International Journal of

Toxicological and Pharmacological Research

e-ISSN: 0975 5160

p-ISSN: 2820-2651

Peer Review Journal

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1. Effect of Intravenous Magnesium Sulphate for Prevention of Postoperative Pain in Infraumbilical Surgeries under Subarachnoid Block
Nikita Verma, Jyoti Nagwanshi, Ashwini Kumar Patel, Sonali Tripathi
Background: In this study, we conducted a randomized, double-blind, prospective investigation to assess the impact of intravenous administration of magnesium sulphate at two distinct dosage levels on spinal anaesthesia, postoperative pain relief, and postoperative analgesic needs in individuals having infraumbilical surgeries. Aims and Objectives: This study aims to conduct a comparative assessment of the efficacy of two different dosages of intravenous magnesium sulphate in preventing postoperative pain following infraumbilical operations performed under spinal anaesthesia. Materials and Methods: Ninety female patients, classified as ASA grade I and II, aged between 20 and 40 years, who were scheduled for infraumbilical procedures (specifically lower segment caesarean section) under spinal anaesthesia, were chosen following a pre-anesthetic evaluation to ensure their physical suitability for the procedure. The patients were randomly assigned to three groups: group MS, group MS-30, and group MS-50, each consisting of 30 patients. The interventions involved administering 100 ml of 0.9% Normal saline, 30 mg kg-1 of Magnesium sulphate in 100 ml of 0.9% Normal saline, and 50 mg kg-1 of Magnesium sulphate in 100 ml of 0.9% Normal saline, respectively. These interventions were administered over a period of 15 minutes, 60 minutes after the administration of spinal anaesthesia. Following the surgical procedure, the patients were administered intravenous rescue analgesia in the form of an injection of Tramadol 100 mg. The study assessed postoperative pain ratings, rescue analgesic consumption, and the occurrence of several adverse events such as nausea, vomiting, dysnoea, respiratory depression, chest discomfort, drowsiness, shivering, dysrhythmia, bradycardia, and hypotension. These assessments were conducted immediately after surgery, as well as after 30 minutes, 1-, 2-, and 3-hours post-surgery. The findings were presented in terms of the mean and standard deviation. A p-value less than 0.05 were deemed to be statistically significant. Results: Intravenous administration of magnesium sulphate at a dosage of 50 mg/kg under spinal anaesthesia resulted in a notable extension of the duration of analgesia, a higher quality of analgesia as shown by a lower Visual Analogue Scale (VAS) score, and a considerable decrease in the amount of postoperative analgesics required, as compared to the administration of a lower dose of 30 mg kg-1. There were no notable occurrences of hemodynamic and respiratory instability seen following the administration of two doses of Magnesium sulphate. Conclusion: The administration of intravenous magnesium sulphate during spinal anaesthesia has been found to enhance postoperative analgesia without notable adverse effects.

2. Comparative Study of Clonidine and Dexmedetomidine as an Adjuvant to Bupivacaine in Supraclavicular Brachial Plexus
Pooja J Patel, S. Sowmya, Ankur F Chaudhari
Introduction: The administration of local anesthetics for regional anesthesia has evolved over the years, with the quest for optimal adjuvants to enhance the quality and duration of nerve blocks. Interest lies in using adjuvants like clonidine and dexmedetomidine to enhance supraclavicular brachial plexus blocks for upper limb surgeries. This study aims to conduct a comparative analysis of clonidine and dexmedetomidine as adjuvants to bupivacaine in supraclavicular brachial plexus blocks, shedding light on their efficacy, safety, and clinical outcomes. Material and Methods: In this study, 80 patients, classified as ASA Grade I and II, undergoing upper limb orthopedic surgeries, received a supraclavicular brachial plexus block (SBPB). They were randomly divided into two groups: Group C (n = 40) received bupivacaine 0.25% with clonidine, and Group D (n = 40) received bupivacaine 0.25% with dexmedetomidine. The patients were assessed for sensory and motor blocks, vital signs, and pain levels at various time points. Adverse events were monitored, and the quality of anesthesia was evaluated. Statistical analysis was performed using Student’s t-test and the Chi-square test. Results: Group D (Dexmedetomidine) showed a faster onset of sensory block (1.76 minutes vs. 3.55 minutes) and motor block (3.45 minutes vs. 4.16 minutes) compared to Group C (Clonidine), although these differences were not statistically significant (p >0.05). However, Group D had significantly longer durations for both sensory and motor blocks (467 min vs. 312 min and 490 min vs. 329 min, respectively) compared to Group C (p<0.05). Additionally, Group D exhibited a substantially extended duration of analgesia (478 min vs. 321.16 min) compared to Group C (p<0.05). Moreover, throughout the study, Dexmedetomidine consistently maintained a more pronounced and sustained reduction in pulse rate compared to Clonidine, which could be particularly relevant in scenarios requiring prolonged hemodynamic control. Conclusion: Dexmedetomidine outperformed clonidine in enhancing the effectiveness and duration of supraclavicular brachial plexus blocks, making it a preferable choice for such procedures, particularly in scenarios requiring prolonged hemodynamic control.

3. Association of Salt Taste Threshold with Blood Pressure among Young Adult Having Family History of Hypertension in Rural Population of Central India
Santosh Gulabrao Balgote, Satish Namdeorao Waghmare, Bhagwat Vaman Shinde
Early development of hypertension in young adults is new challenge in India. In young college students to assess relation between hypertensive subject and their Salt Taste Threshold, 80 subjects of 18-25 years having documented hypertensive family history were selected. We observed a significantly high value of blood pressure and Salt Taste Threshold in hypertensive offspring than the control in the study population. We also found a significant positive association of Salt Taste Threshold in offspring of hypertensive cases after setting 60 mM sodium chloride solution as cut off and applying Pearson Chi-square test. Pearson analysis shows a significant positive correlation exist between Blood pressure and SST. This study reveals a strong relation of reduced salt taste sensitivity in hypertensive offspring. It might be become a reliable indicator for early screening of salt sensibility of subject belonging to hypertensive family in development of hypertension in rural areas where recourses are less.

4. Comparative Evaluation of Mic by E-Test, Chrom Agar MeReSa and Cefoxitin Disc Diffusion for Detection of Methicillin Resistant Staphylococcus Aureus (MRSA)
Mansi Gupta, Lav Gupta, Amit Saxena, Anshul Gupta, Amardeep Rai
Infections caused by MRSA are worldwide, resulting in increased mortality and morbidity. Detecting the mecA gene or its product by PCR is recognized as a gold standard for detection of MRSA.  In resource limited clinical settings phenotypic method which is simple, rapid, accurate and cost effective is required. Cefoxitin disc diffusion is considered as surrogate marker for mec A gene, and could be considered as gold standard for MR isolates. The aim of this study was to do a comparative evaluation of  E-test MIC and Chrom Agar MeReSa against Cefoxitin disc diffusion for detection  of  Methicillin resistant Staphylococcus aureus (MRSA). A total of 174 S. aureus isolates were identified, which were subjected to  Cefoxitin disc diffusion,  Chrom Agar MeReSa and Oxacillin MIC by E-test. A total of 69 isolates were identified as MRSA by Cefoxitin disc diffusion test. In this study sensitivity and specificity of Cefoxitin is 100% while sensitivity and specificity of Chrom Agar MeReSa as 88.23% and 91.50% and  Oxacillin MIC by E-test comes out as 94.02% and 94.39%.

5. Phenotypic Detection of Inducible Clindamycin Resistance in Staphylococcus Aureus: A Study in Central India
Anshul Gupta, Manoj Sahu, Amit Saxena, Mansi Gupta, Ronak Jain, Amardeep Singh Rai
Introduction: Emergence of increasing resistance in Staphylococcus aureus has renewed the interest in Clindamycin (lincosamide) usage because of  its good pharmacokinetic properties in the treatment of Staphylococcal infections especially in Methicillin Resistant Staphylococcus aureus (MRSA) infections. Erythromycin (macrolide) also used to treat Staphylococcal infections but it is a potent inducer of Clindmycin resistance.  Combined use of these drugs pose a threat of treatment failure. Phenotypic detection of Erythromycin induced Clindamycin resistance by a simple D- test can be done in clinical laboratories to curb inappropriate use of these drugs in Staphylococcal  infections including MRSA strains. Objectives: To find out the burden of  Inducible clindamycin resistance & its relation with MRSA. Materials and Methods: A total of 132 clinical isolates of S. aureus between April 2014- June 2014   collected from various Clinical samples were processed to routine antimicrobial Suceptibility test using modified Kirby- Bauer disc diffusion method-using Cefoxitin (30μg) disc to detect MRSA. Erythromycin (15μg) & Clindamycin (2μg) disc placed at a distance of 15mm to detect Erythromycin induced Clindamycin resistance by D – test as per CLSI guidelines. Results: Among 132 isolates, 24(18.18%) isolates showed inducible Clindamycin resistance, out of which 15 were MRSA strains. So percentage of inducible Clindamycin resistance was higher in MRSA (62.5%) as compared to MSSA (37.5%). Conclusions: For optimum treatment of patients, D-test which is simple and feasible test should be used as routine lab method to detect inducible Clindamycin resistance in Staphylococci.

6. Comparative Evaluation of Two Imaging Modalities and Their Application in the Evaluation of Pancreatic Changes Due to Acute Pancreatitis
Diksha Kalariya, Sunil Akhani
Background and Aim: A common radiological problem is the evaluation of suspected pancreaticobiliary pathology, which is routinely diagnosed using a variety of imaging modalities such as ultrasonography (USG), computed radiography, magnetic resonance cholangiography, and endoscopic retrograde cholangiopancreatography (ERCP). The current study aimed to compare two imaging modalities and their application in the evaluation of pancreatic/peripancreatic alterations caused by acute pancreatitis. Material and Methods:  The current investigation was conducted on 80 patients suspected of having acute pancreatitis, as evidenced by high blood amylase and serum lipase levels, over a two-year period in the Department of Radiodiagnosis at an Indian tertiary care institute. A real-time ultrasound scan of the abdomen and triple-phase contrast-enhanced computed tomographies of the abdomen were performed on all patients. Results: Males accounted for 70 of the 80 cases included in the study, with 49 cases of acute pancreatitis and 21 cases of acute on chronic pancreatitis. There were ten females, with six cases of acute pancreatitis and four cases of acute or chronic pancreatitis. Both CT and US detected the same number of cases of necrosis involving the body of the pancreas, but US detected one less case of necrosis involving the head of the pancreas than CT, with US detecting 20 cases compared to CT’s 21 cases with a sensitivity of 95.5%. Conclusion: The current investigation revealed that US has comparable sensitivity to CT in detecting fluid accumulation and necrosis in pancreatitis, except in the tail of the pancreas. However, due to its lack of value in thoracic imaging, US failed to detect mediastinal pseudocysts and infected necrosis.

