European Journal of Molecular & Clinical Medicine

Introduction: Intercostal drainage (ICD) tubes are indicated to drain clinically
undesired substances such as air, excess fluid, blood, chyle or pus from the intrathoracic
space. There are very few studies on pediatric patients managed with intercostal
drainage tube insertion for different indications.
Aims: To study the clinico-epidemiological profile, indications, complications and
outcomes of pediatric patients admitted in Pediatric Intensive care unit who were
managed with ICD tube insertion.
Material and Methods: Records of pediatric patients from Pediatric intensive care unit
(PICU) of Shyam Shah Medical college Madhya Pradesh during a period of one year i e
from July 2020 to June 2021 was collected and analysed prospectively.
Results: a total 25 patients were included in the study (male:female= 1.27:1; mean age
4.9± 3.7 years). Common clinical presentation of the patients were fever (n=18, 72%)
followed by fast breathing (n=11, 44%). Mean duration of stay was 18.7±11.7 days.
Common indications for ICD tube were pyothorax (n=8, 32%), pyopneumothorax,
empyema and pneumothorax (n=4, 16% each). 80 % cases were unilateral and 28%
required blood transfusion and inotropes for shock. Most common pathogen isolated
from cultures was staphylococcus aureus (>75%). 11 patients were started with
antitubercular treatment. In our study the mortality was 24%.
Conclusion: In this study, Staphylococcus aureus was the most common organism
isolated from culture whereas 44% cases were treated with antitubercular treatment
that reflects how common tubercular pleural effusions are in pediatric age group in this
area. Early diagnosis and treatment is the key of management. More extensive studies
are required in this topic of interest.

Background: Sepsis and septic shock cases in the Neonatal intensive care unit (NICU)
and Pediatric intensive care unit (PICU) remain one of the most significant causes of
morbidity and mortality in pediatric patients. Therefore, studying and comparing the
clinical features and outcomes of pediatric patients with sepsis in ICUs are important,
especially in developing countries.
Methods: From 1st July 2021 to 31st December 2021, we have collected data from both of
our pediatric ICU and neonatal ICU of Shyam Shah Medical College using a preformed
proforma. Complete blood count, C - reactive protein and culture sensitivity reports
were used to diagnose or screen sepsis. We compared clinical features, laboratory data,
microbiologic results, and final outcome for patients with sepsis in both NICU and
PICU.
Results: A total 1509 and 236 cases with sepsis from both NICU and PICU respectively
are included in the study (mean duration of stay in NICU 8.9 days±4.3; in PICU 12.5
days±5.3). Among these cases, culture positive cases with sepsis were 66% and 28% in
NICU and PICU respectively. Common pathogens isolated from blood cultures were E.
coli and pseudomonas in NICU and E.coli and S. aureus in PICU. Mortality, discharges,
refers and Left against medical advice cases were compared as outcomes in our study.
Comparing with NICU (n=24, 10.1%), mortality due to sepsis in PICU (n=111, 7.3%)
was less.
Conclusion: Sepsis in children both in NICU and PICU is associated with high mortality
despite aggressive treatment strategies, but more in NICU. Early recognition and
prompt treatment is the key to improve outcome of sepsis.

Introduction: Laminoplasty is indicated in patients with cervical spondylotic myelopathy
(CSM) who have multilevel cervical spinal cord compression and a neutral or lordotic
cervical spine alignment. However, axial neck pain is a common complication post-surgery,
which may be caused by surgical damage to the semispinalis cervicis (SSC) muscle
attachment on the C2 spinous process. Modified C4-C7 laminoplasty with C3 laminectomy
completely preserves the SSC insertion on C2 and reduces the incidence of axial neck pain at
subsequent follow-ups.
Aim: Our study aims to evaluate the clinical and radiological outcome of C4-C7 laminoplasty
with C3 laminectomy for CSM in the Indian population.
Materials and Methods: We performed a retrospective analysis of 21 patients who
underwent the surgery for CSM with a minimum one-year follow-up. Clinical improvement
is measured using the modified Japanese Orthopedic Association (MJOA) score and visual
analogue scale (VAS). Radiographic parameters evaluated were the C2-C7 lordosis angle and
the cervical range of motion (ROM).
Results: In our study, the mean age of the patients was 54±7.7 years, and follow-up period
was 20.5±4.6 months. At a one-year follow-up, the mean pre-operative MJOA score
improved from 9.5±1.9 to 14.9±1.1 (p<0.001). Pre-operative axial neck pain was present in
nine patients with a mean VAS score of 4.9±0.8, which improved to 3.7±0.7 (p<0.001) at
three-month follow-up. At the final follow-up, only four patients had axial neck pain with a
mean VAS score of 1.1±1.4.
Conclusion: C3 laminectomy with C4-C7 laminoplasty is a safe, effective technique, which
achieves good neurological improvement and reduces the incidence and severity of postoperative
axial neck pain in the Indian population

