Acta Medica International

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https://imsear.searo.who.int/handle/123456789/157542

Chief Editor: Prof. S. K. Jain
ISSN (Print): 2349-0578 (Online): 2349-0896

Frequency: Biannual

Language: English

Open Access Peer-reviewed journal

Web site: www.actamedicainternational.com

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A Comparative Study on Conventional Adenoidectomy and Endoscopic Powered Adenoidectomy
(Wolters Kluwer – Medknow, 2024-05) Devi, Sanu; Bhatnagar, Aastha; Swami, Gautam; Kamal, Anil Kumar; Parihar, Anil Kumar; Nidhi
Introduction: Adenoids are a type of nasopharyngeal lymphoid tissue that is a component of Waldeyer’s ring. They are typically present from birth, reach their maximum size between the ages of 7 and 10 years, and then gradually decrease in size to become atrophied in adulthood. The objective of the current study is to compare conventional adenoidectomy using curette with power?assisted adenoidectomy. Materials and Methods: This randomized clinical trial was conducted at Teerthanker Mahaveer Medical College and Research Center from March 2023 to August 2023. A total of 40 patients were planned for adenoidectomy and randomly allocated under two groups. The conventional curettage adenoidectomy method was done on patients in Group A and patients in Group B who underwent power?assisted adenoidectomy using microdebrider. Both the groups were further compared in terms of surgical clearance of adenoids, operative time taken in procedure, injury to surrounding structures, and symptom score improvement on follow?up. Results: Surgical clearance was excellent in Group B with no adenoid tags left in all 20 (100%) patients, whereas few tags were left in 18 (90%) patients in Group A (P < 0.0001). The mean operative time (in minutes) for Group A was 22.4 ± 1.67, whereas Group B was 18.1 ± 1.76 (P = 0.001). Postoperative pain score in Group A was 3.7 ± 1.63, whereas for Group B was 2.8 ± 1.01 (P < 0.043). Recovery time in terms of number of days to return to normal diet and activities in Group A was 3.1 ± 0.3 days, whereas Group B was less 2.1 ± 0.2 days (P < 001). Postoperative nasal symptom score at 6 weeks in Group A was 1 in 1 patient and 2 in 4 patients with mean of 0.45 ± 83, whereas in Group B was 0 (P = 0.043). Conclusion: It was concluded from the study that power?assisted adenoidectomy was a better surgical procedure than conventional adenoidectomy. There was better improvement in nasal symptom score and surgical clearance by power?assisted adenoidectomy. Postoperative pain score and time taken for recovery after surgery were also less in power?assisted adenoidectomy.
Hypertension and Lifestyle Determinants in Public Transport Drivers: A Sector-specific Study in Coimbatore, Tamil Nadu
(Wolters Kluwer – Medknow, 2024-01) Devarasu, Usha; Jayaraj, Naveen Prabhu; Sugunadevi, G.; Kokila, K.
Introduction: Cardiovascular diseases are a leading cause of death worldwide, prompting this investigation into hypertension – a key risk factor – among a vulnerable group, bus drivers, who may be affected by job?related stress and health behaviors. Materials and Methods: This cross?sectional analysis evaluated 800 male TNSTC bus drivers from Coimbatore using a multistage sampling method. Interviews, physical measurements, and blood pressure assessments provided the data, which were subjected to comprehensive statistical analysis. Results: A concerning 49.9% of drivers were hypertensive, and 27.75% did not have their condition under control. Increased risk was linked with advancing age (those above 51 were 3.28 times more at risk than those under 30), lower educational attainment, familial hypertension history, and lifestyle choices, including sedentary habits, excessive salt consumption, and substance use. A striking correlation was observed between obesity and hypertension (odds ratio: 1.36; 95% confidence interval: 1.09–1.69). Conclusion: This research highlights an alarming rate of hypertension within the bus driver cohort, influenced by both modifiable and non modifiable risk factors. It underscores the urgent need for targeted health programs, proactive screenings, and educational initiatives. Expanding the study to other centers will provide a broader context for these findings.
