SRMS JOURNAL OF MEDICAL SCIENCE

Audit of Efficacy of Single-dose Versus Multi-dose Prophylactic Antibiotics in Elective Hernia Repair– A Retrospective Study

Punit Kumar, Saurabh Gupta, Parth Aggarwal — Mon, 30 Dec 2024 00:00:00 +0530

Background: Elective hernia repairs are associated with a high risk of SSIs that may translate to longer hospital stays and elevated costs. The common practice is the use of prophylactic antibiotics to prevent SSIs, but the right dosage schedule is still in question. To audit the efficacy of single-dose versus multidose prophylactic antibiotics in elective hernia repair.

Material and Methods: This retrospective study was conducted based on data from 183 patients of elective inguinal hernia repairs who received either single-dose or multi-dose antibiotic prophylaxis at a tertiary care teaching hospital from 1st July 2023 to 30th June 2024. Based on inclusion criteria, 80 patients from each group were selected, making a total of 160 patients. The rest of the 23 patients fell into the exclusion criteria and were not included. Patients in group A had been given a preoperative dose of 1g of ceftriaxone before the surgery and group B received the same preoperative dose together with a repeat dose 12 hours after the surgery. This study selected patients aged 18 to 70 years, American Society of Anesthesiologists (ASA) physical status grade I and II, who underwent elective inguinal hernia repair operation. Primary end-points were the rate of SSI and secondary outcomes SAS, hospital length of stay, post-operative complications and antibiotic reactions.

Results: There had been a small decrease in the rate of SSI at day 30 in group B (10%) than in group A (12. 5%); however, the difference was not significant with p = 0. 612. The mean hospital stay and the overall mean days in the hospital, as well as post-operative morbidity such as wound dehiscence and seroma formation, had been comparable in both groups. The two antibiotic regimens chosen were also concluded to be equally safe and effective in reducing SSIs in the hernia-repair population.

Conclusion: This study, therefore, concluded that there were no differences between single-dose prophylactic antibiotics and multiple doses of prophylactic antibiotics for the prevention of surgical site infection (SSI) under elective inguinal hernia repair. The overall rate of SSI, length of how hospital stay and post-operative complications were comparable between both regimens. In total, single-dose prophylaxis seems to be safe and efficient in comparison with multi-dose regimens for hernia repair surgery.

Assessing the Efficacy of Intrathecal Ultra-Low Dose Buprenorphine with Hyperbaric Bupivacaine in Infraumbilical Surgeries: A Randomised Control Study

Akhilesh Pahade, Ashita Mowar, Vishwadeep Singh — Mon, 30 Dec 2024 00:00:00 +0530

Introduction: Pain management is one of the defining roles of an anesthesiologist. Across the world, infraumbilical surgeries are carried out under subarachnoid blocks. However, one of the major limiting factors of spinal anesthesia is limited block duration. The addition of opioids and other adjuvants prolongs the block duration but a high dose of intrathecal opioids is associated with adverse events. This study was carried out in an attempt to evaluate ultra-low dose buprenorphine administered intrathecally and its effect on bupivacaine spinal anesthesia.

Material and Methods: The present prospective doubleblind study was undertaken on ninety American Society of Anaesthesiologists I and II patients between 18 and 60 years of age undergoing subarachnoid block for lower limb surgery. Group 1 (n = 45) patients were administered 3 mL of injection bupivacaine heavy 0.5% with 30 mcg of buprenorphine while group 2 (n = 45) was administered 3 mL of injection bupivacaine heavy 0.5%. The following parameters were observed: Onset times and duration of sensory and motor block, time for a 2-segment dermatomal recession, hemodynamic parameters and side effects if any. Data were analyzed by appropriate statistical tests and p < 0.05 were considered significant.

Results: The two groups were comparable in terms of the demographic profile, and onset of sensory blockade mean time taken to achieve the highest level of sensory blockade. Most patients in both groups achieved a maximum sensory level of T4 (n = 29 vs n = 26). However, 2-segment regression time and time for complete sensory recovery was significantly higher in patients who received intrathecal buprenorphine (145.36 ± 7.34 vs 78.956 ± 7.845; p < 0.0001) and (327.31 ± 11.151 vs 160.31 ± 16.258; p < 0.0001). Both groups were comparable in terms of grade III motor block onset and duration (12.620 + 0.79 vs 12.827 + 0.77; p = 0.2215) and duration of motor block (122.58 + 9.117 vs 119 + 16.396; p = 0.2039). There was no significant difference in terms of side effects between the two groups.

