To Study the Efficacy of Ultrasound Guided Pecto-Intercostal Fascial Plane Block in Patients Undergoing Midline Sternotomy in Open Cardiac Surgery: A Randomized Prospective Comparative Study.

BACKGROUND: The incidence of acute poststernotomy pain after cardiac surgery is 80%1. Pecto-intercostal fascial plane block (PIFB) adjacent to the sternum anesthetizes the anterior cutaneous branches of the intercostal nerves and may provide effective analgesia after sternotomy. METHODOLOGY: A randomized controlled, double-blinded, prospective comparative trial was conducted at a tertiary care center on patients of midline sternotomy between 18 and 65 years and NYHA Class 2 and 3 for open cardiac surgery with the primary aim to evaluate analgesia on deep breathing after 3 hours of PIFB block bilaterally. A total of 60 patients were enrolled and randomly divided into three groups. PIFB was administered bilaterally before extubation, with 15 ml 0.125% bupivacaine plain (Group B), and bupivacaine+ clonidine 0.25 mcg/kg (Group B+C). Group C did not receive any intervention. All patients received acetaminophen 1 gram three times a day and injectable tramadol 1 mg/kg as a rescue analgesic. RESULTS: Baseline characteristics were similar among all the groups. The Numeric Rating Scale (NRS) for pain was statistically lower (P < 0.05) in Groups B and B+C compared to Group C at rest, deep breathing, and coughing at 3, 6, and 12 hours after extubation. NRS on deep breathing in Groups B, B+C, and C was {(2.3, 1.5, 4.4) at 3 hours, (2.3, 1.6, 4.3) at 6 hours, (2.8, 2.1, 3.9) at 12 hrs, and {(4.3, 3.5, 3.6)} at 24 hours after extubation. The peak expiratory flow rate was the highest in Group B. Rescue analgesia was not required in Group B. CONCLUSION: PIFB reduces sternotomy pain compared to the control group on deep breathing at 3 hours after block, with delayed requirement of rescue analgesia and improved respiratory mechanics in terms of peak expiratory flow rate at all time points. There is no benefit from adding clonidine.

Satisfaction of mothers with supplementary nutritional services through Anganwadi centres in an urban area of Meerut, India.

Background: Undernutrition in children under 5 years of age is still a great public health burden. Integrated child development services (ICDS) were launched with an idea of making a dent on this age-old issue. Various studies in the past have been done to identify lacunae in the programme, but very few studies are done focussing on the satisfaction of mothers with the supplementary nutrition provided through ICDS programme. The utilisation of the programme depends on various factors, one of which is client satisfaction. Methods and Material: The Anganwadi centres of urban areas of Meerut were line-listed after taking a list of Anganwadis from the Child Development Office. There are 297 Anganwadis in urban areas of Meerut. With help of random number tables, three Anganwadis were selected, and to complete the sample of 152, 51 children from two Anganwadis and 50 from one Anganwadi centre were selected with help of simple random tables. The data thus collected were analysed using Epiinfo version 7.2.3.1. Results: The prevalence of underweight was found to be 34.2%, wasted 19.7%, and stunted 11.2%. Among the characteristics assessed, a majority of mothers, 58.5%, were dissatisfied with the frequency at which supplementary nutrition was provided from the Anganwadis. All children were provided Take Home Ration, and 100.0% of mothers reported using it for all family members. Still 63.2% of mothers were unaware about the iron supplementation in childhood and only 65.8% of mothers had satisfactory handwashing practices. Conclusions: In this study, a majority of mothers were dissatisfied with the frequency at which supplementary nutrition was provided to their children. Also, the prevalence of underweight children was significantly higher when mothers were not aware about the factors affecting nutrition in children. The Take Home Ration given for children was shared among family members in 100.0% families.

Prevalence of hypertension, screening, awareness, and associated risk factors in teaching institution of Etawah District, Uttar Pradesh: A cross-section study.

