Trends in Clinical and Medical Sciences

Abstract:Background: Smoking is currently the most preventable cause of diseases and death worldwide and is one of the causative risk factors for developing cancer in different organs. Therefore, smoking patients must be carefully monitored for alterations in buccal mucosa caused by tobacco abuse.
Aim and Objective: The aim of the study is to investigate cytological changes in buccal mucosa cells and establish a correlation with the morphometric analysis of mouth opening among smokers and non-smokers.
Materials and Methods: A comparative study was conducted on 200 individuals aged between 20 and 60 years. The subjects were randomly chosen from inpatients and outpatients of the Medicine Department at Index Medical College and Hospital. Buccal smears of these patients were processed in the Department of Anatomy.
Results: Significant differences were observed between non-smokers and smokers for cells with binucleation, pyknosis, perinuclear halo, cytoplasmic granules, karyolysis, karyorrhexis, and micronuclei in buccal mucosal cells. However, no significant difference was found for cytoplasmic vacuoles between non-smokers and smokers. Similar studies have reported findings consistent with our non-smoking population.
Conclusion: The present study indicates that almost all cytomorphological findings were higher in smokers than in non-smokers. Early detection of oral cancers becomes complex as they are mostly innocuous and asymptomatic during their initial stages. Cytomorphometric analysis can be used regularly to detect these cell alterations.

Abstract:Childhood constipation is a prevalent issue globally. Certain children experience persistent constipation and soiling, either as a result of surgical repair of anorectal malformations or underlying medical conditions that present management challenges. These refractory cases of constipation significantly affect the psychological well-being of both patients and their families. The available treatment options for refractory constipation are not clearly established. However, prompt and appropriate management of constipation contributes to an enhanced health-related quality of life. This article explores the current modalities available for treating children with challenging constipation and examines their impact on health-related quality of life.

Abstract:Context: HIV/AIDS is known to affect an individual not only physically but also mentally, socially, and financially. It is a syndrome that builds a vacuum in a person affecting his/her life as a whole. Quality of life (QOL) of human immunodeficiency virus/acquired immuno deficiency syndrome (HIV/AIDS) patients has emerged as a significant medical outcome measure in recent times.
Aims: The purpose of the present observational study is to evaluate the quality of life (QOL) of people living with HIV/AIDS (PLHIV) receiving ART and its association with different social and clinical variables.
Materials and Methods: 140 patients of \(\geq\)18 years with HIV attending the tertiary level ante-retroviral treatment (ART) center were interviewed with using a validated standard version of the World Health Organization QOL (WHO-QOL BREF). Data on sociodemographic and clinical profile e.g., BMI, and CD4 were gathered. Mean scores were calculated in each domain. Descriptive statistics, independent t test, ANOVA and logistic regression were done to analyze the results.
Results: The overall QOL score of the subjects was moderate; Mean quality of life score was highest in the environmental domain (Mean=13.2\(\pm\)4.2). PLHIV with lower BMI also had poorer QOL (P<0.05). Employment significantly affected the social health domain and psychological domains of the subjects. Men reported poorer level of independence and physical health while women reported poorer social relationships and environment. All the six domains correlated significantly with the overall QOL indicated by the G-facet.
Conclusion: Attention toward improving the social status by enhancing sociopsychological supports such as social sensitization, mental health care of patients, and interventions to reduce stigma of PLHIV should be accorded with high priority to ensure improvement in the overall QOL of PLHIV.

Abstract:Introduction: Cheiloscopy is the study of furrows and grooves present on the red part, or the vermilion border of the human lips. The type of grooves is unique to an individual and can be used for person identification.
Aim: The aim of this study is to ascertain whether the uniqueness of lip print (LP) can help in identifying a person. In addition, we aimed to evaluate whether there is any correlation between LP types and blood groups.
Materials and Methods: A cross-sectional study was conducted on 100 participants (51 males and 49 females), aged between 18 and 50 years, to determine any correlation between LP types and blood groups. These lip patterns were analyzed and interpreted using Tsuchihashi’s classification, and later, associated blood group matching was performed to determine the predominant LP type with the ABO and Rh blood grouping system.
Results: The present study showed a positive correlation between LP pattern and blood group among males and females. Thus, the distribution of LP patterns and ABO blood groups might help in the identification of an individual.
Conclusion: Since LP and blood group are unique to a person, cheiloscopy, along with blood group, can play a vital role in person identification.

Abstract:Introduction: In 2019, a new coronavirus disease spread throughout the world from the city of Wuhan, China. COVID-19 is divided into four groups according to clinical symptoms and disease severity: mild, moderate, severe, and critical. Budgeted rates of CRP and albumin utilization will be used to estimate the incidence of COVID-19 cases. Based on this data, the aim of this study is to evaluate the diagnostic power of the C-reactive protein to albumin ratio in the early differentiation of severe hospitalized cases of COVID-19.
Materials and Methods: During hospitalization, cases will be classified as mild, moderate, severe, and critical according to the WHO interim guidance. The mild and moderate subgroups will be classified as non-severe (group 1), and the severe and critical subgroups will be classified as severe (group 2). Demographic data, morbidity, and mortality rates will be recorded.
Results: The exitus rates and length of hospital stay were significantly higher in group 2.
Conclusions: The C-reactive protein/albumin ratio has predictive value in severe COVID-19 patients who are candidates for ICU admission or endotracheal intubation. However, it is thought that supporting this data with a larger number of patients and multicenter studies would increase the value of the data.

