International Journal of

Toxicological and Pharmacological Research

ISSN: 0975 5160 Peer Review Journal

Print-ISSN 2820-2651

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1. Experimental Studies on the Possible Role of Nitric Oxide Signalling Pathways in Post-Traumatic Stress Disorder in Rats
Anuj Yadav, Sana Rehman, Nafaa Hasan Ali, Mohd. Rafi Reshi, Mohd. Faizan, Mohd. Iqbal Alam, Arunabha Ray
Abstract
Background: Post-traumatic stress disorder (PTSD) is associated with traumatic experiences for which treatment strategies are poorly defined. Nitric oxide (NO) is a neuromodulator and thus we examined the role of NO in PTSD by assessing behavioral and biochemical parameters in an experimental model in rats. Materials and Methods: Wistar rats were exposed to time dependent sensitization (TDS, stress + re-stress) and the influence of NO modulators were assessed on neurobehavioral parameters and brain biochemistry. Rats were evaluated for anxiety behaviour in the elevated plus maze (EPM) test, and open arm entries/time were recorded. Post EPM test, animals were sacrificed and brain homogenates were assayed for biochemical markers of lipid peroxidation markers (MDA) and NO metabolites (NOx). The effects of various drug treatments, viz. L-arginine, L-NAME and fluoxetine, were evaluated on behavioural and brain biochemical parameters, and compared with disease control (TDS) group. Results: In the EPM test (for anxiety), TDS induced an anxiogenic response (increased % open arm entries) which was inhibited by L-arginine (NO mimetic), but not with L-NAME (NOS inhibitor). Biochemical studies of brain homogenates showed that TDS induced increased MDA and NOx metabolites in brain, and these alterations were attenuated by L-arginine. The L-arginine effects were comparable with fluoxetine on both neurobehavioral and brain biochemical parameters. Conclusion: The NO mimetic drug, L-arginine, attenuated behavioural manifestations and brain biochemical changes of PTSD by interacting with oxidative stress pathways and could be a potential therapeutic agent in this stress disorder.

2. The Analysis of Association between Anticonvulsants and Bone Mineral Density
Ajay Singh Amera, Vijay Singh Amera, Chander Singh Gahlot
Abstract
Introduction: Anti-convulsant drugs are being used increasingly for various conditions including migraine, bipolar disorder, peripheral neuropathy, etc. Along with Conventional anti-convulsants, the newer anti-convulsants are also in use extensively. It is said that the tolerability of newer anticonvulsants is more, but there is rising concern with bone density with the use of anti-convulsants. Many studies have shown that the conventional ones are causing decreased bone mass density leading to fractures. Aims and Objectives: To evaluate the significant effect on bone mass density due to usage of different anti-convulsants. Materials and Methods: This restrospective study assessed the patients for Bone Mineral Density, who were on anti-convulsants for various conditions. According to the patients’ exposure to anticonvulsants, they were classified into five groups. Among them, one of the groups (group 5) was not exposed to anti-convulsant and were considered as the reference group for comparing T-scores with the other groups. Results: It has been observed that T-score is lower with conventional anticonvulsants while newer anticonvulsants (both group 1 and group 2) caused significant (P < 0.01) T-score compared to the unexposed or reference group, when femoral neck is considered. In all the anatomical sites including femoral neck, lumbar spine and hip, T-score in group 2 came to be significantly higher (P<0.05). Conclusion: The study has concluded that newer anti-convulsants does not cause decrease of bone mass density and therefore, there is no risk of causing fractures with the usage of newer anti-convulsants.

3. A Questionnaire Based Study to Assess Knowledge, Attitude and Practice of Pharmacovigilance Among Undergraduate Medical Students in a Tertiary Care Hospital
Chitra. K, Sirisha. N. P, Usha Rani. M, Abhishek. M, Vivek. R
Abstract
Introduction: Drug therapy is an integral part of the medical management. It has many beneficial effects, but side effects and adverse drug reactions (ADR) are some of it’s major disadvantages. ADR is defined by World Health Organisation (WHO) as “a response to a drug that is noxious and unintended, and which occurs at doses normally used in man for prophylaxis, diagnosis, or therapy of disease or for the modification of physiological function”. Spontaneous reporting of these adverse drug reactions is the backbone of the Pharmacovigilance Programme. ADRs have been reported to be among leading causes of morbidity and mortality. Under-reporting is a major problem which still exists. ADR reporting does not currently appear to be considered part of routine professional practice by health care professionals. Medical students could play a major role and bring a paradigm shift in successful implementation of the Pharmacovigilance Programme. Objectives: To assess the Knowledge, Attitude and Practice (KAP) of undergraduate medical students of Pharmacovigilance and ADR reporting. Materials and Methods: It was a questionnaire based cross sectional study with validated 20 questions to evaluate the KAP of undergraduate medical students in a Tertiary Care Hospital. Results: Data was compiled and entered in Microsoft (2010) excel sheet using SAS latest version and analysed by descriptive statistics, chi-square and ANOVA. In knowledge-based questions comparison of mean score was (70.8%,72.2%,79%) of final, prefinal and second year. In attitude-based questions the mean score was (85%,83.3%,85.6%) and in practice-based questions the mean score was (83.5%,80%75%) of final, prefinal and second year students. p (<0.05). Conclusion: In this study, even though the students had positive attitude towards the programme the skill or practice of reporting was lacking. This underreporting of ADRs which is the major problem of the programme can be overcome with various educational and practical integration in the curriculum of the students from second year onwards till final year including internship as the students are the backbone of future health care delivery systems.

