Petrositis is a rare complication of chronic otitis media. It is known to cause variety of intratemporal and intracranial complications, if not managed timely. Traditionally, surgery was advocated, but with better antibiotics availability, focus is now more on conservative treatment. We hereby present a rare case of petrositis, without full triad of Gradenigo’s syndrome and being managed by intravenous antibiotic only. This highlights importance of early diagnosis and treatment. A 19-year-old male presented with discharge from left ear and left sided headache, (becoming holocranial) for 2 years, with increased severity since a month. Discharge was scanty and yellowish; blood tinged occasionally and was often foul smelling. The headache was insidious, gradually worsening, aggravated by cold food intake and exposure to cold weather. He also gave history of mild hearing loss from left ear. There was history of some improvement with oral antibiotics, prescribed by local practitioners, but the relief was incomplete and lasted shortly. He had no complain of trauma to head or ear, double vision, vomiting, fever or facial weakness. Physical examination was normal especially with respect to extra ocular muscles (Fig.1) and muscles of facial expression.
{"title":"Petrositis Following Chronic Otitis Media without Gradenigo’s, Treated without Surgery","authors":"Viswanath, Manish Gupta","doi":"10.18410/jebmh/2021/609","DOIUrl":"https://doi.org/10.18410/jebmh/2021/609","url":null,"abstract":"Petrositis is a rare complication of chronic otitis media. It is known to cause variety of intratemporal and intracranial complications, if not managed timely. Traditionally, surgery was advocated, but with better antibiotics availability, focus is now more on conservative treatment. We hereby present a rare case of petrositis, without full triad of Gradenigo’s syndrome and being managed by intravenous antibiotic only. This highlights importance of early diagnosis and treatment. A 19-year-old male presented with discharge from left ear and left sided headache, (becoming holocranial) for 2 years, with increased severity since a month. Discharge was scanty and yellowish; blood tinged occasionally and was often foul smelling. The headache was insidious, gradually worsening, aggravated by cold food intake and exposure to cold weather. He also gave history of mild hearing loss from left ear. There was history of some improvement with oral antibiotics, prescribed by local practitioners, but the relief was incomplete and lasted shortly. He had no complain of trauma to head or ear, double vision, vomiting, fever or facial weakness. Physical examination was normal especially with respect to extra ocular muscles (Fig.1) and muscles of facial expression.","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86599593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND In developing countries like India, it is essential to spread awareness about cataract and its complications like lens induced glaucoma, uveitis. Lens induced glaucoma (LIG) can lead to irreversible blindness due to secondary optic atrophy. The purpose of this study was to stress on early diagnosis and timely management in preventing blindness due to lens induced glaucoma in patients visiting ESIC Medical College and Hospital, Gulbarga. Karnataka. METHODS This retrospective descriptive type of statistical study was conducted in the Department of Ophthalmology, ESIC Medical College and Hospital, Gulbarga. Karnataka, from March 2018 to March 2021. Intraocular pressure (IOP) and visual acuity was recorded in all patients after through history taking, ocular examination and fundoscopy. After subjecting for exclusion criteria, cases of LIG were confirmed and included in the study. RESULTS In our study we found total 25 cases having LIG, in that 9 were male patients (36 %) and 16 were females (64 %). Phacomorphic glaucoma was recorded in 19 patients (76 %) and phacolytic glaucoma in 5 cases (20 %). Intraocular pressure of 40 - 49 mmHg was recorded in 16 patients (64 %) followed by 30 – 39 mmHg in 5 patients (20 %) and 50 – 59 mmHg in 4 patients (16 %). In our study, 13 patients had visual acuity of counting fingers (CF) 3 meters to 5 meters (52 %) followed by 6/60 to 6/24 (20 %) and hand movements to counting fingers 3 metres in (12 %) and one patient had no perception of light (4 %). All patients underwent cataract surgery with intraocular implantation under local anaesthesia. After 2 weeks of follow up, vision restored was between 6/9 - 6/18 (40 %) in 10 patients followed by 6/18 - 6/60 (28 %) in 7 patients and no improvement in vision in one patient. CONCLUSIONS Glaucoma is one of the causes for irreversible blindness. Though overall prevalence is less than 5 % but gets its one of major contribution from lens induced glaucoma. One good thing about LIG is patient presents early due to loss of vision and pain, so if we intervene with early diagnosis and manage patients, vision can be restored successfully. KEYWORDS LIG, Cataract, IOP, Phacomorphic Glaucoma, Photolytic Glaucoma
