Trends in Clinical and Medical Sciences

Background: Acute pancreatitis is a very common disorder with a substantial burden on the healthcare system. Acute pancreatitis includes a wide spectrum of diseases varying from mild self-limiting symptoms to fulminant multi-organ failure and high mortality. Serum amylase and serum lipase, which are used for diagnosing acute pancreatitis, are relatively less sensitive and specific and give a lot of false positive or false negative values. Based on the immune-chromatographic method, the urinary trypsinogen-2 dipstick test is proposed to be a rapid method for diagnosing acute pancreatitis at the earliest.
Aim of the study: 1. To know the usefulness of urine trypsinogen-2 in accurately diagnosing acute pancreatitis 2. To compare the diagnostic role of urine trypsinogen-2 with that of serum amylase, serum lipase, and imaging studies in acute pancreatitis.
Materials and Methodology: 100 Patients presenting with acute upper abdominal symptoms like pain, vomiting, and abdominal distention, admitted to the emergency department of our hospital from January 2021 to January 2022, are enrolled in the study. Urine samples were obtained from all the patients and tested with Spot Urine trypsinogen-2 dipstick. Serum amylase and serum lipase tests were also simultaneously done in these patients. If required, patients are also evaluated with (USG) abdomen and (CECT) abdomen. The final diagnosis of acute pancreatitis is based on the clinical picture, serum amylase more than the threefold rise, and radiological findings. Urine trypsinogen-2 dipstick tests were compared with serum amylase, serum lipase, and imaging studies in patients with a final diagnosis of acute pancreatitis.
Results: Sensitivity of amylase and lipase was found to be 73.77% and 59.02%, respectively, whereas the sensitivity of trypsinogen was found to be 78.69%. The specificity of amylase and lipase was found to be 89.74% and 89.74%, respectively, whereas the specificity of trypsinogen was found to be 92.1%. Analyzing the data, it is found that the sensitivity and specificity of trypsinogen are higher than the routine investigations. Even though it has a low range of sensitivity, its high specificity ensures that the test can be used as a screening test to check the true negative cases.
Conclusion: 1. The urine Trypsinogen-2 dipstick test is a simple, rapid, easy, and noninvasive test that can diagnose or rule out most cases of acute pancreatitis. 2. Urine Trypsinogen-2 estimation does not require laboratory facilities. It is undertaken almost instantaneously (within 5 minutes) as opposed to serum amylase and lipase, results for which may require an hour to get back to the physician. 3. The urinary trypsinogen-2 test could be used as a screening test for acute pancreatitis. 4. Modification of the cutoff point of this assay increases the specificity to the point where it can be used for diagnosis. Qualitative rapid urine trypsinogen-2 test strip is easy to perform. Moreover, it is a reliable and useful screening test for acute pancreatitis in daily practice, particularly in healthcare units lacking laboratory facilities.

Background: Sickle cell anaemia is a genetic abnormality involving the haemoglobin. Patients present with a wide spectrum of disorders because of a single-point mutation in which thymine substitutes for adenine, thereby encoding valine instead of glutamine in the sixth position of the beta-chain. The repeated sickling and unsickling damage the red cell membrane leading to irreversibly sickled red cell even when the oxygen pressure is increased.
Methodology: Patients admitted in the Medicine department of tertiary care center from December 2020 to December 2022 with sickle cell anaemia were included in the study. Sample size taken for this study was 100 patients. Predesigned and pretested questionnaire was used to record the necessary information.
Result: In this study, association of LVH and severe anemia in sickle cell patients was not statistically significant(P >0.05) Association between anaemia and pulmonary artery hypertension in sickle cell patients was found to be statistically significant.
Conclusion: Most common electrocardiographic finding was sinus tachycardia followed by T-inversions. Most common echocardiographic changes were pulmonary hypertension.

