International Journal of

Toxicological and Pharmacological Research

e-ISSN: 0975 5160

p-ISSN: 2820-2651

Peer Review Journal

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1. Assessment of Serum Interleukin-6 (IL -6) Levels and Its Role in Severity of Psoriasis A Hospital Based Case Control Study in M.Y. Hospital, Indore M.P.
Kapil Raghuwanshi, Swapnesh Sagar, Sharad Manore, Bhavana Tiwari
Abstract
Introduction: Psoriasis is a chronic immuno-inflammatory proliferative skin disease. It is characterized by excessive proliferation of epidermal cells, impaired function of epidermal barrier at the sites of skin lesions and infiltration of skin by activated inflammatory cells. Interleukin 6 (IL-6), a major mediator of the host response to tissue injury and infection, is produced by both epidermal cells and leukocytes in culture. Since immune and inflammatory factors play an important role in the pathogenesis of psoriasis, we aimed to assess the relationship between the serum levels of IL-6 and pathogenesis and severity of psoriasis. Material and Methods: This cross sectional study included 50 Confirmed & diagnosed cases of psoriasis patients (case group) and 50 age and gender matched healthy subjects (control group). Serum IL-6 levels were measured for both the groups. Results: In our study the mean serum IL-6 in case group was higher 6.97 ± 5.43 pg/ml than in control group it was 2.22 ± 2.10 pg/ml thus, serum IL-6 level might be useful for evaluating the disease activity of psoriasis as Novel biomarker. Conclusion: As Interleukin-6 (IL-6) is an important sensitive, diagnostic and prognostic marker in many systemic inflammatory diseases, its detection and serial measurements helps to provide a novel link to evaluate the disease activity, severity and response to treatment in psoriasis.

2. Evaluation of the Effect of Niacin in Chronic Unpredictable Stress Induced Depression in Wistar Rats
Avi A. Sharma, Shirish S. Joshi, Yashoda R. Aithal, Yashoda R. Aithal
Abstract
Everyday functioning is impacted by the common mood disorder known as depression. In addition to the limitations of first-line treatment for depression, it is believed to be ineffective in causing remission of depression. As a result, finding novel targets for the therapy is necessary. One potential new target is brain derived neurotrophic factor (BDNF). Niacin was found to increase the BDNF level in several preclinical study. Present study was designed to validate the efficacy of Niacin as an anti-depressant in chronic unpredictable mild stress (CUMS) model in male Wistar rats with behavioral and biochemical parameters. After obtaining approval from ethics committee, the standardization was carried out. 24 male Wistar rats at random were placed into 3 groups of 8 animals each: Normal saline, Fluoxetine, and Niacin, administered per orally, on each day. Depression was induced by CUMS for 28 days. On the 29th day, behavioural tests were undertaken followed by estimation of serum BDNF via ELISA. Results highlighted a significant difference in Forced swim test and sucrose preference test with the Niacin group and Fluoxetine compared to VC (p<0.001). Results in BDNF- ELISA were significantly higher than those in VC. However, no significant difference was observed between the Fluoxetine and niacin groups (p>0.05), signifying the comparable results. Niacin has been shown to have anti-depressive effects evidenced by behavioral tests and the ability to alter BDNF levels.

3. Occurrence of Non Fermenting Gram Negative Bacilli and their Antibiotic Susceptibility patterns among clinical isolates: Special reference to Beta-lactamase production
Roopashree S, Kaup S, Latharoy S
Abstract
Introduction: Non-fermenting Gram Negative Bacilli (NFGNB) including Pseudomonas aeruginosa and Acinetobacter baumannii are one of the leading causes of Health Care Associated Infections & pose a serious challenge in treatment especially in Intensive care units. Resistance to antimicrobial agents in these bacteria has become an increasingly relevant problem in present scenario. With the increase in the incidence of Multidrug resistant organisms (MDROs) among NFGNB there are only limited options available. Methods: 100 consecutive samples of NFGNB isolated from various clinical samples were included in the study. Identification & Antimicrobial Susceptibility patterns of NFGNB were performed according to Standard conventional methods. Phenotypic detection of various Beta-lacatamases like ESBL, AmpC & Carbapenemase were performed according to Clinical Laboratory Standards Institute (CLSI) guidelines. Results: Out of 100 consecutive NFGNB isolates Pseudomonas aeruginosa (66%), Acinetobacter baumannii complex (12%) & Other NFGNB (22%) were isolated. Cefipime was found to be the most effective antibiotic with 74% of the isolates being sensitive while Ciprofloxacin was found to be least effective with only 56% of the isolates being sensitive. 34% of isolates showed Multidrug Resistance. Out of 100 NFGNB isolated 96% isolates were AmpC producers, 40% isolates produced ESBL & 4% were Carbapenemase producers. Conclusion: Pseudomonas aeruginosa is the most common NFGNB isolated from Clinical samples causing Healthcare Associated Infections. Multidrug Resistant organisms of NFGNB producing significant amount of Beta-lactamases are an issue of concern for clinicians. Strict Infection Prevention & control measures along with effective Antimicrobial Stewardship Programme in a healthcare set up is the need of the moment.

4. Effect of Pre-Treatment with Rocuronium on Serum Potassium, Post-Succinylcholine Fasciculations, and Myalgia Postoperatively
Ashwini Kumar Patel, Bharti Badlani, Ajay Singh, Kapil Raghuwanshi
Abstract
Background: The best drug for endotracheal intubation is succinylcholine, which has a rapid onset, an extremely brief duration of action, and complete predictable paralysis. However, muscle fasciculations, postoperative myalgia, an increase in serum potassium level, and myoglobinuria can occur and limit the drug’s use in conditions like full stomachs, burns, significant trauma, metabolic acidosis, and a few myopathies. Numerous medications have been researched with the purpose of attenuating these effects; however pre-treatment with a non-depolarizing muscle relaxant has proven to be effective. Aims and Objective: The purpose of this study was to evaluate the impact of pre-treatment with rocuronium on post-succinylcholine fasciculations, an increase in serum potassium levels, and postoperative myalgia. Material and Methods: 100 patients (20–50 years old, either sex; ASA grades I and II) having general anaesthesia for different surgical operations were divided into two groups at random, one for pre-treatment using rocuronium (Group R), and the other for pre-treatment with saline (Group P), before succinylcholine injection. On postoperative days 1, 2, and 3 following succinylcholine injection, the intensity of fasciculations, an increase in potassium levels in the blood after 5 minutes, and myalgia were noted. Results: In Group R, 74% of patients had no fasciculation, compared to 36% in Group P. Both groups experienced an increase in blood potassium levels that was statistically insignificant (p>0.05). On postoperative days 2 and 3, a greater proportion of patients in the placebo group experienced mild to severe myalgia. Conclusion: With a statistically non-significant elevation in serum potassium levels, pre-treatment with rocuronium before succinylcholine resulted in greater attenuation of post-succinylcholine muscular fasciculations and postoperative myalgia.

5. A Study on Safety and Efficacy of Haemorrhoidectomy (Milligan Morgan Vs Stapler Haemorrhoidopexy)
Naresh Kumar, Devender, Gopi Sandeep Raj
Abstract
Background: There are various surgical and non-surgical treatment options available for managing hemorrhoids. The conventional open method is widely embraced by many surgeons, while the Minimally Invasive Procedure for Hemorrhoids (MIPH), also known as Stapled Hemorrhoidectomy, represents a recent advancement in hemorrhoid management. The objective of this study is to compare the technical aspects, functional outcomes, and overall effectiveness of two surgical modalities for treating hemorrhoids: Open Hemorrhoidectomy and MIPH (Stapled Hemorrhoidectomy). Methods: A prospective randomized study was carried out at Gandhi Medical College & Hospital, Secunderabad involving a total of n=50 patients. Hospitalization was provided for patients diagnosed with 3rd and 4th-degree hemorrhoids. Comprehensive routine investigations were conducted and evaluated as necessary. The cases were thoroughly examined and closely monitored based on both subjective and objective criteria throughout the study period. Results: The average duration of open hemorrhoidectomy was 46.5 ± 10.5 minutes, whereas it was 38. 0± 5.5 minutes for MIPH (Stapled Hemorrhoidectomy). For MIPH, the initial cases had a duration of approximately 68.9 ± 12.5 minutes. The majority of patients in the MIPH group experienced mild pain (60%), which improved with the administration of analgesics alone. In contrast, 24% of patients in the open hemorrhoidectomy group reported mild pain. The open hemorrhoidectomy group had a higher percentage of patients (48%) who complained of moderate pain, requiring continuous analgesic treatment. Conclusion: Stapler hemorrhoidectomy demonstrates effectiveness in various aspects, including reduced blood loss during both the perioperative and postoperative periods, minimal pain, decreased need for analgesics, reduced pain during the first bowel movement, accelerated wound healing, faster recovery after surgery, shorter hospital stays with an earlier resumption of normal activities.

6. Study of Clinical Profile of Hair Dye Poisoning in A Tertiary Care Teaching Hospital
S. Rajagopal, R. Pandichelvan
Abstract
Introduction: Hair dye poisoning or ingestion was relatively rare in our setting until the last decade, but is now emerging as one of the most important cause of self-harm. PPD is an allergen which causes angioedema with labial, oral, lingual, pharyngeal and laryngeal edema which leads to acute airway compromise threatening the patient’s life within a few hours of ingestion. This study was done as an attempt to study the clinical profile of the patients admitted with ingestional hair dye poisoning in Tirunelveli Medical College and Hospital. Methodology: This study was done in cases admitted in our hospital with ingestional hair dye poisoning and done as a prospective cross sectional observation study. A total of 76 patients admitted with hair dye poisoning in the study period, 68 patients are included in the study. . Previously designed proforma was used to collect the demographic and clinical details of the patient. Results: In our study cervicofacial edema was present in about 47% of the patients. Elevatedure a level was found in 37 out of 68 patients. of 68 patients in our study only about 52% had elevated potassium value.In our study 28 out of 68 patients who had one of the above mentioned features were given forced alkaline diuresis. Out of 32 patients who had edema of the face, neck, tongue, pharynx etc., only 22 patients required tracheostomy. Hemodialysis was required in 5 out of 29 patients who had elevated renal parameters. Conclusion: Hair dye poisoning is an emerging cause of self-harm among people in our region and is well poised to overtake the traditional modes of poisoning and can become one of the leading cause of suicides in our part of the world. Due to absence of antidote it is important to recognize this condition earlier and to start supportive therapy as early as possible to ensure a good outcome. In the primary care setup itself, attempts should be made to prevent future damage by means of instituting steroids and liberal fluid therapy before referring the patients to a higher centre. Thus the knowledge about this condition should be known by all primary care physicians in our country.

7. A Comparative Study of Electrocardiographic and Echocardiographic Evidence of Left Ventricular Hypertrophy
R. Pandichelvan, S. Rajagopal
Abstract
Introduction: Everyday functioning is impacted by the common mood disorder known as depression. In addition to the limitations of first-line treatment for depression, it is believed to be ineffective in causing remission of depression. As a result, finding novel targets for the therapy is necessary. One potential new target is brain derived neurotrophic factor (BDNF). Niacin was found to increase the BDNF level in several preclinical study. Present study was designed to validate the efficacy of Niacin as an anti-depressant in chronic unpredictable mild stress (CUMS) model in male Wistar rats with behavioral and biochemical parameters. After obtaining approval from ethics committee, the standardization was carried out. 24 male Wistar rats at random were placed into 3 groups of 8 animals each: Normal saline, Fluoxetine, and Niacin, administered per orally, on each day. Depression was induced by CUMS for 28 days. On the 29th day, behavioural tests were undertaken followed by estimation of serum BDNF via ELISA. Results highlighted a significant difference in Forced swim test and sucrose preference test with the Niacin group and Fluoxetine compared to VC (p<0.001). Results in BDNF- ELISA were significantly higher than those in VC. However, no significant difference was observed between the Fluoxetine and niacin groups (p>0.05), signifying the comparable results. Niacin has shown to have anti-depressive effects evidenced by behavioral tests and the ability to alter BDNF levels.

8. Evaluation of Amaranthus spinosus Leaf Aqueous Extract Anti-Diabetic Activity in Streptozotocin-Induced Diabetic Rats
Siripuram Sandhya Rani, K. Rani, Ravindra S. Beedimani, K. Anantha Babu
Abstract
All across the world, especially in nations where access to the traditional treatment of diabetes mellitus is insufficient, plants and their bioactive elements are used to treat diabetes mellitus. The hypoglycemic properties of Amaranthusspinosus have been the subject of numerous reports. The goal of the current investigation was to determine whether Amaranthusspinosus leaf extract alone or in conjunction with the oral hypoglycemic medication glibenclamide had any anti-diabetic effects on STZ-induced diabetic rat models. For the purpose of inducing diabetes in albino rats weighing 180–200g, STZ (50 mg/kg, I.P.) was utilised. The fasted diabetic rats were divided in to 5 groups of 6 animals each. Group I Normal control received distilled water 5 ml/kg body weight orally daily, Group II were treated with STZ 50mg/kg body weight induced diabetic rats were served as diabetic control, Group III i.e STZ induced diabetic rats were served as standard group and were treated with Glibenclamide at a dose of 0.5 mg/kg body weight orally daily. Group IV &Group V Amaranthusspinosus leaves extract was administered with 200mg/kg and 400mg/kg dose orally. This study was conducted over a period of 15 days with oral administration of drugs and the plant extract which was started on the 6th day of STZ treatment. The fasting blood glucose levels were determined on day 0, 5th, 10th, and 15th day by using glucometer. The ANOVA statistical test was used to analyse the data, and then the Dunnett’s multiple comparison test. In STZ-induced diabetic rats fed with the aqueous extract of Amaranthusspinosus, all the test groups displayed significantly (P 0.001) reduced fasting blood glucose levels. However, the blood glucose level was significantly (P 0.001) decreased. The presence of flavonoids, tannins, steroids, and trepenoids in Amaranthusspinosusis thought to be responsible for its strong hypoglycemic activity.

9. Effectiveness of Tetracycline Fibers and Chlorhexidine Chip as Local Drug Delivery in Nonsurgical Management of Chronic Periodontitis
Babita Sahu, Khileshwari Belodhiya, Deepa Rayast, Arpana Verma, Shristi Sharan, Smriti Soni, Bhupendra Gathe
Abstract
Background: Periodontal disease is inflammatory disease which causes destruction of the tissues that affects supporting tissue of tooth in its socket occurs. Mechanical treatment scaling and root planing disrupts the subgingival pathogens and provide clean and biologically smooth compatible root surface. Local drug delivery was investigated to find out limitations of conventional therapy. Local drug delivery is treatment of choice to deliver antibacterials to the site of infection (periodontal pocket). Aim: Comparison of effectiveness of tetracycline fibres and chlorhexidine chip as local drug delivery in non-surgical management of chronic periodontitis. Materials and Methods: In this study 20 patients of age 25-55 years of age were included. In each patient 3 sites with 5-8mm periodontal pocket had been taken. The whole study is divided into 3 groups: Group a (SRP alone) and Group b (SRP + tetracycline fibres) Group c (SRP+ Chlorhexidine chip). Plaque index, Gingival index, Sulcular bleeding index, Probing depth (PD) and Relative Attachment Level (RAL) were assessed at baseline before scaling and root planing, at 1 month & 3 month after SRP. Result: Chlorhexidine chip as an adjunct to SRP showed greater improvement in respect to decreased probing depth and gain in clinical attachment level as well as significant improvement in plaque index, gingival index, sulcular bleeding index from baseline to 3 months in comparison to tetracycline fibers as an adjuct to SRP.

