Knowledge, anxiety levels and attitudes of infertile couples towards COVID-19 and its impact on self-funded fertility treatment : a cross-sectional questionnaire survey

Acknowledgement We thank the couples who were willing to participate in the study. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.Peer reviewedPublisher PD

Effect of head pillow and shoulder roll on diameter of the right internal jugular vein

Background: Right internal jugular vein (RIJV) is the most commonly used site for central venous cannulation. Ultrasound guidance has increased success rate and reduced complications of central venous cannulation. The main aim before cannulation is to increase the size of the vein by optimal positioning. We used ultrasound to assess changes in right internal jugular diameter with use of a head pillow and shoulder roll and their effect on the degree of overlap between RIJV and carotid. Methodology: 106 patients were recruited in the study. After intubation the patients were placed in the following 3 positions (i) P1 -without head pillow or shoulder roll, (ii) P2 - with head pillow and (iii) P3- with shoulder roll. All measurements were made in 15 degree Trendelenberg tilt and head turned to the left by 30 degree. The following measurements were recorded in all 3 positions. (a) Transverse and Antero-Posterior diameter of the RIJV. (b) Transverse diameter of the right carotid. (c) Overlap between RIJV and carotid. Results: In our study the mean transverse diameter of RIJV was 1.87cm in P1 and P2 and 1.72 cm in P3respectively. The mean antero-posterior diameter was 1.39cm, 1.37cm and 1.13 cm in P1, P2 and P3 respectively. The increase in diameter in P1 was statistically significant (P < 0.001). The mean overlap percentage between right carotid and RIJV was 49.41%, 50.97% and 35.7% in P1, P2 and P3 respectively. This difference between P3 and other two position was also statistically significant (P < 0.00). Conclusion: We conclude that placing the patient supine in 15 degree Trendelenberg tilt and a30 degree head rotation to the opposite side with or without use of a head pillow would lead to greater chance of first pass success during R IJV cannulation as the diameter was found to be maximum in this position. We do not recommend use of a shoulder roll as there was significant reduction in diameter though the overlap between RIJV and carotid was found to be minimal. Use of ultrasound and proper positioning of the patient will reduce the possible catastrophic complications associated with RIJV cannulation

Comparing the efficacy of aprepitant and ondansetron for the prevention of postoperative nausea and vomiting (PONV): A double blinded, randomised control trial in patients undergoing breast and thyroid surgeries

Background and Aims: Aprepitant, a Neurokinin-1 receptor antagonist, has been evaluated in abdominal and neurosurgeries, but its effect is less clear in breast and thyroid surgeries, which are also known to be high risk for post-operative nausea and vomiting (PONV). This study was done to compare the antiemetic efficacy of ondansetron and aprepitant in women undergoing mastectomy and thyroidectomy. Methods: One hundred and twenty-five ASA I and II, female patients, aged between 18 and 65 years were randomly assigned into Group I (ondansetron group, n = 62) or Group II (aprepitant group, n = 63), by computer-generated random sequencing. Per protocol analysis was done to assess the incidence and severity of PONV, use of rescue antiemetics, and patient satisfaction with PONV control between the two groups, till 24 h post-surgery. Results: In the immediate postoperative period, 79.7% of patients in Group I and 85.2% in Group II were free of emesis (P value: 0.49). In Group I, the first episode of vomiting occurred within a median duration 90 min (IQR 2575: 45-147) postoperatively, whereas the median duration in Group II was 160 min (IQR 25-75: 26-490), with request for rescue antiemetic at 60 min in Group I (IQR 25-75: 27-360) and 147 min in Group II (IQR 25-75: 11-457). Conclusion: A single dose of oral aprepitant has comparable effects to injection ondansetron administered eighth hourly in preventing PONV, the severity of nausea, number of rescue antiemetics, and the time to first emetic episode in the 24-h postoperative period. CTRI Reg No: REF/2017/06/014637

Can the imaging manifestations of melioidosis prognosticate the clinical outcome? A 6-year retrospective study

