International Journal of

Pharmaceutical and Clinical Research

ISSN: 0975 1556 Peer Review Journal

Print-ISSN 2820-2643

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1.A Comparative Study of Sensory Nerve Conduction Indices in Hypothyroid Patients and Healthy Volunteers
Komal Sharma, Jyotsna Shukla, Abhishek Saini, Praveen Choudhary
Introduction: Thyroid hormone is important for neuronal cell integrity and cytoskeletal stability operating via regulation of various stress response intracellular signalling and target molecules. Alteration in thyroid hormone signalling in nerve and other tissues underlie observed manifestations like neuropathy and aberrant nerve conduction. The neurological complications are well established in hypothyroidism, however the exact pathophysiological events culminating in development of these complications are still obscure. Aim and Objective: In view of the same, the present study was aimed towards exploring the possible missing links by assessing and comparing the extent of peripheral sensory neuropathy and its relation to disease duration among hypothyroids and matched controls. Materials and methods: Nerve conduction parameters were recorded from 32 hypothyroid patients and 32 age and sex matched healthy control subjects. Sensory nerve study (SNS) of bilateral median nerve and bilateral sural nerve were recorded and compared. Results: Significant changes were observed in the form of reduction in sensory nerve conduction velocity (SNCV) (p<0.05) in both examined nerves in hypothyroid patients in comparison to healthy control subjects. We also found significantly reduced amplitude (p<0.05) and prolonged sensory latencies (p<0.05) among hypothyroid patients as compared to healthy control subjects. Also, significantly reduced sensory amplitude of median nerve and sural nerve were observed in hypothyroid patients who suffered from the disease for a period of 5 years or more. Conclusion: The present study proffered that the sensory polyneuropathy associated with hypothyroidism was largely of mixed type (demyelinating as well as axonal type). Also, the present study recommends performance of nerve conduction studies in cases of hypothyroidism early in the course of the disease for timely detection and management of peripheral nerve dysfunctions.

2.Analysis of Diagnostic Value of Gram Stain in Comparison to Culture of Sputum Samples at A Tertiary Care Hospital
Esha Singhal, Manjari Kumari, Prashant Bhardwaj
Introduction: Sputum Gram stain and culture are routinely done to determine the causative organism in case of lower respiratory tract infections. Sputum culture takes much more time to give results as compared to Gram stain that’s why Gram stain is valuable in guiding empirical treatment for the patients but Gram stain report alone is not always reliable. Aim: Aim of this study was to analyze the diagnostic performance of Gram staining in comparison to sputum culture results for lower respiratory tract infections. Materials and methods: Study was performed in a 690-bed, tertiary-care hospital of northern India. A total of 477 expectorated sputum samples which were collected in sterile containers were included in this study. Results: A total 311(65%) samples were identified as a good sample, and the count of fair and poor samples were 109(23%) and 57(12%) respectively. Poor sputum samples gave positive Gram stain results and negative cultures more frequently as compared to good & fair samples (p<.05) whereas good quality sputum samples more frequently gave Gram stain results that were compliant with the culture results either positive or negative (p<.05). In good quality sputum samples (311) number of culture positive and Gram stain positive or true positive were 172(55%). The sensitivity, specificity, positive predictive value and negative predictive value for Gram staining in good grade samples were 95.03%, 28.46%, 64.91% and 80.43% respectively (p <0.00001). Conclusion: Consistent interpretation of Gram stain results can be challenging. Correct interpretation of Gram stain results by the physician can improve the choice of antibiotics and thus can greatly reduce morbidity and mortality in critically ill patients.

3.Alobar Holoprosencephaly: A Rare Case Report
Samira Kumar Behera, Lipika Behera, Swetambari Acharya, Dipika Mishra, Chaitali Pattnaik, Shushruta Mohanty
Holoprosencephaly (HPE) is a rare congenital anomaly that occurs due to failure of prosencephalon to develop into two cerebral hemispheres. It results in brain malformation associated with multiple midline facial defects that occurs usually in 4th to 8th week of gestation. Most affected fetuses do not survive; severely affected children typically do not survive beyond early infancy, while a significant proportion of more mildly affected children survive past 12 months. We here in discuss a case of alobar holoprosencephaly in a fetus with midline facial defects that was detected clinically on USG scan. We received a dead fetus of about 21 weeks gestational age for autopsy. On external examination it had deformed facial structure like single eyeball(cyclopia) placed beneath tubular nose (Proboscis). A detail perinatal autopsy was conducted according to protocol which revealed alobar forebrain and dialated ventricles. Other visceras were normal externally and microscopically.

4.Satisfaction Level of Cancer Patients using Ramosetron and Ondansetron: A Comparative Study
Kauser Sayedda, Quazi Shahir Ahmed, Pankaj Kumar Verma, Deepak Chopra, Abdul Shaheer Umar
Background: To compare level of satisfaction of the patients receiving Ramosetron and ondansetron in prevention of acute and delayed nausea and vomiting associated with chemotherapy. Methods: 60 patients were recruited in the study and were allocated to two groups (Ondansetron and Ramosetron group). Patients were initially screened and then study visits included clinic visits on day 8, day 9 and day 14. Patient diaries were used to record patients’ satisfaction which was based on severity of nausea and vomiting using visual analogue scale (VAS). Results: VAS score was significantly lower in Ramosetron group as compared to Ondansetron group in acute phase of nausea and vomiting indicating level of satisfaction higher in Ramosetron group. Similarly, in delayed and overall phase Ramosetron group experienced lower range of scoring on VAS scale as compared to Ondansetron group. The difference was statistically significant (p<0.01). Conclusions: Level of overall satisfaction of the patients in Ramosetron group was significantly higher as compared to Ondansetron group in patients receiving the two drugs for prevention of nausea and vomiting caused by cisplatin chemotherapy in head and neck cancer patients.

5.The Incidence of Tuberculosis Among Children, Adolescents and Young Adults: An Observational, Hospital Based, Single-Center Study
Minali Raja, Tanvi Singh, Rashmi Singla, Shashi Upreti
Background: Historical data show that the risk of tuberculosis increases dramatically during adolescence, and young people face unique challenges in terms of case detection and effective treatment. However, little is known about the burden of tuberculosis among young people in the modern era. This study aimed to assess the regional incidence of tuberculosis among children, adolescents and young adults aged upto 40 years. Objective: This observational, hospital based, single-center study aimed to assess the incidence of tuberculosis among children, adolescents and young adults. Materials and Methods: This study was carried out in the Department of pathology, Himalayan Institute of Hospital trust, University, Swami Ram Nagar, Dehradun with 284 patients over a period of 12 months between March-2008 to March-2009. The data was entered; tabulated and statistical analysis was performed by using Statistical Package for the Social Sciences (SPSS 24.0) and Graph Pad Prism Version 5. A value of p<0.05 was considered significant. Result: In this study, the maximum cases 30.28% (n=86) were seen in the third decade followed by fourth decade 19.36 % (n=55). The youngest patient recored in our study was of only 2 years old while the oldest patient recored in our study was of 40 years old. Incidence of tuberculosis was highest in the third decade whereas lowest in 1st decade of life. In females, 04 cases each were recorded between 21-40 years for tuberculosis of the Female Genital Tract and Breast, whereas no cases were recorded between 0-20 years for tuberculosis of the Female Genital Tract and Breast. In males, 04 cases recorded between 11-30 years for tuberculosis of the Urogenital Tract, whereas no cases were recorded for 0-10 and 31-40 years for tuberculosis of the Urogenital Tract. Conclusion: The current study highlighted the agewise distribution of regional incidence of tuberculosis cases in the study patients.

