Asian Journal of Pharmaceutical and Clinical Research

SPECTRUM OF INTESTINAL COCCIDIAN PARASITES AMONG HIV PATIENTS ATTENDING A TERTIARY CARE HOSPITAL IN NORTH INDIA

HARIPRIYA BANSAL — 2024-12-07

Objectives: Human immunodeficiency virus (HIV) infection severely compromises the immune system, leading to increased susceptibility to opportunistic infections. Intestinal parasitic infections, particularly those caused by coccidian parasites, significantly contribute to morbidity and mortality in HIV-infected individuals, with diarrhea being one of the most common clinical manifestations.

Methods: The study involved HIV seropositive and seronegative patients presenting with diarrhea and other gastrointestinal symptoms. Stool samples were analyzed using direct wet mount preparations and modified acid-fast staining to identify various intestinal coccidian parasites among HIV patients and their prevalence.

Results: Among 207 HIV seropositive patients tested, 62% were male, with ages ranging from 11 to 60 years. Cryptosporidium was the only coccidian parasite detected in our study, with a higher prevalence (77%) in patients with chronic diarrhea compared to those with acute diarrhea (23%). A significant majority of parasites were found in patients with cluster of differentiation (CD) CD4 counts below 200/mm³.

Conclusion: There is a high prevalence of intestinal coccidian parasites among the studied population. Health education targeted at both HIV patients and community health workers regarding potential sources and transmission routes of these infections is crucial to reduce contamination and promote patient health and longevity.

ADHERENCE TO THE WHO CRITERIA ON DRUG PROMOTION LITERATURE: AN EVALUATION OF PHARMACEUTICAL ADVERTISING AT A TERTIARY HEALTHCARE FACILITY IN NORTH INDIA

MADHUMITA DIXIT — 2024-12-07

Objective: This research seeks to evaluate how closely drug promotional materials at a tertiary care center in North India follow the WHO’s ethical standards.

Methods: A cross-sectional analysis was carried out, involving the organized gathering of drug promotion literatures (DPLs) from the healthcare institution over a specific timeframe. A checklist, derived directly from the WHO’s guidelines for ethical drug promotion, was used to evaluate the DPLs’ content. The data were thoroughly examined to determine the degree of adherence to the WHO standards.

Results: In an analysis of 149 DPLs, all included both generic and brand names. Information on the amount of active ingredient and therapeutic applications was present in 91% and 86% of the DPLs, respectively, and dosage forms appeared in 91%, with the remainder depicted pictorially. Only 32% of DPLs described the pharmacological mechanism. Details about side effects and significant adverse drug reactions, as well as precautions and warnings, contraindications, and major drug interactions, were included in 19%, 16%, 18%, and 11% of DPLs, respectively. The manufacturer’s name was mentioned in 72% of the documents, while the manufacturer’s address appeared in 26%. References to scientific literature were included in just 29% of the DPLs.

Conclusion: This research highlights the need for improved oversight and regulation of drug promotion activities within the healthcare facility. Less than 20% of DPLs provide information on drug safety. Compliance with the WHO standards is crucial for ethical drug promotion, protecting patient care, and maintaining the integrity of healthcare services. Cooperative initiatives among healthcare facilities, pharmaceutical firms, and regulatory agencies are urgently required.

PHYTOCHEMICAL SCREENING AND DETERMINATION OF ANTIMICROBIAL, ANTIOXIDANT, AND ANTICANCER ACTIVITY OF ULVA LACTUCA-BASED SILVER NANOPARTICLE

C K BABINI — 2024-12-07

Objective: The current study is proposed to evaluate the potential medicinal value of Ulva lactuca an edible green seaweed. The prime objectives of the research were to determine the anti-oxidant, anti-microbial, and anti-cancer properties of the seaweed extracts and green synthesized nanoparticles.

Methods: Five different solvent extracts were qualitatively and quantitatively analyzed for phytochemicals. A gas chromatography-mass spectrophotometer (GC-MS) analyzed the metabolite profile of the methanol extract. In-vitro anti-oxidant activity is determined by 1-diphenyl 2-picrylhydrazyl (DPPH) and ABT assay. The Resazurin method tested the anti-microbial activity against two uropathogenic bacteria and one fungal pathogen. HeLa cell line was employed to investigate the anti-cancer potential of the seaweed conjugated nanoparticle.

Results: Qualitative analysis revealed the presence of Alkaloids, Phenol, flavonoids, tannins, steroids, carbohydrates, glycosides, amino acids, and proteins. The metabolite profiling of methanol extract was identified by GC-MS analysis. Quantitative estimation exposed total flavonoid content of 2.56±0.30 mg quercetin equivalent/g, total phenolic content −3.66±0.15 mg gallic acid equivalents/g, Tannic acid equivalent – total tannin content (TTC) of 2.90±0.61 mg/g and 3.40±0.30 mg/dL of steroids. EAE, ME, and HE recorded the following IC50 for DPPH −871 μg/mL, 432.264 μg/mL, and 432.273 μg/mL, respectively. In ABTs, AE, ME, and EAE showed the highest activity at IC50 values of 39.090 μg/mL, 104.43 μg/mL, and 252.491 μg/ mL. MIC of Ulva NP against Escherichia coli −250 μg/mL, Candida albicans −500 μg/mL, and Acinetobacter baumannii −1000 μg/mL was depicted. The cytotoxicity nature of UAgNPs is observed in HeLa cell lines. The screening results reveal that the edible green seaweed U. lactuca can be further studied and extended as a potential source of components in controlling Urinary tract infection (UTI) and a drug of choice for cervical cancer.

Conclusion: The current study highlights the antimicrobial, antioxidant, and anticancer properties of green seaweed U. lactuca, a potential source of pharmaceutical application.

PREVALENCE OF STAPHYLOCOCCUS AUREUS AND ESCHERICHIA COLI ON LEAFY VEGETABLES SOLD AT A COMMUNITY MARKET

CELESTINA C UGWU — 2024-12-07

Objective: The aim of this study is to evaluate the presence of Staphylococcus aureus and Escherichia coli in leafy vegetables sold at a community market as well as determine their antibiotic susceptibility patterns on some commonly used antibiotics.

Methods: A total of thirty (30) different leafy vegetables of different species were bought from different vendors at Eke-Agbani market in Nkanu West L.G.A. The bacteria were isolated and identified using standard microbiological methods. Antibiotic susceptibility patterns were determined using the disk diffusion method.

Results: The mean bacterial load of S. aureus and E. coli from these samples ranged from 4.2×106 to 8.3×106 cfu/g and 4.7×106 to 7.6×106 cfu/g, respectively. The number of positive samples and negative samples are 18 (60%) and 12 (40%), respectively. The percentage distribution of both S. aureus and E. coli was 50%, respectively. The susceptibility of the isolates to antibiotics showed that all E. coli isolates had 100% sensitivity to ciprofloxacin, tarivid, reflacin, ceporex, and augmentin. All the S. aureus isolates had 100% sensitivity to gentamycin, amoxicillin, and ciprofloxacin. All the S. aureus isolates had 100% resistant to chloramphenicol.

Conclusions: The results revealed the presence of S. aureus and E. coli in the vegetables screened. The presence of these bacteria may pose a serious threat to human health as some of these vegetables are consumed without proper cooking. Therefore, adequate measures should be taken by consumers to ensure proper washing before consuming as well as advising the public on antibiotic use.

ANALYSIS OF ANTIMICROBIAL SUSCEPTIBILITY PATTERN OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS IN A TERTIARY CARE HOSPITAL

REPATI GOWRI — 2024-12-07

Objective: The present study aimed to evaluate MRSA prevalence among Staphylococcus aureus isolates, identify demographic factors associated with infections, and evaluate susceptibility to various antibiotics.

Material and Methods: The study involved various clinically infectious samples. S. aureus was identified using a battery of tests and MRSA was identified utilizing the cefoxitin disk diffusion technique. At the same time, adherence to Clinical and Laboratory Standards Institute protocols guided the execution of the antibiotic susceptibility assay.

Results: Out of 28,239 culture samples, 569 S. aureus isolates were detected, with 308 (54.1%) being MRSA. Most samples originated from individuals aged 41–60 years (n=110, 36%), and males accounted for (n=205, 67%) of the isolates. Pus samples notably yielded the highest proportion of MRSA (n=249, 80.8%), primarily from the surgery ward (n=120, 38.9%). Remarkably, the strains demonstrated substantial sensitivity (>90%) to linezolid, vancomycin, chloramphenicol, and doxycycline.

Conclusion: In summary, MRSA strains were sensitive to drugs such as linezolid, vancomycin, chloramphenicol, and doxycycline. The emergence of resistant variants emphasizes the necessity for continuous surveillance and careful antibiotic use, informing antibiotic stewardship programs and clinical strategies for managing MRSA infections in health-care settings.

DESIGN, SYNTHESIS, ANTI-CANCER ACTIVITY, AND MOLECULAR DOCKING STUDIES OF LIGNIN-PYRROLE DERIVATIVES AS A JAK3 INHIBITOR

NISHA CHIRIAPANDA LOHITH — 2024-12-07

Objectives: The aim of the study was to predict the interaction patterns between poly (ADP-ribose) polymerase (PARP), vascular endothelial growth factor receptor (VEGFR1), and Janus kinase 3 (JAK3) with lignin-pyrrole derivatives using molecular docking studies. In vitro anti-cancer activity of lignin-pyrrole derivatives on HeLa cells.

