International Journal of

Toxicological and Pharmacological Research

ISSN: 0975 5160 Peer Review Journal

Print-ISSN 2820-2651

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1. To Evaluate the Results of Dynamic Hip Screw (DHS) & Proximal Femoral Nail (PFN) In Intertrochanteric Fractures of Proximal Femur with Special Reference to Surgical Site Infection
Gupta Anshul, Gupta Mansi, Jain Sheela, Meena Rajesh
Abstract
Introduction: Though dynamic hip screw is considered as a gold standard in the management of intertrochanteric fractures, its role is debatable in the management of unstable intertrochanteric fractures and intramedullary devices such as PFN are considered better implants for these fractures. Surgical site infection is an important problem in these surgeries that needs special consideration. Material and methods: The study was conducted on 80 patients with intertrochanteric fracture femur attending the outpatient and emergency department of Bundelkhand Medical College, Sagar (M.P) between January 2021 to February 2022. The patients were divided randomly in two groups A and B, patients of group A were treated by CRIF/ ORIF with Dynamic hip screw and patients of group B were treated by CRIF/ ORIF with long PFN. Results:  Results for DHS and PFN were compared. Mean age in both the groups was 65 years. In DHS group, there were 22(55%) males and 18(45%) females. In PFN group, there were 21(52.5%) males and 19(47.5%) females. In DHS group, there were 15(40%) patients who injured because of high energy trauma like RTA, while 25(60%) were injured due to low energy trauma like trivial fall. Conclusion: In intertrochanteric fractures femur, PFN helps in achieving biological reduction and imparts stability. PFN is a load bearing device and gives stability of fracture area proximally and shaft distally. Therefore, we advocate the use of PFN in comparison to DHS in intertrochanteric fractures femur except when trochanteric entry point for the PFN is fractured.

2. Anthropometric Measurements of Craniofacial Region in Medical Students of RUHS College of Medical Sciences
Sunita Chandouliya, Rajesh Arora, Chandrajeet Singh Chandel, Charu Taneja
Abstract
Background: Anthropometric parameters are important for studying different variations in the human population. The methods involving physical anthropology present high rate of accuracy for human identification and gender estimation. Aim: The aim of the present study is to obtain Anthropometric measurements of craniofacial region in medical students and to observe difference between two genders. Materials & Method: A cross sectional study was conducted among total number of 400 cases were studied which included 200 males and 200 females. These cases were undergraduate medical students, between the ages of 18-25 years. Variables studied through physical anthropometry in both the genders were facial height, nasion‑to‑menton distance, interzygomatic arch width, and intercanthal width using a digital vernier caliper. Result: A significant and high correlation was found in our study, especially between Facial Height and Pronasale to menton distance (r = 0.627, P < 0.01). Pearson,s correlation analysis revealed a significant and positive correlation between Nasal Length and Pronasale to mention (r=0.187, P value<0.01), facial height and Pronasale to menton distance (r = 0.627, P < 0.01), facial height and interzygomatic width (r = 0.396, P < 0.01), Pronasale to menton distance and interzygomatic width (r = 0.346, P < 0.01), and interzygomatic width and intercanthal width (r = 0.242, P < 0.01). This high correlation was especially found between facial height and Pronasale to menton distance and facial height and interzygomatic distance. Conclusion: In this study, significant sexual differences were observed in craniofacial region. Knowledge of mean facial dimensions is important in the evalution of age, sex and racial differences, in clinical applications and in forensic application too.

3. A Comparative Rational Pharmacotherapeutic Research Analysis and a Systematic Review and Meta-Analysis on the Oral Hypoglycaemic Rational Pharmacotherapeutic Research in Metformin Monotherapy and Combination Therapy
Moumita Hazra
Abstract
Introduction: This comparative rational pharmacotherapeutic research analysis, and this systematic review and meta-analysis was conducted for reviewing with a well-organised methodology, along with thorough explanations and analyses of the medical study literature and evidence, compiled from the numerous studies conducted, which authenticated the systematic review and meta-analysis topic of the oral hypoglycaemic rational pharmacotherapeutic research on metformin. Objective: The objective of this comparative rational pharmacotherapeutic research analysis, and systematic review and meta-analysis was the qualitative exploration of the oral hypoglycaemic rational pharmacotherapeutic research in metformin monotherapy and combination therapy, with quantitative interpretations. Methods: The study was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) Statement and Guidelines, 2009, described by the Cochrane Collaboration in June, 2016. At first, the steps of identification included the records which were identified through database searching and the additional records which were identified through other sources. This led to the steps of screening, which included the screened records after the duplicates were removed. From these screened records, few records were excluded, as per the exclusion criteria. Then, in the eligibility step, the full text articles were assessed for eligibility, from which few full text articles were excluded, according to the exclusion criteria, with adequate reasons. This led to the final inclusion step, where the studies were included in the qualitative synthesis of a systematic review and meta-analysis, according to the inclusion criteria, and ultimately the studies were included in the quantitative synthesis. Results: This systematic review and meta-analysis, contributed 2140 refined and relevant medical records, among total 2876 records obtained from the study databases search. It also comparatively analysed the oral hypoglycaemic rational pharmacotherapeutic research on metformin monotherapy and combination therapy, thus comprehensively explaining this evidence-based systematic review and meta-analysis. Conclusions: To conclude, this comparative research analysis, and systematic review and meta-analysis provided the refined qualitatively synthesised medical records, study literature and databases on the oral hypoglycaemic rational pharmacotherapeutic research on metformin monotherapy and combination therapy.

4. Hospital Based KOH Wet Preparation Assessment of the Distribution of Dermatophytes
Shanti Bhushan
Abstract
Aim: The purpose of this study is to determine the prevalence of dermatophytes in Bihar and to identify the causal agents. Materials and Methods: The present study was conducted in the Department of Microbiology, ICARE Institute of Medical Science and Research and Dr Bidhan Chandra Roy Hospital, Haldia , West Bengal, India, duration of one year. A total of 200 samples were gathered from dermatological OPD patients. Results: A total of 200 samples were sent in for fungal testing. In 239 samples, the KOH mount was positive for fungal elements, and in 108 samples, the culture was positive. Conclusion:  In the current research area, dermatophytosis has been recorded throughout the year, with an increase in the predominance of particular species. Dermatophytes’ infections are found all throughout the world, however superficial mycoses are more common in India, where heat and moisture play a big role.

