Trends in Clinical and Medical Sciences (TCMS)

Introduction: In 2019, a new coronavirus disease spread throughout the world from the city of Wuhan, China. COVID-19 is divided into four groups according to clinical symptoms and disease severity: mild, moderate, severe, and critical. Budgeted rates of CRP and albumin utilization will be used to estimate the incidence of COVID-19 cases. Based on this data, the aim of this study is to evaluate the diagnostic power of the C-reactive protein to albumin ratio in the early differentiation of severe hospitalized cases of COVID-19.
Materials and Methods: During hospitalization, cases will be classified as mild, moderate, severe, and critical according to the WHO interim guidance. The mild and moderate subgroups will be classified as non-severe (group 1), and the severe and critical subgroups will be classified as severe (group 2). Demographic data, morbidity, and mortality rates will be recorded.
Results: The exitus rates and length of hospital stay were significantly higher in group 2.
Conclusions: The C-reactive protein/albumin ratio has predictive value in severe COVID-19 patients who are candidates for ICU admission or endotracheal intubation. However, it is thought that supporting this data with a larger number of patients and multicenter studies would increase the value of the data.

Background: Mucocutaneous lesions are the most prevalent sign of HIV infection and serve as the first clue that HIV is present. They are important indications of a patient’s immunological health, and HIV-infected patients typically experience more severe, unusual, and extensive symptoms.
Objectives: To investigate the prevalence and spectrum of mucocutaneous manifestations in patients with HIV infection, and to determine the relationship between these manifestations and CD4 cell counts as an indicator of immunological health.
Materials and Methods: The study was conducted at a tertiary care Medical College and Hospital in Cuttack. Patients were enrolled from two centers, the Dermatology outdoor and Anti Retro Viral Therapy Centre, within the hospital. The mucocutaneous manifestations were classified, and CD4 cell counts were determined through collected samples to assess their immune status.
Results: The most common disorders were fungal infections (18%), followed by oral lesions (15.5%), and Papulosquamous disorder (14.8%). Out of 150 patients, 53 patients had 165 dermatological manifestations with a CD4 count below 200 cells/\(mm^3\), 85 patients had 105 dermatological manifestations with a CD4 count between 200-500 cells/\(mm^3\), and 12 patients had 14 dermatological manifestations with a CD4 count of more than 500 cells/\(mm^3\).
Conclusion: Both CD4 count and mucocutaneous manifestations can be used as markers of immunosuppression in HIV/AIDS patients. In resource-poor countries where CD4 count and other expensive markers are not affordable, mucocutaneous manifestations alone can be used as a marker of immunosuppression.

Aim: This study aims to investigate the clinical changes in the ocular surface of patients diagnosed with type II diabetes mellitus.
Methodology: A total of 75 adult patients of both genders with type II diabetes and ocular surface disease, along with a group of healthy subjects, were included in the study. Various tear film stability tests such as tear film break-up time (BUT) test, Schirmer I test, fluorescein dye test, and rose bengal dye test were conducted to assess ocular surface disorders. Additionally, the Ocular Surface Disease Index (OSDI) questionnaire was administered to all enrolled patients. The duration of diabetes, HbA1C levels, and the stage of diabetic retinopathy were also recorded.
Results: Group I comprised 45 males and 30 females, while group II included 35 males and 40 females. Non-proliferative diabetic retinopathy (NPDR) was present in 48 patients, whereas proliferative diabetic retinopathy (PDR) was present in 19 patients, showing a significant difference (P=0.01). The remaining diabetic patients did not exhibit any clinically observable fundus changes of retinopathy during stereoscopic 90 D examination. The average tear function test was 8.22 seconds in group I and 13.1 seconds in group II, whereas the average Schirmer test values were 8.84 mm in group I and 16.5 mm in group II. Fluorescein staining was observed in 8 patients in group I and 2 patients in group II, while pathologic rose bengal staining was positive in 15 patients in group I and 4 patients in group II, demonstrating a significant difference (P<0.05). The average tear film BUT was 9.25 seconds in patients with a duration of diabetes <10 years and 8.17 seconds in those with a duration of diabetes >10 years. Similarly, the average Schirmer test revealed values of 10.31 mm and 6.72 mm, respectively. Patients with good glycemic control exhibited average tear film BUT and Schirmer test values of 10.85 seconds and 10.21 mm, while those with poor glycemic control showed values of 8.30 seconds and 6.82 mm, respectively. In patients with NPDR, the values were 9.53 seconds for tear film BUT and 10.5 mm for the Schirmer test, whereas patients with PDR had values of 7.84 seconds and 7.6 mm, respectively. The average range of OSDI score was 40-60 in group I compared to 0-20 in group II.
Conclusion: Patients diagnosed with diabetes mellitus are more susceptible to developing ocular surface disorders. Furthermore, a longer duration of diabetes and poor glycemic control are associated with increased chronic inflammation of the ocular surface. The stage of diabetic retinopathy shows a direct correlation with the OSDI questionnaire score.

