International Journal of

Toxicological and Pharmacological Research

e-ISSN: 0975 5160

p-ISSN: 2820-2651

Peer Review Journal

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1. Azithromycin Induced Hemophagocytic Lymphohistiocytosis: A Case Report
Jefry Winner G, Madhumitha
Introduction: Azithromycin is one of the commonly used antibiotics from the macrolide group. It has become prevalent after covid 19 to such an extent that even the common public is well aware of this drug. This is usually well tolerated and rarely produces severe adverse effects. The most common adverse effect is GI distress which is generally tolerable. This drug has triggered this rare condition called HLH in this patient who was treated for an upper respiratory tract infection. Reason for Report: Azithromycin is usually not expected to trigger much of life-threatening reactions in patients. This is the drug of choice for people with rheumatic fever who are allergic to penicillin. This rare adverse effect should be considered while treating patients with this drug for common ailments like this case. Case Summary: The patient was prescribed azithromycin at a dose of 500mg OD for URTI. All the infectious markers in the blood had fallen by day 7, and the fever persisted. With the negative RT-PCR for covid 19 the cause of fever was evaluated. After ruling out other conditions and careful assessment, we diagnosed it as a drug-induced case of Hemophagocytic lymphohistiocytosis.

DOI: 10.5281/zenodo.7537195

2. Comparative Efficacy and Impact on Quality of Life with Add-on Therapy of Emerging Newer Anti Anginal Drugs in Stable Angina – A Meta-Analysis.
Hemant Kumar Dutt, Pratik, Arshad Hasan, Vikram Singh Dhapola
Introduction: Myocardial ischemia, brought on by a discrepancy between myocardial perfusion and oxygen demand, is the usual culprit in cases of angina pectoris. Beta-blockers (BBs) and calcium channel blockers (CCBs) are the drugs of choice for initial treatment of stable angina, with other classes of drugs used in case the first two are insufficient. The development of methods to enhance care for patients with chronic stable angina is ongoing. It was anticipated that this systematic review will help quantify the therapeutic benefit of using Ivabradine, Ranolazine, Trimetazidine, and Nicorandil in addition to first-line monotherapy for stable coronary artery disease. Materials and Methods: The PICOS framework, a standardised worldwide method for defining inclusion and exclusion criteria, was used, as indicated by the PRISMA guidelines. Individuals that were a part of the research population. Results: After an initial literature search, 36 out of 45 studies that could be fully analysed were deemed ineligible for further consideration because either they did not provide any results or their entire texts were unavailable. Each of the prescription medications for adjunctive treatment proved to be efficient, risk-free, and well-tolerated. The frequency of angina events decreased, and so did the need for nitrates, suggesting that angina pectoris symptoms had improved. Add-on Trimetazidine is a fast-acting, low-risk method of lowering both angina episodes and nitrate use in the real-world clinical environment. Moreover, it improves physical fitness and overall health. When combined to regular antianginal medication, nicorandil significantly reduced the frequency of ischemia episodes in coronary heart disease (CHD) patients with stable angina. It has a favourable safety profile, with no unexpected adverse effects found. Quality of life (QoL) was shown to improve in individuals with stable angina and coronary artery disease (CAD) when Ivabradine was coupled with metoprolol. The positive effects seen with this combination are likely the cause of its high rate of adherence. Conclusion: The results of the current research indicate that adjunctive therapy is an effective and safe method of lowering the frequency of angina episodes and the need for nitrates. In addition, evidence suggests that therapy for angina should be tailored to each individual patient, their comorbidities, and the underlying cause of their condition.

DOI: 10.5281/zenodo.7537239

3. Changes in Lipid Profile in Diabetic Patients and Normal Patients from West Bengal Region.
Urvashi Sethia
Glycated haemoglobin (HbA1c) is a routinely used marker for long-term glycaemic control. Apart from functioning as an indicator for the mean blood glucose level, HbA1c also predicts the risk for the development of diabetic complications in diabetes patients. Many studies have proposed HbA1c to be used as a biomarker of both glycaemic control and dyslipidemia in type 2 diabetes mellitus. Hence based on above reported findings the present study was planned for Assessment of Changes.
Total 40 cases were enrolled in the present study. The present study was planned in Department of General medicine, ICARE Institute of Medical Sciences and Research & Dr. Bidhan Chandra Roy Hospital, Haldia, West Bengal, India. The study was conducted from the duration one year.The cases were divided in two study groups as Diabetic patients and normal patients of 20 cases each.
The data generated from the present study concludes that there is significant correlation was observed between HbA1c and various parameters of lipid profile, and there is no standardized protocol to compare the results of various other studies hence more structured and long term studies on larger no of patients are needed to validate HbA1c as a marker of dyslipidemia. Diabetic dyslipidemia or atherogenic dyslipidemia is characterized by low HDL, high TG and high small dense LDL. Early screening of diabetic patients for dyslipidemia and early intervention is required to minimize the risk of future cardiovascular mortality.

DOI: 10.5281/zenodo.7537257

4. Morphological Study of Dry Human Scapula and its Significance in Treatment of Shoulder Disorders.
Shoaib Alimohammed Fazlani
Introduction: This paper will focus on the determination of the Glenoid fossa of the scapula which refers to the articulation with the forms of the shoulder joint and the head of the humerus. Thus, the knowledge of different sizes and shapes of glenoid fossa will be useful to clinical testing on an efficient understanding of various physical problems among human beings. Thus, orthopaedics will easily choose the right processes for each of the problems regarding the joint. Aim: To understand the shape of measuring various dimensions of the glenoid fossa within the dry human scapula of a human being. Material & Methods: A prospective study of 95 dry human scapulae from adults of unknown age and sex which was collected from the Department of Radiology, Icare Institute of Medical Science and Dr. Bidhan Chandra Roy Hospital, Haldia, West Bengal, India over a period of one year. From the 95 samples, 62 will be collected from the right side and the remaining 33 samples will be from the left portions. Various noches will be observed in this study as well. However, digital Vernier callipers will be used here in order to estimate the dimension of the samples. Results: In this study, the pear shape is the most common shape of the glenoid fossa which has been observed to be 44% of the overall samples with 45.5% on the left side and the remaining 42.9% on the right side whereas oval shape has been observed by 34% which are 31.8% on the left and 35.7% on right. The other samples are 22% in inverted comma shape including 22.7% on the left portion and 21.4% on the right portion. Conclusion: Clinicians and orthopaedic doctors can benefit from this study of the glenoid fossa of the scapula when treating shoulder disorders and shoulder replacements.

DOI: 10.5281/zenodo.7537277

5. Assessment of Fat Necrosis of the Breast through Mammographic and Sonographic Features.
Shoaib Alimohammed Fazlani
Aim: To analyze the importance of mammography and sonography in fat necrosis. Material & Methods: A prospective clinicopathological study was carried out for one year period on a population of 52 patients age ranging from 30 to 60 years. The study was conducted at the Department of Radiology, Icare Institute of Medical Science and Dr. Bidhan Chandra Roy Hospital, Haldia, West Bengal, India for one year. Results: Breast fat necrosis is a common perimenopausal female symptom. This disease can mimic breast cancer both clinically and radiologically. Conclusion: Fat necrosis is a condition where the body’s tissues accumulate dead cells and necrotic tissue. The supplied image depicts the development of a tumor, which is essentially the disposition of fat. Therefore, screening for fat necrosis in the breast using mammography and sonography is preferable.