7. A Cross-Sectional Study of Bacteriological Profiles in Patients with Chronic Suppurative Otitis Media at a Medical College
Hardika B Patel, Hemlata B Sunsara, Vaibhavi K Prajapati, Kaushal K Krajapati
Background and Aim: Persistent suppurative otitis media is characterized by persistent inflammation of the middle ear and mastoid cavity, which can manifest as recurrent ear discharges or otorrhoea through a tympanic hole. The purpose of this study is to evaluate the microbiological profile of ear infections in hospitalised patients. Material and Methods: The current cross-sectional study was carried out in the Department of Otorhinolaryngology, Medical College and Hospital, in collaboration with the Department of Microbiology. A total of 200 patients attending the ENT department of Medical College and Hospital, who satisfied the inclusion criteria were included in the study. complete clinical ENT examination carried out, aural swabs were collected, culture was done and antibiotic sensitivity was studied. Results: A total of 75% of the isolates exhibited pure growth, 20% showed mixed growth, and 5% showed no development.  As pure growth, Staphylococcus aureus (70/150) and Pseudomonas aeruginosa (48) were identified as the most prevalent causal microorganisms. The remaining isolates grew various bacteria, including Klebsiella spp. (8.0%) and Escherichia coli spp. (5.3%). Proteus spp. (5.3%), Enterobacter spp. (1.3%), and Citrobacter sp. (1.3%) were the most common. As mixed growth, S. aureus (50.0%) and P. aeruginosa (30.0%) were identified as the most prevalent causal microorganisms. Conclusion: Ear infection is a serious public health issue in poor nations such as India. Early detection of etiological agents and knowledge of their antibiotic sensitivity pattern can help reduce the prevalence of ear infections.

8. Efficacy of Intrathecal Fentanyl for Prevention of PDPH in Cesarean Section
Jaldeep Patel, Khyati A Makwana, Hiral Golakiya
Background and Aim: A side effect of spinal anaesthesia (SA) is postdural puncture headache (PDPH). The purpose of this study was to examine the effect of intrathecal fentanyl vs a control group in preventing PDPH in LSCS. Methods and Materials: The current investigation was carried out at the Tertiary Care Institute of India’s Department of Anesthesiology. A total of 200 ASA grade II patients aged 18 to 45 years who underwent elective or emergency caesarean section were chosen for the study and randomly assigned to one of two groups using a random number system.  AF group: bupivacaine 2ml plus fentanyl 0.5ml (25 g) Group B was given 2mL of bupivacaine and 0.5mL of normal saline. A visual analogue scale (VAS) score was used to assess the severity of the headache. Adequate hydration, coffee, or 500 mg paracetamol were used to treat PDPH. Results: The demographic profile in both groups was comparable. PDPH occurred in 1% of the fentanyl group and 5% of the control group. The PDPH in the fentanyl group was mild, while it was moderate in the control group. Backache, vertigo, nausea, and vomiting occurred at a rate of 1% in the fentanyl group, while they occurred at a rate of 3% in the control group. There was no mention of itchiness in any group. Conclusion: Intrathecal fentanyl (25g) reduced the incidence and severity of post-dural puncture headache (PDPH) in caesarean delivery in a non-significant way. Though the severity increased in the control group, it was not statistically significant.

9. Comparative Study of Clonidine and Dexmedetomidine as an Adjuvant to Bupivacaine in Supraclavicular Brachial Plexus
Pooja J Patel, S. Sowmya, Ankur F Chaudhari
Introduction: The administration of local anesthetics for regional anesthesia has evolved over the years, with the quest for optimal adjuvants to enhance the quality and duration of nerve blocks. Interest lies in using adjuvants like clonidine and dexmedetomidine to enhance supraclavicular brachial plexus blocks for upper limb surgeries. This study aims to conduct a comparative analysis of clonidine and dexmedetomidine as adjuvants to bupivacaine in supraclavicular brachial plexus blocks, shedding light on their efficacy, safety, and clinical outcomes. Material and Methods: In this study, 80 patients, classified as ASA Grade I and II, undergoing upper limb orthopedic surgeries, received a supraclavicular brachial plexus block (SBPB). They were randomly divided into two groups: Group C (n = 40) received bupivacaine 0.25% with clonidine, and Group D (n = 40) received bupivacaine 0.25% with dexmedetomidine. The patients were assessed for sensory and motor blocks, vital signs, and pain levels at various time points. Adverse events were monitored, and the quality of anesthesia was evaluated. Statistical analysis was performed using Student’s t-test and the Chi-square test. Results: Group D (Dexmedetomidine) showed a faster onset of sensory block (1.76 minutes vs. 3.55 minutes) and motor block (3.45 minutes vs. 4.16 minutes) compared to Group C (Clonidine), although these differences were not statistically significant (p >0.05). However, Group D had significantly longer durations for both sensory and motor blocks (467 min vs. 312 min and 490 min vs. 329 min, respectively) compared to Group C (p<0.05). Additionally, Group D exhibited a substantially extended duration of analgesia (478 min vs. 321.16 min) compared to Group C (p<0.05). Moreover, throughout the study, Dexmedetomidine consistently maintained a more pronounced and sustained reduction in pulse rate compared to Clonidine, which could be particularly relevant in scenarios requiring prolonged hemodynamic control. Conclusion: Dexmedetomidine outperformed clonidine in enhancing the effectiveness and duration of supraclavicular brachial plexus blocks, making it a preferable choice for such procedures, particularly in scenarios requiring prolonged hemodynamic control.

10. A Comparison of Unipolar and Bipolar Hemiarthroplasty for Displaced Fracture Neck of Femur in Adults
Mamidi Anil Kumar, Gattu Naresh
Background: Displaced fractures of the femoral neck in adults and their associated complications contribute significantly to morbidity and mortality. Early patient mobilization and extended productive life are facilitated through unipolar and bipolar hemiarthroplasty. The current study aimed to evaluate the short-term functional and radiological outcome of Unipolar and Bipolar hemiarthroplasty in displaced intracapsular fracture neck of the femur. Methods: This study included 40 patients with intracapsular femoral neck fractures. Out of these, 20 patients underwent treatment with unipolar hemiarthroplasty, and the remaining 20 received bipolar hemiarthroplasty. Functional outcomes were assessed in both groups using the Harris Hip Score, and radiological evaluations were conducted. Results: The postoperative Harris Hip Scores (HHS) of patients who underwent unipolar (UPHA) and bipolar (BPHA) hemiarthroplasty for displaced fracture neck of the femur in adults. The majority of patients in both groups had excellent (50% UPHA, 60% BPHA) or good (45% UPHA, 35% BPHA) HHS scores after surgery. A small percentage of patients in both groups had fair (5% UPHA, 5% BPHA) HHS scores after surgery. No patients in either group had poor HHS scores after surgery. Conclusion: Based on our study findings, we concluded that uncemented bipolar hemiarthroplasty delivered superior outcomes compared to uncemented unipolar hemiarthroplasty. Additionally, our results indicated that cemented bipolar hemiarthroplasty yielded better clinical and radiological outcomes compared to cemented unipolar hemiarthroplasty.

11. Assessment of Knowledge, Attitude and Practices towards Pharmacovigilance among Nurses of a Tertiary Care Teaching Hospital
Kakasaniya GG, Mer RJ, Chhaiya SB
Introduction: As Nurses are close to the patients, their role is important in Adverse Drug Reaction (ADR) reporting. Thus, this study was carried out among nurses of tertiary care teaching hospital. Aims and Objectives: This study was planned to assess knowledge, attitude and practices (KAP) of pharmacovigilance among nurses of tertiary care teaching hospital. Method: A questionnaire-based, prospective and observational study was conducted after taken approval from Ethics committee. Total 45 Nurses were voluntary participated in this study. Data were collected in the form of Pre-tested and validated questionnaire consisting of 10 questions about pharmacovigilance. The filled questionnaires were collected and analyzed on Microsoft Excel Sheet. Results: According to the result of present study all nurses were familiar with term of pharmacovigilance and 89% of them were aware of pharmacovigilance programme of India. Out of total filled questionnaire received, most of nurses (93%) believed that all the drugs available in the market are not safe and only 8% believed that patient can also report ADRs. The major factor discouraging for reporting ADR was lack of knowledge regarding where to report ADR. Conclusion: This study has shown that majority of the participants had correct knowledge and positive attitude about pharmacovigilance, In spite of that, reporting rate of ADRs is very low. Hence, steps should be taken to raise awareness among them is important.

12. To Determine the Effect of Oral Pantoprazole and Rabeprazole on Blood Glucose Levels in Type 2 Diabetes Mellitus
Geetika Gupta, Puneeta Gupta, Bhavna Langer, Anil K. Gupta
Background: Diabetes mellitus represents a spectrum of metabolic disorders which has become a major challenge worldwide. There is a plethora of drugs targeting the defects of DM. Recently, however the focus has been on strengthening the enteroinsular axis and incretins. Proton pump inhibitors used extensively for the treatment of gastritis and related symptoms, indirectly elevate gastrin levels which is reported by few studies to have the potential to improve glycemic control. Material & Methods: 195 patients of T2DM satisfying the inclusion criteria were included in the study after taking informed consent. A prestructured questionnaire was used for data collection. Subjects who were prescribed pantoprazole 40mg or rabeprazole 20mg for 12 weeks for their acid related ailments were divided into two groups and those not taking PPI were considered as controls. Fasting blood glucose, HbA1c levels were noted at baseline and after 12 weeks. Results: Comparison of fasting blood glucose and HbA1c at baseline and at 12 weeks for Group I and Group II using paired t test showed that in both the groups there was a statistically significant change for both these parameters (Group I=0.00 & 0.00 respectively; Group II=0.00 &0.00 respectively) thereby implying better glycemic control. Conclusion: The study suggested of a possible role of PPI as an adjunctive therapy in achieving better glycemic control similar to incretin-based therapies in patients of T2DM but further studies are warranted to confirm the effect of combination therapy.

13. Effect of Analgesia Induced by Erector Spinae Plane Block versus Transversus Abdominis Plane Block Post Elective Lower Segment Caesarean Section: A Comparative Analysis
Sagar Nana More, Annop Agarwal, Bhavin Patel
Introduction: This research investigated the anelgesic effectiveness of bi-lateral transversus abdominis plane (TAP) & bi-lateral erector spinae plane (ESP) blocks following elective lower segment cesarean section. Material & Methods: 120 subjects planned for spinal anaesthesia-induced elective cesarean deliveries were arbitrarily allotted to undergo either an ESP-block or a TAP-block. At the conclusion of surgery, the ESP category received an ESP-block with 20 mL of 0.25% bupivacaine at the level of the ninth thoracic transverse process. After delivery, the TAP category underwent an USG-guided TAP-block with 20 mL of 0.25% bupivacaine. The length of anelgesia that each block was able to provide was the main result. Post-operative pain intensity, total tramadol intake, & subject satisfaction were secondary outcome indicators. Results: The ESP category had a extended median (interquartile range) block period than the TAP category (12 Hrs [10, 14] versus 8 Hrs [8, 8], p<0.0001). The average visual analogue pain count at rest was 0.32 units lesser in the ESP category in the initial 24 Hrs. The TAP category consumed considerably more tramadol on average during the first 24 Hrs than the ESP category (125 mg [100, 150] vs 100 mg [75, 100], p=0.003). Conclusion: The ESP-block offers more outcome pain comfort than the TAP-block, has a extended period of anelgesic effect, extends the duration before the first anelgesic is needed, is associated to lesser tramadol utilization, & can be used in multi-modal anelgesia & opioid-sparing regimens following lower segment cesarean section.

