Current Issue Volume 4, Number 1 , January-June 2018

Vandana M Gudhe

Evidence-based Medicine: An Introspection!

[Year:2018] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:39] [Pages No:1]

Research forms a strong basis in our education system, which has shown a significant improvement all these years. The dissemination of research findings and use of clinical evidence benefit the populations and health care systems and influence public health issues globally, offering public and patient education, thus contributing to a quality health care on a global scale.

How to cite this article: Gudhe VM. Evidence-based Medicine: An Introspection! Int J Recent Surg Med Sci 2018;4(1):1.

Source of support: Nil

Conflict of interest: None

Sweta K Pisulkar, Ruchi Agrawal, Surekha R Godbole, Vivek Jadhav

Addressing the Gag Reflex: A Literature Review

[Year:2018] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:39] [Pages No:2-4]

Gagging is an involuntary protective reflex. Some patients have an extremely low threshold for the gag reflex. A severe gag reflex can be a big obstacle in certain dental procedures especially during the making of a maxillary impression. Many dental patients avoid going to the dentist because of an abnormally severe gag reflex. Treating such group of patients can be stressful and a time-consuming experience, both for the dentist and for the patient. The main aim of this article is to understand the etiology and effective management of such patients for a stress-free and fruitful clinical practice.

Keywords: Gagging, Management, Neurophysiology of gagging, Severity index.

How to cite this article: Pisulkar SK, Agrawal R, Godbole SR, Jadhav V. Addressing the Gag Reflex: A Literature Review. Int J Recent Surg Med Sci 2018;4(1):2-4.

Source of support: Nil

Conflict of interest: None

Aditya Khandekar, Sourya Acharya, Samarth Shukla

Mean Platelet Volume as a Prognostic Indicator in Sickle Cell Anemia

[Year:2018] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:39] [Pages No:5-9]

Aim: To assess the use of mean platelet volume (MPV) as a prognostic indicator of sickle cell disease (SCD).

Materials and methods: Fifty sickle cell patients aged 18 to 60 years, attending the Medicine outpatient department (OPD) and sickle cell clinic, or admitted with an ongoing crisis, were chosen as the study group, and 50 healthy participants were chosen as controls. A pro forma detailing relevant clinical history was obtained, with emphasis on admissions. Then, a blood sample was collected and analyzed for various parameters. Patients were classified into two categories:
• Category 1: Patients with <3 reported vaso-occlusive crises in the previous year, and
• Category 2: Patients with >3 reported vaso-occlusive crises in the previous year, or admitted to the medicine ward/ intensive care unit (ICU), currently with an ongoing crises.

Results: Mean hemoglobin (Hb) values were found to be statistically lower in sickle cell patients compared with controls, while mean total leukocyte count (TLC) and mean neutrophil % values were higher in sickle cell patients. Mean platelet volume in category 2 patients was higher compared with category 1 patients (p < 0.001), and values correlated with the mean neutrophil percentages. Also, MPV, TLC, and neutrophil % values showed a statistically significant drop (p < 0.001) 2 weeks after treatment for sickle cell crises.

Conclusion: Thus, MPV can be used as a potential marker to identify patients at a greater risk of developing vaso-occlusive crises in the future, which, in a developing country like India, can be a key step toward affordable, primary prevention of future emergencies.

Keywords: Hydroxyurea, Sickle cell anemia, Vaso-occlusive crises.

How to cite this article: Khandekar A, Acharya S, Shukla S. Mean Platelet Volume as a Prognostic Indicator in Sickle Cell Anemia. Int J Recent Surg Med Sci 2018;4(1):5-9.

Source of support: ICMR Short Term Studentship 2017 Grant

Conflict of interest: None

Himanshu Dodeja, Vinaya Udaybhaskar, Amol Singam

Effects of Dexmedetomidine Infusions on Hemodynamic Stability in Patients undergoing Laparoscopic Cholecystectomy

[Year:2018] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:39] [Pages No:10-14]

Objectives: In laparoscopic cholecystectomy, there has been emphasis on maintaining hemodynamic stability by avoiding hypertension, hypotension, or tachycardia. The hemodynamic instability is persistent during the duration of pneumoperitoneum (PNP), namely, CO2 insufflations. This study helps us to find out the efficacy of dexmedetomidine on cardiovascular system stability in patients undergoing laparoscopic cholecystectomy.

