Asian Journal of Pharmaceutical and Clinical Research

IN VITRO PROTECTIVE EFFECT OF PROTEINS OF TERMINALIA CHEBULA FRUITS ACTION ON INHIBITION OF HEMOLYSIS, PROTEINASE, AND PROTEIN DENATURATION PROCESS

2023-03-30T16:18:34+0530

Objective: The study helps to evaluate the anti-inflammatory activity of Terminalia chebula fruit protein.

Methods: The crude protein extracted from T. chebula fruits was subjected to analysis for its hemolysis inhibitory, proteinase inhibitory, and protein denaturation inhibitory activities.

Results: In the antioxidant property model, the crude protein exhibited an inhibitory activity of 52% compared to 58% and 61% for ascorbic acid and alpha-tocopherol, respectively. In the hemolysis inhibition studies, the crude proteins demonstrated an inhibition of 42.1%. In the protein denaturation inhibitory study, the crude protein showed a maximum inhibition of 28%, while in the proteinase inhibitory studies, it exhibited a maximum inhibition of 43.1%.

Conclusion: The results of the study revealed that the crude proteins possess antioxidant and anti-inflammatory properties in various model systems.

EVALUATION OF KNOWLEDGE REGARDING PUBLICATION ETHICS AMONG MEDICAL AND DENTAL FACULTY AT A TERTIARY CARE HOSPITAL

2023-10-11T09:52:23+0530

Background: The scientific medical research studies conducted on human participants should be guided by fundamental ethical principles which are crucial to ensure the protection of their rights and welfare.

Methods: It is questionnairebased crosssectional study conducted among medical and dental faculties working at a tertiary care center, in India. The questionnaire contains fifteen questions to evaluate the knowledge about publication ethics. Google Form was sent among the groups and data were analyzed using descriptive statistics.

Results: A total of 147 medical and 52 dental staff were enrolled in the study. The response rate of the study was 100%. The data obtained were sorted and categorized. Among 147 medical faculty, 75 were male 72 were female. Moreover, 52 dental faculties 23 were female and 29 were male staff. The study demonstrates balanced knowledge about publication ethics among medical and dental faculties working at a tertiary care hospital, Karnataka, India.

Conclusion: The training programs would definitely increase the awareness of publication ethics among faculties and students which would bring significant changes in the scientific research field.

FACTORS ASSOCIATED WITH LOW BIRTH WEIGHT BABY: A CROSS-SECTIONAL STUDY IN A TERTIARY CARE HOSPITAL

2023-04-24T13:32:57+0530

Objectives: Low birth weight (LBW) is a challenging multifaceted public health problem due to its association with increased risk of morbidity and mortality of infants. Both community and institution-based studies are needed to find out the lacunae regarding the occurrence of LBW babies so that effective strategies which are relevant to the local conditions can be adopted for its prevention. We conducted this study to estimate the prevalence and determine the factors associated with LBW in the live-born infants delivered in a tertiary care hospital.

Methods: This was an observational and cross-sectional questionnaire-based study done in the Department of Pharmacology and Department of Gynecology and Obstetrics in this tertiary care hospital. Mothers who gave birth to their baby in the Obstetrics Ward were included in the study. The subjects underwent a face-to-face interview using a suitably designed and validated questionnaire and the data were collected.

Results: A total of 360 subjects were interviewed. About 34.7% of mothers were below 20 years of age. The majority of the mothers had education up to secondary level (58.33%) and were housewife (82.22%). About 58.2% of mothers belonged to a family size of 5–10 members. Among the 104 LBW infants, 63.46% were small for date and 36.54% were pre-term. The mean weight of the newborn was 2.54 kg. Maternal age, number of family members, number of anti-natal care visits, anemia and maternal weight gain during pregnancy were associated with LBW (p<0.05). No significant differences were found among the newborns with and without LBW regarding variables such as religion, family type, maternal addiction, previous abortion, and tetanus toxoid taken by the mother.

Conclusion: As LBW is the major cause of perinatal morbidity and mortality, every step should be taken for its prevention. In this regard, proper maternal education for antenatal care and regular visits to antenatal care clinics should be done. Field workers may help to impart correct knowledge of diet through proper health education besides providing other advices such as delaying the age of the first child, birth spacing, and family planning services utilization.

A COMPARATIVE DOSE-RESPONSE STUDY BETWEEN INTRATHECAL NALBUPHINE (0.8 MG, 1.4 MG) WITH BUPIVACAINE HEAVY 0.5% 3.5 CC IN LOWER ABDOMINAL SURGERIES

2023-10-20T11:15:25+0530

Aims: To study the efficacy of various doses of nalbuphine as an additive in sub-arachnoid block for lower abdominal surgeries.

Methods: This comparative study was conducted by the addition of two different doses of nalbuphine as an adjuvant: 0.8 mg nalbuphine hydrochloride to 0.5% bupivacaine (heavy) and 1.4 mg nalbuphine hydrochloride to 0.5% bupivacaine (heavy), the onset, maximum level, duration of sensory blockade, motor blockade, and hemodynamic parameters were studied.

Results: It was discovered that group B (1.4 mg of nalbuphine added to 0.5% bupivacaine [H]) results in a later onset and greater degree of sensory and motor blockage. This group also considerably extended the time of analgesia, sensory and motor blockage, and both. The statistical examination of the mean blood pressure and mean pulse rate, together with the study of hemodynamic parameters, revealed that the p value was significant for the mean pulse rate and diastolic blood pressure but negligible for the systolic blood pressure.

Conclusion: It can be concluded that intrathecal 0.5% bupivacaine (H)+nalbuphine (1.4 mg) when compared to intrathecal 0.5% bupivacaine (H)+nalbuphine (0.8 mg) in the patients undergoing lower abdominal surgeries.

COMPARISON OF CONTINUATION OF POST-PLACENTAL INSERTION OF COPPER T AFTER CESAREAN SECTION AND NORMAL VAGINAL DELIVERY

2023-05-02T22:25:21+0530

Objective: The objective of this study was to assess the efficacy of post-placental copper T insertion following vaginal and cesarean delivery.

Methods: This is a prospective study conducted for the period of 1 year on pregnant females undergoing deliveries at Department of Obstetrics and Gynecology, Sardar Patel Medical College and AGH, Bikaner. The total number of postpartum intrauterine contraceptive device inserted participants included in the study were 200, divided into two groups vaginal (group A) and lower segment cesarean section (LSCS) (group B) groups.

Results: Mean age of the patients was 26.15±4.02 years. Most of the acceptors in both the groups were para-2 with 30% in vaginal group and 76% in LSCS group. The complaints at 6 weeks follow-up, in both groups, were similar, but the rate of removal was higher in vaginal group (9%) compared to LSCS group (2%). At 3 months follow-up, in vaginal group, the most common complaint was bleeding per vagina (PV) in 7.31% cases whereas missing thread 31.25% in LSCS group. Over a period of 3 months, the main reason for intrauterine contraceptive devices (IUCD) removal was bleeding PV in both group (six cases in vaginal group and three cases in LSCS group).

Conclusion: Immediate post-partum insertion of IUCD appears to be safe and effective method of contraception.

USEFULNESS OF FASCIA ILIACA COMPARTMENT BLOCK WITH INJECTION BUPIVACAINE AND DEXAMETHASONE AS ADJUVANT IN PATIENTS UNDERGOING HIP FRACTURE SURGERIES UNDER SPINAL ANESTHESIA

2023-05-09T12:59:06+0530

Objectives: The objectives of our study are to study the effectiveness of fascia iliaca block for positioning during spinal anesthesia and to compare the duration of post-operative analgesia using bupivacaine alone and bupivacaine with dexamethasone as an adjuvant.

Methods: This was a prospective randomized study done at a general hospital. Fifty patients aged 18 years and above of ASA Grades II and III undergoing hip fracture surgeries (proximal femur nailing, DHS, and hemiarthroplasty) were included in the study to receive the fascia iliaca compartment block (FICB). Group A (25 patients) received 38 mL of 0.25% bupivacaine with 2 mL normal saline and Group B (25 patients) received 38 mL of 0.25% bupivacaine with 2ml dexamethasone (8 mg). Relief of pain for positioning during spinal anesthesia was assessed by recording the visual analog score, 30 min after the FICB. In both groups, the post-operative analgesia was recorded from the time of giving spinal anesthesia to the time for first rescue analgesia which was given when VAS was 4 or more.

