Comparative Evaluation of Clonidine as an Adjunct to Ropivacaine for Caudal Block Anaesthesia in Children Undergoing Sub-Umbilical Surgeries

BACKGROUND Studies suggest that clonidine can improve the duration of analgesia, quality of pain control when used with ropivacaine for caudal blocks in children. This study was designed to understand the effects of caudally administered ropivacaine 0.25 % (1ml/kg) alone and ropivacaine 0.25 % (1ml/kg) with clonidine 2 mcg/kg, in children between 2- 10 years. METHODS Sixty children posted for various sub-umbilical surgical procedures were included after written informed consent and ethics committee approval. Children were randomly divided into 2 groups of 30 each: Group R —ropivacaine 0.25 % 1 ml/kg into caudal epidural space and Group RC—ropivacaine 0.25 % 1 ml/kg and clonidine 2 mcg/kg into caudal epidural space. RESULTS The mean age of patients was similar with no statistical difference (4.83 vs 5.36, P = 0.3353). The duration of anaesthesia was significantly longer in the RC group (544.83 minutes vs 268.00 minutes, P < 0.0001). The effect size was very high (Cohen d=23.86). The pain score was comparable up to 1 hour for the two groups. But 2 hours later, the pain scores were significantly lower for the ropivacaine and clonidine groups. The effect on motor blockade was similar in both groups with no motor blockade at 4 hours follow up. 5 cases of urinary retention were seen in the study with no statistically significant difference in terms of complication rate between the two groups. No case of hypotension or bradycardia was seen. There was a significant difference between the two groups in terms of cardiovascular parameters (HR, SBP, DBP) after administration of drugs. CONCLUSIONS The addition of clonidine to ropivacaine for caudal blocks in children was associated with better quality of pain control and a longer duration of analgesia without any additional motor blockade. There was no significant difference seen in terms of complication. KEY WORDS Analgesia Duration, Caudal Analgesia, Clonidine, Pain Control, Ropivacaine.

Prevalence of Vitamin D Deficiency in Exclusively Breast Fed Infants in Suburban Area Lucknow, Uttar Pradesh

BACKGROUND Exclusive breastfeeding is recommended up to 6 months of age with all its beneficial effects on child survival. Several studies have shown that adequate intake of vitamin D cannot be met with human milk as the sole source of vitamin D, although risk factors for developing vitamin D deficiency may be low maternal levels of vitamin D, indoor confinement during the day, living at higher altitudes, living in urban areas with tall buildings, air pollution, darker skin pigmentation, use of sunscreen and covering much over the body when outside. An infant who is entirely on breastfeeding and has minimal to no exposure to sunlight is more prone to the development of hypovitaminosis-D. The main purpose of the study was to identify the prevalence & high-risk groups of hypovitaminosis D in exclusively breastfed babies. METHODS It was a cross-sectional observational study consisting of 30 entirely breastfed healthy full-term babies with a birth weight > 2.5 kg. Babies born to mothers with a history of pre-eclampsia, gestational diabetes, antepartum haemorrhage, tuberculosis, and other chronic medical illnesses were excluded from the study. The period of study was from 1st August 2019 to 30th September 2019. Their serum vitamin D3, serum calcium, serum phosphate, and alkaline phosphatase levels were measured using appropriate methods. RESULTS In our study, 25 infants out of 30 came out as vitamin D deficient. The prevalence of vitamin D3 was found to be 83 %. CONCLUSIONS Breastfeeding is of utmost importance but the nutritional status of the mother, proper exposure to the sun, and vitamin D supplementation are the factors that should be taken care of for the prevention of hypovitaminosis D. KEY WORDS Vitamin D3, Hypovitaminosis D, Exclusive Breast Feeding, term babies, infants, Sun Exposure, Rickets

Prevalence of Abnormal Glucose Tolerance in Obese Pregnant Women - A Study from a Tertiary Care Centre

