International Journal of

Toxicological and Pharmacological Research

e-ISSN: 0975 5160

p-ISSN: 2820-2651

Peer Review Journal

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1. Clinical Study on Patients with Duodenal Perforation
Bhagwan Raghunath Korde, Kapildev Ganeshrao Patil
Background: Due to patient delays, surgical delays, and a shortage of antibiotics, perforated duodenal ulcers, the most serious consequence, used to have a high death rate. According to several writers, during the previous three decades, there has been a decrease in the incidence of peptic ulcer illness and perforation. The treatment of peptic ulcer disease has changed, and surgery has become less necessary as a result of advancements in the use of a variety of medications in medical therapy. Males are more likely to experience perforation in their third and fourth decades, and the epidemiological pattern varies globally. The incidence in Western nations is somewhat dropping. Throughout this time, there has been an increase in the age of ulcer perforation patients, with younger patients experiencing a decline in incidence and older patients experiencing an increase in incidence. While the rates of stomach ulcer perforation seem to have remained rather consistent, the majority of this temporal variance may be related to shifting rates of duodenal ulcers in men. Aim: The aim of the study was to review and study the factors influencing, the outcome of the duodenal perforations. Material and Method: The Department of Surgery carried out this cross-sectional investigation. The admitting surgeon made the diagnosis of duodenal ulcer perforation based on clinical characteristics, which was supported by radiographic data and limited during the procedure. Surgery was classified as urgent if it was performed within four hours of admission, same day (4–24 hours), or later in the same admission. Fifty cases of duodenal ulcer perforation that were admitted to the Department of Surgery are included in this study. The location and type of operation carried out were included in the operational information. The information will be placed into a proforma together with the patient’s course of hospitalization, therapeutic interventions, and demographic information. Results: Fifty patients in total were examined. With a mean age of 45.68 years, the age ranged from 20 to 50 years. The age range between 41 and 50 years old had the highest prevalence among 50 patients, followed by 21 to 29 years old. There are 46 (92%) men and 5 (8%) women in the current study, with a majority of men. The majority of patients are admitted in less than a day; pre-pyloric ulcers typically manifest in this manner. Two cases of ileal perforations were multiple, whereas duodenal ulcer perforations were single. Smoking is the primary risk factor for ulcer complications brought on by ARDS in 12% of patients (6 patients). Of these patients, 30% experienced wound issues, 2% died (1 patient), and 44% (22 patients) had no complications at all. Conclusion: Acute abdominal emergencies involving perforations of the duodenum are among the most frequent. Early hospital admission, early diagnosis, timely surgical treatment, and the use of suitable and sufficient antibiotics have all contributed to a decrease in the mortality rate from perforated duodenal ulcers. Patients with duodenal perforation may experience lower morbidity and mortality rates if they smoke, drink alcohol, and change their lifestyle. Acute abdominal emergencies involving perforations of the duodenum are among the most frequent. Peptic ulcer perforation is among the most frequent reasons that need for an urgent laparotomy. Men are more likely to be impacted, with a peak occurrence in their 30s. Pylorus and the duodenum are the most often perforated organs.

2. Digitalization of Informed Consent for Surgery: A Contemporary Perspective
Divyeshkumar Keshavjibhai Vadgama, Ojas Bharatkumar Solanki, Amitkumar Dilipkumar Modi, Piyush Makwana
Background and Objectives: In the realm of surgical practice, informed consent holds a position of paramount significance. The utilization of digital media emerges as a promising approach to augment patients’ comprehension of the proposed surgical procedures. This study aimed to investigate the impact of incorporating an online digital educational presentation (DEP) alongside the conventional informed consent (CIC) for laproscopic cholecystectomy. Material and Methods: This prospective, randomized study involved allocation of 67 patients of laparoscopic cholecystectomy, into two groups: DEP+CIC (intervention, n=33) or CIC (control, n=34). The DEP entailed a comprehensive online 13-slide video-enhanced module that provided a detailed account of the risks, benefits, expectations, and anticipated outcomes associated with laparoscopic cholecystectomy. A 20-item MCQ test was used for assessment of baseline and post-consent comprehension, modified Client Satisfaction Questionnaire (CSQ-8), was used for patient satisfaction and the duration of the consent process was quantified in seconds using a stop watch. Results: Baseline demographic data and procedure-specific knowledge were equivalent between groups. Post-consent knowledge was significantly higher in the DEP+CIC vs CIC group. The duration of time to obtain informed consent was significantly shorter for the DEP+CIC group. Significantly higher patient satisfaction was observed in DEP+CIC group. Conclusion: The incorporation of an online DEP module into the conventional informed consent process for surgery resulted in enhanced patient comprehension, high levels of patient satisfaction and remarkable reduction in time required for consent.

3. An Observational Study to Evaluate the Efficacy and Tolerability of Sodium Valproate and Amitriptyline in Migraine Prevention
Balyam Chathurya, M Damodari Bai
Background: Migraine headaches are a recurring condition marked by intense and throbbing pain, typically localized to one side of the head. These headaches are frequently accompanied by symptoms like nausea, vomiting, and heightened sensitivity to light and sound. Typically, they persist for a duration ranging from four hours to three days. The current study was conducted to investigate the efficacy and tolerability of sodium valproate versus Amitriptyline in migraine prophylaxis. Methods: Patients were included in the study based on predefined inclusion and exclusion criteria. We collected data from 90 outpatient department (OPD) prescription sheets of individuals with migraine who were undergoing prophylactic therapy with either amitriptyline or sodium valproate in the Neurology Department. A record of the patient’s baseline characteristics was maintained in a case record form. Other data collected included the duration of symptoms, frequency of headaches, results of neurological examinations, as well as assessments of migraine pain severity and functional disability. Results: After 3 months, sodium valproate outperformed amitriptyline with a significantly higher percentage of patients experiencing >50% improvement in VAS score (68.29% vs. 50.00%, P = 0.012). The trend continued at 6 months, with sodium valproate surpassing amitriptyline in VAS score improvement (95.12% vs. 71.43%, P = 0.021). In terms of headache severity, a greater proportion of sodium valproate patients had ≥ 1-grade improvement at 3 months (90.24% vs. 76.19%, P = 0.047). Additionally, functional disability improvement was significantly higher for sodium valproate at 3 months (97.56% vs. 90.47%, P = 0.031). Overall, sodium valproate proved more effective in alleviating pain and improving headache and functional disability in migraine patients. Among 83 migraine subjects, 19 in the amitriptyline group and 22 in the sodium valproate group experienced adverse drug reactions. Conclusion: Sodium valproate outperforms amitriptyline in improving pain severity, headache intensity, and functional disability in migraine patients. These findings align with earlier research outcomes. Sedation and weight gain were the most common ADRs associated with both medications. Amitriptyline exhibited a higher incidence of ADRs among patients, particularly after the 6-month mark. The results of this investigation indicate that, for individuals with migraines, sodium valproate may represent a preferable choice over amitriptyline.

4. Computed Tomography in Diagnosing Appendicitis in Ultrasound Negative Patients
M. Kishore, Kishore Chautakuri, Sarah Aishwarya E, Abdul Rahman
Background: Appendicitis is the most common cause of abdomen pain in patients admitted at the emergency department. The two most common modalities in use are abdominal helical computed tomography (CT) and abdominal ultrasound (US). Aim and Objective: To evaluate the accuracy of CT in identifying appendicitis in ultrasound negative cases. Material and Method: This was hospital based observation study conducted on 120 patients, visited to Department of Radiology, Government Medical College, Siddipet, due to the right lower quadrant pain and negative USG findings, for the duration of one year, after following inclusion and exclusion criteria given bellow and also after approval of institutional ethical committee. Results: In the study we have included 120 patients, after their consent, of them majority were males followed by females. Majority of patients were from the age group of 21 – 30 years of age followed by 10 – 20 years and more than 30 years. Sensitivity and specificity of computed tomography in predicting appendicitis was 100% and 90.54% with accuracy of 94.17%. Conclusion: CT is the gold standard imaging modality to diagnose acute appendicitis in order avoid appendicectomies in this Morden era but also ultrasound can be used as the first line imaging tool in diagnosing  appendicitis.

