Contrast-induced Nephropathy among Patients Administered with Contrast Material at a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Administration of an intravenous contrast medium, which is used in various routine hospital procedures, can lead to the development of nephropathy in some patients. This contrast-induced nephropathy is one of the most common reasons for hospital-acquired acute kidney injury. This study aimed to find out the prevalence of contrast-induced nephropathy among patients administered with contrast material at a tertiary care centre. Methods: This descriptive cross-sectional study was conducted from 4 March 2022 to 23 May 2022 at a tertiary care centre after taking ethical approval from the Institutional Review Committee (Reference number: 0812202106). Patients administered with an intravenous contrast medium for diagnostic imaging were included in the study. Data including sociodemographic variables and renal function test results were collected. A convenience sampling method was used. Point estimate was done and 95% Confidence Interval was calculated. Results: Among 174 participants, contrast-induced nephropathy was found in 86 (48.31%) (48.24-48.39, 95% Confidence Interval). Conclusions: The study showed that the prevalence of contrast-induced nephropathy was higher than findings from other studies done in a similar setting. Keywords: contrast material; kidney disease; prevalence.

Comparison of suprainguinal approach with infrainguinal approach of fascia iliaca compartment block for postoperative analgesia.

Background and Aims: Fascia iliaca compartment block (FICB) is increasingly being used for anaesthesia and analgesia of the hip, knee and thigh. It can be administered via two ultrasound-guided approaches, suprainguinal and infrainguinal. This study aimed to compare the analgesic efficacy of the suprainguinal approach of FICB with infrainguinal approach of FICB in patients undergoing above knee orthopaedic surgeries. Methods: In this single-centre, double-blinded randomised trial, 32 patients undergoing above knee lower limb orthopaedic surgery under spinal anaesthesia were randomised into group I (infrainguinal FICB) and S (suprainguinal FICB). They were given ultrasound-guided FICB with 30 mL 0.2% ropivacaine for postoperative analgesia using the respective approaches. Injection tramadol was administered as a rescue analgesic when Numeric Rating Scale (NRS) ≥4. A blinded observer recorded pain score (NRS) from the initiation of the block every 2 h for 24 h. Time to first rescue analgesia, total duration of analgesia and analgesic consumption, and patient satisfaction score were noted. Results: The mean pain scores were comparable between the two groups at all time intervals till 24 h except at 12 h and 20 h, when pain intensity was significantly less in group S than in group I. Total tramadol consumption was also significantly less in group S. There was no significant difference in time to first rescue analgesia and total duration of analgesia between the two groups. At 24 h, the patient satisfaction score was significantly better in group S. Conclusion: Suprainguinal FICB has superior analgesic efficacy over infrainguinal FICB in terms of reduced pain intensity, reduced 24-h tramadol consumption and better patient satisfaction.

A novel fusion based convolutional neural network approach for classification of COVID-19 from chest X-ray images.

Coronavirus disease is a viral infection caused by a novel coronavirus (CoV) which was first identified in the city of Wuhan, China somewhere in the early December 2019. It affects the human respiratory system by causing respiratory infections with symptoms (mild to severe) like fever, cough, and weakness but can further lead to other serious diseases and has resulted in millions of deaths until now. Therefore, an accurate diagnosis for such types of diseases is highly needful for the current healthcare system. In this paper, a state of the art deep learning method is described. We propose COVDC-Net, a Deep Convolutional Network-based classification method which is capable of identifying SARS-CoV-2 infected amongst healthy and/or pneumonia patients from their chest X-ray images. The proposed method uses two modified pre-trained models (on ImageNet) namely MobileNetV2 and VGG16 without their classifier layers and fuses the two models using the Confidence fusion method to achieve better classification accuracy on the two currently publicly available datasets. It is observed through exhaustive experiments that the proposed method achieved an overall classification accuracy of 96.48% for 3-class (COVID-19, Normal and Pneumonia) classification tasks. For 4-class classification (COVID-19, Normal, Pneumonia Viral, and Pneumonia Bacterial) COVDC-Net method delivered 90.22% accuracy. The experimental results demonstrate that the proposed COVDC-Net method has shown better overall classification accuracy as compared to the existing deep learning methods proposed for the same task in the current COVID-19 pandemic.