Conclusion: Intrathecal buprenorphine is a viable alternative for prolonging sensory block in spinal anesthesia without affecting motor blockade and no significant adverse events.

Mannheim Peritonitis Index in Acute Peritonitis due to Hollow Viscus Perforation- A Prognostic Evaluation

Saurabh Gupta, SK Sagar, Amit Kumar Singh — Mon, 30 Dec 2024 00:00:00 +0530

Introduction: Peritonitis caused by hollow viscus perforation remains a significant cause of mortality, despite advancements in surgical and medical interventions. The Mannheim peritonitis index (MPI) is a widely recognized scoring system that predicts outcomes in peritonitis cases. This study aims to evaluate the prognostic value of MPI in patients with peritonitis due to hollow viscus perforation and assess its ability to predict post-operative outcomes.

Material and Methods: This prospective observational study was conducted at Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, from August 2022 to January 2024. Ethical approval was obtained prior to the study. The sample size included 50 patients aged 18 years or older who presented with peritonitis and required surgical intervention. Diagnostic and biochemical tests were conducted, and MPI scores were calculated pre-operatively. Post-operative outcomes, including discharge and mortality, were recorded. Statistical analysis was performed using chi-square tests.

Results: A patient of >50 years of age, with onset of symptoms >24 hours before surgery, with no organ failure, with malignancy, with generalized peritonitis, with clear intra-operative exudates and with higher MPI score showed higher mortality. The study’s final outcome showed a mortality rate of 40% (20 patients), with 60% (30 patients) discharged. Wound infections were the most common post-operative complication (42%).

Conclusion: MPI proved to be an effective tool in predicting post-operative outcomes in hollow viscus perforation-related peritonitis. Higher MPI scores were associated with increased mortality, underscoring the importance of early risk stratification

Evaluating the Effectiveness of Visual Inspection with Acetic Acid as a Cervical Cancer Screening Tool: A Comparative Study with Pap Smear in Low-Resource Settings

Bhoomika Setiya, Shashi Bala Arya, Tanu Agrawal — Mon, 30 Dec 2024 00:00:00 +0530

Introduction: Cervical cancer significantly impacts women’s health worldwide, especially in low-resource settings where access to preventive screening is limited. Persistent HPV infection, particularly with types 16 and 18, is the primary cause. Pap smear screening has reduced cervical cancer rates in high-income countries but is challenging to implement in low-resource areas due to cost and infrastructure needs. This study aimed to assess the effectiveness of visual inspection with acetic acid (VIA) as an alternative screening tool by evaluating its sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

Material and Methods: This prospective observational study was conducted from August 2022 to January 2024 at SRMS Institute of Medical Sciences, Bareilly. Women aged 21 to 65 who met inclusion criteria were screened using VIA and pap smear tests. Data analysis was performed using SPSS, with statistical significance set at p < 0.05. Ethical approval and patient consent were obtained.

Results: VIA demonstrated high sensitivity, specificity, PPV, and NPV, showing a statistically significant correlation with pap smear findings. This highlights VIA’s reliability for detecting cervical abnormalities.

Conclusion: VIA is a practical and effective alternative to pap smear for cervical cancer screening in low-resource settings. Its affordability and ability to provide immediate results make it a valuable tool for early detection of cervical abnormalities and intervention.

Comparison of 1550 nm Erbium Laser and Micro-Needling Radiofrequency for the Treatment of Atrophic Facial Acne Scars: A Prospective, Open Labeled, Hospital-based Study

Mon, 30 Dec 2024 00:00:00 +0530

Introduction: Facial atrophic acne scars can be psychologically devastating. Both Erbium glass 1550 nm laser (EL1550 nm) and microneedling radiofrequency (MNRF) are treatment modalities for it. This study further may be promising for the treatment of acne scars. To compare the clinical efficacy and adverse effects of EL1550 nm and MNRF, for treatment of acne scars.

Material and Methods: About 33 patients with atrophic facial acne scars received 3 treatment sessions by 2 different modalities at 4-week intervals. MNRF on the right and EL1550 nm on the left side in the same patient. Efficacy was evaluated by comparing the change in Goodman and Baron Qualitative Scarring Grading and photographs at baseline and 8 weeks after the last session.