10. The Study Microalbuminuria in Chronic Obstructive Pulmonary Disease: A Tertiary Care Experience
P. Ravi, Divya Sree Lavudya, Muduganti Radhika, P. Radhika
Abstract
Background: Microalbuminuria is utilized as an indicator of endothelial dysfunction and has been identified as a predictor of overall mortality and cardiovascular events. Recent research on COPD management has placed greater emphasis on comorbidities, particularly cardiovascular events. This study aimed to examine the occurrence of microalbuminuria and its correlation with physiological and clinical characteristics in a group of subjects classified according to the updated version of the Global Initiative for Chronic Obstructive Lung Disease stages. Methods: Consecutive patients diagnosed with COPD (diagnosis of COPD conformed to Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. The presence of microalbuminuria was defined as a UACR ranging between 20 mg/g in men and 30 mg/g in women, with an upper threshold of 299 mg/g for both sexes. Results: In the study population, subjects with less than 30% predicted FEV1 showed a higher prevalence of microalbuminuria (88.46%) compared to subjects with 30 to 50% predicted FEV1 (73.33%) and 50 to 80% predicted FEV1 (75%). The distribution of microalbuminuria among the different levels of Gold staging was found to have a statistically significant difference (p < 0.05). Conclusion: Within the limitations of the current study, it can be concluded that Microalbuminuria shows a significant association with various factors including age, BMI, Smoking Index, Gold severity staging, and acute exacerbations. However, gender does not demonstrate a significant association with microalbuminuria. After therapeutic intervention, there is no significant change in microalbuminuria, at follow-up.

11. Surgical Site Infection in Abdominal Wall Surgeries
Bhanu Pratap Rana, Aaryan Kanwarinder Singh, Vishal Shammi, Shikha Raghav
Abstract
Background: Even in hospitals with the most up-to-date equipment and established pre-operative preparation and antibiotic prophylaxis protocols, surgical site infections (SSI) continue to be a serious issue. SSI are to blame for the rising cost, morbidity, and mortality associated with surgical procedures. The purpose of this study was to ascertain the prevalence of SSI following abdominal procedures and to identify the risk variables that contribute to the development of SSI. Settings and Design: Patients who had abdominal surgeries in the departments of General Surgery and were included in this Descriptive Cross sectional study. Materials and Methods: The study included, all surgeries involving abdominal wall opening.
Depending on the level of intraoperative contamination, wound classes were classified as clean, clean contaminated, contaminated, and unclean. Along with the patient’s demographic information, data was gathered on the timing of antimicrobial prophylaxis, surgical wound infections, types of surgeries (emergency and elective surgeries), and wound classes were noted. Results: 13.7% of surgical wounds were infected overall. Compared to elective surgery (7.6%), the infection rate was higher with emergency surgery (25.2%). As the risk index score grew from 0 to 3, the rate of surgical site infection rose. SSI was less common with early surgical and postsurgical prophylaxis. The frequency of wound infections and the timing of prophylaxis showed a clear link. Analytical Statistics: The chi-square test was used, with a 5% level of significance. Conclusion: Wound infection is greatly predisposed by a pre-existing medical condition, extended operating time, the wound class, emergency surgeries, and wound contamination. For a variety of surgical procedures, antimicrobial prophylaxis is beneficial in lowering the incidence of post-operative wound infections, although timing of treatment is crucial.

12. Blunt Abdominal Trauma: Evaluation, Management and Outcome
Adil Shamim, PP Sharma, Sumit Kumar, Deependra Dubey
Abstract
Even though there has been improvement in the recognition, diagnosis, and therapy of blunt abdominal trauma (BAT), it is still a common emergency that is associated with high morbidity and death. With a 16% worldwide burden, trauma is the second-leading cause of disease. The World Health Organisation predicts that by 2020, trauma would rank first or second globally in terms of the number of years of productive life lost. In this study, 100 instances of BAT will be evaluated, with an emphasis on early identification and treatment, increased use of non-operative care, and patient presentation time. The mechanism of trauma, treatment options, and outcomes were some of the study’s topics. Male: female ratio of our study participants was 3.7:1, with the bulk of them between the ages of 21 and 30. Injury from a car accident is the most common cause (39%) of injury. Spleen and liver damage were the two organs most frequently impacted (33 and 30 percent, respectively), and splenectomy was the most frequently done treatment. Rib fractures represented 15% of other abdominal injuries. 2% of persons passed away. Sepsis of the wound occurred most frequently (10%). Initial resuscitation techniques, thorough clinical evaluation, and accurate diagnosis are the three most crucial management components. 83 (83.1%) of the overall patients were addressed surgically, whereas 17 (17.0%) were managed using conservation techniques. An important factor affecting the outcome is when a patient presents. A prompt diagnosis and effective treatment can save many lives.

13. An Observational Study of Different Treatment Modalities of Meniscus Repair
Mukesh Kumar
Abstract
Aim: The objective of the present study was to compare clinical and functional results of meniscus repair treated with various modalities. Methods: The present study was conducted and presenting in the Department of Orthopaedics, Lord Buddha Koshi Medical College and Hospital, Saharsa, Bihar, India. having meniscus injury identified on the basis of clinical examination and MRI findings, the patients were treated with menisceal repair techniques. The study population was made up of 20 knees with medial meniscal lesions and 30 knees with lateral meniscal lesions. Results: This study represents a case series of 50 athletes who underwent repair of isolated meniscal lesions of the knee. Cases of discoid meniscal lesions and combined ligament injuries were excluded. The mean age of the patients was 22.9 years ranging from 12 to 50 years. The meniscal injury on right knee was 30 cases and left knee were 20. The most frequent type of tear in the medial meniscus group was the bucket handle tear that was seen in 8 of 20 knees (40%), while the most frequent type for the lateral meniscus group was the longitudinal tear that was seen in 12 of 30 knees (40%). Conclusion: All meniscus repair techniques outside in, inside out, and all inside technique combination of all yields comparative clinical and functional outcome and statistically difference of result is not significant. Excellent to good results were in 99.66% cases.

14. Evaluation of Radiological and Clinical Findings in Patients with Empyema Thoracis
Gopal Krushna Sahu, Naliniprava Das, Priyanka Das, Abinash Dandasena, N.Akshaya, Swaraj Kumar Dey
Abstract
Background: Empyema thoracis (ET) is characterised by the presence of pus in the pleural cavity and is associated with considerable morbidity and mortality. This study was designed to evaluate the clinical and radiological outcomes of patients with empyema thoracis. Methods: A total of 100 ET patients were evaluated, with a thorough history, physical examination, necessary imaging, pleural fluid/sputum gram and AFB staining, AFB and aerobic culture sensitivity followed by specific treatment. Results: The majority of empyema thoracis patients were between the ages of 21 and 70, with a higher frequency in the early and middle ages and affecting mostly males (87%). No significant correlation between any hemithorax and tubercular empyemas was seen (Right 49%: Left 45%). However, in non-tubercular empyemas, involvement of the right hemithorax was much higher than that of the left (Right 63%: Left 26%).In 67% of cases, free ET was observed, 33% had encysted ET, and 62% had underlying lung parenchymal abnormalities. Gram staining of the pleural fluid showed no bacteria in 82% of the patients, although growth on aerobic culture was seen in 41% of the cases. In 73% of cases, tuberculosis was the main cause of empyema. Staphylococcus aureus (33.3%) was the most prevalent isolate in the 27% non-TB-ET group, followed by Pseudomonas aeruginosa (20%) and Escherichia coli (20%) on aerobic culture. Thoracocentesis was performed in 15% of the cases, ICTD in 84% of the cases, decortication in 4% of the cases, and open drainage in 1% of the cases, in addition to ATT and antibiotics. Conclusion: Empyema thoracis is primarily caused by tubercular and bacterial infections with significant morbidity and mortality. Treatment involves specific antimicrobial agents, closed or open pus drainage, and surgical procedures. Early treatment helps cure the disease, while delay leads to complications and poorer living conditions.

15. A Study of Histopathological Spectrum of Prostatic Biopsy and Correlation of Carcinoma Prostate with PSA Levels at A Tertiary Care Center
Chandra Prakash Kumawat, Radha Sharma, Gajendra Singh Rajpoot
Abstract
Introduction: Prostate Specific Antigen (PSA) is the most important and clinically useful biochemical marker of the prostate diseases. PSA is a good predictor of adenocarcinoma of prostate because adenocarcinoma disrupts the normal architecture of the cells which leads to leakage of PSA into the microvasculature. Gleason scoring and grading is one of the most powerful histopathological predictors of biological behaviour and act as a influential factors in determining the treatment of prostatic adenocarcinoma. Method: This is a two years prospective study. All the prostate biopsies received during the study period were included as per inclusion and exclusion criteria. PSA levels of all the patients were recorded. After studying the histopathological features, the diagnosis of various types of prostatic lesions was made and Gleason’s scoring was done in cases of prostatic carcinoma. Subsequently, a correlation was made between the histopathological diagnosis and serum PSA level. Results: We received a total 146 prostate needle biopsies in our department. The age ranged from 46 years to 84 years with the mean age of the patients was 65.7±8.9 years. Maximum number of patients (32.69%) were in age group 61-70 years. On histopathological examination, the most common type of lesion was benign with 72 (46.1%) cases followed by 46 (29.5%) cases of malignant lesions and 6.41% cases were pure inflammatory lesion. PSA levels was done in all the patients. On comparing PSA levels with types of lesions of prostate, we observed that most of the inflammatory and benign lesions, majority of patients had PSA of <10 ng/ml whereas the PSA was >20 ng/ml in most of the patients with malignant lesion. The distribution was statistically significant (p-value <0.0001). We found that 100% of the cases with PSA levels of more than 100ng/ml has shown various grades of adenocarcinoma. On calculating the sensitivity and specificity of PSA to detect malignancy at different cut off points, we found that serum PSA has a good sensitivity and specificity at a cut off value of 19.5ng/ml, with a sensitivity of 92.3 and specificity of 84.2. It was found that cases with a PSA level above 19.5ng/ml were more of malignant lesions compared to benign. Conclusion: Prostatic adenocarcinoma is one of the leading causes of morbidity and mortality in males, especially in elderly males. PSA is proved to a good marker for the screening of prostatic cancer as it is specific for prostate.

16. An Examination of the Anatomical Variations in the Formation, Branching, Pattern, and Relationship Between the Lumbar Plexus and the Psoas Major Muscle in Humans
Milan Amar Bahadur Singh
Abstract
Background: Between the anterior and posterior masses of the psoas major muscle, the lumbar plexus is located. In 60 percent of plexuses, the twelfth thoracic nerve via the dorsolumbar nerve contributes to their formation together with the anterior rami of the first four lumbar nerves. The lumbar and sacral plexuses are solely responsible for the lower limb’s nerve supply. The muscles and skin of the suprapubic and inguinal areas of the abdominal wall are supplied by nerves coming from the upper lumbar plexus. The Ili hypogastric and ilioinguinal nerves emerge from the lateral edge of the psoas major and cross the quadratus lumborum to supply the skin of the abdominal wall next to the lower limb. Aim: The aim of the present study was Examination of the anatomical variations in the formation, branching, pattern, and relationship between the lumbar plexus and the PSOAS major muscle in humans. Material and Method: The Department of Anatomy undertook this observational investigation. 15 human cadavers were initially used in this investigation. The average age of the cadavers, who were split evenly between 10 men and 5 women, was 70.0 years. The Department of Anatomy, Histology, and Embryology held all autopsy evidence. In order to eliminate out iatrogenic anatomical aberrations, specimens were disqualified if there was proof of surgical intervention involving the belly, lumbar spine, or lumbar plexus. Two of the planned cadavers were eliminated because there was proof of an abdominal surgical procedure, leaving 15 that were suitable for this study. Result: Before leaving the psoas major, the nerve split into its terminal branches in five instances. Only the second lumbar ventral ramus and, in two instances, the first two lumbar nerves were used to create the nerve. On six times, it came from the femoral nerve directly. In more than 70% of plexuses, the lateral femoral cutaneous nerve erupted from the intervertebral spaces next to L5 or the lateral border of the psoas major. Conclusion: Last but not least, cadaveric dissection revealed that the lumbar somatic plexus is located at the L4-5 level within the substance of the psoas major, indicating that psoas compartment techniques offer indirect access to the plexus. Dissection revealed that all previously documented lumbar plexus block techniques appear to be anatomically valid, but changes may improve effectiveness and lower risks.

17. A Study of Styloid Process: Distance between Base of Styloid Process and Carotid Canal and Two Styloid Process
Kiran Kumar S., G. S. Malipatil
Abstract
Background: The styloid process is normally a thin cylindrical sharp bony projection which arises from the lower surface of the petrous part of the temporal bone, derivative of a second branchial arch. Styloid process is usually extends downwards, due to anatomical and congenital variations in length or number and angulations may compress adjacent neurovascular structures. Aim and Objectives: To evaluate distance between base of styloid process and Carotid canal and two styloid process. Material and Method: This was an observational descriptive study conducted in department of Anatomy KIMS, Bangalore and other Medical Colleges in and around Bangalore. Study Includes 121 Adult Human skulls with intact styloid Process. The styloid process length and the interstyloid distance of the skull between the right and left sides were measured using a digital Vernier calliper. Results: 121 fulfilled the study criteria of at least one styloid process intact. distance between styloid process and mastoid base in the range of 0.2 -0.5cm and 0.6-1.1 cm respectively, there was no significance difference between these two groups. There was no significance difference between the two groups with distance between styloid process and carotid canal, in the range of 0.2-0.5 and 0.6-1.1 cm.63(52.07%).were in the range of  6.6-7.5cm  and  7.6-8.5cm were in the range of 53(43.80%) and 5(4.13%) were in the range of 5.6-6.5cm. Conclusion: Our study may be helpful for maxillofacial surgeons, dentists, radiologists, and anaesthetists to reach the proper diagnosis by doing pre-operative evaluation.