{"title":"Clinical Study of Lens–Induced Glaucoma in Elderly Population of Gulbarga","authors":"Jyothi N. Sanganal, K. Manish","doi":"10.18410/jebmh/2021/606","DOIUrl":"https://doi.org/10.18410/jebmh/2021/606","url":null,"abstract":"BACKGROUND In developing countries like India, it is essential to spread awareness about cataract and its complications like lens induced glaucoma, uveitis. Lens induced glaucoma (LIG) can lead to irreversible blindness due to secondary optic atrophy. The purpose of this study was to stress on early diagnosis and timely management in preventing blindness due to lens induced glaucoma in patients visiting ESIC Medical College and Hospital, Gulbarga. Karnataka. METHODS This retrospective descriptive type of statistical study was conducted in the Department of Ophthalmology, ESIC Medical College and Hospital, Gulbarga. Karnataka, from March 2018 to March 2021. Intraocular pressure (IOP) and visual acuity was recorded in all patients after through history taking, ocular examination and fundoscopy. After subjecting for exclusion criteria, cases of LIG were confirmed and included in the study. RESULTS In our study we found total 25 cases having LIG, in that 9 were male patients (36 %) and 16 were females (64 %). Phacomorphic glaucoma was recorded in 19 patients (76 %) and phacolytic glaucoma in 5 cases (20 %). Intraocular pressure of 40 - 49 mmHg was recorded in 16 patients (64 %) followed by 30 – 39 mmHg in 5 patients (20 %) and 50 – 59 mmHg in 4 patients (16 %). In our study, 13 patients had visual acuity of counting fingers (CF) 3 meters to 5 meters (52 %) followed by 6/60 to 6/24 (20 %) and hand movements to counting fingers 3 metres in (12 %) and one patient had no perception of light (4 %). All patients underwent cataract surgery with intraocular implantation under local anaesthesia. After 2 weeks of follow up, vision restored was between 6/9 - 6/18 (40 %) in 10 patients followed by 6/18 - 6/60 (28 %) in 7 patients and no improvement in vision in one patient. CONCLUSIONS Glaucoma is one of the causes for irreversible blindness. Though overall prevalence is less than 5 % but gets its one of major contribution from lens induced glaucoma. One good thing about LIG is patient presents early due to loss of vision and pain, so if we intervene with early diagnosis and manage patients, vision can be restored successfully. KEYWORDS LIG, Cataract, IOP, Phacomorphic Glaucoma, Photolytic Glaucoma","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78948162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND Most common osseous destructive lesions effecting the jawbone are odontogenic cystic lesions, which are lined by epithelium, has been involved in the formation of teeth as the epithelial cell rest are present in jawbone after teeth formation. The three most common odontogenic cysts (OCs) are radicular cyst (RC), dentigerous cyst (DC) and the odontogenic keratocyst (OKC). Less common variety is the residual cyst. Odontogenic cysts are mainly developmental and inflammatory in origin. The objective of the present study was to find clinico-radiographic characteristics of odontogenic cysts in the mandible. METHODS This was a case series (descriptive) study on OCs of mandible conducted at Tripura Medical College and Dr BRAM Teaching Hospital, Hapania, Agartala, Tripura (W), India, over a period of 6 months from August 2019 to January 2020. Subjects showing clinico-radiographic features of OCs in mandible were included, subsequently confirmed by histopathological examinations. Usually orthopantomograms (OPGs) and intra oral peri apical radiograph (IOPAs) were done for radiological findings, computed tomography (CT) scan was required for examination of the size of lesion. Data were analysed using windows excel. RESULTS Diagnosis of OCs was confirmed in 20 patients, among them, males were (60 %) and female were (40 %). The age range of the patients was 17 - 65 years. Most common type of cyst diagnosed in the study was radicular cyst in 50 % cases followed by dentigerous cysts which were in 30 % cases, odontogenic keratocysts were in 15 % patients and others were 5 %. RCs were represented in higher percentage (50 %). Right side of mandible was the most effected side (60 %) than left side (40 %). Main finding of the study was, in every type of cystic lesions, males were recorded as predominant, and it occurred in early age group. CONCLUSIONS Main finding of the study was radicular cyst which was in higher percentage (50 %) and was being most common with association of carious tooth. KEYWORDS Odontogenic Cysts, Mandible, Finding
{"title":"Clinico-Radiological Study of Odontogenic Cysts in Mandibular Region from Agartala, Tripura","authors":"Amit Goswami, M. Saha","doi":"10.18410/jebmh/2021/608","DOIUrl":"https://doi.org/10.18410/jebmh/2021/608","url":null,"abstract":"BACKGROUND Most common osseous destructive lesions effecting the jawbone are odontogenic cystic lesions, which are lined by epithelium, has been involved in the formation of teeth as the epithelial cell rest are present in jawbone after teeth formation. The three most common odontogenic cysts (OCs) are radicular cyst (RC), dentigerous cyst (DC) and the odontogenic keratocyst (OKC). Less common variety is the residual cyst. Odontogenic cysts are mainly developmental and inflammatory in origin. The objective of the present study was to find clinico-radiographic characteristics of odontogenic cysts in the mandible. METHODS This was a case series (descriptive) study on OCs of mandible conducted at Tripura Medical College and Dr BRAM Teaching Hospital, Hapania, Agartala, Tripura (W), India, over a period of 6 months from August 2019 to January 2020. Subjects showing clinico-radiographic