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

Abstract:Background: Conversion disorder is a prevalent psychiatric illness characterized by various clinical patterns, including visual paralysis, dystonia, psychogenic non-epileptic seizures, anesthesia-like symptoms, swallowing problems, motor tics, and difficulty walking. These symptoms vary greatly from case to case and can vary in the same patient during successive episodes. Most symptoms are related to life stressors.
Study design: A cross-sectional study was conducted to estimate the sociodemographic profile, types of stressors, and variety of clinical symptoms presented in patients with conversion disorder in a tertiary care center in the North-East region of India. A total of 74 patients diagnosed according to Diagnostic and Statistical Manual of Mental Disorders Fifth Edition criteria were included. Patients underwent assessments of comorbidity using the Hamilton Depression Rating Scale, Hamilton Anxiety Scale, and assessments of stressful life events using the Presumptive Stressful Life Event Scale.
Result: The most common lifetime stressor was excessive alcohol use by family members with financial loss or problems (43.7%). Immediate stressors prior to the onset of illness were broken engagement or love affair (25.7%), family conflict (24.3%), marital conflict (14.9%), examination-related problems (10.8%), and other problems (23%). Motor symptoms were the most common type of clinical presentation (58.4%), with pseudo-seizures being the most common (29.7%). Other motor symptoms included paresis of the lower limb (9%), paresis of the left-side upper and lower limb (2.7%), aphonia/dysphonia (12.2%), limb paralysis (1.4%), dysphasia (2%), and ataxia (1.4%). Conversion disorder with mixed motor and sensory deficit (multiple fainting spells) was found to be the most common symptom (37.8%) in this region.

Abstract:Background: Hypertension is a major cause of death worldwide. The increasing prevalence of hypertension in young individuals is a warning sign of the impending cardiovascular, cerebrovascular, and renal diseases in the future. Hypertension affects 1 in 8 adults between the ages of 20 and 40 years and this number is likely to increase with unhealthy lifestyle behaviors and the lowering of hypertension diagnostic thresholds. Although the mechanisms are unclear, early-life factors have been found to influence blood pressure (BP), and BP tracks strongly within individuals from adolescence through to later life. Higher BP at a young age is associated with abnormalities on heart and brain imaging and increases the likelihood of cardiovascular events by middle age. However, young patients often have lower diagnosis rates, and their treatment is often delayed.
Methods: This prospective observational study was conducted from January 2021 to March 2021 in a tertiary care hospital. A total of 50 cases, male and female, were studied based on inclusion and exclusion criteria. Routine investigations were done on all patients, and uric acid and lipid profiles were sent to evaluate the association. Patients’ height and weight were recorded to calculate BMI. Patients below 12 years, pregnant women, and patients with previous cardiovascular and secondary causes of hypertension were excluded from the study. The study was carried out in all patients who fulfilled the inclusion and exclusion criteria.
Results: During the study period, a total of 50 patients (27 females and 23 males) were included. Our study revealed a female preponderance in the ratio of 1:1.1. More patients were in the age group of 40-45 years. Overweight was significantly noted with BMI >25 in 30 patients and >30 in 10 patients. Uric acid was significantly increased in 27 patients. Lipid abnormalities were noted: LDL increased in 30 patients, TGL increased in 32 patients, HDL increased in 20 patients, Total Cholesterol in 25 patients, and VLDL increased in 25 patients.
Conclusions: Our study showed that BMI was significantly higher in hypertensive patients. Furthermore, lipid abnormalities were present in overweight patients, contributing to hypertension. Although uric acid was elevated in a significant number of patients, it did not emerge as a risk factor in young hypertensives. We recommend a healthy lifestyle and a disciplined diet to avoid the hazards of hypertension.

