International Journal of

Toxicological and Pharmacological Research

ISSN: 0975 5160 Peer Review Journal

Print-ISSN 2820-2651

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1. Haemoglobinopathy: A Major Concern for Adolescents of Kokrajhar District of Assam
Dipankar Baruah, Miss. Noymi Basumatary, Abhinanda Barua, Jatin Sarmah
Background: Anaemia is prevalent among the adolescents of Assam, India. Different causes are responsible for this global health concern. Vector borne disease like malaria, helminthic infestations, nutritional deficiencies are some of the common causal factors. Similarly; haemoglobinopathy is one of the determinants for this public health problem. Materials and Methods: The present study was conducted among 600 adolescents of Kokrajhar district of Assam to find out haemoglobin level, haemoglobinopathies, stool for helminthic infestations and peripheral blood smear for malarial infection. Result and Observations: The present study revealed that Haemoglobinopathy associated anaemia is a major concern among adolescents of Assam. Out of 600 study samples adolescent boy was 305 (50.8%) and adolescent girl was 295 (49.2%) with a adolescent boy girl ratio of 1.03:1. The overall prevalence of anaemia among the studied subjects is as high as 67.5% (n=405). Out of 305 adolescent boy 140 was anaemic (45.9 % of total 305 adolescent boy and 23.3% of total 600 study cases) and out of 295 adolescent girl 265 was anaemic (89.8 % of total girls and 44.2% of total 600 study case). Non-nutritional factors like helminthic infestation is substantially low 21.5% (n=129). Ascaris is the most frequent infestation (14.2%, n=85, followed by Trichuris (5.1%, n=31), and hookworm (2.2%, n=13). Malaria parasite was not found in any of the cases. We found the gene frequency of 0.201 for globin gene among the subjects. Conclusion: Regression analysis provides information on Hb levels (g/dl), helminthic infestation and haemoglobin type. Revealed haemoglobin type (Hb E) was the important factor of anaemia among adolescents in the present study.

2. Comparison of Bolus Dose versus Fractional Dose of Hyperbaric Bupivacaine in Spinal Anaesthesia among Adult Patients Undergoing Vaginal Hysterectomy: A Prospective Observational Study
Ritesh M Jadav, Neelam M Parmar, Tejal A Chaudhari, Jignasa J Patel, Rakesh R Jalandhara
Background: Spinal anaesthesia is gold standard technique for lower abdominal gynecological surgeries. We conducted a study to compare bolus dose versus fractional dose of hyperbaric bupivacaine in spinal anaesthesia among adult patients undergoing vaginal hysterectomy. Methodology: This prospective, observational study was done on total 60 patients of American society of Anaesthesiologists physical status I, II & III, posted for vaginal hysterectomy under spinal anaesthesia. Patients were divided into two groups as Group B (Inj. Bupivacaine (0.05%) 3.75 cc as a bolus dose) and Group F (Inj. Bupivacaine (0.05%) 3.75 cc in two fractions, 1st 2/3rd dose 2.5 cc and after time gap of 60 seconds remaining 1/3rd dose 1.25 cc). Intraoperatively pulse rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, Spo2, Sensory and motor effect was checked every 2 minutes for first 20 minutes, thereafter every 10 minutes till 30 minutes & then every 30 minutes for rest of the study period. Results: The mean duration of sensory and motor block was significantly longer in fractional group as compared to bolus group. Duration of analgesia was longer in fractional group (335.17 ± 32.07 min) as compared to bolus group (296.67 ± 47.28 min, p<0.001). Total 10 patients (out of 30) in bolus group and only 2 patients (out of 30) in fractional group required ephedrine for hypotension (p<0.05). Conclusion: Fractional dosage of spinal anaesthesia can be used as an acceptable and safe alternative to a conventional bolus method in lower abdominal and lower limb surgeries.

3. A Study of Serum Zinc Levels in Children with Acute Gastroenteritis Admitted in Tertiary Care Hospital
Ashwini B Kundalwal, Telang Bharatbhushan B, Neelam
Background: Acute gastroenteritis (AGE) is one of the common problems causing significant mortality and morbidity among children. In developing countries, diarrhoea is the main cause of illness and death in children. Although acute infection might have a prolonged course, acute diarrhoea is often a self-limited condition. With a wide range of biological functions in humans, zinc is a necessary nutrient. It is especially crucial for the physical growth of immunological and digestive systems. The absence of animal foods, high dietary phytate content, insufficient food intake, and increased fecal losses during diarrhoea all contribute to the prevalence of zinc deficiency in children. Methods: 61 children with acute gastroenteritis for less than 14 days who were admitted to the emergency and general ward units at the tertiary care Hospital between April 1 and September 30, 2018 were the subjects of cross-sectional research. Their ages varied from 6 months to 5 years. For each patient, a thorough history and examination were conducted. For the investigation, a unique questionnaire was created. Patient’s blood was drawn at the time of admission for the determination of the serum zinc level, complete blood count, serum electrolytes, renal functions and urine and stool samples were also collected. Patients’ serum samples were drawn and held at (-20°C) until the zinc levels were measured. Atomic absorption spectrophotometer measurements for zinc concentrations used. Results: The research included 61 children with acute gastroenteritis, ranging in age from 6 months to 5 years (40 male and 21 female). Patients with diarrhea lasting longer than five days had mean blood zinc levels that were lower than those with diarrhea lasting less than five days; this finding is statistically significant in both groups with a p-value of 0.01. The demographic and clinical features of individuals with normal zinc levels and those with zinc insufficiency were not significantly different. Conclusion: Children with longer duration of gastroenteritis had considerably lower serum zinc levels.

4. Assessment of Knowledge and Practices Regarding Drinking Water and Sanitation
Harish Chandra Paliwal
Aim: The aim of the present study was to study knowledge and practice of water and sanitation. Methods: Cross sectional study conducted in the field practice area of the Department of Community Medicine. Sample size was calculated as per last quarterly; total 7500 households were situated in rural and urban areas. Results: The result shows sociodemographic characteristics of 400 households. It showed that 116 (29%) of participants belonged to age group 31-40 years followed by 96 (24%) belonged to 31- 40 years. Maximum number of participants i.e. 368 (92%) were females. Equal number of households was taken from rural and urban areas i.e. 200 from each. 92% of participants belonged to Hindu religion. In education wise distribution, 120 (30%) had studied up to high school, 80 (20%) had studied up to middle school. Majority of participants i.e. 232 (58%) belonged to general category. 256 (64%) of participants belonged to high socioeconomic status as per SLI (Standard of Living Index). Table 2 shows background characteristics of households. Among 400 households, 324 (81%) of participants had pucca house. 392 (98%) of households had family members <10. The distance of water source from the shelter was less than 100 ft. in all the 400 households. The water was available in all the seasons in all the 400 households. In 392 (998%) of households latrine was present. Conclusion: Most of the participants had right knowledge and practice about drinking water and sanitation. Knowledge and practice of drinking water and sanitation is increasing with educational status of the respondents.

