Indira Gandhi Government Medical College & Hospital
Recent publications
Rationale Early mortality in intracerebral haemorrhage (ICH) is due to haematoma volume (HV) expansion and there are no effective treatments available other than reduction in blood pressure. Tranexamic acid (TXA) a hemostatic drug which is widely available and safe can be a cost-effective treatment for ICH, if proven efficacious. Hypothesis Administration of TXA in ICH patients when given within 4.5 hours of symptom onset will reduce early mortality at 30 days. Design Indian Trial of Tranexamic acid in Spontaneous Intracerebral Haemorrhage (INTRINSIC Trial) is a multicenter, randomized, open-label, trial enrolling patients aged more than 18 years presenting with non-traumatic ICH within 4.5 hours of symptom onset or when last seen well. Study participants receive 2 grams of TXA administered within 45 minutes while control group receives standard of care. Intensive blood pressure reduction as per INTERACT 2 protocol is followed in done in both groups. Study plans to recruit 3400 patients. Primary outcome is mortality at day 30. Secondary outcomes are radiological reduction of HV at 24 hours from baseline, neurological impairment at day 7 or earlier (if discharged), and assessments of dependency and quality of life at day 90. Summary If proven to be beneficial, TXA will have a major impact on medical management of ICH. Trial registration Clinical Trial Registry India (CTRI/2023/03/050224) and Clinical Trials.gov (NCT05836831)
Gestational trophoblastic disease is a group of pregnancy-related trophoblastic tumours. Gestational trophoblastic neoplasia refers to its invasive and malignant forms: invasive mole, choriocarcinoma, placental site trophoblastic tumour and epithelioid trophoblastic tumour. Patients exhibit elevated beta human chorionic gonadotropin (β hCG) levels, sometimes exceeding 100 000 mIU/mL. When the serum levels of hCG surpass 500 000 mIU/mL, there is a possibility of encountering a phenomenon called ‘hook effect’ which causes erroneously low or negative value when using the immunometric hCG assays that are presently available in the commercial market. We present a rare case involving a female in mid-30s with an invasive molar pregnancy presenting with bleeding, an abdominal mass, hypertension and hyperthyroidism. Despite a negative urine β hCG test, her serum hCG, after dilution, was recalculated to over 850 000 mIU/mL. MRI confirmed invasive mole. Post-hysterectomy, she received methotrexate chemotherapy. Her β hCG normalised after two cycles, and she remains disease-free for 14 months.
Objective The present study aimed to evaluate the phase transformation behavior and elemental analysis of thermomechanical-treated nickel–titanium (NiTi) rotary instruments, TruNatomy (Dentsply Sirona), HyFlex CM (coltene, Whaledent), and Neoendo Flex (Orikam healthcare India), using differential scanning calorimetry (DSC), X-ray diffraction (XRD), and energy dispersive X-ray spectrometry. Materials and Methods A total of 18 NiTi rotary instruments, TruNatomy, Hyflex CM, Neoendo Flex, taper. 04, size 25 (except TruNatomy, size 26) were selected and were divided into three groups ( n = 6). Three NiTi files from each group were investigated for the DSC test ( n = 3). The two segments of each sample were cut carefully by slow-speed water-cooling carborundum disc at 3 mm from the tip and then 4 mm from the previous section. The mass of the samples was measured on the electronic balance and samples that weighed 10–15 mg were loaded into a 40 µL aluminum crucible. The samples are then subjected first to a heating cycle from 0°C to 100°C and subsequently a cooling cycle from 100°C to 0°C in the differential scanning calorimeter (Mettler-Toledo, NIT Srinagar) at a rate of 10°C min ⁻¹ . XRD (Make. Rigaku Japan, smart lab 3kW, NIT Srinagar.) was performed to verify the DSC results. The remaining two samples from each group ( n = 2) were subjected to XRD analysis. The sample preparation for XRD analyses was done precisely with slow speed water cooled carborundum disc and samples were sectioned into three segments. Each segment was 5 mm long and grounded to obtain a uniform smooth plane. The data obtained from DSC and XRD were subjected to origin 8.5 software and graphs were obtained that depict the transformation temperature and phase composition, respectively. Alloy distribution and trace elements of the NiTi rotary instruments were done using energy dispersive spectrometry microanalysis. Results The DSC results showed that the TruNatomy, Hyflex CM, and Neo Endo instruments had an Austenite finish (Af) temperature exceeding 37°C. The XRD graphs show the different intensity peaks that correspond to the various phases of NiTi rotary instruments. The TruNatomy is predominantly Austenite, Hyflex CM exists mainly in R-phase with a variable amount of austenite and martensite, while Neoendo flex endo mostly contains austenite phase. The elemental analysis revealed that all three file systems show Nickel and Titanium within their bulk structure in an equiatomic ratio. Conclusion This study concluded that TruNatomy is predominantly martensite with a variable amount of austenite phase. There are differences in thermal transition temperature between the files.
