Oral and maxillofacial surgeries are associated with excessive blood loss owing to the vascular richness of this region. Accurate estimation of blood loss using a reliable clinical method shall guide the surgeons towards appropriate blood requisition and usage. This article reviews methods of blood loss estimation that could be used to measure blood loss during oral and maxillofacial surgery procedures. PubMed, Google Scholar and CINAHL databases were searched without a date limit. The phrases ‘estimation of blood loss’ and ‘blood loss in surgical procedures’ were used to search for articles estimating blood loss during surgeries. A total of 57 publications were searched and only 28 of them describing methods that could be used during oral and maxillofacial surgical procedures were included in this review. Different methods of blood loss estimation have been described. This review revealed scanty data on blood loss estimation during oral and maxillofacial surgeries. The available published articles are mostly estimations during obstetric and gynaecological operations. A combination of gravimetric and volumetric methods is the most common method used for the estimation of blood loss in oral maxillofacial surgery procedures. A combination of gravimetric and volumetric methods of blood loss estimation was found to be the most common method of blood loss estimation in oral and maxillofacial surgical procedures as opposed to other surgical specialities. Other methods such as colorimetric and mathematical methods may be more accurate but are not frequently used for routine clinical use likely due to the technicalities surrounding their use.
Clinical presentation of COVID-19 infection can be variable in the current pandemic, even in patients presenting to the clinic with mild history of upper respiratory complaints. Various cutaneous manifestations have been noticed in COVID-19 patients with herpes zoster (HZ) being one among them. HZ is an infection that results when varicella zoster virus reactivates from its latent state in a posterior dorsal root ganglion. Here, we aim to expand our knowledge by reporting three cases of associated zoster infection in COVID-19 patients admitted to our intensive care unit in view of respiratory complaints. All the three patients admitted had revealed lymphocytopenia at the time of HZ diagnosis and were managed conservatively throughout the course. In all the cases, acyclovir/valacyclovir led to the resolution of lesions in 10 days. No postherpetic sequelae were observed. We hereby suggest that the clinical presentation of HZ at the time of current pandemic should be considered as an alarming sign for a latent subclinical SARS-CoV-2 infection and thorough follow-up of such patients should be adopted.
Rationale: Showcasing this case report is of essential importance to shed the light on this rare situation propelling advancement in clinical rationale to detect and manage such cases. Patient Concerns: A 25-year-old male patient presented with suicidal injury by cutting his throat open using a knife due psychiatric history of depression. Diagnosis: Clear-cut injuries to the neck area present with significant impairment to the human body functions from breathing to vascular injuries that eventually will lead to obstructed airways and haemorrhagic shock later. Interventions: In this case, we stress on the essentialness of the multidisciplinary team to manage and treat such critical situations, and this underlines the involvement of the anaesthesiologist to protect the airways in such difficult situations and immediately shifting the patient to the operation theatre involving the otolaryngologist, vascular surgeon and postoperatively by intensivists and psychiatrists. As the patient was arrested in the accident and emergency department, it was not applicable to take the patient to any imaging modality and this even created more challenge for the team to exclude any further injuries and to treat according to the standard acute care approach. Outcomes: Improved physical and psychiatric status which helped the patient to return to pre-injury state after fatal suicidal attempt. Lessons: Here, we highlight the urgency and the importance of immediate action in protecting the airways while following the ABCDE guidelines in addition to the rapid intervention, while minimizing time for imaging and shifting of the patient in such critical situations. Importance of the multidisciplinary team involvement while harmonizing treatment to avoid relapse and failure.
