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 A study on Epidemiology and Symptomatology and Glomerular Filtration Rate (GFR) in Pre-dialysis Chronic Kidney Disease patients <p>Introduction: Longitudinal studies have established that Cardiovascular Disease (CVD) occur more frequently and are the leading cause of death in Chronic Kidney Disease (CKD). Dyslipidemia has been established as an important risk factor in the pathogenesis of CVD in CKD patients. Objectives: Present study was aimed to evaluate (in CKD patients), Demography along with Symptomatology and Glomerular Filtration Rate (GFR) in Pre-dialysis Chronic Kidney Disease patients (Study cases). Methods: Present Cross-sectional study, conducted in Department of Medicine, R.D. Gardi Medical College and CRG hospital, Ujjain, M.P. from 1 st January 2015 to 31st July 2016. We studied 115 pre-dialysis CKDcases and 100 age &amp; sex matched controls. CKD was diagnosed as per 2012 KDOQI Criteria. Result: In CKD cases, maximum 23.47% cases belonged to fifth decade. Mean age was 48.99 ± 16.74. Male to Female ratio was1.21: 1. In the present study of 115 Study cases, pallor was present in ninety five (82.6%) cases, followed by facial puffiness in eighty eight (76.5%) cases, pedal oedema in eighty two (71.3%) cases and oliguria in eighty (69.5%) cases. Hypertension was evident in eighty seven (75.6%) cases. The mean Serum Creatinine, Urea, Total Protein, albumin, Potassium, Phosphorus value were increased in Study group as compared to control group. The mean Serum Calcium value was decreased in Study group as compared to control group.</p> Nitin Choudhary Lal Pranay Singh Nidhi Choudhary Narendra Singh Patel Copyright (c) 2021 Nitin Choudhary, Lal Pranay Singh, Nidhi Choudhary, Narendra Singh Patel 2021-07-09 2021-07-09 4 12 1 3 Comparative Study of Negative Pressure Wound Therapy vs Moist Saline Dressing in management of Stage III/IV Sacral Pressure Sores <p>Introduction: Pressure sores in sacral area are a common cause of prolonged morbidity &amp; increased health expenditure. In this study, we compare two methods of treating pressure sore- the newer “Negative Pressure Wound Therapy”(NPWT) and the conventional moist saline dressing.Materials &amp;Methods: 124 patients participated in the study with half (n=62) of the patients in NPWT group &amp; the other half (n-62) in moist saline dressing group. Descriptive statistics of both the groups were laid out. The two management modalities were compared by Chi square test for granulation tissue formation, wound size reduction, absence of wound discharge and negative wound culture. Statistical calculations were done with Microsoft excel &amp; Results: The patients in the NPWT group had significantly higher formation of granulation tissue, higher contraction of wound size, lesser discharge from wound&amp; lower culture positivity compared to moist saline dressing group (p&lt;0.05). Stroke followed by spinal disorders &amp; malignancy were found to be the commonest precipitating factors for development of pressure sores.Conclusions: NPWT fares significantly better compared to moist saline dressing in pressure sore management. Though expensive but a significantly faster rate of recovery &amp; lower requirement of surgical procedures makes it overall cost effective as well.</p> Sarabarni Biswas Anirban Ghosh Copyright (c) 2021 Sarabarni Biswas, Anirban Ghosh 2021-07-09 2021-07-09 4 12 4 8 Role of saline moist dressings in the treatment of diabetic foot ulcers <p>Background and objective: Diabetes associated problems are the second most common cause of lower limb amputations in India. Majority of amputations are preceded by foot ulcerations. In view of the above said is it is necessary to identify those at an increased risk of diabetic foot and therefore we conducted a study which planned to study the role of saline moist dressings in the treatment of diabetic foot ulcers.Materials and methods: This prospective non-randomized control study was conducted at Yenepoya Medical College Hospital on patients with diagnosed diabetic foot who were chosen by purposive sampling from October 2012 to September 2014. A total of 75 patients were chosen for the study and after taking an informed verbal consent were divided into the test group which received saline most dressings daily and the control group who received the betadine dressings daily. Both the groups received additional treatments in the form of debridements, amputations as and when necessary.Results: Majority of the patients receiving treatment for diabetic foot were males. The average duration of diabetes mellitus observed was for 5-10 years. Our study also revealed that neuropathy was the most common complication associated with diabetic foot. In this study we found that in saline dressings, the cultures mostly revealed mono microbial etiology but the conventional dressings had multiple organisms in their cultures. Saline dressings reduced the need for amputations significantly in comparison to the conventional betadine dressings. Conclusion: We strongly recommended saline dressings for treatment of diabetic foot than betadine dressing.</p> Mohammad Omar Shah MS Moosabba Huzaifa Nazir Tak Copyright (c) 2021 Mohammad Omar Shah, MS Moosabba, Huzaifa Nazir Tak 2021-07-09 2021-07-09 4 12 9 11 Incisional Hernia- Management, Epidemiology, Complication- An In-depth Analysis <p>Background: Incisional hernia is defined as any abdominal wall gap with or without bulge in a postoperative scar perceptible or palpable by clinical examination or imaging. It complicates 5-11% of all abdominal surgeries as reported by various studies.Incisional hernia repair has evolved over the last century, with a humble anatomical repair to mesh repair and now to laparoscopic and robotic meshplasty.Objectives: To analyse the various etiological factors of incisional hernia, the incidence rates for age and sex, therapeutic modalities (anatomical repair and meshplasty) and to study the immediate postoperative complications. Materials &amp; methods: A prospective study was carried out at Narayanahrudayalaya institute of medical sciences Bangalore, between May 2017 and April 2018 involving 72 patients with approval from the Institutional ethics committee. Patients presenting to the General surgery department and emergency in our tertiary center with swelling in the abdomen after undergoing surgical treatment are included in this study.Results: Incisional hernia was found to occur more often in the 5th decade, females (2.6 times more than males), and housewives (53.3%), obese (53.3%). Most patients noticed the incisional hernia only 1 to 3 years after the index surgery. A combination of mesh repair along with anatomical repair was carried out in 63 of the 72 patients including both open and laparoscopic repair and anatomical repair alone in 9 patients. Suction drains were placed in all patients who underwent mesh repair and were associated with fewer immediate post-operative complications.Conclusion:Incisional hernias occur more often in females as they are more likely to undergo lower abdominal surgeries (gynaecological). The incidence was higher if the patients had post-operative wound infection or dehiscence following the index surgery, had associated risk factors such as chronic cough, constipation, voiding difficulties. Interestingly the tone of abdominal muscles did not play an important role in the incidence of incisional hernia in our study. Mesh repair was deemed superior to anatomical repair alone as post-operative complications were lesser. There were no recurrences during our follow up period, albeit a longer follow up is required to draw definitive conclusions.</p> N Mohammed Shahid Jayant Gul Mulchandani Mohamed Shies Sadat Ashwinikumar D Kudari Copyright (c) 2021 N Mohammed Shahid, Jayant Gul Mulchandani, Mohamed Shies Sadat, Ashwinikumar D Kudari 2021-07-09 2021-07-09 4 12 12 15 Association Between Maternal Periodontal Status and Pre Term Low Birth Weight Babies: A Retrospective Clinical Case Control Study <p>Introduction: In reducing the risk for pregnancy-related complications like preterm birth and preeclampsia, maternal health is recognized as an important determinant. In the developing countries as well as developed countries, low birth weight (LBW) and preterm (PTB) delivery are considered to be highly relevant biological determinants for new born infant survival. As per definition,Preterm birth (PTB) delivery is stated as delivery before 37 weeks of gestation and low birth weight (LBW), is a birth weight of less than 2,500 grams.Aims and Objectives: To assess maternal periodontal status among preterm and / or low birth weight and normal birth weight groups to determine if it is a risk factor for low birth weight infants. Material and Methods: A case control study design was chosen involving total 100 pregnant mothers, 50 mothers with presence of periodontal disease with CPI Score 3 in the case group and 50 mothers with CPI Score 1 or 2 in the control group. Our first definition of case and a control was based on the maternal periodontal status. All mothers after screening were categorized into a case group and control group. Results: This study indicated a 4.66 fold increase in PTLBW in cases of periodontal infection with CPI score 3 in comparison to periodontal infection with CPI score 1 or 2. Many Other workers reported a 4.5 to 7 fold increase in incidence of PTLBW in cases of periodontitis with CPI score 3. The important observation which was found in this study was related to the illiteracy of the mother which plays a strong role in causation of periodontal disease as well as to PTLBW.Discussion: The overall importance of periodontal therapy during pregnancy is minimal, but that a threshold level may exist during gestation where the presence of periodontal diseases may have a much more significant effect on a baby’s birth weight. Preterm birth (PTB) and low birth weight (LBW) are the leading perinatal problems worldwide and have evident public health implications, as they are closely related to perinatal mortality and morbidity.According to the Perinatal Oral Health Consensus, diagnosis and treatment of oral diseases as well as their prevention, which may require dental radioFigs and local anaesthesia, are beneficial if commenced during pregnancy, as well as they do not pose any additional foetal or maternal risk as compared to the risk when no care is provided.</p> Dhanesh Singh Rao Tarun Gaur Atul Ashok Jadhav Manish Kumar Syed Monjur Elahi Dushyant Pal Singh Copyright (c) 2021 Dhanesh Singh Rao, Tarun Gaur, Atul Ashok Jadhav, Manish Kumar, Syed Monjur Elahi, Dushyant Pal Singh 2021-07-09 2021-07-09 4 12 16 21 A Study to Evaluate Hemodynamic Response in Patients Undergoing Laparoscopic Surgeries Premedicated with Oral Clonidine in a Tertiary Medical Centre of South Bihar <p>Introduction: Insufflation of CO2 into the peritoneal cavity, ports from which instruments can be negotiated into the distended abdomen, and various changes in patient position depending on the type of operation are all required during laparoscopic procedures. Increased intraabdominal pressure (IAP), blood pooling in the periphery, and stress hormone responses (cortisol, epinephrine, and nor-epinephrine) all lead to the hemodynamic variations. Furthermore, patient's IAP is elevated, and his or her location is changed, in laparoscopic procedure making ventilation difficultAim : To observe hemodynamic changes during pneumoperitoneum (without and with) oral clonidine150 ug in laparoscopic surgery.<br>Material and Methods: This is a prospective observational study, will be conducted on 60 study subjects at Narayan medical college and Hospital, Rohtas , South Bihar. Study subjects will be selected as per Inclusion and exclusion criteria from general surgery theatre complex of the hospital. Patients will be divided into two groups (30 each)Group A (Clonidine) 150 ug - Patients will be given tab. Clonidine 150 ug orally 60 minutes prior to induction.Group B (Control) - Patients will be given sugar coated placebo tablet 60 minutes prior to induction.Hemodynamic assessment was done in both the groups and compared.Result : SBP,DBP ,MAP was also measured at the time of induction, 5 min after induction, 5 min after insufflation , 15min and 30 min after insufflation and it was found that there was statistically significant difference between the two groups, with p value &lt;0.005 each time respectively.Conclusion:Prior to laparoscopic surgeries in adults, oral clonidine 150 mg will effectively blunt the hemodynamic response to pneumoperitoneum. Because of this benefit and the low, easily treatable side effect profile, regular use is recommended.</p> Ravi Kumar S.Nag Copyright (c) 2021 Ravi Kumar, S.Nag 2021-07-09 2021-07-09 4 12 22 27 Demographic Profile of Diabetic Foot Ulcers <p>Background and objective: Diabetes associated problems are the second most common cause of lower limb amputations in India. We conducted this study to find out the socio-demographic profile and factors associated with diabetic foot ulcers.Materials and methods: This prospective non-randomized control study was conducted at Yenepoya Medical College Hospital on patients with diagnosed diabetic foot who were chosen by purposive sampling from October 2012 to September 2014. A total of 75 patients were chosen for the study after taking an informed verbal consent. Data was collected using questionnaire regarding sociodemographic profile, complications and associated factors. Results: Majority of the patients receiving treatment for diabetic foot were males. The average duration of diabetes mellitus observed was for 5-10 years. Our study also revealed that neuropathy was the most common complication associated with diabetic foot. Conclusion: Regular monitoring of blood sugar levels and foot screening should be done for diabetic as well as non-diabetic older adults for early detection of risk factors to reduce the foot complications.</p> Mohammad Omar Shah HuzaifaNazir Tak MS Moosabba Copyright (c) 2021 Mohammad Omar Shah, HuzaifaNazir Tak, MS Moosabba 2021-07-09 2021-07-09 4 12 28 30 Diltiazem as an Antispasmodic Drug in Radial Artery <p>Background: Coronary catheterization is usually performed via the transfemoral approach. Transradial access offers advantages in comparison with transfemoral access, especially under conditions of aggressive anticoagulation and antiplatelet treatment in which bleeding complications at the femoral puncture site can result in increased morbidity and duration of hospitalization. Aim: This study was designed to compare the two different doses of IAD (Intra Arterial Diltiazem) during Trans Radial (TR) coronary procedure. Materials and Methods: This study is a prospective study, double blinded, randomised study comparing 5 mg (Group-I) versus 10 mg (Group-II) of IAD in patients undergoing coronary procedures. Results: Males were more than females in both the groups. The highest number of patients were in age group in both the groups was 50-60 years. Baseline characteristics were comparable between the two groups, There was no statistically significant difference between the two groups in the incidence of pain, spasm, need of additional drugs. In group I, patients needed more hemodynamic support. There was no statistically significant difference between the two groups in the sheath cannulation time. LOC to seath time was 4.2 ± 4.9mins in group I and it was 3.7 ± 3.6 mins in group II, and the p value was 0.15. S to C time was 3.3 ± 2.5 mins in group I and it was 3.4 ± 3.3 mins in group II and the p value was 0.447 and procedure time was 28.5 ± 18.2 mins in group I and it was 32.4 ± 19.9 mins in group II and the p value was 0.008. Conclusion: IAD is an effective antispastic agent that can be used in transradial procedures. 5 mg of bolus of diltiazem is as effective as 10 mg.</p> Sayyid Mohammed Khilar Copyright (c) 2021 Sayyid Mohammed Khilar 2021-07-09 2021-07-09 4 12 31 33 Effectiveness of Dexmedetomidine as an Adjunct Agent to Propofol During ERCP <p>Objectives: To evaluate dexmedetomidine as an adjunct drug to propofol during ERCP, and its effects on hemodynamics.Methods: 80 patients ASA (I-II) scheduled for ERCP procedure were randomly classified to either dexmedetomidine/propofol group or propofol group. In Dexmedetomidine /Propofol group, induction was done using dexmedetomidine (0.5 μg/kg), propofol (50 mg), fentanyl 1μg/kg plus atracurium 0.5mg/kg followed by endotracial intubation. Maintainence of anaesthesia was done using infusion of dexmedetomidine(0.4 μg/kg/h) and propofol (0.5-1 mg/kg/h). In Propofol group, induction was done using propofol (50 mg), fentanyl 1 μg/kg followed by atracurium 0.5mg/kg followed by endotracial intubation. Maintaince of anesthesia was done using propofol infusion (0.5-1 mg/kg/h). HR, SBP, DBP, RR, SPO2 and ETCO2 were continuously monitored and recorded at the time points (T0 to T8).Results: Comparing dexmedetomidine/propofol group versus propofol group; PI values showed significant increase at T2 to T7 (p˂0.001), HR values showed significant decrease at T1 to T8 (p 0.013 at T1 and 0.001 at T2 to T8). In dexmedetomidine/propofol group, the propofol dosage was significantly lower (p value 0.001) and the recovery time was significantly higher (p value 0.001) than that of propofol group, while the procedure time was comparable between both groups. Dexmedetomidine/propofol group showed higher incidence of bradycardia than propofol group (p value 0.035) while propofol group showed more cases with tachycardia (p value 0.016) and more cases with airway obstruction (p value 0.026). Conclusion:Dexmedetomidine is a useful adjunct drug during ERCP procedure.</p> Mohsin Wazir Faizani Asrar Nazki Shashidhar Matam Copyright (c) 2021 Mohsin Wazir, Faizani Asrar Nazki, Shashidhar Matam 2021-07-09 2021-07-09 4 12 34 36 A Prospective Study on Partographic Observations in a Primigravida with Spontaneous Versus Induced Labour at a Tertiary Care Center <p>Background:Labour depends on uterine contractions, cervical dilatation and effacement. It also depends on pelvis and fetal weight. Once labour has started it is possible to regulate its duration and progress. This requires careful diagnosis of onset of labour, regular assessment and decisive action.Aim &amp; Objective: The aim of present study is to compare the labour progress and delivery outcome among induced versus spontaneous labour in women at term using simplified WHO partogram.Methodology: This study was conducted at Government Medical College &amp; Hospital, Nalgonda over a period of 12 months from September 2019 to August 2020. It is a prospective study conducted on 200 antenatal women. 200 women were primigravida, routine history ,physical examination, systemic, obstetric examination and routine investigation and ultrasound scan done. Results: Out of 200 primigravida 100 were allowed for spontaneous labour and another 100 labour was induced with prostaglandins. Partogram was plotted when women reached 4cm dilatation and all partographic observations noted. The labour progress and delivery outcome was measured by total duration of labour, caesarean section rate, comparison of deliveries in group A,B,C ,mean birth weight and APGAR score. Mean total duration in induced group is 3.1hr,in spontaneous is 3hrs,caesarean section rate was high in induced group. Incidence of caesarean section is high in group C (which crossed action line).Most common indication for caesrean section was cephalo pelvic disproportion and fetal distress. Most women delivered before the alert line(groupA) in both induced and spontaneous group. Mean APGAR at 1min and 5min was similar in both groups. APGAR was low in both groups who crossed action line .Incidence of tachysystole is high in induced group compared to spontaneous group 15% cases in induced labour had APGAR 5-6 whereas 3% in spontaneous has 5-6 Incidence of MSL is 16% in induced labour when compared to 9% in spontaneous labour Induced labour is comparable to spontaneous labour when it is partographically monitored. Conclusion:Partogram is efficient, time saving and gives a clear picture of labour. It facilitates anticipation with reasonable certainty of labour problems and indicates the need for clinical re-evaluation.</p> Vijayasree J Kavitha Bhalki P. Padma Copyright (c) 2021 Vijayasree J, Kavitha Bhalki, P. Padma 2021-07-09 2021-07-09 4 12 37 42 Titanium elastic nailing in femoral diaphyseal fractures of children in 6-14 years of age <p>Introduction: This study comprised of evaluation of result of titanium elastic nailing in paediatric femoral diaphyseal fractures of children in 6-14 years of age. Material and Methods:.28 patients were treated with titanium elastic nailing.Evalaution was done on the basis of clinical and radiological evidences.Results: Primary union was achieved in allpatients Mean time to union was about 8-12weeks. Mean operation time 65 minutes. There were 4case of patient who showed entry site irritation.Functional outcome was good for all those acheived union. Conclusion: It was seen that excellent level of bone union was achieved by performing tens nail fixation in paediatric femoral fractures.The titanium elastic nailing is an effective and viable treatment option in selected cases of femoral diaphyseal fractures in the 6-16 years age group.