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


1. Paracetamol Self Overdosing Case Series Study- Analysis of Demography, Clinical Features and Treatment Methods
Vishal KR, Shiva Murthy N
Background: Acute liver failure due to Paracetamol overdosing is the second most common cause requiring liver transplantation worldwide. Objectives: To analyze the demographic features, clinical features and treatment methods used in Paracetamol self-overdosed patients at a tertiary care center in South India. Methods and Material:  A retrospective case series study was conducted after obtaining Ethics Committee approval. Patients reported with Paracetamol overdosing with or without additional drugs from 01 Jan 2020 to 31 Dec 2021 were included in the study. Data collection form was used to collect data on demography, clinical presentation, past/medication/personal history, general physical, vitals, and systemic examination. In addition Psychological evaluation and Treatment methods were also collected. Descriptive statistics applied. Demography, clinical features and treatment methods were analyzed using Instat3 and Microsoft Excel. Results: Thirteen patients aged 26.15±12.35 years who consumed 10±5.195 tablets amounting to 6.23±3.23 grams of Paracetamol as a single dose were analyzed. Vomiting and pain abdomen were common presenting complaints. Signs of injury to GIT and CNS organs were noted in these patients. Seven patients were discharged against the medical advice. All patients received gastric lavage and other supportive treatments as early as possible at a nearby government hospital or at our centre. Conclusions: Young female patients, easy availability of OTC medicines and conflict with family members were the three important factors which contributed to intentional Paracetamol overdosing in our study. We recommend CDSCO, India to take cognizance of amendments made by FDAs of UK and USA with regard to Paracetamol product label and consider similar actions to prevent loss of lives due to Paracetamol overdosing.

2. Electrocardiographic Changes in Case of Acute Organophosphate Compounds Poisoning
Prajapat Narendra Kumar, Bhati Mohammed Riyaz, Ahmad Sayed Wasim, Jain Rajesh
Introduction: Considerable significance has been given to Organophosphorus compounds over past few decades as common poisoning amongst humans. The present study was conducted for assessing the electrocardiographic (ECG) changes in such situations. Materials & Methods: One hundred twelve patients with the alleged history of OPC poisoning were enrolled. Apart from thorough history and detail clinical assessment, electrocardiographic changes were recorded. Results:  The incidence was higher (32.14%) in the age group of 21-30 years followed by 30.35% in the age group of 31-40 years. 79% of the patients were males. In 108 cases, the exposure is intentional. Increased secretions are the most common manifestation followed by fasciculations. The mean atropine and PAM dose and the duration of treatment increase with the increase in severity. Conclusion: ECG variables were significantly altered in OPC poisoning.

3. Bupivacaine Versus 2 Chloroprocaine Spinal Anesthesia Comparison Study at a Tertiary Hospital
Atul Kumar Agarwal, Ravindra Kumar Bhasker
Background: For surgery on the lower abdomen and lower limbs, spinal anesthesia is a tried-and-true, dependable, and safe anesthetic approach. It is simple to administer, acts quickly, poses little danger of infection, and has a low failure rate. Aims & objectives: The goal of the current study was to compare the effectiveness and readiness for discharge of the two local anesthetics used for spinal anesthesia, Bupivacaine and 2-Choroprocaine. Material and Methods: The current study was a short-duration (60min) elective ambulatory perineal surgery (such as a hemorrhoidectomy, a fistula in ano, a rectal biopsy, etc.) or gynecological procedure (such as a check curettage, hysteroscopy, etc.) prospective randomized double-blind study conducted in patients of 18 to 60 years of age, ASA grades 1 and 2, in 60 patients were randomly divided into two groups using a computer-assisted table: Group B received 40 mg of 1-chloroprocaine and Group C received 10 mg of bupivacaine hydrochloride as the spinal anesthetic. Results: In terms of mean age, gender, and ASA grade distribution, there was no discernible statistical difference between the two groups. A statistically significant difference was found between groups B and C for the mean time for onset of sensory block, mean time for onset of motor block, mean time to achieve maximum sensory block, mean duration of sensory block, and mean duration of sensory block. The chloroprocaine group showed better results in these areas. The mean length of stay in group C was 1.40 ±0.64 days and group B was 1.42 ± 0.82 days. There was significant difference in length of stay in two groups. (p<0.05) The mean time to ambulation in group C was 225.46 ±56.22 and group B was 265.36 ±58.46 minutes. The time it took for two groups to ambulate varied significantly. (p<0.05) This demonstrates that patients in Group C are discharged and ambulated earlier than those in Group B. Conclusion: In comparison to intrathecal Bupivacaine, intrathecal 2 percent 2-Chloroprocaine has the advantages of early ambulation and early hospital discharge. It also has an earlier and more satisfactory onset of sensory and motor block, the desired level of spinal block, and an adequate duration of sensory and motor block.

