Author Archives: pisrt

Abstract:Background: Coronavirus Disease 2019 (COVID-19) is characterized by high fever, sudden developing respiratory distress. The Purpose of this study is to identify the association of D-dimer levels and lymphocyte counts with poor prognosis and to predict the clinical course in patients with COVID-19.
Methods: A Total of 85 hospitalized children diagnosed with COVID 19 were included in the study. According to AIIMS guidelines, they were divided into two groups, one with severe disease (N=23) and other with non-severe disease which included mild to moderate cases (n=62), distinctive performance analysis of these values were performed and the cut off values were determined.
Results: A total of 85 hospitalized patients with COVID-19 were included in the final analysis. The mean age was 10 \(\pm\) 5 years and 45 (52.9%) were males. Lymphocyte count was found as statistically significantly low (p <0.001) while D-dimer level was statistically significantly higher in the group with severe disease (p <0.001). As for the effectiveness of lymphocyte count in distinguishing severe and non-severe patients with COVID-19 when cut-off score 1500/mm3 was taken, sensitivity was 30% and specificity was 77% and that of D-dimer when cut-off score 2 mg/L was taken, sensitivity was 22% and specificity was 50%. D-dimer level was found to have a significant discrimination power (AUC = 0.879, p < 0.0001,95% CI).
Conclusions: The lymphocyte value of \(\leq 1500/mm3\) and D-dimer value of \(\geq 2mg/L\) can be used in the early determination of patients with poor prognosis in COVID-19. Using these cut-off values for D-dimer and lymphocyte count will help predict prognosis and make rapid treatment decisions in patients with COVID-19.

Abstract:Background: Nutritional anemia is the commonest type of anemia in India, especially in rural areas. Patients with hemoglobin below 6 gm/dl usually require transfusion therapy. In stabilized patients with hemoglobin values between 6 and 10 gm/dl, the decision to transfuse is based on an evaluation of clinical status. Patients with values above 10 gm/dl rarely require transfusion. Initially, whole blood was transfused due to the activity of 2,3 DPG. However, now it is replaced by packed red cells after the advent of proper refrigeration, component separation method, and anticoagulants, especially additive solution SAGM and polyvinyl chloride blood bags.
Aims: 1) To know the efficacy of packed red cell transfusion in symptomatic nutritional anemia patients. 2) If there is a failure of improvement following packed red cells transfusion, the underlying cause of anemia will be evaluated, which may influence the outcome of the transfusion.
Materials and Methods: The present study comprised 110 nutritional anemia patients who received packed red cell transfusion in Sri Manakula Vinayagar Medical College and Hospital. Data were collected for eight months. A thorough clinical examination and history were taken for all 110 patients, and hematological parameters were collected from the automated cell counter.
Results: In the present study, 110 patients with nutritional anemia who underwent packed red cell transfusion were taken. Out of which, 90 patients had features of only iron deficiency anemia, and 20 had features of anemia of combined deficiency (iron, vitamin B12, and folic acid). Iron deficiency anemia is more prevalent in the third and fourth decades. Anemia of combined deficiency in the sixth and seventh decade. Conclusion: Packed red cell transfusions are reserved for anemia patients whose organs (brain, heart) are being deprived of oxygen due to severe anemia and for people whose hemoglobin or hematocrit level is very low. In chronic anemia, there are increases in the content of 2,3-DPG in the red blood cells, with a shift towards the right in the hemoglobin dissociation curve in the cardiac output and respiratory rate. Hence transfusion is rarely indicated. The mean increase in Hb and PCV values in nutritional anemia patients was statistically more significant (p value<0.05). Hence Hb and PCV can be valuable tools in post-transfusion clinical assessment.

