Introduction: During the coronavirus disease-2019 (COVID-19) pandemic era, different types of emergency gynecological surgeries were performed in the Department of Obstetrics and Gynecology of our tertiary care teaching hospital as per the standard guidelines issued from time to time by the Indian Council of Medical Research (ICMR) and the Federation of Obstetric and Gynecological Societies of India Good Clinical Practice Recommendations (FOGSI GCPR) guidelines for the safety of the patients and healthcare providers.
Materials and methods: A different variety of gynecological surgeries were performed on cases which were admitted in the Obstetrics and Gynecology ward of Sri Guru Ram Das Institute of Health Sciences and Research, Vallah, Amritsar, with effect from the first lockdown, i.e., March 22, 2020, to the end of lockdown, i.e., May 31, 2020 following standard guidelines for the safety of patients and healthcare providers in the COVID pandemic. The details of these cases are being presented in this article.
Results: A very few gynecological surgeries were taken up as they could not have been postponed to the post-COVID times. The use of medical and conservative approach to each possible situation has been tremendous. All cases of abnormal uterine bleeding (AUB), endometriosis, and fibroid uterus were continued to be on medical management. All minor diagnostic procedures were done under short general anesthesia with premedication.
Conclusion: The resumption of regular gynecological work is being regularized in phases. It is a long way before we come back to the original gynecology practice.
Introduction: Adenomyosis is a benign gynecological condition that predominantly affects women in the late reproductive age. It is a real challenge in healthcare with prevalence ranging from 5 to 70%. It is characterized by uterine enlargement caused by ectopic rests of the endometrium within the myometrium. It is mainly associated with abnormal menstrual bleeding and severe dysmenorrhea. But now it can be done by advanced imaging modalities like transvaginal ultrasound (USG) and magnetic resonance imaging (MRI).
Materials and methods: A prospective longitudinal study was conducted from November 1, 2018 to January 31, 2020 on subjects with complaints of abnormal uterine bleeding and or with dysmenorrhea in the department of obstetrics and gynecology (OBG) of a tertiary care hospital and medical institution. Various medical and surgical treatments were offered on merit depending on age group and clinical symptomatology. The subjects were followed up for a minimum period of six months thereafter.
Results: It was found that out of the patients who had visual analog scale (VAS) score less than 7, 22.58% had adenomyosis with normal uterus while 12.90% had bulky uterus with adenomyosis on ultrasound. Of the patients who had VAS score more than or equal to 7, 9.68% had adenomyosis with normal uterus while 54.84% had bulky uterus with adenomyosis. MRI supplemented the ultrasound findings and was found useful in the confirmation of adenomyosis.
Conclusion: The clinical diagnosis of adenomyosis has been called enigmatic largely because there are no pathognomonic symptoms of this disease. Ultrasound and MRI are found to be highly useful in supplementing the correct diagnosis of adenomyosis.
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Mohan G, Mohan G, Singh B, Kaur V. Angiographic Assessment of Coronary Artery Disease and its Correlation with Ankle-brachial Index in Patients with Diabetes Mellitus. Curr Trends Diagn Treat 2020; 4 (2):69-73.
Background: Coronary artery disease (CAD) due to atherosclerosis is like an epidemic in India. The role of diabetes mellitus (DM) with CAD is believed to be as important as CAD itself. Owing to the similar vascular involvement, patients with DM were frequently combined with peripheral artery disease (PAD). Although in outpatients, clinically suspected of having CAD, the relationship and interaction between DM and PAD remain unknown.
Aim and objective: The aim and objective of this study is to evaluate the relation of the ankle-brachial index (ABI) with the angiographic characteristics of CAD in patients with DM.
Materials and methods: This is a tertiary hospital study in which 50 adult patients were admitted and taken according to inclusion and exclusion criteria for the study. All patients in this study population underwent ABI measurement and coronary angiography was done. Patients were subdivided into two groups according to ABI, that is, patients with ABI >0.90 and ABI <0.90.
Results: There was a significant relationship between low ABI and severity of CAD. Low ABI group patients had a more severe form of CAD with a higher prevalence of triple vessel diseases, severe stenosis, and more involvement of the left anterior descending (LAD)artery. Risk factors like hypertension, diabetes mellitus, and low ABI were predictors of significant severe stenosis of coronary arteries.
Conclusion: Low ABI is a surrogate index of the severity of CAD. So it could be used in our everyday clinical cardiology practice as a noninvasive, easy, and cheap bedside test to assess and predict the severity of CAD.
