International Journal of

Toxicological and Pharmacological Research

e-ISSN: 0975 5160

p-ISSN: 2820-2651

Peer Review Journal

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1. Clinical Outcome after Microscopic Assisted Antegrade Parotidectomy: A Retro-Spective Observational Study
S. K. Pippal, Dinesh Kumar, Vrashabhan Ahirwar, Jaymala S Malbhage
Aim objective: The most common type of benign salivary gland tumor is Pleomorphic adenoma. 75% of such tumors occur in the parotid glands. During parotid surgery identification and preservation of facial nerve trunk and its branches is very important. Advancement of microsurgical technique has helped in better visualization, identification and preservation of the facial nerve. Methods: This is retrospective observational study on twenty- eight patients. Preoperative ultrasonography and fine needle aspiration cytology were done for all cases. Computed tomography/magnetic resonance imaging were performed in some cases when needed. Standard surgical technique antegrade parotidectomy was performed by using with microscope. Data analysis was done using SPSS. Results: The patient’s age ranged from 20 to 70 years. 57.14% patients were male and 42. 86% were females. In Seventeen patients, a 60.71% tumor was located on the right side whereas in 11 patients, (39.28%) it was on the left side. Most of the tumors were Pleomorphic adenoma (78.5%). Most commonly performed surgery was superficial parotidectomy (89.28%). Postoperative 7.14% patients had temporary facial paralysis, 3.57% patient had developed a flap necrosis and 3.57% had permanent facial paralysis. Frey’s syndrome was found in none in follow-up. Conclusion: The surgeon’s experience is the main guarantee for facial nerve preservation and low recurrence rates during parotidectomy. Our study found that microscopic assisted antegrade parotidectomy led to fewer complications than reported with conventional methods. The use of a microscope in surgery may represent a useful tool in improving accuracy and minimizing local tissue trauma and thus decreasing facial nerve paresis.

2. An Observational Study on Assessment of Effect of Estradiol Valerate on Endometrial Thickness during Clomiphene Citrate Induced Ovulation
Kumari Anshulata, Avishek Bhadra, Gokul Raman Chandran, Sujata Dalai, Pallab Kumar Mistri
Background: Clomiphene citrate is a first line therapy for ovulation induction in polycystic ovarian syndrome (PCOS) with anovulatory infertility. The drug binds and blocks estrogen receptors and is thought to have an anti-estrogenic effect on endometrial volume thus may have adverse effects on fertility despite good ovulation rates. Hence to counteract anti-estrogenic effects of clomiphene on endometrium, estrogen was added in the proliferative phase in clomiphene citrate induced ovulation and its effects on endometrial thickness and pregnancy rates was studied. Methods: A hospital based observational prospective study was done at Medical College and Hospital, Kolkata in the department of Obstetrics and Gynaecology. Study period was 18 months and the sample size was 45. Results: In our study we found that the endometrial thickness improved after adding estradiol valerate and among the study population 31.1% patients achieved pregnancy and among those who achieved pregnancy, frequency of live birth was more compared to abortion. Conclusions: Adding estradiol valerate to clomiphene citrate induced ovulation produces a favorable endometrial response in infertile women with anovulatory cycle.

3. Treatment Outcome of Nonunion Fracture of Long Bone through Limb Reconstruction System
Pravin P Patel, Ajaysinh Devda, Ajay Yadav, Harsh Patel
Background and Aim: “Established when a minimum of 9 months” is how non-union is defined. Three months have passed since the fracture first became injured, and nonunion has occurred. The study’s objective was to evaluate the results of the limb reconstruction system’s use in treating infected long bone nonunion both prospectively and retroactively in order to determine the system’s true utility. Materials and Method: This study, which was done retrospectively at General Hospital and its affiliated medical college, involved 60 patients who were treated at our facility and ranged in age from 24 to 75 years old (with a mean age of 43 years). Results: 60 cases of infected non-union using limb reconstruction system over the past three years were included in the study. Of the 60 patients, 22 patients acquired infected nonunion after prior implant procedures for closed fractures, while 38 patients developed infected nonunion following open fracture. Our case follow-up ranged from six to twenty-four months. Conclusion: In the current trial, we were able to reach an 80% success rate, providing the majority of our patients with positive, optimistic outcomes. Thus, we draw the conclusion that the Indian adaptation of the Limb Reconstruction System is an efficient and practical method for the treatment of infected long bone nonunion. This can also be utilised to simultaneously fix limb length disparities that may develop during treatment.

4. Prevalence and Pattern of Self-Medication Practices in Patients at a Tertiary Care Centre: A Cross-Sectional Study
Garg Y, Kumar K, Kumar A, Gupta A, Agnihotri D, Kumar S
Introduction & Background: Self-medication is prevalent worldwide. The practice of self-medication has been extensively researched in published literature for medical ailments but there is dearth of information about this malpractice among dental patients. Objective: This study was planned to determine the prevalence and pattern of self-medication, drugs that are frequently self-medicated and the reasons for resorting to self-medication among dental patients. Methods: This was descriptive cross-sectional study among 377 dental patients of a tertiary care centre. After obtaining institutional ethical approval and informed consent from each participant, data was collected via direct interview and analyzed for prevalence, knowledge, attitude and practices of self-medication. All the data was tabulated, analyzed, results expressed in percentages. Results: Prevalence of self-medication in our study was 68.96% (260/377). It was higher in males than females. Most common diagnosis was dental caries followed by periodontitis or dental abscess. The most frequently used drugs were analgesics (73.46%), followed by antimicrobials (6.54%) for chief complaints of pain, fever, or infection by selecting drugs from their previous prescription (41.54%) for various reasons most commonly attributed to easy availability of medicines at pharmacies (44.62%). It is of concern that more than half of them (54.23%) were unaware of the drugs that they were consuming and the hazards of self-medication. Furthermore, majority saved the remaining drugs for later use (82.60%) and admitted that they are likely to indulge in self-medication within next 6 months (78.08%) and/or recommend drug(s) to family members or friends (53.46%). Conclusion: Prevalence of self-medication is high in dental patients. Hazards of self-medication are enormous chiefly gastrointestinal adverse effects, renal or hepatic damage with analgesics & the global emergence of multidrug-resistant pathogens with the use of antimicrobials in suboptimal dose or for inadequate duration. Our study highlights the urgent need for monitoring of drug use & dental health education to limit the hazards of self-medication and antimicrobial resistance.

5. A Study of Learning Approaches in Undergraduate Medical Students
Shivaleela Barawade, Nishikant Ingole, Akshay Dahiwele, Drakshayini Kokati
Introduction: One among various methods adopted by students in the process of seeking knowledge is a learning approach. Learning approach of students will be of concern to the teachers and medical education experts. Methods: Total 155 second year MBBS students were included for study, out of which  143 students were participated in the study. A preformed proforma was prepared for the study which includes demographic details of the student and a R-SPQ-2F questionnaire. SPSS software was used to analysed the data. Outcome variables were described using the descriptive statistics. Mean score of two study approaches (deep & surface) was compared using the Students t-test and the internal consistency of R-SPQ-2F was assessed using Cronbach’s alpha. Results: In 130 total completed form by MBBS students 71(54.61%) were males, 59 were females (45.38%).The mean age of the students were 19.6 years. No significant difference was found in Deep and Surface learning approach in Male vs Female assessment. The deep approach score was significantly higher than those of the surface approach (33.385 Vs 24.254) (P<0.05). In subscale approaches deep motive had high score than deep strategy approaches. The cronbach’s alpha values for deep approach and surface approach were 0.668 & 0.724 respectively. The subscales had alpha values that ranged from 0.48 to 0.65. Conclusion: Our study found that learning approach preferred by students was deep approach than surface approach.

6. Role of Two-Dimensional Ultrasonographic Placental Biometry in Prediction of Small for Gestational Age Fetuses
Mimna, Raini K.P., Mini M.V., Sinni K.V.
Background: Placental insufficiency is a major contributor to the pathophysiology in small for gestational age babies. Small for gestational age refers to those foetuses whose birth weight is less than tenth centile for gestational age Early prediction and detection of foetal growth restriction is important for increased foetal surveillance. The objectives of this study were to assess the placental biometry (placental diameter and placental thickness) between 18 weeks to 22 weeks 6days gestation and compare with birth weight centiles and to analyse whether placental biometry can be used as a predictor for the development of small for gestational age babies. Objectives: (1) To assess the placental biometry (placental diameter and placental thickness) between 18 weeks to 22 weeks 6 days gestation and compare with birth weight centiles. (2) To analyse whether placental biometry can be used as a predictor for the development of small for gestational age babies. Methods: Prospective study was conducted at the Department of Radiodiagnosis, Government Medical College, Thrissur from January 2019 to January 2020 in singleton pregnancies at 18-22 weeks of gestation, placental biometry (in two dimensions) was performed. Maximal placental diameter (Max PD) and Maximal placental thickness (Max PT) was recorded in two orthogonal planes. Mean placental diameter (MPD) and mean placental thickness (MPT) was calculated. At the time of delivery, as per the birth weight the neonate was classified into appropriate for gestational age (AGA) / small for gestational age (SGA) / large for gestational age (LGA).MPD and MPT were analysed as predictors of SGA. Results: Both the Max PDs and MPD were significantly smaller in SGA pregnancies (all with p values <0.001) and Max PT and MPT also were significantly smaller (p values <0.001) in SGA babies. ROC curve plotted for MPD and MPT showed significant area under curve (AUC) 0.87 and 0.80 respectively. Conclusion: Placental measurements taken in mid-gestation are a valuable predictor of SGA. Measurement of placental diameter and thickness is quick and simple. This approach should be explored in future to develop a predictive model for growth restricted foetuses.

