International Journal of

Toxicological and Pharmacological Research

e-ISSN: 0975 5160

p-ISSN: 2820-2651

Peer Review Journal

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1. Assessment of the Impact of Gender on Cardiac Autonomic Function as Determined Through Heart Rate Variability Analysis
Kirtika Shrivastava, Harshali Bharat Rankhambe, Swapnil Bhirange, JyothiVybhavi V S
Abstract
Background: Heart rate variability (HRV) is considered an indicator of cardiovascular health. Women generally show a lower risk of coronary heart disease and serious arrhythmias compared to men, with a significant delay in the incidence of sudden death. This disparity suggests potential gender differences in autonomic modulation. We in the current study aimed to evaluate the Heart rate variability in young adult male and female students of our institute. Methods: The study involved 120 participants (60 males and 60 females). We measured anthropometric parameters such as age, height, weight, and BMI. Baseline characteristics, including resting heart rate and systolic and diastolic blood pressure, were recorded during five minutes of supine rest. HRV parameters like total power, low frequency, low frequency normalized units, high frequency, high frequency normalized units, and low frequency/high-frequency ratio were analyzed using ECG recordings. Results: Males have a significantly higher LF power in milliseconds squared (ms²) compared to females (p=0.023). This suggests greater sympathetic activity or response to stress in males. While the average normalized LF power (nu) is also higher in males, the p-value (0.051) is borderline significant. It suggests a possible trend but needs further investigation. Females have a significantly higher HF power in ms² compared to males (p=0.019). Conclusion: Our study shows that there are possible gender differences in heart rate variability (HRV) among young healthy individuals. Males were more likely to have low frequencies which might be being regulated sympathetically. This corresponds to the previous findings that sympathetic dominance might be related to the cardiovascular disease risk.

DOI: 10.5281/zenodo.

2. Cytomorphological Pattern of Lymph Node Lesions- A Retrospective Study Conducted at District Health Centre, Gujarat
Chauhan Heema, Belani Vaishali, Vastani Yogesh, Dave Rushang M
Abstract
Introduction: Lymphadenopathy, often known as the swelling of lymph nodes, is a common illness that is often encountered in clinical settings. FNAC has become an essential diagnostic technique for identifying the root causes of lymphadenopathies. A new category approach for the classification and reporting of lymph node cytopathology was presented at the 20th International Congress of Cytology in Sydney in May 2019, bringing about a significant transformation in the discipline. Materials and Methods: This retrospective study was carried out at a single center over the course of two years, and it involved the review of slides from cytology and histopathology by two pathologists with extensive experience. The objective of the study was to assess the performance of the Sydney system in terms of its diagnostic accuracy and clinical utility for reporting lymph node cytopathology. Results: The findings showed that the majority of cases (41 cases) were discovered in patients between the ages of 11 and 20. There were 127 cases of lymphadenopathy in the cervical region, which was the region with the highest number of cases. The majority of instances, which totaled 143, were deemed to be benign. It is important to note that the Sydney method has a high diagnostic accuracy, as evidenced by the fact that the study discovered a Risk of Malignancy (ROM) of 100% in categories IV and V, 50% in category III, and 3.8% in category II. Conclusion: This study demonstrates that FNAC is a safe, cost-effective procedure for diagnosing lymph node lesions. Furthermore, the Sydney system provides an effective framework for classifying and reporting lymph node cytopathology, aiding in patient management and treatment decisions.

DOI: 10.5281/zenodo.