18. The Estimation of Time since Death by Rule of Thumb Method Applied to the Corpses Brought to GGH Mortuary, Guntur
Siva Kameswara Rao V., Ananda Kumar L., Jaffar Hussain A.P., Dinesh Varma N.
Abstract
A physical change that may occur in a corpse after death would be heat exchange from the body to the surrounding environment. An attempt has been made by the investigators to estimate time since death by Rule of thumb method which takes into account the rate of fall of temperature. A total of 100 human corpses selected for the study. The study was conducted from January to march of the year 2022. It is very difficult to specify normal body temperature, as this value can vary considerably between individuals. Rectal temperatures in a group of healthy subjects can vary between 34.2 C- 37.6 C, with a mean of 36.9 C. Rectal temperature is often referred to as deep central temperature, similar in value to that of brain, heart, lungs and abdominal organs.

19. Comparative Efficacy and Safety between Combination Therapy of Salmeterol/Fluticasone and Formoterol/Budesonide in Moderate Persistent Asthma
Shilpa Tejavath, Sankara Babu Gorle, Madhav P, P.V Prabhakar Rao
Abstract
Background: Bronchial Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. The chronic inflammation causes an associated increase in airway hyper responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment. It is a heterogeneous pulmonary disorder characterized by recurrent episodes of cough, breathlessness, and wheezing, which may resolve spontaneously or after the use of bronchodilator medication. The global prevalence of asthma is anticipated to be approximately 4.5 per cent. There are about 334 million patients with asthma affecting all age groups across the world5. The prevalence of asthma has increased over time and an additional 100 million people worldwide are expected to develop asthma by the year 2025. Methods: The present prospective study has been done in Vizianagaram population in Maharajah`s institute of medical sciences to compare the efficacy and safety between combination therapy of salmeterol with fluticasone and formoterol with budesonide in moderate persistent asthma. Results & Conclusion: Formoterol budesonide combination is better in comparison to the salmeterol fluticasone combination considering the lesser no of exacerbations and bronchodilator effect, both salmeterol and formoterol being long-acting bronchodilators.

20. Analysis of Cooling Curves Obtained from the Human Corpses where Time since Death is Known
Siva Kameswara Rao V., Ananda Kumar L., Jaffar Hussain A.P., Balamanigandan R.
Abstract
A physical change that may occur in a corpse after death would be heat exchange from the body to the surrounding environment. An attempt has been made by the investigators to analyse the cooling curves obtained from the human corpses where time since death is known. A total of 100 human corpses selected for the study. The study was conducted in typical winter season from October to December of the year 2013. During the process of recording, ambient temperature remains almost same on every day of the study period and it was 27°C-28° C. On average, it took18-20 hours for the thin built bodies to reach the ambient temperature, whereas 20-22 hours for moderately built bodies and for thick built bodies 22-24 hours. The cooling curves obtained by applying observed data, is of more or less double exponential sigmoid one. It is observed that the process of cooling retarded in its earlier stages, represented by a flat portion in its upper most part, signifying the occurrence of a lag period in the earlier stages of cooling, known as “temperature plateau”. Followed by a plateau, the  investigators observed that a steeper portion of the cooling curve having two different components of variable lengths on the curve, representing different phases of  cooling during the process of reaching the equilibrium with the ambient temperature. The initial rate of cooling in most of the cases is to be 0.5ºc/hour rising to 1ºC/hour during the period of maximum cooling. The average rate of cooling/hour has been estimated as 0.5ºC.

21. Evaluation of Drug Resistance Pattern of Mycobacterium Tuberculosis in a Tertiary Care Teaching Hospital
C. Senthil Vadivu, R. Vinotha
Abstract
Introduction: Nowadays with the greatly expanded efforts to strengthen tuberculosis prevention and control programmes worldwide, there is growing concern about the currently reported and potential future rates of drug-resistant tuberculosis. The resistant cases must be identified as swiftly as possible when they present at health care facilities so that they do not pose a threat to the community. Based on this aim of our study is to evaluate the drug sensitivity pattern of TB patients and correlate it with the socio demographic status of these patients, also to assess the influence of risk factors like socio demographic characteristics, DM, HIV status, smoking and previous treatment as a marker for the development of Drug Resistant TB in the study population. Materials and Methods: The present study was conducted at the Department of Microbiology for a period of six months to assess the drug susceptibility profile TB patients registered under RNTCP. Sputum positive patients were included in the study. Socio demographic and clinical characteristics such as category, treatment details such as drug regularity, number of doses taken by the patients and reasons for default were obtained from patient. Early morning sputum specimens were collected in a sterile container from the study group who were smear positive by Ziehl Neelsen method. All the laboratory works were carried out as per standard laboratory procedures and Bio-safety norms. Results and Discussion: Age, diabetes were not risk factors for retreatment tuberculosis and multidrug resistant tuberculosis. Smoking was a significant risk factor among relapse, failure and MDR cases. Irregular and interrupted treatment was a risk factor among defaulters, failures and multidrug resistant cases. Ensuring adherence to a full course of treatment is the key to cure TB patients and prevent the emergence of drug resistance. Drug resistance was more among prior treatment failure cases, necessitating the need for timely culture and sensitivity testing for those who remain sputum positive during the course of treatment to curb the spread of multidrug resistant strains.

22. Study of Diagnostic Efficacy of Ultrasound Guided FNAC Vs Conventional FNAC for Thyroid Nodule at a Tertiary Care Center
Poonam Burdak, Dinesh Kumar, Ajeet Gadwal, Pradeep Kumar
Abstract
Background: FNAC of thyroid is a minimally invasive, simple and cost effective method in the diagnosis and management of palpable thyroid lesions. As the conventional FNAC procedure is an unguided procedure, many times the quality of smear is also compromised in form of blood background or less cells or inadequate smear. Ultrasound-guided fine-needle aspiration (US-FNAC) is a relatively inexpensive, useful and relatively more sensitive diagnostic tool as compared to conventional FNAC for the evaluation of nonpalpable thyroid lesions. Methods: All thyroid FNAC both conventional and ultrasound guided between Jan 2021 to Dec 2022 were included in the study. The smears were processed as per protocol and examined to compare the quality of smears. Results: We received a total of 59 samples of FNAC of thyroid gland. Of these, 36 FNACs were conventional FNAC which were done without guidance (C-FNAC) and 23 FNACs were done under USG guidance (US-FNAC). There were 22 (37.29%) male patients and 37 (62.71%) females. The age of patients ranged from 13 years to 79 years with the median age of 43 years. Histological correlation is present in 12 patients (4 C-FNAC and 8 US-FNAC). Benign lesions were the most common with 57 (96.61%) cases and only 2 cases of malignant lesions were reported, with 1 case of follicular neoplasm and 1 case of Papillary carcinoma. Both the malignant lesions were reported on US guided FNAC. Out of the 36 cases that underwent C-FNAC 10 (27.78%) were given an inadequate report. In contrast, only 1 out of 23 patients (4.35%) were given an inadequate report when US-FNAC was done. The difference between the two were significant (p value = 0.025). Conclusions: The cytological criteria for identification of a lesion are well defined. USG-guided FNAC gives an added advantage of providing a more accurate diagnosis of the lesion or the lesions in thyroid. In our study USG-guided FNAC better tissue yield and better quality of smears in comparison to conventional FNAC and improved the sensitivity and diagnostic accuracy.

23. Progesterone Supplementation in Women with Recurrent Pregnancy Loss
Haresh A Chaudhary, Bhavesh B. Airao
Abstract
Context: Recurrent pregnancy loss, the loss of three or more consecutive intrauterine pregnancies before 20 weeks of gestation with the same partner, affect 1%–1.5% of the pregnant population. The inadequate secretion of progesterone in early pregnancy has been proposed as a cause of recurrent pregnancy loss. Aims: The aim was to investigate the role of progesterone supplementation in patients with recurrent pregnancy loss. Settings and Design: This was a one year study from June 2021 to June 2022 of women with recurrent pregnancy loss who attended clinic at C.U. Shah Medical College & Hospital, Surendranagar at tertiary care center. Subjects and Methods: 50 Women with at least two recurrent pregnancy losses were included in the study. For women with inadequate endogenous progesterone secretion, natural progesterone vaginal pessaries 200 mg 12-hourly were offered until 12 weeks gestation. Results: Pregnancy cycles were analyzed to examine the pregnancy loss rate following progesterone supplementation. Majority of women from 21-25 age groups (48%).majority of women having 2 abortions (46%) and 14% women having hypothyroid. Overall live birth and pregnancy loss rates were 68% and 30%, respectively. When analyzed by the number of previous pregnancy loss there was a reduction in the pregnancy loss rate following progesterone supplementation in women with 3 previous pregnancy losses when compared with historical data. Conclusions: Progesterone supplementation may have beneficial effects as progesterone needed for implantation and helps in women with luteal phase defect in unexplained recurrent pregnancy loss.

24. Comparison of Haemodynamic Responses between Clinical Assessment-Guided Tracheal Intubation and Neuromuscular Block Monitoring-Guided Tracheal Intubation
Ashwin Bhandari, Manu G. R., Yogitha B. S., Harshitha G., Suresh C.
Abstract
Introduction: Endotracheal intubation is the commonest procedure done during general anaesthesia and it includes stressor response during the procedure. It is a challenging task to do it with minimal stress response. The purpose of our study was to find a better technique to assess the adequate intubating condition to reduce the stress response of endotracheal intubating procedure and hence we compared clinical assessment guided tracheal intubation and train of four (TOF) guided tracheal intubation and looked for the haemodynamic responses. Aim: To assess the haemodynamic responses of tracheal intubation guided via Train of Four (TOF) monitoring compared to tracheal intubation guided via clinical assessment. Method: In this prospective randomized clinical study, 70 adults, ASA -1 and ASA-2, MPG- 1 and MPG-2 undergoing elective surgery under general anaesthesia with tracheal intubation were allocated to two groups (n = 35) according to TOF guided (Group T) or Clinical assessment guided (Group C) tracheal intubation. Anaesthesia was induced with Inj.propofol 2mg/kg and after standardization of supramaximal stimulus, Inj.Vecuronium 0.1mg/kg was administered. In group T, trachea was intubated after TOF ratio became zero in Adductor Pollicis muscle, whereas in group C, trachea was intubated after clinical assessment of jaw muscle relaxation, airway tone and ease of ventilation. Changes in heart rate, mean arterial pressure, mean systolic blood pressure, mean diastolic blood pressure were recorded along with intubating conditions which were scored on a Kreig et al score. Results were analysed by Paired-t test and chi square test. Results: Heart rate, mean arterial pressure, mean systolic blood pressure and mean diastolic blood pressure were observed to be significantly higher in Group C compared to Group T (P<0.05). Excellent and good intubating conditions were found in both the groups. However, 91.43% excellent intubating conditions were found in Group T compared to 57.14% in Group C. Conclusion: Neuromuscular block monitoring of Adductor Pollicis muscle based endotracheal intubation can be a suitable, non-pharmacological method in assessing appropriate time of intubation, providing excellent intubating conditions hence significant attenuation of hemodynamic response to laryngoscopy and tracheal intubation.

25. Evaluation of Factors Influencing Drug Adherence to Anti-Retroviral Therapy (ART) in a Tertiary Care Hospital, Vizag
Bheemesh Naidu Mattam, Srinivas Kandrapa, Venkateshwarulu Devarakonda, Chitra Karuppiah, Aditya Ambady
Abstract
Background: Antiretroviral therapy (ART) adherence is a primary determinant of the effectiveness of HIV/AIDS treatment and is also considered a major predictor of survival among patients living with HIV/ AIDS. The present study measures the level of adherence to antiretroviral drug therapy in Vizag district using MARS-5 and various factors influencing the degree of adherence. Methods: This was a cross sectional, semi structured questionnaire based study conducted over a period of 6 months at AMC. Medication  adherence report  scale-5 was used to assess the degree of adherence. A semi-structured questionnaire was designed to assess the factors influencing adherence. Results: A total of 354 patients participated in the study. 126(36%) patients were highly adherent, 126(36%) patients were moderately adherent and 102(29%) patients were low adherent according MARS-5 score. Statistical analysis has shown that using the reminder tools, patients living with family had shown significant adherence to ART (p value<0.001). Conclusions: people who are taking ART in Vizag district are found to be moderate to high adherent according to MARS-5. Degree of adherence to ART is found to be influenced by simplified treatment regimen, patient counselling and family support.

26. Assessment of Catheter Associated Urinary Tract Infection Rate and Antimicrobial Susceptibility Pattern of Isolated Organisms
Nilam V. Patel, Piyush Pujara
Abstract
Background and Aim: The most prevalent nosocomial infection and a major contributor to morbidity is catheter-associated urinary tract infections (CAUTIs). The goal of the current investigation was to determine the uropathogens linked to CAUTI, its prevalence in a tertiary care hospital, and the pattern of antibiotic sensitivity in the isolated organisms. Material and Methods: This prospective investigation was carried out in the tertiary care facility. 80 catheterized patients in all were included for the six-month period. Urine samples were taken under aseptic conditions from clinically probable CAUTI cases, and the samples were processed in the department of Microbiology in accordance with established methods. We isolated, identified, and tested the antibiotic sensitivity of uropathogens. Results of the calculation of the CAUTI rate were recorded. Results: 90 catheterized patients experienced 14 CAUTIs. Male patients required catheterization more frequently than female patients did. Escherichia coli (36.66%) and Klebsiella pneumoniae (33.33%) were the most prevalent uropathogens, followed by Pseudomonas aeruginosa (18.88%) and Acinetobacter spp. (10%) in cases of CAUTI. particularly the bacteria recovered from patients with CAUTI, which are multidrug resistant. The preferred medications included Imipenem, Fosfomycin, Nitrofurantoin, Cotrimoxazole, Tetracycline, and Doxycycline. Conclusion: The results of our investigation and other studies show that CAUTI has grown to be a significant hazard to patient safety globally, that it is still a concern, and that it is crucial to adopt active infection control programmes for infection surveillance. For the prevention and management of CAUTI, infection control procedures must be put into practise.

27. A Comparative Study of Intrathecal Hyperbaric Bupivacaine 0.5 % and Hyperbaric Bupivacaine 0.5% with Midazolam in Lower Limb Surgery
Manisha Kapdi, Vandana Shah, Kinjal Vaghamshi, Ekta Soni, Yash Patel
Abstract
Background: Spinal anaesthesia is common for lower limb surgeries, addition of preservative free midazolam improves sensorimotor charisteristics. Aim & Objectives: In this Retrospective, randomized, double- blind study, we investigated the postoperative analgesic efficacy of intrathecal midazolam 1mg as an adjunct to bupivacaine for spinal anesthesia in 60 patients undergoing lower limb orthopedic surgery. Patients were allocated randomly to 2 groups:
Group A: Received 3.5 ml bupivacaine plus 0.2 ml preservative free midazolam (5 mg/ml).
Group B: Received 3.5 ml hyperbaric bupivacaine 0.5% plus 0.5 ml saline intrathec.
Results: Mean duration of postoperative analgesia was Group A :(370.16 ±15.91) min in group A compared with (512±74.71)min in group B (p<0.001). Supplemental analgesic dose requirement with diclofenac were significantly less in Group B (3±0.86) compared with Group A (1±0.49) (p<0.001). Time to onset of sensory analgesia, maximum level of sensory block, time to reach it, and time to two segment regression were comparable. Conclusion: We conclude that intrathecal midazolam 1 mg provided moderate prolongation of postoperative analgesia when used as an adjunct to bupivacaine.

