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Background: Traditional Indian medical education limits first-year MBBS students to classroom settings, delaying clinical exposure until the second year. Early clinical exposure (ECE) aims to integrate basic sciences with clinical practice, enhancing student understanding and interest through direct patient interaction. Aim was to assess first-year MBBS students' perceptions of ECE. Objectives were to introduce clinical settings to first-year students, and to explore students' experiences and attitudes towards ECE.Methods: The study was conducted at Dr. Panjabrao Deshmukh Memorial Medical College, Amravati, involving 100 first-year MBBS students. Ethical clearance and permissions were obtained. Students participated in bedside teaching in small groups over four weeks, focusing on clinical conditions and diagnostics. Observations in the radiology department included first-trimester ultrasounds with patient interaction. A qualitative approach using focus group discussions and a post-test questionnaire was employed.Results: Learning and knowledge: 81% found ECE helpful, interest in topic: 75% reported increased interest, motivation: 84% felt motivated to learn more, correlation with clinical features: 60% found it helpful, ward rounds: 89% valued participation, knowledge sharing: 87% appreciated discussion opportunities, and overall utility: 79% recognized ECE's utility. Feedback indicated significant enhancements in learning, interest, and motivation, despite some neutral or negative responses.Conclusions: ECE is a vital teaching tool that improves first-year MBBS students' understanding, motivation, and professional skills. Despite logistical challenges, its overall positive impact on medical education justifies its implementation.
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To preview the feto-maternal outcome in post-renal transplant pregnant women with systemic lupus erythematosus (SLE). To distinguish preeclampsia from hypertension in renal transplant recipients as diagnosis is not always straightforward and all differentials need a thorough evaluation. Hypertension is a prevalent issue among kidney transplant recipients, with reported incidence rates ranging from 52% to 69%. Additionally, the occurrence of pre-eclampsia in renal transplant recipients falls within the range of 24% to 38%, demonstrating a significantly elevated risk compared to the 4-5% incidence rate seen in the general population. A 29-year-old female para 1 IUFD 1 abortion 1, in a known case of SLE with hypothyroidism with lupus nephritis with post renal transplant status with thrombocytopenia with preeclampsia with day 7 of emergency LSCS done in view of non-progress of labor with intrauterine fetal demise with abruptio placenta referred in view of query SLE flare or severe preeclamptic features with rectus sheath hematoma. Renal transplant restores fertility; thus, pregnancy requires careful planning and affected women should be managed in tertiary care obstetrics centers working in tight multidisciplinary cooperation with transplant physicians.
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Ovarian torsion is a comparatively rare gynecological emergency. It commonly presents with complaints of acute abdominal pain, nausea, and vomiting. It occurs due to twisting of the ovarian pedicle leading to ischemic changes in the ovary. It can even result in complete loss of blood supply, eventually necrosis of the ovary. It is diagnosed clinically and can be confirmed on ultrasound color doppler. The management of ovarian torsion depends on the age of the patient, size of the mass, ovary condition, and USG findings. Early diagnosis and treatment of torsion are necessary to preserve the viability of the ovary. We are reporting a case of a 30-year-old female with right ovarian cyst torsion of size 6.3×6.8×6 cm. Once torsion is diagnosed surgery is the mainstay of treatment, either detorsion and ovariopexy or oophorectomy if the ovary cannot be salvaged.
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This review addresses new reporting systems for lung and pancreatobiliary cytopathology as well as the most recent edition of The Bethesda Reporting System for Thyroid Cytopathology. The review spans past, present, and future aspects within the context of the intricate interplay between traditional morphological assessments and cutting-edge molecular diagnostics. For lung and pancreas, the authors discuss the evolution of reporting systems, emphasizing the bridge between past directives and more recent collaborative efforts of the International Academy of Cytology and the World Health Organization in shaping universal reporting systems. The review offers a brief overview of the structure of these novel systems, highlighting their strengths and pinpointing areas that require further refinement. For thyroid, the authors primarily focus on the third edition of The Bethesda System for Reporting Thyroid Cytopathology, also considering the two preceding editions. This review serves as an invaluable resource for cytopathologists, offering a panoramic view of the evolving landscape of cytopathology reporting and pointing out the integrative role of the cytopathologist in an era of rapid diagnostic and therapeutic advancements.
