International Journal of

Toxicological and Pharmacological Research

e-ISSN: 0975 5160

p-ISSN: 2820-2651

Peer Review Journal

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1. A Prospective Comparative Study of Vessel Sealer Haemorrhoidectomy versus Conventional Milligan – Morgan Haemorrhoidectomy
Shaktiraj Singh Deora, Anshul Meena, Atul Sharma, Aamir Pathan
Aims and Objective: The purpose of the current study was to compare the short-term outcomes between the VSH group and the MMH group in patients with grade 3 and grade 4 hemorrhoids. Methods: In this study, 100 patients were involved, and they were split into two groups with 50 patients each: the Milligan Morgan Haemorrhoidectomy group (MMHG) and the Vessel sealer Haemorrhoidectomy group (VSHG). Data on demographics, surgical specifics, and postoperative parameters were assessed. Result: Regarding mean age, gender, grade, and the number of hemorrhoids, there was no statistically significant difference between the two groups.The Mean operative time (min) (15.6 ±2.64 versus 24.16±4.30, p value 0.001) and mean intraoperative blood loss per pile mass (ml) (10.5±3.22 versus 20.98±4.02, p value 0.001) were less in VSHG. The mean postoperative pain score on Day 1 (4.6±0.79 versus 6.2± 0.80, p value 0.001), on Day 2 (2.5±0.54 versus 4.02±0.71, p value 0.001), on Day 3(1.92±0.49 versus 3.05±0.32, p value 0.001), the mean postoperative hospital stays (Days) (2.50±0.99 versus 3.48±0.97, p value 0.001), mean time to return to normal activity (Days) (9.54±2.34 versus 13.0±3.14, p value 0.0001), mean time to achieve complete wound healing (Days) (8.20±2.42 versus 10.82±2.48, p value 0.001) and postoperative urinary retention (4 versus 18, p value 0.001) were less in VSHG, although there was no postoperative hemorrhage in both groups. The mean patient’s satisfaction score (3.90±0.61 versus 2.82±0.77, p value 0.006) was higher in VSHG. Conclusion: Our research showed that hemorrhoidectomy with vascular sealing is safe and has a lot of immediate advantages.

2. Evaluate the Effect of Yoga Therapy on Reaction Time, Biochemical Parameters and Wellness Score of Peri and Post-Menopausal Diabetic Patients
Kedar Suresh Kulkarni
Background: There are many positive effects of yoga on one’s health. The purpose of this research was to determine whether or not yoga therapy improved the response time, metabolic markers, and wellbeing score of diabetes patients who were either perimenopausal or postmenopausal. Material & Methods: Fifteen women were selected for this study; all had type 2 diabetes and were under medical supervision. Reaction times, fasting and postprandial blood glucose levels, and lipid profiles were measured before and after a six-week, three-times-a-week yoga therapy program. Using a questionnaire created by ACYTER to assess post-therapy well-being, their feelings were compared. Results: The sensitivity of pancreatic b cells to glucose signals can shift, or the body might become less resistant to the effects of insulin. Our patients were peri and post-menopausal, making the reduction in cardiovascular risk profile due to yoga all the more significant given the recently identified “heart-friendly” lipid profiles. Conclusion: A comprehensive yoga therapy program may complement conventional medical treatment for diabetes mellitus, or it may be used instead.

3. Histomorphology and Immunohistochemistry in Dianosing Soft Tissue Tumors
Wajahat Un Nazir, Gazanfar Rashid Wani, Nazia Bhat, Manal Abdul Lateef
Background: Soft tissue tumors are uncommon and comprise about 2% or less of surgical pathology cases. The annual incidence of soft tissue tumor is 1.4 per 100000 population [3]. Soft tissue tumors are the fourth most common malignancy in children, after neoplasms, neural tumors, and Wilms tumor. Benign tumors outnumber malignant ones by margin of 100:1 [4] Many soft tissue neoplasms, however, show spindle cell, epithelioid cell, small round cell or pleomorphic morphology on initial examination and require further characterization by immunohistochemistry. Methodology: This study was be conducted in the Department of Pathology at Sher-i- Kashmir Institute of Medical Sciences (SKIMS), Srinagar. It was a prospective study of 1 ½ years from November 2017 to April 2019. Complete clinical details, examination findings, and radiological investigations of all patients were studied. The excised tissue specimens were processed routinely, stained with Hematoxylin and Eosin and examined, while special stains like Immunohistochemistry were performed as required. Diagnostic results from patients were compared for diagnostic concordance using immunohistochemistry results as the gold standard where ever required. Results: There were 101(67.33%) benign tumors and 36(24%) malignant tumors and 13 were (8.66%) intermediate tumors with a benign- malignant ratio of 2.80:1.Of total number of cases 88 were males and 62 were females with male to female ratio of 1.38;1 and mean age of 39.38. Male to female ratio among benign tumors was 1.33:1 ,among intermediate group was 1.14:1and among malignant tumors 2:1.Benign tumors were more common on extremities 47 cases (47%)and head and neck 34 cases(33.66%).Intermediate group tumors were mostly commonly found in trunk and retroperitoneum 9 cases(69%).Malignant tumors were common on lower extremities18 cases( 50%) followed by retroperitoneum 8 cases(22.2%).Adipocytic tumors were the most common category found with 41 cases(27.33%)followed by Vascular tumors 31 cases(20.66%)and Peripheral nerve sheath tumors 28 cases(18.66%). Conclusion: Our study highlights the importance of affected age group, sexual predilection, location, size, histopathology, and IHC features in diagnosing STTs. Limitation: Tumors of uncertain differentiation were even difficult to categorize using IHC. Hence, cytogenetic and molecular studies may be needed to accurately diagnose these tumors.

4. A Clinical Study of Humeral Shaft Fractures Treated with Minimally Invasive Plate Osteosynthesis (MIPO) Technique
Pashap Avinash Reddy, P Sai Prashanth Reddy
Background: The population is growing rapidly, and the number of vehicles on the road are increasing accordingly. As a result, the incidence of road traffic accidents and humerus fractures has also risen. Humeral shaft fractures are a frequent occurrence, representing approximately 1 to 3% of all fractures. There are various surgical methods available to treat humeral shaft fractures, including plate fixation, intramedullary nailing, and tens nailing. Biological union occurring at the fracture site is not interfered with by the recently discovered MIPO approach for treating humerus fractures. Methods: Successive cases of shaft of humerus fractures reported to our hospital were included. In all the cases the treatment of fractures was within 3 weeks of the injury. The fractures were classified based on the AO/ASIF (Arbeitsgemeinschaft fuer Osteosynthesefragen/ association for the study of internal fixation) classification system. All operations were performed by the same surgeon using the Standard technique for MIPO plating. Results: In this study, we found 72% of cases were with Good functional outcomes as evaluated by UCLA scores. The range of UCLA scores was from 29 to 35 and the mean scores were 33.2 ± 1.5 (table 3). Similarly, the MEPS scores were evaluated in this study we found all the cases were in Excellent/Good groups by MEPS scores and the range of scores were 80 – 100 and the mean score was 84.5 ± 2.5. In this study, we found the meantime for fracture healing was 14.55 ± 2.5 weeks the range of time was from 12.5 weeks to 16.0 weeks. The range of motion in degrees obtained in the cases of the study was from 115.0 ± 15.0 degrees and the mean range of motion was 123.5 degrees. Conclusion: Compared to the conventional methods of open reduction and internal fixation, the use of humerus MIPO plating yields favorable outcomes and leads to a faster recovery after surgery and minimal post-operative complications. Hence this method must be considered with priority in cases of fracture of the shaft of the humerus whenever feasible.

5. Comparative Study Using Conventional Methods and the Automated VITEK 2 System for Detection of Macrolide, Lincosamide, Streptogramin B Resistance in Coagulase Negative Staphylococci & Staphylococcus aureus in a Tertiary Health Care Centre in Eastern India
Priyanka Paul Biswas, Kahkashan Akhter, Aninda Sen, Anamika Singh
Background: The aim of the study was to investigate the test performance of automated VITEK 2 against the conventional disk diffusion method to detect resistance exhibited by Staphylococcus strains towards macrolides and streptogramins. Materials and Methods: Blood samples were processed both by BacT/ALERT and manual methods, while all other samples were manually processed for bacterial growth and identification. Bacteria were identified based on colony morphology & biochemical testing and antibiotic sensitivity testing performed following CLSI guidelines. Methicillin resistant strains were identified by Disc diffusion method, while Inducible Clindamycin strains were identified by D-zone test. Both manual and the automated VITEK 2 systems were used to assess the antimicrobial sensitivity pattern among isolates. Results: The total number of strains that could be correctly identified as inducible clindamycin resistant using both the automated VITEK 2 system and the manual D-zone Test was 82. Of these VITEK 2 failed to detect 4 strains that could be detected only by the disc diffusion method [negative predictive value 100%]. Hence although the VITEK 2 had a sensitivity of 100% positive predictive value was 95.2%. In comparison, the D-zone Test identified all 82 strains. Conclusion: It is vital to perform D-zone test in routine work on the primary AST plate with erythromycin and clindamycin being correctly placed to detect clindamycin resistance, thus enabling the laboratory in giving the report pertaining to iMLSb and cMLSb appropriately. This will help enable missing any inducible clindamycin resistant strain that might be seen using the automated VITEK 2 system.

