Mrida Jhingan - Academia.edu (original) (raw)

Papers by Mrida Jhingan

Indian Journal of Plastic Surgery, 2014

Indian Journal of Critical Care Medicine, 2019

Background and aim: Thrombocytopenia in pregnancy varies from benign to severe with fetomaternal ... more Background and aim: Thrombocytopenia in pregnancy varies from benign to severe with fetomaternal complications. We aimed to evaluate thrombocytopenia in pregnant Indian females in third trimester mainly during labor and delivery. Materials and methods: It was a prospective observational study done in a tertiary care teaching public hospital over 1 year. Consecutive 150 pregnant patients admitted to labor ward with thrombocytopenia were analyzed for etiology of thrombocytopenia, severity, mode of delivery, type of anesthesia, and fetomaternal complications. SPSS version 17 was used for the analysis. Results: Most common cause of thrombocytopenia was preeclampsia 50 (33.3%) and preeclampsia with hemolysis, elevated liver enzyme, and low platelet count syndrome (HELLP syndrome) 31 (20.7%) together followed by gestational 42 (28%). Infectious causes such as malaria, dengue, and leptospirosis were found in 19 patients (12.7%). Moderate to severe thrombocytopenia was seen in preeclampsia, preeclampsia with HELLP syndrome, and infectious etiology. Eleven patients (7.3%) developed antepartum hemorrhage (APH), 24 (16%) postpartum hemorrhage (PPH), 12 (8%) required ICU admission, and 3 (2%) mortalities were noted. Fifteen neonates (10%) needed ICU admission. Complications were observed in preeclampsia with HELLP syndrome (82%) and infectious causes (18%) and none in gestational. Sixty-eight patients underwent lower segment cesarean section (LSCS), among them 41 (27.3%) were given spinal anesthesia (SA) and none of them developed any neurological complications. Conclusion: Study widened the spectrum of causes for thrombocytopenia in pregnant patients. Preeclampsia with or without HELLP syndrome and vector-borne infections such as malaria, dengue, and leptospirosis were found to be very important causes of moderate to severe thrombocytopenia and were associated with complications. Spinal anesthesia is safe in parturients with mild thrombocytopenia. Awareness and vigilance about thrombocytopenia is vital to reduce maternal morbidity and mortality.

Pleura and peritoneum, Aug 27, 2020

Objectives: Cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy (CRS-HIPEC) for ... more Objectives: Cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy (CRS-HIPEC) for peritoneal malignancies are complex surgeries marked with hemodynamic perturbations, temperature fluctuations, blood loss and metabolic disturbances in the intra-operative and post-operative period. In this report, we highlighted perioperative factors which may have led to cardiac arrest in immediate postoperative period and subsequent successful resuscitation in two patients with high volume peritoneal cancers who underwent CRS-HIPEC. Case presentation: Both patients had a similar clinical course, characterized by massive blood and fluid loss, metabolic derangement, hemodynamic instability, long duration of surgery, post HIPEC rebound hypothermia and hypokalemia which need to be anticipated. Conclusions: We reviewed the literature related to postoperative hypothermia and other major complications after CRS-HIPEC and correlated the available literature with our findings.

International Journal of Medical Research and Review, 2016

Introduction: In the modern era, it is not only the right of every patient to demand best possibl... more Introduction: In the modern era, it is not only the right of every patient to demand best possible medical care in Government runs Hospitals, but it is the moral and legal obligation of every health care provider as well, to deliver his optimum efforts to the entire satisfaction of the patient. Methods: A pre formed questionnaire and personal interview of 350 patients was carried out to determine the level of satisfaction among patients. Results: Most of the patients were found to be more than satisfied in most of the categories of questions asked. Conclusion: Overall assessment of the whole process through this study gave us an opportunity to find loopholes and deficiencies in our services for any future remedial action. The response given by the patients at the end of the data collected enabled us to make any suggestions so as to improve the quality of the services rendered at the hospital.

Indian Journal of Surgical Oncology, Jan 16, 2021

Pleura and Peritoneum, 2020

Objectives Cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy (CRS-HIPEC) for p... more Objectives Cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy (CRS-HIPEC) for peritoneal malignancies are complex surgeries marked with hemodynamic perturbations, temperature fluctuations, blood loss and metabolic disturbances in the intra-operative and post-operative period. In this report, we highlighted perioperative factors which may have led to cardiac arrest in immediate postoperative period and subsequent successful resuscitation in two patients with high volume peritoneal cancers who underwent CRS-HIPEC. Case presentation Both patients had a similar clinical course, characterized by massive blood and fluid loss, metabolic derangement, hemodynamic instability, long duration of surgery, post HIPEC rebound hypothermia and hypokalemia which need to be anticipated. Conclusions We reviewed the literature related to postoperative hypothermia and other major complications after CRS-HIPEC and correlated the available literature with our findings.

