Journal of Medical Sciences and Health最新文献

{"title":"Anaesthetic Management of a Patient with Gullain Barre Syndrome Posted for Emergency Caesarean Section: A Case Report","authors":"Sajjan Prashant Shivaraj, K. Sharashchandra","doi":"10.46347/jmsh.v8i3.22.156","DOIUrl":"https://doi.org/10.46347/jmsh.v8i3.22.156","url":null,"abstract":"Gullain Barre Syndrome (GBS) is an acute inflammatory demyelinating polyradiculopathy of rare occurrence in pregnancy. We report a case of a 36 weeks pregnant patient posted for emergency Caesarean section for foetal distress. At 28weeks of pregnancy the patient was diagnosed with GBS for which she was intubated and was on mechanical ventilation for 19 days. Subsequently she was extubated and discharged after 36 days. During this period, she received treatment with intravenous immunoglobulins and plasmapheresis. The patient continued to have weakness of both lower limbs and bladder incontinence prior to surgery. General anaesthesia was administered to the patient keeping in view the autonomic system involvement in the disease and presence of foetal distress. The intraoperative course was smooth and patient was extubated uneventfully. Keywords: Gullain Barre Syndrome, Pregnancy, Autonomic dysfunction, General anaesthesia, Emergency caesarean section","PeriodicalId":33653,"journal":{"name":"Journal of Medical Sciences and Health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46398988","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}

{"title":"The Current State of Sickle Cell Disease Management: A Concise Review on Stem Cell Transplant as a Cure","authors":"George Nkansah Rost Fordjour","doi":"10.46347/jmsh.v8i3.22.219","DOIUrl":"https://doi.org/10.46347/jmsh.v8i3.22.219","url":null,"abstract":"Treatment of sickle cell disease remains largely palliative. While it may improve the quality of life, persons with sickle cell disease still suffer from extreme sickling crises, end-organ damage, and reduced life expectancy. Increasing studies have led to the identification and advancement of stem cell transplant and gene therapy as potential curative strategies for sickle cell disease. However, there have been various factors that have hindered their clinical application. Stem cell transplantation, the more propitious of the two, is limited by restricted transplant donor pool, transplant complications, and selection criteria. The current paper reviewed the literature on sickle cell disease, current treatment options, and more particularly on the progress of stem cell transplants. It outlined various challenges of stem cell transplant and proposed ways to increase the donor pool using alternative strategies and modifications of regimen conditioning with minimal transplant-related toxicities and associated complications. Keywords: Cord blood, Haploidentical, Sickle cell disease, Stem cell transplantation","PeriodicalId":33653,"journal":{"name":"Journal of Medical Sciences and Health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41774074","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}

{"title":"Role of Diagnostic Laparoscopy in Case of Koch’s Abdomen with Intestinal Obstruction: An Observational Study","authors":"L. Gouri, Satyabrata Jena, G. Satpathy, D. Nanda","doi":"10.46347/jmsh.v8i3.22.70","DOIUrl":"https://doi.org/10.46347/jmsh.v8i3.22.70","url":null,"abstract":"Background & Aims: The diagnosis of abdominal tuberculosis has always been a challenge to the physician. The clinical presentation is subtle with many vague symptoms and nonspecific signs. We did this study to find the various diagnostic findings in a case of chronic abdominal pain and find out the efficacy of laparoscopy in diagnosing Koch’s abdomen. Materials and Methods: A prospective observational study was conducted on patients attending surgery department from Nov-2020 to Nov-2021 having clinical and radiological diagnosis of abdominal tuberculosis. Total 59 patients of suspected abdominal tuberculosis underwent diagnostic laparoscopy and started on anti-tuberculosis treatment. Result: The most common presenting symptom was abdominal pain present in 35 patients (59.32%). In CT scan, 31 of them were suggestive of abdominal tuberculosis and seven were inconclusive. Only 37 of them had positive (62.71%) histology for tuberculosis and 22 were negative (37.28%). The PPV and NPV of CT scan was 77.42% (95% CI=60.19-88.61%) and 85.71%% respectively. Out of 27, 20 mesenteric lymph nodes had positive histology for tuberculosis. 29 patients had caseating granuloma and 12 had non-caseating granuloma. All 18 histology negative patients had nonspecific chronic inflammation with reactive lymph nodes. Peritoneal fluid was aspirated and sent for CBNAAT from 30 patients (50.84%). 10 were positive (33.33%) for tuberculosis gene and 20 (66.33%) were negative. Conclusions: Performing laparoscopy in the majority of patients with suspected abdominal tuberculosis is a clinically rewarding idea. It has a high yield to establish the diagnosis of abdominal tuberculosis (65.78%) by sampling macroscopically pathological tissues. Keywords: Koch’s abdomen, Diagnostic laparoscopy, Koch’s abdomen","PeriodicalId":33653,"journal":{"name":"Journal of Medical Sciences and Health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43861899","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}