Methods: The key proteins such as PARP, Rad18, VEGFR1, JAK3, alpha-beta tubulin, SarA, Rad6, VEGFR2, leukocyte type core 2 beta 1, 6-N-acetylglucosaminyltransferase,and epidermal growth factor receptor kinase domain were retrieved from the protein data bank. The effect of compounds on cell proliferation of HeLa cells was determined by MTT assay. The cell was treated with or without compound and was incubated for 48 h.

Results: The cytotoxicity assay was performed for the initial screening of lignin-pyrrole derivatives. Among the tested molecules, compound 4b emerged to be potent against HeLa cells at lower concentrations.

Conclusion: Molecular docking studies revealed that the screened compounds are found to be good PARP, VEGFR1, and JAK3 inhibitors. In vitro screening proved that the compounds can be good antiproliferative agents.

EXTRACELLULAR MODULATORY AND ANTI-INFLAMMATORY EFFECTS OF A COMBIATION OF CURCUMIN, PIPERINE, AND VIRGIN COCONUT OIL IN ANIMAL MODEL

ADITYA ASISH — 2024-12-07

Objective: The current study investigated the potential of a novel herbal combination of curcumin, piperine, and virgin coconut oil to exhibit anti-inflammatory and anti-rheumatic properties against carrageenan-induced inflammation.

Method: A minimal dose of the drug formulation having a maximal anti-inflammatory effect was found (Dose III). Following the completion of the experiment, the animals were humanely euthanized, and paw tissue and serum samples were collected for further analysis. The expression levels of mRNA for Tumor Necrosis Factor-alpha (TNF-α), interleukin (IL)-6, PGE-2, and Thiobarbituric acid reactive substance (TBARS), as activities of cyclooxygenase -2, superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and TBARS were measured and levels of matrix metalloproteinases (MMP)9 and MMP2 were measured using zymography and western-blotting.

Results: Anti-oxidant assays were performed in serum and synovial tissue, observed that the production of anti-oxidant enzymes such as SOD, GPx, CAT, and GSH was enhanced, and suppression of the accumulation of lipid peroxidation products in the group treated with the potent dose of the drug combination. A decrease in the mRNA expression of IL-6, IL-1β, and TNF α was noted in the treatment group, these are the upstream events of the inflammatory cascade. Radiological and histopathological analysis confirms that the drug formulation acted on MMPs to reduce its baneful consequence.

Conclusion: The drug formulation’s anti-inflammatory and anti-rheumatic properties, combined with its multi-targeted mechanism, suggest its potential as a therapeutic agent for various inflammatory diseases.

QUALITY OF ANTI-COAGULATION, PREDICTORS, AND CONSEQUENCES OF DERANGED INR OF PATIENTS ON WARFARIN THERAPY

AKANKSHA MATHUR — 2024-12-07

Objective: Warfarin therapy is considered challenging because of the narrow therapeutic index and various pharmacokinetic and pharmacodynamic interactions. Inability to maintain the international normalized ratio (INR) in therapeutic range results into adverse events. The study aims to characterize the quality of anti-coagulation with warfarin and its outcome in terms of adverse events along with analysis of various predictors for INR control.

Methods: A cross-sectional study was conducted at a tertiary care center involving all adult patients (≥18 years) on warfarin therapy presenting to the cardiology outpatient department for 1 year. Current INR, time in therapeutic range (TTR), and adverse events, if any were documented and managed appropriately. Logistic regression analysis was used to calculate odds ratios and 95% confidence intervals (CI) to model the predictors of deranged INR values.

Results: Of all 425 patients, 164 (38.58%) patients had non-target INR values, 111 (26.11%) were subtherapeutic, and 53 (12.47%) were supratherapeutic. Increased incidence of subtherapeutic range INR was found in women (IRR=1.09; p=0.002) and in patients with valvular atrial fibrillation (IRR=1.24; p<0.001). On the other hand, increased incidence of supratherapeutic INR was found in patients having renal failure (IRR=1.12; p<0.001). Four (2.4%) patients with subtherapeutic INR developed stroke and 3 (1.92%) patients with high INR resulted into bleeding.

Conclusion: The study found low percentage of TTR in patients on warfarin therapy. Predictors for poor anticoagulation control were women, valvular atrial fibrillation, renal failure along with drug interactions, and non-adherence to therapy.

COMPARATIVE EVALUATION OF P53 IN NORMAL BREAST, FIBROADENOMA, AND CARCINOMA BREAST

KT ATHULYA KRISHNA KUMAR — 2024-12-07

Objectives: The objective of this study was to analyze as well as compare the immunohistochemical expression of P53 in normal breast tissue and cases of fibroadenoma and carcinoma breast.

Methods: The present study was a retrospective analysis over a period of 1 year (2022–2023). A total of 60 cases comprising 10 cases of normal breast tissue, 20 cases of fibroadenoma breast, and 30 cases of carcinoma breast were included. Immunohistochemical staining by P53 antigen was performed and slides were graded accordingly as Grade 0, 1, and 2 depending on the staining intensity and percentage.

Results: Correlation of P53 staining across the spectrum of normal breast, fibroadenoma, and carcinoma breast showed a significant association (p=0.01). There was no significant association between the age and level of P53 expression (p=0.1). On evaluating the association between other clinicopathological variables and grade of P53 expression, we found a significant association with regards to tumor size (p=0.0006), tumor grade (p=0.043), lymph-vascular invasion (p=0.019), and nodal metastasis (p=0.025).

Conclusion: P53 may be a possible prognostic marker, to help in better therapeutic management of cases of breast carcinoma.

STUDY TO ASSESS SERUM FERRITIN LEVELS, LIPID PROFILE, AND THYROID PROFILE IN HYPOTHYROID PATIENTS

PATTI ANUSHA RANI — 2024-12-07

Objective: This study aims to evaluate thyroid hormone levels, lipid profiles, and serum ferritin concentrations in hypothyroid patients, exploring the interplay between iron deficiency, thyroid function, and lipid metabolism.

Methods: A descriptive study was conducted at Gandhi Medical College, Secunderabad, from 2019 to 2021, with 50 hypothyroid patients (aged 25–45 years) and 100 healthy controls. Blood samples were collected after 8–10 h of fasting and analyzed for thyroid hormones, ferritin, and lipid profiles. Statistical analysis was performed using EpiInfo software, with p<0.05 considered significant.

Results: The study revealed significantly elevated thyroid-stimulating hormone levels (13.4±10.2 mIU/l) and reduced Triiodothyronine (T3) (0.81±0.31 nmol/dL) and Thyroxine (T4) (4.4±0.93 μg/dL) levels in hypothyroid patients compared to controls (p<0.05). The serum ferritin levels were markedly lower in hypothyroid patients (16.9±13.9 ng/mL) than in controls (43.3±19.9 ng/mL), with 68% of cases showing ferritin deficiency. Dyslipidemia was prominent, with higher total cholesterol, triglycerides, low-density lipoprotein (LDL), and very LDL levels and reduced high-density lipoprotein in cases compared to controls (p<0.05).

Conclusion: Hypothyroid patients exhibit significant ferritin deficiency and dyslipidemia, highlighting the interconnectedness of iron status, thyroid function, and lipid metabolism. Addressing iron deficiency in hypothyroid patients may improve thyroid function and overall metabolic health.

COMPARISON OF INTRATHECAL NALBUPHINE AND FENTANYL AS ADJUVANTS TO BUPIVACAINE IN SPINAL ANESTHESIA IN PATIENTS UNDERGOING LOWER LIMB SURGERIES

VIRENDRA KISHOR NIMBALKAR — 2024-12-07

Objective: The objective of this study is to compare nalbuphine 0.5 mg and fentanyl 25 μg when used as an adjuvant to 0.5% bupivacaine heavy in spinal anesthesia for their effect on the sensory block, motor block, and post-operative analgesia.

Methods: After fulfillment of inclusion criteria and after obtaining informed written consent from patients, a group of a total of 80 patients was enrolled and divided in GRP-F and GRP-N equally. (1) Group F: Patients received diluted 25 μg of fentanyl with 3 mL (15 mg) of 0.5% hyperbaric bupivacaine. (2) Group N: Patients received diluted 0.5 mg of nalbuphine with 3 mL (15 mg) of 0.5% hyperbaric bupivacaine.

Results: The duration of sensory block and motor block was significantly longer in GRP-F than GRP-N. Post-operative analgesia was comparable in both groups with minimal side effects.

Conclusion: Intrathecal fentanyl in post-operative period was found to be significantly better than nalbuphine when used as an adjuvant therapy with 0.5% hyperbaric bupivacaine in elective lower limb surgeries with insignificant adverse effects like hypotension, nausea, and vomiting.

