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

Abstract:Background: Maternal deaths predominate (99%) in low- and middle-income nations. Postpartum haemorrhage, pre-eclampsia, and puerperal sepsis are identified as the three primary factors contributing to maternal mortality in the aforementioned regions. Various diagnostic criteria are employed to identify sepsis, with one of the frequently utilised criteria being the systematic inflammatory response syndrome (SIRS). Nevertheless, these criteria necessitate laboratory investigations that may not be viable in settings with limited resources. The objective of this study was to devise a model that utilises clinical indicators and risk factors to promptly detect sepsis in postpartum females.
Material and Methods: This is an observational study conducted in the Department of Obstetrics and Gynaecology, Gandhi Medical College, Bhopal, after institutional ethical committee approval, from January 2021 to June 2022. All antenatal and postnatal women (within 42 days of delivery) reporting to the emergency department in the Department of Obstetrics and Gynaecology, Gandhi Medical College, Bhopal were included. All antenatal and postnatal cases meeting 2 or more SIRS criteria at admission during the study period and willing to give written consent were included in the study. Patients who did not meet the SIRS criteria were excluded.
Results: Out of the total included patients, 450 (1.26%) was the total burden of sepsis. Sepsis among antenatal cases was 217 out of 18085, giving a burden of 1.19%. Sepsis among puerperal cases was 233 out of 17354, giving a burden of 1.34%. Unbooked cases had a higher sepsis score of > 6. A significant association was found between maternal outcome and SOS scores. 22 cases were transferred out to other departments (for needed medical interventions) and mortalities were seen in 6 mothers in the present study. Among the mothers who died, 5 had SOS scores of more than 6. Fetal outcome: In the present study, 361 were live births, 29 were stillbirths, and 9 were IUFD.
Conclusion: Sepsis now causes the most preventable maternal deaths worldwide. Prioritising maternal sepsis and septic shock tool development and validation. Early sepsis screening of high-risk obstetric patients uses the SOS score. Pregnancy-associated sepsis and complications have few emergency room scoring systems. This study confirmed the SOS score’s ability to distinguish severe pregnancy-associated sepsis. It may help prioritise and distribute critical care beds in low-resource countries due to high sepsis-related maternal morbidity and mortality. We strongly recommend further validation and demonstration of SOS efficacy in obstetric sepsis.

Abstract:Introduction: Subclinical hypothyroidism is described as a condition where the patients™ serum ft4 is within normal limit , but serum TSH level is raised . These patients have limited or no clinical features of hypothyroidism. It is to be mentioned here that clinical hypothyroidism is biochemically denoted as an elevated TSH level with a decreased serum fT4 level along with florid symptoms of hypothyroidism. There are numerous researches on how clinical hypothyroidism affects the respiratory system, but there are scanty numbers relating to subclinical hypothyroidism, which may also lead to remarkable deficits in lung function. Evaluation of the respiratory system in subclinical hypothyroidism is the prime target of this study . Spirometry was our method of choice here since it is less expensive, smoother, and more readily available than other respiratory function tests.
Aims and Objective: To measure the Expiratory Flow Volumes – FEV1, FVC, FEV1%, FVC%, FEV1:FVC% and rates- PEFR(L), PEFR%, \(FEF_{25-75}\) (L), \(FEF_{25-75}\) %, in subclinical hypothyroid patients and their correlation with serum TSH level and serum fT4 level.
Materials and Methods: The current study was a cross-sectional study with a case-control design conducted at the physiology department of a tertiary hospital situated in West Bengal surrounded by rural population. The selection of 100 subjects (50 cases and 50 controls) was based on age, BMI, inclusion and exclusion criteria. Serum TSH and fT4 levels were measured, and the pulmonary function tests were examined using the RMS Helios 401 Spirometer. The statistical study was conducted using Microsoft Office 2007’s SPSS-17 and Excel. The Student Independent T-test and the Pearson’s Two-Tailed Correlation Study were used for the analysis. The threshold for statistical significance was a P value of \(\leq 0.05\) and P value \(\leq 0.001\) was considered as statistically highly significant.
Results: The pulmonary function parameters in active control subjects and in subclinical hypothyroidism patients were measured by spirometry . It was noticed all the projected study parameters of pulmonary function test were lowered considerably in subclinical hypothyroidism in respect with the control group. The dissimilarities of the FVC, FVC%, FEV1, FEV1%, PEFR(L), PEFR%, FEV1/FVC, \(FEF_{25-75}\) (L) are statistically important (\(p \leq 0.05\)). In SCH , significant negative correlation persists between TSH and FVC(L), between TSH and FEV1(L) and between TSH and FEV1%. In SCH patients, FVC(L) , FVC%, FEV1% and PEFR(L) have significant correlation with fT4 value.
Conclusions: The present study depicts that subclinical hypothyroidism also may cause disorders of lung function along with disturbances of ventilation. Simple spirometry may be used to test patients for the widely prevalent subclinical hypothyroidism affecting a good number of common people. This will aid in prompt patient management.