BACKGROUND Obesity has emerged as an important risk factor in modern obstetrics and poses a major threat to pregnancy by causing complications including gestational diabetes. It also increases the risk of cardiovascular diseases and diabetes mellitus in later life. Obesity creates major technical challenges in providing maternity services too. The objective of the study was to assess the prevalence of abnormal glucose tolerance in obese pregnant women in a Government Medical College over one year. METHODS A prospective observational study was conducted among obese pregnant women, registered at the Outpatient department of Obstetrics and Gynaecology at the Government Medical College, Kottayam from January 2017 to December 2017. 450 women were considered for the study after satisfying inclusion and exclusion criteria. BMI was calculated using pre-pregnant weight. An oral glucose test was performed with 75 gm glucose at 24 to 28 weeks of pregnancy after 8 hours of fasting. International Association of Diabetes and Pregnancy Study Group cut-offs i.e., fasting blood sugar values more than 92 mg/dl, 1hr value more than 180 mg/dl, 2 hr value more than 153 mg/dl were used as the criteria. Oral glucose tolerance was considered abnormal if any of the above values were impaired. RESULTS The prevalence of abnormal glucose tolerance among the 450 pregnant women was 35.6 %. The incidence of abnormal GTT increased with increasing age and in those with a history of menstrual irregularities and infertility treatment. No relation was found between economic status, family history of diabetes, preeclampsia and abnormal GTT. CONCLUSIONS Obesity turns to be a menace in the reproductive life of women that begins by affecting the fertility, continues to cause complications in pregnancy, increases morbidity in the long-term future and reduces the quality of life. Since more than one-third of the study population was affected by gestational diabetes, active intervention to reduce the weight preconceptionally is needed. KEY WORDS Obesity, Glucose Tolerance Test, Gestational Diabetes Mellitus, Body Mass Index, Pregnancy

A Review on Male Infertility - Environmental Factors, Pathophysiological and Oxidative Stress

Male infertility is one of the rising global problems with an increasing decline in male semen quality among men living in Asia, Europe, Africa and North America. Infertility is defined as the failure of conception after at least 12 months of unprotected intercourse. Globally 70 million people are affected by infertility. Environmental, occupational and modifiable lifestyle factors may contribute to this decline of male fertility. Various factors associated with male infertility include smoking cigarettes, alcohol intake, use of illicit drugs, obesity, genetic factors, heavy metals, psychological stress, exposure to pesticides and industrial chemicals, poor nutrition intake, oxidative stress, sedentary lifestyle, advanced paternal age, diet and coffee consumption. KEY WORDS Infertility, Antioxidant, Environmental Factors, Endocrine Factors

Natural Orifice Non-Descent Hysterectomy - Revisiting Fading Surgical Art

BACKGROUND We wanted to assess the feasibility of natural orifice non-descent hysterectomy (NONH) for various benign gynaecological indications. METHODS This retrospective study was conducted at a tertiary care centre including patients requiring hysterectomy for various gynaecological indications over 12 months. Outcomes including time of surgery, blood loss, intraoperative surgical technique, complications, and conversion to the abdominal route were noted. RESULTS A total of 68 cases of natural orifice non-descent hysterectomy were performed. The uterine fibroid was the most common (50 %) indication for surgery followed by adenomyosis. Uteri with previous multiple surgeries were also successfully operated vaginally. The average surgical time was 60 min, with minimal blood loss. Post-operative recovery was good and patients were discharged after 48 hours. CONCLUSIONS This article concludes that natural orifice is a safe route of non-descent hysterectomy even for larger and scarred uteri using various debulking and surgical techniques but requiring good anatomical knowledge, surgical expertise and teamwork. KEY WORDS Natural Orifice Non-Descent Hysterectomy (NONH); Surgical Variations; Debulking Technique; Post-Operative Recovery