6. Study of Lipid Profiles Mainly Triglycerides in Diabetic Patients
Shiv Kumar Suman
Background: Dyslipidemia is one of the common disorders which is seen in most of the diabetes patients, which causes cardiovascular disorders. Objective: To detect the lipid abnormality in diabetic patients. Methods: The present study was planned in Department of General Medicine, Shree Narayan Medical Institute and Hospital, Saharsa, Bihar, India, over a period of 12 months. For the present study total 100 patients were selected and a total of 50 patients were enrolled in the group A as diabetic group and remaining 50 patients were enrolled in group B as normal patients. Results: The biochemical parameters like Fating glucose level, Glycated haemoglobin (HbA1c), Total cholesterol, Triglycerides, High Density Lipid, and Low Density Lipid were estimated. Conclusion: Diabetes has now become a global endemic in both developing and developed countries. Hence it is the need of the hour for early detection and prevention of this non-communicable disease.

7. Clinical and Hematological Profile of Patients with Dengue Fever in Bihar Region
Shiv Kumar Suman
Objectives: To study the clinical and hematological profile of dengue fever cases presenting to a hospital. Methods: Department of General Medicine,Shree Narayan Medical Institute and Hospital, Saharsa, Bihar, India for six months. A total of 450 patients were examined Patients with fever and other signs of dengue with either positive NS1 antigen test or IgM or IgG antibody were included. Results: NS1 was positive in 109 patients (24.2%), IgM antibody test was positive in 302 patients (67.1%) while in 33 patients (7.3%) the IgM antibody was negative but they showed positivity for IgG antibody. Mild dehydration was noted in 164 patients of DF (40%) who were treated with oral rehydration therapy, while 51 cases of DFWS (12.4%) required intravenous fluid therapy. Twelve patients (2.9%) had severe dehydration requiring IV fluid resuscitation. Conclusion: This study highlights the most common clinical and laboratory profiles of dengue viral infections that could alert physicians to the likelihood of dengue virus infections in the study area.

8. Assessment of Electrocardiographic (ECG) Changes in Subclinical Hypothyroidism
Bipin Kumar
Aim: The objectives of this study were to study the electrocardiogram (ECG) changes in a group of newly diagnosed subclinical hypothyroid females and to compare the ECG changes in subclinical hypothyroid females with normal healthy euthyroid individuals. Methods: This study was conducted in the Department of Physiology, Shree Narayan Medical Institute and Hospital, Saharsa, Bihar, India. We studied 50 patients with newly diagnosed and untreated primary SCH who presented to Shree Narayan Medical Institute and Hospital, Saharsa, Bihar, India, outpatient department (Dermatology, Medicine, and Obstetrician-Gynecologist) with non-specific complaints such as fatigue, mild weight gain, dry skin, and depressive feelings but without overt symptoms and signs of thyroid hormone deficiency. Results: A total of 50 subjects (25 in the study group and 25 in the control group) were included in the study. Both groups were well matched with regard to age and BMI. Heart rate and blood pressure were comparable in both the groups. TSH levels were significantly higher in SCH patients than controls, but fT4 and fT3 were comparable. Mean QTc interval of the study group was significantly longer than those of the control group (P = 0.027). Other parameters in ECG were comparable in both the groups. Conclusion: The present study concluded with the following important finding that patients of SCH have prolonged QTc interval, which predisposes to the potentially life-threatening ventricular arrhythmias. Cardiovascular manifestations are common in thyroid disorders.

9. Study of Psychological Parameters in Male and Female Students Depression, Anxiety and Stress Scores
Bipin Kumar
Aim: The present study was undertaken to observe the selected psychological parameters that are depression, anxiety, and stress in young adults. Methodology: A cross sectional study was conducted among students of Department of Physiology, Shree Narayan Medical Institute and Hospital, Saharsa, Bihar, India in which a total of 100 (males =50, females =50) young adults studying undergraduate allied health courses both males and females were part of the study after obtaining the written informed consent. Apparently healthy individuals within the age group of 18-24 were recruited in the study. Participants with health issues or undergoing any treatment or therapy and unwilling participants were excluded from the study. Depression, anxiety, and stress levels were assessed using the DASS-42 questionnaire which is a standard questionnaire to assess the negative psychological aspects stress, anxiety, and depression. Each item comprised a statement and the answers were reported on a four-point scale, with the score 0 representing “did not apply to me at all”, and score 3 “applied to me very much, or most of the time”. By summing the scores for relevant items, the values of depression, anxiety, and stress revealed the degrees of severity of the three scales in question. Informed consent was obtained from all the participants before the study. Results: Out of 100 participants, 50% were males and 50% were females. 76% participants belonged to 18-21 years of age group and 24% were more than 24 years of age.42% belonged to first year, 35% belonged to second year, and 23% belonged to third year of study. The P-value equals 0.0015 for the depression score. By conventional criteria, this difference is considered to be very statistically significant. P-value equals 0.1806 for anxiety score. By conventional criteria, this difference is considered to be not statistically significant. P-value equals 0.0140 for the stress score. By conventional criteria, this difference is considered to be statistically significant. Conclusion: To sum up, it is of great significance for colleges to adopt collegiate policies reflecting the gender differentials and offer female and male students more proper guidance in freshman and sophomore years in order to promote their psychological well-being.

10. Study on Recent Advancements and TL Pattern of in Medical Education in Context with Basic Sciences
Ankur A. Shah, Nita Sahi, Nange Kinnari, Charu Taneja, Basant Kumar, Neha Saxena, Disha Sahi
Background: An updated and perfect knowledge of all the medical subjects is must for becoming a good physician and practising medicine Despite extensive digitalization and moderniza­tion of education field traditional teaching methods like following cadaveric dissections and chalk board methods etc even now hold an importance It is becoming practically acceptable now that no modern technologies or 3D models could replace traditional teaching methods. Methods: Recent studies on advanced teaching methods for undergraduate medico and non-medico students and their impacts are studied. Results: Despite latest advanced methods of teaching, there is still an advantage of old learning styles and methods like cadaveric dissection which helps the students get efficient and proper practical knowledge.

11. A Prospective Observational Study of Response to Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer in Tertiary Centre
Manojit Sarkar, Asis Kumar Saha, Parvej Sultan
Introduction: Carcinoma of the breast from the very beginning has been a feared disease.’ Till today, there is an aura of fear that surrounds the mention of this name ‘breast cancer’. Neoadjuvant chemotherapy (NAC) is increasingly used to treat patients with locally advanced breast cancer (LABC). Such regimens can increase rates of breast-conserving therapy (BCT) compared with post-operative chemotherapy and may minimize the need for aggressive nodal surgery with axillary lymph node dissection. Aims: To assess the change of clinical staging after Neoadjuvant Chemotherapy, Assessment of Lymph node status after neoadjuvant Chemotherapy and type of surgery suitable after neoadjuvant Chemotherapy. Materials and Method: The present study was a hospital based observational study. The study conducted in Nil Ratan Sircar Medical College & Hospital. The study duration was One year (June 2021 to May 2022). 50 patients were included in this study. Result: In our study, all patients [50 (100.0%)] had Lymph node involvement. We showed that, most of the patients had Stage IIIA [25 (50.0%)]. However, Stage IIIB [15 (32.0%)] followed by Stage IIIC [10 (20.0%)] which was statistically significant (p=.00168). It was found that, all patients [50 (100.0%)] had Anterior Chemotherapy. Our study showed that, most of the patients had Stage IIB after chemotherapy [22 (44.0%)] and it was statistically not significant (p< .14706) (z=1.4499). In our study, higher number of patients had Down stage Result [35 (70.0%)] followed by Same Result [15 (30.0%)] but this was statistically significant (p=.00006) (z=4). We showed that, the mean Tumor size of patients was [7.2880± 1.4822 (cm)] and mean % of size reduction of patients was [58.0000± 15.0509]. Conclusion: We conclude that, the change of clinical staging after Neoadjuvant Chemotherapy, Lymph node status after neoadjuvant Chemotherapy.

12. Scrub Typhus- An Under Identified Problem at District Shahdol MP: A Case Series
Rupesh Kumar Gupta, Rupesh Sahu, Gaurav Agarwal, Roopa Agrawal
Introduction: Scrub typhus is an acute zoonotic infection caused by a rickettsial pathogen namely Orientia tsutsugamushi. The disease is endemic in many parts of India and continues to be a public health problem. Materials and Methods: This study describes the clinical and epidemiological profile of scrub typhus positive cases presented in a tertiary care hospital from July to October 2022. Detailed physical examination and investigations were done in all the patients, and diagnosis of scrub typhus was made with rapid diagnostic kit. Results: Of sixteen cases, eight were males and eight were females. Fever was the chief symptom in all the cases. Other complaints were headache, body ache, cough and decreased appetite. Eschar was present in 6 cases. All cases were successfully treated with doxycycline and there were no complications. Conclusion: Scrub typhus is prevalent even in Central India and a high degree of suspicion, thorough examination of the patients and appropriate investigations can help in reaching the accurate diagnosis and treating patients successfully, thus avoiding fatal complications.