14. Short Time Effect of 2% Pilocarpine Eye Drops on Intra Ocular Pressure
KVV Satyanarayana, A Chitra, K Ravi Naini, Ch Ramya, VVL Narasimha Rao, T Jaya Chandra
Introduction: Pilocarpine is direct acting parasympathomimetic agent, acts on autonomic nervous system. Intra ocular pressure (IOP) is the major risk factor for the development of glaucoma. A study was conducted to find the short time effect of 2% Pilocarpine eye drops on IOP. Methods:  This was a hospital based, prospective study, conducted in the department of Ophthalmology, GITAM Institute of Medical sciences & Research, Visakhapatnam. Study was conducted between January to June 2023. Individuals aged > 20 years, both gender diagnosed to be angle closure glaucoma and different subtypes were included in this research. The preprocedural IOP was recorded with goldman applanation tonometer, recorded in milli meters of mercury (mm Hg). Pilocarpine eye drops at 2% concentration was instilled to both eyes for every 30 minutes for 2 hours and IOP was measured. The data were represented in mean + SD. ANOVA test was used for the statistical analysis. P<0.05 was considered to be statistically significant. Results: Total 50 members were included, female male ratio was 2.3. Maximum (24%) study members were in 40 – 50 years group and minimum (8%) in < 20 years group. The mean + SD IOP was 17.3 + 6.2498 and 14.52 + 5.1217, respectively in pre and post administration of 2% pilocarpine eye drops; statistically there was significant difference (P = 0.001). Conclusions: Pilocarpine can bring significant IOP reduction among the glaucoma individuals. But small sample size, short duration of study and not reporting the diurnal and nocturnal data are the limitations of the study. Studies on large sample size for long time is recommended.

15. Microbiological Analysis of CSF in a Tertiary Health Care Setup
Kunduru Jyothi, Mohd Ubaidullah Ansari, T Jaya Chandra
Introduction: Acute bacterial meningitis (ABM) is an infection of central nervous system (CNS), major health problem of developing countries. ABM is associated with significant mortality and morbidity, leads to around 25% deaths. With these, a study was taken to find various bacterial agents that cause ABM and also to find the antibacterial susceptibility testing to various antibiotics. Methods: Study was conducted in the department of Microbiology, GSL Medical College. CSF samples were transported immediately to the microbiology laboratory. Samples were cultured on blood agar, chocolate agar and MacConkey agar, incubated at 370C; incubated plates were checked after 24 and 48 hours. Culture and antibacterial sensitivity for the isolates was carried by using Kibry bauer disc diffusion method. Results: During the study period, total 222 CSF samples were collected, 34 (15.3%) were culture positive (CP); 58.8% were male and 41.2% were female. Staphylococcus aureus was the predominant {23.5% (8)} isolate followed by Klebsiella species (20.6%), Escherichia coli and other 14.7% each, Pseudomonas species 11.8%, Streptococcus pneumoniae (8.8%). In this study, all the isolates were sensitive to vancomycin, imipenem, linezolid, piptaz. Conclusion: Meningitis is prevalent among male and staph.vaureus is the predominant isolate, no significant drug resistance was reported.

16. Cytopathological Study of Oral Lesions in Tertiary Care Hospital in Western Part of India
Jitendra Kumar S Parmar, Manjula J Babariya, Chintan Doshi, Jaymala Solanki
Introduction: Oral cancer is a heterogeneous group of cancers arising from different parts of the oral cavity, with different predisposing factors, prevalence, and treatment outcomes. It is the sixth most common cancer reported globally with an annual incidence of over 300,000 cases, of which 62% arise in developing countries. Oral cancer is a major problem in the Indian subcontinent, where it ranks among the top three types of cancer in the country. It accounts for over 30 % of all cancers in India, posing a significant challenge to health services by both preventive and diagnostic means. Objectives:  The objectives of this study are   1) To study role of FNAC and Brush cytology in diagnosis of various oral lesion   2) To study lesions of oral cavity in relation to age, sex & site  3) To compare observed findings with those of similar studies done by other authors  4) To compare it with final histological diagnosis. Methods: A hospital based retrospective study was conducted in a tertiary care hospital at western part of India from December 2014 to November 2016. Those study participants who fulfilled the inclusion criteria were enrolled in the study. A detailed history of the oral lesion in terms of duration, progress, associated symptoms and any treatment received for the lesion was obtained. Depending on the presenting complain brush cytology and FNAC were done in our department. Results:  In this study, 110 patients presented with different lesions of the oral cavity were subjected to fine needle aspiration and brush cytology. Out of total 110 cases, 44 (40%) cases were Benign,  10 (9.1 %) cases were Premalignant lesions & 56 (50.9%) were Malignant lesions. In the present study Malignant lesions (50.9%) were more common. In the present study most common benign lesion were inflammatory lesion & squamous cell carcinoma is most common malignant lesion. Conclusion: Among the Neoplastic lesions (56 cases), 42(75%) were male & 14(25%) were females showing Male: Female ratio of 3:1. Most common age group affected was 41-50 years (50%). The present study shows majority of cases of lesions of oral cavity involved Cheek or Buccal Mucosa (41.30%). Most common malignant lesion of oral cavity is Squamous Cell Carcinoma with buccal mucosa most common site & common in 41-50 years age group with Male: Female ratio of 3:1. Most common premalignant lesion of oral cavity is Leukoplakia with gingival mucosa most common site & common in 41-50 years age group with Male: Female ratio of 4:1. Most common Benign lesion of oral cavity is inflammation with floor of mouth followed by tongue most common site & common in 21-30 years age group with Male: Female ratio of 1.2:1.

17. Analysis of Reporting Pharmacovigilance in a Rural Tertiary Care Hospital in South India: A Retrospective Study of Two Years Survey
Kanagasanthosh K, Sujeetha C, Saravanan K.S., Elandevan C.K.
Introduction: In India the Adverse Drug Reaction (ADR) reporting have to enhanced in the tertiary care teaching institute and corporate hospital. Majority of the drug fate will be revealed if there is documental evidence of ADR reporting. In many countries ADR ranks among the top ten leading cause of morbidity and mortality. Objective of the Present study was planned to evaluate and analyses the incidence and pattern of various ADR reported from both the outpatient and inpatient department in a tertiary care teaching hospital. The study objective is with special emphasize on causality assessment tool using Naranjo Algorithm and World Health Organization – Uppsala Monitoring Centre (WHO-UPC). Materials and Methods: This study was an observational, retrospective and Cross-sectional study conducted by analyzing the spontaneous ADR forms collected from various clinical departments over a period of 16 months from January 2020 to April 2021. Causality analysis was done based on the two recommended assessment of Naranjo Algorithm and WHO-UPCA. A total of 139 patients ADR were collected and analyzed. Results: Among the total reported ADR, it shows female predominance of 54.68%. The majority of the ADR event occurred in the age group between 51–60 years of 20.86%. Among the various departments, dermatology had higher occurrence with 33.81%. Based on the type of reaction, urticaria was predominant with 30.22% followed by Fixed drug eruption and Maculopapular drug rashes. Parenteral and Oral antibiotics were the major ADR reported in our study with 54.67% followed by other systemic drugs. The causality assessment of both the study reveals that 32.37% were identified in serious reaction. Conclusion:  ADR Reporting is an ongoing and continuous process which is need of the hour to create awareness among health care profession and patients. “Probable” was the most common causality category identified in both the assessment method.

18. Clinical and Histopathological Correlation of Adverse Cutaneous Drug Reactions
Jitendra Kumar Prabhudas Modi, Parth Jitendra Kumar Modi
Background and Aim: Adverse medication reactions are widespread, with the most common being cutaneous symptoms. The incidence of cutaneous medication responses in the hospital ranges from 2% to 3%. The current study sought to investigate the histological aspects of cutaneous adverse drug reactions (ADRs) and their relationship to clinical presentation. Material and Methods: A one-year hospital-based observational study was carried out in the department of dermatology, venereology, and leprology at the Tertiary Care Institute of India on patients presenting with visible cutaneous lesions suspected to be adverse drug reactions and their correlation to histopathological findings. The total sample size was set at 100 patients. All patients underwent a thorough history, physical examination, and standard and relevant investigations. After obtaining informed consent, all patients had biopsies, and histological findings were compared to clinical diagnoses. Results: NSAIDs (37%) were the most common causal agents, followed by amoxycillin (15.0%), fluconazole/itraconazole (9%), ciprofloxacin (5.0%), and cotrimoxazole (7%). (Table 1) Fixed drug eruption (26%) was the most commonly reported lesion, followed by maculopapular rash (20.0%), SJS (11%), urticaria (10.0%), erythema multiforme (8%), AGEP and erythroderma (6%), and TEN (5.0%). Colloid bodies (5.0%), peri appendageal infiltration (6%), interstitial oedema (4%), subepidermal bullae (5.0%), plasma cells (1%), fibrinoid necrosis (1%), intracorneal and subcorneal bullae (4%), were the histological findings observed. Conclusion: Differentiating cutaneous ADR from other inflammatory dermatoses requires the identification of histological patterns and clinical connection. Drug reactions are a clinical problem, therefore clinicopathological correlation can aid in diagnosis.

19. Efficacy and Safety of PRP in the Treatment of Diabetic Foot Ulcers
Pranav Rambhai Patel, Khyati Shah, Mehul Kumar K Vasaiya, Kunal Chinubhai Modi
Background and Aim: Autologous platelet-rich plasma (PRP) has been shown to improve wound healing. However, clinical evidence for its treatment in diabetic ulcer patients is inconclusive. The study sought to ascertain the effects and benefits of PRP in the treatment of diabetic foot ulcers. Material and Methods: This prospective comparative study was carried out in patients with diabetic foot ulcers admitted to the tertiary care department of surgery in India for a period of one year. The study covered 60 patients in total. Case A (experimental group, n=30) and Case B (control group, n=30) were allocated at random. To avoid contamination with deadly viral infections, PRP was checked for all normal blood transmitted diseases before usage. The length and width of the ulcers were measured with a metric tape. The difference in wound decrease between the two groups was measured. Results: Patients ranged in age from 45 to 60 years old, with males being more impacted than females. Furthermore, when compared to the traditional dressing group, the PRP group required less time for wound contraction. PRP was proven to be more effective in wound healing, with less problems, infection, exudates, and discomfort. Conclusion: DFUs have a negative impact on the quality of life of diabetic patients. The wounds in the PRP-treated subjects contracted more than the wounds in the non-treated group, indicating that PRP dressing is an effective modality for facilitating wound contraction in diabetic patients and can be used as an adjunct to the conventional mode of treatment (conventional dressings and debridement) for diabetic wound healing.