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Background: There is widespread acceptance of epidural analgesia among many physicians and patients, but disagreement remains regarding the effect of intrapartum epidural analgesia on the subsequent progress of labour and the mode of delivery. This study was designed to look and assess the effects of labour analgesia on maternal and fetal outcomes.Methods: This is an observational prospective cohort study where 60 parturient visiting the hospital in labour during the study period who fulfilled the eligibility criteria & gave written informed consent for the participation were included as cases. Another 60 parturient visiting the hospital during the same period who also fulfilled the eligibility criteria and consent for the same were included as controls. After test dose of 3 ml of 2% lignocaine with 1:2,00,000 adrenaline, an initial bolus of 10 ml of 0.1% Ropivacaine+1microgram/cc Fentanyl is given.Results: Epidural analgesia gave better pain relief when the VAS scores of the two groups were compared. No effect on increase of Caesarean or instrumental delivery rates was observed. Even though the first stage of labour was prolonged and the second stage shortened, the overall time of active stage of labour remained the same in both groups. No adverse neonatal outcome was seen with respect to epidural analgesia.Conclusions: Epidural analgesia provided excellent pain relief for most of the women delivering at our institute & is associated with high patient satisfaction.
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This surgical technique describes a modification of the continuous curvilinear capsulorhexis (CCC) to achieve an adequate-sized capsulorhexis in pediatric cataracts with high intralenticular pressure. Performing CCC in pediatric cataracts is challenging, especially when the intralenticular pressure is high. This technique involves 30 G needle decompression of the lens to reduce positive intralenticular pressure and subsequent flattening of the anterior capsule. This minimizes the chances of extension of CCC without using any special equipment. This technique was used in two eyes of two patients (age 8 and 10 years) with unilateral developmental cataracts. Both surgeries were performed by a single surgeon (PKM). In both eyes, a well-centered CCC was achieved with no extension, and a posterior chamber intraocular lens (IOL) was placed in the capsular bag. Thus, our technique of 30 G needle aspiration could be extremely useful to achieve an adequately sized CCC in pediatric cataracts with high intralenticular pressure, especially for beginner surgeons.
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Background: Neonatal sepsis is one of the major cause of mortality and morbidity Globally, objective of this prospective study was to evaluate the microorganisms profile involved in neonatal septicemia and their antibiotic susceptibility.Methods: This prospective study conducted in neonate admitted to Mahatma Gandhi Mission Medical College and Hospital Aurangabad Maharashtra in NICU, from June 2021 to May 31, 2022. Data was analysed by percentages of each antibiotic used. And which organism was responsible for neonatal sepsis.Results: In this study we have found that high bacterial prevalence of Klebsiella at 36%, Enterococci at 23.5 and staph aureus at 19.8% in neonatal sepsis. While the antibiotics most used was Piperacillin and tazobactam, meropenam, colistin, cefotaxime, amikacin. In our setting we found that bacteria are still sensitive to third generation cephlosporings.Conclusions: From our study we can conclude that, in our tertiary care hospital Klebsiella is major cause of neonatal sepsis, along with-it sensitivity with effectiveness of cephalosporin.
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Dengue and viral hepatitis A are extensively endemic diseases in India. Coinfection of these infections is uncommon and poses difficulty for physicians to diagnose as their clinical features are quite similar and overlapping. This article presents with 8 paediatric age group cases reporting Dengue fever which occurred concomitantly with Hepatitis A virus infection. Usually these infections are self-limiting but complications of coinfection are described in this article
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Objectives : To study the biometric measurements of the submandibular salivary gland in the Indian population using Computed Tomography. Materials and Methods : From the available database, 300 patients who have undergone Computed Tomography without any salivary gland disease, the CT scans were retrospectively evaluated. The CT scans were obtained with TOSHIBA Activion 16 slice CT machine. The antero-posterior, transverse and cranio-caudal dimensions of bilateral submandibular salivary glands were measured in the axial, coronal and sagittal planes. Results : The mean CT measurements of the patients included was 2.0 ± 0.38 cm in Antero-posterior, 2.1 ± 0.31 cm in Transverse and 2.90 ± 0.27 cm in Cranio-caudal dimensions. The average volume of the submandibular gland was 6.68 ± 0.21 cc.
