Research Article
Open Access
Association of Prostate Volume, Prostate-Specific Antigen Levels, and Lower Urinary Tract Symptoms in Men with Benign Prostatic Hyperplasia: A Cross-Sectional Observational Study
S. Srinivas ,
.Prashanth Kumar Patnaik
Pages 180 - 186
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Abstract
Background: Benign prostatic hyperplasia (BPH) is a common age-related condition in men and frequently presents with lower urinary tract symptoms (LUTS). Prostate volume, serum prostate-specific antigen (PSA), and symptom severity are routinely evaluated, yet their interrelationships vary across populations. Objectives: To assess the association of prostate volume with serum PSA levels and LUTS severity, and to examine correlations among age, prostate volume, PSA, and International Prostate Symptom Score (IPSS) in men with BPH. Methods: This cross-sectional observational study included 80 men with clinically diagnosed BPH at Dr BR Ambedkar Medical College, Kadugondanahalli, Bangalore, Karnataka, India, from June to December 2019. Clinical characteristics, IPSS, serum PSA, and ultrasonographic prostate volume were recorded. Associations across prostate-volume and LUTS-severity categories were examined, and Pearson correlation coefficients were calculated. Results: Mean age was 64.8 ± 8.1 years. Mean prostate volume, serum PSA, and IPSS were 48.6 ± 18.9 mL, 3.62 ± 2.01 ng/mL, and 18.7 ± 7.3, respectively. Moderate LUTS occurred in 53.8% and severe LUTS in 30.0%. Mean PSA increased from 2.41 ± 1.18 ng/mL in men with prostate volume <40 mL to 5.52 ± 2.20 ng/mL in those with volume ≥60 mL. Mean IPSS increased from 14.1 ± 5.8 to 25.8 ± 5.9 across the same categories. Prostate volume correlated positively with PSA (r=0.64) and IPSS (r=0.57), while PSA correlated with IPSS (r=0.41); all p<0.001. Conclusion: Larger prostate volume was associated with higher serum PSA and greater LUTS severity. Combined assessment of prostate size, PSA, and IPSS provides complementary clinical information in men with BPH.
Research Article
Open Access
Clinical Profile, Risk Factors, and Outcomes of Patients with Urolithiasis: A Hospital-Based Prospective Observational Study
S. Srinivas ,
Prashanth Kumar Patnaik
Pages 172 - 179
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Abstract
Background: Urolithiasis is a common and recurrent disorder of the urinary tract influenced by demographic, metabolic, dietary, and environmental factors. Its clinical course ranges from spontaneous stone passage to obstruction, infection, and the need for invasive treatment. Objectives: To describe the clinical profile, recognized risk-factor exposures, stone characteristics, management patterns, and short-term outcomes of patients with urolithiasis. Methods: This hospital-based prospective observational study included 80 consecutive adults with imaging-confirmed urolithiasis at Dr B.R. Ambedkar Medical College, Kadugondanahalli, Bangalore, Karnataka, India, from June to December 2019. Demographic data, symptoms, laboratory findings, risk-factor exposures, imaging characteristics, treatment, and outcomes were recorded prospectively. Results: The mean age was 42.3 ± 13.8 years and 65.0% were male. Flank pain was the predominant symptom (86.3%). Low daily fluid intake (58.8%), high dietary salt intake (43.8%), previous urolithiasis (32.5%), obesity (28.8%), and family history (26.3%) were common recognized risk factors. Ureteric stones were identified in 53.8%, and 58.8% had hydronephrosis. Conservative treatment was used in 31.3%, whereas 68.8% underwent intervention. Complete stone clearance was achieved in 87.5%; complications occurred in 8.8%, repeat intervention in 7.5%, and no deaths occurred. Stones >10 mm were associated with greater intervention requirement and complication frequency. Conclusion: Urolithiasis in this cohort predominantly affected middle-aged men and commonly presented with flank pain. Modifiable lifestyle exposures were frequent. Most patients had favorable short-term outcomes, while larger stones were linked to increased treatment burden and complications.
Original Article
Open Access
Comparative evaluation of pelvic floor muscle strength in multiparous and nulliparous women.
Pages 160 - 171
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Abstract
Background: Pregnancy and childbirth may affect the muscular, connective-tissue and neural components of the pelvic floor. Repeated childbirth may produce cumulative reductions in pelvic floor muscle strength, endurance and coordination, increasing the subsequent risk of pelvic floor dysfunction. Aim: To compare pelvic floor muscle strength between multiparous and nulliparous women and determine the factors associated with reduced strength. Materials and Methods: This hospital-based comparative cross-sectional study included 160 women comprising 80 multiparous and 80 nulliparous participants. Sociodemographic, anthropometric, clinical and obstetric information was recorded using a predesigned data-collection form. Pelvic floor muscle strength was assessed clinically using the Modified Oxford Scale and the PERFECT scheme and objectively using vaginal perineometry. Reduced strength was defined as a Modified Oxford Scale grade ≤2. Continuous variables were compared using the independent-samples t test or analysis of variance, while categorical variables were compared using the chi-square or Fisher’s exact test. Correlation analysis and multivariable logistic regression were performed. A P value <0.05 was considered statistically significant. Results: Multiparous women had significantly lower mean Modified Oxford Scale scores than nulliparous women (2.68±0.88 versus 3.61±0.72; mean difference=−0.93, 95% CI: −1.18 to −0.68; P<0.001). Mean perineometric pressure was also lower among multiparous women (27.4±8.7 versus 39.8±9.2 cmH₂O; mean difference=−12.40 cmH₂O, 95% CI: −15.20 to −9.60; P<0.001). Multiparous women demonstrated significantly lower endurance and completed fewer sustained and fast contractions. Reduced muscle strength was present in 46.3% of multiparous women compared with 13.8% of nulliparous women (OR=5.39, 95% CI: 2.47-11.77; P<0.001). Among multiparous women, reduced strength was more frequent in those with parity ≥3 than those with parity two (64.9% versus 30.2%; P=0.002). Modified Oxford Scale grades correlated strongly with perineometric pressure among nulliparous women (r=0.71, 95% CI: 0.58-0.80; P<0.001). Multiparity (aOR=4.21), age ≥35 years (aOR=2.18), BMI ≥25 kg/m² (aOR=2.36) and chronic constipation (aOR=2.47) were independently associated with reduced strength. Among multiparous women, parity ≥3, vaginal delivery and neonatal birth weight ≥3.5 kg were significant obstetric factors, while previous pelvic floor exercise was associated with lower odds of reduced strength. Conclusion: Multiparous women had significantly lower pelvic floor muscle strength, endurance and contraction performance than nulliparous women. Higher parity and selected maternal and obstetric factors were associated with reduced strength, whereas previous pelvic floor muscle exercise appeared protective. Routine assessment and preventive pelvic floor muscle training should be considered, particularly for women with multiple childbirths and associated risk factors.
