International Journal of

Toxicological and Pharmacological Research

e-ISSN: 0975 5160

p-ISSN: 2820-2651

Peer Review Journal

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1. The Study of Role of CT in Evaluation of Non-traumatic Acute Abdomen
Keerthi Bharathi P, Deepthi Tippani
Background: The term ‘Acute Abdomen’ denotes a medical condition marked by intense abdominal pain that emerges within a few hours. In determining the underlying cause of this condition, CT scans have proven to be more effective than clinical evaluation, basic laboratory tests, and inconclusive imaging examinations, regardless of the duration of signs and symptoms. This study aims to determine the significance of CT scans in diagnosing the origins of acute abdominal pain. Methods: A Toshiba Multi-slice CT scanner with 4 slices was utilized for all cases. Abdominal and pelvic images were captured in serial axial sections from the diaphragm to the lower border of the symphysis pubis. The collimation was set at 5 – 7 mm, and the pitch ranged from 1 to 1.5, depending on the required coverage length. Multi-planar reconstruction was conducted at intervals of 3-7 mm. The images were studied in both axial and coronal/sagittal reformatted views. Results: In this study, out of n=40 cases of non-traumatic acute abdomen existence of urinary pathologies followed by hepatobiliary pathologies. GI pathologies were in 25% of cases and pancreatic pathologies were in 12.5% of cases. Renal calculi were the cause of non-traumatic acute abdomen in 42.58% of cases followed by ureteric calculus in 35.71% and vesical calculus in 21.43% of cases. Conclusion: Proper diagnosis of acute abdomen is essential for effective management and reducing complications and mortality. While radiography is available, its use is mostly limited to cases of hollow-viscus perforation and intestinal obstruction. Ultrasound (USG) may be inconclusive in the presence of excessive bowel gas or abdominal fat, hindering the visualization of abdominal organs. Despite the slight increase in cost and the small risk of radiation, the prompt use of CT in investigating acute abdomen cases results in more accurate diagnoses and improves decision-making, ultimately leading to better patient outcomes.

2. Study of Prescription Audit in Inpatient Department of a Tertiary Care Teaching Hospital in Telangana
Ramasubramanian S, Yamini Vadlamannati, Anveshu Reddy Biradavolu, Naser Ashraf Tadvi
Background: The inappropriate use of drugs is a global health problem, especially in developing country like India. Irrational prescriptions have an ill effect on health as well as health-care expenditure. Prescription auditing is an important tool to improve the quality of prescriptions, which in turn improves the quality of health care provided. The present study was conducted to investigate the rational use of drugs for completeness, legibility, and against the World Health Organization (WHO)-recommended core drug use indicators. Methods: This cross-sectional study was conducted in inpatient department of tertiary care teaching hospital. A total of one hundred prescriptions were analysed from all clinical departments for general details, medical components and WHO core drug use indicators. Results & Conclusion: The prescribing practices in this study were good regarding mentioning of general details of patients and hospital, and satisfactory regarding handwriting legibility of physicians and average number of drugs prescribed per prescription.

3. Antibiogram of Klebsiella Pneumoniae Isolated from Various Clinical Samples of Critically Intensive Care Unit Patients: A Tertiary Care Hospital Based Study from South India
Madhavi Latha Bommala, Anil Kumar Bilolikar
Klebsiella associated infections is the emergence of multi-drug resistant strains particularly those involved in nosocomial diseases. Hence, this study has been designed to determine the isolation rate of Klebsiella pneumoniae, their antibiogram in various clinical samples in patients admitted in intensive care units of a tertiary care hospital. A total of 6274 clinical samples were processed during the study period. Out of which 185 (2.94%) Klebsiella pneumoniae isolates were identified from various clinical samples during the study period. It was isolated highest in ET secretion samples (9.73%), followed by urine (2.18%), pus (1.34%) and blood (1.02%). Imipenem (58%) & Meropenem (58%) showed highest sensitivity followed by Amikacin (52%), Gentamicin (35%). Susceptibility to 3rd generation cephalosporins and beta-lactum & betalactamase inhibitor combinations was 10%-20%. We noticed that Klebsiella pneumoniae resistant to a wider range of antibiotics. Both morbidity and mortality is increased when infection is caused by these drug resistant organisms.

4. Evaluation of Knowledge, Attitude and Practice of Health Care Providers towards Adverse Drug Reaction Reporting in a Tertiary Care Hospital
Ashraf Ali H, T Siyamala Devi, T Meenakshi
Background & Rationale: Pharmacovigilance plays an essential role in the prevention of ADRs. Under-reporting of adverse drug reactions (ADRs) by Health care providers is a common problem. The study was undertaken to evaluate the knowledge, attitude, and practices (KAP) regarding ADR reporting among different healthcare providers. Objectives: (1) To assess the knowledge, attitude and practice of health care providers in pharmacovigilance and adverse drug reactions reporting. (2) To identify the reasons for underreporting of ADR. Materials & Methods: A Cross sectional study was conducted in a tertiary care centre by circulating a standardized e questionnaire among healthcare professionals. Results: Among the total 444 Health Care providers, 90% of the health Care providers were aware of the existence of ADR reporting system in India. 94% have no idea about Causality assessment and 90% don’t know about WHO online database for ADR reporting. 78% agreed that ADR reporting is necessary and 46% agreed that reporting ADR is a professional obligation. 92% have seen an ADR reporting form and 61% were trained in ADR reporting. 23% of responses attributed to Lack of time to report ADR as the most important reason for underreporting.18% think that single report may not affect ADR database. Fear of legal liability (11%) and unavailability of easy access to ADR forms (11%) were also quoted as reasons for under-reporting. 34% think that making ADR reporting mandatory is the way to improve ADR reporting. Conclusion: This study concluded that the health care providers have broader knowledge towards ADR reporting. The attitude towards ADR reporting showed positive trend towards ADR reporting. Further training and motivating them will improve ADR reporting.

5. Surgical Outcomes of Kinder’s Procedure in Symptomatic Accessory Navicular Bone Pain: A Case Series and Literature Review
Balaji. S, Agalya. K, Karthik.V, Arun. K, Arupjyoti Kurmi, Sandeep V.P, Roy Arokiam Daniel, Harish Chandra, Thiruselvam
Accessory Navicular bone is a normal variant in 12% of population. Majority of patients are asymptomatic. Symptomatic patients respond to conservative treatment well. But a little group of patients needed surgical correction. The main purpose of this study is to determine the Efficacy of Kidner’s Procedure. Twelve patients were taken up for the surgery who were followed up for a period of 6 months is discussed in this case series. Patients who undergo Kinder’s Procedure for Symptomatic Accessory Navicular bone had good results and improved in American Orthopaedic Foot and Ankle Score. It is a reliable procedure which can be safely done in those selective subjects.

6. Retrospective Study of Correlation Between Finger Print Pattern and Blood Grouping in First Year MBBS Students of NAMO Medical Education and Research Institute, Silvassa
Viras Patel, Vanraj Parmar, Mohan Gushinge, Nishith Chaudhari, Tejas C Patel, Sonal Govindwar
Introduction: The pursuit of accurate individual identification methods has driven research in fields like forensic science, genetics, and medical diagnostics. Fingerprints, known for their unique and stable nature, have captivated attention alongside blood grouping in medical practices. Fingerprint patterns—loops, whorls, arches—offer distinct identities, while blood groups, ABO and Rh, impact transfusions and compatibility. This study explores potential correlations between these traits, aiming to deepen genetic understanding and applications in forensics and medicine, focusing on first-year MBBS students at NAMO Medical Education and Research Institute, Silvassa. Material and Methods: In this retrospective study, we explored the intriguing correlations among fingerprint patterns, blood grouping, and gender distribution in a cohort of 200 first-year MBBS students at NAMO Medical Education and Research Institute, Silvassa. Data on fingerprint patterns and blood groups were collected during the admission process, and statistical analysis was performed to explore potential correlations. Results: Our findings revealed a distinct prevalence of loop patterns (42.5%) as the most common fingerprint pattern among participants, with arch patterns (34.5%) and whorl patterns (23.0%) following suit. Notably, blood group A+ exhibited a preference for whorl patterns (42.55%), while loop patterns were prominent in blood group B+ (49.06%). Gender distribution closely mirrored blood group representation, underscoring potential genetic influences. These intriguing associations between fingerprint patterns, blood groups, and gender emphasize the complexity of genetic interactions and warrant further exploration. Conclusion: Our study unveils significant correlations between fingerprint patterns, blood groups, and gender distribution among first-year MBBS students. Loop patterns predominate, with distinct preferences observed in blood groups. These findings provide novel insights into genetic interactions with implications for forensics and medical diagnostics.