5. Assessment of Smartphone Addiction among College Students of Junagadh City, Gujarat
Karangiya JP, Dabhi VB, Rojasara BP, Hala NA, Zalavadiya DD5, Nimavat KA
Background: Problem of smartphone addiction is growing fast and it is more prevalent in young age. Smartphone addiction has many risk and effects on mental and physical health. Smartphone addiction affects social life, communication and difficulty in concentration. The present study was conducted to know prevalence of smartphone addiction and smartphone usage pattern among engineering college students. Methodology: A cross sectional study was conducted in an engineering college of Junagadh city. Study includes 386 college students who were using smartphone and willing to participate in the study. Smartphone Addiction Scale – Short Version (SAS-SV) was used to assess smartphone addiction among students. Results: 46.6% college students were addicted to smartphone as per SAS-SV scale. Non educational use of smartphone, smartphone unlock frequency in a day, smartphone usage just before sleep were found to be significantly different between normal and smartphone addicted students. Conclusion: The level of smartphone addiction was high among engineering college students. Students should be counselled for limited and appropriate use of smartphone and harmful effects of excessive use of a smartphone.

6. Study on Incidence and Clinical Importance of Premasseteric Branch of Facial Artery
Sudhakara Babu Chelli, Dnyaneshwar B Patil, Manjunath Halagatti, Channabasanagouda
Facial artery is the principal artery of face. Premasseteric artery is the posterior branch of facial artery that runs along the anterior border of masseter muscle to supply it and the adjacent tissue. This observational study included 25 (50 hemi-faces) adult cadavers which were dissected as per instructions given in volume-3 of Cunningham’s manual of practical Anatomy. Fine dissection was done to find out the branch on both sides. Variations were noted and photographed. In our study the incidence of the artery was observed in 6 (24 %) cadavers. The artery had a normal course after its origin from the point of entry of facial artery on face. It was not observed in remaining 19 cadavers. The incidence of premasseteric artery was less in our study. If present may interfere with other surrounding structure which is of surgical interest.

7. Comparative Study of Use of I-Gel versus Endotracheal Intubation in Paediatric Patients
Khushali Nayak, Palak Modi, Mittal Patel, Subhash K. Patel
Background and Aim: Due to availability of I-gel in different sizes, I-gel has gained increasing popularity as an alternative airway device in paediatric patients which is available in three adult and four paediatric sizes in the range. The depth of the anaesthesia for I-gel insertion is less than that required for endotracheal intubation. Present study is an effort to compare the two devices that is I-gel and Endotracheal Tube in Paediatric Patients. Material and Methods: The present study was carried out as prospective observational study at the tertiary health centre. A total of 50 patients were included in the study. Pediatric Patients posted for surgery fulfilling Inclusion criteria were randomly divided into 2 groups. Group ETT: Endotracheal intubation (n=25) and Group I-GEL: I-gel insertion (n=25). Various parameters recorded were duration of surgery, duration of anaesthesia, insertion time and number of attempts for insertion of I-gel/ Endotracheal tube, ease of insertion and complications and need for rescue anaesthesia. Results: In comparison with I-GEL group in patients of endotracheal intubation mean arterial pressure was significantly higher in postoperative period. There is no significant difference in the MAP after 60 min between two groups (p>0.05) Conclusion: I-GEL insertion is easy, requires less time and less attempts to insert as compared to endotracheal intubation. I-GEL insertion is associated with less Haemodynamic changes as compared to Endotracheal intubation. After removal of I-GEL, patient becomes haemodynamically stable earlier than Endotracheal intubation. I-GEL does not cause tracheal stimulation.

8. Comparative Study on Outcome of Cataract Surgery in Diabetic and Non Diabetic Patients
Nakka Suhasini, Karnasula Balaji, T Jaya Chandra
Introduction: Diabetes mellitus (DM) is metabolic disorder affects multi organs. Age wise DM with < 40 years is 15 – 25 more risky in developing cataract. With this back ground, a study was conducted to find the outcome of cataract surgery in diabetics and its comparison with non DM.  Method: It was a comparative study on the diabetic and the non-diabetic group that underwent small incision cataract surgery with posterior chamber intraocular lens implantation. Age, sex, surgical technique, follow up, pre- and postoperative best corrected visual acuity (BCVA) and post-op complications were evaluated. Chi-square (χ2) test was used for association between two categorical variables. P < 0.05 was considered to be statistically significant. Results: Group wise, 58 members were included both in DM and non DM, respectively. The mean + SD age in DM group was 54.9 + 6.9 and non DM, it was 58.2 + 5.0; statistically there was no significant difference.       Hypertension was the leading comorbid condition; 18 and 1, respectively in groups. In the DM group, the mean best corrected visual acuity (BCVA) was 1.52 ± 0.8 and in non DM group, it was 1.60±0.82; statistically there was no significant difference. The mean post-operative BCVA values were, 0.38±0.3 and 0.35±0.25, respectively in DM and non DM groups; statistically there was no significant difference.  Whereas when the pre and post-surgical BCVA values were compared, statistically there was significant difference, respectively in the groups. Conclusion:The pre-operative BCVA was compared to the post-operative values in in both the groups, respectively. Therefore, small incision cataract surgery in DM without diabetic retinopathy yields similar visual outcomes those without DM. However large sample size studies are commended.

9. Antimicrobial Pattern of Various Upper Respiratory Tract Infections in Pediatric Age Group
Dasari Sandhya, Radha Lavanya Kodali, Golla Eshwara Chandra, Bollineni Prasad, T Jaya Chandra
Introduction: In developing countries like India, acute respiratory infection (ARI) is the major burden to child health. Upper respiratory tract (URT) is the common area which can prone for various infections. With these a study was conducted to find the various bacteria responsible for URTIs and also their antimicrobial pattern.  Methods: It was a prospective study conducted in GSL Medical College, Rajahmundry. School going children who were clinically diagnosed with URTIs were included in the study. Throat swab was collected from posterior pharyngeal wall and also from the tonsils. Swabs were transferred immediately to the microbiology laboratory. Samples were cultured as per the guidelines. Initially the growth was identified based on colony morphology and cultural characteristics then processed for Gram staining and also a battery of biochemical tests as per the protocol for the identification. Simultaneously antibiotic sensitivity testing was done on Kibry bauer disc diffusion method. Results: Total 133 samples were collected, 49% (63) were male and 51% (70) were female. Gender wise, 31%, 45% were culture positive (CP), and 16.5%, 26.5% were culture negative (CN), in male, female, respectively; statistically there was no significant difference. Total 96 (100%) bacteria were isolated; 30% (29) were Staphylococcus aureus. No significant resistance was noted to higher antibiotics like imipenem, piperacillin tazobactum, vancomycin and linezolid. Conclusion: URT infections are common among female children. Staphylococcus aureus is the predominant pathogen, no significant resistance was noted to higher antibiotics. Small sample size, short duration of the study are the limitations of the study.

