Amit Shah, M. Upadhye, H. Deepak, N. Goud, Akshat Shah
Introduction: During the last two decades, the evaluation and management of renal and upper ureteric stones has vastly altered. The era of endoscopic surgery replaced open pyelolithotomy or nephrolithotomy which caused a significant morbidity. During this decade we saw evolution of endoscopic surgery where Mini PCNL (Mini Perc), Ultra Mini and Micro Perc have further achieved stone clearance with better outcomes pertaining to reduced morbidity because of reduction in caliber of tract dilatation, even avoiding a nephrostomy post rocedure in select cases. Aim of this study summarizes the outcome of patients undergoing Mini Perc. The primary objective of the study was to get post-Operative evaluation of complications associated with Mini Perc by Modified Clavien Dindo Grading and secondary objectives were to see Post-Operative pain assessment by Visual Analogue scale and to see Stone clearance rate of the surgical procedure. Materials and Methods: Research was carried out in the form of a Hospital-based prospective observational study as per the guidelines shared by the Prospective Observational Clinical Studies Good Research Practices Task Force (formed May 16, 2010). Hospital-based prospective observational study of 78 consecutive patients who underwent Mini Perc between Aug 2018 and May 2020 at tertiary care centre were vetted against the criteria for inclusion and exclusion. The management policy for pelvicalyceal calculi at the study centre has closely followed those of the American Urological Association (AUA) guidelines for managing renal stones. Results: The mean age of the group was 43.3 years (range 16-84) with 47 males and 38 females. Mean stone size was 20.11 mm (range 11-38 mm) and mean operative time was 44.5 min (range 29-98 min). Double J (DJ) stent was placed in all patients as a prophylaxis to prevent obstructive uropathy / post op urinary leak. Postoperatively, the most commonly noted complication was fever recorded in 12 (15.38%) patients followed by bleeding at the surgical site in 03 (3.84%) patients. Sepsis was noted in 02 (2.56%) patients, pleural injury in 01(1.28) patient. Haemorrhage requiring intervention was recorded in 01 (1.28%) of patients. Pain assessment done at specified interval showed progressive decreasing trend in intensity as evaluated by visual analogue scale. The stone clearance rate in our study was 96.15% at the end of one month following post op period. Conclusion: The study shows that Mini Perc remains standard of care for management of Renal and upper ureteric stone. The technique beyond doubt is safe, efficient, feasible and economical in achieving excellent stone clearance rates. The Modified Clavien-Dindo system of grading for perioperative complications is easy to use and reproducible. It can be used as an objective and reliable method for describing the complications of the surgical procedure.
{"title":"Stone clearance rate and postoperative recovery of mini percutaneous nephrolithotomy: A single-institute study","authors":"Amit Shah, M. Upadhye, H. Deepak, N. Goud, Akshat Shah","doi":"10.4103/jmms.jmms_66_21","DOIUrl":"https://doi.org/10.4103/jmms.jmms_66_21","url":null,"abstract":"Introduction: During the last two decades, the evaluation and management of renal and upper ureteric stones has vastly altered. The era of endoscopic surgery replaced open pyelolithotomy or nephrolithotomy which caused a significant morbidity. During this decade we saw evolution of endoscopic surgery where Mini PCNL (Mini Perc), Ultra Mini and Micro Perc have further achieved stone clearance with better outcomes pertaining to reduced morbidity because of reduction in caliber of tract dilatation, even avoiding a nephrostomy post rocedure in select cases. Aim of this study summarizes the outcome of patients undergoing Mini Perc. The primary objective of the study was to get post-Operative evaluation of complications associated with Mini Perc by Modified Clavien Dindo Grading and secondary objectives were to see Post-Operative pain assessment by Visual Analogue scale and to see Stone clearance rate of the surgical procedure. Materials and Methods: Research was carried out in the form of a Hospital-based prospective observational study as per the guidelines shared by the Prospective Observational Clinical Studies Good Research Practices Task Force (formed May 16, 2010). Hospital-based prospective observational study of 78 consecutive patients who underwent Mini Perc between Aug 2018 and May 2020 at tertiary care centre were vetted against the criteria for inclusion and exclusion. The management policy for pelvicalyceal calculi at the study centre has closely followed those of the American Urological Association (AUA) guidelines for managing renal stones. Results: The mean age of the group was 43.3 years (range 16-84) with 47 males and 38 females. Mean stone size was 20.11 mm (range 11-38 mm) and mean operative time was 44.5 min (range 29-98 min). Double J (DJ) stent was placed in all patients as a prophylaxis to prevent obstructive uropathy / post op urinary leak. Postoperatively, the most commonly noted complication was fever recorded in 12 (15.38%) patients followed by bleeding at the surgical site in 03 (3.84%) patients. Sepsis was noted in 