Trends in Clinical and Medical Sciences (TCMS)

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.

Background:  Alcohol is the most frequently misused substance on a global scale. Research has demonstrated that it can elicit detrimental impacts on nearly all bodily organ systems. A number of medical conditions can be ascribed to the direct impact of alcohol, while others may be indirect consequences stemming from nutritional inadequacies or susceptibility to injury. The consumption of alcohol has been linked to a range of cardiovascular disorders. Consequently, this study was conducted to investigate the Electrocardiographic and Echocardiographic abnormalities in asymptomatic chronic alcoholic patients.
Materials and Methods: The present study, an analytical cross-sectional investigation, was conducted between April 1st, 2021 and September 30th, 2022. The study population consisted of 150 individuals with chronic alcoholism, aged between 21 and 40 years, who had been consuming more than 80 grammes of alcohol per day for a period exceeding 5 years. The participants’ medical history was evaluated according to the definition of chronic alcoholism, and electrocardiography and echocardiography were employed as diagnostic tools. The study group excluded individuals with pre-existing conditions such as diabetes, hypertension, and cardiovascular disorders.
Results: Our study reveals that the incidence of cardiovascular abnormalities among individuals with chronic alcoholism is 37%. The predominant electrocardiogram (ECG) alterations observed are sinus tachycardia (18%) and non-specific ST-T changes (9%). The prevalent alterations observed in 2D ECHO were augmented thickness of the posterior wall (11%), succeeded by heightened thickness of the interventricular septum and diminished ejection fraction (<40%). The incidence of cardiovascular abnormalities is positively correlated with prolonged alcohol consumption and is also elevated in the elderly population.
Conclusions: The present investigation validates that a multitude of electrocardiographic and echocardiographic alterations manifest before the onset of symptomatic cardiac pathologies that are attributed to prolonged alcohol consumption, such as alcoholic cardiomyopathy.Early indicators of the ongoing effects of alcohol may be detected through non-invasive investigations such as Electrocardiography and Echocardiography. These indicators are likely reversible during the early stages but may progress to alcoholic dilated cardiomyopathy if left untreated.

Introduction: Acute kidney injury is characterised by a sudden and potentially reversible deterioration in renal function, resulting in impaired elimination of nitrogenous waste products and compromised fluid and electrolyte homoeostasis. Variations in the definitions utilised, the demographic under scrutiny, and the healthcare environments can result in notable disparities in the epidemiological data pertaining to acute kidney injury.
Methods: This cross-sectional observational study was approved by the Institutional Ethics Committee in a tertiary-care teaching hospital located in a urban area. All individuals diagnosed with acute renal failure as defined by the RIFLE criteria were incorporated into the study. Individuals who were below the age of 18 were not included in the study. The enquiry comprised a comprehensive account of the patient’s medical background, a thorough physical examination, and a systemic evaluation. During the period of hospitalisation, patients were classified based on their RIFLE class, which includes R, I, or F. The classification of RIFLE is determined based on either the glomerular filtration rate (GFR) or urine output. Patients were categorised based on their serum creatinine levels and urine output.
Results: Out of the total of 100 cases of Acute Kidney Injury (AKI), 46% were female patients, whereas 54%) were male patients. The Mean age upon initial presentation was 55.22 \(\pm\) 14.91 years. AKI was determined to be primarily caused by sepsis. Among the sample of patients under investigation, 64% of the total, were identified as being associated with sepsis. The study observed a mortality rate of 40%.
Conclusion: Acute Kidney Injury is a prevalent complication observed in patients admitted to the Intensive Care Unit (ICU). The timely identification and management of acute kidney injury (AKI) in critically ill patients have been shown to decrease mortality rates associated with AKI and all-cause mortality.

Background and Aim: The condition of infertility is recognised as a major healthcare concern across different communities. The issue’s significant prevalence has resulted in its intensified importance. Environmental conditions and acquired risk factors have been found to be associated with a substantial proportion of cases of infertility. Diverse environmental conditions have underscored the necessity to investigate the distinct aetiologies of infertility in various regions.
Objective: The aim of this study was to determine the frequency causes of infertility in infertile couples.
Materials and Methods: In this cross sectional descriptive study 340 infertile couples that were referred to infertility clinic of tertiary care hospital during study period, were examined. This centre is the only governmental centre for infertility. Information about the patients was obtained from medical examinations and laboratory findings. To analyze the data, descriptive statistics such as frequencies and the mean were used.
Results: Among the various causes of infertility women factors (88.6%) had the highest regard. In the causes of female infertility, menstrual disorders, diseases (obesity, thyroid diseases, and diabetes), The causes of infertility in the 340 couples were divided into four standard categories as follows: Female factor 58.7% , Male factor 28.2%, Combined causes 3%, Unexplained infertility 10.1%. The prevalence of primary and secondary female infertility was 70.5% and 29.5% respectively. Tubal cause account most in female infertility.among male sperm morphology was measure cause.
Conclusion: Urban Central India has a lower rate of primary infertility than developing nations. Healthcare professionals and policymakers must understand infertility incidence and risk factors to develop and implement various infertility prevention and management strategies.

