Asian Journal of Medical Research <p><strong class="pull-left">Asian Journal of Medical Research (AJMR)</strong>&nbsp;&nbsp;is an open-access, freely accessible, online and print quarterly peer-reviewed international journal publishes a wide spectrum of advanced research on all medical specialties including ethical and social issues. AJMR is a gateway to enlighten the latest research/issues happening all around the world of medical and health sciences. <br><strong>Online ISSN: 2277-7253 | Print ISSN: 2347-3398</strong></p> en-US (Dr. Rohit Kumar Varshney) (Mr Shadan Pasha) Tue, 07 Jul 2020 01:24:34 +0000 OJS 60 Asymptomatic Isolated Cervical Tubercular Lymphadenopathy, How to Proceed?: A Case Series <p>Tuberculosis is a highly prevalent disease in developing countries, the majority of cases are pulmonary and rest are extra-pulmonary. Cervical LN tuberculosis is one of the most common types of extra-pulmonary tuberculosis. Isolated cervical tubercular Lymphadenitis without accompanying pulmonary tuberculosis or another form of tuberculosis in the body is rare and, when present, requires thorough clinical examination and investigation. In the investigation of such patients, FNAC plays a major role, and aspirate should be tested for AFB through ZN stain and CBNAAT (PCR). Cervical tubercular Lymphadenitis is mainly a disease of young with a female predominance. All patients of cervical tubercular Lymphadenitis must receive antitubercular therapy with strict follow up for compliance and possible side effects from treatment.</p> Ravi Singh Dogra, Arjun Singh, Vinay Bhardwaj, Poonam, Srijan Pandey, Gunjan Modgil, Arpit Goel Copyright (c) 2020 Author Mon, 06 Jul 2020 00:00:00 +0000 Effects of intravenous Dexmedetomidine on Intraoperative Hemodynamic Parameters in the Patients Undergoing Laparoscopic Cholecystectomy <p><strong>Background: </strong>Dexmedetomidine, in addition to sympatholytic effect, diminishes intraoperative requirement of anesthetics including propofol. The present study was conducted to evaluate the effects of intravenous dexmedetomidine on intraoperative hemodynamics in laparoscopic cholecystectomy. <strong>Subjects and Methods: </strong>Five patients undergoing laparoscopic cholecystectomy received dexmedetomidine. Dexmedeto- midine was loaded (1 <em>µ</em>g/kg) before anesthesia induction and infused (0.6 <em>µ</em>g/kg/h) during surgery. Anesthesia was induced with propofol. Mean arterial pressure (MAP) and heart rate (HR) were recorded at baseline and at various time points from the loading of drugs to just after tracheal extubation. <strong>Results: </strong>Both HR and MAPdecreased till insufflation and then increased at extubation. <strong>Conclusion: </strong>During propofol-based anesthesia for laparoscopic cholecystectomy, dexmedetomidine provides stable intraoperative hemodynamics.</p> Arjun Singh, Ravi Singh Dogra, Poonam, Reva Thakur Copyright (c) 2020 Author Mon, 06 Jul 2020 00:00:00 +0000 Short Segment versus Long Segment Posterior Pedicle Screws Fixation for Treatment of Thoracolumbar Burst Fracture: A Comparative Prospective Study <p><strong>Background: </strong>The surgical treatment of unstable burst fracture (TLICS &gt;4) of the thoracolumbar vertebrae remain controversial. This study is aimed to compare the short segment versus long-segment posterior fixation for thoracolumbar burst fracture.The objective of the study is to study comparison of outcome of the Short-Segment Posterior Fixation (SSPF) versus Long-Segment Posterior Fixation (LSPF) for treatment of thoracolumbar burst fracture in term of surgical, radiological, neurological and functional outcome. <strong>Subjects &amp; Methods: </strong>In this prospective study, we included 32 patients with Burst fracture AO type A3, A4 of Thoracolumbar spine (T10-L2), who underwent posterior pedicle screw fixation for Burst fracture Thoracolumbar spine. A total of 18 of the patients underwent Short-Segment Posterior Fixation (SSPF) (Group A); group A is further divided into three subgroups A1: short-segment only(n=10), A2: short-segment with index screw(n=4) and A3: short-segment with anterior column reconstruction(n=4) with cage, Whereas 14 patients had Long-Segment Posterior Fixation (LSPF) (Group B). Surgical (duration of surgery, blood loss, complication), Clinical (Oswestry questionnaire, spinal cord independent measuring scale), radiological (percentage of anterior body height compression, kyphosis correction loss, Mc Cormack classification) and Neurological (Frankel grading) outcomes were analyzed. <strong>Results:&nbsp; </strong>The operative time Group A (159.85 min&nbsp; 22.5) was significantly shorter than Group B (198.7&nbsp; 31.5).