Trends in Clinical and Medical Sciences

Introduction: Spinal TB (Pott’s disease) is the most common, as well as one of the most potentially dangerous forms of skeletal TB, with an incidence of neurological complications as high as 10% to 43%. Radiographic manifestations of tuberculous spondylitis include intraosseous and paraspinal abscess formation, subligamentous spread of infection, vertebral body destruction and collapse, and extension into the spinal epidural space. Catastrophic neurological sequelae can lead to mortality and significant chronic morbidity. Early diagnosis and timely initiation of treatment can be a boon to such patients.
Objective: This retrospective cross-sectional study was conducted to identify common patterns of tubercular spinal osteomyelitis on MRI.
Materials and Methods: The current study is a cross-sectional observational study conducted by reviewing existing MRI images in the radiology department. The MRI spine studies of subsequently proven cases of spinal TB were included in the study. These images were re-evaluated and compiled by experienced radiologists.
Results: The thoracic spine was the most common site of involvement. Vertebral body wedge collapse or compression fracture was seen in 64% of patients. Posterior element involvement was found in 10 out of 20 cases. Prevertebral and paravertebral collections were seen in 65% of cases. Spinal cord compression was seen in 55% of cases.
Conclusion: MRI is an excellent imaging modality for spinal tuberculosis due to its ability to pick up early as well as advanced changes of the disease and provide the best possible anatomic demarcation of the extent of the disease.

Breast tuberculosis (TB) is a rare form of extrapulmonary tubercular infection. The clinical presentations, diagnostic difficulties and therapeutic approach of breast TB are not well understood. This study aimed to review the nonspecific clinical presentations, diagnostic difficulties and therapeutic approach of breast TB. Sixteen female patients diagnosed with breast TB between 2016 and 2019 were retrospectively reviewed. The mean age of the patients was 36.4 years, and the most common complaints were breast mass and pain. While 31.2% of the cases had a physical examination with suspicions for malignancy, 43.5% of the patients had Breast Imaging Reporting and Data System (BIRADS) 3 lesions that suggested malignancy radiologically. Definitive diagnosis was based on histopathologic examination through core needle biopsy, excisional biopsy, and open biopsy taken from the abscess wall during drainage. All patients were treated with standard anti-TB therapy for 6 months. Thirteen patients recovered with standard therapy, while extended treatment for 9 to12 months was needed in 3 (18.8%) cases. Surgery was carried out in 6 cases, and 2 patients developed recurrence. Breast TB can be easily confused with breast cancer, suppurative abscess, and other causes of granulomatous mastitis, both clinically and radiologically. A multidisciplinary approach is required to prevent diagnostic delays and unnecessary surgical interventions. Although anti-TB therapy is the mainstay treatment of breast TB, surgery is usually indicated in patients refractory to medical treatment.

Background: Ventral hernias of the abdomen are defined as a non-inguinal, non-hiatal defect in the fascia of the abdominal wall. Annually, there are about 350,000 ventral hernia operations. The repair of these abdominal wall defects is a common surgery performed by general surgeons. Common causes of acquired ventral hernias include previous surgery causing an incisional hernia, trauma, and repetitive stress on naturally weak points of the abdominal wall. These naturally occurring weak points in the abdominal wall include the umbilicus, semilunar line, ostomy sites. Obesity is a large component of hernias as well because it stretches the fascia of the abdomen causing it to weaken. While repair of ventral hernias with mesh is considered routine, there is no consensus on the best location to place the mesh. Hence, this study aims to compare the outcome of the onlay versus sublay mesh repair for treatment of ventral hernias.
Materials and methods: All subjects undergoing onlay and sublay mesh repair for ventral hernias will be evaluated intraoperatively for duration of surgery and postoperatively for complications like surgical site infections, seroma formation, flap necrosis, duration of hospital stay and recurrence. To find the significance in categorical data Chi-Square test was used.
Aim of the study and objectives: To compare the duration of surgery and postoperative complications of sublay and onlay meshplasty in the treatment of ventral hernias.
Results: Out of 50 patient’s majority were female29 (58%) and belong to the age group of 46-55 yrs (32%). The most common diagnosis among them is supraumbilical hernia (52%). The duration of surgery for sublay group is longer about 117.4 min whereas it about 92.52 min in onlay group. Seroma formation, Surgical site infection, Flap Necrosis in 20%, 16% and 16% patients respectively in onlay mesh repair group and in 4%, 4% and nil patients respectively in sublay mesh repair group. Duration of Hospital Stay was 5 days in onlay group in comparison to 4 days in sublay group. Recurrence was seen in 8% patients in onlay group whereas it was encountered 4% in the sublay mesh repair group.
Conclusion: Sublay mesh repair is a good alternative to onlay mesh repair that may be applicable to all forms of ventral hernia as the mesh related overall complication rate like seroma, surgical site infections, flap necrosis, hospital stay and recurrence are less compared to onlay meshplasty.

