Electronic-ISSN:0975-5160| Print-ISSN: 2820-2651


1. To Evaluate the Results of Dynamic Hip Screw (DHS) & Proximal Femoral Nail (PFN) In Intertrochanteric Fractures of Proximal Femur with Special Reference to Surgical Site Infection
Gupta Anshul, Gupta Mansi, Jain Sheela, Meena Rajesh
Introduction: Though dynamic hip screw is considered as a gold standard in the management of intertrochanteric fractures, its role is debatable in the management of unstable intertrochanteric fractures and intramedullary devices such as PFN are considered better implants for these fractures. Surgical site infection is an important problem in these surgeries that needs special consideration. Material and methods: The study was conducted on 80 patients with intertrochanteric fracture femur attending the outpatient and emergency department of Bundelkhand Medical College, Sagar (M.P) between January 2021 to February 2022. The patients were divided randomly in two groups A and B, patients of group A were treated by CRIF/ ORIF with Dynamic hip screw and patients of group B were treated by CRIF/ ORIF with long PFN. Results:  Results for DHS and PFN were compared. Mean age in both the groups was 65 years. In DHS group, there were 22(55%) males and 18(45%) females. In PFN group, there were 21(52.5%) males and 19(47.5%) females. In DHS group, there were 15(40%) patients who injured because of high energy trauma like RTA, while 25(60%) were injured due to low energy trauma like trivial fall. Conclusion: In intertrochanteric fractures femur, PFN helps in achieving biological reduction and imparts stability. PFN is a load bearing device and gives stability of fracture area proximally and shaft distally. Therefore, we advocate the use of PFN in comparison to DHS in intertrochanteric fractures femur except when trochanteric entry point for the PFN is fractured.

2. Anthropometric Measurements of Craniofacial Region in Medical Students of RUHS College of Medical Sciences
Sunita Chandouliya, Rajesh Arora, Chandrajeet Singh Chandel, Charu Taneja
Background: Anthropometric parameters are important for studying different variations in the human population. The methods involving physical anthropology present high rate of accuracy for human identification and gender estimation. Aim: The aim of the present study is to obtain Anthropometric measurements of craniofacial region in medical students and to observe difference between two genders. Materials & Method: A cross sectional study was conducted among total number of 400 cases were studied which included 200 males and 200 females. These cases were undergraduate medical students, between the ages of 18-25 years. Variables studied through physical anthropometry in both the genders were facial height, nasion‑to‑menton distance, interzygomatic arch width, and intercanthal width using a digital vernier caliper. Result: A significant and high correlation was found in our study, especially between Facial Height and Pronasale to menton distance (r = 0.627, P < 0.01). Pearson,s correlation analysis revealed a significant and positive correlation between Nasal Length and Pronasale to mention (r=0.187, P value<0.01), facial height and Pronasale to menton distance (r = 0.627, P < 0.01), facial height and interzygomatic width (r = 0.396, P < 0.01), Pronasale to menton distance and interzygomatic width (r = 0.346, P < 0.01), and interzygomatic width and intercanthal width (r = 0.242, P < 0.01). This high correlation was especially found between facial height and Pronasale to menton distance and facial height and interzygomatic distance. Conclusion: In this study, significant sexual differences were observed in craniofacial region. Knowledge of mean facial dimensions is important in the evalution of age, sex and racial differences, in clinical applications and in forensic application too.

