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   Table of Contents - Current issue
January-April 2023
Volume 9 | Issue 1
Page Nos. 1-79

Online since Friday, April 28, 2023

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Effect of acute exercise on Cardiovascular and Serum cortisol reactivity to mental stress in offspring of hypertensives p. 1
Pooja Sardar Nigade, VP Varshney, Mona Bedi
Introduction: The purpose of our study was to evaluate the effect of acute exercise on HR, BP and serum cortisol levels in offspring of hypertensives. This could serve as a preventive measure to habituate the high risk population group right at the early age. Material and Methods: The study was a double blind single centered randomized controlled prospective study conducted in the Department of Physiology & Biochemistry, Maulana Azad Medical College and associated hospitals, New Delhi over a period of 1 year. 30 subjects were recruited for the study. They were labelled as:- Group 1–the subjects were rested for 10 minutes after which the measurement of BP, HR and Serum cortisol was done. This resting value was labeled as R-1. The subjects were then exposed to mental arithmetic test (MAT) for 5 minutes. Thereafter their BP, HR and Serum Cortisol were measured again and labeled as T-1. Group 2–Same subjects were similarly rested for 10 minutes after which the measurement of BP, HR and S. cortisol was done. This resting value was labeled as R-2. This was followed by 20 minutes of Bicycle ergometry exercise. The subjects were then exposed to MAT for 5 minutes. Thereafter their BP, HR and Serum cortisol were measured again and labeled as T-2. We then compared (T2–R2) known as Cardio-Adrenal Reactivity (CAR) with exercise vs CAR without exercise (T1-R1). 2ml of blood sample was withdrawn for estimation S. cortisol. Paired t-test was applied for comparison (p value <0.05–significant). Results: The CAR was more in Group 1 compared to Group 2, difference being statistically significant. Conclusion: Study showed statistically significant change between with and without exercise groups. Acute exercise can reduce the adrenocortical reactivity to stress, a preventive tool for development of future hypertension.
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Retropupillary iris-claw lens: Helpful or not? p. 7
Rahul Singh, Divya Ramraika, Seemee Kapadia, Saket Agrawal, Moon Ramraika
Aim: To evaluate the preoperative and intraoperative indications, postoperative complications, incidence of secondary glaucoma, and visual outcome in patient who underwent iris-claw implantation during cataract surgery and effect of vitrectomy on postoperative intraocular pressure (IOP). Material and Methods: A retrospective study was conducted from January 2016 to February 2020. One hundred eighty-seven eyes of 187 patients who underwent iris-claw lens implantation, with minimum 1 month follow-up, were included in the study. Analysis of records was done for preoperative, intraoperative findings and was recorded and postoperative best corrected visual acuity (BCVA) and IOP were noted in each follow-up. Results: Mean preoperative BCVA of 187 eyes was 1.78 logMAR (SD 0.68), which increased to 0.61 ± 0.50, 0.36 ± 0.26, 0.21 ± 0.16 logMAR at postoperative day 1, day 7, and 1 month, respectively. Most common indications included phacodonesis (17.65%), small dilating and nondilating pupil (11.22%), zonular dialysis (6.41%), and pseudoexfoliation in (4.81%). Few patients (6.94%) had preexisting corneal pathologies which lend up in intraoperative complications that lead to iris-claw implantation. Mean IOP in vitrectomized eye after 1 month was 15.53 (SD 2.16) mm Hg and those of nonvitrectomized was 16 (SD 1.90) mm Hg. Posterior capsular rent and whole capsular bag loss were the most common intraoperative indications. Incidence of secondary glaucoma was 2.13%. Irregular pupil was the most common anterior segment finding at 1 month postoperatively. Conclusion: Retropupillary iris-claw implantation is one of the safe and least complicated methods of managing intraoperative complications which gives good visual acuity and prevent patient from the trauma of multiple surgeries.