Research Article
Open Access
Comparative analysis of sexual function and quality of life in women with and without pelvic floor disorder
Pages 149 - 159
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Abstract
Background: Pelvic floor disorders, including urinary incontinence, pelvic organ prolapse, faecal incontinence and pelvic pain, may adversely affect women’s physical, psychological, social and sexual well-being. However, sexual concerns are frequently underreported and may not be routinely assessed during clinical care. Aim: To compare sexual function and quality of life among women with and without pelvic floor disorders. Materials and Methods: A hospital-based comparative cross-sectional study was conducted among 200 women. The study group comprised 100 women with clinically identified pelvic floor disorders, while the comparison group included 100 women without pelvic floor disorders. Pelvic floor symptoms were evaluated using the Pelvic Floor Distress Inventory-20. Sexual function was assessed using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-IUGA Revised, and quality of life was evaluated using the World Health Organization Quality of Life-BREF questionnaire. Continuous variables were compared using Welch’s independent-samples t-test, while categorical variables were analysed using the chi-square test. Effect estimates were presented as mean differences or odds ratios with 95% confidence intervals. A P value <0.05 was considered statistically significant. Results: Women with pelvic floor disorders had a significantly lower mean overall PISQ-IR score than women without PFD [52.8 (12.4) versus 68.9 (10.7); MD=-16.10; 95% CI: -19.33 to -12.87; P<0.001]. Sexual dysfunction was present in 63.0% and 24.0% of women, respectively (OR=5.39; 95% CI: 2.92-9.95; P<0.001), while sexual inactivity was more frequent in the PFD group (26.0% versus 14.0%; OR=2.16; 95% CI: 1.05-4.44; P=0.034). All PISQ-IR domains were significantly poorer among sexually active women with PFD, with the largest difference in the condition-impact domain (MD=-31.20; 95% CI: -35.90 to -26.50; P<0.001). The overall WHOQOL-BREF score was also significantly lower in the PFD group [61.7 (11.2) versus 74.6 (9.3); MD=-12.90; 95% CI: -15.77 to -10.03; P<0.001]. Impaired quality of life affected 58.0% of women with PFD and 19.0% of controls (OR=5.89; 95% CI: 3.11-11.15; P<0.001). Severe PFD was associated with higher odds of sexual dysfunction (OR=8.24; 95% CI: 2.09-32.46) and impaired quality of life (OR=10.42; 95% CI: 2.91-37.29) compared with mild PFD. Conclusion: Pelvic floor disorders were strongly associated with poorer sexual function and quality of life, particularly when the disorders were combined or severe. Incorporating sexual-health and quality-of-life assessment into routine PFD care may facilitate comprehensive, patient-centred management.
Research Article
Open Access
Comparative evaluation of pelvic floor muscle strength in multiparous and nulliparous women
Pages 137 - 148
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Abstract
Background: Pregnancy and childbirth may affect the muscular, connective-tissue and neural components of the pelvic floor. Repeated childbirth may produce cumulative reductions in pelvic floor muscle strength, endurance and coordination, increasing the subsequent risk of pelvic floor dysfunction. Aim: To compare pelvic floor muscle strength between multiparous and nulliparous women and determine the factors associated with reduced strength. Materials and Methods: This hospital-based comparative cross-sectional study included 160 women comprising 80 multiparous and 80 nulliparous participants. Sociodemographic, anthropometric, clinical and obstetric information was recorded using a predesigned data-collection form. Pelvic floor muscle strength was assessed clinically using the Modified Oxford Scale and the PERFECT scheme and objectively using vaginal perineometry. Reduced strength was defined as a Modified Oxford Scale grade ≤2. Continuous variables were compared using the independent-samples t test or analysis of variance, while categorical variables were compared using the chi-square or Fisher’s exact test. Correlation analysis and multivariable logistic regression were performed. A P value <0.05 was considered statistically significant. Results: Multiparous women had significantly lower mean Modified Oxford Scale scores than nulliparous women (2.68±0.88 versus 3.61±0.72; mean difference=−0.93, 95% CI: −1.18 to −0.68; P<0.001). Mean perineometric pressure was also lower among multiparous women (27.4±8.7 versus 39.8±9.2 cmH₂O; mean difference=−12.40 cmH₂O, 95% CI: −15.20 to −9.60; P<0.001). Multiparous women demonstrated significantly lower endurance and completed fewer sustained and fast contractions. Reduced muscle strength was present in 46.3% of multiparous women compared with 13.8% of nulliparous women (OR=5.39, 95% CI: 2.47-11.77; P<0.001). Among multiparous women, reduced strength was more frequent in those with parity ≥3 than those with parity two (64.9% versus 30.2%; P=0.002). Modified Oxford Scale grades correlated strongly with perineometric pressure among nulliparous women (r=0.71, 95% CI: 0.58-0.80; P<0.001). Multiparity (aOR=4.21), age ≥35 years (aOR=2.18), BMI ≥25 kg/m² (aOR=2.36) and chronic constipation (aOR=2.47) were independently associated with reduced strength. Conclusion: Multiparous women had significantly lower pelvic floor muscle strength, endurance and contraction performance than nulliparous women. Higher parity and selected maternal and obstetric factors were associated with reduced strength, whereas previous pelvic floor muscle exercise appeared protective. Routine assessment and preventive pelvic floor muscle training should be considered, particularly for women with multiple childbirths and associated risk factors.