Abstract:Background: Mucocutaneous lesions are the most prevalent sign of HIV infection and serve as the first clue that HIV is present. They are important indications of a patient’s immunological health, and HIV-infected patients typically experience more severe, unusual, and extensive symptoms.
Objectives: To investigate the prevalence and spectrum of mucocutaneous manifestations in patients with HIV infection, and to determine the relationship between these manifestations and CD4 cell counts as an indicator of immunological health.
Materials and Methods: The study was conducted at a tertiary care Medical College and Hospital in Cuttack. Patients were enrolled from two centers, the Dermatology outdoor and Anti Retro Viral Therapy Centre, within the hospital. The mucocutaneous manifestations were classified, and CD4 cell counts were determined through collected samples to assess their immune status.
Results: The most common disorders were fungal infections (18%), followed by oral lesions (15.5%), and Papulosquamous disorder (14.8%). Out of 150 patients, 53 patients had 165 dermatological manifestations with a CD4 count below 200 cells/\(mm^3\), 85 patients had 105 dermatological manifestations with a CD4 count between 200-500 cells/\(mm^3\), and 12 patients had 14 dermatological manifestations with a CD4 count of more than 500 cells/\(mm^3\).
Conclusion: Both CD4 count and mucocutaneous manifestations can be used as markers of immunosuppression in HIV/AIDS patients. In resource-poor countries where CD4 count and other expensive markers are not affordable, mucocutaneous manifestations alone can be used as a marker of immunosuppression.

Abstract:Aim: This study aims to investigate the clinical changes in the ocular surface of patients diagnosed with type II diabetes mellitus.
Methodology: A total of 75 adult patients of both genders with type II diabetes and ocular surface disease, along with a group of healthy subjects, were included in the study. Various tear film stability tests such as tear film break-up time (BUT) test, Schirmer I test, fluorescein dye test, and rose bengal dye test were conducted to assess ocular surface disorders. Additionally, the Ocular Surface Disease Index (OSDI) questionnaire was administered to all enrolled patients. The duration of diabetes, HbA1C levels, and the stage of diabetic retinopathy were also recorded.
Results: Group I comprised 45 males and 30 females, while group II included 35 males and 40 females. Non-proliferative diabetic retinopathy (NPDR) was present in 48 patients, whereas proliferative diabetic retinopathy (PDR) was present in 19 patients, showing a significant difference (P=0.01). The remaining diabetic patients did not exhibit any clinically observable fundus changes of retinopathy during stereoscopic 90 D examination. The average tear function test was 8.22 seconds in group I and 13.1 seconds in group II, whereas the average Schirmer test values were 8.84 mm in group I and 16.5 mm in group II. Fluorescein staining was observed in 8 patients in group I and 2 patients in group II, while pathologic rose bengal staining was positive in 15 patients in group I and 4 patients in group II, demonstrating a significant difference (P<0.05). The average tear film BUT was 9.25 seconds in patients with a duration of diabetes <10 years and 8.17 seconds in those with a duration of diabetes >10 years. Similarly, the average Schirmer test revealed values of 10.31 mm and 6.72 mm, respectively. Patients with good glycemic control exhibited average tear film BUT and Schirmer test values of 10.85 seconds and 10.21 mm, while those with poor glycemic control showed values of 8.30 seconds and 6.82 mm, respectively. In patients with NPDR, the values were 9.53 seconds for tear film BUT and 10.5 mm for the Schirmer test, whereas patients with PDR had values of 7.84 seconds and 7.6 mm, respectively. The average range of OSDI score was 40-60 in group I compared to 0-20 in group II.
Conclusion: Patients diagnosed with diabetes mellitus are more susceptible to developing ocular surface disorders. Furthermore, a longer duration of diabetes and poor glycemic control are associated with increased chronic inflammation of the ocular surface. The stage of diabetic retinopathy shows a direct correlation with the OSDI questionnaire score.

Abstract:Background: Hypothyroidism manifests itself in a wide range of clinical manifestations. ECG and ECHO changes have been reported among patients with both subclinical and manifest hypothyroidism.
Objectives: To enumerate the cardiological manifestations of hypothyroidism in ECG and ECHO.
Methods: The study was carried out as a cross-sectional study comprising 50 patients aged 18 years and above, of both sexes who were detected to have hypothyroidism. A convenient non-random sampling technique was used to select study participants from all eligible patients in the study population. The diagnosis of hypothyroidism was confirmed by measuring serum TSH, total T3 and T4, and subsequently, patients underwent ECG and echocardiography. A p-value <0.05 was considered statistically significant.
Results: It was observed that the majority of the study patients belonged to the middle age group and were females. Overt hypothyroidism was noted in 78%, and low levels of T3 and T4 were observed in 64% and 78%, respectively. Most of the study patients had elevated triglyceride levels (96%), while ECG and ECHO abnormalities were detected in 30%. Low voltage complex was the most commonly noted ECG abnormality (8%), and left ventricular diastolic dysfunction (LVDD) was the most common ECHO abnormality (18%).
Conclusions: ECG and ECHO changes are observed in a considerable proportion of patients with hypothyroidism, with low voltage complexes and LVDD being the most common, respectively.