Objective The objective of our study was to determine the prevalence of anemia among 14-19 years school going girls, risk factors for it and profile of micronutrient status among rural girls from western state of India. Design Using a cross-sectional design, we obtained information on socio-demography, menstruation, dietary habits, knowledge and daily consumption of the government recommended iron and folic acid (IFA) tablets, and anthropometry. Blood was collected to assess haemoglobin, red blood cell indices, serum iron, folate and vitamin B 12 levels. Settings Nagpur district, Maharashtra, India Participants A total of 221 girls aged 14-19 years studying in 24 government institutes included. Results 57% girls were anaemic, 84% had deficiency of one or more micronutrients and 60% were malnourished based on Body Mass Index (BMI). The prevalence of iron, vitamin B 12 and folate deficiency was 37.7%, 69.8% and 1.4% respectively. Among anaemic girls, iron and vitamin B 12 deficiency was observed in 45.5% and 67.5% respectively, vs. among non-anaemic girls it was 27% and 73% respectively. Iron deficiency was a predictor of anaemia and its severity. Girls residing in non-nuclear family were more likely to have anaemia. The consumption of daily non-vegetarian food and green leafy vegetables was 3% and 3.6% respectively. Only 9% consumed IFA tablets in the past two weeks. Conclusions Anemia is common in adolescent girls, particularly associated with iron and vitamin B12 deficiency. There is need to reconsider the approach to prevention of anaemia in adolescent girls, particularly before they become pregnant.
With increasing number of patients with residual hearing being implanted, there is a renewed interest in round window (RW) as the preferred route for electrode insertion to reduce intracochlear trauma. The degree of round window membrane (RWM) visibility and its orientation might hamper the accessibility of RW for electrode insertion. This study is an attempt to identify the various factors affecting the accessibility of RW for electrode insertion. 30 children fulfilling the CI candidacy criteria were recruited for the study. All the surgeries were performed by the standard posterior tympanotomy technique. Round window membrane (RWM) visibility was graded into four types from grade I to grade IV. The membrane visibility was assessed prior to niche drilling. Grade III RW was the most common type. RW insertion could be achieved in 66.7% cases, while extended RW was performed in 33.3% cases. Bony cochleostomy was not required in any of the cases. There was no significant association between grade of RWM visibility and the route of electrode insertion. RW insertion could be achieved in most cases with normal cochlear anatomy. We observed that the grades of RWM visibility did not affect the route of electrode insertion. RW insertion can be performed in a manner that is potentially less traumatic by following the surgical steps meticulously. Both RWM visualization and insertion angle can be improved with careful bone removal in RW niche region making the round window a viable option, when minimizing insertion trauma in patients.