A COMPARATIVE STUDY OF TENELIGLIPTIN VERSUS HYDROXYCHLOROQUINE AS ADD ON THERAPY IN UNCONTROLLED TYPE-II DIABETES MELLITUS PATIENTS

KRUNAL NATVARLAL CHAUHAN — 2024-12-07

Objectives: This study aimed to compare the efficacy and safety of teneligliptin versus hydroxychloroquine (HCQ) as add-on therapy in uncontrolled T2DM patients. To measure the safety and efficacy of Teneligliptin and Hydroxychloroquine as add on therapy in uncontrolled type-2 diabetes mellitus patients. To compare the safety and efficacy of Teneligliptin and Hydroxychloroquine during the study. To assess the Glycaemic control in patients of Type-2 diabetes mellitus before treatment and after treatment.

Methods: This randomized, Observational and Prospective study enrolled 124 uncontrolled T2DM patients who were inadequately controlled on Metformin and Glimepiride therapy. Patients were randomly assigned to receive either teneligliptin (20mg/day) or HCQ (400mg/d ay) as add-on therapy for week 4,12 and 24 weeks. The primary outcome was the change in HbA1c from baseline to week 24.

Results: Both Teneligliptin and HCQ significantly reduced HbA1c levels from baseline, with a greater reduction observed in the Teneligliptin group (p < 0.001). Additionally, the Teneligliptin group demonstrated improved fasting blood sugar (FBS) and postprandial glucose (PPG) levels in comparison to Hydroxychloroquine.

Conclusion: This study suggests that Teneligliptin is a more effective and tolerable add-on therapy compared to Hydroxychloroquine in uncontrolled T2DM patients, highlighting its potential as a valuable treatment option for improving glycaemic control.

A COMPARATIVE STUDY OF ORAL PSORALEN VS METHYLPREDNISOLONE WITH NARROW BAND UVB THERAPY IN VITILIGO

RAHUL KUMAR PAL — 2024-12-07

Objective: The efficacy and safety evaluation of oral Psoralen and of oral Methylprednisolone along with narrow-band ultraviolet B (NB-UVB). To observe the safety and efficacy of oral Psoralen in patients of Vitiligo. To observe the safety and efficacy of oral Methylprednisolone along with NB-UVB in patients of Vitiligo. To compare the safety and efficacy of oral Psoralen and oral Methylprednisolone along with NB-UVB during the study. To assess the dermatological life quality index (DLQI) in patients of Vitiligo before, during treatment, and after treatment.

Methodology: A randomized controlled trial was conducted involving 76 patients diagnosed with generalized vitiligo. Patients were randomly assigned to either Group A or Group B. Group A received oral psoralen (0.3–0.6 mg/kg) followed by Twice-weekly sessions of NB-UVB therapy along with methylprednisolone.

Results: As per the observations, the DLQI of the patients treated with the methylprednisolone with NB-UVB were showing better results as compared to the oral psoralen group.

Conclusion: Even though vitiligo does not pose a direct threat to a person’s physical or mental health, it does cause a great deal of suffering for those who suffer from it and their loved ones. Therefore, treatment is necessary. While there are a number of systemic and topical treatments for this condition, phototherapy – and particularly NB-UVB – is among the most effective and safest options.

A CLINICAL COMPARATIVE STUDY ON THE HEALING EFFICACY OF NANO SILVER AND BETADINE IN DIABETIC FOOT ULCERS

KALANGRI MURALI KRISHNA — 2024-12-07

Objective: The objective of the study was to study the efficacy of topical agents like betadine solution and nano silver solution/gel in the management of diabetic foot ulcer.

Materials: The study was a prospective, parallel-group, comparative trial. The patients were admitted with diabetic foot ulcer for a period of 2 years. A comparative study was done between both groups regarding the time of healing. Number of dressings and reduction of ulcer size was monitored. The number of patients included in our study was 60 out of which 30 were in test group with betadine solution and 30 were in another test group with nano silver solution.

Results: Age distribution, 25 patients are between 51 and 60 years of age. In sex distribution, males are affected more than females. In mode of onset, 68.75% of ulcers are traumatic in onset; plantar aspect and forefoot are most. Blood sugar levels between 200 and 300 mg% are in 38.33% of patients. Patients receiving insulin were 7l.66%, which helped in good glycemic control. Average duration of hospital stay is less with test Group l, that is, 30 patients stay. Percentage reduction of ulcer is between 91 and 99%, in 27 patients of test Group l While only six patients in test Group 2 had 91–99% reduction in ulcer size with p=0.00 and is highly significant, number of dressings required per patient are l0.225±2.957 in test group and are 21.65±3.847 in test Group 2, p=0.00 and significant.

Conclusions: Thus using nano silver dressings in the treatment of diabetic foot ulcers is found to be safe, effective, promoter of wound healing promote epithelization, and accelerates healing. Eliminates anaerobes and breaks microbial synergy more effectively than simple betadine dressing. Hence, nano silver gel proves to be more effective in the management of diabetic foot ulcer.

PEDIATRIC ACCEPTANCE AND SWALLOWABILITY OF MINITABLETS: A BIBLIOMETRIC ANALYSIS

MAHESH PATIL — 2024-12-07

Objective: This study examines current on-going research in the area of acceptance and swallowability of minitablets in paediatrics. The purpose behind this enquiry is due to need for development of minitablets for paediatrics use and determining the safety, acceptability and swallowability of minitablets in children. By going through this paper one will gain knowledge about the aspects in which research has been completed and which areas are yet to be explored.

Methods: The primary goal of this investigation is to combine research published on acceptance and swallowability of minitablets in paediatrics from year 1989 to 2023 in journals indexed by web of science core collection database. Employing bibliometric techniques such as authorship pattern, countries involved, funding agencies, co-authorship pattern etc.

Result: A total of 111 documents have been found from year 1989 to 2023 with total 2,993 citation received so far. The active years of publications is from 2012 to 2023. The countries contributing in this research topic are England, Germany, USA, France, Netherlands, Switzerland, Japan, Belgium, Italy, Norway, Poland, India, Canada. For accurate searching and retrieving of data keywords and Boolean operators such as "mini tablet*" AND ("pediatric" OR "children") AND "safety" AND ("swallow*" OR "accept*") are used.

Conclusion: This bibliometric analysis displays and provides information on this topic and can be used for identifying recent trends, most prolific authors, most impactful journals, contributing countries for research on acceptance and swallowability of minitablets in paediatrics.

EVALUATING THE USE OF A NEW BALANCED CRYSTALLOID SOLUTION (STEROFUNDIN) COMPARED TO RINGER’S LACTATE FOR PRIMING CARDIOPULMONARY BYPASS CIRCUITS

GURPREET SINGH OBEROI — 2024-12-07

Objectives: This study aims to evaluate the effects of using either Ringer’s lactate (RL) or a newer balanced crystalloid solution called Sterofundin (SF) as the priming solution for the heart-lung machine during and immediately after single heart valve replacement surgery.

Methods: The study included 260 patients bifurcated into groups of SF and RL. A pulsatile roller pump and a membrane oxygenator were used for cardiopulmonary bypass. The circuit was primed either with 500 mL of the balanced 6% hydroxyethyl starch 130/0.4 plus 1000 mL of the RL or 1000 mL of balanced crystalloid solution SF.

Results: Significant differences were observed between SF and RL groups based on mean blood pressure, central venous pressure, cardiac index, mixed venous oxygen saturation, blood gas parameters, platelet count, and extubation hours.

Conclusion: Stable blood flow is key in heart bypass surgery. Fluid management is complex, and the ideal fluid type is debated. Colloids may help patients with weak hearts. Modern non-colloids are also safe. Research conflicts likely arise from study differences and researcher bias. This study suggests that both fluid types are useful, with colloids potentially better in certain cases. In addition, acetate solutions like SF were found to lower lactate levels. SF also maintains hemostasis, colloid oncotic pressure and reduced blood product requirement. Patient outcomes and intensive care unit stay were similarly affected by priming solutions.

A SINGLE-BLIND, PLACEBO-CONTROLLED CLINICAL TRIAL OF LOCAL APPLICATION OF KOHL-CHIKNI DAWA-A UNANI COMPOUND FORMULATION IN THE PATIENTS OF PRE-MATURE SENILE CATARACT

ZEHRA ZAIDI — 2024-12-07

Objective: The present clinical trial was undertaken to evaluate the safety, preventive/ curative efficacy of the local application of KCD in patients of premature senile cataract, to provide an economic, safe, and effective alternative treatment for it.

Methods: The present prospective single-blind, placebo-controlled trial was undertaken at Majeedia Hospital, Hamdard University, New Delhi. The diagnosed patients of premature senile cataract were randomly allocated to three groups for local application of KCD/ placebo.

Results: Ninety two patients completed the study period of 6 months. After treatment the results show that KCD was effective in the general amelioration of the signs, and symptoms of the premature senile cataract. KCD have some significant effect on grade I of PS Cataract as out of 52 cases; lens score was nil in 5 patients (9.6 %) but no effect on grades II and III premature senile cataract. Vision remains stationary in 44% cases during study period.

Conclusion: The dose of KCD in two sticks BID was safe, and tolerable with no side effects. KCD was also effective in loss of vision in grade I of PSC. KCD have potential to modulate the progress of early premature senile cataract. A multicentric trial of the test drug on a larger sample size for a longer duration of five years as per WHO recommendation is required to establish the efficacy of the formulation on premature senile cataract.