Materials and methods: Thirty patients were randomized into two groups of 15 members each: group P (placebo group) and group D (dexmedetomidine group). In the former, patients received 0.9% 20 mL normal saline, while in the latter, patients received 0.4 ug/kg/hr of injection dexmedetomidine in 0.9% normal saline. In all patients, age, weight, height, systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded.

Results: Dexmedetomidine being a highly selective and potent and specific alpha 2 agonist attenuates the hemodynamic response to tracheal intubation, decreases plasma catechol-amine concentration during anesthesia, and decreases peri-operative requirements of inhaled anesthetics. We found that dexmedetomidine helped in blunting the pressor response during the intubation, kept the HR and mean arterial pressure stable intraoperatively, and there was faster recovery as the requirement of inhalation agent was decreased intraoperatively.

Conclusion: The drug dexmedetomidine maintained cardiovascular stability during laparoscopic cholecystectomy. The inhalational agent (isoflurane) requirement was found to be considerably lower. Also, the mean recovery time as indicated by the ability to vocalize following extubation was found to be significantly less. Hence, it can be recommended in laparoscopic cholecystectomy for maintaining cardiovascular system stability.

Keywords: Cardiovascular stability, Dexmedetomidine, Laparoscopic cholecystectomy, Post-op recovery.

How to cite this article: Dodeja H, Udaybhaskar V, Singam A. Effects of Dexmedetomidine Infusions on Hemodynamic Stability in Patients undergoing Laparoscopic Cholecystectomy. Int J Recent Surg Med Sci 2018;4(1):10-14.

Source of support: Nil

Conflict of interest: None

Abhinav Gubba, Samir C Dwidmuthe, Anil Golhar, Nilesh Joshi

Effects of Local Infiltration of Autologous Platelet Supernatant in Supraspinatus Tendinopathies

[Year:2018] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:39] [Pages No:15-18]

Aim: The study was conducted to evaluate the therapeutic effects of platelet-rich plasma (PRP) injections in promoting healing of rotator cuff tendinopathies over short term by evaluating pain, range of motion (ROM) using Constant-Murley score (CMS).

Design: This prospective, cohort study was conducted in the Department of Orthopedics at a tertiary care teaching hospital between December 2013 and April 2015. Patients with supraspinatus tendinopathies (partial tear) based on either ultrasonography (USG) or magnetic resonance imaging (MRI) were included in the study. Patients with complete rotator cuff tear were excluded.

Materials and methods: Thirty consecutive patients with supraspinatus tendinopathies were administered subacromial injections of PRP. Platelet-rich plasma was made from 20 mL of patient’s blood after subjecting it to two centrifugal spins and injected into the supraspinatus tendon. All patients were evaluated at the end of 3 months.

Results: Shoulder function was assessed by CMS in present study. Mean score at baseline was 33.87 ± 5.91. After 1 and 3 months, significant reduction in CMS was found with mean score of 27.80 ± 5.17 at 1 month (p < 0.0001) and 21.93 ± 6.17 at 3 months (p < 0.0001). There was a significant difference in score at 1 and 3 months (p < 0.0001). At 6, 12, and 17 months, the CMS was still significantly low but there was no difference in scores when compared with scores at 3 months.

Conclusion: Platelet-rich plasma injection for supraspinatus tendinopathies gives good results at the end of 3 months.

Keywords: Constant-Murley score, Infiltration, Platelet-rich plasma, Tendinitis.

How to cite this article: Gubba A, Dwidmuthe SC, Golhar A, Joshi N. Effects of Local Infiltration of Autologous Platelet Supernatant in Supraspinatus Tendinopathies. Int J Recent Surg Med Sci 2018;4(1):15-18.

