Trends in Clinical and Medical Sciences (TCMS)

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.

Introduction: Adenoviruses are DNA viruses responsible for varieties of human diseases that affect the gastrointestinal tract, respiratory tract, and eye. There are seven species of adenoviruses categorized from A to G with two subgroups. The classification correlates with clinical presentation, antigenic character, and epidemiological spread and can be identified by the genetic methods.
Aims: To study the clinico-pathological relation of adenovirus associated with respiratory infections in children.
Material and Methods: Department of Pediatrics, R.G.Kar Medical College, Kolkata.
Results: In the present study, this was performed by two steps molecular techniques. The first was by the determination of adenovirus by the use of PCR for fiber gene with common primers for adenovirus. The PCR was confirmed to be positive in 11 samples. The differences in the determination of adenovirus in respiratory infections can be attributed to the difference of the studied population.
Conclusion: The prevalence of adenovirus with respiratory tract infections mainly in pneumonia with genotypes 3 and 7 as the predominant geno types in those in children.

Introduction: Under-five mortality rate in India has been steadily decreasing but still the contribution of malnutrition to child deaths is quite high. Despite decades of nutritional interventions, Out of 1.04 million fewer than five children mortality in India the year 2017, almost 706,000 were malnourished till date.
Aim: To estimate the proportion of infants aged 1-6 months with growth faltering and their severity, to examine the association of grades of anthropometric failure, feeding practices, background characteristics and severity of morbidity of infants aged 1-6 months with mortality.
Materials and method: The present study was a hospital-based, observational, descriptive study. This Study was conducted from 18 months at Department of Pediatric Medicine of College of Medicine and Sagore Dutta Hospital, Kolkata-700058 in West Bengal. Total 83 patients were included in this study.
Result: It was observed in present study that 4 in every 10 infant aged less than 6 months admitted in hospital were underweight including 1/10th severe underweight. In our study, 3 in every 10 infant had stunting including 1/10th severe stunting. It was observed that 5 in every 10 infant aged less than 6 months admitted with ARI in hospital were underweight including 2/10th severe underweight. In Severely wasted group, 5 (10.4%) patients had Early initiation of Breastfeeding Which was statistically significant (p=0.0090). In our study number of patients had Up to date Immunization status was[49(100)] which was statistically significant (p=0.0056). It was observed that infants aged 1-6 months with Night feeding in Severely underweight group were 5 (10.4%) infants which was statistically significant (p=0.0258).
Conclusion: Present study showed that growth faltering in early infancy was associated with morbidity and mortality.

Background: Orthopaedic surgeries of lower limb are well suited for central neuraxial blockade. While the surgeries are done under spinal anesthesia, demand for post operative pain relief and need to reduce the use of systemic analgesics requires epidural analgesia in the post-operative period.
Objective: To evaluate and compare the duration of analgesia of 0.375% Ropivacaine and 0.25% Levobupivacaine given by epidural routes in lower limb orthopaedic surgeries in 24 hrs post operative period.
Material and Methods: In this prospective, randomized, double blinded clinical study, 60 adult patients of ASA I-II of both sexes were randomized into 2 groups(n=30). Patients received 7ml of 0.375% Ropivacaine in group R and 7ml of 0.25% Levobupivacaine in group L through epidural catheter.
Results: There was no significant difference between two groups with respect to demographic profile and ASA physical status. The mean duration (minutes) of analgesia after each epidural topup was significantly longer in group L (303.5\(\pm\)21.8) compared to group R (273.2\(\pm\)23.42) with p value 0.001. Total number of epidural topups were 5 for both the groups, rescue analgesics were needed in only 2 patients in each group. Quality of motor block was predominantly grade 0 of modified bromage scale in more than 80% patients in both the groups. Haemodynamic stability was well maintained and no adverse effects encountered in both the groups.
Conclusion: Epidural 0.25% Levobupivacaine and 0.375% Ropivacaine in their equipotent doses provided adequate post operative analgesia for lower limb orthopaedic surgeries. Levobupivacaine provided prolonged duration of analgesia compared to ropivacaine. But the total number of epidural topups, need for rescue analgesics and quality of motor block were similar for both the study drugs without any haemodynamic variations and adverse effects.