features of OCs in mandible were included, subsequently confirmed by histopathological examinations. Usually orthopantomograms (OPGs) and intra oral peri apical radiograph (IOPAs) were done for radiological findings, computed tomography (CT) scan was required for examination of the size of lesion. Data were analysed using windows excel. RESULTS Diagnosis of OCs was confirmed in 20 patients, among them, males were (60 %) and female were (40 %). The age range of the patients was 17 - 65 years. Most common type of cyst diagnosed in the study was radicular cyst in 50 % cases followed by dentigerous cysts which were in 30 % cases, odontogenic keratocysts were in 15 % patients and others were 5 %. RCs were represented in higher percentage (50 %). Right side of mandible was the most effected side (60 %) than left side (40 %). Main finding of the study was, in every type of cystic lesions, males were recorded as predominant, and it occurred in early age group. CONCLUSIONS Main finding of the study was radicular cyst which was in higher percentage (50 %) and was being most common with association of carious tooth. KEYWORDS Odontogenic Cysts, Mandible, Finding","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88610001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND Intercondylar humerus fractures and low transcondylar type fractures of distal humeral often require surgical exposure and anatomical reduction of the articular surface as well as stabilization of the medial and lateral columns of the distal humerus. Traditionally, these injuries have been treated surgically with various extensor mechanism-disrupting surgical approaches. These approaches have often led to delayed union or non-union of the olecranon, triceps weakness, and osteotomy-related prominent implants. To avoid these problems, various extensor mechanism-sparing approaches that provide bicolumnar exposure of the distal part of the humerus have been described, including triceps-splitting and reflecting techniques. The paratricipital approach was developed to avoid the problems of olecranon osteotomy approach for non comminuted distal humerus fractures. The purpose of this study was to compare the paratricipital approach with olecranon osteotomy and evaluate their effects on the functional outcomes of intercondylar fractures of the distal humerus managed with open reduction and internal fixation (ORIF) by reviewing 38 cases of intercondylar distal humerus fractures surgically managed with either of the approaches during 2015 - 2017. METHODS The retrospective study was conducted at our institution, R.G. Kar Medical College, Kolkata from May 2015 to May 2017. OA type C1 and C2 fractures were included in the study. Type C3 fractures were excluded from the study. Distal humeral open reduction and internal fixation (ORIF) was performed with either orthogonal or parallel plate constructs in 38 patients, where paratricipital approach was used in 21 patients and olecranon osteotomy was done for 17 patients. RESULTS Patients in the paratricipital approach group seems to have better range of motion in terms of flexion and extension. Moreover, mayo elbow performance score (MEPS) of the paratricipital group is better than that of olecranon osteotomy group, even more so in younger age groups. CONCLUSIONS We found that ORIF via the paratricipital approach would confer better functional outcomes for simple intra-articular distal humerus fractures in patients of all age groups. KEYWORDS Distal Humerus Fracture, Paratricipital, Olecranon Osteotomy
{"title":"Comparative Analysis of Results of Paratricipital Approach and Olecranon Osteotomy in Non Comminuted Distal Humerus Fractures - A Retrospective Study Conducted at a Tertiary Hospital in Kolkata","authors":"Subhadeep Ghosh, Sunit Hazra","doi":"10.18410/jebmh/2021/602","DOIUrl":"https://doi.org/10.18410/jebmh/2021/602","url":null,"abstract":"BACKGROUND Intercondylar humerus fractures and low transcondylar type fractures of distal humeral often require surgical exposure and anatomical reduction of the articular surface as well as stabilization of the medial and lateral columns of the distal humerus. Traditionally, these injuries have been treated surgically with various extensor mechanism-disrupting surgical approaches. These approaches have often led to delayed union or non-union of the olecranon, triceps weakness, and osteotomy-related prominent implants. To avoid these problems, various extensor mechanism-sparing approaches that provide bicolumnar exposure of the distal part of the humerus have been described, including triceps-splitting and reflecting techniques. The paratricipital approach was developed to avoid the problems of olecranon osteotomy approach for non comminuted distal humerus fractures. The purpose of this study was to compare the paratricipital approach with olecranon osteotomy and evaluate their effects on the functional outcomes of intercondylar fractures of the distal humerus managed with open reduction and internal fixation (ORIF) by reviewing 38 cases of intercondylar distal humerus fractures surgically managed with either of the approaches during 2015 - 2017. METHODS The retrospective study was conducted at our institution, R.G. Kar Medical College, Kolkata from May 2015 to May 2017. OA type C1 and C2 fractures were included in the study. Type C3 fractures were excluded from the study. Distal humeral open