Trends in Clinical and Medical Sciences

Background: The Baricity of bupivacaine is one of the most important factors in influencing the distribution of the local anaesthetic and the spread of the blockade. Bupivacaine is rendered hyperbaric by adding glucose. The effect of differing degrees of hyperbaricity remains to be evaluated regarding spinal anesthesia blockade.
Methods: Hundred patients who underwent lower abdominal, hips, and lower extremity surgeries were randomized into two groups in a double-blind, randomised, parallel-group, prospective study. Group I received 0.5% isobaric bupivacaine with 80 mg/ml of glucose, while Group II received 0.5% isobaric bupivacaine with 40 mg/ml of glucose. The injection was made intrathecally in the midline position at L3-4 and L4-L5 interspace in the sitting position. The measured sensory blockade and motor blockade are the onset and duration. Duration of sensory block was the time measured from the time of the highest block for the regression to the S2 dermatome.
Results: Success rate, spread, and duration of sensory block were similar in both groups. The highest median level of sensory block was T3 (T2-T7) (median (10th/90th percentiles)) in both groups. The time to reach T10 did not differ between the groups. Power analysis suggested that a total number of 100 adults were required in both groups for a 90% chance at the 0.05 level of significance of detecting a 10% difference in success between groups. Categorical data were tested using the chi-square test. For continuous data, the Mann-Whitney test was used. Results are presented as median (10-90\(^{th}\) percentiles), number (%) of cases ,the significance was set as \(P< 0.05.\)
Conclusion: These results demonstrate that bupivacaine in 80mg/ml glucose provides reliable spinal anaesthesia of shorter duration and with less hypotension than bupivacaine in 40 mg/ml glucose. The recovery profile for ropivacaine may be of interest given that more surgery is being performed in the day-case setting.

Background and objectives: Postoperative nausea and vomiting (PONV) are still one of the most common and unpleasant side effects following surgeries under general anesthesia, especially in patients receiving opioids. The primary purpose of this study was to compare Zofran and oxycodone versus Zofran and morphine for the prevention of postoperative nausea and vomiting.
Subjects and methods: A prospective, monocentric clinical trial study was conducted at Mount Lebanon Hospital (MLH) between November 2018 and November 2021. After getting approval from the ethical committee, 237 patients were enrolled on a ratio of 1 to 2 in two groups: the first receiving Oxycodone 5 mg IVP with Zofran 4 mg IVD and the second receiving Morphine 5 mg IVP with Zofran 4mg IVD. Pearson’s Chi-square test and Fisher’s exact test were used to checking for the groups’ differences.
Results: Morphine and Oxycodone had a similar analgesic effect. The use of Zofran lowered PONV incidence rates in both groups. A statistically significant (p-value = 0.047) lower nausea and vomiting incidence in the Morphine group (2.5%) was noted compared to the Oxycodone group (8.8\% incidence). Only 10% of Oxycodone group patients and 8.9% of Morphine group patients had moderate nausea and vomiting, and none of the group’s patients had severe nausea and vomiting. Surgery duration, gender, age, smoking, BMI, pain level, and treatment group were not statistically associated with the severity of NV.
Conclusion: With the same analgesic effect, Zofran injection seemed to lower PONV incidence in both groups, even though the Morphine group had a lower incidence. Zofran seemed effective in lowering the NV severity as well. Therefore, recommending the systematic administration of antiemetic agents in patients receiving Oxycodone or Morphine could enhance patient satisfaction.

Aim: To assess histopathological patterns in the endometrial biopsy of patients presenting with abnormal uterine bleeding.
Methodology: One hundred eight females with the complaint of abnormal uterine bleeding were enrolled. A gynecological examination was done. Dilatation and curettage were carried out. Specimens thus obtained were stored in 10\% formalin. The slides were examined under a microscope, and the various histopathological patterns were assessed.
Results: The age group 20-30 years had 48, 30-40 years had 50, and 40-50 years had ten females. A significant difference was observed. Inflammatory lesions were 28, such as acute endometritis in 12, chronic endometritis in 11, and chorioamnionitis in 5. Proliferative non-neoplastic lesions were 42, such as atypical hyperplasia in 18, typical hyperplasia in 12, and endometrial polyp in 12. Neoplastic lesions in 20 include leiomyoma in 8, a partial mole in 7, the complete mole in 2, and endometroid carcinoma in 3. Normal endometrium in 18, such as proliferative phase in 12 and secretory phase endometrium in 6. A significant difference was observed (P< 0.05).
Conclusion: The most common endometrial biopsy revealed proliferative non-neoplastic lesions such as atypical hyperplasia, typical hyperplasia, and endometrial polyp.