DOI: 10.5281/zenodo.7537285

6. Assessment of the Urinary Tract Infection (UTI) in Patients Suffered from Diabetes.
Urvashi Sethia
Diabetes mellitus is a major risk factor for urinary tract infections (UTIs) and is also associated with increased risk of certain complicated UTIs such as emphysematous pyelonephritis (EPN), emphysematous pyelitis (EP), emphysematous cystitis (EC), xanthogranulomatous pyelonephritis (XGP), renal/perirenal abscess, and renal papillary necrosis (RPN). Such conditions are potentially life-threatening and require prompt evaluation and management. Hence based on above findings the present study was planned for Assessment of the Urinary Tract Infection in Patients Suffered from Diabetes.
Total 50 cases diagnosed with Diabetes who have culture positive UTI were enrolled in the present study.  The present study was planned in Department of General medicine, ICARE Institute of Medical Sciences and Research & Dr. Bidhan Chandra Roy Hospital, Haldia, West Bengal, India. The study was conducted from the duration of one year.
The data generated from the present study concludes that diabetes predisposes humans to the risk of urinary tract infections due to the changes in bladder function and in circulation. The high prevalence of asymptomatic bacteriuria in diabetics, this condition could represent one of the causes leading to an unexplained worsening of the glycosuria in some patients.

DOI: 10.5281/zenodo.7537311

7. Online Medical Education in the COVID-19 Era: Undergraduate Students’ Perspectives.
Bajaj U, Marathe PA, Tadavi FM, Khatri N, Patil SR
Online education became a norm during the recent COVID-19 pandemic and medical education institutes in India accepted the new normal. It was timely to assess the perceptions and experiences of medical students to find out its relevance and application, if required, in the future. Methods: Following permission from the Institutional Ethics Committee, a cross-sectional observational questionnaire-based study was conducted among undergraduate medical students in the fifth semester using a Google form. A validated questionnaire consisting of 21 items was circulated. The data were analyzed using descriptive statistics. Results: A total of 150 students out of 180 (83.3%), who were approached participated in the study. About 46% of the students were of the opinion that online teaching-learning was not as effective as classroom teaching and 25% gave a neutral response. Only half the number of students (50.7%) felt attentive throughout the class and 40.7% attended solely for the purpose of attendance. Around 70% felt that their doubts were clarified while using this method of teaching, but 54% of them felt the amount of interaction was inadequate. Nearly 18% of students found it impossible to prepare for their examinations after learning through online classes. All the students (98.7 %) responded that they lost out on ward postings and clinical training. Although 79.3% of students agreed that online education was a useful option during the pandemic, only 46% of them felt that hybrid mode can be adopted in the post-pandemic era. Conclusion: As per medical students’ perspectives noted in this study, online medical teaching should not completely replace traditional modes of teaching.

DOI: 10.5281/zenodo.7537319

8. Clinico-Histomorphological Spectrum of TURBT Biopsies of Urinary Bladder Lesions in a Tertiary Care Centre: A Two-Year Retrospective Study.
Gausia Rahim, Summyia Farooq, Gul Aalmeen, Farhat Abbas, Sheikh Bilal Ahmed
Introduction: The spectrum of diseases that occur in the urinary bladder, range from congenital malformations to inflammatory conditions to neoplasms. Transurethral resection of bladder tumor (TURBT) aims at completely resecting all the visible tumors, whenever feasible. This provides histological staging and grading for further management of such cases. This study aims to evaluate the clinico-histopathological features of TURBT biopsies in a tertiary care hospital. Materials and Methods: This is a retrospective analysis of urinary bladder lesions received in the Department of Pathology, Government Medical College, Srinagar for histopathological examination over a period of 2 years, January 2019 to December 2020.The department received 166 trans-urethral urinary bladder biopsy specimens during this time interval. Results: In our study most common age group was >61 years with 54/166 patients (32.5%) followed by 51-60 years with 44/166 patients (26.5%). Male to female ratio was 3.15:1. The most common microscopic diagnosis was low-grade papillary urothelial carcinoma 72 cases (43.4%) while the least common microscopic diagnosis was squamous cell carcinoma 01 case (0.60%). While in 154 cases of Neoplastic lesions, there were 72 cases of low-grade papillary urothelial carcinoma,67 cases of high-grade papillary urothelial carcinoma. Conclusion: In Indian population, the diagnosed bladder cancer is predominantly urothelial carcinoma with male predominance. Younger patients present with low grade tumors. Early diagnosis is important in the diagnosis of urinary bladder cancer.

DOI: 10.5281/zenodo.7537332

9. Myocardial Tissue Doppler in Intrauterine Growth Restriction.
Basu B, Das A, Gupta K, Ghosh J D
Objective: A recently postulated method to detect function of the myocardium is the use of Tissue Doppler Echocardiography. As in IUGR, subclinical cardiac dysfunction may set in before the development of ultrasonically visible changes in the foetal circulation; the technique may be able to detect growth restriction changes earlier than conventional vessel Doppler. We undertook this study to assess whether myocardial tissue Doppler is an effective tool in detecting foetal cardiac changes in Intrauterine growth restriction. Materials and Methods: Fetuses in the third trimester of gestation (28-40 weeks) were taken for this prospective case control study. Myocardial Tissue Doppler was used to assess their foetal cardiac function. E’, A, E’/A’ and Myocardial performance index (MPI’) of both ventricles and the interventricular septum were compared between the two groups of IUGR and normal growth fetuses among the study subjects. Comparison was also done after further classifying the IUGR group based on their birth weight, vessel Doppler inferences and outcomes in the neonatal period. Results: Among the 63 patients taken for the study, thirty-three were found to have IUGR and thirty were of normal growth fetuses. In fetuses with IUGR, there was a significant difference in the interventricular septal variables in comparison to their normal counterparts. In fetuses with birth weight between 1-1.5 kg, the right ventricle and left ventricle parameters were also found to be affected. The parameters showed no remarkable deviation in the IUGR fetuses with respect to vessel Doppler and fetal outcomes. Conclusion: We conclude that Myocardial tissue Doppler can diagnose cardiac dysfunction in IUGR. This change was more significant in babies with very low birth weight, abnormal vessel Doppler and adverse perinatal outcomes. Myocardial tissue Doppler has, however, a low specificity in predicting adverse perinatal outcomes in IUGR babies and comparable sensitivity to Conventional Vessel Doppler.

DOI: 10.5281/zenodo.7537349

10. Comparative Assessment of the Impact of Two Different Distraction Strategies as a Non-Pharmacological anxiolytic among Hospitalized Children.
Nouf Rumayd Aldhafeeri, Khaloud Saleh Alharbi, Aishah Eissa Alanazi, Lamyaa Mulfi Alanazi, Mustora Mulfi Alanazi, Alaa Rushaydan Alfahad
Background and Aim: Before surgery, children are extremely anxious. Preoperative anxiety affects how well anaesthesia is administered and is linked to a number of both immediate and long-term postoperative problems. The goal of the current study was to compare the effectiveness of two different distraction techniques as a non-pharmacological anxiolytic for hospitalised children. Materials and Methods: The study included 150 children, both genders, who were hospitalised to the paediatric ward of the study hospitals and ranged in age from 3 to 12 years. Three separate management teams were established: the distraction card therapy group, the animated cartoon video group, and the control group. During the vital signs process, ACV and DCT were guided for 20 minutes in their respective groups, and anxiety was assessed before to, during, and after the 5-minute phase using a modified child faces anxiety scale. Results: The total anxiety scale test score between the DCT and ACV groups did not differ significantly (p > 0.05). Significant correlations between age groups and DCT anxiety test results have been found. ACV and CG anxiety test scores as well as DCT and CG anxiety test scores both showed significant differences (p 0.001). Conclusion: When compared to DCT, ACT is a more effective and dominant non-pharmacological technique for lowering anxiety levels in paediatric individuals. Children of preschool and school age can effectively lower their preoperative anxiety levels by using distraction techniques.

