Trends in Clinical and Medical Sciences

Introduction: Human papillomavirus causes many diseases like genital warts, sexual transmitted diseases; cervical cancer. Human papilloma virus vaccine is available for adolescent girls. Though it is effective its use has not increased. Therefore, the current study is designed to determine the awareness, acceptance and hesitancy among nursing students.

Background: Pregnancy increases the demand for nutrients and hemoglobin. Besides these, physiological changes in blood parameters also occurs during pregnancy. Anemia in pregnancy is a serious condition contributing to increased maternal and fetal morbidity and mortality. Present study has been undertaken with the knowledge of hemoglobin values and its distribution in different trimesters of pregnancy.
Material and Methods: Present study was single-center, prospective, comparative, parallel-group, observational study, conducted in pregnant women attended the ANC OPD or admitted in antenatal ward and sixty healthy non-pregnant women of same age group.
Results: The mean hemoglobin value was \(12.23\pm1.32 gm\) % throughout pregnancy. In control group the mean value was \(12.59 \pm 2.50 gm\)%. Statistically significant variation was observed between control and each trimester of pregnancy \((p<0.05)\). Significant difference observed between 1st and 2nd trimester \((p < 0.05)\) and 2nd and 3rd trimester \((p < 0.05)\). When compared between 1st and 3rd trimester, difference was not significant \((p>0.05)\) Hemoglobin values are lower in pregnant cases as compared to non-pregnant subjects \((p<0.05)\). Lowest hemoglobin value is observed in 2nd trimester in maximum number of cases. Mean hemoglobin level was found lower in pregnant women with gravidity more than 1 as compared to primigravidae.
Conclusion: A significant association was observed between hemoglobin level and trimester of pregnancy. High occurrence of low hemoglobin level in pregnant women was found belonging to lower socioeconomic class. Maternal hemoglobin value decreases with increase in gestational age.

Aims: Mucormycosis is an acute invasive fungal infection which is rare, opportunistic and can potentially cause fatal complications. This study aimed to evaluate demographic data, disease presentation, medical &/or topical, surgical treatment.
Material and methods: Total twenty five patients with mucormycosis treated at tertiary care hospital in Gujarat during three months duration from May to July 2021. After detailed history thorough Ear, Nose and throat examination was performed. Along with local examination, ophthalmologic and neurologic examination performed in every case. After Functional endoscopic sinus surgery, tissue sent for histopathologic examination.
Results: Twenty five patients diagnosed with Mucormycosis, 18(72%) patients were males and 7(28%) were females. All 25(100%) had past history of COVID 19 infection and Diabetes Mellitus. Out of 25, 23(92%) patients were treated with intravenous or oral steroids and 2(8%) patients were not treated with any steroids. MRI paranasal sinuses with orbit with brain cuts performed for all 25 patients after suspicion of mucormycosis. 12(48%) patients had Sinonasal involvement, 11(44%) were Rhino-orbital involvement, and 2(8%) had Rhino palatal involvement. All 25(100%) patients were given Injection Amphotericin B for 3-4 weeks according to response. 6(24%) Patients were also given Oral Posaconazole. We performed Functional endoscopic sinus surgery in 23(92%) patients. In two (8%) cases Sinus surgery performed along with Maxillectomy. All 25(100%) cases on histopathology confirmed of Mucormycosis.
Conclusion: Prognostic factors we observed in our study were involvement of rhino-orbito-cerebral disease shows poor prognosis. Good Diabetes control showed early recovery. Early identification and early treatment improves prognosis as well as survival rates.

Background: Cervical cancer is a major cause of mortality in women. Pap smear is a screening test used in the screening of cervical cancer. There are well defined guidelines regarding its use. It should be offered to all sexually active women between the ages of 30-65 years, irrespective of whether or not they are symptomatic. Moreover, those women who have undergone hysterectomy for reasons other than cervical cancer or precancerous lesions, do not require this test.
Materials and methods: We undertook an observational study to describe the age, presenting complaint, previous history of hysterectomy and reason for hysterectomy in women undergoing Pap smear testing in a private super speciality hospital in Central India in the past 3 years.
Objectives: The objective of this study was to examine how closely the aforementioned guidelines were being followed, so as to deduce how wisely were we choosing the women to whom the test was being offered.
Results: This study found that a significant proportion of tests were being offered to women who did not need them. And more importantly, we were missing the opportunity to screen women who presented with non gynaecologic complaints in our hospital.