Crossword Puzzles – A Fun Educational Tool to Reinforce Information
(Wolters Kluwer – Medknow, 2024-05) Tejeswini, Vaddatti; Chaitra, B.; Renuka, I. V.; Ramya, Potti
Introduction: Students?centered teaching and learning methods are the trends in medical education. Many innovative techniques are introduced and implemented to promote active learning by students, like crossword puzzles, a fun educational tool to generate interest, motivate, and enhance the critical thinking of medical students. Hence, this study was conducted to assess the perception of medical students toward crossword puzzles. Materials and Methods: This is an interventional study done on II MBBS students in the department of pathology. The crossword puzzles are created, and students are allowed to solve them for 15 min after a didactic lecture. Then, students are provided with a questionnaire to assess their perceptions toward this technique. The knowledge gained and retained was evaluated by short answer questions in comparison with topics dealt with only by traditional lectures. Descriptive and analytical statistical analysis of mean, standard deviation, and paired t?test for analysis of scores of both methods are done. Results: The majority of the students in this study perceived that crossword puzzles helped in better understanding of concepts, were fun education tools, challenging and problem?solving, emphasized the core topic, helped reinforcement of lectures, encouraged active learning, and improved overall thinking. The P value between the scores by only lecture method and that reinforced by crossword puzzles was extremely statistically significant. Thus crossword puzzles can be used to enhance retention and help in reinforcement learning. Conclusions: Crossword puzzles are an innovative learning method which promotes active learning and overall thinking of the students. This can be implemented in medical schools as a simple, creative, and effective means of holistic learning.
Assessing Treatment Efficacy and Determinants of Outcome in Isoniazid Mono-resistant Tuberculosis Patients: A Prospective Observational Study in Gujarat
(Wolters Kluwer – Medknow, 2024-01) Patel, Keyur; Yogesh, M.; Makwana, Manju; Misra, Swati
Introduction: There is a high number of isoniazid?resistant tuberculosis (TB) in India; estimates imply that over 25% of TB patients there are isoniazid?resistant. Hence, the study aimed to evaluate the effectiveness of therapy for patients with isoniazid?mono?resistant TB and the negative effects of the H?mono?resistant TB Regime. Materials and Methods: It was a hospital?based prospective observational study from September 2021 to August 2022. Hence, 100 patients diagnosed with isoniazid mono?resistance TB enrolled in this study. After obtaining the prior informed consent of all patients willing to approve the collection and publication of their data, including extensive clinical history and radiological, microbiological, and biochemical investigations, this study included all diagnosed cases of isoniazid mono?resistant TB. A descriptive statistical analysis was done for continuous and categorical variables. Differences in characteristics between participants were tested with logistic regression and cross?tabulation. P <0.05 was considered significant. Results: Among 100 patients participated, their mean age was 50.8 ± 3.2 years. About 72 (72%) participants have successful treatment outcomes (cure). Only about 25 (25%) patients had minor adverse drug reactions. Body mass index (16.6 [3.6–74]), substance addiction history (9.5 [3.3–26.9]), previous history of TB (9 [3.3–24.0]), type of lesion (5.3 [1.6–17]), and extent of the lesion (2.6 [1.03–6.07]) in chest X?ray were associated statistically with the treatment outcome. Conclusion: The findings suggest that the H?mono?resistance regime is generally well?tolerated, with only a small percentage of patients experiencing nonserious adverse drug reactions, and the overall successful treatment outcome in H?mono patients was 72%. The study also highlights the importance of monitoring drug resistance patterns, particularly for levofloxacin and moxifloxacin, and the need for effective treatment regimens for isoniazid mono?resistant pulmonary TB.
Physical, Psychosocial, and Economic Burden of COVID-19 Disease: A Cross-sectional Study among Adult Population in an Urban Community of North 24 Parganas, West Bengal, India
(Wolters Kluwer – Medknow, 2024-01) Ghosh, Sukanya; Mukhopadhyay, Dipta Kanti; Das, Nivedita; Pal, Moumita; Kundu, Sampurna
Introduction: It has been observed that the symptoms and clinical sequelae of COVID?19 disease may develop and persist far beyond the initial illness, but there are limited data documenting this. The present study is planned to find out the physical, psychosocial, and economic burden of COVID?19 disease among the adult population in an urban community. Materials and Methods: This was a community?based, observational, cross?sectional study conducted among 106 adult individuals, who tested COVID?19 positive by rapid antigen test/reverse transcriptase– polymerase chain reaction between May 21 and October 21, residing in North Dum Dum municipality, N 24 Parganas. A predesigned pretested validated questionnaire was used to assess the physical and social burden of the disease by health?related quality of life (HRQoL) questionnaire, psychological burden by the Perceived Stress Scale, and economic burden in terms of the direct and indirect cost of care, job lost, reduction of income, and cost?cutting measures applied to daily life. Results: More than one?third of the study population had HRQoL compromised for almost 1/3 of the past month. The perceived stress was found out to be significantly associated (P < 0.05) with the severity of the disease. The reported median (interquartile range [IQR]) of the direct cost of care for COVID?19 disease was 7000.0 (4000.0–12,000.0) INR, whereas the median (IQR) indirect cost of care was 1250.0 (0–5000.0) INR. Conclusion: The severity of COVID?19 has a great impact on HRQoL, perceived, and economic burden of the disease.