4. Mortality Predictors in Influenza Pneumonia: A Prospective Study in a Tertiary Care Hospital
Basharat A Kassana, Bilal Hassan, Nuzhat Samoon, Gul Aalmeen
Objectives: Influenza causes annual seasonal epidemics around the world. Periodically, genetically novel strain of influenza circulates worldwide, causing an influenzas pandemic. The present study aims to assess the clinical profile, prognosis of the disease and outcome in influenza positive patients during 2017-2018 epidemics in Kashmir, so that epidemiology of the disease could be known, and high-risk groups can be identified. Methods: All influenza positive patients, confirmed by RT -PCR method, admitted in ICU / Isolation ward in SHER –I-KASHMIR INSTITUTE OF MEDICAL SCIENCES SOURA KASHMIR during epidemic of influenza (2017-2018) were studied, the data collected was analyzed. Results: During the study period there were 124 influenza positive admissions. The age group most affected was 20-59 years males (49.2%) and females (50.8%). There were 30 deaths; mortality was high in rural population 73.33% (n=22) and patients with underlying comorbidities. Common presenting symptoms were fever, cough, breathlessness, sore throat. Conclusion: Swine flu influenza infection took its heaviest toll in terms of human lives and economy because the young and productive population was mostly affected. Patients with co-morbid conditions and pregnant women were the susceptible population and thus preventive and therapeutic interventions should be directed to them. Early vaccination of high-risk groups and high index of suspicion in the symptomatic patients and chemoprophylaxis accordingly can save many human lives.

5. Clinico- Cyto-Pathological Study of Cutaneous Metastatic Lesions Using Fine Needle Aspiration (FNAC) in a Tertiary Hospital from Kashmir
Farhat Abbas, Gausia Rahim, Summyia Farooq, Farzana Manzoor
Background: Cutaneous metastasis refers to growth of cancer cells in skin from an internal malignancy they are clinically important because they may represent the terminal stage of carcinoma, sign of relapse following failure of therapy or sometimes first manifestation of internal malignancy. Aims and Objectives: This study focuses on the role of Fine Needle Aspiration Cytology (FNAC) in the diagnosis of cutaneous metastatic deposits. Materials and Methods: The present study was carried out from Jan 2018 to Jan 2020 in in the Department of Pathology, Government Medical College Srinagar j&K India. FNAC was done using 22-gauge needle and 10 ml disposable syringe and the smears were examined and morphology of primary tumour assessed. Results: Total 17 patients were included in the study. The age of subjects ranged from 25 to 63 and majority of subjects were males. Chest wall and scalp were the most common sites of cutaneous metastatic deposits. Adenocarcinoma was the predominant type of tumour which caused deposits. The most common primary organ was lung in males and breast in females followed by gallbladder and kidney. Conclusion: FNAC is minimally invasive, safe, rapid and reliable method for the diagnosis of cutaneous metastases. Majority of these cases can be diagnosed accurately by skilled and experienced pathologists which helps the clinicians to take prompt decision for further therapeutic management.

6. Correlation between Two Monitoring Tools by Subjective and Objective Methods for Evaluation of Adequacy of Brachial Plexus Block: An Observational Study
Sajita Jani, Komal Shah, Chandrika Bhut
Introduction: Supraclavicular block provides adequate anaesthesia and analgesia but lacking objective methods of assessment, so in this study PI index using pulse oximetry was used to assess the adequacy of block. Methods: The study was conducted on 100 patients undergoing elective or emergency orthopaedic procedures under brachial plexus nerve block. After local anaesthetic injection, sensory and motor block  success was assessed every 5min by traditional pinprick and Modified Bromage Scale methods respectively. The PI was recorded at baseline and at every 5 minutes till 30 minutes after anaesthetic injection in both blocked and non-blocked limbs. The PI ratio was calculated as the PI after 5min divided by the PI at the baseline. Result: The PI was higher in the blocked limb at all time points except baseline and this was paralleled by a higher PI ratio compared with the unblocked limb. At the time when complete sensory block achieved, the correlation Pearson coefficient of PI was 0.979 (p < 0.001) and for motor block it was 0.932 (p – 0.002), which shows positive correlation between both the assessment methods. Conclusion: PI and PI ratio are positively correlated with the traditional subjective methods of assessment of block adequacy. So, it can be a good alternative in uncooperative, sedated patients.