7. A Clinical Study of Management of Acute Intestinal Obstruction in Adults and its Surgical Outcome
Vishal Shammi, Lokesh Singh, Bhanu Pratap Rana, Kanhaiya Nayak Bhagel, Parthasarathi Hota
Objectives: Bowel blockage in patients continues to be one of the trickiest and frustrating issues that surgeons deal with today. The saying “never let the sun rise or set on a bowel obstruction” still holds true, however there has been a shift toward judicious non-operative therapy of this issue. The goals and objectives were to investigate the numerous intestinal obstruction causes and modalities of presentation and to assess the significance of various obstruction severity indicators with early recognition, diagnosis, and therefore timely abdominal exploration. Methodology: A two-year prospective study was carried out at PIMS, Udaipur, Rajasthan, India. Each patient with intestinal blockage underwent evaluation using particular severity indicators, scoring, and analysis. Results: Adhesions were the most frequent factor in 33.33% of cases of intestinal blockage in adults in this study series. 7 (11.67%) mesenteric ischaemia, 5 (8.33%) Koch’s abdomen, 5 (8.33%) sigmoid volvulus, and 5 (8.33%) cancer were the other causes. In 45.7% of instances, resection anastomosis was the most often used method, followed by adhesiolysis in 14% of patients. Patients with a score of less than 3 were handled conservatively in 66.66% of cases, while 95.83% of patients with a score of 3 or above underwent surgery. Patients are evaluated in an effort to establish whether surgery is necessary and when to perform it, in addition to confirming the diagnosis. The time of surgery can be improved and mortality can be avoided by using specific severity indicators and rating systems.

8. A Cross Sectional Study to Evaluate the Association between Hypothyroidism and Cholelithiasis
Kanhaiya Nayak Bhagel, Aryan Kanwarinder Singh, Lokesh Singh, Vishal Shammi, Mathura Prasad Agarwal
Introduction: About 10 to 15% of adults suffer from cholelithiasis, a common illness of the gall bladder. Asymptomatic cholelithiasis patients make up more than 80% of the population. Gall stone production is thought to be a result of hypothyroidism, an endocrine condition, hyperlipidemia, and motility issues affecting the bile duct and sphincter of Oddi. Our study’s goal is to find out how common hypothyroidism is among cholelithiasis patients admitted to tertiary care facilities. Method: This descriptive cross-sectional study was carried out from May 2018 to April 2019 at the Department of Surgery, Pacific Institute of Medical Sciences, Udaipur, Rajasthan. The sample size was 50, and the sampling method was consecutive non-probability sampling. The study comprised all patients with cholelithiasis diagnosed by ultrasonography, ranging in age from 20 to 70. Each piece of information, including age, gender, height, weight, BMI, and hypothyroidism, was entered into a pre-made proforma and was analysed. For numerical variables, mean and standard deviation were computed, and for qualitative variables, frequencies and percentages. A t-test was done and p-value of 0.05 was considered significant. Result: Age, height, weight, and BMI had mean values of 41.66 13, 165.15 11, 35, 68.17 11, 95, and 25.69 7.19, respectively. 47.1% of the 174 individuals with cholelithiasis belonged to the 41–50 age group. 14.4% of the patients had hypothyroidism, mostly in women. Twenty (20.6%) of the 97 female patients and five (6.5%) of the 77 male patients both had hypothyroidism. Both males and females had statistically significant hypothyroidism. Conclusion: This study looked into the connection between cholelithiasis and hypothyroidism. It was determined that female, obese, and elderly patients had a higher incidence of hypothyroidism. In contrast to all other variables, the gender distribution of the hypothyroidism in cholelithiasis patients was statistically significant.

9. Clinical Evaluation of Pectoralis Major Myocutaneous Flap Following Pharyngo-laryngeal Cancer Surgery to Reconstruct Tissue Defects
Aaryan Kanwarinder Singh, Kanhaiya Nayak Bhagel, Bhanu Pratap Rana, Subhabrata Das
Objective: To investigate the procedures and outcomes of pharyngolaryngeal cancer surgery using the pectoralis major myocutaneous flap. Methodology: The surgical approach was based on pathologic conditions in 23 cases of patients with pharyngolaryngeal cancer, and the surgical flaws were fixed using a pectoralis major myocutaneous flap. Results: Out of 23 patients, 1 had skin flap necrosis, 4 had pharyngeal fistulas, and 1 had hypopharyngealesophageal stenosis; aside from 1 pharyngeal fistula patient who passed away from infection-caused carotid artery rupture, the remaining patients all had normal swallowing function. Conclusion: The pectoralis major myocutaneous flap has a dependable blood supply and sufficient tissue volume for repair. Applying these techniques appears to increase patient survival and postoperative quality of life.

10. Norepinephrine versus Phenylephrine in Controlling Blood Pressure During Caesarean Section
Arpan Singh Muniyal, Naresh Kumar Tyagi, Pinu Ranawat, Tulsiram Karri
Objectives: Despite proper fluid loading, hypotension after spinal anaesthesia for a caesarean section is typical. To treat spinal hypotension during a caesarean section, phenylephrine is advised. Norepinephrine boluses have recently been recommended as a substitute for phenylephrine boluses. Our study’s objective was to evaluate the efficacy of norepinephrine and phenylephrine bolus dosages for treating spinal hypotension during caesarean delivery. Methodology: 50 patients getting a spinal anaesthetic for an elective caesarean section were divided into two groups at random. In order to address spinal hypotension, Group 1 patients were given a 50 mg intravenous bolus of phenylephrine, and Group 2 patients were given a 4 mg intravenous bolus of norepinephrine. The main goal of study was to compare the number of norepinephrine or phenylephrine bolus doses needed to cure spinal hypotension. Comparing the prevalence of bradycardia, hypertension, nausea, and vomiting in the mother and foetal outcomes were the secondary goals. Results: Group 1 required considerably fewer vasopressor boluses to address hypotension (1.39 0.45 vs. 2.28 1.04, P = 0.001). Although bradycardia was more common in Group 1, the difference (4% vs. 20%, P = 0.192) was not statistically significant. Shivering, nausea, and vomiting among other pregnancy problems were similar between the groups. Additionally comparable across the two groups were the foetal parameters. Conclusion: Norepinephrine intermittent boluses are useful for controlling spinal-induced hypotension after caesarean delivery. Both groups’ neonatal results were comparable.

11. A Hospital Based Prospective Evaluation of Parenchymal Thyroid Diseases with Multiparametric Ultrasonography
Sanjeev Kumar Dwivedi
Aim: The aim of the present study was to evaluate the Parenchymal Thyroid Diseases with multiparametric Ultrasonography. Methods: This study was conducted in the Department of Radio-diagnosis, ICARE institute of medical sciences and research and Dr. Bidhan Chandra Roy hospital, Haldia, West Bengal, India for 12 months. Results: Out of 200, 65% were male and 35% female most of the patients between 30-40 years 45% and followed by 40-50 years was 30%. The Distribution of patients based on diseases and each group had 40 patients. When RI values were evaluated, HM (0.49 ± 0.05) and H (0.49 ± 0.05) groups had statistically lower values than N (0.56 ± 0.05) and M (0.58 ± 0.06) groups. SWV values of EH (1.19 ± 0.18) group were statistically lower than M (1.72 ± 0.33) and HM (1.64 ± 0.42) groups and values of M group (1.72 ± 0.33) were significantly higher than H group (1.45 ± 0.38). In thyroid diseases, presence of H decreased SWV, while presence of M increased SWV. Conclusion: The present study concluded that the resistivity index, acceleration time and shear wave velocity together are reliable for differential diagnosis of parenchymal thyroid diseases.

12. A Hospital Based Prospective Clinicopathological Assessment of Mammographic and Sonographic Features of Fat Necrosis of the Breast
Sanjeev Kumar Dwivedi
Aim: The aim of the present study was to analyze the importance of mammography and sonography in fat necrosis. Methods: A prospective clinicopathological study was conducted on 50 female patients of different age groups from 30 to 60 years. Patients’ information is collected from at Department of Radiology, Icare Institute of Medical Science and Dr. Bidhan Chandra Roy Hospital, Haldia, West Bengal, India for one year. Results: Fifty lesions were identified on mammograms. The predominant mammographic features of the 50 lesions apparent on mammograms were as follows, 13 (26%) radiolucent oil cyst (either with or without curvilinear mural calcification), 6 (12%) round opacity, 8 (16%) asymmetrical opacity or heterogenicity of the subcutaneous tissues 13 (26%) dystrophic calcifications 2 (4%) clustered pleomorphic microcalcifications and 2 (4%) suspicious speculated mass. Fifty lesions were identified at sonography. The predominant US features of the 50 lesions apparent on sonograms were as follows 7 (14%) solid-appearing masses, 8 (16%) anechoic masses with posterior acoustic enhancement (cyst), 8 (16%) anechoic masses with posterior acoustic shadowing (cyst with mural calcification), 5 (10%) cystic masses with internal echoes 2 (4%) cystic masses with mural nodule and 13 (26%) increased echogenicity of the subcutaneous tissues (small cysts inside this area±). In five patients with 7 (14%) masses, no discrete lesion could be identified on sonograms. Conclusion: In conclusion, there is a wide range of mammographic and ultrasonographic patterns of fat necrosis.

13. Comparison of Buprenorphine and Dexmedetomidine as Adjuvants to Bupivacaine in Elderly Patients Undergoing Transurethral Resection of Prostate under Spinal Anaesthesia
Saroj Kanti Gam, Chitra V. R., Sanjay Sahadevan
Transurethral resection of the prostate (TURP) is a commonly performed procedure in elderly male patients. Postoperatively, these patients suffer from bladder spasms associated with using a transurethral balloon to prevent bleeding from the prostatic bed. As a result, anaesthetic techniques that provide postoperative analgesia without jeopardising patient safety must be developed. Spinal anaesthesia is a commonly used technique for these procedures, as this is the quickest and most reliable form of regional anaesthesia. Therefore, a combination of low-dose local anaesthetics along with other adjuvants can prolong postoperative analgesia. This study evaluates the sensorimotor effects of the addition of buprenorphine or dexmedetomidine to low-dose intrathecal bupivacaine in patients undergoing TURP. Aim and Objective: The aim and objective of the study were to compare and contrast intrathecal Dexmedetomidine and intrathecal Buprenorphine as adjuvants to 0.5% hyperbaric Bupivacaine for TURP surgeries. The two groups were intrathecal Dexmedetomidine and intrathecal Buprenorphine. The two groups were compared in terms of, the time required for the first analgesic request in patients, time to sensory regression to S1  and Duration of motor blockade. Methodology: It is a prospective quasi-experimental study. The study was conducted on 116 elderly patients (ASA 1 or 2) over 55 years of age undergoing transurethral resection of the prostate under spinal anaesthesia after receiving approval from the institutional ethical committee at the Government Medical College, Thiruvananthapuram. Patients were divided into two groups, Group B 58 patients and Group D 58 patients. Patients in Group B received 60 mcg of buprenorphine with 0.5% bupivacaine 9 mg intrathecally. Patients in Group D received 5 mcg dexmedetomidine with 0.5% bupivacaine 9 mg intrathecally. Result: The duration of motor blockade was found to be nearly identical in both groups with the highest statistical significance. The duration of analgesia and time to sensory regression to S1 were found to be longer in the dexmedetomidine group than in the buprenorphine group.  During the research, both groups had stable and comparable hemodynamics.  In comparison to buprenorphine, intrathecal administration of dexmedetomidine as an additive to hyperbaric bupivacaine was associated with fewer side effects.

