Volume11,Issue3

1. A Comparative Study between Febuxostat and Allopurinol in the Treatment of Chronic Gout Patients.
Sangita Kumari, Keshav Kumar Sinha, Vijayendra Prasad, Naresh Kumar
Abstract
Introduction: Gout is a common and complex form of Arthritis. It is caused by excess uric acid levels in the bloodstream. The symptoms of Gout are due to the formation of uric acid crystals in the joints. Gout most classically affects the joint in the base of the bigtoe. During an acute attack, Anti-inflammatory drugs (NSAIDs) help to relieve pain and shorten the duration of the attack. Patients with Chronic Gout are used drugs to reduce uric acid levels. Now a days Febuxostat is more effective than Allopurinol for lowering the levels of serum uric acid in Chronic Gout Patients. Objective: To compare the effectiveness and Tolerability of Febuxostat and Allopurinol in gout patients. Materials and methods: It was an observational study on 35 patients each in Febuxostat Group A and Allopurinol Group B. After enrollment in study follow up was done at 8 weeks of therapy. Results: The Change in serum uric acid level in Group A was from 9.24±0.84 to 5.79+0.79 mg/dl and in Group B was from 8.9±0.93 to 6.32±0.60mg/dl. Change in both the groups were highly statistically significant with P-value <0.001. The reduction in uric acid level in Group A was more than in Group B. Conclusion: The present study clearly indicates Febuxostat 80 mg was responsible for lowering the level of serum uric acid much more effectively than Allopurinol 300mg.

2. Effectiveness of including “Alternative Systems of Medicine” in foundation course of First MBBS Students according to CBME (new curriculum) for 2019 Batch.
Shabana Sultana, Pulluri Sadanandam, Ramagalla Amrutha Roopa, Aparna Vedapriya. K
Abstract
Introduction: Definition of traditional medicine according to WHO traditional medicine includes diverse health practices, approaches, knowledge and beliefs incorporating plant, animal, mineral based medicines, spiritual therapies, manual techniques and exercises which can be used to maintain well-being, as well as to treat, diagnose or prevent illness. Hence the knowledge gained so will definitely help the Medical students who are future practitioners to maintain self complete health and also  effectively take care of patients’ complete health. Aim: The aim of the study was to know how far this topic has benefitted the first MBBS students to effectively apply the alternative system of medicine along with modern medicine during their clinical practice. Methods: This was a questionnaire based study where 100 first professional MBBS students of Apollo Medical College, Hyderabad, were asked to fill anonymously a questionnaire about their perceptions of this topic. The results were analyzed to see if there was any use of learning about alternative system of medicine. Results: The majority of the medical students (99.7%) opined that alternative system of medicine topic is very useful, while only 0.3% of students were indifferent about it.  Conclusion: Most of the students clearly preferred and accepted the use of alternative system of medicine for the benefit of personal health and patient care in future. To apply the knowledge of various medical subjects learnt during MBBS curriculum, with  the interrelationships between Alternative systems of medicine using as interprofessional  collaboration for the betterment of self and society’s  health as a whole.

3. A Comparative Study of Effectiveness and Tolerability of Indapamide SR (1.5 mg) and Hydrochlorothiazide (25 mg) in the Treatment of Mild Hypertension.
Sangita Kumari, Keshav Kumar Sinha, Vijayendra Prasad, Naresh Kumar
Abstract
Introduction: Hypertension is a major Cause of Premature death World Wide. Globally, at least l billion people have hypertension and a projected figure of 1.5 billion is expected by 2025. Systemic hypertension is the leading cause of global cardiovascular mortality and morbidity. Uncontrolled hypertension promotes target organ damage and Significantly increases disease burden on the Community Control of Hypertension is mandatory to preserve and protect Public health worldwide. Now a days for mild Hypertension Indapamide is drug of Choice It is a thiazide like diuretics. Indapamide is more effective than Hydrochlorothiazide for (thiazide type diuretic) control of hypertension. Objective: The Study was undertaken to compare the efficacy and tolerability of Indapamide in one group and Hydrochlorothiazide in the other group in the therapeutic treatment of mild Hypertensive Patients. Materials and Methods: It was an observational study on 40 Patients each in Indapamide group and Hydrochlorothiazide group. The Study was conducted in the 80 cases and the effects were evaluated at 8 weeks. For monitoring the effects of the drug two parameters were evaluated for 8 weeks They included Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) in the two groups. Results: The Change in systolic blood Pressure (SBP) in Group – A was from 155.37 ±  2.49 to 133.55 ±2.32  mm Hg and in Group – B from154.55 ±  2.73 to 140.40 ±  2.70 mm Hg. The Change in Diastolic Blood Pressure (DBP) in Group – A was from 96.92 ± 3.20 to 80.10 ± 1.42 mm Hg and in Group – B from 95.02 ± 1.79 to 88.20 ± 1.32 mmHg. Changes in both the groups were statistically Significant with P-value < 0.001. The difference between Group – A and Group – B for reduction in Blood Pressure (for both systolic and diastolic) showed Group A to have Significantly higher reduction than Group B ( P<0.001). Conclusion: The Present Study Clearly indicates Indapamide 1.5mg to be more effective than Hydrochlorothiazide 25 mg in control of mild hypertension with better tolerability.

