Highlights on Medicine and Medical Science Vol. 11

Background: There has been no research on the Indian population that has tested ears for “Noise Induced Hearing Loss.” Furthermore, while there was no study on recruits of Indian descent in the literature, an attempt was made to test the individuals for noise-induced hearing loss.

Objective:  To corelate the initial OAE screening in terms of frequency involved with time frame after firing for the first time to prevent further exposure and hearing loss.

Methods: Otoacoustic emission (OAE) screening is done over recruits before and after first exposure to loud noise of rifle firing in our study. Recruits were followed up at 04 hours, 24 hours, 01 month and 06 months after exposure. Individuals showing variation in OAE at 24 hours were also subjected to Pure Tone Audiometry at 01 month and 06 months.

Results: There were 98 recruits in total. Referred to OAE after 4 hours, 67 recruits recovered in 24 hours.Remaining 31 recruits(45 Ears) when followed up and screened at 01 month shows refer in OAE in 22 recruits (37 Ears) and high frequency loss on PTA in 17 recruits (31Ears). At 06 months 16 recruits (28 Ears) shows refer in OAE and 12 recruits (22 Ears) shows dip in high frequency in PTA.

Conclusion: The OAE is a more sensitive method for detecting noise-induced hearing loss early on. Individuals who demonstrate REFER in OAE at both 04 hours and 24 hours with both 3 kHz and 4 kHz involved are more prone to noise induced hearing loss in the future, according to this study, which also correlates time and frequency involved in OAE in diagnosing early hearing loss.

Introduction: Diabetic retinopathy (DR) affects the majority (70% to 90%) of diabetic patients, causes visual impairment. Diabetes and vision loss can profoundly affect a patient's life. In addition, it can cause a substantial psychosocial impact. Unfortunately, there is still a considerable void in identifying, awareness and managing psychosocial distress in DR patients.

Objective: Our objective was to identify various psychosocial symptoms and evaluate the extent of psychosocial impairment in patients with different DR types.

Materials and Methods: A pretested questionnaire was used to collect data from diabetic patients at the Retina Clinic of CH Nagri Eye Hospital in Ahmedabad.It comprised ocular history, diabetes history, ocular examination data, and retinopathy type (if present). In addition, the patients were requested to complete the "General Health Questionnaire -28 (GHQ 28) for psychosocial assessment" in Gujarati.The self-scoring ranged from 0-1-2-3. (lower to higher disability, respectively). The Mann-Whitney Test was used to determine significance using statistical software.

Results: The researchers looked at 308 cases in all. The participants were separated: (A) Diabetes Mellitus Type-2 (DM-2) patients without retinopathy. (B) DM-2 patients having Non-proliferative diabetic retinopathy. (C) DM-2 patients having Proliferative diabetic retinopathy. 80.26 percent of patients with non-proliferative retinopathy and 93.75 percent of patients with proliferative retinopathy in both eyes were psychosocially affected, according to the GHQ-28 score (cutoff of point 25).In patients with proliferative retinopathy, the impairment was shown to be more severe than in those with non-proliferative retinopathy. (p-value <0.005) (Mean GHQ score in PDR=41.88 > NPDR = 35.74). In DM-2 patients without retinopathy, the average mean score was 25.22, which showed less impairment (p-value <0.005). Detailed analysis showed that there was more impairment in the field of social dysfunction.

Conclusion: Diabetic Retinopathy patients had a higher level of psychosocial impairment, indicating that it has a substantial influence on quality of life and overall health.

As a result, affected individuals must receive psychiatric counselling in order to reduce the disease's influence on the psychosocial side of their health. Along with disease control, it is vital to reduce psychosocial suffering.

Background: Macular amyloidosis (MA) is characterised by small, dusky-brown or greyish pigmented macules that are difficult to cure with topical and systemic medications. However, the Q-Switched neodymium-doped yttrium aluminium garnet (ND:YAG) laser has proven to be a successful therapeutic technique for reducing hyperpigmentation.

