International Journal of

Toxicological and Pharmacological Research

e-ISSN: 0975 5160

p-ISSN: 2820-2651

Peer Review Journal

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1. An RCT: To Evaluate the Clinical Characteristics of Patients Having Spinal Anaesthesia with Intrathecal Bupivacaine and Clonidine, as well as Intrathecal Bupivacaine and Fentanyl.
Satish Kumar
Aim: The aim of this study to assess the clinical profile of patients undergoing spinal Anesthesia with intrathecal bupivacaine with clonidine and intrathecal bupivacaine with fentanyl. Methods: A prospective double blind randomized controlled study was conducted in the Department of anaesthesiology, Katihar medical college Hospital, Katihar, Bihar, India.for 1 year. 110 adult patients were randomly divided on an alternative basis into two groups of 55 each. Group A-Bupivacaine plus clonidine group. Group B-Bupivacaine plus fentanyl group. Patients with ASA grade 1 and 2 patients and age group of 18 –72 yrs. Those patients scheduled to undergo elective lower abdominal, lower extremity, gynaecological or urological surgeries under subarachnoid block were included in this study. Patients belonging to group ‘A’ received 3 ml (15 mg) of hyperbaric bupivacaine 0.5% plus 1 µ of clonidine. Patients of group ‘B’ received 3 ml (15 mg) of hyperbaric bupivacaine 0.5% plus (25 µg) of fentanyl. After injection, patient was immediately turned to supine position. Results: Majority of patients in the both the groups belonged to the group 30 to 40 years 34.54%. The number of males 43.64% and females 56.36%. Majority of female patients in the both the groups belonged to the group 160 to 170 cms and males 171 to 175 cms, Samples were height matched. Most of the patients 41.82 percent from gynaecology surgery followed by lower limb surgery 33.63 percent and  Lower Abdominal Surgery 24.55 percent. Conclusion: We concluded that the administration of local anaesthetics in combination with opioids intrathecally is an established technique for managing postoperative pain following abdominal, pelvic, thoracic or orthopaedic procedures on lower extremities. Local anaesthetics with opioids demonstrate significant synergy.

2. Experimental Evaluation of Nephroprotective Effect of Punica granatum Peel Extract aganist Gentamicin Induced Nephrotoxicity in Albino Rats.
Shakira Fathima Syeda, Mohammed Mohsin, T Sunitha, J Margaret Viola, G Jyothsna
Nephrotoxicity is a disease characterised by derangement in carbohydrate, protein and fat metabolism which is caused by the complete or relative insufficiency of insulin secretions. Long- term complications from high blood sugar can develop heart disease, strokes, diabetic retinopathy where eyesight is affected, kidney failure which may require dialysis, and poor circulation of limbs leading to amputations. AIM: The aim of this study was to investigate the potential Nephroprotective activity of Punica granatum peel extract in Gentamicin induced Nephrotoxicity. Rats were divided into 6 groups, Group I Normal control group received distilled water 5ml/kg body weight orally daily, Group II were treated with Gentamicin 100mg/kg body weight induced nephrotoxicity administered i.p daily for 8 days. Group III Gentamicin 100mg/kg administered i.p for 8 days and Punica granatum extract 100 mg/kg administered orally daily for 10 days. Group IV Gentamicin 100mg/kg administered i.p. for 8 days and  Punica  granatum extract 200 mg/kg administered orally daily for 10 days & Group  V treated with Punica granatum peel extract 200mg/kg alone for 8 days administered respectively. Punica granatum extract had shown Significant in protecting the gentamicin- induced renal failure in rats. The result of this study demonstrates the potentiality of Punica granatum peel extract as a source of a Nephroprotective activity. Observations were recorded and results were analyzed by one way analysis of variance (ANOVA). P<0.001was considered highly significant.