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Background: Neurocysticercosis is one of the common cause of acquired epilepsy in childhood. The objective of this study was to study the clinic-demographic profile of children having Neurocysticercosis and to evaluate the potential risk factors for persistent seizures.Methods: A prospective observational study was conducted after recruiting 30 children with neurocysticercosis. After detailed history and clinical examination, the neuroimaging findings were studied. Patients were started on standard anti-helmenthic and antiepileptic therapy. A regular follow up was taken with regard seizure recurrence. A neuroimaging was repeated at 6 moths follow up.Results: Among 30 children with neurocysticercosis who presented with first seizure due to neurocysticercosis, focal seizure was the commonest (63.3%) presentation and 23.3% of these presented with status epilepticus. Out of 30 cases, 7 (23.3%) patients had seizure recurrence on follow up. Patients presenting with status epilepticus, neuroimaging showing larger lesions (size more than 10 mm), multiple number of lesions and persistent presence of lesion on the CT scan at a follow up of 6 months were the factors found to have significant positive association with recurrence of seizures on follow up.Conclusions: There are potential clinical and radiological risk factors which are associated with the recurrence or persistence of seizures in patients with neurocysticercosis.
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Duchenne muscular dystrophy is one of the most common dystrophinopathies known. It is the most common hereditary neuromuscular disorder and is inherited in an X-linked recessive manner. Incidence is 1:3500 live male infants, characterised by progressive weakness of a selective group of muscles without involvement of nervous system. Age of onset being 3-10 years, many children unable to walk before 18 months of age. The patient usually dies by 18-20 years of age. 80% carries have high CPK values with female being the one. Dystrophin gene is the largest human gene with 79 exons, codes for protein dystrophin required for stabilisation of protein complex at sarcolemma, the abnormal DMD gene is on X chromosome at Xp21 locus. Dystrophin deficiency thus, leads to destruction of muscle fibres and progressive muscular weakness. Corticosteroids are the only medications that have shown to alter the course of DMD but have side effects like weight gain, decreased appetite, increase changes of cataract and osteoporosis. The present study is about management 8 years old male child with B/L lower limb weakness and calf muscle hypertrophy.etc, so according to Ayurvedic management with Panchkarma procedures and internal medicines given the case was managed. Successful improvement in CPK values along with the signs and symptoms was observed. As per Ayurvedic Siddhant and Samprapti application considering Adibalapravrittavyadhi and the Beejabhaga avayava dushti the management done. There is no treatment in any system of medicine and prognosis being unpreventable, Ayurveda instills a regenerative mechanism in neuromuscular disorders with special concern of Panchkarma, Rasayanas, Rasa aushadhi, etc. By this the deterioration can effectively be prolonged and quality of life improved.
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Background and Objectives@#Cholesteatomatous chronic otitis media acquires epithelial proliferation and differentiation characteristics, which render it able to erode the underlying bone and cause complications. We attempt to characterize the cholesteatoma epithelium by observing the expression of cytokeratins (such as 34ße12, CK17, and CK13) and Ki67 among patients with cholesteatoma with different aggressiveness as compared to disease-free controls. @*Subjects and Methods@#In this prospective study (2017-2021), we enrolled all consenting consecutive patients with cholesteatomatous chronic otitis media. They were staged in accordance with the staging guidelines of the European Academy of Otology and Neurotology and the Japanese Otological Society. Bony external auditory canal (EAC) skin specimens of the patients undergoing tympanoplasty were chosen as controls. We did an immunohistochemical analysis of the cholesteatoma specimens and normal bony EAC controls by observing the expression of 34ße12, CK17, CK13, and Ki67 across the layers of the epithelium. Fisher’s exact test and chi-square test were used to evaluate any statistical significance between the cases and the controls, and the subgroups were made based on the clinical stage. @*Results@#An increased expression of CK17 (p<0.001), CK13 (p<0.03), and Ki67 (p<0.001) was observed in cholesteatoma specimens when compared to normal bony EAC controls. Also, there was a loss of expression of 34ße12 in a subset of cholesteatoma specimens, all of which showed full-thickness expression of CK13. There was no difference in the expression of cytokeratin among specimens from patients belonging to different subgroups based on clinical stage, age, sex, duration of ear symptoms, or type of hearing loss (conductive vs. sensorineural). @*Conclusions@#The majority of cholesteatoma specimens significantly overexpressed CK17, CK13, and Ki67 when compared to normal bony EAC skin controls, while a subset showed loss of expression of 34ße12, which provides some insight into its pathogenesis.
