International Journal of

Toxicological and Pharmacological Research

e-ISSN: 0975 5160

p-ISSN: 2820-2651

Peer Review Journal

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1. Patient Perspectives on Informed Consent for Medical and Surgical Procedures: A Cross-Sectional Study from an Indian Tertiary Care Hospital
Viras C. Patel, Anand K Menat, Vishnugiri Jayantigiri Goswami, Vikram Samadhan Lokhande
Abstract
Background and Objectives: In the realm of medical practice, informed consent goes beyond a mere signature on a document; it encapsulates the comprehensive process wherein patients are equipped with knowledge pertaining to their illness, diagnostic alternatives, and specifics regarding intervention strategies for their particular condition. In the Indian context, there is a scarcity of studies delving into the landscape of informed consent.  Against this backdrop, the present study was done to assess the levels of awareness and comprehension regarding the contents of informed consent and to scrutinize the patient’s viewpoint concerning the informed consent process within the setting of an Indian tertiary care hospital. Methodology: Employing a cross-sectional survey design, the study targeted patients who had undergone medical or surgical procedures. The patients were randomly selected for participation. Utilizing a pre-structured questionnaire, interviews were conducted with the patients, with 60.5% responding personally. Results: Among the 345 patients surveyed, 69.29% were acquainted with the proposed procedure, while only 33.15% received information about alternative treatments. Approximately 46.19% were informed about the procedure or type of anesthesia, and merely 13.48% were apprised of its potential complications. Intriguingly, in 8% of cases, patients perceived a lack of informed consent despite documentary evidence suggesting otherwise. Conclusion: In clinical practice, informed consent assumes an indisputable role as a protector of patient rights and serves to mitigate the likelihood of legal repercussions for treating physicians in case of complications arising from the prescribed therapy. This study underscores the critical necessity to sensitize healthcare practitioners about the nuances of informed consent.

2. Prevalence and Presentation of Autoimmune Conditions of Central Nervous System in Bankura, A District Town in West Bengal, India -Recent Scenario
Arup Ghosh, Anjan Debnath, Suvendu Jana, Tunir Haldar, Simran Jha, Purba Haldar
Abstract
Introduction: The immune system’s inability to distinguish between potentially hazardous antigens and healthy tissue is a defining feature of autoimmune diseases. The present study was conducted to assess the prevalence and presentation of autoimmune condition of Central Nervous System in Bankura City, West Bengal. Material & Methods: The cross-sectional study was conducted for a period of one year among 100 patients who visited the department of neurology, Bankura Sammilani Medical College, West Bengal. The demographic characteristics of patients like age, gender, residence etc was noted. The statistical package for social science (SPSS), version 25.0, was used to analyze the data. Results: Out of total 100 patients 41% fell in the age group of above 60 years. Female patients (64%) were higher in number as compared to males (36%). Prevalence of autoimmune conditions seen in patients was Rheumatoid arthritis (33%), Sjogren syndrome (20%), Systemic lupus erythematosus (11%), Polymyalgia rheumatic (8%). Association with age and gender shows significant results (p=0.001). Conclusion: Autoimmune conditions had particular age of onset and prevalence of this disease among females is more as compared to males. Different regions of the country may have different prevalence rates of neurological illnesses due to demographic variety.

3. Study of Increased Prevalence of Refractive Error in Pediatric Age Group at Dr. M.K. Shah Medical College & Research Centre, Chandkheda, Ahmedabad
Bhumika Shah, Romil Patel, Nishtha Patel, Saurabhkumar Hirani, Prerika Patel
Abstract
Background and Aim: Vision is critical in a child’s development for learning and communication. Uncorrected refractive error (URE) has become a major issue for health-care policymakers, particularly among school-age children. The purpose of this study was to evaluate the prevalence of refractive error in school students and its associated risk factors over a one-year period at Tertiary Care Teaching Institute of India. Methods and Materials: The purpose of this cross-sectional study was to determine the prevalence of refractive error and its associated characteristics among school children in selected Gujarat schools. A sample size of 200 was used. Department of Ophthalmology, Dr. M.K.Shah Medical College & Research Centre, Chandkheda, Ahmedabad, organized the current study.  A semi-structured questionnaire was utilised to collect information, and refractive errors were also tested for. SPSS was used to analyse the data. Results: Among the study participants, 8 (4%) were 10 years old, 58 (29%) were 11 years old, 66 (33%) were 12 years old, 56 (28%) were 13 years old, and 12 (6%) were 14 years old. Boys outnumbered girls 55% (110) to 45% (90). The prevalence of refractive error was found to be significantly related to age, parental education and occupation, socioeconomic position, and parental history of refractive error, duration of watching television, and body mass index. Conclusion: Many eye disorders begin in childhood, and the morbidity may go unrecognised, affecting the child’s academic performance and causing significant ocular handicap later in life. As a result, the study emphasises the significant prevalence of undiscovered refractive error in school children, as well as the significance of early detection and treatment with corrective spectacles to arrest the progression of refractive error.

4. Comparison of Epidural Analgesia using 0.25% Bupivacaine and 0.2% Ropivacaine for the Management of Postoperative Pain in Gastrointestinal Surgeries
Pramod Parthasarathy, Triveni M.R., Srinivasa Reddy T.S.
Abstract
Background: Epidural analgesia, especially thoracic epidural analgesia (TEA), has been used extensively for a wide variety of GI surger­ies. The degree to which the GI tract is affected by regional anes­thesia depends on the type and extent of the block. Epidural analgesia not only enhances post operative recovery, minimizes pain & faster mobilization of the patient but also decreases opioid requirements and reduces postoperative ileus.[1] The favorable physiologic effects on the respiratory and cardiovascular systems by epidural analgesia may serve as yet another reason as to why epi­dural analgesia is a devoted part of ERAS protocols. Local anaesthetic drugs like bupivacaine & ropivacaine have widely been used in epidural anaesthesia in recent era. Aims and Objectives: To compare the efficacy of analgesic effect of epidural 0.25% bupivacaine and 0.2% ropivacaine in patients who have undergone gastrointestinal surgeries in the postoperative period. Methods: A total of 60 adult patients of either sex of ASA physical status I and II, aged 20-60 years, undergoing gastrointestinal surgeries were enrolled into the study. Patients were randomly divided into two groups of 30 each: Group B-received 10 cc of 0.25% Bupivacaine as epidural dose & Group R-received 10 cc of 0.2% Ropivacaine as epidural dose in the postoperative period. Onset of pain relief, duration of analgesia & requirement of rescue analgesia using epidural  bolus as top up doses were noted. Incidence of motor blockade, VAS scores, hemodynamic parameters & adverse events were also noted. Result: Time of onset of sensory analgesia (Group B 12.12±2.10 in mins. vs. Group R 11.74±1.55 in mins. P value:0.55) and duration of sensory analgesia (Group B 175.55±23.18 in mins. vs. Group R 170.42±20.25 in mins. P value:0.61) were comparable between both the groups. Total epidural dose requirement (Group B 34.22±3.22 in ml vs. Group R 32.20±2.40 in ml P value: 0.18) and the mean number of epidural top-up doses(Group B 4.45±0.35  vs Group R 4.00±0.25 P value: 0.24)  required for epidural analgesia in the first 12 h of postoperative period between Group B and Group R were comparable and statistically not significant. Six patients (20%) in Group B showed motor blockade of Bromage-I whereas no incidence of motor blockade was reported in Group R. Postoperative hemodynamic parameters and VAS scores were comparable between the two groups for the first 12 hours of postoperative period. The observed side effects included bradycardia, nausea and vomiting, and shivering were comparable between the two groups. However, incidence of hypotension was slightly higher in Group B compared to Group R (26.6% vs 13.3%). Conclusion: 0.2% Ropivacaine as local anaesthetic is a suitable alternative drug to 0.25% Bupivacaine for epidural analgesia in patients who have undergone gastrointestinal surgical procedures in the postoperative period as it not only provides good quality analgesia but also enhances early mobilisation and postoperative recovery of the patients.

