Publications

BACKGROUND: Sphenopalatine ganglion (SPG) block combined with occipital nerve block can attenuate the hemodynamic response to the painful stimulus of skull pin application.

MATERIALS AND METHODS: About 60 patients, aged 18-65 years, were randomly assigned to two groups. All patients were classified as American Society of Anesthesiologists (ASA) grades I and II, had a Glasgow Coma Scale (GCS) score of 15/15, and were scheduled for elective craniotomy. Group S was given a scalp block with 0.25% bupivacaine, while group SPG was given a bilateral transnasal SPG block with 0.5% bupivacaine, along with greater and lesser occipital nerve blocks using 0.25% bupivacaine. The primary objective was to assess the change in mean arterial pressure (MAP) following skull pin application. The dose of propofol used as rescue was also noted.

RESULTS: All 60 patients completed the study. The MAP differed significantly in group SPG from prior to pin insertion to 2 (p-value = 0.034) and 3 minutes (p-value = 0.026) following pin insertion. The maximum percent change from the prior to pin insertion timepoint was observed at 2 minutes (p < 0.001). The heart rate (HR) also differed significantly in group SPG from the prior to pin insertion to 2 (p-value = 0.001) and 3 (p-value = 0.006) minutes following pin insertion. The maximum percent change from the prior to pin insertion was observed at 2 minutes following pin insertion (p < 0.001). There was no significant difference in the percent change in HR between the two groups from prior to pin insertion to any of the timepoints.

CONCLUSION: Bilateral SPG block with posterior scalp block can attenuate the hemodynamic response following skull pin insertion in patients undergoing craniotomy under general anesthesia.

BACKGROUND: Liver fibrosis worsens prognosis in metabolic dysfunction-associated fatty liver disease (MAFLD). FibroScan® is the most widely used noninvasive tool for evaluating fibrosis, but performing this assessment requires specialized equipment and expertise. This study aimed to assess the potential of four additional noninvasive techniques for diagnosing liver fibrosis that rely on routine laboratory measurements, that is, fibrosis (FIB)-4 score, FIB-5 score, aspartate aminotransferase (AST)/alanine transaminase (ALT) ratio, and the aspartate aminotransferase to platelet ratio index (APRI).

METHODS: This study was performed following a cross-sectional observational design at a tertiary care hospital in India. The study included adult patients who were observed to have elevated serum AST and ALT levels and fatty deposition on ultrasonography, as these indicate a risk for liver fibrosis, that is, MAFLD or metabolic dysfunction-associated steatohepatitis. The specificity and sensitivity of FIB-4, FIB-5, APRI, and AST/ALT ratio were compared with those of FibroScan® (FibroScan® 502, Echosens, Paris, France).

RESULTS: Among the alternative noninvasive methods, FIB-4 had the highest specificity (78%) and sensitivity (85%) that were closest to the specificity (88%) and sensitivity (92%) of FibroScan®. FIB-5 and APRI demonstrated moderate sensitivity (80% and 76%, respectively) and specificity (75 and 70%, respectively). The AST/ALT ratio had relatively poor diagnostic capability, with a specificity of 60% and sensitivity of 65%. The area under the curve (AUC) for the methods being compared was 0.82 (FIB-4), 0.79 (FIB-5), 0.74 (APRI), and 0.65 (AST/ALT ratio).

CONCLUSION: FibroScan® is the preferred option for evaluating liver fibrosis in patients with MAFLD. However, when unavailable, FIB-4 may be the next most reliable alternative for identifying or excluding advanced fibrosis. Other methods (FIB-5, APRI, and AST/ALT) are less accurate.

BACKGROUND: Pulmonary tuberculosis (TB) is a significant contributor to illness and chronic functional decline in developing countries. Although treated aggressively through powerful antibiotics, the after-effect of the disease and treatment often has a detrimental impact on overall health, especially muscle function of the person affected. This study aimed at assessing the handgrip strength and its association with common clinical and routine laboratory parameters tested.

