International Journal of

Toxicological and Pharmacological Research

ISSN: 0975 5160 Peer Review Journal

Print-ISSN 2820-2651

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1. A Study of Clinical and Biochemical Profile of Neonatal Seizures
Durgesh Kannam, Chinthireddy Sandeep Reddy
Background: One of the most prevalent and recognizable clinical signs of a neurological system in failure is neonatal seizures. Neonatal seizures are the outcome of the developing nervous system’s reactions to various shocks and can cause significant neonatal death and morbidity as well as childhood physical and cognitive deficits. Preterm infants are more likely to experience newborn seizures than term infants, and metabolic disorders are a frequent cause of neonatal seizures. Methods: Based on the inclusion and exclusion criteria a total of n=50 cases were enrolled for the current study. A detailed record of names, ages, sexes, addresses, weights, lengths, head circumferences, and gestational ages are reported, along with their detailed prenatal histories and baseline features. A thorough physical examination was performed, and clinical observation was used to identify seizures were recorded. Each seizure episode’s clinical information, such as age at seizure onset, seizure duration, number, and type, was documented. According to Volpe’s criteria, seizures were divided into five categories: mild, focal clonic, multifocal clonic, tonic, and myoclonic. Results: Out of a total of n=50 neonates hypoglycemia was found in n=12(24%) of cases. Out of the n=14 preterm babies n=5/14, preterm neonates (35.71%) were with hypoglycemia. In the case of term babies out of n=36 cases n=7/36 (19.44%) were with hypoglycemia although the occurrence of hypoglycemia was higher in preterm neonates the p-values were (>0.05) hence not significant. A total of n=10 cases were detected with hypocalcemia. Based on the term distribution of the cases out of preterm babies n=3/14 (21.42%) were with hypocalcemia and in term babies, hypocalcemia was found in n=7/36 (17.44%) cases. Conclusion: One of the most prevalent neurological conditions in newborns is neonatal seizures. Neonatal seizures can have a variety of origins, which affects not only how the disease develops but also its long-term neurological consequences, mortality, and morbidity. To prevent these issues, early examination, prompt diagnosis, and vigorous care in accordance with the etiology are required. Additionally, biochemical anomalies could either be a secondary issue or could be linked to other etiologies.

2. A Cross Sectional Survey on Patient Responsibility towards Rational Use of Medicine in Chronic Illnesses
Padmaja Shetty K, Anusha S J, Pratibha Nadig D
Background: Responsible,  rational usage of medication  in chronic disease determines the optimal response to treatment, prevention of complications,  active surveillance of adverse drug reactions and  improvement in quality of life. Objective: The aim of this cross sectional  survey  was to determine the responsibility of patients  towards  safe medication usage for  successful management of chronic diseases. Methodology: This prevalidated questionnaire based cross sectional survey was conducted between August 2021 – January 2022 on 400 subjects diagnosed with chronic disease/s. Chi square test was performed for association between several variables affecting patient responsibility towards medication usage and adherence. Association between demographic variables and medication adherence was assessed using multivariate logistic regression. Result: The sociodemography showed that out of 400 participants in this survey, 52.5%  females, 50.5% >65years, 73.5%  were graduates and  78.8% suffering from chronic disease/s for more than 2 years. The most common chronic disease/s noted were diabetes mellitus -35.8%, hypertension- 60.8%, arthritis-15.3%, asthma-14%. Patients’ responsibility towards medication usage showed that 94%-  discussed with the  doctor before going to pharmacy. 94.8% enquired dose, 48.3%- name of the medicine,  83.5%- how to take medicine, 64.0% -duration , 78%- time and 88.8%- frequency of medication. Medication adherence questionnaire showed that 25%- stopped taking medication due to various reasons, 21.3% forgot to take medication and 21.5% felt hassled sticking to routine medication usage. Medication  safety behaviour  showed that 27.8% read package insert, 76% read tablet name before consuming, 52.3%  – follow up. Multivariate logistic regression showed that employed, males were more likely to adhere (OR:0.54; 95% C.I: 0.307-0.951). Chi square test showed a significant (p<0.05) increase in non adherence with pill burden and significantly (p<0.05) less responsible behaviour towards medication is associated with increasing duration of illness and non adherence. Conclusion: There was a suboptimal association between patient responsibility towards medication usage which affected adherence and safety behaviour. This study was also an effort in creating awareness but further sensitization among general population is necessary for effective management of chronic diseases.

