Trends in Clinical and Medical Sciences (TCMS)

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.

Aim: To compare outcome of early and delayed repair of bile duct injuries.
Methodology: Sixty- four patients with bile duct injuries of either gender were divided into group I (Early repair) and group II (Delayed repair). Operative findings such as injury classification and procedural variables and postoperative course, including 30-day re-admission and 90-day mortality, were recorded.
Results:  Aetiology was cholecystectomy in 25 and 21, abdominal trauma in 7 and 8, and non-biliary abdominal procedures in 2 and 5 groups I and II, respectively. There were 18 males and 14 females and 16 males and 16 females in groups I and II, respectively. Hospital length of stay was 7.1 days in group I and 8.4 days, 30 days of re-admission was seen in 3 and 4, and 90 days of mortality was seen in 2 in group I and 1 in group II. Strasburg-Bismuth classification showed A in 1 and 2, B in 3 and 4, C in 8 and 1, D in 6 and 4, E1 in 4 and 4, E2 in 3 and 5, E3 in 4 and 6, E4 in 3 and 4, E5 in 2 and 3 and X in 0 and 1 in group I and II respectively. Preoperative PTC catheter placement was seen in 0 and 18, and preoperative percutaneous transabdominal drain placement was seen in 0 and 12 in groups I and II, respectively.
Conclusion: Early repair found to be better as compared to delayed repair of bile duct injury.

Aim: To assess cases of dengue fever in Pediatric patients.
Methodology: Sixty-eight pediatric cases of dengue of both genders were included in the study. Clinical features and laboratory findings were recorded. Statistical analysis was performed using appropriate tests.
Results: Out of 68 patients, boys were 38, and girls were 30. Common symptoms were fever in 95%, vomiting in 68%, loose stools in 22%, periorbital puffiness in 10% and respiratory distress in 26, pain abdomen in 47% cases. The mean hemoglobin level at admission was 12.6 gm% and at discharge was 12.7gm%. The mean TLC was 56210 cumm of blood at admission, and at discharge was 122452 cumm of blood.
Conclusion: Common symptoms were fever, vomiting, respiratory distress and pain abdomen. Hence careful evaluation of dengue in children is required.

Aim: To assess relation between diabetes mellitus and thyroid dysfunction.
Methodology: 105 type II diabetes mellitus patients of both genders were included. Serum TSH (Thyroid Stimulating Hormone), free \(T_3\) (Triiodothyronine) and free \(T_4\)(Thyroxine) were determined in all enrolled patients.
Results: There were 50 males and 55 females in the present study. Age group 21-30 years had 15 patients, 31-40 years had 26, and 41-50 years had 64 patients. Duration of diabetes was 8.4 years, and the level of glycosylated hemoglobin (HbA1C) was 9.2 years. A significant difference was observed (P< 0.05). Serum T3 was increased by 15% and decreased by 4%. Free T3 was increased in 5% and decreased in 13%, and free T4 was increased in 7% and decreased in 5%. There were 20 hypothyroidism and 29 hyperthyroidism patients. Maximum hypothyroidism patients (12) and hyperthyroidism patients (14) were seen with >7 HbA1C levels.
Conclusion: Most of the type II DM patients had hypothyroidism than hyperthyroidism.

Aim: To assess cases of pregnancy induced hypertension.
Materials & Methods: Our study included 74 cases of pregnancy-induced hypertension. Parameters such as age, marital status, education, parity, etc., were recorded.
Results: Age group (years) <20 had 30%, 20-24 had 45%, 25-29 had 16%, 30-34 had 5% and >35 had 4% cases. Education level was illiterate in 40% and literate in 60%, and marital status was married in 58%, single in 26% and divorced in 16$, parity was 0 in 24%, 1-2 in 46% and >2 in 30%, gravida was primi in 40% and multi in 60%, previous PIH was seen in 24% patients. Family history of DM was observed in 25%, family history of PIH in 18%, family history of hypertension was seen in 10%, history of asthma was seen among in 8\% and history of kidney disease 30% patients. The difference was significant (P< 0.05).
Conclusion: Common risk factors of pregnancy induced hypertension was family history history of asthma, hypertension, family history of PIH, family history of DM, history of kidney disease.

Our aim in this research note is to compare curcumin and clobetasol propionate in management of patients with oral lichen planus. Sixty- four patients of OLP were divided where 32 patients were put in group I in which patients received 0.1% triamcinolone and in group 2, 32 patients received 5% curcumin paste for 4 weeks. Measurement of the appearance score and severity of pain was done at baseline and at the end of 2 and 4 weeks. We found that complete remission in pain was seen in 30% in group 1 and 35% in group 2, good response in 28% in group 1 and 17% in group 2, poor response in 24% in group 1 and 25% in group 2 and no response in 18% in group 1 and 33% in group 2. A non- significant difference among good and no response was seen (P<0.05). Oral lichen planus is common inflammatory autoimmune disease. Curcumin in our study showed slightly better results than triamcinolone, hence suggesting that it can be used in patients with oral lichen planus.

The novel corona virus (COVID-19) outbreak declared as a global pandemic. Glucocorticoids are inexpensive, widely available, and have been shown to reduce mortality in hypoxemic patients with COVID-19. With increasing risk of new strains of covid virus infections and now the latest dreadful fungal infection Mucormycosis, the situation is becoming more and more devastating. Survival in mucormycosis depends on early diagnosis, alleviation of basic predisposing factors, aggressive debridement of necrotic tissues, and appropriate systemic antifungal agents.