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   Table of Contents - Current issue
Coverpage
October-December 2022
Volume 11 |  4
Page Nos. 203-275

Online since Thursday, October 27, 2022

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EDITORIAL  

Treatment duration of osteoarticular tuberculosis: How long is optimum? p. 203
Ravi Mittal
DOI:10.4103/jcsr.jcsr_82_22  
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ORIGINAL ARTICLES Top

Ablative therapies in primary and metastatic liver tumours: An early experience p. 205
Phani Chakravarty Mutnuru, Shabana Begum, Rammurti Susarla, Bheerappa Nagari, Surya Ramachandra Varma Gunturi, Venu Madhav Thumma, Sadashivudu Gundeti
DOI:10.4103/jcsr.jcsr_55_22  
Background: Hepatic resection and hepatic transplantation are considered the only definitive treatment modalities capable of achieving cure for primary and metastatic liver tumours. As few patients qualify to receive these treatments, local ablative therapies are increasingly being used as treatment for primary and metastatic tumours of the liver. Methods: During the period January 2018 to January 2022 we prospectively studied the utility of chemical and thermal ablation ablative therapy in 22 patients with primary and metastatic liver disease. All patients were followed at 1, 3 and 6 months. Results: Percutaneous ethanol injection (PEI) was done in 2 patients. Radiofrequency ablation (RFA) was done in 13 patients [hepatocellular carcinoma (HCC) 8, metastases 5]. With RFA, out of eight HCC patients, complete ablation was seen in 4; 2 patients underwent partial hepatectomy; 2 patients died within a month of ablation due to associated co-morbidities. In 5 patients with metastases, 3 achieved complete ablation; partial hepatectomy and systemic chemotherapy was needed in 1 patient each. With microwave ablation (MA) (n=6; HCC 3, metastases 3), complete ablation was achieved in 3 HCC patients. In patients with metastases, complete ablation was seen in 2 and one patient in addition, underwent transarterial chemoembolization. One patient with metastasis underwent both RFA and MA; complete ablation was achieved; MA was repeated a few months after RFA as new lesion developed. Conclusions: Our study results suggest that chemical and thermal ablation ablative therapies are effective both as palliative and curative in the management of primary and metastatic liver lesions.
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Study of congenital heart diseases among children with Down's syndrome p. 211
Padmini Priya Banoth, Manohar Badur, Bhavana Priyadarshini, Maruthi Aruna Cheni
DOI:10.4103/jcsr.jcsr_43_22  
Background: Congenital heart disease (CHD) is the most common cause for morbidity and mortality among children with Down's syndrome. Methods: This hospital-based descriptive study was conducted on 50 children with Down's syndrome aged <18 years presenting to the department of paediatric medicine at our tertiary care teaching hospital at Tirupati. The prevalence, pattern of congenital heart defects and various factors which are likely to influence the expression of CHD in Down's syndrome are reported. Results: We observed CHD in 27/50 (54%) of patients studied. Ventricular septal defect (n = 40.7%) was s the most common, followed by endocardial cushion defects (n = 29.7%); atrial septal defect, patent ductus arteriosus and tetralogy of Fallot. CHD were more commonly seen in male children (58.6%); karyotyping showed translocation in 30/50 (60%) study subjects. Advanced maternal, paternal age, increased birth order and consanguinity showed a positive association with the occurrence of CHD in children with Down's syndrome. Conclusions: Our observations suggest that routine screening of children with Down's syndrome for cardiac anomalies will help in early diagnosis and early institution of specific treatment.
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Comparative ultrasonography evaluation of the portal vein congestion index in chronic hepatitis B virus infection and apparently healthy adults p. 216
Gbenga Jacob Aderibigbe, Chukwuemeka Agi, Ebbi Donald Robinson, Enighe Wananyo Ugboma
DOI:10.4103/jcsr.jcsr_36_22  
Background: Sonography is a useful tool in the study of the hepatic haemodynamic alterations that occur in chronic hepatitis B virus (HBV) infection using the portal vein congestion index (PVCI). The study was aimed at sonographically assessing the portal vein congestion index in adults with chronic HBV infection and at comparing the same with apparently healthy adults. Methods: This was a comparative, cross-sectional study carried out amongst 124 subjects (62 chronic HBV patients and 62 uninfected, apparently healthy individuals). The participants underwent routine grey scale evaluation of the liver, Doppler ultrasonographic evaluation of the portal vein and the ratio of the portal vein cross-sectional area in centimetre square to the portal vein velocity in centimetre per second. Results: In healthy controls, the mean PVCI was 0.048±0.010 cm, while the mean PVCI in chronic HBV patients was 0.077±0.028 cm (P < 0.001). The mean of duration of illness was 3.63 years with a range of 0.5–15. There was a weak negative correlation between PVCI and duration of illness (r = −0.130, P = 0.313). Conclusions: The PVCI was significantly higher in chronic HBV patients compared to healthy subjects. However, there was a weak correlation between PVCI and duration of illness in patients with chronic HBV.
