Mortality in the case of ovarian malignancy is high due to late diagnosis. Early and accurate diagnosis can improve case-specific management. Paired-box gene 8 (PAX8) has proved to be expressed in the ovarian epithelial cells and is considered a new biomarker for early diagnosis. Case–control studies show that the level of PAX8 in the serum and tissue expressions are positively correlated and increased in ovarian malignancy, especially in the high-grade serous type, the most common variety of ovarian malignancies. The aim of this study was to assess the epidemiological spectrum of ovarian neoplastic lesions and a comparative study of conventional cytology and a cellblock of ascitic fluid and subsequent PAX8 immunohistochemistry (IHC) expression to diagnose ovarian neoplasm. We collected clinical data from participants using a predesigned pro forma. We made a cytological diagnosis using conventional cytology, followed by cellblock preparation and subsequent assessment of PAX8 IHC expression. Ascitic fluid received for cellblock was centrifuged, tissue sediment was mixed with plasma, and then drops of thrombin were added. We fixed the clotted sample by adding 10% formalin for 30 min. The formalin-fixed, paraffin-embedded cellblocks were sliced into 4–5 μ sections and stained with hematoxylin and eosin. Subsequently, we used an immunohistochemical stain for PAX8 expression to diagnose ovarian malignancy. We received 55 ascitic fluid samples. On cytological smear examination, 12 (21.8%) cases were benign, 35 (63.6%) were malignant, and the remaining 8 (14.6%) were suspicious of malignancy. On histological examination of cellblock preparation, 43 (78.2%) were malignant cases, and among these 43 cases of cellblocks studied, 37 were positive for PAX8 status; six were negative for PAX8. There was a statistically significant association between malignant cell positivity and PAX8 status in the cellblock (P < 0.001). An evaluation of PAX8 status in ascitic fluid cellblock study should be considered for high-grade ovarian cancers in patients who may benefit from targeted therapies. Patients with ovarian mass and ascites can be evaluated for PAX8 status in their ascitic fluid cytology study for the purpose of neoadjuvant chemotherapy.
{"title":"Ascitic Fluid in Ovarian Mass with Special Reference to Paired-box Gene 8 Immunoexpression: A Cross-sectional Analysis","authors":"Prabhat Mahato, Chhanda Das, Rama Saha, Ankita Pranab Mandal, Gourisankar Kamilya","doi":"10.4103/ijamr.ijamr_275_23","DOIUrl":"https://doi.org/10.4103/ijamr.ijamr_275_23","url":null,"abstract":"\u0000 \u0000 \u0000 Mortality in the case of ovarian malignancy is high due to late diagnosis. Early and accurate diagnosis can improve case-specific management. Paired-box gene 8 (PAX8) has proved to be expressed in the ovarian epithelial cells and is considered a new biomarker for early diagnosis. Case–control studies show that the level of PAX8 in the serum and tissue expressions are positively correlated and increased in ovarian malignancy, especially in the high-grade serous type, the most common variety of ovarian malignancies.\u0000 \u0000 \u0000 \u0000 The aim of this study was to assess the epidemiological spectrum of ovarian neoplastic lesions and a comparative study of conventional cytology and a cellblock of ascitic fluid and subsequent PAX8 immunohistochemistry (IHC) expression to diagnose ovarian neoplasm.\u0000 \u0000 \u0000 \u0000 We collected clinical data from participants using a predesigned pro forma. We made a cytological diagnosis using conventional cytology, followed by cellblock preparation and subsequent assessment of PAX8 IHC expression. Ascitic fluid received for cellblock was centrifuged, tissue sediment was mixed with plasma, and then drops of thrombin were added. We fixed the clotted sample by adding 10% formalin for 30 min. The formalin-fixed, paraffin-embedded cellblocks were sliced into 4–5 μ sections and stained with hematoxylin and eosin. Subsequently, we used an immunohistochemical stain for PAX8 expression to diagnose ovarian malignancy.\u0000 \u0000 \u0000 \u0000 We received 55 ascitic fluid samples. On cytological smear examination, 12 (21.8%) cases were benign, 35 (63.6%) were malignant, and the remaining 8 (14.6%) were suspicious of malignancy. On histological examination of cellblock preparation, 43 (78.2%) were malignant cases, and among these 43 cases of cellblocks studied, 37 were positive for PAX8 status; six were negative for PAX8. There was a statistically significant association between malignant cell positivity and PAX8 status in the cellblock (P < 0.001).\u0000 \u0000 \u0000 \u0000 An evaluation of PAX8 status in ascitic fluid cellblock study should be considered for high-grade ovarian cancers in patients who may benefit from targeted therapies. Patients with ovarian mass and ascites can be evaluated for PAX8 status in their ascitic fluid cytology study for the purpose of neoadjuvant chemotherapy.\u0000","PeriodicalId":32355,"journal":{"name":"International Journal of Advanced Medical and Health Research","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141834647","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}
