Trends in Clinical and Medical Sciences (TCMS)

Background: Angular deformities of knee in children are a commonly encountered condition in orthopedic practice. Many of the cases are physiological and do not warrant any treatment.
Aim:To assess the functional and anatomical outcome of 8-plate fixation for genu valgum or genu varum deformities in children.
Material and Methods: The study was designed as a prospective and retrospective hospital based study in Dept. of Orthopedics, Govt. Medical College, Kozhikode. Patients attending the Orthopedic outpatient department at Govt. Medical College, Kozhikode between 1/6/2017 to 31/3/2019. Sample size was found to be 24. SPSS was used for analysis.
Results: Out of the 24 cases, 3 were implanted at age < 10 years. Median age at intervention was 13 years. Average age at intervention was 12.25 with a range of 9 years to 14 years. The following results were observed after following up a total of 24 patients who has undergone 8-plate fixation for angular deformities of knee. 15 were boys and 9 were girls. 18 were having valgus deformity and 6 were having varus deformity. In total 39 limbs and 56 physis were intervened. Mean period for implant removal is more when only tibia is implanted and least when both tibia and femur are implanted. However, this can’t be used to compare the efficacy of different implanting sites, as removal of implant is influenced by several factors like follow up visits and severity of primary deformity. More reliable measurement is the rate of correction of deformity.
Conclusion: In our study, we were able to demonstrate that hemiepiphysiodesis using eight plate is an effective and safe treatment for angular deformities of knee in children irrespective of the age group, sex and primary deformity. The rate of correction of deformity decreases as the age increases. So, early surgery is advisable in diagnosed pathological deformities. A proper follow up of the treated patients is needed to assess the response.

Introduction: Three instances of the HBs’ encapsulation with a nodular, grey-white exterior surface were noted. The sliced surface was feshy, tan to grey-white, and there were patches of necrosis and haemorrhage.
Material and Methods: Names, ages, genders, and other information were recorded. Alpha fetoprotein levels (APLs), complete blood counts, liver function tests, and other laboratory data were noted. Contrast computed tomography was used to assign PRETEXT staging (CT).
Results: Patients frequently reported vomiting in 25 cases, 43 cases of abdominal distension, 21 cases of jaundice, and 19 cases of an abdomen mass. The distinction was noteworthy (P 0.05).
Conclusion: Researchers discovered that the majority of cases were epithelial as opposed to mixed epithelial and mesenchymal, and that women predominated.

Background: Otitis media (OM), a common ear infection, affects children. Most pediatric medical appointments are for otitis media. Otitis media (OM) is the major cause of permanent hearing loss. OM has three primary subtypes: acute, OM with effusion, and chronic suppurative OM (CSOM).
Material and Methods: This study is a meta-analysis on the link between air pollution and middle ear infections in Indian children. The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) guidelines for reporting systematic reviews and meta-analyses were followed throughout this investigation. This study was about otitis media, which is also called glue ear, middle ear infection, OM, AOM, OME, CSOM, or middle ear infection. It is important because it affects so many people. We were exposed to air pollution from both inside (from heating and cooking) and outside (from cars and trucks) sources (from factories or cars).
Results: 1246 references were taken out because there were fewer of them. After the first round of evaluation, 661 out of the 743 citations were found to be unnecessary. The full texts of 82 publications were looked at to see if they could be included. There was a total of eleven investigations: three in the US, two in Canada, and one in the both Netherland and Germany, the other studies were conducted in Italy, Czech Republic, South Korea, China and Spain.
Conclusion: This comprehensive review found that air pollution increases the risk of OM in babies and children. Exposure to higher amounts of NO2, PM, SO2, PAH, and wood smoke increases OM infections, however the extent is unclear. PM10, NO2, O3, SO2, and CO enhanced OM risk immediately and for 1-4 weeks.

Background: The present study was performed to determine and compare the analgesic effect of dexamethasone as an adjuvant to caudal block when given intravenously and caudally.
Material and Methods: This interventional, double-blinded, randomized controlled study included 165 pediatric patients aged 1-5 years with anaesthesiology (ASA) physical status I and II admitted to the hospital for elective infraumbilical surgeries. Children were allocated randomly with the chit method to three groups such that subjects in group I received caudal Bupivacaine 0.25% (1ml/kg), along with caudal normal saline (NS) 0.025ml/kg and IV NS 0.075ml/kg; group II received caudal Bupivacaine 0.25% (1ml/kg) with caudal dexamethasone 0.1 mg/Kg (0.025ml/kg) and IV NS 0.075ml/kg; group III received caudal Bupivacaine 0.25% (1ml/kg) along with caudal NS 0.025ml/kg and IV dexamethasone 0.3mg/kg (0.075ml/kg) (dexamethasone sodium phosphate vial 4mg/ml). Patients-intraoperative hemodynamic parameters were recorded every 10 minutes till the end of surgery. Postoperative pain was assessed hourly with a FLACC score until the score was>3, and the time was noted as analgesia duration. Total analgesic consumption during the first 24 hours was also noted down.
Results: In Group 1, the mean time to first rescue analgesia was 4.00\(\pm\)0.69 hours; in Group 2, it was 8.07\(\pm\)0.57 hours and in Group 3, it was 5.51\(\pm\)0.50 hours (p value<.05). In Group 1, mean total analgesic consumed in first 24 hours was 666.09\(\pm\)174.69 mg, in Group 2, it was 200.09\(\pm\)66.42 mg and in Group 3, it was 384.55\(\pm\)135.04 mg (p value<.05).
Conclusion: Dexamethasone as an adjunct to caudal Bupivacaine 0.25% (1ml/kg) provides effective postoperative analgesia.