5. Association of Serum Ceruloplasmin and Uric Acid as Biomarkers for Coronary Artery Disease Diagnosis
Arun Kumar Patil, Chaitanya Y
Background: Coronary artery disease (CAD) is the leading cause of death worldwide, ranking among the top eight fatal diseases. Atherosclerosis, characterized by the buildup of plaque in the arteries, is the hallmark of CAD. Oxidative stress, caused by reactive oxygen species (ROS), plays a crucial role in the development of atherosclerosis. LDL oxidation is a potent initiator of the pathological processes leading to CAD. The current study aimed to assess the risk of CAD in patients by utilizing serum ceruloplasmin and uric acid as potential biomarkers. Methods: This study was conducted in the Department of General Medicine, Prathima Institute of Medical Sciences, Naganoor, Karimnagar. A total of 50 subjects were included in the study. Group (T) labeled as “Cases,” comprised 25 patients diagnosed with coronary artery disease (CAD). Group (C) referred to as “Controls,” consisted of 25 individuals of various ages and both genders, who had come for routine health check-ups or volunteered for the study and were without any known medical conditions. Results: The levels of all eight are significantly higher in the CAD group than in the control group. The level of ceruloplasmin is significantly higher in the CAD group than in the control group (p=0.012).  The level of uric acid is significantly higher in the CAD group than in the control group (p=0.044). Overall, the findings of this table suggest that there is a strong positive correlation between serum ceruloplasmin and total cholesterol, LDL cholesterol, and uric acid in both the CVD group and the control group. There is a strong positive correlation between serum uric acid and both total cholesterol (r = 0.664) and LDL cholesterol (r = 0.662) in CAD cases. Conclusion: Serum levels of Ceruloplasmin and Uric Acid were significantly elevated in CAD cases compared to the control group. Furthermore, a positive correlation was established between these parameters. Consequently, this study suggests that Serum Ceruloplasmin and Uric Acid may serve as biomarkers for coronary artery disease.

6. A Hospital Based Clinical Study Assessing Functional Outcome with Different Modalities in Fixation of Proximal Humerus Shaft Fractures
Rupesh Kumar, Anjana, Shashikant Singh
Aim: The aim of the present study was to assess and compare the functional outcome with different modalities in fixation of proximal humerus shaft fractures. Methods: The present retrospective study was conducted in the Department of Orthopaedics for a period of 1 year. 50 cases who fulfilled the inclusion criteria were enrolled. Results: 46% of the cases were between 41-60 years with 32% between <18-40 years and 22% of cases >60 years of age. The age range was from 19 to 68 years with a mean age of 48.2 years. 52% of cases were females and 48% were males. 64% of the cases sustained fracture on the left side and 36% on right side. 84% of fractures were of closed type and 16% were open. As per Neer’s type of fracture classification, the most common type of fracture observed in our study cases was two-part fracture accounting to 40% of cases followed in order by three part (26%), four part observed in 24% of cases. 5 cases (10%) had fracture dislocation. Road traffic injury was the most common mechanism for injury in 60% of cases and next was a history of fall in 32% of cases and one case was electric shock and other was hit by an iron rod. 23 cases (46%) were managed by open reduction and internal fixation with locking compression plate using 4.5 mm cortical screw plates and 6.5 mm cancellous screws. Percutaneous pinning was done in 10 cases (20%). Open reduction with K-wire was done in 6 cases (12%) and open reduction with K-wire and cancellous screws in 3 cases (6%). Closed reduction with intramedullary nailing was done in 4 cases (8%). The mean scores observed on Neer’s score were pain (34.6 units), function (23.5 units), range of motion (16.55 units) and anatomy (6.9 units). Conclusion: The present study concluded that good surgical skills, surgeons experience in selection of the type of surgery depending upon the factors like type of fracture are necessary to achieve correct and best outcome. Clinical evaluation, obtaining proper radiological views, age of the patient and activity holds the key for realistic approach and surgical management of complex humerus fractures.

7. An Analytical Study to Determine the Association between Iron Deficiency Anemia and Febrile Seizure
Pawan Kumar Yadav
Aim: The aim of the present study was to determine the association between iron deficiency anemia and febrile seizure. Methods: The study was a hospital-based case-control study which was conducted in the Department of Pediatrics in between the duration of 24 months. A total of 100 Children in the age group from 6 months to 5 years admitted with first episode of simple febrile seizure were taken as cases. The control group included 100 children in the same age group admitted with acute febrile illness without seizures. Results: Majority of children were males (58% and 55% in case and control group respectively). Majority of children belonged to lower socioeconomic class in both the study groups (82% and 64% among cases and controls respectively). Majority of children in both the groups were exclusively breastfed (81% and 72% in cases and control respectively). Initiation of complementary feeding at 6 months of age was poor in children with febrile seizure group compared to controls (22% versus 52%). Mean Hb level among cases was 7.63 g/dl whereas in controls it was 11.68 g/dl, which was statistically significant (p-value<0.001). Mean MCV and MCH levels in the cases were 64.6 fl, 24.06 pg and in controls, these values were 76.82 fl, 31.32 pg, respectively which was statistically significant. Mean RDW among cases was 16.04% compared to controls 11.22% which was statistically significant. Mean serum iron level was found to be low among cases compared to controls (43.47 mg/dl and 119.52 mg/dl respectively). Mean TIBC was 476.4 microgram/dl in cases and 302.8 mcg/dl in control, which was statistically significant (p value<0.001). Transferrin saturation was less among case group (12.08%) compared to controls (36%), the difference was statistically significant. Mean serum ferritin level was 20.50 mcg/l in the cases and 71.65 mcg/l in controls which was statistically significant. Conclusion: Iron deficiency anemia (IDA) was more frequent among children with febrile seizures. The result suggests that IDA may be a risk factor for febrile seizures. Early  detection  and  timely  correction  of  iron  deficiency may be of help for prevention of recurrence of febrile seizures in children of this age group.

8. A Study Evaluating the Association of Socio-Demographic Profile and Life-Style Factors with Acute Myocardial Infarction: An Observational Study
Birendra Kumar, Gitanjali Kumari
Aim: The aim of the present study was to study the association of socio- demographic and life-style factors with acute myocardial infarction. Methods: A retrospective study conducted in the Department of General Medicine. Sample size was 200 patients. Patients of acute STEMI who were admitted in our ICCU and thrombolysed were included in this study. Results: In this study, 65% patients were males and 35% patients were females. In this study, there were 56% patients between 40-60 years. In this study, patients had BMI 3% patients had BMI <25 kg/m2, 72% patients had BMI between 25-30 kg/m2, 24% of the patients had BMI between 30-40 kg/m2. In this study 119 (59%) patients had AWMI indicating high prevalence of AWMI in STEMI. 39% patients had inferior wall MI. In our study 32% patients had diabetes. In our study, 45% patients had hypertension indicating it’s the one of the common cause for acute coronary syndrome. 60% had habit of smoking. In this study, 20 patients had depression even though it’s not a significant factor treating depression lowers the ACS risk. In our study patients only 40% patients had Serum cholesterol more than 200 mg/dl. In this study, 85% patients had TGL more than 200 mg/dl indicating TGL is more correlating with. In this study, 28% patients had LDL more than 100 mg/dl indicating LDL is not a good predictor of ACS. In this study, 56% patients had NON-HDL more than 130 mg/dl. Conclusion: Prevention and control of the risk factors for CAD can reduce the rate of CAD. This requires changes in the individual as well as at the community level. Modifying risk factors such as smoking, increased levels of body fat, consuming too much fat and salt, and a sedentary lifestyle together with the use of accessible and affordable preventive medicines, can lower the risk of CAD.

