BACKGROUND Postpartum haemorrhage (PPH) and pre-eclampsia and eclampsia (PE/E) are the leading causes of pregnancy and childbirth-related complications and deaths, particularly in developing countries. FOGSI-Manyata skill transfer training is being implemented in private healthcare facilities in India, enabling ‘task-shifting’ to staff nurses by improving their knowledge and skills towards achieving desired maternal and perinatal outcomes. METHODS In this qualitative study, 4 focus group discussions (FGDs) with staff nurses and 14 in-depth interviews (IDIs) with head consultants of study facilities and assessors from different states (both metro and non-metro regions) were undertaken. Their experiences and perceptions about Manyata training, including its impact on building their capacity towards efficient handling of maternal complications during childbirth, were explored and the data was analysed through thematic analysis. RESULTS The two main overarching themes included: barriers to prevention, early identification and handling of complications, and post-training competency gained for effective management of complications. Lack of skilled staff trained in obstetrics and gynaecology, gaps in basic knowledge and skills in emergency obstetric care (EmOC), limited training opportunities at the workplace, and high staff turnover were identified as the factors contributing to the perceived importance of the training program. The competencies gained by staff nurses through Manyata training included readiness for prevention and early detection of complications (PPH and PE/E), improved understanding of specific causes of PPH, preparedness for timely management of both PPH and PE/E, and coordinated teamwork. CONCLUSIONS All the respondents strongly valued the Manyata training for effective management of maternal complications, PPH, and PE/E. Such in-service training, which is also appropriately tailored to the local context, along with the strong motivation of head consultants and staff nurses to upgrade themselves through continuous efforts, is required to achieve sustainable goals to reduce maternal and perinatal mortality.
{"title":"Impact of Manyata Flagship Program on Effective Management of Maternal Complications - Task-Shifting to Staff Nurses with Improved Competence","authors":"Hema Divakar, Richa Mishra, Sheetal Joshi, Bhagyashri Kulkarni, Poorni Narayanan, Rita Singh, Gubbi Venkatasubbaiah Divakar","doi":"10.14260/jemds.v11i11.236","DOIUrl":"https://doi.org/10.14260/jemds.v11i11.236","url":null,"abstract":"BACKGROUND \u0000Postpartum haemorrhage (PPH) and pre-eclampsia and eclampsia (PE/E) are the leading causes of pregnancy and childbirth-related complications and deaths, particularly in developing countries. FOGSI-Manyata skill transfer training is being implemented in private healthcare facilities in India, enabling ‘task-shifting’ to staff nurses by improving their knowledge and skills towards achieving desired maternal and perinatal outcomes. \u0000METHODS \u0000In this qualitative study, 4 focus group discussions (FGDs) with staff nurses and 14 in-depth interviews (IDIs) with head consultants of study facilities and assessors from different states (both metro and non-metro regions) were undertaken. Their experiences and perceptions about Manyata training, including its impact on building their capacity towards efficient handling of maternal complications during childbirth, were explored and the data was analysed through thematic analysis. \u0000RESULTS \u0000The two main overarching themes included: barriers to prevention, early identification and handling of complications, and post-training competency gained for effective management of complications. Lack of skilled staff trained in obstetrics and gynaecology, gaps in basic knowledge and skills in emergency obstetric care (EmOC), limited training opportunities at the workplace, and high staff turnover were identified as the factors contributing to the perceived importance of the training program. The competencies gained by staff nurses through Manyata training included readiness for prevention and early detection of complications (PPH and PE/E), improved understanding of specific causes of PPH, preparedness for timely management of both PPH and PE/E, and coordinated teamwork. \u0000CONCLUSIONS \u0000All the respondents strongly valued the Manyata training for effective management of maternal complications, PPH, and PE/E. Such in-service training, which is also appropriately tailored to the local context, along with the strong motivation of head consultants and staff nurses to upgrade themselves through continuous efforts, is required to achieve sustainable goals to reduce maternal and perinatal mortality.","PeriodicalId":47072,"journal":{"name":"Journal of Evolution of Medical and Dental Sciences-JEMDS","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43457780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND Modified early warning score (MEWS) is a scoring system being used in hospitals for the identification of patients who may deteriorate into medical emergencies or cardiac arrest. However, the mortality benefit of MEWS hasn’t been established. Also, there is limited data about the experience of MEWS being implemented in low-income countries. Hence, we conducted a before-after prospective observational study to evaluate the impact on ICU mortality post-introduction of the MEWS chart. METHODS MEWS before-after study is a single-centre prospective observational study in a tertiary university hospital conducted in the ICU at Kasturba Hospital, Manipal University, India. We trained ward nurses on MEWS and introduced the MEWS chart and compared the change in outcomes from two months prior (i.e. February-March 2018) to the subsequent two months (i.e. April-May 2018). The primary outcome measured was the ICU mortality between the samples. Our secondary outcomes were the length of stay (LOS) and hospital mortality. Student t-test was used to estimate the total sample size and we used the chi-square test for statistical analyses. RESULTS We enrolled 161 patients into each group and the patient demographics between groups did not show any statistically significant difference. The ICU mortality data did not show any statistically significant difference before the introduction of MEWS after using the chi-square test with a p-value of 0.33. There was no statistically significant difference in ICU LOS, ICU re-admission rates, hospital LOS, hospital mortality, bed occupancy rates, or incidence of CPR between the two periods. CONCLUSIONS Our study did not show a significant difference in the mortality after introduction of MEWS scoring charts to our wards. The introduction of critical care outreach services may improve the outcomes.
