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


1. Percutaneous Closed Pleural Biopsy: A Vanishing Art in Current Era- is Still Alive?
U Maheswar Chandrakantham, Raj B. Singh, Bhupendra Kumar Jain
Study aim and objective: There is no doubt that thoracoscopy has an added advantage over closed pleural biopsy in evaluation of exudative pleural effusion. In many countries, Percutaneous closed pleural biopsy (PCPB) is still being used as an initial investigation of choice due to its easy availability and cost-effective alternative to thoracoscopy. The aim of this study is to observe whether the art of PCPB using Abram’s needle is still alive in the evaluation of exudative pleural effusion in modern era. Design: The medical records of 171 patients with exudative pleural effusion, who underwent PCPB using Abram’s needle between 2012 and 2017, were reviewed. Results: Pleural tissue was adequate in 158(92.3%) cases. The overall diagnostic yield of PCPB was 72.8% and for tuberculosis and malignancies it was 73% and 91.4% respectively. There were no major post procedure complications. The diagnostic yield and rate of complications with PCPB are comparable to thoracoscopy. Conclusion: As PCPB is safe, cheap and easily available, it can be used as an initial diagnostic tool in the evaluation of exudative pleural effusion particularly in resource poor settings and there is a necessity to train the future pulmonologists.

2. Comparative Study of Oral Ketamine Versus Oral Midazolam as Premedicants in the Pediatric Population in Elective Surgical Procedures
Rashim Vachhani, Babita Agrawal
Purpose: To compare oral ketamine and oral midazolam as premedicants in the pediatric population who are undergoing elective surgical procedures. Introduction: Oral ketamine produces predictable satisfactory sedation and anxiolysis without significant side effects. This comparative study was carried out to compare oral ketamine with oral midazolam to know the efficacy of both the drugs as premedicants in the pediatric population. Material and Methods: This prospective, randomized study was conducted in 160 children who posted for elective surgery. These patients were divided in to two groups having 80 patients in each group. Group A which received 0.5mg/kg midazolam and group B: received 5mg/kg ketamine orally. Before and after premedication, sedation and anxiolysis score were assessed, after premedication it was assessed at 10, 20, and 30 minutes. Thirty-five minutes after oral premedication, children were separated from parents. During parental separation, parent child separation score was assessed and recorded. Results:  After premedication at 10 minutes, about 70% and 87.5% patients were unsuccessful while rest successful sedation scores in midazolam and ketamine group respectively. At 20 minutes 22.5% and 70% patients were unsuccessful and 77.5% and 12% were successful sedation scores in midazolam and ketamine group respectively. At 30 minutes, 10% and 42.5% patients were unsuccessful and 90% and 58.7% were successful sedation scores in midazolam and ketamine group respectively. This result was statistically significant. Conclusion: We concluded that oral midazolam showing faster onset of sedation, higher sedation scores with lower anxiety scores as compared to ketamine. Oral midazolam is also provides better easy separation from parents and excellent mask acceptance in children.

3. Pendimethalin Poisoning: A Case Report
Kanika Rohilla, Nitu Yadav, Vasudha Govil, Sandeep Kumar, Elizabeth James, Manisha
In India majority of the population (around 65%) live in rural area. Pendimethalin is a commonly used herbicide with slight toxicity. Suicidal or accidental poisoning from this herbicide is rare. We are reporting a case of a 15 year old female who presented in emergency with history of vomiting, altered sensorium and generalized weakness after alleged history of ingestion of concentrated pendimethalin. She developed aspiration pneumonitis so was admitted in intensive care unit. There she recovered after receiving supportive treatment.