5. A Study to Compare the Anti Inflammatory Activity of Cissus Quadrangularis with Sterile Normal Saline and Diclofenac Sodium in Male Wistar Albino Rats
Praneetha Banavatu, Roopa Bagurubilli, Veeraiah Dakkumalla, T Jaya Chandra
Abstract
Introduction: Several anti-inflammatory (AnI) agents are available in the market but side effects during the clinical usage is the major limitation of these. Cissus quadrangularis (CQ) contain many pharmacological properties. Currents study was taken to assess the AnI activity of CQ in male wister albino rats. Methods: It was a prospective research conducted in the department of Pharmacology, Dr Pinnamaneni Institute of Medical Sciences & Research Foundation between October 2014 and 2016. Male wistar albino rats weighing about 250-300gm were included. Animals were divided in to test, standard and control groups, sterile normal saline, diclofenac sodium and TC were admisntered, respectively; 6 animals each, respectively. CQ was studied at different concentration, 19.95mg/kg, 25.69mg/kg and 33.25mg/kg in the test group on the paw volume, categorized in to 1A, 1B and 1C, respectively and 6 animals in each category. Sterile normal saline and diclofenac to the control and standard groups, respectively. The animals were maintained in well ventilated animal house with light and dark cycle, 12 hours each. Plethysmograph was used to measure different parameters of the animal. Descriptive statistics such as ANOVA, Dunnett’s test, Tukey post hoc test were used for the data analysis; P <0.05 was considered to be statistically significant. Results: The herbal medicament, CQ showed significant reduction in the paw volume of rat. When the test group was compared with the control and standard, there was a significant reduction in the paw volume. Conclusions:  In the animal models also CQ exhibited AnI activity. Studies on large samples with different animal models is recommended.

6. Data Analysis on Risk Factors and Fetomaternal Outcome in Gestational Diabetes Mellitus
Urmi R Parekh, Harshdeep K Jadeja, Bhavesh B Airao, Hemal Sarvaiya
Abstract
Objectives: To determine fetomaternal outcome in patients with Gestational diabetes mellitus and identify risk factors associated with it. Material and Methods: It is a retrospective study of GDM patients who delivered at C.U. Shah medical college over a period of 5 years (January 2018 to December 2022). Only 50 patients fulfilled the criteria. Their detailed data was obtained from the department. Women who had documented evidence of DM prior to pregnancy, irrespective of whether on treatment or not, were excluded from the study. Results: Gestational diabetes mellitus was found to be higher in age group of 31-35 years with increased parity. It was observed that there was increased incidence of delivery by cesarean section. Polyhydramnios and preeclampsia in association with Gestational diabetes mellitus had been found to complicate the course of pregnancy and has adverse effect on fetomaternal outcome. Conclusion: We cannot prevent GDM but appropriate and timely screening is required to maintain good glycemic control. Universal screening and a proper team approach of dialectologist, obstetrician and neonatologist can reduce neonatal and maternal morbidity and mortality associated with GDM.

7. A Retrospective Observational Study to Assess the Clinical Spectrum of Benign Breast Diseases in BMC Sagar
Akhilesh Ratnakar, Sunil Kumar Saxena, Jitendra Singh Dangi, Aditi Kumari
Abstract
Introduction: Benign Breast Disease is a very prevalent condition. It comprises of infectious and inflammatory diseases of the breast, Mondor’s Disease, Fibroadenomas, Fibrocystic Disease, Intraductal Papillomas, Nipple Inversion, Cyclical Mastalgia, Involution, Sclerosing Adenosis, Duct Ectasia and Atypical Ductal or Lobular Hyperplasia. The magnitude is rising day by day. Objective: To study the clinical spectrum of Benign Breast Diseases in patients presenting to Surgery OPD in BMC Sagar. Methods: A total of 90 females more than 15 years of age with Benign Breast Diseases and undergoing USG and FNAC for the same, presenting to Surgery OPD were recruited for study from January to June 2023. OPD records were segregated and compiled. The prevalence and the clinical spectrum of various benign breast diseases were determined at our institute. Results: In 90 subjects enrolled, the most common benign breast disease identified was Fibroadenoma (56.7%) followed by Fibrocystic Disease (10%) and Breast Abscess (7.7%). The least common presentation was that of mycotic infections, involution, macrocysts and radial scars (each 0%).  Conclusion: Epidemiology of Benign Breast Diseases show large interregional variability. Knowledge of spectrum of Benign Breast Diseases and their prevalence is indispensable for the preventive strategies to be structured and encouragement of Breast self-examination to be started early in the concerned population.

8. Effect of Alcohol Intake on Liver Function Tests
Reena Rani, Anupam Kumar Singh
Abstract
Alcohol consumption has been steadily increasing all over world, especially in India. Alcohol can cause physical, mental and social effects which is determined by quantity and pattern of alcohol drinking. All organs can be damaged due to direct effects of alcohol, especially the digestive and nervous systems. At the level of digestive system, alcohol causes gastrointestinal problems, cirrhosis of liver, pancreatitis and cancer of mouth, pharynx and oesophagus. The present study aims to compare the values of Liver function test, LFT parameters in a group of chronic alcoholics and a matched controlled group (non-alcoholics). SGOT levels were more in alcoholic subjects as compared to control subjects and this difference was statistically highly significant. SGPT levels were significantly higher in alcoholic subjects as compared to control group subjects. Total bilirubin direct bilirubin, was more in alcoholic subjects as compared to control subjects and this difference was statistically highly significant. Total protein, albumin was low in alcoholic subjects as compared to control subjects. The present study clearly establishes that alcohol has direct effect on the physiological functioning of the liver which is proved by alteration in liver function tests.

9. Prevalance and Distribution of Ocular Morbidities among High School Going Children in Chandrapur
Namrata S. Loya, Niwrutti Jiwane, Avinash Tekade, Yogesh Gupta
Abstract
Background: Healthy vision plays an important role in academic success. School children are affected by various eye disorders like refractive errors, squint, Vitamin A deficiency and eye infections. Most children do not complain of defective vision, as they may not recognize such conditions as a problem. Uncorrected refractive errors form the primary cause for visual impairment and blindness in India. This warrants early detection and treatment of these problems to prevent future blindness. Aims: The study was conducted to estimate the prevalence and distribution of ocular morbidities among high school going children in Chandrapur and to create ‘eye-health awareness’ among them. Method: This was a cross-sectional study of school children of two schools in Chandrapur city. The students were screened for eye disorders by visual acuity testing, anterior segment torch light examination and eye movements. Results: A total of 450 children were examined. The prevalence of ocular morbidity was 45%. Uncorrected refractive error was commonest morbid condition (27%) and Vitamin A deficiency was the second common morbidity (7%). Conclusion: Regular eye screening programmes play a pivotal role in identification of ocular morbidities among high school going children. Hence, prompt and timely treatment can prevent future complications and childhood blindness. The eye health awareness among children, their parents and school teachers should be improved.

10. Assessment of Patient-Reported Outcomes after Hip Resurfacing Surgery: A Prospective Study
Prafulla Borkar, Kunal Saoji, Vasant Gawande
Abstract
Hip arthritis stands as a widespread and debilitating musculoskeletal condition, causing progressive cartilage degradation, pain, and restricted hip joint function. Such limitations drastically impact individuals’ quality of life, leading to reduced mobility and increased dependency. Hip resurfacing surgery has emerged as a promising alternative to traditional total hip replacement (THR), particularly for younger and more active patient cohorts. While THR historically addressed end-stage hip arthritis, concerns regarding implant longevity and activity limitations in younger patients prompted the exploration of alternative interventions. Hip resurfacing surgery, conserving more natural bone compared to THR, involves the removal of damaged cartilage and minimal femoral head bone, replaced by a metal cap, while resurfacing the acetabulum with a metal component. Patient selection is pivotal, considering factors like age, bone quality, and joint damage extent. This prospective cohort study evaluates patient-reported outcomes post-hip resurfacing in 150 participants, demonstrating a significant increase in Harris Hip Score (HHS) from 48.7 to 89.4 and EQ-5D scores from 0.45 to 0.78 post-surgery. While 85% reported satisfaction, 6.7% faced discomfort. Complications, observed in 8%, included rare dislocations but no implant failures or revisions occurred within the 24-month follow-up. The study underscores hip resurfacing surgery’s efficacy in enhancing patient outcomes, hinting at its potential as an alternative to THR. However, ongoing vigilance and comprehensive long-term research are essential for refining its application and evaluating its lasting effects.

11. Navigating the Therapeutic Landscape: Unveiling the Efficiency and Safety of Oral Tofacitinib in Patients with Rheumatoid Arthritis
Prafulla Borkar, Kunal Saoji, Vasant Gawande
Abstract
Rheumatoid arthritis (RA) looms large as a formidable adversary within the intricate landscape of autoimmune disorders, casting its shadow over millions of individuals worldwide. The prevalence of rheumatoid arthritis transcends geographic boundaries, affecting diverse populations with varying genetic predispositions and environmental factors. Understanding the nuances of patient-specific factors that may influence treatment outcomes is crucial in tailoring therapeutic approaches. The results of this study highlight the efficacy of oral tofacitinib in reducing disease activity, improving functional status, and inhibiting joint damage progression in patients with rheumatoid arthritis.

