International Journal of Research in Medical Sciences
Not a member yet
9900 research outputs found
Sort by
Evaluation of efficacy and safety of Taylor's approach for neuraxial blockade in infraumbilical surgeries with difficult lumbar access: a retrospective, single-centre study
Get PDFBackground: Spinal block, commonly known as subarachnoid anesthesia, is the most popular method for performing lower extremity procedures. In patients with difficult spinal anatomy, the Taylor modified paramedian technique has proven to be beneficial. This study aim is to assess the efficacy and safety of Taylor's technique in a heterogeneous group.
Methods: This retrospective observational study was conducted from March 2018 to August 2024, involving 68 patients aged between 18 and 80 years, classified as ASA I–III. The study focused on patients with degenerative diseases or spinal anomalies that complicated lumbar puncture procedures. For regional anaesthesia, lumbar subarachnoid blocks (LSAB) were administered using Taylor's method. Data on drug dosages, complications, outcomes and procedure parameters were collected and analysed.
Results: The mean time to onset of sensory and motor block was 8.26 minutes, while the mean regression time was 197.98 minutes. The procedure was successful in 97.06% of cases and a large study population needed 2–3 needle redirection attempts. Mean depth of lumbar puncture measured with Stocker's formula was 63.81 mm, which matched nearly with that of the calculated depth. Trendelenburg position was preserved for 10 minutes facilitating anaesthetic flow. The most frequent reasons for disability in the implementation of LSAB were lumbar spinal disorders 48.11% , obesity 35.85% and 16.04% had difficulty in sitting due to pain.
Conclusions: The modified paramedian approach from Taylor's for LSAB is effective, rapid, and reliable technique
Ceftriaxone induced neurotoxicity: a word of caution for elderly and patients with renal impairment
Get PDFCeftriaxone is a third-generation cephalosporin commonly used in inpatient settings and is associated with both hepatic and renal excretion. The cephalosporin group, particularly the fourth generation, including cefepime, has been commonly associated with encephalopathy, but recent literature has also suggested an increasing trend of encephalopathy related to ceftriaxone
Deciphering the prolactin-thyroid-lipid nexus in type 2 diabetes and hypothyroidism: insights into metabolic interactions and dysregulation
Get PDFBackground: Prolactin, thyroid hormones, and lipid metabolism play critical roles in maintaining metabolic homeostasis. Their dysregulation in type 2 diabetes and hypothyroidism may contribute to disease progression and complications. This study investigates the associations between prolactin, thyroid function, lipid metabolism, and glycemic parameters in individuals with type 2 diabetes and hypothyroidism.
Methods: A cross-sectional study was conducted on patients diagnosed with type 2 diabetes and hypothyroidism. Serum levels of fasting blood glucose (FBS), postprandial blood sugar (PPBS), glycated hemoglobin (HbA1c), thyroid hormones [free T3 (FT3), free T4 (FT4), and thyroid stimulating hormone (TSH)], lipid parameters, and prolactin were measured. Correlation analyses were performed to determine associations between prolactin, thyroid function, lipid profile, and glycemic markers.
Results: Significant alterations were observed in metabolic parameters among diabetic and hypothyroid patients. Prolactin levels showed a significant negative correlation with HbA1c (r=-0.42, p<0.05) and triglycerides (TG) (r=-0.38, p<0.05), suggesting a potential role in metabolic regulation. A positive correlation was found between prolactin and thyroid hormones FT3 (r=0.44, p<0.05) and FT4 (r=0.39, p<0.05), highlighting the interplay between the pituitary-thyroid axis and metabolism.
Conclusions: The findings emphasize the need for routine screening of thyroid function in diabetic patients and lipid profile monitoring in individuals with thyroid dysfunction to prevent metabolic complications. Prolactin may serve as a potential biomarker for metabolic dysregulation, warranting further investigation into its diagnostic and prognostic significance
Uterine carcinosarcomas case series of rare uterine malignancy
Get PDFPrimary malignant mixed Müllerian tumor (MMMT) of the ovary is a rare and highly aggressive neoplasm predominantly affecting postmenopausal women. MMMT is a biphasic tumor comprising both epithelial and mesenchymal components and is associated with significantly higher mortality compared to epithelial ovarian neoplasms. Patients typically present with symptoms such as vaginal bleeding, abdominal pain, and a palpable mass. Surgery remains the primary treatment modality, while adjuvant therapies, including chemotherapy and radiotherapy, play a crucial role in improving locoregional control and managing distant metastasis. Due to the rarity of these tumors, there is limited literature on their optimal therapeutic management. This series aims to analyse the clinical presentations and treatment outcomes of patients diagnosed with this uncommon uterine cancer treated at our hospital
A follow up study of warning letters issued by US Food and Drug Administration to clinical investigators, institutional review boards and sponsors: a situational analysis during COVID-19 pandemic
Get PDFBackground: United States food and drug administration (FDA) is the apex body governing and regulating clinical research. FDA issues warning letters (WLs) to individuals and institutions for significant regulatory violations. Our study aimed to evaluate the WLs issued to various stake holders during COVID-19 pandemic.