Abstract Objective Melioidosis being an important cause of community-acquired sepsis, caused by Burkholderia pseudomallei in the tropical and subtropical countries, is often underreported or misinterpreted on imaging investigations. We aim to describe the spectrum of imaging manifestations of melioidosis and to evaluate its role in prognosticating clinical outcome, and look for association of specific organ involvement with risk factors. Methods From January 2011 to October 2017, retrospective analysis of imaging investigations of 189 consecutive patients with culture-proven melioidosis was performed. Clinical and demographic records were collected from the hospital medical records. Results Out of 67% with a localised disease musculoskeletal involvement was most common, whereas the common organs involved in disseminated infections were the lungs, spleen, liver and genitourinary tract in descending order. Twenty percent suffered unfavourable outcome with a mortality rate of 8.5%. The lung involvement was associated with unfavourable outcome (OR 3.2 [95%CI 1.54–6.63] p = 0.002). The lymph node involvement (OR 0.22 [95% CI 0.05–0.95] p = 0.04) predicted a favourable outcome. Those with diabetes were at a higher risk of splenic (OR 3.05 [95% CI 1.62–5.77]; p = 0.001) and musculoskeletal involvement (OR 2.14 [95% CI 1.09–4.17] p = 0.03) of melioidosis. Conclusions In this study, we have described the spectrum of imaging manifestation of melioidosis and evaluated its association with clinical outcome. Respiratory system involvement in melioidosis showed significant association with unfavourable outcome. Diabetes mellitus, a common risk factor for melioidosis, is more prone for infection of the spleen and musculoskeletal system. Thus awareness of imaging manifestations of melioidosis can complement microbiological diagnostic tests for accurate early diagnosis and management

Definitive Surgery after Neoadjuvant Chemotherapy for Locally Advanced Oral Cavity Cancers: Experience from a Tertiary Care Center

Abstract Mansi Agrawal Vidya Konduru Background Oral cavity cancers require definitive surgical resection as the primary treatment, but with advanced T stage, complete resection with pathologically negative margins might be difficult to achieve. Induction chemotherapy helps achieve the balance between resection and morbidity in locally advanced technically unresectable tumors. Aim The aim of this study was to analyze the impact of surgery in locally advanced, technically unresectable oral cavity cancers after neoadjuvant chemotherapy (NACT). Materials and Methods A retrospective analysis of patients with borderline resectable, locally advanced oral cavity cancers who were given NACT between February 2017 and December 2021 was conducted. Data regarding clinical and pathological characteristics, NACT, surgery, adjuvant therapy, and recurrences was analyzed. Results Of the 69 patients in the study, 69.6% had tongue cancer, rest were gingivobuccal complex cancers. All tumors were resected based on the post-NACT tumor volume and clear margins were achieved in 42% of cases. About 85.4% of the tongue cancers required a lesser resection than anticipated, thereby following the concept of organ and functional preservation post-NACT as proposed by Licitra et al. About 30.4% had ypT0 and 17.4% had ypN0. Recurrence and survival rates noted in our study were comparable to those reported in literature. Lymph node density of more than or equal to 0.07 was found in all recurrent cases. Conclusions Induction chemotherapy offers a chance of achieving adequate surgical resection while reducing morbidity and improving functional outcomes for patients with technically unresectable oral cavity cancers. Nodal disease may not respond to chemotherapy as well as the primary tumor. There is a need for comprehensive evaluation of prognostic factors, which could help identify the patients who will most benefit with NACT

Psychiatric presentations and factors associated with suspected organicity in elderly attending a tertiary care facility in South India