</p> Devesh Bandil Vishnu R Megha Bandil Copyright (c) 2021 Devesh Bandil, Vishnu R, Megha Bandil 2021-07-09 2021-07-09 4 12 43 46 A Clinical Comparison between Plain Ropivacaine V/S Ropivacaine and Clonidine by Caudal Route for Post Operative Analgesia in Children <p>Background and objectives: Addition of clonidine to ropivacaine (0.25%) can potentially enhance analgesia without producing prolonged motor blockade. The aim of the present study was to compare the post-operative pain relieving quality of ropivacaine (0.25%) and clonidine mixture to that of plain ropivacaine (0.25%) following caudal administration in children.Method: After careful pre-anaesthetic check-up children posted for elective sub- umbilical surgeries between age groups of 2-10yrs of ASA I &amp; II were randomly divided into Groups R and RC, of 30 each, injected with Inj. Ropivacaine 0.25% (1ml/kg body weight) and Inj. Ropivacaine 0.25% (1ml/kg) and Inj. Clonidine (2 mcg/kg) combination through caudal respectively prior to start of surgery after induction. Intra-op and post-operative duration of analgesia and motor blockade were noted along with other vital parameters.Results: Significantly prolonged duration of post operative analgesia was observed in Group RC. Heart rate and blood pressure was statistically different but not clinically. Neither motor blockade nor post operative sedation varied significantly between the groups.Conclusion: The combination of clonidine 2 mcg/kg and ropivacaine 0.25% 1ml/kg was associated with an improved quality of post-operative analgesia compared to plain ropivacaine 0.25% 1 ml/kg. The improved quality and duration of analgesia of the ropivacaine - clonidine mixture was achieved without causing any significant adverse effects or prolongation of motor blockade.</p> Vuyyuru Babu Rajendra Prasad Copyright (c) 2021 Vuyyuru Babu Rajendra Prasad 2021-07-09 2021-07-09 4 12 47 51 A Hospital Based Study on Impact of Otorrhoea and Ossicular Status on the Effect of Tympanoplasty <p>Background: The surgical treatment of chronic otitis media primarily aims at complete removal of disease from the middle ear cleft, which is achieved in many of the cases nowadays. Each patient is assigned a numerical score based on the risk factors. The total score is 12.Based on MERI score, the patients are classified as mild disease (1-3), moderate disease (4-6) and severe disease (7- 12). Aim:To study the effect of otorrhoea, osscicular and middle ear status on anatomical and functional results in patients undergoing tympanoplasty with or without mastoidectomy for chronic otitis media mucosal disease. Materials and Methods:A prospective study involving 100 patients of COM being treated surgically at the department of ENT at Nimra Institute of Medical Sciences during the time period February 2019-January 2020 .The patients attending the OPD with otological complaints (otorrhoea, hearing loss) were evaluated clinically. On diagnosis of the case of COM mucosal disease, these patients were counselled for surgery. Patients undergoing surgical correction by tympanoplasty with or without mastoidectomy were assessed pre and intraoperatively by MERI scoring in order to classify and identify the disease category. The patients considered for surgery for COM mucosal disease underwent a detailed general physical and otoneurological evaluation. They also underwent hearing assessment by Pure-Tone Audiometry prior to surgery. Air and bone conduction at frequencies of 0.5, 1, 2, 3 kHz were recorded and a 4 tone average will be calculated. Results:In our study of 100 patients,52% were females and 48% males with majority of patients in the group of 21-30 years.The most common presenting complaint amongst these patients was otorrhoea followed by hearing impairment. 33 % had Right sided disease,57 % had left sided disease and 10% had Bilateral disease. Left sided pathology was more common in our study group. Aural swab was done for culture sensitivity of the organisms in all patients and the most common organism isolated in aural swab culture was Pseudomonas (26%). Maximum number of patients 52% had a dry ear ,48% had occasionally wet ears and 8% had persistently wet ears.Patients presented with history of ear discharge of varying duration ranging from 1 year to 30 years. 50 patients(50%) had an intact ossicular chain. Defects of the Incus alone were seen in 36 patients (36%).Defects in both malleus and incus was seen in 7 patients(7%) and stapes and incus was noted in 7 patients(7 %). Of the total number of patients(n=100), majority of the patients 79% had normal middle ear status while 21% of them had middle ear effusion present,20 of the total patients were smokers and 80 of them were non-smokers. Majority of the patients belonged to the group of Mild risk MERI(1-3) which was 69 patients,26 patients came under the Moderate risk category MERI(4-6) and 5 % patients had Severe risk (7-12). Of the total 100 patients being studied,the graft uptake was successful in 78 patients (78%) and there was a failure in 22% of them. Otorrhoea proved to be a significant factor in the success of surgery asdry ears had a better graft uptake compared to wet ears. ‘p’ value less than 0.05 at 5% level of significance shows there is significant relationship between otorrhoea and graft uptake.Of the total of 100 patients,21 of them had non patent Eustachian tube with middle ear effusion of which 10 of them had graft failure, whereas in case of patent Eustachian tube and normal middle ear cleft the success rate was higher(68 out of the 79 were successful). Those patients with a lower MERI score had successful outcome of surgery whereas those with a higher score had lesser chances of successful surgery. Out of 100, 60 patients belonging to the mild MERI and 17 from the moderate risk group had a successful surgery whereas only 1 patient out of the severe category had a successful surgery. Conclusion:Otorrhoea and status of middle ear cleft proved to be significant factors in the graft uptake and success of Tympanoplasty whereas ossicular status did not play a significant role in the result of surgery.Middle Ear Risk Index proved to be very valuable tool in predicting the outcome of surgery.</p> Palukuri Suresh Gopi Naik Bukya Copyright (c) 2021 Palukuri Suresh, Gopi Naik Bukya 2021-07-09 2021-07-09 4 12 52 58 A Comparitive Study of Granisetron and Palonosetron as Antiemetics for Prevention of Post Operative Nausea and Vomiting in Patients Undergoing Laparoscopic Surgeries <p>Laparoscopic surgeries are associated with an appreciably high rate of post operative nausea and vomiting (PONV). This study was designed to compare the effectiveness of Granisetron with that of Palonosetron for prevention of PONV after laparoscopic surgery. Methods:In a randomized, prospective study, 50 adult patients of both sexes received Granisetron 2.5mg and Palonosetron 75mcg intravenously at the end of surgery. Perioperative anaesthetic care was standardized in all patients. Patients were then observed 24 hours after administration of the study drug.Results:A complete response (defined as no PONV and no need for another rescue antiemetic) was achieved in 76% of the patients given Granisetron and 84% of the patients given Palonosetron with (P&lt;0.05%). No significant difference observed in the recovery time from anesthesia between the two drugs and slight difference in the adverse events were observed between the two groups.<br>Conclusion:This study concludes that the prophylactic intravenous administration of Palonosetron is more effective drug than Granisetron for controlling postoperative nausea and vomiting with less incidence of side effects.</p> Vuyyuru Babu Rajendra Prasad Copyright (c) 2021 Vuyyuru Babu Rajendra Prasad 2021-07-09 2021-07-09 4 12 59 63 An Anthtropometric Study of Bicipital Groove of Humerus with Clinical Correlation <p>Background: Keeping in mind the frequency at which the surgeries are performed for shoulder arthroplasty, the antropometric measurements of the bicipital groove are essential for prosthesis manufacture and replacement. The knowledge of anthropometry and its variations in different region are helpful to have a desired clinical outcome. So, there is lack of data pertaining to central Karnataka region, not only morphometric analysis of bicipitalgroove and logical explanation for association of pathologies of biceps tendon on groove morphology is carried out along with a review of the literature. The present study aims at measuring the length, width and depth of Bicipital groove in the population in and around Davangere.Methods: The study was carried out on 51 adult humerus, 25 belonging to the right side and 26 to the left side. The length, width and depth of the bicipital groove were measured using digital verniercaliper. The data obtained calculated as mean +/- SD, which is compared on both sides. Results:The mean length of Medial wall, lateral wall, Transverse width and depth of bicipital groove on the right side were 38.06+/-5.20, 42.93+/-5.97, 9.34+/-1.62, 5.86+/-1.32respectively and on the left side were 37.24 +/- 5.13, 41.98+/-5.28, 9.02+/-1.51, 5.35+/-0.91 respectively.<br>Conclusion:The results of the study demonstrate the anthropometric parameters are higher on the left side compared to right side in the population in and around Davangere. We hope this study will be useful for further clinical research and prosthesis surgeries.</p> Santosh Bhosale Raghavendra A.Y. Premchand S.A. Copyright (c) 2021 Santosh Bhosale, Raghavendra A.Y., Premchand S.A. 2021-07-09 2021-07-09 4 12 64 66 Assessment of Role of alcohol in Road Traffic Accidents: An epidemiological study <p>Background:Alcohol (ethanol) is a widespread euphoriant and acts as a central nervous system depressant. Most of the deaths due to road traffic accidents (RTIs) have occurred in low and middle-income countries. Hence; the present study was undertaken for assessing role of alcohol in road traffic accident cases in a known population. Materials &amp; methods:A total of 200 cases of road traffic accidents were analysed during the study period. Only those cases were enrolled which were victim of road traffic accidents. Ethical approval was obtained from institutional ethical committee and written consent was obtained. A Performa was made and detailed demographic history of all the patients was recorded. Habit history was also noted separately.Results:In 74.5 percent of the patients, speed of the vehicle was within the speed limit. While analysing the correlation of speeding range of vehicle of victim at the time of accident and Alcohol history of victims at the time of accident, it was seen that alcohol led to significant increase in incidence of over speeding of the vehicle.Conclusion: Alcohol is a significant risk factor for road traffic accidents.</p> Rinki Kalra Copyright (c) 2021 Rinki Kalra 2021-07-09 2021-07-09 4 12 67 69 Clinico-Pathological Study and Management of Parotid Gland Tumours <p>Background and Objective:Salivary gland tumours are rare, generally benign and affect mainly the parotid glands. Although parotid tumours can occur from birth onwards throughout the lifespan, incidence varies with respect to age and sex of the individual. Diagnosis and management of parotid tumours is complicated by their relative infrequency, the limited amount of pre-treatment information available and wide range of biological behavior seen. Parotid tumours are interesting to surgeons, as they are unique in the way they present, that is with a diverse array of clinical patterns and varied histological patterns. So the diagnosis is frequently aided by the use of FNAC. So in this study, subjects presenting with symptoms of parotid gland tumours will be assessed clinically, diagnosed with the aid of FNAC and therapeutic procedures will be carried out accordingly. Aim &amp; Objectives: The objectives of the study are 1.To study the age and sex distribution of various types of tumours occurring in Parotid gland.2.To study their various modes of clinical presentation 3.To study the diagnostic accuracy of FNAC.4.To study the various treatment modalities offered. 5. To identify the complications ensuring there in, as a consequence of intervention.Methodology:Registered subjects registered in surgery department of Kamineni Institute of Medical Sciences with diagnosis of parotid gland tumours in FNAC report from January 2019 to February 2020 will be taken up for the study. Primary source of information technique will be used as the source of information with “Informed written consent” method for the subject’s consent. Subjects presenting with signs and symptoms of Parotid gland swellings in KIMS surgery OPD will be subjected to a detailed history and clinical examination. Long term follow up is necessary to study the tumor recurrence, which was not possible in this study.Results:Parotid gland tumours commonly occur between 3-5th decade. Benign tumours are more common in 20 to 50 years. Mean age for benign tumours was 37.51 years and malignant tumourswas 35 years. The salivary gland neoplasms more common in females M:F::1:3.6. So out of which 8 patients were male and 22 patients were female. M:F ratio for benign tumours is 1:3.1, and for malignant tumour was 1:0. Parotid gland is the most common site for salivary gland tumours, accounting for 80%. Among parotid tumours 96.67% were benign and 3.33% were malignant. 66.7% of benign tumours presented within 5 years. Facial palsy was the commonest complication observed after surgery postoperatively 8 patients developed facial palsy, out of which 6 were temporary and 2 were permanent. Wound infection developed in 7 patients. FNAC is a good tool in diagnosing salivary gland with exact cytohistological 96.55% for benign tumours and 100% for malignant tumours. Regarding accuracy of clinical examination in diagnosing parotid gland malignancies, the sensitivity is 100% and specificity is 100%.The overall prognosis was fare for all kinds of parotid gland tumours including benign and malignant tumours. There was no mortality that was observed during the course of this study. No recurrence was reported during the course of this study.<br>Interpretation and Conclusion:Parotid gland tumours are less often encountered in surgical practice. Parotid gland tumours most commonly occur in third and fifth decade.. Surgery is the mainstay of treatment of parotid gland tumours and superficial parotidectomy is the most commonly performed surgery for benign as well as low grade malignant parotid tumours. Most important complications of parotid surgery were wound infection and facial palsy. In facial palsy temporary facial palsy is the one which was encountered most. Long term follow-up is necessary as pleomorphic adenomas tend to recur after long time. Since the most common malignant tumours are asymptomatic and long standing benign tumours especially pleomorphic adenoma can undergo malignant change, community awareness, early detection and earliest referral from primary health care set up to tertiary centres are necessary.</p> Prudhvinath Kurakula Anuj Kumar Patel Copyright (c) 2021 Prudhvinath Kurakula, Anuj Kumar Patel 2021-07-09 2021-07-09 4 12 70 75 A Study on Seroprevalence of HSV-1 In Clinically Suspected Cases <p>Background: Herpes Simplex Virus (HSV) type 1 infects 60%–80% of people throughout the world. The prevalence of HSV-2 infection in adults varies markedly from country to country. A high percentage of genital infections are being caused by HSV-1. HSV-1 is misdiagnosed and overdiagnosed as aphthous ulcers and erythema multiforme due to similar manifestations. Patients of acantholytic disorders are also prone to co- infections by HSV.Objectives: (1) To correlate the seroprevalence with the age and gender of patients. (2) To detect the antibodies against HSV-1 and HSV-2 in clinically suspected cases using IgM ELISA. (3) To evaluate the significance of IgM ELISA as a diagnostic tool in conjunction with provisional clinical diagnosis.Methods: Cross sectional study conducted from January to December 2020. 2-3 ml blood was taken from patients and serum samples were tested for the presence of both HSV-1 and HSV-2 IgM antibodies by ELISA.Results: 82 patients were included in our study. 18.2% showed seropositivity for HSV-1 IgM and 8.5% for HSV-2 IgM, while co-infection was seen in 2.4% patients. 44% patients were in the age group of 21-40 years (p value&lt;0.05) which also accounted for maximum number of positive cases. Higher seropositivity for both HSV-1 (22.5%) and HSV-2 (12.2%) was seen among the patients hailing from urban areas belonging to lower socioeconomic strata. 36.5% were provisionally diagnosed as herpes labialis. 30% of these were positive for HSV-1 IgM antibodies. 23.2% were diagnosed and treated as pemphigus vulgaris. 15.8% of these cases and 14.3% of aphthous ulcers had co-infection with HSV-1.Conclusion: Serological testing for both types of Herpes viruses is recommended in all suspected cases. Differential diagnoses should be considered in seronegative patients. Laboratory confirmation can avoid misdiagnosis and erroneous treatment modalities.</p> Dangudubiyam Sree Usha M. Archana Copyright (c) 2021 Dangudubiyam Sree Usha, M. Archana 2021-07-09 2021-07-09 4 12 76 82 A descriptive study on Epidemiology of Burns in a Medical teaching Institute of Kolkata <p>Background: Burns are a major cause of injury worldwide. According to World Health Organization (WHO) over 1 000,000 people are moderately or severely burnt every year and that more than 300,000 people die annually from fire-related burns worldwide but prevention programs are almost non-existent. Objectives: To investigate the causes and circumstances and severity and types of burn injuries sustained by the study population and to find out the association with different factors.Methods: A Prospective descriptive hospital based study was conducted in a tertiary care centre from 1st May 2012 to 30th April 2013. Cases were selected using systematic random sampling and final sample size was 403. Data were collected by interviewing the patients using pre-designed, pre-tested semi-structured schedule and also from medical records. Results: Mean age of participants was 29.71 years and 25.6% them belonged 15-25 years. Most of participants were females (53.8%) and housewives(21.3%). Almost 81.8% of the injury occurred accidentally and home was most common place (69%). Majority (64.8%) of burn was due to flame and anterior trunk was the commonest (74.9%) body part affected. Most of patients (61.3%) suffered from second degree burn and 23.1% patients had involvement of body surface area ≥60%. Significant association was seen with suicidal burn and female (P=0.002) and Hindus (P=0.009), homicidal burn and Muslims (P=0.000), domestic burn with female (P=0.000). Involvement of surface area were more among female(P=0.000).Conclusion: There is a need to promote education in all aspects of burn for prevention.</p> Rahul Biswas Soumitra Mondal Shibasish Banerjee Copyright (c) 2021 Rahul Biswas, Soumitra Mondal, Shibasish Banerjee 2021-07-09 2021-07-09 4 12 83 88 Pulmonary arterial hypertension in children with sickle cell anaemia <p>Background:Pulmonary hypertension(PHT) is a life threatening complication which occurs in adults with sickle cell disease(SCD). But there is paucity of knowledge about prevalence of pulmonary hypertension in Paediatric SCD population.Objective:To find out the prevalence of pulmonary hypertension in children with SCD.Methods:552 children age between 5 to 14 years were enrolled after written informed consent was obtained from parents/guardian. Children with Congenital heart disease, pulmonary stenosis, Rheumatic heart disease were excluded from the study. PHT in all cases of with SCD children was screened by using 2D Echocardiography in the department of cardiology. PHT is defined as mean pulmonary artery pressure (mPAP) ≥ 25 mmHg at rest. All the data were validated and analyzed with SPSS version 25.Results:Overall prevalence of pulmonary hypertension in our study is 20.4%. Of these, 6.5% subjects have mild and 13.9% subjects have moderate pulmonary hypertension. Low haemoglobin (p=0.021), high number of crisis (p=0.000), high number of blood transfusion (p=0.000), presence of loud second heart sound (p=0.000) and presence of Parasternal heave (p=0.000) were significantly associated with pulmonary hypertension. The prevalence of pulmonary hypertension in children with SCD demonstrated an increase in trend with age.Conclusion:High pulmonary artery pressures do occur in children with SCD. Screening by echocardiography can lead to early detection and intervention.