DOI: 10.5281/zenodo.7537360

11. Comparative Study Computed Tomography Scan And Diagnostic Nasal Endoscopy With Histopathology In Sinonasal Tumours.
Ingita Bhardwaj, Vivek Harkare, Sonali Khaddakar, Priyank Sharma
Introduction: Various sinonasal tumours may mimic a simple nasal mass and their extent cannot be determined by mere clinical examination for that investigations like Diagnostic nasal endoscopy (DNE) and computed tomography (CT) scan are required which help to know the extent into the inaccessible areas and to make a provisional diagnosis and histopathological examination (HPE) is required for making a confirmatory diagnosis. Aim: To study and compare the findings of DNE and CT scan with histopathology in sinonasal tumours. Materials and Methods: The study took place from November 2016 to October 2018, every consecutive patient having sinonasal mass was included in the study and those having congenital sinonasal masses or previous history of surgeries were excluded then patients were subjected to investigations like DNE and CT Scan and a provisional diagnosis was made after which HPE was done to reach to the final conclusion. Results: On DNE, CT scan and HPE highest number of cases belonged to non-neoplastic inflammatory category which was 63.89%, 68.66 % and 58.33% respectively. Performance statistics of differentiating DNE with histopathology showed that there was a good agreement between DNE and histopathology in differentiating neoplastic and non-neoplastic lesions and a moderate agreement in differentiating neoplastic malignant from other sinonasal tumours. Performance statistics of differentiating CT with histopathology showed a very good agreement between CT and HPE in differentiating Neoplastic from non-neoplastic lesions and a very good agreement between CT and HPE in differentiating neoplastic malignant lesions from other sinonasal tumours. Conclusion: Diagnostic nasal endoscopy and CT both have high accuracy in differentiating neoplastic tumours from non-neoplastic tumours but are not 100% accurate. Diagnostic nasal endoscopy and CT both have high accuracy in differentiating neoplastic malignant tumours from other sinonasal tumours but are not 100% accurate. In diagnosing sinonasal tumours histopathological examination is essential neither CT nor DNE can give a final diagnosis. Both CT and DNE should be done to know the exact pathology and extent of disease.

DOI: 10.5281/zenodo.7537386

12. Role of High-Resolution Sonography and Doppler in Evaluation of Acute Scrotal Disease.
Vishnu A.R., Mini M.V., Raini K.P., Sinni K.V.
Background: Acute scrotum possesses a difficult diagnostic challenge because of the non- specific nature of symptoms and difficulty in adequately examining the tender, swollen scrotum. It is a cross sectional study, a diagnostic test evaluation to assess the accuracy of doppler ultrasound in the diagnosis of acute scrotal disease and identify and classify causes of acute scrotum based on the sonographic appearance and doppler evaluation. Methods: This is a cross sectional study carried out in 90 patients presented with acute scrotum in Department of Radiodiagnosis Government Medical College Thrissur, over one year starting from December 2020. The patients were evaluated with high resolution ultrasonography and Doppler ultrasound. Ultrasound diagnosis is then compared with final diagnosis arrived after conservative management or postoperative and histopathological findings.  Results are analysed, and, with the final data sensitivity, specificity, positive predictive value and negative predictive value are calculated. Results: Color Doppler ultrasound was found to be 100% sensitive and 95% specific for the diagnosis of testicular torsion in our study with positive predictive value of 88.4% and negative predictive value of 100%. Color Doppler ultrasound was found to be 96.61% sensitive and 96.78% specific for the diagnosis of testicular/ epididymal / peri-testicular inflammation with positive predictive value of 98.2% and negative predictive value of 93.75%. Conclusion: Grey-scale changes are nonspecific and Doppler ultrasound clinches the diagnosis when evaluating the differential diagnosis of acute scrotum. Power Doppler sonography, because of its better visualization of low velocity flow, increases the diagnostic accuracy by better characterization of the testicular and peri-testicular perfusion.

DOI: 10.5281/zenodo.7537395

13. Assessment of Renal Function among Term Neonates with Perinatal Asphyxia.
Keval Sondager, Rishita Sondager
Background and Aim: One of the most significant organs frequently affected by the multiple organ dysfunction brought on by prenatal hypoxia is the kidney. Monitoring the serum urea, creatinine, and urine production aids in the early diagnosis of prenatal asphyxia’s severity and so improves the result. The goal of the current study was to evaluate renal function and its relationship to the degree of HIE in term infants with HIE. Materials and Methods: The current study examined the relationship between renal function in term infants with HIE and HIE severity over the course of a year in the neonatal ward of a tertiary care facility in India. The total numbers of patients was 240 divided into cases and control 120 patients each. Neonatal patients in case groups received HIE diagnoses in accordance with WHO guidelines, and age and gender matching of infants was carried out. One baseline and one after 48 hours of life were used to calculate the serum creatinine. Results: Between cases and controls, there was a statistically significant difference in the Apgar score at 1 and 5 minutes. Serum creatinine, blood urea, urine salt, creatinine clearance, and renal indices showed statistically significant differences across the various stages of HIE. Except for urine potassium and urine specific gravity, all urine parameters exhibited statistically significant differences between patients and controls, including creatinine clearance, urine output, pH, fractional excretion of sodium, renal failure index, and osmolality. Conclusion: Renal dysfunction is a widespread finding present in subjects of perinatal asphyxia. Renal derangement increases with sternness of disease. Most common form of AKI among neonates with birth asphyxia is prerenal and it responds to fluid resuscitation with 100% recovery.

DOI: 10.5281/zenodo.7537427

14. Pre- Induction Cervical Ripening with Unfavorable Bishop Score Using Two Different Dinoprostone Vaginal Preparation: A Prospective Randomized Comparative Study between Controlled Release Dinoprostone Gel & Dinoprostone Vaginal Insert.
Das Arunabha, Hasan Md Kamal, Char Debasish, Biswas Sucheta
Background: The present study compares the safety and effectiveness of dinoprostone vaginal gel to dinoprostone vaginal insert for cervical ripening and induction of labour in pregnancies with poor Bishop score. Materials & Methods: This prospective randomized comparative study was carried out in 200 pregnant mothers (100 mothers using dinoprostone vaginal gel and 100 mothers using dinoprostone vaginal insert) undergone labour induction with unfavorable Bishop score. Then the safety, efficacy and Bishop score changes over time in between the two groups were compared. Study outcomes included induction to vaginal delivery interval, mode of delivery and hospital stay following delivery. Statistical analysis was done by IBM SPSS Ver. 25 statistical software. Results: Statistically significant difference was found between the two groups regarding the main outcome measures except cervical Bishop score changes at 24 hours. The probability of induction to vaginal delivery interval (p 0.03), successful vaginal delivery (p 0.03), hospital stay after delivery ( p < 0.001) were more favourable to insert group. Conclusion: Dinoprostone vaginal insert used for cervical ripening demonstrate a high degree of efficacy and safety for both mother & fetus as well as distinct superiority in terms of vaginal delivery within 24 hours along with shorter induction to delivery time and less duration of hospital stay following delivery. Single application is sufficient to achieve cervical ripening in majority of patients and adding to patient acceptability.