Abstract:Background:  Alcohol is the most frequently misused substance on a global scale. Research has demonstrated that it can elicit detrimental impacts on nearly all bodily organ systems. A number of medical conditions can be ascribed to the direct impact of alcohol, while others may be indirect consequences stemming from nutritional inadequacies or susceptibility to injury. The consumption of alcohol has been linked to a range of cardiovascular disorders. Consequently, this study was conducted to investigate the Electrocardiographic and Echocardiographic abnormalities in asymptomatic chronic alcoholic patients.
Materials and Methods: The present study, an analytical cross-sectional investigation, was conducted between April 1st, 2021 and September 30th, 2022. The study population consisted of 150 individuals with chronic alcoholism, aged between 21 and 40 years, who had been consuming more than 80 grammes of alcohol per day for a period exceeding 5 years. The participants’ medical history was evaluated according to the definition of chronic alcoholism, and electrocardiography and echocardiography were employed as diagnostic tools. The study group excluded individuals with pre-existing conditions such as diabetes, hypertension, and cardiovascular disorders.
Results: Our study reveals that the incidence of cardiovascular abnormalities among individuals with chronic alcoholism is 37%. The predominant electrocardiogram (ECG) alterations observed are sinus tachycardia (18%) and non-specific ST-T changes (9%). The prevalent alterations observed in 2D ECHO were augmented thickness of the posterior wall (11%), succeeded by heightened thickness of the interventricular septum and diminished ejection fraction (<40%). The incidence of cardiovascular abnormalities is positively correlated with prolonged alcohol consumption and is also elevated in the elderly population.
Conclusions: The present investigation validates that a multitude of electrocardiographic and echocardiographic alterations manifest before the onset of symptomatic cardiac pathologies that are attributed to prolonged alcohol consumption, such as alcoholic cardiomyopathy.Early indicators of the ongoing effects of alcohol may be detected through non-invasive investigations such as Electrocardiography and Echocardiography. These indicators are likely reversible during the early stages but may progress to alcoholic dilated cardiomyopathy if left untreated.

Abstract:Introduction: Acute kidney injury is characterised by a sudden and potentially reversible deterioration in renal function, resulting in impaired elimination of nitrogenous waste products and compromised fluid and electrolyte homoeostasis. Variations in the definitions utilised, the demographic under scrutiny, and the healthcare environments can result in notable disparities in the epidemiological data pertaining to acute kidney injury.
Methods: This cross-sectional observational study was approved by the Institutional Ethics Committee in a tertiary-care teaching hospital located in a urban area. All individuals diagnosed with acute renal failure as defined by the RIFLE criteria were incorporated into the study. Individuals who were below the age of 18 were not included in the study. The enquiry comprised a comprehensive account of the patient’s medical background, a thorough physical examination, and a systemic evaluation. During the period of hospitalisation, patients were classified based on their RIFLE class, which includes R, I, or F. The classification of RIFLE is determined based on either the glomerular filtration rate (GFR) or urine output. Patients were categorised based on their serum creatinine levels and urine output.
Results: Out of the total of 100 cases of Acute Kidney Injury (AKI), 46% were female patients, whereas 54%) were male patients. The Mean age upon initial presentation was 55.22 \(\pm\) 14.91 years. AKI was determined to be primarily caused by sepsis. Among the sample of patients under investigation, 64% of the total, were identified as being associated with sepsis. The study observed a mortality rate of 40%.
Conclusion: Acute Kidney Injury is a prevalent complication observed in patients admitted to the Intensive Care Unit (ICU). The timely identification and management of acute kidney injury (AKI) in critically ill patients have been shown to decrease mortality rates associated with AKI and all-cause mortality.