7. Study to Evaluate the Efficiency of Tranexamic Acid & Mefenamic Acid in DUB
Sahil D. Patel, Harshdeep K. Jadeja, Bhavesh B. Airao
Introduction:  Dysfunctional uterine bleeding is one of the most commonly expressed complaints of women at reproductive age leads to anaemia and its complications. This study compares the efficacy and acceptability of tranexamic acid with mefenamic acid in treating DUB in order to show the most effective drug. Objectives: To determine if tranexamic acid and mefenamic acid can effectively and safely reduce menstrual blood loss & pain. Materials and Methods: 100 cases selected for the study who complained of regular long/ heavy menstrual bleeding more than 7 days or blood loss more than 80ml, who are at the age of 20-45 years. Drug Tranexamic acid 500mg QID were given to the patients who had mean menstrual blood loss of more than 80 ml based on assessment in the previous two menstrual cycles and dosage of mefenamic acid is 500 mg OD then 250 mg QID for 3 days. Results: The total study shows the affect of drugs on the amount of bleeding is 41.6% (P-value <0.05), there is significant reduction is seen in number of sanitary pad usage from 5.44 to 3.96 (P- value <0.05) and there is significant reduction in duration of bleeding. There are minimal gastrointestinal side effects, and there is 32% discontinuation of treatment in our study as patients are not satisfied and effective reduction in pain. Conclusion: Treatment with tranexamic acid and mefenamic acid could potentially improve the quality of life of women.

8. Effect of Nebulised Lidocaine on Haemodynamic Responses during Nasotracheal Intubation
Khyati Makwana, Pooja Fumakiya, Jagdishbhai Mer
Background and Aim: A common side effect of laryngoscopy and nasotracheal intubation is hypertension and tachycardia, which are brought on by temporary sympatho-adrenal activation. In this work, we compared the experimental group to the control group to examine the effects of nebulized lidocaine on the haemodynamic stress responses during nasotracheal intubation. This study’s main goal was to compare the differences in mean arterial pressure between two groups following nasotracheal intubation. Material and Methods: The current prospective comparison study was carried out over the course of a year in a tertiary healthcare facility. The study comprised 120 patients scheduled for head and neck surgery who were classified as physiologic status Classes I–II by the American Society of Anaesthesiologists. 5 ml of ordinary saline were nebulized to Group A (the control group). Lidocaine 4% solution in 5ml was nebulized for Group B. Before and after nebulization, just before intubation, immediately after intubation, and at 3, 5, and 10 minutes after intubation, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), and SpO2 were measured. Results: There was a substantial increase in both groups when SBP, DBP, MAP, and heart rate were compared to pre-intubation values, although the increase in the control group was greater than it was in the lidocaine group (p 0.05). After that, MAP, SBP, DBP, and HR all gradually fell until the study’s 10-minute end. Conclusion: Nebulized 4% inhalation given before to induction reduces the sympathetic activation and cardiovascular response brought on by nasotracheal intubation.

9. Identification, Assessment and Reporting of Adverse Drug Reactions (ADR) in a Large Tertiary Care Hospital in South India using Spontaneous Reporting System (SRS): A Prospective Observational Study
Padmalatha. P, Suhrut Nag. P, K. Chitra, Sirisha N.P., Viswanadh. P
Background: In most of the countries including India, Pharmacovigilance (PvPI) system relies mainly on spontaneous (or voluntary) reporting which provide the highest volume of information at the lowest maintenance cost, It is flexible and very effective method of collecting information whereby health professionals voluntarily submit case reports of ADR. As there is under reporting of ADRs and very less research is conducted in this area especially in south India, this present study was carried out with an aim to detect, assess (establishing causality relationship using WHO Scale), reporting (Using Spontaneous reporting system) and documentation of various Adverse Drug Reactions that occur in our tertiary care teaching government hospital at Visakhapatnam. Methodology: The present study was carried out in the in-patient wards of General Medicine department of King George Hospital (KGH), a large tertiary care teaching hospital at Visakhapatnam, Andhra Pradesh, India. The present study is a Prospective, Observational study done for a period of four months i.e., from 19-Dec-2017 to 16-Apr- 2018. A total of 103 Adverse Drug Reactions (ADRs) were identified and reported in 85 patients who met our study criteria and were enrolled into our study after obtaining the Informed consent. The present study was aimed to Identify, Assess, Report and document the suspected Adverse Drug Reactions using spontaneous reporting system. Results: In our study we have screened about 196 patients out of which 85 people developed ADRs and the causality assessment for each and every ADR was established using WHO probability scale. The details and all data pertaining to our study obtained using MS Excel 2010 work sheet. The most commonly identified reactions were drowsiness, tremor, myalgia and constipation out of 24 different reactions observed. Digestive system (35%) is the most effected organ system followed by integumentary (15%) and muscular (12%). The number of ADRs reported was higher in the age group 46-55. WHO assessment scale revealed that out of 103 ADRs (78.64%) were possibly drug related, (20.38%) probably drug related and( 0.97% )found to be certain. Conclusion: Health professionals have enough knowledge and awareness of the need to report ADR, but only smaller proportions report ADR. It depends on their knowledge, attitude and beliefs. Early identification and management of ADR is essential and special attention is to be taken in elderly patients, patients with comorbidities and poly pharmacy.

10. Endometrial Thickness and Embryo Quality in the Implantation in the Natural Cycle in Vitro Fertilization: A Prospective Analysis
Vineet Mishra, Zainab Raja, Rohina Aggarwal, Sumesh Choudhary, Kunnur Shah
Background and Aim: The challenge of determining thickness at the beginning of growth is one of the major issues in studying change in endometrial thickness. In contrast to a stimulated IVF cycle, one follicle that naturally develops to dominance is the treatment focus in NC-IVF, which leads in the majority of instances with a single embryo being available for transfer. The aim of our study is to assess the effect of endometrial thickness and embryo. Material and Methods: After Natural Cycle in Vitro Fertilization (NC-IVF) was carried out, 250 cases of ET were included in the study. Based on the results of the -hCG pregnancy test two weeks after ET and confirmation by transvaginal ultrasound at six weeks of gestation, the patients were split into two groups: those who were pregnant and those who were not. At the commencement of monitoring (the first to fourth day of the cycle), the levels of estradiol, progesterone, follicle-stimulating hormone (FSH), and LH in serum were assessed. During subsequent routine control visits, millimeter-level ultrasound measurements of the follicle and endometrial thickness were taken every two days after measuring estradiol, progesterone, and LH. The NC-IVF cycle was stopped by the increasing slope of LH (> 20 mIU/mL), declining estradiol levels, and progesterone levels of 1.5 ng/mL. Results: When results were compared between the two groups, the pregnant woman group’s endometrial thickness was found to be significantly larger. (p≤0.05) The highest implantation potential and in utero survival were found in embryos with fragmentation less than or equal to 10% in both univariate and multivariate analyses (p 0.01 and p 0.05, respectively). 18.8% of embryos implanted overall after transfer. Conclusion: Endometrial thickness and embryo quality have a big impact on implantation in NC-IVF. The 8-cell embryos with the lowest or equivalent 10% fragmentation on the third day after oocyte retrieval have the highest implantation potential.

