International Journal of

Toxicological and Pharmacological Research

e-ISSN: 0975 5160

p-ISSN: 2820-2651

Peer Review Journal

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1. Awareness and Risk Perception of Hepatitis B Infection Among Nursing Staff in Tertiary Care Hospital in “A” Grade City of India
Dr. Nita Gangurde, Dr. Aditya Jain, Dr. Jeetendra Singh, Dr. Sneha Gupta, Dr. Muskan Gaba
Background: Hepatitis B infection (HBV) is one of the major public health problems globally and is the 10 th leading cause of death. Worldwide, more than two billion of the population has evidence of past or recent HBV infection and there are more than 350 million chronic carriers of this infection. With the increasing number of invasive diagnostic and therapeutic procedures, there is an increasing risk of HBV infection to the nursing staff. The nursing staff constantly come in contact with blood and its products due to daily handling of biomedical wastes and while performing invasive procedures. Hence, it is necessary for them to be aware of HBV and its prevention. In the present study, we have aimed at investigating the HBV infection related awareness and occupational risk perception of the Nursing Staff. Therefore, the following study is being conducted. Methods: It is a cross-sectional type of descriptive study with sample size of about 200 conducted at Medical College and tertiary care centers of an urban city. Questionnaire and interview based study. Approval was taken from Institutional Ethics Committee (IEC).Permission to conduct the research was obtained from appropriate authorities. Study participants were recruited from a Medical college and various hospitals of a “A Grade” city. Voluntary consent was taken. Results: Overall percentage of knowledge about hepatitis B infection (modes of transmission, methods of prevention, vaccination and curability) is quite satisfactory among the study participants. Awareness: Overall result of awareness about Hepatitis B infection is adequate in this study. Practice: Overall practices among the participants regarding their own vaccination and preventive methods taken were not very satisfactory as compared to knowledge and awareness about the infection. Conclusions: Infection from Hepatitis B virus can be deadly not only to the people who are infected from it but also to the close contacts of the infected person. Though the Knowledge about the virus and awareness about the practices to be followed is adequate in this study but still practices to follow them are lacking.

2. A Comparison of Serum Uric Acid in Acute Stroke Patients  With Healthy Controls
Divya Sharma, Rakhi Pareek, Sulakshmi Kurlekar, Chaitanya Chattree, Divya  Khandelwal, Shakuntala Saini
Background: Stroke is a sudden onset of neurological deficit due to focal vascular cause. It results in reduced cerebral perfusion. Globally every year about 16 million people suffer from stroke.85% of all strokes are ischemic that occur due to blockage of cerebral arteries. The pathophysiology of stroke is complex which may involve inflammation, oxidative damage causing neuronal death. Uric acid has been found to act as both pro-oxidant and antioxidant. As a pro-oxidant, uric acid might increase vascular smooth cell proliferation, reduce nitric acid production, and increase platelet adhesiveness. Present study was thus conducted to find a correlation, if any, between uric acid, and stroke. Material and Methods: A cross-sectional study was conducted at SMS hospital, Jaipur after taking necessary permissions. Uric acid of 50 patients of an acute stroke aged 35-70 years and 50 healthy controls were assessed by spectrophotometric assay. Patients with a known risk for cardioembolic disorders and hyperuricemia were excluded. Results: 50 patients of acute stroke and controls were studied. The mean age in our study was 56.8 ± 9.19 years in cases vs 57.4 ± 8.68 years in controls. Mean serum uric acid level in stroke patients was 6.4 ±1.21 mg/dL and in controls was 5.10±0.97mg/dl(P<0.05). Conclusion: Significant increase in serum uric acid level might be a  risk factor for stroke, hence, it can be a useful diagnostic marker for stroke.

3. A Prospective Study to Evaluate Adverse Drug Reactions in Treatment of  Respiratory Tract Infections and Gastro Intestinal Infections in a Tertiary Care Hospital of  Telangana.
Dr. Katta Nagaraju, Dr. Rahul Pushkar, Dr. Ramala Amala,  Dr. Janardhan Marupaka
Aim: To observe common adverse drug reactions in treatment of gastro intestinal and respiratory tract infections in a tertiary care hospital. Materials and Methods: A  prospective  observational study was  conducted by departments  of  Pharmacology  and Dermatology for a period of one year  from prescriptions and case sheets of medical record section. Adverse drug reaction reporting forms and alert cards were used for reporting. Results: The drugs most commonly used for gastrointestinal tract  and  respiratory diseases are tablets Ofloxacin- Ornidazole, Norfloxacin –Tinidazole, Cefotaxime 200mg, Amikacin and anti Tuberculosis medicines. Systems affected by use of  above drugs were skin and gastrointestinal tract. Urticaria on skin, abdominal pain, itching in genital area, ulcer on oral mucosa are the common adverse drug reactions observed. Conclusion: Drugs used for common gastrointestinal tract and respiratory tract infections  alert cards should be issued to patients when prescribing and adverse drug reactions should be reported to higher centres. Brand names causing adverse reactions should be monitored  regularly and their further usage should be based on signals from other centres. All tertiary care hospitals should have antimicrobial guidelines policy to reduce adverse drug reactions.