10. Outcome of Prophylactic Use of Antibiotic Coated Intramedullary Nail in Treatment of Open Tibia Fractures
Hardik R Patel, Nilay Pavan Kumar
Background and Aim: The most frequent long-bone fractures in both adults and children are tibia shaft fractures. Treatment options range from plaster immobilisation to debridement and surgical stabilisation, among others. It has been demonstrated that implants with an antibiotic coating lower the likelihood of implant-related infection. Thus, the goal of the current study was to evaluate the effectiveness of using an antibiotic-coated intramedullary nail as a preventative measure for treating open tibia fractures. Material and Methods: A prospective study was conducted on 140 patients with infected non-union of lower limb long bones treated with antibiotic cement laden nails and beads. The experiment in this study used a tibia interlocking nail coated with an antibiotic that could release gentamicin over time. The appropriate size of an antibiotic-coated nail is inserted into the medullary canal. After surgery, the patients were observed for up to six months to assess their healing. Results: Road traffic collisions were shown to be the most frequent cause of injury, accounting for 110 patients out of the total cases. At the end of the six-month period, the majority of patients had RUST scores of 9, 21.43% had RUST scores of 11, and 8.57% had RUST scores of 6. Out of a total of 140 patients, 16 patients had great outcomes, 30 patients had good results, 82 patients had medium results, and only 12 patients had poor results. Conclusion:Infected non-union of the femur and tibia have traditionally been treated with several surgical methods that have proven ineffective and have received low patient participation and compliance. But the single-stage antibiotic cemented nailing approach has successfully achieved the objectives of infection control and fracture union with good patient compliance. It delivers high concentrations of local antibiotics, eliminates repeated surgeries, and reduces the systemic toxicity of antibiotics. The patients also comply well with the treatment.

11. Study of Medication Adherence Pattern in Patients with Asthma and Chronic Obstructive Pulmonary Disease in Tertiary Care Hospital
Sohil Makwana, Jitendra Vaghela, Radhika Panchal, Preksha Barot
Background and Aim: Lack of patient compliance with prescribed regimen is an important fascinating problem in medical care, especially in patients suffering from chronic illnesses. Asthma and Chronic Obstructive Pulmonary Disease (COPD) are the two main chronic lung disorders which are particularly vulnerable for medication non-adherence problem. Prescription pattern monitoring (PPMS) are generally focus on prescribing, dispensing, administering of pharmaceuticals they promote appropriate use of monitored drugs and reduction of abuse/misuse. Material and Methods: A prospective observational study was undertaken at Tertiary care Institute of India among 150 Patients. The information regarding patient’s demographic characteristics, medication history, laboratory data and treatment management were acquired from patient’s case sheets. The following parameters were investigated; biochemical profile such as hba1c, fasting blood sugar, randomised blood sugar, post prandial blood sugar, LFT, RFT and all data around the culture was obtained from lab report. Results: On prevalence of co-morbidity among study participants reveals 96 (64%) of patients with co-morbidities and without co-morbidities were 54 (36%). Among 150 study participants, on treatment pattern observation suggests that cephalosporins 75 (50%) were widely administered in contrast other antibiotics such as macrolides 55 (38.66%), penicillin derivatives 17 (11.33%) and aminoglycosides 5 (3.33%). Using the Morisky medication adherence rating scale, researchers looked at the compliance of 150 study participants and discovered that 69% of them adhered to their treatments, followed by 19% who just partially did so, and only 12% who did not. Conclusion: Medication adherence is a crucial component of successful treatment for COPD and bronchial asthma in elderly adults since these conditions are difficult to manage. Elderly patients with long-term comorbidities also had COPD, which made it more severe and put their lives at risk. Future studies should include newer strategies to assess the adherence level and long term and large population studies.

12. Correlation between Hysteroscopic Evaluation, Saline Infusion Sonography (SIS), and Histopathology of the Endometrium in the Diagnosis of Menorrhagia.
Rahul Padval
Background: Menorrhagia is excessive menstrual bleeding evaluated using SIS, an ultrasound using saline injection to visualize endometrial thickness and diagnose uterine conditions. Results of SIS are used with other tests to understand causes and inform treatment. Aims and Objectives: To evaluate the correlation between hysteroscopic evaluation, saline infusion sonography (SIS), and histopathology of the endometrium in the diagnosis of menorrhagia. Materials and Methods:  A study was conducted in Ujjain, India to compare the diagnostic value of hysteroscopy and saline infusion sonography in evaluating AUB in 97 women with prolonged menstrual bleeding. The study was conducted from 2011 to 2013 and involved clinical exams, blood tests, sonography, hysteroscopy, and histopathological examination. Results: Menorrhagia is more common in reproductive-age women (mean age 36.4 years) with 2 or more children. Clinically, most menorrhagia patients had a uterus size of 6-8 weeks, while polymenorrhoea and metrorrhagia patients had normal uteruses. SIS found abnormalities in 57.7% and hysteroscopy in 55.6%, hysteroscopy detected normal and abnormal pathology with 96% sensitivity, 87.23% specificity, 88.88% positive predictive value, 95.34% negative predictive value, and 91.75% accuracy, SIS detected normal and abnormal pathology with 96% sensitivity, 82.97% specificity, 85.71% positive predictive value, 95.12% negative predictive value, and 89.69% accuracy. Conclusion: Hysteroscopy and SIS both can detect structural abnormalities but for greater accuracy and management, hysteroscopy with a guided biopsy should be used if SIS does not detect a lesion. Age, number of pregnancies, and uterine preservation will determine the treatment method.

13. A Retrospective Investigation to Study the Relationship between White Blood Cell Count (WBC), Which is Known Inflammatory Marker and Platelet Count (PLT) and its Parameters.
Ajay Kumar, Binay Kumar, Binita Kanaujia, Sahab Raza
Aim: The aim of this study was to investigate the relationship between white blood cell count (WBC), which is known inflammatory marker and platelet count (PLT) and its parameters including mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT) and platelet- large cell ratio (P-LCR) in all clinical setting of leukocytosis in children. Methods: We performed a retrospective study on the children (2-18 years of age) coming to our laboratory Netaji Subhas Medical College & Hospital, Bihta, Patna, Bihar for the period of 9 months. Total 300 children were evaluated. Out of these,150 children with elevated WBC count (>4000/mm 3) were called as Group 1 and 150 subjects with normal WBC counts and the platelet parameters were included in the study as a control group (Group 2). Results: There were 90 males and 70 were females in the present study. Totally (including Group 1 and Group 2 children), 300 complete blood counts were analysed. The mean age of subjects was 11.88 ± 6.647 years for group 1 and 11.37 ± 6.505 years for group 2. There were not statistically significant differences between two groups with respect to age. The result depicts the best cut-off points, sensitivity and specificity of PLT and platelet indices. The sensitivity was highest for platelets at 96.67 and lowest for MPV 32.97 while as specificity was highest for WBC at 94.4 for MPV was 92.22 and lowest for PLT 30.77. Conclusion: This study showed that platelet count and platelet distribution width values were significantly high in simple infectious and inflammatory conditions in children but there is no correlation with platetcrit, MPV and P-LCR values. The correlation is low as the sample size is less. There are controversial results with regard to platelet parameters in many studies done on both adult and pediatric population.