Effectiveness of Lipid-lowering Therapy for the Secondary Prevention and Achievement of Therapeutic Goals in Atherosclerotic Cardiovascular Diseases in Accordance with the American College of Cardiology/American Heart Association 2018 Guidelines on the Management of Blood Cholesterol
(Wolters Kluwer – Medknow, 2024-01) Sojan, Christy; Joshy, Lakshmiha; Philip, Merlin Susan; Joseph, Merrin
Introduction: According to the India Report 2020, Kerala had the highest prevalence of atherosclerotic cardiovascular diseases (ASCVDs). Dyslipidemia is a modifiable risk factor that can prevent secondary events. American College of Cardiology/American Heart Association 2018 Guidelines for the management of blood cholesterol for secondary prevention of clinical ASCVD recommend high?intensity statins and moderate?intensity statin combination therapy for achieving target low?density lipoprotein?cholesterol (LDL?C). We conducted a study to evaluate the achievement of therapeutic goals in accordance with the guidelines in a tertiary care hospital in Kerala. Materials and Methods: Three hundred and twenty adult patients prescribed with high?intensity statin monotherapy (atorvastatin 40 mg, rosuvastatin 20 mg, and rosuvastatin 40 mg) or moderate?intensity statin combination therapy (atorvastatin 10 mg and fenofibrate 145 mg) for the secondary prevention of ASCVD event were included. Data were collected from the medical records and patient interviews. Achievement of the therapeutic goal of LDL?C ?70 mg/dL in accordance with guidelines was evaluated and compared; the mean percentage change in LDL?C was at the baseline and after 3 months. Patients were counselled on lifestyle modifications and educated about hypolipidemic agents. Since we are aiming for secondary prevention, the patients were given appropriate counselling concerning their disease and medications they are on. Dietary lifestyle modifications were also taught. Results: One hundred and thirty?eight patients achieved the therapeutic goal, with atorvastatin 40 mg (89.37%) being the most prescribed drug, followed by rosuvastatin 20 mg (5.62%) while rosuvastatin 40 mg had a higher efficacy with mean LDL reduction 65.71 ± 15.93 at 3 months follow?up. Comparing the adherence scores before and after patient counseling, the P value was found to be < 0.001, indicating it is significant. Conclusion: Lifestyle modifications and lipid?lowering therapy are crucial to tackle dyslipidemia. Poor achievement of therapeutic goals implies the need for adopting measures to improve adherence and health?related outcomes for patients with ASCVD.
Comparison of Post Operative Analgesic Efficacy of Dexamethasone as an Adjuvant with Ropivacaine 0.25% and Plain Ropivacaine 0.25%, Using Ultrasound Guided Tap Block after Total Abdominal Hysterectomy: A Randomized Controlled Trial
(Wolters Kluwer – Medknow, 2024-01) Parihar, Ashutosh; Shukla, Nidhi; Saxena, Atul; Nigam, Shuchi
Introduction: Following abdominal surgery, transversus abdominis plane (TAP) block, a peripheral nerve block, can be a useful supplement to multimodal postoperative analgesia. The aim was assessment of postoperative analgesic effectiveness of 0.25% ropivacaine with 4 mg of dexamethasone on each side and 0.25% ropivacaine alone in the management of postoperative pain following total abdominal hysterectomy (TAH). Materials and Methods: Sixty adult patients planned for elective TAH with ASA Grades I–II under general anesthesia participated in this prospective, randomized, double?blinded study. Patients of Group A were given 20 mL of 0.25% ropivacaine on both the sides and Group B patients were given 20 mL of 0.25% ropivacaine with dexamethasone 4 mg on each side. The primary objective of this study was a comparison of Visual Analog Scale (VAS) scores between the groups and comparison of mean time of first rescue analgesia. The secondary objectives of this study were a comparison of hemodynamic parameters, postoperative analgesic requirement, patient satisfaction, and incidence of side effects. Results: VAS shows no discernible variation in 1 and 4 h after administration of block in Groups A and B. However, a significant difference appeared in VAS 8 h (P = 0.007), VAS 12 h (P = 0.000), and VAS 24 h (P = 0.000) after the administration of block between Groups A and B. The median time for first rescue analgesia was 2.75 h (interquartile range [IQR] = 1 h) and 5.8 h (IQR = 1.6 h) in Groups A and B, respectively, which was highly significant. Conclusion: We concluded that, after abdominal hysterectomy, dexamethasone added to ropivacaine TAP block tends to prolong postoperative analgesia and decrease the need for analgesics.