DOI: 10.5281/zenodo.7537461

15. Evaluation of the Surgical Field in Functional Endoscopic Sinus Surgery: A Comparative Study of Propofol versus Sevoflurane Anaesthesia.
Sushil Kumar Nayak, Sujata Ghosh, Swapnadeep Sengupta, Sudeshna Ray, Gauri Mukherjee, Mausumi Niyogi
Background and Aims: Hypotensive anaesthesia, to provide a bloodless field plays a very important role in the success of FESS. Among several agents, Sevoflurane and Propofol have been commonly used for the purpose globally. Objectives: This study was done to compare the overall efficacy of Sevoflurane and Propofol as an agent for hypotensive anaesthesia in FESS. Materials and Methods: Hundred patients, between 16-50 years, of either sex, belonging to ASA physical Status I or II, having Mallampatti Score 1 or 2 and posted for endoscopic sinus surgery were equally divided into two groups. After giving general anaesthesia with endotracheal intubation, patients in Group P received Infusion Propofol, starting at 12 mg/kg/hr for 10 minutes followed by 10mg/kg/hr for the next 10 minutes and then continued at 8 mg/kg/hr, whereas those in Group S received Sevoflurane at a dial concentration of 2%. Both the groups aimed a target MAP as 65 – 75mmHg. Intraoperative haemodynamics were assessed every 5 minutes, whereas quality of surgical field and Surgeon’s satisfaction was checked at 30 and 60 minutes. The amount of intraoperative blood loss and postoperative sedation, nausea, vomiting, bradycardia and hypotension were taken into consideration. Results: Patients receiving Propofol maintained a better haemodynamic profile, with low blood pressure and heart rate all throughout the procedure. Amount of intraoperative blood loss was also less with a better quality of surgical field and surgeon’s satisfaction score in the same group as compared to those receiving Sevoflurane. Conclusion: Propofol is overall more efficacious than Sevoflurane to achieve hypotensive anaesthesia during Functional endoscopic sinus surgery (FESS).

DOI: 10.5281/zenodo.7537469

16. Psychosocial Functioning in Patients of Major Depressive Disorders in Tertiary Care Hospital in Haryana.
Nitika Sindhu
Background: One of the most prevalent mood disorders is depression which comprising of symptoms like persistent sadness or low mood, loss of interest or pleasure and fatigue or low energy at least one of these, most days, most of the time for at least 2 weeks. Psychosocial or social is one of the important domains of cognition affected by depression. With the phenomenon of depression, there is often a shift in one’s social behaviour. Objective: This study aimed to compare the effect of fluoxetine, venlafaxine, and mirtazapine on psychosocial functioning in patients with major depressive disorders. Material & Methods: 30 patients of age between 18-69 years of either sex were randomly allocated to receive either fluoxetine (20-40mg), venlafaxine (75-150mg) or mirtazapine (15-30mg). Patients were diagnosed by DSM IV- RC. The patients were clinically assessed by using ABC-Hamilton Depression Rating Scale. The evaluation of patient social motivation and behaviour in depression was done by using Social Adaptation Self-Evaluation Scale (SASS) at the time of enrolment and then at the end of the sixth and twelfth treatment weeks. Results: In Group fluoxetine, scores of SASSS on the day of enrolment, 6th and 12th week were 26.76 ± 4.52, 39.92 ± 5.00, and 51.15 ± 4.78 respectively. Similarly, in group venlafaxine scores of SASSS on the day of enrolment, 6th and 12th week were 29.80 ± 9.00, 39.42 ± 10.21, and 51.5 ± 4.75 respectively. In Group mirtazapine, scores of SASSS on the day of enrolment, 6th and 12th week were 29.80 ± 9.00, 39.42 ± 10.21, and 51.5 ± 4.75 respectively. Our results showed that in all three groups there is improvement in social behaviour after the 6th and 12th week from the baseline scores. At the end of the sixth and twelfth weeks of treatment, however, there was no statistically significant difference between the three groups on an intragroup basis. Conclusion: The SASS total score improved with a varying degree with patient status and is sensitive to active-treatment effect.

DOI: 10.5281/zenodo.7537475

17. Relationship of Serum Magnesium, Serum Uric Acid Levels and Microalbuminuria in Patients with Type 2 Diabetes Mellitus.
Reena Singh, Ronak Kapadia, Paras Shah, Girish Narsinghani
Background: Diabetic nephropathy is a serious side effect of diabetes mellitus. Microalbuminuria is a sign of diabetic nephropathy in people with type II mellitus. Studies have demonstrated that treatments to tightly regulate blood sugar and blood pressure can reverse the development of microalbuminuria. Microalbuminuria is multifactorial and it is an important marker for diabetic nephropathy. Aim and Objectives: Present study aims to study the relationship between serum Mg level, uric acid and incidence of microalbuminuria in type 2 diabetes mellitus. Material and Methods: The present study was a hospital based, cross-sectional study, conducted for a period of one and half years, carried out on 250 patients diagnosed with type 2 diabetes mellitus and admitted to tertiary care institute of India. All the patients’ blood sample was sent for estimation of serum magnesium, serum uric acid, FBS, PPBS, HBA1C and urine spot albumin:creatinine ratio. Results: In our study, 198 out of 250 patients had a positive microalbuminuria and 14% showed macroalbuminuria. Serum magnesium levels were on the lower side in 90% of the population and only 10% had levels within the normal range in our study. Serum uric acid levels were elevated in 62.8% of the study population whereas 37.2% were within the normal range or low. There was a positive correlation between, high uric acid levels and microalbuminuria with a highly significant value of 0.001. Conclusion:Serum magnesium level was inversely related with the incidence of microalbuminuria whereas there was linear association with high serum uric acid level. Good glycemic control and correction of hypomagnesemia and hyperuricemia could be effective to reduce the incidence of microalbuminuria and progression of renal impairment in type 2 diabetic mellitus.

DOI: 10.5281/zenodo.7537483

18. Prospective Analysis of Perfusion CT Imaging of Liver Pathology and Histopathological Relation.
Guruprasadsinh J Vaghela, Premaram Choudhary
Background and Aim: The existence and size of tumor vasculature are closely correlated with CT perfusion parameters, which may be used for earlier liver cancer detection and more individualized patient monitoring. The purpose of the current study was to contrast the histological diagnosis with the imaging diagnostic of liver lesions utilising CT perfusion parameters. Material and Methods: 100 patients who had liver space-occupying lesions by conventional and contrast-enhanced US, CT, or MRI made up the study’s population. Prior to participating in the study, all patients were required to give written informed consent. The 16 SLICE CT scanner and syngo® Body Perfusion CT software were used for all CT perfusion tests. The method is based on a continuous accusation of dynamic contrast flow in cine mode. Results: When perfusion parameters were compared between a few common benign lesions, including liver abscess and hydatid cyst, and normal liver parenchyma, it was discovered that there was a reduction in intralesional BV, BF, PERM, ALP, PVP, and HPI among these benign liver lesions, indicating the cystic content of the lesion. In contrast, there was a relatively higher intralesional BF, ALP, and HP. Conclusion: Using the perfusion parameters, CT perfusion imaging of the liver can be used to distinguish between focal lesions of the liver and functional information about the microcirculation of normal parenchyma. It is an effective method for identifying primary or metastatic tumors.

DOI: 10.5281/zenodo.7537495

19. A Comparison of Management of Low Anal Fistula by Fistulotomy and Fistulectomy.
Lokesh Singh, Vishal Shammi, Kanhaiya Nayak Bhagel, Anurag Pateria, Gaurav Kataria
Objective: The purpose of this study was to compare the operating time, length of hospital stay, time needed for wound healing, postoperative complications (urinary retention, bleeding, infection, incontinence), and recurrence rate between fistulotomy and fistulectomy, the two procedures used to treat low anal fistulae. Methodology: From September 2021 to March 2022, patients who underwent surgery at a tertiary care facility were compared retrospectively. 40 patients were examined and equally split into Group 1, who underwent a fistulotomy, and Group 2, who underwent a fistulectomy. Results: The outcomes for the two groups were contrasted. Since fistulotomy takes less time to perform, requires less post-operative hospital time, and heals wounds more quickly than fistulectomy, it is preferable for treating low anal fistulas. However, the frequency of problems and recurrences.