</p> Subash Chandra Majhi Suren Kumar Sahoo Prakash Chandra Panda Sunil Kumar Sharma Nayan Kumar Patel Copyright (c) 2021 Subash Chandra Majhi, Suren Kumar Sahoo, Prakash Chandra Panda, Sunil Kumar Sharma, Nayan Kumar Patel 2021-07-09 2021-07-09 4 12 89 93 Diagnostic challenges during recognition of isolated posterior wall myocardial infarction <p>Introduction:Patients with isolated PMI is most often misdiagnosed as anterior subendocardial ischemia and get deprived of emergent reperfusion therapy. Therefore patients with PMI often presents with dreadful complications like acute ischemic MR,LVF,leading to higher mortality equivalent to anterior wall MI despite normal or borderline EF. Therefore a qualitative analytic study was conducted after collecting and compiling related literatures and guidelines to derive a conclusion about early and accurate diagnosis of isolated PMI. During analysis we obtained useful information as described below. Prominent R wave in V1-V2 takes averagely 33 hours to develop after onset of symptom, therefore it is unobserved in early golden hour of PMI. However it was included as a sign of acute myocardial ischemia in a recent guideline.As precordial ST depression is the one and only important electrocardiographic signs in early golden hours of PMI,therefore above ECG changes most often misdiagnosed as anterior subendocardial ischemia. Most of the important guidelines considers only isolated pattern ST depression (≥ 0.5 mm) as isolated posterior wall MI. Whereas diffuse pattern(v1-v6) is the common pattern in isolated PMI, therefore such pattern most often misdiagnosed as subendocardial ischemia. As ST depression in V2,V3 is a specific marker of PMI, therefore diffuse patterns with maximal ST depression in V2,V3 may be considered as a criteria for PMI .Guidelines suggests recording of posterior leads in patients with ACS with ST depression (≥0.5 mm) or non-diagnostic ECG changes in right anterior precordial leads in an attempt to fit PMI into ST elevation criteria of STEMI paradigm , whereas the same was not practiced most often by training or resident physicians due to lack of knowledge and awareness. However recent OMI paradigm,which is superior to STEMI paradigm in terms of accuracy,does not strictly considers ST elevation criteria for emergent reperfusion therapy, when ECG entity firmly concludes acute coronary occlusion. Conclusion: Presence of R wave in V1,V2 is a late evolved electrocardiographic sign of PMI and it doesn’t warrants emergent reperfusion therapy.Isolated (v1-v3 ) or diffuse (v1-v6) pattern with maximal ST depression (≥0.5 mm) in V2,V3 is a specific electrocardiographic sign of acute or hyper-acute posterior wall MI and seeks emergent reperfusion therapy . Whereas non diagnostic ECG like minuscule ST depression (&lt; 0.5 mm ) in anterior precordial leads can represent isolated posterior wall MI and may require further confirmation by screening echocardiography or recording posterior leads .</p> Sibaram Panda Sunil Kumar Sharma Suresh Chandra Sahoo Copyright (c) 2021 Sibaram Panda, Sunil Kumar Sharma, Suresh Chandra Sahoo 2021-07-09 2021-07-09 4 12 94 99 Evaluation of molecular subtypes and histological subtypes of breast cancer based on immunohistochemistry markers for assessing the behaviour and disease aggressiveness <p>Background: It is observed that seven percent of all the cases of breast cancer of whole world belong to our country. If our country is being considered then it has been found that more than twenty percent of all cancers affecting females is the breast cancer. The main concern regarding the management of breast carcinoma is the non homogenous characteristics of the breast tumour. Among the various classifications to reduce this non homogenecity in breast carcinoma the most accepted classifications has been based on the genetic characteristics of the tumours. In recent times there has been several studies has been conducted in other populations focussing on the immune histochemistry markers like Ki 67, cytokeratin 5/6, human epidermal growth factor receptor ( HER) and progesterone receptor (PR) in breast carcinoma for assessing molecular and histological subtypes of breast cancer.Aim: To evaluate molecular subtypes and histological subtypes of breast cancer based on immune histochemistry markers for assessing the behaviour and disease aggressiveness Methods and Materials: Immunohistochemistry was performed using four main markers ER, PR, HER2, and Ki67 to classify them into four molecular subtypes Luminal A, Luminal B, TNBC and HER2. An additional marker CK5/6 was used to further classify TNBC into Basal like and Non Basal like. The characteristics of two subtypes Basal like and non basal like TNBC were analyzed separately. These molecular subtypes and tumour histological subtypes were correlated with clinocopathological parameters viz. Age, menopausal status, laterality (right or left), tumour size, tumour grade, LVI, necrosis, stromal reaction, lymph node status, pathological T stage(pT), pathological N (pN) stage, Nottingham’s prognostic index (NPI).Results: In present study the age range of patients was between 28 to 80 years, with majority of patients in age group of 50 to 59 years. The mean age of presentation of histological subtypes was Infiltrating duct carcinoma, no special type (IDC-NST) – 53.56 years Infiltrating lobular carcinoma (ILC) – 54.08 years. Other histological subtypes – 57.07 years. In our study out of 278 patients, 105 were in premenopausal group and 172 were in postmenopausal group. Molecular subtypes was found to be more associated with aggressiveness of disease as compared to histological types. Conclusion:In comparison to histological subtypes, molecular subtypes can be a better tool for analysing the behaviour and disease aggressiveness of breast cancer, according to the findings of this study. We recommend that molecular classification be performed on all breast cancers and that it be used in conjunction with histological classification. It would be premature to dismiss histological classification at this time.</p> Pankaj Gupta Ruchika Solanki Mimansha Patel Sanjay Deb Radhika Vashistha Atul Sharma Copyright (c) 2021 Pankaj Gupta, Ruchika Solanki, Mimansha Patel, Sanjay Deb, Radhika Vashistha, Atul Sharma 2021-07-09 2021-07-09 4 12 100 109 Evaluation of pattern of head injury and skull fractures in victims of road traffic accidents undergoing autopsy <p>Background: It is observed that seven percent of all the cases of breast cancer of whole world belong to our country. If our country is being considered then it has been found that more than twenty percent of all cancers affecting females is the breast cancer. The main concern regarding the management of breast carcinoma is the non homogenous characteristics of the breast tumour. Among the various classifications to reduce this non homogenecity in breast carcinoma the most accepted classifications has been based on the genetic characteristics of the tumours. In recent times there has been several studies has been conducted in other populations focussing on the immune histochemistry markers like Ki 67, cytokeratin 5/6, human epidermal growth factor receptor ( HER) and progesterone receptor (PR) in breast carcinoma for assessing molecular and histological subtypes of breast cancer.Aim: To evaluate molecular subtypes and histological subtypes of breast cancer based on immune histochemistry markers for assessing the behaviour and disease aggressiveness Methods and Materials: Immunohistochemistry was performed using four main markers ER, PR, HER2, and Ki67 to classify them into four molecular subtypes Luminal A, Luminal B, TNBC and HER2. An additional marker CK5/6 was used to further classify TNBC into Basal like and Non Basal like. The characteristics of two subtypes Basal like and non basal like TNBC were analyzed separately. These molecular subtypes and tumour histological subtypes were correlated with clinocopathological parameters viz. Age, menopausal status, laterality (right or left), tumour size, tumour grade, LVI, necrosis, stromal reaction, lymph node status, pathological T stage(pT), pathological N (pN) stage, Nottingham’s prognostic index (NPI).Results: In present study the age range of patients was between 28 to 80 years, with majority of patients in age group of 50 to 59 years. The mean age of presentation of histological subtypes was Infiltrating duct carcinoma, no special type (IDC-NST) – 53.56 years Infiltrating lobular carcinoma (ILC) – 54.08 years. Other histological subtypes – 57.07 years. In our study out of 278 patients, 105 were in premenopausal group and 172 were in postmenopausal group. Molecular subtypes was found to be more associated with aggressiveness of disease as compared to histological types. Conclusion:In comparison to histological subtypes, molecular subtypes can be a better tool for analysing the behaviour and disease aggressiveness of breast cancer, according to the findings of this study. We recommend that molecular classification be performed on all breast cancers and that it be used in conjunction with histological classification. It would be premature to dismiss histological classification at this time.</p> Rinki Kalra Copyright (c) 2021 Rinki Kalra 2021-07-09 2021-07-09 4 12 110 112 Assessment of complications of laparoscopic cholecystectomy <p>Background:The prevalence of gall stones ranges from 10-20% and it is the major cause of morbidity. The present study was conducted to assess complications of laparoscopic cholecystectomy.Materials &amp; Methods:140 cases of gall bladder stones of both genders were treated with laparoscopic cholecystectomy.The operations were performed with standard four port technique. All were subjected to hematological, biochemical and radiological investigation.Complications of procedure was recorded.Results: Diagnosis of cases was chronic cholecystitis in 112, acute calculouscholecystitis in 18, sclero-atrophic cholecystitis in 5, GB mucocele in 4 and chronic cholecystitis with cholecysto-duodenal fistula in 1 case. Common causes of conversion was CBD injury in 3, pericholecystitis in 1 and biliary leak from cystic duct stump in 1 case. Common complications was bile leak in 5, port site hematoma and infection in 1, choleperitoneum in 1, umbilical hernia in 2 and retained duct stone in 1 case. The difference was significant (P&lt; 0.05).Conclusion: Common complications were bile leak, port site hematoma, infection, choleperitoneum, umbilical hernia and retained duct stone.</p> Manoj Kumar Sonkar Vineet Singh Somvanshi Copyright (c) 2021 Alok Chandra Tripathi, Umrao Singh 2021-07-09 2021-07-09 4 12 113 115 An Epidemiological Study on Selected Blood Parameters among COVID-19 Infected patient in a Tertiary Care Centre of India <p>Background:Patients with COVID-19 present with multiple hematological abnormalities.Objectives: This study investigated the impact of selected blood markers in COVID-19 positive patients and to determine any correlation with disease severity.Methods: This cross-sectional study was conducted in a tertiary care dedicated COVID hospital . Study period was March 2021 to April 2021 All moderate and severe category COVID 19 positive patients those were admitted in study period , were included as study participants by complete enumeration method. Blood samples were collected during admission at emergency and Blood parameters like total leukocyte count(TLC), C-reactive Protein(CRP), Neutrophil to Lymphocytes ratio(NLR), Albumin, Globulin, Alanine aminotransferase(ALT), Aspartate Aminotransferase(AST), alkaline phosphatase (ALP), sodium, potassium, urea, creatinine were assessed.Results: Mean of CRP was 33.91 mg/L. Mean of NLR and TLC were 5.8 and 11644.9/cc respectively . Lymphopenia was seen with lowest value was 4% and mean 20.16. Hyponatremia and hypokalaemia were seen 45.9% and 17.3% patients respectively. Blood urea and creatinine were raised almost 44.9 % and 28.6% patients respectively. Only 12.2 % patients had hypoalbuminemia. Positive correlation with statistical significant association was found with NLR with CRP(R=0.225, p=0.026)and NLR with TLC (R=0.625, p=0.000). Negative correlation was found with CRP and albumin though no statistical significant was seen (R= -.024, p=0.813).Conclusion: With this findings it can be concluded that routine blood parameters like CRP, TLC, NLR, albumin, urea ,creatinine, sodium and potassium should be advised all patients irrespective of disease category as a screening tool for disease progression.</p> Tarun Kumar Das Saikat Bhattacharya Soumitra Mondal Shibasish Banerjee Debopam Hazra Debasis Das Copyright (c) 2021 Tarun Kumar Das, Saikat Bhattacharya, Soumitra Mondal, Shibasish Banerjee, Debopam Hazra, Debasis Das 2021-07-09 2021-07-09 4 12 116 119 Morphological evaluation and clinical correlation of bone marrow aspiration cytology at tertiary care centre <p>Background: Bone marrow examination is an important diagnostic test for hematological and non hematological disorder in carefully selected cases after clinical, biochemical and peripheral blood smear examination. The aim of this study was to evaluate the clinical profile of the patient necessitating for bone marrow aspiration and correlate with underlying pathology.Materials and method: This is a retrospective study done for 1 year. A total of 290 patients were included in the study. Data were collected from hospital record and pathology department record. Result: 290 patients were included in the study but 276 patients were analyzed with a male to female ratio of 1.5:1. The age range of subjects varies from 0 year to 80 years with maximum patients in the age group of 11-20(19.2%). The commonest symptom was weakness (30.8%) and the commonest sign was pallor (29.7%). The most frequent indication for BMA was pancytopenia(29.3%) followed by unexplained fever (13.8%) and suspected cases of leukemia (11.2%). The most common diagnosis was deficiency anemia constituting 31.9 % of cases out of which megaloblastic anemia showed highest incidence (16.3%). Among leukemia, AML was most common (9.05%) followed by CML-CP in 5.4% cases. Reactive marrow was found in 12.3% cases followed by normal marrow study in 11.6% cases. Hypoplastic marrow was found in 6.2% cases. Conclusion: BMA is an important hematological investigation useful for diagnostic, prognostic and therapeutic evaluation of various hematological and nonhematological disorders in carefully selected patient.</p> Praveen Kumar Kalpana Chandra Tanwi Singh Anuja Mishra Sanjeet Kumar Singh Amit Kumar Mishra Copyright (c) 2021 Praveen Kumar, Kalpana Chandra, Tanwi Singh, Anuja Mishra, Sanjeet Kumar Singh, Amit Kumar Mishra 2021-07-09 2021-07-09 4 12 120 123 Maternal and Perinatal Outcome in Anaemia Complicating Pregnancy <p>Background: Anaemia in pregnancy is one of the most common problems faced by obstetricians, especially in developing countries. It is frequently severe and contributes to maternal mortality and reproductive health morbidity. This study was done with the objective to find out the maternal and perinatal outcome in anaemia complicating pregnancy.Material &amp; Methods: This was a prospective study which was conducted in the department of Obstetrics and Gynaecology. J K Lon Mother and Child Hospital, Kota from April 2019 to March 2020 to find out the effect of moderate, severe and very severe anaemia on maternal and foetal morbidity and mortality. After applying the inclusion and exclusion criteria, 400 patients were included in this study.Results: Iron deficiency anaemia was found to be the most common type of anaemia in pregnant women. Adverse maternal outcome was observed in the form of high incidence of preterm delivery (34.75 %), Congestive cardiac failure (6.75%), atonic PPH (2%), maternal infections and maternal mortality. Adverse perinatal outcome includes high incidence of low birth weight (47.13%), NICU admission (24.44%), jaundice (20.70%), IUGR (15.96%) and perinatal mortality. Lower the haemoglobin values, higher was the incidence of complications in both mother and neonate.Conclusion: Maternal anaemia is very high in the region in and around Kota. Regular antenatal checkups and appropriate intervention at the right time can prevent anaemia and also improve the fetomaternal outcome of pregnant mothers.</p> Reshma Raj J Santosh Meena Rajendra Prasad Rawat Copyright (c) 2021 Reshma Raj J, Santosh Meena, Rajendra Prasad Rawat 2021-07-09 2021-07-09 4 12 124 127 Diagnostic Laboratory Markers of COVID-19 Positive Patients in a Tertiary Care Hospital of Southern Rajasthan <p>Introduction:As Coronavirus disease is spreading, there is urgent need of identification of clinical and laboratory predictors for progression towards severe and fatal forms of this illness. Corona virus infected people have mild to moderate symptoms. However, 15-32% develops severe symptoms with a case fatality rate of 1-15%. Covid-19 is a systemic infection with adverse impact on hematopoietic system and hemostasis .<br>Aim: The main aim of this study was to predict common laboratory parameters which are altered in covid-19 positive patients. Methods:A retrospective study was conducted at Geetanjali Medical College and Hospital for 2 months during first wave of Covid-19. The confirmed 101 positive patient’s list was collected from Microbiology DPT. HIS system of GMCH Udaipur. This study includes all common laboratory parameters of Covid-19 diagnosed patients. Laboratory parameters included in this study were – Complete blood count, CRP, D-dimer, A/G ratio, S.Ferritin, S.Creatinine and LDH. The data was collected using HIS system.Conclusion:This study predicted that NLR and S.Ferritin get deranged in majority and were best laboratory markers to look after during COVID period .They should be given ICU care. The next good predictors were CRP, S.Creatinine and D-dimer. The tests of LDH and A: G ratio should be avoided as they are poor tests. This has been decided on the basis of ROC curve.</p> Priyanka Purohit Neelam Jain Swati Jindal N.Mogra M.L.Gupta G.Mukhiya Copyright (c) 2021 Priyanka Purohit, Neelam Jain, Swati Jindal, N.Mogra, M.L.Gupta, G.Mukhiya 2021-07-09 2021-07-09 4 12 128 131 Economic Impact of Trauma- A Meta-Analysis <p>Introduction: Orthopaedic trauma is any severe injury to the bones, joints, and/or soft tissue that is caused by an external source. These injuries are often the result of a sudden incident, such as a car accident or fall, but not always. Trauma can also be caused by overuse - for example, running long distances is a common cause of tibial stress fractures, small hairline cracks in the lower leg. The Main objective of this study was to determine the socioeconomic impact of orthopaedic trauma in the available literature. We aimed to achieve this objective by defining the various socioeconomic outcome measures and calculating pooled socioeconomic outcomes for extremity fracture patients at commonly reported time points. Materials and Methods: In our study, Studies were eligible for inclusion if more than 75% of the study population sustained an appendicular fracture due to acute trauma, the mean age of the study population was between 18 and 65 years of age, and the study included a socio-economic outcome, defined as a measure of income, employment status, or educational status. An experienced academic research librarian conducted searches in MEDLINE (Ovid), Embase (Elsevier), and Scopus on December 3, 2020, without restrictions on publication date or language. Searches comprised of two concepts: socio-economic consequences and orthopaedic trauma. Keywords were used in combination with database-specific terminology. The reference lists of the included studies were examined for additional papers. Results: A total of 1702 titles and abstracts, 486 full-text articles were screened in this study; 103 met our eligibility criteria and were included in the review and meta analysis. The included studies comprised of retrospective cohort studies (35.6%) and case series (31.7%). The majority of the studies were performed at a single site (78.0%) with a median sample size of 31 patients (IQR: 34–145), and over half were conducted in either Europe (37.6%) or North America (27.3%). In the included prospective studies, the median follow-up was 12 months (IQR: 6–24 months). Retrospective studies had a median follow-up of 18 months (IQR: 12–25). Fractures of the tibia (31.2%) and hand (31.2%) were the most commonly studied. While calcaneus (n = 15), scaphoid (n = 12), and malleolus (n=9) were the most frequently included fracture locations in the included studies. Over 80% of the included studies were published from 2000 through 2019. Conclusion: The findings of this meta-analysis suggest that orthopaedic trauma can have a substantial socio-economic impact on patients, and therefore also affect a person's psychological well-being and happiness. However, the current techniques to measure socio-economic outcomes following orthopaedic trauma are widely varied in both design and implementation. Informative and accurate socio-economic outcome assessment requires a multifaceted approach and further standardization.</p> Chaitanya R Shetty Savith V Shetty Copyright (c) 2021 Sandeep Kumar, Charumathi A, Abha Kumari 2021-07-09 2021-07-09 4 12 132 136 Histopathological study of leprosy along with Clinicopathological correlation at a tertiary care center <p>Background: Leprosy is a chronic disease, which remains a major public health problem in developing countries. The clinical presentation of various types of leprosy is overlapping. Histopathology remains the gold standard in the diagnosis of leprosy. Hence Clinicopathological correlation is important for the early diagnosis, classification, and treatment.Material and Methods: Two-year retrospective study was conducted in the department of pathology, KBNIMS, Kalaburagi. The study was carried on the skin biopsy specimen of clinically diagnosed leprosy cases.Results: A total of 36 cases were included in the study, which showed a male: female ratio of 2:1. The majority of the cases were in the 3rd decade. The most common clinical symptom was hypopigmented anaesthetic plaque and the most common subtype of leprosy was found to be lepromatous leprosy. Majority of the cases were multibacillary and tuberculoid leprosy showed maximum correlation. Conclusion: Clinicopathological correlation is pivotal in the accurate diagnosis of leprosy to prevent, treat, and eradicate the disease.