3. Covid-19 Disease Outbreak: A Vital & Healthy Review
Nazir Ahmad Var, Saboor Ahmad Naik, Mohd Abass Dar
Abstract
Background: Coronaviruses are RNA viruses that are phenotypically and genotypically myriad. In this Review, we light on the basic virological concept of SARS-CoV-2, including genomic attributes and receptor use, highlighting its role key variance from previously known coronaviruses. The severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), which is also called, as the 2019 novel coronavirus (2019-nCoV) was rapidly spreaded from its origin in Wuhan City of Hubei Province of China to all parts and became a cosmopolitan problem for world. Around 704,539,018 cases of coronavirus disease 2019 (COVID-19), 7,008,958 deaths and 675,395,611 have been reported till 31/ 03/2024 in the world. India has reported 45,034,136 cases, and 533,547 deaths till 31/ 03/2024. But the future course of this virus is unknown. Coronaviruses are known to be associated with a variety of diseases in humans and domestic animals. It has been postulated that the proximity of humans to wild animals might have led to animal pathogens jumping across species from animals to humans, and become the causative pathogen in the latter. It is important to determine whether there is an animal reservoir, as breaking transmission of the virus may be more difficult and a recurrence of the disease is more likely. The clinical manifestations of COVID-19 are found myraid, ranging from asymptomatic state to acute respiratory distress syndrome and multi organ dysfunction. Common characteristics wasclude fever,  cough, sore throat, headache, fatigue, headache, myalgia and breathlessness. Conjunctivitis has also been described. Thus, they are indistinguishable from other respiratory infections. In a subset of patients, by the end of the first week the disease can progress to pneumonia, respiratory failure and death. This progression is associated with extreme rise in inflammatory cytokines including IL2, IL7, IL10, GCSF, IP10, MCP1, MIP1A, and TNFα. This finding suggests that receptor usage may not be the only factor that determines the severity of HCoV infection. Dipeptidyl peptidase 4 (DPP4, also known as CD26), the receptor for MERS-CoV, is a multifunctional cellsurface protein widely expressed on epithelial cells in kidney, small intestine, liver and prostate and on activated leukocytes. DPP4 is expressed in the upper respiratory tract epithelium of camels. In the human respiratory tract, DPP4 is mainly expressed in alveoli rather than the nasal cavity or conducting airways. DPP4 is a key factor in the activation of T cells and immune response costimulatory signals in T cells, which could indicate a possible manipulation of the host immune system. Human aminopeptidase N (CD13), a cell-surface metalloprotease on intestinal, lung and kidney epithelial cells, has been identified as the receptor for hCoV229E. The receptor for HCoV-OC43 is 9-O-acetylated sialic acid. Currently, the receptor for HCoV-HKU1 has not been identified. Aim: This article may try to gives a blue eye view about this new virus. Since knowledge about this virus is rapidly updating and evolving, readers are urged to update themselves regularly. Discussion: Current understanding of the pathogenesis of HCoVs infection is still limited. However, several significant differences in the pathogenesis exist among SARS-CoV, MERS-CoV and the other HCoVs. Cell entry and receptors. The critical first step for HCoV infection is entry into the susceptible host cells by combining with a specific receptor. Spike proteins (S proteins) of HCoVs are a surface-located trimeric glycoprotein consisting of two subunits: the N-terminal S1 subunit and the C-terminal S2 subunit. The S1 subunit specializes in recognizing and binding to the host cell receptor while the S2 region is responsible for membrane fusion. To date, a wide range of diverse cellular receptors specifically recognized by the S1 domains have been identified for all HCoVs except HCoV-HKU1. ACE2, the receptor for SARS-CoV and HCoVNL63. is a surface molecule localized on arterial and venous endothelial cells, arterial smooth muscle cells, epithelia of the small intestine and the respiratory tract. In the respiratory tract, ACE2 is expressed on the epithelial cells of alveoli, trachea, and bronchi, bronchial serous glands, and alveolar monocytes and macrophages. Conclusion: The 2019 novel coronavirus (2019-nCoV) outbreak is a major challenge for clinicians, and social, economic & public health prosperity to almost whole world. In India the economic progress and prosperity sturdily challenged and affected. The clinical course of patients remains to be fully characterized, little data are available that describe the disease pathogenesis, and no pharmacological therapies of proven efficacy yet exist.

DOI: 10.5281/zenodo.