Background: Hypoxia, or low oxygen, is a condition that is characteristic of solid tumours, including cervical cancer. Hypoxia is associated with worse survival in this disease and supports tumorigenic characteristics of stemness, survival, metastasis and angiogenesis, as well as immune resistance. Aims: In this work, we aimed to determine the prognostic significance of a previously derived in vitro eight-gene hypoxia signature in cervical cancer, and to investigate the interplay between the hypoxic and immune features of the cervical tumour microenvironment (TME). Subjects and Methods: The 240 patients with cervical squamous cell carcinoma obtained from the Cancer Genome Atlas Pan-Cancer study were first given a hypoxia score and an immune score (IS) and subsequently subjected to survival analysis. CIBERSORTx was also applied to determine the fractions of immune cells residing in the hypoxia high versus hypoxia low patient groups. Results: We show that the eight-gene hypoxia signature is predictive of worse prognosis in patients with cervical cancer and is associated with a less immunogenic TME. Furthermore, by combining the hypoxia score with an IS to stratify patients based on both their hypoxic and immune status, we achieve an enhancement in survival prediction, with the hypoxia high/immune low subgroup of patients showing the worse probability of overall and disease-specific survival. Conclusions: It is clear from this work that the interplay between the hypoxic and immune microenvironment can contribute to cervical cancer patients' survival. Furthermore, patients with tumours that are both highly hypoxic and immune deprived should be considered for hypoxia-targeted therapy when planning treatment modalities to improve survival.
Introduction: This study aimed to showcase the innovation process and strategy applied and implemented in the Ministry of Health and Prevention (MOHAP) – United Arab Emirates as a case and how it is helped in coping with the changing environment in the field of healthcare. Methods: A comprehensive review of literature was conducted to provide an overview of the current research on the topic, particularly focusing on the MOHAP innovation strategy. Results: MOHAP's innovation system has established a supportive environment that has enabled employees to create numerous innovative projects and ideas. Discussion: This, in turn, has led to an improvement in the services provided to the customers. Furthermore, it's worth noting that MOHAP is consistently striving to enhance their innovation system. Conclusion: The strategy and processes implemented brought innovation in the organisation to new levels of functioning. It is essential to acknowledge and foster such continuing processes of innovation, rather than exclusively focusing on innovations as externally created 'things' that await 'implementation.'
Background: Bladder cancer is the most common malignancy of the urinary tract. Pre-operative tumour staging and grading play a significant role in treatment planning and prognosis estimation for bladder cancer. Aims and Objectives: This study aims to evaluate the utility of multiparametric-magnetic resonance imaging (mp-MRI) in detecting and staging bladder cancers and hence its role in final management. Materials and Methods: A total of 40 patients with documented urinary bladder mass undergoing mp-MRI before transurethral resection of bladder tumours for primary bladder cancer were identified and compared with post-operative histopathological reports. The data were collected and analysed using SPSS software. Results: The mean age in the study population was 53.68 ± 13.2 years, including 7 (17.5%) females and 33 (82.5%) males. Twenty-three (57.5%) of our patients had muscle invasion on the MRI pelvis. In muscle-invasive urothelial carcinoma, there were significantly more patients with Vesical Imaging-Reporting and Data System (VIRADS) 3, VIRADS 4 and VIRADS 5 than in non-muscle invasive urothelial carcinoma. The proportion of patients with VIRADS 1 and VIRADS 2 on MRI pelvis was significantly lower in muscle-invasive urothelial carcinoma than in non-muscle-invasive urothelial carcinoma (P = 0.0001). Histopathology and muscle invasion on the MRI pelvis agree well in the current study (κ = 0.742; P = 0.0001). There was an overall concordance rate of 87.5% and an overall discordance rate of 12.5% between histopathology and muscle invasion on the MRI pelvis. The sensitivity, specificity, area under the curve, positive predictive value, negative predictive value and diagnostic accuracy of the mp-MRI scan were 87.5%, 87.5%, 0.88, 91.3%, 82.35% and 87.50%, respectively. Conclusion: The mp-MRI and VIRADS scoring is an effective comprehensive tool with satisfactory sensitivity, specificity and diagnostic value for detecting muscle invasiveness of primary bladder cancer. We recommend VIRADS scoring for all bladder cancer patients for better pre-operative staging and overall management.
