International Journal of

Toxicological and Pharmacological Research

ISSN: 0975 5160 Peer Review Journal

Print-ISSN 2820-2651

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1. Paracetamol Self Overdosing Case Series Study- Analysis of Demography, Clinical Features and Treatment Methods
Vishal KR, Shiva Murthy N
Background: Acute liver failure due to Paracetamol overdosing is the second most common cause requiring liver transplantation worldwide. Objectives: To analyze the demographic features, clinical features and treatment methods used in Paracetamol self-overdosed patients at a tertiary care center in South India. Methods and Material:  A retrospective case series study was conducted after obtaining Ethics Committee approval. Patients reported with Paracetamol overdosing with or without additional drugs from 01 Jan 2020 to 31 Dec 2021 were included in the study. Data collection form was used to collect data on demography, clinical presentation, past/medication/personal history, general physical, vitals, and systemic examination. In addition Psychological evaluation and Treatment methods were also collected. Descriptive statistics applied. Demography, clinical features and treatment methods were analyzed using Instat3 and Microsoft Excel. Results: Thirteen patients aged 26.15±12.35 years who consumed 10±5.195 tablets amounting to 6.23±3.23 grams of Paracetamol as a single dose were analyzed. Vomiting and pain abdomen were common presenting complaints. Signs of injury to GIT and CNS organs were noted in these patients. Seven patients were discharged against the medical advice. All patients received gastric lavage and other supportive treatments as early as possible at a nearby government hospital or at our centre. Conclusions: Young female patients, easy availability of OTC medicines and conflict with family members were the three important factors which contributed to intentional Paracetamol overdosing in our study. We recommend CDSCO, India to take cognizance of amendments made by FDAs of UK and USA with regard to Paracetamol product label and consider similar actions to prevent loss of lives due to Paracetamol overdosing.

2. Electrocardiographic Changes in Case of Acute Organophosphate Compounds Poisoning
Prajapat Narendra Kumar, Bhati Mohammed Riyaz, Ahmad Sayed Wasim, Jain Rajesh
Introduction: Considerable significance has been given to Organophosphorus compounds over past few decades as common poisoning amongst humans. The present study was conducted for assessing the electrocardiographic (ECG) changes in such situations. Materials & Methods: One hundred twelve patients with the alleged history of OPC poisoning were enrolled. Apart from thorough history and detail clinical assessment, electrocardiographic changes were recorded. Results:  The incidence was higher (32.14%) in the age group of 21-30 years followed by 30.35% in the age group of 31-40 years. 79% of the patients were males. In 108 cases, the exposure is intentional. Increased secretions are the most common manifestation followed by fasciculations. The mean atropine and PAM dose and the duration of treatment increase with the increase in severity. Conclusion: ECG variables were significantly altered in OPC poisoning.

3. Bupivacaine Versus 2 Chloroprocaine Spinal Anesthesia Comparison Study at a Tertiary Hospital
Atul Kumar Agarwal, Ravindra Kumar Bhasker
Background: For surgery on the lower abdomen and lower limbs, spinal anesthesia is a tried-and-true, dependable, and safe anesthetic approach. It is simple to administer, acts quickly, poses little danger of infection, and has a low failure rate. Aims & objectives: The goal of the current study was to compare the effectiveness and readiness for discharge of the two local anesthetics used for spinal anesthesia, Bupivacaine and 2-Choroprocaine. Material and Methods: The current study was a short-duration (60min) elective ambulatory perineal surgery (such as a hemorrhoidectomy, a fistula in ano, a rectal biopsy, etc.) or gynecological procedure (such as a check curettage, hysteroscopy, etc.) prospective randomized double-blind study conducted in patients of 18 to 60 years of age, ASA grades 1 and 2, in 60 patients were randomly divided into two groups using a computer-assisted table: Group B received 40 mg of 1-chloroprocaine and Group C received 10 mg of bupivacaine hydrochloride as the spinal anesthetic. Results: In terms of mean age, gender, and ASA grade distribution, there was no discernible statistical difference between the two groups. A statistically significant difference was found between groups B and C for the mean time for onset of sensory block, mean time for onset of motor block, mean time to achieve maximum sensory block, mean duration of sensory block, and mean duration of sensory block. The chloroprocaine group showed better results in these areas. The mean length of stay in group C was 1.40 ±0.64 days and group B was 1.42 ± 0.82 days. There was significant difference in length of stay in two groups. (p<0.05) The mean time to ambulation in group C was 225.46 ±56.22 and group B was 265.36 ±58.46 minutes. The time it took for two groups to ambulate varied significantly. (p<0.05) This demonstrates that patients in Group C are discharged and ambulated earlier than those in Group B. Conclusion: In comparison to intrathecal Bupivacaine, intrathecal 2 percent 2-Chloroprocaine has the advantages of early ambulation and early hospital discharge. It also has an earlier and more satisfactory onset of sensory and motor block, the desired level of spinal block, and an adequate duration of sensory and motor block.

4. Mortality Predictors in Influenza Pneumonia: A Prospective Study in a Tertiary Care Hospital
Basharat A Kassana, Bilal Hassan, Nuzhat Samoon, Gul Aalmeen
Objectives: Influenza causes annual seasonal epidemics around the world. Periodically, genetically novel strain of influenza circulates worldwide, causing an influenzas pandemic. The present study aims to assess the clinical profile, prognosis of the disease and outcome in influenza positive patients during 2017-2018 epidemics in Kashmir, so that epidemiology of the disease could be known, and high-risk groups can be identified. Methods: All influenza positive patients, confirmed by RT -PCR method, admitted in ICU / Isolation ward in SHER –I-KASHMIR INSTITUTE OF MEDICAL SCIENCES SOURA KASHMIR during epidemic of influenza (2017-2018) were studied, the data collected was analyzed. Results: During the study period there were 124 influenza positive admissions. The age group most affected was 20-59 years males (49.2%) and females (50.8%). There were 30 deaths; mortality was high in rural population 73.33% (n=22) and patients with underlying comorbidities. Common presenting symptoms were fever, cough, breathlessness, sore throat. Conclusion: Swine flu influenza infection took its heaviest toll in terms of human lives and economy because the young and productive population was mostly affected. Patients with co-morbid conditions and pregnant women were the susceptible population and thus preventive and therapeutic interventions should be directed to them. Early vaccination of high-risk groups and high index of suspicion in the symptomatic patients and chemoprophylaxis accordingly can save many human lives.

5. Clinico- Cyto-Pathological Study of Cutaneous Metastatic Lesions Using Fine Needle Aspiration (FNAC) in a Tertiary Hospital from Kashmir
Farhat Abbas, Gausia Rahim, Summyia Farooq, Farzana Manzoor
Background: Cutaneous metastasis refers to growth of cancer cells in skin from an internal malignancy they are clinically important because they may represent the terminal stage of carcinoma, sign of relapse following failure of therapy or sometimes first manifestation of internal malignancy. Aims and Objectives: This study focuses on the role of Fine Needle Aspiration Cytology (FNAC) in the diagnosis of cutaneous metastatic deposits. Materials and Methods: The present study was carried out from Jan 2018 to Jan 2020 in in the Department of Pathology, Government Medical College Srinagar j&K India. FNAC was done using 22-gauge needle and 10 ml disposable syringe and the smears were examined and morphology of primary tumour assessed. Results: Total 17 patients were included in the study. The age of subjects ranged from 25 to 63 and majority of subjects were males. Chest wall and scalp were the most common sites of cutaneous metastatic deposits. Adenocarcinoma was the predominant type of tumour which caused deposits. The most common primary organ was lung in males and breast in females followed by gallbladder and kidney. Conclusion: FNAC is minimally invasive, safe, rapid and reliable method for the diagnosis of cutaneous metastases. Majority of these cases can be diagnosed accurately by skilled and experienced pathologists which helps the clinicians to take prompt decision for further therapeutic management.

6. Correlation between Two Monitoring Tools by Subjective and Objective Methods for Evaluation of Adequacy of Brachial Plexus Block: An Observational Study
Sajita Jani, Komal Shah, Chandrika Bhut
Introduction: Supraclavicular block provides adequate anaesthesia and analgesia but lacking objective methods of assessment, so in this study PI index using pulse oximetry was used to assess the adequacy of block. Methods: The study was conducted on 100 patients undergoing elective or emergency orthopaedic procedures under brachial plexus nerve block. After local anaesthetic injection, sensory and motor block  success was assessed every 5min by traditional pinprick and Modified Bromage Scale methods respectively. The PI was recorded at baseline and at every 5 minutes till 30 minutes after anaesthetic injection in both blocked and non-blocked limbs. The PI ratio was calculated as the PI after 5min divided by the PI at the baseline. Result: The PI was higher in the blocked limb at all time points except baseline and this was paralleled by a higher PI ratio compared with the unblocked limb. At the time when complete sensory block achieved, the correlation Pearson coefficient of PI was 0.979 (p < 0.001) and for motor block it was 0.932 (p – 0.002), which shows positive correlation between both the assessment methods. Conclusion: PI and PI ratio are positively correlated with the traditional subjective methods of assessment of block adequacy. So, it can be a good alternative in uncooperative, sedated patients.

