International Journal of Research in Medical Sciences
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Relationship between blood glucose levels and diabetic neuropathy examination score in patients with diabetes mellitus
Get PDFBackground: Diabetic neuropathy is a specific type nerve damage that primarily affects the peripheral nervous system, causing a loss of sensation in the extremities, disruption of autonomic functions, and to a lesser extent, motor function. The length of time a person has diabetes and their haemoglobin A1C (HbA1C) levels (a measure of glycated haemoglobin which reflects average daily glucose levels) are significant factors in determining the development of diabetic neuropathy.
Methods: This was a cross-sectional study conducted between April 2023- July 2023 among 51 participants who met the selection criteria participated in the study and were assessed using the Diabetic Neuropathy Examination Score (DNE score).
Results: The study concluded that the symptoms of diabetic neuropathy in high blood sugar individuals are higher in males (59%) than females (41%) due to changes in blood sugar levels. A direct correlation found amidst blood glucose volume and diabetic neuropathy examination (DNE score).
Conclusion: Hence the study concluded that the symptoms of glycated haemoglobin neuropathy in diabetes patients are higher in males (59%) than females (41%) due to changes in blood sugar levels
Does chest mobilization affect trunk control and balance in children with spastic cerebral palsy
Get PDFBackground: Chest mobility has been reported to be reduced in children with spastic cerebral palsy (CP). This study was conducted to determine the effectiveness of chest wall mobilisation on trunk control and balance in children with CP.
Methods: The 32 children who participated in this single-blind trial were divided into two groups at random. Group A (n=16) received conventional intervention and chest mobilisation, while group B (n=16) received only conventional intervention. For a period of six weeks, the intervention was carried out three days a week. After six weeks of therapy, participants were reassessed using the paediatric berg balance scale (PBS) for evaluating balance and the trunk control measurement scale (TCMS) for evaluating trunk control.
Results: The Wilcoxon test was used to assess differences within the group, while the Mann Whitney 'U' test was used to determine whether there were any differences between the two groups. The pre- and post-treatment scores of the variables TCMS and PBS were used to illustrate the results as a mean and standard deviation. Comparison of each group's outcome metrics before treatment revealed no significant differences. While, comparing the results of chest mobilisation with conventional physiotherapy in group A showed a notable improvement in the ability to maintain balance and trunk control (p<0.05)
Conclusions: In children with CP, chest mobilisation has a positive effect and can be combined with conventional physiotherapy techniques to enhance balance and develop trunk control
Rekindling the flame: erythema Induratum of bazin as a manifestation of latent tuberculosis
Get PDFErythema Induratum of Bazin is considered a type of tuberculid—a hypersensitivity reaction to Mycobacterium tuberculosis antigens in individuals with underlying tuberculosis infection. EIB primarily occurs in middle-aged women but can also be seen in men, particularly those with predisposing conditions such as diabetes or vascular insufficiency. We report a case of erythema Induratum of Bazin in an elderly diabetic male who present with chronic recurrent, tender erythematous plaques with oozing, crusting and ulceration over both lower limbs with a past history of pleural tuberculosis. Initially he was treated with doxycycline and hydroxychloroquine, but his lesions worsened. However, after starting ATT his condition improved. Early diagnosis and treatment are crucial in preventing associated morbidity and complications.
Use of V-Y advancement flap in digital tip reconstruction after human bite: case report
Get PDFDescribed by Tranquilli-Leali in 1935, the V-Y advancement flap is a technique for reconstructing pulp defects. It involves the displacement of a neurovascular advancement flap. Objective were to demonstrate that the V-Y flap is a good treatment option even in complicated cases. We present the case of a 47-year-old man with diabetes who sustained a traumatic injury to the right thumb due to a human bite during a street fight. A V-Y advancement flap technique was performed for digital tip reconstruction. At 14 days postoperatively, complete flap integration was observed. This technique is ideal for addressing dorsal or transverse oblique amputations where digital tip coverage is required. The efficacy, ease, and good postoperative results make this type of surgical approach suitable for digital tip reconstruction, even in the presence of comorbidities and risk factors for infection.