4. An Observational Study for Early Onset Adverse Drug Reactions of Antiretroviral Therapy in Tribal Population of Eastern Gujarat: Impact on Compliance and Course
Shreyas Mukeshkumar Virvani, Sandeep Kumar Adwal
Abstract
Background and Objectives: Antiretrovirals, as most other chronically administered drugs, are reported to have adverse reactions, and particularly higher occurrences are seen at the beginning of ART. The main aim of this study is to gain knowledge on the profile of early onset ADRs associated with antiretroviral drugs, the burden of ADRs of ART in this setup with the ultimate goal of improving the patients’ compliance and effectiveness of treatment. Methods: An observational longitudinal study conducted at ART Centre of Tertiary care hospital of Eastern Gujarat. Data was collected through active pharmacovigilance and ADRs were recorded through ADR reporting forms. ADR causalities were assessed through WHO and Naranjo’s causality scale, Severity was assessed through Modified Hartwig and Siegel Scale and Preventability was assessed through Modified Shumock and Thorton criteria. Results: A total of 431 patients were interrogated in 6 months, of which 93 patients (21.58%) reported a total of 141 ADRs. ADRs were associated more with TDF+3TC+EFV Regimen. Most common system involved was gastrointestinal system (41.13%) followed by nervous system (34.04%) and the most frequently reported ADRs were of Nausea (17.73%) and Dizziness/Vertigo (17.02%). Majority of ADRs observed under Mild (83.69%) category. Causality assessment of suspected drug using WHO and Naranjo’s scale revealed maximum ADRs were Possible (94.33% and 79.43%). Maximum ADRs were not preventable (59.57%). Interpretation & Conclusion: We can improve the quality of care to patients living with HIV by providing an ADR profile, thus enabling a direct approach for the early detection and subsequent treatment of adverse drug reactions. To optimize adherence and hence effectiveness of treatment, clinicians must focus on preventing adverse effects whenever possible and distinguishing between self-limited and easily treatable ones from the potentially serious ones.

DOI: 10.5281/zenodo.

5. Study on Association of Vitamin D Deficiency and Severity of Symptoms in Dengue Patients Admitted in A Tertiary Care Centre in North India: A Cross-Sectional Study
Jyoti Verma, Jyoti Pankaj, Ankit Singh
Abstract
Introduction: The severity of symptoms of Dengue patients depends upon their nutritional status. Therefore, study on relation of vitamin D deficiency with severity of dengue patients needed attention. Vitamin D plays a crucial role in regulating bone metabolism and maintaining calcium and phosphorus levels in the body. It has been found to be associated with autoimmune diseases, metabolic syndromes, cardiovascular disease, cancers, and all-cause mortality. There is an increasing interest in the potential role of vitamin D in Dengue viral infection. Dengue patients had major complain of severe bodyache, fatigue when other symptoms are absent, which is variable in different patients. Aim: To identify a possible association between low levels of systemic 25-(OH) D and the likelihood of developing severe dengue fever. Materials and Methods: This was a single-center, cross-sectional study conducted in the Department of Medicine, Dr. RMLIMS, Lucknow, Total 156 Dengue patients were taken after confirmation from NS1 Ag and IgM positive reports. Serum vitamin D levels were measured at the time of admission in all patients. MS Excel and R-4.3.2 statistical software were used for statistical analysis. A p-value < 0.05 was considered significant. All statistical tests were two-sided. Results: The results reflected mean age of 36 years with SD of 14.428 and low Serum Vitamin D < 20 ng/ml (P-value 0.944). Out of total (n= 156), 47.4% (n=74) were females and 52.6% (n=82) were males. The levels of vitamin D ranges between 5 and 109 ng/ml. Serum vitamin D was found deficient in 66.7% (n=102) of total Dengue patients. The prevalence of Dengue without warning signs, Dengue with warning signs and severe Dengue fever (according to the latest classification of WHO- 2021, for Dengue) was found to be 69.5%, 75% and 89% respectively in low vitamin D patients. Studies were also done for various demographic characteristics and clinical features in dengue patients with vitamin D deficiency. Conclusion: The study concludes that severity of Dengue patients was directly related and more in low vitamin D patients. The present study revealed that serum vitamin D may contribute in the pathogenesis of dengue infection; thus, vitamin D levels might serve as useful prognostic marker for predicting disease progression.

DOI: 10.5281/zenodo.

