Showing papers by "Mahatma Gandhi Memorial Medical College published in 2020"

Outcomes of Limbal Stem Cell Transplant: A Meta-analysis.

Abstract: Importance Limbal stem cell transplant (LSCT) can be categorized as direct autologous limbal transplant (AULT), direct allogenic limbal transplant (ALLT), cultivated autologous limbal stem cells transplant (cAULT), and cultivated allogenic limbal stem cells transplant (cALLT). To our knowledge, there is no study directly comparing the outcomes and complications of these procedures. Objective To evaluate the outcomes of different LSCT procedures. Data Source We searched PubMed, EMBASE, Web of Science, and Cochrane without language filter for peer-reviewed articles about LSCT. The latest search was performed on June 30, 2019. Study Selection Clinical studies with the outcome of at least 20 eyes after LSCT were included. Animal studies and studies of other surgical interventions were excluded. Data Extraction and Synthesis Two reviewers independently abstracted the data from each study. Heterogeneity was evaluated with theI2statistic, and a meta-analysis was performed using the random-effects model. Main Outcomes and Measures Outcome measures included the improvement of ocular surface, visual acuity (VA), and adverse events of recipient eyes and donor eyes. Results Forty studies (2202 eyes) with a mean (SD) follow-up of 31.3 (20.9) months met the inclusion criteria. The mean (SD) age of study participants was 38.4 (13.1) years, and men accounted for 74%. The number of eyes that underwent AULT, ALLT, cAULT, and cALLT were 505, 742, 771, and 184, respectively. Improvement of the ocular surface was achieved in 74.5% of all eyes, 85.7% of eyes after AULT (95% CI, 79.5%-90.3%), 84.7% after cAULT (95% CI, 77.2%-90.0%), 57.8% after ALLT (95% CI, 49.0%-66.1%), and 63.2% after cALLT (95% CI, 49.3%-75.2%). Autologous limbal transplantation resulted in a greater VA improvement rate (76%) than did the other 3 procedures (cAULT: 56.4%; ALLT: 52.3%; cALLT: 43.3%; allP Conclusions and Relevance These findings suggest LSCT can improve or stabilize the corneal surface with a low rate of severe ocular complications and that autologous LSCT may have a higher success rate and fewer complications than allogenic LSCT.

Inequity in Distribution of Psychiatry Trainee Seats and Institutes Across Indian States: A Critical Analysis.

Abstract: Background The delivery of mental health services largely depends on the adequacy of human resources. In India, the deficit of psychiatrists is more than 90% and is one of the major challenges that needs to be tackled to address the huge burden of mental illness. Psychiatry trainee institutes play a vital role in reducing human resource deficit and inequality in delivering mental health care. However, the distribution pattern of psychiatry trainee seats and institutes across Indian states is unknown. Therefore, we estimated the number of psychiatry trainee seats and institutes in each Indian state and union territory (UT). Materials and Methods In this cross-sectional study, psychiatry trainee seats and institutes were searched on the official web sites of Medical Council of India and National Board of Examinations. The data available on these web sites until December 2019 were included. State-wise data were compared using proportion and percentages. The psychiatry trainee index (PTI) was calculated and compared across Indian states and UTs. Results Among 221 Indian psychiatry trainee institutes considered in the present study, 116 (52.48%) were private institutes and 105 (47.51%) were government institutes. Overall, more psychiatry trainee seats were reported in government institutes (n = 565, 65.89%) than in private institutes. National PTI was considered fair (0.06), and based on their PTIs, Indian states and UTs were classified as follows: worst (n = 9), poor (n = 8), fair (n = 9), average (n = 7), good (n = 1), and excellent (n = 2). Conclusion A huge deficit of psychiatry trainees and institutes exists in more than two-thirds of Indian states and UTs, along with a huge maldistribution of seats. PTI and its distribution across the states and UTs are a crucial indicator of the need to improve the access and equity of mental health care.