Introduction Osteomyelitis as a condition in adolescents is difficult to diagnose as it is. In patients with sickle cell disease, the diagnosis is even more difficult due to the occurrence of Vaso occlusive crisis which being the most common acute clinical manifestation of sickle cell disease in bone may mimic osteomyelitis. No single clinical presentation, laboratory result, or imaging finding can definitively distinguish these diagnoses. Case Report A 15-year-old female presented to the outpatient department with mild pain and swelling in both forearms persisting for the past 3 months. Radiographs revealed predominantly diaphyseal expansile osteolytic lesions in the bilateral distal third radius with periosteal reaction along with a small radiolucent area in the right distal radius. She was subsequently admitted for further assessment. On the 3rd day of admission, pus pointing was noted on the volar aspect of the right forearm while the left side only had bony swelling. Surgical intervention (debridement with saucerization) was performed on both sides. Pus culture (collected intraoperatively) showed Serratia marcescens as the causative organism. Culture-sensitive antibiotics were administered intravenously for 3 weeks followed by oral antibiotics for 3 weeks. At 1-year follow-up near complete resolution of bony lesions with full range of motion in both upper limbs was noted. Conclusion Subacute osteomyelitis may present with just bony swelling without significant pain or fever and can present a diagnostic dilemma, a high index of suspicion is important to rule out other conditions and diagnose osteomyelitis in such cases. Unusual organisms like Serratia can cause osteomyelitis in immunodeficient patients like those with sickle cell disease. Appropriate management in the form of thorough surgical debridement, saucerization, and appropriate antibiotics can lead to complete resolution of the infection with good clinical results.
BACKGROUND There are conflicting data in the literature about the influence of diabetes on clinical outcomes and death in critically ill patients. Thus, we assessed the effect of diabetes on mortality rate and other outcomes in critically ill patients admitted to the intensive care unit (ICU). MATERIALS AND METHODS This prospective case–control was conducted in the ICU of a tertiary care institute. Adult critically ill diabetics (cases, n = 46) and nondiabetic patients (controls, n = 85) were included in this study. Both the groups were compared regarding mortality rate, length of ICU stay, as well as the need for mechanical ventilation (MV) and inotropic/vasopressor supports. RESULTS The groups did not differ significantly regarding age ( P = 0.087), sex ( P = 0.568), and vital parameters ( P > 0.05). The groups were comparable regarding Glasgow Coma Scale ( P = 0.882), Acute Physiology and Chronic Health Evaluation II (APACHE II) score ( P = 0.774), and laboratory parameters ( P > 0.05), except significantly greater proportion of diabetic patients had plasma glucose >200 mg/dL ( P < 0.0001) and serum HCO 3 <18 mEq/L ( P = 0.038) relative to nondiabetic patients. The groups did not differ significantly in need of MV ( P = 0.413), or vasopressor support ( P = 0.590), development of AKI ( P = 0.424), and length of ICU stay of 0–3 days ( P = 0.300). Around a quarter of diabetic (26.09%) and nondiabetic patients (23.53%) were nonsurvivors ( P = 0.745). Assessment of mortality according to the age groups, indication of admission, plasma glucose levels, and APACHE II score suggested no significant difference between the groups (all P > 0.05). CONCLUSION In critically ill patients, the presence of diabetes does not affect outcomes, including the need for MV or vasopressor support, development of AKI, length of ICU stay, and mortality.