02 (2.56%) patients, pleural injury in 01(1.28) patient. Haemorrhage requiring intervention was recorded in 01 (1.28%) of patients. Pain assessment done at specified interval showed progressive decreasing trend in intensity as evaluated by visual analogue scale. The stone clearance rate in our study was 96.15% at the end of one month following post op period. Conclusion: The study shows that Mini Perc remains standard of care for management of Renal and upper ureteric stone. The technique beyond doubt is safe, efficient, feasible and economical in achieving excellent stone clearance rates. The Modified Clavien-Dindo system of grading for perioperative complications is easy to use and reproducible. It can be used as an objective and reliable method for describing the complications of the surgical procedure.","PeriodicalId":41773,"journal":{"name":"Journal of Marine Medical Society","volume":"25 1","pages":"10 - 15"},"PeriodicalIF":0.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48557248","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}
Objectives: The objective of this study was to assess the knowledge, attitude, and practice (KAP) of young doctors on rabies prophylaxis and to determine the impact of the interactive lecture on the KAP of young doctors. Methods: After the formulation of the questionnaire, and review by the faculty of Medical Education, the access web link of the questionnaire was shared in What’sApp with all the young doctors of the hospital. After collecting pretest data, an interactive lecture was delivered, after the lecture, the same questionnaire was again shared, and responses were collected and analyzed. Results: All the young doctors who participated in the study acquired good KAP on rabies prophylaxis, overall 6% of doctors corrected themselves and there was an improvement in rightly answering 11 questions. Conclusion: KAP survey can be an effective tool in achieving the goal for imparting knowledge regarding effective disease prevention and management.
{"title":"Knowledge, attitude, and practice of rabies postexposure prophylaxis among young doctors","authors":"Mahesh Manthene, Rajat Shukla, Anuj Singhal, SubashChandra Shaw, Raghav Sharma, KP Soman, Aditya Singhal","doi":"10.4103/jmms.jmms_9_23","DOIUrl":"https://doi.org/10.4103/jmms.jmms_9_23","url":null,"abstract":"Objectives: The objective of this study was to assess the knowledge, attitude, and practice (KAP) of young doctors on rabies prophylaxis and to determine the impact of the interactive lecture on the KAP of young doctors. Methods: After the formulation of the questionnaire, and review by the faculty of Medical Education, the access web link of the questionnaire was shared in What’sApp with all the young doctors of the hospital. After collecting pretest data, an interactive lecture was delivered, after the lecture, the same questionnaire was again shared, and responses were collected and analyzed. Results: All the young doctors who participated in the study acquired good KAP on rabies prophylaxis, overall 6% of doctors corrected themselves and there was an improvement in rightly answering 11 questions. Conclusion: KAP survey can be an effective tool in achieving the goal for imparting knowledge regarding effective disease prevention and management.","PeriodicalId":41773,"journal":{"name":"Journal of Marine Medical Society","volume":"120 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136202935","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 : 2023-01-01DOI: 10.4103/jmms.jmms_130_22
Varun Vig, Manish Dhawan, Anant Sharma, Ravi Chauhan, Manish Prasad
Background: Deformity of long bones of lower limb leads to frequent gait and joint problems, in addition to the esthetic problems. Correction of such deformities proves to be a challenge due to spatial and soft-tissue considerations. Taylor Spatial Frame (TSF) and Ortho-SUV Frame (SUV) are two six axis correction devices which utilize the Ilizarov methods and allow easier correction of complex deformities. This study was performed to compare the efficacy of TSF and SUV for correction of lower limb long bone deformities. Materials and Methods: The Study was held at Sir Ganga Ram Hospital, New Delhi between January 2015 and November 2019. Twenty patients were included for each correction group. Assessment of correction was done in terms of rate and accuracy of deformity correction, lengthening index, total lengthening achieved, time in frame, assessment of ability to perform Activities of Daily Living, functional outcome using Association for the Study and Application of the Method of Ilizarov (ASAMI) score, and complications during treatment. Results: Both groups showed excellent correction of deformity in all planes and good functional outcomes. TSF group showed lesser incidence of joint stiffness as well as a shorter time in Frame. Pin site infection was the most common complication followed by major residual deformity. Conclusion: Both TSF and SUV provide excellent outcome in correction of complex spatial deformities of lower limb with high accuracy and good functional outcome. The TSF provides an advantage over SUV with reduced time in Frame, lesser joint stiffness and increased patient compatibility due to smaller frame size and reduced bulk as compared to SUV.