5. Randomized Comparative Clinical Study to Assess the Efficacy of LMA (Laryngeal Mask Airway) Supreme and LMA Proseal with LMA Classic in Paralyzed, Anaesthetized Patients
Ravindra Kumar Singh, Nawin Kumar, Meenakshi Singh
Abstract
Objective: In the present study we compared the efficacy and aspiration risk of proseal LMA and LMA supreme with LMA classic in adult anaesthetized paralyzed patients. Methods: A randomized prospective study in 90 adult anaesthetized paralyzed patients. The proseal LMA and LMA supreme were compared with LMA classic in terms of ease of insertion, number of attempts, insertion time & hemodynamic parameters as primary outcome. Results: Ease of insertion was although more in PLMA and SLMA than CLMA but statistically comparable in all three groups. Insertion time i.e. time from jaw relaxation to connection to an aesthetic circuit and checking of adequate ventilation in all the groups was comparable. Conclusion: Clinically PLMA and SLMA are easier to insert than CLMA, but overall the three groups were comparable with respect to insertion characteristics, airway manipulation required, hemodynamics, risk of aspiration and perioperative complications but cost effectiveness along with clinical benefit was seen more with PLMA.

6. A Prospective Study to Evaluate the Role of Topical Insulin in Healing of Chronic Ulcer
Arpit Agrawal, Chandra Shekhar Amb, Virendra Pratap Singh Saytode, Virendra Pachole
Abstract
Background: Healing of chronic wounds (CW) is one of the most complex processes in the human body. Insulin-like growth factor-I role has been demonstrated in animal studies. However, human studies are disproportionately fewer. Aims and Objectives: To evaluate the efficacy of local insulin therapy by comparing insulin dressings with regular saline dressings. Materials and methods:  Seventy patients admitted with CW in Index Medical College, Hospital and Research Centre, Indore, Madhya Pradesh, were studied prospectively. Patients were randomized into Group A and Group B. Each group was subdivided into A1, A2, A3, B1, B2, and B3. Patients with diabetes were grouped as A1 and B1, infective ulcers in groups A2 and B2, and traumatic ulcers in groups A3 and B3. Group A received insulin dressing, and Group B received normal saline dressing without insulin. All diabetic patients were brought under glycemic control with appropriate antidiabetic therapy before enrolling in the study. Ulcer size was measured once a week for 8 weeks. The study’s endpoint has been taken as complete wound epithelialization or healing of wound up to 8 weeks. The rate of wound healing was calculated as the difference between the primary wound on day one till complete wound healing and is reported in terms of mm2/week as a marker of healing. Results: The mean age in group A was 44.486 years and in the control group was 48.8 years. The rate of wound healing in insulin dressing (Group A) was better than in saline dressing (Group B). Hospital stay was less in the insulin dressing (Group A) than in the saline dressing (Group B). The healing rate in the treatment group was higher than in the control group, regardless of initial wound size. There were no episodes of hypoglycemia due to topical insulin. The mean number of days required for healing was 38.7 days in Group A1 and 47.67 days in Group B1 (p = 0.001). The number of days required for healing was 37.87 days in Group A2 and 46.11 days in Group B2 (p=0.005). The number of days required for healing was 37 days in group A3 and 45.5 days in group B3. It was comparable and significant. The difference in the hospital stay of the two groups was studied using an independent sample T-test was found to be significant (p<0.05). Conclusion: Topical insulin dressing in chronic non-healing ulcers is more effective in the early healing of ulcers than normal saline dressings. There is a significant decrease in the mean area of the ulcer.

7. To Evaluate the Results of Lateral Pinning and Crossed Pinning Technique in the Treatment of Displaced (Gartland Type III) Supracondylar Fractures of Humerus in Children Ulcer
Gupta Anshul, Gupta Mansi, Sharma Saurabh, Sahu Manoj, Parteti Ritesh
Abstract
Introduction: Supracondylar fractures of the humerus are the most common elbow fractures in the pediatric age group mainly in age group of 3-12 years, mainly due to trauma by fall from height while playing. Closed reduction and percutaneous pin fixation is considered standard management for displaced supracondylar fractures of the humerus in children. However, controversy exists regarding whether to use an isolated lateral entry or a crossed medial and lateral pinning technique. The aim of this study was to evaluate outcomes of surgery by crossed pinning and lateral pinning technique in displaced supracondylar fractures of the humerus in children. Material and Methods: Between March 2021 to February 2022, of total 60 patients, were divided into two groups; group-A (two lateral k-wires) and group-B (two crossed medial and lateral k- wires) with 30 patients in each group. All children with suspected supracondylar fracture of elbow were seen either at orthopedic emergency room or orthopedic OPD.  Anteroposterior and lateral radiographs of the elbow were done. Preoperative investigations (blood picture and prothrombin time & concentration etc.) were done for all cases in our study. Patients were reassessed in the ward for neurovascular injuries and later surgery was performed after taking consent from patient parents or near relatives. Conclusion: Compared with lateral pinning entry, crossed pinning entry had a higher risk of iatrogenic ulnar nerve injury and increased structural stability. However, in the subgroups, crossed pinning with mini-open incision has decreased the risk of iatrogenic ulnar nerve injury. Therefore, the recommended strategy for the treatment of pediatric SCHF is crossed pinning entry with a mini-open incision, which can provide a stable elbow and avoid iatrogenic injury of the ulnar nerve.

8. A Study on Epidemiological Aspects, Clinical Spectrum, Treatment and Outcome of Scrub Typhus in a Tertiary Care Hospital
Khan Moin, Goyal Dileep Kumar, Parashar Vivek, Mittal Hemlata
Abstract
Background: The objective of the present investigation was to study epidemiological profile, clinical manifestation, laboratory features, complication and out-come of scrub typhus. Methods: This is a prospective descriptive study at a tertiary care hospital including patients diagnosed scrub typhus positive for (IgM by standard Q card test). Results:  Out of the total 42 study patients, 25 (59.53%) patients of scrub typhus were male and 17 (40.47%) were female, in age group 6-10 years, there were 20 (47.65%) patients. Children > 6 years had more cases due to more outdoor play is in this age group. monsoon season had more patients 30(71.43%) because mites are more active during monsoon and post monsoon season. Fever was the common presentation of all the cases followed by 20 (47.61%) had rash, 25 (59.52%) had vomiting. 25 (59.23%) had Hepatosplenomegaly, 19 (45.23%) had anemia, 22 (52.38%) had thrombocytopenia, Impaired liver function due to elevated SGOT 18 (42.86%) and, SGPT 15 (35.72%). Associated disease showed 6 (14.28%) had hepatitis A. Complications showed 9 (21.42%) had meningoencephalitis followed by MODS 3 (7.14%). Rural areas constitute more patients due to availability of more shrubs and forest areas. Mortality was observed in 7% of cases. Conclusions: The present study concluded that a high index of suspicion about scrub typhus must be look and investigated for, so timely treatment can prevent morbidity and complication, because early diagnosis and treatment is only modality which can prevent complication, and fatal outcome of scrub typhus.

