International Journal of

Toxicological and Pharmacological Research

e-ISSN: 0975 5160

p-ISSN: 2820-2651

Peer Review Journal

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1. A Study to Evaluate the Awareness and Perceptions Regarding Covid-19 Prevention and Management Amongst Undergraduate Medical Students at a Tertiary Care Hospital of North India
Sangeeta Bhanwra, Rajiv Kumar, Sonia Shinde Mahajan 
Introduction: The coronavirus pandemic had overwhelmed the healthcare sector and a need was felt to utilize the services of medical undergraduate students. For this, it was imperative that they have the right knowledge and perceptions about it. Therefore, a study was planned to assess the level of awareness and perception regarding the prevention and management of Covid-19 infection among medical undergraduates. Methods: A cross-sectional, questionnaire-based study was conducted over a period of two months in a tertiary care hospital of North India. A written and informed consent was taken. The google form- based questionnaire was distributed to MBBS students via online modes like email and WhatsApp for recording the responses. The categorical data were expressed as frequency, percentages, mean and standard deviation. Batchwise comparison was done using ANOVA. A p-value of <0.05 was considered statistically significant. Results: A total of 381 (76.2%) medical undergraduates participated in the study. They had an average knowledge score of 69.8%. The participants had a favorable attitude and majority of the students (96.2%) agreed that health education and campaigns have a pivotal role in preventing Covid -19. Two-third of students felt that the general public is not practicing Covid appropriate behavior adequately. On inter batch comparison, M.B.B.S second professional (2019 batch) students had significantly higher knowledge (p <0.001) and attitude (p <0.001) scores in comparison to the other batches. Conclusion: The undergraduate medical students were considerably aware of various aspects of Covid-19 infection and had a positive attitude towards the state of affairs as regards to the control and management of the pandemic in the country, with some scope for improvement.

2. Autopsy Study of Death Due to Inhalation Poisons (Asphyxiants): A One Year Retrospective Study Done at Victoria Hospital, Bangalore
V Suresh, C Ramesh, Mukund Kumar 
A poison may be defined as any substance which, if introduced into or brought in contact with a live body, produces disease, deformity, or death.1 Routes may be ingestion, injection, inhalation, or entry through any other orifices of the body. Poisoning may occur accidentally or intentionally as in suicide or homicide. Although poisoning by inhalation makes up the least common way of poisoning, most end up in sudden death. In urban setups like Central Bangalore, inhalational poisons are mainly due to occupational poisoning as seen in industries, sewage workers and in ill ventilated places (irrespirable gases). In both scenarios, most of the cases are lethal which makes this study important. A 12-month study was carried out at Victoria hospital attached to Bangalore Medical College & Research Institute. A total of 2,414 autopsies were done from July 2020 to June 2021, out of which 296 (12.26%) were poisoning cases and. Out of these 18 (6.08%) were due to inhalation of poisonous gases. In majority of cases, Forensic science laboratory reports revealed presence of poisonous substance / irrespirable gases with majority of the gender of the deceased being males. Most of the victims had died on spot or within short intervals after exposure, which points to sudden and high fatality characteristics of inhalation poisons. Maximum number of deaths occurred at workplace followed by accidental inhalation at place of residence.

3. A Comparative Assessment of Topical Mitomycin-C Versus Nasolacrimal Stent in Endoscopic Dacryocystorhinostomy for Chronic Dacryocystitis
Mrinalini Raman, Rakesh Kumar, Pawan Kumar Lal
Aim: A comparative study in the use of topical mitomycin-C versus nasolacrimal stent in endoscopic dacryocystorhinostomy for chronic dacryocystitis. Methods: This prospective study conducted in the Department of ENT, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India.   40 consecutive patients were enrolled and randomly divided into two groups. Patient undergoing EnDCR with mitomycin-C as adjuvant were assigned as Group A and those undergoing NLD stenting were assigned as Group B. Results: Total 40 patients were finally enrolled in the study. There were 62.5% females (n=25) and 37.5% male (n=15) in the study. 75% patients presented with symptoms of chronic dacryocystitis while 25% patients presented with simple epiphora. Sac syringing was done in all the patients which showed NLDO. DCG was done in 25 patients who showed lacrimal sac and blockage in NLD. It was performed in patients with inconsistent findings on sac syringing. It was not performed in balance 15 patients where sac syringing was confirmatory. Among the study subjects, age wise distribution revealed that chronic dacryocystitis was most prevalent in 5th and 6th decade of life, with mean age of 54.54 and standard deviation of 11.5. Out of 40 patients enrolled, only 3 patients (7.5%) patient reported within 06 months of onset of symptoms, balance 37 (92.5%) patients reported after 06 months of onset of symptoms. 20 patients had DNS, however, only in 7 patients it was severe enough to limit access to the sac per se during surgery. These patients underwent access endoscopic septoplasty. 20 patients underwent EnDCR with mitomycin-c application while rest 20 underwent EnDCR with stenting. At 06 months follow up 95% patients of group A (n=19) had a patent sac while in group B 85% (n=17) had a patent sac. Patients in grade 0 and 1 of Munk et al were considered as successful patients. 90% patients in Group A (n=18) and 80% (n=16) patients in Group B had subjective benefit. Conclusion: EnDCR, beyond doubt is now the preferred and established modality of treatment for patients suffering from chronic dacryocystitis.

