International Journal of Current Pharmaceutical Research

STUDY OF HUMAN LEPTOSPIROSIS IN A TERTIARY CARE HOSPITAL, VISAKHAPATNAM

THAMMINA MEHER SRI SAI SUDHA VANI — 2024-11-15

Objective: Prevalence of leptospirosis in humans is found in an alarming number in recent times. This endemic zoonotic disease is widespread and potentially fatal. It is usually seen in areas with poor socioeconomic conditions, water stagnation, garbage accumulation, which becomes breeding sites for the rodents. Infection may turn epidemic during monsoon. Reservoir of infection is rat scientifically named as Rattus rattus and infection results from direct or indirect exposure to host animals that carry the pathogen in their renal tubules and shed pathogenic leptospires in their urine. The main objective of this study was to estimate the seropositivity of leptospirosis in patients presenting with undifferentiated acute febrile illness for 5 to 7 days during one year period from February 2023 to February 2024 in a tertiary care hospital, Visakhapatnam, India.

Methods: A total of 279 blood samples received from suspected cases of leptospirosis were subjected to IgM ELISA.

Results: Out of total 279 cases, 20 were positive for leptospirosis (OD ratio ≥1.00). All the positive cases presented with a fever more than 99.5°F, chills and headache with elevated serum procalcitonin levels. Peak incidence of cases was recorded during July and August 2023.

Conclusion: Seroprevalence of human leptospirosis in this study was found to be 7.2%.

A COMPARATIVE STUDY BETWEEN DRY NEEDLING AND KINETIC CHAIN ACTIVATION TECHNIQUE WITH SPECIFIED EXERCISE PROGRAMME IN PAINFUL ARC SYNDROME

ABHISHEK ARORA — 2024-11-15

Objective: Many researcher have reported that painful arc syndrome arises from multiple lesion i. e. minor tear of supraspinatus tendon, supraspinatus tendinitis, calcified deposit in the supraspinatus tendon, subacromial bursitis, crack fracture of greater tuberosity of humerus and bicipital tenosynovitis. In this study, dry needling and KCAT technique with specific exercise programme has been done to reduce pain and improve functioning and their by prevent shoulder pathologies. The objective of the study is. 1) To evaluate the effectiveness of kinetic chain activation in painful arc syndrome. 2) To evaluate the effectiveness of dry needling therapy in painful arc syndrome. 3) To evaluate the effectiveness of a specific exercise program.

Methods: 50 patient diagnosed with painful arc syndrome by the physiotherapy department orthopedic department OPD will be initially assessed for the inclusion or exclusion criteria. prior to the treatment procedure patients are oriented to the study and taken informed consent, patient is divided in to two groups(Group A and Group B) and both groups will be assessed for the pre-test parameter.

Outcome measure – shoulder pain and disability scale and goniometry is used for measuring pre-test and post-test.

Results: The study was significant in reducing pain level and improving function with the pretest. At the end of 6 w treatment program with, both group A (dry needling) and group B(KCAT) showed improvement in painful arc syndrome. Based on results, the study supports research hypothesis that there was a significant improvement in ROM and significant reduction in SPADI score associated with painful arc syndrome. Patient participated in group B shows more significant changes.

Conclusion: The study showed that significant improvement in symptoms of group B as compared to group A from the initial level to week 6. At the end of 6 w training programme both group A and group B Shows improvements in symptoms but the result of study supports that group B (KCAT CONCEPT-finger fanning technique) B is more efficient compare to group A(dry needling).

COMPUTATIONAL SCREENING OF POTENT ANTI-INFLAMMATORY COMPOUNDS FOR HUMAN MITOGEN-ACTIVATED PROTEIN KINASE: A COMPREHENSIVE AND COMBINED IN SILICO APPROACH

BRIAN BASTO FRANCO — 2024-11-15

Objective: Inflammatory diseases have a serious impact on one’s life and represent a diverse group of ailments stemming from various causes and presenting in various forms. p38α of the mitogen-activated protein kinase family plays a crucial role in regulating inflammation, where the activation of this kinase initiates a cascade of events resulting in the production of proinflammatory mediators and cellular stress responses. In this context, attempts were made to identify potent small-molecule inhibitors of p38α and assess their binding affinity through molecular docking studies.

Methods: From comprehensive reviews of several published reports, a few compounds, such as P38, P39, VPC00628, and N17, have shown substantial inhibitory activity toward p38α at various concentrations. Hence, these four compounds were chosen as lead compounds, and small-molecule libraries were constructed on the basis of their structural similarity. Next, virtual screening docking was performed to investigate the inhibitory potency of the four libraries toward the p38α isoforms (DFG-out and DFG-in), providing insights into their potential mechanisms of action.