13. A Study of Clinical Profile and Outcome of Pharmaceutical Poisonings in Children Less Than 12 Years in a Tertiary Care Hospital
Vignesh VN, Sreelatha Martha, S. Kavitha, N. Ravikumar, Mahitha Krishna
Background: Poisoning among children is one of the common medical emergencies encountered in Pediatric practice. The introduction of a variety of new drugs has widened the spectrum of toxic products children are exposed to. Since such data is very limited in our population, we in the current study aimed to analyze the spectrum and clinical profile of pharmaceutical poisonings in children less than 12 years in our hospital. Methods: In our study, we retrospectively reviewed the medical records of n=49 children aged less than 12 years with pharmaceutical poison exposure, who presented to the Emergency Department at Niloufer Hospital in Hyderabad. A structured proforma was used to record all the pertinent information, including the nature of the poison, clinical features, the amount of time between the poisoning and the patient’s arrival, the social and demographic makeup of the patient, physical examination results, investigations, the therapy administered, and outcomes. Results: The study findings showed that the majority of the cases were of children less than 5 years of age, with a mean age of 2.8 years. Boys accounted for 61.2% of cases, while girls accounted for 38.8%. Accidental ingestion was the primary cause of poisoning, accounting for n=48 cases, while one case was due to suicidal intention. The most common type of poisoning was due to thyroxine tablet ingestion, accounting for 22.4% of cases. Interestingly, almost half of the study population (44.9%) did not show any symptoms of drug poisoning, highlighting the need for increased vigilance and surveillance to identify cases of drug poisoning in children. Conclusion: The study also conducted a comparative analysis of symptoms of drug poisoning in our study population with those described in the literature. The results of the study underscore the need for additional research to determine toxic doses and clinical profiles of pharmaceutical poisonings in children. Of the 20 drugs studied, only 7 drugs had a known toxic dose or blood levels. Furthermore, the drug thyroxine was responsible for the majority of the cases, while phenytoin was responsible for the increased duration of hospital stay. Overall, the study emphasizes the importance of conducting additional research to expand knowledge and improve treatments for pharmaceutical poisonings in children.

14. Weight Gain Pattern in Children Below 14 Years Undergoing Antitubercular Therapy
Priyanka Bansal, Sukriti Mishra, Ravi Ambey
In India, an estimated 3.33 lakh children in the 0–14 years’ age group become ill with Tuberculosis (TB) each year. TB is one of the most pressing health problems nationally. Weight gain during treatment is the main indicator of good treatment outcome, but there is no adequate information on weight gain pattern and the factors that affect weight gain in pediatrics population. Objective: To evaluate the weight gain in pediatric patients undergoing antitubercular therapy and to analyse the various factors associated with weight gain in pediatric patients undergoing antitubercular therapy. Methods: This prospective observational study enrolled 117 patients of ≤ 14 years with newly diagnosed drug susceptible TB. Baseline demographic characteristics and other risk factors were identified. Weight was recorded at time of starting antitubercular treatment [ATT], then at the end of 2 months and 6 months. After completion of data collection change in weight was compared and statistical analysis was done using SPSS software. Results: After comparing the baseline weight at the time of starting ATT and on follow ups it was found that 111 patients [94.8 %] showed gain in at the end of 2 months of treatment with average weight gain of 1.31±0.93 KG. At the end of 6 months of treatment all patients showed an increment in weight with average weight gain of 2.45±1.93 KG. Age, exposure to household smoke and TB contact came out be significant factors associated with weight gain in univariate analysis as well as multivariate linear regression analysis.

15. Steroid Induced Ocular Hypertension and Glaucoma: A Brief Clinical Analysis
Minal Patel, Hasti Lo, Neha Parmar
Background and Aim: Individual differences in steroid response risk play a part in the unpredictability of steroid-induced glaucoma. While topical application of this medication will result in a decrease in aqueous outflow, a rise in circulating corticosteroid may cause an increase in aqueous inflow. The current study sought to examine the etiological risk factors, length of steroid use, and clinical presentation of steroid-induced glaucoma. Material and Methods: The present analysis is the prospective analysis done at the department of the ophthalmology, medical college & hospital. The study was performed for the period of 12 months. The study population consists of 86 patient established with steroid induced glaucoma. The demographic details of the included patients were recorded. The reasons for and length of the detailed history of steroid use were documented. The different risk factors, including primary angle glaucoma, connective tissue disorder, hypertension, diabetes mellitus, and family history of glaucoma, were also thoroughly documented. In order to rectify refractive defects in all the details, visual acuity was measured and refraction was performed in each case. Field of vision defect, frequent eyeglass replacement, and vision defect were all carefully noted. Results: A total of 172 eyes of 86 patients were taken into account of the analysis. Steroid induced glaucoma was resolve in 34 eyes of 26 patients. The visual acutity was found to be normal in 34 eyes. Less vision was found in 16 eyes. The visual acuity was found to be defective in 86 eyes. The defect was due to change in lens in 12 eyes. In 74 eyes the reason was found due to refractive error. 50 patients’ eyes were found to be normal in the current investigation, 36 eyes had tubular fields, 14 eyes had inferior arcuate defects, and 6 eyes had superior arcuate defects. IOP significantly changed between before and after the intervention. Conclusion: Steroids should be avoided or, if necessary, delivered in lesser dosages to people who are at risk or who are susceptible. According to our study, patients who had cataract surgery were more negatively impacted by the ongoing use of topical steroids.

16. Impact of COVID19 Pandemic on Health Care Professional due to Emergency Surgical Practice: A Hospital Based Observational Study
Mukul Mundara, Sunil Agrawal, Ashish Shrivastava
Background and Objectives: The effects of COVID-19 on surgical practice are extensive and include modifications to perioperative practice and ways of working, workforce and staffing difficulties, procedural prioritization, intraoperative viral transmission risk, and surgical training and education. There is a lack of information about the way this pandemic has impacted medical professionals because of surgical practice. Aims and Objectives: The current study’s goal was to determine the dispersion of COVID 19 through patients to healthcare professionals utilising PPE during emergency surgeries. Material and Methods: The study was conducted as a hospital based retro prospective observational study at the Department of General Surgery, Government Medical College and hospital of central India. After receiving institutional ethical committee permission and the informed written consent, 36 patients receiving emergency surgeries during COVID-19 Era and 109 health care professionals involved in patient care were evaluated for the onset of any COVID 19 symptom for 5 days postoperatively. All the data collected were analyzed using SPSS statistical software version 26. Results: Among these 36 emergency surgeries patients, 86.1% (n=31) had COVID positive report during admission, mostly had complain of respiratory symptoms. Out of 16 COVID positive health workers, 81.25% (n=13) suffered from respiratory symptoms, 43.75% (n=7) had G.I symptoms and 12.50% (n=2) were asymptomatic. Analysis showed a positive relation between COVID positive status and depression in health care professionals (p=0.028). Out of 93 COVID negative health care workers involved in emergency surgeries, 90.32 % (n=84) were asymptomatic. Only 9.67% (n=9) health care workers had respiratory symptoms and 2.1% (n=2) had gastrointestinal symptoms. Conclusion: The current study may aid in the development of mitigation measures to enhance mental well-being, as well as the identification of factors of poor mental state and therapies to treat people suffering from a mental condition. Postoperative assessments in a digital environment on an individual basis allow team members to voice their worries and comments to the system as a mitigating technique. Evidence-based training and education for HCWs on pandemic preparation has been shown to be critical for improving hospital staff expertise, abilities, and mental well-being during a pandemic.

17. Does Bupivacaine Plus Butorphanol Provides Better Anesthesia and Analgesia in Comparison to Bupivacaine Plus Fentanyl?
Avaneesh Sandupatla, Munir Ahmad Khan, Gaurav Kanwar, Sudarshan Reddy, Sathish Bobba
Background: Neuraxial opioids are widely used as adjuvants to local anaesthetic as they improve quality and duration of block. Neuraxial opioids like butorphanol and fentanyl enable longer surgical analgesia and quicker spinal anesthesia recovery. The current study aimed to assess the efficacy of anesthesia and analgesia between intrathecal bupivacaine plus fentanyl and bupivacaine plus butorphanol for lower limb orthopedic surgeries. Methods: The n=80 cases were randomly allotted by a computer-generated random number into two groups. Group A cases received 2.5 ml of 0.5% hyperbaric bupivacaine with 0.5 ml of fentanyl (25 µg) a total volume of 3 ml intrathecally. Group B received 2.5 ml of 0.5% hyperbaric bupivacaine with 0.5ml of butorphanol (25 µg), the 0.5 ml of 25 µg butorphanol was obtained by 1ml of 1mg/ml butorphanol with 19ml of sterile distilled water. Results: In the current study a total of n=80 cases divided equally in two groups (A and B) were included. Our results showed Group A showed a lower sensory level of block in compared to group B and the difference is significant. Both males and female cases in the two groups showed significant differences in the time required to reach the highest level of sensory blockade, which was earlier in group B. Both male and female populations of both the groups had shown similar findings in the time taken for sensory regression to S2. Conclusion: We conclude that 25µg fentanyl and 25 µg butorphanol with bupivacaine provide good anesthesia and analgesia and fewer side effects. Neuraxial butorphanol plus bupivacaine provide early onset and prolonged duration of sensory and motor block, and prolonged analgesia then fentanyl and bupivacaine.