4. A Cross Sectional Study on Assessment of Attitude Among Health Professionals Towards the Problem of Substance Abuse at Ananta Hospital, Rajsamand.
B. Agarwal, M. Mazumdar, D. Sharma, S. Kumar, A. Khatri
Abstract
Background: Drug abuse affects the health and lives of millions of individuals across the world. Discrimination faced by substance users and stigmatization becomes a barrier for them thus these patients do not receive the required care and treatment they deserve. The negative perception of healthcare professionals leads to poor therapeutic alliance between them and the patients of substance use. Current study aims to determine and assess the attitudes of the health professionals towards patients with substance use problems and to identify factors causing diverse attitudes of health professionals towards these patients. Method: A questionnaire based cross sectional study was undertaken at Ananta hospital Rajsamand (a tertiary health care centre) which included 134 health professionals both doctor and nursing staff for a duration of one year who provided their consent for this project. The socio- demographic details of every participant was collected and all of them were given the DDPPQ tool which assessed their attitudes and perception towards drug and drug use problems. Results: Younger age group of health professionals showed better outlook towards patients of drug abuse. A linear regression of gender, professional roles (i.e. doctors and nurses), past history of substance abuse and known history of substance abuser in the family with the principal component does not yield any significant results. Majority of the participants had either neutral opinion or positive opinion towards the problem of drug use and the drug users. Conclusions: Healthcare professionals with age on the lower side had more positive regards and significantly positive attitudes towards the problems of substance use and therefore the therapeutic compliance was better. Healthcare delivery needs unbiased and non-judgmental attitude of healthcare professionals towards patients of substance abuse, so in an attempt to provide holistic approach and care that overlooks socio-demographic and clinical profiles, professionals should have adequate and appropriate training and exposure accordingly.

5. Adverse Drug Reaction Monitoring in OPD of Chronic Obstructive Pulmonary Disease and their Assessment of Causality and Severity.
Narendra Kumar Tripathi
Abstract
Aim: the aim of the present study to evaluate the adverse drug reaction monitoring in out patients of chronic obstructive pulmonary disease and their assessment of causality and severity. Methods: A prospective, observational study was conducted in the Department of Pharmacology, Santosh Medical College and Hospital, Ghaziabad, UP, India for 1 year. All the patient selection was random and the patient population was divided into four broad categories based on diagnosis as: • Chronic obstructive pulmonary disease • Infections (pneumonia, tuberculosis (TB), lower respiratory track infection) • Asthma • Others (pleural effusion, anti‑tubercular drug induced hepatitis, obstructive sleep apnea, interstitial lung disease, pleurisy, obesity hypoventilation syndrome, corpulmonale). Results: During the study period, a total of 304 patients were monitored, of which 160 ADRs were observed in 98 patients accounting 32.23% of the incidence). Majority of the patients (n = 60) experienced one ADR, followed by 24 patients who suffered from two ADRs, eight patient experienced three ADRs, four patients experienced four ADRs, while two patient have experienced six ADRs. During the study, it was observed that each patient on an average experienced at least 1.63 ADRs. Based on sex, distribution of ADRs. Among 154 male patients monitored, the incidence of ADRs was 32.5% (n = 50) in males, which were almost similar to 32% (n = 48) observed in females). 32.09% of adults experienced ADRs, which was slightly higher in geriatric patients (32.39%). Drugs contributing majorly to ADRs were theophylline (19.39%), paracetamol (6.66%), salbutamol (5.45%) and levocetirizine (5.45%), respectively. Gastrointestinal system (38.75%) was the most common organ system affected due to ADR’s followed by a neurological system (22.5%), cardiovascular system (12.5%). Conclusion: A relatively high incidence of adverse drug events (32.2%) have been recorded which shows that not only geriatric patients but also adults are more susceptible to adverse drug effects.

