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

Abstract:Preoperative anxiety is a common occurrence in patients undergoing surgery, and it can lead to a range of negative effects, including an increased requirement for anesthetic agents, hemodynamic instability, and delayed recovery. Melatonin has been shown to have an anxiolytic and hypnotic effect with fewer side effects. This study aimed to explore the potential of oral melatonin to reduce preoperative anxiety levels and the dose requirement of propofol for the induction of general anesthesia. The study included 150 patients who were equally divided into two groups: Group M and Group C. Group M received oral melatonin 6mg and vitamin B complex tablets, while Group C received a sip of water and vitamin B complex tablets 90 minutes before the surgery. Anxiety levels were measured using the VAS score preoperatively and 90 minutes after drug administration. Propofol was given until the BIS value was sustained for 1 min at 48\(\pm\), and the total dose was measured in both groups. Postoperative pain was assessed using the VAS score just after extubation and every hour for the next 4 hours, with Inj. Diclofenac given if the score was \(\geq\)4. The time of first rescue analgesia was noted. Results showed that Group M had a significantly reduced VAS score and required a lower dose of propofol for induction compared to Group C (p\(\leq\)0.0001). The time of first rescue analgesia was also prolonged in Group M compared to Group C (p\(\leq\)0.0001). Therefore, oral melatonin is an effective premedicant that reduces preoperative anxiety, the required induction dose of propofol, and provides postoperative analgesia.

Abstract:This prospective observational study aimed to assess the role of transvaginal ultrasound (TVS) in diagnosing the cause of abnormal uterine bleeding (AUB) and characterizing benign and malignant lesions. 130 patients were included and underwent TVS and histopathological examination. TVS showed sensitivity of 59%, specificity of 93%, positive predictive value of 81%, negative predictive value of 82%, and accuracy of 58% for diagnosing malignant lesions. The study provided TVS imaging features for early identification, characterization, and extent of uterine pathologies, as well as relevant information for clinicians to make reasonable decisions. TVS is a good primary imaging modality due to its non-invasiveness, low cost, and wide availability.

Abstract:Introduction: Cytomegalovirus (CMV), a double-stranded DNA virus belongs to a family called herpesviridae or human herpesviruses (HHVs). CMV is spread by direct contact with infectious body fluids such as nasal secretions, saliva, tears, urine, genital secretion or breast milk. After contamination, the virus initially replicates in the epithelial cells at the site of entry, followed by hematogenous spread to numerous organs and cell types.
Aims: to estimate prevalence of CMV in a population of male partners of infertile couples attending a tertiary care hospital of Kolkata and also to determine the impact of CMV infection on sperm parameters.
Materials and method: The proposed study is an observational and descriptive study of cross-sectional study was conducted in department of Physiology, R.G. Kar Medical College & Hospital, Kolkata. The study period was One year January 2021 – January 2022. 56 patients were included in this study.
Result: We showed that, lower number of patients had Normal Morphology in with Cytomegalovirus [4 (100.0%)] this was not statistically significant (p=0.6895). Association of Addiction with Cytomegalovirus was statistically significant (p=0.0059) and Infertility DX with Cytomegalovirus was not statistically significant (p=0.6088). It was found that, higher number of patients had Height in without Needed Mechanical Ventilation [29 (65.9%)] compared to with Needed Mechanical Ventilation [4 (44.4%)] It was not statistically significant (p=0.0504).
Conclusion: we concluded that cytomegalovirus was associated with in male partner of infertile couple and its impact on seminal analysis a tertiary care hospital.

Abstract:Background: Advances in all fields of oncology have resulted in five-year survival rate approaching 80% among pediatric /AYA survivors which has led to increased focus on psychosocial relationship care, identification of late effects and improving quality of life. For this growing population of cancer survivors with a whole life ahead of them, more concrete support structures have been directed towards the evaluation and improvement of post-treatment care. Medical care complemented with non-medical (psychosocial relationship) care increases awareness with respect to many psychosocial relationship aspects such as educational, employment, post treatment distress and coping which need to be addressed for the survivor to lead a normal productive life. Recent studies have shown that regular psychosocial relationship follow ups have resulted in timely identification of late effects followed by appropriate rehabilitation services being provided to survivors.
Method: The study is based on project PICASSO (partnership in cancer survivorship optimization) initiated by Indian Cancer Society which aims at providing holistic care for childhood cancer survivors. The qualitative analysis was performed by using the quality-of-life scale (WHOQoL-BREF). Non probability purpose sampling pediatric/AYA oncology survivors were taken from the act clinic and potential survivors participated who have completed the treatment till June 2022. (n=100).
Results: The Significant difference is seen between ACT and non-ACT survivors as far as psychological well-being health and physical health domain is considered and insignificant difference is seen as far as social relationship and environment wellbeing is considered.
Conclusion: The Study revealed that ACT survivors have good psychological well-being and physical health then non-ACT survivor.

