Electronic-ISSN:0975-5160| Print-ISSN: 2820-2651


1. Percutaneous Closed Pleural Biopsy: A Vanishing Art in Current Era- is Still Alive?
U Maheswar Chandrakantham, Raj B. Singh, Bhupendra Kumar Jain
Study aim and objective: There is no doubt that thoracoscopy has an added advantage over closed pleural biopsy in evaluation of exudative pleural effusion. In many countries, Percutaneous closed pleural biopsy (PCPB) is still being used as an initial investigation of choice due to its easy availability and cost-effective alternative to thoracoscopy. The aim of this study is to observe whether the art of PCPB using Abram’s needle is still alive in the evaluation of exudative pleural effusion in modern era. Design: The medical records of 171 patients with exudative pleural effusion, who underwent PCPB using Abram’s needle between 2012 and 2017, were reviewed. Results: Pleural tissue was adequate in 158(92.3%) cases. The overall diagnostic yield of PCPB was 72.8% and for tuberculosis and malignancies it was 73% and 91.4% respectively. There were no major post procedure complications. The diagnostic yield and rate of complications with PCPB are comparable to thoracoscopy. Conclusion: As PCPB is safe, cheap and easily available, it can be used as an initial diagnostic tool in the evaluation of exudative pleural effusion particularly in resource poor settings and there is a necessity to train the future pulmonologists.

2. Comparative Study of Oral Ketamine Versus Oral Midazolam as Premedicants in the Pediatric Population in Elective Surgical Procedures
Rashim Vachhani, Babita Agrawal
Purpose: To compare oral ketamine and oral midazolam as premedicants in the pediatric population who are undergoing elective surgical procedures. Introduction: Oral ketamine produces predictable satisfactory sedation and anxiolysis without significant side effects. This comparative study was carried out to compare oral ketamine with oral midazolam to know the efficacy of both the drugs as premedicants in the pediatric population. Material and Methods: This prospective, randomized study was conducted in 160 children who posted for elective surgery. These patients were divided in to two groups having 80 patients in each group. Group A which received 0.5mg/kg midazolam and group B: received 5mg/kg ketamine orally. Before and after premedication, sedation and anxiolysis score were assessed, after premedication it was assessed at 10, 20, and 30 minutes. Thirty-five minutes after oral premedication, children were separated from parents. During parental separation, parent child separation score was assessed and recorded. Results:  After premedication at 10 minutes, about 70% and 87.5% patients were unsuccessful while rest successful sedation scores in midazolam and ketamine group respectively. At 20 minutes 22.5% and 70% patients were unsuccessful and 77.5% and 12% were successful sedation scores in midazolam and ketamine group respectively. At 30 minutes, 10% and 42.5% patients were unsuccessful and 90% and 58.7% were successful sedation scores in midazolam and ketamine group respectively. This result was statistically significant. Conclusion: We concluded that oral midazolam showing faster onset of sedation, higher sedation scores with lower anxiety scores as compared to ketamine. Oral midazolam is also provides better easy separation from parents and excellent mask acceptance in children.

3. Pendimethalin Poisoning: A Case Report
Kanika Rohilla, Nitu Yadav, Vasudha Govil, Sandeep Kumar, Elizabeth James, Manisha
In India majority of the population (around 65%) live in rural area. Pendimethalin is a commonly used herbicide with slight toxicity. Suicidal or accidental poisoning from this herbicide is rare. We are reporting a case of a 15 year old female who presented in emergency with history of vomiting, altered sensorium and generalized weakness after alleged history of ingestion of concentrated pendimethalin. She developed aspiration pneumonitis so was admitted in intensive care unit. There she recovered after receiving supportive treatment.

4. Effect of Screen Time, Hours of Physical Activity and Sleep Hours on Overweight and Obesity in School-Going Adolescent Girls of Udaipur
Purohit Arushi, Goyal Dileep, Sareen Devendra, Mittal Hemlata, Agarwal Prateek
Background: Obesity is one of the most common nutritional problems in developing countries of the world and an important cause of childhood mortality and morbidity leading to permanent impairment of physical and mental growth. Objective: Effect of screen time, hours of physical activity, and sleep hours on overweight and obesity in school-going adolescent girls of Udaipur. Materials and Method: The present study was a hospital-based descriptive study, done at the Department of Paediatrics, Geetanjali Hospital, Udaipur, during the term January 2020 to June 2021. A total of 1620 adolescent school-going girls aged 10 years to 18 years were included in the present study after obtaining written informed consent from parents/guardians. They were evaluated on the basis of height and weight and BMI and divided into groups of overweight and obesity on the basis of WHO staging. The detailed history of screen time, physical activity including playing outdoor sports and exercise, and sleep hours were taken along with height, weight, and BMI measurement in case Performa. Statistical analysis was performed using the statistical packages for social sciences (SPSS) version 21 IBM Corporation. Result: The study presented a statistically significant positive correlation between screen time, hours of physical activity including hours of playing sports and hours of physical exercise, and sleep hours in school-going adolescent girls of Udaipur. Significant overweight and obesity were observed in girls who had screen time of more than 2 hours a day. Significant overweight and obesity were observed in children who had less than 30min of physical activity every day and overweight and obesity were comparable in both groups of girls having sleep hours more or fewer than 8.5 hours a day. Conclusion: Overweight and obesity are more prevalent in school-going adolescent girls of Udaipur who had more hours of screen time, fewer hours of physical activity, and more sleep hours.