Source of support: Nil

Conflict of interest: None

Nikhil Mehta, Pratapsingh Parihar, Saherish Khan, Garima Rajimwale

Role of Chest X-ray in Respiratory Distress of Neonates

[Year:2018] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:39] [Pages No:19-23]

Introduction: The initial diagnosis of an infant with respiratory distress is crucial as life-saving measures can be started immediately. Despite all the improved diagnostic modalities out there, a roentgenogram of the chest is still considered the most reliable diagnostic tool to establish respiratory distress. The aim of this study was to assess and evaluate the role of chest X-ray (CXR) in neonatal respiratory distress.

Materials and methods: This study was a prospective correlational hospital-based study done in 300 neonates in Acharya Vinobha Bhave Rural Hospital, Sawangi (Meghe), Wardha. The neonates who were clinically diagnosed having respiratory distress were evaluated using chest radiograph. In all these patients, the chest radiography findings were noted and correlated with clinical findings.

Results: Transient tachypnea of the newborn (TTNB) was the most common cause of respiratory distress (35.7%). Chest radiography had the highest sensitivity and specificity in pneumothorax (PTX), tracheoesophageal fistula, lobar emphysema, and diaphragmatic hernia (100%). Followed by pneumonia, radiography had 81.2% sensitivity and 86.5% specificity; for hyaline membrane disease (HMD), sensitivity and specificity were 80 and 89% respectively; for meconium aspiration syndrome (MAS), sensitivity was 60.5 and specificity was 81.7%; and for TTNB, sensitivity was 36.4% and specificity was 96%. Overall diagnostic accuracy was 59.7%, i.e., the final clinical diagnosis confirmed by CXR.

Conclusion: A chest radiograph has high sensitivity for congenital diaphragmatic hernia (CDH), PTX, congenital lobar emphysema, tracheoesophageal fistula, pneumonia, and HMD and low sensitivity for TTNB. To sum up, a plain chest radiograph is an indispensable tool in neonates with respiratory distress, but as with any diagnostic modality, it has its own limitations.

Keywords: Chest X-ray, Diagnostic role, Respiratory distress of newborn.

How to cite this article: Mehta N, Parihar P, Khan S, Rajimwale G. Role of Chest X-ray in Respiratory Distress of Neonates. Int J Recent Surg Med Sci 2018;4(1):19-23.

Source of support: Nil

Conflict of interest: None

Venus Kumar, HR Chandrashekhar, Suresh Hanagavadi

Burkitt Lymphoma with Multiorgan Involvement

[Year:2018] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:39] [Pages No:24-28]

Burkitt lymphoma (BL) is classified as a poorly differentiated lymphocytic lymphoma of B lymphocytes. It mainly affects children. It is one of the rapidly growing tumors in humans, with profuse proliferation. It is a rare malignancy comprised of only 0.76% of solid malignant tumors among Indian children.
Symptoms occur because of rapid turnover of the mature B lymphocytes with involvement of the extranodal sites and involve -ment of adjacent organs. Initially, this tumor was identified in Africans. The cause of this tumor is uncertain, but shows strong evidence with Epstein-Barr virus (EBV) in its development. A case of BL with multiorgan involvement in a 7-year-old girl was reported, which was confirmed by immunohistochemistry (IHC).

Keywords: B cell, Burkitt lymphoma, Immunohistochemistry, Lymphoma.

How to cite this article: Kumar V, Chandrashekhar HR, Hanagavadi S. Burkitt Lymphoma with Multiorgan Involvement. Int J Recent Surg Med Sci 2018;4(1):24-28.

Source of support: Nil

Conflict of interest: None

Chinnu Sasikumar, Ketaki Utpat, Unnati Desai, Jyotsna M Joshi

Acromesomelic Dysplasia with Interstitial Lung Disease: A Unique Association

[Year:2018] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:39] [Pages No:29-31]

Acromesomelic dysplasia is an extremely uncommon skeletal dysplasia with an autosomal recessive inheritance. It is characterized by a constellation of skeletal anomalies. Respiratory impediments have been sporadically reported earlier in various skeletal dysplasias. However, respiratory affection in acrome-somelic dysplasia has not been elucidated earlier. We herein report a case of acromesomelic dysplasia associated with interstitial lung disease (ILD). Diagnosis of acromesomelic dysplasia was based on radiographs of whole skeleton.