6.Association of Serum Ferritin in Type 2 Diabetes Mellitus Patients- An Observational Study
Sarin S M, Sarosh Kumar K K, Binulal V Bhaskar, Balakrishnan Valliyot
Introduction: Serum ferritin and iron load are proposed to be having significant role in etiopathogenesis of type 2 diabetes mellitus. Our study intends to determine the association of serum ferritin levels in type 2 diabetics of South Indian origin. Methodology: Consecutive type 2 diabetic patients attending medicine op department of a tertiary care centre between the age group of 40 to 70 years are included in the study. The data regarding clinical history, physical investigation and relevant biochemical investigations including HbA1c, Serum Ferritin, Fasting blood sugars were collected of the study population using pre validated questionnaire. Results: 150 patients were studied with mean duration of diabetes of 6.69 ± 3.63 years were included in the study. Mean HbA1c and serum ferritin levels of study population were 8.84 ± 1.68 and 159.40 ± 84.72 respectively. HbA1c, fasting blood sugar and serum triglyceride values had statistically significant correction with serum ferritin levels whereas there was no significant correlation noted with duration of diabetes. A simple linear regression showed that patients’ average HbA1c level increased 0.01 % for every 1ng/ml rise in serum ferritin value. Conclusion: Study shows that serum ferritin is having strong correlation with HbA1c levels and is a good marker of overall diabetic control.

7.A Prospective Clinical Association of Glaucoma with Systemic Hypertension and its Effect on Visual Morbidity
Archana Kumari, Govind Kumar Mandal, Uma Shankar Singh
Aim: To evaluate the association between hypertension and occurrence of glaucoma. Methodology: A prospective study was conducted over a period of 1.5 years in the Department of Ophthalmology, JLNMCH, Bhagalpur, Bihar, India including 100 patients between the age groups of 30 to 70 years diagnosed with hypertension. Patients with other systemic diseases or vascular pathologies were excluded from the study. All the patients were followed up for at-least 6 months and the need for regular review visits was explained to them. During the first visit and each follow up opinions regarding the progress of hypertension was obtained from departments of cardiology and internal medicine. The oral hypertensive medication taken by patients were categorized into 5 groups as calcium channel blockers (CCB), diuretics, angiotensin converting enzyme inhibitors (ACE), angiotensin receptor blockers and beta blockers. A detailed history of age, sex, duration of hypertension, history of other co-morbidities and treatment were collected. The participants then underwent a detailed ophthalmological evaluation. IOP measurement was done by applanation tonometry with Goldman Applanation Tonometer. The same procedure was repeated in the other eye. Phasing technique of repeating recordings was done and the average IOP was used in the study. Visual field assessment was done using Humphrey’s Automated Perimeter. Results: Among the 100 hypertension patients involved in the study, 58% patients were found to have glaucoma. 52% patients were female, and 48% patients were male. Age group affected was 11% between 30-40 years, 14% between 41 to 50 years, 26% between 51 to 60 years and 49% between 61 to 70 years. 35.8% patients taking CCB, 44% taking ACE inhibitors, and 42.2% taking ARB, 60% taking beta blockers, and 42.8% taking diuretics had reduced IOP. The range of IOP in the treated population was between 10-16mmHg and this difference in those on hypertension medications was statistically significant. Conclusion: It can be concluded from this study that there is a correlation between higher systemic blood pressure and higher intraocular pressure, and this also produces effects to be regarded as risk factors for glaucoma.

8.A Prospective Cross–Study to Determine the Prevalence of Refractive Errors among the School Going Children in Bihar
Govind Kumar Mandal, Archana Kumari, Uma Shankar Singh
Aim: The objective of this study is to find out the prevalence of refractive errors among school children. Methodology: The study was conducted by the Department of Ophthalmology, JLNMCH, Bhagalpur, Bihar, India from a period of 1 year. There was a random selection of 500 children from eight schools of Bhagalpur, Bihar region aged 5-15 years studying in Class 1 to Class 10. All subjects were brought to the Outpatient Department of Ophthalmology at JLNMCH, Bihar. It was a prospective study, cross–sectional in design. Written informed consent was obtained from each study participant. Confidentiality was maintained at all levels of the study. Patients who were found to have ocular complaint and refractive error were referred for further investigations and management. Results: A total of 500 children participated in the study. Out of 500 children, 242 (48.4%) were boys and 258 (51.6%) were girls. The most frequently reported ocular problem was eye pain (24.6%) followed by watering from eye (23.6) while reading or watching TV/mobile (23.6%) and headache while reading (19.6%), Blackboard not seen properly (14.4%), difficulty in reading books (12.2%). Also, (5.6%) of the students reported difficulty in seeing at night. Overall, 19.6% children were suffering from refractive errors, out of which 9% were previously diagnosed and 10.6% were newly diagnosed. Conclusion: Refractive error among children is a common problem and needs to be assessed regularly for early intervention. The present study indicates that the school age represents high risk group for refractive errors. Screening of the children for vision at the time of school admission and periodical eye examination of the children is recommended for early rectification of impaired vision.

9.Prospective Case Control Assessment of the Maternal Fetal Outcome in Multiple versus Singleton Pregnancies Delivered PMCH, Patna, Bihar
Priyanka Shahi, Neena Agrawal, Geeta Sinha
Aim: To compare the maternal and fetal outcome in multiple versus singleton pregnancies in PMCH, Patna, Bihar. Material & Method: This was a prospective case control study between twin deliveries (cases) beyond 24 gestational weeks and demographically matched singleton deliveries (controls) immediately following those twin births, were carried out in the Department of Obstetrics and Gynecology, PMCH, Patna, Bihar, India from October 2021 to February 2022. Results: There were 2901 births during the study period, among them 60 were twin births, which were compared with 60 singleton births. Mean parity for twin and singleton deliveries were 3.7±1.8 and 1.88±0.8, mean gestational age were 37.8±3.7 weeks and 39.6±2.7 weeks respectively. Anemia complicated 5 times more often in twin pregnancies than singleton pregnancies (OR: 6.528, CI: 0.92-25.62), similarly hypertension complicated 3.2 times more often than controls (OR; 3.819, CI: 0.86-11.2). Conclusion: Despite improvement in antenatal and neonatal care, twins pose a higher threat to MCH outcome. Hence, thorough counselling, patient awareness, more vigilance at interpretation of antenatal tests, intrapartum monitoring and bridging the gap between demand and supply at NICU facility can improve maternal and neonatal outcome; as well as can help parents cope with the psychological stress.