&nbsp; Blood loss was significantly less in Group A (478 ml&nbsp;&nbsp; 259.3) than Group B (865ml&nbsp;&nbsp; 275.7). Kyphosis Correction loss at 6<em><sup>th</sup> </em>month follow up in Group A (subgroup A1: 10.7deg&nbsp; 6.2, subgroup A2: 7.1deg&nbsp; 7.4 and subgroup A3: Subgroup A3: 6.1deg &nbsp;5.2) was higher than that of group B (6.2deg 6.3). Complication (surgical site infection) occurred in Two patients in group B. There was no significant difference in terms of improvement in functional and neurological outcomes among both groups. The functional outcomes as per the SCIM and ODI score at 6<em><sup>th</sup> </em>month follow up in group A: 74.7 +-22.29, 31.5+-13.73 respectively, and group B: 73.8+-26.07, 26.7+-17.9, respectively. <strong>Conclusion: </strong>Short-Segment Posterior Fixation (SSPF) is a significantly decreased duration of surgery and blood loss compare with Long-Segment Posterior Fixation (LSPF). Loss of kyphosis correction in Short-Segment Posterior Fixation (SSPF) may be decreased with index screws or anterior column reconstruction.</p> Arvind Singh, Shiv Kumar Bali, Subhajit Maji, Kaustubh Ahuja, Nagaraj Manju Moger, Samarth Mittal, Bhaskar Sarkar, Pankaj Kandwal Copyright (c) 2020 Author Mon, 06 Jul 2020 00:00:00 +0000 Fifth toe Fillet Flap for Wound Coverage of Non-Healing Ulcer of the Foot: Surgical Technique and a Case Report <p>Fillet flap is one of the options in the treatment of diabetic non-healing ulcers. The advantages of the fillet flap include the absence of donor site morbidity, excellent durability and preventing the need for more proximal amputation. A 56-year-old farmer presented to the out-patient department with complaints of a non-healing ulcer on the sole of the right foot for the past 7 months which was managed conservatively. A fifth ray partial amputation and a rotational flap of the redundant fifth finger for wound coverage were done. The wound healing was uneventful and the sutures were removed after two weeks. At the latest follow-up of 2 years, the patient was able to walk independently without pain and without any functional limitations. This case report describes the surgical technique of the lateral lesser toe fillet flap for wound closure on the plantar aspect of foot as an alternative to secondary healing or more proximal amputations.</p> Sunny Chaudhary, Shivakumar A Bali, Arvind Singh, R K Siddharth Copyright (c) 2020 Author Mon, 06 Jul 2020 00:00:00 +0000 Management of 6 Months old Neglected Talus Neck Fracture: A Case Report with Review of Literature <p>Talus fractures are very rarely seen and account for approximately 1 percent of fractures around the foot and ankle Talar neck fractures are likely to damage the anastomotic ring, resulting in disruption of blood supply to the talar body which leads to significant problems in fracture healing and integrity. Approximately 39 percent of midfoot and ankle fractures could be missed during initial evaluation due to a lack of adequate radiological and clinical examination. Among these missed injuries approximately 50 percent are talus fractures. A 23-year-old male patient came with complaints of pain over the left foot while walking for 6 months. He had a history of falls from 10 feet height 6 months back. He was conservatively managed in a local hospital without any proper diagnosis. He presented to us 6 months later with chronic, dull aching, continuous pain which aggravates while walking and standing. The diagnosis of the non-union fracture neck of talus was made after radiology and was managed by open reduction and internal fixation with cannulated cancellous screws along with ipsilateral iliac crest cancellous bone grafting. Lack of timely diagnosis escalates the vascular insult, delays timely intervention, and increases morbidity.