reduction and internal fixation (ORIF) was performed with either orthogonal or parallel plate constructs in 38 patients, where paratricipital approach was used in 21 patients and olecranon osteotomy was done for 17 patients. RESULTS Patients in the paratricipital approach group seems to have better range of motion in terms of flexion and extension. Moreover, mayo elbow performance score (MEPS) of the paratricipital group is better than that of olecranon osteotomy group, even more so in younger age groups. CONCLUSIONS We found that ORIF via the paratricipital approach would confer better functional outcomes for simple intra-articular distal humerus fractures in patients of all age groups. KEYWORDS Distal Humerus Fracture, Paratricipital, Olecranon Osteotomy","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"59 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74493410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND Intrahepatic cholestasis of pregnancy (ICP) is a multifactorial pregnancy specific liver disorder which is also known as obstetric cholestasis. The purpose of this study was to establish the value of maternal serum bile acid in diagnosis of ICP, evaluate the treatment of ICP with UDCA (ursodeoxycholic acid) and its influence on maternal and neonatal outcome. METHODS It was a cross-sectional study. 90 women diagnosed with ICP were studied for a period of 2 years and 3 months at tertiary care government hospital. Statistical analysis was performed using chi square test. ‘P’ value of < 0.05 was considered as statistically significant in this observational study. RESULTS The present study evaluates that ICP is more common in multigravida and in age group of 26 years – 30 years. It recurs in subsequent pregnancies significantly. Itching, most common symptom is commenced at 34 weeks ± 2.85 weeks. Transaminases were normal with elevated serum bile acid levels in 32.33 % cases. The mean gestational age at delivery ranged between 35 to 39 weeks. Most common mode of delivery is lower segment caesarean section (LSCS) with commonest indication as meconium-stained amniotic fluid (MSAF) and 31 babies required neonatal intensive care unit (NICU). CONCLUSIONS Precise diagnosis, follow up, target medication and active management is required. Although maternal outcome for patients is good and without any long-term sequelae, fetal outcome can be devastating. Active management with close antenatal surveillance of the fetus is usually recommended for better perinatal outcome. KEYWORDS Intrahepatic Cholestasis of Pregnancy (ICP), Ursodeoxycholic Acid (UDCA), Neonatal Intensive Care Unit (NICU), Lower Segment Caesarean Section (LSCS)
{"title":"A Study of Obstetric Intrahepatic Cholestasis and Its Maternal and Perinatal Outcome at a Tertiary Care Hospital in Nagpur","authors":"Payal Jaywant Vaidya, Sumit Ashok Kumbhalwar, Makarand Jaywant Vaidya","doi":"10.18410/jebmh/2021/603","DOIUrl":"https://doi.org/10.18410/jebmh/2021/603","url":null,"abstract":"BACKGROUND Intrahepatic cholestasis of pregnancy (ICP) is a multifactorial pregnancy specific liver disorder which is also known as obstetric cholestasis. The purpose of this study was to establish the value of maternal serum bile acid in diagnosis of ICP, evaluate the treatment of ICP with UDCA (ursodeoxycholic acid) and its influence on maternal and neonatal outcome. METHODS It was a cross-sectional study. 90 women diagnosed with ICP were studied for a period of 2 years and 3 months at tertiary care government hospital. Statistical analysis was performed using chi square test. ‘P’ value of < 0.05 was considered as statistically significant in this observational study. RESULTS The present study evaluates that ICP is more common in multigravida and in age group of 26 years – 30 years. It recurs in subsequent pregnancies significantly. Itching, most common symptom is commenced at 34 weeks ± 2.85 weeks. Transaminases were normal with elevated serum bile acid levels in 32.33 % cases. The mean gestational age at delivery ranged between 35 to 39 weeks. Most common mode of delivery is lower segment caesarean section (LSCS) with commonest indication as meconium-stained amniotic fluid (MSAF) and 31 babies required neonatal intensive care unit (NICU). CONCLUSIONS Precise diagnosis, follow up, target medication and active management is required. Although maternal outcome for patients is good and without any long-term sequelae, fetal outcome can be devastating. Active management with close antenatal surveillance of the fetus is usually recommended for better perinatal outcome. KEYWORDS Intrahepatic Cholestasis of Pregnancy (ICP), Ursodeoxycholic Acid (UDCA), Neonatal Intensive Care Unit (NICU), Lower Segment Caesarean Section (LSCS)","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90037492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND Anaesthesia is an integral part of any successful surgery. Advances in cataract surgery have led to changes in delivery of anaesthesia as well. Patient and surgeons’ comfort during anaesthesia and surgery is the single most important factor. In developing countries, small incision cataract is preferred sometimes over phacoemulsification in high volume centers. This study was done to compare patient and surgeon satisfaction following topical anaesthesia (TA) versus peribulbar anaesthesia (PA) for small incision cataract surgery (SICS) with intraocular lens implantation (IOL). METHODS This comparative observational study was done at M.R. Medical College, Kalaburagi over a period of 15 months from November 2018 to April 2020. 