Volume 3 (2023) – Special Issue – Indian Medical Research Views And Findings On Last 5years

Abstract:Gallstone disease is a prevalent condition affecting 3-20% of the global population. While the majority of gallstones are asymptomatic, a small percentage of patients develop symptoms requiring cholecystectomy. The classification of gallstones includes cholesterol, pigment, and mixed types, with ongoing debates regarding the association of hyperlipidemia with gallstone formation. However, there is a lack of information regarding the relationship between abnormal lipid profiles and the biochemical analysis of gallstones. Therefore, this study aimed to assess the association between serum lipid profiles and the biochemical analysis of gallstones in patients with cholelithiasis. A total of 100 patients diagnosed with gallbladder stones were included in the study, and preoperative samples were collected for lipid profile analysis. The patients underwent either open or laparoscopic surgery, and their gallstones were sent for biochemical analysis. The findings revealed that cholesterol stones were the most common type observed. The overall prevalence of hyperlipidemia was 48%, and a significant association was found between hyperlipidemia and the cholesterol content of stones. In particular, the prevalence of hyperlipidemia was 54.3% in pure cholesterol stones, 48.8% in mixed stones, and 23.1% in pigmented stones. Moreover, there was a significant association between blood cholesterol levels and cholesterol stones, with a prevalence of 39.1% in pure cholesterol stones, 19.5% in mixed stones, and 7.7% in pigmented stones. However, no association was observed between triglyceride, LDL, and HDL levels with the composition of stones in cholelithiasis cases. In conclusion, this study highlights a significant association between blood cholesterol levels, hyperlipidemia, and the cholesterol content of gallstones, suggesting that hyperlipidemia, particularly raised cholesterol levels, can be considered a major risk factor in cholelithiasis.

Abstract:Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by joint inflammation and systemic involvement. The management of RA has evolved over the years, with early diagnosis and rapid achievement of remission being the primary goals. In this prospective observational study conducted at the Department of Radio-diagnosis, Baroda Medical College and Hospitals, Vadodara, Gujarat, we aimed to evaluate the pathological involvement of hand and wrist joints in patients with rheumatoid arthritis using ultrasonography (USG) and color Doppler. A total of 32 diagnosed RA patients were included, and their clinico-pathological scores were assessed. The most common ultrasonographic finding in the examined wrist joints was joint synovitis, with the radio-carpal joint being the most frequently involved. Among the small joints of the hand, synovitis and erosions were commonly observed, with the second metacarpophalangeal joint showing the highest involvement. Comparison with clinical disease activity using the Disease Activity Score 28 (DAS-28) revealed that patients with higher DAS-28 scores had a higher incidence of pathological changes in hand and wrist joints on USG. The use of power Doppler ultrasound allowed for the monitoring of disease activity, with increased doppler signals observed in joints of patients with high disease activity. These findings were consistent with previous studies showing correlations between DAS-28 scores and ultrasound findings. Ultrasonography and color Doppler proved to be reliable tools for visualizing pathological processes in RA patients, with synovitis grading and power Doppler grading demonstrating good correlations with disease activity. In conclusion, ultrasonography and color Doppler can be valuable in assessing and monitoring rheumatoid arthritis, enabling early detection and accurate evaluation of joint involvement.

Abstract:Introduction: Congenital Talipes EquinoVarus/Clubfoot is a common structural congenital deformity affecting approximately 1 in 1000 live births. The choice of operative procedures for clubfoot management depends on factors such as patient age, rigidity of deformity, and severity. However, there is a lack of consensus regarding the optimal surgical approach, whether comprehensive release or minimal staged surgery. This study aims to evaluate the outcomes of percutaneous tendon release and posteromedial soft tissue release for the treatment of relapsed, neglected, syndromic, and postural clubfoot. The corrective casts applied are assessed using the Pirani scoring system, podography, radiological imaging, and functional evaluation based on Laaveg Ponseti and Cummings scores.
Material and Methods: This prospective observational study was conducted in the Department of Orthopaedics at Netaji Subhash Chandra Bose Medical College, Jabalpur, over an 18-month period. A total of 27 clubfoot patients with 33 affected feet, ranging from 6 months to 7 years old, were included after meeting the inclusion and exclusion criteria. Detailed history, examination, and required investigations were performed and recorded. Patients were treated accordingly and followed up at regular intervals. Data was collected, compiled, and analyzed using SPSS 22.0.
Results: The majority of participants (37%) were in the age group of 6-11 months, with males constituting the majority (66.7%). The study included patients with relapsed clubfeet (n=18) and neglected clubfeet (n=9). Right foot involvement was more prevalent than left foot involvement. Pre- and post-operative measurements showed significant associations between Pirani scores, talocalcaneal angles, tibiocalcaneal angles, and talocalcaneal indices. The mean change in Pirani score was 4.04, and podographic measurements demonstrated increased foot bimalleolar angles. Functional assessment using Laaveg Ponseti and Cumming’s Functional Score indicated good to excellent outcomes in the majority of participants.
Conclusion: Percutaneous tendon release surgery with corrective cast application is a safe, effective, and low-risk method for correcting relapsed clubfoot. Posteromedial soft tissue release, along with corrective cast application, remains the best option for neglected clubfoot, despite the potential risks of neurovascular and wound complications. These preliminary results, with an average follow-up of 1 year, suggest that soft tissue release surgery for neglected clubfoot and percutaneous tendon release for relapsed clubfoot, along with corrective casting in both methods, yield good to excellent outcomes.