9. A Comparison of Functional Outcomes of Femoral Shaft Fractures Treated with Intramedullary Nailing and Plate Osteosynthesis
Shaheed Abdul Arshad, Mahesh Sagar Athinarapu, Phalgun Kumar. K, Samiullah MD
Background: Femoral shaft fractures are most common in young people and older adults. These fractures are frequently caused by high-impact events such as motor vehicle accidents, falls from heights, and pedestrian accidents. In some cases, they are associated with injuries to multiple body systems. Given the substantial risks and potentially severe consequences, it is crucial to promptly assess and provide the appropriate treatment for these injuries. Methods: A total of 30 consecutive cases of femoral diaphyseal fractures divided into two group of 15 each with group I were the cases who underwent plate fixation and group II were the 15 cases who underwent intramedullary nailing were recruited. To confirm the diagnosis, a physical examination was conducted, which included assessing for the absence of an open wound communicating with the fracture hematoma in the thigh, and plain X-rays of the affected thigh with the hip and knee joints in two views (anteroposterior and lateral views) were performed. Results: The majority of shaft of femur fractures in both treatment groups were located in the middle third of the femur (66.67% in plate fixation group and 73.33% in intramedullary nail group). according to the Winquist and Hansen classification. As you can see, the majority of patients (80%) had Group I fractures, which were treated with plate fixation. Based on Thoresen’s criteria. In Group I, 7 patients (46.67%) had an excellent functional outcome, 4 patients (26.67%) had a good functional outcome, 2 patients (13.33%) had a fair functional outcome, and 2 patients (13.33%) had a poor functional outcome. In Group II, 12 patients (80%) had an excellent functional outcome, 2 patients (13.33%) had a good functional outcome, 1 patient (6.67%) had a fair functional outcome, and 0 patients (0.00%) had a poor functional outcome. Conclusion: Based on the findings of this study, we can conclude that the initial functional outcomes of closed femoral shaft fractures in adult patients are notably better when treated with locked intramedullary nailing compared to plating, as per the Thoresen criteria. Therefore, we recommend the use of the locked intramedullary nailing technique as a suitable approach for managing closed femoral shaft fractures in adults in order to achieve favorable outcomes.

10. Comparison of Postoperative Analgesia between Two Pharmaceutical Forms of Diclofenac (Transdermal Patch versus Intravenous) for Patients Undergoing Inguinal Hernioplasty: A Randomized Control Study
Om Prakash Kumar, Saumya Sinha, Mukesh Kumar, Shubham Kumar
Background: Perioperative pain control is an important factor since it affects the patient’s postoperative morbidity and outcome. Early mobilisation and discharge are facilitated by optimal pain management. Since oral drugs are not allowed in the early postoperative period, injectable analgesia is the most often used painkiller. With a better understanding of the pathophysiology of pain and newer drug delivery methods, efforts are being made to provide patients with adequate pain relief while maximising drug action and minimising systemic side effects, so that when the drug is administered in a suitable way, the patient is also comfortable with it. Methods: To compare the analgesic effects of diclofenac transdermal patch 100 mg and diclofenac intravenous 75 mg, we conducted a study on 50 patients with ASA I and II grades, ranging in age from 21 to 70 years, and of either gender. Using a computer-generated random number table, the participants were randomly split into 2 groups of 25 each: the group receiving a transdermal patch received a diclofenac patch; the group receiving an intravenous injection received an intravenous injection of diclofenac. By comparing the VAS score and hemodynamic response to pain in both research groups, the length of postoperative analgesia was determined. Both research groups’ total number of rescue analgesia prescriptions and their duration were documented. When a patient’s VAS score was higher than 3 in the first 24 hours, injection tramadol 2 mg/kg was administered. After administering the study medicines, adverse symptoms such as nausea, gastroenteritis, vomiting, erythema, and pruritis were seen. Results: Over time, the mean VAS change was similar across the two groups (p-value> 0.05). It was also determined that the two groups’ patterns of change were comparable (P value > 0.05). Effective analgesia might be achieved with either the diclofenac patch or intravenous The diclofenac patch resulted in a higher pain score 12 hours after surgery, compared to the intravenous. The duration in the patch group was longer than in the intravenous group (p < 0.05). There were fewer systemic adverse effects and fewer signs of local irritation with transdermal patch administration compared to intramuscular injection. Conclusions: It was concluded that Transdermal diclofenac patch (100 mg) is a better analgesic route than intravenous diclofenac (75 mg) for pre-emptive analgesia in patients undergoing inguinal hernioplasty.

11. Professional Quality of Life and Difficulties in Emotion Regulation of Dead Body Handlers in Kerala
Jomon Jacob, P.T. Baburaj, Deepu T., Seena Sebastian, Nisheed Aubid
Introduction: The objective of the current study was to evaluate the professional quality of life and emotion regulation challenges faced by those who handle dead bodies on a daily basis, particularly forensic doctors. Methods: The study was survey research conducted for a period of one year by administering two instruments, namely the PROQL scale and the DERS scale, to 175 selected samples. The population of the study was all forensic doctors handling dead bodies. Results: The major findings of the study were that the majority of the dead body handlers, 114 or 65%, possessed moderate professional quality of life, and 125 or 71.4% of the total sample had moderate emotional regulation. People who directly handled dead bodies had more difficulties with emotion regulation and a poorer professional quality of life than those who indirectly handled people. Emotion regulation had a positive correlation with professional quality of life. Conclusion : The present study has shown that PROQL and emotion regulation were not poor among dead body handlers in Kerala. There was a significant correlation between PROQL and emotion regulation. Further research into the PROQL and emotion regulation can help formulate policies and practices aimed at improving the working conditions and well-being of dead body handlers, which will ultimately improve the quality of care provided to the deceased and their families.

12. A Study on Teenage Pregnancy and its Outcome from a Tertairy Care Setup
Aswini Vuyyuri, Sarojini Devi V
Introduction: Teenage pregnancy (TP) a burning problem in developed as well as developing countries. Studies reported that nearly 10% of girls become pregnant by 16 years. With these a study was conducted to find the incidence and contributing factors of TP and its outcome. Methods: It was a prospective research. Pregnant women aged <19 years, both multi and primi gravida were included. Non cooperative women and pregnant women aged >19 years were not considered.  The clinical as well as obstetric history were recorded. Onset of menarche, details of menstrual history and the date of last menstrual period were noted and expected date of delivery (EDD) was calculated by Naegele’s rule. The EDD was conveyed, advised to attend the antenatal clinic regularly. Haemoglobin percentage, blood grouping, fasting blood sugar were estimated. Pelvic assessment was done at 38 week and admission was advised few days before the EDD, high risk members admitted two weeks before EDD. The post-natal follow up for general condition, evidence of infection and persistence of blood pressure in cases of hypertension were done. The particulars of the new born whether live or not, apgar score at one minute, maturity, weight, sex and any malformations if present were noted. Babies were admitted in NICU, if required. Perinatal mortality and maternal mortality were recorded. Results: Total 670 TP were included, 18.5±0.6653 was mean age. Highest number were reported in 19 years (379; 56.6%). Nearly 19.9% (133) were illiterates and just 3.9% (26) completed college education. Majority (66.9%; 448) were belong to upper lower socioeconomic category. In this study just 0.9% (6) were unmarried and most of the study members were gravida 1 (419; 62.5%). Anaemia was the commonest (74.7%; 501) comorbid condition. The incidence of abortion was 4.3%, oligohydramnious was the commonest (2.2%; 15) complication. Conclusion: TP is common in this area also. Anaemia is found to be the common clinical condition. Low socioeconomic status is the main contributory factor.

13. Usefulness of RET-He in Evaluation of Anemias in Pediatric Age Group in A Tertiary Care Centre, in Telangana, A Cross Sectional Study
Fakeha Firdous, Zu Afshan Sultana, Anjani M, Md. Saad Hussain, G J Vani Padmaja
Introduction: Anemia in pediatric age group can be due to various etiologies ranging from simple nutritional cause to severe cause like haematological malignancy. Childhood anemias need to be evaluated thoroughly in order to reduce the morbidity of these children. Routine biochemical parameters are helpful in evaluating anemias. RET-He is an important marker for early detection of anemia, thereby reducing the morbidity of the cases. Aim: To study the usefulness of RET-He in anemic children by comparing it with other parameters of hemogram and HPLC. Materials and Methods: This cross sectional study was carried out in Pathology department of Tertiary care pediatric hospital in Telangana, India, from May 2022 to May 2023.The RET-He values were compared with various parameters in the hemogram along with HPLC of the patients. Results: A total of 172 cases were evaluated and the levels of RET –He was compared with other hemogram parameters and HPLC. Conclusion: It was concluded that reticulocyte haemoglobin levels provides us useful information for the early diagnosis, treatment and monitoring of anemias in pediatric age group.

