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

Abstract:Introduction: Vitamin A is an essential nutrient required for normal vision, epithelial maturation, and immunological responses. Vitamin A deficiency (VAD) is a major public health problem in many developing countries, including India, but only 5%-10% show clinical evidence. Studies have shown that subclinical vitamin A deficiency is associated with increased mortality and morbidity.
Materials and Methods: Children suspected of VAD, who were attending the Pediatric OPD at VIMS, Ballari, were studied. Those children with classical features of VAD were excluded. Conjunctival impression was taken using cellulose acetate filter paper, stained, and studied for epithelial changes, which were graded according to the Nelson grading system.
Results: Out of 250 children, 140 (56%) were male and 110 (44%) were female. All age groups were equally affected and had subclinical VAD with an average of 81.2%. The occurrence of subclinical VAD was significantly associated with severe grades of PEM, recurrent LRTI, diarrhea, UTI, measles, etc. Nelson’s grading for Conjunctival imprint cytology (CIC) was effective in detecting more than 80% of all cases of sub-clinical VAD.
Conclusion: Subclinical VAD without ocular manifestations was largely prevalent in a suspected group of children, more so in children of low socio-economic status. Conjunctival Impression cytology was able to detect the majority of these cases, initiate early management of these subclinical cases, and thus reduce the mortality and morbidity associated with VAD.

Abstract:Background: Soft tissue tumors (STTs) and tumor-like lesions have fascinated clinicians and pathologists for years. Due to their wide variety and close histopathological similarities between certain tumors, they pose a diagnostic challenge. They most commonly present as masses and are rarely associated with pain. Fine-needle aspiration cytology (FNAC) has been documented as a reliable preoperative diagnostic tool to broadly differentiate them into benign and malignant categories. Histopathology is still considered the gold standard for STTs.
Aim of the Study:}The aim of this study is to classify and subcategorize soft tissue tumors and to correlate the findings of FNAC of soft tissue tumors with histopathology.
Methods: This prospective study was carried out on patients with palpable soft tissue masses attending the surgical OPD between January 2021 and June 2022. FNAC of soft tissue lesions was performed, and only cases with subsequent histopathological examination were included in the study. Cytopathological and histopathological diagnoses were correlated.
Results: Out of 90 soft tissue tumors, 83 (92.22%) were benign, 1 (1.11%) was intermediate, and 6 (6.6%) were malignant. The male to female ratio was 1.7:1. The most common site was the trunk (34.4%), followed by the lower extremity (30%). Of all benign lesions, lipoma was the most common (71.1%). There was a concordance of FNAC with histopathology in 88 out of 90 cases (97.8%).
Conclusion: Benign soft tissue tumors outnumber malignant tumors. FNAC is an effective method for the rapid diagnosis of STTs, and preoperatively, it helps differentiate between benign and malignant lesions in most cases. Although histopathology is the gold standard, FNAC has high specificity in diagnosing malignant tumors, thereby preventing unnecessary extensive or radical surgery for benign lesions.

Abstract:Background: Abruptio placenta is a serious pregnancy complication that occurs when the placenta separates partially or completely from the uterus after the age of viability and before delivery, which can result in maternal and fetal morbidity and mortality.
Aim: This study aimed to determine the percentage, sociodemographic characteristics, risk factors, and feto-maternal outcomes of abruptio placenta in a tertiary care hospital, Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Sangli.
Materials and Methods: This retrospective study included all cases of abruptio placenta that occurred between June 1\({}^{st}\), 2020 and May 31${}^{st}$, 2022 in the obstetrics ward of Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Sangli. Sociodemographic characteristics, risk factors, and fetal and maternal morbidity and mortality data were extracted from patient case notes for analysis.
Results: Of the 966 deliveries during the study period, 37 cases (3.83%) of abruptio placenta were identified. The incidence of abruptio placenta was higher in the age group of 20-29 years (64.8%) and in multiparous women (59.4%). Hypertensive disorders of pregnancy were the most common risk factors, observed in 54.05% of cases. Prematurity was the major perinatal morbidity and was found in 56.7% of cases, followed by birth asphyxia in 37.8%. NICU admission was required for 48.6% of babies, and 29.7% were stillborn. The caesarean section rate was 70.3%. Blood transfusion was required for 28 subjects (75.6%), postpartum hemorrhage occurred in 10 subjects (27.02%), and postpartum anemia was observed in 20 subjects (54.05%). There were two maternal deaths, resulting in a maternal mortality rate of 5.4%. The perinatal mortality rate was 51.3% due to a higher percentage of stillbirths.
Conclusion: Abruptio placenta is a serious pregnancy complication that can result in significant maternal and fetal morbidity and mortality. Hypertensive disorders of pregnancy were identified as the most important risk factor. Good antenatal care services and early referral to well-equipped institutions with qualified personnel, efficient blood banking systems, and good neonatal services are essential in reducing the adverse outcomes of abruptio placenta.

