Nageswara Rao

Madras Medical Mission

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T Jaya Chandra

GSL Medical College & General Hospital

Desai Vidya Sripad

All India Institute of Medical Sciences

Mhasisielie Zumu

Madras Medical Mission

N V S Chowdary

NRI Medical College

Siva Prabodh

NRI Medical College

R. S. Arun

Madras Medical Mission

Lavanya KM

GSL Medical College & General Hospital

May K

GSL Medical College & General Hospital

Kesava Kumar. P

GSL Medical College & General Hospital

Chaitanya Krishna

GSL Medical College & General Hospital

Cooperative Institutions

GSL Medical College & General Hospital

Madras Medical Mission

NRI Medical College

Institute of Medical Sciences

Guntur Medical College

Osmania Medical College

North Carolina State University

University Hospital Kerry

Instytut Gruźlicy i Chorób Płuc

Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences

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Role of Liver Function Tests and Serum Lactate Levels in Predicting the Severity of Acute Paraquat

PoisoningArif Pasha Siva Prabodh Nageswara Rao T. Suhasini Desai Vidya Sripad

Introduction: The paraquat is a liquid herbicide associated with both accidental and intentional ingestion, leading to severe and often fatal toxicity. Aim: The present study is to evaluate the role of liver function tests and lactate levels in predicting the outcome of acute paraquat poisoning. Materials and Methods: A total of 30 patients with acute paraquat poisoning admitted in intensive care unit (ICU) were included in the study. The paraquat poisoning was confirmed by urine dithionite test. Initial clinical parameters such as vital signs, age, amount of paraquat consumption, respiratory rate, serum creatinine, bilirubin, alanine transaminase (ALT), aspartate transaminase (AST), and lactate levels were obtained at the time of admission to ICU. Depending on the outcome after paraquat poisoning the patients were categorized as survivors and non-survivors, the trend in the clinical parameters was assessed to observe the severity. Results: The overall mortality rate was 66.6% (20/30) during 3 days follow-up, on the 1 st day of admission serum bilirubin, AST, ALT, and lactate levels were statistically significantly high in non-survivors when compared with survivors. Conclusion: The 1 st day of admission serum bilirubin, AST, ALT, and lactate levels are very much elevated and are useful in predicting the outcome of paraquat poisoning.

Aspartate transaminase

Transaminase

Liver function

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Functional outcome in displaced proximal humeral fractures in adults treated by proximal humeral locking plates

International Journal of Research in Orthopaedics (2019)

Nageswara Rao K. Ravi Kanth Rama Priya Yasam T Jaya Chandra

Background: The management of proximal humerus fractures (PHF) is a challenging task to any surgeon. Study was conducted to evaluate the clinical and functional outcome of the proximal humeral internal locking system in fixation of displaced proximal humeral fractures.Methods: Study was conducted in the Department of Orthopedics, GSL Medical College. Informed written consent was taken from the study participants. All skeletally mature patients aged >18 years, presenting with displaced PHF according to Neer two, three and four part fracture were included in the study. Either deltopectoral or deltoid splitting approach was used for surgery, post-operative rehabilitation was started on day one.Results: Twenty-five patients with PHF were enrolled in the study; five-holed proximal humerus locking plate (PHLP) was used for 18 patients, eight-holed PHLP for 05 and three-holed, ten-holed PHLP for 01 for one each. The Constant-Murley score was significantly improved (p=0.000) over each successive follow-up period with the average improvement of around 19 scores between 1st and 2nd follow-up and around 15 score improvement between 2nd and 3rd follow-up.Conclusions: The proximal humeral locking plate is an adequate device for the fixation of displaced two-part, three-part and four-part PHF. Patient can regain good shoulder function, resume normal activities much earlier.

Shoulder Fracture

10.18203/issn.2455-4510.intjresorthop20195813

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Complications of Forgotten or Neglected Biliary Plastic Stents and Their Outcome

Gastroenterology Hepatology and Endoscopy Practice (2024)

Mhasisielie Zumu R. S. Arun Nageswara Rao Surinder Kumar N Sri

Introduction: Before cholecystectomy, endoscopic retrograde cholangiopancreatography (ERCP) with common bile duct (CBD) stent placement is the standard therapy for choledocholithiasis. Prolonged stents in situ may present with various complications, some of which may be life-threatening. Methodology: A study in a tertiary center in South India from January 2018 to July 2023. A total of 624 patients underwent ERCP for biliary stent procedures, out of which 29 had biliary plastic stents in situ for more than 6 months. We retrospectively analyzed these 29 cases for complications and their treatment outcomes. Results: The mean ± standard deviation age was 57.5 ± 16.6 years, male-to-female ratio was 2.2:1, 55.17% had a cholecystectomy ( n = 16), the most common indications for CBD stent placement were choledocholithiasis 75.8% ( n = 22); the median duration of stent in situ was 7 months interquartile range (6–9). The reasons for delayed CBD stent removal were: 27.6% due to the COVID-19 pandemic ( n = 8), 13.8% surgically unfit ( n = 4), 6.9% financial constraints ( n = 2), 3.4% of patients were unaware of the stent in situ ( n = 1), and 48.3% were unknown ( n = 14). The complications associated were that 69% had calculi/sludge ( n = 20), 24.14% had cholangitis ( n = 7), 7% were asymptomatic ( n = 2), and 3% had intestinal perforation ( n = 1). Conclusion: Early complication identification and treatment lead to successful clinical outcomes. Irrespective of cholecystectomy, a check cholangiogram, and CBD clearance should be done in all cases of biliary stent removal.