Aim: To study the efficacy of ND:YAG laser in the management of Macular amyloidosis.

Methods: Thirty female patients were treated with a Q-switched Nd:YAG laser at 1064 nm with a spot size of 3 mm, fluence of 6-7 J/cm2, frequency of 2 Hz, and 350-500 pulses. As the hyperpigmentation intensity decreased, the total number of pulses decreased with each therapy session. For a total of 6 treatment sessions, the technique was repeated at one-month intervals.

Results: After completing treatment sessions with the Nd-YAG laser, 36.66 percent of patients had a pigmentation improvement of more than 50%.The laser treatment was rated as satisfactory by 66.6 percent of patients.33.3 percent of patients improved by less than 25% and were dissatisfied with their treatment.

Conclusion: MA continues to be a mystery and a source of concern for both patients and doctors. The Q-switched Nd-YAG laser with a wavelength of 1064 nm has demonstrated to be effective in reducing pigmentation in MA.

Background: Fungal sinusitis is a distinct clinical entity marked by inflammation of the sinus mucosa produced by Aspergillus (fumigatus, niger, flavus), mucormycosis, Candida(albicans), Scedosporium, and pencillium infections. Immunocompromised patients, farmers, garbage collectors, and patients on long-term nasal sprays are among those who are afflicted. There are several forms of fungal sinusitis, including fungal mycetoma, allergic fungal, chronic indolent, and fulminant sinusitis, which can cause chronic headaches, face swelling, and vision loss. Patients may have polyposis and have thick purulent nasal discharge, nasal obstruction, epistaxis, cheek swelling, and thick purulent nasal discharge. Fungi colonisation is likely to be inhibited by resident bacterial flora through a variety of methods. Antimicrobial medication thus promotes the proliferation of typical fungal flora, such as Candida species, as well as the growth of opportunists such as Aspergillus [1]. The most prevalent condition is allergic fungal rhinosinusitis. The most prevalent fungal infection is aspergillosis. The most common fungal pathogen is Aspergillus fumigatus. The maxillary sinuses are frequently affected. Methods: This is a prospective study conducted at Kunal Institute of Medical Specialities Pvt Ltd's department of otorhinolaryngology. After a thorough history taking and clinical assessment, the patient is chosen for a nasal swab, culture, and sensitivity test. A simple X-ray of the nose and paranasal sinuses. The nose and paranasal sinuses are scanned with a CT scanner. Endoscopy of the nose for diagnostic purposes.

Results: The most common ailment was allergic fungal sinusitis, with aspergillosis being the most prevalent pathogen.

Conclusion: Allergic fungal sinusitis was most common in people aged 20 to 29, with the maxillary sinus being the most commonly afflicted.

According to the World Health Organization, hyperglycaemia first detected at any time during pregnancy should be classified as either diabetes mellitus in pregnancy, or gestational diabetes mellitus. Current definitions of gestational diabetes include women with diabetes and women with intermediate hyperglycaemia impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) as defined in non-pregnant adults. The use of insulin in gestational diabetes mellitus is a category B level of recommendation while the use of oral hypoglycaemic agent is category C. Whichever glucose lowering agent is used whether injectable or oral, the risk of hypoglycaemia in both mother and fetus and in the immediate neonatal period cannot be overemphasized, this fact is what makes Ademolus Classification of Hypoglycaemia (ACH) a valuable tool in evaluating hypoglycaemia complicating the management of gestational diabetes mellitus. It is noticed that studies reported on maternal hypoglycaemia had varying results due, in part, to differences in the definition of hypoglycaemia. This is one of the gap in knowledge and controversies that will be addressed usefully by Ademolus Classification of Hypoglycemia in gestational diabetes mellitus management complication worldwide, it will helps to unify definition of hypoglycaemia irrespective of race and also allow for comparing of data objectively.ACH will make interpretation of continuous glucose monitoring easier. The more we use ACH, the more we will see the gap in our existing knowledge, the more insight we will get in hypoglycaemia complicating gestational diabetes mellitus and the more scientifically knowledgeable we will become as it will open up new path of scientific understanding of fetomaternal pathophysiology for the benefit of mankind.