A COMPARITIVE STUDY OF TOPICAL MINOXIDIL (5%) PLUS FINASTERIDE (0.1%) VERSUS PLATELET-RICH PLASMA PLUS TOPICAL MINOXIDIL (5%) PLUS FINASTERIDE (0.1%) IN PATIENTS WITH ANDROGENIC ALOPECIA

DHARA D PATEL — 2024-12-07

Objective: Androgenic alopecia is progressive loss of terminal hairs in patterned distribution. It causes psychoemotional problems and affects the quality of life. Therefore, to achieve optimal results, multiple modalities are required. In this study, the combination of platelet-rich plasma (PRP) along with topical drugs such as minoxidil and finasteride is compared with the conventional combination of topical minoxidil (5%)+Finasteride (0.1%)

Methods: A prospective randomized study was conducted on a total of 50 males with androgenetic alopecia (AGA) at the Department of Dermatology, Parul Institute of Medical Sciences and Research for 1 year. A total of 50 males diagnosed with AGA were divided into two groups randomly. Patients in in Group A were recommended topical minoxidil (5%)+finasteride (0.1%), and Group B was treated with PRP along with topical minoxidil (5%)+finasteride (0.1%). PRP was done every month for 6 months and minoxidil applied over scalp twice daily for 6 months. Both groups were followed up monthly for 6 months and then after 6 months of last visit. Hair density was assessed using the Hamilton–Norwood scale using photographs and patient’s self-assessment scores. Data were evaluated applying Chi-square test.

Results: After 6 months of the last visit subjective response with minoxidil (5%) +finasteride (0.1%) showed good response in 26%, moderate in 39%, and poor in 35%, whereas PRP+minoxidil (5%)+finasteride (0.1%) group showed good response in 65%, 26% responded moderately and 9% responded poorly.

Conclusion: The combination therapy of PRP and topical minoxidil+finasteride being safe and effective can be used for patients unresponsive to conventional therapy and for faster outcome.

ASSOCIATIONS BETWEEN HBA1C LEVELS AND LIVER FUNCTION TESTS IN DIABETES: A COMPREHENSIVE ANALYSIS

JOSEPH KI — 2024-12-07

Objective: To determine the liver function tests status among the diabetic patients. Diabetes mellitus (DM) is a chronic multi-system disease characterized by hyperglycemia. The most common type of DM, Type 2 DM (T2DM), is characterized by insulin resistance and insufficient insulin secretory response. T2DM is frequently associated with abnormal liver function tests (LFTs). Our study aims to widen our knowledge of the complex interrelationship between T2DM and LFTs.

Methodology: This study was done in a multi-specialty hospital in Western part of Tamil Nadu among the patients who came for master health check-up between 2017 and 2024. From the laboratory database of 67,000 patients, patients who reported for the 1st time and had their hemoglobin A1c (HbA1c) and LFT values evaluated were selected. They were categorized as normal, pre-diabetic, and diabetic based on HbA1c values. Data were analyzed using SPSS 27. Categorical variables were expressed in the form of frequency and percentages whereas continuous variables were expressed in the form of mean and standard deviation. Analysis of variance (ANOVA) was used to find out any significant difference in lipid profile among the three groups.

Results: Our study had 23,238 participants. Out of them 7168 (30.84%) had normal HbA1c levels, 8347 (35.91%) were pre-diabetics and 7955 (34.23%) were diabetic patients. The mean total protein (TP), serum glutamic-pyruvic transaminase (SGPT), and alkaline phosphatase (ALP) were higher among the diabetic patients. ANOVA showed that there was a significant difference in serum total bilirubin, TP, albumin, serum glutamic-oxaloacetic transaminase (SGOT), SGPT, and ALP between the three groups. Pearson correlation coefficient showed a positive correlation between SGOT, SGPT, ALP, and HbA1c. It showed a negative correlation between TB, albumin, and HbA1c.

Conclusion: From the findings of this study, there is evidence that there exists a significant association between HbA1c levels and LFTs. Elevated HbA1c levels correlate with abnormal LFT results, suggesting a potential link between glycemic control and liver health. These results underscore the need for monitoring both HbA1c and LFTs in patients with diabetes to manage their overall health comprehensively.

HISTOPATHOLOGICAL SPECTRUM OF THYROID LESIONS IN THE SOUTH-WEST PART OF PUNJAB- A TERTIARY CARE CENTER STUDY

JASMINE KAUR — 2024-12-07

Objective: The objective is to study histomorphological patterns of thyroid lesions and to classify various thyroid malignant neoplasms according to the World Health Organization (WHO) classification.

Methods: The present observational study was done in the department of pathology in a tertiary care institute in 254 thyroid specimens to study histomorphological patterns of thyroid lesions and to classify various thyroid malignant neoplasms according to the WHO classification over 7 years from January 01st, 2010 to December 31st, 2016.

Results and Discussion: The most common age group affected was between the 2nd and 3rd decades. Females were more commonly affected than males and females: Male was 5:1. of the 254 cases, 221 were nonneoplastic and 33 were neoplastic. Among nonneoplastic lesions, the most common lesion was multinodular goiter with 121 (47.63%) cases, followed by Colloid goiter 63 (24.80%), adenomatoid goiter- 19 (7.48%), lymphocytic thyroiditis/Hashimoto’s thyroiditis (HT) 17 (6.69%) and only 1 (0.39%) case was found to be of thyroglossal cyst. Among neoplastic lesions, follicular adenoma-24 (9.45%) was the most common lesion, then papillary carcinoma-7 (2.76%) cases, of which 2 (0.79%) were follicular variants of papillary carcinoma, medullary carcinoma - 1 (0.39%), and paraganglioma only 1 (0.39%) case.

Conclusion: The histological spectrum of thyroid diseases in the Malwa Region, Punjab, is similar to that seen around the globe and the region. Iodine deficiency has been identified as a significant public health problem, especially in the Sub Himalayan region of India. The consequences of persisting iodine deficiency are goiter, hyperavidity of the thyroid for iodide, and subclinical hypothyroidism during pregnancy and early infancy. Similarly, clinical evaluation of goiter should be thorough and use all means, especially histopathological study of the specimens, to arrive at a definitive diagnosis, as thyroid carcinoma is not uncommon.

A STUDY ON THE PREVALENCE OF ADVERSE EFFECTS ASSOCIATED WITH SODIUM-GLUCOSE COTRANSPORTER 2 INHIBITOR DAPAGLIFLOZIN IN A TERTIARY CARE CENTRE

ASWINI S — 2024-12-07

Objectives: The objective of this study was to assess the prevalence of adverse effects associated with sodium-glucose cotransporter 2 inhibitors (SGLT2i) dapagliflozin in a real-world setting.

Methods: This observational study was conducted prospectively over 3 months in a tertiary care center in India. It focused on in-patients aged over 18 who were diagnosed with heart failure, Type 2 diabetes mellitus, or chronic kidney disease, and undergoing treatment with SGLT2i, specifically dapagliflozin, at doses of 5 or 10 mg. Patients with a glomerular filtration rate of <25 mL/min/1.73 m², pregnant or lactating women, and individuals with end-stage renal disease or undergoing dialysis were excluded from this study. Patient demographics, clinical history, and medication usage were collected using a structured pro forma.

Results: Among 60 patients, 15 (25%) experienced adverse effects. Women and those over 50 years had a significantly higher prevalence of adverse effects. The common adverse effects were urinary tract infection 5 (8.3%), urinary-like symptoms 4 (6.6%), gastrointestinal upset 3 (5%), weakness 2 (3%), and hyponatremia 1 (1.6%). The dosage (5 mg and 10 mg) was significantly associated with side effects (p<0.002). Management strategies varied, including discontinuation, temporary halting, or no change in treatment.

Conclusion: The observed higher prevalence of adverse effects in older individuals, particularly women, and with higher drug doses further emphasizes the necessity for close clinical monitoring during the initial phases of treatment.

CONNECTING THE DOTS: INVESTIGATING THE RELATIONSHIP BETWEEN HBA1C AND LIPID PROFILE

JOSEPH KI — 2024-12-07

Objectives: To determine the association between lipd profile and HbA1c. Hemoglobin A1c (HbA1c) is used to monitor blood sugar levels. HbA1c is one among the panel of tests that is done for patients who come for routine master health check-ups. This helps us to identify pre-diabetic and diabetic individuals. Diabetic individuals are at increased risk for dyslipidemia. The aim of this study is to look into the association between lipid profile and HbA1c.

Methodology: This study was done in a multispecialty hospital in the Western part of Tamil Nadu among the patients who came for master health check-ups between 2017 and 2024. Ethical Committee approval was obtained (EC/AP/1100/12/2023). From the laboratory database of 67,000 patients, patients who reported for the 1st time and had their HbA1c and lipid profile levels evaluated were selected. They were categorized into normal, pre-diabetic, and diabetic based on HbA1c values. Data were analyzed using the Statistical Package for Social Sciences 27. Categorical variables were expressed as frequency and percentages whereas continuous variables were expressed as mean and standard deviation. Analysis of variance (ANOVA) was used to find if there was a significant difference in lipid profile among the three groups.