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A prospective observational study to determine the predictors of failure of non-invasive ventilation in patients with type 2 respiratory failure p. 223
Mohammed Fahad Khan, Vasudeva Acharya, Barkur Ananthakrishna Shastry
DOI:10.4103/jcsr.jcsr_42_22  
Background: This study aims to evaluate clinical and biochemical parameters likely to predict the failure of non-invasive ventilation (NIV) in patients with type 2 respiratory failure. Methods: The study was conducted from September 2016 to August 2018. Clinical and biochemical parameters of 151 patients were analysed after the application of NIV and divided into two groups, success group if they remained on NIV after 48 h and failure group if intubated. Results: Among 151 patients, 65 patients (43%) were intubated and included in the failure group. The remaining 86 patients (57%) were included in the success group. Of the 65 patients who got intubated, 16 patients died while 49 recovered. Out of the 151 patients enrolled the gender distribution was 65 males and 86 females. There was no statistically significant association of the outcome of NIV usage with the comorbidity of the patient and with the underlying lung pathology of the patient. Seventy-two per cent (47 patients) of the NIV failures were in the first 6 h. Lower pH, higher partial pressure of carbon dioxide, higher heart rate and respiratory rate (RR) at baseline showed a statistically significant association with the failure of NIV usage in patients with type 2 respiratory failure. Failure of clinical and biochemical parameters to improve at various time points was also associated with increased chances of failure of NIV usage. Conclusions: Linear regression analysis showed that pH and RR at baseline and presence of severe pulmonary artery hypertension were found to be predictors of failure of NIV.
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Device-associated healthcare-associated infections surveillance in an intensive care unit of a tertiary care hospital in COVID-19 patients p. 228
Varun Goel, Savita Gupta, Harmesh Manocha, Saurabh Srivastava
DOI:10.4103/jcsr.jcsr_56_22  
Background: Surveillance for healthcare-associated infections has a major role in hospital infection prevention and control programmes. In the present study, we estimated the impact of the COVID-19 pandemic on device-associated healthcare-associated infections (DA-HAI) ventilator-associated events (VAE), central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infections (CAUTI). Methods: This was a prospective surveillance study from January 2021 to June 2021 conducted in a 30-bed intensive care unit (ICU) of tertiary care, and academic healthcare organisations. Targeted surveillance was carried out by the National Healthcare Safety Network surveillance requirements of the Centers for Disease Control and Prevention. Results: A total of 249 patients admitted to the ICU with 2920 patient days of surveillance data were included during the study. A DA-HAIs attack rate of 17.67/100 admissions was seen during the study. The device utilisation ratios of central line, ventilator and urinary catheters were 0.49, 0.60 and 0.83, respectively. VAE, CLABSI and CAUTI rates were 12.44, 6.91 and 9.01/1000 device days, respectively. Among 54 DA-HAIs reported, pathogens could be identified for 41 DA-HAI cases. The most common organisms causing VAE, CAUTI and CLABSI were Acinetobacter baumannii (42.1%), Escherichia coli (30%) and Pseudomonas aeruginosa (41.7%), respectively. Of the Gram-negative organisms 61.7% were carbapenem resistant and 50% of Staphylococcus aureus were methicillin resistant. Conclusions: The present study shows high rates of ICU-acquired DA-HAIs and moderately high resistance patterns of the organisms causing HAIs, which poses a great risk to patient safety.
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Role of neutrophil-to-lymphocyte ratio in predicting microvascular complications in type 2 diabetes mellitus p. 234
Nandita Gollakota, Swaroopa Deme, Bhaskar Kakarla, M Nageswara Rao, Y Sathyanarayana Raju, Megha Uppin, Noorjahan Mohammed
DOI:10.4103/jcsr.jcsr_24_22  
