Asian Journal of Pharmaceutical and Clinical Research

SYSTEMATIC REVIEW ON THE EPIDEMIOLOGY AND CLINICAL MANIFESTATIONS OF VARICOSE VEIN DISEASE

SAMIKSHA BENKE, PADMAJA SANTOSH KORE — Fri, 07 Jun 2024 00:00:00 +0530

This article examines the management of varicose vein disease, a condition affecting lower limbs and characterized by swollen, convoluted veins. It highlights that prolonged standing and obesity, particularly in older adults, increase the likelihood of varicose vein disease. It provides a comprehensive analysis of treatment options and preventative strategies. The review discusses varicose veins, their causes, prevention methods, risk factors, and treatments. It highlights the effectiveness of endovascular, surgical, and herbal therapies in improving quality of life and reducing secondary vein-related issues. Lifestyle interventions like consistent yoga and certain fruits and vegetables are also emphasized as preventative strategies. The article emphasizes the importance of antioxidant medications, particularly flavonoid-based ones, in reducing arterial blood pressure and preventing atherosclerosis in patients with varicose veins. These veins, typically found in the thigh or calf, are enlarged due to sensitivity to the venous wall and abnormal valve function. Over time, they may become longer, twisted, pouched, and thicker due to gravity pulls.

FLAVANOIDS: AN ERA OF NUTRACEUTICALS TURNING IN TO MEDICINAL AGENTS

NARENDRA PENTU, SAI BINDU M, RAMA RAO T — Fri, 07 Jun 2024 00:00:00 +0530

Flavonoids, present in plants, constitute a varied group of naturally occurring compounds well-known for their potential positive effects on health. These molecules present in fruits, vegetables, and beverages such as tea exhibit antioxidant, anti-inflammatory, and other bioactive properties that contribute to their positive impact on human health. In addition, flavonoids act as antioxidants, helping plants combat oxidative stress. Some flavonoids also participate in ultraviolet protection, defense against pathogens, and modulation of plant-microbe interactions. Flavonoids have a different subclass of flavones, flavonols, flavanones, flavan-3-ols, anthocyanins, and isoflavones. The term “bioavailability” describes how well the body absorbs and uses flavonoids, a broad class of plant-based chemicals. The chemical structure of flavonoids, the matrix of foods they are eaten interactions with other dietary components influence their bioavailability. This metabolism can lead to the formation of various metabolites, impacting the compounds’ bioactivity. Understanding these aspects is crucial for unlocking the full potential of flavonoids in promoting health and preventing diseases. Patents on flavonoids serve as legal protections for innovations related to these plant compounds. Companies and researchers seek patents to safeguard novel methods of extraction, synthesis, and applications ensuring exclusivity for a specified period. This exclusivity incentivizes investment in research and development, promoting the exploration of flavonoids for pharmaceuticals, food additives, and cosmetics. Ultimately, these legal protections encourage advancements in understanding and harnessing the diverse benefits of flavonoids across various industries.

AN AUTOPSY-BASED STUDY ON THE PATTERNS OF INJURIES OF BURN CASES IN JORHAT DISTRICT, ASSAM

BIKKI LAMA, VED PRAKASH GUPTA, DIPANKAR THAKURIA — Fri, 07 Jun 2024 00:00:00 +0530

Objective: This autopsy-based study aimed to determine the incidence of burn-related fatalities in Jorhat District, Assam, identify associated factors, investigate injury patterns and severity, explore contributing factors, examine the relationship between injuries and cause of death, differentiate between dermo-epidermal and deep burns, investigate circumstances surrounding burn injuries, and offer recommendations for prevention and forensic investigation improvements.

Methods: Data were collected from medico-legal autopsies conducted at the Mortuary of the Department of Forensic Medicine, Jorhat Medical College and Hospital, Jorhat, between May 11, 2020, and May 10, 2021. Demographic information, burn characteristics, autopsy findings, and circumstances of injuries were analyzed.

Results: Out of 628 medico-legal autopsies, burn-related deaths comprised 7.32% of cases. Victims with 51–60% total body surface area burns were most common (23.91%). Burns often occurred indoors, notably in kitchens (56.52%) and bedrooms (26.08%), with a majority in closed rooms (54.35%). Synthetic (47.82%) or cotton (41.30%) clothing was prevalent, and kerosene was common in alleged suicidal cases (23.92%). Most victims died within 24 h (43.46%), primarily due to shock (52.17%), and septicemia (45.65%). Dermo-epidermal burns were prevalent (93.47%), and deaths were mainly accidental (65.21%). Histopathological analysis revealed dermis and epidermis separation (82.60%), flattened and elongated epithelial cells (73.91%), congestion (76.09%), leukocyte infiltration (73.91%), capillary dilatation (67.39%), and edema (67.39%).

Conclusion: This study provides comprehensive insights into burn injury characteristics, circumstances, and consequences. Recommendations include preventive measures and improvements in forensic investigation practices related to burn injuries, offering valuable implications for health care, forensic medicine, and public awareness initiatives.

RELATIONSHIP BETWEEN HOUSEHOLD ACTIVITIES PERFORMANCE AND BODY MASS INDEX OF HOUSEWIVES

Fri, 07 Jun 2024 00:00:00 +0530

Objective: The objective of this study was to find out the relationship between household activities performance and body mass index (BMI) of housewives.

Methods: This cross-sectional study was undertaken among housewives residing in Shivalli village in Udupi district. The ages of the participants were between 30 and 45 years. The total number of the participants was 61. Household activities performance questionnaire was developed for data collection. The content of the questionnaire was validated by five registered occupational therapists with more than 15 years’ experience. The BMI of the participants was taken to ascertain their body weight status. Semi-structured interview was conducted to inquire about their household tasks using the developed household activities performance questionnaire. A diet chart with a total number of 7 days of meal was collected to calculate the participants’ calorie intake. The corresponding metabolic equivalent of task values for each mentioned task was assigned from compendium of physical activities (PA) to determine the relationship between household activities (manual and mechanical) performance and BMI of the participants.

Results: While there was no significant negative correlation between housewives’ household manual activities performance and their BMI, housewives’ household mechanical activities performance and BMI showed a significant positive correlation. Sociodemographic characteristics showed no significant weak negative relationship with BMI score except socio-economic status which showed a significant weak positive relationship.

Conclusion: Household activities performed by housewives might not have an impact on their BMI. However, combining household activities with moderate PA might tends to have an impact on the BMI of housewives. Further study with more sample size and a standardized questionnaire is recommended for future study.

MONITORING OF CONTRAST AGENT-INDUCED TOXICITY IN A TERTIARY HEALTH-CARE CENTER

MANTASHA REHMANI, IRFAN AHMAD KHAN — Fri, 07 Jun 2024 00:00:00 +0530

Objective: The objective of the study is to monitor radiological contrast agent-induced toxicity in patients and compare the toxicity and safety profiles of different radiological contrast agents.

Methods: This is an open-label, prospective, observational study conducted in a tertiary care hospital in April 2021 and September 2021. The study assessed the incidence of contrast-induced adverse events in different radiological procedures, i.e., contrast-enhanced computerized tomography (CECT) scans and contrast-enhanced magnetic resonance imaging (CEMRI). Adverse drug reactions (ADRs) were recorded using the standard central drug standard control organization ADR reporting form. Causality assessment of the ADRs was done using Naranjo’s scale while severity assessment was measured using the Modified Hartwig and Siegel scale.

Results: The baseline characteristics of patients were almost similar in both groups. The mean age and gender distribution of the patients were not significantly different among both groups. For the adverse reaction in CECT, the male-to-female ratio was 1.88, and for CEMRI, it was 1.61. The ADRs due to CEMRI and CECT were mild in severity. The results showed that ADRs between contrast-enhanced MRI and contrast-enhanced CT were not significantly different.

Conclusion: Based on the results obtained, we concluded that the contrast agents used in the radio-diagnostic procedures are safe, and further research in this field is of fundamental importance.

AN ANALYSIS OF ANTIMICROBIAL AND ANTIDIABETIC FIXED DOSE COMBINATIONS BANNED IN INDIA

jitendra Hotwani, Ankita Rao — Fri, 07 Jun 2024 00:00:00 +0530

Objective: National regulatory authority reviewed various fixed-dose combinations (FDCs) in view of doubtful rationality status and subsequently 349 FDCs were banned in 2018. This study was conducted to analyze the antimicrobial and antidiabetic FDCs banned by the Central Drugs Standard Control Organization in India.

Methods: Data were collected from the report of drugs technical advisory board subcommittee. Banned antimicrobial and antidiabetic FDCs were assessed for the following parameters – number of active pharmacological ingredients, routes of administration and dosage forms, indications for marketing, reasons for banning, and pharmacological group of FDCs.