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Evaluation of Efficacy of Two Different Doses of Intravenous Lidocaine in Patients with Chronic Pain p. 13
Anju Ghai, Bharti Verma, Kanika Rohilla
Background: An intravenous infusion of lidocaine has been used on numerous occasions to produce analgesia in neuropathic pain. It has been shown to be beneficial for the treatment of variety of neuropathic pain states in a wide range of dosage, from 2 to 7.5 mg/kg. The aim of our study was to evaluate the efficacy of two different doses of intravenous lidocaine (3 and 4 mg/kg) in patients with chronic pain. Methods: Patients above the age of 18 years suffering from chronic pain due to postherpetic neuralgia, post-surgical scar pain, chronic low back pain having numeric analogue scale (NAS) pain score of ≥3 without satisfactory pain relief from conservative treatment were randomised to receive either 3 mg/kg or 4 mg/kg intravenous lidocaine in 250 mL normal saline infusions weekly over a period of 1 hour for 3 weeks. NAS was measured before starting each infusion, immediately after completion of infusion, 2 and 24 hours, 7th day, 14th day, 21st day, and 28th day. Results: NAS score at first hour and 24th hour was significantly reduced (P = 0.001), after each infusion [7th, 14th day] in both the groups. There was no statistical difference in pain score among both groups except for day 7 (P value 0.04). Reduction in NAS score was also present on 21st and 28th day in both groups, but it did not reach a significant value. On 28th day, NAS score values showed increasing trend. Duration of pain relief was around 1 week after each infusion in both groups. Conclusion: Intravenous lidocaine at a dose of 3 mg/kg or 4 mg/kg was effective in reducing pain in patients with chronic pain. The analgesic effect was not different among both groups. Trend of greater response was observed with 4 mg/kg dose.
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Iliopsoas bleeds in patients with hemophilia: A single-center experience from South India p. 18
Meera Varadarajan, Smitha Ramaiah
Background: Iliopsoas bleed is a serious complication in people with hemophilia (PWH), with significant morbidity. Studies examining the profile, incidence, and outcomes in psoas bleeds are scarce and will shed more light and increase awareness about its management. Material and Methods: Data of 453 PWH with confirmed iliopsoas bleed treated at Bangalore Medical College were retrospectively analyzed. Results: Eighty-five (18.8%) PWH presented with total of 154 psoas bleeds. Their mean age was 21.96 years. Common symptoms were thigh/hip/groin pain (100.0%), hip flexion spasm (41.2%), numbness/tingling in quadriceps muscle (5.9%), abdominal tenderness (3.5%), hematuria, and anemia requiring blood transfusion in 2.4% each. Long-term complications were quadriceps atrophy (9.4%), permanent abnormal posture (10.6%), transient paresthesia in the distribution of femoral nerve (3.5%), and pseudo tumor in pelvis (1.2%). The overall average duration of therapy with clotting factor concentrate was 1.7 days with a mean duration of therapy of 1.4 days in patients without inhibitors and 2.8 days in patients with inhibitors (p = 0.010). The overall mean duration of hospitalization was 7.2 days with 5.3 days in PWH without inhibitors and 8.3 days in PWH with inhibitors (p = 0.342). Conclusion: Pain in hip joint/groin/hip flexion spasm suggests the possibility of an iliopsoas hematoma and early factor replacement therapy should be started to prevent complications. Early treatment at first sign of discomfort reduces the duration of treatment, and prevents severe complication and invasive interventions. Patients with inhibitors were overrepresented in the cohort who needed longer duration of factor replacement therapy.
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Six Sigma metrics as an indicator for Randox International Quality Assessment Scheme in clinical biochemistry laboratory: A pilot study with thyroid function test in a tertiary care hospital p. 25
Neeraj Yadav, Mukesh Kumar Meena, Shailata Prisi, Aditi Singh, Ritu Singh
Context: Six Sigma methodology represents an evolution in quality assessment and management that has been implemented widely in industry and health sector since the mid-1980s. It consists of five steps: define, measure, analyze, improve, and control (DMAIC). Randox International Quality Assessment Scheme (RIQAS) program Target Score (TS) is a performance indicator, and Sigma metrics is considered as a gold standard for overall performance. Aim: The aim of this study is to present the TS and Sigma metrics observed in clinical chemistry laboratory in SSK Hospital associated with Lady Hardinge Medical College to evaluate the analytical performance of T3, T4, and thyroid-stimulating hormone (TSH) parameters. The study period is from June to August 2022. Materials and Methods: The Sigma metrics for the various analytes was calculated by the following equation: Σ = TEa − bias/CV (TEa—total allowable error, CV—coefficient of variation). Acceptable performance criteria: standard deviation index (SDI) <2; TS >50; the closer a value is to 120, the better the performance, <40 is unacceptable; and %deviation should be less than the defined acceptable limits which is unique to each analyte, the closer the value is to zero, the better is the performance. Results: Our RIQAS results lie in acceptable range except for T3 in the month of August in which TS was unacceptable. Our laboratory Sigma metrics were below three sigmas. The findings of our exercise emphasize the need for a detailed evaluation, and we promote the use of Sigma metrics in quality assurance in the best interest of the patient. Conclusion: Quality check strategies were applied according to the TS and sigma values.