{"title":"Evaluating the Impact of Introducing Modified Early Warning Score to Identify Deteriorating Patients in the Wards at a Tertiary University Hospital - A before-after Study","authors":"Anusha Arbettu Kamath, Ashwin Neelavar Udupa, Anitha Nileshwar","doi":"10.14260/jemds.v11i11.235","DOIUrl":"https://doi.org/10.14260/jemds.v11i11.235","url":null,"abstract":"BACKGROUND \u0000Modified early warning score (MEWS) is a scoring system being used in hospitals for the identification of patients who may deteriorate into medical emergencies or cardiac arrest. However, the mortality benefit of MEWS hasn’t been established. Also, there is limited data about the experience of MEWS being implemented in low-income countries. Hence, we conducted a before-after prospective observational study to evaluate the impact on ICU mortality post-introduction of the MEWS chart. \u0000METHODS \u0000MEWS before-after study is a single-centre prospective observational study in a tertiary university hospital conducted in the ICU at Kasturba Hospital, Manipal University, India. We trained ward nurses on MEWS and introduced the MEWS chart and compared the change in outcomes from two months prior (i.e. February-March 2018) to the subsequent two months (i.e. April-May 2018). The primary outcome measured was the ICU mortality between the samples. Our secondary outcomes were the length of stay (LOS) and hospital mortality. Student t-test was used to estimate the total sample size and we used the chi-square test for statistical analyses. \u0000RESULTS \u0000We enrolled 161 patients into each group and the patient demographics between groups did not show any statistically significant difference. The ICU mortality data did not show any statistically significant difference before the introduction of MEWS after using the chi-square test with a p-value of 0.33. There was no statistically significant difference in ICU LOS, ICU re-admission rates, hospital LOS, hospital mortality, bed occupancy rates, or incidence of CPR between the two periods. \u0000CONCLUSIONS \u0000Our study did not show a significant difference in the mortality after introduction of MEWS scoring charts to our wards. The introduction of critical care outreach services may improve the outcomes.","PeriodicalId":47072,"journal":{"name":"Journal of Evolution of Medical and Dental Sciences-JEMDS","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49016289","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 : 2022-09-27DOI: 10.14260/jemds.v11i10.226
Priyash Verma, Lucy Bates
Splenic artery aneurysm (SAA) is a rare clinical condition that is associated with a risk of rupture and catastrophic haemorrhage, and its incidence ranges between 0.01-0.09%.[1,2] Although a seemingly rare entity, SAA has been estimated to affect 20-40% of parturients with no other underlying medical problems.[3] This has been attributed to the various hormonal changes that accompany normal pregnancy. Rupture of SAA has been described as either a single precipitous event or a two-staged phenomenon with the bleed being initially contained in the lesser sac with an apparent antecedent haemodynamically stable phase followed by cataclysmic decompensation when the contained bleed leaks into the greater sac. This can take anything between 6 – 96 hours.[4] However, in pregnancy, this process can be rapid. We present one such case of a parturient, with initially preserved haemodynamics, followed by rapid decompensation, with ultimately good maternal and neonatal outcomes.
{"title":"Splenic Artery Aneurysm Rupture in a Parturient - Case Report","authors":"Priyash Verma, Lucy Bates","doi":"10.14260/jemds.v11i10.226","DOIUrl":"https://doi.org/10.14260/jemds.v11i10.226","url":null,"abstract":"Splenic artery aneurysm (SAA) is a rare clinical condition that is associated with a risk of rupture and catastrophic haemorrhage, and its incidence ranges between 0.01-0.09%.[1,2] Although a seemingly rare entity, SAA has been estimated to affect 20-40% of parturients with no other underlying medical problems.[3] \u0000This has been attributed to the various hormonal changes that accompany normal pregnancy. Rupture of SAA has been described as either a single precipitous event or a two-staged phenomenon with the bleed being initially contained in the lesser sac with an apparent antecedent haemodynamically stable phase followed by cataclysmic decompensation when the contained bleed leaks into the greater sac. This can take anything between 6 – 96 hours.[4] However, in pregnancy, this process can be rapid. We present one such case of a parturient, with initially preserved haemodynamics, followed by rapid decompensation, with ultimately good maternal and neonatal outcomes.","PeriodicalId":47072,"journal":{"name":"Journal of Evolution of Medical and Dental Sciences-JEMDS","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49668775","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 : 2022-09-27DOI: 10.14260/jemds.v11i10.228
Deepak Johnson, Ajitha Kumari, Asha Punnoose, Sany Philip, George Chandy Mattethra
BACKGROUND Evaluation of intra-abdominal/intrathoracic lymphadenopathy in the absence of enlarged peripheral nodes has always been a challenging problem for clinicians, especially with unfavourable general conditions of the patient where surgical interventions are difficult. Endoscopic ultrasound-guided FNA has been used for the last two decades for tissue acquisition from patients with such deep-seated lesions. But its use in the diagnosis of lymphoma has always been challenging. However, the addition of fine needle core biopsy into this procedure has given promising results. In this study, we wanted to evaluate the effectiveness of EUS-FNA/FNB as an alternative to invasive open surgical procedures. METHODS We exhibit a case series of 6 patients who presented with mediastinal and/ or intraabdominal lymphadenopathy in whom EUS-FNA & FNB were done simultaneously to obtain tissue for histological and ancillary studies. RESULTS Clinically these lymph nodes were detected by CECT and there was no peripheral lymphadenopathy. In this case series, we were able to make a diagnosis of lymphoma in all 6 cases. With the help of immunohistochemistry, 2 cases were further classified into Hodgkin’s lymphoma and one case was diagnosed as ALK-positive anaplastic large cell lymphoma. All three patients underwent treatment from our hospital and are on follow-up. CONCLUSIONS Our experience with this case series report suggests that EUS-FNA/FNB is a minimally invasive procedure which can be tried effectively as an alternative to invasive open surgical procedures.