3. Clinical Profile of Spontaneous Bacterial Peritonitis in Cases of Liver Cirrhosis
Akula Sanjeev, D Guruva Reddy
Background: As a consequence of decompensated liver cirrhosis, spontaneous bacterial peritonitis is infamous for having a high recurrence rate and is usually linked to both short- and long-term mortality in the afflicted individuals. To evaluate the prognostic indicators for the development of spontaneous bacterial peritonitis (SBP) or its variations and afterward associate the in-hospital mortality in these patients with several potential metrics, patients with SBP or its variants were compared to patients with Non-SBP Ascites. Methods: Patients with CLD and ascites were gathered from Prathima Institute of Medical Sciences, Naganoor, Karimnagar.  Patients’ demographics, symptoms, and clinical indications were noted. Patients who had recently used antibiotics or had an infection from an intra-abdominal source were excluded. Diagnostic paracentesis was performed for the detailed report (D/R) and culture of ascitic fluid. Total leukocyte count, serum protein, and bilirubin levels were measured in blood samples. Results: The predominant complaint/symptoms reported by the cases in the study included Abdominal distension in 92% of the cases followed by abdominal pain in 64% of cases, and swelling of the feet bilaterally was reported in 68% of the cases. E. coli was the predominant organism found in 5/10(50%) of the culture-positive SBP cases followed by Enterococcus species in 2/10(20%) cases, followed by Klebsiella, Pseudomonas, CoNs in 1/10 (10%) cases each. Ceftriaxone was the initial antibiotic given in 40% of cases followed by Cefotaxime in 18% of cases and Norfloxacin in 20% of cases. Conclusion: Our research aimed to examine the prevalence of individuals with SBP or its variations as well as their diverse clinical and bacteriological profiles. Diagnostic paracentesis for D/R and C/S is crucial since it is difficult to diagnose SBP based solely on clinical signs. Escherichia coli (E. coli) is the most frequently isolated pathogen. Prompt broad-spectrum antibiotic therapy is the recommended course of treatment for SBP.

4. An Observational Study of Outcome of the Absorbable Suture and Non-Absorbable Suture in Laparotomy Wound Closure in Tertiary Care Hospital in South Gujrat
Jigar Aagja, Prabhuta Khare, Dipali Sadhu, Purvesh Bhatt
Background: Whether inflicted by chance or sustained during a surgical procedure, every wound is simply a disruption of the normal continuity of tissue. Although the skill and technique of the surgeon is important, so is the choice of wound closure material. Every surgeon aims to close the abdominal incisions securely, so as to prevent complications, such as wound infection, dehiscence, incisional hernia, and suture sinuses. Since decades Polypropylene has been widely used for the closure of laparotomy wounds. Another suture material Polydioxanone is also used for the closure of laparotomy wound. Aim: To document the efficacy of absorbable and non-absorbable sutures in LAPAROTOMY wound and to observe the early post-operative complications. Material and methods: The present clinical study was carried out at the surgical wards of NCHS from September 2019 to September 2020. Patients underwent emergency laparotomies through midline vertical incisions. In all patients, mass closure of abdomen was employed. Continuous interlocking sutures were taken in all patients. 40 Patients underwent emergency laparotomy.  Equal numbers of cases (20 each for Polydioxanone and Polypropylene group) were studied for closure with these two suture materials; Polypropylene and Polydioxanone. Observation & Results: The male to female ratio was 4.71:1. Patients with age group of 18 – 29 years formed the maximum number of this study. The mean age was 33 years. The youngest patient was 18 years old and oldest patient was 60 years old. There were 5 cases of burst abdomen in the present study, out of which 3 (8%) cases were in Polypropylene group and 2(5%) were in Polydioxanone group. The incidence of wound infection was higher in Polypropylene (Prolene) (15%) compared to Polydioxanone (PDS) (12%). There was no incidence of incisional hernia and stitch granuloma in any group after 3 months of follow-up Most patients in the present study stays for 7 days in hospital, Maximum number of patients (30) stays in hospital for 7 days. 6 patients stays for 10 to  15 days and 4 patients stays more than 15 days. Conclusion: Polydioxanone has slightly upper edge over Polypropelene as far as burst abdomen is concerned. Polydioxanone has slightly upper edge over Polypropelene in wound infection. There is no significant difference between two suture materials in the development of incisional hernia. Overall, Polydioxanone has higher merits over Polypropylene for laparotomy present study. Although ideal suture material for closure of laparotomy wound depends upon the surgeon’s choice.

