Asian Journal of Pharmaceutical and Clinical Research

MAGNETIC RESONANCE IMAGING IN DIAGNOSIS AND CLASSIFICATION OF MULLERIAN DUCT ANOMALIES: CASE SERIES

BHAVYA KATARIA — 2024-11-07

Objectives: Mullerian duct anomalies (MDAs) arise from the aberrant development of the uterus, cervix, and vagina, impacting the potential for successful conception and full-term pregnancy. This category encompasses a diverse range of developmental defects, leading to a spectrum of clinical presentations such as amenorrhea, infertility, recurrent miscarriages, intrauterine growth retardation, malposition of the fetus, preterm labor, and retained placenta.

Case(s): In this study, we present 17 cases of MDA with a wide array of clinical manifestations. The varied symptoms included amenorrhea, infertility, repeated miscarriages, intrauterine growth retardation, malposition of the fetus, preterm labor, and retained placenta. Accurate categorization of these cases is crucial for determining the appropriate surgical intervention. While ultrasonography aids in the initial diagnosis of MDA, our focus on accurate classification necessitates the use of magnetic resonance imaging (MRI).

Conclusion: Our findings underscore the significance of MRI in precisely categorizing MDA, and facilitating effective management strategies. The 17 cases presented demonstrate the diverse spectrum of MDA manifestations, emphasizing the need for tailored surgical interventions for successful conception and optimal pregnancy outcomes. The use of MRI proves instrumental in guiding clinical decisions, offering a comprehensive understanding of MDA, and informing targeted interventions to enhance reproductive success.

TOXIC ALCOHOL POISONING: A CASE REPORT

SANAL K THOMAS — 2024-11-07

During the COVID-19 pandemic, toxic alcohol poisoning, notably from methanol, has emerged as a significant concern due to increased consumption of illicit liquor amidst lockdown restrictions. We present a case of a middle-aged man who developed altered consciousness, metabolic acidosis, and shock two days after ingesting hospital spirit. Although initial qualitative tests only detected ethanol, subsequent MRI findings showed classical signs of methanol poisoning, including basal ganglia abnormalities. Prompt management with dialysis, ventilatory support, and adjunctive therapy successfully addressed the acute phase despite the patient remaining delirious for seven days. This case underscores the importance of considering methanol toxicity even in the absence of direct evidence, necessitating comprehensive diagnostic approaches. Awareness and incorporating point-of-care assessments such as arterial blood gas analysis and osmolar gap evaluation in suspected cases are crucial, especially in resource-limited settings. Recognizing unexplained high anion gap metabolic acidosis with a high osmolar gap and characteristic MRI findings can aid in the early diagnosis and management of toxic alcohol poisoning

EXPERIENCE OF CHRONIC LYMPHOPROLIFERATIVE DISORDER CASES IN A NEWLY ESTABLISHED FLOW CYTOMETRY LABORATORY IN A TERTIARY CARE HOSPITAL: A SERIES OF 8 CASES

RAJANI RAJKUMARI — 2024-11-07

Chronic lymphoproliferative disorder (CLPD) represents a heterogenous group of conditions affecting lymphocytes – especially white blood cells crucial for combating infections. The utilization of flow cytometry for immunophenotyping has significantly improved the diagnosis and differentiation between various CLPDs. The diagnosis of CLPD is based on the findings of peripheral blood smear, bone marrow aspiration and flow cytometry examinations. Here, we report a series of eight cases, diagnosed as CLPD by flow cytometry out of a total 78 cases received for flow cytometry analysis for a period from March, 2022 to March, 2024 after the establishment of a new flow cytometry laboratory

PROTECTIVE EFFECT OF COMBINATION OF ETHANOLIC EXTRACTS OF XIMENIA AMERICANA AND TERMINALIA MACROPTERA AGAINST ALCOHOL-INDUCED HEPATOTOXICITY IN RATS

Mahamadou BALLO — 2024-11-07

Objective: The aim of this study was to evaluate the hepatoprotective effect of the combination.

Methods: Serum liver markers, tissue antioxidant activity, and histological changes in the livers of rats from the blank, negative (distilled water), positive (silymarin 100 mg/kg bw), and test (combination 500 mg/kg bw) groups were measured after 7 days of pretreatment and induction of hepatotoxicity by 10 g/kg bw alcohol every 12 h for 48 h.