背景:下肢长骨畸形除了导致审美问题外，还会导致步态和关节问题。由于空间和软组织的考虑，这种畸形的矫正被证明是一个挑战。Taylor Spatial Frame (TSF)和Ortho-SUV Frame (SUV)是两个六轴校正装置，利用Ilizarov方法，可以更容易地校正复杂的变形。本研究比较了TSF和SUV在下肢长骨畸形矫正中的疗效。材料和方法:该研究于2015年1月至2019年11月在新德里Sir Ganga Ram医院进行。每个矫正组各20例。根据畸形矫正率和准确性、延长指数、实现的总延长、框架内时间、日常生活活动能力评估、使用Ilizarov方法研究和应用协会(ASAMI)评分的功能结局以及治疗期间的并发症进行矫正评估。结果:两组均表现出良好的各平面畸形矫正效果和良好的功能预后。TSF组关节刚度发生率较低，在Frame中的停留时间较短。针部感染是最常见的并发症，其次是主要的残余畸形。结论:TSF和SUV对下肢复杂空间畸形的矫正效果良好，准确度高，功能预后良好。与SUV相比，TSF具有更短的框架时间、更小的关节刚度和更小的框架尺寸和更小的体积，从而提高了患者的兼容性。
{"title":"Taylor spatial frame versus ortho SUV for correction of lower limb deformities: A comparative study","authors":"Varun Vig, Manish Dhawan, Anant Sharma, Ravi Chauhan, Manish Prasad","doi":"10.4103/jmms.jmms_130_22","DOIUrl":"https://doi.org/10.4103/jmms.jmms_130_22","url":null,"abstract":"Background: Deformity of long bones of lower limb leads to frequent gait and joint problems, in addition to the esthetic problems. Correction of such deformities proves to be a challenge due to spatial and soft-tissue considerations. Taylor Spatial Frame (TSF) and Ortho-SUV Frame (SUV) are two six axis correction devices which utilize the Ilizarov methods and allow easier correction of complex deformities. This study was performed to compare the efficacy of TSF and SUV for correction of lower limb long bone deformities. Materials and Methods: The Study was held at Sir Ganga Ram Hospital, New Delhi between January 2015 and November 2019. Twenty patients were included for each correction group. Assessment of correction was done in terms of rate and accuracy of deformity correction, lengthening index, total lengthening achieved, time in frame, assessment of ability to perform Activities of Daily Living, functional outcome using Association for the Study and Application of the Method of Ilizarov (ASAMI) score, and complications during treatment. Results: Both groups showed excellent correction of deformity in all planes and good functional outcomes. TSF group showed lesser incidence of joint stiffness as well as a shorter time in Frame. Pin site infection was the most common complication followed by major residual deformity. Conclusion: Both TSF and SUV provide excellent outcome in correction of complex spatial deformities of lower limb with high accuracy and good functional outcome. The TSF provides an advantage over SUV with reduced time in Frame, lesser joint stiffness and increased patient compatibility due to smaller frame size and reduced bulk as compared to SUV.","PeriodicalId":41773,"journal":{"name":"Journal of Marine Medical Society","volume":"113 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136202952","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}
Introduction: Osteoporosis is a condition which affects both men and women but occurs a decade later in men as compared to women. Males constitute a very small percentage of patients who report for dual-energy X-ray absorptiometry (DEXA) scan. This difference may be largely because of lack of information about risk factors for secondary osteoporosis in men. In the present study, we have tried to explore the attributes of males undergoing DEXA scan at a tertiary care center. Materials and Methods: It was a cross-sectional study conducted in males visiting the general physician outpatient department in a tertiary care institute. All study participants who were males, based on inclusion and exclusion were included in the study. DEXA scan for hip and vertebra was performed for all the participants. Results: A total of 486 males fitting the inclusion criteria were included in the study. The mean age of the study participants was 66.98 (standard deviation: 8.55) years. Fifty-six (11.52%) of these participants had hypertension and 41 (8.43%) subjects had diabetes. Patient attributes and DEXA scan parameters of hip and vertebra showed a significant negative correlation with age and positive correlation with body mass index (BMI). Stratified analysis revealed that only 39% of individuals with a BMI of more than 25 kg/m2 had a high risk of osteoporosis (T ≤ −2) as compared to 58.4% of individuals with a BMI of <25 kg/m2. Conclusion: Osteoporosis among men remains a neglected aspect among physicians and surgeons. The DEXA scan is available in urban centers even in the developing countries; however, the lack of knowledge about indications seems to be the major factor for not evaluating the condition at the right time.