3. A Comparative Rational Pharmacotherapeutic Research Analysis and a Systematic Review and Meta-Analysis on the Oral Hypoglycaemic Rational Pharmacotherapeutic Research in Metformin Monotherapy and Combination Therapy
Moumita Hazra
Introduction: This comparative rational pharmacotherapeutic research analysis, and this systematic review and meta-analysis was conducted for reviewing with a well-organised methodology, along with thorough explanations and analyses of the medical study literature and evidence, compiled from the numerous studies conducted, which authenticated the systematic review and meta-analysis topic of the oral hypoglycaemic rational pharmacotherapeutic research on metformin. Objective: The objective of this comparative rational pharmacotherapeutic research analysis, and systematic review and meta-analysis was the qualitative exploration of the oral hypoglycaemic rational pharmacotherapeutic research in metformin monotherapy and combination therapy, with quantitative interpretations. Methods: The study was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) Statement and Guidelines, 2009, described by the Cochrane Collaboration in June, 2016. At first, the steps of identification included the records which were identified through database searching and the additional records which were identified through other sources. This led to the steps of screening, which included the screened records after the duplicates were removed. From these screened records, few records were excluded, as per the exclusion criteria. Then, in the eligibility step, the full text articles were assessed for eligibility, from which few full text articles were excluded, according to the exclusion criteria, with adequate reasons. This led to the final inclusion step, where the studies were included in the qualitative synthesis of a systematic review and meta-analysis, according to the inclusion criteria, and ultimately the studies were included in the quantitative synthesis. Results: This systematic review and meta-analysis, contributed 2140 refined and relevant medical records, among total 2876 records obtained from the study databases search. It also comparatively analysed the oral hypoglycaemic rational pharmacotherapeutic research on metformin monotherapy and combination therapy, thus comprehensively explaining this evidence-based systematic review and meta-analysis. Conclusions: To conclude, this comparative research analysis, and systematic review and meta-analysis provided the refined qualitatively synthesised medical records, study literature and databases on the oral hypoglycaemic rational pharmacotherapeutic research on metformin monotherapy and combination therapy.

4. Hospital Based KOH Wet Preparation Assessment of the Distribution of Dermatophytes
Shanti Bhushan
Aim: The purpose of this study is to determine the prevalence of dermatophytes in Bihar and to identify the causal agents. Materials and Methods: The present study was conducted in the Department of Microbiology, ICARE Institute of Medical Science and Research and Dr Bidhan Chandra Roy Hospital, Haldia , West Bengal, India, duration of one year. A total of 200 samples were gathered from dermatological OPD patients. Results: A total of 200 samples were sent in for fungal testing. In 239 samples, the KOH mount was positive for fungal elements, and in 108 samples, the culture was positive. Conclusion:  In the current research area, dermatophytosis has been recorded throughout the year, with an increase in the predominance of particular species. Dermatophytes’ infections are found all throughout the world, however superficial mycoses are more common in India, where heat and moisture play a big role.

5. Randomized Comparative Clinical Study to Assess the Efficacy of LMA (Laryngeal Mask Airway) Supreme and LMA Proseal with LMA Classic in Paralyzed, Anaesthetized Patients
Ravindra Kumar Singh, Nawin Kumar, Meenakshi Singh
Objective: In the present study we compared the efficacy and aspiration risk of proseal LMA and LMA supreme with LMA classic in adult anaesthetized paralyzed patients. Methods: A randomized prospective study in 90 adult anaesthetized paralyzed patients. The proseal LMA and LMA supreme were compared with LMA classic in terms of ease of insertion, number of attempts, insertion time & hemodynamic parameters as primary outcome. Results: Ease of insertion was although more in PLMA and SLMA than CLMA but statistically comparable in all three groups. Insertion time i.e. time from jaw relaxation to connection to an aesthetic circuit and checking of adequate ventilation in all the groups was comparable. Conclusion: Clinically PLMA and SLMA are easier to insert than CLMA, but overall the three groups were comparable with respect to insertion characteristics, airway manipulation required, hemodynamics, risk of aspiration and perioperative complications but cost effectiveness along with clinical benefit was seen more with PLMA.

