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

Abstract:Objective: To compare the efficacy of sublingual misoprostol tablet and intracervical dinoprostone gel for induction of labour in nulliparous postdated pregnancy and assess the maternal and fetal outcome after induction.
Methodology: It is a prospective randomized controlled study conducted over a period of 2 years (nov 2020 to nov 2022), in dept. of obstetrics and gynecology, mkcg mch. Out of 200 cases 100 cases were given sublingual misoprostol tablet (Group 1) and rest were given intracervical dinoprostone gel (Group 2). The efficacy of both the drugs were assessed by favorability of Bishop’s score at 24 hours, need of augmentation with oxytocin, drug administration to delivery interval, mode of delivery, APGAR score, NICU admission, maternal complication and number of failed induction, data was analyzed description statistics and chi square test.
Result: Mean Drug administration to delivery interval was shorter and significant (18. 53hours vs 20.42) hours, p-value 0.0018). Need for augmentation (48 vs 65, p-value 0.0125), failed induction rate (5 vs 11), post-delivery mean blood loss( 436.50mL vs 516 mL, p value- 0.0173) were significantly lower with misoprostol group. NICU admission was lower in dinoprostone group (7 vs 14).
Conclusion: Sublingual misoprostol tablet is efficacious in inducing labour, with shorter drug administration to induction interval, and higher vaginal delivery rate as compared to dinoprostone gel.

Abstract:Introduction: Preanaesthetic medicaments are the drugs used before surgery procedure. They are one or more drugs can be used in several reasons. Drugs used to, control pain, gastric secretion and anxiety. The main aim of the study is to analyze the serious preoperative complications and pre anaesthesic drugs used in different surgical procedure in tertiary care hospital.
Aim: To study the utilization of preanesthetic medications used in different surgical procedure in tertiary care hospital.
Material & Methods: The cross-sectional study was conducted after taking permission from institution ethical committee permission. Data was collected retrospectively from inpatient ward those who have undergoing surgeries in the Department of General Surgery, Orthopaedics, Obstetrics, and Gynecology. The collected data was analyzed using SPSS software version 21.
Results: the study was conducted on 386 patients undergoing surgery in different specialties. Majority of the patients were male from general surgery department. Total of 386 patients, 169 patients showing symptoms before surgery and reduce to 74 patients one week after surgery. Increased in HR, anxiety was observed in majority of the patients. Esmolol is the drugs showing significant improvement in HR, SBP & DBP (p <0.005) respectively.
Conclusion: Alprazolam and esmolol was most commonly used preanaesthetic mediation in patients undergoing surgery in different departments.

Abstract:Context: The dental needs of elderly are changing and growing. Prosthetic rehabilitation can positively impact the quality of life of an elderly edentulous patient.
Aims: 1) Estimate denture needs by analysing number of edentulous patients requiring dentures and the factors depriving them for the complete denture rehabilitation. 2) Analyse the quality of dentures and relate it to their satisfaction with prosthetic rehabilitation.
Materials & Methods: This study was conducted on 847 patients over a period of 10 months. The sample size was divided into the edentulous patients deprived of dentures and the denture user groups. Each groups were examined clinically and interviewed with a separate close ended, prevalidated multiple choice questionnaire. The questionnaires were available in English as well as Hindi to promote better understanding.
Statistical Analysis: Discrete (categorical) datas were summarized in frequency and compared by using chi-square (\(\chi^{2}\)) test, with P< 0.05 considered statistically significant.
Results: 1) 68% of the sample were deprived of removable complete denture and 53% denture wearer were unsatisfied with their existing denture. 2)Significant association between gender and distance of dental facility from residence of patients. 3) Difficulty in eating was the prime reason for complete denture requirement (38.55%).4) (38.89%) patients, wearing denture needs relining or rebasing.
Conclusion: Strategies are to be planned by health care providers to make oral health care and denture treatment available to this unprivileged section of the society.

Abstract:Introduction: Esophageal varices are a major cause of morbidity and mortality in patients with liver cirhhosis. Esophageal varices can be screened with invasive procedures like esophageal endoscopy which might not be affordable to all in developing countries. This study aimed to find the diagnostic efficacy of some non-invasive markers for detection of esophageal varices in people with cirrhosis.
Objective: To assess the feasibility of platelet count/ spleen diameter (PLC/BPD) ratio and Aspartate transaminase / Alanine transaminase (AST/ALT) ratio as a non-invasive marker for esophageal varices in patients with cirrhosis.
Materials and method: Platelet count/ bipolar spleen diameter (PLC/BPD) ratio and Aspartate transaminase / Alanine transaminase (AST/ALT) ratio were analysed in hundred patients with cirrhosis admitted in the Medicine Ward of Vinayaka Mission’s Medical College and Hospital, Karaikal . The values obtained were co-related to presence or absence of esophageal varices on upper GI endoscopy in these patients.
Results: A statistically significant correlation between platelet count/ bipolar spleen diameter (PLC/BPD) ratio and Aspartate transaminase / Alanine transaminase (AST/ALT) ratio and esophgeal varices was found in our study group.