14. A Study of Perceived Stress, Anxiety, Depression and Coping Stratergies in Wives of Patients with Alcohol Dependence
Krupa Mukeshbhai Unadkat, Bharat Navinchndra Panchal, Ashokkumar Ukabhai Vala, Sneha Bhagvanbhai Vadher, Dimple Ramankumar Gupta, Chirag Sanjaybhai Ambaliya
Background: Alcohol use disorder is quite prevalent in general population. Often the family members of alcoholics suffer intense psychological, physical and social trauma due to the core drinking problem of the family member. Most deeply affected are the wives of alcoholics. To deal with such situations the wives use coping strategies which are combined efforts of behavioral and psychological changes to reduce the stress related to their spouses drinking. Objectives: To study assess the prevalence of perceived stress, anxiety, depression assess coping strategies in wives of patients with alcohol dependence. Material and Methods: This was an observational, cross sectional, single-centered, interview based study of total 150 consecutive female aged 20-80 years whose Husbands were admitted in psychiatry ward & coming to psychiatry OPD of Sir.T.Hospital, Bhavnagar. Interview of their Husbands was taken for diagnosis of Alcohol Use Disorder using DSM- 5(Diagnostic and Statistical Manual of Mental Disorders-5) Criteria. Every subject was assessed by proforma containing demographic details, Cohen Perceived Stress Scale-10 (PSS-10), Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HRDS), Coping Inventory For Stressful Situations (CISS-21) And their Husbands’ Severity of Alcohol is Assessed By using questionnaires of SAD-Q (Severity of Alcohol Dependance). Results: Frequency of mild, moderate, severe and very severe depression is 18.67%, 14%, 10% and 8.67% depression respectively in wives of alcohol dependent males. There is significant association between emotion oriented coping and duration alcohol. There is no significant association between any coping behaviors and duration of marriage. There is significant association between task, emotion and avoidance oriented coping and education. There is significant association between task, emotion and avoidance oriented coping and anxiety, depression and perceived stress. Conclusion: Wives of alcohol dependent male patients are having high level of perceived stress, anxiety and depression. The most common mechanism of coping used is avoidance oriented coping in wives of alcohol dependent males. Duration of marriage is not having any correlation with coping mechanism. Education and socioeconomical class are having correlation with coping in wives of alcohol dependent male patients.

15. Efficacy of Ondansetron Alone and Combination with Dexamethasone in the Management of Post-Operative Nausea and Vomiting
Kalpesh Manohar Parekh, Parikshit Dinkar Salunkhe, Meera Pandey, Mukesh Bharat Parmar, Prachi Gupta, Girij Bhople
Introduction: Ondansetron, a 5-HT3 antagonist, blocks the serotonin-induced depolarization of vagal afferent neurons to produce its antiemetic and antinauseant effects. It was first created to treat cancer chemotherapy and radiotherapy-induced vomiting, but it was later discovered to be useful for post-surgical nausea and vomiting (PONV). When PONV is severe, it can cause bleeding, dehydration, electrolyte imbalance, wound dehiscence, and pulmonary aspiration all of which lengthen hospital stays and raise medical expenses. Aims and Objectives: To evaluate the efficacy of ondansetron alone and in combination with dexamethasone in the management of postoperative nausea and vomiting Methods: This is a Prospective randomized double-blind control study conducted on 170 patients who had ASA grades I and II who were in the age group 20 to 65. 170 ASA grade I and II patients undergoing elective laparoscopic surgeries under general anaesthesia were explored in this randomized clinical study. All patients were randomly assigned to IPV. Preoxygenation was done and anaesthesia was applied and ventilated with the combination of O2, air and isoflurane for 1 MAC for 3 minutes. ETCO2 monitor was connected. Monitoring was done for PONV episodes within 24 hours at fixed intervals. Results: Group A had a mean age of vs. 1. (p>0.05), which was statistically insignificant. Group A had 4 headaches, while group B had 3. Group A had no dizziness, while group B had 1. Both A and B had 1 patient with diarrhoea. No significant side-effect differences. (p<0.05). Group A had 4 headaches, while group B had 3. Group A had no dizziness, while group B had 1. Both A and B had 1 patient with diarrhoea. No significant side-effect differences. (p<0.05).  In group A, 10 (11.76%) patients vomited in 0-4 hours, versus 2 (2.35%) in group B. 11 (12.94%) patients in group A vomited within 4-8 hours, compared to 2 (2.35%) in group B. 7 (8.24%) group A patients vomited in 8-12 hrs vs. 1 (1.18%) group B patient. 4.7% of group A patients vomited in 12-24 hours, compared to 1.8% in group B. 0-4 hours, 4-8 hours, and 8-12 hours have different statistics. 0-4- and 4-8-hours antiemetic rescue (p>0.05). Conclusion: Ondansetron has shown to be a successful antiemetic drug in the prevention of postoperative vomiting and nausea (PONV), which is still a frequent perioperative complication.

16. A Hospital Based Cross Sectional Observational Study on Sexual Dysfunction and Sexual Quality of Life in Psychiatric Outpatients with Special Emphasis on Female Sexual Dysfunction
Rahul Mishra, Umesh Pathak, Amendra Kumar Singh, Rakesh Ghildiyal
Background: Sexuality is an important aspect of the personality of an individual and influences psychological, physical and social wellbeing of both men and women, sexual dysfunctions are often associated with psychiatric illness mostly due to the psychotropic drugs prescribed to the patients also duration of illness has an impact of the quality of life of these patients. It is a paradox, that in the country where ‘Kamasutra’ by Vatsyayana took birth, there is a lack of research publications and sexuality related literature. Aim and Objectives: To study sociodemographic profile, sexual dysfunction and sexual quality of life in male and female psychiatric outpatients. Method: This was a cross sectional hospital based observational study conducted at psychiatry Department, MGM Medical College, Navi Mumbai. 400 consecutive patients from the outpatient department were enrolled for the study who fulfilled the inclusion and exclusion criteria. Subjects were interviewed using a structured questionnaire. Sociodemographic details of the patients were takes and patients were asked question based on FSFI and SQOL-F for females to diagnose female sexual dysfunction and sexual quality of life. SQOL-M for male was used. Data was entered on excel sheet and analyzed on SPSS using appropriate statistical methods. Results: Study consisted of 142 females and 258 males belonging to age group 16yrs to 60yrs with minimum age of participant being 19 years and maximum age 58 yrs, 73% of the study sample were married and 27% were unmarried, 46.5% of the respondents were educated up to graduation,32% up to higher secondary, 19% were educated up to Senior secondary school, 91.5% belonged to Hindu religion ,majority of respondents were house wives 23.75% ,17.25% were self-employed, 16.75% were skilled workers, 14.5% were students. In our study 59.25% of the respondent belonged to middle class and 19.75% belonged to lower middle class. Depression was diagnosed in 28.75%, 14.75% had alcohol use disorder,13% had schizophrenia, 22% of patients had interpersonal stressors, 10% of patients had Dhat syndrome, 38% of females had lack of desire, 51.3% had arousal problems, 49.8% had lubrication problems, 40.7% had orgasm problems,35.2% satisfaction and 28.8% had pain. Female sexual dysfunction was 56.5% in our sample. Conclusion: The findings in our study suggest that large number of patients attending psychiatry OPD need to be screened for sexual dysfunction as it may be caused by medication or the illness itself, depression, schizophrenia, alcohol use disorder, BPAD were commonly associated with psychiatric illness further anti-depressants and anti-psychotics are known to cause sexual dysfunction and caution should be taken while giving these medications. Psychoeducation of the patients helps overcome many problem areas in these patients. Further research in this area is needed as there is lack of research from India.

17. Histomorphological and Immunohistochemical Study in Adrenal Masses: A Five-Year Study at a Superspeciality, Tertiary Care Centre
Asima Ajaz, Nuzhat Samoon, Maliha Afsar
Background: Primary adrenal tumours are comparatively rare in literature and requires a multi-disciplinary approach. A vast majority of these masses are benign, and only a small subset is malignant. Histopathology still remains the gold standard in their diagnosis. Material & Methods: A five-year study was conducted and included all the adrenal specimens as well as biopsies. In each case brief clinical history, relevant biochemical investigations, hormonal assays and radiological findings were recorded. The findings of H and E sections, special stains and Immunohistochemistry were compiled to arrive at a final diagnosis. Results: The study was conducted on a total of 70 cases. Majority of cases 53(75.7%) were benign whereas 15 (21.4%) cases were malignant. The age was ranging between 2-70 years. The most common symptom was hypertension followed by muscle weakness and others. VMA was the most common biochemical test done and was elevated in 16 (51.6%) cases of pheochromocytoma and other adrenal masses also. Conclusion: Adrenal neoplasms although not so common, they are encountered in routine practice, overall, they are amenable to surgical modalities and have good prognosis.

