree and duration of post-operative pain relief and neurologic outcome was assessed. MRI was done preoperatively in all the cases to rule out a secondary cause for trigeminal neuralgia. All the cases of secondary trigeminal neuralgia were excluded from the study. A favourable outcome was defined as a post-operative Barrow Neurological Institute pain intensity score of 1.ResultsEighty patients had excellent immediate postoperative pain relief without any need for medications. None of these patients have developed any recurrence of pain till date. Four operated patients did not experience any pain relief after surgery.ConclusionMicrovascular decompression for trigeminal neuralgia is a safe and effective procedure which treats the root cause of the disease and hence provides good long term pain relief.

Clinicomycological profile of dermatophytosis in a tertiary care teaching hospital, Vadodara

Dermatophytosis is the most common type of cutaneous fungal infection seen in man infecting the superficial keratinized layer of the skin, hair and nails. The aim of the study is to isolate and identify the dermatophytes from clinically suspected cases of dermatophytosis, to determine the frequency of occurrence of various species of dermatophytes, to know the prevalence of age and sex of dermatophytosis in the locality.: The present study was carried out in the Department of Microbiology, Medical College and SSG Hospital, Vadodara. A total of 150 clinically diagnosed cases of dermatophytosis were taken for this study. Skin, hair and nail samples were aseptically collected and were subjected to KOH mount examination and culture. Differentiation of the dermatophyte species was performed based on the macroscopic and microscopic examination of culture and physiological test including urease test.: Tinea corporis (41.3%) was the commonest clinical type with a male to female ratio of 1.05:1. Out of these samples, dermatophytes were isolated in 108 cases with the overall isolation rate of 72%. Seven species of dermatophytes were isolated. 53 (49.1%) was the commonest species followed by 22(20.4%).: Identifying dermatophyte species and knowledge of their host preference and ecology play an important role in treating the patient. Correct and efficient laboratory methods for diagnosis of dermatophytosis is the need of the hour to provide correct and timely treatment and prevent the further spread and chronicity of the disease.

Comparison of oral mifepristone with intracervical foleys catheterisation for induction of labour in term pregnancy: A randomized control trial

The purpose of this study is to compare the efficacy of oral Mifepristone with the efficacy of intracervical Foley catheterisation for induction of labour in term pregnancy. The primary outcome of this study is to compare both methods of induction of labour in terms of induction to delivery interval and the secondary outcome is to compare the two methods in terms of route of delivery, indications of caesarean section and the neonatal outcomes. This study is a randomized control trial conducted from May 2022 to December 2022 in Department of Obstetrics and Gynecology, SSG Hospital, Baroda Medical College. 180 term pregnant patients were enrolled in this study based on a pre-established criteria. Patients were randomised into group A and B. Group A included patients who were given Tablet Mifepristone 200 mg PO followed by per vaginum Tablet Misoprostol and Group B included patients who underwent intracervical Foleys catheterisation followed by placement of per vaginum Tablet Misoprostol. The study concluded that there was significantly decreased induction-delivery interval in women induced with intracervical Foleys catheterisation (Group B) as compared to those given oral Tablet Mifepristone (Group A). There was no significant difference between the two groups in terms of the route of delivery, rate of C Sections and neonatal outcomes.Mifepristone is effective for inducing indicated term pregnancies, despite no decrease in induction delivery interval. Incidence of fetal distress with oral Mifepristone is comparable to intracervical foley's catheterization. Further research is needed to assess tachysystole/hyperstimulation and fetal distress caused by Mifepristone.

THYROID FUNCTION IN POSTMENOPAUSAL WOMEN IN WESTERN INDIA AND ITS IMPACT ON MENOPAUSAL SYMPTOMS, BMI, GLYCEMIC, LIPID AND CARDIAC PROFILE