Methods: A web-based analytical study was employed to analyse WLs issued between 01 January 2020 to 31 December 2022 to clinical investigators, institutional review board (IRB) and sponsors. The outcome measures were: total number of WLs, violation theme and trend analysis in comparison with the previous study.
Results: A total of 241 WLs were analyzed which included 232 (96.27%) letters to sponsors, 9 (3.73%) to clinical investigator and none to IRB. Device-related violations were failure to comply with current good manufacturing practice (CGMP) (26/39, 66.67%; 8/14, 57.14%), adulterated/misbranded products (19/39, 48.71%; 7/14, 50%) and failure to follow monitoring schedule (16/39, 41.02%; 5/14, 35.71%) in 2020 and 2022 respectively. While in 2021, failure to submit investigational device exemption (50/61, 81.87%) was the commonest theme. In the drug-related group, violation trends were similar for 2020, 2021 and 2022. The frequent violations were misbranded/unapproved drug (24/26, 92.3%; 15/21, 71.43%; 40/57, 70.17%) and failure to comply with CGMP (8/26, 30.77%; 8/21, 38.09%; 19/57, 33.33%). Our previous study of 2015 is at variance, highlighting deviations as failure to follow monitoring schedule, failure to obtain investigator agreement and failure to maintain data record.
Conclusions: Majority warning letters were issued to sponsors, pertaining to quality and process of drug and device related research
Assessing the appropriateness of lumbar spine MRI referrals in low back pain management: a tertiary care hospital study
Get PDFBackground: Low back pain (LBP) is a leading cause of disability globally, yet most cases are nonspecific, with no clear pathology. The routine use of MRI for diagnosing LBP is debated, as overuse may lead to unnecessary procedures, increased healthcare costs, and patient anxiety. This study aimed to evaluate adherence to the American College of Radiology (ACR) appropriateness criteria for lumbar spine MRI referrals at a tertiary care hospital.
Methods: A retrospective study analysed 200 lumbar spine MRI referrals from January to June 2022. Referrals were reviewed for appropriateness based on ACR guidelines. Data included patient demographics, referring specialties, and clinical indications. Referrals were classified as appropriate or inappropriate, with trends across specialties identified.
Results: Of the 200 referrals, 71% (142) were deemed appropriate, primarily for cases with red flags or persistent neurological symptoms. 29% (58) were inappropriate, often involving acute back pain without red flags or failed conservative management. General practitioners and emergency medicine specialists had the highest rates of inappropriate referrals (43.5% and 37.2%, respectively), while orthopedics and neurosurgery showed more adherence to guidelines.
Conclusions: This study highlights the need for improved adherence to the ACR appropriateness criteria in MRI referrals for LBP. Overuse of MRI contributes to unnecessary healthcare costs and patient risk. Enhancing clinician education, documentation practices, and decision support tools could reduce inappropriate MRI use, improving patient care and reducing costs
Assessment of venous thromboembolism awareness among surgical ward patients in Hail, Saudi Arabia: a cross-sectional study
Get PDFBackground: Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major cause of morbidity and mortality among hospitalized patients in Saudi Arabia. However, there is limited data on VTE awareness in the northern region. This study aimed to assess the awareness and perceptions of VTE and thromboprophylaxis among surgical ward patients in Hail, Saudi Arabia.
Methods: A descriptive cross-sectional study was conducted at King Khalid Hospital from September to December 2024, involving 300 patients hospitalized in the surgical ward for more than three days. Patients with shorter hospital stays, cognitive impairments, language barriers, or a previous VTE diagnosis were excluded.
Results: Patients with higher education and those who had received pharmacological or non-pharmacological thromboprophylaxis showed significantly greater knowledge of VTE (p<0.05). No significant associations were found between knowledge scores and age, gender, admission reason, or personal/family VTE history (p>0.05). A positive correlation was observed between knowledge and attitude scores (r=0.132, p=0.037).