4. A Pharmacovigilance Study on Comparative Safety Assessments of Delamanid, Ofloxacin, Levofloxacin and Bedaquiline, in Tertiary Healthcare of Multi-Drug Resistant Tuberculosis
Moumita Hazra
Abstract
Background: Delamanid is bactericidal to Mycobacterium tuberculosis and M. kansasii. Ofloxacin is bactericidal to M. tuberculosis, MAC, M. fortuitum, and other atypical mycobacteria. Bedaquiline is consecutively bacteriostatic and bactericidal to M. tuberculosis. Objective: A pharmacovigilance study on comparative safety assessments of delamanid, ofloxacin, levofloxacin and bedaquiline, in tertiary healthcare of multi-drug resistant tuberculosis. Materials and Methods: Among 100 multi-drug resistant tuberculosis patients, Group A was prescribed delamanid 100 mg twice daily, Group B was prescribed ofloxacin 400 mg twice daily, Group C was prescribed levofloxacin 750 mg once daily, and Group D was prescribed bedaquiline 400 mg once daily followed by 200 mg thrice weekly, for 24 – 48 weeks. These anti-tubercular drugs’ safety assessment was performed by monitoring the occurrence of any adverse drug reaction, like nausea, vomiting, headache, insomnia, dizziness, tinnitus, hypokalaemia, gastritis, decreased appetite, asthenia, diarrhoea, skin rash, arthralgia, constipation, ECG QT prolongation, myalgia, chest pain, or, haemoptysis, with Adverse Event Case Report Forms, on days 0, 30, 60, 90, 120, 150, 180, 210, 240, 270, 300, 330, 360 and on further follow-ups, which was statistically analysed. Results: The safety assessments showed that among Group A patients, 1 patient had decreased appetite, among Group B patients, 1 patient had nausea, among Group C patients, no patients had any adverse drug reaction, and among Group D patients, 1 patient had myalgia. The occurrence of adverse drug reactions was statistically non-significant, among all 4 groups. Conclusion: Delamanid, ofloxacin, levofloxacin and bedaquiline were safe and tolerable for treating multi drug-resistant tuberculosis tertiary healthcare patients.

5. Drug Utilization Study in Patients with COVID-19 Associated Mucormycosis in a Tertiary Care Hospital, South India
Sirisha N P, Chitra K, Veera Sekhar M, Vijay B Talla, Viswanadh P, Akhil Raj A
Abstract
COVID-19 associated Mucormycosis (CAM) is a serious condition in India considering its unprecedented surge due to COVID-19 and associated high morbidity and mortality. Diabetes and widespread usage of steroids in a background of COVID-19 appear to increase the risk of CAM exponentially. Management includes control of the underlying disease or risk factor, strict glycemic control, surgical debridement of necrotic infected tissue, and specific antifungal therapy. First-line antifungal treatment consists of intravenous liposomal Amphotericin-B (LAB) or deoxycholate Amphotericin-B (AMB) and second-line antifungals are intravenous (IV) or oral Posaconazole (POS) which can also be used as salvage therapy. This study is conducted to observe the drug utilization pattern in CAM patients in tertiary care hospital in South India. A prospective, observational study of 55 patients admitted with CAM are studied in terms of drug usage. POS (98.2%) is the most used drug followed by intravenous AMB (49.1%). POS-Oral are used in 83.6 %, POS-IV in 49.1% and AMB-retrobulbar is used in 12.7% of the patents and average doses are within recommended limits. Anti-bacterial and other antifungal are used in 12.7% and 1.8% of the patients respectively, and 34.5% underwent debridement surgery. Though LAB is the recommended 1st line treatment, AMB and POS are used as a reasonably accepted alternative. Guidelines and recommendations should consider cost, compliance (availability ot oral formulations), safety profile, and accessibility aspects which suit the needs of Low- and middle-income countries (LMIC) especially during an unprecedented event like COVID-19 and CAM.

6. Pregnancy Outcome and Early Neonatal Morbidities among Women in Labour with Meconium Stained Liquor: A Prospective Observational Study in a Peripheral Tertiary Health Care Facility in West Bengal
Rajib Pal, Sadariya Parthkumar Vipulkumar, Jayanta Kumar Chandra, Subodh Kumar Hansda
Abstract
Background: In this study we wanted to evaluate the incidence of deliveries with meconium stained liquor and assessment of early neonatal morbidities, assess the mode of delivery in meconium stained liquor, ascertain the correlates of meconium stained delivery and study the effects of meconium stained liquor on the babies in terms of early neonatal morbidities. Materials and Methods: This was a hospital based prospective observational study conducted among 96 parturients with meconium-stained liquor at the Department of Obstetrics and Gynecology & in Emergency, Deben Mahata Sadar Hospital (now Deben Mahata Government Medical College), Purulia from 1st January 2018 to 31st December 2018, after obtaining clearance from the Institutional Ethics Committee and written informed consent from the study participants. Results: Maximum patients (66.7%) of meconium stained liquor were nullipara (para 0) and the most common age group in MSAF (meconium stained amniotic fluid) patients was found to be ≤ 20 years. We found that 27.1% of patients had thick meconium and 72.9% of patients had thin meconium. In 96 MSAF patients, 50.0% of patients were delivered by VD, LSCS was done in 40.6% of patients and 9.4% of patients were delivered by instrumental delivery. In our study, 68.8% of newborns had a birth weight of 2.5-3.5 kg and 29.2% of newborns needed admission to SNCU. The association between FHR abnormality and type of meconium was statistically significant. In thin meconium, VD was significantly higher and in thick meconium, the LSCS rate was significantly higher. In the presence of FHR abnormality, 92.9% of patients were delivered by LSCS. The association between Apgar scores at 1 min and 5 min. vs. type of meconium was statistically significant. The association between early neonatal complications and type of meconium was statistically significant. Conclusion: Most of the newborns born through MSAF have normal birth weights. Early neonatal mortality is increased in pregnant women with MSAF as evidenced by the low Apgar score at 1 min and 5 min, increased SNCU admission, increased duration of stay in SNCU, more neonatal complications and higher neonatal mortality. Thin meconium is more common in labour and is a less detrimental effect on a newborn than thick meconium. In the presence of thick meconium, there is increased instrumental vaginal delivery and caesarean section rates, low Apgar score at 1 min & 5 min, more SNCU admission, increased duration of stay in SNCU, more early neonatal complications mainly MAS and birth asphyxia and higher neonatal death than thin meconium. Thus, we found that MSAF is associated with poor perinatal outcomes. Therefore, early detection of meconium, prompt early intervention and neonatal resuscitation by a skilful neonatologist are strongly recommended for the improvement of perinatal outcomes.

