International Journal of Medical Sciences and Education (IJMSE)
Vol. 9 Issue: 1 (Jan -Dec. 2022), Date of Publication: 01.01.2023

1.ASSESSMENT OF BACTERIAL DIVERSITY ASSOCIATED WITH ATHEROSCLEROTIC PLAQUE IN STROKE
                                                                                                                                                                              1-6
Lokendra Bahadur Yadav, Atulabh Vajpeyee, Manisha Vajpeyee, Shivam Tiwari                   PDF FULL TEXT

ABSTRACT

Background:We aimed to investigate the microbial features of cerebral thrombi retrieved via Mechanical thrombectomy in stroke patients. The microbial compositions of all samples were compared using 16S rRNA gene amplicon next-generation sequencing.Materials and Methods: Enrollment of 18 Acute ischemic stroke (AIS) patients was done who underwent mechanical thrombectomy in which 12(66.66%) male and 33.3% (n=6) female. The patients' median age was 51±14.6 years old, and they were male and female. During the window of acute stroke with symptomatic carotid stenosis and blockage of the ipsilateral middle cerebral artery, all were submitted to mechanical thrombectomy. After mechanical thrombectomy we extracted the DNA from thrombus sample. Results:All of the thrombi retrieved for bacterial DNA in qPCR from the18 patients who had thrombectomy for ischemic stroke were positive. We discovered more than 25 bacteria in plaque that included Pseudomonas putida, Staphylococcus epidermidis, Staphylococcus hominis, and Finegoldia magna and other. Additionally, members of the genera Propionibacterium and the unclassified Burkholderiales were frequently the most important taxa for all atherosclerotic plaque. Conclusion:Large bacterial diversity was found in thrombus in ischemic stroke patients in this study, which also indicated that microbes present in thrombus also played role in formation of plaque and Bacteria have direct mechanisms such as acidification and local inflammation of the plaque milieu with lactobacillus, biofilm dispersion leading to inflammation with pseudomonas fluorescence, the gut microbiota, could all lead to thromboembolic and cause stroke.
Keywords: Stroke, Mechanical Thrombectomy, Thrombus, Microbiome, MetagenomicsKeyword: Postoperative analgesia patient-controlled epidural analgesia patient-controlled intravenous analgesia.

2.   PREDICTIVE ROLE OF CELL FREE DNA AND HS-CRP AS A BLOOD BIOMARKER IN ACUTE ISCHEMIC              STROKE PATIENTS                                                                                                                                            7-10

    Shivam Tiwari, Atulabh Vajpeyee, Manisha Vajpeyee, Lokendra Bahadur Yadav                 PDF FULL TEXT

ABSTRACT

Background: Stroke being an important health issue, several blood biomarkers of stroke are being evaluated. High sensitivity C-reactive protein (hsCRP), an indicator of inflammation and cell free- DNA (cf-DNA) released from damaged neurons in stroke patients can be helpful to assess stroke prognosis. We planned to assess the role of. Cell free DNA (cf-DNA) and High sensitivity CRP.  Previous studies showed that C-reactive protein (CRP), an inflammatory marker, was associated with stroke severity and long-term outcome. Material & Methods: This study comprised of 154 acute ischemic stroke patients. The plasma (cf-DNA level) was estimated with real-time PCR assay for the β-globin gene (Qiagen- Roter- Gene Q MDX, Germany), while hsCRP was measured by immunoturbidimetric method (Roche Cobas C311, Fully automatic). The clinical assessment was done with National Institutes of Health Stroke Scale (NIHSS) at the time of admission. After a period of three months from the onset of stroke, the modified Rankin scale (MRS) scores were estimated. Results: Elevated levels of cf-DNA and hsCRP were found in patients with higher NIHSS admission score and MRS 3-month scores (p<0.05).  Favorable stroke outcome was consistent with cf-DNA level <10000 kilogenome-equivalents/L or hsCRP <6mg/L (p<0.05). Conclusion: The estimation of Cf-DNA and hsCRP can contribute to the clinical evaluation and optimal management of ischemic stroke patients.
Keywords: Cell-Free DNA, hsCRP, Modified Rankin Scale, Acute Ischemic Stroke, Prognosis.

