International Journal of

Toxicological and Pharmacological Research

e-ISSN: 0975 5160

p-ISSN: 2820-2651

Peer Review Journal

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1. A Study of Immunization Status of Children Under Five Years in a Defined Rural and Urban Population: A Temporal Trend
Anjali Singh Kanwar, Ravishankar Uikey
Background: Individuals who encounter obstacles in obtaining immunization services are at a heightened risk of developing morbidities associated with vaccine-preventable illnesses. The spectrum of variables that may hinder immunization programmes and their health benefits includes affordability, accessibility, lack of knowledge, and other constraining elements. Aims and Objectives: The present study aimed to study the immunization status of children aged one month to sixty months in a defined urban and rural population and to evaluate the impact of National Immunization Schedule and assess the progress made in the areas studied. Materials and Methods: The study was conducted as an OPD based cross sectional survey on children aged one month to sixty months in defined urban and rural areas from 01 March 2021 to 31 August 2022 where 608 children were randomly taken from the study areas which was the Department of Pediatrics Tertiary health care center, a community health centre and Primary Health Centre belonging to central India. Our data were collected from the parents of the children coming to the study area. The immunization status of these children was analyzed and the cause for partial immunization was studied. Data was analyzed by using statistical software SPSS version 21. The chi-square test was used to compare various determinants. A p-value <0.05 was considered significant. Results: Highest percentage of study participants in both urban as well as rural areas belonged to the 1-12 months of age group (35.7% and 61.7%) respectively. There was no statistically significant difference found between gender and place of residence for study participants (p = 0.07). The association between socioeconomic status of the family, mother’s as well as father’s education and occupation and the place of residence was found to be statistically significant (p < 0.0001). It was observed that 256 (84.5%) in the urban areas were fully immunized while 255 (83.6%) in the rural areas were fully immunized (p=0.08). A total of 47 (48.5%), of participants gave the reason for delay as domestic work followed by non-availability of health staff at centre which was the reason given by 16.5% of the participants. This difference was found to be statistically significant between urban and rural population (p <0.0001). Conclusion: The importance of parental education in improving child health and the socioeconomic status of the family were found to be significant determinants of incomplete immunization. Coverage of optional vaccines was found to be very low in comparison with routine vaccines. From this study, policymakers and social workers can target young pregnant women to increase female education. These findings emphasize the need for regular monitoring and evaluation of immunization coverage to achieve the benefits of vaccination in all strata of society.

2. Short-Term Outcomes of Mechanochemical Ablation Versus Trendelenburg Procedure for Varicose Veins: A Randomised Control Trial
Swathi Vellaichamy, Narenkumar A, Sarathganesh S, Gokul D Yatheendranathan
Introduction: Varicose veins is a common disease of the lower limbs, affecting predominantly the great saphenous system. Various methods are in place for effective management of varicose veins. Trendelenburg operation with stripping of the vein has long been considered as the gold standard of treatment. However, in the era of minimal access surgery, it is necessary to study the wide application of various endovenous procedures and its effectiveness against the standard of care. In our study we have compared the effectiveness of mechanochemical endovenous ablation (MOCA), using FlebogrifTM, a newer non thermal endovenous therapy with conventional surgery. Methods: Randomised control trial was conducted among 71 patients undergoing mechanochemical endovenous ablation using FlebogrifTM and conventional surgery for the treatment of great saphenous varicose veins. Factors such as blood loss, pain scores, return to mobility, duration of hospital stay, incidence of surgical site infection, recanalization rates, and cost were compared between the groups. Results: Age, Gender, and Diagnosis weren’t significantly different between the groups. Patients undergoing mechanochemical endovenous ablation had lower blood loss, lesser pain scores in early post-operative period and earlier return to mobility. They also had significantly decreased length of hospital stay as compared to the conventional surgery group. However, cost of the surgery was found to be more in the endovenous group. Further, on follow up the recanalization rates in the endovenous group was found to be significantly higher than the conventional surgery group. However, patients with recanalization presented back with only minimal or no symptoms. Ulcer healing, complications, and Pain scores at one month and six months were not significantly different between the groups. Conclusion: Mechanochemical endovenous ablation is preferred over conventional surgery for the treatment of great saphenous varicose veins. It can be performed under local anaesthesia and ensures better early post-operative outcomes as compared to the Trendelenburg operation with stripping of the veins.