18. Organ Donation – Attitude and Awareness among Undergraduate Medical Students at Mediciti Institute of Medical Sciences, Ghanpur Village, Medchal Mandal, Telangana
Rathod Vinayak, Sowmya Kandadi, Harsha Sree Katuri
Introduction: Organ donation is when a person allows an organ of theirs to be removed, legally, either by consent while the donor is alive or after death with the assent of the next of kin. But in our country prevalence of organ donation is very less and also awareness of organ donation is very meagre. Aim and Objective: To know about awareness and attitude over the organ donation among undergraduate medical students. Material and Method: This Cross-sectional study was conducted in Mediciti institute of Medical Sciences, Telangana, India. A predesigned questionnaire was used to collect data from 172 individuals. Data collected were analysed using Microsoft Excel, which were tabulated and figured  accordingly. Results: The results show that 72%(123) of participants were aware about organ donation, and out of all participants, families of only three have donated organ in the past 4 years. A total number of 12 participants have signed up for organ donation. A significant portion of the study population 22(12.79%) opined that there might be some religious beliefs which are preventing certain strata of local population from donating or accepting organs. 92(53.48%) of the study group opined that there is lack of awareness among people which may be one of the reasons for low rates of organ donation. Conclusion: Organ donation programs are at a very primordial stage in India . It is high time for the policy makers and other stake holders of a global giant like India to understand the magnitude of the benefits from these programs. Making tangible policies that are reflected nationally, emphasizing attention to both the organ donors and recipients, is the need of the hour.

19. Analysis of the Development of Resistance to Anti-Tubercular Drugs among Previously and Newly Treated Patients
Priyanka Das, Naliniprava Das, Gopal Krushna Sahu, Hemanta Kumar Sethy, Sushree Swetapadma, Debabrata Barik
Introduction: The paper discusses drug-resistant tuberculosis (TB) treatment. In resource-poor countries, TB is a public health threat. TB treatment involves long-term antibacterial and sterilizing medications. MDR-TB, resistant to at least two first-line anti-TB medications, is complicated. Better-targeted, easier-to-administer TB drugs are needed to improve treatment. Drug susceptibility tests and effective MDR and XDR-TB treatment programmess are essential for fighting the disease. Aims and Objective: The study aims to evaluate anti-tuberculosis medication resistance in once-treated and recently treated patients. Methods: An observational study conducted using a cross-sectional design was carried out on the 693 patients who visited the outpatient department of our hospital. We collected sputum samples from clinically suspicious people diagnosed with lung sickness and tested them in the Diagnostic Microscopic Centre (DMC) under the Department of Pulmonary Medicine and Department of Microbiology for MTB using standard detection methods and Drug Susceptibility Testing (DST). In addition, the CBNAAT and LPA molecular procedures were carried out by our team at the Pulmonary Medicine Department. Result: 693 individuals, 64 per cent of whom were male, were screened for pulmonary tuberculosis during the trial. Patients’ average age ranged from 21 to 40. Of those patients, 84% were newly diagnosed, whereas 16% had been treated before. Twenty-four per cent of the 218 individuals with a positive AFB smear grew Mycobacterium TB. The prevalence of extensively drug-resistant tuberculosis (MDR-TB) was 0% in newly diagnosed patients and 7.1% in previously treated patients. Conclusion: The study has concluded that previous anti-TB treatment is the most critical risk factor for the development of MDR-TB. However, it is also being reported in newly diagnosed TB patients.

20. Systemic Diseases Associated with Severe Acute Malnutrition (SAM): A Prospective Observational Study
Ameta Gaurav, Aswani Nishant, Maru Lipika
Introduction: Severe acute malnutrition (SAM) is a cause of almost 50 childhood deaths in children below 5 years in developing world. In India, as National Family Health Survey (NFHS), prevalence of SAM has increased from 7.5% in NFHS-4 (2015-16) to 7.6% in NFHS-5 (2019-21). The aim of study was to determine systemic diseases associated with SAM among 6 months to 5 years children admitted at the department of Paediatrics, GBH General Hospital, American International Institute of Medical Sciences, Bedvas, Udaipur. Methods: We did a prospective observational study of 208 SAM children over 24 month’s duration. Systemic diseases were determined by history, physical examination and uniform investigation protocol. Therapeutic nutritional rehabilitation was provided for 14 days along with management of associated systemic diseases. Cases were followed up weekly for 2 months by monitoring anthropometric parameters of SAM. Results: Systemic diseases were detected in 57.69 % of cases. Celiac disease (16.82%), Tuberculosis (12.01%), Bronchial asthma (8.18%), severe nutritional anemia (6.78%), congenital haemolytic anemia (4.80%), congenital heart disease (3.84%), chronic kidney disease (2.88%) and recurrent UTI (1.92%), HIV (0.48%) were there. 42.30% cases were not associated with any systemic disease. Among nutritional factors associated were 28.84% of cases and SGA was also associated (13.46%) with SAM. 76.91% subjects started gaining weight during 15 days hospital stay. Weight gain was observed in 91% subjects at follow-up. Weight was attained by 9% subjects. 64.42% children were from rural background and 35.58% from urban background. Timing of initiation of complementary feeding was incorrect in 44%. Conclusion: Systemic diseases such as celiac disease, tuberculosis, severe bronchial asthma, severe anemia, congenital heart disease, recurrent UTI, chronic kidney disease and HIV were associated with SAM. Our findings also confirm the association of SAM with noncompliance of exclusive breast feeding and delayed complementary feeding.

21. Assessment of Management Outcomes of Mandibular Fracture at a Tertiary Care Centre
Abha Kumari, M. Junaid Alam, Sandeep Kumar,V.K. Prajapati
Introduction: The facial area is one of the most frequently injured areas of the human body. Mandibular fractures forms a major proportion as it is the second most facial bone to be fractured next only to nasal bone despite being the largest and the strongest facial bone. The main goal in the treatment of fracture is to predictably restore preinjury anatomical form and occlusion. If treated incorrectly, significant functional and aesthetic sequel may happen which includes malocclusion, temporomandibular joint disorders and facial asymmetry.This study attempts to define the outcomes for the mandibular fracture after different treatment measures were employed. Method: This is an observational study design done in the period between November 2021 to October 2022 in the department of ENT at RIMS Ranchi. The study comprises of 50 patients of mandibular fracture that were included. This study evaluated the outcome of mandibular fracture after treatment on the basis of pain, occlusion, mouth opening and infection. Results: The study reviewed 50 patients with mandibular fractures of age ranging from 18-70 years significantly higher for males. The highest incidence was in the age group of 21–30 years. The main cause were road traffic accidents (RTAs, 76%) followed by self fall (16%) and assaults (8%). Parasymphyseal fractures were the most frequent (48%), followed by condyle (32%) and angle (26%) fractures in occurrence. Pain and occlusion improved to near normal in all the patients. Mouth opening improved to normal in 86% and was a bit less than normal in 14% following treatment. Infection was present in only 4 patients (8%) following treatment. Conclusion: Following treatment pain resolved in almost all of the cases irrespective of the site or treatment used. Same was true for occlusion while mouth opening reverted back to normal except in cases involving condylar fractures especially bilateral condylar fractures. Infection at fracture site was seen only in 8% of the cases that had age of more than 50 years, suffered multiple fractures and underwent open reduction. Outcome for parasymphysis was better than that for condylar fractures.

22. Blunt Trauma Abdomen and its Management: An Observational Clinical Study
Kirti Baghmare, Ashish Kumar Gupta, Shyam Gupta, Prashant Shrivastava
Background and Objectives: The abdomen is among the three most often damaged bodily components, behind the extremities and the head. Blunt Abdominal Trauma (BAT) can be especially misleading since clinical symptoms might take hours or even days to appear, even if the internal organ damage may be severe and fatal. RTAs are the most frequent type of injury that results in BAT. Blunt abdominal injuries can be caused by external compression, crushing, or deceleration. Aims and Objectives: Current research aimed to study and evaluate the different available modalities of investigations and their application in management of blunt trauma abdomen. Material and Methods: The study was conducted as a hospital based prospective observational study at the Department of General Surgery, Government Medical College and Hospital of Central India. The clinical presentation, investigations, management, and outcomes of 100 patients experiencing blunt abdominal injury were assessed after acquiring institutional ethics committee approval and the informed written consent. All the data collected were analyzed using SPSS statistical software version 26. Results: The mechanism of trauma, clinical presentation, investigation techniques, management used, and their correlation with the outcome were all examined and compared in the current study. Demographic information including age and gender were also compared. It was discovered that BAT frequently includes young men between the ages of 21 and 30. The most frequent type of injury is determined to be RTA. Splenectomy and intestinal perforation closure were the procedures that were carried out the most often. 61 among the 100 patients received conservative treatment. Mean duration of stay in hospital was found to be 8.19 days. Mortality was observed in 16% patients due to respiratory complications. Conclusion: Due to its ambiguous presentation, subtle clinical presentation in initial phases, and the patient’s quick deteriorating health, blunt trauma to the abdomen is a difficult entity to diagnose. Blunt abdominal trauma can be significantly decreased by preventing automobile accidents. When feasible, conservative care can be used on patients with mild injuries who are hemodynamically stable.