Results: There was a significant prolongation in the post-operative analgesia in Group B patients who received FICB with bupivacaine and dexamethasone in comparison to Group A in which bupivacaine alone was used. However, the VAS score after 30 min of FICB, for positioning for spinal anesthesia and the patient satisfaction score was similar in both groups.

Conclusion: FICB is effective for providing adequate positioning for spinal anesthesia and the addition of dexamethasone (8 mg) to bupivacaine for FICB significantly prolonged the duration of the block and increased the time to first rescue analgesia as compared to using bupivacaine alone.

PROSTAGLANDIN ANALOG OR RHO KINASE INHIBITOR – WHICH ONE IS BETTER IN PRIMARY OPEN-ANGLE GLAUCOMA

2023-05-16T13:05:40+0530

Objective: The aim of the study was to compare the efficacy, safety, and adverse drug reactions of ripasudil and bimatoprost.

Methods: An open-label, prospective, observational, randomized study was carried out in the Department of Pharmacology M.L.N. Medical College in association with Manohar Das Regional Institute of Ophthalmology, Prayagraj, for 1 year after ethical clearance. A total of 118 patients with primary open-angle glaucoma fulfilling the inclusion and exclusion criteria were taken and randomized into two groups. Only 109 patients completed the study, Group 1 received ripasudil (n=54) and Group 2 received bimatoprost (n=55). Intraocular pressure (IOP), ocular surface disease index (OSDI), tear brake-up time (TBUT), and hyperemia were measured at the initiation of treatment and then measured at different time intervals.

Results: Group 1 and Group 2 patients were observed and followed up for 3 months. At the end of the 2nd, 4th, 6th, and 12th week in Group 1, ripasudil significantly showed better results in reducing IOP as compared to Group 2 bimatoprost. In terms of TBUT, both groups at the 12th week did not show any significant difference. The OSDI score of both groups showed a non-significant difference at the 12th week. At the end of 2nd week, hyperemia was comparable for both groups but ripasudil showed more hyperemia at the end of the 12th week.

Conclusion: We concluded that ripasudil is more effective than bimatoprost in reducing IOP in patients with primary open-angle glaucoma. In terms of adverse effect profile, both drugs showed similar effects in TUBT and OSDI scores. The safety profile of both drugs is similar but the hyperemia score of ripasudil is more than bimatoprost.

HYPOTHYROIDISM IN HEAD-AND-NECK CARCINOMA PATIENTS AFTER RADIATION

2023-06-19T13:10:41+0530

Objective: The objective of the study was to determine the incidence of clinical hypothyroidism in patients undergoing radiation therapy for head-and-neck carcinomas.

Methods: One hundred and fifty patients with head-and-neck cancers visiting the Department of Otorhinolaryngology and head-and-neck surgery and undergoing treatment after histological confirmation at the Department of ENT and Radiation Oncology at Sardar Patel Medical College, Bikaner, Rajasthan, from January 2022 to January 2023 were taken up for the study. Tumor response and symptom relief were monitored at the completion of treatment, at 3 months, and at 6 months.

Results: Mean age of 51.42±12.24 years (21–78 years), 59.33% were males, and 63.34% of the study population was residing in rural areas. About 30.67% were in the oral cavity followed by 28.67% and 28.5 in the larynx and nasopharynx, respectively. Mean FT4 was 1.35±0.40 before radiotherapy and decreased to 1.20±0.43 after 3 months and 1.12±0.40 after 6 months of radiotherapy (p<0.0001*). Mean thyroid stimulating hormone was 2.14±2.50 before radiotherapy and increased to 3.55±4.5 after 3 months and 4.1±6.8 after 6 months of radiotherapy (p<0.0001*). At 3-month follow-up, 8% had clinical hypothyroid, at 6-month follow-up, 18% had clinical thyroid (p<0.05).

Conclusion: Thyroid hormone monitoring following radiotherapy for head-and-neck cancers should incorporate part of follow-up of these patients, especially those patients who receive chemotherapy with radiotherapy.

CLINICAL PROFILE AND OUTCOME OF PEDIATRIC TUBERCULOSIS IN A TERTIARY CARE SETTING IN CENTRAL INDIA

2023-10-02T11:33:44+0530

Objective: To study the clinical profile and outcome of tuberculosis (TB) in children under 14 years of age.

Methods: It is a hospital-based cross-sectional study done in a tertiary referral center in Central India from July 2017 to June 2019. After ethical approval, 80 children (under 14 years of age) diagnosed with presumptive TB were enrolled. Those already on TB treatment or prophylaxis for more than 7 days were excluded from the study. Relevant patient details were noted on a predesigned pro forma. Routine first-line investigations for TB were done in all cases. Histopathological and specific radiology tests were done as per the site involved. Microbiological confirmation was done using microscopy, and molecular diagnosis was done by a cartridge-based nucleic acid amplification test (CBNAAT).

Results: Overall mortality was 13.8%, and 82% of them were children below 5 years of age. As per WHO criteria, 52.5% and 20% of children below 5 years of age were severely and moderately undernourished, respectively. History of contact was present in 66%; BCG scar in 91.3%; and tuberculin sensitivity test positivity in 56% of cases. Fever, cough, and weight loss were the most common presenting complaints. The majority had extrapulmonary involvement (75%), with neurotuberculosis being the most common and with the highest mortality (70%). Microbiological confirmation was possible in only 8.8% of cases.

Conclusion: It is still challenging to diagnose pediatric TB. Though newer diagnostics are now available, clinical suspicion is a valuable tool. The diagnosis of pediatric TB should thus be based on a combination of epidemiological variables, clinical suspicion, and supported by various laboratory investigations.

BIOACTIVE METABOLITE PRODUCTION BY NOCARDIOPSIS SYNNEMATAFORMANSVLS-10 OF MANGROVE ORIGIN

2023-04-21T12:00:21+0530

Objective: Antibiotic resistance of pathogens has become a serious problem all over the world. Therefore, focusing for novel antibiotics is an important endeavor which is very much needed. Around 50 morphologically different Actinobacteria isolated from mangrove habitats of Krishna district, Andhra Pradesh, India were screened for antimicrobial activity.

Methods: Among 50 isolates, one strain Nocardiopsis synnemataformans VLS-10 was identified based on morphological, physiological, biochemical, and molecular approaches. The effect of environmental parameters such as incubation period, pH, temperature and salt concentration, and effect of various nutrients such as carbon and nitrogen sources and minerals on the bioactive metabolite production by N. synnemataformans VLS-10 was evaluated by employing agar well diffusion assay.

Results: Among the 50 isolates, one strain designated as VLS-10 was efficient to produce potential secondary metabolites. It was identified as N. synnemataformans based on polyphasic taxonomy. The present work is mainly aimed to study process optimization parameters to get high yield of bioactive compounds. ISP-2 medium supplemented with sodium chloride @ 9% maintained at pH 7.0 supported maximum yield of secondary metabolites by the strain when incubated at 35°C for 9 days.

Conclusion: Secondary metabolites possessed broad-spectrum activity against human pathogenic bacteria and fungi. Hence, strain N. synnemataformansVLS-10 becomes a significant source for antimicrobial compounds.

A COMPARATIVE STUDY OF DOXYLAMINE SUCCINATE WITH PYRIDOXINE HYDROCHLORIDE AND ONDANSETRON IN TREATING UREMIA-INDUCED NAUSEA AND VOMITING IN CHRONIC RENAL FAILURE PATIENTS

2023-10-19T15:00:54+0530

Objective: Advanced-stage chronic kidney disease (CKD) patients often complain of uremic dyspeptic syndrome specifically nausea and vomiting. This is a distressing phenomenon that compromises the patients’ quality of life. There is no guideline available for a complete cure for nausea and vomiting in CKD. The objective of this study was to evaluate and compare the effect of doxylamine succinate with pyridoxine hydrochloride and routinely used ondansetron in improving the symptoms of non-dialyzed conservative CKD patients.

Methods: A randomized, open-label, comparative study was done with 70 patients in the doxylamine succinate-pyridoxine group and 65 in the ondansetron group, a total of 135 patients completed the study. The study duration was 7 days. A catboost regression on the response of area under curve matric was carried out to compare the visual analog scale (VAS) score differences. Analysis of covariance and Wilcoxon signed-rank test was used to compare biochemical parameters and quality of life (SF-36) scores of both groups.