3.   A COMPARATIVE STUDY: SINGLE DOSE VERSUS MULTIDOSE PROPHYLACTIC ANTIBIOTICS IN                        ELECTIVE INGUINAL HERNIA REPAIR                                                                                                          11-16

      Dr. Ashish Acharya                                                                                                                      PDF FULL TEXT

ABSTRACT

Background: Inguinal hernia repair surgery, a common procedure in general surgery, poses a risk of surgical site infections (SSIs), despite its classification as a "clean" procedure. Antibiotic prophylaxis plays a crucial role in minimizing SSIs. Single-dose prophylactic antibiotics offer simplicity and potential cost savings, while multidose regimens provide extended coverage. This study compares the efficacy and cost-effectiveness of single-dose versus multidose prophylactic antibiotics in elective inguinal hernia repair. Materials and Methods: A prospective, comparative study was conducted over 12 months on 140 patients undergoing elective inguinal hernia repair. Patients were randomly assigned to receive single-dose or multidose antibiotic prophylaxis. Surgical techniques, patient demographics, and post-operative outcomes were meticulously recorded and analyzed. Results: Both groups showed comparable rates of SSIs, with 8.57% in the single-dose group and none in the multidose group. Notably, the single-dose regimen demonstrated significant cost savings compared to the multidose approach. These findings align with previous research and underscore the potential economic advantages of optimized antibiotic utilization in surgical settings. Conclusion: While both single-dose and multidose antibiotic prophylaxis demonstrate comparable efficacy in preventing SSIs after inguinal hernia repair, the single-dose approach offers significant cost advantages. Future studies with larger sample sizes and longer follow-up periods are needed to definitively determine the optimal prophylactic regimen.
Keywords: inguinal hernia repair, antibiotic prophylaxis, single-dose regimen, multidose regimen, surgical site infections, cost

4.   MRI VERSUS ARTHROSCOPIC FINDINGS IN ACL AND MENISCAL INJURIES OF THE KNEE -                                A COMPARATIVE STUDY                                                                                                                             17-21

      Dr. Ankur Jain                                                                                                                              PDF FULL TEXT

ABSTRACT

Background: The knee joint is one of the most commonly injured joints due to its anatomical configuration, susceptibility to external forces, and the functional demands placed upon it. Historically, orthopedic surgeons have relied heavily on clinical assessments to diagnose internal derangements of the knee. However, with the advent of advanced clinical techniques for identifying ligament injuries and cartilage defects, there is a notable scarcity of studies comparing the diagnostic accuracy of magnetic resonance imaging (MRI) and arthroscopy in establishing a conclusive diagnosis.Objective: This prospective research aimed to compare MRI findings with arthroscopic findings in anterior cruciate ligament (ACL) and meniscal injuries of the knee. Methods:  This prospective study enrolled 70 individuals who sustained knee injuries and were admitted to the Department of Orthopedics at our tertiary care hospital from January 2021 to December 2021. Individuals aged 18-60 years with ACL and meniscus injuries who underwent MRI scans and surgery were included in the study. Results: The sensitivity and specificity of MRI in diagnosing ACL tears were 88.66% and 81.45%, respectively. For detecting medial meniscus injuries, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MRI were 93.67%, 87.92%, 89.64%, 81.34%, and 86%, respectively. Similarly, the sensitivity, specificity, PPV, NPV, and accuracy of MRI in detecting lateral meniscus injuries were 74.63%, 86.79%, 71.23%, 87.54%, and 83%, respectively. Conclusion: MRI is a reliable and non-invasive technique for evaluating ligamentous injuries, making it a suitable initial investigative approach for individuals with knee injuries, including ligamentous tears.
Keywords: ACL, meniscal injuries of the knee, MRI, arthroscopy