5. A Clinical Pharmacological Study on the Prevailing Prescription Patterns Appraisal of the Combination Therapies of Metformin and Remogliflozin, Metformin and Sitagliptin, and Metformin and Gemigliptin, among Early Grade Type II Diabetic Patients
Moumita Hazra
Background: Oral hypoglycemic response is brought about through the activation of 5’ adenosine monophosphate induced protein kinase by metformin, inhibition of dipeptidyl peptidase-4 by the dipeptidyl peptidase-4 inhibitors, sitagliptin and gemigliptin, and the inhibition of a selective insulin-independent sodium glucose cotransporter subtype 2 by remogliflozin. Objectives: The objective of this clinical pharmacological study is the prevailing prescription patterns appraisal of the combination therapies of metformin and remogliflozin, metformin and sitagliptin, and metformin and gemigliptin, among early grade type II diabetic patients. Materials and Methods: 93 early moderate grade, type II diabetes mellitus patients, were prescribed oral 250 mg metformin and 50 mg remogliflozin combination therapy, or oral 250 mg metformin and 25 mg sitagliptin combination therapy, or 250 mg metformin and 25 mg gemigliptin combination therapy, once daily, for 3 months. The prescription patterns of the administered anti-diabetic combination therapies, and the prescription content were analysed, and statistically interpreted. Results: Among the prescribed anti-diabetic combination therapies, metformin and sitagliptin was most commonly prescribed (67 prescriptions, 72.04%), followed by metformin and remogliflozin, which was followed by metformin and gemigliptin. The completeness of the different aspects of the prescription contents was 100%. Conclusions: Metformin and sitagliptin was the most commonly prescribed anti-diabetic combination therapy, followed by metformin and remogliflozin, and metformin and gemigliptin. The prescriptions had 100% completeness.

6. Utilization Pattern of Dermatological Procedures for Skin Disorders in a Tertiary Care Hospital, Telangana
Dasari Gayathry, Sandhya, Anil Kumar, Hima Bindu Moluguri
Background: Globally, skin diseases pose a significant public health problem both in developing and industrialized countries. During the last decade, there have been a lot of changes in diagnostic and therapeutic modalities in dermatology, hence the present study was undertaken to outline the spectrum of various skin diseases and investigates treatment modalities & their adherence. Methods: This cross-sectional study was conducted among 250 patients from March to May 2022. A semi-structured questionnaire was used to evaluate the socio-demographics, pattern of skin diseases, utilization of dermatological procedures, treatment adherence, and preventive strategies for skin disorders. Results: Among 250 study samples, 86(34.4%) had infectious and 164 (65.6%) had non-infectious skin disorders respectively. Eczema represented a high prevalence of 54(22.4%) followed by Pigmentary conditions 44(17.6 %) in both genders. The majority of respondents received combination therapy, particularly drug prescription 130(52%) as the preferred treatment followed by prescription of cosmetic products 60(24%) and topical retinoids 16 (6.4%). A few patients had received phototherapy 10 (4%), chemical peelers 10(4%), soft tissue fillers 5(2%), and Hyaluronic acid 8 (3.2%) respectively. Conclusion: The present study concluded that there was a higher prevalence of non-infective skin diseases than infective skin diseases. The surprisingly high overall prevalence of skin diseases and the great need for treatment warrant further epidemiologic studies on the factors which are associated with skin diseases. A well-implemented skin health preventive approach throughout the lifespan might reduce the frequency and severity of cutaneous diseases.