Single-stage versus two-stage reconstruction in chronic multi ligament knee injury.

BACKGROUND: Multi ligament knee injury (MLKI) refers to the disruption of at least 2 of the 4 major knee ligaments. These injuries are managed in single and two-stage surgeries however, treatment guidelines for best practice are unsettled. There is no study in the literature that compares single and two-stage surgery for the management of chronic multiligament knee injury. Therefore, the aim of this study was to compare the functional outcome between single-stage and two-stage surgical fixation in chronic multi-ligament knee injury. METHODS: Twenty seven patients with chronic MLKI with at least 2 years of follow up were included. Fourteen patients underwent reconstruction of torn ligaments in a single-stage operation (Group I) and 13 patients underwent reconstruction of torn ligaments in two stages (Group II). Assessment of clinical outcome was done with IKDC knee score, TEGNER LYSHOLM knee score, range of movement and laxity tests (Anterior drawer test, Lachman, Posterior drawer test, pivot shift test, dial test, varus and valgus stress test). RESULTS: At final follow up, there was no significant difference in post-operative IKDC knee scores in group I and group II (84.7±7.1 and 81.4±8.4 respectively, p=0.3) and Lysholm scores (85.8±8.3 and 80.9±8.3 respectively, p=0.1), range of movement (133.2±5.7 and 131.5±6.6 respectively, p=0.5) and all the patients regained full extension. At the final follow up 12/14 patients (85.7%) in group I and 11/13 patients (84.6%) in group II had a negative/grade 1 anterior drawer test (p=0.6), 14/14 (100%) in group I and 13/13 (100%) patients had negative/grade 1 lachman test (p=0.6), 13/14 patients (92.8%) in group I and 13/13 patients (100%) patients in group II had negative/grade 1 pivot shift test (p=0.4), 9/10 patients (90%) in group I and 12/13 patients (92.3%) in group II had negative/grade 1 posterior drawer (p=0.6), 6/6 patients (100%) in group I and 6/7 patients (85.7%) in group II had negative/grade 1 dial test (p=0.3), 5/6 patients (83.3%) in group I and 5/7 patients (71.4%) in group II had negative/grade 1 varus stress test (p=0.4), 6/7 patients (85.7%) in group I and 7/7 patients (100%) in group II had negative/grade 1 valgus stress test (p=0.1). CONCLUSION: Chronic MLKI managed by single stage and two stage reconstruction provides similar functional outcomes. LEVEL OF EVIDENCE: Level III Retrospective Cohort Study.

A prospective randomized study of arthroscopic ACL reconstruction with adjustable- versus fixed-loop device for femoral side fixation.

PURPOSE: Suspensory devices are extensively used in the management of anterior cruciate ligament (ACL) tear. They include fixed- and adjustable-loop devices. There are only a few studies comparing the efficacy of these two devices in the available literature. Therefore, the aim of this study is to compare clinical outcomes between the adjustable-loop device (group I) and fixed-loop device (group II). MATERIALS AND METHODS: This was a prospective randomized study. Both groups were equivalent in demographic, preoperative, and intraoperative variables. Twenty-three patients underwent femoral side graft fixation with adjustable-loop and 20 with fixed-loop devices. Four patients were lost to follow-up. Assessment of clinical outcome was done with International Knee Documentation Committee (IKDC) score, Lysholm score, and knee stability tests (Lachman test and pivot shift test). Patient evaluation was performed preoperatively and finally postoperatively 2 years after surgery. RESULTS: Postoperative IKDC scores of group I and II were 91.9 ± 3.6 and 91.5 ± 3.6, respectively, and Lysholm scores were 91.0 ± 3.6 and 91.4 ± 3.5, respectively, after 2 years; however, the difference in the outcomes was statistically insignificant (p > 0.05). Twenty patients (87%) in group I and 17 patients (85%) in group II had a negative Lachman test (p = 0.8). Twenty-two patients (95.7%) in group I and 19 patients (95%) in group II had a negative pivot shift test (p = 0.9). CONCLUSION: ACL reconstruction with fixed- and adjustable-loop suspensory devices for graft fixation gives equivalent and satisfactory clinical results. LEVEL OF EVIDENCE: 1.