20. Drug Utilization Evaluation in Breast Cancer Patients in a Tertiary Cancer Hospital: A Descriptive Observational Study
Kamanashis Dutta, Snigdha Dutta, Kailash Chandra Mishra, Nomita Tangneijon Hrangkhol, Chandan N.G.
Introduction: Evaluating the prescribing patterns of anticancer and supportive care drugs in cancer breast patients is necessary for ensuring effectiveness and patient’s quality of life. This study aims to evaluate the prescribing patterns in patients receiving chemotherapy. Methods: A prospective observational study was conducted in the Department of Medical Oncology at Assam cancer care Hospital, Diphu center. The study was conducted from January 2021 to August 2023. Cancer breast patients who are on chemotherapy for ca breast along with supportive care medications were enrolled. Data were analyzed using descriptive statistics. Continuous data were expressed as mean ± standard deviation, and the nominal data were expressed as frequency and percentages. Results: Among 37 patients, majority of patients were in the age group of 31-45 years. Only two were males and rest were females. Single regimen (57%) was the most commonly prescribed chemotherapy followed by multiple drug regimens (43%). Most common being 34 encounters of Adriamycin with cyclophosphamide were seen followed by Epirubicin with cyclophosphamide and triple combination of docetaxel, cyclophosphamide with transtuzumab. The percentage of drugs prescribed from the National List Essential Medicine and the World Health Organization (WHO) model list was 74% and 70%, respectively. Conclusion: Various anticancer drug prescription patterns are being used for treatment of patient with metastatic cancers. In this study, Adriamycin with cyclophosphamide was commonly used. Injudicious antibiotic prescribing was not observed. The percentage of drugs prescribed from list of essential drugs may be improved. Polypharmacy was not observed. Drug utilization review should be conducted periodically to minimize the untoward effects at least to some extent.

21. Drug Utilisation Pattern and Cost Analysis of Anticancer Drugs in a Cancer Care Hospital, Diphu Medical College & Hospital
Kamanashis Dutta, Snigdha Dutta, Kailash Chandra Mishra, Nomita Tangneijon Hrangkhol, Chandan NG
Introduction: Evaluating the prescribing patterns of anticancer and supportive care drugs in cancer breast patients is necessary for ensuring effectiveness and patient’s quality of life. The present study aimed to evaluate the trends and pattern of prescribing of anticancer drugs. The objectives of the study were to assess the rational use of anticancer drugs, to identify various types of cancer and to estimate the cost distribution of anticancer drugs. Methods:  A prospective observational study was conducted in the Department of Medical Oncology at Assam cancer care Hospital, Diphu center. The study was conducted from January 2021 to June 2023. Cancer patients who are on chemotherapy along with supportive care medications were enrolled. Data were analyzed using descriptive statistics. Continuous data were expressed as mean ± standard deviation, and the nominal data were expressed as frequency and percentages. Results: Among 79 patients, majority of patients were in the age group of 31-45 years. Among a total of 627 encounters single regimen (57%) was the most commonly prescribed chemotherapy followed by multiple drug regimens (43%). Cancer breast was the commonest type of cancer in our study. Most common being tranztuzumab only treatment followed by Adriamycin with cyclophosphamide were seen followed by paclitaxel and Epirubicin with cyclophosphamide combination. Average cost of chemo drugs per encounter in our study was Rs.14186.68 while as a whole per encounter cost was Rs.17242.84 which include the supportive care medicine. Conclusion: Various anticancer drug prescription patterns are being used for treatment of patient with metastatic cancers. The study implies that most of the anticancer drugs were prescribed either single or in combination for improved therapy and are highly expensive. The complexity in prescribing can be improved by introducing cost controlling policies and new systemic interventions that might increase the quality of patient care. The prescribing pattern and cost distribution have to be examined from time to time so as to manage the inventory control in hospital pharmacy.

22. A Cross Sectional Study of Advantages of Laparoscopic Intraperitoneal ONLAY Mesh Technique (IPOM) Vs Conventional Open Mesh Repair in a Tertiary Care Hospital
Balraju Ajmir, Shaik Akbar Pasha, Pidathala Gopal Rao, Khethavath Giridhar Nayak, Himanish Sen
Background and objectives: Ventral hernias (VH) occur as a result of weakness in the musculofascial layer of the anterior abdominal wall. The ventral hernia (VH) repair is based on the principle of Rives Stoppa open tension free mesh repair. In the laparoscopic technique, the mesh is placed in an intraperitoneal location and where the rise in the intra-abdominal pressures (IAP) is totally diffused along each square inch and keeps the mesh in place. This study aims to draw a comparison between the open mesh repair vs the laparoscopic IPOM procedures with regards to several parameters. Methodology: This is a Prospective Study involving 50 patients with ventral hernia, those presented during the period of 24 months, followed by a 1 year follow up of the patients in a tertiary care hospital. Patients were subjected to either repair by open or laparoscopy and were followed for a period of up to 1 year from the date of surgery. Results: The results of the study revealed post-operative pain, average hospital stay, average duration of surgery, post-operative complications (seroma, wound infection and recurrence), are less in laparoscopic ventral hernia repair compared with open ventral hernia mesh repair, and early return to normal activity, attained in laparoscopic ventral hernia repair, as compared to open mesh repair. Conclusion: So, laparoscopic repair (IPOM) should be considered as the preferred method of repair in patients with ventral hernia.

23. Role of Fibular Resection in Ununited Tibial Shaft Fracture
Kumar Mayank, Abhijit Kumar
Background: Intact fibula may delay Union in ununited fracture of tibia. Method: 15 cases of 5 months or more old ununited fracture of tibia with intact fibula were studied in the present series between Jan 2021 to Jan 2022. Partial fibulectomy was done and long leg POP cast was applied for four weeks. After four weeks a PTB cast was applied, and weight bearing encouraged. Results: All fractures united at an average time of 14 weeks after partial fibulectomy. (Range of 6 to 20 weeks) in acceptable position. No neurovasular complication was present. Ankle stiffness was present in 3 of the cases which improved after physiotherapy. Conclusion: Partial fibulectomy is a viable option in the management of delayed tibial fractures.

24. Evaluation of the Safety and Efficacy of Pregabalin, Gabapentin, and  Amitriptyline for Neuropathic Pain
Sridharrao Boyinapelly, Rameshchandra Basani
Background: The existing treatment options for managing neuropathic pain frequently fall short of providing satisfactory relief. Despite the abundance of literature available in various guidelines, there remains notable inconsistency in treatment approaches. This study is designed to assess the safety and effectiveness of gabapentin, amitriptyline, and pregabalin in individuals experiencing severe neuropathic pain that hasn’t responded to basic analgesics. Methods: After the selection of the cases a thorough physical examination, comprehensive systemic assessment, monitoring of vital signs, review of past medical history, assessment of concurrent medications, clinical evaluations for chronic lumbar radiculopathy, lumbosacral spine x-rays (both anterior-posterior and lateral views utilizing a digital x-ray machine), and nerve conduction studies. The study included a total of 150 cases, evenly distributed across three groups: Group (P) received pregabalin 75 mg, Group (G) received Gabapentin 300 mg, and Group (A) received Amitriptyline 10 mg. Results: At baseline, there was no significant difference in NPRS scores between any of the three groups. This suggests that the groups were well-matched at the start of the study. At the 1-month follow-up, there was still no significant difference in NPRS scores between any of the three groups. This suggests that all three treatments were equally effective in reducing neuropathic pain intensity at this early stage. At the 3-month follow-up, there was a significant difference in NPRS scores between Group P (pregabalin) and the other two groups (gabapentin and amitriptyline), with Group P having the lowest mean NPRS score. This suggests that pregabalin may be more effective in reducing neuropathic pain intensity over the long term. Conclusion: In summary, this study reveals that gabapentin, pregabalin, and amitriptyline all prove effective in mitigating neuropathic pain (NeP). Notably, pregabalin demonstrates a noteworthy advantage by significantly reducing the NPRS score compared to gabapentin and amitriptyline after 3 months of therapy. Gabapentin, on the other hand, is linked to a lower incidence of reported adverse effects, promoting improved adherence during extended usage. Amitriptyline, being more cost-effective than pregabalin, is a crucial factor to weigh when making treatment decisions for patients.

25. A Histopathological Analysis of Ovarian Tissue Biopsy Samples: A 3 Year Retrospective Cohort Study
Shruti Jaiswal, Swapnil Jaiswal
Background: Ovarian neoplasms represent a diverse spectrum of tumours with distinct histopathological features that vary across different age groups. AIM: This study aimed to analyse the histopathological patterns of ovarian neoplasms across various age cohorts within a tertiary care centre. Material and Methods: This was a hospital-based, single-centre, retrospective, cohort, observational study conducted over a period of 12 months by reviewing the records of 315 histological samples sent to the laboratory in the last three years. Primary outcome was the histopathological diagnosis of the biopsy specimen. Age-specific subgroups were defined, and the prevalence and distribution of different histopathological types were assessed within each subgroup. Results: Most of the population (39.4%) falls within the age range of 21 to 50 years, with a mean age of 39 years. The majority of individuals (64.1%) are in their menstruating years, while a significant portion (29.2%) has reached menopause. The median duration of symptoms is 6 months. Abdominal swelling and pain are the most common presenting symptoms (28.3%). The benign ovarian neoplasms accounted for the majority of cases (70%), while borderline and malignant neoplasms represented 10% and 20%, respectively. Most common type of cancer was serous (16.5%) followed by seromucinous (13.1%), and mucinous (11.5%). Most types of benign and malignant tumours showed clear age distribution pattern. Conclusion: Benign ovarian growths were more prevalent than malignant ones in every age category. Surface epithelial growths stood out as the prevailing histopathological kind of ovarian tumor. Patients tend to seek medical attention late due to nonspecific symptoms. Thus, there is an urgent requirement to establish techniques for detecting ovarian growths early. The proportions of various ovarian growths differ by region, underscoring the necessity to pinpoint risk factors specific to each region.

26. Current Status of Essential & Emergency Neurosurgical care in India
Mayank Kumar, Abhijit Kumar
Traumatic brain injuries (TBIs) are a leading cause of morbidity, mortality, disability and socioeconomic losses in India. Road traffic injuries are the leading cause (60%) of TBIs followed by falls (20%-25%) and violence (10%). About 5,04,123 RTAs occurred in 2015 in India with 1,46,135 deaths, averaging to about 1374 accidents daily and about 400 deaths/day. These data makes us the leaders in the world in RTAs. On the other hand, comparing this with developed world, in Sweden only single death occurred due to RTA in 2015, which is hard to believe. It is not as if the development of trauma care in India has significantly lagged compared to global standards. Over the years, the number of Trauma Centers has increased with adequately equipped units distributed in different corners of the country based in and around major cities. But there is uneven distribution of emergency and essential neurosurgical care with even basic trauma care missing from small towns and rural areas. Even in big cities, slum dwellers and poor population lack accessibility to quality neurosurgical care. We hereby discuss the current status of trauma care and various hurdles faced in providing emergency & essential neurosurgical care at the grassroots (Rural) as well as at the higher urban (Metropolitan) levels.