28. Prevalence of Hypertension among Alcohol Consumers in Adults of Rural and Urban Field Practice Area of Rajarajeswari Medical College and Hospital, Bangalore: A Comparative Study
Krithika TT, Balwant Singh Patle, Sandeep Jain, Jitendra Satpute
Abstract
Background: Hypertension is a Global Public Health issue. It contributes to the burden of Heart disease, Stroke, kidney diseases and premature mortality and Disability. A direct press or effect of alcohol is proposed as the basis for the association between regular alcohol consumption and an increase in blood pressure found in population studies. Aim and Objective: To estimate the Prevalence of Hypertension and to describe the risk factor associated with Alcohol consumption among adults of the Rural and Urban field practice area of RajaRajeswari Medical College and Hospital (RRMCH), Bangalore. Method: A Cross Sectional study was conducted on 675 Rural subjects (18 years and above) and 500 Urban subjects (18 years and above) during January 2019 to June 2020 through multistage sampling method. The participants were interviewed using a pretested structured standard questionnaire to obtain data on Demographic data, Dietary history, Alcohol consumption, past medical history in adults. The data was collected and compiled in MS Excel and analyzed by using SPSS software version 24.0. Result: The study included 1175 subjects, out of which Prevalence of Hypertension in Rural area is 21% and in Urban is 28%. Study subjects of the Rural area (OR=2.02) and Urban area (OR=2.81) showed higher risk of Hypertension associated with Alcohol consumption and they are found to be significant, (Rural: p value = 0.0009) (Urban: p value = 0.0001). Conclusion: This study showed that Alcohol consumption had a significant association with Hypertension in both Rural and Urban areas. In Rural study subjects, Current consumer have an ODDs of 2.02 times to get Hypertension than the Non consumer and the difference is statistically significant. (p = 0.0009). In Urban area, the Current consumer have an ODDs of 2.81 times to get Hypertension than the Non consumer and the difference is statistically significant. (p = 0.0001). Similarly in the Urban areas, the Ex consumer (past consumer) have the ODDs of 2.91 times to get Hypertension than the Non consumer and the difference is statistically significant. (p = < 0.0001). There is a felt need for more community-based studies in Urban And Rural areas of our country (India) with a view to determine the geographic differences in the prevalence of Hypertension and the various risk factor which are associated to it.

29. Clinical And Biochemical Profile of Acute Myocardial Infarction in Young Adults
Jitendra Satpute, Sandeep Kumar Jain, Balwant Singh Patle, Krithika T.T.
Abstract
Background: Coronary artery disease (CAD) is a multifactorial disease involving both genetic and environmental factors, multiprong approach for prevention is warranted since atherosclerosis has its origin in childhood, particularly in Indians; preventive strategy should begin in childhood though it is probably never too late so that younger population in their prime period of life can have better quality of life. Aim and Objectives: Hence, this work was undertaken in young patients of ischemic heart disease (IHD) to assess clinical, biochemical correlated with significant and non-significant CAD. Materials and Methods: Weighty nine patients less than 45 years old presenting with acute myocardial infarction (defined by the 4th Universal Definition of Myocardial Infarction) were studied in the Department of Cardiology, Fortis Escorts Heart Institute, Delhi from September 2022 to March 2023. Preformed Questionnaire was used to collect the data and data was entered using Google Forms and MS Excel. Results:  The baseline data showed that mean age of the subjects was 39.3 years with standard deviation of 5.2 years. The youngest subject was 19 years and oldest was 45 years of age. Further the mean height, weight and BMI was 169.1 Cm, 76.3 Kg, 26.2 respectively. 86.5% of the patients among the sample were males. The clinical characteristics showed that mean Hb of the sample was 13.5 g/dl with a std. deviation of 1.8. The platelet count was 248.5 million. Other characteristics of the sample are summarized in Table 05. The number of patients with homocysteine level above normal range were 15 (16.8%) with average level of 59.8 umol/L. LP (a) levels were elevated (30-50 mg/dl) in 6 patients and were very high (>50 mg/dl) in 6 patients. The sample also showed that 62 subjects were ST Elevation MI followed by 25 subjects having NSTEMI. Around 12 subjects were diagnosed with unstable Angina. 88.8% of the patients had PTCA. Comparison of the clinical risk factors with the outcome variables showed no significant difference. Conclusion: This original research contributes valuable information to the growing body of knowledge surrounding AMI in young adults. The insights gained from this study can guide healthcare providers in delivering more targeted and personalized care to this vulnerable population. By addressing the unique risk factors and implementing early preventive measures, we can strive to curb the rising prevalence of AMI in young adults and ultimately improve their overall cardiovascular health and well-being.

30. Profile of Deaths Due to Poisoning at a Tertiary Care Centre
Vanraj Parmar, Jashvant Darji, Jitendra Tanna
Abstract
Introduction: Poisoning is a critical public health concern with increasing mortality rates in India. Intentional poisoning, particularly through suicidal acts, and unintentional poisoning incidents both contribute to the burden of poisoning-related deaths. This study aims to provide a comprehensive profile of deaths due to poisoning at a tertiary care center, including demographic information, manner of poisoning, types of poisons involved, and socioeconomic factors. Methods: This retrospective study was conducted at GMERS Medical College Morbi during the period of Feb 2022 to Jan 2023. It involved the collection and analysis of data related to deaths due to poisoning. Detailed information and history were obtained from police records, relatives of the deceased, and hospital records. Meticulous autopsies were performed, and routine viscera and body fluids were collected for chemical analysis. The data collected was analyzed using descriptive statistics, and the findings were entered into a standardized proforma. Results: The results of our study revealed that out of the total victims, 64% were males and 36% were females. In terms of age group distribution, the highest number of victims (29%) belonged to the 21-30 years age group, followed by 21% in the 31-40 years age group. Among the occupation of the victims, housewives accounted for the highest number of cases (23), followed by laborers (15) and farmers (16). Students and individuals in private jobs had lower numbers, with 9 and 16 victims respectively. The most prevalent type of poisoning identified in our study was organophosphorus, accounting for 52% of the cases. Aluminium phosphide was the second most frequently detected poison, with 25% of the cases. Conclusion: This study provides important insights into the demographics, occupational profiles, types of poisoning, and religious distribution of poisoning cases. The findings highlight the need for targeted interventions, increased awareness, and preventive measures to reduce the incidence of poisoning-related deaths.

31. A Clinico-Histopathological Correlation of Various Photodermatoses
Anand Saraswat, Delux Godghate, Minal Sharad Thakre, Amar Surjushe
Abstract
Background and Aim: Photosensitive diseases are a group of dermatoses characterized by the development of cutaneous eruptions after exposure to UV. Hence the present study was undertaken to correlate the Clinico-histopathological patterns of various photodermatoses. Methods: Fifty patients were selected from those attending the skin OPD at a teaching institution. The histopathological study was carried out in collaboration with the Department of Pathology in the same institution. Results: Out of 50 patients, maximum i.e., 35(70%) were in the age group of 11 to 40 years with female’s predominance (54%). Majority were new patients (previously unaffected) (58%). Photo exposed parts were mostly affected (84%). The incidence of various photodermatoses in present study was Polymorphous light eruption (PMLE) 23 (46%), followed by phytophotodermatitis (PPD) 6 (12%). The commonest morphological presentations were papules and plaques (68%). Macules were seen as early lesion in 24% of cases and erythema were present in 8% of cases. The various histopathological patterns were consistent with the clinical features, while pellagra and phytophotodermatitis showed histo-pathological features of non-specific chronic dermatitis. Conclusion: In conclusion, it can be said that though in general, clinical features are more useful in the diagnosis of various photosensitivity disorders and histopathology is usually only corroborative, there are many instances where the distinct histopathological features can be an important aid in differentiating some dermatoses which may appear clinically similar.

32. Anti Snake Venom Induced Anaphylactic Reaction: A Case Report
Neeraj Rajdan, Shujauddin, Kunal Sharma, Bhavana Srivastava, Kalpana Joshi, Bhawna Virak
Abstract
Adverse reactions to snake antivenom are widespread in many places of the world where snakebite is common. Mortality due to snakebites and serious adverse reactions to anti-snake venom (ASV) are both underreported in India. Antivenom is an immunoglobulin usually pepsin refined F(ab)2 fragments of IgG purified from the serum or the plasma of a horse or sheep that has been immunized with the venom of one or more species of snakes which is given to prevent snake venom from binding to tissues causing serious blood, tissue, or nervous system problems. In India only polyvalent ASV is available. Benom vial of 0.0021gm powder is a polyvalent ASV. Suspected ADRs due to anti-snake venom were reported from the emergency department. The ADRs were filled in Suspected ADR reporting form and as per WHO-UMC causality assessment scale, causality was assessment was done and ADRs were reported through vigiflow to Indian Pharmacopoeia commission, Ghaziabad. A case report of anaphylactic reaction due to anti-snake venom was presented. A 12-year old male with history of snake bite presented with neurological symptoms such as pupil mydriasis, ptosis and treated symptomatically with Antisnake venom but after half an hour anaphylaxis reaction occurred due to Antisnake venom. Symptomatic treatment was given and patient was recovered. Snake bite is a medical emergency faced mainly by rural populations. Anaphylaxis reactions are rare and are dependent on the patient’s inherent characteristics which cannot be modified. As a clinician, it is our responsibility to report these reactions to ensure treatment at right time to right patient with right drugs and doses.

33. A Comparative Study of Dexmedetomidine and Clonidine as an Adjuvant to Bupivacaine in Ultrasound-Guided Supraclavicular Brachial Plexus Block
Lakshmi Deepthi Davuluru
Abstract
Background: For upper limb surgeries, ultrasound-guided brachial plexus block is the preferred technique. Adding adjuvants to peripheral nerve blocks is common to enhance their analgesic effectiveness and duration. In this study, we compared the analgesic effects of dexmedetomidine 1µg/kg and clonidine 1µg/kg as adjuvants to a low volume of bupivacaine in ultrasound-guided supraclavicular brachial plexus block. Methods: A prospective, randomized controlled, double-blind study was conducted after obtaining permission from the institutional ethics committee. We included 40 ASA grade I and II patients, aged 18 to 60 years, who were scheduled for upper limb orthopedic surgery. Group D (Dexmedetomidine group) received 20 ml of bupivacaine along with dexmedetomidine (10 ml of 0.5% bupivacaine + 1µg/kg of dexmedetomidine, diluted with 0.9% NS to 20 ml). Group C (Clonidine group) received 20 ml of 0.25 bupivacaine along with clonidine (10 ml of 0.5% bupivacaine + 1µg/kg of clonidine, diluted with 0.9% NS to 20 ml) in the ultrasound-guided supraclavicular brachial plexus block. Results: The mean age of Group C, receiving bupivacaine with clonidine, had a mean age of 37.5 ± 10.55 years, while Group D, receiving bupivacaine with dexmedetomidine, had a mean age of 35.81 ± 8.55 years. The average time for the onset of sensory block in group C was 12.22 minutes, while in group D, it was 9.55 ± 1.2 minutes. The mean time of onset of motor block in group C was 14.2 ± 1.56 minutes and in group D it was 11.9 ± 0.88 minutes no instances of hypotension or bradycardia were observed in either group. Conclusion: The addition of dexmedetomidine to bupivacaine 0.25% has been found to significantly prolong the pain-free period, duration of motor blockade, and sensory blockade when compared to clonidine or the control group. This combination offers the advantage of maintaining hemodynamic stability while keeping the patient calm. Ultrasound-guided supraclavicular block using a low volume of bupivacaine with 1µg/kg dexmedetomidine resulted in adequate blockade and provided effective postoperative analgesia.

34. Serum Electrolyte Concentrations in Primary Glaucoma Patients
Aditya Vikram Sharma, Aditi Sharma, Sharda Punjabi, Hem S Desai
Abstract
Glaucoma advances covertly, and a late presentation is not uncommon. This study investigated the association between glaucoma and the concentration of tear and serum ions. We evaluated the levels of sodium, potassium, and chloride in the tears and serum of 50 glaucoma patients and 50 controls with similar ages and sexes. Both the test and control groups had a 56.00 ± 14.6 and 56.74 ± 16.74 years old on average, respectively. Their age was not statistically significant. The mean concentrations of sodium, potassium, and chloride in control subjects’ tears were 130.22 ± 1.20, 22.38 ± 5.30 and 121.65 ± 12.20, respectively, whereas for test subjects (Glaucoma patients), the values were 135.06 ± 9.34, 16.86 ± 2.3, and 125.91 ± 10.50. A paired comparison of means of Control & test was statistically significant. The average levels of sodium, potassium, and chloride ions in the serum of test individuals were 135.82 ± 8.66, 4.0 ± 0.52 and 101.85 ± 2.77 respectively, while the average levels in the serum of control subjects were 135.00 ± 2.4, 4.4,± 0.98 and 101.53 ± 13.6, respectively. It was not statistically significant if means were compared. Sex did not significantly influence any of the assessed variables. Low potassium ion concentration in glaucoma patients in tears may be a valuable biomarker for the condition. At-risk people can be protected from irreversible glaucoma blindness to a greater extent by an efficient glaucoma screening test.

35. Intrathecal Midazolam as an Adjuvant to Bupivacaine for Spinal Anaesthesia in Orthopaedic Surgery
Pujaben A Barad, Kiritbhai L. Jadav
Abstract
Background and Aim: The most prevalent criticism levelled against spinal anaesthesia, one of the methods used for infraumbilical procedures, is its short-lived postoperative analgesia. For extending the analgesic effect’s duration, a number of adjuvants have been tested in conjunction with local anaesthetic. The goal of the current study was to determine the impact of post-operative analgesia in orthopaedic surgery using 2 mg of midazolam as an adjuvant to intrathecal bupivacaine. Material and Methods: The study comprised 100 patients who had lower limb or hip surgeries and were either male or female, ASA grade I-II, between the ages of 20 and 50, weighing between 50 and 80 kg. Two groups of 50 patients each were created by randomly dividing the patients. Each subject received 3.6 cc of medication intravenously overall: Group 2 (BS): 3.2 ml of 0.5% hyperbaric bupivacaine + 0.4 ml of ordinary saline; Group 1 (BM): 3.2 ml of 0.5% hyperbaric bupivacaine plus 0.4 ml (2 mg) of preservative-free midazolam. Results: The midazolam group’s mean analgesia duration was longer than in the control group (p<0.05). Diclofenac injections used as rescue analgesics were also much less frequent in the BM group. The time it took for the BM group to reach the highest sensory level (T4) was likewise noticeably shorter. The midazolam group had a longer time to two segment regression and longer motor block duration. Conclusion: As it extends the duration of post-operative analgesia and minimizes the need for rescue analgesia, preservative-free midazolam at a dose of 2 mg appears to be an efficient and safe adjuvant to bupivacaine in spinal anaesthesia. For more clarification, long-term analyses of the aforementioned modalities are needed in the future.