6. A Prospective Study to Assess the Mother and Foetal Outcomes in Term Prelabor Rupture of Membranes.
Snehil, Krishna Sinha, Anupama Sinha
Abstract
Aim: To determine major maternal and neonatal outcomes in patients of PLROM. Methods: A prospective study was conducted in the Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India, from December 2019 to December 2020. 120 pregnant women who reported to the labour room with premature rupture of membranes at or after 34 completed weeks to 41 weeks of gestation were analysed for maternal and perinatal outcome. Results: The rate of maternal morbidity was 28.33% (34 out of 120), commonest was clinical chorio-amnionitis 10.83% (13 out of 120) followed by febrile morbidity seen in 8.33% (10 out of 120). Other maternal morbidities were in the form of wound infection-2.5% (3 out of 120), LRTI-1.67% (2 out of 120), MRP 0.83% (1 out of 120), puerperal sepsis 0.83% (1 out of 120). No maternal mortality was seen in the study. Perinatal morbidity was seen in 35.83% of cases. Clinical early onset neonatal infection was the commonest cause for perinatal morbidity noticed in 19.17% cases. Other perinatal morbidities were birth asphyxia 5.83% (7 out of   120),   hyperbilirubinemia   3.33%   (4  out   of   120), congenital pneumonia 1.67% (2 out 120), congenital malformations 1.67% (2 out of 120), late onset sepsis 1.67% (2 out of 120). Perinatal mortality observed was 2.5% (3 out of 120). Out of 120 newborns of mothers who were having prelabour premature rupture of membranes at 34-41 weeks’ gestation 65% had birth weight more than 2500 grams, 26.67% had low birth weight, 8.33 % had one minute Apgar score less than 7, 55 (45.83 %) were male and 65 (54.17%) were female, 26(21.67 %) had C-Reactive protein positive, out of them 9(7.5%) were having blood culture growth positive and 20(16.67%) were having WBC count more than 15,000. Conclusion: PLROM is an enigmatic condition associated with high risk of maternal and perinatal morbidity and mortality. Major maternal morbidity is chorio-amnionitis (10.83%). Major perinatal morbidity observed is early onset neonatal infection (19.17%). Prediction of these morbidities is an important step in the management of infection-associated with PLROM.

7. The Outcome of Systemic Administration of Itraconazole, Fluconazole and Terbinafine in Different Groups of Patients Treated for Skin Infection:  A Randomised Control Study.
Narendra Kumar Tripathi
Abstract
Aim: The aim of the present study to compare the outcome of systemic administration of itraconazole, fluconazole and terbinafine in different groups of patients treated for skin infection. Methods: A randomised control study was conducted in the Department of Pharmacology, ICARE Institute of Medical Sciences and Research & Dr. Bidhan Chandra Roy, Hospital, Haldia, West Bengal, India, for 24 months. A total of 300 patients were selected for the study. 3 groups were made (group A, group B, group C) under which each 100 patients were assigned. All consenting patients with different types of superficial fungal infections like tinea corporis, tinea cruris, tinea pedis, tinea barbae, tinea manuum, tinea faciei were included in the study. Only those patients who were diagnosed de novo for superficial fungal infections were considered for the study. Itraconazole 100 mg od for 14 days was given for group A, terbinafine 250 mg od for 14 days was administered to the group B, fluconazole 150 mg was given once in every 3 days for 6 weeks. All patients in group A and group B were asked to come back for follow up after 15 days, group C patients were asked to come after 6 weeks. Results: The response to treatment was found statistically significant (p<0.05) with various antifungal molecules. Response to itraconazole and terbinafine was good in majority of patients (72% and 42% respectively) while it was poor in 15% of the patients for fluconazole. the clinical response observed with various antifungal molecules. Peripheral spread was present in 19% cases with itraconazole, while it was present in 60% and 70% with terbinafine and fluconazole, respectively. The distribution of peripheral spread was statistically significant (p<0.05) with various antifungal molecules. Increased erythema was present in 12%, 61% and 82% of the cases with itraconazole, terbinafine and fluconazole respectively. Similarly, increased scaling was present in 22%, 38% and 77% of the cases with itraconazole, terbinafine and fluconazole, respectively. Spread to other body sites was present in 30%, 52% and 77% of the cases with itraconazole, terbinafine and fluconazole, respectively. Chi Square test was 63.68; p<0.001, therefore it was highly significant. Conclusion: Itraconazole was the most superior antifungal drug in terms of clinical remission. This was closely followed by terbinafine in terms of drug being effective in superficial fungal infection patients.