{"title":"Dual-energy X-ray absorptiometry scan: A neglected but essential investigation in men","authors":"Saurabh Bobdey, Anupam Kumar, Kumar Pushkar, Suraj Kapoor, ChandanKumar Panigrahi, Priyanka Sharma","doi":"10.4103/jmms.jmms_17_23","DOIUrl":"https://doi.org/10.4103/jmms.jmms_17_23","url":null,"abstract":"Introduction: Osteoporosis is a condition which affects both men and women but occurs a decade later in men as compared to women. Males constitute a very small percentage of patients who report for dual-energy X-ray absorptiometry (DEXA) scan. This difference may be largely because of lack of information about risk factors for secondary osteoporosis in men. In the present study, we have tried to explore the attributes of males undergoing DEXA scan at a tertiary care center. Materials and Methods: It was a cross-sectional study conducted in males visiting the general physician outpatient department in a tertiary care institute. All study participants who were males, based on inclusion and exclusion were included in the study. DEXA scan for hip and vertebra was performed for all the participants. Results: A total of 486 males fitting the inclusion criteria were included in the study. The mean age of the study participants was 66.98 (standard deviation: 8.55) years. Fifty-six (11.52%) of these participants had hypertension and 41 (8.43%) subjects had diabetes. Patient attributes and DEXA scan parameters of hip and vertebra showed a significant negative correlation with age and positive correlation with body mass index (BMI). Stratified analysis revealed that only 39% of individuals with a BMI of more than 25 kg/m2 had a high risk of osteoporosis (T ≤ −2) as compared to 58.4% of individuals with a BMI of <25 kg/m2. Conclusion: Osteoporosis among men remains a neglected aspect among physicians and surgeons. The DEXA scan is available in urban centers even in the developing countries; however, the lack of knowledge about indications seems to be the major factor for not evaluating the condition at the right time.","PeriodicalId":41773,"journal":{"name":"Journal of Marine Medical Society","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136202960","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}
Introduction: The purpose of the study was to determine forward-planned intensity-modulated radiotherapy which improves the sparing of organs at risk (OAR), heart, lungs, and contralateral breast, when compared with multi-field inverse-planned intensity-modulated radiation therapy (RT). The anatomy of the chest wall is curved, which makes it difficult to achieve a homogeneous dose; therefore, it is essential to know the technique by which we can render a better treatment. Methods: The three-dimensional field-in-field (FIF) technique for radiotherapy is an advanced state-of-the-art method that uses multileaf collimators to generate a homogeneous and conformal dose distribution through segmental subfields. The planning computer tomography (CT) scans of 30 women with left-sided breast cancer previously treated with whole breast RT on an inclined breast board with both arms supported above the head were retrieved. The whole-breast planning target volume (PTV) was defined by clinical markup and contoured on all relevant CT slices as were the OARs. For each patient, two plans were generated using FIF and five-field inverse-planned IMRT, with a prescription dose of 50 Gy in 25 fractions to the whole breast. The mean and maximum doses to the OARs, conformity index, and homogeneity index (HI) of the whole-breast PTV were compared. Results: The FIF technique significantly reduced the maximum dose of the PTV as well as the mean doses of the heart, ipsilateral lung, contralateral lung, esophagus, and contralateral breast (P < 0.001 for each). When the organ at risk volumes irradiated with 10, 20, 30, and 40 Gy were compared, the results were in favor of the FIF technique. The volume receiving <20 Gy of the prescription dose for the ipsilateral lung was significantly decreased using the FIF technique (P < 0.001). The FIF technique allowed us more homogenous dose distribution. Conclusions: FIF resulted in a lower mean heart and contralateral breast dose with comparable HI of the whole-breast PTV compared to inverse-planned IMRT using five fields. These results with significantly fewer monitor units essential for therapy in FIF suggest that this technique may be more advantageous during breast irradiation.