Abstract:The pathogenesis of autoimmune diseases (AD) is based on the “recognition of the body’s own structures by immunocompetent cells and subsequent activation, proliferation, and induction of inflammation. Most lymphocytes directed towards their own antigens are removed in the thymus through apoptosis.” Currently, research is being conducted to investigate the genes involved in the development of autoimmune diseases, specifically in the context of vitiligo, such as HLA genes (HLADR3 associated with a common process, HLADR4 with limited), TNFAIP3 genes, and A20 deficiency haplotype (a product of this gene). The importance of immune inflammation, mononuclear infiltration of marginal zones, and the cytotoxic effect of CD8+ on melanocyte changes in CD4, CD8, and their ratios have been identified as early indicators of vitiligo progression. A local deficiency of SOD, glutathione, and scavengers from ROS regulated through Nrf2 and ARES in the skin and blood of vitiligo patients has also been revealed. This study included 287 patients with non-segmental vitiligo (148 men and 139 women) aged 19-68 years who sought treatment at the Republican Specialized Scientific and Practical Medical Center of Dermatovenerology and Cosmetology between 2018 and 2022. The average age was 28.1\(\pm\)1.3 years, and the duration of the disease was 42.6\(\pm\)3.6 months. Of these patients, 114 (40%) had the debut of vitiligo less than a year before treatment. The study found that the average level of TNF-alpha was higher than the reference interval and the data of the control group, supporting the contribution of inflammation and apoptosis to depigmentation in vitiligo. The study also highlighted the levels of TNF-alpha and IL-21 in patients who had an unfavorable allele for the SNPs among the other patients in the main group.

Abstract:This article discusses the feasibility of using lightweight polypropylene nets for onlay plastic surgery of postoperative ventral hernias (POVH). The study involved 137 patients with POVH, who were divided into two groups: the control group (64 patients) who underwent traditional Esfil-heavy mesh endoprosthesis and the primary group (73 patients) who received Esfil-light endoprostheses. The study investigated the clinical and immunological aspects of using propylene nets in these two groups of patients. Before surgery, the examined patients showed a suppression of the cellular link of immunity, an imbalance of the humoral link, and non-specific factors of protection. The use of polypropylene meshes (Esfil-light and Esfil-heavy) triggered an inflammatory reaction associated with the structural properties of the prostheses. However, the use of Esfil-light PP prosthesis in onlay allogernioplasty caused less inflammation in the alloplasty area compared to Esfil-heavy. Overall, the findings suggest that Esfil-light PP prosthesis can be a suitable alternative to traditional Esfil-heavy mesh endoprosthesis for onlay plastic surgery of postoperative ventral hernias. The reduced inflammatory reaction in the alloplasty area may lead to improved outcomes for patients undergoing this procedure.

Abstract:Background: Hypertension affects individuals of all classes and across all groups. The relationship between blood pressure and the risk of cardiovascular disease events is continuous and independent of other risk factors.
Aim and Objectives: The present study aimed to identify various modes of presentation and the clinical profile of hypertensive emergencies in our hospital.
Materials and Methods: Data were collected from 100 patients admitted to this hospital over a period of two years. Patients who presented with an elevated blood pressure of systolic blood pressure >180mmHg or diastolic blood pressure >110mmHg, with a history of acute target organ damage, or with laboratory evidence of acute target organ damage were included in the study.
Results: Of the 100 patients studied, 88 were known hypertensives, among whom 54 had discontinued their antihypertensives before the incident, while the remaining 46 patients continued their medication. Among the 100 patients, 28 had diabetes mellitus and 28 had dyslipidemias. Out of 100 patients with hypertensive emergencies, 12 died before discharge, resulting in a hospital mortality rate of 12%. All expired patients had intracerebral hemorrhage.
Conclusion: Known hypertensives are at a higher risk of presenting with acute target organ damage associated with hypertensive emergency. The presence of diabetes mellitus and dyslipidemia increases the chance of developing hypertensive emergencies.

Abstract:In modern education, innovative techniques and updated technology are essential tools for effective teaching. As the medical field advances, new teaching methods and modalities are necessary to generate interest and provide practical learning experiences. Histology is a crucial component of medical education, and a thorough understanding of both the theory and slide recognition is necessary for medical students. This study aimed to investigate the intervention of Basic Pathology into Histology and its impact on First MBBS students’ response. The study involved 81 students from SKIMS Medical College in the Department of Anatomy and Pathology, who were administered a questionnaire. The results showed that students appreciated the integration of pathological perspectives with normal histology and found the combined approach useful and relevant. The study highlights the importance of practical teaching methods and the need for continuous improvement in teaching and assessment methods in medical education.

Abstract:Background: Diabetes mellitus is a serious public health issue globally, and India is no exception to its growing prevalence in many emerging nations. In the near future, India will emerge as the global capital of diabetes.
Objective: The objective of this study is to investigate ocular surface changes and ocular surface disorders in patients with diabetes mellitus.
Methods: This cross-sectional observational study was conducted among all known cases of diabetes mellitus aged over 40 years, attending the eye outpatient department and diabetic clinic at Dr. Sushila Tiwari Government Hospital, Haldwani, Nainital.
Results: The mean age of diabetic patients was 60.82\(\pm\)10.23 (41-79) years. The majority of cases were female (59.7%), followed by males (40.3%). The rural population (56%) was more affected by ocular surface disorders in patients with type II diabetes mellitus than the urban population (44%). Homemakers (50.2%) were the largest group, followed by outdoor workers (30.8%), office workers (12%), and factory workers (7%). Itching was present in 22.0%, lacrimation in 54.8%, burning in 66.8%, foreign body sensation in 85.6%, and blurring of vision in 53.2%.
Conclusions: This study establishes a causal relationship between ocular surface disorder and diabetes mellitus.