4. Prospective Outcome Assessment of the Importance of Educating Patient Regarding the Use of INCS
Rakesh Kumar, Mrinalini Raman, Pawan Kumar Lal
Aim: The aim of the study to patient education on nasal spray technique for allergic rhinitis. Methods: Present interventional study was conducted in the Department of ENT, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India, for the period of 1 year. AR who had never been on steroid nasal spray treatment was included in this study. All patients were treated with intranasal mometasone furoate monohydrate (Nasonex) manufacture by MSD. The dose prescribed was two puffs in each nostril once daily. Each puff contains 50 mcg of Mometasone furoate monohydrate. The patients were reviewed and assessed 4 times after the initial visit. The interval between each visit was 6 weeks. Results: A total of 100 patients satisfied the inclusion criteria and consented to participate in this study. Patients were between 18 to 60 years old (mean=31.2 years) and among them 38 (38%) were male patients and 62 (62%) were female patients. Based on the 2008 ARIA guidelines, 91 (91%) patients were diagnosed with moderate-severe persistent (MSP) AR, 3 (3%) had moderate- severe intermittent (MSI) AR while 6 (6%) had mild persistent (MP) AR. During the 3rd visit despite re-education, only 27% of participants were able to show the correct techniques. However, by the 3rd and 4th visit, a good improvement was seen as more were able to demonstrate the INCS delivery technique correctly. At the end of the study, all 100 (100%) patients successfully applied and demonstrated proper technique of INCS using the Hospital Putrajaya INCS spray delivery technique.  Baseline TNSS on V1 showed that 69 patients (71.9%) came with severe symptoms. Conclusion: The present study strongly advocates that patient are effectively counseled about proper INCS spray application technique when they receive a nasal spray. Patients must be given clear instructions for correct administration.

5. A Comparative Pharmacovigilance Analytical Research Study on the Glycaemic Stabilisation Rate and Safety Levels, Between Metformin Monotherapy and Combination Therapies, Among Type II Diabetic Patients
Moumita Hazra
Background: Metformin causes sufficiently higher efficacious and safe glycaemic stabilisation rates, more significantly as a combination therapy than while being prescribed as a monotherapy, during the routine treatment of type-II anti-diabetic patients, in regular tertiary healthcare, due to its synergistic action with the other anti-diabetic drugs. Analysing metformin monotherapy and combination therapies based on rational pharmacotherapeutics, it might be stated that the beneficial pharmacotherapeutic effects of metformin were greater than the metformin induced adverse drug reactions. Aim and Objectives: This comparative analytical research study was performed, to comprehend the comparative patterns of glycaemic stabilisation and pharmacovigilance between regular anti-diabetic mono- and combination treatment regimens prescribed to type II diabetic patients. Materials and Methods: 42 type II diabetes mellitus patients, were prescribed oral metformin 250-500 mg once daily, depending upon the monotherapeutic or combination therapeutic regimen, severity or grade of type – II diabetes, the status of glycaemic stabilisation, prognostic progress of the anti-diabetic treatment, any occurrence of adverse effect, or the therapeutic control of co-morbid conditions. The percentage of during anti-diabetic treatment and post-treatment glycaemic stabilisation of the patients with metformin monotherapy and metformin combination therapies were comparatively analysed. The corresponding drug safety levels were comparatively analysed with percentage derivations. Results: The glycaemic stabilisation rate was 100% with both metformin monotherapy as well as combination therapies. The comparative safety levels of metformin monotherapy and combination therapies, deduced with percentages, showed 100% safety levels. Conclusion: Glycaemic stabilisation was found among all patients undergoing metformin monotherapy and metformin combination therapy, and both the types of metformin treatments have high safety levels.

6. A Molecular Pharmacokinetic Study on the Comparative Pharmacological Response and Patient Adherence to Ferrous Ascorbate, Ferrous Sulphate, Ferrous Fumarate and Ferric Ammonium Citrate: An Analytical Evidence-Based Clinical Research
Moumita Hazra
Background: Anaemia is a global health concern, during adolescence, pregnancy and lactation, controlled by oral haematinics, like ferrous ascorbate, ferrous fumarate, ferrous sulphate and ferric ammonium citrate. Objectives: This analytical evidence-based clinical research was conducted for the molecular pharmacokinetic study on the comparative pharmacological response and patient adherence to ferrous ascorbate, ferrous sulphate, ferrous fumarate and ferric ammonium citrate, in tertiary patient healthcare hospitals. Materials and Methods: 100 anaemic patients, who were treated for moderate iron-deficiency anaemia, were prescribed oral haematinics, such as, ferrous ascorbate, ferrous sulphate, ferrous fumarate and ferric ammonium citrate containing 60 mg of elemental iron, once to thrice daily, with or after meals. The comparative pharmacological response of the patients to the prescribed oral haematinics was evaluated by the efficacy assessment by measurement of haemoglobin concentration improvement and safety assessment, on 1st, 2nd, 3rd months and follow-up visits, and also the percentage rate of recovery. A comparative assessment of patients’ participation and adherence to treatment, including patients who completed the study thoroughly, number of drop-out patients due to adverse effects, patients who were lost to follow-up and patients who withdrew voluntarily, was done. Results: The comparative pharmacological response of the patient to the prescribed oral haematinics, comprised of 100% patient recovery rate, high efficacy and safety of the patient. The comparative patient adherence to the treatment was very high. Conclusions: This molecular pharmacokinetic study concluded that there was high patient recovery rate and patient adherence, thus emphasising on the effectiveness of the oral haematinics.