12. Clinicopathological Profile of Head and Neck Cancers at Tertiary Care Centre of Gujarat
Pramod T Kharadi, Viral G Prajapati, Hitesh Satapara
Abstract
Background and Aim: Understanding the regional patterns of cancer is crucial for identifying the most pressing areas for cancer prevention and treatment on a global scale. Our study aims to gather comprehensive data on the demographics, subsite distribution, histologic differentiation, and treatment received, and other pertinent characteristics of patients diagnosed with head and neck cancer. Our study also seeks to understand the results of managing head and neck cancer in a specialized healthcare facility. Material and Methods: A study was conducted at the Tertiary Care Teaching Institute of India for a period of one year. Information on age, gender, risk factors, clinical features, grading, staging, treatment received, and presenting symptoms during follow-up were collected and analysed statistically. A thorough and comprehensive history was obtained, covering presenting complaints, past medical history, family history, and personal history. Special attention was given to personal habits such as tobacco and alcohol consumption. The patients were monitored for a period of 6 months after they finished their treatment. Results: Final analysis included a total of 80 subjects. A significant number of cases were observed in individuals aged 61 to 70. Our study found that the majority of patients were male, with only 25% being female. The study found that dysphagia was the most frequently reported symptom, accounting for 40% of cases. Ulcerative lesions were the second most common complaint, reported in 20% of cases, followed by neck swelling, which was observed in 17.5% of cases. It was noted that a significant majority of the cases, 76% to be precise, had habits of smoking, alcohol consumption, and tobacco chewing.  The oropharynx was the most frequently affected area, accounting for 20% of cases, closely followed by the hypopharynx and the larynx, both at 17.5%. Conclusion: Based on the study findings, it is evident that factors such as older age group, smoking, alcohol consumption, and tobacco chewing play a significant role in increasing the risk of head and neck cancers. The study also revealed positive outcomes and minimal side effects in patients who had received chemotherapy, radiotherapy, or surgeries during their treatment. By implementing thorough screening, promptly identifying the disease, and ensuring adherence to treatment, we can enhance the chances of survival for individuals with head and neck cancer.

13. Congenital Elongated Cervix – A Rare Case Report from a Tertiary Medical Hospital, Burdwan
Arpita Pramanik, Manojit Sarkar
Abstract
The normal length of an adult non-pregnant cervix is about 2.5 cm to 3.0 cm. Isolated cervical descent with a normally positioned uterus is found in the case of true cervical elongation, which is a form of congenital elongation of the cervix and is a rare presentation in adolescence and young women. We report a case of a 2 days old newborn girl baby with congenital elongated cervix delivered vaginally, uneventfully, of a 21 year’s old primi mother.

14. Multidrug Resistance among Penicillin Resistant Pneumococcus Isolated from Respiratory Specimens
Gupta Kanchan, Agrawal Ruchi, Shah Mitesh, Misra Vaibhav
Abstract
Introduction: Diseases caused by Streptococcus pneumoniae are the cause of global concern. S. pneumoniae is common causative agent of pneumonia, bacteremia and meningitis which lead to morbidity and mortality, even after being treated in hospital. S. pneumoniae shows resistance for multiple antimicrobial drugs as penicillin, clindamycin, erythromycin, clarithromycin, tetracycline, chloroamphenicol, trimethoprim/sulfamethoxazole. Present study is conducted to find distribution of multidrug resistance among penicillin resistant pneumococci isolated from respiratory specimen. Aims & Objectives: To find distribution of multidrug resistance among penicillin resistant pneumococcal strains isolated from respiratory specimen with age distribution. Material & Methods: The study was conducted in the Department of Microbiology Gajra Raja Medical College, Gwalior (M.P.) for a period of one year. Respiratory samples were collected from patients of all age groups suffering from lower respiratory tract infection and identification of pneumococci was done. Antimicrobial susceptibility testing done. Penicillin resistance and resistance for other antimicrobial drugs was screened. Data was statistically analyzed by odds ratio, p-value <0.05 was considered statistically significant. Result: Pneumococci isolated maximum from patients under 5 years and >50 years age group. 24 isolates (48%) showed penicillin resistance. Among other antimicrobial drugs resistance was maximum for erythromycin (46%) followed by tetracycline (38%), cotrimoxazole (36%), cefotaxime (30%) and ciprofloxacin (14%). Statistically significant correlation between penicillin resistance and multidrug resistance among S. pneumoniae isolates [odds ratio 3.31, 95% confidence interval, (CI) 1.02-10.72, p value 0.045 (i.e. p<0.05)]. Conclusion: Pneumococci can cause disease at any age though more frequently at extremes of age. Multidrug resistance is common among the penicillin resistant pneumococcal isolates. Antimicrobial-susceptibility testing must be done for pneumococcal isolates.

15. A Study to Evaluate Effectiveness of Role Play as A Teaching Learning Method for Communication Skills among Phase II Undergraduate Medical Students
Priyanka Kumawat, Rajendra Sharma, Gunja Jain, Seema Jawalekar
Abstract
Introduction: Good communication skill is directly linked with positive outcomes in all the aspects of patient care. With the introduction of new curriculum in CBME there is inclusion of AETCOM module as well as competencies related to communication skills “Role play” is widely used as a teaching learning method to develop communication skills to enhance cognition, psychomotor skills, and affective domains in learners. The present study was undertaken to determine the perceptions of Phase II undergraduates about the use of role play as educational tool for communication skills. Methodology: It was a prospective; questionnaire based observational study done in department of Pharmacology on 100 2nd phase MBBS students. In which two competencies were finalized by the subject experts, from communication topic in pharmacology for role play session. The students were divided in two groups of 50 each and it further divided in 5 subgroups having 10 students in each subgroup to perform role play. Group I acted role play for one competency and Group II performed as observer for second session a crossover was done with 2nd communication competency. A pre and posttest in the form of MCQ was taken before and after role play respectively. At the end of the role play student and faculty feedback were taken by prevalidated questionnaire contain both close-ended (using 5-point Likert scale) and open-ended questions to know their perceptions for role play in Pharmacology as a tool for communication skills. Overall faculty and students’ perception was also taken on VAS. Results: The results showed that students preferred role play as the preferred instructional tool to teach communication skills. Pre and post test score comparison showed significant improvement with p<0.001. Impression of actor students was that 98% agreed or strongly agreed that role play assisted them in learning communication skills, and almost all (99%) enjoyed the simulation.  87% thought simulation covered critical content necessary for the mastery of medical curriculum. 91% considered that they understood how to use simulation activities to learn critical aspects of these skills. The overall acceptance of role play on Likert scale by actor students was around 8.0 on a scale of 0 to 10. The impression of the observer group students via Kalamazoo scale about the roleplay was that 91% agreed or strongly agreed that role play helped in learning communication skills to establish the relation among patients, 90% felt that it improves ability to communicate accurate information to patients. The students response for open ended questions was like “It was a very efficient way of learning; it was easy and fun filled experience to get knowledge.” 100% of faculty agreed to strongly perceived that role play helped teaching communication skills with more objectivity Conclusion: Almost all the students and faculty felt that role play can be used as an effective tool to improve the communication skills and it should be started at the foundation level. Besides the communication skills, knowledge was also enhanced and It imparts the good doctor patient relationship. This would help in achieving one of the IMG goals, to be a physician of the first contact with good communication skills.

16. Comparison of Recovery Characteristics by Using Low Dose Bupivacaine 10 mg and Injection 2- Chloroprocaine 40 mg for Spinal Anaesthesia in Short Duration Surgeries
Bhoomika G Chaudhari, Mitali K Ahir, Dhavalkumar C Patel, Sunaina Patel
Abstract
Introduction: An ideal local anaesthetic should have quick onset, reliable sensory and dense motor block and at the same time quick sensory and motor regression so that patient can ambulate and discharged early for day care surgery. Method: Patients posted for short duration surgeries (1 to 1.5 hours) with day care procedure under ASA physical status I to III without any contraindication to spinal anaesthesia and allergy to local anesthetic agents were included in study. Patients in group A had received Inj. Bupivacaine 0.5% 10 mg (2 ml+0.5 ml sterile normal saline and group B had received Inj. Chloroprocaine 1 % 40 mg. (4 ml). Sensory and motor block between two groups in terms of duration and their regression, as well as time to micturition and time to assisted ambulation were compared between two groups. Result: There was significant difference between both the groups in time for regression to L1 and S2 level. Group B had earlier regression of sensory blockage at L1 which was 96.46±31.18 min compared to bupivacaine group A which was 113.33 ±30.7 min (P<0.0001). Total duration for regression of   Bromage score 0 was 133.3±34.02 min in bupivacaine group whereas 109.96±33.52 min in chlorprocaine group (P<0.0001). When compared time for assisted ambulation it was 148.33±40.15 min in bupivacaine group compared to 121.23±39.46 min in chlorprocaine group (P<0.0001). Conclusion: From this study we observed that for short duration surgeries, intrathecal 2- chloroprocaine 40 mg shows faster regression in terms of sensory/motor blockade; earlier assisted ambulation and ability to micturate compared to Bupivacaine 10 mg without causing any significant hemodynamic compromise.