4. Effect of Screen Time, Hours of Physical Activity and Sleep Hours on Overweight and Obesity in School-Going Adolescent Girls of Udaipur
Purohit Arushi, Goyal Dileep, Sareen Devendra, Mittal Hemlata, Agarwal Prateek
Background: Obesity is one of the most common nutritional problems in developing countries of the world and an important cause of childhood mortality and morbidity leading to permanent impairment of physical and mental growth. Objective: Effect of screen time, hours of physical activity, and sleep hours on overweight and obesity in school-going adolescent girls of Udaipur. Materials and Method: The present study was a hospital-based descriptive study, done at the Department of Paediatrics, Geetanjali Hospital, Udaipur, during the term January 2020 to June 2021. A total of 1620 adolescent school-going girls aged 10 years to 18 years were included in the present study after obtaining written informed consent from parents/guardians. They were evaluated on the basis of height and weight and BMI and divided into groups of overweight and obesity on the basis of WHO staging. The detailed history of screen time, physical activity including playing outdoor sports and exercise, and sleep hours were taken along with height, weight, and BMI measurement in case Performa. Statistical analysis was performed using the statistical packages for social sciences (SPSS) version 21 IBM Corporation. Result: The study presented a statistically significant positive correlation between screen time, hours of physical activity including hours of playing sports and hours of physical exercise, and sleep hours in school-going adolescent girls of Udaipur. Significant overweight and obesity were observed in girls who had screen time of more than 2 hours a day. Significant overweight and obesity were observed in children who had less than 30min of physical activity every day and overweight and obesity were comparable in both groups of girls having sleep hours more or fewer than 8.5 hours a day. Conclusion: Overweight and obesity are more prevalent in school-going adolescent girls of Udaipur who had more hours of screen time, fewer hours of physical activity, and more sleep hours.

5. Misuse of Topical Steroid Applications among Outpatients in Maharashtra
Prashant Mahajan, Mitali Patil
Topical corticosteroids have become available as over the counter drugs and are widely misused for various conditions. The aim of this study is to assess the clinical and epidemiological aspects of the unjustified use of topical corticosteroids. A total of 200 patients with facial dermatoses and topical corticosteroid misapplication daily over face for not less than 30 days were included in the study. Total Subjects included in the study were 200 adults. Adverse effects among them included acneiform lesions, telengiectasias, dyspigmentation, hypertrichosis, perioral dermatitis and tinea incognito. A total of 89 (44.5%) patients fulfilled the criteria of “topical steroid dependent face”. These patients reported erythema, burning and itching on stopping the application of topical corticosteroids.
In most cases the use prolonged use of topical corticosteroids on facial skin was recommended by non-professional persons. The adverse events ranged from transient to permanent. The results of this study underline the indispensable role of dermatology specialists in diagnosing and treating cutaneous disorders.

6. Effect of Dexmedetomide & Propofol on Haemodynamic Response During Tracheal Extubation among Hypertensive Patients – A Comparative Study
Nisarg B Patel, Manthan Parmar, Kinjal Prajapati, Anilkumar S Patel, Beena Parikh, Bina Butala, Punit Patel
Background: Recovery from general anaesthesia and tracheal extubation is often accompanied with tachycardia and hypertension which may cause myocardial ischemia or infarction in susceptible patients. Propofol and Dexmedetomidine have been studied seperately in attenuating pressure response during extubation, quality of extubation and postoperative sedation in normotensive patients but these two drugs have been compared rarely in hypertensive patients. Objective: This study was conducted with objective of to compare hemodynamic changes (heart rate, systolic blood pressure, diastolic blood pressure and mean arterial blood pressure) during tracheal extubation after general anaesthesia between two groups. Materials and Methods: Prospective observational comparative study was carried out at tertiary care hospital in Central Gujarat between July 2017 to October 2019. Results: It can effectively be concluded that Propofol (0.5 mg/kg) 2 min prior to extubation and Dexmedetomidine (0.5µg/kg) infusion 10 min before extubation both are safe and efficacious in attenuating the hemodynamic stress response during extubation. Dexmedetomidine is better at controlling HR, DBP, MAP than Propofol. Conclusion: Dexmedetomidine is an effective and safe drug to provide stable hemodynamics and protects against the stress response to extubation.

