Recent Developments in Medicine and Medical Research Vol. 6

Background: Breast cancer is a severe health problem that affects people all over the world. In underdeveloped nations, outcome indices have remained dismal despite the fact that breast cancer is now the most common cancer in women and the primary cause of cancer deaths in women in our environment.

Aims: The aim of this study was to ascertain the major challenges to good management outcome of breast cancer patients in our centre.

Methods: The case notes of all histologically confirmed cases of breast cancer presenting to our centre from January 2016 to December 2017 were reviewed. Information on the variables of interest were extracted using a proforma.

Results: Fifty-five (55) patients’ case notes were reviewed. All were females. 30.9% of the patients had early disease versus 67.3% with advanced disease. 76.4% had invasive ductal carcinoma. More lesions occurred on the left and the upper outer quadrants. 46% of the 37 patients with advanced disease who required chemotherapy completed the prescribed six courses. None of the patients who required radiotherapy received it. Only 1.8% of those who required hormonal therapy were still taking them at two years follow-up. 3.6%, 11%, and 0% used alcohol, oral contraceptives and tobacco respectively. 81.8% had been lost to follow-up at two years while 14.5% had died while on admission.

Conclusions: This study identified late presentation with advanced disease; poor compliance and adherence to treatment strategies, and poor access to adjuvant therapy as the major challenges to good outcome for this disease.

This is a case report of a patient with rhinophyma who presented with respiratory difficulties and cosmetic deformity. This study reviews the incidence and presentation of this disorder in other parts of the world and discuss management options.

Background: Tobacco smoking is one of the most widely abused drugs among people of all ages. Because of the stimulant properties of its active ingredient nicotine, cigarettes are a factor that affects reaction time. The smoking index is a tool for determining how much people smoke. The smoking index [SI] is calculated by multiplying the average number of cigarettes/bidis smoked per day by the tobacco smoking duration (in years).

Study Objectives: To measure and compare auditory reaction time in smokers with different smoking index. To evaluate smoking index as a factor associated with auditory reaction time changes.

Methods: This study was done in MR Medical College, Kalaburgi after obtaining clearance from the institutional ethical committee. For the study, 50 apparently healthy male smokers between the ages of 40 and 60 were considered. The smoking history was obtained in detail, and the auditory reaction time was recorded using a Reaction Timer. Three readings were taken, and the average of the three readings was taken, with the student's t test utilised for analysis. Statistical significance was defined as a P value of less than 0.05.

Interpretation: In our investigation, we discovered that reaction time to high and low pitch sounds is increased in smokers with higher smoking indexes compared to smokers with lower smoking indexes, which contrasts many previous studies that found smoking causes a decrease in reaction time. Conclusion: We conclude our study by observing that the smoking index has an effect on the central nervous system, but because the majority of our study subjects are elderly (aged 51-60 years), this may have resulted in an increase in auditory reaction time.

The study investigated the impact of gas flares in some cardiovascular parameters of apparently healthy pregnant women residing within gas flaring communities in Bayelsa state. Women reproductive organs have created much interest and research on this area in the medical field. Out of six hundred volunteers screened, two hundred subjects met the inclusion criteria drawn from Obuna, Polaku, Immiringi and Amossoma communities as study group. The subjects were match for age, trimesters and duration of exposure to gas flares in their respective communities. The study reveal a prevalence rate of 0.33%,0.66% and 2.33% hypertension among the pregnant women in their first, second and third trimesters but 2%,and 10.33% prehypertension during second and third trimesters with normal blood pressure of 6%, 26.66% and 17.33% in their first through third trimesters respectively during pregnancy. However, the prevalence of prehypertension and hypertension in non pregnants was (14%) and (4.66%). The study also reveal a significant increase (p<0.05) in the systolic, diastolic, mean arterial and pulse pressure with a decrease percentage difference in respect to their duration of exposure to gas flares. Further revelations from the study also indicate a negative effect of gas flares in the age of the subjects in relation to their blood pressures. In conclusion, prolonged exposure to gas flares will result in an increase case of hypertension, and cardiovascular diseases among pregnant women living in gas flaring communities in Bayelsa state, Nigeria.

Kleptomania is a disabling impulse control disorder, that can be treated with cognitive behavioral therapy (CBT). Kleptomania is disorder that affects a small percent of the general population and a larger percent of the clinical population.  This was achieved through the results of a case study. The presenting case is 20-year-old college student. The complaint at the first interview was that she was stealing from others during childhood, with other symptoms matching DSM-5 for diagnosis of kleptomania.