Comparison of Interventional Methods to Motivate and Change the Behavioural Stage of Smokers to Quit Smoking- A Hospital Based Randomised Controlled Trial.

OBJECTIVE: Addictions can be beaten if started off with a true motivation to quit it. Enhancing motivation is an important part of overall treatment for smoking cessation as it increases a smoker's courage and enthusiasm to quit smoke. This study aimed to assess effectiveness of various interventional methods to motivate unmotivated smokers with a focus on changing behavioural stage of  smokers to quit. METHODOLOGY: A single blinded trial was conducted at the outpatient department of ITS dental college and hospital among precontemplation stage smokers allocated into 4 groups and given interventional therapies like general counselling only(group 1), counselling and intra oral camera assessment (Group 2), counselling as well as carbon monoxide monitoring(Group 3)whereas fourth group(Group 4) given a combination therapy of all of them. A baseline evaluation of nicotine dependence and behavioural stage of the smoker was assessed. The patients were then evaluated on presence on their scheduled follow up visits done at interval of 2 weeks and 4 weeks. Descriptive statistics were addressed and the association was evaluated using Pearson chi square test. Any p value less than 0.05 was considered statistically significant. RESULTS: Majority of  smokers were males(88% ) and about 48.8% of them were highly dependent smokers . The change in precontemplation behavioural stage was assessed on basis of follow up visits after interventional therapy which was significantly higher in group 4 receiving combination therapy, followed by carbon monoxide therapy ,counselling and intra oral camera assessment and the least visits in behaviour counselling group (p <0.05). CONCLUSION: A combination of counselling and other motivational aids therapy is best way possible to help smokers focusing a change on the behavioural stage of the patient from precontemplation to preparation stage.

Accuracy of tibial component positioning in the robotic arm assisted versus conventional unicompartmental knee arthroplasty.

BACKGROUND: Our study aims to determine the planned accuracy of the tibial component placement in robotic arm assisted unicompartmental knee arthroplasty (UKA) versus the conventional jig based UKA of the initial cases done in India for the first time with this particular robotic system.Materials & Methods: Study group 1 consisted of patients who underwent robotic arm (MAKO, Stryker, USA) assisted UKA. Group 2 consists of patients who underwent a standard conventional jig based (Oxford knee, Biomet, UK). Post-operative radiographs were taken to determine the Tibial Implant position and orientation which were compared to their preoperative plan respectively by two independent observers. The mean error value was obtained for both study groups respectively and compared to determine the accuracy of the post-operative tibial implant placement. RESULTS: In the Robotic arm assisted UKA, the deviation of post-operative varus angle from preoperative planned angle was about 0.43° and post-operative Tibial slope alignment differed from preoperative plan was 0.41°. In the Conventional UKA group post-operative varus angle differed from preoperative planned angle by about 2.12° and post-operative Tibial slope alignment deviation from preoperative plan was 2.47°. CONCLUSIONS: Robotic arm assisted system was more accurate compared to the conventional jig-based technique in achieving the planned orientation and alignment of the tibial implant in the initial learning phase of this particular Robotic System used for the first time in India. MESH TERMS: partial knee replacement, robotic assisted surgery.

Comparison of oral health status among adult tobacco users and non-tobacco users of Ghaziabad District, Uttar Pradesh: A cross sectional study.

BACKGROUND: Tobacco dependence is a major public health problem that results in significant morbidity and mortality. Approximately, 5 million people are killed annually by tobacco use. AIM: To assess the oral health status among adult tobacco and non-tobacco users attending outreach activities in Ghaziabad District, Uttar Pradesh. METHODS: A cross-sectional study was conducted on 800 subjects from all the 4 blocks of Ghaziabad district visiting the outreach activities. A pre-tested questionnaire was used to assess the demographic variables and oral hygiene practices. Oral health status was assessed using WHO (World Health Organization) 2013 Oral Health Assessment Form and the Smith and Knight Tooth wear index was used to assess the degree of tooth wear. Statistical analysis was done by the Statistical Package for Social Sciences (SPSS) version 20.0. RESULT: The mean age of the tobacco users in the study was 40.94 (13.83) years. The prevalence of dental caries and tooth wear was 88.0% and 89.2%, respectively. Majority of tobacco users consumed a smokeless form of tobacco 67.5%, followed by smoke 21.5% and followed by both form 11.0%. CONCLUSION: The present study concluded that adult population of Ghaziabad lack the knowledge and awareness regarding consumption of areca nut, gutka, and tobacco smoking. Hence, there is an urgent need to take effective steps, especially on launching community awareness programs for the adult population and public to educate them about the consequences of tobacco use, and on assessing their effectiveness in curbing the problem.