7. A Rational Pharmacotherapeutic Research Study on the Prescription Patterns of Anti-Tubercular Drugs Monotherapy or Combination Therapies in Multi Drug-Resistant Tuberculosis Patients at Tertiary Patientcare Hospitals
Moumita Hazra
Background: This rational pharmacotherapeutic appraisal study was conducted to assess the maintenance of the various aspects of rational pharmacotherapeutics, including appropriateness, efficacy, safety, availability, and ease of administration in prescribing different anti-tubercular drugs, like ofloxacin, delamanid or bedaquiline, which reflected upon the prescription percentages of these drugs, thus delineating the choice of drugs, treatment regimens and the routine prescription patterns of anti-tubercular monotherapy or combination therapies, among multi-drug resistant tuberculosis patients, in multi-centre tertiary patientcare hospitals. Aim and Objectives: This rational pharmacotherapeutic research study was conducted to interprete the prescription patterns of anti-tubercular drugs monotherapy or combination therapies, among multi drug-resistant tuberculosis patients at tertiary patientcare hospitals. Materials and Methods: From the clinical prescriptions of 102 multi drug-resistant patients, thorough patients’ history with complete examination details and the prescription patterns were obtained with the study proforma, and the study data were observed, thoroughly analysed and recorded. For 24-48 weeks, these patients had been prescribed anti-tubercular drugs, like delamanid 100 mg twice daily, ofloxacin 400 mg twice daily, and bedaquiline 400 mg four times daily followed by 200 mg thrice weekly, as part of MDR-TB treatment regimens. The number of prescriptions for each drug were recorded, and the corresponding prescription rates were statistically derived in percentages. Results: The prescription frequency of delamanid was followed by ofloxacin and bedaquiline. Conclusion: Delamanid was more commonly prescribed anti-tubercular drug, followed by ofloxacin, which was less commonly prescribed, and finally followed by bedaquiline, which was the least prescribed anti-tubercular drug.

8. Prevalence of Anemia in Children Between 2 to 10 Years of Age: An Observational Study
Vijay Kumar Gupta, Amit Patidar, Neeta Singh, Yusuf Ahmed
Introduction: Anaemia is the most common hematological disease of the pediatric age group. Highest prevalence of anaemia is seen in childrens of developing countries. The present study was conducted in Shrimant Rajmata Vijyaraje Scindia Medical College Shivpuri, Madhya Pradesh to identify prevalence of anemia in children between 2 to 10 years of age. Material and methods: This is a observational study conducted in SRVS , Medical college and associated District Hospital from January 2021 to June 2021 and includes 500 children coming to OPD and admitted in IPD . Complete blood count was obtained by taking 5ml of blood using fully automated MINDRAY Hemat analyser-BC5800. Peripheral blood smear study was performed on all the children. Anemia was diagnosed according to the World Health Organization (WHO) standard for the given age. The data was analyzed and interpreted using descriptive and inferential statistics. Results  (47%) were male and 265 (53%) were female. A total of 410 (82%) children were anemic and mild, moderate, and severe Anemia was found in 60.97 %, 25.60 %, and 13.41%, respectively.Both mild and moderate Anemia was more prevalent in girls (54.33% and 27.92%) compared to boys (45.10% and 13.19). Conclusion: Anaemia is still a major health problem in children between 2 to 10 years. Nutritional deficiency, particularly, iron deficiency is the leading cause of anemia. This can be primarily prevented by proper nutritional habits and adequate treatment.

9. A Prospective Study of Chest Physiotherapy in Patients with Burn in Bundelkhand Region
Akhilesh Ratnakar, Deepak Shrivastava, Dushyant Rohit, Omkar Thakur
The role of exercise in the rehabilitation of patients with severe burns. trauma results in persistent skeletal muscle catabolism and prolonged immobilization. We hypothesize that structured rehabilitative exercise is a safe and efficacious strategy to restore lean body mass and physical function in burn victims. Here, we review the evidence for the utility of rehabilitative exercise training in restoring physiological function in burn survivors. Burns is a very critical area of medicine citing the doctors to be on their toes. The prognosis being lowest and treatment  the hardest, this area has not cited much research. Largely these medico legal cases are accidental and rare around the world but Indian scenar io is opposite. A rural set up here will admit a minimum of two burn cases a day, with 50% chances of it being an inhalational burn. Grave is the prognosis of these patients but attempts if made properly by trained indivisuals can help save life on the edge of death. Method: 104 patients were selected randomly from the Bundelkhand medical college Sagar, allocated in two groups. The group with traditional approach was named GROUP A and had 32 Patients. The group with changed approach was named GROUP B and it also had 32 Patients. OF them 4 patients from group a died due to severe deep burns in wards, while one patient from group B was shifted to a other burn centre. This led to the final sample size to be 98. The group B received immediate chest physiotherapy as compared to group A which received the same treatment 3Days later. Result: Team approach and early physiotherapy i.e. immediately as the patient is stabilized and shifted to the burn ward, improves the chest condition, prevents post burn chest complications, facilitates healthy recovery and helps improve the prognosis. Conclusion; chest Physiotherapy in immediate Post Burn period is Important and plays a vital role in rehabilitating the patient. It also affects the survival rate.

10. To Determine the Bacteriological Profile of Surgical Site Wound Infection: A Cross Sectional Assessment
Nilesh Kumar
Aim: The aim of the present study to determine the bacteriological profile of surgical site wound infection. Methods: The study was a cross-sectional study which was carried in the Department of Microbiology, Madhubani Medical College Madhubani, Bihar, India for 15 months. Using sterile cotton swabs, two pus swabs/ wound swabs were collected aseptically from each patient suspected of having SSI. Gram stained preparations were made from one swab for provisional diagnosis. The other swab was inoculated on nutrient agar, 5% sheep blood agar (BA) and MacConkey agar (MA) plates and incubated at 37°C for 24-48 hours before being reported as sterile. Growth on culture plates was identified by its colony characters and the battery of standard biochemical tests. All the isolates were tested for antimicrobial susceptibility by Kirby Bauer disk diffusion technique on Muller Hinton Agar. Results: Out of 410 samples, 200 samples were culture positive (48.78%). Among 200 positive samples 109 (54.5%) were males. Maximum no. of culture positive samples in age 20-30 years (33.5%) followed by 30-40 (16.5 %) and then followed by 40-50 (14.5%) of age group respectively. Out of 200 culture positive samples S.aureus (26.5%) was the most common pathogen isolated followed by Escherichia coli. (22.5%), Citrobacter spp. (15.5%) and Pseudomonas aeruginosa (9.5%) respectively . Among gram negative bacilli, E.coli was most sensitive to Imipenem 88.89%) followed by Amikacin (77.77%) and Piperacillin Tazobactam (73.33%) whereas for Citrobacter spp., Imipenem (74.19%) followed by Gentamicin (45.16%), Ciprofloxacin (41.93%) was the drug of choice then for Klebsiella spp., Imipenem (76.47%) followed by Gentamicin (47.05%), Amikacin (47.05%) was the drug of choice. For Pseudomonas aeruginosa, Imipenem (68.42%) followed by Piperacillin Tazobactam (63.16%), Gentamicin (57.89%) was the drug of choice and for Enterobacter spp., Imipenem (76.92%) followed by Amikacin (53.84%), Piperacillin Tazobactam (53.84%) showed maximum sensitivity. Among gram positive organism, S.aureus showed maximum antibiotic sensitivity to Linezolid (96.22%) followed by Vancomycin (94.33%), Amikacin (83.02%) whereas CONS was sensitive to Linezolid (93.33%) followed by Vancomycin (86.67%), and Gentamicin (80%). Conclusion: We conclude that despite of modern surgical techniques and antimicrobial availability and use, SSIs are common among patients undergoing surgeries. Bacterial resistance is a serious threat for treating infections and exists for more commonly available and used antimicrobials.

