International Journal of Health and Clinical Research <p style="text-align: justify;">International Journal of Health and Clinical Research (IJHCR) is an open-access; freely accessible, online and print monthly peer-reviewed international journal publishes a wide spectrum of advanced research on all medical specialties including ethical and social issues. IJHCR is a gateway to enlighten the latest research/issues happening all around the world of medical and health sciences.</p> <p style="text-align: justify;">The journal publishes Original research articles in the form of full-length papers or short communications especially those with multidisciplinary nature. The journal welcomes review articles, mini-reviews, case reports, letter to the editor, guest editorial or commentaries.</p> IJHCR Publicaion en-US International Journal of Health and Clinical Research 2590-325X Crumbs, Criss Cross across Cornea-Avellino Dystrophy (A Rare Mixed Stromal Entity) <p>Male patient aged 50 years presented with redness, pain and watering in right eye since 8 days. Examination revealed that right eye corneal transparency was lost in central and temporal half of cornea due to multiple small and white dot without any clear space in between and with presence of network of lines called lattice in stroma. Transparency was present in peripheral cornea. Surface was irregular with presence of foreign particle (hair). Foreign body removal was done. On follow-up, due to poor compliance, we observed fungal ulcer for which therapeutic keratoplasty was done which lead to graft rejection after few months.</p> Shweta Walia Varun Upadhyay Ankita Bala Baldev Sastya Copyright (c) 2021 Shweta Walia, Varun Upadhyay, Ankita Bala, Baldev Sastya 2021-10-20 2021-10-20 4 18 1 2 Clinical implication of microbiological evaluation of corneal ulcer and its correlation with outcome: A follow up study from a central Indian tertiary health care center <p>Objective: To find out the incidence of different types of corneal ulcers and outcome of target-specific treatment based on microbiological evaluation. Materials and methods: In a hospital based prospective studies spanning over 2 years, 50 cases of corneal ulcer underwent microbiological evaluation of corneal scrapings and were started on culture-guided antimicrobial therapy. Result: Most ulcers were found to be prevalent in age between 51-70 years. 72 % were males, 28% females, 52% from rural areas, 50% were labourers (agricultural 28% and manual 22%), with ocular trauma and vegetative foreign body being the commonest predisposing factors. Among culture positive cases, 58.6% and 41.4% were positive for fungi and bacteria, respectively. Aspergillus was the most commonly isolated fungal species and Pseudomonas aeruginosa was the most common bacterial isolate. Moxifloxacin and tobramycin were effective in treating a majority of bacterial corneal ulcers, and hence can be considered to be the drugs of choice for the same. Complete healing of corneal ulcer with treatment was seen in 82.8% of culture positive patients. Conclusion: Infective keratitis should be managed as an ophthalmic emergency. Instantaneous administration of culture-guided antimicrobial therapy to patients with infective keratitis can avert disabling ocular morbidity and sequential blindness.</p> Ravi Chauhan Sachin Agrawal Rahul Dagwar Nidhi Lalwani Copyright (c) 2021 Ravi Chauhan, Sachin Agrawal, Rahul Dagwar, Nidhi Lalwani 2021-10-20 2021-10-20 4 18 3 9 A study on microalbuminuria as a nephropathic marker in type 2 diabetes mellitus and its correlation with the glycated hemoglobin <p>Introduction: Diabetic nephropathy is a leading cause of morbidity and premature mortality in diabetic subjects. Glycemic control is closely associated with renal involvement in diabetes and microalbuminuria can be used to detect the early stage also known as incipient nephropathy. Objectives:<br>1. To estimate the microalbuminuria and HbA1c in patients with type 2 diabetes mellitus and in normal healthy controls.<br>2. To correlate HbA1c and microalbuminuria with duration of type 2 diabetes mellitus.<br>3. To study the correlation between HbA1c and microalbuminuria level in patients with Type 2 diabetes mellitus and normal healthy controls.<br>Materials and methods: It is cross sectional observational study, 50 patients with type 2 Diabetes Mellitus and 50, age and sex matched normal healthy controls were recruited. 5ml of fasting venous blood was collected and used for the analysis of plasma fasting and post prandial glucose and HbA1c was assayed in EDTA blood, serum was used to assay urea, creatinine, sodium, potassium, and early morning mid stream urine sample for estimation of the microalbuminuria. Data was statistically analyzed. Results: In the present study there was significant association (P&lt;0.001) and positive correlation between microalbuminuria and HbA1c in cases as compared to controls. The occurance of microalbuminuria showed a direct relationship with increase duration of diabetes since diagnosis. We also found positive correlation between microalbuminuria with duration of diabetes. Conclusion: Current study shows elevated HbA1c and microalbuminuria with duration of diabetes. The risk of microalbuminuria increases with poor glycemic control are strongly associated with the presence of nephropathy, a microvascular complication of diabetes. Thus HbA1c and microalbuminuria may be considered as risk marker in diabetic nephropathy. Hence regular screening for microalbuminuria and HbA1c can help in clinical management for prevent of complication.</p> Vijaitha S M Copyright (c) 2021 Vijaitha S M 2021-10-20 2021-10-20 4 18 10 14 Clinical evaluation of fundus first laparoscopic cholecystectomy in obscured calot’s triangle <p>Background: During laparoscopic cholecystectomy dissection at the calot’s triangle can be difficult due to dense adhesions, abnormal anatomy or mirizzi’s syndrome. This increases the incidence of bile duct injuries resulting in conversion to open cholecystectomy and increased hospital stay and cost effectiveness and decreases the advantages conferred by laparoscopic cholecystectomy. Fundus first laparoscopic cholecystectomy offers the advantage of laparoscopic surgery without any increase in the incidence of bile duct injuries. This study was done to evaluate and observe the complications and clinical outcome of fundus first laparoscopic cholecystectomy. Material Methods: The prospective study was conducted on 30 patients undergoing fundus first laparoscopic cholecystectomy over a period of one year. Approval for the study was obtained from the institutional ethical committee. During laparoscopic cholecystectomy where ever the calot’s triangle was found obscured, the decision of performing laparoscopic cholecystectomy using the fundus first technique was taken. Intraoperative and postoperative observations were made and complications were noted. Results: Fundus First Laparoscopic cholecystectomy was done in 30 patients among 138 patients undergoing Laparoscopic cholecystectomy. 73% of our patients had marked fibrosis at cystic pedicle. Operating time in our cases ranged from 80 to 140 minutes (mean, 106.73 ± 16.85 minutes). We observed a mean hospital stay of 7.70 ± 2.55 days in present study (range, 5 - 15 days). We had two cases of External biliary fistula due to leakage from stump and got settled with endoscopic retrograde cholangiopancreatography (ERCP) stenting. We had port site infection in 3 cases and drain site infection in 2 cases. Conclusion: Fundus first laparoscopic cholecystectomy is a better alternative and a bail out procedure in difficult cholecystectomy reducing incidence of bile duct injuries and offers the surgeon the same safety and versatility during laparoscopic cholecystectomy that it confers during open cholecystectomy</p> Yasir Aaffaaq Ahmed Mir Sandeep Bhat Neeraj Kaul B S Pathania Copyright (c) 2021 Yasir Aaffaaq Ahmed Mir, Sandeep Bhat, Neeraj Kaul, B S Pathania 2021-10-20 2021-10-20 4 18 15 19 Study of clinical profile of open angle glaucoma patients at tertiary care centre <p>Aim: To do appropriate study of clinical profile of patients with open angle glaucoma. Materials and Methods: Cross-sectional, observational, clinical study over 2 years. 80 patients with open angle glaucoma above 40 years of age underwent thorough ocular examination i.e., visual acuity, intra ocular pressure, fundus examination, gonioscopy, optical coherence tomography (OCT) of optic disc and autoperimetry. Results: 160 eyes of 80 patients were examined. 77.5% patients had primary open angle glaucoma whereas 22.5% had secondary open angle glaucoma. Maximum (42.5%) were in the age group of 51-60 years. 61.25 % were males and 38.75 % were females. Most common chief complaint was painless diminution of vision (54.55%), followed by headache (25%) and eye ache (23.75%). 13.75% were asymptomatic while 7.5% had frequent change of glasses. Most patients presented with more than one symptom. Amongst risk factors, 54.83 % were hypertensive, 35.48% had diabetes mellitus, 19.35% were myopic, 9.67% had positive family history of open angle glaucoma and 4.83% had coronary artery disease, rest 4.83% had no risk factors. Causes of secondary open angle glaucoma were aphakic glaucoma (22.22%) and pseudophakic glaucoma in (22.22%) followed by post vitrectomy glaucoma (16.66 %), post traumatic glaucoma (11.11%), neovascular glaucoma in (11.11%), pseudoexfoliation ( 5.55%), pigment dispersion syndrome (5.55%) and steroid induced glaucoma (5.55%). Conclusion: Early diagnosis and treatment can prevent loss of vision due to glaucoma, so primary health care system should also refer patients with risk factors to the specialists for further evaluation to prevent progression and for further management.</p> Rahul Dagwar Jayshree Gopal Jibhkate Megha Yadorao Kalam Copyright (c) 2021 Rahul Dagwar, Jayshree Gopal Jibhkate, Megha Yadorao Kalam 2021-10-20 2021-10-20 4 18 20 23 Study of intraoperative and postoperative complications and visual outcome of SICS (Small Incision Cataract Surgery) in patients with pseudoexfoliation syndrome <p>Aim: To study intraoperative and postoperative complications and analyse visual outcomes in patients with pseudoexfoliation syndrome undergoing SICS. Settings and Design: Hospital based prospective interventional study in a tertiary care hospital. Methods and materials: A prospective interventional study was carried out on 60 patients with cataract and pseudoexfoliation who underwent SICS in a tertiary care hospital and patients were followed up for 6 months and final visual outcome analysed. Results: Mean age at which patients were operated was 70 years. 43.33% of patients were male and 56.67% were females. 44 (73.33%) patients had inadequate pupillary dilatation (≤ 6mm). Intraoperatively, difficulty in capsulorrhexis occurred in 26 (43.33%) patients, zonular dialysis was seen in 8 (13.33%) patients, 2 (3.33%) patients had posterior capsular rent with vitreous loss in whom anterior vitrectomy was done and SFIOL was implanted after 2 months. Early Postoperative complications were corneal edema in 26.66%, retained cortical matter in the bag in 10%, iritis in 10% and elevated IOP in 3.33%. Late postoperative complications at 6 months were IOL decentration in 3.33% and posterior capsular opacification in 3.33%. Final BCVA at 6 months was 6/6-6/12 in 58 (96.67%) patients and 6/18-6/36 in 2 (3.33%) patients. Conclusion: SICS in patients with PXF is associated with vision threatening complications which can be reduced by thorough preoperative evaluation, and with appropriate intraoperative measures, good visual outcome can be achieved.</p> Ravi Chauhan Rahul Dagwar Sachin Agrawal Aditi Pradiprao Yadgire Copyright (c) 2021 Ravi Chauhan, Rahul Dagwar, Sachin Agrawal, Aditi Pradiprao Yadgire 2021-10-20 2021-10-20 4 18 24 28 A Study to Assess the Effect of Clonidine Administration in Three Different Routes as an Adjuvantive to Bupivacaine in Spinal Anaesthesia <p>Aim:The present study was undertaken to observe and compare the effectiveness of clonidine administration in three different routes as an adjuvantive to bupivacaine in spinal anaesthesia.Material and Methods: The study recruited 40 male and female patients with ASA grade score of 1 and 2 and undergoing lower abdomen surgery. Patients within the age group of 20 to 60 years were included in the study. The selected participants were randomly assigned to four groups with 10 participants in each group. All the participants underwent thorough physical examination. Demographic data of the patients were collected. Block characteristics was assessed using standard methods. Incidence of side effects also noted.Results:Weight of the participants was significantly different. Height and age of the participants was not significantly different. Block characteristics of the participants was presented in table no 2. There was a significant difference observed in sensory onset, motor onset and demand for analgesia.Conclusion: The study results confirm that all the three routes administration of clonidine was effective to cause early onset of blockage of sensory and motor conduction also causes prolonged analgesia effect. The study recommends further detailed studies in this area.</p> Nikulbhai J. Prajapati Prasant D Chaudhary Copyright (c) 2021 Nikulbhai J. Prajapati, Prasant D Chaudhary 2021-10-20 2021-10-20 4 18 29 30 A comparative study among clinical and non clinical medical professional’s experiences perceived stress during Covid -19 pandemic era, at tertiary health care centre in central India <p>Background: The COVID-19 pandemic changed the daily routines of each individual worldwide in tandem with efforts to prevent and control the transmission of COVID-19. The increasing trend of suspected and confirmed cases of COVID-19 required healthcare workers, particularly doctors, to be involved in the management of the COVID-19 pandemic such as contact tracing, diagnosis, treatment, and care of patients with COVID-19. Methodology: This is a cross sectional study has been conducted at Government Medical College and associated hospital, Datia, MP, India during April 2021 to June 2021 among doctors who did different duties in covid-19 pandemic era and comparison between clinical and non clinical specialist in terms of perceived stress. Participants surveyed by socio demographic Performa and Perceived Stress Scale [PSS-10]. Results: Study discloses significant level of stress among medical professionals invariable of gender, age and department. Clinical specialist displayed higher range of perceived stress in comparison of non clinical doctors. Conclusion: Understanding and addressing the mental health issues of health care professionals is important in terms of their efficiency and adaptability towards current scenario of Covid-19 pandemic and this is also noteworthy to identify and neutralise their rising burden of stress and promotion of positive mental health.</p> Kapil Dev Arya Praveen Tagore Prashant Harit Kamal Kachhawa Copyright (c) 2021 Kapil Dev Arya, Praveen Tagore, Prashant Harit, Kamal Kachhawa 2021-10-20 2021-10-20 4 18 31 34 Does early enteral feeding delay the gastric emptying?- A prospective randomized controlled trial in post gastrojejunostomy patients <p>Introduction: Postoperative early enteral feeding has become a very common application in the present day surgical practice. Enteral nutrition has been found to increase the blood supply to the intestines, increase the gut secretions like hormones, various peptides and enzymes, which increases the gut motility and thereby enhances gastric emptying. Materials &amp; Methods: This is prospective and observational study conducted at Tertiary care teaching hospital and research center over a period of 18monthswere included in the study. Patients included in the study were those who underwent gastric bypass (Gastrojejunostomy) for gastric outlet obstruction either due to benign or malignant condition. Results: Total of 138 patients entered into the study, out of which 94 were excluded. The age of the patients ranged from 14 to 74 years with a mean (±SD) of 47.71(16.729) years in Early Feeding (EF) group and 44.95 (16.694) in No early Feeding (NEF) group. 15 patients were men and 9 were women in EF and 15 patients were men and 5 were women in NEF group. The NasoGastric tube was inserted for an average of 6.04 days in the Enteral feeding group and an average of 6.40 days in the No Enteral feeding group. Conclusion: Present study concludes that post operative enteral nutrition has no impact on DGE after gastric bypass and Ileal brake mechanism might not be clinically relevant. Most of patients who had enteral nutrition gained weight as compared to no Enteral feeding group.</p> Prasad K Yoganand Mahadev Dadge Nivedita Copyright (c) 2021 Prasad K, Yoganand Mahadev Dadge, Nivedita 2021-10-20 2021-10-20 4 18 35 38 Mucormycosis in COVID-19- A burgeoning epidemic in the ongoing pandemic <p>Introduction: Along with COVID-19, India is also experiencing an outbreak of mucormycosis, a deadly fungal infection, which is affecting thousands of COVID-19 patients. Also known as black fungus, this disease is caused by opportunistic fungi in the Mucorales family. Material and Method: This is a retrospective study among mucormycosis patients, admitted to tertiary care teaching centre over a period of 3 months. These cases were admitted for the management of mucormycosis. They were assessed and treated by the relevant specialties at various time points, which included internists, infection disease specialists, intensivists and otolaryngologists. Data pertaining to demographics, clinical features, co-morbidities, laboratory investigations, histopathology, management and outcomes were collected. Results: In our study, 461 patients diagnosed with mucormycosis were included. Male were predominant (63.3%) and the mean age was 53 ± 9.7 years. All patients initially presented with nasal congestion with or without discharge consistent with sinusitis. The majority of patients with mucormycosis experienced a non-descript localised or generalised headache. Symptoms include diplopia, visual disturbances, facial weakness or numbness. Features of ophthalmoplegia, proptosis and long-tract signs were also observed in a proportion of patients. Imaging investigations revealed that most of the patients had features of maxillary sinusitits. Based on microbiology and/or histopathology, all subjects had features of mucormycosis. A small proportion had additional co-infection with aspergillosis and bacteria. Conclusion: The incidence of mucormycosis in the setting of the COVID-19 pandemic is likely to rise and result in significant morbidity and mortality. Physicians caring for severely ill patients with COVID-19 and concomitant poorly controlled diabetes should have a high index of suspicion of mucormycosis, especially if corticosteroids are used during the course of disease.</p> Mahak Lamba Deepak Bhagchandani Ambuj Yadav Virendra Atam Copyright (c) 2021 Mahak Lamba, Deepak Bhagchandani, Ambuj Yadav, Virendra Atam 2021-10-20 2021-10-20 4 18 39 42 Prevalence of stress and associated changes in the personal habits of frontline healthcare workers during COVID-19 pandemic: A questionnaire based study <p>Background: Coronavirus disease (COVID-19) pandemic has spread to 198 countries, with approximately 104 million confirmed cases and 2.21 million deaths globally as of January 28. Frontline healthcare workers face a substantially higher risk of infection and death due to excessive COVID-19 exposure. The aimed of the study to assess the prevalence of stress and associated changes in the personal habits of frontline healthcare workers during COVID-19 pandemic - A questionnaire based study. Material and Methods: It was a cross-sectional, online survey conducted in May 2021 among FHWs who are directly involved in the triage, screening, diagnosing, and treatment of COVID-19 patients and suspects. Demographic characteristics were summarized using descriptive statistics such as frequency and percentages in case of discrete data. Data were exported from the Google Forms to Microsoft Excel spreadsheet and coded. Result: A total of 332 responses were received and involved in any of the COVID-19 related activities. The 332 participants from across 36 states and including union territory were included in the analysis. The majority of the participants age 25-40 years (86.45%). Male are predominance in our study (53.92%). Of the 332 participants, 81.0% (n = 269/332) were doctors and the remaining 18.9% (n = 63/332) were nurses and OT technician. Anaesthesiologist formed the major proportion (n = 145/332; 43.67%). The maximum percentage of experience were 47.59% between 1-5 years. The prevalence of FHWs with sometimes felt nervous and stress was 40.0% (118). The prevalence rates FHWs with fairly often stress was 28.14%. Conclusion: The frontline healthcare workers are at risk of physical and mental consequences directly as the result of providing care to patients with COVID-19. Even though there are few intervention studies, early data suggest implementation strategies to reduce the chances of infections, shorter shift lengths, and mechanisms for mental health support could reduce the morbidity and mortality amongst Frontline healthcare workers.