14. A Prospective Observational Assessment on Pattern of Acute Poisoning Cases with Drug Utilization and their Outcome in a Tertiary Care Hospital
Choppadandi Anil, Sharan Kumar K B, Kasireddy Govardhan Reddy
Introduction: Poisoning has become an important cause for concern not only in India but globally over the past few years. Pattern of poisoning varies depending upon geographical regions of the country. It is necessary to analyse epidemiologic data every year on acute poisoning cases at each medical setting for better handling and managing drug and antidote stockpiles. Aim and Objectives: To estimate the incidence, nature, severity, pattern of acute poisoning cases with drug utilization and treatment outcome, including drug overdose and venomous snakebites and also to suggest strategies to reduce associated morbidity and mortality in a tertiary care setting. Material and Method: A Prospective observational study was conducted on 362 patients of either of cases at CAIMS, a tertiary care teaching hospital, Karimnagar, for a period of one year starting from June 2022 to May 2023. Patients admitted with diagnosis of poisoning/animal bites in medical wards of hospital were enrolled in the study after obtaining informed consent and approval of Institutional ethical committee and following inclusion and exclusion criteria. Results: Of the total Male to female ratio was 3:1, majority from age group Male to female ratio was 3:1. intentional poisoning cases for suicidal attempt were 70.42.% and 29.58% cases were due to accidental poisoning. Incidence of acute poisoning cases was more common among males. Pesticides were commonly used agents for poisoning followed by others. Conclusion: From study we can conclude that, for the better management and prevention of poisoning cases, there should be need for a poison information centre. This study has managed to contribute significant additional information regarding the pattern and outcome of poisoning in a tertiary care hospital at a district level.

15. Clinical Study to Evaluate the Outcome of Conservatively Managing the Posterior Malleolus Fracture in a Trimalleolar Ankle Fracture
Gaurav Agarwal, Harshit Khare, Gaurav Jain
Background: Ankle fractures are one of the most common lower limb injuries, accounting for about 9 % of all fractures.  The incidence of ankle fracture is roughly 187 cases per 1 lac people each year, out of which 7-11% constitutes the Trimalleolar ankle fracture. [1] The treatment of the posterior malleolus still remains controversial as to when to fix it and when to conservatively manage it, if at all. This Clinical study aimed at assessing the functional outcome of conservatively managing the posterior malleolar fragment of Trimalleolar ankle fractures based on functional scoring systems. Materials and Methods: 30 patients with Trimalleolar ankle fracture were managed with operative treatment for medial and lateral malleoli and conservative management for posterior malleoli. The functional outcome was evaluated at 6 months by AOFAS score. Result: The mean age in this study was 35.4 years (range 20 to 55 years) with male and right-side predominance. The mean follow up was 5.4 months (range 2 to 7 months). The mean AOFAS score at 6 months follow up was 88.6 (range 71 to 93), with 18 cases having an excellent score,7 cases of a good score and 5 cases with a fair result. None of cases had poor results. None of the patients have any limitation to the daily activities, wound dehiscence, gait abnormality, implant failure, non-union. 5 patients had limitation of recreational activities but without support. Conclusion: Conservatively managing the posterior malleolar fracture can give favourable functional outcome but requires further comparative studies and employ the use of CT for better diagnosis and decision making.

16. Age Distribution of Various Prostatic Lesions: Hospital Based Study
Shah Mitesh, Agrawal Ruchi, Gaur Rajesh
Introduction: Benign prostatic hyperplasia and prostatic adenocarcinoma are the common prostatic diseases found in most of the patients. There is increase in incidence of BPH worldwide and predicts by the age of 60 years more than 50% of men will have microscopic evidence of the disease. Although the etiology of prostatic cancer remains unknown, the most consistent risk factors are advanced age and racial/ethnic factors. Hence present study was an effort to find age distribution of various prostatic lesions. Objectives: To determine the age distribution of patients with prostatic lesions of Gwalior region. Materials and Methods: Study was conducted in the Department of Pathology, Gajra Raja Medical College and J.A. Group of Hospitals, Gwalior (M.P.) over prostatic specimens that received over a period from 2015-2017. The prostatic specimens include transurethral resection of prostate chips, prostatectomy specimen and needle biopsy samples. Result: Among benign lesions 05 cases (5.5%) are in age group 40-49 years, 17 (18.7%) in 50-59 years, 35 (38.4%) in 60-69 years, 26 (28.5%) 70-79 years, and 07 (7.7%) in 80-89 years, 01 (1.1%) in 90-99 years. 2 cases (11.8%) of Prostate adenocarcinoma are in age group 40-49 years. 6 (35.3%), 5 (29.4%) and 4 (23.5%) cases are in 60-69, 70-79 and 80-89 years age group respectively. Correlation is statistically not significant. Highest Gleason score found was 8 and maximum number of Gleason score 8 cases are in age group 80-89 years. Conclusion: Present study shows both benign and malignant lesions are more common in older age group mostly above 60 years of age. Severity of prostatic adenocarcinoma also seems to be higher for older age patients.

17. Prescription Audit Study From a Tertiary Care Teaching Hospital in Telangana
Pendurthi Vidyasagar, Karrepu Sri Chaitanya Reddy, Cheemala Naresh Yadav, Yamini Vadlamannati, Naser Ashraf Tadvi
Background: The inappropriate use of drugs is a global health problem, especially in developing country like India. Irrational prescriptions have an ill effect on health as well as health-care expenditure. Prescription auditing is a crucial tool to improve the quality of prescriptions, which in turn improves the quality of health care provided. Methods: This observational cross-sectional study was conducted for a period of one month in GMC, GGH, Nalgonda. All prescriptions were analysed for Demographic data, medical components and WHO core drug use indicators. The obtained data was expressed in percentage and frequency. Results & Conclusion: The prescribing practices in this study were good regarding mentioning of general details of patients and hospital, and satisfactory regarding handwriting legibility of physicians and average number of drugs prescribed per prescription.

18. A Medication Audit to Assess the Knowledge and Practice Among Community Pharmacists Regarding Medication Dispensing and its Safety in Pregnancy
Nivethitha T, Vijayarangan S, Suguna Anbazhagan
Introduction: Medication use during pregnancy is challenging because of the potential fetal risk associated with its use. Pharmacists are primary health care providers for a pregnant woman. Hence the main objectives of the study were to determine the knowledge among community pharmacists towards drug dispensing and its safety in pregnancy and also to assess the knowledge and practice gaps by performing a medication audit. Materials and Methods: The study was a mixed method study conducted among community pharmacists within the field practice area of Trichy SRM Medical College Hospital for 3 months. 260 pharmacists were enrolled. The knowledge was assessed by a pre-tested semi-structured questionnaire. A medication audit was performed of the medications dispensed to pregnant women by the community pharmacist for the past 3 months. Results: The average knowledge score was 6.64 ± 1.36. The knowledge scores were higher among B. Pharm graduates and (7±1.8), Pharmacists with experience 5 to 9 years (7.6±0.9) which were statistically significant (p<0.05). Pharmacists dispensed ≤ 50 prescriptions per day (n=135, 52%). Analgesicswere most frequently dispensed (n=115, 44%). None the prescribed drugs belonged to FDA Category X and were dispensed in the prescribed dose, duration and frequency. However, 202 pharmacists dispensed drugs without prescription, at patient request (n=83, 33%) and based on previous knowledge (n=52, 20%) and experience of the pharmacist (n=41, 16%). Conclusion: The community pharmacists had average knowledge and a gap between knowledge and practice. Hence there is a need for continuous education programmes to ensure safe and effective drug dispensingamong pregnant women.

19. Comparing IV Fentanyl Alone to a Combination of IV Fentanyl and Nebulized Lignocaine for Minimizing Hemodynamic Responses during Laryngoscopy and Endotracheal Intubation in Elective Surgeries under General Anesthesia
Kiruthika Rathinasabapathy, L. Uma Pradeepa, Devendran P, K Uma
Background: Laryngoscopy and intubation are essential steps in the administration of general anesthesia for various surgical procedures. These procedures are critical tools for anesthesiologists in managing the airway, involving the manipulation of airway structures. The current study aimed to determine the efficacy of IV fentanyl 2µg/kg versus a combination of IV fentanyl 2µg/kg and 4% lignocaine nebulization 3mg/kg on hemodynamic responses during laryngoscopy and intubation. Methods: A total of 80 ASA I-II patients aged 18-45 years scheduled for elective surgeries under general anesthesia based on the inclusion and exclusion criteria were selected and randomly allocated for this comparative cross-sectional study. The study cases were divided into two groups. In Group A, Patients received IV fentanyl 2 μg/kg and in Group B patients received IV Fentanyl 2µg /kg with nebulized 4% lignocaine 3mg/kg. Results: The results indicated that the combination of IV fentanyl with nebulized lignocaine was effective in attenuating the hemodynamic response. The mean age and weight of the two study groups showed no statistical difference, and there was no significant difference in heart rate over time between the groups. Analysis of blood pressure revealed that systolic blood pressure in the Fentanyl-only group (Group A) was higher than the IV Fentanyl + Lignocaine nebulization group (Group B) from the 1st minute, with statistical significance observed after 6 minutes. Similarly, diastolic blood pressure in the Fentanyl-only group was higher than the IV Fentanyl + Lignocaine nebulization group from the 1st minute, with statistical significance (p < 0.05) noted at the 1st minute and 6 minutes onwards. Conclusion: Fentanyl and lidocaine nebulization were more effective than fentanyl alone in reducing SBP during anesthesia, particularly in the later stages of anesthesia. Fentanyl and lidocaine nebulization were more effective than fentanyl alone in reducing DBP during anesthesia, particularly in the later stages of anesthesia. No significant adverse effects were observed in either group.