9. Perinatal Outcomes in Amniotic Fluid Index in Postdated Pregnancies at Tertiary Care Center, Karimnagar
Jyothi Tippoji, Gade Rama, B. Sweethi, R. Padma Latha
Abstract
Background: The Amniotic fluid is the protective liquid and important part of pregnancy sac. This fluid serves as or helps for the growing fetus and also serves to facilitate the exchange of nutrients, water and biochemical product between mother and fetus. Patients with Low Amniotic fluid Index (AFI) need to deliver quickly, So, an assessment of amniotic fluid volume has become an important component of antenatal testing for the high-risk pregnancy. Aim & Objective: Study aimed to find the significance of amniotic fluid index in determining the maternal and perinatal outcome in pregnant women who came postdated. Material and Methods: This was an Prospective observational study conducted at Department of OBG, CAIMS, Karimnagar, for the duration of one year. 100  antenatal women whose gestational age is > 40 weeks  admitted in the hospital and who fulfilled the following inclusion and exclusion criteria and after getting ethical clearance considered for the study. Results: Out of 100 patients Maximum number of patients were getting admitted from a low socioeconomic status who lacked the knowledge about the maternal and perinatal morbidity and mortality associated with postdatism. Parity, gestational Age, mode of Delivery and APGAR score were significantly associated with Amniotic Fluid Index (P-value<0.001). Perinatal outcome like CTG, onset of labour, colour of Liquor, Indication for LSCS and NICU Admission was statistically significant. It means these parameters were strongly associated with AFI. Conclusion: Amniotic Fluid Index is important predictor of adverse event in high risk pregnancies.  Women with AFI ≤ 5 cm can expect a good outcome if they have regular ANC visits and intrapartum monitoring than the AFI > 5 cm.

10. Prevalence of Sexual Dysfunction among Different Female Psychiatric Patients
Monica Shringirishi, KC Gurnani
Abstract
Objective: Female sexual dysfunction is a common, condition that significantly reduces the quality of life of the affected persons. Unfortunately, because of the veil of secrecy that shrouds discussions on human sexuality, there has been limited research on this topic in some sociocultural settings. The aim of this study was to study sexual dysfunctions and factors that may be associated with them in female psychiatric patients. Methods: The study had a cross-sectional design and the sample was recruited by purposive sampling. Psychiatric cases were taken both from OPD and IPD of People’s Hospital Bhopal, Data from control population was collected from the married females who came along as informant with the psychiatric patient to our hospital. Results: Comparison of mean FSFI Domain score and Total FSFI Scale Score between Different Psychiatric Illness patients and Healthy Control. Total FFSI Score was highest in migraine followed by borderline disorder and bipolar or dissociative disorder. It was least in insomnia cases. It was 26.00±3.46 in migraine, 23.66±4.82 in dissociative disorder and 18.60±11.73 in insomnia cases. There was statistically highly significant difference in FSFI score among different Psychiatric patients. Conclusion: Ascertaining and attending to sexual dysfunctions not only enhance the therapeutic bond between psychiatrist and patients but also will have several positive spinoffs out of which sense of wellness and competence in the patients can be considered as most important.

11. Prevalent Serogroups and Serovars of Leptospira Causing Leptospirosis in Clinically Suspected Patientsin Tertiary Care Hospital in South Kerala
Preetha Rajan, Ajitha K C, Ramani Bai JT
Abstract
Introduction: In Kerala, Leptospirosis, which started as an isolated public health problem of some of the water logged areas of Alappuzha and Kottayam districts in the 1990s, has now become a public health problem in all districts. This has been causing the highest number of deaths consistently for the last few years with the younglabour class getting affected posing a serious concern. Preliminary analysis of Leptospirosis deaths shows that delay in definitive diagnosis and effective treatment cause high case fatalities. According to statistical data of DHS Kerala during 2011-2012, Eranakulam and Thiruvananthapuram districts reported the largest numbers of confirmed cases, respectively. This study attempts to find out the prevalent serogroups and serovars causing the disease in Thiruvananthapuram and their association with clinical features and complications. Objectives: 1. To estimate IgM Leptospira antibodies in 1:100 and 1:200 dilution of serum of clinically suspected patients of Leptospirosis. 2. To estimate the predominant serogroups and serovars of Leptospira causing Leptospirosis in clinically suspected cases. 3. To estimate the complications due to serogroups and serovars of Leptospira. Conclusions: Out of the 400 suspected cases, 96 were IgM Lepto ELISA positive showing 24% (95%CI,19.8- 28.8) prevalence of Leptospirosis in the study population. The present study shows 34.78% L. icterohaemorrhagiae, 15.21% L. hebdomadis, 13% L. autamnalis, 8.6% L. australis, 6.5% L. grippotyphosa, 6.5% L. pomona, 6.5% L. tarassovi, 4.34% L. canicola and 4.34% L. bataviaserovars causing leptospirosis by MAT.

12. Clinical Comparative Study of Topical Analgesia with 4% Lignocaine and Intravenous Tramadol for Post-Operative Analgesia After Tonsillectomy
Kishore Keerthy N., Narendra Babu Chanappa, Archana G., Suraj H. S.
Abstract
Introduction: Tonsillectomy is one of the most commonly performed surgical procedures, often associated with significant intraoperative bleeding and postoperative pain. The objective was to compare the postoperative analgesic efficacy of topical 4% lignocaine with intravenous tramadol after tonsillectomy surgery. Methodology: After institutional ethical committee clearance and written informed consent, 60 patients of either sex undergoing tonsillectomy were randomised into 2 groups, one received topical 4% lignocaine (3cm2 gauze soaked in 2ml) and other received intravenous tramadol (2mg/kg). Type of pain was assessed at intervals of 30min for 4hrs and 4th hourly for 24hrs. post operatively by visual analogue scale. Results: The pain response initiated at 12 hours among group-A respondents (19.2%) increased to 35.8% at the end of 24 hours and group-B respondents (54.9%) at 12 hours increased over the period to 60.3% at 24 hours of duration. The data subjected to statistical students t-test reveals that the mean difference in the pain scores between group-A and group-B during the initiation to the end period under study found to be statistically significant (p<0.01). Conclusion: Topical 4% lignocaine provided a better postoperative analgesia when compared with intravenous tramadol.