Results: Seventy antimicrobial and 25 antidiabetic FDCs were analyzed. These FDCs contained 2–7 drugs, available mostly as tablets (51.42%, 100%) in antimicrobial and antidiabetic groups, respectively. Antimicrobial FDCs were marketed most for respiratory tract infections and infection and inflammatory conditions of the skin (17, 24.28% each) while antidiabetic FDCs were marketed for Type 2 diabetes mellitus (14, 56%). The reasons for ban were pharmacodynamic (68.57%, 16%) and pharmacokinetic (20%, 40%) mismatches, lack of evidence of efficacy (7.14%, 36%), and safety concerns (4.28%, 8%) in antimicrobial and antidiabetic groups, respectively. In antimicrobial FDCs, the most common combination was that of an antibacterial with other miscellaneous drugs (like zinc, Vitamin E, serratiopeptidase, etc.) (19, 27.14%) whereas antidiabetic FDCs most commonly had biguanide with thiazolidinedione and sulfonylurea (7, 28%).

Conclusion: There is a need for scrutiny of other FDCs in larger interests of patient care and prescribers should be made aware about recently banned FDCs to promote rational pharmacotherapy.

THE CORRELATION BETWEEN SERUM SODIUM LEVELS AND THE SEVERITY OF CIRRHOSIS OF LIVER AND ITS COMPLICATIONS

RUPA PRADHAN, DIPTIMAYEE TRIPATHY, SIBANARAYAN JALI — Fri, 07 Jun 2024 00:00:00 +0530

Objective: The study aimed to assess the incidence of hyponatremia in cirrhosis of the liver and to evaluate the association between serum sodium levels and the severity of cirrhosis and its complications.

Methods: Data on inpatients with cirrhosis of the liver were collected on the date of admission. The serum sodium levels on day 1 and the presence of complications and their severity in 100 patients were analyzed.

Results: The incidence of dilutional hyponatremia, which was subdivided into three groups (mmol/L): A-≤130, B-131-135, and C-≥136, were 55%, 25%, and 20%, respectively. The severity of liver cirrhosis was assessed using the CTP score and the MELD score, with a higher score seen in Group A (p=0.011 and p=0.012), respectively. Furthermore in group A, higher grades of complications were seen: grade 3/gross ascites (p=0.001), grade lll/lV hepatic encephalopathy (p=0.007), spontaneous bacterial peritonitis (p=0.049), and hepatorenal syndrome (p=0.022). Even in group B with s.Na+level 131–135 mmol/L, the development of complications was no less common.

Conclusion: Serum sodium levels must be closely monitored in cirrhotic patients as they suggest the possibility of a potentially negative impact on the clinical course of the disease.

AN OBSERVATIONAL STUDY OF KNOWLEDGE, ATTITUDE AND PRACTICE OF USAGE OF ORAL CONTRACEPTIVE PILLS AMONG UNDERGRADUATE STUDENTS OF THIRD FIRST MBBS IN A TERTIARY CARE TEACHING HOSPITAL

Prachi mehta, sneh dudhia — Fri, 07 Jun 2024 00:00:00 +0530

Objective: Education about contraceptive measures in reproductive health is of utmost importance. Doctors can directly influence the patients, and it is, therefore, necessary to know their attitude toward contraceptives. This study will assess the knowledge, attitude, and practice of the usage of oral contraceptive pills (OCPs) among the students of the III^rdfirst MBBS.

Methods: Among 125 students of the third first MBBS, a questionnaire-based observational knowledge, attitude, perception, and practice study was conducted using Google Forms, at SBKSMI&RC (Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre), Sumandeep Vidyapeeth in June 2023.

Results: In our study, 59.2% of participants were female and 40.8% were male. Students were of the age 20–23 years. 60.8% of students mentioned their source of information as formal education. On being asked about the different uses of OCPs, 69.6% knew about their use as contraception and 52.8% knew their use in menstrual irregularities. In case of a dose being missed, 18.4% did not know what to do whereas 28% would consult a gynecologist and 53.6% knew what to do. 41.6% of students believed that OCPs carry significant side effects. 42.4% preferred getting OCP from medical stores. For usage or prescription in the future, 52.8% preferred barrier methods whereas 24.8% chose intrauterine devices and only 19.2% opted for OCP. When inquired on reasons for not using OCPs, 31.2% opted for fear of side effects.

Conclusion: The majority of the students had good knowledge, fair attitude, and fair practice toward the use of OCPs.

A COMPARATIVE STUDY OF POLYPHENOLIC CONTENT IN ACACIA CATECHU BARK EXTRACTS AND BIBLIOGRAPHIC ANALYSIS WITH REFERENCE TO GUNA (MADHYA PRADESH), INDIA

Archana Tiwari, Avinash Tiwari — Fri, 07 Jun 2024 00:00:00 +0530

Objective: Plant-based polyphenolic compounds are important phytonutrients found in many meals such as fruits, vegetables, tea, coffee, and red wine. The literature study has gathered enough evidence confirming the existence of the same substance in the bark of Acacia catechu plants. The literature review verified that the dense forest with comparable plant life in Guna district of Central India has not been systematically studied. This research aims to analyze the total polyphenolic content of A. catechu bark from this location.

Methods: Thirty samples of test plants were collected from the research area in different seasons for this investigation. Each sample was made using six distinct solvents. Subsequently, quantitative testing was conducted using a standardized laboratory approach. Bibliographic analysis was conducted to confirm and establish a connection between the current study and previous research.

Results: The results indicated that the test parameter was present in large quantities in all polar extraction systems, but only insignificant amounts were seen in chloroform and benzene. The comparative bibliographic investigation was confirmed the advantageous uses of the same.

Conclusion: This exploratory investigation potentially identified novel, cost-effective, and easily accessible sources of polyphenolic chemicals from the local flora of Guna region and serve as the foundation for future researches on the same.

A COMPARISON BETWEEN ENTERAL AND PARENTERAL METHOTREXATE INTAKE IN IRAQI PATIENTS WITH RHEUMATOID ARTHRITIS REGARDING EFFICACY AND LIVER FUNCTION IMPAIRMENT

ALI M KADHIM AL-TUMA — Fri, 07 Jun 2024 00:00:00 +0530

Objectives: Methotrexate (MTX) is a disease-modifying ant-rheumatic drug that has been used commonly in patients with rheumatoid arthritis (RA) with a goal of reducing RA activity or RA remission. Response to MTX varied among patients and side effects including liver impairment are not uncommon. The study aimed to compare oral and parenteral MTX intake regarding the efficacy and risk of liver impairment in patients with RA.

Subject: Thirty patients who were newly diagnosed with RA according to EULAR/ASAR were included in the study. MTX was given for them for 6 months in a dose ranging between 2 and 25 mg either orally or parenterally intramuscular and subcutaneously once weekly. Patients were assessed depending on clinical disease activity index (CDAI) score and liver enzymes were measured before and after the start of the treatment.

Results: The study showed that parenteral MTX intake significantly improves the CDAI score more than oral intake, CDAI reduced from 13.15±3.25 to 5.57±2.34 following 6 months of treatment in comparison to its’ insignificant reduction from 12.72±3.13 to 8.90±3.08 following oral treatment. Regarding liver enzymes, the impairment in alanine aminotransferase and aspartate aminotransferase is significantly less than that with oral ones with the same effect on alkaline phosphatase.

Conclusion: Parenteral MTX intake tends to be more efficacious in attaining low disease activity than oral intake with a lower rate of impaired liver function.

NEED OF EXTERNAL QUALITY ASSESSMENT SCHEME – AN EXPERIENCE IN CENTRAL LABORATORY AT RNTMC, UDAIPUR

PRAGYA JAKHAR, VIJAY RAJAK, GUNJA DWIVEDI, KIRAN MEENA — Fri, 07 Jun 2024 00:00:00 +0530

Objectives: The objectives of the study are to periodically assess the quality of the external quality assessment scheme (EQAS) with the aim of enhancing laboratory performances.

Methods: An observational study was done at our central laboratory at RNTMC, Udaipur, after approval from the institutional review board. Our laboratory receives quarterly blood samples and already prepared slides from AIIMS, Delhi, for complete blood count (CBC). In addition, lyophilized blood samples for fibrinogen, prothrombin time/international normalized ratio (PT/INR), and activated partial thromboplastin time (APTT) analysis are received quarterly from CMC, Vellore, through courier package. As for cytopathology, the third package includes already prepared 10 slides of 2 cycles for cytopathology analysis along with a brief clinical history.

Results: CBC, peripheral blood film examination findings, and reticulocyte count results were consistently acceptable, except in August 2021, December 2022, and March 2023 when some parameters of CBC were deemed unacceptable. Results for PT/INR, APTT, and fibrinogen were within consensus at all-time except in March 2022, when they were out within consensus and deemed unacceptable. Similarly, results for cytopathology evaluation were in concordance with the results of the provider except for a few occasions were deviations were seen for some diagnoses due to interpretation error.