11. Prospective, Observational and Longitudinal Study to Evaluate the Use of Laparoscopy As A Diagnostic Tool in Patients with Lower Abdominal Pain
Nilesh Kumar
Aim: To evaluate the use of laparoscopy as a diagnostic tool in patients with lower abdominal pain where other investigations fail to reach a conclusion, to enumerate the common causes of intractable abdominal pain and to study the usefulness of incidental appendectomy performed during diagnostic laparoscopy. Material & Method: The study was a prospective, observational and longitudinal. Diagnostic laparoscopy was performed in 50 patients with intractable lower abdominal pain. Results: All the patients in the study presented with abdominal pain (100%). Majority of patients 46% showed pain at right iliac fossa followed by lower abdomen (22%). 48% patients showed Mesenteric lymphadenopathy. Conclusion: When radiological studies are inconclusive, diagnostic laparoscopy is a very excellent and accurate technique for diagnosing the causes of abdominal pain. It should be utilized on a regular basis. When performed on the right age group and in the right circumstances, incidental appendectomy provides a lot of benefits.

12. Comparison of Percutaneous Pin Fixation Versus Closed Reduction and Cast for Colles Fractures
Raghvendra Choubey, Punyapratap Singh, Sheela Jain, Nitin Kiradiya
Introduction: Treatment of Colles fractures is difficult due to comminution. K wire is now the standard treatment method for Colles fractures because of higher rate of complications after conservative management. Aim: The aim of the study was to compare the result of percutaneous pin fixation versus closed reduction and cast for Colles fractures. Materials and Methods: 145 cases of Colles fracture operated by either closed reduction and percutaneous pin fixation or cast for Colles fractures from December 2018 to March 2021 in our institution were reviewed. Standard X-ray and clinical assessment after six were measured and final outcome were assessed using modified Gartland and Werley score. Results: According to the Gartland and Werley point system, 67% of the wrists in the k wire fixation group were rated as excellent, 30% were rated as good, 3% were rated as fair, and none were rated as poor at the time of the six month follow-up. In the cast group, 39% were rated as excellent, 55% were rated as good, 6% were rated as fair, and none were rated as poor at six  months. Conclusion: Both closed reduction with percutaneous pin fixation or cast application are effective methods for the treatment of Colles fractures of the radius. Better functional results can be expected in k wire fixation method as compared to cast application, prevents postoperative collapse of fracture.

13. Gender and Stature Determination from Measurements of Biacromial Breadth Measurements Among Adults in Southern Rajasthan
Somshekhar Sharma, Meghna Bhaumik
Stature and gender  determination and identification play an important role in establishing the identity of a deceased person. The forensic specialist is often mandated to partake in these exercises for effective identification of the deceased. The present study was conducted to ascertain the viability of a specific post cranial measurement, Biacromial breadth (BAB) in determining gender and estimating stature. The study revealed that though BAB can be used as an effective and significant marker for stature and gender determination, its efficacy in the selected population was not as significant as long bones.

14. A Study to Evaluate Transmission Potential of COVID 19 Infection from Mother to Neonate
Bharti Parihar, Jaya Patel, Deepti Chaurasia
Objective: To see the potential of transmission of COVID 19 in amniotic fluid,breast milk & neonatal nasal swab from mother to neonate by comparing two modes of delivery. Methods: After taking written informed consent amniotic fluid samples from patients with COVID-19 infection was obtained via direct syringe aspiration during labour and neonatal throat swab samples was collected immediately after delivery & breast milk samples from mother were be collected within 3 hours of delivery. The presence of SARS-CoV-2 in these clinical samples were processed at the Virology Lab of Gandhi medical College Bhopal for evaluating the vertical transmission. Results: 58 patients were included in the study. Most of the patients were asymptomatic. Regarding delivery 46 patients underwent emergency LSCS, 2 had PTVD, 1 VBAC and 9 patients have Normal Vaginal Delivery. All samples of Breast milk and nasopharengeal swab of neonate were negative for COVID RTPCR. 2 samples of Amniotic fluid were found positive for COVID RTPCR.COVID 19 infection was observed in 2 out of 46 neonates delivered via LSCS and none following normal vaginal delivery. Conclusion: None of the neonate tested negative for COVID-19 after birth, so we suggest that vertical transmission is unlikely.But more study is need with the large sample size for future study.

15. A Hospital-Based Cross-Sectional Assessment of the Association Between Gestational Age (Ga) and Neonatal Anthropometric Parameters
Chandan Kumar Mishra
Aim: To evaluate the relationship between gestational age (GA) and neonatal anthropometric parameters, namely head circumference and crown heel length. Method: a cross-sectional study in a Darbhanga medical College and Hospital with 250  live-born newborns. Their birth weight, mid-arm circumference, length and head circumference were measured and compared with gestational age assessed by New Ballard score. We summarized the variables using descriptive statistics, and the strength of association was determined through correlation analysis. Result: Amongst 250 newborns, 71% were term and 29% were preterm. Pearson’s correlation coefficient between gestational age as assessed by New Ballard score and head circumference, birth weight, mid-arm circumference and length all showed a significant positive correlation in the decreasing order [maximum with head circumference (r = 0.526)]. Linear regression analysis was done to develop predictive equations. Conclusion: Head circumference measurement can be a surrogate marker to predict prematurity as a significant correlation is seen between it and gestational age assessed by the New Ballard score. Further studies are needed to cross-validate our result.