13. Comparative Study to Assess the Synergistic Effect and Safety Profile of Adding Adjuvants Dexmedetomidine and Clonidine with 0.5% Bupivacaine Intrathecally in Elective Lower Abdominal Surgeries
Udit Dhingra, Sreeraghu G. M., Sufiyan Faizi N, Vinuth K. Murthy
Abstract
Background: In this study we wanted to assess the synergistic effect and safety of adding Dexmedetomidine to 0.5% hyperbaric Bupivacaine compared with Clonidine to 0.5% hyperbaric Bupivacaine in patients undergoing elective lower abdominal surgeries under spinal anaesthesia. Methods: This was a randomized comparative study carried out in the Department of Anesthesiology and Critical care, Kempegowda Institute of Medical Sciences, Bangalore among two groups of 30 patients each, from August 2020 to September 2021. Results: The difference in onset of the sensory blockade was significant as indicated by the p-value of < 0.001. The difference in onset of the motor blockade was insignificant as indicated by the p-value of 0.883. Clinically the mean SBP was lower in Group D as compared to group C. Clinically the mean DBP was lower in Group D as compared to group C. Conclusion: 10µg of Dexmedetomidine as adjuvant to intrathecal 0.5% bupivacaine provides better postoperative analgesia, longer duration of motor and sensory blockade, optimal sedation and is safe with regard to the haemodynamic variables and adverse effects when compared to 50µg of clonidine as an adjuvant to intrathecal 0.5% bupivacaine.

14. A Prospective Investigation of Low-Dose Aspirin Treatment and Renal Function in the Geriatric Patients
Binod Kumar, Pankaj Kumar
Abstract
Aim: The aim of this study to evaluate the low dose aspirin therapy and renal function in elderly patients. Methods: This prospective study was carried out in the Department of General medicine, ICARE Institute of Medical Sciences and Research And Dr. Bidhan Chandra Roy Hospital, Haldia, West Bengal, India for 1 year. This study employed a cohort of 50 elderly patients (age 60 years) and was comprised of 30 male and 20 female patients at the commencement of the study. The United Nations definition of an elderly person was used. Results: A total of 50 participated in this preliminary study. There were 20 (40%) females and 30 (60%) males with age range between 50–80 years and mean ages of 59.88 years (±7.16) and 65.77 years (±10.09) for males and females, respectively. 21 (42%) of the patients had more than one diagnosis. Systemic hypertension was the most common diagnosis, accounting for 31 (62%) of cases. Hypertension and diabetes mellitus coexisted in seven (24%) of the study participants. 88% exhibited their basal renal function in stages 1 and 2 based on CrCl. The P-value for all these weekly parameters did not show statistical significance except for the CrCl (P = 0.021). The CrCl reduced at week 2, and then increased at week 3, pleateauing before gradually returning to baseline at the sixth week. The mean hemoglobin was 12.7 ± 5.7 g/dL with a range of 7.7–15.7 g/Dl. Conclusion: This study did not show any deleterious effects of short-term, low dose aspirin (75 mg) use on the renal function of elderly patients. This 6-week study was cumbersome for most of the patients, and this precluded the participation of a lot of eligible geriatric patients.

15. An Observational Descriptive Assessment of Lipid Profile of Diabetic Patients
Pankaj Kumar, Binod Kumar
Abstract
Aim: The aim of this study was the assessment of lipid profiles mainly triglycerides in diabetic patients from Bihar region. Methods: This was a cross-sectional study was done in the Department of General medicine, Shri Ramkrishna Institute of Medical Sciences and Sanaka Hospital, Durgapur, West Bengal, India, for the period of 1 year. A total of 160 newly diagnosed type 2 diabetes mellitus within the last 3 months using the ADA (American Diabetes Association) criteria  and  both males and females were include in this study for determine the lipid profile levels. Results: According to ATP III classification 68 (42.5%) participants had normal serum triglycerides levels which is <150 mg/dl whereas 112 (57.5%) participants had an abnormal level of serum triglycerides. Among the 112 (57.5) participants with abnormal triglycerides, 32.5% had borderline high levels (150-199mg/dl), 25% had high levels (200-499 mg/dl). In our study, 52.5% participants had low HDL and 47.5% participants had normal HDL. The Gender distribution showed that 32 male participants and 52 female participants had low HDL. In our study, among the 160 participants, 110 (68.75%) participants had desirable total Cholesterol levels of <200mg/dl, 40 (25%) had borderline high levels of 200- 239mg/dl and 10 (6.25%) had high total cholesterol levels of ≥240mg/dl. 20 (12.5%) had high levels of LDL of which 6 were males and 14 were females. 4 (2.5%) participants had very high levels of LDL of which 2 was male and  2 was female. Conclusions: Patients who have diabetes mellitus are at a greater risk of developing early atherosclerosis and microvascular problems if they have hyperlipidemia, which is the most prevalent diabetic consequence. The development and progression of typical lipid abnormalities in diabetes, such as elevated triglycerides, LDL, serum cholesterol, and low HDL, may be prevented by maintaining good control of blood glucose levels.

16. A Study to Establish Correlation between Various Stages of HIV and Clinical and Radiological Findings of Multi Drug Resistance Tuberculosis
Vishwas Gupta, Sourabh Jain, Khushboo Saxena, Lokendra Dave, Vikas Mishra, Nishant Shrivastava
Abstract
Tuberculosis (TB) and HIV together is one of the important causes of morbidity and mortality.  With the emergence of multi drug resistance (MDR) this problem increases by many folds. We conducted a study with aim to establish a correlation with severity of HIV (CD4 Counts) with clinical & radiological findings of MDR TB. We conducted a cross sectional study enrolling all MDR TB cases admitted in one year duration among which HIV MDRTB coinfected cases were taken in to consideration. HIV was staged in four stages on the basis of CD4 counts. Among total 534 cases, 44 (8.2%) patients were found to have coinfected with HIV-MDRTB. Stage 4 has maximum radiological involvement in chest radiograph and also, patients in this stage show more severe symptoms related to both the disease. It is concluded that HIV MDRTB coinfection should be classified by the clinicians on the basis of CD4 counts for the better understanding of the future course of coinfections.

17. A Prospective Study on Surgical Management of Supracondylar Fractures of Femur by Various Modalities
Dodda Prasad Reddy, Ravikanth Kolluri, Nagaraju P
Abstract
Background: There is an increase in the frequency of distal femoral fractures in recent times. It is because of increased urbanization and high use of transport resulting in RTA. Distal femoral fractures are difficult to treat because of the thin cortex of the distal femur and the involvement of the knee joint in fractures or osteopenic bone in the elderly. We in the current study tried to evaluate three different methods of treatment of distal femoral fractures. Methods: This cross-sectional interventional study was conducted in the Department of Orthopedics, Kakatiya Medical College, and MGM Hospital, Warangal, Telangana State. The selected cases underwent a thorough clinical examination to find out the nature of fracture-associated injuries and the general condition of the patients. The injured limb was examined for swelling, tenderness, crepitus, abnormal mobility, and deformity. Splinting of the affected limb was done. A systemic examination was also performed. They were managed by Knee spanning External Fixator (Ex. Fix), Supra-Condylar Nail (SCN), and Locking Compression Plate (LCP). Results: A total of n=30 fractures n=14(46.67%) cases were closed fractures. Out of these n=14 cases, n=2(14.28%) cases were treated with Ex. Fix N=7(50%) treated with SCN and n=5(35.71%) cases were treated with LCP. Similarly, for type 1 compound fractures the total number of cases was n=6, and n=2 each was treated by the three methods. In type II n=5 cases were present out of which n=2 each by Ex. Fix and LCP respectively and n=1 case by SCN. Type 3 compound fractures were n=5 cases out of which n=4 cases were treated by Ex Fix and n=1 cases by LCP. Conclusion: Supracondylar femur fractures. remain a significant challenge to the orthopedic surgeon The significant forces applied to this area, even during restricted patient activities, require a strong implant. The best device for distal femur fixation is still a subject of debate. For all fractures, one implant is suitable. Patient factors, type of fracture, personality, soft tissue quality, and anatomical reduction of the distal femoral articular surface all influence the kind of fixation device used.

