International Journal of Medical and Biomedical Studies

Complex Tooth Extraction: An Overview

Inneke Cahyani — 2025-03-26

Tooth extraction is a common dental procedure, but complex cases present significant challenges due to anatomical and pathological variations. Factors such as root dilaceration, fusion, gemination, hypercementosis, dense cortical bone, and ankylosis can complicate extraction, increasing the risk of root fractures, excessive bleeding, infection, and paresthesia. Proper preoperative assessment, including cone-beam computed tomography (CBCT), is crucial for identifying these complexities and planning appropriate surgical techniques. Advances in minimally invasive approaches, such as piezosurgery and periotomes, have improved outcomes by reducing trauma and enhancing healing. This literature review synthesizes documented cases of complex extractions, highlighting the challenges encountered and the effective management strategies employed. By integrating current evidence and surgical advancements, this review aims to enhance clinical decision-making, improve patient outcomes, and minimize complications in complex tooth extractions.

Keywords: Surgical extraction ,Tooth Extraction, Dental anomalies, Complications

Bardet-Biedl Syndrome: A Case Report

Sagar Sahadeo Akarte — 2025-03-26

Bardet Biedl syndrome is an autosomal recessive ciliopathy. The primary clinical features of BBS include rod?cone dystrophy, polydactyly or dystrophic extremities (brachydactyly and syndactyly), obesity, reduced intelligence, renal dysfunction, and male hypogonadism that manifests in the first decade of life with polydactyly as a congenital feature. The other commonly associated secondary features include hepatic fibrosis, endocrinological disturbances such as diabetes mellitus, hypercholesterolemia, and reproductive abnormalities, short stature, speech defects, and developmental delay. We report a 29-year-old male patient presenting with classical features of BBS with significant similar history in siblings. we confirm the diagnosis on basis of clinical criteria. Genetic testing could not be done due to limited resources. There is no definite treatment. Early diagnosis and symptomatic, supportive and rehabilitative measures can reduce the disability. This includes dietary modification, oral hypoglycaemic drugs, testosterone supplement etc. Relatives of the patient should be screened for renal abnormality.

Keywords: Bardet-Biedl Syndrome, retinitis pigmentosa, hypogonadism

Milan Scoring System for Diagnosing Salivary Gland Lesions: Assessing the Risk of Malignancy

Manish Kumar Saroj — 2025-04-07

Background: Salivary gland lesions encompass a wide spectrum of benign and malignant conditions, necessitating accurate preoperative diagnosis for optimal patient management. Fine-needle aspiration cytology (FNAC) is a widely used diagnostic tool; however, the variability in interpretation has led to the development of the Milan Scoring System, which stratifies lesions based on the risk of malignancy. This study evaluates the effectiveness of the Milan Scoring System in diagnosing salivary gland lesions and assessing malignancy risk.

Aim: To assess the diagnostic accuracy of the Milan Scoring System in salivary gland lesions by correlating FNAC results with final histopathological diagnoses.

Methods: 400 patient records from Madhubani Medical College and Hospital in Bihar were used in a two-year retrospective observational research. The Milan Scoring System was used to classify the FNAC data, and 362 instances had histological confirmation. SPSS version 23.0 was used for statistical analysis, which included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

Results: Of the 400 cases, 218 (54.5%) were females and 182 (45.5%) males, with a mean age of 45.6 years. FNAC categories were distributed as follows: Category 1 (7.5%), Category 2 (42.5%), Category 3 (10.5%), Category 4 (27%), Category 5 (6.5%), and Category 6 (6%). Histopathological confirmation was available in 362 cases. The Milan System demonstrated a sensitivity of 85.6%, specificity of 92.3%, PPV of 88.4%, NPV of 90.8%, and overall diagnostic accuracy of 89.5%. The risk of malignancy ranged from 1.8% in Category 2 to 91.7% in Category 6. The parotid gland was the most commonly affected site (57%).

Conclusion: The Milan Scoring System is a reliable tool for classifying salivary gland lesions, demonstrating high diagnostic accuracy and strong correlation with histopathological outcomes. Its structured approach aids in risk stratification, reducing unnecessary surgeries while ensuring timely management of malignant cases.

Recommendations: To improve the system's applicability, more prospective studies with bigger cohorts and multi-center validation are advised. Additionally, integrating molecular diagnostic techniques with FNAC may improve diagnostic precision, particularly in indeterminate (Category 3) cases.

