Pub Date : 2023-07-08DOI: 10.46347/jmsh.v9i1.22.343
Aparna Mohan, Michell Gulabani, A. Tyagi, Jubin Jakhar, Mahendra Kumar
Background: Percutaneous nephrolithotomy (PCNL) surgery may be associated with postoperative Acute Kidney Injury (AKI). Commonest intraoperative risk factors for postoperative AKI include hypotension and hypoperfusion. Intravenous fluids are administered during surgery to optimize intravascular status and thus prevent hypotension. Conventionally, intravenous fluids are administered during surgery using pre-calculated volumes based on maintenance needs. Alternatively, goal-directed fluid therapy using Stroke Volume Variation (SVV) can be used to decide the volume of intravenous fluids. We compared early postoperative AKI following intraoperative use of conventional (group C, n=15) versus SVV directed fluid therapy (group S, n = 17) in patients undergoing PCNL surgery. Methods: This double-blinded pilot study involved 32 adult patients, randomised to two groups according to type of intraoperative fluid therapy (group C or group S). Postoperative AKI was diagnosed as per KDIGO guidelines. Results: Incidence of early postoperative AKI was clinically higher for group S, though statistically similar, as compared to group C (47.1% versus 26.7%) (P = 0.234). Postoperative increase in eGFR, and 24-hour urine output were clinically greater for group S (P > 0.05). Volume of intraoperative fluids infused was significantly lesser for group S (P = 0.000). The incidence of hypotension and requirement of vasopressor to maintain blood pressure was clinically lesser, though statistically similar for group S as compared to group C (P = 0.659). Conclusions: There appears to be a clinical trend of greater incidence of AKI with use of SVV guided therapy despite better intraoperative hemodynamic stability and greater improvement in postoperative urine output and eGFR in the first postoperative day. Keywords: Percutaneous nephrolithotomy, Acute kidney injury, Fluid therapy, General anesthesia, Blood pressure
{"title":"Stroke Volume Variation Directed Versus Conventional Fluid Therapy for Postoperative Acute Kidney Injury after Percutaneous Nephrolithotomy - A Randomized Pilot Study","authors":"Aparna Mohan, Michell Gulabani, A. Tyagi, Jubin Jakhar, Mahendra Kumar","doi":"10.46347/jmsh.v9i1.22.343","DOIUrl":"https://doi.org/10.46347/jmsh.v9i1.22.343","url":null,"abstract":"Background: Percutaneous nephrolithotomy (PCNL) surgery may be associated with postoperative Acute Kidney Injury (AKI). Commonest intraoperative risk factors for postoperative AKI include hypotension and hypoperfusion. Intravenous fluids are administered during surgery to optimize intravascular status and thus prevent hypotension. Conventionally, intravenous fluids are administered during surgery using pre-calculated volumes based on maintenance needs. Alternatively, goal-directed fluid therapy using Stroke Volume Variation (SVV) can be used to decide the volume of intravenous fluids. We compared early postoperative AKI following intraoperative use of conventional (group C, n=15) versus SVV directed fluid therapy (group S, n = 17) in patients undergoing PCNL surgery. Methods: This double-blinded pilot study involved 32 adult patients, randomised to two groups according to type of intraoperative fluid therapy (group C or group S). Postoperative AKI was diagnosed as per KDIGO guidelines. Results: Incidence of early postoperative AKI was clinically higher for group S, though statistically similar, as compared to group C (47.1% versus 26.7%) (P = 0.234). Postoperative increase in eGFR, and 24-hour urine output were clinically greater for group S (P > 0.05). Volume of intraoperative fluids infused was significantly lesser for group S (P = 0.000). The incidence of hypotension and requirement of vasopressor to maintain blood pressure was clinically lesser, though statistically similar for group S as compared to group C (P = 0.659). Conclusions: There appears to be a clinical trend of greater incidence of AKI with use of SVV guided therapy despite better intraoperative hemodynamic stability and greater improvement in postoperative urine output and eGFR in the first postoperative day. Keywords: Percutaneous nephrolithotomy, Acute kidney injury, Fluid therapy, General anesthesia, Blood pressure","PeriodicalId":33653,"journal":{"name":"Journal of Medical Sciences and Health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47144417","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 : 2023-07-08DOI: 10.46347/jmsh.v9i1.22.365
G. Neethu, T. Mounika, P. Rashmi, V. Kulkarni