7. A Study on Maternal Body Mass Index Effect on Pregnancy Outcomes
N. Pallavi, Ramadevi E., Gade Rama, B. Sweethi
Background: Early pregnancy Body Mass Index (BMI) and weight gain during pregnancy are important predictors of adverse pregnancy outcomes. BMI is widely accepted as a better measure of underweight or overweight than weight alone. The developing countries including India are facing a dual burden of undernutrition and obesity. Aim and Objective: This study aim to study to  evaluate  the  effect  of   body weight on pregnancy  outcome  in  our  Indian  population. Materials and Method: This was a prospective observational study conducted at Department of OBG for the duration of one year in the CAIMS, Karimnagar. Study comprised of 120 patients who have consented for the study within the first 12 weeks of gestation. The patients were included after fulfilled exclusion and exclusion criteria. Results: A Prospective observational study comprising 120 antenatal women with singleton uncomplicated pregnancies, booked at CAIMS Hospital within the  first  12  weeks  of  pregnancy. mean age of the study population was 25.78±24.8 years and among the group it was not statistically significant. 55% of the patients were having multi gravida, among all the pregnant women 52.50% of the women gained weight between 8 to 13 Kg, 10.80%  patients were preterm, 6.70% PIH, 11.70% PROM, 2.50% had IUGR, polyhydramnios, 8.30%  oligohydramnios. Conclusion: After analysing the data we conclude that majority of antenatal patients being catered in our hospital have normal BMI. Adverse maternal and perinatal outcomes are seen more commonly with the extremes of BMI.

8. A Clinical Pharmacological Comparative Quantification Analytical Research Study Among Systematic Reviews and Meta-Analyses on Bronchodilators and Anti-Diabetic Drugs
Hazra M
Background: There are numerous systematic reviews and meta-analyses conducted on the β adrenergic agonistic bronchodilators, like salbutamol, formoterol, salmeterol and other β adrenergic agonists, as well as, on the anti-diabetic drugs, like biguanides, dipeptidyl peptidase-4 inhibitors and sodium glucose co-transporter-2 inhibitors. Systematic Review and Meta-Analysis, are the two very novel methods of Clinical Research Methods in Clinical Research, Pharmacology, Clinical Pharmacology, and Evidence-Based Medicine, integrated within Medical Sciences, that define the intricacies of the clinical analytical research study, with a uniquely balanced representation of qualitative and quantitative research, review and analysis. Aim and Objectives: The objective of this clinical pharmacological study was a comparative quantification analytical research among systematic reviews and meta-analyses on bronchodilators and anti-diabetic drugs. Materials and Methods: This study involved the comparative and quantitative analysis on these clinical research methods conducted on the bronchodilators and the anti-diabetic drugs. In this study, the comparative quantification of the different experimentations was conducted as systematic review and meta-analysis on bronchodilators and anti-diabetic drugs. After that, the comparative percentages of systematic reviews conducted on anti-diabetic drugs as well as on bronchodilators was derived; and the comparative percentages of meta-analyses conducted on anti-diabetic drugs and on bronchodilators was also derived statistically. Results: The comparative percentages of systematic reviews conducted on anti-diabetic drugs was 66% and on bronchodilators was 34%; whereas the comparative percentages of meta-analyses conducted on anti-diabetic drugs was 53% and on bronchodilators was 47%. Conclusion: Therefore, this was concluded that both systematic reviews as well as meta-analyses were more widely conducted on anti-diabetic drugs than on bronchodilators.

9. Outcomes of Spousal Versus Related Donor Kidney Transplants: A Single Center Experience
Amruta Devi, Aruna Acharya, Haladhar Naik
Background: Kidney transplantation is the preferred modality of treatment, and it provides the better quality of life than dialysis in patients with end stage renal disease. Living donation constitutes the vast majority of cases in India. The demand and availability of organ gap is fulfilled by spousal donation. Objective: To assess the graft and patient outcomes of spousal transplant compare with those of related transplant. Methods and materials: This retrospective observational study was conducted among the transplant patients during the period of 2012 and 2022. The spousal donors as well as related donors with their demographic details, pre- and post-transplant evaluation, immunosuppressive therapy and followed up with post-transplant complications, were obtained and recorded. Result: A total number of transplants were179. After exclusion of unrelated and cadaveric transplants, 135 cases were taken in the study. They were analysed,45 cases were spousal, and 90 cases were related. Mean age of recipient was 42.8+/-7.5 in the spousal and 30.3+/-7.7 in related transplants. Delayed Graft Function (DGF) was 8.8% in spousal and 10% in related transplants. Rejection episodes were13% in spousal and 20% in related donors. Serum creatinine at one year was 1.39+/-0.7 and 1.26+/-0.37 in spousal and related donors respectively. Patientr   survival was 93% and 97% in spousal and related donors respectively. One year graft survival was 91% in both. Rejection episodes were also comparable.3-year survival was 90.2%in spousal donor group and 89.0% in related donor group. Conclusion: Spousal donation particularly wife is the major source of donor in our country and the post-transplant complication and survival is compared to related transplant groups.

