Trends in Clinical and Medical Sciences (TCMS)

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.

Introduction: Fractures in the upper end of the ulna, including its olecranon and coronoid processes, are common. Poor replacement of a dislocated or fractured bone can result in complications such as joint instability, stiffness, and functional deformity. This study aimed to determine the morphometry of the upper end, length, weight, and volume of the ulna bone on both sides in a cross-sectional study.
Materials and Methods: Eighty-four dry ossified ulna bones (42 right, 42 left) were used in this study. The length of the ulna (L) was measured using a digital vernier caliper, while the weight of the ulna (W) was measured using an electronic weight balance. Alginate cast material was used to measure the volume of the upper end of the ulna (V). Longitudinal dimensional parameters, such as the distance between the highest point of the olecranon and that of the coronoid process (OCD) and the mid-olecranon thickness in the mediolateral (T1) and anteroposterior orientation (T2), were measured using a digital vernier caliper. Paired t-tests were used to compare the parameters between the right and left ulnas, with a statistically significant p-value <0.05.
Results: There was a statistically significant variation (p<0.05) in T1, length, weight, and volume between the right and left ulna. However, there was no statistically significant variation in OCD and T2 between the right and left ulna. The average value of T1, T2, length, weight, and volume in the right ulna was higher than that of the left ulna, while the OCD of the left ulna was higher than that of its counterpart.
Conclusion: The findings of this study can be useful for engineers and medical professionals in designing implants for conditions such as fractures and dislocations. Parameters of the olecranon and coronoid processes can also be helpful in determining an individual’s sex.

Background: Intubation is one of the most commonly done procedures in a hospital. Endotracheal intubation is the gold standard for securing airway. Direct laryngoscopy (DL) using Macintosh laryngoscope (MCL) has long been in use as a conduit for intubation. I-gel a second generation airway has been designed to conduct intubation, which reduces the pressure response and also eliminates the disadvantages of the LMA such as aspiration of gastric contents, compression of vascular structures, trauma and nerve injury. One of the most important advantages of the I-gel is it’s ability to maintain oxygenation and ventilation during periods of apnea at the time of intubation.
Aim: The present study has been undertaken with an aim to evaluate and compare the intubation time and success rate of direct laryngoscopy and I-gel guided method for endotracheal intubation.
Material and Methods: In this comparative study, 80 patients of ASA grade I and II, aged 20-60 years undergoing elective surgeries under general anesthesia were included and divided into two groups – A DL and B- I-gel as a conduit for endotracheal intubation.
Result: The mean total intubation time was 18\(\pm\)1 seconds for direct laryngoscopy method and 26\(\pm\)5 seconds for I-gel guided method (p<0.05).Although the total number of attempts required in group A were 43 as compared to 47 in group B ,the difference was statistically insignificant (P=0.38).The changes in mean HR and mean MAP from baseline were less in group B in comparison to group A (p<0.05). The incidence of postoperative sore throat and hoarseness were also found to be less in group B as compared to Group A (p<0.05).
Conclusion: I-gel guided intubation can be an effective alternative to the conventional DL method as it offers more hemodynamic stability and less post operative adverse events.

Primary brain tumors are a major cause of cancer-related deaths worldwide, and numerous studies have indicated an increase in their incidence over the past two decades. This study aimed to estimate the frequency of primary intracranial tumors presenting at KLE’s DR Prabhakar Kore’s Hospital and MRC, Belgaum, and to examine correlations between various factors, including age, sex, clinical symptoms, and signs. Between January 2006 and December 2010, 159 patients with proven cases of primary intracranial tumour based on CT/MRI scans were included in the study. Gliomas were the most frequent tumor type (45.28%), followed by meningiomas (23.89%). Males were more commonly affected (55.97%) than females, and the most commonly affected age group was 41-60 years, including 74 of the 159 cases (46.65%). Over half of the tumors were located in the cerebral lobes, with the frontal lobe being the most frequently involved. Headaches, seizures, and focal neurologic deficits related to the anatomic site of involvement were the most common presenting signs and symptoms. The findings of this study can be extrapolated to the population of North Karnataka and are consistent with similar studies conducted elsewhere in the country. Additionally, the study reveals a significant relationship between patient age and sex and the occurrence of different tumor types.

