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

Abstract:Purpose: Early prediction of the non-union tibia by the RUST score (Radiographic union score for tibia fracture) at three months postoperatively. That will help with early detection of non-union, intervene to treat the non-union and help get back to normal daily life.
Materials and method: Systematic search was done in an electronic database (Google Scholar, PubMed , Chochrane library ) for articles published till 5th January 2022 investigating RUST score as a predictor for non union tibia . The new castle Ottowa scale (NOS) was used to determine risk of bias for each study.
Result: The search turned up 81 records. The final sample included three trials ( 2 cohorts and 1 case control study) involving 510 patients. Statistical analysis showed that if RUST score is >6 at 3rd month then there is 7.12 times more chance for union( OR -7.12, 95% CI-4.06 to 12.49). This meta analysis suggests that the RUST score at 3rd month has the potential to provide an early prediction of tibial non-union. Radiographic union scale in tibial fracture (RUST), the Newcastle ottowa scale (NOS), fracture tibia, non-union, intramedullary interlocking nail.

Abstract:Context: The high risk HPV 16 and 18 are known to be associated with some cancers of UADT, particularly oropharynx. These are more commonly seen in young patients, predominantly in male without known risk factors like smoking and alcoholism. Clinically they present with small or occult primary tumor with advanced neck disease. These patients are sensitive to radiotherapy and have better prognosis than conventional keratinizing SCC. The p16 is a surrogate marker for detection HPV.
Aims: To detect the frequency of p16 positivity in UADT cancer and correlate p16 positivity with the clinical presentation, histological type and grade of UADT cancers.
Methods and Material: Observational study conducted from January 2016 to June 2017 on all the newly diagnosed cases of primary UADT cancer confirmed by histopathological examination. Tissue biopsies were processed, 5 micron sections were stained with H and E and 3 micron sections were subjected for p16 IHC. The collected data was entered in Excel sheet and analyzed using Microsoft Excel software for percentages and proportions.
Results: The UADT cancer study subjects showed 37.2% positivity for p16. They were in the age group of 41 to 50 years, most of them were male. Majority of p16 positive UADT cancer study subjects were non smokers, non alcoholics and were not chewing betel nuts. Common site of involvement is oropharynx.
Conclusions: Analysis of our result with review of literature showed significant comparable p16 positivity with oropharyngeal cancers. The p16 immunohistochemistry is a surrogate marker for detection of HPV.

Abstract:Background and Aims: Diastolic dysfunction is the commoncondition with Subclinical Hypothyroidism and is reversible inmany cases after treatment. We aimed to investigate the responseof diastolic dysfunction to thyroid hormone replacement therapyin patients of Subclinical Hypothyroidism.
Methods: 100 newly diagnosed cases of SubclinicalHypothyroidism (78 females and 22 males) and age more than 18years were included. Diagnosis was made on the basis of history,clinical examination and thyroid function tests. Echocardiographywas performed in all and was repeated after 4-6 months inthose who had diastolic dysfunction. Distribution of Diastolicdysfunction among the involved cases and their response totreatment with L-thyroxine were studied.
Results: Out of 100 patients included in the study, 78 patients were female and 22 patients were males. Out of 78 female patients, 28 patients had grade-1 diastolic dysfunction and 50 patients did not have diastolic dysfunction. Out of 22 male patients, 08 patients had grade-1 diastolic dysfunction and 14 patients did not have diastolic dysfunction. With replacement therapy, 28 reverted backto the normal whereas one having grade 2 diastolic dysfunction(pseudonormal pattern) reverted to grade 1. One patient whohad grade 1 diastolic dysfunction (impaired relaxation) did notimprove. Pericardial effusion subsided in all 5 cases.
Conclusions: Echocardiography may be a useful tool formonitoring the response of diastolic dysfunction to thyroid hormonereplacement therapy in patients with Subclinical Hypothyroidism. Our findings suggest that Thyroid Hormone Replacement Therapymay reverse diastolic dysfunction in Subclinical Hypothyroidism.