11. MR Spectroscopy in Evaluation of Cerebral Tumors
S. Ravinder, PVS. Abhishek
Background: Intra axial brain tumors are a significant health problem and present several limiting challenges. These lesions include primary neoplasm (high and low grade), secondary (metastatic)neoplasm, lymphoma, tumefactive demyelinating lesions, abscesses and encephalitis. We are witnessing a shift in imaging from merely providing anatomical information towards providing information about tumor physiology. Aim/Objectives: (1) To determine biochemical markers of intra axial brain tumors using MR. (2) To evaluate role of MR spectroscopy in diagnosing and grading of intra axial brain tumor with histopathological co-relation. (3) To evaluate role of MR spectroscopy in determining the infiltrative nature of the intra axial brain. Materials and Methods: The main source of data for the study: Patients from the Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar. All patients referred to the, Department of Radiodiagnosis with clinically suspected brain tumors in a period from July 2022 to June 2023 will be subjected for the study. Results: The tumors showed decreased NAAC and Cr contents and a high cho signal. The Lac-Lip signal was high in grade III astrocytomas, glioblastomas. Reports that Cho/Cr ratio and Cho/NAA ratio increases with glioma’s whereas NAA/Cr decreases were confirmed with histopathological correlation. 20% of the patients with intra axial brain tumor were between 31 to 40 years of age. 73.33% of the patients were having intra axial brain tumors in supratentorial location. In this study majority of the patients i.e., 43.33% had hypointense signal on T1. Conclusion: Accurate grading of gliomas on the basis of MRS alone may be difficult. Combining MRS with conventional and other advanced MR imaging techniques, grading becomes more precise.

12. To Evaluate the Associated Factors and Cardio Pulmonary Exercise Testing in Young Indian Patients with Cardiac Risk
Satendra Mishra, Rajesh Kharadee, J. K. Bhargava, Sunil Yadav, Vikas Patel, Aashutosh Asati
Background: Cardiovascular diseases (CVDs) are increasingly affecting young individuals in India, necessitating a comprehensive evaluation of associated factors and cardiac risk. Cardio-pulmonary exercise testing (CPET) provides valuable insights into cardiovascular fitness and response to physical exertion, making it a crucial tool for assessing cardiac risk in this demographic. Aims and Objective: To identify the associated factors and Cardio Pulmonary Exercise testing in young Indian patients with cardiac risk. Materials and Methods: A cross-sectional study was conducted with a sample size of 30 young participants (aged 18 to 40 years) presenting with cardiac risk factors. Demographic information, medical history, and lifestyle habits were obtained through structured interviews. CPET was performed using standardized protocols on treadmill, with continuous monitoring of ECG, VO2, VCO2, respiratory rate, heart rate, and blood pressure during exercise. Associated factors, including, anthropometric parameters, blood pressure, BMI, smoking status, and alcohol consumption, were assessed. Results:  Out of all 30 patients, 66.67% were males while 33.33% were females. There was no significant (p>0.05) difference in number of patients in different age group, between males and females. The mean height of all patients was 162.6 ± 6.11 cm, mean Weight was 65.23 ± 12.04 Kg, mean BMI 24.71 ± 4.65 Kg/m2, mean Waist Circumference was 84.9±7.41 cm, mean Hip Circumference was 89.87 ± 5.06 cm and mean Waist Hip Ratio was 0.95 ± 0.08. The mean systolic Blood Pressure of all patients was 125.27 ± 12.59 while diastolic Blood Pressure 81.67 ± 9.06 was mmHg. Seven (23.33%) were smokers, 30% (n=9) had alcohol abuse and tobacco use was found to be in 5 (16.67%) patients. Dyspnea on exertion was the main complaint among 17 (56.67%) patients, followed by complain of cough which occurred in 7 (23.33%) patients. Most common co-morbidity was hypertension and diabetes which was present in 10(33.33 %) of both followed by obesity in 06 (20 %), Diabetes and hypertension both 04(13.33%) patients. Among CPET parameter VO2max was scattered around mean of 30.22 ± 3.32 ml/kg/min. Anaerobic Threshold (AT) was 19.45 ± 2.22 ?, while breathing Reserve (BR) and Oxygen Utilization Efficiency Slop (OUES) were having a mean value of 12.2 ± 2.02 and 0.92 ± 0.04, respectively. Conclusion: This original research highlights the importance of evaluating associated factors in young Indian patients with cardiac risk to inform early cardiac risk assessment and management strategies. The significant associations between CPET outcomes and blood pressure, BMI, and smoking underscore the relevance of these factors in determining cardiovascular fitness. These findings emphasize the need for targeted interventions and lifestyle modifications to mitigate cardiac risk among the young Indian population.

13. To Study the Prognostic Efficacy of Thyroid Hormones with S.O.F.A. Score in Predicting Mortality of Critically Ill Patients Admitted in ICU
Sayed Wasim Ahmad, Surendra Kumar, Imran Ali, Manoj Kumar Mali, Harish Kumar, Naveen Jeengar, Navneet Kumar, Chandrapal, Surendra Kumar Prajapat, Sandeep Kumar Dangi, Kokila R
Background: Intensive care unit (ICU) scoring systems have been in use for more than three decades to objectify and quantify the physician’s clinical decision in critically ill patients. Aim: A study for prognostic efficacy of thyroid hormone with SOFA score in predicting mortality, serum uric acid and serum albumin in critically ill patients. Material & Methods: This was a prospective cross sectional study conducted on 400 randomly selected patients during one year period. All patients admitted in intensive care unit had age >16 years and gave informed consent were included in the study. Results: Mean age in non survivors and survivors patients wee was 55.66±18.03 age 46.21±20.08 years (p<0.001). Mean serum albumin in non survivors and survivors patients were 3.01±0.46, and 3.13±0.56 respectively (p<0.05). Mean serum uric acid in non survivors and survivors were 5.29±0.79mg/dl and 5.34±0.83mg/dl respectively (p>0.05). Mean TSH in SOFA group 0-9, 10-14 and >14 groups were 3.01±0.93, 2.92±0.68 and 2.20 respectively (p>0.05). Conclusion: We concluded that Free T3 level can be used independently as a predictor of mortality in critically ill patients admitted in intensive care unit. The addition of Free T3 to SOFA can significantly improve the ability of SOFA score to predict mortality in critically ill patients. The addition of Free T3 level to SOFA score can significantly improves is ability to predict mortality in critically ill patients. Low serum albumin level on day of admission to ICU also appears to be a significant marker in predicting outcome of critically ill patients in the form of mortality and morbidity. Thus, serum albumin level measurement can be used as a prognostic marker in critically ill patients in addition to SOFA Score along with clinical judgment.

14. Clinical Study of Effectiveness of Peripheral Nerve Stimulator Guided Multiple Injection in Axillary Brachial Plexus Block
Hardik D. Kavar, Vidhi A. Gajjar, Vibhuti A. Shah, Aelish D. Mendapara
Background and Aim: Axillary brachial plexus block is one of the most widely used regional anesthesia technique for surgical procedures involving forearm, wrist, and hand. Peripheral nerve stimulator (PNS) was considered as the gold standard technique for nerve location. Present study was done with an aim to Study Effectiveness of Peripheral nerve stimulator guided multiple injection technique of axillary brachial plexus block. Material and Methods: Forty patients with physical status ASA grade I and II aged between 18 – 60 years, scheduled for elective hand, wrist and forearm surgeries were included in this study. Under all aseptic precautions, all patient were given peripheral nerve stimulator-guided axillary brachial plexus block with multiple injection technique was using 20 ml of 0.5% inj Bupivacaine and 20 ml of 2% inj Lignocaine with Adrenaline. All patients were observed for following parameters: Onset of sensory and motor block, Duration of sensory and motor block, Duration of analgesia, Hemodynamic changes, adverse effect/ complications. Results: Mean onset of sensory and motor block was 9.48 ± 1.28 min and 12.60 ± 0.98 min respectively. Mean Duration of sensory and motor block was 432.00 ± 78.61 min and 399.00 ± 76.49 min. Patients remained hemodynamically stable throughout the surgery and postoperatively. Mean duration of analgesia was 470.62 ± 81.65 min. VAS was increased with time. VAS at 1 hour was 0.07 ± 0.2667, VAS at 6 hours was 3.38 ± 0.69, and VAS at 8 hours was 4.00 ± 0.00. So, Rescue analgesic required mostly after 8 hrs post operatively. Conclusion: The peripheral nerve stimulator guided axillary brachial plexus block with multiple injection technique using 20 ml of 0.5% inj Bupivacaine and 20 ml of 2% inj Lignocaine with Adrenaline shorten the onset of sensory and motor block, prolong the duration of sensory and motor block and better postoperative analgesia without any major significant complications.

