International Journal of Research in Medical Sciences
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Evidence of benefit of lower limb exercise immediately after major abdominopelvic surgery
Get PDFBackground: Repeated active dorsiflexion of the ankle joint in knee and hip flexion state (moving the whole lower limb) i.e. active lower limb exercise (ALLE). Benefits of ALLE over non-ALLE approaches during the postoperative period in patients following major abdominopelvic surgery was studied. The aims of the study were to determine whether early return of intestinal peristaltic sound (IPS), early pain relief, early control of blood sugar in diabetic patients and early return of wellbeing of patients occurred in patients undergoing major abdominopelvic surgery.
Methods: Randomized comparative study was done. 100 patients above 15 years of age who underwent major abdominopelvic surgery participated in this study from one of the government medical colleges. Samples were randomly allocated to the experimental and control group. Experimental group were counselled, motivated, and trained in pre-operative period, to do ALLE in short interval after operation. Data was collected on post operative day (POD) 0, POD 1, POD 2, and POD 3. The tools used to collect data was visual analogue scale (VAS) for pain, capillary blood glucose (CBG) for blood sugar level, IPS for intestinal motility and WHO-5 well-being index for assessment of wellbeing.
Results: Patients who were in the test group showed- better pain relief and lees use of analgesic (p value=0.0259), better control of blood sugar in diabetic patients (p value=0.0076), early return of IPS (p value=0.0002) and early return of wellbeing (p value=0.0056).
Conclusions: ALLE after major abdominopelvic surgery is very effective practice for better relief of pain, early return of IPS, better control of blood sugar in diabetic patients and less anxiety and more comfort
Drug utilization study and safety profile of iron isomaltoside 1000 in treatment of iron deficiency anemia in cancer patients: a retrospective study
Get PDFBackground: Anemia is prevalent among cancer patients, affecting 39.3% to 63.4%, depending on the diagnostic threshold used. Cancer treatments often exacerbate anemia, significantly impacting patients' quality of life. In 2019, Feruno (Iron Isomaltoside 1000) was introduced in India for rapid intravenous infusion, offering controlled and gradual iron release, thereby reducing toxicity risks. Studies have confirmed its safety, effectiveness, and tolerability across various patient populations.
Methods: This single-centre, retrospective drug utilization study evaluated Iron Isomaltoside 1000 (Feruno) in 98 cancer patients with iron deficiency anemia.
Results: The mean age of patients was 56 years, with breast, ovarian, and colon cancers being the most common. The average iron requirement was 1,396.9 mg, and the most frequently administered dosage was 1,000 mg. The treatment was effective and well-tolerated, with minimal adverse reactions.
Conclusions: Iron Isomaltoside demonstrated a good safety profile. The iron requirement in cancer patients is usually above 1 gram, and the most frequently prescribed dose was 1,000 mg. To improve patient compliance and leverage the benefit of a higher dose (20 mg/kg body weight) administered in a single infusion, most patients can be treated effectively with a total dose infusion
A comparative study of quality of life with respect to EORTC scale in lung cancer patients undergoing chemo radiation
Get PDFBackground: In lung cancer patient's data regarding comparison of quality-of-life pre and post treatment as per EORTC score is sparse. So, we conducted this study on lung cancer patients to compare the quality of life.
Methods: Demographic data were collected from new lung cancer patients (not taking treatment elsewhere) attending the Radiation and Oncology Department of Government Medical College, Nagpur. ECOG performance score noted before starting treatment. Pre-treatment and 6 weeks’ post-treatment quality of life score measured according to EORTC QLQ-C30 and EORTC QLQ-LC13 and compared. Treatment given was either chemotherapy, radiotherapy or chemo-radiotherapy according to standard guidelines.
Results: 79 patients received treatment and completed regular follow-up. The mean age of the patients was 56.06 years (SD±10.46). The number of male patients was 47, and the number of female patients was 32. The number of patients with ECOG scores 0, 1, 2, 3, and 4 was 3 (3.8%), 35 (44.3%), 24 (30.4%), 14 (17.7%), and 3 (3.8%), respectively. EORTC QLQ-C30 score pre- and post-treatment was 70.14 (±16.309) and 53.58 (±16.445), respectively (p<0.001).
Conclusions: QoL in lung cancer patients improves after chemotherapy, radiotherapy, or chemo-radiotherapy. EORTC is a simple and useful score system for comparing pre- and post-treatment QoL
Kt/V and its association with nutritional status and quality of life in end-stage renal disease patients: a cross-sectional multivariate study
Get PDFBackground: Dialysis adequacy assessed by Kt/V is a key predictor of outcomes in end-stage renal disease (ESRD). However, its relationship with nutritional status and health-related quality of life (HRQoL) remains unclear in low-resource, single-center settings.