Results: Our study had 23,238 participants. Out of them 7168 (30.84%) had normal HbA1c levels, 8347 (35.91%) were pre-diabetics, and 7955 (34.23%) were diabetic patients. The mean total cholesterol (TC) level (186.8±40.14) and low-density lipoprotein (LDL) cholesterol level (129.74±37.20). It was high for pre-diabetic patients. The median very LDL (VLDL) cholesterol (29.00(21–39) levels were higher for diabetic patients. The mean high-density lipoprotein (HDL) cholesterol levels (39.54±9.40) were less for diabetic patients. One-way ANOVA revealed a significant difference in TC, HDL cholesterol, LDL cholesterol, and VLDL cholesterol levels between the three groups. Pearson correlation coefficient showed a positive correlation between VLDL, LDL, TC, and HbA1c. HbA1c and HDL cholesterol were negatively correlated.

Conclusion: Our study revealed a significant correlation between HbA1c and these changes signify a higher risk of cardiovascular complications in individuals with diabetes mellitus. Understanding these associations underscores the need for vigilant monitoring and proactive management of lipid profiles among pre-diabetics and diabetics to reduce the risk of cardiovascular diseases and enhance their overall health.

A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED STUDY ON STANDARDIZED FENUGREEK SEED EXTRACT COMPOSITION FOR ENDURANCE ENHANCEMENT IN RECREATIONALLY ACTIVE YOUNG SUBJECTS

PRASAD ARVIND THAKURDESAI — 2024-12-07

Objective: To evaluate the efficacy and safety of 8-week supplementation with FEΔE (fenugreek seed extracts composition, standardized to 4-hydroxyisolecuine, trigonelline, and select glycosides) on endurance capacity in recreationally active young male subjects, in a randomized, double-blind, Placebo-controlled manner.

Methods: The 153 male participants were randomized equally into three groups and received either 300 mg or 600 mg of FeΔE capsules or a matching Placebo. Each participant performed endurance exercise training four times per week and visited the study center on the day of recruitment (baseline) and end of week-4, and week-8. The efficacy outcome measures were endurance (overall, cardiovascular, respiratory, and metabolic), power, work, physical and central fatigue, and stress, whereas safety outcomes were adverse events monitoring, compliance, and biochemical laboratory measurements.

Results: FEΔE supplementation (but not Placebo) showed statistically significant beneficial changes in overall (increased time to exhaustion and total distance run), respiratory (increased oxygen consumption), metabolic (increased metabolic equivalent and decreased non-esterified fatty acids levels), physical fatigue (decreased Wingate fatigue index), central fatigue (reduced visual analog score), and mental endurance (decreased mental domain score in the Multidimensional Fatigue Symptom Inventory-Short Form) during within the group (vs. baseline) comparisons. The safety outcome measures did not differ between the groups (FEΔE vs. Placebo).

Conclusion: Eight weeks of FEΔE supplementation in recreationally active participants resulted in comprehensive endurance enhancement, including respiratory, metabolic, and mental endurance. FEΔE supplementation was found to be safe without serious adverse events.

ASSESSMENT OF LOWER URINARY TRACT SYMPTOMS IN BENIGN PROSTATIC HYPERPLASIA TREATED BY CONSERVATIVE MANAGEMENT

ANIL P SINGH — 2024-12-07

Objective: The objective of the study is to evaluate the effectiveness of prescribed drug therapy for patients with benign prostatic hyperplasia (BPH) and to analyze the quality of life (QOL) of these patients.

Methods: A prospective observational study was conducted over 1 year, from October 2019 to September 2020, aiming to assess the effectiveness of medications used in BPH treatment. Urine flow was measured at each follow-up visit using an uroflow meter to evaluate treatment effectiveness. The American Urological Association’s QOL and the International Prostate Symptom Score (IPSS) were utilized to assess patients’ QOL.

Results: Out of 250 patients screened, 138 were eligible for the study, with 82 (59.43%) in the 60–80 age group. A total of 1212 medications were prescribed, with alpha-adrenergic blockers and 5-alpha reductase inhibitors (5-ARIs) making up 34.08% of all prescriptions. Urine flow increased from 13.42 mL/s at the first visit to 14.46 mL/s at the second visit, reaching 15.62 mL/s by the third visit. The IPSS score decreased from 15.44 at the first visit to 13.51 at the second and further to 12.28 at the third.

Conclusion: Alpha-adrenergic blockers such as tamsulosin (30.12%) and silodosin (3.96%), along with the 5-ARI dutasteride (0.50%), were prescribed for BPH treatment. A statistically significant improvement (p<0.05) in lower urinary tract symptoms and QOL was observed at each follow-up visit.

STUDY OF SERUM URIC ACID LEVELS IN PATIENTS DIAGNOSED WITH METABOLIC SYNDROME IN A HOSPITAL-BASED STUDY IN WEST BENGAL

GUNJAN KUMAR MANDAL — 2024-12-07

Objective: The occurrence of hyperuricemia is growing even in developing countries. It has been known to be associated with metabolic syndrome (MetS). MetS is a bunch of numerous metabolic disorders including reduced high-density lipoprotein cholesterol (HDL-C), hypertension, hyperglycemia, abdominal obesity, and raised triglyceride level in serum.

Methods: The present work was done in the Department of Biochemistry in combination with Medicine Department, SRIMS and Sanaka Hospital, Durgapur, WB, India. A total of 50 diagnosed MetS patients were selected for further studies and same number (50) of healthy volunteers controls without MetS were selected. Diagnosis of MetS was done according to the National Cholesterol Education Program Adult Treatment Panel-III.

Results: In our study, the level of serum uric acid (SUA) is high in MetS patients (7.8 mg/dL) compared to control group (4.6 mg/dL). The compared between two groups was statistically significant (p<0.000).

Conclusion: Our study showed that the components of MetS are increased with rise in the concentrations of SUA.

FROM PLEASURE TO PERIL: EXAMINING THE TOXIC AND POTENTIAL CARCINOGENIC IMPLICATIONS OF PREMIUM PAN MASALA CONSUMPTION

PRERONA BORUAH — 2024-12-07

Objective: This study aims to assess the phytochemical composition and toxicity profile of pan masala, with and without tobacco, through cellular toxicity analysis. The specific objectives are to analyze the cytotoxicity of pan masala extracts on fibroblast and keratinocyte cells and to investigate DNA fragmentation and apoptosis induced by these products.

Methods: Two popular brands of pan masala, one with and one without tobacco, were selected for phytochemical and toxicity evaluation. Aqueous extracts of both products were tested on mice fibroblast cells for cytotoxicity analysis. In addition, keratinocyte cell lines were employed to assess DNA fragmentation and apoptosis through standard molecular assays.

Results: The study revealed a significant increase in toxicity in both types of pan masala. Pan masala extracts caused marked cytotoxic effects on fibroblast cells and induced DNA fragmentation and apoptosis in keratinocytes. These toxicological impacts were observed in both tobacco-containing and tobacco-free samples, with heightened damage noted in the presence of tobacco.

Conclusion: The findings confirm that pan masala, with or without tobacco, has substantial cytotoxic effects, posing serious risks to normal cellular functions. Both varieties are implicated in DNA damage and apoptosis, underscoring the urgent need for public health interventions to reduce the consumption of these products due to their potential to cause severe oral and systemic health issues.

MORPHOLOGICAL AND MORPHOMETRIC VARIATIONS OF SPLEEN: A CADAVERIC STUDY IN NORTH INDIAN POPULATION

NEELAM BALA — 2024-12-07

Objective: The aim of study is to study morphological and morphometric analysis of spleen and its clinical importance. Spleen consists of a large encapsulated vascular organ and important lymphatic tissue in the human body. Its immunological functions are being well realized. The weight, size, and shape of the spleen vary in human being with age, sex, and under different conditions in the same individual. The morphological variations are important for physicians, surgeons, and radiologists to avoid misinterpretation of the splenic variants.

Methods: A cross-sectional study of a total of 50 adult human cadaveric spleens was done in the Department of Anatomy Government Medical College, Amritsar, Punjab. The study observed the morphological features such as shape, anomalous fissures, and morphometric measurements such as length, breadth, thickness, and weight of all the spleen specimens.

Results: The wedge-shaped spleen constituted 62%, tetrahedral (30%), triangular (4%), and irregular (4%), shaped spleens. Out of 50, 60% displayed notches on the superior border of spleen and 10% on inferior border of spleen. There was no notch in 30% of the specimens. Mean length of spleen was 9.2 cm, mean breadth was 6.2 cm, and thickness was 3.08 cm, respectively. The mean weight of the spleens was 140.008 g. Anomalous fissures were 2% found on the diaphragmatic surface.

Conclusion: The findings of the present study will be of fundamental importance to the physicians, surgeons, and radiologists and give clues for various clinical diseases.

EVALUATION OF EFFICACY AND SAFETY OF AZITHROMYCIN AND DOXYCYCLINE IN TREATMENT OF ACNE VULGARIS WITH DIFFERENT LEVELS OF SERUM TESTOSTERONE: A PROSPECTIVE, RANDOMIZED, CONTROLLED, COST-EFFECTIVE, COMPARATIVE STUDY

PADMAJA MEKALA — 2024-12-07

Objectives: The objectives of this study are to compare the therapeutic efficacy, safety, quality of life (QoL), and cost-effectiveness of azithromycin and doxycycline in patients with acne vulgaris and the correlation of serum testosterone levels with the severity of acne.