Abstract:The COVID-19 pandemic has affected both the physical and psychological well-being of those who have been infected or have lost loved ones. Among those most affected are healthcare workers who have been on the frontline throughout the pandemic. This study aims to assess the levels of anxiety and depression among healthcare workers and their association with various demographic parameters. Additionally, we sought to determine the association between the Global Fatigue Index (GFI) and HADS score. Of the participants, 12 (16.22%) had borderline HADS scores (8-10) and 4 (5.41%) had abnormal HADS scores for depression (11-21). Furthermore, 13 (17.57%) had abnormal HADS scores for anxiety. HADS scores for both anxiety and depression were associated with female gender, profession (paramedic staff were more affected than doctors), and income. The GFI was calculated using the Multidimensional Assessment of Fatigue (MAF) score and found to have a positive correlation with various demographic parameters as well as with the HADS score, indicating that psychological stress has an impact on physical well-being and can lead to prolonged fatigue, thereby affecting an individual’s working capacity.

Abstract:Twenty-six patients with massive combat injuries to the lower extremities were treated with Ilizarov bone transport and free flap coverage. In all cases, debridement was performed thoroughly and with caution, followed by free flap coverage and external fixator application. The Ilizarov transport method using ring fixators was applied 4-6 weeks later, with distraction osteogenesis beginning 2-3 days later. The segmental bone defects ranged from 5cm to 16cm in the greatest dimension, and the total disability time from initial injury ranged from 14-26 months. However, two patients experienced partial flap necrosis, which was later treated with local transposition flap cover and split skin graft. Despite the late treatment, successful results were obtained in all 26 patients, with the original length of the tibia maintained and timely definitive treatment provided for the massive injuries of the lower extremities. Thus, the Ilizarov transport method used in combination with free flap coverage provides an effective therapy for repairing massive injuries to the lower extremities.

Abstract:Background: Radio-cephalic arteriovenous fistula (RC-AVF) is considered the preferred vascular access for dialysis, particularly in the non-dominant arm. However, elderly patients and those with comorbidities have a higher failure rate of RC-AVF. Therefore, clinical examination before surgery is crucial, and careful postoperative monitoring is necessary to overcome impaired fistula maturation. This study aims to evaluate different factors that may affect the outcome of arteriovenous fistula creation.
Methods: The study included patients aged 20-65 years with chronic kidney disease, without prior radio-cephalic arteriovenous vascular access intervention, from February 1, 2021, to January 31, 2022. Factors affecting the outcome were assessed, including preoperative, intraoperative, and postoperative factors. In this study, an end-to-side anastomosis technique was used with prolene 7-0 suture material in an interrupted suturing technique.
Results: Out of 250 patients, the highest successful AVF creation rate was observed in the 20-30 years age group (84%), followed by the 31-40 years and 41-50 years age groups (78%). The success rate was found to be higher in males (61%) than in females (39%). Moreover, the success rate of AVF had an incremental relation with the diameter of the radial artery and cephalic vein.
Conclusion: The success of fistula maturation is strongly correlated with postoperative monitoring. Therefore, AV fistula monitoring should begin immediately during surgery and continue in the postoperative period.

Abstract:Background: The spleen is a crucial intra-peritoneal hemo-lymphoid organ that is related to various abdominal viscera and the diaphragm. It is known for its variable size and shape and receives its blood supply from the tortuous splenic artery and is drained by the splenic vein. Palpation of the spleen is possible in certain pathological conditions. Notches on the spleen are a result of incomplete fusion of the embryonic splenunculi. In blunt trauma to the abdomen, the spleen is the most common intra-abdominal organ to rupture.
Aims: The study aimed to investigate the variations in morphology, morphometry, shape, size, and weight of cadaveric spleens in the Santhal-Pargana Division of Jharkhand, India.
Materials and Methods: The study was conducted on 30 dissected human spleens of both sexes. The spleen was removed by detaching it from various attachments, and the splenic vessels near its hilum were cut with the help of scalpel, scissors, and forceps. The shape, notches, length, breadth, thickness, and weight were studied.
Results: The study found that a wedge shape was the most common (40%). The mean weight of the spleen was 145.13 gm, and the average number of notches on the superior border was 2. The mean length, breadth, and thickness were 10.8 cm, 6.83 cm, and 4 cm, respectively. These findings were consistent with most similar studies on the spleen, although some studies had different results.
Conclusion: The study reaffirmed that the spleen is quite variable in shape and size. Splenomegaly may be more prevalent due to some endemic diseases. This knowledge is important for clinicians, physicians, radiologists, surgeons, and for routine anatomical dissection. The findings of the study may also contribute to a better understanding of the structure and function of the spleen, which can aid in the diagnosis and treatment of various diseases and injuries related to this organ.