7. The Current Practices of Storage and Maintenance of Cadavers and Dissected Parts in Medical Colleges of Udaipur, India
Sharma Hina, Bhaumik Meghna, Goyal Samata, Sharma Kartikeya
Background: This study delves into the practical approach taken by the stakeholders for maintenance and storage of cadavers. Aim: This study aims at getting into the depth of the various methods employed by the anatomists of Udaipur, to study the various techniques being used to embalm the dead bodies and to keep the cadavers and dissected parts safe from decomposition and to find out methods of tackling untoward incidences of decomposition, or fungal/ parasitic infestation. Settings and Design: A descriptive, cross-sectional questionnaire-based study. Methods and Material: Study was carried on the medical colleges of Udaipur, Rajasthan, India. A detailed questionnaire of fifty-eight items was prepared to investigate about the management of the cadavers and shared via google forms and received answers were then analysed. Statistical analysis used: Microsoft excel was used for statistical analysis. Results: The chemicals used by the participants are formaldehyde, alcohol, glycerine, phenol and thymol. 5 litres of 15% concentration of formaldehyde, 5 litres of alcohol, 2 litres of glycerine (amount may vary), thymol crystals and remaining amount of water is added to make a solution of 15 to 20 litres for one cadaver using the carotid or femoral artery with gravity method. Storage tanks are regularly inspected and dealt with accordingly. The procurement of dead bodies is done strictly as per the Anatomy Act of the state. Conclusions: By and large all the medical colleges of the region of Udaipur, Rajasthan, India employ similar techniques of procuring, embalming, storing, maintaining, utilizing and disposing the cadavers.

8. To Evaluate the Effect of Deep Breathing Exercises and Incentive Spirometry on Peak Expiratory Flow Rate and FEV1/FVC Ratio in Patients Undergoing Laparoscopic Cholecystectomy
Sharad Kumar, Ram Prakash Gangwar, Supriya, Raghav Gupta
Background: Respiratory exercise and flow breathing spirometer is an exercise of importance for patients with upper abdominal surgery. Postoperative pulmonary complications have been found to be lower in patients with laproscopic cholecystectomy who receive physiotherapy and respirator compared to those who do not take it. Aim: To evaluate the effect of deep breathing exercises and incentive spirometry on Peak expiratory flow rate and FEV1/FVC ratio in patients undergoing laparoscopic cholecystectomy. Methodology: The study was carried out in S.N Medical College, Agra, starting from December 2016 to September 2018. Eligible patients were selected based on the inclusion and exclusion criteria. Results: In all groups there was a statistically significant decrease in peak expiratory flow rate (PEFR) on the 1st and 2nd post-operative day as compared to the preoperative period. Conclusion: Pulmonary function (FVC, FEV1, and PEFR) in all experimental groups ( Flow Incentive Spirometry group and deep Breathing Exercise group) showed a greater improvement than the control group on 2nd postoperative day in comparison to the 1st postoperative day.

9. Retrospective Analysis of Yeast Isolates: Emerging Mycological Trends
Areena Siddiqui, Preetha Rajan, Poonam Verma
Introduction: Candida infections are increasing. Broad spectrum antibiotic use in critically ill patients, immunocompromised status of the patient, long ICU stay has led to increase prevalence of Candida infection. Purpose: This study was undertaken to find the prevalence of Candida species in tertiary care hospital. Retrospective analysis of clinical samples received in microbiology laboratory from April 2017 to November 2019 were analyzed for the prevalence of various Candida species. The samples included urine, SSTI, blood, respiratory sample, sterile body fluid, high vaginal swab, and nasal and throat swab. The inclusion criteria for the samples were implemented. Method: Samples fulfilling inclusion criteria and yielding candida species were processed manually as well as by automated system Vitek 2C. Both the results were compared and in case of discrepancy Vitek result were considered as final. The isolates obtained in various locations viz ICU, emergency, ward and OPD and samples were analyzed. Result: A total of 1441 candida isolates were obtained from various clinical samples submitted in Lab. Candida tropicalis was the most common isolate obtained (47.19%) followed by C. albicans 24.84%. ICU (58.1%) was most common location where candida species was isolated. Urine (56%) was the most common sample yielding candida sp. rare pathogens (C. parapsilosis) was obtained in ICU. Conclusions: This study shows that brief knowledge of the prevalent isolate helps in initiating and chosing the right antifungal therapy. It also highlights the role of implementing antifungal stewardship program.

10. Analysis of Risk Factors Associated with Ectopic Pregnancy: A Cross-Sectional Study
Surabhi Vegad
Background and Aim: A ruptured ectopic pregnancy is a true medical emergency. It is the leading cause of maternal mortality in the first trimester and accounts for 10 to 15 percent of all maternal deaths. This study was conducted to provide more light on the risk factors associated with ectopic pregnancy. Material and Methods: This prospective study was carried out at Department of Obstetrics & Gynecology, Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat, for the duration of one and half year. The study included 100 women with a diagnosis of ectopic pregnancy. Detailed history, menstrual and obstetric history, clinical examination, urine pregnancy test, and ultrasonography were obtained for each patient. Their clinical profile was noted, including their name, age, marital status, socioeconomic status, parity, and last childbirth. A list of potential risk factors was compiled. The general, systemic, abdominal and vaginal examination was done. Results: The highest number of patients were noted in the 20-24 years age group (n=35) and the least in the 35–39 years age group (n=2). Symptoms include pain in the abdomen was the most commonly noted symptom at 88%, followed by bleeding per vaginum (76%), vomiting (73%), fainting (58%), shock (30.0%), and abdominal distention (22%). While 18 % of cohorts did not present with any risk factor, pelvic inflammatory disease (n=22) was the most commonly noted risk factor. Conclusion: Early diagnosis of ectopic pregnancy minimizes morbidity and mortality and improves the quality of life. It is important to remember that only half of all women with ectopic pregnancies have recognizable risk factors. Therefore, it is crucial to remain vigilant in all women of childbearing age with amenorrhea, abdominal pain, vaginal bleeding, or previous episode of ectopic pregnancy.

11. Analysis of Different Modality of Treatment in Floating Knee Injury
Suresh N Parmar, Chirag Prajapati, Rahul Gunvantray Sutariya
Background and Aim: Floating Knee injuries are complex injuries. The type of fractures, soft tissue and associated injuries make this a challenging problem to manage. Generally caused by high energy trauma, the soft tissue is often extensive damaged and life threatening injuries to the head, chest or abdomen may also be present. The aim of the present study was to study the different modality of treatment is Floating Knee Injury by various operative methods. Materials and Methods: A total of 30 patients with floating knee injuries were managed over a 3 year period. This was a prospective study were both fractures of the floating knee injury were surgically fixed using different modalities. The associated injuries were managed appropriately. Assessment of the end result was done by the Karlstrom criteria after bony union. Results: Road traffic injury is the most common cause mode of injury leading to floating knee injury. 95 % patients had open fractures. 8o% patients were having ligamentous injury. Majority of patients were operated within 72 hours of the injury. 85% patients required secondary bony procedure like bone grafting like autologous, artificial bone graft. 85 % patients required secondary plastic surgery procedures like split thickness graft and flaps and other like quadricepsplasty. Conclusion: Floating knee injuries to be a group of complex injuries that needed careful assessment to detect poor prognostic factors (open, intra-articular, comminuted fractures) and associated injuries, surgical fixation of the fractures with thorough planning of surgeries and prolonged rehabilitation.