20. Prognostic Insights: Mortality Prediction in Dengue Patients at a Tertiary Care Center
Kinjal Patel, Nikhil Shah, Dipesh Patel, Purvi Patel

Introduction: Dengue fever, a globally pervasive mosquito-borne viral infection, poses a significant health threat, particularly in tropical regions. While often presenting as a self-limiting febrile illness, a subset of patients can progress to severe forms, necessitating a deeper understanding of mortality predictors. This study explores critical factors such as severe plasma leakage, thrombocytopenia, age, and comorbidities that influence mortality in dengue patients. Recognizing these predictors is vital for early intervention, significantly impacting patient outcomes. Materials and Methods: In this study at NAMO Medical Education and Research Institute, Silvassa, we explored mortality predictors in dengue patients from January 1 to December 30, 2022. Our inclusive approach covered all ages and genders. Ethically approved, the study involved a meticulous review of medical records, assessing demographics, clinical data, and comorbidities. Patient evaluations included history, physical exams, and lab tests. Descriptive statistics and various tests identified mortality predictors. This comprehensive methodology unveils the intricate dynamics of mortality prediction in dengue patients. Results: In our study of 100 subjects, we observed a mean age of 40.2±15.2 years, with 59% males and 41% females. The mean hospital stay was 5.5 ± 3.2 days, and complications were reported in 39%, with an overall mortality rate of 11%. Comparing 11 non-survivors to 89 survivors, non-survivors were older (49.2 ± 18.5 years vs. 37.4 ± 15.3 years, P = 0.01) and exhibited higher rates of leukocytosis, elevated CRP, and acute kidney injury. Our univariate and multivariate analyses identified age, leukocytosis, and acute kidney injury as potential predictors of mortality, emphasizing their significance in determining outcomes in dengue patients. Conclusion: our study identifies advanced age, leukocytosis, elevated CRP, and acute kidney injury as significant predictors of mortality in dengue fever patients. These findings underscore the complexity of dengue prognosis and emphasize the importance of a multifaceted approach in clinical assessments.

21.Association between Sleep Disorders among Adult Patients in a Tertiary Care Center in North India
Satish Kumar Budania, Prabhukiran V Gogi , Hemant Kumar, Sachin B S, Sunil Kumar
Objective: This study aimed to evaluate the association between sleep duration and hypertension among adults in tertiary hospital in India.  Methods: Baseline variables were collected from a representative sample of 200 adults aged 23–98 years in a tertiary hospital in North India who received physical examinations from January 2021 to December 2022. All participants were categorized into either a hypertension group or a non-hypertension group. Sleep duration was classified as short (<6 h/day), normal (6–8 h/day),or long (>8 h/day). Baseline variables were compared between individuals with and without hypertension by rank-sum tests for two independent samples or χ2 tests for nonparametric data. Multivariate logistic regression analysis was performed to evaluate the association between sleep duration and hypertension.  Results: The overall incidence of hypertension was 51.2%. Unadjusted analysis showed that the risk of hypertension was higher in individuals with short (<6h/day) or long (>8h/ day) sleep durations compared with those with a normal (6–8 h/day) sleep duration. The risk of hypertension was significantly increased by 30.1% in participants with a long (>8h/day) sleep duration compared with those with a normal (6–8h/day) sleep duration (OR = 1.301, P < 0.010, 95%CI = 1.149–1.475). The risk of hypertension was also increased by 1.1% in participants with a short (<6h/day) sleep duration compared with participants with a normal (6–8h/day) sleep duration, but the difference was not significant (OR = 1.011, P = 0.849, 95%CI = 0.905–1.129). After fully adjusting for confounding factors (model 4), the risk of hypertension was increased significantly (by 25%) in individuals with a short (<6h/day) sleep duration (OR = 1.25, P = 0.02, 95%CI= 1.036–1.508) but not in those with a long (>8h/day) sleep duration (17.5% increase) compared with participants with a normal (6–8h/day) sleep duration (OR = 1.175, P = 0.144, 95%CI = 0.946–1.460).  Conclusion: The results of this study indicate that a short (<6h/day) sleep duration is related to an increased risk of hypertension, suggesting that sleep helps to protect against hypertension.

22. A Study on Adverse Effects of Antiepileptic Drugs in a Tertiary Care Hospital
Kotra Vijay Kumar
Background: A study was planned to overlook the adverse effects of antiepileptic drugs in tertiary care hospital Methods: It is a cross sectional study conducted on total of 184 patients in the medical department of tertiary care hospital. The data was entered in Microsoft excel. Inclusion criteria includes patients who are diagnosed with epilepsy and are aged greater than 17 years. Results: Among 184 patients 56.5% were male and 43.4% were female. About 43% were treated with monotherapy and  And 57% were treated with polytherapy. The most common side effect is sedation. The statistical analysis showed statistically significant between polytherapy and monotherapy patients against sedation (p value < 0.05) Discussion and Conclusion: Levetiracetam is the safest drug. According to a study, side effects due to polytherapy are more than side effects due to monotherapy. We can reduce adverse effects by reducing the combinational therapy.

23.Clinical Presentation and Management of Hydatidiform Mole Cases
Sushma Kumari, Priyanka Kumari
Hydatidiform mole is an abnormal pregnancy of clinical and epidemiological importance because it affects women in the reproductive age group and is potentially fatal with a lot of associated morbidities. Hydatidiform mole is the non- malignant form of gestational trophoblastic neoplasia. The prevalence of 1:250 to 1:500 has been reported which vary widely in different parts of the world. Therefore, Knowledge of prevalence and associated risk factors may add value in the management outcomes of molar pregnancy in our setting.  Objectives of this study  was to determine the  clinical presentation and management outcome of Hydatidiform mole . We assessed 30 women who clinically diagnosed with hydatidiform mole in Tertiary Hospital during 2019-2021 . The diagnosis of HM was based on a pelvic ultrasonography, quantitative estimation of the serum We assessed 30 women who clinically diagnosed with hydatidiform mole Tertiary Hospital. 66.66 % cases had Uterine size> Gestational age. 93.33 % cases had Vaginal bleeding. 50% cases had Hyperthyroidism. 96.66 % cases were treated by Uterine suction evacuation and curettage. Hydatidiform mole remains an important cause of maternal morbidity which is largely due to poor and inadequate follow-up. Better outcome is possible with good patients’ counseling for improved follow up.

24.A Comparative Study of Intrathecal Dexmedetomidine and Fentanyl as Adjuvants to Bupivacaine in Lower Abdominal, Perineal and Lower Limb Surgeries
Jayanta Padun, Barnita Basumatary, Arnav Das, Dibyajyoti Sonowal
Introduction: Neuraxial administration of opioids along with local anaesthetics improves the quality of intraoperative analgesia and also provide postoperative pain relief for longer duration. Fentanyl in various doses( 10, 20, 30, 40 micrograms) when added to intrathecal bupivacaine significantly reduces somatic and visceral pain and prolongs the time of regression of sensory block. Dexmedetomidine has been used for premedication and as adjunct to general anaesthesia. It reduces opioid and inhalational anaesthetics requirements. Intrathecal α2-receptor agonists are found to have anti nociceptive action for both somatic and visceral pain. Aims and Objectives: To compare the subarachnoid block characteristics, quality of  analgesia, sedation, haemodynamic properties, sedation and any any adverse effects between dexmedetomidine and fentanyl as adjuvant with intrathecal bupivacaine Materials and Methods: Total 120 patients were randomly allocated in two groups. Group d (n=60) = received 5 micrograms (0.5ml) dexmedetomidine with 15 milligrams (3ml) of 0.5% hyperbaric bupivacaine intrathecally. Group f (n=60) = received 25 micrograms (0.5ml) of  fentanyl with 15 milligrams (3ml) of 0.5% hyperbaric bupivacaine intrathecally. Onset of analgesia, quality of motor block, haemodynamic properties, any adverse side effects were noted, Conclusions: In conclusion , dexmedetomidine (5 µg) seems to be a better alternative to fentanyl (25 µg) as additive to intrathecal hyperbaric 0.5% bupivacaine (15 mg), since it produces more prolonged sensory and motor block with similar kind of haemodynamic stability , better postoperative analgesic and sedation and is assaociated with lesser adverse effects.

