Biopsy Proven Kidney Disease From A Rural Tertiary Care Centre — A Social And Epidemiological Perspective

The prevalence of chronic kidney disease (CKD) is rising in rural areas. Screening of high risk cases, early detection and referral by the physicians reduces the prevalence of kidney disease in the population. Hereditary disorders, Glomerular diseases, Obstructive nephropathies are common causes in CKD in rural areas. Kidney biopsy is an essential diagnostic tool in to diagnose glomerular diseases. This prospective study done at tertiary care teaching hospital between 2017 and 2020 to understand the profile of glomerular diseases in rural area. Forty patients were included in the Study. Primary glomerular disease (PGD) was present in 26 patients and Secondary glomerular disease (SGD) in 10 and primary tubulointerstitial pathology in 4 patients. The most common Secondary glomerular disease was lupus. Glomerular diseases are amenable to immunomodulatory therapy leading to change in clinical outcome of the disease. However, Kidney biopsy is underutilized particularly in elderly patients, hypertensive nephropathy patients, suspected non diabetic kidney disease and lupus patients. Financial and social issues play dominant role in the treatment plan of chronic diseases in rural areas. Regional registry of kidney biopsy of urban and rural areas separately helps in paving a way of understanding the profile of glomerular diseases and its prevention.

Oliceridine as a Novel Selective mu-receptor G-protein Pathway Modulator: A Narrative review

Objective: To review the literature on equianalgesic efficacy and better safety(less respiratory depression and gastrointestinal dysfunction) of oliceridine versus opioid analgesic in moderate to severe postoperative pain. Methodology: A comprehensive literature search was conducted in PubMed (January 2021 to March 2021) using keywords as ‘oliceridine’, ‘ligand biased mu receptor agonist’, ‘acute postoperative pain’, ‘conventional opioids’ and ‘morphine’. All English language full text pre-clinical and clinical research articles were searched. In addition, other data source was from ClinicalTrial. Gov. Data Synthesis: Oliceridine is a novel selective µ (mu)-receptor G-protein pathway modulator. G protein biased mu receptor agonists are a new class of opioids exhibiting analgesic properties at par to morphine with less respiratory depressant properties. Oliceridine a first-in-class intravenous (IV) analgesic has received the US FDA approval in August 2020, for management of moderate to severe acute pain in adults. The drug can be administered in cases where the pain is severe enough to require an intravenous opioid and when alternative treatments become inadequate. Oliceridine is an opioid agonist with a rapid onset of action within two to five minutes, was administered via clinician-administered bolus dosing, patient-controlled analgesia (PCA), or a combination of the two. Bolus dosing was initiated at 1 to 2 mg, with supplemental doses of 1 to 3 mg every one to three hours, as needed, based on individual patient need and previous response to oliceridine in management of acute post-operative pain. If oliceridine was administered via PCA, the loading dose was 1.5 mg, the demand dose was 0.5 mg, and the lockout interval (repeat dose)was six minutes. The clinically relevant concentration range of 0 to 35 ng/ml. It is indicated for short-term use only & limited to hospitals or other controlled clinical settings. Oliceridine requires no dosage adjustments in patients with renal impairment as well as in patient with significant medical complications. Therefore, opioids that bias towards G-protein and away from β arrestin signaling should produce analgesia with reduced side effects.

Comparative Diagnostic Accuracy of Mean and Lowest Cycle Threshold Levels in Xpert MTB/RIF Assay and Molecular Epidemiology of Missing Probes In Rifampicin Resistant Tubercular Cases From A Tertiary Care Hospital