Background: Fistula-in-ano is a tract connecting the anal canal to the perianal skin. It is a complication of anorectal sepsis in approximately 25% of patients within 6 months of the incidence. Alternatively, a nonsurgical cost efficient treatment with Ksharasutra (cotton Seton coated has minimal complications).
Objectives: To compare the outcome of Seton treatment using ksharasutra and Conventional fistula surgery (fistulotomy).
Methods: It was a prospective observational study. 96 patients were selected for these studies who were admitted for fistula repair Between November 2016 to December 2021 in R.G kar medical College \& Rampurhat Government Medical College. Patients coming at outpatient department of surgery with the complaint of persistent perianal discharge with or without pain were examined by per rectal digital examination and those with perianal fistula were included in the study.
Results: out of 96 patients, 50 were selected in the study group who were treated with ksharasutra and 46 patients were selected in the control group in whom fistulotomy was done. Study was male preponderance (87%). Out of 96 patients 86 were male and 10 were female. Most (84 out of 96) belong to 20-39 year age group. There were 10 cases of high anal fistula in the study group while the number was 9 in the control group. The mean duration of healing was 53.00 \(\pm\) 26.75 days in medicated Ksharasutra group whereas in fistulotomy group, mean duration of healing was 35.67 \(\pm\) 9.17 days. Ksharasutra group required significantly (P = 0.02) more number of days for healing.
Conclusion: The application of Ksharasutra is a better option not only because it is cost effective but also due to lesser postoperative complications.

Background: GBS is an acute-onset, monophasic immune-mediated disorder of the peripheral nervous system that often follows an antecedent infection.
Objectives: To assess the factors (clinical, investigatory tools, and therapies) that may affect the outcome of patients with GBS.
Methods: This is an analytical observational study that was conducted at Tertiary care Hospital including thirty patients with the diagnosis of GBS in the duration from May 2018 to December 2021 after the patients or their relatives signed an informed consent. Included patients from both genders aged from 16 to 70 years old who were diagnosed as GBS within two weeks from onset of neurologic symptoms, depending on the history, clinical examination and investigatory tools. Hughes scales was used for outcomes. SPSS (Version 22.0).
Results: the study was female preponderance as compared to males (60%). Mean age was 36.18 years and the most common age group was found to be 16-39 years (70%). 26 patients (85%) had preceding respiratory tract infection, 4 patients (15.0%) had preceding gastrointestinal tract infection. The Pattern of weakness was ascending in 26 patients (85%) and descending in 4 patients (15%). there was no statistically significant difference found between both groups regarding gender and age of the study population. But it was noticed that patients with age ranging from 16 to 39 years showed significantly good or favorable prognosis compared to those with age ranging from 40 – 59 or \(\geq\)60 years. There was no significant difference between both groups regarding infection preceding illness, the pattern of weakness either ascending or descending and the nature of first symptoms. As regards the treatments received during period of admission, 20 patients (50.0%) received plasma exchange sessions, 4 patients (20.0%) received IVIG only and 6 patients (30.0%) received plasma exchange session then followed by IVIG due to unsatisfactory response after sessions.
Conclusion: Ascending pattern of weakness was more common than descending pattern in this study population and was not related to prognosis. High Hughes score at admission was associated with poor outcome at 8 weeks.