{"title":"Histomorphological Study of Nail Changes in Various Dermatoses — An Understudied Entity in Dermatopathology","authors":"R. Gowda, T. Krishnamurthy","doi":"10.46347/jmsh.v8i3.22.98","DOIUrl":"https://doi.org/10.46347/jmsh.v8i3.22.98","url":null,"abstract":"Background: The nail is our most versatile tool and serves a very important function of protecting the distal phalanx. The nail unit shows specific changes that are markers for a wide range of local and systemic conditions. Objectives: The objectives of the study are to identify the spectrum of histomorphological features in various nail lesions and to highlight the role of histopathology in diagnosis of nail diseases. Methods: This is a descriptive study done over a period of 18 months. The nail biopsy specimens were received in 10 % formalin, softened with 10% nitric acid, processed and stained with routine Hematoxylin & Eosin [H&E] stains. Periodic Acid stain[PAS] stain was done wherever necessary. Histopathological examination by light microscopy was done to arrive at a precise diagnosis. Brief patient history and clinical features were also noted. Results: A total of 50 nail punch biopsies were examined. Psoriasis was the most common accounting for 38%. The combined approach of H & E and PAS stain was helpful in diagnosis of onychomycosis in 24%. Pigmentary disorders (14%) , lichen planus (10%) and alopecia areata (6%) were the other conditions observed. In 8% of cases microscopic features were nonspecific. Conclusion: The nail unit has a complex morphology with many peculiarities. Though it is quite accessible, it remains understudied. Histomorphological evaluation of nail punch biopsy is useful in understanding the involvement of nail in various dermatoses and also aids in the accurate diagnosis. Keywords: Dermatoses, Histopathology, Nail biopsy","PeriodicalId":33653,"journal":{"name":"Journal of Medical Sciences and Health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44475427","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}

{"title":"Benzonatate Induced Neck Stiffness: A Case Series","authors":"Nikhil Era, Ritika Singh, Shatavisa Mukherjee, S. Bordoloi","doi":"10.46347/jmsh.v8i3.22.210","DOIUrl":"https://doi.org/10.46347/jmsh.v8i3.22.210","url":null,"abstract":"As a non-narcotic antitussive, benzonatate has been effective in symptomatic relief of dry cough. Cough following recovery from acute COVID-19 has widely been treated with over-the-counter cough suppressants like benzonatate, guaifenesin, dextromethorphan etc. However, despite being an effective non-narcotic cough suppressant modality, benzonatate has been constrained by its poor safety profile. The present case series describes a very rare side effect of neck stiffness reported in patients who were prescribed benzonatate for dry cough suppression post COVID 19. Keywords: Benzonatate, Neck stiffness, Post-COVID complications, Cough","PeriodicalId":33653,"journal":{"name":"Journal of Medical Sciences and Health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41800091","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}

{"title":"Comparative Study Between Combined Spinal Epidural Analgesia (CSEA) and Pre-Emptive Multimodal Analgesia for Pain Control in Joint Replacement Surgeries of Lower Limbs","authors":"D. Maiti, T. Mitra, Manisankar Nath, Swapnadeep Sengupta","doi":"10.46347/jmsh.v8i3.22.276","DOIUrl":"https://doi.org/10.46347/jmsh.v8i3.22.276","url":null,"abstract":"Background and aims: Epidural analgesia has been considerably used for postoperative analgesia in Orthopaedic surgeries, however, combination of opioid and non-opioid medications in the perioperative period seems to provide an effective alternative. Objectives: To compare the efficacy of pre-emptive multimodal analgesia with combined spinal epidural for postoperative analgesia in lower limb arthroplasties. Materials and methods: 50 patients scheduled for elective lower limb Arthroplasties were randomly divided into two groups. Spinal anaesthesia with 2.5ml of 0.5% Bupivacaine (heavy) plus 0.5ml (25µg) Fentanyl was given in both the groups for procedure. Group I received Cap. Pregabalin 150mg and Inj Paracetamol 1000mg IV 1 hour before surgery and 75mg 12 hourly and 1000mg IV 8 hourly respectively, while Group II received epidural top up with 10 ml of 0.125% bupivacaine 8 hourly, both for 3 days postoperatively. Perioperative haemodynamics, postoperative VAS, rescue analgesics requirement, and Patient satisfaction level were monitored for 72 hours. Results: Postoperative VAS score was significantly higher in Group II from 4th hour postoperatively, and, accordingly, more patients in this group required rescue analgesia (21 and 20 in Group II vs 10 and 1 in group I in 12-24 hrs and 24-36 hrs respectively with p value <0.001). Modified Bromage score, haemodynamics and side effect profiles were comparable in the groups, however, patient satisfaction level was more in Group I (p value <0.001) after 72 hours. Conclusion: Pre-emptive multimodal analgesia can be used as an effective alternative to epidural for postoperative analgesia in patients undergoing lower limb joint replacement surgeries. Keywords: Pre-emptive multimodal analgesia, Combined spinal epidural analgesia, Lower limb arthroplasties, Postoperative analgesia","PeriodicalId":33653,"journal":{"name":"Journal of Medical Sciences and Health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46777542","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}

