GMC Patiala Journal of Research and Medical Education

Anaesthetic Management of 66 year old with severely reduced ejection fraction Undergoing Gastrojejunostomy

2023-11-29T14:19:25+0530

Patients of gastric outlet obstruction are usually sick because of underlying pathology ,electrolyte imbalances and subsequent poor intake. Such patients with cardiac compromise is further challenging . The combined risk of low ejection fraction and poor cardiac reserve may predispose to increase perioperative mortality. Complications in the perioperative period include acute exacerbation of heart failure which can arise from pump failure. Therefore, maintaining good systolic function and cardiac rhythm will ensure cardiovascular stability. We present the case of an 66 year old man k/c/o DMT2 who had severe LV systolic dysfunction with EF 25% that successfully had gastrojejunostomy under general anaesthesia.

MORPHOLOGICAL VARIANT OF STERNOCLEIDOMASTOID MUSCLE

2023-09-20T23:46:06+0530

The sternocleidomastoid is an important muscle of head and neck region dividing the neck into anterior and posterior triangles. It arises from two heads one sternal and other clavicular and gets inserted into the lateral surface of mastoid process and lateral part of superior nuchal line.

Unilateral variation found in origin of sternocleidomastoid muscle during routine dissection of head and neck region on a 60 year old male cadaver. Three heads of sternocleidomastoid were found on the left side.

The accessory head of sternocleidomastoid muscle was found on the left side taking origin from clavicle 4.2cm lateral to the normal clavicular head. Its fibres then merged with the normal clavicular fibers and got inserted into the lateral surface of mastoid process and lateral part of superior nuchal line.

The study will help the surgeons and interventionists for muscle graft and also approach of this area carefully during neck surgery or while taking MRI scans.

Self-inflicted accidental penile fracture: A rare case report in Indian scenario.

2023-12-18T13:03:23+0530

Penile fracture is a rare injury sustained during sexual intercourse. We report a rare case of 30 years old male who had accidental self-inflicted penile fracture , not related to masturbation or sexual intercourse. Diagnosed promptly on clinical assessment ,confirmed on medical imaging and managed surgically. Our case highlights the importance of maintaining a high index of suspicion to diagnose this rare condition even in absence of typical mechanism of injury in Indian scenario in order to ensure that such an injury is not missed.

A Rare Case of Idiopathic Frontal Bone Osteomyelitis

2023-08-08T08:33:03+0530

Osteomyelitis, although seen usually in long bones, shows a rare occurrence in the frontal bone as well. Acute osteomyelitis mostly presents as a soft, tender and fluctuant swelling on the forehead, known as Pott’s puffy tumour when subperiosteal abscess is present, first described by Sir Percival Pott. Whereas chronic osteomyelitis presents as a forehead lump with or without fistula. We present a case of a 70 year old female who presented with a long-term history of forehead swelling and right upper eyelid fistula without any prior history of sinusitis, trauma or sinus surgery. She underwent surgical debridement of the necrotic bone and sequestrum with an uneventful post operative period.

Newer Advances in the Management of Hepatitis C

2023-12-08T14:24:56+0530

HCV(hepatitis C virus) is single-stranded enveloped RNA virus. Chronic HCV infection is one of the leading causes of liver-related deaths in many countries.About 130-170 million peopleare estimated to be infected with the hepatitis C virus (HCV). Main aim of antiviral treatment targets eradication of the virus. Until a few years ago,the combination of pegylated interferon and ribavirin (PEG/RBV) was the only treatment strategy available and the rates of viral clearance response did not surpass 50% in certain genotypes (1 and 4) with these treatments. In 2011, the first direct acting antiviral agents (DAA), boceprevir and telaprevir were approved for treatment of genotype 1, in combination with traditional dual therapy which accomplished to increase the rates of sustained viral response (SVR) in both naive patients and in retreated patients. New, more effective DAAs have been incorporated since 2013. Besides increasing the rates of SVR, these have pan-genomic properties, excellent tolerance and ease of administration being oral drugs. This has led to shorter therapies, lesser toxicities and regimens free of PEG/RBV, which has enabled their almost generalised applicability in all patients with minimal invasive investigations required.

Role of Oximes in Organophosphorous Poisoning

2023-12-23T16:34:47+0530

Poisoning both intentional and accidental are huge contributor to mortality and morbidity throughout the world. The most common cause of poisoning in developing countries like India are pesticides, the reason being agriculture-based economics and among them organophosphorus constitutes the largest bulk of pesticides. Standard treatment involves supportive measurements, administration of intravenous atropine and oxime to counter acetylcholinesterase inhibition at the synapse^.[1] However, the usefulness of oximes, such as pralidoxime and obidoxime has been challenged over the past 20 years by physicians in many parts of the world who have failed to see benefit in their clinical practice. But there are various reasons for that as the published methodology in such studies is unclear and another study conducted in Sri Lanka shows that 70% patients had ingested dimethyl compounds, where ageing of enzyme occurs at much early stage and hence, ineffectiveness of oximes.