18. A Randomized Control Study of Minimal Dissection Technique and Conventional Eversion of Sac in Primary Vaginal Hydrocele
Shailesh Barbde
Background: Tunica vaginalisis is an invaginated serous sac with a visceral and parietal layer, separated by a potential cavity. A thin fluid layer is present in the cavity to lessen friction. The single layer of flattened endothelial cells that make up the lining membrane is supported by thin areolar tissue. By creating a shiny, smooth surface, it protects the testicles from damage caused by repeated contact with the medial thigh. The osmotic pressure, also known as the colloid oncotic pressure of the blood, maintains the proper equilibrium of the thick fluid in the tunica vaginalis. The volume of fluid, which is of a transudate character, increases in response to an increase in intracapillary blood pressure or injury to the capillary endothelium. The current research is a comparison of Jaboulay’s procedure and Sharma and Jhawar technique for primary hydrocele of tunica vaginalis testis. The purpose of the study was to examine the efficacy of various surgical procedures for treating primary tunica vaginalis testis hydrocele and any potential postoperative consequences. In the initial postoperative period, every patient was closely watched, and any problems were documented. Aim: A Randomized Control Investigation of Minimal Dissection Technique and Conventional Sac Eversion in Primary Vaginal Hydrocele is the purpose of the current study. Material and Method: In the present study, all clinically diagnosed and admitted cases of hydrocele, were enrolled for study after considering inclusion and exclusion criteria. In the current study, both unilateral and bilateral hydrocele are considered as a single case. The sample size was calculated by adopting the post operative complication proportion among the two surgical procedures. An exploratory calculation of sample was done for all the post operative complication where the maximum sample size was associated with the prevalence of scrotal oedema indifferent surgical procedures. Patient age, symptoms and their duration, prior medical history, full physical examination, laboratory and radiographic tests, and length of hospital stay. Patient were observed from the date of admission, pre-operatively, intra-operatively and postoperatively till the date of discharge. Data was collected from case sheets and medical records. Results: Most of the patients in both groups did not have any co-morbidity The only 2 comorbidities noted in a few of the patients were diabetes and hypertension, either isolated or combined. The maximum number of patients in both groups had unilateral hydrocele i.e., 38 and 40 in Jaboulay’s procedure and Sharma and Jhawar technique cases respectively. 9 With the exception of diabetic patients, who received 4 such doses, patients only received 2 injections of amoxicillin and clavulanic acid, which totaled 1.2g. The same postoperative analgesia protocol was used for all patients. They all received 2 doses of Inj Paracetamol 1gIV8hourlyin their immediate post-operative period. Inj Diclofenac 100 IV was kept as an SOS drug. Conclusion: Thus, it can be concluded that both procedures have comparable outcomes and can be well performed in our patient population. However, Sharma and Jhawar’s technique had a short duration of surgery, less post-operative pain, and short post-operative hospital stay than its counterpart Jaboulay’s procedure, without any added benefit with respect to the incidence of hematoma, fever, and scrotal edema, attainment of Normal size of Scrotum and cost of surgery.

19. Early Osteoarthritis of Knee an Integrated Approach to Clinical Assessment and Management
Anil Patel, Divyesh J. Chaudhari
Background: Early diagnosis of OA knee joint with detailed clinical history with the help of a simple questionnaire, X-ray evaluation, and baseline biochemical tests can help to initiate early intervention in the form of analgesics and physiotherapy with follow-up can significantly reduce the progression and morbidity due to arthritis. With the help of imaging studies, early structural changes in the disease may also be captured.. This can help in the initiation of therapy at an earlier stage and good outcome of the disease Detection of those subjects with comorbidities and with early knee, OA may offer an opportunity to successfully intervene in the disease and reduce the burden on patients and the community. Knowledge of the modifiable risk factors associated with knee OA in younger populations indirectly helps earlier identification of individuals at high risk of developing OA and also offers an opportunity to treat them successfully. Aim: To evaluate the effectiveness of an integrated approach to clinical assessment and management in the whole sample population. To evaluate the effectiveness of an integrated approach to clinical assessment and management in subsets of the sample population. Material and Method: According to the sample size calculation, a total of 50 patients were selected after screening and exclusion. Baseline characteristics and clinical scores of 50 patients were recorded. The patients were followed up after 3 months and 6 months for clinical scores. Informed written consent in a language understood by the patient was taken. Personal data, clinical findings, radiological findings, biochemical reports, and related medical records of all patients were obtained. A pre-tested semi-structured questionnaire was administered to all patients. The second part was comprised of the possible risk factors for developing OA of the knee such as age, gender, body mass index, occupation, family history of OA, physical activity, history of injury to the knee, etc. X-ray, weight, and height measurements along with all necessary investigations according to the standard protocol were done. Results: An almost equal number of elderly (above the age of 60) and non-elderly were involved in the study. Hence it could be concluded that early changes in knee OA may not necessarily be age dependent. After analyzing a total of 50 patients in the study, it was observed that there was almost an equal distribution of males and females in the study. On the evaluation of BMI of the individual patients, it was noticed that the majority of the patients belonged to either the overweight or obese class. The majority of the patients were found to be vitamin D deficient and patients were anemic. Those patients were given supplementation accordingly. Conclusion: All patients of early knee OA are presently getting benefitted from an integrated approach where clinical examination, imaging techniques, and laboratory investigations are used systematically and routinely for clinical assessment while simultaneously exercise, lifestyle modifications, and medication is used for the management of knee OA. Each risk factor associated with knee OA is studied individually as a subset and thus can be of great future research potential.

20. Rapid Detection of Drug Resistant Pulmonary Tuberculosis by Line Probe Assay at a Tertiary Care Centre in North Kerala
Sreelatha S, Kalpana George
Background: Early detection of Isoniazid (INH) and rifampicin resistance is essential for treatment and control of multidrug resistant tuberculosis (MDR-TB). Conventional method will take about 8-10 weeks for culture and drug susceptibility tests (DST). MTBDR plus VER 2.0 Line probe assay (LPA) can be used for identification of Mycobacterium tuberculosis complex (MTB complex) and to detect drug resistance of INH and Rifampicin. Materials and Methods: Cross sectional study was conducted in 100 smear positive patients with clinical features of pulmonary tuberculosis. After decontamination and concentration of sputum subjected to LPA and inoculated in parallel to LJ medium. Identification of MTB complex and resistance to INH, rifampicin were detected along with common mutations. Drug susceptibility test from LJ isolates were done by proportional method. Result: Detection rate of MTB complex by LPA in comparison with conventional DST was determined. Sensitivity, specificity, PPV and NPV of LPA was 100%, 97.47%, 77%, 100% for detection of rifampicin mono resistance and 92.86%100%,100%,98.6% for INH mono resistance. Common mutation detected in rpoB gene was S531L.and S315T1 in katG gene. Mean turnaround time for LPA was 3.47 days and for conventional method it was 49.6 days. Conclusion: Direct LPA from smear positive sputum is sensitive and specific diagnostic method for detection of MDR TB along with INH and rifampicin mono resistance. Shorter turnaround time with LPA helps in initiation of treatment earlier and preventing spread of MDR TB.

21. A Study of Different types of Hemoglobinopathies in Pediatric Population with Anemia by High Performance Liquid Chromatography in a Tertiary Care Centre
Ankita Garg, Pooja Agarwal, Prashant Bhardwaj, Ranjan Agrawal, Rajesh Bansal
Background: Hemoglobinopathies are the most common inherited red cell disorders worldwide. Identification of these disorders is immensely important epidemiologically and for improved management protocols. Among these Hemoglobinopathies, Thalassemia and Sickle Cell Anemia constitute major public health problems. Aim: To study the prevalence of Hemoglobinopathies in anemic pediatric population by using HPLC. Materials and Methods: This study was done at our tertiary care center, from January 2021 to July 2022. Hematological indices were derived from hematology analyzer (Mindray BC-5150) and Hemoglobin Electrophoresis was carried out by D-10 (BIO-RAD). Results: Out of 378 cases 33 (8.73%) cases had Hemoglobinopathies. The most predominant hemoglobinopathy was of Thalassemia cases 27 (7.76%) followed by Sickle Cell disorders cases 4(1.06%) with slight male preponderance, 20 were male and 13 were female. Conclusion: An extensive screening of the population is important to assess the prevalence of hemoglobinopathies, which will help in identification of carriers and take adequate therapeutic and preventive measures. Cation Exchange HPLC is emerging as one of the best methods for screening and detection of various Hemoglobinopathies with rapid, reproducible and precise results.

22. Antimicrobial Susceptibility Pattern of Pseudomonas aeruginosa Isolates in Clinical Samples with Special Reference to Metallo Beta Lactamase Detection at a Tertiary Care Hospital
Sukhada Buwa, Hemangi Ingale, Rashmi Bawane, Sunita Bhandari, Shubhra Sengupta
Introduction: In recent years, a significant rise in the incidence of P. aeruginosa as well as multidrug resistance (MDR) has been seen, which has been accompanied by an increase in morbidity and death. The purpose of this study was to ascertain the current status of antimicrobial susceptibility to anti-Pseudomonal drugs and to identify the presence of metallo- beta lactamase (MBL) in these isolates. Material and Methods: A prospective study was carried out to obtain P. aeruginosa isolates from various clinical samples and to detect MBL production in them. Pseudomonas aeruginosa was isolated from a total of one hundred various clinical samples for the purpose of this study. The organisms were identified based on the cultural characteristics and results of biochemical reactions. The modified Kirby-Bauer disc-diffusion method was used, as recommended by CLSI 2018, to determine the antimicrobial susceptibility to various antipseudomonal drugs. Antimicrobial susceptibility to colistin was detected by Epsilometric test. The isolates which showed resistance to imipenem were further identified as MBL producers by the phenotypic approach known as the IPM-EDTA combined disc synergy test. Results : Colistin was shown to be the most effective treatment against P. aeruginosa in this study. This was followed by Piperacillin/Tazobactam, Cefoperazone/Sulbactam, Imipenem, Meropenem, Ciprofloxacin, Amikacin, Gentamicin, Ceftazidime, Tobramycin, and Aztreonam. There were 33 isolates that showed resistance to imipenem, and out of those 33 isolates, 17 were detected as MBL producers when tested using the IPM-EDTA combined disc synergy method.