A Comparative Study on the Effect of Different Management Options on Body Mass Index in Overweight Polycystic Ovarian Syndrome Patients at a Tertiary Care Hospital
(Wolters Kluwer – Medknow, 2024-05) Krishna, U. R. Namrutha; Nazrin, T. M. Safhana; Biju, Abin; Joseph, Merrin
Introduction: According to the data from the World Health Organization, polycystic ovarian syndrome (PCOS) may affect as many as 116 million women worldwide (3.4%). The main objective of the study was to determine the effectiveness of treatment on the body mass index (BMI) of overweight PCOS patients. Materials and Methods: This prospective, observational study was conducted from December 2022 to February 2023 and 252 PCOS patients were included in the study. Results: A detailed analysis of the risk factors in the study population concluded that a family history of the PCOS, lack of exercise, regular consumption of fast food, broiler chicken, high sugar, soft drinks, and packed foods had contributed to the lifestyle syndrome, where each showed a P = 0.0001. Conclusion: The comparative analysis of the treatment effectiveness in terms of BMI among three treatment strategies—(1) medication, (2) lifestyle, and (3) medication along with lifestyle established the conclusion that the treatment with lifestyle alone and lifestyle along with medication together showed similar extend in weight reduction in overweight PCOS patients after performing post hoc statistical analysis. However, a greater proportion of people who experienced weight reduction falls under lifestyle + exercise.
Diagnostic and Management Challenges of Acute Fatty Liver of Pregnancy: A Case Series
(Wolters Kluwer – Medknow, 2024-05) De, Anirban; Dwivedi, Deepak; Mohan, Sanil; Roy, Palash
Introduction: Acute fatty liver of pregnancy remains an elusive and potentially fatal complication of a rare liver disease in late pregnancy. Due to sparse research, diagnostic dilemmas, and multi?organ involvement of the disease, it is imperative to elaborate the evaluation and management principles to confine the outcomes. Case Reports: Here, we aim to discuss in detail the peripartum manifestations and goal?directed management protocols in a case series of four patients managed at a tertiary care setup in India. Conclusion: It was found that all four cases had varied presentations ranging from asymptomatic hypoglycemia to liver failure and multiorgan dysfunction requiring a multidisciplinary perioperative care approach to prevent complications by incorporating supportive care along with latest available point of care diagnostics, interventional care, Extracorporeal Membrane Oxygenation (ECMO) and Continuous renal replacement therapy (CRRT).
Comparison of Balance during Dual-Task in-between Cognitively Impaired and Nonimpaired Individuals with Parkinson’s Disease
(Wolters Kluwer – Medknow, 2024-05) Kandharkar, Samruddhi Sunil; Paldhikar, Sayli S.
Introduction: Parkinson’s disease manifests as bradykinesia, stiffness, tremors, and abnormalities in gait and balance. When performing dual activities, people with cognitive impairments exhibit noticeable alterations in mobility. The purpose of this study was to determine whether balance during dual tasking is related to cognitive deterioration. The aim was to compare balance during dual?task in?between cognitively impaired (CI) and nonimpaired individuals with Parkinson’s disease. The objective was to evaluate balance using timed up and go test (TUG), TUG?manual (TUG?m), and TUG?cognitive (TUG?c) and to compare its scores in both the groups. Materials and Methods: It was a cross?sectional observational study carried out at outpatient department and Parkinson’s societies. The sampling technique was purposive sampling, and the sample size was 22. Subjects were divided into two groups (by stratification method) according to Montreal Cognitive Assessment (MOCA) scores as CI and nonimpaired group. Both groups performed TUG with manual task and cognitive task. The time taken to complete all TUG tests was measured. Results: Comparison of TUG between the groups showed a highly significant difference in TUG and TUG?m tests (P < 0.001) and a significant difference in TUG?c (P = 0.028). Conclusion: The study found a significant difference in balance scores, assessed by the TUG test during dual?task conditions, between CI and nonimpaired individuals with Parkinson’s disease. This highlights the important role cognition plays in balance regulation in Parkinson’s disease.