Methods: A prospective, randomized, open-label study was conducted at a tertiary care hospital in South India, according to the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use Guideline for Good Clinical Practice principles. After institutional ethics committee approval, 100 patients aged 15–40 with moderate-to-severe acne were enrolled, excluding those with a history of gastritis, drug hypersensitivity, pregnancy, or under 12 years old. Participants were randomized to receive either oral azithromycin 500 mg daily for three consecutive days each week for 4 weeks, or doxycycline 100 mg daily for 28 days, along with topical treatments. Efficacy was measured by the type and number of acne lesions, graded according to standardized criteria. QoL was assessed using the Cardiff Acne Disability Index (CADI). Serum testosterone levels were correlated with acne severity.

Results: Of the 96 patients (42 males, 54 females) who completed the study, 49 were in the azithromycin group and 47 in the doxycycline group. The mean age was 23.5 years in the azithromycin group and 22.1 years in the doxycycline group. Significant reductions in acne severity and number of lesions were observed in both groups (p<0.0001), with azithromycin showing superior improvement (p<0.01). At baseline, most patients had Grade 3 or 4 acne, which improved significantly post-treatment. QoL improvements were also significant in both groups, with mean CADI scores reducing from around 8 to below 4 (p<0.0001). A weak positive correlation (r=0.24) was found between serum testosterone levels and acne severity. Adverse events were mild and did not necessitate discontinuation. To achieve a 1 unit decrease in CADI, azithromycin treatment costed an additional rupees of 264.5 over doxycycline.

Conclusion: Azithromycin and doxycycline are effective treatments for moderate-to-severe acne vulgaris, with significant improvements in clinical and QoL outcomes. While azithromycin offers better clinical efficacy, doxycycline provides a more cost-effective option. Further studies could explore long-term outcomes and the impact of hormonal variations on treatment efficacy.

A COMPARISON OF ULTRASOUND-GUIDED SUPRACLAVICULAR VERSUS INFRACLAVICULAR BLOCKS FOR HAND AND FOREARM SURGERIES

ANANYA HAGJER — 2024-12-07

Objective: Regional anesthesia, particularly techniques such as supraclavicular (SCB) and infraclavicular (ICB) blocks, is increasingly favored over general anesthesia for upper limb surgeries due to its safety and efficacy, especially with ultrasound guidance.

Methods: A study was conducted at Silchar Medical College and Hospital involving 120 patients undergoing elective hand and forearm surgeries. These patients were randomly divided into SCB and ICB groups. Each block was performed using ultrasound guidance with an 8-MHz ultrasonic linear scanning probe. Patients received pre-medication, including pantoprazole/ranitidine, ondansetron, and midazolam (anxiolytic dose), 15 min before the procedure. The aim of our study was to compare the efficacy of ultrasound guidance in SCB block versus ICB block in terms of sensory and motor block, time taken to visualize structures, block performance time, and observe other parameters such as complications.

Results: Significant differences were observed between the SCB and ICB groups in terms of systolic BP, diastolic BP, and mean arterial pressure (MAP). The SCB group exhibited a higher MAP, whereas the ICB group required more time for structure visualization and block performance. However, the ICB group achieved complete sensory blocks quicker than the SCB group. Needle advancements were more frequent in the SCB group as compared to the ICB group.

Conclusion: The study concluded that while the ICB group had a longer block performance time, it experienced fewer complications, making ultrasound-guided ICB block a more effective option for upper limb surgeries compared to the SCB block.

A USG GUIDED ASSESSMENT OF ANTERIOR SOFT-TISSUE THICKNESS OF NECK FOR PREDICTION OF DIFFICULT INTUBATION IN MALE POPULATION ONLY: PROSPECTIVE OBSERVATIONAL STUDY

NEERAJA BALAKRISHNA — 2024-12-07

Objective: The use of ultrasound (US) imaging for anatomical evaluation has been an exciting technological advancement in the field of anesthesia. The growing utilization of the US is due to its proven clinical effectiveness, cost-effectiveness, and practicality. This technology allows anesthesiologists to assess complex and diverse anatomy.

Methods: In a prospective observational study, US was used to measure the airway dimensions of 100 male patients. The study included assessing the minimal distance from the hyoid bone to the skin surface (DSHB-HB), the distance from the skin to the midway point between the hyoid bone and thyroid cartilage (DSEM-TM), and the minimal distance from the skin to the anterior commissure (DSAC-AC). These patients were scheduled for surgery under general anesthesia after giving informed written consent. The relationship between easy and difficult laryngoscopy and categorical variables was analyzed using the Pearson Chi-square test and Fisher’s exact test. A p<0.05 was considered significant.

Results: No significant difference in body mass index values in the easy and difficult laryngoscopy group. Out of 100 male patients, 80 were (80%) in the easy laryngoscopy group and 20 were (20%) in the difficult laryngoscopy group . The mean distances were 62.81 ± 22.82 mm, 41.09 ± 22.33 mm, and 39.30 ± 14.97 mm, respectively, for DSHB-HB, DSEM-TM, and DSAC-AC. There is a significant association between easy and difficult laryngoscopy and the increased distance from the hyoid bone to the skin surface, the distance from the skin to the epiglottis midway, and the distance from the skin to the anterior commissure (p<0.05).

Conclusion: US-assisted evaluation of the airway by the anesthesiologist has significant advantages compared to relying solely on clinical assessment.

NATURAL HISTORY OF ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION WITH TOTAL OCCLUSION OF INFARCT-RELATED ARTERY DURING SIX-MONTH FOLLOW-UP WITH OPTIMUM MEDICAL THERAPY

MANISH SAHA — 2024-12-07

Objectives- Fate of STEMI patients on optimum medical therapy who remains asymptomatic following MI within 24 hours ,electrically and haemodynamically stable regarding their clinical status , LV function, with totally occluded infarct related artery.

Methods-100 patients whose angiography performed 3 to 28 days after ST segment elevation myocardial infarction, showed total occlusion of the infarct-related artery with poor or absent ante grade flow,were put on optimum medical therapy in absence of contraindication and follwed up for 6 months.

Results- At 1^st month among 100 patients 46 ( 46% ) patients were asymptomatic.43 (43%)patients were presented with shortness of breath on exertion (SOBE) and rest 11(11%)had both chest pain and shortness of breath. In subsequent visit at 6 months 46 % patients were asymptomatic and rest presented with SOBE, none of them presented with significant chest pain

Conclusion- In spite of optimum medical therapy patients with total occlusion of IRA and non viable myocardium developed progressive remodeling. Collateral flow is not adequate to prevent remodeling.Remodeling causes gradually progressive HF symptoms.If the patient has not developed new coronary lesion patients usually didn’t present with chest pain, shortness of breath was predominant symptoms in follow up in this group of patients.

TO STUDY THE SEROPREVALENCE OF BRUCELLOSIS IN CASES OF ACUTE UNDIFFERENTIATED FEBRILE ILLNESS AT A TERTIARY CARE HOSPITAL, AMRITSAR

SUNIDHI SOHAL — 2024-12-07

Objective: This study sought to determine the seroprevalence of human brucellosis in patients presenting with acute undifferentiated illness at a tertiary care hospital.

Methods: The cross-sectional investigation was done on patients presenting to the outpatient or inpatient Department of Medicine at Government Medical College, Amritsar during the study period, regardless of age group, with an acute undifferentiated febrile illness. A 5 mL of whole blood was extracted in a plain vacutainer from suspected patients and enzyme-linked immunosorbent assay (ELISA) was performed.

Results: Out of 100 samples,11 came out positive by ELISA. Four females and seven males tested positive. Three (27.27%) of the 11 samples had immunoglobulin (Ig)G anti-bodies, whereas 8 (72.72%) samples had IgM anti-bodies.

Conclusion: Brucellosis is a serious zoonotic illness with consequences for public health. Efforts should be focused on creating and executing efficient animal vaccination programs, as well as on better diagnostic techniques.

A CLINICAL STUDY OF NEONATES FROM A TERTIARY CARE TEACHING HOSPITAL IN SOUTHERN HARYANA

SHRADHANG PRATAP GAUTAM — 2024-12-07

Objectives: The present investigation has been undertaken to study certain aspects of neonates clinically at a tertiary care teaching hospital in southern Haryana.

Methods: All the patients attending the pediatric department referred from peripheral healthcare facilities to the study site and neonates delivered at the study site formed the study population. Neonates subjected to two or more inter-healthcare facility referrals, neonates with surgical conditions and neonates whose parents/legal caretaker denied consent, were excluded from this study.

Results: Among 256 neonates, 59 (23.0%) neonatal sepsis was present out of which 16 (17.8%) were inborn neonates and 43 (25.9%) were outborn neonates. One hundred and ninety-nine (77.7%) neonates were discharged after treatment out of which 76 (84.4%) were inborn neonates and 123 (74.1%) were outborn neonates. One hundred and ninety-nine (77.7%) neonates were discharged after treatment out of which 76 (84.4%) were inborn neonates and 123 (74.1%) were outborn neonates, whereas 40 (15.6%) unfortunately experienced a fatal outcome (death) out of which 9 (10.0%) were inborn neonates and 31 (18.7%) were outborn neonates.