36. Safety Profile of Antidepressant Drugs in Tertiary Care Teaching Hospital, Haldwani
Chavi Jain, Bhavana Srivastava, Rajat Kumar Agarwal
Abstract
Objective: This prospective observational study was carried out to identify the safety profile of antidepressant drugs in a tertiary care teaching hospital. Materials and Methods: New patients aged above 18 years prescribed with at least one antidepressant reporting to outpatient and inpatient unit of Department of Psychiatry of Dr. Susheela Tiwari Government Hospital, Haldwani, meeting the inclusion criteria and consenting to participate in the study were recruited. Results: Of the 205 patients who received antidepressants, 44 patients (21.4%) experienced 69 ADRs. Maximum ADRs were reported from the central nervous system (46.3%) followed by gastrointestinal system (44.9%). Sleep disturbance (15.9%), dyspepsia (11.6%) and headache (10.1%) were the most common ADRs reported. The rate of occurrence of adverse drug reactions was highest with fluoxetine (20.3%) followed by paroxetine (17.4%) and desvenlafaxine (14.5%) utilization. WHO-UMC scale and Naranjo scale showed similar causality assessment scale. Most cases were of possible category (74%) followed by probable (26%). According to modified Hartwig and Siegel severity assessment scale, most of the ADRs were mild in severity (31.9%) and on Schumock and Thornton preventability scale, the occurrence of maximum number of ADRs was definitely preventable (68.1%). Most of the ADRs reported were Type A category. Severity of the ADRs was rendered mild due to the judicious use of the antidepressant drugs. Conclusion: Antidepressant drugs were safe to use in psychiatric patients as most of the ADRs were of mild severity.

37. Effects of Intravenous Dexmedetomidine on the Quality of Subarachnoid Block with Hyperbaric Intrathecal Bupivacaine for Lower Limb Surgery: A Randomized Study
Ray A, Roy S, Mitra A
Abstract
Background: The present study has been conducted to evaluate the intraoperative and postoperative effects of intravenous dexmedetomidine as an adjuvant on the characteristics of bupivacaine spinal anaesthesia in lower limb surgeries. Materials and Methods: One hundred subjects of ASA Grade I and II of either sex undergoing elective lower limb surgery under spinal anaesthesia were randomized into two groups of 50 each. Dexmedetomidine group (Group D) received 3ml (15mg) 0.5% Heavy Bupivacaine via subarachnoid block with intravenous dexmedetomidine at 0.5 mcg/kg bolus over 10 minutes, then maintenance infusion at 0.5 mcg/kg/hr and control group (Group C) received 3ml (15 mg) 0.5% Bupivacaine Heavy via subarachnoid block with normal saline of equivalent amount as bolus and maintenance infusion. Along with demographic parameters, block characteristics, haemodynamic parameters, intraoperative sedation score and perioperative complications were assessed and compared between the two groups. Results: Onset of sensory and motor blocks did not differ significantly between the groups. Time for sensory regression to S1, time for motor recovery and time to rescue analgesia was significantly prolonged in Group D. The mean intraoperative heart rate of the patients of Group D was significantly lower than that of Group C from 5 minutes after subarachnoid block till the end of surgery but the mean arterial pressure and respiratory rate were comparable. The intraoperative sedation score was significantly higher in Group D. No significant difference in perioperative complications were seen between the groups. Conclusion: Intravenous dexmedetomidine significantly prolongs the duration of sensory and motor block of bupivacaine spinal anaesthesia and provides excellent intraoperative sedation and postoperative analgesia in patients undergoing lower limb surgeries.

38. A Case Study on Different Morphological Patterns and Incidence of Synchronous Endometrial Carcinoma in A Tertiary Care Centre
Velayutham Sumathi, B. Indumati, Vishnu Pratap
Abstract
Introduction: Endometrial Adenocarcinoma by far is the most common malignant tumors of the uterine corpus, which are divided into endometroid and special variant types. It is frequently observed in elderly age group with varied morphological patterns. The objective of this study is to delineate different histologic presentation and associated condition with endometrial carcinoma. Aim: The aim of the study is to delineate different morphological presentation associated with endometrial carcinoma. To differentiate other aggressive types as they have prognostic outcomes. Methods: The study was conducted in Department of Pathology, KAP Viswanatham Government Medical College Trichy on 24 cases of surgically resected specimens diagnosed as endometrial carcinoma over a period of 19 months from June 2021 to December 2022. Routine formalin fixed, paraffin embedded tissue sections stained with H&E done was taken for this study. Result: In this study, we observed the most frequent types of endometrial carcinoma was endometrioid and common presentation was as a proliferative growth. The common age group in our study was between the ages of 50 and 60. On the other hand, instances of endometrial carcinoma associated with fibroids tend to be observed in individuals aged 40 to 60. Furthermore, our study documented an interesting case where a 35-year-old woman had both endometrial carcinoma and ovarian carcinoma at the same time. Conclusion: The average age range for the occurrence of endometrioid adenocarcinoma in our study was between 50 and 60 years. The most common type was endometrioid (79.5%) , the next most common was high grade serous carcinoma (8.2%) ,most of our cases was observed to be isolated (37.6 %) followed by atypical hyperplasia (25%).

39. Autopsy Death Due to Strangulation in Palghar Region of Maharashtra
Umang Patel, Amol Ghule
Abstract
Background: Strangulation are quite common in depressed and helpless and subjects when they does not find any solution for their problems. They submit themselves for suicide by strangulation which is an easy method or somebody might have killed by using any object which causes suffocation and ultimately to death due to wealth, health or jealousy. Method: In the study of medico-legal out of 1678 autopsies, 99 (5.9%) of death due to strangulation were selected for study. Results: The males were 70 (70.7%), and females were 29 (29.2%). The age group was between 11 years to 70 years. The highest percentage of death by strangulation between the age 21-30 years were 35.3%, followed by ii-20 years of age had 21.2%, 31-40 years of age group were 20.2%, and least percentage was observed (4%) in the age group between 51-60, and 61-70 years of age. Death percentage was highest in Rainy season 39-9%, followed by Summer 37.3%, and winter 23.2%, Urban area had maximum death 60.6% as compared to rural areas 39.3%, Indoor had 71.7%, and Outdoor had 28.2%. The site of ligature mark were highest above the level of Thyroid cartilage 73.7%, At the level of Thyroid cartilage were 19-9%, and least ligatures were below the Thyroid cartilage 7%. The significant findings in the dissection of neck in the deaths by strangulation were — Hemorrhages in the strap muscles 24.2%, injury to neck muscles 8%, fracture of Hyoid bone 9%, injury to Thyroid cartilage 4%, tear of Carotid Artery 7%. Conclusion: This pragmatic study of death by strangulation will certainly help the medico-legal expert, police and judiciary officials to differentiate death from strangulation and Hanging.

40. Epidemiological Profile of Road Traffic Accidents Injuries in Western Maharashtra
Umang Patel, Amol Ghule
Abstract
210 autopsies (176 males and 34 females) aged between 2 to 70 years ware studied. 12(6.81%) males, 8(23.5%) females total 20(9.52) were aged between 2-10 years 32 (18.1%) males. 4(11.7%) females total 36(17.1%) were aged between 11-20 years. 52(29.5%) males, 12(35.2%) female total 64(30.4%) were aged between 21-30 years. 31(17.6%) males, 3(8.82%) females total 34(16.1%) aged between 31-40 years 21(11.9%) males, 2(5.81%) females, total 23(10.9%) were aged between 41-50 years 15(8.5%) males, 3(8.82%) females, total 18(8.57%) were aged between 51-60 years 13(7.3%) males, 2(5.88%) female total 15(7.14%) aged between 61-70 years. The types of riders were, 17(8.09%) pedestrian 29(13.8%) cyclist, 103(49%) were riding two wheelers. 49(23.3%) travelling in car, 12(5.71%) were Lorry drivers / bus travellers. The types of injuries were 72(34.2%) had head injury 22(10.4%) had neck injury, 31(14.7%) had injuries to lower limb, 21(10%) abdominal injuries, 34(16.1%) had injuries to thorax, 13(6.19%) had injuries to upper limb 17(8.09%) had injuries to face. This pragmatic study will be quite useful to medico legal expert to assess the age group, region wise injury, types of riders because accident is an unexpected mishap which claims life, who are in hurry and disobey the traffic rules.

41. To Study the Role of Forced Alkaline Diuresis in Prevention of Acute Kidney Injury in Patients with Hematotoxic Snake Bite
Guruprasad Shetty, Mrunalini TR, Shreedevi Yenni, Varun Byrappa
Abstract
Background: Snake bite is a common medical emergency and an occupational hazard, more so in tropical India, where farming is a major source of employment. Viper bites are more common than other poisonous snakebites in humans. INDIA is among the countries most dramatically affected by snake bite and accounts for almost half the total number of annual deaths across the world. According to WHO estimate- India had 1.2 million snake bite deaths from 2000-2019 and nearly half of the victims aged 30-69 and over a quarter being children under 15. The WHO has set the target of reducing these deaths to half the number by 2030 and India’s efforts to prevent and control these deaths will largely influence this global target. To avoid gross under reporting, few authors have even recommended Government of India to designate and enforce snake bite as “NOTIFIABLE DISEASE” within Integrated Disease. Surveillance Program. More than 2700 species of snakes exist in the world, of which only 450 have front fangs making them capable of injecting venom during bite. India harbors more than 250 species and subspecies, out of which around 50 are venomous. Hence the need for a useful tool to fight the most dreaded complication of snake bite is necessary. Methods: After obtaining approval and clearance from the institutional ethics committee, a study was conducted in the department of emergency medicine in KIMS over a period of 1.5yrs which included 25 patients above the age of 18 years. Each patient with a definitive history of snake bite was admitted, evaluated and considered for forced alkaline diuresis based on the relevant comorbidities. Patient was followed up throughout the stay and renal functions monitored. Patients who failed were taken up for hemodialysis and outcome of the procedure charted. Results: In the study, 20% were <30 years, 40% were 31 to 40 years, 28% were 41 to 50 years, 12% were >50 years. 36% were Female and 64% were Male. At baseline 24% and had metabolic acidosis and 76% had Normal ABG. In the study, HB was 12.97 ± 2.25, TLC was   11271.6 ± 4019.09, Platelets was 2.33 ± 0.99, Neutrophil was 81.94 ± 9.63, Lymphocyte was 18.05 ± 9.81, Monocyte was 4.68 ± 5.35, Basophil was 0.88 ± 2.13 and Eosinophil was 1.44 ± 2.74. In Fang Marks Distribution, 4% had in Left Ankle, 28% had in Left Foot, 4% had in Left Great Toe, 12% had in Left Hand, 4% had in Left Thumb, 4% had in Left Wrist, 8% had in Right Ankle, 8% had in Right Finger, 4% had in Right Foot, 12% had in Right Hand, 8% had in Right Leg and 4% had in Right Toe. Most common site of fang marks was Left Hand and Right Hand (12% respectively). In 2D echo, 8% had LVH and 92% were WNL. In Doppler, 60.0% had No DVT and for 40% doppler was not done. Cellulitis was present in 64%. Cycle 1 FAD was Done in 100.0%, 24.0% in cycle 2, 8.0% in cycle 3. Haemodialysis was done in 4% of subjects. Interpretation & Conclusion:  Forced alkaline diuresis proved to be a good intervention to save patients from developing or worsening AKI. It is a much-needed tool in our country which contributes significantly to snake bite related deaths. It also helps to decide on early intervention with hemodialysis, in case of failure to respond to FAD.

42. A Prospective Study on Pattern of Adverse Drug Reactions Reported at Pharmacovigilance Centre of RIMS, Ranchi
Shekhar Kumar Choudhury, Subhankar Choudhury, Vineet Kumar
Abstract
Background: Adverse drug reactions (ADR) are rated as fifth leading cause of death and accounts for approximately 5% of all hospital admissions. ADR monitoring plays a major role in pharmacotherapy, decision making in individual reports, regional, national and international programs. ADR monitoring can help to ensure that patients obtain safe and efficacious products. With the existing limited and inconsistent ADR data, more studies at institutional level can generate valid ADR information. Hence, this prospective study was designed to evaluate the pattern of ADRs in a tertiary care hospital. Methods: In our study all spontaneously reported ADRs were evaluated based on data collected from various clinical departments. Suspected drugs were coded according to WHO-anatomical therapeutic chemical classification. The organ system involvement for ADR was labeled as per WHO-ADR terminology. ADRs were also categorized into two types – augmented (A) and bizarre (B) as per Rawlins and Thompson classification. Causality Assessment was performed using WHO Uppsala Monitoring Centre (UMC) Causality Assessment Criteria. Severity of the identified ADRs was assessed using modified Hartwig’s criteria. The preventability of the reactions was assessed according to Schumock and Thornton’s criteria. Results: Out of all ADRs, 31.68% was type-A reactions while 68.32 % was type-B reactions. The commonly involved organ system was skin and appendages 56 (34.78%). The major causative drug class was antimicrobials (43.02%).  The causality of most ADRs was “probable” (60.25%) followed by “possible” (34.78%). Most of the ADRs were moderate in nature (45.96%). Around 42.24% of the reported ADRs were definitely preventable. Conclusion: Adverse drug reaction is one of the leading cause of hospital based admissions. Practicing rational use of medicines and avoiding medication errors, a major fraction of ADRs can be prevented. Proper awareness among health care personnel and involvement of drug controlling authorities can minimize this grave situation.

43. Comparative Study of the Stone Expulsion Rate after Treatment with Tamsulosin, Tadalafil and Combination of Tamsulosin and Tadalafil
Sanjay Parashar, Pradeep Kumar Saxena, Akshat Pathak, Hemlata Gupta
Abstract
Objective: To compare the stone expulsion rate after treatment with tamsulosin, tadalafil and combination of tamsulosin and tadalafil. , the spontaneous passage of stones, the stone expulsion time, episodes of pain and analgesic dose required and side effects of drugs were noted and compared. Methods: Study is a hospital-based observational study conducted over a period of 18 months Patients aged ≥18 years presenting with solitary, symptomatic ureteral stone, size of 5-10 mm were grouped into three equal drug groups. Patients was advised drugs in Group A Tamsulosin 0.4 mg, Group B Tadalafil 10 mg and Group C Tamsulosin 0.4 mg with Tadalafil 10 mg . Follow-up routine visits on day 14, 28 and as and when required in acute pain. At each follow-up visit, the spontaneous passage of stones, the stone expulsion time, episodes of pain and analgesic dose required and side effects of drugs were noted. Results: The results of this study indicate that the use of tadalafil in comparison to tamsulosin increases the ureteric stone expulsion rate, although not statistically significant. The combination therapy of, tamsulosin and tadalafil proved to be safe and effective as demonstrated by the low incidence of side effects although more than single drug therapy but tolerable, and the increased stone expulsion rate and reduced expulsion time in comparison to singe drug therapy. Conclusion: The results of this study have shown a potentially significant role of tamsulosin, tadalafil and combination therapy for medical expulsive therapy of distal ureteral stones, broadening pharmacological spectrum of medical expulsion therapy which can be easily be provided in an outpatient setting.