{"title":"Imaging Findings in A Rare Case of Congenital Intrapericardial Herniation of Liver","authors":"Gohain Dhruba Borpatra, Goswami Sukanya, Padhy Punyada","doi":"10.46347/jmsh.v8i2.21.87","DOIUrl":"https://doi.org/10.46347/jmsh.v8i2.21.87","url":null,"abstract":"Congenital intrapericardial liver herniation via a diaphragmatic defect associated with a peritoneo-pericardial communication is extremely rare and poses a diagnostic dilemma for clinicians. Radiological investigations play an unparalleled role in arriving at an accurate diagnosis. We, therefore, describe the imaging findings on chest roentgenogram, computed tomography, and ultrasonography in a four-day-old infant who presented with difficulty in breathing since birth and was eventually diagnosed as having herniation of the left lobe of the liver into the pericardium. Both ultrasonography and computed tomography can detect the disease by demonstrating anatomical and vascular continuity of the presumed intrapericardial mass with the liver. The correct diagnosis of this unusual condition is essential because surgical management is simple and distinct from other intrapericardial masses. Keywords: Intrapericardial liver herniation, Congenital diaphragmatic hernia, Peritoneo-pericardial defect","PeriodicalId":33653,"journal":{"name":"Journal of Medical Sciences and Health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45349056","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}

{"title":"A Study on Knowledge and Attitude on Vector-Borne Diseases among Secondary School Students in Rural Setup","authors":"Chidri Srusti, J. Vinay, P. Thejaswini, S. Raghavendra","doi":"10.46347/jmsh.v8i2.21.142","DOIUrl":"https://doi.org/10.46347/jmsh.v8i2.21.142","url":null,"abstract":"Background: In India, Vector-Borne Diseases (VBD) account for the majority of communicable illnesses. They account for 17% of the projected worldwide burden of all infectious illnesses, posing serious public health issues and impeding the country's socio-economic growth. To make a significant change in society, it is vital to increase the knowledge and attitudes of school students who serve as effective whistle-blowers between community and health educators. Hence the present study was undertaken. Methodology: Descriptive cross-sectional study including 194 secondary school students of rural Mandya. Students who were present and willing to participate were included. A pre-tested structured questionnaire was used to obtain their knowledge and attitude towards VBD. The data obtained before and after the health education was analysed using the McNemar X2 test and Wilcoxon signed-rank test. Results: In the pre-test, 6.2% and 93.8% of the participants have obtained average and poor knowledge scores respectively. A statistically significant improvement in the knowledge score was seen after the health education (Z=-11.91, p<0.001). About attitude, 89.2% had a very good attitude, 9.8% had good and 1.0% had a poor attitude towards vector-borne diseases. However, after health education, it was observed that betterment in the attitude of the students. (Z= -2.63, p=0.009). Conclusion: A significant improvement in the knowledge and attitude towards VBD among the study population was observed after the health education. Keywords: Vector-Borne diseases, School students, Health education, Knowledge, Attitude","PeriodicalId":33653,"journal":{"name":"Journal of Medical Sciences and Health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45675657","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}