Abstract: Background: Beta-thalassemia syndromes are a category of genetic blood disorders defined by reduced or incomplete beta globin chain synthesis, leading to lower hemoglobin levels in red blood cells (RBC), lower RBC output, and anemia.
Aims and objectives: To study the growth pattern in thalassemic children who are on regular chelation therapy and blood transfusion in comparison to normal children and serum ferritin level in these children and its relation to growth pattern and oral chelation therapy.
Methods: The present study was a hospital-based cross-sectional study. One hundred and one transfusion-dependent thalassemic children on oral chelation therapy, attending the pediatric ward in Gauhati Medical College and Hospital, Guwahati, Assam, were enrolled during the study period from 1st May 2021 to 30th April 2022.
Results: This study provides evidence that children suffering from transfusion-dependent thalassemia (TDT) are prone to growth retardation, with underweight, stunting, and wasting being 31.6%, 52.4%, and 27.7%, respectively.
Conclusion: In conclusion, short stature is an important complication in TDT. Growth in patients with TDT is significantly related to age, sex, hemoglobin level, and iron overload status. Management with hypertransfusion and good control of iron overload is important to achieve optimum growth in patients with TDT.

Abstract: Introduction: Human papillomavirus causes many diseases like genital warts, sexual transmitted diseases; cervical cancer. Human papilloma virus vaccine is available for adolescent girls. Though it is effective its use has not increased. Therefore, the current study is designed to determine the awareness, acceptance and hesitancy among nursing students.

Abstract: Background: Pregnancy increases the demand for nutrients and hemoglobin. Besides these, physiological changes in blood parameters also occurs during pregnancy. Anemia in pregnancy is a serious condition contributing to increased maternal and fetal morbidity and mortality. Present study has been undertaken with the knowledge of hemoglobin values and its distribution in different trimesters of pregnancy.
Material and Methods: Present study was single-center, prospective, comparative, parallel-group, observational study, conducted in pregnant women attended the ANC OPD or admitted in antenatal ward and sixty healthy non-pregnant women of same age group.
Results: The mean hemoglobin value was \(12.23\pm1.32 gm\) % throughout pregnancy. In control group the mean value was \(12.59 \pm 2.50 gm\)%. Statistically significant variation was observed between control and each trimester of pregnancy \((p<0.05)\). Significant difference observed between 1st and 2nd trimester \((p < 0.05)\) and 2nd and 3rd trimester \((p < 0.05)\). When compared between 1st and 3rd trimester, difference was not significant \((p>0.05)\) Hemoglobin values are lower in pregnant cases as compared to non-pregnant subjects \((p<0.05)\). Lowest hemoglobin value is observed in 2nd trimester in maximum number of cases. Mean hemoglobin level was found lower in pregnant women with gravidity more than 1 as compared to primigravidae.
Conclusion: A significant association was observed between hemoglobin level and trimester of pregnancy. High occurrence of low hemoglobin level in pregnant women was found belonging to lower socioeconomic class. Maternal hemoglobin value decreases with increase in gestational age.

Abstract: Aims: Mucormycosis is an acute invasive fungal infection which is rare, opportunistic and can potentially cause fatal complications. This study aimed to evaluate demographic data, disease presentation, medical &/or topical, surgical treatment.
Material and methods: Total twenty five patients with mucormycosis treated at tertiary care hospital in Gujarat during three months duration from May to July 2021. After detailed history thorough Ear, Nose and throat examination was performed. Along with local examination, ophthalmologic and neurologic examination performed in every case. After Functional endoscopic sinus surgery, tissue sent for histopathologic examination.
Results: Twenty five patients diagnosed with Mucormycosis, 18(72%) patients were males and 7(28%) were females. All 25(100%) had past history of COVID 19 infection and Diabetes Mellitus. Out of 25, 23(92%) patients were treated with intravenous or oral steroids and 2(8%) patients were not treated with any steroids. MRI paranasal sinuses with orbit with brain cuts performed for all 25 patients after suspicion of mucormycosis. 12(48%) patients had Sinonasal involvement, 11(44%) were Rhino-orbital involvement, and 2(8%) had Rhino palatal involvement. All 25(100%) patients were given Injection Amphotericin B for 3-4 weeks according to response. 6(24%) Patients were also given Oral Posaconazole. We performed Functional endoscopic sinus surgery in 23(92%) patients. In two (8%) cases Sinus surgery performed along with Maxillectomy. All 25(100%) cases on histopathology confirmed of Mucormycosis.
Conclusion: Prognostic factors we observed in our study were involvement of rhino-orbito-cerebral disease shows poor prognosis. Good Diabetes control showed early recovery. Early identification and early treatment improves prognosis as well as survival rates.

Abstract: Background: Cervical cancer is a major cause of mortality in women. Pap smear is a screening test used in the screening of cervical cancer. There are well defined guidelines regarding its use. It should be offered to all sexually active women between the ages of 30-65 years, irrespective of whether or not they are symptomatic. Moreover, those women who have undergone hysterectomy for reasons other than cervical cancer or precancerous lesions, do not require this test.
Materials and methods: We undertook an observational study to describe the age, presenting complaint, previous history of hysterectomy and reason for hysterectomy in women undergoing Pap smear testing in a private super speciality hospital in Central India in the past 3 years.
Objectives: The objective of this study was to examine how closely the aforementioned guidelines were being followed, so as to deduce how wisely were we choosing the women to whom the test was being offered.
Results: This study found that a significant proportion of tests were being offered to women who did not need them. And more importantly, we were missing the opportunity to screen women who presented with non gynaecologic complaints in our hospital.