Indian Journal of Surgical Oncology, 2021

To the Editor, As the number of coronavirus disease 2019 (COVID-19) cases are rapidly increasing,... more To the Editor, As the number of coronavirus disease 2019 (COVID-19) cases are rapidly increasing, hospitals are finding it progressively difficult to accommodate an increased patient load and provide services, both emergent and elective in nature. During this pandemic, it has become essential to ensure adequate allocation of resources for the management of both COVID19 patients and non-COVID-19 patients, and in particular, patients with cancer. Delayed cancer treatment may lead to an increased risk of disease progression and subsequent, worsening prognosis [1]. The Lancet reported an estimated 59.7% cancer surgeries being postponed in India during the peak 12 weeks of disruption due to the COVID-19 pandemic and lockdown, translating to about 51,100 cancer patients being denied of treatment. This delay in treatment could have led to disastrous consequences, such as increase in the tumor load leading to increased morbidity, inoperability, and eventual palliative intent of treatment [2...

International Journal of Medical Research and Review, Jun 30, 2016

Introduction: In the modern era, it is not only the right of every patient to demand best possibl... more Introduction: In the modern era, it is not only the right of every patient to demand best possible medical care in Government runs Hospitals, but it is the moral and legal obligation of every health care provider as well, to deliver his optimum efforts to the entire satisfaction of the patient. Methods: A pre formed questionnaire and personal interview of 350 patients was carried out to determine the level of satisfaction among patients. Results: Most of the patients were found to be more than satisfied in most of the categories of questions asked. Conclusion: Overall assessment of the whole process through this study gave us an opportunity to find loopholes and deficiencies in our services for any future remedial action. The response given by the patients at the end of the data collected enabled us to make any suggestions so as to improve the quality of the services rendered at the hospital.

Indian Journal of Plastic Surgery, 2014

Indian Journal of Critical Care Medicine

Background: This preliminary randomized controlled study evaluated effect of thoracic epidural bl... more Background: This preliminary randomized controlled study evaluated effect of thoracic epidural block (TEB) on progression of acute pancreatitis induced organ dysfunction/failure. Methods: Patients with predicted severe acute pancreatitis, without contraindication to TEB were randomized to receive (group TE) or not receive a TEB (group NTE) (n = 16 each). For group TE, TEB was performed at T8-9 or T9-10 vertebral level, with infusion of ropivacaine (0.2%) along with fentanyl 2 µg/ml; in group NTE, intravenous morphine was used instead, both interventions titrated to NRS of < 4. SOFA score was assessed daily till discharge from ICU, and aggregate SOFA calculated by summing worst scores for each of organ system during ICU stay as primary outcome measure. Other surrogate measures of patient outcome were recorded as secondary objectives. Results: Aggregate SOFA score was statistically similar between both groups (group NTE: 3 [2-4]; group TE: 5 [2-6]) (P = 0.379); but there was trend of improvement in SOFA score in group TE versus a worsening in group NTE. Duration of hospital stay, and number of patients requiring mechanical ventilation were statistically similar; mortality was insignificantly lesser for group TE (12.5% versus 6.6%; P = 1.000). Fall in serum procalcitonin was significantly greater for group TE. Conclusions: Thoracic epidural was associated with insignificant clinical trend towards better organ functions and lesser mortality; along with significantly greater fall in serum procalcitonin. These are encouraging results that could guide future use of thoracic epidural in acute pancreatitis for its non-analgesic benefits.

Objectives: Cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy (CRS-HIPEC) for ... more Objectives: Cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy (CRS-HIPEC) for peritoneal malignancies are complex surgeries marked with hemodynamic perturbations, temperature fluctuations, blood loss and metabolic disturbances in the intra-operative and post-operative period. In this report, we highlighted perioperative factors which may have led to cardiac arrest in immediate postoperative period and subsequent successful resuscitation in two patients with high volume peritoneal cancers who underwent CRS-HIPEC. Case presentation: Both patients had a similar clinical course, characterized by massive blood and fluid loss, metabolic derangement, hemodynamic instability, long duration of surgery, post HIPEC rebound hypothermia and hypokalemia which need to be anticipated. Conclusions: We reviewed the literature related to postoperative hypothermia and othermajor complications after CRS-HIPEC and correlated the available literature with our findings.