400 patients undergoing manual small incision cataract surgery (MSICS) after obtaining consent were included in the study, out of which 200 patients were administered TA while 200 were given PA randomly. Patients were prospectively evaluated for pain during administration, during surgery and 4-hours postoperatively through a questionnaire. RESULTS In our study TA group complained no pain whereas 85 % had mild pain and 13 % had moderate pain in PA group during administration of anaesthesia (P < 0.05). During surgery, none of the patients in both the groups experienced severe pain. 17 % patients in TA group had mild pain at 4 hours while only 4 % patients in PA group had pain (P < 0.05). There was no statistically significant difference in surgeon’s satisfaction between 2 groups. CONCLUSIONS Although the administration of PA is painful compared to TA, the patient satisfaction was more post-operatively in PA group. Topical anaesthesia has gained popularity due to minimal discomfort, speed of onset and lack of PA related complications. It is a safe and effective alternative to PA in MSICS with proper selection and education of patient. KEYWORDS Small Incision Cataract Surgery, Topical Anaesthesia, Peribulbar Anaesthesia
{"title":"Topical Anaesthesia Versus Peribulbar Anaesthesia in Small Incision Cataract Surgery – A Comparative Study from Hyderabad Karnataka Region","authors":"Sumeet Deshpande, Rashmi R. Anwekar, R. Reddy","doi":"10.18410/jebmh/2021/604","DOIUrl":"https://doi.org/10.18410/jebmh/2021/604","url":null,"abstract":"BACKGROUND Anaesthesia is an integral part of any successful surgery. Advances in cataract surgery have led to changes in delivery of anaesthesia as well. Patient and surgeons’ comfort during anaesthesia and surgery is the single most important factor. In developing countries, small incision cataract is preferred sometimes over phacoemulsification in high volume centers. This study was done to compare patient and surgeon satisfaction following topical anaesthesia (TA) versus peribulbar anaesthesia (PA) for small incision cataract surgery (SICS) with intraocular lens implantation (IOL). METHODS This comparative observational study was done at M.R. Medical College, Kalaburagi over a period of 15 months from November 2018 to April 2020. 400 patients undergoing manual small incision cataract surgery (MSICS) after obtaining consent were included in the study, out of which 200 patients were administered TA while 200 were given PA randomly. Patients were prospectively evaluated for pain during administration, during surgery and 4-hours postoperatively through a questionnaire. RESULTS In our study TA group complained no pain whereas 85 % had mild pain and 13 % had moderate pain in PA group during administration of anaesthesia (P < 0.05). During surgery, none of the patients in both the groups experienced severe pain. 17 % patients in TA group had mild pain at 4 hours while only 4 % patients in PA group had pain (P < 0.05). There was no statistically significant difference in surgeon’s satisfaction between 2 groups. CONCLUSIONS Although the administration of PA is painful compared to TA, the patient satisfaction was more post-operatively in PA group. Topical anaesthesia has gained popularity due to minimal discomfort, speed of onset and lack of PA related complications. It is a safe and effective alternative to PA in MSICS with proper selection and education of patient. KEYWORDS Small Incision Cataract Surgery, Topical Anaesthesia, Peribulbar Anaesthesia","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89475323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND Chronic kidney disease (CKD) encloses a continuum of pathophysiological processes associated with deranged kidney function and a progressive decrease in glomerular filtration rate (GFR). There are many anatomic similitudes between cochlea and kidney at an ultra-structural level and antigenic level along with comparable physiological mechanisms, specifically, the active fluid and electrolytes transport in the cochlea and the kidney. The purpose of the present study was to determine the proportion, type and degree of hearing loss in patients with renal disease and its comparison according to the stage of CKD. METHODS The study was conducted on 60 patients of chronic kidney disease labelled as stage 3, 4 and 5 on the basis of GFR. An audiogram charted by pure tone audiometry was used to find the degree of hearing loss and its comparison in patients with moderate, severe and end stage CKD was done. The data was collected and analysed statistically. RESULTS The mean age of patients was 55.58 +/- 11.36 years and the mean duration of CKD was 15.61 months. 90 % patients of CKD had sensorineural hearing loss while 10 % had hearing sensitivity within normal limits. In the present study, mild degree hearing loss and high frequency hearing loss was found to be predominant constituting 68.3 % (n = 41) and 58.3 % (n = 35) respectively. Mild degree of hearing loss was a predominant finding irrespective of the stage and duration of CKD. CONCLUSIONS Sensorineural hearing loss was found predominantly amongst the CKD patients in our study population. Mild degree hearing loss was predominant but there was no correlation between stage of CKD and degree of hearing loss. While there was a significant correlation between degree of hearing loss with duration and haemodialysis amongst the non-diabetic CKD patients. KEYWORDS Chronic Kidney Disease, Sensorineural Hearing Loss