Abstract:Background and Aim: The condition of infertility is recognised as a major healthcare concern across different communities. The issue’s significant prevalence has resulted in its intensified importance. Environmental conditions and acquired risk factors have been found to be associated with a substantial proportion of cases of infertility. Diverse environmental conditions have underscored the necessity to investigate the distinct aetiologies of infertility in various regions.
Objective: The aim of this study was to determine the frequency causes of infertility in infertile couples.
Materials and Methods: In this cross sectional descriptive study 340 infertile couples that were referred to infertility clinic of tertiary care hospital during study period, were examined. This centre is the only governmental centre for infertility. Information about the patients was obtained from medical examinations and laboratory findings. To analyze the data, descriptive statistics such as frequencies and the mean were used.
Results: Among the various causes of infertility women factors (88.6%) had the highest regard. In the causes of female infertility, menstrual disorders, diseases (obesity, thyroid diseases, and diabetes), The causes of infertility in the 340 couples were divided into four standard categories as follows: Female factor 58.7% , Male factor 28.2%, Combined causes 3%, Unexplained infertility 10.1%. The prevalence of primary and secondary female infertility was 70.5% and 29.5% respectively. Tubal cause account most in female infertility.among male sperm morphology was measure cause.
Conclusion: Urban Central India has a lower rate of primary infertility than developing nations. Healthcare professionals and policymakers must understand infertility incidence and risk factors to develop and implement various infertility prevention and management strategies.

Abstract:Background and Aim: Surgical site infections (SSIs) are common after laparotomy wounds and are associated with a significant economic burden. The use of negative pressure wound therapy (NPWT) has recently been broadened to closed surgical incisions.
Material and Methods: The Institutional Ethics Committee approved this single-center, parallel, randomised controlled trial, which followed the Declaration of Helsinki. If they were 18–65 year old , patients were eligible. All surgery patients undergoing abdominal surgery and closed abdominal surgical wounds who received negative pressure wound therapy or conventional therapy. Exclusion criteria included abdominal pathology re-explored or re-operated and inability to consent. Trial participants received an information leaflet and gave written consent.
Result: The primary objective to assess the relative risk of development of SSI in the ciNPWT, the relative risk of development SSI in CiNPWT group was found to be 0.69 and 1.44 in group with conventional dressing, thus CiNPWT was found to be protective for SSI in incisional wound. CiNPWT and conventional patients were mostly 31-60 years old. 84 patients (70%) were male, while 36 (30%) were female in the study cohort.NPWT reduced wound complications like soakage and dehiscence by 20% on the 14th day after surgery. A 0.013 p-value indicated statistical significance. NPWT reduced wound complications like soakage and dehiscence on the 21st day after surgery. The 18.33% reduction was statistically significant at 0.0134. Negative Pressure Wound Therapy (NPWT) reduced soakage and dehiscence by 10% in serial follow-ups on the 30th day post-surgery. The study revealed a negative correlation between the levels of Total Serum Protein and Serum Albumin and both wound healing duration and duration of hospital stay. Specifically, lower levels of total protein and albumin were associated with longer healing time and extended hospitalisation.
Conclusion: Surgical site infections are common, especially in high-risk patients. SSI costs hospitals a lot. SSI research is underway. This study used Negative Pressure Wound Therapy (NPWT) as a prophylactic dressing for closed incisional wounds in 60 patients and compared its efficacy to conventional dressings. Based on relative risk analysis, CiNPWT prevented SSI after one year. NPWT significantly reduced seroma formation. Negative Pressure Wound Therapy (NPWT) shortened wound healing and hospitalisation. Negative pressure wound therapy (NPWT) reduced wound complications like dehiscence, blistering, necrosis, and reoperation or rehospitalization. These findings were not statistically significant. NPWT reduced SSI.