Background: To assess clinico-pathological study of colonic biopsies.
Materials and methods: One hundred ten colonic biopsies obtained from Gastroenterology department were collected in 10% neutral buffered formalin processed and embedded with the mucosal surface being uppermost. 4\(\mu\) thick serial sections were prepared and stained with H&E. Detailed study of the sections was done under light microscope and diagnosis rendered accordingly.
Result: Age group 11-20 years had 8, 21-30 years had 22, 31-40 years had 40, 41-50 years had 24 and >50 years had 16 cases. The difference was non- significant (\(P> 0.05\)). Most common clinical features were constipation seen in 36, bleeding PR in 28, bleeding PR weakness in 17, diarrhea in 16 and diarrhea \(+\) pain abdomen \(+\) weakness in 14 patients. The difference was non-significant (\(P> 0.05\)). Non-neoplastic lesions were 74. These were as non-specific colitis in 22, ulcerative colitis in 16, acute inflammation in 14, hyperplastic polyp in 10, inflammatory polyp in 6, retention polyp in 4 and endometriosis in 2 cases. Neoplastic benign lesions were 25. Benign spindle cell lesion was in 3, tubular adenoma in 15, villous adenoma in 5 and tubulovillous adenoma in 2 cases. Neoplastic malignant lesions were well differentiated adenocarcinoma seen in 4, moderately differentiated adenocarcinoma in 6, poorly differentiated adenocarcinoma in 2 and signet ring cell carcinoma in 1 case.
Conclusion: Colonoscopy is a simple and a safe procedure. It helps in assessing the lesions clinically and confirming histopathologicaly through guided biopsy. Colonoscopic biopsies also play a key role not only in diagnosis, but also in follow up and treatment.

Bacterial bloodstream infections are important causes of morbidity and mortality, globally. The aim of the present study was to determine the bacterial profile of bloodstream infections and their antibiotic susceptibility pattern among the patients admitted to ICU at a tertiary care hospital.This prospective study was conducted over a period of eighteen months. Inclusion criteria comprised of patients admitted to ICU who belonged to either gender and were in the age group of 15-60 years. Over the course of study, 30 out of total 140 blood culture samples were identified to be culture positive (18 GNB and 11GPB). The most common Gram-positive isolate was Staphylococcus spp (26%) while Escherichia coli was the most common gram negative isolate (36%).Escherichia coli expressed highest resistance to all the drugs but sensitivity to Meropenemand Polymyxin B was 72% and 90%, respectively. High degree of resistance was noted to cephalosporins and piperacillin -tazobactam, among all the groups. The study indicated high level of antimicrobial resistance among Gram negative bacilli, esp E.Coli and justifies the need for antimicrobial stewardship to prevent development of further resistance.

Background and Aim: Chronic cancer pain is one of the major challenges of palliative care and it is prevalent in 80\% of all the gastric and pancreatic malignancies. Adequate pain relief not only improves the drug compliance, but also alleviates depression among the cancer patients, thereby improving the quality of life. This study was carried out with the aim of evaluating the role of Coeliac Plexus ethanol Neurolysis (CPN) in pain relief among patients with gastric and pancreatic malignancy.
Methods and materials: This is an uncontrolled before-and-after non randomized trial. This bedside procedure was done in an ICU in chronic pain management centre. Trial coeliac plexus block was done after identification of coeliac trunk using ultrasound and 15 cc of 1% xylocard was given. After 30 minutes, pain relief was assessed with Numerical Rating Scale for pain (NRS). Patient was then given 20ml of 60% ethanol. Pain relief was documented using NRS immediately at 24hours, 72 hours,1 week and 3 months. Statistical analysis was done using Statistical Package for the Social Sciences version (SPSS) version 16.0. Paired t test was used to analyze the difference between variables.
Results: Our study shows statistically significant difference between pre-NRS and post immediate-NRS (mean 8.26\(\pm\)0.52 and 3.40 \(\pm\)0.47)(P value \(<0.0001\)) and significant decrease in NRS seen after 24 hours,72 hours,1 week and 3 months.
Conclusion: USG guided anterior approach coeliac plexus ethanol neurolysis is effective in decreasing pain associated with gastric and pancreatic malignancy.