{"title":"Endoscopic Ultrasound-Guided Fine Needle Aspiration (FNA) Combined with Fine Needle Biopsy (FNB) in the Diagnosis and Subclassification of Deep-Seated Lymphomas - Report of a Case Series and Review of Literature","authors":"Deepak Johnson, Ajitha Kumari, Asha Punnoose, Sany Philip, George Chandy Mattethra","doi":"10.14260/jemds.v11i10.228","DOIUrl":"https://doi.org/10.14260/jemds.v11i10.228","url":null,"abstract":"BACKGROUND \u0000Evaluation of intra-abdominal/intrathoracic lymphadenopathy in the absence of enlarged peripheral nodes has always been a challenging problem for clinicians, especially with unfavourable general conditions of the patient where surgical interventions are difficult. Endoscopic ultrasound-guided FNA has been used for the last two decades for tissue acquisition from patients with such deep-seated lesions. But its use in the diagnosis of lymphoma has always been challenging. However, the addition of fine needle core biopsy into this procedure has given promising results. In this study, we wanted to evaluate the effectiveness of EUS-FNA/FNB as an alternative to invasive open surgical procedures. \u0000METHODS \u0000We exhibit a case series of 6 patients who presented with mediastinal and/ or intraabdominal lymphadenopathy in whom EUS-FNA & FNB were done simultaneously to obtain tissue for histological and ancillary studies. \u0000RESULTS \u0000Clinically these lymph nodes were detected by CECT and there was no peripheral lymphadenopathy. In this case series, we were able to make a diagnosis of lymphoma in all 6 cases. With the help of immunohistochemistry, 2 cases were further classified into Hodgkin’s lymphoma and one case was diagnosed as ALK-positive anaplastic large cell lymphoma. All three patients underwent treatment from our hospital and are on follow-up. \u0000CONCLUSIONS \u0000Our experience with this case series report suggests that EUS-FNA/FNB is a minimally invasive procedure which can be tried effectively as an alternative to invasive open surgical procedures.","PeriodicalId":47072,"journal":{"name":"Journal of Evolution of Medical and Dental Sciences-JEMDS","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44837229","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 : 2022-09-27DOI: 10.14260/jemds.v11i10.227
Namdev Seth
A bilobed testicle is an extremely rare congenital malformation. Only seven cases have been reported in the literature to date.[1] In our knowledge, this is the first case of the bilobed testis to be reported in any radiology journal. Bilobed testis could be a variant of polyorchidism, having incomplete expression, so it may also be termed incomplete unilateral polyorchidism. Polyorchidism is relatively a more common condition than bilobed testis, still very rare in terms of overall incidence, with only about 200 cases reported to date.