Results: It was observed that there was a stark difference in the VAS score (nausea scale) for the non-dialysis patients in doxylamine succinate-pyridoxine hydrochloride in comparison to the ondansetron. Among the different measures of quality of life, physical function, physical role, and social function were found to be significantly improved by doxylamine succinate-pyridoxine hydrochloride as compared to ondansetron.

Conclusion: Doxylamine succinate-pyridoxine hydrochloride is frequently prescribed for pregnancy-induced nausea and vomiting but is also effective in reducing uremia-induced nausea and vomiting symptoms in conservative CKD patients.

QUALITY OF LIFE IN PEDIATRIC PATIENTS WITH EPILEPSY ON ANTIEPILEPTIC DRUGS: A CROSS-SECTIONAL STUDY USING QOLCE-55 TOOL IN NORTH INDIA

2023-05-05T11:31:43+0530

Objective: The objective of this study is to assess the impact of epilepsy and antiepileptic medication on the quality of life (QoL) of children with epilepsy, particularly in the northern region of India.

Methods: This was a cross-sectional, hospital-based study that collected social demographic and clinical data from 100 children aged between ≥4 and ≤14 years. QoL was assessed using the QoL in Children with Epilepsy (QOLCE-55) questionnaire.

Results: The mean total QOLCE-55 score was 58.66±22.02, with the physical domain being the most affected. Age, seizure frequency in the last year, and schooling status showed significant associations with the mean QOLCE-55 score. However, there were no significant associations observed with gender, area of residence, socioeconomic status, type of epilepsy, type of antiepileptic drug, and family history of epilepsy.

Significance: The study emphasizes the significance of health-care providers focusing on the physical well-being of children with epilepsy, especially in resource-constrained developing countries, particularly in their rural areas. Age, seizure frequency, and schooling status showed significant associations with the QOLCE. These factors should be taken into account while designing treatment plans to ensure effective and equitable health care interventions.

CONTINUOUS PEDIOCIN PRODUCTION BY PEDIOCOCCUS ACIDILACTICI USING DAIRY WASTE

2023-05-17T16:26:40+0530

Objective: The production of pediocin by Pediococcus acidilactici has been conducted in continuous operation using dairy waste, namely whey.

Methods: Whey supplemented with yeast extract was used as growth media of P. acidilactici. A series of batch fermentation have been conducted in whey with varying concentrations (0–40 g/L) of yeast extract. A continuous mode of fermentation was performed at the dilution rate of 0.05–0.25/h. The volumetric productivity of pediocin in continuous run has also been compared with batch process. A mathematical model has been developed to explain the reactor performance for pediocin production in both batch and continuous processes.

Results: The highest specific pediocin production rate (36.8 AU mg/cell dry mass/h) and growth rate (0.41/h) were observed in batch runs using whey broth supplemented with 20 g/L yeast extract. Maximum cell growth and pediocin activity were obtained at 1.36 g/L and 2286 AU/mL in batch experiments. The highest pediocin productivity (514125 AU/h) was found in continuous mode for a dilution rate of 0.0625/h. The model was validated through well matching of simulated data with experimental ones.

Conclusion: The study should be suitable for large-scale implementation of pediocin production.

A STUDY OF CLINICOPATHOLOGICAL PROFILE IN PATIENTS OF APPENDICULAR PERFORATION

2023-09-29T22:28:21+0530

Introduction: Appendicular perforation is one of the most common surgical emergencies. The diagnosis of appendicular perforation is based on clinical history, examination combined with investigation. Hb, total leukocyte count (TLC), and neutrophil USG CT help in confirming the diagnosis.

Methods: A prospective study was conducted on patient coming with appendicular perforation, at a tertiary care center. Included subject underwent a through physical and clinical evaluation. Data were collected in performa and statistical analysis was done by applying the appropriate test.

Results: Among 100 cases of operated appendectomy, great number of patients belonged to 11–20 years (40%) with male predominance (72%). Among all, 90% were diagnosed as histopathological examination positive (appendicular perforation). Sixty-nine percent (69%) patients were C-reactive protein (CRP) positive. Increased TLC in 70% of patients and raised neutrophilia in 54% of patients was observed. Out of 100 patients, 86% were USG positive and retrocecal appendix was the most common position. Tenderness at RIF was the most common sign present (100%). Rovsing’s sign was present in 25% cases while 15% cases were noted with obturator test. Majority of them (70%) had score of >7 and were diagnosed as modified Alvarado-positive cases.

Conclusion: In our study, the combination of CRP, TLC, and neutrophil count has PPV of 100% which signifies their greater diagnostic accuracy in early diagnosis of acute appendicitis while the NPV after combining this test is 100% which signifies negative appendectomy can be decreased, if appendectomy is avoided in cases where TLC, CRP, and NC are normal.

VIDEOLARYNGOSCOPE VERSUS TRADITIONAL LARYNGOSCOPY FOR COMPARISON OF EASE OF INTUBATION AND HEMODYNAMIC CHANGES – A PROSPECTIVE RANDOMIZED STUDY

2023-04-03T11:00:57+0530

Objective: The objective of the study is to compare ease of intubation and hemodynamic changes with video laryngoscope (VL) (C-MAC) versus traditional laryngoscopy and to assess any complication such as arrhythmias, local injuries, bleeding, laryngospasm, regurgitation during intubation, and sore throat post-intubation.

Methods: This prospective randomized study was conducted on 200 patients of Mallampati (MP) Grades 1 and 2, ASA-PS I and II, randomly allocated to Group M (Macintosh) and Group V (C-MAC) (n=100 each). Hemodynamic changes (heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure [MAP], SpO2, and EtCO2) were recorded at baseline, during pre-oxygenation, during laryngoscopy, and during intubation, at 1 min, 3 min, 5 min, and then, at 10 min after endotracheal intubation. Ease of intubation and any complications were also recorded.

Results: Laryngeal view was significantly better in Group V. The mean heart rate during laryngoscopy and intubation (L&I) and after endotracheal intubation at 3rd min (ETI3); mean systolic blood pressure during L&I and after ETI1, ETI3, and ETI5 min; mean diastolic blood pressure after ETI1 and ETI min; and mean MAP during L&I and after ETI1 min were found to be significantly higher in Group M as compared to Group V (p<0.05). The difference in mean SPO2 and ETCO2 between the two groups was not found to be significant at any time interval. No significant difference was observed with respect to complications.

Conclusion: Group V (VL C-MAC) showed better ease of intubation, decreased hemodynamic response, and fewer complications as compared to Group M (Macintosh laryngoscope).

A STUDY ON SURGICAL MANAGEMENT OF MONTEGGIA FRACTURE-DISLOCATION IN ADULTS

2023-10-14T14:14:20+0530

Introduction: Open reduction and internal fixation of the ulna with dynamic compression plate and screws not only prevent malunion or non-union but also achieve rapid union of the fracture site.

Objectives: The objective of the study was to study the functional outcome of Monteggia fracture-dislocation in adults by surgical management.

Methods: Twenty cases of simple Monteggia fracture-dislocation in adults were treated by open reduction and internal fixation with a minimum six-holed AO 3.5 mm dynamic compression plate of the ulna with closed reduction of the radial head. In a case with a delayed presentation, the radial head was removed. The follow-up ranged from 5 to 15 months.

Results: Right elbow affliction was more common in males than left. The majority of fracture-dislocation cases resulted from auto accidents. With an average age of 35.9 years, fracture dislocations were more prevalent in the third and fourth decades of life. According to Bado’s categorization, Type 1 fracture-dislocation accounted for the majority of the cases. To avoid radial head redislocation, the upper limb was immobilized with the elbow flexed 110–120° and the forearm supinated. We had 13 (65%) instances with great results using the Anderson et al. grading system, six (30%) with good results, one (5%) with bad results, and no cases with failure. The only problems were a superficial infection and posterior interosseous nerve damage, both of which healed on their own when the radial head dislocation was closed down and the ulna was internally fixed with an AO 3.5 mm dynamic compression plate.

Conclusions: Adults with Monteggia fracture-dislocation can be treated simply and effectively with a high level of functional result utilizing the approach of early closed reduction of the radial head and open reduction and internal fixation of the ulna using a minimum of six holes AO 3.5 mm dynamic compression plate.