3. Prevalence of Traumatic Dental Injuries to the Permanent Anterior Teeth Among 7-12 year Old Schoolchildren of Darbhanga Town.
Shagufta Syreen, Ahtasham Anwar, Bimleshwar Kumar
A traumatic dental injury has become a major key hole of a public health. Before dealing with such problem its extent, type and severity of injury should be kept in mind. Aims And Objective: To assess the prevalence and distribution of dental injuries to anterior teeth among 7-12 years old school children in Darbhanga town. Material And Methods: Total of 200 participants was taken. Information regarding sex, age, cause, number & type of teeth were recorded. Result: The Prevalence rate of trauma was found to be 14%. Also, the prevalence rate was found more in male as compared to female. Maximum number of trauma was found in the age group of 11-12 years. Conclusion: A special consideration must be given to traumatic dental injuries as it may disturb the masticatory function and phonation. Also, it might affects the physical appearance of a well being. Educational programmes must be implemented by keeping in mind to prevent dental trauma so that the prevalence is reduced in children. The programs should be conducted in schools and in community. For managing traumatized teeth, educational program plays a major role in reducing the prevalence rate.

4. Common  Parental  and  Physician  Concerns  in  Neonates.
Paramesh Pandala, Rakesh kotha, Kalyan Chakravarthy Konda, Alimelu Maddireddy
The happiest moment in a person’s life is when a child is born, but ironically, at the same time parents may be stressed with many concerns pertaining to their child’s care. Experienced grandparents may be involved and assist in developing confidence in some families regarding baby’s care, but it is the responsibility of the Paediatrician to address parental apprehension, guide them and help establish and develop a bond and confidence between mother infant dyad. In this brief article, we will discuss about common neonatal conditions of a healthy baby which may mimic pathology and cause unwanted fear in parents.

5. Comparative Study of FNAC and Trucut Biopsy for the Diagnosis of Palpable Breast Lumps.
Rajan, Ashwani Kumar, Manjit Singh Khalsa, Ashwathi Menon
Introduction: Definitive diagnosis of patients who present with palpable breast lump is the need of the hour now a days. The method must be accurate, easy to perform and acceptable to the patient, can be carried out in a busy clinic setting and must not require too much preparation or expensive equipment. Aims and Objectives: To compare fine-needle aspiration cytology and tru-cut biopsy in differentiating benign and malignant lesions of palpable breast lumps and to analyze sensitivity, specificity, positive and negative predictive values of fine-needle aspiration cytology and Trucut biopsy. Materials and Method: It is a study conducted on 100 patients with palpable breast lump underwent FNAC and Trucut biopsy and compared with final histopathological confirmation. Results: There were 100 patients who presented with breast lump during the study period. Out of a total 100 breast lump study, final diagnosis was 28 benign breast lump and 72 malignant breast lumps. Sensitivity of FNAC and TRUCUT biopsy were 94.4% and 100% respectively. While TRUCUT was more accurate when compared to FNAC. Conclusion: Trucut biopsy is at par or superior to the FNAC by accurately detecting malignant lesions, providing information regarding local invasion, hormone receptors, and assist in immunohistochemistry, in turn helping direct appropriate treatment.

6. Assessment of Clinico-Etiological Profile of Urinary Bladder Carcinoma in Patients Presenting to Tertiary Care Centre.
Md Faizul Hassan, Mohammad Tarique
Aim: The aim of this study was to determine the etiological of urinary bladder carcinoma patients. Methods: This Prospective observational study was done in the Department of General Surgery, Madhubani Medical College and Hospital, Madhubani, Bihar, India, for 13 months. 100 patients with a diagnosis of bladder cancer were included in the study. Clinical details including history of hematuria, smoking, daily fluid intake, dietary history, symptoms of urinary tract infection (UTI), loss of weight/appetite, past medical history and blood tests including hemogram, renal function tests, liver function tests, imaging like ultrasonography of kidney, ureter, urinary bladder (USG KUB), contrast enhanced computed tomography of kidney, ureter, urinary bladder (CECT KUB) (if needed) and chest X-ray (CXR) was done in all the patients as per the standard protocol in the department of surgery. Results: The mean age of presentation of carcinoma urinary bladder was 53.16 years. The male to female ratio was 3:1. The mean age of presentation of carcinoma urinary bladder was 53.16 years (27-81 years) with the maximum number of patients being in the age group of 60-70 years followed by below 40 years. 88% of the patients of carcinoma urinary bladder in our study were non-smokers. History of UTI was present in only 27% of the patients of carcinoma urinary bladder. Maximum number of patients of carcinoma urinary bladder belonged to A+ blood group followed by B+ and the least number of patients belonged to O- blood group. Conclusion: we concluded that the majority of the patients turned out to be non-smokers and A +ve blood group in contrast to the strong predilection of smoking and bladder cancer.