Objective this study detecting the symptoms of kleptomania and the causes that help this disease. In addition to use of CBT techniques to treat of kleptomania, with the application of psychological analysis theory techniques.

Used of the clinical interview, thematic apperception test (TAT) and neuroticism trait from big five personality traits. With these measurements was determined causes and level of the disorder, in addition behavior motivated and neuroticism trait.

Through the application of techniques and strategies of CBT and psychological analysis theory techniques the patient was treated for kleptomania symptoms and neuroticism trait (anxiety, anger, hostility, depression, consciousness-self, impulsiveness, stress and vulnerability). After treatment, the patient regained the ability to self-control, control of negative thoughts, and emotional stability. The study recommends for avoid harsh punishment, the Importance of using the right methods of education with children and adolescents, especially the child talented. In addition to the importance of dealing with the kleptomania as a disease and not a crime. With the possibility using of projective tests and some psychological analysis techniques with CBT.

Alpha-lipoic acid (ALA) has been widely prescribed drug for treatment and prevention of diabetic complications since it affects the main pathogenetic links. ALA has many biochemical functions acting as biological antioxidant, anti-inflammatory properties, metal chelators, reducing the oxidized forms of other antioxidant agents such as vitamin C and E and glutathione, and modulating the signaling transduction of several pathways, like insulin and of nuclear factor kappa-light-chain-enhancer of activated B cells. Prescription of ALA was associated with improvement of neurons function and conduction has been shown in several experimental and clinical trials. ALA, which plays an essential role in mitochondrial bioenergetic reactions, was considered as a valuable therapeutic option in prevention and treatment of diabetic complications, first of all diabetic neuropathy.

Medical images produced from different modalities are stored in image database. These databases should be safely moved over the public network with control viably and Medical images need to be transmitted with the patient's information without altering the image data. Medical image watermarking is a proper strategy utilized for improving security. Furthermore, validation of medical data, which is pivotal and utilized for additional deduction what's more, reference. The task centres on the investigation of medical image watermarking techniques for securing and validating medical data. Moreover, it covers calculation for utilization of water stamping procedure on. The objective of this chapter is to discuss Secured Indexing of Lung CT Image (SILI) which is a secured way of indexing the lung CT images with the patient information. Authentication is provided using the sender's logo information and the secret key is used for embedding the watermark into the host image. Watermark is embedded into the Region of Noninterest (RONI) of the lung CT image. RONI is identified by segmenting the lung tissue from the CT scan image.

Introduction: Professionalism as one of the core competencies in health care service is addressed from a patient’s point of view. Professionalism is defined as the means by which employers and employees abide by certain guidelines that ensure cordial relations with their consumers. This paper covers the rights of patients and the ethical obligations of health care workers to ensure patient’s satisfaction.

Methods: This research is of a short span and an opportunity to bring about a change in the health care institutions across the nation. Hand written documentations, and patient’s daily notes were used to gather information in this article. Internet searches based on medical publications were also used to support this article.

Results: Unprofessional behaviors displayed signified infringement of patient’s rights. For instance, false statements on routine court order to ensure mandatory medication use. Disregarding the dangers accompanying such actions. With professionalism overlooked, the normal became verbal abuse and false claims on patient’s daily notes in order to justify prolonged hospital stay and wasteful use of health funds. 

With reports made to the ethics and grievance committee, patient was given a little bit more audience. However, certain privacy rights were still ignored. Professionals that verbally abused patient were still kept on ward with minimal change to their invading of patient’s privacy.

Conclusion: Regular meetings by the board of ethics and grievance committee, which reviews these institutions and their actions regarding abuse of patients’ rights, are necessary.  Documentations of actions taken by the committee are essential to cause feasible changes that ensure quality of human life. Research has shown that lack of prompt response to unethical or unprofessional behavior as observed in the institution addressed in this paper leads to more professionals mirroring these unprofessional behaviors as if they were normal and patients left to bear the brunt. Thereby creating poor well-being of patients’ and the health care system.

Background: Predominant isolation of Candida glabrata or Candida parapsilosis in all age groups in Indian Scenario is unique. Thus, there is greater need for reproducible susceptibility testing method as a guide to selecting and monitoring antifungal therapy.