DOI: 10.5281/zenodo.7537531

20. A Study to Investigate the Possible Root Causes of Abdominal Wound Dehiscence.
Sunita Yadav, Rupali Kaur, Apurva D, Atul Mishra
Background: The most infamous complication seen following abdominal surgery is unquestionably abdominal wound dehiscence. In order to understand the factors influencing the disruption and incidence of abdominal wound dehiscence in various types of incisions, this study was conducted on 35 patients with abdominal wound dehiscence who were admitted and treated in the general surgery department at PIMS hospital. Methods: The study comprised 35 individuals who had abdominal wound dehiscence or bowel protrusion following any abdominal incisions for either emergency or elective abdominal procedures. Results: Age groups between 41 and 60 years saw the highest abdominal wound dehiscence (34%), followed by more than 60 years with 28 %, 21 to 40 years (22%) and least in less than 20 years patients (14%). It was discovered that men (65%) were more affected than women (35%). Compared to elective procedures (43%), emergency surgeries (57%) had a higher prevalence of it. The most prevalent condition linked to wound dehiscence was appendicitis (31%), followed by cholelithiasis (29%), intestinal obstruction (12%) and ileal perforation (12%). The most frequent incision linked with wound dehiscence was vertical midline (57%) followed by Kocher’s incision (29%) and Mcburney’s incision (12%). Conclusions: Anaemia, malnutrition, obesity, diabetes mellitus, coughing, and surgery factors such as type of surgery (elective/emergency), underlying condition, type of incision, type of closure, suturing material, and suturing procedure all play significant roles in the development of wound dehiscence.

DOI: 10.5281/zenodo.7538117

21. Effect of BIS (Bispectral Index) Monitoring on Recovery Profile of Patients using Sevoflurane as a Maintenance Inhalational Anaesthetic Agent.
Mohammed Abdul Samad, Yaseen Fathima, Vamshi Krishna B, Bharat Kumar
Background: One of the objectives of modern anaesthesia is to ensure adequate depth of anaesthesia to prevent awareness without inadvertently overloading the patient with potent drugs. An important achievement of modern anaesthesia is the ability to monitor depth of anesthesia. Bispectral index uses a combination of EEG sub parameter that were selected after analysis of large database of EEG. This parameter were combined to form optimum configuration to monitor the hypnotic state. This is then described as a dimensionless number ranging from o to 100 with lower number corresponding to deeper level of hypnosis. Aim of the Study: To evaluate efficacy of Bispectral index monitoring on recovery profile of patients maintained with sevoflurane under general Anaesthesia. Methods: This clinical study was conducted in the Department of Anaesthesiology & Critical care of Osmania General Hospital, Hyderabad, from June 2020 to November 2021. Results: The recovery profile is better in patient who were administered BIS guided anaesthesia. Conclusion: BIS monitoring results in higher modified aldrete score on arrival to PACU, there by leading to early discharge from PACU.

DOI: 10.5281/zenodo.7538123

22. Serum Uric Acid and CRP as Prognostic Predictor in Acute Myocardial Infarction.
Singamaneni Manjusha, J. Rajesh, A. Shiva Prasad
Aim of the Study: To see for correlation of CRP and hyperuricemia with Killip’s Class and mortality. Material & Methods:  50 patients as cases (diagnosed as acute myocardial infarction) and 50 controls (healthy volunteers). All cases and controls were taken from Mamata General Hospital by applying inclusion and exclusion criteria. Patients were followed up for 7 days in the hospital and observed for complications such as complete heart block, cardiogenic shock, arrhythmias. Results: Fifty patients presenting with acute myocardial infarction and fifty controls who satisfied the inclusion criteria were enrolled into the study. Data was collected and analysed with clinical and laboratory parameters. Conclusion: Higher CRP and serum uric acid levels with Killip’s class III & IV showed increased mortality. CRP >3.0 mg/dl and serum uric acid levels >7.5 mg/dl were associated with highest mortality.

DOI: 10.5281/zenodo.7538127

23. A Cross Sectional Study on Platelet Indices in Acute Ischemic Stroke among Adults in a Tertiary Care Hospital.
Ch. Chaitanya, Tejaswini Gannamaneni, Dulam Pradeep Kumar, M L N Phanindher
Aim of the Study: To investigate relationship between platelet indices, MPV (mean platelet volume) and PDW (platelet distribution width) in acute ischemic stroke. Methods: 80 stroke patients admitted to the hospital from November 2018 to October 2020 were screened. Each of them was entered into a stroke log. Patients fulfilling the criteria were enrolled into the study after obtaining an informed consent. Each patient was given a serial number and was formally included into the study as a case. Results: Age group with highest stroke incidence is 61-70yr, with 66.7% falling in the age group. 17.5% are between 51- 60yrs age group. 11.3% for 71-80 yrs, and 5% are stroke in young. 66.3% of the cases were males and 33.8% are females. There was a clear male preponderance in the cases of stroke recruited in this study. Conclusion: The observations here suggest a role for larger platelets in the genesis of cerebral thrombosis and are likely to represent changes occurring at thrombopoiesis. Further research is required into the role of platelet volume in stroke pathology, outcome, and, most importantly, in individuals at risk for stroke.

DOI: 10.5281/zenodo.7538148

24. Comparative Study between Preloading with Fluids Vs Phenylephrine in the Management of the Hypotensive Effects of Propofol in Patients Undergoing Rapid Sequence Intubation.
Md Sofiullah, Sushil Kumar Nayak, Sujata Ghosh, Manisankar Nath, Purba Haldar, Mousumi Neogi, Joydeb Roy
Introduction: The induction of general anaesthesia with propofol has been associated with a decrease in systolic arterial blood pressure. Various strategies have been attempted to prevent this hypotension with inconclusive evidence. Ketamine, ephedrine, atropine, glycopyrolate, dopamine, dobutamine etc have been administered in various studies to prevent this hypotension with various results. Aims and Objective: Present study was undertaken to compare, the effect of preloading with crystalloid (Ringer lactate) and the effect of prophylactic administration of intravenous phenylephrine against the hypotensive effects of induction of anesthesia with propofol in rapid sequence intubation. Material and Methods: After taking ethical committee clearance and written informed consent from every patients randomly selected 60 patients aged between 18-50 years , ASA grade I-II , Mallampati class I-II posted for elective surgical procedure requiring general anaesthesia were included in  the a prospective, randomized, single blind study study. Group R-Patients (30) who received Inj Propofol (2.5mg/kg) & 10-15 ml /kg Ringer lactate 10 minutes prior to induction of anaesthesia and  Group P –Patient who received inj propofol (2.5mg/kg) & inj phenylephrine 0.1 mg intravenously before induction of anaesthesia. Haemodynamic parameters (HR, SBP, DBP and MAP) were monitored & recorded in following specific time intervals: Before the starting of anaesthesia (baseline value), Just before intubation and  1, 2, 3, 4, 5, 10 minute after intubation. Results: All the patients of two study groups were comparable with respect to sex, age, height, weight. No significant differences were observed between the groups (p value >0.05). During the entire process of intubation up to 10 minutes, heart rate was significantly lower in Group P compared to Group R. However the mean heart rate was within the physiological limit. In group P the systolic ,diastolic ,mean arterial pressure all significantly increased in the first two reading than reading taken just before in the intubation .Then the pressure gradually tends to normalise for upto 10 minutes. Conclusion: Phenylephrine infusion in the dose of 100 microgram is effective in obtunding hypotension caused by propofol induction with minimal side effects and is a better option than crystalloid infusion.