4. Association of Depression with IL-6 and CRP Levels Among COVID Recovered Patients: A Hospital Based Case Control Study.
Dr. Priyanka Soni, Dr. Ajitabh Soni, Dr. Paramjeet Singh, Dr. Manoj Verma
Introduction: Depression has been reported in patients suffered from COVID 19 (corona virus disease). Inflammatory markers like IL-6 and CRP have been also found raised in COVID 19 patients. Aim: The objective of present study was to find out the association of serum IL-6 and CRP levels with depression in COVID 19 patients discharged from hospital. Materials and Methodology:  This Case control study included 30 patients of depression attending post COVID OPD after getting discharged from hospital and 30 post COVID patients without depression. Depression was diagnosed using PHQ-9 scores. A cutoff value of 10 was taken to diagnose depression upon PHQ-9 scale. Both groups were compared in relation to socio-demographic variables, serum IL-6 & CRP levels and other clinical variables. Results: Serum IL-6 and CRP levels were significantly higher in post COVID patients with depression (IL-6=39.71 ± 46.39, CRP=43.66 ± 31.78) than those without depression (IL-6= 13.42 ± 18.98, CRP= 21.02 ± 25.36). Hospital stay was also greater in post COVID patients with depression. Conclusion: Post COVID depression was significantly associated with IL-6 and CRP levels. Patients with raised level of these markers could be screened for early identification of depression and counseled preferentially for prevention of depression during post COVID period.

5. Comparative  study of Clomiphene Citrate + Metformin and Clomiphene Citrate + n-Acetylcysteine in the Treatment of Infertile Women with Poly Cystic Ovarian Syndrome.
Sangita Kumari, Keshav Kumar Sinha, Vivek Prasad, Rajesh Kumar
Introduction: Polycystic ovarian syndrome (PCOS) is a hormonal disorder common among women of reproductive age group. Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone (Androgen) levels. The ovaries may develop numerous small cysts on the outer edges. Polycystic ovarian syndrome affects up to almost 27 % of women during their childbearing years. Metformin is most commonly used in a dose between 500-1500mg/d. Now a day combination of Clomiphene Citrate+ Metformin are more effective than combination of Clomiphene Citrate+ N-acetyl cysteine for ovulation induction. Objective: The study was undertaken to compare the efficacy of Clomiphene Citrate + Metformin in one group and Clomiphene Citrate + N-acetylcysteine in the other group in PCOS patients. Materials and Methods: It was an observational study on 35 patients each in Clomiphene Citrate +Metformin group and Clomiphene Citrate +N acetylcysteine group. The study was conducted in the 70 cases and the effects were evaluated at 12 weeks. For monitoring the effects of the drug various parameters were evaluated for 3 cycles. They included number of follicles, size of follicles, endometrial thickness and rate of conception between the two groups. Results: In all cycles mean number of follicle, mean size of follicle, Endometrium thickness and rate of conception in group A were significantly higher than that of Group B (P<0.01). Conclusion: Number of follicles, size of follicles, endometrial thickness and rate of conception was better in group treated with CC+ Metformin as compared to group treated with CC+ N-Acetyl cysteine.