17. A Retrospective Observational Study to Compare the Effect of Low-Pressure Versus Standard-Pressure pneumoperitoneum in Laparoscopic Cholecystectomies Performed at BMC Sagar
Akhilesh Ratnakar, Sunil Kumar Saxena, Jitendra Singh Dangi, Lav Gupta, Aditi Kumari, Hemal Vithani
Abstract
Introduction: Laparoscopy, owing to its minimally invasive nature, has become the standard of treatment for cholelithiasis. It decreases post-operative pain, morbidity and length of hospital stay. Objective: Our aim in this study is to assess whether low pressure in laparoscopic surgeries (7 mm Hg instead of 12 mm Hg) would have added benefit of reduced post-operative use of analgesia and morbidity, subsequently, shorter hospital stay. Methods: A total of 80 patients who underwent laparoscopic cholecystectomy were studied and divided into low-pressure group (7 mm Hg) and standard-pressure (12 mm Hg) group. The outcomes were measured as primary and secondary. Primary included length of hospital stay whereas secondary compared post-operative pain, amount of analgesia required, day on which bowel sounds heard and time to ambulation. Results: Out of 80 subjects enrolled, 36 were males and 44females. Laparoscopic cholecystectomy using low pressure for pneumoperitoneum yielded no mortality and no significant difference in surgical complication or conversion to open surgery. On the other hand, it resulted in better outcome in terms of need for analgesia, reduced period of ileus and early ambulation. Conclusion: Low pressure pneumoperitoneum in laparoscopic cholecystectomies has an edge over standard pressure since cardiovascular and respiratory physiology is comparatively less affected. Thus, it may emerge as a better alternative to improve patient outcome.

18. A Double Blind Comparative Study of Efficacy and Safety of Intra-lesional Triamcinolone Alone versus Intra-lesional 5-Fluorouracil and Triamcinolone Combination in Treatment of Keloids in a Tertiary Care Hospital
Veena V, Shakuntala B, Anusha P H, Muralikrishna V, Sameena A R B
Abstract
Introduction:  Keloids are benign dermal collagen and fibro-proliferative growths. They are a variant of wound healing and are prone to recur. Though there are a variety of treatment options for keloids, no standardized treatment is available. Intra-lesional steroid is the commonest treatment modality in use. 5-Fluorouracil, a cytotoxic drug in combination with steroid relieves symptoms of keloids. Hence the study was planned. Objectives: To compare early improvement, efficacy, response and safety of Triamcinolone alone with 5-Fluorouracil and Triamcinolone combination in keloids treatment. Materials and Methods:  An open labelled randomized comparative study was conducted. 60 patients with keloids, were randomly divided into 2 groups of 30 each. Group A patients were given intra-lesional Triamcinolone 1ml (40mg/ml) and Group B patients were given a combination of 5-Fluorouracil 0.9ml (50mg/ml) and Triamcinolone 0.1ml (40mg/ml) intra-lesionally, weekly once for 4 weeks, later fortnightly once for 6 weeks. Follow- up was done till 12 wks. Efficacy was assessed by noting the shrinkage of keloid (volume), improvement in vascularity, pigmentation, pain and itch score. Safety was assessed by adverse effects experienced by the patients. Data was collected, statistical analysis done and results were compiled. Result: Group B patients showed better improvement than Group A patients in terms of lesion shrinkage (78.69%, 48.72%), vascularity (77.5%, 36.84%), pigmentation (43.75%, 30.3%), itch relief (87.8%,53.09%) & pain relief (87.84%,54.05%). There was statistical significance (p < 0.002) between the groups in all parameters except pigmentation. Pain at the injection site was experienced by all patients in both groups (100%) and local burning sensation by 3 patients in Group A (10%) compared to 1 patient (3.33%) in Group B. Hypopigmentation and hyperpigmentation were seen in 3.33% patients in Group A and Group B respectively. Good to excellent response was seen in >50% patients in both the groups except for keloid volume which was fair to good in 75% Group A patients. Response to treatment with regard to all parameters was much better in Group B than in Group A. Conclusion:  Combination of 5-Fluorouracil and Triamcinolone has early onset of action, is more effective and safer than Triamcinolone alone to treat keloids.

19. Ligature Mark in Deaths Due To Hanging –Retrospective Study
Rohit Raj Singh, Prabhat Kumar, Nishant Purbey, Dharmendra Kumar, Kaushal Kishore, Bijay Kumar Prasad
Abstract
Background and Objective: Hanging is one of the ten leading causes of death in the world accounting for more than a million deaths annually. The hanging deaths are one of the most important asphyxial types of death which are encountered in day to day life by forensic pathologists. Ligature mark in the neck is the principal external sign in hanging depending on body suspension from ligature point. Material and Methods: This Retrospective study was conducted at the Department of Forensic Medicine, SKMCH Muzaffarpur and Other Medical College to assess the information provided by a ligature mark in deaths due to hanging. Conclusion: We found that typical hanging is seen in 50 cases and atypical hanging in 225 cases. Partial hanging is seen in 73.09% deaths and complete hanging in 26.9% deaths. Ligature mark was obliquely placed in 91.3% cases and was found to be running above thyroid cartilage in 80.7% cases. Single ligature mark with a breadth of 1-2cms is observed in the maximum number of cases. In 93% of the incidents, ligature mark showed discontinuity. The colour of ligature mark was reddish-brown in 46.9% cases.

20. Pattern of Fatal Injury in Driver and Pillian Rider in Two Wheeler Accidents in Bihar
Prabhat Kumar, Rohit Raj Singh, Ravi Kumar Sharma, Dharmendra Kumar, Kaushal Kishore, Bijay Kumar Prasad
Abstract
Background and Objectives: Two-wheelers accounted for the highest share in total road crashes (1,62,280), contributing 33.8%, followed by cars, jeeps and taxis (1,13,267) contributing 23.6% and trucks, tempos, tractors and other articulated vehicles (1,01,085) contributing 21.0% and buses (37,487) contributing 7.8% to total road crash fatalities. ‘New Birth’ is rejoiced as a happy occasion and loss of a family member in the form of ‘death’ is mourned. To study the pattern of fatal injuries by two wheeler accidents. To compare the pattern of injuries sustained by two wheeler riders wearing the helmet and without helmet. To study the relationship between two wheeler accidents and various factors like age, sex, weight, height, time of incidence etc. and type of other vehicles involved. Materials and Methods: Study is to be conducted on dead bodies received for medico legal autopsy at mortuary of Department of Forensic Medicine & Toxicology, AIIMS, Patna and Other medical College, Bihar. Study Duration of Two Years. Conclusion: None of the victims who were wearing helmet of standard quality (ISI) had spot death. Spot death was seen in victim who had head injury with or without any other injury. And, ISI helmet definitely protects from head injury. 2-7 days was critical in significant number of cases for both groups wearing 1ST helmet and Non-ISI helmet.

21. A Study of Impact of Losartan on Serum Uric Acid Levels in Essential Hypertension
Afreen Fatima, Ahemadi Firdous Nikhat
Abstract
Background: There is a strong correlation between hypertension and elevated levels of uric acid, contributing to the onset of cardiovascular disease. The impact of angiotensin II AT-1 receptor antagonists on uric acid metabolism, along with potential variations in this effect among them, is yet to be conclusively determined. This study was structured to assess and compare the effects of losartan on uric acid metabolism in individuals experiencing mild to moderate essential hypertension. Methods: This cross-sectional interventional study focused on newly diagnosed stage 1 and stage 2 essential hypertension patients with elevated serum uric acid levels. Conducted at the Non-Communicable Disease outpatient department, clinical assessments, and baseline investigations, including serum uric acid, blood urea, serum creatinine, random blood sugar, and serum cholesterol, were performed upon enrollment. Demographic data were recorded, and blood pressure measurements were taken after 10 minutes of rest in a seated position. Results: Losartan therapy appears to be effective in improving blood pressure control in patients with essential hypertension. We saw a reduction in the number of patients in higher stages (Stages 2 and 1) and an increase in those categorized as Prehypertension or even returning to the normal range. This suggests successful blood pressure lowering over the 6-month follow-up period. Losartan therapy has been shown to have a positive effect on reducing serum uric acid levels in patients with essential hypertension. The gradual decrease observed over 6 months suggests a sustained benefit of the medication in managing uric acid levels. Conclusion: The current study concluded that losartan effectively lowered blood pressure over 6 months, showing a significant decrease in both systolic and diastolic values. Additionally, there was a statistically significant reduction in serum uric acid levels with losartan treatment. This reduction in uric acid is noteworthy, as it is independent of blood pressure reduction, emphasizing that losartan possesses uric acid-lowering effects beyond its significant impact on blood pressure.