Background: Tools for early recognition to enable timely intervention and prevention of micro and macrovascular complications are needed in diabetes mellitus. Our study was aimed at assessing the role of neutrophil-to-lymphocyte ratio (NLR) as a tool to identify individuals at risk for microvascular complications in type 2 diabetics, i.e., diabetic nephropathy, retinopathy and neuropathy. Methods: This was a cross-sectional study conducted at a tertiary care hospital in south India that included 98 patients with type 2 diabetes mellitus. NLR was calculated; clinical and laboratory work-up was done in all patients. This was done by quantifying albuminuria by albumin-creatinine ratio (ACR), fundus examination and nerve conduction studies. Correlation between NLR, ACR and other variables was studied in individuals with or without microvascular complications. Results: The NLR in patients with increased ACR was found to be significantly higher when compared to patients with normal ACR (P < 0.001) with a correlation coefficient of 0.783 between ACR and NLR. Receiver operater characteristic curve analysis suggested an NLR cut-off value of 2.032 with a sensitivity and specificity of 89.1% and 81.2%, respectively. A statistically significant higher NLR value was observed in patients with diabetic retinopathy (P = 0.0005) and neuropathy (P < 0.0001). Conclusions: NLR can be used as an early predictor of diabetic nephropathy, neuropathy and retinopathy. It, being an easier tool, can be routinely measured in diabetic individuals to identify at-risk individuals, so that early intervention with appropriate measures can be instituted.
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Awareness of biomedical waste management among health-care workers at a tertiary hospital of Kolkata, India: How much are they acquainted with the good practices? p. 240
Supantha Chatterjee, Sukesh Das
DOI:10.4103/jcsr.jcsr_41_22  
Background: Enormous volume of biomedical waste (BMW) is generated in health-care facilities with threat of multiple adverse consequences to human and environment. Proper BMW management is of utmost importance to get rid of those adverse effects. Methods: This institution-based cross-sectional study, conducted between 1 February 2020 and 31 March 2020, among 151 health care workers (HCWs) (80 junior doctors and 71 nursing staff) was conducted to assess the knowledge and practice about BMW management among health-care workers (HCWs) at a tertiary hospital at Kolkata. Results: All the nursing staff and 92.5% of junior doctors could identify biohazard symbol. About three-fourth of junior doctors were aware of the categories of BMW, while only 47.8% of nursing staff knew this. Only half of the HCWs knew the four colour-coded bags. About 79.5% of the HCWs knew the use of hub cutters. About three-fourth of the HCWs used colour-coded bags correctly while 90% used white puncture-proof containers for sharps. Only one-third of the HCWs were trained on BMW management. There were no significant differences in knowledge and practice scores among the two groups. Conclusions: The HCWs lacked in appropriate knowledge and practices on BMW management. BMW management rules should be strictly implemented through periodic training and monitoring of HCWs.
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Perceived stress and coping strategies among junior doctors during the COVID-19 pandemic: A cross-sectional study in a tertiary care hospital, West Bengal p. 245
Sukanya Ghosh, Kajari Bandyopadhyay, Sukesh Das
DOI:10.4103/jcsr.jcsr_83_22  
Background: The severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) disease (COVID-19) pandemic has put frontline health-care workers into unprecedented amounts of difficulty and psychological stress. Methods: In this cross-sectional, analytical study 122 junior doctors (interns, house staffs and postgraduate trainee) of a tertiary care hospital in West Bengal were studied during the period November 2021–January 2022. Data were collected using an online structured questionnaire, prepared as Google Forms and shared by WhatsApp. The Perceived Stress Scale (PSS-10) was used for the study. Information regarding various coping strategies adopted in the past 1 month was also collected. Results: High prevalence (83.7%) of moderate-to-high stress was observed among junior doctors (mean PSS score 21±6.9). Multivariable analysis showed female gender, single (unmarried) status and separation from family during COVID duty assignment were significantly at risk of moderate-to-high stress. The coping behaviours commonly used by the study participants were physical exercise, sharing feelings, talk therapy, meditation, hoping for the best, faith in God/religion, watching movies etc., with many struggling to cope. Conclusions: High prevalence of moderate-to-high stress and difficulty in coping were observed among the junior doctors. It's the need of the hour to plan support programmes dedicated to junior doctors emphasizing coping strategies and stress management.
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REVIEW ARTICLE Top