Pub Date : 2024-06-06DOI: 10.4103/ijamr.ijamr_265_23
J. R. Selvaraj, Anjana N Sathyan, N. Plakkal, K. E. Sivavignesh
Neonatal electrocardiogram (ECG) screening can potentially identify congenital long QT syndrome and other heart diseases. Early identification is likely to reduce mortality. A barrier is the difficulty in obtaining a 12-lead ECG in an infant. We aimed to assess the feasibility of using a single lead ECG recorded with a handheld device (Eko DUO) in neonates. This cross-sectional study included neonates in the first 3 days of life. We recorded a single-lead ECG using the Eko DUO. Time from the beginning of recording until a satisfactory recording was measured with a stopwatch and reported as mean and standard deviation. We reported the ratio of interpretable recordings and the proportion of those with any abnormalities. The mean time for recording was 198.1 ± 94.7 s. The total number of interpretable recordings was 63% (n = 63). Of the interpretable recordings, one neonate was found to have tachycardia (1.6%). Neonatal ECG screening using Eko DUO is feasible. However, the fidelity of the recorded ECG is suboptimal. While most of the ECGs were interpretable for rate and rhythm, QT interval measurement was not possible in most neonates.
{"title":"Feasibility and Utility of Single-lead Electrocardiogram Recorded with a Handheld Device for Screening of Neonates: A Pilot Study","authors":"J. R. Selvaraj, Anjana N Sathyan, N. Plakkal, K. E. Sivavignesh","doi":"10.4103/ijamr.ijamr_265_23","DOIUrl":"https://doi.org/10.4103/ijamr.ijamr_265_23","url":null,"abstract":"\u0000 \u0000 \u0000 Neonatal electrocardiogram (ECG) screening can potentially identify congenital long QT syndrome and other heart diseases. Early identification is likely to reduce mortality. A barrier is the difficulty in obtaining a 12-lead ECG in an infant. We aimed to assess the feasibility of using a single lead ECG recorded with a handheld device (Eko DUO) in neonates.\u0000 \u0000 \u0000 \u0000 This cross-sectional study included neonates in the first 3 days of life. We recorded a single-lead ECG using the Eko DUO. Time from the beginning of recording until a satisfactory recording was measured with a stopwatch and reported as mean and standard deviation. We reported the ratio of interpretable recordings and the proportion of those with any abnormalities.\u0000 \u0000 \u0000 \u0000 The mean time for recording was 198.1 ± 94.7 s. The total number of interpretable recordings was 63% (n = 63). Of the interpretable recordings, one neonate was found to have tachycardia (1.6%).\u0000 \u0000 \u0000 \u0000 Neonatal ECG screening using Eko DUO is feasible. However, the fidelity of the recorded ECG is suboptimal. While most of the ECGs were interpretable for rate and rhythm, QT interval measurement was not possible in most neonates.\u0000","PeriodicalId":32355,"journal":{"name":"International Journal of Advanced Medical and Health Research","volume":"45 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141376515","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}
Pub Date : 2024-06-06DOI: 10.4103/ijamr.ijamr_332_23
Paruvathavarthini Thambiraj, Swetha Venkatakrishnan, D. Gochhait, J. Rekha
Pathological examination plays a significant role in diagnosing and distinguishing benign and malignant tumors of the salivary gland. One such lesion which mimics malignancy clinically is sclerosing polycystic adenosis (SPA). This is a rare benign reactive lesion of the salivary glands included in the WHO 2017 classification in the “non-neoplastic epithelial lesion” category. Here, we describe a young female with SPA of the parotid gland showing classic histomorphological features. We clinically suspected a malignancy as it was recurrent with an expansile growth pattern. Awareness of this nonneoplastic rare entity is crucial to avoid misdiagnosis as it mimics malignancy.
