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   Table of Contents - Current issue
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April-June 2022
Volume 10 | Issue 2
Page Nos. 43-82

Online since Wednesday, November 16, 2022

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ORIGINAL ARTICLE  

Indications for percutaneous ultrasound-guided renal biopsy and complications associated with it: An observational study p. 43
Mohammad Ashraf Bhat, Shahid Sulayman, Manzoor Ahmad Parry, Muzaffar Maqsood Wani, Imtiyaz Ahmad Wani
DOI:10.4103/DYPJ.DYPJ_56_22  
Introduction: Renal biopsy is performed for various reasons depending on the signs and symptoms presented. Although percutaneous kidney biopsy is a safe procedure, major or minor complications may occur. Our study aimed to assess the indications for percutaneous renal biopsy and complications associated with the procedure. Materials and Methods: This was a prospective observational study conducted in the Department of Nephrology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar. Patients who underwent percutaneous ultrasound-guided renal biopsy at the Institute between October 2017 and June 2019 were enrolled in the study. Data regarding indications for performing a percutaneous renal biopsy and incidence of minor and major post-biopsy complications were collected. Results: A total of 229 patients who underwent ultrasound-guided percutaneous renal biopsy under ultrasound guidance were enrolled in the study. The most common indications for ultrasound-guided percutaneous renal biopsy were nephrotic syndrome (33.3%), subnephrotic proteinuria with azotemia (14%), and unexplained azotemia with proteinuria and hematuria (13.5%). Post-biopsy complications were observed in 89 (37.55%) patients. Minor complications developed in 83 (36.22%) patients and major complications in 6 (2.62%) patients. Among patients with major complications, two (0.87%) patients underwent invasive procedures (embolization and cystoscopic removal of bladder clot) and four patients developed hemodynamic instability. There was no procedure-related mortality reported in the study. Conclusions: The most common indications for renal biopsy were nephrotic syndrome, subnephrotic proteinuria with azotemia, unexplained azotemia with proteinuria, and hematuria. The incidence of major complications was low.
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A comparative study of nalbuphine and fentanyl as adjuvants to bupivacaine in spinal anesthesia in lower limb orthopedic surgeries p. 48
Khushbu M Parekh, Namita Gupta, Sudhir Sachdeva, Durga Jethava
DOI:10.4103/DYPJ.DYPJ_17_22  
Background: Subarachnoid block is the most common technique employed for lower limb orthopedic surgeries. Adjuvants such as fentanyl and nalbuphine are added to increase the duration of post-operative analgesia. This study aimed to compare the efficacy of nalbuphine and fentanyl as adjuvants to bupivacaine in providing intra-operative anesthesia and post-operative analgesia in lower limb orthopedic surgeries. Objectives: The aim of this article is to compare the characteristics of sensory and motor block, hemodynamic parameter, time of first rescue analgesia, and adverse effects between the two groups. Materials and Methods: In this clinical trial, 80 patients undergoing elective lower limb orthopedic surgeries under spinal anesthesia were randomly allocated into two groups. In group BN, the patients received 0.5% 3 mL (H) bupivacaine + 800 mcg nalbuphine. In group BF, the patients received 0.5% 3 mL (H) bupivacaine + 25 mcg fentanyl. In both the groups, characteristics of sensory and motor block and time for first rescue analgesia were compared. Results: The onset of motor block, the maximum level of the block, and time to reach the peak level of the block were significantly faster in the BF group. Duration of motor block and time for first rescue analgesia were significantly prolonged in the BN group. However, there was no significant difference in time for two-segment regression [P = 0.157 (NS)] and hemodynamic changes. Conclusion: We conclude that combination of fentanyl as adjuvant to bupivacaine provides higher segmental level sensory blockage and faster sensory and motor blockage than nalbuphine. But nalbuphine gives longer time of post-operative analgesia than fentanyl did.