Background: Doctor-patient relationships are having a difficult time in this period, particularly in India. It is exemplified by the rising number of lawsuits and acts of violence against doctors. This introduces a patient-centered approach, as well as patient happiness, and leads to conceptions of quality health care. Through the Quality Council of India, there is a renewed focus on improving quality of life. Here is an attempt to seek for any causal relationship using some common indications that, if changed, could lead to a better doctor-patient relationship.

Aim and Objectives: To compare, analyse and document parameters of quality health care in Indian set up and to bring out association of quality health care indicators with patient satisfaction level statistically if any.

Methods: Patient satisfaction was measured using quality care indicators at an Ear, Nose, and Throat (ENT) Out Patient Department (OPD) in an Indian setting. These indicators are based on factors that are divided into two categories: hospital domain and doctor domain, with each parameter graded on a five-point likert scale.

Results: The statistically significant high scores in the doctor domain. The parameters with the highest scores were examination and doctor communication (domain).The hygiene and sanitation of the hospital received the highest grade from patients in the hospital domain.

Conclusion: Quality health care is multifaceted, and characteristics in the hospital and doctor domains are highly interdependent. According to statistics, a doctor's examination and communication results in a greatly improved sense of trust and doctor-patient relationship.

A few patients with hyperthyroidism are resistant to the conventional antithyroid medications. In several trials, cholestyramine has been used to sequester thyroid hormones in the intestine and when added as an adjuvant treatment to the conventional antithyroid drugs, leading to a more rapid decline in thyroid hormone levels. The objective of this study is to present a case of resistant graves’ disease that respond well to the adjunctive oral cholestyramine and to discusses the safety and efficacy of this adjunctive medication.

Here we report a 27-year-old female patient with Graves’ disease who complained of thyrotoxicosis symptoms for 18 months that not responded even to a high dose of a combination therapy of Neomercazol, Propranolol and Prednisolone. On presentation, her T4 was 19.3 (4.9 – 11.0 \(\mu\)g/mL). We administer an oral cholestyramine (5g twice daily) as adjunctive therapy. After 1 week, the patient shows dramatic response, her T4 level became 10.6 (4.9 – 11.0 \(\mu\)g/mL). Total thyroidectomy has been done after another one week of same treatment combination. The postoperative course was passed smoothly without complications.

Prisoners are created, not born. For decades, custodial fatalities have become a thorn in the side of the mistreated police control. A 32-year-old male was found dead inside prison because of depression that he was prisoned. On investigation, a ligature mark above the neck was found to be suicidal in nature. Proper prisoner care, motivation within the prison, surprise visits from higher officials, and close surveillance by CCTV may all help to avoid suicidal behaviour within the prison. The current instance provides inspiration for police officers to motivate and monitor prisoners in order to prevent suicidal behaviour.

Globally, malaria continues to be a major health problem and remains unsolved. Just like an iceberg phenomenon, WHO mentioned on their 2020 report that even though at the beginning of the third millennium there had been improvements, in the last three years (since 2017) there has actually been a plateau that seems to have slowed down efforts to eradicate global malaria. Poor access to medical service and proper treatment remains a problem in certain areas entangled in war and poverty. Other than that, persistent endemic areas with global and or regional travel of susceptible indidual to and from endemic areas increases the risk of morbidity and mortality.

Malaria causes a spectrum of signs and symptoms with classic trias consist of fever, anemia and splenomegali. Other sign that sometimes being complained by the patients is muscle and joint pain, a condition related to inflammation induced by the parasite. If that pain persistent during the course of the disease, it might probably be the untimely personalized complaint of rhabdomyolisis, a potentially fatal and lethal clinical condition that catagorized as complication of malaria or severe malaria. Without proper antimalaria treatment, the patient's condition may worsen and can be fatal.