Interquartile range

Biliary stent

Perforation

10.4103/ghep.ghep_5_24

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Platelet rich plasma injection in treatment of plantar fasciitis: An interventional study in a tertiary care hospital, Andhra Pradesh

International Journal of Orthopaedics Sciences (2019)

Nageswara Rao Sudeepthi M Jayagopal C J Satyaprasad Lavanya KM

Background: Plantar fasciitis accounts for 11 to 15% of all foot problems in adults. It peaks in 40 to 60 years of age group and in younger age group, commonly among runners. Plantar fasciitis causes heel pain in both active and sedentary adults of all ages. It is the most common degenerative disease for the cause of heel pain and a self limiting disease that affects most of the adult age group in most southern parts of India. Though NSAIDs, steroids, botulinum toxin –A and shock wave therapy have shown better results in plantar fasciitis, they carry potential risk of serious complications and functional disability. Objectives: To evaluate pain following Platelet rich plasma injection in plantar fasciitis among adults in a tertiary care centre. Methodology: A Hospital based non – randomized trial (NRT) was conducted among 30 adults (18 – 50 years) in the Orthopaedic out – patient department of GSL Medical College, Rajahmundry, for a period of six months. Results: Mean age of the study subjects was 37.5+ 9.17 years. About two – third of the subjects had duration of symptoms for 7-12 months. All the patients with pain for more than 12 months duration had complete pain relief. Response to autologous PRP injection is statistically significant in patients with chronic plantar fasciitis. Conclusions: Autologous PRP injection is a safe and useful modality for treatment of chronic plantar fasciitis.

10.22271/ortho.2019.v5.i4e.1678

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Surgical management of fracture shaft tibia with closed interlocking intramedullary nailing – A clinical study

Surgical Update International Journal of Surgery and Orthopedics (2020)

Nageswara Rao R K.K.Tetali Venkata Rama Reddy T Jaya Chandra

Introduction: The tibia being the most commonly fractured long bone. A study was conducted to analyze the efficacy of closed intramedullary nailing tibial shaft fractures. Materials and methods: Study was conducted in the Department of orthopedics. Individuals with closed tibial diaphyseal fractures of >18 years, open diaphyseal fractures of tibia type I, type II were included. Open diaphyseal fractures of tibia Type III A, B, C, tibial fractures with intraarticular extensions and medically ill were excluded. Under spinal anesthesia, intramedullary locking was done as per the protocol. Results: During the study period, 50 fractures were included. the male-female ratio was 5.25. The youngest patient was 19 years and the oldest patient was 67 years. 60% of the participants had right tibial fractures and 40% with left. Thirty-nine (78%) participants simple and 22% (11) had type I and type 11 compound fractures. The majority of fractures (58%; 29) were united within 18-20 weeks. The average healing time was 19 weeks. Conclusion: In this study 16.9 weeks was the average healing time and 76% patients showed excellent outcome.

Tibia Fracture

Closed Fracture

10.17511/ijoso.2020.i01.10

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Relationship between Serum Lactate Levels and Fatal Outcome in Critically Ill Patients: A Prospective Study in Intensive Care Unit

Mohammad Arif Pasha Nageswara Rao Siva Prabodh Desai Vidya Sripad N V S Chowdary

Introduction: Blood lactate levels are suggested as more important parameter to evaluate patient condition particularly in critical illness. Aim: The aim of this study is to find a relation between lactate levels and hospital fatal outcome in critical illness. Methods: This was a prospective observational study in 125 critical ill-patients admitted in intensive care unit. Serial serum lactate levels were estimated from the time of admission for every 24 h and the results were correlated with Acute Physiology and Chronic Health Evaluation II (APACHE) score and fatal outcome. Results: Non-survivors (n = 32, 25%) had significantly higher lactate levels than survivors at the time of admission (137.5 mg/dl vs. 37.7 mg/dl). Fatal outcome rate was significantly higher in patients with lactate levels 100 mg/dl or higher when compared with lactate levels below 100 mg/dl. A significant positive correlation was observed between APACHE II scores and admission lactate levels in nonsurvivors.