23. Effect of Pre-Emptive use of Paracetamol Vs Paracetamol Plus Dexamethasone on Postoperative Analgesia in Laproscopic Appendicectomy: A Comparative Study
Sheetal M Shah, Saurin B Panchal, Aniket R Aghara, Ayushi T Patel, Kusum B Bilwal
Postoperative pain has significant impact on health of patients besides delay in discharge. Appropiate methods should be applied as early as possible to control postoperative pain effectively. Pre-emptive analgesia is being widely used nowadays to control postoperative pain. Paracetamol and dexamethasone were used as preemptive analgesic in various surgeries. A total of 90 patients posted for elective laproscopic appendicectomy were randomly divided into three groups. Group A – Inj Normal saline 100 ml iv, Group B – Inj Paracetamol 1gm in 100 ml  iv, Group C – Inj Paracetamol 1gm in 100 ml iv + Inj Dexamethasone 8 mg iv. Study drug was given 30 minutes before induction according to groups. Visual analogue score was used to measure postoperative pain at various time intervals in postoperative period. Time for first rescue analgesic, number of rescue doses in first 24 hrs, incidences of postoperative nausea-vomiting and patient satisfaction were noted. There were significant better pain control in paracetamol and paracetamol-dexamethasone group compared to saline group, with least PONV and highest patient satisfaction for paracetamol-dexamethasone group.

24. Relationship between Abdominal Circumference and Incidence of Hypotension During Cesarean Section Under Spinal Anesthesia in Rural Northern Indian Females
Jyoti Rao, Shivani Sharma, Zeenat Akhtar, Shwait Sharma, Sujata Gupta
Background and Aim: Enlarged uterus can compress the inferior vena cava and cause hypotension when lying supine. Previous studies have shown have a positive association between the abdominal circumference and size of the uterus during pregnancy. The aim of this study was to evaluate the relationship between abdominal circumference and incidence of hypotension during cesarean section under spinal anesthesia. Methods: The study cohort comprised women undergoing cesarean section under spinal anesthesia. Patients were divided into two groups according to them median abdominal circumference (<101cm and ³ 101cm). Hypotension was defined as a systolic blood pressure of <90mm Hg or mean arterial pressure of <65mm Hg. The primary outcome of this study was the relationship between the incidence of hypotension and the abdominal circumference after spinal anesthesia in term pregnant women in rural northern Indian females. Results: The study cohort comprised 50 pregnant women. The incidence of hypotension was noted in both the groups at T1 (80.83±17.27 in the smaller vs 67.35±13.98 in the large abdominal circumference group, P=0.004). However, the decrease in mean arterial pressure and its percentage decrease from baseline were greater in the larger than in the smaller abdominal circumference group (change in mean arterial pressure 8.6 mnHg (3.63- 12.32mmHg) in the smaller vs 20.27mmHg (4.82-23.45 mmHg) in the larger abdominal circumference group, p=0.011 percentage decrease: 8.01% (3.38-11.47%) in the smaller vs 18.40%. (4.38-21.29%) in the larger abdominal circumference group, p=0.049. Conclusions: Large abdominal circumference in pregnancy is associated with greater decrease in mean arterial pressure from baseline. However, the incidence of hypotension defined by standard criteria did not differ between larger and smaller abdominal circumference groups.

25. Incidence of Hiatus Hernia among Patients with Various Upper Gastrointestinal Symptoms
Ashok M Ram, Girish Vasharambhai Parmar
Background and Aim: A hiatus hernia is a disorder in which parts of the abdominal cavity, most frequently the stomach, herniate into the mediastinum through the oesophageal hiatus. During an upper gastrointestinal endoscopy, hiatal hernias are frequently discovered. The goal of the current study was to determine the prevalence of hiatus hernia among individuals who had different upper gastrointestinal symptoms. Material and Methods: This was a Prospective study done in patients who presented to the surgical outpatient at Tertiary care institute of India and associated medical college for the duration of 1 year upper gastrointestinal endoscopy after complaining of upper gastrointestinal problems. 600 patients in total were enrolled in the research. Results: Out of the total 600 study patients, majority 200 (33.33%) of the patients belonged to the age group of 46 to 60 years followed by 31 to 45 years 190 (31.66%). Of the total 600 patients the common symptoms with which majority of the patients presented was dyspepsia 370 (61.66%) followed by 290 (48.33%) belching and 250 (41.66%) epigastric pain. A total of 115 (19.16%) and 43 (7.16%) study patients had lax hiatus and hiatus hernia respectively. Though lax hiatus was more commonly seen among female compared to male and hiatus hernia observed more in male than female, there was no statistical significance observed among both the gender. Conclusion: The incidence of hiatus hernia in this study has shown to be significantly lower compared to the overall sample size of 600 patients. Incidentally, most of the patients belonged to the age group of 46-60 years presenting with dyspepsia as the major complaint.

26. Psychiatric Morbidities, Neurocognitive Impairment, Quality of Life, And Burden of Care in Elderly Patients: A Tertiary Care Hospital-Based Cross-Sectional Study
Jagdish Varotariya, Rahul Mishra, Daisy Rure, Umesh Pathak
Background: The elderly population suffers from disability and functional impairment due to the increasing age and changing social circumstances. Besides physical illnesses, psychiatric morbidities are frequently encountered among elderly individuals. Functional dependency for the activities of daily living is common among elderly people. All these collectively hamper quality of life in elderly patients and increases the burden of caregivers as well. With this background, the present study was carried out to explore the psychiatric morbidities, quality of life and caregiver burden in elderly population. Aim and Objectives: To study sociodemographic profile, psychiatric morbidities, neurocognitive impairment, quality of life, and burden of care in elderly patients. Method: This was a hospital-based cross-sectional observational study conducted at a tertiary care center. 195 consecutive patients from the various outpatient departments fulfilling the study criteria were enrolled. Subjects were interviewed using a pre-designed study pro-forma. The Montreal Cognitive Assessment (MoCA), the 36-items Short Forn Survey (SF 36) and the Zarit Burden Interview (ZBI) were used for cognitive impairment, quality of life and caregiver burden, respectively. Data was analyzed on SPSS 22.0 using appropriate statistical methods. Results: The mean age of patients was 67.59± 6.09 years. Majority of patients were males (63.08%), married (82.6%), uneducated (43.6%) and unemployed (49.23%) and were staying in a Joint family. 35.38% (N=69) patients were found to be having psychiatric morbidity among which most prevalent class of psychiatric morbidity was Depressive disorder (30.43%). One fourth (24.62%) of the patients had cognitive impairment on MoCA assessment. Mean scores ranging from 30 to 60 out of 100 in Health-Related Quality of life were obtained in all domains of SF-36 with lowest in Physical role limitation domain. The mean score of caregiver burden (ZBI) was 26.12. More than half 59.49% of the caregiver reported as feeling burdened ranging from mild to severe burden, while 40.51% of the caregivers reported no burden at all. The caregivers who were burdened, 72.5% had patients with psychiatric illness, while 52.4% were burdened with patients other than psychiatric morbidity. Conclusion: Despite adequate healthcare, the main issues concerning aging and mental health are prevention, early recognition of major psychiatric morbidities, treatment and quality of life interventions. There is a need to undertake routine screening of psychiatric disorders in geriatric population considering the common occurrence in them. Early diagnosis and timely intervention can improve the quality of life in the elderly and reduce the burden of care in their caregivers.

27. Newborn Care Practices among Slum Dwellers of Guwahati City, Assam
Jhankar Hazarika, Soumitra Nath, Pankaj Jyoti Barman
Background: The newborn health challenge faced by India is more than that experienced by any other country in the world. The current neonatal mortality rate (NMR) of 44 per 1,000 live births, accounts for nearly two-thirds of all infant mortality and translates into at least two newborn deaths every minute. Newborn care is sub-optimal in the slums and the newborns here are victims of various malpractices endangering their health and survival. The major causes of the neonatal deaths are infections (sepsis, pneumonia, tetanus and diarrhoea), hypothermia, prematurity and birth asphyxia. One-third of India’s urban population resides in slums and squatters and this is expected to rise. Material and Methods: The study was conducted under the field Practice area of the Urban health Centre, Ulubari Under the Department of Community Medicine during August to October, 2019.The household visits were conducted in the urban slums of Guwahati city. 10 slums were taken for the study and 12 households from each slum were taken. The study population comprises of the newborns up to the age of 6 months living in the families in the mentioned areas. Results: Out of the 120 families, 75(62.5%) applied nothing on the baby’s cord, 17(14.17%) applied antibiotics, 6(5%) applied traditional substances like dried cow dung, honey, paste of tulsi leaves, 22(18.33%) applied substances like powder, cream etc. Out of the 120 babies, 33(27.5%) were below 2.5kg at birth, 71(59.17%) were between 2.5-3.5 kg and 16(13.33%) were above 3.5kg at birth.  Out of the 120 babies, 97(80.83%) cried immediately after birth and 23 (19.17%) cried late after birth. Out of the 120 mothers, 76(63.33%) had normal(vaginal) delivery and 44(36.67%) had caesarean delivery. Out of the 120 cases, 29(24.17%) babies were breastfed within 1hr of delivery, 49(40.83%) within 5 hrs, 31(25.83%) within 24hrs and 11(9.17%) babies were breastfed after 24hrs of delivery. Out of the 120 families, 29(24.17%) families are aware about exclusive breast feeding and followed it, 28(23.33%) are aware but didn’t follow, 36(30%) not aware but did exclusive feeding for 6 months and 27(22.5%) are not aware and didn’t follow. Out of the 120 mothers, 23(19.17%) fed their babies the colostrum while 97(80.83%) mothers didn’t feed the colostrum. Conclusion: In conclusion, although a few newborn care practices were correct and encouraging in the study area, yet many unhealthy neonatal practices were still found to be prevalent. ANC visits by the Healthcare staff and   counselling of mothers regarding neonatal care practices is of great relevance. The ANM, ASHA and the Anganwadi worker should be moviated through incentivized methods to take care of the new borns in the slums and educate the mother. The present study revealed the influence of elders also in newborn care practices.