Background: The thyroid gland is the largest gland among all endocrine glands. It secretes active hormones (T3 and T4, Calcitonin) influencing various metabolic processes. Diseases of the thyroid include developmental, inflammatory, hyperplastic and neoplastic disorders. The present work is an attempt to study the histopathological details of various thyroid lesions, to analyze them and to correlate them with clinical data.
Aim and Objectives: To study frequency and histopathology of non-neoplastic and neoplastic lesions of thyroid.
Material and Methods: The present study, ‘Histopathological study of Lesions of Thyroid’, was undertaken at Histopathology section of Department of Pathology, Government Medical College, Miraj, Maharashtra. The study was of 3 years duration from January 2013 to December 2015. The material was obtained by different surgical procedures such as total thyroidectomy, near total thyroidectomy, hemithyroidectomy, lobectomy and excision of cyst. Tissue samples for H\&E sections were fixed in 10% formalin and subjected to routine paraffin embedded processing after which this was then stained with Haematoxylin and Eosin. The thyroid lesions are classified into of non-neoplastic and neoplastic lesions on the basis of the World Health Organization histological classification of the thyroid tumours.
Results: In our study, Out of total 104 cases of thyroid lesions, there were 93 (89.42%) non neoplastic and 11 (10.58%) neoplastic lesions. The most frequently encountered specimen was hemithyroidectomy (58.65%), followed by near total thyroidectomy (22.12%). Out of total cases of 104 thyroid lesions, a maximum number of lesions were seen in patients in the age group of 31-40 years. Thyroid lesions predominantly seen in females with female to male ratio of 6.4:1 for all thyroid lesions Out of total 104 cases of thyroid lesions, there were 93 (89.42%) non neoplastic and 11 (10.58%) neoplastic lesions. Goiter was the most common lesion, which accounted for 80 cases (76.92%) of all the cases followed by thyroglossal cyst 07 cases(6.73%), follicular adenoma 07 cases (6.73%) and Hashimoto’s thyroiditis 06 cases (5.76%). The benign tumors were more common (72.73%) than malignant tumors (27.27%).
Conclusion: In our study, thyroid lesions showed a female predominance with most of them occurring in the age group of 31-40 years and most common thyroid lesions were non-neoplastic. Diagnosis by histopathological examination is important for the correct diagnosis and treatment of neoplastic lesions.

Background: Coronavirus Disease 2019 (COVID-19) is characterized by high fever, sudden developing respiratory distress. The Purpose of this study is to identify the association of D-dimer levels and lymphocyte counts with poor prognosis and to predict the clinical course in patients with COVID-19.
Methods: A Total of 85 hospitalized children diagnosed with COVID 19 were included in the study. According to AIIMS guidelines, they were divided into two groups, one with severe disease (N=23) and other with non-severe disease which included mild to moderate cases (n=62), distinctive performance analysis of these values were performed and the cut off values were determined.
Results: A total of 85 hospitalized patients with COVID-19 were included in the final analysis. The mean age was 10 \(\pm\) 5 years and 45 (52.9%) were males. Lymphocyte count was found as statistically significantly low (p <0.001) while D-dimer level was statistically significantly higher in the group with severe disease (p <0.001). As for the effectiveness of lymphocyte count in distinguishing severe and non-severe patients with COVID-19 when cut-off score 1500/mm3 was taken, sensitivity was 30% and specificity was 77% and that of D-dimer when cut-off score 2 mg/L was taken, sensitivity was 22% and specificity was 50%. D-dimer level was found to have a significant discrimination power (AUC = 0.879, p < 0.0001,95% CI).
Conclusions: The lymphocyte value of \(\leq 1500/mm3\) and D-dimer value of \(\geq 2mg/L\) can be used in the early determination of patients with poor prognosis in COVID-19. Using these cut-off values for D-dimer and lymphocyte count will help predict prognosis and make rapid treatment decisions in patients with COVID-19.

Background: Nutritional anemia is the commonest type of anemia in India, especially in rural areas. Patients with hemoglobin below 6 gm/dl usually require transfusion therapy. In stabilized patients with hemoglobin values between 6 and 10 gm/dl, the decision to transfuse is based on an evaluation of clinical status. Patients with values above 10 gm/dl rarely require transfusion. Initially, whole blood was transfused due to the activity of 2,3 DPG. However, now it is replaced by packed red cells after the advent of proper refrigeration, component separation method, and anticoagulants, especially additive solution SAGM and polyvinyl chloride blood bags.
Aims: 1) To know the efficacy of packed red cell transfusion in symptomatic nutritional anemia patients. 2) If there is a failure of improvement following packed red cells transfusion, the underlying cause of anemia will be evaluated, which may influence the outcome of the transfusion.
Materials and Methods: The present study comprised 110 nutritional anemia patients who received packed red cell transfusion in Sri Manakula Vinayagar Medical College and Hospital. Data were collected for eight months. A thorough clinical examination and history were taken for all 110 patients, and hematological parameters were collected from the automated cell counter.
Results: In the present study, 110 patients with nutritional anemia who underwent packed red cell transfusion were taken. Out of which, 90 patients had features of only iron deficiency anemia, and 20 had features of anemia of combined deficiency (iron, vitamin B12, and folic acid). Iron deficiency anemia is more prevalent in the third and fourth decades. Anemia of combined deficiency in the sixth and seventh decade. Conclusion: Packed red cell transfusions are reserved for anemia patients whose organs (brain, heart) are being deprived of oxygen due to severe anemia and for people whose hemoglobin or hematocrit level is very low. In chronic anemia, there are increases in the content of 2,3-DPG in the red blood cells, with a shift towards the right in the hemoglobin dissociation curve in the cardiac output and respiratory rate. Hence transfusion is rarely indicated. The mean increase in Hb and PCV values in nutritional anemia patients was statistically more significant (p value<0.05). Hence Hb and PCV can be valuable tools in post-transfusion clinical assessment.