Objectives: To compare the traditional teaching with algorithm or flowchart-based teaching method in cytology and to assess the performance of newly joined residents in cytopathology after training them with algorithm-based approach. Materials & Methods: The study included 20 newly joined residents who were divided into two groups I.e., group A and group B and was conducted in two different sets. In set 1, group A residents were trained with the algorithmic approach and group B residents by theoretical method for 10 different cytological cases of thyroid and breast. In set 2, group B residents were taught the algorithmic approach and group A residents by theoretical method for 10 different cytological cases of salivary gland and lymph node. The performance of the residents in both the sets was assessed and pre-test and post-test scores were given based on their ability to diagnose the lesions before and after the training. The feedback on the utility of algorithmic approach in cytopathology was received from the participated residents after the study. Results: The performance of the residents was compared using Mann Whitney U test of post-test scores and was found that in set 1, group A residents’ performance was greater than that of group B residents. Similarly for the set 2, the performance of group B residents was greater than group A residents. The performance of group A residents in set 2 was found to be better than their performance in set 1. Conclusion: The algorithm or flowchart-based teaching is a unique teaching method which enhances case solving skills and effective reasoning in the residents. Keywords: Algorithm based approach, Cytopathology, FNAC, Pathology resident training
{"title":"Algorithmic Approach in Cytopathology : A Mode of Training the New Residents","authors":"G. Neethu, T. Mounika, P. Rashmi, V. Kulkarni","doi":"10.46347/jmsh.v9i1.22.365","DOIUrl":"https://doi.org/10.46347/jmsh.v9i1.22.365","url":null,"abstract":"Objectives: To compare the traditional teaching with algorithm or flowchart-based teaching method in cytology and to assess the performance of newly joined residents in cytopathology after training them with algorithm-based approach. Materials & Methods: The study included 20 newly joined residents who were divided into two groups I.e., group A and group B and was conducted in two different sets. In set 1, group A residents were trained with the algorithmic approach and group B residents by theoretical method for 10 different cytological cases of thyroid and breast. In set 2, group B residents were taught the algorithmic approach and group A residents by theoretical method for 10 different cytological cases of salivary gland and lymph node. The performance of the residents in both the sets was assessed and pre-test and post-test scores were given based on their ability to diagnose the lesions before and after the training. The feedback on the utility of algorithmic approach in cytopathology was received from the participated residents after the study. Results: The performance of the residents was compared using Mann Whitney U test of post-test scores and was found that in set 1, group A residents’ performance was greater than that of group B residents. Similarly for the set 2, the performance of group B residents was greater than group A residents. The performance of group A residents in set 2 was found to be better than their performance in set 1. Conclusion: The algorithm or flowchart-based teaching is a unique teaching method which enhances case solving skills and effective reasoning in the residents. Keywords: Algorithm based approach, Cytopathology, FNAC, Pathology resident training","PeriodicalId":33653,"journal":{"name":"Journal of Medical Sciences and Health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43353114","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 : 2023-07-08DOI: 10.46347/jmsh.v9i1.21.22
O. R. Krishna, Narahari Bapanpally, S. Fatima, G. Padmaja