</p> Saara Neeha Syeda Heena Kauser Pratima S Sambrani Zeenath Begum Copyright (c) 2021 Saara Neeha, Syeda Heena Kauser, Pratima S Sambrani, Zeenath Begum 2021-07-09 2021-07-09 4 12 137 140 Assessment of midshaft clavicle fractures treated by 3.5 LCP reconstruction plate <p>Background: Fractures of the clavicle, which primarily occur in young males, constitute 2.6–4% of all fractures in adults. The present study was conducted to assess midshaft clavicle fractures treated by 3.5 LCP reconstruction plate.Materials &amp; Methods: 98 cases of midshaft clavicle fractures of both genders were included. All cases were managed with 3.5 LCP reconstruction plates. Parameters such as mode of injury, Constant-Murley Score and Quick DASH and complications were recorded.Results: Out of 98 patients, males were 52 and females were 46. Cause of fracture was RTA seen in 60, sports injury in 25 and domestic violence in 13. The mean Constant-Murley Score was 91.4 and Quick DASH score was 12.6. Common complications noted were delayed union (11), superficial infection (5), neuropraxia (2), non- union (3), hypertropic scar (1) and vascular lesion (1). The difference was significant (P&lt; 0.05).Conclusion: LCP reconstruction plate 3.5 in cases of clavicle fractures resulted in excellent outcome</p> Vinod Kumar Copyright (c) 2021 Vinod Kumar 2021-07-09 2021-07-09 4 12 141 143 Carotid Intima-Media Thickness: An Index Early Detection of Subclinical Atherosclerosis in Rheumatoid Arthritis <p>Background: Increased cardiovascular risk has been observed in patients with rheumatoid arthritis due to accelerated atherosclerosis. The significance of Carotid Intima-Media thickness as a surrogate marker for detecting subclinical atherosclerosis is uncertain.Objective: To assess the carotid intima-medial thickness (CIMT) in rheumatoid arthritis patients and to correlate it with the prognostic outcome of patients with rheumatoid arthritis(RA)Methods: In this cross-sectional study, 50 patients diagnosed with Rheumatoid arthritis (according to ACR-EULAR criteria)who presented to the hospital were recruited. Ultrasound B-mode examination of carotids and carotid intimamedial thickness measurement(CIMT) was carried out in these patients. Statistical software SPSS-15.0 was used for the analysis of the data. Descriptive and inferential statistical analysis was carried out.Results: Out of total 50 patients, 31 females (62%) and 19 patients males (38%), a total of 30(60%) had atherosclerotic changes on CIMT. These included 19 females(63.3%) and 11 males(36%). In female sub-group, atherosclerotic changes in left common carotid artery (68%) were predominant and right common carotid artery in male sub-group(64%). In case of atherosclerotic right common carotid artery(CCA) mean PSV, mean EDV and ,mean RI were found to be 55.48±9.37, 15.36±3.66 and 0.64±0.07 and in the left CCA, mean PSV, mean EDV and mean RI were 59.44±6.98, 16.80±4.48 and 0.64±0.08 respectively.EDV was found to be statistically significantly altered. There was no significant correlation between Doppler velocities in both right carotid and left carotid with Gender or age.Conclusion: Based on the findings of the study, it can be concluded that CIMT screening by B-mode Doppler USG scan is a useful surrogate marker for assessing subclinical atherosclerosis in patients with RA.</p> Hrishikesh Shiva Kumar Madhu G Anugraha Durairaj Shilpa TA Copyright (c) 2021 Hrishikesh Shiva Kumar, Madhu G, Anugraha Durairaj, Shilpa TA 2021-07-09 2021-07-09 4 12 144 146 Association of Low Birth weight and Cerebral palsy <p>Introduction: Damage to the motor control centres of the developing brain causes cerebral palsy (CP), which can occur during pregnancy, childbirth, or after delivery. Objective: To study the associated risk factor low birth weight for spastic CP in a retrospective study involving children with CP. Materials and methods: The study population included 187 children with CP. Data was collected from the medical records and from the parents of affected 187 Cerebral palsy children attended / admitted during the period from 2014 to 2020 in Rani Chandramani Devi Government hospital and Rehabilitation centre, PedaWaltair, Visakhapatnam, Andhra Pradesh and analysed retrospectively. The analysis of data from the case records included the following: new born gestational age, mother’s age, gender, birth weight, maternal health factors, CP child order in the family. Results: Cerebral palsy was seen more in males 122 (65.24%) than females. Taking 2500 grams is the average weight of a normal baby in our Indian set up, 187 Cerebral palsy children are below 2500 g. Out of 187 babies, 115 are of Low Birth Weight (LBW) with weight ranging from 2500 g to 1501 g,55 very low birth weight (VLBW) weight ranging from 1500 g to 1001 g, and 17 were extremely low birth weight (ELBW) weight ranging below 1000 g. Among the total 187 low birth weight babies, 62 are Pre term and 125 are full term born. The maternal co-morbid factors anaemia 68 (36.36%) plays a major role in the present study. Gestational age is one of the major factor responsible for CP in children of low birth weight. More CP cases were seen in pre-term gestational age 28 weeks 23 (12.29%). Conclusion: Using recent advances in diagnostic modalities for detecting any deviations in the growing foetus and mother's health, appropriate and early interventions for problems that are treatable should prevent low birth weight and its serious consequences in the immediate or future neurodevelopmental status of the born child.</p> Tatavarti Srinivasa Rao Telidevara Durga Poorna Subbalakshmi Copyright (c) 2021 Tatavarti Srinivasa Rao, Telidevara Durga Poorna Subbalakshmi 2021-07-09 2021-07-09 4 12 147 150 A study of Multi Drug Resistant UTI caused by Klebsiella Oxytoca <p>Background:Klebsiella oxytoca is one among the several Klebsiella species that are opportunistic pathogens that cause a wide spectrum of severe diseases. This bacteria is naturally found in the intestinal tract, mouth and nose. Outside the gut, however these bacteria can cause serious infection. Klebsiella oxytoca is emerging as an important bacterial isolate causing urinary tract infections in adults and having multiple drug resistance to commonly used antibiotics. It is a gram-negative pathogen, cylindrical rod shaped and non-motile in nature.Aim and objective: To study multi drug resistant urinary tract infection caused by Klebsiella oxytoca.Material and methods: The urinary samples were inoculated on CLED and MacConkey agar. Further identification was done as per routine laboratory protocols. Antibiotic susceptibility testing was done in accordance with Clinical and Laboratory Standard Institute (CLSI) guidelines. Antibiotics disks included in this study by Kirby–Bauer's disk diffusion method. Collected samples were processed at Department of Microbiology, PMCH, Patna.Results: We analyzed our data to observe the current pattern of drug resistance among Klebsiella Oxytoca isolated from urinary samples from the period of March 2020 to April 2021 at Patna Medical College Hospital, Patna. A total of 15,200 samples were processed at the hospital laboratory during this period. Klebsiella species were isolated from 510 of these clinical samples Out of these, 480 were Klebsiella pneumoniae and 30 were Klebsiella Oxytoca. These isolates showed 62% of resistance to Imipenem and Meropenem. The resistance to Gentamicin and Amikacin was 62%. Resistance to Ciprofloxacin, Levofloxacin, Moxifloxacin and Aztreonam were 45%. The data from our study showed an increasing burden of infection caused by this bacteria. It is recommended that Hospital Infection Control Committee must keep a close watch on the antibiotic pattern of KlebsiellaOxytoca for better patient care.Conclusion: K. Oxytoca species are rapidly developing multi drug resistance in UTI. Earlier it was only Pseudomonas and Acinetobacter that showed high resistance to commonly used antibiotics. UTI caused by multidrug resistant bacteria pose a serious threat to public health and economy. A society without working antibiotics would be like returning to era when a small injury or infection could easily become a threat to life. It is recommended that hospital infection control committee must keep a close watch on the antibiotic pattern of Klebsiellaoxytoca of better patient care and genomic surveillance focus should remain a priority in the hospital environment.</p> Priyanka Narain Nand Kishor SN Singh Copyright (c) 2021 Priyanka Narain, Nand Kishor, SN Singh 2021-07-09 2021-07-09 4 12 151 153 Study of the incidence of various retroperitoneal masses and accuracy of MDCT in detection of retroperitoneal masses <p>Background: Recognizing specific features of various retroperitoneal tumors is the next agenda on the list which includes evaluating the tumor components, vascularity and variable behaviour on imaging followed after intravenous injection of contrast media. Evaluation of all these features is made quite easy by the high contrast resolution provided by CT. Therefore, the present study was undertaken to study the incidence of various retroperitoneal masses and accuracy of MDCT in detection of retroperitoneal masses. Method: The present prospective study was carried out in the Department of Radiology, Ashwini Rural Medical College, Hospital and Research Centre, Kumbhari,India from 1.10.19 to 30.09.2020. The study consists of 50 patients referred to computed tomography with clinical and sonological suspicion of retroperitoneal mass who fulfills selection criteria.Result: Out of 50 cases, 42(84%) were malignant while 8(16%) were benign neoplasms. Among 50 patients, 28(56%) were males while 22(44%) were females. Commonest age group was 51-60years (26%) followed by 41-50 years (20%). Among malignant retroperitoneal neoplastic masses, most common were retroperitoneal neoplastic lymph nodal masses 24(42%) followed by STS 17(34%). Malignant lesions were more common in males 25(60%). Among the benign lesions, 2 were each of schwannoma, neurofibroma and paraganglioma while one each of lipoma and teratoma. Benign lesions were more common in females (62%). With female to male ratio of 5:3. Conclusion: CT is highly accurate/high efficacy in the detection of RP masses However differentiation of various malignant lesions from each other is difficult on CT features alone. CT is the modality of choice for pretreatment staging and post treatment follow-up of RP tumors.</p> Jyoti Tapadia Anand Shrikant Gajakos Copyright (c) 2021 Jyoti Tapadia, Anand Shrikant Gajakos 2021-07-09 2021-07-09 4 12 154 159 Study of the incidence of various retroperitoneal masses and accuracy of MDCT in detection of retroperitoneal masses <p>Background: Recognizing specific features of various retroperitoneal tumors is the next agenda on the list which includes evaluating the tumor components, vascularity and variable behaviour on imaging followed after intravenous injection of contrast media. Evaluation of all these features is made quite easy by the high contrast resolution provided by CT. Therefore, the present study was undertaken to study the incidence of various retroperitoneal masses and accuracy of MDCT in detection of retroperitoneal masses. Method: The present prospective study was carried out in the Department of Radiology, Ashwini Rural Medical College, Hospital and Research Centre, Kumbhari,India from 1.10.19 to 30.09.2020. The study consists of 50 patients referred to computed tomography with clinical and sonological suspicion of retroperitoneal mass who fulfills selection criteria.Result: Out of 50 cases, 42(84%) were malignant while 8(16%) were benign neoplasms. Among 50 patients, 28(56%) were males while 22(44%) were females. Commonest age group was 51-60years (26%) followed by 41-50 years (20%). Among malignant retroperitoneal neoplastic masses, most common were retroperitoneal neoplastic lymph nodal masses 24(42%) followed by STS 17(34%). Malignant lesions were more common in males 25(60%). Among the benign lesions, 2 were each of schwannoma, neurofibroma and paraganglioma while one each of lipoma and teratoma. Benign lesions were more common in females (62%). With female to male ratio of 5:3. Conclusion: CT is highly accurate/high efficacy in the detection of RP masses However differentiation of various malignant lesions from each other is difficult on CT features alone. CT is the modality of choice for pretreatment staging and post treatment follow-up of RP tumors.</p> Jyoti Tapadia Anand Shrikant Gajakos Copyright (c) 2021 Jyoti Tapadia, Anand Shrikant Gajakos 2021-07-09 2021-07-09 4 12 154 159 A prospective study on risk factors and outcome of management of respiratory distress syndrome among preterm babies in rural tertiary care hospital in South India <p>Background: RDS is one of the common causes of admission to NICU. Half of the neonates born at 26-28 weeks gestation ,whereas less than 30% of preterm at 30-31 weeks gestation develop RDS. The main risk factors were prematurity, perinatal asphyxia, maternal diabetes, lack of labor, absence of antenatal steroid administration to the mother, male gender. Hence, our study was intended to assess the risk factors and RDS outcome among preterm babies.Materials and Methods: A prospective study was conducted in a tertiary hospital in a rural area within a period between January 2019 to June 2020. Preterm babies (&lt;37weeks) with RDS admitted in NICU were included. Preterm with congenital anomalies, Meconium Aspiration syndrome were excluded. The Sample size was 114 done by purposive sampling. Data recorded from maternal records, Neonatal history and detailed examination. This study's data were subjected to standard statistical analysis using the SPSS ver.20.Results: Out of 114 study subjects, 20% mothers were diagnosed with diabetes, and 91(80) doesn’t have diabetes. Most of the mothers 60.52% does not taken steroids during Antenatal period. Most of babies were within 30-33 weeks(64%). Out of 114, only 40% required surfactant. About 75%required CPAP, 25% preterms required mechanical ventilation. Most commonest complications of preterm was PVL, PDA, pneumonia respectively. Out of 23 maternal diabetes,56.5% had severe RDS and it is statically significant. Out of 45 Mothers with antenatal steroid, 73.3% stayed &lt;13 days, was statistically significant. Out of the total of 11 deaths, 10 were born to mothers who didn’t receive antenatal steroid. Conclusion: We observed that with lower gestational age, maternal diabetes, mothers who did not received steroids the risk of RDS is very high. Emphasis should be geared towards preventing and reducing preterm delivery, control of asphyxia, and neonatal sepsis to reduce neonatal mortality in our country.</p> Haricharan KR GP Chandran D Anwar Basha Rajendra Naidu Copyright (c) 2021 Haricharan KR, GP Chandran, D Anwar Basha, Rajendra Naidu 2021-07-09 2021-07-09 4 12 160 164 Effect of Iron deficiency anemia on glycated hemoglobin levels in non-diabetes patients: Prospective Case-Control study <p>Background: Glycated hemoglobin (HbA1c) has become the gold standard for the diagnosis and scale for measuring the glycemic control among the physicians. The level of HbA1c is influenced by several factors, including red blood cell turnover. There are various types of anemia that affect HbA1c readings, but iron deficiency anemia (IDA) is one of the most frequent. IDA has been shown to exhibit HbA1c readings that are greater than normal.Aims and objectives: To study the effect of IDA on HbA1c in subjects with normal fasting and postprandial blood glucose levels. Materials and Methods: Fifty subjects with IDA were studied attending OPDs in a tertiary care hospital, and findings were compared with a control arm having 50 subjects without anemia. Patients with IDA defined per WHO [Hb: &lt;13.0 g/dl (adult males), &lt;12 g/dl (non-pregnant women) and those with the microcytic, hypochromic picture in peripheral blood smear, serum ferritin &lt;15 ng/ml suggestive of iron deficiency, subjects with normal fasting and postprandial plasma glucose level, normal blood urea and serum creatinine level were included. Patients who were being quantified underwent a comprehensive history, clinical examination, and pertinent biochemical examination, including HbA1c.Results: The study observed a statistically significant difference in Hba1c levels in non-diabetic patients withIDA compared with the normal population. The mean baseline serum ferritin level was significantly lower in patients with IDA than in controls (P&lt;0.01). The mean HbA1C levels in patients with moderate anemia were 6.74. In severe anemia, the mean HbA1c was 7.07, significantly higher than the control group (P &lt; 0.01). there was a significant negative correlation between the following parameters and Hba1C, which are Hb (r= -0.727), serum ferritin (r=-0.827) ,( r = -0.909), MCV levels ( r = -0.839), between % saturation ( r = -0.592). The study has shown a significant positive correlation between total iron-binding capacity and hbA1c levels (correlation co-efficient r = 0.743).Conclusion: HbA1c is not affected by blood sugar levels alone. There are various confounding factors when HbA1c is measured, especially iron deficiency, which is the commonest of the deficiency diseases worldwide. Hence, it is prudent to rule out IDA before making a therapeutic decision to treat diabetes mellitus based on the HbA1c levels.</p> Jisha Antony Copyright (c) 2021 Jisha Antony 2021-07-09 2021-07-09 4 12 165 168 “Evaluation of Anterior Knee Pain in Diaphyseal Tibial Fracture Treated with Intramedullary Nailing”- A Retrospective Study <p>Intramedullary Nailing is considered as gold standard treatment option for diaphyseal tibial fractures in adults. Anterior knee pain is the commonest post-operative complication encountered in diaphyseal tibial fracture treated with intramedullary nailing. Incidence of anterior knee pain ranges from 10% to 86% respectively. Moreover, aetiology of anterior knee pain is multifactorial following intramedullary nailing. This study was undertaken to analyse the association between knee apex distance, anterior cortical nail distance and anterior knee pain. Methods and Material: 36 consecutive patients with diaphyseal tibial fracture treated with intramedullary interlocking nailing using either trans-tendious approach / paratendinous approach from March 2017 to March 2019 were studied. Anterior knee pain was measured and assessed at regular successive interval using Visual analogue scale scoring system and its association with 2 parameters i.e., knee apex distance, anterior cortical nail distance. Result: Out of 36 patients evaluated, 14 patients i.e., 38.88% had knee apex distance &gt;2.5 and 22 patients i.e., 61.11% had knee apex distance &lt; 2.5 where as 12 patients i.e., 33.33% had ACND &gt; 1.0 cm, 8 patients i.e., 22.22% had ACND between 0.5-1.0 cm, 16 patients i.e., 44.44% ACND below 0.5cm in which 10 patients i.e., 27.77% (ACND was negative) nail was buried. Conclusion: Anterior cortical nail distance had a strong association with postoperative anterior knee pain. This study finds statistically significant association of anterior cortical nail distance with anterior knee pain (p = 0.023) while knee apex distance doesn’t show a statistical association with anterior knee pain (p = 0.781). The surgical approaches show no significant association with anterior knee pain.</p> Prabhu Ethiraj Vinod Kumar.K Sandesh Subhas Agarawal Arun HS Nagakumar J S Copyright (c) 2021 Prabhu Ethiraj, Vinod Kumar.K, Sandesh Subhas Agarawal, Arun HS, Nagakumar J S 2021-07-09 2021-07-09 4 12 169 173 Laparoscopic Management of Groin Hernias Our Early Experience <p>Introduction: Worldwide, more than 20 million patients undergo inguinal hernia repair annually. The problem of our age is to find an operation that is simple, does not require implantation of a foreign body like mesh and does not produce major complications during or after surgery. While not all hernias require repair, the overwhelming majority of patients will develop symptoms from their hernia which will lead them to seek surgical intervention. There are a variety of surgical techniques available for the repair of inguinal hernias, each with their own set of benefits and challenges. This is our experience in laparoscopic management of groin hernias.Material: Prospective study of 47 patients with clinical diagnosed as groin hernia subjected to different laparoscopic techniques for groin hernia from June 2018 to December 2021. The main outcome measurements included the following: operative time, conversion to open, hospital stay, time to return to daily activity and complication like hernia recurrence, vascular injury and mesh infection.Inclusion Criteria: All patients with Groin hernias who were managed by TEP or TAPP during the period of study. They were bilateral cases, recurrent hernias, unilateral hernia which are direct or indirect inguinal hernias or both and unilateral femoral hernias.Results: A total of 47 patients with groin hernias were corrected with different laparoscopic procedures either TEP or TAPP. They were 43 males and 5 females. The age range was variablefrom 33 to 52years (mean 42.32 – 46.46 years). Allcases were completed laparoscopically with mean operative time of 77.03 minutes withmajor intraoperative complications being bladder injury in 1 patient (2.12%) during who were among the early cases and others being Peritoneal tear occurred in 8 patient(17.02%) and injury to inferior epigastric in 2 patient(4.25%); and our major post-operative complication being mesh infection in 2 patient(4.25%) and recurrence in 1 patient(2.12%). Following laparoscopic management of groin hernia, we found out that the mean duration of hospital stay being 2.03 days and return to daily activity being ranging from 13.84 to 20.65 days.Conclusion: Our results lead us to believe that laparoscopic management of groin hernia is safe and effective with improving learning curve even though it represents a formidable surgical challenge. It enables the patient to have a better cosmetic outcome, early ambulation, return to daily activity. Hence with improving learning curve laparoscopic management of groin hernias may be a safe alternative to open hernioplasty.