12. A Retrospective Study of Infertility Patterns Based on Semen Analysis in Patients Presenting in a Tertiary Care Centre
Santosh Kumar Gond, Atul Jain, Bhupendra Kumar Rohit, Shatkratu Dwivedi
Background: Perception of infertility is a major taboo & stigma in Indian society. Using WHO standards this study aimed to evaluate seminal fluid parameters in the male partners of the infertile couples presenting to the infertility clinic in a Tertiary Care Centre. Materials and Methods: In this retrospective study, patients who attended the infertility clinic in our Medical College Hospital from 2018 to 2021 were included in this study. Semen sample of 110 patient was collected and the wet preparation was made to determine the concentration sperm motility, sperm vitality, sperm numbers, concentration, motility, morphology, viability, and the presence of WBC or RBC. Data was collected & analyzed using Microsoft Excel & appropriate statistical tests were applied wherever necessary. Results: The average age of the participants in this study was 30 years, ranging from 21 to 50. The mean semen volume is 2.76 ml, sperm concentration 42.4 million/ml and vitality 38.7% of the semen. Abnormal semen was seen in 63 (57.27%). According to age-wise distribution maximum cases of oligospermia 13(11.8%) were between the age group of 20-35 years and second common abnormal sample finding is Asthenozoospermia 12.7%. Conclusion: Oligospermia is most common abnormality that causes male infertility after Asthenozoospermia, and routine semen analysis is the still gold standard for detection of male infertility in developing country like India. One main significant factor for male infertility is poor quality of semen.

13. Comparison of Clinical effects of Fentanyl and Esmolol for Attenuation of Hemodynamic Responses to Endotracheal Intubation
Shah Bansari Mahendrakumar, Shah Darshna Rakesh, Shah Sonal Aashish, Dimple Kinjalbhai Pandya, Akshatkumar Prakashkumar Trivedi, Twinkle Jayesh Gupta
Objective: The purpose of this experiment was to compare the clinical effects of fentanyl and esmolol for attenuation of hemodynamic responses to endotracheal intubation. Material and Methods: A prospective randomized study was conducted in 60 patients of ASA grade I or II, AGED 18-60 years who underwent elective surgical procedures. All patients randomly allocated in 2 groups; each having 30 patients. Group E: received esmolol 2mg/kg iv 3 min before intubation. Group F: received fentanyl 2mcg/kg iv 3 min before intubation  All patients preoxygenated with 100% O2;  Induced with Inj. Thiopentone 6mg/kg iv + Inj. Suxamethonium 2 mg/kg iv Intubated with appropriate ET tube;  Maintained with O2 50%, N2O 50%, Vecuronium bromide 0.08 mg/kg  Vitals – HR, SBP, DBP, MAP,SpO2 recorded at baseline, after premedication, study drug,  at intubation, at L+1, L+3, L+5, L+7, L+10. Results: Readings of HR, BP and Rate pressure product were compared with baseline and among each group.  Esmolol was significantly more effective in suppressing HR as compared to fentanyl at all the time. No significant difference noted at baseline, following laryngoscopy and intubation at 1,3,5,7 minutes. SBP was lower in E group than in F group.  No statistically significant difference between 2 groups with respect to mean DBP at baseline, after premedication, study drug and intubation.  At 1,3,5,7 min DBP lower in F group than in E group. At 1,3,5,7 min the RPP lower in E group than in F group. Conclusion: Esmolol 2mg/kg IV provides more reliable and consistent protection against increase in mean HR and SBP than Fentanyl 2mcg/kg IV; Fentanyl provides reliable protection against rise in DBP.  No significant difference between 2 drugs in terms of effects on MAP. Esmolol better at achieving a low-Rate pressure product than fentanyl which is a good predictor of myocardial oxygen consumption. Esmolol and fentanyl both can attenuate the hemodynamic responses, but Esmolol provides better hemodynamic stability during laryngoscopy and intubation.

14. Pulmonary Function Tests in Type 2 Diabetes Mellitus and Their Association with Glycemic Control and Duration of the Disease
Kailash Charel, Mukesh Singh Tomar, Poonam Motwani
Background: Pulmonary complications of diabetes mellitus (DM) have been poorly characterized. Some authors have reported normal pulmonary functions and even concluded that spirometry is not at all necessary in diabetic patients. Some studies have shown abnormal respiratory parameters in patients of DM. Moreover, the duration of DM and glycemic control have varied impact on the pulmonary functions. Aims and Objectives: The study was undertaken to analyze the pulmonary function parameters in diabetic patients and compare them with age and gender matched healthy subjects. We correlated forced vital capacity (FVC) and forced expiratory volume in 1st second (FEV1) in diabetic patients with duration of the disease and glycosylated hemoglobin (HbA1c). Materials and Methods: Pulmonary function tests (PFTs) were recorded in 60 type 2 diabetic male patients and 60 normal healthy male controls aged 40-60 years by using Helios 702 spirometer. The PFTs recorded were – FVC, FEV1, FEV1/FVC, and peak expiratory flow rate (PEFR). HbA1c of all the patients was also estimated. PFTs of diabetic patients and controls were compared by applying Student’s unpaired t test. Associations between FVC and FEV1 and HbA1c and duration of illness in diabetic patients were analyzed by applying Pearson’s coefficient. Results: The PFTs were significantly decreased in diabetic patients compared with the healthy controls except FEV1/FVC. There was no correlation found between FVC and FEV1 and duration of illness as well as HbA1c. Conclusion: DM being a systemic disease, which also affects lungs causing restrictive type of ventilatory changes probably because of glycosylation of connective tissues, reduced pulmonary elastic recoil and inflammatory changes in lungs. We found glycemic levels and duration of disease are probably not the major determinants of lung pathology, which requires further research.

15. Evaluation of Early Pregnancy Failure with Transvaginal Sonography: A Prospective Observational Study
Rajib Pal, Anwshka Kumari, Mrinalkanti Ghosh
Background: Spontaneous miscarriage is one of the common complications in pregnancy. It occurs in up to 20% of clinical pregnancies. In the first trimester with transvaginal ultrasonography a series of measurements like embryonic crown-rump length (CRL), embryonic heart rate (EHR), gestational sac diameter (GSD) and yolk sac diameter (YSD) were taken. The objective of this study is to evaluate early pregnancy developmental changes in first trimester ultrasound screening also to identify abnormal ultrasound parameters and correlate the ultrasound findings with the clinical outcomes. Materials & Methods: The study included 100 pregnant women attending antenatal clinic at 5-12 weeks of gestation fulfilling inclusion and exclusion criteria. They were subjected to TVS. Mean Gestational Sac Diameter (MGSD), Yolk Sac Diameter (YSD), morphology of yolk sac, Crown rump length (CRL), Retroplacental or Perisac Collection, Embryonic Heart Rate (EHR) were noted. Results: In our study, 34% patients had abnormal pregnancy. Maximum patients belonged to the age group 26-30. Majority of abortions occurred before 12 weeks of gestation. Threatened abortion was noted in 23% of patients. 50% of patients with abnormally large yolk sac, 94% of patients with MSD>25 mm with absent embryo, 100% of patients with CRL>9mm and 100% with EHR<100bpm aborted. Conclusion: TVS can help in early diagnosis of EPF in asymptomatic patients. Timely appearance of parameters like Gestational Sac, CRL, EHR, Yolk Sac and evaluation of retroplacental and perisac area can be used to predict pregnancy outcome.

16. High Dependency Unit- A Boon for High Risk Mother
Bharati Misra, Anuradha Mishra, Aishwarya Sahu
Background: The management of critically ill obstetric patients has always been a difficult task. High Dependency Unit setup in all over India has helped in curbing various complication and thus helped in reducing maternal morbidity and mortality rate. The objective of this study was to observe the management of patients admitted in High Dependency Unit and compare and evaluate the outcome of the patients during presence and absence of High Dependency Unit. Materials and Method: This is a retrospective study carried out from May to October in the year 2021 in Department of Obstetrics and Gynaecology, M.K.C.G Medical College Hospital, Berhampur, Odisha. Data’s were collected from Hospital information record over a period of 3 months from May to July with no High Dependancy Unit and from August to October with fully functioning High Dependency Unit. Patients address, age, socio economic status indication of admission, whether a booked case or unbooked case, preterm or term pregnancy, distance of referral centre, no of hours patient stayed in High Dependency Unit, shock index, no of blood transfusion, application of anti-shock garment, and the outcome of the patient were all noted. Statistical analysis was performed by the SPSS program for Windows. Results: Obstetrical complication was managed well with intensive monitoring provided by High Dependency Unit set up in M.K.C.G medical college and hospital. A total of 9231 patients were admitted in labour room. Total no of deliveries was 7346. 150 (3.4 %) were admitted in High Dependency Unit. Haemorrhagic cases accounted for, 26 % (n=13), hypertensive cases 16% (n= 8), anemic cases were 6 % (n=3) of total admission in High Dependency Unit. Maximum no of patients was in the age group 23 to 29 years of age group (72.56%), 69% of the patients constitute lower socio-economic status group, 65 % patients reside in rural areas and there was inadequacy in receiving antenatal care in case of 60.6% of patients. Term pregnancy developed more complications (66.6%) than preterm pregnancies. Maximum no of patients stayed in High Dependency Unit 48 to 72 hours. Blood transfusion (72.5%), the use of inotropic drugs (38%), mechanical ventilation (60%) was noted in HDU. A lower Intensive Care Unit of 2.6% was noted with High Dependency Unit, as well maternal mortality ratio of 4.8 per 1000 live births as compared to 6.8 per 1000 live births with no High Dependency Unit. Conclusion: Haemorrhage cases accounted for most no of cases in High Dependency Unit. Delayed identification and distance of referal centre were important obstacles in hindering the better outcome of patients. 62.6% (n=94) were unbooked cases. So, increasing awareness and encouraging people to report at health centre at the earliest has to be stressed on. In addition to timely referral, health education and training of health professionals may improve clinical outcome and better obstetric practice, especially in countries like India. Pregnancy itself carries a lot of complication which if not taken care of at the the earliest can lead to devastating results. Hence for easy and smooth management of the patients High Dependency Unit concept was introduced which with the help of advanced facilities and dedicated competent care providers can help avert unforeseen complications arising out in pregnancy. Obstetric High Dependency Unit dedicated for management of only obstetric patients should be constructed in order to compensate for heavy burden critically ill patients.