25. A Correlative Study of Serum CRP with Thyroid Dysfunction in Covid-19 Patients Admitted in a Rural Referral Hospital
Amulya. T, Bhagyamma. S.N, Sandhya Rani B, Durga. T, Shyam Prasad B.R
Introduction: A novel coronavirus, also known as SARS-COV-2 was responsible for the COVID-19 global pandemic that began in December 2019. There seems to be a complex interplay between the causative agent and the inflammatory-immune responses occurring in the body in response to the infection. The triggered immune response is believed to affect multiple systems including endocrine system. Serum C-reactive protein (CRP) is one of the sensitive markers for inflammatory response.  Aim: To study the correlation between serum CRP values and possible thyroid dysfunction in Covid-19 positive patients. Materials & Methods: A retrospective study was done on 50 patients who were admitted between May and October of 2021 with covid-19 infection at Government General Hospital, Ananthapuramu. The data regarding serum CRP and Thyroid parameters (Total T3, Total T4, TSH) was collected and analyzed for correlation between them by Pearson correlation using SPSS-25. Results: The study showed correlation coefficient (r) values between thyroid parameters and CRP as: Total T3 values are positively correlated with serum CRP levels in Covid-19 patients with a correlation coefficient, r=0.525 (p < 0.01). Total T4 values are positively correlated with serum CRP levels in Covid-19 patients with a correlation coefficient, r=0.9 (p<0.01). TSH values are negatively correlated with serum CRP levels in Covid-19 patients with a correlation coefficient, r = -0.475(p<0.01) Conclusion: There is a significant positive correlation between Total T3 & T4 values with CRP and a significant negative correlation was seen between TSH and the bio-inflammatory marker, CRP.

26.Comparative Study between Single vs Double Layer Intestinal Anastomosis
Juhi Singh, Anju Nagar, Dharmraj Meena, Meenesh Meena, Radheyshyam Meena
Background: In gastrointestinal surgeries, intestinal anastomosis is a routine and important process. While double layer anastomosis was once thought to be secure, several surgeons now contend that single layer anastomosis with non-absorbable suture yields comparable outcomes. Methods: A single-centre retrospective cohort comparative study was conducted in the Department of General Surgery, Govt. Medical College and Hospital, Kota, Rajasthan, India during April 2022 to June, 2023. A total of 50 patients were taken, out of which 35 underwent double layer anastomosis and 15 patients had single layer anastomosis. Result: A total of fifty patients were enrolled; thirty-five underwent double layer anastomosis and fifteen underwent single layer anastomosis. Accordingly, the patients in each group were matched for diagnosis, sex, and age. Both the length of hospital stay and the mean time required for anastomosis were significantly shorter in Group-A. Compared to the double layer group, the single layer group experienced a faster postoperative return of bowel function. The double-layered group incurred a comparatively higher cost for the suture material used. However, there was no significant difference in the complication rates between the two groups. Conclusions: There is not much difference in development of complications in both the methods. Both have same efficacy, mean time taken return of bowel movements. A single layer requires less operating time and is more economical.

27. Efficacy of Suprascapular Nerve Block Guided by Anatomical Landmarks in Arthroscopic Shoulder Procedures to Alleviate Postoperative Pain
Ravindra Gandhi, Duraiya Gulamali
Background and Aim: By enhancing perioperative pain management, regional anaesthesia in shoulder arthroscopy decreases the necessity for analgesics and their well-documented adverse effects. At times, a particular type of anaesthetic block may not be appropriate for the anatomy or comorbidities of a patient or its safe execution may necessitate the expertise of a specially trained anaesthetist. The purpose of this research is to assess the analgesic effectiveness of suprascapular nerve block during shoulder arthroscopic procedures. Material and Methods: The results of an observational investigation involving sixty patients who underwent arthroscopic surgery. Thirty patients out of sixty had undergone blind suprascapular nerve block; the remaining thirty patients had not been administered block. For both groups, pain scores (NRS), rescue analgesics for breakthrough pain, and total fentanyl consumption were documented. Results: Of the total number of cases, 51 were rotator cuff repair, 4 were SLAP repair and 5 were bankart repair. There was only a statistically significant difference in the NRS value between the groups in the immediate 0 hours postoperative period (p value > 0.05). At 1, 4, 8, and 12 hours, no statistically significant difference existed between the two groups. The acute pain service’s records were consulted to determine the total number of fentanyl doses required over a period of 12 hours. The doses required were greater in the GA-only group than in the GA+SNNB group. Conclusion: In comparison to patients who solely received IV PCA, the total opioid consumption of patients who received SSNB was not significantly reduced. It is our determination that blind SSNB does not provide an additional benefit in relation to alleviating discomfort during arthroscopic shoulder procedures. Additional research involving a more extensive cohort of patients may, nevertheless, contribute to a deeper understanding of this postoperative analgesic approach.

28. Determination of Foot Surface Area as a Ratio of Body Surface Area, in Maharashtra Population.
Ravindra Vedpathak, Nishigandha Sadamate, Ranjit S. Ambad, R. B. Vaidya
Introduction: Estimation of Total Body Surface Area (TBSA) plays crucial role in variety of clinical conditions, such as Renal Clearance, Cardiac Index, Chemotherapy and Glucocorticoid dosage, and also in Thermal Burns related injuries.  In small and patchy burns patients hand is used to estimate percentage of burn which is traditionally 1%, Feet surface area values of this kind are usually estimated as a percentage of TBSA and it is 7% according to Lund and Browder chart. There is a discrepancy about what percentage of TBSA is continued by the Foot, therefor this study was designed to determine correctly the TBSA represented by the Foot surface area in Maharashtra population. Aim and Objective: To correlate morphometric measurements of Foot with the Total Body Surface Area. Materials and Methods: 512 healthy adult age group from 30 – 40 years of both sexes (255 male and 257 female) are selected. Right and Left Foot Surface area and Body Surface area was calculated using Du Bois  and  Du Bois  formula. Result : The mean Foot ratio of both sides for male and female was 3.28% and 3.18% respectively. Conclusion: The Hand surface area is around 3.25% of TBSA in Maharashtra population.

29. Evaluation of Immature Reticulocyte Fraction in Microcytic Hypochromic Anaemias of Paediatric Age Group in Tertiary Care Hospital-a Cross Sectional Study
Zu Afshan Sultana, Fakeha Firdous, Anjani M , Md. Saad Hussain, G J Vani Padmaja
Microcytic hypochromic anemia is characterized by presence of microcytic and hypochromic RBC’s on peripheral smear and MCV of less than 80fl.It could be due to iron defeciency anemia or thalassemia or other causes. Differentiation between the thalassemia and non thalassemic microcytosis has important clinical implications, because each has a different causes, pathogenesis, prognosis and treatment.  The assessment of reticulocyte maturation is useful in understanding pathophysiology of anemias.  Immature Reticulocyte Fraction [IRF] represents the proportion of young reticulocytes with highest RNA content. It is a sensitive measure of erythropoiesis. Its clinical utility has been reported in a variety of conditions. It’s analysis has been made easy by the use of automated hematology analyzers.  In our study which was carried out in a tertiary pediatric hospital in Telangana, all microcytic hypochromic anemia patients in the age group of new born to 12 years of age were evaluated. IRF is an important parameter which helps in diagnosis and thereby helps in treatment at an early stage itself,thereby decreasing the morbidity in pediatric population . IRF helps in differentiating etiological causes of anemia like nutritional anemia, hemoglobinopathies and aplastic crisis.It also gives information about the recovery status of anemia cases on treatment.  IRF is a simple, quick, effective and cost effective tool on automated hematology analyzers, which helps in diagnosing anemia cases.