7. Study of Lipid Profile and Apolipoprotein in Patients Diagnosed with the Coronary Heart Disease
Sudipta Dutta
The cause of CHD is atherosclerosis. Atherosclerosis is a chronic inflammatory response of the arterial wall initiated by an injury to the endothelium by activation of various factors for which apolipoproteins have been implicated. Moreover, lesion progression is sustained by interaction between modified lipoproteins (e.g. oxidized low density lipoprotein), lipid laden macrophage (foam cells), T-lymphocytes and the normal cellular constituents of the arterial wall. Atherosclerosis is also characterized by thickening of the arterial wall, which protrudes into and obstructs the vascular lumen. Hence based on above findings the present study was planned for Assessment of Apolipoprotein and Lipid Profile in Patients Diagnosed with the Coronary Heart Disease.
The present study was planned in Department of Biochemistry, Shri Ramkrishna institute of medical sciences and Sanaka Hospitals, Durgapur, West Bengal, India for 1 year . The 20 cases were enrolled in Group A as cases of coronary heart disease and 20 cases were enrolled in Group B as control cases for comparative study. Estimation of serum Apo A-I and Apo B were done by Turbidimetric Immunoassay, serum cholesterol by cholesterol oxidase- peroxidase (CHOD-PAP) enzymatic colorimetric end point method, HDL cholesterol and LDL cholesterol by direct enzymatic method and serum triglycerides by glycerol phosphate oxidase peroxidase (GPO-PAP) enzymatic end point method.
The data generated from the present study concludes that the levels of apo A1 and apo B are strongly related to CHD in addition to the conventional lipid profile. Our findings support the consideration of the measurement of serum Lipo-A as a screening tool for the risk of ischemic heart disease. Therefore, this study suggests the need for routine measurement of apo A1 and apo B in the diagnosis of CHD and thus helps in early detection of myocardial damage which warrants timely intervention leading to lowered morbidity and mortality.

8. Study of Microalbuminuria as a Nephropathic Marker in Patients Suffered from Type 2 Diabetes Mellitus and its Correlation with the Glycated Hemoglobin
Sudipta Dutta
Diabetic nephropathy is the leading cause of end-stage renal failure in patients with Type 2 DM, and its prevalence is increasing annually worldwide. Compared to 20 years ago, the incidence of diabetic complications without diabetic nephropathy has decreased; however, is still the main complication in diabetes. Microalbuminuria is defined as levels of albumin ranging from 30 to 300 mg in a 24-hrs urine collection. Microalbuminuria was the strongest predictor of cardiovascular events in a high-risk population with underlying atherosclerosis. It was found to be stronger than other risk factors such as coronary artery disease and diabetes. Microalbuminuria does not directly cause cardiovascular events; it serves as a marker for identifying those who may be at increased risk. Microalbuminuria is caused by glomerular capillary injury and so may be a marker for diffuse endothelial dysfunction. Hence based on above findings the present study was planned for Assessment of Prevalence of Microalbuminuria as a Nephropathic Marker in Patients Suffered from Type 2 Diabetes Mellitus and its Correlation with the Glycated Hemoglobin. The present study was planned in Department of Biochemistry, Shri Ramkrishna institute of medical sciences and Sanaka Hospitals, Durgapur, West Bengal, India for 1 year . Total 40 cases were enrolled in the present study. The 20 cases were enrolled in Group A as cases of diabetes mellitus and 20 cases were enrolled in Group B as control cases for comparative study. The data generated from the present study concluded that estimating glycosylated hemoglobin as an indicator of glycaemic control and microalbuminuria in random urine sample for renal involvement in diabetic subjects provide a convenient method for early diagnosis and intervention. Hence the microalbuminuria is nephrotic market in cases diagnosed with the diabetes mellitus.  Hyperglycemia is the major factor initiating the changes in the kidney. The tissue damage caused by hyperglycemia can be attributed to the hemodynamic factor, glycosylation of tissue proteins and increase activity of the polyol pathway.