7. A Hospital-Based Prospective Study: To Assess the Prevalence and Risk Factors of Neonatal Hypoglycemia
Rashmi Agrawal, Devanshu Kumar, Md Nasim Ahmed, Shilpi Golwara, Binod Kumar Singh
Aim: The aim of the present study is to determine the Incidence and risk factors of hypoglycemia among neonates. Methods: This prospective observational study was done in the Department of Pediatrics, Nalanda Medical College and Hospital, Patna,Bihar, India, from January 2020 to March 2021. 110 Patients admitted in NICU with blood glucose less than 45 mg/dl were included in this study. In neonates with risk factors blood sugar was screened at 2, 6, 12, 24, 48 and 72 hours of life or whenever symptoms suggestive of hypoglycemia developed in any neonate.  For critically sick neonate blood sugar was screened in every 6 hours in active phase of illness. Results: The total number of admissions in NICU during the study period was 680 and among them the prevalence of hypoglycemia was 110 (15.94%). Among the 110 neonates with hypoglycemia, 66 (60%) were male and 54 (40%) were female. Among the study population 97 (88.18%) of neonates had at least one risk factor (maternal/neonatal) and 13 cases (11.82%) had no risk factor. The maternal risk factors that were associated with hypoglycemia were GDM, PIH, PROM. Maternal age and drug intake. 18.18% had GDM, 10.90% had PIH and 1.82% had PROM as maternal risk factors. 68.18% had no maternal risk factor. The neonatal risk factors associated with hypoglycemia were prematurity 21(28.18%), SGA 36(32.73%), LGA 7(6.36%), IDM 24(21.18%) and comorbidities (sepsis, birth asphyxia, polycythemia and shock) were present in 19(17.27%) of the hypoglycemic neonates. Among the comorbid condition birth asphyxia was present in 7 (6.64%), sepsis in 8(7.27%), polycythemia in 3(2.73%) and shock in 1 (0.91%). 82.73% of the hypoglycemic neonates had at least one risk factor. Out of 110 neonates 9 (8.18%) neonates attained euglycemia within 30 minutes, 85(77.27%) in 1 hour, 11(10%) in 2 hours, 3 (2.73%) within 2-6 hours and 2 (1.82%) neonates required 6-12 hours to attain euglycemia. Out of 110 neonates 65 (59.09%) required 24 hours of hospital stay, 13 (11.82%) required 24-48 hours, 15(13.64%) required 48-72 hours, and 17(15.45%) required more than 72 hours of NICU stay. In the present study 106 (96.36%) neonates recovered and mortality was observed in 4 (3.64%) neonates. Conclusion: Blood glucose screening in neonates with risk factor is mandatory as many of the neonates were asymptomatic. The importance of early initiation of breast feeding to prevent hypoglycemia should be emphasized.

8. Prospective Clinical Study to Assess the Prevalence of Vitamin D Deficiency in Orthopedic Patients.
Neeraj Kumar
Aim: To determine the prevalence of vitamin D deficiency in orthopaedic patients. Methods: The prospective clinical study was conducted in the Department of Orthopaedics, All India Institute of Medical Science, Patna, Bihar, India for 1 year. The serum 25-OH-D levels of every patient consecutively admitted to the Orthopaedic Department (in total 950 patients) was measured after admission. Patients from the following orthopaedic sections were included in the study: elbow/shoulder, hip, knee, foot/ankle, spine and bone tumour. Measurement of serum 25-0H-D was standardized, the hospital laboratory used the ARCHITECT 25-OH Vitamin D assay. Results: A total of 950 patients participated in this study, of which 500(52.63%) were women, 450(47.37%) men. Ages ranged from 11 to 88 years, with a mean age of 57.5 years. The body region-specific patient census was as follows: 222 patients (25.5% of all patients) were scheduled to undergo back surgery (spondylodesis or kyphoplasty). 202 (21.26%) presented for knee surgery, 147 (15.47%) foot and ankle, 142 (14.95) hip, 137 (14.42%) shoulder and elbow. 100 (10.53%) patients were scheduled to undergo cancer associated surgery of different body regions. The serum 25-OH-D levels for all participants were normally distributed, with a mean of ng/ml. Lowest measured level was <8.5 ng/ml, highest measured level was 77.9 ng/ml. Statistical analyses failed to disclose any relationship between vitamin D level and body region scheduled to undergo surgery. All tested patient subgroups showed low vitamin D levels. Multivariate analyses showed no significant correlation between medication history and hypo- vitaminosis D. Conclusion: Our data suggests a possible way to improve the outcome after orthopaedic surgery by supplementing vitamin D. Nevertheless, heightened awareness is necessary, especially as vitamin D deficiency is preventable.