Abstract:Background: Laparoscopic cholecystectomy (LC) is considerably gold standard for symptomatic cholelithiasis. Preoperative prediction of difficult LC and operative grading system may not only improve patient safety but also be beneficial in lessening the overall cost of therapy.
Aim: The present study aimed to predict and analyze risk factors using a scoring system deemed responsible for surgical difficulties in patients undergoing laparoscopic cholecystectomy (LC) for symptomatic cholelithiasis.
Material & Methods: This hospital based prospective study was conducted at Department of Surgery, A tertiary care teaching Hospital, central India. Various factors considered preoperatively were gender, age, previous history of hospitalization, impacted stone, obesity; gall bladder wall thickness, pericholecystic collection; previous abdominal scar and palpable gall bladder were evaluated.
Results: Out of 150 patients, majority of the (34.2%) was 41-50 years age group, predominantly female (62.7%).The scoring system predicted easy LC for 106(70.7%), and difficult for 44(29.3%). No significant association of difficult LC with age group, gender, BMI, h/o hospitalization with acute cholecystitis, abdominal scar, leucocytes count and Hepatic echotexture (P>0.05), whereas palpable gall bladder, GB wall thickness, Distended gallbladder, impacted stone and pericholecystic collection were significantly associated with difficult LC.
Conclusion: Preoperative prediction of the factors leading to difficulty or conversion in cholecystectomy could help plan the surgical strategies and possible outcomes beforehand which can reduce the overall mortality and morbidity.

Abstract:Background: Postoperative pain is a major problem associated with any surgery. Thoracic surgeries result in excessive breakthrough pain which should be countered appropriately to decrease postoperative poor ventilation. Extrapleural paravertebral catheter is one such modality effective for postoperative pain caused by thoracic surgeries, comparable to thoracic epidural. Adjuvants like fentanyl or dexmedetomidine not only reduce the total local anesthetic dose but also provide superior and profound analgesia.
Aims and Objectives: To compare the effect of bupivacaine with fentanyl or with dexmedetomidine via extrapleural paravertebral catheter for continuous postoperative analgesia.
Materials and Methods: Our study was a prospective, randomized, and comparative study conducted in the Department of Anesthesiology, M.Y. Hospital and M.G.M. Medical College, Indore. A total of 40 patients (taking the COVID era into consideration) aged between 18 to 65 years with ASA Grade I, II \& III undergoing thoracic surgeries were included. Patients were divided into two groups of 20 each: Group (B+F) who received 0.125\& Bupivacaine along with Fentanyl 2 mcg/ml @ 0.15ml/kg/hr and Group (B+D) who received 0.125\& Bupivacaine with Dexmedetomidine 0.2 mcg/kg/hr @ 0.1ml/kg/hr via extrapleural paravertebral catheter.
Results: The mean PEFR was comparable between the two groups at 12 hours (P=0.198), 24 hours (P=0.058), 48 hours (P=0.15), and 72 hours (P=0.10). Improvement in PEFR was observed in both groups from 12 hours to 72 hours, with group 1 (B+F) showing 348.00 \(\pm\) 18.317 L/min at 12 hours and 521.50 \(\pm\) 24.468 L/min at 72 hours, while group 2 (B+D) showed 355.50 \(\pm\) 15.39 L/min at 12 hours and 535.00 \(\pm\) 28.562 L/min at 72 hours, indicating improvement in lung function. The mean time taken for the request to first analgesia in Group 1 (B+F) was 259.15 \(\pm\) 11.536 minutes and in Group 2 (B+D) was 360.2 $\pm$ 13.671 minutes, and this mean time was found to be statistically significant between the two groups (P=0.000*).
Conclusion: The mean VAS score (visual analog scale) noted at 72 hours with coughing was better with dexmedetomidine than with fentanyl. The mean time taken for the request to first rescue analgesia in group B+F was 259.15 \(\pm\) 11.536 minutes, and in group B+D, it was 360.20 $\pm$ 13.671 minutes, which was significantly higher in the dexmedetomidine-containing group. A more stable hemodynamic profile was observed in the B+D group.