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Assessment of morbidity profile of rural population residing in the field practice area of a Government Medical College p. 53
Bhagyashri S Bhure, Rajendra T Ankushe
DOI:10.4103/DYPJ.DYPJ_44_22  
Background: Morbidity can be defined as any deviation from the state of normal physical and mental well-being. The health of an individual does have a direct relationship with human resources, development and economic development of a nation. The existing hospital based, disease – oriented health care model has provided health benefits mainly to the urban elite, approximately 80% of health facilities are concentrated in urban areas. The rural areas where nearly 69% of the population live, do not enjoy the benefits of the modern curative and preventive health services. Therefore the present study was undertaken with the objective to assess the health needs of the rural population in terms of morbidity. Materials and Methods: The Cross-sectional study was conducted in a village which comes under field practice area of the Department of Community Medicine. The village was selected by using lottery method out of all the villages which comes under the field practice area. All villagers in the village constituted the study population. 2270 Study population (420 families) were involved in the study. A house to house survey was done using interview technique as a tool for data collection. Predesigned questionnaire was used to record the necessary information. Data regarding socio demographic factors and any disease condition among family members was collected. Results and Conclusions: Present study comprises of 2270 study participants in all age groups. The most common morbidities more than 1% population affected (> 22 cases) were Anaemia 517(22.77%), Acute respiratory infection 260(11.45%), Diabetes and Hypertension 255(11.23%), Diarrhoea 93(4.09%), Refractory error and cataract 46(2.02%), Arthritis 44(1.93%) and Dental caries 34(1.49%). There is dual burden of communicable as well noncommunicable diseases in our study population.
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Role of laparoscopy in complicated appendicitis in children: A 5-year single-center experience p. 59
Pramod S, Tejashwini K
DOI:10.4103/DYPJ.DYPJ_39_22  
Background: Appendicitis is one of the most common surgical emergencies among children. Approximately 30% of children present to the hospital with complicated appendicitis, which is associated with higher morbidity than simple appendicitis. Controversy exists in the treatment of complicated appendicitis in the pediatric age group. The goal of this study was to review the results of laparoscopic surgery in complicated appendicitis in terms of safety, efficacy, and complicationsMaterials and Methods: A retrospective observational study was conducted in a tertiary care hospital in Bangalore from 2015 to 2020 over a period of 5 years. All children who underwent laparoscopic surgery for complicated appendicitis (perforated, gangrenous, and mass) were included in the study. Thorough history with respect to symptoms and their duration were recorded followed by general and abdominal examination. Routine blood investigation and imaging were done before surgery. Intraoperative data regarding the type of complication, presence or absence of fecolith, and position of appendix were documented. Postoperatively duration of stay and complications were analyzed. Results: Sixty cases were included in the study. The mean age of presentation was 10.11 ± 0.855 years. Of 60 children, 53 were males and 7 were females. The mean operative time was 55.8333 ± 4.806 min. The rate of conversion from the laparoscopy to open surgery was 11.5%. The mean time of duration of intravenous antibiotics was 4.2778 ± 0.446 days. The mean time for starting of oral feeding was 2.8333 ± 0.307 days. The mean duration of hospital stay was 5.11 ± 0.545 days. Wound infection in the immediate postoperative period was seen in 6.6% of the children. No long-term complications were noted. Conclusion: Laparoscopic appendectomy (LA) for complicated appendicitis is safe and effective. Therefore, it should be the first choice for cases of complicated appendicitis in children.
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REVIEW ARTICLE Top