Abstract:Background: To study the outcome and safety of various day care surgeries in a tertiary care hospital, Jorhat.
Method: A prospective study was conducted on patients who underwent various day care surgeries at Jorhat Medical College & Hospital from August 2021 to July 2021. Patients between 18 to 65 years of age were included in the study. Patients underwent various surgeries and were discharged within 24 hours after surgery as day care surgery. Patients were followed on day 3, day 7 and day 30 for complication/ readmission.
Results: 51 patients underwent day care surgeries. Among the 51 patients, 14 (27%) were males and 37 (73%) were females. Patients were between the age of 18- 65 years with a mean age of 36.75 years. All patients were discharged between 7 – 23 hours after surgery. Most patients (n=20, 39.2%) were discharged at 22 hours after surgery. Procedures done during the study period includes Laparoscopic Cholecystectomy (n=34, 66.6%), Excision (n=14, 27.4%), Circumcision (n=1, 1.9%), Hernioplasty (n=1, 1.9%) and diagnostic laparoscopy (n=1, 1.9%). During follow up at 3rd day, 7th day and 30th day, 3 presented with complications and 1 patient needed readmission. There was no mortality during the study period.
Conclusion: Day care surgery in a tertiary care hospital of Jorhat is safe with low complications and zero mortality rate in well selected patients.

Abstract:Background: To identify and address the factors which lead to ulceration in patients with chronic venous disease is essential to prevent progression of disease. Obesity is one such controversial factor. The aim of our study was to assess the influence of body mass index on the development of ulceration in patients with venous disease. We also analysed other risk factors that might lead to progression of disease to ulceration.
Aim and objectives: The aim of this study is to evaluate the impact of Body Mass Index on the occurrence of ulceration in venous disease patients.
Methods: This prospective case-control study was carried out at ASRAM Medical College, Eluru, AP in the general surgery department. Every patient who participated in the trial had a venous duplex that was documented as having venous insufficiency. A comparison of 130 cases with venous ulcers that were either active or healed and 130 controls without ulcers was conducted. A survey was given out to examine the variables affecting the likelihood of acquiring an ulcer. The clinical class of venous illness was identified after a clinical evaluation of the patients. Using standardised equipment, the patient’s height, weight, and body mass index(BMI) were measured.
Results: The study’s sample’s mean BMI was 29.04 pounds. 260 individuals were enrolled, and 38.8% of them were obese and another 38.8% were overweight. Inactive or healed ulcers were present in 45.5% of the obese patients. Patients with recurrent ulcers made up 77.8% of the population and were either overweight or obese. However, there was no statistically significant difference when comparing the body mass index between the cases and controls. A strong connection between ulceration in venous disease and older age, male gender, deep vein thrombosis, and prolonged durations of standing was discovered by multivariate analysis.
Conclusion: According to our study, there is no connection between body mass index and ulceration in venous disease patients. Venous ulceration is linked to advanced age, male gender, deep vein thrombosis, and periods of extended standing. However, the researchers did take into account the likelihood that overweight individuals may have a different pathophysiology of venous illness, and as a result, they concluded that venous duplex alone might not be a sufficient diagnostic tool for selecting obese patients for subsequent trials. In order to establish obesity as a risk factor for ulcers, we suggest that additional research be conducted in this area and that obese individuals in the control group be monitored to see if they experience ulcers in the future.