27. A Retrospective Assessment of Neurodevelopmental Outcome among Babies Requiring Neonatal Intensive Care Unit (NICU) Stay During Their Initial Days: A Follow-Up Study
Kumar Arpit, Rizwan Akhtar, Alka Singh
Aim: The aim of the present study was to determine neurodevelopmental outcome of these babies requiring neonatal intensive care unit (NICU) stay during their initial days at the age of 2 years. Methods: The present study was conducted in the Department of Pediatrics and total duration of study was one year. Retrospective analysis of data of 240 high risk newborns admitted in NICU for more than 48 hours. In this study of 240 babies, 200 babies were followed up for clinical assessment at the age of 2 years. These were contacted and followed up for clinical assessment including motor and neurological function, visiomotor integrative skills, language, executive function, behavioral issues and child behavioral checklist applied. Findings described in simple descriptive manner. Results: In the present study, 48% were male and 52% females. 33% babies were preterm born prior to 37 weeks, 67% were term babies.  46% babies were born low birth weight. 52% were normal vaginal deliveries, 44% were cesarean and 2% were assisted deliveries. 34.5% babies required NICU stay for more than 8 days. 65% required less than 7 days of NICU stay. 12% babies required more than 30 days of NICU stay, 11% required 15-30 days, 12% required 8-14 days. 17.5% had behavioral issues, 12% had withdrawal, 16% had aggressiveness, 20% babies had features of attention deficit hyperactivity disorder and 2% had features related to autism. Immediate complications 25% babies had neonatal hypoglycemia, 8% babies had neonatal seizures, 64% babies required phototherapy for hyperbilirubinemia. 28% had neonatal sepsis requiring antibiotics. Conclusion: Neonatal period is a critical period for proper neurodevelopment, having impact on child development. Babies with difficulties during transition period including prematurity, prolonged requirement for neonatal intensive care, resuscitation, ventilation, birth asphyxia, meconium complicating pregnancy had higher immediate as well as long term morbidities.

28. A Hospital Based Observational Study Assessing the Neuropathological Spectrum of All the Surgically Resected Vascular Malformations of Central Nervous System
Gaurav Batra, Sachin Kumar Singh, Girish K. M.
Aim: The aim of the present study was to assess the neuropathological spectrum of all the surgically resected vascular malformations of central nervous system. Material & Methods: The present study was conducted at Department of Neurosurgery and patients with neurosurgical, and psychiatric disorders were included. All VMs diagnosed in the Department of Neurosurgery over a period of 2 years were retrieved from the archives. Demographic details, clinical features, and follow-up, wherever available, were obtained from the medical records. Results: Among 200 cases, 160 (80%) were intracranial and 40 (20%) involved the spine. CCMs were most common (43%), followed by AVMs (40%), capillary telangiectasia (10%), venous angioma (2%), and AVFs (5%). Clinical presentation varied from focal deficit to features of raised intracranial tension. Conclusion: Imaging and histopathology plays an important role in the diagnosis and management of VMs. Histopathological examination is essential for characterization of the VMs, which influences the prognosis.

29. A Clinical Study of Prevalence of Fungal Sinusitis in Cases of Chronic Rhinosinusitis
K Gokul Kumar, M Hemanth Rao, S Prasanna Laxmi
Background: Chronic sinusitis is a prevalent condition globally, and a notable portion of cases is linked to fungal origins, countering the prevailing notion that fungal sinusitis is uncommon. This is particularly true in countries like India, characterized by warm and humid climates in various regions and a steadily increasing prevalence of diabetes mellitus, creating an ideal environment for fungal growth. The primary objective of this study is to determine the occurrence and clinical characteristics of fungal rhinosinusitis in individuals with chronic rhinosinusitis. Methods: All enrolled patients were introduced to the study’s protocol. A comprehensive history was gathered, and thorough clinical examinations, including a detailed Ear, Nose, and Throat examination, were conducted. A total of 25 patients exhibiting clinical indications of Chronic Rhinosinusitis with suspected Fungal Rhinosinusitis underwent a meticulous history-taking and clinical examination. The investigative procedures were Complete hematogram, Blood Sugar level, Serum Electrolytes, Serum Proteins, Blood Grouping, etc. HIV/HBsAg tests were performed to assess the general condition of the patients. Relevant X-rays of the nose and paranasal sinuses were taken. Patients provisionally diagnosed with fungal Rhinosinusitis underwent CT scans of the nose and paranasal sinuses. Results: The most common type of fungal rhinosinusitis accounted for 12 of 25 cases. The causative organism was the Aspergillus species. It is characterized by an allergic reaction to fungi. The second most common type of fungal rhinosinusitis accounted for nine of the 25 cases. It is characterized by the formation of a fungal mass in the sinus cavity. The table shows that fungal rhinosinusitis is most common in adults, with the average age of all patients being 43.4 years. The most common type of fungal rhinosinusitis is AFRS followed by fungal balls. AIFRS, CIFRS, and CGFRS are rare fungal rhinosinusitis types. Conclusion: Fungal ball, primarily caused by Aspergillus species, frequently involved the maxillary sinuses and affected both sexes equally. Allergic fungal rhinosinusitis was more common in males and consistently presented with nasal polyps and allergic mucin. Invasive forms of fungal rhinosinusitis were less common, with acute presentations being more frequent. Acute invasive fungal rhinosinusitis was predominantly caused by Rhizopus and exhibited a wide range of manifestations, with a higher incidence among elderly and immunocompromised individuals.

30. A Prospective Cohort Study Evaluating Medical or Surgical Treatment of Endometriosis and Fertility
Monica Singh, Jitendra Gothwal, Mahesh Kumar Singh, Priyanka Verma
Objectives: To evaluate the impact of medical and surgical endometriosis treatment on IVF reproductive outcomes in patients with primary infertility. Material and Methods: The study, conducted over a three year period (2020-2023), included 51 patients with endometriosis associated primary infertility. Group I included patients treated for endometriosis before the IVF (subgroups A: surgical and pharmacological treatment and B: only surgical treatment). Group II included patients immediately subjected to IVF. Assessed outcomes were pregnancy rate (PR) per started cycle, fertilization rate (FR), implantation rate (IR) and live birth rate (LBR). Results: Group IA included 17 patients, Group IB 17 and Group II 17 patients. FR and IR showed no significant differences between groups. PR was significantly higher in the Group I than Group II (49% vs 25%, p = 0.030). PR per started cycle was the highest in the Group IA and the lowest in the Group II (p = 0.040). LBR was significantly higher in whole Group I  (p = 0.043) and subgroup IA (p = 0.020) than Group II. Group IA and IB did not differ regarding examined outcomes. Regression analysis showed that endometriosis pre-treatment method can impact both achieving pregnancy (p = 0.036) and having a live born child (p = 0.008) after IVF. The combined surgical and pharmacological endometriosis treatment, shorter infertility duration, lower EFI score, using long protocol with FSH+HMG gonadotropins increase the probability of successful IVF. Conclusions: A combined surgical and pharmacological endometriosis treatment had a positive impact on IVF reproductive outcomes, both on pregnancy and on live birth rates.

31. Morphometric Study of Suprascapular Notch in Dry Adult Scapula
Sonal A Talokar, Abhilasha M Wahane, Rajashri N. Dange
Introduction: The suprascapular notch is a depression on the lateral part of the superior border of the scapula, situated medial to the coracoid process. It is bridged by the superior transverse scapular ligament. Suprascapular notch transmits the suprascapular nerve to the supraspinatus fossa and suprascapular vessels pass above the ligament. Various morphological variations of suprascapular notch have been identified as one of the causes of suprascapular nerve entrapment. Based on its shape, Rengachary et al. classified this notch into six types. Aim of Study: To study morphometry and morphological variations of suprascapular notch in Indian dry scapulae and to analyze the incidence of completely ossified superior transverse scapular ligament with other ethnic populations which have been studied earlier. Materials and Methods: A total of 100 human dry scapulae which were collected from the museum of Department of Anatomy, Govt. Medical College were analyzed. The suprascapular notch was classified according to Rengachary et al. The results of the present study were compared with the results of previous authors in different populations. Results: In our study, out 100 scapulae, the incidence of various types of suprascapular notches were: Type I -26%, Type II -28%, Type III -34%, Type IV -8%, Type V -4%, Type VI -0%. Conclusion: Since ossification of superior transverse scapular ligament with formation of suprascapular foramen and other morphometric variations of suprascapular notch, are responsible for the suprascapular nerve entrapment syndrome, the knowledge of variations is essential for clinicians, for a proper diagnosis and suitable surgical intervention.

32. An Observational Study of Allergic Rhinitis and Asthma: Assessing Severity and Co-Occurrence
Arpit D. Prajapati, Trupti Savariya
Introduction: Allergic rhinitis and asthma are prevalent respiratory conditions with a known association, often referred to as the “united airway disease.” This connection is of particular interest in India, where the burden of these conditions has been on the rise, especially among adolescents. While their co-occurrence is well-documented, the underlying mechanisms of their interplay remain the subject of ongoing investigation. The allergic march theory suggests a bidirectional relationship, where allergic rhinitis may influence the development of asthma, and asthma can exacerbate rhinitis. Our study aims to assess the severity of allergic rhinitis and its correlation with asthma, providing valuable insights for comprehensive therapeutic approaches. Material and Methods: This year-long observational study, conducted at a tertiary care center, investigated the co-occurrence and severity of allergic rhinitis (AR) and asthma in a cohort of 70 patients aged six and older. AR and asthma diagnoses followed established criteria and guidelines (ARIA, GINA, and NAEPP). Diagnostic investigations included anterior rhinoscopy, nasal endoscopy, and spirometry. Data analysis done using Chi-Square and Spearman’s Rho correlation tests to explore associations and correlations. Results: This study, comprising 70 patients, exhibited diverse age distribution, with 41.43% falling within the 19-30 years group, emphasizing the relevance of young adults in assessing allergic rhinitis and asthma prevalence. Males accounted for roughly 54% of participants, while females constituted around 45.71%, showing a slightly higher male presence. In our study, 27.14% had a history of allergic rhinitis, 18.57% had asthma, and 7.14% had atopic dermatitis. The majority, 70%, experienced seasonal allergic rhinitis, with watery runny nose being the most common symptom at 61.43%. Importantly, we observed a significant positive correlation (Spearman’s rho r=0.311, p<0.01) between the severity of allergic rhinitis and asthma, indicating a corresponding increase in severity between the two conditions. Conclusion: The correlation observed between allergic rhinitis and asthma severity in our study underscores their intertwined nature, shedding light on potential common pathogenesis. Treating them as a united airway disease could offer holistic therapeutic opportunities.