Acute Encephalitis Syndrome (AES) is a significant cause of mortality and morbidity in children in endemic regions. While viruses have been the primary etiological agents attributed to AES in India, other microbes and toxins have also been reported in recent years. This study aimed to determine the etiology, clinical features, and outcomes of AES in children. This prospective observational study was conducted in the pediatric department of Jorhat Medical College and Hospital of Assam over a period of one year. The study included 49 diagnosed cases of AES in children aged between one month to 12 years as per the WHO case definition. Clinical features, etiology, and outcomes (recovery without or with neurological sequelae or death) were recorded for each patient. The study found that fever (100%) and altered sensorium (100%) were the most common clinical presentations in AES cases. Seizure (63%), headache (34.7%), vomiting (26.5%), diarrhea (22.4%), and other symptoms such as excessive crying and irritability (22.4%) were also observed. Japanese Encephalitis (JE) was the most common cause of AES (28.6%), followed by Herpes Simplex Virus (4.1%), pyogenic meningitis (4.1%), and tubercular meningitis (2%). The majority of cases (61.2%) were of unknown etiology. Among the 49 cases, 27 (55.1%) recovered without neurological sequelae, 8 (16.8%) had neurological sequelae, and 14 (28.6%) died during hospital treatment. The most common neurological sequelae was motor deficit (37.5%), followed by behavioral disorders and aphasia (25% each). Cranial nerve palsy was observed in one case (25%). Of the eight AES cases with neurological sequelae, five were JE positive and three were caused by other agents. The study concludes that AES cases commonly present with fever, altered sensorium, seizure, headache, vomiting, and signs of meningeal irritation. JE remains a major cause of AES in children in this region of India. These findings highlight the need for global attention to combat the menace of this arboviral encephalitis and save the lives of children.

Background: Non-alcoholic fatty liver disease (NAFLD) is a common condition characterized by excess fat in the liver, which ranges from simple steatosis to steatohepatitis, cirrhosis, and hepatocellular carcinoma (HCC) in the absence of excessive alcohol intake. This study aimed to determine the prevalence of NAFLD among pre-diabetic and diabetic patients at a tertiary hospital.
Methods: This single-center, prospective, comparative, parallel-group, observational study included male and female patients between 30 and 70 years old who were either diabetic or pre-diabetic. A total of 600 patients with NAFLD were studied.
Results: Of the 200 diabetes cases studied, the prevalence of NAFLD was 52% (104 cases), while the prevalence of NAFLD among pre-diabetic cases was 45.5% (91 cases), and the prevalence of NAFLD among normal cases was 30.5% (61 cases). The prevalence of NAFLD was significant among females in all patient groups. Diabetic patients with NAFLD had a higher BMI and waist circumference than pre-diabetic and non-diabetic patients, and this difference was statistically significant. Diabetic patients with NAFLD also had higher Glycohemoglobin (%) and fasting glucose (mmol/L) than pre-diabetic and non-diabetic patients, and this difference was statistically significant. Liver function tests and other parameters such as total bilirubin, AST, ALT, GGT, LDL, HDL, total cholesterol, triglycerides, and platelet count were comparable in diabetic, pre-diabetic, and non-diabetic patients, and the difference was not statistically significant.
Conclusion: The prevalence of NAFLD among diabetic patients was 52%, while the prevalence of NAFLD among pre-diabetic cases was 45.5%. These findings highlight the importance of early screening and prevention strategies for patients with diabetes and pre-diabetes to reduce the burden of NAFLD.

Introduction: Vitamin A is an essential nutrient required for normal vision, epithelial maturation, and immunological responses. Vitamin A deficiency (VAD) is a major public health problem in many developing countries, including India, but only 5%-10% show clinical evidence. Studies have shown that subclinical vitamin A deficiency is associated with increased mortality and morbidity.
Materials and Methods: Children suspected of VAD, who were attending the Pediatric OPD at VIMS, Ballari, were studied. Those children with classical features of VAD were excluded. Conjunctival impression was taken using cellulose acetate filter paper, stained, and studied for epithelial changes, which were graded according to the Nelson grading system.
Results: Out of 250 children, 140 (56%) were male and 110 (44%) were female. All age groups were equally affected and had subclinical VAD with an average of 81.2%. The occurrence of subclinical VAD was significantly associated with severe grades of PEM, recurrent LRTI, diarrhea, UTI, measles, etc. Nelson’s grading for Conjunctival imprint cytology (CIC) was effective in detecting more than 80% of all cases of sub-clinical VAD.
Conclusion: Subclinical VAD without ocular manifestations was largely prevalent in a suspected group of children, more so in children of low socio-economic status. Conjunctival Impression cytology was able to detect the majority of these cases, initiate early management of these subclinical cases, and thus reduce the mortality and morbidity associated with VAD.