Aim: In this study, our aim was to identify and isolate Candida species from patients admitted in ICU,s of our hospital and to determine their susceptibilities to various antifungal agents so as to find the local resistance pattern and guide for empirical treatment.

Methods: In our study 37 strains of candida were isolated (4 Candida albicans, 33 Non-albicans Candida strains). Candida species were identified by conventional, biochemical and molecular methods. Antifungal susceptibility tests for amphotericin B, fluconazole, itraconazole, ketoconazole and voriconazole were performed with broth microdilution method and E- tests as described by National Committee for Clinical Laboratory Standards (NCCLS).

Results: Out of 37 Candida strains, the most prevalent species were C. tropicalis (43.2%), C. parapsilosis (24.3%), C. krusei (16.2%), C. albicans (10.8%), and C. glabrata (2.7%). Among all strains four strains (10.8 %) were resistant, two Candida albicans where found resistant to fluconazole one Candida krusei and one Candida parapsilosis were found to be resistant to all azoles.

Conclusions: Candidemia continues to be associated with substantial morbidity and mortality and non albicans Candida species are the commonly isolated pathogen from those patients admitted in tertiary care hospitals in Indian scenario. Thus, it is imperative to perform antifungal susceptibility to select appropriate and effective antifungal therapy.

Coronavirus disease-2019 (COVID-19) a pandemic has reached almost every country in the world; this crisis continues to have a significant impact on terms of lives lost and global economic growth. Current understanding of its pathogenesis is relevant to control the currect public emergency. This review aims to analyze the information on the molecular mechanisms that trigger the alterations caused by SARS-CoV-2 from published articles related to COVID-19. The COVID-19 virus infects people when the SARS-CoV-2 S protein reaches cells with ACE2 receptors, which are primarily found in the upper respiratory tract, followed by the oral cavity, and, in a lesser frequency through the conjunctiva. Inflammation and thrombus formation in symptomatic patients are the major causes of SARS-CoV-2 aggravation. This is due to an imbalance of regulation caused by diminishing ACE2 receptors, which serves to activate the regulatory axis Ang-II\(\rightarrow\) ACE2 \(\rightarrow\) Ang-(1-7) \(\rightarrow\) MAS receptor, which counteracts the negative effects of Ang-II. The ACE2 is also the main receiver for SARS-CoV-2, allowing it to initiate virulence processes in the host.

Background: Internet is used in the field of medicine for a variety of purposes, including teaching, diagnosis, medical examination, and research. It has grown into the world's largest library, with retrieval of scientific resources only a mouse click away, providing a wide range of information. Objectives: To study the pattern of internet access and utilization among first MBBS students. Materials and Methods: A cross-sectional study was carried out on 142 first-year MBBS students at an Indian tertiary health care centre. A questionnaire was used to collect data.

Results: The current study found that all students used the internet and thought it was a useful tool. Most of the individuals felt that use of internet was time saving and preferred mobile over other gadgets for various browsing activities like downloading text materials, videos and pictures. Conclusion: Despite the fact that the majority of students had knowledge and awareness of internet usage, it is not being used effectively as an educational tool. To reduce the occurrence of internet addiction behaviour, efforts should be made to implement interventional measures that can improve computer usage skills and access among students.

Background: Histopathological lesions have long been employed as biomarkers for assessing the health of organisms exposed to pollutants, and they can also serve as early warning signs of illness. We decided to conduct this investigation because there are few data on histomorphological changes in the kidney after exposure to the pesticide chlorpyrifos.

Methods: The rats used in this investigation were 45 inbred adult Wistar albino rats, both sexes, weighing 145–165 gms. These animals were divided into three groups at random: A, B, and C.The experimental groups B and C were given oral chlorpyrifos at doses of 5 mg/kg body weight and 10 mg/kg body weight, respectively. Group A was designated as the control group and was left as such. After 1 week, 2 weeks, 4 weeks, 6 weeks, and 8 weeks of the experiment, 3 mice from each group were sacrificed to see the histological alterations in the kidney architecture.