The coeliac trunk provides arterial supply primarily to derivatives of foregut such as the stomach, spleen, the liver, gall bladder, abdominal esophagus, pancreas and duodenum. Vascular anatomy of the pancreas is very important for the surgeons to do ligation and to arrest profuse bleeding in case of any surgery involving pancreas. So the knowledge about vessels supplying pancreas and its variations is very important. Here was an unusual rare tetrafurcation of coeliac trunk. Apart from the usual three branches namely left gastric, splenic and common hepatic artery, one more branch called dorsal pancreatic artery arises directly from the coeliac trunk to supply most of the pancreas.

Aims and Objectives: To analyze the various indications for blood and blood component transfusion in obstetric patients.

1. To study the prevalence and indications for blood transfusion among obstetric patients.
2. To evaluate the various risk factors among these women.
3. To study the role of antenatal visits in patients requiring blood transfusion.

Methodology: A prospective observational study will be conducted in the department of OBG at SSIMS & RC, Davangere for a year, from July 2018 to June 2019. This study looked at pregnant women and postpartum patients (up to 7 days after birth) who were hospitalised to the OBG department and needed blood and blood component therapy. Statistical analysis will be performed using Chi square test and Student’s t test.

Results: 543 individuals out of 5486 required blood transfusions during the study period. Transfusions are used 9.89 percent of the time. Anemia, obstetric haemorrhage, thrombocytopenia, disseminated intravascular coagulopathy, ruptured ectopic pregnancy, incomplete miscarriage, full abortion, and hydatidiform mole were among the reasons for blood and blood product transfusion that we identified in our study.   The most prevalent cause was anaemia in pregnancy, which was identified in 217 cases (39.96%), followed by postpartum haemorrhage, which was seen in 117 cases (21.54 percent ). In our study, transfusion responses occurred 5.34 percent of the time.

Conclusion: A thorough understanding of blood and blood product transfusion is required to make it available to those who are truly in need while also reducing the financial burden. Regular prenatal checks should be prioritised in order to maximise haemoglobin levels at the time of delivery and identify high-risk patients. To reduce blood loss, active management of the stage of labor is essential. Anemia, followed by maternal haemorrhage, is still a common reason for blood and blood product transfusions.

Rosai-Dorfman disease, also defined as sinus histiocytosis with massive lymphadenopathy (SHML), is represented by a distorted lymph node architecture with marked dilation of lymphatic sinuses occupied by numerous lymphocytes, as well as histiocytes with vesicular nuclei and abundant clear cytoplasm with phagocytized lymphocytes or plasma cells, also known as 'emperipolesis.' This disease of unknown cause develops with a favourable prognosis only if and when it is diagnosed and treated early. A dismal prognosis is exacerbated by a late diagnosis and widespread lymph node involvement. A 29-year-old Indian woman with a 4-month history of a painful unilateral cervical tumour and low-grade fever was diagnosed with Rosai-Dorfman disease.  Fine needle aspiration (FNA) biopsy of the cervical lymph node was used to make the final diagnosis. Finally, due to the specific cytological features of SHML, FNA biopsy may be sufficient to make the diagnosis in the majority of patients, eliminating potentially unnecessary invasive procedures. The disease can be diagnosed on the histopathologically and immunohistochemically.

In more than a century, Approaches to performing thoracic surgical procedures have been changed significantly.  A milestone of those changes has been the advent of video-assisted techniques which quickly progressed from minor diagnostic procedures to the performance of almost any major thoracic surgery. by video-assisted thoracic surgery (VATS). Despite this, there are still indications for open chest surgeries, as well as the fact that thoracotomy techniques have grown to be significantly less invasive than the full thoracotomy of the past. This chapter examines the evolution of open chest techniques and describes in detail the current method of performing low invasiveness open chest surgery, which leads in excellent results with a mild postoperative course. Unresolved concerns in the comparison of video-assisted and open surgical procedures, notably in lung cancer surgery, are also discussed.