</p> Nagaraj Manju Moger, Pragadeeshwaran J, Mosharaf Hossain Sarkar, Pradeep Kumar Meena Copyright (c) 2020 Author Mon, 06 Jul 2020 00:00:00 +0000 A Study on Clinical Profile, Risk Factors, Angiographic Profile and Short-Term Mortality of Acute Coronary Syndrome in Smokers vs Non Smokers <p><strong>Background: </strong>Smoking has long been positively associated with the development and progression of coronary heart disease. However, lon- gitudinal cohort studies evaluating smoking habits among cardiac patients as well as the role of socio-demographic factors determining such behaviours are scarce and have been focused on primary care practice. Prevalence of acute coronary syndrome in young individuals is increasing progressively. Previous studies have focused on the analysis of risk factors and to some extent coronary angiographic profile in smokers&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; vs non-smokers patients with acute coronary syndrome. The aim of the study is to study the acute coronary syndrome in smokers versus non-smokers and to analyse with respect to baseline characteristics. <strong>Subjects and Methods: </strong>It was a prospective study conducted at Department of Cardiology, Katuri Medical College &amp; Hospital Guntur. <strong>Results: </strong>In the present study, Acute coronary syndrome occurred seven years earlier in smokers compared with non-smokers (p&lt;0.05) Smokers were frequently male subjects compared with non-smokers (p&lt;0.001) Smokers had a lower prevalence of Diabetes compared with non-smokers (p&lt;0.001) Smokers had a higher prevalence of Obesity compared with non-smokers (p&lt;0.001). Smokers presented with more acute infarctions and less Unstable angina compared with non-smokers (P&lt;0.001). <strong>Conclusion: </strong>In&nbsp; the present study, significant differences were observed in coronary risk factor profile between smokers and non-smokers patients with STEMI and NSTEMI/UA. Larger studies will be required to establish specific associations between presentation of acute coronary syndromes and angiographic profiles in smokers.</p> B V Narayana Reddy, Hemasundar Korrapati, Supraja Chegireddy Copyright (c) 2020 Author Mon, 06 Jul 2020 00:00:00 +0000 A Comparative Study of Storage Related Haematological Changes in Whole Blood and PRBC in Blood Bank of a Tertiary Care Hospital <p><strong>Background: </strong>Blood transfusion is very common in present era. Now day’s whole blood transfusion is common but also the blood product like red blood cell, white blood cell, platelets, clotting factor, plasma can be done .the aim of study to know the storage related changes in whole blood, packed red blood cell. <strong>Subjects and Methods: </strong>In our institution we have selected 100 voluntary blood donors sample in blood bank of Teerthankar Mahaveer medical college and research centre, Moradabad up to 12 month. <strong>Results: </strong>The store blood is Followed up to 35th days .during regular interval 1<em><sup>st</sup></em>, 7<em><sup>th</sup></em>, 14<em><sup>th</sup></em>, 21<em><sup>st</sup></em>, 28<em><sup>th</sup> </em>and 35<em><sup>th</sup> </em>day, in the blood there is significant change in and all other component in all sample. <strong>Conclusion: </strong>In the case of storage of blood in blood bank. As the number day of store is more the haematological changes is more significant.</p> Pratibha Shirvastava, Shyamoli Dutta Copyright (c) 2020 Author Thu, 09 Jul 2020 00:00:00 +0000 Spectrum of Benign Histopathological Lesions in Cholecystectomy Specimens <p><strong>Background</strong>: The most commonly received specimen in any histopathology laboratory is cholecystectomy specimen. The majority of the cholecystectomies are done for Cholelithiasis. Inflammation may be acute, chronic or acute on chronic. It almost always occurs in association with gallstones, which is responsible for carcinoma and if the diagnosed early prognosis of the carcinoma gall bladder is good. Histopathological examination is therefore a must for diagnosis of early carcinomas. <strong>Subjects and Methods</strong>: 100 cholecystectomy specimens from patients&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; of all ages were included. All specimens were subjected to gross and microscopic assessment. Different histological findings were noted in various layers of the gall bladder. The study includes all radiologically confirmed inflammatory pathologies