European Journal of Cardiovascular Medicine

Background: Postoperative respiratory complications (PRCs) remain a significant source of morbidity and extended hospitalization following general anesthesia. Identification of preoperative and intraoperative risk factors is essential to implement preventative strategies. Objective: To identify and evaluate independent risk factors contributing to PRCs in adult patients undergoing elective surgeries under general anesthesia. Methods: In this prospective observational study, 300 adult patients undergoing elective surgery under general anesthesia were enrolled over 12 months. Data on demographic, clinical, anesthetic, and surgical variables were collected. Postoperative respiratory complications (e.g., hypoxia, pneumonia, bronchospasm, and re-intubation) were recorded during the first 72 hours post-surgery. Multivariate logistic regression was used to determine independent predictors. Results: PRCs occurred in 48 (16%) patients. Independent risk factors included age ≥ 65 years (OR 2.4, 95% CI 1.3–4.2), ASA class III/IV (OR 3.1, CI 1.7–5.7), preexisting pulmonary disease (OR 4.2, CI 2.1–8.6), smoking history (OR 2.3, CI 1.2–4.6), surgery duration >3 hours (OR 2.1, CI 1.1–4.0), and inadequate reversal of neuromuscular blockade (OR 3.9, CI 1.9–7.8). Conclusion: PRCs are multifactorial and more common in elderly patients, those with pulmonary disease, and prolonged surgeries. Optimizing respiratory function preoperatively and ensuring adequate neuromuscular reversal may reduce incidence.

Background: Intra-articular Distal radius fractures lead to pain, decreased grip strength, limited mobility around the wrist and cosmetic deformity and it can be significant enough leading to loss of employment. Earlier recognition and intervention gives better functional results Aim: To study results of distal radius intra-articular fractures managed by using volar locking and non locking plate by Flexor carpi radial is approach and Prof. Vasudhevan 5 K wire technique. Methodology: This was a prospective study conducted during the period of 2020 to 2021 in Department of Orthopaedics, Govt General Hospital, Ananthapur. Cases with Distal Radius Intraarticular fractures were admitted and evaluated clinically and radiologically. Results: In the present study, fractures were more common in males. In our study of 30 Patients, 19 (63%) were male and 11 (37%) were female patients. The LEFT side is predominantly involved with 19 (63.33%) cases than Right side with 11 (36.6%) cases in our study. The common mechanism of injury in this study was Road traffic accident with 19(63.33%) cases than Fall on outstretched hand with 11 (36.6 %) cases. Distal Radius Fractures treated with Plating require longer duration of surgery than those treated with Percutaneous 5 K-wire fixation with Mean duration of surgey for plate fixation is 63.67 minutes and for k wire fixation 36.00 minutes with t = 8.784 and p value= 0.000 which is statically significant. In our study according to sarmientos modification of lindstrom criteria15 (50%) cases have excellent results, 13 (43%) cases have good outcome, 2(7%) case has fair outcome and no cases have poor outcome with P value= 1.000 which is not significant which implies both procedures give good anatomical results. In this study at the end of follow-up 14(94.1%) cases have Excellent outcome, 1(5.9%) case have Good outcome and no cases with fair or poor outcome in PLATING group. 12(80%) cases have Excellent outcome, 1 case have Good outcome ,2(13.3%) cases have Fair outcome and none have poor outcome in K Wire group. P value= 0.598 which is not significant and with this study both procedures are reliable for intraarticular distal radius fracture fixation and gives good functional outcome.  Conclusion:  Based on experience from this study we conclude that VOLAR PLATE fixation and 5 K wire fixation are reliable methods for the treatment of intraarticular distal radius fractures both volar plating and 5 k wire fixation are reliable and effective means. Both 5 K wire fixation and volar plating have good efficacy with similar radiological and functional outcomes.