MATERIALS AND METHODS: This was a cross-sectional study with a predetermined sample size of 72 participants. Sociodemographic data, symptoms, and complete blood chemistry (CBC) findings were noted. Handgrip strength was measured by a rather inexpensive and validated Camry handheld digital dynamometer, which determined handgrip strength in pounds after adjusting for the individual's age, sex, and weight.

RESULTS: Among the total number of study subjects, 49% were females and 51% were males. Out of the total study population, 29 were newly diagnosed, while 43 were treated for the disease. Symptoms of the disease (p < 0.001) and poor clinical findings like tachycardia (p < 0.001), raised temperature (p = 0.011), low mid-arm circumference (p < 0.05), and abnormal chest auscultatory findings (p = 0.002) were reported more among newly diagnosed patients. There was no difference between handgrip strength or inflammatory indices among the two groups (p > 0.05). The respective calf circumference and monocyte count were significant factors determining handgrip strength.

DISCUSSION: This study accounts for the introduction of a new concept of assessment of muscle function among patients and survivors of TB as an indicator of disease improvement and to prognosticate outcomes and quality of life.

BACKGROUND: Liver cirrhosis indicates inflammation, necrosis, as well as fibrosis, resulting in progressively decreasing liver function. As the disease advances from a compensated to a decompensated stage, patients experience severe clinical complications, that result in elevated mortality, as well as morbidity, rates. Accurate predicting short-term mortality is essential for making clinical decisions, particularly when it comes to liver transplantation (LT). Several scores, encompassing model for end-stage liver disease (MELD), Child-Turcotte-Pugh (CTP), as well as their variants, along with specific biomarkers such as red cell distribution width (RDW) alongside RDW to platelet ratio (RPR), have been proposed for assessing these patients' prognosis. However, comparative effectiveness of these scoring systems in predicting outcomes remains underexplored.

METHODS: This study involved a cohort of participants diagnosed with cirrhosis, who were evaluated to identify the most reliable predictors of 30-day mortality. The study compared the efficacy of multiple scoring systems, including CTP, MELD, model for end-stage liver disease-sodium (MELD-Na), model for end-stage liver disease-high-density lipoprotein cholesterol (MELD-HDLc), RDW, and RPR, by analyzing their correlation with patient outcomes. Data were collected on demographic profiles, clinical findings, and laboratory markers to calculate these scores and assess their predictive accuracy.

RESULTS: The study found that among the various scores, the MELD as well as MELD-Na scores demonstrated the highest accuracy predicting 30-day mortality in liver cirrhosis patients. Alcohol emerged as the predominant etiology of cirrhosis, and there was a significant male predominance in the cohort. The results were consistent with existing literature, confirming the reliability of MELD alongside MELD-Na as stronger prognostic tools compared to the CTP score and other markers.

CONCLUSION: MELD along with MELD-Na scores constitute reliable indicators of mortality over the short term in individuals with cirrhosis and should be preferred in practice for assessing the need for LT and other critical interventions. These findings underscore the importance of using evidence-based scoring systems to improve patient management and outcomes in liver cirrhosis, a condition with a high global mortality burden.

BACKGROUNDS AND AIMS: Idiopathic Parkinson's disease (IPD) patients had progressively increased slowness, rest tremors, rigidity, and postural instability (PI). Postural stability depends on sensory inputs from visual, auditory, and somatosensory modalities. We tried to find important cutoff values of visual evoked potential (VEP), brainstem auditory evoked response (BAER), and short-latency somatosensory evoked potentials (SSEP) for determining postural stability in IPD patients.

METHODOLOGY: About 50 IPD patients were recruited in a cross-sectional observational study. A pull test was used to determine postural stability. Patients were subgrouped into tremor dominant (TD variant) (n = 37) and PI and gait disorder (PIGD) (n = 13). We generated receiver operating characteristic (ROC) curves to classify patients into posturally stable and unstable and measured VEP, BAER, and SSEP cutoff values. The area under the curve (AUC) >0.8 was taken as significant.

RESULTS: Significant VEP N75, P100, and N145 cutoff values were noted bilaterally in IPD and its subgroups (TD and PIGD). Except for wave I, the latency of all other BAER waves showed significant cutoff values bilaterally in IPD and subgroups (TD and PIGD). Most BAER cutoff values in the IPD and TD subgroups reached 100% specificity. No significant SSEP values were noted.