3. Comparative Study of Tissue Glue vs Traditional Suturing in Skin Approximation in Surgical Wound Closure: A Randomised Control Trial
Adhiyaman Manimaran, Narenkumar A, Swathi Vellaichamy, Gokul D Yatheendranathan
Introduction: Tissue approximation is one of the fundamental requirements for skin closure. An ideal surgeon’s practise would result in a satisfactory tissue reunion and a scar that is cosmetically acceptable. If advanced suturing techniques are effective, the patient might experience less anxiety, better cosmesis, less postoperative pain, fewer wound infections, and shorter stays in the hospital as a result of these benefits. Objective: To compare between tissue glue and traditional suturing and its adequacy in skin approximation, and to evaluate the pain score of the patient between the two techniques. Method: Randomized controlled trial was conducted among fifty Patients who came to ER, OPD as well as IP of General Surgery Shri Sathya Sai Medical College and Research Institute, a Tertiary Care Hospital, Ammapettai, Chengalpet District, South India. This was done to study the efficacy, patient satisfaction levels, cosmetic outcome and cost effectiveness between skin adhesive and suture material in skin approximation during surgical wound closure. Results and Discussion: The mean of the study group and control group was found to be 44.09±6.3 and 45.63±8.4 years respectively. Most of the patients were males. Postoperative pain score is better in Tissue glue group compared to traditional suturing group. Association is statistically significant (P<0.05). Duration of procedure is less in Tissue glue group compared to Traditional suturing group. Wound infection is more in traditional suturing compared to Tissue glue. Association is statistically significant (P<0.05). Conclusion: Our study proved that tissue glue is better than traditional suturing. The two groups are comparable with respect to age, sex, mean haemoglobin and diabetes status. Mean duration of procedure is less in tissue glue group. Postoperative pain score and wound infection  is better in tissue glue group.

4. A Prospective Observational Study on Diabetic Foot Ulcer and Prevalence of Drug Resistant Organisms
Lavanya Gopinath, D. Harindranath. H.R., Vishnupriya G
Introduction: Diabetes mellitus is a chronic disease with chronic micro vascular and macro vascular complications. The major concern at present is the increasing incidence of multi-drug resistant organisms. The problem of multi-drug resistant organisms was poorly studied because of lack of uniform definitions and specific criteria to name an organism as multi-drug resistant. Hence this study was done to analyses the prevalence, risk factors and impact of multi-drug resistant organisms in diabetic foot ulcers at a tertiary care hospital. Methodology: 150 diabetic patients with foot ulcer were prospectively studied. Detailed clinical history and clinical examination of the ulcer were done for all patients. The microbiological profile was analysed in detail for each patient. Using internationally accepted criteria, the multidrug resistant organisms were identified. Each patient was followed for a period of ten weeks to assess the status of wound healing. Results: Multi drug resistant organisms were isolated from 99 patients of 150 (66%). 54.8% (153 out of 279) of isolated organisms were multidrug resistant organisms. The commonest organism isolated in our study was Escherichia coli followed by Staphylococcus aureus and Pseudomonas aeruginosa. Poor glycemic control, previous hospitalization, previous history of amputation, previous antibiotic usage, size of ulcer, higher grade of ulcer, and polymicrobial culture, were associated with multidrug resistant infected foot ulcers. Conclusion: The prevalence of multi drug resistant organisms is alarmingly high in infected diabetic foot ulcers. Recurrent ulcers and higher grade of ulcers are more prone to acquire multi drug resistance. They are associated with longer duration of hospital stay and higher rates of amputations. The study also directs us to manage the diabetic foot ulcers with appropriate antibiotics adhering to the institutional antibiotic policy along with effective glycemic control to decrease the incidence of multi-drug resistant organisms.

5. A Comparative Study on Health Problems among the Rural and Urban Post-Menopausal Women of Telangana
M Sheeba Apoorva, Y Sai Krishna, Vimala Thomas
Background: Hormonal changes after the menopause and the process of ageing cause marked health issues among the post-menopausal women, which varies between urban and rural women. The objective of the study was to assess the health problems among rural and urban postmenopausal women. Methods: A cross sectional comparative study was conducted among 300 rural and 300 urban post-menopausal women in the field practice area of Gandhi Medical College, Hyderabad from August 2015 to September 2017. The information from respondents was collected using pre designed semi structured questionnaire administered in their local language after taking informed consent. Results: The mean age at menopause of rural women was found to be 46.21 ± 3.33 and that of urban women was 47.40 ± 3.45. Vasomotor symptoms such as Hot flushes, night sweats, increased sweating are found to be more among urban population. Among the non-communicable diseases, Majority (37.6%) were hypertensive .Obesity was among 18.5% of the women and diabetes mellitus among 16.3%. Conclusions: Of the physical symptoms, most commonly reported was muscle and joint ache and among non-communicable diseases, more than one third were diagnosed with hypertension followed in a descending order by cataract, obesity, diabetes, coronary artery disease, malignancies and stroke.