Comparison Of Clinical Pulmonary Infection Score (CPIS) versus Johanson Criteria for The Diagnosis Of Ventilator Associated Pneumonia (VAP)

2023-12-04T14:07:59+0530

INTRODUCTION: A prospective observational cohort study was carried out in ICU patients requiring ventilatory support for 48 hrs or more to compare the diagnostic tool of clinical pulmonary infection score (CPIS) versus Johanson criteria for the diagnosis of ventilator associated pneumonia (VAP).
MATERIAL AND METHODS: After obtaining approval from the ethics committee and informed written consent from the patient’s relatives an observational study was carried out in 25 patients admitted to the ICU, in Government Medical College and Hospital Chandigarh, in a 2-month period. The inclusion criteria were adults (18-80yrs) who required ventilator support for a minimum of 48 hrs. Patients with primary respiratory pathology and those not requiring ventilator or requiring ventilator for <48hrs were excluded from the study. The study group was regularly evaluated for development of VAP based on CPIS which was compared to Johanson clinical criteria. Data was expressed as median ±interquartile range (QR), minimum-maximum. Fischer and Pearson Chi-square tests, Mann-Whitney U test were used for statistical analysis. P<0.05 was considered as significant. The sensitivity, specificity and positive and negative predictive values (PPV, NPV) of CPIS were determined by comparing patients of VAP with non-VAP. CPIS evaluation includes- body temperature, leucocyte count, tracheal secretions, oxygenation, chest x-ray findings, tracheal culture aspirate. The Johanson clinical criteria includes- new infiltrates on chest x-ray and at least 2 of the following: leukocytosis, leucopenia, fever, hypothermia and purulent tracheal secretions.
RESULTS: Taking Johanson criteria as the reference standard, CPIS had a sensitivity of 60% and specificity of 90% on 3rd day which increased considerably by 5th day to 100% to 87.6% respectively. The PPV was 60% and 83.3% on the 3rd and 5th day respectively. The corresponding NPV were 90% and 100% respectively.
CONCLUSION: CPIS can be used as an effective and comprehensive screening tool for the diagnosis of VAP which will help reduce overtreatment significantly.

Sero-Epidemiological Investigationof Hepatitis A Virus (HAV) and Hepatitis E Virus (HEV) among Acute Viral Hepatitis Cases at a Tertiary Care Centrein Punjab

2023-12-04T09:35:56+0530

Abstract:BACKGROUND:Acute viral hepatitis, primarily caused by enteric viruses like hepatitis A (HAV) and hepatitis E (HEV) carry a significant health burden in India. It poses serious health concerns due to their link with inadequate hygiene and sanitation practices.AIM:In a tertiary care facility in Punjab, North India, the current study sought to determine the prevalence of the hepatitis A and hepatitis E viruses in patients who were presenting with acute viral hepatitis.MATERIAL AND METHOD:A total of 483 serum samples collected from tertiary care hospital in 2022 were analyzed for IgM antibodies against HAV and HEVusing rapid diagnostic tests(RDTs).RESULTS:The results revealed a higher incidence of HAV IgM positivity (13.4%) compared to HEV IgM positivity (8.7%). The combined prevalence of HAV and HEV infections was 22.15%. Gender-wise analysis showed a higher incidence of Hepatitis A in males, while Hepatitis E was more prevalent among females. Additionally, the study found a higher incidence of enteric viral hepatitis in males compared to females. Age-wise distribution indicated a higher proportion of HAV-positive cases in patients < 20 years (76.9%) and HEV-positive cases in young adults of age group 21-30 years (50%). Seasonal variation demonstrated the prevalence of both viruses throughout the year, with peaks in cases observed at the end of the monsoon season and the beginning of winter in this geographical region.CONCLUSION:The study highlights a higher prevalence of Hepatitis A Virus (HAV) as compared to Hepatitis E Virus (HEV) among suspected Acute Viral Hepatitis cases, emphasizing a significant public health concern, and underscores the need for targeted interventions and sanitation measures in our region.

Critical View of Safety in Laparoscopic Cholecystectomy: Can it prevent bile duct injuries. An Institutional Prospective Observational Study

2023-12-18T13:02:27+0530

Background Laparoscopic Cholecystectomy is the most commonly performed procedure and is the ‘gold standard’ for the treatment of cholelithiasis, however, it is associated with a preventable complication that is bile duct injury. Strasberg, in 1995 suggested a technique called “Critical View of Safety” (CVS) to avoid this complication. The effectiveness of CVS in preventing bile duct injuries is still debatable.

Methods This prospective trial was conducted on 100 patients posted for Laparoscopic cholecystectomy in the Department of General Surgery, Government Medical College and Rajindra Hospital, Patiala during the study period of May 2019 to December 2020. An attempt was made to achieve critical view of safety in each case. All the patients were assessed for various patient related and surgery related parameters which might affect the outcome and the results were evaluated.

Results Critical view of safety could not be achieved in 14% of patients, all these patients were overweight (BMI = 25 to 29.9) and had longer hospital stay. 12 % of the patients were converted to open cholecystectomy and 2% had bile duct injuries.

Conclusion Critical view of safety is an effective method of preventing bile duct injuries and thereby minimizing complications while performing laparoscopic cholecystectomy. However further studies to strengthen these results may be warranted.

Title: Trends of Transfusion transmitted Viral Infections in Whole Blood donors of tertiary care hospital in North India.

2023-12-18T13:09:43+0530

Background: Blood Transfusion plays a vital role in patient management and is life saving in many instances. The priority objective of Blood Transfusion Services (BTS) is to ensure safe, adequate accessible efficient blood supply at all times. The magnitude of Transfusion transmitted infections (TTI) varies from country to country and depends directly on the TTI load of society and also effective screening of donors at blood centre..

Aim and Objectives: To study the sero prevalence and trends in Transfusion Transmitted viral infections including HIV, HBV, HCV in whole blood donors

Materials and Methods: A retrospective study was conducted in our hospital based blood centre from January 2021 to December 2022.

Results: The sero- prevalence of HCV, HBV, and HIV decreased steadily over 2 years, whereas incidence of syphilis and malaria was same in 2 years. HCV was noted to be more than HBsAg and followed by HIV.TTI was more common in age group 21-30 years. The trends of sero-prevalence of TTI in blood donors is decreasing from 2021 to 2022.

Conclusion: Strict selection of blood donors is mandatory and is recommended to ensure safe blood supply. Voluntary blood donations need to be increased to decrease the incidence of TTI.