Background: Before starting the coronavirus vaccination drive in children, it is necessary to know about the knowledge, attitude and perceptions of the parents regarding vaccinating their children. This study aimed to explore the knowledge of the parents of children aged <12 years on coronavirus infection and vaccine and to assess their beliefs and attitude about COVID vaccination amongst the 0–11 years of age group. It also aimed to find out the factors to prefer government facility for COVID vaccination. Materials and Methods: An observational, descriptive, hospital-based cross-sectional study was conducted by interviewing parents who attended Medical College, Kolkata, during November–December, 2021. The data were analysed with the Statistical Package for Social Sciences (SPSS). Results: A total of 106 respondents were interviewed (50.9% males and 49.1% females). All the respondents heard about coronavirus disease and vaccines, almost everybody knew how to prevent transmission of the virus. 56.6% respondents were aware of the correct age group for vaccination and 77.4% considered the vaccines to be safe. Regarding the factors amongst parents to prefer government facilities, significant associations were found with the level of education, employment status, number of children and vaccination status of the parents. Statistical significance level was at P< 0.05. Conclusion: Majority of parents considered existing vaccines as safe for children and almost everyone thought of vaccination as social responsibility. Most parents wanted the vaccines to be given from immunisation clinics or through schools. They also had a clear preference for government facilities.
Rationale: Mesenteric cysts are rare abdominal tumours that can originate from any part of the mesentery of the bowel but have been found mostly in the mesentery of the small bowel. Patient Concerns: Because they lack specific clinical signs, mesenteric cysts can be difficult to diagnose. Diagnosis: Especially when there are concomitant abdominal conditions. In some circumstances, these cysts can grow to considerable sizes making resection almost impossible as different structures can be compromised. Intervention: Surgery is the treatment of choice as complete resection is the only curative treatment. Outcome: We present the case of a 27-year-old pregnant female patient who presented with recurrent abdominal pain and was discovered to have calcular cholecystitis along with a huge mesenteric cyst. She underwent laparoscopic cholecystectomy with complete excision of the mesenteric cyst without the need for bowel resection and anastomosis.
Rationale: Primary mesenteric leiomyosarcoma is a very rare finding. It is seen predominantly in the seventh decade and is very rare in the young. Fine needle aspiration cytology is the initial diagnostic procedure in soft tissue lesions, followed by excision biopsy. Patient Concerns: Herein, we present a rare case of primary multiple mesenteric leiomyosarcoma in a 19 year old female, who presented with abdominal lump and pain since the last 4 months. Diagnosis: CT scan of abdomen showed multiple large multiloculated masses in the sub-hepatic space and sub-diaphragmatic region, which seemed to be arising from the mesentery. The uterus and cervix were normal. Fine needle aspiration cytology of the mass revealed fascicles of spindled cells with elongated, blunt ended fusiform nuclei admixed with dispersed cells or stripped nuclei. Some cells showed pleomorphism with occasional intranuclear vacuoles. Grossly the resected specimen was multiple nodular, brown, soft to firm, with the largest measuring 8.5x8x2.5 cm and the smallest 2.2x2.2x1 cm in size. On microscopic examination, sections showed fascicular pattern of atypical spindle cells having cigar shaped nuclei showing pleomorphism and eosinophilic fibrillary cytoplasm with 1-2 mitotic figures/10HPF. Immunohistochemistry with SMA showed strong diffuse cytoplasmic positivity and desmin showed mild focal cytoplasmic positivity in the tumor cells. A diagnosis consistent with primary multiple mesenteric leiomyosarcoma was given. Interventions: Wide surgical excision of the mass lesion was performed. The patient was subsequently administered 6 cycles of 5- Fluorouracil based chemotherapy. Outcomes: She is recovering well after 2 month of follow up period. Lessons: Our case will widen the vision of both physicians and pathologists to consider the possibility of primary mesenteric leiomyosarcoma in young females, presenting without any involvement of female genital tract, thus guide in the proper diagnosis and management of such lesions.
