Current Research in Scientific Medicine

Long COVID – Need for follow-up clinics Journal of Current Research in Scientific Medicine 2020 6(2):71-72

Social capital and maternal health: A narrative review Journal of Current Research in Scientific Medicine 2020 6(2):73-76 Social capital (SC) is a well-known concept studied in developed countries, but it is relatively a new concept for Indian setting. Social scientists have studied this concept in detail, but in the medical field, this concept and its application is still unexplored. This article is a review conducted from the published literature, from all over the world on SC and its relationship with pregnancy and its outcome for the past 20 years. Along with other social determinants, namely, caste, religion, and socioeconomic status, SC also plays a vital role in determining the health of women in various ways. Poor SC has been found to be associated with low birth weight, depression, poor mental health, poor self-rated health, and quality of life. SC also helps in accessing better prenatal care and delivery care. To conclude, SC has a positive association with improving pregnancy and its outcome. There is a lot of scope to venture into this topic in the near future in India.

Copeptin: Short term prognostic biomarker in ischemic stroke among Indian - A prospective cohort study Journal of Current Research in Scientific Medicine 2020 6(2):77-83 Background: Copeptin a precursor of arginine vasopressin is associated with stroke severity and functional outcome among Chinese and Western population. We aimed to evaluate copeptin as a prognostic marker in patients with acute ischemic stroke (IS) by assessing the functional outcome of patients after 90 days of stroke. Methodology: Sixty out of 88 adult patients were included in the study who presented with symptoms of acute stroke within 72 h of onset. Patients with intracranial hemorrhage and transient ischemic attack were excluded from the study. Spearman correlation method was applied to see correlation between copeptin and National Institutes of Health Stroke Scale (NIHSS) calculated at the time of admission. Logistic regression analysis was done to identify independent risk variables for the functional outcome (modified Rankin Scale) of IS. Receiver operating characteristic curve was calculated to find the sensitivity and specificity of copeptin. Results: Out of 60 patients, 62% were male and 38% were female. The mean age was 57.7 ± 14.8 years. Copeptin levels were high among patients with severe stroke (14.9 ± 0.8). Copeptin at the time of admission showed a significant positive correlation with stroke severity (r = 0.702, P < 0.001). The multiple logistic regression analysis showed that copeptin level (odds ratio [OR]: 3.05, 95% confidence interval [CI]: 1.00–9.32, P = 0.05) and NIHSS at day 0 (OR: 7.05, 95% CI: 1.39–35.78, P = 0.02) were independently associated with functional outcome at day 90. The area under the curve was 0.898, with a sensitivity of 77.8% and specificity of 97.6%, P < 0.001. Conclusion: Copeptin is independently associated with the severity and functional outcome of IS among Indians. A larger cohort study may be required to further establish its association.

Evaluation of carotid intima-media thickness in primary hypertensive patients using B-mode ultrasound: Cross- sectional study Journal of Current Research in Scientific Medicine 2020 6(2):84-88 Background: Hypertension (HTN) is one of the most common health problems. Carotid wall changes are one of the most important and mortal complications of HTN; therefore, rapid diagnosis of HTN is essential to avoid vascular issues. Ultrasonography is a vital imaging modality used for the assessment of this vessel wall disorder by determining the carotid intima-media thickness (CIMT). The present study aims to explore the association between HTN and elevation of CIMT. Materials and Methods: This was a cross-sectional of 81 patients with documented essential HTN and 83 healthy controls. HTN was controlled by the administration of drugs. The mean participant's age was 66.09 ± 9.94 years. The CIMT of both the right and left common carotid arteries (CCAs) was measured using the B-mode ultrasound. Results: The CIMT in the CCAs was greater in hypertensive patients than in the controls (P < 0.001). The intima-media thickness of the right and left CCAs increased significantly as the duration of HTN increased (P = 0.023 and 0.031, respectively). Conclusions: HTN is significantly associated with increased CIMT. The CIMT increases with increasing duration of HTN.