{"title":"Recurrent Sclerosing Polycystic Adenosis of the Parotid Gland: An Entity with Distinct Histomorphology on Biopsy","authors":"Paruvathavarthini Thambiraj, Swetha Venkatakrishnan, D. Gochhait, J. Rekha","doi":"10.4103/ijamr.ijamr_332_23","DOIUrl":"https://doi.org/10.4103/ijamr.ijamr_332_23","url":null,"abstract":"\u0000 Pathological examination plays a significant role in diagnosing and distinguishing benign and malignant tumors of the salivary gland. One such lesion which mimics malignancy clinically is sclerosing polycystic adenosis (SPA). This is a rare benign reactive lesion of the salivary glands included in the WHO 2017 classification in the “non-neoplastic epithelial lesion” category. Here, we describe a young female with SPA of the parotid gland showing classic histomorphological features. We clinically suspected a malignancy as it was recurrent with an expansile growth pattern. Awareness of this nonneoplastic rare entity is crucial to avoid misdiagnosis as it mimics malignancy.","PeriodicalId":32355,"journal":{"name":"International Journal of Advanced Medical and Health Research","volume":"34 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141377612","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}
Pub Date : 2024-05-22DOI: 10.4103/ijamr.ijamr_281_23
Biswajit Majumder, S. Chakraborty, Rammohan Roy, S. Sarkar, Ratul Ghosh
Tetralogy of Fallot (TOF) with absent pulmonary valve (APV) is a rare congenital heart disease with a 2% incidence among patients of TOF. The main hallmark of the disease is the presence of a rudimentary pulmonary valve or a ridge-like structure with pulmonary regurgitation and a hugely dilated main pulmonary artery. It has a perinatal mortality of 14%–64%, depending on the severity of the disease. Surgical correction is done urgently in severely symptomatic patients, whereas surgery can be delayed in asymptomatic or mildly symptomatic patients. In the last 2 years (July 2021–June 2023) in our single tertiary care center, five patients of TOF with APV with varying severity have been documented. Among these five patients, two patients had cyanosis and three patients had recurrent cough and cold during childhood. Two patients were diagnosed during health screening. One newborn had respiratory distress due to compression of the tracheobronchial tree by a hugely dilated pulmonary artery. TOF with APV has features of both pulmonary stenosis and regurgitation, a malaligned ventricular septal defect, and a dilated pulmonary artery. The direction of the shunt depends on the severity of pulmonary stenosis. Patients with left-to-right shunt may develop pulmonary artery hypertension depending on flow and gradient across the pulmonary valve. Patients with a massively dilated pulmonary trunk obstructing the tracheobronchial tree and patients with right-to-left shunt and cyanosis usually have worse outcomes. Often, the disease is diagnosed in late childhood, particularly in mildly symptomatic and asymptomatic patients.