6. A Prospective Study to Evaluate the Role of Topical Insulin in Healing of Chronic Ulcer
Arpit Agrawal, Chandra Shekhar Amb, Virendra Pratap Singh Saytode, Virendra Pachole
Background: Healing of chronic wounds (CW) is one of the most complex processes in the human body. Insulin-like growth factor-I role has been demonstrated in animal studies. However, human studies are disproportionately fewer. Aims and Objectives: To evaluate the efficacy of local insulin therapy by comparing insulin dressings with regular saline dressings. Materials and methods:  Seventy patients admitted with CW in Index Medical College, Hospital and Research Centre, Indore, Madhya Pradesh, were studied prospectively. Patients were randomized into Group A and Group B. Each group was subdivided into A1, A2, A3, B1, B2, and B3. Patients with diabetes were grouped as A1 and B1, infective ulcers in groups A2 and B2, and traumatic ulcers in groups A3 and B3. Group A received insulin dressing, and Group B received normal saline dressing without insulin. All diabetic patients were brought under glycemic control with appropriate antidiabetic therapy before enrolling in the study. Ulcer size was measured once a week for 8 weeks. The study’s endpoint has been taken as complete wound epithelialization or healing of wound up to 8 weeks. The rate of wound healing was calculated as the difference between the primary wound on day one till complete wound healing and is reported in terms of mm2/week as a marker of healing. Results: The mean age in group A was 44.486 years and in the control group was 48.8 years. The rate of wound healing in insulin dressing (Group A) was better than in saline dressing (Group B). Hospital stay was less in the insulin dressing (Group A) than in the saline dressing (Group B). The healing rate in the treatment group was higher than in the control group, regardless of initial wound size. There were no episodes of hypoglycemia due to topical insulin. The mean number of days required for healing was 38.7 days in Group A1 and 47.67 days in Group B1 (p = 0.001). The number of days required for healing was 37.87 days in Group A2 and 46.11 days in Group B2 (p=0.005). The number of days required for healing was 37 days in group A3 and 45.5 days in group B3. It was comparable and significant. The difference in the hospital stay of the two groups was studied using an independent sample T-test was found to be significant (p<0.05). Conclusion: Topical insulin dressing in chronic non-healing ulcers is more effective in the early healing of ulcers than normal saline dressings. There is a significant decrease in the mean area of the ulcer.

7. To Evaluate the Results of Lateral Pinning and Crossed Pinning Technique in the Treatment of Displaced (Gartland Type III) Supracondylar Fractures of Humerus in Children Ulcer
Gupta Anshul, Gupta Mansi, Sharma Saurabh, Sahu Manoj, Parteti Ritesh
Introduction: Supracondylar fractures of the humerus are the most common elbow fractures in the pediatric age group mainly in age group of 3-12 years, mainly due to trauma by fall from height while playing. Closed reduction and percutaneous pin fixation is considered standard management for displaced supracondylar fractures of the humerus in children. However, controversy exists regarding whether to use an isolated lateral entry or a crossed medial and lateral pinning technique. The aim of this study was to evaluate outcomes of surgery by crossed pinning and lateral pinning technique in displaced supracondylar fractures of the humerus in children. Material and Methods: Between March 2021 to February 2022, of total 60 patients, were divided into two groups; group-A (two lateral k-wires) and group-B (two crossed medial and lateral k- wires) with 30 patients in each group. All children with suspected supracondylar fracture of elbow were seen either at orthopedic emergency room or orthopedic OPD.  Anteroposterior and lateral radiographs of the elbow were done. Preoperative investigations (blood picture and prothrombin time & concentration etc.) were done for all cases in our study. Patients were reassessed in the ward for neurovascular injuries and later surgery was performed after taking consent from patient parents or near relatives. Conclusion: Compared with lateral pinning entry, crossed pinning entry had a higher risk of iatrogenic ulnar nerve injury and increased structural stability. However, in the subgroups, crossed pinning with mini-open incision has decreased the risk of iatrogenic ulnar nerve injury. Therefore, the recommended strategy for the treatment of pediatric SCHF is crossed pinning entry with a mini-open incision, which can provide a stable elbow and avoid iatrogenic injury of the ulnar nerve.

8. A Study on Epidemiological Aspects, Clinical Spectrum, Treatment and Outcome of Scrub Typhus in a Tertiary Care Hospital
Khan Moin, Goyal Dileep Kumar, Parashar Vivek, Mittal Hemlata
Background: The objective of the present investigation was to study epidemiological profile, clinical manifestation, laboratory features, complication and out-come of scrub typhus. Methods: This is a prospective descriptive study at a tertiary care hospital including patients diagnosed scrub typhus positive for (IgM by standard Q card test). Results:  Out of the total 42 study patients, 25 (59.53%) patients of scrub typhus were male and 17 (40.47%) were female, in age group 6-10 years, there were 20 (47.65%) patients. Children > 6 years had more cases due to more outdoor play is in this age group. monsoon season had more patients 30(71.43%) because mites are more active during monsoon and post monsoon season. Fever was the common presentation of all the cases followed by 20 (47.61%) had rash, 25 (59.52%) had vomiting. 25 (59.23%) had Hepatosplenomegaly, 19 (45.23%) had anemia, 22 (52.38%) had thrombocytopenia, Impaired liver function due to elevated SGOT 18 (42.86%) and, SGPT 15 (35.72%). Associated disease showed 6 (14.28%) had hepatitis A. Complications showed 9 (21.42%) had meningoencephalitis followed by MODS 3 (7.14%). Rural areas constitute more patients due to availability of more shrubs and forest areas. Mortality was observed in 7% of cases. Conclusions: The present study concluded that a high index of suspicion about scrub typhus must be look and investigated for, so timely treatment can prevent morbidity and complication, because early diagnosis and treatment is only modality which can prevent complication, and fatal outcome of scrub typhus.