Conclusions: The study revealed low awareness of VTE, its symptoms, and risk factors among surgical patients. It highlights the importance of educational initiatives by healthcare providers to enhance patient understanding and support VTE prevention
A rare case study: pre-excited atrial fibrillation in Wolff-Parkinson white syndrome associated with partial ventricular septal defect
Get PDFWolff–Parkinson–white (WPW) syndrome is a congenital disorder affecting the hearts’ conduction system, which is recognized by the existence of an accessory pathway (AP) that can lead to pre-excitation of ventricles, paroxysmal supraventricular tachycardias and in severe cases to sudden cardiac death. Thus, AP usually has non-decremental conduction allowing immediate ventricular activation which in case of AF leads to rapid ventricular response with high risk of transformation into ventricular fibrillation and cardiac arrest. Physical examination of this patient revealed the following clinical manifestations of WPW syndrome like severe tachycardia, dizziness and presyncope. The lab findings revealed an increase in the high-sensitive troponin I suggesting the underlying result from atrial fibrillation. And hyperbilirubinemia was shown in the biochemical analysis confirming the concomitant disease of this patient which is Gilbert’s Syndrome. The ECGs depicted the presence of a type A WPW pattern and paroxysmal form of atrial fibrillation (AF). The echocardiograms disclosed the presence of ventricular septal defect (VSD) in the membranous part of the interventricular septum. Both the ECGs and Echocardiograms revealed type A WPW pattern and paroxysmal form of atrial fibrillation respectively. The patient’s heart rate was monitored routinely in the intensive care unit with the help of 24-hour Holter monitoring device, breathing rate and blood pressure to detect the evaluation the patient’s prognosis. This article enhances the difficulties in differential diagnosis, experience of amiodarone uses in acute management, interventional treatment of pre-excited AF and VSD, because this can be a primary manifestation in young patients
Epidemiological, clinical, biological, therapeutic and evolutionary profiles of infected diabetic foot hospitalized in the endocrinology department of Joseph Raseta Befelatanana University Hospital in Antananarivo, Madagascar
Get PDFBackground: Diabetic foot infection is a serious risk of amputation and death. Our study aims to describe the epidemiological, clinical, biological, therapeutic and evolutionary profiles of patients hospitalized for infected diabetic foot.
Methods: This is a descriptive cross-sectional study conducted in the Endocrinology department of the Joseph Raseta Befelatanana University Hospital, Antananarivo over a period of 4 years. The diagnosis of infected diabetic foot was made according to the criteria of the French-Speaking Society of Infectious Pathology. We included all patients who had undergone bacteriological examination with antibiogram of their diabetic foot lesion.
Results: Fifty patients were retained, giving a hospital prevalence of 2.84%. Their mean age was 55.50±9.63 years, the sex ratio was 0.72 and mean duration of their diabetes was 6.87±6.13 years. The majority of the lesions were post-traumatic (28%). The mean hospital length stay was 42.82±35.26 days. Infections were classified as stage 4 for 72% of the patients. The main isolated bacteria were Staphylococcus aureus (54.69%), of which 83% were sensitive to Amoxicillin-Clavulanic Acid. Seventy percent of the patients were infected with multidrug-resistant bacteria. The amputation rate was 30% and the mortality rate was 2%.
Conclusions: Therapeutic education on podiatric care must be optimized. Multi-disciplinarity is essential for management. Amoxicillin-clavulanic acid should be preferred as probabilistic antibiotic therapy for diabetic foot infection in our country where bacteriological examination is often lacking
Agnatia-otocephaly complex in a low-resource setting and its implication for maternal and child health: a case report
Get PDFAgnatia-otocephaly complex is an extremely rare congenital fatal anomaly. This case is being reported to raise awareness of this condition and the need for sonographers to deliberately evaluate for this anomaly in patients with severe polyhydramnios in pregnancy. This allows for more effective management of this congenital anomaly. We report a 31-year-old gravida 3 para 2 who presented with complaints of difficulty with breathing and ultrasound scan findings of live fetus with severe polyhydramnios at about 34 weeks of gestation. About 2 days on admission, she spontaneously ruptured membranes and had assisted vaginal breech delivery of a live male 1.9 kg neonate who suffered early neonatal death after 20 min of active resuscitation with agnatia-otocephaly complex anomaly noticed. She was counselled on the neonatal outcome and the need for autopsy, but the parents declined. Otocephaly should be suspected in cases of fetal anomaly with polyhydramnios. In this patient, severe polyhydramnios was a presenting feature, deliberate effort could have been made to identify this congenital anomaly. It highlights the need for better training and provision of advanced tools to aid diagnosis. In this case, the neonatal outcome was fatal, and the mother suffered from respiratory distress from polyhydramnios, which could have been avoided by accurate prenatal diagnosis. Otocephaly poses a significant challenge for patients and clinicians globally, especially in low-income countries, due to its rarity, high fatality rate and complexity. This case is being reported to raise clinician awareness for proper sonographic evaluation and better management of this rare congenital disorder