Abstract:Background: Pregnancy is associated with numerous physiological and pathological changes. Thrombocytopenia, defined as a platelet count of less than 150,000/\(\mu\)L, is the second most common hematological finding in pregnancy after anemia. It may manifest during pregnancy and increase the risk of bleeding.
Materials & Methods: This prospective observational study was carried out in the Antenatal outpatient and inpatient Department of Gynecology and Obstetrics at Bharati Vidyapeeth Medical College and Hospital, Sangli. All pregnant women diagnosed with thrombocytopenia during the six-month study period were included. Patients were followed until delivery to record any complications such as preterm labor, abruption, preeclampsia, postpartum hemorrhage, or any other morbidities, and to determine maternal outcomes.
Results: Out of 246 pregnant patients, 30 were found to have thrombocytopenia with a platelet count of 150,000/mm\(^3\) or below, giving a prevalence of approximately 12%. The cases were recorded based on demographic characteristics, gestational age at the time of first onset of thrombocytopenia, severity of thrombocytopenia, and any intervention. Maternal outcomes were recorded.
Conclusion: Gestational thrombocytopenia is the most common cause of thrombocytopenia during pregnancy and has good maternal outcomes. Managing pregnant women with platelet disorders requires a multidisciplinary approach and close collaboration between obstetricians and hematologists.

Abstract:Introduction: Guillain-Barre Syndrome (GBS) is an acute and often severe polyradiculoneuropathy caused by autoantibody-mediated destruction of the myelin sheath, which presents with ascending paralysis and areflexia. The mortality rate of GBS is less than 5%. We conducted a study in our hospital to identify the epidemiological features, clinical profile, and electrophysiological features of GBS and to determine the various GBS variants present in the studied population. We also aimed to correlate the prognosis of GBS with age, critical time period, and requirements for ventilatory support.
Methods: We conducted a cross-sectional analytical study of 32 adult patients (age > 20 years) meeting the criteria for GBS after a detailed study and 3-month follow-up.
Results: GBS occurred in 71.87% males, mostly in those over 50 years of age. Antecedent events were present in 65.26% of patients, with respiratory tract infections being the most common (43.75%). The most common initial motor symptom was distal weakness (28.12%) with ascending progression. The most commonly involved cranial nerve was the facial nerve (49.99%). Twenty-two patients (68.65%) had a disability grade of 3 at peak. Ten patients developed respiratory weakness, with acute motor axonal neuropathy (AMAN), acute motor and sensory axonal neuropathy (AMSAN), and acute inflammatory demyelinating polyneuropathy (AIDP) cases being 4 (40%), 3 (30%), and 2 (20%), respectively. Postural hypotension was the most common autonomic dysfunction (12.5%). AIDP (71.87%) was the most common variant, and aspiration pneumonia (18.75%) was the most common complication in patients requiring mechanical ventilation (60% of ventilator-assisted patients developed aspiration pneumonia), while urinary tract infection (UTI) (3 cases, 9.37%) was the most common complication in non-ventilator-associated patients. Intravenous immunoglobulin (IVIG) was found to be beneficial, with a 72% recovery rate.
Conclusion: GBS is a disease that primarily affects adult males, with a rapid onset to peak, prolonged duration at peak, need for assisted ventilation, and axonal pattern being poor prognostic factors.

Abstract:Objectives and methods: The present study is a cross-sectional study of 250 women with abnormal uterine bleeding in the reproductive age group undertaken in Srinivasan Medical college Hospital and Research centre over a period of 12 months. It was done to ascertain the possibility of a correlation between subclinical thyroid dysfunction and AUB.
Results and conclusion: The incidence of thyroid dysfunction in the reproductive age group is 1-2%. It is 10 times more common in women than in men. The incidence of thyroid dysfunction in a population with AUB is 20.4% according to our study and hence selective screening of this population would result in a higher yield. The study showed a significant correlation (p= 0.019, significant) between increasing age and thyroid dysfunction. TSH is a good screening test with a sensitivity of 72% and specificity of 100%. The positive and negative predictive values were 100% and 91% respectively.

Abstract:This study aimed to clinically investigate cases of tuberculous lymphadenopathy in a tertiary care center in Madhya Pradesh. 67 patients with swelling in the neck and clinically diagnosed as Cervical Tuberculous Lymphadenopathy were included. Data was collected through detailed history, physical examination, routine investigations, radiological tests, and FNAC. Most participants were females (56.7%) in the 11-20 years age group (32.8%). Chest X-ray/ CT thorax findings showed infiltrates in 7.5%. Mantoux test was positive in 85.1% participants. FNAC revealed granuloma without caseous necrosis in 80.6% cases, with AFB found in 28%. 91% were treated with ATT only, while 6% were treated with ATT+ART. 28.4% experienced a paradoxical reaction during treatment, with 94.7% undergoing modification of treatment. USG neck at the end of 6 months treatment revealed residual lymph nodes in only 20.9%. 22.4% required an extended duration of treatment. The study concludes that cervical lymph node tuberculosis is the most common form of extra-pulmonary tuberculosis and FNAC is the simplest procedure for diagnosis. The presence of residual LNs after 6 months of anti-tuberculosis treatment does not necessarily indicate recurrence or treatment failure but must be re-evaluated and differentiated from active TB.