14. Comparative Research on Pulmonary Function Tests in Smokers and Non Smokers.
Diksha Yadav
Background and Aim: Smoking causes inflammation, squamous epithelium metaplasia, globlet cell alterations, the creation of mucus plugs in tiny airways, and ultimately alveolar structural abnormalities. The physical changes in respiratory disorders like asthma, COPD, etc. are caused by these changes in smaller airways. The purpose of the current study was to compare the results of lung function tests in smokers and non-smokers. Material and Methods: The present study observational analysis included total of 200 individuals; which were divided into two groups: group A (Smokers group) included 100 individuals who had the habit of smoking and group B (non- smoker group) were taken as control group with no history of smoking. Spirometry recording was done for the included individuals in the study. Results: Between smokers and nonsmokers, there is a statistical difference in the mean FVC (L), FEV1 (L), PEFR, and FEF25-75%) values for spirometry. Smokers’ spirometric data were shown to be more obstructive than non-smokers’. When compared to non-smokers, the mean values of all lung function tests are significantly lower in smokers. In the current study, smokers were more likely to develop restricted (2.0%) than mixed (4.0%) or obstructive (36.0%) pulmonary alterations. 96.0 percent of nonsmokers had PFT results that were normal. Conclusion: In each age group, nonsmokers had higher mean FVC, FEV1, and PEFR values. From adolescence to old age, lung function changes, but it does so differently in men and women. Most spirometric measures had little or no correlation with BMI. A larger investigation that adheres to the ATS criteria is required in order to generalize these reference values.

15. Evaluation of Suspected Adverse Drug Reactions and their Causal Associations: Experience of an Adverse Drug Reaction Monitoring Centre of A Tertiary Health Care Unit.
Arunabha Ray, Shoma Mukherjee, Shamran Ahmad, Kajal Kiran Sharma, Jai Prakash
Objective: The objective of this study was to evaluate the profile and causality of adverse drug reactions reported from various departments of a tertiary care teaching hospital in North India. Methods: This was an observational study which was conducted in a 510 bedded tertiary care teaching hospital in New Delhi for a period of 2 years. A retrospective analysis of ICSRs from the Adverse Drug Reaction Monitoring Centre (AMC) was done from the records in the department and the reports submitted by VigiFlow. Patients of all age and either sex were included. The WHO_ UMC scale was used to assess if the AE had any causal relationship to the drug/ drugs administered. Results: Three hundred and thirty-eight (338) ADRs from 218 patients were obtained during a period of 2 years. The mean age was 43 ± 19 years. Highest number of adverse drug reactions 63(29%) were witnessed in the age group of 26- 40 years. Adult group (18- 60yrs) has experienced significantly higher ADRs (70.6%) than the paediatric (18%) or elderly (10%). Females experienced higher number of ADRs 123 (56.42) as compared to males 95(43.57). The most common organ system that was affected was Skin & Subcutaneous Disorders 80 (23.66%). Most common ADR was hypersensitivity reactions (15.68%) followed by pruritus (10.35%), injection site pain and swelling & rash (~5%). Forty five percent (45%) of ADRs were implicated only due to antimicrobials, which is highest among all other groups of drugs. This was followed by anticancer drugs (11.7%), agents used for gastrointestinal disorders (7.3%) and vaccines (6.5%). On WHO-UMC Probability Assessment Scale, majority (55.04%) of the reports were evaluated as `possible’ and 26.14% were evaluated as `unassesssable` due to lack of medical reports which the patient could not produce. Conclusion: Poor quality of the suspected ADR reports reduces the chances of establishing a causal relationship, as essential information to evaluate the likelihood of an event being caused by a drug may be lacking. Measures to improve detection and quality reporting of ADR by all healthcare professionals should be undertaken, to ensure patient’s safety. The involvement of Pharmacologists may greatly improve the quality of ADR reporting and can subsequently help in detecting preventable adverse drug events and reduce the incidence of such ADRs.

16. Fluid in Sphenoidal Sinus In Cases of Drowning.
Abhiram M. Unnithan, Santhosh Joy, Liza John, Sreechithra P. Karippuram, Nisheed Aubid
Background: Drowning can be defined as death due to submersion in a liquid. Diagnosis of death by drowning is one of the challenges in the field of Forensic pathology as there is no pathognomonic sign for drowning. As sphenoid sinus is easily accessible during autopsy, fluid aspirated from the sinus could be used to ascertain drowning. The same is extremely useful in drowning cases where foreign body and water does not enter the air passages due to laryngospasm and in decomposed bodies. Therefore, this study was done to illustrate the significance of fluid in the sphenoidal sinus in drowning cases. Methods: This was a descriptive study done on 168 drowning cases brought for autopsy in the Department of Forensic Medicine, Government Medical College, Kottayam. Study tools included semi structured proforma, needle bearing syringe, Lugol’s iodine, concentrated nitric acid, 30% hydrogen peroxide, test tubes, centrifuge, glass slides and microscope. The paranasal sinuses were opened in all cases to look for presence of fluid. Diatom test performed for the fluid and diatoms compared with that of drowning medium. Data were entered in Microsoft excel and analysed using Statistical Package for Social Sciences (SPSS) software (version 26). Results: In the present study total 168 drowning cases were taken of which 152 (90.48% of total, with 95% confidence interval 86.05 to 94.91) showed the presence of fluid in sphenoid sinus. Conclusion: The present study supports previous research that studied on significance of fluid in sphenoid sinus in diagnosing drowning. In the study, a high proportion of drowning cases showed the presence of fluid in sphenoid sinus along with identical diatoms to that of drowning medium which proved that the victim had inhaled fluid from the medium along with the diatoms. Therefore, it can be concluded that that the presence of fluid in the sphenoidal air sinus could point towards drowning as cause of death and so it is suggested to look for the presence of fluid in sphenoid sinus in all cases of drowning.