A study on prostate movement and dosimetric variation because of bladder and rectum volumes changes during the course of image-guided radiotherapy in prostate cancer

Abstract: Aim To study the impact of bladder and rectum volume changes on prostate positioning and the dosimetric parameters. Background Prostate is a moving organ, and its position is also affected by bladder and rectum volumes. Image-guided radiotherapy (IGRT) is being practiced widely for the treatment of prostate carcinoma (Ca). So, it is important to accurately study the effect of bladder and rectum volume changes in treatment. Materials and methods Thirty patients with Ca prostate were included in this study, and all were treated with 50 Gray (Gy) in 25 fractions for the first phase of treatment. A total of 750 cone-beam computed tomography (CBCT) sessions were performed. Prostate position w.r.t. its day one position was noted, and the bladder and rectum volumes were compared with their volumes on day one. Also, repeat CT was done for five patients after 10 fractions. The initial plan was imported as it was on the repeat CT images, and a hybrid plan was prepared by putting the plan isocenter at the relative anatomical reference point in repeat CT images as it was in primary CT images. The multileaf collimators (MLC) fluence was put as it is, and the dose was calculated using the monitoring units (MU), which were in the initial plan. Doses to bladder, rectum, and the target were analyzed. Results The mean prostate motion in lateral and anterior-posterior direction was found to be 0.71 (±0.69) centimeter cm) and 0.77 (±0.57) cm, respectively. The mean change in bladder and rectum volumes as compared to that in day one CT images was found to be 110.51 (±84.25) cubic centimeters (cc) and 10.89 (±10.17) cc, respectively. No significant variation was observed in the doses to bladder, rectum, and the target volume in a hybrid plan, as compared to that in actual initial plan. Conclusions Bladder and rectum volume affects the position of prostate, rather the dosimetric parameters, and therefore, it can be concluded that daily CBCT should be done for accurate IGRT delivery to the prostate cancer.

A comprehensive analysis of recovered COVID-19 patients and dynamic trend in antibodies over 3 months using ELISA and CLIA methods

Abstract: Background Since the Coronavirus disease-2019 outbreak, most studies have focused on etiopathogenic aspects and treatment strategies. Acquired immunity still remains a dilemma. The aim of our study included a comprehensive analysis of patient characteristics, evaluation of antibody response, and its trend over a period of three months in recovered patients. Methods Monocentric investigator-initiated pilot longitudinal observational study conducted by the Association Naso Sano, on a cohort of 30 COVID recovered patients based in the Umbria region, followed up from April to June 2020 for baseline blood counts, IgM and IgG trends using two different serological assays-ELISA and CLIA. The demographics, blood group, co-morbidities and treatment modalities were recorded from each patient along with an analysis of clinical profile, dates concerning symptom onset, first positive and two consecutive negative swabs using an online questionnaire followed by serological testing. Descriptive and Bivariate (Pearson correlation coefficient) statistics were conducted to detect statistically significant correlations. Findings The study involved 30 patients with a M:F ratio of 0.57 and a distribution of mild (67%), moderate (30%) and critical (3%). Majority of the patients were healthcare workers (40%) and the mean viral shedding duration was 20.13 ± 6.17 days. The IgG levels offered long-standing protection as long as 3 months in some cases. A statistically significant, directly proportional correlation (Pearson) exists between ELISA and CLIA values for IgM. Some patients also expressed titers lower than the detection threshold and therefore a positive RT-PCR test does not necessarily guarantee a high IgG response in the recovery period. Interpretation The data presented in our study provides a relative long-term analysis and possible explanation regarding the protection developed by patients recovered from COVID-19.

Pattern, clinical and demographic profile of inpatient psychiatry referrals in a tertiary care teaching hospital: a descriptive study.