Methods: A cross-sectional study was conducted on 65 ESRD patients receiving maintenance haemodialysis (HD) at Wangaya Hospital. Dialysis adequacy was evaluated using single-pool Kt/V. Nutritional status was assessed using BMI and Malnutrition Inflammation Score (MIS), and HRQoL was measured using KDQOL-36. Bivariate and multivariate logistic regression analyses were performed.
Results: A total of 70.8% of patients achieved adequate dialysis (Kt/V ≥1.2). Adequacy was significantly associated with BMI (p=0.024), but not with MIS. Among HRQoL domains, only the physical component summary showed a significant association with dialysis adequacy (p=0.014). Multivariate analysis identified employment status and serum albumin as independent predictors of quality of life and nutritional status. Low TIBC and female gender were associated with impaired mental health and higher malnutrition risk.
Conclusion: Kt/V-based dialysis adequacy correlates with improved physical functioning and BMI, though not all HRQoL aspects. Findings may support further multicentre research on adequacy and patient outcomes in resource-limited settings
Recent advances in computed tomography and magnetic resonance imaging techniques for cancer detection with artificial intelligence and machine learning integration
Get PDFCancer is one of the leading causes of death all over the world. The International Agency for Research on Cancer (IARC) estimated 20 million new cancer cases in 2022. However, detecting cancer is difficult because it shows symptoms in the final stage. Diagnostic imaging plays a vital role in the early detection of cancer. Advanced imaging technology includes X-ray mammography, ultra-low-dose computed tomography (ULDCT), and dual-source CT, which uses two X-ray sources and improves the resolution of images. Radiomics is another advanced approach that converts medical images into quantitative data and deep learning methods (DL) using Artificial intelligence (AI), which tremendously increases the accuracy of tumor detection. Several automated and semi-automated methods are proposed to detect pulmonary nodules using DL methods such as Conventional neural network (CNNs), which include ResNet-50, VGG16, and InceptionV3. In addition to techniques that involves ionizing radiation, this review also explains the magnetic resonance imaging (MRI) techniques for cancer detection. MRI uses radio-frequency (RF) pulses to form images with high spatial resolution. Diffusion-weighted imaging (DWI), functional magnetic resonance imaging (fMRI), and MR spectroscopy (MRS) are the MRI sequences generally used for cancer detection. The aim of this paper is to provide an overview of modern CT and MR imaging techniques integrating with AI and machine learning for cancer detection
Aerobic exercises and ambulatory blood pressure monitoring in resistant hypertension population: a systematic review
Get PDFResistant hypertension associated with increased risk of morbidity and mortality. Here our aim was to systematically evaluate and sum up evidence on the impact of aerobic exercise on ambulatory blood pressure (ABP) in resistant hypertension population. This systematic review followed PRISMA guidelines, and we explored PubMed, Cochrane Library, SCOPUS, and Science Direct for apropos studies. This systematic review included randomized controlled trials and crossover trials focusing on resistant hypertension population undergoing aerobic exercise compared to routine management. The primary outcome was blood pressure (BP) control, which was measured using 24-hour ambulatory blood pressure monitoring (ABPM). Secondary outcome were office blood pressure and adverse effects. Three authors independently selected studies, extracted data, and assessed the risk of bias. The conflicts were resolved by consensus. This systematic review summarizes findings of six randomized controlled trials with 187 participants assessing the impact of exercise on ambulatory blood pressure in resistant hypertension population. Aerobic training was associated with significant reduction of 5-10 mmHg in 24- hour ambulatory BP. Similar pattern was observed in day time BP, while night time BP were less pronounced. Office BP showed inconsistent changes. Exercise interventions, particularly supervised programs and light-to-moderate intensity activities, also improved cardiorespiratory fitness and physical performance. In studies exercise intervention were usually safe and well tolerated without serious adverse events. Moderate evidence supports the addition of aerobic exercise to usual care in resistant hypertension population. However small number of participants and heterogenicity in methodology and outcome limiting the strength of findings
Longitudinal impact of sodium-glucose co-transporter-2 versus dipeptidyl peptidase-4 inhibitors on weight and body mass index in type 2 diabetes: a 12-month comparative analysis
Get PDFBackground: Obesity and elevated body mass index (BMI) are strongly associated with poor glycaemic control and increased cardiometabolic risk in type 2 diabetes mellitus (T2DM). Beyond glycaemic efficacy, contemporary antidiabetic agents are increasingly evaluated for their effects on weight and metabolic outcomes. Sodium-glucose co-transporter-2 (SGLT-2) inhibitors and dipeptidyl peptidase-4 (DPP-4) inhibitors are widely prescribed, yet comparative long-term data on their impact on weight and BMI in Indian populations remain limited.
Methods: This 12-month observational study included 200 T2DM patients 100 each receiving SGLT-2 or DPP-4 inhibitors. Assessments were conducted at baseline and at 3, 6, 9, and 12 months. Primary outcomes were changes in body weight and BMI, analysed using SPSS v31.0 with paired t-tests, repeated measures ANOVA, and Bonferroni/Sidak post hoc tests. Statistical significance was set at p<0.05.