Research Article
Open Access
Comparative study of lower urinary tract symptoms among women following vaginal delivery and caesarean section
Pages 126 - 136
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Abstract
Background: Lower urinary tract symptoms are common after childbirth and may adversely affect women’s physical, psychological and social well-being. Vaginal delivery can cause pelvic-floor muscular, connective-tissue and neural injury, whereas caesarean section may offer partial protection. This study compared the prevalence, pattern and severity of LUTS among women following vaginal delivery and caesarean section. Aim: To compare lower urinary tract symptoms among women following vaginal delivery and caesarean section. Materials and Methods: This hospital-based comparative cross-sectional study included 140 postpartum women, with 70 women following vaginal delivery and 70 following caesarean section. Sociodemographic, maternal and obstetric information was collected using a structured proforma. LUTS and their impact were assessed using the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms. Continuous variables were compared using Welch’s independent-samples t-test, while categorical variables were compared using the chi-square test. Associations were expressed as odds ratios with 95% confidence intervals. A P value <0.05 was considered statistically significant. Results: The overall prevalence of LUTS was 35.7%. LUTS were significantly more frequent following vaginal delivery than caesarean section (45.7% versus 25.7%; OR=2.43, 95% CI: 1.19-4.96; P=0.014). The mean ICIQ-FLUTS score [7.8 (5.2) versus 4.9 (4.4); P<0.001] and quality-of-life interference score [3.1 (2.4) versus 1.9 (2.0); P=0.002] were significantly higher after vaginal delivery. Stress urinary incontinence was significantly more common following vaginal delivery (34.3% versus 14.3%; OR=3.13, 95% CI: 1.36-7.19; P=0.006). Differences in urgency, urgency urinary incontinence, frequency, nocturia, voiding symptoms and incomplete emptying were not statistically significant. Age ≥30 years, BMI ≥25 kg/m², parity ≥2, instrumental delivery, prolonged labour and episiotomy or perineal tear were significantly associated with LUTS. Conclusion: Women following vaginal delivery had a significantly higher prevalence and greater burden of LUTS, particularly stress urinary incontinence, than women following caesarean section. Screening for LUTS and early pelvic-floor rehabilitation should be integrated into postnatal care, especially for women with additional maternal or obstetric risk factors.
Research Article
Open Access
Pelvic organ prolapse and it's association with obstetrics and life style factors - A hospital based cross sectional study
Pages 115 - 125
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Research Article
Open Access
A Prospective Randomized Comparative Study of PRST Score and Bispectral Index in Assessment of Depth of Anaesthesia during General Anaesthesia
Pages 108 - 114
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Abstract
Adequate monitoring of depth of anaesthesia is essential for ensuring patient safety during general anaesthesia. Conventional monitoring based on clinical signs and haemodynamic parameters may be unreliable because cardiovascular responses can be influenced by multiple factors including analgesics, muscle relaxants, and surgical stimulation. Processed electroencephalographic (EEG) monitoring devices such as Bispectral Index (BIS) and Patient State Index (PSI) provide objective assessment of the hypnotic component of anaesthesia. BIS is widely used; however, newer monitoring systems such as PSI have emerged as potential alternatives. A light plane of anaesthesia results in awareness and a depth above the desired level causes cardiovascular depression. 100 ASA-PS 1,2 patients undergoing elective surgeries under general anaesthesia were grouped into two. In first group, the depth of anaesthesia was assessed using clinical parameters (PRST Score) and in second group, along with clinical parameters, BIS was also used. After analysis of data, it was found that along with the PRST score, BIS helps in decision making, facilitates titration of anaesthetics and achieve the best possible outcome for the patient.
Research Article
Open Access
Meibomian Gland Dysfunction and Its Systemic Associations: A Cross-Sectional Comparative Study
Dr Abeer Fatima ,
Dr N Khaiser Jehan ,
Dr Sowmya Chowdhury
Pages 101 - 107
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Abstract
Background: Meibomian gland dysfunction (MGD) is the most common cause of evaporative dry eye disease and is increasingly recognised as a multisystem condition extending beyond the ocular surface. This study aimed to systematically evaluate the prevalence and strength of association between MGD and various systemic diseases. Methods: A prospective cross-sectional comparative study was conducted on 300 participants (150 MGD cases and 150 age-and-sex-matched controls) over 18 months at a tertiary ophthalmology centre. MGD was graded using slit-lamp examination, tear film break-up time (TBUT), meibography and the Standardised Patient Evaluation of Eye Dryness (SPEED) questionnaire. Systemic conditions were documented and confirmed by subspecialty review. Logistic regression analyses were used to determine independent associations. Results: MGD was significantly associated with rosacea (OR 7.1, p<0.001), Sjögren's syndrome (OR 8.3, p<0.001), dyslipidaemia (OR 3.7, p<0.001), metabolic syndrome (OR 4.5, p<0.001), type 2 diabetes mellitus (OR 3.3, p<0.001), hypothyroidism (OR 3.0, p=0.002), hypertension (OR 2.1, p=0.008), rheumatoid arthritis (OR 3.0, p=0.011), seborrhoeic dermatitis (OR 5.6, p<0.001), and obstructive sleep apnoea (OR 3.0, p=0.008). Systemic burden correlated significantly with MGD severity (p<0.001). Conclusion: MGD carries substantial systemic comorbidity. Ophthalmologists should adopt a holistic, multidisciplinary approach, and clinicians managing the identified systemic conditions should actively screen for MGD as part of routine assessment.