5. Misuse of Topical Steroid Applications among Outpatients in Maharashtra
Prashant Mahajan, Mitali Patil
Topical corticosteroids have become available as over the counter drugs and are widely misused for various conditions. The aim of this study is to assess the clinical and epidemiological aspects of the unjustified use of topical corticosteroids. A total of 200 patients with facial dermatoses and topical corticosteroid misapplication daily over face for not less than 30 days were included in the study. Total Subjects included in the study were 200 adults. Adverse effects among them included acneiform lesions, telengiectasias, dyspigmentation, hypertrichosis, perioral dermatitis and tinea incognito. A total of 89 (44.5%) patients fulfilled the criteria of “topical steroid dependent face”. These patients reported erythema, burning and itching on stopping the application of topical corticosteroids.
In most cases the use prolonged use of topical corticosteroids on facial skin was recommended by non-professional persons. The adverse events ranged from transient to permanent. The results of this study underline the indispensable role of dermatology specialists in diagnosing and treating cutaneous disorders.

6. Effect of Dexmedetomide & Propofol on Haemodynamic Response During Tracheal Extubation among Hypertensive Patients – A Comparative Study
Nisarg B Patel, Manthan Parmar, Kinjal Prajapati, Anilkumar S Patel, Beena Parikh, Bina Butala, Punit Patel
Background: Recovery from general anaesthesia and tracheal extubation is often accompanied with tachycardia and hypertension which may cause myocardial ischemia or infarction in susceptible patients. Propofol and Dexmedetomidine have been studied seperately in attenuating pressure response during extubation, quality of extubation and postoperative sedation in normotensive patients but these two drugs have been compared rarely in hypertensive patients. Objective: This study was conducted with objective of to compare hemodynamic changes (heart rate, systolic blood pressure, diastolic blood pressure and mean arterial blood pressure) during tracheal extubation after general anaesthesia between two groups. Materials and Methods: Prospective observational comparative study was carried out at tertiary care hospital in Central Gujarat between July 2017 to October 2019. Results: It can effectively be concluded that Propofol (0.5 mg/kg) 2 min prior to extubation and Dexmedetomidine (0.5µg/kg) infusion 10 min before extubation both are safe and efficacious in attenuating the hemodynamic stress response during extubation. Dexmedetomidine is better at controlling HR, DBP, MAP than Propofol. Conclusion: Dexmedetomidine is an effective and safe drug to provide stable hemodynamics and protects against the stress response to extubation.

7. A Study on Maternal Body Mass Index Effect on Pregnancy Outcomes
N. Pallavi, Ramadevi E., Gade Rama, B. Sweethi
Background: Early pregnancy Body Mass Index (BMI) and weight gain during pregnancy are important predictors of adverse pregnancy outcomes. BMI is widely accepted as a better measure of underweight or overweight than weight alone. The developing countries including India are facing a dual burden of undernutrition and obesity. Aim and Objective: This study aim to study to  evaluate  the  effect  of   body weight on pregnancy  outcome  in  our  Indian  population. Materials and Method: This was a prospective observational study conducted at Department of OBG for the duration of one year in the CAIMS, Karimnagar. Study comprised of 120 patients who have consented for the study within the first 12 weeks of gestation. The patients were included after fulfilled exclusion and exclusion criteria. Results: A Prospective observational study comprising 120 antenatal women with singleton uncomplicated pregnancies, booked at CAIMS Hospital within the  first  12  weeks  of  pregnancy. mean age of the study population was 25.78±24.8 years and among the group it was not statistically significant. 55% of the patients were having multi gravida, among all the pregnant women 52.50% of the women gained weight between 8 to 13 Kg, 10.80%  patients were preterm, 6.70% PIH, 11.70% PROM, 2.50% had IUGR, polyhydramnios, 8.30%  oligohydramnios. Conclusion: After analysing the data we conclude that majority of antenatal patients being catered in our hospital have normal BMI. Adverse maternal and perinatal outcomes are seen more commonly with the extremes of BMI.

8. A Clinical Pharmacological Comparative Quantification Analytical Research Study Among Systematic Reviews and Meta-Analyses on Bronchodilators and Anti-Diabetic Drugs
Hazra M
Background: There are numerous systematic reviews and meta-analyses conducted on the β adrenergic agonistic bronchodilators, like salbutamol, formoterol, salmeterol and other β adrenergic agonists, as well as, on the anti-diabetic drugs, like biguanides, dipeptidyl peptidase-4 inhibitors and sodium glucose co-transporter-2 inhibitors. Systematic Review and Meta-Analysis, are the two very novel methods of Clinical Research Methods in Clinical Research, Pharmacology, Clinical Pharmacology, and Evidence-Based Medicine, integrated within Medical Sciences, that define the intricacies of the clinical analytical research study, with a uniquely balanced representation of qualitative and quantitative research, review and analysis. Aim and Objectives: The objective of this clinical pharmacological study was a comparative quantification analytical research among systematic reviews and meta-analyses on bronchodilators and anti-diabetic drugs. Materials and Methods: This study involved the comparative and quantitative analysis on these clinical research methods conducted on the bronchodilators and the anti-diabetic drugs. In this study, the comparative quantification of the different experimentations was conducted as systematic review and meta-analysis on bronchodilators and anti-diabetic drugs. After that, the comparative percentages of systematic reviews conducted on anti-diabetic drugs as well as on bronchodilators was derived; and the comparative percentages of meta-analyses conducted on anti-diabetic drugs and on bronchodilators was also derived statistically. Results: The comparative percentages of systematic reviews conducted on anti-diabetic drugs was 66% and on bronchodilators was 34%; whereas the comparative percentages of meta-analyses conducted on anti-diabetic drugs was 53% and on bronchodilators was 47%. Conclusion: Therefore, this was concluded that both systematic reviews as well as meta-analyses were more widely conducted on anti-diabetic drugs than on bronchodilators.