Abstract:Introduction: In many Western countries, non-alcoholic fatty liver disease (NAFLD) is now surpassing viral hepatitis as the primary cause of chronic liver disease and hepatocellular carcinoma (HCC). In India, the current high burden of NAFLD is likely to rise further in the future. Given the significant prevalence of NAFLD in the community, identifying those at risk of developing liver disease is critical in order to simplify referral and advice effective management. Thus, the present study was carried out with the aim to diagnose Non-alcoholic fatty liver disease based on ultrasound and study its clinical profile in patients attending outpatient clinic and inpatients in a tertiary care hospital in Central India.
Material and Methods: This observational study was carried out in the Department of Medicine, Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur, after approval by Institutional Ethics Committee. 100 consented patients,>18 years of age presenting to the OPD and IPD of the hospital and suspected and later diagnosed as NAFLD were included in the study using a proforma, ultrasonography and investigations. Data was collected, compiled and analysed using SPSS 22.0 (trial version).
Results: 68%, 27%, 5% cases were diagnosed as grade I, grade II and grade III fatty liver respectively. The mean age was 47.07\(\pm\)11.95 years. Female preponderance was observed (55%). Abdominal pain (55%), fatigue (73%) and dyspepsia (48%) were the dominant symptoms. 51% patients had increased waist circumference (mean =87.06\(\pm\)10.46 cm). Mean BMI was 26.77+4.01 kg/m2. 46% were pre-obese and 15% were obese (BMI >30). Majority of Grade III fatty liver (60%) were diabetics. Mean values of impaired fasting blood sugar in grade I, II, III were 109.6\(\pm\)45.02, 117.52\(\pm\)56.93, 138.20 \(\pm\)53.31 mg/dl and when compared was statistically significant (p<0.05).29% patients had hypertension (\(\geq\)130/85 mmHg. 18% patients had high bilirubin levels. Deranged AST (46.48\(\pm\)27.30) and ALT (57.51\(\pm\)52.10) were found in greater percentage of patients (p value <0.001, <0.001 respectively) and had positive co-relation (r+0.36 and r+0.43). Hypercholesterolemia (>200mg/dl) was found in 46% patients. Mean cholesterol level in grade I, II and III was 192.71\(\pm\)43.43, 210.37\(\pm\)44.11 and 277.34\(\pm\)34.06; when compared it was found to be statistically significant (p< 0.01) with positive co-relation (r+0.39).Hypertriglyceridemia (>150mg/dl) was present in 60% cases. The mean triglyceride level in grade I, II and III was 160.46\(\pm\)51.28, 211.00\(\pm\)111.432 and 240.14\(\pm\)174.111 mg/dl respectively and when compared was statistically significant (p<0.05) with positive co-relation (r+0.29). Low HDL was present in 71% of patients. HDL cholesterol had a negative co-relation (r-0.17). In the present study mean LDL was 119.66+31.11 mg/dl and elevated LDL (>130mg/dl) was found in 29% of patients. Elevated VLDL was seen in 36% of patients with mean of 30.496+10.33 mg/dl.
Conclusion: Non-alcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease in both the developed and developing worlds. It is emerging as a major public health problem. The present study throws light on the clinical spectrum of the disease. Early detection and treatment is of utmost importance in preventing this disease from emerging as a new epidemic globally.