28. Effect of Oral Moxonidine in the Attenuation of the Haemodynamic Responses Seen During Laparoscopic Cholecystectomy
Anija Pattnaik, D.V. Ravi Kumar, Suryasnata Sahoo, Amiya Kumar Nayak
Background: In this study, we wanted to evaluate the effect of orally administered moxonidine in attenuating the hemodynamic responses that occur during laparoscopic cholecystectomy. Materials and Methods: This was a hospital based prospective double blinded randomized study conducted among 50 patients underwent elective laparoscopic cholecystectomy in the Department of General Surgery and Department of Surgical Gastroenterology, in S.C.B. Medical College and Hospital, Cuttack, Odisha, over for a period of one and a half years, from January 2021 to October 2022 after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants. Results: The mean pulse rate in the preoperative, at induction, at intubation, before PNP, at 5 min,10 min, 20 min, 30 min, 40 min, 60 min after PNP, at the end of PNP, extubation was lower in moxonidine group than placebo group. The results were statically significant (P < 0.05). The mean systolic blood pressure between moxonidine and placebo at various intervals during the surgery was recorded and the result was statistically significant (P < 0.05). Whereas in comparison of mean diastolic blood pressure between moxonidine and placebo, most of the results were statistically significant (P < 0.05). Conclusion: The use of moxonidine in laparoscopic cholecystectomy is a promising approach in attenuating the hemodynamic response (PR, SBP, DBP and MAP) not only during the operative procedure but also at induction of anaesthesia, endotracheal intubation, recovery from anaesthesia and post-operative period. There were no side effects or deleterious influences on the hepatic, renal and gastro-intestinal function in any of the patients of the moxonidine group in view of its safety profile. Moxonidine is worth considering not only in ASA grade I and II patients but also in ASA grade III patients too because of the stable haemodynamic it ensures when used. As it seems placebo group resulted in a stable hemodynamic (within 10 % of base line) in ASA grade I and II patients. So, 5 – 10 % increase in hemodynamic parameter can be detrimental in ASA III and IV patients.

29. A Study of the Demographic Profile and Clinical Features of Snake Bites in Patients Attending Tertiary Care Centre in Karnal, Haryana
Amandeep Singh Kaloti, Jyoti Kadian, Aseem Garg, Rajesh Garg, Manish Garg
Objectives: To learn more about the profiles of snake bite patients in northern India because there aren’t enough studies on these topics. Materials and Methods: It is a descriptive observational study conducted on patients who had been bitten by snakes and had been admitted to the wards or ICU of the Department of Medicine at the KCGMC in Karnal. The study covered all of the snake bite instances that occurred over the course of a year. A pre-structured proforma was used to collect comprehensive data on the demographic and epidemiological factors, including age, sex, place of residence, occupation, site of the bite, location of the bite, type of snake recognised, etc. Results: A total of 45 patients were enrolled in the study. Out of which, 19 (42.22%) were females and 26 (57.78%) were males. The mean age of the patients was 35.96 ± 18.22 years. Out of all the patients, 17.77% had anaemia, 8.89% had leucopenia, 20% had leucocytosis, and 2.22% had thrombocytopenia. Among 24.44% patients the blood urea was elevated, and 31.11% patients had reduced serum creatinine. The Prothrombin time was increased in 17.78% patients, and 26.67% patients had reduced INR. Conclusion: A tropical snake bite is a common rural and work-related risk for farmers, plantation workers, herders, and hunters. There is a dearth of information on the epidemiology of snake bites on the Indian subcontinent.

30. To Observe the Effects of Sevoflurane and Isoflurane in Hemodynamic Parameters During off-pump Coronary Artery Bypass Graft Surgeries at Tertiary Care Center of Central India
Arvind Meena, Chandrashekhar Waghmare, Raju Singh Rathor, R P Kaushal, Sweyta Shrivastava
Introduction: Perioperative course and outcome of patients undergoing cardiac surgery is affected by inhalational anaesthetic agents which we use for Maintenance. Hence the present study comprising of observing Sevoflurane and Isoflurane with respect of hemodynamic effects, and amount of analgesic needed during surgery undergoing off-pump coronary artery bypass (OPCAB) surgery. Materials: In present hospital based observational prospective study a total of 50 cases were observed after written and informed consent of the participants or their relatives. Before the start pf the procedure demographic data of the patients were recorded in terms of age, height and weight. These cases were operated for coronary artery bypass grafting at tertiary care centre. Out of these 25 (Group A) cases were administered sevoflurane and rest 25 (Group B) were administered isoflurane to observe the hemodynamic effects during the procedure. Results: Differences between the groups. The mean heart rate at baseline, 2 minute after induction, after anastomosis and before I.C.U shift was respectively ( 88.44±7.53, 86.12±6.0, 93.48±3.28, 90.52±8.05) beats/min in group A and mean heart rate baseline, 2 minute after induction, after anastomosis, before I.C.U shift was respectively (87.64±7.84,84±9.79, 96.72±7.84, 91.64±5.15) beats/min in group B. We found that heart rate increased from baseline in both the groups in postoperative period, but not statistically significant The mean arterial blood pressure (MAP) at baseline, 2 minute after induction, after anastomosis and before I.C.U shift was respectively (94.16±10.78, 85.16±11.57, 75.08±5.77, 77.52±7.03) mmHg in group A and mean arterial blood pressure (MAP) at baseline, 2 minute after induction , after anastomosis and before I.C.U shift was respectively (91.24±10.42, 86.12±8.26, 76.28±6.06, 76.36±4.56) mmHg in group B. Conclusion: Sevoflurane and isoflurane can safely be used for patients undergoing coronary artery bypass graft cardiac surgery without compromising haemodynamic parameter. Thus, Sevoflurane may be safely utilised in patient undergoing CABG heart surgery.

31. Morphometric Study of Coracoid Process in Adult Dry Human Scapula and its Clinical Implications in Telangana Region
Padmavathi, Zainab Fatima, Niveditha Samala, D. Sudhakara Babu
Introduction: Coracoid process is a part of scapula it plays an important role in shoulder function. It arises from the antero-lateral aspect of the scapula. The coracoid process is joined to clavicle by the coracoclavicular ligament. The coracoid process gives attachment to coracoacromial ligament, coracohumeral ligament, coracoclavicular ligament and provides attachment to coracobrachialis and the short head of biceps brachii muscles. Aim: To study the morphometric details of coracoid process of dried adult human scapula bones. Objectives: To study the dimensions of coracoid process of dried adult human scapula like length, breadth, thickness, base height and base width of coracoid process and coraco-glenoid distance, and the types of coraco-glenoid space. Design: Observational study. Materials and Methods: The study was done on 100 dried adult human scapula bones (50 right and 50 left) of unknown sex available in the Department of Anatomy, Osmania Medical College, Koti, Hyderabad, and other medical colleges in Telangana. Damaged bones were omitted from the study. Coracoid process was studied for the following dimensions length, breadth, thickness, base height and base width of coracoid process and coraco-glenoid distance by using digital vernier calipers and the types of coraco-glenoid space were observed. These parameters were compared on both the sides, the results were tabulated and subjected to statistical analysis. Results: The most predominant type of coraco-glenoid space was found to be the Type I – round bracket (63%) then Type II Square bracket (25%) and type III Fish hook (12%). All the parameters such as length, breath, thickness, base height, base width of coracoid process and coraco-glenoid distance have higher values on Right side when compared to left side but the difference was statistically insignificant (p value >0.05 is insignificant). Conclusion: The study of variation of dimensions of coracoid process provides valuable information regarding the role of these parameters in etiology of subcoracoid impingement syndrome. It will also help the radiologist and orthopedic surgeons for diagnosing various pathologies and plan for surgical procedure on coracoid process. Also useful in biomechanical engineering for designing implants for total shoulder replacement.

32. Off Label Prescribing in Neonatal Intensive Care Unit: A Prospective Observational Study
Seema Gupta, Sunita Pandita, Himani Gupta, Ashu Jamwal, Dinesh Kumar
Background: Hospitalized newborns need multiple medications to survive and in most situations, therapeutic options might get restricted without off‐label prescribing of medicines. This study was planned to evaluate the off-label and unlicensed use of medicines in a neonatal intensive care unit (NICU) of a tertiary care teaching hospital. Methods: This was a 1-year prospective observational study in which prescriptions of 100 neonates who were admitted to the NICU were evaluated. For Demographic data, the patients’ files were used. The drugs used were classified as off-label, unlicensed, or licensed. Results: A total of 291 prescriptions were given to the 100 hospitalized newborns (term and preterm). The mean numbers of prescriptions and drugs received were 2.9 and 5.0, respectively for each neonate. The mean numbers of prescriptions and drugs were greater for preterm neonates. In our study, all 100 neonates received at least one drug for off-label use. Among the neonates who received off-label drugs, most of the neonates (92%) recovered at the time of discharge. In our study there was no use of unlicensed drugs and all the prescriptions had licensed drugs. Of the total 502 drugs prescribed 373(74%) were off-label and 129(26%) were prescribed on label i.e. prescribed by our reference standards. Term neonates(53.5%) were given more off-label drugs as compared to pre-term neonates(25%). Off-label prescriptions were mostly related to dose (35.9%), duration (30.5%) and frequency (30.8%). Antibiotics (mainly Ampicillin and gentamicin) were the most commonly prescribed off-label drugs. Conclusions: Conclusions drawn from this study are that off-label drug use is very common and is a routine practice in the NICU of our setting. All the neonates were exposed to off-label drug use. There was no use of unlicensed drugs in our study. There is a need for developing proper guidelines for the use of drugs in neonates and updating the previous label of drugs for neonates through evidence-based information and clinical trials to ensure the safe and efficient use of drugs in neonates.

33. The Impact of Metabolic Syndrome on Pulmonary Function Assessments
Meet Kumar, Shambhu Nath Goit
Metabolic syndrome is a constellation of metabolic abnormalities that increases the risk of developing cardiovascular disease, type 2 diabetes, and other conditions. Several studies have investigated the association between metabolic syndrome and pulmonary function, but the results have been conflicting. The aim of this study was to evaluate the effects of metabolic syndrome on pulmonary function tests (PFTs). Methods: This was a prospective, observational study conducted over a period of one year. We included patients with metabolic syndrome who presented to the Department of General Medicine at ICARE Institute of Medical Science & Research & Dr.Bidhan Chandra Roy Hospital, Haldia, West Bengal, India. We measured their PFTs, including forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow (PEF), and forced expiratory flow at 25% to 75% of FVC (FEF25-75%). We also collected data on their demographic characteristics, medical history, and laboratory values. Results: A total of 100 patients with metabolic syndrome were included in the study. The mean age was 51.3 ± 9.5 years, and 52% were male. The mean values for PFTs were as follows: FVC, 3.02 ± 0.64 L; FEV1, 2.42 ± 0.58 L; PEF, 9.2 ± 1.9 L/s; and FEF25-75%, 3.4 ± 0.7 L/s. There was a significant negative correlation between the number of metabolic syndrome components and PFTs. Patients with more components of metabolic syndrome had lower values of FVC, FEV1, PEF, and FEF25-75% (p < 0.05 for all). Conclusion: Metabolic syndrome is associated with a decline in pulmonary function tests. Patients with more components of metabolic syndrome had lower values of PFTs. Our findings suggest that patients with metabolic syndrome should be screened for pulmonary function abnormalities to prevent the development of respiratory complications.