Keywords: Salivary gland lesions, Milan Scoring System, FNAC, malignancy risk, histopathology correlation

Spermatocytic Tumor of Testis In 31 Year Old Male Patient: A Rare Case Report

Sumiti Gupta — 2025-04-24

Case summary: 31-year-old male presented with swelling in left scrotum since 2 years. Patient was apparently alright 2 years back but later on he started having increase in testicular size progressively and had a episode of perrectal bleeding 20 days back. Contrast-enhanced MRI of pelvis showed a large heterogeneous lesion measuring 12x9x7 cm involving left testis. There is enhancement and diffuse restriction,?neoplastic nature,?germ cell tumor of left testis. Left orchidectomy was done and the specimen was sent to pathology department. On histopathology and IHC examination, the features were consistent with spermatocytic tumor. Spermatocytic tumor indeed, is a rare but distinct subtype of testicular germ cell tumor, comprising about 1% of all testicular germ cell tumors and a small percentage of all seminomas. Its occurrence is primarily in older males, typically in the 5th and 6th decades of life, distinguishes it from classic seminoma, which is more common in younger age groups. Histopathology and immunohistochemistry are necessary for confirmatory diagnosis.

Keywords: Testicular tumor, Germ cell tumor, Spermatocytic tumor.

Microbial Profile of Infections in Various Surgical and Non-Surgical Intensive Care Units

Chinchu Elizabeth John — 2025-04-17

Background : Intensive care units(ICUs) are specialized departments that provide life-sustaining treatment to critically ill patients. ICUs can be broadly categorized into two types: Surgical ICUs(SICUs) and Non-surgical ICUs (NSICUs). Infections with resistant strains in the ICUs leads to increased mortality, morbidity and health care cost. The microbiological profile of ICUs plays a critical role in guiding antimicrobial therapy, infection control measures, and patient outcomes.

Aims and objective : To study the isolates causing infections in various surgical and non-surgical ICUs and their antimicrobial susceptibility pattern.

Materials and Methods : A cross sectional study was conducted in various ICUs (MICU,PICU,NICU,SICU,TICU) . Samples like blood , Endotracheal aspirate, sputum/BAL, CSF, pleural fluid, ascitic fluid, peritoneal fluid, urine, pus were collected from the patients admitted in various ICUs. These samples were transported immediately to Department of Microbiology laboratory .All samples were processed by Standard bacteriological techniques and the Antimicrobial susceptibility testing was done by Kirby-Bauer disk diffusion method and results were interpreted in accordance with CLSI 2023 guidelines.

Results: Respiratory infections were more common in both non-surgical and surgical ICUs(46.07% and 62.92% respectively ) , followed by blood stream infection, skin and soft tissue and urinary infections. Gram negative pathogens were predominant which include Klebsiella pneumoniae(32.30%),Acinetobacter baumannii (15.17%), Pseudomonas aeruginosa (14.05%), Escherichia coli (10.67%). Among these, 30.16% were ESBL producers, 14% were MBL producers, and 6.44% were Amp C producers. Gram-positive cocci, primarily Staphylococcus aureus, constituted 17.13% of isolates, with 60% of Staphylococcus aureus isolates being methicillin-resistant.

Conclusion: High prevalence of gram-negative bacterial infections and multi-drug resistant isolates was noted in Indian ICUs.

Keywords: Intensive care units, Klebsiella pneumoniae, Acinetobacter baumannii, drug resistance

Assessment of Prothrombin Time, International Normalized Ratio, and Platelet Count in Women with First-Trimester Vaginal Bleeding

Priti Singh — 2025-04-17

Background: Vaginal bleeding during the first trimester of pregnancy is a common clinical issue, affecting a significant proportion of women. Coagulation abnormalities such as prolonged prothrombin time (PT), elevated international normalized ratio (INR), and altered platelet count may play a role in the severity of bleeding and pregnancy outcomes. However, the relationship between coagulation parameters and early pregnancy complications remains inadequately explored.

Aim: The aim of this study was to evaluate PT, INR, and platelet count in women with first-trimester vaginal bleeding and examine their association with pregnancy outcomes.

Methods: This was a retrospective observational study conducted at Madhubani Medical College and Hospital, Madhubani, Bihar, over a period of two years. A total of 115 women presenting with vaginal bleeding during the first trimester of pregnancy were included. Coagulation parameters, including PT, INR, and platelet count, were assessed, and their relationship with pregnancy outcomes (viable pregnancy, threatened miscarriage, and complete miscarriage) was analyzed using SPSS version 23.0. Descriptive and inferential statistical methods were applied, with a significance level set at p < 0.05.