23. Prescribing Pattern and Safety Profile of Anticancer Drugs in Carcinoma Lung in Tertiary Care Teaching Hospital, Haldwani
Prashant Kumar, Bhavana Srivastava, Reena Bhardwaj, Nirdosh Kumar Pant, Neeraj Rajdan, Jalaj Gaur
Introduction: Cancer is most common cause of morbidity and mortality in world, Lung carcinoma second most commonly diagnosed cancer in men. It is multifactorial, most common cause is smoking. Objective: This study was conducted to evaluate prescription pattern and adverse drug reactions (ADR) of Anti cancer drugs in Carcinoma Lung patients. Material and Methods: An observational, prospective, open label hospital based study of 114 patients, from January 2021 to September 2022. All cases of diagnosed lung carcinoma patients coming to Radiation Oncology OPD of Swami Ram Cancer Institute, Haldwani, Uttarakhand. All the reported ADRs were analyzed using WHO-UMC and Naranjo causality assessment scale and Schumock and Thornton preventability scale. Results: In our present study of 114, male: female was 3:1, majority in age group of. 50-70. Most patients were Smokers ( 73.7% ). Commonly prescribed drug were Platinum coordination complexes, Taxanes, Topoisomerase 2 inhibitor, Folate antagonist, Pyrimidine antagonist, Nitrogen mustard, Antibiotics. Most common ADR were nausea & vomiting, generalized weakness, anaemia and thrombocytopenia.. It was observed that 9.6% had Certain, 79.8% had Possible and 10.5% of the patients had Probable Causality Assessments according to WHO-UMC scale. Conclusion: Lung carcinoma is more common in males then females. Smoking being a major cause. Squamous cell carcinoma was most common followed by small cell carcinoma.

24. Pattern of Adverse Events Following COVID-19 Vaccine among Vaccinated Individuals Aged Above 18 yrs in Kerala
Siji V S, Ruksana Fathima, Sai Kripa P S, Nikhil V Pillai
Background: Coronavirus pandemic is an ongoing pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). WHO declared the outbreak as a Public Health Emergency of International Concern in January 2020 & a pandemic in March 2020. In India Oxford University-Astra Zeneca’s Covishield vaccine, manufactured by serum institute of India and Bharath Biotech’s Covaxin are being used for vaccination programme. In this study, we assess adverse reactions following Covid-19 vaccination & incidence of COVID-19 disease among vaccinated people across Kerala. Since it was newer vaccine and general population was afraid of side effects. The present study aimed to study the adverse effects of COVID-19 vaccination among general population aged above 18 years in Kerala. Methods: A descriptive cross sectional study was conducted among COVID-19 vaccinated individuals above 18 yrs of age residing in Kerala from July 2021 to December 2021. Pattern of adverse events following COVID-19 vaccination (AEFI) were assessed using a semi structured questionnaire. An online questionnaire using Kobo Toolbox was developed and shared via online platform to record the self-reported adverse events following vaccination. A respondent driven sampling method was used. The data was downloaded in MS Excel and analysed using Microsoft excel. Results: Study was conducted among 526 people across Kerala, among which both males(45.63%) and females (54.18%). Majority of them received COVISHEID (92.97%) and rest of them received COVAXIN (6.24%) and SPUTNIK (0.57%). Out of which 65.97% received 2 doses and 34.03% received only one dose of vaccine. More than half of them (61.5%) faced side effects during post vaccination period. The symptoms were very mild in which fever (65.74%) and tiredness (76.85%) were the commonest symptoms. Conclusion: In the present study, majority of the vaccinated people experienced very mild and self limiting adverse effects, those were very mild & self limiting. It is a fact that COVID-19 vaccines doesn’t provided 100% efficiency, but our study indicates that it does provides protection against COVID-19 infection to a great extend & breakthrough infections are very less severe and asymptomatic for vaccinated people.

25. Comparison between Fentanyl and Nalbuphine in Blunting Hemodynamic Stress Response to Laryngoscopy and Endotracheal Intubation in Etomidate Induction of General Anesthesia
Irfan Ahmad Siddiqui, Neelofar Shaikh, Nishtha Sharma, Prayank Mandloi, Fauzia Siddiqui
Background:  Propofol has a favourable pharmacokinetic and pharmacodynamic profile making it the most commonly used intravenous induction agent for general anesthesia but adverse cardiovascular effects like hypotension and bradycardia are well-documented. Therefore, hemodynamic stability associated with etomidate makes it an ideal induction agent in patients with compromised cardiac reserves. Laryngoscopy and intubation elicits a noxious stimulus, leading to intense sympathetic activity. Various drugs have been tried to attenuate this response. Opioids are known to aid in maintaining proper depth of anaesthesia and attenuating the pressor response. Keeping this background in mind this study was designed to compare the efficacy of 2mcg/kg fentanyl with 0.2mg/kg nalbuphine in attenuating haemodynamic pressor response caused by laryngoscopy and intubation with etomidate induction. Aim and Objectives: Primary objective of this study is to compare change in mean heart rate and mean arterial pressure from baseline after laryngoscopy and intubation between both groups, secondary objectives is to compare safety profile of both the drugs. Material and Methods: This prospective randomized double blind study was conducted in a tertiary hospital associated with a medical college, 60 patients undergoing elective surgeries in general anaesthesia were randomly allocated to one of the two groups. Patients belonging to Group I were administered 2mcg/kg fentanyl in 10ml of normal saline whereas patients belonging to Group II were administered with 0.2mg/kg of nalbuphine in 10ml of normal saline, 150 seconds before injecting iv Etomidate 0.3mg/kg administered over 20 seconds, all vital parameters of the patients were recorded every minute for the first five minutes then  every 5 minutes till completion of the surgery. Students t test, chi square test were used as per the requirement and a P value of <0.05 was considered statistically significant. Result: Mean heart rate in group I at 1 minute was 87.3 bpm, at 2 minutes 79.4 bpm at 5 minutes 66.7 bpm, whereas in group II mean heart rate at 1 minute was 91.4 bpm, at 2 minutes 83.6 bpm, at 5 minutes 71.1 bpm. Mean arterial blood pressure in group I at 1 minute was 99.5 mmHg, at 2 minutes 93.8 mmHg, at 5 minutes 77.3 mmHg whereas mean arterial pressure in group II at 1 minute was 105.4 mmHg, at 2 minutes 98.9 mmHg, at 5 minutes  82.5 mmHg. Out of 60 patients 11 patients from group I developed minor side effects whereas in group II 5 patients developed such side effects. Conclusion: Both groups were comparable with respect to demographic characteristics. Compared to nalbuphine, fentanyl causes a significant reduction in hemodynamic pressor response due to laryngoscopy and intubation after induction of general anaesthesia using etomidate as induction agent. Whereas safety profile of both the drugs was observed to be comparable in our study.

26. The Determinants of Knowledge and Practices of Postnatal Mothers on Essential Newborn Care in a Selected Area of Bihar Region: A Community Based Study
Prabhas Kumar
Aim: To assess determinants of the knowledge and practices of postnatal mothers on essential newborn care. Material & Methods: A community based cross-sectional study was conducted among 200 postnatal mothers and neonates dyads in the one of the selected Primary Health Centers (PHC) of the Intensive Field Practice Area (IFPA) of the Comprehensive Rural Health Services Project (CRHSP). Birth register at every sub-center was referred for making a list of postnatal mothers delivered during the study period. Postnatal mothers were contacted by making home visits along with ASHA (Accredited Social Health Activists) workers and enrolled using convenience sampling techniques. Results: The mean knowledge scores of postnatal mothers on ENBC was 24.72 ± 6.60. More than half of postnatal mothers (67%) had moderate knowledge. The mean practice scores of postnatal mothers on ENBC was 23.71 ± 3.52. More than two-thirds of postnatal mothers had adequate practices. Conclusion: Some gaps were observed in the adopting safe practices in the domains of thermal control, breastfeeding, cord care and eye care among the postnatal mothers; necessitating need for education, reinforcement and dispelling the cultural beliefs.

27. To Assess the Adequacy of Knowledge to Prevent COVID-19 Pandemic: Cross-Sectional Descriptive Online Survey
Prabhas Kumar
Aim: To determine the level of knowledge towards COVID-19 among people. Material & Methods: A cross-sectional descriptive research design was used for the present study and was conducted among people attending Darbhanga Medical College, Darbhanga, Bihar, India, to assess their knowledge regarding COVID-19. A total of 461 people were recruited for this study and sample of 400 eligible people who fulfill the inclusion criteria were enrolled. Results: The association of socio-demographic variables of participants and their knowledge score. It shows that group (p>0.001), gender (p=0.020), education (p=0.001), marital status (p=0.001), age (p=0.020), and inhabitants (p=0.001) were significantly associated with knowledge. Majority of participants 63% having good knowledge while 33% and 1.4% having average and poor knowledge respectively regarding the corona virus pandemic. Conclusion: Study concluded that many people were still had average and poor knowledge on COVID-19. Higher authorities must find the ways for making people more aware on this pandemic to control its impact.

