Trends in Clinical and Medical Sciences (TCMS)

Background: The Transversus Abdominis Plane (TAP) Block is a method used for regional anaesthesia. It offers analgesia during lower abdominal surgery, especially when parietal wall pain is a significant source of discomfort. Through the local anaesthetic deposition between the Transversus Abdominis muscle and internal oblique muscle, it permits sensory blockage of the lower abdominal wall’s skin and muscles. In a hospital-based, prospective observational study we assessed the effectiveness of unilateral TAP Block with bupivacaine for postoperative analgesia in hernia repair.
Material and Methods: After institutional research ethics committee approval, the M.G.M Medical College and M.Y Hospital Anesthesiology Department will conduct this prospective randomised controlled study. Convenient sampling was used90 to randomly assign 30 patients from the American Society of Anesthesiologists physical status grade I–II, age 20–40, to three groups:
Group B (n=30) received TAP blocks on both sides with 18 ml 0.25% bupivacaine and 2 ml normal saline.
Group BM (n=30) patients received TAP blocks on both sides with 18 ml 0.25% bupivacaine, 1.5 ml (150 mg) mgso4, and 0.5 ml NS.
Group BD (n=30) patients received TAP blocks on both sides with 18 ml of 0.25% bupivacaine mixed with 2 ml of NS and 0.5 mcg/kg dexmedetomidine.
A 10-point VAS assessed post-operative analgesia. After securing intravenous lines, all patients received 10-5 ml/kg Inj. Ringer Lactate preloading injections. Premedication consisted of 0.2 mg glycopyrrolate intravenously and 4 mg ondansetron intravenously 30 minutes before surgery.
Results: Combination of 0.25% bupivacaine and 150mg magnesium sulfate and combination of 0.25% bupivacaine and 0.5mcg/kg dexmedetomidine provides longer duration of analgesia compared to 0.25% bupivacaine alone.
Conclusion: When utilized in patients undergoing inguinal hernioplasty, TAP Block with 0.25% bupivacaine offered powerful and longer duration of analgesia, with little any need for diclofenac. There were no side effects linked to TAP Block or the medications being tested.

Context: Periodontal disease is a disease, or more likely a number of diseases of the periodontal tissues that results in attachment loss and destruction of alveolar bone. The dental biofilm is responsible for the pathogenesis of the periodontal lesions, resulting both from the direct degradative action and the indirect inflammatory lesions, mediated by microbial cells and their virulence factors.
Aims:The aims of this prospective study were the isolation, identification and characterization of the antibiotic susceptibility profiles of bacterial isolated from patients with periodontal lesions.
Material and Methods: This prospective and non-randomized study was carried out at Department of Periodontology, MPCD & RC, Gwalior and Microbiology, G. R. M. C., Gwalior, Madhya Pradesh for the period of one and half years. The study was conducted for the period of 1 and half year. During the period a total 50 samples were collected following inclusion and exclusion criteria and processed as per Clinical and Laboratory Standards Institute guidelines. The statistical analysis was performed by SPSS software.
Results: A total of 50 study subjects were included, with culture positivity rate of 36% (18). Male to female ratio was 2:1 with mean age of 38.1 years. E. coli, Staphylococcus aureus, Streptococcus mutant, Klebsiella species and Candida species were isolated. Maximum resistant was observed against ceftriaxone (60%), ceftazidime (53%), amoxicillin clavulanate (46%) and low resistance against gentamicin, ciprofloxacin and doxycycline.
Conclusion: The antibiotic susceptibility assay revealed different profiles and significant levels of antimicrobial resistance, reflecting the necessity to perform the microbiological analysis and the antibiotic susceptibility testing in order to select the optimal antimicrobial therapy for the treatment of the periodontal disease.