</p> Hosni Mubarak Khan BS Ramesh Shashank Dev TS Copyright (c) 2021 Hosni Mubarak Khan, BS Ramesh, Shashank Dev TS 2021-07-09 2021-07-09 4 12 174 178 Post Irradiation Cytopathology of Cervical Cancer Patients <p>Introduction: Pap smear from uterine cervix or vaginal vault (in hysterectomised) patient is an important tool for follow up after completion of radiation therapy. It is quick, simple and cost effective. It can be used for monitoring and early detection of residual/recurrent neoplasm. In this study we report the cytopathological changes in patients undergoing radiation therapy for carcinoma cervix.Aim and Objectives: This study aims at awaring about cellular changes resulting from irradiation and varied composition of post irradiation smear which may lead to more accurate interpretation of cytological findings.Material and Methods: This is a descriptive study of 42 cases presented in cytological section of department of Pathology, PMCH, Patna from January 2020 to March 2021Pap-smear was collected from vaginal vault in hysterectomised patient and from endocervix/ectocervix in patient who retained uterus due to one or another reason Pap-smear was collected on three occasion i.e. on 1st follow up at one month of completion of radiotherapy, 2nd follow up at four month after completion of radiotherapy and 3rd follow up at ten month after completion of radiotherapy.Observations: Out of 42 carcinoma cervix patients participating in this study, youngest patient was a 26 years old married female coming from a rural area and was having well differentiated squamous cell carcinoma. Another female was 30 years old with a history of early marriage and having three children. Peak incidence in this study was observed in age group 41-50 years with all grades of squamous cell carcinoma i.e well, moderately and poorly differentiated SCC and one case of adenocarcinoma of endocervix. In age group greater than 61 years, five cases were seen of which one was diagnosed as poorly differentiated SCC. Rest four were well differentiated SCC. Conclusion: Cytology is a valuable tool for the detection of local recurrence of carcinoma cervix. It is simple and economical to perform at the time of follow up examination of the patients of carcinoma cervix after completion of radiotherapy. Awareness of cellular changes resulting from irradiation and varied composition of post irradiation smear led to more accurate interpretation of cytological finding. However cytological features of post irradiation dysplasia are difficult to distinguish from recurrent carcinoma cervix and owing to its higher progression rate of colposcopic examination and biopsy are recommended.</p> Ravi Byahut Pratibha Srivastava N.K. Bariar Copyright (c) 2021 Ravi Byahut, Pratibha Srivastava, N.K. Bariar 2021-07-09 2021-07-09 4 12 179 180 Bacteriological Profile and Antimicrobial Susceptibility Pattern of Blood Culture Isolates Among Septicemia Suspected Children at PMCH Patna <p>Background: Bacterial infections remain an important cause of pediatric mortality and morbidity. It might be possible to reduce this by early diagnosis and proper management. When the body gets an infection, the immune system fights it. Sepsis happens when the immune system goes into overdrive and attacks the body’s own organs and tissues. Aim:Bacteriological Profile and Antimicrobial Susceptibility Pattern of Blood Culture Isolates Among Septicemia Suspected Children at PMCH Patna.Material and methods: Blood culture reports were studied in 424 suspected septicemias in patients attending the pediatrics department, using the standard technique of Mackie and McCartney. The antibiotic sensitivity was performed by Kirby-Bauer’s disc diffusion method. Risk factors for the sepsis were registered. Collected samples were processed at Department of Microbiology, PMCH, Patna.Result:Culture positivity was seen in 106 (25%) samples, and 317 (75%) samples were sterile. Gram-negative bacilli (GNB) were most common bacteria isolated 71%, followed by Gram-positive cocci (GPC) which comprises 29%, E. coli was the most commonly isolated 41.5% followed by Staph aureus 28.3%, followed by Klebsiella species 13.2%. Another organism isolated were Pseudomonas species 7.5%, Enterobacter 4.7%, Coagulase negative Staphylococcus 1.8%, Citrobacter 1.8% and Acinotobacter 0.9%. E Coli was the most common bacterial isolate in all the age groups of the study. Levofloxacin, linezolid, Ofloxacin, Vancomycin, Ampicillin &amp;Amoxyclav were the most effective drugs for treating septicemia. In this study, it was seen that GPC were 100% sensitive to vancomycin and linezolid.Conclusion: Bloodstream infection is a challenging problem, and sometimes, it may be life threatening; therefore, timely detection, identification, and antimicrobial susceptibility testing of blood-borne pathogens are one of the most important functions of a diagnostic microbiology laboratory.</p> Nand Kishor Priyanka Narain S. N. Singh Copyright (c) 2021 Nand Kishor, Priyanka Narain, S. N. Singh 2021-07-09 2021-07-09 4 12 181 183 Evaluation of Thyroid Hormone Status in Acute ST Elevation Myocardial Infarction <p>Introduction:A change in thyroid function caused by non-thyroidal illnesses is found in acute myocardial infarction (AMI), as well as malnutrition, sepsis, and surgery. The goal of this study was to discover SES in AMI and its relationship to ventricular function and CKMB. Aim: To investigate whether low T3 syndrome in Acute ST elevation MI is associated with severity of myocardial injury. Severity of MI is evaluated by Isoenzyme CKMB and echocardiography.Material and Methods:Patients with acute ST elevation MI were studied over the course of a year in a cross-sectional, observational research. The researchers looked at 40 instances of AMI in a row. On day 1 (24-36 hours following the start of chest discomfort) and day 7, the thyroid profile and CKMB levels were measured. The left ventricular function was assessed by echocardiography.Results:There was no significant difference in serum T3, T4, TSH when comparing the mean values on day 1 and day 7. There was no link between the site of AMI and T3 levels, however there was a significant correlation between LVEF (p=0.05) and T3 levels. There was also a strong negative association between CKMB and T3 levels (p=0.0001).Conclusion:The LVEF and T3 levels had a significant relationship. There's also a strong negative relationship between CKMB and T3 levels. During short-term follow-up, those SES in AMI were linked to poor LV</p> J. Archana Geetha Navuduri Mranu Sai Ramani Sirikonda Aishwarya Copyright (c) 2021 J. Archana, Geetha Navuduri, Mranu Sai Ramani, Sirikonda Aishwarya 2021-07-09 2021-07-09 4 12 184 187 A Comparative Study to Evaluate thePeri-Operative and Post-Operative Complications of Vaginal and Abdominal Hysterectomy <p>Background: Abdominal and vaginal hysterectomies are the two predominant operative modalities for various uterine conditions; however the indications for selecting a particular procedure in any setting may not be optimally defined. Aim: This study was undertaken to evaluate the appropriate route of hysterectomy (abdominal or vaginal) in a hospital population for women with benign disease by comparing peri-operative and post-operative complications. Materials and Method:Eighty subjects were equally divided into vaginal and abdominal hysterectomy groups by convenience (non-probability) sampling. The primary outcome measures were operative time, primary haemorrhage, wound infection, post-operative analgesia, febrile morbidity, hospital stay and secondary haemorrhage; secondary outcome measure were re-admission and reopening.<br>Results: There were no differences in the patients’ mean age, parity, body mass index, and preoperative haemoglobin levels between groups. Vaginal hysterectomy was associated with less febrile morbidity, wound infection operative time, bleeding requiring transfusion and re-admission than abdominal hysterectomy. Main indication for women having abdominal operation was leiomyomas, whereas more women having uterovaginal prolapse had vaginal hysterectomy. Conclusion: Patients requiring a hysterectomy for benign lesions having a moderate-sized uterus can be offered vaginal route for surgery.</p> Sanghmitra Kumari Sushma Singh Ishmat Khanam Prem Sagar Chaudhary Copyright (c) 2021 Sanghmitra Kumari, Sushma Singh, Ishmat Khanam, Prem Sagar Chaudhary 2021-07-09 2021-07-09 4 12 188 191 A clinical study of various methods of reconstruction of scalp defects and its outcomes <p>Introduction: The scalp, as the body's superior boundary, is often subjected to environmental insults. Since the scalp is seldom covered by clothing, it is more vulnerable to burns and other wounds that can result in extensive disfigurement and scarring. The scale, depth, and position of scalp defects all influence decision-making in their repair. The existence of the defect is another important factor in determining management. Aim : To study the various scalp defects in terms of their clinical presentation, Management and their outcome and reconstruction of scalp defects with local flap and split thickness skin grafts. Materials and methods: This prospective interventional research was performed in the Department of Plastic and Reconstructive Surgery over the course of 18 months,. Patients with 0-70 years of age with electrical burns, trauma , benign tumors and congenital abnormality associated with loss of scalp tissue.Results: In this sample, 12 (60%) patients had a defect size varying from 9 to 100 cm2, 02 (10%) patients had a defect size of less than 9 cm2, and 6 (30%) patients had a defect size of more than 100 cm2. In our sample, the majority of patients presented within 24 hours, 15% presented within one week, and 15% presented after three months. Transposition flap with ssg was performed in the maximum number of patients (50%) in ten patients, rotation flap in three (15%), ssg in five (25%) patients, and primary closure in three (15%) patients. Conclusion: Good knowledge of the anatomy, the individual patient, and the resurfacing choices that are available is the beginning, but the surgeon's success needs creativity to add all these elements together to give a satisfactory result for the patient.</p> Ashish S Kokate G Praveen Harish M Madhusudana Naik N Nagaprasad Copyright (c) 2021 Ashish S Kokate, G Praveen Harish, M Madhusudana Naik, N Nagaprasad 2021-07-09 2021-07-09 4 12 192 197 Prevalence of Candida Species in oral cavity during radiation therapy in Oral cancer patients <p>Background: It is observed that during the course of radiotherapy many patients of oral cancer develop many changes in the oral cavity due to effects of radiation. There is increase in candida infection in oral cavity which may be attributed to radiation induced xerostomia. Reduced salivary production can predispose patients to oral candidiasis as salivary constituents inhibit the overgrowth of candida, as radiation reduces the amount and characteristics of saliva secretion leading to candida overgrowth. There is an increased rate of candida infection associated with neutropenia also.Objective and hypothesis: The objective of this study was to investigate the prevalence of candida species in oral cavity of patients of oral cancer during the course of radiotherapy. Methods: We collected samples using two swabs from 40 patients of oral cancer who developed oral lesions suggestive of candidiasis, while undergoing radiotherapy treatment.Results: In this study Candida species isolated from oral cavity lesions clinically diagnosed as Candidiasis from the patients undergoing radiotherapy were Candida albicans - 28 (70%) was the predominant species isolated followed by Candida dubliniensis 4 (10%), C. tropicalis was isolated in 3 (7.5%) of the samples, C. krusei - 2 (5%), C. guilliaermondii, C. parapsilosis, C. glabrata were found in 1 (2.5%) patient each.Conclusion:Oropharyngeal candidiasis is a common fungal infection in patients undergoing radiation treatment. Clinical signs and symptoms and microbiological studies will help us in early diagnosis. There are several practical considerations which patients can take to reduce the risk of such infections.</p> Ravi Byahut Priyanka Narain Nand Kishor SN Singh Copyright (c) 2021 Ravi Byahut, Priyanka Narain, Nand Kishor, SN Singh 2021-07-09 2021-07-09 4 12 198 200 A study to evaluate the bacteriological profile of Chronic Suppurative Otitis Media and its antibiotic susceptibility pattern in subjects attending OPD of Tertiary Care Institution <p>Background: Chronic suppurative otitis media (CSOM) is defined as persistent or intermittent infection of ear for more than three months duration where the infected discharge occurs through the perforated tympanic membrane caused by bacteria , fungi and virus resulting in inflammation of mucosal lining that results in partial or total loss of the tympanic membrane and ossicles. Aim: To evaluate the bacteriological profile of Chronic Suppurative Otitis Media and to evaluate their antibiotic susceptibility pattern.Methods: A total of 66 patients with symptoms of CSOM were enrolled in the study. Out of 66 patients, 54 were unilateral cases and 12 were bilateral cases. Thus the total 78 samples were available for culture. Samples from 78 discharging ears were collected with the help of aural speculum by swabbing the discharging ears with two sterile cotton swabs.Results: Antimicrobial susceptibility testing was carried out for all the isolates. Imipenem resistance was not seen to any of the isolate. Amikacin was the most effective antibiotic in the present study. It was effective against maximum number of strains 74 (94.9%) followed by levofloxacin 72 (92.3%), Gentamicin 70 (89.7%), Ofloxacin 68 (87.2%) and Ciprofloxacin 62 (79.5%).Conclusion:The chronic suppurative otitis media has become public health importance in the present days in developing countries like India. It is well known disease of multiple etiology and its recurrence and persistence. Irregular, haphazard and indiscriminate use of antibiotics has precipitated the emergence of multi resistant bacteria. The most common the bacteriological agent associated with CSOM in our area was Pseudomonas aeruginosa with a gradual decline in their sensitivity pattern to a number of fluoroquinolones. Amikacin and levofloxacin has proven to be the drug of choice.</p> Ranjan Kumar Srivastava Poonam Sagar Nand Kishor Satyendra Narayan Singh Rajneesh Kumar Ranjan Copyright (c) 2021 Ranjan Kumar Srivastava, Poonam Sagar, Nand Kishor, Satyendra Narayan Singh, Rajneesh Kumar Ranjan 2021-07-09 2021-07-09 4 12 201 203 A randomized comparative study of progress of labour amongst spontaneous and induced labour in term pregnancy primigravida by using modified WHO partograph <p>Background: Pregnancy extending after 37 weeks poses risk to neonates in terms of their survival and other complications. When it is risky to continue pregnancy, induction of labour is done which is artificial initiation of uterine contraction prior to its spontaneous onset. This study aimed to compare the progress of labour between nulliparous women with spontaneous labour and in whom labour was induced.Methods: Primigravida females admitted in labour room at term, were divided into Spontaneous and Induced labour group after reaching cervical length at least 4 cm. Both the groups were monitored according to modified WHO partograph and compared for progress of labour. Results: Total 180 females were compared with 90 in each group. Cases falling between alert line and action line in the cervicograph were significantly more in Induced Group (p&lt;0.05). Mean duration of labour was more in Spontaneous group which was significant in 1st stage and 2nd phase. There was no significant difference between postpartum stay in hospital in both the group (p&gt;0.05). Conclusion: We concluded from this study that though requirement of augmentation for progress of labour was found significantly more in induced group but duration of labour was shorter in induced labour when monitored with modified WHO partograph.</p> Anju Sharma Charusmita Agrawal Yeshwant Singh Chouhan Copyright (c) 2021 Anju Sharma, Charusmita Agrawal, Yeshwant Singh Chouhan 2021-07-09 2021-07-09 4 12 204 206 An autopsy study of cases of Death Due to Poisoning in the Department of FMT, RIMS, Adilabad <p>Introduction: Pesticide poisoning is one of the major problems across the world and more so in developing countries like India where there is the ease of availability of poisons. Therefore,in all cases of unnatural deaths when the cause is elusive, poisoning remains an important aspect for investigating officers and forensic experts while conducting post-mortem examinations. Methods: Detailed information of the deceased was collected from the concerned police officials and relatives of the case. Post-mortem findings were analyzed with chemical analysis reports. If the cases were treated before death information was obtained from the hospital records.Results: The chemical analysis reports of the study revealed n=120(80%) cases of poisoning with agricultural poisons. Out of n=120 cases in which agricultural poisons were used n=100 cases were poisoning with organophosphorus compounds. Carbamate and phosphide poisoning were seen in n=8 each and pyrethroid and paraquat poisoning were found in n=2 cases each. Cyanide poisoning was found in 1.33% of cases. Corrosive poisoning occurred in n=18 cases out of which phenol was used in 6.67% cases and formaldehyde in 5.33% cases. N=10 cases were due to neurotoxic poisons.Conclusion: Pesticides are frequently used in agriculture and ease of access to these products has led to the use of them for suicidal purposes. Several studies have described the gravity of acute pesticide poisoning however, only a few have described the findings during autopsy and histopathological findings. Efforts must be made to find more effective alternative pesticides which may be relatively harmless to humans.</p> Ramu Yangala Dhanpal Pragna Copyright (c) 2021 Ramu Yangala, Dhanpal Pragna 2021-07-09 2021-07-09 4 12 207 210 Study of sociodemographic and clinical factors affecting duration of stay of Child and Adolescent patients admitted in Child and Adolescents Psychiatry unit of a tertiary care center in India <p>Background :Need is to identify psychiatric illnesses at the earliest and to effectively manage them not only because they have significant impact on the long term development of the child or adolescent but also because first onset of mental disorders usually occurs before 18 years of age. Child and adolescent specialized psychiatric units are now gradually on increase improving quality of care particularly inpatient care. The present study gains insight about inpatient admissions (Hospitalization) of children and adolescents i.e. factors affecting duration of stay in inpatient wards.Methods :Our sample included past treatment record of all patients who were treated as inpatients in childhood and adolescent unit. We carried out a retrospective search of past records for socio demographic profile, diagnosis, mode of discharge, Duration of stay, Family History of psychiatric illness and CGAS scores at the time of admission of admitted from the July 2017 to June 2018.Results: Mean age of subjects was 14.2 years. 56.9% were male, rest were female. 84.7% children were from Hindu families. Most of the patients (70.8%) were from rural background. Bipolar affective disorder (27.5%) was found the most common diagnosis in childhood and adolescent unit. Only factor found to be significantly associated with duration was CGAS score at the time of admission.Conclusion :Level of functioning at the time of admission may significantly predict duration of admission in psychiatric ward which may help clinician to effectively plan management although it needs to be individualized in hospitalized child and adolescents</p> Sangeeta Hatila Mahak Aggarwal Aditya Sharma Gunjan Solanki Copyright (c) 2021 Sangeeta Hatila, Mahak Aggarwal, Aditya Sharma, Gunjan Solanki 2021-07-09 2021-07-09 4 12 211 215 Prevalence of hepatitis-B surface antigen in subjects attending OPD of Tertiary care institution <p>Background: Hepatitis B virus is a partially double-stranded circular DNA virus and is a member of the Hepadnaviridae family. The virus consists of a core capsid which contains viral DNA and this is surrounded by an envelope containing surface antigen (HBsAg). Both whole and incomplete virus particles, consisting entirely of HBsAg, are produced during replication of HBV. The HBsAg particles vary greatly in morphology and are found in high concentrations in early acute infection and continue to be produced in chronic disease.Aim: Diagnostic potential of Hepatitis-B surface antigen (HBsAg) positivity and its prevalence was evaluated among OPD Patients. Methodology: The prevalence of hepatitis B surface antigen (HBsAg) was studied among 767 subjects (male 470 and female 297), aged 05-55 years volunteers, who required medical check-ups. Blood samples, collected were tested for HBsAg using a third-generation ELISA kit. Results: Of the 767 subjects, male 1.82% and female 1.17% were positive for HBsAg. The results revealed that hepatitis B infection in the target group was below the intermediate endemicity. Conclusion: This study demonstrates that proper training of new entrants in the medical field can be pivotal in preventing HBsAg and it is advocated that a programme for education, vaccination and prophylaxis must be implemented in all healthcare set ups.