{"title":"To Study the Effect of Chronic Kidney Disease on Hearing Function of the Patients in a Tertiary Care Centre of North India","authors":"J. Sodhi, V. Sarin, Manish Chandey","doi":"10.18410/jebmh/2021/597","DOIUrl":"https://doi.org/10.18410/jebmh/2021/597","url":null,"abstract":"BACKGROUND Chronic kidney disease (CKD) encloses a continuum of pathophysiological processes associated with deranged kidney function and a progressive decrease in glomerular filtration rate (GFR). There are many anatomic similitudes between cochlea and kidney at an ultra-structural level and antigenic level along with comparable physiological mechanisms, specifically, the active fluid and electrolytes transport in the cochlea and the kidney. The purpose of the present study was to determine the proportion, type and degree of hearing loss in patients with renal disease and its comparison according to the stage of CKD. METHODS The study was conducted on 60 patients of chronic kidney disease labelled as stage 3, 4 and 5 on the basis of GFR. An audiogram charted by pure tone audiometry was used to find the degree of hearing loss and its comparison in patients with moderate, severe and end stage CKD was done. The data was collected and analysed statistically. RESULTS The mean age of patients was 55.58 +/- 11.36 years and the mean duration of CKD was 15.61 months. 90 % patients of CKD had sensorineural hearing loss while 10 % had hearing sensitivity within normal limits. In the present study, mild degree hearing loss and high frequency hearing loss was found to be predominant constituting 68.3 % (n = 41) and 58.3 % (n = 35) respectively. Mild degree of hearing loss was a predominant finding irrespective of the stage and duration of CKD. CONCLUSIONS Sensorineural hearing loss was found predominantly amongst the CKD patients in our study population. Mild degree hearing loss was predominant but there was no correlation between stage of CKD and degree of hearing loss. While there was a significant correlation between degree of hearing loss with duration and haemodialysis amongst the non-diabetic CKD patients. KEYWORDS Chronic Kidney Disease, Sensorineural Hearing Loss","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"116 5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84234380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Samrat Ghosh, Ankur B. Shah, Ritwik Chakraborti, Debraj Sen
BACKGROUND An important part of human placental development is the extensive modification of maternal vasculature by trophoblasts. Fetal growth retardation (FGR) and preeclampsia (PE) are associated with deficient trophoblastic invasion and modification of the uterine spiral arteries leading to small-caliber vessels of high resistance which impairs placental blood flow, creating a hypoxic environment and subsequent oxidative stress. FGR and pre-eclampsia are important causes of maternal and perinatal morbidity and mortality and it is important to identify such ‘at risk’ pregnancies during routine antenatal care. Ultrasonography (USG) and colour-Doppler are readily available tools that may be used for identifying such ‘at risk’ pregnancies. The purpose of this study was to evaluate the accuracy of 2-D sonographic placental volumetry, umbilical arterial doppler and uterine arterial doppler in predicting adverse fetomaternal outcomes and compare the accuracy of these three tests with each other in terms of sensitivity and specificity. METHODS A total of 100 women were randomly selected from the antenatal clinics, and were subject to serial ultrasounds at 12 - 16 weeks, 20 - 24 weeks, and 28 - 32 weeks. The 2-D sonographic placental volume, umbilical and uterine arterial resistivity index (RI), and pulsatility index (PI) were measured. The pregnancies were followed up till delivery and the measurements were plotted against the actual placental weight and development of FGR and/or pre-eclampsia. RESULTS In pregnancies with FGR or pre-eclampsia, the placental volumes were low, and correspondingly the uterine and umbilical arterial RI and PI were high (increased impedance) as compared to the normal pregnancies. For the prediction of adverse outcomes, a receiver operating curve (ROC) analysis showed that placental volume and umbilical artery RI and PI had high sensitivity in the 1st-trimester, and high specificity in the 2nd-trimester. CONCLUSIONS 2-D sonographic placental volumetry and umbilical arterial Doppler studies may be used as 1st-trimester screening tools to predict adverse fetomaternal outcomes. These patients may be subjected to more intensive follow-up to minimize maternal and perinatal morbidity and mortality. KEYWORDS Doppler Ultrasonography; Fetal Growth Retardation; Placenta; Pre-eclampsia; Umbilical Arteries; Uterine Artery