9. A Comparative Study between Nebulized Nitroglycerin and Lignocaine Nebulization for Attenuation of Haemodynamic Response to Laryngoscopy and Endotracheal Intubation during Elective Surgical Procedures: A Randomised Clinical Trial
Banani Ray, Sushil Kumar Nayak, Amitayu Nandi, Sujata Ghosh, Purba Haldar, Mausumi Niyogi
Introduction: Laryngoscopy and endotracheal intubation violates protective airway reflexes.  This technique is found to have association with profound reflex sympatho-adrenal reflex by epi-pharyngeal and para-pharyngeal stimulation resulting in tachycardia, overshooting blood pressure, occasional disturbance in cardiac rhythm. Aims and Objective: Aim of the study was to find out the hemodynamic effect on patients receiving   Nitroglycerine and Lignocaine nebulization and whether any of the study drugs was significantly more efficacious to attenuate the hemodynamic response followed by laryngoscopy and intubation. Material and Methods: 50 patients aged between 18 to 45 years of both sexes with ASA grading I & II and Malampatti grading I & II posted for elective surgical procedures under general anaesthesia were included in our study were randomly allocated in two different groups (n=50), Group L(lignocaine) and Group N(nitroglycerin).  Group L patients were subjected to lignocaine nebulization for 3 minutes before induction, 4% Lignocaine nebulization 3mg/kg was administered to the patient in sitting position by asking the patient to inhale the drug for 3 minutes. Group N Patients were subjected to Nitroglycerin nebulization in a dose of 2.5 mg / kg / min for 3 minutes before induction. Hemodynamic parameters (HR, SBP, DBP and MAP) were recorded in the specific time intervals (preoperatively baseline, Pre intubation, immediate & 1, 3, 5 and 10 min after post intubation and operation was done as per schedule. Results: Demographic variables taken here were Age, Sex, Weight, and ASA grading. All the variables were comparable with the p value < 0.001. . In group N heart rate was persistently increased in post intubation 1, 3, 5 minutes which was statistically significant with a decreasing trend and at 10 minutes interval it came to almost near baseline level. The SBP, DBP & MAP variation in both groups were significant up to 3 minutes, but from 5 minute onward, the variation is not much significant. Conclusion: Attenuation of heart rate is better with lignocaine nebulization but the attenuation of blood pressure is better with Nitroglycerin nebulization compared after direct laryngoscopy and intubation.

10. Evaluation of Cardiovascular Autonomic Function in Patients with Rheumatoid Arthritis
Pragna Jayesh Rawal, Jayesh R Rawal
Background: Rheumatoid arthritis is common inflammatory arthritis arising throughout the world. A chronic systemic inflammatory autoimmune disorder is known as Rheumatoid arthritis (RA). Aim and objectives: The aim of this study was to evaluate cardiac autonomic function in RA and compare with healthy individuals. Materials and Methods: A total of 100 patients were included in the study. The included individuals were divided into two groups with equal participants in each group. One group was taken as control group with all individuals included were healthy. The other group was study group that included the 50 patients who were diagnosed with RA. Results: Heart rate when compared between the study and control group in standing position and lying down position showed Non significant changes. Systolic blood pressure and diastolic pressure in Valsalva maneuverer and sustained hand grip when compared in study group and healthy group showed changes but the difference was found to be non-significant. Conclusion: Cardiac autonomic nervous system dysfunction (both sympathetic and parasympathetic) occurs in Rheumatoid arthritis when compared to control. Therefore cardiovascular autonomic function tests in routine clinical examination helpful in early detection of autonomic dysfunction in this disease. Cardiac autonomic neuropathy can lead to sudden cardiac death, various arrhythmias, in elderly further aggravating the morbidity.