Results: There are no histological changes in Group A. After one week, there were no histological changes in the kidneys in Group B. At the beginning of treatment, there was glomerulus shrinkage, tubular dilation, glomerular hypercellularity, tubular epithelial hypertrophy, degeneration of renal tubules, and deposition of eosin positive substance in the glomerulus and renal tubules. There was lymphocyte infiltration and enhanced vascularity in the form of dilated vessels, fibrosis, and interstitial oedema in the interstitium. All of these changes pointed to glomerulonephritis, acute tubular necrosis, and interstitial nephritis, all of which can contribute to acute renal failure that progresses to chronic renal failure over time. The kidneys of 1 week Chlorpyrifos-treated rats showed reduced glomeruli and renal tubular epithelial hypertrophy in Group C.

The differences between Group A and Group B were more pronounced from the second to the eighth week.

Conclusion: The current study found that Chlorpyrifos caused significant histomorphological changes in the kidneys of rats. These changes were noticeably different from those seen in control rats. As a result, this study shed light on the renal toxicity caused by chlorpyrifos, which was discovered to be significant at high dose levels.

Psoriasis (Da'u-us-Sadaf) is a common, disfiguring, inflammatory, and chronic autoimmune skin illness that affects people all over the world. Europeans have the highest incidence, while Asians from the East have the lowest. In India, the prevalence of psoriasis in adults ranges from 0.44 percent to 2.8 percent. The name psoriasis derived from the Greek word psora, which means "itch," and iasis, which means "activity, condition." Da'u-us-Sadaf is formed from the Arabic terms "daun" and "Sadaf," which mean "disease" and "oyster shell," respectively. Since ancient times, psoriasis or Da'u-us-Sadaf has not been mentioned in any classic literature. Famous Unani physicians Razi, Majoosi, Ahmad Bin Mohd Tabari, Ibn-e-Zohr, Akbar Arzani, and Azam Khan viewed it in the context of Taqashur-e-Jild and Qashaf-e-Jild because of dryness of the skin and scale formation, which clinically resembles psoriasis (Da'u-us-Sadaf). According to Ali Ibn-e-Abbas Al- Majoosi, Tabiyat expels the Khilt-e-Ghaleez from internal organs to the skin, causing dryness and itching, but the skin is unable to eliminate the Khilt-e-Ghaleez, resulting in the accumulation of sauda in the skin and the production of Taqashur-e-Jild. Unani scholars has emphasized the Usool-e-Ilaj (principle of treatment) ,which includes evacuations of black bile (Istifragh or Tanqiyahe Sauda), use of blood purifier (Tasfeeh-e-Dam), Munzijate Sauda (Melancholic concoctives), Mushilate Sauda (Melancholic purgatives), Tabreed Badan (genesis of ratoobat or fluids in the body), try to restore normal temperament (Tadeele Mizaj), topical application of jali (detergent), murakhi (emollient), murattib and mohallil (anti-inflammatory) advia. In this review we have tried to discuss about Unani and modern aspects of psoriasis (Da’u-us-Sadaf).

Objectives: To review the treatment of psoriasis through modern medicine as well as unani medicine. To know about facts of psoriasis.

Background: Pediatric palliative care services in the world are provided through two principal models: Institutional and home-based. Integration of those models is also applied.

Aim: To assess the effectiveness of home-based pediatric palliative care model in the developing economy setting of Ukraine.

Design: Retrospective analysis of Ukrainian nation-wide data from pediatric palliative care providers using different pediatric palliative care models was conducted.

Data Sources: Original research data for January 2014 – December 2018 based on the Ukrainian National Scientific Medical Library database records available for four service providers (N=4) (one institutional, two home-based, one integrated model), was analyzed. 7 studies (N=7) were evaluated based on the set of outcomes: morbidity and mortality, health care utilization, patients’ quality of life, cost-and time- effectiveness and continuity of care.

Results: Use of home-based pediatric palliative care model in Ukraine improves health-related and health care utilization outcomes and the patients’ quality of life by wider coverage of families’ psychological/social demands, including home-based death. Under the developing economy conditions, it is more cost-and time-effective than institutional model. Due to Ukraine geographic specifics, it allows wider population coverage and better health services use. To ensure continuity of care, coordination of services between different care providers, defining a detailed scope of the national health insurance coverage for home care services, and rapid transfer protocols elaboration is essential.

Conclusion: Cost-and time-effectiveness of mobile units’ establishment improves health care resources use in lower middle-income country. Home-based pediatric palliative model is an effective way of the development of national pediatric palliative care infrastructure under lower middle income country conditions.