Abstract:Background: Acute pancreatitis is a very common disorder with a substantial burden on the healthcare system. Acute pancreatitis includes a wide spectrum of diseases varying from mild self-limiting symptoms to fulminant multi-organ failure and high mortality. Serum amylase and serum lipase, which are used for diagnosing acute pancreatitis, are relatively less sensitive and specific and give a lot of false positive or false negative values. Based on the immune-chromatographic method, the urinary trypsinogen-2 dipstick test is proposed to be a rapid method for diagnosing acute pancreatitis at the earliest.
Aim of the study: 1. To know the usefulness of urine trypsinogen-2 in accurately diagnosing acute pancreatitis 2. To compare the diagnostic role of urine trypsinogen-2 with that of serum amylase, serum lipase, and imaging studies in acute pancreatitis.
Materials and Methodology: 100 Patients presenting with acute upper abdominal symptoms like pain, vomiting, and abdominal distention, admitted to the emergency department of our hospital from January 2021 to January 2022, are enrolled in the study. Urine samples were obtained from all the patients and tested with Spot Urine trypsinogen-2 dipstick. Serum amylase and serum lipase tests were also simultaneously done in these patients. If required, patients are also evaluated with (USG) abdomen and (CECT) abdomen. The final diagnosis of acute pancreatitis is based on the clinical picture, serum amylase more than the threefold rise, and radiological findings. Urine trypsinogen-2 dipstick tests were compared with serum amylase, serum lipase, and imaging studies in patients with a final diagnosis of acute pancreatitis.
Results: Sensitivity of amylase and lipase was found to be 73.77% and 59.02%, respectively, whereas the sensitivity of trypsinogen was found to be 78.69%. The specificity of amylase and lipase was found to be 89.74% and 89.74%, respectively, whereas the specificity of trypsinogen was found to be 92.1%. Analyzing the data, it is found that the sensitivity and specificity of trypsinogen are higher than the routine investigations. Even though it has a low range of sensitivity, its high specificity ensures that the test can be used as a screening test to check the true negative cases.
Conclusion: 1. The urine Trypsinogen-2 dipstick test is a simple, rapid, easy, and noninvasive test that can diagnose or rule out most cases of acute pancreatitis. 2. Urine Trypsinogen-2 estimation does not require laboratory facilities. It is undertaken almost instantaneously (within 5 minutes) as opposed to serum amylase and lipase, results for which may require an hour to get back to the physician. 3. The urinary trypsinogen-2 test could be used as a screening test for acute pancreatitis. 4. Modification of the cutoff point of this assay increases the specificity to the point where it can be used for diagnosis. Qualitative rapid urine trypsinogen-2 test strip is easy to perform. Moreover, it is a reliable and useful screening test for acute pancreatitis in daily practice, particularly in healthcare units lacking laboratory facilities.

Abstract:Background: Sickle cell anaemia is a genetic abnormality involving the haemoglobin. Patients present with a wide spectrum of disorders because of a single-point mutation in which thymine substitutes for adenine, thereby encoding valine instead of glutamine in the sixth position of the beta-chain. The repeated sickling and unsickling damage the red cell membrane leading to irreversibly sickled red cell even when the oxygen pressure is increased.
Methodology: Patients admitted in the Medicine department of tertiary care center from December 2020 to December 2022 with sickle cell anaemia were included in the study. Sample size taken for this study was 100 patients. Predesigned and pretested questionnaire was used to record the necessary information.
Result: In this study, association of LVH and severe anemia in sickle cell patients was not statistically significant(P >0.05) Association between anaemia and pulmonary artery hypertension in sickle cell patients was found to be statistically significant.
Conclusion: Most common electrocardiographic finding was sinus tachycardia followed by T-inversions. Most common echocardiographic changes were pulmonary hypertension.

Abstract:Background: The thyroid gland is the largest gland among all endocrine glands. It secretes active hormones (T3 and T4, Calcitonin) influencing various metabolic processes. Diseases of the thyroid include developmental, inflammatory, hyperplastic and neoplastic disorders. The present work is an attempt to study the histopathological details of various thyroid lesions, to analyze them and to correlate them with clinical data.
Aim and Objectives: To study frequency and histopathology of non-neoplastic and neoplastic lesions of thyroid.
Material and Methods: The present study, ‘Histopathological study of Lesions of Thyroid’, was undertaken at Histopathology section of Department of Pathology, Government Medical College, Miraj, Maharashtra. The study was of 3 years duration from January 2013 to December 2015. The material was obtained by different surgical procedures such as total thyroidectomy, near total thyroidectomy, hemithyroidectomy, lobectomy and excision of cyst. Tissue samples for H\&E sections were fixed in 10% formalin and subjected to routine paraffin embedded processing after which this was then stained with Haematoxylin and Eosin. The thyroid lesions are classified into of non-neoplastic and neoplastic lesions on the basis of the World Health Organization histological classification of the thyroid tumours.
Results: In our study, Out of total 104 cases of thyroid lesions, there were 93 (89.42%) non neoplastic and 11 (10.58%) neoplastic lesions. The most frequently encountered specimen was hemithyroidectomy (58.65%), followed by near total thyroidectomy (22.12%). Out of total cases of 104 thyroid lesions, a maximum number of lesions were seen in patients in the age group of 31-40 years. Thyroid lesions predominantly seen in females with female to male ratio of 6.4:1 for all thyroid lesions Out of total 104 cases of thyroid lesions, there were 93 (89.42%) non neoplastic and 11 (10.58%) neoplastic lesions. Goiter was the most common lesion, which accounted for 80 cases (76.92%) of all the cases followed by thyroglossal cyst 07 cases(6.73%), follicular adenoma 07 cases (6.73%) and Hashimoto’s thyroiditis 06 cases (5.76%). The benign tumors were more common (72.73%) than malignant tumors (27.27%).
Conclusion: In our study, thyroid lesions showed a female predominance with most of them occurring in the age group of 31-40 years and most common thyroid lesions were non-neoplastic. Diagnosis by histopathological examination is important for the correct diagnosis and treatment of neoplastic lesions.