Results: Rats in the negative control group showed a highly significant (p<0.001) increase in aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin (BT) levels by 281.13%, 221.7%, and 93.44%, respectively, compared to rats in the blank group. Pretreatment with the combination resulted in a highly significant (p<0.001) decrease in AST, ALT, and BT levels of 69.19%, 62.24%, and 41.52%, respectively. The study of tissue oxidative stress parameters revealed a very significant (p<0.01) increase in superoxide dismutase (123.08%), glutathione (131.66%), and catalase (49.01%) activities and a significant (p<0.05) decrease in malondialdehyde concentration (59.72%) in the group pretreated with the combination compared with the negative control group. Steatosis and necrosis estimated at 50% were observed in rats in the negative control group. In contrast, necrosis observed in the group pre-treated with the combination was <10%.

Conclusion: These data suggest that the combination is effective in preventing the elevation of biochemical markers and the imbalance of enzymatic and non-enzymatic antioxidant systems caused by alcohol.

QUIZ AS AN ACADEMIC TOOL FOR TEACHING LEARNING PHARMACOLOGY IN INDIAN MEDICAL STUDENTS: A CROSS-SECTIONAL STUDY

SHOBHIT KAUSHIK — 2024-11-07

Objectives: The aim of the study is to analyze the effectiveness of quiz as an academic tool for teaching learning pharmacology.

Methods: The study enrolled 150 students of MBBS Phase 2 (batch 2022) of GS Medical College and Hospital, Hapur. Quizzes were conducted throughout the year and feedback was collected by students at the year end.

Results: The data were compiled and analyzed in Microsoft Excel 2016 and is expressed as percentages/number.

Conclusion: Quiz is an effective and interactive teaching-learning method.

KNOWLEDGE, ATTITUDES, AND PRACTICES REGARDING CHATBOTS AMONG HEALTHCARE PROFESSIONALS IN A TERTIARY CARE HOSPITAL

REGINA ROY — 2024-11-07

Objective: (1) Primary: Determine healthcare professionals’ knowledge, attitudes, and practices (KAP) related to AI Chatbots. (2) Secondary: Assess healthcare professionals’ perspectives on using Chatbots as teaching tools and implementing them in the Competency-Based Medical Education curriculum.

Methods: An online questionnaire was distributed to 132 health professionals, including faculty and CRMIs, through Google Forms. Data on artificial intelligence (AI)-related KAP and barriers were collected following IHEC approval. The KAP scores, along with the relationship between categorical variables – such as population type and the use of AI Chatbots – were analyzed using Statistical Package for the Social Sciences software.

Results: The study revealed that participants had a moderate level of knowledge about AI Chatbots. Attitudes were mixed, with some skepticism about AI replacing human teachers but also recognition of its benefits. Most participants infrequently used AI Chatbots in their daily activities. Barriers to usage included lack of knowledge, limited access, time constraints, and curriculum gaps.

Conclusion: This study underscored the need to enhance medical education with AI topics and address existing barriers. It is crucial to better prepare health professionals for AI integration to leverage AI’s potential for improving patient care and training.

CONGENITAL HYPOTHYROIDISM IN NEWBORN AND ASSOCIATION WITH SOCIODEMOGRAPHIC PARAMETERS AMONG NEONATE DELIVERED AT MILITARY HOSPITAL IN A CITY OF CENTRAL INDIA

ANISHA BEEGUM — 2024-11-07

Objectives: The present study aims to assess the incidence of congenital hypothyroidism (CH) among neonates in a tertiary care hospital in central India, examining its association with various sociodemographic parameters.

Methods: This cross-sectional study, conducted between January and December 2022, included all live births at a tertiary care center in Jabalpur, Madhya Pradesh. Cord blood thyroid-stimulating hormone (TSH) levels were measured for all newborns as part of routine screening. Sociodemographic data, including maternal age, gestational age, birth order, and newborn sex, were collected. Universal sampling was employed, encompassing all consenting parents and their neonates.

Results: Among 388 live births, TSH values ranged from 0.23 to 35.59 mIU/L, with a mean TSH of 8.76±5.92 mIU/L. Of the neonates, 95.9% had normal TSH levels, while 4.1% exhibited elevated levels. Subsequent follow-up identified CH in two neonates (5.2 per thousand live births). Analysis revealed no significant association between elevated TSH levels and maternal age or newborn sex. However, a significant association was observed with gestational age. Birth order also displayed significance, with the third birth order having a higher proportion of neonates with raised TSH levels.

Conclusion: This study highlights the importance of CH screening in preventing long-term complications and the various sociodemographic factors linked to CH, such as maternal age, gestational age, and birth order.

A PHARMACOEPIDEMIOLOGICAL STUDY OF NEW DRUG APPROVAL PATTERN OF JAPAN

Nirav Patel — 2024-11-07

Objectives: The objective of the study was to study the drug development and drug approval pattern of a developed Asian country: Japan.