6. Arthroscopic Staple Fixation of Displaced Anterior Cruciate Ligament Avulsion Fractures: Study of 60 Cases
Manthan Soni, Haresh Fatesinh Chaudhary
Background and Aim: Arthroscopic Anterior Cruciate Ligament (ACL) avulsion fracture fixation has acquired popularity in recent years, but there is no consensus regarding the most effective method of fixation. Our study’s objective was to evaluate the clinical and radiographic outcomes of arthroscopic staple fixation for the treatment of ACL avulsion fractures. Material and Methods: This two-year prospective study includes 60 patients who underwent arthroscopic fixation of displaced ACL avulsion fractures at a tertiary care institute in India. All patients were clinically evaluated by calculating their Lysholm and International Knee Documentation Committee (IKDC) scores, and their radiological union was evaluated using follow-up radiographs. Results: At the conclusion of the follow-up period, 58 patients’ knees had regained their full range of motion. Two patients had a 5° fixed flexion deformity and a 15° terminal flexion restriction. The average IKDC score was 90,9, while the average Lysholm score was 95,1. In our study, 19 patients with large avulsed fragments underwent double staple fixation, while 41 patients with minor fragments underwent single staple fixation. At the ultimate follow-up, there was no difference in the functional outcome of the patients based on the number of staples. Conclusion: Using arthroscopic technique enables the surgeon to minimise soft-tissue injury and evaluate other potential knee injuries. According to our study, arthroscopic fixation is preferable to open fixation for the treatment of displaced ACL avulsion fractures in terms of earlier mobilisation, averting knee stiffness, and residual instability.

7. Medico legal Aspects and Pattern of Head and Neck Injury Cases in a Tertiary Care Centre: A Retrospective Study
Showket Rashid, Mohammad Zahoor Hamdani, Arshad Bashir
Background and Aim: The goal should be to eliminate head and neck injuries, which can be accomplished by improving socioeconomic conditions, raising educational standards, implementing more security measures in this evolving and changing lifestyle, and extending corroboration to judicial authorities through the best submission of evidences as an expert to avoid failure of justice. We attempted to identify factors influencing allegations and verdicts in cases involving head and neck practices in this study. Material and Methods: The current study was conducted for one and a half years in the Department of Forensic Medicine and Toxicology of a Tertiary Care Medical Teaching Institute. A total of 100 Medicolegal head and neck reports were reviewed. Age, gender, diagnosis, treatment information, surgical note, plaintiff allegations, and date of verdict were all extracted. Cases were divided into medical or surgical treatment groups, and the distribution of cases by year was examined. Plaintiff demographics, defendant speciality, procedure performed, plaintiff symptoms, cause of claim, distribution of files by years, treatment centre, and jury final report data were gathered. Cases were also categorised based on the nature of allegation. Results: The most common reasons for claims were dyspnea (n=24) and dysphonia (n=22) after thyroidectomy. These were followed by the requirement for additional procedures (n=19), mortality (n=11), needless procedures (n=13), unsuccessful procedures (n=8), and delayed diagnosis (n=3). Conclusion: Malpractice claims in head and neck practises cover a broad spectrum. According to studies, the majority of head injury victims admitted to a tertiary care hospital were involved in traffic accidents, and males are more likely to sustain a brain injury. Aside from otolaryngologists, other physicians who practise in the head and neck region, such as general surgeons, radiologists, and anaesthesiologists, should be wary of malpractice lawsuits.

8. A Prospective Comparative Study between Dural Puncture Epidural and Lumbar Epidural in Knee and Hip Arthroplasty
Das Arunima, Shaikh Rahaman Mijanur, Sarkar Manabendra
General Objective: To compare the effectiveness of Dural puncture epidural with Lumbar epidural techniques regarding onset, duration and regression of analgesia in knee and hip arthroplasty. Specific Objective: (1) To compare onset of sensory (T8 level) and motor block between Dural puncture epidural and Lumbar epidural group in knee and hip arthroplasty. (2) To compare duration of analgesia between dural puncture epidural and lumbar epidural group in knee and hip arthroplasty. (3) To find out hemodynamic variables (arrhythmia, hypotension, palpitation) and nausea and vomiting. (4) To see any adverse effects. Background: Disease of knee and hip is very common in older patients. Previously these surgeries were done under general anaesthesia. But due to postoperative complications after general anaesthesia, scope of neuraxial anaesthesia has been increased. Dural Puncture Epidural (DPE) is Modified Epidural which has faster onset of analgesia and long duration of analgesia and anaesthesia. So, in this study we will be able to differentiate between Dural Puncture Epidural and Lumbar Epidural regarding onset, duration and regression of anaesthesia. Materials and Methods: The Sample Consists of a total of Eighty (80) ASA Grade I AND II patients of either sex and age group of 50-65 years, scheduled for Knee and Hip Arthroplasty in Orthopaedic Operation Theatre was observed. Patient undergone Dural Puncture Epidural was included in Group A and patient undergone Lumbar Epidural was included in Group B. After obtaining informed consent the data collection was done intra operatively through a pre-designed pre tested questionnare. The data was by statistical methods, P VALUE<0.5 was considered significant. Results: Dural Puncture Epidural technique produced faster onset of sensory block than in group Lumbar Epidural without affecting patient’s outcome. Conclusion: Both techniques were effective in producing adequate sensory block however, the use of Dural Puncture Epidural technique produced faster onset of sensory block than in group Lumbar Epidural when continuous epidural infusion was used in both groups without affecting patient’s outcome.