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Purpose: This study was conducted to determine the morphological and functional retinal changes in patients with neovascular age?related macular degeneration (nAMD) treated with intravitreal bevacizumab 1.25 mg. Methods: This was a prospective, nonrandomized, interventional study. Eighteen eyes of 18 subjects with nAMD were treated with intravitreal bevacizumab (1.25 mg) injection. Subjects underwent complete ophthalmic evaluation which included visual acuity, slitlamp examination, tonometry, binocular ophthalmoscopy, optical coherence tomography (OCT), and MP1 microperimetry before the intravitreal injection and the follow?up at 1 and 3 months. Test of significance such as Chi?squared test, paired ttest and oneway analysis of variance (ANOVA) linear trend were used to compare the pre? and post?anti?VEGF outcomes. Intraclass correlation was done to assess the intra observer variability. Results: Mean retinal sensitivity had increased from 3.77 ± 3.13 dB at baseline to 4.93 ± 2.42 dB at 3 months (P = 0.05). Visual acuity improved from 0.62 ± 0.36 at baseline to 0.52 ± 0.36 at 1 month and 0.48 ± 0.34 at 3?month followup, but overall change was not significant (P = 0.40). There was a significant reduction in central foveal thickness (CFT) from 274.61 ± 117.95 at baseline to 179.83 ± 84.18 at 1 month and 179.00 ± 126.55 at 3?month follow?up (P = 0.013). Conclusion: Intravitreal bevacizumab (1.25 mg) injection in nAMD improves retinal function, quantified by retinal sensitivity, scotoma characteristics, fixation stability by MP 1 microperimetry and morphological parameters quantified by CFT in SDOCT. These changes show the effectiveness of treatment with intravitreal bevacizumab in nAMD
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The aim of the present study is the Evaluation, preparation, and description of chitosan nanoparticles and bioavilibility enhancement of rivaroxaban. Preparation of Rivaroxaban nanoparticles (RB-NPs) were prepared by the ionic gelation method. Different parameters were studied for evaluation, Preparation & description of nanoparticles. The results of the present study showed that the formulation F7 showed the significant results for all the selected parameter as compared to the other formulations. The formulation F1, F5, and F6 showed the highest production yield (52.5, 52.35, and 52.35% respectively) and F7 showed the significant production yield (51.85%), zeta-potential (23.63 mV), entrapment efficiency (99.87), particle size (316.12±2.14 nm) and poly disparity index (0.32). Nanoparticles are solid colloidal drug carriers ranging from 10—1000 nm in diameter and are composed of synthetic, natural or semi-synthetic polymers encapsulating the drug molecule.
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Background: The proportion of caesarean sections at the population level is a measure of the level of access to and use of this intervention. Over the last few years, governments and clinicians have expressed concern about the rise in the numbers of caesarean section births and the potential negative consequences for maternal and infant health. There is a lack of a reliable and internationally accepted classi?cation system to produce standardized data, enabling comparisons across populations and providing a tool to investigate drivers of the upward trend in caesarean section. Among the existing systems used to classify caesarean sections, the 10-group classi?cation (also known as the 'Robson classi?cation') has become widely used in many countries in recent years,thereby allowing a comparison of caesarean section rates with fewer confounding factors. In the present study, all cases delivered by cesarean section Methods: during the period of six months were recorded and classi?ed according to Robson's 10 group classi?cation system. Results: Overall, CS rate calculated for our hospital in this speci?ed period was 36.6%, There was a trend of increased percentage of cesarean section in group 5 and 8 respectively in present study. Even though the overall CS rate in the study is not Conclusions: high as compared to other Indian or International studies, it is important that efforts to reduce the overall CS rate should focus on reducing the primary CS rate. More analytical studies based on Robson's 10-group classi?cation are needed locally, to evaluate the indications of CS within each group.