Results: In addition, a comprehensive analysis of physicochemical and pharmacokinetic properties was also performed for the identified hits from each library. Our findings have shown that, compared with those of the p38α DFG-in motif, the binding energies of the p38α DFG-out motif are greater.

Conclusion: Furthermore, a few compounds from each library presented binding energies higher than those of their respective lead compounds, confirming their potential as novel therapeutic agents against inflammation.

PREDICTIVE MARKERS FOR ADVERSE PREGNANCY OUTCOMES: INSIGHTS FROM A PROSPECTIVE COHORT STUDY ON MATERNAL FACTORS, BIOMARKERS, AND UTERINE ARTERY DOPPLER RESULTS

ANJU SURYAPANI — 2024-11-15

Objective: Effective prediction tools are necessary for better outcomes when it comes to pregnancy-related complications such as intrauterine growth restriction (IUGR), pregnancy-induced hypertension (PIH), and premature birth. In order to improve early risk diagnosis and treatment, this study investigates relationships between maternal variables, first-trimester biomarkers, and second-trimester uterine artery Doppler findings.

Methods: Correlations between demographic characteristics, maternal dual test indicators (serum beta-HCG, serum PAPPA), and uterine artery Doppler tests were examined in a prospective cohort study including 500 pregnant women. Statistical studies evaluated correlations with IUGR, PIH, and premature birth.

Results: Serum beta-HCG levels below the 5th percentile correlated significantly with preterm birth (RR 2.3131, p = 0.0288). Low serum PAPP-A levels (<5th percentile) associated with PIH (RR 2.1447, p = 0.0204) and IUGR (RR 2.0953, p = 0.0002). Uterine artery Doppler indices (>0.58 RI) demonstrated associations with PIH (RR 2.2448) and IUGR (RR 1.6293).

Diastolic notching correlated with preterm birth, PIH, and IUGR.

Conclusion: The potential of serum beta-HCG, PAPP-A, and uterine artery Doppler indices as useful predictors of unfavorable pregnancy outcomes is highlighted by this study, which also highlights their use in early risk detection.

CASE SERIES: CHALLENGES AND OUTCOMES OF TLIF PROCEDURES IN A PERIPHERAL HOSPITAL IN BHARATPUR, RAJASTHAN

PUNEET BANSAL — 2024-11-15

Objective: Chronic back pain, particularly from degenerative spinal conditions, significantly impacts patient quality of life, especially in regions with limited healthcare resources, such as rural Rajasthan. Transforaminal Lumbar Interbody Fusion (TLIF) has been recognized for its efficacy in treating severe spinal degeneration and instability. This case series examines the application of TLIF in a peripheral hospital setting, assessing its challenges and outcomes in such environments.

Methods: This study included three patients aged 34 to 75, who underwent TLIF at a peripheral hospital in Bharatpur, Rajasthan, from February to July 2024. Detailed preoperative and postoperative evaluations were conducted, focusing on pain levels and functional mobility. Follow-ups were performed at the first, second, and fourth weeks post-surgery to monitor recovery and assess surgical success.

Results: All patients reported significant improvements in pain and mobility by the first-month follow-up. The 34 y old female experienced complete pain relief and returned to full activities by four weeks. The 75 y old female and 65 y old male also showed considerable improvements in pain and function, with no severe complications noted during or after surgery.

Conclusion: TLIF can be effectively implemented in peripheral hospital settings with outcomes comparable to those in higher-resource environments. This case series demonstrates the feasibility and significant benefits of advanced spinal surgeries in resource-limited settings, highlighting the potential for expanding such sophisticated interventions to improve healthcare accessibility and patient outcomes in rural areas.

COMPARATIVE ANALYSIS OF COVID-19 PATIENTS DURING DELTA AND OMICRON WAVES OF COVID-19 PANDEMIC: AN EXPERIENCE FROM RURAL TERTIARY CARE HOSPITAL IN NORTH INDIA

SAUMYA SHUKLA — 2024-11-15

Objective: In this study, an effort has been made to find out possible clinical parameters that may have played role in differences in the disease outcome in the delta and omicron waves.

Methods: This is a retrospective observational study conducted at a rural tertiary care center of North India. We recorded sociodemographic and clinicopathological parameters of the admitted patients during delta and omicron waves in India. The outcome measures were demographic, baseline clinical, disease severity, ICU admissions and hospital mortality.