9. Age and Incidence of Pharyngeal Candidiasis in Patients Undergoing Bronchoscopy
Tauseef Neem Rashid Akhtar, Pankaj Bhat, Yatin Wagh
Candidiasis is a type of fungal infection that often spreads to the skin, mouth, throat, oesophagus, and vagina. It is caused by the build-up of yeast called Candida. Multiple types of Candida can be infective agents, with C. albicans being the most prevalent. When it spreads to the mouth and throat, it is called thrush otherwise known as Oropharyngeal Candidiasis. In this retrospective study, the frequency of candidiasis in the “throat” (pharyngeal), was examined exclusively in 1255 patients who underwent bronchoscopy. Most of the findings of pharyngeal candidiasis were incidental.
The objective of this retrospective study was to investigate whether or not age was a factor in the occurrence of pharyngeal candidiasis in patients undergoing bronchoscopy. The age of the sample ranged from 18-95 years. It was found that the lowest incidence of pharyngeal candidiasis was at age ≤ 25 (0.2%). Moreover, at ages 26 to 50 years there was a moderate chance of having the condition (9.3%). As well between ages 76-100 years, there was slightly more incidence (16.1%). The highest incidence of presenting pharyngeal candidiasis was between ages 51-75 years (39.2%). Furthermore, additional study is required before confirming a link between age and pharyngeal candidiasis.

10. A Prospective Randomized Study of Etomidate and Propofol Induction on Hemodynamic Response in Patients Undergoing Short Surgical Procedures with Laryngeal Mask Airway
Deepa Yadav, Santushti Vijay, Jyoti Kanwat, Brijesh Kumari
Objective: This study was done to compare Etomidate and Propofol as inducing agent in general anaesthesia for laryngeal mask airway with following objectives. To evaluate and compare haemodynamic parameters between the two groups and compare the ease of insertion of laryngeal mask airway. Methods: Prospective randomized single blind controlled study was conducted in 90 patients of either sex in the age group of 20-60 years of ASA grade I or II scheduled for short surgical procedures with LMA insertion under general anaesthesia. Patients were randomly divided into two groups of 45 patients each. Group P Propofol (P) (n=45) Group E: Etomidate (E) (n=45). Total sample size-90. Pulse rate (PR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), oxygen saturation and end tidal carbon dioxide (ETCO2;) baseline and then every minute after the induction until ten minutes. Duration and number of attempts for LMA insertion, side effects such as pain on injection, myoclonus and postoperative nausea & vomiting if any were recorded. Results: Demographic variables were comparable in both the groups. Patients in etomidate group showed little change in mean arterial pressure (MAP) and heart rate (HR) as compared to propofol (p > 0.05) from baseline value. Pain on injection was more in propofol group while myoclonus activity was higher in etomidate group. Conclusion: This study concludes that etomidate is a better agent for induction than propofol in view of hemodynamic stability and less pain on injection.

10. Therapeutic Outcome and Safety of Intralesional Vitamin D3 in the Treatment of Cutaneous Warts
Neelima Goyal, Maulik Kotadia, Sarita Beniwal
Introduction: Cutaneous warts are a common but vexing condition with high recurrence rate and tendency to spread in spite of various therapeutic options. Intralesional immunotherapy is an attractive modality as it has an additional role of clearing both treated and distant warts by stimulating cell-mediated immunity against human papilloma virus. Aims and Objectives: To evaluate efficacy and safety profile of intralesional Vitamin D3 formulation in the treatment of cutaneous warts. Materials and Methods: Patients with multiple cutaneous warts were injected intralesionally with Vitamin D3 (0.2 ml, 15 mg/ml) at an interval of 2 weeks for maximum of 4 sessions, and patients were followed up for 6 months. Results: Of the 106 patients included, complete clearance was seen in 26 (76.4 %) patients of verruca vulgaris, 20 (66.6 %) of palmoplantar warts, 18 (100 %) of plane warts, 6 (50 %) of genital and filiform warts each. Moderate response was seen in 14 (13.2%) patients while mild response was seen in 6 (5.7 %) patients. No response was seen in 10 (9.4 %) patients. No serious adverse effects were reported. Conclusion: Intralesional Vitamin D3 is effective, safe, cheap and long lasting modality with a short downtime for the treatment of multiple cutaneous warts.