22. A Cross-Sectional Autopsy Study of Pyogenic Meningitis in Cases of Fatal Head Trauma
Soma Dash, Sasmita Khatua, Geeta Sahu, Suvendu Kumar Panda, Bhabani Patnaik, Sourav Parida, Pratyush Mishra
Abstract
Background: Traumatic brain injury (TBI) and meningitis are serious complications with high mortality rates. Little is known about the specific factors influencing mortality in patients with both conditions. Objectives: To study autopsy findings, survival time, isolate and study microscopic finding of meningitis in fatal head trauma cases. Methods: This cross-sectional autopsy study included 118 deceased patients with TBI and meningitis who underwent medico-legal autopsies between January 2021 and August 2022. Data were collected on socio-demographic characteristics, type of injury, skull fracture type, CSF findings, organisms isolated from CSF culture, and survival time. Results: Male gender, young age (20-39 years), Hindu religion, road traffic accidents as the injury cause, linear skull fractures, bloody or turbid CSF appearance, increased cell count and protein, and decreased glucose in CSF analysis were independent predictors of mortality. Streptococcus pneumoniae and Hemophilus influenza were the most commonly isolated organisms. Median survival time was short, at only 5 days. Conclusion: This study highlights the alarmingly high mortality rate and its association with specific socio-demographic and clinical factors in patients with TBI and meningitis. Early diagnosis, comprehensive intervention, and targeted approaches based on risk factors are crucial to improve survival and outcomes in these vulnerable patients.

23. Pulsed Oral Azithromycin Therapy for Meibomian Gland Dysfunction: A Prospective Clinical Study
Dasari Gayatri, Syam Kumar Addepalli, Yamalakonda Veerendra Goud, Chippada Tejaswi, Satyavaraprasad Chavali
Abstract
Introduction: Meibomian Gland Dysfunction (MGD) affects a substantial portion of the population, necessitating interventions beyond conservative measures. Tetracyclines, although effective, pose adverse effects. Previous trials suggest comparable outcomes for a 5-day pulsed oral azithromycin course and prolonged oral doxycycline in managing MGD. This study aims to assess the effectiveness of oral azithromycin in an Indian population. Material and Methods: Conducted at Gitam Institute of Medical Sciences and Research from January to December 2023, this study enrolled 35 MGD patients (20 females, 15 males). Comprehensive three-month treatment regimens, including pulsed oral azithromycin (5 days), warm compresses, and lid massage and topical lubricants and azithromycin, were administered. Assessments included symptom relief, meibomian gland functionality, TBUT, lid margins, ocular staining and ocular inflammation. Results: Post-treatment, majority experienced symptom relief, 80% with improved gland expressibility, 90% improved lid margins, with increase average TBUT and reduced ocular unflammation. Statistical analysis revealed significant improvements (p < 0.05) in symptoms, gland expressibility, gland pore opening, and other parameters. Conclusion: This study validates the efficacy of short pulsed doses of oral azithromycin in alleviating MGD symptoms. This approach demonstrates potential advantages over prolonged doxycycline use, offering a short term patient-friendly and economically viable alternative. Larger studies are warranted to refine MGD management strategies in the Indian population.

24. Study of Clinical Response between Treatment of Keloids with Intralesional Injection of Bleomycin plus Triamcinolone Acetonide versus Intralesional Cryotherapy plus Triamcinolone Acetonide
Manohari Tushar, Pati Sandhyarani, Subudhi S Jaganath, Rout Kumar Suresh, Ram Kumar Manoj, Mohanty Prasenjeet, Bisoyi Diptiranjani, Mohanty Jayashree
Abstract
Introduction: Keloids are an unusual pathological reaction to skin damage in which the tissue of the wound expands excessively beyond the initial cause of the lesion. These are benign non-cancerous fibro proliferative skin growths that occur when there is an excessive development of bigger, thicker, and more irregularly arranged collagen near the site of a previous skin injury. Frequent factors encompass surgical procedures, immunisation, thermal injuries, ear piercing, and acne. Bleomycin is a glycopeptide antibiotic commonly employed as an anti-cancer medication. It triggers programmed cell death in endothelial cells and hampers the production of collagen by blocking the lysyl-oxidase enzyme and TGFβ. In 1996, Bodokh and Brun were the first to utilise it in the treatment of keloids. The medications can have a synergistic impact when administered together. Objectives: (1) To compare the efficacy of both the procedures. (2) To achieve minimum recurrence and side effects. Methodology: After obtaining ethical clearance and written informed consent, this study was done among 50 patients with keloid/s, both male and female attending the dermatology OPD in a tertiary health care centre and not received any kind of treatment or intervention before commencement of this study. Skin test with lignocaine was done using 0.1ml of 2% lignocaine solution to see for any hypersensitivity in both the groups. After surgical cleaning of the site, 2% lignocaine was administered as field block in both the groups. Results: In our study the prevalence of keloids was found to be more among males as compared to females. The majority of keloids were seen in the 16 to 35 years of age group in our study. About 56% patients had keloids of <5 year Duration. Family history of keloid was present in 10% of Patients. Pruritus was the most common presenting symptoms seen in 74% cases, followed by cosmetic and pain. In Group A pain was the most common early side effect, But in Group B all other early side effects like ulceration, bulla formation and secondary infection was more common. Delayed Side effects like hyperpigmentation, atrophy and telamgiectasia were slightly common in Group A as compared to Group B probably because of more no of steroid doses. But hypopigmentation was common in Group B. Conclusion: Our study concludes that combination therapies should be the preferred modalities of treatment in keloids rather than monotherapies. Both the treatment options showed promising result. Tramcinolone plus Bleomycin was found to be slightly better in terms of efficacy as compared to crytherapy plus tramcinolone.

25. A Retrospective Observational Study to Compare the Efficacy between Dorsal Slit Technique and Sleeve Technique for Circumcision Performed At BMC Sagar
Sunil Kumar Saxena, Akhilesh Ratnakar, Jitendra Singh Dangi, Ajit Singh Morey
Abstract
Introduction: Circumcision is the commonly performed surgical procedure. It can be done via several techniques. Dorsal slit technique is the most commonly used procedure. The sleeve technique introduced later on which helps in preventing common complications of open technique for male circumcision. Objective: Our aim in this study is to assess the efficacy between dorsal slit technique and sleeve technique for circumcision. Methods: A total of 80 patients were studied out of which 40 patients underwent dorsal slit technique and 40 patients underwent sleeve technique the outcomes were measured in terms of post-operative pain, post-operative edema, cosmetic outcomes and duration of hospital stay. Results: 80 subjects were enrolled. Circumcision via dorsal slit technique had no significant difference from sleeve technique In terms of surgical site infection, none observed in any case. On the other hand, sleeve technique resulted in better outcome in terms of post-operative pain, post-operative edema, cosmetic outcomes and duration of hospital stay. Conclusion: Sleeve technique in circumcision has an over dorsal slit technique since it results in reduced post-operative pain, better cosmetic outcome, reduced duration of hospital stay. Thus, it may emerge as a better alternative to improve patient outcome.

26. Evaluation of Biomedical Waste Management Practices at Primary and Secondary Level of Healthcare Facilities of Saurashtra Region of Gujarat, India
Paras Mehta, Sunil Jangid, Dhaval Patel, Mohnish Tundia
Abstract
Background: Biomedical waste (BMW) collection and proper disposal has become a significant concern for both the medical and the general community as improper management poses risks to the health care workers, patients, general community and largely the environment. In order to improve biomedical waste management, it is important to understand and evaluate the current practices in biomedical waste management, to identify the gaps and to address them. Objectives: (i) Assessment of current Bio-medical waste management practices including collection, segregation, transportation, storage, treatment and disposal technologies in healthcare facilities of Bhavnagar district. (ii) Assessment of health and safety practices for the health care personnel involved in Bio-Medical Waste Management. Materials and Methods: This was a cross-sectional study. The study employed random sampling. Two Primary health centers (PHC) were randomly selected from each taluka and all Community health centers (CHC) of Bhavnagar district were selected. Study participants included- doctors, staff nurses, laboratory technicians, pharmacists and sanitary staffs. So total 18 PHCs, 15 CHCs and 165 study participants were included in the study. The study was conducted by using pretested, semi-structured proforma. The study included details of various biosocial profiles, an observational checklist and other details regarding practice of biomedical waste management. Results: Only 38.8% study participants had received training for bio medical waste management and poor biomedical waste management was observed at the primary and community health centres. The safety measures taken by health care workers was not satisfactory, it was basically due to un-awareness of health hazards which may occur because of improper waste management practices. There was significant association between practice of waste segregation and training of study participants.