</p> Rajeev Pareek Bhagwati Chundawat Kailash Chand Jat Chitti Baby Nitika Sharma Copyright (c) 2021 Rajeev Pareek, Bhagwati Chundawat, Kailash Chand Jat, Chitti Baby, Nitika Sharma 2021-10-20 2021-10-20 4 18 43 50 A Study to Evaluate the Intubating Conditions Between Propofol-Sevoflurane and Propofol Alone Without Using Neuromuscular Blocking Agents <p>Aim: The present study was undertaken to observe the intubating conditions between propofol-sevoflurane and propofol alone without using neuromuscular blocking agents.Material and Methods: The study recruited 40 male and female patients with ASA grade score of 1 and 2 and undergoing different surgical procedures were recruited in the study. Patients within the age group of 20 to 60 years were included in the study. Demographic data of the patients were collected. Endotracheal intubation was performed using laryngoscope with Macintosh blade and appropriate sized cuffed endotracheal tube. The intubating conditions were assessed by using Copenhagen Consensus Conference (CCC) score. Results:Demographic data of participants was presented in Table 1. Weight and height of the participants was significantly different. Age of the participants was not significantly different. Table 2 presents the endotracheal intubation score in of the participants in group 2 (n=20). Endotracheal intubation score was easy in majority of the patients. Table 3 presents the endotracheal intubation score in of the participants in group 1 (n=20). On comparison group 2 patients scores were better than group 1. Table 4 presents the side effects during induction in both groups. On comparison, the participants in group 2 exhibit fewer side effects than group 1.Conclusion :The study results confirm that all propofol-sevoflurane combination was much more effective than propofol alone. The study recommends further detailed studies in this area.</p> Dinesh M Chaudhary Kaushikkumar D. Prajapati Copyright (c) 2021 Dinesh M Chaudhary, Kaushikkumar D. Prajapati 2021-10-20 2021-10-20 4 18 51 53 Pattern of female deaths: An autopsy-based cross-sectional study <p>Objective:To find out the pattern of firearm deaths including its manner and demographical aspects in Islamabad and to see institutions, administrations and planning authorities are taking remedial steps to reduce firearm deaths comprising of the most of the unnatural deaths in a society. Materials and Methods: This is a Cross-sectional study conducted at Tertiary care teaching hospital over a period of 1 year. The major sources of information reviewed in this study were the autopsy registers and autopsy reports of the police clinic, Benin City, Edo State, over 10 years. Results: A total of 200 female medicolegal autopsies were performed, accounting for 17.4% of all cases. The mean age of cases was 38.20 ± 17.39. Age group of 30–39 years accounted for 14.3% (n = 90) of cases, closely followed by the age group of 20–29 years, which accounted for 16.2% (n = 80) of cases. Accidental deaths accounted for 37% (n = 74) of cases. RTA was the most common cause of accidental deaths (n = 55; 84.4%). The most common pattern of RTA was a vehicle knocking down a pedestrian as seen in 36 cases (40.4%). The most common age group involved in RTA was 20–29 years (n = 17; 18.8%). For homicides, shotguns were mainly used (n = 25; 31.3%), distantly followed by those caused by the use of sharp objects (n = 14; 17.4%) and most cases belonged to the age groups of 40–49 years and 30–39 years (21.2% and 16.2%, respectively). In 4 (66.8%) cases, hanging was the method of choice for suicide. A majority of suicide victims (n = 2; 45%) were aged between 30 and 39 years, with an average age of 36.3. Diseases of the cardiovascular system accounted for 13.1% (n = 10) of cases, whereas pregnancy-associated deaths (excluding criminal abortions) accounted for 10% (n = 8) of cases in the natural causes group. Conclusion: There is a need to provide basic infrastructure, formulate policies, and implement them, to reduce female MLD, which a significant number of them are preventable.</p> P. Ravi Kumar Copyright (c) 2021 P. Ravi Kumar 2021-10-20 2021-10-20 4 18 54 58 Relationship between socioeconomic status and quality of life in Haemophilia <p>Introduction: The relationship between quality of life in haemophilia and socioeconomic status of patient has not been well studied. Many of the previous studies were present on health related quality of life but only a few have enlighten the relationship between health related quality of life and socioeconomic status. Objective: To find the effect of socioeconomic status on quality of life in Haemophilia patients. Method: The study was conducted in S.M.S Medical college from April 2012 to November 2013. We included 88 patients in our study. Socioeconomic status of the patients wasassessed by Kuppuswamy scale and evaluation of quality of life was done by WHO SF-36 scale. Comparison of SF 36 and Kuppuswamy scale was done by appropriate statistical methods. Results: Out of 88 patients, 80 patients were having Haemophilia Type A and 8 patients were having Haemophilia Type B.Average age of patients was 21± 9.9 yrs. Spearman rank order test was done for forcomparison of socioeconomic status and Physical Component Summary(PCS), Mental Component Summary(MCS) of quality of life . We found a positive correlation between socioeconomic status and quality of life. Conclusion: Positive correlation was found between socioeconomic status and physical and mental component of quality of life. As we proceed from poor to upper 1 we found an increase in quality of life in haemophilia patients with best quality of life in upper 1 and worst quality of life in lower group. Availability of free Factor for Haemophiliawill benefit the lower strata patients and help them in improving quality of life.</p> Ashish Kavia Mrinal Joshi Surbhi Mittal Copyright (c) 2021 Ashish Kavia, Mrinal Joshi, Surbhi Mittal 2021-10-20 2021-10-20 4 18 59 62 Analysis of Haematological Parameters and Peripheral Smear findings of COVID- 19 Patient’s Blood Sample <p>Introduction: Lymphopenia is an important finding in COVID-19 is a systemic infection which can help to predict the prognosis. The ratio of neutrophils to lymphocytes ratio,lymphopenia andthrombocytopenia can help to determine the severity of an incident. Severe thrombocytopenia can lead to potentially fatal consequences in the form of DIC. Objectives: To know the haematological parameters and peripheral smear findings in blood samples of COVID -19 patients and their relation with severity of infection. Materials and Methods: This prospective study was conducted at Department of Pathology, Hassan Institute of Medical Sciences, Hassan, Karnataka. 12288 confirmed cases from Covid -19 infection from June 2020 to May 2021, were evaluated in detail for complete blood count analysis by Cell Dyn Rubyand peripheral smear study.Findings were noted and correlated with severity of infection. Results: In the present study from asymptomatic cases to critical cases, there was gradual increase in leucocytes count, along with neutrophilia,absolute neutrophils count, neutrophil to lymphocyte ratio and gradual decrease in lymphocytes, absolute lymphocyte count andplatelets. In our study, peripheral smear findings showed toxic granules along with other reactive changes in neutrophils. Lymphopenia worsens as the disease progresses to a more advanced state.Individual proper managementand the disease's outcome can be monitored effectively by noting above discussed haematological parameters in COVID-19 infection.</p> Udasimath Shivakumarswamy Nagesha Puruhotham Copyright (c) 2021 Udasimath Shivakumarswamy, Nagesha, Puruhotham 2021-10-20 2021-10-20 4 18 63 66 Study on clinical and etiological profile of hypothyroid patients at tertiary care center <p>Background: Hypothyroidism was common endocrine disorder all over the world.Most prevalent among Indian population. common symptoms of hypothyroid patients were fatigaability,weight gain. Most of the time symptoms were non specific,most common aetiology for hypothyroid patients was auto immune aetiology like Hashimoto’s thyroiditis. Aims: To determine the etiological profile of hypothyroid patients and to describe various Clinical Manifestations in Hypothyroid patients. Materials and Methods: The hospital based cross sectional observational study was carried out in department of General Medicine, atMandya institute of medical sciences ,Mandya. Total 90 patients were included in the study. Results: In present study, total 90 patients were included, out of these 84(93.3%) were females and 6(6.7%) were males. Most common age group was 31-40(37.7%) years, followed by 41 -50(33.3%) years. most common symptoms were fatigability(57.7%),weight gain (53.3%),hair loss (38.8%). Most common Etiology was Hashimoto’s thyroidits(46.6%). Conclusions: Hypothyroidism was common endocrine disorder among females. Early diagnosis can be made out by Biochemical investigations. Early treatment can prevent long term Morbidity.</p> Lokesh N K Suresh C Manju B Copyright (c) 2021 Lokesh N K, Suresh C, Manju B 2021-10-20 2021-10-20 4 18 67 70 Distortion Product Otoacoustic Emission (DPOAE) Measurement in Tinnitus Patients: Is it Really Useful? <p>Objectives: To evaluate the Distortion product otoacoustic emission (DPOAE) in tinnitus patients as an indicator of the outer hair cell function of cochlea. Study Design: Prospective study. Setting: Tertiary care hospital. Subjects and Methods: The study included 90 subjects aged between 12 years and 76 years. The subjects were divided into three groups, Group-I included the normal hearing subjects without tinnitus, and they were taken as control, Group-II included patients with tinnitus and normal hearing and Group-III included patients with tinnitus and reduced hearing. The Pure Tone Audiometry (PTA) hearing threshold and DPOAE were evaluated and their correlationin tinnitus patients was studied. Results:The PTA hearing threshold in the patients with tinnitus and normal hearing was higher than the normal hearing and without tinnitus subjects and it was further higher in the patients with tinnitus and reduced hearing. The DPOAE levels in the patients with tinnitus and normal hearing was lower than the normal hearing and without tinnitus subjects and this was much lower in the patients with tinnitus and reduced hearing. The DPOAE had non-linear relationship with the hearing level. Conclusions:The tinnitus patients have impaired function of the outer hair cells of cochlea as revealed byDPOAE measurement in our study. The reduced DPOAE in the patients with tinnitus and normal hearing threshold also predicts the possibility of impending hearing loss.</p> Danish Ahmad Khan Aftab Ahmed Md Anas Pramod Kumar Varshney Copyright (c) 2021 Danish Ahmad Khan, Aftab Ahmed, Md Anas, Pramod Kumar Varshney 2021-10-20 2021-10-20 4 18 71 76 Bacteriological Profile in the Catheter Associated Urinary Tract Infection (CAUTI) Patients in a Tertiary Care Hospital of Uttarakhand, India <p>Introduction: UTIs are the most common type of healthcare-associated infection (HAI). Among UTIs acquired in the hospital, approximately 75% are associated with a urinary catheter. According to the CDC, Catheter associated urinary tract infections (CAUTIs) are defined as an UTI developing in a patient after 48 hours of implantation of an indwelling urinary catheter. Materials and Methods: The present study was a cross sectional study, conducted over a period of one year.A total of 468 subjects (patients) were included in this study.Before enrolling patients into study, an informed written consent from each patient was taken.Taking all aseptic precautions and following CDC guidelines, Urine samples of catheterized patients received and sent for bacterial culture and sensitivity in the Microbiology section of Central laboratory (an ISO 15189:2012 certified, NABL accredited Laboratory) of SMIH, Patel Nagar, Dehradun. Out of 468 patients, only 100 were culture positive and were processed and reported as per the standard methods. Results: In our study we found that Escherichia coli (53%) were the predominant bacteria isolated, followed by Klebsiella Pneumoniae (16%). Minimum (1%) isolation was seen for Enterococcus casseliflavus.Maximum number of cases were from age-group of 71-80 years (18%) followed by 61-70 years (16%) and least number of cases from age-group of 1-10 years &amp; 91-100 years (1%) each. The prevalence of CAUTI was more in females (53%) than in males (47%). Conclusion: Based on this study, we conclude that Catheter associated urinary tract infections (CAUTI) are one of the most common nosocomial infections. Escherichia coli are found to be the most common causative organism followed by Klebsiella Pneumoniae, responsible for CAUTI in a tertiary care hospital of north India. Advanced age and female sex are more vulnerable group to get CAUTI. To avoid device associated infections, it is required to establish a standard guideline for the indwelling urinary catheter management.</p> Ruqaiyah Nadeem Furquan Alam Dimple Raina Gaurav Saxena Copyright (c) 2021 Ruqaiyah Nadeem, Furquan Alam, Dimple Raina, Gaurav Saxena 2021-10-20 2021-10-20 4 18 77 80 Comparative Analysis of Sputum Microscopy and Gene xpert Technique for Pulmonary Tuberculosis Along with Rifampicin Resistant in Tertiary Health Facility, Udaipur <p>Introduction: Mycobacterium tuberculosis (MTB) rapid identification, differentiation of MTB from nontuberculous mycobacteria (NTM) along with its resistance to rifampicin is necessary in mycobacterial diseases management. Culture beingthe “gold standard” for the detection of MTB, is time consuming. Smear microscopy, inspite of its rapidity and low cost, has poor sensitivity for the detection of acid-fast bacilli (AFB). GeneXpert MTB/RIF assay, a real-time PCR based rapid diagnostic method can simultaneously detect M. tuberculosis and its resistance or sensitivity to Rifampicin. Hence, we aim to compare the performance of GeneXpert assay with ZN smear along with rifampicin resistant pattern in tertiary health facility. Aim: The Study aims to analyze patients’ respiratory samples. Objectives:1.Comparative analysis of GeneXpert and ZN Smear for detection of Mycobacterium tuberculosis2.To find out the sensitivity of GeneXpertAssay method along with Ziehl-Neelsen method in Tuberculosis infection diagnosis3.To determine the prevalence of Rifampicin resistance. Materials and Methods: This study included 1857 suspected tuberculosis patients,who had their sputum samples tested for ZN smear microscopy and GeneXpert during the period January to December 2019. The results of ZN smear microscopy and Gene Xpert was collected for data analysis. Results: A total of 1857 of patients were evaluated in final analysis.The Gene xpert performance was compared with Ziehl Neelsen technique. Out of the 1857 persons, 709 were smear Positive (38.2%) and 1148 were smear negative (61.8%), while for the Genexpert873 (47.01%) were MTBdetected, 984 (52.98%) MTB not detected. Out of 873 were 816 RIF (82.92%) Sensitive and 57 (5.79%) RIF resistance. 667 (35.91%) were TB Positive with both techniques, 206 (14%) were GeneXpert positive but ZN staining technique negative,942 (50.72%) were negative with both methods and 42 (2.26%) was ZN stain Positive but GeneXpert negative. Conclusions: The GeneXpertis a cartridge-based nucleic acid amplification test (NAAT) is best available for simultaneous rapid tuberculosis diagnosis and antibiotic sensitivity test.Accuracy and negative predictive value of GeneXpert was found to be better than AFB staining. Thus, a negative GeneXpert test can rule out TB. Further, the test may helpful in diagnosis of TB in patients likely to be missed by traditional tests. Also,positive ZN Stain and negative GeneXpert results indicate the presence of NTM. However, when compared to ZN smear, GeneXpert is expensive and needs sophisticated instrument.</p> Arif Saumya Singh Jyoti Tomar Neelam Copyright (c) 2021 Arif, Saumya Singh, Jyoti Tomar, Neelam 2021-10-20 2021-10-20 4 18 81 84 Comparison of the Efficacy of Topical Tacrolimus and Pimecrolimus in Treatment of Stable Vitiligo <p>Background: The topical calcineurin inhibitors (TCIs) are emerging treatment modalities for vitiligo patients. Aim and objective: The aim of this study was to assess the efficacy and tolerability of the TCIs Tacrolimus and Pimecrolimus in vitiligo patients. Methods: A total of 40 patients with vitiligo were enrolled in this study. They were divided into two groups: topical Tacrolimus 0.1% ointment(20) and topical Pimecrolims 1% cream(20). The efficacy of treatment was assessed 2,4,8,12 and 24 weeks. Results: At the end of 24th week, Tacrolimus users showed 25% repigmentation with score of repigmentation 2.62 whereas Pimecrolimus users showed 20% repigmentation with score of repigmentation 2.02. Conclusion: After 24 weeks, Tacrolimus 0.1% users showed more efficacy comparing Pimecrolimus 1% topical drug users.</p> Yashwant Anant Lal Shankar K Copyright (c) 2021 Yashwant Anant Lal, Shankar K 2021-10-20 2021-10-20 4 18 85 90 Isolation of Uropathogensin Catheterized Patients and Their Biofilm Formation Capacity and Comparison of Biofilm Formation by Two Different Methods in a Tertiary Care Hospital of North India <p>Introduction: Urinary tract infections (UTIs) account for 30% of all hospital acquired infections (HAI). Of these 30% infections, 80% of them are estimated to be catheter-associated. According to the CDC, Catheter associated urinary tract infections (CAUTIs) are defined as an UTI developing in a patient after 48 hours of implantation of an indwelling urinary catheter. In most of the cases, the underlying cause of CAUTI is formation of a pathogenic biofilm on the surface of the indwelling urinary catheter.Most important medical significance of biofilm is decrease in susceptibility of antimicrobial agents. Materials and Methods: The present study was a cross sectional study, conducted over a period of one year.A total of 468 subjects (patients) were included in this study.After taking informed written consent from each patient, Urine samples of catheterized patients were received and sentfor bacterial culture and sensitivity in the Microbiology section of Central laboratory (an ISO 15189:2012 certified, NABL accredited Laboratory) of SMIH, Patel Nagar, Dehradun. Samples were collected taking all aseptic precautions, out of which 100 samples were processed and reported as per the standard methods. Results: Taking Tissue culture plate (TCP) as gold standard, sensitivity of Tube method (TM) method was found to be 76.4%; specificity 71.5%.64.1% of Escherichia coli isolates were positive by both tube method and tissue culture plate method; However, 75% of Klebsiella pneumonia isolates were positive by tissue culture plate method. Pseudomonas aeruginosa showed a positivity of 88.8% by tissue culture plate method. Conclusion: Based on this study, we conclude that Catheter associated urinary tract infections are the most common nosocomial infections. Most aspects of the diagnosis, treatment, and prevention of CAUTI are influenced by the tenacity of biofilm-associated uropathogens. Based on our study results, we can conclude that TCP is a quantitative and reliable method to detect biofilm forming micro-organisms. When compared to TM, the TCP can be recommended as a general screening method for detection of biofilm producing bacteria in laboratories.</p> Ruqaiyah Nadeem Dimple Raina Furquan Alam Surabhi Singh B. S. Mahawal Copyright (c) 2021 Ruqaiyah Nadeem, Dimple Raina, Furquan Alam, Surabhi Singh, B. S. Mahawal 2021-10-20 2021-10-20 4 18 91 96 Microbiological Profile of Acute Appendicitis in Pediatric Population Admitted in Yenepoya Medical College <p>Aim: To study the most common bacterial microorganism aerobic or anaerobic involved in appendicitis post appendectomy in Paediatric population admitted in Yenepoya Medical College. Method: Total of 60 patients admitted with admitted in the department of Paediatric Surgery clinically diagnosed as Appendicitis with age less than 14 years of age and post Appendicectomy at Yenepoya Medical College during the October 2017 to March 2019 were considered for the study. Results: The most common drug which the isolated organism was sensitive to was Ciprofloxacin, with the exclusion of Multidrug resistant organism. The second most common drug which was sensitive forthe isolated organism was Amikacin. Conclusion: There was a positive association between diarrhoea and the severity of acute appendicitis. The most common isolated organism was E-coli.</p> Sashidhar NDK Christopher Sam Thomas Ashraf Ahmad Copyright (c) 2021 Sashidhar NDK, Christopher Sam Thomas, Ashraf Ahmad 2021-10-20 2021-10-20 4 18 97 100 Hepatitis B Virus Genotypes and Liver Function Tests in Chronic Hepatitis B Patients <p>Introduction: Hepatitis B virus (HBV) infection is a major public health problem worldwide. Almost 296 million people around the world are suffering from chronic hepatitis B with addition of 1.5 million cases per year. Chronic HBV infection causes morbidity and mortality mostly from chronic liver diseaseslike cirrhosis and Hepatocellular carcinoma (HCC). At least ten HBV genotypes have been identified so far and genotype D and A are commonly found in India. Materials and Methods: Two years cross sectional study was done and a total of 78 patients were included in this study. Among all 53 were HBsAg positive. All the processes of diagnosis were carried out at Biochemistry and Microbiology section of Central Laboratory (an ISO 15189:2012 certified and NABH accredited laboratory), Shri Mahant Indiresh Hospital and Central Molecular Research Laboratory (CMRL) [a BSL-III laboratory], Department of Biochemistry, Shri Guru Ram Rai Institute of Medical and Health Sciences (SGRRIMHS), Patel Nagar, Dehradun (U.K). Results: Out of 78 subjects, only 53 were positive for HBsAg and of these, DNA was detected only in 43 cases. The genotype D (53.48%) was the most common finding followed by genotype A (23.33%) and genotype F was found in lowest number (2.33%). No significant associations were established between HBV genotypes and Liver function tests (serum ALT, AST, serum Albumin and total serum Bilirubin). Conclusion: This study concludes that no significant associations were found between HBV genotypes and liver function tests in chronic hepatitis B patients in north India.