Results: In our study, 1731 patients were tested positive for SARS-CoV-2, out of which 16 patients were admitted during the omicron wave and 878 admissions during the delta wave. In delta wave, the ratio of male to female was 1:2 and in omicron wave, it was 1:3. There were 271 deaths in delta wave and 2 deaths in omicron wave. A significantly lower number of admissions were noted during omicron wave (p<0.001). Patients without previous history of COVID-19 and unvaccinated status had significantly higher admission (p<0.001). The admission rate among comorbid patients was also significantly low in the omicron wave (p<0.001). 251 patients had one or more comorbidities and were mostly in severe (13.4%) or critical (88.4%) conditions in delta wave while among 13 comorbid patients in omicron wave, 7.7% were in severe and 15.4% were in critical condition.

Conclusion: The hospital admissions were very low in comparison to delta wave. During delta wave, the degree of severity and number of deaths were also very high.

PASS-ASSISTED PREDICTION OF NOVEL TETRACYCLINE HYBRIDS

MANSI SHAH — 2024-11-15

Objective: The study aimed to determine the biological activity of various novel tetracycline hybrids using way 2 drug platform's online pass software.

Methods: Novel structures were designed computationally by hybridization of 9-amino tetracycline with various phyotchemicals using various covalent linkers and prediction of biological activity was done using online pass software.

Results: The study investigated showed the antibacterial activity of almost all hybridized tetracycline compounds. The PASS predictions suggested that modifications at the 9^th position of tetracycline with various phytochemicals enhanced the antibacterial activity or retained the antibacterial activity for several of the designed structures when compared with standard tetracycline.

Conclusion: With an alarming increase of antibiotic resistance, we must identify ways to combat these diseases. This work implies that combining antimicrobials with phytochemicals can create new antimicrobial-photochemical conjugates, potentially addressing antimicrobial resistance in bacteria. Tetracycline hybrids can be used in the future to produce many more hybrids, potentially embarking in a new era of medicine research.

CORRELATION OF LEPTIN AND ADIPONECTIN LEVELS WITH METABOLIC AND HORMONAL PROFILES IN PCOS PATIENTS: A COMPARATIVE STUDY WITH NORMAL CONTROLS

ANJU SURYAPANI — 2024-11-15

Objective: Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder characterized by metabolic and reproductive abnormalities, including insulin resistance and hyperandrogenism. Leptin and adiponectin, two adipokines involved in metabolic regulation, are known to be dysregulated in PCOS. This study aims to investigate the correlation between leptin and adiponectin levels and their association with metabolic and hormonal profiles in PCOS patients compared to healthy controls.

Methods: A prospective, observational study was conducted involving 120 women diagnosed with PCOS and 50 healthy controls. Leptin and adiponectin levels were measured using enzyme-linked immunosorbent assay (ELISA). The adiponectin-to-leptin ratio (ALR) was calculated, and correlations with BMI, LH/FSH ratio, and other metabolic parameters were analyzed. Data were analyzed using appropriate statistical methods.

Results: Leptin levels were significantly higher in the PCOS group compared to controls (25.34 ng/ml vs. 11.16 ng/ml, p<0.0001), while adiponectin levels were significantly lower (2.93 mcg/ml vs. 21.44 mcg/ml, p<0.0001). The adiponectin-to-leptin ratio was markedly reduced in PCOS patients (0.13 vs. 2.05, p<0.0001). A significant correlation was observed between the adiponectin/leptin ratio and the LH/FSH ratio (r = 0.2138, p = 0.019).

Conclusion: This study highlights the dysregulation of leptin and adiponectin in PCOS, suggesting their potential role in metabolic and reproductive dysfunction. The adiponectin-to-leptin ratio emerges as a promising biomarker for insulin resistance and metabolic risk in PCOS patients.

COMPARATIVE EFFICACY OF SLICED TRAGAL CARTILAGE VERSUS TEMPORALIS FASCIA IN TYMPANOPLASTY: A STUDY ON HEARING IMPROVEMENT AND GRAFT UPTAKE

HEMENDRA SINGH SHEKHAWAT — 2024-11-15

Objective: Chronic suppurative otitis media (CSOM) often necessitates surgical intervention, with tympanoplasty being a key procedure to restore hearing. The choice of graft material-sliced tragal cartilage versus temporalis fascia remains controversial due to potential differences in acoustic transmission and graft resilience.