7. Clinicopathological Study of Tubal Ectopic Gestation in a Tertiary Care Centre
Athira K P, Umashankar T, Mohit Kumar
Abstract
Background: Implantation of fertilized ovum at an aberrant site outside the uterus is termed as ectopic gestation. More than 95% of ectopic gestation occurs in fallopian tube and has a multifactorial pathogenesis with numerous contributing risk factors. This study was undertaken to assess the clinical presentation and predisposing risk factors of tubal ectopic gestation. Methods: This was a retrospective study conducted in a tertiary care centre, for a period of three years, from October 2017 to September 2020, in the department of pathology. All cases of tubal ectopic gestation confirmed by histopathology were included in the study. Demographic data, clinical presentation and data regarding the predisposing risk factors of tubal ectopic gestation were collected from the medical records. Results: The study includes a total of 88 cases that are confirmed by histopathological analysis. Majority of the cases were in the age group of 26 to 30 years. Pain abdomen was the most common clinical presentation followed by bleeding per vagina. The highest incidence of tubal ectopic gestation is among nulliparous women followed by women with para 1 and para 2 status. Pelvic inflammatory disease, previous history of caesarean section followed by previous history of other pelvic surgeries, abortion, bilateral tubal ligation (recanalized), and infertility treatment are the most common risk factors. Conclusion: Identification of risk factors helps the clinician to conduct a precise workup which aids in early diagnosis of tubal ectopic gestation. Thus, a timely intervention can reduce the morbidity and mortality associated with tubal ectopic gestation.

8. Retrospective Study of Profile of Infertile Couples Attending Infertility Clinic
Deepti Gupta, Jagmohan Singh Dhakar, Devesh Kumar
Abstract
Aim: This retrospective study was conducted to analyse the demographic profile of infertile couples. Materials & Methods: Retrospective analysis of outpatient records of 500 infertile couples attending OPD of infertility clinic was done. Patient data, investigations and relevant history was entered in master chart. Descriptive analysis, means were calculated. Result: The percentage of Primary infertility was 66.4% and that of secondary infertility was 33.4 %. Mean age of female 32.082 ± 5.9 years (20-57), Mean age of male 35.8 ± 6.3 years (20-62) and Mean duration of infertility 7.4 ± 5.6 (1-37). 71% patients were from urban areas, and 29% from rural areas. The distribution of causes Ovarian 21.2%, Tubal 16.6%, Male factor 17.4%, Unexplained 18.6%, Both male/ female 5.6%, Others 4.6%. 16% couples were un-investigated at the time of 1st visit. Conclusion: majority of couples are presenting after the age of 30. Ovarian factor contributes significantly to the burden of disease. Clinical Significance: It is proven that female age is single most important factor that affects outcomes of fertility treatment. Hence it is important to offer systematic thorough evaluation so that couple does not lose precious time. Considering the proportion of ovarian factor in light of ART act 2022, ovarian reserve assessment and ovarian rejuvenation strategies should be considered. In a country lie ours where most infertile couples are dependent on private treatment, it is prudent to evaluate and treat these patients in systematic and judicious manner so that precious time and money are not lost.

9. Pattern of Head Injury Cases At A Tertiary Care Centre In Southern Rajasthan
Dattatray G Ghodake,  Somshekhar Sharma
Abstract
Background: The incidences of head injuries are growing with increasing number of high speed motor vehicle, more movement of the public and mechanization as well as modernization in industry. Head injury is most common causes of mortality in road traffic accidents and fall from Height. This study is conducted to explore and evaluate pattern of Head injuries in victims reporting to the tertiary health care Hospital. Material and methods: This study was a prospective analysis of 450 patients of head injury reporting at the Emergency Department, Pacific Institute of Medical Sciences, Umarda, Udaipur, Rajasthan India, during the period 2020 to 2021. Result: Most common cause of Head Injury victims reporting to the tertiary care hospital was Road Traffic Accident. Male victims were more commonly getting Head injury due to Road Traffic Accident followed by Occupational Head injury, while Female victims were getting Head injury due to fall from Height followed by Road Traffic Accident. Common age group involved in Head injury was of 21-40 years. It was clearly reflected that in Head injury, commonest lesion was scalp laceration followed by fractures to the skull. Conclusion: The study showed that most head injury victims, brought to a tertiary care hospital, were due to road traffic accidents and males are more prone to get Head injury. By establishing good pre-hospital care and provision of efficient and well organized trauma services at Road side can minimize or prevent mortality due to road traffic accidents and fall from Height.

10. Analysis of the Effects of Frusemide on Quality of Life in Patients of CHF
Sanjeevani M. Chawre, Shraddha M. Pore
Abstract
Aim: We performed the study protocol to investigate the efficacy and adverse effects of furosemide in patients with heart failure (HF). Methods: Patients were enrolled in a consecutive prospective manner on a voluntary basis. Patients who were aged 18years and older with HF who were eligible to enroll in this randomized trial. All patients had evidence of left ventricular systolic dysfunction, confirmed by echocardiographic or nuclear imaging. The exclusion criteria were left ventricular diastolic dysfunction only, or receipt of medical or pharmaceutical care in other health systems. Results: One hundred patients who met the inclusion criteria were included in our study. Conclusion: In conclusion, our heart failure self-management program, designed for patients of all literacy levels, appears to reduce rates of hospitalization and death. Patients with low literacy, and other vulnerable patients, may stand to benefit most from these programs.