Cardiovascular disease is still the leading cause of death. In our tertiary care centre, we
looked at the change in outcomes for anterior ST-elevation myocardial infarction
(STEMI) between January 2017 and December 2021. Over the last five years, 1,658
patients with anterior STEMI who presented to our centre underwent primary
percutaneous coronary intervention within 12 hours of their arrival. We gathered
demographic, clinical, and mortality data during a five-year period and divided it into
four quartiles: 2017-2018 (n=312), 2019 (n=408), 2020 (n=428), and 2021 (n=510).
The average age declined across the four quartiles (64.4, 62, 60.3, and 60 years,
respectively, p<0.01). There was a significant increase in the prevalence of smoking,
hypertension, and obesity in all groups, but no change in diabetes. The median hospital
stay was shorter (6, 4.4, 4.2, and 3.6 days, respectively, p<0.01), as was the median doorto-
balloon time (DBT) (217, 194, 135, and 38 minutes, respectively, p<0.01). Thirty-day
and one-year mortality rates improved over time (14.4, 11.8, 8.4, and 7.8%) and (20.5,
16.4, 15.9, and 13.9 percent) respectively (p=0.01). In addition, 3-year mortality
decreased (25.3, 21.6, 21.3, and 16.5 percent, respectively, p=0.02).Shorter DBT was
associated with lower long-term mortality after adjusting for age, gender, comorbidities,
ejection fraction, clinical shock, and mitral regurgitation (compared to
DBT <60 minutes; 60-90 minutes HR 1.67, 95 percent CI 0.93-3.00, p=0.084; 90-120
minutes, HR 1.74, 95 percent CI 1.02-2.95, p=0.04; >120 minutes, HR 1.91, 95 percent
CI 1.23-2. In conclusion, patients with anterior STEMI have had better long-term
results when DBT has been shortened over the last fiveyears.

The aim of this study was to evaluate the management and outcomes of patients with synovial sarcoma in the extremities.
Material and Methods: 46 patients were included in this retrospective longitudinal study conducted at a tertiary cancer center between 2010 and 2017. There were 29 males with a median age of 21 (7-70) years and 17 females with a median age of 35 (13-50) years. On immune-histochemical staining CD-99 and vimentin stained positive in 100%, and BCL2 Positive in 94 %.
Results: Limb salvage with wide excision was performed in 28 (61%) and amputation was needed in 18(39 %).12 (26%) received neoadjuvant chemotherapy with ifosfamide and Adriamycin-based chemotherapy.  Older Age (>25 years) was associated with lower 5-yeardisease-free survival (p=0.04). The high-grade tumor was associated with lower 5-year disease-free survival (p=0.008). The 5-year disease-free survival in tumor size ≤ 10 cm compared to tumor size >10 cm had no significant difference. The median disease-free survival in the neoadjuvant chemotherapy group as compared to no neoadjuvant chemotherapy was (28.5 vs 21 months) (p>0.05). The adjuvant treatment group and non-adjuvant treatment group had median disease-free survival of 29 months and 11.5 months respectively.
Conclusion: The age of the patient, stage of the tumor, tumor differentiation, and metastatic disease at presentation are risk factors for poor survival for patients with synovial sarcoma. The patients treated with adjuvant radiotherapy or adjuvant chemoradiation had beneficial outcomes as compared to patients who received no adjuvant treatment

State of neurological disorders patients evaluated by the Glasgow Outcome Scale extended. Thus, it may be noted positive clinical and neurological changes of patients who were treated according to our suggested methods – endolumbar introductions of nootropic ozone mixture and endocystal introductions of ozone.