30. Agenesis of Thyroid Isthmus in Adult Human Cadavers.
Nishigandha Sadamate, Ravindra Vedpathak, Ranjit S. Ambad, Swati Belsare
Introduction : The thyroid gland is the most common endocrine organ which gets operated throughout the globe. It is ensheathed by the pre-tracheal layer of deep cervical fascia. The two lobes are connected by a narrow median isthmus.  In our study, on the morphometric features of the thyroid gland it was found that, 4 out of 25 thyroid glands that were dissected, showed an absence of the isthmus. The respective lateral lobes were positioned independently on either side of the trachea. The incidence of agenesis of isthmus, along with the developmental and clinical significance are discussed. Aim and Objective : To study the morphometric features of the thyroid gland with its neurovascular relations.  Materials and Methods : The Morphometric study carried on 25 human adult cadavers aged between 40 to 70 years, out of which 19 were male and 6 were female cadaver. Various morphometric parameters like length of lobes, width of lobes, height of isthmus, levator thyroidae glandulae and pyramidal lobe were recorded. Observation : Absence of isthmus is rare in humans, In this morphometric study out of 25 thyroid glands only two glands with agenesis of thyroid isthmus. Conclusion : On the partial thyroidectomy, the surgeon should aware of the absence of the isthmus which  may be associated with absence of whole or part of the lobes. He should assess whether the remaining portion of thyroid gland is present and functioning otherwise patient may be inadvertently rendered hypothyroid.

31. Ascertain Fundamental and Legal Knowledge about the Art of Prescription Writing in Tertiary Care Hospital
Harcharan Singh, Monika Gaur, Urmila Choudhary and Dishika Choudhary

Background- A medical student to become a prescribing physician, must acquire both the fundamental and regulatory understanding of prescription writing. Prescriptions become the most significant clinical pharmacology tool and proof of pharmaceutical access, prescription errors, prescribing errors, negligence, and subsequent litigations. Given the rising violence against doctors in India, a cross-sectional questionnaire-based study was conducted to assess participants’ understanding of the fundamental and legal aspects of writing prescriptions. Methodology- The basic and regulatory knowledge and awareness of 90 doctors was evaluated for arts of prescription writing by a novel questionnaire based on Indian regulatory guidelines. It was assessed for content validity and reliability. A total of 39 questions comprised of 70 statements categorised into three broad sections containing 13 questions in each were asked in 30 min. Results- Doctors’ knowledge of writing prescriptions is very limited. Most doctors do not knew that over-the-counter drugs do not require a prescription, that a pharmacist is the one who decodes their written prescriptions, that it is illegal to cross-prescribe (write a prescription for a drug from another system of medicine), or that they should not transcribe prescriptions over the phone. Conclusion- Prescription mistakes plague the practice of writing prescriptions for medication access. The doctors’ grasp of prescription writing basics and regulations is poor. It is therefore necessary to train them in prescription writing through standardized worldwide teaching modules. Prescription communications between physicians and patients must adhere to national regulatory requirements and be clear, accessible, thorough, and direct.

32.Evaluation of Glycaemic Status and Diabetic Kidney Disease among Patients with Type 2 Diabetes: A Cross-Sectional Analytical Study
Shubham Jain, Birata Debbarma, Devdas Rai

Background: Diabetic kidney disease is a major risk factor for microvascular and macrovascular complications in diabetes patients but recently, fewer studies have correlated glycaemic status and diabetes kidney disease in south Indian population. Objective: To evaluate the relation between glycaemic status and diabetes kidney disease in type 2 diabetes mellitus (T2DM). Methods: This was a Cross-sectional analytical study among T2DM patients. Poor glycaemic status was defined as a serum value of glycosylated haemoglobin A1C (HbA1C) ≥ 7%. Albuminuria was defined as albumin values > 30 mg/dl in the first morning urine.  Results: 100 cases of Type 2 DM patients comprises  75% males. The prevalence of diabetes kidney disease was 60%. The prevalence of microalbuminuria in groups with poor glycaemic status was 46% and adequate glycaemic status was 40% only. The findings were statistically significant between poor glycaemic status and albuminuria(Microalbuminuria, Mean FBS 201.33 mg/dl, 95% CI 185.6-216.9, Macrolbumininuria, mean FBS 219.6 mg/dl, 95% CI 180.8-258.4). Conclusion: The prevalence of poor glycaemic status and Diabetes Kidney disease was high among T2DM patients.

33. Analysis of the Intraoperative and Postoperative Analgesic Efficacy of Transabdominal Block vs. Caudal Block in the Adolescents Experiencing Laparoscopic Appendectomy
Neha Rusia Saxena, Deepesh Saxena, Nitin Ojha, Pallavi Singh
Background: Laparoscopic appendectomy is often conducted in the adolescents population. Regional anaesthesia for young patients is an adjunct to general anaesthesia, enabling conscious postoperative analgesia and minimizing hospitalization duration. The utilization of caudal anaesthesia with transversus abdominis plane (TAP) block is widespread due to its simplicity and efficacy in providing analgesia during surgical procedures. Nevertheless, its effectiveness in laparoscopic appendectomy has not been extensively evaluated. Aim and Objectives: This study aims to assess the effectiveness of caudal block and TAP block as pre-emptive analgesia utilizing ropivacaine in the context of opioid usage, postoperative visual analogue score (VAS), duration of analgesia, time until  rescue analgesia is needed, postoperative nausea and vomiting, and other potential side effects after elective laparoscopic appendectomy. Material and Methods: The study employed a prospective, double-blinded, comparative randomized experiment to investigate the effects of laparoscopic appendectomy on teenagers. The research comprised a total of sixty individuals aged between 13-17 years. The patients were assigned to one of two groups, each consisting of 30 individuals, using computer-generated randomization. Group I participants will undergo a caudal block procedure with the assistance of ultrasound guidance, using a 0.2% ropivacaine solution at a dosage of 1 mL/kg of body weight. Group II participants will undergo a TAP block procedure with the administration of 0.2% ropivacaine at a dosage of 1 mL/kg, guided by ultrasonography. Results: The total amount of opioid fentanyl used during surgery was 14.84 ± 18.77 in Group I and 25.51 ± 17.89 in Group II. This difference was of statistical significance (P = 0.0281). The Visual Analogue Scale (VAS) score was substantially lower in Group II when compared with Group I, with a p-value of less than 0.001. Conclusion: The caudal block is efficacious for managing intraoperative ailments whereas the TAP block is efficacious for managing postoperative ailments among adolescents having laparoscopic appendectomy.

34. Incidence of Hepatic Steatosis and Other Adverse Outcomes in Patients using Atorvastatin
Bodu Godavari, M Damodari Bai
Background: Statins, widely prescribed for various chronic conditions such as cardiovascular diseases, cerebrovascular diseases, peripheral vascular diseases, and diabetes mellitus, have raised concerns regarding potential side effects with prolonged usage, including hepatic steatosis. We in the current study tried to analyze the incidence of hepatic steatosis in patients taking statins for long duration. Methods: Patients on prolonged statin therapy were selected. Lab investigations (ALT), (AST), and (ALP), and Lipid Profile: serum levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides to monitor lipid levels. Fasting Blood Sugar (FBS) Fasting blood glucose levels to identify patients with diabetes or impaired glucose metabolism. Abdominal ultrasound was done to detect fatty changes in the liver. Results: Overall, 34.33% of cases taking Atorvastatin tablets had fatty liver, while 65.67% did not. For diabetics, the prevalence of fatty liver was 36.84%, while for non-diabetics, it was 31.03%. The p-value for diabetics is 0.065, suggesting a possible association between diabetes and fatty liver change. The prevalence of fatty liver is slightly higher among diabetics than non-diabetics. The most common ADRs reported were fatigue (24 cases), myalgia (muscle pain) (16 cases), joint pain (12 cases), dysphagia (difficulty swallowing) (12 cases), and insomnia (11 cases) all were mild and self-limiting. Conclusion: This study concludes that prolonged statin use induces fatty acid synthesis, leading to the accumulation of excess fatty acids in visceral organs, particularly the liver, and consequently resulting in fatty liver. To minimize the overall occurrence of adverse effects associated with statin use and enhance patient quality of life, it is crucial to exercise caution when employing these medications and avoid prolonged administration.