9. A Prospective Single Centre Study to Examine the Differences Between the Outcomes of Operation Fixation of Acute Scaphoid Fractures and Those of Non-Operative Therapy
Anshu Anand, Ajoy Kumar Manav
Aim: To compare the results of operative fixation of acute scaphoid fractures with those of non-operative treatment. Materials & Method: This clinical study was carried out among 26 patients with an acute nondisplaced or minimally displaced scaphoid fracture reported to the OPD of Department of Orthopaedics, Patna Medical College and Hospital, Patna, Bihar, India. Patients were non-randomly allocated to group A (non-operative treatment with a cast) and group B (internal fixation with a Herbert screw). Results: mean age of the study population was 41.23 years. Majority of them were male 21 (80.7%) and rest 5 (19.3%) were female. Out of total 26 scaphoid fracture cases 16 (61.5%) were of right hand and rest 10 (38.5%) found on the left hand. Most common location of fracture was waist fracture (B2) 10 cases. 100% union was observed in group B. Conclusions: It has been demonstrated in this study that cast treatment has the disadvantages of prolonged immobilisation time, joint stiffness, decreased grip strength, and a longer time to return to work, whereas operative fixation of acute scaphoid fractures results in a predictable satisfactory union rate and a good functional outcome.

10. Radiological Evaluation of Femoral and Tibial Tunnel Placement in Arthroscopic ACL Reconstruction Using Hamstring Graft: A Prospective Study
Bibek Kumar Rai, Ajoy Kumar Manav
Aim: To evaluate the Radiological assessment of femoral and tibial tunnel placement in arthroscopic ACL reconstruction using hamstring tendon graft. Methods: This prospective study   was carried out in the Department of Orthopaedics, Patna Medical College and Hospital, Patna, Bihar, India from January 2020 to November 2020, after taking the approval of the protocol review committee and institutional ethics committee. The study included patients using hamstring graft from either sex of ACL tear undergoing reconstruction of ACL. 50 patients were included in this study.  Patients Diagnosed to have ACL tear clinically and radiologically with/without associated Menisci injuries, age group 14-60 years, and both male and female were included in this study. Patients with ACL injury in individuals associated with osteoarthritis, ACL avulsion fractures, observed chondral lesions that could modify the post op rehabilitation protocol, Collateral or/and PCL injuries and associated tibia plateau fractures and previously operated knee were excluded from this study. Results: This research included 50 patients undergoing reconstruction of ACL with hamstring tendon graft Aperture fastening using titanium screws. Male preponderance was noted in our study, with 90% of males and 10% of females in the total population of the sample. Most patients had a third decade of life, with the youngest patient being 18 years of age and the oldest being 60 years of age with a mean age of 33.5. The nature of the injury in our series was mainly Sports injury, which accounts for 36 patients (72%) and the rest were RTA, Work injury and slip and fall, respectively, which accounts for 14 (28%). The position of the tibial tunnel from the anterior edge of the tibia is found at an average of 45.98% ± 8.87% later. The femoral tunnel was located 37.4% ± 4.89% before the posterior femoral cortex along the axis of the Blumensaat’s. Radiographic impingement was found in 33.5% of the patients. The roof angle averaged 40.8° with interquartile range of 4°. The position of the tibial tunnel was found at an average of 40.3% ± 4.3% from the medial edge of the tibial plateau. The coronal tibial tunnel angle averaged 59.7° ± 8.8°. The average femoral tunnel coronal angle was 40.8 ° ± 3.36 °. Conclusion: The radiological outcome for patients who underwent ACL reconstruction using hamstring tendon graft is that the placements of the femoral and tibial tunnels are well associated with anatomical landmarks except for graft impingement, which is seen radiologically in 33.5% of patients.