34. Comparison of Platelet-Rich Plasma and Corticosteroid Injection for Treating Lateral Epicondylitis: A Prospective Study
Chandan Sheokumar Shekhar
Aim: The purpose of this research is to evaluate the effectiveness of platelet-rich plasma (PRP) injection versus corticosteroid injection in the diagnosis of lateral epicondylitis. Methods: This was a one-year comparative prospective study conducted at, Department of Orthopaedics, Shree Narayan Medical institute and Hospital, Saharsa, Bihar. Patients of lateral epicondylitis were enlisted from a tertiary care hospital’s outpatient department. The study included 60 patients who were randomly assigned to one of two groups: Group A received PRP injections and Group B received corticosteroid injections. Both groups were evaluated one week, four weeks, eight weeks, and twelve weeks after injection. A visual analogue scale (VAS), dynamometer, and the Impairments of the Arm, Shoulder, and Hand (DASH) questionnaire were used to assess pain management, grip strength, and functional status. Result: The patients’ average age was 42.5 8.4 years. The average VAS score in Group A decreased from 8.4 1.3 at base point to 2.7 0.9 at twelve weeks, while the mean VAS score in Group B decreased from 8.3 1.4 at base point to 4.2 1.2 at 12 weeks. The average grip strength and DASH scores improved significantly in Group A compared with Group B. Furthermore, Group A had a lower risk of recurrence of lateral epicondylitis than Group B. Conclusions: When compared to corticosteroid injection, the use of PRP injection in the diagnosis of lateral epicondylitis resulted in a significant improvement in pain management, grip strength, and functional status. PRP injection also resulted in a lower incidence rates of lateral epicondylitis. As a result, PRP injection can be considered a safe and effective substitute to corticosteroid injection in the recovery of lateral epicondylitis.

35. An Analysis of the Sociodemographic Factors among People Impacted by Snakebites
Shambhu Nath Goit, Meet Kumar
Aim: The objective of this research was to analyze the sociodemographic characteristics of patients who suffered from snakebites in a hospital in West Bengal, India, during a 12-month period. Methods: The methodology utilized in this study involved a retrospective analysis of patient records for those admitted to the Department of General Medicine at ICARE Institute of Medical Science & Research and Dr. Bidhan Chandra Roy Hospital in Haldia, West Bengal, India. Data collected in 1year was analyzed using descriptive statistical techniques. Results: According to the study’s findings, 125 individuals suffering from snakebite were hospitalized during the research period. The majority of these patients (68%) were male, with an average age of 38.5 years. The period with the highest frequency of snakebites was the monsoon season (July-September), with the majority of incidents occurring in rural areas (71%). Among the snakes responsible for bites, the Russell’s viper was the most common (47%). Pain (100%), swelling (86%), and bleeding (38%) were the most commonly reported symptoms. Finally, the study reported an 8% mortality rate among the hospitalized patients. Conclusion: This study provides important insights into the sociodemographic profile of patients with snakebite in West Bengal, India. The results suggest that snakebite is more common in males, occurs most frequently in rural areas during the monsoon season, and is often caused by the Russell’s viper. These findings can be used to inform public health strategies aimed at reducing the incidence and improving the management of snakebite.

36. Examining the Results of Cervical Pap Smears at a Hospital Specializing in Advanced Medical Treatment
Ankit Gaba, Uma Shankar
Aim: The objective of the present investigation is the study of cervical pap smears in a tertiary care hospital. Methods and Material: This research was carried out at the Department of Pathology, Lord Buddha Koshi Medical College and Hospital, Saharsa, Bihar, and 50 women participants with cervical cancer disease were included. The duration of the study was one year. Local ideas and culture were incorporated. Confidentiality was assured. They were given thorough explanations in their native tongue about the purpose and aim of the survey. Result: There were 50 women subjects analyzed out of which the age range of 30-39 years had the highest percentage of cases (38%). The oldest case involved a 79-year-old man. A minimum of 4% of instances involved people under the age of 70-79. Conclusion: This test is an effective analytical tool for discerning cervical cancer. The results obtained from this study demonstrate that the pap test is exceedingly sensitive, specific, and accurate in detecting pre-cancerous changes in the cervix. Therefore, it is recommended that all women above the age of 20 should be routinely screened for cervical cancer with a pap test.

37. Examining the Tissue Samples of Granulomatous Lesions on the Skin through Histopathological Analysis
Ankit Gaba, Uma Shankar
Aim: The objective of the present study is to evaluate the histopathological study of cutaneous granulomatous lesions. Methods: This study was conducted at the Department of Pathology, Lord Buddha Koshi Medical College and Hospital, Saharsa, Bihar, India, and 50 subjects with cutaneous granulomatous lesions were included. The duration of the study was one year. Local ideas and culture were incorporated. Confidentiality was assured. They were given thorough explanations in their native tongue about the purpose and aim of the survey. Results: There were 50 subjects analysed, of which 29 (58%) had male predominance and 21 (42%) had female predominance, resulting in a M:F ratio of 1.3:1. 15 (30%) instances. Conclusion: A procedure namely a biopsy should be carried out to confirm the detection, particularly in cases where the patient is presenting with more than one type of lesion. Treatment of cutaneous granulomatous lesions should be tailored to the individual patient and the particular type of lesion they have.

38. Study of Symptomatic Urinary Tract Infections During Pregnancy
Nina Mishra, Siba Prasad Das, Susanta Kumar Behera, Preetam Kumar Rath
Introduction: Urinary tract infection (UTI) is one of the most distressing problems faced during pregnancy producing profound psychological effect on the pregnancy what is being encountered by family physicians. In general 15% of women suffer at least one attack of UTI sometime during their lifetime. A significant bacteriuria is the major risk factor for developing symptomatic urinary tract infection during pregnancy, hypertension, preeclampsia, LBW, fetal wastage and prematurity. Materials and Methods: The present study titled as “Study of Symptomatic Urinary tract infections during Pregnancy” is descriptive study conducted in the department of Obstetrics and Gynaecology, MKCG Medical College, Berhampur, Odisha from October 2018 to November 2021. All the selected 110 cases were subjected urine culture and sensitivity after rountine antenatal check-up. All the symptomatic patients are followed up in all the three trimesters by urine culture to detect any relapse or reinfection by same or different organisms respectively. Observation: Symptomatic UTI occurs most commonly in age group of 21-30 yrs in 75 cases (68.2%), of blood group of ‘O’ in 64 cases (58.2%). According to mode of presentation, maximum cases i.e 96 cases (87.2%) presented with frequency, 89 cases (81%) with dysuria whereas 56 cases (51%) with fever with rigor and chill. The maximum numbers are detected as colony count in urine culture of having value > 105 CFU/ml in 98 cases (89.1%).In response to treatment among all cases of symptomatic UTI with culture positive report, 82 cases (74.5%) treated by Nitrofurantoin, 16 cases(14.5%) by Amoxicillin+Clavulanic acid, 4 cases(3.6%) 68 cases (61.8%) are of small for gestational age (SGA), 25 cases (22.7%) are complicated with preterm contraction, 15 cases (13.6%) with leaking of membrane. The Neonatal asphyxia is highest in 30 cases (27.3%), 74 cases (67.2%) are within 2-2.5 kg birth weight. So low birth weight as the most common complications followed prematurity in 66 cases (60%) IUGR in 19 cases (17.2%). E Coli is the most common organism isolated in 76 cases (69.1%) strongly sensitive (SS) to Amoxicillin+Clavulinic acid; Klebsiella is strongly sensitive (SS) to Amoxicillin, Cefuroxime, Amoxicillin+Clavulanic acid and Piperacillin+Tazobactm; Proteus species is strongly sensitive (SS) to Amoxicillin, Amoxicillin+Clavulanic acid and Piperacillin + Tazobactm. Conclusion: Symptomatic urinary tract infection during pregnancy causes both maternal and fetal complications. The maternal complications encountered in this study are PPROM, PPH, anemia, puerperal pyrexia, breast complications, preterm contractions. The fetal complications encountered in are Low birth weight, prematurity, intra partum asphyxia, IUGR. Majority of cases are having colony count > 105 CFU/ml among the symptomatic cases studied. E. Coli and Staphylococcus are treated with Nitrofurantoin as first line of drug followed by reculture and retreatment as required. So any evidence of symptomatic urinary tract infection should be diagnosed as early as possible by urine culture and to be treated judiciously to prevent and improve maternal and perinatal outcome of each and every pregnancy.

39. Analysis of Bacteriological Profiles and Clinical Features of Hospital Acquired Pneumonia
Shrikrishna Joshi, Sushmita Barua, Rita Swaminathan, Abhay Chowdhary
Introduction: Nosocomial pneumonia (NP), also known as hospital-acquired pneumonia (HAP), is pneumonia that develops 48 hours or more after being admitted to the hospital; it doesn’t develop just at the moment after admission.  There are several causal agents which can cause HAP and there are similar clinical features between HAP and CAP. Aims and Objectives: To analyze the bacteriological and clinical aspects of HAP. Methods: This is a prospective study where samples from the lower respiratory tract of LRTI patients are collected. Samples which are contaminated when in contact with the secretions of the upper respiratory tract are not accepted. Microscopic preparations and culture examination was carried out for identification of microorganisms. Identification and characterization of the micro-organisms were carried out by employing various biochemical tests. Finally, these findings were evaluated. Results: Females are seen higher in 0-20 and 21-40 years 4 and 23, males are seen high in 41-60 and 61-80 years 40 and 18 respectively.  The highest co-morbidities are septicaemia, acute bronchitis, consolidation, and cystic fibrosis each with more than 8% of patients, and the least is seen with acute renal failure, mitral regurgitation, and alcoholic liver disease. Conclusion: The study has concluded that most of the patients of HAP are mid-aged to elder and also concluded that Pseudomonas, Streptococcus species and Klebsiella spp. have been the most common cause of HAP in this sample.