Abstract:Background: Metabolic syndrome is characterized by abnormalities in blood pressure, blood sugar, waist circumference, and cholesterol or triglyceride levels.
Aim: The unique aspect of this study is its primary focus on determining whether there is a distinction in inflammatory markers between individuals with metabolic syndrome and those without the condition.
Material and Methods: The study included 50 patients with metabolic syndrome and 50 healthy controls. The research was conducted at Indore Index Medical College & Research Centre. After obtaining approval, the study’s researchers commenced their work. Each subject provided informed consent prior to the study. Individuals with type 1 diabetes or clinical symptoms for fewer than five years and documented T2DM duration were excluded. Healthy controls (non-metabolic syndrome) were individuals without diabetes, multivitamin use, or comorbidities.
Statistical analysis: Regressions were used to determine the relationship between two variables. Additionally, percentages were calculated. A significance level of \(p < 0.05\) was considered significant.
Conclusion: The significance of these results cannot be overstated. The study’s findings unequivocally demonstrate that both pro-inflammatory and anti-inflammatory cytokines contribute to the development of secondary illnesses associated with metabolic syndrome.

Abstract:Background and Aim: Corrosive gastric strictures may require more frequent dilations compared to peptic ulcer-related strictures. Strictures occurring at the distal gastric site may necessitate sufficient dilatation to prevent obstructive symptoms, but this comes with an increased risk of perforation. The aim of the study was to determine the mean duration between corrosive consumption and the development of gastric stricture.
Material and Methods: The present study analyzed data collected from patients admitted to the surgical unit of Medical College & associated hospital following corrosive ingestion. Clinical data, including a history of difficulty in swallowing, cough with expectoration, difficulty in breathing, abdominal pain, abdominal distension, vomiting, and fever, were collected. Barium swallows were performed to assess and locate the stricture site in the stomach and assess the distal flow. Intraoperative findings of corrosive strictures and the nature of the performed surgery were analyzed. Barium meal studies were conducted for all patients to locate the level of stricture in the stomach, identify associated esophageal strictures, and detect coexisting trachea-esophageal fistulas.
Results: A total of 24 patients who met the inclusion and exclusion criteria were included in the study. Among the 24 patients, 6 had hyponatremia, 5 had type I strictures, 3 had type VII strictures, and 2 had type IV strictures with hyponatremia. Type I strictures were observed in 4 patients, 1 patient had type VII, and 1 patient each had other types of strictures with hypokalemia. Hypokalemia was present in 8 patients with type I strictures, 3 with type VII, and 1 each with type IIa, type IIb, type III, and type IV strictures. Arcade-preserving antrectomy was performed in 6 patients. One patient had type IIa corrosive gastric stricture and was managed with stricturoplasty. Two patients with type IIb corrosive gastric strictures were treated with Pylorus Preserving Antrectomy. Two patients had type III corrosive gastric strictures, and they underwent circumferential sleeve resection and gastro-gastrostomy.
Conclusion: Adequate preoperative nutritional optimization and evaluation to assess the extent of injury can significantly reduce the morbidity and mortality associated with gastric corrosive strictures.

Abstract:Vitamin D is a crucial fat-soluble vitamin with various functions. Its deficiency is widespread and affects individuals of all age groups. This study aimed to determine the prevalence of Vitamin D deficiency in different age groups and genders within the East Nimar region. A total of 236 participants were included, and their Vitamin D levels were measured using a Mindray CL-900i Chemiluminescence Immunoassay Analyzer. The results were stratified by age groups and gender. Among the 236 individuals, 47.9% were males and 52.1% were females. The study revealed that 86.4% of the subjects had insufficient or deficient levels of Vitamin D, while only 13.6% had sufficient levels. Specifically, 33.5% of the cases had Vitamin D deficiency, and 57.2% had Vitamin D insufficiency. Vitamin D deficiency was observed in 51.80% of individuals with higher sun exposure and 75% of those with lower exposure. Among supplement users, 45.2% had Vitamin D deficiency, whereas among non-users, the rate was 69.58%. The findings underscore the high prevalence of Vitamin D deficiency in India. Considering the inadequate dietary intake of Vitamin D in the Indian population, measures such as food fortification, Vitamin D supplementation, and exposure to sunlight (especially in the morning) are crucial to address this issue and prevent the complications associated with Vitamin D deficiency.