Background Menopause is characterized by estrogen deciency and appearance of variety of menopausal symptoms like lethargy, hotushes, anxiety, sexual problems, tiredness, insomnia, weight gain and mood swings. Many of these symptoms are similar to symptoms of thyroid dysfunction and hence there is likelihood of symptoms of thyroid dysfunction in this age group being misinterpreted as menopausal symptoms and thyroid dysfunction remaining undetected. If thyroid dysfunction remains undetected and untreated, it can lead to health hazards like hyperlipidemia, atherosclerosis and heart disease.2Presently there are no clear cut guidelines about screening menopausal patients for thyroid function and existing studies on screening of menopausal women for thyroid disorders are not conclusive. Therefore this study was undertaken to look at thyroid functions in postmenopausal women and impact of thyroid dysfunction on their cardiovacular health through its action on their glycemic status, BMI and lipid prole. Aims And Objectives 1. To assess the basic thyroid functions in postmenopausal women. 2. To evaluate the effect of abnormal thyroid function on glycemic status, lipid prole, body weight and BMI in postmenopausal women. 3. To look for association of severity of menopause symptoms with the degree of thyroid dysfunction in postmenopausal women. Materials And Methods A cross-sectional observational study was carried out in the indoor and outdoor sections of Department of Medicine at SSG Hospital Vadodara for a period of one year from March 2015 to Feb 2016 in which 130 patients were enrolled. All patients were subjected to a standardized interview in which their symptoms were graded on the basis of the Simplied Menopausal Index , their BMI was calculated from their height and weight and investigations (Fasting thyroid prole, fasting blood sugar, fasting lipid prole, ECG) were carried out. Association between abnormalities in thyroid prole and severity of menopausal symptoms as well as abnormalities in BMI , fasting blood sugar, lipid prole and ECG were analyzed using appropriate statistical tests (Odd's ratio). A P value&lt;0.05 was considered statistically signicant. Thyroid dysfunction is Conclusion common in postmenopausal females and the symptoms of the two entities overlap but with a higher intensity in the former and the simplied menopausal index score can be used as an efcient tool to further increase the index of suspicion for thyroid dysfunction in postmenopausal women. Abnormal thyroid function is statistically associated with BMI with higher prevalence of hypothyroidism in overweight, preobese and obese postmenopausal subjects and hyperthyroidism in underweight postmenopausal subjects. Abnormal thyroid function is statistically associated with abnormal glucose metabolism with higher prevalence of fasting hyperglycemia at either end of the spectrum of thyroid disorders. Abnormal thyroid function is statistically associated with Dyslipidemia in the form of raised total cholesterol, LDL cholesterol and serum triglycerides with no signicant association with HDL cholesterol in postmenopausal women. There is no statistically signicant association between thyroid dysfunction and ischemic heart disease

A cross sectional study of various types of acute poisoning; pharmacological management and their outcome in a tertiary care hospital

Background: Acute poisoning is a common and life-threatening crisis, leading to serious complications and death of patients. Poisoning may be due to self-consumption, accidental exposure of chemical compounds, medications and poisonous animal bites/stings. Aim of current study was to investigate the pattern of drug utilization, poisoning agents and outcome in patients with acute poisoning treated at a tertiary care teaching hospital, Vadodara, Gujarat. Methods: This prospective cross-sectional study was done on patients of acute poisoning admitted in emergency department, SSG Hospital during August 2021-March 2022. Results: 400 patients were enrolled during the study, from which 262 (65.50%) were male and 138 (34.50%) were female. Mean age of patients was 30.30 ± 13.79 years. The commonest mode of poisoning observed was Suicidal (66.25%). The most common cause of poisoning was due to Pesticides (33.25%), followed by venomous animal exposures (30.75%). Death was recorded in 53 (13.25%) patients with highest number seen in suicidal poisoning (14.34%) compared to accidental poisonings (11.19%). Mainly, multivitamins (19.03%), Antimicrobials (16.65%), Proton Pump Inhibitors (15.85%) and Antiemetics (11.10%) were prescribed. Antidotes used were Atropine (4.81%), Pralidoxime (4.46%) and Anti-snake venom (2.80%). Median number of drugs per patient was 8; range: 2-25. Conclusions: Pattern and magnitude of poisoning are multidimensional and demand multi-sectoral approach for facing this problem. Due to high incidence of snakebites, hospital stockpiles should be regularly checked for availability of antivenom. There is a need for stringent pesticide regulation laws, counselling and training programs to reduce incidence of poisonings and deaths due to it.