Conclusion: Biomedical waste management practices were poor. Periodic training of health care personnel on BMW management needs to be emphasized to have a significant impact on BMW disposal and practices.

27. Histopathological Spectrum of Oral Cavity Lesions at a Tertiary Care Center in Western Rajasthan
Vijayta Modi, Sunita Kulhari, Ajit Singh, Guman Singh, M. P. Khatri
Abstract
Background: Oral cavity lesions, encompassing benign, premalignant, and malignant conditions. Global oral cancer prevalence is a significant health concern, especially in developing regions, ranking as the 13th most common cancer worldwide. India faces a high incidence of oral cancers due to socioeconomic challenges and limited healthcare access. Tobacco use, a major risk factor, contributes to substantial morbidity and mortality. Smokeless tobacco alone causes around 200,000 deaths annually in India. The study emphasizes the importance of histopathological evaluation for early identification and treatment, considering it the gold standard in diagnosing oral cavity lesions. Methods: This is a retrospective descriptive study conducted for two years from January 2021 to January 2023. All oral cavity lesions received by the department during the study period were included in the study. The tissues received were fixed in buffered formalin and grossed as per the department protocols. The blocks were made by wax block method and 5-micron sections were taken and slides prepared and stained with hematoxylin and eosin stain and observed under light microscope. Relevant special stains were used as and when required. Results: We received a total of 259 biopsies and specimens of lesions of oral cavity during the study period. The male to female ratio of 2.12: 1. The male gender dominated in all the three types of lesions, benign, premalignant, and malignant lesions, however the difference was not statistically significant (p-value = 0.06) The age of patients ranged from 13 years to 80 years with the median age of 41 years. Maximum number of patients was in the 6th decade of life with 78 (30.12%) cases followed by 5th decade with 57 (22%) cases. Our study shows that the frequency of malignant lesions increases with the increase in age and in younger patients, benign lesions outnumber the other type of lesions, and the variation is statistically significant (p-value = 0.0001). Smoking was the most common risk factor identified. The most common presenting complaint of the patients was growth in the mouth (167; 64.47%), followed by ulcer (129; 49.80%), pain in the mouth was present in (87; 33.59%) and difficulty in opening of mouth was present only in (34; 13.12%) patients in the present study. The most common site of the lesion was buccal mucosa (42: 16.22% cases) followed by base of tongue (35: 13.51%). In subcategory of inflammatory lesions, there were 2 (0.77%) cases of lichen planus. Out of 43 benign lesions, pyogenic granuloma (12: 27.91% cases) was the most common diagnosis followed by hemangioma (7; 16.28% cases) and lipoma (6; 13.95% cases). In premalignant lesions hyperkeratotic leucoplakia was diagnosed in 12 (57.14%) cases and dysplastic leucoplakia with 9 (42.86%) cases. In malignant lesions the major bulk of diagnosis was squamous cell carcinoma taking the total number to 179 (69.11%) cases. Conclusions: The present study shows that most of the lesions of oral cavity are malignant and squamous in origin. Histopathological examination provides crucial information regarding the nature of lesion and early treatment can be initiated if a malignant lesion is suspected.

28. Comparison of Polyethylene Glycol (Peg 3350) and Lactulose in Functional Constipation in Children (1- 4 Years): A Double Blinded- Randomised Controlled Trial
Hitender Rao, Sanjay Mandot, Dileep Goyal, Anjali Vyas
Abstract
Introduction: Functional constipation is a common problem confronted by Paediatricians in today’s time. It is important for the child’s physical and mental health that an early evaluation with prompt treatment is given. The objective of the study was to compare the efficacy of polyethylene glycol 3350 versus lactulose in treatment of functional constipation in children from age 1-4 years. Aims: To compare the safety and efficacy of polyethylene glycol 3350 (PEG) and lactulose for the treatment of functional constipation in children (1-4 years). Objective: (1) To compare the effectiveness of polyethylene glycol and lactulose in the treatment of functional constipation in children. (2) To compare the short term (up to 12 weeks) adverse effects of both the drugs in the treatment of functional constipation in children. Methods: A randomized controlled trial was conducted in Pediatric department, at a tertiary care hospital, Udaipur, Rajasthan, over a period of February 2021-July2022, after obtaining permission from ethical committee of the institute. Total 70 children (age 1-4years) with functional constipation according to Rome IV criteria were included in the study. Polyethylene glycol 3350 was given in one group while lactulose was given to another group. Improvement in number and consistency of stools according to Bristol scale at 4, 8 and 12 weeks was considered as primary outcome and adverse events were the measure of secondary outcome. Results: Among 70 children, with 35 children in each group, results by 12th week in PEG 3350 group showed 8.6 to be mean number of stools per week and lactulose group showed 7.1. PEG3350 group showed statistically significant difference when compared to lactulose group (P value = 0.0001). At 12 weeks, PEG 3350 group showed 4.5 to be the mean stool consistency (Bristol scale) per week and lactulose group showed 3.9 per week with a statistically significant on comparison (P value = 0.038). Common side effects observed in both groups were bloating and abdominal pain. Conclusion: Polyethylene glycol 3350 is a safer and more effective alternative to lactulose in the treatment of functional constipation in children. Both PEG 3350 and lactulose were successful in treatment, although the PEG 3350 group significantly showed more efficacy and low and mild overall rates of adverse events.

29. A Study on Effect of Depression on Quality of Life in Post-Menopausal Women
Akhila Sabbavarapu, Nimidithalli Annapurna, Shaik Noor Ahammad, P. Suseela Kumari, T Jaya Chandra
Abstract
Introduction: Menopause is a crucial physiological process in women’s lives here depression is one the psychological condition. A study was conducted to assess the severity of depression in post-menopausal women (PMW). Methods: It was a cross sectional study conducted in the department of Psychiatry, GSL Medical College, conducted between November 2018 and March 2020. The PMW attended psychiatry department on OPD basis, met ICD 10 criteria for depression were considered, those with other psychiatric disorders, chronic physical illness were not considered. The study population were thoroughly explained the purpose of the study and informed consent was obtained. For all the eligible study participants, socio-demographic and clinical information was recorded. Hamilton depression Rating (HAM D) scale was applied to assess the severity of depression and utian quality of life (UQOL) scale was used to assess the QOL. Chi square test was used, P <0.05 was considered to be statistically significant. Results: Total 120 PMW were included, the mean age was 48.13 ± 4.74 years. Out of the 40 (100%) PMW with depression, total QOL wise, 65% (26) were in 48 – 60 group followed by 35% (14) in 61 – 74 group. Whereas in the UQOL group, the total QOL was 75 to 87 in 47.5% (19) and 88 to 100 in 52.5% (21) of study members; statistically there was significant association. Conclusion: Depression is also one of the commonest psychological disorder among the PMW. No assessment of severity of depression, small sample size are the limitations of this research.

30. Cytological Spectrum of Breast Lesions on Fine Needle Aspiration Cytology at a Tertiary Care Center in Western Rajasthan
Sunita Kulhari, Vijayta Modi, Nikita Manoj, Shailee Chhabra, Guman Singh
Abstract
Background: Breast carcinoma poses a significant health challenge in India, with a rising incidence of approximately 50% between 1965 and 1985. In India, breast cancer constituted 13.5% of all cancer cases in 2020. Diagnostic procedures, like fine needle aspiration cytology (FNAC), play a crucial role in evaluating breast lesions. FNAC, recommended by the National Cancer Institute, aids in determining the nature of lesions, guiding treatment decisions. The study aims to explore the cytological spectrum of breast lesions at their institution. Methods: The current study was a hospital based retrospective descriptive study conducted for the period of one years between July 2022 and June 2023. Patients attending the hospital with palpable breast masses, whose FNACs were done at our department or at the department of radiation oncology, and the smears were sent to the Department of Pathology were included in the study as per the inclusion and exclusion criteria. The FNAC smears were properly fixed by 95% ethanol and stained with H&E and examined under light microscope. Clinical details of the patients were obtained from the requisition form or medical records, including age, habits, clinical examination, clinical diagnosis and noted in the prefixed format / Performa. Results: We received a total of 1750 FNAC smears out of which, breast FNAC’s accounted for 216 cases. 200 (10.95%) cases were included. Youngest patient was 16 years and oldest being 77 years old accounting for range of 61. Mean 42.22, median 39.50 and standard deviation being 15.55. Maximum number of patients were in the age group 21-30 years, followed by age group 31-40 years. Least number of patients were seen in both extremes of ages with 12 (6%) cases in 11 – 20 years age group and only 10 (5%) patients in age beyond 70 years. Most common type of lesions were benign lesions with 92 (46%) cases followed by 84 (42%) were malignant and 24 (12%) were inflammatory. Left sided beast lesions were slightly more common than right sided breast lesion. Left sided lesions were 1.08 times more common. Benign lesions were more common in younger age group and malignant lesions were more common in older age group and the difference in the age distribution is statistically highly significant with p value of < 0.0001. On analysing the occurrence of benign and malignant lesions based on the laterality of lesion. We did not find any significant association between the occurrence of breast lesion to any specific side of breast (p-value=0.620). On cytology examination most common individual diagnosis was malignant lesion with 84 (42%) of all breast lesions. Benign breast disease with 32 (16%) was second most common followed by fibroadenoma in 32 (16%) cases. Conclusions: Fine needle aspiration cytology is an efficient, rapid, inexpensive, safe and reliable diagnostic method. It causes minimum morbidity with very less complications and has excellent patient acceptance. It helps to take the decision for the mode of surgery. Despite of its few limitations, FNAC has got high levels of diagnostic accuracy when performed by experienced pathologist.