11. Evaluation of Drug Prescription Pattern in Patients of Rheumatoid Arthritis
Nagula Jayababu
Background: The most prevalent autoimmune arthritis, Rheumatoid Arthritis (RA), affects approximately 1% of adult Indians. It is an inflammatory condition that causes swelling and discomfort in both bilateral joints. Joints are destroyed by swelling, which also causes long-lasting abnormalities such as ankylosis. The current study aimed to determine the prescription pattern for the treatment of RA patients visiting our tertiary care hospital. Methods: A pre-designed and validated proforma was used for the collection of demographic profile as well as the other details of the cases in the study. All the cases were subjected to investigations that included ESR, C Reactive Protein, Serological rest for RA, Anti-CCP, LFT, and RFT. The patients were subjected to X-ray investigations based on the joints involved. The drug details which were noted were the names of the prescribed drugs, the dose of the drugs, the route of administration and duration of therapy, and drug adverse reactions if any reported during the subsequent follow-up. Results: In this study, 93.75% of cases were diagnosed with seropositive RA and anti-cyclic citrullinated peptide (ACCP) was positive in all these cases. Rheumatoid factor was found to be positive in 92.5% of cases and abnormally increased ESR was found in 85% of the cases. Based on the prescription pattern of drugs Disease-modifying antirheumatic drugs (DMARDs) were the most commonly prescribed drugs followed by NSAIDs and corticosteroids. Out of the NSAIDs, the commonly prescribed drug was Naproxen followed by aceclofenac. In DMARDs methotrexate was commonly prescribed followed by hydroxychloroquine and combinations. Conclusion: In the current study, which involved n=80 patients with rheumatoid arthritis and in the majority of RA patients the drug users were DMARDs. Methotrexate with hydroxychloroquine was the most often utilized medication combination. NSAIDs, corticosteroids, and opioid analgesics act as both analgesics and anti-inflammatory drugs. Early identification of the patients was followed by an aggressive, goal-oriented approach was the pattern utilized in the treatment.

12. Tattoo and Crime: A Cross Sectional Study of Convicted Prison Inmates from Central India
Nisha Kaithwas, Ashok Najan, Daisy Rure, Anil Mangeshkar
Background: The meaning and significance of tattoos varies from person to person across different cultures. Tattoos have been associated with both positive and negative attributes. The importance of studying tattooed individuals and its relation to the crime is particularly more important among prisoners. Objectives: The primary objective of this study was to estimate the prevalence of tattoo, their number, types and location on body among convicted prison inmates from Khandwa district jail. The secondary objective was to assess association between tattoo and crime. Materials and Methods: This cross sectional study was conducted in district prison/Jail, Khandwa, Madhya Pradesh, India, over a period of six months from April 2022 to September 2022. Total 106 convicted prison inmates were studied for presence for tattoo and crime committed. Results: Male predominance (89.6%) was observed.  Mostly were from rural background (77.3%) and lower socio-economic class (78.3%). Majority of the prison inmates belonged to 31-40 year age group (36.8%) and 18-30 years age group (29.2%). Majority (83.9%) had tattoos and among these, mostly were male 92%. Most of them had (41.6%) had one to two tattoos. The most common body sites for tattoo were forearm (91%) and wrist and hand including fingers and thumb (85.4%). most common tattoo content was religious symbols/Gods (91%). Overall, 70.7% were incarcerated for criminal offences whereas among tattooed participants, 75.2% were incarcerated for criminal offences. Among non-tattooed participants, nearly half participants were incarcerated for civil offences and difference was statistically significant (P = 0.04).

13. Comparative Study between 0.5% Levobupivacaine and 0.5% Ropivacaine in Ultrasound Guided Infraclavicular Brachial Plexus Block
Sonal Kedia
Background and Objectives: Infraclavicular Brachial plexus block is one of the most commonly used anaesthesia technique for any upper limb surgery specially orthopaedics surgery as it is very safe and also eliminates the risk of general anaesthesia. In one hand Use of ultrasound have made this block more safer and on the other hand use of Levobupivacaine and ropivacaine also reduces chances of Local Anaesthesia toxicity. This study was aimed at comparing effects of 0.5% Levobupivacaine and 0.5% Ropivacaine in USG guided Infraclavicular Brachial plexus block. Materials and Methods: This is a randomized controlled trial done at a Tertiary care hospital in West Bengal in patients posted for Upper Limb surgery in patients aged more than 60 yrs of ASA 1 and ASA 2 status. Patient posted for upper limb surgery received USG guided Infra Clavicular Brachial plexus block with either 0.5% Ropivacaine or 0.5% Levobupivacaine. Statistical Analysis: Statistical Analysis was done by SPSS software.Chi-square test or Fischer’s exact test was used for analysis where applicable. Results: The aim of our study was to compare the efficacy of 0.5% Levobupivacaine and 0.5%. Perioperative hemodynamic parameters were also compared and any obvious side effects noted.There was no statistically significant difference between the two groups in terms of demographic parameters like Age, Gender, Body Weight, Height and BMI. P value was >0.05.
We found that there was no statistically significant difference between the two groups in terms of heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure at different time intervals (p>0.05). We also found that mean duration of sensory block,motor block was almost similar and statistically nonsignificant. Also the duration of analgesia in both Ropivacaine and Levobupivacaine was statistically nonsignificant. Conclusion: We conclude that for ultrasound guided infraclavicular brachial plexus block both the S enantiomer of Bupivacaine i.e. Levobupivacaine and Ropivacaine are similar for both sensory, motor block and duration of analgesia.