Abstract: Background: To assess clinico-pathological study of colonic biopsies.
Materials and methods: One hundred ten colonic biopsies obtained from Gastroenterology department were collected in 10% neutral buffered formalin processed and embedded with the mucosal surface being uppermost. 4\(\mu\) thick serial sections were prepared and stained with H&E. Detailed study of the sections was done under light microscope and diagnosis rendered accordingly.
Result: Age group 11-20 years had 8, 21-30 years had 22, 31-40 years had 40, 41-50 years had 24 and >50 years had 16 cases. The difference was non- significant (\(P> 0.05\)). Most common clinical features were constipation seen in 36, bleeding PR in 28, bleeding PR weakness in 17, diarrhea in 16 and diarrhea \(+\) pain abdomen \(+\) weakness in 14 patients. The difference was non-significant (\(P> 0.05\)). Non-neoplastic lesions were 74. These were as non-specific colitis in 22, ulcerative colitis in 16, acute inflammation in 14, hyperplastic polyp in 10, inflammatory polyp in 6, retention polyp in 4 and endometriosis in 2 cases. Neoplastic benign lesions were 25. Benign spindle cell lesion was in 3, tubular adenoma in 15, villous adenoma in 5 and tubulovillous adenoma in 2 cases. Neoplastic malignant lesions were well differentiated adenocarcinoma seen in 4, moderately differentiated adenocarcinoma in 6, poorly differentiated adenocarcinoma in 2 and signet ring cell carcinoma in 1 case.
Conclusion: Colonoscopy is a simple and a safe procedure. It helps in assessing the lesions clinically and confirming histopathologicaly through guided biopsy. Colonoscopic biopsies also play a key role not only in diagnosis, but also in follow up and treatment.

Abstract:Bacterial bloodstream infections are important causes of morbidity and mortality, globally. The aim of the present study was to determine the bacterial profile of bloodstream infections and their antibiotic susceptibility pattern among the patients admitted to ICU at a tertiary care hospital.This prospective study was conducted over a period of eighteen months. Inclusion criteria comprised of patients admitted to ICU who belonged to either gender and were in the age group of 15-60 years. Over the course of study, 30 out of total 140 blood culture samples were identified to be culture positive (18 GNB and 11GPB). The most common Gram-positive isolate was Staphylococcus spp (26%) while Escherichia coli was the most common gram negative isolate (36%).Escherichia coli expressed highest resistance to all the drugs but sensitivity to Meropenemand Polymyxin B was 72% and 90%, respectively. High degree of resistance was noted to cephalosporins and piperacillin -tazobactam, among all the groups. The study indicated high level of antimicrobial resistance among Gram negative bacilli, esp E.Coli and justifies the need for antimicrobial stewardship to prevent development of further resistance.

Abstract: Background and Aim: Chronic cancer pain is one of the major challenges of palliative care and it is prevalent in 80\% of all the gastric and pancreatic malignancies. Adequate pain relief not only improves the drug compliance, but also alleviates depression among the cancer patients, thereby improving the quality of life. This study was carried out with the aim of evaluating the role of Coeliac Plexus ethanol Neurolysis (CPN) in pain relief among patients with gastric and pancreatic malignancy.
Methods and materials: This is an uncontrolled before-and-after non randomized trial. This bedside procedure was done in an ICU in chronic pain management centre. Trial coeliac plexus block was done after identification of coeliac trunk using ultrasound and 15 cc of 1% xylocard was given. After 30 minutes, pain relief was assessed with Numerical Rating Scale for pain (NRS). Patient was then given 20ml of 60% ethanol. Pain relief was documented using NRS immediately at 24hours, 72 hours,1 week and 3 months. Statistical analysis was done using Statistical Package for the Social Sciences version (SPSS) version 16.0. Paired t test was used to analyze the difference between variables.
Results: Our study shows statistically significant difference between pre-NRS and post immediate-NRS (mean 8.26\(\pm\)0.52 and 3.40 \(\pm\)0.47)(P value \(<0.0001\)) and significant decrease in NRS seen after 24 hours,72 hours,1 week and 3 months.
Conclusion: USG guided anterior approach coeliac plexus ethanol neurolysis is effective in decreasing pain associated with gastric and pancreatic malignancy.