Abstract:Introduction: Epistaxis is a common condition witnessed in the Emergency department. Due to the discomfort patients experience, the likelihood of complications, and the necessity of following up with their treating physician to remove the nasal packing, it may be reasonable to utilize other drugs to treat epistaxis before nasal packing. It is well-recognized that the antifibrinolytic drug tranexamic acid (TXA) is helpful in various therapeutic contexts where uncontrolled bleeding may be an issue. There is anecdotal data that suggests topical TXA may be helpful for acute epistaxis, but more research is needed.
Material and Method: The Patients were divided into two groups- Group T- A cotton pledget soaked in 5ml of Tranexamic acid (prefilled syringe) and 10 ml of Phenylephrine with 5ml of 2% Lignocaine with 1:1000 adrenaline and Group C- A cotton pledget soaked in 10ml of Phenylephrine with 5ml of 2% Lignocaine with 1:1000 adrenaline with 5ml Normal saline (prefilled syringe). Outcomes recorded were the proportion of patients in both groups who needed anterior nasal packing after 20 minutes of pack removal, the number of patients whose bleeding stopped within ten minutes, the length of stay in the ED, the necessity of cauterization, and a telephonic follow-up conducted by an independent ENT resident using a structured questionnaire to record any episode of rebleeding within 24 hours to five days. Any drug-related side effects were recorded, such as thrombosis, nausea, and hypersensitivity.
Result: Patients requiring anterior nasal packs were less in the Tranexamic acid group (P<0.038). The length of hospital stay was decreased in Group T (P <0.045), and the proportion of patients whose bleeding was stopped within 10 mins was more in Group T (P< 0.04). The incidence of rebleeding within 24 hours decreased in Group T (P< 0.038), but no significant difference was found in rebleeding number within 1- 5 days. No minor/major complications to the drug were noted in Group T.
Conclusion: Topical TXA is safe and effective for the cessation of anterior nasal bleeding, thus preventing the use of anterior nasal packing, which is tedious for the patient and medical staff. TXA has been shown to decrease the rate of packing significantly.

Abstract:Background: Intubation is one of the most commonly done procedures in a hospital. Endotracheal intubation is the gold standard for securing airway. Direct laryngoscopy (DL) using Macintosh laryngoscope (MCL) has long been in use as a conduit for intubation. I-gel a second generation airway has been designed to conduct intubation, which reduces the pressure response and also eliminates the disadvantages of the LMA such as aspiration of gastric contents, compression of vascular structures, trauma and nerve injury. One of the most important advantages of the I-gel is it’s ability to maintain oxygenation and ventilation during periods of apnea at the time of intubation.
Aim: The present study has been undertaken with an aim to evaluate and compare the intubation time and success rate of direct laryngoscopy and I-gel guided method for endotracheal intubation.
Material and Methods: In this comparative study, 80 patients of ASA grade I and II, aged 20-60 years undergoing elective surgeries under general anesthesia were included and divided into two groups – A DL and B- I-gel as a conduit for endotracheal intubation.
Result: The mean total intubation time was 18\(\pm\)1 seconds for direct laryngoscopy method and 26\(\pm\)5 seconds for I-gel guided method (p<0.05).Although the total number of attempts required in group A were 43 as compared to 47 in group B ,the difference was statistically insignificant (P=0.38).The changes in mean HR and mean MAP from baseline were less in group B in comparison to group A (p<0.05). The incidence of postoperative sore throat and hoarseness were also found to be less in group B as compared to Group A (p<0.05).
Conclusion: I-gel guided intubation can be an effective alternative to the conventional DL method as it offers more hemodynamic stability and less post operative adverse events.

Abstract:Background: Central venous cannulation a vital intervention can be done using numerous approaches for cannulating the internal jugular vein such as anterior, posterior and approach. Of these, the anterior approach is being practised widely, since the identification of landmarks and palpation of carotid artery permits a beginner to learn the procedure easily. The major complications of this approach are carotid artery puncture and hematoma formation. Posterior approach needs identification of only the main bulk of the sternocleidomastoid muscle and external jugular vein, which could be identified even in obese patients easily by the trendelenberg position.
Aim: To evaluate and compare the success rates of anterior and posterior approach for internal jugular vein cannulation.
Material and methods: Hundred patients of American society of Anaesthesiologist (ASA) grade I and II, aged 20-60 years of age were divided into two groups. Group A patients were cannulated by anterior approach while Group-B patients cannulated by posterior approach. Number of attempts, time to identify vein, duration of cannulation, ease of threading and complications like carotid artery puncture, hematoma formation, pneumothorax, hemothorax, thrombophlebitis and catheter displacement were taken into consideration.
Result: The total number of attempts was statistically lower in group B as compared to group A (p value= 0.042). The mean time to identify vein and duration of cannulation was also found to be significantly lower in group B as compared to group A (p value= 0.0043,p value=0.001 respectively). The incidence of carotid artery puncture and hematoma formation was less in group-B as compared to group-A (p value=0.001).
Conclusion: Since Posterior approach for IJV cannulation required lesser number of attempts, less time to identify vein and also less duration of cannulation, It can be considered as a preferred choice for cannulation of internal jugular vein as compared to anterior approach.