Trends in Clinical and Medical Sciences

Background: Infected non-union and gap non-union are challenges that orthopaedic surgeons have to face globally. The open fracture is the most common cause of infected nonunion and tibia is the most commonly involved bone in the infected nonunion. In Ilizarov technique, vascularity is increased by corticotomy and application of a circular external fixator. It also provides micro motion due to distraction and gives an excellent biological environment for fracture healing.
Material and Methods: Seventeen consecutive patients with infected nonunion of long bones were treated from 2012 to 2016. The age range was 20 to 65 year-old male patients. Five cases were admitted with femoral infected non-union and twelve with septic non-union of tibia. Patients were followed up for one year. The predominant bacteria were Staphylococcus aureus and Pseudomonas aeruginosa. Average duration of antibiotics treatment was 4.9 (range, 2-6) weeks. The outcome measures were according to the classification of ASAMI, which is based on radiological (defect filling) and clinical (functional) findings.
Results: The cases were followed with mean period of 3.5 years (range, 2-5 years). In the present study, seventeen cases with septic non union of tibia and femur were evaluated. All cases completed treatment and achieved bony union with no signs of infection. In the present study, bone union result as per ASAMI score was excellent in 76.5%, good in 23.5% cases, and also the functional results were excellent in 76.5%, good in 23.5% cases. No patient had gone for amputation in our study.
Conclusion: Ilizarov technique has been a successful treatment for infected long bone non unions of tibia and femur associated with bone loss. Our results were similar with the existing literature about the study. The lengthy treatment time and considerable number of complications must be fully understood both by the surgeon and the patient before undertaking the ilizarov treatment method.

Background: Breast cancer is the most common malignancy among women worldwide. According to the GLOBOCAN 2020 estimates of cancer incidence and mortality, female breast cancer has surpassed lung cancer and is now the most commonly diagnosed cancer, with an estimated 2.3 million new cases. In India, breast cancer has moved from being the fourth most common cancer in the 1990s to the first. The prevalence of established hormonal and reproductive risk factors is higher in Western countries, but these risk factors are not commonly observed in the rural population of India. Therefore, it is important to study the probable risk factors in our population, including the potential role of obesity, especially in postmenopausal women, in the development of breast cancer.
Aim and Objectives: The aim of our study is to determine the demographic profile of breast cancer patients and identify any associated risk factors for breast cancer in this population.
Methods: This analytical cross-sectional study was conducted at Alluri Sita Rama Raju Academy of Medical Sciences (ASRAM) over a period of one year from March 2021 to February 2022. We included 72 patients with histologically proven breast carcinoma who attended the Oncology OPD and met the inclusion criteria.
Results: In our study, approximately 86% of breast cancer patients had a body mass index (BMI) greater than 23. Obesity is known to be associated with increased estrogen levels, which can be a risk factor for hormonal-dependent breast cancer. Among the study group, 52% were luminal positive, 25% were triple negative, and 22.2% were HER2 neu positive.
Conclusion: Our study found that approximately 86% of breast cancer patients were obese. The association between BMI and breast cancer needs to be further studied in randomized control trials. Furthermore, reproductive and hormonal risk factors were not significantly observed in our population group.

Background and Aims: Ventilator associated pneumonia (VAP) develops after more than 48 hours of mechanical ventilation. VAP is the leading cause of death among hospital acquired infection and prolongs time spent on the ventilator, length of intensive care unit (ICU) stay and length of hospital stay after discharge from the ICU. The concept of ‘bundles’ which can be defined as groups of evidence based interventions when, performed together, improve outcome. Hence this study was undertaken to assess the incidence of VAP and effectiveness of Bundle to prevent VAP.
Methods: This study was conducted in two phases. Pre-interventional phase (Phase-1) is done for three months by observing the current practices in mechanically ventilated patents and assessing the incidence of VAP. Then in post-interventional phase is conducted for three months by applying the bundle care approach, educating the interns, staff nurses and contact care givers regarding the quality improvement project and then assessing the incidence of VAP.
Results: Total 40 patients were involved in the study with 20 patients in each trial. The incidence of VAP was more in pre-interventional trial and the VAP incidence was reduced in post-interventional trial after implementing bundle care.
Conclusions: VAP prevention can be achieved to a large extent with the use of Bundle care approach .However, a major limitation is the lack of adherence to the set protocols by the health care professional especially in developing countries like India where the still the Patient to Nurse ratio is poor and overworked doctors . But one of the way to improve is by educating them through targeted training and using checklist which will help to improve adherence and ultimately patient outcome.