Background: Hypertension is one of the leading causes of death worldwide, affecting over one billion people. It is responsible for roughly half of all heart disease and stroke-related deaths globally. Because hypertension does not cause any symptoms on its own, it is commonly referred to as "the silent killer." Objective: This study aimed to determine (1) the prevalence of hypertension and its associated risk factors and (2) the level of awareness of hypertension status among study participants. Material and Methods: A facility-based cross-sectional analytical study was conducted for 3 months during January-March 2023 at the teaching institution in Etawah District, Uttar Pradesh. It was conducted among 392 study participants who were ≥18 years old. Data were collected through a predesigned, pretested, semi-structured questionnaire, and anthropometric measurement was determined using standard guidelines. Results: The overall prevalence of hypertension screening was 69.4% (male: 33.8% and female: 66.2%), respectively. The majority of hypertensives were found in female participants. Tobacco and alcohol consumption, obesity, physical inactivity, stress and strain, and an unhealthy diet were also associated with hypertension. Among 392 study participants, only 67 (24.6%) were aware of their hypertension status. Conclusion: We conclude that hypertension has been described as an "Iceberg disease" as those who suffer are usually unaware and hence usually seek healthcare services at a very late stage. Preventive measures should be needed to improve hypertension screening, awareness, treatment, and control.

Evaluation of new haematology analyser, XN-31, for malaria detection in blood donors: A single-centre study from India.

BACKGROUND AND OBJECTIVES: Malaria continues to be a significant public health concern in India, with several regions experiencing endemicity and sporadic outbreaks. The prevalence of malaria in blood donors, in India, varies between 0.02% and 0.07%. Common techniques to screen for malaria, in blood donors and patients, include microscopic smear examination and rapid diagnostic tests (RDTs) based on antigen detection. The aim of this study was to evaluate a new fully automated analyser, XN-31, for malaria detection, as compared with current practice of using RDT. MATERIALS AND METHODS: Cross-sectional analytical study was conducted to evaluate clinical sensitivity and specificity of new automated analyser XN-31 among blood donors' samples and clinical samples (patients with suspicion of malaria) from outpatient clinic collected over between July 2021 and October 2022. No additional sample was drawn from blood donor or patient. All blood donors and patients' samples were processed by malaria rapid diagnostic test, thick-smear microscopy (MIC) and the haematology analyser XN-31. Any donor blood unit incriminated for malaria was discarded. Laboratory diagnosis using MIC was considered the 'gold standard' in the present study. Clinical sensitivity and specificity of XN-31 were compared with the gold standard. RESULTS: Fife thousand and five donor samples and 82 diagnostic samples were evaluated. While the clinical sensitivity and specificity for donor samples were 100%, they were 72.7% and 100% for diagnostic samples. CONCLUSION: Automated haematology analysers represent a promising solution, as they can deliver speedy and sensitive donor malaria screening assessments. This method also has the potential to be used for pre-transfusion malaria screening along with haemoglobin estimation.

The effect of non-surgical periodontal therapy on salivary IL-6 levels in patients with moderate to severe generalized chronic periodontitis.

BACKGROUND: Gene regulation of IL-6 is characterized by the presence of inflammatory cytokines, bacterial products, viral infection, and activation of the diacylglycerol-, cyclic AMP-, or Ca + + -activated signal transduction pathways. AIM: Scaling and root planning (SRP), a non-surgical periodontal therapy, was studied in connection to several clinical parameters for its effect on salivary IL-6 levels in patients with generalized chronic periodontitis. METHODS: For this study, a total of 60 GCP patients were included. Plaque index (PI), gingival index (GI), pocket probing depth (PPD), bleeding on probing percentage (BOP%), and clinical attachment loss were among the clinical indicators covered (CAL). RESULTS: Following SRP, mean IL-6 levels in patients with GCP were significantly higher in the pre-treatment group (2.93 5.17 pg/ml; p 0.05) than in the posttreatment group (5.78 8.26 pg/ml; baseline). Pre- and post-treatment IL-6 levels for PI (pre), BOP percent (pre/post), GI (post), and PPD were found to be positively correlated (post). In patients with GCP, the study showed a statistically significant correlation between periodontal metrics and salivary IL-6. CONCLUSIONS: Changes in periodontal indices and IL-6 levels that are statistically significant over time indicate that non-surgical treatment is effective, and IL-6 can be regarded as a potent disease activity marker.

Resilience related to novel coronavirus among doctors and undergraduate medical students-A study from India.