{"title":"Bilobed Testis in an Adult - An Extremely Rare Entity","authors":"Namdev Seth","doi":"10.14260/jemds.v11i10.227","DOIUrl":"https://doi.org/10.14260/jemds.v11i10.227","url":null,"abstract":"A bilobed testicle is an extremely rare congenital malformation. Only seven cases have been reported in the literature to date.[1] In our knowledge, this is the first case of the bilobed testis to be reported in any radiology journal. Bilobed testis could be a variant of polyorchidism, having incomplete expression, so it may also be termed incomplete unilateral polyorchidism. Polyorchidism is relatively a more common condition than bilobed testis, still very rare in terms of overall incidence, with only about 200 cases reported to date.","PeriodicalId":47072,"journal":{"name":"Journal of Evolution of Medical and Dental Sciences-JEMDS","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43686261","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 : 2022-09-27DOI: 10.14260/jemds.v11i10.225
Terapalli Srinivas, Moravineni Usharani
BACKGROUND Hypertension, an elevated blood pressure of systolic /diastolic, is a serious medical condition and is a "silent killer" which increases the risks of heart disease, brain stroke, renal diseases etc. The WHO estimate is that 45% of deaths from heart disease and 51% of deaths from stroke worldwide are caused by hypertension. Policemen working in Greyhounds are having one of the most stressful occupations; hypertension is highly prevalent in this population, because their job is task-oriented, stressful duties and combing operations in naxalite areas. Some of the policemen habituated to unhealthy habits like smoking, consumption of alcohol and irregular dietary pattern. The contributory factors like obesity, excessive dietary sodium intake, and low physical activity, family history of hypertension increase BMI. The prevalence of hypertension observed among Greyhounds policemen is 39.6%, which is significantly higher than previous studies of hypertension in policemen. Hypertension can be prevented by adopting healthy lifestyle modifications, periodical check-ups, timely diagnosis and treatment. In this study, we wanted to find out the prevalence of hypertension in the policemen randomly selected in greyhounds Visakhapatnam. METHODS A cross-sectional study of total of 124 police men randomly selected greyhounds Visakhapatnam, the age ranged from 18 to 60 years. Data were collected using sphygmomanometer, body mass analyser (In Body 570), semi-structured interview schedule, and analysed in EXCEL using SPSS version 21.0. RESULTS Among 124 participants, 49 (39.6%) participants were found to be hypertensive. Increasing age, family history, smoking, higher BMI, presence of diabetes were the significant factors associated with hypertension among study subjects. CONCLUSIONS Hypertension in policemen emerged as an important health problem. Therefore, it is the need of the hour to devise a sound screening strategy to diagnose and treat hypertension among policemen. Devise a comprehensive strategy for the management of HTN.
背景高血压，即收缩压/舒张压升高，是一种严重的疾病，是一个“沉默的杀手”，它增加了心脏病、脑卒中和肾脏疾病等的风险。世界卫生组织估计，全球45%的心脏病死亡和51%的脑卒中死亡是由高血压引起的。在灰狗队工作的警察是压力最大的职业之一；高血压在这一人群中非常普遍，因为他们的工作是以任务为导向的，工作压力大，在纳萨尔派地区进行梳理作业。一些警察习惯了吸烟、饮酒和不规律饮食等不健康的习惯。肥胖、过量的钠摄入、低体力活动、高血压家族史等因素会增加BMI。灰狗警察中观察到的高血压患病率为39.6%，显著高于以往对警察高血压的研究。高血压可以通过改变健康的生活方式、定期检查、及时诊断和治疗来预防。在这项研究中，我们想了解在维萨卡帕特南灰狗中随机选择的警察中高血压的患病率。方法对124名警察进行横断面研究，随机选择年龄在18-60岁之间的维萨卡帕特南灰狗。使用血压计、体重分析仪（In body 570）、半结构化访谈表收集数据，并使用SPSS 21.0版在EXCEL中进行分析。结果在124名参与者中，49名（39.6%）参与者被发现患有高血压。年龄增加、家族史、吸烟、BMI升高、糖尿病是研究对象中与高血压相关的重要因素。结论警察高血压是一个重要的健康问题。因此，制定合理的筛查策略来诊断和治疗警察高血压是当务之急。为HTN的管理制定一个全面的战略。
{"title":"Prevalence of Hypertension in Policemen in Greyhounds Visakhapatnam, Andhra Pradesh, India","authors":"Terapalli Srinivas, Moravineni Usharani","doi":"10.14260/jemds.v11i10.225","DOIUrl":"https://doi.org/10.14260/jemds.v11i10.225","url":null,"abstract":"BACKGROUND \u0000Hypertension, an elevated blood pressure of systolic /diastolic, is a serious medical condition and is a \"silent killer\" which increases the risks of heart disease, brain stroke, renal diseases etc. The WHO estimate is that 45% of deaths from heart disease and 51% of deaths from stroke worldwide are caused by hypertension. Policemen working in Greyhounds are having one of the most stressful occupations; hypertension is highly prevalent in this population, because their job is task-oriented, stressful duties and combing operations in naxalite areas. Some of the policemen habituated to unhealthy habits like smoking, consumption of alcohol and irregular dietary pattern. The contributory factors like obesity, excessive dietary sodium intake, and low physical activity, family history of hypertension increase BMI. The prevalence of hypertension observed among Greyhounds policemen is 39.6%, which is significantly higher than previous studies of hypertension in policemen. Hypertension can be prevented by adopting healthy lifestyle modifications, periodical check-ups, timely diagnosis and treatment. In this study, we wanted to find out the prevalence of hypertension in the policemen randomly selected in greyhounds Visakhapatnam. \u0000METHODS \u0000A cross-sectional study of total of 124 police men randomly selected greyhounds Visakhapatnam, the age ranged from 18 to 60 years. Data were collected using sphygmomanometer, body mass analyser (In Body 570), semi-structured interview schedule, and analysed in EXCEL using SPSS version 21.0. \u0000RESULTS \u0000Among 124 participants, 49 (39.6%) participants were found to be hypertensive. Increasing