Background: Sickle cells are easily identified on the peripheral smear however quantification of sickle cells is seldom done. This study attempts to understand the importance of the sickling index in the reporting of peripheral smear in patients with SCD. Objectives: This study aims to standardize the methodology of quantification of sickle cells on the peripheral smear in paediatric SCD cases and study its relation to the patient characteristics like age and sex, SCD genotype, and treatment. Materials and Methods: A prospective study of 6 months duration was conducted at a tertiary paediatric referral hospital for 6 months. 30 known cases of SCD were admitted during this period. Routinely studied peripheral smears were used in the study. 30 normal smears of age-matched patients were also used for comparative purpose. The sickling index was calculated in both patient and age matched smears. The sickling index was compared in both the groups and also the index in the known SCD cases was studied in relation to the patient's age, SCD genotype, and treatment with blood transfusions or hydroxyurea. Statistical analysis: Descriptive statistics were used in the study Results & Conclusion: Hb SS was the commonest genotype seen in 69% of the cases. Higher sickling index was noted in older children, SS genotype and those on treatment with blood transfusions or Hydroxyurea. Sickling index is an interesting prospect which may provide helpful information regarding cases with increasing hemolysis and vasocclusive crises and also help in follow up of patients on treatment. Keywords: Paediatric, Disease severity, Sickling index
{"title":"Quantification of Sickle Cells in the Peripheral Smear as a Marker of Disease Severity in Sickle Cell Disease in Paediatric Patients","authors":"O. R. Krishna, Narahari Bapanpally, S. Fatima, G. Padmaja","doi":"10.46347/jmsh.v9i1.21.22","DOIUrl":"https://doi.org/10.46347/jmsh.v9i1.21.22","url":null,"abstract":"Background: Sickle cells are easily identified on the peripheral smear however quantification of sickle cells is seldom done. This study attempts to understand the importance of the sickling index in the reporting of peripheral smear in patients with SCD. Objectives: This study aims to standardize the methodology of quantification of sickle cells on the peripheral smear in paediatric SCD cases and study its relation to the patient characteristics like age and sex, SCD genotype, and treatment. Materials and Methods: A prospective study of 6 months duration was conducted at a tertiary paediatric referral hospital for 6 months. 30 known cases of SCD were admitted during this period. Routinely studied peripheral smears were used in the study. 30 normal smears of age-matched patients were also used for comparative purpose. The sickling index was calculated in both patient and age matched smears. The sickling index was compared in both the groups and also the index in the known SCD cases was studied in relation to the patient's age, SCD genotype, and treatment with blood transfusions or hydroxyurea. Statistical analysis: Descriptive statistics were used in the study Results & Conclusion: Hb SS was the commonest genotype seen in 69% of the cases. Higher sickling index was noted in older children, SS genotype and those on treatment with blood transfusions or Hydroxyurea. Sickling index is an interesting prospect which may provide helpful information regarding cases with increasing hemolysis and vasocclusive crises and also help in follow up of patients on treatment. Keywords: Paediatric, Disease severity, Sickling index","PeriodicalId":33653,"journal":{"name":"Journal of Medical Sciences and Health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48894456","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 : 2023-07-08DOI: 10.46347/jmsh.v9i1.22.374
Teleflo Boopathy, S. Kanimozhi, V. Ramya, P. L. Piriya
Diabetic mastopathy is an uncommon fibrous tissue lesion of the breast which is usually seen in patients with longstanding type 1 diabetes mellitus. We report a case of diabetic mastopathy in an insulin dependent type 2 diabetes mellitus patient. 47-year-old postmenopausal woman, presented with two lumps, one firm mobile mass and another, a firm-hard mass in the upper inner quadrant of the left breast. Mammography and ultrasonography came out to be BIRADS III lesion. Fine-needle aspiration cytology [FNAC] was performed showing features of fibroadenoma with fibrocystic change. Histopathological examination and Immunohistochemistry studies revealed it to be fibroadenoma along with lymphocytic mastopathy. Keywords: Fibroadenoma, Lymphocytic mastitis, Mimicker, Diabetes