Anemia is a common problem during pregnancy, and no reference values for haematological parameters during pregnancy have been reported in the rural population. Present study was aimed to study the hematological profile of normal pregnant females of western India. The prime objectives of present study were to determine the hematological parameters in all three different trimesters of rural pregnant women and their comparison with matched nonpregnant control group.  A longitudinal study was undertaken in a cohort of 302 normal, apparently healthy rural pregnant women who attended the Dhiraj General Hospital's antenatal clinic in Vadodara, Gujarat, India. Apparently healthy 94 nonpregnant women matched with age and socioeconomic status was studied as control. Blood sugar, Hb concentration, packed cell volume (PCV), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), total and differential leucocyte concentration (TLC & DLC), red cell distribution width (RDW), red blood cell count (RBC) and platelet count were studied in both groups.  Sumandeep Vidyapeeth's ethical standards were followed during the research. The ANOVA test was used to analyse data from different trimesters, and the unpaired t-test was used to compare pregnant and nonpregnant females (\(\alpha\) error was set at 5% level). Statistical significant variations were recorded for platelet count, RDW, PCV, TLC and DLC in all trimesters during pregnancy, while other parameters like RBC count, blood indices, Hb concentration remain unaltered during pregnancy. Comparison of pregnant with nonpregnent shows significant changes (p < 0.05). Our results represent the rural population data and prepared a base for reference value for this ethnic group. Although pregnancy affects the haematological parameters, our results evident that pregnancy is a state of adaptation.

Objective: To report a rare case of inverting papilloma originating from the lacrimal sac, and to review the literature of inverting papilloma of the lacrimal sac as main origin.

Method: Case report.

Results: Inverting papilloma is uncommon in the lacrimal sac. More often it presents in the maxillary sinus, ethmoid sinus and lateral wall of the nasal cavity. This is a case of a 69 year old, Filipino male, who presented with a two-year history of gradually enlarging left medial canthal mass, and tearing. The patient had no history of trauma. There were no ophthalmoplegia, visual disturbances, proptosis or pain but there was globe displacement superolaterally. Orbital CT-scan revealed a heterogenously enhancing mass extending to the ipsilateral nasolacrimal canal and nasal cavity causing mass effect. There was note of a suspicious area of hyperostosis. Patient was referred to the Department of Otolaryngology Head and Neck Surgery for co-management. Punch biopsy was done and histopathology revealed inverting papilloma. Combined surgical management of anterior maxillectomy via lateral rhinotomy approach and dacryocystectomy was done. Intraoperatively, there was note of adhesion to bone in the area of the lacrimal sac corresponding to the area of hyperostosis on CT-scan. Post-operative recovery was unremarkable with unchanged visual acuity and extraocular muscle movement.

Conclusion: This is a case of an inverting papilloma involving the lacrimal sac and nasolacrimal duct that was managed with combined anterior maxillectomy via lateral rhinotomy approach and dacryocystectomy for complete resection. We recommended complete resection of the tumor to minimize recurrence. Origin in the lacrimal sac area was confirmed by intraoperative findings which correlated with CT- scan findings.

Objective: To determine the relationship between the prostate volume and the serum values of prostate specific antigen (PSA)among patients in the “grey zone, “classified according to their age group.

Material and Methods: Prospective and retrospective 1420 patients classified in four age-groups  with LUTS were analyzed. Patients were treated for Benign prostate hyperplasia (BPH) in the urology clinical at the University Clinical Center of Kosovo during the period of January 2010 - October 2014. Data were recorded from patients according to age, prostate size estimated by trans abdominal ultrasound using 3.5MHz ultrasonography, according to the ellipsoid formula, V = D1xD2xD3/2.5, volume of  prostate, V=T x AP x CC x Pi /6 where T =  transverse diameter, AP =  antero -posterior diameter, CC = cranial caudal diameter. Patients with confirmed prostate cancer were excluded from the study. Statistical analyses used t-test and ANOVA with 95 and 99% confidence intervals. 

Results: For the “grey zone” patients, these mean values were 44.6 cm³ and 5.9 ng/mL.

Conclusions: PSA is strongly correlated with prostate volume and age in patients with BPH. The data provide evidence to support that prostate volume and serum PSA concentration significantly correlate with aging and within the “grey zone” patients.

