GMC Patiala Journal of Research and Medical Education

Comparative Evaluation of Intravenous Labetalol Dexmedetomidine and Lignocaine for Attenuation of Hemodynamic Response to Pneumoperitoneum A Randomized Controlled Study

Harsimran Kaur Manocha — 2025-08-13

Background and Objective:
Laparoscopic cholecystectomy, though minimally invasive, is associated with significant hemodynamic stress responses due to pneumoperitoneum and anaesthetic interventions. Effective attenuation of these responses is crucial, particularly in patients with cardiovascular risks. This study compares the efficacy of intravenous labetalol, dexmedetomidine, and lignocaine in controlling these responses.

Material and Methods:
In this prospective, randomized controlled study, 150 ASA I–II normotensive patients aged 16–60 years undergoing elective laparoscopic cholecystectomy under general anaesthesia were randomized into three groups (n = 50 each). Group L received labetalol 0.25 mg/kg in 200 ml NS over 10 minutes before induction, Group D received dexmedetomidine 0.5 µg/kg in 200 ml NS over 10 minutes before induction, and Group Lox received lignocaine 1.5 mg/kg as bolus 3 minutes before induction. Hemodynamic parameters (HR, SBP, DBP, MAP) were recorded at baseline, induction, laryngoscopy, and at 3-minute intervals up to 30 minutes post-intubation.

Results:
Dexmedetomidine demonstrated the most consistent and significant control of heart rate and blood pressure throughout the intraoperative period. Labetalol effectively maintained blood pressure but was less effective in controlling heart rate. Lignocaine showed moderate efficacy in attenuating hemodynamic responses. Adverse events were minimal: hypotension occurred in 2% of patients in Group L, and bradycardia occurred in 10% of Group D. No adverse events were noted in Group Lox.

Conclusion:
Dexmedetomidine was superior in maintaining hemodynamic stability during laparoscopic cholecystectomy, with labetalol serving as an effective alternative for blood pressure control. Lignocaine, while safe, was less effective in managing acute hemodynamic fluctuations. Dexmedetomidine may be preferred in patients at risk of exaggerated sympathetic responses.

Keywords:
Dexmedetomidine, Labetalol, Lignocaine, Hemodynamic response, Laparoscopic cholecystectomy, Pneumoperitoneum, General anaesthesia

Seroprevalence of Viral Hepatitis in A Tertiary Care Hospital

Rupinder Bakshi — 2025-08-13

Background: Viral hepatitis remains a significant global public health concern, accounting for over one million deaths annually. Acute hepatitis is often caused by the hepatitis A and E viruses, and it can progress to acute liver failure. Chronic hepatitis, primarily due to Hepatitis B and C viruses, often remains asymptomatic until it leads to seriouscomplications such as cirrhosis and hepatocellularcarcinoma.
Aim and Objective: This study aims to assess the seroprevalence of viral hepatitis among clinically suspected patients presenting to a tertiary care hospital.

Materials and Methods:A retrospective analysis was carried out on probable viral hepatitis cases, based on blood samples received from RH Patiala and processed at the Virus Research and Diagnostic Laboratory (VRDL), Department of Microbiology, over a period of three months. Serological testing of all the samples was performed, by using rapid card tests and confirmation is done by ELISA for HEV IgM antibodies, HBsAg of HBV and anti HCV IgG antibodies.

Results:The seroprevalence of hepatitis markers observed in our study was as follows: HCV – 7.48%, HBV – 1.69%, HEV – 3.13%, and HAV – 15.6%. Among cases of acute hepatitis, HAV positivity was notably higher than HEV, whereas in chronic hepatitis, HCV positivity exceeded that of HBV.Gender-wise distribution showed a higher proportion of males testing positive across all hepatitis markers: HEV (58.33%), HCV (51.83%), HBV (50.74%), and HAV (56.86%).Age-wise analysis revealed that the majority of positive cases for HCV (69.59%), HBV (63.33%), and HEV (66.66%) occurred in the 20–60-year age group, while HAV positivity was predominantly observed in the 0–20-year age group (60%).

