End-to-Side Ileo-Sigmoid Anastomosis and Late Onset Gangrenous Diverticulitis: A Case Report.

End-to-side ileo-sigmoid anastomosis converts the proximal colon into a blind intestinal segment which is excised during the surgery. If we do not resect the proximal colon, it is expected to behave like a colonic diverticulum, but direct evidence of this assumption is lacking. During an exploratory laparotomy, we detected an end-to-side ileo-sigmoid anastomosis and found that the proximal colon was gangrenous. The patient passed away during the postoperative period, yet their remarkably long period of symptom-free survival remained intriguing.

Platelet-rich plasma injection in the treatment of patellar tendinopathy: a systematic review and meta-analysis.

PURPOSE: The objective of the study was to assess the efficacy of autologous platelet-rich plasma (PRP) injections in the treatment of patellar tendinopathy. METHODS: The PubMed, MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials databases were searched for clinical trials which compared PRP injection with other 'active treatment' interventions ('Non-PRP' injection and 'No-injection' treatments) or 'No-active treatment' interventions. Randomized and non-randomized clinical trials that had been published up to 15 November 2021, were included in the meta-analysis. The primary outcome, pain relief, was measured on a 'visual analog scale.' Secondary outcomes were knee functional activities and quality of life (QoL). The PRISMA guidelines were followed throughout the study. RESULTS: Eight comparative studies were identified for inclusion in the meta-analysis. Assessment of these studies revealed that there were no significant differences in pain relief, functional outcomes, and QoL in the short, medium, and long term between PRP injection and Non-PRP injection interventions. Similarly, comparison of PRP injection to the No-active treatment intervention showed no differences in short- and medium-term pain relief. However, when PRP injection was compared to the No-injection treatment intervention extracorporeal shock wave therapy (ECWT), the former was found to be more effective in terms of pain relief in the medium term (mean difference [MD] - 1.50; 95% confidence interval [CI] - 2.72 to - 0.28) and long term (MD - 1.70; 95% CI, - 2.90 to - 0.50) and functional outcomes in the medium term (MD 13.0; 95% CI 3.01-22.99) and long term (MD 13.70; 95% CI 4.62-22.78). CONCLUSIONS: In terms of pain relief and functional outcomes, the PRP injection did not provide significantly greater clinical benefit than Non-PRP injections in the treatment of patellar tendinopathy. However, in comparison with ESWT, there was a significant benefit in favor of PRP injection.

Respiratory rehabilitation in patients recovering from severe acute respiratory syndrome: A systematic review and meta-analysis.

BACKGROUND: With an increase in published reports on respiratory rehabilitation (RR) in severe acute respiratory syndrome (SARS), there is a need for a meta-analysis and systematic review to measure the effects of the RR in SARS. OBJECTIVE: Objective of the review was to evaluate the efficacy and safety of RR in patients recovering from SARS. METHODS: PubMed/ MEDLINE, CENTRAL, EMBASE, and Clinical Trial Registries were systematically searched (between January 1, 2003, to July 31, 2021) to identify all patients who received RR, at least for six days, following SARS. The primary outcome was exercise capacity [6-meter walking distance (6-MWD)], and secondary outcomes were change in pulmonary function test (PFT) parameters, activities in daily livings (ADLs), and quality of life (QoL). Meta-analysis was performed by using RevMan 5.4. RESULTS: Twenty-one observational studies, including eight comparative studies, were included. Eight comparative studies participated in quantitative meta-analysis. The intervention group, who received RR, improved significantly in exercise capacity (6-MWD) [mean difference (MD):45.79, (95% CI:31.66-59.92)] and PFT parameters, especially in forced vital capacity (FVC%) [MD:4.38, (95% CI:0.15-8.60)], and diffusion lung capacity for carbon monoxide (DLCO%) [MD:11.78, (95% CI:5.10-18.46)]. The intervention group failed to demonstrate significant improvement in ADLs and QoL outcomes. No significant adverse events were reported during the intervention. CONCLUSION: Respiratory rehabilitation can improve exercise capacity and PFT parameters in patients recovering from SARS infection. The RR does not cause serious adverse events. Clinical trials to determine the best RR program (in terms of initiation, duration, and components) in SARS and its treatment efficacy, both in the short and long- term are needed.