For timely prediction of the development of AHI syndrome in patients with closed abdominal trauma, it is necessary to monitor the IAP level. IBH syndrome develops in patients with concomitant abdominal trauma and is characterized by relatively high mortality rates. A statistically significant correlation was established between the level of AHI, APD, the frequency of development of a picture of multiple organ failure, and the severity of the patient’s condition according to the SOFA and APACHE II scales (p <0.05). A sudden increase and persistence of a high IAP level for a long time in patients with closed abdominal trauma indicate the use of active surgical tactics to perform decompression. The decision to decompress the abdominal cavity is based on IAP monitoring, considering the clinical picture of developing multiple organ failure.

Aim: To assess traumatic axial cervical spine injuries in 84 patients.
Methodology: Eighty-four patients with traumatic axial cervical spine injuries of either gender were enrolled. Magnetic imaging resonance (MRI) was performed in all. Conservative treatment was given to those with minimal no bony injuries with or without spinal cord contusion, and decompression and fixation were performed in moderate to severe bony injuries with spinal cord compression. In addition, patients were treated for anterior fixation, i.e., corpectomy with either autologous bone graft or titanium cage and plate fixation and with corpectomy with tricorticate graft.
Results: Out of 84 patients, males comprised 54 (64.2\%), and females had 30 (35.8\%). Aetiology in the present found to be assault in 9, road traffic accident in 48, sports injury in 17, and workplace injury in 10 cases. Body fracture was evident in 24 and ligamentous injury in 60 patients. The type of body fractures was C3 in 3, C4 in 2, C5 in 12, C6 in 3, and C7 in 4 patients. Management performed was corpectomy with tricorticate graft in 26 cases and a corpectomy with fixation with a titanium cage and plate/screws in 58 cases.
Conclusion: Discoligamentous was a major type of injury, and road traffic accident was the main cause of injury among patients with subaxial cervical spine injuries.

The article presents the results of studying the modern literature on diagnosing and treating severe concomitant abdominal trauma and their prediction. In addition, the authors provide the primary literature data of domestic and foreign authors in recent years.

Prevalence of Obstructive sleep apnoea (OSA) has been increasing owing to increase in its risk factors. The pathophysiology of OSA is related to narrowing or obliteration of upper airway. Neck circumference (NC) is a measure which predicts the neck fat and hence narrowing of airway. Modified Berlin’s Questionnaire is a validated tool to assess the risk of OSA in Indian setting. The present study was designed to determine the association of NC with the risk of OSA in young adults. 1500 subjects of both genders between 18 to 30 years of age were recruited, their NC was measured and they were administered screening questionnaire first. Those who gave one or more positive response were administered modified Berlin questionnaire and risk of OSA was assessed and it was compared with NC. There was a significant increase in risk of OSA in subjects with higher NC with a cut off of 36 cm in males and 32 cm in females. NC is an important anthropometric measurement to predict risk of OSA.

Background: The aim of the study is to evaluate effect of type 1 tympanoplasty on the quality of life of CSOM patients.
Materials and Methods: In this observational study, ninety- two patients of chronic suppurative otitis media with perforations of either genders were included. The chronic otitis media-5 (COM-5) questionnaire was administered to all patients. Air bone gap, physical suffering scores, hearing loss score, caregiver’s concern scores, emotional distress score and activity limitation scores were recorded.
Results: Side involved was right in 58 and left in 34. Location of perforation was anterior quadrant in 15, posterior quadrant in 7 and central perforation in 70 cases. Pre- operative physical suffering scores was 3.74 and post- operative score was 2.10, hearing loss score was 3.24 and 1.28, caregiver’s concern scores was 2.34 and 1.12, emotional distress score was 1.92 and 1.04 and activity limitation scores was 1.62 and 1.10 respectively. Pre-op mean air bone gap was 32.2 db and post- op mean air bone gap was 18.4 db. The difference was 13.8 decibels.
Conclusion: Type 1 tympanoplasty is common surgical procedure performed in patients with chronic suppurative otitis media and it found to be effective in improving quality of life in these patients.