Abstract:Introduction: The frontotemporal type is characterised by a pterional sutural configuration between the frontal and temporal bones. The stellate kind of suture is formed by the fusion of the flat sphenoid, frontal, parietal, and temporal bones.
Methods: The kind of pterion based on sutural pattern was determined using Murphy’s classification into sphenoparietal, frontoparietal, stellate, and epipteric kinds on both the left and right sides of each skull. The centre of the circle, which connects the four bones that make up the pterion, is thought to be the centre of the pterion. Distance between the pterion’s centre and the external auditory meatus’s anterosuperior margin, P-PM: the distance between the pterion’s centre and the lateral margin of the optic canal, P-AM.
Results: The current investigation was carried out using 115 dried adult skull bones that were gathered from the central Karnataka region. On the right side, there were 115 pterions, and on the left, there were 115. The most frequent type of pterion was sphenoparietal (82.1%), followed by epipteric (26.1%), stellate (18.6%), and frontotemporal (17.8%).
Conclusions: The findings of this study may be useful for forensic pathologists, neurosurgeons, anatomists, and anthropologists in the region of the population under study.

Abstract:Background: Severe acute malnourishment (SAM) is a significant public health problem in India and many developing countries. The World Health Organization (WHO) defines – Severe acute malnutrition (SAM) as very low weight-for-height or a mid-upper arm circumference (MUAC) of less than 115 mm or the presence of nutritional edema. According to the most recent NFHS-5 survey (2019- 2021) covering 36 states and union territories (UTs), the prevalence remains at an alarming 7.7%. Malnutrition slows down the myelination process, thus preventing the increase in the calibre of myelinated nerve fibres. Motor nerve conduction, auditory evoked potential and visual evoked potential changes caused by severe acute malnutrition can be evaluated clinically and electrophysiologically. These changes are produced mainly due to a deficiency of micro and macronutrients like vitamins, minerals, protein, fat & Carbohydrates.
Aim: Severe acute malnutrition affects the myelination and growth of the central and peripheral nervous systems. This study aimed to assess the effects of severe acute malnutrition on peripheral motor median and ulnar nerve conduction, auditory evoked potential and visual evoked potential in children.
Materials & Methods: The study group included 50 severely acute malnourished children (SAM) of 6 – 59 months of age, recruited from SMTU, J.A. Group of the Hospital, G.R.M.C. Gwalior (M.P.), based on WHO classification for severe acute malnutrition. The Control group consisted of 50 normally nourished healthy children of the same age group. The case-control study period was extended from January 2021 to December 2021. Ethical clearance from the Institutes and written informed consent were taken from the parents/guardians of SAM patients. The family, immunization, birth, metabolic, endocrinal disorder, and history of neuromuscular disease were taken in detail. The study was performed using the four-channel RMS – EMG EP MARK- II. The electrophysiological parameters were evaluated for velocity, distal latency, and amplitudes. Results were analyzed statistically using the unpaired student’s t-test.
Results: This study showed decreased motor nerve conduction velocity ( p < 0.05 ) and delayed distal latencies in the median and ulnar motor nerves of both upper limbs in children with severe acute (SAM) malnutrition. There were significant differences in the mean latencies of the waves I to V and the mean interpeak latencies (IPLs) of the waves I-III and I-V on the right and left ears between the study and control groups (P < 0.05). We observed significant alteration in mean latencies of wave p 100 in VEP.
Conclusion: The present study shows a statistically significant alteration in electrophysiological parameters in children with severe acute malnutrition. This may be due to nutritional deficiency affecting the myelination of peripheral nd central nerves depending on the duration and severity of malnutrition.

Abstract:Background: Diabetic foot ulcer (DFU) is a major complication of Diabetes Mellitus. The International Working Group on Diabetic Foot defines DFU as a “full-thickness lesion of the skin distal to the malleoli in a person with Diabetes Mellitus”.
Objective: The objective of this study was to evaluate the clinico-microbial profile of patients with diabetic foot ulcers and the pattern of antimicrobial susceptibility.
Methods: This hospital-based, prospective observational study was conducted among patients with diabetic foot ulcers in the Department of General Surgery at Era’s Lucknow Medical College \& Hospital, Lucknow, after taking written informed consent.
Results: Pseudomonas was found in 39 (18.2%) cases, coagulase-negative Staph aureus was found in 23 (10.7%) cases, Acinetobacter was found in 80 (37.3%) cases, E. coli was found in 56 (26.1%) cases, Proteus spp was found in 13 (6%) cases, Staph aureus was found in 23 (10.7%) cases, Acetobacter was found in 1 (0.46%) case, and Enterococcus was found in 2 (0.93%) cases. A single organism was involved in 48 (47.1%) cases, while multiple organisms were involved in 54 (52.9%) cases in our study. In our study, 83 (81.3%) cases were gram-negative and 11 (10.7%) cases were gram-positive.
Conclusions: According to microbial culture, Pseudomonas, Klebsiella, E. coli, and coagulase-negative Staph aureus were the most commonly found organisms in diabetic foot ulcers. These findings suggest that appropriate management of diabetic foot ulcers should involve selecting an appropriate antimicrobial agent based on microbial culture and susceptibility testing.