8. A Study of Homicidal and Suicidal Deaths in Bhopal District of Madhya Pradesh.
Brinda Patel, Ranjan Parashar
Abstract
Background: The pattern of injuries is unique to the mode of death (homicide or suicide) as well as to the causative agent(s). The objective of the present study was to study sociodemographic details and describe the pattern of injury among victims of homicide and suicide. Material and Methods: A total of 160 cases of unnatural death were brought for autopsy at the two selected post-mortem centres were included in the present study. Out of them, 15 cases where the manner of death was either suicidal or homicidal were selected. The data relating to socio-demographic variables and circumstances leading to the death of the individual were gathered from documents and detailed interview of the eyewitnesses. Results: Burns were the single largest cause of death both among victims of homicide and suicide. Septicaemic shock and craniocerebral injury were the most common cause of death. Most victims of suicide survived for more than 48 hours after the incident. Conclusion: Suicide was most commonly seen among young married women secondary to marital disputes.

9. ICD Classification of Autopsies Conducted for Deaths due to Trauma in Bhopal, Madhya Pradesh.
Brinda Patel, Jayanthi Yadav
Abstract
International Classification of Diseases (ICD) aims at systematic recording, analysis & comparison of mortality & morbidity data collected in different places & times. It facilitates evidence-based decision making. In India, in medico-legal cases, cause of death is mostly ascertained by autopsy surgeons but coding is done at The Office of Registration of Births & Deaths where proper attention to coding is not paid leading to poor utilisation of ICD-10. This paper aims at the possibility of mortality coding from autopsy itself. We retrospectively coded 160 trauma cases that were autopsied, according to Chapter-XX of ICD-10. The data were systematically analysed. 18.75% of the total cases could not be coded specifically. There were cases where unspecific code was allotted even when a lot of details were available. Based on difficulties faced during the study, suggestions were thought upon to make ICD coding easier & more practical.

10. Assessment of Vitamin B12 Deficiency in Patients Diagnosed with Pancytopenia in Bihar State.
Ghanshyam Jha
Abstract
Aim: The aim of the present study to assessment of vitamin B12 deficiency in patients diagnosed with Pancytopenia in Bihar state. Methods: A descriptive observational study was conducted in the Department of General Medicine, Lord Buddha Koshi Medical College and Hospital, Saharsa, Bihar, India for 1 year. We included 100 patients of both sexes of age 14 years and above with pancytopenia.  Detailed history was obtained from all the participants using predesigned proforma. Complete physical and detailed clinical examination to detect pallor, jaundice, lymphadenopathy, sternal tenderness, hepatosplenomegaly was done for all the patients. Detailed neuropsychiatric evaluation was done. The blood samples were collected from all the patients and sent for basic routine tests like complete blood count including red cell indices like mean corpuscular volume (MCV). Results:  Among 100 patients with pancytopenia, 54% of the patients were on vegetarian diet, 43% of the patients were smokers 46% were alcoholics.  All the patients in the study were noticed with history of fatigability. 32% of the patients had bleeding manifestations in addition to easy fatigability. Only 3% of the patients presented with neurological symptoms and signs like posterior column, pyramidal involvement and psychiatric manifestations. Only 7% of the patients gave positive history of intake of drugs like metformin, proton pump inhibitors, H2 blockers etc. chronically.  On hematological analysis of the patients presenting with pancytopenia, 67% of the patients were having MCV >100 fL and 33% of the patients are having MCV <100 fL. SGOT and SGPT was more than 40 in 75% and 66% of the patients respectively. On USG of the abdomen, 69% of the patients showed normal finding. Indications of hepatosplenomegaly were seen in 20% of the patients, splenomegaly in 8% of the patients. 3 patients found to have features suggestive of cirrhosis of liver with portal hypertension. Conclusion: Pancytopenia is a hematological feature of varying etiologies with male preponderance. Megaloblastic anemia due to vitamin B12 deficiency is the most common cause of pancytopenia and can be prevented by improving the nutritional status of the population.