A COMPARATIVE STUDY BETWEEN 0.5% LEVOBUPIVACAINE AND 0.75% ROPIVACAINE IN PATIENTS UNDERGOING ELECTIVE LOWER LIMB SURGERIES UNDER SUBARACHNOID BLOCK

2023-10-23T13:47:35+0530

Objective: The aim of the study was to compare the efficacy of 0.5% levobupivacaine and 0.75% ropivacaine after intrathecal administration in elective lower limb surgeries.

Methods: A prospective, randomized, controlled, and double-blind study was conducted on 100 patients undergoing elective lower limb surgeries under subarachnoid block using 0.5% levobupivacaine and 0.75% ropivacaine.

Results: Demographic characteristics of both groups are comparable. It is observed the onset of sensory blockade is earlier in ropivacaine group, Grade 4 bromage scale motor blockade onset is shorter in levobupivacaine and most of the parameters are comparable between two groups. Duration of sensory blockade is more in ropivacaine when compared to levobupivacaine. Levobupivacaine is more cardiostable with stable hemodynamic profile compared to ropivacaine.

Conclusion: Levobupivacaine is more cardiostable with stable hemodynamic profile compared to ropivacaine.

A PROSPECTIVE STUDY TO COMPARE THE POST-OPERATIVE PAIN AND POST-OPERATIVE COMPLICATIONS IN CONVENTIONAL GRID IRON AND TRANSVERSE CREASE COSMETIC INCISION APPENDECTOMY

2023-05-02T22:46:13+0530

Objective: The objective of our study is to compare the conventional grid iron incision with transverse crease cosmetic incision in terms of post-operative pain, mean operating time, duration of hospital stay, and post-operative complications.

Methods: This is a prospective and comparative study and was carried out between December 2021 and November 2022. During the study period, 50 patients presented to surgical outdoor and emergency at PBM hospital, Bikaner, with clinical presentation and eventual radiological diagnosis of acute appendicitis were enrolled in the study and were randomly allocated to two groups including grid iron=25 and transverse crease=25. All patients were contacted 1 week and 2 months after surgery and the efficacy of grid iron and transverse crease incision in terms of post-operative pain, mean operating time, duration of stay in hospital, and post-operative complications.

Results: Post-operative pain, duration of stay in hospital (mean stay for grid iron group=4.32 vs. transverse crease group=2.16 days), and operating time (mean operating time for grid iron group=33 min vs. transverse crease group was 20.3 min) were significantly lower in cases of transverse crease incision as compared to grid iron cases. Post=operative complications were lesser in transverse crease incision but were not very significant as compared to grid iron incision.

Conclusion: Open appendectomy using transverse crease cosmetic incision was superior to conventional grid iron incision in terms of post-operative pain, operating time, duration of hospital stay, blood loss, and post-operative complications.

INCIDENCE, RISK FACTORS, AND OUTCOME OF ACUTE KIDNEY INJURY AMONG CHILDREN IN PEDIATRIC INTENSIVE CARE UNIT IN A TERTIARY CARE HOSPITAL

2023-05-10T11:18:12+0530

Objective: The study aimed to study the incidence, risk factors, outcome, and disease pattern of acute kidney injury (AKI) among children admitted in the pediatric intensive care unit (PICU).

Methods: The present study was a prospective study done to study the incidence, risk factors, and outcome of AKI among children of the age group 1 month–12 years admitted in PICU at a tertiary care hospital.

Results: A total of 480 PICU admissions were recruited, of which 276 children met the inclusion criteria. Of these, AKI was diagnosed in 119 children (50.4%) using pediatric risk, injury, failure, loss, and end-stage renal disease criteria, and the remaining 117 children were classified as non-AKI. The majority of children (63%) were in the age group of 5–12 years, and the male-to-female ratio was 1.2:1. From this study, it was recorded that the pathogenesis of AKI could be attributed to acute glomerulonephritis (AGN) (85%), sepsis (74%), and others like snake bite, diarrhea, poisoning cases, scorpion sting, diabetic ketoacidosis, heart failure, and unclassified causes with observable numbers. The most common offender is shock (91.4%) with vasopressor support (85.4%). Out of 82 children on inotropic support, 46 were on adrenaline. It was observed that the majority of children (93.5%) developed AKI during the course in hospital. The mortality rates were 64.7% and 24.5% among AKI and non-AKI patients. The mean duration of hospital stays among children without AKI was 5 days.

Conclusion: The presence of AKI is associated with longer PICU and hospital stay, with higher mortality imposing a significant burden to health-care system.

SPECTRUM OF PERFORATIVE PERITONITIS-A PROSPECTIVE OBSERVATIONAL STUDY

2023-05-17T01:06:38+0530

Objectives: Peritonitis secondary to gastrointestinal perforation is a common surgical emergency that has significant mortality and morbidity rates. The aim was to study the etiologies of perforative peritonitis, treatment modalities, and treatment options.

Methods: This was a prospective observational study conducted between January and December 2020. Patients with perforative peritonitis either clinically or radiologically were included in the study after obtaining informed consent. Etiology of perforation, surgical procedures, complications, and outcomes was observed and collected in preformed pro forma. Data were collected in Microsoft Excel and analyzed.

Results: Out of 94 patients, 92 underwent emergency surgery. About 56.38%, (n=53/94) were in the age group of 31–60 years, 86.17%, n=81/94 were males, 79.78%, (n=75/94) presented late to the hospital, abdominal pain and tenderness were seen in all patients and pneumoperitoneum was seen in 58.51%, (n=55/94). The most common cause was peptic ulcer (46.80%, n=20/94) and the most common site of perforation was the first part of the duodenum (35.10%, n=33/94). About 84.04%, (n=79/94) of surgeries were uneventful while surgical site infection was the common complication (40%, n=6/15). About 80.85%, (n=76/94) of patients recovered uneventfully while 19.14% (n=18/94) expired.

Conclusion: Peptic ulcer being the common etiology indicates improper peptic ulcer management. Early presentation to the hospital and prompt resuscitation with surgical interventions can improve recovery and reduce mortality in perforative peritonitis.

CONVENTIONAL TURBINOPLASTY AND COBLATION TURBINOPLASTY IN PATIENTS WITH BILATERAL INFERIOR TURBINATE HYPERTROPHY

2023-06-20T11:55:03+0530

Objective: The objective of the study was to compare the efficacy of conventional turbinoplasty and coblation turbinoplasty in patients with bilateral inferior turbinate hypertrophy.

Methods: A prospective comparative study was conducted on 60 patients undergoing turbinoplasty at the Department of ENT, Sardar Patel Medical College and PBM Hospital, from July1st, 2021, to June 30th, 2022. About 60 patients were randomly divided into two groups, Group A patients were surgically managed by conventional turbinoplasty, and Group B patients by coblation turbinoplasty. Intraoperatively, the time for each surgery was individually calculated from incision to nasal packing. Follow-up was done at 3 months and at 6 months to assess the post-operative efficacy.

Results: The mean age of participants was 36.57±8.01 years (21 years–49 years). On comparing the post-operative mean medial mucosal thickness, and mean airway space achieved in 6 months by both the surgeries, a statistically significant difference was found. The mean duration of surgery for coblation turbinoplasty was 435.50 s or 7.25 min (ranging from 6.17 min to 8.33 min) and 1039.33 s or 17.32 min (ranging from 19.16 min to 15.48 min) for conventional turbinoplasty (p<0.001).

Conclusion: Coblation has an upper hand in terms of improvement of patient symptoms and reduction in turbinate size. The only and major deterring factor in the regular usage of coblation is its cost.

A CLINICAL PROFILE AND RISK FACTORS IN VENTRAL HERNIA PATIENTS: A RETROSPECTIVE STUDY

2023-10-05T14:39:45+0530

Introduction: About 4% of all hernia patients admitted to the ward had ventral hernias. Obesity, wound infections, malnutrition, immunosuppression, and inappropriate suture materials or incorrect suture placement were important causative factors for ventral hernia.

Methods: This retrospective study was carried out among 50 patients of ventral hernias. Data were compiled in a pre-designed proforma using information from clinical notes, discharge summaries, and operation notes. This study excluded patients under the age of 18, those with femoral, inguinal, or posterior abdominal wall hernias.