Methods: This prospective cohort study included 48 patients with CSOM, randomly assigned to receive either tragal cartilage or temporalis fascia grafts. Outcomes measured were hearing improvement and graft uptake, assessed through audiometric testing and otoscopic evaluations.

Results: Both groups showed significant improvements in hearing postoperatively, with no statistically significant difference in hearing gain (P=0.3064). Graft uptake rates were comparable, with a non-significant lower reperforation rate in the cartilage group (P=0.551).

Conclusion: The study supports the use of either sliced tragal cartilage or temporalis fascia as effective materials for tympanoplasty, offering substantial hearing improvement and reliable graft uptake.

FORMULATION AND CHARACTERISATION OF RISEDRONATE SODIUM SUBLINGUAL SPRAY

VATSAL NAVAPARIYA — 2024-11-15

Objective: To formulate a propellant-free sublingual spray of Risedronate sodium, addressing issues of gastrointestinal side effects associated with current oral formulations and improving patient compliance.

Methods: Initially, a fractional factorial design was used to screen variables, followed by a face-centered central composite design for optimization. Formulation batches were characterized by spray pattern, spray angle, leak test, prime test, drug delivery uniformity, drug content per spray, and ex-vivo permeation study.

Results: The optimized batch O1 exhibited an ovality ratio of 1.1, a spray angle of 640, and a drug permeation percentage of 4. In vivo absorption analysis revealed that the relative bioavailability of optimized batch O1 was 2.27 times higher than that of the plain drug solution. Compatibility of the product pack with excipients and the drug was confirmed through stability studies of batch O1.

Conclusion: The study concluded that Risedronate sodium sublingual spray presents a promising alternative to oral administration, potentially reducing gastrointestinal side effects and enhancing patient compliance.

EVALUATING THE EFFICACY OF TRANSCUTANEOUS VERSUS SERUM BILIRUBIN MEASUREMENTS IN MANAGING NEONATAL JAUNDICE IN PRETERM INFANTS

AISHWARAYA MANTHALE — 2024-11-15

Objective: Managing neonatal jaundice effectively in preterm infants is crucial due to their increased vulnerability to bilirubin-induced neurological disorders. This study evaluates the efficacy of transcutaneous (TcB) versus serum bilirubin (TSB) measurements in this context.

Methods: A total of 100 preterm neonates undergoing treatment for jaundice were assessed using both TcB and TSB measurements before, during, and after phototherapy. The study conducted paired t-tests and correlation analyses to evaluate the agreement between these two methods.

Results: Before phototherapy, there was a strong positive correlation (r = 0.8319) between TcB and TSB, with a statistically significant mean difference (p = 0.0001). During phototherapy, TcB measurements were consistently lower than TSB, indicating significant discrepancies. The differences highlighted the influence of clinical interventions like phototherapy on the accuracy of TcB readings.

Conclusion: The study validates transcutaneous bilirubinometry (TcB) as a non-invasive, effective alternative for jaundice monitoring in preterm infants. Despite some discrepancies with traditional serum bilirubin (TSB) measurements during phototherapy, the integration of TcB can decrease the reliance on invasive procedures. This research supports the potential of TcB to replace serum assessments, promoting a less stressful clinical experience for neonates while maintaining accuracy in therapeutic decisions. Future advancements are encouraged to enhance TcB measurement techniques to align more closely with serum bilirubin levels.

ASSESSMENT OF RISK FACTORS AND FOLLOW-UP OUTCOMES FOR HEARING LOSS IN HIGH-RISK NEONATES

RASHMI KAMATH — 2024-11-15

Objective: Hearing loss in neonates, particularly those in high-risk categories such as NICU graduates, can significantly impede speech, cognitive, and psychosocial development. Early detection and management are pivotal to mitigating these risks.

Methods: A prospective observational study was conducted on 425 neonates at SDM Medical College and Hospital, utilizing Otoacoustic Emissions (OAE) for initial auditory screening. This study assessed the incidence of hearing loss in relation to neonatal risk factors, including birth weight, ABO incompatibility, and maternal health conditions.

Results: A majority of the neonates (58.82%) were screened within 3-7 d post-birth. Notable risk factors impacting hearing outcomes included low birth weight, with 11.53% of neonates weighing between 1.0 and 1.50 kg. The initial failure rates in OAE screenings were low, with 2.59% failing in the right ear, 1.18% in the left, and 0.94% in both ears.