Background: Caesarean section (CS) rate is showing an alarming increase in India, as a result, high-risk pregnancies with previous CS are becoming more frequent. Objective: The present study compared the additional risk for previous CS among a retrospective cohort of women who had maternal near miss (MNM). Materials and Methods: Record analysis of women with MNM between April 2019 and March 2020 at the tertiary level teaching hospital of Kolkata, India. Data for the selected study variables were extracted from the patient's case record forms. The main outcome measures were crude odd's ratio for risk of post-partum haemorrhage (PPH), repeat CS and adverse birth outcome; difference of mean for units of blood products transfused, number of clinical signs and hospital stay and adjusted odds ratio for PPH. Results: In this study, 100 records were analysed. The mean age of the cohort was 27.65 years with a standard deviation (SD) of 6.25 years. Forty women had previous CS, among whom 27 (67.5%) had a single CS while 13 (32.5%) had CS twice. A number of clinical signs, duration of hospital stay, total units of packed red cells (PRBCs) and total units of blood products transfused were similar between the groups. Women with previous CS had a significantly higher risk for PPH and having a repeat CS in the present pregnancy. CS at the present pregnancy was the only predictor for PPH after adjusting for other variables. Conclusion: It is difficult to ascertain whether a patient's antepartum and intrapartum course prior to delivery is responsible for the patient's morbidity, or if the previous CS is responsible for some component of the adverse outcomes. Repeated, poor-quality, repeated, closely-spaced CS, can likely result in maternal morbidity, especially PPH. The effect of CS not only affects the incident pregnancy, but future ones as well.
Background: An important component of the mother-and-baby-friendly birthing facility is respectful maternity care (RMC) during delivery. Aims and Objectives: The objectives of this study were to identify resident doctors' and staff nurses' opinions on the provision of RMC at their workplace, to explore the association between opinion on RMC and respondent's characteristics, and to explore the perceived barriers. Materials and Methods: A facility-based observational, descriptive study of the cross-sectional design was thus conducted among 78 resident doctors and staff nurses posted in the labour room of the study hospital. Data were collected by a predesigned, self-administered questionnaire. Variables included were demographic, service related and opinion on prevalent RMC practice at the respondents' workplace. SPSS version 17 was used for data analysis. Results: Providers' mean age was 30.5 years, and the mean work experience of 3.1 years. About two-thirds of the respondents were resident doctors and 83.3% were female. More than 60% of providers were trained on RMC. Providers reported desirable practices on most items related to RMC except in providers introducing themselves to women, allowing birthing companions and allowing women to assume the position of choice. Opinion about RMC was significantly associated with training status. Uncooperative women were considered the most important barrier to providing optimum RMC. Conclusion: It can be concluded from this study that training providers can reinforce good practices related to RMC and improve the quality of care at birth.
Rationale: Papillary thyroid carcinoma arising from ectopic thyroid tissue within a branchial cleft cyst is extremely rare. To the best of our knowledge, only 17 cases have been reported as Papillary carcinoma in branchial cyst, being primary or secondary in the archives. Only 7 cases are reported as primary, with only 5 cases having regional lymph node metastasis. Patient Concerns: We present a case report of an Indian male in his 30s, presented with complaints of a progressively enlarging, non-tender swelling in the left cervical region for 1 year. Diagnosis: The Contrast - enhanced computed tomography & Fine needle aspiration performed in an outside laboratory showed findings suggestive of branchial cyst. A clinical diagnosis of “branchial cyst” was formed. Interventions: The Cyst excision was done and sent for histopathological examination(HPE) for confirmation. Outcomes: Microscopic examination revealed papillary carcinoma arising from branchial cleft cyst with three out of seven lymph nodes identified showing metastatic deposits. The remaining four lymph nodes showed marked fibrosis and sinus histiocytosis. Then the patient was subjected for total thyroidectomy, which showed no evidence of malignancy on HPE, followed by I-131 radioactive ablation. Lessons: Primary PTC arising in a branchial cleft cyst is an incidental, extremely rare entity and should be kept in mind while dealing with a lateral cervical cystic lesion. They bear a high risk of regional lymph node metastasis. FNAC and radiological investigations alone cannot warrant the diagnosis. Histopathological examination is the key to unlocking the diagnosis and is considered the “gold standard”. Complete cyst excision and regional lymph node removal, along with precautionary hemi- or total thyroidectomy, are highly suggested to reduce metastasis and increase survival rates.