40. Dermatology OPD Patients’ Misuse of Topical Steroid
Yashdeep Singh
Background: Today, topical corticosteroids are the most often prescribed medications in dermatology offices. The therapeutic effects are mediated by their anti-inflammatory, vasoconstrictive, anti-proliferative, and immunosuppressive properties. They are powerful drugs used to manage a range of inflammatory and autoimmune dermatological conditions. According to information on acknowledged dermatological indications of TC provided on the Central Drugs Standard Control Organization (CDSCO) website (although indications are not specified for all the TC molecules), off-label usage of TC appears to be a common clinical practice in India. Material and method: A cross-sectional observational questionnaire-based study was conducted at the Department of Dermatology outpatient clinic of a tertiary care hospital. A total of 110 people of all ages and genders who had taken topical corticosteroids improperly (i.e., for conditions for which they are not advised) for particular skin problems and had shown at least one side effect from these drugs were enlisted sequentially. These included at least one of the following symptoms: infantile gluteal granuloma, pyoderma, stretch marks, hyper/hypopigmentation, tinea incognito, facial acne, facial hypertrichosis, and cutaneous atrophy. They also included plethoric face and telangiectasia. Results: Out of 110 patients, 64 subjects received a combination cream containing steroids (58%), while other major steroids prescribed as single ingredient were betamethasone valerate (12%), clobetasol propionate (10%), halobetasol propionate (6%) and fluticasone propionate (8%). Conclusion: The problem is exacerbated by how simple it is for a patient to acquire these medications, even without a valid prescription. In our study, it was shown that females and younger age groups abused steroids more frequently. Due to the ease with which topical steroids may be bought, the difficulty patients have in seeing dermatologists, and a lack of knowledge about non-adverse physicians, steroid misuse is consequently a major problem in India. The findings of our study indicate that this problem is already serious, and that it requires prompt attention by making steroids a prescription-only medication rather than an over-the-counter one.

41. Comparing Visual Evoked Potentials in Patients with Chronic Kidney Disease, Hemodialysis, and Renal Transplantation  Patients: A Comprehensive Study
Suganya Gunasekaran, Dhivya Krishnamoorthy, Ramya Selvaraj
Chronic kidney disease (CKD), hemodialysis, and renal transplantation patients are at risk for functional changes in the central nervous system (CNS), even if they show no clinical symptoms in the early stages. These changes can be detected by measuring the electrical activity of the brain (electrocortical activity). Visual evoked potentials (VEPs) are a type of electroencephalography (EEG) test that is more sensitive than traditional EEG for detecting early CNS involvement in CKD, hemodialysis, and renal transplantation patients. In this study, a total of 80 eligible participants were selected in four groups of which 20 were sex and gender matched controls, 20 were CKD patients, 20 were CKD patients on hemodialysis, 20 were CKD patients who underwent renal transplantation. Height, weight, BMI, Serum urea, Serum creatinine, and Blood pressure and VEP parameters were measured. Serum urea and creatinine levels were significantly higher in hemodialysis patients than in CKD patients and CKD patients on renal transplantation. Hemodialysis patients have higher levels of serum urea and creatinine than CKD patients and CKD patients on renal transplantation. In the present study, significant association between serum urea, serum creatinine and N 75, P100, N 145 latency, which was not corroborated by other studies, an association was found between VEP results and biochemical parameters. In summary, our study findings reveal significant differences between the control group and the CKD study groups across various VEP parameters. Notably, in CKD patients, there is a trend of prolonged latencies, particularly in P100, when compared to controls. Additionally, a decrease in VEP amplitude is observed in the study groups, particularly in CKD HD patients, indicating the impact of uremic toxicity. These results emphasize the potential diagnostic value of VEP in assessing CNS involvement in CKD patients.

42. A Comparative Study to Find the Utility of Bone Marrow Culture and Blood Culture in the Diagnosis of Osteomyelitis
N Brahmananda Reddy, Pathuri Venkata Rama Chowdary, T Jaya Chandra
Introduction: Bone marrow culture (BMC) is a key tool in the diagnosis of osteomyelitis (OM), performed along with blood culture (BC). But the literature is limited from this area. With this a study was conducted to compare the BMC and BC techniques in the diagnosis of OM. Methods: It was a prospective research conducted in the department of Microbiology, GSL Medical College between January to May 2022. Study protocol was approved by the Institutional ethical committee. Individuals of both gender, aged > 18 years, with OM were considered in this research. Non cooperative individuals were not considered. Clinical findings were recorded in the study proforma. BM was collected as per the guidelines. Blood was collected for culture test under sterile precautions. Utmost care was taken to avoid contamination. After successful collection of the clinical specimen, cultured as per the standard guidelines. Identification of the bacteria and antibiotic susceptibility test (AST) were also carried as per the guidelines. Chisqaure test for the culture positive (CP) and culture negative (CN) results; P<0.05 was considered to be statistically significant. Results: Total 23 specimen were collected for BM and BC, 39. 2 years was the mean age. Maximum (10) study members were in 30 – 40 years group. The male female ratio was 1.08. In BMC 15 (65.2%) were CP whereas it was just 43.5% (10) in the BC test; statistically there was no significant difference. Conclusion: BMC is a better tool for the diagnosis of OM.  gram negative rods are the common pathogens. The infection rate is high in 30 – 40 years group.

43. Comparative Analysis of Sub-Tenon’s and Peribulbar Anesthesia in Manual Small Incision Cataract Surgery
Anuradha Manish Totey
Background:  The most common cause of blindness worldwide is cataracts. In a growing nation such as India, where employment is the primary driver of advancement, cataract-related blindness presents a major public health, economic, and social challenge. The anesthetic used during cataract surgery has changed over time in an effort to lower risks and problems. These days, small incision cataract surgery is performed under shorter acting, less invasive anesthetic protocols. This is made possible by advancements in surgical techniques, such as smaller and self-sealing wounds, improved intraocular lens designs, and less tissue manipulation with modern instrumentation. Comparing it to the earlier retro bulbar procedure, it produces less akinesia but has a lower rate of optic nerve injury. There have been documented incidences of brainstem anesthesia following peribulbar block, despite the fact that the peribulbar approach is thought to be safer than retrobulbar block. One of the most dangerous side effects of this method is globe perforation. The symptoms include rapid loss of vision, severe ocular discomfort, and hypotonicity of the globe. This condition needs to be surgically managed right away. Aim: The aim of the study was to Comparison of peribulbar anesthesia with sub-Tenon’s anesthesia in manual small incision cataract surgery in relation to the time of onset of akinesia of extraocular movements, pain at the time of administration, end of surgery, and complications. Material and Method: Selected patients hospitalized to a hospital’s ophthalmology department for cataract surgery participated in a randomized comparison research conducted within the hospital. Every patient who was part of the study gave written, informed consent. Each participant received comprehensive explanations regarding the research protocol, the administration of the consent form, the use of a numerical rating scale for pain assessment, the comfort score, and the satisfaction score during the visit. Patients with diabetes and hypertension under clinical control were given their medication the morning of surgery. The surgeon randomly divided the patients into two groups of thirty each. Results: The mean age of patients was 43.28+ 7.4 years. There were 30 women (50%) and 30 men (50%) in the study cohort. The age distribution of the participants was not different for men and women. The peribulbar group had a significantly higher percentage of patients with mild pain, while the sub-tenons group had a higher percentage of patients who were pain-free during the block administration. Perioperative pain grade did not differ significantly between the two groups. The peribulbar group also had significantly higher baseline and postoperative pain scores. However, patients in both groups experienced similar levels of pain during the postoperative period. Conclusion: We conclude that, with no technical challenge to the surgeon, sub-tenon anesthesia is equally successful a strategy for inducing analgesia and akinesia in MSICS as peribulbar anesthesia. Notably, it provides a different kind of safe anesthetic that causes the patient a lot less pain than peribulbar block. We did not include complex cataracts; therefore, further research is needed to determine whether the subtenon block is effective in those situations. We think that this procedure is relatively safe given the equipment and technique employed, and it should be taught to residents undergoing training.

44. Investigating Burnout in Medical Students in Associations with Demographics, Academics, and Sleep: A Cross-Sectional Study in Erode, Tamilnadu
R.K. Viswanathan, B.Saranya, Vignesh Sivaraj3, T. Kokila, Sasikala Gunasekaran, Panneerselvam Periasamy
Introduction: The objective of this study was to investigate the frequency of burnout syndrome and examine how burnout symptoms are related to sociodemographic characteristics in medical students. Methods: An observational study was carried out among students ranging from their first year to final year in a district of Erode, spanning from June 2023 to August 2023. The study involved 308 medical students’ participants, with Mean age of 19.79+1.26 years of age. The convenience sampling method was employed. Data collection was conducted subsequent to obtaining ethical approval from the institutional review committee. Students at Government Erode Medical College in Tamilnadu, data were collected in January –March 2023. The survey was conducted using a semi-structured and self-reported questionnaire by using Google Forms and a shareable link was generated and distributed via email and social media for 4 weeks’ s containing informed consent along with sections (Demographic Details, self-rated sleep quality, academic performance and The Maslach Burnout Inventory–Student Survey burnout questionnaire). Correlation between academic performances, sleep quality, Emotional Exhaustion Cynicism and Academic Efficacy was analysed using Karl Pearson correlation method. Results: The prevalence of burnout among medical students 56 out of 308 (18.18%). The study found that individuals aged 21-24 years and students beyond their first year have a higher percentage of burnout (30.23%) compared to those aged 17-20 years (13.51%) (p=0.02). Poor sleep quality (25.58%) and individuals scoring less than 60% marks (26.47%) (p=0.01) also have a higher percentage of burnout compared to those scoring above 60% marks (11.63%). Conclusions: Medical student’s burnout leads to low academic performance. Final year students, male, and poor sleep have a significant association with burnout. The high prevalence of burnout syndrome necessitates appropriate interventions to identify and reduce the prevalence of burnout in medical students.

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