Pulmonary Fissures Including Accessory and Azygos Fissures and their Clinical Significance
(Wolters Kluwer – Medknow, 2024-01) Agrawal, Nitin; Bhardwaj, Harshita; Chhabra, Neeta; Chaudhary, Neha
Introduction: The lungs are divided into lobes by oblique and horizontal fissures. Knowledge of extent of completeness of fissures is important for surgical planning. This study highlights the variation in Pulmonary fissures including accessory and azygos fissure and their clinical relevance. Materials and Methods: The sample consists of fifty (50) lung specimens (25 right and 25 left), collected from formalin fixed cadavers, which were dissected during undergraduate teaching. The lungs were observed for complete, incomplete, and absent fissures. Additional fissures including accessory and azygos fissures were also observed and findings compared with previous studies. Results: Accessory fissure was found in 35% right and 40% left lungs. Horizontal fissure was found to be absent in 30% right lungs. Oblique fissure was found absent in 5% right and left lungs. Four right lungs had azygous fissure. Inferior accessory fissures were found in 15% right lungs. 20% left lungs had both inferior accessory and left minor fissures. Conclusion: It is important to assess the incompleteness or absence of fissures, when planning any surgical procedure. Lung fissure variations are frequently encountered during surgical procedures and knowledge of pattern of these fissures is important to avoid and reduce associated mortality and morbidity.
A Study on Variations in Size and Shape of Left Atrial Appendage from Formalin-fixed Cadavers
(Wolters Kluwer – Medknow, 2024-01) Sapna, C. S.; Vellani, Haridasan
Introduction: Atrial appendages were once considered vestigial structures with no significant role in atrial function. However, they are now recognized as significantly impacting various pathophysiological conditions, including cardiac thromboembolism and arrhythmias. The left atrial appendage (LAA), in particular, has been found to have significant variations in shape and size, and its relationship with nearby structures, such as the pulmonary veins (PVs), is crucial in planning interventional and surgical procedures in and around the LAA. Although most studies examining variations in the LAA are image?based, few have focused on anatomical studies. Materials and Methods: In this study, we examined heart specimens from 54 cadavers for anatomical dissection at a tertiary care teaching hospital. After removing the heart from the pericardial cavity, we opened the left atrium and examined its interior. Observations were made regarding the LAA orifice and PV orifices, and measurements were taken. Subsequently, we removed the LAA along with a portion of the left atrial wall, observed its shape and number of lobes, and took measurements. To classify the shape, we used a system proposed by Wang et al. based on resemblance to familiar objects. Categorical variables were expressed as percentages and continuous as mean and standard deviation. The institutional research committee and the institutional ethics committee approved the study. Results: The most common shape variant observed was the Chicken Wing type, followed closely by the Windsock type. Specimens with Cauliflower or Cactus morphology were rare, with the Cactus variant being the least common. The LAA orifice was round or oval shaped in most cases. In most cases, the LAA orifice was at the same or lower level as the left superior PV orifice, with a prominent ridge between the two orifices in most patients. We observed most of the appendages to be trilobed, with considerable variations in length and diameter. We found two specimens with unusual morphologies but no specimens with accessory appendages. Conclusions: Based on our study, there are significant differences in findings compared to some of the previous studies reporting the shape variations of LAA. However, our findings are matching with those of some other earlier studies. The variations in the shape and size of LAA orifices and their relationship to PV orifices are similar to those reported in earlier studies. The distribution of variations in the size of LAA was also similar to those reported in earlier studies. Conducting larger studies to explore these variations could aid in designing and developing therapeutic interventions in the LAA.
Morphological Study of Human Fetal Lung with Respect to Gestational Age in the Tertiary Care Center of Kumaon Region of Uttarakhand
(Wolters Kluwer – Medknow, 2024-05) Jaiswal, Pragya; Deopa, Deepa; Sharma, Vandana; Thomas, Sonali
Introduction: The lung fissures are helpful in the movement of lobes in relation to one another. Variation in the presence or absence of fissures indicates about the pattern of development of the lung. The study was done to observe the appearance of lung fissures in human fetal lungs in relation to the gestational age. Materials and Methods: This cross?sectional study was conducted in the Department of Anatomy on 32 pairs of human fetal lungs of either gender which were divided into five subgroups of various gestational ages ranging from 15 weeks to 40 weeks. The morphological details of the appearance of fissures of lungs and the presence of any variation were noted. Results: Out of 32 specimens of the right fetal lung, the horizontal fissure was absent in two fetuses. The oblique fissure was complete and present in all 32 specimens of the right lung. Among 32 specimens of the left lung, the absence of oblique fissure was observed in one lung. No accessory fissure and lobe was seen. Conclusion: In our study, there was no correlation between the appearance of fissure and gestational age as the absence of horizontal fissure in the right lung is found among two gestational age groups; one in 21–25 weeks and one in 36–40 weeks. Furthermore, the absence of oblique fissure in the left lung is seen in the age group of 36–40 weeks. However, it was found that oblique fissure in both lungs and horizontal fissure in the right lung appear as early as 15 weeks of gestation.