Artificial Intelligence (AI) is a technology that allows computers to replicate human behaviour and outperform human decision-making in solving complex tasks, either independently or with minimal human involvement. AI technologies, including machine learning and deep neural networks, significantly enhance the accuracy and efficiency of analyzing dental evidence, such as radiographs and bite marks, facilitating reliable identification of individuals, even in complex cases like mass disasters or decomposed remains. Additionally, AI aids in estimating age and determining sex by analyzing dental and skeletal features. The automation of image analysis tasks reduces human error and accelerates identification processes. Furthermore, AI supports the creation of 3D models for facial reconstruction, improving investigative efforts to visualize unidentified remains. Overall, the integration of AI in forensic odontology enhances investigative capabilities, providing valuable tools for law enforcement and contributing to the pursuit of justice. This review article explores the transformative role of Artificial Intelligence (AI) in forensic odontology, highlighting its applications in dental identification, age and sex estimation, bite mark analysis, facial reconstruction, and dental databases
Introduction and importance Severe preeclampsia is a medical condition that affects women during the last two trimesters of pregnancy. Hemorrhagic hepatic infarction is a hepatic complication and is rarely encountered in women with severe preeclampsia. This case report aims to present the characteristics of hemorrhagic hepatic infarction in a pregnant woman with severe preeclampsia. Case presentation A 27-year-old pregnant woman with a 30-week gestation of amenorrhea was admitted with a blood pressure of 160/100 millimeters of Mercury (mm Hg), headaches, dizziness and oedema in the lower limbs. Clinical discussion These complaints with clinical and paraclinical examinations led to the diagnosis of severe preeclampsia and she underwent an emergency cesarean section but 6 hours later, she presented with hypovolemic shock and this led to a new surgery. A surgery which made it possible to develop or discover a diffuse hepatic infarction with hemorrhagic infiltration of the gallbladder and the falciform ligament without active bleeding in the liver. Emergency management of preeclampsia was adopted and the postoperative course was simple with a good clinical outcome when the patient was discharged. Conclusion Severe preeclampsia and hemorrhagic hepatic infarction are complications of pregnancy which require emergency treatment and above all these medical conditions require the termination of the pregnancy.
Oral cancer (OC) is the most common forms of head and neck cancer. Even with advancing research it still continues to have lowest survival rate globally. Histopathologiy still remains the gold standard for oral cancer diagnosis. But, it has few drawbacks being prone to errors (variability) and is time consuming leading to delay in diagnosis. In order to overcome these pitfalls there is a need for alternative diagnostic approaches which are faster and accurate at the same time. Considerable efforts have been focused on exploring the role of artificial intelligence (AI) in medical diagnostics in recent times. The role of AI in medical imaging and diagnosis seems promising. Key benefit of AI is better accuracy, rapid diagnosis and reduced manual visualization of slides. This review article focuses on the role of AI in oral cancer detection with emphasis on machine learning and deep learning methods, decision support systems. Future challenges, benefits and limitations of AI have also been discussed.
Anterior uveitis is one of the most prevalent forms of ocular inflammation caused by infections, trauma, and other idiopathic conditions if not treated properly, it can cause complete blindness. Therefore, this study aimed to formulate and evaluate dexamethasone sodium phosphate (DSP) loaded polyelectrolyte complex (PEC) nanoparticles (NPs) for the treatment of anterior uveitis. DSP-loaded PEC-NPs were formed through complex coacervation by mixing low molecular weight chitosan and the anionic polymer carboxy methyl cellulose (CMC). The formulations were optimized using Box–Behnken design and evaluated the effect of independent variables: Chitosan concentration, CMC concentration, and pH of chitosan solution on the dependent variables: particle size (PS), Polydispersity Index (PDI), pH of the formulation, and % entrapment efficacy (%EE). The PS, PDI, zeta potential, and pH of the optimized formulation were found 451 ± 82.0995 nm, 0.3807 ± 0.1862, +20.33 ± 1.04 mV and 6.8367 ± 0.0737 respectively. The %EE and drug loading of formulation were 61.66 ± 4.2914% and 21.442 ± 1.814% respectively. In vitro drug release studies of optimized formulation showed the prolonged release up to 12 h whereas, the marketed formulation showed the burst release 85.625 ± 4.3062% in 1 h and 98.1462 ± 3.0921% at 6 h, respectively. Fourier transform infrared studies suggested the effective incorporation of the drug into the PEC-NPs formulation whereas differential scanning calorimetry and x-ray diffraction studies showed the amorphized nature of the drug in the formulation. Transmission electron microscopy study showed self-assembled, nearly spherical, core–shell nanostructures. The corneal permeation study showed higher permeation of the drug from PEC-NPs compared to the marketed formulation. Hen’s Eggs test-Chorioallantoic Membrane test of the optimized formulation revealed non-irritant and safe for ocular administration. Therefore, DSP-loaded PEC-NPs are an effective substitute for conventional eye drops due to their ability to increase bioavailability through longer precorneal retention duration and sustained drug release.