16. Prospective Randomized, Double-Blind Comparative Assessment of the Continuous Epidural Infusion of 0.125% Ropivacaine with 1µg/Ml Fentanyl Versus 0.125% Bupivacaine With 1µg/Ml Fentanyl for Postoperative Analgesia in Major Abdominal Surgery
Ankita Singh
Aim: The present study was carried out to compare the efficacy of continuous epidural infusion of two amide local anesthetics, ropivacaine and bupivacaine with fentanyl for postoperative analgesia in major abdominal surgeries. Material and Methods: A total of 80 patients scheduled for major abdominal surgery were randomized into two Groups B and R with forty patients in each group. All patients were administered general anesthesia after placing epidural catheter. Patients received continuous epidural infusion of either 0.25% bupivacaine with 1 ug/ml fentanyl (Group B) or of 0.25% ropivacaine with 1 ug/ml fentanyl (Group R) at the rate 6 ml/h intraoperatively. Postoperatively, they received 0.125% bupivacaine with 1 ug/ml fentanyl (Group B) or 0.125% ropivacaine with 1 ug/ml fentanyl (Group R) at the rate 6 ml/h. Results: Till the end of 120 min, the sensory blockade was comparable in both the groups. After 150 min, however, the number of patients with level above T10 were significantly more in Group B as compared to Group R till the end of 24 h (P = 0.001 at 12 h). Conclusion: Both ropivacaine and bupivacaine in the concentration of 0.125% with fentanyl 1 ug/ml are equally safe, with minimal motor block and are effective in providing postoperative analgesia.

17. Hospital Based Prospective Evaluation of the Functional Visual Assessment, Pattern of Manifestation and Refractive Status of Angle Closure Glaucoma
Kundan Kumar Singh
Aim: Functional Visual Assessment, Pattern of Manifestation and Refractive Status of Angle Closure Glaucoma in Bihar region. Methods: This prospective study was done in the department of Opthalmology, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India for 1 year. The patients were informed about the study. For data collection consent was taken from them including their age, gender, occupation, educational qualification etc by face to face interview with the patient in the clinic. Primary Angle closure Glaucoma was defined as an intra ocular pressure of more than 35 mmHg or higher in presence of typical glaucomatous optic disc changes with close angle in Gonioscopy. Result:  Out of 100 respondent 44% were come with tubular field in right eye 19% were advanced field defect, 14% were superior field defect,5% were inferior field defect, 9% were normal cupping and 9% were not possible due to poor vision. In the left eye out of 100 patients 32% were come with tubular field in the left eye at the clinic while 17% were advanced field defect 13% were normal cupping,11% were superior field defect 11% were temporal island of vision , 8% were nasal step and 10% were not possible due to poor vision. Out of 100 patient 52% had tritan defect in right eye and 42% in left eye, 11% deutran defect in right eye and 17% in left eye, 2% protan defect in right and left eye, 4% only blue colour defect in right eye and 2% in left eye, 2% only yellow color defect in right eye and 9% in left eye, 21% normal color vision in right eye and 20% in left eye, rest are not possible due to poor vision. Among the study population the most frequent range of unaided contrast sensitivity in right eye was 0.5-1.00 log units and median was 0.81log units, where the aided contrast sensitivity was 0-0.49 log units and the median was 0.60 which was statistically significant (p>0.00, at 0.1 level). Conclusion: Most of the PACG patient was associated with Hypermetropia. Most of them presented with advanced visual field defect, severe increased in IOP, advanced glaucomatous changes, poor contrast sensitivity and tritan color vision defect in both eyes. Identifying risk factors, early diagnosis, appropriate investigations and proper management in time could prevent the prognosis of the diseases.

18. An Observational Utility of Pre-Operative Abdominal Ultrasound to Predict Conversion to Open Cholecystectomy
Md. Sarfraz Alam, Shahid Ahmed
Aim: To establish a radiologic view on prediction of conversion from laparoscopic cholecystectomy to open surgery. Methodology: This observational study was conducted 12 months in Jagannath Gupta institute of medical sciences and Hospital, Budge Budge, Kolkata, West Bengal, India. Written informed consent was obtained from all the patients prior to enrollment. Patients were explained the risks and benefits of the procedure. Patients aged between 20 and 75 years with a diagnosis of cholelithiasis/cholecystitis were included. Patients with choledocholithiasis on USG, having co-morbid conditions like uncontrolled diabetes mellitus, uncontrolled hypertension, coagulopathies, chronic obstructive pulmonary disease, severe cardiac failure, jaundice, cholangitis, body mass index (BMI) >30 kg/m2 and a history of upper abdomen surgery were excluded. The data was collected by pre-tested study proforma, which included general information, clinical details of the patient and investigations. Every patient underwent USG. The USG findings such as gallbladder wall thickness, presence or absence of stones, number of calculi, the size of the calculi, presence of adhesions/fibrosis, pericholecystic fluid collection and common bile duct diameter was recorded. All the patients underwent diagnostic laparoscopy. If feasible, laparoscopic cholecystectomy was performed. If not, the procedure was converted to open. All patients’ findings at laparoscopy were compared to USG findings and the reason for conversion in each patient was documented in detail. Association of USG findings was correlated with conversion to open cholecystectomy. Results: The present research was an observational study to find the utility of abdominal USG parameters which can predict the conversion from laparoscopic to open cholecystectomy. A total of 100 patients were included in the study. Of 100 patients, 11% had a conversion to open cholecystectomy. There was no statistically significant difference between the two groups in relation to age groups and gender. There was no statistically significant difference between the two groups in relation to abnormal gallbladder, presence and number of calculi, size of the calculus (>6 mm), gallbladder thickness (>4 mm), pericholecystic collection, adhesions/fibrosis and size of the common bile duct. Conclusion: 11% patients had a conversion to open cholecystectomy. There was no statistically significant difference of USG parameters studied such as gallbladder wall thickness >4 mm, pericholecystic fluid collection, common bile duct diameter >7 mm, presence of calculus, number of calculi, size of calculus >6 mm and adhesions/fibrosis in patients who required conversion to open cholecystectomy and who were operated laparoscopically.