9. Perinatal Outcomes in Amniotic Fluid Index in Postdated Pregnancies at Tertiary Care Center, Karimnagar
Jyothi Tippoji, Gade Rama, B. Sweethi, R. Padma Latha
Background: The Amniotic fluid is the protective liquid and important part of pregnancy sac. This fluid serves as or helps for the growing fetus and also serves to facilitate the exchange of nutrients, water and biochemical product between mother and fetus. Patients with Low Amniotic fluid Index (AFI) need to deliver quickly, So, an assessment of amniotic fluid volume has become an important component of antenatal testing for the high-risk pregnancy. Aim & Objective: Study aimed to find the significance of amniotic fluid index in determining the maternal and perinatal outcome in pregnant women who came postdated. Material and Methods: This was an Prospective observational study conducted at Department of OBG, CAIMS, Karimnagar, for the duration of one year. 100  antenatal women whose gestational age is > 40 weeks  admitted in the hospital and who fulfilled the following inclusion and exclusion criteria and after getting ethical clearance considered for the study. Results: Out of 100 patients Maximum number of patients were getting admitted from a low socioeconomic status who lacked the knowledge about the maternal and perinatal morbidity and mortality associated with postdatism. Parity, gestational Age, mode of Delivery and APGAR score were significantly associated with Amniotic Fluid Index (P-value<0.001). Perinatal outcome like CTG, onset of labour, colour of Liquor, Indication for LSCS and NICU Admission was statistically significant. It means these parameters were strongly associated with AFI. Conclusion: Amniotic Fluid Index is important predictor of adverse event in high risk pregnancies.  Women with AFI ≤ 5 cm can expect a good outcome if they have regular ANC visits and intrapartum monitoring than the AFI > 5 cm.

10. Prevalence of Sexual Dysfunction among Different Female Psychiatric Patients
Monica Shringirishi, KC Gurnani
Objective: Female sexual dysfunction is a common, condition that significantly reduces the quality of life of the affected persons. Unfortunately, because of the veil of secrecy that shrouds discussions on human sexuality, there has been limited research on this topic in some sociocultural settings. The aim of this study was to study sexual dysfunctions and factors that may be associated with them in female psychiatric patients. Methods: The study had a cross-sectional design and the sample was recruited by purposive sampling. Psychiatric cases were taken both from OPD and IPD of People’s Hospital Bhopal, Data from control population was collected from the married females who came along as informant with the psychiatric patient to our hospital. Results: Comparison of mean FSFI Domain score and Total FSFI Scale Score between Different Psychiatric Illness patients and Healthy Control. Total FFSI Score was highest in migraine followed by borderline disorder and bipolar or dissociative disorder. It was least in insomnia cases. It was 26.00±3.46 in migraine, 23.66±4.82 in dissociative disorder and 18.60±11.73 in insomnia cases. There was statistically highly significant difference in FSFI score among different Psychiatric patients. Conclusion: Ascertaining and attending to sexual dysfunctions not only enhance the therapeutic bond between psychiatrist and patients but also will have several positive spinoffs out of which sense of wellness and competence in the patients can be considered as most important.

