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

Abstract:Background: Breast cancer is the most common malignancy among women worldwide. According to the GLOBOCAN 2020 estimates of cancer incidence and mortality, female breast cancer has surpassed lung cancer and is now the most commonly diagnosed cancer, with an estimated 2.3 million new cases. In India, breast cancer has moved from being the fourth most common cancer in the 1990s to the first. The prevalence of established hormonal and reproductive risk factors is higher in Western countries, but these risk factors are not commonly observed in the rural population of India. Therefore, it is important to study the probable risk factors in our population, including the potential role of obesity, especially in postmenopausal women, in the development of breast cancer.
Aim and Objectives: The aim of our study is to determine the demographic profile of breast cancer patients and identify any associated risk factors for breast cancer in this population.
Methods: This analytical cross-sectional study was conducted at Alluri Sita Rama Raju Academy of Medical Sciences (ASRAM) over a period of one year from March 2021 to February 2022. We included 72 patients with histologically proven breast carcinoma who attended the Oncology OPD and met the inclusion criteria.
Results: In our study, approximately 86% of breast cancer patients had a body mass index (BMI) greater than 23. Obesity is known to be associated with increased estrogen levels, which can be a risk factor for hormonal-dependent breast cancer. Among the study group, 52% were luminal positive, 25% were triple negative, and 22.2% were HER2 neu positive.
Conclusion: Our study found that approximately 86% of breast cancer patients were obese. The association between BMI and breast cancer needs to be further studied in randomized control trials. Furthermore, reproductive and hormonal risk factors were not significantly observed in our population group.

Abstract:Background and Aims: Ventilator associated pneumonia (VAP) develops after more than 48 hours of mechanical ventilation. VAP is the leading cause of death among hospital acquired infection and prolongs time spent on the ventilator, length of intensive care unit (ICU) stay and length of hospital stay after discharge from the ICU. The concept of ‘bundles’ which can be defined as groups of evidence based interventions when, performed together, improve outcome. Hence this study was undertaken to assess the incidence of VAP and effectiveness of Bundle to prevent VAP.
Methods: This study was conducted in two phases. Pre-interventional phase (Phase-1) is done for three months by observing the current practices in mechanically ventilated patents and assessing the incidence of VAP. Then in post-interventional phase is conducted for three months by applying the bundle care approach, educating the interns, staff nurses and contact care givers regarding the quality improvement project and then assessing the incidence of VAP.
Results: Total 40 patients were involved in the study with 20 patients in each trial. The incidence of VAP was more in pre-interventional trial and the VAP incidence was reduced in post-interventional trial after implementing bundle care.
Conclusions: VAP prevention can be achieved to a large extent with the use of Bundle care approach .However, a major limitation is the lack of adherence to the set protocols by the health care professional especially in developing countries like India where the still the Patient to Nurse ratio is poor and overworked doctors . But one of the way to improve is by educating them through targeted training and using checklist which will help to improve adherence and ultimately patient outcome.

Abstract:Objective: The objective of this study was to compare the effects of single intra-articular platelet-rich plasma (PRP) and corticosteroid (CS) injections in patients diagnosed with adhesive capsulitis of the shoulder.
Design: Patients between the ages of 30-70 years, of either sex, diagnosed with adhesive capsulitis of the shoulder with a duration of less than 6 months, were included. In the intra-articular corticosteroid (IA-CS, control) group, 30 patients received a single injection of IA-CS (2 ml), while in the IA-PRP (test) group, 30 patients received a single IA-PRP injection (2 ml) into the glenohumeral joint under ultrasound guidance. All patients were prospectively followed for 24 weeks.
Results: Thirty patients in the IA-PRP group and thirty in the IA-CS group completed the entire 24-week study period. At 24 weeks, a decrease in QUICK DASH score was observed in the IA-PRP group (16) compared to the IA-CS group (33). In terms of range of movement, the IA-PRP group showed significant improvement in abduction, internal rotation, and external rotation compared to the IA-CS group. No major complications were observed in any patients.
Conclusions: At the 24-week follow-up, a single dose of IA-PRP injection was found to be more effective than an IA-CS injection in improving pain, disability, and shoulder range of motion in patients with adhesive capsulitis of the shoulder.