Background: During the second wave of COVID-19 starting in January 2021, an increase in Mucormycosis infection was recorded in various Indian states. With the aim of identifying the contribution or relationship of covid 19 infection in the incidence, severity and treatment outcomes of Mucormycosis during the pandemic, this retrospective observational research study was conducted.
Method: 113 people with rhino orbital Mucormycosis were included in the retrospective observational investigation. Based off the past medical records, basic demographic information was gathered. In order to evaluate the association between covid 19 infection and Mucormycosis, patient histories of COVID infection, steroid usage during therapy, and oxygen consumption were collected. Positive RTPCR and/or Positive Rapid antigen tests were used to diagnose active covid positive status. Using a nasal swab/tissue KOH mount, nasal endoscopy with biopsy, and radiographic tests to determine the extent, the diagnosis of Mucormycosis infection was established. A multidisciplinary strategy was used to handle the patients in collaboration with the departments of medicine, ophthalmology, neurosurgery, and OMFS. Individuals with uncontrolled diabetes received insulin and/or oral medications, and BSL was aggressively managed. Each patient received 3 to 5 mg/kg body weight/day of intravenous amphotericin B, adjusted according to renal function, medication availability, and the severity of the illness. Individuals who underwent endoscopic debridement using a modified Denker’s technique or medial maxillectomy had disease that was restricted to the nose and paranasal sinuses but did not affect the palate or orbit. Whole maxillectomy was performed on patients who had palatal involvement. Most individuals with orbital involvement underwent a limited procedure for orbital decompression or rarely an exenteration/evisceration procedure.
Results: Out of 113 patients, 26 (23%) had a Covid positive status at the point they were initially assessed, 56 (49.55%) had confirmed prior h/o covid infection, 31 (27.4%) had no proven h/o covid 19 infection, and 62 (54%) had h/o usage of steroids to treat their covid infection. Of of the 113 patients, 90 patients underwent combination medicinal and surgical therapy, which comprised of administering injectable Amphotericin B and performing endoscopic endonasal debridement of the afflicted areas. 23 patients (20%) were left unoperated, largely as a result of problems arising from active COVID-19 infection (15 patients, 13%) or severe cerebral involvement (6 patients), as well as the refusal of two patients undergo surgery. Out of the 113 patients who received treatment, 24 (21.23%) died from the disease, leaving 89 (78.76%) surviving. Of the survivors, 27 (23.89%) had some form of disability at the end of the treatment period (in form of cranial nerve palsies, permanent loss of vision, palatal perforations and in 1 case a patient had an open left maxillary and nasal cavity which was referred to plastic surgeon for revision surgery and rehabilitation and 62 patients (54.86%) healed fully without any sequelae. Those who received combination therapy, which included both surgery and IV amphotericin, fared far better (84 in 90 survived 93%) than those who had only IV amphotericin B therapy (5 in 23 survived 22%).
Conclusion: Covid positive status was linked to higher disease severity, increased morbidity, and increased mortality after therapy. There were several individuals with Mucormycosis who had no prior history of COVID. Increased mortality was linked to uncontrolled diabetes, Rhino orbital cerebral expansion, and concurrent covid positive status. Our study shows that invasive Mucormycosis can have a positive clinical result with immediate vigorous surgical debridement and antifungal drug administration.

Introduction: Hypertensive disorders in pregnancy lead to placental immaturity and uteroplacental under-perfusion, resulting in increased production of beta-hCG hormone. The aim of this research is to compare beta-hCG levels after the 20th week of pregnancy between normotensive and hypertensive pregnant women in order to assess its predictive value for hypertensive conditions during pregnancy.
Material and Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Govt. Medical College, Srinagar over a period of 18 months (January 2021 to July 2022). One hundred patients fulfilling the selection criteria were included in the study and divided into two groups (cases and controls). The data was collected in Excel Sheets and analyzed using SPSS v20.
Results: A total of 109 patients were included in our study, out of which 9 patients were lost to follow-up and were omitted from the study. Among the 100 patients, 50 were cases and 50 were controls based on the inclusion and exclusion criteria. In our study, mean systolic and diastolic blood pressure, mean gestational age, mean beta hCG, and proteinuria were statistically significant. However, mean beta hCG values based on PIH (Pregnancy-Induced Hypertension) severity and mean age were statistically insignificant.
Conclusion: In our study, we concluded that hypertensive pregnant women have abnormally elevated beta hCG levels.