11. To Study the Pre-Emptive Analgesic Efficacy of Single Low Dose Pregabalin for Postoperative Pain Relief in Patients Undergoing Inguinal Hernioplasty
Choudhary Shashibala, Jain Amit, Jain Sarvesh, Anitha R

Abstract
Introduction: Postoperative pain is one of the most common concern for people undergoing surgery. Preventing and treating postoperative pain is crucial to the patient’s early mobilisation and well-being. Pre-emptive analgesia prevents central sensitization caused by incisional and inflammatory damage during surgery and the early postoperative period and has the potential to be more effective than a similar analgesic treatment started after surgery, reducing immediate postoperative pain and preventing the development of chronic pain by reducing altered central sensory processing. Pregabalin, a GABA analogue, is effective in the treatment of neuropathic pain, incisional injury and inflammatory injury. Perioperative administration of pregabalin is reported to reduce perioperative anxiety, opioid consumption and opioid related side effects. Materials and Methods: 60 patients of ASA 1 and 2 were randomized into two groups as Group A (placebo,n=30) and Group B (Pregabalin 75 mg,n=30). Patients received placebo or pregabalin 2 hours before surgery. Demographic data, postoperative pain score, sedation score, time since spinal anaesthesia to requirement of first rescue analgesic, total opioid consumption in 24 hours and side effects were recorded. Results: Time for first rescue analgesic was longer in Group B as compared to Group A, although statistically insignificant. There was no significant reduction in mean VAS score between the two groups. The two groups were comparable in terms of total postoperative opioid consumption. Side effects were negligible. Conclusion: Single preemptive oral pregabalin 75 mg is ineffective in reducing the severity of postoperative pain as compared to placebo in patients undergoing inguinal hernioplasty.

12. Infection in Trauma Patients – Focus on Predisposing Factors, Types of Infection and Antibiotic Usage: A Prospective Study at Emergency Medicine Department of a Tertiary Care Hospital
Lad Deshna, Gupta Sapna, Rana Devang, Malhotra Supriya
Abstract
Background: The India has a high incidence of vehicular accidents (6% of global vehicular accidents). Nosocomial Posttraumatic Infections (NPIs) are one of the most common and fatal complications following trauma and complicate the recovery of significant number of injured patients. Materials and Methods: This Prospective, observational, single centre, follow-up study was conducted for a duration of 18 months at the Department of Emergency medicine of a Tertiary Care Teaching Hospital, Ahmedabad. Patients meeting inclusion and exclusion criteria were enrolled in the study and patients’ demographic details, data related to predisposing factors, antibiotics usage, Culture and sensitivity reports were recorded. Patients who developed infection, their data analysed for; Predisposing factors for developing infection, Types of infection and causative organisms, Antimicrobial resistance pattern and Antibiotics usage. Statistical analysis was carried out with the help of SPSS version 21.0 and Microsoft Excel version 2019. P<0.001 was considered as statistically significant. Results: 105 patients of either gender were enrolled in the study and out of them, 36(34.3%) patients developed infection. Vehicular accidents (22; 61%), Head injury (33, 92%), multiple sites of trauma27(75%), Traumatic brain injury (TBI) (31, 86%), Urinary catheterization (34) followed by Endotracheal tube (25) and 17(47%) had hypotension were the most common predisposing factors in patients with NPIs. Infection rate was 100% in patients having Injury Severity Score (ISS) > 45. Out of 105 patients, 48 (46%) patients had SIRS (Systemic Inflammatory Response Syndrome) score of ≥2 out of which 31(65%) developed infection. Most common type of NPIs was Ventilator Associated Pneumonia (VAP) (78%) and Acinetobacter baumannii (17, 23%) was the most common type of isolate among NPIs. Metronidazole (75, 71%) was most commonly used prophylactic antibiotic and Colistin (23, 64%) was most commonly prescribed antibiotic for NPIs. Conclusion: Trauma is one of the common causes for nosocomial infections after hospitalization and certain risk factors like brain injury, advanced age, high ISS and SIRS score, invasive procedures, hypotension also has potential impact on the development of NPIs. Colistin was the most commonly used for NPIs that shows rising trends of antimicrobial resistance.

13. Pattern of Head Injury Cases At A Tertiary Care Centre In Southern Rajasthan
Dattatray G Ghodake,  Somshekhar Sharma
Abstract
Background: The incidences of head injuries are growing with increasing number of high speed motor vehicle, more movement of the public and mechanization as well as modernization in industry. Head injury is most common causes of mortality in road traffic accidents and fall from Height. This study is conducted to explore and evaluate pattern of Head injuries in victims reporting to the tertiary health care Hospital. Material and Methods: This study was a prospective analysis of 450 patients of head injury reporting at the Emergency Department, Pacific Institute of Medical Sciences, Umarda, Udaipur, Rajasthan India, during the period 2020 to 2021. Result: Most common cause of Head Injury victims reporting to the tertiary care hospital was Road Traffic Accident. Male victims were more commonly getting Head injury due to Road Traffic Accident followed by Occupational Head injury, while Female victims were getting Head injury due to fall from Height followed by Road Traffic Accident. Common age group involved in Head injury was of 21-40 years. It was clearly reflected that in Head injury, commonest lesion was scalp laceration followed by fractures to the skull. Conclusion: The study showed that most head injury victims, brought to a tertiary care hospital, were due to road traffic accidents and males are more prone to get Head injury. By establishing good pre-hospital care and provision of efficient and well organized trauma services at Road side can minimize or prevent mortality due to road traffic accidents and fall from Height.