Patients presenting with acute abdominal pain can benefit greatly from the additional diagnostic information provided by multidetector CT (MDCT). Correctly interpreting the patient’s unique clinical data and test results is necessary for establishing a diagnosis. The patient’s hemodynamic status has been stabilized, MDCT is the preferred imaging test for acute, severe, and widespread abdominal pain. The primary objective of our investigation is to determine whether 64-slice Multi-detector Computer Tomography (MDCT) is useful for diagnosing and evaluating patients with acute abdominal pain before surgery. This prospective study at Sri Aurobindo Medical College and Post Graduate Institute, Indore, randomly selected 200 participants. MDCTs were performed on all patients. Initially, pre-contrast images were obtained. Blood samples were drawn at 25 seconds, 45 seconds, and 7 minutes after contrast administration using bolus tracking and automated triggering. Contrast was administered intravenously or orally, depending on the patient’s condition. Each patient’s pre-CT and post-CT diagnoses were contrasted with intraoperative findings and discharge diagnosis. In total, 200 individuals participated in the study. Most of our patients (26%) were between the ages of 41 and 50, followed by those between the ages of 21 and 30 (21.5%). The majority of patients who participated in the study were males. In addition to severe abdominal pain, nausea and vomiting were the most frequently reported side effects. According to our research, the most common causes of acute abdomen are pancreatitis, small intestinal obstruction, appendicitis, and cholecystitis. We conclude that MDCT accurately detects a broad spectrum of acute abdominal diseases, including some that are uncommon, such as liver abscess, splenic abscess, pyelonephritis, epiploic appendagitis, ovarian torsion, omental infarct, and aortic dissection. CT is a useful diagnostic tool for determining the cause of non-traumatic acute abdominal discomfort.

Infertility, defined as the inability to achieve pregnancy after one year of regular unprotected sexual intercourse, is a prevalent issue affecting couples worldwide. Among the various causes of infertility, uterine abnormalities have a significant prevalence, ranging from 34% to 62%. This study aimed to assess the effectiveness of saline infusion sonography (SIS) and hysteroscopy in evaluating uterine cavity abnormalities in infertile women. The inclusion criteria included primary and secondary infertility, while exclusion criteria involved active pelvic infection, unexplained genital tract bleeding, suspected pregnancy, and male factor infertility. The study was conducted prospectively in a hospital setting, and the majority of the infertile women were in the age group of 25-29 years. Primary infertility was observed in 75% of the subjects, while secondary infertility was seen in 25% of the patients. The results of SIS revealed the presence of endometrial polyps, submucosal fibroids, septum, and adhesions in various proportions. The overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of SIS for diagnosing uterine anomalies were determined. However, hysteroscopy remains the gold standard for detecting uterine cavity abnormalities, with a sensitivity of 100% in identifying different structural anomalies and intrauterine adhesions. In conclusion, hysteroscopy is considered the superior technique for detecting uterine abnormalities, while SIS shows moderate sensitivity and specificity in diagnosing uterine anomalies in infertile women.

Introduction: Fractures of the proximal femur are a big challenge in traumatology. Trochanteric fractures of the femur are rising in incidence. By definition pertrochanteric fractures are those occurring in the region extending from the extracapsular basilar neck to the region along the lesser trocchanter before the development of the medullary canal. Intertrochanteric and peritrochanteric are generic terms for pertrochanteric fractures.
Material and Methods: This is a Randomized and prospective study. All the patients with unstable intertrochanteric fracture femur, presenting to the Orthopedic Department of K.S.Hegde Charitable hospital from October 2011 to October 2013 are included in the study after explaining the procedure and getting the consent. 30 patients meeting the criteria are included for the present study and are randomized equally into two groups: 15 DHS cases and 15 PF- LCP. The study follow up requires evaluation at discharge, 6 weeks 3 months and 6 months. Patient information, including age and sex, nature of violence, type of fracture, associated injuries, operative treatment including and length of hospital stay will be recorded for each patient.
Results: In our series of 30 patients 4 patients expired due to associated medical problems. Functional outcome was assessed by taking the remaining 26 patients into consideration of which 14 patients were from DHS group and 12 patients from PF-LCP group. Among the 15 patients operated by PF-LCP, 8(53.3%) patients were found to have intertrochanteric fractures on the left side while 7(46.7%) patients were found to have fracture on the right side. Among the 15 patients operated by DHS, 3(20%) patients were found to have intertrochanteric fractures on the left side while 12(80%) patients were found to have fracture on the right side. In our present study we consider unstable intertrochanteric fractures Type2, Type 3 and Type 4 as classified by Boyd and Griffin We had 19(63.3%) patients of Type 2, 9(30%) patients of Type 3 and 2(6.67%) patients of Type 4 intertrochanteric fracture.
Conclusion: We conclude that DHS is a better alternative in unstable intertrochanteric fractures when compared to PF-LCP as the functional outcome was better and the complications were fewer in the DHS group when compared to PF-LCP group. The advantages of DHS being the ease and expertise with the procedure, the mechanism of sliding of the plate allowing the fracture to collapse into a stable configuration. PF- LCP being a complex system needs further understanding of the plate biomechanics.