Evaluation of Postoperative Analgesia on Addition of Dexmedetomidine to Ropivacaine 0.2% in Femoral Nerve Block in Patients undergoing Open Knee Surgery-A Randomised Single Blinded Study

Introduction: Femoral Nerve Block (FNB) renders marked postoperative analgesia in patients undergoing knee surgery and use of adjuvant to Local Anaesthetic (LA) agent is more advantageous in lengthening duration of sensory effect of block. Aim: To evaluate the effect of addition of dexmedetomidine to 0.2% Ropivacaine in FNB. Materials and Methods: The randomised clinical trial was conducted at Medical College and SSG Hospital, Vadodara, Gujarat, India which included 60 patients of either sex, American Society of Anaesthesiologists (ASA) Grade-I,II,III posted for open knee surgery. Patients were randomly allocated to two groups-Group RD patients received 0.2% ropivacaine 20 milliliter (mL) with dexmedetomidine 2 mL (50 μg) and Group R received 0.2% ropivacaine 20 mL with normal saline 2 mL for FNB. Duration of postoperative analgesia, total requirement of systemic rescue analgesic in 24 hours, vital parameters and complications were observed. Statistical analysis was done with Medcalc 14.8.1 statistical software. A p&lt;0.05 considered as significant. Result: Duration of analgesia was significantly longer in Group RD (484±26.98 min) than in Group R (338±29.40 min), p&lt;0.0001. Mean postoperative cumulative requirement of analgesic (Tramadol) was lesser in Group RD (207±25 milligram (mg)) than in Group R (290±30 mg), p&lt;0.0001. Conclusion: Dexmedetomidine to ropivacaine 0.2% for FNB significantly augments duration of analgesia and reduces requirement of systemic analgesic declining its unfavourable effect.

Association of Mean Platelet Volume with Acute Coronary Syndrome: A Case–Control Study

Abstract Background: Acute coronary syndrome (ACS) is a group of symptoms associated with acute myocardial ischemia and is one of the major causes of morbidity and mortality across the world. Its primary etiology is atherosclerosis which is crucially dependent on platelets, and hence, mean platelet volume (MPV) could be a new biomarker for predicting or diagnosing ACS. Our study aims to measure the MPV in patients of ACS and compares it with patients of noncardiac chest pain to evaluate its usefulness as a new marker for ACS. Materials and Methods: A case–control study with 50 cases and 50 controls was carried out in SSG Hospital, Vadodara, over a period of 1 year (November 2016–November 2017). ACS patients were identified according to inclusion and exclusion criteria and their MPV was compared to that of noncardiac chest pain patients. Results: The cases had a higher MPV as compared to the control group, with both males and females being affected, but a stronger association was seen in case of males. Conclusions: Raised MPV has shown significant association with ACS and the test has reasonable sensitivity and specificity, which warrants larger scale studies to confirm its utility as a biomarker for ACS.

Study of outcome of calcaneum fractures treated with calcaneum plate or cc screw

Background and Aims: Conservative treatment for displaced intra-articular fracture calcaneum can lead to incongruence of the posterior facet and, incongruence of the calcaneocuboid joint. Therefore surgical treatment is advocated to restore anatomy of calcaneum and reduce complications like subtalar arthritis, malunion and pain while walking. Aim of study is to study functional outcome of fractures treated with calcaneum plate or CC screw.Material and Methods: Total 20 cases were studied fom June 2021 to July 2022 in SSG hospital of calcaneum fractures treated surgically and monthly follow up were taken. Fracture classified on basis of Sanders classification and treated with plate or screw depending on type. Post-operative BK slab for 6 weeks and partial weight bearing till 3 months till sign of union visible.Results: 75% showed excellent results 20% good and 5% poor results.Discussion and Conclusion: Lateral approach to the calcaneum is more widely followed worldwide providing wide exposure of subtalar joint decompression of lateral wall, no risk of any injury to neurovascular structure and wide area for internal fixation. Early mobilization to prevent ankle stiffness. Meticulous surgical techniques, respect for soft tissues, antibiotics are essential to minimize the postoperative infection and skin problems.

A study on clinical, radiological, and histopathological correlation of lung cancer

Background: In developed countries, lung cancer is the most common cause of cancer-related death for both men and women. In the last three decades, its incidence and mortality rates have decreased. Contrary to this, lung cancer remains a major cause of death and incidence in developing nations. Smoking is responsible for most lung cancer deaths. Aims and Objectives: The aim of the study was to study the clinical presentations, the radiological and histopathological appearance of lung cancer and various factors contributing to lung cancer. Materials and Methods: All clinically suspicious patients who came to SSG hospital were sent for radiological and histopathological confirmation for lung cancer. Hence, a total of 50 patients were selected during the period of December 2020–December 2021. Results: Out of the total of 50 cases, male to female ratio was 4.5:1. The prevalence of smoking was 66% (n = 33). All smokers were male. The most common histological subtype was Squamous cell carcinoma (n = 25.50%), followed by adenocarcinoma (n = 15.30%) and small cell carcinoma in 10 patients (20%). The most common metastasis was lymph node metastasis (n = 9.43%), followed by liver metastasis (n = 4.19%) and vertebral metastasis (n = 4.19%). Smoking is the principal risk factor for lung cancer. Conclusion: Histologically, squamous cell carcinoma remains the most common. A poor prognosis is associated with patients who were diagnosed late in the disease. Hence, smoking cessation program and screening program for the detection of lung cancer are essential.