Background: With an estimated 13.3 million cases each year, acute kidney injury (AKI) become a problem for world health. India has a high prevalence of AKI following volume depletion from gastrointestinal fluid loss. Due to poor socioeconomic situations, limited access to care, lack of awareness of personal cleanliness, crowding, and climatic factors that encourage the spread of infection, diarrheal illnesses are widespread in India. AKI following gastroenteritis is probably caused by a lack of medical facilities in rural areas and a delay in treating dehydration. Therefore, in order to come up with solutions to this issue, it is necessary to comprehend the disease’s clinical spectrum.
Materials and Methods: This is a prospective observational study conducted on 50 patients with AKI due to Acute Gastroenteritis admitted to Narayana medical college \& hospital, Nellore, Andhra Pradesh, over a period of 1 year. The diagnosis of acute kidney injury was used when there was evidence of kidney injury in some clinical settings without any kidney disease history. The term acute kidney injury was used when there was a rise in Serum creatinine \(\geq44 \mu mol/L (\geq0.5mg/dL)\) and the history of decreased urine output of less than \(0.5ml/kg/hr\) for more than 6hrs. The criteria used for AKI in the study was Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE) criteria (given by Acute Dialysis Quality Initiative Group 2004) and is as follows.
Results: Pre Renal Azotemia, which occurred in 58% of cases, was followed by Acute Tubular Necrosis, which occurred in 42% of cases in this study. The pre-renal group’s mean age was \(49.3 + 5.66\) years, while the ATN group’s was \(48.6 + 7.40\) years. The mean age of those who survived was 46.73 4.75, while that of those who did not survive was 65 6.034. On admission, Baseline creatinine with a mean of \(3.032+0.37mg/dl\). It was \(2.70+0.29\) and \(3.48\pm0.77\) inpre-renal and Acute Tubular Necrosis (ATN) groups. The mean peak creatine was \(4.73+0.48mg/dl\). It was 4.13+ 0.59 in pre-renal and 5.56\(\pm\) 0.66 in ATN groups, respectively. The Mean creatinine at the time of discharge 2.87 \(\pm\) \(0.39mg/dl\). The mean peak creatinine was 2.42 \(\pm\) 0.33 in pre-renal & 3.48+0.42 in ATN groups (In survivors) and 4.11\(\pm\) 0.79 in non-survivors.
Conclusion: Replacement of lost fluids, correction of electrolyte imbalances, and delivery of the proper antibiotics made up the course of treatment. Due to the frequent incidence of hypokalemia, ARF brought on by gastroenteritis differs from other ARF and has a better prognosis. An significant electrolyte disruption in AKI brought on by gastroenteritis is hypokalaemia. It was determined that the primary factor leading to death in AKI caused by gastroenteritis is septicemia.

Background: Awake brain surgery is used to treat brain tumors and epileptic seizures near areas that control language, movement or cognition, movement disorder, and recently during neurovascular surgery.
Methods: Preoperative airway evaluation should be performed in all patients. There are two commonly used anesthetic methods for awake craniotomy: monitored anesthesia care (MAC) and asleep-awake-asleep (AAA) technique, after the tumor resection, sedation is often sufficient until completion of the surgery. In our institution at Mount Lebanon hospital-Balamand university hospital, the combination of propofol and remifentanil has been considered as the standard protocol for sedation during the first stage of awake craniotomy because of the ease of use and reliability. The application of neuro-navigation, and intraoperative electrical mapping are a reliable method to minimize the risk of permanent deficit during surgery for brain tumors in eloquent areas.
Results: Whether sedation or an asleep-awake-asleep technique is chosen, it is crucial to apply adequate local anaesthesia on the skin incision what we call elliptic block using combinations of lidocaine and bupivacaine with epinephrine. If we perform awake-asleep-awake anesthesia type than similar to the pre-awake phase, one can also choose awake, spontaneous ventilation under light or deep sedation, or GA with airway control. Sedation often suffices. The patient usually requires lower rates of sedative infusions during the postawake phase than during the pre-awake phase as patients are often fatigued, and there is a lower level of painful stimuli during skull closure.
Conclusion: Patients receiving awake craniotomy have better outcomes in many aspects. The improvements in anesthetic agents and techniques, the application of neuro-navigation, and intraoperative electrical mapping are a reliable method to minimize the risk of permanent deficit during surgery. Appropriate patient selection, perioperative psychological support, and proper anesthetic management for individual patients in each stage of surgery are crucial for procedural safety, success, and patient satisfaction.