10. Correlation of Hba1c With Microalbuminuria and Fundoscopic Finding in Type-2 Diabetes Mellitus Patients
Anil Kumar, Neha, Madhuri Meena
Background: Diabetes is a very common disease now days. It has adverse effect on many human organs as its duration increases. Many studies exist to show its bad effects on body organs in different parts of world. We have studied is there any relation between microalbuminuria and fundoscopic finding with HbA1c levels. Methods: Our study includes all the known case of type 2 diabetes mellitus patients of age group of 45 years and above. Five milliliters of venous blood is collected from all patients. For glycosylated hemoglobin estimation, EDTA blood samples were used. Blood sugar was investigated by the glucose oxidase method, glycosylated hemoglobin (HbA1c) by the cation exchange resin method and micro albumin levels in the urine sample by using the turbilatex method. Retinopathy was tested by using the Direct Fundoscopic Method. Results: HbA1c with microalbuminuria: Total 31 patients had Urinary albumin level more than 30 mg/dl out of which only 3% had Hb1Ac value less than 6.5 % whereas 96% had Hb1Ac value more than 6.5%. This association was found to be clinically significant (Pearson Chi-Square- 4.888, df is 1 and p value is 0.027, Fishers Exact test is 0.033). Fundoscopic changes: It was seen that, 81 patients had grade 1 fundoscopic changes from which 14 (17.2%) shows Hb1Ac was less than 6.5% whereas 67(82.7%) had Hb1Ac level more than 6.5%. 15 patients had grade 2 fundoscopic changes from which 1 (6%) had Hb1Ac level less than 6.5% and 14 (94%) had Hb1Ac level more than 6.5%. 4 patients had grade 3 fundoscopic changes and all of them were having Hb1Ac level more than 6.5%.This Fundoscopic finding was not statistically associated when compared with Hb1Ac. (Pearson Chi-Square- 1.854 with df 2 and p value is 0.396). Conclusion: Patients having microalbuminuria were associated with high level of glycosylated haemoglobin. Fundoscopic changes in patients was not found associated with glycosylated haemoglobin as p <0.3.

11. Evaluation of Drug Utilization in Myocardial Infarction at a Tertiary Care Hospital
Arun Hebbar J N, Arun R Keshwala, Hiren R Trivedi
Background: Asian Indians have considerably higher prevalence of premature Coronary Artery Disease (CAD). Over the last four decades there has been a tenfold increase in the prevalence of CAD in urban area of India. Materials and Methods: A prospective, observational study was carried out in ICCU for duration of two years. Patient details and demographic characteristics were recorded from the case files. The morbid condition, treatment with drugs and other supportive modalities were recorded. The outcome of treatment was also noted. Present study aimed to focus on the trends in the WHO drug utilization core indicators. Results: Out of 600 cases most affected were males of 51-60 years with mortality rate of 9.17%. Most common co-morbid condition of hypertension (61.50%). Mean hospital stay was 1.35 ± 1.17 days. Average no of drug per prescription of 9.37 ± 3.01. Generic drugs were 61.05% and essential drugs up to 90.02%. Cost per case ₹ 1023.05 and injections accounted for 97.32%. Conclusions: Current study reflects myocardial infarction affects frequently amongst males of 51-60 years with hypertension; lower mortality and morbidity rate observed with utilising majority of medication being generic drugs and from essential medicine list. Cost of treatment was of modest amount of about thousand rupees; which makes even economically backward class to get adequate treatment.