Abstract: Background Consultation liaison psychiatry (CLP) as a subspecialty is defined as the area of clinical psychiatry that encompasses clinical understanding, teaching and research activities of psychiatrists and allied health professionals in the non-psychiatric divisions of a general hospital. Psychiatric comorbidity of inpatients in tertiary care hospitals is huge. However, the amount of research in India in the field of consultation liaison is strikingly low. Aim To investigate the sociodemographic profile and psychiatric and physical subtypes of illness in patients admitted in other departments and referred to psychiatry department. Methods The study population comprised all consecutive inpatients referred for psychiatric consultation from other departments of a multispecialty tertiary care teaching hospital over 3 months. In a semistructured proforma, sociodemographic profile, referring departments, reasons for referral, referral rate, psychiatric diagnosis and physical illness diagnosis were recorded and analysed using descriptive statistics. Results 172 patients were included and assessed after referral from various departments, of which 56.4% were male and 43.6% were female. The mean age was about 33.95 years, with majority of the patients in the 21–30 years age group. The referral rate was 1.1%. The maximum referrals were from the medicine department, with abnormal behaviour (26.2%) being the most common reason for referral, followed by alleged suicide attempt or self-harm (24.4%), anxiety (10.5%), substance use (10%) and disorientation (7.6%). The most common psychiatric disorder among patients was depressive disorder (24.4%), followed by substance use disorder (19.7%), schizophrenia and psychotic disorder (9.3%), and stress and trauma-related disorder (8.1%). Conclusion There are very few psychiatry referrals and an alarmingly low referral rate, given the psychiatric morbidities in the medical setting. Psychiatry training should have more weightage across different medical specialties and liaison activities between psychiatry and other disciplines should be augmented, which can lead to a better understanding of psychiatric symptomatology, early symptom recognition, swift referral and ensuring follow-up, which, in turn, would be key to improving CLP services.

Acute oedema associated with risperidone use: a report.

Abstract: Risperidone acts by potent serotonergic, dopaminergic and alpha adrenergic receptor antagonism. The most common side effects reported are extrapyramidal symptoms, dizziness, sedation, insomnia, headache, anxiety, nausea, constipation and weight gain. Oedema associated with risperidone use is a rare side effect. Here we present a report on pedal oedema associated with use of oral risperidone 4 mg per day for acute-onset psychotic illness. Through this case report we want to make clinicians aware about this important side effect as it can affect patients' compliance and quality of life.

Mapping fear among doctors manning screening clinics for COVID19. Results from cloud based survey in Eastern parts of India.

Abstract: Background As the number of cases of COVID19 from novel corona virus 2019 rises so are the number of deaths ensuing from it. Doctors have been in front in these calamitous times across the world. India has less number of doctors so doctors are overwhelmed with more number of patients to cater. Thereby they are also fearing that they will be exposed much as they often work in limited resource settings. Methods An on line survey was to include doctors from eastern states in India for measuring the reasons of their fear and suggest possible solutions based on the results achieved thus. After IEC clearance a semi-structured anonymous questionnaire was sent on google forms as links on known to doctors, working in screening OPDs or flu clinics especially for COVID-19. Results Out of 59 Doctors majority were provided with sanitizers for practicing hand hygiene. Gloves were provided everywhere but masks particularly N95 and Triple Layer surgical masks were not there for all. Training was not given universally. Fear was dependent on age in our sample. Conclusion Training and strict adherence to infection control measures along with resources can help in removing the fear.

Intragluteal Cleft Ulcer: a Rare Presentation of Primary Cutaneous Non-Hodgkin’s Lymphoma

Abstract: Primary cutaneous non-Hodgkin’s lymphoma (PCNHL) is defined as lymphoma limited to skin without extracutaneous involvement at presentation and accounts for ∼ 5% of all non-Hodgkin’s lymphomas (NHLs). [1, 2] After gastrointestinal lymphomas, skin is the second most affected organ by extranodal NHL with an estimated annual incidence of 1/100,000 in Western countries [3, 4]. Histopathological evaluation including immunophenotyping of the skin biopsy specimen is the basis of the diagnosis. Treatment modalities include chemotherapy, immunotherapy, and radiotherapy. We report a case wherein PCNHL had a very unusual site of presentation at intragluteal cleft and showed a complete remission on radiotherapy alone without recurrence on 6 monthly follow-up. Case Report

Study of retinal nerve fiber layer analysis using optical coherence tomography in different demyelinating diseases and its correlation with the severity of visual impairment.