31. A Community-Based Study Exploring the Impact of Mothers’ Education on their Engagement with Prenatal Care and Childcare Resources
Vishnu CS, N. Praveen Kumar
Abstract
Background: Educated women tend to have a greater awareness of the existence of ANC services, are more aware of health problems, know more about the availability of healthcare services, and utilize the information more effectively than non-educated women. Moreover, higher levels of education tend to positively affect health-seeking behaviors, and education may increase a woman’s control over her pregnancy. In this study, we tried to analyze to what level maternal education can influence antenatal care services and childcare. Methods: A community-based cross-sectional study was conducted on 150 randomly selected mothers who have children aged less than 7 years by using a pre-tested structured questionnaire for data collection at RHC, Karimnagar district from January 2021 to June 2022. Results: Out of 150 study subjects, 12.6% (19) of the study subjects were not registered for antenatal services. The higher the maternal education more the birth spacing between the pregnancies (p<0.05), the more preference for institutional deliveries (p<0.05), the more the birth weight of the child (p<0.05), a smaller number of babies hospitalization due to illness (p<0.00001). Conclusion: This study revealed that the utilization of ANC services was relatively better for the mother’s education higher than secondary school, but they are still low. Educational status is important in having more health-seeking behavior. In this study, it proves that health education is more important than mere school education which can help to improve knowledge on ANC.

32. Heart Rate Variability During Practical Examination Among 1stYear Medical Students of Medical College in South India
S. Selva Kumar, G. Radhika, K. Sarala, G. Shravya Keeethi
Abstract
Introduction: Stressors such as examination, cause an increase in sympathetic activity of the nervous system innervating the heart, and thus an increase in heart rate. Our study aimed to detect changes in heart rate variability (HRV) during an exam in a group of healthy medical students. Methodology: Cross-sectional study was conducted in GMC-Anantapuramu among 1st year medical students to compare HRV during and after practical examination. Convenient sample of 50 healthy students were enrolled in the study. Spandan ECG portable Device was used for the recording of the 5-minute Lead II HRV test. Institutional ethics committee approval obtained prior to study. Statistics: Data collected was entered into MS Excel and analysis was done using SPSS version25, Descriptive statistics were presented using mean and standard deviation, Paired sample t test was used to test difference between two groups (During exams & After exams), correlation was done. P value <0.05was considered to be statistically significant. Results: (mean age-19.42withSD+/-0.992). Significant difference was observed in Low frequency /High frequency (LF/HF) ratio during exam and after exams (1.17+0.29vs0.96+0.15; p<0.0001) on paired sample t test. A positive correlation was found between female gender and Heart rate during exams as compared to male gender. RMSSD (Root Mean Square of Successive Differences) was higher in males during exams. A positive co relation was found between female and LF/HF ratio after exams (co-relation coefficient r=0.321) p Value=0.023. Conclusion: HRV was significantly high after the exam, indicating release from stress, as compared during the examination when stress was observable. Results also suggest that HRV in females is significantly lower than that in males after examination. In conclusion, the results of our study assessing stress in real-time examination show important gender differences, and lack of adaptation with academic study year.

33. A Study to Find the Prevalence of Pulmonary Tuberculosis among the Diabetes Individuals using Ziehl Neelsen Staining
Swetha Sutrave, Pedapati Kasturi, T Jaya Chandra
Abstract
Introduction: Tuberculosis (TB) is a world pandemic, bacterial disease caused by Mycobacterium tuberculosis (MTB) complex. Diabetes mellitus (DM) is a metabolic disorder, very common in low and middle income countries (LMICs) such as India. A study was undertaken to find the prevalence of pulmonary tuberculosis (PT) among the diabetes individuals using Ziehl Neelsen (ZN) staining. Methods: It was a prospective research conducted in the department of Microbiology, GSL Medical College. Study protocol was approved by the Institutional Ethics Committee. Study was conducted between June to September 2023. Informed written consent was taken from the study participants. Individuals aged >18 years, with cough for >2weeks were included in this research. Detailed clinical history was collected and study was explained. Sputum specimen collection was demonstrated practically. New, sterile sample containers were provided and asked for specimen collection. Smears were predated and stained by ZN technique as per the guidelines. Simultaneously fasting blood sample was collected by venue puncture by following the universal safety precautions, serum glucose was estimated by automated analyser as per the manufacturer instructions. Chisqaure test was used for statistical analysis and P <0.05 were considered to be statistically significant. Results: Total 232 members were included. 41.4 years was mean age. In this 58 (25%) were diabetes. Total 48 (20.7%) PT cases were identified; in this 7.3% (17) were diagnosed in DM and 13.4% (31) were identified in non DM individuals; statistically there was no significant difference. Conclusion: There was high prevalence of PT among the DM individuals. Studies for long duration with high sample size is recommended.

34. A Retrospective Observational Study to Compare the Outcome of Two Port versus Three Port Laparoscopic Cholecystectomies Performed at BMC Sagar
Akhilesh Ratnakar, Sunil Kumar Saxena, Jitendra Singh Dangi, Lav Gupta, Hemal Vithani
Abstract
Introduction: Laparoscopic cholecystectomy is conventionally done by using three or four ports of various size. Cosmesis is very important aspect of laparoscopic surgery. So, trend is towards us of fewer ports for better cosmesis. Objective: Aim of the study is to compare outcome between two port & three port laparoscopic cholecystectomy and see whether there is any advantage in using one technique over the other. Method: Total number of 42 patients who underwent laparoscopic cholecystectomy were studied and divided into two groups. In Group A, patients who were operated by three port and in Group B, those operated by two port laparoscopic cholecystectomy were studied. The outcome was measured as primary and secondary. Primary included better cosmetic appearance of scar & secondary included post-operative pain, amount of analgesic required, time to ambulation & duration of hospital stay. Results: Out of 42 subjects enrolled, 16 were males and 26 females. Laparoscopic cholecystectomy using two ports yielded no mortality and no significant difference in surgical complications or conversion to open surgery. On the other hand, it resulted in better outcome in terms of cosmetic appearance, patient satisfaction, need for analgesia, early ambulation & cost effectiveness. Conclusion: Two port laparoscopic cholecystectomy has an edge over three port laparoscopic cholecystectomy due to excellent appearance of scar and less post-operative pain. Thus, it may emerge as a better alternative to improve patient outcome.

35. Comparative Analysis of Conventional Dose to Low Dose of Hyperbaric Bupivacaine for Spinal Anaesthesia in Elective Caesarean Section
Milan Mehta, Ketan Modi, Balraj B. Joshi, Aalap Miteshbhai Shah, Mitul Hareshkumar Chaudhary
Abstract
Background and Aim: Various local anesthetics, such as bupivacaine, chloroprocaine, levobupivacaine, lidocaine, ropivacaine, and tetracaine, are commonly used in combination with opioids like morphine or fentanyl, or their derivatives, for caesarean sections. In order to assess the effectiveness of two varying doses of 0.5% hyperbaric bupivacaine (7.5mg and 10mg), this study was carried out on women who were undergoing caesarean section. Material and Methods: We conducted research at a prestigious teaching institute in India. Over the course of one year, we enrolled 100 patients who were scheduled for elective caesarean section. These patients had an American Society of Anaesthesiologists (ASA) physical status of I or II. Monitoring of haemodynamic parameters during the spinal anaesthetic included heart rate, non-invasive blood pressure, ECG, mean arterial pressure (MAP), and SpO2. The recorded data included the sensory and motor onset time, as well as the time to regression. Results: The results show that the age, BMI, and ASA grades were similar between the two groups of patients. Group B patients exhibited a notable increase in pulse rate following the spinal procedure, while experiencing a significant decrease in pulse rate at various time intervals (6, 8, 10, 16, 19, 25, 30, 35, 40, 45, and 60 minutes) compared to Group A (P≤0.05). Patients in Group B experienced a notable increase in systolic blood pressure after receiving a spinal procedure, with significant elevations observed at 2, 4, 6, 35, and 50 minutes. Patients in group B required a longer duration to achieve maximum motor and sensory block compared to those in group A. Conclusion: The study found that using a lower dose (7.5mg) of Bupivacaine instead of the conventional dose (10mg) resulted in improved hemodynamic stability. This was evidenced by a decrease in falls in blood pressure, pulse rate, and mean arterial pressure, as well as a significant reduction in the incidence of intraoperative hypotension.