{"title":"Evaluation of Serial 2-D Sonographic Placental Volumetry and Umbilical Arterial Doppler and Their Correlation with Uterine Arterial Doppler in Predicting Adverse Fetomaternal Outcomes – An Observational Study from a Tertiary Care Centre in Pune, India","authors":"Samrat Ghosh, Ankur B. Shah, Ritwik Chakraborti, Debraj Sen","doi":"10.18410/jebmh/2021/595","DOIUrl":"https://doi.org/10.18410/jebmh/2021/595","url":null,"abstract":"BACKGROUND An important part of human placental development is the extensive modification of maternal vasculature by trophoblasts. Fetal growth retardation (FGR) and preeclampsia (PE) are associated with deficient trophoblastic invasion and modification of the uterine spiral arteries leading to small-caliber vessels of high resistance which impairs placental blood flow, creating a hypoxic environment and subsequent oxidative stress. FGR and pre-eclampsia are important causes of maternal and perinatal morbidity and mortality and it is important to identify such ‘at risk’ pregnancies during routine antenatal care. Ultrasonography (USG) and colour-Doppler are readily available tools that may be used for identifying such ‘at risk’ pregnancies. The purpose of this study was to evaluate the accuracy of 2-D sonographic placental volumetry, umbilical arterial doppler and uterine arterial doppler in predicting adverse fetomaternal outcomes and compare the accuracy of these three tests with each other in terms of sensitivity and specificity. METHODS A total of 100 women were randomly selected from the antenatal clinics, and were subject to serial ultrasounds at 12 - 16 weeks, 20 - 24 weeks, and 28 - 32 weeks. The 2-D sonographic placental volume, umbilical and uterine arterial resistivity index (RI), and pulsatility index (PI) were measured. The pregnancies were followed up till delivery and the measurements were plotted against the actual placental weight and development of FGR and/or pre-eclampsia. RESULTS In pregnancies with FGR or pre-eclampsia, the placental volumes were low, and correspondingly the uterine and umbilical arterial RI and PI were high (increased impedance) as compared to the normal pregnancies. For the prediction of adverse outcomes, a receiver operating curve (ROC) analysis showed that placental volume and umbilical artery RI and PI had high sensitivity in the 1st-trimester, and high specificity in the 2nd-trimester. CONCLUSIONS 2-D sonographic placental volumetry and umbilical arterial Doppler studies may be used as 1st-trimester screening tools to predict adverse fetomaternal outcomes. These patients may be subjected to more intensive follow-up to minimize maternal and perinatal morbidity and mortality. KEYWORDS Doppler Ultrasonography; Fetal Growth Retardation; Placenta; Pre-eclampsia; Umbilical Arteries; Uterine Artery","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74266862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND Corona virus disease 2019 (COVID 19) outbreak have evolved rapidly throughout the world. The knowledge on severe acute respiratory disease-corona virus-2 (SARS-CoV-2) infection in pregnant women and newborn is incomplete. Understanding the impact of COVID 19 in pregnancy in terms of morbidity mortality, perinatal and neonatal outcome is essential to propose a strategy for the management of pregnant women with COVID 19 infection. METHOD It is a prospective study of all pregnant women who have delivered in the period of April 2020 to December 2020 at Government T.D. Medical College, Alappuzha. In this study, the mode of delivery, neonatal outcome, maternal mortality, morbidity were evaluated. The outcome of pregnancies includes vaginal delivery, caesarean delivery, vacuum delivery and intrauterine fetal demise. RESULTS A total of 265 pregnant women infected with COVID 19 delivered during the period. Out of these, 49.4 % was full term caesarean delivery, 3.8 % was preterm caesarean delivery, 39.3 % was full term vaginal delivery and 4.9 % was preterm vaginal delivery. Moreover, 1.1 % of the total pregnant women had intrauterine fetal demise on admission. Among 265 new-borns, 2.3 % babies became COVID 19 positive, of this, 83.3 % were mothers who delivered within 7 days of COVID 19 infection. 0.75 % needed resuscitative emergency caesarean delivery for COVID 19 pneumonia. 0.38 % maternal mortality occurred during the period due to COVID 19 infection. CONCLUSIONS Obstetric outcome in most COVID 19 infected term pregnant patients is comparable to non-COVID 19 pregnant women except for a higher incidence of caesarean delivery. Most of the neonates who became positive were born to mothers delivered within 7 days of COVID 19 infection. Severe morbidity among COVID 19 pregnant women were seen only in a small proportion complicated by COVID 19 pneumonia, who required ventilator support. KEYWORDS COVID 19, Pregnancy, Maternal, Perinatal, Neonatal Outcome
{"title":"Maternal and Fetal Outcomes of COVID-19 Positive Pregnant Women in Government T.D. Medical College Alappuzha","authors":"Lalithambica Karunakaran, P. Deepthi, T. Shijini","doi":"10.18410/jebmh/2021/600","DOIUrl":"https://doi.org/10.18410/jebmh/2021/600","url":null,"abstract":"BACKGROUND Corona virus disease 2019 (COVID 19) outbreak have evolved rapidly throughout the world. The knowledge on severe acute respiratory disease-corona virus-2 (SARS-CoV-2) infection in pregnant women and newborn is incomplete. Understanding the impact of COVID 19 in pregnancy in terms of morbidity mortality, perinatal and neonatal outcome is essential to propose a strategy for the management of pregnant women with COVID 19 infection. METHOD It is a prospective study of all pregnant women who have delivered in the period of April 2020 to December 2020 at Government T.D. Medical College, Alappuzha. In this study, the mode of delivery, neonatal outcome, maternal mortality, morbidity were evaluated. The outcome of pregnancies includes vaginal delivery, caesarean delivery, vacuum delivery and intrauterine fetal demise. RESULTS A total of 265 pregnant women infected with COVID 19 delivered during the period. Out of these, 49.4 % was full term caesarean delivery, 3.8 % was preterm caesarean delivery, 39.3 % was full term vaginal delivery and 4.9 % was preterm vaginal delivery. Moreover, 1.1 % of the total pregnant women had intrauterine fetal demise on admission. Among 265 new-borns, 2.3 % babies became COVID 19 positive, of this, 83.3 % were mothers who delivered within 7 days of COVID 19 infection. 