Background: Diabetes mellitus (DM) is a metabolic disorder that has reached epidemic proportions, with India being designated as the diabetic capital. It is a chronic disorder that can lead to many microvascular and macrovascular complications. Vitamin D deficiency has been linked to insulin resistance and impaired insulin secretion. This study aimed to assess the levels of Vitamin D in Type-2 diabetes mellitus and its correlation with microvascular complications and glycemic control.
Methodology: The study was conducted at the Department of General Medicine, SCB Medical College Hospital, Cuttack, Odisha. A total of 50 patients with type 2 diabetes, who were admitted to SCB Medical College hospital, were randomly selected after obtaining informed consent. The detailed medical history was collected through clinical examination and necessary laboratory tests were conducted. Two groups were formed, comprising diabetes patients in group I and healthy subjects in group II.
Results: Of the total 50 cases in group I, 31 (62%) were male and 19 (38%) were female, and in group II, 10 (50%) were male and 10 (50%) were female. The mean level of 25 OH vitamin D was 17.09 \(\pm\) 1.36 ng/ml in group I. Out of 50 subjects, 98% were vitamin D deficient, i.e., < 20 ng/ml, 2% were insufficient, and none were sufficient. The mean 25 OH vitamin D level in group II was 18.29 \(\pm\) 1.36 ng/ml. Out of 20 controls, 18 (90%) were vitamin D deficient i.e., < 20 ng/ml, and 2 (10%) controls were vitamin D insufficient.
Discussion: This study found that the mean level of vitamin D3 in diabetes patients was 17.09 \(\pm\) 1.36 ng/ml compared to the control group. The correlation coefficient between vitamin D level and fasting blood sugar, postprandial blood sugar, and HbA1c was statistically significant, with retinopathy and neuropathy significantly associated with hypovitaminosis.
Conclusion: Given the enormous social and economic costs of type 2 diabetes and its devastating complications, there is an urgent need to develop effective strategies for curbing the epidemic through prevention and early treatment. Further interventional studies may be required to determine the recommended daily allowances of vitamin D.

Background:  Alcohol is the most frequently misused substance on a global scale. Research has demonstrated that it can elicit detrimental impacts on nearly all bodily organ systems. A number of medical conditions can be ascribed to the direct impact of alcohol, while others may be indirect consequences stemming from nutritional inadequacies or susceptibility to injury. The consumption of alcohol has been linked to a range of cardiovascular disorders. Consequently, this study was conducted to investigate the Electrocardiographic and Echocardiographic abnormalities in asymptomatic chronic alcoholic patients.
Materials and Methods: The present study, an analytical cross-sectional investigation, was conducted between April 1st, 2021 and September 30th, 2022. The study population consisted of 150 individuals with chronic alcoholism, aged between 21 and 40 years, who had been consuming more than 80 grammes of alcohol per day for a period exceeding 5 years. The participants’ medical history was evaluated according to the definition of chronic alcoholism, and electrocardiography and echocardiography were employed as diagnostic tools. The study group excluded individuals with pre-existing conditions such as diabetes, hypertension, and cardiovascular disorders.
Results: Our study reveals that the incidence of cardiovascular abnormalities among individuals with chronic alcoholism is 37%. The predominant electrocardiogram (ECG) alterations observed are sinus tachycardia (18%) and non-specific ST-T changes (9%). The prevalent alterations observed in 2D ECHO were augmented thickness of the posterior wall (11%), succeeded by heightened thickness of the interventricular septum and diminished ejection fraction (<40%). The incidence of cardiovascular abnormalities is positively correlated with prolonged alcohol consumption and is also elevated in the elderly population.
Conclusions: The present investigation validates that a multitude of electrocardiographic and echocardiographic alterations manifest before the onset of symptomatic cardiac pathologies that are attributed to prolonged alcohol consumption, such as alcoholic cardiomyopathy.Early indicators of the ongoing effects of alcohol may be detected through non-invasive investigations such as Electrocardiography and Echocardiography. These indicators are likely reversible during the early stages but may progress to alcoholic dilated cardiomyopathy if left untreated.

