Trends in Clinical and Medical Sciences (TCMS)

Introduction: Sore throat following endotracheal intubation is a long-standing concern for anaesthesiologists worldwide.
Objectives: To determine the occurrence of post-intubation sore throat and associated risk factors in patients undergoing surgeries under general anesthesia.
Materials and Methods: A total number of 400 patients, ASA Grade I and II, aged between 18 to 75 years of either gender posted for surgery under general anesthesia were selected. Body Mass Index and history of smoking were noted. Intubation-related factors including technique, number of attempts, size of endotracheal tube, Cormac-Lehane grade, need for external laryngeal pressure during intubation, endotracheal tube cuff pressure, duration of surgery, patient position during surgery, and coughing during emergence were observed to determine the relation of sore throat with the above factors in patients undergoing surgery.
Results: The results from this study showed that intracuff pressure at intubation (p value 0.009), extubation (p value 0.001), and cough at emergence had significant association with sore throat by multivariate analysis (p value 0.001). Number of intubation attempts, duration of surgery, body mass index of patients, and need of external laryngeal pressure during intubation had significant association with sore throat by bivariate analysis (p value \(\leq 0.05\)).
Conclusion: The discomfort in patients in the postoperative period due to sore throat occurs due to a number of factors. Endotracheal tube cuff pressure at intubation and extubation, and cough at emergence being significant among them.

Introduction: Elastography has emerged as a valuable diagnostic method for assessing the integrity of the pelvic floor muscles. It measures tissue stiffness and deformation in response to compression, providing a non-invasive and objective assessment of tissue stiffness using gray-scale ultrasonography. In this study, we aim to evaluate the clinical outcomes and elastographic changes following Pelvic Floor Muscle Training (Kegel Exercises) among patients with Pelvic Organ Prolapse in Stage 1 and Stage 2.
Materials & Methods: Patients eligible for the study were enrolled after obtaining written informed consent, ensuring the confidentiality of their details. Detailed history, general examination, systemic examination, and local examination were performed following standard protocols. Per speculum examination was conducted to determine the degree of prolapse based on POP-Q staging. Transperineal Elastography was performed on women diagnosed with Stage 1 or Stage 2 POP to evaluate Pelvic floor dysfunction. Study participants were instructed on how to perform Kegel exercises and were followed up. Clinical and elastography scores were recorded and analyzed.
Results: Out of 120 subjects, 56 had a clinical score of 3 (46.7%) and 52 had a clinical score of 4 (43.3%) at the 1st month evaluation. For elastography scores, 60 subjects had an ES2 score (50%) and 60 had an ES3 score (50%). After 6 months of performing Kegel exercises as prescribed, 44 subjects had a clinical score of 1 (36.7%), 32 had a clinical score of 2 (26.7%), and 44 had a clinical score of 3 (36.7%). In terms of elastography scores, 48 subjects had an ES4 score (40%), 48 had an ES3 score (40%), and 24 had an ES2 score (20%). There was a statistically significant difference between the baseline clinical and elastography scores and the scores at 6 months (p<0.05).
Conclusion: The results of this study indicated that pelvic organ prolapse stage and levator ani distension in women were correlated with the elasticity properties measured by elastography. Further research is required to explore the relationship between pelvic floor elasticity characteristics and clinical data.

Objectives and methods: The present study is a Prospective study of clinico-pathologic patterns, in women 40 years and below, with ovarian cancer undertaken in Srinivasan Medical College Hospital and Research Centre over a period of 36 months.
Inclusion Criteria: Patients $\leq$ 40 years with histologically proven ovarian cancer and Primary ovarian cancers \textbf{Exclusion Criteria:} Patients above age 40 years, Those who did not have cancer ovary on final histopathology, Patients who were treated with chemotherapy only and not operated. 115 patients were retrospectively enlisted for our study out of which 93 could fulfil our inclusion criteria.
Results and conclusion: Even in women 40 years and less, 70% of the ovarian tumors were epithelial in histological type. Serous ovarian cancer was the most common. Germ cell tumor constituted 20% of the ovarian cancers. Mixed malignant germ cell tumor was the commonest type. The mean overall survival was 5.4 years. The overall survival was 87%. For epithelial tumors it was 82% and for non-epithelial tumors it was 96%. For early stage disease it was 100% but for advanced stages it was 73%.