of including metaplastic changes of the gall bladder epithelium, irrespective of age and sex. The study excludes patients with evident gallbladder malignancy, cases with known secondaries from gall bladder, traumatic rupture of gallbladder. <strong>Results: </strong>The age of patients varied from 16 to 70 years, with a maximum number of patients (25%) belong to 31 to 40 years<strong>. </strong>Gall stones were associated with 59% cases of cholecystitis. Pigment stones were most common (74%). Histopathologically the most common diagnosis was chronic cholecystitis (69%). <strong>Conclusion: </strong>Almost all of the gallbladder lesions are inflammatory in origin, of which the most common disease being chronic cholecystitis. Chronic cholecystitis was found to be most probable diagnosis in a female of 30-40 years. Pigmented gall stones were found to be the most common etiology of chronic cholecystitis. Prompt detailed histopathological analysis will help to confirm the benign nature of the disease or to detect any precursors of malignancy.</p> Prachi Singh, Faiyaz Ahmad, Shyamoli Dutta, Seema Awasthi, V. K Singh Copyright (c) 2020 Author Mon, 06 Jul 2020 00:00:00 +0000 Extraskeletal Chondroma of the Fallopian Tube; An Incidental Finding During LSCS in 32 Years Old Female <p>Extraskeletal chondroma (also known as ”Chondroma of soft parts”) is a cutaneous condition, a rare benign tumor of mature cartilage usually occurs in the hands, feet, head and neck. This tumor regularly presents as a small solitary nodule. The histogenesis of the cancer is controversial, but some have suggested a metaplastic origin. Chondroma of the fallopian tube is very rare. There are only three case reports in English literature. The source of this tumor can be subcoelomic mesenchyme of the tubal serosa or mesenchyme of the mesosalpinx. We describe a case of chondroma arising from the serosal surface of the fallopian tube with a review of the literature. A 30-yr-old woman with term pregnancy visited the hospital for cesarean section and tubal ligation. On operating findings, 1 1.5 cm sized nodular mass was noted in the left tubal serosal area. The excised mass showed a multilobulated appearance covered with a thin fibrous membrane. The cut surface was solid, grayish-yellow, and myxoid with a focal gelatinous area. The microscopic finding showed islands and elongated lobules of mature benign cartilage.</p> Summyia Farooq, Basharat Farooq Rather, Farhat Abbas Copyright (c) 2020 Author Mon, 06 Jul 2020 00:00:00 +0000 Cognitive dysfunctions in patients with bipolar disorder: A comparative study from Western Rajasthan <p><strong>Background: </strong>Cognitive dysfunction is an established entity in bipolar disorder. The affected individuals exhibit wide-ranging deficits involving multiple domains of cognitive functioning. These deficits are associated with poor functional outcome and residual disability in patients. A substantial literature exists globally on cognition in bipolar disorder; however, few studies have been carried out on this subject in India and&nbsp;&nbsp;&nbsp; in Rajasthan. The aim of the study is to compare cognitive functions of bipolar disorder patients and healthy control subjects. <strong>Subjects and Methods: </strong>This cross-sectional study was conducted at the Psychiatry department of a tertiary care institution on 50 bipolar disorder patients and matched healthy controls subjects who fulfilled the inclusion criteria. The diagnosis was made by DSM-V criteria, and symptom severity was determined by the Young Mania Rating Scale (YMRS) and the Hamilton Depression Rating Scale (HAM-D). After seeking socio-demographic details, all participants were administered the Post Graduate Institute Battery of Brain Dysfunction (PGI-BBD) to assess cognitive functioning. Data collected were subjected to suitable statistical analysis (mean, standard deviation, and chi-square test). <strong>Results: </strong>The majority of the bipolar disorder patients (54%) were under 35 years of age, were males (60%), were from the urban background (70%), and were married (82%). Bipolar disorder patients performed poorly on all domains of cognitive functioning, i.e. memory, performance and verbal intelligence, and perceptuo-motor skills. <strong>Conclusion: </strong>The present study affirmed the previous findings of wide-spread cognitive impairment in bipolar disorder patients. Prompt diagnosis and treatment are the key steps to reduce the cognitive morbidity associated with this disorder.