Results: Both MNRF and EL1550 nm, showed significant improvements in scarring grades and patient satisfaction from baseline, with no statistically significant difference between the scarring grades of the two modalities (p - 0.857, 0.476, 0.466 at second, third, and fourth visits, respectively). EL1550 nm had significantly less adverse effects than MNRF at all follow-ups (p 0.003, < 0.001, 0.026).

Conclusion: Both MNRF and EL1550 nm are comparative and effective treatments for acne scars. Also, boxcar scars showed more improvement on the MNRF side and rolling scars on EL1550 nm side (percentage reduction of 37.4 and 43.1%, respectively)

To Compare Uroflowmetric Parameters in Benign Prostatic Hyperplasia Pre and Post Trans Urethral Resection of Prostate

Gaurav Sharma, Brijesh Kumar Agarwal, Pradeep Mendiratta, Sudesh Kumar Sagar — Mon, 30 Dec 2024 00:00:00 +0530

Introduction: Men’s lower urinary tract problems sometimes stem from benign prostatic hyperplasia (BPH), the noncancerous growth of prostate tissue. Disease rates rise with age. The histological prevalence of BPH at autopsy is 50 to 60% in men in their 60s and 80 to 90% in those over 70.

Material and Methods: The Shri Ram Murti Smarak Institute of Medical Sciences’ General Surgery Department conducted the prospective study with Ethics Committee approval. All lower urinary tract patients aged 40 to 80 who needed surgery (transurethral resection of the prostate). The 18-month research assessed 50 patients.

Results: IPSS patients were moderate in the post-treatment, 1, and 3 months period, however only 6% were moderate and 94% were severe in the pre-treatment period. In QMAX, all patients were under 10 before treatment, 36% were between 10 and 15 after treatment, 64% were above 15 one month after treatment, and 14% were between 10 and 15, 3 months later. QMAX scores averaged 6.62 ± 1.03, 15.9 ± 1.84, 16.64 ± 1.22, and 17 ± 1.24. In QAVG, all patients were under 10 before treatment, 74% were under 10, 26% were between 10 and 15, 58% were under 10, 42% were between 10 and 15, and 36% were under 10 and 64% were over 15 during the 3 month treatment. Q avg score mean was 3.22 ± 0.78, 8.74 ± 1.29, 9.3 ± 1.15, and 10.22 ± 1.06. In the post-treatment, 1 and 3 month follow-up periods, all Tmax patients were under 10, whereas in the pre-treatment period, 76% were between 10 to 15 and 24% were beyond 15. Tmax averaged 14.66 ± 1.47, 6.9 ± 0.64, 6.34 ± 0.62, and 5.68 ± 0.61.

Conclusion: After TURP, objective uroflowmetry measures improved and correlated with subjective IPSS scores. Thus, uroflowmetry can objectively assess bladder outlet obstruction symptoms after TURP.

A Comparative Study of Carotid Doppler and Magnetic Resonance Angiography Neck Vessels in Stroke Patients

Girish Magadum, Neeraj Prajapati, Vinod Kumar Mogha, Divyant Rawal — Mon, 30 Dec 2024 00:00:00 +0530

Introduction: According to the definition provided by the World Health Organization, stroke is delineated as a clinical syndrome characterized by the rapid onset of observable clinical indicators indicative of either localized or widespread disruption in cerebral function, enduring for a duration exceeding 24 hours. The study aimed to evaluate the positive findings of color Doppler and MRA in neck vessels in stroke patients and to delineate the pitfalls during imaging, interpretations and limitations of color Doppler ultrasound.

Material and Methods: A prospective observational study was conducted in the Radiodiagnostic Department of SRMSIMS hospital in Bareilly, India. Over a period of 1.5 years in the Department of Radiodiagnosis. The study included a total of 60 patients with a history of stroke and coming for ultrasound carotid Doppler is further evaluated using MRA to determine stenosis or occlusion of carotid artery and assessed using Acuson Siemens Juniper Ultrasound, 3 Tesla 48 Channel MRI Machine Seimens Magnetom Skyra and 1.5 Tesla 16 Channel MRI Machine Seimens Magnetom Sempra.

