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

Abstract:Background: Peri-puberty is a critical period between 10-16 years of age, during which various environmental factors, such as family, peer group, school, and community characteristics, contribute to adolescent health and risk behaviors. The present study aimed to determine the prevalence of hypertension, anemia, and malnutrition in school children of the peri-pubertal age group, along with associated social factors.
Material and Methods: This single-center, cross-sectional study was conducted in school children from standard 7th to 9th who were present during the survey. They underwent history taking, anthropometric measurements, and clinical examination.
Results: The study included 300 school children aged 12-14 years. Most of the children were 14 years old (39.33%), boys (83%), and from socioeconomic class IV (50.67%). Of the total, 185 (61.67%) children were underweight, 85 (28.33%) were normal, 21 (7%) were overweight, and 9 (3%) were obese. Among the children, 32 (10.67%) had hypertension, with diastolic hypertension being more prevalent (19, 6.33%) than systolic hypertension (13, 4.33%). The prevalence of hypertension in girls (13.72%) was higher than in boys (10%). HTN was found more in obese children (5, 55.6%), followed by overweight children (7, 33.33%), normal children (14, 16.5%), and lastly underweight children (6, 3.2%). A total of 123 (41%) children were anemic, and the prevalence of anemia was insignificantly higher in girls (43.13%) than in boys (40.56%) (p-value=0.36, not significant). Out of 133 (44.33%) malnourished children, boys (46.18%) were more prevalent than girls (35.29%). Among 215 malnourished children, 104 (34.67%) children were anemic, and out of 85 well-nourished children, 19 (6.33%) were anemic.
Conclusion: The prevalence of hypertension was higher in children from higher socioeconomic status, obese and overweight children. Anaemia was more common in undernourished children.

Abstract: Background: Down syndrome is a genetic disorder caused by the presence of an extra copy of chromosome 21. It is characterized by intellectual disability, developmental delays, and physical features such as a flattened face, short neck, and small head and ears. Previous research has suggested that having a sibling with Down syndrome may have a positive impact on children, as they may develop richer family values, warmth, kindness, and empathy. However, research on the needs and perceptions of siblings with Down syndrome in the Indian population is limited. Therefore, this study aims to assess the feelings and perceived impact among siblings of children with Down syndrome.
Methodology: From September 2015 to August 2016, 40 siblings of children with Down syndrome were recruited for this study, after obtaining written informed consent from both parents and siblings. Socio-demographic details were collected, and the siblings were interviewed using the “feeling and perceived impact questionnaire scale” to assess their feelings and perceived impact. Each sibling was interviewed only once.
Results: The majority of siblings, across all ages, expressed feelings of love or fondness towards their siblings with Down syndrome. A minority of siblings reported feeling sad or sorry for their sibling with Down syndrome. The majority of younger siblings enjoyed helping their sibling with Down syndrome learn new things.
Conclusion: The findings suggest that having a sibling with Down syndrome does not negatively impact the feelings or perceptions of siblings. Rather, siblings express positive emotions towards their brothers and sisters with Down syndrome, and enjoy helping them learn and grow. This study adds to the limited literature on the perceptions and needs of siblings of children with Down syndrome in the Indian population.

Abstract: Background: Hoarseness of voice is a common manifestation of structural or functional anomalies affecting the glottis. A detailed examination is necessary to ensure accurate diagnosis and management. Patients from rural areas often present with the condition at a later stage, emphasizing the need for creating awareness to facilitate early diagnosis and treatment. Indirect or video laryngoscopy (IDL/VDL) is the preferred method for evaluating hoarseness.

Abstract: Background: Pilon fractures are complex fractures of the lower limb in adults that can be managed by various modalities, including open reduction and internal fixation (ORIF), external fixation, and conservative management.
Materials and Methodology: In this study, 30 patients with pilon fractures were treated with external fixation at a tertiary care center. The patients were followed up for 12 months, and their functional outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle and Hindfoot Score.
Results: The results showed that the use of external fixation led to a significant improvement in functional outcome in patients with pilon fractures, including range of motion, pain, and anatomical reduction.
Conclusion: External fixation is a less invasive and less time-consuming surgical modality for the treatment of pilon fractures. This technique has a favourable functional outcome and can be considered as an effective option for managing this complex fracture in adults.