15. Can Ropivacaine 0.75% Heavy replace Bupivacaine 0.5% Heavy for Infraumbilical Day Care Surgeries
Vedprakash Popli, Rakhi Goyal, Nirupma Bansal, Gunjan Arora
Background: Spinal Anaesthesia is the most common type of regional anaesthesia to establish dense and reliable motor blockade in infraumbilical surgeries. The present study was aimed at evaluating the efficacy of intrathecal Ropivacaine 0.75% heavy as compared to 0.5% Bupivacaine heavy for patients undergoing infraumbilical surgeries. Materials & Methods: The study was conducted on 100 patients. All patients were randomly allocated in to two groups of 50 each, In Group RO- Patients were given 0.75% hyperbaric ropivacaine 3ml intrathecally and in group BU- Patients were given 0.5% hyperbaric Bupivacaine 3ml intrathecally. Onset of sensory block, onset of motor blockade, duration of motor block and hemodynamic were assessed. Statistical software SPSS (Statistical Package for Social Sciences) 20.0 and graph Pad Prism 6.0 version were used for analysis of the data. Results: It was observed that there was no statistically significant difference between these two in terms of age, gender, ASA status, weight and height. There was no statistical difference in the two groups regarding the surgical duration also. The mean time of onset of sensory block in group BU was shorter than in RO group which was significant (p<0.05). Mean time to achieve peak sensory block in group BU was 7.92±1.1 and in group RO was 9.5±1.1 with p value <0.05 which was significant. Motor blockade was faster in group BU than in RO group. A remarkable difference in the mean duration of motor block was observed clinically and statistically (p<0.05). The hemodynamic parameters including HR, MAP, RR, BP were found to be more stable in group RO as compared to group BU (p < 0.05). Conclusion: The present study concluded that Intrathecal hyperbaric Ropivacaine 0.75% did show promising results in terms its efficacy, safety and analgesia as it was seen with 0.5% hyperbaric Bupivacaine but with a shorter duration of motor blockade for spinal anaesthesia in infraumbilical surgeries.

16. Prevalence and Associated Risk Factors of Urinary Tract Infections among the Immunocompromised Patients Visiting a Microbiology Center in Srinagar, Kashmir
Owaice F, Nabi N, Shrivastava P
Introduction: Immunocompromised hosts have more inclination towards developing infections, especially infections of the renal system. Morbidity in immunocompromised patients is considerably attributed to urinary tract infections, which when complicated fuel the mortality rate. In Kashmir, the magnitude of immune compromise-associated renal tract infections has increased in the past few years. The containment of these infections majorly depends upon the risk identification in the immunocompromised population. This research study is directed to assess the prevalence and associated risk factors of urinary tract infections in the immunocompromised subjects. Methods: It was a cross-sectional and facility based study, screening 405 immunocompromised patients visiting the study center in Srinagar, Kashmir from April, 2021 to 31st March, 2022. Demographic data was collected through structured face-to-face interview. Standard microbiological testing protocol was followed to diagnose urinary tract infections. To evaluate the actual prevalence of urinary tract infection amid the heterogeneous immunocompromised patients, the study population were stratified into 6 categories. For risk assessment, univariate logistic regression was used to correlate the population characteristics with UTI positivity, with p-value<0.05 considered statistically significant. For the risk factors, adjusted and unadjusted odds ratios along with 95% confidence intervals were calculated. Results: The general prevalence of urinary tract infections was found to be 34.81% with females accounting for 58.2% of the patients. Highest proportion of UTI positive patients (21.98%) were found between 31-40 years of age. Significantly raised occurrence of UTI (43.58%) was recorded among the diabetes mellitus category with AOR of 5.50 (p<0.001). The odds of acquiring UTI were notably higher in hyperglycemic women (adjusted odds ratio: 55.06). Interestingly we also observed that among the 141 UTI positive samples, 61 (43.26%) were positive for bacterial isolates whereas, 80 (56.73%) were positive for candida species. Conclusion: Urinary tract infections were highly prevalent among the immunocompromised patients. Significant risk factors correlating with urinary tract infections were female gender, age, and hyperglycemic state. Assessment of risk factors predisposing the subjects with compromised immune system to UTIs along with standardized screening protocols can help in early identification of the vulnerable population and provide more effective management and prevention against urinary tract infections.

17. Comparative Assessment of Supraclavicular and Infraclavicular Approaches to Brachial Plexus Block for Upper Limb Surgeries
Sujata R Chaudhary, Priyanka Chaudhari, Nirali H Prajapati, Richa Gupta
Background and Aim: Both the supraclavicular and infraclavicular brachial plexus blocks can be used successfully for procedures on the upper limb. They both have a similar anaesthetic distribution. In this study, brachial plexus blocks for patients having upper limb surgery were evaluated between the supraclavicular and infraclavicular procedures employing neurostimulation in a prospective randomised way. Material and Methods: In a tertiary medical college hospital, this prospective, randomised, and observer-blinded study was conducted on 80 patients who were having elective surgery on their elbows, forearms, and hands. A vertical infraclavicular plexus block (group I, n = 40) or supraclavicular plexus block (group II, n = 40) was randomly administered to the patients. The very same anaesthesiologist performed all of the blocks. Onset of sensory and motor blockage, readiness for surgery, success rate, and complications were all compared between the two groups. Results: The demographic characteristics of the two groups were comparable. Additionally, it was discovered that the length of operation and the location of surgeries were comparable, and statistical significance was not observed. In comparison to Group II (10.983.47), Group I (9.402.34 min) had a relatively faster block performance time (P = 0.02). In contrast to Group II, Group I had a higher satisfaction rating. In Group I, motor blockade began more quickly than in Group II, although this difference was not statistically significant. The amount of time it took for patients to be prepared for surgery was not statistically different. Conclusion: Infraclavicular block was performed faster using the ultrasound-guided neurostimulation approach than supraclavicular block. The infraclavicular technique may be preferred for surgery on the hand, forearm, or elbow, according to these findings. To contrast the supraclavicular block with the infraclavicular block utilising neurostimulation, additional large-scale investigations will be required.

18. Comparison of Perineural versus Perifascial Approach to USG Guided Axillary Block for Upper Limb Orthopedic Procedures
M.P. Santhanakannan, R. Premnath
Introduction: Numerous nerve block techniques are available for upper limb procedure. Axillary brachial plexus block is relatively easy to perform. It is used in elbow forearm and arm surgeries. The classic approach is perineural approach wherein the median, ulnar, radial and musculocutaneous nerves are anaesthetized individually. This study concentrates on a newer approach called perifascial approach wherein the drug is deposited along latissmus dorsi and superficial Axillary fascia. This study compares the efficacy of both the block techniques. Methods: 50 patients who were admitted for upper limb orthopaedic procedures and who had ASA physical status 1 and 2 and were selected according to inclusion and exclusion criteria were divided into group PN to receive perineural approach to Axillary block and group PF to receive perifascial approach to Axillary block. Parameters like time taken for successful block, number of needle passes, hemodynamic parameters, patient satisfaction via VAS, rescue analgesic requirements, post-operative adverse events were observed in both the groups. Results: It was observed that the perifascial approach was easier to perform, performance time was comparatively less, reduced incidence of vascular puncture and provides similar analgesia as in perineural approach. Hence it can be considered an alternative to perineural approach for first time users. Conclusion: It can be thus concluded that the perifascial plane technique is simpler and more time saving than the perineural procedure.

19. Spinal Cord Compressive Myelopathy: Radiological Evaluation Using Magnetic Resonance Imaging in a Tertiary Care Center
Jijo Joseph, Lakshmi Narayana Kammila, Rajeev Anand
Background: Compressive myelopathy is the term used to describe spinal cord compression from different causes. This can be caused by etiologies either from outside or within the cord. The aim of the study is to determine the various causes of compressive myelopathy and their MRI characteristics. Methods: A prospective hospital-based study was conducted. Total of 30 cases were analysed over a period of from January 2020 to January 2022 and were investigated with MRI. Results: MRI is the modality of choice to image spine and spinal cord pathologies because of its ability to delineate soft tissue anatomy in multiple planes without ionizing radiation and non –invasiveness. Most common cause for compressive myelopathy in our study was spinal trauma (46.6%)> Metastasis (20%) > Infection/TB (16.7%) = Primary neoplasm (16.7%). Most of spinal injuries (most common), infections and secondary neoplasms involve extradural compartment while most of primary neoplasm involves intradural compartment. The common site involved is the cervical (50%) followed by thoracic (37.5%) Regions in cases of spinal injury. Conclusions: MRI is a very definitive, sensitive, accurate, specific, and non-invasive modality for evaluation of spinal cord myelopathy.

