Trends in Clinical and Medical Sciences

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.

Background: Fractures of the proximal humerus are extremely common, and these are true osteoporotic fractures. Due to rich vascularity and broad cancellous surfaces most of these fractures can be effectively treated nonoperatively as this imparts a high propensity for healing. In addition, many of these fracture patterns result in adequate bone contact and minimal displacement with acceptable alignment. For displaced fractures open reduction and internal fixation can improve outcomes, depending on the pre-injury functional status of the patient. Unique operative treatment challenges include obtaining and maintaining reduction of small bone fragments with strong muscle forces especially in osteoporotic bone. Many options are feasible, including plates, nails, sutures, and other novel devices. Now locking plates are being used more commonly and for a successful result technical details are critical and this minimizes loss of reduction, the risk of implant failure, and reoperation. To our knowledge, very few studies were done on the outcome of operative treatment of these osteoporotic fractures.
Material and Methods: During this observational study, we analyzed all operatively treated proximal humerus fractures between January 2015 and December 2020. Patient selection was on clinical grounds, based on physical, mental, and social criteria. To investigate functional outcome, pain, and ADL limitations we used the DASH Questionnaire. Documented complications were also evaluated.
Results: There were total of 128 patients with displaced proximal humerus fractures treated surgically: 30 two-part, 64 three-part, and 34 four-part fractures. Mean DASH scores were 37.5, 36.9, and 48.6, respectively. Overall good results were obtained with the modern locking plates (mean DASH 34.4). In highly comminuted fractures prosthetic treatment were used and this resulted in poorer function (mean DASH 72.9). Again in this sub group persistent pain and ADL limitations were more present (64 and 50% in patients with 4-part fractures vs. 14% in 2-part fractures). Fracture-related and non-fracture-related complication rates were low (non-union 3%; 2 myocardial infarction) and there were no postoperative deaths within 3 months of surgery.
Conclusion: It is justifiable to consider surgical treatment in selected comminuted dislocated proximal humerus fractures in patients aged 75 and older.

The SARS-CoV-2 virus has had a significant impact on a major part of the world, with kidneys being identified as a major target for infection. The incidence of acute kidney injury (AKI) associated with COVID-19 has been reported to range from 5% to 40% worldwide. Pre-existing renal dysfunction has been identified as a risk factor for adverse outcomes. This observational study aimed to analyze the impact of COVID-19 on kidneys in Indian patients hospitalized with various presentations of the disease. A total of 300 adult hospitalized patients with COVID-19 were included, and baseline clinical and laboratory data were analyzed. Follow-up was conducted after 3 months to assess the frequency and outcomes of renal dysfunction in patients with or without previous renal disease. The study found that the mean age of the patients was 37.15 \(\pm\) 9.78 years. The incidence of AKI was 12%, of which 80.6% of patients normalized their renal functions, while 8.30% progressed to chronic kidney disease (CKD). The mortality rate among these patients was 11.1%. Among the patients with pre-existing CKD, 66.6% experienced worsening renal function and 33.3% died. Additionally, 44.4% of these patients required hemodialysis. In conclusion, renal involvement was common among hospitalized COVID-19 patients, and outcomes were worse for patients with pre-existing CKD. The need for hemodialysis increased with disease severity and in patients with pre-existing CKD.

David Barker proposed the hypothesis of the “Fetal origin of cardiovascular disease” in 1995, suggesting that the origins of the disease can be traced back to in-utero conditions and adaptations that occur in undernourished fetuses during middle-to-late gestation. The objective of this hospital-based cross-sectional comparative study, conducted from February 2021 to August 2022, was to compare cord blood lipid profiles between Small for Gestational Age (SGA) and Appropriate for Gestational Age (AGA) full-term newborns. A total of 59 SGA babies were enrolled as the study group, while 59 healthy AGA babies were included as the control group. Written informed consent was obtained, and relevant maternal data were collected. Cord blood samples were collected immediately after delivery and sent for lipid profiling. All babies were examined, and anthropometric variables were recorded, and they were classified into SGA or AGA using AIIMS Intrauterine growth charts and Ponderal index. Comparisons of cord blood lipid profile parameters were made between neonatal groups based on gestational age. The study found that Total Cholesterol (TC) and Triglycerides (TG) levels were significantly higher in SGA babies compared to AGA babies. However, the differences in other parameters, such as High-Density Lipoprotein (HDL) and Low-Density Lipoprotein (LDL), were statistically insignificant between the two groups. The findings suggest that SGA neonates have elevated lipid profiles compared to AGA neonates, indicating that maternal changes during gestation may have a significant impact on neonatal lipid metabolism. Therefore, close monitoring for cardiovascular morbidities early in life is recommended for SGA newborns.

Background: In pandemic situations, it is essential that the limited resources are used judiciously to achieve most benefits. Prediction of the disease severity at the earliest will help in better allocation, thus, positively affecting prognosis and treatment.
Aim and objective: To investigate patient characteristics and specific biomarker IL 6 as possible early predictors of disease severity of SARS-COV-2 infection.
Material and Methods: Retrospective single-centric record based observational study conducted at intensive care unit of tertiary care hospital in Central , India. 124 consecutive RT-PCR positive coronavirus disease-2019 (COVID-19) adult patients. Demographics, and Inflammatory markers were compared with respect to severity of disease.
Results: The study involved 124 individuals who were affected, out of which 32 patients were categorised as having severe disease, while the remaining 92 patients were categorised as having non-severe disease. Male gender was the predominant demographic in both the severe group. all the symptomps are observed more in frequency among severe group. Immune-inflammatory Markers such as IL-6 The mean value of interleukin-6 in NS-Group patients was 17.6792 27.08 pg/ml, while in S-Group patients it was 97.6515 96.032 pg/ml.
Conclusion: Our study found that high peripheral blood IL-6 levels independently predict COVID-19 severity.IL-6 affected COVID-19 severity and may have been useful for monitoring severe cases. It emphasizes the cytokine storm in COVID-19 progression and suggests IL-6 blockade for severe patients.