Background: Among common physiologic causes of pain, labor results in severe pain, similar in degree to that caused by complex regional pain syndromes or the amputation of a finger. The pain of labor, caused by uterine contractions and cervical and other pelvic structure dilatation, is transmitted through visceral afferent (sympathetic) nerves entering the spinal cord from T10 through L1 and later in labor, perianal stretching transmits painful stimuli through the pudendal nerve and sacral nerves S2 through S4. Materials And Methods This study was conducted as a comparative observational study to assess the effectiveness of Entonox and spinal anesthesia in pain management during labor and delivery. The study was carried out in the labor and delivery unit of Indian Institute of Medical Science & Research over a period of 6 months. Participants included pregnant women who were admitted to the labor and delivery ward and met the following inclusion and exclusion criteria. Participants were categorized into two groups based on their choice or clinical recommendation for pain management. Results A total of 300 subjects were studied, with 150 women in each group. The total labor duration was significantly shorter in the spinal anesthesia group (340.2 ± 45.6 min) compared to the Entonox group (385.7 ± 50.2 min) (P < 0.001), suggesting that spinal anesthesia may contribute to a more efficient labor process. The first stage of labor was also significantly shorter in the spinal anesthesia group (290.5 ± 42.1 min vs. 330.8 ± 47.3 min, P < 0.001). Interestingly, the second stage of labor was longer in the spinal anesthesia group (40.3 ± 8.2 min vs. 30.5 ± 7.8 min, P < 0.001). The cesarean section rates were 14.7% in the spinal anesthesia group and 16% in the Entonox group. Conclusion: Overall, the choice of pain management should be individualized based on maternal preferences, labor conditions, and clinical indications. While spinal anesthesia remains the gold standard for complete pain relief, Entonox serves as a valuable alternative for women desiring a non-invasive, easily accessible option. Future research should explore combination approaches and assess long-term maternal and neonatal outcomes to further optimize labor analgesia strategies.

Background: Electrocardiographic (ECG) changes are reported frequently after acute strokes. It seems that cardiovascular effects of strokes are modulated by concomitant or pre-existent cardiac diseases, and are also related to the type of cerebrovascular disease and its localization. We aimed to determine the pattern of ECG changes associated with pathophysiologic categories of acute stroke among patients with/ without cardiovascular disease and to determine if specific ECG changes are related to the location of the lesion. Every year, more than half a million people in the world suffer from acute cerebrovascular events, including ischemic stroke, intracerebral and subarachnoid hemorrhage.  Materials and methods: This is a Prospective and observational study conducted in the Department of Medicine, Tertiary Care Teaching Hospital over a period of 1.5 years. Selection of study subjects - After admission, based on clinical history and Physical Examination, a presumptive diagnosis is made and later the patient will be subjected to Serial ECGs after informed consent. Patients admitted in the NICU and various medical wards within 24 hours after the onset of neurological deficit. Patients who developed stroke during their stay in hospital. Result: We have recruited 90 stroke patients, most of them were males. Major type was ischemic stroke. In total 62 (68.89%) stroke patients had some form of ECG change. Majority i.e. 35 (38.89%) patients had QTc prolongation followed by 32 (35.56%) patients had T wave changes. QTc prolongation and Atrial fibrillation were significantly more among hemorrhagic stroke patients (p<0.05) and T wave changes and ST changes (elevation or depression) were significantly more among ischemic stroke patients (p<0.05). Conclusion: PWDis and PTFV1 are independent predictors of PAF in patients with acute ischemic stroke. These simple and easily accessible predictors that can be detected via surface ECG may be used as a guide to identify patients who require longer rhythm monitoring to better detect occult PAF, thereby preventing recurrent strokes.