Results: The study shows that the 60 stroke patients aged 58.43 ± 13.25 years, comprised 78.33% males and 21.67% females. Presenting complaints of 28.33% with right-sided paralysis, 20% with left-sided paralysis and bilateral lower limb weakness (13.33%). About 55% had right-sided strokes and 45% had left-sided strokes. For right-sided strokes, Doppler identified mild stenosis in 11.11% of cases, whereas MRA detected 6.06%. Statistical analysis revealed no significant difference in between Doppler (p = 0.610) and MRA (p = 0.552) for mild stenosis. MRA detected additional cases of mild to severe stenosis not identified by Doppler (p > 0.05). Among left-sided stroke patients, Doppler identified mild stenosis in 12.12%, slightly less than the 15.15% detected by MRA, with a non-significant p-value of 0.72 indicating comparable performance in mild stenosis detection. For internal carotid artery (ICA) stenosis, Doppler and MRA demonstrated differing capabilities. Doppler identified mild stenosis in 14.81 and 6.06% of right and left stroke patients, respectively, while MRA detected similar patterns in 14.81 and 7.41% of cases. Both modalities exhibited high agreement in detecting the absence of stenosis (p >0.05). Doppler showed notable differencesbetween right and left stroke patients, whereas MRA depicted more consistent findings across both sides in the assessment of plaque nature. Doppler detected hypoplastic vertebral artery (VA) in 15.15% of right-sided strokes and 6.06% for left-sided strokes, MRA identified higher rates at 21.21 and 18.18%, respectively, with non-significant differences (p > 0.05). MRA significantly outperformed Doppler in detecting diffuse VA involvement (22.22 vs. 0% in right-sided strokes, p = 0.005; and 0 vs. 77.78% in left-sided strokes, p = 0.000) and in identifying the absence of abnormalities (p = 0.002 and p = 0.000 for right and left VA, respectively).

Conclusion: This study concluded that MRA tended to detect more cases of stenosis across various severity levels compared to Doppler, particularly in severe stenosis among left-sided stroke cases, however, the differences were not statistically significant. MRA significantly outperformed Doppler in detecting diffuse vertebral artery involvement. This shows the complementary roles of Doppler and MRA in assessing CCA and ICA stenosis, MRA tends to offer a marginal advantage due to its superior resolution and ability to detect subtle abnormalities such as minor calcifications.

Evaluation of Maternal Risk Factors in Preterm Neonates and their Clinical Outcome in a Tertiary Care Teaching Hospital

Prem Lochan Prasad, Amit Kumar Gupta, Preeti Lata Rai, Surabhi Chandra — Mon, 30 Dec 2024 00:00:00 +0530

Introduction: Preterm birth is a significant global health concern with various maternal risk factors and clinical outcomes. This study aims to understand the prevalence of preterm birth worldwide and specifically in India, as well as the complications and long-term consequences associated with it. Additionally, the economic burden and regional disparities in preterm birth outcomes are explored, along with the factors contributing to the rising prevalence of preterm birth.

Material and Methods: The objectives of this study include investigating the incidence of preterm birth, analyzing the distribution of birth weights, identifying maternal and obstetric risk factors associated with preterm birth, examining the association between mode of delivery and preterm birth, and assessing the morbidities observed in preterm neonates. The study is conducted using a specific sample size and inclusion criteria, and ethical considerations are taken into account.

Results: In this study of 55 preterm neonates, various morbidities were observed. Hyaline membrane disease affected 14 neonates (25.45%), while birth asphyxia occurred in 6 neonates (10.90%). Sepsis was a major concern, developing in 40 neonates (72.73%). Neonatal hyperbilirubinemia was seen in 26 neonates (47.3%), hypoglycemia in 17 neonates (30.9%), hypocalcemia in 33 neonates (60%), and hypothermia in 11 neonates (20%). Apnea of prematurity was predominantly seen in 9 neonates (16.36%), and shock affected 11 neonates (20%). Patent ductus arteriosus (PDA) developed predominantly in 8 neonates (14.54%) and bronchopulmonary dysplasia (BPD) in 3 neonates (5.45%). Retinopathy of prematurity occurred in 2 neonates (3.6%), as did intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL). Nutritional inadequacy was a concern in 12 neonates (21.81%).

Conclusion: This study sheds light on the prevalence of preterm birth, identifies important risk factors, and highlights the morbidities associated with prematurity in neonates. The implications of this research extend to improving preventive measures and enhancing preterm care protocols.

The Present Study Examined the Correlation of Vitamin D Level with Disease Activity in Rheumatoid Arthritis: Crosssectional Study

Anuj Yadav, Sanjay Gupta, Shubham Rathee — Mon, 30 Dec 2024 00:00:00 +0530

RA patients. A person >39 vulnerability to RA and RA activity is correlated with their vitamin D level. The aim is to study the correlation of vitamin D levels with disease activity in patients with rheumatoid arthritis.