6. Variational Anatomy of Ansa Cervicalis and its Clinical Implications
Chodisetti Krishna Kumari, Lella Udayasree, Katuri Yesupadamu, Sunnapu Umamaheswara Rao, D.A.V.S. Sesi
Abstract
Background: Ansa cervacalis is a nerve loop which gives branches to innervate the infrahyoid group of   muscles.  Any injury to these muscles would cause disturbance in phonation.  The Ansa cervicalis nerve loop is formed by superior root i.e arise from the cervical spinal nerves (C1-C2) inferior root is descending from C2-C3 .In the present study, We aim to document anatomical variations of Ansa cervicalis and can be important acknowledgment in specific surgeries of the neck region and its clinical implications. Materials & Methods: During routine dissection of adult cadavers of age 30-60 years old at department of anatomy, Rangaraya Medical College, Kakinada. while performing neck dissection, location and level of ansa cervicalis are  observed in 25 cadavers on both sides of neck (50 hemineck dissections). Results: Among 50 hemineck dissections (In 25 cadavers ), 1 hemineck dissection on right side of neck showing abnormal location of ansa cervicalis i.e inside to the carotid sheath and in remaining 49 hemineck dissections ansa cervicalis is located on anterior aspect of carotid sheath intermediate level ansa seen in 40 hemineck dissections, low level ansa seen in 10 hemineck dissections but high level ansa not observed in any hemineck dissection. Conclusion: Knowledge regarding the location & level of ansa cervicalis is very useful to ENT Surgeons ,Head and neck surgeons, Onco surgeons to minimize the complications like paralysis of infrahyoid muscles while performing surgeries over the neck.

DOI: 10.5281/zenodo.

7. Comparison between Conventional Block and Nerve Locator Techniques for Supraclavicular Brachial Plexus Block in Upper Limb Surgeries
Jonada Shashidhar Reddy, Priyanka Priyadarshini C, Thati Ajith Kumar, Muppidi Dilip Kumar
Abstract
Background: The supraclavicular block provides effective anesthesia for the brachial plexus for surgical procedures at or below the elbow level. Traditionally, the landmark technique has been used, but this blind method often necessitates multiple needle attempts through trial and error, leading to prolonged procedure times, associated pain, discomfort, and potentially severe complications. Peripheral nerve locator, a newer technique, offers advantages such as reduced procedure time, less pain, and discomfort, and fewer complications. This study aimed to compare two techniques in terms of the time required for the procedure, the onset and duration of sensory and motor blockade, and the overall effectiveness of the block. Methods: Surgeries involving upper limbs. Patients belonging to the American Society of Anesthesiologists Grade I & II. Patients of either sex, aged between 15-70 years. In one group (Group C, n=30), the conventional subclavian perivascular technique was employed, while in the other group (Group NS, n=30), the supraclavicular nerve block was administered under peripheral nerve locator guidance. In both groups, the block consisted of 15 ml of 0.5% bupivacaine and 15 ml of 2% lignocaine with 1:200,000 adrenaline. Results: The nerve locator technique was quicker (average time: 5.66 minutes) than the conventional method (8.7 minutes), potentially due to simpler procedures in the latter. The nerve locator approach significantly accelerated the onset of both sensory and motor blocks (p<0.005), likely because of direct nerve stimulation and more precise injections. It also prolonged the duration of these blocks (p<0.005) and achieved a higher success rate, with 97% complete block compared to 73% in the conventional group. Both methods exhibited low complication rates, which might be attributed to the use of short needles and correct techniques. Conclusion: Our study reveals that among the available anesthesia techniques to be utilized for the supraclavicular blocks during upper limb surgeries, locating a nerve with a nerve locator results in an early onset of both sensory and motor blockade and a prolonged blockade duration and a decreased need of analgesics both during and after surgery. Furthermore, this technique is seen to have a relatively higher success rate and fewer complications.

DOI: 10.5281/zenodo.