</p> Poonam Sagar Nand Kishor Ranjan Kumar Srivastava Satyendra Narayan Singh Rajneesh Kumar Ranjan Copyright (c) 2021 Poonam Sagar, Nand Kishor, Ranjan Kumar Srivastava, Satyendra Narayan Singh, Rajneesh Kumar Ranjan 2021-07-09 2021-07-09 4 12 216 218 Pre emptive use of Gabapentine for Reducing Early Post operative Pain and Analgesic Requirement in Laparoscopic Cholecystectomy <p>Background: Pain,the oldest symptoms of human existance,is thought to be inadequetly treated in most of the surgical patients. Surgical stimulation leads to peripheral sensitization(a reduction in the threshold of nociceptor afferent peripheral terminals) and central sensitization (an activity dependent increase in the excitability of spinal neurons) Prevention and treatment of postoperative pain is a major challenge in postoperative care and plays an important role in the early mobilization and well-being of the surgical patient.The optimal form of treatment is that applied pre,intra and postoperatively to preempt the establishment of pain hypersensitivity during and after surgery. Gabapentin, an anti-epileptic drug that has demonstrated analgesic effect in diabetic neuropathy, post-herpetic neuralgia and neuropathic pain, has shown anti-hyperalgesic properties, possibly by reducing central sensitization. Use of Gabapentin has more recently extended into the management of more acute conditions, particularly in the perioperative pain. Objective: To study the efficacy of gabapentin used preemptively for reduction of early post operative pain &amp; analgesics requirement in laparoscopic cholecystectomy patients. Materials &amp; Methods: A prospective randomised control trial was done in Department of Surgery,TUTH, on 121 consecutive patient selected for laparoscopic cholecystectomy.All patients were randomised into two groups. Study group (N=60) was given gabapentine 300mg orally 2 hrs before surgery and to control group (N=58) no preoperative drugs was given. All procedures were performed under general anesthesia. As a post operative analgesics both group were given inj. pethidine 1mg/kg/dose I.M. as when pain score 4 or more and on demand basis. Post-operative pain score was monitored by using numerical pain score, 0-10; 0= no pain, 10= worst possible pain. Pain score was taken at different time interval 2 hourly for 1st 6 hoursthen 6 hrly upto 24 hrs.Adverse effects of drugs were recorded in both groups. Results: Patients in gabapentine group had significantly lower pain scores (2.40±0.78, 2.91±1.14, 3.58±1.21, 3.58±1.11,2.13±0.85) in comparison to no preemptive drug group (5.33±1.77, 4.12±1.85, 5.28±1.25, 4.67±1.33, 3.45±1.11) at all time interval (0 hr,0 6hr,6 12hr,12 18hr.18 24hr).The requirement of pethidine also significantly less in study group (115±26.52 mg) compare to control group (198±31.21 mg) p&lt;0.05. It was seen that Nausea, Vomiting and Retching were more in control group 36% (n=21) than in study group 31% (n=19). But dizziness and sedation were more common in study group 27% (n=16) than control group 20% (n=12). Conclusion: Preemptive use of gabapentine significantly decreases post operative pain and pethidine requirement in laparoscopic cholecystectomy without any significant adverse effect.</p> Prabal Karmahapatra Charanjeet Rai Mrinalkanti Karmakar Sukanta Sen Ramesh Sahu Copyright (c) 2021 Prabal Karmahapatra, Charanjeet Rai, Mrinalkanti Karmakar, Sukanta Sen, Ramesh Sahu 2021-07-09 2021-07-09 4 12 219 224 Injection adrenaline plus Heater probe coagulation or Injection adrenaline plus Argon plasma coagulation in nonvariceal upper gastrointestinal bleeding <p>Aim: To compare the effectiveness of Injection adrenaline plus Heater probe coagulation versus Injection adrenaline plus Argon plasma coagulation in the management of non variceal upper gastrointestinal bleeding.Methods: 115 patients admitted with gastrointestinal bleeding due to gastric, duodenal and stoma ulcers were included in the study. Upper endoscopy was performed and injection adrenaline plus HPC (group A) and injection adrenaline plus APC (group B) were chosen randomly to achieve hemostasis. Initial hemostasis and rebleeding rates were primary and secondary endpoints of this study. Results: Initial hemostasis was achieved in 96.6% (57/59) of group A and 96.4% (54/56) of group B patients. Among group A 7% (4/57) cases had rebleed while in group B only 1.9% (1/54) had rebleed after upper GI endoscopy within 72 hours of observation within hospital stay.Conclusion: Both methods are almost equally effective in achieving hemostasis and preventing future risk of rebleed in nonvariceal upper GI bleed.</p> Aadil Ahmad Mir Afaq Ahmad Khan Javid Ahmad Sofi Mushtaq Ahmad Khan Ajaz Qadir Santosh Govind Rathod Copyright (c) 2021 Aadil Ahmad Mir, Afaq Ahmad Khan, Javid Ahmad Sofi, Mushtaq Ahmad Khan, Ajaz Qadir, Santosh Govind Rathod 2021-07-09 2021-07-09 4 12 225 227 Segmental Scoring In Covid 19 Pneumonia On HRCT Chest <p>Aims:To understand the common patterns of CT Chest in Indian population who have proven to be RT-PCR COVID positive and/or suspected COVID with RT-PCR negative.Settings and Design: Descriptional study done in patients of Dr. D.Y. Patil Hospital and Yashwantrao Chavan hospital which have COVID-19 ward. Methods and Material:CT chest was employed in patients with both confirmed and suspected COVID-19 pathology have been recognized in our study. Association with COVID-19 infection was based on Reverse transcription polymerase chain reaction (RT-PCR) method. Statistical analysis used: The data was entered in MS EXCEL spreadsheet and analysis done using licensed Stastical Package for Social Sciences (SPSS) version 21.0.Descriptive statistics for each parameter were computed for different variables. Results:Commonly found were ground glass opacities, consolidations, septal thickening often showing bilateral involvement. New segmental scoring system is provided with division based on the anatomical bronchopulmonary segments. Grading done &lt;12-Mild, 12-24 – Moderate, &gt; 24 – Severe. Conclusions:Study provides us with knowledge to use CT thorax as an excellent modality in the initial evaluation as well as follow up in COVID-19 positive and suspected cases.</p> Tushar. M. Kalekar Samanta Dhulipala Nitish Gupta Copyright (c) 2021 Tushar. M. Kalekar, Samanta Dhulipala, Nitish Gupta 2021-07-09 2021-07-09 4 12 228 234 Current Trend in the Treatment of Mandibular Fracture in Central India <p>Introduction: Maxillofacial trauma being one of the most commonly &amp; frequently addressed disease condition in any trauma centre. Hence, providing a vast scope for timely research and audit for betterment of treatment being provided and also precautions to be implemented for such settings and locations.Methods: Retrospectively 3 year medical records of mandibular fracture cases from 12 selected fracture treatment centers of central India were collected and analyzed. In all, 797 patients of mandibular fracture were reported, which had 1165 fracture i.e. approximately 1.5 fractures in every patient.Results:Parasymphysis region was the most common fracture site (33.3%), followed by body and condyle (21.3% &amp; 21.1% respectively). Majority of the cases were managed by open reduction and internal fixation (ORIF) which accounted for 52.6% of total cases, cortical miniplates were used in majority of these cases. Closed reduction modalities were used in 15.8% of cases, in this arch bar was the most preferred modality for Inter-maxillary Fixation (IMF). 10.2% of the cases did not undergo any treatment, or palliative treatment was advised. Supplemental post operative IMF were given in 21.4% of the cases.Conclusion: In the present study, inclination for ORIF as treatment modality emerged which was in accordance with the majority of similar studies. Also escalating usage of post-operative supplementary IMF emerged after ORIF. Former finding highlighted the fact that surgical procedure is the most preferred option among surgeons, or the mandibular fracture cases been treated were indicated for ORIF. But the latter finding indicated 3 possibilities, first a large number of cases were displaced or comminuted fractures, second a large number of condyle fracture or concomitant condyle fracture cases, and third the lessened effectiveness of ORIF treatment to render functional rehabilitation at the earliest, post operatively.</p> Mrinal Satpathy Saba Tiwari Yogesh Sharma Sumit Bhargava Copyright (c) 2021 Mrinal Satpathy, Saba Tiwari, Yogesh Sharma, Sumit Bhargava 2021-07-09 2021-07-09 4 12 235 240 Effect of Pregnancy Induced hypertension on morphology of placenta and birth weight of newborn <p>Background: Hypertensive pregnancy may be responsible for vascular damage, enhanced systemic inflammation and insulin resistance in the placenta as oxygen and nutrient transfer is impaired and oxidative stress is generated affecting the placental growth and development. Placental growth pattern in hypertensive pregnancies shows a variable pattern owing to placental insufficiency. Present study was done to investigate the morphological changes in placenta in hypertensive pregnancy. And its effect on birth weight of newborn.Material Method: The study was carried out on 80 placentae, mothers and their babies. The placentae was collected from Obstetrics and Gynaecology, Department of NSCB Medical College, Jabalpur. Out of 80 placentae 40 from Pregnancy induced hypertensive and 40 normotensive mothers. As soon as the placenta was delivered, the umblical cord was cut it was put into formal saline. It was kept in a tray, to the membranes were trimmed ofl, cord was cut about 10 cm from the insertion. The blood clots adherent to maternal surface were picked up. The placenta was then washed in plain tap water naked Eye examination was done and following variables studied.Result: A Macroscopic study of the placenta revealed placental weight, placental volume, diameter, placental thickness and number of cotyledons were less in study group. Mean placental weight in study group was 336gm and in control group was 425 (p&lt;0.05). Mean placental volume in study group &amp; control group were 236and352 ml respectively (p&lt;0.05). Mean number of cotyledons were 14.7and 16 in study &amp; control group respectively but not significant and mean diameter15.6 cms and17.05cms in study and control group. But in the present study placental thickness was not significant (p&lt;0.539). There was a single umbilical artery present in one patient in PIH group .. There was a tendency of lowering the weight of neonate 2.1kg in study group and 2.7kg in control group (p&lt;0.05).Conclusion: In PIH group placental changes were related with fetal outcome. Common placental changes were significant in this study.</p> Nisha Gajbhiye Sachin Gajbhiye Copyright (c) 2021 Nisha Gajbhiye, Sachin Gajbhiye 2021-07-09 2021-07-09 4 12 241 243 An Epidemiological and Clinical Analysis of Patients Presenting with Delirium in the Emergency Department: A Prospective Single Center Observational Study <p>Background: Delirium is a state of acute brain dysfunction. It is one of the most common diagnoses encountered in the Emergency Department(ED), but frequently missed or under-evaluated. In developing countries like India, there is extreme paucity of reliable research data of patients presenting with delirium in the ED.Objectives: To evaluate the demographics and analyse the risk factors, triggers and clinical features in patients confirmed with delirium, attending the ED.Methods: Patients aged ≥18 years, attending the ED, of a tertiary care medical college hospital, from November 2020 to April 2021, were screened with Delirium Triage Screen, then confirmed for delirium by brief Confusion Assessment Method. These patients were classified into psychomotor subtypes on the basis of Richmond Agitation-Sedation Scale and into severity subtypes based on Delirium Rating Scale-revised-98 score. A wide range of demographic, epidemiological and clinical data was compiled and analyzed for statistical significance.Results: A total of 1660 patients were included. Almost 30% were young adults (&lt;50 years age), while 61.5% patients were males. Hypoactive delirium was the most common psychomotor subtype. The younger adults and males predominantly showed delirium with less severity while females had more of severe delirium. The commonest risk factor was a recent decrease in food intake. Vomiting was the commonest presenting symptom. Hyponatremia was the commonest laboratory abnormality. Conclusion: Recognizing delirium by rapid validated methods and treating it appropriately in time, while working in a busy ED setup, will help in reducing the morbidity and mortality associated with this condition.</p> Lissa Abraham Sajit Varghese Copyright (c) 2021 Lissa Abraham, Sajit Varghese 2021-07-09 2021-07-09 4 12 244 251 Effect of Anaemia on Morphology of Placenta and Fetal Birth Weight <p>Anaemia is a common medical problem in pregnancy. The extent up to which, maternal anaemia effects maternal and neonatal health is still uncertain. Anaemia in pregnancy is linked with an increased risk of preterm delivery, low birth weight, perinatal and maternal mortality and it is related with variable morphological changes in placenta which show a reflection for the poor foetal outcome. The aim of this study was to determine whether maternal anaemia would affect the morphology of placenta and fetal outcome like birth weight of the baby and compare this with that of nonanaemic mothers. It was a cross-sectional comparative study carried out at the maternity ward and anatomy department of NSCB Medical College, Jabalpur.</p> Nisha Gajbhiye Rajeshwari Kanwar Nidhi Agrawal Vandana Punase Copyright (c) 2021 Nisha Gajbhiye, Rajeshwari Kanwar, Nidhi Agrawal, Vandana Punase 2021-07-09 2021-07-09 4 12 252 254 Assessing role of chest radiography in management of COVID- 19 pneumonia <p>Aim: Role of chest radiography in management of COVID- 19 pneumonia.Materials &amp; Methods:Forty- six patients who tested rtPCR positive for SARS COV2 of both genders were included. Chest X-rays were obtained. The progression, regression of abnormalities, number of days to reach progression, number of days to regression either from initial X-ray or after peak of progression was also recorded.Results:Maximum cases were seen in age group 50-60 years (males- 8, females- 7) followed by 40-50 years (males- 7, females- 5), &gt;60 years (males- 5, females- 4), 30-40 years (males- 4, females- 3) and 20-30 years (male- 1, females- 3). Normal X- ray were observed in 13 (28.2%) patients, abnormal x- ray in 33 (71.8%), x-ray showing only peripheral opacities in 16 (34.7%), x-ray showing both central and peripheral opacities in 30 (65.3%), x-ray showing haziness (GGO) in 14 (30.4%), x-ray showing consolidation in 32 (69.2%). Left lung involvement was seen in 7 (15.2%), right lung involvement in 11 (24%) and bilateral lung involvement in 28 (60.8%) patients. Total HRCT was done in 25 (54.3%), out of which abnormal HRCT was seen in 40 (86.9%), abnormal X-ray abnormal HRCT in 32 (80%) and normal x-ray abnormal HRCT in 8 (20%). A significant difference as observed (P&lt; 0.05) Conclusion:Chest X-ray is an important diagnostic aid in the detection and management of Covid-19 pnuemonia.</p> A Antony Jean K. Karthikeyan Ajit Kumar Reddy Annitha Elavarasi J Copyright (c) 2021 A Antony Jean, K. Karthikeyan, Ajit Kumar Reddy, Annitha Elavarasi J 2021-07-09 2021-07-09 4 12 255 257 Medical Education Online:Remote Training Practice During the Covid-19 Pandemic <p>Background: During the current COVID-19 pandemic, offline medical education was mandated to suspend at the teaching departments of medical colleges, so the teaching was done online , yet there is insufficient evidence regarding the preferred practice and methods for online training .Objective: The investigation aimed to examine whether the online training and blending learning mode can achieve a good effect and cater for students and whether the learning group size affects the teaching effect.Design: The subjects were 150 students. After completing the online course, the final scores and evaluation results were compared, and their preference to distinct contents of the course was analyzed. Statistical analysis was performed using the SPSS program (version 22.0).Results: Our online course received consistent positive recognition from the students. Ninety-nine percent of the students recommended incorporating the online course into the conventional offline training program after the pandemic. There was no significant difference concerning the final scores and course evaluation. A smaller learning group size (&lt;25 students) could achieve a better teaching effect than a larger group size (p &lt; 0.05). The students preferred interactive discussions, and course contents that they can get practice and feedback from, rather than video watching and didactic lectures.Conclusion: The online training course and blending learning mode is worthy of popularization in a large student base. The teaching effect of an online training program may be improved by limiting the group size to less than 25 students and encouraging more interactive discussion, more practice and feedback.</p> Bhavna Gupta Chhaya Batham Dinesh kumar Patel Sujata Maini Copyright (c) 2021 Bhavna Gupta, Chhaya Batham, Dinesh kumar Patel, Sujata Maini 2021-07-09 2021-07-09 4 12 258 261 Assessment of Prevalence of Osteoporosis Among Female Chronic Obstructive Pulmonary Disease Patients at A Rural Tertiary Care Centre of North India <p>Background: Chronic obstructive pulmonary disease (COPD) is a lung disease that is thought to result from chronic inflammation that may affect other organ systems. Evidence suggeststhat the prevalence of osteoporosisin patients with COPD is high and potentially important.The strength of the bone depends on bone mineral density (BMD) and bone quality. The BMD is measured by the dual-energy X-ray absorptiometry (DEXA) scan. This disease being severe but its prevalenceamongfemale COPD patients in North India is not well documented. Objectives: To find the prevalence of osteoporosis among female chronic obstructive pulmonary disease patients at a rural tertiary care centre of north India. Materials &amp; Method: This is a cross sectional study conducted between January 2019 to June 2020 in Department of Respiratory Medicine, UPUMS, Saifai, Etawah. Female COPD patients those who fulfilled the inclusion criteria were included in the study and Classification of Osteopenia and Osteoporosis were done by World Health Organization Criteria.Result: A total of 210 female COPD patients were included. The mean age of the patients in this study was 63.38 +10.54years with a range from 40 to 92 years.In this study 88% patients were exposed to biomass fuel smoke and 44.76% were exposed to smoking. Out of 210 female COPD patients 44.29% were of GOLD Stage2, 30.48% were of GOLD Stage 3, 17.62% were of GOLD Stage 1 and 7.61% were of GOLD Stage 4. Out of 210 patients 3.81% had T-Score in DEXA Scan of ≥(-1.0) i.e. Normal, 25.71 % had T-Score in range of (-1.0) to (-2.5) i.e. Osteopenia and 70.48% had T-Score in DEXA Scan &lt;(-2.5) i.e. Osteoporosis.Conclusion: Out of 210 patients prevalence of Osteoporosisin female Copd patients was 70.48%. There was a significant correlation of severity of COPD (GOLD Stage) with Osteoporosis. There was no positive correlation between route and duration of steroid use with Osteoporosis and number of COPD exacerbations with Osteoporosis. There was no significant correlation between Body mass index (BMI) and Osteoporosis. Osteoporosis is common in female patients with COPD and its presence may have significant impact on the quality of life of such patients.</p> Ashish Kumar Gupta Prashant Yadav Aditya Kumar Gautam Adesh Kumar Copyright (c) 2021 Ashish Kumar Gupta, Prashant Yadav, Aditya Kumar Gautam, Adesh Kumar 2021-07-09 2021-07-09 4 12 262 266 Prevalence of Hypothyroidism in Patients with Benign Breast Disease and Effect of Thyroxine Supplementation in Intractable Mastalgia-A Prospective Study at A Tertiary Care Centre <p>Introduction: Benign breast diseases (BBD) constitute a heterogeneous group of lesions including developmental abnormalities, inflammatory lesions, epithelial and stromal proliferation, and neoplasms. Benign breast lesions deserve attention because of their high prevalence accounting for 36% of all breast diseases, their impact on women's life and due to cancerous potential of some histological types.Materials and Methods: This is a prospective study conducted in the Department of General Surgery,JSS Hospital, Mysuru from January 2018-June 2019. Those patients with symptomatic benign breast disease who attended Surgical OPD were screened for their thyroid function. Among those, patients with intractable mastalgia and fibroadenosis with deranged thyroid function were started on low-dose thyroxine supplementation and were followed up at a regular interval of 2 months, for a total of 6 months. Results: In our study, the prevalence of hypothyroidism in BBD was found to be 36%.BBD symptoms were alleviated in 71% of the hypothyroid patients with only thyroxine replacement. The final clinical outcomes of hypothyroid patients with mastalgia were significantly better than that of their euthyroid counterparts (0.001); 3.22 % of patients with BBD were found to be in a hyperthyroid state, which was clinically insignificant. Conclusion: Given the significant prevalence of hypothyroidism in benign breast disease at our centre, it is to be made mandatory to screen all benign breast disease patients for thyroid function. However, further larger studies are required to throw light on whether bringing such patients to a euthyroid state by thyroxine supplementation can prevent mastectomy in intractable mastalgias and also can prevent a small number of benign breast lesions turning to malignancy. Also, further studies are needed to establish a causal relationship between thyroid supplementation and symptom regression.