10.Ectopic Pregnancy: Assessing the Incidence, Risk Factors, Clinical Characteristics, Diagnosis, Treatment, and Maternal Outcome in Tertiary Care Hospital
Anupam Kumar Chaurasia, Girija Kumari
Aim: The present study aims at determining the incidence, risk factors, clinical features, diagnosis, management and outcome of ectopic pregnancies. Methods: This prospective observational study was carried out in the Department of Obstetrics and Gynecology, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India in opd and ipd from April 2019 to February 2022 antinatal check-up. Total 120 cases were diagnosed with ectopic pregnancy. Results: The incidence of ectopic pregnancy (0.029%) or 2.9 per 1000 antinatal up to 20 weeks. The most common site of ectopic pregnancy was fallopian tube 102(89.17%). Ampulla was the commonest site 90 (75%) for ectopic implantation in the fallopian tube. Heterotopic pregnancy is rare where pregnancy is seen in the uterus and tube at the same time. In our study, there were 3 (2.5%) cases of heterotopic pregnancies. The most common risk factor was pelvic inflammatory disease 55(45.83%) followed by H/o previous abortion 25(20.83%) and H/o previous abdominopelvic surgery including tubal ligation, LSCS and appendicectomy 32(26.67%). In our study, 17(14.17 %) patients were using copper IUCD. 67.5% of the patients had bleeding or spotting per vaginum. Urine pregnancy test was positive in 113(94.17%) of patients. Culdocentesis was positive in 53(44.17%) of patients. Ultrasound was able to diagnose 99(82.5 %) of cases. USG findings suggestive of ectopic pregnancy were extra-uterine gestational sac 15(12.5%), haemoperitoneum 71(59.17%) and adnexal mass 91(75.83%). The incidence of ruptured ectopic pregnancy was 88%. 97.5% of the patients received one or more units of blood transfusion intra operatively and/or post operatively. All the patients with ectopic pregnancy were managed surgically. 95% patients underwent laparotomy and 5 % patients had laparoscopic treatment. 95% patients underwent unilateral or bilateral salpingectomy or salpingoophrectomy. Milking of tube was performed in 2.5% of patients. Concurrent dilatation and curettage were performed in the patients who had heterotopic pregnancy 3 (2.5%). There was no maternal mortality in the present study. Conclusion: Early diagnosis, timely referral, improved access to health care, aggressive management and improvement of blood bank facilities can reduce the maternal morbidity and mortality associated with ectopic pregnancy.

11.Analysis of Maternal Morbidity and Mortality in Hepatitis E Virus Infection in Pregnant Women
Shikha Jain, Shammi Kumar Jain, Preeti Nigotia, Gorav Jain
Aim: To analyses of maternal morbidity and mortality in hepatitis E virus infection in pregnant women. Method: A prospective study was conducted over a period of 1 year in a tertiary care hospital of Delhi. Total of 48 HEV positive patients confirmed by anti IgM test were included .Demographic profile along with antenatal and postnatal complications of patients were studied. Result: The mean age of women was 23.5year.The mean gestational age of women was 32 week. Mean gravidity was of the total 48 pregnant women; 38 delivered and 10 undelivered. Of these 35 was vaginal delivery (72.9%) (27 preterm, 08term) and 03 (6.25%) underwent caesarean section. Maternal morbidity were studied in terms of admission in intensive care unit 15 (31.25%) coagulopathy 04 (8.3%), postpartum haemorrhage 04 (8.3%), intrauterine growth retardation 03(6.25%), and sepsis 01(2.08%). Maternal mortality was occurred in 12 out of 48 cases (25%).While all 12 mortality reported in postnatal period, no mortality found in antenatal period. Most of postnatal death occurred due to hepatic encephalopathy (n=8) after 1 week of delivery. All these patients had hepatic encephalopathy at the time of admission. 34 babies were born alive, among them 20 (41.6%) were shifted to newborn intensive care unit (NICU). Conclusion: Maternal prognosis is poor in HEV positive patient particularly in postnatal period. HEV infection can be prevented by good sanitation measures while development of encephalopathy can be prevented by earlier and careful evaluation of mental status .By doing this we can reduce the burden of maternal mortality to some extent.

12.Comparison of two Suture Techniques on Postoperative Healing of third Molar: An Original Study
Bhupinder Kumar, Debasis Sahu, Sarada Challa, Praveena Adusumilli, Shiny Mounica Penumudi, Madhur Arora, Afroz Kalmee
Introduction: Minimizing post-operative complications following lower third molar surgery is a key component of patient care. Modification of the wound closure technique is one of these simple measures which have a crucial effect on the post-operative course, in patients undergoing lower third molar surgery. This study aims to determine which of the two secondary closure techniques assessed is superior in improving wound healing, and reducing post-operative complications, following lower third molar surgery. Material & Methods: A prospective, randomized clinical study was conducted to compare partial closure using one suture to the suture- less technique. Surgical sites were divided into two groups, Group A: one suture, and Group B: suture-less. Each patient received both treatments at the same time. During the first post-operative week, all patients were asked to daily assess pain, trismus & facial swelling using subjective self-assessment scales. Results: Our study showed that the age interval ranged from 20-40 years with an average age of 26.2 years. The results demonstrated that post- operative pain and wound healing are influenced by the type of the closure technique used by the surgeon. Conclusion: It can be concluded that that the placement of one suture, distal to the lower second molar, after raising a small buccal envelope flap for lower third molar surgery, is superior to the suture-less technique, in decreasing postoperative pain and enhancing wound healing.

13.Odontogenic Infection: A Review
Debasis Sahu, M. Martha Florence, Shiny Mounica Penumudi, Sarada Challa, Surapaneni keerthi Sai, Madhur Arora, Afroz Kalmee
Odontogenic infections are frequently seen in the dental practice, being dental caries its main etiology; therefore, dentists should be familiarized with its presentation and management as it can spread rapidly and have serious consequences. The purpose of this article is to provide essential knowledge on the pathogenesis, diagnosis, possible complications and treatment of odontogenic infections.

14.A Study of Anti-inflammatory Activity of Nigella Sativa in Experimental Models of Acute & Subacute Inflammation
Tripathi A, Mishra S, Bist A, Sayedda K, Ahmed QS, Chopra D, Gupta P
Aims and objectives: To evaluate antiinflammatory activity of Nigella sativa seeds in acute & sub-acute models of inflammation in rats & to compare it with control & indomethacin. Materials & Methods: Male wistar rats of weight 100-150 gram were used in the study. Ethanolic extract of N.sativa was used to evaluate antiinflammatory activity by carrageenan induced hind paw edema, kaolin induced paw edema & cotton pellet granuloma by oral gavage method. Institutional Ethical Committee approval was taken before start of study. Results: In model of acute inflammation i.e. carrageenan induced paw edema in rats, N sativa in graded doses & indomethacin exhibited antiinflammatory activity which was statistically significant as compared to control (p<0.05). Anti-inflammatory activity with 500 mg/kg & 1000 mg/kg Nigella sativa were not significantly different (p>0.05) to those of Indomethacin at all-time intervals tested. In kaolin induced paw edema, similar results were obtained as that of carrageenan induced paw edema. In cotton pellet granuloma method, N. sativa significantly decreased the formation of granuloma tissue as compared to control. There was a significant (P< 0.05) decrease in weight of cotton pellet at day 14 in all the groups treated with graded doses of N. sativa and Indomethacin in comparison to control group. Weight reduction of granuloma in N. sativa 1000mg was not significantly different (p>0.05) from Indomethacin group. Conclusion: The results suggest that N. sativa has significant anti-inflammatory activity that is comparable to that of indomethacin at 500mg/kg & 1000mg/kg.

15.Establishing Cephalometric Norms of Yen, W and Beta Angles with Evaluation of Sagittal Jaw Relationship in Guntur District Population: An Original Study
Sreelekha S, Debasis Sahu, Meesala Neeraja, Ramya Alla, Shaik Asma Sultana, Afroz Kalmee Syed
Aim: The purpose of this study was to assess the validity of the Yen, W, and Beta angles, as well as to compare them to other regularly used sagittal measurements in the South Indian population. Methodology: A total of 200 Andhra subjects (Dravidian) were considered for the study. ANB, Wit’s appraisal, Beta angle, W angle, and YEN angle were all traced on the lateral cephalograms. With the patient in Natural Head Position, sitting Condyle, and Passive Lips, a Lateral Cephalometric Head film was taken. The cephalograms were then traced by the same operator, resulting in the study’s Cephalometric database. The study’s final results were compared between males and females to ensure that they met acceptable standards. Results: There was no statistically significant difference between the genders. As a result, a single normative range for both genders might be provided. The findings suggest that all five skeletal cephalometric sagittal studies, namely the ANB angle Wit’s analysis, BETA angle, YEN angle, and W angle, are reliable and may be utilized in diverse populations without producing significant differences in the results. Conclusion: Based on the findings of this study, no statistically significant differences in any of the parameters were discovered between the subjects of the Local population, as well as between males and females. ANB angle, Wit’s analysis, BETA angle, YEN angle, and W angle can be employed based on the above assertion because they are dependable.