{"title":"Lymphocytic Mastitis with Fibroadenoma – A Case Report","authors":"Teleflo Boopathy, S. Kanimozhi, V. Ramya, P. L. Piriya","doi":"10.46347/jmsh.v9i1.22.374","DOIUrl":"https://doi.org/10.46347/jmsh.v9i1.22.374","url":null,"abstract":"Diabetic mastopathy is an uncommon fibrous tissue lesion of the breast which is usually seen in patients with longstanding type 1 diabetes mellitus. We report a case of diabetic mastopathy in an insulin dependent type 2 diabetes mellitus patient. 47-year-old postmenopausal woman, presented with two lumps, one firm mobile mass and another, a firm-hard mass in the upper inner quadrant of the left breast. Mammography and ultrasonography came out to be BIRADS III lesion. Fine-needle aspiration cytology [FNAC] was performed showing features of fibroadenoma with fibrocystic change. Histopathological examination and Immunohistochemistry studies revealed it to be fibroadenoma along with lymphocytic mastopathy. Keywords: Fibroadenoma, Lymphocytic mastitis, Mimicker, Diabetes","PeriodicalId":33653,"journal":{"name":"Journal of Medical Sciences and Health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43419874","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 : 2023-07-08DOI: 10.46347/jmsh.v9i1.22.492
B. Soumya, L. Sharma, V. Kulkarni, C. Preethi
The spectrum of lipomatous lesions ranges from benign to highly malignant disease. Differentiation between these mesenchymal lesions is important for pathologist as well as clinician to indicate prognosis and choose the most appropriate treatment. Hemosiderotic firohistiocytic lipomatous tumor (HFLT) is a rare subtype of lipomatous tumor. The diagnosis is usually based on clinical, histological, and immunohistochemical (IHC) information. We reported a case of 56 years old man with a painful mass in the dorsal aspect of the thigh showing an unusal clinical presentation but a characteristic histological and IHC features. In this article we have retrospectively reviewed the 67 cases of HFLT reported in literature so far along with one case reported at our institution. The review focuses on clinicopathological and histomorphological characteristics of HFLT and the related entities. The hallmark of HFLT and its related lesions is complex admixture of mature adipose tissue, spindle tumor cells with striking deposition of hemosiderin pigment. Even though HFLT shows marked predeliction for the distal extremeties especially the foot/ ankle with a female preponderance, they can occur at uncommon site such as thigh and also in males as seen in our case. Keywords: Pleomorphic hyalinizing angiectatic tumor, Hemosiderotic fibrolipomatous tumor, Myxoinflammatory Fibroblastic Sarcoma, Hemosiderin, Lipoma
{"title":"Report of an Unusual Case of Hemosiderotic Fibrohistiocytic Lipomatous Tumor with Systematic Review of Clinicopathological Characteristics and Differential Diagnosis","authors":"B. Soumya, L. Sharma, V. Kulkarni, C. Preethi","doi":"10.46347/jmsh.v9i1.22.492","DOIUrl":"https://doi.org/10.46347/jmsh.v9i1.22.492","url":null,"abstract":"The spectrum of lipomatous lesions ranges from benign to highly malignant disease. Differentiation between these mesenchymal lesions is important for pathologist as well as clinician to indicate prognosis and choose the most appropriate treatment. Hemosiderotic firohistiocytic lipomatous tumor (HFLT) is a rare subtype of lipomatous tumor. The diagnosis is usually based on clinical, histological, and immunohistochemical (IHC) information. We reported a case of 56 years old man with a painful mass in the dorsal aspect of the thigh showing an unusal clinical presentation but a characteristic histological and IHC features. In this article we have retrospectively reviewed the 67 cases of HFLT reported in literature so far along with one case reported at our institution. The review focuses on clinicopathological and histomorphological characteristics of HFLT and the related entities. The hallmark of HFLT and its related lesions is complex admixture of mature adipose tissue, spindle tumor cells with striking deposition of hemosiderin pigment. Even though HFLT shows marked predeliction for the distal extremeties especially the foot/ ankle with a female preponderance, they can occur at uncommon site such as thigh and also in males as seen in our case. Keywords: Pleomorphic hyalinizing angiectatic tumor, Hemosiderotic fibrolipomatous tumor, Myxoinflammatory Fibroblastic Sarcoma, Hemosiderin, Lipoma","PeriodicalId":33653,"journal":{"name":"Journal of Medical Sciences and Health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47406376","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 : 2023-07-08DOI: 10.46347/jmsh.v9i1.21.253
Salman Mohammad Tariq, K. Khan, M. M. Sadiq, S. Pooja, Sindhu Suyog, S. K. Devendra
