All India Institute of Medical Sciences Patna (AIIMS Patna), previously Jaya Prakash Narayan All India Institute of Medical Sciences (JPNAIIMS), is a medical college and medical research public institute located in Phulwari Sharif, Patna, Bihar, India. It is one of the Institutes of National Importance in India. It started operating on 25 September 2012 after a series of observations by Patna High Court. The institute operates autonomously under the Ministry of Health and Family Welfare. Its foundation was laid by Bhairon Singh Shekhawat, on 3 January 2004, during his tenure as vice-president. As of 2018[update], it became fully functional.
Objective: Burr-hole craniostomy is a common surgical intervention for patients with chronic subdural hematoma (cSDH). Single burr hole craniostomy (SBHC) and double burr hole craniostomy (DBHC) are widely practiced techniques; however, debate continues regarding the superior approach owing to limited comparative literature. This study aimed to compare the clinical outcomes, complications, and recurrence rates between SBHC and DBHC in patients with cSDH. Methods: This prospective, open-label, non-inferiority, randomized controlled trial was conducted at the AIIMS Patna. Sixty-six patients with cSDH were enrolled in this study and randomized to either SBHC or DBHC. Assessments were performed before surgery and at 1 week and one month after surgery. Preoperatively, no differences were observed in the noncontrast computed tomography scans, Glasgow Coma Scale scores, ventilator/intensive care unit days, recurrence, or complications. Statistical analysis was done using SPSS v22.0. Results: Patient characteristics were comparable between groups. One week after surgery, mortality rate was higher in the SBHC group (11.43%) than in the DBHC group (3.12%), but the difference was not statistically significant (p=0.34). The duration of ventilator use was significantly longer in the SBHC group (p=0.001). Subsequent analysis showed that recurrence and reoperation rates were higher with SBHC (20.69% each) than those with DBHC (9.68% each), although the differences were not statistically significant (p=0.13 and 0.07, respectively). Neurological improvements and radiological outcomes showed similar trends. The difference in the non-recurrence rate (11.01%) remained within the noninferiority margin (11.5%). Conclusion: Both SBHC and DBHC were effective in evacuating cSDH. SBHC was shown to be non-inferior to DBHC, but had a slight increase in the recurrence rate and ventilator time. Based on patient characteristics, SBHC may be a simple and less invasive treatment option. Trial Registration: International Standard Randomised Controlled Trial Number Identifier: ISRCTN53688663
Allergic bronchopulmonary aspergillosis (ABPA) is a T helper 2 cell-mediated hypersensitive lung disorder in response to Aspergillus that usually affects asthmatic and cystic fibrosis patients. However, it rarely presents as lung collapse.We report a case of an elderly male who presented in the emergency department with respiratory distress, with oxygen saturation 80% with room air (RA). On evaluation with examination and radiology, the case was revealed as left lung collapse. Fibreoptic bronchoscopy revealed a huge mucus plug (MP) obliterating the left main bronchus, causing collapse of the entire left lung. The MP could not be completely removed by suction and was extracted with a cryoprobe. Post procedure, SpO2 improved to 99% RA with X-ray showing complete lung aeration restoration. A suspicion of ABPA was made. Aspergillus-specific IgE and IgG came positive, along with raised total IgE and peripheral eosinophilia. The patient was started on itraconazole and oral corticosteroids and discharged in stable condition.This case highlights that it is important to consider an MP with ABPA as a differential in cases of lung collapse after ruling out malignancy.
Background:Epilepsy possesses significant long-term health sequelae and potential morbidity among children globally. A diagnosis of seizures can often be challenging in the paediatric population owing to seizure mimics and absence of classical features in clinical as well as electroencephalographic (EEG) presentations. Purpose:The objective of the study is to explore potential EEG biomarkers using quantitative analysis of conventional EEG records of subjects with seizure in paediatric populations. Method:66 subjects with generalised seizures in the age group of 2-15 years had been recruited along with an equal number of age-matched healthy control subjects. Readings obtained from a 32-channel EEG were recorded along with the demographic details of the subjects. Using the Fast Fourier Transform (FFT) in the MATLAB environment, quantitative spectral features were extracted and compared between the groups and within the group to explore EEG markers related to the generalised seizures in the study population. Results:The case group showed significantly higher alpha power in both left (17.86 vs 15.06 µV2/Hz) and right (20.76 vs 16.12 µV2/Hz) hemispheres compared to the controls. The case group had lower beta power in the left hemisphere (33.34 vs 35.52 µV2/Hz) but no difference in the right hemisphere. Significant asymmetries were observed across all cortical regions, including the temporal region showing the highest theta and delta asymmetry (asymmetry indices of -0.142 for both), whereas alpha asymmetry was highest in the occipitotemporal regions (asymmetry indices -0.125 and -0.141, respectively). Conclusion:The study reveals a complex pattern of characteristic quantitative electroencephalographic (qEEG) alterations in the paediatric seizure population suggestive of significant neurophysiological implications, including alterations in arousal, attention and inhibitory control mechanisms and the features may be of some value in objective seizure assessment using EEG.
Thyroid swellings represent one of the most frequently encountered endocrine disorders, with their incidence rising worldwide. Achieving an accurate preoperative diagnosis is crucial for distinguishing between benign and malignant lesions and preventing unwarranted surgical interventions. The triple assessment approach, which includes clinical evaluation, ultrasonography, and fine needle aspiration cytology (FNAC), is considered a dependable method, with histopathology remaining the definitive gold standard. This observational study was conducted over an 18-month period. 92 patients with thyroid swellings who underwent clinical evaluation, ultrasonography, FNAC, and subsequent surgical excision were included. A correlation was performed between clinical, radiological, and cytological findings and histopathology. The sensitivity, specificity, and diagnostic accuracy of all parameters were calculated. Out of the total 92 cases, 74 were females and 18 males, with a mean age of 42.7 years. Clinical evaluation suggested benign lesions in 91.3
AIM:To compare the sentinel lymph node (SLN) identification proportions using Indocyanine green with the standard radio colloid-blue dye method. BACKGROUND:Radioisotope and blue dye are standard agents for performing sentinel lymph node (SLN) biopsy in breast cancer. Limited centers offering nuclear medicine services along with the short half-life of technetium and the hazards associated with radioactive materials contribute to the low acceptability of SLNB. METHODS:This randomized controlled trial conducted between September 2022 and May 2024 compared SLN identification proportions of radioisotope-blue dye [Group A] with Indocyanine Green (ICG) [Group B]. Sample size of 70 (35 in each arm) was calculated. Upfront operable node negative early breast cancer patients were included in the study. Clinico-demographic data, number and type of SLN, and time taken were recorded. Chi-squared/Fisher exact tests were used to compare proportions between two groups. p value of less than 0.05 was considered to represent statistical significance. RESULTS:Seventy patients were randomized to either group (35 in Group A and 35 in group B). The clinico-demographics and the tumor characteristics were similar between both the groups. SLN identification rate (IR) was 100% in group A and 97.14% in group B. Median of 3 lymph nodes were identified in Group A and Group B. Median operative time for SLNB was 12 min in both the groups. CONCLUSIONS:Indocyanine green (ICG) fluorescence offers comparable sentinel node identification rate when compared to current standard of radioisotope and blue dye. TRIAL REGISTRATION:This study is registered under Clinical Trials Registry-India (CTRI) vide registration no. CTRI/2022/09/045719.