16.Assessment of Enamel Colour Variations using Different Orthodontic Adhesives: An in Vitro Study
Meesala Neeraja, Debasis Sahu, Sreelekha S, Ramya Alla, Afroz Kalmee Syed, Praveena Adusumilli
Introduction: Aesthetics is a crucial aspect of orthodontics, and color is a big part of it. The irreversible penetration of resin tags into the enamel structure at depths of up to 50 meters may cause enamel color changes. The goal of this study was to analyze enamel color changes in an in vitro investigation utilizing various orthodontic adhesives. Methodology: Forty removed human premolar teeth were collected and they were divided into four equal groups and compared for color variation caused by photo aging for the various bonding agents. ANOVA and Post hoc analysis were used to compare significance. Results: We observed a significant change in there was a significant variation in the E1 between the TRANSBOND XT, ORMCO, RELY A BOND, and BRACEPASTE. However there was no variation for the E2 and E3 between the groups. Conclusion: After debonding and finishing, Ormco Enlight demonstrated the maximum enamel color change of E2 value 2.92. Rely A bond with an E2 value of 2.80 had the least enamel color change. There is a considerable color shift in the enamel in all of the groups investigated, however it is less than the minimum threshold value of E 3.7 units.

17.To Assess the Role of to Cilizumab with or without Remdesivir in Covid-19 Diabetic Patients
Monika Gaur, Sujeet Kumar Jangid, Shefali Mehta, Ronak Jain, Aditi Mehta, Vishwa Mehta
Background: The clinical presentation of Covid-19 positive person can range from asymptomatic to severe pneumonia with acute respiratory diseases. The major impact of Covid-19 is identified on respiratory system of the human and leading to death. There are different types of treatment options available for managing the health of the people but first was remdesivir that approved by the FDA. The dexamethasone has been associated with decreased mortality in recovery of the medicine trail. Apart from this, the major benefits of interleukin 6 antagonists are still subject of debate as tocilizumab FDA approved the interleukin 6 for treatment considering the side effects too. Aim: The study aims to assess the role of tocilizumab with or without remdesivir in COVID-19 diabetic patients. Method: The current study is retrospective, single centered, observational cohort and based on the patients who were diagnosed with Covid-19 considering the PCR test and hospitalized at ESI Chitrakoot Nagar, Udaipur under RNT Medical College, Udaipur from October-20 to December-21. The study has involved the patients who were 18 years and older and had the clinical association with diabetes mellitus. Moreover, the respiratory findings also defined as infiltrates, SPO2 < 93% on room air and requirements of respiratory assistance. For the current study, the data was collected related to demographics, co-morbidities, symptom, oxygen support category, laboratory values and outcome of the therapies. The level of oxygen support was analyzed considering the ACTT-1. Results: There were total of 127 patients considered for analyzing the role of tocilizumab with or without remdesivir in COVID-19 diabetic patients. The group 1 is involving the 54 patients and group 2 has 73 covid-19 patients. According to the outcome of the analysis, the mean age of both groups were 62 and 64 years for group 1 and 2. There was significant difference identified for respiratory support received by the patients and obesity, COPD and CVD. However, there was no significant difference found for diabetes patients as the P value was more than 0.05. As per the outcome of the study focusing on the Chi Square, most of the variables have shown significant difference but Remdesivir, and low vitamin D levels have shown the no significant difference. Conclusion: From the analysis, it has been concluded that the combinations of tocilizumab and remdesivir did not have any significant difference in mortality but the patients who recovered from the covid-19 has influenced with diabetic issues. The improvement in practice and advancement in laboratory trail has helped to improve the effectiveness of these treatment options.

18.Comparative Study of Fixation versus Conservative Treatment of Posterior Malleolar Fragment in Ankle Fractures
Deependra Sonkar, Akhil Bansal, Shubham Chourasiya, Brajesh Meher, Suneet Tandon
Background: Ankle fracture involving posterior malleolus, whether to fix it or not has always been a subject of controversy for a long time. Aim of this study was to compare the outcomes of fixation vs conservative treatment of trimalleolar ankle fractures. Material and Method: A total of 30 patient with ankle fracture were taken into study. In group I Posterior malleolus fracture was fixed by means of screw or plate in 18 patients  along with medial and lateral malleolus while in group II posterior malleolus fracture was left unfixed in 12 patients .In addition to reduction quality at fracture site, pain and range of motion at ankle joint was assessed in each follow up. Results: The mean follow up was 12 month. Ankle pain and motion was assessed according to Olerud and Molander scoring system. The score was found significantly higher in group I. Conclusion:  Fixation of posterior malleolus restores the articular surface and helps in maintaining the congruity of tibial plafond. These results suggested that posterior malleolar fracture fixation has better functional and radiological outcome in an ankle fracture.

19.Study of Spinal Cord Injury in Tertiary Care Hospital of Bhopal City
Anupam Surendran, Devendra Chaudhary, A P Sharath, Sudhir Singh
Objectives: To evaluate outcome and prognosis of spinal cord injury in patients admitted in Tertiary care hospital of Bhopal from July 2019 to June 2021. Methods: Consecutive Spinal cord injury cases admitted from July 2019 to June 2021 were evaluated on a preformed proforma for demographic factors, epidemiological data and neurological status. Exclusion criterion – Patient admitted after 15 days of injury, Patient operated outside and Patients sustaining spinal column injury without cord involvement or with nerve root injury. Results: In 140 cases of Spinal cord injury, 73 were cervical and 67 had thoracolumbar injuries, with male to female ratio of 3.8:1 and 71% in the age group of 20–49 years. Around 79% patients were from rural background. Among the causes of injury, 53% patients had a road traffic accident and 28% had fall from height. Fall of heavy object overhead and back (10.7%), fall with heavy object overhead (3.0%) and fall following electric shock (4.0%) were uncommon causes. Complete paralysis was found in 20.5% cervical and 23.3% in thoracic injuries. Extremity and rib fractures (10.6%) and head injuries (7.2%) were common associated injuries. About 55% cases were initially attended at non-specialized centers. Conclusion: The present study found no significant difference in the length of stay and degree of neurological recovery between the patients treated by non-operative and operative methods. Therefore, the value of surgery in the management of spinal cord injury remains undefined and must await the performance of a rigorously controlled, randomized, prospective study.