Background: The comparative diagnostic accuracy of mean and lowest Ct values needs to be evaluated for the assessment of mycobacterial burden in tubercular cases. Mutation in any codon of 81 base-pair core regions prevents the hybridization of one or more of five overlapping Probes A-Ein Xpert MTB/RIF assay indicated by “missing probe. Molecular epidemiology of missing probes may prove useful in tracing the source of infection and selection of a more suitable drug regimen for treatment. Methods: This study included 65 rifampicin resistant cases and an equal number of rifampicin sensitive cases detected by Xpert MTB/RIF assay. Only samples tested positive for tubercular bacilli were included. The information regarding the tubercular load, Ct values of five probes targeting the rpoB gene, lowest Ct value among the five probes, missing probe in rifampicin resistant cases and time taken for the entire cycle were recorded in each case. Results: Lowest Ct is a stronger indicator of tubercular load than the mean Ct value. E probe was found to be missing in majority (64.6%) of the cases, followed by A (6.2%), B and D (4.6%), C (1.5%) probes. In 7.6% cases, more than one probe was missing. None of the probe was missing in 10.6% of rifampicin resistant cases. Conclusions: Lowest Ct value was found to be a better tool than mean Ct value for the determination of mycobacterium burden. Molecular epidemiology of missing probes could be useful in the development of new probes for the detection of rifampicin resistance.

Acceptance of COVID-19 Vaccine A mong Residents of South India: A Cross-sectional Survey

Background COVID-19 vaccines provide concrete hope of mitigating the spread of the virus and enabling countries worldwide to resume financial and social activities disrupted by the pandemic. Several COVID 19 vaccines have already received approval from regulatory bodies across the world, the vaccine roll out has started and many countries are implementing mass vaccination campaigns. This study aims to evaluate the acceptability of COVID-19 vaccines and its predictors, along with the attitudes towards the vaccines among the general population of South India. Materials and Methods This study was conducted as an online survey during December 2020 and January 2021. A Self-administered pre-tested questionnaire was used for the survey. Excel 2019 and SPPS 24 were used for statistical analysis. Descriptive statistics were used, and a Chi-square test was performed. Results A total of 686 people have participated in this study, with a mean age of 30.4 years. 30.9% of study participants have already been infected with COVID-19. 76.2% responded 'yes' for accepting the COVID-19 vaccine, 69% responded to prefer 'routine' administration of the vaccine, and 50.1% were likely to take the COVID-19 vaccine 'as soon as possible' once available. Conclusion Public health authorities and policymakers need to streamline systematic interventions and awareness campaigns to improve the acceptance of COVID 19 vaccines and reduce vaccine hesitancy levels. Vaccination strategy should be targeted at the specific needs and attitudes of the concerned population. Reviving the trust in the vaccination procedures and outcomes and offering transparent information regarding the vaccines' efficacy and safety seem to be particularly importance for the population of our study.

Evaluation of Diagnostic Performance of MDCT Coronary Angiography in Comparison with Conventional Coronary Angiography

Background: Coronary artery disease is now becoming increasingly prevalent than before especially in younger age groups. We in the current study tried to evaluate the potential of 128 slice MDCT coronary angiography for the detection of stenotic coronary lesions by comparing the results of computed tomographic coronary angiography to a gold standard set by Conventional coronary angiography. Methods: A total of n=30 patients with clinically suspected Coronary artery disease. They were evaluated with 128 Slice CT Scanner (PHILIPS INGENUITY) and conventional coronary angiography. All patients were examined with a 128 slice MDCT scanner (Philips Ingenuity 128 slice Netherlands) using standard cardiac CT protocol. Gantry rotation time was 400 ms with a half sector acquisition protocol and multisector reconstruction permitting an effective temporal resolution between 50 and 200 ms depending on patient heart rate. Results: In the n=30 Patients included in the study with CCA, the n=450 coronary segments included in the study were found to contain a total number of n=138 stenoses among them non-significant stenoses. The accuracy of MDCT detection of coronary stenoses greater than 50% diameter of vessel lumen is about 94.78. When raising the threshold for stenosis from 50% to 70% of the vessel lumen, so that only hemodynamic relevant stenoses enter the evaluation, the sensitivity decreases from 88%. The MDCT detection in the patient group with heart rates below 60 beats per minute higher values for sensitivity 93% and specificity 97% were observed, compared to sensitivity 87% and specificity 93% of the patient group with heart rates above 60 beats per minute. Conclusion:The present study revealed that a high negative predictive value (98.08%)suggests that 128- Slice MDCT coronary angiography is a good screening modality for evaluation of patients with mild to intermediate-risk factors who might otherwise require invasive angiography.