DOI: 10.5281/zenodo.7538159

25. Analysis of Demographic and Microbiological Characteristics of Surgical Site Infection.
Rahila Khan, Shrikrishna A. Joshi, Abhay Chowdhary
Introduction: An infection at the surgical site that affects the incision or deeper tissues within 30 days of the procedure (or within a year if the implantation is left in place just after the procedure) is referred to as a surgical site infection (SSI). The prevalence of postoperative SSI varies significantly across procedures, hospitals, doctors, patients, and geographical locales.  Staphylococcus aureus infection accounts for a significant number of SSIs that occur in hospitals. Again, gram-negative bacilli, Pseudomonas aeruginosa, Klebsiella, as well as Escherichia coli are frequently isolated from SSIs. SSIs contribute to post-surgical complications significantly. However, with proper characterization of the infection demographically and microbiologically and its related factors, SSIs can be properly controlled. Aims and Objectives: To study the demographic and microbiological characteristics of Surgical Site Infection in patients. Methods: This is a prospective study conducted on 430 patients for assessing SSI post-surgery. The demographic and microbiological characteristics were determined in each patient after the surgery. The infected wound was regarded when it appears to be serous or non-purulent discharge, pus discharge, or the presence of inflammation (oedema, redness, warmth, raised local temperature, tenderness, induration). Results: The study found that it was found that 9.35% of surgeries were on abdominal sites, while 8.30% of surgeries were Spinal surgeries and 12.5% were hysterectomy, based on General Surgery, Orthopedics and Obstetrics and Gynecology ward, respectively. The study has shown that diabetes was present in 23.8% of the patients followed by obesity (19.37%) and Anemia (18.20%). In the whole sample, 14.70% of the patients had comorbidities. Conclusion: The study also found that most of the patients who had SSI, were infected with Klebsiella spp. (34%), followed by E. coli (22%) and S. aureus (17%). The study concluded that Klebsiella pneumonia was the most isolated pathogen and the highest number of isolates were obtained from abdominal surgeries, spinal surgeries, and hysterectomy.

DOI: 10.5281/zenodo.7606700

26. The Infection Risk during Normal Knee Arthroscopy Performed without the Use of Antibiotics for Preventative Purposes.
Daivesh P. Shah, Shruti D. Shah, Sandip R. Rathod
Background: Despite the fact that previous research has indicated that giving prophylactic antibiotics to patients having normal knee arthroscopy may not be necessary and may, in fact, cause more problems than it solves, it is yet usual practice to do so. The objective of this study is to assess the incidence of surgical site infections in patients who have routine knee arthroscopy without the use of antibiotics as a prophylactic strategy in order to determine the frequency of such infections. Methods: This is an analysis of 250 consecutive patients who had regular knee arthroscopy done on them between the Jan 2020 to Dec 2021 at a single institution by a single fellowship-trained sports surgeon. The assessment was carried out by one researcher. The operation was performed on each of the patients at precisely the same time. Patients had a large number of different surgical techniques, including arthroscopic meniscectomy, meniscal repair, microfracture, chondroplasty, removal of loose bodies, and lateral retinacular release. Antibiotics were not administered to any of the patients as a prophylactic measure. The postoperative care of each and every patient was monitored for a period of at least two years, and the patients’ demographic information as well as their list of ailments were evaluated. After the surgery, every issue that surfaced was documented in detail. Results: The findings revealed that there were a total of 150 male and 100 female patients. The standard deviation was 11, and the mean operating duration was 31 minutes. The mean age was 42.1 years. Two young patients who were otherwise healthy developed a postoperative superficial wound infection within a week after their surgery, but they made a full recovery after receiving oral antibiotic therapy in the outpatient setting. The incidence of infection was 0.36 percent across the board. There were no reports of any instances of severe infection. This research found an extremely low risk of surgical site infections, which is equivalent to rates that are already known to occur after these types of surgeries. This indicates that preventive antibiotics are not required, which allows one to avoid the hazards that are often linked with their use.

DOI: 10.5281/zenodo.7606708

27. A Study of the Liver Involvement in Autoimmune Diseases.
Somasekhar Patil, Ramesh
Background: There has been evidence of significant regional variation in the prevalence and clinical symptoms of autoimmune hepatitis (AIH). In India, it is regarded as a sporadic cause of liver disease. The goal of the current investigation was to ascertain the prevalence, clinical, biochemical, and histological characteristics of AIH in patients visiting our tertiary care teaching hospital in south India. Methods: All patients underwent thorough physical examinations, with specific emphasis dedicated to checking for symptoms of liver illness such as icterus, edema, hepatosplenomegaly, and ascites, as well as characteristics of autoimmune phenomena such as alopecia and vitiligo. LFT, ESR, and whole blood count were standard lab tests. Prothrombin time was one of the measures used to assess liver function. Immunological markers were detected by using the immunofluorescence approach, and rheumatoid factor (RF) and antinuclear antibody (ANA) were measured. Results: Out of n=40 cases included in this study n=20 cases out of n=29 cases of Rheumatoid Arthritis suffering from systemic conditions which included 13/29 cases of diabetes mellitus and 7/29 suffering of thyroid disorders. Similarly, in the cases of systemic lupus erythematosus, we found n=2/11 cases with diabetes mellitus and n=/11 cases of thyroid diseases. The mean Globulin level was 3.1 gm/dl, Elevated globulin (> 3.4 gm %) was seen in n=19 cases. The AST range (8 to 48 U/L) estimation was found to be elevated in n=15 cases and ALT (7 to 55 U/L) was found to be elevated in n=22 cases and ALP (44–147 IU/l) was found to be elevated in n=23 cases. Conclusion: Autoimmune diseases like SLE and Rheumatoid arthritis are the major causes of liver dysfunction in autoimmune diseases. Clinical presentation may be nonspecific with myalgia, arthralgia, and chronic fatigue syndrome. Diabetes and thyroid diseases are mostly associated disorders. Serological markers of autoimmunity are positive in most cases. The presence of multiple markers is probably proportional to activity. A small minority of patients present with decompensated liver disease and signs of portal hypertension, with varices and ascites.

DOI: 10.5281/zenodo.7606715

28. Evaluation of Results of Open Reduction and Internal Fixation of Acetabular Fractures.
Madas Ravichandra Yadav
Background: Acetabular fractures are a rather infrequent injury. Early accounts of acetabular fractures are based on postmortem results of individuals who had experienced substantial trauma, indicating the severity of these injuries. The current study aimed to evaluate the results and functional outcome of open reduction and internal fixation in patients with complex acetabular fractures. Methods: This cross-sectional interventional study was conducted in a tertiary care hospital. The study comprised a total of n=25 individuals with the diagnosis of an acetabular fracture. The main cause of acetabular fractures was a motor vehicle accident. Surgery was used to treat every case, using plates and screws. Radiologically and functionally, the outcome was evaluated using the Modified Merle D’Aubigne Score. Patients were followed up on an average for 18 months after surgery. Results: In the cases of transverse fractures n=8 total we found excellent results in n=4(50%) cases and n=3(37.5%) cases and n=1(12.5%) cases. In the cases of transverse with the posterior wall, we found no case in the excellent category and n=3(60%) cases with good results and n=1(20%) cases with fair results, and n=1(20%) cases. An anterior column with posterior hemitransverse in n=3 out of which n=1(33.33%) with excellent results and n=1(33.33%) cases each in fair and poor results. Conclusion: We found favourable functional results can be achieved in complex acetabular fractures treated with open reduction and internal fixation. Utilizing non-extensible methods alone is sufficient to result in a satisfactory fracture reduction with fewer problems. The fractured fragments must be reduced anatomically wherever feasible, fixed tightly, and mobilized as soon as possible for improved function, which are not attainable using conservative methods.

