Trends in Clinical and Medical Sciences

This paper highlights the significance of cadaver dissection as an essential part of medical education and emphasizes the shortage of cadavers in medical colleges. The study aimed to evaluate the knowledge and attitude of medical students towards body donation. The results indicate that a majority of students are willing to donate organs but not their whole body due to concerns about disrespectful behavior in the dissection hall. Moreover, some students were not aware of the legal procedures involved in body donation. The study found no significant difference in opinion based on gender or religion. The findings of this study may be useful in promoting body donation and addressing the shortage of cadavers in medical colleges.

Introduction: Fine Needle Aspiration Cytology (FNAC) is a quick, simple, efficient, and inexpensive way to sample superficial masses in the head and neck due to the wide range of primary as well as metastatic neoplasms and the close proximity of several types of tissues. Due to its minimally invasive nature and easy access to target sites, FNAC has gained popularity and acceptance. Although FNAC cannot provide the same level of morphological detail as histology, it can reveal cells from the whole lesion since aspirating allows for many passes through the lesion. In addition to confirming the existence of metastatic disease, FNAC also offers information on the type and origin of the primary tumor. It provides the added advantage of being an outpatient procedure and lowers the frequency of exploratory procedures. The present study was carried out to study the lesions of the anterior triangle of the neck in correlation with histopathology and determine the diagnostic accuracy of FNAC.
Materials and Methods: This prospective observational study was carried out in the Department of Pathology, MGM Medical College and MYH Hospital, Indore, over a period of 2 years (2013-2015), among 1110 patients of both sexes and all age groups with palpable anterior triangle neck swellings reporting in the Department of Surgery, ENT, Pediatrics, TB, and Cancer hospital, who were referred to Pathology. A detailed clinical history was recorded, and a complete physical examination was carried out. FNAC was performed under all aseptic precautions. Cytological findings from the smears were recorded, and a diagnosis was made. Excisional biopsy specimens received were processed and mounted by DPX. Cytohistopathological correlation was done. Data were collected, compiled, and analyzed using SPSS 22.0 (trial version).
Results: Most participants belonged to the age group of 21-30 years. The male to female ratio was reported to be 1:1.35. A large proportion of lesions (71.08%) were found in lymph nodes, while 22.25% were in the thyroid, and the rest (6.67%) were distributed in various other regions. The majority of the lesions (77.12%) in the anterior triangle of the neck were non-neoplastic (inflammatory) lesions. Among the neoplastic lesions located in the thyroid gland, 13.76% were benign and 1.62% malignant. No benign neoplastic lesions were noted in the lymph node. Rather, 14.57% were malignant. Most lesions (38.66%) in the lymph nodes were classified as tuberculous lymphadenitis, followed by reactive hyperplasia of lymph nodes (15.59%). Thyroiditis was most common (84.62%) among the lesions found in the thyroid gland, followed by colloid goiter (8.10%). The sensitivity and specificity were calculated as 85.50% and 99.23%, respectively.
Conclusion: In addition to being safe and comparatively free of complications, FNAC offers a quick, efficient, and accurate approach to diagnosing lesions, especially of the neck. Consistent results were found between cytological and histological examinations, and hence it works as a useful adjunct to histopathology. It can help to significantly reduce morbidity and mortality by early as well as accurate diagnosis of benign and malignant lesions.

Background: Conversion disorder is a prevalent psychiatric illness characterized by various clinical patterns, including visual paralysis, dystonia, psychogenic non-epileptic seizures, anesthesia-like symptoms, swallowing problems, motor tics, and difficulty walking. These symptoms vary greatly from case to case and can vary in the same patient during successive episodes. Most symptoms are related to life stressors.
Study design: A cross-sectional study was conducted to estimate the sociodemographic profile, types of stressors, and variety of clinical symptoms presented in patients with conversion disorder in a tertiary care center in the North-East region of India. A total of 74 patients diagnosed according to Diagnostic and Statistical Manual of Mental Disorders Fifth Edition criteria were included. Patients underwent assessments of comorbidity using the Hamilton Depression Rating Scale, Hamilton Anxiety Scale, and assessments of stressful life events using the Presumptive Stressful Life Event Scale.
Result: The most common lifetime stressor was excessive alcohol use by family members with financial loss or problems (43.7%). Immediate stressors prior to the onset of illness were broken engagement or love affair (25.7%), family conflict (24.3%), marital conflict (14.9%), examination-related problems (10.8%), and other problems (23%). Motor symptoms were the most common type of clinical presentation (58.4%), with pseudo-seizures being the most common (29.7%). Other motor symptoms included paresis of the lower limb (9%), paresis of the left-side upper and lower limb (2.7%), aphonia/dysphonia (12.2%), limb paralysis (1.4%), dysphasia (2%), and ataxia (1.4%). Conversion disorder with mixed motor and sensory deficit (multiple fainting spells) was found to be the most common symptom (37.8%) in this region.