Abstract: Background: With an estimated 13.3 million cases each year, acute kidney injury (AKI) become a problem for world health. India has a high prevalence of AKI following volume depletion from gastrointestinal fluid loss. Due to poor socioeconomic situations, limited access to care, lack of awareness of personal cleanliness, crowding, and climatic factors that encourage the spread of infection, diarrheal illnesses are widespread in India. AKI following gastroenteritis is probably caused by a lack of medical facilities in rural areas and a delay in treating dehydration. Therefore, in order to come up with solutions to this issue, it is necessary to comprehend the disease’s clinical spectrum.
Materials and Methods: This is a prospective observational study conducted on 50 patients with AKI due to Acute Gastroenteritis admitted to Narayana medical college \& hospital, Nellore, Andhra Pradesh, over a period of 1 year. The diagnosis of acute kidney injury was used when there was evidence of kidney injury in some clinical settings without any kidney disease history. The term acute kidney injury was used when there was a rise in Serum creatinine \(\geq44 \mu mol/L (\geq0.5mg/dL)\) and the history of decreased urine output of less than \(0.5ml/kg/hr\) for more than 6hrs. The criteria used for AKI in the study was Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE) criteria (given by Acute Dialysis Quality Initiative Group 2004) and is as follows.
Results: Pre Renal Azotemia, which occurred in 58% of cases, was followed by Acute Tubular Necrosis, which occurred in 42% of cases in this study. The pre-renal group’s mean age was \(49.3 + 5.66\) years, while the ATN group’s was \(48.6 + 7.40\) years. The mean age of those who survived was 46.73 4.75, while that of those who did not survive was 65 6.034. On admission, Baseline creatinine with a mean of \(3.032+0.37mg/dl\). It was \(2.70+0.29\) and \(3.48\pm0.77\) inpre-renal and Acute Tubular Necrosis (ATN) groups. The mean peak creatine was \(4.73+0.48mg/dl\). It was 4.13+ 0.59 in pre-renal and 5.56\(\pm\) 0.66 in ATN groups, respectively. The Mean creatinine at the time of discharge 2.87 \(\pm\) \(0.39mg/dl\). The mean peak creatinine was 2.42 \(\pm\) 0.33 in pre-renal & 3.48+0.42 in ATN groups (In survivors) and 4.11\(\pm\) 0.79 in non-survivors.
Conclusion: Replacement of lost fluids, correction of electrolyte imbalances, and delivery of the proper antibiotics made up the course of treatment. Due to the frequent incidence of hypokalemia, ARF brought on by gastroenteritis differs from other ARF and has a better prognosis. An significant electrolyte disruption in AKI brought on by gastroenteritis is hypokalaemia. It was determined that the primary factor leading to death in AKI caused by gastroenteritis is septicemia.

Abstract: Background: Awake brain surgery is used to treat brain tumors and epileptic seizures near areas that control language, movement or cognition, movement disorder, and recently during neurovascular surgery.
Methods: Preoperative airway evaluation should be performed in all patients. There are two commonly used anesthetic methods for awake craniotomy: monitored anesthesia care (MAC) and asleep-awake-asleep (AAA) technique, after the tumor resection, sedation is often sufficient until completion of the surgery. In our institution at Mount Lebanon hospital-Balamand university hospital, the combination of propofol and remifentanil has been considered as the standard protocol for sedation during the first stage of awake craniotomy because of the ease of use and reliability. The application of neuro-navigation, and intraoperative electrical mapping are a reliable method to minimize the risk of permanent deficit during surgery for brain tumors in eloquent areas.
Results: Whether sedation or an asleep-awake-asleep technique is chosen, it is crucial to apply adequate local anaesthesia on the skin incision what we call elliptic block using combinations of lidocaine and bupivacaine with epinephrine. If we perform awake-asleep-awake anesthesia type than similar to the pre-awake phase, one can also choose awake, spontaneous ventilation under light or deep sedation, or GA with airway control. Sedation often suffices. The patient usually requires lower rates of sedative infusions during the postawake phase than during the pre-awake phase as patients are often fatigued, and there is a lower level of painful stimuli during skull closure.
Conclusion: Patients receiving awake craniotomy have better outcomes in many aspects. The improvements in anesthetic agents and techniques, the application of neuro-navigation, and intraoperative electrical mapping are a reliable method to minimize the risk of permanent deficit during surgery. Appropriate patient selection, perioperative psychological support, and proper anesthetic management for individual patients in each stage of surgery are crucial for procedural safety, success, and patient satisfaction.

Abstract: Background: The Baricity of bupivacaine is one of the most important factors in influencing the distribution of the local anaesthetic and the spread of the blockade. Bupivacaine is rendered hyperbaric by adding glucose. The effect of differing degrees of hyperbaricity remains to be evaluated regarding spinal anesthesia blockade.
Methods: Hundred patients who underwent lower abdominal, hips, and lower extremity surgeries were randomized into two groups in a double-blind, randomised, parallel-group, prospective study. Group I received 0.5% isobaric bupivacaine with 80 mg/ml of glucose, while Group II received 0.5% isobaric bupivacaine with 40 mg/ml of glucose. The injection was made intrathecally in the midline position at L3-4 and L4-L5 interspace in the sitting position. The measured sensory blockade and motor blockade are the onset and duration. Duration of sensory block was the time measured from the time of the highest block for the regression to the S2 dermatome.
Results: Success rate, spread, and duration of sensory block were similar in both groups. The highest median level of sensory block was T3 (T2-T7) (median (10th/90th percentiles)) in both groups. The time to reach T10 did not differ between the groups. Power analysis suggested that a total number of 100 adults were required in both groups for a 90% chance at the 0.05 level of significance of detecting a 10% difference in success between groups. Categorical data were tested using the chi-square test. For continuous data, the Mann-Whitney test was used. Results are presented as median (10-90\(^{th}\) percentiles), number (%) of cases ,the significance was set as \(P< 0.05.\)
Conclusion: These results demonstrate that bupivacaine in 80mg/ml glucose provides reliable spinal anaesthesia of shorter duration and with less hypotension than bupivacaine in 40 mg/ml glucose. The recovery profile for ropivacaine may be of interest given that more surgery is being performed in the day-case setting.