20.A Study of Complications after Ileostomy Reversal in a Tertiary Care Center
Sulaksh Mittal, Sudhir Singh, Kunal Vaidya, Devendra Choudhary
Background: Closure of a loop ileostomy or colostomy is relatively a simple procedure although many studies have demonstrated high morbidity rates following it. Methods to reduce number of complications are investigated. The aim of this study to determine complications after ileostomy closure. Objectives: To study the incidence of complications of ileostomy reversal and also the potential risk factors leading to complications after ileostomy reversal. Study design: Prospective cohort study. Methods: Data from 108 patients who underwent closure of stoma from December 2019 to August 2021 at Hamidiya Hospital, Bhopal (MP) were collected including demographics, causes of ileostomy formation, additional diseases, time from creation to closure of stoma, duration of operation, postop complications and duration of stay after surgery. Results: Complications occurred in 55 patients at different follow up periods in total 108 patients undergoing stoma reversal of variable age. 25% (n = 14) of patients had surgical site infection, malnourishment 7.4% (n=8), incisional hernia 6.5% (n=7), diarrhoea 5.6% (n=6), bowel obstruction 4.6% (n=5), anastomotic leak 0.9% (n=1). Most common potential risk factors after complications were low Hb, critical status of the patient, sunken stoma and comorbidities. 2 patients died (1.8%). Conclusion: Meticulous care and attention to advanced techniques and methods, post operative education regarding stoma care and its resumption and multidisciplinary follow ups reduces post op stoma creation or closure complications.

21.A Study to Evaluate Hypercoagulable State in Patients of Chronic Obstructive Pulmonary Disease
Shivani Chaturvedi, Vishwas Gupta, Vikas Kumar Mishra, R.S. Chatterjee, Sourabh Jain
COPD is a multisystem disorder associated with pulmonary and systemic inflammation. This systemic inflammation contributes to various extra pulmonary manifestations of COPD. Exacerbations are associated with increased airways inflammation. In this study we studied prothrombotic state in COPD patients by analysing fibrinogen and D dimer levels. Aim and Objectives: To study the prothrombotic markers plasma D-dimer and fibrinogen levels in stable COPD patients and during exacerbation and to compare the above parameters during exacerbations of COPD on day 1 and after stabilization, and its significance if any. Material and Method: 30 patients with COPD exacerbation were studied. Blood samples were obtained for fibrinogen and D-dimer levels  on two different occasion-on day 1 of admission and at follow up when clinically stable after day 5 in exacerbation group and on entry of study in stable COPD group. Data were compared in both groups. Statistical testing was conducted with the statistical package for the social science system version SPSS 17.0. Result: Most patients fall into the age group 41-70 year corresponding to the peak age group of COPD population. The sex distribution is study is 47 were male (78%) and 13 female (22%). All patients were smoker. The smoking mean was found to be 25±5.9 pack years. , the mean value of fibrinogen in COPD exacerbation group was 491±225mg% which declined to 267±89mg% after stabilization. In stable COPD group, the mean value of fibrinogen was 426.86±144.0mg%. In conclusion, we have demonstrated in the study the presence of a hypercoagulable state in COPD patients. However, the present study has the limitation of small sample size. Further studies are needed to identify the exact mechanisms underlying the hypercoagulative state in COPD, and to determine whether anticoagulant therapy is clinically useful in COPD.

22.A Clinico Histopathological Study to Identify Non Diabetic Renal Disease in PTS of Type 2 DM with Renal Involvement
Lavanya Mandli, Shamsheer Khan, SS Rama Kalyana Praveen
Background: Both diabetic nephropathy (DN) and nondiabetic renal disease (NDRD) are reported to occur in patients with type 2 diabetes mellitus (DM). The precise diagnosis of the type of nephropathy has obvious clinical, therapeutic and prognostic implication. Aim: The aim of our study was to find out the frequency of nondiabetic kidney diseases in patients of type 2 DM with renal involvement. Methodology: Sixty-five type 2 diabetic patients with renal involvement were included in the study.  Percutaneous renal biopsy was carried in these sixty-five patients after informed consent. Results: There was a preponderance of males (66.2%) and majority of the patients were in the age group of 41-60 years. Duration of diabetes ranged between 3 months to 30 years. The indications for renal biopsy were nephrotic syndrome 35 (53.8%), 8(12.3%) rapidly worsening renal functions,7(10.7%) significant renal failure with normal or insignificant proteinuria at presentation,5 (7.6%) microscopic haematuria, 10(15.3%) proteinuria in the absence of diabetic retinopathy. Renal biopsy in 65 cases revealed: isolated diabetic nephropathy   in 44(67.7%), NDRD in 7(10.8%) and 12(18.5%) patients had NDRD superimposed on diabetic nephropathy. Nondiabetic glomerular disease in our patients include Membranous glomerulonephritis, IgA Nephropathy, Endocapillary Glomerulonephritis. Interstitial Nephritis and Acute tubular injury are predominant tubulointerstial lesion in this study. Conclusion: This study demonstrates presence of both glomerular and tubulointerstitial lesions unrelated to diabetes (NDRD) in type 2 diabetic patients with renal involvement.

23.Comparative Study of Fentanyl and Fentanyl Plus Lidocaine on Attenuation of Hemodynamic Responses to Tracheal Intubation in Controlled Hypertensive Patients Undergoing General Anaesthesia
Bheem Raj Singhvi, Dilip Kumar, Hans Raj Charan
Aim: Comparative analysis of fentanyl and fentanyl plus lidocaine on attenuation of hemodynamic responses to tracheal intubation in controlled hypertensive patients undergoing general anaesthesia. Methodology: This prospective randomized observational study was conducted in the Department of Anaesthesiology, Govt. Medical College, Barmer from Jan-2021 to Dec-2021 at Rajasthan after getting approval from ethical committee 90 patients aged between 30 years to 60 years of either sex belonging to ASA class II (controlled hypertensives) posted for various elective surgeries under general anesthesia at our institute were randomly selected for the study. Study population (90 patients) were randomly divided by computer generated numbers into 3 groups with 30 patients in each group. Group A: will receive Inj Fentanyl 2 µg/kg before induction. Group B: will receive Inj. Fentanyl 2µg/kg plus inj Lignocaine 1.5mg/kg before induction. Group C: will receive normal saline before induction. Results: We found that our study suggests that combination of fentanyl and lignocaine provides more significant attenuation of heart rate, MAP, controls more effectively rise in SBP and DBP than fentanyl alone after laryngoscopy and tracheal intubation. No clinically relevant side effects were observed in all three groups. Conclusion: Fentanyl and combination of Fentanyl and lignocaine, both effectively decreased hemodynamic response to tracheal intubation. However, neither fentanyl nor fentanyl plus lignocaine could inhibit all hemodynamic responses. Fentanyl plus lignocaine was more effective in attenuating hemodynamic responses than fentanyl alone.

24.Clinical Study of Headache in Relation to Sinusitis and its Management
Ritesh Nandwani
Aim: To study relation of headache with sinusitis and its management. Methodology: Patients clinically presenting with headache were selected. Only patients with headache due to rhinogenic causes were subjected to X-ray paranasal sinuses and diagnostic nasal endoscopy and followed-up to evaluate management. Results: Majority of the patients were of age group 21-30 years, and it is more predominant in males. Majority of the patients of headache were having DNS (56.5%), acute sinusitis (34.5%) and few numbers of patients had nasal polyp (10%). Majority of the patients who underwent antral washout were not relieved, so they underwent functional endoscopic sinus surgery, which gave dramatic results in improving symptoms of patients including headache. Conclusion: To know whether the headache is sinogenic or not; firstly the patient is clinically assessed, then radiological investigations (X-ray PNS) are done. Role of FESS is huge and ultimately it is the cure for the headache due to rhinogenic causes.