</p> Furquan Alam Ruqaiyah Nadeem Farah Ahsan Farah Ahsan R. K. Singh Copyright (c) 2021 Furquan Alam, Ruqaiyah Nadeem, Farah Ahsan, Farah Ahsan, R. K. Singh 2021-10-20 2021-10-20 4 18 101 104 Comparative study of induction of labour with dinoprostone gel versus mechanical dilatation in unfavorable cervix (low Bishops Score) <p>Background: Induction of labour is defined as initiation of uterine contractions before spontaneous onset of labour. This observational study compares the effect of prostaglandin E2 (PGE2) and extra amniotic saline infusion (EASI) for pre-labour ripening of unfavourable uterine cervix. Methods: This is a prospective and randomised study was conducted in the Department of Obstetrics and Gynaecology, in a tertiary care teaching hospital over a period of six months. Patient admitted for induction of labour were randomized to receive intravaginal dinoprostone or intracervical Foley’s catheter. Patient not entering active labour and having rupture membranes or arrest of dilatation received IV oxytocin. Results: A total of 140 women with gestational ages of 37-42 wks were enrolled in this study. Of the 140 pregnant women, 70 were assigned to the PGE 2 group and 70 to the foley’s group. Baseline characteristics of both groups were similar including age, gravidity, parity. The mean gestational age was statistically higher in the PGE2 group; however, this was clinically not significant. Overall indication for induction were also similar across intervention apart from more small for gestational age (SGA) or IUGR induction being performed with Foleys catheter. Additionally, cervical station at the time of induction did not differ across intervention group. Conclusions: Group A was associated with more rapid cervical ripening, shorten induction to vaginal delivery interval and greater no. of vaginal deliveries within 24 hours.</p> Surekha Tadisetti Nanda S Shinge Copyright (c) 2021 Surekha Tadisetti, Nanda S Shinge 2021-10-20 2021-10-20 4 18 105 108 A Prospective Study to Evaluate the Possible Etiology of Bleed, Clinical Profile and Probable Hospital Outcome of Patients with Upper Gastrointestinal Bleed <p>Background: Acute upper gastrointestinal bleeding (UGIB) is a potentially life-threatening abdominal emergency that remains a common cause of hospitalization. The aim of this study to evaluate the possible etiology of bleed &amp; clinical profile of patients and probable hospital outcome of upper gastrointestinal bleed in patients. Materials&amp; Methods: A prospective study done on 100 patients presenting with complains of hemetemesis or malena admitted in department of Medicine, RNT Medical College, Udaipur, Rajasthan, India. All patients were interviewed, detailed history taken with respect to risk factors and detailed physical examination was carried out along with appropriate investigations. Results: The mean age of male patients was 49.13 yrs and female was 47.04 yrs. The most common cause for upper GI bleed was Varices which comprised of 40% of cases. Majority of patients belonged to the age group of 31-40. Gastric ulcer (N=12) was more common in females and varices (N=32) was more common in males cause for upper GI bleed in our study. Conclusion: Endoscopy can be used as diagnostic as well as therapeutic measures. It is therefore recommended that, early endoscopy should be performed preferably within 24 hours of bleeding. Endoscopic treatment was successful in most cases besides conservative treatment.</p> Annu Raj Brajesh Dhaker Bheem Nath Copyright (c) 2021 Annu Raj, Brajesh Dhaker, Bheem Nath 2021-10-20 2021-10-20 4 18 109 112 A Hospital Based Prospective Study for Assessment of Sensorineural Hearing Loss (SNHL) in Type-II Diabetes Mellitus Patients <p>Background: Diabetes mellitus is an increasing health problem worldwide and the prevalence is steadily increasing. The organ of corti cells are important structures for hearing mechanism and turn out to be the potential target for damage, due to high glycemic levels, micro vascular compromise, their complex structure and arrangement. Thus, screening of these patients at a higher risk of developing sensory neural hearing loss, will aid in early diagnosis and management. The aim of this study to assess the sensorineural hearing loss in diabetes mellitus type II patients. Materials&amp; Methods: This is a prospective study in which evaluation of 50 patients who were diagnosed with diabetes mellitus undergoing treatment on Out–Patient or In-Patient basis in department of E.N.T and Medicine at RVRS Medical College, Bhilwara, Rajasthan, India. All the patients were taken up for Otoscopic examination, in which the ear canal and status of tympanic membrane were assessed. Assessment of hearing loss in these patients is done using PTA. In this method, they are exposed to pure tones, the intensity of which can be increased or decreased in 5 dB steps. The amount of intensity that has to be raised above the normal level is a measure of the degree of hearing impairment at that frequency. Statistical Package of Social Sciences (SPSS) Trial Version 24.0 Significant level was p ≤ 0.05. Results:The present study showed that mean age of patients was 56.43 years &amp; male to female ratio was 1.5:1. The mean duration of diabetes was 12.36 years,the distribution among the study sample showed majority among ≤15years duration of diabetes mellitus at 72% (36 out of 50) and shows significance among PTA results of hearing loss degree with P-value &lt;0.01. Conclusion: Hearing loss observed in diabetics is mostly bilaterally symmetrical, progressive, ranging from mild to severe.</p> Jairaj Kumar Vaishnav Anju Kochar Farzana Siddiqui Bhagirath Singh Copyright (c) 2021 Jairaj Kumar Vaishnav, Anju Kochar, Farzana Siddiqui, Bhagirath Singh 2021-10-20 2021-10-20 4 18 113 116 Comparative Study of Lipid Profile in Young Smokers and Non- Smokers <p>Background and Objective: The present study provides a detailed profile of the plasma lipid and lipoprotein levels according to cigarette smoking status (smoker, ex-smoker and non-smoker) and dosage [number of cigarette(s) smoked per day] in this part of Rajasthan. Materials and Methods: The study is being carried out in 100 healthy male smokers and 100 healthy males non smokers selected from volunteers from general public, patient attendants and hospital staff of New Medical College and Hospital &amp; MBS Hospital Kota. Results: Out of 100 patients in the present study the number of subjects in mild, moderate and high smokers group were 42 (42%), 44 (44%), 14 (14%) respectively. Smokers had higher total cholesterol, plasma triglycerides, serum LDL, serum VLDL and lower levels of serum HDL compared to non-smokers which was statistically significant. Conclusion: The present study provides a detailed profile of the plasma lipid and lipoprotein level according to cigarette/ beedis smoking status (smoker, ex-smoker and non-smoker) and dosage (number of cigarettes/ beedis smoked per day). Cigarette / beedi smoking is associated with significant lower levels of serum HDL and high levels of serum cholesterol, serum triglycerides, serum LDL levels.</p> Himanshu Goswami Shivcharan Jelia Pankaj Jain Devendra Ajmera Copyright (c) 2021 Himanshu Goswami, Shivcharan Jelia, Pankaj Jain, Devendra Ajmera 2021-10-20 2021-10-20 4 18 117 120 An Observational study to Compare the Clinical Outcomes of Antegrade and Retrograde Nailing in Humerus Fracture <p>Background: Fractures of the humeral shaft account for approximately 3% of all fractures. Intramedullary nailing is a minimally invasive osteosynthesis procedure. Aim: This study aimed to compare antegrade nailing with retrograde nailing with respect to clinical aspects of both the procedures. Methods: Patients aged 18 years or above with fracture humerus were consented to be enrolled for the study, excluding patient younger than 18 years of age, or patients with open fracture, or those with pre-existing elbow or shoulder problems. Clinical history of all patients were noted along with all clinical variables like mode of injury and associated injuries. Patients were followed up at 8,12,16 weeks and were assessed clinically and radiologically. Clinical outcomes of the patients were compared statistically. Results: We included 88 patients in this study, 34 underwent antegrade nailing and 54 underwent retrograde nailing. According to Orthopedic Trauma Association classification majority of the patients belonged to Type A. Operating bleeding was 80 ml in antegrade nailing and 50 ml in retrograde nailing, with no statistical difference. Operating time was found to be lower in antegrade nailing. However, fracture healing rate and time to healing were better in retrograde nailing (96% and 11.9 weeks), with statistical significance. Conclusion: Retrograde nailing had better perioperative and postoperative parameters like fracture healing rate and time to healing.</p> Narendra Kumar Sinha Copyright (c) 2021 Narendra Kumar Sinha 2021-10-20 2021-10-20 4 18 121 123 Recurrent abdominal Pain in Children – An analysis of the aetiological factors <p>Background: Recurrent abdominal pain (RAP) is common in children. One to two of every 10 children will experience it at some time. Children with recurrent abdominal pain are often anxious or depressed. Aim: To study the etiological factors related to RAP. Methods: Patients of age group of 4 to 14 years attending the paediatric OPD was included in the study. Children with age less than 4 years and more than 14 years not meeting the criteria of RAP were excluded from the study. Children with organic causes of RAP have been treated according to corresponding reason. Results: Occurrence of abdominal pain every day in ORAP was 10 and 32 NORAP children, and once per week in organic ORAP was 3 and 14 NORAP children. Duration of a pain episodes most of the day in ORAP was 11 and 21 NORAP children. Severe pain can see in 9 ORAP and 24 NORAP, and mild pain in 2 ORAP and 19 NORAP. Whereas, site of pain especially in periumbilical region in ORAP was 5 and 28 NORAP children, and lower abdomen pain in organic ORAP was 4 and 23 NORAP children. Moreover, 2 months duration of disease in ORAP was 17 and 3 NORAP children. In addition, presence of bloating in ORAP was 6 and 22 NORAP children, and absence of bloating in ORAP was 11 and 51 NORAP children. Presence of early satiety in in ORAP was 8 and 19 NORAP children, and absence of satiety in ORAP was 9 and 54 NORAP children. Conclusion: Recurrent abdominal pain (RAP) in children with careful history and examination, clear explanation and follow-up and a commitment from parent and child to stop the condition limiting normal activities, good results are obtained for children without referral, drugs or extensive testing.</p> Santosh Kumar Bir Prakash Jaiswal Copyright (c) 2021 Santosh Kumar, Bir Prakash Jaiswal 2021-10-20 2021-10-20 4 18 124 127 A Study Of Post Spinal Headache: The Effect Of Age And Gender On Its Incidence <p>Background: Post spinal headache is a common complication after spinal anaesthesia, lumbar puncture and myelography. Aim: The aim of study is to calculate the incidence of post dural puncture headache in non-obstetric patientsSubjects and Methods: A prospective observational study was conducted on 150 patients of ASA grade I and II admitted in the department of general surgery, orthopedic and gynecology under spinal anaesthesia. All patients were interviewed after 12 hours, 24 hours, 36 hour, 48 hours, 60 hours and 72 hours as regard to headache, its severity, location character, duration, associated symptoms like nausea, vomiting, auditory and ocular symptoms. PDPH was treated initially conservatively with bed rest, hydration, caffine intake, and analgesic (injection diclofenac 75 mg). If the PDPH persisted longer than 24 hour with same severity, epidural blood patch was considered before discharged from hospital. Results: The incidence of PDPH in young patients was 12.12% and in old patients were 3.44%. The incidence of PDPH in female was 12.5% and in male was 4.08%. The onset of PDPH after dural puncture among the patients who develop PDPH occurred within 24 hours in 33.3%, within 30 hours in 40% and within 36 hours in 26.6% of patients. PDPH was most commonly located in occipital region in 60% of patients. In 73.3% of patients the maximum severity was grade II. Nausea and vomiting was associated with severe PDPH. Conclusion : Severity of PDPH was mild to moderate. Female significantly have more risk of developing PDPH.</p> Madiha Shadab Shreya Saurav Shrutika Bhagat Binod Kashyap Copyright (c) 2021 Madiha Shadab, Shreya Saurav, Shrutika Bhagat, Binod Kashyap 2021-10-20 2021-10-20 4 18 128 131 Diagnostic Utility and Cyto-Histopathological Evaluation of Tzanck Smear For Bullous Lesions of Skin <p>Background and Objective: This study attempts to illustrate the importance of Tzanck smear and its Histopathological correlation. Methods:<br>The material for this study constituted patients selected from the Department of Pathology, Smt.Kashibai Navale Medical College and General Hospital, Narhe, Pune,India from January 2015 to December 2020.Results: The study group comprised of 26 females and 24 males, a total of 50 patients. Majority of patients are in 30 to 60 years of age group. Pemphigus group constituted the largest group with 58%, followed by Bullous Pemphigoid (28%), and Dermatitis Herpetiformis with 6%. One case each of Molluscum Contagiosum, Steven Johnson syndrome is among others. In our study, Tzanck smear was compared with histopathology &amp; found 89% sensitivity and 100 % specificity in Pemphigus Vulgaris. In Bullous Pemphigoid lesions, we found 71% sensitivity and 100% specificity when Tzanck smears are compared with Histopathology. Conclusion: Tzanck smear is inexpensive, minimally invasive rapid test with high sensitivity and low cost. It doesn’t need any expensive laboratory setup.</p> Chaitnya D. Khillare Aditya M. Nesargi Bageshri P. Gogate Yogesh R. Malwe Madhulika H. Katey Pooja V. Mishra Copyright (c) 2021 Chaitnya D. Khillare, Aditya M. Nesargi, Bageshri P. Gogate, Yogesh R. Malwe, Madhulika H. Katey, Pooja V. Mishra 2021-10-20 2021-10-20 4 18 132 134 Study of the clinical and cytological spectrum of Granulomatous Mastitis: A Retrospective Study in Bundelkhand Medical College Sagar MP <p>Background: Granulomatous mastitis (GM) is a benign condition, and therefore its early diagnosis is essential to avoid invasive surgery. The fine needle aspiration cytological (FNAC) features of GM have rarely been discussed in the literature.Aims and objectives: To study the various clinical and cytological presentations of GM and its differentiation from neoplastic lesions of the breast, thus avoiding time-consuming histopathological workup of cases.Materials and methods: Fifty-two cases of GM diagnosed on FNAC were studied between 2017 to 2021 retrospectively. The patient history, clinical findings, and the cytology slides of all the cases were retrieved and studied. Patient details including age, sex, presenting symptoms, obstetrics and lactational history, relevant past medical history, and treatment history were collected. The radiological diagnoses when present were also recorded. The patient's age, sex, history of recent childbirth or lactation, duration of symptoms, laterality of lump,nature of lump whether well-defined or diffuse, presence of discharging sinus,presence or absence of nipple retraction, and axillary lymph nodes were noted and analyzed. Cytological findings include the presence of epithelioid cells, as granulomas or in singles, multinucleated giant cells and their morphology, necrosis, caseous and non-caseous, and type of background inflammation of neutrophils, lymphocytes, and macrophages were also studied from the cytology slides.Results: All patients with GM except one were females (98.08%) with a mean age of 38 years. The majority had left side lump (69.23%) and the size of lump &lt;5 cm (88.46%). 48 (92.3%) patients had a palpable lump, and 8 (15.38%) had axillary lymphadenopathy. In USG, 28.85% had an abscess, 21.15% had irregular hypoechoic mass, and 15.38% had increased vascularity. On fine needle aspiration, blood mixed aspirate was obtained in 65.38% cases, whereas in 34.62% cases, pus was aspirated. On cytological smears, 30.77% of patients showed the presence of ill-formed granulomas, one case had scattered epithelioid histiocytes, and the rest of the cases had well-formed granulomas. Multinucleated giant cells, containing nuclei ranging from 5 to 8, were present in 2 (3.85%) cases, 27 (51.92%) cases also had a predominance of neutrophils among other inflammatory cells forming microabscesses, and 8 (15.38%) cases showed the presence of benign ductal cells of the breast.Conclusion: The common clinical findings include a positive history of recent childbirth or lactation along with results of the firm to hard unilateral palpable lump associated with skinulceration, sinus formation with or without discharge, nipple eversion, or retraction with any associated axillary lymphadenopathy. Epithelioid histiocytes, singly scattered or present as granulomas, multinucleated giant cells along with the background of caseationnecrosis, or neutrophils present in the background are the common cytological features. However, a confident diagnosis requires a multidisciplinary approach based on microbiological investigations, radiological correlation, and histopathological confirmation.</p> Shikha Agarwal Atul Jain Amar Gangwani Copyright (c) 2021 Shikha Agarwal, Atul Jain, Amar Gangwani 2021-10-20 2021-10-20 4 18 135 137 Role Of Interleukin 6, Ferritin, Troponin I, Procalcitonin and D Dimer in COVID 19: A Tertiary Care Centre Study In Central India <p>Background: COVID 19, a febrile respiratory illness caused by a novel coronavirus, severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), emerged in Wuhan China in December 2019. Cytokine storm and hyper inflammation consisting of elevated serum C-reactive protein (CRP), procalcitonin (PCT), D-dimer, and hyperferritinemia have been reported in COVID 19. Troponin I elevation is found in many studies. This is an attempt to study the role Of Interleukin 6, Ferritin, Troponin I, Procalcitonin and D Dimer in COVID 19 disease in Indian population. Material and methods: This is a retrospective observational study on 933 patients admitted for COVID 19. Data on demographic characteristics and laboratory tests were collected from electronic and paper medical records. Patients were categorized into mild and severe groups (MDG and SDG). Results: Serum levels of IL 6, ferritin, procalcitonin, troponin I and d dimer were compared in SDG and MDG, with statistically significant rise in SDG found in IL 6, Troponin I and D dimer, p = 0.00001, 0.012 and 0.001 respectively. Mortality rate was found to be 11.36 %. Inflammatory markers and D dimer showed significant rise in deceased patients as compared to survivors. Conclusion: Data on inflammatory markers is limited in patients with COVID-19 in India. We observed significantly raised IL 6, troponin I and PCT in severe COVID 19 and results showed their effectiveness of IL 6, PCT, Ferritin and D dimer in assessing disease severity and predicting mortality in patients with COVID-19.</p> Reema Bhushan Prakriti Gupta Reena Jain Copyright (c) 2021 Reema Bhushan, Prakriti Gupta, Reena Jain 2021-10-20 2021-10-20 4 18 138 142 Difficult Airway Assessment Score for Prediction of Difficult Intubation in Pre-Operative Assessment <p>Background:Maintaining a patent airway in anesthetized patients undergoing any procedure or surgery is very important for an anaesthesiologist. The vast majority of the airway-related events, especially inability to maintain patent airway, involve brain damage or death. Several independent bedside tests have been designed to predict a difficult airway or intubation but many have not gained popularity due to practical difficulties. So a new scoring system of Difficult Airway Assessment score based on ratio of patient’s height to thyromental distance, upper lip bite test, head and neck movements, modified mallampati test and neck circumference was developed.Objectives:To determine the diagnostic validity of Difficult Airway Assessment score in predicting difficult intubation defined by Intubation difficulty scale.Methods:This prospective study was conducted among 300 patients aged between 18 and 65 years with ASA physical status I, II and III who underwent elective surgeries under general anaesthesia with endotracheal intubation at a tertiary care centre. Patients with history of burns, trauma or surgeries to airway, any obvious airway anomalies, inability to sit, edentulous or need awake intubation were excluded from the study. The Difficulty Airway Assessment Scoring system was devised with the airway parameters of Modified Mallampati test, Upper Lip Bite Test, Ratio of Height to Thyromental Distance, Neck Circumference and Head and Neck Movements. Each airway parameter was assessed pre-operatively and assigned a score of 0, 1, 2 depending on the severity and summated all the individual scores. Wilson score was also calculated for all the subjects. The difficulty in intubation was assessed with Intubation difficulty scale.Results:Out of 300 patients, the incidence of difficult intubation was 12%. Modified Mallampati test had the highest sensitivity (61.1%) and head and neck movements had the highest specificity (95.5%). Upper lip bite test and head and neck movements had highest Positive predictive value (42.9%) and likelihood ratio (5.5). Accuracy was highest for head and neck movements followed by Upper Lip Bite Test and RHTMD. Difficult airway assessment score with cut off &gt;=3 had a sensitivity of 88.9%, specificity of 82.6%, PPV of 41%, NPV of 98%, likelihood ratio of 5.1 and the accuracy was 83.3%.Conclusion:Difficulty airway assessment score constructed using Modified Mallampati test, Upper Lip Bite Test, Ratio of Height to Thyromental Distance, Neck Circumference and Head and Neck Movements has a good predictive accuracy and was very much better compared to individual parameters.