age, family history, smoking, higher BMI, presence of diabetes were the significant factors associated with hypertension among study subjects. \u0000CONCLUSIONS \u0000Hypertension in policemen emerged as an important health problem. Therefore, it is the need of the hour to devise a sound screening strategy to diagnose and treat hypertension among policemen. Devise a comprehensive strategy for the management of HTN.","PeriodicalId":47072,"journal":{"name":"Journal of Evolution of Medical and Dental Sciences-JEMDS","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47208243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND The standard of care in non-resectable locally advanced head and neck cancer with squamous cell histology is radical radiotherapy (RT) along with concurrent chemotherapy. Previously, these patients were treated with conventional radiotherapy techniques. Such conventional techniques can lead to morbidity with an impact on quality-of-life (QOL) in long-term survivors. Conformal radiotherapy experiences significant improvements in QOL domains versus conventional techniques. Radiotherapy planning and treatment with conformal techniques require advanced and relatively expensive equipment. Our study is aimed at evaluating the feasibility of conventional radiotherapy techniques in terms of quality of life in locally advanced head and neck cancer patients in comparison to the conformal technique in the Indian setting. METHODS Sixty patients with locally advanced head and neck cancer who received chemo-radiation therapy and came for follow-up after a minimum of two years were scheduled to complete the QOL questionnaire (QLQ-C30 and QLQ-H&N35 scores). These scores were compared between the patients who were treated with conventional and conformal techniques. RESULTS Results showed that when comparing EORTC QLQ–C30 scoring, patients who were treated with conventional RT had a significantly higher median score for emotional QOL and lower median scores for fatigue, pain, appetite loss, and financial difficulties as compared to the conformal RT group. But only the financial difficulties scale showed a significant p-value. When comparing EORTC QLQ–H&N35 scores, all QLQ-HN35 scores did not show any significant difference, except for speech problems. Patients treated with the conventional technique had a significantly lower median score for speech problems compared to the conformal RT group. CONCLUSIONS Based on these results, it is concluded that conventional radiotherapy techniques can be advised to locally advanced head and neck cancer patients when conformal radiotherapy techniques are not available, especially in developing or underdeveloped countries.
{"title":"Quality of Life in Locally Advanced Head and Neck Cancer Patients with Different Radiotherapy Techniques after Definitive Chemo Radiotherapy - A Real-World Data Study with Indian Patients","authors":"Akkineni Naga Prasanthi, Ashwini Gopal, Sukrutha Boggula, Heena Kauser, Vallurupalli Sudhakar Kumar, Deleep Kumar Gudipudi, Alluri Krishnam Raju","doi":"10.14260/jemds.v11i10.219","DOIUrl":"https://doi.org/10.14260/jemds.v11i10.219","url":null,"abstract":"BACKGROUND \u0000The standard of care in non-resectable locally advanced head and neck cancer with squamous cell histology is radical radiotherapy (RT) along with concurrent chemotherapy. Previously, these patients were treated with conventional radiotherapy techniques. Such conventional techniques can lead to morbidity with an impact on quality-of-life (QOL) in long-term survivors. Conformal radiotherapy experiences significant improvements in QOL domains versus conventional techniques. Radiotherapy planning and treatment with conformal techniques require advanced and relatively expensive equipment. Our study is aimed at evaluating the feasibility of conventional radiotherapy techniques in terms of quality of life in locally advanced head and neck cancer patients in comparison to the conformal technique in the Indian setting. \u0000METHODS \u0000Sixty patients with locally advanced head and neck cancer who received chemo-radiation therapy and came for follow-up after a minimum of two years were scheduled to complete the QOL questionnaire (QLQ-C30 and QLQ-H&N35 scores). These scores were compared between the patients who were treated with conventional and conformal techniques. \u0000RESULTS \u0000Results showed that when comparing EORTC QLQ–C30 scoring, patients who were treated with conventional RT had a significantly higher median score for emotional QOL and lower median scores for fatigue, pain, appetite loss, and financial difficulties as compared to the conformal RT group. But only the financial difficulties scale showed a significant p-value. When comparing EORTC QLQ–H&N35 scores, all QLQ-HN35 scores did not show any significant difference, except for speech problems. Patients treated with the conventional technique had a significantly lower median score for speech problems compared to the conformal RT group. \u0000CONCLUSIONS \u0000Based on these results, it is concluded that conventional radiotherapy techniques can be advised to locally advanced head and neck cancer patients when conformal radiotherapy techniques are not available, especially in developing or underdeveloped countries.","PeriodicalId":47072,"journal":{"name":"Journal of Evolution of Medical and Dental Sciences-JEMDS","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42308037","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 : 2022-09-21DOI: 10.14260/jemds.v11i10.218
Gayathri Shivakumar, Suresh M.K., Naveen P.V.