ORIGINAL RESEARCH ARTICLE
Gurmehar S Hundal,
Anterpreet K Arora,
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Mahajan S, Hundal GS, Arora AK, Gupta P. Effects of Obesity and Spirometric Ventilatory Status in Male Medical Students of Amritsar. Curr Trends Diagn Treat 2020; 4 (2):74-77.
Aim and objective: To study the effects of obesity on the pulmonary functions in male medical students of Amritsar.
Materials and methods: Pulmonary function tests (PFTs) of normal, healthy, male medical students of Amritsar were determined and were compared and correlated with other studies. Criteria for obesity in our study taken were according to WHO criteria of BMI. The PFTs were carried out with a computerized spirometer “Med-Spiror”. The data were collected; compiled, statistically analyzed, and valid conclusions were drawn. Higher lung volumes and flow rates were achieved.
Results: There was a statistically highly significant decline in forced vital capacity (FVC) in obese when compared with nonobese groups. The values of forced expiratory volume in first second (FEV1) in both groups when were compared showed significant changes. The ratio of FEV1/FVC, the values of peak expiratory flow rate (PEFR), and forced mid-expiratory flow (FEF25–75%) showed insignificant changes but maximum voluntary ventilation (MVV) when were compared showed highly significant changes.
Conclusion: There is a decline of various respiratory functions in obesity. The cause of the decline of various respiratory functions in obesity may be due to a decrease in distensibility of the chest wall or limited expansion of the thoracic cavity and is the cause for reduced ventilatory volumes and total lung capacity.
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Janagal A, Pushkarna G, Gupta R. Nerve Stimulator vs Ultrasound-guided Femoral Nerve Block for Ease of Positioning before Spinal Anesthesia in Fracture Femur Patients: A Randomized Comparative Study. Curr Trends Diagn Treat 2020; 4 (2):78-83.
Introduction: Severe pain in the fractured femur makes it difficult to position a patient for spinal anesthesia. Femoral nerve block (FNB) has been studied for relief of pain, but studies are inconclusive regarding the superiority of one technique over another, i.e., nerve stimulation vs ultrasound for guidance.
Aims and objectives: This study aims to compare the ease of positioning for spinal anesthesia in fracture femur cases using two different techniques of localization of femoral nerve for the block.
Materials and methods: In this prospective, randomized, single-blind study, 60 patients of fracture femur were allocated in two equal groups of nerve stimulator (group NS) and ultrasound-guided (group US) femoral nerves block and compared regarding ease of positioning, duration of analgesia, and need for rescue doses of tramadol using SPSS version 26.
Results: The patients in the two groups were similar in age, sex, weight, BMI, and initial pain severity (p = 0.920). The visual analog scale (VAS) scores within the groups were markedly reduced at 15 minutes in both the groups (p = 0.000) and between the two groups pain relief was more in group US than group NS at 5 and 10 minutes (p = 0.000 and p = 0.034, respectively), but, was comparable at 15 minutes (p = 0.310). The ease of positioning was observed in 27 patients in group US vs 20 patients NS (p = 0.028) as grade-I (comfortable), whereas grade II (discomfort) present in 3 vs 9 patients (p = 0.053), and grade III (uncomfortable) was seen only in one patient in group NS. The duration of analgesia in group US vs NS was 464.0 ± 170.61 and 282.9 ± 126.85 minutes, respectively (p = 0.003) and lesser need for rescue dose of tramadol (134.20 ± 23.20 vs 174.43.83 ± 47.74 mg) (p = 0.002). The vascular puncture was the main complication observed in group NS.
Conclusion: Both the techniques of FNB provided adequate analgesia for fracture femur pain, but the ultrasound technique provided early-onset, better patient comfort, and longer duration of analgesia than the landmark nerves stimulation technique.
Introduction: Coronavirus disease-2019 (COVID-19) has spread at an exponential rate in several countries. Whereas understanding of clinical consequences, prevention, and management of COVID-19 is increasing, little is known about the collateral damage caused by it. It is noteworthy that ectopic pregnancies contributed to significant obstetric emergencies in the COVID-19 pandemic and sensitized the caregivers to report the event.
Materials and methods: This retrospective study was conducted at the Tertiary Care Medical and Teaching Institute, Amritsar, India, to observe the rising trends of ectopic pregnancy during the lockdown period from March 22, 2020, to July 30, 2020. Data were taken from the hospital records of Emergency and Gynaecology and Obstetric departments after getting ethical clearance from the ethics committee of the institute. The details of demographic characters, clinical presentation, risk factors, and treatment plan for ectopic pregnancy, as well as associated morbidity and mortality were studied in detail in comparison to times other than during COVID-19 pandemic.