Background: Hypothyroidism manifests itself in a wide range of clinical manifestations. ECG and ECHO changes have been reported among patients with both subclinical and manifest hypothyroidism.
Objectives: To enumerate the cardiological manifestations of hypothyroidism in ECG and ECHO.
Methods: The study was carried out as a cross-sectional study comprising 50 patients aged 18 years and above, of both sexes who were detected to have hypothyroidism. A convenient non-random sampling technique was used to select study participants from all eligible patients in the study population. The diagnosis of hypothyroidism was confirmed by measuring serum TSH, total T3 and T4, and subsequently, patients underwent ECG and echocardiography. A p-value <0.05 was considered statistically significant.
Results: It was observed that the majority of the study patients belonged to the middle age group and were females. Overt hypothyroidism was noted in 78%, and low levels of T3 and T4 were observed in 64% and 78%, respectively. Most of the study patients had elevated triglyceride levels (96%), while ECG and ECHO abnormalities were detected in 30%. Low voltage complex was the most commonly noted ECG abnormality (8%), and left ventricular diastolic dysfunction (LVDD) was the most common ECHO abnormality (18%).
Conclusions: ECG and ECHO changes are observed in a considerable proportion of patients with hypothyroidism, with low voltage complexes and LVDD being the most common, respectively.

The pathogenesis of autoimmune diseases (AD) is based on the “recognition of the body’s own structures by immunocompetent cells and subsequent activation, proliferation, and induction of inflammation. Most lymphocytes directed towards their own antigens are removed in the thymus through apoptosis.” Currently, research is being conducted to investigate the genes involved in the development of autoimmune diseases, specifically in the context of vitiligo, such as HLA genes (HLADR3 associated with a common process, HLADR4 with limited), TNFAIP3 genes, and A20 deficiency haplotype (a product of this gene). The importance of immune inflammation, mononuclear infiltration of marginal zones, and the cytotoxic effect of CD8+ on melanocyte changes in CD4, CD8, and their ratios have been identified as early indicators of vitiligo progression. A local deficiency of SOD, glutathione, and scavengers from ROS regulated through Nrf2 and ARES in the skin and blood of vitiligo patients has also been revealed. This study included 287 patients with non-segmental vitiligo (148 men and 139 women) aged 19-68 years who sought treatment at the Republican Specialized Scientific and Practical Medical Center of Dermatovenerology and Cosmetology between 2018 and 2022. The average age was 28.1\(\pm\)1.3 years, and the duration of the disease was 42.6\(\pm\)3.6 months. Of these patients, 114 (40%) had the debut of vitiligo less than a year before treatment. The study found that the average level of TNF-alpha was higher than the reference interval and the data of the control group, supporting the contribution of inflammation and apoptosis to depigmentation in vitiligo. The study also highlighted the levels of TNF-alpha and IL-21 in patients who had an unfavorable allele for the SNPs among the other patients in the main group.

This article discusses the feasibility of using lightweight polypropylene nets for onlay plastic surgery of postoperative ventral hernias (POVH). The study involved 137 patients with POVH, who were divided into two groups: the control group (64 patients) who underwent traditional Esfil-heavy mesh endoprosthesis and the primary group (73 patients) who received Esfil-light endoprostheses. The study investigated the clinical and immunological aspects of using propylene nets in these two groups of patients. Before surgery, the examined patients showed a suppression of the cellular link of immunity, an imbalance of the humoral link, and non-specific factors of protection. The use of polypropylene meshes (Esfil-light and Esfil-heavy) triggered an inflammatory reaction associated with the structural properties of the prostheses. However, the use of Esfil-light PP prosthesis in onlay allogernioplasty caused less inflammation in the alloplasty area compared to Esfil-heavy. Overall, the findings suggest that Esfil-light PP prosthesis can be a suitable alternative to traditional Esfil-heavy mesh endoprosthesis for onlay plastic surgery of postoperative ventral hernias. The reduced inflammatory reaction in the alloplasty area may lead to improved outcomes for patients undergoing this procedure.