{"title":"Dosimetric comparison of radiation techniques for comprehensive radiation therapy for left-sided breast cancer: A treatment planning study","authors":"SajadAhmad Rather, MuddasirSharief Banday, AijazAhmad Khan, ShaqulQamar Wani, MudasirAshraf Shah, Samina Mufti","doi":"10.4103/jmms.jmms_158_22","DOIUrl":"https://doi.org/10.4103/jmms.jmms_158_22","url":null,"abstract":"Introduction: The purpose of the study was to determine forward-planned intensity-modulated radiotherapy which improves the sparing of organs at risk (OAR), heart, lungs, and contralateral breast, when compared with multi-field inverse-planned intensity-modulated radiation therapy (RT). The anatomy of the chest wall is curved, which makes it difficult to achieve a homogeneous dose; therefore, it is essential to know the technique by which we can render a better treatment. Methods: The three-dimensional field-in-field (FIF) technique for radiotherapy is an advanced state-of-the-art method that uses multileaf collimators to generate a homogeneous and conformal dose distribution through segmental subfields. The planning computer tomography (CT) scans of 30 women with left-sided breast cancer previously treated with whole breast RT on an inclined breast board with both arms supported above the head were retrieved. The whole-breast planning target volume (PTV) was defined by clinical markup and contoured on all relevant CT slices as were the OARs. For each patient, two plans were generated using FIF and five-field inverse-planned IMRT, with a prescription dose of 50 Gy in 25 fractions to the whole breast. The mean and maximum doses to the OARs, conformity index, and homogeneity index (HI) of the whole-breast PTV were compared. Results: The FIF technique significantly reduced the maximum dose of the PTV as well as the mean doses of the heart, ipsilateral lung, contralateral lung, esophagus, and contralateral breast (P < 0.001 for each). When the organ at risk volumes irradiated with 10, 20, 30, and 40 Gy were compared, the results were in favor of the FIF technique. The volume receiving <20 Gy of the prescription dose for the ipsilateral lung was significantly decreased using the FIF technique (P < 0.001). The FIF technique allowed us more homogenous dose distribution. Conclusions: FIF resulted in a lower mean heart and contralateral breast dose with comparable HI of the whole-breast PTV compared to inverse-planned IMRT using five fields. These results with significantly fewer monitor units essential for therapy in FIF suggest that this technique may be more advantageous during breast irradiation.","PeriodicalId":41773,"journal":{"name":"Journal of Marine Medical Society","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136203534","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}
Shekhawat Vikram, S. Mohanty, V. Behera, R. Ananthakrishnan, Jnanaprakash B. Karanth, Nagargoje Mahadev
Background and Aims: Thyroid hormones play a key role in modulating the cardiac function and structure. Expectedly, thyroid hormone deficiency in primary hypothyroidism has a profound and clinically relevant effect on the cardiac structure and function manifesting in characteristic electrocardiographic and echocardiographic (ECHO) abnormalities. The aim is to evaluate the effects of levothyroxine replacement therapy on the electrocardiographic (ECG) and ECHO changes in patients with primary hypothyroidism by assessing the changes in ECG and ECHO before and after 6 weeks of optimal levothyroxine (LT4) treatment in adults with newly diagnosed primary hypothyroidism. Methodology: Prospective, observational study conducted in the department of medicine in an armed forces tertiary care teaching hospital from October 2018 to April 2021. We studied newly diagnosed adults with primary hypothyroidism who were treated with optimal LT4 replacement. Descriptive statistics along with Student's t-test and Chi-square test were used to determine the statistical significance. Results: In 152 participants, the mean age was 41.0 ± 13.2 years and 79% were female. After 6 weeks of LT4 treatment, the proportion of participants with abnormal ECG findings reduced significantly (from 77% to 14.5%, P < 0.0001) with a significant reduction in those having sinus bradycardia (P < 0.0001) and low-voltage complexes (P < 0.0001). On ECHO, there was a significant improvement in left ventricular ejection fraction (P < 0.001), fractional shortening (P < 0.001), and a significant reduction in myocardial thickness parameters. The systolic and diastolic function improved significantly after 6 weeks of treatment. The proportion of patients without pericardial effusion increased from 34.9% to 79.6%. Conclusion: Replacement therapy with LT4 in newly diagnosed primary hypothyroid patients substantially improves cardiac structure, systolic and diastolic function and has a positive impact on underlying pericardial effusion. A large, prospective, trial is necessary to determine the long-term effects after thyroid hormone replacement.