20. Thyroidal Hormonal Variations A Neglected Entity in Type II Diabetes Mellitus
Bhagyamma Sollapurappa Narayanaswamy, Padmaja Pujari, Venkateswarulu. K., Sreenivasulu Uppara, T Durga, P V Srinivasa Kumar
Introduction: The co-existence of thyroid dysfunction in type 2 diabetes mellitus patients will worsen the macrovascular and microvascular complications, morbidity, mortality, and quality of life. Over the years it has been evident that there exists regards a strong relationship between thyroid and diabetes. The incidence of thyroid diseases differs in different diabetic population. Thyroid through its hormones exert a great influence on various organs in the body. Similarly insulin also plays a major role in various cellular metabolic activities. Hence, a deficiency or excess of the thyroid hormones are thought to alter the functional integrity of insulin. Aim and Objective: The objective of this study was to determine the prevalence of thyroid dysfunction among patients with Type 2 diabetes. Methods: This Hospital based prospective cross sectional study was conducted from May 2022- May 2023. A total of 100 patients with type-2 diabetes who regularly attend the outpatient Endocrinology Department, GGH Ananthapuramu. A detailed history and examination was done after getting informed consent. Blood samples were collected and sent to the laboratory for the evaluation of thyroid profile. Results: Thyroid dysfunction was found in 36%of the patients with Type 2 DM. Among 100 patients the prevalence of subclinical hypothyroidism was 18 %, primary hypothyroidism was 10 %, clinical hyperthyroidism 16 %.and 64 are in euthyroid state. Conclusion: Thyroid Hormone testing is usually neglected in Type 2 Diabetes mellitus. Unidentified Thyroid Dysfunction will have impact on microvascular and macrovascular complications of Type 2DM. Thus, Routine Screening of Thyroid is advised in all patients of type 2 DM to reduce the morbidity and mortality.

21. Efficacy of Monolateral External Fixator in the Complicated Traumatic Lower Extremity through Limb Reconstruction System with Evaluating The Result in Respect to Time for Union, Knee Range of Motion and Shortening
Kishor Uikey, Shailendra Saiyam, Morin Joy, Mona Bhalavi
Background: High-impact accident, often resulting from such as car crashes, motorcycle, and falls from heights, is a significant cause of fatalities among the younger population worldwide. The implications of losing a young and active member of the population due to such traumatic incidents are indeed profound and multifaceted, affecting individuals, families, communities, and the nation as a whole. The LRS (limb reconstruction system) consists of an assembly of clamps usually two or three which can slide on a rigid rail & can be connected by compression distraction units. The LRS may be used to achieve 15 cm or more of lengthening without the need to change the device for a longer one. The goal of these treatments is to promote optimal healing, restore function, and minimize the risk of complications such as decrease range of motion, malunion, nonunion and shortening. Aim: Evaluating the efficacy of Monolateral external fixator for the management of lower extremity with respect to time for union, Knee range of motion and shortening. Methods: Prospective study of 26 cases of lower extremity trauma managed by LRS over a period of 6 months. Mean age group of the patient is 37 years i.e. 26.92%. Dominancy of Male and common mode of injury is Road Traffic Accidents. Patients had already received surgical interventions for their lower extremity trauma but required further treatment using the LRS due to the complexity of their injuries. All the patient got treatment in the hospital and the surgery were done in the period of June 2005-June 2007. The combination of pulsed lavage, debridement, and fracture fixation helps create a suitable environment for subsequent interventions, like using the LRS for limb reconstruction in cases where multiple surgeries were necessary due to the complexity of the injuries. Combination of radiography, clinical evaluations, and standardized scoring systems like the ASAMI score provides a comprehensive picture of the treatment outcomes. Results: Union was achieved in n=9(73%) patient, out of 26 patient and n=22(68%) patients have good range of motion with no limb length discrepancy, has been found associated with difference of Postoperative 1-4cm after Preoperative 3-15 cm shortening. Average time for frame removal 28 weeks then patient nailing done. It reduced the financial burden 40% compared to multi staged surgery make the patient stay average 7 days in the hospital. Conclusion: LRS External fixator is simple, rigid and safe device in trauma management with excellent result respect to time for Union, Knee Range of Motion and Shortening. Research findings, which indicate that the LRS can be an effective tool for treating lower extremity trauma, promoting bone healing, maintaining joint function, and achieving positive patient outcomes.

22. A Study on Liver Function Abnormalities in Congestive Cardiac Failure in Government General Hospital, Siddipet
S. Srilaxmi, J. Swathi, S. Thabitha Rani, A. Madhav
Aim of the Study: To study the liver function tests in congestive cardiac failure and the relationship between liver function test and remission and exacerbation of congestive cardiac failure. Material and Methods: All cases of congestive cardiac failure (100), of varied etiologies observed in patients from July 2020 to December 2021. This study is an observational study, comparing the liver functions between cases (various causes of heart failure) and between cases and controls. Results: 24 patients with rheumatic heart disease,17 patients showed abnormal liver function (72%), Of the 18 patients with cor pulmonale 12 showed abnormal liver function (69%). In 6 patients with hypertensive heart disease 3 showed abnormal liver function (57%), whereas in 38 patients with coronary artery heart disease, 27 showed abnormal liver function (73%) 10 out of 14 patients with cardiomyopathy showed abnormal liver function. Conclusion: Liver function abnormalities were mostly present in patients with coronary artery disease (73%) and rheumatic valvular heart disease (70%) developing heart failure.

23. The Study of Etiological and Clinical Profile of Paraparesis / Paraplegia in a Tertiary Care Center
Jakati GopalaKrishna, Sunitha Kumari Namindla, K. Sudhakar Suresh3 , Azmath Begum
Aim of the Study: To the Study the etiological factor and determine the clinical profile. Material & Methods: A total of 50 patients underwent with weakness of lower limbs and admitted in Osmania General Hospital, Hyderabad Telangana State from January 2021 to December 2022. Results: A total 50 cases were studied. 92% of the study population presented with clinical picture of non-traumatic Paraparesis. 62% of the study population was below 40 years of age, which highlights the brunt of illness in young people. 66% of the cases has presented with acute onset of weakness, followed by 18% subacute onset followed by 16% presented with insidious onset. 69.2% of non-compressive myelopathy have preceding symptoms and 46% of polyradiculopathy cases. 43% of the cases are showing demyelinating lesion among which 50% are LETM cases. 75% of tumors are primary tumors of brain and spinal cord in this population study. Conclusion: In the study, most common cause was acute inflammatory demyelinating polyradiculoneuropathy and acute transverse myelitis followed by Spinal Tuberculosis.