Background and Aim: Surgical site infections (SSIs) are common after laparotomy wounds and are associated with a significant economic burden. The use of negative pressure wound therapy (NPWT) has recently been broadened to closed surgical incisions.
Material and Methods: The Institutional Ethics Committee approved this single-center, parallel, randomised controlled trial, which followed the Declaration of Helsinki. If they were 18–65 year old , patients were eligible. All surgery patients undergoing abdominal surgery and closed abdominal surgical wounds who received negative pressure wound therapy or conventional therapy. Exclusion criteria included abdominal pathology re-explored or re-operated and inability to consent. Trial participants received an information leaflet and gave written consent.
Result: The primary objective to assess the relative risk of development of SSI in the ciNPWT, the relative risk of development SSI in CiNPWT group was found to be 0.69 and 1.44 in group with conventional dressing, thus CiNPWT was found to be protective for SSI in incisional wound. CiNPWT and conventional patients were mostly 31-60 years old. 84 patients (70%) were male, while 36 (30%) were female in the study cohort.NPWT reduced wound complications like soakage and dehiscence by 20% on the 14th day after surgery. A 0.013 p-value indicated statistical significance. NPWT reduced wound complications like soakage and dehiscence on the 21st day after surgery. The 18.33% reduction was statistically significant at 0.0134. Negative Pressure Wound Therapy (NPWT) reduced soakage and dehiscence by 10% in serial follow-ups on the 30th day post-surgery. The study revealed a negative correlation between the levels of Total Serum Protein and Serum Albumin and both wound healing duration and duration of hospital stay. Specifically, lower levels of total protein and albumin were associated with longer healing time and extended hospitalisation.
Conclusion: Surgical site infections are common, especially in high-risk patients. SSI costs hospitals a lot. SSI research is underway. This study used Negative Pressure Wound Therapy (NPWT) as a prophylactic dressing for closed incisional wounds in 60 patients and compared its efficacy to conventional dressings. Based on relative risk analysis, CiNPWT prevented SSI after one year. NPWT significantly reduced seroma formation. Negative Pressure Wound Therapy (NPWT) shortened wound healing and hospitalisation. Negative pressure wound therapy (NPWT) reduced wound complications like dehiscence, blistering, necrosis, and reoperation or rehospitalization. These findings were not statistically significant. NPWT reduced SSI.

Introduction: In many Western countries, non-alcoholic fatty liver disease (NAFLD) is now surpassing viral hepatitis as the primary cause of chronic liver disease and hepatocellular carcinoma (HCC). In India, the current high burden of NAFLD is likely to rise further in the future. Given the significant prevalence of NAFLD in the community, identifying those at risk of developing liver disease is critical in order to simplify referral and advice effective management. Thus, the present study was carried out with the aim to diagnose Non-alcoholic fatty liver disease based on ultrasound and study its clinical profile in patients attending outpatient clinic and inpatients in a tertiary care hospital in Central India.
Material and Methods: This observational study was carried out in the Department of Medicine, Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur, after approval by Institutional Ethics Committee. 100 consented patients,>18 years of age presenting to the OPD and IPD of the hospital and suspected and later diagnosed as NAFLD were included in the study using a proforma, ultrasonography and investigations. Data was collected, compiled and analysed using SPSS 22.0 (trial version).
Results: 68%, 27%, 5% cases were diagnosed as grade I, grade II and grade III fatty liver respectively. The mean age was 47.07\(\pm\)11.95 years. Female preponderance was observed (55%). Abdominal pain (55%), fatigue (73%) and dyspepsia (48%) were the dominant symptoms. 51% patients had increased waist circumference (mean =87.06\(\pm\)10.46 cm). Mean BMI was 26.77+4.01 kg/m2. 46% were pre-obese and 15% were obese (BMI >30). Majority of Grade III fatty liver (60%) were diabetics. Mean values of impaired fasting blood sugar in grade I, II, III were 109.6\(\pm\)45.02, 117.52\(\pm\)56.93, 138.20 \(\pm\)53.31 mg/dl and when compared was statistically significant (p<0.05).29% patients had hypertension (\(\geq\)130/85 mmHg. 18% patients had high bilirubin levels. Deranged AST (46.48\(\pm\)27.30) and ALT (57.51\(\pm\)52.10) were found in greater percentage of patients (p value <0.001, <0.001 respectively) and had positive co-relation (r+0.36 and r+0.43). Hypercholesterolemia (>200mg/dl) was found in 46% patients. Mean cholesterol level in grade I, II and III was 192.71\(\pm\)43.43, 210.37\(\pm\)44.11 and 277.34\(\pm\)34.06; when compared it was found to be statistically significant (p< 0.01) with positive co-relation (r+0.39).Hypertriglyceridemia (>150mg/dl) was present in 60% cases. The mean triglyceride level in grade I, II and III was 160.46\(\pm\)51.28, 211.00\(\pm\)111.432 and 240.14\(\pm\)174.111 mg/dl respectively and when compared was statistically significant (p<0.05) with positive co-relation (r+0.29). Low HDL was present in 71% of patients. HDL cholesterol had a negative co-relation (r-0.17). In the present study mean LDL was 119.66+31.11 mg/dl and elevated LDL (>130mg/dl) was found in 29% of patients. Elevated VLDL was seen in 36% of patients with mean of 30.496+10.33 mg/dl.
Conclusion: Non-alcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease in both the developed and developing worlds. It is emerging as a major public health problem. The present study throws light on the clinical spectrum of the disease. Early detection and treatment is of utmost importance in preventing this disease from emerging as a new epidemic globally.