44. Prospective Assessment within a Hospital Setting to Investigate the Utility of Diffusion-Weighted Imaging (DWI) in the Evaluation of Perianal Fistulae
Preeti Meena, Rajeev Ranjan
Abstract
Aim: The present study was conducted to evaluate the role of diffusion-weighted MRI in the evaluation of perianal fistulae. Methods: This prospective study was conducted in the Department of Radiology , Lord Buddha koshi medical college and Hospital, Saharsa, Bihar, India and included 80 patients with a total of 100 cryptogenic perianal fistulas and abscesses. These patients presented to the surgery clinic during the time period of 1 year. These patients were then referred for MRI evaluation if a perianal fistula was suspected. Results: The study included 80 patients, 67 were males and 13 were females. Mean age was 35.5 ± 9.2 years old with a range of 24–60 years of age. The total number of cryptogenic perianal fistulas and abscess was 100. These included 80 fistulas and 20 abscesses. Eight patients had more than 1 fistula or fistula and abscess. In perianal fistulas (n = 80), 30 fistulas were well visualized (score 2) on DWI, in comparison to 50 fistulas well visualized on T2W. In comparison, 20 fistulas were poorly visualized (score 1) on T2W and only 4 was not visualized (score 0). The visibility scores on T2W were not significantly different from that of DWI and both of them were less than the visibility scores of the combined DWI and T2W evaluation, although not significant. All perianal abscesses were well visualized on both sequences, with the same size, location, and extension. The visibility scores of perianal fistulas on DWI were not significantly different between PIA and NIA groups. Similarly, these scores on T2W did not show any significant variation between PIA and NIA groups. Conclusion: DWI alone is not superior to the T2W regarding the visibility of perianal fistula in our study. However, the best performance was observed for combined DWI-T2W image evaluation, although it was not statistically significant than DWI or T2W alone.

45. Serum Levels of Zinc, Copper and Magnesium in Type 2 Diabetes Mellitus: A Comparative Study
Kamlesh Kumar, Ankit Gaba, Vidyut Prakash
Abstract
Aim: The aim of the study was to estimate and compare serum zinc, copper and magnesium in Type 2 DM patients with nondiabetic controls and to correlate the serum zinc, copper and magnesium with HbA1c levels in Type 2 DM. Material & Methods: This study was a cross-sectional study conducted in Department of Pathology, Shree Narayan Medical Institute and Hospital, Saharsa, Bihar, India. . The sample collection and analysis was carried out between 10 months. Results: In controls, deficiency of zinc was not observed. However, 04 subjects had decreased serum levels of both copper and magnesium. Individual serum copper and serum magnesium deficiency were noted in 10 subjects each. Comparison of means between Type 2 DM patients and healthy controls using Independent t-test demonstrated that serum zinc was significantly decreased in Type 2 DM. Pearson’s correlation analysis showed that the association between zinc, copper and magnesium with HbA1c was random. Although, the correlation is not statistically significant. Conclusion: Zinc deficiency noticed in Type 2 DM patients may be due to increased excretion in urine. Zinc oral preparations are cheap and easily available. Considering these, it can be further explored if micronutrient supplementation would help to improve the glycaemic variability in Type 2 DM.

46. Clinico-Demographic Profile and Outcome Assessment of Surgical Management of Local Complications of Acute Pancreatitis
Nikhil Kumar, Sanjay Kumar
Abstract
Aim: This study aims to evaluate the indication and outcome of different surgical management modalities in local complications of acute pancreatitis. Methods: A hospital-based retrospective study was conducted in the Department of General Surgery at Shree Narayan Medical institute & Hospital, Saharsa, Bihar, India for six months. A purposive sampling method was utilized to recruit the patients. 383 patients were admitted to the surgery department with the diagnosis of acute pancreatitis or with complications of acute pancreatitis. Among them, 50 patients had local complications due to acute pancreatitis. Results: Out of 50 patients, 46% were females and 54% were male. 50% had ethanol etiology and 32% had pseudocyst pancreatic fluid collection. According to the location, 70% were at body or tail. According to Clavien-Dindo classification, 30% were in grade 2 followed by grade 1 (26%) and grade 4 (22%). Conclusion: Although various endoscopic techniques are now available to manage the pancreatic fluid collection and pancreatic necrosis, surgery remains essential in managing the disease.

47. A Hospital-Based Assessment of the Drugs and Multimodal Drugs Used in the Post-Operative Pain Management in Elective Laparotomies
Nikhil Kumar, Sanjay Kumar
Abstract
Aim: The study was conducted to record the drug used for postoperative pain in elective laparotomies and to determine the effectiveness of multimodal analgesics used. Methods: The present study conducted in the Department of General Surgery, Shree Narayan Medical institute & Hospital, Saharsa, Bihar, India for period of 10 months and all patients who underwent elective laparotomy were provided details about the study and method. Informed written consent was obtained. Detailed history of the patient, condition, surgery performed, analgesics used were documented. NRS score was calculated. A sample size of 100 patients fulfilling eligibility criteria was taken for the study. Results: A total of 100 patients were included among which 45 (45%) were female and 55 (55%) were the male patients. The patients who underwent elective laparotomies were 42 (42%) patients were in the age group of 40-50 years. The 20 different types of surgeries were recorded. The most common surgery performed in our study was open appendectomy which included 20 (20%) patients followed by open cholecystectomy (for carcinoma gall bladder and other indications) which included 8 (8%) patients. Most common was general anaesthesia with transverse plane block which was used in 36 (36%) patients, followed by general anaesthesia with quadratus lumborum block which was used in 20 (20%) patients. Most common mode of analgesia used was combined analgesia. Injection tramadol 50 mg in 100 ml normal saline with continuous epidural bupivacaine in 50 (50%) patients followed by injection diclofenac AQ 75 mg in 100 ml N.S with continuous epidural in 30 (30%) patients. NRS score was recorded for all the 100 patients on postoperative days 1, 2 and 3. Severity of pain gradually reduced from post -operative days 1-3 with the use of various analgesics. Conclusion: Multimodal analgesia was used in most of the patients for management of post – operative pain combined analgesia was better mode of pain management method than a single analgesic.

48. A Study of Association of Blood Pressure Distribution with Age, Anthropometric Measurements, and Socioeconomic Status in School Children
Mohd. Sirazuddin, N. Ranjith Kumar, Cheguru Sripal Reddy
Abstract
Background: Numerous studies have established standard blood pressure norms for children of different ages and races in their respective countries. Over the past four decades, there has been a two-fold increase in rural and a six-fold increase in urban areas. Various environmental and genetic factors, such as sex, body surface area (BSA), obesity, family history of hypertension, dietary habits, physical activity, stress, race, ethnicity, and socioeconomic status, play a role in influencing blood pressure among children and adolescents. Methods: This cross-sectional study was conducted in Mahbubnagar city, spanning school children aged 5 to 16 years from 11 randomly selected schools (Government and Private) based on a simple random sampling method from a provided list. Before commencing the study, clearance was obtained from the institutional ethical committee, and permission was granted by the school authorities. Results: There is a linear increase in mean blood pressure (BP) concerning age, sex, weight, height, social status, and locality. However, diastolic blood pressure (DBP) shows a strong negative correlation with sex, indicating that females have higher DBP, and children from lower socioeconomic classes and rural areas tend to have higher DBP levels. Furthermore, 27 children with a parental history of hypertension are found to be above the 85th and 95th percentiles. Both sexes demonstrated a positive correlation between BP and BMI. Conclusion: we observed similar results were observed for both sexes regarding systolic blood pressure (SBP) and diastolic blood pressure (DBP). We noted a linear increase in mean SBP and DBP with advancing age, weight, height, and BMI. Moreover, there was a direct correlation between a family history of hypertension and high socioeconomic status (SES) with SBP and DBP levels. Specifically, class I SES exhibited higher mean SBP than class III SES.

49. Hypersensitivity Reaction Induced by Lignocaine Hydrochloride: A Case Series
Bhavana Srivastava, Neeraj Rajdan, Kunal Sharma, Bhawna Virak, Kalpana Joshi
Abstract
Lignocaine Hydrochloride is the preferred anaesthetic agent used in surgical procedures. Hypersensitivity reactions are exaggerated immunologic reaction occurring in response to exogenous and endogenous substances. Triple Response is an immediate type Hypersensitivity reaction having cutaneous response due to release of histamine which is a dibasic vasoactive amine located in skin and other body tissues Suspected ADRs due to Lignocaine Hydrochloride were reported from Obstetrics and Gynaecology Dept. The ADRs were filled in Suspected ADR reporting form and as per WHO-UMC causality assessment scale causality was assessment was done and ADRs were reported through vigiflow to Indian Pharmacopeia commission, Ghaziabad. A case series of hypersensitivity reaction due Lignocaine Hydrochloride is presented. First one is 40-year-old-female admitted for Vaginal hysterectomy with perineal floor repair under surface anaesthesia. Second one is 24 -year- old female admitted for Tubal Ligation under surface anaesthesia and third one is 21 -year- old female admitted for resuturing of incision site under surface anaesthesia. All these patients experienced triple response after the injection was given.It is important for practitioners to be aware that allergic reactions though very rare, can occur after injection of lignocaine intradermally for allergy testing. A proper diagnosis and management of such allergic reaction is very essential to avoid undesired consequences. `

50. Factors Influencing the Decomposition of Human Dead Bodies in Tropical Climate- All Weather Cross-Sectional Study
Mukesh Rai, Avinash Thakur, Jayanthi Yadav, Gaurav Tiwari
Abstract
Background: The decomposition process of human dead bodies in tropical climates is a complex and dynamic phenomenon, influenced by a multitude of factors. Aim: This research paper presents a comprehensive all-weather cross-sectional study aimed at investigating the various factors that significantly impact the decomposition of human remains in tropical environments. Material and Methods: A single cross-sectional study was conducted on dead bodies brought for autopsy at the Department of forensic medicine, Gandhi Medical College, Bhopal. The body was examined on several parameters related to human decomposition and total body decomposition score was calculated. Employing a multidisciplinary approach, researchers conducted macroscopic and microscopic analyses to comprehensively assess the decomposition stages and processes. Results: Of the total 105 human dead bodies included in the present study-Males Contributed to 83 cases (79%) of cases and Females contributed to 22 (21%) cases. The mean age of the person at the time of death was 36.5 years, ranging from a minimum of 8 months infant to a maximum of 84 years. Most of the dead bodies were found and brought to the mortuary during the summer months (63- 60%), followed by the rainy season (30, 28.6%), and winter season (12, 11.4%). We observed a positive correlation and association between several factors, including scavenging, insect activity, temperature, and humidity, and the process of decomposition. Conclusion- In addition to environmental factors, insect colonization and micro environment where the body was found emerged as a critical determinant influencing the rate and pattern of decomposition in tropical regions. The study highlights the diversity and speed of insect activity in tropical climates, providing crucial insights into the timeline of decomposition and the succession of insect species.`

51. Correlation Between Gestational Age and Placental Thickness as Determined by Ultrasonography
Diddi Vamshi Kiran
Abstract
Background: Assessing placental thickness is a relatively straightforward and valuable clinical practice. Anomalies in placental thickness are widely acknowledged as early indicators in a range of pathological conditions. The measurement of placental thickness can play a pivotal role in the care and management of a potentially compromised fetus. The present study aimed to investigate the utilization of ultrasonography for measuring placental thickness during the third trimester of pregnancy and establishing a correlation between placental thickness and the gestational age of the fetus. Methods: This was a cross-sectional study carried out in the Department of Radiology, Prathima Institute of Medical Sciences, Naganoor, Karimnagar. Sample Size: 100 antenatal women. Placental thickness was assessed at the point of umbilical cord insertion. The investigation focused on measuring placental thickness, and the mean thickness was then correlated with gestational age ranging from 28 weeks to 40 weeks. Results: The findings revealed a gradual increase in placental thickness from 34.9mm at 28 weeks to 43.4mm at 40 weeks. Conclusion: The study established a direct relationship between placental thickness and gestational age. Moreover, placental thickness also displayed a linear relationship with other parameters such as biparietal diameter (BPD), femur length (FL), and abdominal circumference (AC). As a result, placental thickness in millimeters could serve as a valuable supplementary parameter for estimating gestational age, particularly between the 28th and 40th weeks of pregnancy.

52. Assessing Prevalence of SNHL in Type 2 Diabetes Patients and to find the Effect of Duration and Control of Diabetes on Hearing Loss: An Analytical Cross-Sectional Study
Satyabrata Dash
Abstract
Aim: The aim of the present study was to find the prevalence of SNHL in type 2 diabetes patients and to find the effect of duration and control of diabetes on hearing loss. Methods: The present analytical cross sectional study was conducted in Department of ENT, Gauri Devi Institute of medical Sciences and Hospital, Durgapur, West Bengal, India for period of one year after obtaining the ethical clearance from the Institutional Ethical Committee. The present study was conducted on 100 type 2 diabetes patients and age and gender matched 100 non- diabetic controls in the age group of <50 years. Results: In the present study, 65% were females and 35% were male. The mean age of patients was 43.17, mean fasting blood sugar was 131.49±28.52, mean PP blood sugar was 170.20±40.25 and mean HbA1c was 7.43±0.49. Mean age of patients was 36.54, mean fasting blood sugar was 109.01±3.14, mean post-prandial blood sugar was 124.56±9.81 and mean HbA1c was 6.006±0.222. The result showed that only 26 patients had normal hearing and 74 patients had SNHL whereas 14 patients in this group had minimal hearing, 20 had mild SNHL, 48 had moderate, 5 had severe SNHL and 13 patients had profound SNHL. 70 patients had DPOAE refer whereas 30 patients had DPOAE pass. Wave V grossly delayed in DM group as compared to non-DM with all frequencies (i.e. 70, 80 and 90) whereas interpeak latencies of wave I-V at 70 db frequency is almost equal in DM and non-DM group but it increase with increase in frequencies (i.e. 80 and 90 db). Conclusion: The findings of this study indicate that individuals with diabetes are at a significant risk of experiencing auditory dysfunction. As a result, it is strongly advised that individuals who are newly diagnosed with diabetes undergo a comprehensive audiological assessment upon diagnosis. Additionally, regular follow-up evaluations every six months to one year are recommended in order to promptly identify any impairment to auditory functions. While it is acknowledged that hearing loss may be influenced by other variables apart from diabetes, maintaining optimal glycemic control in individuals with type 2 diabetes may potentially decrease the likelihood of developing this condition.