14. A Study of Structural Variations of Jugular Foramen of the Dried Adult Human Skulls
Yelpula Jyothi, M Pranay Kumar
Abstract
Background: The internal jugular vein, in particular, travels via the jugular foramen (JF), a bigger, curving, irregular foramen located near the base of the skull. JF variations are more prevalent among people of the same or different ethnicities, gender, and crania. To perform microsurgeries in and around these foramina, a thorough understanding of anatomy is also required. The current study aimed to determine the morphological features of jugular foramen from dried skull bones. Methods: This study was conducted in the Department of Anatomy at the Prathima Institute of Medical Sciences, Naganoor, Karimnagar. Dried Adult human skulls n=50 with 100 jugular foramina were studied. Using digital vernier calipers, we took metric measurements of the jugular foramen’s anteroposterior and mediolateral diameter, width, and depth, then tabulated, analyzed, and compared the results. Results: The anterioposterior diameter of JF on the left side mean values were 7.93 ± 1.47. On the right side, the mean value was 9.31 ± 2.11 mm. The mediolateral diameter of JF left side was 14.28 ± 2.29 mm and similarly, on the right side the mediolateral diameter of JF was 15.10 ± 3.57 mm. Bony partitions of skulls found bilateral septations (complete/partial) found in 14% of skulls, bilateral complete septations were found in 12% of skulls and bilateral partial septations were found in 10% of skulls. The width of the jugular fossa was measured it ranged from 5.5 to 13.2 mm on the right side and 0.0 to 10.5 mm on the left side. The Dome of the Jugular fossa was prominent in 86% of skulls out of which 72% were having a bilateral prominent dome. Conclusion: Understanding the morphology, compartmentation, and arrangement of the structures within the jugular foramen (JF) enables one to infer the locations of numerous structures from photographs of the area surrounding the jugular foramen. The JF’s surgical anatomy is intricate, as are its components. Therefore, when surgically treating this complicated area, having a thorough understanding of its variations and the connections between the neurovascular structures is essential to maximizing the surgical result and minimizing postoperative problems. The results of this may be utilized in interpreting JF imaging and understanding how neurovascular structures are involved or spared in JF lesions.

15. Current Trends in the Diagnosis and Management of Solitary Thyroid Nodule
Vimal Singh Thakur, L Surender, N. Viswanath
Abstract
Background: Solitary Thyroid Nodule is a one, which on clinical examination appears to be a single nodule in one lobe of thyroid with no palpable abnormality anywhere else in the gland. Thyroid nodules are very common and also there are variety of lesions that can arise within thyroid gland, thus in order to minimize complication, early diagnosis is needed to manage patients. Aim and Objective: To study evaluation and management of solitary Thyroid Nodule. Materials and Method: A prospective study conducted for period of 18 months in which 65 patients were included who were presented with solitary thyroid swelling. Results: Majority of the patients were female compared to male, and male is to female ratio was 1:2.82. More than 50% of the study population was from age group of 21 – 40 years. 52.31% of the patients had nodule in right lobe. Among all , 81.5% of the patients had euthyroid state followed by 12.3% who had hypothyroid state and only 4 patients had hyperthyroid state. 64.4% of the patients were managed with hemi thyroidectomy and 16% were found to be malignant. Conclusion: We can conclude that in the study, majority of the patients were from age group of 21 – 40 years and majority of them were females compared to males. FNAC was found to be most valuable diagnostic tool especially in benign cases and moreover hemithyroidectomy was the most common procedure done in solitary thyroid nodule.

16. Morphometric Study of Proximal End of Femur in Telangana Region
Niveditha Samala, B. Mahita, T. Sumalatha, M. Padmavathi
Abstract
Background: The femur is the longest, strongest and heaviest bone of human body. It has upper end, lower end and an intervening shaft. Upper end consists of head, neck, greater trochanter and lesser trochanter. Head of the femur articulates with the acetabulum of hip bone to form hip joint. The morphometric analysis of proximal end of femur is immense importance in designing prosthesis and implants of appropriate size for total hip replacement. Methods: The present observational study was conducted on 100 (47 Right & 53 Left) dry femurs of unknown sex in the department of Anatomy, Osmania medical college, Hyderabad, Telangana. The study has taken prior approval from Institutional Ethical Committee. Fully ossified, dried, femur bones of unknown sex were included in our study. Broken & deformed femur bones were excluded from the study. Results: In the present study the mean length of femur (FL) was 419.60 ± 24.32mm, 420.52 ± 26.76mm on right and left side respectively. The mean transverse diameter (TD) of Femoral head was 42.84 ± 3.95 mm and 42.93±3.98 mm on right and left side respectively. The mean neck shaft angle (NSA) of Femur was 132.60 ± 7.03 and 137.80 ± 9.06 on right and left side respectively. Conclusion: The knowledge of morphometry of proximal end of femur will be useful in anthropological and Medico-legal practice, as well as to orthopedecians for diagnosis and treatment of disease related to hip & femur.