Masson’s Tumour - Case Report of a Malignant Masquerader with Literature Review

Masson’s tumour, an uncommon, benign vascular disorder was first described by Pierre Masson in 1923 as an intravascular papillary proliferation that emerged from an inflamed hemorrhoidal vein of a 68-year-old man and termed it as “Hemangioendotheliome vegetant intravasculaire”.1 He interpreted the lesion as a form of neoplasm, however, Henschen portrayed it as a reactive phenomenon. The current terminology intravascular papillary endothelial hyperplasia (IPEH) was put forward by Clearkin and Enzinger in 1976 considering it as a reactive change occurring secondary to trauma-related vascular stasis.2 The tumour constitutes 2-4 % of all skin and soft tissue tumours. The common locations are head, neck and extremities.3 Masson’s tumour being a benign entity with an excellent prognosis is essential to differentiate from its closer mimic, angiosarcoma which needs aggressive treatment. This case is put up here because of its rarity and its clinical implications.

Effect of Different Cavity Disinfectants on Microleakage

BACKGROUND Cavity disinfectants are frequently used for the elimination of bacteria that remain in the cavity, which are shown as the cause of secondary caries. However, its effect on microleakage from the tooth-restoration interface is still under investigation. The purpose of this study was to compare and evaluate the effects of the use of three different cavity disinfectants on microleakage in Class V composite restorations. METHODS For this study, 28 permanent third molar teeth without caries and restoration were used. Class V cavities of 4 mm x 3 mm x 3 mm were prepared on the buccal surfaces of each tooth. The teeth were randomly divided into 4 groups, with 7 teeth in each group. No cavity disinfectant was applied to the teeth in group 1. Tubulicid Red Label (Dental Therapeutics AB, Sweden) cavity disinfectant was applied to the 2nd group teeth, Cavity Cleanser (BISCO Inc., USA) cavity disinfectant to the 3rd group teeth, and Oxygenated Water (Dermosept, Turkey) cavity disinfectant to the 4th group teeth. Composite resin with universal adhesive and nanohybrid filler was applied to all samples in the groups in accordance with the recommendations of the manufacturers, and finishing and polishing processes were performed. Then, the thermal cycle (NOVA, Konya, Turkey) procedure was applied. After the restorations were covered with nail polish, they were kept in a 5 % basic fuchsin solution. The teeth were cut vertically in the buccolingual direction and examined with a stereomicroscope at x 40 magnification. The results were statistically evaluated with Kruskal-Wallis and Mann-Whitney U tests. RESULTS When the microleakage scores were compared between the control group and the groups treated with Tubulicid Red Label (p:0.204), Cavity Cleanser (p:0.204) and Oxygenated Water (P: 0.788), it was determined that there was no statistically significant difference (P > 0.05). CONCLUSİONS It was determined that different cavity disinfectants applied in Class V cavities did not have a negative effect on microleakage and the closest results to the control group were seen in the group where cavity cleanser disinfectant containing 2 % chlorhexidine digluconate was applied. KEY WORDS Cavity Disinfectants, Class V Cavity, Microleakage.

Associated Factors with the Mortality Rate in Patients with COVID-19 - Decision Trees Vs. Logistic Regression

BACKGROUND Given the global burden of COVID-19 mortality, this study intended to determine the factors affecting mortality in patients with COVID-19 using decision tree analysis and logistic regression model in Kermanshah province, 2020. METHODS This cross-sectional study was conducted on 7799 patients with COVID-19 admitted to the hospitals of Kermanshah province. Data gathered from February 18 to July 9, 2020, were obtained from the vice-chancellor for the health of Kermanshah University of Medical Sciences. The performance of the models was compared according to the sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve. RESULTS According to the decision tree model, the most important risk factors for death due to COVID-19 were age, body temperature, admission to intensive care unit (ICU), prior hospital visit within the last 14 days, and cardiovascular disease. Also, the multivariate logistic regression model showed that the variables of age [OR = 4.47, 95 % CI: (3.16 -6.32)], shortness of breath [OR = 1.42, 95 % CI: (1.0-2.01)], ICU admission [OR = 3.75, 95 % CI: (2.47-5.68)], abnormal chest X-ray [OR = 1.93, 95 % CI: (1.06-3.41)], liver disease [OR = 5.05, 95 % CI (1.020-25.2)], body temperature [OR = 4.93, 95 % CI: (2.17-6.25)], and cardiovascular disease [OR = 2.15, 95 % CI: (1.27-3.06)] were significantly associated with the higher mortality of patients with COVID-19. The area under the ROC curve for the decision tree model and logistic regression was 0.77 and 0.75, respectively. CONCLUSIONS Identifying risk factors for mortality in patients with COVID-19 can provide more effective interventions in the early stages of treatment and improve the medical approaches provided by the medical staff. KEY WORDS COVID-19, Decision Tree, Logistic Regression, Mortality, Risk Factor