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Correlation of Clinical, MRI and Arthroscopic findings in internal derangements of knee – A Crosssectional study in a tertiary care hospital, Rajahmundry, Andhra Pradesh, India

International Journal of Orthopaedics Traumatology & Surgical Sciences (2019)

Nageswara Rao

Background: Knee joint is the most frequently injured joint as it is more superficial and susceptible.Previously, clinical examination was the sole method used to diagnose various knee disorders.Later, MRI and Arthroscopy were introduced and suggested by many surgeons. Aims and Objectives:This study was conducted to analyze the correlation between all three methods in the diagnosis of internal derangement of the knee in a tertiary care centre. Methodology:A hospital based cross-sectional study conducted at a tertiary care centre in Rajahmundry, India, between January 2017 to December 2017 among 124 patients aged 18-60 years and with internal derangement of the knee.Results: Among 124 patients, 111 (89.52%) were males and 13 (10.48%)females.Right side 84 (67.74%) was affected more than the left side 40 (32.26%).Mean age of the patients was 31 years with maximum number of them within 20-40 years.The most common mode of injury was road traffic accident followed by sports injuries.Clinically, ACL was the structure most commonly involved followed by medial meniscus, lateral meniscus, PCL, medial collateral ligament and lateral collateral ligament.MRI also revealed similar hierarchy in the involvement of structures, while arthroscopy showed that medial meniscus was most commonly involved followed by lateral

Tertiary care

10.47618/ijotss/v5i1.18

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Dynamic hip screw technique in the management of trochanteric fracture

International Journal of Research in Orthopaedics (2019)

Nageswara Rao Chaitanya Krishna Kota Aditya T Jaya Chandra

Background: Study was conducted to find the results of dynamic hip screw in the management of trochanteric fracture by analyzing the factors which influence post-operative mobility.Methods: Study was conducted in the department of orthopedics, GSL Medical College. Individuals >18 years, both genders who were diagnosed having trochanteric type I and II Boyd and Griffin stable fractures were included in the study. All surgeries were performed under spinal anesthesia, internal fixation with dynamic hip screw and 135o angled blade plate. Injectable third generation cephalosporins were used 24 hours preoperatively, intra- operatively and 5 days post-operatively, and oral antibiotics till suture removal. Patients allowed to sit on bed on 2nd and 3rd day and static quadriceps exercises were started from 2nd day onwards, hip and knee flexion exercises from 6 or 7th day and weight bearing walking form 10th day.Results: The average age was of the participants was 61.53 years, ranged between 41 to 80 years; 65% were female participants and 35% were male patients. In the study, 20 (50%) patients had right side fracture and left sided affection of trochanteric fracture to the remaining 50%. Most of the patients (67.5%) in this study were classified as type II Boyd and Griffin criteria, and 32.5% were type I. The clinical and functional outcome was calculated using the Kyle's criteria; 25% (10) showed excellent response, followed by good (50%), fair (15%) and poor (10%) results.Conclusions: Dynamic hip screw is the operative treatment of choice for stable trochanteric fractures. However, studies on large sample for long time are recommended.

Dynamic hip screw

Hip Fracture

Intertrochanteric fracture

10.18203/issn.2455-4510.intjresorthop20195795

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Endoscopic Management of Early and Potentially Life Threatening Complications of Plastic Biliary Stents: A Case Report

Journal of Digestive Endoscopy (2024)

Mhasisielie Zumu R. S. Arun Nageswara Rao Krishna Kumar Nayansri Nayansri

Introduction: The 5-year cumulative incidence of pyogenic liver abscess in a patient undergoing endoscopic sphincterotomy with biliary stenting is 2.4%. Diabetes appears to increase pyogenic liver abscess risk substantially, regardless of the presence or absence of other risk factors.

10.1055/s-0044-1786269

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LEARNING METHOD PREFERENCES AMONG ADOLESCENT MEDICAL STUDENTS IN SOUTH INDIA

Indian Journal Of Applied Research (2021)

Kesava Kumar. P May K Sushant Kumar Mishra Nageswara Rao

BACKGROUND: Adolescent medical students are freshly exposed to the medical subjects and the experience is entirely new and different compared to their earlier school learning. OBJECTIVES: To determine the preferences of learning methods among adolescent medical students and to determine which is the best method for learning different components. MATERIAL AND METHODS: It is a cross – sectional study conducted among the first year MBBS students in the class rooms of GSL Medical College, Rajahmundry for a period of three months using a standard pre – designed and pre – tested “VARK” questionnaire with learning methods as study variables. A class of 150 students was divided into 3 groups of 50 students each. They were initially taught about the different methods of learning by means of a lecture using power point presentation covering three sessions of 40 minutes each. Then, they were sensitized to the “VARK” questionnaire in the next session of 30 minutes and data was collected using the standard pre – designed and pre – tested “VARK” questionnaire. Time given to complete the questionnaire was 20 minutes. RESULTS: Among 134 adolescent medical students, 89 (66.13%) had completed 17 years age, 24 (17.91%) completed 18 years age, 14 (10.46%) completed 19 years age and 7 (5.2%) completed 20 years age. Mean age of students was 17.54±0.32 years. There were 77 (57.5%) females and 57 (42.5%) males. The students mostly preferred kinaesthetic style of learning. CONCLUSION: The present study emphasizes that different students have different learning styles and hence, using only one method of teaching may not benefit all the students.

Power point

10.36106/ijar/8200452

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