The benefit of platelet-rich plasma injection over institution-based physical therapy program in adhesive capsulitis patients with diabetes mellitus: prospective observational cohort study.

BACKGROUND: The objective of this study was to compare the efficacy of platelet-rich plasma (PRP) injection with an institution-based physical therapy (PT) program for adhesive capsulitis (AC) of the shoulder in patients with diabetes mellitus (DM). METHODS: A total of seventy diabetic patients with AC of the shoulder for <6 months were assigned to two groups: PRP group and PT group. In the PRP group, 35 patients were administered a single shot of PRP (4 mL) into the glenohumeral joint. In the PT group, 35 patients were given institution-based PT that included 10 30-minute sessions of planned PT over a 2-week period. After the interventions, all patients were prospectively followed for 12 weeks. Intensity of shoulder pain, function, and range of motion were assessed at baseline and then at 3, 6, and 12 weeks. RESULTS: Thirty-three patients in the PRP group and 32 in the PT group completed the 12-week study. At 12 weeks, patients who received PRP injections showed greater improvement in shoulder pain (p<0.001) than those recruited to the PT group. In the range of motion and shoulder function activities, patients in the PRP group showed significant improvement compared with the institution-based PT group (p<0.001). No significant complications were reported from any groups. CONCLUSIONS: In a diabetic population, PRP injections significantly improved shoulder pain and function compared with an institution-based PT program for shoulder AC. Additionally, it is a safe and well-tolerated method for AC management for diabetic patients.

Traumatic Splenic Infarction and Pulmonary Embolism: A Case Report of Rare Radiological Finding.

Focused abdominal sonography in trauma (FAST) and contrast-enhanced computed tomography (CECT) abdomen are important radiological tests for evaluating the abdomen in polytrauma cases. When vitals are stable, they help to reach a diagnosis in the majority of patients. However, in a small number of cases they fail to explain the clinical scenario. A continued serial clinical assessment may be helpful in these circumstances. A polytrauma patient was found to be FAST positive. The CT scan revealed pulmonary embolism, splenic infarction, perisplenic and perihepatic hematoma. The patient was complaining of pain abdomen and it worsened on day three of the injury. An exploratory laparotomy was performed. A circumferential intestinal wall hematoma with a tear in mesentery was found. This is a rare case of traumatic splenic infarction with evidence of pulmonary embolism. The serial clinical assessment was helpful as it indicated the need for intervention.

Menace of Hepatitis C virus among multitransfused thalassemia patients in Balasore district of Odisha state in India.

CONTEXT: Hepatitis C virus (HCV) is a potential cause of morbidity and mortality worldwide. It is most commonly transmitted through injecting drug use; the reuse or inadequate sterilization of medical equipment and the transfusion of unscreened blood products. Management of thalassemia requires long-term blood transfusion. Though it improves the overall survival, it carries a definite risk of infection which is expected to be higher in resource limited settings. AIMS: To find the percentage of transfusion-transmitted infections (TTIs) in multitransfused patients of thalassemia in Eastern India. SETTINGS AND DESIGN: The study was conducted to assess blood safety in rural population in India by measuring the percentage of TTIs including HCV in multitransfused thalassemia patients. METHODS AND MATERIALS: One hundred and twenty three patients with major beta-thalassemia were enrolled in this study. The blood samples were tested using ELISA technique for all TTIs. HIV fourth generation kits, HbsAg, HCV third generation kits, malaria and syphilis, parbovirus IgM and parbovirus IgG kits, HEV Antigen and IgM antibody were used. STATISTICAL ANALYSIS USED: Proportions and means were calculated for categorical and continuous variables, respectively. Chi-square test was applied and P value of <0.05 was taken as significant. RESULTS: The mean age of patients was 9.5 years ± 5.2 years. Among various TTIs, Hepatitis C and HIV was prevalent among 59.3% and 4.1% of the study participants, respectively. CONCLUSIONS: The causes of high prevalence of HCV may be due to donors being usually asymptomatic in early stages, despite being screened for HCV possibly due to missing early window period infections. The screening methodology of TTIs particularly HCV at the district and village level and consequent increased prevalence of HCV in multitransfused rustic population of India shows the extent of blood safety.