Conclusion: The study underscores the efficacy of early hearing screenings in identifying potential hearing loss in neonates, especially those exposed to multiple risk factors. Continuous and comprehensive monitoring is crucial for these high-risk groups to facilitate timely and effective interventions.

EARLY DETECTION AND LONGITUDINAL OUTCOMES OF HEARING IMPAIRMENT IN NICU GRADUATES AT SDM COLLEGE OF MEDICAL SCIENCES AND HOSPITAL

RASHMI KAMATH — 2024-11-15

Objective: Hearing impairment is a prevalent congenital anomaly, particularly in neonates in NICUs, due to various risk factors. Early detection through screening programs is crucial for developmental outcomes.

Methods: A prospective observational study was conducted at SDM College of Medical Sciences and Hospital, involving 425 neonates. Otoacoustic Emissions (OAE) testing was used for early detection and longitudinal outcome assessment.

Results: Out of 425 neonates, 95.3% passed the initial OAE screening. However, 4.7% failed, necessitating further evaluation. Notable risk factors included neonatal jaundice and perinatal asphyxia, particularly impacting neonates with lower birth weights.

Conclusion: The study underscores the importance of early and universal hearing screening in NICU settings, emphasizing the need for tailored protocols to address specific neonatal risks.

A PROSPECTIVE, OBSERVATIONAL DRUG UTILIZATION STUDY IN THE DERMATOLOGY OUT-PATIENT DEPARTMENT OF A GOVERNMENT HOSPITAL, NANDYAL, ANDHRA PRADESH

PUJARI SREENIVASULU NAIK — 2024-11-15

Objective: The data regarding drug utilization in dermatology departments of southern parts of India is limited. Recent studies on drug utilization in dermatology across India, reported high prescription of branded drugs, low adoption of essential drugs and polypharmacy. Hence, this study was conducted to analyze the drug utilization pattern for common skin diseases as per WHO prescribing indicators.

Methods: This study was done in the Out-patient department (OPD) of dermatology at Government General Hospital (GGH), Nandyal, in collaboration with department of Pharmacology for a period of 4 mo and Institutional ethical committee (IEC) permission was taken before conducting the study.

Results: A total number of 344 prescriptions were analyzed. Average number of drugs per prescription was 2.5 (including Fixed drug combination (FDC) drugs). Total number of drugs accounted to 860. Majority of prescriptions have 3 drugs per prescription (57.1%) and only 8.7% of prescriptions have more than 3 drugs per prescription. Analyzed data as per World Health Organization (WHO) prescribing indicators indicate 74% of prescribed drugs were from National List of Essential Medicines (NLEM), 2.5% were FDC drugs and 13.14% of the drugs prescribed were antibiotics. Polypharmacy was noted to be only 0.7% in the study.

Conclusion: A periodic audit of prescriptions will reduce errors and motivate the health care professionals for rational drug use. Special consideration is to be given to extended public health initiatives to prevent skin infections because they account for about 70% of diseases in daily life.

POORLY DIFFERENTIATED CLUSTERS IN COLORECTAL CARCINOMA: ASSOCIATION WITH OTHER HISTOPATHOLOGICAL PROGNOSTIC PARAMETERS INCLUDING TUMOUR BUDDING

PRAGNYA PARAMITA MISHRA — 2024-11-15

Objective: In India, colorectal carcinoma (CRC) ranks third in terms of cancer incidence. Pathologists are essential when it comes to determining the stage, examining surgical margins, and recording the histopathologic prognostic factors. A new prognostic grading system is proposed named poorly differentiated clusters (PDCs), which are defined by neoplastic clusters of 5 cells lacking glandular structure in the invasive front of the stroma. It is significant for cancer-specific and recurrence-free survival in CRC patients, reflecting the biological aggressiveness of the tumor. Aim of the study was to analyse of PDCs in colorectal carcinomas and association with other histopathological prognostic factors.

Methods: The Hematoxylin and Eosin (HandE)-stained slides of 76 histopathologically diagnosed CRC resection specimens were reviewed. Poorly differentiated clusters (PDC) were assessed into under 200x power. The correlation of PDC with other histopathological prognostic parameters like tumor size, site, grade, laterality, lymphovascular invasion, perineural invasion, T stage, N stage, and tumor budding was analyzed using descriptive statistics and the Chi-square test with SPSS version 26.0.

Results: There was no significant association between PDC and age, tumor location, tumor size, histological grade, LVI, PNI, or lymphnode status. Where a significant association was noted between the sex and PDC grade (P value = 0.035), T stage and PDC grade (P value = 0.045), and N stage and PDC grade is significant (P value = 0.001).