Results: Patients on SGLT-2 inhibitors exhibited consistent and significant reductions in both parameters: mean body weight declined from 91.61±4.09 kg to 77.63±4.61 kg (Δ=-13.98 kg, p<0.001), and BMI from 29.57±2.68 to 23.13±2.09 (Δ=-6.44, p<0.001). Conversely, DPP-4 users showed negligible changes (Δ=+0.14 kg and -0.10, both p>0.3). The SGLT-2 group’s weight loss was progressive and sustained throughout 12 months. Although gender distribution was similar (p=0.744), younger age in the SGLT-2 group may have influenced outcomes.
Conclusions: SGLT-2 inhibitors produced significant, durable reductions in weight and BMI versus DPP-4 inhibitors, highlighting their dual metabolic advantage in comprehensive T2DM management
Anatomical evaluation of supraorbital notch and supraorbital foramen morphology and supraorbital nerve distribution: a cadaveric study
Get PDFBackground: Peripheral nerve compression at trigger points is considered a cause of migraine and primary headaches. These trigger points are most commonly found in the sensory regions. In particular, compression of the supraorbital nerve by fascial bands or at the supraorbital foramen has been reported as a source of headache in the literature. This study aimed to evaluate the structures through which the supraorbital nerve passes to reach the innervation area.
Methods: Eleven female and 11 male cadaver heads fixed with formalin were dissected and the formation of the supraorbital nerve emerging the cranium was evaluated.
Results: Cadaveric sides were divided into four types based on the presence of a notch or foramen. Sides with only one notch constituted the majority at 45.4% (Type A).
Conclusions: In this study, in cases with only supraorbital notch, the distance of the notch to the midsagittal line was found to be 23.51±3.74 mm on the right side and 22.77±3.75 mm on the left side on average. In cases with only supraorbital foramen, the right side average was calculated as 20.50±4.30 mm and the left side average was calculated as 25.60±3.83 mm. These measurements are of considerable importance in procedures such as migraine botox or migraine surgery
Current management and controversies in acute cholecystitis: a narrative review of surgical and nonsurgical strategies, with emphasis on suspicion or incidental detection of gallbladder carcinoma
Get PDFAcute cholecystitis (AC) is a frequent surgical emergency. Laparoscopic cholecystectomy (LC) remains the standard treatment, though debate continues over surgical timing, the role of percutaneous cholecystostomy (PC), and the management of incidental gallbladder carcinoma (GBC). This review analyzed data from randomized trials, meta-analyses, and large observational studies (1966–2023) on these key issues. Evidence supports early LC (within 24–72 hours) as the optimal approach, consistently reducing hospital stay by about 3–4 days (weighted mean difference: –3.07 to –4.1 days, p<0.00001) without increasing mortality or bile duct injury. Operative time is slightly longer (+9.29 minutes, NS). In high-risk patients (APACHE II ≥7), the CHOCOLATE trial demonstrated LC superiority over PC, with lower complication rates (12% versus 65%, p<0.001), fewer reinterventions, and shorter length of stay (5 vs. 9 days, p<0.001). A meta-analysis of 32 studies found PC followed by delayed LC reduced overall complications (RR 0.28, 95% CI 0.14–0.56) but increased biliary leakage when drainage was delayed. Large databases confirm PC alone yields higher mortality and longer hospitalization than LC. Incidentally detected GBC occurs in 0.25–0.89% of cholecystectomies. Registry data show re-resection significantly improves survival for pT2 (44.1 versus 12.4 months) and pT3 (23.0 versus 9.7 months) disease. Early LC is therefore preferred for most AC patients, while PC serves only as a bridge in unstable cases. For incidental GBC, timely re-resection remains essential for curative outcomes, though standardized timing and patient selection criteria require refinement
Low alkaline phosphatase levels: a potential indicator of Wilson disease
Get PDFA young adult female patient presented with complaints of jaundice, intermittent vomiting, and weight loss. Upon examination, pedal oedema and abdominal distension were observed. Laboratory investigations indicated macrocytic anaemia, hemolysis, prolonged prothrombin time, mixed hyperbilirubinemia, elevated aspartate/alanine transaminase (AST/ALT), and a normal alkaline phosphatase (ALP). The investigations repeated showed an increase in bilirubin, AST, and ALT. However, the levels of ALP and the ALP: total bilirubin ratio (ALP:TB ratio) were found to be very low. This raised the suspicion of Wilson disease, and further laboratory workup was initiated. Urine (24-hour) and serum copper levels were elevated, while serum ceruloplasmin levels were lower. Based on this, the diagnosis of acute on chronic liver failure (ACLF) related to Wilson disease was made. The levels of ALP and the ALP:TB ratio remained low until the sixth day. This report demonstrates the clinical relevance of low levels of ALP and ALP: TB ratio and its diagnostic utility in establishing the diagnosis of Wilson disease