Does modified computed tomography severity index need a revision? Journal of Current Research in Scientific Medicine 2020 6(2):89-95 Background: Several radiologic prognostic scoring systems have been developed in the past for grading of pancreatitis. Modified computed tomography severity index (MCTSI) incorporates extrapancreatic complications in the assessment and simplifies the evaluation of the extent of pancreatic parenchymal necrosis and peripancreatic inflammation. MCTSI does not give detailed evaluation with regard to the specific prevalence of each of the extrapancreatic complications. All extrapancreatic complications are given a score of 2. Objective: The primary aim of our study is whether vascular extrapancreatic complication has an overall effect on clinical outcome in pancreatitis. Materials and Methods: This was a hospital-based prospective correlational study done in Government Medical College, Srinagar, from December 2018 to November 2019, on patients with acute pancreatitis. Twenty-seven patients of acute severe pancreatitis, as per MCTSI, were divided into the following two groups: Group A of 18 patients having no vascular complications and Group B of nine patients with vascular complications, and 28 patients of moderate pancreatitis were divided into the following two groups: Group A of 24 patients with no extrapancreatic vascular complications and Group B of four patients having vascular complications. Major parameters that were evaluated were rate of intervention, infection rate, organ involvement, and duration of hospital stay in patients with vascular complications as compared to patients having no vascular complications. Results: Pleural effusion was the most common extrapancreatic complication in our study followed by ascites. Thrombosis was the most common vascular complication followed by pseudo aneurysm. Cholelithiasis was the most common cause of acute pancreatitis followed by idiopathic cause. Patients with vascular complications had higher intervention, infection rate, organ involvement, and longer duration of hospital stay. Conclusion: Patients with vascular complications have higher rate of intervention, infection rate, organ involvement, and longer duration of hospital stay irrespective of MCTSI.

Bacteriological profile and antimicrobial susceptibility pattern in sterile body fluid specimens from a tertiary care hospital, South India Journal of Current Research in Scientific Medicine 2020 6(2):96-101 Introduction: Sterile body fluids are biological fluids that do not normally contain any microorganisms. Examples include cerebrospinal fluid (CSF), pleural, peritoneal, synovial, drain, and pericardial fluids along with bile. If these are infected with microorganisms, then this could be life-threatening and may result in severe morbidity and mortality. Therefore, early identification of these organisms with antimicrobial susceptibility is decisive for the proper management of these infections. Materials and Methods: This was a retrospective study conducted between December 2017 and August 2019, in the Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research. During this period, a total of 4358 sterile fluid samples from patients with suspected body fluid infections were received. Then, the specimen processing, identification, and antimicrobial susceptibility testing were performed. Results: During the study period, a total of 4358 sterile fluid specimens were received which included 313 CSF, 224 pleural, 391 peritoneal, 30 synovial, 66 drain fluid, and 281 bile. Of the samples received, 1305 were culture positive, with an isolation rate of 29.9%. Among the culture positives, the frequency of Gram-negative bacteria was 83.2% (1086/1305) and Gram-positive bacteria: 16.3% (213/1305) and yeast: 0.4% (6/1305). Conclusion: Sterile body fluid infections are usually life-threatening and have a high chance of morbidity and mortality. Therefore, early identification of the organism and performing the antimicrobial susceptibility testing are very important. This not only helps to reduce longer hospital stay and start the patient on targeted therapy but also decreases the risk of acquiring infections in the hospital and develop resistance to antibiotics.

Determinants of psychological distress among school-going girls in a rural district of Haryana, India: A multivariate analysis Journal of Current Research in Scientific Medicine 2020 6(2):102-108 Background: Mental health of children is not adequately explored in India, especially in Haryana. If untreated, these conditions severely influence children's development and their potential to live fulfilling and productive lives. In this study, we aimed to screen school -going adolescent girls for common mental disorders and find potential psycho social and socio demographic determinants. Materials and Methods: This cross-sectional study was done January to March 2019 and included 649 school-going adolescent girls (12–19 years). This study used a pretested, predesigned, standardized questionnaire and General Health Questionnaire-12 (GHQ-12). Multiple logistic regression had been done to find the strength of association between dependent variable and independent variables. All tests were performed at a 5% level of significance. Results: The overall mean age (±standard deviation) of study participants was 15.5 ± 1.09 years with nearly equal distribution in each standard. Two hundred and eighty-three participants (43.6%) had a score of 3 or more for GHQ-12, which is suggestive of mental health problems. The GHQ-12 score was higher in young age adolescents (53.3%), those studying in the ninth standard (65.4%), the adolescents belonging to nuclear family, higher socioeconomic status, and having previous exposure to mental health programs. Conclusion: Mental health problems are highly prevalent among the adolescent population in India. In the scope of preventive health services, health workers shall provide information to the adolescents and their parents about these specific psychiatric changes and provide psychological help for children and adolescents by the guiding the teachers working at the schools. In addition this will help to establish a positive and supportive relationship between the teachers and students.