Abstract: Background: Proximal humerus fractures are one of the most common fractures of the upper limb in older individuals and can be managed by multiple modalities, from ORIF to K-wire fixation, and can even be managed conservatively.
Materials and Methodology: Thirty patients with proximal humerus fractures were treated with K-wire fixation at a tertiary care center and followed up for six months to evaluate the functional outcome using the Neer scoring system.
Results: The patients who underwent K-wire fixation had a significant functional outcome in terms of range of motion, pain relief, and anatomical reduction.
Conclusion: K-wire fixation is a simpler, less invasive, and less time-consuming surgical modality of treatment with a favorable functional outcome for proximal humerus fractures.

Abstract: Background: Oral squamous cell carcinoma is a carcinoma with squamous differentiation arising from the mucosal epithelium. The pathogenesis of oral cancers is multifactorial. P53, guardian of the genome regulates cell cycle progression, DNA repair, cellular senescence and apoptosis. Ki-67 is a cell cycle associated nuclear protein used as a proliferation marker to measure the growth fraction of cells in human tumours.
Aims and Objectives: To compare demographic factors like age, sex and predisposing factors. To evaluate grade of differentiation, expression of p53, Ki67 and their comparison in various grades of differentiation in oral squamous cell carcinomas.
Materials and Methods: This study comprises of 35 cases of oral squamous cell carcinoma After processing of representative tissue block, H\&E and IHC stain with Ki-67 and p53 immunomarkers were carried out.
Results: Out of 35 cases of oral squamous cell carcinoma,20(57%) were well differentiated, 14(40%) moderately differentiated, 1(3%) was poorly differentiated. The age range was 26-85 years. Sex ratio was 2:1. The most common risk factor for development of cancer was found to be smoking (57%) followed by betel quid chewing (43%). The most common clinical presentation was non healing ulcer (80%). Sensitivity of Ki67 and P53 is 100% and 63% respectively.
Conclusion: P53 positivity was demonstrated in majority of cases indicating that it is most common genetic mutations in oral cancers. The present study showed an inverse correlation between the degree of tumour differentiation and the rate of cell proliferation obtained by the expression of Ki-67.

Abstract: Background: Thoracic epidural analgesia (TEA) remains a critical tool for anaesthesiologists to use in acute pain management. Present study was aimed to investigate the analgesic effect of buprenorphine and fentanyl as adjuvant with bupivacaine in thoracic epidural anaesthesia in patients undergoing open cholecystectomy.
Material and Methods: Present study was prospective, randomized, blinded study, conducted patients 18-50 years, of either sex, ASA physical status I and II, posted for elective open cholecystectomy under thoracic epidural anaesthesia. The patients were randomly allocated into 2 groups, A (buprenorphine) or B (fentanyl) of 30 each.
Results: Onset of analgesia in group A was 5.97 min while that of group B is 5.43 min at T10 level. There was no difference in the onset of analgesia between the two groups. Mean duration of analgesia of group A is 701.53 min while that of group B is 477.17 min, which is statistically significant with p value <0.0001. So, duration of analgesia is higher in buprenorphine compared to fentanyl as an adjuvant with bupivacaine in thoracic epidural anaesthesia. Mean two segment regression time of group A is 129.96 min while that of group B is 120.7 min, which is statistically significant with p value 0.0057. VAS is statistically significant in group B at 6th ,12th and 20th hrs. In the Group A, 20 % patients show nausea and 10% shows vomiting, while in the group B, 10% complained of nausea and 36.67% complained of pruritus.
Conclusion: Open cholecystectomy cases can be done under thoracic epidural anaesthesia with 0.5% bupivacaine and buprenorphine or fentanyl as an adjuvant. Buprenorphine having prolong duration of analgesia can be better than fentanyl even in postoperative period.