0.75 % needed resuscitative emergency caesarean delivery for COVID 19 pneumonia. 0.38 % maternal mortality occurred during the period due to COVID 19 infection. CONCLUSIONS Obstetric outcome in most COVID 19 infected term pregnant patients is comparable to non-COVID 19 pregnant women except for a higher incidence of caesarean delivery. Most of the neonates who became positive were born to mothers delivered within 7 days of COVID 19 infection. Severe morbidity among COVID 19 pregnant women were seen only in a small proportion complicated by COVID 19 pneumonia, who required ventilator support. KEYWORDS COVID 19, Pregnancy, Maternal, Perinatal, Neonatal Outcome","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74111175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 63-year-old male patient with diabetes mellitus, hypertension and chronic kidney disease who has been undergoing haemodialysis thrice weekly developed fever and shivering during haemodialysis for one week. He was doing haemodialysis from elsewhere and presented to nephrology department of our hospital with the same complaints. The patient had an intravenous catheter over left internal jugular vein, which was placed one month back from elsewhere for doing haemodialysis. He is a known case of diabetes mellitus and hypertension for the past ten years and on regular medications. On examination, the patient was moderately built and nourished, pallor was present and icterus, cyanosis, clubbing, lymphadenopathy, oedema were absent. His respiratory, cardiovascular, central nervous and gastro intestinal system examinations were within normal limit. The patient was febrile (101̊ F). pulse rate - 98/min, blood pressure – 150/80 mmHg, respiratory rate - 20 cycles per minute, fasting blood sugar - 140 mg/dl, Hb – 9 mg%, WBC count - 5600/μL. On local examination, mild erythema was noted over his neck on intravenous catheter site of left internal jugular vein. Other investigations were within normal limit. Human immunodeficiency virus (HIV), HBsAg and hepatitis C virus (HCV) antibodies were negative. The urine and sputum cultures were done to rule out any genitourinary or respiratory system involvement. Both cultures yielded no pathogens. The patient was treated with removal of internal jugular vein catheter, and a femoral vein catheter was placed. Blood and tip of intravenous catheter were sent to microbiology laboratory for culture and sensitivity testing. The patient was empirically started on intravenous antibiotic vancomycin.
{"title":"Chryseobacterium indologenes Infection in an Immunocompromised Patient - A Rare Case Report","authors":"Shafeedha Rashbi Karakulangara, R. J. Payyappilly","doi":"10.18410/jebmh/2021/601","DOIUrl":"https://doi.org/10.18410/jebmh/2021/601","url":null,"abstract":"A 63-year-old male patient with diabetes mellitus, hypertension and chronic kidney disease who has been undergoing haemodialysis thrice weekly developed fever and shivering during haemodialysis for one week. He was doing haemodialysis from elsewhere and presented to nephrology department of our hospital with the same complaints. The patient had an intravenous catheter over left internal jugular vein, which was placed one month back from elsewhere for doing haemodialysis. He is a known case of diabetes mellitus and hypertension for the past ten years and on regular medications. On examination, the patient was moderately built and nourished, pallor was present and icterus, cyanosis, clubbing, lymphadenopathy, oedema were absent. His respiratory, cardiovascular, central nervous and gastro intestinal system examinations were within normal limit. The patient was febrile (101̊ F). pulse rate - 98/min, blood pressure – 150/80 mmHg, respiratory rate - 20 cycles per minute, fasting blood sugar - 140 mg/dl, Hb – 9 mg%, WBC count - 5600/μL. On local examination, mild erythema was noted over his neck on intravenous catheter site of left internal jugular vein. Other investigations were within normal limit. Human immunodeficiency virus (HIV), HBsAg and hepatitis C virus (HCV) antibodies were negative. The urine and sputum cultures were done to rule out any genitourinary or respiratory system involvement. Both cultures yielded no pathogens. The patient was treated with removal of internal jugular vein catheter, and a femoral vein catheter was placed. Blood and tip of intravenous catheter were sent to microbiology laboratory for culture and sensitivity testing. The patient was empirically started on intravenous antibiotic vancomycin.","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81093476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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