Introduction: The term “superior shoulder suspension complex (SSSC)” coined by Goss is a bone and soft tissue stable ring made up of clavicular-acromioclavicular strut, the three-process scapular body and the clavicular-coracoclavicular ligamentous-coracoid (C-4) linkage. Disruption at any one site of the SSSC complex makes the other site unstable in a vicious cycle altering the functional anatomy and muscular forces resulting in a “floating shoulder injury” (FSI). The purpose of this study is to evaluate the functional outcome after open reduction and internal fixation of both clavicle and scapula in FSI using Herscovici and American shoulder and Elbow score (ASES) scores. Materials and Methods: This is a prospective study conducted at level 1 trauma care center in India from May 2019 to May 2023 in 18 cases of unstable FSI. All the cases were followed up post-operatively for a period of 18 months. Results: All the injuries were high energy motor vehicular accidents. Fracture union was seen in all cases with mean period of 13.55 weeks for clavicle and 8.5 weeks for scapula on plain radiographs. 72.22% of the patients had an excellent to good functional outcome assessed by Herscovici scoring system and 61% had an ASES score between 50 and 100. No patient had any adverse complication which precluded their return to their daily activities. Conclusion: Early open reduction and internal fixation of significantly displaced unstable FSIs allows early rehabilitation and better functional outcome. Keywords: Floating shoulder injury, surgical fixation, clavicle fracture, spinal pillar fractures.
This study aimed to evaluate the effectiveness and safety of laparoscopic intraperitoneal onlay mesh plus (IPOM plus) repair for ventral hernia. Conducted at a tertiary care hospital between March 2022 and August 2024, it included 50 patients who underwent IPOM plus repair. The research focused on the patients' demographic and clinical characteristics, operative details, outcomes, and complications. Among the 50 patients, most (36%) were between 31 and 40 years old, with a female majority (64%). Primary ventral hernias were more common (70%) compared to incisional hernias (30%). Many patients had signicant co-morbidities, with diabetes (36%) and hypertension (24%) being the most prevalent. The study also noted that most hernias were between 2-5 cm in size. The surgical procedure had a mean operative time of 85.34 minutes, which indicates a reasonable duration for laparoscopic intervention. Only 6% of patients experienced intraoperative complications, showcasing the safety prole of the procedure. Postoperatively, most patients (92%) were discharged within 2-4 days, highlighting the potential for a faster recovery compared to traditional open surgery. However, some postoperative complications were observed. About 18% of patients experienced issues such as subacute intestinal obstruction, port site infections, and seroma formation. Despite these complications, the overall outcomes were favorable, with no mortality reported and a low recurrence rate during the follow-up period. The study concludes that IPOM+ repair is an effective and safe technique for ventral hernia repair. It offers several advantages, including reduced recurrence, faster recovery, and fewer complications compared to traditional open repair methods. These results suggest that IPOM+ is a viable alternative for ventral hernia surgery, particularly for patients seeking minimally invasive options with favorable outcomes.