17. Conventional Methods of Identification of Pseudomonas aeruginosa and its Antibiotic Resistance in Clinical Isolates of a Tertiary Care Hospital in South India
Atiya Kausar, Prashanth H V, Imtiaz Ahmed, Anusuya Devi D
Abstract
Introduction: Pseudomonas aeruginosa is an emerging pathogen that can survive in a wide range of environmental conditions. It is a leading cause of hospital-acquired infections. It is inherently resistant to many drugs. There is a need for appropriate identification of the organism in conventional setup among non-fermenters. In the present era where there is a highlight about antibiotic stewardship, it is necessary to have an idea about the emerging antibiotic resistance trends for better infection control practices. Aims and objectives: The main objective of this study was to know the characteristic features and antibiotic resistance of pseudomonas aeruginosa isolated from all clinical samples in a tertiary care hospital. Materials and Methods: A prospective study was conducted for 18 months. All the isolates presumptively identified as pseudomonas aeruginosa from various clinical samples received at the department of microbiology were included in the study. Identification of the isolates was done using conventional methods of identification, Further characterization was done using pseudomonas isolation agar, utilization of amines. Antibiotic sensitivity pattern was studied for the anti-pseudomonal group of antibiotics. The blue-green pigment was demonstrated in nutrient agar and pseudomonas isolation agar. Results:  In our study all P. aeruginosa isolates showed growth at 420C, attack carbohydrates like glucose, xylose oxidatively, produce blue-green pigment, utilizes citrate, decarboxylases arginine. Among 105 isolates the antibiotic-sensitive pattern was imipenem (95%), meropenem (94%) and ceftazidime (65%). Conclusion: The ability of pseudomonas aeruginosa to acquire various resistance mechanisms and the emergence of carbapenem resistance emphasizes the need for antimicrobial studies in the future.

18. Anaesthetic Management of Gaucher’s Disease in Obstetric Patient
Das Arunima, Khatun Ayesha, Sarkar Debananda, Sarkar Manabendra
Abstract
As we know Gaucher is the most common form of lysosomal storage disorder due to deficiency of the beta glucocerebrosidase enzyme. This condition may be a challenge for both anaesthesiologist and obstetrician as there is abnormal coagulation profile and multiorgan involvement in obstetric condition. Our aim was to report divergent management of “Gaucher disease” depending on patient’s characteristics.

19. Effect of Pitavastatin and Gemfibrozil on Motor Coordination by using Rotarod in Mice
Shoebul Haque, Ajit Mishra, Narendra Kumar, Rishi Pal, Rajendra Nath, Amod Kumar Sachan, Rakesh Kumar Dixit
Abstract
Introduction: An ability to perform a motor task accurately, rapidly, and controlled manner are known as “motor coordination.” Neurodegenerative diseases like Parkinson’s disease (PD) are characterized by motor incoordination, gait disturbances, and static tremors. Motor control and muscle coordination also decrease with age, and other diseases are reflected by down neuromotor functions. Pitavastatin and gemfibrozil both causes lipid lowering effects by different mechanisms of action. Few studies positively report skeletal muscle contraction behavior with statin use. In the drug-repurposing process, hidden therapeutic functions of the drugs are uncovered using different approaches. Aim and Objectives: Present study was done to assess the motor coordination effect of pitavastatin and gemfibrozil in Comparison to diazepam using Balb-c mice in the rotarod behavioural model. Material and Methods: 20 balb/c mice were divided into 4 groups. The rotarod was used to evaluate the motor coordination effect. The fall-off time was compared among 4 groups. Observations were analyzed by using paired t-tests, ANOVA, and post hoc Tukey’s test. Results: Pitavastatin (30mg/kg) and gemfibrozil (60mg/kg) make a decline in the fall-off time at all period of time with significant results at 60 and 120 minutes. Conclusion: In the present study we concluded that both pitavastatin and gemfibrozil possess muscle relaxant properties. Our study fails to conclude any positive effect of pitavastatin and gemfibrozil on motor coordination. However further studies are needed to confirm that hypothesis.

20. Colonoscopic Evaluation for Lower G.I Bleeding in a Tertiary Care Teaching Hospital
Ramu, M Anil
Abstract
Background: The most frequent cause of endoscopic examination is hematochezia (Lower Gastrointestinal Bleeding (LGIB). Hemorrhoids and diverticular illness are the most common causes, however, other anorectal disorders can also cause LGIB. Secondary iron deficiency anemia could be brought on by persistent bleeding. The primary diagnostic method for determining whether colonic bleeding is present is a colonoscopy. Methods: A total of n=50 cases were included in the study based on the inclusion and exclusion criteria. All the colonoscopy procedures were done on an in-patient basis. All patients presenting with bleeding per rectum were enquired regarding their history followed by which detailed clinical examination was done. A colonoscopy is carried out while the patient is in the left lateral position with monitoring in the presence of an Anesthesiologist, with normal blood pressure, heart rate, oxygen saturation, and short-term intravenous general anesthesia. Results: Out of the total n= 50 cases n=14 patients were diagnosed to have Haemorrhoids of different Grades n=8 patients had Polyps. Out of this n=8, n=4 polyps were found in the transverse colon, n=1 in ascending colon, n=2 in the rectum, and n=1 in descending colon.  Out of the n=8 polyps, n=4 cases were adenomatous, n=2 cases were inflammatory and n=2 cases were diagnosed as malignant. N=8 cases had inflammatory bowel disease (IBD) out of which n=4 cases were ulcerative colitis, n=2 was Crohn’s disease and n=2 were proctitis. Conclusion: Hemorrhoids, Carcinoma colon, polyps, and Inflammatory bowel disease were the common cause of lower GI bleeding. More commonly affecting males as compared to females. The majority of cases with age < 40 years were cases of hemorrhoids and other colonic pathologies. All the cases of carcinoma were above 40 years of age.

21. A Prospective Comparative Study of Recovery Characteristics and Hemodynamic Stability of Cisatracurium with Vecuronium
Binal Patel, Mitali B Saraswala, Nidhi Patel, Vijalbahen K Patel
Abstract
The modern practice of anesthesiology relies on the use of combinations of intravenous and inhaled drugs to take advantage of the favorable properties of each agent while minimizing their adverse effects. The choice of anesthetic technique is determined by the type of diagnostic, therapeutic, or surgical intervention to be performed. As laparoscopic surgery cause more hemodynamic changes, Neuromuscular blocking agents with better hemodynamic stability and with predictable recovery is preferred. After approval from ethical committee, a prospective comparative study was conducted in tertiary care hospital. Comparison of hemodynamic stability and recovery characteristics between cisatracurium and vecuronium was done. After thorough preoperative evaluation and written informed consent, total 60 patients were scheduled for planned laparoscopic surgery.  We concluded from our study that vecuronium  and cisatracurium provides comparable intubating conditions, onset of time and hemodynamic stability. Recovery time from last supplemental dose to extubation time was shorter and positive clinical tests (head lift for 5 sec, effective hand grasp, visual disturbance, facial weakness)were noticed early (15 minutes after extubation) in most of the patients in cisatracurium group. Vecuronium showed significantly longer duration of action compared to cisatracurium. But, if recovery time is priority, cisatracurium is good alternative.