We present a rare case of a 27-year-old woman with a complete hydatidiform mole, which is an abnormal pregnancy that typically causes vaginal bleeding and elevated serum \(\beta\)-human chorionic gonadotrophin (hCG) levels. However, this patient had a 36-week size uterus, severe anemia, and vaginal bleeding, but with a non-detectable \(\beta\)-hCG level, likely due to the “hook effect.” She also had chronic pancreatitis, with a dilated hepatobiliary system and free fluid in the pelvis, caused by the enlarged uterus compressing the abdominal organs. The patient received blood transfusions and was treated with dilation, evacuation, and serial monitoring of serum \(\beta\)-hCG levels. It is important to note that a negative urine pregnancy test or non-detectable \(\beta\)-hCG level should be followed up with a repeat measurement on a diluted sample to avoid the “hook effect.”

Background: We aimed to study the influence of low dose dexmedetomidine as an adjuvant on hemodynamic parameters and recovery profile of patients maintained on desflurane for sitting position intracranial tumor surgeries.
Method: 60 ASA class I to III patients undergoing elective sitting position intracranial tumor surgery were randomized to receive either Dexmedetomidine infusion at the rate of 0.25 \(\mu\)g/kg/hr (Group D) or normal saline infusion (Group C) from the time patient was taken on table and continued till the end of dura closure. Monitoring done for hemodynamic changes, minimum alveolar concentration, BIS, recovery endpoints and adverse events.
Result: The heart rate was comparable in both the groups at baseline and decreased significantly in patients of Group D. The mean MAC in patients of Group C was high. The Bispectral Index values decreased significantly in patients of Group C as compared to Group D till the end of the study. The recovery endpoints parameters were significantly lower in patients of Group D as compared to patients of Group C. Ramsay Sedation Score was significantly lower in Group D compared to Group C from the time of discontinuation of anesthesia delivery till the end of 120 mins. This difference was statistically significant as per Student t-test (p<0.05).
Conclusion: Dexmedetomidine infusion started in low dose before surgery maintains hemodynamic stability intraoperatively, reduces the amount of anaesthetic drug required for induction, decreases the requirement of analgesic drug without any residual sedation.

Introduction: Stress among undergraduate students has become a significant concern in higher education due to its detrimental effects on their health and academic performance. This study aims to investigate the prevalence of stress among students pursuing their undergraduate education in a college in Kerala. By exploring the association between various sociodemographic variables and stress levels and identifying the relationship between different risk factors and stress, this research aims to provide valuable insights into the factors contributing to stress among undergraduate students.
Materials and Methods: A cross-sectional study was conducted among 133 undergraduate students. Convenience sampling was utilized to select the participants. A pre-designed closed-ended questionnaire, specifically tailored for this study, was employed to collect data. The questionnaire consisted of relevant items related to stress experienced by undergraduate students. Appropriate statistical analyses were performed on the collected data, with a significance level set at p < 0.05.
Results: The findings of this study revealed that among the study participants, 19% of undergraduate students experienced high perceived stress, 67% experienced moderate stress, and 13% experienced low-stress levels. A statistically significant association was observed between reduced appetite and perceived stress (p-value = 0.014). Additionally, statistically significant associations were found between stress and poor relationships with faculties (p-value = 0.003), the warden (p-value = 0.01), family members (p-value = 0.003), facing time pressure (p-value = 0.006), heavy workloads (p-value = 0.029), fear of failure (p-value = 0.002), suffering from frequent exams (p-value = 0.003), and exam patterns and curriculum (p-value = 0.024).
Conclusion: The results of this study highlight the considerable prevalence of stress among undergraduate students, with the majority falling into the category of moderate stress levels. It is imperative to prioritize undergraduate students’ mental and physical well-being by incorporating counseling services and preventive mental health programs as integral components of routine clinical services. Encouraging students to engage in regular physical exercise, maintain balanced nutrition, foster positive relationships with peers, family, faculty, and college staff, ensure adequate sleep, and participate in extracurricular activities can significantly reduce stress levels. By addressing these factors, educational institutions can foster a supportive learning environment that promotes undergraduate students’ overall health and well-being.