DOI: 10.5281/zenodo.7606724

29. A Comparative Study of Treatment of Neovascular Glaucoma.
Pragna V, Mythili Kota
Background: A fibrovascular membrane that forms on the surface of the iris and the angle is the primary cause of the secondary form of glaucoma known as neovascular glaucoma. It is generally accompanied by other anomalies, mainly ischemia, and it never occurs as a basic disorder. The study’s primary goal was to evaluate the impact of trabeculectomy surgery in neovascular glaucoma patients in comparison to Mitomycin C Ologen implant/glaucoma drainage device surgery. Methods: N=30 Patients with neovascular glaucoma seen at the ophthalmology Department of the Prathima Institute of Medical Sciences, Naganoor, Karimnagar, were thoroughly assessed. Randomly, n=10 of these patients had trabeculectomy with mitomycin C (Group I), N=10 received trabeculectomy with an implanted ologen (Group II), and n=10 received glaucoma drainage device implant surgery (Group III). The visual result, postoperative complications, and intraocular pressure management were evaluated and compared. Results: The mean IOP reductions were 27.5 mmHg in Group I, 26.8 mmHg in Group II, and 23.15 mmHg in Group III. A maximum weekly mean IOP decrease was observed in group II. After 12 weeks, there was no statistically significant difference between these three groups’ mean IOP reductions. Preoperative visual acuity for the majority of patients ranged from PL to 1/60. In Group II, N=3 patients had improved eyesight. After surgery, the majority of the patients experienced decreased eyesight. Conclusion: Neovascular glaucoma presents more commonly in advanced ages and is more commonly affected in males. In the first week, patients treated with Trab and glaucoma implants had a lower IOP than the other two groups, but after 12 weeks, the mean IOP decrease was the same in all three groups. Compared to the other 2 Groups, patients treated with Trab with ologen Implants experienced the fewest post-operative complications.

DOI: 10.5281/zenodo.7606731

30. A Study of Use of Immunosuppressant Drugs in Dermatology for Chronic Skin Diseases.
Swathi, S Sirisha
Background: Autoimmune illnesses including psoriasis, pemphigus vulgaris, and systemic sclerosis are examples of chronic skin diseases that call for long-term pharmacological therapy. The goal of the current study was to track the effectiveness and unfavourable side effects of immunosuppressive medications used to treat chronic skin disorders. Methods: N=50 patients with newly diagnosed chronic skin disorders were enrolled in the research. Methotrexate, Dexamethasone-Cyclophosphamide Pulse Therapy, Azathioprine, Folic Acid, Calcium, and Antiulcer Drugs were initiated in their treatment regimen. At the conclusion of the first, third, and sixth months of therapy, the response was evaluated. The Psoriasis Area Severity Index (PASI) score was used to track the effectiveness of therapy in psoriasis patients. The Pemphigus Area and Activity Score (PAAS) was used to measure therapy effectiveness in patients with pemphigus vulgaris, and modified Rodnan’s skin scores were used to measure treatment effectiveness in patients with systemic sclerosis (MRSS). Haematological and clinical exams were used to evaluate tolerability. Results: In this study out of n=50 cases 44% were males and 56% were females. Among the cases included in the study n=30(60%) patients were with psoriasis n=10(20%) cases of pemphigus vulgaris and n=10(20%) cases of systemic sclerosis. Among the n=30 psoriasis cases analyzed, most of the patients belonging to 40 – 50 years of age n=12 followed by patients in age of 31- 40 years n=8. The mean age of the subjects was 37.5 ± 6.5 years. Among the n=30 psoriasis cases n=18(60%) were males and n=12(40%) were females. Conclusion: From the study we conclude that prolonged use of typical daily steroids frequently has negative, potentially life-threatening consequences. Immunosuppressive medications including methotrexate and dexamethasone-cyclophosphamide pulse treatment were well tolerated and effective when used together to treat autoimmune skin disorders.

DOI: 10.5281/zenodo.7606741

31. A Study on type of Branching Pattern of Internal Iliac Artery in the Spontaneously Aborted Human Foetus Specimens.
Saraswathamma, Mohd Abid Ali
Background: Internal iliac artery is considered as the prime artery of the pelvic region. Angio-architecture of this artery is clinically significant in many surgeries, interventional procedures and also in recent advances. Despite its remarkable significance, in India very few literatures are available to learn the morphology of the branches of internal iliac artery. Aim and Objectives: To know branching pattern of internal iliac artery in the spontaneously aborted human foetus specimens. Materials and Method: This is an observational descriptive study conducted in the Department of Anatomy, Bhaskar Medical College, Moinabad, 60 Spontaneously aborted foetuses Specimens were included after following inclusion and exclusion criteria. As per the Piersol guidelines (1930), spontaneously aborted foetal specimens of the internal iliac artery were categorised into four types. They were type I, type II, type III and type IV. Results: Study included 60 spontaneously aborted foetus, among which 44 were males and 16 were females. Type I branching pattern of the internal iliac artery was found in 50% of the specimens, followed by Type II, Type III and Type IV. Conclusion: In the study most significant type was type I and the insignificant one was type IV. The variations in the arterial branching pattern may be due to the defective arteriogenesis during 3rd to 4th month of intrauterine life.

DOI: 10.5281/zenodo.7606750

32. Stress and Lipid Peroxidation in Pregnancy and Associated Disorders.
Shailesh Barde
Background: Glutathione, superoxide dismutase, and Vitamin C, and E are antioxidants that are essential for all phases of pregnancy, including conception, fetal growth and development, labor, and postpartum health. They offer defense against oxidative stress, which is known to induce congenital abnormalities, abortion, and miscarriage, as well as protection against the harmful effects of pollutants, carcinogens, and teratogens on the developing fetus. Free radical production is a physiologically necessary process to counteract the oxidant effects of free radicals Numerous antioxidant defenses have developed in cells. These antioxidants are essential for avoiding oxidative stress in babies at risk of developing cystic fibrosis or in pregnant mothers with inflammation or illness states like diabetes and pre-eclampsia. Supplementing with antioxidants can lower the risk of birth abnormalities and shield moms and fetuses from the harmful and potentially deadly effects of pregnancy problems. Aim: The aim of the current research is to assess the lipid peroxidation as malondialdehyde (MDA), enzymatic antioxidant activities like Superoxide dismutase & Catalase and non-enzymatic antioxidant activity i.e. ascorbic acid, alpha-tocopherol, uric acid along with lipid profile in the compared to non-pregnant women in the general population of pregnant women. Material and Method: In the current research, the first group consisting of 50 healthy non-pregnant women were studied. The second group was age and socioeconomic status matched 50 healthy normal pregnant women. 100 pregnant women with iron deficiency anemia made up the third group. The last research group consisted of 35 pregnant women with moderate preeclampsia and 15 pregnant women with severe preeclampsia. The fourth group consisted of 50 pregnant women with gestational diabetes mellitus. All the study groups were assessed for serum MDA, Vitamin C, and E, Uric acid, lipid profile, Erythrocytic SOD, and Catalase. Results: In the present study serum malondialdehyde (MDA) level was raised in normal pregnant women significantly. The Erythrocytic SOD was decreased significantly compared to non-pregnant women in healthy pregnant women. Ascorbic Acid shows a less significant decrease and α -tocopherol shows a highly significant decrease in the current study’s typical pregnant ladies compared to non-pregnant women. Compared to non-pregnant women, typical pregnant women’s serum uric acid changes insignificantly. When normal pregnant women are compared to non-pregnant women in the current study, total cholesterol, triglycerides, LDL cholesterol, and VLDL cholesterol all rise considerably, while HDL cholesterol does not alter appreciably. Conclusion: Based on the findings of the current study, it can be deduced that iron deficiency anemia is linked to the production of free radicals, anomalies, and peroxidation of critical body components, increasing the danger for both pregnant women and fetuses. To evaluate the status of antioxidants in pregnancy-related disorders, more extensive research is required. Pregnancy with gestational diabetes causes an oxidative stress situation that makes it simpler for membranes to be damaged by oxidation and lipoperoxidation.