Conclusion: Engaging in EQAS has facilitated the enhancement of test result accuracy, thereby improving the overall quality of laboratory practices and minimizing erroneous outcomes.

A CROSS-SECTIONAL STUDY ON SELF-MEDICATION PRACTICES, PERCEPTION, AND ATTITUDES OF UNDERGRADUATE MEDICAL STUDENTS AT A GOVERNMENT TERTIARY CARE TEACHING HOSPITAL IN EASTERN INDIA

KUSHAL BANERJEE, MANASI BASU BANERJEE, ABHISHEK GHOSH — Fri, 07 Jun 2024 00:00:00 +0530

Objectives: Self-medication (SM) is common in India. It is of greater significance when practiced by medical students as they going to be medical practitioners in the future. This study was conducted to assess the pattern of SM practices, perceptions, and attitudes among students pursuing 2nd-year professional MBBS in a tertiary medical college in the year 2019.

Methods: This study was a cross-sectional one based on a questionnaire. It was conducted among the 2nd-year undergraduate (MBBS) medical students in a tertiary care medical college in West Bengal, India.

Results: Out of 199 students approached, 198 consented to the study and filled in the supplied study questionnaire. Thirteen incomplete questionnaires were excluded and the remaining 185 were analyzed. It was found that 81.6% (151/185) respondents practiced SM. The most common ailments for seeking SM were fever 66.2% (100/151), followed by cough cold, and sore throat 55.0% (84/151), diarrhea/nausea, and vomiting 40.4% (61/151). The most common drug used for SM was paracetamol 73.51% (111/151), followed by H1 antihistaminics and proton pump inhibitors. A small percentage of students used topical preparations of steroids, analgesics, antibiotics, and antifungals as well. Among the common reasons for seeking SM, 72.2% (109/151) felt that their illness was mild and 57% (86/151) preferred it as they had prior experience.

Conclusion: Our study showed that SM is commonly practiced among the students of this institution. Therefore, medical teachers need to try even more to generate adequate awareness among the students about inherent risks of SM.

COMPARISON OF CASE-BASED LEARNING AND TRADITIONAL TEACHING TO EVALUATE LEARNING AND ACADEMIC OUTCOME OF FIRST-YEAR MBBS STUDENTS IN BIOCHEMISTRY CURRICULUM

KAVINDRA BORGAONKAR, RANJIT PATIL — Fri, 07 Jun 2024 00:00:00 +0530

Objectives: Competency-based medical education (CBME) is an outcome-based teaching method in which gain the knowledge of competencies for early clinical exposure. Case-based learning (CBL) is one of the approaches of CBME which makes learning more effective and interesting. In this backdrop, the present study was conducted to compare the outcome of CBL and the traditional method of teaching in the biochemistry curriculum.

Methods: This cross-sectional study was conducted on 130 MBBS 1st year students and was divided into two groups, Group A (n=65) was allocated to CBL, and Group B (n=65) underwent a traditional teaching module. The pre- and post-test scores were compared between the groups and p<0.05 was considered significant.

Results: The students were exposed to two lectures and for lecture 1 the post-test scores were significantly higher in CBL as compared traditional learning module (55.42±10.72 vs. 51.32±9.43; p=0.02). Similarly in lecture 2, the post-test scores were significantly higher in CBL as compared traditional learning module (58.87±10.76 vs. 53.12±8.28; p=0.01).

Conclusion: CBL is a remarkable and efficient method for teaching biochemistry and it was positively perceived by students.

EVALUATION OF CLINICAL COURSE AND OUTCOMES IN ZONE I RETINOPATHY OF PREMATURITY IN A TERTIARY CARE INSTITUTE

BHAWNA PARMAR, VIVEK SOM, ADITI DUBEY — Fri, 07 Jun 2024 00:00:00 +0530

Objectives: The objectives are to study the clinical course and outcomes of Zone I retinopathy of prematurity and also to study the indication of management and the factors affecting the choice of treatment modality.

Methods: The present study was a prospective observational study conducted at the Department of Ophthalmology. All the neonates having Zone I retinopathy of prematurity (ROP) at presentation according to the International Classification of ROP classification were included in the study after obtaining permission from the institutional ethics committee and consent from parents.

Results: In the present study, 526 neonates were screened and ROP was detected in 131 neonates with an incidence of 24.90%. Out of those 131, Zone I ROP was detected in 50 neonates, giving an incidence of 9.50%.

Conclusion: In our study, Type 1 ROP has a variable course with 47.61% who initially had mild-looking disease developed Type 1 ROP requiring treatment. Hence, a proper timely follow-up is also important in these patients, we cannot exclude the probability of ROP based on the first examination, because when they are present, they are very preterm so vascularization is only until Zone I.

PHYTOCHEMICAL SCREENING, ANTIMICROBIAL, AND ANTIOXIDANT ANALYSIS OF BERBERIS LYCIUM ROYLE CRUDE ROOT EXTRACTS

Fri, 07 Jun 2024 00:00:00 +0530

Objective: This particular study was designed to evaluate the qualitative, quantitative, anti-oxidant, and antimicrobial potential of Berberis lycium root extracts.

Methods: The plant root extracts were prepared using a sequential extraction method using different solvents with increasing polarity. Further extracts were evaluated qualitatively for the presence of different phytochemicals and quantitatively for the presence of total phenols and flavonoid, antioxidant potential using DPPH, ferric reducing anti-oxidant power, and H2O2 radical scavenging assay. Biological potential of these extracts was established for antibacterial effect against different Gram-negative and Gram-positive bacteria and antifungal potential against fungal strains.

Results: Qualitative analysis of the root extracts showed the presence of phytochemicals such as saponins, tannins, phenols, and flavonoids. Among all the evaluated extracts in quantitative analysis, methanolic extracts showed the highest content of phenolic with 39.75 mg gallic acid equivalence/g and flavanoid with 456 mg QE/g, highest antioxidant potential with half-maximal inhibitory concentration (IC50) value of 10.96 μg/mL in DPPH assay. Similarly, the highest antibacterial effect against Bacillus cereus (20±0.86 mm) and antifungal against Aspergillus niger (IC50 399.64 μg/mL) was observed.

Conclusion: The plant root extracts of B. lycium have shown substantial content of phytochemicals with appreciable antioxidant and antimicrobial activities comparable to the currently prescribed modern drugs tested. Accordingly, further studies on clinical efficacy trial, safety, and toxicity analyses have to be instigated promptly, so as to head to the final step to synthesize precursor molecules for new effective antimicrobials.

A STUDY ON ASSESSMENT OF RIGHT VENTRICULAR FUNCTION BY RIGHT VENTRICULAR OUTFLOW TRACT SYSTOLIC EXCURSION IN ADULT POPULATION ATTENDING A TERTIARY CARE HOSPITAL IN EASTERN INDIA

KAPIL KANT TRIPATHI, ANURAG JAIN, VISHAL SHRIVASTAVA, DILEEP DANDOTIYA — Fri, 07 Jun 2024 00:00:00 +0530

Objectives: The objectives of the study are as follows:

(1) to assess the right ventricular function (RVF) by right ventricle outflow tract systolic excursion through M-mode echocardiography and (2) to correlate the right ventricle outflow tract systolic excursion value with other 2D echocardiographic methods of RVF assessment.

Methods: The present observational prospective study was conducted in the department of cardiology, Apollo Multispeciality Hospital, Kolkata, among patients visiting the cardiology outpatient department and inpatient department from August 2021 to August 2022 to assess the RVF by right ventricle outflow tract systolic excursion through M-mode echocardiography and correlate the results with other methods (tricuspid annulus plane systolic excursion, tissue Doppler imaging, pulmonary artery pressure, fractional area change [FAC]) of RVF assessment.

Results: Majority of the patients in both groups belong to the age group of 51–60 years (45.5%), followed by 61–70 years (29.5%) and 41–50 years (20.5%). Patients with right ventricular (RV) dysfunction were more aged as compared to normal RVF. The mean body mass index (BMI) was significantly higher and mean hemoglobin level was significantly lower in patients with RV dysfunction as compared to the control group (p<0.05). Both systolic and diastolic blood pressures were significantly higher among the patient group than in the control group (p<0.05). We found that right ventricular outflow tract systolic excursion (RVOT-SE), tricuspid annular plane systolic excursion (TAPSE), tissue Doppler myocardial performance index, left ventricular (LV) ejection fraction (%), and FAC were significantly lower among patient group than control group (p<0.01). TAPSE ≤17 mm was the best cutoff value that differentiates patients with RV systolic dysfunction from healthy individuals with normal RV systolic function. There were 67% of patients with ≤17 mm and 33% had >17 mm TAPSE.