Since the beginning of use of video-assisted techniques for performance of thoracic surgical procedures more than two decades ago, the advances have been undeniable. Along that time, conversion of the initially planned video-assisted procedure to an open-chest technique because of intraoperative difficulties and/or accidents, was reasonable practiced and patients advised of that possibility beforehand. Along the same period, although numerous published studies can be find, still remain under discussion, two important areas worth to consider:  1. If in practice, similar or even better results are generally obtained.   2. If new, proved and recommended developments are in fact, followed.

In this chapter, reasons for that conversion attitude of the past are reviewed in light of the advances achieved and considerations are made about quality of video-assisted procedures. Particularly on how well advances, recommendations and guidelines are followed, specially regarding lung cancer treatment.

Metastasis is the leading cause of death in non-small cell lung cancer patients (NSCLC). Actin cytoskeletal rearrangement is frequently accompanied by cancer cell invasion and metastasis induced by the epithelial-mesenchymal transition (EMT). The expression levels of the actin-associated protein cofilin-1 and the crucial EMT molecule Twist-1 in NSCLC tissues were investigated in this work. Immunohistochemical (IHC) staining was used to identify 67.4% of tissue locations that had reciprocal amounts of cofilin-1 and Twist-1 using lung cancer tissue arrays. This reciprocal expression pattern was also found in 10 out of 15 NSCLC cell lines and 21 out of 25 clinicopathological NSCLC tissue sections. Furthermore, in tissue arrays and clinicopathological tissue samples, high levels of cofilin-1 and low levels of Twist-1 accounted for 80% and 71.5% of the reciprocal expression pattern, respectively. This pattern was also found in normal lung tissues, lung cancer tissues in stages I and II, and NSCLC tissues with adenocarcinoma subtypes. Despite the fact that cofilin-1 and Twist-1 were expressed in opposite directions, there was a positive association between the two proteins in normal lung tissues and lung tumor tissues. In addition, induced expression of cofilin-1 in H1299 NSCLC cells may suppress Twist-1 expression. A public microarray dataset with a maximum of 1,926 NSCLC samples were made accessible through an online Kaplan-Meier survival analytic tool. The investigators discovered that high levels of expression of both the cofilin-1 and Twist-1 genes were linked to lower NSCLC patient survival, particularly in the adenocarcinoma subtype. The multivariate Cox regression model was used in the analysis. Even though more data is required to confirm the reciprocal relationship between cofilin-1 and Twist-1 expression levels and NSCLC survival rates, it could be a useful indication of NSCLC progression.

Objective: Because the peripheral iris is jailed between the claws, the iris-claw lens may be fixed to the iris without using sutures, therefore implantation just takes a few minutes. As a result, the hypotonic open sky period is reduced as compared to combination surgery. The purpose of this study was to see how safe and effective retropupillary iris-claw intraocular lens insertion was in our facility.

Methods: In this prospective investigation, 36 eyes with aphakia without capsular support were included. All of the patients were thoroughly examined before receiving retropupillary iris-claw intraocular lens implantation

Results: The mean age of patients was 63.6 years with SD of 10.5 years. Highest number of patients were in the age group of 60-70 years (46%). The mean follow-up of patients was 3.1 years ranging from one month to six years. Out of 36 eyes, 25 (69%) eyes had visual acuity of 6/9, five (14%) eyes had 6/12, three eyes (8%) had 6/6 vision, two eyes had 6/24 and one presented with only perception of light and projection of rays. Subconjunctival bleeding was the most prevalent postoperative complication, occurring in 13 (36%) of patients. Due to pupillary obstruction, two eyes acquired secondary glaucoma in the postoperative period. One eye showed signs of retinal detachment. Until the latest follow-up, we had not noticed any cases of bullous keratopathy, infection, or cystoid macular edoema.