25.A Comparative Study on the Effect of Isometric Hand Grip Exercise in Normotensive Offspring of Normotensive Vs Hypertensive Parents Assessed in Terms of Rate Pressure Product and Pulse Pressure
Nidhi Gupta, Kapil Gupta, Sanjay Kumar Singhal, Abhishek Saini
Introduction: Rate pressure product (RPP) is a valuable marker of cardiac function and is expressed as a product of Heart Rate (HR) and Systolic Blood Pressure (SBP) (HR*SBP/1000). Pulse Pressure (PP) is the difference between systolic and diastolic blood pressure and depends on the interplay between cardiac output and peripheral resistance. Aim: RPP and PP responses to isometric hand grip exercise (IHG) were measured and compared among offspring of normotensive and hypertensive parents to reveal the differential change in patterns of these parameters so as to objectively unearth the predisposition towards development of hypertension at a later age. Material and methods: The present study was a case control study wherein two groups namely, “Cases” and “Controls” were formed comprising 45 subjects in each, on the basis of presence or absence of hypertension in parents, respectively. While forming the groups, age, gender and Body mass index (BMI) matching was ascertained resulting in recruitment of 27 males and 18 females in each group. HR, SBP and diastolic blood pressure (DBP) were recorded at baseline, 4 minutes after starting IHG exercise (“during IHG”) and 5 minutes after the end of IHG exercise (at “5-minute post IHG”). RPP and PP were calculated secondarily from the so obtained primary parameters. Statistical analysis was performed using Paired and Unpaired t-test while comparing among same group and between the groups respectively. Results: The groups so formed, were comparable with respect to BMI. RPP and HR were found to be significantly higher in male cases in comparison to male controls in basal stage with a p value of ≤0.001. Significant increase in RPP, HR, SBP and DBP occurs in both cases and controls (in both males and females) during IHG exercise and remained significantly elevated post 5 minutes of IHG exercise only in cases (p≤0.001). No significant difference was observed in the basal PP between cases and controls (across both genders). During IHG no significant difference in PP was observed in control subjects (both male and female) as well as in male subjects enrolled under case group. However, statistically significant change in PP was observed in female subjects constituting case group during IHG exercise (p≤0.01). Both male and female subjects enrolled under the case group demonstrated statistically significant change in PP after IHG exercise (p≤0.01). Conclusion: RPP and PP are promising markers for assessment of autonomic reactivity and can serve as objective tools for deciphering the propensity of development of hypertension in normotensive individuals later in life.

26.Effectiveness of Submucosal Resection and Septoplasty in Deviated Nasal Septum: A Study from Vindhya Region
Yasmeen Siddiqui, Arshi Ishteyaq, Irfan Ahmad Siddiqui, Neelofar Shaikh
Background:  Deviated nasal septum is a commonly faced challenging surgical morbidity in outpatient’s department of otorhinolaryngologist now days. Different surgical modalities have been accepted by surgeons to treat this condition based on their clinical decision. Aims and objectives: To study submucosal resection and septoplasty to evaluate its effectiveness by comparing clinical outcome and complications. Material and methods: Eighty patients with deviated nasal septum were studied. Baseline laboratory and clinical investigations were done to rule out the other conditions. Deviated nasal septum and its type were identified by anterior rhinoscopy. Type of surgical procedure was accepted based on type of deviation. Results: Out of 80 patients 40 patients had SMR and 40 underwent septoplasty. In our study, all the 73 patients had presented with nasal obstruction (91%) followed by headache (48%), nasal discharge (22%). On endoscopy, C-shaped deviation was present in (74%) followed by S-shaped deviated nasal septum (19%), spur (9%). Post operative nasal obstruction relief was seen in 80% patients. In our study, postoperative anterior rhinoscopy and diagnostic endoscopy findings show reduced fogging (5%) and persistent septal deviation (5%). In our present study complications seen in both the group includes excessive bleeding (9%), crust formation (6%), synechiae (9%), septal haematoma (4%), septal perforation (2%), residual deviation (5%), secondary atrophic rhinitis (1%). Conclusion: Based upon analysis of data of our study we concluded that females are more affected in third decade of life to deviated nasal septum than male with the most common presenting symptoms of nasal obstruction. C-shaped deviation is a more common form of septum deviation. Both surgical modalities have similar post-surgical pain relief but after sub mucosal resection patients may have higher chances of having complications.

27.A Comparative Study between Dexmedetomidine and Fentanyl as Adjuvant with Epidural Levobupivacaine in Abdominal Hysterectomy
Anirban Kundu, Suchismita Pal, Souvik Saha, Sudipa Mandal
Background: Objective of this study was to compare epidural dexmedetomidine or fentanyl with levobupivacaine in terms of onset of sensory block, peak height of sensory block, duration of analgesia, Onset, and duration of motor block, intra operative haemodynamic stability, surgeon’s satisfaction regarding operating condition by VAS scale and untoward side effects. Methods: After the approval of the Institutional Ethics Committee this randomized, parallel group, double-blind controlled study was carried out under the Department of Anaesthesiology of a tertiary care centre in north India. Results: Dexmedetomidine (50µg) is better adjuvant that fentanyl (50µg) in terms early onset of sensory and motor block. Dexmedetomidine provides longer duration of sensory and motor block than fentanyl. Both are comparable regarding maximum level of sensory block. Regarding haemodynamic parameter (Mean BP, Heart rate) and adverse effect (bradycardia, hypotension, nausea & vomiting, pruritus) dexmedetomidine is better alternative than fentanyl, though it cause more decrease of heartrate. Dexmedetomidine provides more satisfaction among surgeon than fentanyl. Conclusions: Therefore, epidural dexmedetomidine is a feasible, safe, and more reliable adjuvant with levobupivacaine (0.5%) to provide smooth anaesthesia and analgesia with higher satisfaction to surgeon than epidural fentanyl in abdominal hysterectomy.

28.Efficacy of Oscillating Positive Expiratory Pressure (OPEP) Therapy in Patients with Bronchiectasis – A Prospective Study
Chandrasekar S., Mohamed Musthafa A., Laila K.V., Rajagopal T. P.
Background: A characteristic feature in bronchiectasis is the impairment in clearance of secretions leading to frequent colonization and recurrent infection with various pathogenic organisms. This results in a vicious cycle of purulent secretions, bronchial damage, bronchial dilation, and further impairment. Chest physiotherapy (CPT) with postural drainage is the standard treatment for mobilization and removal of airway secretions. Airway clearance can be augmented by use of devices such as oscillating positive expiratory pressure (OPEP) devices which combines positive expiratory pressure therapy with high frequency oscillations within the airways. Objectives: To study the efficacy of Oscillating Positive Expiratory Pressure (OPEP) Therapy compared with Conventional Chest Physiotherapy (CCPT) in patients with bronchiectasis in reducing exacerbations, improving lung functions, quality of daily life activity and healthy status. Methods: A Prospective cohort clinical study conducted in patients with bronchiectasis in a tertiary care setting for a period between February 2018 and July 2019.A total of 130 patients were randomized into two groups to receive either Oscillating Positive Expiratory Pressure (OPEP) therapy using Acapella device or conventional chest physiotherapy in addition to regular pharmacotherapy. All patients were reassessed every 2 months. FEV1 was measured at the beginning of study, 4th month and at the end. Comfort, well-being and adherence were assessed in the two study groups using a 5-point Likert scale at the end of the study. The Statistical software SPSS 22.0, and R environment ver.3.2.2 were used for the analysis of the data. Results: The number of exacerbations was significantly less in OPEP group compared to CCPT group and the onset of exacerbations was later in the former group. Health related quality of life, comfort and wellbeing showed improvement in OPEP group. Conclusion: The relatively lower exacerbation rates and their later onset, improvement in health-related quality of life, comfort and wellbeing in patients performing OPEP therapy compared with CCPT supports the use of OPEP therapy for airway clearance than other conventional airway clearance techniques in patients with Bronchiectasis.