Abstract:Non-healing ulcers can cause significant health problems and impair quality of life. Standard treatment procedures have been found to be ineffective in curing such lesions. Autologous platelet-rich fibrin matrix (PRFM) has been cited in many research papers as an effective treatment for non-healing ulcers. This study aims to evaluate the efficacy of PRFM in treating chronic non-healing ulcers. A prospective study was conducted in patients with trophic ulcers due to Hansen’s disease or diabetes mellitus, traumatic ulcers, and venous ulcers, aged between 18-85 years. PRFM was applied to healthy ulcers at weekly intervals, repeated for a maximum of five sittings as per requirement. Photographs were taken before treatment and at every subsequent sitting, and area and volume were calculated at baseline and every subsequent sitting until closure was achieved. The results of the study will help to determine the efficacy, feasibility, and cost-effectiveness of PRFM in the treatment of non-healing ulcers.

Abstract:Breast tuberculosis (TB) is a rare form of extrapulmonary tubercular infection. The clinical presentations, diagnostic difficulties and therapeutic approach of breast TB are not well understood. This study aimed to review the nonspecific clinical presentations, diagnostic difficulties and therapeutic approach of breast TB. Sixteen female patients diagnosed with breast TB between 2016 and 2019 were retrospectively reviewed. The mean age of the patients was 36.4 years, and the most common complaints were breast mass and pain. While 31.2% of the cases had a physical examination with suspicions for malignancy, 43.5% of the patients had Breast Imaging Reporting and Data System (BIRADS) 3 lesions that suggested malignancy radiologically. Definitive diagnosis was based on histopathologic examination through core needle biopsy, excisional biopsy, and open biopsy taken from the abscess wall during drainage. All patients were treated with standard anti-TB therapy for 6 months. Thirteen patients recovered with standard therapy, while extended treatment for 9 to12 months was needed in 3 (18.8%) cases. Surgery was carried out in 6 cases, and 2 patients developed recurrence. Breast TB can be easily confused with breast cancer, suppurative abscess, and other causes of granulomatous mastitis, both clinically and radiologically. A multidisciplinary approach is required to prevent diagnostic delays and unnecessary surgical interventions. Although anti-TB therapy is the mainstay treatment of breast TB, surgery is usually indicated in patients refractory to medical treatment.

Abstract:Background: Ventral hernias of the abdomen are defined as a non-inguinal, non-hiatal defect in the fascia of the abdominal wall. Annually, there are about 350,000 ventral hernia operations. The repair of these abdominal wall defects is a common surgery performed by general surgeons. Common causes of acquired ventral hernias include previous surgery causing an incisional hernia, trauma, and repetitive stress on naturally weak points of the abdominal wall. These naturally occurring weak points in the abdominal wall include the umbilicus, semilunar line, ostomy sites. Obesity is a large component of hernias as well because it stretches the fascia of the abdomen causing it to weaken. While repair of ventral hernias with mesh is considered routine, there is no consensus on the best location to place the mesh. Hence, this study aims to compare the outcome of the onlay versus sublay mesh repair for treatment of ventral hernias.
Materials and methods: All subjects undergoing onlay and sublay mesh repair for ventral hernias will be evaluated intraoperatively for duration of surgery and postoperatively for complications like surgical site infections, seroma formation, flap necrosis, duration of hospital stay and recurrence. To find the significance in categorical data Chi-Square test was used.
Aim of the study and objectives: To compare the duration of surgery and postoperative complications of sublay and onlay meshplasty in the treatment of ventral hernias.
Results: Out of 50 patient’s majority were female29 (58%) and belong to the age group of 46-55 yrs (32%). The most common diagnosis among them is supraumbilical hernia (52%). The duration of surgery for sublay group is longer about 117.4 min whereas it about 92.52 min in onlay group. Seroma formation, Surgical site infection, Flap Necrosis in 20%, 16% and 16% patients respectively in onlay mesh repair group and in 4%, 4% and nil patients respectively in sublay mesh repair group. Duration of Hospital Stay was 5 days in onlay group in comparison to 4 days in sublay group. Recurrence was seen in 8% patients in onlay group whereas it was encountered 4% in the sublay mesh repair group.
Conclusion: Sublay mesh repair is a good alternative to onlay mesh repair that may be applicable to all forms of ventral hernia as the mesh related overall complication rate like seroma, surgical site infections, flap necrosis, hospital stay and recurrence are less compared to onlay meshplasty.