BACKGROUND Multimodal Computed Tomography (CT) imaging with contrast-enhanced CT angiography (CTA) is frequently being used to guide the management of acute ischemic stroke. The administration of contrast media (CM) may lead to nephrotoxicity. However, little has been reported about the safety of intravenous CM exposure in acute stroke patients. This study aims to evaluate whether there is a significant change in renal function following contrast agent administration, determine the proportion of patients developing contrast-induced acute kidney injury(CI-AKI), and analyze the risk factors associated with the same. METHODS We analysed 138 patients with acute ischemic stroke who underwent emergency CTA at our centre, followed up on the renal parameters and prospectively evaluated them for the development of CI-AKI. The patients who developed CI-AKI were analysed for specific risk factors and categorized into risk groups based on a pre-validated risk score. Univariate and multivariate logistic regression was done to identify independent predictors of CI-AKI. RESULTS CI-AKI occurred in 19 patients (13.7%). Significant (p<0.001) changes in renal parameters were observed following contrast administration irrespective of whether it satisfied the criteria for CI-AKI. Most of the patients had a low-risk score for CI-AKI. The predicted risk of CI-AKI based on the Mehran Risk Score (MRS) was similar to that observed in our study population. No patient had to be on haemodialysis. Raised baseline S.creatinine(p-value<0.03), Diabetes with microangiopathy(p-value<0.001), and systemic hypertension(p-value<0.001) were significant predictors for CI-AKI. CONCLUSIONS The development of renal sequelae is low in acute ischemic stroke patients undergoing contrast imaging. Prompt CTA, if indicated, need not be delayed in those with no history of renal impairment or without relevant risk factors. A practical reflection of this study is to be cognizant of the renal risks that an in-patient stroke population is exposed to as Intravascular depletion, infections(urinary tract infections, pneumonia), and nephrotoxic medications.
{"title":"Prevalence of Contrast-Induced Acute Kidney Injury in Acute Ischemic Stroke Patients Undergoing Contrast-Enhanced CT Angiography at a Tertiary Care Centre","authors":"Gayathri Shivakumar, Suresh M.K., Naveen P.V.","doi":"10.14260/jemds.v11i10.218","DOIUrl":"https://doi.org/10.14260/jemds.v11i10.218","url":null,"abstract":"BACKGROUND \u0000Multimodal Computed Tomography (CT) imaging with contrast-enhanced CT angiography (CTA) is frequently being used to guide the management of acute ischemic stroke. The administration of contrast media (CM) may lead to nephrotoxicity. However, little has been reported about the safety of intravenous CM exposure in acute stroke patients. This study aims to evaluate whether there is a significant change in renal function following contrast agent administration, determine the proportion of patients developing contrast-induced acute kidney injury(CI-AKI), and analyze the risk factors associated with the same. \u0000METHODS \u0000We analysed 138 patients with acute ischemic stroke who underwent emergency CTA at our centre, followed up on the renal parameters and prospectively evaluated them for the development of CI-AKI. The patients who developed CI-AKI were analysed for specific risk factors and categorized into risk groups based on a pre-validated risk score. Univariate and multivariate logistic regression was done to identify independent predictors of CI-AKI. \u0000RESULTS \u0000CI-AKI occurred in 19 patients (13.7%). Significant (p<0.001) changes in renal parameters were observed following contrast administration irrespective of whether it satisfied the criteria for CI-AKI. Most of the patients had a low-risk score for CI-AKI. The predicted risk of CI-AKI based on the Mehran Risk Score (MRS) was similar to that observed in our study population. No patient had to be on haemodialysis. Raised baseline S.creatinine(p-value<0.03), Diabetes with microangiopathy(p-value<0.001), and systemic hypertension(p-value<0.001) were significant predictors for CI-AKI. \u0000CONCLUSIONS \u0000The development of renal sequelae is low in acute ischemic stroke patients undergoing contrast imaging. Prompt CTA, if indicated, need not be delayed in those with no history of renal impairment or without relevant risk factors. A practical reflection of this study is to be cognizant of the renal risks that an in-patient stroke population is exposed to as Intravascular depletion, infections(urinary tract infections, pneumonia), and nephrotoxic medications.","PeriodicalId":47072,"journal":{"name":"Journal of Evolution of Medical and Dental Sciences-JEMDS","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44828576","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 : 2022-09-19DOI: 10.14260/jemds.v11i10.215
Sharat Gurudutt Kalavar, Bhavana B.L., Arundati N. Raj, Rupesh P.L., Basavaraj S. Salagundi, Tejal N. Jivrajani
BACKGROUND The purpose of the present study was to assess the knowledge and perception of safety protocols used before and after dental aerosol procedures among dental professionals. METHODS An online survey was conducted with a self-prepared questionnaire with a sample size of 354 participants consisting of postgraduate students, and dental practitioners who work in private/government institutes/hospitals. The questionnaire was prepared on Google forms and the link was circulated to postgraduate students and dental practitioners via email and WhatsApp platforms. Descriptive statistics analysis was carried out including frequency and percentage. The results of the study were tabulated. RESULTS 94.9 % of the participants performed aerosol-generating procedures, and 76.8 % of the participants used personal protective equipment (PPE) during the procedure. 43.2 % of the participants preferred reusable elastomeric respirators with cartridges. 37.9 % of the participants responded that ventilation is the preferred method. 75.4 % of the participants felt incorrect doffing of the PPE could increase the chances of contracting the coronavirus. 83.3 % of the participants felt using PPE reduces performance and skills during dental aerosol procedures. CONCLUSIONS The present study revealed that 76.8 % of the participants used PPE during aerosol-generating procedures, 54 % and 39.5 % of the participants knew the first procedure in donning and doffing PPE respectively, and 73.7 % of the participants knew which area to doff the PPE in whereas only 48 % knew the correct colour of the bag in which to dispose the PPE and only 49.7 % of the participants knew when to fumigate the aerosol generated surgical area.