Objective: Black cumin (Nigella sativa L.) seeds and its crude extract or essential oils have been widely used traditionally for nutritional and medicinal applications in Asian countries. Its effects on diabetics with high fat diet consumption have not been adequately studied. This study was undertaken to study its effects on body weight, abdominal girth, lipid profile and plasma glucose levels in diabetic high fat diet fed rats. Materials and Methods : Streptozotocin induced male Wistar rats were fed high fat diet [5130 kcal] for 4 weeks after which they were given vehicle, Nigella sativa ethanolic extract (300mg/kg), Nigella sativa ethanolic extract (600 mg) or metformin (100 mg). Lipid profile, blood glucose, body weight & abdominal girth were measured. Results: Nigella sativa ethanolic extract (600 mg) caused significant reduction in blood glucose, total cholesterol, triglycerides, VLDL and non HDL cholesterol comparable to metformin. Conclusion : Nigella sativa shows anti-hyperglycemic effects and improvement in lipid profile in diabetic high fat diet fed rats which is comparable to metformin. Further studies are required to advocate its use in patients with diabetes and dyslipidemias. Keywords: Nigella sativa, diabetes mellitus, antihyperlipidemic, antihyperglycemic, high fat
{"title":"Nigella Sativa's Effect on Biochemical as well as Anthropometric Parameters in Diabetic Rats on High Fat Diet","authors":"Salman Mohammad Tariq, K. Khan, M. M. Sadiq, S. Pooja, Sindhu Suyog, S. K. Devendra","doi":"10.46347/jmsh.v9i1.21.253","DOIUrl":"https://doi.org/10.46347/jmsh.v9i1.21.253","url":null,"abstract":"Objective: Black cumin (Nigella sativa L.) seeds and its crude extract or essential oils have been widely used traditionally for nutritional and medicinal applications in Asian countries. Its effects on diabetics with high fat diet consumption have not been adequately studied. This study was undertaken to study its effects on body weight, abdominal girth, lipid profile and plasma glucose levels in diabetic high fat diet fed rats. Materials and Methods : Streptozotocin induced male Wistar rats were fed high fat diet [5130 kcal] for 4 weeks after which they were given vehicle, Nigella sativa ethanolic extract (300mg/kg), Nigella sativa ethanolic extract (600 mg) or metformin (100 mg). Lipid profile, blood glucose, body weight & abdominal girth were measured. Results: Nigella sativa ethanolic extract (600 mg) caused significant reduction in blood glucose, total cholesterol, triglycerides, VLDL and non HDL cholesterol comparable to metformin. Conclusion : Nigella sativa shows anti-hyperglycemic effects and improvement in lipid profile in diabetic high fat diet fed rats which is comparable to metformin. Further studies are required to advocate its use in patients with diabetes and dyslipidemias. Keywords: Nigella sativa, diabetes mellitus, antihyperlipidemic, antihyperglycemic, high fat","PeriodicalId":33653,"journal":{"name":"Journal of Medical Sciences and Health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45118477","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 : 2023-07-08DOI: 10.46347/jmsh.v9i1.22.512
Benjamin Jelley, T. Hughes, Phil Jones
Background: The All Wales Stroke Meeting (AWSM) is a multidisciplinary stroke meeting. Stroke clinicians can present cases to review the neuroradiology and discuss the clinical story to further clinical care, seek consensus views on the management in specific rare or complex cases or provide an educational opportunity for the group centred around a rare case or specific feature of the case. Methods: The meeting was created to pool the knowledge of clinicians working across Wales to benefit patient care throughout the country. Here we describe the development, structure and personnel involved in the meeting. There is a focus on the technological requirements of the meeting and how utilising newly introduced IT solutions further improved the meeting’s accessibility. Results: There is a positive economic and environmental impact of delivering multidisciplinary meetings through videoconference technology. The AWSM is estimated to annually save 97.16 days of clinician time and £13,087.18 in travel expenses. We estimate a reduction of carbon footprint of 15,792.38–19,722.44 kg CO2. Conclusion: The AWSM has been an invaluable component of stroke healthcare in Wales since 2009. We think this is an example of where collaborative working and innovative use of technologies can benefit clinicians, patients, NHS services and the environment. Keywords: Stroke, Stroke evaluation, Video conference, Neuroradiology, Continued professional development, Education, Multidisciplinary meeting
