Volume 3 (2023) – Special Issue – Recent developments of medical and surgical research

Abstract:Background: During the second wave of COVID-19 starting in January 2021, an increase in Mucormycosis infection was recorded in various Indian states. With the aim of identifying the contribution or relationship of covid 19 infection in the incidence, severity and treatment outcomes of Mucormycosis during the pandemic, this retrospective observational research study was conducted.
Method: 113 people with rhino orbital Mucormycosis were included in the retrospective observational investigation. Based off the past medical records, basic demographic information was gathered. In order to evaluate the association between covid 19 infection and Mucormycosis, patient histories of COVID infection, steroid usage during therapy, and oxygen consumption were collected. Positive RTPCR and/or Positive Rapid antigen tests were used to diagnose active covid positive status. Using a nasal swab/tissue KOH mount, nasal endoscopy with biopsy, and radiographic tests to determine the extent, the diagnosis of Mucormycosis infection was established. A multidisciplinary strategy was used to handle the patients in collaboration with the departments of medicine, ophthalmology, neurosurgery, and OMFS. Individuals with uncontrolled diabetes received insulin and/or oral medications, and BSL was aggressively managed. Each patient received 3 to 5 mg/kg body weight/day of intravenous amphotericin B, adjusted according to renal function, medication availability, and the severity of the illness. Individuals who underwent endoscopic debridement using a modified Denker’s technique or medial maxillectomy had disease that was restricted to the nose and paranasal sinuses but did not affect the palate or orbit. Whole maxillectomy was performed on patients who had palatal involvement. Most individuals with orbital involvement underwent a limited procedure for orbital decompression or rarely an exenteration/evisceration procedure.
Results: Out of 113 patients, 26 (23%) had a Covid positive status at the point they were initially assessed, 56 (49.55%) had confirmed prior h/o covid infection, 31 (27.4%) had no proven h/o covid 19 infection, and 62 (54%) had h/o usage of steroids to treat their covid infection. Of of the 113 patients, 90 patients underwent combination medicinal and surgical therapy, which comprised of administering injectable Amphotericin B and performing endoscopic endonasal debridement of the afflicted areas. 23 patients (20%) were left unoperated, largely as a result of problems arising from active COVID-19 infection (15 patients, 13%) or severe cerebral involvement (6 patients), as well as the refusal of two patients undergo surgery. Out of the 113 patients who received treatment, 24 (21.23%) died from the disease, leaving 89 (78.76%) surviving. Of the survivors, 27 (23.89%) had some form of disability at the end of the treatment period (in form of cranial nerve palsies, permanent loss of vision, palatal perforations and in 1 case a patient had an open left maxillary and nasal cavity which was referred to plastic surgeon for revision surgery and rehabilitation and 62 patients (54.86%) healed fully without any sequelae. Those who received combination therapy, which included both surgery and IV amphotericin, fared far better (84 in 90 survived 93%) than those who had only IV amphotericin B therapy (5 in 23 survived 22%).
Conclusion: Covid positive status was linked to higher disease severity, increased morbidity, and increased mortality after therapy. There were several individuals with Mucormycosis who had no prior history of COVID. Increased mortality was linked to uncontrolled diabetes, Rhino orbital cerebral expansion, and concurrent covid positive status. Our study shows that invasive Mucormycosis can have a positive clinical result with immediate vigorous surgical debridement and antifungal drug administration.

Abstract:Introduction: Hypertensive disorders in pregnancy lead to placental immaturity and uteroplacental under-perfusion, resulting in increased production of beta-hCG hormone. The aim of this research is to compare beta-hCG levels after the 20th week of pregnancy between normotensive and hypertensive pregnant women in order to assess its predictive value for hypertensive conditions during pregnancy.
Material and Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Govt. Medical College, Srinagar over a period of 18 months (January 2021 to July 2022). One hundred patients fulfilling the selection criteria were included in the study and divided into two groups (cases and controls). The data was collected in Excel Sheets and analyzed using SPSS v20.
Results: A total of 109 patients were included in our study, out of which 9 patients were lost to follow-up and were omitted from the study. Among the 100 patients, 50 were cases and 50 were controls based on the inclusion and exclusion criteria. In our study, mean systolic and diastolic blood pressure, mean gestational age, mean beta hCG, and proteinuria were statistically significant. However, mean beta hCG values based on PIH (Pregnancy-Induced Hypertension) severity and mean age were statistically insignificant.
Conclusion: In our study, we concluded that hypertensive pregnant women have abnormally elevated beta hCG levels.