Comparative Study of Modified Ultrafast Papanicolaou and Standard Papanicolaou Staining Technique for the Assessment of Cervical Smears
(Wolters Kluwer – Medknow, 2024-05) Mitra, Nishant; Singh, Vivek; Rawat, Anamika Singh; Awasthi, Seema; Mittal, Ankita; Dutta, Shyamoli
Introduction: Cervical invasive carcinoma is one of the most frequent cancers in the world, and it can be prevented with screening. The papanicolaou (Pap) smear is the most common screening procedure. Pap staining, as it is now done, is costly, requires a large amount of alcohol, and takes a long time. Materials and Methods: A total of 170 patients were recruited. One hundred and sixty?six patients, considering eligibility criteria, undergoing Pap smear test. Eligibility criteria: Age: 18–49 years females, who did not have a total hysterectomy done, who consented to participate in the study. Each patient had two smears taken on glass slides. Standard Pap smears were fixed for at least 15 min in 95% ethanol. The other smear was air?dried before being fixed with alcohol formalin and stained with modified ultrafast Pap (MUFP) stain. A comparison of two different techniques was made on the basis of cytomorphological features. Results: In studied smears, a clean background was seen in 18.24% and 14.12% of the cases in Pap stain and MUFP, respectively. Kappa analysis found a good correlation between Pap stain and MUFP (kappa: 0.81, P < 0.01). Crisp chromatin was seen in 89.41% and 67.65% of MUFP and Pap staining, respectively. About 88.82% of MUFP stains showed optimal cytoplasmic details and the same was revealed by 81.18% of Pap stains. MUFP has a better quality index (QI) as compared to Pap staining as no case in MUFP had QI of < 0.80 with a statistically significant difference as P < 0.05. Conclusion: MUFP is a simple, user?friendly, affordable, and less time?consuming alternative in low?resource areas in comparison to the traditional technique for mass cervical cancer screening.
Effect of Intermittent Fasting Interventions for Treatment of Overweight and Obesity in Adults – A Systematic Review
(Wolters Kluwer – Medknow, 2024-01) Lal, Teena; Arulkumar, S. J. Ajeet; Roopa, S.
Recent data from the 2019 Global Health Metrics report indicates a troubling trend: more than five million deaths annually can be traced back to health issues related to being overweight or obese. This comprehensive review, scrutinizes the role of intermittent fasting (IF) in improving metabolic functions and aiding in weight loss among the adult demographic. This review, built on the solid foundations of the Cochrane and PRISMA protocols, thoroughly examines a plethora of research concerning IF as a viable approach to combat adult obesity and overweight conditions. Our extensive research canvassed several academic and scientific databases such as PubMed, Embase, PsycINFO, Web of sciences, Scopus and the Cochrane Library, up until the latter part of February 2023, with no barriers on language. We identified 3241 studies, which after deduplication procedures, narrowed down to 3065. Through meticulous evaluation, we shortlisted 386 studies. Ultimately, our synthesis includes 10 research papers with contributions from India (6 studies), as well as individual studies from Pakistan, Saudi Arabia, the USA, and China, collectively observing 845 adults. Our synthesis of the selected research posits that IF provides enduring and beneficial outcomes for adults suffering from obesity and excess weight. The intervention showcases a marked improvement in managing blood glucose, lipid concentrations, insulin sensitivity, and overall cardiovascular functioning. It is also observed that integrating IF with consistent physical activity serves as an effective dual strategy for not only weight control but also for fostering an enhanced state of general health.