Significance of endometrial thickness on transvaginal ultrasonography in abnormal uterine bleeding Journal of Current Research in Scientific Medicine 2020 6(2):109-113 Background: Abnormal uterine bleeding (AUB) is characterized by excessive flow at the time of an expected menses or by bleeding at abnormal or unexpected times. Aims: The study aimed to evaluate the endometrial thickness (ET) on ultrasound and histopathological examination and their correlation in patients with AUB. Materials and Methods: The present prospective study was conducted on 100 female patients of all age groups attending the Department of Obstetrics and Gynaecology at S. P. Medical College and A. G. H. Bikaner, Rajasthan, India, from June 2018 to May 2019, with a clinical diagnosis of AUB. These women underwent clinical examination, investigations, and ultrasound examination, followed by endometrial biopsy. Results: The mean age of the patients was 43.14 ± 10.44 years. Menometrorrhagia (28%) was the chief complaint. The mean ET in the premenopausal group (7.568 ± 2.774 mm) was more than the postmenopausal group (7.388 ± 4.138 mm) (P = 0.795). Proliferative endometrium (66%) was the most common endometrial pattern, followed by secretory endometrium (16%), endometrial hyperplasia (7%), adenocarcinoma (3%), atrophic endometrium (2%), and pseudodecidual reaction (1%). Out of the total cases, in 5 (5%) cases, no histopathological pattern was observed because of inadequate sample. After applying analysis of variance, the association between histopathological findings and mean ET was found to be statistically significant (P = 0.00). When ET was >12 mm, endometrial hyperplasia and adenocarcinoma were observed in six and one cases, respectively. Conclusion: ET can be used as a marker of endometrial hyperplasia and malignancy; however, it cannot replace comprehensive tissue diagnosis.

Antegrade intramedullary interlocking nailing for midshaft humerus fractures: A retrospective study evaluating functional and radiological outcome Journal of Current Research in Scientific Medicine 2020 6(2):114-122 Background: The incidence of humeral shaft fracture has significantly increased during the past decade due to the rising population and the number of road traffic accidents. Numerous surgical implants have been devised in order to achieve a stable fixation and early mobilization. Plating is considered as the gold standard for humerus shaft fracture fixation. With the advancement in nailing techniques and newer nail design, there is a shift of trend in the treatment of diaphyseal fractures towards use of nails by the trauma surgeons. The aim of this study was to evaluate the functional outcome of acute humeral shaft fractures undergoing fixation by intramedullary interlocking (IMIL) nails. Materials and Methods: 52 patients (mean age: 29.42 years) with acutely displaced midshaft humeral fractures who underwent intramedullary nailing (Sharma antegrade IMIL Humeral Nail) were retrospectively studied. They were assessed radiologically for fracture union and functional outcome using Constant and Murley Shoulder Score, American shoulder and Elbow Surgeons (ASES) score, and Mayo Elbow Performance score. Results: The mean Constant–Murley score and ASES score at a mean follow-up period of 4.6 years (range: 1–11.3 years) were 87.4 ± 11.2 and 92 ± 1.45, respectively. Out of 52 patients, 6 patients had shoulder impingement, 3 delayed union, 1 had nonunion, and 1 periarthritis of shoulder. Conclusion: Intramedullary nail fixation in the humeral shaft fracture is a minimally invasive procedure with excellent functional and radiological outcome. The results are comparable with that of plating which is considered as the gold standard.

Correlation of red cell distribution width with the severity of acute pancreatitis Journal of Current Research in Scientific Medicine 2020 6(2):123-128 Aim: The present study was conducted with aim to determine the correlation of red blood cell distribution width (RDW) with mortality in patients of acute pancreatitis (AP). Materials and Methods: This was a prospective, observational study conducted among the 100 patients, admitted in the Department of Medicine, PBM Hospital, Bikaner, with a definite diagnosis of AP, confirmed both clinically and radiologically. Patients were enrolled justifying predefined inclusion and exclusion criteria. All routine investigations such as complete blood chemistry including RDW, renal function test, liver function test, and random blood sugar, more specific ones such as serum amylase and lipase, and contrast-enhanced computed tomography of abdomen were performed both at the time of admission and discharge. Receiver operating characteristic and logistic regression analyses were employed for evaluation. Results: Of 100 patients, 69% were male whereas 31% were female. The predominant etiology of AP in our study was cholelithiasis (64%). Mean RDW on the day of presentation and discharge was 14.10 ± 3.12 and 13.56 ± 1.34, respectively. Among the total 38 patients of mild AP, 47.36% (18) had RDW <12.6, 44.7% (17) had RDW ranging from 12.6 to 13.3, whereas only 7.89% (3) had RDW >13.3. From the 62 patients of severe AP, 91.9% had RDW >13.3 and 8.1% had RDW ranging from 12.6% to 13.3%. The total mortality rate of our study was 4%. Conclusion: It was seen that most of the patients who had severe AP have high RDW. Of the four patients that expired, three had RDW >13.3. Thus, RDW increases with the severity of pancreatitis, which was statistically significant and correlated with mortality among acute AP patients. Hence, RDW can be considered as a convenient, time, and cost-effective method.

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