Non-Invasive Assessment Of Liver Fibrosis In Patients With Non-Alcoholic Fatty Liver Disease In A Tertiary Care Hospital

Aims :To compare the NAFLD fibrosis score and FIBROSIS 4 score to fibroscan, and affirm whether the scores shall be used as a screening tool for liver fibrosis, in place of fibroscan. Methodology: It was a cross-sectional study. Patients with fatty liver on ultrasonological examination with 200 sample size. After obtaining the informed consent the following details were collected socio-demographic details, history, co-morbidities, anthropometric measurements, Laboratory investigations. Results: the ROC curve analysis of fibroscan reveals the area under curve of 0.499 and based on the cut off value of 4.50Kpas the sensitivity and specificity was found to be 85.7% and 83.5% respectively. The ROC curve analysis of fibrosis-4 reveals the area under curve of 0.495 and based on the cut off value of 0.80 the sensitivity and specificity was found to be 91.9% and 92.1% respectively. Analysis of NAFLD fibrosis score reveals the area under curve of 0.476 and based on the cut off value of -1.53 the sensitivity and specificity was found to be 93.1% and 93.9% respectively. Conclusion: Henceforth the study suggests that NAFLD fibrosis score shall be used as a non -invasive bedside assessment of liver fibrosis in high risk population and hence guiding their follow up for prevention of morbidity in resource limited settings.

Tension-Free Inguinal Hernia Repair in Local Anaesthesia versus Spinal Anaesthesia

Background: Inguinal hernia is a common presentation in surgical clinics. In the past, the hernia surgeries were done under general and spinal anesthesia. Recently local anesthesia is being increasingly used due to the increased efficacy of local anesthetics and economic reasons. We in the current study tried to evaluate the effectiveness of Lichtenstein repair under local anesthesia and spinal anesthesia and the overall outcomes of both methods. Methods: This cross-sectional study was conducted in the Department of General Surgery, Prathima Institute of Medical Sciences, Naganoor, Karimnagar. Successive cases of uncomplicated inguinal hernia were selected for the study. A total of n=60 cases randomly allotted in two groups The LA group and SA group were taken and studied. Post-operatively VAS scale was used to evaluate pain, other postoperative complications such as testicular swelling and pain, urinary retention, nausea/vomiting, postural hypotension, and wound infections were recorded. Results : The age of the patient varied from 20 to 80 years with the highest prevalence noted in the age group of 41 to 60 years. The Mean age of presentation is 51.3 years. The anatomical location and type of hernia are given in table 1. 60.9% of inguinal hernia in this study was an indirect type, 30.4% was direct, 6.5% was pantaloons type and 2.2% was Ogilvie's hernia. Out of 74 patients, 62.1% had a right-sided inguinal hernia compared to the left side which accounted for 37.8%. Complication records showed N=9(23.7%) of the SA group and n=8(22.2%) LA group developed scrotal edema and in total n=17(23%) developed scrotal edema. N=7(18.4%) patients in the SA group and n=7(19.4%) in the LA group developed seroma and in total patients, n=14(18.9%) developed seroma. Conclusion: Lichtenstein tension-free hernioplasty done under local anesthesia is with less immediate postoperative complications, also the best suitable for patients with medical comorbidities and those who are on antiplatelet therapy where spinal anesthesia is contraindicated.