12. Spectrum of Renal Calculi Composition in Southern Rajasthan Using Infrared Spectroscopy
Manish Bhatt, Patel Ujaskumar Ashvinbhai, Ali Abbas Shakir Hussain Sabunwala, Rishabh Saini
Introduction: The aim of this study was to evaluate the chemical composition of urinary stones and pattern of changes according to the patient’s age in Southern Rajasthan using infrared spectroscopy (IRS). Materials and Methods: A prospective study of 500 urolithiasis patients was carried out in a tertiary care center from August 2021 to August 2023. Chemical composition of urinary stones was analyzed using IR spectroscopy, and a subgroup study based on the patient’s age was done (8–12 years – Group A, 13–18 years – Group B, and >18 years – Group C). Results: Out of 500 patients, 29 were in Group A, 52 in Group B, and 419 in Group C. Male predominance was found in all age groups. Mixed composition stones were much more common than pure one (74.83% vs. 25.17%). Overall, combination of calcium oxalate monohydrate with dehydrate was the most common composition (58.0%). Calcium oxalate was the predominant chemical composition in 91.54% of stones, followed by uric acid in 4.28%, struvite in 2.29%, calcium phosphate in 1.49%, and cystine in 0.4%. The proportion of calcium oxalate stone was increasing while that of struvite, uric acid, and cystine stone was decreasing with age. Most of the vesical calculi in pediatric age group (Group A; 8–12 years) patients were made up of combination of struvite, calcium phosphate, and uric acid. A total of 85.11% of staghorn calculi were of oxalates. Conclusion: In Southern Rajasthan, calcium oxalate is the most common composition of urinary stones in all age groups. Mixed stones are more common than pure ones. The incidence of calcium oxalate stone increases while that of struvite, uric acid, and cystine stone decreases with age.

13. Non-Antibiotic Therapy for Infectious Diseases in the Era of Antibiotics: A Foresee into the Future
Ganesh Perumal P, Gnanadeepan, Sreeram Astic Deshpande, Preethi Thiruvengadam
Antibiotic misuse or unregulated use has contributed to the rise and spread of resistant microorganisms. Owing to increase rates of resistance and stagnating rates of the discovery of novel antibiotics, the efficacy of conventional antibiotics in the treatment of bacterial infections has been put under growing strain. As a result, it is widespread to meet bacterial strains that are pan-drug resistant. Fears have been expressed about a “post-antibiotic era” where many bacterial illnesses might not be curable. It is essential to investigate alternative non-antibiotic therapy methods to guarantee that practitioners have access to a wide range of potent treatments. In an era of multidrug-resistant (MDR) bacterial infections, the new therapeutic techniques for bacterial infections (beyond antibiotics) may offer a solution to shorten the utility of present antibiotics. This review focuses on major alternatives to antibiotics on which include: phages, bacteriocins, antibacterial activities of non-antibiotic drugs, quorum sensing inhibitors, probiotics, nanobiotics, faecal microbiota transplant, stem cell derived antimicrobial peptides, immunotherapeutics, and hemofiltration devices.

14. Study of Effect of Alcohol Intake on Blood Indices
Ketan R. Ganvit
Alcoholic beverages have been associated with human civilisation since time immemorial, and today, alcohol is ubiquitous, with constantly changing patterns of alcohol intake around the world. This study was undertaken to assess and compare the blood parameters in form of Blood Indices among these two groups, which would help when detected earlier in preventing serious complications due to alcoholics. 30 adult patients who are alcoholics and 30 adult’s patients who are non-alcoholics are included in this study. Haemoglobin Estimation, RBC counts and MCV, MCH, MCHC was done in all alcoholics and non-alcoholics subjects. Hemoglobin, Red blood cell counts, MCH, MCHC was less in alcoholic subjects as compared to non-alcoholic subjects and this difference was highly significant. MCV was more in alcoholic subjects as compared to non-alcoholic subjects and this difference was highly significant. This shows alcoholic subjects had megaloblastic anemia.

14. ‘Deb’s Active Surveillance & Assisted Reporting System: A District Based Innovative Approach to Adverse Drug Reaction Monitoring
Tirthankar Deb, Saurav Misra, Nitika Sindhu, Ritu Beniwal
Pharmacovigilance aims to alert healthcare professionals and the general public about risks from medications by gathering data, analysing it, and drawing findings that may be used to recommend sensible regulatory actions aimed at patient safety. The product, the indication, the target audience, and the problem at hand should decide the approach of pharmacovigilance to be taken in a given circumstance. Adverse drug reaction (ADR) monitoring in India mostly follows passive surveillance where voluntary and individual case reports of suspected adverse reactions are examined. Getting reports facilitates the creation of an alert. In contrast to passive monitoring, active surveillance employs a continuous, pre-planned strategy to thoroughly collect the desired information. Using an active surveillance system in pharmacovigilance is expected to make it more possible to gather comprehensive information on each adverse event report, including those missed out in passive monitoring. With this background, this innovative ‘Deb’s active surveillance & assisted reporting system has been designed for ADR monitoring of special situations of mass administration of medications or vaccines in a short span of time or extensive use of specific disease-related pharmacotherapy in a defined population of a particular geographical area, for example, mass administration of albendazole to children, vaccination drives in response to epidemics like COVID, at the level of a district. This strategy offers to increase the involvement of pharmacovigilance specialists, health care professionals, other service providers like school teachers and beneficiaries in adverse drug reaction monitoring, making it possible to find all potential, unreported suspected ADRs by proactive methods. A well-defined and novel six-step wise approach (TTWVAA) comprising team formation, train the trainers, work distribution, visits, active extraction and assisted reporting makes this technique highly promising and implementable. Among other aspects, assisted reporting of individual information through direct assistance provided by experts to end level service provider in completing every report makes this monitoring system very end user friendly. In this review, the steps of this new approach have also been further elaborated with respect to a particular situation and two cases have been described where this novel approach has been used in a district.