The COVID-19 pandemic has affected both the physical and psychological well-being of those who have been infected or have lost loved ones. Among those most affected are healthcare workers who have been on the frontline throughout the pandemic. This study aims to assess the levels of anxiety and depression among healthcare workers and their association with various demographic parameters. Additionally, we sought to determine the association between the Global Fatigue Index (GFI) and HADS score. Of the participants, 12 (16.22%) had borderline HADS scores (8-10) and 4 (5.41%) had abnormal HADS scores for depression (11-21). Furthermore, 13 (17.57%) had abnormal HADS scores for anxiety. HADS scores for both anxiety and depression were associated with female gender, profession (paramedic staff were more affected than doctors), and income. The GFI was calculated using the Multidimensional Assessment of Fatigue (MAF) score and found to have a positive correlation with various demographic parameters as well as with the HADS score, indicating that psychological stress has an impact on physical well-being and can lead to prolonged fatigue, thereby affecting an individual’s working capacity.

Background: Hypertension is a major cause of death worldwide. The increasing prevalence of hypertension in young individuals is a warning sign of the impending cardiovascular, cerebrovascular, and renal diseases in the future. Hypertension affects 1 in 8 adults between the ages of 20 and 40 years and this number is likely to increase with unhealthy lifestyle behaviors and the lowering of hypertension diagnostic thresholds. Although the mechanisms are unclear, early-life factors have been found to influence blood pressure (BP), and BP tracks strongly within individuals from adolescence through to later life. Higher BP at a young age is associated with abnormalities on heart and brain imaging and increases the likelihood of cardiovascular events by middle age. However, young patients often have lower diagnosis rates, and their treatment is often delayed.
Methods: This prospective observational study was conducted from January 2021 to March 2021 in a tertiary care hospital. A total of 50 cases, male and female, were studied based on inclusion and exclusion criteria. Routine investigations were done on all patients, and uric acid and lipid profiles were sent to evaluate the association. Patients’ height and weight were recorded to calculate BMI. Patients below 12 years, pregnant women, and patients with previous cardiovascular and secondary causes of hypertension were excluded from the study. The study was carried out in all patients who fulfilled the inclusion and exclusion criteria.
Results: During the study period, a total of 50 patients (27 females and 23 males) were included. Our study revealed a female preponderance in the ratio of 1:1.1. More patients were in the age group of 40-45 years. Overweight was significantly noted with BMI >25 in 30 patients and >30 in 10 patients. Uric acid was significantly increased in 27 patients. Lipid abnormalities were noted: LDL increased in 30 patients, TGL increased in 32 patients, HDL increased in 20 patients, Total Cholesterol in 25 patients, and VLDL increased in 25 patients.
Conclusions: Our study showed that BMI was significantly higher in hypertensive patients. Furthermore, lipid abnormalities were present in overweight patients, contributing to hypertension. Although uric acid was elevated in a significant number of patients, it did not emerge as a risk factor in young hypertensives. We recommend a healthy lifestyle and a disciplined diet to avoid the hazards of hypertension.

Twenty-six patients with massive combat injuries to the lower extremities were treated with Ilizarov bone transport and free flap coverage. In all cases, debridement was performed thoroughly and with caution, followed by free flap coverage and external fixator application. The Ilizarov transport method using ring fixators was applied 4-6 weeks later, with distraction osteogenesis beginning 2-3 days later. The segmental bone defects ranged from 5cm to 16cm in the greatest dimension, and the total disability time from initial injury ranged from 14-26 months. However, two patients experienced partial flap necrosis, which was later treated with local transposition flap cover and split skin graft. Despite the late treatment, successful results were obtained in all 26 patients, with the original length of the tibia maintained and timely definitive treatment provided for the massive injuries of the lower extremities. Thus, the Ilizarov transport method used in combination with free flap coverage provides an effective therapy for repairing massive injuries to the lower extremities.

Background: Radio-cephalic arteriovenous fistula (RC-AVF) is considered the preferred vascular access for dialysis, particularly in the non-dominant arm. However, elderly patients and those with comorbidities have a higher failure rate of RC-AVF. Therefore, clinical examination before surgery is crucial, and careful postoperative monitoring is necessary to overcome impaired fistula maturation. This study aims to evaluate different factors that may affect the outcome of arteriovenous fistula creation.
Methods: The study included patients aged 20-65 years with chronic kidney disease, without prior radio-cephalic arteriovenous vascular access intervention, from February 1, 2021, to January 31, 2022. Factors affecting the outcome were assessed, including preoperative, intraoperative, and postoperative factors. In this study, an end-to-side anastomosis technique was used with prolene 7-0 suture material in an interrupted suturing technique.
Results: Out of 250 patients, the highest successful AVF creation rate was observed in the 20-30 years age group (84%), followed by the 31-40 years and 41-50 years age groups (78%). The success rate was found to be higher in males (61%) than in females (39%). Moreover, the success rate of AVF had an incremental relation with the diameter of the radial artery and cephalic vein.
Conclusion: The success of fistula maturation is strongly correlated with postoperative monitoring. Therefore, AV fistula monitoring should begin immediately during surgery and continue in the postoperative period.