Abstract: Subjects and methods: A prospective, monocentric clinical trial study was conducted at Mount Lebanon Hospital (MLH) between November 2018 and November 2021. After getting approval from the ethical committee, 237 patients were enrolled on a ratio of 1 to 2 in two groups: the first receiving Oxycodone 5 mg IVP with Zofran 4 mg IVD and the second receiving Morphine 5 mg IVP with Zofran 4mg IVD. Pearson’s Chi-square test and Fisher’s exact test were used to checking for the groups’ differences.
Results: Morphine and Oxycodone had a similar analgesic effect. The use of Zofran lowered PONV incidence rates in both groups. A statistically significant (p-value = 0.047) lower nausea and vomiting incidence in the Morphine group (2.5%) was noted compared to the Oxycodone group (8.8% incidence). Only 10% of Oxycodone group patients and 8.9\% of Morphine group patients had moderate nausea and vomiting, and none of the group’s patients had severe nausea and vomiting. Surgery duration, gender, age, smoking, BMI, pain level, and treatment group were not statistically associated with the severity of NV.
Conclusion: With the same analgesic effect, Zofran injection seemed to lower PONV incidence in both groups, even though the Morphine group had a lower incidence. Zofran seemed effective in lowering the NV severity as well. Therefore, recommending the systematic administration of antiemetic agents in patients receiving Oxycodone or Morphine could enhance patient satisfaction.

Abstract: Aim: To assess histopathological patterns in the endometrial biopsy of patients presenting with abnormal uterine bleeding.
Methodology: One hundred eight females with the complaint of abnormal uterine bleeding were enrolled. A gynecological examination was done. Dilatation and curettage were carried out. Specimens thus obtained were stored in 10\% formalin. The slides were examined under a microscope, and the various histopathological patterns were assessed.
Results: The age group 20-30 years had 48, 30-40 years had 50, and 40-50 years had ten females. A significant difference was observed. Inflammatory lesions were 28, such as acute endometritis in 12, chronic endometritis in 11, and chorioamnionitis in 5. Proliferative non-neoplastic lesions were 42, such as atypical hyperplasia in 18, typical hyperplasia in 12, and endometrial polyp in 12. Neoplastic lesions in 20 include leiomyoma in 8, a partial mole in 7, the complete mole in 2, and endometroid carcinoma in 3. Normal endometrium in 18, such as proliferative phase in 12 and secretory phase endometrium in 6. A significant difference was observed (P< 0.05).
Conclusion: The most common endometrial biopsy revealed proliferative non-neoplastic lesions such as atypical hyperplasia, typical hyperplasia, and endometrial polyp.

Abstract:For timely prediction of the development of AHI syndrome in patients with closed abdominal trauma, it is necessary to monitor the IAP level. IBH syndrome develops in patients with concomitant abdominal trauma and is characterized by relatively high mortality rates. A statistically significant correlation was established between the level of AHI, APD, the frequency of development of a picture of multiple organ failure, and the severity of the patient’s condition according to the SOFA and APACHE II scales (p <0.05). A sudden increase and persistence of a high IAP level for a long time in patients with closed abdominal trauma indicate the use of active surgical tactics to perform decompression. The decision to decompress the abdominal cavity is based on IAP monitoring, considering the clinical picture of developing multiple organ failure.

Abstract:Aim: To assess traumatic axial cervical spine injuries in 84 patients.
Methodology: Eighty-four patients with traumatic axial cervical spine injuries of either gender were enrolled. Magnetic imaging resonance (MRI) was performed in all. Conservative treatment was given to those with minimal no bony injuries with or without spinal cord contusion, and decompression and fixation were performed in moderate to severe bony injuries with spinal cord compression. In addition, patients were treated for anterior fixation, i.e., corpectomy with either autologous bone graft or titanium cage and plate fixation and with corpectomy with tricorticate graft.
Results: Out of 84 patients, males comprised 54 (64.2\%), and females had 30 (35.8\%). Aetiology in the present found to be assault in 9, road traffic accident in 48, sports injury in 17, and workplace injury in 10 cases. Body fracture was evident in 24 and ligamentous injury in 60 patients. The type of body fractures was C3 in 3, C4 in 2, C5 in 12, C6 in 3, and C7 in 4 patients. Management performed was corpectomy with tricorticate graft in 26 cases and a corpectomy with fixation with a titanium cage and plate/screws in 58 cases.
Conclusion: Discoligamentous was a major type of injury, and road traffic accident was the main cause of injury among patients with subaxial cervical spine injuries.

Abstract:The article presents the results of studying the modern literature on diagnosing and treating severe concomitant abdominal trauma and their prediction. In addition, the authors provide the primary literature data of domestic and foreign authors in recent years.

Abstract:Prevalence of Obstructive sleep apnoea (OSA) has been increasing owing to increase in its risk factors. The pathophysiology of OSA is related to narrowing or obliteration of upper airway. Neck circumference (NC) is a measure which predicts the neck fat and hence narrowing of airway. Modified Berlin’s Questionnaire is a validated tool to assess the risk of OSA in Indian setting. The present study was designed to determine the association of NC with the risk of OSA in young adults. 1500 subjects of both genders between 18 to 30 years of age were recruited, their NC was measured and they were administered screening questionnaire first. Those who gave one or more positive response were administered modified Berlin questionnaire and risk of OSA was assessed and it was compared with NC. There was a significant increase in risk of OSA in subjects with higher NC with a cut off of 36 cm in males and 32 cm in females. NC is an important anthropometric measurement to predict risk of OSA.