Aggressive angiomyxoma (AAM) is a rare, slow-growing, benign neoplasm with high recurrence and local invasion. It is usually asymptomatic and frequently presents as a mass affecting the perineal and pelvic regions of women in reproductive age group. We present a rare case of a 34-year-old woman with second recurrence of a giant AAM arising from labia majora. The patient presented with a slow-growing pedunculated mass (around 20 × 12 cm) over the right labia majora for the past 1 year. In the last 10 years, she was operated on two different occasions (2013 and 2015) for similar lesion and was a confirmed case of AAM. Ultrasound of the lesion and magnetic resonance imaging of the abdominopelvic region was suggestive of recurrent AAM. The patient underwent en bloc dissection of the tumor with negative margin. Histopathological examination confirmed the diagnosis of recurrent AAM. En bloc dissection with negative margin leads to complete removal of tumor mass. However, long-term follow-up with annual magnetic resonance imaging is advised.
Giant cell tumors (GCT) are benign tumors with potential for aggressive behaviour and capacity to metastasize. Although rarely lethal, benign bone tumors may be associated with a substantial disturbance of the local bony architecture that can be particularly troublesome in peri-articular locations. It is characterized by a proliferation of mononuclear stromal cells and the presence of many multi- nucleated giant cells with homogenous distribution. There is no widely held consensus regarding the ideal treatment method selection. There are advocates of varying surgical techniques ranging from intra-lesional curettage to wide resection. Although GCT is classified as a benign lesion, few patients develop progressive lung metastases with poor outcomes. Treatment is mainly surgical. Options of chemotherapy and radiotherapy are reserved for selected cases. A case of giant cell tumor of distal femur with pathological fracture is reported here. A 39 yr old male with h/o trivial trauma presented with swelling and tenderness over Left thigh and knee. A detailed work up was done and a GCT of distal femur (causing pathological fracture) was confirmed. Patient was managed with surgery in which Tumor excision, curettage and bone grafting was done, and the fracture fixed with locking compression plate. After 6 months of follow up, fracture was well united with no radiological sign of recurrence of tumor.
Background In the Asian population, proximal femoral nail anti-rotation II (PFNA-II), an implant device is one of the treatment modalities designated to treat unstable osteoportotic intertrochanteric fractures. The aim of the present study was to evaluate the functional outcome of PFNA-II in intertrochanteric femur fractures (that includes both stable and unstable). Objective The objective is to analyze clinico-radiological and functional outcomes of unstable intertrochanteric fractures by PFNA-II. Methodology This was a prospective study conducted in the Department of Orthopaedics at Indira Gandhi Government Medical College, Nagpur (Vidarbha region) from August 2018 to August 2020. Patients’ demographic data such as age, gender, occupation, mode of injury, mode of trauma, presence of any co-morbidities, and fracture classification of the normal hip were recorded, from all the included patients 24 months follow-up was noted. The Boyd and Griffin’s classification was used. In the present study, the implant-related complications, including blade cutout, varus collapse, and loss of reduction, were observed. The functional evaluation of the patients was done based on the Modified Harris Hip Score. Outcome of the Study Approximately 25 patients with radiological diagnosis of unstable intertrochanteric femur fractures were considered, out of which 13 (52%) patients were male and 12 (48%) patients were female, with the mean age of 68.61 ± 7.79 years, over the range of 40–90 years. The majority of cases were found to be in Boyd and Griffin classification, i.e., around 15 (60%), while in the Type III classification, there were 10 (40%) cases, and in the Type IV classification none of the cases were noted. Conclusion PFNA-II provides good outcomes, low morbidity, and high mortality in elderly Indian populations with unstable intertrochanteric fractures. To the best of our knowledge, this was the first study done in Vidarbha region that focuses on the utility and feasibility of PFNA-II implant and represents its functional outcome.
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44 members
Gyanshankar Mishra
  • Department of Respiratory Medicine
Sudhir Babhulkar
  • Dept of Orthopedics & Traumatology
Anuradha Vijay Shrikhande
  • Department of Pathology
Jyotsna S. Deshmukh
  • Department of Community Medicine
Vandana Avinash Badar
  • Department of Pharmacology
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Nagpur, India
Head of institution
Dean IGGMCH Nagpur