6. A Review: On Antioxidant Activity and Antiaging Property of Herbal Drug.
Abhimanyu Singh Rathore, Aakash Singh Panwar, Nirmal Dongre
Antioxidants are abundant in fresh, healthy foods. There’s plenty of research that confirms eating a diet rich in antioxidants can help stave off aging and keep you healthier for longer. Many skincare products incorporate antioxidants into their formulations to deliver the benefits of antioxidants directly to the skin. How effective topically applied antioxidants are is still a bit unclear. More in-depth research is currently being done, but so far, it seems that topical antioxidants may deliver a host of benefits. Skin is the largest organ of the integumentary system. The overall well-being& perception of health in humans, very much depends on skin health & beauty. Skin plays a vital role in immunity& protects the body against pathogens, maintains water and electrolyte balance & also regulates body temperature. Epidermis is the protective covering over the body surface which serves as a barrier to infection. Thinning of this epidermal layer, loosening of collagen & elastic fiber, leads to the wrinkle formation and causes ageing. Ageing occurs due to the intrinsic factors like genetics, cellular metabolism, hormone & metabolic process or extrinsic factors like sun exposure, smoking, diet and pollution. In this era of modern science, people choose natural herbs rather than plastic surgery or laser therapy for not only looking younger but also to reduce complications. Herbs help in biological functioning of the skin & supplies nutrients required for healthy skin.

7. A Comparative Study of Effectiveness and Tolerability of Metformin and Combination of Metformin and Teneligliptin in the Treatment of  Type II Diabetes Mellitus Patients.
Sangita Kumari, Keshav Kumar Sinha, Vivek Prasad, Rajesh Kumar
Introduction: Diabetes Mellitus is a chronic Metabolic disorder affecting large population all over the world. Metformin is a first line drug therapy for the Management of Type II Diabetes Mellitus especially in obese patients. Now a days a new drug Dipeptidyl Peptidase 4 Inhibitors (DPP-4) ,Teneligliptin is more effective in combination with Metformin than Metformin monotherapy in patients with inadequately controlled Plasma Glucose levels. Objective: To compare the effectiveness and tolerability of Metformin and combination of Metformin and Teneligliptin in the treatment of Type II Diabetes Mellitus Patients. Materials and Methods: It was an observational study on 35 patients each in metformin group and Metformin with Teneligliptin group. After enrollment in study follow up was done at 8 weeks of therapy. Results: The change in fasting blood glucose (FBG) in Group A was from 150.18 + 3.75 to 140.3 + 3.41 mg/dl and Group B was from 154.68 + 3.6 to 122.36 + 2.57 mg/dl. Changes in both the groups were statistically significant with P-value < 0.00001. The change in post prandial blood sugar in Group A was from 188.68 + 8.4 to 169.66 + 3.62 mg/dl and Group B was from 187.5 + 10.29 to 152.08 + 5.19 mg/dl. Changes in both the groups were statistically significant with P-value < 0.00001. Conclusion: The addition of Teneligliptin (20 mg) to Metformin treatment was effective in controlling blood glucose (Fasting and Post Prandial) and was well tolerated in patients with Type II DM. It provided clinically significant glycemic control.

8. Post Traumatic Anterolisthesis of Sub Axial Cervical Spine: A Case Series with Literature Review.
Dr. B. L.Bairwa, Prof. (Dr.) Sanjeev Chopra, Dr. Mahesh Bairwa
The term anterolisthesis refers to anterior displacement (forward slip) of a vertebral body relative to the one below. Cervical anterolisthesis is defined as the dislocation of the spinal column most often caused by trauma. This study includes a case series and literature review. We studied 10 cases of post-traumatic cervical anterolisthesis in the sub axial cervical spine, and reviewed the literature, which largely consists of isolated case reports. On the basis of the 10 cases from the literature and our experience of three cases, we obtained the following results. The sub axial cervical spine C7–T1 was the most common location of anterolisthesis (n=4/10). Though the injury could be seen in various age groups (32–67 years), it was most common in middle-aged people (mean age, 45 years) and in males, with road traffic accidents being the most common cause because of the nature of force required for this injury to occur. 6 patients were classified as category 1 and 4 were classified as category 2. As expected, all category 1 patients had a complete injury and category 2 patients showed incomplete or normal neurological status on presentation. The majority of cervical injuries occur in the sub axial spine (approximately 65% of fractures and more than 75% of all dislocations. This study found an overall success rate of traction achieving reduction of 80% and a permanent neurologic complication rate of 1%, with a 2% rate of transient neurologic deterioration. It found that the causes of deterioration were not limited to disk herniation. Such causes also included over distraction, spinal cord edema, and a more rostral noncontiguous injury. Sub axial cervical anterolisthesis is a common injury with varied clinical presentations. Management of these patients requires the most care in terms of methods of reduction of the fracture and subsequent surgical stabilization.