Abstract:Background: Coronavirus Disease 2019 (COVID-19) is characterized by high fever, sudden developing respiratory distress. The Purpose of this study is to identify the association of D-dimer levels and lymphocyte counts with poor prognosis and to predict the clinical course in patients with COVID-19.
Methods: A Total of 85 hospitalized children diagnosed with COVID 19 were included in the study. According to AIIMS guidelines, they were divided into two groups, one with severe disease (N=23) and other with non-severe disease which included mild to moderate cases (n=62), distinctive performance analysis of these values were performed and the cut off values were determined.
Results: A total of 85 hospitalized patients with COVID-19 were included in the final analysis. The mean age was 10 \(\pm\) 5 years and 45 (52.9%) were males. Lymphocyte count was found as statistically significantly low (p <0.001) while D-dimer level was statistically significantly higher in the group with severe disease (p <0.001). As for the effectiveness of lymphocyte count in distinguishing severe and non-severe patients with COVID-19 when cut-off score 1500/mm3 was taken, sensitivity was 30% and specificity was 77% and that of D-dimer when cut-off score 2 mg/L was taken, sensitivity was 22% and specificity was 50%. D-dimer level was found to have a significant discrimination power (AUC = 0.879, p < 0.0001,95% CI).
Conclusions: The lymphocyte value of \(\leq 1500/mm3\) and D-dimer value of \(\geq 2mg/L\) can be used in the early determination of patients with poor prognosis in COVID-19. Using these cut-off values for D-dimer and lymphocyte count will help predict prognosis and make rapid treatment decisions in patients with COVID-19.

Abstract:Background: Nutritional anemia is the commonest type of anemia in India, especially in rural areas. Patients with hemoglobin below 6 gm/dl usually require transfusion therapy. In stabilized patients with hemoglobin values between 6 and 10 gm/dl, the decision to transfuse is based on an evaluation of clinical status. Patients with values above 10 gm/dl rarely require transfusion. Initially, whole blood was transfused due to the activity of 2,3 DPG. However, now it is replaced by packed red cells after the advent of proper refrigeration, component separation method, and anticoagulants, especially additive solution SAGM and polyvinyl chloride blood bags.
Aims: 1) To know the efficacy of packed red cell transfusion in symptomatic nutritional anemia patients. 2) If there is a failure of improvement following packed red cells transfusion, the underlying cause of anemia will be evaluated, which may influence the outcome of the transfusion.
Materials and Methods: The present study comprised 110 nutritional anemia patients who received packed red cell transfusion in Sri Manakula Vinayagar Medical College and Hospital. Data were collected for eight months. A thorough clinical examination and history were taken for all 110 patients, and hematological parameters were collected from the automated cell counter.
Results: In the present study, 110 patients with nutritional anemia who underwent packed red cell transfusion were taken. Out of which, 90 patients had features of only iron deficiency anemia, and 20 had features of anemia of combined deficiency (iron, vitamin B12, and folic acid). Iron deficiency anemia is more prevalent in the third and fourth decades. Anemia of combined deficiency in the sixth and seventh decade. Conclusion: Packed red cell transfusions are reserved for anemia patients whose organs (brain, heart) are being deprived of oxygen due to severe anemia and for people whose hemoglobin or hematocrit level is very low. In chronic anemia, there are increases in the content of 2,3-DPG in the red blood cells, with a shift towards the right in the hemoglobin dissociation curve in the cardiac output and respiratory rate. Hence transfusion is rarely indicated. The mean increase in Hb and PCV values in nutritional anemia patients was statistically more significant (p value<0.05). Hence Hb and PCV can be valuable tools in post-transfusion clinical assessment.