Objective: To evaluate fertility outcomes on ovulation induction with clomiphene citrate versus letrozole among anovulatory Polycystic Ovarian Syndrome (PCOS) women.
Material and Methods: This randomized controlled study was conducted in the infertility clinic of our institute between 2015 to 2018. 106 subjects from 18-39 years, BMI \(<\) 30 kg/m\(^2\), anovulatory infertility, at least one patent fallopian tube, diagnosis of PCOS, and male partner sperm concentration of at least 15 million/ml were included. These subjects were randomly allocated into 2 groups. One group was given letrozole and the other group clomiphene citrate. Follow-up with serial transvaginal ultrasonography was done for follicular growth. Inj. Human chorionic Gonadotropin (hCG) was administered 36 hours prior to ovulation as predicted by folliculometry, and a check scan was done for ovulation. The result was evaluated in terms of the number of follicles, ovulation rate, endometrial thickness from D11 to D14, successful pregnancy outcome, complications, and failure.
Results: A total of 106 patients were included, 52 cases were treated with Letrozole and 54 cases with clomiphene. Most subjects in either group had oligomenorrhea (57.4% & 61.4%) with regular cycles. Ovulation occurred in 27 (51.9%) subjects with letrozole and 18 (33.3%) with clomiphene. Successful pregnancy outcomes were seen in 24 out of 52 (46.1%) with letrozole and 16 out of 54 (29.6%) with Clomiphene.
Conclusion: Successful pregnancy outcome was higher with letrozole despite a lesser number of mature follicles. Clomiphene citrate could be replaced by Letrozole as the key medication for chronic anovulation in PCOS.

Coronary artery disease (CAD) is a significant health concern among females, and understanding its modes of presentation and clinical profile is crucial for effective management. This prospective cross-sectional study was conducted at the Department of General Medicine, Sri Venkateshwaraa Medical College Hospital and Research Centre, Ariyur, Puducherry, from May 2022 to April 2023. The study aimed to explore the various modes of presentation and clinical characteristics of CAD in females. The inclusion criteria consisted of female patients above 40 years with hypertension, diabetes mellitus, and dyslipidemia, while patients with congenital heart disease, rheumatic heart disease, structural heart disease, or electrical abnormalities were excluded. A total of 100 female patients presenting with symptoms, signs, and electrocardiogram (ECG) changes suggestive of CAD, along with elevated biochemical markers, were included as cases. The results revealed that 33% of the patients belonged to the age group of 60-70 years. Age was found to be a significant risk factor for CAD mortality among women, with increasing age correlating with a higher incidence of hypertension, diabetes, obesity, and dyslipidemia. The most common mode of presentation was chest pain, highlighting the importance of recognizing this symptom in the evaluation of CAD in females. Furthermore, systemic hypertension and diabetes mellitus were identified as additional risk factors for myocardial infarction (MI) in this population. In conclusion, this study underscores the need for early recognition and understanding of the various modes of presentation and clinical characteristics of CAD in females. Chest pain, along with systemic hypertension and diabetes mellitus, emerged as important factors to consider in the evaluation and management of CAD in this population.

Objectives: There is a lot of evidence that oxidative stress plays a role in the etiology of aging. PON-1 is mostly complexed to HDL and is responsible for its antioxidant properties. This investigation was undertaken to assess age-dependent changes in plasma PON-1 concentration and its association with age, HDL, BMI, and duration of diabetes among T2DM patients.
Methods: This study was carried out on 125 clinically diagnosed T2DM patients (young and middle-aged) attending the OPD and IPD of Rohilkh and Medical College and Hospital. Laboratory investigations such as fasting plasma glucose (FPG), HbA1c, and plasma PON-1 were measured.
Results: When compared with young patients, middle-aged patients showed a significantly declined plasma PON-1 (p < 0.01) and HDL (p < 0.05) levels and increased BMI (p < 0.05). The young and middle-aged patients showed a negative correlation of PON-1 with BMI (p < 0.01), duration of diabetes (p < 0.01), and a positive correlation with HDL (p < 0.01). However, only middle-aged diabetic patients showed a significant correlation of PON-1 with FPG (p < 0.01) and HbA1c (p < 0.01).
Conclusion: Decreased PON-1 concentration in middle-aged patients might be due to a decrease in HDL levels as a consequence of oxidative stress since PON-1 is mainly complexed to HDL.