17. A Study on Association of Serum Amylase Levels in Assessing Clinical Severity and Outcome of Organophosphorous Poisoning at Osmania General Hospital, Telangana State
T.V. Sowmya, D. Sridhar, P. Srujan, D. Naveen Reddy
Introduction: Poisoning by organophosphosphorous Pesticides has reached epidemic proportions in most parts of the India. There is increased incidence of elevated serum amylase levels after consumption of organophosphorus compounds. Many deaths can be prevented if we assess the severity of poison initially. Aims and Objectives: To estimate serum Amylase levels in acute organophosphorus compound poisoning, to find out its relationship with clinical severity and outcome. Material and Methods: A prospective cross – sectional study with 50 Patients presenting with Organophosphorous poisoning were the study subjects evaluating with clinical history and all relevant investigations as per norms. Results: Of the 40 patients in our study 15 patients (37.5%) had normal serum amylase level, 25patients (62.5%) had elevated serum amylase level. Age and sex of the patients have no significant relationship with the amylase levels and strong correlation between serum amylase levels with respiratory failure with significant p(<0.01). Conclusion: Symptoms like convulsions, Severe secretions, CNS depression, Fasciculations, Respiratory failure correlated very well with increasing severity of serum Amylase levels.

18. A Study on Caustic Ingestion and Outcome at Osmania General Hospital, Telangana State
Srujan, D. Sridhar, Md. Anfas Nusrath Pasha, Rohith
Background: Poisoning is one of the most commonly used suicidal methods in India. Caustic ingestion is one among them. Aims and Objectives: To find out the prevalence & pattern of Corrosive injury and to elicit the clinical features / clinical course and outcome by endoscopy. Material and Methods: A prospective cross – sectional study with 50 Patients presenting with caustic ingestion were the study subjects evaluating with clinical history and all relevant investigations as per norms. Results: In our study the most commonly used corrosive was acid (70%), Alkali was only 30%. Among the acid, Carbolic acid (phenol) was the most commonly used acid. Out of 50 patients, 40 patients were discharged. 8 patients died within 48 hours. Conclusion: Females had outnumbered the males in our study (64:36). The quantity and concentration of caustic consumed determined the outcome. Patient with Grade – III injury had more morbidity in the form of stricture involving upper gastro intestinal tract.100% mortality observed in Grade – IV injury.

19. Estimation of Antibody Titre of Hepatitis B Surface Antigen among Medical Students of a Tertiary Care Centre in North Kerala
Jasmine KA, Sujatha VS, Babu PK
Background: Hepatitis B virus (HBV) infections at younger age lead to chronic liver damage and hepatocellular carcinoma. Medical students have high risk of exposure to HBV. Vaccination certificate is mandatory for medical course admission as it is vaccine preventable. The immune response wanes gradually over time and antibody level was needed to be maintained by booster dose. Objective of the study was to find out anti-HBs titre and to evaluate the seroprotection in students of Govt. Medical College, Manjeri in North Kerala. Methods: A cross sectional study was conducted among 375 students of Govt. medical college, Manjeri in north Kerala during 2018-2019. Anti-HBs titre was estimated in serum samples by quantitative ELISA method using direct antibody sandwich enzyme immunoassay kits (Monolisa Anti- HBs PLUS 72566). Results: Among the 375 participants, 149(39.7%) were completely vaccinated, 90 (24%) had partial immunization and 136 (36.27%) had no vaccination records. Protective titre of >10 mIU/mL was maintained by 304(81.06%) students. Good seroprotection >100mIU /mL was seen in 234 (62.4%) and 70 (18.7%) individuals were with 10-100mIU/mL. No significant association was seen with age, gender or body mass index (BMI) to seroprotection. Time since last dose of vaccination and number of doses were associated with good immune response (p <0.005). Conclusions: Anti-HBs wanes over period of time. Partially immunised individual were sensitised to complete the doses. Fully immunized individuals with <100mIU /mL titre were advised to take single booster dose. Subjects who had <10 mIU/mL after the booster dose were asked to repeat three primary doses. Instead of submitting a vaccination certificate, an electronic register is preferred in Medical institutions to record of HBV seroprotection. Immune status against HBV is to be rechecked at the end of course before starting the internship.

20. Clinicopathological Studies in Case of Generalized Lymph Node Enlargement, Done Under Local/Regional/General Anaesthesia in A Peripheral Medical College and Hospital
Babrak Manuar, Tapobrata Mitra, Habibur Rahaman, Utpal Kumar Ray
Background: Lymph node enlargement may be primarily the site of a disease but mostly it is involved secondarily as a part of a disease. Lymphadenopathy which gives rise pain & swelling of node & clinically manifested by tender, enlarged node, sometimes matted by the presence of discharging sinus. Fine needle aspiration cytology (FNAC) is simple, safe, cost-effective, reliable and rapid procedure. Histopathological examination is universally accepted as final diagnostic method of any organ or tissue. Materials and Methods: About 50 cases admitted or attended to Murshidabad Medical College & Hospital both medical and surgical ward with generalized lymph adenopathy during the periods from 1st April 2021 to 30th June 2022 were studied. The data was collected with the help of a proforma. The cases were analysed with respect to age, sex, distribution, symptomatology & their duration. The investigation was scrutinized to establish mode of diagnosis in these cases. An attempt was made to find out various regimens of treatment of these patients. Results: Surgical biopsies of lymph nodes of 50 patients were reviewed microscopically and analysed. In our studies, tuberculosis accounts for 46% of the total cases, next being reactive hyperplasia of lymph node which accounts for one fourth (24%), this is followed metastatic carcinoma of total cases, next being non-Hodgekin’s lymphoma (4cases) being greater than Hodgekin’s lymphoma. In our studies male female preponderance 3:2. In our studies reactive hyperplasia of lymph node affects all the age uniformly whereas tuberculosis was common in the 2nd, 3rd &4th decade of life. Swelling was the common symptoms followed by fever, weight loss varying degree & loss of appetite, gastrointestinal symptoms like vomiting, constipation & jaundice was present in few cases. Conclusion: In our study most of the lesions were found to be being (74%) tubercular lymphadenitis, being the commonest (23 out of 50cases). Swelling is the commonest mode of presentation. The commonest mode of diagnosis was lymph node biopsy. FNAC showed that was quite reliable, safe, rapid method of diagnosis.

21. Comparison of the Neonatal Lipid Profile, Apolipoproteins, and Atherogenic Index in Cases of Vaginal Delivery versus Caesarean Section
Rajkumari Samar, Suman Jain, Chitra Purohit
Background: The preservation of tissue and numerous internal metabolisms require a significant amount of cholesterol in the human body. Evidence suggested that factors such placental insufficiency, delivery method, and circumstances impacting foetal growth may have an impact on the amount of lipoprotein in cord blood. The goal of the current study was to assess the gender differences in the cord blood lipid profile, apolipoproteins, and atherogenic index across different delivery methods. Methodology: Cord blood samples from 319 normal vaginal deliveries and 321 caesarean section patients were used in the comparative analytical investigation. When the baby was delivered, the cord blood was taken. The lipid profile, apolipoproteins, and atherogenic index of the blood were evaluated. Results:  The data showed that neonates delivered vaginally normally had considerably decreased cord blood lipid values. In comparison to neonates delivered via caesarean section, the lipid profile, apolipoproteins, and atherogenic index were greater in neonates delivered via normal vaginal birth. Total cholesterol, TG, and HDL-C levels were greater in female NVD and Cesarean infants than male neonates when compared on a sex-by-sex basis. Male neonates had greater LDL levels. Conclusion: As a result of the investigation, it was concluded that the concentrations of lipid parameters are strongly affected by the route of delivery. For such women, postpartum changes in lipid markers necessitate significant care.