Research Article
Open Access
Pharmacovigilance and Clinical Outcomes of Polypharmacy Among Patients with Chronic Non-Communicable Diseases: A Prospective Observational Study
Swati Narayanrao Pullewar ,
Amolkumar Bhagwanrao Gore ,
. Zeenat Fatima ,
Zadte Nagesh M
Pages 96 - 100
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Abstract
Background: The growing burden of chronic non-communicable diseases (NCDs) has resulted in increased medication use, often leading to polypharmacy. While polypharmacy is frequently necessary for disease control, it may increase the risk of adverse drug reactions (ADRs), drug-drug interactions (DDIs), medication non-adherence, and poor clinical outcomes. Pharmacovigilance plays a critical role in identifying and preventing medication-related harm among patients with chronic diseases. Objectives: To assess the prevalence of polypharmacy, evaluate associated adverse drug reactions and drug interactions, and determine their impact on clinical outcomes among patients with chronic non-communicable diseases. Methods: A prospective observational study was conducted among adult patients diagnosed with one or more chronic NCDs attending outpatient and inpatient departments of a tertiary care hospital. Patients receiving five or more medications for at least three months were included. Data regarding demographics, disease characteristics, prescribed medications, ADRs, DDIs, hospitalizations, and treatment adherence were collected over a six-month follow-up period. ADRs were assessed using the WHO-Uppsala Monitoring Centre causality assessment scale. Results: A total of 320 patients were enrolled, with a mean age of 58.4 ± 11.2 years. Hypertension (72.5%), diabetes mellitus (64.7%), and cardiovascular diseases (31.9%) were the most common NCDs. The prevalence of polypharmacy was 68.4%. A total of 96 ADRs were reported among 78 patients. Gastrointestinal disturbances (28.1%), dizziness (19.8%), and hypoglycemia (14.6%) were the most frequently observed ADRs. Potential DDIs were identified in 42.8% of prescriptions. Patients exposed to excessive polypharmacy (≥10 medications) demonstrated significantly higher hospitalization rates and poorer medication adherence compared to those receiving fewer medications (p < 0.05). Conclusion: Polypharmacy is highly prevalent among patients with chronic NCDs and is associated with increased ADRs, DDIs, hospitalization risk, and reduced treatment adherence. Strengthening pharmacovigilance practices and regular medication review may improve patient safety and clinical outcomes.
Research Article
Open Access
Comparison of Gabapentin v/s Pregabalin for Preemptive Analgesia for Acute Postoperative Pain after Surgery under Spinal Anaesthesia
Pages 90 - 95
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Abstract
Background: Postoperative pain is one of the most common and distressing complications following surgery. Despite advances in anaesthesia and pain management, many patients continue to experience moderate to severe pain in the postoperative period. Inadequate pain control leads to delayed mobilization, increased hospital stay, patient dissatisfaction, and higher morbidity. Preemptive analgesia, which involves administration of analgesics before surgical stimulus, has emerged as an important strategy to reduce postoperative pain and central sensitization. Preemptive analgesia is a proactive approach that entails administering an analgesic regimen before exposure to noxious stimuli, aiming to hinder the sensitization of the nervous system and mitigate the amplification of pain from subsequent stimuli. This study was crafted to assess and compare the effectiveness of Gabapentin and Pregabalin. The focus was on examining their impact on prolonging analgesia duration, diminishing the overall need for post-operative analgesics, and scrutinizing potential side effects and complications. Methods: This prospective randomized study encompassed 124 patients classified as ASA grade I or II, aged between 20 and 50 years, with a body weight ranging from 50 to 70 kg. The participants were slated for elective infra-umbilical surgeries under spinal anesthesia. The cohort was randomly divided into two groups, each consisting of 62 individuals. Group G received a 1200 mg dose of Gabapentin, while Group P received a 300 mg dose of Pregabalin, administered one hour prior to spinal anesthesia. Pain levels were evaluated using the Visual Analogue Scale immediately in the postoperative period and subsequently every two hours. The time elapsed between spinal anesthesia and the initial analgesic dose (diclofenac) as well as the total analgesic doses administered within the first 24 hours were meticulously recorded for analysis. Results: Within Group G, participants necessitated rescue analgesia after an average of 12.00 ± 2.02 hours, while in Group P, this need arose later at 16.48 ± 4.48 hours. Additionally, in Group G, subsequent rescue analgesia was essential in only 6 cases, whereas in Group P, it was required in just 4 cases. Furthermore, the occurrence of somnolence and dizziness was less frequent with Pregabalin compared to Gabapentin. Conclusion: Pregabalin was found to be superior to gabapentin as a preemptive analgesic in surgeries performed under spinal anaesthesia. It provided prolonged postoperative analgesia, reduced pain scores, and decreased rescue analgesic requirements with minimal adverse effects. Administering a preoperative single oral dose of Pregabalin (300 mg) proves to be more effective in postoperative pain management and results in a reduction in the consumption of postoperative rescue analgesics when compared to a single dose of Gabapentin (1200 mg). Additionally, Pregabalin exhibits a favorable profile with fewer side effects in this context.
Research Article
Open Access
Prospective Study of Functional Outcome of Fractures of Calcaneum Treated Surgically by Plating in a Tertiary Care Hospital.
Shashank Balasaheb Karvekar
Pages 85 - 89
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Abstract
Background: About 60% of all tarsal bone fractures are calcaneum fractures. 70% of all calcaneal fractures are intra-articular fractures. There are disagreements on how to operate on calcaneum fractures. In order to quantify the functional results of calcaneum fractures treated with open reduction and internal fixation with plate and screws, this study was conducted. Calcaneum intraarticular fractures are not unusual. The calcaneus is the tarsal bone that fractures most commonly. 60% of tarsal bone injuries and 2% of all fractures are calcaneal fractures. The most frequent mode of injury is axial loading, which results in bilateral calcaneal fractures when someone falls from a height. It is necessary to rule out further fractures such pelvic and spinal fractures that are linked to falls from height. Thanks to improved knowledge of fracture patterns and the availability of superior implants, the care of Calcaneal fractures has changed over the past several years from conservative to surgical management.Aim: To evaluate the functional outcome of calcaneal fractures treated surgically by plating in a tertiary care hospital. The goal of the current study is to evaluate the surgical outcomes of Calcaneal fractures treated with improved implants after intra-articular reduction.Material and Method: Patients who were hospitalized from the hospital's emergency and outpatient departments were the subjects of the study at the department of orthopedics. Twenty-five patients (20 men and 5 women) who met the inclusion and exclusion criteria for the study had 26 fractures that we assessed. All patients gave their informed consent.Results: We used plating, such as locking the calcaneal plate, to treat a total of 26 calcaneal fractures in 25 patients. There was a tendency for right-sided fractures among the 25. There were no lost patients to follow-up. Most of the patients were adults in the 30- to 45-year age range. The oldest and youngest patients were 53 and 19 years old, respectively. Therefore, falls from a height occurred most frequently when people were engaged in the construction industry. A small proportion of fractures occurred as a result of four-wheeler-related traffic accidents. In this investigation, there was a minor tendency toward right-side fractures. Compound fractures and bilateral fractures were excluded from this investigation.Conclusion: Open reduction and internal fixation with an expanded lateral approach and calcaneum locking plates and screws produce a high percentage of positive outcomes in displaced intra-articular calcaneum fractures and very few negative outcomes. For the treatment of displaced intra-articular calcaneum fractures, it may therefore be a superior alternative.