Introductions: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) represent different ends of the spectrum of the same clinical entity of severe mucocutaneous reactions, usually to drugs, characterized by intraepidermal cell death leading to blistering and epidermal sloughing. SJS is the milder variant with <10% of total body surface area involvement. To describe the ocular manifestations in the acute stage of Stevens-Johnson syndrome/ toxic epidermal necrolysis. Materials and Methods: We reviewed all the medical records of patients diagnosed with Stevens-Johnson syndrome/ toxic epidermal necrolysis and erythema multiforme between 2012 and 2019. Demographics, ophthalmic manifestations, and the treatment given systemically and locally were reviewed and analyzed. Results: A total of 40 patients were included in the study during the study period, of which 19 were males and 21females. Out of these, 22 were SJS or SJS/TEN overlap and 8 were TEN patients. Ocular manifestations were observed in 27 patients (90%), with a male to female ratio of 10:17. All cases were drug-induced, except one, in which no history of any drug intake prior to the appearance of lesions could be elicited [Table 1]. All patients had bilateral ocular findings. All the patients having ocular involvement, presented to us in the acute phase, with symptoms such as redness, burning, watering, discharge, swelling, and sloughing of skin over lids and so on. The acute manifestations were classified as mild, moderate, or severe using the classification system described above. About 30.0% (12patients) had mild involvement, 55.0% (22patients) had moderate involvement, and 15.0% (6 patients) had severe involvement [Table 2]. Conclusion: Comprehensive management of the patient in the acute stage of SJS/TEN is crucial in preventing long-term visual morbidity. An ophthalmologist needs to be part of the primary treating team, as early recognition and management of the ocular involvement can avoid many long-term ocular complications. The grading of ocular involvement in the acute stage is a useful tool that helps the ophthalmologist identify the sentinel signs and helps in deciding about the need for surgical management in patients with severe grades.

Introduction Asthma is a long-term condition affecting children and adults. The air passages in the lungs become narrow due to inflammation and tightening of the muscles around the small airways. This causes asthma symptoms such as cough, wheeze, and shortness of breath and chest tightness. It can be difficult to coordinate breathing using an inhaler, especially for children and during emergency situations. The assessment of asthma control has become pivotal in the management of asthma. However, several surveys in developed nations have shown that the majority of patients with asthma do not enjoy adequate asthma control. This is not because asthma control is unrealistic and not achievable; the multicentre, multinational study of asthma management, the Gaining Optimal Asthma control (GOAL) study, has shown that well-controlled asthma is achievable in the majority of patients.  Materials and Methods: This is a descriptive and cross-sectional study to assess the levels of asthma control among adult patients attending Tertiary Care Teaching Center. The study used those (physician-diagnosed asthma patients) participants who volunteered. There is a causality department where patients presenting with acute asthma attack are managed. Complicated cases of asthma including status asthmaticus are managed in the high dependency unit. Results: Prevalence of bronchial asthma in adolescents was 13.1% (n = 110) of which 10.2% had episodes in the past 1 year. Prevalence was higher among males (6.23%) compared to females (3.94%). About 79.1% of total asthmatics were newly diagnosed cases. Prevalence was significantly higher among those having pets at home (P < 0.001), belonging to higher socioeconomic status (P = 0.021), using smoke producing fuel at home (firewood/cow dung/kerosene; P = 0.021), and with history of smoking among family members (P = 0.027). Among current asthmatics, 71.8% reported cold/rhinitis (51.3% in March–May duration), 59.1% nocturnal dry cough, 48.2% sleep disturbances, and 42.7% speech disturbances in the past 1 year. Discussion: In our study we found, there is significant increase in weight, BSA, BMI, where as significant decrease in DBP of diabetic group compared to Non-Diabetics & there is significant increase in FBS, HbA1C levels of Diabetic group significant decrease in LH levels of Diabetics compared to Non-Diabetics. However T3 levels of Diabetic and Non-Diabetic group were almost same, where as T4, Oestradiol and progesterone levels of diabetic group non-significantly increased and FSH and TSH levels non-significantly decreased in Diabetics. There is frequent co-existence of thyroid dysfunction and diabetes mellitus among post menopausal diabetic women. Conclusion: We estimated the global prevalence of ACO based on population-based studies and found that 2.0% of the general population is affected. However, the prevalence of ACO depends on its diagnostic criteria. Therefore, there is a vital need to better define the ACO diagnostic criteria, management and treatment. It is worth noting that the limitations of the present study include lack of studies in some region of the world and small number of studies included in the subgroup analyses