33. A Study to Find Various Sociodemographic Factors in TB COVID-19 Coinfection
Sujatha Tejavat, Krishna Swaroop Duddi Sreehari, Sayed A Quadri, T Jaya Chandra
Introduction: Tuberculosis (TB) and COVID-19 are infectious diseases, infect lungs. TB is global pandemic and 2nd highest number of COVID cases were reported from India. Infection control measures are almost similar for both these infections. With this a study was conducted to find the correlation between the coinfection and various sociodemographic factors from a tertiary health care setup. Methods: It was a prospective research conducted in the department of Microbiology, GSL Medical College. Individuals of both gender, > 18 years with cough for > 2 weeks and with signs and symptoms of COVID-19 were included. Non cooperative individuals were excluded. The clinical findings and socio demographic factors were recorded in the study proforma. Specimen collection and diagnosis of infections were carried as per the guidelines. The data were analysed using SPSS version 21. Data was presented in mean and percentages. Results: During the study period, total 142 members were included, coinfection was diagnosed in 23 (100%) members. The mean age was 36.6 years. Gender wise 13 (57%) were male and 43% (10) were female participants; the male female ratio was 1.3. Age wise, maximum (11; 48%) members were in 21 – 40 years group. As per the income wise most of the coinfection participants were lower income category and all are employees. Conclusion: TB COVID-19 coinfection is common among men with low socioeconomic back ground. Hence coinfection screening guidelines are to be followed strictly. Screening of large number of cases for long time is recommended for better outcome.

34. A Cross-Sectional Assessment of Knowledge, Attitude and Practice Regarding Menstrual Cup
Bhanawat M, Mehta D, Vachhani P, Bhimani N, Patel U, Patel K
Background: Menstrual cups are device for controlling menstrual flow and have been seen as safe, effective and environmentally friendly option in comparison to conventional sanitary pads. It is a nonabsorbent reusable cup that collects menstrual blood. Although menstrual cups have been around for a while, their use is restricted by their heavy construction and tedious methodology of insertion. Nevertheless, there have been documented advantages, including enhancements in the management of health and hygiene during the menstrual period. Additionally, it has provided us with improved insights into the typical volume of menstrual fluid discharged by women during their periods. Furthermore, this research has contributed to a broader understanding, addressing gaps in our knowledge regarding the suitability and effectiveness of menstrual cups as a superior choice compared to traditional options. Objective: This study aims at assessing the knowledge, attitude and practice among adolescent girls about menstrual cup. Methodology: In April 2023, a cross-sectional study took place at Banas Medical College & Research Institute in Gujarat, India, involving 256 female medical students who willingly took part out of a pool of around 331. The study used a self-administered questionnaire to evaluate these students’ knowledge, attitudes, and behaviours regarding menstrual cups. Data collection was carried out during their academic sessions, allowing participants approximately 15-20 minutes to complete the questionnaire. The research received ethical approval, and all participants provided informed verbal consent. This study’s objective was to collect insights into the use of menstrual cups among female medical students. Results: Involving 256 female medical students, 85.94% were familiar with menstrual cups, primarily through social media (37.27%). Surprisingly, 54.54% didn’t know the cup’s material. 50% recognized “Collection” as its mechanism, and 32.7% knew the insertion methods. Only 27.27% emptied the cup every 5-6 hours, with 80% uncertain. Sterilisation preferences included boiling (30.47%), while 64.06% were unsure. Positive aspects included rash-free (37.27%) and itch-free (32.27%) periods. Negative effects were pain (9.09%), urinary problems (11.81%), and infection (18.63%). Most (78.63%) were uncertain about harmful effects. Around 16.79% considered changing their menstrual protection method. Concerns among those hesitant included discomfort (37.11%), limited knowledge (27.73%), leakage (14.84%), and allergies (6.25%).Notably, 90.23% preferred sanitary pads, while only 5.86% favoured menstrual cups, and 1.17% leaned towards sanitary tampons. Out of 256 female participants, 10 currently use menstrual cups. Among these users, 80% find them easy to insert and remove, and 60% find them easy to clean. However, 80% experience leakage issues, while 80% feel comfortable using menstrual cups. Regarding adverse events, 20% report pain, 10% discomfort or irritation. Encouragingly, 70% of users express a desire to continue using menstrual cups. Conclusion: The research underscores the need for education among medical students about menstrual cup materials and functioning, while highlighting potential benefits. It also calls for product design improvements and safety information dissemination. Future studies should explore reasons behind discomfort and limited knowledge. Overall, this research emphasises the importance of education, product enhancement, and support in promoting menstrual cup adoption among medical students.

35. Lightning Strike: Multisystem Trauma
Komal Gharsangi, Pratibha Himral, Gurpreet Sharma
Lightning is a common natural disaster in India which causes casualties every year. It rarely causes serious internal injuries but can cause life threatening tissue damage due to high voltages, high temperatures and blast waves which have be addressed immediately. It can lead to cardiac, respiratory, nervous system trauma, rhabdomyolysis, ear and eye injury which can have immediate or long term sequelae. Therefore it is important to understand the pattern of injuries which can facilitate early recognition and treatment.

36. Study of Anatomy of Inguinal Canal in Both Sex in Bihar
Vivekanand, Rekha Sinha, Amrita Kumari, Birendra Kumar Sinha
Background and Objectives: Inguinal canal is an oblique musculo-aponeurotic tunnel in lower part of anterior abdominal wall, situated just above and parallel to the medial half of inguinal ligament. Inguinal hernia is more common in low socio-economic group than others. Most of the people of Bihar comes under this group. The dimension and the content of inguinal canal in both sexes varies. Material and Method: The anatomy of inguinal canal was studied in  cadaver of both sexes in the Department of Anatomy, PMCH Patna (Bihar). Freshly embalmed bodies were used for purpose of dissection of inguinal canal. Both male and female bodies were dissected and superficial and deep inguinal rings and inguinal canal were studied. Conclusion: In most cases muscular fibres of internal oblique strengthened the canal anteriorly, where deep inguinal ring was situated. The musculo aponeurotic fibres of transverses abdominis did not take part in formation of anterior wall.

37. Observation on Origin Course and Branching Pattern of Posterior Cerebral Artery in Human Brain
Rekha Sinha, Vivekanand , Amrita Kumari, Birendra Kumar Sinha
Background and Objectives: The brain is an organ that serves as the centre of nervous system. It is the master regulator of the whole body function containing about 15-33 billion neurons. This regulating function of the brain on the rest of the body allows rapid and coordinated responses to changes in the environment. As the artery supplies very important areas of the central nervous system, it becomes important to know the variations in the artery. To facilitate better understanding of pathogenesis of various diseases involving posterior cerebral artery perfused regions of brain. Materials and Methods: The present study was done in 20 posterior cerebral arteries (20 cerebral hemispheres) in the department of Anatomy.  The present work entitled “Observations on origin, course and branching pattern of posterior cerebral artery in human brain” was carried out in Department of Anatomy, PMCH, Patna. Conclusion: In all the 10 brains the posterior cerebral artery (PCA) was present on either side, arising from the basilar bifurcation. In one brain fetal configuration of PCA origin was seen on left side in which the posterior communicating artery was visible to be much thicker than the P1 segment of PCA.

38. Study on Femoral Neck Anteversion and its Radiological Correlation in Population
Rupesh Kumar Sriwastawa, Alpana Pathak
Background and Objectives: Anatomists and orthopaedics have long been interested in the femoral neck anteversion angle (FNA) since it is widely recognised as an important factor for hip stability. To study the Femoral neck anteversion (FNA) angle in dry femora. Methodology: The study was conducted after receiving approval from the Ethical Committee of BHU Varanasi. Study duration of Two years. Conclusion: In the present study, the mean FNA angle measured Physically and Radiologically were 13.22° and 15.65° with Standard Deviation of 4.20 and 4.65 respectively. The range was from 5°-27° on physical measurement and from 6°-29° on radiological measurement.

39. Observation on the Anatomical Pattern of Superficial Cubital Veins in the People of Bihar
Amrita Kumari, Rekha Sinha, Vivekanand, Birendra Kumar Sinha
Background and Objectives: Venipuncture for obtaining a blood sample is one of the most common procedures in the emergency room. It is performed by various medical practitioners such as physicians, nurse, emergency medical technician. For inexperienced health workers, it can be the most frustrating and most important task for building rapport with patients. Many variations of superficial cubital veins were observed by different researchers of anatomy and various articles were also published in different periods of time to state the anatomical patterns and variations of superficial cubital veins. Materials and Methods: This research is an observational study, which is purely descriptive and was done with the purpose of examining the pattern of superficial veins of the cubital fossa among randomly selected volunteers from the staff and medical students in PMCH Patna. Conclusion: “M” shaped or type A pattern of arrangement of superficial veins at the cubital fossa, was the most commonly observed pattern seen in people of Bihar. It was seen in 35% of the living subjects, whereas in the cadavers it also accounted for 35%. Subtype A, the variant of “M” shaped pattern of superficial cubital veins, with subtype A1 showing the most common pattern of arrangement accounting for 30% whereas subtype A2 accounting for only 5% of cases. Consent was taken from the volunteers and further study was initiated. A total 40 subjects were chosen aged between 20-27 years irrespective of their sex.

40. Spectrum of Clinical Presentation of Abdominal Tuberculosis and its Surgical Management
Kapildev Ganeshrao Patil, Bhagwan Raghunath Korde
Background: Clinicians still face difficulties diagnosing abdominal TB. Between 5% and 10% of TB notifications in the UK are related to the abdomen, which affects 10%–30% of people with pulmonary TB. Over 75% of instances involve immigrants, the majority of whom are from the Indian subcontinent. A common and serious health issue is tuberculosis, particularly in underdeveloped nations where the disease is more common due to illiteracy, poverty, overcrowding, inadequate sanitation, and malnutrition. The World Health Organization has deemed it a global emergency and the most significant communicable illness globally. Three million people worldwide lose their lives to tuberculosis each year, afflicting nearly one-third of the world’s population. Even though developed nations have higher health standards, the incidence of tuberculosis—which was previously thought to be low in these nations—is once again rising. This can be attributed to a number of factors, including the influx of immigrants from third-world nations, an aging population, alcoholism, increased use of immunosuppressive drugs, and the emergence of multi-resistant strains of Mycobacterium tuberculosis. Aim: To assess clinical features and investigations for the diagnosis of abdominal TB and to analyze its various surgical manifestations and management. Material and Method: This retrospective investigation was carried out in a general surgery department. All patients who received a clinical diagnosis of abdominal tuberculosis during the study period were subsequently enrolled in the study following the completion of a written informed consent form for HIV testing and study participation. M. tuberculosis infections affecting the peritoneum, intra-abdominal solid organs, or the gastrointestinal system were classified as abdominal tuberculosis. Based on their age and clinical appearance, they were admitted to the surgical, medical, pediatric, or emergency departments. A thorough medical history, physical examination, and pertinent investigations were used in each instance to make the assessment. Antituberculosis medication was used to treat each patient, either non-surgically or surgically. Results: For the trial, 100 participants were enrolled. The male to female ratio in the sample was 1:1.2, with 30 (45%) men and 70 (55%) females. Ninety (90%) of the patients were from low-income rural families that lived a long way from the research location. Sixty percent of patients with abdominal TB were between the ages of 21 and 40. Patients aged 13 to 20 make up 15% of the patient population, and patients aged 41 to 60 make up 20%. Five percent of patients are above 60. In our study, the most prevalent symptom was abdominal pain (88%) which was reported by 70 out of 100 patients. Other common symptoms included vomiting (70%) and distention (18%), with the least common symptom being an abdominal lump (12%) reported by 12 individuals. Conclusion: In conclusion, current statistics indicate that the frequency of abdominal tuberculosis appears to be rising despite significant advancements in medicine. Due to the disease’s variable clinical presentation that mimics other abdominal illnesses, diagnosing it is challenging and delaying treatment increases morbidity and mortality. A high degree of suspicion should constantly be maintained in order to diagnose this entirely treatable illness as soon as possible. Medical therapy is the cornerstone of treatment, and for a significant portion of patients, prompt surgical intervention is necessary.