Abstract:Overview: Cancer poses a significant global threat\({}^{1}\). Lymph nodal metastasis is a crucial prognostic factor, and its detection presents a challenge for pathologists.
Aims: The aims of this study are as follows: to determine the common sites affected by metastatic lymphadenopathy, to evaluate the effectiveness of the cell block technique in preserving cell morphology compared to conventional fine needle aspiration (FNA) samples, to assess the preservation of immunohistochemical properties using the cell block technique, and to determine the role of immunohistochemistry in cell block preparations of malignant breast neoplasms for making a final diagnosis.\\
Materials and Methods: Immunohistochemistry using AE1 and AE3 markers was performed on sections made from cell blocks obtained through the fine needle aspiration technique. Cell block preparation involved a mixture of 9 parts ethyl alcohol and 1 part 10% formalin, followed by hematoxylin and eosin staining. Two pathologists independently analyzed H&E-stained smears and immunocytochemistry results, and the findings were calculated.
Results: In the present study, pan CK positivity was observed in 31 out of 48 cases, of which 25 were squamous cell carcinomas, 2 were suspicious for malignancy, and 2 were other cases.
Conclusion: The use of Pan CK (AE1/AE3) markers demonstrated a significant percentage of positivity in identifying squamous differentiation. This panel of markers, along with others, can be employed for epithelial differentiation and can assist in neoadjuvant therapy and patient care.

Abstract:The objective of this study was to compare the outcomes of repairing Tetralogy of Fallot (TOF) using two different techniques: trans-annular patch alone versus pulmonary valve cusp augmentation (Sung technique) with pericardium. A total of sixty TOF patients underwent successful surgical repair using either the traditional trans-annular patch or Sung’s technique. Parameters such as postoperative use of inotropes, duration of recovery, and residual pulmonary insufficiency (PI) were compared between the two groups. The results showed that the age, weight, pulmonary valve annulus diameter, and Nakata index were similar in both groups. The mean aortic clamp time and median cardiopulmonary bypass time were also comparable. However, the patients who underwent Sung’s repair had a lesser requirement for inotropes and faster recovery compared to the trans-annular patch group. Postoperative 2D echocardiography revealed a lower incidence of moderate or more pulmonary insufficiency in patients who underwent Sung’s pulmonary valve augmentoplasty. Based on these findings, it was concluded that the augmentation of the pulmonary valve cusp reduces the occurrence of clinically significant postoperative pulmonary insufficiency. Therefore, this technique may improve the early outcome for patients with TOF who require a trans-annular patch.

Abstract:The global elderly population is rapidly increasing, and India has the second-largest population of elderly people. The elderly population in India has increased from 5.6% in 1961 to 7.7% in 2001. Depressive disorders are prevalent among the elderly population, with estimates ranging from 10% to 20% depending on cultural factors. Studies conducted in India have found that the point prevalence of depressive disorders among the elderly population varies between 13% and 25%. Despite India being the second-most populous country, elderly depression is not yet recognized as a public health problem. The present study aimed to investigate the prevalence of depressive features among individuals aged 60 years and above attending the psychiatric outpatient department (OPD) of a tertiary care teaching hospital. A cross-sectional design was used, and convenient sampling was employed to select a sample of 206 participants. The Beck Depression Inventory was used to assess the prevalence of depressive characteristics. The results of the study indicate that the majority of participants (56%) belonged to the age group of 66 to 70 years, and 52% were male. Hindus accounted for 68% of the participants in terms of religion. In terms of education, 28% were illiterate, and 43% had only primary education. Additionally, 49.5% of the participants were unemployed. The Depression Score revealed that 50% of the participants suffered from moderate depression, while 3.9% of the participants suffered from major depression. The results of the study indicate that depression is prevalent among the elderly population in India and is a significant public health problem that needs to be prioritized by the Indian healthcare system. Further research is needed to identify the factors contributing to the prevalence of depression among the elderly population in India. This will inform the development of effective interventions and strategies to improve mental health in the elderly population. It is essential to recognize elderly depression as a public health problem and develop appropriate policies and interventions to improve the quality of life of the elderly population in India.