{"title":"Knowledge and Perception of Dental Professionals Regarding the Use of Various Safety Protocols During and after Dental Aerosol Procedures in COVID-19 Pandemic","authors":"Sharat Gurudutt Kalavar, Bhavana B.L., Arundati N. Raj, Rupesh P.L., Basavaraj S. Salagundi, Tejal N. Jivrajani","doi":"10.14260/jemds.v11i10.215","DOIUrl":"https://doi.org/10.14260/jemds.v11i10.215","url":null,"abstract":"BACKGROUND \u0000The purpose of the present study was to assess the knowledge and perception of safety protocols used before and after dental aerosol procedures among dental professionals. \u0000METHODS \u0000An online survey was conducted with a self-prepared questionnaire with a sample size of 354 participants consisting of postgraduate students, and dental practitioners who work in private/government institutes/hospitals. The questionnaire was prepared on Google forms and the link was circulated to postgraduate students and dental practitioners via email and WhatsApp platforms. Descriptive statistics analysis was carried out including frequency and percentage. The results of the study were tabulated. \u0000RESULTS \u000094.9 % of the participants performed aerosol-generating procedures, and 76.8 % of the participants used personal protective equipment (PPE) during the procedure. 43.2 % of the participants preferred reusable elastomeric respirators with cartridges. 37.9 % of the participants responded that ventilation is the preferred method. 75.4 % of the participants felt incorrect doffing of the PPE could increase the chances of contracting the coronavirus. 83.3 % of the participants felt using PPE reduces performance and skills during dental aerosol procedures. \u0000CONCLUSIONS \u0000The present study revealed that 76.8 % of the participants used PPE during aerosol-generating procedures, 54 % and 39.5 % of the participants knew the first procedure in donning and doffing PPE respectively, and 73.7 % of the participants knew which area to doff the PPE in whereas only 48 % knew the correct colour of the bag in which to dispose the PPE and only 49.7 % of the participants knew when to fumigate the aerosol generated surgical area.","PeriodicalId":47072,"journal":{"name":"Journal of Evolution of Medical and Dental Sciences-JEMDS","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43163393","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 : 2022-09-10DOI: 10.14260/jemds.v11i10.212
Sanath Kumar Shetty, Feba Maria Varghese, Mohammed Zahid, Kevin Fernandes, Fahad Mohammad, Prakyath Malli
BACKGROUND Monolithic zirconia restorations are known to exhibit good mechanical properties and acceptable aesthetics. During the fabrication of zirconia prostheses, the sintering process is the most critical step which determines the performance of the final product. However, a lot of issues with zirconia restorations were related to sintering cycles which can affect the crystalline content and grain growth that can affect its mechanical properties. The purpose of this study was to evaluate and compare the effect of different sintering cycles on the flexural strength of full-contour monolithic zirconia. METHODS In this in-vitro study, a total of 44 bar-shaped zirconia samples (Amann Girrbach Ceramill® CAD/CAM Material – ZOLID HT+) of final dimensions 20 x 4 x 2 mm were fabricated using Amann Girrbach Ceramill mind – computer-aided designing software and Amann Girrbach Ceramill® motion2 – computer-aided milling unit. These samples were randomly allocated into four groups with 11 samples in each group namely, Group 1, 2, 3 and 4 (Group 1: Long sintering cycle, Group 2: Intermediate sintering cycle, Group 3: Short sintering cycle, Group 4: Ultra-short sintering cycle) and sintered under the respective sintering cycles. The Ceramill® therm (Amann Girrbach) sintering furnace provided 3 sintering cycles ranging from the longest group-1 (19 hours), to the short sintering cycle group-3 (8 hours), with an intermediate sintering cycle group-2 (15 hours). The zircon (KDS) sintering furnace provided an ultra-short sintering cycle group-4 (2 hours). The testing of flexural strength was performed using a three-point bend test on a universal testing machine. Statistical analysis of the collected data was performed by one-way ANOVA using SPSS software. RESULTS One-way ANOVA showed no statistically significant difference in the flexural strength of full-contour monolithic zirconia sintered under the four different sintering cycles. (P > 0.05). CONCLUSIONS The flexural strength of full-contour monolithic zirconia was influenced to some extent by various sintering cycles. The longest sintering cycle (Group 1) showed the least flexural strength whereas the intermediate sintering cycle (Group 2) showed the highest flexural strength. Also, the ultra-short sintering cycle (Group 4) of 2 hours exhibited flexural strength comparable to the rest of the groups with longer sintering cycles, thus making the cycle a viable alternative to the conventional sintering cycles, thereby making the ‘tooth-in-a-day‘ possible for the patients.