11. Outcome Comparison Between Diabetes and Non-Diabetic Individuals Following Cataract Surgery
Utkarsh Bhardwaj, Navin Chandra, Rajesh Tiwary
Aim: The aim of this study comparison of outcomes after cataract surgery in diabetic and non-diabetic patients. Methods: A prospective study was done to compare outcome of cataract surgery in 100 diabetics as compared to 100 nondiabetics Within 15 days of cataract surgery; all the patients underwent fasting blood glucose analysis. Recording of the complete intra-surgical and post- surgical complications along with visual acuity was done at 15 days, three month and six months’ time in all the subjects. Results: Mean age of subjects in the study group and control group was 48.8 and 53.1 years respectively. In diabetic group 44(44%) were females and 56(56%) were males. Among the non-diabetics, 58 (58%) were males & 42(42%) were females. At 15 days’ time, the occurrence of Post-surgical visual acuity in diabetic group and non-diabetic group was found to be 0.21 and 0.29 respectively. At three month’s time, the occurrence of Post- surgical visual acuity in the diabetic group and the non-diabetic group was found to be 0.29and 0.41 respectively (table 2). Glycemic control was assessed using fasting blood sugar levels at the time of admission. Of the 100 patients in the diabetic group, 36(36%) had high blood glucose level (FBS: >100mg/dl). Their blood sugar was controlled, and they were operated. 64(64%) patients had normal blood sugar levels at the time of examination (70-100mg/dl). Striate keratopathy Was most commonly encountered post- surgical complication in the diabetic group 14 (14%) and the non-diabetic group 9(9%) and followed by Posterior capsular opacity 12(12%) and 8(8%) and Posterior capsular rent 11% and 6% in diabetic and non-diabetic, Pigment dispersion 11% and 8% per in diabetic and non-diabetic patients respectively. Conclusion: The small incision cataract surgery in diabetics without diabetic retinopathy yields similar visual outcomes as non-diabetics. There is a higher incidence of post-operative complications among diabetics, which can be managed conservatively.

12. A Cross-sectional Retrospective Study to Determine the Pattern of Reported Adverse Drug Reactions with Reference to Specific Drug Class and Organ System
Sachida Nand Sachit, Swetabh Verma, Asha Kumari, V K Mishra
Aim: The pattern of reported adverse drug reactions with reference to specific drug class and organ system. Methods: A cross-sectional retrospective study was conducted in the Department of Pharmacology Darbhanga Medical College, Darbhanga Bihar India for 10 months (1 October 2020 – 30 July 2021). The department of pharmacology, of our college has been a recognized ADR monitoring centre (AMC) under the PvPI. Results: The highest percentage of ADRs 21.46% were reported among the age group of 40-49 years followed by 17.54% of ADRs among the age group of 50-59 years. The most common therapeutic class of drugs causing ADRs, were antimicrobial agents (36.07%) followed by drugs acting on the central and peripheral nervous systems including the NSAIDS (7.49%), anti- epileptics (4.08%) and anti-depressants (2.72%). 12.92% of ADRs are caused by hormones like the corticosteroids and anti-diabetic drugs. 8.16% of ADRs were reported by the CVS drugs like the antihypertensive drugs and anti- angina drugs. 6.80% of ADRs were reported with anticoagulants, anti-platelets and statins. A total 9.52% of ADRs were reported with other classes of drugs like drugs acting on the respiratory system, diuretics, anti-emetics, antacids and antihistaminic. Also, vaccines, immuno suppressants, vitamins and herbal medicines have been reported to cause ADRs. The clinical presentation of affected system shows that, the skin is the most common affected organ system (n=97; 25.39%) and gastrointestinal tract system (n=74; 19.37%). Other organ systems involved are the central and peripheral nervous system, elevated liver and renal function tests and electrolyte disturbances. Conclusion: The skin and subcutaneous is the most commonly affected specific organ class. 104 ADRs were reported under the seriousness criteria. The outcome of reported ADRs was recovering in 52.10 and 81% of ADRs were probable as per WHO causality assessment scale.