{"title":"Tetralogy of Fallot with Absent Pulmonary Valve: A Single-center Experience","authors":"Biswajit Majumder, S. Chakraborty, Rammohan Roy, S. Sarkar, Ratul Ghosh","doi":"10.4103/ijamr.ijamr_281_23","DOIUrl":"https://doi.org/10.4103/ijamr.ijamr_281_23","url":null,"abstract":"\u0000 Tetralogy of Fallot (TOF) with absent pulmonary valve (APV) is a rare congenital heart disease with a 2% incidence among patients of TOF. The main hallmark of the disease is the presence of a rudimentary pulmonary valve or a ridge-like structure with pulmonary regurgitation and a hugely dilated main pulmonary artery. It has a perinatal mortality of 14%–64%, depending on the severity of the disease. Surgical correction is done urgently in severely symptomatic patients, whereas surgery can be delayed in asymptomatic or mildly symptomatic patients. In the last 2 years (July 2021–June 2023) in our single tertiary care center, five patients of TOF with APV with varying severity have been documented. Among these five patients, two patients had cyanosis and three patients had recurrent cough and cold during childhood. Two patients were diagnosed during health screening. One newborn had respiratory distress due to compression of the tracheobronchial tree by a hugely dilated pulmonary artery. TOF with APV has features of both pulmonary stenosis and regurgitation, a malaligned ventricular septal defect, and a dilated pulmonary artery. The direction of the shunt depends on the severity of pulmonary stenosis. Patients with left-to-right shunt may develop pulmonary artery hypertension depending on flow and gradient across the pulmonary valve. Patients with a massively dilated pulmonary trunk obstructing the tracheobronchial tree and patients with right-to-left shunt and cyanosis usually have worse outcomes. Often, the disease is diagnosed in late childhood, particularly in mildly symptomatic and asymptomatic patients.","PeriodicalId":32355,"journal":{"name":"International Journal of Advanced Medical and Health Research","volume":"36 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141110785","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}
Male infertility is a concern affecting approximately 8% of couples worldwide, with ejaculatory duct obstruction contributing to about 5% of male infertility cases. Prostatic utricle cysts are a rare but surgically correctable cause of ejaculatory duct obstruction. While often asymptomatic, these cysts can manifest as azoospermia with low ejaculate volume, necessitating intervention for fertility restoration. We present the case of a 22-year-old newly married male with azoospermia and otherwise unremarkable medical history. Clinical examination revealed normal bilateral vas deferens and epididymis, along with low ejaculate volume. Testicular size, follicle-stimulating hormone, and testosterone levels were within the normal range. Transabdominal ultrasound uncovered a midline cystic structure within the prostate. Bilateral testicular fine-needle aspiration confirmed the presence of spermatozoa at various stages of development. The patient underwent urethroscopy, bilateral retrograde seminal vesiculography, and transurethral resection of the midline prostatic cyst. At 3 months, the follow-up revealed normal semen analysis. Transurethral resection of the roof of the midline prostatic cyst can effectively restore fertility in cases of ejaculatory duct obstruction. Precise resection technique is crucial to prevent damage to the urethral sphincter and subsequent incontinence. This approach offers a favorable prognosis for fertility restoration in patients with prostatic utricle cysts and associated azoospermia.
{"title":"A Rare Case of Prostatic Utricle Cyst Causing Obstructive Azoospermia","authors":"Madhur Anand, Bhupendra Pal Singh, Ujjawal Jain, Nitish Dev, Mayank Kesharwani","doi":"10.4103/ijamr.ijamr_317_23","DOIUrl":"https://doi.org/10.4103/ijamr.ijamr_317_23","url":null,"abstract":"\u0000 Male infertility is a concern affecting approximately 8% of couples worldwide, with ejaculatory duct obstruction contributing to about 5% of male infertility cases. Prostatic utricle cysts are a rare but surgically correctable cause of ejaculatory duct obstruction. While often asymptomatic, these cysts can manifest as azoospermia with low ejaculate volume, necessitating intervention for fertility restoration. We present the case of a 22-year-old newly married male with azoospermia and otherwise unremarkable medical