Keywords: Acromesomelic dysplasia, Interstitial lung disease, Skeletal dysplasia.

How to cite this article: Sasikumar C, Utpat K, Desai U, Joshi JM. Acromesomelic Dysplasia with Interstitial Lung Disease: A Unique Association. Int J Recent Surg Med Sci 2018;4(1):29-31.

Source of support: Nil

Conflict of interest: None

Rohit Juneja, L Manjunath, HS Veerendra, Ananth S Mathad

Once in a Blue Moon, Congenital Anterior Urethral Diverticulum

[Year:2018] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:39] [Pages No:32-36]

Anterior urethral valves (AUVs) are rare congenital anomalies causing lower urinary tract obstruction in children. Although they are referred to as valves, these obstructive structures often occur in the form of a diverticulum. Congenital anterior urethral diverticulum (CAUD) is an uncommon/rare entity in children which can lead to obstructive lower urinary tract symptoms and urosepsis. Over the past 20 years, more than 260 cases have been reported. However, most cases are diagnosed on prenatal ultrasonography (USG) in early life if patients present with bilateral hydronephrosis and/or azotemia. Diagnosis is by ureteroscopy and radiological imaging. Surgical treatment can be open or endoscopic. Here, we report a new case of CAUD and discuss its clinical presentation, diagnosis, and management. A brief review of the literature is also presented.

Keywords: Anterior urethral diverticulum, Anterior urethral valves, Congenital anterior urethral diverticulum, Micturating cystourethrogram, Transurethral resection, Ultrasonography.

How to cite this article: Juneja R, Manjunath L, Veerendra HS, Mathad AS. Once in a Blue Moon, Congenital Anterior Urethral Diverticulum. Int J Recent Surg Med Sci 2018;4(1):32-36.

Source of support: Nil

Conflict of interest: None

Richa S Nathani, Zeba Nisar

A Rare Case Report of Molar Pregnancy with Coexisting Fetus

[Year:2018] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:39] [Pages No:37-39]

Aim: Here we report a molar pregnancy with a coexisting fetus progressing to a viable, healthy infant which is an extreme rarity, with the incidence of 0.005-0.01% of all the pregnancies.

Background: Partial mole is defined as excessive trophoblastic proliferation with normal and hydropic villi and presence of a fetus or a fetal circulation with nucleated cells. Partial molar pregnancy with a singleton live fetes is a rare condition. it is commonly seen with twin gestation and it is rare with singleton pregnancy

Case report: A 30 years old primigravida, referred from a private hospital at 38 weeks of gestation delivered a phe-notypically normal and healthy infant 2200 gm in weight by caesarean section. The placenta weighed 500 gms and on sectioning revealed widespread, grape-like vesicles. Light microscopy revealed normal villi coexisting with villi showing hydropic change and cistern formation and diffuse circumferential trophoblastic hyperplasia consistent with molar change. A diagnosis of partial molar pregnancy with normal fetus was made.

Conclusion: Very few twin pregnancies with a hydatidiform mole and a foetus continue to term as they often have spontaneous or induced terminations for maternal complications Management of molar changes associated with normal appearing fetus still remains challenging as not many studies have been done due to rarity of this disorder.

Clinical significance: Though the general trend is to terminate pregnancy in foetus with coexistent mole in anticipation of complications, under close surveillance, optimal outcomes can be achieved. Monitoring of serum (3-hCG, serial ultrasound for fetal growth, size of molar component, and theca lutein cysts can help to predict good patient outcomes.

Keywords: Beta-hCG, Molar pregnancy.

How to cite this article: Nathani RS, Nisar Z. A Rare Case Report of Molar Pregnancy with Coexisting Fetus. Int J Recent Surg Med Sci 2018;4(1):37-39.

Source of support: Nil

Conflict of interest: None