14. Doppler Sonography of Maternal Opthalmic, Cubital and Uterine Arteries in Hypertensive Disorders of Pregnancy and Normotensive Pregnancy -A Cross Sectional Study
Manjusha Aasaarikudiyil Vijayan, Sinni K.V., Thahirabi K.A.
Among the hypertensive disorders that affect pregnancy, preeclampsia is the primary cause of perinatal and maternal morbidity. The identification of women who are at risk of cerebral complications that are associated with adverse pregnancy outcomes must be the goal of preeclampsia management. In this study, doppler sonographic parameters of maternal opthalmic, cubital and uterine arteries of pregnant  women with normal blood pressure   and preeclampsia were compared. Methodology: Consecutive patients who came to radiology department who attends to obstetrics and gynecology Outpatient department and are clinically diagnosed to have preeclampsia in the third trimester for routine as well as emergency scans for assessment of fetal well being and Doppler studies. Patients were evaluated with Mindray DC8 USG machine. Ophthalmic artery Doppler and brachial artery Doppler was evaluated using high resolution flat probe12.5 M Hz. Uterine artery Doppler was evaluated using curvilinear probe 6MHz. Study Design: Cross sectional study. Results: Out of the 140patients included in the study 70 are normotensive , 58 patients diagnosed with  mild preeclampsia and 12 patients diagnosed with severe preeclampsia. Ophthalmic artery Doppler studies shows reduced mean resistivity index, pulsatality index among preeclamptic populations compared with normotensive population. Lowest mean resistivity  index, and pulsatality index values were observed among the severe preeclamptic patients. Peak ratio of ophthalmic artery showed highest mean  value among severe preeclamptic population and lowest value among normotensive population. Uterine artery S/D Ratio was significantly higher among severe PE population compared to normotensive population, which indicating a higher uteroplacental resistance in severe preeclamptic population. No statistically significant evidence of systemic vessel resistance elevation could be demonstrated by studying the brachial artery pulsatality index of preeclamptic patient ,in the present study. Conclusion: Ophthalmic artery doppler parameters such as resistivity index , pulastality index and peak ratio shows significant reduction in preeclamptic patients compared to normotensive patients and uterine artery S/D ratio is higher in preeclamptic patients.

15. Challenges in Diagnosis and Treatment of Mammary Analogue Secretory Carcinoma of Salivary Glands – Our Experience
Nitish Virmani, Ratna Priya, Ved Prakash Popli, Nirupma Bansal
With the recent WHO classification listing atleast 40 histological types of salivary gland tumors, their pathological diagnosis remains a challenge.
Mammary analogue secretory carcinoma (MASC) is a recently described tumor of salivary glands. As its name suggests, it bears a striking resemblance to secretory carcinoma of the breast. Both the tumors are currently defined by the presence of a balanced translocation, t(12;15) (p13;q25) creating a ETV6-NTRK3 fusion gene. Histologically, MASC is often confused with other malignancies such as acinic cell carcinoma, mucoepidermoid carcinoma and adenocarcinoma, not otherwise specified. Immunohistochemistry and molecular studies play a crucial role in differentiating MASC from its mimickers. This distinction is important because of differences in their biological behavior.
We describe our experience with mammary analogue secretory carcinoma over a three-year period, all of our cases being diagnosed only on histology of the excised tumor. Diagnosis was confirmed by the presence of characteristic histological features together with strong positivity for S-100 and mammaglobin on immunohistochemistry. The challenges faced in diagnosing and treating this tumor has been discussed.