9. Outcomes of Spousal Versus Related Donor Kidney Transplants: A Single Center Experience
Amruta Devi, Aruna Acharya, Haladhar Naik
Background: Kidney transplantation is the preferred modality of treatment, and it provides the better quality of life than dialysis in patients with end stage renal disease. Living donation constitutes the vast majority of cases in India. The demand and availability of organ gap is fulfilled by spousal donation. Objective: To assess the graft and patient outcomes of spousal transplant compare with those of related transplant. Methods and materials: This retrospective observational study was conducted among the transplant patients during the period of 2012 and 2022. The spousal donors as well as related donors with their demographic details, pre- and post-transplant evaluation, immunosuppressive therapy and followed up with post-transplant complications, were obtained and recorded. Result: A total number of transplants were179. After exclusion of unrelated and cadaveric transplants, 135 cases were taken in the study. They were analysed,45 cases were spousal, and 90 cases were related. Mean age of recipient was 42.8+/-7.5 in the spousal and 30.3+/-7.7 in related transplants. Delayed Graft Function (DGF) was 8.8% in spousal and 10% in related transplants. Rejection episodes were13% in spousal and 20% in related donors. Serum creatinine at one year was 1.39+/-0.7 and 1.26+/-0.37 in spousal and related donors respectively. Patientr   survival was 93% and 97% in spousal and related donors respectively. One year graft survival was 91% in both. Rejection episodes were also comparable.3-year survival was 90.2%in spousal donor group and 89.0% in related donor group. Conclusion: Spousal donation particularly wife is the major source of donor in our country and the post-transplant complication and survival is compared to related transplant groups.

10. Correlation of Hba1c With Microalbuminuria and Fundoscopic Finding in Type-2 Diabetes Mellitus Patients
Anil Kumar, Neha, Madhuri Meena
Background: Diabetes is a very common disease now days. It has adverse effect on many human organs as its duration increases. Many studies exist to show its bad effects on body organs in different parts of world. We have studied is there any relation between microalbuminuria and fundoscopic finding with HbA1c levels. Methods: Our study includes all the known case of type 2 diabetes mellitus patients of age group of 45 years and above. Five milliliters of venous blood is collected from all patients. For glycosylated hemoglobin estimation, EDTA blood samples were used. Blood sugar was investigated by the glucose oxidase method, glycosylated hemoglobin (HbA1c) by the cation exchange resin method and micro albumin levels in the urine sample by using the turbilatex method. Retinopathy was tested by using the Direct Fundoscopic Method. Results: HbA1c with microalbuminuria: Total 31 patients had Urinary albumin level more than 30 mg/dl out of which only 3% had Hb1Ac value less than 6.5 % whereas 96% had Hb1Ac value more than 6.5%. This association was found to be clinically significant (Pearson Chi-Square- 4.888, df is 1 and p value is 0.027, Fishers Exact test is 0.033). Fundoscopic changes: It was seen that, 81 patients had grade 1 fundoscopic changes from which 14 (17.2%) shows Hb1Ac was less than 6.5% whereas 67(82.7%) had Hb1Ac level more than 6.5%. 15 patients had grade 2 fundoscopic changes from which 1 (6%) had Hb1Ac level less than 6.5% and 14 (94%) had Hb1Ac level more than 6.5%. 4 patients had grade 3 fundoscopic changes and all of them were having Hb1Ac level more than 6.5%.This Fundoscopic finding was not statistically associated when compared with Hb1Ac. (Pearson Chi-Square- 1.854 with df 2 and p value is 0.396). Conclusion: Patients having microalbuminuria were associated with high level of glycosylated haemoglobin. Fundoscopic changes in patients was not found associated with glycosylated haemoglobin as p <0.3.

11. Evaluation of Drug Utilization in Myocardial Infarction at a Tertiary Care Hospital
Arun Hebbar J N, Arun R Keshwala, Hiren R Trivedi
Background: Asian Indians have considerably higher prevalence of premature Coronary Artery Disease (CAD). Over the last four decades there has been a tenfold increase in the prevalence of CAD in urban area of India. Materials and Methods: A prospective, observational study was carried out in ICCU for duration of two years. Patient details and demographic characteristics were recorded from the case files. The morbid condition, treatment with drugs and other supportive modalities were recorded. The outcome of treatment was also noted. Present study aimed to focus on the trends in the WHO drug utilization core indicators. Results: Out of 600 cases most affected were males of 51-60 years with mortality rate of 9.17%. Most common co-morbid condition of hypertension (61.50%). Mean hospital stay was 1.35 ± 1.17 days. Average no of drug per prescription of 9.37 ± 3.01. Generic drugs were 61.05% and essential drugs up to 90.02%. Cost per case ₹ 1023.05 and injections accounted for 97.32%. Conclusions: Current study reflects myocardial infarction affects frequently amongst males of 51-60 years with hypertension; lower mortality and morbidity rate observed with utilising majority of medication being generic drugs and from essential medicine list. Cost of treatment was of modest amount of about thousand rupees; which makes even economically backward class to get adequate treatment.