22. Comparison of Intraoperative Hemodynamic Parameter and Recovery Characteristics between Propofol Infusion and Sevoflurane Inhalation in Subjects undergoing General Anaesthesia
Usha Patel, Dipika Parmar, Dharmesh Pandya, Rinku Patel
Abstract
Background and Objectives: Current research was planned to compare intraoperative hemodynamic changes and recovery characteristics among propofol infusion and sevoflurane inhalation in subjects undergoing General Anaesthesia. Material and Method: It was hospital based single blinded comparative research among 40 subjects undergoing surgeries lasting less than 2 hours under General Anaesthesia. One group of 20 subjects were given Propofol Infusion 0.1 -0.3mg/kg/min while other group were given Sevoflurane Inhalation 1-2%, Vital Datas like Pulse, BP, and Recovery in the form of Eye Opening, Response to verbal command, Muscle tone and Extubation time after discontinuation of Anaesthetic Agent were compared. Results: Changes in heart rate were analogous. Mean arterial pressure was also lesser in the propofol compared to sevoflurane group. More subjects in propofol group had episodes of hypotension and hypertension than sevoflurane group. Recovery profile was comparable in both groups which was not statistically significant. Conclusion: Sevoflurane demonstrated advantage over propofol in respect of intraoperative cardiovascular stability without increasing recovery time. The time taken for extubation and recovery was parallel in both groups.

23. Perception of Physiotherapists about Webinars and its Role in Building Professional Relationships
Gulati P., Choudhry D., Sharma N, Savarna, Ridham Sharma, Priyanka Siwach
Abstract
Webinar is an online process of gathering and presenting the information. Webinars are proving a boon for all academic fraternity in the present scenario of COVID-19 pandemic. Till now no previous work has explored the perceptions of physiotherapists on Webinar as an evolving platform in this new era. The objectives of this study were to evaluate physiotherapist’s perception towards Webinars as a new way of learning and whether webinar builds sense of professional relationship. An online survey using a web-based questionnaire was conducted in which an already framed & validated questionnaire as a google form was circulated amongst all the practicing physiotherapists of various institutes & universities of North India through different social media apps. After 10 days, data was collected from 145 participants and was used for further analysis. Results indicate that the most common reason to attend webinar is to gain Knowledge regarding burning topics (76.6%). More than seventy percent were satisfied with webinars & want them to continue. More than eighty percent think Webinars build professional relationships among physiotherapists. Our findings suggest that webinars should continue for physiotherapists with or without lockdown period & can be used as an effective way to build professional relationships among physiotherapists.

24. Isolated Hoffa Fracture – Functional Outcome in Isolated Hoffa Fractures
Anant Kumar Garg, Gagan Pratap Singh, Nitin Kumar, Sanjay Kumar
Abstract
Background: The aim of this study was to assess the functional outcomes of open reduction and internal fixation of isolated Hoffa fractures. Materials and Methods: This was a prospective study comprising 24 patients from December 2018 to January 2021 at Murshidabad Medical College and Hospital with isolated Hoffa fractures in 20 males and 4 females., in 18 cases only fixation with screw was used and in 6 cases both screw and plates were used. In 17 cases screw was given in anteroposterior direction and in 7 cases posteroanterior screw was given. Results: The minimum follow-up period 9 months. None of the patients in our series was treated conservatively. The mean ROM was 102.7 degree, KSS rating was 83.92 and functional rating was 80.63 at the final follow-up. At 12 months of follow up 16 cases(66.7%) had excellent functional rating 4 cases (16.7%) had good functional rating 3 cases (12.5 ) had fair functional rating and 1 case (4.2%)had poor functional rating. Conclusions: Operative management seems to be a good treatment option isolated Hoffa fractures, All parameters of knee society score showed less morbidity and better functional outcome.

25. To Study the Factors Influencing Seroma Formation after Modified Radical Mastectomy/Breast Conservative Surgery in MCH VIMS Ballari
Khalid Muqueem, Maktum Naik, E. Govindaraja
Abstract
Background: Seroma, defined as subcutaneous collection of serous fluid within the surgical cavity i.e. clinically evident, is diagnosed on clinical examination as soft/boggy swelling in the region of flaps, usually in the axilla, which can also be confirmed by wide-bore needle aspiration. Seroma is the most frequent post-operative complication following Modified Radical Mastectomy (MRM) / Breast Conservative Surgery (BCS), developing in approximately 30 % of cases. The pathophysiology and mechanism of seroma formation in breast cancer surgery remains controversial and not fully understood, as little attention has been paid in the literature to etiologic factors. Therefore, understanding of various risk factors and its proper quantification is important to predict and if possible, prevent, risk of seroma formation. The purpose of this study was to establish an association between various risk factors and seroma formation following MRM/BRC. Materials and Methods: This prospective study was conducted among 30 patients over a period of 1 year 10 months from November 2016 to September 2018 in the Department of Surgery, Vijayanagara Institute of Medical Sciences-Ballari, after obtaining ethical committee clearance from the Institutional Ethical Committee and informed written consent from study participants. Results: 4 out of 30 patients, accounting for 13.3 percent, developed seroma. The mean age of patients who developed seroma was 50.50 + 9.29 (38 – 60) years. The mean volume of breast and axilla in the seroma group was 1662.50 + 179.69 (1400 -1800 ml). This is statistically significant compared to patients without seroma formation. And drain output on post-op day 3 was 287.50 + 25 ml (250 – 300 ml) also significant, which is a good predictor of seroma formation. 2 out of 4 were having hypertension in seroma group, which is statistically insignificant. Other variables studied had no statistical significance with respect to seroma formation. Conclusion: The factors influencing seroma formation following MRM/BCS for carcinoma breast were found to be volume of the breast and axillary fatty-lymphatic tissue – greater the volume, higher the seroma rate. And drain output in first 72 hours is a good predictor of seroma formation.