19. Occurrence of Mucormycosis in Setting of Covid 19 –  A Prospective Observational Study
Vaishali Dhawan, Suresh Phatak, Harshith Gowda KB
Coronavirus disease 2019 (COVID-19),  an infectious disease caused by newly discovered novel severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2), affecting millions of people worldwide .During the coronavirus pandemic, A sudden surge of sino-nasal mucormycosis has been observed in  post-Covid patients or Covid patients, especially in former group. A prospective observational study was undertaken in department of Radio-Diagnosis at Jawaharlal Nehru medical college, Sawangi, Wardha, India on 30 patients over a period of 45 days, who had either tested SARSCOV-2 positive with RTPCR or who had recovered from Covid-19 infection and underwent CECT Paranasal sinus study for clinical suspicion of rhino-sinusitis or orbital cellulitis showing  features of invasive sinusitis and its complications. All the patients showed involvement of one or more sinuses. Ethmoid sinus was the most commonly involved sinus in our study which was seen in 29 (96.6%) of patients, while bilateral involvement was slightly more in maxillary sinuses i.e 22 patients (73.3%) as compared to ethmoid sinus which was seen in 21 (70%) patients. Majority of the patients were affected on left sided sinuses i.e. 20 patients (66.6%), whereas 13(43.3%) patients were affected on right side. A total of 25 (83.3%) of patients showed involvement of nasal cavity, of which 16(64%) had bilateral nasal cavity involvement, while nasal cavity was not involved in 5 (16.7%) patients.  Of these 30 patients, 16 (53.3%) patients developed orbital cellulitis, more on left side. Cavernous sinus thrombosis was seen in 2 patients. 19 (63.3%) patients underwent Sino-nasal surgery and were confirmed having mucormycosis on histopathological examination. Rest of the patients diagnosed with mucormycosis showed radiological and microbiological evidence of mucormycosis and were treated medically. We concluded early diagnosis of Sino-nasal mucormycosis and ROCM with help of early clinical suspicion and available imaging modalities is possible and should be practiced.

20. A Study on the Diagnostic Assessment of Congenital Urinary Tract Abnormalities at a Tertiary Medical Facility
Avadhesh Kumar Gupta, Jagdish Kumar
Background: Congenital illness prenatal diagnosis gives information for pregnancy decisions and proper parental treatment, which is thought to improve perinatal and long-term outcomes. Twenty to thirty percent of all detectable defects are kidney malformations, which are frequently discovered in the prenatal period. Aims & objectives:The purpose of the current study was to examine the diagnostic procedures for congenital urinary tract abnormalities at a tertiary medical facility. Material and Methods:A prospective observational study was conducted on neonates who were born at our institute, referred there within 24 hours of birth, followed up for 6 months, or who passed away within 6 months of birth and whose antenatal anomaly scans had revealed the presence of CAKUT (Congenital anomalies of the kidney and urinary tract). Results: 136 instances were examined over the study period. Initial USG examinations (antenatally, 86.76 percent; postnatally, 13.24 percent) identified every anomaly. Few patients obtained further radiological tests, such as MRIs (7.35 percent during pregnancy and 5.88 percent afterward), and postnatal CT scans (5.88 percent) (as antenatally CT is relatively contraindicated). In the current study, polycystic kidney disease (20.59 percent), pelviureteric junction obstruction (19.12 percent), the posterior urethral valve (17.65 percent), ambiguous genitalia (4.41 percent), epispadius (2.94 percent), duplicated collecting system (2.94 percent), hypospadias (1.47 percent), and bladder exstrophy were the next most common congenital malformations of the urinary tract (1.47 percent ). Conclusion: The most frequent CAKUT seen both antenatally and postnatally was hydronephrosis. Compared to other renal anomalies, defects of the renal collecting system were easier to detect by prenatal imaging.

21. Prevalence of Frailty Syndrome among Diabetic and Non-Diabetic Elderly in a Tertiary Care Hospital
Ajay Abel Mall, Lal Babu Prasad
Background: An increase in the percentage and overall number of people over 90 years old, as well as a sizeable number of centenarians, have coincided with an increase in life expectancy during the course of the 20th century. Care for this most vulnerable subset of patients can be improved by clinicians being aware of the Frailty syndrome, its biological foundation, and the elevated risk for negative consequences. The ability to identify and address frailty in clinical practice gives geriatric medicine a fresh perspective. Aims & objectives: This includes researching the frequency of frailty among the elderly in the neighborhood and providing specialized care for this vulnerable group. Material & methods: People older than 65 years old were included in this hospital-based observational study. According to Fried et al definition .’s of the frailty phenotype (2001), physical frailty is a clinical syndrome in which the subject exhibits three or more of the five criteria. The sample population’s elderly frailty prevalence was evaluated. Additionally, we contrasted the prevalence of frailty across groups with and without diabetes. Results: The age range of 80 years and older was where frail subjects tended to fall. Pre-frail patients tended to congregate in the 65–69 age range. Male:female ratio for patients who were fragile was 0.46:1. Study participants who were frail as opposed to pre-frail had a higher percentage of diabetes. Though it was not statistically significant (p = 0.197), there was a connection between diabetes and frailty.Conclusion: Frailty is prevalent in people aged more than 80 years and females.