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A Prevalence Study of Post-Traumatic Stress Disorder and Its Sociobiological Determinants During Second Wave of COVID-19 Pandemic Among General Population of National Capital Territory of Delhi p. 29
Neeti Purwar, Ambren Chauhan, Anshu Singh, Khushboo Juneja, Harsh Mahajan, Shalini Srivastava
Introduction: Nationwide lockdown during COVID-19 pandemic, rapid transmission of SARS-CoV-2 and more intense second wave of pandemic in terms of high caseload, reduced essential supplies and scarcity of beds, and unpredictable mortality had a huge impact on mental health of general population. Objectives: This study aimed to estimate the prevalence and determine the factors of Post-Traumatic Stress Disorder (PTSD) among the general population of India during the second wave of pandemic. Methodology: An online survey was conducted to estimate the prevalence and assess the factors responsible for PTSD among 614 participants who were above 18 years of age. The prevalence of PTSD was measured using PTSD checklist for Diagnostic and Statistical Manual of Mental Disorder-5 (DSM-5). Results: In the present study, there were a total of 614 participants and the mean age of the participants was 23.64 years. More than half of the participants were female and majority of them were unmarried (76.7%). The prevalence of PTSD was 30.62%. A significant association was observed between occupation and PTSD prevalence. Also, COVID-19 illness, COVID-19 infection among the family members, work outside the home, hospital admissions, difficulty in acquiring the required medication were significantly associated with PTSD. Conclusion: COVID-19 pandemic and nationwide lockdown led to increased prevalence of psychological effects like PTSD. This highlights the importance of focusing on mental health during the pandemic.
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Tracking Annual Antimicrobial Resistance at a Tertiary Care Hospital amidst Raging COVID-19 Pandemic p. 35
Sonal Saxena, Prabhav Aggarwal
Background: Timely preparation and presentation of the annual cumulative antibiogram play an important role in the dissemination of an updated susceptibility pattern to clinicians and thus aid in the appropriate choice of antimicrobials for empirical therapy while minimizing adverse effects and resistance. The study aimed to present and analyze the annual AMR data that may be helpful in designing antibiotic policy. Methods: All clinical specimens routinely submitted to the Department of Microbiology from January to December 2021 for bacteriological culture and antimicrobial susceptibility testing (AST) were included. AST was performed for pathogenic isolates by disc diffusion/agar dilution/broth microdilution methods/VITEK® 2 compact system. All data were entered and analyzed using WHONET 2020 software. Results: A total of 46,629 routine specimens were processed, yielding 5792 non-repeat bacterial isolates. Relatively fewer specimens were received during the first few months when the hospital catered exclusively to COVID-19 patients. The most common bacterial isolates were Escherichia coli (30%), Staphylococcus aureus (21%), Klebsiella sp. (18%), Pseudomonas sp. (10%), Acinetobacter sp. (8%) and Enterococcus sp. (5%). Analysis showed low susceptibility to 3rd generation cephalosporins, fluroquinolones, and cotrimoxazole among Gram negative bacteria. Less than 50% Acinetobacter sp. were carbapenem susceptible. We report high rate of methicillin resistance in S. aureus (74%). Overall susceptibility was much lower in specimens from ICU followed by in-patients and out-patients. Conclusion: Antimicrobial resistance is rapidly assuming the proportions of a pandemic, with several authors calling it “invisible” pandemic. As is evident from the present study, low susceptibilities to all but a few last-resort drugs are leaving few choices for treatment. This mandates effective preparation, distribution, and presentation of annual antibiograms, which will help in formulating hospital antibiotic policy.