Indian Journal of Plastic Surgery, 2014

Indian Journal of Critical Care Medicine, 2019

Background and aim: Thrombocytopenia in pregnancy varies from benign to severe with fetomaternal ... more Background and aim: Thrombocytopenia in pregnancy varies from benign to severe with fetomaternal complications. We aimed to evaluate thrombocytopenia in pregnant Indian females in third trimester mainly during labor and delivery. Materials and methods: It was a prospective observational study done in a tertiary care teaching public hospital over 1 year. Consecutive 150 pregnant patients admitted to labor ward with thrombocytopenia were analyzed for etiology of thrombocytopenia, severity, mode of delivery, type of anesthesia, and fetomaternal complications. SPSS version 17 was used for the analysis. Results: Most common cause of thrombocytopenia was preeclampsia 50 (33.3%) and preeclampsia with hemolysis, elevated liver enzyme, and low platelet count syndrome (HELLP syndrome) 31 (20.7%) together followed by gestational 42 (28%). Infectious causes such as malaria, dengue, and leptospirosis were found in 19 patients (12.7%). Moderate to severe thrombocytopenia was seen in preeclampsia, preeclampsia with HELLP syndrome, and infectious etiology. Eleven patients (7.3%) developed antepartum hemorrhage (APH), 24 (16%) postpartum hemorrhage (PPH), 12 (8%) required ICU admission, and 3 (2%) mortalities were noted. Fifteen neonates (10%) needed ICU admission. Complications were observed in preeclampsia with HELLP syndrome (82%) and infectious causes (18%) and none in gestational. Sixty-eight patients underwent lower segment cesarean section (LSCS), among them 41 (27.3%) were given spinal anesthesia (SA) and none of them developed any neurological complications. Conclusion: Study widened the spectrum of causes for thrombocytopenia in pregnant patients. Preeclampsia with or without HELLP syndrome and vector-borne infections such as malaria, dengue, and leptospirosis were found to be very important causes of moderate to severe thrombocytopenia and were associated with complications. Spinal anesthesia is safe in parturients with mild thrombocytopenia. Awareness and vigilance about thrombocytopenia is vital to reduce maternal morbidity and mortality.

Pleura and peritoneum, Aug 27, 2020

Objectives: Cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy (CRS-HIPEC) for ... more Objectives: Cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy (CRS-HIPEC) for peritoneal malignancies are complex surgeries marked with hemodynamic perturbations, temperature fluctuations, blood loss and metabolic disturbances in the intra-operative and post-operative period. In this report, we highlighted perioperative factors which may have led to cardiac arrest in immediate postoperative period and subsequent successful resuscitation in two patients with high volume peritoneal cancers who underwent CRS-HIPEC. Case presentation: Both patients had a similar clinical course, characterized by massive blood and fluid loss, metabolic derangement, hemodynamic instability, long duration of surgery, post HIPEC rebound hypothermia and hypokalemia which need to be anticipated. Conclusions: We reviewed the literature related to postoperative hypothermia and other major complications after CRS-HIPEC and correlated the available literature with our findings.

International Journal of Medical Research and Review, 2016

Introduction: In the modern era, it is not only the right of every patient to demand best possibl... more Introduction: In the modern era, it is not only the right of every patient to demand best possible medical care in Government runs Hospitals, but it is the moral and legal obligation of every health care provider as well, to deliver his optimum efforts to the entire satisfaction of the patient. Methods: A pre formed questionnaire and personal interview of 350 patients was carried out to determine the level of satisfaction among patients. Results: Most of the patients were found to be more than satisfied in most of the categories of questions asked. Conclusion: Overall assessment of the whole process through this study gave us an opportunity to find loopholes and deficiencies in our services for any future remedial action. The response given by the patients at the end of the data collected enabled us to make any suggestions so as to improve the quality of the services rendered at the hospital.

Indian Journal of Surgical Oncology, Jan 16, 2021

Pleura and Peritoneum, 2020

Objectives Cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy (CRS-HIPEC) for p... more Objectives Cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy (CRS-HIPEC) for peritoneal malignancies are complex surgeries marked with hemodynamic perturbations, temperature fluctuations, blood loss and metabolic disturbances in the intra-operative and post-operative period. In this report, we highlighted perioperative factors which may have led to cardiac arrest in immediate postoperative period and subsequent successful resuscitation in two patients with high volume peritoneal cancers who underwent CRS-HIPEC. Case presentation Both patients had a similar clinical course, characterized by massive blood and fluid loss, metabolic derangement, hemodynamic instability, long duration of surgery, post HIPEC rebound hypothermia and hypokalemia which need to be anticipated. Conclusions We reviewed the literature related to postoperative hypothermia and other major complications after CRS-HIPEC and correlated the available literature with our findings.