Context: Menstruation is a physiological process that occurs naturally and needs to be managed appropriately. Hygienic menstrual practices, such as the use of sanitary pads, are crucial during menstruation. Adolescent girls are prone to emotional and physical challenges during their menstruation days because of a lack of knowledge and proper sanitary facilities. Aims: This study was sought to investigate the age at menarche, menstrual pattern, menstrual hygiene practice and association with psychological stress in adolescent girls in North India. Settings and Design: This was a retrospective descriptive hospital-based study including 150 adolescent girls attending the outpatient department of a tertiary care centre in North India from April 2022 to September 2022. Subjects and Methods: The data were collected retrospectively from the registry system. Statistical Analysis Used: A descriptive research design using frequency, percentage and mean with standard deviation was used to collect and analyse the data using SPPSS-22 software. Results: Approximately, 47% of adolescent girls were unaware of menarche, and most of the girls were baffled by menarche. The majority of information about menstruation was gathered from mothers. During menstruation, exclusion and embarrassment lead to misconceptions and unsanitary practices. Instead of seeking medical advice, girls prefer to skip school, self-medicate and limit social contact. Conclusions: Adolescent girls’ health education must include learning about proper menstrual hygiene and psychological counselling to maintain hygienic habits and prevent absenteeism in school.
Introduction: Nitrofurantoin like fosfomycin is an old antibiotic that has stood the test of time and has been explored and re-explored as a good alternative in treating drug-resistant bacterial urinary tract infections (UTI’s). The low degree of resistance to nitrofurantoin has been an advantage in acute uncomplicated UTIs; however, there are some limitations to its use. This study explores the in vitro sensitivity of multidrug-resistant (MDR) Escherichiacoli uropathogens to nitrofurantoin. Materials and Methods: This 1-year observational descriptive study screened 127 MDR E. coli for the in vitro activity of nitrofurantoin by the conventional disc diffusion technique. Results: The majority of the bacterial isolates screened were from females above 61 years of age at various inpatient locations of the tertiary care centre. The predominant risk factors identified were diabetes mellitus, hypertension, sepsis, chronic kidney disease and ischaemic heart disease. 87.4% isolates showed in vitro nitrofurantoin sensitivity. Amongst the nitrofurantoin-resistant isolates, additional contributory risk factors were patients >80 years of age and those with chronic kidney disease. Conclusion: Nitrofurantoin showed a good in vitro sensitivity to most multidrug-resistant E. coli isolates and is a safe drug of choice in cases of uncomplicated UTIs, and it should be used cautiously even as reports of low resistance rates to this drug still lingers across the globe.
Silence in medical education plays a pivotal role in creating an enabling learning environment that promotes the development of in-depth understanding, critical thinking and empathy amongst medical students, who are expected to soon become a part of the health workforce. Even though silence has been linked with multiple benefits to both students and patients nevertheless, there are some potential challenges as well that must be taken into account before inclusion in the medical curriculum. Most of the identified challenges dealing with students, teachers and patients can be addressed significantly if we sensitise and train all stakeholders about the purpose, the merits and the intended outcomes of adding silence in the curriculum. In conclusion, the incorporation of silence in medical education can play a significant role in fostering active listening, enhancing understanding and promoting empathy. We must acknowledge that the introduction of silence can significantly benefit both students and teachers in multiple domains, and thus, we must look to actively incorporate the same into teaching practices. However, to benefit students with different learning preferences and learning styles, it is crucial to maintain a balance between silence and active engagement.
Introduction: Restorative dentistry has recently changed its approach and now favours a conservative method that utilises remineralisation techniques as the best way to restore damaged tooth structure. Instead of relying on traditional restorative procedures, dentists are now focused on detecting and preventing tooth decay at an early stage to preserve the tooth and avoid costly and painful treatments for the patient. This new preventive approach is more efficient for the dentist and more beneficial for the patient.This systematic review aimed to investigate and map the evidence of the remineralization potential of Strontiumdoped nanohydroxyapatite (Sr-nHAP) in dental applications and explore its use as a novel toothpaste. Material and Methods: The authors conducted a literature search using PubMed, Google Scholar, and Cochrane Central Register of Controlled Trials, using MeSH terms and keywords related to strontium-doped nanohydroxyapatite and dentifrices. The search was conducted on publications between January 2012 and February 2023. Inclusion criteria were studies that researched the impact of Sr-nHAP mineralization on hard dental tissues and those that used Sr-nHAP in dental applications. Exclusion criteria were studies that did not use Sr-nHAP or nHAP, and non-English publications. Results: Out of the 2685 publications initially identified, 7 studies were included in the review. The results showed that the use of Sr-nHAP in dental applications improved remineralization potential and antibacterial activity. Furthermore, the substitution of strontium enhanced the antibacterial properties and the ability to promote remineralization, making Sr-nHAP a promising material for toothpaste. Result: The systematic review found that the use of Sr-nHAP in dental applications could be a promising technique to prevent disease progression, improve aesthetics, strength, and function of non-cavitated caries lesions. Sr-nHAP showed better remineralization potential than traditional fluoride and was effective in reducing tooth sensitivity and blocking dentin tubules. Sr-nHAP was also found to have improved antimicrobial activity against major causes of periodontal disease. Discussion: Sr-nHAP could be a promising material for toothpaste due to its remineralization potential, antibacterial activity, and deep curing depth, which would help prevent dental caries and periodontal disease. Sr-nHAP has the potential to provide a conservative approach to restorative dentistry, avoiding costly and painful treatments for the patient, and providing an efficient approach for the dentist.