36. Histopathological Spectrum of Non-Neoplastic Lesions of Skin
Saumya Pandey, Vatsala Kishore, Ajmal Singh Bhayal
Abstract
Background: Clinical presentation of Skin lesions is highly variable and common disorders worldwide. Histopathology is definitive and essential for correct diagnosis and proper management. Aims and Objectives: To study histopathologic spectrum of non-neoplastic skin lesions and to determine age and sex distribution pattern of these lesions. Material and Methods: 109 skin biopsies received in the histopathology section of the Department of Pathology of a tertiary care hospital in Northern India were studied over a period of 2 years. 5 micron thick sections were done and routine staining with haematoxylin and eosin was done in all the cases. Special stain was applied as and when required. All data was recorded carefully and represented in the form of tables/ charts. Results: A total of 109 skin lesions were analysed, of which 27.5% were detected in age-group 21-30 years and male to female ratio was 1.18:1. Clinically, hyperpigmented patches/plaques were most frequently encountered. Hansen’s disease was most common histopathologic diagnosis (30.27%) with borderline tuberculoid leprosy being the most common subtype among 39.39% cases. Cysts and vasculitis were the least common lesions with 1.83% cases in each. Conclusions: Punch biopsy is a very simple outpatient procedure and very useful for diagnosis of skin lesions. Leprosy is still the most common skin disease for which biopsies are done followed by Vesiculobullous lesions and psoriasis.

37. Transdermal Nitroglycerine as a Co Adjuvant to Intrathecal Nalbuphine With 0.5% Hyperbaric Bupivacaine for Various Infraumbilical Surgeries
Manisha S Kapdi, Shruti Desai, Ishan Patel, Aditiba Gohil, Parth Prajapati, Ami Atodaria, Hardik Bamania
Abstract
Purpose: Spinal anesthesia for infraumbilical surgery is common. Various adjuvants are taken to improve sensorimotor characteristics of intrathecal bupivacaine. We have used Nalbuphine as intrathecal adjuvant in both groups & Transdermal NTG in one group as coadjuvant. Study type: Randomised double blind comparative observational study. Methods: We have selected 60 adult patients for the study, 30 in each group. Group A: patients received 3 mL of 0.5% heavy bupivacaine 15 mg + 0.1 mL of 1 mg of preservative free nalbuphine (total volume of 3.1mL) and placebo patch was applied after 20 minutes of spinal anesthesia. Group B: patients received 3 mL of 0.5% heavy bupivacaine 15 mg + 0.1 mL of 1 mg of preservative free nalbuphine (total volume of 3.1mL) and tNTG patch of 5 mg was applied after 20 minutes of spinal anesthesia. Demographical data were comparable among the two groups. Statistical analysis was done by noting parameters in MS EXCEL spread sheet in the form of mean ± SD. ‘p’<0.05was taken as significant and ‘p’ value of <0.001 was taken as highly significant. Results: There was no stastically significant change in vital parameters in both groups. (p > 0.05 ) The sensory &motor characteristics were comparable in the two groups. (p >0.05) Time of 1st rescue analgesia (min) in group A is 327.83 ± 31.61 min and group B is 501.03 ± 40.22 min. ( p <0.001 ). Total analgesic request in 24 hrs in group A is 2.83±0.69 min, group B is 1.83 ± 0.74 which is highly significant stastically. (p < 0.05) Complications like shivering, pruritus, nausea and vomiting were more in patients of group A as compared to group B. Conclusion: Transdermal NTG is good coadjuvant to intrathecal bupivacaine + Nalbuphine for infraumbilical surgery.

38. Assessment of Oral Misoprostol versus Oxytocin for Labor Induction in Term Prelabor Rupture of Membranes
B Sreelatha, Ch. Mamatha
Abstract
Objective: PROM at term is a common complication of pregnancy that can lead to significant perinatal morbidity and mortality, especially when accompanied by a prolonged latency period from membrane rupture to delivery. This study seeks to evaluate and compare the effectiveness and safety of oral misoprostol versus oxytocin infusion for labor induction in women experiencing prelabour rupture of membranes (PROM) at term. Methods: This prospective randomized trial involved 100 pregnant women admitted to the Department of Obstetrics and Gynecology at Prathima Institute of Medical Sciences, Naganoor, Karimnagar, with the term PROM. Participants were randomly assigned to two equal groups (groups A or B): group A received oral misoprostol at a dosage of 100 μg every 4 hours for a maximum of three doses, while group B received intravenous oxytocin infusion, starting at 4 mU/min with incremental increases of 4 mU/min every 30 minutes up to a maximum dose of 32 mU/min. The primary outcome measure was the time from induction to vaginal delivery, with secondary outcomes including mode of delivery, as well as maternal and neonatal outcomes. Results: A statistically significant contrast emerged between the two groups regarding the induction-to-delivery interval (IDI), with the mean being notably lower in the misoprostol group compared to the oxytocin group (6.45 ± 1.85 and 9.43 ± 2.19; P < 0.001), respectively. Furthermore, a highly significant difference was observed between the study groups concerning the mean IDI in nulliparous and multiparous women. Conclusion: Administering oral misoprostol at a dosage of 100 μg every 4 hours proved to be not only equally effective as oxytocin for labor induction in term PROM patients but also shortened the duration of labor, particularly in nulliparous women. Moreover, oral misoprostol demonstrated safety in terms of both maternal and neonatal outcomes. Considering these findings, oral misoprostol emerges as a viable alternative to oxytocin for labor induction in term PROM cases.

39. The Spectrum of Psoriatic Arthritis: A Polymorphic Puzzle
Abhijeet Kumar Agrawal, Jahnabi Bhagawati
Abstract
Background: Psoriatic arthritis was once diagnosed as Rheumatoid arthritis and was treated as such. Its significance as a separate arthritis has evolved after years of studies that revealed its pathogenesis, varied manifestations, and prognosis. It is one of the most common misdiagnosed inflammatory arthritis and requires its voice among the more known forms of arthritis. Material and Method: Cases coming to Rheumatology OPD with complaints of arthritis, dactylitis, and other associated presentations known in Psoriatic arthritis and its variants were collected. All the cases were extensively evaluated based on history, clinical findings, and investigations. Results:  6 cases were identified as having presentations of psoriatic arthritis. Patients came with manifestations like dactylitis, asymmetrical polyarthritis, oligoarthritis, SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis), axial involvement and psoriatic osteoarthritis knee. Conclusion:  This case series illuminates the importance of suspecting psoriatic arthritis in every case of arthritis showing the above-mentioned features as they may not have a classical history of psoriasis always. These patients are often treated with seronegative arthritis or early osteoarthritis. Correct assessment and treatment can improve the outcome in such patients as they may be responsive to different sets of medications and have different prognoses than Rheumatoid arthritis.

40. Determination of Prostatic Specific Antigen (PSA) Level in Patients with Polycystic Ovary Syndrome (PCOS)
Nisha Jangir, Neha, A K Bhargava, US Solanki
Abstract
Introduction: The polycystic ovary syndrome (PCOS) is a reproductive endocrine disorder, clinically characterized by oligo-ovulation/chronic anovulation, menstrual irregularities and hyperandrogenism. Objectives: The aim of this study was determined and compare the concentration PSA in 50 patients with PCOS and 50 healthy female controls. Result: The present observation showed that the mean level of PSA concentration in case (group I) was found to be (0.84 ± 0.30 ng/ml) and in control (group II) was found to be (0.53 ± 0.29 ng/ml). Statistical analysis showed that p < 0.05. Conclusion: The PSA concentration in PCOS patient was found to be higher than that of healthy controls, and the difference was statistically significant. A comparatively elevated PSA level in PCOS women as compared to normal women is an indication of hyperandrogenism.

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