Results: The most common subtype of ventral hernia was incisional hernia (54.0%). The most common presenting symptom was swelling only (60.0%). The most common associated risk factor was obesity (36.0%) and constipation (26.0%). About 48.0% hernia occurred following gynecological procedures (hysterectomy - 22.0%, lower segment cesarean section - 8.0%, and tubectomy - 8.0%).

Conclusion: The most common ventral hernia is the incisional hernia, which often occurs after obstetric and gynecological surgeries. Surgical site infection, obesity, and constipation increase the risk of ventral hernias.

ROLE OF DIFFUSION-WEIGHTED MAGNETIC RESONANCE IMAGING FOR BRAIN TUMOR CHARACTERIZATION

2023-04-22T15:26:29+0530

Objectives: This study was conducted with the objective to link the results of diffusion-weighted magnetic resonance imaging (MRI) with the tumor’s histopathological grade. The current study aims to evaluate this and determine the accuracy of diffusion-weighted MRI to determine grade of glioma.

Methods: The present study was a hospital-based cross-sectional purposive study. A total of 50 patients undergoing the MR evaluation of the brain with evidence of clinically suspected cerebral mass were enrolled in study based on inclusion and exclusion criteria. Statistical analysis was performed.

Results: In our study, the minimum apparent diffusion coefficient (ADC) was significantly lower for high-grade than for low-grade gliomas (1119.68±138.33 vs. 717.18±154.38, p<0.001).

Conclusions: By examining diffusion-weighted images and comparing the ADC of gliomas with the World Health Organization grade, we analyze the potential of ADC in predicting tumor grade through this study.

ROLE OF MODIFIED EARLY WARNING SCORE IN EVALUATING MORTALITY IN POSTOPERATIVE PERIOD

2023-10-19T15:31:11+0530

Objectives: The intent of the study is to analyze the role of modified early warning score (MEWS) in the assessment of the need of early intervention and surgical intensive care unit (SICU) admission in patients undergoing elective and emergency major surgical procedures.

Methods: This prospective study incorporated 150 patients who underwent emergency or elective major surgical procedures, with monitoring of physiological parameters in the post-operative period with implementation of MEWS. The MEWS score of 1–3: Escalation of monitoring done. MEWS of 4–5: Escalation of monitoring, urgent assessment by the surgical team, shift of patient to intensive care unit (ICU) if required. MEWS of ≥6: Shift of patient to ICU with emergency assessment by the surgical/medical/ICU team. Outcomes were (1) improvement in patients’ clinical condition after early goal-directed therapies (frequent monitoring, shifting to ICU), (2) discharged alive from the hospital, and (3) patient death.

Results: In our study, all the patients with MEWS from 1 to 7 were discharged alive and all the patients with a score above ≥8 were succumbed to death suggesting MEWS score of ≥8 implicates the strict need for SICU admission and an increased mortality of the patient in the post-operative period. MEWS improved communication between nursing staff, junior doctors with surgical team to “flag-up” and prioritize patients.

Conclusion: The MEWS is an important risk management tool that is simple to implement and effective in identifying the early deterioration of the patients, which can be used as a routine protocol in post-operative period and assessing the need of ICU for further interventions.

CLINICOPATHOLOGICAL STUDY OF NON-NEOPLASTIC LESIONS OF NASAL CAVITY AND PARANASAL SINUSES IN A TERTIARY CARE TEACHING HOSPITAL

2023-05-02T12:21:58+0530

Objective: A variety of non-neoplastic lesions involving the nasal cavity (NC) and paranasal sinuses (PNS) are encountered in clinical practice. The clinical features, symptoms, and advanced imaging technique help to reach a provisional diagnosis but histopathological examination remains the mainstay of final definitive diagnosis. There is a lack of studies that exclusively cover non-neoplastic lesions of sinonasal region. Hence, this study was done with the aim of examining the clinicopathological features of various non-neoplastic lesions of NC and PNS.

Methods: The formalin-fixed specimens of polypectomy/biopsy were received with complete clinical and radiological features in the department of pathology. Routine gross examination and required number of sections were taken and stained with hematoxylin and eosin stain. Periodic acid Schiff’s was used wherever necessary.

Results: Histologically, maximum number of cases were of inflammatory polyp (IP) (57%), followed by Allergic polyp (AP) (18%) and Invasive Fungal Sinusitis-Mucormycosis (17%). Mucormycosis was found in patients who have recovered from COVID along with a steroid intake history or had diabetes mellitus or had multiple comorbidities along with COVID recovery and steroid intake.

Conclusion: Among the non-neoplastic lesion, IP is the most common lesion followed by AP. The significant number of mucormycosis cases was seen due to the ongoing COVID pandemic and liberal use of corticosteroids in the treatment.

SARS-COV-2 INFECTION AND ITS SYMPTOMS AMONG COVID-19 VACCINATED AND UNVACCINATED HEALTH-CARE WORKERS

2023-05-06T20:07:46+0530

Objective: India’s national coronavirus disease 2019 (COVID-19) vaccination programs started during January 2021 and prioritized health-care workers (HCWs). In this study, we are attempting to measure post-vaccination product-specific (ChAdOx1_nCoV-19/COVISHIELD) COVID-19 vaccine effectiveness among vaccinated hospital HCWs and also to assess symptoms in HCWs with reverse transcription-polymerase chain reaction (RT-PCR) confirmed severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection.

Methods: This is an online web-based cross-sectional study conducted in June 2021 among vaccinated HCWs, comparing SARS-CoV-2 incidence and symptoms. In this study, demographic data such as age, gender, and profession were collected. Other data collected were vaccination status at the time of infection, the gap between COVID-19 positivity and vaccination, symptoms, hospitalization, time to recovery, and previous positive history before vaccination.

Results: A total of 1685 HCWs were vaccinated with the COVISHIELD vaccine from January 16 to March 18, 2021. Out of 1685 HCWs, 82 (4.8%) were tested positive by RT-PCR after vaccination. Out of 82 positive HCWs, 84% experienced mild symptoms, 12.2% experienced moderate symptoms, and 3.7% had severe manifestations leading to hospitalization. Among these positive HCWs, 25.6% recovered within 7 days, 35.3% recovered in 7–10 days, 15.8% recovered in 11–14 days, and 23.1% recovered after 2 weeks from the 1st day of experiencing symptoms.

Conclusion: Although COVID-19 vaccination by COVISHIELD may not fully prevent from infection by SARS-CoV-2 or its different variants, majority of positive cases present with asymptomatic/mild symptoms. Post-vaccination-positive cases may also present with severe symptoms and require hospitalization.

CLINICAL FEATURES, ELECTROENCEPHALOGRAM FINDINGS AND TREATMENT OF SELF-LIMITED FOCAL EPILEPSIES OF CHILDHOOD

2023-05-15T17:06:31+0530

Objectives: The objective is to study the clinical features of self-limited focal epilepsies of childhood and to describe their electroencephalogram (EEG) findings and treatment.

Methods: Twenty cases of self-limited focal epilepsies of childhood attending the Department of Neurology Government Medical College, Kozhikode, between August 2019 and July 2020 were included in the study. Details of history, examination, EEG, and treatment were collected.

Results: The age at first seizure was 1.5–12 years. Most children were diagnosed with self-limited focal epilepsy of childhood with centrotemporal spikes. One child had Panayiotopoulos syndrome. Most of the seizures occurred during sleep. The majority were generalized tonic–clonic seizures. The majority had bilateral centrotemporal spikes in EEG. The child with Panayiotopoulos had bilateral spikes from the posterior head region. All were treated with antiepileptics.

Conclusion: Self-limited focal epilepsy of childhood with centrotemporal spikes was the most common self-limited focal epilepsy of childhood. They had typical centrotemporal epileptiform discharges, seen bilaterally in most. The most commonly used drug was valproate. None had any major adverse effects on therapy.

STUDY OF FACIAL NERVE COURSE AND ITS VARIATION IN TEMPORAL BONE DISSECTION

2023-06-16T14:43:16+0530

Objectives: There are various anatomical variations of the facial nerve in the bony canal making it prone to injury during mastoid surgeries. The objective of the present study is to find the course of the facial nerve and its variation in 40 cases of temporal bone dissection and to evaluate various parameters of the tympanomastoid segments of the facial nerve and its relation with the important middle ear structures.