Conclusion: PDCs may be considered, along with other clinical-pathological parameters, a promising prognostic factor for the management of patients with CRC and should be included in pathological reports, but it still needs standardization and further validation. At the same time, tumor budding can become an irreplaceable histological indicator for identifying a high malignant potential carcinoma and poor prognosis in CRCS, thus indicating the need for aggressive postoperative management to improve the prognosis of the patient. PDC is important for the survival of CRC patients, indicating the aggressiveness of the tumor both in terms of cancer-specific survival and freedom from recurrence. PDC may help to identify patients who need a more intensive postoperative follow-up and the possibility of adjuvant therapy.

INCREASED COST BURDEN ON PATIENTS OF MENTAL DISORDERS CORRELATED WITH POOR MEDICATION ADHERENCE: A CROSS-SECTIONAL STUDY AT A TERTIARY CARE HOSPITAL IN NORTH INDIA DURING COVID-19 PANDEMIC

ASHISH KUMAR — 2024-11-15

Objective: This study was planned to evaluate the correlation between cost borne by the patient and medication adherence in common mental disorder patients during COVID-19 pandemic.

Methods: A descriptive cross-sectional drug utilization study was undertaken in 200 patients. Pattern of psychotropic drugs usage was analyzed as per WHO/INRUD guidelines and average monthly cost borne by the patient/hospital per prescription was correlated with medication adherence of the patients.

Results: The average monthly costs borne by patients and hospital were observed to be more during the pandemic as compared to pre-pandemic time. It was observed that patients bearing some cost on their own had significantly lower medication adherence compared to those patients whose cost of treatment was borne by the government-funded hospital (p-value of 0.017). The medication adherence in patients of mental disorders was found to be negatively correlated to the cost was borne by the patients.

Conclusion: The COVID-19 pandemic has escalated the total cost borne by the patients as well as the financial burden on government-funded hospitals.

A COMPARATIVE STUDY ON DYNAMIC NECK EXERCISE VERSUS ISOMETRIC NECK EXERCISES WITH THERABAND IN CHRONIC NECK PAIN

RINKU CHOUDHARY — 2024-11-15

Objective: To compare the efficacy of dynamic neck exercises versus isometric neck exercises with theraband in chronic neck pain

Methods: 60 patients with chronic neck pain selected as per the inclusion criteria; all the conditions in exclusion criteria was excluded. By dividing them into group A (n =30) (treated with dynamic neck exercise), group B (n=30) (treated with isometric neck exercise with theraband).

Results: After screening of the 60 patients for study eligibility, a total of 30 patients were included for analysis, of whom 30 were in the control group A (Dynamic neck exercise with theraband) and 30 were in group B (Isometric neck exercise with theraband) Analysis pre-test and post-test score within and between the values of groups are tabulated with intervention of the result of the study. Group B showed significant change in ROM and Neck pain.

Conclusion: Isometric Exercise is very well known for its pain reliving and long-lasting properties, but variability of techniques make it difficult to document but Theraband is known to provide consistency in training whilst preventing fatigue. Hence, patients in group B (treated with Theraband) showed decrease in VAS (Visual Analog Score) and NDI (Neck Disability Index) scores, which prove that isometric with theraband is better in treating Chronic Neck Pain.

STUDY OF PREVALENCE OF MULTI-DRUG RESISTANT ACINETOBACTER SPECIES IN VENTILATOR-ASSOCIATED PNEUMONIAE CASES IN A TERTIARY CARE HOSPITAL, VISAKHAPATNAM

MATTAM SUNEETHA RANI — 2024-11-15

Objective: Acinetobacter sps are important oppurtunistic pathogens with their significance in colonising and persistent biofilm production capabilities. The aim of the present study was to assess the prevalence of multidrug-resistant Acinetobacter sps in ventilator-associated pneumoniae cases in a tertiary care hospital Visakhapatnam.

Methods: A prospective study was conducted on 328 endotracheal aspirate samples received in Clinical Laboratory, Department of Microbiology for a period of 1 y, from June 2023 to June 2024, in mechanical ventilated cases, admitted in intensive care units, in a tertiary care hospital, Visakhapatnam.

Results: Out of 328 samples received, 42 (12.8%) were Acinetobacter isolates with resistance to Aminoglycosides (66.7%), Cephalosporins (57.1%), Quinolones (52.4%), Carbapenems (42.9%). Biofilm production was identified in 31 isolates (73.8%) by Congo Red Agar method in this study.