Comparative Study of Knowledge of Urban and Rural Mothers about Neonatal Care

Objectives: The purpose of this study is to assess and compare the knowledge about the neonatal care among the mothers in urban and rural area in district Ajmer province of Rajasthan Materials and methods: Comparative randomized descriptive study was conducted among mothers who willingly gave consent to participate in the study. A structured questionnaire were framed and mothers were interviewed, the answers were recorded. To judge the knowledge score of the mothers closed ended questions having four alternatives were also framed. One mark was allocated for correct response. Results: Among 5800 deliveries, 400 mothers (205 mothers were Urban and 195 mothers were from Rural area) were randomly selected. Mothers with Antenatal check-up had knowledge score of 61% compared to 24% who had no regular antenatal checkup. Knowledge about “Exclusive Breastfeeding” was 84.39% and 68.20% urban mothers and rural mothers and regarding adequacy was 73.17% in Urban and 44.61% in rural mothers. Knowledge about Hygiene was 89.75% and 53.33% in Urban and rural mothers. Skin care and baby bath was 28.29% and 18.46% in Urban and Rural mothers respectively. Knowledge about danger signs was 81.95% and 60% in Urban and Rural mothers respectively. Knowledge regarding immunization at birth was 70.7% and 35.89% in Urban and Rural mothers respectively. Conclusions: Main factors affecting the knowledge score of the mothers about neonatal care were Educational status and Antenatal checkup. Knowledge about adequacy of breastfeeding, Immunization at birth, Danger signs, Temperature maintenance and hygiene was less in rural mothers as compared to urban mothers.

Use of Computed Tomography (CT scan) for delineating anatomy and variation of frontal Sinus before Functional Endoscopic Sinus Surgery

Introduction: For Functional Endoscopic Sinus Surgery (FESS), the surgeon needs an accurate depiction of the anatomy of paranasal sinuses and their variations. Computed tomography (CT Scan) fulfills this requirement by providing detailed anatomy, the anatomical variants, and the extent of the disease in and around the Para nasal sinuses. The aim of this study is to show the anatomy of the Frontal sinus as delineated by the computed tomography. Materials and Methods: STUDY DESIGN: Cross section Descriptive Study. Out of 337 patients above 12 years of age who were referred for computed tomography of paranasal sinuses in the Dept. of Radio- Diagnosis, Govt. Medical College and Hospital from December 2015 till October 2017, 200 adults(males and females) were randomly selected.Of the 200 subjects studied 37(18.5%) subjects had hypoplastic/ non or poorly pneumatised frontal sinuses of which 31 (15.5%) were bilateral and 6 (3%) were unilateral i.e. on right side. Observations and results: Intra frontal cell were seen in about 64 (32%) subjects of which 26 (13%) on right side, 24 (12%) were on left side and 14 (7%) were bilateral. Extension of pneumatisation into crista galli was seen in 16 (8%) subjects and into orbital roof was seen in 6 (3%) subjects. Conclusion: The findings in this study show that anatomical variations in the Para nasal sinuses and nasal cavity are common. Computed tomography is fundamental radiologic investigation for diagnosis of the Sino nasal lesions or pre and post-surgical assessment.

An Analysis of Aetiology, Pattern and Outcome of Head Injury in Trauma Patients

Background: Head injury is considered as a major health problem in developed and developing nations. Analysis of etiology, patterns, and outcome of head injury in trauma patient is essential for understanding and planning for better management. Materials and Methods: The prospective observational study carried out among patients who presented with head injury at the tertiary care hospital, Mumbai from July 2015 to July 2017. Demographic details recorded were age, sex, blood pressure on arrival, Glasgow Coma Scale (GCS) score, the interval between injury and admission, associated injury, co-morbidities, hospital stay, and outcome. Results: The age group at which maximum patients of head injury were admitted was 18-29 years (31%) followed by 40-49 years (21%). Eighty one percent patients were males and 19% patients were females, the male to female ratio being 4:1. Road traffic accidents (36% cases) were the commonest cause leading to acute head injury followed by accidental fall (21% cases). 47% patients presented with mild head injury according to GCS. Conclusion: Head injuries mainly caused by vehicular accidents and affect mainly the young men. Road traffic accidents were the commonest mode of head injury, but railway accident had the worst outcome in our study. Factors associated with outcome were Pre-hospital delay, GCS on arrival, Blood pressure on arrival, Associated injury, Need for ventilator support, CT scan findings.