Background and objectives: In situ hybridization (IHC) markers p63, SMA, and ki67 in the spectrum of ductal proliferative breast lesions: a study employing excision biopsy and mastectomy patients. The goal of this study is to evaluate myoepithelial markers for their potential in spotting breast cancer in its earliest stages. Methods: The research used representative paraffin sections from 30 breast mass tissue samples submitted to the Department of Pathology, Osmania Medical College, Hyderabad, Telangana, India, between April 2018 to March 2019. P63, SMA, and Ki 67 antibodies were used to immunostain 40 breast masses categorised as ductal proliferative lesions, ductal carcinoma in situ, or invasive ductal carcinoma by the Department of Pathology. Results: p63 non myoepithelial had 22 in negative frequency and 8 in positive frequency. While for SMA nonmyoepithelial negative frequency was 4 and positive frequency was 16. Over and over, it was shown that stromal cells, and myofibroblasts in particular, did not react to the stimuli. There was a ring of p63-immunoreactive cells encircling lobular and ductal cancer in situ, however it was disjointed compared to the normal structures. Conclusion: Ki67, myoepithelial P63, and stromal myoepithelial antigen (SMA) were shown to be reliable markers for discriminating normal epithelium from hyperplasia, MIN, and invasive carcinoma in this study.

Background: Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder (5-10%) in women of reproductive age. It is characterized by clinical and biochemical hyperandrogenism, menstrual irregularities, infertility and metabolic syndrome. Hypothyroidism is more common in PCOS

Introduction: The aim of our study was to compare the effectiveness of both TA and EACA in reducing post surgical bleeding in on-pump CABG surgeries with regards to the amount of blood loss at 4 hrs and 24 hrs asthe primary outcome. Materials and Methods: After the completion of surgery patients were shifted to ICUand were assessed for blood loss at 4 hrs and 24 hrs after shifting. Indication for transfusion of PRBC was a haemoglobin level of <8gm/dl. FFP was trasfused if post operative drain was > 250ml/hr in first hour. Platelet trasfusion was indicated if platelets counts were <50000/mm3. Results: The requirement of PRBC in group TA was for 4patients, where as in EACA group 5patients required PRBC (P>0.05). One patient in each group required FFP transfusion (P>0.05).Both the groups did not require any platelet transfusion & the transfusion rate was non-significant between the groups. Both the groups had no re exploration due to excessivebleeding. Conclusion: Based on the results of our study it can be concluded that both TA & EACA effectively inhibits fibrinolysis during on pump CABG surgery and thus results in decreased post operative bleeding. When compared between the two, TA was slightly better with respect to post operative bleeding at 24hrs

Anaemia is the result of a wide variety of causes that can be isolated, but more often coexist. Globally, the most significant contributor to the onset of anaemia is iron deficiency so that IDA and anaemia are often used synonymously, and the prevalence of anaemia has often been used as a proxy for IDA. It is generally assumed that 50% of the cases of anaemia are due to iron deficiency 15, but the proportion may vary among population groups and in different areas according to the local conditions. The clinical examination included resting pulse, blood pressure, nail changes, jugular venous pressure, pedal oedema.

Background: We aimed to investigate the post-procedure effect of pulsatile and non-pulsatile flow utilized in cardiopulmonary bypass on brain ischemia among patients undergoing coronary artery bypass grafting (CABG) surgery. Methods: A total of 80 patients undergoing elective CABG between April 2012 and January 2013 were separated into two groups. While pulsatile flow was implemented during cardiopulmonary bypass in 40 patients, non-pulsatile flow was used in the remaining 40 cases. Formation of new ischemic lesions in the brain was evaluated by Diffusion-weighted magnetic resonance imaging (DW-MRI), performed prior to and after the operation. Results: No statistically significant differences were found between the two groups in terms of demographic values and concomitant diseases. New focal lesions were detected in 7 of 40 patients subjected to pulsatile flow (17.5%) and in 4 of 40 cases subjected to non-pulsatile flow (10%). Although the number of new lesions detected on brain diffusion MRI in the non-pulsatile flow patient group was lower in terms of the number of patients and the number of lesions, no statistically significant differences were determined between the two groups. Conclusions: Magnetic resonance imaging evidence of brain injury were similar after pulsatil-pump and nonpulsatil-pump coronary artery bypass grafting surgery.