Effect of dexamethasone versus dexamethasone with granisetron in prevention of nausea and vomiting in caesarian section under spinal anesthesia: a randomized double blind study
Get PDFBackground: Postoperative nausea and vomiting (PONV) are a common occurrence in patients undergoing caesarean section under spinal anaesthesia. It can lead to adverse events like pain, bleeding, dehydration, electrolyte imbalance, aspiration pneumonia etc.
Methods: This study was aimed at comparing the effectiveness of dexamethasone alone with dexamethasone with granisetron in prevention of PONV in patients undergoing caesarean section under spinal anaesthesia. This was a double blinded prospective randomized controlled trial conducted on 60 pregnant mothers undergoing elective caesarean section under spinal anaesthesia. One group of patients (n=30) received dexamethasone 8 mg intravenously whereas the other group received dexamethasone 8 mg plus granisetron 2 mg intravenously after baby was delivered and cord clamped. Patients were then observed for a period of 24 hrs postoperatively.
Results: Upon comparison of PONV score between both groups, at 0-2 hrs dexamethasone-granisetron (PONV 0=50%, 1=33.3%, 2=13.3%, 3=3.3%) showed better control than dexamethasone alone (PONV 0=40%, 1=36.7%, 2=16.7%, 3=6.7%). Similar results were seen at 2-24 hrs with dexamethasone-granisetron (PONV 0=83.3%, 1=16.7%, 2=0%, 3=0%) having better score than dexamethasone (PONV 0=66.7%, 1=26.7%, 2=3.3%, 3=3.3%). Need for rescue antiemetic was less in dexamethasone+granisetron (5 out of 30=16.7%) compared to dexamethasone (10 out of 30=33.3%). No major side effects were seen.
Conclusions: Our study shows that dexamethasone combined with granisetron is a safe and effective prophylactic antiemetic in pregnant ladies undergoing caesarean section under spinal anaesthesia, compared to monotherapy of dexamethasone
Differentiating iron deficiency anaemia and β thalassemia trait based on red cell indices- an economic way to health care in a resource limited setup
Get PDFBackground: In a developing country like India, anaemia is a significant health burden. Specific cost-effective methods for screening of β-thalassemia trait (BTT) should be adopted to differentiate from iron deficiency anemia (IDA) with the use of various indexes derived from red blood cell (RBC) indices.
Methods: A total of 845 adults were screened for carrier detection of β thalassemia during May to July, 2024. A complete hemogram and HPLC analysis for thalassemia was done on all the samples. Serum ferritin was estimated in samples with MCV<78 fl and MCH<27 pg. Different discriminant functions like Mentzer index (MI), Shine and Lal (S and L) index, red cell distribution width index (RDWI) and red cell distribution width (RDW) were used.
Results: Of the 135 individuals, 80 individuals had iron deficiency anaemia (IDA). 17 individuals had β-thalassemia trait (BTT), 19 had coexistent IDA and BTT, 8 individuals had other haemoglobinopathies; 11 individuals had normal ferritin with normal HbA2 levels. RBC count was higher in BTT as compared to IDA cases (p value <0.001). MI and S and L index showed 97.20% and 83.78% sensitivity (p value <0.01); RDWI and MI showed 96.15% and 92.4% specificity value (p value <0.01) while RDWI and MI had 91.23% and 89.66% (p value <0.01) accuracy for detection of BTT.
Conclusions: Combination of these two indices, MI and RDWI with final confirmation by HPLC would help to reduce the overall cost of screening in situations where the ideal screening approach of doing CBC and HPLC analysis of all individuals as a first step itself is not possible due to cost constraints
A 24-year-old man with fibrodysplasia ossificans progressiva: clinical challenges and management
Get PDFFibrodysplasia ossificans progressiva (FOP) is a rare, disabling genetic disorder characterized by progressive heterotopic ossification of skeletal muscles and connective tissues. It is recognized as the most disabling condition of extraskeletal bone formation. The worldwide prevalence is approximately 1 in 2,000,000, with no ethnic, racial, gender, or geographic predilection. The hallmark clinical features include congenital malformation of great toes (commonly bilateral hallux valgus) and recurrent episodes of heterotopic ossification, often triggered by trauma or occurring spontaneously. Pathogenesis involves dysregulated bone morphogenetic protein (BMP) signaling due to mutation in the ACVR1 gene. Here we report a case of 24-year-old male with classical FOP, presenting with bilateral deformities of the big toes and progressive ectopic ossification. Despite advances in understanding the molecular mechanisms of the disease, there are currently no definitive preventive treatments. Early recognition of FOP, particularly by pediatric clinicians, is critical to avoid exacerbating factors, such as invasive procedures or trauma that may accelerate disease progression. This case report highlights the importance of clinical vigilance and continued research into therapeutic options for this devastating condition.