24. A Hospital Based Prospective Study the Assessing the Role of Magnesium Supplement in Laryngopharyngeal Reflux Disease
Satyabrata Dash
Aim: The aim of the present study was to evaluate the association between Mg intake and the risk of reflux disease and that the addition of magnesium supplements should be considered and added to the LPRD treatment protocol for adults in accordance with the dietary reference intake (DRI). Methods: This was a hospital based prospective study done over a period of 1 year in the Department of ENT at Gauri Devi Institute of medical Sciences and Hospital, Durgapur, West Bengal, India in patients presenting with symptoms suggestive of LPR of the age group 18-65 years. A total of 100 patients were included in the study. Results: Out of total 100 cases, 62 (62%) were females and 38 (38%) were males. Out of 68 female patients, 24.19% (n=15) were below 30 years, 61.29% (n=38) were within 30 to 50 years and 14.52% (n=9) were above 50 years. Out of 38 male patients, 23.68% (n=9) were below 30 years, 57.89% (n=22) were within 30 to 50 years and 18.43% (n=7) were above 50 years. The mean RSI score in each of these age groups for females were 17.4, 18.6 and 16.4 respectively and for males were 12.8, 14.6 and 14.2. Similarly, the mean RFS for females were 13.3, 14.4 and 12.6 and for males were 10.2, 13.4 and 12.3 respectively. Foreign body/sticky sensation in throat was the foremost presenting complaint found in 69% of the study population, followed by excessive throat mucus (64%) and constant throat clearing (48%). Hoarseness of voice was seen in 7% of the patients. Dysphagia and dyspnea were the least common symptoms noticed 6% and 3% respectively. A significant number of patients had overlap of two or more symptoms. Among the laryngeal signs of LPRD, granular pharynx, laryngeal erythema and posterior commissure hypertrophy were present in all the cases. 70% of the cases had diffuse laryngeal oedema and thick endolaryngeal mucus (‘positive string sign’) was noted in 40% cases. Subglottic edema and ventricular obliteration were rare findings, found only in 10% and 8% cases respectively. Conclusion: The use of magnesium supplements in conjunction with standard therapy for laryngopharyngeal reflux disease (LPRD) has the potential to enhance LPRD symptomatology and warrants consideration within the treatment regimen for LPRD.

25. Postoperative Analgesia with Nefopam or Tramadol in Adults Undergoing Laparoscopic Abdominal Surgeries: A Hospital Study
Neha Rusia Saxena, Deepesh Saxena, Rakesh Kumar Raju, Nitin Ojha
Background and Aim: Nefopam and Tramadol have been employed as pharmacological agents for the management of postoperative pain in several therapeutic contexts. The objective of this study is to assess and contrast the analgesic effects following surgery in adult patients having laparoscopic abdominal procedures, specifically focusing on the intravenous administration of nefopam and tramadol. Materials and Methods: A total of 126 adult patients, belonging to American Society of Anaesthesiologists physical Status I & II and aged between 20 and 60 years, were randomly assigned to two groups. These patients were scheduled to have either elective or emergency laparoscopic abdominal procedures under general anaesthesia. In the post-anaesthesia care unit, a total of 63 patients were assigned to Group N and 63 patients were assigned to Group T. Patients in Group N got an intravenous infusion of Nefopam at a dosage of 20 mg, while patients in Group T received an intravenous infusion of Tramadol at a dosage of 100 mg. Both infusions were administered in 100 ml of 0.9% saline solution over a period of 15 minutes. The administration of identical dosages occurred at intervals of 6 hours or when the Visual Analogue Scale (VAS) score reached or exceeded 4. The Visual Analogue Scale (VAS) ratings following the surgical procedure were documented at certain time intervals, including 30 minutes, 1.5 hours, 3 hours, 6 hours, 12 hours, 18 hours, and 24 hours. The hemodynamic variables were measured both before to and following the administration of the study medications. A significance level of P < 0.05 was deemed to indicate statistical significance. Results: The pain score exhibited a statistically significant decrease in Group N compared to Group T. There was a statistically significant difference in the mean VAS scores among the two groups at 1.5 hours, 3 hours, 6 hours, 12 hours, 18 hours, and 24 hours after the surgery (P < 0.05). There wasn’t any statistically significant disparity observed in the occurrence of adverse effects between the two groups. Conclusion: The administration of intravenous Nefopam yielded superior analgesic efficacy compared to Tramadol in individuals having laparoscopic procedures while under the influence of general anaesthesia.

26. Study of Serum Electrolyte Levels in Hypothyroidism Patients: A Hospital-Based Study in Govt General Hospital, Kadapa, YSR Kadapa District, Andhra Pradesh
U. Sreenivasulu, P. Nagadasaiah, M. Aparna, B R Shyam Prasad, V. Lakshmi Narasamma
Background: Thyroid gland is an important endocrine gland which produces two important hormones –Thyroxine (T4) and Triiodothyronine (T3) -which regulates the metabolic rate of the body. Thyroid hormones perform a wide array of metabolic functions including regulation of lipid, carbohydrate, protein and electrolytes and mineral metabolism. In India 42 million people are suffering from thyroid diseases, hypothyroidism is 10 times more common in women than men and its prevalence increases with age. Among the endocrine glands, thyroid is the most susceptible for hypo (or) hyper function. Hypothyroidism is accompanied by remarkable alterations in the metabolism of water and electrolytes. Hypo natremia is the commonest electrolyte derangement in hypothyroid patients. Aim: The aim of our study is to find out electrolyte derangement in hypothyroid patients and to study correlation of TSH with serum electrolytes. Material and Methods: A total of 100 subjects were taken for this study and divided into 2 groups. Group-1: 50 Hypothyroidism patients, Group-2: 50 Healthy controls. The age group included individuals is between 30-55years. Blood samples were collecting from Government General Hospital, Kadapa. 5ml of venous blood sample was collected in plane tube in the morning after an overnight fast. After sample collection, samples were centrifuged and serum was analysed for estimation of blood urea, serum creatinine, serum electrolytes, thyroid hormones-T3, T4 and TSH. Serum creatinine, blood urea was estimated by using Erba semi auto-analyzer. Serum electrolytes were analyzed by using electrolyte analyser. Thyroid hormones were analyzed by using Asses 2 thyroid (Chemiluminescence immune assay analyser-Beckman coulter). Statistical analysis: The data was analyzed and consolidated as mean and standard deviation (SD). To analyze the statistical significance, the student t-test was performed by using Graph pad software. The test of probability of lessthan0.05 (<0.05) was significant. Results: In present study, age of the subjects varied from 30-55 years. The mean age of Hypothyroid patients was43.16 ± 6.67 and mean age of mean age of healthy controls was 42.3 ± 6.30. The mean value of T3,T4 are low in Hypothyroid patients when compared to healthy control(p<0.0001,p<0.0001 respectively). The mean value of serum TSH is high in Hypothyroidism patients when compared to healthy controls(p<0.0001).The mean value of serum Na+, serum K+ are low in Hypothyroidism patients compared to controls(p<0.0001, p<0.0001 respectively). The mean value of Cl- is high in Hypothyroidism patients when compared to controls (p<0.0001) .There is a negative Pearson correlation between serum TSH & serum Na+(r= -0.02177), serum TSH & serum K+ (r= -0.09019) and positive Pearson correlation between serum TSH &Cl- (r= +0.1188). Conclusion: In the present study we found there is a decrease in serum sodium and serum potassium levels in hypothyroid patients when compared to healthy controls. Serum TSH shows negative correlation with serum Na+ and serum K+ in Hypothyroid patients and positive correlation with serum chloride. Regular monitoring of serum electrolyte levels during the routine screening of Hypothyroid patients will be more helpful during the management of thyroid patients prevention of further complications.

27. Perinatal Outcomes in Children Born After Fresh or FET (Frozen Embryo Transfer) Using Donar Oocytes
Randhir Singh, Ankur Singhai, Rashmi Vishwakarma, Monica Singh
Background & Objective: To study whether children born after vitrified–thawed embryo transfers (ETs) using donated oocytes have worse perinatal outcomes when compared with fresh ET. Methods: Patients with a first singleton live birth after single blastocyst transfer were compared using multivariable regression analysis to account for potential confounding factors. The primary outcome was birth weight. Secondary outcomes were birth weight z-scores and percentiles, small/large for gestational age, gestational age at delivery, gender, prematurity (<37 weeks and <32 weeks), neonatal morbidity (Apgar scores and need for neonatal intensive care) and maternal morbidity (gestational hypertensive disorders, gestational diabetes and caesarean delivery). Results: There was no significant difference between the fresh ET and FET groups in terms of mean birth weight and birth weight z-scores, in both the unadjusted and confounder-adjusted models. However, artificial endometrial preparation was associated with a higher birth weight and birth weight z-scores when compared with a transfer in a natural cycle. Although a 1-day statistically significant difference in gestational age at birth was detected, premature birth rates (<37 weeks) did not vary significantly between groups. No other statistically significant differences were found in the remaining neonatal and maternal outcomes studies between the fresh ET and FET groups. Conclusion: No significant difference in birth weight and prematurity rates between fresh or frozen embryo transfers (FETs) in new-borns after oocyte donation was found.