Methods: The present study was conducted in the Department of Otolaryngology, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, on 40 temporal bones from January 2022 to December 2022. Various parameters of the tympanomastoid segments of the facial nerve and its relations with the important middle ear structures were studied in the present study.

Results: In the present study, out of 40 bones dissected, 34 bones (85%) were well pneumatized whereas 6 bones (15%) were sclerotic in nature. In the present study, tympanic segment length varied from 7.65 to 11.72 mm with a mean of 9.32 mm (±1.02 mm). Vertical segment length varied from 10.2 to 15.9 mm with a mean of 13.48 mm (±1.21 mm). The distance of the second genu from the outer cortex varied from 17.67 to 23.71 mm with a mean of 19.73 mm (±1.44 mm). The distance of chorda tympani from stylomastoid foramen varied from 3.2 to 7.6 mm with a mean of 5.54 mm (±1.41 mm).

Conclusion: Anatomical knowledge of facial nerve in the canal and its relation to surrounding structures is very helpful for ENT surgeons to avoid injury to it during middle ear surgeries.

TO STUDY THE EFFECT OF MATERNAL FACTORS ON MORTALITY OF VERY LOW BIRTH WEIGHT NEONATES

2023-09-30T13:09:02+0530

Objectives: The present study is to determine the influences of maternal risk factors on neonatal mortality in very low birth weight (VLBW) infants born in central India.

Methods: A nested case–control study was conducted in the prospectively assembled cohort at the Department of Pediatrics Government Medical College and Hospital, Nagpur, India, for 2 years. Intramural neonates admitted to NICU with a birth weight of 500–1500 g were included in the study. Newborns with major congenital malformation and those who died in the delivery room or within 12 h of birth were excluded from the study.

Results: A total of 260 inborn VLBW newborns admitted to the NICU were enrolled. The mean gestational age was 33.58±4.8 weeks, and the mean birth weight was 1256.56±182.8 g. The overall case fatality rate was 50.38%. Maternal body mass index (BMI) <18.5 g/m2 (p=0.0019 [(Odds Ratio [OR]=3.23) (95% confidence interval [CI]. 1.43–7.80)]) and ante partum hemorrhage (p=0.0001[(OR=3.57) (95% CI 1.82–7.22)]) were two maternal factors which significantly increased the risk of death. However, antenatal steroid coverage (p=0.0005 [(OR=2.25) (95% CI 1.12–5.35)]) was associated with improved survival of VLBW neonates.

Conclusion: It can be said that very low birth neonates, especially those weighing <1000 g, preterm, and who are critically ill due to disturbance in pulmonary and circulatory physiology have a very high risk of mortality. Low maternal BMI and antepartum hemorrhage in mothers of VLBW neonate were associated with increased neonatal mortality and ACS therapy was associated with decreased neonatal mortality.

EVALUATION OF RISK FACTORS AND THEIR PROGNOSTIC VALUE IN PATIENTS WITH ISCHEMIC STROKE

2023-04-04T15:54:48+0530

Objectives: The objectives of this study were to evaluate the risk factors in patients with ischemic stroke, to find out the prognosis of ischemic stroke regarding risk factors, and to identify the patients having modifiable risk factors so that care can be taken to prevent recurrences.

Methods: This was a prospective and observational study with 100 patients with ischemic stroke. Patients were recruited from November 2017 to October 2018. NIHSS score was used to classify the severity of the stroke. The Barthel index was used to assess prognosis at the time of discharge.

Results: The mean age of the study population was 61.4±13.7 years. There was no statistically significant (p=0.28) difference in the outcome of the patients with respect to gender. There was a statistically significant (p=0.04) difference in the severity of the patients respective to gender. Among 100 patients, 55 had hypertension and the relative risk of hypertension was found to be 1.22, indicating hypertension is the most predominant risk factor.

Conclusion: Hypertension is the most prevalent risk factor in the present study. As per our study findings, hypertension, diabetes mellitus, a history of smoking, and a history of alcohol intake were the preventable risk factors, leading to severe stroke and poor functional outcome. Patients with multiple risk factors had severe stroke and poor functional outcome when compared to patients with single or no risk factors. Patients with severe stroke based on NIHSS score had the poor functional outcome.

A STUDY ON MALNUTRITION AMONG CHILDREN UNDER THE AGE OF 5 IN MANDLA DISTRICT OF MADHYA PRADESH

2023-10-18T15:06:36+0530

Objectives: To determine the prevalence and socio-demographic determinants of malnutrition among under-5 years old children in Mandla district.

Methods: This cross-sectional study was conducted in three blocks (Bijadandi, Narayanganj, and Niwas) of Mandla district of M.P. For this study, the calculated sample size was 276 children under 5 years of age. Multistage Random sampling was used, and the required sample size was collected from 12 villages in these 3 blocks. A predesigned and pretested schedule was administered by asking for a history from the mother, and anthropometric measurements of the children were recorded.

Results: The overall prevalence of underweight (<median-2SD) was found to be 51.81%. Whereas 18.12% were severe underweight (<median- 3SD) and 33.70% were moderate underweight (<median 3SD to-2SD). The prevalence of stunting among under-5-year-old children was found to be 46.74% (<median-2SD). The prevalence of severe stunting (<median-3SD) was 15.94%, while that of moderate stunting (<median 3SD to-2SD) was 30.80%. The overall prevalence of wasting was 24.72%. In which 21.01% were moderately wasted, and 4.71% were severely wasted.

Conclusion: The findings of the present study revealed the widespread prevalence of undernutrition among under-5-year-old children. Data show that 51.81% of children under 5 years of age are underweight, 46.74% are stunted, and 24.72% are wasted in our study area, which is much higher than national figures and highlights the need for an integrated approach toward improving child health as well as nutritional status in this area.

PREVALENCE OF CERVICAL CANCER AMONG THE WOMEN’S ATTENDING THE TERTIARY CARE CENTER OF EASTERN PART OF BIHAR

2023-04-27T14:09:42+0530

Objectives: The objective of this study was to study the prevalence of cervical cancer and its grade in the patients presenting to the gynecology outpatient department (OPD) of a tertiary care center.

Methods: This is a record based cross-section study which shows the percentage of women having pathological cervical lesions from the total number presenting to gynecology OPD of our tertiary hospital with specific symptoms with in a period of more than past 2 year.

Results: As the catchment area is of lower status general health which was low and routine regular check-up was not considered important by the patients. Poor knowledge about cancer cervix and lack of regular screening at primary center’s was the main constraint. The mean age of patient was 37±5.4 years and shows that maximum incidence that is reported is of negative for intraepithelial lesion for malignancy followed atypical squamous cells of undetermined significance and high-grade squamous intraepithelial lesion.

Discussion: The major limitation found in this study was lack of proper knowledge among patients, poor health-care facilities, and shortage of trained staffs. It is essential to upgrade the basic facilities of primary health-care centers and mass education to vulnerable age group and enhanced awareness on this issue will lead to early diagnosis and greater chance of screening leading to timely diagnosis and treatment.

Conclusion: Lack of awareness has led to underreporting and faulty health seeking behaviour has led to delayed diagnosis. Comprehensive approach and affordable extended package of health care under Ayushmann Bharat can be helpful in reducing the disease burden.

A PROSPECTIVE STUDY OF ELECTROLYTE IMBALANCE AND ITS MANAGEMENT IN GASTROINTESTINAL SURGERY

2023-05-02T23:09:54+0530

Objective: The objective is to study electrolyte imbalance and its management in gastrointestinal (GI) surgery.

Methods: The present study was carried out in the Department of Surgery, S.P. Medical College and P.B.M Hospital, Bikaner. This is a prospective descriptive study and was carried out between December 2021 and November 2022 including 100 cases operated for GI tract surgeries (both elective and emergency).

Results: Out of 100 patients, 54% patient had electrolyte imbalance and required correction for same. 46% of patients had normal serum electrolytes post-operatively. The most common electrolyte imbalance observed is hyponatremia (30%) followed by both hypokalemia and hyponatremia (14%). We observed that the most common surgical interventions which had electrolyte imbalance were ileostomy patients (84%) followed by resection and anastomosis of bowel (70%).

Conclusion: Patients who had electrolyte imbalance were found to have more post-operative complications, longer hospital stay, and probably had an association with mortality. Early diagnosis, aggressive resuscitation, and timely definitive surgical treatment along with correction of electrolyte imbalance are essential to decrease the incidence of morbidity and mortality associated with electrolyte imbalance.