17. Research of the Sociodemographic Characteristics of the Victims in Cases of Homicide.
Vijoy Pratap Singh
Aim: To study the socio-demographic profile of victims in case of deaths due to homicide. Method: This research was carried out at the Department of Forensic Medicine & Toxicology, Darbhanga medical College, Darbhanga, Bihar, India, for one year and 50 instances were brought for homicidal death study. Result: In this study, 50 instances in all were examined, demonstrating unequivocally that men predominate 38 cases with 76% across all age demographics. Primary-level educational people have a higher percentage with 13 cases in males and 8 cases in females with a total 42% than others. Conclusion: In conclusion, studying the socio-demographic profile of victims in cases of homicide is an important area of research that can provide valuable insights into the social and environmental factors that contribute to this type of violence. By understanding these risk factors, interventions can be developed to prevent future homicides and promote social justice.

18. Exploring Final Year MBBS Students’ Knowledge of National Tuberculosis Programs and Antitubercular Medications in a Tertiary Care Hospital.
Sudhir Kumar
Aim: The goal of this study is to assess final-year MBBS students’ knowledge of National Tuberculosis Programs and antitubercular drugs at a Tertiary Care Hospital. Methods: A cross-sectional study was conducted in a Department of Tb and Chest, Lord Buddha Koshi medical College, Saharsa, Bihar, India in duration of 1 year. 120 final year MBBS students were selected for the research using a simple random sampling technique. A pre-designed survey form was used to collect data, which also included queries about national tuberculosis programmes and anti-tuberculosis drugs. The questionnaire was validated by experts, and it was pretesting to guarantee its trustworthiness. The information was entered into Microsoft Excel and analysed using SPSS version 26. Inferential and descriptive statistics were used to analyse the data. Results: The 120 participants included 60 men and 60 women. The vast majority of pupils (90%) were conscious of national tuberculosis prevention and treatment programmes, as well as antitubercular drugs. However, the students’ understanding of tuberculosis transmission and treatment was found to be inadequate. Approximately 56% of the students were unaware of the Revised National Tuberculosis Control Programme (RNTCP) guidelines for TB diagnosis and management. There was a significant difference in tuberculosis knowledge and understanding between male and female students, with female students having more knowledge than male students. Conclusions: The study concludes that there is a need to raise awareness about national tuberculosis programmes and antitubercular drugs among final year MBBS students. There must be daily training sessions and workshops on the most recent TB guidelines and protocols. This research can assist policymakers in improving the syllabus for MBBS students and providing them with practical sessions in tuberculosis diagnosis and management.

19. Sociodemographic Profile of Traffic Accident Head Injury Victims, Research Based on Autopsy.
Vijoy Pratap Singh
Aim: To study the Socio-demographic profile of head injury victims in road traffic accidents, an autopsy-based study. Material and Method: This research was carried out at the Department of Forensic Medicine & Toxicology, Darbhanga medical College, Darbhanga, Bihar, India for one year, and throughout this time, 50 head damage sufferers from numerous auto accidents were summoned in for both medical and legal evaluation. Result: According to the analysis, from 50 instances, people here between the ages of 21 -30 were the majority afflicted, accounting for 16 cases with 45.71%, The age bracket of those younger than 10 years old was relatively untouched) % in females and 2% in males & senior adults from 61-70 years old made up 0% of females and 5.71% in males of all cases. Conclusion: A socio-demographic profile of head injury victims in road traffic accidents, an autopsy-based study, can provide valuable insights into the social and demographic factors that are associated with an increased risk of head injury in road traffic accidents.

20. The Incidence of Initial INH and Rifampicin Resistance in Untreated Cases of Tuberculosis at a Teaching Hospital Providing Tertiary Care.
Sudhir Kumar
Aim: With the underlying cases of tuberculosis, it is imperative to detect issue of drug resistance that is prevailing amongst the newly diagnosed cases of tuberculosis. The existing cross-sectional study was structured to find the occurrence of primary INH and Rifampicin resistance among treatment Naïve tuberculosis cases in tertiary care teaching hospitals. Material and Methods: This research was carried out at the Department of Tb and Chest, Lord Buddha Koshi Medical College, Saharsa, Bihar, India for one year and 50 participants were there. Prospective and cross-sectional design method. Patients diagnosed newly with pulmonary tuberculosis cases. The specimen samples of the patients (with informed consent) were subjected to MGIT 960 and further the positive cultures were subjected to the INH (0.1 µg/ml) and Rifampicin (1 µg/ml) testing. At the same time, for control sampling, a non-drug MGIT was used. Result: Isoniazid (INH) resistance was found in 8 out of 50 samples, none had resistance to rifampicin. Conclusion: All of the samples were showing mycobacterium tuberculosis growth and out of the fifty samples, only 8 showed resistance to the INH. None of the sample showed resistance towards rifampicin.

21. Exploring the Knowledge, Attitude, and Practices of Postpartum Women towards Breastfeeding in Saharsa, Bihar.
Vijay Raghwan
Aim: This research aims to better understand the attitudes, perspectives, and breastfeeding practises of newly delivered women in Saharsa, Bihar. Methods: This research was carried out in Department of PSM, Lord Buddha Koshi Medical College, Saharsa, Bihar, over the course of a one year. The study included 54 recently delivered women who were chosen for their convenience. Data was collected using a pre-planned and pre-sampled questionnaire that included questions about the participants’ breastfeeding knowledge, attitude, and practises. Results: According to the findings, 63% of participants had insufficient knowledge about the benefits of breastfeeding, while only 37% had adequate knowledge. The majority of participants (56%), had a neutral attitude towards breastfeeding, 35% had a positive attitude, and 9% had a negative attitude. Furthermore, only 41% of participants reported complete breastfeeding for the first six months of the newborn’s life, with the remainder reporting partial or no breastfeeding. Conclusion: The analysis showed that there is a lack of knowledge and neutral-to-negative attitudes towards breastfeeding among recently delivered women in Saharsa, Bihar. The low percentage of women practising exclusive breastfeeding is also concerning. Given the region’s socioeconomic status, there is a need for targeted interventions to improve breastfeeding practices and awareness campaigns to promote the importance of breastfeeding. The conclusions of this study could be useful for healthcare experts and policymakers to develop such interventions and campaigns to improve infant and maternal health in the region.