22. Study on Prescribing Pattern and Drug Utilization among Depressed Patients in Tertiary Care
Palak Agrawal
Introduction: The purpose of drug utilization pattern is determination of benefit-risk relationship, cost effectiveness and to ensure the appropriate use of dose, duration of therapy and outcomes of therapy with drugs. The prescribing pattern promotes appropriate use of monitored drugs, reduction of abuse and ensures rationale for drug therapy. The aim was to study the prescribing pattern and drug utilization review on depressed patients. Materials & Methods: A total of 120 prescriptions were included in the study and analysed. As per the HAM-D scoring criteria, the included patients were divided as mild, moderate and severely depressed patients. The included patients were prescribed with benzodiazepenes, antidepressents and antipsychiotic. The data of the included patients were recorded in the preformed performa. Results: There were 76 males and 44 females in the research study. The most preferred antidepressant was found to be escitalopram. Total of 42 prescriptions contains the drug name escitalopram. This was followed by combination of drugs name such as citalinforte prescribed in 60 patients and linotril was seen in 42 prescriptions of the included patients. Discussion & Conclusion: Most of the patients in this study were males and the most susceptible age group was the 31-40 years age group. SSRIs and SNRIs seem to have replaced the older group, namely the TCAs because of fewer side effects of the newer group of drugs and the prolonged therapy which was needed to combat depression effectively. Escitalopram was the most commonly prescribed drug for depressive disorder followed by lorazepam, Clonazepam and haloperidol.

23. Assessment of Prevalence of Thyroid Disorders Among Pregnant Women at Tertiary Care Hospital
Tasneem Zahra, Rinki Hada, Sunita Chandouliya, Mohammed Abbas Ali,  Jitendra Ahujha, Chandrajeet Singh Chandel
Introduction: Thyroid disorders are reported in higher magnitude among pregnant women, Maternal thyroid function changes rapidly during pregnancy and weaker adaptation to these changes may results in thyroid dysfunction. These changes are a result of various risk factors like an elevated thyroglobulin levels due to increase in estrogen and serum HCG levels, and also increased renal losses of iodine because of increase in glomerular filtration rate and changes in iodine transport to the placenta. Material & Methods: All the pregnant women coming to OPD in 1st trimester for regular antenatal visits were selected for the sampling. After obtaining the gestational age and informed consent ,100 pregnant women in 1st trimester according to inclusion and exclusion criteria were enrolled in the present study. Clearance from hospital ethics committee was taken before start of study. Written informed consent was taken from each study participant. Results: In present study, On the assessment of thyroid function test it was found that 88% of study participants were euthyroid while 9% had subclinical hypothyroidism and 3% had overt hypothyroidism. None of the study participants had subclinical or overt hyper-thyroidism in the present study. The mean serum TSH levels were 3.85±3.1, mean levels of serum T3 was 2.31±0.92 and mean levels of serum T4 was 1.52±0.63. The prevalence of thyroid disorders was 8.57% in the age group of 20-25 years. The prevalence of thyroid disorders was 22.58% in the age group of 26-30 years. The prevalence of thyroid disorders was 8.82% in the age group of more than 30 years. Conclusion: We concluded from the present study that the most common thyroid disorder was subclinical hypothyroidism which was followed by overt hypothyroidism there was no case of subclinical hyperthyroidism or overt hyperthyroidism.

24.Effectiveness of Motor Imaginary Technique for Improving of Upper Limb Function in Post Stroke Patients
Md Haider Ali, Ghazi Sharique Ahmad, Saad Bin Saif, Choudhary Mehboob Alam
Objectives: This study was to compared the conventional exercises and conventional exercises with motor imaginary technique for improvement of hand function in post stroke patients. Methods: The subjects of both control group and experimental group were involved for pre-test assessment by Fugl- Meyer assessment scale (hand component). The subjects of control group were given conventional physiotherapy and experimental group were given conventional physiotherapy and motor imaginary technique. The treatment was given for 1 hour for a period of 6 weeks as 5 days per week, one session per day. Results: When compared the mean ± standard deviations of pre-test and post- test value of control group patients. P-value was found to be 0.003. it was statistically significant. While, when we compared the mean ± standard deviations of pre-test and post- test value of experimental group patients. P-value was found to be less than 0.0001. it was highly statistically significant differences. Conclusions: Conventional physiotherapy exercises with motor imaginary technique is the most effective for improving of upper limb function as compared with only conventional physiotherapy exercises in post stroke patients. Hence, this form of technique can be use in post stroke patients for improvement of activity of daily livings.

25. A Pilot Research to Better Understand How Antibiotics are Used in the Community: A Study from Central India
Amit Singhal, Yogendra Kumar Dwivedi
Background: Antibiotics, also known as antimicrobial agents (AMAs), are chemicals derived from bacteria that are used in small doses to kill other microbes with little harm to the host cells. By lowering infections, this series of agents helped advance contemporary medicine. Aims and Objectives: to assess the level of knowledge regarding antibiotics, gauge the prevalence of self-medication, and investigate some of the variables affecting this practice. Methodology: This study, which was carried out in Central India, was descriptive, comparative, and cross-sectional. The study included 40 families from low- and high-income groups, respectively. The study took place over the course of six months. After receiving the respondent’s informed written consent and the ethics committee’s clearance, the data gathering process began. The data was gathered using a structured questionnaire that was specially created. A trained individual interviewed one responder per household who was in charge of looking after the family’s health in order to complete the questionnaire. The questionnaire had three sections: one on sociodemographic information, one on their knowledge of antibiotics, and one on the specifics of the family’s self-medication habits. Data were analyzed using SPSS 25.0. Results: Few respondents could define the term “antibiotics,” however some could name specific antibiotics like streptomycin and amoxicillin. Antibiotic self-medication was found to be a widespread practice in both income categories, but it was more prevalent in the high-income group. Approximately 75% of the individuals thought that antibiotics could have negative side effects, of which 70% reported ADRs as a result of using AMA for self-medication. 65 percent of people got their antibiotics via a previous doctor’s prescription. The majority of people in low socioeconomic areas got their antibiotics on prescription. Conclusion: Antibiotic self-medication is widespread among all socioeconomic categories in society. It is absolutely necessary to educate the public about this behavior and the grave consequences of self-medicating with antibiotics.