</p> Balasubramanian Seeralan Kavin Kumar Shanmugam Siva Shanmugam Copyright (c) 2021 Balasubramanian Seeralan, Kavin Kumar Shanmugam, Siva Shanmugam 2021-10-20 2021-10-20 4 18 143 149 Clinico-epidemiological study of female pattern hair loss (FPHL) with special reference to obesity and menstrual disorders in a tertiary care centre in North Eastern India <p>Introduction: Female pattern hair loss (FPHL) is the most common hair loss disorder in women. Initial signs may develop during the age between 21-40 years of age leading to a progressive hair loss with a characteristic pattern distribution. Women diagnosed with FPHL may undergo significant impairment of quality of life. The present study was done to find out the clinical profiles of FPHL and its correlation with obesity and menstrual irregularities in MGM Medical College &amp; LSK Hospital, Kishanganj, Bihar. Methods: This was a cross-sectional study where a total of 100 patients in a semi-urban tertiary care hospital that caters both urban and rural population of Bihar and adjacent areas of West Bengal. The study was conducted over the period of one year. Detailed history, physical examination and routine investigations were recorded for all patients. Results: Maximum (n=12) patients were in 21-25 years, followed by age group 25- 30 (n=11), and least in 31-40 (n=8) age group, the mean age was being 25.575 years. Maximum number of patients were suffering from disease from &lt;1 years duration. Family history of FPHL either in the paternal or maternal relatives, does not influence it’s the age of onset or severity. Obesity and PCOS are some of risk factors which should be addressed in patients with FPHL, for better treatment response and hence compliance. Hypothyroidism is one of the cause of FPHL The mean and SD value of Hb was 10.802 and + 1.139; and the serum ferritin level the values we found were 44.645 and +21.211 respectively. The P value was &lt;0.001 which is statistically significant. The mean and SD value of prolactin was 22.821 and + 10.799. In case of T3 level the values we found were 0.873 and +0.514 respectively. The score of Ludwig scale is -16. 42.5% (17) patients fall in grade II, 15(37.5%) patients fall in grade I and 8 (20%) patient fall in grade III. The result of hair pull test of the study group, Maximum number of patients i.e. 30 (75%) patients showed greater than 10% and 10 (25%) showed less than 10%. Showing Distribution of patients according to Ludwing scale and age group. From the above table we found that majority of patients i.e. 17(42.5%) patients belonged to Ludwing scale-II. Among these 17 patients maximum number of patients (58.3%) belonged to 21-25 years of age group. 16 patients (40%) belonged to Ludwing scale-I, in this group prevalence rate higher among the patients belonged to 26-30 years of age group i.e. 6(54.5%), and 8 patients belonged to Ludwing scale-III, in this group prevalence rate was higher 15-20 years age group 3(33.3%) patients. Conclusion: FPHL is a very common, non scarring form of hair loss occurring most commonly in postmenopausal women. Although hormonal factors and genetic predisposition contribute to FPHL, the complete mechanism remains elusive and the most affected women have normal androgen levels. Owing to the high prevalence of FPHL in Indian woman, while dealing with diffuse hair loss in females, we should consider FPHL as one of the aetiology and assess for the risk factors associated with it.</p> Kumar Satya Prakash Swarnali Sasmal Pranab Kumar Saha Copyright (c) 2021 Kumar Satya Prakash, Swarnali Sasmal, Pranab Kumar Saha 2021-10-20 2021-10-20 4 18 150 155 Histomorphological appraisal of orchidectomy specimens in a tertiary care centre of North Maharashtra-A descriptive observational study <p>Introduction:Testicular lesions are ranges from varied spectrum of non-neoplastic to neoplastic ones with diverse etiologies. Non-neoplastic testicular lesions usually preceded by neoplastic ones. The malignant tumors of testis constitute fourth most common cause of death in young males.<br>Objectives:The present study was undertaken to study varied spectrum of neoplastic and non-neoplastic lesions of testis in our tertiary care institute with emphasis on study of histomorphological patterns of testicular tumors.Material and Methods- Our study was a retrospective, descriptive and observational study over a period of 6 years from May 2015 to April 2021 in our tertiary care centre. We received 60 orchidectomy specimens over a study period. Histopathological slides were collected and reviewed for specific tumor/non-tumor category and results were analyzed.Results- We studied 60 orchidectomy specimens over a period of six years. As per age groups distribution, the childhood predominates in non-neoplastic category and 2nd to 4th decade in malignant category. Out of 60 cases (100%), majority (57%) were malignant testicular tumors. In the malignant category, non seminomatous germ cell tumor (56%) were most frequent finding with mixed germ cell tumor (68%) as predominant histopathological diagnosis. Leydig cell tumor and pure yolk sac tumor was rare findings. In non-neoplastic category, vascular causes (61%) like torsion, ischemic necrosis were major findings. Epidermoid inclusion cyst, acute and chronic orchitis, atrophy are rare findings.<br>Conclusion – Neoplastic lesions were preceded by non-neoplastic lesions in our study. Variable testicular tumors were encountered in present study as per different age groups. Histopathological spectrum of testicular lesions was comparable with other parts of the country. We highlight the role of histopathological examination of each resected orchidectomy specimens as it’s most important to diagnosis and rule out malignant tumors.</p> Dhiraj B Nikumbh Ajay D Subhedar Shakuntala L Shelke Roopali D Nikumbh Copyright (c) 2021 Dhiraj B Nikumbh, Ajay D Subhedar, Shakuntala L Shelke, Roopali D Nikumbh 2021-10-20 2021-10-20 4 18 156 161 Evaluation of the efficacy of Ormeloxifene in DUB <p>Background: Dysfunctional uterine bleeding (DUB) is a common gynaecological disorder that usually ends up in hysterectomy and causes psychological and physiological stress. Medical management with hormones and NSAIDS has inherited side effects. Ormeloxifene, a selective estrogen receptor modulator, is emerging as a safe and effective agent for dysfunctional uterine bleeding. The objective of the study was to evaluate the role of ormeloxifene in medical management of dysfunctional uterine bleeding.Methods: 60 patients, on whom diagnosis of dysfunctional uterine bleeding was made, were included in the study. Patients were given ormeloxifene 60mg. The primary outcome measures were menstrual blood loss (assessed by pictorial blood assessment chart score), hemoglobin concentration and endometrial thickness. The secondary outcome measures were acceptability and side effects of ormeloxifene.Results: There was a significant reduction in mean PBAC after treatment. The mean hemoglobin concentration increased significantly. The mean pretreatment endometrial thickness decreased significantly after treatment with ormeloxifene (p &lt; 0.05). 76.7% of the women showed marked subjective improvement in symptoms. The most common side effect reported was amenorrhea (13.3%).Conclusion: Ormeloxifene can be considered as an effective and safe therapeutic option for the medical management of dysfunctional uterine bleeding.</p> Sanghmitra Kumari Sushma Singh Ishmat Khanam Prem Sagar Chaudhary Copyright (c) 2021 Sanghmitra Kumari, Sushma Singh, Ishmat Khanam, Prem Sagar Chaudhary 2021-10-20 2021-10-20 4 18 162 164 An observational study of Central Corneal Thickness and Refractive Error <p>Background: Central corneal thickness (CCT) is an essential tool in the assessment and management of corneal disease. CCT has thus become very important for the interpretation of intraocular pressure and prerefractive procedure assessment; however little is known about its distribution within a population with wide range of refractive errors. AIM: To study the correlation of CCT with a broad range of refractive errors in rural population. Materials and Method: Prospective analysis of patients with refractive error presenting to the Ophthalmology outpatient services were included as cases. Age and sex matched emmetropic subjects were included as controls. Both cases and controls were undertaken for CCT measurements by ultrasonic pachymetry. Results: A total of 187 eyes as cases, 101 as controls. Among cases, 122 eyes myopic (Group- 1) (Mean CCT= 531.80±37.83 μ) and 65 hypermetropic (Group- 2) (Mean CCT=549.66±45.66 μ). The results shows that the central corneal thickness was decreased in the myopic eyes in comparison to the normal eyes which was statistically significantly (p=0.001). However in the hypermetropic group, no correlation was found between central corneal thickness and degree of hypermetropia. Conclusion: This study provides pilot data of CCT in different types of refractive errors which helps us in understanding the variation of CCT with refractive errors.</p> Ramakant Thakur Rajiv Kumar Singh Copyright (c) 2021 Ramakant Thakur, Rajiv Kumar Singh 2021-10-20 2021-10-20 4 18 165 167 Seroprevalence of Dengue infection in febrile patients at a tertiary care centre of Patna <p>Background : Dengue, an arboviral infection emerging as the most important mosquito-borne viral disease. It is a serious global public health problem. Currently there are no licensed vaccines or specific therapeutics to stop its rapid emergence and global spread. There are four serotypes of the virus and all four virus types circulate and cause epidemics. Clinical features of dengue virus infection include continous high fever lasting 2-7 days, rash with haemorrhagic tendency and joint pain. Efficient and accurate diagnosis of dengue is of primary importance for clinical care surveillance activities, outbreak control and vaccine development. For the prevention of dengue and other arboviruses, there is a need of developing and implementing preparedness plans. Dengue vaccines have been under development since the 1940s, but a tetravalent vaccine which simultaneously provides long-term protection against all DV serotypes is round the corner. AIM: To assess Seroprevalence of Dengue infection in febrile patients at a tertiary care centre of Patna. Methods : All clinically suspected patients tested for NS1 Ag &amp; IgM Ab by ELISA. Result: out of 9332 samples tested, 4710 samples tested were positive for dengue infection (50.47%) and the remaining 4622 (49.53%) samples were negative. Conclusion : The seroprevalence of dengue is high especially in post monsoon season. There is a need of special attention by the authorities for the control and prevention.</p> Archna S.N. Singh Mukesh Kumar Copyright (c) 2021 Archna, S.N. Singh, Mukesh Kumar 2021-10-20 2021-10-20 4 18 168 171 A Compararative Study to Evaluate Surgical Site Infections Using Diathermy and Scalpel <p>Background: The use of electrocautery for making skin incisions remains controversial. Aim: Its effect on the rate of Superficial Surgical Site Infection (SSSI) vis-à-vis scalpel use was compared in this study. Methods: A total of 100 patients undergoing open inguinal hernia repair were divided into two: 50 in Electrocautery group, 50 in Scalpel group. Patients were assessed for up to 30 days post-operatively by an assessor blinded to the method used for making skin incision. CDC/NHSN criterion for SSSI was adopted for wound assessment while grading was done using Southampton Wound Grading System. Results: Both groups had comparable mean age (p-value=0.29) and BMI (p-value=0.39). The difference in the incidence of SSSI (5 in Electrocautery, 7 in Scalpel group) on statistical analysis was found to not be significant (p-value=0.53).<br>Conclusion: We conclude that skin incision made with electrocautery is a safe alternative and a convenient method for performing surgeries.</p> Jaikant Paswan Bijendra Kumar Mishra V.S. Prasad Copyright (c) 2021 Jaikant Paswan, Bijendra Kumar Mishra, V.S. Prasad 2021-10-20 2021-10-20 4 18 172 174 To study the effect of septoplasty in relieving nasal obstruction and on quality of life <p>Septoplasty is a surgical procedure to correct the deviation of nasal septum. Nasal obstruction is the most common complaint in majority of these patients. There are two potential ways to assess the outcome of surgery after septoplasty: objective and subjective measures. Subjective assessment is done in our study with Nasal obstruction symptom evaluation (NOSE) scoring. In the present study the effectiveness of septoplasty in treating nasal obstruction and its effect on quality of life was evaluated.Method:A prospective randomized study was done on 100 patients with symptomatic deviated nasal septum. These patients underwent septoplasty between the study period of November 2018 to May 2020. Follow up was done for a period of 6 months after surgery. We used NOSE scoring to analyze the severity of symptoms both preoperatively and postoperatively and did diagnostic nasal endoscopy to compare the results and to look for residual deviations.Results:We found statistically significant improvement in mean NOSE score during the follow up visits. The mean value increment was 48.70 and 48.95 after 3 months and 6 months respectively following surgery (p &lt;0.0001). Each individual symptom score improvement was also compared which showed a significant improvement in all the four symptom scores out of five. Diagnostic nasal endoscopic evaluation also showed promising results with less residual deformity on follow up.Interpretation and conclusion:Septoplasty is an effective surgical procedure for deviated nasal septum which produces significant symptomatic relief for the patient. Nasal obstruction symptom evaluation (NOSE) questionnaire effectively assessed the improvement in quality of life among the symptomatic patients.</p> Sharmila Dhulipalla Copyright (c) 2021 Sharmila Dhulipalla 2021-10-20 2021-10-20 4 18 175 179 Evaluating Role of Mean Platelet Volume as a Measure of Glycemic Control in Type 2 Diabetes Mellitus Patients <p>Background: Diabetes mellitus (DM) has become a worldwide epidemic. Platelet indices can be used to interpret the effects of hyperglycemia on platelet function (mean platelet volume-MPV, platelet distribution width and plateletcrit). These parameters are also valuable in determining the aetiology of DM as well as the risk of disease development. The mean platelet volume (MPV) is a measurement of platelet size and activity on average. Larger platelets are younger and more active. Aims and Objectives: To study the mean platelet volume to measure glycemic control in type 2 diabetes mellitus (T2DM). Methods and materials: Two hundred subjects were studied after dividing them into Cases (n=100; subjects with T2DM) and Control (n=100 subjects without T2DM) at the Department of Medicine, Netaji Subhash Chandra Bose Medical College, and Hospital, Jabalpur (MP) from January 2018 to August 2019. Complete blood counts, random blood sugar (RBS), fasting blood sugar (FBS) and glycated hemoglobin (HbA1c), was estimated and recorded. People with diabetes with good glycemic control (patients with HbA1c&lt;7%) called Group A and diabetic patients with poor glycemic control (HbA1c≥7%) called Group B. The MPV in each group was compared. MPV, FBS, and post prandial blood sugar (PPBS) were compared between cases and control. Results: Age and gender distribution were similar between both the groups (p&gt;0.05). A strong positive correlation between HbA1c levels and MPV levels (r= 0.65; p&lt;0.0001). For every 1% increase in HbA1c level, there is a 2.28 fl increase in MPV among the study subjects. A positive correlation was obtained between RBS levels and MPV levels (r=0.42, p&lt; 0.0001). For every 100mg/dl increase in RBS, there is a 2.96 fl increase in MPV among the study subjects. Conclusion: MPV was greater in patients with poor glycemic control compared to those with good glycemic control. Hence, MPV can be used as a simple measure to assess the glycemic control in T2DM patients.</p> Shivendra Nagiya Sandeep Singh Copyright (c) 2021 Shivendra Nagiya, Sandeep Singh 2021-10-20 2021-10-20 4 18 180 182 A comparative study of conventional extra-capsular and small incision cataract surgery <p>Introduction: The small-incision cataract surgery is gaining popularity among the ophthalmic surgeons.Aim: To compare the visual outcome of conventional extra-capsular cataract extraction (ECCE) and small-incision cataract surgery (SICS).Materials and methods: A prospective interventional study without randomization was carried out including the patients undergoing cataract surgery by either conventional ECCE or manual SICS. They were followed up for 6 weeks postoperatively. The visual outcomes were compared between the two groups.Results: Of 85 patients, 44 (M: F=10:34) underwent ECCE and 41 (M: F=15:26) SICS (RR= 0.71, 95% CI=0.42-1.2, p value=0.16). Unaided visual acuity on the 1st postoperative day in the ECCE group was e”6/ 18 in 22.7%,&lt;6/18-6/60 in 63.6 %,&lt; 6/60 in 13.7%, whereas in the SICS group, the same was e”6/18 in 70.7%,&lt;6/18-6/60 in 22 %,&lt; 6/60 in 7.3% (95% CI = 0.23 – 0.48, p=0.001). Best corrected visual acuity on the 6th week follow-up in the ECCE group was e”6/18 in 79.5%,&lt;6/18-6/60 in 18.2 %,&lt; 6/60 in 2.3% and in the SICS group the same was 6/18 in 90.5% and &lt;6/18-6/60 in 4.9% (95% CI=0.44 – 0.73; p=0.0012).Conclusion: Both ECCE and SICS are good procedures for hospital based cataract surgery but within the 6 weeks postoperative period SICS gives better visual outcome. Remarkably higher number of female patients can be provided service in a hospital based cataract programme as compared to males.</p> Rajiv Kumar Singh Ramakant Thakur Copyright (c) 2021 Rajiv Kumar Singh, Ramakant Thakur 2021-10-20 2021-10-20 4 18 183 185 A study of the side effects of general vs spinal anesthesia during Caesarian Section Surgery <p>Aim : The present study was aimed to compare the side effects of general vs spinal anesthesia during caesarean surgery.Materials and methods: This study was conducted on 50 randomly selected participants. Of them 25 participants referred as case group A (treated with general anesthesia), and 25 participants were referred as case group B (treated with spinal anesthesia). Blood samples were collected before and after the operation to see the differences in WBCs, RBCs, Hemoglobin concentration and platelets count. Blood pressure and body temperature were also measured after operation. Other parameters were collected from patient's thick report or by direct interviewing questionnaire.Results: The mean age of the participants was 30.52 ± 4.608, majority of them have their first or second caesarean section. 23/25 (92%) of spinal anesthesia was decided with the doctor while 20/25 (80%) of general anesthesia was chosen the patient's themselves. Local pain and headache were clearly observed in spinal anesthesia while vomiting, fever, ICU admission and infection were very rare when using both types of anesthesia. Marked differences were observed in the hemoglobin concentration, RBCs count, WBCs count and platelets count when using the two techniques of anesthesia before and after operation.In our study, we observed in 40% of participants suffered from pain and 34% suffered from headache after operation in both groups A and B. No remarkable difference was noted on blood pressure range (but some participants have slightly decrease in BP). All participants have slight changes in WBCs, platelets count, RBCs count and Hemoglobin concentration. Conclusion: Differences were observed in the tested parameters between general and spinal anesthesia, and the decision for types of anesthesia was made according to patient's psychological behavior rather that her medical condition.</p> Deepak Kumar Ranjeet Kumar Bihari Praveen Kumar Tiwary Copyright (c) 2021 Deepak Kumar, Ranjeet Kumar Bihari, Praveen Kumar Tiwary 2021-10-20 2021-10-20 4 18 186 188 Effectiveness of Tens Versus Intermittent Cervical Traction in Patients with Cervical Radiculopathy <p>Background: Cervical radiculopathy is a dysfunction of nerve root of the cervical spine where C6&amp; C7 nerve roots are the most commonly affected. It encompasses important symptoms other than pain, such as paresthesia, numbness and muscle weakness in dermatomal or myotomal distribution of an affected nerve root. A multitude of physical therapy interventions have been proposed to be effective in the management of cervical radiculopathy, including mechanical cervical traction, manipulation, therapeutic exercises and TENS. Studies to find out the effectiveness of TENS versus Intermittent Cervical Traction among patients with Cervical Radiculopathy are sparse. Aim: The present study was undertaken to find out and compare the effectiveness of TENS versus Intermittent Cervical Traction a newer technique towards betterment in treatment of cervical radiculopathy patients. Methodology: 30 patients chosen based on the inclusion and exclusion criteria. Group A comprised of 15 people with cervical radiculopathy were given TENS with Isometric neck exercises and active neck movements. Group B comprised of 15 people with cervical radiculopathy were given Intermittent Cervical Traction with Isometric neck exercise and active neck movements. VAS Scale &amp; Neck Disability Index (NDI) were used as outcome measures pre &amp; post treatment. Results: The pre test evaluation showed that, there is no significant difference (P&gt; 0.05) between the two groups for all the variables measured. The post-test evaluation of both groups showed a very high significance (P&lt; 0.05) within the group for all the outcome measurements. A post-test comparison of measured variables, between the groups showed that the Group A demonstrated a statistically significant (P&lt; 0.05) reduction in pain and Neck Disability Index.Conclusion: From the above study concluded that TENS was more effective in the management of cervical radiculopathy along with isometricneck exercise, in reducing both neck &amp; arm pain, neck disability &amp; in improving activities of daily living.