Correlation Between Hypothyroidism and Gallstone Disease in Central India

Introduction The decreased thyroid-stimulating hormone (TSH) levels affect almost every nucleated cell in our body, which directly affects the basal metabolic rate (BMR). It tends to affect multiple organ systems in the human body. In recent times, there have been changes in lifestyle and the consumption of processed foods has increased. Thus, cholelithiasis and hypothyroidism are being encountered frequently, even in rural populations. In recent times, the overt clinical presentation of hypothyroidism is rare due to early diagnosis and treatment of the subclinical hypothyroidism state itself. Aim The aim is to determine the correlation between cholelithiasis and hypothyroidism. Methods This was a cross-sectional study done on the patients presenting to the surgical department at Acharya Vinoba Bhave Rural Hospital affiliated to Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, India between the duration from December 2020 to December 2022, having gallstone disease or with symptoms suggestive of gall bladder stones. The admitted patients were then evaluated for hypothyroidism by thyroid profile tests, and the results were documented. Using the collected data, factors such as clinical spectrum, correlation between cholelithiasis and hypothyroidism, relation with the demographic data, and body mass index (BMI) were studied. Results A total of 52 gallstone patients were included in the study. A greater number of patients were found to be above the age of 40 years (82.7%), with female preponderance (61.5%). More patients with cholelithiasis were from the group with having BMI more than normal (57.6%). More patients having both cholelithiasis and hypothyroidism were also from the group with having BMI more than normal. Most symptomatic patients complained of pain in the right hypochondriac region (88.5%). Of these 52 patients, nine (17.3%) were found to have hypothyroidism (seven were subclinical, two patients had overt clinical symptoms and signs) and the remaining 43 patients were euthyroid. Conclusions Our study supports that there is a correlation between cholelithiasis and hypothyroidism. Out of all the 52 patients, nine had hypothyroidism, seven were subclinical, and two had overt symptoms. Thus, we conclude that there is a correlation between cholelithiasis and hypothyroidism.

A Rare Incidental Finding of Phrygian Cap in a Case of Pyloric Perforation

Deviation from the normal development of the biliary tree and gall bladder gives rise to numerous different types of anomalies. One of the anomalies is the Phrygian cap. The Phrygian cap is an even rarer condition. We report a case that was asymptomatic. In a rare case, the Phrygian cap anomaly may cause symptoms that are mainly due to superadded cholelithiasis. A detailed pre-operative history and thorough physical examination should be done. Many of the cases may be missed during the routine examination. The diagnosis, with the help of radiological investigations, will be helpful to keep the location and anatomy of the anomalous gall bladder in mind during the intra-operative period. The patient was operated on to seal off a perforation, where a Phrygian cap was observed as an incidental finding. The patient did not have any complaints pointing toward the presence of cholelithiasis or cholecystitis. Due to the asymptomatic incidental presentation of the condition, the operating surgeons decided on avoiding further dissection and an increase in the morbidity load. Thus, we report this case to focus on this rare entity and consider it a differential while dealing with a case of pain in the abdomen.

A Comparative Study Between Conventional Sutures, Staples, and Adhesive Glue for Clean Elective Surgical Skin Closure

As long as medicine has subsisted, wound closure has existed. When assessing a surgical wound, physicians are more than ever confronted with various sutures and other closure materials. The surgeon must choose the most appropriate material for that specific closure because not one substance is perfect in all circumstances. The history of suturing wounds is intertwined with the history of surgery. Wound suturing is a critical component of wound therapy, including suturing materials and techniques. Suturing has been practiced for thousands of years. Although suture materials and techniques have changed, the goals like closing dead space, supporting and strengthening wounds until healing increases their tensile strength, approximating skin edges for an aesthetically pleasing and functional result, and reducing the risk of bleeding and infection remain the same. Traditional skin closure with sutures requires time and effort, creates an unsightly scar, and requires infection removal. In this modern era, patients find it appealing when the operated location has a decent cosmetic appearance. The quicker, more comfortable, and most aesthetically pleasing method of skin closure is what surgeons are searching for. Assessing whether newer methods are superior to sutures and staples is necessary. Better cosmesis, flexibility, water resistance, painless sealed skin closure, and ease of application are all advantages of 2-octyl cyanoacrylate. This article aims to provide an overview of the critical characteristics of traditional sutures, common suture materials, sticky glue, and staples, as well as additional closure materials.

Pentoxifylline: a new armamentarium in diabetic foot ulcers

BACKGROUND

Diabetic foot ulcers are estimated to affect 15% of all diabetics and precede almost 85% of foot amputations. Pentoxyfylline a substituted xanthenes' derivative has been reported to increase the blood flow to the microcirculation and enhances tissue oxygenation. It has been widely used in the treatment of intermittent claudication.

MATERIALS AND METHODS

Pentoxyfylline is known to decrease the rouleaux formation of RBC and hence helps in improving the microcirculation. Out of 67 patients 30 received pentoxyfylline and 32 were on traditional treatment and there was loss of follow-up in five cases. The response was observed subjectively, histologically and by Doppler studies.

RESULTS

It was observed that the patients on pentoxyfylline had early healing as compared to patients receiving only conventional treatment as evident on biopsy and Doppler.

CONCLUSION

Here in this research our objective was to determine whether pentoxyfylline (trental 400 mg) taken orally TDS in addition to ambulatory compression bandages and dressings improves the healing rates of diabetic ulcers.