Aim: A clinicopathologic investigation study of lichen planus.
Methods: This prospective and observational study was carried out in the Department of Oral Pathology & Microbiology, S.B.Patil Dental College \& Hospital, Bidar, Karnataka for a period of 1 year. 90 cases of Lichen Planus (LP) were included in this study. A complete clinical history was obtained, including duration, place of start, symptoms, medication history, and family history. A thorough general checkup, systemic examination, and dermatological examination were performed. The form and location of skin lesions, as well as the existence of any other related disorders, were all documented. Mucosa, hair, nails, palms, soles, and extremities involvement were all noted as concomitantly affected. To assess the histological diagnosis, haematoxylin and eosin stained sections of lesional tissue biopsies were generated. Once the histopathology slide was complete, each slide was attentively examined, and the findings were thoroughly analyzed and appraised.
Results: Out of 90 patients 55(61.11%) were male and 35(38.89%) were female and male to female ration were 1:1.57. Most of the patients belong to 30-40 years of age group (38.89%), followed by 20-30 years (26.67%), below 20 years (22.22%) and 12.22% above 40 years. 45 individuals had LP for less than 5 months before presenting to our out-patient service. The length varied from 5 to 11 months in 22 cases. The duration was longer than 24 months in 15 individuals. The length varied from 11 to 17 months in 5 individuals and from 17 to 24 months in the remaining 3. The classical type was encountered in 51 (56.67 percent) of the 90 Lichen Planus(LP) patients, followed by the hypertrophic type in 23 (25.56 percent) patients, linear LP and lichen planopilaris (LPP) in 4 (4.44 percent) patients each, oral and annular 2(2.22 percent) patients each, and follicular, bullous LP and LP pigmentosus in 1 (1.11 percent) patients each. Of the 90 patients in our research, 40 showed oral signs of LP, and four of them were diagnosed with just oral LP devoid of cutaneous indications of LP. Buccal mucosa was usually implicated in the oral cavity in 30 (75%) patients, lips in 10 (25%) individuals, and tongue in 7 (17.5%) patients. In our study, only two clinical kinds of oral LP were identified: the reticulate type in 35 (87.5 percent) of the subjects and the erosive variation in the other 5 people (12.5 percent ).
Conclusion: The current study sheds light on the clinicopathological behaviour of lichen planus patients according on their gender. Further research in this area will aid in the exploration of this uncharted territory, allowing for faster diagnosis and better treatment. LP was usually noticed in people in their forties and fifties. In our analysis, classical lesions were the most prevalent, followed by hypertrophic and linear types.

Aim: To compare preperitoneal meshplasty and Lichtenstein’s hernioplasty in patients with inguinal hernia.
Methodology: A total of one hundred six cases of inguinal hernia were included in the study. Patients were divided into two groups of 53 each. Group, I patients underwent preperitoneal meshplasty, and group II patients underwent Lichtenstein’s hernioplasty technique of inguinal hernia repair. Parameters such as time taken for surgery early complications were recorded.
Results: Group I had 22 males and 18 females, and group II had 25 males and 15 females. The mean time of surgery in group I was 46.2 minutes, and in group II was 55.2 minutes. An early complication was seroma two each in group I and 1 in group II, wound infection 3 cases in group I and 2 in group II, pain 2 in group I, mesh infection 3 in group I and 1 in group II and testicular atrophy 1 in group I. The difference was significant (P< 0.05).
Conclusion: Both techniques such as preperitoneal meshplasty and Lichtenstein’s hernioplasty were effective in management of inguinal hernia.