4.   ASSOCIATION BETWEEN FRAGMENTED QRS AND CORONARY FLOW VELOCITY RESERVE
      IN TYPE 2 DIABETES MELLITUS                                                                                                                22-26

       Dr. Praveen Kothari                                                                                                                    PDF FULL TEXT

ABSTRACT

Background: Coronary microvascular dysfunction (CMD) is a key contributor to cardiovascular risk in diabetes mellitus (DM). The fragmented QRS (fQRS) complex on surface electrocardiogram (ECG) is a marker of myocardial fibrosis and conduction heterogeneity. Its relationship with CMD in asymptomatic diabetic patients remains unexplored.Objective: To investigate the association between the presence of fQRS and coronary microvascular function, assessed by coronary flow velocity reserve (CFVR), in asymptomatic patients with type 2 DM. Methods: This cross-sectional study included 186 asymptomatic patients with type 2 DM and no history of coronary artery disease. All patients underwent resting 12-lead ECG to assess fQRS and transthoracic Doppler echocardiography to measure CFVR in the left anterior descending coronary artery. CMD was defined as CFVR < 2.0. Multivariable linear and logistic regression analyses were performed to determine the independent association of fQRS with CFVR and CMD. Results: Patients with fQRS (n=62, 33.3%) had significantly lower CFVR compared to those without fQRS (1.98 ± 0.41 vs. 2.41 ± 0.52, p < 0.001). The prevalence of CMD (CFVR < 2.0) was significantly higher in the fQRS group (75.8% vs. 29.0%, p < 0.001). After adjustment for age, diabetes duration, HbA1c, hypertension, and left ventricular mass index, the presence of fQRS remained independently associated with a lower CFVR (β = -0.283, p < 0.001) and with 4.2-fold increased odds of CMD (adjusted OR: 4.21, 95% CI: 2.15–8.24, p < 0.001). Conclusion: The presence of fQRS on resting ECG is independently associated with impaired coronary microvascular function in asymptomatic patients with type 2 DM. fQRS may serve as a simple, non-invasive, and inexpensive marker to identify diabetic patients with underlying CMD who are at heightened cardiovascular risk.
Keywords: Fragmented QRS, coronary microvascular dysfunction, coronary flow velocity reserve, diabetes mellitus, electrocardiography, echocardiography.

5.   CORRELATION OF INFECTIOUS TRIGGERS WITH GANGLIOSIDE AUTOANTIBODY PATTERNS IN PATIENTS WITH GUILLAIN-BARRÉ SYNDROME                                                                                          27-33

         Dr Vijay Kataria                                                                                                                         PDF FULL TEXT

ABSTRACT

Background: Guillain-Barré Syndrome (GBS) represents an acute inflammatory polyradiculoneuropathy frequently triggered by antecedent infections. Anti-ganglioside antibodies play a crucial role in disease pathogenesis, yet their relationship with specific infectious triggers remains incompletely understood.Objective: To investigate the correlation between antecedent infections and the development of antibodies against gangliosides and ganglioside complexes in patients with GBS. Methods: A prospective observational study was conducted on 124 patients diagnosed with GBS between January 2019 and December 2020. Serum samples were analyzed for anti-ganglioside antibodies using enzyme-linked immunosorbent assay. Antecedent infections were identified through serological testing and clinical history. Statistical analysis examined correlations between infection types and antibody profiles. Results: Among 124 patients, 89 (71.8%) had identifiable antecedent infections. Campylobacter jejuni was the most common pathogen (38.7%), followed by cytomegalovirus (19.4%) and Epstein-Barr virus (13.7%). Anti-ganglioside antibodies were detected in 76 patients (61.3%). GM1 antibodies showed strong association with C. jejuni infection (p<0.001), while GQ1b antibodies correlated with viral infections (p=0.003). Patients with bacterial infections demonstrated higher antibody titers compared to viral infections (p=0.012). Conclusion: Specific antecedent infections correlate with distinct anti-ganglioside antibody patterns in GBS. C. jejuni infection predominantly triggers GM1 antibodies, while viral infections associate with GQ1b antibodies. These findings enhance understanding of GBS immunopathogenesis and may guide targeted therapeutic approaches.
Keywords: Guillain-Barré syndrome, gangliosides, molecular mimicry, Campylobacter jejuni, autoantibodies