Research Article
Open Access
A Study on Prevalence of Vitamin D Deficiency Among Orthopaedic Patients Attending Tertiary Care Teaching Hospital.
Shashank Balasaheb Karvekar
Pages 80 - 84
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Abstract
Aim: A Study on Prevalence of Vitamin D Deficiency Among Orthopaedic Patients Attending Tertiary Care Teaching Hospital. Methods: The prospective clinical study was conducted in the Department of Orthopaedics The serum 25-OH-D levels of every patient consecutively admitted to the Orthopaedic Department (in total 950 patients) was measured after admission. Patients from the following orthopaedic sections were included in the study: elbow/shoulder, hip, knee, foot/ankle, spine and bone tumour. Measurement of serum 25-0H-D was standardized, the hospital laboratory used the ARCHITECT 25-OH Vitamin D assay. Results: A total of 950 patients participated in this study, of which 500(52.63%) were women, 450(47.37%) men. Ages ranged from 11 to 88 years, with a mean age of 57.5 years. The body region-specific patient census was as follows: 222 patients (25.5% of all patients) were scheduled to undergo back surgery (spondylodesis or kyphoplasty). 202 (21.26%) presented for knee surgery, 147 (15.47%) foot and ankle, 142 (14.95) hip,
137 (14.42%) shoulder and elbow. 100 (10.53%) patients were scheduled to undergo cancer associated surgery of different body regions. The serum 25-OH-D levels for all participants were normally distributed, with a mean of ng/ml. Lowest measured level was <8.5 ng/ml, highest measured level was 77.9 ng/ml. Statistical analyses failed to disclose any relationship between vitamin D level and body region scheduled to undergo surgery. All tested patient subgroups showed low vitamin D levels. Multivariate analyses showed no significant correlation between medication history and hypo- vitaminosis D. Conclusion: Our data suggests a possible way to improve the outcome after orthopaedic surgery by supplementing vitamin D. Nevertheless, heightened awareness is necessary, especially as vitamin D deficiency is preventable.
Research Article
Open Access
A Retrospective Analysis of Lesional Patterns in Cervical Biopsies Received in a Pathology Department
Dr. Narendra Kumar Chandrashekar
Pages 74 - 79
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Abstract
Background: Cervical biopsy is a key diagnostic tool for distinguishing inflammatory, premalignant, and malignant lesions of the cervix. Analysis of biopsy patterns in institutional pathology archives provides clinically relevant insight into the burden and spectrum of cervical disease in a given setting. Objectives: To analyze the age distribution, clinical indications, and histopathological patterns of cervical biopsy lesions received in the pathology department of a tertiary care hospital. Methods: This retrospective descriptive study was conducted in the Department of Pathology, KIMS, Amalapuram, Andhra Pradesh, India, over a six-month period from July 2019 to December 2019. Fifty cervical biopsy specimens were included. Archived records and hematoxylin and eosin stained slides were reviewed, and lesions were categorized as non-neoplastic, premalignant, or malignant. Results: The mean age of patients was 43.8 +/- 10.9 years, and the largest proportion belonged to the 41-50 year age group. White vaginal discharge was the most frequent indication for biopsy. Non-neoplastic lesions accounted for 68.0% of cases, with chronic nonspecific cervicitis as the predominant diagnosis. Premalignant lesions constituted 20.0%, while malignant lesions accounted for 12.0%. Squamous cell carcinoma was the most common malignancy. Premalignant and malignant lesions were more frequent in women older than 40 years. Conclusion: Inflammatory and reactive lesions formed the major share of cervical biopsies, but a clinically important proportion showed cervical intraepithelial neoplasia and invasive carcinoma. Histopathological evaluation remains indispensable for early detection, risk stratification, and timely management of cervical lesions.
Research Article
Open Access
A Cross-Sectional Study of Histopathological Patterns in Endometrial Biopsies Among Women Presenting with Abnormal Uterine Bleeding
Dr. Narendra Kumar Chandrashekar
Pages 68 - 73
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Abstract
Background: Abnormal uterine bleeding is a common gynecologic complaint and a frequent indication for endometrial sampling, particularly in perimenopausal and postmenopausal women. Histopathological evaluation remains central for identifying benign, premalignant, and malignant endometrial lesions. Objectives: To evaluate the histopathological patterns in endometrial biopsy specimens obtained from women presenting with abnormal uterine bleeding and to assess their distribution across age groups. Methods: This cross-sectional study was conducted at KIMS, Amalapuram, Andhra Pradesh, India, from September 2019 to February 2020. Fifty women presenting with abnormal uterine bleeding and undergoing endometrial biopsy were included. Clinical details were recorded, specimens were processed by standard histopathological methods, and findings were analyzed using descriptive statistics. Results: The mean age of the participants was 42.8 ± 9.6 years, and the largest proportion belonged to the 41–50 year age group. Heavy menstrual bleeding was the most frequent presentation. Proliferative endometrium was the most common histopathological finding, followed by secretory endometrium and disordered proliferative endometrium. Endometrial hyperplasia without atypia was seen in a smaller proportion, while atypical hyperplasia and endometrial carcinoma were identified in one case each. Benign lesions predominated overall, whereas atrophic endometrium and premalignant or malignant lesions were more frequent in older women. Conclusion: Most endometrial biopsies in women with abnormal uterine bleeding showed benign histopathological patterns, with proliferative endometrium being the leading finding. Endometrial biopsy remains a valuable diagnostic tool for excluding significant pathology, especially in perimenopausal and postmenopausal women.