</p> Hareesh HD Harish Iyyanna Preethi SP Thrishuli PB Copyright (c) 2021 Hareesh HD, Harish Iyyanna, Preethi SP, Thrishuli PB 2021-07-09 2021-07-09 4 12 267 269 Assessment of twin pregnancies- A clinical study <p>Background:Multiple births are much more common today than in the past. Throughout the world, the prevalence of twin pregnancies varies from approximately 2-20 /1000 live births. The present study was conducted to assess twin pregnancies.Materials &amp; Methods: 102 cases of twin pregnancies underwent USG examination performed with Toshiba machine. Factors such as mode of delivery and antepartum maternal complications were recorded.Results: Mode of delivery was vaginal in 40, LSCS in 54 and instrumental in 8 cases. The difference was significant (P&lt; 0.05). Maternal complications comprised of PPROM in 7, GDM in 12, GHTN in 16, Oligohydraminios in 6, preterm labour in 34 and anemia in 58. The difference was significant (P&lt; 0.05). Conclusion: Most common maternal complications wereGHTN, preterm labour and anemia.</p> Rishika Raj Swati Dubey Pankaj Mishra Copyright (c) 2021 Rishika Raj, Swati Dubey, Pankaj Mishra 2021-07-09 2021-07-09 4 12 270 272 A Study of Feto Maternal Outcome in Severe Acute Maternal Morbidity (Samm) <p>Background &amp;Objectives: Severe acute maternal morbidity (SAMM), also known as “near miss”, is defined as “A very ill pregnant or recently delivered woman who would have died had it not been that luck and good care was on her side.” This concept which is relatively new in maternal care identifies health system failures or priorities in maternal health more rapidly than maternal deaths. This study was undertaken to document the frequency and nature of maternal near miss and to evaluate feto maternal outcome. Material &amp;Methods: It is a prospective observational study conducted at Vanivilas hospital attached to BMCRI, Bangalore. All maternal near-miss cases which occurred between January 2013 to June 2014 at or after arrival at Vanivilas Hospital who were admitted to an intensive care unit (ICU) during pregnancy or in the Puerperium which met disease specific inclusion criteria was included in study. Results: In the study period 115 maternal near miss cases were admitted at ICU. 73.1% patients were uneducated, 78.3% were 20-29 years age group, 53.9% were from rural area, 88.7% of women belonged to low SES, 89.6% were referred, 67.8% were near miss at arrival, 57.4% were multigravida, 58.7% had delay in seeking care and 47.9% delivered vaginally. Mean duration of ICU stay was 4 days, intensive monitoring with blood transfusion (60.9%) was the most common intervention required at ICU. Hypertensive disorders (47%) followed by hemorrhage (27%) was leading cause for SAMM. Out of 115 SAMM patients 66 were alive babies, 8 were aborted, 19 were still born, and 22 were foetal deaths. Conclusion: In the present study it is concluded that illiteracy, low income, late referral, delay in seeking care were nature of SAMM. Hypertensive disorders and severe hemorrhage are the leading causes of SAMM and SAMM severely affects the perinatal outcome. An urgent review of the referral system and the emergency obstetric care is highly recommended to prevent Near miss.</p> Bhavya YR Anusha GK Renukamma H Sunil Kumar P Copyright (c) 2021 Bhavya YR, Anusha GK, Renukamma H, Sunil Kumar P 2021-07-09 2021-07-09 4 12 273 278 Contrast-Induced Nephropathy: Myth or Reality? Single center experience in patients undergoing planned percutaneous coronary intervention <p>The definition of Contrast-induced nephropathy (CIN) is the impairment of renal function and is measured either as increase in serum creatinine (SCr) by 25% from baseline or 0.5 mg/dL increase in absolute value, within 48-72 hours of intravenous contrast administration.<br>The objectives were to establish the incidence of CIN and to define the clinical and periprocedural risk factors leading to CIN in patients receiving contrast media.Methods: In a retrospective, observational, descriptive study, patients who were admitted to the hospital for therapeutic Percutaneous Coronary Inervention (PCI) between June 2020 to December 2020, the serum creatinine and glomerular filtration rate (GFR) prior to angiography and 72 hours post procedure were measured. Results: 202 patients were included in the study, of which 4.45 % developed CIN.<br>Discussion: In our study,the incidence was found to be lower than the literature review. The present study investigated renal function in the chronic phase in patients with ischemic heart disease undergoing planned PCI. The progression of renal dysfunction in patients who develop CIN is thought to result from glomerular overfiltration in the residual nephrons and the release of neurohormones that reduce renal blood flow.</p> Harshal Joshi Archit Jain Keyur Patel Copyright (c) 2021 Harshal Joshi, Archit Jain, Keyur Patel 2021-07-09 2021-07-09 4 12 279 281 Medical Air-Oxygen versus Nitrous Oxide-Oxygen: A comparative study in Patients Undergoing Laparoscopic Cholecystectomy under General Anaesthesia <p>Background: Laparoscopic procedures are gaining more popularity over conventional open abdominal surgeries.Nitrous oxide is still a popular anaesthetic carrier gas as it is cheap and reliable, provides powerful analgesia, decreases the need for maintenance anaesthetics, etc. However one of the most notable side effects of nitrous oxide is its ability to expand air-filled cavities such as the bowel. Medical air is an inert gas, environment friendly and does not have greenhouse effect as seen with nitrous oxide. However, it can cause awareness and increase requirement of anaesthestic agents to maintain depth of anaesthesia.Objective: To compare Propofol doses used for maintaining the depth of anaesthesia and to observe clinical signs of awareness in patients receiving oxygen-air and oxygen-nitrous oxide in undergoing laparoscopic cholecystectomy. Methods:80 adult patients of ASA grade I and II scheduled for elective laparoscopic cholecystectomy surgeries under GA were randomly divided into two groups of 40 each. Group A received oxygen and air (FiO2 0.4) and Group B received oxygen and nitrous oxide (FiO2 0.4). Dose of IV propofol infusions to maintain depth of anaesthesia, clinical signs of awareness and post op hypoxaemia were assessed. Data obtained was analyzed with suitable statistical tests.Results: Propofol requirements in both the groups were comparable. The total mean dose of Propofol required in Group A was 424.20±14.37 mg whereas in Group B, it was 402.20±14.56 mg (p=0.001) to maintain the depth of anaesthesia. There was no incidence of awareness or post op hypoxaemia in both the groups.Conclusion: Air can be used as a carrier gas instead of nitrous oxide with a significant increase in requirement of anaesthetic agentbut no increased incidence of hypoxaemia or signs of awareness.</p> Aditya Samudrala Md Shahbaz Alam Vipin Kumar Varshney Rohit Varshney Wasim Khursheed Copyright (c) 2021 Aditya Samudrala, Md Shahbaz Alam, Vipin Kumar Varshney, Rohit Varshney, Wasim Khursheed 2021-07-09 2021-07-09 4 12 282 287 Comparison of the Effects and Complications of Unilateral Spinal Anesthesia Versus Standard Spinal Anesthesia in Lower-Limb Orthopedic Surgery <p>Objective :The aim of this prospective, randomized, parallel group study was to evaluate vital parameters , sensory and motor block during unilateral subarachnoid block and to compare it with that produced by standard bilateral spinal anaesthesia. Side effects and complications were also noted and compared.Methods: 100 ASA I-II patients scheduled for one leg surgery. Dural puncture was performed by 25-G spinal needle with patients lying in the lateral position and the side to be operated on dependent. Patients then randomly received 8 mg of 0.5% hyperbaric bupivacaine injected over 80 sec with needle hole orientated towards the dependent side (Unilateral, n = 30), or 15 mg of the same solution injected over 6 sec with needle bevel cranially directed (Control, n = 30). Only patients of the Unilateral group remained in the lateral position for 15 min. Blood pressure, heart rate were measured before spinal block (baseline) and then at 5, 15, 30 and 45 min; while sensory and motor blocks were evaluated at 15, 30 and 45 min on both sides.Results:Patients characteristics in terms of age and weight were comparable in both the groups All blocks were fully effective. Mean blood pressure was significantly lower in the bilateral group. Heart and respiratory rates did not differ between the groups. There was no statistically significant difference in mean time for onset, peak of sensory block in two groups. But there was statistically significant difference in two segment and complete regression of sensory block. Regression of sensory block was prolonged in group A as compared to group B (P&lt;0.0001).There was no statistically significant difference in onset of motor block in two groups. But there was statistically significant difference in regression of motor block. There was delayed regression of motor block in group A as compared to group B (P&lt;0.01).There was significant prolongation of analgesia in Group A where first rescue analgesic was required after 9 hours of subarachnoid blockade. Patients in Group B required rescue analgesic at 7 hours after subarachnoid blockade. There was statistically significant difference in duration of analgesia in two groups. Postoperative analgesia was significantly prolonged in Group A as compared to Group B.The total number of side effects (hypotension, bradycardia, apnoea) requiring intervention was similar in both groups.Conclusion: The use of 8 mg of 0.5% hyperbaric bupivacaine slowly injected through a directional needle provided a spinal block relatively restricted to the operative side with minimal effects on cardiovascular homeostasis. Unilateral spinal anaesthesia is safe. The dose of bupivacaine is lower and haemodynamic stability is better. The technique is more time consuming, compared to standard spinal anaesthesia and the patient's cooperation is essential.</p> Shailendra Dawer Ranjita Aske Dawer Rahul Meda Yogesh Tilkar Copyright (c) 2021 Shailendra Dawer, Ranjita Aske Dawer, Rahul Meda, Yogesh Tilkar 2021-07-09 2021-07-09 4 12 288 292 Etiology and Outcome of Fever of Unknown Origin in a tertiary care center in South India-A prospective study <p>Background:Fever is a common symptom for which patient seeks medical attention. Globally, and especially in developing countries, Fever of unknown origin (FUO) is an important cause of morbidity and mortality. The pattern of fever has apparently changed over the years, though there are no data available in this regard. There is a perception of change in patterns among treating physicians. The present study aims at finding out the different etiology and factors causing delay in diagnosis should be identified and overcome to improve outcome of FUO.Materials and Methods:Consecutive patients admitted with a diagnosis of FUO admitted in the Department of General Medicine,Govt. Medical College Thrissur are enrolled into the study. The clinical and investigation findings and outcome were recorded in a proforma for analysis.Results:53 patients were enrolled into the study and they were followed up till a definite outcome is met.37(71.2%) were males and 15(28.8%) whereInfection was the etiology in majority of the cases. 32(91%), followed by malignancy and inflammatory disorders. Tuberculosis was found to be the most common infectious etiology followed by Urinary tract infections and enteric fever.Among the tuberculosis majority was extrapulmonarytuberculosis(87.5%)There were 2 cases of Vivax Malaria which is not endemic to this part of the country. HIV constituted (5.7%) among this population with various complications. Multiple metastasis, Multiple myeloma, Lymphoma,Leukemia and Hepato-cellular carcinoma were the malignant etiologies reported. A significant proportion (11.5%) of patients etiology of Fever could not be diagnosed. Conclusion:Infectious etiology, especially Tuberculosis was the most common cause for FUO in this part of the country. A thorough search for otherinfections, malignancy and inflammatory disorders should be undertaken in case of FUO. A significant (11.5%) patients’ etiology could not be diagnosed despite thorough workup.</p> Renny Issac Muraly CP Swathy S Sudhiraj TS Ravindran Chirukandath Copyright (c) 2021 Renny Issac, Muraly CP, Swathy S, Sudhiraj TS, Ravindran Chirukandath 2021-07-09 2021-07-09 4 12 293 297 A Study of Clinical Profile and Functional Outcome of Lateral Epicondylitis Post PRP Injection <p>Introduction: Lateral epicondylitis also known as tennis elbow attributed the onset of symptoms due to overexertion of the extremity with repeated wrist extension and alternating forearm pronation and supination. In Lateral epicondylitis , the mainstay of management which involves a variety of options, including rest, physical therapy, non steriodalanti inflammatory drugs (NSAIDS), local cortisone injection, autologous Platelet-Rich Plasma injection , botulinum toxin injections, shockwave therapy , supportive forearm bracing and local modalities. For patients with recalcitrant disease, open debridement technique, arthroscopic or percutaneous procedures are tried. Despite its high prevalence the development of a single effective and consistent management remains an unrealized goal. Aim: To study the effictiveness of autologous Platelet -rich plasma injections and look for best available treatment in the management of Lateral epicondylitis of humerus. We focused on comparing different modalalties of treatment for lateral epicondylitis and drew a conclusion after evaluating merits and demerits of the same.Methodology: All patients were included in the study after full filling the inclusion criteria and informed consent. Total 25 patients were included in the study of who did not get relief from conservative management were selected. All patients were treated with three injections of autologous PRP and followed up for a minimum period of six months. The treatment options were discussed before the procedure with patients and close relatives and an informed consent was taken for the study. The primary analysis included local tenderness, Grip test, Cozen test, The Disabilities of the Arm, Shoulder and Hand(DASH) score , Nirschl Pain Score and Visual Analogue Scale(VAS) for pain which were used for clinically assessing the outcome and improvement at different follow up periods of 1,4 and 24 weeks.Conclusion: The results obtained in this study indicate that autologous Platelet Rich Plasma injection in patients with Lateral Epicondylitis produced significant improvement in reducing pain, restoring functions and returning to previous activities. It also did not provoke any local or systemic adverse effects. The safety of autologous PRP makes it an attractive option for the treatment of lateral epicondylitis.</p> Rishav Krishna Amrit Jha Mohit Sharma Tarun Duggal Copyright (c) 2021 Rishav Krishna, Amrit Jha, Mohit Sharma, Tarun Duggal 2021-07-09 2021-07-09 4 12 298 303 Painful OsPeroneum Syndrome Presenting as Lateral Plantar Foot Pain: A Case Report <p>The painful osperoneum syndrome (POPS) results from a wide spectrum of conditions, including fractures, diastases, and other causes. POPS can result in tenosynovitis or discontinuity of the peroneus longus tendon with a clinical presentation of pain in the lateral aspect of the midfoot. We report a rare case of painful Osperoneum syndrome (POPS) of 52 year-old man who had suffered from chronic pain on lateral foot after varus ankle injury and been treated successfully with surgical excision of the Osperoneum and preserved eroneuslongus tendon at a same time.</p> Mohit Khanna Anas Ibrahim Delair Kunal Arora Roop Singh Aditya Seth Ipanshu Manmeet Malik R.K. Mishra Copyright (c) 2021 Mohit Khanna, Anas Ibrahim Delair, Kunal Arora, Roop Singh, Aditya Seth, Ipanshu, Manmeet Malik, R.K. Mishra 2021-07-09 2021-07-09 4 12 304 307 Type 2 Diabetes Mellitus and Hyperglycemia in Medical-IcuMorbidiy, Mortality and Functional Outcome <p>Introduction:Diabetes mellitus, a major lifestyle disease is undoubtedly the most challenging public health problem of 21st century with a worldwide prevalence of 387 million (8.3%) and predicted to be 592 million by 2035. 77% of people with diabetes live in low- and middle-income countries. India, once known as the ‘diabetes capital of the world’ was home to 61.3 million patients with T2DM in 2011 with predictions of 101.2 million diabetics by 2030. India is second only to China which is home to 92.3 million diabetics. The International Diabetes Federation estimated a doubling of diabetic population between 1995 and 2005, and predicted 70 million diabetics by 2025. Materials and Methods:Patients admitted to the Medical ICU during a consecutive period of four months from November 2014 to February 2015.Study was conducted among the patients admitted to the Medical ICU through the OP Department and casualty. Detailed history and physical examination along with relevant investigations were done after getting written, informed consent A proper proforma was set up emphasizing history, physical findings, and investigations.Results:Out of the total 144 patients 27 (18.75%) were found hyperglycemic with a history of Diabetes Mellitus and 20 (13.88%) were hyperglycemic without a history of DM. Rest ofthemi.e 97patients(67.36%)were found to be normoglycemic.Conclusion: Patients admitted with Infections and Poisoning have a higher chance to remain normoglycemic. Patients with Cardiovascular diseases are prone to become hyperglycemic. Snake bite and other poisonings have lesser chance to develop hyperglycemia. Hyperglycemia in general leads a poor functional outcome. Treatment with Insulin does not cause any significant variation in the mortality rate of the glycemic group when compared to the normoglycemics. Hyperglycemia can lead to increased mortality. Known diabetics and new hyperglycemics have equal mortality rate.</p> Sasidharan Kovvalveeti Faisal KK Copyright (c) 2021 Sasidharan Kovvalveeti, Faisal KK 2021-07-09 2021-07-09 4 12 308 311 Study of correlation between obesity and glycated hemoglobin in type 2 diabetes patients: a retrospective cross-sectional study from Bundelkhand medical college <p>Background: With the rapid rise in incidence and prevalence over the last two decades, type 2 diabetes has become a global issue. The economic burden of diabetes on individuals and the nation is expected to rise as the epidemiological burden of diabetes grows. Glycemic control is critical for diabetes management because obesity is a significant risk factor for the development of T2DM and its complications. Aims and objectives: The aim of this research was to observe if there was a link between obesity and T2DM, as well as to see if there was a link between obesity and dysglycemia.Materials and methods: Hundred T2DM patients with age between 30-70 years with more than one year duration of diabetes were studied.Participants had their anthropometric measurements, comprehensive histories, and biochemical indices evaluated. All the subjects' medical history was documented, including their age, gender, diabetes length, and diabetes family history. The subjects were measured without the use of shoes or clothes, and according to the updated consensus guidelines. Body mass index, waist circumference, glycemic profile and blood pressure were also measured. Participants were divided based on BMI in to 3 groups viz. Normal BMI (18.0-22.9 kg/m2), Overweight (23.0-24.9 kg/m2) and Obesity (&gt;25 kg/m2).Results: T2DM was more prevalent in 40-60 years of age (60%) and among males (60%). The mean age, duration of diabetes, FPG, were higher in male than in female diabetics while the mean levels of BMI and HbA1c are higher in female than male diabetics but not statistically significant. Duration of diabetes was longer in male as compared to female diabetics and statistically significant. Age of onset, systolic and diastolic blood pressure were found to be only marginally elevated in males as compared to female diabetics. A positive correlation was observed between the BMI and WC of both female (r=0.68, p&lt;0.001) and male diabetics (r=0.66, p&lt;0.001), between BMI and HbA1c of both female (r=0.41, p=0.002) and male diabetics (r=68, p=0.021) and between WC and HbA1c of both female (r=-0.54, p=0.001) and male diabetics (r=0.75, p=0.021). An increasing trend in WC and BMI and HbA1c is seen from Normal BMI group to Obese group, p&lt;0.05. A statistically significant difference was noted also for age of the diabetics (p=0.001), and age of onset of diabetes (p=0.002) on comparison of the three groups.Conclusion: Dysglycemia was found to be on the rise in diabetic subjects with average BMI, overweight, and obese. Diabetic subjects had a higher prevalence of both central and peripheral obesity.