{"title":"Short-term electrocardiographic and echocardiographic effects of levothyroxine replacement in adults with newly diagnosed hypothyroidism","authors":"Shekhawat Vikram, S. Mohanty, V. Behera, R. Ananthakrishnan, Jnanaprakash B. Karanth, Nagargoje Mahadev","doi":"10.4103/jmms.jmms_95_22","DOIUrl":"https://doi.org/10.4103/jmms.jmms_95_22","url":null,"abstract":"Background and Aims: Thyroid hormones play a key role in modulating the cardiac function and structure. Expectedly, thyroid hormone deficiency in primary hypothyroidism has a profound and clinically relevant effect on the cardiac structure and function manifesting in characteristic electrocardiographic and echocardiographic (ECHO) abnormalities. The aim is to evaluate the effects of levothyroxine replacement therapy on the electrocardiographic (ECG) and ECHO changes in patients with primary hypothyroidism by assessing the changes in ECG and ECHO before and after 6 weeks of optimal levothyroxine (LT4) treatment in adults with newly diagnosed primary hypothyroidism. Methodology: Prospective, observational study conducted in the department of medicine in an armed forces tertiary care teaching hospital from October 2018 to April 2021. We studied newly diagnosed adults with primary hypothyroidism who were treated with optimal LT4 replacement. Descriptive statistics along with Student's t-test and Chi-square test were used to determine the statistical significance. Results: In 152 participants, the mean age was 41.0 ± 13.2 years and 79% were female. After 6 weeks of LT4 treatment, the proportion of participants with abnormal ECG findings reduced significantly (from 77% to 14.5%, P < 0.0001) with a significant reduction in those having sinus bradycardia (P < 0.0001) and low-voltage complexes (P < 0.0001). On ECHO, there was a significant improvement in left ventricular ejection fraction (P < 0.001), fractional shortening (P < 0.001), and a significant reduction in myocardial thickness parameters. The systolic and diastolic function improved significantly after 6 weeks of treatment. The proportion of patients without pericardial effusion increased from 34.9% to 79.6%. Conclusion: Replacement therapy with LT4 in newly diagnosed primary hypothyroid patients substantially improves cardiac structure, systolic and diastolic function and has a positive impact on underlying pericardial effusion. A large, prospective, trial is necessary to determine the long-term effects after thyroid hormone replacement.","PeriodicalId":41773,"journal":{"name":"Journal of Marine Medical Society","volume":"25 1","pages":"63 - 68"},"PeriodicalIF":0.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41751802","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}
Introduction: Ventilator-associated pneumonia (VAP) is an important cause of increased morbidity, mortality, duration of hospital stay, and increased health-care costs. It is the second-most common hospital-acquired infection associated with high morbidity and mortality. Identification of the spectrum of causative organisms of VAP is imperative in the proper utilization of antimicrobials for VAP and the prevention of multidrug resistance (MDR) organisms. Aim and Objective: The spectrum of organisms responsible for VAP in the trauma center of our tertiary care hospital is not known and additionally, the ideal use of antimicrobials for proper treatment of these cases had to be formulated. This study was planned to identify the organisms and antimicrobial susceptibility patterns of bacteria causing VAP in patients admitted to trauma intensive care unit (ICU) of this tertiary care general hospital. Materials and Methods: In this study, 150 cases of VAP from a trauma ICU were included, who met the criteria of VAP as per the Clinical Pulmonary Infection Score. Endotracheal aspirate (ETA) samples were collected and processed for Gram stain; organisms were isolated and antibiotic sensitivity was performed by Kirby–Bauer method. Statistical analysis was performed using SSPI 23.0.0.0. Results: Our study showed predominantly Gram-negative bacilli (GNB) (70.6%) in the isolates, Gram-positive cocci in 4.67% of isolates, and 2% polymicrobial. The most common organism isolated was Klebsiella pneumoniae (44.08%), followed by Acinetobacter baumannii (17.77%). K. pneumoniae showed maximum resistance to cefotaxime (98.51%) and most sensitivity to colistin (13.43%). Maximum resistance was seen against cefotaxime (97.08%) and least against moxifloxacin (37.96%) and colistin (13.08%). K. pneumoniae had the highest MDR (47.6%), followed by A. baumannii (17.14%). Conclusion: VAP is a significant cause of mortality in ICU settings. The significant isolation of GNB in ETAs and the resistance pattern seen in our study shows that judicious and appropriate use of antimicrobials in this setting would be highly beneficial to prevent the emergence of MDR organisms and reduce mortality in cases of VAP.