41. An Observational Study of Profile and Outcome in Cases of Emergency Abdominal Surgeries in SMS Hospital, Jaipur
Aviral Nagar, Shahid Hussain, Varsha Nagar, Prem Dayal
Background: Emergency laparotomy is a common procedure which is associated with substantial postoperative morbidity and mortality. Perforation peritonitis, acute intestinal obstruction and ruptured appendix, blunt and penetrating abdominal injuries either due to road traffic accident, fall from height or gun shot or stab injuries are few major indications for an emergency laparotomy. Aims: To determine the socio demographic pattern at presentation, identify the spectrum of disease, indications for surgery and identify post-operative complication of emergency laparotomies. Methods and Material: It was a hospital based prospective observational study. Total 303 patients undergoing emergency abdominal surgeries in SMS hospital Jaipur from May, 2019-May, 2020 were included.  In present study, socio-demographic profile, initial diagnosis in the emergency room, final diagnosis, organ system involved and outcome of treatment (discharge, morbidity and mortality) and duration of hospital stay were recorded. Results: In this study, mean age of 303 patients was 40.36 ±18.35years (range 10 to 81years) and male to female ratio was 2.93:1. Perforation peritonitis was most common cause of emergency abdominal surgery (149, 49.17%). The most common organ involved was ileum (107, 35.31%) followed by appendix (73, 24.09%) and stomach (70,23.10%). Surgical site infection was most common complication encountered in study (53,17.49%). Mortality seen in 49 (16.17%) patients and perforation peritonitis carried the highest mortality. Mean duration of hospital stay was 6.03±3.92 days. Conclusions: Most commonly affected population was age group between 21-30 years old, male gender with ileal perforation. Wound infection was most common post-operative complication.

42. Isolation, Identification and Antifungal Susceptibility of Dermatophytes in a Tertiary Care Hospital
Milankumar Dharsandia, Jayasukhbhai D Mangukiya, Jigisha R.  Bhoya, Twinklekumar Kantilal Parmar
Background and Aim: Dermatophytes have become more common during the last few decades. Although dermatophytosis cannot cause death, it does cause morbidity and is a serious public health concern, particularly in tropical nations like India because to the hot and humid atmosphere. The study’s objectives were to isolate and identify dermatophytes from clinically suspected instances of dermatophytosis from skin, hair, and nail samples, as well as to test dermatophyte isolates for antifungal susceptibility. Material and Methods:  The current dermatophytosis investigation was conducted for a year at the Department of Microbiology, Tertiary Care Teaching Institute of India. The study comprised 100 clinically diagnosed cases of dermatophytosis in all age groups and both sexes attending the outpatient department of Dermatology and Venereology. Slide culture, lacto phenol cotton blue mount, hair perforation tests, and urease assays were used to identify the causal bacteria. In this work, we used the CLSI broth microdilution method (M38-A) to assess the efficacy of seven antifungal drugs. Sertaconazole, terbinafine, griseofulvin, fluconazole, itraconazole, voriconazole, and amphotericin B were the antifungals utilised. Results: Tinea corporis was reported to be the most prevalent clinical manifestation (58%), followed by Tinea cruris (24%). Tinea pedis (7%), followed by Tinea unguium (7%), was the next most common clinical form. Tinea faciei (1%) was the least common kind in our investigation. Out of 100 samples, 61 were KOH positive (61%), while 39 were KOH negative (39%). Out of 100 samples, 32 were culture-positive (32%), whereas 68 were culture-negative (68%). Conclusion: Dermatophytes are a specialised category of fungus that cause superficial infections in keratinous tissue of humans and other mammals. This study provides an assessment of the prevalence and etiological profile, which may aid in the quantification of the problem and the prevention of dermatophytosis spread by appropriate control methods. Our current research indicates that itraconazole, voriconazole, and griseofulvin are effective against dermatophytes.

43. A Hospital-Based Study to Evaluate Asphyxial Deaths: An Observational Study
Ambedkar Ranjan
Aim: The aim of the present study was to analyze asphyxial deaths in region of eastern UP. Methods: The present study of violent asphyxia deaths was conducted at Department of Forensic Medicine and Toxicology, Maa Vindhyawasini Autonomous State Medical College, Mirzapur, Uttar Pradesh, India College for the period of two years. Total 3215 of autopsies were conducted during the period of which 200 (6.22%) were asphyxial death which are included in this study. Results: Hanging was found to be most common type of asphyxial death and accounts for more than half (120 cases, 60%) asphyxial deaths, followed by drowning which accounts for 28% (56) of cases and ligature strangulation 5% (10). Least number of cases seen was smothering and manual stragulation 2% (4). It was observed all types of asphyxia deaths common in males compared to female except smothering which accounts for same number of cases. The study revealed that maximum number asphyxia deaths due to hanging were in the age group of 21-30 years. All the asphyxial deaths in age group of 1-10 years were due to drowning alone. Maximum number of ligature strangulation seen in age group of 31-40 years. Conclusion: The Present study revealed that males and young age group population between 11–30 years are more susceptible victims of violent asphyxial deaths. Suicidal deaths as a result of hanging and accidental deaths as a result of drowning in this age group are the major causes of asphyxial deaths in present study. This young adult group is most active group of population and more exposed to external environment and stress and strain of life which leads to suicide by means of hanging in this age group.

44. Assessing Serum Level of Different Biomarkers in Children with Asthma to Evaluate Their Role in Response to Treatment
Arunika Prakash, Shruti, Kaushalendra Kumar Singh, Bhupendra Narain
Aim: The aim of the present study was to examine the changes of serum levels of biomarkers which may occur as a result of treatment in children with asthma. Material & Methods: The present study was conducted for 1 year and 50 children who were referred to Upgraded Department of Pediatrics to evaluate the changes of biomarkers (Immunoglobulin E, Eosinophil and Eosinophil Cationic Protein),  5ml peripheral blood samples were drawn before and after the treatment period of six-month. They were measured by ELISA method. The data were analyzed by SPSS software ver.16.0 using descriptive statistics and Paired Sample t test. Results: According to the results, 70% of the children were male and 30% were female. In order to investigate the role of biomarkers in the evaluation of the treatment and management of asthma, the results of the analysis showed that serum levels of Periostin, ECP, IgE and number and percentage of eosinophil decreased after six months of treatment. Based on the results of paired t-test, there was a significant difference between the mean biomarkers studied in beginning of the study and the six months later. Comparison of mean blood cells before and after treatment showed a significant difference in white blood cells and erythrocyte sedimentation rate. In addition to the main findings, regarding the relationship between the demographic variables and the biomarkers levels, result of independent t-test showed that there was no significant relationship between gender and serum biomarkers in pre-treatment and post-treatment measurements (P>0.05). Also, based on Pearson test results, there was no significant relationship between age and serum biomarkers in pre-treatment and post-treatment measurements (P>0.05). Conclusion: The biomarkers serum levels in the children were reduced after the end of the treatment period. Thus, in this study, the role of selective biomarkers in asthma management was confirmed.

45. A Hospital-Based Study Evaluating Clinical and Echocardiographic Assessment of Patients with Atrial Fibrillation
Birendra Kumar, Gitanjali kumari
Aim: The aim of the present study was to assess the clinical and echocardiographic assessment of patients with atrial fibrillation. Methods: The present study was conducted in the Department of General Medicine for 2 years. 200 patients, 80 males and 120 females were included in this study. Results: The most common symptom was dyspnoea 75% followed by Congestive cardiac failure 70%. There was history of mild to moderate chest pain in 12% of patients. 17% of patients had history of syncope/dizzy spells. Fatigability was noticed in 20% cases. Majority of patients, 55% had RHD as underlying cause of atrial fibrillation. There were 40% females and 60% females in this group.  9%  patients  had  coronary artery disease. Hypertension alone was present in 7% of patients. 9% of patients had COPD as a risk factor. 8% of patients had cardiomyopathy Hyperthyroidism was found in 3% of patients. 72% patients had heart rates >100. Fibrillary P wave was seen in 23% patients and absent p waves in 78% of patients. LVH was seen in 12% patients, RVH in 30% patients, RBBB in 5% patients, and LBBB in 6% patients, ST depression and T wave inversion in 60% patients. The maximum number of patients i.e. 36% had LA dimension between 4.1-5.0 cm2. Conclusion: In our study dyspnoea was the commonest symptom in atrial fibrillation and rheumatic heart disease was the major aetiological factor. Patient with left atrial dimension >4.0 cm had sustained atrial fibrillation. Thromboembolic phenomenon was more common in chronic AF and all the patients had mitral valve disease.

46. Clinico-Demographic Profile of Patients Underwent Conservative Treatment and Surgical Management of Venous Ulcers
Santosh kumar, Balkeshwar Kumar Suman, Shri Krishna Ranjan
Aim: The aim of the present study was to assess the role of conservative treatment and surgical management of venous ulcers. Methods: A cross-sectional study was conducted at the Department of General Surgery for the period of one year. 100 patients were studied who were patients attending the outpatient department and casualty during the study period with venous ulcers over the leg. Results: Out of 100 patients, 15 (15%) patients were from 21-30 years age group, 17 (17%) from 31-40 years, 20 (20%) from 41-50 years, 48 (40%) from 51-60 years and 8 (8%) from 60 and above years of age. The mean age was noted to be 46 years. There were 80 (80%) males and 20 (20%) females. Total 18 (18%) patients had a normal BMI, 48 patients (48%) were overweight and 34 (34%) patients were obese. All 15 females were overweight or obese. Along with ulceration, 42 (42%) patients had pain, 69 (69%) patients had edema and 72 (72%) patients had skin changes. All our patients had underlying venous abnormalities either clinically or radiologically. Of the patients, 42 (42%) patients had venous ulcer in the right leg, 53 (53%) in the left leg. 5 (5%) had bilateral venous ulcers. In our study, 72 (72%) patients had pathology of great saphenous vein, 23 (23%) patients had perforator incompetence, and 5 cases (5%) had involvement of short saphenous vein. In our study, 20 patients (20%) underwent conservative management alone and 80 patients (80%) underwent surgery. Amongst 80 patients who underwent surgery, flush ligation of Sapheno-femoral junction with stripping of GSV up to knee was done in 56 (70%) patients. All of these patients had phlebectomy below the knee also. 7 (8.75%) cases underwent subfascial endoscopic perforator ligation (SEPS). Phlebectomy alone was done in 16 (20%) patients. 7 cases were operated with SSV ligation. Conclusion: Venous ulcers are common ulcers of lower limb causing a progressive disability affecting patient with pain, disability, loss of work, and social isolation. Ulcers need prompt treatment with dressings and surgery. Correction of underlying venous insufficiency is the main stay of the treatment. Surgery gives best results with long term benefits.