22. Comparison of Fasting and non-Fasting Lipid Biographies in Healthy Adult Populations.
Naresh Kumar Jha
Aim: The objective of this research was to analogize the lipid profile outcomes of healthy adult attendees who fasted versus those who did not fast. Methods: Study was carried out at the Department of Biochemistry, Shree Narayan Medical Institute & Hospital, Saharsa, Bihar for one year conducted this prospective study. The outpatient clinic was used to recruit 45 healthy adults (26 females and 19 males). Participants were divided into two groups: those who fasted for at least 8 hours before the blood draw (n=23) and those who did not fast (n=22). Standard methods were used to assess lipid profile parameters such as total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). Results: There were no significant differences between the two groups in terms of age, gender, body mass index (BMI), or smoking status. In the fasting group, the average level of TC, TG, HDL-C, and LDL-C were 184.6 35.4 mg/dL, 118.9 48.9 mg/dL, 52.4 10.1 mg/dL, and 112.8 28.2 mg/dL, respectively. In the non-fasting group, the average level of TC, TG, HDL-C, and LDL-C were 182.9 38.1 mg/dL, 118.2 45.5 mg/dL, 53.6 12.3 mg/dL, and 111.5 26.8 mg/dL, respectively. There were no statically substantial distinctions between the two groups in the lipid profile parameters. Conclusions: Our findings reveal that there is no massive distinction in lipid profile specifications between healthy adults who fast and those who don’t fast. This discovery could have far-reaching effects on patient convenience and healthcare resources.

23. An Investigation into the Dietary and Physical Activity Habits of Adolescents Attending Schools in Saharsa, Bihar.
Vijay Raghwan
Aim: The aim of this cross-sectional study is to assess the pattern of dietary practises and physical activity among Saharsa school-aged adolescents, with a focus on determining the factors that lead to malnutrition and associated health risks in this population. Methods: The research was conducted at the Department of PSM at Lord Buddha Koshi Medical College and Hospital in Saharsa, Bihar. The duration of the study was one year. We gathered a convenience sample of 57 school-aged adolescents aged 11 to 18 from two Saharsa schools. A structured questionnaire was used to collect data, which included questions about dietary habits, physical activity, and sedentary behaviour. The questionnaire was given to the participants in person at their respective schools. Descriptive statistics were used to analyse the data. Results: According to our research, a significant proportion of adolescents in Saharsa regularly consume unhealthy foods such as fast food, soft drinks, and sweets. Approximately 80% of participants said they ate fast food at least once a week, and more than 60% stated they consumed soft drinks and sweets at least once a week. Furthermore, more than half of the participants reported inadequate fruit and vegetable intake. The study also discovered that physical activity levels were low among the study population’s adolescents, with more than 60% reporting no daily physical activity. Sedentary activities were performed by a significant proportion of the participants (approximately 40%). Conclusions: Our findings highlight the importance of interventions to promote healthy eating habits and physical activity among Saharsa’s school-aged adolescents. The findings show a high prevalence of unhealthy dietary practises and low levels of physical activity, which increases the risk of malnutrition and related health issues. It is critical to develop and implement appropriate interventions to address these issues and promote healthy lifestyles among Saharsa’s school-aged adolescents. The findings of this study can be used to develop targeted interventions to improve the dietary habits and physical activity levels of adolescents in this region and other rural areas throughout India.

24. Comparison of Serum and Plasma Electrolyte Levels.
Naresh Kumar Jha
Aim: To compare electrolyte levels in serum and plasma in a group of 55 people over a year. Methods: A longitudinal observational study was conducted in the Department of Biochemistry, Shree Narayan Medical Institute & Hospital, Saharsa, Bihar on 55 people who were followed for a year. Blood samples were taken at the start of the study and periodic intervals throughout. Sodium, potassium, calcium, magnesium, chloride, and bicarbonate levels in serum and plasma were calculated and compared between both groups using standard laboratory techniques. Descriptive statistics, the t-test, and correlation analysis were used to analyse the data collected. Results: The mean serum and plasma electrolyte levels were not substantially different at baseline. However, there were statistically significant variations in potassium, sodium, calcium, magnesium, chloride, & bicarbonate levels between the serum and plasma groups throughout the study. Excluding bicarbonate, which was higher in the plasma group, all electrolytes were found to be significantly higher in the serum group than in the plasma group. Conclusion: Our findings reveal that there are substantial distinctions in electrolyte levels between serum and plasma and that these differences can change over time. When interpreting laboratory results, clinicians should be familiar with these distinctions as they may affect the treatment and diagnosis of certain conditions. More research is needed to investigate the clinical relevance of these differences.

25. Comparative Study between the Efficacy of Single Dose Caudal Bupivacaine and Levobupivacaine for Post Operative Analgesia after Infraumbilical Surgeries in Children.
Krishnendu Chandra, Sandipa Sarkar, Asis Kr Patra, Jayanta Bhattacharya
Background: Among all postoperative pain management techniques in paediatric population caudal epidural block has emerged as a safe, effective and preferred technique for postoperative analgesia. Caudal block is easy to perform in children and is associated with fewer complications. In addition, newer agents having lesser cardiotoxicity and motor block have made it more safer. Objectives: Our present study was conducted to compare the postoperative analgesic efficacy of two local anaesthetic agents- Bupivacaine and Levobupivacaine used in caudal route for infra-umbilical surgeries of less than 90 min duration in children. After ethical committee clearance this study was carried out at VIMS, RKMSP, Kolkata. 60 children aged between 1 year to 5 years of ASA physical status I posted for infraumbilical surgeries were included in the study. Children were divided into two equal groups based on the local anaesthetic agent used. After inducing the patient caudal anaesthesia was administered. Group B received Bupivacaine 0.25% 1ml/kg and group L received Levobupivacaine 0.25% 1ml/kg via caudal route. Postoperative pain assessment was done using children and infants postoperative pain scale (CHIPPS). Duration of postoperative analgesia was recorded by noting the time of first rescue analgesic. Residual motor blockade was recorded in terms of modified Bromage scale. Changes in hemodynamic parameters like systolic blood pressure (SBP), mean arterial pressure (MAP), heart rate (HR), and SpO2 were monitored intraoperatively. Any adverse effect in each of the groups was also taken into account. Observed data were analyzed with the help of Statistical Package for Social Sciences software (SPSS version 20). Results: According to demographic characteristics two groups was comparable (median age group B=37.17±12.4 vs group L=36.90±14.14, p=0.938, male 25/30 in group B vs 24/30 in group L, female 5/30 in group B vs 6/30 in group L, p=0.739, mean body weight of group B=14.63±2.01 kg and group L=14.27±2.78 kg, p=0.560). The 2 groups were comparable in pre-operative, intraoperative and post operative haemodynamic parameters i.e. HR, SBP and MAP, the difference being statistically insignificant i.e. p > 0.05. CHIPPS scores was significantly lower at 60 min (p=0.024), 120 min (p<0.001), 180 min (p<0.001) and 240 min (p=0.002) in groupB than group L. There was increase in the mean CHIPPS scores with time starting from the first measurement within the groups. Duration of postoperative analgesia was significantly higher in group B (334±22.34 min for group B vs 284.7±16.11minutes for group L, p<0.001). Residual motor blockade recorded in terms of Bromage score was observed to be significantly higher at wake up (p=0.001), 30min (p=0.005) and 60min (p<0.001) in group B than group L. No group showed significant number of side effects. Conclusion: From our study it can be concluded that in children caudal administration with bupivacaine provide prolonged postoperative analgesia and motor blockade than levobupivacaine and none causes any hemodynamic instability or side effects. Further large RCTs are needed to establish these present findings.