12. 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
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.

13. Nephroprotective Role of Nigella Sativa Oil Against Gentamicin Induced Nephrotoxicity: An Experimental Study in Rats
Murtuza Bohra, Poonam Patel, Kamayani Dighe, Rahat Ali Khan, Aijaz Ahmed Khan
The objective of this study is to evaluate the nephroprotective activity and antioxidant potential of Nigella sativa oil against Gentamicin-induced nephrotoxicity. Healthy adult albino rats of either sex (100-200 g) was randomly divided into six groups of five animals each. Group I (normal control) were administered distilled water intra peritoneally for 8 days. Group II (LNSO). were administered low dose nigella sativa oil 1ml/kg orally for 10 days. Group III (HNSO) were administered High dose nigella sativa oil 2ml/kg orally for 10 days. Group IV (GNCG)Gentamicin negative control group. were administered Gentamicin (80mg/kg) From day 1-8 Intra-peritoneally. Group V (GLNSO) were administered Low dose of Nigella sativa oil (1ml/kg) orally (From day 1-10) + Gentamicin (80mg/kg) (From day 3-10) Intra-peritoneally. Group VI (GHNSO) were administered high dose Nigella sativa oil.(2ml/kg) orally (From day 1-10) + Gentamicin (80mg/kg) (From day 3-10) intra-peritoneally. On the 10th day (8th 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. Gentamicin 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-dependent reduction in the rise of BUN, blood urea and serum creatinine as compared to Group IV (gentamicin negative control group).There was increased catalase and glutathione and decreased malondialdehyde levels in Group IV, while  Group V (GLNSO) and Group VI(GHNSO) treatment with low dose and high dose of Nigella sativa oil significantly reversed the changes toward normal values. Histological examination of the kidney revealed renoprotection in Group V and Group VI compared with Group IV. The Nigella sativa oil has a nephroprotective activity against Gentamicin-induced nephrotoxicity in rats.

14. To Study Clinical and Bio Chemical Parameters of Diabetic Keto Acidosis Patients
Mukesh Singh Tomar, Dharmendra Katariya, Kailash Charel
Background: With the changes in the frequency of DKA and the increased incidence of DKA in patients with type 2 diabetes mellitus, the question arises regarding change in the clinical or laboratory characteristics of the patients with DKA. Hence this study was planned to explore the clinical and biochemical characteristics of patients with type 2 diabetes compared with type 1 diabetes admitted with DKA in a tertiary care hospital. Material & Methods: The present study was a case control study with 50 Diabetic ketoacidosis patients as cases and 50 controls. The Inclusion criteria for cases was kept aspatients who were known diabetic either type I or type II and presenting with DKA or accidently detected. On admission, a careful and detailed history was recorded and thorough clinical examination was conducted. Additional information if any was recorded and were investigations carried out. Results: Diabetes ketoacidosis develops in a significant number of Type II DM patients. Most common cause of diabetic ketoacidosis was infection (56%) followed by omission or irregular treatment (28%). Most common presenting clinical features were vomiting, abdominal pain, dehydration, acidotic breathing, altered mental status and fever. Total leucocyte count was significantly higher in DKA compared to control group. Serum sodium was significantly lower in DKA cases compared to control group. Clinical profile was similar in between Type I and Type II DM patients presenting as DKA. Conclusion: Diabetes ketoacidosis develops in a significant number of Type II DM patients. Most common cause was infection and irregular treatment. Most common presenting clinical features were vomiting, abdominal pain, dehydration, acidotic breathing, altered mental status and fever. Overall mortality rate is 6% in diabetic ketoacidosis.

15. Surgically Induced Astigmatism in Manual Small-Incision Cataract Surgery: A Comparative Study between Straight, Frown and Inverted V Shape (Chevron) Incision
Venkatesan C., Maagnaah S., M. J. Venkatesan
Background: In  majority of developing countries, the cause of total  blindness by cataract is 50-90% among the people aged above 50 years. Surgical removal of the opacified lens is considered to be the most effective and definitive treatment of cataract. Due to the cataract  backlog and higher surgical volume in developing countries like in India  manual  small  incision  cataract surgery in comparison to phacoemulsification proves to be a viable cost-effective  alternative. Aim: To determine the Surgically induced astigmatism in manual small-incision cataract surgery between Frown, Straight and Inverted V shape (Chevron) incisions. Methods: A hospital based prospective interventional study was carried out  on 75 cataract patients between age group of 45 to 70 years were randomly split into 3 groups (25 each)  based on  Inverted V ‘Chevron’ , Frown and Straight incision . For comparing different categorical data among three types incision Fisher Exact test was applied. SPSS version 20 was used. Results: Surgically induced astigmatism is nil in 32% of cases in Inverted V type incision,12% in Frown type incision , 4% in straight  type incision, more than 2 is 0 in inverted V incision, 4% in Frown  incision, 4% in Straight line type of  incision. Conclusion: Chevron incision has lesser surgically induced astigmatism compared to frown and straight type of incisions with  statistically significance (P < 0.01). Additionally on comparison between  straight and frown  type there was no statistically significant difference (p value 0.732).