Introduction: Breast masses can have various causes, including inflammatory, benign, or malignant conditions. Although most masses are benign, breast cancer is the most common cancer and the second leading cause of cancer deaths in women. Breast lumps pose a diagnostic dilemma for both general practitioners and surgeons. Fine needle aspiration cytology (FNAC) is increasingly used for preoperative diagnosis of breast cancer to determine various prognostic parameters and offer the best therapy to patients.
Objectives: The objectives of this study were to determine the common causes of breast mass in the population in and around our district, assess the diagnostic accuracy of FNAC in differentiating benign from malignant masses, and assess the diagnostic accuracy of correlation between FNAC and histopathological examination.
Materials and Methods: The study included patients presenting with palpable lumps in the breast and attending the Department of Surgery at VIMS Ballari. A detailed history and thorough physical examination were carried out, and FNAC of the breast lump was performed at the Cytology section of CDL. Only cases with subsequent excision/mastectomy for histopathological examination were included in the study.
Results: In the present study, Fibroadenoma was the most commonly detected lesion on both FNAC and histopathological examination, and invasive Ductal carcinoma -NOS was the most common malignant lesion. The diagnostic accuracy of FNAC was 94%. The overall specificity of FNAC in diagnosing palpable breast lumps in this study was 100%, sensitivity was 94%, positive predictive value was 100%, and negative predictive value was 93%. The false-negative rate in our study was 7.6%.
Conclusions: Breast lumps cause immense anxiety among patients and their families. To address this issue promptly, FNAC has been found to be a reliable tool. It is simple, cost-effective, accurate, and provides rapid diagnosis, which helps alleviate fears. Additionally, it gives good histopathological correlation, thus eliminating the need for surgical intervention for definitive diagnostic purposes.

Background: The spleen is a crucial intra-peritoneal hemo-lymphoid organ that is related to various abdominal viscera and the diaphragm. It is known for its variable size and shape and receives its blood supply from the tortuous splenic artery and is drained by the splenic vein. Palpation of the spleen is possible in certain pathological conditions. Notches on the spleen are a result of incomplete fusion of the embryonic splenunculi. In blunt trauma to the abdomen, the spleen is the most common intra-abdominal organ to rupture.
Aims: The study aimed to investigate the variations in morphology, morphometry, shape, size, and weight of cadaveric spleens in the Santhal-Pargana Division of Jharkhand, India.
Materials and Methods: The study was conducted on 30 dissected human spleens of both sexes. The spleen was removed by detaching it from various attachments, and the splenic vessels near its hilum were cut with the help of scalpel, scissors, and forceps. The shape, notches, length, breadth, thickness, and weight were studied.
Results: The study found that a wedge shape was the most common (40%). The mean weight of the spleen was 145.13 gm, and the average number of notches on the superior border was 2. The mean length, breadth, and thickness were 10.8 cm, 6.83 cm, and 4 cm, respectively. These findings were consistent with most similar studies on the spleen, although some studies had different results.
Conclusion: The study reaffirmed that the spleen is quite variable in shape and size. Splenomegaly may be more prevalent due to some endemic diseases. This knowledge is important for clinicians, physicians, radiologists, surgeons, and for routine anatomical dissection. The findings of the study may also contribute to a better understanding of the structure and function of the spleen, which can aid in the diagnosis and treatment of various diseases and injuries related to this organ.

Background: Sepsis and septic shock are among the leading causes of death and the most common cause of death among critically ill patients. Severity scores and prognostic models are used to evaluate the severity of illness in patients in the critical care unit. The present study aimed to compare the APACHE II and SOFA scoring systems in critically ill patients with sepsis in the medical ICU of a tertiary hospital.
Materials and Methods: The present study was a prospective observational study conducted on patients aged > 18 years, of either gender, admitted to the medical ICU for sepsis. All patients were evaluated using the APACHE II and SOFA scoring systems.
Results: The present study included 225 cases that met the study criteria. The mean age was 59.2 \(\pm\) 12.3 years, the mean length of stay was 9.3 \(\pm\) 4.2 days, and the mean length of ICU stay was 7.3 \(\pm\) 3.7 days. The majority of the patients were male (63.56%). The mortality rate was 58.22%, 39.56% of patients had multiple organ dysfunction, 74.22% were diagnosed with septic shock, and positive blood culture was noted among 34.67% of patients. On the day of admission, a significantly higher APACHE II score was noted among non-survivors (23.8 \(\pm\) 11.65) compared to survivors (16.59 \(\pm\) 8.24). The daily SOFA score was higher among non-survivors than survivors, and the difference was statistically significant (p < 0.001). Both APACHE II and SOFA scoring systems were found to be equivalent in predicting mortality in patients diagnosed with sepsis, and there was no statistical significance.
Conclusion: The APACHE II and SOFA scoring systems are equivalent in predicting mortality in patients diagnosed with sepsis, and there was no statistical significance.