Conclusion: Respiratory distress syndrome, neonatal jaundice, and meconium aspiration syndrome are significant contributors to morbidity in newborns. The most prevalent causes of mortality included prematurity, respiratory distress syndrome, birth asphyxia, and sepsis.

ENDOMETRIAL HISTOPATHOLOGICAL PATTERNS IN PATIENTS WITH ABNORMAL UTERINE BLEEDING: A SIX MONTHS OBSERVATION OF 285 CASES IN A TERTIORY CARE HOSPITAL

ABHILASHA — 2024-12-07

Objectives: the objective of the study was to assess the histopathological patterns of endometrial lesions in patients with abnormal uterine bleeding (AUB) across different age groups.

Methods: A descriptive cross-sectional study was conducted over 6 months at RNT Medical College, Udaipur after the approval of the Institutional Ethics Committee. A total of 285 cases presenting with AUB were analyzed through clinical history, physical examination, and endometrial biopsy. Cases were categorized into reproductive, perimenopausal, and postmenopausal groups for comparative analysis.

Results: The perimenopausal group had the highest incidence of AUB (50.88%). The most common histopathological findings included secretory (39%) and proliferative (31%) phases. Senile cystic atrophy was prevalent in postmenopausal women (38.71%), while endometrial hyperplasia was observed more in perimenopausal and postmenopausal women. Malignant cases, including adenocarcinoma, were rare but significant, particularly in the postmenopausal group.

Conclusion: Age-specific variations in endometrial patterns highlight the influence of hormonal changes and the increased risk of malignancy in postmenopausal women. The findings support the importance of endometrial histopathological evaluation in managing AUB, especially in perimenopausal and postmenopausal patients to identify potentially precancerous conditions.

STUDY OF RENAL FUNCTION TESTS IN THYROID DISORDER PATIENTS

VANITA SHARMA — 2024-12-07

Objective: To analyse serum creatine, urea, fT3, fT4 and TSH among thyroid disorder patients.

Method: 75 thyroid disorder patients were included in the study. Serum creatinine and blood urea were determined by the colorimeteric method using an autoanalyzer c311. Thyroid Profile-fT3, fT4, and TSH were estimated by chemiluminescence immunoassay. Serum creatinine and blood urea were found to be raised among hypothyroidisms.

Results: The mean fT3=2.09, mean fT4= 0.88 and mean TSH=17.82μIU/ml, mean urea=72.32 mg/dl and mean creatinine=2.4 mg/dl. The highest creatinine value was 12 mg/dl and highest urea value among the hypothyroidism patient was found to be 180.4 mg/dl.

Conclusion: Assessment of hypothyroidism and its effect on kidney will be helpful in early diagnosis and management of the patients

PREVALENCE OF DRY EYE IN CHILDREN AGED 5 TO 15 YEARS AND ITS PATTERN WITH DURATION OF SCREEN TIME IN THE EASTERN PART OF BIHAR

ANTARYAMI SHARMA — 2024-12-07

Objectives: Dry eye disease (DED) is increasingly recognized as a significant health problem in children, particularly about screen time exposure. However, detailed epidemiological data on DED in young populations, especially in regions such as Eastern Bihar, are sparse. This study aims to assess the prevalence of DED among children aged 5–15 years and explore the relationship between the duration of screen time and the occurrence of DED.

Methods: A cross-sectional study at M.G.M. Medical College and L.S.K. Hospital, Kishanganj, Bihar, examined 140 children with DED symptoms. Diagnostic tests such as tear film breakup time and Schirmer’s test were conducted during comprehensive ocular examinations. The association between DED prevalence and parental and self-reported screen usage was examined.

Results: The prevalence of DED among the participants was 12.1%. There was a significant association between higher screen time and increased prevalence of DED, with the severity of symptoms correlating positively with a longer duration of screen exposure. Children with severe DED reported significantly more screen time compared to those with milder forms.

Conclusion: The study confirms a notable prevalence of DED among children in Eastern Bihar, closely linked to excessive screen time. These findings highlight the need for public health strategies to manage screen exposure in children to prevent the onset of DED.

DUAL TARGET REVERSE TRANSCRIPTION POLYMERASE CHAIN REACTION FOR SARS-COV-2 FOR ENHANCING ACCURACY WITH E GENE AND ORF1B GENE: A CROSS-SECTIONAL STUDY

GAUTAM BARIK — 2024-12-07

Objectives: The pandemic of the recently emerged 2019- novel coronavirus infection was a challenge to public health. The current gold standard for the molecular diagnosis of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is the reverse transcription polymerase chain reaction (RT-PCR) for the qualitative and quantitative detection of viral nucleic acids. However, superior combination of gene targets for SARS-CoV-2 detection is underexplored. To find out the possible combination of target genes for maximizing RT-PCR accuracy in SARS-CoV-2 detection.

Methods: This study is an observational, cross-sectional study conducted at a tertiary care hospital in Kolkata. Study population included all SAR-CoV-2-infected patients attended either inpatient or outpatient department in a tertiary care hospital in eastern India. 870 patient’s respiratory tract samples with the clinical diagnosis of COVID-19 were collected. E gene, N gene, RNA dependent RNA polymerase (RdRp) (open reading frame [ORF1ab]) gene, ORF1b gene, and human RNase P (Internal control) gene targets were detected.

Results: Among all the genes, E gene was the most frequently detected (n=665; 86.70%) closely followed by N gene (n=429; 83.30%). ORF1b could be detected in 69.73% (n=159). RdRp was least frequently detected in only 44.64% (n=175). The E gene and ORF1b could simultaneously be detected in 85.12% samples when tested together. E gene and N gene could be detected together in 71.16% and E gene and RdRp could be detected in only 53.41%.

Conclusion: Our study found that the combination of E gene and ORF1b gene as optimal targets for assay design as these two genes are expressed simultaneously, that will minimize inconclusive results and maximize diagnostic yield.

A COMPARATIVE STUDY OF CLINICAL EFFECT OF HYPERBARIC BUPIVACAINE WITH FENTANYL VS HYPERBARIC LEVOBUPIVACAINE WITH FENTANYL FOR SPINAL ANAESTHESIA IN ADULT PATIENTS UNDERGOING ELECTIVE LOWER LIMB SURGERIES

TEJINDERPAL KAUR GREWAL — 2024-12-07

Objective: The aim of the present study was to compare the safety and efficacy of 2.5 ml of 0.5 % hyperbaric bupivacaine with 25 mcg of fentanyl and 2.5 ml of 0.5 hyperbaric levobupivacaine with 25 mcg fentanyl when given intrathecally in adult patients undergoing elective lower limb surgeries.

Methods: Our study was carried out in the Department of Anaesthesiology & Intensive Care, Rajindra hospital attached to Government Medical College Patiala from Jan 2023 to Jan 2024. The study was conducted on 100 patients and randomly divided into two groups with 50 patients in each group.

Results: There was no significant difference in the age, sex and weight distribution of the patients between the groups. The baseline data in both the groups was not statistically significant. In group I, Incidence of hypotension was 44% while it was 8% in group II and Incidence of bradycardia in group I was 48% while it was 8% in group II. Thus the difference between incidence of hypotension and bradycardia was found statisticallly significant as p value is <0.05. In group I, Mean time to onset of sensory block was 2.72±0.08 minutes while it was 2.76±0.08 minutes in group II which was statistically nonsignificant as p value was >0.05. In group I, Mean Duration of sensory block was 247.90±24.12 minutes while it was 311.18±15.57 minutes in group II which was statistically highly significant as p value was <0.001. In group I, Mean time to onset of motor block was 1.60±1.18 minutes while it was 2.27±0.064 minutes in group II which was statistically highly significant as p value is <0.001. In group I , Mean duration of motor block was 144.32±18.48 minutes while it was 112.04±12.15 minutes in group II which was statistically highly significant as p value was <0.001.The mean bromage scale at different intervals in group I and group II intraoperatively showed statistically significant results.

Conclusion: We concluded that in Lower limb surgeries, combination of levobupivacaine and fentanyl decreases the incidence of adverse effects such as hypotension and bradycardia, provides a better hemodynamic stability and offers shorter block time thus minimizing the risk and providing early mobility. Therefore, the combination of levobupivacaine with fentanyl could be preferred combination for lower limb surgeries.

COMPARISON OF SEVOFLURANE AND ISOFLURANE ON HEMODYNAMICS AND RECOVERY CHARACTERISTICS IN GERIATRIC PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY

VISHALDEEP SINGH — 2024-12-07

Objective: The aim of the present study was to compare sevoflurane and isoflurane on hemodynamics and recovery characteristics in geriatric patients undergoing laparoscopic cholecystectomy (LC).

Methods: The prospective, comparative, and randomized study was conducted on a total of 80 patients aged above 60 years of either sex and American Society of Anesthesiologists physical status I and II who were scheduled for elective LC under general anesthesia in Government Medical College, Rajindra Hospital, Patiala.

Results: Patients were hemodynamically stable throughout the surgery in both the groups but the emergence and recovery were significantly faster in the sevoflurane group. The sevoflurane group showed a faster time to spontaneous breathing, time to eye-opening, response to verbal commands, extubation time, and early orientation of the patient.