9. A Retrospective Study of Clinico-Microbiological Profile of Post-Traumatic Endophthalmitis Cases Treated at A Tertiary Care Centre in Rajasthan.
Ashu Agarwal, Daksh Sharma, Kamlesh Khilnani
Purpose: The purpose of this study is to evaluate the clinical and microbiological profile of patients presenting with post-traumatic endophthalmitis to a tertiary care centre in Rajasthan. Methods: A Retrospective chart review of consecutive cases with endophthalmitis presenting to vitreoretinal facility of tertiary care centre of Rajasthan from January 2019 to January 2020 and studying their clinico-microbiological profile. Results: The study included 43 patients where the mean age of the sample was 37.8 years (SD=24.1). The majority of patients were males 36 (83.7%) and with predominant left eye involvement 30 (69.7%). Majority of patients had PL only vision, 23.35% of patients had vision greater than perception of light. At presentation majority of patients were phakic (60.4%) in which traumatic cataract was seen in 25.6% of patients. About 90.6% underwent pars plana vitrectomy with intravitreal antibiotics. Oil tamponade was used in 70% of patients who underwent Pars Plana Vitrectomy. The microbiological analysis of vitreous fluid revealed a predominance of gram negative bacilli (51.1%), gram positive cocci (13.9%) and fungi (13.9%). Conclusions: More than 3/4th of of post-traumatic endophthalmitis patients at our centre had PL only vision. Majority of these patients had to undergo pars plana vitrectomy. Most commonly found organism on microbiological profile was gram negative bacilli.

10. A Prospective Study of Frontal Lobe Injury: Clinical and Radiological Predictors and Outcome.
Dr. B L Bairwa, Prof. (Dr.) Sanjeev Chopra
Background: The frontal lobes are considered our emotional control centers and home to our personality. There is no other part of the brain where lesions can cause such a wide variety of symptoms. The frontal lobes are involved in motor function, problem solving, spontaneity, memory, language, initiation, judgment, impulse control, and social and sexual behavior. One of the most common effects of frontal damage can be a dramatic change in social behavior. A person’s personality can undergo significant changes after an injury to the frontal lobes, especially when both lobes are involved. Material and Methods: The study was conducted in Department of Neurosurgery at Institute of Traumatology and Orthopedics, SMS Medical Collage Jaipur, Rajasthan (India).The study was conducted from Nov. 2020 to April 2021. Duration of follow up was minimum 6 month.  34 patients were included in this study. All included patient was evaluated for the following factor –Demographic Features (Age, Sex), Clinical Features , Radiological , Decision of Management. Result: Age Distribution Patients were divided into7 age group according to their age. 2 (5.88%) patients were in age group of 15-20 years, all 2 patients had good recovery. 2 (5.88%) patients were in age group of 21-25 years, all had good recovery. Sex Distribution, 76% patients were male and 24% were female. Mode of Injury, RTA 16 (47.05%) patient and fall from height 15 (44.11%) patient were the commonest modes of injury followed by assault (8.82%). Conclusion: In this study concluded that the favorable prognosis and outcome in frontal lobe injury depends on young age of patient, Moderate to good GCS, Focal contusion operated before clinical deterioration. Contusion volume has significant effect on outcome because patient with large volume contusion had poor outcome, Early CT scanning is the optimal investigation and has greatly improved prognosis.

11. The Treatment of Lower Urinary Tract Symptoms (LUTS) in Perimenopausal Females Using Alpha-1A Blockers (Tamsulosin) and Estrogen’s: A Comparative Study.
Dr. Narendra Kumar Tripathi
Aim: The aim of the present study to compare the alpha-1a blockers (Tamsulosin) with Estrogen’s in the treatment of lower urinary tract symptoms in perimenopausal females. Methods: A comparative 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 13 months. All 80 perimenopausal females between the age group of 40 and 58 years presented with the retention, past history of urethral dilatation, or having urinary infection were excluded from the study. All 80 other patients between the age group of 40 and 58 years having LUTS were included in the study. The first group was given alpha-1a blocker (tablet Tamsulosin 0.4 mg OD HS) and other group was given estrogen in the topical form (0.5% to 1% twice daily) for application topically in the periurethral region. Results: Perimenopausal women were divided into two groups and females of each group were given either alpha-1a blocker or topical estrogen. The mean age group of patients was 50.50 years (45–55 years). Alpha-1a blocker group had 80 females and topical estrogen had 80 females. Patients were followed up with uroflowmetry and PVR urine assessment with USG. In the first group, pre-treatment mean Qmax (maximum flow rate) of patients was 6.9 ± 1.3 ml/s and post treatment Qmax was 17.8 ± 1.6. In the second group, pre-treatment Qmax was 7.6 ± 1.2 ml/s and post treatment Qmax was 9.8 ± 2.1. This difference was statistically significant (P ≤ 0.0001). In the first group, pre-treatment PVR urine was significant, which became insignificant after the treatment, whereas in the second group, PVR was significant post treatment also. Conclusion: The conclusion of this study is that alpha-1a blockers should be used as a first-line medical management in perimenopausal females with symptoms of LUTS, as they have a clear advantage over topical estrogens in improvement in symptoms of LUTS.