22. The Effect of Intraoperative Dexmedetomidine Infusion on Analgesia in Laparoscopic Cholecystectomy
Somnath Bhar, Saikat Majumdar, Tapobrata Mitra, Swapnadeep Sengupta, Jayanta Chakraborty, Manabendra Sarkar
Background and Aims: Laparoscopic cholecystectomy requires creation of pneumoperitoneum following direct laryngoscopy and tracheal intubation, all of which may lead to several deleterious haemodynamic alterations. Dexmedetomidine has been found to blunt these haemodynamic responses effectively along with providing sedation without respiratory depression and also decrease postoperative analgesic requirements. Objectives: The current study was thus planned with an aim to evaluate the overall efficacy of intra-operative dexmedetomidine infusion during laparoscopic cholecystectomy. Materials and Methods: 80 patients posted for laparoscopic cholecystectomy were divided in two equal groups. After giving general anaesthesia, patients in Group D received Dexmedetomidine infusion at a rate of 1µ/kg bolus followed by a continuous infusion set at 0.5µ/kg/hr whereas those in group C received Normal Saline in the same dose. Haemodynamic profiles were recorded every 15 minutes, total intraoperative analgesic consumption was calculated at the end of surgery. Any adverse effects, Pain and sedation scores were assessed postoperatively. Results: Heart rate and Mean arterial pressures were better maintained, with significantly lower values from 15 and 30 minutes respectively in Group D. The total analgesic consumption was significantly low in Group D (142.50 ± 38.48 µg in Group D versus 240 ± 30.38 µg in Group C). The mean pain and sedation scores as also incidences of adverse events were also significantly less in Group D subjects than in patients of Group C. Conclusion: Dexmedetomidine infusion serves as an efficacious analgesic adjuvant for laparoscopic cholecystectomy.

23. Electrolyte Analysis of Serum and Aqueous Humour in Cataract Patients
Arun Kumar Samar, Suman Jain
Background: Cataract, the most common preventable cause of blindness in the world, is an age-related illness that impairs vision and is defined by a slow, increasing thickening of the lens. The etiopathogenesis of cataracts involves changes in serum electrolyte content, which is a critical factor. Using patients with cataracts and healthy controls, this study examined and evaluated the levels of serum sodium, potassium, and chloride. Methodology: A cross-sectional comparison study including 100 participants, 50 of whom had cataracts and the remaining 50 were healthy controls, was done on adults between the ages of 45 and 85. For statistical analysis, Excel 13 version was utilized. Results: Cataract patients had considerably higher mean serum sodium, potassium and chloride levels than controls. The comparison of electrolytes in serum and aqueous humour of patients revealed that sodium, potassium and chlorides were higher in aqueous humour than in serum. Between the two groups, the mean potassium level did not significantly differ. Conclusion: Changes in the serum electrolyte concentration can affect how much is in the aqueous humour, which could be more than the lens membrane’s pumps and channels can handle, leading to volume overload and lens opacities. Therefore, serum salt and potassium levels can be utilized as indicators of the development of cataracts. Reducing your salt intake can slow the development of cataracts.

24. Current Scenario of Antimicrobial Drug Resistance Pattern of Bacteria Isolated from Patients of Urinary Tract Infection Attending Tertiary Care Teaching Hospital, Vijayapur
Leela Hugar, Daneshwari C. Kottalamath, Chandrashekhar B. Bhuyyar
Background: Detection of UTI causing pathogens and analysing resistance pattern of these pathogens to commonly prescribed antibiotics in the clinical practice is essential and helpful in improving the efficacy of empirical treatment. Objectives: this study was conducted to analyse the current trend of antimicrobial drug resistance pattern of bacteria isolated from patients of urinary tract infection. Methods: A total of 120 positive urine culture and sensitivity reports of either sex and all the age groups were analysed. Sensitivity/resistance of isolated microorganisms to commonly used antimicrobial agents was detected by Kirby-Bauer disc diffusion method in the laboratory. Results: E coli (50%) was the most common organism isolated followed by Klebsiella (20%), Pseudomonas aeruginosa (10%), Enterobacter (7%), Staphycococcus aureus (5%), CONS (5%) and Citrobacter (3%). The overall antimicrobial sensitivity pattern to uropathogens was the highest to FOS (70%) and NFT (70%).  Moderate susceptibility was seen with AMI (67%) and C+S (51%).Highest resistance was seen with C+C (92.5%) followed by AMP (91%), and other Penicillins, AZI, other Cephalosporins, Fluoroquinolones, COT. Conclusion: This study provides valuable laboratory data to monitor the status of antimicrobial resistance among uropathogens and to improve treatment recommendations in a specific geographical region. From the study, it is clear that, E. coli is still the most common uropathogen. Sensitivity to nitrofurantoin, fosfomycin and amikacin are still retained and may be prescribed for complicated UTI, hence they should be used as a reserve antibiotics to prevent the development of resistance.

25. A Study of Clinical Profile, Characteristics and Outcome of Patients Presenting with Chest Pain to the Tertiary Care Center (Teaching Hospital), Belagavi
Raju Talawar
Introduction:  Chest pain may be a symptom of a number of serious conditions and is generally considered a medical emergency. Patients presenting with chest pain are a common daily occurrence in emergency medicine. Chest pain is quite common and up to 25% of the general population experience it in some form during their lifetime. The causes for cardiac-mimicking chest pain are numerous, but the most common causes can be narrowed down by system: musculoskeletal, gastrointestinal, psychological, and pulmonary. Proper management of non-cardiac chest pain is also important for patient well-being and it also reduces health care costs and increases the quality of life of patients. Objectives: To study the clinical profile, characteristics and outcome of patients presenting with chest pain to tertiary care centre (teaching hospital), Belagavi. Methods: The Observational Cross-Sectional study was conducted on 200 patients presenting to the tertiary care centre (teaching hospital), Belagavi from January 2018 to December 2018, among patients presenting with chest pain who satisfied the inclusion criteria. Results:  Out of 200 patients who reported to the emergency department with complaints of chest pain, 74 (37%) patients had CVS cause of chest pain, 48 (24%) had GIT cause, 46 (23%) had MSK cause, 18 (9%) had a respiratory cause, 10 (5%) had psychiatric cause and 4 (2%) patients had other causes of chest pain. Conclusion: As chest pain is the most common symptom in general practice and the present study also suggests that cardiac causes should be considered as the prime cause until they are ruled out. Therefore thorough history and physical examination should be part of the initial evaluation of all patients with chest pain.

26. Study of Effect of Zinc on the Diarrhea among Breast Feeding Babies of Maharashtra: A Study from Central India
Pankaj Kumar Jain, Amarjeet Singh
Background: Zinc deficiency can have a significant impact on general immune function, increasing susceptibility to diarrhea-causing organisms such as parasites, bacteria, and viruses. Aims & objectives: To investigate the effects of zinc on diarrhoea in Maharashtra’s breast-fed babies. Method: 180 diarrhea-affected breast-feeding babies aged 6 months to 2 years were studied and compared to 180 control breast-feeding babies of the same age. The babies were given a zinc supplement in the form of an oral syrup containing 10 mg of zinc per day (2.5 ml once daily), while the control group was given a placebo. Three follow-ups (at 6, 9, and 12 months) were completed, and the results from each follow-up were compared in both groups. Results: The interventional group had 176 (3.8) total episodes between 6 and 9 months, while the control group had 130 (4.8). Similar to the comparison between 9-12 months between two groups, the t test was 36.7 and the p value was very significant. The intervention group’s mean value was 172 (3.4), while the control group’s was 122 (4.5), with a t test of 42.05 and a p0.000 value. Conclusion: Zinc is also important for the maintenance of gut mucosal cells, according to this study. Zinc supplementation dramatically lowers the morbidity associated with diarrhea in breast-fed neonates by blocking baso-lateral potassium (k+) channels, inhibiting CAMP, inducing chloride-dependent fluid production, and maintaining mineral normality in the body.