16. Comparison of Basal Heart Rate Variability in Patients of Primary Open Angle Glaucoma and Healthy Controls
Singh H, Singh I, Khurana I, Dhull CS
Introduction: Primary Open Angle Glaucoma (POAG) is diagnosed by characteristic pattern of visual field defects, morphological changes in optic disc and raised intraocular >21mm Hg. Autonomic dysfunction is contributory factor in pathophysiology POAG. Heart rate variability (HRV) refers beat to beat variation of heart rate and reflects the modulating effect of autonomic nervous system on intrinsic firing rate of cardiac pacemaker. Analysis of HRV was done by time and frequency domain variables. Material and Methods: Study comprised of 30 POAG cases (group I) and 30 controls (group II). Basal HRV was recorded in Physiology department. Data was statistically analysed using student t-test. Observations: Insignificant low values of time domain parameters of basal HRV were observed in group I. On comparison of frequency domain analysis of basal HRV, significant high values of LF(nu) in group I was observed. LF/HF ratio was insignificantly higher in group I. Discussion: HRV reflects fluctuations of impulses as the heart rate reflects. Low values of time domain variables observed in the present study document reduced parasympathetic tone in patients of POAG. Higher LF/HF ratio of basal HRV among group I suggests higher degree of sympathetic tone and relatively less parasympathetic tone. Conclusion: The cardiac sympathetic markers of HRV change parallel to autonomic challenges. High vagal tone is cardioprotective while high sympathetic activity increases the vulnerability of the heart for cardiovascular risks.

17. Audit of Antibiotic Prescription with Emphasising Adherence to Antibiotic Policy: A Prospective Observational Study from South India
Kanagasanthosh K, Prabhusaran N, Saravanan KS, Poorani S
Introduction: Antimicrobial resistance being a public health challenge, Ministry of Health and Family Welfare Department of Government of India recognized this as a high priority area. In collaboration with ICMR, lots of efforts are taken to implement antimicrobial stewardship program. Our objective was to peruse the antibiotics prescribed for inpatients and day care surgical cases with emphasizing the importance of adherence to antibiotics. Appraise and to find out the deviation of antibiotic prescriptions from the department policy before and after training with antibiotic policy and highlighting the areas for improvement in the prescription. Materials and Methods: It is a Prospective, observational and Cross-sectional study for the patients who are admitted to General Surgical wards and day care surgical patients in the two months period between august and September 2022. Consecutive cases receiving the antibiotic prescription were screened using a structured proforma in order to elicit various data for analysis. Results: Males predominated and male to female ratio was 2:1 among the cases included in Phase 1 (50 cases) and Phase 2 (54 cases). Nearly, 90% of the patients had one or other evidence of overt infections. In this category (Phase 1) the surgeon did not deescalate the antibiotics prescribed. After training, among the 54 cases, (90.74%) received empirical antibiotic therapy and escalation and de- escalation were noticed in 17 (31.4%) and 15 (27.77%) cases respectively. The pattern of antibiotic prescription invariably reflected a combination of antibiotics, and these were administered parenterally in 74% of cases. Conclusion:The audit of antibiotic prescription revealed that many surgeons prescribed high end antibiotics invariably. The indications stated by the surgeons were co morbid conditions and a fear of cross infection. Deviation of antibiotic prescription was noticed even after training in 66.6% of cases. Though training has helped to alter the approach of surgeons towards antibiotic prescription.

18. Histopathological Evaluation of Lower Gastrointestinal Biopsies
Anil Kumar Gupta
Aim: The endoscopy evaluation and biopsy is common and frequently used in the diagnosis and treatment of gastrointestinal tract (GIT) mucosal pathology. Lower GIT is relatively common to navigate and thus gives easy accessibility for endoscopic evaluation, and plays an important role for direct visualization as well biopsy for histopathological evaluation of various pathology. In our study, we retrospectively evaluated the histopathological results of the lower gastrointestinal endoscopic biopsies. Materials and Methods: A total of 130 (n=130) patients were endoscopically examined and biopsied from lower GIT between Jan 2015 to Dec 2015. Results: out of 130 patients, 96 (73.8%) were male and remaining 34 (26.2%) patients were female. The average age of patients was 39.2 years (Male 41.73 years and female 38.77 years), their age range varies from 5 years to 84 years. Histopathological diagnosis inferred in descending order of frequency as inflammatory bowel disease in 49 patients (37.69%), nonspecific colitis in 42(32.2%), acute infectious colitis in 13 (10%), Solitory rectal ulcer syndrome in 7(5.38%), carcinoma in 6(4.60%), chronic colitis in 4(3.04%), granulomatous and amoebic colitis – 3 each (each 2.30%) and polyp in 2(1.53%) patients. Conclusion: Endoscopy is an important tool for direct evaluation of GIT and histopathological diagnosis for variety of pathological lesions.