47. A Hospital-Based Study to Assess the Clinical Profile of Neonates with Jaundice: A Descriptive Study
Pawan Kumar Yadav
Aim: The aim of the present study was to assess the clinical profile of neonates with jaundice. Methods: The descriptive study was conducted in the Department of Paediatrics. Total study duration was of 2 years. Total 800 neonates were admitted in NICU and post natal ward during this period. Out of them, 200 newborns were having jaundice (Serum bilirubin > 10 mg/dl). 200 cases in total were enrolled in the study. Results: 116 neonates (58%) developed jaundice after 72 hours of birth. Only 39% developed jaundice within 24 hours of birth. 64% babies were male as compared to 36% female babies. Surprisingly neonatal jaundice was most commonly noted in babies delivered at more than 37 weeks gestational age (60%), while only 10% babies were delivered between 28-32 weeks gestational age. 2500-4000 gm birthweight babies were 62%, while 38% babies had birthweight less than 2500 gm. Incidence of neonatal jaundice was 60%, 32% and 8% in vaginal delivery, caesarean section, instrumental delivery respectively. Physiological jaundice (32%), prematurity (24%), breast feeding (10%), idiopathic (4%), were most common causes noted in our study. Less common causes noted in our study were ABO incompatibility (6%), sepsis (3%), Rh incompatibility (11%), cephalhematoma (6%), haemolytic anemia (1%), G6PD deficiency (0.50%), and hypothyroidism (4.50%). Yellowish discolouration with good activity (25%), Jaundice with refusal of feeds (30%) were most common symptoms noted. History of delayed cry (18%), fever (15%), and vomiting (12%) symptoms were noted in our study. Conclusion: Male gender, 2500-4000 gm birthweight, vaginal delivery, physiological jaundice, prematurity were common causes associated with neonatal jaundice in our study. Parental counselling and monitoring of baby is most important in management of neonatal jaundice. Though there is less incidence of progression to severe hyperbilirubinemia, complications associated to severe hyperbilirubinemia are dangerous.

48. A Hospital Based Prospective Assessment of Platelet Parameters as a Diagnostic Marker in Early Diagnosis of Neonatal Sepsis
Brajesh Kumar, Prashant Kumar, Gopal Shankar Sahni
Aim: The aim of the present study was to evaluate the platelet parameters as a diagnostic marker in early diagnosis of neonatal sepsis. Methods: This was a prospective study conducted in the Department of Pediatrics, for the period of one year. A total of 620 neonates were admitted during the study period. Based on inclusion and exclusion criteria, 50 neonates were diagnosed as blood culture‑positive sepsis and their platelet parameters were compared with those of 60 cases of non‑septic neonates. Results: Both the groups were comparable for weight and gestational age. There was no significant difference in the gender distribution of the patient or the mode of delivery in the septic and non‑septic groups. Among 50 blood culture‑positive sepsis, 33 (66%) cases were gram‑negative sepsis, 14 (28%) were gram‑positive sepsis, and 3 (6%) cases were fungal sepsis. Both the groups were compared for the mean ± SD of platelet parameters. There was a significant difference in the mean ± SD of TPC, MPV, and MPV/TPC ratio between septic groups and non‑septic groups. The septic group had significantly lower platelet counts (187123.37 ± 118487.41) lakhs/mm3, higher MPV (9.91 ± 1.54) fL, and had a higher ratio of MPV (fL)/TPC (in lakhs) compared with (9.25 ± 1.44) the non‑septic group. The sensitivity, specificity, PPV, NPV values of MPV (cut‑off >9 fL) were 64.60%, 54.6%, 52.0%, and 65.15% respectively. The sensitivity, specificity, PPV, NPV of MPV/TPC ratio (>7.2) were 48.8%, 96.40%, 91.9%, and 70.44% respectively. Conclusion: To conclude, all neonates presenting with signs and symptoms of neonatal sepsis should have at least a CBC done, along with other markers of sepsis. Platelet parameters, i.e., TPC, MPV, and MPV/TPC ratio should also be utilized for early diagnosis of neonatal sepsis.

49. A Study to Compare the Difference in the Amount of Energy between the Two Most Commonly Used Assistive Devices (Prosthesis and Axillary Crutches) in Adults with Transtibial Amputation by Indirect Calorimetric Method at the Self-Selected Speed in Plane Surface Walking
Ratnesh Kumar, Arun Kumar, Nitin Joshi
Aim: The aim of the present study was to compare the difference in the amount of energy between the two most commonly used assistive devices (prosthesis and axillary crutches) in adults with Transtibial amputation by indirect calorimetric method at the self-selected speed in plane surface walking. Methods: The present study was conducted in the Department of Physical Medicine and Rehabilitation. 50 unilateral TTA took part in this study. They were advised to walk in level ground surface using ‘‘prosthesis’’ and ‘‘crutches without prosthesis’’ individually. The environmental conditions were maintained the same throughout the study. Results: There were 80% were male and 20% were female. The mean age of the participants was 32.18 ± 4.36. The VO2 uptake and EE comparisons were highly significant for both prosthesis and crutches without prosthesis walking. The VO2 uptake data showed more symmetry in prosthesis walking compared to crutch walking without prosthesis. The EE/min data showed more symmetry in prosthesis walking compared to crutch walking without prosthesis. The results for HR indicated that the patients were in a comfortable range throughout this study. Conclusion: The data on energy cost indicates that all below knee amputee groups walk with less effort by using prosthesis. It may be concluded that crutches without prosthesis may not be used as a permanent rehabilitative measure in transtibial amputations.

50. The Association between Lifestyle Choices and Myocardial Infarction Prevalence in Young Adults (Aged 18-40 Years)
Rajesh Atal, Rakesh Bhaisare
Background: Myocardial infarction (MI) is a critical cardiovascular event with substantial implications for both individual well-being and public healthcare systems. This study aims to address extant knowledge gaps through the implementation of a cross-sectional study focusing on elucidating the complex relationships between diet, physical activity, smoking, stress, and the prevalence of MI in individuals aged 18 to 40 years. Methods: The study included a total of 800 participants, with a mean age of 28.5 years (SD = 5.2), comprising 45% males and 55% females. Subsequently, the association between lifestyle choices and the incidence of MI was assessed using multivariate regression models, adjusting for potential confounders such as age, gender, and family history of cardiovascular diseases. Results: The results of the study reveal a significant positive correlation between current smoking status, pack- years of smoking, and MI. The presence of acute stressors, as gauged by the Perceived Stress Scale, is associated with the presence of heightened stress levels. The identification of these modifiable risk factors establishes a basis for formulating targeted interventions and public health strategies aimed at preventing MI in young adults. Conclusion: The advocacy of heart-healthy dietary patterns, encouragement of regular physical activity and anti- smoking initiatives, and stress management programs could significantly impact the cardiovascular health of this population.

51. Visual Analog Scale Score in Patients Undergoing Surgery Diagnosed with Hypertension Undergoing the Regional Anesthesia and General Anesthesia
Rajesh Raushan, Birendra Prasad Sinha
Cardiovascular stability is important during anaesthesia and the perioperative period. Hypertensive patients are at risk of greater swings of blood pressure than the normal population and it has been shown that blood pressure lability can be associated with increased cardiovascular morbidity and mortality postoperatively, particularly in patients with severe uncontrolled hypertension. Optimisation of such patients with investigation and drug treatment can improve long term outcome and prevent such complications. Patients who have hypertension require a higher blood pressure for adequate organ perfusion than normotensive patients – this is particularly in the elderly. Avoidance of hypotension (and apparent normotension in patients who normally rely on higher values in everyday life), may prevent complications of under perfusion. Hence based on above findings the present study was planned for Evaluation of VAS Score in Patients Undergoing Surgery Diagnosed with Hypertension Undergoing the Regional Anesthesia and General Anesthesia.
The present study was planned in Department of Anesthesiology .Total 30 cases of the hypertensive patients undergoing surgery by General and regional anaesthesia were enrolled in the present study. The 15 cases were enrolled in the Group B as patients undergoing the General Anesthesia. The remaining 15 cases were enrolled in Group A as Regional anesthetic cases. The post operative VAS pain score among the patients of both the groups were retrieved for the study.
The increased intra-operative fluctuations and reduced post operative pain among the patients in the regional anaesthesia group in comparison to those under general anaesthesia group. Hypertension is a modifiable risk factor for cardiovascular diseases and outcomes, and the same is true of the patient presenting for surgery.

52. Assessment of Submuscular Plating for Diaphyseal Long Bone Fractures in Paediatric Age: A Retrospective Study
Neeraj Kumar, Manishi Anant
Aim: To evaluate long term results of submuscular plating in closed paediatric femur fractures. Methods: This retrospective  study was carried out in the department of Orthopaedics. Total 70 cases with closed femoral shaft fractures with age between 8 years to 16 years were included in the study. Results: Total 70 patients with 40 boys and 30 girls were included in the study. The average age of the patients was 13 years (range=8-16 years). 42 patients were with right femur fracture and 28 with left femur fracture. All the patients had unilateral femur fracture. 46 patients were having isolated femur fracture and 24 were cases of polytrauma. 61 out of 70 patients regularly followed up during the full duration of the study. The average follow up duration was 20-24 months. 26 fractures were comminuted, 19 were spiral, 15 were oblique and 10 were transverse. Conclusion: Submuscular plating is a surgical method with a learning curve and is a very effective method of fixation for paediatric femur fractures. It has definitive advantages over other surgical methods and is associated with minimal complications.

53. Ultrasound Diagnosis for Assessment of Focal Hepatic Lesions
Daya Prakash
The study to assess the role of ultrasound in estimation of focal hepatic lesions was planned in department of Radiology. Total 50 patients in age group of 25-65 years were enrolled in to the study. Liver was scanned in various planes. Various ultrasonographic features of focal liver lesions were observed. The maximum ultrasound diagnoses were confirmed by the CT scan. The main aim of the present study is to assess the role of ultrasound in estimation of focal hepatic lesions. The primary function of investigating a focal liver lesion is to characterise it with confidence as either needing no or only routine follow-up, or needing further, more rigorous exploration (including biopsy). The exclusion of malignancy is paramount, and most benign lesions can be characterised on non-invasive imaging grounds alone. Conventional ultrasonography is often used as the first line imaging investigation. High degree of sensitivity and specificity of ultrasonographic diagnosis in the present study confirms the value of ultrasonographic evaluation of focal liver lesions and suggests that it can be effectively used in the routine diagnostic work.

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