{"title":"Comparative Study of the Role of MRCP and USG in Patients with Pancreatic Duct and Biliary Duct Pathology","authors":"M. Kumari, S. Suman, Ruchita Gupta, Aishwerya Singh, Pragya Verma, Ashish Jha","doi":"10.46347/jmsh.v8i2.22.45","DOIUrl":"https://doi.org/10.46347/jmsh.v8i2.22.45","url":null,"abstract":"Background: Various imaging modalities like USG, CT, Invasive cholangiography has been used since long for the evaluation of the pathology of hepato-biliary-pancreatic duct. These techniques pose some limitations either due to bowel gas and obesity in USG, distal CBD calculus and isodense calculus (isodense to bile) in CT (also not used in patient with history of contrast allergy) and post-procedural complications (followed by invasive cholangiography like ERCP and PTC). MRCP is a non-invasive diagnostic technique for the direct visualization of the biliary ducts images similar to that produced in PTC (percutaneous trans-hepatic cholangiography) and ERCP. Also, the continuous expanding spectrum of therapeutic options, including radiological interventions (for palliative and curative) for the patients with biliary tree pathology requires the accurate assessment of the lesion visualized. Aims & objectives: Comparison of sensitivity, specificity and diagnostic accuracy between the MRCP/MRI and USG in patients with pancreatic and hepato-biliary pathology and it’s related complications. Materials & methods: The study was a retrospective, single institutional study done during the last two years (January 2018 – December 2019) at IGIMS, Patna, Bihar (A tertiary care hospital). Data was collected from the departmental record for USG findings, medical record for history and PACS (Picture archiving and communicating system) for MRCP findings. Hundred patients were included in our study. All the data were entered in the MS Excel sheet and were expressed as percentage and variables as required. Vassarstats software was used for the data analysis. Results: Benign lesions were common in the age range of 46-60 years (23%), followed by 31-45 years. Most of the malignant lesions were detected in the age range of 31-45 years of age group (13%). USG detected and MRCP detected lesions were benign in 63% and 62% of the cases and malignant in 34% and 35% of the cases respectively. There were overlapping findings present in most of the cases. Pancreatitis, cholecystitis and choledochal cysts were usually associated with biliary tree calculi. Overall sensitivity, specificity and diagnostic accuracy of MRI with MRCP sequence (97%, 85% and 92.75%) is greater than that of USG (92%, 80% and 85.5%). Conclusion: MRCP combined with other MRI sequences was superior to the USG in identifying benign and malignant pathology. However, ultrasound remains the primary investigating modality of choice. However, with use of recent advances of USG like harmonic imaging there is significant improvement in the lesion characterization. MRCP is the modality of choice of imaging investigation for the characterization of the lesion especially in obese patients or to choose the patients who are ideal candidate for the MRCP. Keywords: Hepato-biliary-pancreatic pathology, MRCP","PeriodicalId":33653,"journal":{"name":"Journal of Medical Sciences and Health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47944815","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}

{"title":"Air Medical Casualty Evacuation in High Altitude: An Experience of 100 Cases in High Altitude and Hilly Terrain of Northern India","authors":"S. Singh, Dhananjay Singh, Haneesh Thakur, Ajit Bhardwaj, V. Chawla","doi":"10.46347/jmsh.v8i2.21.54","DOIUrl":"https://doi.org/10.46347/jmsh.v8i2.21.54","url":null,"abstract":"Objectives: This article describes the on ground challenges faced by the medical care team deployed for transferring critically ill patients by air from remote locations of the high altitude and hilly terrain to definitive health care facility. Methods: All intubated critical patients requiring definitive and super specialty medical care, transferred by air from high altitude hilly terrain to tertiary care hospital during Jan 2016 to Dec year 2020, analyzed in this retrospective study. Results: The total duration of flight was between 40 – 150 min and average being 83 min. Twenty four patients were transferred by fixed wing aircraft and rest 76 by helicopters. All patient were given sedation in form of injection fentanyl 1mcg/kg in dividing doses and boluses of propofol 10 mg intravenously during transfer. The most common change noticed was fall in oxygen saturation with incidence almost 100% of the patients. The mean fall in saturation was 17.29%. Four patients required injection atropine for bradycardia which resulted with decrease of Saturation of peripheral oxygen (SpO2). Conclusion: Transferring a critically ill patient by road to distant medical centers is often not an option because of losing the golden hour of the medical care. Here comes the importance of aeromedical evacuation for a timely transfer for early medical attention. But shifting the critical patients through aerial mode requires planning and poses a variety of challenges. Keywords: Air­evacuation, High altitude, Air ambulance","PeriodicalId":33653,"journal":{"name":"Journal of Medical Sciences and Health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41713692","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}