Indian Journal of Surgical Oncology, 2021

To the Editor, As the number of coronavirus disease 2019 (COVID-19) cases are rapidly increasing,... more To the Editor, As the number of coronavirus disease 2019 (COVID-19) cases are rapidly increasing, hospitals are finding it progressively difficult to accommodate an increased patient load and provide services, both emergent and elective in nature. During this pandemic, it has become essential to ensure adequate allocation of resources for the management of both COVID19 patients and non-COVID-19 patients, and in particular, patients with cancer. Delayed cancer treatment may lead to an increased risk of disease progression and subsequent, worsening prognosis [1]. The Lancet reported an estimated 59.7% cancer surgeries being postponed in India during the peak 12 weeks of disruption due to the COVID-19 pandemic and lockdown, translating to about 51,100 cancer patients being denied of treatment. This delay in treatment could have led to disastrous consequences, such as increase in the tumor load leading to increased morbidity, inoperability, and eventual palliative intent of treatment [2...

International Journal of Medical Research and Review, Jun 30, 2016

Introduction: In the modern era, it is not only the right of every patient to demand best possibl... more Introduction: In the modern era, it is not only the right of every patient to demand best possible medical care in Government runs Hospitals, but it is the moral and legal obligation of every health care provider as well, to deliver his optimum efforts to the entire satisfaction of the patient. Methods: A pre formed questionnaire and personal interview of 350 patients was carried out to determine the level of satisfaction among patients. Results: Most of the patients were found to be more than satisfied in most of the categories of questions asked. Conclusion: Overall assessment of the whole process through this study gave us an opportunity to find loopholes and deficiencies in our services for any future remedial action. The response given by the patients at the end of the data collected enabled us to make any suggestions so as to improve the quality of the services rendered at the hospital.

Indian Journal of Plastic Surgery, 2014

Indian Journal of Critical Care Medicine

Background: This preliminary randomized controlled study evaluated effect of thoracic epidural bl... more Background: This preliminary randomized controlled study evaluated effect of thoracic epidural block (TEB) on progression of acute pancreatitis induced organ dysfunction/failure. Methods: Patients with predicted severe acute pancreatitis, without contraindication to TEB were randomized to receive (group TE) or not receive a TEB (group NTE) (n = 16 each). For group TE, TEB was performed at T8-9 or T9-10 vertebral level, with infusion of ropivacaine (0.2%) along with fentanyl 2 µg/ml; in group NTE, intravenous morphine was used instead, both interventions titrated to NRS of < 4. SOFA score was assessed daily till discharge from ICU, and aggregate SOFA calculated by summing worst scores for each of organ system during ICU stay as primary outcome measure. Other surrogate measures of patient outcome were recorded as secondary objectives. Results: Aggregate SOFA score was statistically similar between both groups (group NTE: 3 [2-4]; group TE: 5 [2-6]) (P = 0.379); but there was trend of improvement in SOFA score in group TE versus a worsening in group NTE. Duration of hospital stay, and number of patients requiring mechanical ventilation were statistically similar; mortality was insignificantly lesser for group TE (12.5% versus 6.6%; P = 1.000). Fall in serum procalcitonin was significantly greater for group TE. Conclusions: Thoracic epidural was associated with insignificant clinical trend towards better organ functions and lesser mortality; along with significantly greater fall in serum procalcitonin. These are encouraging results that could guide future use of thoracic epidural in acute pancreatitis for its non-analgesic benefits.

Objectives: Cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy (CRS-HIPEC) for ... more Objectives: Cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy (CRS-HIPEC) for peritoneal malignancies are complex surgeries marked with hemodynamic perturbations, temperature fluctuations, blood loss and metabolic disturbances in the intra-operative and post-operative period. In this report, we highlighted perioperative factors which may have led to cardiac arrest in immediate postoperative period and subsequent successful resuscitation in two patients with high volume peritoneal cancers who underwent CRS-HIPEC. Case presentation: Both patients had a similar clinical course, characterized by massive blood and fluid loss, metabolic derangement, hemodynamic instability, long duration of surgery, post HIPEC rebound hypothermia and hypokalemia which need to be anticipated. Conclusions: We reviewed the literature related to postoperative hypothermia and othermajor complications after CRS-HIPEC and correlated the available literature with our findings.