Trends in Clinical and Medical Sciences

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.

Background and Aim: Blood scarcity is a common problem in hospitals and is caused by an imbalance between the rising demand for safe blood and blood products on the one hand and the failure to organize regular blood supply as a result of misconceptions, perceived harms and risks, and a lack of motivation among potential donors. Determining students’ knowledge, attitudes, and practices about voluntary blood donation was the goal of the study.
Material and Methods: The study, which lasted a year, involved undergraduate medical students from the Department of Pathology, GMERS MEDICAL College and Hospital, Dharpur, Patan, Gujarat. A semi-structured questionnaire was prepared by referring to various published articles and was validated by concern experts. The questionnaire was further refined by doing a pilot study among students. The first section of the four-part questionnaire asks about participants’ fundamental characteristics. In the second section, 14 multiple-choice and yes-or-no questions were used to gauge students’ knowledge levels. While there were three practice questions provided as yes/no and multiple-choice questions, there were six questions to gauge attitude in the third and fourth sections. Participants’ responses were evaluated, with >50% being deemed to have high knowledge and 50% having low knowledge.
Results: The majority of participants (93.12%) had heard of blood donation and 96.4% were aware of its significance. Less than 50% of study participants were unaware of the quantity and duration of blood donations. Of the total respondents, 98.11% believed that giving blood saves lives, 96.9% thought it was a good habit, 89.11% thought voluntary blood donation was the best way to get safe blood, and 89.9% and 88.9% said they would be willing to give blood in the future and encourage their family members to do the same. Compared to male students, female students were 43% less likely to donate blood.
Conclusion: The study subjects had good knowledge and a good attitude towards blood donation. Although it is still uncommon, particularly among girls, for students to donate blood, this is true. This demonstrates the need for ongoing instructional and inspirational programmes to promote student blood donation on a voluntary basis.

Background: Ectopic pregnancy (EP) is a condition presenting as a major health problem for women of childbearing age. This study aimed to identify potential risk factors for EP and to evaluate the contribution of the risk factors associated to EP.
Material and Methods: The present Prospective (Hospital based) Observational study was conducted in the Department of Obstetrics and Gynaecology, Gandhi Medical College, Bhopal. After approval from institutional ethical committee for a period of 18 months from January 2021 to June 2022. All diagnosed cases of ectopic pregnancy during 18 months of study period in GMC Bhopal. The diagnosis of ectopic pregnancy was made by detailed history, clinical examination, laboratory evidence (urine pregnancy test/serum beta HCG), and radiological investigations (ultrasound).
Results: In our study 65.0% of the patients were from the age group of 21-30 years, 63.6% of the patients were multigravida, 48.6% patients belonged to low socio-economic status, 55.7% were educated, 50% cases were less than 7 weeks of gestation ,and 45.7% patients were between 8-14 weeks of gestation, 8.6% patients had undergone sterilization, while 2.1% were using IUCD, Majority of ectopic pregnancy occurred in fallopian tube i.e., 124 (88.57%) followed by Ovary in 10 (7.1%) patients. Rudimentary horn ectopic pregnancy was witnessed in 5 (3.6%) patients. In our study 111 (79.3%) patient presented with ruptured ectopic pregnancy to the department, while the rest 21.7% were unruptured. surgical intervention done in 133 individuals, accounting for 95.0% of the sample, whereas the remaining 7 participants (5.0%) received medical treatment.
Conclusion: Ectopic pregnancy can be life-threatening. Hormonal assays, transvaginal sonography, and laparoscopy are detecting ectopic pregnancies early, increasing their incidence. Reproductive organ mutilation can affect fertility. Tubal surgery, PID and abortions increase ectopic pregnancy risk. In patients without risk factors, early diagnosis is critical. Antenatal care facilities should have USG, particularly transvaginal sonography (TVS), and trained staff. Early detection of first-trimester complications like ectopic pregnancies reduces mortality. As the incidence of ectopic pregnancy has been on the rise, screening of high risk cases, early diagnosis and early intervention are required to enhance maternal survival and conservation of reproductive capacity.