Introduction: Fever with thrombocytopenia is a common clinical presentation among patients in tertiary care hospitals. Various etiologies, such as malaria, dengue, leptospirosis, typhoid, miliary tuberculosis, and septicemia, are the common causes of fever with thrombocytopenia.
Aim: This study aimed to determine the various etiologies of febrile illness in children with thrombocytopenia, study their bleeding and clinical manifestations, and examine their correlation with the severity of platelet count.
Materials and methods: This study included 1000 pediatric patients with thrombocytopenia between January 2021 and December 2021 at an autonomous state medical college in Firozabad, Uttar Pradesh.
Results: In our study, the most common etiology was dengue, followed by sepsis and hematological malignancies. The most common age group of patients was 10-15 years. The severity of cases was determined based on the grading of thrombocytopenia and bleeding and clinical manifestations. Fever and myalgia were the most common clinical presentations of patients with thrombocytopenia.
Conclusion: Platelet count is a good predictor of bleeding manifestations due to severe thrombocytopenia, which can lead to life-threatening conditions. Prompt diagnosis is crucial to start treatment as soon as possible, including platelet transfusions for patients.

This study aimed to clinically investigate cases of tuberculous lymphadenopathy in a tertiary care center in Madhya Pradesh. 67 patients with swelling in the neck and clinically diagnosed as Cervical Tuberculous Lymphadenopathy were included. Data was collected through detailed history, physical examination, routine investigations, radiological tests, and FNAC. Most participants were females (56.7%) in the 11-20 years age group (32.8%). Chest X-ray/ CT thorax findings showed infiltrates in 7.5%. Mantoux test was positive in 85.1% participants. FNAC revealed granuloma without caseous necrosis in 80.6% cases, with AFB found in 28%. 91% were treated with ATT only, while 6% were treated with ATT+ART. 28.4% experienced a paradoxical reaction during treatment, with 94.7% undergoing modification of treatment. USG neck at the end of 6 months treatment revealed residual lymph nodes in only 20.9%. 22.4% required an extended duration of treatment. The study concludes that cervical lymph node tuberculosis is the most common form of extra-pulmonary tuberculosis and FNAC is the simplest procedure for diagnosis. The presence of residual LNs after 6 months of anti-tuberculosis treatment does not necessarily indicate recurrence or treatment failure but must be re-evaluated and differentiated from active TB.

Introduction: Epistaxis is a common condition witnessed in the Emergency department. Due to the discomfort patients experience, the likelihood of complications, and the necessity of following up with their treating physician to remove the nasal packing, it may be reasonable to utilize other drugs to treat epistaxis before nasal packing. It is well-recognized that the antifibrinolytic drug tranexamic acid (TXA) is helpful in various therapeutic contexts where uncontrolled bleeding may be an issue. There is anecdotal data that suggests topical TXA may be helpful for acute epistaxis, but more research is needed.
Material and Method: The Patients were divided into two groups- Group T- A cotton pledget soaked in 5ml of Tranexamic acid (prefilled syringe) and 10 ml of Phenylephrine with 5ml of 2% Lignocaine with 1:1000 adrenaline and Group C- A cotton pledget soaked in 10ml of Phenylephrine with 5ml of 2% Lignocaine with 1:1000 adrenaline with 5ml Normal saline (prefilled syringe). Outcomes recorded were the proportion of patients in both groups who needed anterior nasal packing after 20 minutes of pack removal, the number of patients whose bleeding stopped within ten minutes, the length of stay in the ED, the necessity of cauterization, and a telephonic follow-up conducted by an independent ENT resident using a structured questionnaire to record any episode of rebleeding within 24 hours to five days. Any drug-related side effects were recorded, such as thrombosis, nausea, and hypersensitivity.
Result: Patients requiring anterior nasal packs were less in the Tranexamic acid group (P<0.038). The length of hospital stay was decreased in Group T (P <0.045), and the proportion of patients whose bleeding was stopped within 10 mins was more in Group T (P< 0.04). The incidence of rebleeding within 24 hours decreased in Group T (P< 0.038), but no significant difference was found in rebleeding number within 1- 5 days. No minor/major complications to the drug were noted in Group T.
Conclusion: Topical TXA is safe and effective for the cessation of anterior nasal bleeding, thus preventing the use of anterior nasal packing, which is tedious for the patient and medical staff. TXA has been shown to decrease the rate of packing significantly.