</p> Ravi Narayan Sinha Vinod Prasad Harsh Vardhan Munnu Prasad Singh Copyright (c) 2021 Ravi Narayan Sinha, Vinod Prasad, Harsh Vardhan, Munnu Prasad Singh 2021-10-20 2021-10-20 4 18 189 191 A study to evaluate Lipid profile between type 2 Diabetes mellitus without any complications and type 2 Diabetes mellitus with nephropathy <p>Introduction: bnormalities of lipoprotein metabolism is associated with Diabetic nephropathy(DN), which can be influenced by derangement of<br>renal function and the degree of metabolic control in diabetes mellitus.AIM: Our Aim is to compare the levels of lipid profile, urine<br>microalbumin and glycated haemoglobin (HbA1c) between type 2 Diabetes mellitus (T2DM) without any complications, T2DM with<br>nephropathy and normal controls who were age and sex matched.Materials and Method: Study group consisted of 75 individuals of whom 25<br>were T2DM without any complications, 25 were T2DM with nephropathy and 25 were healthy controls.Total cholesterol (TC), Triglycerides<br>(TG), LDL Cholesterol (LDL-c), HDL Chlolesterol (HDL-c), HbA1c and urine microalbumin were measured in these subjects.Results: The<br>values of TC, TG, LDL-c, HbA1c and urine microalbumin levels were significantly higher in T2DM without any complications and T2DM with<br>nephropathy when compared to controls. HDL- c level was significantly lower in T2DM without any complications and T2DM with nephropathy<br>when compared to controls.Conclusion: T2DM and DN are associated with dyslipidemia which is more pronounced in diabetic nephropathy.<br>Therefore, early detection of dyslipidemia in Type 2 diabetics and accordingly therapeutic intervention could control the resulting cardiovascular<br>or renal complications.</p> MD Abu Nasar Ram Ranjan Singh Brajesh Kumar Singh Khursheed Alam Copyright (c) 2021 MD Abu Nasar, Ram Ranjan Singh, Brajesh Kumar Singh, Khursheed Alam 2021-10-20 2021-10-20 4 18 192 194 Comparative evaluation of the effects of adjuvant clonidine to bupivacine with solo bupivacine for axillary brachial plexus block <p>Background: Peripheral nerve blockade has become an important and growing part of anesthesia. It offers an excellent substitute for patients<br>who are hemodynamically compromised or too ill to tolerate general anesthesia. However, there is no data available on the effect of clonidine<br>with bupivacaine in axillary plexus block or any peripheral nerve block.Aim: Therefore, present study was designed to compare the effects of<br>adjuvant clonidine to bupivacine with solo bupivacine for axillary brachial plexus block. Materials and Methods: The present prospective,<br>randomized, controlled, study was conducted in the Department of Anaesthesiology and Intensive Care. Patients were arbitrarily assigned to one<br>of the two groups of 30 patients each. Group I (n=30) Patients received 25 ml of Bupivacaine (0.5%) + 1 ml of normal saline. Whereas, Group II<br>(n =30) Patients received 25 ml of Bupivacaine (0.5%) + 1ml (150μg) clonidine. Results: It is evident that onset of motor block was 8.72 minute<br>faster in group I Bupivacaine clonidine patients. Duration of motor block was significantly high in Bupivacaine clonidine group patients<br>(440.4±42.18 min) compare to Bupivacaine group patients (198.33±27.86 min) with p value &lt;0.01. Duration of analgesic effects was<br>significantly high in bupivacaine clonidine patients in comparison of bupivacaine patients (718.6±40.6 min vs 512.8 ± 32.9 min, p&lt;0.01).<br>Conclusion: Findings of the current study suggest that use of clonidine as adjuvant to bupivacaine hasten motor and sensory block as well as<br>prolonged duration of analgesic effects in comparison of solo use of bupivacaine without inducing any side effects except some sedation in<br>postoperative period.</p> Shrutika Bhagat Madiha Shadab Shreya Saurav Binod Kashyap Copyright (c) 2021 Shrutika Bhagat, Madiha Shadab, Shreya Saurav, Binod Kashyap 2021-10-20 2021-10-20 4 18 195 198 Maternal Determinants in Full Dilatation Caesarean Section (FDCS): A Prospective Study in Tertiary Teaching Hospital in North Kerala <p>Background: Caesarean section (CS) is the most commonly performed abdominal operation in women in both industrialised and low-income<br>countries. CS at full cervical dilatation is a technically more challenging procedure than CS in early labour. Material and Methods:This<br>prospective case- control study was conducted at a tertiary care teaching institute from Aug 1 2019 to July 31 2020. It included all women (N = 90)<br>delivered by caesarean section. There were 103 caesareans out of which 37 were FDCS and 66 were first stage caesareans. Maternal variables<br>included age of the mother, maternal weight, obstetric score, spontaneous or induced labour and analysed the indications of primary caesarean.<br>The duration of surgery was defined as the time elapsed between skin incision and skin closure and measured.Results:Primigravidae constituted<br>73% in second stage caesareans and 47% of in first stage caesarean and hence a significant determinant of FDCS. Maternal and foetal weight<br>significantly increased FDCS rates. Mean gestational age was 39.08 and 38.72 weeks in second stage and first stage group and it was comparable.<br>We found that mean operative time was 18.4 minutes longer for FDCS when compared to first stage CS. Arrest of descent due to cephalopelvic<br>disproportion was the most common indication in FDCS (25.2%) followed by malposition, NRFHR and Failed vacuum. Patwardhan method<br>followed by pushing from below and breech extraction were methods adopted to deliver the impacted foetus.Conclusion: Decision making in<br>second stage caesarean section is often challenging and involvement of senior obstetrician is desired for decision making and for performing second<br>stage CS. Special attention should be provided to the patients undergoing FDCS.</p> Jensy Chembakassery Heera Shenoy T Copyright (c) 2021 Jensy Chembakassery, Heera Shenoy T 2021-10-20 2021-10-20 4 18 199 203 Visual Outcomes in Pediatric Cataract <p>Background- Childhood cataract is one of the leading causes of treatable blindness accounting for 7.4%–15.3% of pediatric blindness. Age at<br>presentation, age at the time of surgery and associated ocular abnormalities determine the outcome of pediatric cataract surgery. The main aim of<br>the pediatric cataract surgery is to provide a clear optical axis. The two main factors that affect the final outcome are amblyopia and posterior<br>capsular opacification. This study was conceptualized to study the visual outcomes, etiology and complications of pediatric cataract<br>surgery.Material and Methods: This prospective study included 71 eyes of 52 patients with childhood cataract &lt;18 years of age. Detailed history<br>and ocular history were taken. Relevant investigations for surgery and for establishing the etiology were undertaken. All the children underwent<br>irrigation and aspiration of lens matter with wide anterior capsulotomy, posterior capsulotomy and implantation of IOL. All children were followed<br>up for one year. Post-operative complications were managed accordingly and occlusion therapy for amblyopia was given in unilateral<br>cases.Results:The mean age at the time of surgery in our study was 6.5±1.22 years. There were 63.46% cases of unilateral cataract with more than<br>half of the cases being idiopathic in etiology. Vitreous thrust was the most common intra-operative complication (8.45%). Post-operative<br>inflammation manifesting as iridocycllitis was the most common early post-operative complication (15.49%) and posterior capsular opacification<br>was the most common late post-operative complication (25.35%). Final visual outcome was good in 43.66% cases with final visual acuity of &gt;6/24.<br>Conclusion:Management of childhood cataract is a challenging process. The age at which cataract is operated is very crucial for final visual<br>outcome. After cataract removal, regular update on refraction and occlusion therapy for amblyopia are crucial for achieving good visual outcome.</p> Sachit Mahajan Satish K Gupta Copyright (c) 2021 Sachit Mahajan, Satish K Gupta 2021-10-20 2021-10-20 4 18 204 207 Body image dissatisfaction and its relation to Body Mass Index, Self-esteem and Big Five Personality traits in India <p>Background: Body Image is known to be influenced by Body Mass Index (BMI), self-esteem and personality. Body image dissatisfaction (BID) is<br>associated with depression, anxiety, low self-esteem and maladaptive eating pattern. Therefore, it is important to identify factors that can contribute<br>to BID. Material and Methods: This study is observational cross-sectional study on 200 medical doctors in India. Data collection was by selfreported<br>questionnaires: Sociodemographic proforma, Body Shape Questionnaire-34 for BID, Rosenberg’s Self-Esteem Scale, and Big Five<br>Inventory for Personality traits. Results: Out of 200, 23.5% (n=47) participants had BID. BID significantly correlated with higher body mass index<br>(BMI) (r = .402, P = 0.000) and lower self-esteem (r = −-.200, P =0.004). Among the personality traits, neuroticism (r = .309, P = 0.000) showed<br>significant positive correlation and openness (r = -.309, P = 0.000) extraversion (r= -.139, P = 0.05) conscientiousness (r = -.188, P = 0.004)<br>agreeableness (r = -.176, P = 0.014) had significant negative correlation. Conclusion: BMI, self-esteem, personality have a role in BID and this<br>knowledge can be further utilized in identifying the contributing factors for development of BID and its psychiatric consequences which might<br>serve as targets for designing intervention.</p> Priyam Singh Kunjal Odedra Timirkant J Takwani Mukesh J. Samani Durgesh Shukla Copyright (c) 2021 Priyam Singh, Kunjal Odedra, Timirkant J Takwani, Mukesh J. Samani, Durgesh Shukla 2021-10-20 2021-10-20 4 18 208 213 Determine the Pattern of HRCT Findings in Active and Inactive Pulmonary Tuberculosis <p>Background: Tuberculosis (TB) is a common and frequently fatal infectious disease caused by Mycobacterium strains. The delay in diagnosis<br>leads to a delay in isolation of the patient, which increases the risk of infection spreading and the severity of the disease, and this delay in diagnosis<br>is caused by a variety of factors, so we aim to determine the pattern of HRCT findings in active and inactive pulmonary tuberculosis.Material and<br>Methods- This was the prospective descriptive clinical study carried out on 50 patients suspicious of Pulmonary Tuberculosis who underwent<br>HRCT Thorax. Patients suspected with tuberculosis, new patients (on treatment) and AFB positive included in study.Results- Most patients were in<br>40 – 60 year age group with Males comprising 54%, Females 46%. The common complaints patients presented were Cough, Fever, Nightsweats.<br>Ill-defined nodules, consolidation, tree-in-bud look, and cavitation were the most frequent HRCT findings in Active disease. Traction<br>bronchiectasis, atelectasis, calcified granulomas, and peribronchial thickening were the most prevalent symptoms of Inactive disease.Conclusion –<br>HRCT chest results can assist distinguish higher-risk individuals from those with active pulmonary tuberculosis but negative sputum smears. HRCT<br>is a helpful diagnostic and treatment tool because it can distinguish between active and inactive disease.</p> Shaik Ameenulla Hafeezuddin Pilli Srujana Bangaru Bhavani Vighnesh Kanugula Kowshik Manikonda Raghavender Reddy Copyright (c) 2021 Shaik Ameenulla Hafeezuddin, Pilli Srujana, Bangaru Bhavani, Vighnesh, Kanugula Kowshik, Manikonda Raghavender Reddy 2021-10-20 2021-10-20 4 18 214 219 Evaluation of Ascitic Fluid to Serum Bilirubin Ratio to Distinguish Transudates and Exudates <p>Background: Many diseases are known to lead to the formation of free fluid within the peritoneal cavity. The evaluation of a patient with ascites requires that the cause of the ascites to be established. Diagnostic paracentesis (50-100ml) should be part of the routine evaluation of the patient, with ascites. The present study was conducted to evaluate the ascitic fluid to serum bilirubin ratio to distinguish between transudates and exudates.<br>Material and Methods- The present prospective observational study was conducted at Departments of General Medicine and Medical Gastroenterology at Vydehi Institute of Medical Sciences and Research centre. Demographic data, history, clinical examination and details of investigations were recorded in the case record form, patients were subjected to specific investigations to find out the underlying etiology. Diagnostic paracentesis was done. All the data was analysed using SPSS software.Results- The sensitivity and specificity of Ascitic Bilirubin/Sr. Bilirubin ratio was 16.7% and 17.4% respectively. The PPV and NPV was 26.92% and 10.25% respectively using SAAG criteria. The sensitivity and specificity of Ascitic Bilirubin/Sr. Bilirubin ratio was 50% and 62.74% respectively. The PPV and NPV was 26.92% and 10.25% respectively using Light’s criteria.Conclusion – Our study concludes that diagnostic accuracy of Ascitic Bilirubin/Sr. Bilirubin ratio was very less when compared with SAAG criteria and better when compared with Lights criteria.</p> R. S. Vishnuvarthan Sanjana Rai Lokesh S Copyright (c) 2021 R. S. Vishnuvarthan, Sanjana Rai, Lokesh S 2021-10-20 2021-10-20 4 18 220 222 Comparative Study of Ropivacaine 0.75% Alone and Ropivacaine 0.75% with Dexmedetomidine 50 μg as Adjunct in Supraclavicular Brachial Plexus Block Using Peripheral Nerve Stimulator <p>Introduction: Supraclavicular brachial plexus block is preferred for its rapid onset, reliable anesthesia and as a safe technique for any surgery in the upper extremity that does not involve the shoulder. Aim: The aim of the present study is to compare haemodynamic, sensory and motor effects of Ropivacaine alone and Ropivacaine along with Dexmedetomidine in Supraclavicular Brachial Block in upper limb surgery. Methods and materials: The present study was carried out on patients undergoing elective upper limb surgery during the period from January- 2018 to August-2019. The study included total 60 patients belonging to ASA grade I and II of either sex with age between 18-60 years posted for various elective upper limb surgery.Results: There was no significant difference in the study groups with regards to demographic profile and duration of surgery. The onset of sensory and motor blockade was faster in group-RD than group-R. Onset of sensory block: (group-R=14.133± 1.676 min &amp; group-RD=12.667± 1.213min) (p=0.000), Onset of motor block :( group-R=25.967± 2.748min &amp; group-RD=23.333± 3.467min) (p=0.002). Also total duration of sensory blockade {Group R=547.833± 26.152mins, Group RD =811.667± 25.405 mins (p value = 0.000)}, motor blockade {Group R=509.667± 24.703mins, Group RD = 760.667± 28.062mins (p value = 0.000)} and number of rescue injections in 24 hours {Group R=2.733± 0.450, Group RD=1.400± 0.498 (p value = 0.000)} was significantly different in two groups. There was good haemodynamic stability in both groups. There was no incidence of any side effects in both groups.Conclusion: Dexmedetomidine in a dose of 50μg added to ropivacaine in supraclavicular brachial block for upper limb surgery significantly shortens the onset time and prolongs the duration of sensory and motor blocks without producing sedation in patients. Total number of rescue analgesics required in postoperative period is also less with use of Dexmedetomidine as an adjuvant to Ropivacaine.</p> Sairaj V P Sravani N Gorintha Copyright (c) 2021 Sairaj V, P Sravani, N Gorintha 2021-10-20 2021-10-20 4 18 223 227 A Comparative Study of Epidural 0.5%Bupivacaine with Nalbuphine And 0.5% Bupivacaine with Fentanyl in Lower Abdominal and Lowerlimb Surgeries <p>Background: Epidural opioids have unique advantages over conventional, intermittent IV/ IM administration, in that patients given epidural opioids have fewer respiratory complications and can be mobilized sooner in the postoperative period. Aim: To compare the effects of epidural 0.5%Bupivacaine with nalbuphine and 0.5%Bupivacaine with fentanyl in lower abdominal and lower limb surgeries. Methods and materials: A randomized, single blinded, clinical study was conducted involving 60 patients belonging to ASA Grade I &amp; II posted for elective infra umbilical surgeries. Patients were randomly divided into 2 groups of 30 each. Group A received 15ml of 0.5% bupivacaine + 1 ml of nalbuphine (10 mg); Group b received 15ml of 0.5% bupivacaine + 1 ml of fentanyl (50g).Results: Demographic parameters in both groups were comparable (p &gt; 0.05). Nalbuphine and fentanyl when used with Bupivacaine has comparable onset of time for sensory blockade and motor blockade. Total duration of sensory blockade is more with Nalbuphine and bupivacaine and has provided excellent analgesia in the immediate intraoperative and postoperative period. It produced postoperative analgesia for a period of 4-7hours. As reported in several studies Nalbuphine offered good cardiovascular stability without the risk of respiratory depression which was noted with fentanyl. No significant side effects were noted with epidural nalbuphine when compared to fentanyl.Conclusion: Epidural Nalbuphine with 0.5%bupivacaine significantly prolongs the total duration of sensory blockade with better postoperative analgesia when compared to Epidural Fentanyl with 0.5%bupivacaine.</p> A Sagar Maskuri Soujanya Madan Mohan Madaraboina Copyright (c) 2021 A Sagar, Maskuri Soujanya, Madan Mohan Madaraboina 2021-10-20 2021-10-20 4 18 228 234 Extrapulmonary tuberculosis in pediatric patients- A matter to worry??MRI <p>Introduction: Tuberculosis(TB) is still a major problem worldwide, it is estimated that, one third of the world population is affected with TB. Extrapulmonary TB accounts for 10-15% of tuberculosis worldwide. Pediatric TB is ignored mainly due to the fact that BCG vaccine will provide protection. Cartridge Based Nucleic Acid Amplification Test (CBNAAT) gives results in 4-5 hours and is therefore widely used. Aims and objectives: 1.To study the age and sex distribution of pediatric patients suspected to have extra pulmonary tuberculosis.2.To detect tuberculosis in extra pulmonary samples in pediatric patients by GeneXpert.3.To detect the rifampicin resistance in these cases.4.To evaluate the co-occurrence of HIV with tuberculosis in these cases.Material and methods: Retrospective study was conducted from 1st January 2016 to 31st December 2020. GeneXpert was done on all the clinically suspected cases of extrapulmonary tuberculosis. Results: Cerebrospinal fluid (CSF), Gastric lavage and Pleural fluid were the major samples received (31.15%, 29.91% and (22.94%) respectively. Majority of suspected patients were from less than 3 years age group (54.92%). Minimum age found was 1.5 month child. Males predominated females in clinically suspected cases M:F ratio was 1.37:1. 86.47% negative by GeneXpert and 12.29% were positive. Rifampicin sensitive were 8.61%, Resistant were 0.82%.In positive cases female outnumbered males. 3.28% pus samples were positive, 2.46% CSF was positive. There was no co-infection of HIV with Tuberculosis in our study. Conclusion: We found a rise in cases of extrapulmonary tuberculosis as compared to our previous study. This may be due to proper detection of cases, interaction with clinicians and encouraging them to send the suspected samples in microbiology department. CSF samples constituted 31.15% of total sample. This alarm us the increase in meningeal tuberculosis cases.</p> Priyanka Patil Madhuri Suryawanshi Ravidas Vasave Copyright (c) 2021 Priyanka Patil, Madhuri Suryawanshi, Ravidas Vasave 2021-10-20 2021-10-20 4 18 235 238 Lipid abnormalities in patients with newly diagnosed hypertension <p>Introduction: The coexistence of hypertension with other risk factors including dyslipidemia is well known. The pattern of dyslipidemia in<br>Indians is different from that seen in the Western population. There is limited data from India on dyslipidemia in patients with newly diagnosed<br>hypertension. Objective: To examine the serum lipid patterns and analyse the prevalence of dyslipidemia in patients newly diagnosed<br>hypertension. Methods and Material: Patients who had been newly diagnosed with hypertension were studied. Those with the past history of<br>dyslipidemia, coronary artery disease, diabetes mellitus, chronic kidney disease, or any other systemic illness were excluded. A sample size of<br>476 patients with a mean age of 53.81±13.74 years and male, 71% and female 29% were considered in the study. Lipids including, total<br>cholesterol (TC), triglycerides (TG), and high-density lipoprotein cholesterol (HDL) were measured for all patients and low-density lipoprotein<br>cholesterol (LDL) was calculated by Friedwald’s equation. Results: Out of the 476 patients, 75 patients (15.7%) had a normal lipid profile. Low<br>HDL (n=281, 59.0%) was the most common abnormality followed by elevated TG (n=175, 36.9%), elevated LDL (n=117, 24.5%) and elevated<br>TC (n=112, 23.7%). Among isolated lipid abnormalities, isolated low HDL was most commonly seen in 45.4% patients. A greater percentage<br>(n=213, 56.64%) of males with waist circumference above 90 cm had elevated LDL as compared to males with waist circumference below 90 cm<br>(p=0.01). Apart from higher TG levels, all the other parameters remained same in younger patients (age&lt;55 years) and in elders who were more<br>than 55 years. Conclusions: Our study found a high prevalence of dyslipidemia in patients with hypertension with low HDL being the dominant<br>abnormality. Considering that these lipid abnormalities were present in both young and old patients, a careful evaluation of the hypertensive<br>patient to uncover dyslipidemia is warranted.