Abstract:Background: During the second wave of COVID-19 starting in January 2021, an increase in Mucormycosis infection was recorded in various Indian states. With the aim of identifying the contribution or relationship of covid 19 infection in the incidence, severity and treatment outcomes of Mucormycosis during the pandemic, this retrospective observational research study was conducted.
Method: 113 people with rhino orbital Mucormycosis were included in the retrospective observational investigation. Based off the past medical records, basic demographic information was gathered. In order to evaluate the association between covid 19 infection and Mucormycosis, patient histories of COVID infection, steroid usage during therapy, and oxygen consumption were collected. Positive RTPCR and/or Positive Rapid antigen tests were used to diagnose active covid positive status. Using a nasal swab/tissue KOH mount, nasal endoscopy with biopsy, and radiographic tests to determine the extent, the diagnosis of Mucormycosis infection was established. A multidisciplinary strategy was used to handle the patients in collaboration with the departments of medicine, ophthalmology, neurosurgery, and OMFS. Individuals with uncontrolled diabetes received insulin and/or oral medications, and BSL was aggressively managed. Each patient received 3 to 5 mg/kg body weight/day of intravenous amphotericin B, adjusted according to renal function, medication availability, and the severity of the illness. Individuals who underwent endoscopic debridement using a modified Denker’s technique or medial maxillectomy had disease that was restricted to the nose and paranasal sinuses but did not affect the palate or orbit. Whole maxillectomy was performed on patients who had palatal involvement. Most individuals with orbital involvement underwent a limited procedure for orbital decompression or rarely an exenteration/evisceration procedure.
Results: Out of 113 patients, 26 (23%) had a Covid positive status at the point they were initially assessed, 56 (49.55%) had confirmed prior h/o covid infection, 31 (27.4%) had no proven h/o covid 19 infection, and 62 (54%) had h/o usage of steroids to treat their covid infection. Of of the 113 patients, 90 patients underwent combination medicinal and surgical therapy, which comprised of administering injectable Amphotericin B and performing endoscopic endonasal debridement of the afflicted areas. 23 patients (20%) were left unoperated, largely as a result of problems arising from active COVID-19 infection (15 patients, 13%) or severe cerebral involvement (6 patients), as well as the refusal of two patients undergo surgery. Out of the 113 patients who received treatment, 24 (21.23%) died from the disease, leaving 89 (78.76%) surviving. Of the survivors, 27 (23.89%) had some form of disability at the end of the treatment period (in form of cranial nerve palsies, permanent loss of vision, palatal perforations and in 1 case a patient had an open left maxillary and nasal cavity which was referred to plastic surgeon for revision surgery and rehabilitation and 62 patients (54.86%) healed fully without any sequelae. Those who received combination therapy, which included both surgery and IV amphotericin, fared far better (84 in 90 survived 93%) than those who had only IV amphotericin B therapy (5 in 23 survived 22%).
Conclusion: Covid positive status was linked to higher disease severity, increased morbidity, and increased mortality after therapy. There were several individuals with Mucormycosis who had no prior history of COVID. Increased mortality was linked to uncontrolled diabetes, Rhino orbital cerebral expansion, and concurrent covid positive status. Our study shows that invasive Mucormycosis can have a positive clinical result with immediate vigorous surgical debridement and antifungal drug administration.

Abstract:Introduction: Hypertensive disorders in pregnancy lead to placental immaturity and uteroplacental under-perfusion, resulting in increased production of beta-hCG hormone. The aim of this research is to compare beta-hCG levels after the 20th week of pregnancy between normotensive and hypertensive pregnant women in order to assess its predictive value for hypertensive conditions during pregnancy.
Material and Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Govt. Medical College, Srinagar over a period of 18 months (January 2021 to July 2022). One hundred patients fulfilling the selection criteria were included in the study and divided into two groups (cases and controls). The data was collected in Excel Sheets and analyzed using SPSS v20.
Results: A total of 109 patients were included in our study, out of which 9 patients were lost to follow-up and were omitted from the study. Among the 100 patients, 50 were cases and 50 were controls based on the inclusion and exclusion criteria. In our study, mean systolic and diastolic blood pressure, mean gestational age, mean beta hCG, and proteinuria were statistically significant. However, mean beta hCG values based on PIH (Pregnancy-Induced Hypertension) severity and mean age were statistically insignificant.
Conclusion: In our study, we concluded that hypertensive pregnant women have abnormally elevated beta hCG levels.

Abstract:We present a rare case of a 27-year-old woman with a complete hydatidiform mole, which is an abnormal pregnancy that typically causes vaginal bleeding and elevated serum \(\beta\)-human chorionic gonadotrophin (hCG) levels. However, this patient had a 36-week size uterus, severe anemia, and vaginal bleeding, but with a non-detectable \(\beta\)-hCG level, likely due to the “hook effect.” She also had chronic pancreatitis, with a dilated hepatobiliary system and free fluid in the pelvis, caused by the enlarged uterus compressing the abdominal organs. The patient received blood transfusions and was treated with dilation, evacuation, and serial monitoring of serum \(\beta\)-hCG levels. It is important to note that a negative urine pregnancy test or non-detectable \(\beta\)-hCG level should be followed up with a repeat measurement on a diluted sample to avoid the “hook effect.”

Abstract:Background: We aimed to study the influence of low dose dexmedetomidine as an adjuvant on hemodynamic parameters and recovery profile of patients maintained on desflurane for sitting position intracranial tumor surgeries.
Method: 60 ASA class I to III patients undergoing elective sitting position intracranial tumor surgery were randomized to receive either Dexmedetomidine infusion at the rate of 0.25 \(\mu\)g/kg/hr (Group D) or normal saline infusion (Group C) from the time patient was taken on table and continued till the end of dura closure. Monitoring done for hemodynamic changes, minimum alveolar concentration, BIS, recovery endpoints and adverse events.
Result: The heart rate was comparable in both the groups at baseline and decreased significantly in patients of Group D. The mean MAC in patients of Group C was high. The Bispectral Index values decreased significantly in patients of Group C as compared to Group D till the end of the study. The recovery endpoints parameters were significantly lower in patients of Group D as compared to patients of Group C. Ramsay Sedation Score was significantly lower in Group D compared to Group C from the time of discontinuation of anesthesia delivery till the end of 120 mins. This difference was statistically significant as per Student t-test (p<0.05).
Conclusion: Dexmedetomidine infusion started in low dose before surgery maintains hemodynamic stability intraoperatively, reduces the amount of anaesthetic drug required for induction, decreases the requirement of analgesic drug without any residual sedation.