11. Prevalent Serogroups and Serovars of Leptospira Causing Leptospirosis in Clinically Suspected Patientsin Tertiary Care Hospital in South Kerala
Preetha Rajan, Ajitha K C, Ramani Bai JT
Introduction: In Kerala, Leptospirosis, which started as an isolated public health problem of some of the water logged areas of Alappuzha and Kottayam districts in the 1990s, has now become a public health problem in all districts. This has been causing the highest number of deaths consistently for the last few years with the younglabour class getting affected posing a serious concern. Preliminary analysis of Leptospirosis deaths shows that delay in definitive diagnosis and effective treatment cause high case fatalities. According to statistical data of DHS Kerala during 2011-2012, Eranakulam and Thiruvananthapuram districts reported the largest numbers of confirmed cases, respectively. This study attempts to find out the prevalent serogroups and serovars causing the disease in Thiruvananthapuram and their association with clinical features and complications. Objectives: 1. To estimate IgM Leptospira antibodies in 1:100 and 1:200 dilution of serum of clinically suspected patients of Leptospirosis. 2. To estimate the predominant serogroups and serovars of Leptospira causing Leptospirosis in clinically suspected cases. 3. To estimate the complications due to serogroups and serovars of Leptospira. Conclusions: Out of the 400 suspected cases, 96 were IgM Lepto ELISA positive showing 24% (95%CI,19.8- 28.8) prevalence of Leptospirosis in the study population. The present study shows 34.78% L. icterohaemorrhagiae, 15.21% L. hebdomadis, 13% L. autamnalis, 8.6% L. australis, 6.5% L. grippotyphosa, 6.5% L. pomona, 6.5% L. tarassovi, 4.34% L. canicola and 4.34% L. bataviaserovars causing leptospirosis by MAT.

12. Clinical Comparative Study of Topical Analgesia with 4% Lignocaine and Intravenous Tramadol for Post-Operative Analgesia After Tonsillectomy
Kishore Keerthy N., Narendra Babu Chanappa, Archana G., Suraj H. S.
Introduction: Tonsillectomy is one of the most commonly performed surgical procedures, often associated with significant intraoperative bleeding and postoperative pain. The objective was to compare the postoperative analgesic efficacy of topical 4% lignocaine with intravenous tramadol after tonsillectomy surgery. Methodology: After institutional ethical committee clearance and written informed consent, 60 patients of either sex undergoing tonsillectomy were randomised into 2 groups, one received topical 4% lignocaine (3cm2 gauze soaked in 2ml) and other received intravenous tramadol (2mg/kg). Type of pain was assessed at intervals of 30min for 4hrs and 4th hourly for 24hrs. post operatively by visual analogue scale. Results: The pain response initiated at 12 hours among group-A respondents (19.2%) increased to 35.8% at the end of 24 hours and group-B respondents (54.9%) at 12 hours increased over the period to 60.3% at 24 hours of duration. The data subjected to statistical students t-test reveals that the mean difference in the pain scores between group-A and group-B during the initiation to the end period under study found to be statistically significant (p<0.01). Conclusion: Topical 4% lignocaine provided a better postoperative analgesia when compared with intravenous tramadol.

13. Comparative Study to Assess the Synergistic Effect and Safety Profile of Adding Adjuvants Dexmedetomidine and Clonidine with 0.5% Bupivacaine Intrathecally in Elective Lower Abdominal Surgeries
Udit Dhingra, Sreeraghu G. M., Sufiyan Faizi N, Vinuth K. Murthy
Background: In this study we wanted to assess the synergistic effect and safety of adding Dexmedetomidine to 0.5% hyperbaric Bupivacaine compared with Clonidine to 0.5% hyperbaric Bupivacaine in patients undergoing elective lower abdominal surgeries under spinal anaesthesia. Methods: This was a randomized comparative study carried out in the Department of Anesthesiology and Critical care, Kempegowda Institute of Medical Sciences, Bangalore among two groups of 30 patients each, from August 2020 to September 2021. Results: The difference in onset of the sensory blockade was significant as indicated by the p-value of < 0.001. The difference in onset of the motor blockade was insignificant as indicated by the p-value of 0.883. Clinically the mean SBP was lower in Group D as compared to group C. Clinically the mean DBP was lower in Group D as compared to group C. Conclusion: 10µg of Dexmedetomidine as adjuvant to intrathecal 0.5% bupivacaine provides better postoperative analgesia, longer duration of motor and sensory blockade, optimal sedation and is safe with regard to the haemodynamic variables and adverse effects when compared to 50µg of clonidine as an adjuvant to intrathecal 0.5% bupivacaine.