Aims: To evaluate changes in electrolyte profiles during dual pharmacotherapy with amlodipine (AML) and hydrochlorothiazide (HCZ) in hypertensive Nigerians.
Introduction: In Nigeria, hypertension is the commonest non-communicable disease representing the commonest cardiovascular cause of hospitalisation and mortality among the indigenous people.
Study Design: Randomized, open-label, prospective, two-centre, outpatient, 48-week study.
Methodology: We enrolled 90 male and female Nigerians aged 31-86 years with uncomplicated essential hypertension (blood pressure [BP] > 160/90 \(\le\) 180/120mmHg). Patients, who were 30 each (15males [M] and 15females [F]) in AML, HCZ and AML-HCZ groups, were treated, respectively, with 5mg AML for 6 weeks (wks) and the dose increased to 10mg till wk 12 (monotherapy) after which HCZ 25mg was added; HCZ 25mg till wk 6 (monotherapy) after which AML 5-10mg was added; and AML 5-10mg + HCZ 25mg. Body mass index (BMI), BP, 24h urine volume, serum and urine electrolytes (Na+, K+, Cl-) were assessed at baseline and at the end of wks 1, 3, 6, 12, 24, 36 and 48 during treatment.
Results: The 3 regimens comparably significantly (P= .05) reduced BP. Diuresis was greatest and significant (P= .05) in HCZ group. A time dependent significant (P< .0001) hyponatraemic changes were observed in all subgroups except AML M subgroup such that the mean maximum M/F decrease in AML, HCZ and AML-HCZ groups, respectively, were 5.07/14.74, 17.40/16.40 and 10.93/16.86 mmol/L. A parallel significant (P< .01) increase in urine Na+ was observed in all groups with maximum mean M/F increase in AML, HCZ and AML-HCZ groups being, respectively, 26.00/24.40, 28.07/40.94 and 30.47/27.67 mmol/L. A baseline hypokalaemia was observed in all groups except in the AML M subgroup. Significant (P< .0001) M/F hypokalaemic changes were 0.23/0.35, 0.76/0.53 and 0.18/0.19 mmol/L for AML, HCZ and AML-HCZ groups, respectively. Corresponding significant (P< .0001) M/F increase in urine K+ were 4.60/5.71, 10.67/18.60 and 8.2/9.3 mmol/L for AML, HCZ and AML-HCZ groups, respectively. Significant (P= .05) disproportionate chloraemia was observed at baseline in all groups. The observed significant (P< .0001) M/F hypochloraemic changes in AML, HCZ and AML-HCZ groups were, respectively, 10.60/11.46, 25.60/26.94 and 22.93/17.67. A significant (P < .0001) parallel hyperchloriuria was evident in all groups and M/F values in AML, HCZ and AML-HCZ groups were, respectively, 8.09/6.46, 26.00/39.86 and 24.53/18.00 mmol/L.
Conclusion: Long-term AML and HCZ combination therapy, though effective, is associated with biochemical changes – Na+, K+ and Cl- depletion, thus making serum electrolytes monitoring and K+ supplementation or concomitant use of a K+-sparing diuretic clinically imperative. The associated robust natriuresis and diuresis suggest that the patients were salt-sensitive and so may benefit from salt restriction as a lifestyle intervention to control hypertension.

Introduction: The surgical removal of the appendix is known as an appendectomy. Appendectomy can be done either laparoscopically or openly. It should be performed immediately otherwise it could burst and the bacteria and fecal particles within the organ can spread into the abdomen. Laparoscopy is now commonly used as patients can resume normal activity in less time than with open appendectomy. Patients had a better cosmetic outcome and significantly less postoperative discomfort.

Study Objectives: We attempted to identify predictors of difficult appendectomy using history and clinical examinations, preoperative laboratory data, ultrasonography findings, and intraoperative findings in this study.

Materials and Methods: The research was carried out at Agra's Sarojini Naidu Medical College.

The study included all patients who underwent laparoscopic appendectomy between January 1st, 2016 and June 30th, 2017.

A detailed Performa was created to record patient history, physical examination, laboratory parameters, ultrasonography (USG) findings, and intra-operative details.

A difficult appendectomy was defined as a laparoscopic appendectomy that took more than 120 minutes and was converted to an open surgery due to difficulty in surgery rather than complications. Severe adhesion was considered a case of difficult appendectomy.

Results: We discovered thatthe difficult laparoscopic appendectomy can be predicted preoperatively based on age > 60 years, history of previous lower abdominal surgery, time of onset to surgery > 24 hours, acute appendicitis and periappendicular collection.