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In Vitro Isolation and Molecular Characterization of Genomic DNA from Ancient Human Long and Hip Bones p. 44
Dinesh Kumar, Lalit Mohan Jeena, Devendra Shekhawat, Ira Verma, Sidd Sana
Background: A simple and effective modified ethanol precipitation-based protocol was described for the extraction of genomic DNA from ancient human bones. The qualitative and quantitative evaluation of genomic DNA was done based on DNA purity (260/280) and the PCR method. Method and Materials: In this study, a total of 50 embalmed ancient bones, including 20 long and 30 hip bone samples, were taken for genomic DNA extraction. The efficiency of the genomic DNA extraction was demonstrated on >50-year-old ancient human HIP and long bone samples. In vitro quantitative and qualitative analysis of extracted genomic DNA was performed by 0.8% agarose gel electrophoresis and PCR amplification. To assess the quality of extracted genomic DNA, a mitochondrial-specific ATPase6 gene primer was used to obtain sequence information of 675 bp. Result: Our data show that a concentration of genomic DNA between 1.6 and 2.0 at 260/280 resulted in successful PCR amplification. Our results demonstrated that the extraction of DNA from ancient bone samples with a manual approach will increase the amplification efficiency of the polymerase chain reaction (PCR). Conclusion: In the present study, a simple, time-saving, and cost-effective protocol is described for the extraction of genomic DNA from ancient human bones. Further, we believe the extraction of genomic DNA from ancient bone samples with this approach will increase the success rate of PCR amplification.
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Assessment of Vitamin A Status in Patients with Iron Deficiency Anemia p. 50
Sunita Aggarwal, Abhishek Verma, Surendra Tiwari, Smita Kaushik, Sandeep Garg, Suresh Kumar
Introduction: Iron and vitamin A deficiency are two very prevalent and easily preventable nutrient deficiencies. This study was conducted to assess vitamin A status in patients with iron deficiency anemia and to further study the correlation of vitamin A status with biochemical markers of iron deficiency. Materials and Method: Eighty patients with iron deficiency anemia were enrolled and investigated for a complete blood count, an iron profile, liver, and kidney function tests and plasma retinol binding protein levels. The mean age of patients was 31.14 ± 11.33 years, with a range of 16 to 62 years. Results: Mean hemoglobin was 7.19 ± 2.1 g/dL. Serum iron, ferritin, and transferrin saturation were low in all patients, while total iron binding capacity (TIBC) was elevated in only 74 patients (94.81%). Nineteen patients (23.8%) had vitamin A deficiency, with a mean retinol binding protein (RBP) 0.53 ± 0.13 µmol/L. Vitamin A deficient patients had a mean hemoglobin of 6.8±2.14 gm/dL, mean corpuscular volume (MCV) 71.35 ± 8.86 fL, a mean corpuscular hemoglobin (MCH) 19.43±4.36 pg, mean corpuscular hemoglobin concentration (MCHC) 25.44±4.92 gm/dL, serum iron of 28.21 ± 9.73 mcg/dL, serum ferritin 13.04 ± 12.41 ng/mL, transferrin saturation 6.81 ± 3.07%, and TIBC 427.85 ± 78.57 mcg/dL. Among vitamin A deficient patients, RBP had positive correlation with serum iron and transferrin saturation; while, simultaneously showing negative correlation with serum ferritin and TIBC. Conclusion: Vitamin A deficiency affects iron metabolism, causing abnormal iron trapping and systemic iron deficiency, thus worsening the clinical profile of iron deficiency anemia. This study guides us to screen iron deficiency anemia patients for the concomitant vitamin A deficiency for efficient treatment of such patients.
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Clinical profile and outcome of AKI in snake bite in a tertiary care hospital, India p. 57
Aruna Acharya, Haladhar Naik
Introduction: Acute kidney injury (AKI) is one of the complications of envenomation that is frequently fatal. Aim: To evaluate the clinical profile and outcome of AKI in snake bite patients and to identify the predictors of mortality in these patients. Methods: All patients admitted with history of envenomation and AKI were included in the study. A detailed history was obtained from all the patients about the time of antisnake venom administration and time interval between the event and admission in hospital, and then hematological and biochemical investigations were performed. Results: A total of 202 patients were diagnosed with snake bite induced AKI, of which 8.6% had died. Majority of patients were males (82.7%). The dialysis requirement was significantly higher in patients who died as compared to those who survived (100% vs. 72.6%, p = 0.013). The disseminated intravascular coagulation was found to be higher in patients who died due to snake bite (p < 0.001). The median (range) length of hospitalization was shorter for the nonsurvivors than the survivors (3.0 [1.0–4.0] days vs. 8.0 [3.0–27.0] days; p < 0.001). Compared to patients who survived, the total leukocyte count and serum urea were significantly higher among patients who died due to snake bite induced AKI. Conclusion: The present study revealed that higher dialysis requirement, high complication rate, and lower duration of hospital stay were the risk factors associated with patients who died due to snake bite induced AKI.