Abstract: Purpose: This purpose of this study was to find the association between severity of visual impairment and retinal nerve fiber layer (RNFL) thickness loss in different demyelinating diseases using optical coherence tomography (OCT) and, simultaneously, assess the fellow eye for subclinical RNFL thickness loss. Methods: This cross-sectional, observational study included 60 eyes of 30 patients above the age of 20 years with diagnosed cases of multiple sclerosis (MS), neuromyelitis optica (NMO), and clinically isolated syndrome (CIS) who had history of (h/o) optic neuritis (ON) attack were included. Participants included in the study group underwent best-corrected visual acuity (BCVA) measurement, color perception, swinging flashlight test, slit-lamp examination, and dilated fundus examination (DFE). RNFL thickness was measured using spectral domain OCT (SD-OCT) (Optovue RTVue-V6.11 A Fourier). Intergroup analysis of RNFL thickness was done using a Chi-square test (P

Diphtheritic Myocarditis: Case Series in the present era of Universal Immunization programme

Abstract: Diphtheria continues to be reported from the developing world and is a major preventable disease of childhood with high morbidity and mortality. It can affect many organ systems but the cardiovascular involvement in the form of myocarditis carries a high mortality. We report a case series of eight children with the diagnosis of diphtheria who presented with arrhythmias or cardiogenic shock suggestive of severe myocardial damage. Out of eight children, five (62.5%) died. Early detection, careful monitoring and aggressive management may result in improved outcomes in these critically sick children. Introduction Diphtheria is an acute infectious disease caused by the exotoxin producing strains of Corynebacterium diphtheria. C. diphtheriae is an aerobic gram-positive pleomorphic bacillus.1 Throughout history, diphtheria has been one of the most dreaded infectious diseases globally causing epidemics and high mortality amongst children. Due to the availability of effective vaccination, diphtheria has shown a declining trend world over.2 However, it remains a significant health concern in countries with poor routine immunization coverage. And it still continues to be reported from the developing countries.3,4,5,6 From 2011-2015, India had the largest number of reported cases (18350) followed by Indonesia and Madagascar (3203 and 1633 respectively).2 Hospital-based surveillance studies, as well as diphtheria outbreaks published in the last 20 years (1996-2016), indicate that diphtheria cases are frequent among school-going children and adolescents.7 As per the national level health surveys, coverage of three doses of diphtheria vaccination was 80% during 2015-2016. Information about coverage of diphtheria boosters is not routinely collected through these surveys but is expected to be low.8 There have been reports of outbreaks of diphtheria from a few states namely Assam (2010), Karnataka (2011), Andhra Pradesh (2014).7 Diphtheria can affect many systems and cardiovascular involvement is a major contributor to mortality. Arrhythmias, heart blocks and cardiogenic shock are the manifestations of severe myocardial damage.9 There is a scarcity of literature describing these manifestations and very few studies have been reported from central India regarding this disease.10 Hence, we did a retrospective study of children admitted with diphtheria who presented with cardiac complications to the pediatric intensive care unit (PICU). Methods & Materials We conducted a retrospective observational study in the Department of Paediatrics at a tertiary care teaching institute from central India. Institutional Ethics committee approval was taken before the commencement of the study. Data was collected from the in-patient records of the patients retrieved from the Medical Records Department. The pediatric cases admitted within the study duration period of 4 months from August 2018 to November 2018 with the diagnosis of diphtheria with myocardial involvement were enrolled in the study. The diagnosis of diphtheria was made clinically on the basis of classic clinical findings of fever, throat pain, white membrane in the throat that bled on touching.11 The diagnosis of myocarditis was made on the basis of symptoms and signs of cardiac failure or arrhythmias or electrocardiographic (ECG) findings in the form of conduction abnormalities (heart block) or arrhythmias.11 ECG was done in all patients; however, echocardiography could be done only in one patient. Children with other causes of myocardial dysfunction were excluded from the study. The details of demography, clinical history and examination findings, immunization status, family history, ECG/ Echocardiography findings, laboratory investigations in the form of complete blood count, renal function tests and throat swab smear examination by Albert’s stain and treatment given were recorded. Leucocytosis was defined as total leucocyte count more than 15,500/cumm (Age: 4-7 years) and 13,500/cumm (Age: 8-13 years). Hypotension was defined as systolic BP <2 SD below normal for age.11 The identity of the patients was not revealed in the study. Data was tabulated and analyzed. Results A total of eight patients were enrolled during the study period of four months. Male to female ratio was CONTACT Dr. Anjali Bharani Email: dr.anjalibharani@gmail.com Address for Correspondence: Dr. Anjali Bharani (Associate Professor), Department of Pediatrics, Mahatma Gandhi Memorial Medical College and M.Y Hospital Indore, Madhya Pradesh, India. ©2020 Pediatric Oncall ARTICLE HISTORY Received 10 February 2020 Accepted 3 June 2020