Background: Bile duct injuries after laparoscopic cholecystectomy (LC), being one of the most commonly performed surgical procedures, remain a substantial problem in gastrointestinal surgery. The most important aspect regarding this issue is the prevention of bile duct injury during index cholecystectomy. Once it occurs, early and accurate diagnosis of bile duct injury is very important for surgeons and gastroenterologists, because unidentified bile duct injury may result in severe complications such as hepatic failure and death. Laboratory tests, radiological imaging, and endoscopy play an important role in the diagnosis of biliary injuries.
Material and Methods: This is a prospective, single-center, observational study including patients treated for a bile duct injury during a cholecystectomy at the tertiary care Teaching Hospital over a period of 1 year. All patients were older than 18 years and were informed of the study and gave informed consent. All types of iatrogenic injuries were included: minor or more complex, regardless of their management (endoscopic, radiological, surgical, or combined). Other biliary injury etiologies, mainly traumatic causes, were excluded. Minor wounds were defined as those affecting the cystic stump, the cystic duct, and the junction between the cystic duct and the MBD, and major wounds were defined as those affecting the MBD, the common hepatic duct, and the right hepatic branch.
Results: Out of 90 patients with bile duct injuries, 58 (64.4%) incurred the injuries during open cholecystectomy and 32 (35.6%) during laparoscopic cholecystectomy. No differences between the groups were observed concerning the time of bile duct injury diagnosis, type of injury, incidence of concomitant vascular and bile duct injuries, type of reconstruction procedure, or complication rates after the primary intervention. The latency of bile duct injury management was found to differ between the study groups. In the open cholecystectomy group, bile duct injuries were managed significantly later than in the laparoscopic one.
Conclusion: Bile duct injury after laparoscopic cholecystectomy requires a multidisciplinary approach with specialized physicians at tertiary hospitals. Imaging techniques and proper classification are required in order to prevent or treat sepsis, biliary leaks, and collections.

Introduction: The coronavirus 2019 (COVID-19) pandemic has significantly impacted the management of cardiovascular emergencies across the world. Early in the pandemic, an unforeseen decline in hospital admissions of patients with acute cardiovascular emergencies was noted. Furthermore, the overall reduction in respiratory infections and vigorous exercise related to social isolation may have contributed to a decrease in the incidence of acute coronary syndrome (ACS). However, a significant number of patients have presented with late-stage cardiac diseases, such as late-presenting ACS, and with serious cardiac complications including cardiac arrests and out-of-hospital death.\\
Material and Methods: A retrospective cross-sectional study of all consecutive COVID-19 infected ACS patients admitted during the period April 1st, 2021 to March 1st, 2022, at VIMSAR BURLA. The cases could be ACS patients shown to be COVID-19 positive during routine screening after admission or referred from elsewhere as COVID positive or ACS developing in the hospital after admission for the treatment of COVID-19 infection. All consecutive COVID-19 (RT-PCR) positive patients above the age of 18 years with ACS admitted to VIMSAR Burla. Data of patients with age and sex-matched COVID-19 free ACS patients treated in the same period in VIMSAR Burla was enrolled as the control group for comparison in a 1:3 ratio. Data about baseline characteristics, electrocardiographic findings, clinical findings, and outcomes of patients were compared between the case and control groups.
Results: Once ACS is suspected, medical therapy should be instituted immediately along with a decision on whether to proceed with an invasive strategy. Medical therapy for ACS in COVID-19 patients is identical to patients without COVID-19. This includes dual antiplatelet therapy (aspirin and a P2Y12 inhibitor), intravenous or subcutaneous anticoagulation, statins, and beta-blockers (if no contraindications). However, only one in vitro study has shown that SARS-CoV-2 downregulates the ACE2 expression, and further studies are needed to confirm this pathophysiological pathway.
Conclusion: Despite the overall reduction in cases admitted to the emergency departments during the early phase of the pandemic, ACS is a potential life-threatening complication of COVID-19. The pathophysiological mechanisms are multiple and include atherosclerotic plaque rupture, overactivation of the coagulation system, platelet hyperreactivity, abnormal systemic inflammatory response, and oxygen supply/demand imbalance. When compared to non-COVID-19 cases, patients with ACS and SARS-CoV-2 infection present distinctive clinical and anatomical features, including the absence of obstructive CAD, the higher burden of thrombus, and the angiographic evidence of multiple thrombotic lesions.