26. Exploring the Prevalence of Skin Morbidities in Alcohol and Illicit Drug Dependent Patients.
Joydeep Roy, Arup Paul, Syeda Sahnaj Azmi, Nalla Rakesh
Background: Abuse of alcohol and other drugs has been linked to many negative social and physiological effects. Skin changes might be the first observable effect. There are enough evidences which show that patients with alcohol and opioid dependence have higher incidence of skin disorders such as pruritus and pigmentary alterations, etc. which has negative impact on quality life of patients. Timely intervention in this regard will definitely improve patient’s quality life. There is limited research done in this particular geographical region of our country. So, the following study shall thus be a sincere effort to fill the gaps that have been mentioned above. Aims and Objectives: To study prevalence and types of dermatologic morbidities in patient of alcohol and illicit drug dependence. Materials and Methods: Cross-sectional study where 200 patients of age-groups 18-60 years, irrespective of gender with alcohol and illicit drug dependence attending Department of Dermatology and Psychiatry, Silchar Medical College with various dermatological manifestations were enrolled in the study spanning over 6 months from January 2022 to June 2022. Results: In this study, total of 200 cases with alcohol and illicit drug dependence with dermatological diseases were enrolled. 192 (96%) patients were male and 8(4%) patients were females. 122 (61%) patients were in age group of 21-30 years. 62(31%) patients were students followed by 56 (28%) patients were business man. In our study, alcohol dependency was seen in 84(42%) patients, opioid (heroin, tramadol and codeine) dependency was seen in 58(29%) patients, cannabis dependency in 48(24%) patients and other (cocaine, methamphetamine etc) dependency noted in 10(5%) patients. Pruritis and prurigo were the most common manifestations seen in 113(56.5%) patients. Cutaneous infections were second most common manifestations more commonly associated with alcohol dependant patients. They were seen in 68 (34%) patients. 52 (26%) patients who used injectable heroin had track marks and sooting tattoos, which are stigmatizing signs of injection drug use (IDU). Other dermatoses were also seen like nummular eczema (7%), papulosquamous disorders (7%), urticaria (6%), skin ulceration (5%) and pellagra (3%). Conclusion: The prevalence of dermatological symptoms is relatively high among drug users. In these situations, it’s critical to recognize these cutaneous symptoms for more accurate diagnosis and therapy. It is also crucial to raise awareness of these symptoms and the likelihood that they are related to drug use.

27. The Prevalence and Manifestations of Computer Vision Syndrome among Software Employees in Andhra Pradesh.
Naga Pravisha, K. Sravani Lakshmi
Background: One of the most often utilized office supplies is the computer. Long-term computer use increases the risk of COMPUTER VISION SYNDROME. The leading occupational health issue of the twenty-first century is computer vision syndrome, particularly in software workers. Aim: To study the effect of prolonged computer usage on the eyes of individuals. Methods: The study was conducted on 500 software employees aged 25 to 40 years with minimum exposure of two years to the computer every day for about 8 hours per day were included. A validated structured questionnaire was developed to analyze the data from those individuals. These symptomatic patients were called to OPD in a tertiary care hospital in Andhra Pradesh and evaluated further. Anterior segment examination with slit lamp bio microscopy, Schirmer’s test, and tear film break up time and posterior segment with slit lamp bio microscopy using 90D lens. Results: It was observed that 72.6% suffer from eye strain, 65.3% from dry eyes, 52% from headache, and 49.3% from watering and redness. Conclusion: Most individuals suffer from the symptoms of computer vision syndrome. Optimizing the exposure time and improving the awareness of safety measures in preventing computer vision syndrome plays a vital role.

28. Evaluation of the Histomorphometric Effects on Testis Following Administration of Cypermethrin in a Mammal, Albino Rat.
Sonu, Renu Chauhan
Background: In India, the commonly used pesticides belong to organochlorines, organophosphates, carbamates or pyrethroids group. Pyrethroids are insecticides chemically similar to pyrethrum found in natural pyrethrum extracted from the flower of chrysanthemum. The available information indicates there is an ongoing concern that cypermethrin may be causing a variety of reproductive disorders in humans and wildlife. Despite testicular toxicity after cypermethrin administration, there is a dearth of literature on the histopathological features in the testis. Aim: To evaluate the histomorphometric effects on testis following administration of Cypermethrin in a mammal, albino rat. Methods and Materials: Adult male Wistar albino rats, weighing 150-200 grams were procured from animal house of UCMS and associated GTB hospital, Dilshad Garden. The animals were divided into two groups as follows: Group I: experimental: 6 evaluable rats. Group II: control: 6 evaluable rats. Animals were kept in separate cages under natural light and dark conditions. The size of the seminiferous tubules was measured in the peripheral and central regions, from four different fields of every sections of the testis. Two diameters at right angles to each other, passing through the center of the tubules were measured. One was considered the long diameter and the other called the short diameter. Hundred tubular profiles that were round or nearly round were chosen randomly and measured in each animal. There readings, obtained from experimental and control animals were tabulated and statistically analyzed by independent sample “t” test. Results: In the control group, the mean weight of left testis was 905.83±21.77 mg and that of right testis was 902.00±22.80 mg while in the experimental animals the mean weight of testis on the left side was 989.50±111.66 mg and on the right testis was 981.00±113.07 mg. The mean vertical, anteroposterior and transverse diameters of left testis in control animals were 1.875±0.122, 0.875±0.176 and 0.845±0.016 cms respectively while the diameters of right testis were 1.875±0.029, 0.845±0.034 and 0.866±0.039 cms respectively. In experimental animals, the mean vertical, anteroposterior and transverse diameters of the left testis were 1.878±0.028, 0.858±0.031 and 0.855±0.023 cms respectively and on the other side in right testis the diameters were 1.868±0.027, 0.848±0.028 and 0.851±0.029 cms respectively. Conclusion: Although the pyrethroid pesticides are stated to be less toxic to mammals, the present study showed distinct histomorphological changes in the testes of adult albino Wistar rats.