Background: Soft tissue tumors (STTs) and tumor-like lesions have fascinated clinicians and pathologists for years. Due to their wide variety and close histopathological similarities between certain tumors, they pose a diagnostic challenge. They most commonly present as masses and are rarely associated with pain. Fine-needle aspiration cytology (FNAC) has been documented as a reliable preoperative diagnostic tool to broadly differentiate them into benign and malignant categories. Histopathology is still considered the gold standard for STTs.
Aim of the Study:}The aim of this study is to classify and subcategorize soft tissue tumors and to correlate the findings of FNAC of soft tissue tumors with histopathology.
Methods: This prospective study was carried out on patients with palpable soft tissue masses attending the surgical OPD between January 2021 and June 2022. FNAC of soft tissue lesions was performed, and only cases with subsequent histopathological examination were included in the study. Cytopathological and histopathological diagnoses were correlated.
Results: Out of 90 soft tissue tumors, 83 (92.22%) were benign, 1 (1.11%) was intermediate, and 6 (6.6%) were malignant. The male to female ratio was 1.7:1. The most common site was the trunk (34.4%), followed by the lower extremity (30%). Of all benign lesions, lipoma was the most common (71.1%). There was a concordance of FNAC with histopathology in 88 out of 90 cases (97.8%).
Conclusion: Benign soft tissue tumors outnumber malignant tumors. FNAC is an effective method for the rapid diagnosis of STTs, and preoperatively, it helps differentiate between benign and malignant lesions in most cases. Although histopathology is the gold standard, FNAC has high specificity in diagnosing malignant tumors, thereby preventing unnecessary extensive or radical surgery for benign lesions.

Background: Abruptio placenta is a serious pregnancy complication that occurs when the placenta separates partially or completely from the uterus after the age of viability and before delivery, which can result in maternal and fetal morbidity and mortality.
Aim: This study aimed to determine the percentage, sociodemographic characteristics, risk factors, and feto-maternal outcomes of abruptio placenta in a tertiary care hospital, Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Sangli.
Materials and Methods: This retrospective study included all cases of abruptio placenta that occurred between June 1\({}^{st}\), 2020 and May 31${}^{st}$, 2022 in the obstetrics ward of Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Sangli. Sociodemographic characteristics, risk factors, and fetal and maternal morbidity and mortality data were extracted from patient case notes for analysis.
Results: Of the 966 deliveries during the study period, 37 cases (3.83%) of abruptio placenta were identified. The incidence of abruptio placenta was higher in the age group of 20-29 years (64.8%) and in multiparous women (59.4%). Hypertensive disorders of pregnancy were the most common risk factors, observed in 54.05% of cases. Prematurity was the major perinatal morbidity and was found in 56.7% of cases, followed by birth asphyxia in 37.8%. NICU admission was required for 48.6% of babies, and 29.7% were stillborn. The caesarean section rate was 70.3%. Blood transfusion was required for 28 subjects (75.6%), postpartum hemorrhage occurred in 10 subjects (27.02%), and postpartum anemia was observed in 20 subjects (54.05%). There were two maternal deaths, resulting in a maternal mortality rate of 5.4%. The perinatal mortality rate was 51.3% due to a higher percentage of stillbirths.
Conclusion: Abruptio placenta is a serious pregnancy complication that can result in significant maternal and fetal morbidity and mortality. Hypertensive disorders of pregnancy were identified as the most important risk factor. Good antenatal care services and early referral to well-equipped institutions with qualified personnel, efficient blood banking systems, and good neonatal services are essential in reducing the adverse outcomes of abruptio placenta.