Background: Maternal deaths predominate (99%) in low- and middle-income nations. Postpartum haemorrhage, pre-eclampsia, and puerperal sepsis are identified as the three primary factors contributing to maternal mortality in the aforementioned regions. Various diagnostic criteria are employed to identify sepsis, with one of the frequently utilised criteria being the systematic inflammatory response syndrome (SIRS). Nevertheless, these criteria necessitate laboratory investigations that may not be viable in settings with limited resources. The objective of this study was to devise a model that utilises clinical indicators and risk factors to promptly detect sepsis in postpartum females.
Material and Methods: This is an observational study conducted in the Department of Obstetrics and Gynaecology, Gandhi Medical College, Bhopal, after institutional ethical committee approval, from January 2021 to June 2022. All antenatal and postnatal women (within 42 days of delivery) reporting to the emergency department in the Department of Obstetrics and Gynaecology, Gandhi Medical College, Bhopal were included. All antenatal and postnatal cases meeting 2 or more SIRS criteria at admission during the study period and willing to give written consent were included in the study. Patients who did not meet the SIRS criteria were excluded.
Results: Out of the total included patients, 450 (1.26%) was the total burden of sepsis. Sepsis among antenatal cases was 217 out of 18085, giving a burden of 1.19%. Sepsis among puerperal cases was 233 out of 17354, giving a burden of 1.34%. Unbooked cases had a higher sepsis score of > 6. A significant association was found between maternal outcome and SOS scores. 22 cases were transferred out to other departments (for needed medical interventions) and mortalities were seen in 6 mothers in the present study. Among the mothers who died, 5 had SOS scores of more than 6. Fetal outcome: In the present study, 361 were live births, 29 were stillbirths, and 9 were IUFD.
Conclusion: Sepsis now causes the most preventable maternal deaths worldwide. Prioritising maternal sepsis and septic shock tool development and validation. Early sepsis screening of high-risk obstetric patients uses the SOS score. Pregnancy-associated sepsis and complications have few emergency room scoring systems. This study confirmed the SOS score’s ability to distinguish severe pregnancy-associated sepsis. It may help prioritise and distribute critical care beds in low-resource countries due to high sepsis-related maternal morbidity and mortality. We strongly recommend further validation and demonstration of SOS efficacy in obstetric sepsis.

Introduction: Subclinical hypothyroidism is described as a condition where the patients™ serum ft4 is within normal limit , but serum TSH level is raised . These patients have limited or no clinical features of hypothyroidism. It is to be mentioned here that clinical hypothyroidism is biochemically denoted as an elevated TSH level with a decreased serum fT4 level along with florid symptoms of hypothyroidism. There are numerous researches on how clinical hypothyroidism affects the respiratory system, but there are scanty numbers relating to subclinical hypothyroidism, which may also lead to remarkable deficits in lung function. Evaluation of the respiratory system in subclinical hypothyroidism is the prime target of this study . Spirometry was our method of choice here since it is less expensive, smoother, and more readily available than other respiratory function tests.
Aims and Objective: To measure the Expiratory Flow Volumes – FEV1, FVC, FEV1%, FVC%, FEV1:FVC% and rates- PEFR(L), PEFR%, \(FEF_{25-75}\) (L), \(FEF_{25-75}\) %, in subclinical hypothyroid patients and their correlation with serum TSH level and serum fT4 level.
Materials and Methods: The current study was a cross-sectional study with a case-control design conducted at the physiology department of a tertiary hospital situated in West Bengal surrounded by rural population. The selection of 100 subjects (50 cases and 50 controls) was based on age, BMI, inclusion and exclusion criteria. Serum TSH and fT4 levels were measured, and the pulmonary function tests were examined using the RMS Helios 401 Spirometer. The statistical study was conducted using Microsoft Office 2007’s SPSS-17 and Excel. The Student Independent T-test and the Pearson’s Two-Tailed Correlation Study were used for the analysis. The threshold for statistical significance was a P value of \(\leq 0.05\) and P value \(\leq 0.001\) was considered as statistically highly significant.
Results: The pulmonary function parameters in active control subjects and in subclinical hypothyroidism patients were measured by spirometry . It was noticed all the projected study parameters of pulmonary function test were lowered considerably in subclinical hypothyroidism in respect with the control group. The dissimilarities of the FVC, FVC%, FEV1, FEV1%, PEFR(L), PEFR%, FEV1/FVC, \(FEF_{25-75}\) (L) are statistically important (\(p \leq 0.05\)). In SCH , significant negative correlation persists between TSH and FVC(L), between TSH and FEV1(L) and between TSH and FEV1%. In SCH patients, FVC(L) , FVC%, FEV1% and PEFR(L) have significant correlation with fT4 value.
Conclusions: The present study depicts that subclinical hypothyroidism also may cause disorders of lung function along with disturbances of ventilation. Simple spirometry may be used to test patients for the widely prevalent subclinical hypothyroidism affecting a good number of common people. This will aid in prompt patient management.