Conclusion: Our study concludes that RVOT-SE is a highly sensitive and specific method for diagnosing reduced RV systolic function patients. RVOT SE is not accurate as a sole parameter, but its high values can be used as an indicator for normal RV systolic function. It is simple to get, requiring one easy and reproducible M-Mode measurement from the parasternal short-axis view.

COMPARISON OF PEDIATRIC INDEX OF MORTALITY (PIM)-3 AND PEDIATRIC SEQUENTIAL ORGAN FAILURE ASSESSMENT (pSOFA) SCORES TO PREDICT MORTALITY IN PEDIATRIC INTENSIVE CARE UNIT

ANKIT KUMAR PAWAR, GAURAV KUMAR PRAJAPATI, KANCHAN CHOUBEY, RASHMI RANDA — Fri, 07 Jun 2024 00:00:00 +0530

Objective: The objective of the study is to evaluate and compare the pediatric index of mortality (PIM)-3 and pediatric sequential organ failure assessment (pSOFA) scores to predict mortality in pediatric intensive care unit (PICU).

Methods: This cross-sectional study was conducted prospectively in PICU over 1 year. All consecutive patients admitted to the PICU aged 1 month to 12 years on designated study days were enrolled in the study (n=400). Mortality scores were calculated on the same day of admission using an Android calculator application.

Results: The mean PIM-3 score in the non-survivor group (n=48) was higher, i.e., −0.81 (−2.05 to −0.44) than in the survivor group (n=352), i.e., −4.67 (−5.83 to −4.05) with p<0.001. The pSOFA score was also found higher in the non-survivor group, i.e., 11 interquartile range (IQR) (8–11) as compared to the survivor group, i.e., 3 IQR (2–5) with statistically significant difference (p<0.001). The median value of sensitivity and specificity for PIM-3 was reported to be 97.46% and 86.67%, respectively. The median value of sensitivity and specificity for pSOFA was 97.72% and 85.11%, respectively. The area under-receiver operating characteristic (AU-ROC) 0.9145 (95% confidence interval [CI]: 0.8595–0.9695) for the PIM-3 was almost equal to the AU-ROC of pSOFA score, i.e., 0.9554 (95% CI: 0.918–0.992). Both scores were positively associated with each other (r=0.807, <0.0001)

Conclusion: Both PIM-3 and pSOFA scores were effective in predicting mortality in critically ill children.

A STUDY ON TRANSFORAMINAL BLOCK COMPARISON OF TANSELONE AND DEXAMETHASONE

YUGAL CHANDRAKAR, NINJARAO EVANE, AKHILESH YONA — Fri, 07 Jun 2024 00:00:00 +0530

Objectives: To compare the efficacy and safety of Tanselone and Dexamethasone in TFESIs and provide guidance for their use, particularly for new pain specialists and postgraduate students.

Methods: A prospective, randomized controlled trial was conducted, enrolling 100 patients with spinal pain syndromes randomized to receive either Tanselone or Dexamethasone in TFESIs. Pain intensity scores and functional outcomes were assessed at baseline and follow-up intervals (11). Adverse events related to TFESIs were monitored. Statistical analysis was performed to compare outcomes between the two groups.

Results: Tanselone demonstrated superior efficacy in pain relief and functional improvement compared to Dexamethasone, with patients in the Tanselone group experiencing greater reductions in pain intensity scores and improvements in functional outcomes at all follow-up intervals. However, concerns were raised regarding the potential risk of vascular complications associated with Tanselone’s particulate nature. For new pain specialists and postgraduate students, Dexamethasone may be considered a safer alternative to minimize the risk of complications associated with TFESIs (11). A difference which was significant statistically in the Pain intensity score questionnaire (3.73±1.15 in group T, 6.55±0.51 in group Dx) and Oswestry disability index (18.67±7.13 in group T, 35.83±5.10 in group Dx) was found in both but was more in Tanselone group.

Conclusion: By comparing Tanselone and dexamethasone for epidural injection, for the duration of analgesia of pain in lumbar radiculopathy, injection of Tanselone has been found to be more effective than injection of dexamethasone through transforaminal route. Clinicians should weigh the potential benefits of Tanselone’s efficacy against its perceived risks and consider using Dexamethasone, especially for novice practitioners, to minimize the risk of complications and ensure procedural safety in patients with spinal pain syndromes.

CLINICAL PROFILE OF TUBERCULOSIS PATIENTS (PULMONARY AND EXTRA-PULMONARY) PRESENTING TO A TERTIARY CARE HOSPITAL

AMIT SATISH GUPTA, ADITYA AIRAN, APURVA SATISH GUPTA — Fri, 07 Jun 2024 00:00:00 +0530

Objective: The objective of the study is to estimate the burden of tuberculosis (TB) patients, both pulmonary and extra-pulmonary, presenting to a tertiary care hospital in southern Rajasthan and to understand the resistance pattern among them.

Methods: It is a retrospective observational study. The duration of the study was 3 years (January 2021–December 2023). Data were collected from TB registers maintained by the respiratory medicine department. The inclusion criteria were all suspected TB patients (pulmonary and extra-pulmonary). Both microbiologically confirmed and clinically diagnosed TB patients were included in the study.

Results: The total number of sputum samples received of suspected pulmonary TB patients was 1923, out of which 600 (31.2%) were acid–fast bacilli (AFB) smear positive. The total number of samples received for CBNAAT testing was 1292, out of which 266 (20.59%) were CBNAAT positive. Total multidrug-resistant (MDR) TB patients were 58 (49 pulmonary TB and 9 extra-pulmonary TB (EPTB) [5 lymph, 3 pleural, and 1 bone]). The percentage of MDR-pulmonary TB patients among total sputum samples tested was 2.55%. The total number of pulmonary TB patients diagnosed was 1016 (microbiologically confirmed 866 + clinically diagnosed 150). Total EPTB patients diagnosed were 805 (microbiologically confirmed 141 + clinically diagnosed 664).

Conclusion: 31.2% of total sputum samples tested of suspected pulmonary TB patients were AFB smear positive, and 20.59% were CBNAAT positive. Most of the patients diagnosed with EPTB were diagnosed on a clincoradiological basis. The percentage of MDR–PTB among all sputum samples tested was 2.55%.

FORAMEN MAGNUM – A STUDY ON ITS MORPHOMETRY AMONG THE SOUTH INDIAN POPULATION

MONICA DIANA, NUVEEN AK, PANAMPARAMBIL RAMAKRISHNAN REMITH, BINI MARKOSE — Fri, 07 Jun 2024 00:00:00 +0530

Objective: Foramen magnum is an oval opening present in the median region of the posterior cranial fossa of the occipital bone. The lower end of the medulla, meninges, spinal arteries, and spinal roots of accessory nerve pass through the foramen. Morphometry of the foramen magnum is studied for better learning of the structure, but this study helps in planning a safe surgery and exploration in the head-and-neck region. Various surgical approaches of the foramen provide access to the foramina on the base of the skull and prevent broad retraction of the neurovascular structures passing through them, so the morphometric study plays an important role in transcondylar approach.

Methods: Fifty dry human skulls available in the Department of Anatomy, Amala Medical College and Hospital, and also at Jubilee Medical College and Hospital, Thrissur were studied for this research work, and results were statistically analyzed.

Results: The most common shape of the foramen magnum was oval, the mean of anteroposterior diameter was greater than the mean of transverse diameter, p-value of the diameters was found to be significant, p-value of the mean of foramen magnum index was significant.

Conclusion: This study will help the surgeons to effectively plan a surgery at the head and neck site

CORRELATION BETWEEN FETAL BIOMETRY AND FETAL TRANSVERSE CEREBELLAR DIAMETER IN DETERMINATION OF GESTATIONAL AGE FROM THE 15TH WEEK OF GESTATION TO TERM IN HEALTHY WOMEN WITH UNCOMPLICATED PREGNANCY

AMANJEET KAUR, AMITA KUMARI, YADAV SUMAN, KAUR PARASDEEP — Fri, 07 Jun 2024 00:00:00 +0530

Objectives: The present study was conducted as an attempt to determine a correlation between the transverse cerebellar diameter (TCD) and the gestational age (GA) as determined by the last menstrual period (LMP) and other sonographic parameters such as biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) in healthy women with uncomplicated pregnancy between the 15th week of gestation to term, to derive normogram for estimating the GA of the fetus from ultrasonographically measured transverse cerebellar diameter.

Methods: This prospective study was conducted on 1040 healthy women with uncomplicated pregnancy between the 15th week of gestation to term. Correlation between the GA by LMP with GA by other ultrasound parameters was done using Karl Pearson’s correlation(r).

Results: This study demonstrated that throughout 15–40 weeks, TCD showed a strong correlation with clinical GA with a correlation coefficient (r) of 0.967 and a statistically significant correlation. Correlation coefficients between TCD and BPD, TCD and HC, TCD and AC, and TCD and FL being 0.987, 0.987, 0.986, and 0.988, respectively, indicated statistically significant and very strong correlation. Normogram of TCD showed that there was a linear relationship between cerebellar growth and gestational age.