11. A Study to Find the Association Between Gender and Anatomical Variation of Circle of Willis in Terms of Shape, Symmetry and Completeness.
Safia Wasi, Geetanjali Arora
Abstract
Aim: To provide some information regarding the anatomical variations circle of willis and its gender association. Materials and Methods: The present observational study was conducted on 80 cadavers collected from voluntary body donation at the Department of Anatomy and Fresh corpses undergoing autopsy at the Department of Forensic Medicine, Hi-tech Medical College, Bhubaneswar, Odisha, India, from November 2016 –October 2018. The Circle of Willis of each brain was dissected carefully and a part of the base of the brain was cut and removed, if necessary, to expose the arterial circle clearly. The posterior communicating artery was observed carefully because it might be hidden by the thickened arachnoid mater. The length and circumference of different components of the Circle of Willis was measured. The circumference (perimeter) of artery was measured by a fine malleable copper wire. Photograph was taken and the detailed identity of the cadaver and its brain was marked. Whenever a circle revealed any gross deviations from what had been mentioned as normal in, it was represented by a free hand sketch or photograph. Results: Out of 80 specimens, 62.5% were male and 37.5% were female. Mean age of the study specimens’ was 54.19 years. The ‘normal’ circles 62.9% are male and 37.1% female; whereas, in ‘variant’ circles 61.1% are male and 38.9% female. Sex variation of circle of willis according to shape, completeness and symmetry reveals no statistically significant difference. Conclusion: No significant variations are noted in either sex regarding shape, symmetry, completeness of the circle.

12. Study of Renal Function after Administration Different Doses of Aspirin in Bihar Region.
Ghanshyam Jha
Abstract
Aim: The aim of this study to evaluate the renal function after administration different doses of aspirin in bihar region. Methods: A double-blind, cross-over design study was conducted in the Department of General Medicine, Lord Buddha Koshi Medical College and Hospital, Saharsa, Bihar, India. For 18 months. Patients were divided into two groups and each group received two different doses of aspirin in a randomised order. The volunteers were randomised into two groups (n =20per group).The first group received aspirin doses of 0 mg (placebo) and 160 mg. The second group received doses of 80 mg and 320 mg. The doses were given in a randomised order with at least 14 days wash-out between treatments. The same pre- treatment was given before each dose of aspirin. A total of 40 subjects were included, 30 were women and 10 men. Sodium, potassium, creatinine and osmolality in serum, and sodium, potassium and osmolality in urine, were analysed by standard methods. Results: The urine flow, GFR, excretion rate of sodium, osmolality clearance and free water clearance 75 min after dosing diminished in a dose-dependent manner. Urine flow, sodium excretion rate and free water clearance were significantly lower with 320 mg aspirin vs. placebo and 80 mg aspirin. GFR was significantly lower with 320 mg vs. 80 mg aspirin. Urine flow, sodium excretion rate, osmolality clearance and free water clearance were also significantly lower with the 160 mg aspirin dose than placebo. Urine flow decreased  from  6.5 (4.2–7.3)  ml/min  with  placebo  to  5.9 (3.5–6.7) with 80 mg aspirin, to 4.2 (2.6–5.7) with 160 mg and to 2.7 (1.4–4.6) ml/min with 320 mg aspirin. table 1. Least square means of the observations 30 to 180 min after dosing showed dose-dependent decreases in urine flow, GFR, excretion rate of sodium, osmolality clearance and free water clearance. However, statistical significance was only shown for dose comparisons of aspirin 320 mg vs. placebo and 80 mg in urine flow, sodium excretion rate and osmolality clearance and vs. placebo in free water clearance. Statistical significance was also reached for dose comparisons of 160 mg aspirin vs. placebo in sodium excretion rate and free water clearance. With placebo the urine flow was 5.6 (3.8–6.5), with 80 mg aspirin 4.9 (3.2–6.0), with 160 mg it was reduced to 4.4 (2.6–5.4) and with 320 mg it was further reduced to 3.5 (1.7–4.4) table 2. No significant differences were found between 80 mg aspirin and placebo. Conclusion: We concluded that aspirin deteriorated renal function in a dose-dependent manner in elderly healthy volunteers with an activated renin–angiotensin system from pre-treatment with diuretics, who were also being treated with ACE-inhibitors. However, the lowest dose which does not cause adverse effects for the individual patient cannot be determined in advance and the risk that aspirin may neutralise the clinical benefits of ACE-inhibitors must be taken into consideration even with low-dose aspirin.