28. Comparative Evaluation of Oral Health Knowledge, Practices and Attitude of Pregnant and Non-Pregnant Women, and Their Awareness Regarding Adverse Pregnancy Outcomes
Lavanya Dharmana, Manish Kumar, Ankit Sharma, Kapil Karwasra
Background: Negative experiences for both mother and child during pregnancy are often referred to as “adverse pregnancy outcomes.” Preterm birth with a low birth weight (PLBW) and preeclampsia are two such outcomes. Even after controlling for other known risk factors, recent research reveals that periodontitis, a kind of gum disease, might increase the likelihood of a premature delivery. Objective: The purpose of this research was to examine pregnant women’s oral health-related beliefs and behaviors, as well as their understanding of the connection between poor dental health and negative birth outcomes. compare these factors with those of non-pregnant women, and assess whether pregnancy increased awareness of dental treatment. Methods: A validated questionnaire was administered to 400 pregnant and 400 non-pregnant women. The questionnaire included inquiries about personal information, oral hygiene knowledge, beliefs, customs, and awareness of the link between poor dental health and unfavorable childbirth outcomes. Statistical Analysis: Data analysis was conducted using SPSS for Windows (version 15.0; SPSS Inc., Chicago, IL, USA). Results: No statistically significant changes were found between the two groups on any of the measured factors, suggesting that the women did not learn anything new after they became pregnant. on 96% of women in both groups (p > 0.05) said that their gynecologists did not provide them with any information on the connection between dental health and pregnancy outcomes. In addition, 89.5% of women who were not pregnant did not have regular dental checkups, whereas 93.9% of pregnant women did not. (p > 0.05). Fewer than 4% of pregnant women knew that poor dental health was linked to negative birth outcomes. Conclusion: The findings of this study suggest that pregnancy had minimal impact on the future attitudes of women toward dental care. To enhance oral health care, it is crucial to provide pregnant women and the medical community with more knowledge and information.

29. Hollow Viscus Injuries in Abdominal Trauma: An Observational Clinical Study
Nihir Gupta, Anju Nagar, Dharmraj Meena, Anshul Meena, Juhi Singh, Radheyshyam Meena
Background: In today’s highly developed civilised society, trauma is thought to be the main factor contributing to morbidity and mortality. Methods: In the current study, 50 cases of abdominal trauma (including blunt and penetrating wounds) were examined over a 12-month period in our institute. Results: Males between the ages of 21 and 30 were most frequently impacted. Injury from a car accident is the most frequent type. 93% of patients experienced abdominal pain, and 86% report tenderness. An upright abdomen plain x-ray was effective at spotting hollow viscus damage. An ultrasound examination clearly showed free fluid and solid organ damage. Small bowel was the viscera that was most frequently injured in this study, and it was treated with straightforward anastomosis, resection, and closure of perforations. There were postoperative issues such wound infection, wound dehiscence, respiratory issues, pelvic abscess, and faecal fistula. Most of the patients in this study stayed between 11 and 20 days, with a mean of 15 days. In this trial, mortality was 4%. Conclusions: Young boys are most frequently impacted by traffic accidents. The prognosis for penetrating abdominal trauma is made worse by factors such as small bowel injury, long time between injury and operation, presence of shock at admission, and female gender.

30.  Observational Study on Non Rebreathing Mask Versus Additional Low Flow Oxygen Supplementation with Non Rebreathing Mask Versus HFNC in Improving Oxygenation with Limited Resources in Situation Like COVID-19 Pandemic
Nishtha Sharma, Chandra Shekhar Mishra, Irfan Ahmad Siddiqui, Mayank Karode, Alok Dubey
Background: A novel coronavirus (SARS-CoV-2) is responsible for rapidly evolving illness called as COVID-19.while most patients present with mild illness, but a few presented with severe respiratory crisis requiring hospitalization and ICU admission and thus need of devices like HFNC and ventilators increased. This lead to increased pressure on ICUs and shortage of devices like HFNC and ventilators. Thus we incorporate easy-to-perform techniques to improve oxygenation with limited resources. We used high-flow nasal cannula (HFNC), Non-rebreathing face masks and additional low flow oxygen therapy through nasal prongs (6 L/min) along with a non-rebreathing mask, which helped to minimize air entrainment and thereby increase FiO2. Aim: Aim of the study is to compare effective of non-rebreathing mask, additional low flow oxygen along with non-rebreathing mask and HFNC device in improving oxygenation parameters during respiratory crisis. Material and Methods: This study was conducted in a 40-beded ICU at Bhopal which is a tertiary care centre associated with medical college. We enrolled a total of 72 patients and divided into three groups ‘N’ (those receiving non rebreathing mask), ‘NL’ (those receiving additional low flow oxygen along with non-rebreathing face mask) and ‘H’ (those receiving HFNC device). Primary data was collected including age, sex, initial vitals and ABG at the time of admission. Repeat ABG was done after 6 hours to compare the oxygenation. The pre and post therapy ABGs were analysed by paired t test and the outcome of the three modalities was compared using unpaired t test. A ‘p-value ‘of less than 0.05 is taken statistically significant. Result: In our study we found that in group NL due to additional low flow oxygen with NRBM, PaO2 and SaO2 improved significantly with p values of 0.020 and 0.031 respectively. While comparing group NL and group H we found that PaO2 and SaO2 values improved significantly in group H with p value 0.001 and 0.001 respectively, thus proving that HFNC device is more efficient and standard treatment. Conclusion: NRBM alone was not much effective during respiratory crisis. An additional low flow with NRBM improved oxygenation but was not as effective as HFNC device, thus this assembly can be used in resource limited settings. HFNC device proved best during respiratory crisis and is established modality for the same.

31. Post-Operative Analgesic Requirement in Hypothyroid Patients Undergoing Laparoscopic Bariatric Surgery
Jaya Sinha, Irfan Ahmad Siddiqui, Renu Dhmanani, Srishti Jain
Introduction: Hypothyroidism is a common endocrine disorder with reduced thyroid hormone secretion. Patients with hypothyroidism may require increased doses of anesthesia and analgesia due to altered metabolism and reduced drug clearance. Laparoscopic bariatric surgery is a standard procedure for weight loss in morbidly obese patients. Post-operative pain management in these patients is important for effective recovery and reduced morbidity. Aim and Objectives: To assess the post-operative analgesic requirement in hypothyroid patients undergoing laparoscopic bariatric surgery. Materials and Methods: This was a prospective study of hypothyroid patients who underwent laparoscopic bariatric surgery between January 2015 and December 2020 at a tertiary care hospital. Patients were included if they had a confirmed diagnosis of hypothyroidism, were undergoing laparoscopic bariatric surgery, and received post-operative analgesia. Patients with other endocrine disorders or incomplete data were excluded. Demographic data, thyroid function tests, anesthesia type, and analgesic requirements were collected from medical records. The primary outcome was the total analgesic requirement during the first 24 hours after surgery. Results: A total of 105 hypothyroid patients were included in the study. The mean age was 37.8 years (SD = 9.5), and most were female (n = 87, 82.9%). The mean body mass index (BMI) was 44.6 kg/m2 (SD = 6.8). The most common type of anesthesia was general anesthesia with endotracheal intubation (n = 79, 75.2%). The mean total analgesic requirement during the first 24 hours after surgery was 20 mg pethidine equivalents (SD = 7.4). There was a no significant correlation between total analgesic requirement and age, BMI, or duration of surgery. Conclusion: Hypothyroidism significantly affects post-operative analgesic requirements in laparoscopic bariatric surgery patients. Further studies with larger sample sizes and randomized designs are needed to confirm these findings and investigate other factors affecting analgesic requirements in hypothyroid patients.

32. Spinal Anaesthesia for Trans-Urethral Resection of Prostate; A Comparative Study Between Hyperbaric Solutions of Levo-Bupivacaine and Ropivacaine in Patients Between Age Group of 50-70 Years
Irfan Ahmad Siddiqui, Lal Pravin Singh, Renu Dhamnani, Neelofar Shaikh
Introduction: Benign prostatic hyperplasia is very common in males in their 5th-7th decade of life. Old age is associated with various comorbidities including cardiopulmonary diseases. Spinal anesthesia induced by racemic bupivacaine further aggravates this problem increasing their susceptibility to hypotension and bradycardia, levobupivacaine is known for its safer hemodynamic profile and has a low incidence of cardiotoxicity and neurotoxicity in case of accidental intravascular administration, whereas ropivacaine is associated with short duration of action and aids in early mobilization. Intraoperative complications like shock, TURP syndrome and LAST are difficult to diagnose clinically therefore hemodynamic stability and prevention of LAST becomes a matter of utmost importance in trans urethral resection of prostate. Therefore, our study was structured for comparison of the sensory and motor block achieved with intrathecally administered 0.5% hyperbaric bupivacaine with 0.75% hyperbaric ropivacaine. Aim: The primary objective of our study was comparison of adequacy and duration of sensory and motor block achieved by intrathecal administration of hyperbaric levobupivacaine with hyperbaric ropivacaine. The secondary objective of our study was to compare the safety profile of both the drugs. Material and Methods: 60 consenting males belonging to ASA I and ASA II category aged between 50-70 years undergoing elective trans-urethral resection of prostate under spinal anaesthesia were selected, and randomly assigned to either, group L or group R by closed envelop method, patients belonging to group L were injected with 2.5 ml 0.5% heavy levobupivacaine whereas patients belonging to group R were injected with 2.5 ml 0.75% heavy ropivacaine. Patients were assed for onset and regression of levels of sensory block and motor block and the hemodynamic stability and side effects of both the drugs. Result: Both groups were comparable in terms of mean time to onset of the sensory block at T10, the extent of spread & time to achieve maximal sensory block. The regression of sensory block was observed to be more rapid in the ropivacaine group compared to levobupivacaine group, as observed in the findings of duration at T10 and the overall duration of sensory block. Patients belonging to ropivacaine group demonstrated a rapid recovery from motor block and were able to mobilize early compared to levobupivacaine group. A similar incidence of  side effects was observed in both groups. Conclusions: Intrathecal administration of hyperbaric ropivacaine provides adequate anaesthesia which lasts for a shorter duration compared to levobupivacaine which can be utilized in patients requiring early ambulation. Safety profile of both the drugs are observed to be comparable.