18. Postpartum Depression and Child Caring Behaviour of Mother and Development of Children
Chintan K Dasharatha, Monika Singla, Kalpeshkumar V Vadher, Nikulkumar R Thakkar, Punit Patel
Abstract
Background: Depression and other psychiatric disorders during pregnancy and postpartum is an important health problem, especially if the symptoms are recurrent or sustained. Postnatal depression is a recognised cause of delayed cognitive development in infants. Aims: To determine the relation of maternal depression during post-partum period with development of their children. Methods: A cross sectional study was conducted among 92 women with a 2-12 months-old child. Edinburgh Postnatal Depression Scale was used for maternal mood. Children were weighed and measured for weight, length and Z score. Collected data was analyzed for comparison. Results: Out of the total 92 babies recruited in this study, 12% had mothers who were suffering from Post-partum Depression. For weight and weight-for-length there was a significant difference in the growth between the children of mothers with and without Depression (p<0.05). Conclusions: Post-partum depression was associated with poor growth and development in children.

19. Amelioration of Amikacin Induced Nephrotoxicity by Nigella Sativa Oil: An in Vivo Study in Rats
Murtuza Bohra, Kamayani Dighe, Poonam Patel, Rahat Ali Khan, Aijaz Ahmed Khan
Abstract
The objective of this study is to evaluate the nephroprotective role and antioxidant effects of Nigella sativa oil against Amikacin-induced nephrotoxicity in rats.We divide Healthy adult albino rats of either sex (100-200 g) randomly and equally into six groups of five animals each. Group I animals (normal control) were administered distilled water intra peritoneally for 14 days. Group II animals (LNSO) were administered low dose nigella sativa oil 1ml/kg orally for 16 days. Group III animals (HNSO) were administered High dose nigella sativa oil 2ml/kg orally for 16 days. Group IV animals (ANCG)Amikacin negative control group. were administered Amikacin (300mg/kg ) From day 1-14  Intra-peritoneally. Group V animals (ALNSO) were administred Low dose of Nigella sativa oil (1ml/kg) orally (From day 1-16) + Amikacin (300mg/kg) (From day 3-16) Intra-peritoneally.Group VI animals (AHNSO) were administered high dose Nigella sativa oil.(2ml/kg) orally (From day 1-16) + Amikacin (300mg/kg) (From day 3-16) intra-peritoneally. On the 16 th day (14th day for normal control group), blood was collected for biochemical tests and the rats were sacrificed. The kidney was removed for histology and lipid peroxidation-antioxidant test. Amikacin caused nephrotoxicity as evidenced by elevated BUN, blood urea and serum creatinine. Co-administration of Nigella sativa oil at doses of 1ml/kg and 2ml/kg in Group V and Group VI caused a dose-dependant reduction in the elevated levels of BUN, blood urea and  serum creatinine as compared to Group IV (amikacin negative control group).There was increased catalase and glutathione and decreased malondialdehyde levels in Group IV, while  Group V (ALNSO) and Group VI(AHNSO) treatment with low dose and high dose of Nigella sativa oil significantly reversed the changes toward normal values. Histological examination of the kidney shows nephroprotection  in Group V and Group VI compared with Group IV. It is seen that Nigella sativa oil has a nephroprotective role against Amikacin-induced nephrotoxicity in rats as is evident from biochemical parameters of blood samples, oxidative stress studies and histopatholgical examinations of tissue samples.

20. Knowledge, Attitude, and Practice of Medical Students about Antibiotic Usage and Antimicrobial Resistance
Rushika S. Modi, Archanabahen Chaudhari, Arunkumar Chaudhari, Chintan K Dasharatha, Punit Patel
Abstract
Background: To reduce the magnitude of antimicrobial resistance, there is a need to strengthen the knowledge for future prescribers regarding use and prescription of antibiotics. Before that, it is required to have a conclusive evidence about knowledge, attitude, and practices of that group. Objective: to evaluate the knowledge, attitude and practices (KAP) towards the use of antibiotics as well as their resistance among Lebanese university students. Materials and Methods: A survey was conducted by distributing an online questionnaire to 260 medical students & they were required to fill up the questionnaire which contained questions regarding knowledge, attitude and practice of antimicrobial usage and antimicrobial resistance. This research study was conducted from 10th to 21st march, 2022. Data gathered from the survey were analysed with SPSS statistical software. Results:  Majority of the students (91.2%) were aware of the fact that antimicrobial resistance is a serious global public health issue. Only 13.3% felt the need of antimicrobials to treat common cold, while Around two third students (77.3%) were disbelieved about injudicious use of Antimicrobials shortens the duration of illness. Majority 74.6% of the students completed the full course of antibiotics Only half (47.3%) of the students always consulted a doctor before starting an antimicrobial agent. Conclusion: The knowledge of the students regarding antimicrobials was satisfactory, though the attitude was moderate towards it. Appropriate educational interventions and strategies can be introduced to tackle this weak aspect of our students.