13. Study on Effect of Vitamin D Supplementation in Vitamin D Deficient Patients of Diabetes Mellitus with Poor Glycemic Control in a Tertiary Care Hospital of Andhra Pradesh.
Padma Sravani Sagi, Venkata Kalyan Kumar Ammisetty, Rajanikanth Munirajulu, Suneetha Sunkari
Abstract
Background: Vitamin D3 is fat soluble vitamin, known to affect glucose homeostasis and is inversely related to the glycosylated haemoglobin level in diabetes mellitus. Vitamin D3 deficiency is associated with higher risk of insulin resistance and metabolic syndromes. This study was aimed to evaluate the relation of the levels of 25(OH)D3 to HbA1C levels in diabetes mellitus cases and effect of supplementation of 25(OH)D3 in cases with decreased Vit D levels in poor glycaemic control and changes in levels of Glycosylated haemoglobin post treatment. Methods: This is a prospective interventional study of all patients with diabetes with less than normal Vit. D levels (above 33 years and less than 69 years) attending as outpatient in General Medicine Department, Tertiary Care Centre, Ananthapuramu. Parameters – FT4, TSH, Calcium, Creatinine, Vitamin D3 levels and HbA1C level were analysed in serum and recorded prior to supplementation and after 3 month of supplementation with vitamin D3. All patients were divided in to two groups – deficient and insufficient, according to the vitamin D3 deficiency levels, the association between the levels of 25(OH)D3 and HbA1c was studied, pre supplementation and post supplementation. Results: 176 patients had 25(OH)D3 level <20 nanograms (Deficient Group) and 39 patients had 25(OH)D3 levels of 20 -30 nanograms (Insufficient group). We observed lowering of HbA1C after Vit D supplementation from 10.5± 2.5 in deficient group and 9.5 ± 2.4 in insufficient group to a mean of 8.5 ± 1.1 in deficient group, 7.5± 2.2 in insufficient group and 6.8 ± 1.2 in normal group. We found HbA1C to be inversely related to Vitamin D3 levels in our study. Conclusions: Patients with higher HbA1C had altered Vit D levels and supplementation of Vit D3 improved HbA1C levels in poor glycemic control patients.

14. Research Sought to Evaluate the Clinical Spectrum of Dengue at a Tertiary Care Hospital in Bihar Region.
Mrityunjay Kumar
Abstract
Aim: The aim of the study was to determine the clinical spectrum of dengue at a tertiary care hospital in Bihar region. Methods: A prospective study was conducted in the General Medicine Netaji Subhas Medical college & Hospital, Amhara, Bihta, Patna, Bihar, India. Total 100 patients with complaints of fever and clinical features of dengue with positive NS1 antigen test or dengue antibody serology IgM or IgG or both were included in the study. Results: Fever was the most common presentation and was seen in 49 cases (49%) cases and followed by Fever and  Myalgia 13%, Myalgia 11%, Petechiae 10%, Fever and  Skin rashes, Nausea and vomiting and Fever and  Itching. Present study showed hemoglobin range of 6.5 gm% to 16.5 gm%. 47 (47%) cases showed Hb of 9-12 gm %, followed by 30 (30%)   cases showed Hb of 12-15 gm %, 7 (7%) had Hb of below 9 gm % and 16 (16% ) had Hb of above 15 gm%. In the present study, 56 (56 %) cases showed hematocrit of 25-35% and 28 (28%) showed hematocrit of 35-45%. Raised hematocrit (>45%) was noted in 16(16%) of patients at presentation. The total leukocyte count ranged from 1500 cells/cumm to >11000 cells/cumm. Leucopenia with less than 4000 cells/cumm was present in 19 (19%) cases , count of  4000- 11000 cells/cu mm seen in  64 (64%)  cases  and  >11000/  cumm was  seen   in 17 cases (17%). In the present study out of 100 cases of dengue fever, 89% cases had thrombocytopenia and 11% cases had severe thrombocytopenia (< 20,000/cumm) with bleeding manifestations. Serum AST and ALT were elevated in 69 (69%) cases and were normal in 31 (31%) cases. In the present study, hepatomegaly was noted in 35 (35%) and splenomegaly was seen in 15 (15%) of cases. Conclusion: Hemoconcentration, leucopenia, thrombocytopenia, and raised liver enzymes SGOT and SGPT along with reactive/ plasmacytoid lymphocytes on peripheral smear gives enough clues to test for dengue serology so that dengue cases can be diagnosed in their initial stages.