26. To Determine the Incidence of Acute Renal Failure in a Cohort of Patients with Risk, Injury, and Failure Factors Admitted to the Surgical Intensive Care Unit
Santosh Kumar Gupta, Arun Kumar Kulshreshtha
Background: Critically sick patients who experience acute renal failure (ARF) have a higher fatality risk. Our understanding of the disease has improved as a result of several pathophysiologic pathways linked to ARF. Changes in glomerular filtration, tubular dysfunction, and changes in renal perfusion can all lead to ARF. ARF’s effects can be changed by early intervention and adjustment of these conditions. Renal replacement therapy (RRT) is one of the new therapeutic therapies that has been established that has the ability to alter the course of ARF in critically ill patients. Over the previous three decades, patient survival has not significantly increased despite advancements in intensive care and dialysis technology. Aim: To ascertain the prevalence of acute renal failure in a group of patients admitted to the surgical intensive care unit of the hospital who also had risk, injury, and failure factors. To evaluate patient mortality after developing acute renal failure. Material and Method: The study was a uni-center prospective cohort study with an observational design, conducted in the Department of Anesthesiology. 500 patients were admitted to the surgical intensive care unit during the research period. 60 of these patients had acute renal failure according to the RIFLE criteria. The distribution of the 60 patients with ARF throughout the age deciles followed a normal distribution, with the majority of the patients lying in the 30 to 70 age range. All patients >14 years old admitted to the surgical intensive care unit who met any one of the inclusion criteria for acute renal failure were included in this study. Results: Sepsis was the main contributor of ARF in the research population. Sepsis was determined to be present in 35 of the 60 individuals. Polytrauma (10%) was the second most typical cause of ARF. 10% of patients had ARF as the cause of post-arrest sequelae. ARF was brought on by hemorrhagic shock in 4% of patients and hepatorenal syndrome in 6% of patients, respectively. All three groups’ mean values were discovered to be lower for the risk group and higher for the injury and failure groups after that. When these prognostic scores were applied to the survivors and non-survivors, we discovered statistical significance between them for the APACHE and sofa scores. The analysis of variance for these components was statistically significant. Conclusion:  The clinical profiles and outcomes of patients classified as risk, injury, or failure using the rifle grading for ARF are identified and described in this study. We discovered that 22% of patients admitted to the surgical ICU over time had ARF as part of their clinical profile. Those with ARF had a mortality rate of 47%. Mortality was associated with higher APACHE II scores, extended breathing, lower mean arterial pressures at admission, lower arterial pH, poorer urine output, and higher random blood sugar levels on admission. The aforementioned findings demonstrate that the RIFLE grading was very precise in terms of identifying sicker patients within the study sample.

27. A Hospital based Survey Assessing Awareness about National Tuberculosis Programmes and Antitubercular Drugs among final year MBBS Students: An Observational Study
Girijesh Kumar
Aim: The aim of the present study was to assess the awareness about National Tuberculosis Programmes and Antitubercular drugs among final year MBBS students. Methods: A questionnaire-based study was performed among 100 final year MBBS students after obtaining clearance from the Institutional Ethics Committee. Results: Most of the participants were aware about the most common symptom of Pulmonary TB, first line antitubercular drugs, common side effects, and that TB is a notifiable disease. Regarding questions on newer drugs, 62% of the participants were aware about the new drug Bed aquiline but only 26% responded correctly regarding the properties of Delamanid. In case of TB- HIV co-infection, 52% were aware that Rifampicin is replaced by Rifabutin and 28% were aware about Cotrimoxazole prophylaxis to reduce morbidity. Question on Nikshay portal was answered by 89% of the participants. 85% were aware about sputum collection for AFB testing and 95% were aware about facilities provided at DOTS centre under RNTCP. Out of which, 52% were aware of the aim of NTEP, 14% were aware about new guidelines regarding the use of streptomycin, 20% were aware about the categorisation of TB treatment under NTEP, 34% were aware about the modification in INH prophylaxis guidelines for contacts. Conclusion: It can be concluded by the present study that majority of the participants were aware about the basics of tuberculosis symptoms, diagnosis and first line drugs. Most participants are aware of the Launching of NTEP programme, but they need further updating sessions.

28. A Clinical Study Assessing the Necessity of Determining the Incidence of Double Cystic Artery: A Retrospective Study
Barun Kumar
Aim: The present study was conducted to find out the incidence of double cystic arteries. Methods: The present study was conducted in the Department of Surgery, Lord Buddha Koshi medical College and Hospital, Saharsa, Bihar, India for the period of 2 years and for symptomatic gallstones and other benign gallbladder diseases and underwent laparoscopic cholecystectomy operation were retrospectively analyzed. Results: A total of 210 patients, 42 males and 168 females were included in the study. The mean age was 50.2±12.80 (25- 81). When the files of the patients were examined, it was found that double cystic arteries were detected during the operation in two male and 8 female patients. Gall bladder polyp was found as an indication for operation in one of 10 patients, while multiple gallbladder stones were found as an indication for operation in the other patients. The mean duration of hospital stay in the patients with double cystic artery was 5.2 (3-11) days and longer compared to the patients without a double cystic artery. Conclusion: Laparoscopic cholecystectomy has been accepted as the preferred method of treatment of gallbladder stones in healthy individuals. During laparoscopic cholecystectomy, dissection of a limited field is visualized on the video monitor for detailed anatomical variations of cystic artery. As a result, cystic artery variations occur at different rates.

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