{"title":"Bacteriological profile of ventilator-associated pneumonia in trauma intensive care unit of a tertiary care hospital","authors":"Bhasker Mukherjee, Neetu Mehrotra, Rajesh Karyakarte, Rajesh Sahu","doi":"10.4103/jmms.jmms_179_22","DOIUrl":"https://doi.org/10.4103/jmms.jmms_179_22","url":null,"abstract":"Introduction: Ventilator-associated pneumonia (VAP) is an important cause of increased morbidity, mortality, duration of hospital stay, and increased health-care costs. It is the second-most common hospital-acquired infection associated with high morbidity and mortality. Identification of the spectrum of causative organisms of VAP is imperative in the proper utilization of antimicrobials for VAP and the prevention of multidrug resistance (MDR) organisms. Aim and Objective: The spectrum of organisms responsible for VAP in the trauma center of our tertiary care hospital is not known and additionally, the ideal use of antimicrobials for proper treatment of these cases had to be formulated. This study was planned to identify the organisms and antimicrobial susceptibility patterns of bacteria causing VAP in patients admitted to trauma intensive care unit (ICU) of this tertiary care general hospital. Materials and Methods: In this study, 150 cases of VAP from a trauma ICU were included, who met the criteria of VAP as per the Clinical Pulmonary Infection Score. Endotracheal aspirate (ETA) samples were collected and processed for Gram stain; organisms were isolated and antibiotic sensitivity was performed by Kirby–Bauer method. Statistical analysis was performed using SSPI 23.0.0.0. Results: Our study showed predominantly Gram-negative bacilli (GNB) (70.6%) in the isolates, Gram-positive cocci in 4.67% of isolates, and 2% polymicrobial. The most common organism isolated was Klebsiella pneumoniae (44.08%), followed by Acinetobacter baumannii (17.77%). K. pneumoniae showed maximum resistance to cefotaxime (98.51%) and most sensitivity to colistin (13.43%). Maximum resistance was seen against cefotaxime (97.08%) and least against moxifloxacin (37.96%) and colistin (13.08%). K. pneumoniae had the highest MDR (47.6%), followed by A. baumannii (17.14%). Conclusion: VAP is a significant cause of mortality in ICU settings. The significant isolation of GNB in ETAs and the resistance pattern seen in our study shows that judicious and appropriate use of antimicrobials in this setting would be highly beneficial to prevent the emergence of MDR organisms and reduce mortality in cases of VAP.","PeriodicalId":41773,"journal":{"name":"Journal of Marine Medical Society","volume":"57 57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136202531","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}
Splenic infarction without splenic vessel thrombosis is an infrequent presentation in clinical practice. The case discussed here is a 45-year-old male with a history of alcohol abuse, who presented to the hospital with pain abdomen epicentered in the left upper quadrant. On evaluation, the patient was found to be having portal hypertension complicated with alcoholic hepatitis, acute necrotizing pancreatitis, gastric, and paraesophageal varices. The presence of splenic infarction without concomitant splenic vessel thrombosis in this patient merits a discussion of relevant investigations and their findings thereof.