35. Study of Lipid Profile Parameters in Type 2 Diabetes Mellitus Patients
Sandeep U, Meghna Mohan, Kiran D R.
Dyslipidaemia is one of the common disorders which is seen in most of the diabetes patients, which causes cardio vascular disorders. This study was conducted to compare the lipid profile of diabetic patients and healthy controls. The patients admitted 50 representative cases with H/O Type 2 DM are taken as subjects for the study. Age and sex matches 50 non diabetic are taken as controls. Lipid profile and Hba1c was estimated. Total cholesterol, LDL, VLDL, Triglycerides, Hba1c were high in diabetics subjects as compared to normal control subjects. HDL was higher in normal control subjects. The difference between the control and the study groups was high and it was highly significant. The frequencies of the high TC, high TG and high LDL-C levels were  higher in the diabetic group, thus indicating that diabetic patients  were more prone for dyslipidaemia, which  could cause cardiovascular disorders.

36. Refractive Changes and Visual Acuity among Pregnant Women of Southern Rajasthan Region
Arun Samar, Isha Arora, Rajkumari Samar, Garima Tiwari
Introduction: Changes in the eye have been linked to pregnancy; these changes may be natural, pathogenic, or an aggravation of pre-existing ocular diseases. Changes in refractive error (RE) and visual acuity (VA) are two examples of the physiological changes that might take place during pregnancy. Objective: The goal of the current study was to examine changes in VA and RE in pregnant women of Udaipur region during the course of second and third trimesters and six weeks after giving birth. Materials and Methods: Pregnant women in their second trimester who were attending an antenatal clinic were sequentially recruited for a longitudinal study. Information on their sociodemographic and clinical traits was gathered using a questionnaire. Measurements of visual acuity and refractive error were made during the second and third trimesters as well as six weeks following delivery. Result: The average age of women were 36.87 ± 6.35 years. In comparison to the second trimester, more women in the third trimester saw a worsening in Visual Acuity (VA) for distance. VA remained essentially changed during the course of the trial. Pregnant women experienced an increased myopic shift in the third trimester (40.83 % in left eye and 44.16 % in right eye) compared to the second trimester (35.83 % in left eye and 37.50 % in right eye). Simple myopia was the most prevalent refractive error among the women. Six weeks after delivery, these modifications disappeared. Conclusion: Pregnancy worsened Visual acuity (VA) for distance, and simple myopia was the most prevalent Refractive Error among pregnant women. However, during the postpartum phase, these modifications disappeared.

37. Comparison of First and Second Wave of COVID-19 in Relation to Clinical Profile & Laboratory Investigations at a Single Centre in Northern India- A Retrospective Study
Quazi Shahir Ahmed, Deepak Chopra, Kauser Sayedda, Nazia Siddiqui
Introduction: SARS-CoV-2, a highly contagious virus, emerged and spread as a global pandemic in 2020. Its various mutants are continuously evolving though out the world. Repetitive waves of Covid-19 have drastically affected the whole world including India in terms of health and economy. The disease had a variable clinical course & laboratory investigation. Thus, in the present study, comparison was carried out between patients of first and second wave of Covid -19 regarding demographic profile, clinical severity, patients’ outcome & laboratory findings. Materials and Methods: 894 patients during first wave (01.08.2020 to 31.10.2020) & 367 patients during second wave (01.04.2021-01.06.2021) with laboratory confirmed diagnosis admitted at a tertiary care teaching Institute, in Northern India were enrolled in the study. Data was retrieved from Medical Records Department of the Institute. Result: About 86 % of the people were symptomatic at the time of presentation in first wave while it was nearly 99% in case of 2nd wave. (P<0.0001). Most common symptoms were fever, cough and breathlessness. 53 % of the population had at least one-comorbidity in first wave while it was 67.30% in second wave. (P<0.0001). 13.4% & 44.10 % of the study subjects belonged to severe category in first & second wave respectively. (P<0.0001). On comparing lab investigations of two waves, leukocytes & neutrophils counts were more (P<0.0001) while lymphocytes & platelets were less in second wave (P<0.0001). Gender comparisons (first wave) of renal function tests, serum creatinine came out to be significantly higher (P<0.0001) in males. Similarly, liver function tests & CRP were significantly higher in males (P<0.0001, P<0.05). D-dimer & random blood sugar values were not significantly different. (P>0.05). Reduced lymphocytes count & increased neutrophils count were more in males (P<0.01). As against first wave, males & females exhibited almost similar values of lymphocytes & neutrophils in second wave (P>0.05). Platelets were decreased in males. (P<0.001). Number of deaths was significantly more in second wave (p<0.0001). Conclusion: Second wave of Covid was significantly more aggressive. Significant laboratory findings differences in several parameters were observed in between two waves. Significant gender differences regarding lab investigations were also revealed in both the waves. Thus, knowledge of these differences is crucial for primary health care physicians to make the diagnosis and subsequent treatment strategies.

38. A Study of Posterior Reversible Encephalopathy Syndrome (PRES) in Eclampsia and in Severe Preeclampsia Patients with Neurological Symptoms
Srinka Mukherjee, Sumana Pal, Manami Roy, Prabodh S. Soreng, Debsadhan Biswas, Arka Bhattacharjee
Background: PRES is an often underdiagnosed neurological disorder occurring as a complication of eclampsia and severe preeclampsia. It resolves completely in most patients but some may develop residual neurological deficits. Methods: An institution based prospective observational study done at Medical College, Kolkata in department of Obstetrics and Gynaecology. Study period was 18 months and sample size was 42. RESULTS: In our study we found that PRES occurred in 6 out of 11 patients with eclampsia (54 %) and 1 out of 31 patients with severe preeclampsia with neurological symptoms (3. 22%), higher values of serum LDH can be associated with the occurrence of PRES and most recovered fully with one death (2.38 % mortality) and 2 patients developing residual neurological deficit. Conclusion:  PRES has a stonger association with eclampsia than severe preeclampsia, certain biomarkers like LDH may have significant predictive value and prompt management of hypertensive disorders of pregnancy along with prevention of progression of preeclampsia as well as eclampsia may be key in preventing the development and fatal consequences of PRES.

39. The Role of Intraoperative Imprint Cytology in Case of Radiologically Proven Ovarian Complex Space Occupying Lesion
Sumana Pal, Srinka Mukherjee, Prabodh S. Soreng, Manami Roy, Senjuti Dasgupta
Objective: To determine the role of intraoperative IC in radiologically proven ovarian complex SOL & to compare it with that of histopathology.  Background of Present Study: Ovarian neoplasms are a heterogenous group of benign & malignant tumours classified depending on different cells of origin. HPE however remains the gold standard in tissue diagnosis but takes about  10 to 15 days for results. Intraoperative pathology consultation is often required for guiding immediate surgical decisions to limit the extent of surgery or to perform radical surgery. Till date FS is the preferred method for providing rapid intraoperative diagnosis though it is technically more difficult than various cytological techniques. IC is easy to perform, gives  results in minutes, does not need any expensive machines and is thus useful in resource poor countries. Methodology: This study was carried out in Medical College Kolkata in approximately 12 month’s time period. A total number of 40 cases was studied. Surgical specimens from the operations done for radiologically proven ovarian complex SOL were taken in this study. During intra operative period IC was done on the operated specimens and they were also sent for HPE. The accuracy and diagnostic utility of IC was correlated with that of the HPE. Results: Of the 40 lesions studied by IC, 17 lesions were labelled as benign, 21 lesions as malignant and 2 lesions were borderline. Final histological diagnoses labelled 15 lesions as benign, 20  as malignant and 5 as borderline. Sensitivity, specificity were 100%  and 95% respectively for malignant tumours.

40. Clinical Profile of Neuropsychiatric Manifestations in Alcohol Use Disorder (Audit >8)
Pooja B.N., Kondal Reddy Sankepally, Sreekanth Rachakonda
Aim of the Study: To observe the neuropsychiatric manifestations of Alcohol Use Disorder (AUDIT>8). Material & Methods: The study was performed over a period of 1 and half year from November 2019 to March 2021. We screened 256 in patients with history of alcohol abuse from General medicine wards in Tertiary care Hospital, Telangana, Hyderabad. Results: A total of 259 patients admitted in medicine wards with age >18 years and history of alcohol use were asked to fill the AUDIT form. Among them 131 patients scored <8 (excluded) and 128 patients scored >8 were considered for inclusion in the study. Of the 128 patients, based on exclusion criteria 48 patients were further eliminated. Finally 80 patients were included in the present study. Conclusion: Alcohol is a known behavioral risk factor for several non-communicable diseases such as coronary artery disease, liver disease and mental health disorders. n the present study, we found that, harmful alcohol use is associated with various medical, psychiatric and social issues in inpatients of medicine wards. This study is to identify the patients having harmful alcohol habits and identifying the subclinical neuropsychiatric manifestations associated with alcohol.

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