Abstract:We present a rare case of a 27-year-old woman with a complete hydatidiform mole, which is an abnormal pregnancy that typically causes vaginal bleeding and elevated serum \(\beta\)-human chorionic gonadotrophin (hCG) levels. However, this patient had a 36-week size uterus, severe anemia, and vaginal bleeding, but with a non-detectable \(\beta\)-hCG level, likely due to the “hook effect.” She also had chronic pancreatitis, with a dilated hepatobiliary system and free fluid in the pelvis, caused by the enlarged uterus compressing the abdominal organs. The patient received blood transfusions and was treated with dilation, evacuation, and serial monitoring of serum \(\beta\)-hCG levels. It is important to note that a negative urine pregnancy test or non-detectable \(\beta\)-hCG level should be followed up with a repeat measurement on a diluted sample to avoid the “hook effect.”

Abstract:Background: We aimed to study the influence of low dose dexmedetomidine as an adjuvant on hemodynamic parameters and recovery profile of patients maintained on desflurane for sitting position intracranial tumor surgeries.
Method: 60 ASA class I to III patients undergoing elective sitting position intracranial tumor surgery were randomized to receive either Dexmedetomidine infusion at the rate of 0.25 \(\mu\)g/kg/hr (Group D) or normal saline infusion (Group C) from the time patient was taken on table and continued till the end of dura closure. Monitoring done for hemodynamic changes, minimum alveolar concentration, BIS, recovery endpoints and adverse events.
Result: The heart rate was comparable in both the groups at baseline and decreased significantly in patients of Group D. The mean MAC in patients of Group C was high. The Bispectral Index values decreased significantly in patients of Group C as compared to Group D till the end of the study. The recovery endpoints parameters were significantly lower in patients of Group D as compared to patients of Group C. Ramsay Sedation Score was significantly lower in Group D compared to Group C from the time of discontinuation of anesthesia delivery till the end of 120 mins. This difference was statistically significant as per Student t-test (p<0.05).
Conclusion: Dexmedetomidine infusion started in low dose before surgery maintains hemodynamic stability intraoperatively, reduces the amount of anaesthetic drug required for induction, decreases the requirement of analgesic drug without any residual sedation.

Abstract: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.

Abstract: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.

Abstract: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.

Abstract:Background: Incisional hernia (IH) is a frequent complication of open abdominal surgery. Patients with Incisional hernia present with symptoms such as pain, discomfort, limitation of routine activities, skin problems, strangulation of hernia content etc. It is one of the most frequent long-term complications of abdominal surgery and it continues to be a significant problem for patients as well as surgeon.
Methodology: The study was conducted at R. G. Kar Medical College & Hospital; Department of General Surgery. 50 elective patients having ventral hernia who have undergone conventional open ventral hernioplasty were included in the study. All the patients were given a Questionnaire initially in the pre-operative stage and subsequently in the 1st and 7th post-operative day and later on during 1st month and 6th months of post-operative follow up.

Abstract:Background: MRSA is one of the leading causes of infections among hospitalized patients. The present study was conducted to know the prevalence of nasal colonization of MRSA in hospitalized patients.
Methodology:

Abstract:Background: Currently measuring the preoperative size of the ACL tibial footprint. Length on sagittal MRI view is measured as the most anterior and most posterior portion of the ACL tibial attachment. To have an accurate measurement for the size of an ACL footprint, the ability to accurately identify the insertion site on MRI is important.
Methodology: 20 patients with ACL tear were included in the study.
Results: The mean age of the study participants was found to be 29.35+6.507 years. The mean weight of the study participants was found to be 75.55+12.84. The mean pre-op Tibial footprint of the study participants was found to be 12.54+2.24. The mean intra-op Tibial footprint of the study participants was found to be 12.87+1.53. The correlation was found to be statistically significant between the pre-op findings and the intra-op findings.
Conclusion: Tibial foot print length measured preoperatively on MRI can be used as a strong predictor for actual tibial length which can be helpful for prior planning of ACL reconstruction to improve the outcome.