33. Relationship between Serum Vitamin D Levels and Simple Febrile Seizures in Children
Zahida Inkisar Khan
Background and Aim: A few studies have documented the occurrence of hypocalcaemia seizures caused by vitamin D deficiency in kids and vitamin deficiency rickets in kids with recurrent febrile seizures. In order to determine whether vitamin D levels and febrile seizures are related, researchers looked at vitamin D status in children aged 6 months to 5 years who had their first episode of a febrile seizure. Material and Methods: The current study is a case control analysis carried out in the paediatrics department in collaboration with the casualty and occupational therapy departments at the Dr. Kiran C. Patel Medical College and Research Institute, Bharuch, Gujarat. The inclusion criteria included fever-related seizures, brief episodes lasting less than 15 minutes, no subsequent seizures within 24 hours, a child who was otherwise neurologically healthy and free of any neurological abnormalities both before and after the seizure episode, and an age range of 6 months to 5 years. Each instance was compared to a control who had the same age as the patient, was the same sex, and experienced a brief fever but no seizures. The scientists classified the various levels of vitamin D deficiency using standards from the 2017 Indian Academy of Paediatrics guidelines. Results: A total of 150 patients and 150 controls were included in the investigation. Vitamin D levels and febrile seizures correlated significantly (p 0.01) and strongly. People with low vitamin D levels (12–20ng/ml) had a three times (OR=3.03) higher likelihood of having febrile seizures than those with normal vitamin D status, while those with low vitamin D levels (12ng/ml) had the highest risk. Conclusion: Among patients with uncomplicated febrile seizures, vitamin D deficiency was prevalent. Accordingly, it may be inferred from the current study that there is a connection between vitamin D deficit and uncomplicated febrile seizures, and that vitamin D insufficiency may even be a risk factor for such seizures.

34. Study of Spectrum of Various Histopathological Patterns in Specimens of Thyroid Surgeries: A Combined Prospective and Retrospective Study Design
Priya Sunda, Neha Mali, Surendra Prakash Vyas, Yogesh Kumar, Sharda Dawan
Introduction: Among all the endocrine disorders, thyroid gland disorders are commonest in India. Thyroid lesions may be developmental, inflammatory, hyperplastic and neoplastic. To es­tablish final diagnosis, histopathological evaluation is vital. Therefore the present study was conducted with the objective to analyse the histological spectrum of thyroid diseases, frequency of malignant lesions and their correlation with age and sex. Material and Methods: This study was a hospital based, both prospective and retrospective type of study. It was carried out at the Department of Pathology, Sardar Patel Medical College and Associated Group of Hospitals, Bikaner for a period of five years between August 2017 and December 2022. Patients of all age groups, all kind of thyroid biopsies and thyroidectomy specimens were included in this study. Results: Out of total of 232 cases, non-neoplastic lesions were 173(75%) and neoplastic were 59(25%). Female:Male ratio was 7.28:1. Age range was 4 to 76 years with mean age of 39.21+14.29 years. Among non-neoplastic lesions, colloid goiter cases were highest(37%). Follicular adenoma (n=28) was commonest in benign and Papillary carcinoma was highest (n=15) in malignant category. Conclusion: Non-neoplastic lesions were 3 times of neoplastic lesions. Females were affected more. Most common affected age group was 31-40 years (26.29%). Colloid goiter was commonest in non-neoplastic lesions. Follicular adenoma was commonest in benign tumours and Papillary carcinoma was commonest in malignancies. All type of lesios were predominantly found in females.

35. A Study on the Impact of Supplemental Bicarbonate on the Development of Chronic Kidney Disease
Sanjay Parashar, Akshat Pathak, Hemlata Gupta, Sachin Singh Yadav
Background: One of the major public health issues, chronic kidney disease (CKD) is characterized by structural and functional abnormalities around the kidney. Objectives: To analyze the effect of oral supplementation of bicarbonate on the progression of CKD. Methods: It was a double blinded Randomized controlled trial conducted at Tertiary care centre. Patients with CKD who were visiting hospital were considered as the study subjects. A total of 60 patients participated in the study. Patients were randomly grouped into two groups through block randomization. The first group of patients received oral sodium bicarbonate, whereas the second group of patients was on standard therapy without oral sodium bicarbonate supplementation. SPSS was used for analysis. Results: Group 1 consisted of 31 subjects, out of which 18 (69.7%) were males and 13 (30.3%) were females. Group 2 included 29 patients, of which 16 (73.53%) were males and 13 (26.47%) were females. Among the causes for CKD, hypertension was the most common cause followed by diabetes seen in almost 50% of cases. The mean weight of groups 1 and 2 was 58.12 and 61.96 kg, respectively, whereas the mean height of groups 1 and 2 was 161.70 and 161.82 cm, respectively. The mean bicarbonate levels of groups 1 and 2 patients were 16.62 and 16.84 mEq/L, respectively. After 6 months, the bicarbonate level of group 1 significantly increased to 18.02 mEq/L, which was further increased to 19.77 mEq/L after 9 months (p<0.05). The baseline eGFR values in group 1 and 2 subjects were 22.39 and 21.20 mL/min/1.73 m2, respectively. The difference between these values was not significant (P = 0.31). Similarly, no significant difference was observed in group 1 after 6 and 9 months. Conclusion: Oral bicarbonate supplementation raised the participants’ serum bicarbonate levels. Additionally, oral supplementation caused patients’ serum albumin levels to rise and their GFR to remain constant having CKD.

36. Comparative Levels of Urinary Prostate‑specific Antigen and Microseminoprotein‑beta in Men with and without Prostate Cancer
Sanjay Parashar, Akshat Pathak, Hemlata Gupta, Sachin Singh Yadav
Introduction: The role of urinary proteomics in the diagnosis of prostate cancer (PCa) is undefined. Levels of urinary biomarkers such as prostate‑specific antigen (PSA) and microseminoprotein‑beta (MSMB) may differ between men with and without PCa. Objective: We tested this hypothesis using urine samples before and after digital rectal examination (DRE) in men with an indication for prostate biopsy. Materials and Methods: This prospective cohort study was done in Department of Urology, GRMC, Gwalior and approved by the institutional ethics committee and all individuals provided informed consent for inclusion. Men scheduled to undergo transrectal ultrasound (TRUS)‑guided biopsy of the prostate for suspicion of PCa due to either elevated PSA (>4 ng/mL) or a nodule on DRE were recruited. A sterile urine culture was confirmed before inclusion. Results: Seventy‑seven patients were recruited of whom 32 had PCa (Group A) and 45 had no cancer (Group B) on biopsy. The median (interquartile range) serum PSA was 49.6 (0.2–254) ng/ml. The median urine PSA (29.5 vs. 26.4 mg/dl) and MSMB (1.7 vs. 2.4 mg/dl) were similar in both groups at baseline. However, post‑DRE, both these metabolites rose in Group B but not in Group A, resulting in significantly higher post‑to‑pre values in Group B versus Group A. The post‑DRE urine PSA/MSMB ratio was also significantly different between the groups. Conclusions: Urinary PSA and MSMB rose significantly after DRE only in men without PCa. Post‑DRE urine PSA, MSMB, and PSA/MSMB ratio can differentiate PCa from benign pathology in men with an indication for prostate biopsy.

37. A Comparative Study of Tubeless Percutaneous Nephrolithotomy with Standard Percutaneous Nephrolithotomy
Sanjay Parashar, Akshat Pathak, Hemlata Gupta, Sachin Singh Yadav
Introduction and Objective: To assess the efficacy, safety and morbidity of tubeless percutaneous nephrolithotomy.  Materials and Methods: From June 2022 to March 2023, 69 patients (71 renal units; group 1) fulfilling the following criteria were included in the study for tubeless PCNL under Department of Urology, GRMC, Gwalior. One hundred and fifty-two patients with renal and upper ureteric calculi were included in this study. Sixty-nine patients (71 renal units; group 1) in whom no nephrostomy tube was placed at the conclusion of the procedure was compared with a similar control group of 83 patients (group 2) in whom a nephrostomy tube was placed. Operating time, blood loss, analgesia requirement, puncture site urinary leakage, hospital stay and mean convalescence period were compared in both groups. Results: Both groups were similar with respect to age, sex distribution and stone size. Operating time and blood loss were less in group 1 although they did not reach statistical significance. The mean analgesic requirement, puncture site urinary leakage and hospital stay were significantly less in group 1.  Conclusion: Tubeless percutaneous nephrolithotomy is a safe and effective procedure in this selected group of patients.