Conclusion: TCD can be used as a reliable parameter for the determination of GA.

CLINICAL AND LABORATORY PROFILE OF ADMITTED PATIENTS PRESENTING WITH FEBRILE ILLNESS DUE TO DENGUE AND SCRUB TYPHUS COINFECTION FROM A TERTIARY CARE HOSPITAL IN SOUTH RAJASTHAN, INDIA

Fri, 07 Jun 2024 00:00:00 +0530

Objective: The present study aims at describing the clinical features, laboratory diagnosis, and complications in patients presenting with febrile illness due to scrub typhus and dengue coinfection from Southern Rajasthan, India.

Method: This present prospective, observational, and hospital-based study conducted in the Department of Microbiology of AIMS & RC, Rajsamand, located in Southern Rajasthan, from January 2021 to December 2021. Scrub typhus was diagnosed in the microbiology laboratory by performing SD Bioline, one-step scrub typhus for the detection of IgM antibody, and dengue fever using J.mitra and Co. Pvt. Ltd., rapid card test for the detection of NS1 antigen and IgM antibody.

Result: Out of 500 patients suspected of AUFI, 25 (5%) patients diagnosed of having dengue and scrub typhus coinfection. Fever was present in all 25 (100%) patients and 13 (52%) of patients had arthralgia, nausea, and vomiting. The most common sign noticed in our study was pallor and icterus in 10 (40%) patients each followed by shock/hypotension in 8 (32%) and hepatosplenomegaly in 5 (20%). The most predominant laboratory finding was thrombocytopenia (<1.0 × 106/cumm) in 23 (92%) patients, while elevated bilirubin (>2 mg/dl) in 22 (88%) and elevated transaminase and prolonged aPTT in 21 (84%) patients each. The majority of patients 23 (92%) had hepatic dysfunction, i.e., in followed by multi-organ dysfunction (MODS) in 15 (60%).

Conclusion: In developing countries like India, particularly in tropical areas, dengue, and scrub typhus coinfection is under-recognized entity. Additional investigation should be carried out in cases of AUFI patients with features such as hypotension, leukocytosis, early drop in platelet counts, and hypoalbuminemia.

EFFECT OF VARYING TIME INTERVALS BETWEEN FENTANYL AND PROPOFOL ADMINISTRATION ON PROPOFOL REQUIREMENT FOR INDUCTION OF ANESTHESIA - AN OBSERVATIONAL STUDY

RINU JONSAN, SANTHI KS — Fri, 07 Jun 2024 00:00:00 +0530

Objective: The objective of the study is to determine the dose of propofol required for induction when fentanyl was administered just before, 3 min, and 5 min before propofol administration. Furthermore, to determine changes in heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP), when fentanyl was given at varying time intervals.

Methods: A prospective observational study was conducted in a tertiary care teaching hospital for 12 months. A total of 150 patients belonging to ASA 1 and 2 in the age group of 18–60 years scheduled for elective surgery under general anesthesia were allocated into three groups. Group 1 received propofol immediately after a 2 mcg/kg fentanyl injection and Group 2 and Group 3 received propofol 3 and 5 min, respectively, after the administration of fentanyl. The total dose of propofol required for induction is noted. Heart rate, systolic, diastolic, and MAPs after induction were also noted. Data analysis was done using SPSS version 25.

Results: All three groups were comparable concerning demographic variables. The total dose of propofol required for induction was highest in Group 1, where propofol was given immediately after fentanyl, followed by Group 2, and lowest in Group 3 where propofol was given 5 min after fentanyl. Fall in heart rate, SBP, DBP, and MAP after propofol administration was highest in Group 1, followed by Group 2, and least in Group 3 where fentanyl was administered 5 min before propofol. The results were statistically significant.

Conclusion: Administering fentanyl 5 min before propofol causes a marked reduction in the dose requirement of propofol along with a significantly decreased incidence of hypotension after induction.

MEDICAL STORE MANAGEMENT AT ABVGMC VIDISHA (MP): AN ANALYSIS AT TERTIARY CARE HOSPITAL

SUDHIR KUMAR JAIN — Fri, 07 Jun 2024 00:00:00 +0530

Objective: The objective of this study was to perform a qualitative and quantitative comparison of the practice and infrastructure with applicable legislations governing hospital pharmacy while the secondary objective was to calculate the average dispensing time of a prescription in the hospital pharmacy.

Methods: Our hospital was established in 2018. A prospective cross-sectional analytic study was carried out in the hospital pharmacy for 6 months (January 23–June 23). A blend of quality control parameters was drafted after referring various guidelines put forward by the statutory bodies. Qualitative data were collected by continuous observation, physical inspection, and after a thorough interview of hospital pharmacists. The collected data were summarized and compared with the standards. Quantitative data on the minimum requirement of hospital pharmacy infrastructure and dispensing time were collected using the designed data collection form and analysis was performed.

Results: The hospital pharmacy met all the criteria that are necessary to satisfy legal requirements, availability of medicine, medicine, and general safety, and most of the quality parameters. However, few deviations were observed in the management of the drug store. The shortage in the floor space and waiting area was identified. In the study, we find that the average waiting time for the patient at the drug distribution center is 180 s and the average drug dispensing time was 130 s. On the basis of our good working in pharmacy, we got NABH approval in 2023 which includes pharmacy with other departments of this hospital.

Conclusion: Majority of the quality parameters were noted to be compliant with the standards. Few deviations were identified and measures to improve them were suggested.

ROLE OF ULTRASONOGRAPHY IN RESPONSE ASSESSMENT FOLLOWING NEOADJUVANT CHEMOTHERAPY IN LOCALLY ADVANCED BREAST CARCINOMA: EXPERIENCE FROM A TERTIARY CARE CENTER

BIDYUT BISWAS, MD ASIF ALI, ARABINDA ROY, LINKON BISWAS — Fri, 07 Jun 2024 00:00:00 +0530

Objective: Neo-adjuvant chemotherapy (NACT) has a pivotal role in the treatment of locally advanced breast carcinoma (LABC). In this study, we assess the efficiency of ultrasound in the response assessment of NACT in patients with LABC using RECIST criteria and its correlation to the final histopathological report.

Methods: 40 patients with LABC underwent clinical examination and ultrasonography (USG) of the bilateral breast and axilla before starting NACT. After receiving three cycles of NACT, a repeat USG and clinical examination were done to assess the response to chemotherapy. Patients with responsive disease underwent radical surgery, and we correlate the findings of histopathological examination (HPE) with those of post-NACT USG findings.

Results: After three cycles of NACT, clinical examination showed a complete response in 15 (37.5%) patients and a partial response in 21 (52.5%) patients. While USG detected a complete response in 8 (20%) patients and a partial response in 28 (70%) patients, seven patients, in whom clinical examination did not find any disease, were detected by USG. HPE showed a complete pathological response in 5 specimens, and in the rest of 31 cases, HPE revealed a residual tumor. USG did not miss any of the pCR cases but overestimated CR cases by 9% (3 patients). On the other hand, all partial response diagnoses by USG were acknowledged by HPE.

Conclusion: To conclude, it can be said that USG can be used as an effective radiological tool for response assessment and subsequent treatment decisions, especially in places where there is a lack of infrastructure and affordability.

THE UNSEEN: BURDEN IN CAREGIVERS OF PATIENTS WITH SCHIZOPHRENIA IN A TERTIARY CARE INSTITUTE

Fri, 07 Jun 2024 00:00:00 +0530

Objectives: This study aims to evaluate the prevalence of caregiver burden in patients with schizophrenia using the burden assessment schedule (BAS).

Methods: A cross-sectional study was conducted with 100 patients diagnosed with schizophrenia and their respective caregivers from the patients admitted in the male and female wards of the psychiatric department to evaluate caregiver burden. The BAS is used to determine the burden on caregivers of schizophrenic patients.

Results: This study revealed that 51% of the caregivers had experienced moderate levels of burden. Older caregivers experienced a significantly higher burden (p=0.03), whereas residence and educational status had no significant effect on the burden. The burden was highest among parents, followed by spouses, and the burden is positively correlated with gender and older caregivers.

Conclusion: It is evident that an unaddressed burden exists among the caregivers of patients who have mental illness. It is crucial to develop strategies to lessen the load of caregiving and implement them effectively. Counseling and psychological support, though they do not directly mitigate the suffering of patients, may help improve the quality of care given by them to individuals with schizophrenia, thus overall improving the mental well-being of the whole family.