DOI: 10.5281/zenodo.7606757

33. An Analysis of the Orthodontic Awareness and Perceived Needs for Treatment of Two Tribal Populations as Related to the Prevalence of Malocclusion.
Anil Patel, Divyesh J. Chaudhari
Background: On the path to progress, Man often experiments with options that are different from those already existing, be it a lifestyle or food habits, or aspects related to luxury or convenience. Nature, on the other hand, tries to allow the survival of certain genetic attributes that are best suited to the changing environment. It is interesting to acknowledge that if one were to consider the simple lifestyle of the tribes as in contrast to that of a city dweller, one must pause to wonder if the multitude of dental problems ranging from decay to malocclusion is a sad consequence of the path taken to progress. However, as true progress is made by introspection and retrospection, it is always possible to retain the best practices and pass these on to future generations. The pattern of maturity and mental growth starts to settle during adolescence period of life. Here, the individual reinforces the habits, beliefs, and opinions based on social interaction with the peer group and external community. The major trend includes the patterns of growth and development, including the alignment of teeth and perceptions of esthetics. Aim: The main goal of this epidemiological survey was to evaluate the orthodontic malocclusion status and perceived treatment needs of two populations of adolescent trials screened in the Maharashtra District. Material and Method: The sample chosen for this epidemiological survey comprised a total of 400 higher secondary school students aged 13 to 19 years (200 boys and 200 girls) & a total of 300 higher secondary school students aged 13 to 19 years (150 boys and 150 girls) Maharashtra District none of whom had undergone any prior orthodontic treatment. The occlusion of the students was assessed and classified into the categories of ideal occlusion and Angle’s Class I, II & III malocclusions. Other parameters noted were overjet, overbite, crowding, spacing, and midline diastema. The school-going children of standards 8th to 12th in the average age range of 13 to 19 years were selected from the schools after obtaining the necessary permission from the tribal authorities. Results: Statistical results of Pearson’s chi-square test based on the data obtained from the Division showed no significant relationship between the prevalence of malocclusion and gender in the tribal population. During the examination, certain questions were posed to assess orthodontic awareness, self-perceived dental aesthetics, and perceived treatment needs. While 75% were aware of orthodontic treatment, only 25% had a perceived need for treatment. It may be due to the conduction of regular orthodontic awareness camps in the regions of Maharashtra district by which the tribes over there were aware of orthodontic treatment. Conclusion: There are two essential conclusions from the data gathered in this study about the orthodontic treatment needs of the populations evaluated. On the one hand, there were a few adolescents with orthodontic awareness on account of knowledge gained from media, schooling, and dental camps who were keen on an orthodontic correction but who expressed a degree of reluctance solely based on factors like duration, number of treatment visits, expense, and remote access to treatment.

DOI: 10.5281/zenodo.7606759

34. Comparative Study of Oral Clonidine Vs Oral Metoprolol for Induced Hypotensive Anaesthesia in Functional Endoscopic Sinus Surgery.
Gajanan Dhakne, Madhuri Ugalmugle
Background: Over the last few years, considerable interest in endoscopic surgery of the paranasal sinuses has been expressed, which is a minimally invasive technique. Complications related to this technique often arises due to excessive bleeding during surgery. This study compares oral Clonidine (centrally acting a-2 agonist) and oral Metoprolol (cardioselective beta blocker) used as premedication in functional endoscopic sinus surgery to evaluate improvement in operative field. Method: This prospective, randomized, double blind study included 50 ASA Grade I and II patients, aged between 18-60 years, who were equally divided into two groups as Group I (received oral Metoprolol 50 mg) and  Group II (received oral Clonidine 3mcg/kg ) 90 min prior to surgery. Pulse Rate and blood pressure were recorded at different time intervals including before starting the drug, before pre medication, after intubation, every 5 minutes thereafter for 30 minutes, every 10 minutes thereafter till the end of surgery and after extubation. Assessment of surgical field was done by using Fromme et al scale adapted by Boezaart et al. Results: Metoprolol was more effective in controlling heart rate intra operatively than Clonidine, whereas Clonidine was more effective than Metoprolol in maintaining better surgical field that too in lower doses as compared to the one used in previous studies. Both the drugs were effective in preventing the haemodynamic response associated laryngoscopy, intubation and surgical stimulus. Conclusion: Clonidine is more effective than Metoprolol in reducing intra operative bleeding and maintaining better surgical field even in low doses of 3 mcg/ kg.

DOI: 10.5281/zenodo.7606769

35. A Comparative Study on the Use of Prophylactic Intravenous Ephedrine to Reduce Hypotension During Spinal Anaesthesia for Caesarean Sections
Deepali Rahate Gomase
Background: The most frequently used and favoured method for caesarean birth is spinal anaesthesia. It is however linked to hypotension, which is harmful to the mother and foetus. The goal of the study is to ascertain how bolus intravenous ephedrine can reduce spinal-induced hypotension. Due to decreased uteroplacental blood flow, regional anaesthetic for Caesarean delivery is linked to a high prevalence of maternal hypotension and may cause foetal acidemia. Preloading with fluids, avoiding aortocaval compression, and giving vasopressor medications are all common ways to prevent or treat this hypotension. Many vasopressor medications, including ephedrine, mephentermine, methoxamine, metaraminol, phenylephrine, angiotensin II, dopamine, and dobutamine, have been researched for this purpose. Both phenylephrine and ephedrine are used to avoid maternal hypotension, but each has disadvantages of its own. Aim: The study has been undertaken to determine the effect of bolus intravenous ephedrine in ameliorating spinal-induced hypotension. Material and Method: The research was carried out in the anesthesiology department and was randomised, prospective, and double-blind. The 40 participants were divided into two groups of 20 patients each by computer-generated randomization after receiving approval from the Institutional Ethics Committee and written informed consent from the 40 primiparous term participants, aged 19 to 42 and American Society of Anesthesiologists I, who were scheduled for an elective caesarean section. Group 1 (study group) was given 1 ml of 5 mg of injection ephedrine intravenously, and Group 2 (control group) was given an ephedrine placebo. Results: Episodes of hypotension, reactive hypertension, the number of patients who needed rescue ephedrine, the total dose of rescue ephedrine (mg), bradycardia, nausea, and vomiting, as well as the average length of labour in the two groups are all factors to consider. The incident episode of hypotension in the ephedrine group was marginally lower than in the control group, necessitating an ephedrine injection to restore blood pressure. Neonatal outcome data, including umbilical cord blood pH and Apgar scores at 1 and 5 minutes, were comparable across the two groups, and no discernible difference was seen. Conclusion: While being lower than in the control group, prophylactic intravenous ephedrine 5 mg bolus administration did not significantly reduce the incidence of maternal hypotension. We advise trying doses more than 5 mg in order to effectively treat hypotension. Following spinal anesthesia-induced hypotension during an elective caesarean section, intravenous norepinephrine is more effective than mephentermine in terms of response percentage to the first dose and maintaining a stable maternal heart rate without having any unfavourable effects on the Apgar score.

DOI: 10.5281/zenodo.7948304

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