Conclusion: The potential ability of Acinetobacter sps to form biofilms and antibiotic selective pressure leading to emergence of resistant clones is directly proportional to the injudicious use of antibiotics. There is a strict need of antibiotic stewardship measures in intensive care units to restrict development of pan-resistant strains.

SAFETY AND MATERNAL-FETAL OUTCOMES OF ISOSORBIDE MONONITRATE AND MISOPROSTOL COMBINATION VERSUS MISOPROSTOL ALONE FOR LABOR INDUCTION: A RANDOMIZED DOUBLE-BLIND STUDY

MOLLY SHARMA — 2024-11-15

Objective: The induction of labor is essential in managing pregnancies where early delivery benefits outweigh the risks. Misoprostol is a common agent for labor induction but has side effects like uterine hyperstimulation. Isosorbide mononitrate (ISMN), a nitric oxide donor, may enhance cervical ripening and reduce complications when used with misoprostol. This study evaluates the safety and maternal-fetal outcomes of ISMN combined with misoprostol versus misoprostol alone.

Methods: A randomized, double-blind study was conducted at Dr. R. P. G. M. C. Kangra. Patients meeting the inclusion criteria were randomly assigned to receive either ISMN with misoprostol or misoprostol with a placebo. Primary outcomes measured were maternal complications (e. g., uterine hyperstimulation, headache, postpartum hemorrhage) and neonatal outcomes (e. g., birth weight, APGAR scores, NICU admission). Secondary outcomes included the need for oxytocin augmentation and the duration of labor stages.

Results: The study included 100 patients divided into two groups of 50 each. The ISMN and misoprostol group had significantly fewer headaches and dizziness but showed no significant difference in uterine hyperstimulation or postpartum hemorrhage compared to the misoprostol alone group. The ISMN group required less oxytocin augmentation, and their total labor duration was shorter, though not significantly. Neonatal outcomes were similar across both groups.

Conclusion: The combination of ISMN and misoprostol appears to be a safer and potentially more effective alternative to misoprostol alone for labor induction, with fewer maternal complications and similar neonatal outcomes. Further large-scale studies are recommended to confirm these findings and inform clinical practice.

ACUTE INFECTIVE CONJUNCTIVITIS A RETROSPECTIVE STUDY OF THE RECENT OUTBREAK REPORTED IN TERTIARY CARE CENTRE

A.MOHAMED SHAKIL — 2024-11-15

Objective: Acute conjunctivitis refers to the inflammation of conjunctiva, mostly of viral etiology and is highly contagious and self-limiting. The present study aims to assess the clinical characteristics, presentation, outcomes of acute conjuctivitis and its treatment for complications among the study population.

Methods: It was a record-based retrospective study conducted in a tertiary care teaching hospital in Puducherry for the period of two months among 100 study participants.

Results: The study showed that 62% and 16% of patients had complications like membrane formation and Superficial Punctate Keratitis (SPK). Moxifloxacin was highly used antibiotics (57%), with the median duration of the treatment being six days (IQR: 5 – 7.75).

Conclusion: From our study, we found that even though the conjunctivitis outbreak is widespread among the general population due to its contagious nature and is self-limiting, it requires medical attention to prevent complications. Public awareness is required regarding this

MEGALOBLASTIC CRISIS IN SICKLE CELL DISEASE–A RARE PHENOMENA WITH AVAILABLE REVIEW OF LITERATURE

MONICA DASH — 2024-11-15

Sickle cell disease (SCD) is an inherited disease where some red blood cells are shaped like sickles or crescent moons. This condition affects the blood and various organs of the body. These sickle cells also become rigid and sticky, which can slow or block blood flow, resulting in episodes of sickness that produce pain and other crisis. There are different types of crisis. SCD with a megaloblastic crisis is rare. The frequency of the carrier state determines the prevalence of sickle cell anemia. Here we describe a 20 y old female patient with sickle cell disease who experienced a megaloblastic crisis.

SARCINA VENTRICULI-RELATED GASTRITIS: A RARE CASE OF GASTRIC INFECTION IN A PATIENT WITH DELAYED GASTRIC EMPTYING

PRIYA KUMARI — 2024-11-15

Sarcina ventriculi (SV), which is also called Clostridium ventriculi, is a rare, non-motile, aerobic, Gram-positive coccus that breaks down carbohydrates through fermentation. It thrives in acidic environments, making the human stomach a suitable habitat, particularly in conditions associated with gastric stasis. SV belongs to the Clostridiaceae family. Recent studies have implicated Sarcina ventriculi in severe gastrointestinal conditions, including emphysematous gastritis, pyloric stenosis, gastroparesis, gastric outlet obstruction, gastric perforation, and gastric adenocarcinoma. Increased awareness of this organism and further studies are essential to understanding its role in human disease.