28. Analysis of Role of Single Dose Magnesium Sulphate in Cases of Severe Pre-Eclampsia in A Tertiary Care Centre
Shanti Snehlata, Sadhna Kumari, Raj Rani Choudhary
Background: Preeclampsia is a pregnancy specific multi organ disease process characterized by de novo development of hypertension and proteinuria after 20 weeks of gestation. It complicates 2-8 % of pregnancies. Aims and Objective: To study the effect of single dose magnesium sulphate in cases of severe preeclampsia to reduce the incidence of seizures. The ultimate aim is to reduce maternal mortality and morbidity and improve perinatal outcome. Material and Methods: In this study total 100 patients with severe preeclampsia were selected and were divided in two groups, study group and control group. Each group had 50 patients with severe preeclampsia. Study group received Prophylactic dose of Magnesium Sulphate that is , 4 gm intravenous MgSO4(20%) on admission. The control group was not given prophylactic MgSO4. Monitoring of BP, urine output, respiratory rate and FHS was done. Result: We had one case of seizure in study group 6 hours after giving prophylactic dose of MgSO4 which was further managed with Prichard’s regime. In the control group seven (7) patients had seizures. There was no case of MgSO4 toxicity seen. There was no case of maternal deaths and postpartum convulsions in both the group. Conclusion: single loading dose of magnesium sulphate is very effective in preventing eclampsia. It will help to reduce maternal mortality and morbidity and improve perinatal outcome.

29. Morphometry of C1 & C2 Lateral Mass-Relative to Lateral Mass Screw Placement
Archana. A, V.Sailaja, V.Deepika, Fahemeena Faiz
Introduction: The anatomy of the atlanto-axial region is complex and demands knowledge of its structure and morphometry. With the knowledge of morphometry of C1 and C2 vertebrae it is quite easy to carry out the process of placing lateral mass screws during cervical spine surgeries. Cervical spine surgery includes many common surgical procedures performed by spine surgeons. The pathologies treated include radiculopathy, myelopathy, instability caused by degeneration or trauma, infection and tumours. It is very important to have an understanding of surrounding anatomy at the C1 lateral mass screw site to avoid injury to the spinal cord, vertebral artery, C2 ganglion or nerve root, internal carotid artery or hypoglossal nerve. Cervical spine surgery performed for the correct indications yields good results. Aims and Objectives: (1) The main objective of our study is to provide data to spine surgeons in assessing the size of the screw having different morphological measurements known. (2) Our study included the measurements such as antero-posterior diameter, transverse diameter, heights of lateral mass taken in both dried specimen and a CT scan as well. Having this data of variable morphological measurements surgeon can easily select the size of the screw to be placed by correlating the data of our study. (3) Malpositioning of the screw can be rectified as the study provides the ideal entry and exit points of the screw. Material: (1) 40 dried cadaveric specimens of cervical vertebrae (20C1+20C2). (2) 40 CT scans of same cervical vertebrae (20C1+20C2) are taken. (3) Total of 80 samples that is 40 cadaveric specimens and 40 CT scans were included. Methodology: (1) Cadaveric specimens to be studied were collected from different Medical colleges in the city of Hyderabad. (2) The cadaveric specimens included were adult first (C1) and second (C2) cervical vertebrae of both the sexes. (3) CT scans of the collected vertebrae were taken from the department of Radiology, Mediciti institute of Medical Sciences.(4) The manual and the CT scan measurements were taken for each vertebra using vernier calliper and three dimentional (3D) imaging, computer aided navigation tools and special software respectively. Observation and Results: 40 cervical vertebrae (20 C1 & 20 C2 ) i.e. total of 80 lateral masses of both C1 and C2 were studied , manual and CT scan measurements were noted and compared. The data was analysed by using medcalc statistical version 13.0 .Unpaired t-test was used to compare CT and manual measurements. Among the CT and manual measurements of both C1 and C2 lateral mass there is significant difference between transverse diameter and height ( P<0.05), which are important parameters for the surgeons in fixation of posterior arch screws. No significant differences were found between antero-posterior parameters and height between manual and CT measurements. Conclusion: This study may be useful for surgeons and academicians in understanding the morphometry of C1 and C2 and to compare morphometric data with CT derived data to determine the accuracy in selecting the size of screw.

30. Study of Renal Function in Hypothyroidism Patients with and without Type-2 Diabetes Mellitus: A Hospital Based Study in Govt General Hospital, Kadapa, YSR Kadapa District, Andhra Pradesh
U. Sreenivasulu, M. Aparna, P. Nagadasiah, B R. Shyam Prasad, V. Lakshmi Narasamma
Introduction: Diabetes mellitus is a metabolic disease due to absolute or relative insulin deficiency. The association of thyroid dysfunction with type 2 Diabetes mellitus is widely known. Diabetic Nephropathy, a major microvascular complication of type 2 Diabetes mellitus and is an important cause of chronic kidney disease. Approximately 20%-40% of patients with diabetes progress to Diabetic kidney disease   and   40% also progress to ESRD. Measurement of serum urea and creatinine are easily available tests for this purpose which can assist in detection and prevention diabetic kidney disease at an early stage and can limit the progression to end stage renal disease (ESRD). The main aim of our study is to compare the renal parameters in Hypothyroidism with typ2 Diabetes mellitus and without Diabetes mellitus. Materials and Methods: Total of 150 subjects were taken for our study. The subjects were divided in to 3 groups, group-1: Hypothyroidism without Type 2 Diabetes mellitus patients (n= 50), Group-2: Hypothyroid patients with Type 2 Diabetes mellitus(n=50), group-3: Healthy controls(n=50) Ethical clearance: Institutional ethical committee approval was taken before commencement of study. Sample Collection: Blood samples were collected in Govt general hospital, Kadapa, YSR Kadapa district, Andhra Pradesh. 5 ml of venous blood sample was collected from subjects in a plain tube under aseptic conditions in the morning after an overnight fast. After collection, the samples were centrifuged and serum was analysed for estimation of Thyroid hormones (T3, T4, TSH) by Chemiluminescent immunoassay- Assess 2 thyroid analyser (Beckman coulter) r. plasma glucose, serum creatinine, blood urea analysed with Semi-auto analyser. Statistical Analysis: The data was entered and complied in an excel sheet. The data was analysed and consolidated as mean and standard deviation (SD). To analyse the statistical significance, the student t-test was performed utilizing Graph pad software. The test of the probability of less than 0.05(<0.05) was considered as significant. Results: In the present study, the age of the subjects varied from 40-60 yrs. The mean age of the healthy controls is 44.94±2.91, Hypothyroidism without type 2 Diabetes is 45.92±3.69, Hypothyroidism with type 2 Diabetes mellitus is 46.38 ±3.98.  In the present study the mean value of serumT3 and serumT4 value is low in Group-1 when compared to Group-3 (p<0.001, p<0.0001respectively). The mean serum value of TSH is significantly high in Group-1 compared to Group-3(p<0.0001). Fasting plasma glucose mean value is high in Group-2 compare with Group-3(p<0.0001). The mean value of serum T3, T4 is low in Group-2 compared to Group-3(P<0.0001, P< 0.0001 respectively). The mean value of serum creatinine and blood urea are high in Group-2 compared to Group-3(p<0.0001, p<0.0001 respectively). There is a positive Pearson correlation between Fasting Plasma glucose and serum creatinine(r=+0.31239) and between Fasting plasma glucose and blood urea (r = +0.1636) in Hypothyroid patients with type-2 DM.  Discussion: Type 2 Diabetes mellitus patients were more prone to Hypothyroidism frequently. Estimation of serum creatinine and blood urea are often used to assesses the overall kidney function.  Prolonged hyper glycemia which causes irretrievable damage to the nephrons of the kidney. The Serum creatinine concentration increases in hypothyroidism patients due to reduction of glomerular filtration rate because of hemodynamic changes in severe hypothyroidism. The main cause for increase in blood urea is Hypo thyroidism with type2 Diabetes patients is due to diminishing of glomerular filtration rate (GFR). Conclusion: The development of Diabetic nephropathy (DN) is common in hypothyroidism patients with type 2 diabetes mellitus compared with hypothyroidism patients without type 2 Diabetes mellitus. Regular monitoring of thyroid patients for type-2 Diabetes mellitus is very important to rule out any impact on renal function. Measurement of  blood urea  and serum creatinine  helps in the early detection  and prevention of diabetic kidney diseases and prevents the progression of end stage  renal disease(ESRD).