16. Quality of Life of Psoriasis Patients of a Tertiary Care Centre of Eastern India
Ratna Upadhyay, Ashutosh Pandya
Background: Psoriasis is a chronic immune mediated inflammatory skin disease. It is common in both sexes and leaves a significant effect on the quality of life (QOL) of the affected patients. Aim: This study is conducted to determine the correlation between psoriasis and its impact on the quality of life and also the relation between the QOL and certain demographic and clinical factors. Method: The study was conducted in 78 patients who were diagnosed with psoriasis from outpatient department of Dermatology department and the disease impact on the quality of life by using the Dermatology Life Quality Index (DLQI) questionnaire. Result: 39.73% patients were severely affected with psoriasis and they had an equal impact on the quality of life. Effect of quality of life varied in different sexes, however females were majorly effected. Age of the patient did not have any relevance to the disease progression or QOL. Duration of disease and body surface area involved had significant impacts on QOL. Conclusion: Quality of life was affected and had major impact on female population suffering from psoriasis. Age correlation was not established. However body surface area involved in psoriasis also impacted on QOL. Early diagnosis and proper counseling would lower the impact of psoriasis on the population exposed. Research and introduction to latest techniques are essential in minimizing the duration of treatment.

17. Ultrasonography and Computed Tomography’s Diagnostic Performance in Acute Appendicitis
Dilip Jha, Prashant Nath Gupta
Background: An Appendectomy is type of surgery done for Acute Appendicitis which can be m done as an open surgery or as laparoscopic surgery. This surgical procedure has lower-risk, and has few mortality rates reported ranging between 0.03 and 0.24%. Complications include Infectious cause occurring in some 9–20% of patients, followed by a hospital readmission rate of 6%. Perforation sometimes presents in 30%-75% of children, at the time of diagnosis and particularly common with younger ones are being at higher risk. Perforation rate varies from 16% to 40%, commonly occurring at higher frequency in younger age groups (40–57%) and in 50 years (55–70%) above patients. Basing on the medical condition, the recommendation of treating physician include Appendicitis treatment plan which may include surgery of Appendix removal (Appendectomy), needle drainage, abscess drainage, antibiotics, pain relievers, IV fluids and liquid diet. Aim: The current study’s goal is to compare the diagnostic abilities of computed tomography and ultrasonography in cases of acute appendicitis. To assess the sensitivity and specificity of USG and CT for the diagnosis of acute appendicitis. Material and Method: The study is non-interventional, analytical, and prospective. The study’s goals were to analyze the surgical and histological association of radiological abnormalities in both modalities, as well as the sensitivity and specificity of CT and USG in identifying acute appendicitis. The Department of Radio-Diagnosis was where the study was carried out. The GE Voluson S6 scanner was used to do the ultrasound evaluation. It used a curvilinear probe with a frequency range of 1.6 to 4.6 MHz and a linear high-frequency transducer with a frequency range of 5 to 13 MHz. The GE Optima 660, 64 slice Scanner was used to perform an abdominal CT scan. Results: All patients with right iliac fossa pain or acute abdomen pain should undergo USG as their primary imaging modality because it is the most accessible, least expensive, and radiation-free option. Therefore, it is favored in patients who are pregnant or children. All individuals with stomach pain who have probing tenderness over the right iliac fossa on a USG should have their appendix thoroughly examined. There are certain technological and operator-dependent limits with USG, as well as concerns with significant abdominal gaseous distension, obesity, and the inability to provide enough compression in cases of acute severe abdominal soreness. In these circumstances, CECT clearly outperforms ultrasound. Conclusion: In comparison to USG, CECT abdomen and pelvis offers higher sensitivity, specificity, PPV, NPV, and diagnostic accuracy for the diagnosis of acute appendicitis. Additionally, it aids in identifying the various anatomical regions, which aids surgeons in arranging treatments. Therefore, suspected instances of acute appendicitis with negative USG results should have CECT abdomen and pelvis performed for further assessment. A number of CT’s drawbacks include ionizing radiation exposure, a lack of universal accessibility, a higher cost, and the possibility of contrast allergy. Peri Appendiceal fat stranding is the most specific finding amongst different CT features of Acute Appendicitis. Due to higher diagnostic performance of CECT, it should be advocated in cases of high clinical suspicion of Acute Appendicitis, which are inconclusive on USG.

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