Background: Hypertension affects individuals of all classes and across all groups. The relationship between blood pressure and the risk of cardiovascular disease events is continuous and independent of other risk factors.
Aim and Objectives: The present study aimed to identify various modes of presentation and the clinical profile of hypertensive emergencies in our hospital.
Materials and Methods: Data were collected from 100 patients admitted to this hospital over a period of two years. Patients who presented with an elevated blood pressure of systolic blood pressure >180mmHg or diastolic blood pressure >110mmHg, with a history of acute target organ damage, or with laboratory evidence of acute target organ damage were included in the study.
Results: Of the 100 patients studied, 88 were known hypertensives, among whom 54 had discontinued their antihypertensives before the incident, while the remaining 46 patients continued their medication. Among the 100 patients, 28 had diabetes mellitus and 28 had dyslipidemias. Out of 100 patients with hypertensive emergencies, 12 died before discharge, resulting in a hospital mortality rate of 12%. All expired patients had intracerebral hemorrhage.
Conclusion: Known hypertensives are at a higher risk of presenting with acute target organ damage associated with hypertensive emergency. The presence of diabetes mellitus and dyslipidemia increases the chance of developing hypertensive emergencies.

In modern education, innovative techniques and updated technology are essential tools for effective teaching. As the medical field advances, new teaching methods and modalities are necessary to generate interest and provide practical learning experiences. Histology is a crucial component of medical education, and a thorough understanding of both the theory and slide recognition is necessary for medical students. This study aimed to investigate the intervention of Basic Pathology into Histology and its impact on First MBBS students’ response. The study involved 81 students from SKIMS Medical College in the Department of Anatomy and Pathology, who were administered a questionnaire. The results showed that students appreciated the integration of pathological perspectives with normal histology and found the combined approach useful and relevant. The study highlights the importance of practical teaching methods and the need for continuous improvement in teaching and assessment methods in medical education.

Background: Diabetes mellitus is a serious public health issue globally, and India is no exception to its growing prevalence in many emerging nations. In the near future, India will emerge as the global capital of diabetes.
Objective: The objective of this study is to investigate ocular surface changes and ocular surface disorders in patients with diabetes mellitus.
Methods: This cross-sectional observational study was conducted among all known cases of diabetes mellitus aged over 40 years, attending the eye outpatient department and diabetic clinic at Dr. Sushila Tiwari Government Hospital, Haldwani, Nainital.
Results: The mean age of diabetic patients was 60.82\(\pm\)10.23 (41-79) years. The majority of cases were female (59.7%), followed by males (40.3%). The rural population (56%) was more affected by ocular surface disorders in patients with type II diabetes mellitus than the urban population (44%). Homemakers (50.2%) were the largest group, followed by outdoor workers (30.8%), office workers (12%), and factory workers (7%). Itching was present in 22.0%, lacrimation in 54.8%, burning in 66.8%, foreign body sensation in 85.6%, and blurring of vision in 53.2%.
Conclusions: This study establishes a causal relationship between ocular surface disorder and diabetes mellitus.

Background: Beta-thalassemia syndromes are a category of genetic blood disorders defined by reduced or incomplete beta globin chain synthesis, leading to lower hemoglobin levels in red blood cells (RBC), lower RBC output, and anemia.
Aims and objectives: To study the growth pattern in thalassemic children who are on regular chelation therapy and blood transfusion in comparison to normal children and serum ferritin level in these children and its relation to growth pattern and oral chelation therapy.
Methods: The present study was a hospital-based cross-sectional study. One hundred and one transfusion-dependent thalassemic children on oral chelation therapy, attending the pediatric ward in Gauhati Medical College and Hospital, Guwahati, Assam, were enrolled during the study period from 1st May 2021 to 30th April 2022.
Results: This study provides evidence that children suffering from transfusion-dependent thalassemia (TDT) are prone to growth retardation, with underweight, stunting, and wasting being 31.6%, 52.4%, and 27.7%, respectively.
Conclusion: In conclusion, short stature is an important complication in TDT. Growth in patients with TDT is significantly related to age, sex, hemoglobin level, and iron overload status. Management with hypertransfusion and good control of iron overload is important to achieve optimum growth in patients with TDT.