SERUM 25 (OH) VITAMIN D AND CALCIUM LEVELS AND ADVERSE MATERNAL AND PERINATAL OUTCOMES IN PREGNANCY INDUCED HYPERTENSION

MONIKA, SHELLY KHILLAN, RAMA GARG, PARNEET KAUR, JASVIR SINGH — Fri, 07 Jun 2024 00:00:00 +0530

Objectives: Incidence of hypertensive disorders in pregnancy is about 5–10% of all pregnancies [1]. Pre-eclampsia alone or superimposed on chronic hypertension is the most threatening. This study is done to evaluate the levels of serum 25 (OH) Vitamin D and Calcium in normal antenatal patients and patients with pregnancy-induced hypertension and their effects on perinatal and maternal outcome. Hence, that timely intervention can prevent adverse perinatal and maternal outcomes.

Methods: The present prospective observational study was done in the Department of Obstetrics and Gynecology, Government Medical College and Rajindra Hospital, Patiala, Punjab, India from May 2018 to April 2019. The study was conducted on 80 antenatal patients. Patients were divided into two groups with 40 patients in each group. Group I included patients with pregnancy-induced hypertension and Group II included normal antenatal patients. Serum levels of calcium and 25 (OH) Vitamin D were evaluated in both groups. Adverse perinatal and maternal outcomes were assessed in relation to the serum levels of calcium and 25 (OH) Vitamin D in patients with pregnancy-induced hypertension and normal antenatal patients. Categorical variables were analyzed by Chi-square test and Fisher’s exact test. The analysis of continuous variable was done by ANOVA. The data were analyzed using SPSS version 22 and Microsoft Excel. p≤0.05 is taken as statistically significant.

Results: The mean value of serum Vitamin D level in Group I was 22.30±6.11 ng/ml and 36.68±9.34 ng/ml in Group II giving p=0.016 which was highly significant. In Group I, mean calcium levels were 8.58±0.63 mg/dl and 9.27±0.40 mg/dl in Group II giving p=0.018 which was highly significant. The Pearson’s correlation coefficient was −0.753 for serum Vitamin D and systolic blood pressure (BP) and the same for serum Vitamin D and diastolic BP with p=0.001 which was highly significant. The Pearson correlation coefficient was −0.537, −0.514 for serum calcium and systolic BP and serum calcium and diastolic BP, respectively, giving p=0.001.

Conclusion: Serum levels of 25 (OH) Vitamin D and calcium have a significant relationship with pregnancy-induced hypertension. Low levels of calcium and 25 (OH) Vitamin D cause an increased risk of pregnancy-induced hypertension and supplementation of these reduces the incidence of pregnancy-induced hypertension. Hence, their supplementation can be used as a possible intervention strategy in preventing one of the most common causes of perinatal and maternal morbidity and mortality around the world.

A STUDY TO ESTABLISH THE AGREEMENT BETWEEN THE RESULTS OF ELECTROLYTES (SERUM SODIUM AND POTASSIUM) ESTIMATED BY A WET CHEMISTRY INSTRUMENT (EASYLYTE) WITH THAT OBTAINED BY A DRY CHEMISTRY ANALYZER (VITROS 350)

SHARMISTHA CHATTERJEE, DIVYA M, KAUSHIK MAJUMDER, INDRANIL CHAKRABORTY — Fri, 07 Jun 2024 00:00:00 +0530

Objectives: The objective of the study was to assess the agreement between results of electrolytes (serum sodium and potassium) estimated by a wet chemistry instrument with that obtained by a dry chemistry analyzer.

Methods: It was an observational analytical cross-sectional study done in the Departmental clinical laboratory. The samples were selected randomly from the usual lab workflow. All the samples were first run on the Easylyte (wet chemistry) and then run on the Vitros 350 (dry chemistry). The paired data thus obtained were compiled and tabulated and then statistically analyzed.

Results: The agreement of the results between the two methods was evaluated using the Bland–Altman difference plot and the Passing–Bablok Regression Equation and the Deming regression studies. By analyzing the diagram of Bland–Altman, it is seen that for sodium, the average bias is of −2.22; limits of agreement being −26.12–21.77. For potassium, Bland Altman plots show a bias of −0.21; limits of agreement −0.61–0.19. Passing Bablock regression calculated an intercept of −56.86, 95% confidence interval (CI) (−100, −28) and Slope of 1.43 for sodium measurements and calculated an intercept of −0.706, 95% CI (−0.66, −0.45) and Slope of 1.2 for potassium estimation.

Conclusion: Statistical analysis revealed conflicting solutions. There is a great discrepancy between the results of the electrolyte estimation by the two methods since the methodologies are not identical.

STUDY THE IMPACT OF THE RESEARCH ORIENTATION PROGRAM ON UNDERSTANDING THE BASICS OF RESEARCH AMONG UNDERGRADUATE MEDICAL STUDENTS

RAJESH CS, PRABHAKAR R PATIL, NEETA T GAVIMATH — Fri, 07 Jun 2024 00:00:00 +0530

Objective: This study was conducted to evaluate the impact of research orientation program on understanding the basics of research among undergraduate medical students. Basic knowledge of research is required to prepare a research protocol.

Methods: A research orientation program was conducted for enhancing the basic knowledge/skills of research for preparing a research protocol for short-term research projects. This basic knowledge of research among the undergraduate students was determined by using a set of questionnaire. The participants were given a set of questionnaire before and after attending the research orientation program.

Results: It was observed that the participated candidates improved their skills between the pretest and posttest which is due to well planned workshop/research orientation program.

Conclusion: This study indicates these kind of research orientation program could help undergraduate students for enhancing the research skills required for preparing research protocol of short term research projects.

EVALUATION OF HEPATIC MASS LESIONS BY DIFFUSION WEIGHTED MAGNETIC RESONANCE IMAGING

CHANDRA SEKHAR PONNADA, Harpreet Singh, Rajat Shukla, ARVINDER KAUR HEER — Fri, 07 Jun 2024 00:00:00 +0530

Objectives: The purpose of this study was to compare apparent diffusion coefficient (ADC) values for benign and malignant neoplastic hepatic lesions and also for suspected infective hepatic masses in which histopathology may always not be indicated.

Methods: This is a cross-sectional study conducted in the department of radio diagnosis and imaging, army hospital research and referral, Delhi Cantt. All the patients coming for magnetic resonance imaging (MRI) scans for focal liver lesions detected on other imaging modalities were included. The imaging was done at the 1.5 Tesla MAGNETOM AVANTO A Tim system (Siemens Ltd.). Various parameters of the morphology of lesions in conventional MRI and parameters in diffusion-weighted MRI were evaluated.

Results: A total of 75 patients were included in the study. The mean age of the subjects was 52.57±15.28 years, with a male: female sex ratio of 0.5:1. Among the 75 subjects, 20 subjects with hepatic cysts had no restrictions, and 12 patients with hemangioma were hyperintense on both diffusion-weighted imaging (DWI) and ADC. The mean differences between benign and malignant lesion ADC values. The difference was statistically significant (p<0.001). In the present study, we get a cut-off for the ADC value of 1.581×10-3 mm2/s, which proved to be an optimal parameter for differentiation between benign and malignant lesions.

Conclusion: DWI proved to be a very useful supplementary imaging technique in conjunction with conventional imaging sequences in the analysis of focal hepatic lesions and should be included in the imaging algorithm for such lesions.

A STUDY ON ECG FINDINGS IN ACUTE LIVER CELL FAILURE DUE TO RAT KILLER PASTE POISONING

SETHURAMAN AL, BALAMURALI R, MANIMARAN M, CHITRA S, SATHYA G — Fri, 07 Jun 2024 00:00:00 +0530

Objectives: The objective of this study was to study the various electrocardiogram (ECG) manifestations in patients who develop acute liver cell failure due to rat killer paste poisoning.

Methods: Patients who developed acute liver cell failure due to rat killer paste ingestion admitted during the time period of July 2022–December 2022 in our institution were taken up for the study. Serial ECG monitoring was done in all these patients and observed for any changes.

Results: Eighty-eight cases of rat killer paste poisoning that developed acute liver failure during this time period were included in the study. Out of 88 patients, 24 patients (27%) had ECG manifestations. The different ECG manifestations are ST depression with T wave inversion – 13 patients (10 expired), QT prolongation – 8 patients (3 expired), sinus bradycardia – 2 patients, and atrial fibrillation with rapid ventricular rate – 1 patient (expired). The mean time of onset of ECG findings is 22 h from intake of poison. The overall mortality rate is 23% (20 patients). About 70% of expired patients (14 patients) had abnormal ECG manifestations.

Conclusion: ST depression with T wave inversion was the most common ECG manifestation due to rat killer paste poisoning in our study and it correlates with mortality. Since cardiotoxicity due to rat killer paste poisoning is also a major contributor to mortality, proper measures have to be taken to create awareness to the general public regarding the toxicity of rat killer paste.