history. Clinical examination revealed normal bilateral vas deferens and epididymis, along with low ejaculate volume. Testicular size, follicle-stimulating hormone, and testosterone levels were within the normal range. Transabdominal ultrasound uncovered a midline cystic structure within the prostate. Bilateral testicular fine-needle aspiration confirmed the presence of spermatozoa at various stages of development. The patient underwent urethroscopy, bilateral retrograde seminal vesiculography, and transurethral resection of the midline prostatic cyst. At 3 months, the follow-up revealed normal semen analysis. Transurethral resection of the roof of the midline prostatic cyst can effectively restore fertility in cases of ejaculatory duct obstruction. Precise resection technique is crucial to prevent damage to the urethral sphincter and subsequent incontinence. This approach offers a favorable prognosis for fertility restoration in patients with prostatic utricle cysts and associated azoospermia.","PeriodicalId":32355,"journal":{"name":"International Journal of Advanced Medical and Health Research","volume":"57 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141111482","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}
Pub Date : 2024-05-15DOI: 10.4103/ijamr.ijamr_237_23
Mitra Kar, Romya Singh, Ashima Jamwal, Akanksha Dubey, Nidhi Tejan, M. Gurjar, C. Sahu
Ventilator-associated pneumonia (VAP) in acute respiratory distress syndrome patients is expected in the setting of prolonged mechanical ventilation due to abridged immunity and dysregulation of the microorganisms inhabiting the oral cavity. We conducted this study to identify the spectrum of microorganisms causing VAP in patients admitted to the medicine intensive care unit (MICU) and their antibiotic susceptibility patterns. We conducted a retrospective cross-sectional laboratory-based study from January 2021 to April 2021. Our cohort included patients with respiratory distress who were admitted to the MICU. We observed the incidence of VAP and the risk factors responsible for multidrug resistance (MDR) microorganisms in the MICU, along with 250-day survival in the existence of specific comorbidities along with VAP. Clinical charts of patients (n = 366) admitted to the MICU between January 2021 and April 2021 were used. The mean age of patients admitted to MICU was 57.3 ± 18.7 years with a male predominance (n = 252, 68.8%). VAP was diagnosed in 69.1% (n = 253) of patients, and the most common microorganism in our cohort was Klebsiella pneumoniae (n = 78, 30.8%), followed by Acinetobacter spp. (n = 77, 30.4%). None of the K. pneumoniae isolates (n = 0/78) and only a minority of Acinetobacter spp. (n = 4/77, 5.2%) and Pseudomonas aeruginosa isolates (n = 8/54, 14.8%) were susceptible to fluoroquinolones. A higher proportion of K. pneumoniae (n = 1/78, 1.3%), Acinetobacter spp. (n = 2/77, 2.6%), and P. aeruginosa isolates (n = 9/54, 16.7%) were susceptible to aminoglycosides. The incidence rate of MDR microorganisms among the 253 patients diagnosed with VAP was 92.8% (n = 219/253). There is a high prevalence of multidrug resistance (MDR) isolates among those causing VAP in the MICU setting. Knowing the broad spectrum of causative pathogens and their susceptibility to various antibiotics may guide the physician injudicious and appropriate use of antibiotics for treatment.
{"title":"Prevalence of Ventilator Associated Pneumonia Caused by Multidrug Resistant Isolates in an Intensive Care Unit Setting at a University Hospital","authors":"Mitra Kar, Romya Singh, Ashima Jamwal, Akanksha Dubey, Nidhi Tejan, M. Gurjar, C. Sahu","doi":"10.4103/ijamr.ijamr_237_23","DOIUrl":"https://doi.org/10.4103/ijamr.ijamr_237_23","url":null,"abstract":"\u0000 \u0000 \u0000 Ventilator-associated pneumonia (VAP) in acute respiratory distress syndrome patients is expected in the setting of prolonged mechanical ventilation due to abridged immunity and dysregulation of the microorganisms inhabiting the oral cavity. We conducted this study to identify the spectrum of microorganisms causing VAP in patients admitted to the medicine intensive care unit (MICU) and their antibiotic susceptibility patterns.\u0000 \u0000 \u0000 \u0000 We conducted a retrospective cross-sectional laboratory-based study from January 2021 to April 2021. Our cohort included patients with respiratory distress who were admitted to the MICU. We observed the incidence of VAP and the risk factors responsible for multidrug resistance (MDR) microorganisms in the MICU, along with 250-day survival in the existence of specific comorbidities along with VAP.