12. 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.

13. Nephroprotective Role of Nigella Sativa Oil Against Gentamicin Induced Nephrotoxicity: An Experimental Study in Rats
Murtuza Bohra, Poonam Patel, Kamayani Dighe, Rahat Ali Khan, Aijaz Ahmed Khan
The objective of this study is to evaluate the nephroprotective activity and antioxidant potential of Nigella sativa oil against Gentamicin-induced nephrotoxicity. Healthy adult albino rats of either sex (100-200 g) was randomly divided into six groups of five animals each. Group I (normal control) were administered distilled water intra peritoneally for 8 days. Group II (LNSO). were administered low dose nigella sativa oil 1ml/kg orally for 10 days. Group III (HNSO) were administered High dose nigella sativa oil 2ml/kg orally for 10 days. Group IV (GNCG)Gentamicin negative control group. were administered Gentamicin (80mg/kg) From day 1-8 Intra-peritoneally. Group V (GLNSO) were administered Low dose of Nigella sativa oil (1ml/kg) orally (From day 1-10) + Gentamicin (80mg/kg) (From day 3-10) Intra-peritoneally. Group VI (GHNSO) were administered high dose Nigella sativa oil.(2ml/kg) orally (From day 1-10) + Gentamicin (80mg/kg) (From day 3-10) intra-peritoneally. On the 10th day (8th day for normal control group), blood was collected for biochemical tests and the rats were sacrificed. The kidney was removed for histology and lipid peroxidation-antioxidant test. Gentamicin caused nephrotoxicity as evidenced by elevated BUN, blood urea and serum creatinine. Co-administration of Nigella sativa oil at doses of 1ml/kg and 2ml/kg in Group V and Group VI caused a dose-dependent reduction in the rise of BUN, blood urea and serum creatinine as compared to Group IV (gentamicin negative control group).There was increased catalase and glutathione and decreased malondialdehyde levels in Group IV, while  Group V (GLNSO) and Group VI(GHNSO) treatment with low dose and high dose of Nigella sativa oil significantly reversed the changes toward normal values. Histological examination of the kidney revealed renoprotection in Group V and Group VI compared with Group IV. The Nigella sativa oil has a nephroprotective activity against Gentamicin-induced nephrotoxicity in rats.

14. To Study Clinical and Bio Chemical Parameters of Diabetic Keto Acidosis Patients
Mukesh Singh Tomar, Dharmendra Katariya, Kailash Charel
Background: With the changes in the frequency of DKA and the increased incidence of DKA in patients with type 2 diabetes mellitus, the question arises regarding change in the clinical or laboratory characteristics of the patients with DKA. Hence this study was planned to explore the clinical and biochemical characteristics of patients with type 2 diabetes compared with type 1 diabetes admitted with DKA in a tertiary care hospital. Material & Methods: The present study was a case control study with 50 Diabetic ketoacidosis patients as cases and 50 controls. The Inclusion criteria for cases was kept aspatients who were known diabetic either type I or type II and presenting with DKA or accidently detected. On admission, a careful and detailed history was recorded and thorough clinical examination was conducted. Additional information if any was recorded and were investigations carried out. Results: Diabetes ketoacidosis develops in a significant number of Type II DM patients. Most common cause of diabetic ketoacidosis was infection (56%) followed by omission or irregular treatment (28%). Most common presenting clinical features were vomiting, abdominal pain, dehydration, acidotic breathing, altered mental status and fever. Total leucocyte count was significantly higher in DKA compared to control group. Serum sodium was significantly lower in DKA cases compared to control group. Clinical profile was similar in between Type I and Type II DM patients presenting as DKA. Conclusion: Diabetes ketoacidosis develops in a significant number of Type II DM patients. Most common cause was infection and irregular treatment. Most common presenting clinical features were vomiting, abdominal pain, dehydration, acidotic breathing, altered mental status and fever. Overall mortality rate is 6% in diabetic ketoacidosis.