ANALYTICAL METHOD DEVELOPMENT AND VALIDATION FOR ESTIMATION OF EZETIMIBE IN RABBIT PLASMA USING REVERSED-PHASE HIGH-PERFORMANCE LIQUID CHROMATOGRAPHY

NEELIMA RANI T, INDIRA MUZIB Y — Fri, 07 Jun 2024 00:00:00 +0530

Objectives: The objective of the present work was to develop an analytical method and validation for the estimation of Ezetimibe in rabbit plasma using high-performance liquid chromatography (HPLC).

Methods: A simple, rapid, sensitive, and accurate HPLC method was developed and validated for the quantification of Ezetimibe concentration in rabbit plasma using metoclopramide as an internal standard. Separation was performed on the Xerra C18 column (250 × 4.6 mm 5 μm) using a mobile phase consisting of 0.1% perchloric acid: acetonitrile(55:45 v/v) at a flow rate of 1 ml/min. Validation of the method was performed to demonstrate its selectivity, linearity, precision, accuracy, ruggedness, recovery, and matrix effect.

Results: The calibration curves of Ezetimibe were linear over a concentration range of 5–1022 μg/mL. The with-in and between-day coefficients of variation were <10%. The extraction recoveries of Ezetimibe at the three levels of quality control samples were 99.961%, 99.767%, and 99.938%.

Conclusion: The method was rapid with a retention time of Ezetimibe and the internal standard observed at 10 min, respectively. The developed method was successfully applied to studying the pharmacokinetics of Ezetimibe in rabbits.

ONE-YEAR PROSPECTIVE STUDY OF PATTERNS OF HOMICAL DEATHS- AN AUTOPSY BASED STUDY

SUNNY BASRA, JASPINDER PRATAP SINGH SINGH — Fri, 07 Jun 2024 00:00:00 +0530

Objectives: The aim of the study was to observe the profiling of the homicidal cases for 1 year.

Methods: The present study was a prospective 1-year study of all autopsies alleged to be homicide under 302 Indian Penal Code, performed in the department of forensic medicine and toxicology at Government Medical College, Amritsar, Punjab, India, from January 01, 2021 to December 31, 2021, (1-year period) after taking permission from the institutional ethical committee.

Results: The majority of cases reported were in the age group of 20–49 years, with 24 (61.5%) cases, followed by the age group of 40–59 years, which had 13 (33.3%) cases. 37 (94.9%) cases were males, followed by females 02 (5.1%).The male-to-female sex ratio is 18.5:1; 30 (76.9%) were married, while 09 (23.1%) were unmarried. The deaceased had Sikh religion in 24 (61.6%) cases, followed by Hindus in 11 (28.2%) cases; 26 (66.7%) belonged to the rural area, while 13 (33.3%) belonged to the urban area. The majority of cases where only a sharp weapon was used were 16 (41%), followed by both blunt and sharp in 14 (35.9%) cases, and blunt only in 06 (15.4%). Firearms were used in 03 (7.7%) cases.

Conclusion: Based on the aforementioned observations, we believe there is a pressing need to address issues concerning youth, given their frequent involvement in such crimes. Additionally, enforcing strict nighttime surveillance and rigorously implementing laws against individuals in possession of dangerous weapons can contribute significantly to reducing such crimes.

An AWARENESS OF DELAYED HEALING IN POST-OPERATIVE FRACTURE CONDITIONS IN OSTEOPOROTIC PATIENTS

KEZIAH K VIJU, MAYURI R SHAH — Fri, 07 Jun 2024 00:00:00 +0530

Objectives: The study aimed to determine the knowledge of delayed healing in postoperative fracture conditions in osteoporotic patients.

Method: In this observational study, 60 subjects were taken between the age group 50–80 years, which consisted of 52% of females and 48% of males. The study was done with self-made questionnaires.

Result: A sample of 60 people was taken; out of this, only 11% were aware of the relationship between osteoporosis and fracture healing, and the other 89% lacked the awareness of the relationship between osteoporosis and fracture healing.

Conclusion: In this study, it was found that there was 11% of people aware of fracture healing and osteoporosis.

TO STUDY ASSOCIATION OF OBESITY WITH HORMONAL IMBALANCE IN PRIMARY INFERTILITY AND EARLY PREGNANCY LOSS

JASVIR SINGH, SEEMA, MANINDER KAUR, MANJIT KAUR MOHI — Fri, 07 Jun 2024 00:00:00 +0530

Objectives: The study aimed to assess follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, and thyroid-stimulating hormone in obese patients with primary infertility and early pregnancy loss (EPL) and compare with normal fertile patients.

Methods: Patients were divided into two groups. Group A consists of 50 patients with a history of infertility and EPL with a body mass index of more than 30 kg/m2. Group B consists of 50 normal fertile patients. Informed written consent was taken from all the patients. Blood samples were taken and hormone levels in two groups were measured and compared statistically.

Results: Comparison and statistical analysis of FSH levels in obese infertile and normal fertile groups showed the difference to be statistically highly significant. LH levels in both groups were statistically highly significant. When compared statistically, the difference between prolactin levels of both groups was highly significant.

Conclusion: This study supports the impact of obesity on infertility and pregnancy outcomes. Obesity affects dysfunction of the hypothalamus, pituitary ovarian axis, and results in a higher risk of infertility and EPL.

EVALUATION OF MATERNAL AND PERINATAL OUTCOME IN WOMEN WITH BORDERLINE AFI AND OLIGOHYDRAMNIOS IN THIRD TRIMESTER: A TERTIARY CARE HOSPITAL-BASED STUDY

ARSHDEEP KAUR, MANJIT KAUR MOHI, PUNEET GAMBHIR, MANJEET KAUR, GURTEJ SINGH — Fri, 07 Jun 2024 00:00:00 +0530

Objectives: Objectives of our study were (1) to study and compare obstetric outcome in women with oligohydramnios, borderline amniotic fluid index (AFI), and normal AFI in terms of (a) type of labor (spontaneous/induced) and (b) mode of delivery-C-section or vaginal delivery and (2) to study and compare perinatal outcome in women with oligohydramnios, borderline AFI, and normal AFI in terms of (a) prematurity, (b) APGAR score at 1 and 5 min, (c) fetal distress, (d) low birth weight, (e) weight for gestational age, (f) neonatal intensive care unit (NICU) admission, (g) cause of NICU admission, and (h) neonatal deaths.

Methods: This prospective and comparative study was conducted in Rajindra Hospital Patiala, over a period of 1 year. Women with ≥34 weeks POG were subjected to ultrasonography. They were then divided into following three groups of 50 women each depending upon AFI: Group A – oligohydramnios (AFI <5 cm), Group B – borderline AFI (AFI 5–8 cm), and Group C – normal AFI (AFI >8–25 cm). Patients were followed up to 40 weeks POG or till delivery occurred or decision for C-section was taken.

Results: Perinatal outcome was adversely affected by decrease in AFI in terms of increase in rate of preterm delivery, small for gestational age babies, low birth weight babies, and neonatal deaths.

Conclusion: Measurement of AFI is an important tool for prediction of adverse neonatal outcome

THE IMPACT OF SUPERFICIAL DERMATOPHYTOSIS ON QUALITY OF LIFE IN A RURAL POPULATION: A CROSS-SECTIONAL OBSERVATIONAL STUDY

Ruchika tripathi, Uday prabhakar, Rajaram yadav — Fri, 07 Jun 2024 00:00:00 +0530

Objective: The present study aims at measuring the impact of the disease on the quality of life (QoL) of the patients and its relation to the number of relapses in the disease course and the socio-economic status (SES) of the patients.

Methods: The study was a cross-sectional study that was undertaken for a period of 6 months. A total of 100 patients aged 16 or more were enrolled with clinically and microscopically proven dermatophytosis of the skin and evaluated for impact on QoL using the dermatology life quality index (DLQI) questionnaire. A modified BG Prasad scale was used for assessing the SES of the study subjects. Statistical analysis was performed using the t-test to determine the impact of dermatophytosis on QoL, and the correlation of DLQI scores with the number of relapses and SES of the patients was also assessed.

Results: The majority of patients (80%) reported to have a moderate to very large impact on QoL due to tinea. The DLQI was found to be significantly associated with the number of relapses (p=0.023). However, no significant association was seen with socioeconomic class (p=0.670).

Conclusion: Superficial dermatophytosis has a large effect on the QoL of the patients, and it impacts their lives adversely, leading to psychological and social problems.