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Gadolinium-induced acute respiratory distress syndrome: A rare clinical entity p. 61
Lalit Gupta, Prathap T H
Gadolinium-based magnetic resonance imaging (MRI) contrast is considered stable and safe compared to iodine-based contrast agents; however, unseen and unexpected complications may occur at any time. We present the case of a 45-year-old patient who was posted for MRI contrast of the abdomen. After a few minutes of contrast injection, the patient was found having shortness of breath, chest pain with nausea, and vomiting. Pulmonary auscultation revealed bilateral fine crepitations, but he did not develop rash or angioedema and was immediately managed with steroids and with supplemental oxygen support. However, he started desaturating and shifted to the nearby emergency department where high-resolution computed tomography (HRCT) was done and showed ground-glass opacities. Coronavirus disease (COVID) swab test was negative and the patient was shifted to intensive care unit (ICU) with the provisional diagnosis of developing acute respiratory distress syndrome (ARDS). He was managed conservatively on bilevel positive airway pressure (BiPAP) and discharged after 10 days with full recovery. There is no specific biomarker for ARDS triggered by MRI contrast, and the clinical presentation is indistinguishable from other causes. Gadolinium contrast-induced ARDS is a rare but potentially life-threatening complication that should be considered in the differential diagnosis of respiratory failure following an MRI contrast injection. It is critical to be aware of this potential complication in order to provide the best outcome for the patient’s management.
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Pharmacovigilance Activities in Maulana Azad Medical College and Associated Hospitals: A Step towards Patient Safety p. 64
Vandana Roy, Vandana Tayal, Ijasul Haque, Jamshed Ahmad, Kavita Verma, Virendra Singh
Introduction: Pharmacovigilance plays an important role in patient safety and rationalizing the use of medicines. It helps in identifying the frequency of adverse drug reactions (ADRs), their causes, and the associated risk factors. Pharmacovigilance activities are facilitated through adverse drug reactions monitoring centers (AMCs) in most of the institutions. Aim: The objective of this paper is to provide an overview to the health care professionals regarding ADRs reported from the associated hospitals of Maulana Azad Medical College (MAMC) and the pharmacovigilance activities undertaken. Observations: Maulana Azad Medical College, Department of Pharmacology was recognized as an AMC in 2014 under the Pharmacovigilance Program of India (PvPI). The AMC established a way for reporting ADRs both by spontaneously and through active monitoring of ADRs from different wards. The causality assessment of all ADR reports collected is done. The program was informed by a college pharmacovigilance committee, emails, and by putting posters in the hospital nursing stations. Fourteen training workshops for doctors and pharmacists and two training workshops exclusively for nurses have been conducted so far on pharmacovigilance. In 2017, a program to sensitize doctors working in the Delhi government hospital was started. A total of 854 healthcare workers have been sensitized. The center has reported a total of 2572 ADRs to the National Coordination Centre (NCC) at Indian Pharmacopoeia Commission until December 2021. ADRs reported were highest in the age group of 20 to 59 years. Most of the reports were from the department of T.B. and Chest (n = 589, 23.8%). The most common class of medicines implicated in causing ADRs was antimicrobials (n = 1100, 44%). Among the ADRs reported, the majority were mild (n = 1451, 81.1%) with 346 (18.8%) reported as serious. Conclusion: A system for reporting ADRs on campus has been established. The pattern of ADRs reported to this ADR monitoring center is comparable to the national and global data. Hospital-based ADR monitoring and reporting programs are very crucial to identify and quantify the risks associated with the use of medicines. The pharmacovigilance program at MAMC is a commitment and a small step towards patient safety.
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