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Aim To study topographic findings in patients with established vernal keratoconjunctivitis (VKC). Materials and methods In a hospital based cross sectional study, 112 eyes of age group 11-22 years with established case of VKC were selected for topography. Result In 112 eyes with VKC; 69.64% (78 eyes) had significant history of eye rubbing. 14.28% (16 eyes) had Kmax values >=47.2D , 85.71%(96 eyes) had Kmax values <47.2D. 19.64%(22 eyes) had I-S Difference >=1.2D ; 80.36%(90 eyes) had I-S Difference <1.2D. Topographical patterns observed included 49.11%(55eyes) with round pattern, 20.54%(23 eyes) with oval shaped, 9.82%(11 eyes) with symmetric bowtie, 6.25%(7 eyes) with asymmetric bow tie with skewing of radial axis, 5.36%(6 eyes) with inferior steepening, 6.25%(7 eyes) with irregular pattern, 0.89%(1 eye) with crab claw pattern. ConclusionHigh occurrence of keratoconus-like topographic pattern seen in patients of VKC. Topographic analysis should be performed in all cases of VKC.
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Purpose: To compare the efficacy of topical nonsteroidal anti?inflammatory drugs (NSAIDs) and prednisolone acetate in controlling inflammation and preventing cystoid macular edema (CME) after uneventful phacoemulsification. Methods: All patients who underwent uneventful phacoemulsification from December 2020 to Feb 2021 were included in the study. These were randomly assigned to receive any one anti?inflammatory agent among topical nepafenac (0.1%) [96 eyes], bromfenac (0.07%) [93 eyes], preservative?free ketorolac (0.4%) [94 eyes], nepafenac (0.3%) [96 eyes], or prednisolone acetate (1%) [91 eyes]. The efficacy of the drugs was evaluated by comparing the grade of anterior chamber (AC) cells, conjunctival hyperemia, pain score, visual acuity, intraocular pressure (IOP), and central macular thickness (CMT) at 1 and 6 weeks after surgery. Results: At 1 and 6 weeks, there was no significant difference in pain score, conjunctival hyperemia, AC cells, change in IOP, and visual acuity between the prednisolone and the NSAIDs groups, though nepafenac 0.3% was most effective. At 6 weeks, there was no significant difference in the number of patients developing subclinical CME in the prednisolone versus NSAID group. The mean increase in CMT was significantly lower in nepafenac 0.3% than prednisolone at 1 and 6 weeks (P = 0.003 and 0.004, respectively). Conclusion: NSAIDs used in isolation are comparable to prednisolone in preventing inflammation and pain after uneventful phacoemulsification. However, nepafenac 0.3% is most comparable to prednisolone and more efficacious in reducing the incidence of CME. We recommend that nepafenac 0.3% can be used as a sole anti?inflammatory agent in patients with uneventful phacoemulsification.
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Epithelioid inflammatory myofibroblastic sarcoma (EIMS) is an aggressive subtype of inflammatory myofibroblastic tumor (IMT) harboring anaplastic lymphoma kinase (ALK) gene fusions and is associated with high risk of local recurrence and poor prognosis. Herein, we present a young, non-smoking male who presented with complaints of cough and dyspnoea and was found to harbor a large right lower lobe lung mass. Biopsy showed a high-grade epithelioid to rhabdoid tumor with ALK and desmin protein expression. The patient initially received 5 cycles of crizotinib and remained stable for 1 year; however, he then developed multiple bony metastases, for which complete surgical resection was performed. Histopathology confirmed the diagnosis of EIMS, with ALK gene rearrangement demonstrated by fluorescence in situ hybridization. Postoperatively, the patient is asymptomatic with stable metastatic disease on crizotinib and has been started on palliative radiotherapy. EIMS is a very rare subtype of IMT that needs to be included in the differential diagnosis of ALKexpressing lung malignancies in young adults.
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The coronavirus disease (COVID-19) pandemic is a global health crisis that negatively impacts the health infrastructure by diverting resources to manage this infection. The long-term impact on the health of patients due to a lack of appropriate medical care to avoid COVID-19 infection is already visible in the mortality rates of the general population. The presence of the severe acute respiratory syndrome coronavirus 2 in the female genital tract is not clear. Bubbles produced during hysteroscopy tend to cool down to the temperature of the distension medium and then dissolve. Hence, aerosols are not produced during hysteroscopy, which is usually performed in an office setting. If anesthesia is required, conscious sedation or regional anesthesia should preferably be used to reduce aerosol production. Hence, hysteroscopy is not an aerosol-generating procedure and the risk of COVID-19 infection is low; therefore, hysteroscopy should not be ruled out in emergencies.