13. To Study the Effect of Transversus Abdominis Plane Block with or without Buprenorphine after Inguinal Hernia Repair
Sankalp Srivastava, Madhav Mayank Sharma
Background: One of the most frequent surgical procedures worldwide is inguinal hernia repair. It is frequently accompanied by moderate to severe postoperative pain, which peaks the day of surgery. A risk factor for prolonged postoperative pain following surgery is poorly managed postoperative pain, which can also lengthen the hospital stay and postpone the return to normal activities. Recent research indicates that the severity of initial postoperative pain correlates with peri-incisional hyperalgesia, which may be a precursor to persistent postoperative pain. After inguinal hernia repair, there is an approximately 23.48% incidence of persistent pain with both nociceptive and neuropathic characteristics. Given the enormous number of people receiving treatment, even a rare severe long-term consequence would have a significant effect. In order to effectively control postoperative pain, multimodal analgesia that combines opioids, local infiltration, and nonsteroidal anti-inflammatory medications (NSAIDs) has been employed. Material and Method: Sixty patients from ASA I and II were enrolled in a prospective, randomized, double-blinded research for unilateral inguinal hernia repair under spinal anesthesia. Utilizing 180g Vonfrey filament, mechanical temporal summation was assessed. Patients in groups B and BB got 20ml of 0.25% bupivacaine and 300g of buprenorphine for an ultrasound-guided transversus abdominis plane block at the conclusion of their surgeries, respectively. Effect of age, BMI, anxiety, mechanical temporal summation on pain intensity were determined in group B. Finally, effect of buprenorphine on high pain responders and incidence of persistent postoperative pain upto 6 months were recorded. Results: Patients with perineural buprenorphine had prolonged duration of analgesia with reduced tramadol consumption and pain scores up to 24 hours both at rest and sitting along with the reduction of extent of WHI both at 24 and 48 hours. Among the studied predictors of pain intensity in group B, only temporal summation predicted the postoperative pain intensity and WHI. Only one patient in group B had neuropathic pain which was not statistically significant. Conclusion: The present study shows that TAP block with buprenorphine produces superior analgesia and lowers the extent of wound hyperalgesia compare to control group without any significant side effects even in high pain responders. Among the studied predictors of pain intensity only enhanced mechanical temporal summation predicted the pain intensity and wound hyperalgesia. The enhanced mTS can be utilized as a possible clinical predictor to identify high pain responders, who may need antihyperalgesic drug in postoperative period.

14. Assessing the Inflammatory Blood Markers in Subjects having Sinonasal Inverted Papilloma: A Clinical Evaluation
Gosetti Sreenivasulu, Challa Venkatasubbaiah, Kundirthi Chaitanya Babjee
Background: Sinonasal inverted papillomas represents the benign neoplasms of the paranasal sinus and nasal cavities with associated high recurrence risk and potential for malignant transformation. Aim: The present study aimed to assess the relationship between inflammatory blood markers and Sinonasal inverted papilloma. Methods: In 130 subjects with a confirmed histologic diagnosis of Sinonasal inverted papilloma and in age and gender-matched controls (n=130) inflammatory blood markers were assessed and compared including the platelet distribution width (PDW), mean platelet volume (MPV), red cell distribution width (RDW), platelet–lymphocyte ratio (PLR), and neutrophil–lymphocyte ratio (NLR). Results: The difference for the lymphocytes, neutrophils, hemoglobin, platelets, and white blood cells was statistically non-significant in the study and control subjects with p>0.05. Also, a statistically non-significant difference between cases and controls was seen for PDW, MPV, RDW, PLR, and NLR (p>0.05). However, a decrease in PLR and an increase in NLR were seen as statistically significant factors in the cases. Conclusion: The study concludes that PLR and NLR can help in differentiating controls from the subjects having Sinonasal inverted papilloma being reliable inflammatory blood markers. However, further longitudinal studies are needed to reach a generalized conclusion.

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