A COMPARATIVE STUDY OF ULTRASOUND AND COMPUTED TOMOGRAPHY IN EVALUATION OF ACUTE AND CHRONIC PANCREATITIS, ASSOCIATED COMPLICATIONS AND PREDICTING SEVERITY AND PROGNOSIS

MAHESH HARIHARAN, VIVEK CHAIL, AMEET MUDDA, PRIYA MODI, MAYANK RANGARI — Fri, 07 Jun 2024 00:00:00 +0530

Objectives: (1) The objective of the study was to determine the value of USG and computed tomography (CT) in early diagnosis of acute pancreatitis (AP). (2) The study aimed to compare which of the above two radiological investigations (USG/CT) provides the most important information of the disease process and to determine value of CT in evaluating complications, morbidity/severity, and predicting prognosis of AP using modified CT severity index (MCTSI).

Methods: This study included 50 patients diagnosed with pancreatitis, consisting of 38 cases of AP and 12 cases of chronic pancreatitis (CP). Both USG and contrast-enhanced CT (CECT) were used to visualize the pancreas, assess its size, detect peripancreatic inflammation and fluid collections, and identify the extent of necrosis and complications. The sensitivity and specificity of USG and CECT were compared. The severity of AP was classified using the MCTSI within 3 days of symptom onset. Clinical outcomes, including hospital stay duration, organ failure, systemic infection, and the need for surgical intervention, were recorded and correlated with MCTSI scores. Statistical Package for the Social Sciences 22.0 was used for statistical analysis and p<0.05 was taken as statistically significant.

Results: The mean age of patients was 37.92±12.14 years. USG had a sensitivity of 58% for detecting AP, significantly lower than the 95% sensitivity of CECT, primarily due to bowel gas interference. Both USG and CECT had high positive predictive values. The MCTSI effectively classified the severity of AP, with 41.5% of cases categorized as mild, 39% as moderate, and 19.5% as severe. Extrapancreatic complications were significantly correlated with adverse clinical outcomes and end-organ failure when included in the MCTSI scoring. USG was adequate for diagnosing CP through visualization of dilated ducts, calcifications, and atrophic pancreas, but CECT demonstrated higher specificity and accuracy, especially for rare forms like groove and mass-forming pancreatitis. The study showed a strong correlation between MCTSI scores and patient outcomes. The mortality rate was 2%, observed only in patients with severe AP.

Conclusion: The MCTSI is a valuable tool for accurately classifying the severity of AP and predicting clinical outcomes. CECT is superior to USG in diagnosing and managing pancreatitis, providing better visualization and assessment of complications. While USG is useful for diagnosing CP, CECT offers greater specificity and accuracy. The study supports the use of MCTSI in routine clinical practice to guide the management and predict outcomes in patients with AP.

DEPRESSION AND QUALITY OF LIFE IN PATIENTS WITH PEMPHIGUS: A CROSS-SECTIONAL STUDY

MEGHA MAGHADE, ANAND SAOJI, ABHISHEK SOMANI, ABHIJEET FAYE — Fri, 07 Jun 2024 00:00:00 +0530

Objective: The objective of the study is (1) to analyze the prevalence and severity of depression in cases of pemphigus and (2) to study the association of demographic factors with the presence of depression in cases with pemphigus.

Methods: A cross-sectional single-interview study was carried out on 100 consecutively selected patients with pemphigus attending the dermatology out-patient department in a tertiary care hospital. The assessment was done with semi-structured pro forma, Beck depression inventory (BDI), and quality of life (QoL) measure – Skindex-16. The Statistical Package for the Social Sciences 24.0 was used for statistical analysis and p<0.05 was taken as statistically significant.

Results: Out of 100 cases, there were 60 (60%) males and 40 (40%) were females with M: F ratio of 1:0.66. The mean age of male and female patients was found to be comparable with no statistically significant difference (p=0.6061). The majority were married, employed, and from rural backgrounds. 22% satisfied the Diagnostic and Statistical Manual for Mental Disorders 5th edition criteria for major depressive disorder. Assessment using BDI in these patients for severity of depression showed mild depression in 12%, moderate depression in 7%, and severe depression in 3%. Patients having a longer duration of illness and a history of frequent hospitalization were found to have significantly high scores on the subscale for depressive symptoms. QoL assessment using the Skindex-16 scale among these patients showed that they experienced more severe emotional and symptomatic effects due to skin disease compared to functional effects, especially during relapse. Those who had poor QoL showed significantly high scores on the subscale for depressive symptoms.

Conclusion: More than 20% of patients of pemphigus had diagnosable depression with significant effects on QoL. Therefore, regular screening for depression is important in pemphigus patients as it will help in planning early intervention.

PREVALENCE OF OBSTRUCTIVE SLEEP APNEA IN CASES OF METABOLIC SYNDROME: A CROSS-SECTIONAL STUDY

BHAVYA SHIVALINGAIAH, MALLIKARJUN, VARSHINI J, SPURTHI K — Fri, 07 Jun 2024 00:00:00 +0530

Objectives: The study aimed to find out the prevalence of obstructive sleep apnea (OSA) in individuals with metabolic syndrome (MS).

Methods: This was a cross-sectional study conducted in the department of respiratory medicine of a tertiary care medical institute. Eighty patients infected with MS diagnosed on the basis of national cholesterol education program adult treatment panel III criteria were included in this study on the basis of predefined inclusion and exclusion criteria. Demographic details such as age, gender, and socioeconomic status of all the patients were noted. A thorough general and clinical examination was conducted, including the assessment of vital signs. Polysomnography was done in all cases and the diagnosis of OSA was based on polysomnography results. SSPS 21.0 was used for statistical analysis and p<0.05 was taken as statistically significant.

Results: Out of 80 patients, there were 58 (72.50%) males and 22 (27.50%) females with a M: F ratio of 1: 0.37. The overall mean age of the studied cases was found to be 44.60±12.92. Mild (apnea-hypopnea index [AHI] 5–14), moderate (AHI=15–30), and severe OSA (AHI >30) was seen in 33 (41.25%), 17 (21.25%) and 9 (11.25%) patients, respectively. Overall prevalence of OSA in cases of MS was found to be 73.75% as the severity of OSA increased there was decreased in mean sleep time and the difference was found to be statistically significant (p<0.05). The most common presenting complaint was loud snoring, observed in 55 patients (93.22%). This was followed by daytime sleepiness in 47 patients (79.66%), waking up tired in 37 patients (62.71%), and disturbed sleep in 36 patients (61.02%).

Conclusion: The prevalence of OSA is notably high among individuals with MS. Consequently, routine assessment for OSA should be an integral component of the management strategy for patients with MS.

COMPARISION OF LICHTESTEIN OPEN TENSION-FREE VERSUS LAPROSCOPIC TOTALLY EXTRAPERTIONEAL TECHNIQUE FOR INGUINAL HERNIA REPAIR

VINEET SHARMA, GIRISH BHARDWAJ, VIVEK SAINI, PANKAJ PORWAL, ANIL KUMAR TRIPATHI — Fri, 07 Jun 2024 00:00:00 +0530

Objectives: The study aimed to assess and compare Litchtenstein’s open tension-free and laparoscopic totally extraperitoneal (TEP) mesh repair.

Methods: This hospital-based comparative type of observational study was conducted on 50 cases for each of two groups at upgraded Department of General Surgery, SMS Hospital, Jaipur, between January 2014 and January 2016. All the cases of elective inguinal hernia coming to SMS outpatient department in a single surgical unit operated by a single surgeon in the given period which meet the inclusion and exclusion criteria. Thus, collected data were entered in Microsoft Excel sheet and analysis was done by Epi info software of CDC.

Results: Total 100 patients were included in this study; 50 each in the two groups, the laparoscopic TEP group and open Lichtenstein group. Mean age in the laparoscopic group was 39.54 years and the open Lichtenstein group was 42.78 years. The mean pain score out of 10 at 24 h was 2.96 (±0.638) and 3.60 (±0.969) in TEP and Lichtenstein groups, respectively. The mean return to work for open group was 17.00 and TEP group was 11.34 days. There is no any recurrence and readmission in both groups.

Conclusion: Laparoscopic TEP repair may be done in all uncomplicated inguinal hernia by an experienced surgeon for those desiring less pain, better cosmotic results, less post-operative complications, less hospital stay, and early return to work.

UNFORESEEN COMPLICATION OF TRAMADOL ADMINISTRATION: A CASE REPORT

YUGAL CHANDRAKAR — Fri, 07 Jun 2024 00:00:00 +0530

We present a detailed case report of a 22-year-old male patient admitted with severe back pain who experienced an unexpected complication following tramadol administration. Despite initial investigations showing no abnormalities, the patient developed convulsions shortly after receiving tramadol. This case underscores the importance of considering rare adverse reactions when administering medications, even in patients without a predisposing medical history.

TO REPORT A CASE OF OCULAR ZOONOTIC INFESTATION OF DIROFILARIA REPENS

KHUSHDEEP KAUR, REENA KUMARI, DINESH KUMAR BHAGAT, SANJAY BOSAK — Fri, 07 Jun 2024 00:00:00 +0530

To report a case of ocular zoonotic infestation of Dirofilaria Repens.