16. Comparison Between Transcranial Ultrasound And Magnetic Resonance Imaging In The Evaluation Of Neonatal Hypoxic-Ischemic Encephalopathy
Dibyajyoti Nath, Rabin Mili, Pranjit  Thapa, Aditi Das
Background: Hypoxic-ischemic encephalopathy (HIE) is the condition that is diagnosed based on specific clinical findings of profound acidosis, poor Apgar score (0–3) at birth, seizure, coma, hypotonia, and multi-organ dysfunction and it is the most common cause of cerebral palsyThe essential role of neuroimaging in the evaluation of the early cerebral injury in neonatal encephalopathy (NE) is to establish the time, severity, extent, location, and pattern of injury, and the probable neurological outcome. Ultrasound is an ideal screening modality in the neonate because it is widely available, non-ionizing, painless, and no need for sedation or intravenous contrast. Magnetic Resonance Imaging (MRI) is the most sensitive and specific imaging technique for examining infants with suspected HIE of the brain. MRI can demonstrate better soft-tissue contrast differentiation, the exact extent, and site of brain injury. Aim: The goal of this study is to compare the Transcranial ultrasound (TCUS) with MRI in the evaluation of HIE in neonates. Methods: This is an observational cross sectional study conducted in the Department of Radiology, Silchar Medical College and Hospital, Silchar for one year from 1st of June 2019 to 30th of May 2020. Forty-nine neonates with HIE have undergone TCUS and MRI brain examinations, and the findings were compared using suitable statistical methods. Result: Out of 49 HIE cases, MRI detected basal ganglia-thalamus injury in 23 (46.9%), cortex and subcortical white matter predominant in 14 (28.6%), white matter injury in 5 (10.2%), Germinal matrix hemorrhage (GMH) in 4 (8.2%), and mixed pattern in 2 (6.1%). Out of 49 HIE cases; TCUS was positive in 46 cases. The overall sensitivity of the TCUS in comparison with MRI was 93.87% in the evaluation of HIE. Conclusions: Hypoxic-ischemic encephalopathy (HIE) following birth asphyxia is the most common cause of neonatal encephalopathy (NE) that is associated with high mortality and morbidity. The main role of neuroimaging in the evaluation of HIE is to establish the time, severity, extent, location, and pattern of injury, and the probable neurological sequelae. TCUS is an ideal screening modality in the neonate, which can be performed at the bedside without sedation, and suitable for follow-up. MRI is the most sensitive and specific imaging technique for examining infants with suspected HIE.

17. A Retrospective Cross-Sectional Study to Analyze ABO & Rh Blood Group Distribution Among Blood Donors, Issued Units and Seasonal Trends of Blood Donations at A Tertiary Care Hospital of Northern India
Prashant Bhardwaj, Manjari Kumari, Shabdakant Mishra, Ranjan Agrawal
Background and Aim: Blood transfusion service is one of the essential components of health care system. Due to higher immunogenicity ABO and Rh blood group system are clinically significant. The aim of this study to determine the frequency of ABO and Rh blood groups among blood donors, fractions of issued units according to the blood groups and month-wise and blood group wise trend of blood donation. Material and Method: This study was conducted at a blood bank of medical college & hospital in north India, over a period of 6 years from January 2016 to December 2021. Blood group of the blood donors was determined by commercially available standard monoclonal antisera by test tube agglutination technique accompanied by reverse grouping. Results: Total 8656donations occurred with mean of 1462.67±395.05 during the six-years period from January 2016 to December 2021. Female donors were 183(2.11%) and 8473(97.88%) were males. Maximum donations and blood units were issued in September and minimum in January. The Rhesus (D) positive and Rhesus (D) negative blood donors was 94.82 and 5.18% respectively. The donors of blood group B (35.90%) are highest in number followed by donors of blood group O (33.07%), A (20.93%), and AB (10.08%). Conclusions: This study is useful to identify the various reasons of deficiency of a particular group in a particular area and helpful in the preparedness and policy making for the improvement of blood transfusion services.

18. A Morphometric Assessment of the Anatomical Variations in Branching Pattern of Middle Cerebral Artery: An Observational Study
Pallavi, Priyanka Raj, Birendra Kumar Sinha
Aim: The study aimed to study the anatomical variations in branching pattern of middle cerebral artery. Material & Methods: A total of 50 cadavers were studied in the department of Anatomy, Patna Medical College, Patna, Bihar, India . During post-mortem examination of the cadavers, a skin incision was made in front of one ear to another ear in the coronal plane. Results: The average mean outer diameter of the M1 segment was 3.70mm with a standard error of 0.69 mm. The pre-central branch shows the highest superior division in the trifurcation branching pattern, whereas the posterior parietal shows the highest in the middle division. In lenticulostriate trunk were shown in 85% whereas division pattern was shown in 15%. Conclusion: MCA branching pattern is slightly higher in trifurcation pattern as compared to bifurcation and ramification. Thorough knowledge of the microvascular anatomy and the myriads of variations are essential for the operating surgeon to choose the ideal technique to avoid any catastrophe during and after surgery and give the best possible functional outcome.