BACKGROUND: There are no studies pertaining to resilience related to novel coronavirus focusing primarily on doctors and undergraduate medical students in India. The objectives of this survey were to assess the resilience and its various domains that are needed for dealing with novel coronavirus among doctors, interns, and undergraduate students and to see its correlation with various sociodemographic factors. MATERIALS AND METHOD: An online cross-sectional survey was done among doctors and undergraduate medical students during the first COVID-19 wave from May 19, 2020 to June 8, 2020. A total of 434 responses were recorded during the study period. All the recorded full responses were considered for data analysis. Snowball sampling was used for this study. Resilience was assessed using three items, which were taken from the Brief Resilience Scale (BRS). RESULT: Out of 434 responses, 51.7% (224/433) of the respondents were non-resilient. The presence of the elderly at home was significantly associated with poor resilience (P = 0.02). Resilience was not significantly associated with other socio-demographic factors. Younger respondents (P = 0.019) and females (P =0.0004) were of the opinion that they recovered late from stressful events. Elderly respondents (P = 0.003) and those with chronic illness (P = 0.008) reported that it is hard for them to snap back if something bad happens (P = 0.003). CONCLUSIONS: More than half of the doctors and undergraduate medical students were found to be non-resilient, underscoring the urgent need to take steps to improve the resilience of this group of frontline workers.

Prevalence of E. Coli in Urinary Tract Infection of Children Aged 1-15 Years in A Medical College of Eastern Nepal.

INTRODUCTION: Urinary tract infection is one of the commonest causes of childhood morbidity. Early diagnosis and appropriate choice of antimicrobials is essential. Hence, this study aims to identify the prevalence of Escherichia coli in childhood urinary tract infections. METHODS: This was a hospital based descriptive cross-sectional study conducted in Nobel Medical College, Biratnagar over a period of one year. A total of 163 cases aged 1-15 years were included and clinical profile, laboratory reports including bacterial isolates in urine cultures and their sensitivity patterns were documented. RESULTS: The prevalence of Escherichia coli is 45 (53.57%) C.I. Escherichia coli was the most common organism isolated in bacterial cultures followed by Klebsiella 12 (14.29%), Enterococcus 10 (11.90%). Urinary tract infection was common among females with male: female ratio of 1:2.3. Fever 152 (93.2%) and abdominal pain 113 (69.3%) were the most common presenting symptoms. Escherichia coli was found most sensitive to Nitrofurantoin 43 (95.5%) followed by Ciprofloxacin 41 (91.1%) and Amikacin 40 (88.8%). CONCLUSIONS: Urinary tract infections in childhood require prompt attention and treatment to prevent significant morbidity and mortality. From this study it can be concluded that Escherichia coli is one of the most common isolates in urine culture and Aminoglycosides and Fluoroquinolones can be accepted as empirical treatment regimens for childhood Urinary tract infections.

Study of Acid-Base Disorders and Biochemical Findings of Patients in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Acid base disorder is a condition characterized by alteration in blood pH by the imbalance between the components of blood leading to a life threatening situation. The main aim of this study was to find the prevalence of acid-base disorders and biochemical findings of such disorders in patients in a tertairy care hospital. METHODS: This descriptive cross-sectional study was conducted in Nobel Medical College Teaching Hospital from 1st September, 2018 to 31st August, 2019. Ethical apporoval was taken from Institutional Review Committee. All the patients presented to emergency department, intensive care units and wards were included during the study period. Data were entered and calculations were done in Microsoft Excel, point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Out of arterial blood gas analysis of 1144 patients, the prevalence of acid base disorders was 718 (62.76%) at 95% Confidence Interval (59.96-65.56%). Simple and mixed acid base disorders were observed in 332 (46.24%) and 386 (53.76%) patients respectively. Respiratory alkalosis was most common among 134 (40.36%) cases in simple acid base disorder whereas metabolic acidosis and respiratory alkalosis was most common among 204 (52.85%) in mixed acid base disorder. All types of disorders were observed more in elderly people (41-60 and >60 age group) than other age groups. CONCLUSIONS: Acid base disorder was found to be more common in very ill patients in emergency and intensive care units. Mixed acid base disorder was the most common with male and elderly patients in predominance.

Study the Impact of Diabetes Camps on Adherence to Medication and Glycaemic Control in Uttarakhand.