\u0000 \u0000 \u0000 \u0000 Clinical charts of patients (n = 366) admitted to the MICU between January 2021 and April 2021 were used. The mean age of patients admitted to MICU was 57.3 ± 18.7 years with a male predominance (n = 252, 68.8%). VAP was diagnosed in 69.1% (n = 253) of patients, and the most common microorganism in our cohort was Klebsiella pneumoniae (n = 78, 30.8%), followed by Acinetobacter spp. (n = 77, 30.4%). None of the K. pneumoniae isolates (n = 0/78) and only a minority of Acinetobacter spp. (n = 4/77, 5.2%) and Pseudomonas aeruginosa isolates (n = 8/54, 14.8%) were susceptible to fluoroquinolones. A higher proportion of K. pneumoniae (n = 1/78, 1.3%), Acinetobacter spp. (n = 2/77, 2.6%), and P. aeruginosa isolates (n = 9/54, 16.7%) were susceptible to aminoglycosides. The incidence rate of MDR microorganisms among the 253 patients diagnosed with VAP was 92.8% (n = 219/253).\u0000 \u0000 \u0000 \u0000 There is a high prevalence of multidrug resistance (MDR) isolates among those causing VAP in the MICU setting. Knowing the broad spectrum of causative pathogens and their susceptibility to various antibiotics may guide the physician injudicious and appropriate use of antibiotics for treatment.\u0000","PeriodicalId":32355,"journal":{"name":"International Journal of Advanced Medical and Health Research","volume":"55 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140972163","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}
Pub Date : 2024-05-15DOI: 10.4103/ijamr.ijamr_307_23
P. Kundra, P. G. Raju, Stalin Vinayagam, Vikram Kate
The aim of this study was to evaluate the feasibility of ultrasound-guided pectoral nerve block combined with interpleural block for surgical anesthesia during the modified radical mastectomy (MRM). Thirty-six female patients scheduled to undergo MRM were included in this study. After taking all aseptic precautions, an ultrasound-guided pectoral nerve block and interpleural block were performed with 20 ml of 0.25% bupivacaine for each block. We started all patients on dexmedetomidine infusion to achieve conscious sedation and used injection ketamine as rescue analgesia. We recorded hemodynamic parameters throughout the surgery and visual analog scale scores of pain at baseline and after providing rescue analgesia. Postoperatively, we assessed surgeon and patient satisfaction scores. MRM was completed in 31 (86%) out of the 36 recruited patients. Among these 31 patients, 5 (16%) did not require a rescue dose of ketamine, 14 (45%) required one rescue dose, and 12 (39%) patients required two rescue doses of ketamine. Postoperatively, the median patient and surgeon satisfaction scores were 85 (75–90) and 85 (80–90), respectively. The mean dose of dexmedetomidine was 175 (±27) μg, and the mean dose of ketamine was 32.8 (±6) mg. No serious adverse events were reported. MRM can be feasibly performed under ultrasound-guided pectoral nerve block and interpleural block, along with conscious sedation, without any significant adverse events.
{"title":"Ultrasound-guided Pectoral Nerve Block in Combination with Interpleural Block for Surgical Anesthesia during Breast Cancer Surgery: A Prospective Feasibility Study","authors":"P. Kundra, P. G. Raju, Stalin Vinayagam, Vikram Kate","doi":"10.4103/ijamr.ijamr_307_23","DOIUrl":"https://doi.org/10.4103/ijamr.ijamr_307_23","url":null,"abstract":"\u0000 \u0000 \u0000 The aim of this study was to evaluate the feasibility of ultrasound-guided pectoral nerve block combined with interpleural block for surgical anesthesia during the modified radical mastectomy (MRM).\u0000 \u0000 \u0000 \u0000 Thirty-six female patients scheduled to undergo MRM were included in this study. After taking all aseptic precautions, an ultrasound-guided pectoral nerve block and interpleural block were performed with 20 ml of 0.25% bupivacaine for each block. We started all patients on dexmedetomidine infusion to achieve conscious sedation and used injection ketamine as rescue analgesia. We recorded hemodynamic parameters throughout the surgery and visual analog scale scores of pain at baseline and after providing rescue analgesia. Postoperatively, we assessed surgeon and patient satisfaction scores.