{"title":"Case report: Splenic infarct without splenic vessel thrombosis in a patient with portal hypertension and acute pancreatitis","authors":"RanjitSingh Lahel, A. Chail","doi":"10.4103/jmms.jmms_38_22","DOIUrl":"https://doi.org/10.4103/jmms.jmms_38_22","url":null,"abstract":"Splenic infarction without splenic vessel thrombosis is an infrequent presentation in clinical practice. The case discussed here is a 45-year-old male with a history of alcohol abuse, who presented to the hospital with pain abdomen epicentered in the left upper quadrant. On evaluation, the patient was found to be having portal hypertension complicated with alcoholic hepatitis, acute necrotizing pancreatitis, gastric, and paraesophageal varices. The presence of splenic infarction without concomitant splenic vessel thrombosis in this patient merits a discussion of relevant investigations and their findings thereof.","PeriodicalId":41773,"journal":{"name":"Journal of Marine Medical Society","volume":"25 1","pages":"97 - 99"},"PeriodicalIF":0.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42486588","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 : 2023-01-01DOI: 10.4103/jmms.jmms_113_21
Prabhakar Teli, T. Ekambaram, A. Yadav
Introduction: Insulin is one of the most effective agents in reducing hyperglycemia when used in appropriate doses. However, insulin may have risks if used inappropriately. Insufficient knowledge of insulin self-injection can result in complication, adverse patient outcomes, and invariably poor glycemic control. Methods: A cross-sectional observational study was conducted among patients with diabetes mellitus attending the outpatient department of the hospital in western Maharashtra. Data on sociodemographic factors and knowledge and attitude with insulin syringes were collected. Results: A total of 93 participated in the study. The mean age of the participant was 55.5 years, and most were male (52, 55.9%). Seventy-five (80.7%, 95% confidence interval [CI]: 71.1–88.1) were having adequate knowledge. Higher education was associated with adequate knowledge. The attitude was adequate in 24 (25.8%, 95% CI: 17.2–35.9) participants. Higher duration of illness of diabetes mellitus was associated with good attitude. Conclusion: The study found that there are gaps in knowledge and attitude for the use of insulin syringes. Opportunistic or one-to-one health education may be taken to improve knowledge and attitude regarding insulin syringes.
{"title":"Insulin therapy among outpatient department patients of diabetes mellitus in a tertiary care hospital: Do they have adequate knowledge about insulin?","authors":"Prabhakar Teli, T. Ekambaram, A. Yadav","doi":"10.4103/jmms.jmms_113_21","DOIUrl":"https://doi.org/10.4103/jmms.jmms_113_21","url":null,"abstract":"Introduction: Insulin is one of the most effective agents in reducing hyperglycemia when used in appropriate doses. However, insulin may have risks if used inappropriately. Insufficient knowledge of insulin self-injection can result in complication, adverse patient outcomes, and invariably poor glycemic control. Methods: A cross-sectional observational study was conducted among patients with diabetes mellitus attending the outpatient department of the hospital in western Maharashtra. Data on sociodemographic factors and knowledge and attitude with insulin syringes were collected. Results: A total of 93 participated in the study. The mean age of the participant was 55.5 years, and most were male (52, 55.9%). Seventy-five (80.7%, 95% confidence interval [CI]: 71.1–88.1) were having adequate knowledge. Higher education was associated with adequate knowledge. The attitude was adequate in 24 (25.8%, 95% CI: 17.2–35.9) participants. Higher duration of illness of diabetes mellitus was associated with good attitude. Conclusion: The study found that there are gaps in knowledge and attitude for the use of insulin syringes. Opportunistic or one-to-one health education may be taken to improve knowledge and attitude regarding insulin syringes.","PeriodicalId":41773,"journal":{"name":"Journal of Marine Medical Society","volume":"25 1","pages":"21 - 24"},"PeriodicalIF":0.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47701950","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}
P. Dubey, S. Rohatgi, P. Rao, S. Nirhale, P. Naphade, Advait Gitay
We hereby report an interesting case of tractopathy following COVID-19 vaccine. Acute transverse myelitis following COVID-19 infection or vaccination is well documented. However, to the best of our knowledge, no case of selective tract involvement following COVID-19 vaccine has been reported so far. One case of tract-specific central nervous system involvement following COVID-19 infection has been reported from India. We report the case of a 46-year-old male who developed clinical and radiological evidence of tractopathy involving the corticospinal tracts and posterior columns following the first dose of the Covishield vaccine.
{"title":"Tract specific CNS involvement post COVID-19 vaccine: A case report","authors":"P. Dubey, S. Rohatgi, P. Rao, S. Nirhale, P. Naphade, Advait Gitay","doi":"10.4103/jmms.jmms_56_22","DOIUrl":"https://doi.org/10.4103/jmms.jmms_56_22","url":null,"abstract":"We hereby report an interesting case of tractopathy following COVID-19 vaccine. Acute transverse myelitis following COVID-19 infection or vaccination is well documented. However, to the best of our knowledge, no case of selective tract involvement following COVID-19 vaccine has been reported so far. One case of tract-specific central nervous system involvement following COVID-19 infection has been reported from India. We report the case of a 46-year-old male who developed clinical and radiological evidence of tractopathy involving the corticospinal tracts and posterior columns following the first dose of the Covishield vaccine.","PeriodicalId":41773,"journal":{"name":"Journal of Marine Medical Society","volume":" ","pages":"100 - 102"},"PeriodicalIF":0.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48273854","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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