Abstract:Background: The spleen is a crucial intra-peritoneal hemo-lymphoid organ that is related to various abdominal viscera and the diaphragm. It is known for its variable size and shape and receives its blood supply from the tortuous splenic artery and is drained by the splenic vein. Palpation of the spleen is possible in certain pathological conditions. Notches on the spleen are a result of incomplete fusion of the embryonic splenunculi. In blunt trauma to the abdomen, the spleen is the most common intra-abdominal organ to rupture.
Aims: The study aimed to investigate the variations in morphology, morphometry, shape, size, and weight of cadaveric spleens in the Santhal-Pargana Division of Jharkhand, India.
Materials and Methods: The study was conducted on 30 dissected human spleens of both sexes. The spleen was removed by detaching it from various attachments, and the splenic vessels near its hilum were cut with the help of scalpel, scissors, and forceps. The shape, notches, length, breadth, thickness, and weight were studied.
Results: The study found that a wedge shape was the most common (40%). The mean weight of the spleen was 145.13 gm, and the average number of notches on the superior border was 2. The mean length, breadth, and thickness were 10.8 cm, 6.83 cm, and 4 cm, respectively. These findings were consistent with most similar studies on the spleen, although some studies had different results.
Conclusion: The study reaffirmed that the spleen is quite variable in shape and size. Splenomegaly may be more prevalent due to some endemic diseases. This knowledge is important for clinicians, physicians, radiologists, surgeons, and for routine anatomical dissection. The findings of the study may also contribute to a better understanding of the structure and function of the spleen, which can aid in the diagnosis and treatment of various diseases and injuries related to this organ.

Abstract:Background: Sepsis and septic shock are among the leading causes of death and the most common cause of death among critically ill patients. Severity scores and prognostic models are used to evaluate the severity of illness in patients in the critical care unit. The present study aimed to compare the APACHE II and SOFA scoring systems in critically ill patients with sepsis in the medical ICU of a tertiary hospital.
Materials and Methods: The present study was a prospective observational study conducted on patients aged > 18 years, of either gender, admitted to the medical ICU for sepsis. All patients were evaluated using the APACHE II and SOFA scoring systems.
Results: The present study included 225 cases that met the study criteria. The mean age was 59.2 \(\pm\) 12.3 years, the mean length of stay was 9.3 \(\pm\) 4.2 days, and the mean length of ICU stay was 7.3 \(\pm\) 3.7 days. The majority of the patients were male (63.56%). The mortality rate was 58.22%, 39.56% of patients had multiple organ dysfunction, 74.22% were diagnosed with septic shock, and positive blood culture was noted among 34.67% of patients. On the day of admission, a significantly higher APACHE II score was noted among non-survivors (23.8 \(\pm\) 11.65) compared to survivors (16.59 \(\pm\) 8.24). The daily SOFA score was higher among non-survivors than survivors, and the difference was statistically significant (p < 0.001). Both APACHE II and SOFA scoring systems were found to be equivalent in predicting mortality in patients diagnosed with sepsis, and there was no statistical significance.
Conclusion: The APACHE II and SOFA scoring systems are equivalent in predicting mortality in patients diagnosed with sepsis, and there was no statistical significance.