27. Neurilemmoma Nose: Nasal Polyp, Always Needs a Histopathological Evaluation
Sunda Priya, Mali Neha, Vyas Surendra Prakash
Background: Neurilemmoma also known as Schwannoma, is one of the most common benign peripheral nerve sheath tumors. The Head and Neck region is the fare common site for the occurrence of schwannoma. The tumors arising from the nasal septum are extremely rare to be reported as Schwannoma. Incidence is 1 in 3000 schwannomas. Case Report: We report a case of a 62-year-old male who presented in ENT OPD with the complaint of a painless mass in the left side of the nose, obstructing the airway and causing difficulty in breathing. On clinical and radiological evaluation, a diagnosis of the nasal polyp was made. On histopathological examination, the diagnosis of neurilemmoma was confirmed. Discussion and Conclusion: We reported a 68-year-old male patient with nasal polypoidal lesion as shwannoma. Schwannoma of the nose is a rare entity, which should be evaluated histologically, and other differential diagnosis must be excluded. Although it’s a benign tumor, it’s the extent and bony erosion should be determined radiologically, and any malignant transformation changes should be kept in mind. In our case, the lesion was surgically excised completely, and recurrence was not seen after that.

28. Secretory Carcinoma of Breast in Elderly Patient: A Case Report
Neha Mali, Priya Sunda, S. P. Vyas, Vanita Kumar
Introduction: Secretory breast carcinoma (SBC) is a rare variant of invasive breast carcinoma comprising less than 0.015% of invasive breast cancers. It is identified by its distinct histomorphology owing to the copious intra- and extracellular secretory material seen on histologic analysis. Case Report: A 72-year-old female presented to surgical OPD with a complaint of a recurrent palpable mass in the left breast. She first noticed the lump in her upper inner quadrant of her left breast with pain and nipple discharge, in 2015 when on fine needle aspiration was diagnosed with low-grade carcinoma of the breast. The patient did not consent to excision and was treated conservatively. FNAC was again repeated in 2018 which showed ductal carcinoma of papillary type. Now patient complains of an increase in the size of the lump with pain. Only a single palpable lymph node was identified on physical examination. On ultrasonography, there were multiple dilated ducts with heterogenous hypoechoic mass measuring approximately 32x20x10 mm in the upper inner quadrant of the left breast suggestive of intraductal papilloma or carcinoma. The tumor is mainly comprised of microcysts and glandular structures that contained secretory material in their lumen. At high magnification, the tumor cells were mostly medium-sized with round and oval nuclei and inconspicuous nucleoli generally contained abundant cytoplasm and were vacuolated or eosinophilic granular in appearance. A preliminary diagnosis of secretory carcinoma was made. PAS and D-PAS stains were performed. The secretions and cytoplasm stained positive with PAS and were also D-PAS positive. Immunostaining for ER / PR / HER2 was negative. Based on microscopic findings, special stains and triple-negative status, the diagnosis of secretory carcinoma was approved. Conclusion: In this report, we reported an elderly patient with recurrent secretory carcinoma of the breast which remained dormant for more than 7 years without any distant metastasis and the patient survived with only symptomatic treatment. Although secretory carcinomas as shown in this case tend to recur and should be treated with surgical options whenever not contraindicated.

29. Evaluation of Analgesic Property of Ethanolic Extract of Mimosa Pudica Leaves in Swiss Albino Mice
Shruthi, Sharath Kumar K, Sanat Udyavar
Introduction: Pain is a localized or generalized, unpleasant sensation that causes a person physical discomfort or mental stress. It is a multi-dimensional experience which involves both the sensory and affective components. Many unpleasant feelings are associated with pain. Analgesia is the absence of pain in response to stimulation that would normally be painful. Mimosa pudica is a source of natural origin which has numerous medical benefits and has a tremendous future potential for research. The present study was undertaken to screen for analgesic property of Ethanolic Extract of Mimosa pudica (EEMP). Objective: To evaluate the potential analgesic effects of Ethanolic Extract of Mimosa pudica leaves on thermal induced pain in Swiss Albino mice. Materials and Methods: Swiss albino mice of either sex weighing 20-30 g were used. Thirty mice were divided into 5 groups each having 6 mice. Group 1 received normal saline (10 ml/kg per oral.). Group 2 received Pentazocine (standard 10 mg/kg intra peritoneal.). Group 3, 4 and 5 received test compound Ethanolic Extract of Mimosa pudica in doses 100 mg/kg, 200 mg/kg, 400 mg/kg per oral respectively. Analgesic property was evaluated using Eddy’s Hot plate method on day 1 and day 10. Results: The study showed increase in reaction time in Eddy’s Hot plate method on day 1 and day 10 in EEMP treated groups when compared with control group. Conclusion: The study suggests that Ethanolic extract of Mimosa pudica (EEMP) has analgesic property and can be considered for use in treatment of pain after further testing.

30. Evaluation of Anti–Inflammatory Activity of Ethanolic Extract of Mimosa Pudica in Swiss Albino Mice
Sanat Udyavar, Sharath Kumar K, Shruthi
Introduction: Inflammation is a common physiological event that leads to acute or chronic pain in response to tissue injury. It serves as a mechanism for initiating the elimination of noxious agents and damaged tissue. Herbaceous plants are one of the more important sources of biologically active compounds that are known to have and are being used for therapeutic benefits. In recent times, emphasis on medicinal plants has gained momentum since many studies have proved tremendous therapeutic potential in medicinal plants. Mimosa pudica is a creeping herb growing annually or perennially. In Ayurveda it has been identified as lajjalu and has been found to have antiasthmatic, aphrodisiac, analgesic, and antidepressant properties. Previous studies have revealed sedative, emetic, and tonic properties of M pudica and traditionally it has been used in the treatment of various ailments including alopecia, diarrhea, dysentery, insomnia, tumor, and various urogenital infections. Phytochemical studies on Mimosa pudica have revealed the presence of constituents like alkaloids, non-protein amino acid (mimosine), flavonoids C-glycosides, sterols, terpenoids, tannins, and fatty acids. Mimosa pudica is a source of natural origin which has numerous medical benefits and has a tremendous future potential for research. Objective: To evaluate the acute and subacute anti-inflammatory effects of Ethanolic Extract of Mimosa pudica leaf on carrageenan induced paw edema in Swiss Albino mice. Materials and Methods: Swiss albino mice of either sex weighing 20-30 g were used. Thirty mice were divided into 5 groups each having 6 mice. Anti-inflammatory activity using Carrageenan induced paw edema method. Group 1 was the Control group and received normal saline, Group 2 received standard drug – Diclofenac at 10 mg/kg, Group 3, Group 4 and Group 5 received test drug EEMP at doses of 100 mg/kg, 200 mg/kg and 400 mg/kg respectively. Anti- inflammatory potential of EEMP was evaluated on day 1 and day 10 by measuring paw volume using plethysmograph by dipping the hind limb up to the marked level after 1 hour, 2 hours, 3 hours, 4 hours and 6 hours following the administration of drugs. Results: Ethanolic Extract of Mimosa pudica showed reduction in paw edema in a dose dependent manner. Conclusion: The study suggests that Ethanolic extract of Mimosa pudica (EEMP) has anti – Inflammatory property and can be considered for use in treatment of pain after further testing.

31. A Cross Over Study to Establish Effectiveness of Phenol Blocks to Peripheral Nerve in Reducing Spasticity in Traumatic and Non-Traumatic Brain Injured and Spinal Cord Injured Patients
E. Rajendra Kumar, Rama Santharam Kaja, Suranjan Bhattacharjee, George Tharion
Aim: To Study phenol block to peripheral nerves, in patients with traumatic and non-traumatic brain injury and spinal cord injury, resulting in reduction in spasticity as measured by the modified Ashworth scale. Material & Method: This study was conducted in the Department of Physical Medicine & Rehabilitation Tertiary Care Hospital, Telangana State, during the period March 2016 to January 2018. Results: There were more male patients (18) compared to females (2), Spinal cord injury is the common etiology of neurological spasticity. Conclusion: There is a significant improvement in the range of movement of joints after blockade of spasticity using phenol and there was a 5% incidence of adverse effect (pain) following administration of phenol during the period of this study.

32. A Study on Prevalence of Transfusion Related Infections amongst Voluntary Blood Donors in a Tertiary Health Care Centre
P Madhavi, P Anuradha, Srikanth T, K. Rajani Kumari, P. Swaroop
Background: In several medical and surgical circumstances, blood transfusion is a life-saving intervention. In addition to its relevance for the medical treatment of each patient, transfusion medicine has a substantial impact on public health. Aim: The purpose of this research is to investigate the seroprevalence of HIV, HBV, HCV, SYPHILIS, and Malaria amongst voluntary blood donors in a tertiary health care facility. Material and Methods: The current research was conducted at the Kakatiya Medical College, MGM Hospital Warangal, Department of General Medicine. The study was conducted between December 2019 and November 2021. By using the ELISA approach, 300 volunteer blood donors (270 males, 30 females) aged between 18 to 50 years were evaluated for the presence of HIV, HBV, HCV, syphilis, and malaria. Observations and Results: 90% of the 300 volunteer blood donors were men, whereas 10 % were women. 2.667 % were positive for transfusion-related infection. The most common infections among blood donors were HBV1% and HCV1%. HIV is 0.33 %, malaria is 0.33 % and no cases of syphilis were found. Conclusion: Blood transfusion is an essential and life-saving procedure in critical care medicine, which depends on the supply of safe blood made available to those who are in need. Vigorous screening of blood donors and donated blood may help accomplish this goal.