</p> Ankit Awasthi, Arpit Koolwal, Nikita Dhaka, Ghanshyam Das Koolwal, Sanjay Gehlot Copyright (c) 2020 Author Mon, 06 Jul 2020 00:00:00 +0000 Clinical Study on Psychiatric Morbidity in Suicide Attempters- A Observational Study <p><strong>Background: </strong>Suicide is a tragic and serious preventable public health problem all over the world. It is one of the three leading causes of&nbsp;&nbsp; death globally. Usually suicide has no single cause. It is the endpoint of an individual process, in which several cultural, social, situational, psychological, and biological factors interact. The objective of the current study is to evaluate the nature of psychiatric morbidity and it’s severity in patients who have attempted suicide, its relation to the socio-demographic and clinical variables and the particulars of the current attempt. <strong>Subjects and Methods: </strong>Fifty patients with alleged history of suicide attempt were evaluated. Tools used were Socio Economic Status Schedule, Suicide Intent Scale and Comprehensive Psychopathology Rating Scale. ICD 10-AM Symptom Check List was used to evaluate and find out psychiatric diagnosis and final diagnosis was made on the basis of ICD-10- Classification of mental and behavioral disorders, Diagnostic Criteria for Research (DCR-10). <strong>Results: </strong>Most subjects are in the age group of 18-30, married, Hindus, with a primary education, semi-skilled workers with average monthly income of more than 3000 rupees from a nuclear family of semi urban area and belong to SESS category III. Adjustment disorder with brief depressive reaction is the most common diagnosis made and the diagnosis has statistically significant relation with past attempt, recent stressors, and motive. Type of attempt, method used, venue, lethality, and medical complication of the attempt have significant relation with, substance dependence and its total duration, gender, medication history and total duration of symptoms. Suicide intent score is statistically related with gender, total duration of symptoms, family history, motive, venue and lethality. <strong>Conclusion: </strong>Significant proportions of the individuals who attempt suicide have psychiatric morbidity. Attempted suicide can be considered to be a distinct sub- group of psychiatric symptoms which is usually neglected but is the most common cause of morbidity and mortality in subjects with psychiatric disorders. Patients who attempt suicide require special attention and management by all the medical professionals.</p> Charan Teja Koganti, Neeta Sagar Bobba Copyright (c) 2020 Author Sun, 05 Jul 2020 00:00:00 +0000 Knowledge, Attitude and Practice toward legalization of abortion among female students of Sabiyan secondary and preparatory school, Dire Dawa, Eastern Ethiopia, 2018. A descriptive cross-sectional study <p><strong>Background: </strong>Ethiopian abortion law is relatively liberal, but due to lack of knowledge and negative attitude toward legalization of abortion among most women, shortage of safe abortion services provision and significant amount of sociocultural pressures women still go to unsafe abortion service. So the objective of this study was to assess the knowledge, attitude and practice toward legalization of abortion among female students of Sabiyan secondary school, Dire Dawa, March 20-30/ 2018. <strong>Subjects &amp; Methods:&nbsp;&nbsp; </strong>The study was conducted in Dire Dawa city,&nbsp;&nbsp; in Sabiyan high school. An institutional based cross-sectional survey was employed on randomly selected female students. Data was collected using pre- tested self-administered questionnaire and analyzed using computer software SPSS version 24.0. Tables, graphs and charts were used for some variable to describe the results of the study. <strong>Results</strong>: A total of 320 regular female students were included making the response rate of 100%. Ethiopian abortion law was assessed only 40 (12.5%) of participants were knowledgeable and only 98 (30.6%) of the respondents were having positive attitude. Out of 24 (7.5%) who ever get pregnant, 15 (4.7%) seek for unsafe abortion and only 7 (2.2%) were having experience (practice) of legal abortion. <strong>Conclusion: </strong>there was a low level of knowledge of the revised Ethiopian abortion law among study participants and majority of the participants had a negative attitude towards legal abortion services and only few of them had practice of legal abortion. So focusing on awareness creation strategy by each stakeholder is an important.