19. Adult Human Cadaveric Heart Assessment for Anatomical Variations of Papillary Muscles in Both the Ventricles
Priyanka Raj, Pallavi, Ashok Kumar Singh
Aim: To analyze the papillary muscles of heart with respect to the variations in their number, length, shape, position and pattern in both ventricles. Material & Methods: The study was conducted using 20 well preserved adult cadaveric human hearts obtained from the department of Anatomy, Vardhman institute of medical sciences, Pawapuri, Nalanda, Bihar, India for four months .The values of the length of papillary muscles and thickness of both ventricles of cadaveric heart specimens were presented as Mean± SD and p value was calculated using student t-test. Different variables of the papillary muscles were compared between two ventricles and p value was calculated by performing chi-square test. P-value < 0.05 was considered as statistically significant. Results: In our study we observed 33.3% conical apex, 4.3% broad apex and 53.4% pyramidal apex in right ventricles whereas 21.3% conical apex, 26.7% broad apex, 21.3% pyramidal apex in left ventricles. Length of papillary muscles in right ventricle were1.28±0.46, 1.39±0.50, 0.90±0.56 in anterior, posterior and septal segments. Whereas, it was 2.15±0.46 in anterior segment and 1.78±0.48 in posterior segment of left ventricle. Conclusion: The papillary muscles have complex and variable anatomy. Knowledge of this variation to the cardiac surgeons during reparative surgical procedures conducted for mitral/ tricuspid valve replacement is of utmost importance to prevent untoward event.

20. A Retrospective Study of USG Guided Drain Placement in Critically Ill Patients with Pyoperitoneum
Ashish Kumar Dubey, Sunil Kumar Saxena, Deepak Shrivastav, Shatkratu Dwivedi
Background: Pyoperitoneum is a well encountered condition noted by surgeons during their lifetime practice. Primarily this study points about the management of critically ill patients with Pyoperitoneum by minimal invasive surgery with good outcome. In this study the patients with Pyoperitoneum in critical condition underwent minimal invasive surgery with the aim for better survival rates and less morbidity. Materials and Methods: This is a retrospective record based observational study conducted at tertiary care centre from September 2018- to December 2021 for 3 Years. During this period a total of 26 patients who were suggestive of Pyoperitoneum and detailed analysis was conducted on their medical records. Data is expressed as numbers and percentages in tables and figures with appropriate statistical analysis. Results: Twenty-six patients records were suggestive of Pyoperitoneum and 19 patients out of this 26 were found to be of ruptured liver abscess leading to the Pyoperitoneum with detailed results discussed in the study. Conclusion: It is concluded with a message that all the patients of Pyoperitoneum with critical condition should undergo minimally invasive drain placement procedure and should be given a chance for survival.

21. An Analysis of Prescription Pattern of Antiepileptic Drugs in a Pediatric Population of Tertiary Care Teaching Hospital
Hemal J. Dholakia, Anil Singh
Background: Prescription pattern of drugs plays a important role in helping the health care system to understand, interpret and improve the prescribing administration and using medications. Without the knowledge of how drugs are being prescribed and used in children with epilepsy, it is difficult to initiate discussion on rationale drug use and to suggest measures to change prescribing habits for the better management. Aims and Objectives: To study prescribing patterns of antiepileptic drugs (AEDs) in pediatric patients along with the assessment of effectiveness, compliance and safety profile of AEDs in tertiary care teaching hospital. Methodology: This was a prospective, observational, single center study conducted at Pediatrics department of tertiary care teaching hospital in Gujarat from August 2019 to July 2020. Prescriptions of patients attending pediatric outpatient and inpatients department were collected prospectively. The particulars of the participants were collected at the time of enrollment comprised of baseline demographics data, type(s) of seizures, characteristics of the disease, existing drug therapy (dose and duration), and any other concurrent medications during the study. All data were recorded on case record forms and analyzed using descriptive statistics. Result: A total of 599 prescriptions were collected, male female ratio being 1.6:1. Most common pediatric age group diagnosed with epilepsy was less than 5 years of age. Duration of epilepsy was between 1 to 5 years in 63.7% of patients. In the pediatric patients of above 3 years age group, schooling was compromised because of epileptic disease. EEG was advised to 17% of patients and MRI to 3.8% of patients. Generalized epilepsy was the most common type of epilepsy observed in 46.2% of patients followed by focal Epilepsy in 25.2% of patients. Most common AED prescribed was sodium valproate in 57.9% prescriptions and 24.7% patients were prescribed with carbamazepine. Average number of drugs prescribed per patient was 1.56. Sodium valproate in generalized seizure patients and carbamazepine in focal epilepsy patients most commonly prescribed AEDs. After 6 months of therapy, seizure free patients with valproate were 58%, with carbamazepine were 75% and with levetiracetam were 20%. Total 61.1 % patients were seizure free. Lowest dose of all the AEDs achieved max seizure free patients and highest doses were less effective. Conclusion: Generalized tonic clonic seizure was the most commonly observed type of seizure and sodium valproate was the most frequently prescribed drug to them followed by focal seizure. Most common drug prescribed to patients with focal seizure is carbamazepine.  Majority of patients were given monotherapy to achieve seizure control. Reduction in seizure episodes was noted with all the drugs and doses but highest seizure free patients were observed with lowest doses of AEDs. The higher doses were found less effective reason for which needs to be explored.