Abstract:Background: Febrile neutropenia (FN) is a common and potentially life-threatening complication of childhood cancer therapy. Patients with neutropenia are at a higher risk of acquiring infections compared to individuals with normal immune function. In severe cases, absolute neutrophil count (ANC) can be less than 500 per microliter. The aim of this study was to understand the clinical and etiological profile of febrile neutropenia in hemato-oncological and aplastic anemia patients in a tertiary care center in India and to determine the outcome of patients after starting empirical antibiotic therapy. Additionally, we aimed to formulate specific antibiotic therapy based on etiological data from our study.
Methodology: The study was conducted in the pediatric hemato-oncology department of a tertiary care center in India from March 2015 to September 2016. The study included 76 children aged between 1 month and 18 years diagnosed with febrile neutropenia in aplastic anemia and hemato-oncological patients. All febrile neutropenia patients received ceftriaxone and amikacin empirically according to the hospital protocol. Vancomycin was administered additionally to patients who had persistent fever, and fluconazole was initiated empirically in patients in whom fever persisted despite antibiotics on day 4 or 5. In culture-negative and stable patients, intravenous antibiotics were continued for 3 days or until ANC recovered to >500/\(\mu\)l. Bacterial pathogens in all samples yielding culture positivity were identified, and their antibiogram was recorded.
Results: The study found that febrile neutropenia occurs almost equally in all age groups, with a mean age of 6.2 \(\pm\) 4.1 years. Males were predominantly affected, and the mean temperature was 101.7 \(\pm\) 0.7350F. The mean ANC count was 257 \(\pm\) 226.4 neutrophils/mm, and the mean duration of hospital stay was 6.7 \(\pm\) 5.7 days. The respiratory system was the most commonly affected, followed by problems associated with the gastrointestinal tract. In other antibiotic therapies used for our patients empirically or according to the culture sensitivity, we found that the drugs used in decreasing order of frequency were piperacillin-tazobactam (14.4%), vancomycin (11.8%), metronidazole (10.5%), fluconazole (7.9%), meropenem (6.5%), and imipenem (2.6%), while linezolid, ciprofloxacin, and colistin were used in one patient each. Culture reports were positive in a total of 11 (14.5%) patients. No significant difference was found in mean ANC count, but a significant difference was found in the duration of hospital stay between culture-positive and culture-negative patients, with a difference of almost 10 days. The mortality rate was 2.6%.
Conclusion: Males were more commonly affected than females, and most patients presented with symptoms of the respiratory system, followed by the gastrointestinal and urinary tract systems. Most episodes of febrile neutropenia occurred during the induction phase of treatment of acute leukemia, with acute lymphoblastic leukemia being the most common malignancy followed by acute myeloid leukemia. Empirical therapy with ceftriaxone and amikacin leads to a satisfactory clinical outcome in febrile neutropenia. A significant difference was found in the duration of hospital stay between culture-positive and culture-negative patients, with a difference of almost 10 days between the two. The mortality rate in our study was found to be 2.6%.

Abstract:Background: Ovarian neoplasms can be benign or malignant and accurate preoperative diagnosis is crucial for determining the appropriate surgical approach. Risk of malignancy index (RMI 4) is a useful tool that combines radiological findings, CA-125 levels, and tumor size to predict the likelihood of malignancy. The RMI 4 score is interpreted as either <450 or >450 and compared to the final histopathology report.
Aim and Objectives: The aim of this study is to evaluate the accuracy of RMI 4 in predicting the risk of malignancy in early ovarian neoplasms and to investigate its association with histopathological findings. The specific objectives are:
1) To determine the sensitivity of RMI 4 in predicting malignancy in suspected early ovarian neoplasms.
2) To compare the sensitivity of RMI 4 with CA-125 levels in predicting malignancy.
3) To examine the association between RMI 4 score and final histopathological examination findings.
Methods: This cross-sectional study was conducted in the Oncology OPD of ALLURI SITA RAMA RAJU ACADEMY OF MEDICAL SCIENCES (ASRAM) over a period of one year, from February 2021 to January 2022. We included 46 patients who met the inclusion criteria.
Results: The sensitivity of RMI 4 in predicting malignancy was found to be 52.4% for all cases, while it was 84.6% for serous and mucinous tumors. The sensitivity of CA-125 was 61.9% for all cases and 84.6% for serous and mucinous tumors. Our study found that RMI 4 and CA-125 are more predictive of malignancy in serous tumors compared to mucinous and other pathologies.
Conclusion: In conclusion, RMI 4 is a useful tool for differentiating malignant from benign ovarian lesions. Our study shows that RMI 4 and CA-125 are more sensitive in predicting malignancy in serous tumors compared to mucinous and other pathologies. Clinicians can use these tools to guide the appropriate surgical approach and improve patient outcomes.