Background: In general practise, frozen shoulder is a common condition, in which pain and gross restriction of movement around affected shoulder joint occur.
Aim: To compare the effectiveness of fluoroscopic guided capsular distension with and without suprascapular nerve block to relieve pain and improve range of movement.
Method: An observational study of 60 patients to compare capsular distension with steroid,local anaesthetic and normal saline in 30 patients with suprascapular nerve block (group A). Capsular distension with steroid, local anaesthetic and normal saline without suprascapular nerve block in 30 patients (Group B). After capsular distension all patients advised physiotherapy, ranges of movement and pain over shoulder joint were assessed over a 12-week period.
Results: In comparison to fluoroscopic guided capsular distension without suprascapular block (Group B), fluoroscopic guided capsular distension with suprascapular block (group A) has a more decreased SPADI and VAS score.
Conclusions: According to this study, suprascapular nerve block is a more safe and effective method of treating frozen shoulder than distension with no nerve block.

Purpose of Study: For colon problems, colonoscopy is a frequently used diagnostic and therapeutic procedure. Adults with lower GI symptoms such stomach pain, persistent diarrhoea, blood in the rectum, constipation, protrusion from the rectum, changes in bowel habits, iron deficiency, or anaemia are the best candidates for the procedure. Although colonoscopy is the gold standard for diagnosing colon neoplasms and inflammatory bowel disease (IBD), early detection of both illnesses is still difficult. In order to discover overlooked lesions in routine perirectal and proctoscopy examination and corroborate the findings of ultrasonography anorectal complaints, we investigate in this study the role of colonoscopy screening in patients receiving surgical treatment of anorectal disorders.
Methods: We have included colonoscopies of 96 patients who underwent various surgical procedures at R. D. Gardi Medical College and associated hospitals from December 2019 to April 2021. Data on age, gender, medical symptoms, comorbidities and family history were collected, and a colonoscopy was done prior to surgery.
Results: Colonoscopic examinations resulted in 80 abnormal findings, of which 12 were malignant. Twelve anorectal conditions that would have been missed otherwise were diagnosed among the 80 abnormal findings, including ulcerative colitis, haemorrhoids, tubercular colitis, fissure in ano and Carcinoma colon and carcinoma rectum. The most common symptoms that were significantly associated with abnormal findings were burning sensation or pain in the anal region, blood in stools, weight loss, diarrhoea and family history.
Conclusion: Colonoscopy is emerging as a community screening tool to identify malignancy in a very early stage. Our results emphasize the need to perform a simple out/ inpatient colonoscopy procedure before undertaking any anorectal surgery that may facilitate the early detection of colon malignancies.

Background: Vast majority of fractures of distal radius are articular injuries that result in disruption of both radiocarpal and radioulnar joints. Therefore, this study evaluates the functional and radiological outcomes of distal radius fractures treated by percutaneous pinning in ulno-carpal joint and distal radius.
Material and Methods: A Prospective Interventional Study conducted at Department of Orthopaedics, N.S.C.B. Medical College and Hospital, Jabalpur (M.P.) with the study population of patients attending OPD and casualty diagnosed with distal Radius fracture from the duration of 1st March 2021 to 31st June 2022. Total of 50 Sample size was taken estimated through the formula \(n = \frac{z^2 \times p \times q}{d^2}\) . Data analysis was done through the IBM software SPSS and the statistical association was fund with the Confidence Interval of 95% and p-value>0.5.
Results: Total of 50 patients, 30 were male, and 20 were females, who were assessed through follow-up. According to Sarmiento score of range of motion, 21 Patients have excellent score (0-2),12 patients have good score (3-8), 12 patients have fair (9-20), and 5 patients have poor (above 21).
Conclusion: Closed reduction and percutaneous K-wire fixation is a less intrusive, safer, and successful approach to preserve the reduction, avoid radial collapse during healing, and maintain DRUJ stability even when the fracture is extensively comminuted, intra-articular, or unstable.