53. Efficacy and Safety of Olopatadine 0.1% Ophthalmic Solution and Bepotastine 1.5% Ophthalmic Solution in Patients with Vernal Keratoconjunctivitis
Niroop R, Chandani Ashok Kumar
Abstract
Aim: The purpose of the present study was intended to compare the effectiveness and safety of olopatadine 0.1% ophthalmic drops and bepotastinebesilate 1.5% ophthalmic drops with BD administration to relieve the symptoms of VKC in a tertiary care hospital. Methods: The study was done in the Department of Pharmacology, for duration of 12 months. Institutional ethics committee approved the study. By simple randomization (odd/even number) method, registered patients were grouped into A and B. Group A and Group B were given olopatadine 0.1% ophthalmic drops and bepotastinebesilate 1.5% ophthalmic drops, respectively, administered one drop in the affected eye twice daily for 6 weeks. Results: The itching scores among the treatment groups with all follow-ups compared with baseline are not statistically significant. The mean ocular discomfort scores during each visit. At the 1st, 2nd, and 3rd follow-up, there is statistical significance in ocular discomfort scores with Group B.The mean watering scores during each visit. In Group B, during the 2nd, 3rd, and 4th follow-ups, there is statistical significance in watering scores (P < 0.05). Conclusion: In this study, based on the evaluation of therapeutic performance, bepotastine eye drops proved quicker relief of symptoms and signs compared to olopatadine eye drops but was not statistically significant which would prove beneficial for the patients.

54. Efficacy of Addition of Dexmedetomidine to Levobupivacaine in Patients Posted Electively for Upper Limb Orthopedic and Soft Tissue Surgery
Rajeev Kumar, Asif Siddiqui
Abstract
Aim: To assess the effect of levobupivacaine 0.5% alone and with dexmedetomidine 100 µg as an adjuvant to levobupivacaine 0.5% on the onset and duration of sensory and motor block, the duration of perioperative analgesia, complications and sedation score. Methodology: This analytical comparative study was carried out Department of Anesthesiology for one year on 50 patients in hospital  The participants were divided randomly into two groups of 25 each using sealed envelope technique. The first group (LD group) was administered 1 ml (100µg) dexmedetomidine with 39 ml of 0.5% Levobupivacaine. The second group was given 1 ml of 0.9% normal saline and 39 ml of 0.5% Levobupivacaine as anesthetic agent. Saturation of oxygen (SpO2), heart rate, diastolic blood pressure, systolic blood pressure, were noted at 0, 5, 10, 15, 30, 60, 90, and 120 minutes. Side effects like heart rate less than fifty per min (bradycardia) and blood pressure less than 20% with respect to resting conditions (hypotension) were treated with appropriate measures. Then we noted the period of motor and sensory blocks once the surgery is started. Results: In the LD group males and females were 64% and 36% respectively. In LS group, it was 56% and 44% respectively. All the study participants in LD group did not require post-operative analgesia while all in LS group were given Postoperative analgesia. 28% in LD group were slightly drowsy compared to 100% in LS group. The mean duration of onset of sensory and motor block was nearly 4 min earlier in LD group compared to LS group.(5.42 vs 9.21 min of sensory and 8.40 vs 12.33 min of motor). The mean duration of sensory block (533 vs 921.75 min) and motor block (553.73 vs 943.18 min) were approximately 400 minutes lesser respectively between both the groups. The duration post-operative analgesia was 579 and 980.74 min in both the groups respectively. All the results were statistically significant. 24% of study population in LD group had bradycardia compared to 0% in LS group. No other adverse effects was recorded in the study subjects. Conclusion: Based on the findings of this study, perineural infiltration of dexmedetomidine as an adjunct to 0.5% levobupivacaine increases the sensory and motor block duration. It also prolongs the duration of analgesia and also provides a good intraoperative sedation as well and helps to reduce the postoperative analgesic requirement.

55. Study of Sepsis and its Markers in Renal Failure Patients on Hemodialysis
Manish Gautam, Binod Kumar
Abstract
Aim: The present study was conducted to study the presence of bacteremia, markers of sepsis and Inflammation in renal failure patients on hemodialysis, along with correlation of hematological abnormalities with sepsis in such patients. Material & Methods: The present study was conducted at department of General medicine for one year and total of 100 patients of both sexes who were diagnosed as case of renal failure which include both acute kidney injury (AKI) and CKD on basis of clinical history, examination, biochemical markers and were advised for hemodialysis were included in the study. Results: In our study among 100 patients of renal failure on hemodialysis the mean age in our study was 44.76±14.46 years with 65 male patients. Out of 100 patients 20 (20%) had positive blood and catheter tip culture and 80 (80%) of patients had negative blood and catheter tip culture. Out of 20 patients with sepsis 4 (20%) were in the age group between 15–25 years, 4 (20%) were in the age group between 26–35 years, 3 (15%) were in the age group 36–45 years and 9 (45%) were above 45 years of age. All 20 (100%) patients had episode of fever with chills and rigor, 9 (45%) patients had redness and pain at hemodialysis catheter site, 6 patients (30%) were confused, disoriented or comatose and 4 (20%) patients had hypotension. Among 20 patients of renal failure with sepsis, none had TLC less than 4.8/cumm (leucopenia), 5 (25%) patients had count between 4.8–10.8/cumm and 15 (75%) patients had TLC more than 10.8/cumm. Conclusion: Patients requiring hemodialysis, who are having non modifiable risk factors like age, sex other risk factors for infection should be controlled to reduce incidence of infection.

56. A Hospital Based Assessment of the Factors Increasing the Risk of PROM and Effect of Duration of Rupture of Membranes on Fetomaternal Outcome
Suchandra, Renu Jha, Kumudini Jha
Abstract
Aim: The aim of the present study was to assess factors increasing the risk of PROM and effect of duration of rupture of membranes on fetomaternal outcome. Methods: A prospective observational study was conducted on 200 patients presented with term PROM in the Department of Obstetrics and Gynaecology for the period of one year. Results: PROM was more common in women with age 21-25years (73%), who were housewife (90%), were underweight (19%), were from the rural area (58%), belong to lower SES (62%) and were primigravida (58%). Majority (85%) of patients had spontaneous onset of labour in less than 24 hours of PROM and 6 (15%) went into spontaneous labour after 24 hours of PROM. Out of 60 women who had vaginal delivery, labour was induced in 86.66% women. Most common risk factor was malpresentation (45%) followed by history of PROM (30%), Polyhydramnios (14%), multiple pregnancy (10%) and febrile illness (5%). The most common indication for Caesarean section was previous 1 LSCS (10%), followed by fetal distress (4%), breech presentation (4%) and cephalopelvic disproportion (1.5%). Out of 220 babies, 12 (5.45%) were admitted in NICU for jaundice, RDS, early neonatal sepsis, conjunctivitis, neonatal seizures, meconium aspiration syndrome, perinatal asphyxia. It was found statistically significant. Majority of the neonates were admitted for 3 days. 3 (25%) neonates required admission in NICU for <3days and 4 (33.34%) neonates required NICU admission for >3days. Conclusion: PROM is associated with poor fetomaternal outcome and timely diagnosis and prompt management is required for better outcome.

57. Assessment of the Outcome of Vacuum Assisted Wound Therapy in Patients with Open Musculoskeletal Injuries: An Observational Study
Sanjay Kumar, S.K. Jha, P. D.Verma, R. K. Ajay
Abstract
Aim: The aim of the present study was to evaluate the results of vacuum assisted wound therapy in patients with open musculoskeletal injuries. Methods: The study was conducted on 50 patients in the Department of Plastic Surgery over a period of  12 months, after obtaining the permission from institutional ethical committee and taking informed and written consents from the patients. Results: Out of 50 patients, 35 were male and 15 were females. Mean patient age was 39 ± 18 years (range, 18 to 76 years). Road traffic accident was the most common mode of injury (56%), with most of the wounds located over extremities. According to Gustilo Anderson classification, out of 50 patients, 28 patients had grade IIIb injury, 10 had grade IIIc injury, 7 had IIIa injury, and 5 had grade II injury. There was significant decrease in wound size from day zero to day eight in VAC group in comparison to saline-wet-to-moist group. There was significant decrease in the bacterial growth in the VAC group as compared to saline-wet- to-moist group. On histological comparison too, there was a statistical difference between the VAC group and saline-wet-to-moist group, 𝑃 value being less than 0.05 by using Wilcoxon signed rank test between the findings from day zero to day eighth. Conclusion: Vacuum assisted closure therapy appears to be a viable adjunct for the treatment of open musculoskeletal injuries. Application of sub atmospheric pressure after the initial debridement to the wounds results in an increase in local functional blood perfusion, an accelerated rate of granulation tissue formation, and decrease in tissue bacterial levels.

58. An Observational Study to Study Pattern of Cervical Pap Smear Cytology at a Tertiary Hospital and to Correlate it with Clinical Findings
Shweta Sushmita, Kamlesh Kumar, Anjay Abhiram Sharma
Abstract
Aim: The present study is intended to evaluate the pattern of cervical Pap smear cytology at a tertiary hospital and to correlate it with clinical findings. Methods: The prospective study was carried out at Department of Pathology during for the period of one year and total 500 patients were screened. The patients were in the age range of 19-69 years, having complaints like watery vaginal discharge, bleeding per vaginal, intermenstrual bleeding, post-coital bleeding, something coming out per vagina, foul smelling discharge and itching in private parts. Results: The maximum number of cases was in the age group 30-39 years constituting 34% of the total cases followed by age group 20-29 yrs. The oldest case was of age 65 years. Minimum percentage (2%) of cases were under 60-69 age group. The maximum number of cases was in the age group 30-39 years constituting 34% of the total cases followed by age group 20-29 yrs. The oldest case was of age 65 years. Minimum percentage (2%) of cases were under 60-69 age group. Vaginal discharge was the commonest chief complaint followed by lower abdominal pain. Total 46% showed inflammatory lesion, 1% showed atrophy, 0.2% showed ASCUS, 0.2% showed LSIL, 0.2% showed HSIL, 2% showed SCC, 10% showed metaplasia. Cytological findings broadly classified into unsatisfactory smears, normal and abnormal smears. There were 350 (70%) abnormal Pap smears (benign cellular changes of inflammation as well as Epithelial Cell Abnormalities (ECA), with 20% normal cases and 10% unsatisfactory samples. Inadequate smear are reported unsatisfactory. They did not show adequate number of well visualized and preserved squamous cells either less in number or observed by inflammatory cells or blood. Conclusion: This study emphasized the importance of Pap smears screening for early detection of premalignant and malignant lesions of cervix.

59. An Observational Study to Assess Visual Outcome after Cataract Surgery in Rural Population
Pankaj Varshney, Monika Agarwal, Dhananjay Kumar
Abstract
Aim: The aim of the present study was to assess the visual outcome after cataract surgery in rural population of Bihar. Material & Methods: We carried out a population-based cross-sectional study at department of Ophthalmology. All the adults who were 50 years and older for over 1 year were included in the study.Results: The odds of poor visual outcomes among those aged over 80 years was higher than for those 50–59 years. T he most likely causes were visual impairment and blindness in eyes with presenting visual acuity worse than 6/18. Factors associated with risk of poor visual outcomes were evaluated using univariate multivariate logistic regression. Conclusion: Cataract outcomes can be definitely improved with a good follow-up component in the cataract blindness program that results in elimination of the treatable causes for poor outcomes. Though the proportion of IOL implant surgery has increased, support services such as the availability of YAG lasers and infrastructure for follow-up have not kept pace. There is a need to enhance the cataract surgery program to include adequate infrastructure for postoperative monitoring and appropriate management. By improving this facility, the prevalence of visual impairment in pseudophakics can be minimized.

60. Frequency and Patterns of Different Cutaneous Granulomatous Lesions with its Clinico-Histopathological Correlation: An Observational Study
Shweta Sushmita, Anjay Abhiram Sharma, Tanvi Agarwal
Abstract
Aim: This study was conducted with the aim to evaluate the frequency and patterns of different cutaneous granulomatous lesions with its clinico-histopathological correlation to reach etiological diagnosis. Materials and Methods: The present cross-sectional Observational was conducted in the Department of Pathology for the period of 2 years. This prospective cross sectional study enrolled 200 cases of skin biopsies after histopathological confirmation of granulomatous lesions. Results: Among 200 cases were studied in which male predominance was noted with 130 (65%) cases and females constituted 70 (35%). Most of the patients were noted in age group of 21 to 30 years i.e 74 (37%) cases followed by 38 (19%) case in 31 to 40 years. 87% of cases were seen below 50 years of age in our study. Leprosy remained the significant causative reason for infectious granulomatous dermatoses succeeded by tuberculosis of skin. Borderline tuberculoid leprosy was found to be predominant, constituting 50 (25%) cases followed by indeterminate 46 (23%) and lepromatous leprosy had 44 (22%) cases, tuberculoid leprosy 34 (17%) case and 14 (7%) of borderline lepromatous. Lupus vulgaris constituted 4 cases (2%) and only 4 (2%) case of sarcoidosis was found. Conclusion: Leprosy was the most common cause of cutaneous granuloma followed by Tuberculosis, fungal infection and foreign body reaction. Among the cases of leprosy, borderline tuberculoid leprosy and tuberculoid leprosy were the commonest subtype.

61. An Analytical Cross-Sectional Study Assessing Prevalence of SNHL in Type 2 Diabetes Patients and to Find the Effect of Duration and Control of Diabetes on Hearing Loss
Anjay Abhiram Sharma, Tanvi Agarwal, Sawan Kumar
Abstract
Aim: The aim of the present study was to find the prevalence of SNHL in type 2 diabetes patients and to find the effect of duration and control of diabetes on hearing loss. Methods: The present analytical cross-sectional study was conducted at department of Pathology for period of one year. The present study was conducted on 100 type 2 diabetes patients and age and gender matched 100 non- diabetic controls in the age group of <50 years. Results: In the present study, 65% were females and 35% were male. The mean age of patients was 45.15, mean fasting blood sugar was 132.58±26.64, mean PP blood sugar was 174.16±43.27 and mean HbA1c was 7.40±0.45. Mean age of patients was 36.64, mean fasting blood sugar was 110.04±3.16, mean post-prandial blood sugar was 127.53±8.92 and mean HbA1c was 6.004±0.220. The result showed that only 26 patients had normal hearing and 74 patients had SNHL whereas 17 patients in this group had minimal hearing, 20 had mild SNHL, 23 had moderate, 6 had severe SNHL and 8 patients had profound SNHL. Wave V grossly delayed in DM group as compared to non-DM with all frequencies (i.e. 70, 80 and 90) whereas interpeak latencies of wave I-V at 70 db frequency is almost equal in DM and non-DM group but it increases with increase in frequencies (i.e. 80 and 90 db). Conclusion: This study concluded that the diabetics are at definite risk of developing auditory dysfunction, therefore it is recommended that all newly diagnosed diabetic patients should undergo a complete audiological evaluation at the time of diagnosis and a regular half yearly or yearly follow up is warranted for early detection of damage to auditory functions. Although factors other than diabetes contribute to hearing loss, early glycemic control for type 2 diabetic patients may reduce the incidence rate of this disease.