8. A Study of Profile of Children aged 2 months to 5 Years Admitted with Tachypnoea
Jahnavi Iyer, Vinjal Patel
Abstract
Background and Aim: Clinical profile of patients having tachypnoea in tertiary care hospitals reflects the burden in the community and identifying the risk factors for mortality and morbidity in the children between 2months to 60 months, will help proper utilization of available resources and ensure adequate management of these children. Aim of this study was to identify the various causes of tachypnoea among 2months to 60 months old and to analyze various factors influencing morbidity and mortality patterns among them. Material and Methods: Present Descriptive observational study was conducted at Paediatric ward in a tertiary care hospital in All Indoor patients between 2 months to 5 years for the duration of 6 months. A structured proforma was prepared, after taking consent from the parents, detailed history with presenting complaints and detailed general and systemic examination was done. Nutritional status assessed using WHO Z score weight for Age. WHO weight for age less than -2 Z score is considered as a risk factor in this study. Details regarding immunization were taken from parents and immunization cards. Results: Out of 846 total admissions, 145 children (2 months – 5years of age) had Tachypnea, overall occurrence of Tachypnea was 17.13%. Occurrence of tachypnea among 2 months – 12 months (Infants) was 24.53% and 13 months to 60 months was 11.13%, more number of infants was suffering from tachypnea owing to the infantile respiratory anatomy they have. More deaths were observed in infantile age group. 54 children admitted with tachypnea had longer hospital stay (>7 days) out of which 28 were suffering from pneumonia, 6 were suffering from underlying CNS disease and 5 had septic shock. Conclusion: Prevention of anemia and malnutrition will significantly improve the less than 5 morbidity and mortality. Strengthening of immunization is still required even in urban areas. Introduction of pneumococcal vaccine and flu vaccine will help to improve less than 5 morbidity and mortality.

DOI: 10.5281/zenodo.

9. A Comparative Evaluation of Epidural Anesthesia with Ropivacaine Combined with Dexmedetomidine versus Plain Ropivacaine for Lower Limb Surgeries
Muppidi Dilip Kumar, Mrunalini Alugolu, Gouthami M., Polugari Anand Vijaya Bhasker
Abstract
Background: Epidural administration of ropivacaine offers effective analgesia, minimal motor blockade, and cardiac stability. The incorporation of adjuncts such as dexmedetomidine extends the duration of analgesia, prolongs motor blockade, and ensures sufficient sedation. Our research directly compares the effects of ropivacaine alone versus ropivacaine combined with dexmedetomidine on block characteristics, postoperative pain relief, and sedation levels. Methods: A total of 60 cases were identified and included in the study during the duration of the study. They were equally and randomly allotted by a computer-generated random number into one of the two groups.  Group I (n=30) received 15 ml of 0.75% ropivacaine (Ropivacaine 0.75% preservative-free 0.75% 20 ml ampoules.  Group RD (Number of patient-50) 15ml of 0.75% ropivacaine + 0.6µg/kg of dexmedetomidine (inj.1ml = 100µg, 1ml ampoule). Results:  There were no significant differences between the two groups regarding age, sex, height, weight, or body mass index. On average, Group II achieved a slightly higher level of sensory block, but the difference wasn’t statistically significant.  Group I experienced a more complete motor block (no leg movement) compared to Group II. Patients in Group II had deeper sedation levels compared to Group I. The sensory and motor blocks lasted significantly longer in Group II compared to Group I. Group II experienced a significantly faster onset of both sensory and motor blocks compared to Group I. Overall, the findings suggest that adding Dexmedetomidine to Ropivacaine (Group II) might lead to deeper sedation but result in a less complete motor block compared to using Ropivacaine alone (Group I). Conclusion: The Dexmedetomidine group exhibited a rapid onset of action, prolonged duration of sensory and motor block, improved sedation scores, and a more pronounced motor block. No difference was noted in the maximal dermatomal level of analgesia, and any associated side effects such as bradycardia and hypotension did not pose significant challenges to the hemodynamic profile.

DOI: 10.5281/zenodo.

10. Vitamin D and Diarrhea in Childhood: An Observational Study in a Teaching Hospital of Bihar
Suman Kumari, Naz Yasmeen, Alka Singh, Binod Kumar Singh
Abstract
Objective: To determine the prevalence of vitamin D deficiency in Indian children hospitalized with diarrhea and evaluates the association between vitamin D status and severity of diarrhea. Methods: A hospital-based cross-sectional study was conducted from June 2023 to March 2024 in Nalanda Medical College and Hospital in the state of Bihar, India. Infants and young children aged 6–60 months hospitalized with diarrhea were recruited. Serum blood samples were collected on admission and analyzed for total serum 25-hydroxyvitamin D3 and 25-hydroxyvitamin D2 concentrations using liquid chromatography-tandem mass spectrometry. Vitamin D deficiency was defined as a level of serum vitamin D <50 nmol/L. The association between vitamin D deficiency and severity of hospitalized diarrhea patients according to WHO criteria, including the presence of danger signs, signs of severe dehydration, shock, duration of hospitalization, and admission to Intensive Care Unit (ICU), was analyzed using logistic regression. Results: 133 children with WHO-defined diarrhea were enrolled in the study and 127 (96%) had their vitamin D status determined. The mean vitamin D concentration was 56 (± 18 SD) nmol/L and 30.7% of participants were vitamin D deficient. Age younger than 12 months was associated with prolonged hospitalization (> 5 days) and low birth weight and poor nutritional status on admission were risk factors for severe dehydration. However, vitamin D status was not associated with the presence of danger signs, duration of hospitalization, or severe dehydration. Conclusions: One in every three children hospitalized with diarrhea was vitamin D deficient. Vitamin D status was not associated with the severity of diarrhea.