19. Hematologic Evaluation of Beta Thalassemia Major Patients
Vipul Kavar, Garasiya Harshalkumari Bharatbhai, Dhaval. P. Chadasaniya
Background and Aim: Thalassemia is a common inherited illness, with Beta-thalassemia major being the most severe kind. The current study has the following goals: To investigate several RBC parameters and their relationships in patients with multi-transfused beta thalassemia major.  To evaluate changes in serum ferritin levels following blood transfusions, the efficacy of chelation therapy, and the prevalence of seropositivity among beta thalassemia major patients. Material and Methods: The study included 100 individuals with significant beta thalassemia from a pediatric/medicine department of an Indian tertiary care centre. A thorough history was taken, as well as a physical examination and laboratory measures such as full blood counts. Over a year, all patients were evaluated for serum ferritin levels, chelation therapy, and screening for transfusion-transmitted illnesses. All of the data was collated, and statistical analysis was performed. Results: The younger age group patients required less chelating agent at a lower transfusion frequency compared to the older age group patients who required a larger dose of chelating agents. Out of the 100 cases, 19 had the A+ blood group (19%), 12 had the AB+ blood group (12%), 29 had the B+ blood group (29%), and 38 had the O+ blood group (38%). There were 28 HCV+ patients (28%), 4 HIV+ cases (4%), and 66 nonreactive cases (66%). With p values of 0.005, serum ferritin levels were shown to be substantially linked with transfusion frequency. Serum ferritin levels were usually higher in patients who received two or more transfusions per month. Serum ferritin levels were shown to be substantially linked with medication and chelating agent dose, with p values 0.001. Conclusion: Haematological metrics such as haematocrit, RBC mass, haemoglobin, and mean corpuscular volume have high covariances, whereas mean corpuscular haemoglobin and mean corpuscular haemoglobin concentration have relatively narrow covariances.

20. An Epidemiological Study Detecting Mycobacterium Tuberculosis Using Sputum Evaluator Methods: An Observational Study
Rizwan Ahmad, Sanjay Nag
Aim: The aim of the present study was to evaluate the detection of mycobacterium tuberculosis using sputum evaluator methods. Methods: The Study was conducted as a prospective epidemiological study in Department of Microbiology for one year. Total of 100 sputum samples obtained from both in-patients and out-patients of Hospital from various departments like Medicine, Surgery, TB and RD and Orthopedics were subjected to decontamination by both HS-SH method and NALC-NAOH methods. Results: Out of 100 microbiological sputum samples, 70 were found to be positive for acid fast bacilli by both Modified petroff’s method and Hypertonic Saline Sodium Hydroxide method (HS-SH) of concentration and decontamination and 30 samples were negative by both these methods. Sensitivity, Specificity, Positive predictive value and Negative predictive value of the HS- SH method was found to be 100%. Conclusion: In conclusion, the HSSH sputum decontamination method is equally sensitive, specific, cost-effective, feasible and less time consuming procedure compared to the gold standard NALC-NaOH method for decontamination of Mycobacterium tuberculosis from sputum samples and can be routinely used in all peripheral health centres because of the low cost, especially in developing countries.

21. Assessing Recurrence Rate in Patients with Epilepsy During and After Discontinuation of Antiepileptic Drug (AED) Treatment: An Observational Study
Satya Prakash Singh, Asha Kumari, Kanchan Kumari
Aim: The aim of the present study was to assess the recurrence rate in patients with epilepsy during and after discontinuation of antiepileptic drug (AED) treatment who had been seizures free for either 2 or 4 years and to identify the risk factors for recurrence of seizures. Methods: The present study was conducted at Department of Pharmacology and One hundred patients with epilepsy were prospectively studied for the period of 1 year. The epilepsy diagnosis was established by obtaining detailed history and descriptions from an eyewitness. All patients had Electroencephalography (EEG) and CT brain scan. Results: There was no statistically significant difference between the groups regarding the demographic and clinical characteristics. There was significant correlation between the risk of seizure recurrence, duration of active seizure and number of seizures prior to seizure control. No significant correlation was found with the number of AEDs, the duration of seizure free period before drug withdrawal and family history of epilepsy. Conclusion: The risk of recurrence during drug tapering after discontinuation of AEDs was related to the duration of active disease and number of seizures prior to control.