Results: The mean PT was 13.6 ± 1.4 sec, INR was 1.08 ± 0.12, and platelet count was 198.5 ± 48.3 × 10?/L. Women with a history of miscarriage had significantly higher PT and INR values compared to those without. Coagulation abnormalities (prolonged PT or INR >1.2) were observed in 16.5% of participants. A higher incidence of coagulation abnormalities was found in women presenting at later gestational weeks (10–12 weeks). Platelet count was inversely related to the severity of bleeding, with lower platelet counts observed in women with severe bleeding.

Conclusion: Coagulation abnormalities, particularly prolonged PT and elevated INR, were significantly associated with adverse pregnancy outcomes in women with first-trimester vaginal bleeding. Additionally, lower platelet counts were linked to increased bleeding severity. Early assessment of coagulation parameters can help predict pregnancy outcomes and guide clinical management.

Recommendations: Routine assessment of coagulation parameters should be considered in women presenting with first-trimester vaginal bleeding to identify those at higher risk for adverse outcomes. Further prospective studies with larger sample sizes are needed to explore the causal relationship between coagulation abnormalities and early pregnancy complications.

Keywords: First-trimester bleeding, prothrombin time, international normalized ratio, platelet count, pregnancy outcomes.

Sero-predominance of Transfusion-Transmitted Infections Among Blood Donors at a Tertiary Care Teaching Hospital in North Bihar, India

Manish Kumar Saroj — 2025-04-17

Background: Blood transfusion is a critical therapeutic intervention that saves millions of lives worldwide. However, transfusion-transmitted infections (TTIs), such as Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Human Immunodeficiency Virus (HIV), and Syphilis, pose significant health risks to recipients. Despite advancements in screening and testing protocols, TTIs continue to be a public health concern, especially in resource-limited settings. Blood donation practices in regions like North Bihar still face challenges due to a higher proportion of replacement donors and insufficient screening methods.

Aim: This study aims to assess the sero-predominance of TTIs among blood donors at a tertiary care teaching hospital in North Bihar, India, and to identify the demographic and infection-related factors correlated with TTI positivity.

Methods: This retrospective study included 125 blood donors who donated blood at Madhubani Medical College and Hospital, Bihar, over a two-year period. Donor records were reviewed for demographic data and screening results for TTIs (HBV, HCV, HIV, Syphilis, and Malaria). The sero-predominance of TTIs was analyzed, and statistical tests (Chi-square) were applied to determine the association between donor demographics and infection status. Data analysis was performed using SPSS version 23.0.

Results: Out of 125 blood donors, 10 (8%) tested positive for TTIs. The most common infection was Hepatitis B (4%), followed by HIV (1.6%), HCV (1.6%), and Syphilis (0.8%). No cases of Malaria were detected. TTIs were more prevalent among male donors (9 out of 10 cases) and the 31-40 years age group (40%).

Conclusion: The sero-predominance of TTIs among blood donors in this region is notable, with Hepatitis B being the most prevalent infection. While the study found no significant association between gender and TTI positivity, it highlights the necessity for enhanced screening practices, especially for voluntary donors. Further, age-specific screening strategies may be useful in identifying high-risk groups.

Recommendations: It is recommended to strengthen voluntary blood donation programs, increase awareness regarding infection prevention, and implement nucleic acid testing (NAT) to improve blood safety. Regular health education for donors and healthcare workers is essential to mitigate the risks of TTIs.

Keywords: Sero-predominance, Transfusion-Transmitted Infections, Blood Donation, Hepatitis B, Blood Safety

Co-Relation Between USG- Guided Methods and Conventional Methods for the Assessment of Airway and Cormack Lehane Grading in Adult Patients - A Randomized, Double Blinded Prospective Observational Study

Swapnil Keshav — 2025-04-19

Background: A comprehensive examination of the airway is essential for secure anesthetic administration. Conventional clinical evaluations, like the Mallampati classification and thyromental distance, are commonly employed although frequently lack reliability in predicting challenging airway situations. The introduction of point-of-care ultrasonography (POCUS) has established non-invasive imaging as a valuable supplement in preoperative airway assessment. This study examines the efficacy of ultrasound-guided measurements relative to traditional methods in forecasting Cormack-Lehane (CL) grades during laryngoscopy.

Objective: To evaluate the predicted accuracy of ultrasound-guided assessment compared to conventional methods in identifying difficult laryngoscopy, as indicated by CL grading, and to ascertain whether their combination improves overall predictive performance.