Conclusion: Viral hepatitis poses a substantial public health burden; however, its transmission can be effectively reduced through the implementation of comprehensive control strategies. These include timely laboratory diagnosis, appropriate therapeutic interventions, and widespread vaccination efforts. Strengthening these measures is essential to limit disease spread and reduce associated morbidity and mortality.

Preoperative Predictors of Mortality in Adult Patients with Gastric and Small Bowel Perforation

PARTH DHAMIJA — 2025-08-13

Background: Perforation peritonitis is one of the most serious conditions encountered by a surgeon in the emergency. As a result, it becomes important to diagnose this condition early and intervene at the earliest. Higher mortality rates have been implicated with this disease as a result of which understanding of preoperative predictors of mortality becomes necessary to lower down these rates. Methods: A prospective study of 60 cases diagnosed with perforation peritonitis who underwent laparotomy was undertaken at Government Medical College and Rajindra Hospital, Patiala and data was collected in terms of age, gender, signs and symptoms, presentation to hospital, surgery timing and hematological investigations and was evaluated. Results: Distribution of cases showed a bimodal pattern where both younger and middle age group patients were present, majority of which were males (53/60). Ileal perforation was the most common intraoperative finding in the younger population whereas 50% (7/14) of cases in the middle age group had gastric perforation. 41/60 patients presented within 72 hrs from the onset of symptoms out of which only 3 patients died. 53/60 patients underwent exploratory laparotomy within 24hrs of admission. Higher mortality was observed in patients having raised total leucocyte count(TLC), deranged renal function tests (RFT) and dyselectrolytemia. Conclusion: Through our study we aimed to evaluate the importance of certain preoperative factors that can play a role in predicting mortality in patients of gastric and small bowel perforation.

Keywords : Peritonitis, Perforation, Predictors, Mortality

Acute Myeloid Leukemia with Basophilia with t(6;9) (p23;q34) – A Rare Subtype of AML

Rajni Bassi — 2025-08-13

Acute Myeloid Leukemia (AML) with the translocation t(6;9) (p23;q34), involving breaks at band 23 of the short arm of chromosome 6 and band 34 of the long arm of chromosome 9, is a rare subtype, representing 0.5% to 4% of AML cases.1

A 50-year-old male presented with a gradual onset of fever and a cough with expectoration lasting for one month, followed by episodes of hemoptysis and associated generalized weakness. He also reported history of blood transfusions and recurrent infections in the past. The persistent symptoms, along with the patient's medical history, raised concerns for an underlying chronic infection or hematological disorders.

Laboratory investigations - Hemoglobin levels : 8.7 g/dl

Bone marrow findings:-

Cellularity- Moderately cellular

Reaction- Mild megaloblastic

NE:E ratio- 98:2

Erythroid series: Markedly diminished with mild megaloblastic maturation and features of dyserythropoiesis seen.

Myeloid series: Cellularity of marrow is mainly due to medium sized Blasts(70%) showing basophilic cytoplasm with 1-4 conspicuous nucleoli. Scattered cells are seen covered with basophilic granules. Basophilic precursors (17%) are increased in number. Rest of the myeloid series is markedly diminished.

Rare Megakaryocyte seen.

Impression:- Acute Myeloid Leukemia (AML) with Basophilia.