Challenges in successful management of haemophilic knee arthropathy: Our experience in a tertiary centre.

BACKGROUND: Haemophilia is characterized by a partial or complete deficiency of clotting factor VIII or IX. The repeated bleeding episodes into the joints contributes to subsequent chronic arthropathy which debilitates the patient and affects the quality of life. There are lot of hurdles in successful management of such patients. We present our experience in dealing such patients. MATERIALS AND METHODS: 24 patients (27 knees) with haemophilic knee arthropathy were included. The preoperative VAS (Visual Analogue Scale) and KSS (Knee Society Score) were assessed. All underwent total knee arthroplasty with stemmed constrained prosthesis. Postoperatively VAS and KSS were analysed at the end of 12 months. RESULTS: The mean preoperative VAS was 8.2 (Range: 7-10), mean KSS clinical score was 39.9 (Range: 12-61) and mean KSS functional score was 51.4(Range: 20-70). The mean postoperative VAS was 2.7(Range: 2-4), mean KSS clinical score was 70.5 (Range: 61-80) and mean KSS functional score was 74.2(Range: 60-80). There was statistical significant difference between preoperative and post-operative scores. At the end of 12 months, 17 patients (63%) had good outcome, seven patients (26%) had fair and three patients (11%) had excellent outcome as per the KSS scores. CONCLUSIONS: Total knee arthroplasty has good outcome with respect to clinical as well as functional outcome in haemophilic arthropathy. Although the results and outcome of total knee arthroplasty in haemophilic knee arthropathy may still be inferior to the results seen in a normal individual, a multidisciplinary approach yields a better functional and quality of living in such haemophilic patients.

Prevalence of periodontal status among nicotine dependent individuals of 35-44 years attending community dental camps in Ghaziabad district, Uttar Pradesh.

BACKGROUND: Tobacco is the second driving reasons for mortality worldwide and its broad utilization in the smoking and smokeless form have added to the expanding weight of non-communicable disease. AIM: To study the prevalence of periodontal status among nicotine dependent individuals of 35-44 years attending community dental camps in Ghaziabad District, Uttar Pradesh. METHODS: A cross-sectional study was conducted on 800 individuals with the age range of 35-44 years. A pre-tested questionnaire was used to gather information about the sociodemographic profile and the pattern of substance use. Fagerstrom Test for Nicotine Dependence-Smokeless Tobacco (FTND-ST) and for smokers; Fagerstrom Test for Nicotine Dependence (FTND) for testing dependence. Periodontal status was assessed by Community Periodontal Index (Modified CPI WHO 2013) and loss of attachment (LOA). Statistical analysis was done by the Statistical Package for Social Sciences (SPSS) version 20.0. RESULT: The prevalence of periodontal disease was found to be 78.5% with maximum disease prevalence among males of 42-44 age. Majority of male consumed a smokeless form of tobacco (50.23%), followed by smoke (14.19%) form whereas females predominantly consumed smokeless form (37.36%). The mean number of teeth with pocket (3.37 ± 1.86) and mean of loss of attachment of more than 9 mm (0.67 ± 0.88) was higher among smokeless form of tobacco users as compared to other habit groups. CONCLUSION: Higher prevalence of periodontal disease was seen among nicotine dependent individuals. A model for a comprehensive program in the dental office including the five A's and five R's for tobacco counseling must be applied at every institute.

Association between maternal dental anxiety and its effect on the oral health status of their child: An institutional cross sectional study.