{"title":"The Evolution and Environmental Benefits of the All Wales Stroke Meeting (AWSM), a Video Conference Multidisciplinary Meeting for Stroke Physicians","authors":"Benjamin Jelley, T. Hughes, Phil Jones","doi":"10.46347/jmsh.v9i1.22.512","DOIUrl":"https://doi.org/10.46347/jmsh.v9i1.22.512","url":null,"abstract":"Background: The All Wales Stroke Meeting (AWSM) is a multidisciplinary stroke meeting. Stroke clinicians can present cases to review the neuroradiology and discuss the clinical story to further clinical care, seek consensus views on the management in specific rare or complex cases or provide an educational opportunity for the group centred around a rare case or specific feature of the case. Methods: The meeting was created to pool the knowledge of clinicians working across Wales to benefit patient care throughout the country. Here we describe the development, structure and personnel involved in the meeting. There is a focus on the technological requirements of the meeting and how utilising newly introduced IT solutions further improved the meeting’s accessibility. Results: There is a positive economic and environmental impact of delivering multidisciplinary meetings through videoconference technology. The AWSM is estimated to annually save 97.16 days of clinician time and £13,087.18 in travel expenses. We estimate a reduction of carbon footprint of 15,792.38–19,722.44 kg CO2. Conclusion: The AWSM has been an invaluable component of stroke healthcare in Wales since 2009. We think this is an example of where collaborative working and innovative use of technologies can benefit clinicians, patients, NHS services and the environment. Keywords: Stroke, Stroke evaluation, Video conference, Neuroradiology, Continued professional development, Education, Multidisciplinary meeting","PeriodicalId":33653,"journal":{"name":"Journal of Medical Sciences and Health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46151588","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 : 2023-07-08DOI: 10.46347/jmsh.v9i1.22.244
J. Sriharsha, S. Adarsh, Madhu Srinivasarangan, S. Omar
Introduction: Rapid Sequence Intubation (RSI) is the definitive modality of airway management when resuscitating trauma patients in the Emergency Department (ED). This study was done to evaluate the utility of POCUS in RSI and its efficacy in confirming tube placement as compared to conventional methods. Aims & Objectives: Primary Objectives - Time taken for airway evaluation and identifying potentially fatal conditions using POCUS guided Intubation Algorithm (PA) during RSI. Proper placement of the endotracheal tube and confirmation of the same was also assessed and compared with the conventional technique. Methodology: A prospective, randomized single-centred study was conducted in 100 trauma patients requiring emergent airway management, presenting to the ED. The time taken and efficacy of confirmation of tube placement is recorded and compared in two arms. Results: In our study we found the mean procedure time for ETT placement was less in the PA arm compared to the CE arm (45 vs 91.36 seconds, p<0.0001). Oesophageal intubations were detected in the PA arm in 22 seconds vs 114 seconds in CE arm with a p< 0.0001 and the time taken for effective reintubation was 26.67 vs 55 seconds in the PA and CE arm with a p value < 0.007 respectively. Conclusion: POCUS detected oesophageal intubations and confirmed proper tube position in less time when compared to standard techniques such as five-point auscultation and capnography. The results of this study have proved that POCUS is a useful adjunct to the Emergency physician to improve quality of care in trauma patients. Keywords: Point of care ultrasound, Rapid sequence intubation, Trauma, Emergency department, Emergency physician, Endotracheal tube, End tidal carbon dioxide, Ultrasound, Clinical examination
{"title":"Integration of Point of Care Ultrasound during Rapid Sequence Intubation in Trauma Resuscitation","authors":"J. Sriharsha, S. Adarsh, Madhu Srinivasarangan, S. Omar","doi":"10.46347/jmsh.v9i1.22.244","DOIUrl":"https://doi.org/10.46347/jmsh.v9i1.22.244","url":null,"abstract":"Introduction: Rapid Sequence Intubation (RSI) is the definitive modality of airway management when resuscitating trauma patients in the Emergency Department (ED). This study was done to evaluate the utility of POCUS in RSI and its efficacy in confirming tube placement as compared to conventional methods. Aims & Objectives: Primary Objectives - Time taken for airway evaluation and identifying potentially fatal conditions using POCUS guided Intubation Algorithm (PA) during RSI. Proper placement of the endotracheal tube and confirmation of the same was also assessed and compared with the conventional