Bone metastasis from endometrioid ovarian carcinoma: a case study and literature review

Rajni Bassi — 2025-08-13

Ovarian epithelial malignancy rarely metastasize to the skeletal system. They usually spread by direct extension , transcoelemic spread and by lymphatic channel. Hematogenous spread is rare and late occurance. Metastasis to bone from these tumours is rare. (0.1- 0.12%) and is reported in a few series. A 75 year old post menopausal lady presented in surgery department with chief complaints of swelling and pain over left thigh since 2 months. Swelling appeared 5 months back , it was drained at that time, but recurred 1 month back. Grossly we received skin covered biopsy, partly solid and partly cystic in multiple pieces measuring 12x11.5x 2.5 cm. external surface of skin was ulcerated and cut surface showed necrotic areas. Two bony pieces were received separately. Section from bony pieces showed deposits of tumour cells amongst normal bony trabeculae. Diagnosis of bony metastasis from unknown primary was made and clinicians were informed to search for primary in ovary, breast, GIT etc. serum CA 125 levels were increased to 230 U/ml.

A Hidden Foot Melanoma’s Path to The Inguinal Nodes: Diagnostic Pitfalls and Therapeutic Considerations

NAVNEETH SANKAR — 2025-08-13

Malignant melanoma of the lower limb and foot frequently metastasizes to the inguinal lymph nodes, carrying a poor prognosis akin to other tumors with distant spread. Due to patient unawareness, foot melanomas are often misdiagnosed or undetected, delaying diagnosis. In rare instances, the popliteal fossa serves as the initial site of nodal metastasis, with popliteal metastasis rates in lower extremity melanomas ranging from 0.3% to 7%. Concurrent popliteal and inguinal lymph node metastases are exceptionally uncommon. We report the case of a 67-year-old woman presenting with a right inguinal mass, later diagnosed with metastatic malignant melanoma following surgical excision. Further history revealed a prior excision of a lesion on the right sole of the foot without histopathological analysis, suggesting an undiagnosed primary melanoma. This case underscores the diagnostic challenges of foot melanoma and the rare potential for atypical metastatic patterns.

Management of Undiagnosed Case of Snakebite Patient with Respiratory Failure in ICU

Veena Chatrath — 2025-08-13

Venomous snakebite is an acute life -threatening emergency. Snakebite is most common among agricultural workers and children especially in rural areas all over the world.¹ The snake venom can be neurotoxic, hematotoxic or myotoxic. Rarely, snakebite can be occult where history is not clear with no visible bite marks which delays the diagnosis and complicates management. In such cases, clinical suspicion is of utmost importance for unexplained neuroparalysis. Sometimes, neuromuscular paralysis is so severe that it mimics brain death. In north india, the two important neurotoxic snakes leading to muscle paralysis are Cobra and Common krait. Due to respiratory muscle paralysis these patients require ventilator support in addition to anti-snake venom. We present a case of suspected snake bite presenting with loss of consciousness and h/o vomiting and remained in comatose state for over 4 days before gradual recovery.

Rare Adrenal Incidentaloma: Ganglioneuroma

Harnam Singh Rekhi — 2025-08-13

Adrenal ganglioneuromas (AGNs) are rare, benign, well-differentiated tumors of neural crest origin. They are usually hormonally non-functional and asymptomatic, frequently discovered incidentally during imaging for unrelated concerns. We present the case of a 19-year-old female who exhibited vague gastrointestinal and autonomic symptoms. Imaging revealed a right adrenal mass suggestive of malignancy. However, hormonal evaluation was unremarkable. Surgical excision was performed, and histopathology confirmed the diagnosis of adrenal ganglioneuroma. This case underscores the diagnostic challenge of such rare adrenal incidentalomas and highlights the importance of multimodal imaging and histopathology in guiding management.

Artificial Intelligence in Medical Science

Balwinder Kaur — 2025-08-13

Artificial Intelligence (AI), though first conceptualized in 1956, has seen rapid progress in the last decade—especially in the medical field. It empowers healthcare by simulating human intelligence through machine learning, data analysis, and self-correction. AI assists in processing massive volumes of patient records, thus enhancing diagnosis, treatment planning, and personalized care. It reduces documentation burdens by digitizing data and enables tailored platforms for various medical tasks. With the ability to interpret language, images, and other complex data, AI boosts the precision and efficiency of surgical procedures and risk predictions. The success of these systems, however, relies heavily on the quality of data they are trained on.