21. A Comparative Study of Dexmedetomidine and Nitroglycerine for Induced Hypotension in Functional Endoscopic Sinus Surgery
M Satish Kumar, A Sanjeev Kumar, A. Naga Raju, P Sridevi
Abstract
Background: During functional endoscopic sinus surgery, induced hypotension reduces intra-operative blood loss, allowing for greater sight of the surgical field and reducing the risk of significant complications (FESS). The aim of the study was to compare Dexmedetomidine with Nitroglycerine for hypotensive anesthesia for Functional Endoscopic Sinus Surgeries (FESS) with respect to quality of the surgical field, hemodynamics, amount of blood loss, intraoperative opioid requirement, time to first analgesic request and recovery profile. Methods: A total of n=100 patients of physical status American Society of Anesthesiologists (ASA) I and II between elective Functional Endoscopic Sinus have been randomly selected for the present study. The patients were randomly allocated into two groups comprising n=50 patients in each group. Group D (n=50) received Dexmedetomidine, 0.4-0.8 μg/kg/hr and Group N (n=50) received Nitroglycerine infusion at 0.5-1.0 µg/kg/hr. The infusion rates were then titrated to keep the MAP between 50-60 mm Hg or a 30% drop from baseline, whichever was higher. Heart rate, mean arterial pressure, blood loss (Average Category Scale), emergence time, time to first rescue analgesia, and post-operative recovery are among the parameters measured. Results: The volume of blood loss in cases in both groups was measured. It was found that the mean volume of blood loss in the dexmedetomidine group was 91.0 ml and, in the nitroglycerine, group the mean blood loss was 107.0 ml the p-values were found to be significant. Similarly, the surgeon’s satisfaction with anesthesia and blood loss was assessed and in group D all the cases have satisfactory results and in group N n=4 cases the results were not satisfactory. Conclusion: Both Nitroglycerine and Dexmedetomidine can be used for hypotensive anesthesia in Functional Endoscopic Sinus Surgeries alone or combined with other drugs. The Mean Heart Rate was more in the Nitroglycerine Group compared with the dexmedetomidine group. Lower changes in HR and Less Blood loss were observed in the Dexmedetomidine group. Slower reversibility to normal limits was seen in the dexmedetomidine group.

22. Comparative Analysis of Individuals with Hepatitis B Suffering from Covid-19 for Symptomatology & Demographics: A Cross Sectional Study
Mahendra R. Pakhale, Jusmita Dutta
Abstract
Background: The global pandemic of the corona-virus infection in 2019 (COVID-19) has attracted attention from all across the world. Acute respiratory distress syndrome may develop in serious cases of the illness, which mostly affects the respiratory system and causes flu-like clinical features as fever, dry cough, and dyspnea. Aims and Objectives: Comparative analysis of Covid-19 cases for symptomatology & demographics. Material and Methods: The research was conducted in the Department of Biochemistry L.N. Medical College, Bhopal. 200 subjects who are Covid positive will be included in the research. Category-1 – 60 corona positive subjects who are Hepatitis B virus positive. Category-2 – 140 corona positive subjects. Results: Out of 200 cases, 106 were males and 94 were females. When were compared for comorbidities then hypertension was most common overall but was more common in covid cases. All the individuals were suffering from one or the other clinical feature like fever, fatigue, myalgia, cough, dyspnoea, diarrhoea, headache & so on. Conclusion: COVID-19’s clinical features extend beyond the respiratory system. There have also been reports of multiple organ involvement, including the gastrointestinal, cardiovascular, and neurological systems. This multisystem illness may be caused by SARS-CoV-2 binding to the angiotensin-converting enzyme-2 (ACE2) receptors, which are widely distributed throughout.

23.To Study the Safety Profile of Vaccines Covishield and Covaxin Administered for Prevention of Sars-Cov-2 in MBBS Students of NSCB Medical College, Jabalpur
Supriya Sharma, Vaibhav Singh Chauhan, Akshata Kalyani, Vimmi Agrawal
Abstract
Background: The vaccine hesitancy is not a new phenomenon and was witnessed in previous outbreaks of infectious diseases like measles-mumps-rubella vaccines. In view of above context present study was conducted to study the safety profile of vaccines covishield and covaxin administered for prevention of sars-cov-2. Methods: It was an observational study to assess the safety profile of covishield and covaxin vaccine. The participants were those pursuing MBBS in NSCB Medical College, Jabalpur. The tool used was Google form based questionnaire. Snowballing of invitation was encouraged. Results: Study shows most adverse effect was mild to moderate with pain at injection site being the most common. Paracetamol (NSAID) was the most taken drug. Conclusions: It seems that such mild side effects are acceptable during COVID-19 vaccination as the body will need some time to adopt vaccination dose. Therefore the general people should be aware of these minor side effects which are manageable with some symptomatic treatment like paracetamol and increase the acceptance of the COVID-19 vaccine among the mass population.

24. A Tertiary Care Hospital Study of Patients Having Cataract Surgery with Corneal Astigmatism
Mukesh Kumar Taneja, Arpita Gupta
Abstract
Background: The only way to treat a cataract, which is an opacity of the eye’s lens and one of the leading causes of blindness globally, is through surgery. Both spherical and cylindrical components need to be adjusted during surgery for the greatest postoperative visual performance. Aims & Objectives: This study’s objectives were to assess the clinical profiles of patients with astigmatism who were scheduled for cataract surgery at our tertiary hospital and to report the prevalence of corneal astigmatism. Material and Methods: The astigmatism of the cornea was measured in the current cross-sectional study, which was carried out on patients scheduled for cataract surgery. Results: In total, 920 patients with 920 eligible eyes were scheduled for cataract surgery during the study period. Males made up the majority (55.22%) of the population with a gender ratio of 1.23:1 and a mean age of 67.4 13.4. The majority of cataracts (45.43%) and nuclear sclerosis (38.91%) were of the mixed type. Other less frequent kinds included cortical cataract (2.39%), mature cataract (5.22%), posterior sub capsular opacification (7.61%), and developing cataract (0.43%). K1 and K2 had mean keratometry values of 42.10 and 42.45 D, respectively, with a range of 32 to 51 D. Mean astigmatism of the cornea was 0.45 0.41 D, with a range of 0 to 5.31 D. The range of the cylinder was 0-2.25 D, and the mean sphere was 1.25 1.46 D. The mean cylinder was 0.20 0.30 D. In the current investigation, astigmatism was absent in 8.04% of patients, but oblique astigmatism was present in 14.78%. With the rule astigmatism was present in the majority of instances (41.09%), followed by against the rule astigmatism (36.09%). Conclusion: Astigmatism worsens with age, and a sizable portion of patients have preoperative corneal astigmatism of 1D or higher, which might impair the quality of vision after cataract surgery. The majority of them are treatable with straightforward, affordable keratorefractive techniques.