technique. Methodology: A prospective, randomized single-centred study was conducted in 100 trauma patients requiring emergent airway management, presenting to the ED. The time taken and efficacy of confirmation of tube placement is recorded and compared in two arms. Results: In our study we found the mean procedure time for ETT placement was less in the PA arm compared to the CE arm (45 vs 91.36 seconds, p<0.0001). Oesophageal intubations were detected in the PA arm in 22 seconds vs 114 seconds in CE arm with a p< 0.0001 and the time taken for effective reintubation was 26.67 vs 55 seconds in the PA and CE arm with a p value < 0.007 respectively. Conclusion: POCUS detected oesophageal intubations and confirmed proper tube position in less time when compared to standard techniques such as five-point auscultation and capnography. The results of this study have proved that POCUS is a useful adjunct to the Emergency physician to improve quality of care in trauma patients. Keywords: Point of care ultrasound, Rapid sequence intubation, Trauma, Emergency department, Emergency physician, Endotracheal tube, End tidal carbon dioxide, Ultrasound, Clinical examination","PeriodicalId":33653,"journal":{"name":"Journal of Medical Sciences and Health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47777833","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 : 2023-07-08DOI: 10.46347/jmsh.v9i1.22.369
.. Vishwajith
Introduction: Infections from gram negative bacilli is a challenge for clinicians and laboratory personnel. Treatment of these infections remained as an area of concern. Both fluroquinolones and cephalosporins are most common choice of antibiotics. Despite Cephalosporins, being drug of choice they are expensive also showed many adverse reactions. This study, compares and reevaluates the susceptibility of gram negative bacteria to fluroquinolones (ciprofloxacin) compared to cephalosporins. Method: Various samples(pus, sputum, urine, blood and bodyfluids) were processed according to standard protocols. Antibiotic done susceptibility by using Kirby-baur disc diffusion method. ESBL and Amp C producers were identified using CLSI guidelines. Result: Among 400 isolates, majority were from pus followed by urine, sputum. The most common organism isolated was Klebsiella spp, (33.25%) Escherichia coli (29.5%), Pseudomonas spp (27.25%), Enterobacter spp (6.25%), Citrobacter 5 (1.25%), and Acinetobacter spp (2.5%). Isolates showed 20-80% susceptibility to ciprofloxacin, 30-60% to third and fourth generation cephalosporins. Klebsiella and Pseudomonas showed 64% and 31% susceptibility to ciprofloxacin. Acinetobacter spp showed 30% susceptibility to cefipime and 20% to ciprofloxacin. 34 isolates were ESBL 18 were AmpC producers, of which 15(44%) ESBL and 7(38%) of AmpC producers were ciprofloxacin susceptible. Conclusion: Ciprofloxacin was found to be more effective than the fourth generation cephalosporin (cefepime) against gram negative bacilli. Ciprofloxacin can be considered for treatment as it is more active and cost effective when compared to cephalosporins. Keywords: Fluroquinolones, Cephalosporins, Multidrug resistant, ESBL, Amp C
{"title":"Comparison of in-vitro Antibiotic Susceptibility of Ciprofloxacin, Cefotaxime, Ceftazidime and Cefepime against Gram Negative Bacilli Infections - A Study from Tertiary Care Centre","authors":".. Vishwajith","doi":"10.46347/jmsh.v9i1.22.369","DOIUrl":"https://doi.org/10.46347/jmsh.v9i1.22.369","url":null,"abstract":"Introduction: Infections from gram negative bacilli is a challenge for clinicians and laboratory personnel. Treatment of these infections remained as an area of concern. Both fluroquinolones and cephalosporins are most common choice of antibiotics. Despite Cephalosporins, being drug of choice they are expensive also showed many adverse reactions. This study, compares and reevaluates the susceptibility of gram negative bacteria to fluroquinolones (ciprofloxacin) compared to cephalosporins. Method: Various samples(pus, sputum, urine, blood and bodyfluids) were processed according to standard protocols. Antibiotic done susceptibility by using Kirby-baur disc diffusion method. ESBL and Amp C producers were identified using CLSI guidelines. Result: Among 400 isolates, majority were from pus followed by urine, sputum. The most common organism isolated was Klebsiella spp, (33.25%) Escherichia coli (29.5%), Pseudomonas spp (27.25%), Enterobacter spp (6.25%), Citrobacter 5 (1.25%), and Acinetobacter spp (2.5%). Isolates showed 20-80% susceptibility to ciprofloxacin, 30-60% to third and fourth generation cephalosporins. Klebsiella and Pseudomonas showed 64% and 31% susceptibility to ciprofloxacin. Acinetobacter spp showed 30% susceptibility to cefipime and 20% to ciprofloxacin. 