29.Spectrum of Histopathological Changes in Ischemic Heart Disease: An Autopsy Study
Rashmi Gupta, Sujata Singh, Superna Ganguly, Krati Agrawal
Background: cardiovascular disease comprising of mostly ischemic heart disease and stroke are leading cause of death worldwide. WHO estimates that India accounts for just over a fifth of these deaths. A thorough autopsy under expert supervision and histomorphological examination of heart plays an essential part to confirm the cause of death. Aims and objectives: This study was conducted to study the spectrum of histopathological changes in ischemic heart disease. Material and methods: A retrospective study of 252 cases of formalin fixed heart specimen was undertaken in the Department of Pathology, Chhattisgarh Institute of Medical Sciences, Bilaspur, Chhattisgarh. Out of 252 specimen, 32 specimen of heart showed autolytic changes and hence their histomorphological findings were not included in the study. A detailed gross and microscopic examination was performed, and findings were correlated with available clinical data to establish the cause of death. Result: Atherosclerosis was the most common lesion found in 124 cases (64%) followed by medial hypertrophy in 56 cases (28%) and intimal hyperplasia in 46 cases (23%). Other frequent findings were disruption of myocardial architecture 44 cases (22%) and patchy interstitial fibrosis 47 cases (23.5%). Also seen was presence of collateral formation in 39 cases (19.5%) and recanalization in 22 cases (11%). Microthrombi in circulation was seen in 27 cases (13.5%). These cases could have been the undiagnosed covid patients. Fibromuscular dysplasia was seen in 12 cases (6%) and thickening of pericardial fat in 10 cases (5%). Fibrous cap formation was seen in 7 cases (3.5%) and transmural inflammation in 12 cases (6%). Other less common findings were presence of Lines of Zhan in 7 cases (3.5%), Giant cell arteritis in 2 cases (1%) and dissection of aorta in 2 cases (1%). Conclusion: Atherosclerosis was found out to be the most common lesion responsible for causing mortality.

30.Influence of Epidural Analgesia on Pain Relief, Progression of Labour and Neonatal Outcome: A Comparative Study
Nikita Bagdi Kapoor, Manisha Bagdi
Introduction: Developed nations have shown an increase in the use of painless labour techniques with the most commonly use of epidural Ropivacaine with Fentanyl as an adjuvant. Several research have showed minimal side effects & no increase in the incidence of cesarean sections. However, in developing nations the use of labour analgesia is minimal, claiming doubts on its efficacy and risks associated. Thus, this comparative study was undertaken to evaluate the influence of epidural analgesia on pain relief, progression of labour, neonatal outcome & overall patient satisfaction. Material & Methods: 90 nulliparous parturients with established labour, age 20-35 y, body weight < 80 kg, at least 36 completed wk of gestation (confirmed by ultrasound), single fetus in vertex presentation, cervical dilatation > 4 cm were included in the study. Epidural group-Participants were administered 0.25% Ropivacaine and 50μg fentanyl (n=45), Control Grou-Did not receive any anaesthesia(n=45). Both the groups were assessed for Duration of labour, Number of vaginal, instrumental vaginal delivery & caesarean sections, neonatal outcome, VAS Pain scores & overall patient satisfaction. Result: Both the groups were comparable with respect to demographic variables. In epidural group, mean duration of first stage of labour was statistically significantly shorter as compared to control group(p<0.05). The Epidural group showed statistically significantly prolongation of second stage of labour (p<0.05). There was no statistically significantly difference in the number of vaginal deliveries, instrumental deliveries or C section in both the groups (p >0.05). No difference in APGAR scores were observed between groups. Conclusion: Increased pain relief & patient satisfaction observed with no increase in incidences of instrumental vaginal delivery or cesarean section and similar neonatal outcomes observed with epidural analgesia. With advancements in technology , patient awareness & continued medical education the labour analgesia would prove to be a boon to alleviate the pain of delivery in developing nations.

31.A Study of Seroprevalence of  Hepatitis B, Hepatitis C and Human Immunodeficiency Virus among Pregnant Women Attending Antenatal Care Clinic of a Tertiary Care Hospital in Jaipur, Rajasthan
Anil Yadav, Manju Yadav, Ashok Kumar Yadav, Rameshwari Bithu, R.K. Maheshwari, Bharti Malhotra
Introduction: Hepatitis B Virus, Hepatitis C Virus and Human Immune -Deficiency Virus by vertical transmission are major public health problem during pregnancy as associated with high risk of maternal complications. This study aimed to estimate the seroprevalence of HBV, HCV and HIV infection and their co-occurence in antenatal screening at tertiary care hospital, Jaipur. Material and methods: This study was conducted in Department of Microbiology, Sawai Man Singh Medical College, Jaipur. 364 Pregnant females attending ANC in Obstetrics and Gynecology Department of SMS Medical College, Jaipur over a period of one year from May 2020 to April 2021 .  All the serum samples were screened for HBV, HCV and HIV. Results: In this one year study a total 364 serum samples were analysed for HBV, HCV and HIV. Seroprevalence were observed that 7 positives for HBV (1.92%), 1 was positive HCV (0.27%) and 1 was positive for HIV (0.27%). Conclusion: Pregnant women visiting ANC clinic of SMS Hospital should be screened for HBV, HCV and HIV treated necessary to reduce their viral loads and their children vaccinated at birth with the single dose hepatitis B vaccine to break the cycle of mother to child transmission.

32.Assessment of Infraorbital Levobupivacaine vs. Ropivacaine in Post Operative Analgesia Following Cleft Palate Surgery
Aastha Jindal, G. Prasanna Kumar, Pinu Ranawat
Background: Ropivacaine and levobupivacaine have been used for the peripheral block in children for surgical pain. The present study is aimed to compare the effectiveness of 0.375% levobupivacaine and 0.375% ropivacaine in the infraorbital block for cleft palate surgery. Methods: Eighty patients between the age group of 2–12 years planned for elective surgery for cleft palate were included in the study. The solution for Group L was a mixture of 0.375% levobupivacaine and the solution for Group R was a mixture of 0.375% ropivacaine. Infraorbital nerve blocks were conducted by landmark-guided technique. We used the Verbal Rating Scale (VRS) to assess the postoperative pain. Results: There was a statistically significant difference in the time interval until the first request for pain medication was made by the participants in the two groups. There were differences in pain scores calculated at regular intervals after surgery comparing the two groups. There were differences in the need for rescue analgesics comparing the two groups. Conclusion: The analgesic effects of levobupivacaine are statistically better than ropivacaine in the infraorbital block in children who underwent cleft palate surgery.