Conclusion: Sevoflurane might be considered a useful alternative to isoflurane in providing anesthesia in laparoscopic cholecystectomies, especially in elderly patients where rapid emergence and recovery are very much desired along with stable hemodynamic parameters.

ENDOMETRIOID ENDOMETRIAL CARCINOMA: AN INSTITUTIONAL CASE SERIES

K T ATHULYA KRISHNA KUMAR — 2024-12-07

Objective: To present a case series of endometrioid endometrial carcinoma having diverse presentations, histopathological features, and therapeutic modalities.

Methods: A case series of five cases of histopathologically diagnosed endometrioid endometrial carcinoma in a tertiary care center has been presented. Cases were collected over a period of 8 months (April 2017–December 2017).

Results: The ages of the patients ranged from 48 to 67 years. All patients were post-menopausal and one patient was pre-menopausal. In histopathology, there were two cases of grade 1, two cases of grade 3, and a single case of grade 2. FIGO staging of the cancers ranged from stage I to stage IIIc and appropriate therapeutic modalities were used based on grading and staging of the malignancies.

Conclusion: This case series highlights the clinical heterogeneity of endometrioid endometrial carcinoma. Increased education regarding early screening measures of endometrial carcinoma will aid in optimizing prevention and treatment protocols.

VARIED CLINICAL PRESENTATIONS OF CHANCROID: A CASE SERIES AND LITERATURE REVIEW

SPANDAN K. SHAH — 2024-12-07

Objectives: This study aimed to explore the diverse clinical manifestations of chancroid, investigate associated coinfections, and evaluate treatment outcomes.

Methods: A prospective case series was conducted involving six patients diagnosed with chancroid. Each patient underwent a detailed clinical evaluation, with photographic documentation of lesions. Laboratory investigations were performed to confirm chancroid and identify potential coinfections. Treatment was tailored according to the clinical findings and diagnostic results.

Results: The study revealed a spectrum of atypical ulcer presentations, including phagedenic ulcers, large ulcers, and small discrete lesions, suggesting the influence of coexisting STIs. Laboratory evaluations confirmed the presence of coinfections such as HIV, syphilis, and herpes in several cases.

Conclusion: Chancroid can present with diverse and atypical clinical features, often in the context of coexisting STIs. Early diagnosis and appropriate management are critical to preventing complications and improving patient outcomes.

NEUROLEPTIC MALIGNANT SYNDROME: THE NEED FOR A HIGH INDEX OF CLINICAL SUSPICION EVEN WHEN ON ATYPICAL ANTIPSYCHOTICS IN ASIAN POPULATION – A CASE REPORT

HIMA SABU — 2024-12-07

Neuroleptic malignant syndrome (NMS) is a rare life-threatening neurological disorder associated with the use of antipsychotic medications. Second-generation antipsychotics were assumed to have a lower risk of developing NMS; however, cases are being reported nowadays. Here, we are discussing of a 64-year-old male patient with underlying coronary artery disease, chronic obstructive pulmonary disease, and recurrent depressive disorder for which he was on an atypical antipsychotic, olanzepine from an outside center admitted in our hospital with the syndrome of NMS. He was brought to the emergency department with complaints of delirium, confusion, and urinary incontinence. On examination, he had fever, disorientation, and cogwheel rigidity with raised creatine phosphokinase values in blood tests. He was diagnosed with NMS after ruling out other causes for delirium and similar manifestations such as serotonin syndrome and malignant hyperthermia. This case illustrates the fact that the incidence of NMS due to atypical antipsychotics is not negligible and the need for monitoring elderly patients who take this class of drug, especially while escalating doses as the condition is fatal. Our case report also looks into other probable predisposing as well as precipitating factors which need to be considered with caution.

ATYPICAL PRESENTATION OF METASTATIC LOBULAR BREAST NEOPLASM

MADHURIMA BHATTACHARYYA — 2024-12-07

The diagnosis of cholecystitis is based on physical examination, laboratory tests, and abdominal ultrasound. After cholecystectomy, the surgical specimen is sent to the pathology department for routine histopathological examination to rule out pre-malignant and malignant conditions. Even less common is metastatic breast cancer that has spread to the gallbladder, which is itself a rare occurrence. We present a case of a 55-year-old female patient who underwent cholecystectomy for symptomatic chronic calculous cholecystitis. On histological examination, to the utmost surprise, a metastatic deposit in the wall of the gallbladder was detected by the pathologist, with a specific pattern of cell disposition, pointing to the primary site to be the breast, of which the patient was totally unaware. Metastasis in the gallbladder from primary lobular carcinoma of the breast was confirmed by a Tru-Cut biopsy from an ill-defined right breast lesion, with immunohistochemistry showing positive E-cadherin staining. Symptoms of right hypochondrial pain with nausea and vomiting in a patient should be investigated meticulously, as it can ultimately lead to the diagnosis of primary breast cancer. The role of the pathologist is emphasized in tracing the primary source of cancer and arriving at a clinical diagnosis.

ALPHA-LIPOIC ACID IN TYPE 2 DIABETES MELLITUS: MECHANISMS, CLINICAL BENEFITS, AND IMPLEMENTATION IN THERAPY

B DHARANI — 2024-12-07

Diabetes Mellitus (DM) encompasses a range of metabolic disorders marked by persistent high blood glucose levels. Type 2 Diabetes Mellitus (T2DM), the more common form of the disease is characterized by insulin resistance and partial insulin deficiency. The primary contributors to mortality and morbidity in diabetes are its vascular complications. Alpha-Lipoic Acid (ALA) is an antioxidant derived from caprylic acid and synthesized within the mitochondria. Extensive research shows that ALA aids in preventing and treating Diabetic Neuropathy (DN), lowers the risk of diabetes in at-risk individuals and is also beneficial for those with impaired glucose tolerance. Therefore, this review article aims to explore the different aspects of ALA and its beneficial effects on individuals with T2DM. A range of articles from databases such as Springer, Wiley, Web of Science, PubMed, Google Scholar, SCOPUS, Embase and Cochrane were examined. References from these articles were also analysed to broaden the search for pertinent reviews. Administering ALA in T2DM was found to have beneficial effects like anti-oxidant, anti-inflammatory, enhance glucose uptake, prevents diabetic neuropathy, neuroprotective, anti-obesity, cardio-protective, reno-protective, prevent diabetic retinopathy, anti-aging and improve metabolic parameters in Polycystic Ovary Syndrome (PCOS). Incorporating ALA into a comprehensive treatment plan, combined with lifestyle changes and standard therapies could improve patient outcome and enhance the quality of life for those managing T2DM and related conditions.

Th SYSTEMATIC REVIEW ON SYNTHETIC AND HERBAL MEDICATIONS FOR THE TREATMENT OF ALOPECIA

PRIYA BHAWARE — 2024-12-07

Alopecia refers to the scientific word for diminished hair growth or balding. It describes a disease in which hairs falls off from one or more parts of your body, most commonly the scalp. Losing your hair might be triggered by a variety of factors, including hereditary traits, external factors, chemical exposure, medication, dietary insufficiency, chronic tension, or prolonged sickness, among others. Alopecia is categorized into different types depending upon its pattern of diminished hair growth and its genesis. The pursuit of effective treatments has led to the exploration of both synthetic and herbal medications. This study examines the performance, mechanisms of action, tolerability profiles, and limits of synthetic and herbal remedies for alopecia. Synthetic medications such as minoxidil and finasteride are commonly prescribed and have demonstrated varying degrees of success in clinical trials. However, concerns regarding adverse effects and long-term efficacy persist. Conversely, herbal medications, including saw palmetto, ginseng, and pumpkin seed oil, have gained popularity due to their perceived natural origin and potentially fewer side effects. Nevertheless, the scientific evidence supporting their efficacy remains limited and often inconclusive. Additionally, challenges in standardization and regulation pose significant barriers to the widespread adoption of herbal treatments. This study aims to provide healthcare professionals and patients with a comprehensive overview of the current landscape of synthetic and herbal medications for alopecia, highlighting the need for further research to elucidate their therapeutic potential and optimize patient outcomes.

REVIEW ON PELLETIZATION: DRY POWDER LAYERING OF PELLETS USING TANGENTIAL SPRAY ROTOR PROCESSOR/INSERT

RITIK R RAMDHANI — 2024-12-07

Pelletization turns fine powders or granules into small, round pellets for easy flow and handling. These pellets offer advantages such as improved absorption, modified drug release patterns & reduced irritation at application sites. Dry powder layering is gaining popularity in the pharmaceutical industry due to its cost and time efficiency. This method is an effective and straightforward process, can be alternative to liquid-based coating techniques. In recent years, active pharmaceutical ingredient layering onto multi-particulate core materials. One innovative pelletization method uses a rotor processor for powder layering. This process involves applying drug powder onto sugar spheres & spraying a binder solution to achieve uniform distribution and enhance drying efficiency. Compared to traditional methods, this dry powder layering is faster & more energy-efficient, reducing drying time & energy consumption. It is a streamlined and eco-friendly method as no solvent is required which makes it beneficial for pellet coating. This article provide insights on the powder layering technique with innovative fluid bed pelletizing technologies like rotor processor, glatt powder coater granulator series, tangential spray in the rotary insert, complex perfect sphere insert and glatt procell series & their applications.