Abstract:Background: The aim of the study is to evaluate effect of type 1 tympanoplasty on the quality of life of CSOM patients.
Materials and Methods: In this observational study, ninety- two patients of chronic suppurative otitis media with perforations of either genders were included. The chronic otitis media-5 (COM-5) questionnaire was administered to all patients. Air bone gap, physical suffering scores, hearing loss score, caregiver’s concern scores, emotional distress score and activity limitation scores were recorded.
Results: Side involved was right in 58 and left in 34. Location of perforation was anterior quadrant in 15, posterior quadrant in 7 and central perforation in 70 cases. Pre- operative physical suffering scores was 3.74 and post- operative score was 2.10, hearing loss score was 3.24 and 1.28, caregiver’s concern scores was 2.34 and 1.12, emotional distress score was 1.92 and 1.04 and activity limitation scores was 1.62 and 1.10 respectively. Pre-op mean air bone gap was 32.2 db and post- op mean air bone gap was 18.4 db. The difference was 13.8 decibels.
Conclusion: Type 1 tympanoplasty is common surgical procedure performed in patients with chronic suppurative otitis media and it found to be effective in improving quality of life in these patients.

Abstract:Aim: A clinicopathologic investigation study of lichen planus.
Methods: This prospective and observational study was carried out in the Department of Oral Pathology & Microbiology, S.B.Patil Dental College \& Hospital, Bidar, Karnataka for a period of 1 year. 90 cases of Lichen Planus (LP) were included in this study. A complete clinical history was obtained, including duration, place of start, symptoms, medication history, and family history. A thorough general checkup, systemic examination, and dermatological examination were performed. The form and location of skin lesions, as well as the existence of any other related disorders, were all documented. Mucosa, hair, nails, palms, soles, and extremities involvement were all noted as concomitantly affected. To assess the histological diagnosis, haematoxylin and eosin stained sections of lesional tissue biopsies were generated. Once the histopathology slide was complete, each slide was attentively examined, and the findings were thoroughly analyzed and appraised.
Results: Out of 90 patients 55(61.11%) were male and 35(38.89%) were female and male to female ration were 1:1.57. Most of the patients belong to 30-40 years of age group (38.89%), followed by 20-30 years (26.67%), below 20 years (22.22%) and 12.22% above 40 years. 45 individuals had LP for less than 5 months before presenting to our out-patient service. The length varied from 5 to 11 months in 22 cases. The duration was longer than 24 months in 15 individuals. The length varied from 11 to 17 months in 5 individuals and from 17 to 24 months in the remaining 3. The classical type was encountered in 51 (56.67 percent) of the 90 Lichen Planus(LP) patients, followed by the hypertrophic type in 23 (25.56 percent) patients, linear LP and lichen planopilaris (LPP) in 4 (4.44 percent) patients each, oral and annular 2(2.22 percent) patients each, and follicular, bullous LP and LP pigmentosus in 1 (1.11 percent) patients each. Of the 90 patients in our research, 40 showed oral signs of LP, and four of them were diagnosed with just oral LP devoid of cutaneous indications of LP. Buccal mucosa was usually implicated in the oral cavity in 30 (75%) patients, lips in 10 (25%) individuals, and tongue in 7 (17.5%) patients. In our study, only two clinical kinds of oral LP were identified: the reticulate type in 35 (87.5 percent) of the subjects and the erosive variation in the other 5 people (12.5 percent ).
Conclusion: The current study sheds light on the clinicopathological behaviour of lichen planus patients according on their gender. Further research in this area will aid in the exploration of this uncharted territory, allowing for faster diagnosis and better treatment. LP was usually noticed in people in their forties and fifties. In our analysis, classical lesions were the most prevalent, followed by hypertrophic and linear types.

Abstract:Aim: To compare preperitoneal meshplasty and Lichtenstein’s hernioplasty in patients with inguinal hernia.
Methodology: A total of one hundred six cases of inguinal hernia were included in the study. Patients were divided into two groups of 53 each. Group, I patients underwent preperitoneal meshplasty, and group II patients underwent Lichtenstein’s hernioplasty technique of inguinal hernia repair. Parameters such as time taken for surgery early complications were recorded.
Results: Group I had 22 males and 18 females, and group II had 25 males and 15 females. The mean time of surgery in group I was 46.2 minutes, and in group II was 55.2 minutes. An early complication was seroma two each in group I and 1 in group II, wound infection 3 cases in group I and 2 in group II, pain 2 in group I, mesh infection 3 in group I and 1 in group II and testicular atrophy 1 in group I. The difference was significant (P< 0.05).
Conclusion: Both techniques such as preperitoneal meshplasty and Lichtenstein’s hernioplasty were effective in management of inguinal hernia.

Abstract:Aim: To compare outcome of early and delayed repair of bile duct injuries.
Methodology: Sixty- four patients with bile duct injuries of either gender were divided into group I (Early repair) and group II (Delayed repair). Operative findings such as injury classification and procedural variables and postoperative course, including 30-day re-admission and 90-day mortality, were recorded.
Results:  Aetiology was cholecystectomy in 25 and 21, abdominal trauma in 7 and 8, and non-biliary abdominal procedures in 2 and 5 groups I and II, respectively. There were 18 males and 14 females and 16 males and 16 females in groups I and II, respectively. Hospital length of stay was 7.1 days in group I and 8.4 days, 30 days of re-admission was seen in 3 and 4, and 90 days of mortality was seen in 2 in group I and 1 in group II. Strasburg-Bismuth classification showed A in 1 and 2, B in 3 and 4, C in 8 and 1, D in 6 and 4, E1 in 4 and 4, E2 in 3 and 5, E3 in 4 and 6, E4 in 3 and 4, E5 in 2 and 3 and X in 0 and 1 in group I and II respectively. Preoperative PTC catheter placement was seen in 0 and 18, and preoperative percutaneous transabdominal drain placement was seen in 0 and 12 in groups I and II, respectively.
Conclusion: Early repair found to be better as compared to delayed repair of bile duct injury.