DOI: 10.5281/zenodo.

11. Clinico Microbiological Profile of Dengue and Chikungunya Co-Infections in Patients Attending A Tertiary Care Hospital, Siddipet
Hashna Hashim, L. Prashanthi, Syed Irfan Ali Kazim, V.V. Shailaja, Chaitanya Kumar Bukhya
Abstract
Introduction: Aedes aegypti mosquitoes are common carriers of dengue virus (DENV) and CHIK virus (CHIKV). At times where both viruses coexist, they can spread simultaneously. There are extremely few investigations on the dengue-chikungunya coinfection, which results in the difficulty in treatment aspects. Methodology: In the present study 200 suspected samples were subjected to the presence of antibodies sensitive to DENV for detection of NS1 antigen and Dengue IgM and the Chikungunya IgM was used for diagnosis of chikungunya. Results: A total of 200 samples from suspected patients for dengue infection, 29 (14.5%) samples were positive for DENV NS1. While 21 (10.5%) were tested positive for DENV IgM, 11 (5.5%) samples were positive for CHIK IgM antibodies. A total of 7 (3.5%) patients showed dengue chikungunya coinfection. Conclusion: The rise in the rate of Dengue and Chikungunya illnesses, as well as their cocirculation, is an important health issue that necessitates intensive prevention and control strategies.

DOI: 10.5281/zenodo.

12. A Clinical Study of Acute Kidney Injury in Patients with Acute Febrile Illness with Thrombocytopenia
S Sathish Kumar, J Ravikiran, Kukatla Sadhashiv, Harish Sagar Kotla
Abstract
Background: Infectious diseases significantly contribute to morbidity and mortality in our country, with tuberculosis, falciparum malaria, and leptospirosis being common causes of death. This study aims to investigate the causes, clinical features, and associated organ dysfunction in patients with acute febrile illnesses and acute renal failure. Methods: This cross-sectional study was conducted in the Department of General Medicine, Government Medical College, and Hospital, Wanaparthy, Telangana State. Patients over 18 years old with an acute febrile illness and a platelet count below 150,000/mm3, who have acute kidney injury due to Dengue, Malaria, Leptospira infection, Rickettsial fever, Typhoid, or Chikungunya, confirmed by laboratory tests. AKI was diagnosed based on the recent KDIGO AKI Guidelines. Results: A variety of AFI diagnoses were identified, with Dengue being the most frequent, followed by Malaria, Scrub Typhus, Leptospirosis, and unspecified causes. The majority of patients (64.0%) presented with mild thrombocytopenia. A significant proportion also had moderate (18.0%) and severe thrombocytopenia (18.0%). Dengue appeared to be associated with a higher risk of moderate and severe thrombocytopenia compared to other diagnoses. A significant proportion of patients (50.0%) developed AKI during their AFI illness. Dengue and Leptospirosis were associated with a higher prevalence of AKI compared to other diagnoses. The severity of AKI also differed based on the diagnosis. Dengue and Leptospirosis had a wider range of AKI stages, while Scrub Typhus and Malaria had mostly less severe stages. Conclusion: This study highlights the complex clinical picture associated with AFI and thrombocytopenia. While Dengue appears to be the most common diagnosis, other infectious agents can also contribute. The presence of thrombocytopenia is a frequent finding, with Dengue potentially leading to more severe cases. The study also emphasizes the significant risk of AKI in this patient population, particularly with Dengue and Leptospirosis.

DOI: 10.5281/zenodo.

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