Advances in pediatric anesthesia: safety protocols and emerging practices
Get PDFPredictive modelling implementation with safety protocols in paediatric anaesthesia has contributed to major improvements in the safety measures and performance quality of child anaesthetic treatment. The review gathers and examines contemporary research between 2017 and 2022 to assess how predictive models can be implemented with safety protocols which improve anesthesia management effectiveness. Healthcare models developed using electronic medical records (EMRs) and real-time monitoring systems and specialized equipment enable medical staff to predict postoperative complications such as respiratory events and thrombotic complications along with blood loss. The advancement of machine learning (ML) technology together with artificial intelligence (AI) supports unique anesthesia treatment plans for risky high-risk pediatric surgeries. Different intervention approaches form the basis of the investigation to enhance care results and minimize medical complications through improved sedation depth monitoring and pain control and airway management practices. The deployment of these models meets continuous resistance to implement across different clinical settings. The study examines contemporary developments in paediatric anaesthesia while stressing the necessity to construct better predictive methods and the AI potential to enhance safety and treatment results for paediatric anaesthesia care
Incidence of left ventricular diastolic dysfunction in patients with subclinical hypothyroidism
Get PDFBackground: Subclinical hypothyroidism (SCH) is a common endocrine disorder categorized by increased serum thyroid-stimulating hormone (TSH) levels with normal free thyroxine (FT4) levels. The study determined the prevalence of LVDD in females aged 20 to 50 years with SCH and to explore the relationship between serum TSH levels and left ventricular diastolic dysfunction (LVDD).
Methods: One hundred female participants aged 20 to 50 years with SCH were included in this study conducted between September 2014 to October 2015. All participants underwent 2D echocardiography to assess diastolic function. Data were collected on age, serum FT3, FT4, TSH levels, and echocardiographic parameters. Statistical analysis was achieved using SPSS.
Results: The study found that 34% of the participants had LVDD. The prevalence of LVDD was significantly higher in the 36-50 age group (45.8%) compared to the 20-35 age group (23.1%). A considerable correlation was observed between elevated serum TSH levels (8-10 µU/l) and the prevalence of LVDD (47.1%) compared to lower TSH levels (5-7 µU/l) (22.2%). Echocardiographic findings showed significantly lower E/A ratios and increased left atrial volume indices in participants with LVDD (p<0.001).
Conclusions: The study demonstrated a substantial incidence of LVDD among females with SCH, particularly in older participants and those with higher TSH levels. These findings suggest that advancing age and elevated TSH levels are important risk factors for LVDD in this population. Regular cardiac assessments and monitoring of thyroid function are recommended for females with SCH, especially those in older age groups or with elevated TSH levels, to prevent the progression to overt cardiovascular disease.
Caterpillar chronicles: adventuring through Moynihan’s legacy in laparoscopic cholecystectomy
Get PDFBefore the introduction of minimally invasive surgery, there was a heightened focus on studying anatomical variants and their frequency due to the increased risk of biliary tract injury and hemorrhagic and ischemic arterial injury. This was done through the "Culture for safe cholecystectomy (CSC)" proposed by Strasberg, which underscored the significance of standardizing these variants using the classifications of Blumgart and Michael. These classifications centered on the insertion site of the biliary duct and cystic artery (CA), respectively. A tortuous pattern of the right hepatic artery (RHA) resembling a caterpillar or a hump (caterpillar hump or Moynihan's hump) that runs proximal or parallel to the cystic duct and gallbladder is often associated with the presence of a short CA, posing a high risk of vascular injury. The tortuous RHA can form a single or double loop and pass posteriorly or anteriorly to the common hepatic duct, with the posterior presentation being the most common. This represents one of the most serious lesions described, despite its low frequency, with an incidence reported to be between 1.3% and 13.3%. We present a case of a 33 years old woman with acute cholecystitis and a Moynihan’s hump or caterpillar configuration of the RHA, which was identified during laparoscopic cholecystectomy