33.A Comparative Study of Intravenous Dexmedetomidine and Intravenous Tramadol for Post Spinal Anaesthesia Shivering
Dilip Kumar, Bheem Raj Singhvi, Hans Raj Charan
Introduction: Shivering is a natural protective phenomenon. The main causes of intra/post-operative shivering are temperature loss, increased sympathetic tone, pain, and systemic release of pyrogens. Spinal anaesthesia significantly impairs the thermoregulation system by inhibiting tonic vasoconstriction, which plays a significant role in temperature regulation. Several drugs have been studied for the prophylaxis as well as treatment of shivering. Tramadol, an opioid receptor agonist, has also proved to be effective in the treatment of shivering after general anesthesia, On the other hand Dexmedetomidine, a congener of clonidine, has been used as a sedative agent and is known to reduce the shivering threshold. The aim of the study was to compare the efficacy of dexmedetomidine and tramadol in the treatment of post-spinal anesthesia shivering as well as their side-effect profile. Materials and methods: The present study was conducted in the Department of Anaesthesiology, Govt. Medical College, Barmer from oct-2021 to march-2022 at Rajasthan after getting approval from ethical committee. This is a Prospective Randomized Comparative Study. Patients aged 18-65 years, American Society of Anesthesiologists I & II and scheduled to undergo elective surgeries under spinal anesthesia and developing shivering grade 3 or grade 4 were included in the study. We made two groups of cases i.e., Group T (TRAMADOL) and Group D (DEXMEDETOMIDINE). sample size was 64, which was divided into two groups of 32 each. Standard protocol followed to administering spinal anaesthesia. On occurrence of shivering its intensity graded using a four-point scale as per Wrench. All data were collected and analysed with the help of suitable statistical parameters. Results: Our study results in that dexmedetomidine are more effective in the treatment than tramadol for treatment of postspinal anaesthesia shivering.

34.Comparative Study of BIS Values Required for Insertion of Proseal Laryngeal Mask Airway or Endotracheal Intubation in Paediatric Patients Undergoing Sevoflurane Anaesthesia
Bheemraj Singhvi, Bhupendra Rathore, Hans Raj Charan
Aim: The aim of present study is comparison of BIS values required for insertion of proseal laryngeal mask airway or endotracheal intubation in paediatric patients undergoing sevoflurane anaesthesia. Methodology: This prospective randomized observational study was conducted in the Department of Anaesthesiology, from Aug-21 to Feb-22 at Government Medical College, Kota after getting approval from ethical committee. children between 2 and 14 years of ASA I and II and they were randomly allocated to Group P (proseal laryngeal mask airway insertion) and Group TI (tracheal intubation) scheduled for elective surgical procedure requiring general anaesthesia. This study was conducted on 60 patients who were randomly divided into 2 groups of 30 patients each. Results: BIS score decreased in both the groups during induction period BIS score was significantly higher 1 min after Endotracheal intubation as compared to 1 min post LMA insertion, and the difference was statistically significant. BIS score required for insertion of LMA ranges from 55-60 whereas slight deeper levels of anaesthesia of BIS range between 50-55 are required for endotracheal intubation. No clinically relevant side effects were observed in both groups. Conclusion: LMA is a better option than endotracheal intubation for short surgical procedures requiring general anaesthesia in terms of less requirement of inhalational agent, lesser induction times and BIS score is concerened.

35.Comparative Evaluation of the Treatment Planning According to the Figo Staging and MRI Staging Classification in Carcinoma Cervix
Shubhkirti Agrawal, Rahil Kumar Sharma, Aarti Sharma
Background: Cervical cancer is a major public health problem for women. Accurate staging may lead to proper management of cervical cancer. Methodology: We retrospectively reviewed all patients from 1st June 2015 to 31st March 2017 with cervical cancer who underwent pre-treatment MRI and analyzed the correlation between the FIGO clinical staging and MRI staging. Results: Correlation of overall clinical and MRI staging by percent agreement is moderate (73.9%), but the kappa coefficient showed a slight correlation. The correlation of clinical and MRI findings in the vaginal invasion, pelvic sidewall invasion, adjacent pelvic organ invasion, and spreading to distant organ also showed moderate-to-strong correlation by percent agreement (ranging from 67.6 to 91.9%) but slight correlation between clinical and MRI examinations by kappa or weighted kappa coefficient (K = 0.000–0.128w). Conclusion: In patients with cervical cancer, pretreatment MRI provides higher spatial soft tissue resolution which can define pelvic tumor extent, including a more accurate assessment of tumor size (due to multiplanar evaluation), parametrial invasion, pelvic sidewall invasion, and adjacent pelvic organ invasion. This could potentially lead to a reduction in staging morbidity by invasive investigation such as cystoscopy and proctoscopy.

36.Study of Functional Outcome of Arthroscopic ACL Reconstruction by Various Grafts
Abhishek Pathak, Deependra Sonkar, Shailandra Pandey, Himanshu Patel, Mohammad Zuber
Introduction: Anterior knee instability associated with rupture of the ACL is a disabling clinical problem. The ACL has a poor capacity for intrinsic repair. Thus, ligament reconstruction as a means of stabilizing the tibio-femoral joint and restoring high level function of the knee joint becomes destined. Therefore, present study was aimed to study the functional outcome of arthroscopic ACL reconstruction by various grafts. Materials and methods: The present Study was carried out in patients coming to a tertiary care hospital considering a total of 24 patients. Arthroscopically assisted Anterior Cruciate Ligament Reconstruction surgery was performed in patients concluding inclusion criteria. ACL repair was done by Bone patellar tendon bone (BTBP), hamstrings and Peroneus grafts were used as and when required. Results: In present study patients average age was 29.8± 7.6 years with 3 females and 21 males. Considering the mode of injury majority patients were having sports playing. Considering the mechanism of injury most of the patients reported the “valgus” posture to be the mode of injury to the knee joint. Majority of the patients were treated using hamstring and peroneus grafts (41.7%). During pre-operative evaluation, majority of the patients showed grade 3 results upon Lachman test. During post-operative evaluation, majority of the patients were observed to be at grade 0 on Lachman evaluation similar results were observed by Lysholm scoring. Conclusion:  We found that all three methods had shown equal potential however, majority of the patients were benefited by hamstring and peroneus grafts with optimistic Lachman and Lysholm scorings.

37.Approach to Wound Bed Preparation in Superficial Soft Tissue Infections: A Comparative Study of Methods of Debridement
Arun Kumar Pargi, Ajay Gangji
Introduction: Venous ulcers (additionally called varicose or venous stasis ulcers) are a chronic, ordinary and debilitating situation that impacts up to at least one% of the populace. The science of wound bed preparation is evolving at a pace faster than ever as advances in molecular techniques are bringing out the pathophysiology of wound healing in a better light. Today’s surgeons have an overwhelming choice of newer techniques to assist wound bed preparation from use of recombinant growth factors and genetically engineered tissues to hyperbaric oxygenation. Translating these new principles into everyday practice remains a long way off and one must not forget the importance of assessment of various local and systemic factors that may impair healing. Results: This study involves selecting hundred suffering from acute or chronic wounds, randomly distributing them to the following groups irrespective of age, sex and etiology of wounds and then treating them with different methods of debridement as denoted by the group’s name Group I Surgical debridement group, Group II Autolytic debridement group, Group III Mechanical debridement group, Group IV Enzymatic debridement group. Discussion: The term debridement comes from the French debrides, meaning to unbridle. It was probably first used as a medical term by surgeons working several hundred years ago in war zones, who recognized that grossly contaminated soft tissue wounds had a better chance of healing (and the soldier surviving) if the affected tissue was surgically removed to reveal a healthy bleeding wound surface. When necrotic or foreign material is present in a wound, sharp or surgical debridement can reduce the risk of infection and sepsis and aid wound healing. Several studies have been conducted to compare sharp debridement with enzymatic/ autolytic/ mechanical debridement as by far it has been considered the gold standard of debridement. Conclusion: Even though surgical debridement has by some distance been taken into consideration as the gold standard for casting off necrotic tissue, it could now not essentially be satisfactory. It does remove the supply of infection inside the quickest manner and promotes the levels of healing both proliferative and inflammatory and enables in accurate assessment of the wound however it also destroys the crucial new tissue. Also it can no longer be safe and has headaches like bleeding.

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