\u0000 \u0000 \u0000 \u0000 MRM was completed in 31 (86%) out of the 36 recruited patients. Among these 31 patients, 5 (16%) did not require a rescue dose of ketamine, 14 (45%) required one rescue dose, and 12 (39%) patients required two rescue doses of ketamine. Postoperatively, the median patient and surgeon satisfaction scores were 85 (75–90) and 85 (80–90), respectively. The mean dose of dexmedetomidine was 175 (±27) μg, and the mean dose of ketamine was 32.8 (±6) mg. No serious adverse events were reported.\u0000 \u0000 \u0000 \u0000 MRM can be feasibly performed under ultrasound-guided pectoral nerve block and interpleural block, along with conscious sedation, without any significant adverse events.\u0000","PeriodicalId":32355,"journal":{"name":"International Journal of Advanced Medical and Health Research","volume":"60 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140973573","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}
Pub Date : 2024-04-24DOI: 10.4103/ijamr.ijamr_187_23
I. Udenze, Idowu Adewunmi Taiwo, C. Amadi, W. Adeyemo
Gene–environment interactions play a major role in the phenotypic expression of complex disease traits such as those for cardiovascular diseases. This study aimed to determine the gene–environment interactions that underpin the relationship between interleukin-10 (IL-10) single-nucleotide polymorphism (1082 G/A [rs1800896]) with lifestyle on cardiovascular disease risk in adult Nigerians with type 2 diabetes mellitus (DM). This case–control study involved patients with type 2 DM with high cardiovascular risk, determined by the Framingham’s classification, and age, sex, and diabetes-duration matched subjects with low and intermediate cardiovascular risks. The genotypes were detected by polymerase chain reaction (PCR) followed by allelic discrimination using the Applied Biosystems 7900HT Fast Real-Time PCR System. One-way analysis of variance and logistic regression were employed for analysis. Odds ratios (ORs) with 95% confidence intervals (CI) were calculated to estimate the risk caused by the polymorphism. P <0.05 was considered significant. The odds for cardiovascular risk decreased progressively in individuals with the GG, GA, and AA genotypes (OR = 0.80, 95% CI = 0.49–1.28, P = 0.345 and OR = 0.46, 95% CI = 0.24–0.88, P = 0.018 for GA and AA genotypes, respectively. A significantly higher proportion of homozygous (AA) individuals were in the low cardiovascular risk group (54.2%, P = 0.018). Compared with the whole study population, individuals with the AA genotype had consistently lower odds for cardiovascular risk in subpopulations like alcohol users (OR = 0.25 [0.11–0.55], P = 0.001), but the odds were higher among smokers (OR = 1.80 [1.14–2.90], P = 0.017) and those with sedentary lifestyles (OR = 2.46, 95% CI = 1.14–5.33, P = 0.024). The homozygous mutant genotype AA of the IL-10 gene 1082 G/A had a protective effect on cardiovascular risk in type 2 DM. However, this protection was absent in those leading a sedentary lifestyle.
{"title":"Gene-Environment Interaction of Interleukin 10 Gene Polymorphism, rs1800896, with Lifestyle on Cardiovascular Risk in Type 2 Diabetes","authors":"I. Udenze, Idowu Adewunmi Taiwo, C. Amadi, W. Adeyemo","doi":"10.4103/ijamr.ijamr_187_23","DOIUrl":"https://doi.org/10.4103/ijamr.ijamr_187_23","url":null,"abstract":"\u0000 \u0000 \u0000 Gene–environment interactions play a major role in the phenotypic expression of complex disease traits such as those for cardiovascular diseases.\u0000 \u0000 \u0000 \u0000 This study aimed to determine the gene–environment interactions that underpin the relationship between interleukin-10 (IL-10) single-nucleotide polymorphism (1082 G/A [rs1800896]) with lifestyle on cardiovascular disease risk in adult Nigerians with type 2 diabetes mellitus (DM).\u0000 \u0000 \u0000 \u0000 This case–control study involved patients with type 2 DM with high cardiovascular risk, determined by the Framingham’s classification, and age, sex, and diabetes-duration matched subjects with low and intermediate cardiovascular risks.\u0000 \u0000 \u0000 \u0000 The genotypes were detected by polymerase chain reaction (PCR) followed by allelic discrimination using the Applied Biosystems 7900HT Fast Real-Time PCR System. One-way analysis of variance and logistic regression were employed for analysis. Odds ratios (ORs) with 95% confidence intervals (CI) were calculated to estimate the risk caused by the polymorphism. P <0.05 was considered significant.