Clinical and bacteriological profile of children with community acquired pneumonia admitted in pediatric ward in tertiary care hospital of central Gujarat, India

Background: Community-acquired pneumonia is the leading cause of mortality of under-five children in developing countries, including India. Based on the burden of CAP, India is among the top five countries and has over 23% of the global cases. Accurate, reliable, and rapid determination of etiology in childhood CAP is important because it would influence individual treatment decisions, antibiotic policy in the community, and also rational immunization policy at a national level. Objectives of current study were to study the clinical and bacteriological profile of children admitted with CAP and to determine sensitivity and resistance patterns to various antibiotics to these organisms.Methods: This was a prospective and observational study conducted over one year in the Paediatric ward SSG hospital Vadodara, Gujarat, India. Blood culture and Oropharyngeal swab/endotracheal swab for culture and sensitivity were collected in all study patients. Organisms isolated in blood culture and oropharyngeal/ET swab were analysed in percentage and frequency. Results: Chest retraction (88%) was the commonest sign observed in this study followed by tachypnoea (74%). In blood culture, Acinetobacter was the most common organism isolated and in oropharyngeal and ET swab culture was Klebsiella spp. Major co-morbidity contributing to mortality was severe anemia followed by severe acute malnutrition.Conclusions: Bacterial cultures of blood and oropharyngeal/ ET secretion swab culture have grown predominantly Acinetobacter and Klebsiella pneumoniae in this study. Administration of sensitive antibiotics as per the geographical bacteriological profile of community-acquired pneumonia will help to improve outcomes and prevent antibiotic resistance.

Appropriate Method of TIBC Estimation in Reference to Serum Transferrin Levels.

Background The currently available various methods of estimation of total iron binding capacity (TIBC) show marked variation in reference range. Although serum transferrin (TF) level is a sensitive indicator of iron status, its measurement requires immunoassay equipment which may not be available in many routine biochemistry laboratories. So, this study was planned to find the most appropriate method to estimate TIBC. Objectives This study aimed to compare different methods of TIBC estimation and to corelate the TIBC values obtained by different methods with serum TF concentration. Material and Methods This analytical cross-sectional study was performed in the clinical chemistry laboratory of the Biochemistry Department of Medical College Baroda & SSG Hospital, Vadodara, Gujarat, on 250 leftover serum samples destined to be discarded. In all these samples, serum TIBC was estimated by direct method, indirect method, as well as calculated method (iron + unsaturated iron binding capacity [UIBC]) along with the measurement of serum TF level. Statistical Analysis Among the different methods, repeated analysis of variance (ANOVA) analysis and Bland-Altman plot were used to find out significance of difference. Correlation coefficients were found between different methods of TIBC estimation and serum TF levels. Results The means of TIBC by calculated, indirect, and direct methods were 344.51, 342.23, and 378.24 µg/dL, respectively. The mean of serum TF was 295.3 mg/dL. There was statistically significant difference between TIBC by direct and indirect methods and between direct and calculated methods. There was a strong positive correlation between TIBC by direct method and serum TF ( r = 0.888, p < 0.0001), but there was moderate correlation between TIBC by indirect method and serum TF ( r = 0.748, p < 0.04), and between TIBC by calculated method and serum TF ( r = 0.725, p < 0.05). Conclusion Among different methods of estimation of TIBC, direct method is more reliable in reference to serum TF levels.