22. Doppler Ultrasound Versus Three-Dimensional Computed Venography : Diagnostic Accuracy in Varicose Veins
Pranjit Thapa, Jyotshna Bhowmik, Dibyajyoti Nath, Aditi Das
Introduction: Varicose veins are one of the most widely recognized illnesses of the lower limb venous system. The distribution of varicose veins varies for age, sex and occupation. Mostly because of easy availability, lesser radiation exposure and low- cost, Duplex Ultrasound is most commonly used in the evaluation of varicose veins of the lower limb which provides morphological and hemodynamic information. Aim : To determine the diagnostic efficacy of Duplex USG and Three Dimensional Rendered Computed Tomography in the evaluation of varicose veins of the lower limb and the distribution of varicose veins for age, sex, and occupation. Methods: It was an observational study conducted at the Department of Radiology, Silchar Medical collegefrom June 2019 to May 2020 for one year on 50 patients with varicose veins. Duplex Ultrasound was performed on varicose vein cases followed by CT Venography. Results- Total of 56 limbs were examined of 50 patients, out of 50 patients, 20 were males (40%) and 30 (60 %) were females. It was more common in the age group 55-64 yrs (24%). The prevalence of varicose veins of lower limbs amongst occupations including standing types (48%) is more than that of walking types (32%) and sitting types (20%). CT venography produced excellent images in 21.4%, fair images in 60.7% and poor images in 17.8 % cases. Conclusion: It was found that in detecting GSV incompetence CT Venography compared to Duplex USG has a sensitivity of 97.7%, a specificity of 90.9%, PPV of 97.7%, NPV of 90.90%, and in detecting SSV incompetence CT Venography compared to Duplex USGhas a sensitivity of 57.14%, a specificity of 95.23%, PPV of 80% and NPV of 86.9%.It was also found that CT venography could detect more number of perforators as compared to Duplex Ultrasound.

23. Assessment of Cumulative Irritation and Sensitization Potential of Himalaya’s Baby Skin Care Products in Adult Healthy Volunteers by Human Repeat Insult Patch Test (HRIPT)
Rajesh Kumawat, Mukta Sachdev, Mukesh Ramnane, Swathi B, Babu U V
This study was to assess the mildness, gentleness and allergenic potency of 18 marketed baby skin care products. This open-label, controlled, single-center, HRIPT was conducted in 2 studies as per BIS 4011:2018 guidelines. Each study included 200 healthy participants in the age of 18-65years (of either sex). 10 products in study 1 and 8 products in study 2 were evaluated in different phases. Induction phase, products were repeatedly applied on the back of study subjects in the form of occlusive patch for 24 hours for 3 times a week, for 3 weeks. The reactions were assessed 48 hours after every patch application. Post 2-week rest period, subjects had 24-hour challenge contralateral patch application on treatment naïve site. The reactions were evaluated at 48, 72, and 96 hours post patch application. In study 1, 6 products were mild with cumulative irritation score of 0 and 4 products namely gentle baby soap, refreshing baby soap, nourishing baby soap, extra moisturizing baby soap elicited cumulative irritation score of 267.0, 289.0, 326.0, 137.0, respectively, they indicated probably mild in normal use.  In study 2, 6 products were mild, with cumulative irritation score of 0 and 2 products namely gentle baby shampoo, extra moisturizing baby wash had cumulative irritation score of 375.12, 215.92 respectively, they indicated mild in normal use. All 18 baby skin care products concluded to be hypoallergenic and non-irritating, implies the products are safe, mild, and gentle in study population.

24. Is Nutritional Anaemia Dilemma of Only Lower Socioeconomic Strata: A Comparative Study of Iron Deficiency Among Adolescents of Government and Private Schools
Priyasha Tripathi, Priyanka Srivastava, Om Prakash Vishwakarma, Sharad Thora
Objective: A comparative study of iron deficiency among adolescents of government and private schools ,research was done to understand the burden of iron deficiency among the middle and upper socio-economic strata and compare it with the underprivileged ones. Methods: A cross-sectional study was done in Indore where 500 adolescent students, of age group 10-18 years, from government (250 students) and private (250 students) schools were individually studied and compared clinically for signs and symptoms of iron deficiency. Their weight, height and BMI were also recorded to assess nutritional status and relate it clinically with micronutrient deficiency. Results: 45.8% students belonged to lower socio-economic strata out of which 74.2% students attended government school, whereas 54.2% students belonged to middle and upper socio-economic strata, out of which 92.1% attended private schools. 34% students from government school and 32% students from private school students had signs and symptoms of anaemia. The prevalence of iron deficiency anaemia was higher in female population, i.e. 61.3% as compared to males, 11.8%. Conclusion: Anaemia being an iceberg disease, often has no obvious clinical signs and symptoms but every other child, especially adolescent female irrespective of her socio-economic status is having iron deficiency anaemia. The almost equal prevalence of anaemia in private schools and upper socio-economic strata can be attributed to the high consumption of JUNCS among adolescents which is often ignored.