整体氧化锆修复体具有良好的力学性能和美观性。在氧化锆假体的制造过程中，烧结过程是决定最终产品性能的最关键步骤。然而，氧化锆修复的许多问题与烧结循环有关，烧结循环会影响晶体含量和晶粒生长，从而影响其力学性能。本研究的目的是评估和比较不同烧结周期对全轮廓整体氧化锆抗弯强度的影响。方法采用Amann Girrbach Ceramill®CAD/CAM Material - ZOLID HT+，利用Amann Girrbach Ceramill mind -计算机辅助设计软件和Amann Girrbach®motion2 -计算机辅助铣床，制备最终尺寸为20 x 4 x 2 mm的44个条形氧化锆样品(Amann Girrbach Ceramill®CAD/CAM Material - ZOLID HT+)。将样品随机分为4组，每组11个样品，分别为1、2、3、4组(第1组:长烧结周期，第2组:中等烧结周期，第3组:短烧结周期，第4组:超短烧结周期)，在各自的烧结周期下烧结。Ceramill®therm (Amann Girrbach)烧结炉提供3个烧结周期，从最长的第1组(19小时)到最短的第3组(8小时)，以及中间的第2组(15小时)。锆石(KDS)烧结炉提供了超短的烧结周期族4(2小时)。在万能试验机上采用三点弯曲试验进行抗弯强度试验。采用SPSS软件对收集的数据进行单因素方差分析。结果单因素方差分析显示，四种不同烧结周期下烧结的全轮廓单片氧化锆的抗弯强度差异无统计学意义。(p < 0.05)。结论不同烧结周期对全轮廓整体氧化锆的抗弯强度有一定影响。最长烧结周期(组1)的抗折强度最低，而中间烧结周期(组2)的抗折强度最高。此外，2小时的超短烧结周期(第4组)显示出与其他较长烧结周期组相当的弯曲强度，从而使该周期成为传统烧结周期的可行替代方案，从而使患者“一天一颗牙”成为可能。
{"title":"Effect of Different Sintering Cycles on the Flexural Strength of Full Contour Monolithic Zirconia – An In-Vitro Comparative Study","authors":"Sanath Kumar Shetty, Feba Maria Varghese, Mohammed Zahid, Kevin Fernandes, Fahad Mohammad, Prakyath Malli","doi":"10.14260/jemds.v11i10.212","DOIUrl":"https://doi.org/10.14260/jemds.v11i10.212","url":null,"abstract":"BACKGROUND \u0000Monolithic zirconia restorations are known to exhibit good mechanical properties and acceptable aesthetics. During the fabrication of zirconia prostheses, the sintering process is the most critical step which determines the performance of the final product. However, a lot of issues with zirconia restorations were related to sintering cycles which can affect the crystalline content and grain growth that can affect its mechanical properties. The purpose of this study was to evaluate and compare the effect of different sintering cycles on the flexural strength of full-contour monolithic zirconia. \u0000METHODS \u0000In this in-vitro study, a total of 44 bar-shaped zirconia samples (Amann Girrbach Ceramill® CAD/CAM Material – ZOLID HT+) of final dimensions 20 x 4 x 2 mm were fabricated using Amann Girrbach Ceramill mind – computer-aided designing software and Amann Girrbach Ceramill® motion2 – computer-aided milling unit. These samples were randomly allocated into four groups with 11 samples in each group namely, Group 1, 2, 3 and 4 (Group 1: Long sintering cycle, Group 2: Intermediate sintering cycle, Group 3: Short sintering cycle, Group 4: Ultra-short sintering cycle) and sintered under the respective sintering cycles. The Ceramill® therm (Amann Girrbach) sintering furnace provided 3 sintering cycles ranging from the longest group-1 (19 hours), to the short sintering cycle group-3 (8 hours), with an intermediate sintering cycle group-2 (15 hours). The zircon (KDS) sintering furnace provided an ultra-short sintering cycle group-4 (2 hours). The testing of flexural strength was performed using a three-point bend test on a universal testing machine. Statistical analysis of the collected data was performed by one-way ANOVA using SPSS software. \u0000RESULTS \u0000One-way ANOVA showed no statistically significant difference in the flexural strength of full-contour monolithic zirconia sintered under the four different sintering cycles. (P > 0.05). \u0000CONCLUSIONS \u0000The flexural strength of full-contour monolithic zirconia was influenced to some extent by various sintering cycles. The longest sintering cycle (Group 1) showed the least flexural strength whereas the intermediate sintering cycle (Group 2) showed the highest flexural strength. Also, the ultra-short sintering cycle (Group 4) of 2 hours exhibited flexural strength comparable to the rest of the groups with longer sintering cycles, thus making the cycle a viable alternative to the conventional sintering cycles, thereby making the ‘tooth-in-a-day‘ possible for the patients.","PeriodicalId":47072,"journal":{"name":"Journal of Evolution of Medical and Dental Sciences-JEMDS","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48655141","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：