Clinical Experience of Intensity Modulated Radiotherapy Pre-Treatment Quality Assurance for Carcinoma Head and Neck Patients with EPID and IMatriXX in Rural Center.

Abstract: Background: Radiation therapy techniques as Intensity Modulated Radiotherapy (IMRT), rapid arc have been used for treatment of cancer with high accuracy. Objective: Verification of planned and delivered dose distribution is important, therefore current study aims to analyse quality assurance (QA) results of IMRT by Electronic Portal Imaging Device (EPID) and IMatriXX in head and neck Carcinoma (Ca H&N) patients.Material and Methods: In this experimental study, performance of an EPID and IMatriXX was assessed with dose measurements using ionization chamber. Calibrated IMatriXX and EPID are used for pre-treatment patient specific quality assurance (PSQA), for 122 patients’ plans of Ca H&N with IMRT treatment technique on linear accelerator. Dose images were acquired and compared with gamma evaluation (3% / 3 mm) and three scalar parameters, named average γ (γavg), maximum γ (γmax) and area gamma <1, were analyzed in the region of interest. Results: The γ correlation comparisons yielded average correlation of 0.990 and 0.982 for IMatriXX and EPID respectively. Maximum value of gamma is 0.998, while minimum gamma is 0.872 for IMatriXX and 0.953 for EPID. For students, unpaired ‘t’ test analysis is applied for comparison to two data sets. P-value was set at 0.005 which, for this study, was computed 0.001, showing good correlation between measured data with IMatriXX and EPID. Conclusion: The EPID and IMatriXX have significantly improved dosimetric properties, resulting in more sensitive, accurate measurements before actual treatment. The result shows EPID can be replaced with other dosimetry method and ionization chamber measurements. Portal imager is an efficient, accurate and sensitive dosimetry tool and is also the basis of pre-treatment quality assurance protocol.

Tarlov Cyst: A Case Report

Abstract: Case Report: Tarlov cyst is rare perineural cyst, which may be symptomatic and present with with low back pain, sciatica, coccydynia or cauda equina syndrome. Symptomatic tarlov cyst needs to be removed surgically. We present such a rare case of symptomatic sacral cystic mass (tarlov cyst) presenting with severe lower back pain for months which was successfully treated by sacral laminotomy and cyst excision. The aim of reporting this case was to create awareness among the surgeons regarding this rare entity and to include it in differential diagnosis of chronic low back pain.