</p> Amitesh Aggarwal Nishant Raizada Ankur Chikara Ajay Kumar Gupta Niveditha Hariharan Copyright (c) 2021 Amitesh Aggarwal, Nishant Raizada, Ankur Chikara, Ajay Kumar Gupta, Niveditha Hariharan 2021-10-20 2021-10-20 4 18 239 244 A study on assess components of tracheostomy care involved in non ventilated tracheostomised patients <p>Aim&amp; Objective: The main aim of the present study to assess the compone nt s of tracheostomy care involve d in non ventilated tracheostomised patients . Methodology: It was a Prospec tive cohort study. The study was conducted at Department of ENT, Katuri Medical College during the year June 2017-May 2019. The satisfaction with life was deve loped to assesssatisfaction with respondent’s life as a whole . Fifty (50) t ra cheos tomi sed patients who are not vent ilator dependant. Results: The mean initial and final func tional aspec tive values are 5.50 and 3.00 respectively. The mean initial and final Psychological aspect ive values are 5.50 and 3.00 re spec tive ly which indicates very poor quality of life initially and with high s igni ficant increase in quality of life at final admini st ra tion of questionnaire with highly signif icant P value of 0.000. The mean initial and final social aspect ive values are 7.94 and 5.96 re spec tive ly which indicates very poor quality of life initially and with high signif icant increase in quality of life at final admini st ra tion of ques tionna ire with highly signif icant P value of 0.000 Conclusion: The functional , psychological and social aspects of quality of life improved over a period of time</p> Srinivasa Reddy Chilaka Vivekanandan Balakumar Copyright (c) 2021 Srinivasa Reddy Chilaka, Vivekanandan Balakumar 2021-10-20 2021-10-20 4 18 245 248 Fungal suppurative otitis media: Histopathology in central Uttar Pradesh <p>Background: Chronic suppurative otitis media (CSOM) is the infection of the middle ear that lasts for &gt;3 months and is accompanied by tympanic membrane perforation. The present study was conducted to assess cases of fungal suppurative otitis media with histopathology.<br>Materials &amp; Methods: 46 samples of chronic suppurative otitis media of both genders were received in 10% neutral buffered formalin. Routine hematoxylin and eosin (H&amp;E) stained sections were studied for histopathology. Special stains i.e. periodic acid-Schiff (PAS) and Gomori methenamine silver (GMS) were evaluated. Results: Out of 46 patients, males were 30 and females were 16. Common symptoms were pain in 40, itching in 34, ear discharge in 27, blocking sensation in 12 and decrease hearing in 17 cases. The histopathology revealed Aspergillus in 26, Mucormycosis in 10, Aspergillus+Candida in 7 and Aspergillus+Mucor mycosis in 3 cases. The difference was significant (P&lt; 0.05).<br>Conclusion: Most commonly fungus found was aspergillus followed by mucormycosis. Mixed infection was also observed in few cases.</p> Shambhavi Tripathi Shubhanshu Kumar Kanchan Garg Copyright (c) 2021 Shambhavi Tripathi, Shubhanshu Kumar, Kanchan Garg 2021-10-20 2021-10-20 4 18 249 250 A comparative study of derma roller therapy and fractional carbon dioxide laser technique in patients with post-acne scars <p>Background: Acne is a very common problem affecting more than 90% of adolescent population. The present study was conducted to compare<br>derma roller therapy (DT) and fractional carbon dioxide (CO2) laser technique in patients with post-acne scars. Materials &amp; Methods: 80<br>patients with post-acne scars of both genders were divided into 2 groups. Group I patients (40) were treated with derma roller therapy and group<br>II patients (40) were treated with fractional CO2 laser every 4 weeks. Goodman and Barons Qualitative Scale was recoded. Complications were<br>compared. Results: Group I had 22 males and 18 females and group II had 14 males and 26 females. 1 grade up was seen in 32 in group I and 30<br>un group II and 2 grade up in 8 in group I and 10 in group II. The complications recorded were post- treatment erythema in 3 in group I and 2 in<br>group II, oedema 4 in group I and 5 in group II and post- inflammatory pigmentation 1 in group I and 4 in group II. The difference was significant<br>(P&lt; 0.05). Conclusion: Both the modalities were effective in management of post acne scars.</p> Anurag Bhawna Kapoor Copyright (c) 2021 Anurag, Bhawna Kapoor 2021-10-20 2021-10-20 4 18 251 253 A Retrospective study of intrauterine fetal death cases and associated maternal conditions <p>Introduction: Intrauterine fetal death is an important indicator of maternal and perinatal health of a given population. This study was undertaken<br>to study the maternal and fetal factors associated with intrauterine fetal death. Materials and Methods: This was a retrospective study of<br>intrauterine fetal death and associated maternal conditions over a period of one year from January 2020 to December 2020 in the department of<br>Obstetrics and Gynaecology, Maharaja YashwantRao Hospital, Indore. The details were entered in a preformed proforma. The details of<br>complaints at admission, obstetrics history, menstrual history, examination findings, per vaginal examination findings, mode of delivery and fetal<br>outcomes, placental examination, condition of cord and investigation reports were recorded. Results: A total of 360 intrauterine fetal deaths were<br>reported amongst 8800 deliveries conducted during the study period. The incidence rate of intrauterine fetal death was 41/1000 live births. Three<br>hundred and fourteen deliveries were unbooked and unsupervised. The other observations were previous stillbirth (9.2%), gestational<br>hypertension (23.3%), antepartum hemorrhage (22%), and congenital malformations (CMFs) (16.9%).Conclusions: The incidence of intrauterine<br>fetal deaths in our population is higher than that reported from developed countries. This is associated with anemia, pregnancy-induced<br>hypertension, illiteracy, low socioeconomic status, and higher incidence of undiagnosed CMFs.</p> Mohini Rajoriya Sanju Agarwal Ayushi Bhardwaj Copyright (c) 2021 Mohini Rajoriya, Sanju Agarwal, Ayushi Bhardwaj 2021-10-20 2021-10-20 4 18 254 256 Comparison of the clinical effectiveness and intraoperative and postoperative complications of proximal femur locking compression plate (PFLCP) with dynamic hip screw (DHS) in the management of inter-trochanteric fracture <p>Background: Intertrochanteric femur fractures are a very common injury seen in the elderly. Understanding the pathophysiology as well as the proper treatment options will significantly decrease the risk of mortality and morbidity of this injury. Anatomically contoured proximal femur locking compression plate (PFLCP) is the latest addition to deal with these fractures, which creates an angular stable construct. It will theoretically lessen the risk of failure by screw cut-out and varus collapse, the common mode of DHS failure. Hence here we intended to study these two implants in inter-trochanteric fracture management regarding its clinical effectiveness and intraoperative and postoperative complications. Materials &amp; Methods: This study was done to prospectively compare, the rate of union, complications, operative risks and functional outcomes in inter-trochanteric fractures treated with dynamic hip screw (DHS) and Proximal femur locking compression plate (PFLCP). It also determined the effectiveness of PF-LCP in comparison to DHS in treatment of inter-trochanteric fractures. The data collected during the study of 30 cases of inter-trochanteric fractures, 15 cases were treated using PFLCP and other 15 group of cases were treated using DHS in the Department of Orthopaedics in Rajendra Institute of Medical Sciences, Ranchi from December 2012 to December 2014. Results: The functional outcome was measured with Harris Hip Score. In PFLCP group 7 (46.67%) cases had excellent result, 5 (33.33%) cases had good result, and 3 (20%) cases had fair result with no poor result. The mean score in PFLCP group was 86.4. In DHS group 7 (46.67%) cases had excellent result, 4 (26.67%) cases had good result, 2 (13.33%) cases had fair result and 2 (13.33%) cases had poor result. The mean score in DHS group was 83.4, although the PFLCP had better results but the difference between the two groups was not statistically significant P-value &gt;0.05. In PFLCP group there was varus malunion in 3 (20%) cases, shortening &gt;2cm in 2 (13.33%) cases. Delayed union was seen in 2 (13.33%) cases. No case of non union was seen. No case had Infection, bed sore, deep venous thrombosis and death. In 5 (33.33%) cases we failed to accommodate all three screws. There was no incidence of plate breakage or screw cut out. In DHS study group there were 4 (26.67%) cases with improper placement of the lag screw, shortening in 4(26.67%) cases and rotational deformity in 2(13.33%) case. Post operative superficial infection was seen in 2(13.33%) case. No case had deep venous thrombosis or death. Varus malunion was seen in 3(20%) cases and delayed union in 2(13.33%) cases, no case of non union was seen. Implant failure was seen in 1 case with screw breakage. Conclusion: PFLCP is a good option for the management of inter-trochanteric fracture with high union rate and low rate of complication with high functional outcome and with a possibility that it can be done without C-Arm.</p> Samuel Lakra Manju Boipai Jaiwant Joshua Murmu Lal Bahadur Manjhi Vijay Kumar Govind Kumar Gupta Copyright (c) 2021 Samuel Lakra, Manju Boipai, Jaiwant Joshua Murmu, Lal Bahadur Manjhi, Vijay Kumar, Govind Kumar Gupta 2021-10-20 2021-10-20 4 18 257 265 Assessment of cases of diabetic foot ulcers <p>Background: Diabetes prevalence is increasing in developing and developed countries all over the world. The present study was conducted to<br>assess cases of diabetic foot ulcers. Materials &amp; Methods: 60 cases of diabetic foot ulcers of both genders were enrolled. Parameters such as<br>complete blood counts, fasting and postprandial blood sugar levels, ESR, ECG were also done. Patients with diabetic ulcer foot were treated with,<br>debridement, split skin grafting, and amputation. Results: Out of 60, males were 32 and females were 28. Common risk factors were trauma in<br>45, infection in 51 and uncontrolled DM in 56. Associated diseases were diabetes mellitus in 60, hypertension in 42, diabetic neuropathy in 34,<br>family history of DM in 36. Presentation was cellulitis in 26, gangrene in 14 and ulcer in 20 cases. The difference was significant (P&lt; 0.05).<br>Conclusion: Common risk factors were trauma, infection and uncontrolled DM. Presentation was cellulitis, gangrene and ulcer.</p> Uzair Athar Mohd Ajmal Ashish Kumar Tripathi Copyright (c) 2021 Uzair Athar, Mohd Ajmal, Ashish Kumar Tripathi 2021-10-20 2021-10-20 4 18 266 268 A study of health care seeking behavior of elderly in the rural area of Eastern Uttar Pradesh <p>Background: Ageing is a complex process, influenced by many factors. The present study was conducted to assess health seeking behavior of<br>elderly. Materials &amp; Methods: The present study was conducted on 540 elderly aged 60 years and above of both genders. A through clinical<br>examination was performed. Type of morbidity was recorded. Results: Out of 540 subjects, males were 380 and females were 160. Common<br>morbidities in elderly was diabetes mellitus seen in 280, hypertension in 265, Cancer in 110, vision impairment in 340, gastroenterology in 315,<br>respiratory in 470, cereberovascular in 180, musculoskeletal in 480 and genitourinary in 235 subjects. The difference was significant (P&lt; 0.05).<br>120 seek no medication, 220 self medication, 80 traditional, 110 allopathic and 50 ayurvedic. Conclusion: Authors found that there is rise in<br>elderly people in the country in last couple of years. Common morbidities in elderly was diabetes mellitus, hypertension, cancer, vision<br>impairment, gastroenterology, respiratory, cereberovascular, musculoskeletal and genitourinary ailments.</p> Alpana Saxena Copyright (c) 2021 Alpana Saxena 2021-10-20 2021-10-20 4 18 269 271 Comparison of 1% Chloroprocaine and 1% Chloroprocaine With Clonidine In Daycare Surgeries Under Spinal Anaesthesia: A Prospective, Randomized, Double Blind study <p>Background and Aims: Delayed ambulation due to prolonged residual blockade and urinary retention with Bupivacaine and Transient<br>Neurological symptoms with Lignocaine have been the main limitation of spinal anaesthesia for day care surgery. Preservative free 1%<br>Chloroprocaine is an alternative to Lidocaine in day care surgery. We compared the efficacy of 1% Chloroprocaine alone and with Clonidine in<br>patients posted for day care surgeries under spinal anaesthesia. Methods: 60 patients were randomly divided into two groups (n=30 each). Group<br>C patients received 30 mg of 1% Chloroprocaine and Group CC patients were given 30 mg of 1%Chloroprocaine with 30 mcg Clonidine<br>intrathecally. Time for onset, duration of sensory and motor block, Peak level dermatome, duration of analgesia and time of first mobilization was<br>noted. Results: Time of onset of sensory and motor block were faster in Group CC (P&lt;0.05). Higher peak level dermatome achieved in Group<br>CC. Duration of motor block was increased with addition of Clonidine (69 min.vs76 min;P=0.006),prolonged duration of analgesia in Group CC<br>as compared to Group C (193 min vs100 min;P= 0.00) and prolonged time of first mobilization in Group C vs Group CC (120 min vs 210 min)<br>were the main observations.. No subject reported any Transient Neurologic Symptom. Conclusion: Addition of Clonidine as an adjuvant to<br>Chloroprocaine in low doses provides early onset and prolonged sensory and motor block, prolonged duration of analgesia along with improved<br>quality of spinal anaesthesia in comparison to Chloroprocaine alone.</p> Dilip Kothari Priyanka Goyal Suman Gupta Copyright (c) 2021 Dilip Kothari, Priyanka Goyal, Suman Gupta 2021-10-20 2021-10-20 4 18 272 274 An invitro study to understand the relation between apical seal and apical preparation diameter <p>Background: The current recommendations for the apical preparation diameter, one of the most important mechanical imperatives in the apical<br>third preparation is to preserve the apical foramen in its original position along with its narrowest diameter in order to avoid any complication<br>such as tearing, zipping, or transport of the foramen. Objectives: The aim of our study is see the correlation between apical seal and apical<br>preparation diameter. Methodology: Freshly extracted 90 central incisors were selected and they were randomly allocated into 3 experimental<br>groups of 30 teeth each. Group 1: Canals were prepared up to size 20 corresponding by Coltene Hyflex rotary system coinciding F1. Group 2:<br>Canals were prepared up to size 30 by Coltene Hyflex rotary system coinciding F3. Group 3: Canals were prepared up to size 50 by Coltene<br>Hyflex rotary system coinciding F5. After the filing of the root canals, the teeth were isolated and immersed in a dye solution, then cut<br>longitudinally, photographed, and the dye penetration were calculated using a computer software. Results: The comparison of three different<br>apical preparation sizes showed no statistically significant differences regarding the apical microleakage. Conclusion: The most important value<br>of the dye penetration was observed in the group with the largest apical diameter.</p> Abdulelah Sameer Sindi Youssef Abdullah Algarni Shafait Ullah Khateeb Suheel Manzoor Baba Copyright (c) 2021 Abdulelah Sameer Sindi, Youssef Abdullah Algarni, Shafait Ullah Khateeb, Suheel Manzoor Baba 2021-10-20 2021-10-20 4 18 275 277 A comparative evaluation of management of tuberculosis patients <p>Background: Tuberculosis is still one of the major causes of mortality and morbidity in the world population. The present study was conducted to evaluate different treatment management of tuberculosis patients. Materials &amp; Methods: 46 tuberculosis patients of both genders were divided into 2 groups. Group I comprised of 23 patients who received tab. Isoniazid, rifampicin, pyrazinamide and ethambutol 7 days/ week for 56 doses (8 weeks) and group II also comprised of 23 patients who received tab. Isoniazid, rifampicin and ethambutol 7 days/ week for 56 doses (8 weeks). Treatment outcome in both groups was compared. Results: Group I had 15 males and 8 females and group II had 16 males and 7 females. Smoking was seen in 12 and 10, alcoholism in 4 and 6 and smoking+ alcoholism in 7 and 8. New cases were seen among 10 and 9, relapse cases were 12 and 10 and failure was 1 and 4 in group I and II respectively. Treatment outcome was success cases 17 in group I and 15 in group II. Failed 3 in group I and 5 in group II, died 1 in group I and 2 in group II and lost follow up 2 in group I and 1 in group II. The difference was significant (P&lt; 0.05). Conclusion: Group I patients had less failure cases and high success rate than group II patients.</p> Mazhar Alam Mohd. Ajmal Faraz Ahmad Copyright (c) 2021 Mazhar Alam, Mohd. Ajmal, Faraz Ahmad 2021-10-20 2021-10-20 4 18 278 280 To Investigate the Incidence and Severity of Hearing Loss Caused By Chemoradiotherapy in Head and Neck Cancer Cases <p>Background: In head and neck oncology, treatment-induced hearing loss has been reported in patients treated with high-dose cisplatin chemoradiotherapy (CRT). The present study was conducted to investigate the incidence and severity of hearing loss caused by chemoradiotherapy in Head and Neck cancer cases. Materials &amp; Methods: All patients with head and neck cancers who visited the Department of Otorhinolaryngology and Head and Neck surgery and undergone treatment, after histological confirmation, at the Department of Radiation Oncology at Sardar Patel Medical College, Bikaner, Rajasthan from November 2019 to October 2020 were taken up for the study. 80 patients were included in the study out of which 40 undergone concurrent chemoradiation. Patients with concurrent chemoradiotherapy were selected for the study. Data was entered in Microsoft Excel and was subsequently imported to Statistical package for the social sciences (SPSS) free version 21.0 and Epi info version 3.0 for analysis. Results: 80 patients were included in the study out of which 40 undergone concurrent chemoradiation. Hearing levels were documented before starting of treatment, after completion of treatment and 3 months of follow up. Our study consisted of 80 subjects out of which 52 (65%) were male and 28 (35%) females. The age of the subjects ranged from 30 to 60 years, with highest number of patients belonged to the age group of 51-60 (57.5%) years. In our study, majority of the patients had carcinoma oral cavity (35%) followed by Larynx (28.75%), Hypopharynx (16.25%), Oropharynx (8.75%), Nose &amp; PNS (6.25%), Nasopharynx and Occult primary with secondary neck (each 2.5%). In patients having RT+CT , 45% had conductive hearing loss after completion of treatment which declined to 30% after 3 months follow up. Otitis media with effusion and Eustachian tube dysfunction are temporary and reversible side effects of the irradiation of the ear. Conductive hearing loss develops as a reversible side effect of radiation of the ear. The impact of radiation dose on hearing loss was studied and was found that patients with radiation dose less than 60 Gy showed no hearing loss. Dose of the radiation is proportional to development of ototoxicity. Total radiation dose of minimum 60 Gy is required to produce noticeable ototoxic effects.Conclusion: Thus, we conclude that patients who received concomitant chemoradiation experienced greater hearing loss. Hearing loss was evident after 1 month of therapy and was persistent. The incidence and severity of hearing loss increased with time and higher frequencies were affected predominately. High-frequency hearing loss can have a significant impact on quality of life because it affects speech discrimination. It is recommended to perform a pre-treatment and post- treatment audiological evaluation with special emphasis on high frequencies.</p> Devendra Singh Chawra Suresh Jakhar Ram Chander Bishnoi Charu Prabhakar Vivek Samor Copyright (c) 2021 Devendra Singh Chawra, Suresh Jakhar, Ram Chander Bishnoi, Charu Prabhakar, Vivek Samor 2021-10-20 2021-10-20 4 18 281 284 To study the levels of serum sodium and potassium in newly diagnosed essential hypertensive patients <p>Background: Essential hypertension comprises more than 90% of hypertension. Unfortunately even in developed nations like the United States, around fifty million subjects are diagnosed with hypertension. An acute high intake of sodium in the form of salty meals, leads to a temporary rise in blood pressure and is associated with several other significant diseases. The present study was conducted with the aim to study the levels of serum sodium and potassium in newly diagnosed essential hypertensive patients. Materials and methods: The study consisted of 100 newly diagnosed primary hypertensive patients attending the medicine OPD . Around 100 healthy people were kept as controls. Subjects below 30 years of age or subjects with any other co morbidities were excluded from the study. All the peripheral pulses were checked. The blood pressure was measured using the standard guidelines. Overnight (12 hour) fasting blood sugar, urea, serum creatinine, sodium and potassium were estimated . All the data thus obtained was arranged in a tabulated form and analysed using SPSS software. Results: There were 8% underweight subjects with Grade II hypertension. Overweight subjects were 6% with Grade I hypertension and 14% with Grade II hypertension. The mean systolic pressure was 174.15 ± 15.10 amongst cases and 104.23 ± 6.36 amongst the controls. The mean sodium level amongst the cases was 146.45 +/-4.55 while that amongst the controls was 169.8 +/-3.25. Conclusion: Our study shows a positive correlation between hypertension and sodium levels. Hypertensive subjects had increased sodium levels.