Research Article
Open Access
Clinical Presentation and Surgical Outcomes of Acute Appendicitis at Tertiary Care Teaching Center
Dr. Sanikommu Srinivas Reddy
Pages 64 - 67
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Abstract
Background: Acute appendicitis is one of the most common surgical emergencies worldwide. Prompt diagnosis and surgical intervention are essential to prevent complications such as perforation, abscess formation, and peritonitis. Understanding the clinical presentation and surgical outcomes helps improve management strategies. Aim: To evaluate the clinical presentation, diagnostic findings, and surgical outcomes of patients with acute appendicitis. Materials and Methods: A prospective observational study was conducted in the Department of General Surgery at a tertiary care hospital over a period of 12 months. A total of 120 patients diagnosed with acute appendicitis and undergoing appendectomy were included. Clinical presentation, laboratory investigations, operative findings, and postoperative outcomes were analyzed Results: The most common presenting symptom was right lower abdominal pain (100%), followed by nausea/vomiting (78.3%) and fever (62.5%). The majority of patients underwent open appendectomy, while a smaller proportion underwent laparoscopic appendectomy. Postoperative complications were observed in 10.8% of cases, with wound infection being the most common. Conclusion: Acute appendicitis commonly presents with classical symptoms of right lower quadrant pain, nausea, and fever. Early diagnosis and prompt surgical intervention lead to favorable outcomes with minimal complications.
Research Article
Open Access
Efficacy of Topical and Systemic Therapies in Treating Melasma in Pregnant and Postpartum Women: A Comparative Study
Y Nikhil Kumar Reddy,
Mounika Reddy Chitikela,
Shashi Jyothsna
Pages 60 - 63
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Abstract
Background: Melasma, a chronic hyperpigmentation disorder, is frequently observed in women during pregnancy and the postpartum period due to hormonal influences. This study aimed to compare the efficacy of topical and systemic therapies in treating melasma among pregnant and postpartum women. Methods: A prospective comparative study was conducted on 60 women, including 30 pregnant and 30 postpartum patients diagnosed clinically with melasma. Pregnant women received only topical therapy (combination of hydroquinone 2%, azelaic acid, and broad-spectrum sunscreen), while postpartum women were randomized into two groups: one receiving topical therapy (n = 15), and the other receiving systemic therapy (oral tranexamic acid 250 mg twice daily) along with sunscreen (n = 15). The Melasma Area and Severity Index (MASI) was recorded at baseline, 8 weeks, and 16 weeks. Results: In the pregnant group (n = 30), topical therapy led to a mean reduction in MASI score from 12.8 ± 2.3 to 8.4 ± 1.9 after 16 weeks (34.4% reduction, p < 0.01). In the postpartum group, patients on systemic therapy (n = 15) showed a more significant improvement in MASI scores, from 13.2 ± 2.1 to 6.5 ± 1.6 (50.8% reduction, p < 0.001), compared to those on topical therapy (n = 15), who improved from 13.0 ± 2.0 to 9.0 ± 1.8 (30.8% reduction, p < 0.05). Mild adverse effects, such as transient skin irritation, were reported in 4 patients on topical therapy; no systemic side effects were observed. Conclusion: Topical therapy is effective and safe during pregnancy for managing melasma. However, systemic therapy with oral tranexamic acid in postpartum women offers superior clinical improvement and higher patient satisfaction. Therapy selection should consider the patient’s reproductive status to ensure optimal safety and efficacy.
Research Article
Open Access
Prevalence and Clinical Profile of Pregnancy-Associated Dermatoses in Indian Women: A Cross-Sectional Study
Mounika Reddy Chitikela,
Y Nikhil Kumar Reddy,
Shashi Jyothsna
Pages 55 - 59
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Abstract
Background: Pregnancy-associated dermatoses (PADs) include specific skin disorders unique to pregnancy and physiological changes influenced by hormonal and immunological shifts. Timely recognition of these conditions is essential for optimal maternal and fetal outcomes. This study aimed to evaluate the prevalence and clinical profile of PADs among Indian pregnant women. Methods: A cross-sectional observational study was conducted at a tertiary care centre in South India over one year. A total of 412 pregnant women attending the antenatal outpatient department were recruited. Detailed obstetric history, dermatological examination, and relevant investigations were performed. PADs were categorized into specific dermatoses and physiological/nonspecific dermatoses. Results: Out of 412 women, 157 (38.1%) were diagnosed with pregnancy-associated dermatoses. Among specific PADs (n = 157), the most common was Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP) in 64 women (40.8%), followed by Prurigo of Pregnancy in 35 (22.3%), Intrahepatic Cholestasis of Pregnancy (ICP) in 27 (17.2%), Atopic Eruption of Pregnancy in 19 (12.1%), and Pemphigoid Gestationis in 6 (3.8%). The highest prevalence was in the third trimester with 91 cases (57.9%), followed by the second trimester with 51 (32.5%) and first trimester with 15 (9.6%). Obstetric complications were noted in cases of ICP, including preterm labour in 6 (22.2%) and fetal growth restriction in 4 (14.8%). Conclusion: PADs were observed in over one-third of the pregnant women, with PUPPP being the most frequent. While most cases were benign, certain dermatoses such as ICP showed associations with adverse pregnancy outcomes. Early dermatological screening is recommended for prompt diagnosis and management
Research Article
Open Access
To Study the Efficacy and Safety of Sodium Cromoglycate, Lodoxamide and Loteprednol in Treatment of Vernal Keratoconjunctivitis at Tertiary Care Hospital
Kiran P,
Anila Sadipirala,
K Vijay Kumar,
Chandrasekhar Reddy Bolla
Pages 42 - 49
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Abstract
Vernal keratoconjunctivitis (VKC) is a complex, Th2 cell-mediated inflammatory condition of the ocular surface that primarily affects males, particularly children and young adults. This condition involves an overactivity of immune cells, including mast cells, eosinophils, and Th2 cells, along with increased levels of cytokines, chemokines, and adhesion molecules. The main aim the study is the detect the efficacy of sodium cromoglycate, lodoxamide and loteprednol in treatment of Vernal keratoconjunctivitis (VKC). Methods randomized; comparative study was conducted on patients visiting the OPD at tertiary care hospital. The study included 150 patients diagnosed with VKC (vernal keratoconjunctivitis), patients were divided into three groups based on randomisation. Group A 50 patients treated with sodium cromoglycate Group B 50 patients treated with lodoxamide and group C patients treated with loteprednol, administered twice daily for 8 weeks. The reduction in signs and symptoms in groups was compared. White blood counts were measured for all patients before and after the treatment. Observations and results were systematically tabulated, and data were analysed using SPSS software. An unpaired t-test was used to determine statistical significance between the three groups, with a P-value < 0.05 considered statistically significant. Results: The study population included 150 patients, with 108 (72%) aged 5-10 years and 42 (28%) aged 11-15 years. Among them, 98 (65.3%) were male and 52 (34.7%) female. Shield ulcer was the most common symptom in patients with Vernal keratoconjunctivitis (VKC), occurring in 94.7% of cases, followed by sticky mucous discharge in 88% of patients. Infection was associated with elevated white blood cell count and CRP levels, as well as increases in neutrophils, eosinophils, and CRP. After treatment, improvements were noted in neutrophils, and significant changes were seen in basophils and CRP by the third visit (p = 0.005). Average CRP levels were monitored across all three treatment groups, alongside eosinophil and neutrophil counts. Conclusion for the treatment of vernal keratoconjunctivitis (VKC) mono drug therapy of sodium cromoglycate, lodoxamide and loteprednol shows significant improvement in treatment of Vernal keratoconjunctivitis (VKC).