38. Determine the Infectious Skin Disorders Encountered in Children Attending LBKMCH Saharsa Bihar: A Retrospective Study
Sudhir Kumar Shreevastav
Aim: To determine the infectious Skin Disorders Encountered in Children Attending LBKMCH in Bihar region. Methods: This retrospective study was done the Department of skin & V D for one year. 250 children aged less than 18 years were included in this study. Diagnosis of skin diseases in the clinic were made by trained dermatologists. The diagnoses were mainly clinical but laboratory confirmation was done where necessary. The infectious skin diseases diagnosed were categorized into bacterial, fungal, viral disorders and infestations. Results: A total of 250 children aged less than 18 years were seen in the Dermatology clinic over the 1 year period. The mean age of children with ISDs was 8.12±6.3 years with a male to female ratio of 1.22:1. ISDs were diagnosed in 100 (40%) of these children. Types of ISDs Fungal skin infections were seen in 45 (45%) patients. Parasitic skin infections were diagnosed in 30 (30%) patients. Viral and Bacterial skin infections were observed in 15 (15%) and 10 (10%) children respectively. The most frequent ISDs according to a etiologic group were: Scabies in 30 (30%), Verruca Vulgaris in 12 (12%), Tinea corporis in 12(12%) and Impetigo in 5 (5%). 3.1.7 Relationship of age and gender occurrence of ISDs Age and Gender showed no significant association with the occurrence of skin diseases. Conclusion: ISDs are common in children with a prevalence of 40%. Scabies was the leading   ISDs in our study. Age and gender showed no significant association with the occurrence of ISDs among the children studied.

39. Major Infections in Children with Nephrotic Syndrome
Sandeep Dankhade
Background: The illness itself and the usage of different immunosuppressive medications put children with nephrotic syndrome at higher risk of infection. Most often, infections cause relapses that necessitate hospitalization and raise the risk of morbidity and death. Children with nephrotic syndrome (NS) have a high morbidity and mortality rate due to infections. The types of infections that are reported vary greatly, and little research has been done on how therapy or patient characteristics affect the risk of infection. In light of this context, our goal was to investigate the prevalence and pattern of infections in kids with nephrotic syndrome. Children with nephrotic syndrome continue to have significant rates of morbidity and mortality due to infections. It may also be the cause of a poor response to steroid medication and the beginning of disease or relapses. Aim: This study was conducted to determine the frequency and type of major infections in children with nephrotic syndrome. Material and Method: The Department of Pediatrics carried out this descriptive cross-sectional investigation. Included were all children between the ages of 2 and 12 who met the requirements of the Study of Kidney Disease in Children (ISKDC) definition for nephrotic syndrome, whether or not they had an infection. This included all relapse cases who were admitted to the hospital’s pediatric ward during the study period. Children with urogenital abnormalities or acute or chronic renal insufficiency were not included. Ninety kids were eligible for the study during this time, but ten of them either ran away from the hospital or refused to agree to participate. As a result, the study comprised 80 kids in all. We began enrolling individuals in the current trial after receiving signed informed permission. Patients who wished to participate in the trial or their guardians gave written, informed consent. Results: Among 80 study cases, 60% of cases were in the 2-5 year age group, and the rest were in the 5-12 year age group. The ratio of males and females was 0.95:1. The patients were divided into two thirds rural residents. The majority of the kids (63%) came from a middle-class socioeconomic background. Out of the 90 instances that were examined, 27% of the cases were the result of relapses, and 73% of the children were admitted because they had experienced an initial bout of nephrotic syndrome. When children with infection and non-infection cases are compared, the children with infection have lower rates of hematuria (20% vs 27%), pus cells (40% vs 60%), lymphocytes (43% vs 46%), and erythrocyte sedimentation rate (ESR) (40% vs. 51%), white blood cell (WBC) counts (51% vs. 47%), and neutrophil counts (91% vs. 29%). Only the elevated neutrophil count was Noticeably Higher, Though. Conclusion:  Children with NS frequently get infections; the most common illnesses are peritonitis, pneumonia, UTIs, and diarrhea. When compared to nephrotic children who do not have an infection, the length of hospital stay in these children is much longer when an infection occurs. We recommend broader pneumococcal vaccine coverage in such children, given the burden of pneumococcal infection in our study. In conclusion, serious infections are still a significant risk factor for children with nephrotic syndrome, particularly during relapses. Children with nephrotic syndrome who have these infections should be treated with consideration for drug-resistant organisms.

40. A Study on Incidence of Ventilator-Associated Pneumonia Causing Bacteria with Drug Resistance among the Diabetes and Non Diabetes
B. Nirmala Grace, K Lakshmanarao, KSR Krishna Sai, M.Rama Rao, T Jaya Chandra
Introduction: Pneumonia in the lung parenchyma among the patients after 48 – 72 hours after invasive mechanical ventilation is termed as ventilator-associated pneumonia (VAP) A study was conducted to find the various bacteria responsible for VAP and comparison of antimicrobial susceptibility among the diabetes and non diabetes individuals. Methods: It was a prospective research conducted in the department of Microbiology, GSL Medical College, Rajahmundry. Study protocol was approved by the institutional ethics committee. Study was conducted between February to December 2022. Individuals of both gender, >18 years, those on ventilator support were included in this study. Sputum sample, broncho alveolar lavage (BAL) venous blood specimen was collected. Specimen culture and sensitivity and HbA1c technique was used for glucose estimation. Bacterial identification and AST were studied as per the standard guidelines. Chi square test was used for the statistical analysis and P<0.05 was considered statistically significant. Results:  VAP was detected in 52 (100%) members, statistically there was no significant difference in DM and non DM individuals with VAP. Pseudomonas aeruginosa (40.4%) was the leading pathogen that cause VAP followed by Staphylococcus aureus (29%). More drug resistance (DR) was detected in DM individuals. Conclusion: VAP along with DR was common among the DM individuals. Improved care may be required for better outcome.

41. A Study of Tropical Febrile Illness’s Clinical Profile and Reaction to Acute Kidney Damage
Ashish Bhansali
Background: One of the leading causes of morbidity in the community is Tropical Acute Febrile Illness (TAFI). A significant consequence is Acute Kidney Injury (AKI) from both infectious and non-infectious causes. One of the main causes of death for TAFI patients is the existence of AKI. In tropical nations like India, acute febrile fever ranks among the leading causes of morbidity and mortality. Fever-related acute kidney damage (AKI) is a common, potentially fatal consequence that also increases morbidity and death. Prerenal and intrarenal factors account for the majority of acute kidney injury in cases of tropical diseases. The rising occurrence of tropical infections linked to thrombocytopenia, which raises the risk of acute kidney injury, may be caused by the growth of risk factors such as migration, urbanization, international travel, and global warming. Aim: The aim of the study was to Study the Clinical Profile and Outcome of Acute Kidney Injury in Acute Febrile Illness. Material and Method: This cross-sectional observational study was conducted in the General Medicine department. We assessed thirty patients with acute renal injury who also had acute febrile sickness and thrombocytopenia, and we tracked their progress until they were discharged. The inclusion and exclusion criteria were used to choose patients for the observational trial who had a history of acute febrile illness at the time of admission. Acute kidney injury patients had extensive study and were monitored till they were discharged or passed away. Thorough medical history at the time of admission on the length of the fever and any accompanying symptoms, such as nausea, vomiting, chest discomfort, dyspnea, and decreased urine production. The next step was a thorough physical examination to check for petechiae or purpura in the event of bleeding manifestation brought on by low platelet count, and eschar in the case of scrub typhus. Results: After applying inclusion and exclusion criteria, 104 individuals were admitted with acute febrile illness during the study period. Thirty of them experienced AKI at some point throughout their illness. These thirty cases underwent extensive research. About 12.5% of cases of acute febrile fever also have acute renal damage. Of these, four had dialysis, and the other twenty-six were treated conservatively. Of those, the dengue virus is responsible for about 14 cases. Yet among individuals who test positive for dengue, dengue AKI makes up a smaller percentage of AKI. Conclusion:  In the study population, the incidence of AKI is approximately 14%. AKI is more prevalent in older age groups and in men. The most frequent cause of acute renal damage is malaria. A significant epidemic outbreak of dengue fever has occurred recently. Acute renal damage is increasingly being caused by dengue infection. In the event that AFI is not identified and treated as soon as feasible, the death rate is significant. In individuals with AFI, multiorgan dysfunction is the cause of death. The rising trend of mixed infections is challenging to both diagnose and treat. The single most effective life-saving intervention is awareness of probable renal problems and the prevention and treatment of them when necessary.

42. A Prospective Research on Various Bacteria from Surgical Site Infection and Drug Susceptibility Pattern
N Durga Prasad, Kamadi Ramarao
Introduction: Surgical site infections (SSIs) are a significant healthcare challenge, driven by diverse bacterial species with varying resistance profiles. This prospective study aims to characterize the microbial landscape of SSIs using advanced sequencing and susceptibility testing methods, informing evidence-based strategies for better management and prevention, thus improving patient outcomes. Methods: This prospective study included individuals >18 years of both genders with SSIs. Clinical data including surgical site, pus type, and socioeconomic status were recorded. Swabs were collected, transported in BHI broth, cultured, and identified using standard methods. Antibiotic sensitivity was determined by disk diffusion on MHA. Blood samples were collected following universal guidelines for DM analysis. Results: Infection rate was 65.4%; 43 were diabetic, showing significant difference. Male-to-female ratio was 1.4; most were aged 41-50, mean age 45.76. Majority (50.1%) had low socioeconomic status. Of 93 bacteria isolated, Staphylococcus aureus (38) and Klebsiella pneumoniae (24) predominated. No significant drug resistance was observed. Conclusion: This study underscores the complex interplay of diabetes mellitus, gender, age, socioeconomic status, and microbial pathogens in surgical site infections. Addressing these factors is crucial for tailored preventive strategies. Encouragingly, current antimicrobial stewardship practices appear effective in managing antibiotic resistance, but ongoing surveillance is imperative.

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