29. The Synergistic Effect of Sildenafil with Letrozole in Ovulation Induction and Conception Rate.
Harshdeep K Jadeja, Bindraba Rana, Bhavesh B Airao
Background: Sildenafil relaxes the smooth muscles of blood vessels, which results in vasodilation. This promotes endometrial development, which is essential for implantation and the growth of the embryo and foetus. Aim: To evaluate the impact of sildenafil on endometrial thickness (ET), follicular development, and pregnancy rates when used in ovulation induction cycles with letrozole. Materials and Methods: We allocated the 80 infertile women in this prospective comparative study at random into two groups. Letrozole was used to induce ovulation in group A’s 40 patients, and oral Sildenafil Citrate 25 mg BD was added in group B’s 40 patients from day 8 until the hCG trigger in the Letrozole-induced cycle. On Day 13, a transvaginal ultrasound was performed to evaluate follicular development and ET. On Day 30, a urine B-hCG test was performed to identify pregnancy. Ectopic pregnancies, multiple foetal gestations, and miscarriages were all tracked for 8 weeks. Results: After the hCG trigger was activated, the mean ET in the Sildenafil group was 10.57mm as opposed to 8.50mm in group A without Sildenafil. Compared to 21 (52.5% of the patients in group A), 30 (75%) of the 40 patients in group B became pregnant after 3 cycles of ovulation induction. The average number of follicles larger than 18 mm at hCG trigger was 1.7 for group A and 2.1 for group B, respectively. Conclusion: We advise the regular use of Sildenafil in ovulation induction procedures because our research demonstrates that its use increases ET and conception rates.

30. Comparative Analysis of Intravenous Ferric Carboxymaltose vs Intravenous Iron Sucrose for the Treatment of Iron Deficient Anaemia in Pregnancy.
Ashraf Memon, Charmi Pawani, Akansha
Background and Aim: The most typical anaemia with a substantial impact on health is iron deficiency anaemia. Pregnant women experience a serious haematological and nutritional shortage, yet it is a controllable health issue. Oral iron is frequently used as a preventative measure and is advised as the first-line treatment for iron deficiency anaemia in pregnancy. In the current study, the effectiveness and safety of intravenous Ferric Carboxymaltose (FCM) against intravenous Iron Sucrose Complex (ISC) for treating iron deficiency anaemia in pregnancy are being compared. Material and Methods: At a tertiary care teaching hospital in India, this prospective, comparative interventional study was conducted among the obstetrics and gynaecology departments. There were 200 instances in the study, which were divided into two groups of 100 cases each at random. 100 cases in Group A are treated with intravenous iron sucrose treatment. Group B: 100 cases are treated with intravenous iron carboxymaltose in this group. Following the start of treatment and four weeks and ninety days later, all patients were monitored. After 90 days, investigations on serum iron, haemoglobin, and RBC indices were conducted. Results: In the study, there was a statistically significant variation in the haemoglobin distribution between the two groups. (P<0.005) Patients in the ferric carboxymaltose group had an average blood ferritin level of 98.10 21.14 (mg/L). Patients on the iron sucrose group had a mean blood ferritin level of 22.90 4.09 (mg/L). In the study, there was a statistically significant variation in the serum ferritin distribution between the two groups. Conclusion: The results of our investigation revealed a considerable rise in Hb and ferritin levels in both groups following treatment, however the increase was greater in the group that received injection FCM than in the group that received injection iron sucrose. Moreover, this study proved that FCM is less dangerous than iron sucrose.

31. A Randomized Comparative Study of Different Doses of Chloroprocaine for Spinal Anaesthesia.
Ankita Patel, Vidhi A Gajjar, Vibhuti A Shah, Saloni Jain, Mearajfatema Tharadara, Shreeya Chaya, Vidushi Purohit
Background: Regional anaesthesia and analgesia has the potential to provide excellent operating conditions and prolonged post-operative pain relief. The aim of the present study was to compare clinical efficacy of two doses of  chloroprocaine for spinal anaesthesia. Method: This randomized prospective observational study included total 60 adult female patients undergoing short elective gynecological procedures, who were equally divided into Group A (receiving  20mg 1% 2-Chloroprocaine ) and Group B (receiving  30mg 1% 2-Chloroprocaine). Patients were observed for haemodynamic parameters, time to onset of sensory T12 Block(sec), time to onset of motor Block ( Modified Bromage scale >2) (sec), time to sensory block up to T10 (sec), maximum sensory level, time to 2 dermatome regression of sensory block (min), time to resolution of motor block ( Modified Bromage scale returned to 0) (min), time to first spontaneous urine voiding (min), intra operative complications, post operative neurological sequelae at 24 hrs and on 7th day. Results: Group B had earlier time to sensory and motor blockade, longer duration of motor blockade than Group A. However, time to 2 dermatome regression, resolution of motor blockade and first spontaneous urine voiding was earlier in Group A than Group B. There were no any variations in Haemodynamic parameters and no any intraoperative complications in both groups. There were no any postoperative neurological sequelae in any patient. Conclusion: The preservative free formulation of 2-Chloroprocaine appears to be an excellent alternative for short acting spinal anaesthesia in ambulatory surgical procedures.

32. A Comparison of the Efficacy of Thiopentone, Propofol, and Admixture of Propofol and Ketamine (Ketofol) for Modified ECT Anesthesia.
Meera Pandey, Akansha Jain, Ajay Singh, Sonali Tripathi, Amit Jain
Background: Electrically inducing seizures in patients during electroconvulsive therapy (ECT) has been proven to have therapeutic effects. The circulatory system may experience severe disruptions as a result of ECT, and cerebral blood flow and intracranial pressure may noticeably increase. Many anaesthetic medications may be used to affect these cardiovascular alterations. The two induction drugs for ECT that are most frequently used are thiopentone and propofol. Ketofol, a propofol and ketamine admixture has recently been tested in ECT. Aims and Objectives: This study compared the efficacy of intravenous (IV) sodium thiopentone, propofol, and ketofol, used as IV anaesthetic agents in modified ECT, on the hemodynamic changes caused by the procedure, the length of the seizures, and the time it took for patients to recover. Materials and Methods: Ninety patients between the ages of 18 and 60 with ASA grades I and II who were scheduled for ECT participated in this prospective, randomized controlled trial. Patients in group T received 3 mg/kg of thiopentone, patients in group P received 1 mg/kg of propofol, and patients in group K received an injection of Ketofol, which is a combination of 0.5 mg/kg of propofol and 0.5 mg/kg of ketamine. For the first thirty minutes, the hemodynamic and recovery parameters in both groups were assessed. Agitation scores, obeying to verbal commands, spontaneous eye opening timings, and seizure duration were also recorded. Results: Following the administration of shock, there was a statistically significant difference in heart rate at 10 minutes and systolic blood pressure at 5 minutes between the Thiopentone group and the other two groups (p-values 0.008 and 0.011, respectively). The variations in seizure duration, the amount of time it took for the eyes to open spontaneously, and the ability to comply with vocal commands were not statistically significant (p>0.05). In comparison to groups P (1.64 0.48) and K (1.78 0.64), Group T had the highest mean agitation score (2.14 0.56) (P=0.004). Conclusion: Thiopentone demonstrated inferior hemodynamic stability compared to propofol and ketofol, but similar seizure duration and recovery measures. Propofol and Ketofol can therefore be employed as efficient induction drugs for ECT, despite the fact that propofol causes less agitation than Ketofol.

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