Research Article
Open Access
Antibiotic Susceptibility Patterns of Common Pathogens Causing Chronic Suppurative Otitis Media in Patients at a Tertiary Care Hospital's ENT Department
Pages 35 - 41
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Abstract
Background Chronic Suppurative Otitis Media (CSOM) is a persistent middle ear and mastoid cavity infection characterized by ear discharge and tympanic membrane perforation. Its prevalence is higher in developing nations due to factors such as malnutrition, overcrowding, and inadequate healthcare. The emergence of multidrug-resistant pathogens has posed challenges in the management of CSOM, necessitating regular updates on microbial patterns and antibiotic susceptibility. Objective: This study aimed to evaluate the microbial diversity and antibiogram of aerobic bacterial, anaerobic, and fungal isolates in patients with CSOM attending a tertiary care hospital. Methods: A six-month prospective study was conducted on 102 clinically diagnosed CSOM patients who had not received antimicrobial therapy in the preceding seven days. Ear discharge samples were collected and processed for aerobic, anaerobic, and fungal cultures using standard microbiological protocols. Antimicrobial susceptibility testing for aerobic isolates was performed using the Kirby-Bauer disc diffusion method, and results were analyzed per CLSI guidelines. Results: Among 102 patients, 57.8% of cases were monomicrobial, 33.3% polymicrobial, and 7.8% sterile. Aerobic isolates included *MSSA* (48.04%), *Pseudomonas aeruginosa* (19.61%), and *Klebsiella pneumoniae* (8.82%). Anaerobic isolates accounted for 22 cases, with *Clostridium* and *Peptococcus species* being the most common (7.35% each). Fungal isolates were identified in 18 cases, predominantly *Aspergillus niger* (14.58%) and *Aspergillus fumigatus* (12.50%). Antimicrobial susceptibility testing revealed high sensitivity of *MSSA* to amikacin and cefuroxime, whereas *Pseudomonas aeruginosa* exhibited variable resistance patterns. Conclusion CSOM significantly impacts the quality of life, particularly in developing nations. The study highlights the importance of monitoring microbial trends and antibiotic susceptibility to guide effective management. Efforts to educate high-risk populations, especially parents and guardians of children, may help reduce disease burden. The findings provide valuable insights into the microbiological profile and resistance patterns in CSOM, aiding in its effective treatment and prevention.
Research Article
Open Access
Preparing for the coronavirus disease-2019 pandemic in the African region
Saurabh RamBihariLal Shrivastava,
* ,
Prateek Saurabh Shrivastava
Pages 33 - 34
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Abstract
The coronavirus disease-2019 (COVID-19) pandemic has been reported across all continents and the disease is growing at a very brisk pace, both in terms of the number of reported cases and the attributed deaths.It is important to note that the novel viral infection has been reported in 213 nations and territories. As per the recent estimates, a cumulative caseload of 2,314,621 cases and 157,847 deaths has been reported globally since the outbreak begun in a single city in China. The worst affected area has been the European region, wherein 1,149,071 cases has been reported and even the number of reported deaths (103,586) has clearly exceeded the number of deaths reported across the other 5 regions cumulatively.The disease already has attained pandemic status and is a global health emergency that has impacted the lives of all the stakeholders and will require an aggressive and a dedicated response from all the stakeholders to flatten the epidemic curve of the disease.
Research Article
Open Access
Comparative evaluation of nanocrystalline hydroxyapatite and bioactive calcium phosphosilicate grafts in the treatment of class II furcation defects – A randomized controlled trial
Pooja Palwankar,
Shetal Gupta,
* ,
Ruchi Pandey
Pages 22 - 32
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Abstract
Introduction Furcation involvement is a unique pathological entity, due to its complex structure and inadequate instrumentation which results in progression of further attachment loss with early and frequent loss of molars. Various alloplastic bone graft materials are used to regenerate the lost periodontal attachment apparatus. This study aims to compare the efficacy of nanocrystalline hydroxyapatite (NHA) and bioactive calcium phosphosilicate grafts (BG) in the treatment of class II furcation defects. Methods Twenty-four systemically healthy patients with class II furcation defects were selected and randomly assigned into three groups depending on the treatment received: Test group I (treated with open flap debridement (OFD) + NHA), Test group II (treated with OFD + BG) and Control group (treated with OFD alone). Clinical parameters, plaque index, gingival index, horizontal probing depth (HPD), vertical probing depth (VPD), clinical attachment level (CAL) were recorded at baseline, 3 and 6 months post-surgically. Radiographic depth of furcation defect (FD) and percentage bone fill was evaluated at baseline and 6 months postoperatively. Results When compared to baseline, all three groups demonstrated improvements in the clinical parameters at 6 months. There was no statistically significant difference between both Test groups (p=1.00). In contrast to the Control group, the Test groups showed a statistically significant reduction in probing depth, greater CAL gain, reduction in furcation defect and radiographic percentage bone fill (p<0.05). Conclusions There is a potential benefit of nano-crystalline hydroxyapatite and bioactive calcium phosphosilicate grafts in percentage bone fill in the treatment of class II furcation defects.