ENHANCING TRANSDERMAL DELIVERY OF POORLY WATER-SOLUBLE NSAIDS: EFFECTIVE STRATEGIES

PRACHI SHARMA — 2024-11-15

Transdermal drug delivery offers significant advantages for administering non-steroidal anti-inflammatory drugs (NSAIDs) and anti-complementary drugs, particularly those with poor water solubility. This delivery route bypasses first-pass metabolism and gastrointestinal degradation, enhancing bioavailability and patient compliance. However, the stratum corneum, the outermost layer of the skin, poses a formidable barrier to drug permeation. To address this challenge, several innovative strategies have been developed to improve the transdermal delivery of these poorly soluble drugs.

Chemical enhancers, such as alcohols, fatty acids, and surfactants, can disrupt the lipid structure of the stratum corneum, increasing drug solubility and permeability. Nanoformulations, including liposomes, niosomes, solid lipid nanoparticles, and nanoemulsions, enhance drug solubility, provide protection against degradation, and facilitate controlled release with deeper skin penetration. Prodrugs, designed to convert into the active drug within the skin, can improve solubility and permeability. Physical methods like microneedles, iontophoresis, and phonophoresis create micropores or use electrical and ultrasound waves to enhance permeation without compromising skin integrity.

Cyclodextrins form inclusion complexes with drugs, boosting solubility and stability. Hydrogels and polymer-based formulations create a moist environment for sustained drug release and better absorption. Co-solvents and surfactants, such as ethanol and DMSO, further enhance solubility and disrupt the stratum corneum to facilitate drug penetration. Electroporation and thermal ablation transiently disrupt the skin barrier, significantly improving drug permeation.

These strategies, individually or in combination, hold promise for optimizing the transdermal delivery of poorly water-soluble NSAIDs and anticomplementary drugs, ensuring effective therapeutic outcomes and improved patient compliance.

ADVANCEMENTS IN UNDERSTANDING AND MANAGING ALCOHOL WITHDRAWAL SYNDROME: A COMPREHENSIVE REVIEW

AJEET PAL SINGH — 2024-11-15

Alcohol withdrawal syndrome (AWS) is a clinically significant condition that can arise upon abrupt cessation or reduction of alcohol consumption in individuals with alcohol dependence. This review article provides a comprehensive overview of AWS, encompassing its epidemiology, pathophysiology, clinical manifestations, assessment tools, and management strategies. We discuss the neurobiological mechanisms underlying AWS, including the role of neurotransmitter systems such as gamma-aminobutyric acid (GABA) and glutamate, as well as neuroadaptive changes that occur with chronic alcohol use. Furthermore, we explore the spectrum of clinical manifestations associated with AWS, ranging from mild withdrawal symptoms to severe complications such as delirium tremens and seizures. Diagnostic tools and scoring systems commonly used for assessing AWS severity are examined, along with evidence-based approaches for pharmacological and non-pharmacological management of AWS. Additionally, we highlight emerging research areas and future directions in the field of AWS, including novel treatment modalities and potential biomarkers for predicting withdrawal severity and treatment response. This comprehensive review aims to provide clinicians, researchers, and healthcare professionals with a thorough understanding of AWS to facilitate early recognition, appropriate management, and improved outcomes for individuals affected by this condition.

A SYSTEMATIC REVIEW ON ADHERENCE TO ORAL ANTIDIABETIC DRUGS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

ARVIND NARWAT — 2024-11-15

Type 2 diabetes mellitus (DM) is a chronic metabolic disorder in which prevalence has been increasing steadily all over the world and one of the main reason for this is poor adherence to oral anti-diabetic drugs, which can lead to therapy failure and increase risk of complications. So we planned this systematic review with an aim to get an adherence estimation to oral anti-diabetic drugs in type 2 diabetes mellitus patients for which a literature search was performed in pubmed, Google Scholar, scopus, and central databases to find observational studies on therapeutic adherence in users of oral anti-diabetic drugs. Our analyses showed that adherence rate to oral anti-diabetic drugs therapy ranged from 23 to 90%. This review confirms that many patients for whom diabetes medication was prescribed were poor compliers with treatment of oral anti-diabetic drugs.