22. A Prospective Randomized Study of Etomidate and Propofol Induction on Hemodynamic Response in Patients Undergoing Short Surgical Procedures with Laryngeal Mask Airway
Deepa Yadav, Santushti Vijay, Jyoti Kanwat, Brijesh Kumari
Objective: This study was done to compare Etomidate and Propofol as inducing agent in general anaesthesia for laryngeal mask airway with following objectives. To evaluate and compare haemodynamic parameters between the two groups and compare the ease of insertion of laryngeal mask airway. Methods: Prospective randomized single blind controlled study was conducted in 90 patients of either sex in the age group of 20-60 years of ASA grade I or II scheduled for short surgical procedures with LMA insertion under general anaesthesia. Patients were randomly divided into two groups of 45 patients each. Group P Propofol (P) (n=45) Group E: Etomidate (E) (n=45).Total sample size-90. Pulse rate (PR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), oxygen saturation and end-tidal carbon dioxide (ETCO2;) baseline and then every minute after the induction until ten minutes. Duration and number of attempts for LMA insertion, side effects such as pain on injection, myoclonus and postoperative nausea & vomiting if any were recorded. Results: Demographic variables were comparable in both the groups. Patients in etomidate group showed little change in mean arterial pressure (MAP) and heart rate (HR) as compared to propofol (p > 0.05) from baseline value. Pain on injection was more in propofol group while myoclonus activity was higher in etomidate group. Conclusion: This study concludes that etomidate is a better agent for induction than propofol in view of hemodynamic stability and less pain on injection.

23. Study on Sociodemographic and Clinical Profile of Opioid Dependence Patients in a Tertiary Health Care Center in Central India
Vijay Savita, Megha Maholi, Vijay Niranjan, Varchasvi Mudgal, Priyash Jain
Background: Abuse of opiates is a widespread issue that affects people of many nationalities worldwide. Opi-oid use and dependence have recently increased both internationally and in India. It severely affects social, psy-chological, physical, and environmental aspects of existence and complicates the law. Therefore, among other substance addiction, the rise in opioid dependence is one of the major problems. Methods: It was an observational study, which enrolled 100 patients from DTC OPD through purposive sam-pling for one year duration after fulfilling inclusion and exclusion criteria patient included in the study, with the help of pretested semi structured questionnaire. Results: Majority of the opioid abusers were males (97%) and within the age group of 26 to 35 years (40%). Most commonly used method of opioid consumption is by chasing method Mean age of initiation of substance 23years. Conclusions: Opioid is illicit drug of abuse in India showing raising concern as these associated with more serious and fatal outcome as well as has medicolegal implications. While many of the respondents began using drugs as early as age of 15 or younger. Our results show that India needs management and prevention methods for substance abuse at central and state level to protect future generations. Policymakers must act right away to deal with this hidden epidemic.

24. A Study of Prescription Pattern in Musculoskeletal Disorders Causing Low Back Pain in a Tertiary Care Teaching Hospital in Northern India
Abdul Waseem Khan, Quazi Shahir Ahmed, Kauser Sayedda, Abdul Shaheer Umar, Nazia Siddiqui
Background: Prescription pattern analysis studies are a tool to provide feedback to the prescriber and also create awareness regarding rational use of medicines. Objective: To explore the pattern of prescriptions in the treatment of acute LBP and to ascertain the level of adherence of health care providers to prescribing patterns according to WHO/INRUD core drug use indicators. Material & Methods: Total 100 patients >18 years of age having confirmed diagnosis of acute LBP attending the OPD of Orthopedics were enrolled in this study. Prescribing patterns of drugs for LBP were elucidated based on differences in age, gender, etiology, socioeconomic profile & severity of pain. The study was a descriptive observational type. Results: Ratio between males & females was 1:1.7 (P<0.05). Maximum patients (37%) belonged to the upper lower class. 27% were from Upper Middle class. 25 % belonged to Lower middle class, 9% from lower class & only 2% were from upper class. (P0.05) Drugs prescribed in LBP patients were NSAIDs, proton pump inhibitors, H2 blockers, opioids, Muscle relaxants, steroids, Ca++, cholecalciferol and multivitamins. All patients invariably received NSAIDs & Proton pump inhibitors (PPIs)/H2 blockers. 4 patients received opioids. 80 patients received muscle relaxants, 11 patients received steroids. 94supplementary drugs in the form of Ca++, Vit D3 & multivitamins were prescribed. Each category of patients (age wise, gender wise, socioeconomic wise, etiology wise, severity wise) received same drugs. (P>0.05) Total 236 systemic NSAIDs were prescribed. Non-selective NSAIDs were used more than selective (79.23% vs 20.76%). Etoricoxib was the only selective NSAID used. According to WHO/INRUD drugs use core indicators by health care providers in the Institute, average number of medicines prescribed per patient encounter was 5.25. Medicines prescribed by generic name were 10. No antibiotics & injections were given. 100% drugs were from Essential Medicine List. Conclusion: A very common practice of poly pharmacy was seen in many prescriptions. Health care providers are not adhered to WHO/INRUD drug use Indicators Thus, we can conclude that irrational prescribing exists all around. To minimize this, regular CMEs, workshops, lectures, OPD/ward visits on rational prescribing should be held by competent authorities without hurting anyone’s ego.

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