COVID - 19 Presenting with Fungal Infections - The Hidden Pandemic within Pandemic?

As the pandemic continues to spread vigorously, it is being noted that the COVID 19 virus is associated with various complications during the disease and also a great deal of post disease sequel.1 These gruelling complications are integrated with the overwhelming infection caused by the cytokine storm produced by the virus. While the treatment modalities are still under trial, glucocorticoids seem to have played a pivotal role in putting a check to the inflammation caused by the virus and have forbidden the organ damage caused thereafter. However, the aftermath of glucocorticoids usage has its own benefits and risks. Glucocorticoids cause cellular immunodeficiency and thus have immunosuppressive effects, additionally the use of immunomodulators such as tocilizumab alters the immune system and it subsequently predisposes the host to various secondary opportunistic infective agents. In the current state, as the pandemic abstains from fading away, an increasing trend of secondary fungal infections has been seen with COVID-19, resulting in an outbreak of fungal infections such as mucormycosis and candidiasis. Mucormycosis refers to any infection caused by the fungi of the Order Mucorales. Mucormycosis has been documented in the literature to be associated with a high rate of mortality due to its potential to spread drastically.2 Altered immunity is an important risk factor for mucormycosis. Additionally, diabetes has been noted to be critical for the development of mucormycosis in immunocompetent patients. Candidiasis is an infection caused by the candida species due to the immunosuppressed state developed by the use of glucocorticoids, which results in secondary fungal infection requiring urgent medical attention. The objective of this case report is to highlight the impending secondary fungal infection outbreak in COVID-19 and the need to contain this emerging spread of fungal infections under the blanket of this deadly pandemic.

Impact of Dengue Fever on Pregnancy and Its Outcome

BACKGROUND Dengue fever is a vector-borne disease common in the tropics. It is known to have an adverse effect on pregnant women with unfavourable foetal outcomes. However, only a few studies are addressing this problem. Many of the studies had confounding factors such as the simultaneous occurrence of other vector-borne diseases and maternal health conditions. Therefore, the actual impact of dengue fever on pregnancy and pregnancy outcome is not clear. We wanted to study maternal and foetal outcomes in dengue positive pregnant females. METHODS This is a retrospective study done over 6 months in a tertiary care institute. Data regarding demography, obstetric history, biochemical parameters / blood investigation and pregnancy outcomes were collected and analysed. RESULTS Most of the dengue positive women presented with fever and thrombocytopenia in 44 % of cases. Obstetric complications such as preterm labour, abruption and postpartum haemorrhage (PPH) were common. Caesarean section rate was increased and the most common indication was foetal distress. The need for new-born intensive care unit (NICU) admission for new-born and foetal death was also increased. No evidence of congenital anomaly was found in the study. CONCLUSIONS Antenatal complications like preeclampsia, oligohydramnios; intrapartum complications like abruption, DIC, foetal distress and immediate postpartum complications like postpartum haemorrhage, need for blood, platelet transfusion were common in women with a history of dengue fever especially more in the low platelet group. The maternal and foetal outcomes were compromised and both required intensive care. A high index of clinical suspicion is essential in pregnant women presenting with fever and thrombocytopenia. Early diagnosis and management are essential. KEY WORDS Dengue Fever, Dengue in Pregnancy, Complications of Dengue Fever in Pregnancy