Conclusion: There are few reports determining the predictors of difficult appendectomy, and more research is needed to establish them.

Background: Solid organ injuries are the most common type of injury during blunt abdominal trauma (BAT).

When compared to non-hollow viscus injuries, hollow viscus injuries are far more common.

The most serious issue with these disorders is that, despite modern procedures like focused abdominal sonography for trauma (FAST), computer tomography, and magnetic resonance imaging, they are frequently undetected or diagnosed too late. This study evaluates gastrointestinal perforation following blunt abdominal trauma, their anatomical distribution, diagnosis, management, and outcome.

Study Objective: This study evaluates gastrointestinal perforation following blunt abdominal trauma, their anatomical distribution, diagnosis, management, and outcome.

Methods: The study was a prospective observational study that was carried out after receiving ethical approval from the hospital. Patients who presented with symptoms of peritonitis following blunt trauma, with isolated injury to the abdomen, and who were found to have gastrointestinal perforation on exploratory laparotomy were included in the study. Exclusion criteria included no perforation discovered during surgery and penetrating abdominal trauma. Each patient's data was entered into the Performa that had been set up for the study.

Results: During the study period, 32 patients were operated on for perforation caused by blunt abdominal trauma. The most common site of perforation in the study subjects was the jejunum, followed by the ileum and then the stomach. Among the procedures performed, simple perforation closure with peritoneal lavage was the most frequently performed procedure in 24 patients (75.0 percent). Resection anastomosis was performed in 3 (9.3 percent) of the cases, while stomas were created in 5 (15.6 percent) of the patients. In the postoperative period, 5 (15.6 percent) patients experienced complications, with chest infection being the most common. One patient died during the postoperative period, resulting in a 3.1 percent mortality rate.

Conclusion: To summarise, early detection and treatment are critical. The jejunum is the most common site of perforation in blunt trauma. Early surgery after adequate resuscitation is associated with a very good outcome in gastrointestinal perforation following blunt trauma to the abdomen.

A 45-year-old male patient with diabetes mellitus was diagnosed with testicular necrosis in this case. Past history suggestive of diabetes with very irregular medication. For three weeks, the patient had gradually increasing right testicular enlargement. Ultrasonography revealed an abscess with no vascularity in the right testis. The right orchiectomy was completed. Testicular necrosis was confirmed by histopathology. Testicular necrosis is a common complication after torsion which leads to orchiectomy. In those cases, patients present with acute onset scrotal pain, which is usually unilateral. On examination, the testis is acutely tender, with red and angry-looking skin overlying it. Urinary tract infections and epididymo-orchitis are common in diabetic patients. Patients present with testicular pain, fever, leucocytosis, and other symptoms.

However, testicular necrosis is extremely uncommon. Retinopathy, nephropathy, and neuropathy are long-term complications of diabetes mellitus. Patients with all forms of diabetes of sufficient duration, including insulin-dependent diabetes mellitus and non-insulin-dependent diabetes mellitus, are vulnerable to these complications, which cause serious morbidity. Diabetes mellitus can cause testicular necrosis, which is a very rare complication. An internet search turned up no articles about testicular necrosis as a diabetes complication. For the first time, a case of unilateral testicular necrosis as a complication of diabetes mellitus is presented. This unusual complication was most likely caused by accelerated microangiopathy combined with poor blood glucose control.

Diabetes is a common metabolic disorder that affects the global population and is responsible for a significant portion of morbidity and mortality, primarily because of its micro-vascular and macrovascular complications. This is a comparison study that looks at the relationship between platelet indices such as mean platelet volume, platelet distribution width, plateletcrit, and total platelet count in diabetic patients with and without microvascular problems. This  review of the literature was carried out using an Internet search on a public access website such as PubMed, Google Scholar, or Medline databases until 2019. The studies that included patients with macrovascular problems and those using medicines that change platelet indices were the main exclusion criteria. All of these articles were analyzed. When compared to those without microvascular difficulties, platelet indices such as mean platelet volume and platelet distribution width were significantly larger in those with microvascular consequences, primarily Diabetic Nephropathy and Diabetic Retinopathy. Diabetic microvascular problems were found to be significantly linked with changes in platelet indices. As a result, these variables can be utilised to monitor and forecast the risk of microvascular problems.