26. Efficacy of Ferric Citrate Over Other Phosphate Binders in Chronic Kidney Disease
Krishnendu C., Laila K.V.
Abstract
Background: Chronic kidney disease (CKD) represents an enormous global public health concern, affecting an estimated 8% to 16% of the world’s population. Hyperphosphatemia in patients with chronic kidney disease (CKD) indicates the development of secondary hyperparathyroidism and renal osteodystrophy, and is independently associated with an increased risk of death among dialysis patients. The mechanism by which hyperphosphatemia increases mortality risk is not yet clear, but it is thought to promote cardiovascular calcification. Currently available phosphate binders include Calcium acetate, Sevelamer, Lanthanum carbonate. Ferric citrate is a newer phosphate binder which is found to have high efficacy with additional benefits of improvement in iron parameters. Objectives: The objectives of the study were to compare the efficacy and safety of Ferric citrate over other phosphate binders Calcium acetate and Sevelamer carbonate in chronic kidney disease patients , and to assess the improvement in iron parameters by Ferric citrate. Methods: In this prospective comparative study, 72 patients were randomized to receive either Ferric citrate or other phosphate binders (Calcium acetate or Sevelamer carbonate). The efficacy was measured in terms of reduction in mean serum phosphorus values. Safety of the study drugs were measured in terms of the adverse effects reported during therapy. Improvement in iron parameters in Ferric citrate group was assessed by assessing Hb, Ferritin and transferrin saturation before and after the study. Results: Reduction in the mean serum phosphorus was statistically significant in Ferric citrate group compared to other phosphate binders (p<0.05). Adverse effects were mild and well tolerated in both the groups. There was no significant improvement in iron parameters in the Ferric citrate group. Conclusion: Ferric citrate was found to be superior compared to other phosphate binders (Calcium acetate and Sevelamer carbonate) in terms of efficacy.  Hence Ferric citrate is an effective and well tolerated alternative phosphate binder to be used in patients with Chronic Kidney Disease.

27. Functional Outcome in Isolated Hoffa Fractures
Anant Kumar Garg, Gagan Pratap Singh, Nitin Kumar, Sanjay Kumar
Abstract
Background: The aim of this study was to assess the functional outcomes of open reduction and internal fixation of isolated Hoffa fractures. Materials and Methods: This was a prospective study comprising 24 patients from December 2018 to January 2021 at Murshidabad Medical College and Hospital with isolated Hoffa fractures in 20 males and 4 females., in 18 cases only fixation with screw was used and in 6 cases both screw and plates were used. In 17 cases screw was given in anteroposterior direction and in 7 cases posteroanterior screw was given. Results: The minimum follow-up period 9 months. None of the patients in our series was treated conservatively. The mean ROM was 102.7 degree, KSS rating was 83.92 and functional rating was 80.63 at the final follow-up. At 12 months of follow up 16 cases(66.7%) had excellent functional rating 4 cases (16.7%) had good functional rating 3 cases (12.5 ) had fair functional rating and 1 case (4.2%)had poor functional rating. Conclusions: Operative management seems to be a good treatment option isolated Hoffa fractures, All parameters of knee society score showed less morbidity and better functional outcome.

28. Comparative Study of Intrathecal Tramadol and Intrathecal Buprenorphine Added with Bupivacaine for Postoperative Analgesia in Lower Limb and Lower Abdominal Surgeries
Bhuvneshwar Minj, Rakesh Singh Baghel, Radhika Pathak, Anju Verma
Abstract
Objective: To compare the analgesic effects, duration of analgesia, haemodynamic parameters of tramadol and buprenorphine ,4administrated intrathecally with bupivacaine against the control group of bupivacaine alone. Methods: The patients were divided into three groups according to the drugs administered for subarachnoid block. In Group I: 3 ml of 0.5% bupivacaine (H) + 25 mg tramadol. In Group II: 3 ml of 0.5% bupivacaine (H) + 150 ug buprenorphine. In Group III: 3 ml of 0.5% bupivacaine. The patients of three groups were comparable at demographic data. For the assessment of postoperative pain using numerical scale of one hour interval until the end of analgesia explained to all the patients to make them able to express pain in terms of scale. Results: The duration of analgesia obtained following intrathecal tramadol administration (10.72± 2.84 hours) is statistically highly significant than following bupivacaine administration (2.88 ± 0.55 hours).The duration of analgesia obtained following intrathecal buprenorphine administration (14.02 ± 2.45 hours) is statistically significantly more than tramadol (10.72 ± 2.84 hours).The duration of analgesia obtained by intrathecal buprenorphine (14.02 ± 2.45 hours) is statistically highly significant than analgesia obtained by bupivacaine alone (2.88 ± 0.55 hours). Nausea and vomiting was seen in both groups. But more often in tramadol group (40%) than buprenorphine group (30%) within 8 hours which then gradually decreased. Nausea and vomiting was not seen with bupivacaine alone. Conclusion: Both tramadol & buprenorphine can be used effectively for post operative analgesia but buprenorphine is superior than the tramadol regarding duration of analgesia. There are some side effects like nausea-vomiting, in both the groups & pruritis in buprenorphine group.

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