Abstract:The physical and psychological well-being of individuals are significantly influenced by their oral health, impacting growth, appearance, speech, chewing, taste, and socialization. Dental caries are a major public health issue, particularly among children and adolescents, with high prevalence rates reported. This study focused on the age group of 11-15 years from a Government high school, with a final sample size of 120 participants. Data were collected using a pre-designed and semi-structured questionnaire, which included components such as socio-demographic profile, an oral cavity examination, awareness about oral hygiene and dental caries, and the frequency of toothache. The study revealed that 29.1% and 19% of the participants had good and poor health of teeth, respectively, while 34.1% and 15.8% had good and poor gum health status. Toothache was reported as a frequent complaint by 28.3% of the participants, occasionally by 52.5%, rarely by 9.1%, and never by 10%. Pain or trouble with teeth was the reason for visiting a dentist for 26.6% of the participants, and 51.66% visited a dentist for follow-up treatment. Consumption of sugar-associated food items such as biscuits, cakes, cream cakes, sweet pies, etc. several times a day was reported by 71.6% of the participants. The study also found that the educational status of mothers was significantly associated with the dental and oral health of their children, with those having uneducated mothers having average and poor dental and oral health. Most of the participants had average gum and teeth health and cleaned their teeth only once a day. None of the participants visited a dentist for a routine check-up of teeth, and a substantial number of participants missed their activities due to toothache. In conclusion, this study highlights the importance of oral health in physical and psychological well-being and the need for awareness and education about oral hygiene and dental caries, particularly among children and adolescents. It also emphasizes the significance of regular dental check-ups and avoiding the consumption of sugar-associated food items to maintain good oral health.

Abstract:This cross-sectional analytical study aimed to investigate the possible association between extended high-frequency hearing and mastoid pneumatization. A total of 206 patients were involved in the study, and a statistically significant difference was found that the patients with higher mean mastoid volume had a response to that particular frequency when compared to patients with lesser mean mastoid volume in both the right and left ear. However, there was no statistically significant association between various age groups and responses and between gender and responses at all frequencies. The study concludes that there is a correlation between mastoid pneumatization and extended high-frequency hearing.

Abstract:This study aimed to compare the efficacy of Midazolam and Dexmedetomidine as premedication agents in pediatric patients administered via the intranasal route. 100 children in ASA physical status I and II, aged 2-8 years, planned for surgery under general anesthesia, were randomly assigned to Group D, which received 1 mcg/kg of Intranasal dexmedetomidine, or Group M, which received 0.2 mcg/kg of Intranasal midazolam for premedication. The patients’ sedation status, separation anxiety, and mask acceptance were evaluated using UMSS, PSAS, and MAS, respectively, along with hemodynamic parameters and side effects. The mean sedation score was higher in Group D than Group M, and the mean parental separation anxiety score and mean mask acceptance score were also higher in Group D than Group M. All hemodynamic parameters were comparable and stable in both groups. In conclusion, intranasal dexmedetomidine was found to provide better sedation, relieve preoperative anxiety, make parental separation easier, and promote better mask acceptance, without any significant side effects.

Abstract:The study aimed to compare the analgesic efficacy of USG-guided versus landmark-based transversus abdominis plane (TAP) block using 0.25% bupivacaine in abdominal surgeries. A total of 100 patients undergoing elective abdominal surgery were included in the study, with 50 patients receiving USG-guided TAP block and the other 50 patients receiving landmark-guided TAP block. The patients were evaluated post-operatively for up to 24 hours for their VAS score, amount of analgesic required, and time for the first rescue analgesia. The results showed that the USG-guided TAP block group had a significant decrease in pain at 4 and 8 hours following surgery compared to the landmark group, with a lower total analgesic demand in the postoperative period. The study concluded that USG-guided TAP block is an efficient and safe addition to multimodal post-surgical analgesia compared to landmark-guided block. The study was conducted at the Department of Anesthesiology of the M. G. M. Medical College and M. Y. Hospital in Indore, Madhya Pradesh, and was approved by the Institutional Ethical and Scientific Review Committee.