Background: Cataract is the leading cause of blindness, but vision can be restored with cataract surgery. Information-seeking behaviour on the internet influences the acceptance of cataract surgery. This study aimed to examine public online searches for cataract in India from January 2011 to December 2022. Methodology: The study retrieved online search data for 'cataract' and 'cataract surgery' from the Google Trends (GT) Explorer page. These searches were measured in terms of relative search volumes (RSVs). The researchers conducted a one-way analysis of variance to examine variations in quarterly 'cataract' searches across each year from 2011 to 2022. In addition, a joinpoint regression analysis was employed to identify significant changes in searching patterns over time with statistical significance. Results: The highest annual mean RSV for cataract was recorded in 2022 (88.58%) and 2021 (80.83%), and the lowest annual mean RSV was recorded in 2014 (53.50%). The joinpoint regression shows an average annual increase of 3.3% in cataract searches from 2011 to 2022. A statistically significant linear trend was observed from quarter 1 (April–June) to quarter 4 (January–March) in the year 2016–2017 (contrast estimates [CE] = 6.18, ηp2 = 64.4%), 2017–2018 (CE = 8.72, ηp2 = 77.5%), 2018–2019 (CE = 7.91, ηp2 = 65.8%) and 2020–2021 (CE = 21.45, ηp2 = 80.6%). Conclusion: There are a growing number of individuals searching for online health information related to cataracts, and medical professionals need to educate them on the proper selection of websites based on established guidelines and quality standards. The study indicates that there is a preference during winter months for seeking information about cataracts. Public health initiatives can collaborate with internet-based media platforms during this time frame to enhance public awareness, knowledge and access to surgical services for all eligible individuals.
Background: Pro-B-type natriuretic peptide (BNP) is a well-known predictor of congestive heart failure. No published data, to our knowledge, are available on the correlation of NT-proBNP with microvascular complications of type 2 diabetes in the Emirati population. Aims and Objectives: We aimed to evaluate the correlation between N-terminal-proBNP (NT-proBNP) and microvascular complications in patients with type 2 diabetes and to evaluate the correlation between NT-proBNP and metabolic parameters in patients with type 2 diabetes. Materials and Methods: This was a cross-sectional study conducted from 1st January 2016 to 31st December 2016. Eligible participants with type 2 diabetes were assessed for the evidence of nephropathy, neuropathy and retinopathy as well as biochemical testing for metabolic parameters. They were divided into two groups based on NT-proBNP level (100 pg/mL). Results: The total number of patients recruited was 236; 39.5% (n = 93) had an NT-proBNP of ≥100 pg/mL (Group A), and 60.5% (n = 143) had an NT-proBNP of <100 pg/mL (Group B). The odds ratio (OR) for patients with NT-proBNP ≥100 (Group A) to develop retinopathy was 2.196 (95% confidence interval [CI] 1.307–3.689, P = 0.003), the OR for Group A to develop neuropathy was 1.607 (95% CI 1.046–2.469, P = 0.031), while the OR for Group A to develop microalbuminuria was 1.082 (95% CI 0.855–1.369, P = 0.515). Conclusion: NT-proBNP is related to the prevalence of microvascular complications in patients with type 2 diabetes mellitus. Using NT-proBNP as a marker can define the population of patients at risk who may benefit from the therapeutic interventions to delay microvascular complication.