AIM: To assess the association between maternal dental anxiety and its effect on the oral health status of their child, in Murad nagar -An institutional cross-sectional study. MATERIALS AND METHODS: Among the randomly selected 200 mother-child pairs, a cross-sectional study was done. The children of 2-5 years were selected for the study. A five-level Modified Dental Anxiety Scale (MDAS), Hindi edition, was used to assess dental anxiety among the mothers. Clinical examination of the wards was finished by using a modified gingival record and WHO dentition status (2013). The SPSS software version 20 was used for statistical analysis. RESULTS: Approximately, 61% of the children were males, and 39% were females. The modified gingival index (MGI) score was high, if there should arise an occurrence of high MDAS values. The mean MGI score was most astounding in phobic class of MDAS and least in the not anxious classification. The MGI score expanded on increment in maternal anxiety. Dental caries expanded in kids, if there should be an occurrence of high maternal dental uneasiness. The MDAS demonstrated a critical association with clinical oral health results of the child. The children whose mothers were "extremely anxious" (phobic) had the highest mean decayed, missing, or filled teeth. CONCLUSION: Maternal dental anxiety significantly affects the oral health status of their ward.

Indian Subcontinent's First Bilateral Supracondylar Level Upper Limb Transplantation.

Introduction This is the first case of supracondylar level transplant from the Indian subcontinent, performed for a bilateral below elbow amputee. It has a completely different set of challenges for the transplant team, with a relatively shorter ischemia time window. The technical considerations for the same have been discussed in detail in this article. Materials and Methods The patient was a 19-year-old female who lost her both upper limbs at proximal forearm level due to severe crush injury following a road traffic accident. Insufficient bone length on either side necessitated a supracondylar level transplant. The preoperative workup included detailed clinical evaluation, biochemical, and psychological evaluation. The donor was a young brain-dead, male patient from a hospital, 30 minutes away. The donor and recipient preparations in this case were unique. The recipient's own elbow flexors and extensors were used while the elbow joint was from the donor. The specific challenges we faced during this procedure have been described in detail. Results The transplantation has been a complete technical success, with the patient rehabilitated back to her independent life style. This article describes only the technical considerations. The functional recovery aspect is part of an another soon to be published manuscript. Conclusion Supracondylar level arm-transplant requires a highly coordinated team effort with precise preoperative planning, along with meticulous attention to detail to achieve a successful outcome. In properly selected patients, it could be a life-changing procedure, worth all the effort.

Intracranial Hydatid Cyst: A Report of Three Cases in North-West India.

Human echinococcus is caused by tapeworm, Echinococcus granulosus, which forms larval cysts in the human tissue. Incidence in the cerebral form is only 1-2%. This localization can be associated with the involvement of other organs such as liver or lung or may be an isolated infestation of the brain or spinal column. Surgical removal of the intact and unruptured cyst is advised to prevent local recurrence that may require further surgery and long-term treatment with parasiticidal agents. We report three cases who presented with headache, vomiting, hemiparesis with decreased visual acuity, and convulsions. MRI showed a giant hydatid cyst in all three cases which was removed surgically and the patient was successfully discharged. Successful treatment of hydatid cyst requires preoperative diagnosis and meticulous surgical technique for complete excision of cyst without rupture under perioperative coverage of albendazole to avoid recurrence and anaphylaxis.

A randomized clinical study for comparative evaluation of Aloe Vera and 0.2% chlorhexidine gluconate mouthwash efficacy on de-novo plaque formation.

OBJECTIVE: To comparatively assess the antiplaque efficacy of Aloe vera mouthwash and 0.2% chlorhexidine gluconate mouthwash on de novo plaque formation. MATERIALS AND METHODS: This was a randomized, single blind, parallel, controlled clinical study with 90 healthy participants, with mean age of 27.19 ± 12.08 years. After thorough oral prophylaxis, participants were instructed to discontinue mechanical plaque control. Participants were divided randomly into three groups; pure Aloe vera mouthwash was dispensed to the test group; control group received 0.2% chlorhexidine gluconate mouthwash; in Placebo group, flavored distilled water was used as oral rinse twice daily. Effect on 4-day de novo plaque formation was assessed by comparing pre-rinsing Quigley Hein Modified Plaque Scores were analyzed statistically using analysis of variance and Student's t-test. RESULTS: Post-rinsing control group showed the least plaque score which was comparable to the test group. Both the control group and test group showed significant difference with the placebo group. CONCLUSIONS: Herbal mouthwash containing Aloe vera mouthwash has comparable antiplaque efficacy as the gold standard 0.2% chlorhexidine gluconate with fewer side effects and can be considered as an alternative.