</p> Devendra Ahirwar Shikha Agarwal Diwashish Biswas Copyright (c) 2021 Devendra Ahirwar, Shikha Agarwal, Diwashish Biswas 2021-07-09 2021-07-09 4 12 312 314 Qualitative analysis of multiple choice questions in Department of Anatomy <p>Introduction: Multiple choice questions are the most frequently used assessment methods in the Medical colleges. It can be used for assessment of higher levels of cognitive domain, if constructed properly. Each MCQ or item is made up of a stem and incorrect responses or distracters. Objective:Main objective of this study is to analyze items given in formative assessment of the Anatomy department using different statistical indices.Methodology:fifty multiple choice questions from 5 PCTs of 150 students of 2017-18 batch were selected using systematic random sampling for the same. Items were analysed using the formulae and microsoft excel.Result:In the present study, total 30 items are found to be ideal with acceptable difficulty index, acceptable discrimination index &amp;atleast 66% distractor effectiveness.Weak positive correlation is found between difficulty index &amp; discrimination index. Out of total 150 distracters, 13 distracters are found to be non-functional, 8 items with 1 nonfunctional distractor (NFD), 1 item with 2 NFD &amp; 1 item with 3 NFDs have been observed. Conclusion:Ideal items are preserved for the departmental question bank for future use and items with some flaws are rectified and those with no possible corrections are discarded.</p> Soniya Arun Kumar Gupta Tanya Agarwal Tarsem Kumar Ujwal Gajbe Copyright (c) 2021 Soniya Arun Kumar Gupta, Tanya Agarwal, Tarsem Kumar, Ujwal Gajbe 2021-07-09 2021-07-09 4 12 315 318 Comparison of Rosuvastatin (10mg) and Atorvastatin (10mg) in achieving the treatment goals of dyslipidemia: Government Medical College, Suryapet <p>Background: Atherosclerosis and coronary artery disease are both caused by dyslipidemia, which has been identified as the primary cause. The statin medication class is the most often recommended therapy for dyslipidemia. Among these, atorvastatin and rosuvastatin, a relatively new medication, are more commonly recommended. The goal of the study was to evaluate the efficacy of rosuvastatin and atorvastatin in the treatment of dyslipidemia.Methods and Material: Patients with dyslipidemia between the ages of 30 and 72 were eligible. One of two therapy groups was allocated to the patients. A total of 250 patients were randomly divided into two groups, each with 125 patients, and labeled Group I and Group II. For 12 weeks, Group I was given rosuvastatin (10 mg tablet OD) while Group II was given atorvastatin (10 mg tablet OD). The lipid profile low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), non-high-density lipoprotein cholesterol (non-HDL-C), triglycerides (TG), and very-low-density lipoprotein cholesterol (VLDL-C) were measured before the start of therapy and after 12 weeks. Percentage changes from baseline were calculated and adverse effects were recorded. Results: During the 11 months study, A total of 250 patients were screened for the study, of which males represented 63.60% (n = 159), female 36.40% (91) of the population, male and female ratio was 1.7:1. A total of 250 patients were divided randomly into two groups of 125 patients each and assigned as group I (male 80, female 30) and Group II (male 79, female 31. The group-I mean age was 53.66 ± 7.69 and group-II mean age 52.75 ± 6.89. Group I received rosuvastatin (10 mg tablet OD) and Group II received atorvastatin (10 mg tablet OD) for 12 weeks. The levels of serum TC and LDL-C are decreased by 38.01% and 47.55 % respectively with the use of rosuvastatin (Group-I) after 12 weeks. atorvastatin 10 mg/day ((Group-II)for 12 weeks resulted in a statistically significant fall in levels of serum TC and LDL-C by 23.50 % and 29.79 %.Conclusions: Generally, medication of Rosuvastatin could reach a better lipid-reducing effect and yield a higher attainment rate of LDL-C and TC than Atorvastatin in the same dose in high-risk hyperlipidemic Indian patients.</p> Polagani Padma C. Muralidhar Kavitha Mudavath Copyright (c) 2021 Polagani Padma, C. Muralidhar, Kavitha Mudavath 2021-07-09 2021-07-09 4 12 319 324 The Role of Antibiotic Prophylaxis in Elective Tension Free Mesh Inguinal Hernioplasty <p>Objective:To determine whether the use of prophylactic antibiotics is effective in the prevention of postoperative wound infection after open tension free repair of inguinal hernia.Methods: 150 Patients with a primary inguinal hernia repair were randomized in two groups .One group given a preoperative single dose of 1.5 g intravenous cephalosporin and the other group was given a placebo. Patients with recurrent hernias, immunosuppressive diseases, or allergies for the given antibiotic were excluded. Infection,seroma ,wound dehiscence etc was defined and their incidence noted. Follow up of the patients were done at I week,2 week and than 1 month.Results: Groups were well matched for all preoperative variables studied, including comorbid conditions. Superficial surgical site infection developed in 2 patients (1.7%) from the antibiotic group and 3 (3.3%) from the placebo group (p = 0.50). One from each group developed deep surgical site infection. Both patients were readmitted and underwent repeated debridement, which eventually resulted in graft loss.Conclusion: A low percentage of wound infection after primary open mesh inguinal hernia repair was found, and there was no significant difference between the antibiotic prophylaxis or placebo group. The results show that in primary hernia repair, antibiotic prophylaxis is not indicated in low-risk patients.</p> Sunil Kumar Maini Neeraj Gupta Vikas Kumar Malviya Pradeep Kumar Saxena Copyright (c) 2021 Sunil Kumar Maini, Neeraj Gupta, Vikas Kumar Malviya, Pradeep Kumar Saxena 2021-07-09 2021-07-09 4 12 325 328 Three-dimensional analysis of mandibular lingula apex to guide the mandibular foramen location in North Indian population: a computed tomography study <p>Purpose: Mandibular lingula apex (MLA) acts as an important landmark for identifying the site for injection of local anesthetics during inferior alveolar nerve block. The authors aimed to determine the three-dimensional position of MLA to guide clinician for inferior alveolar nerve block and surgical procedures.Methods: Computed tomography (CT) images of 100 MLAs from 50 patients (12 females, 38 males) aged between 16-85 years were evaluated. Distances and angles from MLA to different anatomic landmarks on mandibular ramus were measured. Pearson’s correlation was performed for the statistical comparisons.Results: The authors found that the shortest distance of MLA from ramus anterior, posterior, superior, inferior border and mandibular angle was 14.07 mm, 17.32 mm, 16.23 mm, 34.1 mm, and 30.9 mm respectively. The MLA was positioned nearly 1.63 mm behind the midpoint of the ramus horizontally and 8.94 mm above the midpoint vertically. Mandibular angle was 121.7 degree and MLA angle from inferior border was 87.74 degree. There was found no correlation between DLA and age and also there was strong positive correlation between DLA and height of ramus. A negative correlation was found between DLA and mandibular angle. Conclusion: The present study represents that CT provides reliable information about the position of MLA in relation to different anatomical landmarks of mandibular ramus which may help in successful and safe treatment procedures with reduced complications. MLA distance from anterior border of ramus will be more with increased ramus height and decreased mandibular angle and also vice versa, which may be helpful to give an accurate location of MLA during inferior alveolar nerve block procedure.</p> Kapil Karwasra Copyright (c) 2021 Kapil Karwasra 2021-07-09 2021-07-09 4 12 329 331 Analysis of Prevalence of Dry Eyes in Diabetic Patients at a Tertiary Care Centre <p>Background:Dry eye (DE) is a multifactorial pathology characterized by a progressive dysfunction of the lacrimal and meibomian glands that typically lead to decreased aqueous tear production and increased tear evaporation, respectively.Hence; the present study was undertaken for assessing prevalence of dry eyes in diabetic patients.Materials &amp; Methods: A total of 250 diabetic patients, who reported to the Department of Ophthalmology, RVRS Medical College &amp; Attached group of Mahatma Gandhi Hospital, Bhilwara, Rajasthan (India) were enrolled in the present study. Complete demographic details of all the patients were obtained. Recording visual acuity with snellen’s chart followed by slit lamp biomicroscopic examination was done. Tear films break up time (TBUT) was done in all the patients by instilling a 2% fluorescein dye into the inferior conjuctival fornix and allowing blinking several times before stopping. A value less than 10 seconds was taken as abnormal.<br>Results: Among diabetic patients, prevalence of dry eyes was found to be 55.6 percent. While correlating the prevalence of dry eyes with age-wise distribution of patients, non-significant results were obtained. However, significant results were obtained while correlating the prevalence of dry eyes with duration of diabetes. Conclusion: Significant proportion of diabetic population is affected by dry eyes, with its prevalence being directly proportional to the duration of diabetes.</p> Rajni Gaur Arun Gaur Manish Kumar Singhal Surender Kumar Meena Copyright (c) 2021 Rajni Gaur, Arun Gaur, Manish Kumar Singhal, Surender Kumar Meena 2021-07-09 2021-07-09 4 12 332 334 Assessment of Prevalence and Risk Factors of Inguinal Hernia: A Prospective Study <p>Background: The protrusion from the abdominal cavity through the inguinal canal is called inguinal hernia. This is the most common type of hernia and affects chiefly men. The present study was conducted to assess the prevalence and risk factors of inguinal hernia.Materials and Methods: The present study was carried out among 180 adult patients of inguinal hernia over the period of 1 years. The demographic details were collected, and complete clinical examination was performed. Details of the hernia, such as the type of hernia, primary or recurrent was noted. Statistical analysis were performed using SPSS version 21.0 statistical software (SPSS, Chicago, IL).Results: In the present study total patients were 180 &amp; maximum patients were of age group 31-40yrs(40%) and minimum (10%) were of age group 20-30yrs. Primary hernia was present in 80.55% and recurrent hernia was present in 19.44%. Period of swelling was less than one year for majority (48.88%) of the patients, while the least of them had swelling for more than 2years (13.88%). The most common side where the hernia was observed was on the right side (44.44%). The most common cause for the presence of hernia was lifting heavy objects (22.22%).Conclusion: The present study concluded that maximum inguinal hernia patients were of age group 31-40yrs. Primary hernia was present in majority patients. Period of swelling was less than one year for majority of the patients. The right side was most common side and the most common cause for the presence of hernia was lifting heavy objects.</p> Kalicharan Bansal Chandresh Bhooshan Bhardwaj Copyright (c) 2021 Kalicharan Bansal, Chandresh Bhooshan Bhardwaj 2021-07-09 2021-07-09 4 12 335 337 A Study of Relation of Hemoglobin A1c to Left Ventricular Diastolic Function in Patients with Type 1 Diabetes Mellitus and Without Overt Heart Disease <p>Introduction: Diabetes mellitusis a group of metabolic disease characterized by hyperglycemia results from defects in insulin secretion, insulin action or both. It affects more than 120 million worldwide.Materials and Methods: The Clinical materials were of Type-1 Diabetes Mellitus individuals selected from Endocrinology OP,Andhra Medical College,Vishakhapatnam. About 87 patients were subjected to initial assessment it included through clinical examination, routine blood investigation consisting of complete blood count, biochemistry investigation, ECG, estimation of HbA1c and echo cardiography were done from which 50 patients were included in the study.Results: In this study,left atrial area [19 ± 5.1] was more in group with HbA1C&gt;7 i.e group II when compared to group (15.1±2.6)with HbA1C &lt;7 i.e group I. Mean peak early mitral inflow velocity E wave [m/sec] was low [75 ± 1.1] in patients of Group II compared with Group I (77±0.9). Mean peak late mitral inflow velocity A wave [m/sec] was more [70 ± 14 ] in patients of Group II compared to patients of group I (48±15) with statistical significance (P 0.003). In this study, E/A ratio less (1.28±0.31) in group II patients when compared to group I (1.6±0.3) patients with statistical significance (P 0.01). Here in our study Isovolumetric relaxation time was prolonged (99±1) in group II compared to Group I (71±8) with statistical significance (P 0.003).Conclusion: The findings in our study concludes that left ventricular diastolic dysfunction represents the first stage of diabetic Cardiomyopathy preceding systolic dysfunction reinforcing the importance of early examination of ventricular function in patients with diabetes and importance of well controlled glycaemic status in diabetes.</p> Jaya Kumar Palepu Kommagiri Anusha Copyright (c) 2021 Jaya Kumar Palepu, Kommagiri Anusha 2021-07-09 2021-07-09 4 12 338 342 The Clinical outcome of Core decompression and autologous iliac crest bone grafting for avascular necrosis of the femoral head before collapse <p>Iliac crest bone graft offers three properties (i:e.) osteogenesis,Osteoinduction and Osteoconduction.Removing of dead bone and providing structural support to prevent collapse is the key concept in treatment of core depression and autologous iliac crest bone grafting for avascular necrosis of the femoral head before collapse.</p> P. Pavan Kumar B.S.Ravi Teja Copyright (c) 2021 P. Pavan Kumar, B.S.Ravi Teja 2021-07-09 2021-07-09 4 12 343 347 A study of blood group frequencies in malaria patients <p>Malaria is an endemic disease and claims many lives especially in tropical countries. Many studies have been reported where some specific blood groups were linked to the malaria. The frequencies were unknown. Many reports have been done to identify the intensities also. No such studies have been reported in the local population and our study is an effort to find the frequencies of malaria in particular blood groups. This study puts in a sincere effort to find the frequencies of malaria in different ABO blood groups. This is the step one of research and will be reported. Further varieties of malarial parasite and complications associated would be studied in the future and reported.</p> Faseeh KM Syed Sirajudeen Mukhtar Ahmed Dawood Bendigiri Emad Mir Abbas Copyright (c) 2021 Faseeh KM, Syed Sirajudeen, Mukhtar Ahmed Dawood Bendigiri, Emad Mir Abbas 2021-07-09 2021-07-09 4 12 348 353 To evaluate anti-nociceptive activity of Aloe vera gel extract in graded doses in Albino rats by using radiant heat induced pain by using Analgesiometer <p>Background: Pain is a reaction of the body to harmful stimuli and is therefore a protective early warning system, the sensation of pain in postoperative patients, cancer patients, and other chronic pain patients has little positive effect. Objective: To evaluate anti-nociceptive activity of Aloe vera gel extract in graded doses in Albino rats by using radiant heat induced pain by using Analgesiometer. Materials and methods:The present study is undertaken to evaluate the anti-nociceptive effect of Aloe vera in animal models of pain in Albino rats. It was conducted in the Department of Pharmacology, Kamineni Institute of Medical Sciences (KIMS) from October 2012 - September 2014.Results:Aloe vera leaf gel extract powder dissolved in distilled water was evaluated for anti-nociceptive activity in tail flick method in albino rats. Tramadol, the known synthetic opioid analgesic is used as standard drug for comparing the effects of Aloe vera. Aloe vera in the doses of 200mg/kg and 400mg/kg orally produced significant anti-nociceptive effect in tail flick method in comparison to control group (DW). The standard drug tramadol in the dose of 20mg/kg orally also produced significant anti-nociceptive effect in tail flick method in comparison to control group (DW).Conclusion: Aloe vera leaf gel extract powder (dissolved in distilled water) possesses anti-nociceptive activity at 200 mg/kg and 400 mg/kg dosage at 60, 90 and 120 minutes when given orally in tail flick, model in albino rats.</p> P Srujana Bapugouda Patil Dattatraya Joshi Copyright (c) 2021 P Srujana, Bapugouda Patil, Dattatraya Joshi 2021-07-12 2021-07-12 4 12 354 359 To study clinical features of Electrolyte abnormalities in Intensive Care Unit patients at Base Hospital Delhi Cantt <p>Background: Electrolytes are involved in many metabolic and homeostatic functions, including enzymatic and biochemical reactions. Objective: To study clinical features of Electrolyte abnormalities in Intensive Care Unit patients, Base Hospital Delhi Cantt. Materials and methods: A prospective observational study of Clinical Profile of Electrolyte Abnormalities in patients admitted in Intensive Care Unit and their management and outcome at Base Hospital Delhi Cantt. The study was carried out over a period starting 01 Apr 2013 to 31 Sep 2014 at Intensive Care Unit at Base Hospital Delhi Cantt.Results:Hyperkalemia was more common electrolyte disorder in the ICU followed by Hypokalemia &amp; hyponatremia. Hypermagnesemia and hypernatremia was the least common electrolyte disorder in our study. Muscle weakness and peaked T waves for hyperkalemia. Fatigue, muscle weakness, leg cramps and T wave flattening was the most common association with hypokalemia. Nausea, vomiting, headache, lethargy and altered sensorium for hyponatremia. Coma occurred in 2 patients and seizure in only one patient. Nausea, vomiting, headache and altered sensorium for hypernatremia.Conclusion:Clinical symptoms and findings of dyselectrolytemias in the ICU are a reflection of multiple interactions of electrolytes and regulatory systems. Therefore, it is suggested that clinicians working in emergency department should have good knowledge of fluid and electrolyte balance dynamics.</p> Lt Col Shankar Guru Kurugod Sreenivasa S CS Narayanan Ranjith K Nair Copyright (c) 2021 Lt Col Shankar Guru Kurugod, Sreenivasa S, CS Narayanan, Ranjith K Nair 2021-07-12 2021-07-12 4 12 360 364 Clinical attachment level gain as a parameter to assess the effectiveness of root conditioning in periodontal regenerative surgical procedures <p>Background: The conventional periodontal treatment aims to resolve the inflammatory lesion in the periodontal tissues, by eliminating plaque and calculus from tooth surfaces, either with scaling and root planning alone or combined with periodontal surgery. Objective: to appraise the clinical attachment level gain as a parameter to assess the effectiveness of root conditioning in periodontal regenerative surgical procedures. Study design: A case-control study. Setting: OPD of Periodontics, Subharti Dental College, Meerut UP.Participants:20 patients. Sampling: Random sampling. Statistical Analysis: statistical analysis was done using SPSS 10 and Unpaired student “t” test.Results:On comparing the treatment outcomes it was observed that the gain in the clinical attachment levels was not statistically different in either of the groups i.e. P &gt; 0.05 and P &gt; 0.001.Conclusion: The outcome of this study emphasizes that the clinical effect of the acid conditioning may have been overshadowed by the healing potential generated by the barrier membrane. Regenerative technique to treat a defect must be based on consideration of these factors, which will determine the predictability of a successful result.</p> Ruby Khan Mohd Haroon Khan Copyright (c) 2021 Ruby Khan, Mohd Haroon Khan 2021-07-13 2021-07-13 4 12 365 368 A study of Prevalence, Demographic Profile and Risk factors of Coronary Artery Disease <p><strong>Introduction:</strong> In India CHD prevalence has increased in last six decade from1% to 9%-10% in urban populations and &lt;1% to 4%-6% in rural populations. This epidemiological transition is mainly because of the increase in the prevalence CHD risk factors among Indian population. The present study has been undertaken with the objectives of studying the prevalence rates of coronary risk factors as well as demographic profile, age and sex specific high- risk groups.<strong>Materials and Methods:</strong> A cross-sectional study was conducted by using stratified multistage random sampling. 270 participants aged ≥40 years participated in this study.&nbsp; The Study variables were age, sex, occupation, addiction, food habit, physical activity, body mass index, blood pressure, and electrocardiogram change were recorded. <strong>Results:</strong> The prevalence of IHD among smokers was higher than among non-smokers (P&lt;0.01) Table 4. Prevalence of IHD increases with the increase in blood pressure (P&lt;0.01). The highest prevalence of IHD was found among the severe hypertensive population (33.3%) and the lowest prevalence was found in those patients with normal blood pressure (5.2%). The prevalence of IHD increased with higher BMI (P&lt;0.05). <strong>Conclusion</strong> CAD among the study population is significantly associated with hypertension and smoking.Risk factors for coronary heart disease which were higher among males.</p> Umesh Babu M.G Ananthoju Raghramulu K.P. Joshi Adupala Divya Copyright (c) 2021 Umesh Babu M.G, Ananthoju Raghramulu, K.P. Joshi, Adupala Divya 2021-07-09 2021-07-09 4 12 369 373