12. A Comparative Randomised Research to Assess the Efficacy of Parenteral Iron Sucrose and Oral Iron in the Treatment of Iron Deficient Anaemia in Pregnancy.
Dr. Snehil, Dr. Krishna Sinha, Dr. Anupama Sinha
Aim: To compare and observe the effect of parenteral iron sucrose and oral iron in the treatment of iron deficiency anaemia in pregnancy. Methods: Total 120 Pregnant women with gestational age between 26 to 34 weeks with mild to moderate iron deficiency anemia (Hb 7-10 g/dl) who gave informed consent were selected from ANC clinic were included in this study. Two groups were made and in each group 60 patients were included. The women in group A received IV iron sucrose. The women in the group B received ferrous sulphate as oral iron BD for 6 weeks. Women were instructed to take the tablets on an empty stomach either two hour before or after meal. Each tablet contained 200 mg as salt (60 mg elemental iron). The each and every patient of these two groups was followed up every week for six weeks. At the end of six weeks all the initial investigation viz: haemoglobin, red blood cell count, reticulocyte count, PCV, MCHC, serum iron, serum ferritin and total iron binding  capacity of serum were estimated. All the haematological parameters were repeated at the time of delivery and one week after delivery. Results: Mean age of the patients in oral group was 28.69+1.77 and in the intravenous group it was 26.98+0.79 years. The baseline mean Hb level in the oral iron therapy group was 8.81±0.17g/dl and parental iron therapy it was 8.77±0.11g/dl, which was found to be statistically insignificant between the groups. 6 weeks after starting the therapy, there was a high significant change (p<0.05) in the Hb level in both oral and injectable iron group. The mean Hb rise in the injectable iron group was 3.26 g/dl (p <0.05) and in the oral iron group was 1.52 g/dl (p <0.05). The significant difference (p<0.05) in increase in serum iron, serum ferritin and TIBC was also observed in two group A and B in our study, whereas the rise of other haematological parameters i.e. red cell count, packed cell volume, mean corpuscular haemoglobin concentration and reticulocyte counts were non-significant. Indicate that IV group respond better than the oral group (p<0.05). To compare the weekly change in haemoglobin level in two groups, independent sample t-test was performed. Two group differ significantly (p<0.05) change in haemoglobin per cent in all the weeks. Conclusion:The intravenous iron sucrose appeared to be more efficacious in increasing hemoglobin level more rapidly than prolonged course of oral iron therapy.

13. A Retrospective Research to Assess the Usage of Levetiracetam During Pregnancy in Epileptic Mothers.
Dr. Narendra Kumar Tripathi
Aim: The aim of the present study to determine the levetiracetam use during pregnancy in women with epilepsy. Methods: A retrospective 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 1 year. All female cases of >18 years epileptic women with pregnancy that were included in this study. 100 women were found to have active epilepsy and were using AED before conception and through the whole pregnancy (WWAE). The other group included 100 pregnant women, in which the mother reported having seizures 5 years or more before conceiving but no need for AED at the time of pregnancy were termed non-active epilepsy cases. Results: The mean age of patients was 24.5 years (range 18–42 years). Majority of our women (73) were multiparous (73%), 65 women (65%) were from low or rural stratum. Complete outcome data were available for 100 pregnancies. Of these 45 pregnancies had been exposed to levetiracetam in monotherapy and 55 had been exposed to Levetiracetam in combination with at least one other AED. Mean gestational age at enrolment was 14.5 weeks (standard deviation 10.55 range 5 to 38 weeks). We observed 58 (58%) women with generalized epilepsy (absence or myoclonic seizures), 37 (37%), women with focal epilepsy (localization related) and 6% with unspecified epilepsy. 61% of patients did not experience any change in seizure frequency, 20% experienced a change for better. Conclusion: Pregnancy course is uncomplicated and neonatal outcome is good in the majority of women with active epilepsy with proper antenatal and neurologic care. Levetiracetam taken in monotherapy can be considered as safer alternative for women with epilepsy of childbearing age.

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