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

Abstract:Background: Fistula-in-ano is a tract connecting the anal canal to the perianal skin. It is a complication of anorectal sepsis in approximately 25% of patients within 6 months of the incidence. Alternatively, a nonsurgical cost efficient treatment with Ksharasutra (cotton Seton coated has minimal complications).
Objectives: To compare the outcome of Seton treatment using ksharasutra and Conventional fistula surgery (fistulotomy).
Methods: It was a prospective observational study. 96 patients were selected for these studies who were admitted for fistula repair Between November 2016 to December 2021 in R.G kar medical College \& Rampurhat Government Medical College. Patients coming at outpatient department of surgery with the complaint of persistent perianal discharge with or without pain were examined by per rectal digital examination and those with perianal fistula were included in the study.
Results: out of 96 patients, 50 were selected in the study group who were treated with ksharasutra and 46 patients were selected in the control group in whom fistulotomy was done. Study was male preponderance (87%). Out of 96 patients 86 were male and 10 were female. Most (84 out of 96) belong to 20-39 year age group. There were 10 cases of high anal fistula in the study group while the number was 9 in the control group. The mean duration of healing was 53.00 \(\pm\) 26.75 days in medicated Ksharasutra group whereas in fistulotomy group, mean duration of healing was 35.67 \(\pm\) 9.17 days. Ksharasutra group required significantly (P = 0.02) more number of days for healing.
Conclusion: The application of Ksharasutra is a better option not only because it is cost effective but also due to lesser postoperative complications.

Abstract:Background: GBS is an acute-onset, monophasic immune-mediated disorder of the peripheral nervous system that often follows an antecedent infection.
Objectives: To assess the factors (clinical, investigatory tools, and therapies) that may affect the outcome of patients with GBS.
Methods: This is an analytical observational study that was conducted at Tertiary care Hospital including thirty patients with the diagnosis of GBS in the duration from May 2018 to December 2021 after the patients or their relatives signed an informed consent. Included patients from both genders aged from 16 to 70 years old who were diagnosed as GBS within two weeks from onset of neurologic symptoms, depending on the history, clinical examination and investigatory tools. Hughes scales was used for outcomes. SPSS (Version 22.0).
Results: the study was female preponderance as compared to males (60%). Mean age was 36.18 years and the most common age group was found to be 16-39 years (70%). 26 patients (85%) had preceding respiratory tract infection, 4 patients (15.0%) had preceding gastrointestinal tract infection. The Pattern of weakness was ascending in 26 patients (85%) and descending in 4 patients (15%). there was no statistically significant difference found between both groups regarding gender and age of the study population. But it was noticed that patients with age ranging from 16 to 39 years showed significantly good or favorable prognosis compared to those with age ranging from 40 – 59 or \(\geq\)60 years. There was no significant difference between both groups regarding infection preceding illness, the pattern of weakness either ascending or descending and the nature of first symptoms. As regards the treatments received during period of admission, 20 patients (50.0%) received plasma exchange sessions, 4 patients (20.0%) received IVIG only and 6 patients (30.0%) received plasma exchange session then followed by IVIG due to unsatisfactory response after sessions.
Conclusion: Ascending pattern of weakness was more common than descending pattern in this study population and was not related to prognosis. High Hughes score at admission was associated with poor outcome at 8 weeks.

Abstract:Background: Diabetes mellitus (DM) is a metabolic disorder that has reached epidemic proportions, with India being designated as the diabetic capital. It is a chronic disorder that can lead to many microvascular and macrovascular complications. Vitamin D deficiency has been linked to insulin resistance and impaired insulin secretion. This study aimed to assess the levels of Vitamin D in Type-2 diabetes mellitus and its correlation with microvascular complications and glycemic control.
Methodology: The study was conducted at the Department of General Medicine, SCB Medical College Hospital, Cuttack, Odisha. A total of 50 patients with type 2 diabetes, who were admitted to SCB Medical College hospital, were randomly selected after obtaining informed consent. The detailed medical history was collected through clinical examination and necessary laboratory tests were conducted. Two groups were formed, comprising diabetes patients in group I and healthy subjects in group II.
Results: Of the total 50 cases in group I, 31 (62%) were male and 19 (38%) were female, and in group II, 10 (50%) were male and 10 (50%) were female. The mean level of 25 OH vitamin D was 17.09 \(\pm\) 1.36 ng/ml in group I. Out of 50 subjects, 98% were vitamin D deficient, i.e., < 20 ng/ml, 2% were insufficient, and none were sufficient. The mean 25 OH vitamin D level in group II was 18.29 \(\pm\) 1.36 ng/ml. Out of 20 controls, 18 (90%) were vitamin D deficient i.e., < 20 ng/ml, and 2 (10%) controls were vitamin D insufficient.
Discussion: This study found that the mean level of vitamin D3 in diabetes patients was 17.09 \(\pm\) 1.36 ng/ml compared to the control group. The correlation coefficient between vitamin D level and fasting blood sugar, postprandial blood sugar, and HbA1c was statistically significant, with retinopathy and neuropathy significantly associated with hypovitaminosis.
Conclusion: Given the enormous social and economic costs of type 2 diabetes and its devastating complications, there is an urgent need to develop effective strategies for curbing the epidemic through prevention and early treatment. Further interventional studies may be required to determine the recommended daily allowances of vitamin D.