25. Development of a Tool to Objectively Identify the Normal Human Voice
Krishna Murari Bansal, Prithvi Raj Singh
Abstract
Background:  Acoustic analysis is used to assist in differential diagnosis, documentation, and evaluation of treatment for voice disorders. Clinical data has shown that Jitter, Shimmer, Mean Pitch, and Harmonic Noise Ratio are the indices of voice pathology. A voice with some periodicity can now be analyzed with a computerized acoustic analyzer, a relatively newer technique that can be widely used in clinical practice. Voice is an acoustic output of the vibrations of the vocal folds and is the basic source of speech. In contrast, speech is a meaningful acoustic output created by the modulation of voice by organs of articulation into basic building blocks, the ‘phonemes’. Phonemes help in distinguishing one word from another in a particular language. Some sounds like clicks, whistling, and whispering can be produced by organs of articulations without voice. Because of anatomical, physiological, racial, cultural, and social factors, every human voice is unique and fingerprints is the signature of each individual. Aim: To create a database of normal voices, analyze and identify different parameters of these voices and hence identify benchmarks of normal voices. Material and Method: The study were conducted in the department of Otolaryngology. Voice samples of 250 normal males and 250 normal females aged between 19 to 30 years were collected using a sustained vowel /a/ which was recorded and analyzed using a freely downloadable software “PRAAT”. The parameters like Jitter, Shimmer, and Pitch were derived, and mean, SD, and range of voice parameters were calculated. The Microphone was held at a distance of 5cm in front of the lips and 3 cm above the breath stream. Each person was first trained to produce sustained vowel /a/ by the examiner herself through utterance of the voice at comfortable loudness and pitch. Results: In males, the value of parameters was mean pitch (124.05), jitter (0.011), and shimmer (0.04). In females the parameters were mean pitch (212.27), jitter (0.01), shimmer (0.06). The Pitch in females is consistently higher than in males. Jitter Range is almost the same in both males and females. There is not much difference in Shimmer between Males and Females. Conclusion: Voice can be objectively analyzed using Acoustic Parameters like mean Pitch, Jitter, and Shimmer. Most of the studies show that normal voice parameters depend on gender, region, methodology of the voice collection, software and hardware used, different algorithms used for calculations and the setup, etc. Hence every institution should standardize the method of acoustic analysis for its own consumption. For the purpose, we have created a huge database of the voices of normal young adults. Voices can be objectively analyzed using acoustic parameters like mean pitch, jitter, shimmer, and harmonic-to-noise ratio. A large database yields more reliable normative parameters. Institutions should develop their own standard protocol for the selection of subjects, recording of voices, and their analysis.

26. Histopathological Spectrum of Female Genital Tract Malignant Tumors
Shalini Sharma, Yogesh Chandra Sharma
Abstract
Background: Female genital tract diseases, which include pregnancy difficulties, inflammations, malignancies, and hormonally driven consequences, are particularly prevalent in clinical and pathological practice. Lesions of the female genital tract are among the most prevalent illnesses for which women seek medical attention, and they are also highly related with gynecological and reproductive morbidity. For successful and comprehensive treatment to be implemented and to stop future lifetime consequences, early and accurate diagnosis of female genital tract lesions is crucial. In order to streamline efficient ways for its management and diagnostics, it is consequently desirable to investigate the range of lesions of the female genital tract. Lesions of the female genital tract (FGT) are among the most prevalent illnesses that lead women to seek medical attention, and they are also highly related with gynecological and reproductive morbidity. To simplify efficient approaches for its care and diagnosis, it is therefore desirable to research the range of lesions associated with FGT. Aim: This study’s objective is to assess the histological range of female malignancies with a view to comprehending the general patterns of this complicated illness. Material and Method: The Department of Pathology conducted a retrospective and prospective investigation to identify the histological range of cancers in females. The information was gathered from all of the histopathology reports kept in the department’s histological section. Each patient’s location, age, parity, clinical symptoms, and histological type of female genital cancer were all recorded in the data. The samples were prepared by fixing them in 10% formalin, dehydrating them with progressively stronger alcohol, clearing them in xylene, and then embedding them in paraffin. Before the study began, an Institutional Ethics Committee Clearance (IECC) was attained. Results: In our study, 100 cases of malignant tumors on females were examined. Most of the patients in the study were between the ages of 40 and 69; cases between the ages of 50 and 59 and cases between the ages of 40 and 49 were closely behind. The most frequent type of cervical cancer was squamous cell carcinoma, which accounted for instances. Adenocarcinoma, neuroendocrine carcinomas, and undifferentiated endocervical sarcoma were next in prevalence. Approximately 70% of initial ovarian cancers occurred in patients between the ages of 40 and 70. Surface epithelial tumors made up the bulk of ovarian malignancies, followed by germ cell tumors and sex cord-stromal cancers. Conclusion: Our study includes details on the numerous histological forms of malignant tumors of the female genital tract that are common in our area. The reason why cancers occur so frequently is because healthcare services are inaccessible, there is a lack of awareness, and there are no good screening tools like the pap smear. The overall cancer prevalence is impacted by the unreported cases. Synchronous gynecological cancers are rare clinical entities, but because of the earlier age of presentation, they raise serious concerns. Doctors must receive vigorous training in screening techniques, and the general public must also be made aware of them.

27. Evaluate the Outcome of Step-Up Management in Severe Acute Pancreatitis
Surendra Kumar Sharma, Brijendra Kumar Tiwari
Abstract
Background: The incidence of acute pancreatitis is increasing globally leading to tremendous economical, physical, and psychological burden. It has a wide clinical spectrum from mild to severe form. Early identification of severe form is one of the major challenges in managing severe acute pancreatitis, as it is associated with worsening of organ failure. Different prognostic indicators have been followed to predict the severity of SAP. Infection of the pancreatic and extra pancreatic necrosis occurs in about 20–40% of patients with severe acute pancreatitis and is associated with high mortality rate. Many trials and studies have been conducted for studying the management modalities of SAP to reduce morbidity and mortality. Over the past decade, new developments in etiology, diagnosis, classification, and management have been made. The second common cause is excessive alcohol consumption (25% cases). But nowadays alcohol-induced pancreatitis is increasing and is usually associated with heavy alcohol consumption exceeding 50g/day. Aim: The aim of the present study is to Evaluate the Outcome of Step-up Management in Severe Acute Pancreatitis an Observational Study. To study complications of severe acute pancreatitis. Material and Method: Prospective observational study of 47 patients admitted with severe Acute Pancreatitis was done in the Department of Surgery. The clinical course, complications and their management by step up approach and outcome has been analyzed in our study. The most common age group affected in my study population is 31 to 40 years with mean age of 38 years. Most common etiology in our study is alcohol, followed by Idiopathic and Gallstone, the other rare causes are Hypertriglyceridemia, Drug induced. Patients with local complications were 33, 3 patients had pseudocyst and 30 patients had necrotizing pancreatitis, 14 patients had Fluid collection and the rest 6 had interstitial pancreatitis. All patients were managed by step up approach. All patients were managed conservatively first, and with intervention like Percutaneous drainage, EUS, Necrosectomy. Results: Patients with organ failure at the time of admission was. There is a significant relation between organ failure at the time of admission and lenght of hospital and ICU stay (thrice more) and Mortality. Patients presenting with organ failure at the time of admission had 43% mortality. Patients with Retrocolic, Epigastric and subhepatic collection had longer hospital and ICU stay. Patients with more Intrapancreatic collection has more morbidity. There is significant correlation between the size of collection and Hospital stay, Intervention. Larger the size, longer the stay. Patients with organ failure at the time of admission, longer ICU stay, larger intrapancreatic collection had high mortality. Conclusion: Pancreatitis due to alcohol is increasing gradually due to heavy consumption. Organ failure at the time of admission is one the important factors that helps in deciding prognosis of the patient. The number, site and size of pancreatic and Extra-pancreatic collection has significant effect ion variable like length of hospital stay, ICU stay, Intervention to be taken and finally the mortality of the patient. Thus, step up management has effective role in reducing the mortality.