A retrospective study of transfusion practices in a Tertiary Care Institute.

BACKGROUND AND AIMS: Excessive requests for cross matching blood which is more than the blood required for transfusion are usually based on worst case assumptions leading to overestimation of blood usage. We investigated the blood ordering pattern and transfusion practices so as to incorporate a blood ordering schedule for streamlining the use of blood in various hospital departments. METHODS: The study was conducted over a period of 19 months in a 350 bedded tertiary teaching hospital. Source of data was blood bank requisition forms and blood bank registers of patients who underwent elective or emergency procedures in the hospital, for which blood was ordered. Data were entered in MS Excel and analysed using SPSS version 20. RESULTS: The blood bank was requested to prepare 10,594 units of blood for 2556 patients. The blood utilised was 16.04% of total cross matched blood, leaving 83.9% of units cross matched but not transfused to patient for whom it was prepared, i.e., wasted. The surgery department had the highest number of units cross matched and transfused. The least number of units cross matched and wasted due to non-transfusion were from the Department of Oncology. CONCLUSION: The current deficiency of explicit maximum blood order schedule in our hospital is the major factor responsible for high cross match: transfusion ratio. Therefore, a maximal surgical blood order schedule has been suggested to the hospital transfusion committee to implement maximum surgical blood order schedules for selected procedures.

Voluntary Blood Donation among Students - A Cross-Sectional Study on Knowledge and Practice vs. Attitude.

INTRODUCTION: The factors influencing blood donation decisions are varied and complex and one's attitude can influence this decision. AIM: To find the factors affecting the knowledge and practice of blood donation among college students and their attitude towards the same. MATERIALS AND METHODS: This cross-sectional study was conducted among 399 college going students using convenience sampling from medical, nursing and engineering colleges in Bhubaneswar city, where blood donation camps were to be held. Data was collected through self-administered questionnaires and, analysed in SPSS Version 20.0. RESULTS: Knowledge regarding blood donation was adequate among 228 (57.1%) of the students and, 221 (55.4%) students had donated blood. Knowledge was significantly better among female students, medical stream and in those whose parents were in non-medical jobs; whereas blood donation had been done significantly more by male, non-medical stream students and by those whose parents were in medical field. Most common reason for donating blood was a sense of social responsibility and most common reason of non-donation was fear of the procedure. An 85% of the students were of the view that they would donate blood if asked. Students suggested that small incentives like certificates and arranging transport for blood donation would make it easier to donate. CONCLUSION: Just over half of the students had adequate knowledge about blood donation and similar percentage had donated blood. There is this large pool of safe blood in college going students who are willing, but not tapped as source of blood donation.

Discovertebral (Andersson) lesion of the Ankylosing Spondylitis, a cause of autonomic dysreflexia in spinal cord injury.

Autonomic dysreflexia is a medical emergency in spinal cord injury. Majority of cases of autonomic dysreflexia are known to be induced by either bladder or bowel distension. Very few cases of recurrent postural autonomic dysreflexia, due to secondary spinal pathology, have been reported. Discovertebral or Andersson lesion, a recognized complication in Ankylosing Spondylitis, can give rise to similar kind of recurrent postural dysreflexic symptoms. Here, we report a case of Ankylosing Spondylitis with high level, complete spinal cord injury, where the patient was developing recurrent postural autonomic dysreflexia and its successful management. Andersson lesion in the lumbar spine below the level of injury was demonstrated in this case report.