Background: Chronic suppurative otitis media (CSOM) is the commonest clinical condition diagnosed in ENT out patients department (OPD) in the developing country like: India. CSOM can lead to serious intracranial/extracranial complications. Hence knowledge of local bacteriological pattern and its antibiotic sensitivity may help for treating them with appropriate antibiotic therapy.
Methods: This prospective study was done with the collaboration of ENT and microbiology department. in a tertiary care centre, India The pus sample was collected from clinically suspected CSOM patients and culture sensitivity as done. Identification of bacterial isolates and antibiotic susceptibility patter was done by standard CLSI guidelines.
Results: On assessing about 122 patients of CSOM, most of them (2 group with male predominance. The commonest organism isolated was Pseudomonas species (24.2%) followed by klebsiella. Pseudomonas species was most sensitive to imipenem, colistin and polymixin b Staphylococcus aureus was mainly sensitive to linezolid and Vancomycin.
Conclusion: The study concludes imipenem for Pseudomonas species and linezolid and Vancomycin for Staphylococcus was most sensitive drug. The appropriate and adequate antibiotic therapy is always recommended for chronic otitis media to avoid complications.

Introduction: The dynamics of bacterial populations in soft tissue wounds and bone differ greatly over time. The primary goal in the management of open fracture is the prevention of the infection of the bone and soft tissue. To achieve this goal, the most widely accepted treatment protocols include early surgical debridement, irrigation of open wounds, administration of broad- spectrum antibiotics, and stabilization of fractures.In this study, we studied the pattern of bacterial isolates in all cases of open fractures of extremities that came to the local secondary \& tertiary care hospitals.
Material and Methods: This Cross Sectional analytical study involved Prior Consent from the patients \& was found to be within ethical standards. It was conducted in nine months. In the present study, 100 patients of all ages, both the sexes, with open fracture of all the grades as per Gustilo-Anderson classification, coming to Orthopaedic Outpatient Department and Emergency Dept of selected hospitals including ours were selected.
Results: Patients who were brought after 6 h showed maximum growth of bacterial isolates. Pre-debridement cultures were taken in all 100 patients, and the presence of growth of organism was found in 56% . Out of the positive 56 patients, 37 (66%) were found to have Gram-positive bacterial growth. Coagulase-negative \textit{Staphylococcus aureus} was the most common Gram- positive bacteria isolated. Gram-negative bacteria were found in 19 (34%) cases, which showed different isolates occurring in same number.Post-debridement cultures showed growth in 34% patients with no growth in rest patients [Table 2]. Out of the 34 patients, Gram-positive bacteria were isolated in 18 patients and Gram-negative in rest 50%. Coagulase-negative S. aureus was the most common.
Conclusion: Predebridement cultures are of no importance in treating open fractures. Postdebridement cultures are important in formulating an antibiotic policy to be started in patients of open fractures as soon as possible. Gram-negative organisms are the most probable cause of infection in cases of open fracture. Our antibiotic policy should cover both Gram-positive and Gram-negative organisms with two antibiotic drug regimen if possible. Aminoglycosides are the most sensitive group of drugs in both Gram- positive and Gram-negative bacteria.

Background: Rocuronium produces faster neuromuscular blockade compared with other neuromuscular blocking drugs. It produces intubating condition similar to succinylcholine, but does not have the short duration of action. Objective: to compare the onset time of intubation and intubating condition of rocuronium with priming versus without priming.
Methods: Sixty patients of ASA physical status I and II, aged between 18-60 years, of both the sexes, grouped randomly and divided into priming group (group P) and control group (group C) of 30 subjects each. Priming group (Group P) receives 0.06mg/kg of rocuronium and control group (group C) receives normal saline. All patients received inj. Fentanyl 1mcg/kg, followed by inj. thiopentone 5mg/kg for induction. Intubating dose of rocuronium 0.54mg/kg for priming group and 0.6mg/kg for control group administered 3min after priming.
Results: The present conducted study shown that onset time of intubation was 56.4(\(\pm\)6.43) sec in priming group (group P) with 3 min priming interval, 117.6(\(\pm\)16.78) sec in non priming group (group C) with clinically acceptable intubating conditions were obtained in both groups without any adverse effects.
Conclusions: Priming with the rocuronium provide excellent intubating condition in less than 60 sec when compare to non priming group and is a safe alternative to succinylcholine.