Results: It was observed that the proportion of ruptured ectopic pregnancies was significantly higher during the lockdown period in comparison to the prelockdown period (12/617; 1.94% vs. 17/4367; 0.381%, Fisher\'s exact test p 0.02). Majority of patients (91.66%) presented late with ruptured ectopic pregnancy with hemoperitoneum and had to undergo emergency laparotomy and a salpingectomy was done in 66.66% of cases.
Discussion: Social lifestyle changes, increased use of emergency contraceptive pills, and medical abortion pills due to poor accessibility of healthcare facilities were observed during this period. Noticeably, a high number of patients came in an emergency with failed medical abortions who were later diagnosed with ruptured ectopic pregnancies.
Conclusion: We think that monitoring the indirect potential consequences of COVID-19 pandemic is imperative in order to avoid unexpected deleterious complications in women\'s health.
Off-label use of drugs means the use of drugs for indications, dose, dosage forms, route, and patient population for which approval from the regulatory bodies like US Food and Drug Administration (US FDA) and Drugs Controller General of India (DCGI) has not been obtained. It does not mean that it is illegal or contraindicated to use the drug as off-label. The purpose of off-label prescribing is to provide the maximum benefit to the patients, especially the vulnerable population like pediatric, psychiatric, pregnant, and cancer patients where there is not sufficient data available for the drug use or in diseases where no treatment is yet available. Hence, valid scientific data and an expert opinion can be relied upon for off-label use. There still remains concerns for safety when prescribing for off-label purpose due to the lack of adequate safety and efficacy studies, and thus a physician must assess the risk/benefit ratio before its use. The regulatory bodies like US FDA has formulated certain guidelines for off-label use while the DCGI still does not support its use. Hence, there is no uniformity in the rules and regulations about off-label prescribing around the world, which needs to be streamlined.
Congenital vertical talus is a rare rigid flat foot deformity. Although the cause of the congenital vertical talus is heterogeneous, recent researches strongly support a genetic cause linking the genes expressed during early limb development. If remain untreated, it causes a lot of disability like pain and functional limitations. Traditional treatment for vertical talus involves extensive surgeries, which are associated with short and long complications. A minimally invasive approach involving serial manipulation and casting will produce excellent short-term results with regard to clinical and radiographic correction. To achieve correction without extensive surgery leading to more flexible and functional foot, a long-term research study is required.
Richa G Thaman,
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Kumar R, Singh P, Thaman RG, Choudhari R, Kaur S. SARS-CoV (COVID-19) Pandemic—Detailed Insights into Diagnosis, Management, and Role of Indian Herbal Drugs. Curr Trends Diagn Treat 2020; 4 (2):95-102.
Coronavirus-2019 (COVID-19) (SARS-CoV-2), a pandemic by World Health Organization on March 11, 2020, is caused by corona viruses which is highly contagious with enveloped positive-sense RNA particles with a size of 60–140 nm in diameter. The COVID-19 infection may be an asymptomatic, mild, moderate or severe illness with severe potentially lethal complications, such as severe pneumonia, respiratory failure, acute respiratory distress syndrome, sepsis, and septic shock due to induction of cytological storm. Diagnostic confirmation is by reverse transcription polymerase chain reaction. The treatment is mainly symptomatic with management of complications. Antiviral drugs like lopinavir administration have not been proven very useful and other drugs, such as Arbidol and favipiravir have some hope. Remdesivir, a drug approved by USFDA, has shown benefits in critical patients with COVID-19 infection. The mode of action of chloroquine and hydroxychloroquine is via immunomodulatory effects. Ministry of AYUSH has recommended intake of ayurvedic herbal drugs like curcumin, tulsi, cinnamon, black pepper, ashwagandha, shunthi (dry ginger), and regular yoga. Curcumin and garlic are important anticytokine agents and decrease various substances like interleukin (IL)-1β, IL-10, and IL-12 by macrophages with additional fibrinolytic and antiplatelet aggregatory actions. Amla is an immunity booster. Tulsi due to phytocompounds and apigenin might be useful in COVID-19 infection. Cinnamomum has eugenol with antiviral activity. Black pepper suppresses the nuclear factor kappa-B signaling pathway. Ginger (Zingiber officinale) decreases various proinflammatory chemokines IL-8 and regulated upon activation, normal T-cell expressed and secreted. Mulethi has saponins which inhibit in vitro several DNA- and RNA-viruses. Thus, Indian herbal system of Ayurveda is very useful in COVID-19 infection.
Aim and objective: To report a case of woolly hair in a 7-year-old girl due to its rarity.
Background: Woolly hair is a rare autosomal dominant disorder manifested by short, tightly coiled hair. When associated with systemic findings, it is known as woolly hair syndrome.