6.  RECOVERY OF SKELETAL MUSCLE MASS AFTER CURATIVE ADRENALECTOMY IN PATIENTS WITH                 PHEOCHROMOCYTOMA AND PARAGANGLIOMA                                                                                34-40
 
         Dr Akhil Joshi                                                                                                                          PDF FULL TEXT

ABSTRACT

Background: Pheochromocytoma and paraganglioma (PPGL) are catecholamine-secreting tumors associated with a hypercatabolic state. While weight loss is a recognized feature, quantitative data on specific changes in body composition, particularly skeletal muscle mass (SMM), are scarce. Objective: To investigate the change in skeletal muscle mass in patients with PPGL before and after curative adrenalectomy. Methods: This retrospective study included 38 patients with PPGL who underwent curative surgery at our tertiary care center. Skeletal muscle index (SMI, cm²/m²) was calculated from abdominal computed tomography (CT) scans at the level of the third lumbar vertebra (L3) obtained during diagnostic workup (preoperative) and during follow-up (6-18 months postoperatively). Clinical and biochemical data were collected from medical records. Results: Preoperatively, patients had a low mean SMI. A significant increase in SMI was observed postoperatively (42.1 ± 6.8 cm²/m² vs. 47.8 ± 7.1 cm²/m², p < 0.001), representing an average gain of 13.5%. Preoperative SMI was inversely correlated with 24-hour urinary normetanephrine levels (r = -0.52, p = 0.001). Patients with higher preoperative catecholamine levels experienced a more pronounced muscle gain post-surgery. No significant correlation was found with age or tumor size. Conclusion: Patients with PPGL exhibit significant skeletal muscle wasting, which is strongly correlated with the intensity of catecholamine excess. Curative surgery leads to a substantial recovery of muscle mass. Assessment of body composition via CT should be considered in the management of these patients to guide nutritional and rehabilitative interventions.
Keywords: Pheochromocytoma, paraganglioma, skeletal muscle mass, catecholamines, adrenalectomy.

7.  PROPOFOL AND ETOMIDATE FOR INDUCTION OF ANAESTHESIA IN DILATATION AND CURETTAGE –               A RANDOMISED CONTROLLED TRIAL                                                                                                 41-47
          
         Dr Neha Sharma                                                                                                                 PDF FULL TEXT

ABSTRACT

Background: Dilatation and curettage (D&C) for first trimester abortion is a commonly performed outpatient surgical procedure within obstetric practice. Propofol, an alkyl derivative, is widely utilized intravenous anesthetic for induction in outpatient surgery.Aims- To Evaluate safety and efficacy with propofol and etomidate for induction of Anaesthesia in dilatation and curettage.Methods: This double-blind study involved 70 female participants, aged between 20 and 50 years, who were 6 to 8 weeks pregnant and classified as American Society of Anesthesiologists (ASA) physical status I and II. The patients were randomly assigned to two groups, each consisting of 35 patients. Group PF was administered propofol at 2 mg/kg along with fenanyl at 1 mcg/kg, also totaling 2 ml for anesthesia, while Group EF received etomidate at 0.2 mg/kg along with the same dose of the opioids. Results: Both the induction agents maintained hemodynamic stability during anesthesia for D&C, despite a significant reduction in arterial pressure observed in the group PF, although this difference was not clinically significant. No significant changes in recovery times (from eye opening on verbal commands to the time at patient achieved MAS 9) were observed in both the groups (p >0.05). There was no significant difference in the incidence of side effects like myocardial infarction (PONV) between the two groups. Conclusions: Both propofol and etomidate are effective in induction of anesthesia; however, Etomidate demonstrates superior hemodynamic stabilization and a reduced incidence of injection pain.
Keywords: Propofol , Etomidate, Dilatation and curettage