Method: A randomized, double-blind, prospective observational study was performed at the Indira Gandhi Institute of Medical Sciences in Patna over the course of one year. One hundred twenty adult patients scheduled for elective procedures under general anesthesia were enrolled. Airway evaluations were conducted utilizing conventional methods (Mallampati classification, thyromental distance, etc.) and ultrasound-assisted metrics (skin-to-epiglottis distance [SED], hyomental distance ratio [HMDR], etc.). The anesthesiologist conducting the intubation was unaware of the evaluations. The link with CL grades was examined by Pearson correlation, logistic regression, and ROC curves.

Result: Ultrasound-guided metrics exhibited enhanced prediction precision relative to traditional techniques. SED ?2.54 cm and HMDR ?1.2 were substantially correlated with challenging laryngoscopy (CL Grade III–IV), with sensitivities of 78.5% and 83.3%, respectively. Conversely, conventional procedures like Mallampati class III–IV and thyromental distance <6.5 cm exhibited diminished sensitivities (47.6% and 59.4%). The integration of two modalities resulted in the highest prediction accuracy, achieving an AUC of 0.93.

Conclusion: Ultrasound-guided airway assessment is a dependable, objective, and reproducible method that improves the prediction of challenging intubation. When combined with traditional clinical methods, it markedly enhances the sensitivity and specificity of airway assessment. Integrating POCUS into conventional preoperative screening techniques may improve patient safety and diminish airway-related problems.

Keywords: Airway examination, ultrasonography, Cormack-Lehane classification, endotracheal intubation, point-of-care ultrasound, preoperative assessment

Biological Effects of Radiation Therapy on Cancer Cells

Harihar Nath Tiwari — 2025-03-07

Background: Radiation therapy damages tumour cells' DNA and induces apoptosis, a common cancer treatment. The biological response to radiation depends on tumour type, genetics, and microenvironment. This study examines radiation therapy's effects on cancer cells and tumour regression and survival.

Methods: A prospective observational study of 150 radiation therapy patients was done at Patna Medical College and Hospital (PMCH) from April 2022 to March 2024. The biological response was evaluated using ?-H2AX DNA damage markers, caspase-3 apoptosis markers, and tumour regression rates. We also examined treatment-related toxicity and survival.

Results: Of the patients, 85% demonstrated a strong DNA damage response (?-H2AX expression) and 70% indicated enhanced apoptosis (caspase-3 activation). Head and neck (75%) and cervical (70%) malignancies had the highest tumour regression rates (68%). Patients had 40% treatment-related toxicities, 10% of which were severe (Grade 3–4). PFS was 65% and OS was 72% at 1 year.

Conclusion: Radiation therapy effectively induces DNA damage and apoptosis, leading to significant tumor regression. However, tumor resistance remains a challenge, necessitating further research into radiosensitizers and combination therapies to enhance treatment efficacy.

Keywords: Radiation therapy, DNA damage, apoptosis, tumor regression, survival outcomes

Management Complexity of Elderly Cancer Patients: the Potential of Radiation Oncology

Harihar Nath Tiwari — 2025-03-07

Background: Age-related physiological changes, various comorbidities, and higher treatment toxicity make elderly cancer patients distinctive. Radiation therapy is important in curative and palliative contexts, although its effects on clinical outcomes need greater study.

Methods: This retrospective analysis examined 160 elderly cancer patients (?60 years) who received radiation therapy at PMCH from April 2022 to March 2024. Assessments included patient demographics, cancer kind, disease stage, treatment intent, radiation procedures, toxicity profiles, and clinical results. OS and PFS were analyzed by illness stage, performance status, and radiation modality.

Results: Patients had a mean age of 68.4 ± 5.7 years, with 58.7% men and 41.3% females. The most prevalent cancers were head and neck (30%), lung (20%), and gastrointestinal (17.5%). In 61.3% of instances, radiation therapy was curative and in 38.7% palliative. Advanced methods like IMRT and SBRT enhanced response rates and reduced toxicity. Curative cases had an ORR of 81.6%, a median OS of 24.8 months, and a median PFS of 15.2 months. Acute toxicity (Grade 3–4) was 30% and late toxicity was 16.3%. Advanced-stage illness and many comorbidities were linked to poor prognosis (p < 0.05).

Conclusion: Radiation therapy is an effective treatment modality in elderly cancer patients, providing significant survival benefits and symptom relief. Advanced radiation techniques improve outcomes while minimizing toxicity. A personalized, multidisciplinary approach is essential for optimizing treatment in this vulnerable population.