Megaloblastic anemia: An updated review p. 63
Atul Khajuria, Raju Sehrawat
DOI:10.4103/DYPJ.DYPJ_40_22  
Megaloblastic anemia is a kind of anemia, which is triggered by means of inhibition of DNA synthesis at some point of erythropoiesis. The most frequent motive of defects in red blood cell DNA synthesis is vitamin deficiency, especially vitamin B12 deficiency or folic acid deficiency. Micronutrient loss can additionally be a cause. Moderate deficiency can consist of swollen tongue and neurological problems, inclusive of peculiar sensations such as a tingling sensation, whereas severe deficiency can encompass reduced coronary heart feature and greater serious neurological issues
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Microbiology of chronic otitis media—A review p. 67
Santosh K Swain, Smarita Lenka, Debasmita Dubey, Pragnya P Jena
DOI:10.4103/DYPJ.DYPJ_55_22  
Chronic otitis media (COM) is a major health problem in the world, particularly in the underdeveloped and developing countries. COM is typically persistent, insidious in onset, and usually capable to manifest deafness and otorrhea. The common microorganisms isolated from COM include Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Bacteroides. Otorrhea and healing of the tympanic membrane perforation in COM is a virtuous circle of events detected by the classic sequence of acute inflammatory change. In COM, a vicious circle occurs when incomplete healing predisposes the ear to further acute episodes, and these occur so frequently that they merge and are seen as continuous and chronic. Conservative medical treatment of COM is required to control active otorrhea. Effective treatment of COM needs a thorough knowledge of causative microorganisms and their antibacterial sensitivity. The appropriate identification of microorganisms and timely administration of antibiotics in COM patients ensure prompt clinical recovery and avoid possible complications. Bacterial predominance and sensitivity to antibiotics have changed over time, so these need periodic surveillance for guiding the appropriate antibacterial therapy. Early and effective treatment is based on the knowledge of causative microorganisms, and their antimicrobial sensitivity that ensures the prompt clinical recovery and possible complications of COM. The objective of this review article is to discuss the prevalence, bacteriology, treatment, and bacterial resistance in COM.
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Unraveling the significance of immune contexture in oral cancer p. 73
Deepti Sharma, George Koshy, Vishal Kumar Sharma, Gauri Malik
DOI:10.4103/DYPJ.DYPJ_22_21  
Numerous epidemiological and molecular biological studies have shown that inflammatory cells and cytokines in the tissues that surround tumors contribute to tumor development and progression. The immune response to tumors is complex, involves the interaction of several cell types of the adaptive and the innate immune systems, and has an important role in the progression of a variety of solid tumors. Tumor-infiltrating lymphocytes (TILs) have been studied as an indicator of tumor inflammation, and it has been reported that TIL subsets have their own roles in cancer progression. The differences in T-cell repertoire in different stages of cancer influence the prognostic and predictive response of the patient. Several studies have reported that CD3+ and CD8 + TILs are associated with good clinical prognosis in different cancer types including head-and-neck cancer, although contradictory reports are available regarding the role of CD4+ T-cells and + regulatory T-cells (Treg cells; forkhead box protein 3 [FOXP3] cells). This review is an attempt to elucidate the concept of immune infiltrate in oral squamous cell carcinoma to comprehend the role of immunoscore as an adjunct to tumor, node, metastasis staging to guide patient treatment. Immunoscore could provide an excellent setting for immunotherapeutic strategies to complement current standard chemoradiation and may benefit high-risk patients. We emphasize the need to standardize methodology, scoring criterias and also to develop validated cutoff values. Tumor aggressiveness and therapy resistance are influenced by the interplay between tumor cells and their microenvironment, only a better understanding of this will permit a rational design of new immunotherapeutic approaches.
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CASE REPORT Top

A case of scrub typhus meningoencephalitis complicated by a rare pathogen Leclercia adecarboxylata p. 80
Sanjay K Sahu, Surya N Mishra, Seba R Biswal, Hari K P Yerru, Chinmay K Behera
DOI:10.4103/DYPJ.DYPJ_2_22  
Leclercia adecarboxylata is Gram-negative bacteria and belongs to the family Enterobacteriaceae, which is motile and is considered as a commensal in normal gut flora. It causes opportunistic infection in immunocompromised hosts but also has been isolated from pus, blood, urine, and sputum of immunocompetent hosts. It is often found to be a part of polymicrobial infection indicating synergistic effect, enhancing its virulence. Rarely, it has been isolated from the cerebrospinal fluid of a child, and its coinfection with scrub typhus has hardly been reported. Because of significant morbidity and mortality associated with nosocomial infections, microbiologists and clinicians should be aware of such unusual pathogens such as L. adecarboxylata. Though most L. adecarboxylata isolates are sensitive to many of the antibiotics, their coexistence with multidrug resistant organisms could result in the transmission of resistance elements.
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