25. Effectiveness of Intra-Articular Methylprednisolone along with Platelet Rich Plasma Vs. Platelet Rich Plasma in Early Osteoarthritis
Jay Shah, Alpesh Chauhan, Sonali Naringrekar, Shrijikumar C. Thakkar
Background: Osteoarthritis (OA) is a slowly progressive chronic disease characterized by pain, loss of function, and deformity of the affected joints. In the past, OA was considered a normal sign of aging and it was described as a degenerative disorder that mainly causes cartilage loss. The use of platelet rich plasma in treatment of degenerative osteoarthritis of knee is more safe, can be easily produced and administered with relative ease. Present study was done to study the efficacy of intra-articular methylprednisolone therapy along with platelet rich plasma when compared with only platelet rich plasma in treatment of early osteoarthritis. Material and Methods: Present cross-sectional hospital-based study was designed to include 200 patients with initial stages of osteoarthritis of knee who were diagnosed as per the Kellgren-Lawrence classification. Selected patients were then categorized into; group I: It comprised of 100 subjects who were treated with intra-articular injections of platelet rich plasma in combination with methylprednisolone and group II: This group was comprised of 100 patients who were treated with intra-articular injection of platelet rich plasma alone. Clinical data pertaining to medical history, VAS and KOOS scores were collected. Statistical analysis was performed using the student’s t test. Results: The differences in the VAS scores at one and three month intervals when compared with baseline scores demonstrated no statistically significant differences. It was noted that differences in KOOS-QOL scores and ADL between baseline; 3 and 6 months was found to increase significantly in PRP group when compared to the methylprednisolone group. Conclusion: Treatment of osteoarthritis of knee joint in initial stages has not been studied in detail though there are studies related to treatment in advanced stages. Our study has analyzed combination therapy using PRP and methylprednisolone than compared to PRP alone.

26. Comparative Efficacy of Minoxidil and Minoxidil Finasteride Combination in Management of Noncicatricial Alopecia in a Population in Maharashtra
Prashant Mahajan, Mitali Patil
Alopecia is a common condition which adversely affects the quality of life. It is not always possible to make an accurate and quick diagnosis by clinical examination. Trichoscopic analysis is a widely used noninvasive tool for diagnosis. Based on diagnostic findings, management protocols can be outlined. The present study was planned to comparatively assess the Efficacy of Minoxidil and Minoxidil Finasteride in managing Noncicatricial Alopecia. The study involved a pool of 40 subjects. The study concluded that combination of finasteride and minoxidil is more effective and promising option in the treatment of noncicatricial alopecia than minoxidil alone.

27. An Observation Study to Estimate the Stature from Length of Arm in Persons (both male and female living adults) Belonging to 20-50 years Age group: Metrical Assessment
Kundan Kumar
Aim: To estimate the stature from length of arm in persons (both male and female living adults) belonging to 20-50 years age group. Methodology: The present research activity was performed in the Department of Anatomy, Santosh Medical College, Ghaziabad, Uttar Pradesh, India. The subjects enrolled in study were asymptomatic 200 healthy students (adult males and females) between 20 to 50 years of age. The length of arm was measured in 90 degrees bended elbow in persons with standing position. The length of arm was defined as the distance between acromion end of clavicle and olecranon process. During the stature evaluation, subjects were in standing barefoot position and were on the platform of the stadiometer with the upper back buttock and heels pressed against the upright position of the instrument. The correlation between height and arm length was evaluated, and the simple linear regression model was used for describing the formula of the population. Then standard error of estimate (SEE) and coefficient of determination (R2) were calculated for the relation. Results: The mean age of cases was 22±1.90 years. Mean age of male cases was 21±1.8 years and female cases was 20±2.42 years and there wasn’t significant difference in the age of sex groups (P=0.196). Mean height of all subjects was 173.38±3.64 m. Mean height of males and females was 178.46±3.02 cm and 159.98±6.45 cm, respectively. Significant differences were observed in the height between the two sexes (P=0.0001). There was a significant difference in the UAL of sex groups (P=0.0001). There was a correlation between stature and UAL of cases (P=0.0001). There was a correlation between height and FAL of male cases (P=0.0001). However, this correlation wasn’t significant for female cases (P=0.098). According to the linear regression, there was a relation between height and UAL of all cases (SEE=7.32, R2 =0.502) and male cases (SEE=4.48, R2 =0.410). Conclusion: From this study, it can be concluded that there was relationship between the UAL and height; and UAL can be a moderate predictor for stature estimation. This fact can be of practical use in medico legal investigations and anthropological and archeological studies where the stature of a person can be found out if the lengths of upper arm and or forearm long bones is known.

28. Evaluation of Knowledge, Attitude and Practice of Pharmacovigilance among Healthcare Professionals
Aman Sharma, Rekha Rani, Sanjeev Gupta, Surbhi Mahajan
Background: The pharmacovigilance programme of India is aimed at inculcating a culture of ADR reporting and monitoring as underreporting is still very prevalent. The present study was conducted to assess knowledge, attitude and practice of pharmacovigilance among healthcare professionals. Materials and Methods: 140 healthcare professionals including Doctors, nurses, and pharmacists of both genders were subjected to KAP questionnaire (17 questions) wherein 8 were related to knowledge, 4 related to attitude, and 5 related to practice. These questions were designed based on earlier studies for assessing KAP of ADR reporting. Results: 70% correctly defined pharmacovigilance, 81% replied correct regarding role of pharmacovigilance, 74% correctly answered regarding which healthcare professionals are responsible for ADR reporting, only 30% knew how to and where to report an ADR and 25% knew how to fill an ADR form. 78% had correct idea regarding pharmacovigilance programme of India and 48% replied correctly regarding which body is responsible for monitoring ADR’s in India, 92% consider ADR reporting as a professional obligation. 60% had witnessed an ADR, 54% had been trained regarding how to report an ADR, 28% had reported ADRs to monitoring centre, and only 15% had actually filled an ADR form. Conclusion: Though health care professionals had fair degree of knowledge regarding pharmacovigilance and are positive regarding ADR reporting but practice of ADR reporting is found to be deficient among health care professionals.