Case description: A 7-year-old girl presented in Dermatology OPD at Sri Guru Ram Das Institute of Medical Sciences and Research with a complaint of short, curly, brittle hair since birth. A similar complaint was present in her 9-year-old sibling. There were no associated systemic features. Based on the clinical features, a diagnosis of woolly hair was made.
Conclusion: We are presenting this case due to its exclusive occurrence.
Clinical significance: Awareness and knowledge of varied associations of woolly hair will help in early diagnosis and alleviate any complications. Hence, a thorough history and examination is mandatory to rule out any associated features.
Though cerebrovascular accident in hypertensive disorders of pregnancy is a rare entity, it causes high morbidity and mortality because of unpredictable onset and late diagnosis. Incidence of intracranial hemorrhage (ICH) accompanying nonfatal eclampsia is unknown, but the lesion is found in 10–60% of all mortalities that occur due to eclampsia.
We report an unusual case of a 25-year-old primigravida who developed sudden eclampsia and intracranial hemorrhage leading to a mass effect on the right ventricle and a midline shift. She was managed by a multidisciplinary approach involving an emergency lower section cesarean section by an obstetrician, a craniotomy by a neurosurgeon, and intensive care by an anesthesiologist.
Background: Myiasis is the infestation of live human tissues by the larvae of flies, more commonly known as maggots. Wound myiasis occurs when fly larvae infest open wounds. This kind of infestation may be the result of facultative or obligatory parasites. Treatment with application of mineral oil and manual removal of maggots is the usual routine.
Case description: We report a case of 19-year-old female presenting with bilateral orbital edema. The differential diagnosis of eyelid erythema and edema is broad, ranging from benign, self-limiting dermatoses to malignant tumors and vision-threatening infections. History revealed that she had cutaneous myiasis of the scalp for which she was treated with mineral oil and maggots were removed manually a day prior to presentation. Irritant dermatitis by trickling of the mineral oil led to bilateral edema in this case. A definitive diagnosis usually can be made on physical examination of the eyelid, a careful evaluation of symptoms and history of exposure.
Conclusion: Detailed history and meticulous workup can be of great help in the differential diagnosis of bilateral orbital edema.
Background: Guillain–Barré syndrome (GBS) is an immune-mediated disorder of the nervous system that shows acute or subacute onset. It is also known as Landry\'s paralysis. It is characterized by muscle weakness of legs and arms, limb paresthesias, and total or relative areflexia. Acute motor sensory axonal neuropathy (AMSAN) is a distinct subtype of GBS. It is not only a rare but severe variant that involves axonal degeneration in motor and sensory nerve fibers and has a prolonged recovery course.
Case description: A 60-year-old male presented to the emergency department having complaints of weakness, numbness, and tingling sensation in feet for the last fortnight, which ascended gradually towards the calves. He was observed to have a sensory disorder in hands, but not flaccid paralysis. The patient history and nerve conduction studies were indicative of AMSAN variant of GBS.
Discussion: In patients of AMSAN, the reduction of sural nerve amplitude is more pronounced as compared to acute inflammatory demyelinating polyneuropathy (AIDP) patients. In case of our patient, the electrophysiological feature indicated a more than 50% decrease in SNAP. A marked reduction in sensory nerve action potential and compound muscle action potential with only slightly decreased conduction velocities is a requirement for the diagnosis of axonal neuropathies, which is the trait seen in the reported case.
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Kaur S, Sandhu IM, Nagpal M. Transferring Mosaic Embryos during ART Cycles: Increasing the Load of Genetic Diseases in Human Generations—A Critical Analysis. Curr Trends Diagn Treat 2020; 4 (2):112-116.
“Mosaic” as an adjective describes any type of work or art which is produced by joining of many small pieces differing in size and color. Virtually all multicellular organisms are mosaics of cells with different forms and functions. Normal developmentally determined mosaicism involves permanent changes in the DNA of somatic cells giving rise to specialized cells of various organ systems of the body. Several mechanisms, such as cell cycle dysregulation, centrosome overduplication, and cancer formation, have been reported as end products of mosaicism, either chromosomal or germline, arisen prenatally or postnatally, in many cases. There is an extensive literature present which describes the presence of genetic mosaicism in human diseases. With the development of more advanced molecular genetic diagnostic techniques, it has been recognized that genetic mosaicism is involved in many monogenic and polygenic complex diseases. This review highlights the dilemma between the creation and transferring of the mosaic embryos detected by preimplantation genetic diagnosis aneuploidy testing during assisted reproductive technology cycles. The main question of concern is not only the implantation potential of the accepted mosaic embryos but also the well-being of future generations to follow from these phenotypically normal mosaic individuals.