Introduction: Thyroid nodules are commonly encountered in clinical practice. The palpable thyroid nodules prevalence in the worldwide population ranges from 4 to 7%. The thyroid lesions are mostly benign (95%) and thyroid cancer is responsible for only 0.4% of all cancer deaths. The Bethesda System for Reporting thyroid Cytopathology (TBSRTC) was done in 2010. The liquid-based cytology (LBC) technique used in exfoliative cells and in non-gynecological aspiration like fine needle aspiration (FNA) samples. Liquid-based cytology (LBC) preparation is a way to improve and refine the fine-needle aspiration (FNA) samples of thyroid lesion. It achieves a diagnostic sensitivity as accurate as conventional preparations, especially for its excellent cell preservation and rapid fixation, lack of background which decrease the number of inadequate diagnoses.
Aims and Objectives: 1) To compare conventional and manual liquid-based cytology in thyroid lesion at tertiary care centre. 2) To find out if there is any significance increase in the positive cases which were negative on conventional smear. 3) Whenever possible correlate the histopathological finding with the Liquid Based Cytology results to make a more confirmed diagnosis.
Material and Methods: This is prospective conducted on 70 patients at Department of Pathology, Mahatma Gandhi Medical College and Maharaja Yeshwant Rao Hospital, Indore, Madhya Pradesh, India for duration of 2 years. Permission was obtained from the departmental scientific committee and the institutional ethical committee at the beginning of the study.
Results: With the help of above thesis work we have observed that manual LBC is also a relatively simple technique.

Background: The increased risk of cardiovascular disease and type II diabetes is attributed to the cluster of metabolic abnormalities known as metabolic syndrome. Most people with metabolic syndrome also have several other metabolic problems, including high blood sugar, insulin resistance, abnormal lipid profiles, and high blood pressure.
Aim: This study’s objective was to investigate the relationships between insulin, glucose, homeostasis metabolic assessment-estimated insulin resistance (HOMA-IR), and lipids in persons with metabolic syndrome.
Material and Methods: All the study participants consented. Control volunteers were 100 age- and gender-matched healthy volunteers. Second cohort: 100 metabolic syndrome patients treated. Same-age as well as gender normal-glycemic controls were used as the non-metabolic syndrome group. Each cohort was designated as normal if Body Mass Index (BMI) was (18.5-24.9 kg per m2), overweight (25-29.9 kg per m2), or obese (30 kg per m2).
Results: There was a statistically significant variation between 2 groups in terms of hemoglobin A1c (HbA1c), fasting blood sugar (FBS), and insulin mean values. Figure 1 displays the average levels of TC and triacylglycerols (TAGs) in patients having metabolic syndrome and in healthy control subjects. Serum weight measurements were found to be significantly varied between 2 groups. Metabolic syndrome sufferers had a mean TAGs level that was somewhat elevated compared to the control group, although they were still only around 40% higher than the norm.
Conclusion: Research along these lines is encouraged since it will lead to molecular insights that will help doctors control hyperglycemia and slow the development of related diseases. Open cholecystectomy cases can be done under thoracic epidural anaesthesia with 0.5% bupivacaine and buprenorphine or fentanyl as an adjuvant. Buprenorphine having prolong duration of analgesia can be better than fentanyl even in postoperative period.

Tuberculosis is a major public health issue in India, caused by Mycobacterium tuberculosis, and it affects not only the lungs but also other organs and bone marrow. Hematological abnormalities are frequently observed in tuberculosis patients and can serve as markers for diagnosis, prognosis, and treatment response. The aim of this study was to evaluate various hematological characteristics in patients with pulmonary tuberculosis. A total of 50 diagnosed tuberculosis patients were included, and their blood samples were collected at MGM Medical College and associated hospitals. Hematological analysis was performed using 4 ml of venous blood in an ethylenediamine tetra acetic acid (EDTA) tube. Two milliliters of blood were used for hematological analysis with a hematology analyzer, and the remaining 2 ml were utilized for erythrocyte sedimentation rate (ESR) measurement using Wintrobe’s method. The observations revealed significantly low levels of hemoglobin, packed cell volume (PCV), and blood indices values, indicating anemia. The white blood cell (WBC) count, absolute neutrophil count, platelet count, and ESR values were elevated in tuberculosis patients. In conclusion, measuring hematological parameters in tuberculosis patients provides a simple and cost-effective approach to monitor disease progression and complications, particularly in resource-limited settings like India.