PROFILE OF CUTANEOUS ADVERSE DRUG REACTIONS IN PATIENTS ATTENDING THE DERMATOLOGY OUTPATIENT DEPARTMENT OF A TERTIARY CARE HOSPITAL, GANGTOK

2023-05-10T15:55:04+0530

Objectives: The present study was undertaken to evaluate the frequency of occurrence of cutaneous adverse drug reactions (ADRs) in patients attending dermatology outpatient department (OPD) and to assess causality and severity of the reported cutaneous ADRs, using different scales.

Methods: The study involved descriptive through retrospective review of patient medical records for patients who attended dermatology OPD for a period of 9 months. Patients’ records specifying with cutaneous ADRs were taken for the study.

Results: The record of 30 patients reported with cutaneous ADRs with certain exclusions was studied. Higher incidence was found among females with 20–40 years of age. The most common presenting symptom was found to be erythematous rash (33%) and the drug groups involved in reactions were NSAIDS, beta-lactams, antitubercular drugs, and antifungals (16.7% each). The most common drug associated with cutaneous ADRs (CADRs) was itraconazole and aceclofenac (16.7% each). On the Naranjo scale, 86% reactions were labeled as “possible” while others as “doubtful”. All the reactions were labeled as mild on Hartwig’s Severity Assessment Scale.

Conclusions: Lack of post-treatment follow-up could be a reason for the difference in the causality result as compared to other studies. The data recorded in this study can be utilized as reference for future studies with large population.

THE HISTOPATHOLOGICAL STUDY OF TUMOR AND TUMOR-LIKE LESIONS OF ORAL CAVITY AND OROPHARYNX

2023-05-17T11:39:56+0530

Objective: The objective is the histopathological study of tumor and tumor-like lesions of the oral cavity and oropharynx.

Methods: This study was conducted in the Department of Pathology, SBKS Medical Institute and Research Centre, Piparia, for 1 year. One hundred oral biopsies received from the ENT department were studied. Clinical details were obtained from the requisition form. Biopsies received were processed and stained with Hematoxylin and Eosin. Histopathological diagnosis regarding type and differentiation was made.

Results: Among 100 cases of the oral cavity and oropharynx biopsies analyzed in the present study, malignant lesions were 90 (90%), premalignant lesions were 4 (4%), and benign lesions were 6 (6%). The study included 86 cases (86%) of squamous cell carcinoma, 2 cases (2%) of verrucous carcinoma, 1 case (1%) of adenosquamous carcinoma, 1 case (1%) of adenocarcinoma, 3 cases (3%) of leukoplakia, 1 case (1%) of severe dysplasia, 3 cases (3%) of pleomorphic adenoma, and 1 case (1%) each of pyogenic granuloma, squamous papilloma, ossifying fibroma. Maximum number of cases was of squamous cell carcinoma (86%). Maximum number of cases was seen inthe age group of 36–45 years, the youngest patient was 25 years old. There was a male preponderance for oral and oropharyngeal lesions (73%) as compared to females (27%). Male: Female ratio was 1:0.37. The most common site of the lesion was the tongue (41%) followed by buccal mucosa (30%). The majority of the tumors were well-differentiated.

Conclusion: Males are more likely to develop lesions of the oral cavity and oropharynx than females. Typically, older age groups are affected. Drinking alcohol, smoking, and chewing tobacco can contribute to oral and oropharyngeal lesions. The most frequent place implicated is the tongue. The most prevalent histological variation is squamous cell carcinoma, and the majority of these tumors are well-differentiated.

A QUESTIONNAIRE-BASED STUDY TO ASSESS THE AWARENESS OF MATERIOVIGILANCE AMONG HEALTH-CARE PROFESSIONALS WORKING IN A TERTIARY CARE TEACHING HOSPITAL IN THE KURNOOL DISTRICT

2023-07-06T11:38:25+0530

Background: Materiovigilance (MV) is the coordinated system of identification, collection, reporting, and analysis of untoward occurrences associated with the use of medical devices (MD) and enhancing patients safety, also preventing their recurrence by health-care professionals (HCPs). The HCPs have a key role in the identification and reporting of adverse events associated with MD for continued patient safety.

Aim and Objectives: The aim of the study is to assess awareness of the recently launched MV Programme in India among the health-care professionals working in a tertiary care teaching hospital.

Methods: A questionnaire-based study was conducted among health-care professionals of Viswabharathi Medical College and General Hospital, like residents, interns, nurses (OT, emergency, intensive care unit, etc.), and laboratory technicians of various specialties working in a tertiary care teaching hospital in Kurnool. A pre-validated questionnaire consisting of questions pertaining to knowledge, attitude and practice of MV was circulated to HCPs through Google Forms, and data were recorded and analyzed using statistical tests.

Results: One hundred and eighteen doctors responded out of 200 contacted, providing a response rate of 59%. They belonged to medical and allied branches (77), surgical branches (24), and diagnostic branches (17). Sixty-nine (58.5%) doctors strongly agreed that these types of programs are very effective in keeping a check on AE caused by MD. 98 (83%) doctors responded-certainly; we should report all the AEs.

Conclusion: This study creates awareness about MV and imparts a reporting culture among the HCPs.

PREVALENCE OF THYROID DYSFUNCTION IN PREVIOUSLY DIAGNOSED DIABETES MELLITUS IN GERIATRIC AND NON-GERIATRIC PATIENTS

2023-10-26T14:51:29+0530

Objectives: The aim of the study was to assess the prevalence of thyroid dysfunction in previously diagnosed diabetes mellitus in geriatric and non-geriatric patients.

Methods: The present study was done at a medical college tertiary care center that caters to the needs of a vast amount of population in and around the region of Indore.

Results: In the present study, we noted that the thyroid stimulating hormone levels were higher in the older population as compared to the non-geriatric group which was significant p=0.002. In the present study, we noted that the overall mean levels of thyroid stimulating hormone were 3.89 mg/dL standard deviation (SD) + 4.57, in the non-geriatric group, the mean levels of thyroid stimulating hormone were 4.63 mg/dL SD + 5.15 mg/dL and in the geriatric group, the mean levels of thyroid stimulating hormone were 13.15 mg/dL SD + 3.81 mg/dL. In the present study, we noted that the thyroid stimulating hormone levels were higher in the older population as compared to the non-geriatric group which was significant p=0.002.

Conclusion: The disease diabetes mellitus has a higher prevalence in males as compared to the females with the male-to-female ratio being (1.57:1), and this trend was same in both the study groups non-geriatric (1.8:1), and geriatric (1.68:1).

THE ROLE OF AUTOLOGOUS HAMSTRING GRAFT IN IMPROVING FUNCTIONAL OUTCOME AFTER ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: PROSPECTIVE STUDY AT GGH, KURNOOL

2023-05-12T16:46:05+0530

Objectives: The prevalence of knee ligament injuries is on the rise due to increasing engagement in sports activities. Among the various ligaments present in the knee joint, the anterior cruciate ligament (ACL) is the most commonly injured. Several procedures have been described for the reconstruction of a torn ACL, ranging from open to arthroscopic techniques. In this particular study, we utilized an autograft from the hamstring muscle for ACL reconstruction. The graft was secured with an Endobutton on the femoral end and an interference screw at the tibial end. If necessary, cancellous screws or a suture wheel was used as well.

Methods: This is a 2-year prospective study conducted between April 2021 and March 2023 at GGH, Kurnool, which included 20 cases of complete ACL tear. All patients underwent arthroscopic ACL reconstruction using a hamstring graft. Following the procedure, all patients were assessed using the lysholm knee scoring questionnaire and were monitored at specific intervals, including 3 months, 6 months, and 1 year, to evaluate their progress.

Results: After 1 year, the lysholm knee scoring questionnaire was used to evaluate the results of the ACL reconstruction with the hamstring graft. The findings revealed that 30% (6 cases) of the cases reported excellent results, 50% (10 cases) of the cases showed good results, 15% (3 cases) of the cases showed fair results, and 5% (1 case) of the cases obtained poor results. In addition, 80% of patients achieved functional restoration to their pre-injury level. At 1-year follow-up, our study found that the average pre-operative lysholm score was 63.24, while the average post-operative score was 91.98, which showed a statistically significant improvement in the post-operative lysholm score compared to the pre-operative score (p<0.05).