Materials and Methods: The present study was conducted in the Department of Orthopaedics at SRMS Institute of Medical Sciences, Bareilly, from 1st August 2022 to 31st January 2024 in all the diagnosed patients of rheumatoid arthritis after obtaining approval from an institutional ethics committee.

Results: In 41 to 60 years (46.42%) was the most common age group followed by ≤20 years (14.28%), There was a significant difference in gender between the groups (p = 0.041). Most patients with rheumatoid arthritis have a duration of illness of 1 to 2 years. The correlation between low disease activity and moderate disease activity was significant (p = 0.045) and between low disease activity and high disease activity was significant (p = 0.030), between moderate disease activity and high disease activity was not significant (p = 0.825).

Conclusion: It can be concluded that vitamin D deficiency precipitates disease activity in rheumatoid arthritis patients. Serum vitamin D levels in RA patients typically decline as the disease progresses.

Role of PET CT in Radiotherapy Planning of Head and Neck Cancers

Aniket G. Jadhav, Piyush Kumar, Jitendra Nigam, Silambarasan NS, Ayush Garg — Mon, 30 Dec 2024 00:00:00 +0530

Introduction: The use of new imaging modalities and combined chemoradiotherapy has resulted in significant improvements in treatment outcome for head and neck cancer patients. Presently, 3-D planning is standard in head and neck cancers and tissue volumes are delineated using computed tomography (CT) images. Role of positron emission tomography (PET) in radiotherapy planning is evolving. The PET/CT in radiotherapy planning may improve tumor delineation in terms of primary and nodal. The present study is designed to evaluate the role of PET-CT in radiotherapy planning of head and neck cancer and compare the dosimetric parameters for tumor and organs at risk between CT scan planning and PET-CT fusion planning.

Material and Methods: The present prospective study is of head and neck cancers was conducted in the department from August 2022 to January 2024. Histopathology proved squamous cell carcinoma head and neck cancers with age > 18 years and normal liver and kidney functions and not previously treated were selected. All patients were planned and delivered standard radiotherapy at a dose of 70 Gy in 35 fractions over 7 weeks. Two treatment plans were generated based on CT (group 1) and PET-CT (group 2) contours using intensity modulated radiotherapy technique (IMRT). Various dosimetric parameters of planning target volumes (PTV) and organs at risk (OAR) were evaluated for both groups. Collected data was analysed using standard statistical methods and the unpaired t-test was used to compare the means of both groups. p-value <0.05 was taken to be statistically significant.

Results: In the present study of 35 patients, majority of the patients were in the 7th decade of life with male predominance The commonest site involved was oropharynx (n = 13; 37.1%). T stage, N stage and overall stage, 17.1% cases were downstaged in PET CT. Total CTV (361.89 vs 355.96) and total PTV (692.33 vs 686.49) along with other PTV dosimetric parameters were slightly different in CT and PET CT which were not statistically significant. Similarly, various organs at risk did not show statistical difference in dosimetric parameters of both groups.

Conclusion: PET-CT supplementing radiotherapy planning contrast CT scan for tumor volume delineation has shown no statistical advantage in identifying the tumor more precisely in head and neck cancers. Cost-effectiveness and logistics associated with PET CT should be considered for radiotherapy planning.

Solitary Fibrous Tumor of Orbit Mimicking Sarcoma in 14 Years Old Boy: A Rare Case Report

Shabana Andleeb Ansari, Vaanika Kaira, Azmat Kamal Ansari — Mon, 30 Dec 2024 00:00:00 +0530

A solitary fibrous tumor (SFT) is a rare spindle cell neoplasm representing <2% of all soft tissue tumors. SFT was first described in the pleura and previously thought to be arising from mesothelium but recent studies have shown that any part of the body can be affected. Here, we report a case of SFT arising from the extraconal compartment of the right eye of a 14-year-old boy who presented with painless, slowly progressive swelling of the right eye for two years. On the basis of clinical details, a diagnosis of sarcoma was made. MRI findings revealed a well-circumscribed heterogeneously enhancing extraconal right orbital lesion suggestive of low-grade sarcoma. The patient underwent wide local excision. Grossly, it was a grey-white firm tumor. Histopathological features and immunohistochemistry were consistent with solitary fibrous tumor.