28. Stress and Lipid Peroxidation in Pregnancy and Associated Disorders
Ricky Mittal, Vikas Saxena
Abstract
Background: Glutathione, superoxide dismutase, 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 normal process, and cells have developed a variety of antioxidant defenses to offset their oxidative effects. 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 fatal effects of pregnancy problems. Aim: The current study aims to compare the lipid profiles of normal pregnant women to non-pregnant women in order to evaluate lipid peroxidation as measured by malondialdehyde (MDA), enzymatic antioxidant activities such as Superoxide dismutase and Catalase, and non-enzymatic antioxidant activity such as ascorbic acid, alpha-tocopherol, and uric acid. Material and Method: The first group in the current study, 50 healthy non-pregnant women, was examined. 50 healthy, typical pregnant women in the second group were matched for age and socioeconomic status. 100 pregnant women with iron deficiency anemia made up the third group. The final study group consisted of 35 pregnant women with mild preeclampsia and 15 pregnant women with severe preeclampsia. The fourth group consisted of 50 pregnant women with gestational diabetes mellitus. Serum MDA, Vitamin C, E, Uric acid, lipid profile, and erythrocytic SOD and Catalase levels were evaluated in all study groups. Results: In the current investigation, normal pregnant women had considerably higher serum levels of malondialdehyde (MDA). When compared to non-pregnant women, the erythrocytic SOD was considerably lower in normal pregnant women. When compared to non-pregnant women in the current study, ascorbic acid shows a less significant decline and -tocopherol shows a highly significant decrease in normal 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 significantly, 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 molecules, increasing the danger for both pregnant women and fetuses. To evaluate the status of antioxidant in pregnancy-related disorder, more extensive research is required. During a diabetic pregnancy, gestational diabetes causes an oxidative stress situation that makes membrane damage and lipoperoxidability easier to occur.

29. Clinical Features and Outcomes of Idiopathic Pulmonary Fibrosis Patients Hospitalized for Pneumonia
Dinesh Baghel, Shraddha Soni
Abstract
Background: Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive lung condition that exhibits the typical interstitial pneumonia histopathologic pattern. Despite a diverse natural history, the prognosis is dismal and the median survival following diagnosis is 2 to 3 years. IPF patients frequently experience acute respiratory problems. Acute exacerbations are the primary cause of acute respiratory events, followed by pulmonary infections such pneumonia and bronchitis. When an acute respiratory episode occurs, patients with IPF are typically hospitalized, albeit this relies on the availability of local medical resources. The importance of respiratory-related hospitalizations in IPF outcomes has just lately come to light. This is due in part to the high death rate associated with respiratory hospitalizations as well as the fact that hospitalization affects survival after discharge. Aim: With the advent of the new, more inclusive definition of acute exacerbations, the goal of this study was to examine the clinical characteristics and outcomes of IPF patients hospitalized for pneumonia. It is critical to assess the importance of pneumonia in the management of Idiopathic Pulmonary Fibrosis (IPF) in light of the revised definition and new diagnostic criteria for acute exacerbations of Idiopathic Pulmonary Fibrosis (IPF), which proposed sub-categorization of acute exacerbations as “triggered”. Material and Method: We performed a retrospective cohort analysis in the Department of Respiratory Medicine on a series of IPF patients who had been hospitalized to the hospital for pneumonia. Clinical records served as the primary source for baseline demographic, clinical, and outcome information. All patients with IPF who were admitted to the hospital for pulmonary infections, including pneumonia and bronchitis, had their medical records reviewed retrospectively to determine the severity of their pneumonia using the A-DROP (Age, Dehydration, Respiratory failure, Orientation disturbance, and low blood pressure) scoring system. Every admission made by a patient who was admitted more than once during the study period was taken into account. Admissions that took place fewer than two weeks after the one before were, however, counted as a single continuous admission. Results: 300 IPF cases were found to have been admitted to our hospital during the research period. Of them, 60 cases (19.9%) experienced an acute aggravation of IPF, while 50 cases (17.4%) developed pneumonia. The average age of the former group, 45 males (76.8%) and 15 females (23.2%), was 79.3 years. Prior to the development of pneumonia, steroid therapy, immunosuppressive therapy, and anti-fibrotic medications were used to treat IPF. Patients with IPF and pneumonia had considerably lower 30-day and in-hospital death rates than patients with acute IPF exacerbations identified in our hospital using the diagnostic criteria from 2016. Conclusion: When IPF patients were admitted for pneumonia, their 30-day and in-hospital death rates were significantly lower than those with acute exacerbations identified using the diagnostic criteria from 2016. The 30-day mortality from pneumonia was substantially correlated with the A-DROP score. In the era of a new, larger definition of acute exacerbations, it is critical to distinguish between pneumonia and acute exacerbation.

30. Safety of Post-Operative Epidural Analgesia in the Paediatric Surgery
Santosh Kumar Gupta, Aruna Mahanta
Abstract
Background: Regional analgesia has been associated with earlier ambulation and discharge, as well as decreased need for both narcotic and non-narcotic analgesics. Profound analgesia is produced with minimal physiologic alterations. This pain-free period provides ideal psychological conditions for the recovering child and the family, and because the duration of action of most blocks is fairly predictable, administration of a subsequent analgesic drug can be precisely timed so that it becomes effective as the block wears off. Regional anaesthesia is also useful when general anaesthesia is technically difficult or is associated with an increased morbidity & mortality. Material and Method: The present study was carried out on sixty in the department of Anaesthesia. The study was carried out on Thirty paediatric patients admitted in surgical and orthopaedic units of the tertiary care hospital. Results: Mean Weight in group A was 9.75 Kg with range of approximately 7 to 12 Kg and in group B the mean weight was 22.59 Kg with the range of approximately 15 to 29 Kg. The mean dose on the basis of weight, was 8.0 ± 0.72 mg/Kg in group A and 9.0 ± 0.59 mg/kg in group B. The mean volume of local anaesthetic solution (1.5%) came out to be 6.58 ±2.41 ml for group A and for group B it was 14.11±5.19 ml. Conclusion: The patient wakes pain-free after surgery is over – child is much easier to manage and at the same time the anxiety of attendants becomes much less as the patient lies comfortably post-operatively. Many of the harmful effects of general anaesthesia when general anaesthesia is used as a sole anaesthetic technique, can be avoided by using epidural block.

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