</p> Hariprasad S Neha Sukhani Muralidhar T Copyright (c) 2021 Hariprasad S, Neha Sukhani, Muralidhar T 2021-10-20 2021-10-20 4 18 285 287 Evaluating laboratory parameters for diagnostic accuracy in COVID-19 patients in a tertiary care Government Hospital in Greater Noida, UP, India <p>Introduction: The occurrence, development, mechanism of prognosis and immune status of patients with COVID-19 are still unclear. Timely identification of virus carriers is vital not only to prevent their spread but also to more efficiently control disease progression. Objective: In this study, we have assessed the hematological characteristics of the patients. This study aimed to evaluate the accuracy of laboratory parameters in predicting cases with positive RT-PCR for COVID-19. Material and Methods: This was a cross sectional study that included 67 RTPCR +ve and 69 RTPCR -ve cases over a period of 5 weeks. The blood samples were collected from symptomatic patients presented to the cough OPD of the hospital and undergoing RT-PCR testing for Covid-19 between 9am to 4 pm on consecutive working days till the sample size requirement was met. On the day of swab sampling, blood sampling was done for each participant included in our study as mentioned in the sampling method above. All tests were performed in an appropriate autoanalyser after complying internal quality control. Results: The mean age of patients included in this study was 34.1 (24.05) years. The mean CT value among RTPCR positive patients was 22.7 (SD 4.99) with mean(SD) values of PCT, ferritin, D-dimer, LDH and CRP was 1.30 (SD 2.52), 197.2 (SD 284.40), 1.7 (SD 2.08), 353.5 (SD 186.43) 20.5 (SD 37.58) respectively . On the other hand the mean(SD) value of PCT, ferritin, D-dimer, LDH and CRP was 0.045 (SD 0.073), 84.6 (SD 137.51), 1.1 (SD 1.70), 328.5 (SD 99.84) and 5.7 (SD 16.67) respectively in the RTPCR negative patients. The sensitivity and specificity for procalcitonin analysis among these patients were 97% with CI (93.8-100) followed by serum ferritin with 82%, CI (70-94) and CRP levels were having just 77.3%, CI (61.2-93.4). Conclusion: In the current study, the AUC of procalcitonin and serum ferritin were above 0.80; thus, they are effective markers and have very good predictive value for predicting COVID-19. The mean values in the RTPCR positive patients were significantly high for the biochemical markers namely procalcitonin, ferritin and CRP whereas the mean levels of total protein and albumin were significantly lower among RTPCR positive patients compared to RTPCR negative patients. It seems that these blood laboratory parameters could be used in screening cases with positive RT-PCR for COVID-19. However, serum LDH, D Dimer, and vitamin D3 levels or liver function tests, renal function tests remain insignificantly linked with covid-19 positivity rate in this study.</p> Mamta Padhy Ajay kumar Garg Hariom Kumar Solanki Ravoori Saideswar Rao Manisha Singh Vivek Gupta Copyright (c) 2021 Mamta Padhy, Ajay kumar Garg, Hariom Kumar Solanki, Ravoori Saideswar Rao, Manisha Singh, Vivek Gupta 2021-10-20 2021-10-20 4 18 288 293 Comparative study of functional outcome of displaced paediatric supracondylar humerus fracture fixed with two lateral or crossed percuteneous kirschner-wire after closed reduction <p>Introduction: Supracondylar humerus fractures (SCH) are more common in the pediatric population than in the adult population. Children often utilize an outstretched arm as a protective mechanism when falling, creating a high incidence of fractures about the elbow. Supracondylar fractures of the humerus account for up to 18% of pediatric fractures overall, and up to 60% of elbow fractures. The modified Gartland classification is often used to describe fracture patterns and guide treatment. These injuries can be significant due to the risks of neurological damage, vascular injury, and compartment syndrome. Inadequate reduction and fixation can also lead to malunion and deformity. Some patients who develop a malunion but may have a satisfactory function in the long-term. Case series: In this study, we had studied the correlation of supracondylar fracture fixation, 30 cases with cross k wire fixation and 30 cases with 2 lateral k wire fixation . Our study concluded that Cross and lateral k wire pin fixation of Supracondylar fracture humerus result in similar construct stability and functional outcome. Conclusion: Our study concluded that Cross and lateral k wire pin fixation of Supracondylar humerus fracture (SCH) result in similar stability and functional Range of motion. Although ulnar nerve injury was 3.33% more likely in the crossed K-wire group, the overall incidence of this complication and other complications was very low.</p> Surendra Singh Yadav Vikas Singhal Vivek Dhakad Tarun Naugraiya Satyam Kumre Copyright (c) 2021 Surendra Singh Yadav, Vikas Singhal, Vivek Dhakad, Tarun Naugraiya, Satyam Kumre 2021-10-20 2021-10-20 4 18 295 299 A prospective observational study on thyroid malignancy in a tertiary care hospital <p>Introduction: Thyroid cancer constitutes a heterogeneous group of malignancies which exceeds half a million cases annually, ranking it as the fifth most common cancer worldwide. Head and neck cancers account for 6% of all cancers worldwide, with nearly 150,000 new cases in Europe alone each year. Materials and Methods: This prospective, observational, and clinical study on thyroid cancer was conducted in Department of General Surgery, JSS Academy of Higher Education and Research, Mysuru, India from July 2019 to December 2020. This study includes patients selected on a non-probable convenience sampling method with histopathologically confirmed TC cases. The informed consent was obtained from the participant before being enrolled. The IBM SPSS program for Windows was used to analyse the results. Sampling technique used is nonprobability sampling. Statistical tests used are univariant analysis, proportions and percentages. Results: During this study period, 700 patients are admitted to the hospital with various newly diagnosed oncological diseases, including Fourty one thyroid cancer patients. Five patients are excluded from studies. Three of them had benign lesions in the postsurgical histopathological examination. Two patients lost during the follow-up period. A total of Thirty six patients were considered for final analysis; thus, thyroid cancers accounted for 2.39% of oncological disease. Females are commonly affected than men with a ratio of 5:1. The population standard deviation is σ 12.55 Table 1. Conclusion: The incidence of thyroid malignancies is more common among women (80.66%) than men. Papillary carcinoma (86.11%) is the common differentiated thyroid cancer. The prevalence of distant metastasis is 2.78% to the vertebral body. In our study, 41.66% of patients belongs to less than 30 years of age; this may be due to the trend of over diagnosis due to the introduction of ultrasonography guided Fine needle aspiration study.</p> Hareesh H D Harish Iyyanna Preethi S.P. Copyright (c) 2021 Hareesh H D, Harish Iyyanna, Preethi S.P. 2021-10-20 2021-10-20 4 18 300 303 Efficacy of total contact cast application versus conventional dressings in the management of plantar diabetic ulcers <p>Introduction: Neuropathic ulcers are the prime precipitant of diabetes-related amputations of the lower extremity. Traditionally, diabetic foot ulcers are treated with regular dressings with frequent debridements with minimal weight bearing on the affected foot. The key element of any treatment programme designed to heal these wounds is effective reduction in pressure (offloading). Materials and Methods: This study was carried out in the Department of General Surgery, JSS Academy of Higher Education and Research, Mysuru, India from January 2020 to December 2020. This is an observational study and the data was collected prospectively. All diabetic patients with foot ulcers, who were admitted as in-patients, who gave consent, meeting the inclusion criteria were enrolled in the study. Patient’s history, clinical, biochemical and radiological data were collected. Results: A total of 50 patients were included in the study. In that, the average age of patients in Group P was 55.6 years and in Group C was 57.8 years. Group P had 17 males and 8 females and Group C had 18 males and 7 females. Average duration of diabetes in Group P was 6.7 years and in Group C was 5.6 years. Mean HbA1c values of patients in Group C was 8.4% and in Group P was 8.3%; 73% of patients presented with ulcer secondary to trauma and in 27% of the patients the cause was unknown or had spontaneously occurred. Conclusion: Surgical debridement is the cornerstone of management of diabetic foot ulcers. Purified placental extract dressings showed faster and better healing rates when compared with conventional dressings.</p> Hareesh H D Preethi S.P Harish Iyyanna Champa B V Copyright (c) 2021 Hareesh H D, Preethi S.P, Harish Iyyanna, Champa B V 2021-10-20 2021-10-20 4 18 304 306 A study to assess the effect of intravenous dexmedetomidine oncis-atracurium induced neuromuscular blockade -A prospective double blind randomized controlled study <p>Introduction: Ideal neuromuscular blocking agent should act through the mechanism of nondepolarizing agent, have rapid onset of action, be highly potent, have rapid recovery and completely reversible by cholinesterase inhibitors, should not release histamine, should have good hemodynamic stability, with pharmacologically inactive metabolites and effects should be non-cumulative. Materials and Methods: Sixty patients of ASA physical status 1 &amp;2 aged 18-60 years of both gender undergoing general anaesthesia for surgery lasting less than 2 hours were randomly allocated into two groups (n=30), group D received dexmedetomidine 1μg/kg iv diluted to 10 ml infusion and group C received equal volume of normal saline infusion ten mins prior to propofol induction and both groups were relaxed with Inj cisatracurium 0.15mg/kg. Neuromuscular transmission was assessed by NMT (Avance GE). Time of onset of neuromuscular blockade i.e time to achieve TOF count 0, duration of neuromuscular blockade ( till TOF ratio of 0.6 / TOF count of 2) and recovery time that is time from administration of reversal at TOF ratio of ≥0.65/TOF 3 till extubation was noted. Infusion of normal saline or Inj dexmedetomidine 0.5μg/kg was started at the same rate via infusion pump during maintenance. Anaesthesia was maintained with oxygen, nitrous, isoflurane and Inj cisatracurium 0.03 mg/kg iv boluses for muscle relaxation. Results: In the control group mean duration was 46.80 ± 6.74 min and recovery time was 15.93 ± 2.79 min and in dexmedetomidine group mean duration was 60.40 ± 9.36 min and recovery time was 19.60 ± 2.82 min, which is statistically significant however there was no significant difference in mean time taken for onset of neuromuscular blockade. Conclusion: Intravenous dexmedetomidine prior to induction and during maintenance prolongs duration and recovery of cisatracurium induced neuromuscular blockade.</p> Sudha Shree P Savita Patil Vandana Hebballi Copyright (c) 2021 Sudha Shree P, Savita Patil, Vandana Hebballi 2021-10-20 2021-10-20 4 18 307 315 A study of various hepatic manifestations in dengue fever and their correlation with severity of dengue fever <p>Background: Dengue is the most crucial of the arboviral infections amongst humans. The incidence of Dengue fever and Dengue hemorrhagic fever has drastically increased in the recent years. The higher involvement of younger ages and increase in the incidence of epidemics are indicators of higher occurrence of infection. The mortality rate from complications is as high as 20%, while if they are properly managed, the mortality rate reduces to less than 1%. The present study was conducted with the aim to determine various hepatic manifestations in dengue fever and their correlation with severity of dengue fever. Materials and methods: The present prospective study was conducted on cases of Dengue fever (DF) and Dengue hemorrhagic fever reporting at RIMS Hospital. Adults positive for IgM alone or both IgM and IgG were followed up for clinical profile. Complete blood profile including hematocrit was repeated daily during the acute phase of the illness and chest X-ray was taken to demonstrate pleural effusion amongst the cases. The clinical manifestations and laboratory findings of each group of illness was compared using chi-square or fisher’s exact test for proportions and analysis of variance (ANOVA) for continuous data. Results: There was a male predominance in the study with 66.7% males having dengue fever. There was statistically no significant difference in the demographic variables. Fever was observed in 60% of the cases with Infection and 100% patients had fever in dengue. Vomiting was observed in 93.3% cases with dengue fever and 100% cases had body pains. Conclusion: The incidence of dengue infection in increasing in developing countries like India and different degree of hepatic complications has been observed.</p> Hariprasad.S Neha Sukhani Muralidhar.T Copyright (c) 2021 Hariprasad.S, Neha Sukhani, Muralidhar.T 2021-10-20 2021-10-20 4 18 316 318 A comparative study of magnesium sulphate v/s clonidine as adjuvants to intrathecal hyperbaric bupivacaine under spinal anaesthesia for infraumbilical surgeries <p>Introduction: Spinal anaesthesia is the most common technique of regional anaesthesia used for lower abdominal and lower limb surgeries. Local anaesthetic Bupivacaine is the commonly administered drug. Many adjuvants to local anaesthetic have been used for intraoperative as well as post-operative period. In this study magnesium sulphate and alfa 2 adrenergic agonist Clonidine are used as adjuvant to hyperbaric bupivacaine. In this study we evaluate and compare the characteristics of spinal block and side effects in patients undergoing infraumbilical surgeries who received a subarachnoid block with either bupivacaine with magnesium sulphate or with clonidine. Methods: 90 patients of ASA I/II physical status undergoing elective infraumbilical surgeries were randomised into 2 groups. Group M (n=45) patients received 2.5ml of 0.5%bupivacaine with 30mg magnesium sulphate and Group C (n=45) patients received 2.5ml of 0.5% bupivacaine with 30mcg Clonidine. In both group, final drug volume made equal to 3ml by adding normal saline. Quality of block in terms of Time of Onset and total Duration of Sensory and Motor Blockade, 2 Segment regression time, Total analgesia time, Hemodynamic parameters and any Side Effects were recorded. Results: Demographic data were comparable. The mean time of Duration of Sensory Blockade in group M was 130.78±5.95 and in group C 165.02±12.72 (p value &lt;0.001), mean time of 2 segment regression in group M was 103.44±8.01 and in group C 122.49±9.76 (p value &lt;0.001), mean time of duration of motor blockade in group M is 144±6.78, in group C 208.27±21.39 (P value &lt;0.001). Mean time onset of sensory block in group M was 9.44±0.69, in group C 5.85±0.32 (p value &lt;0.001) were statistically significant. Hemodynamic parameters were comparable between the groups except at few intervals. Group C showed significant sensory and motor blockade and delayed requirement of rescue analgesia compared to group M. Conclusion: Intrathecal clonidine as adjuvant is better than intrathecal magnesium sulphate as it prolongs sensory and motor block with no significant haemodynamic variations and side affect.</p> Vandana Hebballi Navya SA Anusha K M Champa B V Vishwanath V.M Copyright (c) 2021 Vandana Hebballi, Navya SA, Anusha K M, Champa B V, Vishwanath V.M 2021-10-20 2021-10-20 4 18 319 330 Clinical profile of sleep apnea syndrome in a tertiary care center <p>Introduction: Sleep related breathing disorders refer to an abnormal respiratory pattern (e.g.: apneas, hypopneas, or respiratory effort related arousals) or an abnormal reduction in gas exchange (e.g., hypoventilation) during sleep. They tend to repetitively alter sleep duration and architecture, resulting in daytime symptoms, signs, or organ system dysfunction. Materials and Methods: All patients attended Chest OPD with complaints of sleep disordered breathing (SDB) like Snoring, excessive day time sleepiness, witnessed breathing pause, nocturnal choking, as well as patients referred from other departments for evaluation of SDB were taken up for further screening. All patients attended Chest OPD with complaints of sleep disordered breathing (SDB) like Snoring, excessive day time sleepiness, witnessed breathing pause, nocturnal choking, as well as patients referred from other departments for evaluation of SDB were taken up for further screening. Results: There were 33 (63.46%) males and 19 (36.53%) females in the study population. Patients with age &gt;40 years were 40 (79.9%). Patients with BMI ≤ 25.0 Kg/mt2 were 14(26.9%); BMI &gt;25.0 and ≤ 30 Kg/mt2 were 8(15.38%); BMI &gt; 30 kg/m2 were 30(57.7%). 9(47.3%) females had neck circumference &gt;15 inches and 10 (52.63%) males had neck circumference &gt;17 inches which was considered as risk factor for Sleep apnea. There were no other obvious significant anthropometric abnormalities on clinical examination. 22(42.30%) subjects had hypertension (according to JNC 8 criteria). 7(13.46%) patients had diabetes mellitus. The symptomatology of the subjects is summarized in Table5. The most common symptoms were snoring 28(53.8%), excessive day time sleepiness 28(53.8%), Witnessed breathing pause 21(40.4%), frequent awakening 19(36.5%) and difficulty in falling asleep 17(32.7%). Conclusion: It is important from clinician point of view to take detail history and thorough clinical examination to suspect SDB and refer them to centers where PSG is conducted. This is possible if awareness for SDBs is increased among general population and physicians, including its effects on individuals’ physical, mental and social health and also needs to be emphasized that it is amenable to cure. Overall, polysomnography is an effective tool for diagnosis of SDBs and should be carried out in patients with symptoms suggestive of SDBs and also in patients having other co morbidities which are known to be associated with SDB.</p> Raju Kottakota Nikhila Dasari V.V.N.Goutham Mahanti Sreenu Copyright (c) 2021 Raju Kottakota, Nikhila Dasari, V.V.N.Goutham, Mahanti Sreenu 2021-10-20 2021-10-20 4 18 331 342 A study to find the commonest plasmodium malaria in Srikakulam district, Andhra Pradesh <p>Introduction: Due to thorough implementation of national malaria eradication programme, there was drastic decline in malaria. A study was conducted to find the commonest malaria causing plasmodium in paediatric age group. Materials and methods: Study was conducted in Great Eastern Medical School &amp; Hospital, Andhra Pradesh from January to December 2019, approved by the institutional ethics committee. Children aged &lt; 12 years with clinical suspicion of malaria were included. Blood was collected following standard aseptic precautions in sterile EDTA tube, 2 smears were prepared. Thin smear was stained by giemsa and thick smear by Jaswant Singh Battacharya staining. As a part of internal quality control, all positive and 25% of negative smears were randomly screened. Commercially available, rapid malaria Pan+Pf cards were used for antigen detection. Chi square test was used to find statistical difference, P&gt;0.05 was considered statistically significant. Results: Total601 (59%) were malaria cases, 559 were positive by blood smear examination (BSE) and 579 by raid diagnostic technique (RDT), male female ratio was 0.97. More cases were detected in 5 – 10 years. With BSE, 31.1% were identified as Plasmodium falciparum and 41.6% by RDT. Conclusion: Plasmodium falciparumis the predominant malaria causing agent in this area.</p> Nagesh Vitthalrao Dasarwar G. Sudha Vatchala Swamy Naidu Dasari Somasekhar Pothula Tammana Jaya Chandra Copyright (c) 2021 Nagesh Vitthalrao Dasarwar, G. Sudha Vatchala, Swamy Naidu Dasari, Somasekhar Pothula, Tammana Jaya Chandra 2021-10-20 2021-10-20 4 18 343 345 A Hospital Based Prospective Study to Evaluate the Comparison of Radiological and Functional Outcome in Patients with Fracture Shaft of Humerus Treated with Interlocking Nailing and with Plate Osteosynthesis at Newly Established Tertiary Care Centre <p>Background: Intramedullary nailing is considered as gold standard in treatment in fracture of femoral and tibial shaft fractures. But there is no agreement about the ideal treatment for fractures of humeral shaft. The aim of this study is to compare the Radiological and Functional outcome in patients with fracture shaft of the humerus treated with Dynamic Compression plating and those treated with Intramedullary Interlocking nailing. Materials &amp; Methods: This is a prospective comparative study of 20 patients with humeral shaft fractures treated with Intramedullary interlocking nailing and Plate osteosynthesis done in the Department of Orthopaedics, Newly established Government Medical College, Dungarpur, Rajasthan, India during one year period.Wound inspection done on 2nd post op day. Suture removal done on 12th day. Active shoulder and elbow started on 3rdin nailing procedure and 5th to 6th day in compression plate once the pain level decreases under physiotherapist guidance and tolerability of the patient. Results: The average age of patients was 46 years in both groups. Mostly patients were males (75%) in both groups. The mode of injury in most of the cases in both the groups are due to Road Traffic Accidents (70% in IL nailing group and 80% in Plating group).The remaining are due to fall and due to assault. 60–80 % of the patients in the study have involvement of the dominant side in both groups. Average time of union in INL group was22 weeks &amp; 20 weeks in DCP group. The functional Range of Movements in shoulder joint after Nailing is excellent and good in 90% of patients and fair in 1 patient (10%) &amp;elbow function recovered in almost all patients with 90% excellent result and 10 % has good recovery in INL group. All patients treated with Plate Osteosynthesis had excellent to good functional outcome in elbow, 90% of cases have excellent and good results in shoulder function and 1 case had fair result. Conclusion: We concluded that patients can be treated with dynamic compression plating andinterlocking nailing for fracture of shaft of humerus. Intramedullary interlocking nailing is an effective and safe alternative for treatment of diaphyseal fractures of humerus. It is suitable for patients with osteoporosis, polytrauma and in segmental fractures.