A Prospective, Randomized, Comparative Study between Dexmedetomidine and Buprenorphine as an Adjuvant to Ropivacaine in Ultrasound-guided Supraclavicular Brachial Plexus Block for Upper Limb Orthopaedic Surgeries
(Wolters Kluwer – Medknow, 2024-05) Sangeetha, C.; Kumar, Malathi Anil; Bathalapalli, Aparna; Kumar, K Bharath; Malashree, G; Heggeri, Vijayakumar M
Introduction: Supraclavicular approaches serve as a common method for administering regional anesthesia in upper limb procedures. In improving the impact with a length of pain relief, medical professionals frequently include additional substances such as dexmedetomidine, buprenorphine, dexamethasone, clonidine, sodium bicarbonate, and tramadol alongside local anesthetics. The intent of this study was to evaluate its impact of incorporating buprenorphine and dexmedetomidine into ropivacaine 0.5%. Materials and Methods: The trial of 90 patients between the ages of 18 and 60, who were identified as American Society of Anesthesiologists Grade 1 and 2, and scheduled upper limb surgery using the supraclavicular approach, were included. They were assigned into distinct groups, each of the groups consisting of thirty individuals. Group R was administered anesthesia consisting of 25 ml of ropivacaine 0.5% along with 1 ml of saline. Group B was administered anesthetics containing ropivacaine 0.5% and buprenorphine, which was diluted in saline. Group D was administered a solution containing ropivacaine 0.5% and dexmedetomidine, which was diluted in saline. Results: Group D had an earlier sensory blockade onset (8.25 min) compared to Group B (9.64 min) and Group R (12.89 min). Group D demonstrated a notably quicker motor blockade onset (9.21 min) in contrast to Group B (12.07 min) and Group R (15.03 min). In contrast with the other groups, Group D exhibited a more longer time frame of both sensory and motor blockades and also an extended period of anesthesia after the surgery. Conclusion: Dexmedetomidine was a more effective adjuvant over buprenorphine in the brachial plexus blocks. This resulted in significantly lower postoperative pain scores at 407.67 min and 612.32 min for the plain ropivacaine and buprenorphine groups, respectively.
Prevalence of Diabetes Distress among Adults with Diabetes Mellitus in a Rural Area of West Bengal: A Cross-sectional Study
(Wolters Kluwer – Medknow, 2024-05) Pal, Arpan; Das, Nivedita; Ray, Soumalya; Mukhopadhyay, Dipta Kanti
Introduction: Diabetes distress is the emotional burden of diabetics and it may have a devastating impact on the health and well?being of people with diabetes. This study aims to estimate the prevalence of diabetes distress among adults with diabetes mellitus registered in the National Programme for Prevention and Control of Non?Communicable Diseases (NP?NCD) register in a rural area of West Bengal and to identify its distribution across different sociodemographic and treatment?related variables. Materials and Methods: This community?based descriptive, cross?sectional study was conducted in Barrackpore II block of North 24 Parganas district between July 2023 and September 2023. The study population consisted of diabetics registered under the NP?NCD register. The minimum required sample size of 155 was selected through a multistage sampling technique. Socioeconomic and sociodemographic data were collected using standardized questionnaire. Problem Areas in Diabetes questionnaire was used for assessing diabetes distress. Medication Adherence Report Scale questionnaire was used to check for medication adherence. Data were collected by house?to?house visits. Data were analyzed using jamovi (v2.4.8). Results: Out of the 142 participants, 52 (36.6%) had diabetes distress. Odds of diabetes distress were higher among <50 years of age (6.25 [2.41, 16.18]), females (3.66 [1.46, 9.21]), individuals with poor adherence to medications (8.40 [3.26, 21.59]), and individuals procuring medicines from private shops (3.47 [1.00, 12.00]). Conclusion: Diabetes distress is a public health problem among adults living with diabetes, which may have negative impacts on their quality of life and health outcomes. Further research is needed to explore the possible mitigating measures for the same.
Perceived Barriers of Managing Teaching–Learning during COVID-19 Pandemic: A Descriptive Observational Study among Medical Educators in West Bengal
(Wolters Kluwer – Medknow, 2024-05) Chakraborty, Sajib; Das, Nivedita; Biswas, Puspendu; Ray, Soumalya
Introduction: The COVID?19 pandemic led to a paradigm shift in the landscape of medical education, necessitating a transition from traditional pedagogical methods to digital learning platforms. This study aims to find out the barriers faced by medical educators in West Bengal during the pandemic. Materials and Methods: This descriptive type of observational study with a cross?sectional design was conducted between December 2022 and February 2023 with a reference period of March 2020 to December 2020. The study population was the medical educators working during the reference period in the various departments of Government Medical Colleges in West Bengal. One hundred and twenty medical educators were selected using simple random sampling and responses were collected through a predesigned and pretested Google Forms. Collected data were checked for consistency and analyzed in GNU PSPP (v 1.4.2). Quantitative data were expressed as mean (±standard deviation) or median (±interquartile range), and qualitative data were expressed in frequency and percentage. Results: Out of the 120 sample population, 100 responded within the stipulated 7 days with a response rate of 83%. Most of the respondents had opined that they did not have a dedicated e?classroom facility for online education (87, 87%) and web camera (63, 63%). The majority had a prevailing teacher?centric approach to education including a lack of incorporating student feedback in deciding mode of communication. Conclusion: The study identifies the deficiency of logistical support and identifies the importance of capacity building of medical educators for tiding over similar situations in future.