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: Fever with thrombocytopenia is a common clinical presentation among patients in tertiary care hospitals. Various etiologies, such as malaria, dengue, leptospirosis, typhoid, miliary tuberculosis, and septicemia, are the common causes of fever with thrombocytopenia.
Aim: This study aimed to determine the various etiologies of febrile illness in children with thrombocytopenia, study their bleeding and clinical manifestations, and examine their correlation with the severity of platelet count.
Materials and methods: This study included 1000 pediatric patients with thrombocytopenia between January 2021 and December 2021 at an autonomous state medical college in Firozabad, Uttar Pradesh.
Results: In our study, the most common etiology was dengue, followed by sepsis and hematological malignancies. The most common age group of patients was 10-15 years. The severity of cases was determined based on the grading of thrombocytopenia and bleeding and clinical manifestations. Fever and myalgia were the most common clinical presentations of patients with thrombocytopenia.
Conclusion: Platelet count is a good predictor of bleeding manifestations due to severe thrombocytopenia, which can lead to life-threatening conditions. Prompt diagnosis is crucial to start treatment as soon as possible, including platelet transfusions for patients.

Abstract:Introduction: Spinal TB (Pott’s disease) is the most common, as well as one of the most potentially dangerous forms of skeletal TB, with an incidence of neurological complications as high as 10% to 43%. Radiographic manifestations of tuberculous spondylitis include intraosseous and paraspinal abscess formation, subligamentous spread of infection, vertebral body destruction and collapse, and extension into the spinal epidural space. Catastrophic neurological sequelae can lead to mortality and significant chronic morbidity. Early diagnosis and timely initiation of treatment can be a boon to such patients.
Objective: This retrospective cross-sectional study was conducted to identify common patterns of tubercular spinal osteomyelitis on MRI.
Materials and Methods: The current study is a cross-sectional observational study conducted by reviewing existing MRI images in the radiology department. The MRI spine studies of subsequently proven cases of spinal TB were included in the study. These images were re-evaluated and compiled by experienced radiologists.
Results: The thoracic spine was the most common site of involvement. Vertebral body wedge collapse or compression fracture was seen in 64% of patients. Posterior element involvement was found in 10 out of 20 cases. Prevertebral and paravertebral collections were seen in 65% of cases. Spinal cord compression was seen in 55% of cases.
Conclusion: MRI is an excellent imaging modality for spinal tuberculosis due to its ability to pick up early as well as advanced changes of the disease and provide the best possible anatomic demarcation of the extent of the disease.

Abstract:Introduction: Fractures in the upper end of the ulna, including its olecranon and coronoid processes, are common. Poor replacement of a dislocated or fractured bone can result in complications such as joint instability, stiffness, and functional deformity. This study aimed to determine the morphometry of the upper end, length, weight, and volume of the ulna bone on both sides in a cross-sectional study.
Materials and Methods: Eighty-four dry ossified ulna bones (42 right, 42 left) were used in this study. The length of the ulna (L) was measured using a digital vernier caliper, while the weight of the ulna (W) was measured using an electronic weight balance. Alginate cast material was used to measure the volume of the upper end of the ulna (V). Longitudinal dimensional parameters, such as the distance between the highest point of the olecranon and that of the coronoid process (OCD) and the mid-olecranon thickness in the mediolateral (T1) and anteroposterior orientation (T2), were measured using a digital vernier caliper. Paired t-tests were used to compare the parameters between the right and left ulnas, with a statistically significant p-value <0.05.
Results: There was a statistically significant variation (p<0.05) in T1, length, weight, and volume between the right and left ulna. However, there was no statistically significant variation in OCD and T2 between the right and left ulna. The average value of T1, T2, length, weight, and volume in the right ulna was higher than that of the left ulna, while the OCD of the left ulna was higher than that of its counterpart.
Conclusion: The findings of this study can be useful for engineers and medical professionals in designing implants for conditions such as fractures and dislocations. Parameters of the olecranon and coronoid processes can also be helpful in determining an individual’s sex.