</p> Legesse Abera, Adisalem Debebe Copyright (c) 2020 Author Mon, 06 Jul 2020 00:00:00 +0000 Efficacy of Double Pop Blind TAP Block – Double-Blinded Randomized Controlled Study <p><strong>Background: </strong>The transversus abdominis plane block (TAP block) in the petit triangle is being used since 2001 for analgesia by blocking&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; the T6 to T12 nerves, which is devoid of the sympathetic blockade and has opioid-sparing effect during and after abdominal operations.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; The appropriateness and efficacy of using double pop blind transversus abdominis plane block were studied in abdominal surgeries using bupivacaine with butorphanol as additive. <strong>Subjects and Methods: </strong>A total of 78 adult patients of ASA I and II were included, who were to undergo laparoscopic cholecystectomy under general anesthesia. The control group patients received tramadol, diclofenac, and paracetamol in the perioperative period. The study group patients received TAP block by double pop blind technique after induction of anesthesia but before surgical incision as preemptive analgesia. The p-value, the mean and the confidence interval were calculated by using Student t-test with the use of online software by <strong>Results: </strong>Each of the two groups had 39 patients, and none met the exclusion criteria. Patients of the study (TAP) group remained pain-free for a longer time by 439 (416 – 463) minutes more than the control (IV, Intravenous) group. Rescue analgesia in the study group was required 640 minutes after the end of the surgery, but in the control group, rescue analgesia was required earlier at 200 minutes only after the surgery. <strong>Conclusion: </strong>Double pop blind technique for TAP block is appropriate and without complications if done with carefulness as to avoid penetration of the blunted green needle beyond the fascia between the internal oblique and the transversus abdominis muscle.</p> Simon Richard, Sharad Goel, Akhilesh Mishra, S. Ali Imam, Samir El Said, Medhat Mahmoud Elhantery Copyright (c) 2020 Author Mon, 06 Jul 2020 00:00:00 +0000 Assessment of Preoperative and Postoperative Changes in Corneal Astigmatism after Pterygium Excision by Different Techniques <p><strong>Background: </strong>Pterygium causes visual problems due to induced corneal astigmatism or direct encroachment onto the visual axis. The present study was conducted to compare preoperative and postoperative changes in corneal astigmatism after pterygium excision by different techniques. <strong>Subjects and Methods: </strong>The present study was conducted from May 2018 to August 20018 on 69 patients of age range 20-55 years of primary Pterygium. Patients were divided into three groups of 23 each. Group I was treated with bare sclera (BS) technique, Group II with conjunctival autograft (CAG) technique and Group III with amniotic membrane graft (AMG) technique. All the patients were preoperatively assessed for visual acuity, anterior and posterior segments, autorefraction, and autokeratometry. After surgery, the patients were recalled on day 5, 1 month, and 3 months for the analysis. <strong>Results: </strong>Uncorrected visual acuity (UCVA) preoperatively was 0.57, on the 5th day was 0.45 after 1 month was and after 3 months was 35. The mean preoperative astigmatism value in group I was 3.45, in group II was 3.52 and in group III was 3.49. Postoperative astigmatism value in group I was 1.60, in group II was 0.92 and in group III was 0.81. The difference was significant (P&lt; 0.05). <strong>Conclusion: </strong>Authors found that amniotic membrane graft and a conjunctival autograft is better surgical techniques than bare sclera in reducing astigmatism.</p> Madhavi Chevuturu Copyright (c) 2020 Author Mon, 06 Jul 2020 00:00:00 +0000