Objectives: The objectives were to determine the proportion of elderly among the new psychiatry outpatient attendees, identify their sociodemographic profile and clinical presentations, and determine risk factors associated with suspected organic conditions in patients presenting with acute onset and chronic presentations. Methodology: This retrospective cross-sectional study focused on the elderly presenting with psychiatric symptoms to a psychiatric setting. The onset of symptoms at presentation was divided into acute and chronic conditions. Clinical symptom clusters and the risk factors associated with organic conditions were identified. The Chi-square and Fisher's exact test were used to find an association between factors and outcome (organic/functional). Results: Elderly seeking consultation constituted < 10% of total new case registration. Acute onset was seen in one-third and chronic presentation constituted nearly two-thirds of the group. The common clinical presentations with acute onset were acute psychosis, altered sensorium, and psychosis due to an organic etiology. The most common clinical presentation with chronic course was chronic psychosis. Nearly 40% had suspected organicity. Increasing age, structural abnormality in brain imaging, and the presence of stressors were risk factors for the onset of psychiatric presentation in the elderly (P = 0.001). Conclusion: Early detection of the clinical syndrome, identification of organic conditions, and appropriate and prompt referral to the general physician should be the rule for the care of the elderly presenting to a psychiatric facility

Association of serum 25-Hydroxy vitamin D with total and regional adiposity and cardiometabolic traits.

BackgroundLower serum 25-hydroxyvitamin D [25(OH)D] is associated with greater adiposity and adverse cardiometabolic risk profile. The evidence is inconsistent among South Asian Indians. We aimed to examine associations between 25(OH)D and cardiovascular (CVD) risk markers in a rural and urban cohort from South India.Subjects/methodsIn this cross sectional study, 373 individuals (men, n = 205) underwent detailed CVD risk marker assessment including anthropometry [body mass index (BMI), waist, (WC) and hip circumferences (HC)], body composition analysis using dual energy x-ray absorptiometry (DXA), blood pressure and biochemical analysis (glucose, insulin and lipids). The distribution of CVD risk factors were compared across serum 25(OH)D levels, stratified as deficiency (ResultsThe mean and standard deviation (SD) of age, BMI and 25(OH)D levels were 41.4 (1.1) years, 25.5 (4.8) kg/m2 and 23.4 (10.4) ng/ml respectively. The prevalence of 25(OH)D deficiency was 39.9% in this cohort. Individuals in the 25(OH)D deficiency category had significantly higher mean (SD) BMI [26.6 (5.1) kg/m2], waist circumference [89.9 (12.5) cm] and total fat mass [20.6 (7.9) kg] compared with the Vitamin D sufficient group [BMI: 24.0 (4.4); WC 84.7 (12.0); total fat mass: 15.2 (6.8)]. Significantly inverse associations were observed with DXA measured total and regional fat depots with 25(OH)D levels, while anthropometric indices of adiposity showed significant inverse association only in women. After adjusting for total fat mass, no significant associations were observed between 25(OH)D and the cardiometabolic traits.ConclusionsOur results confirm that lower 25(OH)D is independently associated with both total and regional adiposity, but not with cardiometabolic traits, in this population

Evaluation of deoxyribonucleic acid damage using neutral comet assay for high radiation doses: A feasibility study

Purpose: This study aims to investigate the use of the neutral comet assay to assess deoxyribonucleic acid (DNA) damage in lymphocytes exposed to high doses of radiation. Materials and Methods: The research was conducted by obtaining informed consent, after which blood samples were taken from seven healthy individuals and this study was approved by the institutional ethics committee. At first, for the determination of dose-effect curves, samples obtained from the first five individuals were irradiated for doses ranging from 0 to 35 Gy after which they were processed under neutral comet assay. In order to verify the determined dose-effect curves, a test dose of 15 Gy was delivered to the samples obtained from the sixth and seventh individuals. The amount of DNA damage from the obtained comet assay images was analyzed using four comet assay parameters namely % tail DNA, tail length, tail moment (TM), and Olive TM (OTM). The most suitable comet assay parameter was evaluated based on the obtained dose-effect curves. Furthermore, the distribution of individual cells for each dose point was evaluated for all the four comet assay parameters to find the optimal parameter. Results: From our results, it was found that from 0 to 25 Gy all the four comet assay parameters fit well into a linear quadratic curve and above 25 Gy saturation was observed. Based on the individual cell distribution data, it was found that % tail DNA could be an optimal choice to evaluate DNA damage while using neutral comet assay for high-dose ionizing radiation. Conclusion: The neutral comet assay could be a potential tool to assess DNA damage from high doses of ionizing radiation greater than 5 Gy

Can clinical parameters at admission predict severity and intensive care unit mortality outcomes in patients with COVID-19?