Objective: The objective of this study was to compare the effects of single intra-articular platelet-rich plasma (PRP) and corticosteroid (CS) injections in patients diagnosed with adhesive capsulitis of the shoulder.
Design: Patients between the ages of 30-70 years, of either sex, diagnosed with adhesive capsulitis of the shoulder with a duration of less than 6 months, were included. In the intra-articular corticosteroid (IA-CS, control) group, 30 patients received a single injection of IA-CS (2 ml), while in the IA-PRP (test) group, 30 patients received a single IA-PRP injection (2 ml) into the glenohumeral joint under ultrasound guidance. All patients were prospectively followed for 24 weeks.
Results: Thirty patients in the IA-PRP group and thirty in the IA-CS group completed the entire 24-week study period. At 24 weeks, a decrease in QUICK DASH score was observed in the IA-PRP group (16) compared to the IA-CS group (33). In terms of range of movement, the IA-PRP group showed significant improvement in abduction, internal rotation, and external rotation compared to the IA-CS group. No major complications were observed in any patients.
Conclusions: At the 24-week follow-up, a single dose of IA-PRP injection was found to be more effective than an IA-CS injection in improving pain, disability, and shoulder range of motion in patients with adhesive capsulitis of the shoulder.

Background: Metabolic syndrome is characterized by abnormalities in blood pressure, blood sugar, waist circumference, and cholesterol or triglyceride levels.
Aim: The unique aspect of this study is its primary focus on determining whether there is a distinction in inflammatory markers between individuals with metabolic syndrome and those without the condition.
Material and Methods: The study included 50 patients with metabolic syndrome and 50 healthy controls. The research was conducted at Indore Index Medical College & Research Centre. After obtaining approval, the study’s researchers commenced their work. Each subject provided informed consent prior to the study. Individuals with type 1 diabetes or clinical symptoms for fewer than five years and documented T2DM duration were excluded. Healthy controls (non-metabolic syndrome) were individuals without diabetes, multivitamin use, or comorbidities.
Statistical analysis: Regressions were used to determine the relationship between two variables. Additionally, percentages were calculated. A significance level of \(p < 0.05\) was considered significant.
Conclusion: The significance of these results cannot be overstated. The study’s findings unequivocally demonstrate that both pro-inflammatory and anti-inflammatory cytokines contribute to the development of secondary illnesses associated with metabolic syndrome.

Background and Aim: Corrosive gastric strictures may require more frequent dilations compared to peptic ulcer-related strictures. Strictures occurring at the distal gastric site may necessitate sufficient dilatation to prevent obstructive symptoms, but this comes with an increased risk of perforation. The aim of the study was to determine the mean duration between corrosive consumption and the development of gastric stricture.
Material and Methods: The present study analyzed data collected from patients admitted to the surgical unit of Medical College & associated hospital following corrosive ingestion. Clinical data, including a history of difficulty in swallowing, cough with expectoration, difficulty in breathing, abdominal pain, abdominal distension, vomiting, and fever, were collected. Barium swallows were performed to assess and locate the stricture site in the stomach and assess the distal flow. Intraoperative findings of corrosive strictures and the nature of the performed surgery were analyzed. Barium meal studies were conducted for all patients to locate the level of stricture in the stomach, identify associated esophageal strictures, and detect coexisting trachea-esophageal fistulas.
Results: A total of 24 patients who met the inclusion and exclusion criteria were included in the study. Among the 24 patients, 6 had hyponatremia, 5 had type I strictures, 3 had type VII strictures, and 2 had type IV strictures with hyponatremia. Type I strictures were observed in 4 patients, 1 patient had type VII, and 1 patient each had other types of strictures with hypokalemia. Hypokalemia was present in 8 patients with type I strictures, 3 with type VII, and 1 each with type IIa, type IIb, type III, and type IV strictures. Arcade-preserving antrectomy was performed in 6 patients. One patient had type IIa corrosive gastric stricture and was managed with stricturoplasty. Two patients with type IIb corrosive gastric strictures were treated with Pylorus Preserving Antrectomy. Two patients had type III corrosive gastric strictures, and they underwent circumferential sleeve resection and gastro-gastrostomy.
Conclusion: Adequate preoperative nutritional optimization and evaluation to assess the extent of injury can significantly reduce the morbidity and mortality associated with gastric corrosive strictures.

Vitamin D is a crucial fat-soluble vitamin with various functions. Its deficiency is widespread and affects individuals of all age groups. This study aimed to determine the prevalence of Vitamin D deficiency in different age groups and genders within the East Nimar region. A total of 236 participants were included, and their Vitamin D levels were measured using a Mindray CL-900i Chemiluminescence Immunoassay Analyzer. The results were stratified by age groups and gender. Among the 236 individuals, 47.9% were males and 52.1% were females. The study revealed that 86.4% of the subjects had insufficient or deficient levels of Vitamin D, while only 13.6% had sufficient levels. Specifically, 33.5% of the cases had Vitamin D deficiency, and 57.2% had Vitamin D insufficiency. Vitamin D deficiency was observed in 51.80% of individuals with higher sun exposure and 75% of those with lower exposure. Among supplement users, 45.2% had Vitamin D deficiency, whereas among non-users, the rate was 69.58%. The findings underscore the high prevalence of Vitamin D deficiency in India. Considering the inadequate dietary intake of Vitamin D in the Indian population, measures such as food fortification, Vitamin D supplementation, and exposure to sunlight (especially in the morning) are crucial to address this issue and prevent the complications associated with Vitamin D deficiency.