Platelet concentrates: An elixir of periodontal regeneration p. 251
Deepika Chandel, Aditya Sinha, Shailendra Singh Chauhan, Satendra Sharma, Ankita Garg
DOI:10.4103/jcsr.jcsr_53_21  
Platelet concentrates (PCs) such as platelet-rich plasma and platelet-rich fibrin (PRF) are commonly used in various surgical procedures in medical as well as dental fields, oral and maxillofacial surgery, plastic surgery and sports medicine. The main motive is to elicit all the components of a blood sample that can be used to promote healing and regeneration. PCs came a long way since their existence in 1954 from titanium-PRF, advanced-PRF and injectable-PRF being introduced newly. These concentrates have been successfully applied in periodontal regenerative procedures and implantology. However, the preparation techniques, methodology, standing time, transfer process, temperature of centrifuge, vibration and other factors tend to produce mixed results. This review is designed to sort out all the confusions by introducing the exact origination of PCs, preparation techniques along with recent trends and clinical applications in periodontology.
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CASE REPORTS Top

Anaesthetic management of right tibia intramedullary nailing in a patient with extradural haematoma p. 261
Harsha Narkhede, Dipanjali Mahanta
DOI:10.4103/jcsr.jcsr_11_22  
Cases of extradural haematoma (EDH) are often encountered in the emergency department in patients with multiple traumatic injuries. If the haematoma is small, non-expanding and asymptomatic, it is often managed conservatively. However, other injuries sustained during trauma may require surgical intervention, during which anaesthetic management can become challenging. Here, we present a case where closed reduction and intramedullary nailing was done for a right tibia fracture, successfully performed in a patient with traumatic EDH under combined femoral and popliteal sciatic nerve block with supplementary dexmedetomidine infusion for sedation.
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Gastric glomangioma masquerading gastrointestinal stromal tumour - A case report with review of literature p. 264
Krishnan Govindaraman Padmanaban, U Aravindan
DOI:10.4103/jcsr.jcsr_5_22  
Glomus tumours (GT) are mesenchymal tumours composed of modified smooth muscle cells of the glomus body. It commonly occurs in skin and soft tissue of the distal extremities. Gastric GT is a rare neoplasm of gastrointestinal tract that frequently mimics other mesenchymal neoplasms clinically and radiologically. We report a case of glomangioma of gastric antrum in a 55-year-old female, mimicking gastrointestinal stromal tumour (GIST) endoscopically. Radiographically, tumour was intramural, 6 cm in size, and initial biopsy was inconclusive. Laparoscopic-assisted partial gastrectomy was done. Histopathological examination showed uniform round cells arranged around the blood vessels, a characteristic of glomangioma. Tumour cells were strongly immunoreactive for smooth muscle actin and h-Caldesmon and negative for desmin, cytokeratin, CD34, CD117 and chromogranin, which helped rule out other differential diagnoses. Recognition of this rare entity is important as most of them are benign and surgical resection is curative.
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Rediscovering child-to-child programme – A case study and brief discussion p. 268
Srivaishnavi Sridhar Madabhushi, Mohammed Ashraf Mohiddin Siddiq, G Somaiah, N Shivaramakrishna Babji, MS Sridhar
DOI:10.4103/jcsr.jcsr_6_22  
Child-to-child programme was conceptualized on the eve of the International Year of the Child in 1979. A case study of child-to-child programme piloted in a rural area is documented. A primary schoolboy participated and followed up with seven other children in matters of personal hygiene and health habits and the result of that effort is reported. He documented 95% of the possible responses.
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SPECIAL FEATURE: COMMENTARY Top

2022 monkeypox outbreak: Global risk assessment and areas to strengthen p. 271
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jcsr.jcsr_109_22  
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CORRESPONDENCE Top

Lipoma in the submandibular gland: An exotic rarity!! p. 274
Prateek Das, Urvashi Ghosh, Sujata Naik, Rashmi Patnayak, Satya Sundar Mohapatra
DOI:10.4103/jcsr.jcsr_93_22  
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