31. A Comparative Analysis of Ropivacaine (0.2%) and Ropivacaine (0.125%) With Fentanyl (2mcg/Ml) for Epidural Labour Analgesia
Annet Thatal, Gunjan Arora, Yogesh Narwat
Aim: The purpose of this study was to establish the lowest effective local anaesthetic concentration needed to deliver adequate analgesia while utilizing less opioid. Objective: The epidural analgesic is the most efficient type of analgesia among the many labour analgesic treatments. The goal of this study was to establish the lowest effective local anaesthetic concentration needed to deliver adequate analgesia while using less opioid. This study’s goal was to compare the effectiveness of 0.125% & 0.2% ropivacaine in combination with 2 g/ml of fentanyl for epidural labour analgesia. Materials and Methods: 50 term pregnant women with vertex presentation in active labour and physical status grades I and II according to the American Society of Anesthesiologists were divided into two groups, Group R1 and Group R2, and given an initial bolus dose of 10 ml each of 0.125% ropivacaine and 0.2% ropivacaine with fentanyl 2 g/ml and intermittent top-up doses epidurally. The block’s characteristics, the onset as well as duration of the analgesia, and the total amount of analgesic needed were documented. The Visual Analogue Scale score was used to evaluate the degree of pain and overall pleasure. Findings for the mother and foetus were documented. Results: Demographic features of mothers were comparable. The ideal labour analgesia can be achieved with any concentration; however reducing the ropivacaine concentration has led to more doses being repeated, which has increased fentanyl use. Regarding motor block, hemodynamics, and neonatal outcomes, there were not significant variations between the two groups. Conclusion: We come to the conclusion that 0.2% ropivacaine appeared superior in terms of quicker onset, longer duration, less breakthrough pain necessitating fewer top ups, and consequently reduced opiate intake. Therefore, we draw the conclusion that 0.2% ropivacaine is preferable to 0.125% ropivacaine combined with fentanyl.

32. An Observational Study to Identify the Non-Fermenters from Blood Specimens and Their Antimicrobial Susceptibility Pattern
Rizwan Ahmad, Sanjay Nag
Aim: The aim of the present study was to assess frequency and antibiotic susceptibility pattern of non-fermenting gram-negative rods isolated from blood culture of patients. Material & methods: The prospective study was conducted in the Department of Microbiology in between the duration of 1year. Blood Stream Infection (BSI) was defined as the isolation of a pathogen microorganism from >1 blood culture bottle. BSIs were classified as community- and hospital-acquired infections if detected within the first 48 h of hospitalization, or after 48 h of hospitalization, respectively. Results: Total 500 NFGNB were isolated from 3455 culture positive clinical samples accounting for an isolation rate of 14.47%. Urine was the most common specimen (30%) followed by pus (26%), blood (16%), sputum (12%), tracheal aspirate (8%) and remaining 8% included other samples. Acinetobacter baumannii was the predominant isolate, 260 (52%) followed by Pseudomonas aeruginosa 200 (40%) and Burkholderia cepacia complex (BCC) 25 (5%). Burkholderia pseudomallei, Acinetobacter lwoffii and Stenotrophomonas maltophilia altogether accounted for 3%. Among the NFGNB isolated, A. baumannii showed highest sensitivity to gentamicin (61.53%) and lowest sensitivity to ceftriaxone (22.30%). P. aeruginosa was mostly sensitive to amikacin (84%) but least sensitive to ceftriaxone (28%). B. cepacia complex, B. pseudomallei and S. maltophilia showed 100% susceptibility to cotrimoxazole. A. lwoffii showed sensitivity to most of the antibiotics. A. baumannii and P. aeruginosa were mostly sensitive to gentamicin and amikacin and least sensitive to ceftriaxone. Conclusion: This study underlines the need to identify NFGNB in tertiary care hospitals and to monitor their susceptibility pattern to guide the clinician for better care and management of patients. Improved antibiotic stewardship and strict infection control measures especially hand washing need to be implemented to prevent emergence and spread of multidrug resistant NFGNB in health care settings.

33. Assessing Clinico-Etiological Pattern and Their Drug Sensitivity and Resistance Pattern of Antimicrobial Drug Use in Ventilator Associated Pneumonia (VAP)
Satya Prakash Singh, Asha Kumari, Naveen Kumar
Aim: The aim of the present study was to assess the pattern of antimicrobial drug use in VAP and to assess the etiological organisms and their drug sensitivity and resistance pattern. Material & Methods: Study participants admitted to Department of Pharmacology, who developed VAP were included in this prospective observational study. Bronchial secretions were subjected to microbiological analysis. The etiological organisms, their drug sensitivity and resistance pattern, and the outcome of drug therapy were recorded. The clinical course of the study participants was monitored till either the resolution of pneumonia or the demise of the participant. Qualitative data were analyzed using the Chi-square test or Fischer’s exact test and quantitative data using the independent t-test. Results: In the present study, 68% were male and 32% were females. 58% patients belonged to 18-60 years of age and 67% were unemployed. 96% were living in rural area and 66% had education of primary school. 905 belonged to lower middle class. Majority of the patients admitted to ICU due to acute respiratory failure (34%), followed by shock (21%).  Majority of the patients had systemic hypertension followed by diabetes. Out of 42 patients >60 years, 34 had early LAP and out of 68 male, 60 had early LAP. 74% had VC-AC ventilator mode followed by VC-SIMV 20% and SIMV 6%. Most of the antibiotics used were Piperacillin + tazobactam, Meropenem, Macrolides, Cephalosporins. Comparison of mean duration of intubation, mean period of stay in the intensive care unit and mean period of hospital stay after extubation in early versus late ventilator-associated pneumonia showed significant result. Conclusion: VAP is a serious problem in ICU leading to prolonged hospitalization and its associated financial implications, and mortality. Effective sepsis practice like hand washing is widely considered as an important but underutilized measured to prevent nosocomial infections like VAP.

34. The Effectiveness of 0.1% Olopatadine Hydrochloride and 0.5% Ketorolac Tromethamine in Managing Seasonal Allergic Conjunctivitis
Md Idris Akbani
Background: Allergic conjunctivitis, a prevalent allergic ocular condition, often presents with itching and discomfort. This study aims to compare the clinical effectiveness and therapeutic impact of 0.1% olopatadine hydrochloride and 0.5% ketorolac tromethamine ophthalmic solutions—each with distinct pharmacological mechanisms—in managing seasonal allergic conjunctivitis. Methods: Using specific inclusion and exclusion criteria, a total of n=80 cases were selected through convenient sampling and evenly distributed into two groups: Group I (administered 0.1% Olopatadine hydrochloride) and Group II (administered 0.5% Ketorolac tromethamine). Thorough ocular examinations were conducted, encompassing visual acuity, slit-lamp bio-microscopy to assess conjunctival and corneal involvement, intraocular pressure (IOP) measurement with a non-contact tonometer, and fundus examination using indirect ophthalmoscopy. Results: The comparison of itching score improvement at various intervals revealed significant p-values at the 30-minute and 2-day marks. Notably, rapid symptom alleviation was observed in Group I (Olopatadine) compared to Group II (Ketorolac). Evaluation of hyperemia score improvement during follow-up visits showed significant p-values at the 30-minute interval only, with no significant values on day 2 and day 7. Both drugs demonstrated equal efficacy in managing hyperemia during follow-up. Conclusion: This study concluded that 0.1% Olopatadine eyedrops exhibited superior efficacy and a quicker response compared to 0.1% Ketorolac eye drops. However, both were equally effective after a 14-day treatment period. Minor side effects were noted in two patients from the Ketorolac group, while no side effects were observed in the olopatadine group. Therefore, when selecting treatment for seasonal allergic conjunctivitis, careful consideration should be given to factors such as cost, side effects, and patient compliance.

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