Factors associated with vitamin B12 deficiency in adults attending tertiary care Hospital in Vadodara: a case control study

BackgroundIn India, approximately 75% of population that is over 650 million people have B12 deficiency majority of which is caused by variation in demography, diet, and religion. Conditions such as smoking, alcohol, and antacid use are certain causes for incidence of vitamin B12 deficiency. Looking at various adverse health effects of drinking demineralized water, there is possibility that it may also be one of the newly associated factors for increasing incidence and prevalence of vitamin B12 deficiency.ObjectiveTo assess the risk factors associated with vitamin B12 deficiency.MethodsA case control study was conducted at SSG Hospital in Vadodara, Gujarat, wherein all the patients visiting the hospital from November 2017 to June 2018 with symptoms suggestive of B12 deficiency and serum B12 level below 200pg/mL were included in the study. Information regarding the vitamin B12 deficiency was obtained from the patients. Controls were selected and matched with cases as per age group to minimize confounding.ResultsOur study showed statistically significant association of vegetarian diet (p value=0.0027, OR=2.00) (odds ratio), dark complexion (0.0069, OR=2.53), socio economic status (p value= 0.0001), and use of RO (reverse osmosis) water (p value=0.0099, OR=3.61) with vitamin B12 deficiency at 95% CI (confidence interval).ConclusionIndependent association between use of R.O. water, vegetarian diet, socio economic class, and dark complexion with vitamin B12 deficiency.

Collagen Dressing Versus Conventional Vaseline Gauze Dressing in Reducing Pain and Infection at the Donor Area for Skin Grafting: A Prospective Interventional Study

Introduction: The harvest of a split thickness skin graft causes a partial thickness injury and an outflow of blood and protein rich exudate from the donor site wound. Conventionally, closed dressings are employed using petroleum jelly impregnated gauge which are permeable to bacteria and wound exudate soaks through. This may lead to pain and infection of the donor site. Biological dressings create the most physiological interface between the wound surfaces and the environment and also dressings are natural, non immunogenic, non pyrogenic and hypo allergenic. Collagen sheet is one such dressing material used. Aim: To compare the conventional dressing using petroleum jelly impregnated gauze versus biological dressing with collagen sheets in terms of pain, infection and healing at skin graft site. Materials and Methods: It was a prospective interventional study conducted in Department of Surgery, SSG Hospital and Medical College, Baroda, Gujarat, India over a period of November 2012 to November 2017 on 220 participants. Randomisation was done by choosing an envelope containing cards marked ‘A’ or ‘B’. The group A (110) was a study group with collagen sheet dressing while group B (110) was the control group with conventional vaseline gauze dressing. Both group patients were examined at six hours postoperatively and then two times a day at 8:00 am and 8:00 pm daily. They were evaluated for pain with Visual Analogue Scale (VAS) score, infection, haematoma formation, healing at donor site and allergic reaction to collagen. Results: Mean VAS score for pain showed that it decreased over a period of time in both the groups. The group with collagen sheet dressing shows decreasing means VAS score from 4.34 on 1st day to 0.29 on 3rd day (p&lt;0.0001). Similarly, the vaseline gauze dressing shows decreasing mean VAS score from 5.64 on 1st day to 1.39 on 3rd day (p&lt;0.0001). Conclusion: Collagen sheet dressing are easy to apply, with advantage of less pain at donor site and lower infection rate. Also healing time required is less than the vaseline gauze dressing. collagen sheet dressing is clinically more efficient overall.

A cross-sectional observational study assessing the liver function in malarial patients

Background: Malaria is a major cause of morbidity in the tropics, being a disease of global importance that results in 300-500 million cases annually. Liver involvement manifests as jaundice, hyperbilirubinemia, hepatomegaly and elevated enzymes (transaminases and alkaline phosphatase). Our objective in this study was to evaluate the role of liver function as an indicator of malaria in endemic regions and as a marker of disease severity.Methods: This was an observational cross-sectional study conducted in central laboratory, department of pathology, central laboratory, department of biochemistry, and out-patient department, department of medicine, medical college Baroda and SSG hospital over a period of ten months, from February, 2019 to November, 2019 and included 137 microscopy proven malaria positive cases. The parasite density on peripheral smear was graded as scanty, moderate and heavy. After procuring the records of serum bilirubin, SGPT and SGOT, statistical analysis of the data was performed.Results: All the 3 parameters show maximum derangement in severe parasitemia with mean values of 3.57, 81.44, and 92.9. While comparing vivax and falciparum malaria, all the LFTs studied show greater derangement in Plasmodium Falciparum when compared to Plasmodium vivax, with greatest difference seen in bilirubin levels (27.78% cases with hyperbilirubinemia in Plasmodium vivax versus 71.43% cases of Plasmodium falciparum showing hyperbilirubinemia).Conclusions: We conclude that altered liver function in form of hyperbilirubinemia and increased liver enzymes in a patient with acute febrile illness increase the probability of malaria, hence directing the clinician along the correct path of further work-up and accurate treatment.