Background and Objectives: Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 is a hyper inflammatory syndrome manifesting commonly with a cytokine storm that causes wide spread multi organ involvement.
Aim: To study the clinical profile & outcome of multisystem inflammatory syndrome in children (MIS-C) related to covid-19 infection.
Methodology: This retrospective study was done in Pediatric Intensive Care Unit of a tertiary care teaching hospital. Case records of children with discharge diagnosis of MIS-C, full filling the WHO criteria were included. The cases were categorized into two subsets based on presentation: with shock and without shock. Demographic parameters, clinical symptomatology, laboratory parameters, echocardiography findings and treatment were compared between these two groups. Coronary artery diameter was measured by using Z score in echocardiography. Outcome of the study was measured in terms of mortality or discharged.
Results: During the study period, 96 children presented with signs and symptoms suggestive of MIS-C and out of them 63 children fulfilled the WHO MIS-C criteria. The mean age of study population was 6.8 \(\pm\) 5.31years (1 month-17 years). Majority of cases were in the age group of 0-5 years (47.61%) with male preponderance of 55.55%. Half (50.79%) of the children presented with shock and maximum cases were in 6-12 years of age group (p=0.008). Most common presenting symptoms were vomiting and rash observed in 58.73% children each. C reactive protein (p=0.001) and Sr Ferritin (p=0.009) were significantly higher in children with shock. Echocardiography was done in 38 children and 30(78.94%) of them had abnormalities. Left ventricular dysfunction was significantly higher in children with shock as compared to those without shock (p=0.02). Majority of children who presented with shock required IVIg along with steroids as against those presented without shock(p=0.003). Mortality was 12.7%.
Conclusion: Shock was a common manifestation in MISC, affecting half of the children. CRP, Sr ferritin and echocardiography abnormality were significantly higher in children with shock. Majority of the children with shock required IVIg along with steroids.

Background: Upper limb surgeries can be performed by the administration of general anaesthesia or regional nerve blocks. Brachial Plexus Block either conventional or Ultrasound-guided is preferred to general anaesthesia.
Aim and Objectives: This study was designed to compare the conventional paresthesia technique with an ultrasound-guided approach for supraclavicular brachial plexus block with regard to the onset and duration of sensory and motor block, success rate, and incidence of complications.
Methods: The study was conducted in the operation theatre complex in Alluri Sitarama Raju Academy of Medical Sciences (ASRAM) over a period of one year, from January 2022 to December 2022.
Results: Ultrasound-group had a significantly longer duration of motor block and sensory block when compared to the conventional approach.

Background: Cerebrovascular disease in children is a rare occurrence with an annual incidence of 2.7/100,000 children. There are limited reports revealing stroke in pediatric population associated with hyperhomocysteinemia. We present a series of cases discussing the clinicolaboratory, radiological findings and management of children presenting with hyperhomocysteinemia and stroke.
Aim and Objective: To study the clinicolaboratory profile, radiological findings and outcome of children with hyperhomocystienemia and stroke.