Keywords: Elderly cancer patients, radiation therapy, survival outcomes, treatment toxicity

Role of USG in Patients with Acute Abdomen

Kanika Purohit — 2025-03-17

The main goal of imaging in acute abdomen is to narrow down the differential diagnosis and for prompt treatment. This study was done on patient presented with acute abdomen in Department of Radiodiagnosis , Sardar Patel Medical College & Associate Group of Hospitals, Bikaner. USG was able to diagnose 94% cases of perforation peritonitis. intestinal obstruction was diagnosed only in 73.17% of cases with USG. This study shows that simple X-Ray plays an important role in definite diagnosis of acute abdomen as compare to USG.

Keywords: Ultrasound, X- Ray, Acute Abdomen

Evaluation of Diabetes related distress and its prevelance in patients with Type 2 diabetes Mellitus

Kanika Purohit — 2025-03-17

Diabetes Mellitus (DM) is one of the most challenging public health problems in 21^st century. Aims at examining the diabetes related distress among adults living with type 2 diabetes mellitus. We conducted a study on 100 patients who were known cases of type 2 diabetes mellitus, to screen and account for diabetes related distress according to the DDS 17 scale. In our study, 72.00% diabetic patients had no distress, 26.00% patients had moderate distress and only 2.00% patients’ high distress. We concluded that prevalence of diabetes related distress in our study was less.

Keywords: DM, Diabetes related distress, Prevalence.

Evaluating the Efficacy of Novel Drug Combinations Against MDR Gram-Negative Bacteria: A Comparative Study

Namrata Kumari — 2025-03-18

Background: The emergence of multidrug-resistant bacterial infections has challenged the effectiveness of conventional antibiotics. Evaluating new combination therapies can help identify more effective treatment options.

Aim: This study investigates the sensitivity of bacterial isolates to three antibiotic combinations—Cefepime Enmetazobactam, Ceftazidime Avibactam, and Ceftriaxone+Sulbactam+Disodium Edetate—to determine their potential role in managing multidrug-resistant infections.

Methods: A total of 100 bacterial isolates were collected from urine, sputum, blood, pus, and tissue samples obtained in ICU and non-ICU settings. Antibiotic sensitivity was assessed using standard disc diffusion methods, with sensitivity rates determined for each bacterial species.

Results: Ceftriaxone+Sulbactam+Disodium Edetate showed the highest sensitivity rates across all species tested, including 71.5% for Klebsiella species, 78% for Escherichia coli, 75% for Pseudomonas species, and 80% for Acinetobacter species. Cefepime Enmetazobactam and Ceftazidime Avibactam demonstrated lower sensitivities, particularly against Acinetobacter species. The findings suggest that Ceftriaxone+Sulbactam+Disodium Edetate is the most effective combination among the three tested.

Conclusion: Ceftriaxone+Sulbactam+Disodium Edetate exhibits superior efficacy against a range of bacterial pathogens, making it a promising option for treating resistant infections. The other two combinations, while moderately effective, may require more targeted use.

Recommendations: Further studies with larger sample sizes and diverse clinical settings are recommended to confirm these findings and develop more refined antibiotic guidelines to address multidrug resistance.

Keywords: Antibiotic sensitivity, multidrug-resistant bacteria, cefepimeenmetazobactam, ceftazidime avibactam, ceftriaxone+sulbactam+disodiumedetate

Age, Sex, and Hemoglobin Levels Influence Arteriovenous Fistula Failure in Chronic Kidney Disease Patients

Pusparini Pusparini — 2025-03-23

Persons with chronic kidney disease (CKD) are increasing in number every year. End-stage CKD patients experience damage to kidney structure and function, therefore need kidney replacement therapy such as hemodialysis. Hemodialysis (HD) requires access to the bloodstream i.e. arteriovenous fistula (AVF) which is a permanent and most widely used HD access route. Arteriovenous fistulas are influenced by various factors that can affect their success for HD. The purpose of this study was to determine the relationship of age, sex, and Hb levels with AVF failure in CKD patients. This study used a cross-sectional design in 89 patients in whom an AVF was created. The study was conducted from February to June 2023, using secondary data from patient medical records according to inclusion criteria from January to December 2022 at a private hospital in Pekanbaru, Sumatra, Indonesia. Data analysis was carried out using the chi-squared test at a significance level of p<0.05. The majority of respondents in this study were aged 46-59 years and 62 (69.7%) were females. Mean Hb level was 9.15±0.92 g/dL and patients with diabetes and hypertension accounted for 51.7% and 73%, respectively. The results of the chi-squared test of age, sex, and Hb levels with AVF failure showed a significant relationship at p=0.045, p=0.029, and p=0.005, respectively. This study showed that there was a significant association of age, sex, and Hb levels with AVF failure in CKD patients.

Keywords: age, sex, Hb level, AVF failure, chronic kidney disease