INTRODUCTION: Diabetes is a major public health problem which needs to be addressed with outmost planning in resource poor settings. Good glycaemic control and medication adherence patterns can play an important role in reducing disease related complications thereby reducing morbidity and mortality among diabetics. Disease specific camps can act as a stepping stone in providing limited care to the patients. AIM: The study was planned to study the impact of diabetes camp on glycaemic control and adherence to antidiabetic medication among diabetic patients at a Government Teaching Hospital, Srinagar, Garhwal, Uttarakhand, India. MATERIALS AND METHODS: A cross-sectional study using a medication adherence questionnaire collected from the patients participating in diabetic camps and measuring their HbA1C levels before and after the camps along with spreading awareness about the disease. Two diabetes awareness camps were organized, three month apart and the participants were imparted knowledge about the disease. A total of 50 patients with type 2 DM who had self reported history of diabetes and were on some form of oral anti diabetics confirmed by their prescriptions. The patients were called for monthly follow up in outpatient department. A six question preformed questionnaire - the Girerd's instrument was used to assess the level of adherence to the prescribed anti-diabetic drugs in 50 patients with type 2 diabetes mellitus, their HbA1C levels were estimated and the results were analysed using standard statistical methods. RESULTS: A total of 50 type 2 diabetic, 48 were studied comprising 23 (47.9%) women and 25 (52.1%) men with a mean age of 57.43 years. The average duration of diabetes among participants was 7.02 years. Poor medication adherence score was recorded in 27 participants and only 7 participants had good adherence to medication before the camp. After the camp, 19 participants had good adherence and 7 had poor medication adherence scores. As a result of improved adherence, improvement in glycaemic control was noticed by a decrease of 0.5 units in the mean HbA1C value by the end of the study. CONCLUSION: The results clearly showed that group intervention in the form of camp combined with monthly follow-ups could improve adherence as well as glycaemic control at a government teaching hospital in a resource poor setting. This could also involve and encourage society as well as young trainees to participate collectively in the care of diabetics.

Risk Factors For Necrotizing Fasciitis And Its Outcome At A Tertiary Care Centre.

BACKGROUND: Necrotizing fasciitis (NF) is a serious and potentially fatal condition where there is rapid progression of inflammation of skin, subcutaneous tissue, and superficial fascia and can be mono-microbial or poly-microbial. The disease is rapidly progressive in nature and if not promptly treated leads to significant morbidity or even mortality. This study was designed to explore the various risk factors commonly present and study the outcome of the disease. METHODS: This was a cross sectional study done in tertiary centre over period of one year from April 2014 to March 2015. Patient admitted with soft tissue infection were presumptively made diagnosis of NF based on clinical features and final diagnosis was made after pre-operative surgical findings. RESULTS: Forty two (40.38%) patients had final diagnosis of NF out of 102 soft tissue infections. Twentynine (69%) of 42 patients with NF fully recovered with surgical and medical management. Eleven (26.2%) of these patients succumbed to their illness and two (4.8%) needed amputation of limb to control the infection. The most common co-morbid condition was alcoholism, followed by diabetes mellitus. CONCLUSIONS: The incidence of necrotizing fasciitis in patients admitted with soft tissue infection was 40.38%. Mortality and morbidity due to this condition was found to be high.

Effect of periodontal therapy on salivary interleukin-12 levels in chronic periodontitis.

BACKGROUND: Interleukin-12 (IL-12) is considered a central regulator of host resistance against a variety of pathogens. The influence of scaling and root planing was evaluated on amount of IL-12 in salivary fluid of patients with chronic generalized severe periodontitis, in relation to clinical parameters. MATERIALS AND METHODS: A total of 50 subjects were enrolled, of which 25 had chronic generalized severe periodontitis, and 25 periodontally healthy as control. The clinical parameters included plaque index (PI), gingival index (GI), pocket probing depth (PPD) bleeding on probing (BOP) and clinical attachment loss (CAL). The level of IL-12 in salivary fluid was measured by ELISA kit at baseline and at four week following scaling and root planing. RESULTS: Mean IL-12 levels in patients with periodontitis at baseline (9.79 ± 5.70 pg/ml) were higher than in controls (9.18±4.94 pg/ml; p=0.54.) Scaling and root planing resulted in significant increase in IL-12 levels (mean: 15.93±12.09 pg/ml; p =0.001) (control vs postoperative p <0.001). No significant correlations were found between IL-12 levels and any of the above clinical parameters. CONCLUSION: Short-term nonsurgical therapy resulted in a significant improvement in periodontal indices and a marked increase in IL-12 levels.

Amphotericin B--fat emulsion in treatment of visceral leishmaniasis--a cost effective substitute for liposomal amphotericin B.

In spite of high dosage and prolonged treatment schedule of sodium antimony gluconate, unresponsiveness and relapse ranging from 25 to 40% has been reported. The cure rate of 90 to 92.9% with amphotericin B-fat emulsion is comparable to that with liposomal amphotericin B (80 to 100%). Due to high cost liposomal amphotericin B is beyond the reach of most of the Indian patients, whereas the cost of treatment with amphotericin B-fat emulsion is quite affordable. Further large scale studies with amphotericin B-fat emulsion are required to evaluate its effectiveness in Indian kala-azar patients and to establish its optimal dose.