33. Screening of Pulmonary Tuberculosis in Newly Detected HIV Patients in a Tertiary Care Hospital
Anuradha, P. Sammaiah, Pratibha Lakshmi, Kondle Venkatesh, K. Harsitha
Background: AIDS disease was recognized in male and female injection drug users and blood transfusion recipients; among female sexual partners of men with AIDS; and among infants born to mothers with AIDS. In 1983, human immunodeficiency virus (HIV) was isolated from a patient with lymphadenopathy, and by 1984 it was demonstrated clearly to be the causative agent of AIDS. Aim of the study: To screen for pulmonary tuberculosis in newly detected HIV cases. Material & Methods: The present study was conducted in a Tertiary Care Hospital of Telangana State CBNAAT test was done for all newly HIV positive cases, who attended hospital/ ART centre on OPD basis from April 2019 to March 2020. Results: 18 to 30 years age group constitutes majority (37.9%), Males constitutes majority (57.9%), majority of cases are TST negative (74.6%) and Sputum smear negative (83%). Conclusion: CXR findings (61.6%) and symptoms (57.5%) have high sensitivity; most common presentation was infiltrates (34.6%) in both symptomatic and asymptomatic cases. Among the study population, smear negative TB were more (83%) and tuberculin skin test negative were more (74%) indicating low sensitivity.

34. Comparison of Intubating Conditions and Haemodynamic Responses in Rapid Sequence Induction using Rocuronium Verses Rocuronium with Ephedrine Pre-Treatment
Madhavi Latha Pinnelli, Voviliveni Srikala, B Srinivas
Background: The fastest acting non-depolarizing muscle relaxant currently is rocuronium, it may be used instead of suxamethonium for rapid sequence intubation. According to reports, rocuronium at doses more than 0.9 mg/kg provides intubating circumstances at 60 seconds that are comparable to those seen with suxamethonium, but with a longer duration of action. Methods: Based on the inclusion and exclusion criteria a total of n=60 cases were included in the study, and they were allotted in two separate groups randomly by a computer-generated random number. Group I n=30 cases patients received rocuronium 0.6mg/kg with pre-treatment of saline. Group II n=30 cases received rocuronium 0.6mg/kg with pre-treatment of ephedrine 100mcg/kg. Results: In group I, the patient’s heart rate increased from the baseline up to 3 min after intubation (P<0.05) and came to below the baseline value during the fourth and fifth minute after intubation (P>0.05). In group II patients, heart rate was significantly high from the baseline value during all the time intervals (P<0.05) and heart rate did not reach the baseline or below the baseline when compared to group I, which can be explained by the fact that group II received ephedrine pre-treatment which might have counteracted the fall in heart rate when compared to group I. When compared clinically heart rate variability was within 30% of the baseline value in both groups. Conclusion: In this study the hemodynamic responses, but for raise of 25% in the heart rate in the ephedrine group other parameters were normal in both groups. Although both groups had clinically acceptable intubating conditions, rocuronium with ephedrine pre-treatment group had better intubation scores. Therefore, the quality of intubation with rocuronium – ephedrine group is better than with rocuronium. None of the patients had any adverse reaction to the drugs used and no critical incident was encountered during the study.

35. Thenar Flap: A Study of 20 Cases of Industrial Fingertip Injuries, Functional and Aesthetic Outcome
Raghuram Prasad, S. Kiranmai, Fatima Heba Habeeb, B. J. V. Ramana
Background: Fingertip injuries are the most common injuries, predominant in the industrial production activities. Treatment of fingertip injuries should be based on specific tissue losses. Thenar flaps provide adequate glabrous and durable soft tissue to restore the pulp. Aims & Objectives: Present study demonstrates distinct advantages of thenar flap used for finger pulp reconstruction and evaluates functional and aesthetic aspects of thenar flaps. Materials and Methods: Patients with acute fingertip injuries attending the emergency department of a super speciality hospital which is amidst an industrial zone were included in this prospective study. Thenar flap design was customised according to the defect. Following flap inset, the finger was immobilised in palmar flexion and flap division was performed after 3weeks. Further follow up for assessment of aesthetic (static 2-point discrimination) and functional outcome was done upto six months. The results were analysed by unpaired t-test. Results: A total of 20 fingertip injuries were reconstructed with thenar flap. The sensory assessment at the thenar flap was 2-8mm with mean 5.6+/-1.2. The range of movement was found to be 95-110, 90-100 degrees with mean 98.5+/-2.1, 92.5+/-3.2 at Metacarpophalangeal (MPJ) and Proximal interphalangeal (PIP) joint respectively. During follow up, temporary joint stiffness occurred in two patients, which recovered with strict physiotherapy. No long-term complications, and good patient satisfaction were observed. Conclusion: When proper principles of flap design, care of wound and early mobilization are followed, excellent outcomes can be expected with thenar flaps.

36. Maternal and Perinatal Outcome in Antepartum Eclampsia- A Prospective Observational Study
Rajib Pal, Bandaru Sreelatha, Rinku Adarshi, Subodh Kumar Hansda
Background: In this study, we wanted to find out the magnitude and pattern of maternal morbidity, analyse the clinical profile and management of antenatal eclampsia and determine the maternal and perinatal outcome including morbidity and mortality. Materials and Methods: This was a hospital based prospective observational study conducted among pregnant women admitted with or who developed antepartum eclampsia in the antenatal ward of the Department of Obstetrics and Gynecology, Deben Mahata Sadar Hospital, Purulia, West Bengal, and the new-borns of those antenatal eclamptic mothers, during the study period (September 2018 to August 2019). Results: Antepartum eclampsia results in adverse maternal outcomes like preterm delivery, stillbirth, caesarean section, maternal complications, and mortality. Further it also results in adverse neonatal outcomes including low birth weight, low APGAR (appearance, pulse, grimace, activity and respiratory rate) score, need for resuscitation, neonatal intensive care unit (NICU) admission, early neonatal complications, and early neonatal death. Conclusion: Eclampsia is still major cause of not only maternal mortality and morbidity but even neonatal morbidity and mortality in the study area. Antepartum eclampsia results in adverse maternal outcomes like preterm delivery, stillbirth, caesarean section, maternal complications and mortality.

37. Burden Borne by the Primary Caregivers of Patients Seeking Treatment for Alcohol and Opioid Dependence
Padma Angmo, Manish Borasi, Rajesh Kumar, Ajay Thangaraj
Background: Alcoholism and opioid dependence is a major threat to the individual as well as the society and the maximum burden of the illness is borne by the family. Aim: The study is aimed at assessing the pattern of burden on the caregivers of alcohol dependent patients and at assessing the relationship between the severity of dependence and the burden on caregivers. Materials and Methods: Cross-sectional descriptive study conducted in the Department of Psychiatry at Institute of human behaviour and Allied Sciences.  A cross-sectional assessment was done in 60 patients with alcohol and opioid dependence and their caregivers. The severity of dependence and the pattern of burden on caregivers were assessed. Results: The study demonstrates that caregivers of alcohol dependent patients reported significant objective burden and subjective burden. Furthermore, the severity of alcohol dependence and the domains of burden such as financial burden, disruption of family interaction, and disruption of family routine activities were positively correlated with high level of significance. Conclusion:The current study has illustrated that all the caregivers experienced significant amount of burden which has to be addressed for better treatment outcome of the patients.

38. A Hospital Based Assessment Incidence of Various Types of Hernia and Factors Responsible
Sanjay Kumar
Aim: The purpose of the present study was to analyze various etiological factors responsible for incision hernia. Methods: The present study was conducted in the Department of General Surgery, Sri Ramkrishna Institute of Medical Sciences and Sanaka, Hospital, Durgapur, West Bengal, for the period of 1 year .Out of 200 cases of various types of hernias operated a total of 60 cases of incisional hernias were studied and followed for a period varied from 6 months to 18 months. Results: During the period of our study, a total of 200 patients have been operated for various types of hernia, out of these 60 cases were incisional hernia. Inguinal hernia was most common type accounting for 45%, next common hernia was incisional hernia (30%) remaining rare type of hernias constituting 25% of total cases studied. Maximum number of cases in middle age group (30-60 yrs.) constituting 71.66 %. Conclusion: Hence the incidence of the incisional hernia can be decreased by preventing these factors. Incidence of incisional hernia is more common in the age groups 30-50 years. Incidence of incisional hernia is more common in females especially due to abdominal wall weakness secondary to multiple pregnancies, increased number of caesarean sections and gynaecological surgeries.

