Trends in Clinical and Medical Sciences (TCMS)

Background: Diabetic foot ulcer (DFU) is a major complication of Diabetes Mellitus. The International Working Group on Diabetic Foot defines DFU as a “full-thickness lesion of the skin distal to the malleoli in a person with Diabetes Mellitus”.
Objective: The objective of this study was to evaluate the clinico-microbial profile of patients with diabetic foot ulcers and the pattern of antimicrobial susceptibility.
Methods: This hospital-based, prospective observational study was conducted among patients with diabetic foot ulcers in the Department of General Surgery at Era’s Lucknow Medical College \& Hospital, Lucknow, after taking written informed consent.
Results: Pseudomonas was found in 39 (18.2%) cases, coagulase-negative Staph aureus was found in 23 (10.7%) cases, Acinetobacter was found in 80 (37.3%) cases, E. coli was found in 56 (26.1%) cases, Proteus spp was found in 13 (6%) cases, Staph aureus was found in 23 (10.7%) cases, Acetobacter was found in 1 (0.46%) case, and Enterococcus was found in 2 (0.93%) cases. A single organism was involved in 48 (47.1%) cases, while multiple organisms were involved in 54 (52.9%) cases in our study. In our study, 83 (81.3%) cases were gram-negative and 11 (10.7%) cases were gram-positive.
Conclusions: According to microbial culture, Pseudomonas, Klebsiella, E. coli, and coagulase-negative Staph aureus were the most commonly found organisms in diabetic foot ulcers. These findings suggest that appropriate management of diabetic foot ulcers should involve selecting an appropriate antimicrobial agent based on microbial culture and susceptibility testing.

Introduction: The frontotemporal type is characterised by a pterional sutural configuration between the frontal and temporal bones. The stellate kind of suture is formed by the fusion of the flat sphenoid, frontal, parietal, and temporal bones.
Methods: The kind of pterion based on sutural pattern was determined using Murphy’s classification into sphenoparietal, frontoparietal, stellate, and epipteric kinds on both the left and right sides of each skull. The centre of the circle, which connects the four bones that make up the pterion, is thought to be the centre of the pterion. Distance between the pterion’s centre and the external auditory meatus’s anterosuperior margin, P-PM: the distance between the pterion’s centre and the lateral margin of the optic canal, P-AM.
Results: The current investigation was carried out using 115 dried adult skull bones that were gathered from the central Karnataka region. On the right side, there were 115 pterions, and on the left, there were 115. The most frequent type of pterion was sphenoparietal (82.1%), followed by epipteric (26.1%), stellate (18.6%), and frontotemporal (17.8%).
Conclusions: The findings of this study may be useful for forensic pathologists, neurosurgeons, anatomists, and anthropologists in the region of the population under study.

Background: Severe acute malnourishment (SAM) is a significant public health problem in India and many developing countries. The World Health Organization (WHO) defines – Severe acute malnutrition (SAM) as very low weight-for-height or a mid-upper arm circumference (MUAC) of less than 115 mm or the presence of nutritional edema. According to the most recent NFHS-5 survey (2019- 2021) covering 36 states and union territories (UTs), the prevalence remains at an alarming 7.7%. Malnutrition slows down the myelination process, thus preventing the increase in the calibre of myelinated nerve fibres. Motor nerve conduction, auditory evoked potential and visual evoked potential changes caused by severe acute malnutrition can be evaluated clinically and electrophysiologically. These changes are produced mainly due to a deficiency of micro and macronutrients like vitamins, minerals, protein, fat & Carbohydrates.
Aim: Severe acute malnutrition affects the myelination and growth of the central and peripheral nervous systems. This study aimed to assess the effects of severe acute malnutrition on peripheral motor median and ulnar nerve conduction, auditory evoked potential and visual evoked potential in children.
Materials & Methods: The study group included 50 severely acute malnourished children (SAM) of 6 – 59 months of age, recruited from SMTU, J.A. Group of the Hospital, G.R.M.C. Gwalior (M.P.), based on WHO classification for severe acute malnutrition. The Control group consisted of 50 normally nourished healthy children of the same age group. The case-control study period was extended from January 2021 to December 2021. Ethical clearance from the Institutes and written informed consent were taken from the parents/guardians of SAM patients. The family, immunization, birth, metabolic, endocrinal disorder, and history of neuromuscular disease were taken in detail. The study was performed using the four-channel RMS – EMG EP MARK- II. The electrophysiological parameters were evaluated for velocity, distal latency, and amplitudes. Results were analyzed statistically using the unpaired student’s t-test.
Results: This study showed decreased motor nerve conduction velocity ( p < 0.05 ) and delayed distal latencies in the median and ulnar motor nerves of both upper limbs in children with severe acute (SAM) malnutrition. There were significant differences in the mean latencies of the waves I to V and the mean interpeak latencies (IPLs) of the waves I-III and I-V on the right and left ears between the study and control groups (P < 0.05). We observed significant alteration in mean latencies of wave p 100 in VEP.
Conclusion: The present study shows a statistically significant alteration in electrophysiological parameters in children with severe acute malnutrition. This may be due to nutritional deficiency affecting the myelination of peripheral nd central nerves depending on the duration and severity of malnutrition.

Non-healing ulcers can cause significant health problems and impair quality of life. Standard treatment procedures have been found to be ineffective in curing such lesions. Autologous platelet-rich fibrin matrix (PRFM) has been cited in many research papers as an effective treatment for non-healing ulcers. This study aims to evaluate the efficacy of PRFM in treating chronic non-healing ulcers. A prospective study was conducted in patients with trophic ulcers due to Hansen’s disease or diabetes mellitus, traumatic ulcers, and venous ulcers, aged between 18-85 years. PRFM was applied to healthy ulcers at weekly intervals, repeated for a maximum of five sittings as per requirement. Photographs were taken before treatment and at every subsequent sitting, and area and volume were calculated at baseline and every subsequent sitting until closure was achieved. The results of the study will help to determine the efficacy, feasibility, and cost-effectiveness of PRFM in the treatment of non-healing ulcers.

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.