Conclusions: Our study suggests that the use of a hamstring graft for the reconstruction of a torn ACL can result in excellent to good outcomes. However, it should be noted that proper patient selection and physiotherapy play a significant role in achieving favorable results.

ANATOMICAL STUDY OF NUTRIENT FORAMINA IN LONG BONES OF HUMAN UPPER AND LOWER LIMBS

2023-10-26T16:09:54+0530

Aims and Objectives: The objectives of the study are as follows: (1) To determine the number, location, position, and direction of nutrient foramina in the shaft of long bones. (2) To determine the foraminal index of the long bones.

Methods: This was a cross-sectional study, undertaken on dry cadaveric human long bones of unknown age and sex from the Department of Anatomy, M.S. Ramaiah Medical College, Bangalore. The duration of study was 2 years. In this study, 350 human long bones which include the clavicle, humerus, radius, and ulna from the upper extremity; femur, tibia, and fibula from the lower extremity were examined in detail for the number, position, location, and directions of the nutrient foramen. For statistical purposes, p<0.05 was taken as significant.

Results: All the bones had single nutrient foramina and a higher percentage of double nutrient foramina was seen in femur. The most common position was the middle one-third of the shaft and the surface distribution was different in different bones. All the bones had the nutrient foramina, which were directed away from the growing end. The mean foraminal index for clavicle, humerus, radius, and ulna was 52.85±9.24, 56.92±6.57, 34.80±6.07, and 36.0±5.85, respectively. Mean foraminal index for femur, tibia, and fibula was 43.54±10.32, 32.37±3.1, and 51.68±9.77.

Conclusion: Knowledge of nutrient foramina of long bones is crucial for orthopedic surgery, forensic identification, obtaining vascularized bone grafts, and treating trauma or malignant bone conditions.

COMPARATIVE STUDY OF BUPIVACAINE WITH DEXMEDETOMIDINE AND BUPIVACAINE ALONE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

2023-10-27T16:07:13+0530

Objective: The objective is to compare the efficacy of bupivacaine with dexmedetomidine and bupivacaine alone when used for supraclavicular brachial plexus block in patients undergoing upper limb surgeries.

Methods: This was a comparative study conducted in the department of anesthesiology of a tertiary care medical college. 80 patients scheduled for upper limb surgeries under supraclavicular brachial plexus block were included on the basis of a predefined inclusion and exclusion criteria. Patients were divided into 2 groups depending on whether they received only Bupivacaine (Group B) or Bupivacaine and Dexmedetomidine (Group BD) for supraclavicular block. The onset and duration of sensory as well as motor blockade, intensity of Pain as assessed by Visual Analog Score, requirement of rescue analgesia, hemodynamic profile, and side effects were compared in both the groups. For statistical purpose p<0.05 was taken as statistically significant.

Results: Group BD exhibited significantly faster onset and longer duration of sensory blockade compared to Group B. Group BD also showed significantly faster onset and longer duration of motor blockade compared to Group B. Moreover, Group BD had significantly longer analgesia duration (614.84±52.02 min) compared to Group B (352.62±32.46 min). The hemodynamic parameters, including mean heart rate and mean arterial pressure, were not significantly different between the groups. In addition, side effects such as bradycardia and hypotension were observed in Group BD, but these differences were not statistically significant.

Conclusion: Dexmedetomidine, when used as an adjuvant to bupivacaine during supraclavicular brachial plexus block in upper limb surgeries provided longer-lasting analgesia, and reduced pain intensity as compared to Bupivacaine alone with a comparable side effect profile.

FUNCTIONAL OUTCOME OF PATIENTS WITH OSTEOARTHRITIS KNEE TREATED BY INTRAARTICULAR INJECTIONS OF PLATELET-RICH PLASMA

2023-11-06T15:33:21+0530

Objectives: The aims and objectives of the study are (1) to assess pain relief and functional outcome in knee osteoarthritis (OA) cases treated by intra-articular injection of platelet-rich plasma (PRP) and (2) to study the complication in patients treated by intra-articular injection of PRP.

Methods: This was a prospective study conducted in the department of orthopedics of a tertiary care medical institute. 60 patients with Grade 2 and Grade 3 OA of knee were included in this study on the basis of a pre-defined inclusion and exclusion criteria. All patients were treated by intra-articular injection of PRP. Patients were followed up for 6 months. During follow-up visits, assessment of severity of pain and functional outcome was done by Visual Analog Scale (VAS) Score and Japanese Orthopedic Association (JOA) Score. Patients were also assessed for complications. p<0.05 was taken as statistically significant.

Results: Out of 60 studied cases, there was a female preponderance with a M: F ratio of 1:0.62. The mean age of affected cases was found to be 65.84±11.86 years and mean duration of symptoms was found to be 2.52±1.26 years. Majority of the patients were either overweight (45.00%) or obese (36.67%) and only 11 (18.33%) patients had a healthy weight. 38 (63.33%) patients were having Grade 3 OA whereas 22 (36.67%) patients were having Grade 2 OA. There was a significant reduction in pain and significant functional improvement at the time of final follow-up as compared to VAS and JOA scores at the time of presentation (p<0.0001). Complications were seen in any of the cases.

Conclusion: Patients with Grade 2 and Grade 3 OA of knee treated by intra-articular injection of PRP show excellent outcome in terms of pain relief and functional outcome with no significant complications.

INTEGRATING ARTIFICIAL INTELLIGENCE IN DISEASE DIAGNOSIS, TREATMENT, AND FORMULATION DEVELOPMENT: A REVIEW

2023-04-27T15:16:57+0530

Artificial intelligence (AI) is rapidly advancing and significantly impacting clinical care and treatment. Machine learning and deep learning, as core digital AI technologies, are being extensively applied to support diagnosis and treatment. With the progress of digital health-care technologies such as AI, bioprinting, robotics, and nanotechnology, the health-care landscape is transforming. Digitization in health-care offers various opportunities, including reducing human error rates, improving clinical outcomes, and monitoring longitudinal data. AI techniques, ranging from learning algorithms to deep learning, play a critical role in several health-care domains, such as the development of new health-care systems, improvement of patient information and records, and treatment of various ailments. AI has emerged as a powerful scientific tool, capable of processing and analyzing vast amounts of data to support decision-making. Numerous studies have demonstrated that AI can perform on par with or outperform humans in crucial medical tasks, including disease detection. However, despite its potential to revolutionize health care, ethical considerations must be carefully addressed before implementing AI systems and making informed decisions about their usage. Researchers have utilized various AI-based approaches, including deep and machine learning models, to identify diseases that require early diagnosis, such as skin, liver, heart, and Alzheimer’s diseases. Consequently, related work presents different methods for disease diagnosis along with their respective levels of accuracy, including the Boltzmann machine, K nearest neighbor, support vector machine, decision tree, logistic regression, fuzzy logic, and artificial neural network. While AI holds immense promise, it is likely to take decades before it completely replaces humans in various medical operations.

BIOAVAILABILITY AND POLYMORPHIC STABILITY CHALLENGES AFFECTING DRUG PRODUCT’S POTENTIAL: A CRITICAL EVALUATION AND PERTINENT SOLUTION

2023-04-25T10:11:39+0530

Clinical failure remains an ongoing challenge in pharmaceutical drug product development. Solubility and permeability therefore play a very critical role in achieving desired bioavailability and pharmacological response, which in turns affects clinical safety and efficacy significantly. The situation becomes more critical when the drug candidate exhibits polymorphism and undergoes polymorphic transformation due to its meta-stable nature. This review article outlines the available technologies, pertinent regulations, the concepts involved in the enhancement of bioavailability and polymorphic stability to overcome the clinical failures. Various available technologies for bioavailability enhancement such as salification, micronization, complexation, microemulsification, nano emulsification, cocrystal formation, and amorphous solid dispersion with their advantage and disadvantage in formulating a stable drug product containing a polymorphic and meta-stable drug substance. Thermodynamic and kinetic aspects of polymorphic transformation are discussed to understand different excipient and process-induced transformation during manufacturing and shelf life of the drug product. Selecting the right instrument from the analytical toolbox is equally important to understand the diverse nature of polymorphic transformation. This review provides state-of-the-art information available on advanced analytical tools along with their capabilities, advantages, and disadvantage with respect to physical/structural analysis of polymorphs and polymorphic transformation.