Background: COVID-19 acute respiratory distress syndrome (ARDS) is associated with high morbidity and mortality. Identification of clinical prognostic factors at admission is crucial in the triage and therapeutic selection of patients in resource-poor settings. The study was done to identify clinical parameters at admission to prognosticate patients who required intensive care unit (ICU) admission. Methods: In this retrospective study, the clinical parameters and outcomes of critically ill patients admitted from a single medical unit during the second wave of COVID-19 were studied. Patients were categorized as survivors and nonsurvivors. Factors associated with mortality were explored using Fisher's exact and t-test as appropriate. Results: The study population included 62 patients with a male: female ratio of 43 (69.3%):19 (30.7%) with a mean (standard deviation [SD]) age of 50.97 (±9.9) years. The mean (SD) O2 saturation was 82% (±10%) and median (interquartile range) PaO2/FiO2 ratio was 161 (89–214) on arrival to the emergency department. Forty-two (66%) required mechanical ventilation and the mean (SD) duration of hospital stay was 20 (±15) days. Thirty-six patients died, and the overall mortality was 58.1%. Increasing age, low SpO2 at presentation to the hospital, and need for mechanical ventilation were noted to be independent predictors of mortality with an odds ratio of 5.1 (95% confidence interval) (1.61–16.2) (P = 0.006) and 25 (3.70–180.19) (P = 0.001), respectively. Admission respiratory rate >36/min (P = 0.009) and SpO2 ≤83% (P = 0.001) were predictive of increased mortality among ICU patients. Conclusion: Low SpO2 at presentation (36/min), and requirement of mechanical ventilation were strong predictors of mortality in patients admitted to ICU with COVID-19 ARDS

Patterns of Renal Dysfunction and Profile of Kidney Biopsies in Hematopoietic Stem Cell Transplant Recipients

Introduction: Post hematopoietic stem cell transplant (HSCT), kidney can be subjected to injury by various causes. Of these, graft versus host disease (GvHD) affecting the kidney is an under-recognized entity with no clear guidelines on its diagnosis, clinicopathological manifestations, and outcomes. Material and Methods: Out of 2,930 patients who underwent HSCT at our center between 2005 and 2020, kidney biopsy was performed in 19 allogenic and 5 autologous recipients. Results: The mean age of the cohort at transplant was 33.2 ± 7 years, and 15 (62%) were males. Median time to kidney biopsy from HSCT was 14 (IQR, 9–30) months. Aplastic anemia was the most common underlying hematological disease (54.2%). All 19 allogenic recipients were classified based on clinicopathological manifestations into either thrombotic microangiopathy (TMA, 12/19 [63%]) or nephrotic syndrome (NS, 7/19 [37%]) pattern. Glomerular tuft “mesangiolysis” was the dominant pattern of injury noted in 9/12 cases of TMA pattern. There was a predominance of acute microangiopathic changes restricted primarily to the glomerular compartment. Of the 7 patients with NS pattern, membranous nephropathy was seen in 4 (57%) and minimal change disease in 3 (43%) patients. Thirty-nine percent (7/18) stained positive for C4d which was predominantly glomerular. Allogenic recipients who did not receive immunosuppression (IS) for renal disease had a lower eGFR at biopsy, a longer latency between withdrawal of GvHD prophylaxis and biopsy, and were significantly at a higher risk of kidney failure (IS: 2/11, 18.1% vs. no IS: 2/6, 33.3%, p = 0.04). “Associated extra-renal GvHD” occurred in 11/19 (57.9%) allogenic recipients. Patients with “associated extra-renal GvHD” had significantly more deaths (6/11, 60% vs. 0, p = 0.02) but comparable renal outcomes. Conclusion: Renal GvHD can present with or without “associated extra-renal GvHD” after a prolonged period of withdrawal of GvHD prophylaxis, requiring careful diagnostic vigilance and consideration of IS