</p> Santosh Kumar Yadav Chandra Prakash Rawat Copyright (c) 2021 Santosh Kumar Yadav, Chandra Prakash Rawat 2021-10-20 2021-10-20 4 18 346 349 A Hospital Based Comparative Study to Evaluate the Efficacy of Methotrexate v/s Dapsone/ASST for Treatment of Chronic Urticaria <p>Background: Chronic Urticaria remains a major problem in terms of etiology, investigation, and management and causes comorbidity and high cost to the health care system. In our study, we are comparing the use of ASST, Dapsone and Methotrexate for the treatment of resistant chronic urticaria. So, these study findings will play an important role to determine treatment protocols for patients with chronic urticaria. Materials &amp; Methods: A prospective comparative study done on 100 patients with chronic urticaria were selected from the patients attending out-patient clinic in Department of Dermatology, S.K. Government Medical College, Sikar, Rajasthan, India. The patients will be randomly allotted to any one of the following four treatment groups after calculating their Urticarial Activity Score (UAS) &amp; Dermatology Life Quality Index (DLQI). Group A (Dapsone 50 mg), Group B (Methotrexate 10 mg), Group C (ASST) &amp; control group. Patients were then divided into three categories based on these parameters into Good Responders, Average Responders &amp; Poor Responders. Results: More than 76% of patients treated with ASST had good response to treatment while only 52% of those treated with dapsone and 32% of those treated with methotrexate had good response to treatment. Poor response was seen in 4% of ASST and Dapsone patients compared to the 20% in patients receiving Methotrexate. This is still better than the 60% with poor response in the control group. Side effects were more common in patients taking methotrexate with 3 out of 25 patients experiencing minor side effects while two patients taking dapsone also had documented side effects. Conclusion: Managing cases of urticaria has always been an challenging issue. Various treatment modalities are available for treating recalcitrant cases of urticaria. We concluded that ASST can be considered as a first line of treatment, Dapsone can be considered for patients refractory to treatment and Methotrexate is recommended as last resort, in patients who are refractory to other modalities of treatment.</p> Madan Singh Batar Seema Kumari Mourya Copyright (c) 2021 Madan Singh Batar, Seema Kumari Mourya 2021-10-20 2021-10-20 4 18 350 353 A Hospital Based Prospective Study to Evaluate the Risk Factors for Chronic Urticaria Amongst Children <p>Background: Urticaria is a disease characterized by erythematous, edematous, itchy and transient urticarial plaques, and covering the skin and mucous membranes. Also known as hives among people. The present study was conducted to evaluate the risk factors for Chronic Urticaria Amongst Children. Materials and Methods: This Hospital Based Prospective Study was conducted to evaluate the Risk Factors for Chronic Urticaria Amongst Children of age group 5 to 13 year-old. 2130 children were included in this study. The modified urticaria activity score (UAS) was used to assess disease severity. The presence of factors that might induce urticaria were also noted. Blood sampling was performed to measure white blood cell count, vitamin D, total eosinophil count (TEC), and total IgE levels. Statistical analysis was performed using SPSS version 22.0 (IBM Co, Armonk, NY, USA). Results: In the present study a total of 2130 subjects were included in the study in which 84.50% were control and 15.49% were having urticaria. Mean age of controls was 8.56yrs and urticaria was 8.40yr. The characteristics of the 324 subjects with urticaria, which included 267 subjects with acute urticaria and 57 with chronic urticaria. The maximum UAS for wheals and pruritus was significantly higher in subjects with chronic urticaria than in those with acute urticaria. Risk factors for acute urticaria was food (40.44%) followed by environmental changes 36.70%. Risk factors for chronic urticaria was food (31.57%) followed by warm exposure (28.07%). Conclusion: The present concluded that among 324 subjects with urticaria, which included 267 subjects with acute urticaria and 57 with chronic urticaria. The maximum UAS for wheals and pruritus was significantly higher in subjects with chronic urticaria than in those with acute urticaria. Risk factors for acute urticaria was food (40.44%) followed by environmental changes 36.70%. Risk factors for chronic urticaria was food (31.57%) followed by warm exposure (28.07%).</p> Sonakshi Pargi Pratap Singh Parmar Copyright (c) 2021 Sonakshi Pargi, Pratap Singh Parmar 2021-10-20 2021-10-20 4 18 354 356 Risks of obesity among Indian adolescents <p>Obesity is connected to a wide range of ECG abnormalities that take place in adolescents leading to risks of Cardio Vascular Disease (CVD) mortality and sudden cardiac death. Some of the ECG abnormalities are being caused by the position of the diaphragm being pushed-up as a result of obesity (1). The position of the R wave might change, the QT might be prolonged or various malignant arrhythmias could develop. In obesity, the ECG signals of ventricular hypertrophy tend to be less informative because of the subcutaneous and epicardial adipose tissue. This study revealed that in adolescents, general and abdominal obesity is correlated to long PR intervals, wide duration of QRS, leftward shifts of the frontal P-wave, T-wave and QRS axes, free from the ECG variables like gender, age, blood pressure and ethnicity.</p> Samir Kumar Praphull Deepankar Jyoti Dinkar Copyright (c) 2021 Samir Kumar, Praphull Deepankar, Jyoti Dinkar 2021-10-20 2021-10-20 4 18 357 360 Study to Find Hemodynamic Changes and Complications Occurring with Propofol and Etomidate During General Anaesthesia: A Tertiary Care Institutional Based Study <p>Background: Among general anesthesia induction drugs, etomidate is the only imidazole, and it has the most favourable therapeutic index for single bolus administration. Propofol is non-barbiturate short acting intravenous anaesthetic agent. It is a phenol derivative (2,6-Diisopropylphenol). Hence; the present study was undertaken for assessing the hemodynamic changes and complication occurring with propofol and etomidate during general anaesthesia. Materials &amp; Methods: A total of 40 patients scheduled to undergo surgical procedure under general anesthesia were enrolled. All the patients were divided broadly into two study groups with 20 patients in each group as follows: Group 1: Propofol group, and Group 2: Etomidate group. Propofol group received propofol at 2 mg/kg and etomidate group received etomidate at 0.2 mg/kg. Pain on injection and myoclonic movements were recorded, if any at induction. As soon as the onset of unconsciousness occurs consumed dose of anaesthetic were recorded individually. All the results were recorded and analysed by SPSS software. Results: Mean heart rate among patients of group 1 at baseline, at induction and at 10 minutes was 85.6, 98.4 and 81.3 respectively. Mean heart rate among patients of group 2 at baseline, at induction and at 10 minutes was 84.2, 96.1 and 82.7 respectively. Mean arterial pressure among patients of group 1 at baseline, at induction and at 10 minutes was 89.3, 80.4 and 94.6 respectively. Mean arterial pressure among patients of group 2 at baseline, at induction and at 10 minutes was 90.1, 88.6 and 95.4 respectively. Significant results were obtained while comparing the mean arterial pressure at induction among the two study groups. Pain on injection was seen in 2 patients of group 1 and 1 patient of group 2. Conclusion: From the above results, the authors concluded that etomidate was better in comparison to propofol during general anaesthesia.</p> Sheikh Mustak Ali Rohan Roshan Nayak Bhagesh Kar Jagadish Jena Copyright (c) 2021 Sheikh Mustak Ali, Rohan Roshan Nayak, Bhagesh Kar, Jagadish Jena 2021-10-24 2021-10-24 4 18 361 363 A study of non tuberculous bacterial pneumonia cases admitted in department of pulmonary medicine at a tertiary care hospital <p>Background: Pneumonia is an infection of the pulmonary parenchyma. Despite being the cause of significant morbidity and mortality, pneumonia is often misdiagnosed, mistreated and underestimated. Aim: The main aim of the present study was to the impact of co morbid conditions on the prevalence of type of pneumonia, its severity and its outcome. Materials and Methods: This study entitled “Study of Non Tuberculous Bacterial Pneumonia cases admitted in Department of Pulmonary Medicine at Rangaraya Medical College and Hospital, Kakinada, during the period August 2018 to July 2020. All the cases of CAP admitted during this period in the medical wards were randomly selected and studied with patient consent. A detailed analysis of history, clinical examination bacteriology, radiology (CXR PA and lateral, CT) were done. Results: All the findings of this study were compared to similar studies done at other centres in India and abroad and available literatures were reviewed. The age group in this study group varied from 27-80 years, most of them were between 30- 65 years, predominantly middle and elderly age accounting for 96%. The incidence of pneumonia is most common in men (77%) compared to females (23%). The associated diseases in this study are COPD (35%) &amp; DM (22.0%). The commonest presenting symptoms are cough (100%), expectoration (100%), fever (60%) other symptoms include dyspnoea (45%), and chest pain (13%). The haematological value showed leucocytosis (35%). The Sputum culture showed 23% streptococcal, 26% staphylococcus aureus, 9% pseudomonas, 13% Klebsiella, 16% normal comensols and 7% mixed, staphylococcus and klebsiella (5%), citrobacter(1%). Radiology showed preponderance of the rt. lung involvement and rt. Upper, middle and lower lobe accounting for about 42%. Conclusion: Medical line of treatment in appropriate time and with appropriate antibiotics and ventilator support in few patients. Duration of hospital stay increased in patients with co morbidities. Patients requiring ICU treatment in this present study include 15 (15%) of which 11 (11%) required ventilator support mortality encountered in 4(4%).</p> Kuraganti Chakravarthi Copyright (c) 2021 Kuraganti Chakravarthi 2021-10-24 2021-10-24 4 18 364 377 Case Based Learning: An Effective Teaching Learning Method in Pharmacology for MBBS Students <p>Introduction: Medical education in India is currently going through major changes by bringing competency based undergraduate curriculum (CBME) from 2019. CBME aim to train graduates to efficiently take care of the health needs of the society. Pharmacology is an important subject in MBBS curriculum and involves treatment and prevention of a disease. This study aimed to compare, Case based learning (CBL) and Didactic lecture (DL) in Pharmacology and also to evaluate the student perception and effectiveness of these teaching methods. Materials and Methods: Total 140 MBBS students participated in this study. Students were randomly divided into two groups. Group A &amp; B were exposed to CBL &amp; Didactic lecture respectively. Student’s knowledge of the topic was assessed before and after the sessions in both the groups. Student’s perception of teaching method was assessed by five-point Likert scale. Results: The scores of pre-session of multiple-choice questions were compared in both the groups. There was no significant statistical difference in the marks obtained between the CBL and didactic lecture group (p&gt;0.05). On comparing the scores post session between the groups, there was statistically significant difference between CBL and Didactic lecture group. The mean score was found to be higher in the CBL group. Most of the students strongly agreed that CBL improved their problem-solving ability, boosted confidence in clinical case scenario, improved communication skill and increased their interest in applied pharmacology as compared to didactic lecture. Conclusion: CBL is an effective teaching method and with student’s positive response and perception, it can be a good add-on teaching method in Pharmacology for MBBS students.</p> Patrick S Vishwakarma K Singh P Matreja P Copyright (c) 2021 Patrick S, Vishwakarma K, Singh P, Matreja P 2021-10-24 2021-10-24 4 18 378 381 To Assess Post Anesthesia Pulmonary Complications after Use of Muscle Relaxants: An Institutional Based Study <p>Background: Incomplete return of neuromuscular function is associated with an increased risk of impaired respiratory and airway control, risk of aspiration and postoperative hypoxic events and pulmonary complications. Therefore, measures have been proposed to avoid residual neuromuscular block postoperatively. The present study was conducted to assess post anesthesia pulmonary complications after use of muscle relaxants. Materials and Methods: The present prospective observational cohort study was conducted to assess post anesthesia pulmonary complications after use of muscle relaxants. The sample size of the study was 120 patients. Patient characteristics, medical history, surgical and anaesthetic details (including management of neuromuscular function), postoperative physical examination, and chart review at discharge were collected. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Results: In the present study total sample size was 120 patients in which 55% were females and 45% were males. Maximum patients belong to age group 40-50yrs (41.66%). Any postoperative pulmonary complication found in 10.83% patients, Intermediate or severe postoperative pulmonary complication found in 6.66% patients, No postoperative pulmonary complication found in 82.5% patients. Conclusion: The present study concluded that any postoperative pulmonary complication found in 10.83% patients, Intermediate or severe postoperative pulmonary complication found in 6.66% patients, no postoperative pulmonary complication found in 82.5% patients.</p> Reena Chaudhary Copyright (c) 2021 Reena Chaudhary 2021-10-24 2021-10-24 4 18 382 384 Post-Operative Complications and Their Management After Pancreaticoduodenectomy: A Single Centre Experience <p>Objectives: To evaluate post-operative complications and their management after Pancreaticoduodenectomy (PD) at Surgical Gastroenterology department at Government Medical College Hospital in North India. Materials and Methods: Retrospective analysis of database of Pancreaticoduodnectomy patients was done. Main demographic variables, indications of surgery and early postoperative complications and their management were evaluated. Statistical analysis was done with the help of Microsoft excel software.Results: A total of 176 Patients underwent PD from January 2013 to December 2018. 162 patients underwent open PD and 14 underwent laparoscopic/ laparoscopic assisted PD. 128 operations were done for periampullay carcinoma, 16 for carcinoma head of pancreas, 7 for neuroendocrine tumor, 7 for cystic tumor of pancreas, 4 for duodenal carcinoma, 3 for cholangiocarcinoma, 2 for GIST, 1 for carcinoma stomach, 2 for carcinoma Gallbladder with ampullary carcinoma (dual malignancy) and 2 for tubercular CBD stricture and 4 for chronic pancreatitis. Overall mortality was 4.5% (8 patients). Most common morbidity was surgical site infection (21%). Post-operative pancreatic fistula (POPF) rate was 16% (28 pt.), of which 21 patients has type A POPF, 5 patients has type B POPF and 2 patient has type C POPF. Incidence of DGE and post-operative bleed was 14.7% and 3.4% respectively.Conclusion: With adequate surgical expertise, improved perioperative care and multispecialty approach, pancreaticoduodenectomy now can be performed with low morbidity and mortality in present era of surgical advancement and nihilistic view regarding this surgery prevalent in some developing countries should be abandoned. Internal stenting may be useful in decreasing POPF rates, all measures should be taken to control preoperative cholangitis to decrease postoperative sepsis and mortality and levosulpiride may be helpful in early recovery of bowel function and oral intake.</p> Ram Daga Nishant Jangir Lokesh Yadav B. D. Soni Randhir Rao Surendra Gupta Girish Chauhan Copyright (c) 2021 Ram Daga, Nishant Jangir, Lokesh Yadav, B. D. Soni, Randhir Rao, Surendra Gupta, Girish Chauhan 2021-10-24 2021-10-24 4 18 385 389 A ProspectiveStudy ofcomplications, risks and causes while repairing theIncisional Hernia by Preperitoneal Meshplasty <p>Background: An abdominal wall hernia is defined as an intermittent or continuous protrusion of abdominal organs through a defect in the abdominal wall. In case of an incisional hernia an abdominal wall defect develops in the scar of a wound in the abdominal wall, which was inflicted during previous surgery. Incisional hernia is a frequent complication of abdominal surgery the exact incidence has not been well defined, although a number of reports in the literature suggest that the incidence is probably between 2% and 11%. Another study shows Incisional hernia occurs in 10- 20 % of patients subjected to abdominal operations. Aim &amp; Objective: To study the causes, complications, operating time, while dealing to Incisional hernia cases. Materials and Methods: This is a prospective study, our sample size was of 30 patients, data collection from Jan 2018 to September 2020 of the admitted patients in the department of surgery, R.D.J.M. medical college &amp; hospital.Patients fulfilling the selection criteria were offered Preperitoneal mesh repair. Results: A total of 30 patients were included in the present study. In which 11 (37%) were male and 19 (63%) were female. All patients were in ranged of 16years to 64 years of age. Maximum number of patients were between to the age group of 36-45 years followed by 46-55 years and 10-20 years. And 14 patients (46.7%) with abdominal swelling and 16 Patients (53.3%) presented with swelling and pain both in abdomen. Out of total of 30 patients, (12) of patients had history of Exploratory Laparotomy followed by Hysterctomy (7), LSCS (6), Herniorraphy and Laproscopy 2 each and Tubal Ligation and open Appendectomy one each, 7 patient ( 23.3%) presented with incisional hernia within 3 months of the previous surgeries. 9(30%) patients noticed swelling at the operation site within 3 months to one year of surgery, 5 patients (16.7%) within 1-3 years of surgery and Remaining 9(30%) patients developed hernia after 3years. Conclusion: The preperitoneal mesh repair an excellent method called as Rive’s stoppa technique where mesh was placed between peritoneum and abdominal wall or rectus muscle and posterior rectus sheath. The main advantage of pre peritoneal mesh repair are - Less chance of mesh infection and erosion through skin because the graft lies in preperitoneal plane between posterior rectus sheath and peritoneum, avoids adhesions, bowel obstruction, enterocutaneous fistula and erosion of mesh, minimal morbidity and duration of hospital stay is less compared to other techniques.</p> Smit Shahi Shruti Kirti Copyright (c) 2021 Smit Shahi, Shruti Kirti 2021-10-24 2021-10-24 4 18 390 399 Awareness regarding covid 19 disease among healthcare workers in a Tertiary Care Hospital in Southern Bihar <p>Background: The SARS-COVID-19 virus is a highly infectious and life threatening which has taken the form of a global pandemic since march 2020. It presents with symptoms similar to comman respiratory illness like sore throat,fever,cough,weakness,myalgia and dyspnoea. At present<br>no definitive treatment is available for this deadly virus. Hence prevention is the most effective intervention. This global pandemic is causing severe burnout and exhaustion in health care workers. Hence, this study was conducted based on a questionnaire to assess the skills and attitude<br>of the health care professionals. Materials and methods: A cross sectional study was conducted from October to December 2020 after approval<br>by the ethics committee of Narayan Medical College and Hospital, Jamuhar ,Bihar. A written and informed consent was obtained from the respondents before administering the questionnaire using WHO course materials on emerging respiratory viruses, including COVID-19, a 13- item based survey questionnaire was developed. Health care workers features, memory, information sources, skills, and attitudes were all addressed in the survey questionnaire. The data was coded, validated, and analysed using open source software that is static. To measure frequencies and proportions, descriptive analysis was used. The chi-square test was used to determine the degree of correlation between variables. Statistical significance was described as a P value of less than 0.05. Results: The majority of the sample population (50.8 percent) was between the ages of 21 and 30, with 67.7% males and 32.3 percent females. Non-clinical/administrative employees made up 51.5 percent of The workforce, while nursing made up 48.5 percent (students and faculty). Among the sample population, the most common source of knowledge was Family/ Peers (64.6%), followed by News and Blogs (43.8%) and Social Media (40.8%). Corona virus transmission and prevention were not well understood. Nursing (students and faculty) performed substantially better than Non-clinical/personnel in charge of administration. Conclusion: It is critical that the health care workers community members knowledge and preparedness be strengthened. For reaching out to staff, directed educational interventions are needed, as well as the evolution and evaluation of these interventions.</p> Amit Kumar Singh Avinash Kumar Mukesh Kumar Soumya Singh Abhishek Kamendu Copyright (c) 2021 Amit Kumar Singh, Avinash Kumar, Mukesh Kumar, Soumya Singh, Abhishek Kamendu 2021-10-24 2021-10-24 4 18 400 404