15. Surgically Induced Astigmatism in Manual Small-Incision Cataract Surgery: A Comparative Study between Straight, Frown and Inverted V Shape (Chevron) Incision
Venkatesan C., Maagnaah S., M. J. Venkatesan
Background: In  majority of developing countries, the cause of total  blindness by cataract is 50-90% among the people aged above 50 years. Surgical removal of the opacified lens is considered to be the most effective and definitive treatment of cataract. Due to the cataract  backlog and higher surgical volume in developing countries like in India  manual  small  incision  cataract surgery in comparison to phacoemulsification proves to be a viable cost-effective  alternative. Aim: To determine the Surgically induced astigmatism in manual small-incision cataract surgery between Frown, Straight and Inverted V shape (Chevron) incisions. Methods: A hospital based prospective interventional study was carried out  on 75 cataract patients between age group of 45 to 70 years were randomly split into 3 groups (25 each)  based on  Inverted V ‘Chevron’ , Frown and Straight incision . For comparing different categorical data among three types incision Fisher Exact test was applied. SPSS version 20 was used. Results: Surgically induced astigmatism is nil in 32% of cases in Inverted V type incision,12% in Frown type incision , 4% in straight  type incision, more than 2 is 0 in inverted V incision, 4% in Frown  incision, 4% in Straight line type of  incision. Conclusion: Chevron incision has lesser surgically induced astigmatism compared to frown and straight type of incisions with  statistically significance (P < 0.01). Additionally on comparison between  straight and frown  type there was no statistically significant difference (p value 0.732).

16. Comparison Between Transcranial Ultrasound And Magnetic Resonance Imaging In The Evaluation Of Neonatal Hypoxic-Ischemic Encephalopathy
Dibyajyoti Nath, Rabin Mili, Pranjit  Thapa, Aditi Das
Background: Hypoxic-ischemic encephalopathy (HIE) is the condition that is diagnosed based on specific clinical findings of profound acidosis, poor Apgar score (0–3) at birth, seizure, coma, hypotonia, and multi-organ dysfunction and it is the most common cause of cerebral palsyThe essential role of neuroimaging in the evaluation of the early cerebral injury in neonatal encephalopathy (NE) is to establish the time, severity, extent, location, and pattern of injury, and the probable neurological outcome. Ultrasound is an ideal screening modality in the neonate because it is widely available, non-ionizing, painless, and no need for sedation or intravenous contrast. Magnetic Resonance Imaging (MRI) is the most sensitive and specific imaging technique for examining infants with suspected HIE of the brain. MRI can demonstrate better soft-tissue contrast differentiation, the exact extent, and site of brain injury. Aim: The goal of this study is to compare the Transcranial ultrasound (TCUS) with MRI in the evaluation of HIE in neonates. Methods: This is an observational cross sectional study conducted in the Department of Radiology, Silchar Medical College and Hospital, Silchar for one year from 1st of June 2019 to 30th of May 2020. Forty-nine neonates with HIE have undergone TCUS and MRI brain examinations, and the findings were compared using suitable statistical methods. Result: Out of 49 HIE cases, MRI detected basal ganglia-thalamus injury in 23 (46.9%), cortex and subcortical white matter predominant in 14 (28.6%), white matter injury in 5 (10.2%), Germinal matrix hemorrhage (GMH) in 4 (8.2%), and mixed pattern in 2 (6.1%). Out of 49 HIE cases; TCUS was positive in 46 cases. The overall sensitivity of the TCUS in comparison with MRI was 93.87% in the evaluation of HIE. Conclusions: Hypoxic-ischemic encephalopathy (HIE) following birth asphyxia is the most common cause of neonatal encephalopathy (NE) that is associated with high mortality and morbidity. The main role of neuroimaging in the evaluation of HIE is to establish the time, severity, extent, location, and pattern of injury, and the probable neurological sequelae. TCUS is an ideal screening modality in the neonate, which can be performed at the bedside without sedation, and suitable for follow-up. MRI is the most sensitive and specific imaging technique for examining infants with suspected HIE.