Abstract:Gastric cancer, ranking as the fourth most prevalent cancer and the second leading cause of cancer-related deaths worldwide, poses a significant public health challenge with approximately 800,000 new cases and 650,000 deaths annually, with 60% of cases occurring in developing countries. Regions with the highest incidence rates, exceeding 40/100,000 in males, are Eastern Asia, the Andean regions of South America, and Eastern Europe. Incidence rates are notably higher among socio-economically disadvantaged groups and in developing countries. The aim of this study was to analyze the levels and ratios of pepsinogen-I and pepsinogen-II in gastric dysplasia and malignancy. Conducted at the Pathology Department of MGM Medical College and Maharaja Yashwantrao Hospital in Indore, Madhya Pradesh, the prospective study spanned one year from May 2020 to April 2021 and included a total of 30 cases diagnosed with gastric dysplasia and malignancy through endoscopy and histopathology. The results revealed a significant decrease in serum mean PG-I level and PG I/II ratio in patients with gastric cancer (P=0.00). Moreover, both the mean serum PG-I level and PG I/II ratio were lower in patients with gastric cancer compared to those with dysplastic lesions.

Abstract:Leukemia, the most common childhood cancer, is predominantly acute, with acute lymphoblastic leukemia (ALL) and acute myelogenous leukemia (AML) being the primary subtypes. The incidence rates for ALL and AML are 1.5 and 2.7 per 100,000 population, respectively. The objective of this study conducted at the Pathology department of M.G.M. Medical College in Indore was two-fold: firstly, to classify acute leukemia into ALL or AML using flow cytometry, and secondly, to assess the diagnostic value of specific markers (Anti-MPO, CD34, HLA-DR, CD45, CD79a, CD3) in acute leukemia diagnosis. The study involved evaluating cases through routine peripheral smear and subsequently analyzing relevant cases on a flow cytometer. The results revealed that 23 cases (77%) were diagnosed as ALL, while 7 cases (23%) were identified as AML. Among the ALL cases, 19 were classified as B-cell ALL (64%), whereas 4 were T-cell ALL (13%). In conclusion, the use of multicolor flow cytometry enables simultaneous assessment of multiple antigens, facilitating more precise categorization of cell populations. Furthermore, flow cytometry plays a crucial role in differentiating AML from ALL and its subtypes.

Abstract:Infertility, characterized by the failure to conceive after a year of regular unprotected sexual intercourse, affects a significant proportion of couples. Male factors contribute to approximately 40-50% of infertility cases, with around 2% of men exhibiting suboptimal sperm parameters. Semen analysis serves as the primary diagnostic tool for male infertility. Elevated levels of serum follicle-stimulating hormone (FSH) often indicate severe impairment of spermatogenesis. In contrast, inhibin B concentrations are closely associated with sperm concentration and testicular volume, making it a valuable marker for assessing spermatogenesis. This prospective study aimed to investigate the relationship between semen parameters and the levels of serum FSH and inhibin B. The study included 35 cases of male infertility, and their semen samples were subjected to microscopy and comprehensive analysis. Among the cases, 14.3% exhibited a sperm count of =5 million/ml, with a mean serum FSH level of (46.45 \(pm\) 2.68) and a mean serum inhibin B level of (4.34 \(pm\) 2.34). The results revealed a significant negative correlation between inhibin B levels and FSH concentrations (r = 0.919, p < 0.0001). Furthermore, a positive correlation was observed between sperm concentrations and inhibin B (r = 0.945, p < 0.0001), while a negative correlation existed between sperm concentrations and FSH levels (r = -0.980, p < 0.0001). These findings suggest that the degree of male infertility is directly proportional to elevated FSH levels and inversely proportional to serum inhibin B levels. Thus, serum inhibin B emerges as a more sensitive parameter for assessing male infertility.