34 isolates were ESBL 18 were AmpC producers, of which 15(44%) ESBL and 7(38%) of AmpC producers were ciprofloxacin susceptible. Conclusion: Ciprofloxacin was found to be more effective than the fourth generation cephalosporin (cefepime) against gram negative bacilli. Ciprofloxacin can be considered for treatment as it is more active and cost effective when compared to cephalosporins. Keywords: Fluroquinolones, Cephalosporins, Multidrug resistant, ESBL, Amp C","PeriodicalId":33653,"journal":{"name":"Journal of Medical Sciences and Health","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41417954","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 : 2023-07-08DOI: 10.46347/jmsh.v9i1.21.33
B. Archana, S. Sangeetha
Background: Sepsis is a life-threatening infection, responsible for tremendous morbidity, mortality and healthcare expenditure worldwide. Sepsis is characterized by non-specific symptoms and clinical diagnosis remains difficult. C Reactive protein (CRP) and procalcitonin (PCT) are now days used as surrogate markers of sepsis. Aim: To determine PCT levels in patients with suspected sepsis and its correlation with CRP and total leucocyte count (TLC). Material & Methods: The retrospective study was conducted in tertiary care hospital in India. Adults patients (> 18 years) admitted to Intensive care unit in the hospital during study period, fulfilling the ACCP criterion for the diagnosis of sepsis were included in the study. Data was collected using laboratory software maintaining confidentiality. Results: The study comprised of 190 patients. Patients were divided into four groups based on PCT values and severity of sepsis. Out of 190 patients, PCT was positive in 135 patients. The CRP and TLC levels were distributed into the four PCT groups and their correlation with PCT was studied. For PCT values between 2-10ng/ml, >10ng/ml CRP showed statistically significant correlation with p value <0.05, whereas correlation of TLC with PCT was poor. Conclusion Procalcitonin along with CRP is a better diagnostic tool for sepsis but their correlation in context to TLC was poor. Due to lack of an ideal isolated marker, our study mandates multidisciplinary approach for diagnosis of sepsis. Keywords: Sepsis, Procalcitonin, C reactive protein, Total leucocyte count, Culture
{"title":"Role of Procalcitonin, C-reactive Protein and Total Leucocyte Count in Suspected Cases of Sepsis","authors":"B. Archana, S. Sangeetha","doi":"10.46347/jmsh.v9i1.21.33","DOIUrl":"https://doi.org/10.46347/jmsh.v9i1.21.33","url":null,"abstract":"Background: Sepsis is a life-threatening infection, responsible for tremendous morbidity, mortality and healthcare expenditure worldwide. Sepsis is characterized by non-specific symptoms and clinical diagnosis remains difficult. C Reactive protein (CRP) and procalcitonin (PCT) are now days used as surrogate markers of sepsis. Aim: To determine PCT levels in patients with suspected sepsis and its correlation with CRP and total leucocyte count (TLC). Material & Methods: The retrospective study was conducted in tertiary care hospital in India. Adults patients (> 18 years) admitted to Intensive care unit in the hospital during study period, fulfilling the ACCP criterion for the diagnosis of sepsis were included in the study. Data was collected using laboratory software maintaining confidentiality. Results: The study comprised of 190 patients. Patients were divided into four groups based on PCT values and severity of sepsis. Out of 190 patients, PCT was positive in 135 patients. The CRP and TLC levels were distributed into the four PCT groups and their correlation with PCT was studied. For PCT values between 2-10ng/ml, >10ng/ml CRP showed statistically significant correlation with p value <0.05, whereas correlation of TLC with PCT was poor. Conclusion Procalcitonin along with CRP is a better diagnostic tool for sepsis but their correlation in context to TLC was poor. Due to lack of an ideal isolated marker, our study mandates multidisciplinary approach for diagnosis of sepsis. Keywords: Sepsis, Procalcitonin, C reactive protein, Total leucocyte count, Culture","PeriodicalId":33653,"journal":{"name":"Journal of Medical Sciences and Health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43140077","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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