17. A Retrospective Cross-Sectional Study to Analyze ABO & Rh Blood Group Distribution Among Blood Donors, Issued Units and Seasonal Trends of Blood Donations at A Tertiary Care Hospital of Northern India
Prashant Bhardwaj, Manjari Kumari, Shabdakant Mishra, Ranjan Agrawal
Background and Aim: Blood transfusion service is one of the essential components of health care system. Due to higher immunogenicity ABO and Rh blood group system are clinically significant. The aim of this study to determine the frequency of ABO and Rh blood groups among blood donors, fractions of issued units according to the blood groups and month-wise and blood group wise trend of blood donation. Material and Method: This study was conducted at a blood bank of medical college & hospital in north India, over a period of 6 years from January 2016 to December 2021. Blood group of the blood donors was determined by commercially available standard monoclonal antisera by test tube agglutination technique accompanied by reverse grouping. Results: Total 8656donations occurred with mean of 1462.67±395.05 during the six-years period from January 2016 to December 2021. Female donors were 183(2.11%) and 8473(97.88%) were males. Maximum donations and blood units were issued in September and minimum in January. The Rhesus (D) positive and Rhesus (D) negative blood donors was 94.82 and 5.18% respectively. The donors of blood group B (35.90%) are highest in number followed by donors of blood group O (33.07%), A (20.93%), and AB (10.08%). Conclusions: This study is useful to identify the various reasons of deficiency of a particular group in a particular area and helpful in the preparedness and policy making for the improvement of blood transfusion services.

18. A Morphometric Assessment of the Anatomical Variations in Branching Pattern of Middle Cerebral Artery: An Observational Study
Pallavi, Priyanka Raj, Birendra Kumar Sinha
Aim: The study aimed to study the anatomical variations in branching pattern of middle cerebral artery. Material & Methods: A total of 50 cadavers were studied in the department of Anatomy, Patna Medical College, Patna, Bihar, India . During post-mortem examination of the cadavers, a skin incision was made in front of one ear to another ear in the coronal plane. Results: The average mean outer diameter of the M1 segment was 3.70mm with a standard error of 0.69 mm. The pre-central branch shows the highest superior division in the trifurcation branching pattern, whereas the posterior parietal shows the highest in the middle division. In lenticulostriate trunk were shown in 85% whereas division pattern was shown in 15%. Conclusion: MCA branching pattern is slightly higher in trifurcation pattern as compared to bifurcation and ramification. Thorough knowledge of the microvascular anatomy and the myriads of variations are essential for the operating surgeon to choose the ideal technique to avoid any catastrophe during and after surgery and give the best possible functional outcome.

19. Adult Human Cadaveric Heart Assessment for Anatomical Variations of Papillary Muscles in Both the Ventricles
Priyanka Raj, Pallavi, Ashok Kumar Singh
Aim: To analyze the papillary muscles of heart with respect to the variations in their number, length, shape, position and pattern in both ventricles. Material & Methods: The study was conducted using 20 well preserved adult cadaveric human hearts obtained from the department of Anatomy, Vardhman institute of medical sciences, Pawapuri, Nalanda, Bihar, India for four months .The values of the length of papillary muscles and thickness of both ventricles of cadaveric heart specimens were presented as Mean± SD and p value was calculated using student t-test. Different variables of the papillary muscles were compared between two ventricles and p value was calculated by performing chi-square test. P-value < 0.05 was considered as statistically significant. Results: In our study we observed 33.3% conical apex, 4.3% broad apex and 53.4% pyramidal apex in right ventricles whereas 21.3% conical apex, 26.7% broad apex, 21.3% pyramidal apex in left ventricles. Length of papillary muscles in right ventricle were1.28±0.46, 1.39±0.50, 0.90±0.56 in anterior, posterior and septal segments. Whereas, it was 2.15±0.46 in anterior segment and 1.78±0.48 in posterior segment of left ventricle. Conclusion: The papillary muscles have complex and variable anatomy. Knowledge of this variation to the cardiac surgeons during reparative surgical procedures conducted for mitral/ tricuspid valve replacement is of utmost importance to prevent untoward event.