Background and Aim: Due to the etiological agent, Salmonella enterica serovar typhi (S.Typhi), enteric fever is a potentially lethal multisystemic disease. Leukopenia is considered a key feature of Enteric fever, but studies have shown it to be present in only 20-25% of cases. The aim of the present study was to determine specific hematological changes in typhoid fever.
Material and Methods: There were 300 individuals overall, who had typhoid fever clinical diagnosis. 150 patients were chosen as the case group and 150 as the control group out of the total. Blood samples were taken and analysed in a medical hospital for various haematological parameters as well as the Widal test in 300 patients with clinical suspicion of typhoid fever.
Results: In around one-third of cases, anorexia and abdominal pain were also observed. The least common symptoms were headache and diarrhoea. In patients who tested positive for typhoid, anaemia was present in 32% of cases, leukocytosis predominated over leukopenia, and thrombocytopenia affected roughly 24% of cases, which was significantly higher than the control group’s rate.
Conclusion: Our research led us to the conclusion that men get typhoid fever more frequently than women. And this can be explained by the fact that male subjects exhibit higher levels of the predisposing factors that lead to typhoid fever; this is likely due to their occupational and social practises, which tend to give male subjects greater immunity to this infection than do female subjects. Typhoid fever also tends to infect those who are uneducated and of poor socioeconomic position. Significant haematological alterations occur in people with typhoid fever.

Background and Aim: The most typical menstrual issue is abnormal uterine bleeding (AUB), which affects women of all ages and is also indicative of a significant underlying illness. The gold standard for determining the causes of AUB is still endometrial biopsy and subsequent histological analysis. In order to assess and determine the most prevalent patterns of endometrial histological findings and their prevalence in women of various age groups presenting with AUB in MRMCW, this study was conducted.
Material and Methods: This observational study was conducted in conjunction with the Department of Obstetrics \& Gynaecology at the Tertiary Care Institute of India for Women over a period of one and a half years on cases of abnormal uterine bleeding that underwent endometrial sampling (endometrial curettage and biopsy). A total of 200 premenstrual endometrial samples were included in the study material. Endometrial biopsy or sedation-assisted dilatation and curettage were both used to collect endometrial samples. Based on the architecture and cytologic features, hyperplasia was divided into benign (non-atypical) endometrial hyperplasia and atypical endometrial hyperplasia/endometrioid intraepithelial neoplasia (EIN).
Results: The most frequent observation was normal cyclical patterns with proliferative and secretory phase in 114 cases (57%) overall. 41 patients (20.5%) were found to have hyperplasia, of whom 3 had atypical endometrial hyperplasia. Pregnancy complications were observed in 10 (5%) cases, with abortion being the most common cause. Ectopic gestation, partial moles, and complete moles were all contributing factors.
Conclusion: The current study demonstrates that the most typical histological pattern of endometrium for AUB in perimenopausal women in our region is endometrial hyperplasia. The etiology and appearance of AUB, as well as the ensuing endometrial pathology, vary depending on the age group, just as endometrial physiology does with age and reproductive activity.