Abstract:Primary brain tumors are a major cause of cancer-related deaths worldwide, and numerous studies have indicated an increase in their incidence over the past two decades. This study aimed to estimate the frequency of primary intracranial tumors presenting at KLE’s DR Prabhakar Kore’s Hospital and MRC, Belgaum, and to examine correlations between various factors, including age, sex, clinical symptoms, and signs. Between January 2006 and December 2010, 159 patients with proven cases of primary intracranial tumour based on CT/MRI scans were included in the study. Gliomas were the most frequent tumor type (45.28%), followed by meningiomas (23.89%). Males were more commonly affected (55.97%) than females, and the most commonly affected age group was 41-60 years, including 74 of the 159 cases (46.65%). Over half of the tumors were located in the cerebral lobes, with the frontal lobe being the most frequently involved. Headaches, seizures, and focal neurologic deficits related to the anatomic site of involvement were the most common presenting signs and symptoms. The findings of this study can be extrapolated to the population of North Karnataka and are consistent with similar studies conducted elsewhere in the country. Additionally, the study reveals a significant relationship between patient age and sex and the occurrence of different tumor types.

Abstract:Acute Encephalitis Syndrome (AES) is a significant cause of mortality and morbidity in children in endemic regions. While viruses have been the primary etiological agents attributed to AES in India, other microbes and toxins have also been reported in recent years. This study aimed to determine the etiology, clinical features, and outcomes of AES in children. This prospective observational study was conducted in the pediatric department of Jorhat Medical College and Hospital of Assam over a period of one year. The study included 49 diagnosed cases of AES in children aged between one month to 12 years as per the WHO case definition. Clinical features, etiology, and outcomes (recovery without or with neurological sequelae or death) were recorded for each patient. The study found that fever (100%) and altered sensorium (100%) were the most common clinical presentations in AES cases. Seizure (63%), headache (34.7%), vomiting (26.5%), diarrhea (22.4%), and other symptoms such as excessive crying and irritability (22.4%) were also observed. Japanese Encephalitis (JE) was the most common cause of AES (28.6%), followed by Herpes Simplex Virus (4.1%), pyogenic meningitis (4.1%), and tubercular meningitis (2%). The majority of cases (61.2%) were of unknown etiology. Among the 49 cases, 27 (55.1%) recovered without neurological sequelae, 8 (16.8%) had neurological sequelae, and 14 (28.6%) died during hospital treatment. The most common neurological sequelae was motor deficit (37.5%), followed by behavioral disorders and aphasia (25% each). Cranial nerve palsy was observed in one case (25%). Of the eight AES cases with neurological sequelae, five were JE positive and three were caused by other agents. The study concludes that AES cases commonly present with fever, altered sensorium, seizure, headache, vomiting, and signs of meningeal irritation. JE remains a major cause of AES in children in this region of India. These findings highlight the need for global attention to combat the menace of this arboviral encephalitis and save the lives of children.

Abstract:Background: Non-alcoholic fatty liver disease (NAFLD) is a common condition characterized by excess fat in the liver, which ranges from simple steatosis to steatohepatitis, cirrhosis, and hepatocellular carcinoma (HCC) in the absence of excessive alcohol intake. This study aimed to determine the prevalence of NAFLD among pre-diabetic and diabetic patients at a tertiary hospital.
Methods: This single-center, prospective, comparative, parallel-group, observational study included male and female patients between 30 and 70 years old who were either diabetic or pre-diabetic. A total of 600 patients with NAFLD were studied.
Results: Of the 200 diabetes cases studied, the prevalence of NAFLD was 52% (104 cases), while the prevalence of NAFLD among pre-diabetic cases was 45.5% (91 cases), and the prevalence of NAFLD among normal cases was 30.5% (61 cases). The prevalence of NAFLD was significant among females in all patient groups. Diabetic patients with NAFLD had a higher BMI and waist circumference than pre-diabetic and non-diabetic patients, and this difference was statistically significant. Diabetic patients with NAFLD also had higher Glycohemoglobin (%) and fasting glucose (mmol/L) than pre-diabetic and non-diabetic patients, and this difference was statistically significant. Liver function tests and other parameters such as total bilirubin, AST, ALT, GGT, LDL, HDL, total cholesterol, triglycerides, and platelet count were comparable in diabetic, pre-diabetic, and non-diabetic patients, and the difference was not statistically significant.
Conclusion: The prevalence of NAFLD among diabetic patients was 52%, while the prevalence of NAFLD among pre-diabetic cases was 45.5%. These findings highlight the importance of early screening and prevention strategies for patients with diabetes and pre-diabetes to reduce the burden of NAFLD.