\u0000 \u0000 \u0000 \u0000 The odds for cardiovascular risk decreased progressively in individuals with the GG, GA, and AA genotypes (OR = 0.80, 95% CI = 0.49–1.28, P = 0.345 and OR = 0.46, 95% CI = 0.24–0.88, P = 0.018 for GA and AA genotypes, respectively. A significantly higher proportion of homozygous (AA) individuals were in the low cardiovascular risk group (54.2%, P = 0.018). Compared with the whole study population, individuals with the AA genotype had consistently lower odds for cardiovascular risk in subpopulations like alcohol users (OR = 0.25 [0.11–0.55], P = 0.001), but the odds were higher among smokers (OR = 1.80 [1.14–2.90], P = 0.017) and those with sedentary lifestyles (OR = 2.46, 95% CI = 1.14–5.33, P = 0.024).\u0000 \u0000 \u0000 \u0000 The homozygous mutant genotype AA of the IL-10 gene 1082 G/A had a protective effect on cardiovascular risk in type 2 DM. However, this protection was absent in those leading a sedentary lifestyle.\u0000","PeriodicalId":32355,"journal":{"name":"International Journal of Advanced Medical and Health Research","volume":"77 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140665530","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}
Pub Date : 2024-04-24DOI: 10.4103/ijamr.ijamr_303_23
Adib Shifas, Z. A. Bhat, Femitha Pournami
{"title":"Training Neonatal Intensive Care Nurses Using Two Adult Teaching–Learning Methods","authors":"Adib Shifas, Z. A. Bhat, Femitha Pournami","doi":"10.4103/ijamr.ijamr_303_23","DOIUrl":"https://doi.org/10.4103/ijamr.ijamr_303_23","url":null,"abstract":"","PeriodicalId":32355,"journal":{"name":"International Journal of Advanced Medical and Health Research","volume":"30 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140659965","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}
Pub Date : 2024-03-14DOI: 10.4103/ijamr.ijamr_212_23
Snehasish Das, Sagar Prakash, Julia Sunil, O. Shaikh, U. Kumbhar
Testicular compartment syndrome (TCS) impedes the microcirculation in the testicle, resulting from increased venous resistance or an extraluminal compression that might lead to a cascade of hypoxia, ischemia, and gangrene. We report a case of fulminant necrotizing orchitis occurring in a 45-year-old immunocompetent patient in the form of TCS. The patient underwent imaging, which suggested extensive localized right testicular abscess formation, for which the patient underwent guided drainage from the abscess. Subsequently, the patient was started on culture-sensitive intravenous antibiotics. Due to the failure of conservative treatment and symptomatic deterioration, we planned scrotal exploration. Intraoperatively, we found that the testicular tissue was necrotic and completely replaced by frank pus, with an already ruptured tunica, due to higher compartmental pressure. The patient underwent a right orchidectomy. The postoperative course in the hospital was uneventful. We report that this case as TCS is rare, and all surgeons should be aware of such possibility of occurrence.
{"title":"Testicular Compartment Syndrome in a Case of Fulminant Necrotizing Orchitis","authors":"Snehasish Das, Sagar Prakash, Julia Sunil, O. Shaikh, U. Kumbhar","doi":"10.4103/ijamr.ijamr_212_23","DOIUrl":"https://doi.org/10.4103/ijamr.ijamr_212_23","url":null,"abstract":"\u0000 Testicular compartment syndrome (TCS) impedes the microcirculation in the testicle, resulting from increased venous resistance or an extraluminal compression that might lead to a cascade of hypoxia, ischemia, and gangrene. We report a case of fulminant necrotizing orchitis occurring in a 45-year-old immunocompetent patient in the form of TCS. The patient underwent imaging, which suggested extensive localized right testicular abscess formation, for which the patient underwent guided drainage from the abscess. Subsequently, the patient was started on culture-sensitive intravenous antibiotics. Due to the failure of conservative treatment and symptomatic deterioration, we planned scrotal exploration. Intraoperatively, we found that the testicular tissue was necrotic and completely replaced by frank pus, with an already ruptured tunica, due to higher compartmental pressure. The patient underwent a right orchidectomy. The postoperative course in the hospital was uneventful. We report that this case as TCS is rare, and all surgeons should be aware of such possibility of occurrence.","PeriodicalId":32355,"journal":{"name":"International Journal of Advanced Medical and Health Research","volume":"19 S2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140244491","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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