Endometrial Hormonal Receptor Expression and Blood Vessel Density in Abnormal Uterine Bleeding: A Cross-sectional Descriptive Study
(Wolters Kluwer – Medknow, 2024-05) Jetley, Sujata; Bushra, Bushra; Ahmad, Nehal; Elahi, Arifa Anwar; Jairajpuri, Zeeba S.; Rana, Safia; Khetrapal, Shaan
Introduction: Abnormal uterine bleeding (AUB) is bleeding which is abnormal in amount, duration, frequency, and cyclicity and differs from the normal pattern. The aim of the study is to evaluate the expression of endometrial estrogen (ER) and progesterone receptor (PR) immunohistochemically and blood vessel density in AUB patients. Furthermore, we will correlate hormonal receptor expression and blood vessel density with various endometrial pathologies presenting with AUB. Materials and Methods: A cross?sectional study of 60 cases with clinical diagnosis of AUB, (30 cases of cyclical endometrium and 30 cases of hyperplasia/carcinoma) was done. Histological typing of endometrial lesions was done. Microvessel density (MVD) was calculated by counting the average number of blood vessels/10 HPFs. Evaluation of MVD was done on hematoxylin and eosin (H and E) stain and also reticulin stain which highlighted the basement membrane. Immunohistochemistry for steroid hormone receptors, ER and PR was done as per avidin?biotin technique with Diaminobenzidine as the chromogen. Carcangiu scoring system for semiquantitative analysis of ER/PR expression in endometrial samples was adopted. Results: There was a significant difference in microvessel density between different histopathology microscopic diagnoses (P < 0.05). The mean value of microvessel density on reticulin stain was significantly higher as compared to the mean value of MVD on H and E. A decrease of the hormonal receptor expression, ER and PR was observed in parallel with the decreased histological degree of differentiation, the lowest values occurring in the case of endometrioid Grade 3 carcinomas. Conclusion: Angiogenesis is significantly correlated with increasing severity of the lesion. The correlation of immunohistochemical findings with histologic grade can be useful in predicting biological behavior in patients.
Status of Nutritional Services to Vulnerable Population in West Bengal and Their Hardship during COVID-19 Pandemic: A Community-based Qualitative Exploration
(Wolters Kluwer – Medknow, 2024-05) Bandyopadhyay, Kajari; Ray, Soumalya; Das, Nivedita; Mukhopadhyay, Dipta Kanti
Introduction: In response to the COVID?19 pandemic, restrictions were imposed on various activities including nutritional services. This study was conducted with the objective to explore the status of the nutritional services and to identify the hardship and barriers faced by the vulnerable population and challenges for service providers and program managers during the initial phase of pandemic. Materials and Methods: A community?based cross?sectional qualitative study was conducted among three vulnerable population groups (slum dwellers, tribal population, and residents of disaster?prone area) in three districts of West Bengal, the reference period being April–September 2020. To assess the status of nutritional services and identify existing barriers or challenges, the study employed a mixed? methods approach utilizing focus group discussions (FGDs) as well as in?depth interviews (IDIs) conducted with beneficiaries, service providers and program managers. One habitation in each district was selected to obtain case scenarios on food insecurity and hardship. Descriptive analysis of household surveys and thematic analysis of FGDs and IDIs were done, and the findings were triangulated. Results: Different nutritional services (supplementary nutrition, micronutrient supplementation, growth monitoring, nutrition counseling, and nutrition rehabilitation) were disrupted. Shifting from hot?cooked meals to dry take?home ration was the most conspicuous change during restoration phase. Food security was absent in majority of the households. Reduction of income affected their affordability, which along with difficult accessibility to diverse food items contributed to their hardship. Service providers identified several challenges, including increased workload due to both COVID?19 activities and a rise in beneficiaries, transportation difficulties, and experiences of stigma and discrimination. Long administrative decision?making process, additional hurdles due to cyclone, and containment zones were identified as challenges by the program managers. Conclusion: As the hardship of vulnerable population was pervasive, it is necessary to formulate mitigating measures in light of the identified challenges and to combat similar crises in future.

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