Research Article
Open Access
Highly drug resistant microorganisms causing ventilator associated pneumonia at a tertiary care center
Kundan Tandel,
Puneet Bhatt,
* ,
Lavan Singh,
Praveer Ranjan,
Khushi Ram Rathi
Pages 15 - 21
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Abstract
Introduction Ventilator associated pneumonia (VAP) is one of the most frequent intensive care unit (ICU) acquired infections. In recent years there has been an increase in antibiotic resistance among causal agents of VAP. This study was carried out to assess the profile of culture isolates and their antimicrobial sensitivity from the endotracheal aspirates (ETA) of patients with clinically suspected ventilator associated pneumonia. Methods In this observational study, ETA was collected from patients who were on mechanical ventilation for >48 hours in the ICU with clinically suspected VAP. Samples were mechanically liquefied, homogenized and serially diluted for quantitative culture. Identification and antibiotic sensitivity of the isolate was performed using Vitek2 (BioMérieux, Marcy-l'Étoile, France). Results We received a total of 196 tracheal aspirates during the study period, out of which 100 samples showed growth. The most common isolate was A. baumannii (38%) followed by K. pneumoniae (33%). Among the Enterobacteriaceae group of organisms isolated (n=41), 37 isolates (90%) were extended spectrum beta lactamase (ESBL) producing organisms and 35% were metallo-β-lactamases (MBL) producers. All Staphylococcus aureus (n=3) isolates were methicillin resistant (MRSA). Conclusions Multidrug resistant organisms are now commonly reported from patients with VAP in our ICUs. A majority of the organisms were sensitive only to tigecycline and colistin. Our data suggest the need for strengthened infection control efforts in the intensive care unit, and for reevaluating compliance with the antibiotic stewardship programme.
Research Article
Open Access
Temporomandibular joint: a cone beam computed tomography study of the articular eminence inclination and glenoid fossa
Cătălina Bichir,
* ,
Mihai Săndulescu,
Mugurel Constantin Rusu
Pages 8 - 14
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Abstract
Introduction Over the years, many studies concerning the articular eminence (AE) of the temporomandibular joint (TMJ) have been conducted. Very few used the now available cone-beam computer tomography (CBCT) technology. Thus, the aim of the current study was to contribute with our own findings to the recent available literature and to compare results. Methods Forty-eight CBCT files (96 TMJs) were analyzed in mid-condyle orthogonal plane. AE inclination (AEI), length of condylar path (LCP), length of the glenoid fossa (FL), sex and occlusion class were defined as parameters. Results In the examined lot, 9% of the slopes were below 30°, 70% between 30° and 50° and 21% above 50°. A minimum value of 21.63° was found in a female patient with a LCP of 11.07 mm and a FL of 19.96 mm, and a maximum value of 59.62° in a male patient with a LCP of 7.72 mm and a FL of 14.39 mm. A decrease in mean LCP and FL values for each increase in AEI category was noticed. Averages of both sexes were similar. Asymmetry was found in all patients. There were some differences between the two occlusal groups. Conclusions CBCT is a useful, non-invasive tool in analyzing TMJ bone structures. There might be a connection between AEI, LCP and FL in dictating the geometrical shape of the glenoid fossa. Differences in the values of the occlusal groups denote that occlusion could act as a factor for slope steepness.
Editorial
Open Access
Overlapping epidemics - a lesson in the chapter called "Vaccination”
Veronica Georgiana Preda*
Pages 7 - 7
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Abstract
One of the most famous quotes of Rudolf Virchow, a German researcher in Cell Biology, urges us to "learn to see microscopically”. In this complex situation that the world is facing nowadays, it seems vital to return to these words and complete them by adding that we should think globally, as well. The humanity encountered and won battles against many pathogens, such as Yersinia pestis, Mycobacterium tuberculosis or Variola viruses. However, at this moment in time we are confronted with multiple epidemics simultaneously. For instance, Romania is fighting both the COVID-19 pandemic and the measles epidemic. While the former is driven by an emerging virus, the latter is driven by a well-known virus, and one of the reasons behind the current epidemic is the parents’ hesitancy in immunizing their children through vaccination, as a result of misleading information in social media.
Research Article
Open Access
Cystic Duct Stump Leak after Laparoscopic Cholecystectomy: A Small Thorn Causing Greater Pain
Dinesh Kumar Bharti,
Anupama Nagar ,
K. M. Garg
Pages 1 - 6
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Abstract
Objective: To explore the prevalence, clinical indicators, detection methods, treatment approaches, and outcomes of cystic duct stump leak (CDSL) following laparoscopic cholecystectomy. Background: Laparoscopic cholecystectomy, a preferred treatment for symptomatic gallstones, occasionally leads to biliary complications, with CDSL emerging as a subtle yet significant issue. Methods: This prospective analysis reviewed 7000 laparoscopic cholecystectomies conducted from September 2008 to December 2015. It included 50 patients with imaging-confirmed CDSL, excluding those with main bile duct or .accessory duct injuries. Evaluations encompassed clinical symptoms, laboratory tests, and imaging (ultrasound, CT, MRCP, ERCP). Treatments included ERCP with stenting, drainage, or surgical revision. Follow-up occurred biweekly for one year. Statistical methods involved descriptive measures (averages, percentages) and chi-square tests (p < 0.05).Results: CDSL incidence was 0.71% (50/7000). Mean age was 44.85 years, with 36% in the 40-50 age group. Females were predominant (72%). Acute cholecystitis was noted in 56% via preoperative ultrasound. Common symptoms included abdominal discomfort (64%) and bilious drainage (48%). Elevated leukocyte count and alkaline phosphatase were observed in 72% each. ERCP confirmed CDSL in 95.65% of cases. Complications included perihepatic inflammation (80%) and bilioma (20%). ERCP resolved 84% of cases, with no mortality. No significant association was found between sex and preoperative ultrasound (p = 0.62) or acute cholecystitis and bilioma (p = 1.00).Conclusions: Though rare, CDSL poses a significant challenge post-laparoscopic cholecystectomy, with ERCP proving effective for diagnosis and treatment. Early intervention is key to reducing complications.