15. A Study to Find the Anatomical Variation of Circle of Willis in Relation with Gender and Laterality.
Safia Wasi, Geetanjali Arora
Abstract
Aim: To provide some information regarding the anatomical variations circle of willis and its gender association. Materials and Methods: The present observational study was conducted on 80 cadavers collected from voluntary body donation at the Department of Anatomy and Fresh corpses undergoing autopsy at the Department of Forensic Medicine, Hi-tech Medical College, Bhubaneswar, Odisha, India, from January 2017 to November 2018. The Circle of Willis of each brain was dissected carefully and a part of the base of the brain was cut and removed, if necessary, to expose the arterial circle clearly. The posterior communicating artery was observed carefully because it might be hidden by the thickened arachnoid mater. The length and circumference of different components of the Circle of Willis was measured. The circumference (perimeter) of artery was measured by a fine malleable copper wire. Photograph was taken and the detailed identity of the cadaver and its brain was marked. Whenever a circle revealed any gross deviations from what had been mentioned as normal in, it was represented by a free hand sketch or photograph. Results: Out of 80 specimens, 62.5% were male and 37.5% were female. Mean age of the study specimens’ was 54.19 years. Variations are seen in posterior communicating artery (10%), followed by anterior cerebral artery (6.25%) and anterior communicating artery (6.25%). Conclusion: Total 22.5% variations have been found during the course of investigation. Most of the variations are seen in posterior communicating artery. No variations are noticed in Posterior cerebral artery in the present study.

16. The Effect of Nebulised Magnesium Sulphate on the Incidence of Post Operative Sore Throat: A Prospective Clinical Study
Satish Kumar
Abstract
Aim: The aim of the present study to determine the effect of Nebulised Magnesium Sulphate on the Incidence of Post Operative Sore Throat. Methods: This was a prospective, observational study conducted in the Department of anaesthesiology, Katihar medical college Hospital, Katihar, bihar, India, for 10 months. 100 Patients included in study were of either gender, aged between 20 and 70 years belonging to American Society of Anesthesiologist (ASA) 1 or 2 statuses undergoing elective surgery of approximately 2 h or more duration under GA requiring tracheal intubation. Patients in the study group were nebulized with 3 ml of 225 mg isotonic nebulized magnesium sulphate for 15 min in the holding area. Presence of sore throat was noted at rest and on swallowing immediately after extubation, and 2 h, 4 h, 10hand 24 h postoperatively. In the postoperative ward, patients were also monitored for any drug-related side effects. Results: With respect to age, gender, and ASA status, there was no significant difference in POST between the two groups. POST at rest at 0h and 2h between the two groups didn’t show any significant difference. There was a significant. Difference in POST at rest between group A and group B at 4h (p=0.08), 10h (p=0.003) and 24h (p=0.003) using chi square test. With respect to POST on swallowing, there was a significant difference in POST at 2h (p=0.007), 4h (0.003), 10h (0.002) and 24h (0.003) using chi square test. Conclusion: POST is common in the patients undergoing GA with a tracheal tube for routine surgical cases for up to 24 hr. We conclude that the use of magnesium sulphate in the form of nebulization as a pre-medication agent significantly reduces the incidence of POST compared to normal saline and it was found to be safe, simple and effective in preventing the occurrence of postoperative sore throat.