39. A Prospective Etiological Assessment of Hypersegmented Neutrophils in Peripheral Blood Smear
Nivedita Singh, O.P.Dwivedi
Background: Hypersegmented Neutrophils Are Usually Associated With Deficiency Of Or Failure To Utilize Cobalamin Or Folate And Impaired DNA Synthesis Is The Accepted Mechanism For The Morphological Changes Seen In Megaloblastosis. Material & Methods: This Is A Prospective Study Conducted In Department Of Pathology, NMCH, Patna, Bihar, India, From April 2018 To March 2019. Results: Cases Were Further Analyzed For Associated Peripheral Smear Picture. Although Major Cases Were Contributed By Macrocytic Anemia, 46 Cases Were Having Microcytic Hypochromic Anemia. Out Of The 120 Cases, Only 4 Had Thrombocytopenia. 91 Cases Had Platelet Count In The Normal Range. Conclusion: The Present Study Indicates That Other Than The Already Established Causes Of Neutrophil Hyper Segmentation, Microcytic Hypochromic Anemia, Myelodysplastic Syndromes And Inflammatory Conditions Also Can Cause Hypersegmented Neutrophils In Peripheral Smears.

40. Current Situation in India for Central Nervous System Imaging Findings in HIV/AIDS
Urvil A. Shah
Background: India has the second-highest burden of HIV-related pathology after Sub-Saharan Africa. One of the primary targets of the neurotropic human immunodeficiency virus is the central nervous system (HIV). Despite the fact that there have been many in-depth research on the subject, HIV and AIDS are still prevalent. Aims & objectives: This study was started to determine the current state and range of neurological diseases associated with HIV/AIDS and to clarify how magnetic resonance imaging (MRI) helps to characterize and distinguish disorders of the central nervous system. Materials and Methods: This cross-sectional descriptive study was conducted in city of Dahod, Gujarat , India, at a Tertiary Care Diagnostic Centre affiliated with the Department of Radiodiagnosis of Zydus Medical College & Hospital, Dahod, Gujarat ,India . MRI was performed on 120 seropositive individuals who had neurological complaints, and the imaging results were examined. Results: 51.6% of the participants in our study were over 40, making up the age group with the highest prevalence. More men (65%) than women (35%) were impacted. Opportunistic infections were found in 60% of cases, while HIV-induced primary neurological disease was observed in 25% of cases. Tuberculosis was the most prevalent opportunistic infection in HIV, followed by PML (22%), toxoplasmosis (14%), and fungi (6%). In 5% of instances, primary CNS lymphoma was discovered. Fever (41.6%) and altered sensorium (33.3%) were the two most frequent presenting symptoms at the time of admission. In our investigation, TB was the most frequent cause of meningitis. The most frequent causes of infarction (focal neurological impairment) were thought to be HIV vasculopathy and tubercular meningitis. Conclusion: We got to the conclusion that Tuberculosis is still the most common CNS pathology found in HIV/AIDS in India. In the absence of any contraindications, MRI should be thought of as one of the first lines of investigations in a seropositive patient with neurological complaints. MRI is an excellent way to detect and characterize brain lesions in AIDS.

41. Exploring the Clinical Signs of Cholelithiasis and How They Relate to Histological Results
Ashish Manoharao Dagwade
BackgroundOne of the most common gastrointestinal ailments and a major financial strain on the healthcare system is gall stone disease. Gallstone formation is facilitated by the bile becoming concentrated and the gallbladder not emptying completely and frequently. Aims & Objectives: In the current study, we sought to examine the clinical characteristics of cholelithiasis and their relationship to histological results. Material and Methods: The current investigation was an observational, prospective, hospital-based study that examined patient gall bladder samples who had already received a cholelithiasis clinical diagnosis. Results: There were 200 total specimens examined. In the fourth decade, there were the most cases. 64 men (32%) and 136 women (68%) participated in our study. With a male to female ratio of 1:2.1, there were more females than men. With a ratio of 5.6:1, non-vegetarians were more negatively impacted than vegetarians. In our study, 35% of subjects with a BMI >30 kg/m2 were obese. In 110 patients (or 55%), pain in the right hypochondrium was the most prevalent symptom. In 80% of the instances, multiple stones were the most frequent stones seen. Gross examination revealed that the gall bladder was thicker in 57% of cases. In our investigation, the gallstones ranged in size from 0.2 to 3 cm, with the majority measuring 0.2 cm (25%). In our investigation, chronic nonspecific cholecystitis was the most prevalent lesion, occurring in 80% of cases. The most frequent types of stones in patients with chronic nonspecific cholecystitis were mixed stones (71%). In follicular cholecystitis, pigment stones were common (8%); in xanthogranulomatous cholecystitis, both pigment and cholesterol stones were present (1%). Conclusion: Females and non-vegetarians are more likely to have cholelithiasis. The bulk of the instances had multiple stones, and biochemical research revealed that most of the stones were mixed varieties.

42. Study of Histopathological Patterns of Endometrium in Abnormal Uterine Bleeding
Prashant N. Deore, Nilesh R Sonawane, Dhananjay V Newadkar
Background: Abnormal uterine bleeding (AUB) is a common gynecological complaint which has significant morbidity as well as plays an important role in affecting patients’ personal and social life. The aim of this study was to analyze histo-morphological patterns of endometrium in patients with complain of AUB and also in determining the incidence of AUB in various age groups. Material and Methods: This is a prospective study conducted with 156 endometrial specimens with clinical diagnosis of AUB in the department of pathology, ACPM Medical College, Dhule, Maharasthra. Analysis was done in the form of percentages and proportions and represented on tables wherever necessary. Result: Majority of patients were from 46-55 years age group. Most common complaint was menorrhagia which accounted for 47%. Moreover commonest pathology observed in the study was endometrial hyperplasia. Conclusion: On evaluation from the samples collected, incidence of AUB was seen in different age groups. In patients with no organic pathology, normal physiological patterns with proliferative, secretory, and menstrual changes were observed.Histopathological evaluation of endometrial samples was done to rule out malignancy and pre-neoplasia.

43. Ascitic Fluid Cytology in Establishing Diagnosis: A Prospective
Prashant N. Deore, Dhananjay V Newadkar, Nilesh R Sonawane
Introduction: Ascitic fluid cytology is the most efficient as well as reliable mode for the diagnosis of cause of ascites. Malignancy could be ruled out by ascitic fluid cytology with consideration to the clinical presentation and previous history. This study is conducted aiming to study cytology of ascetic fluid in various diseases to establish clinic-cytological correlation for better management of patients. Material and Methods: A total of 115 samples were collected and was subjected to various physical as well as biochemical and cytological examination done in the department of pathology. Result: From the samples collected and analysed, 81.74% were cytologically non malignat and the remaining 18.26% were malignant. Moreover 62.61% were females and 37.39% were males. Transudative and exudative effusion accounted for 66.95% and 33.04% respectively. Most of the malignant effusions were exudative. Conclusion: This study concludes that most useful tests used in establishing the diagnosis of peritoneal effusion are peritoneal fluid cytology and peritoneal fluid cell count. It is a complete diagnostic modality which aims at pointing out the etiology of effusion as well as in certain cases a means of prognostication of the disease process. Non-malignant causes are more common causes of peritoneal effusion.

44. Profile of Snake Bite Induced Acute Kidney Injury in Indian Population: A Systematic Review
Venkataravikumar Chepuri, Bhargav Chandan Sumanth T., Madhu Sai S.
Snakebite deaths and disability is a major public health challenge in India. India has more than 300 species of snakes, of which 60 are labelled venomous or mildly venomous. India has the highest number of deaths because of snakebites in the world. Data regarding the actual number of SAKI and requiring HD and their complications are inadequate in our country. This study aimed to study the profile of snake bite induced acute kidney injury in Indian population. A systematic search was conducted to identify papers published in PubMed, Google Scholar and Cochrane electronic databases from January 2017 to March 2022 with the PRISMA statement. Totally, 1377 were listed in our review. After removing duplicates, not accessible, incomplete, subscription articles only 13 studies were found eligible for the present systematic review. The study findings indicate that the most common snake causing acute kidney injury is viper. Mortality is less in patients underwent early hemodialysis.

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