62. A Retrospective Assessment of the Change in Profile of Cutaneous Manifestations of HIV after the Advent of Antiretroviral Therapy
Rajeev Jain, Rudra Pratap Singh Kaurav, Rajesh Kumar
Abstract
Aim: The aim of the present study was to determine the prevalence of mucocutaneous conditions among HIV positive patients on antiretroviral therapy. Material & Methods: A retrospective medical record review of patients attending an out-patient antiretroviral clinic at department of skin and VD were reviewed. 150 records were included in the analysis. These were classified as antiretroviral naïve (100 medical records) and antiretroviral experienced (50 medical records). Results: Of the 150 patients included in the analysis, 50 (33.34%) were on antiretroviral therapy while 100 (66.66%) were antiretroviral naive. 74 patients were male while 76 were female. For patients on antiretroviral therapy, the majority were in the age group 45 to 55 years. The majority of antiretroviral naive patients were in the age group 35 to 44 years. The mean duration on ART was 66.94 weeks (95% CI 42.86 to 95.85; standard deviation 102.18) for patients on antiretroviral therapy. The median baseline CD4 count was 154 for antiretroviral naive patients and 122 for patients on antiretroviral therapy. 15 patients tested positive for Syphilis and 5 had positive HbsAg tests. There was no significant difference in the CD 4 categories between patients on antiretroviral therapy and antiretroviral naive patients. Our findings were classified into infectious and non-infectious causes based on their etiologies. Viral infections were observed in 60 cases and bacterial infections in 20 cases. Conclusion: Dermatological complications of HIV/AIDS arise from a variety of conditions with various etiologies. Therefore, careful considerations should be given to timely diagnosis and prompt treatment of dermatological complications among HIV patients. Besides the clinical difficulty in preventing and treating skin diseases, the skin also affects the patient’s general appearance and their quality of life.

63. Prospective Observational Assessment of Hypocalcemia in Neonates with Unconjugated Hyperbilirubinemia Receiving Phototherapy
Pradeep Kumar Singh, Ajay Kumar, G. Dharamraj Patra
Abstract
Aim: The aim of the present study wads to assess the prevalence of hypocalcemia in neonates with unconjugated hyperbilirubinemia receiving phototherapy and to observe association of hypocalcemia with duration of phototherapy. Material & Methods: A prospective observational study conducted over a period of 30 months among 200 neonates (both term and preterm) in the Department of Paediatrics. Results: The mean age of preterm and term neonates was 118.12±42.78 and 122.28±41.19. There were more males as compared to females in preterm and term neonates. Mean birth weight of preterm and term in this study were 2723.17±246.44 grams and 3132.78±370.90 grams respectively. 10 term neonates experienced hypocalcemia at 12 hours after starting of phototherapy. Similarly, 20 term neonates had hypocalcemia 48 hours after starting of phototherapy. None of the preterm neonates enrolled in the study experienced hypocalcemia after starting of phototherapy. It was observed that occurrence of hypocalcemia was not significantly associated with the duration of phototherapy. On comparing the 0 hours calcium level with subsequent hours, the mean difference in total serum calcium levels in both term, and preterm babies were found to be statistically significant and the difference was seen to be more significant in term babies. Correlation analysis of a duration of phototherapy with hypocalcemia showed a negative but insignificant correlation with a coefficient (r of −0.045 and a p=0.95). Conclusion: A reduction in the serum calcium with increased duration of phototherapy, however, it does not fall to the level where treatment is required. Hence it is not recommended to monitor serum calcium levels in neonates receiving phototherapy.

64. A Case Control Assessment of LFT and Haemoglobin and Plasma Glucose Levels between Alcoholic and Non-Alcoholics
Ravi Shankar Singh, Munindra Kumar, Swayam Prakash
Abstract
Aim: The aim of the present study was to compare anthropometric measurements, liver function tests, haemoglobin and plasma glucose levels in individuals with alcohol abuse and normal population. Material & Methods: The study was carried out in the Department of General Medicine in between the duration of 24 months. The study included 100 individuals with alcohol abuse recruited from department of General Medicine. A total of 50 patients, age, sex, height and weight matched healthy individuals were taken as controls. Results: The mean age of the individuals with alcohol abuse was 42.8 years and mean age of controls (non-alcoholics) was 41.09 years. This difference was not statistically significant with respect to the age of the cases and controls. About 42% of the individuals with alcohol abuse belonged to 31-40 years and 38% belonged to 41- 50 years. About 44% of the non-alcoholics belonged to 41-50 years and 42% belonged to 31-40 years. About 16% of the individuals with alcohol abuse had hypertension, 2% had Dyslipidemia, 1% had Prolapse intervertebral disc, 1% had obesity and 80% had no comorbidy. About 8% of the non-alcoholics had hypertension. There were 30% of the individuals with alcohol abuse had the history of binge drinking in this study which was statistically significant. The difference was not statistically significant between the cases and controls in terms of anthropometric measurements. The mean post prandial glucose among the individuals with alcohol abuse was 116.8 mg/dl and among the controls was 121.1 mg/dl. The difference was statistically significant. Conclusion: The individuals with alcohol abuse have raised serum bilirubin, AST and ALT levels compared to the non-alcoholics. Prevalence of hypertension is higher in the individuals with alcohol abuse compared to normal population.

65. A Retrospective Observational Assessment of Acute Lower Limb Ischemia (ALLI) among Patients Infected with COVID-19
Reyaz Anjum, Navneet Kumar Agarwal, Rajeev Ranjan
Abstract
Aim: The aim of the present study was to investigate the prevalence of acute lower limb ischemia (ALLI) among patients infected with COVID-19. Material & Methods: We performed a retrospective observational study on 50 patients with acute limb ischemia (ALI) and SARS-CoV-2 infection at department of Radiology  The inclusion criteria were: presence of SARS-CoV-2 infection and acute event of vascular disease, i.e., acute limb ischemia. Results: 50 patients aged 43–86 years old (mean age 62.88 ± 8.52 years) were admitted. There were 35 males (70%) and 15 females (30%). In terms of co-morbidities, patients were obese, had diabetes mellitus, high blood pressure. 46% patients had habit of smoking. The patients were treated by open surgery (42 patients—84%) or by the means of endovascular techniques (8 patients—16%). The amputation-free survival rate was 82% in hospital and 86% at 1-month follow-up. Conclusion: The application of the standard treatment—open surgery or endovascular revascularization in patients with acute limb ischemia and SARS-CoV-2 infection is the key to success for lower limb salvage. The prolonged administration of anticoagulants (both in the periprocedural period and after discharge) can improve surgical results, limb salvage, and patient survival.

66. A Retrospective Observational Study to Evaluate the Functional Outcome of Type III and IV Radial Head Fractures Treated by Radial Head Prosthesis
Durga Shankar Meena, Kirti R. Ramnani, Ashiwani Kumar Pankaj
Abstract
Aim: The aim of the present study was to evaluate the functional outcome of type III and IV radial head fractures treated by radial head prosthesis. Material & Methods: A retrospective study included 70 patients of type III and IV radial head and neck fractures according to Mason’s classification. They were admitted and treated in the Department of Orthopaedics with radial head prosthesis over the duration of 2 years. Results: Out of 70 cases, 45 cases were <40 years and 25 cases were >40years. The mean age was 39.3 years. Maximum age was 54 years, minimum age was 30 years. Majority were females as compared to males. Mechanism of injury most of the cases i.e 68.58% were due to history of fall and remaining were due to RTA. 54 cases (77.14%) were right side dominant and 16 cases (22.86%) were left side dominant. In our case study group, out of 70 cases, 56 cases (80%) were under Modified Mason’s classification type Ill and 14 cases (20%) were under Modified Mason’s classification type IV. Out of 70 cases, 55 cases (78.57%) were not associated with any ligamentous injury, 7 cases of LUCL and 8 cases of MCL injury was noted. Mean flexion at 2nd week post-op was 79.31 degrees which improved to 118.32 degrees at 6 post-op weeks. The mean extension deficit at 2nd post-op week (24 degrees) improved to (10 degrees) at end of 6th post-op week. The mean pronation at end of 2nd post op week was 20 degrees which improved to a mean of 63.17 degrees at end of 6th post op week. The mean supination at end of 2nd post-op week was 37 degrees and it improved to a mean of 70.32 degrees at end of 6th week post-op. The P value of flexion, extension, pronation and supination was found to be very significant. 49 cases (70%) had MEPI score (Mayo Elbow Performance Index) >90 which indicates excellent result, 14 cases (20%) had MEPI score 75-89 which is good result and 7 cases (10%) had MEPI score 60-74 which indicates fair result. Conclusion: Radial Head Prosthesis is a viable option in communited and irreparable radial head fractures. Proper preoperative planning, good Intraoperative technique and rigorous postoperative rehabilitation gives predictable results.

67. A Study to Assess the Role of Conservative Treatment and Surgical Management of venous Ulcers: An Observational Study
Prabhat Ranjan, Sanjay Kumar, Shashi Dharan
Abstract
Aim: The aim of the present study was to assess the role of conservative treatment and surgical management of venous ulcers. Methods: An observational study was conducted at the Department of General Surgery, Lord Buddha Koshi Medical College and Hospital, Saharsa , Bihar, India for the period of 2 years. 200 patients were studied who were patients attending the outpatient department and casualty during the study period with venous ulcers over the leg. Results: Out of 200 patients, 32 (16%) were 21-30 years old, 30 (15%) 31-40, 44 (22%) 41-50, 78 (39%) 51-60, and 16 (8%) 60+. The mean age was 48. There were 160 men (80%) and 40 women (20%). Of the total patients, 36 (18%) had a normal BMI, 104 (52%) were overweight, and 60 (30%) were obese. Fat was present in all 40 women. individuals with ulceration, discomfort, edoema, and skin abnormalities included 88 (44%) and 140 (70%) individuals. All of our patients had venous anomalies on clinical or radiological imaging. Out of the total number of patients, 84 (42%) had right leg venous ulcers and 106 (53%) had left leg ulcers. Ten people (5%) developed bilateral venous ulcers. In our analysis, 144 (72%) patients exhibited severe saphenous vein pathology, 46 (23%) had perforator incompetence, and 10 (5%) had short saphenous vein involvement. In our research, 40 patients (20%) had conservative therapy while 160 (80%) underwent surgery. 112 of 160 surgical patients had their Sapheno-femoral junction drained and GSV stripped to the knee. Each patient had a below-knee phlebectomy. Subfascial endoscopic perforator ligation was performed on 14 instances. Phlebectomy was performed alone on 32 individuals. 14 instances underwent SSV ligation. Conclusion: Treatment focuses on venous insufficiency correction. Surgery has the finest long-term outcomes.

68. An Observational Histopathological Assessment of the Changes in Liver Due To Poisoning Cases
Navin Kumar
Abstract
Aim: The aim of the present study was to assess histological changes in liver due to poisoning. Material & Methods: A two-year prospective study on assessment of histopathological changes in liver due to poisoning cases was studied amongst autopsies conducted at department of FMT In the present study, a total of 1785 autopsies were conducted. Of the total, 500 cases with the history of poisoning were studied in that 300 cases were females and 200 cases were male. Results: Age of the individuals varied from 7 years to 65 years amongst 51% of cases was in the age group of 25 to 35 years. Of 500 cases in 350 cases poisons were confirmed by chemical analysis of state forensic science laboratory, in that 200 cases were organo phosphorus compound, 100 cases were aluminium phosphide and zinc phosphide, 50 cases were Pyrethrin compounds and in remaining cases poison was not detected by chemical analysis. Of 500 cases, 200 were organophosphorus compound in that Congestion, sinusoidal dilatation, mononuclear and neutrophillic infiltration (Group I) were predominantly seen. 100 cases are phosphide compounds in that Cytoplasmic vacuolization, hydropic degeneration, Patchy or centrilobular necrosis and patchy haemorrhages (group II & III) were predominant. In 50 cases of Pyrethrin compound group I & II changes were predominantly, in remaining unidentified poison cases mixed feature was observed. Amongst 500 cases, 325 cases were hospitalized for 0 – 1 day. In that group I histological feature were predominantly seen, 100 cases were hospitalized for 2-5 days; in that group II changes were predominant, 75 cases were hospitalized for 5- 10 days; in that group III changes were seen. Conclusion: By knowing the exact histopathological changes in these organs, it is easier to attribute death to a failure of one of these organs as a consequence of organophosphate consumption. Knowing the rapidity of involvement of an organ is beneficial to the treating physician as well thereby helping him reduce the morbidity and hence mortality

69. A Study on Mannheim Peritonitis Index in Peritonitis Individuals from a Tertiary Health Care Setup
N Durga Prasad, Kamadi Ramarao, P. Anusha, K. Sailaja
Abstract
Introduction: The Mannheim Peritonitis Index (MPI) stands out as a precise scoring system with high accuracy, offering a convenient means to predict the individual prognosis of peritonitis patients. The objective of this study was to assess the effectiveness of the MPI in predicting morbidity and mortality among patients with peritonitis. Methods: It was a prospective research conducted in government Medical College, Eluru. Study was conducted for a period of 8 months, from January to August 2021. Study protocol was approved by Institutional ethical committee. An informed written consent was taken from all the study participants. The study included patients of both gender, >18 years admitted to surgical wards and SICU with secondary peritonitis, encompassing both local peritonitis (LP) and general peritonitis (GP), throughout the study period. Detailed clinical history was collected, findings were recorded. After clarifying all the doubts MPI was calculated as per the standard and categorised to <21, 22 – 29 and >30. All the study members underwent laparotomy, antimicrobials were given for 10 – 14 days as protocol. Chisqaure test was used for statistical analysis and P <0.05 were considered to be statistically significant. Results: Total 98 members were included, the male female ratio was 1.43. Total 48 (49%) LP cases were detected, appendicitis was found to be the leading cause for the inflammation.  MPI scores wise, 59.3% were in <21, 26.5% in 21 – 29 and 14.3% in >30, maximum deaths were in >30 group; statistically there was significant difference. Conclusion: Patients with MPI scores below 21 exhibited a favorable prognosis, with a 0% mortality rate. Scores ranging from 22 to 29 were associated with high morbidity and mortality. In cases where scores were ≥ 30, the mortality rate peaked.

70. Study of Management of Intracapsular Fracture Neck of the Femur in Elderly with Bipolar Hemiarthroplasty
P. Kiran Kumar, T.V.S.S.N Leelaprasad, K. Srinivas Rao, P. Pavan Kumar
Abstract
Hemiarthroplasty is a common treatment for fracture neck of femur in elderly patients. Unipolar hemiarthroplasty has shown good results, though there is high incidence of erosion, protrusion and needs revision in future. The concept of dual bearing surfaces results in sharing of motion at the two surfaces and hence reduction of net wears at either surface, thus reducing erosion at the acetabular-joint interface. From our relatively short term prospective nonrandomized study, we conclude that bipolar hemiarthroplasty gives good results.

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