DISCUSSION: Many significant VEP and BAER parameters with good sensitivity and specificity would guide clinicians in predicting PI and falls in IPD. The TD had lower BAER latency cutoff values than the PIGD. The postural stability of the TD subgroup was more dependent on the vestibular sensory input than that of the PIGD subgroup. Less vestibular compensatory support in PIGD led to a more severe phenotype than in TD.

CONCLUSION: We found many evoked potential significant cutoff values determining postural stability in IPD and its subgroups (TD and PIGD). Lesser vestibular compensatory support in PIGD led to a more severe phenotype than in TD.

BACKGROUND: Cavernous sinus thrombosis (CST) in rhino-orbital cerebral mucormycosis (ROCM) poses a challenge for clinicians in predicting outcomes and formulating management strategies, particularly with the concurrent coronavirus disease 2019 (COVID-19) infection.

PURPOSE: This study was done to evaluate cavernous sinus (CS) involvement in ROCM. Additionally, we explored the association between CS thrombosis and COVID-19, exploring its potential impact on patient mortality.

MATERIALS AND METHODS: A retrospective analysis was conducted on 106 ROCM patients, examining their COVID-19 status and reviewing imaging findings from contrast-enhanced computed tomography (CT) and magnetic resonance (MR). The imaging assessment focused on evaluating fungal sinusitis, identifying CS involvement qualitatively, and detecting extension to orbit or other intracranial areas. Findings were correlated with patient mortality.

RESULTS: CS involvement in ROCM was 48.1%, with a higher distribution (clinically insignificant) in COVID-positive patients (51.8%) compared to the COVID-negative group (34.8%). Most participants showed unilateral (78%) and diffuse pattern (71%) of CS involvement. A statistically significant association was observed between CS imaging parameters (filling defect, diffuse involvement pattern, convex shape of the lateral wall, and orbital cellulitis) and patient mortality, according to bivariate analysis (p < 0.05). Among 106 ROCM patients, 9.4% succumbed to the disease, with significantly higher mortality in those with CS thrombosis. However, subgroup analysis for the additional effect of COVID-19 on mortality yielded nonsignificant results.

CONCLUSION: CS involvement in ROCM does not significantly impact mortality in both COVID-positive and negative patients. Imaging parameters such as filling defects, diffuse CS involvement, convex lateral wall, and orbital cellulitis may suggest the disease severity when observed.

Type 1 diabetes (T1D) management is complex and requires a multifaceted approach. This includes daily multiple insulin injections, home monitoring of blood glucose, screening for potential complications, and patient education and support. Many T1D patients face untimely death due to lack of structured and timely care.1 India has the highest number of children and adolescents (aged 0-19 years) living with T1D,2 but there is no national health program or policy targeting this population.3 The average life expectancy for a person diagnosed with T1D in India is only 29 years.2.

We read with interest an article titled "Estimation of Predictors of Mortality in Patients with Acute Respiratory Failure Secondary to Chronic Obstructive Pulmonary Disease Admitted in Tertiary Care Center" published in the Journal of the Association of Physicians of India.1 We have the following comments to offer.

We would like to highlight the clinical spectrum of human metapneumovirus (hMPV) infection in 11 patients diagnosed in the year 2024 at our center, clarifying that it is neither new nor does it resemble COVID-19. Our observations aim to provide insights and contribute to a clearer understanding of its role in respiratory diseases.

A 34-year-old female, a diagnosed case of chronic liver disease, presented to the emergency department with yellowish discoloration of the skin, abdominal distension, and bilateral lower limb swelling for 1 week. She also complained of painless swelling over her umbilicus for the last 6 months. On examination, she was conscious, oriented, and hemodynamically stable. General physical examination revealed icterus and bilateral pitting pedal edema up to the knees. On abdominal examination, the abdomen was distended and shifting dullness was present. A large swelling of approximately 7 × 5 cm was present over the anterior abdominal wall with a palpable thrill and an audible Cruveilhier-Baumgarten murmur (Figs 1A and B). The swelling was not reducible and had no signs of inflammation. The rest of the systemic examination was normal.