Conclusion: According to our findings and those of other research, retropupillary iris-claw implantation in such patients is the safest and most successful therapy option currently available.

The American Psychiatric Association has replaced the concept hypochondriasis with two new categories, Illness Anxiety Disorder (IAD) and Somatic Symptom Disorder (SSD), based on updated DSMV criteria.

It was plagued by imprecise definitions and was unreliable with DSM IV criteria, as it had been previously.

Hypochondriasis has two key components: disease phobia and disease conviction.   The person is frequently searching for disease information and is under a great deal of discomfort and anxiety.

These hypochondriac traits are common among medical students.

Methods: The study targeted 1175 students of which 393 from medical background and 792 was from Science University. Students were provided with self assessment questionnaire based on HAI (Health anxiety Inventory). Statistical analysis was done on observation on Anxiety index by using Chi – square on statistical software SPSS Version 22.

Results: Medical students had a slightly higher prevalence of IAD and SSD, as well as a higher level of disease phobia, than non-medical students, due to the fact that they must deal with disease characteristics throughout their lives and must read about it.

Conclusion: The overall prevalence of SSD and IAD among students was determined to be 3.28 %.

However, a more defined method is required for classification using DSM V criteria.

This is due to a categorised and unclear assessment of patients' symptomatic behaviour due to co morbidity. It suggests that a large sample size be used to determine prevalence in the general population, as well as the demographic parameters that influence the results, with more exact categorization to eliminate co morbidity and a better approach for identifying patients.

Guillain-Barre syndrome (GBS) is an autoimmune condition characterised by acute, rapidly progressive ascending paralysis involving the bilateral cranial nerves. The facial nerve is the most typically affected nerve, which is usually bilateral but can also be unilateral. In this case, we have a very rare case of unilateral facial nerve palsy in GBS. The electrophysiological tests including blink study are important in such cases. Our patient experienced demyelinating polyneuropathy in upper and lower limb motor nerves, as well as motor axonopathy in both facial nerves (left > right), which is an unusual combination in GBS patients. This can be a new variant seen in GBS patients which is first of its kind.

Background: Stroke is the world's second leading cause of mortality and a major cause of disability. Stroke is a medical emergency condition, which needs immediate hospitalization to treat and save lives.  The goal of this study is to determine the risk factors for stroke in Government general hospital Nalgonda patients.

Methods: From December 2018 to April 2019, a prospective study was undertaken on patients at the District Hospital in Nalgonda. In the hospital, all stroke patients were examined for age and sex.

Results: The study enlisted the participation of 100 stroke patients. There were 80 ischemic stroke patients and 20 haemorrhagic stroke patients among the 100 patients. Males had 64% of the strokes, while females had 36%.This incident had a 50-year-old average age.  Age was shown to be the most common predisposing factor for stroke in 72 patients, followed by hypertension in 65 patients, diabetes in 45 patients, smoking in 40 patients, alcohol in 50 patients, hypercholestrolemia in 35 patients, and others in 30 patients. Conclusion: According to this study, senility, as well as a lack of awareness of concomitant illnesses like hypertension and diabetes, is a risk factor for stroke.

The world is facing an unprecedented test by an enemy, a novel and deadly enemy, the COVID-19 pandemic. As COVID-19 continues to spread all around the world, social, political and serious economic consequences await this planet. After the introduction and a brief epidemiological summary, this article discusses the threat that is COVID-19 to major global urban centers and crowded rural areas. The impact of COVID-19 across the globe is particularly inimitable and more so in major global urban centers for several reasons including these being international hot spot destinations, global financial hubs attractive for entrepreneurs from across the globe, densely populated areas, as well as having higher percentages of low-income individuals and families.