Abstract:This prospective cross-sectional study aimed to identify clinical patterns of patients admitted with hypoglycemia to the Department of General Medicine at Dhanalakshmi Srinivasan Medical College Hospital in Perambalur between January 2021 and December 2021. The inclusion criteria were patients admitted to the medical ward with documented hypoglycemia (i.e., blood glucose levels < 70 mg/dL) and aged = 18 years. Pregnant women, patients < 18 years, and those unwilling to participate were excluded. Out of 119 patients, the maximum number of patients (54.6%) belonged to the 41-60 age group, while the >60 age group accounted for 34.5%. However, this age group constituted 61.5% of the total deaths, indicating that hypoglycemia in the elderly is a significant predictor of mortality. Dysregulation of glucose metabolism in the body and the failure of endogenous defense mechanisms to combat low blood sugar levels revealed hypoglycemia. Therefore, hypoglycemia should be taken seriously and investigated appropriately. Elderly people are more prone to low blood sugar levels, and in them, diabetes treatment should be moderate. Tight glycemic control in the elderly can lead to fatal episodes of hypoglycemia.

Abstract:Diabetes mellitus affects approximately 13 million people and is associated with various vascular complications. Microvascular and macrovascular problems are common in diabetes, with the latter being similar in both diabetic and non-diabetic patients. The study aimed to estimate the incidence of diabetic foot in patients with diabetes and vascular complications. The study included 330 patients (M:F 170:160) who underwent tests for retinopathy, nephropathy, neuropathy, peripheral vascular disease (PVD), and cardiovascular disease. The results showed that nephropathy was present in 9% of patients, CHD in 12.5%, PVD (diabetic foot) in 12.4%, and neuropathy in 12.5%. Diabetes duration was significantly correlated with neuropathy, nephropathy, and PVD, while higher HbA1C levels were associated with an increased risk of nephropathy and neuropathy. The study highlights the high incidence of diabetic foot in patients with vascular complications.

Abstract:This paper highlights the significance of cadaver dissection as an essential part of medical education and emphasizes the shortage of cadavers in medical colleges. The study aimed to evaluate the knowledge and attitude of medical students towards body donation. The results indicate that a majority of students are willing to donate organs but not their whole body due to concerns about disrespectful behavior in the dissection hall. Moreover, some students were not aware of the legal procedures involved in body donation. The study found no significant difference in opinion based on gender or religion. The findings of this study may be useful in promoting body donation and addressing the shortage of cadavers in medical colleges.

Abstract:Introduction: Fine Needle Aspiration Cytology (FNAC) is a quick, simple, efficient, and inexpensive way to sample superficial masses in the head and neck due to the wide range of primary as well as metastatic neoplasms and the close proximity of several types of tissues. Due to its minimally invasive nature and easy access to target sites, FNAC has gained popularity and acceptance. Although FNAC cannot provide the same level of morphological detail as histology, it can reveal cells from the whole lesion since aspirating allows for many passes through the lesion. In addition to confirming the existence of metastatic disease, FNAC also offers information on the type and origin of the primary tumor. It provides the added advantage of being an outpatient procedure and lowers the frequency of exploratory procedures. The present study was carried out to study the lesions of the anterior triangle of the neck in correlation with histopathology and determine the diagnostic accuracy of FNAC.
Materials and Methods: This prospective observational study was carried out in the Department of Pathology, MGM Medical College and MYH Hospital, Indore, over a period of 2 years (2013-2015), among 1110 patients of both sexes and all age groups with palpable anterior triangle neck swellings reporting in the Department of Surgery, ENT, Pediatrics, TB, and Cancer hospital, who were referred to Pathology. A detailed clinical history was recorded, and a complete physical examination was carried out. FNAC was performed under all aseptic precautions. Cytological findings from the smears were recorded, and a diagnosis was made. Excisional biopsy specimens received were processed and mounted by DPX. Cytohistopathological correlation was done. Data were collected, compiled, and analyzed using SPSS 22.0 (trial version).
Results: Most participants belonged to the age group of 21-30 years. The male to female ratio was reported to be 1:1.35. A large proportion of lesions (71.08%) were found in lymph nodes, while 22.25% were in the thyroid, and the rest (6.67%) were distributed in various other regions. The majority of the lesions (77.12%) in the anterior triangle of the neck were non-neoplastic (inflammatory) lesions. Among the neoplastic lesions located in the thyroid gland, 13.76% were benign and 1.62% malignant. No benign neoplastic lesions were noted in the lymph node. Rather, 14.57% were malignant. Most lesions (38.66%) in the lymph nodes were classified as tuberculous lymphadenitis, followed by reactive hyperplasia of lymph nodes (15.59%). Thyroiditis was most common (84.62%) among the lesions found in the thyroid gland, followed by colloid goiter (8.10%). The sensitivity and specificity were calculated as 85.50% and 99.23%, respectively.
Conclusion: In addition to being safe and comparatively free of complications, FNAC offers a quick, efficient, and accurate approach to diagnosing lesions, especially of the neck. Consistent results were found between cytological and histological examinations, and hence it works as a useful adjunct to histopathology. It can help to significantly reduce morbidity and mortality by early as well as accurate diagnosis of benign and malignant lesions.