Methods: Data available on official website of Japan government health authority was compiled for the duration of January 2017–December 2021. The new approved drugs were classified based on different parameters such as active ingredient, drug approval date, review category, new approval or partial change, Indication of drugs, and WHO anatomic thoracic classification. The descriptive analysis of data was done using LibreOffice Calc.

Results: Out of 545 drugs approved, 46% were anti-neoplastic and immunomodulating agent, 10% were anti-infective and 9% were Nervous system category. Furthermore, among all approved drugs, 51.38% were new approved drugs while 48.62% of drugs were approved with partial change in dosage, route, or indications.

Conclusion: This study showed new drug development and approval was done significantly for anti-cancer agents and agents for non-communicable diseases.

COMPARATIVE STUDY OF PREVALENCE OF DEPRESSION, ANXIETY, AND STRESS AMONG UNDERGRADUATE MEDICAL STUDENTS IN LONGITUDINAL CURRICULUM OF MEDICAL COLLEGE

PREET — 2024-11-07

Objective: Medical education is long and stressful due to academic demands, frequent examinations, excessive workload, chronic exposure to human suffering and death and vast extensive syllabus, and increased psychological pressure due to multiple reasons, all of which can cause burnout, leading to mental disorders such as depression and anxiety. The aim of the study is to estimate the prevalence of depression, anxiety, and stress among undergraduate medical students of Rama Medical College, Kanpur, and its correlation with year of medical education.

Methods: A cross-sectional study was conducted by providing self-administered questionnaire containing sociodemographic datasheet and depression, anxiety, and stress scale (DASS 42). Descriptive statistics were used to analyze participants’ sociodemographic characteristics and the prevalence of academic burnout using SPSS. The association of academic burnout with academic year was determined using the Pearson correlation coefficient. The data were also analyzed using analysis of variance.

Results: Using DASS 42, it was found that 11.8%, 16.8%, and 19% experienced mild, moderate, and severe depression, respectively. 32.5% had mild and 16.6% had moderate anxiety. 17.9%, 22.1%, 9.0%, and 2.0% of students experienced mild, moderate, severe, and extremely severe stress, respectively. The percentages of students experiencing depression, anxiety, and stress increased as the academic year progressed.

Conclusion: High prevalence of depression, anxiety, and stress was found among undergraduate medical students. One out of every three students is found to be depressed and about half of the students were reported experiencing anxiety and stress. A clear progression of depression, anxiety, stress, and burnout was observed as the academic year progressed.

CONVENTIONAL TEACHING VERSUS COMPUTER-ASSISTED LEARNING IN EXPERIMENTAL PHARMACOLOGY AMONG 2ND-YEAR MBBS STUDENTS: A QUESTIONNAIRE-BASED STUDY

NIVEDITA SAHA — 2024-11-07

Objectives: The primary objective was to evaluate the effectiveness of CAL in improving students' understanding of pharmacological concepts. The secondary objective was to assess students' acceptance and preference for CAL compared to traditional teaching methods.

Methods: A prospective cross-sectional study was conducted with 128 second-year MBBS students at Silchar Medical College & Hospital, Assam. Participants were divided into two groups: one group was taught using traditional methods, while the other utilized CAL. Data were collected through post-session quizzes and a feedback questionnaire. Statistical analysis included Chi-square tests to determine the significance of differences between the two groups.

Results: The CAL group demonstrated significantly higher understanding and application of pharmacological concepts, with students reporting greater satisfaction and increased interest in the subject. Key findings include a significant improvement in understanding (χ² = 11.25, p = 0.023) and the ability to relate drugs to basic mechanisms (χ² = 10.54, p = 0.032). However, concerns about the resource requirements of CAL were noted (χ² = 9.98, p = 0.041).

Conclusion: CAL significantly enhances the learning experience in experimental pharmacology, improving student comprehension, application of knowledge, and engagement. Despite its advantages, the implementation of CAL requires careful consideration of resource constraints. The study suggests that a hybrid approach, combining CAL with traditional methods, may offer the most effective strategy for teaching pharmacology.

ASSESSMENT OF MEDICATION ADHERENCE IN BIPOLAR DISORDER PATIENTS USING MEDICATION ADHERENCE TOOL

NIVEDITA SAHA — 2024-11-07

Objective: The aim of this study was to evaluate the levels of medication adherence among patients with bipolar disorder and to identify the factors associated with low adherence.

Methods: This prospective cross-sectional study was conducted over 6 months at the Psychiatry outpatient department of Silchar Medical College and Hospital, Assam, India. A total of 140 patients with bipolar disorder were recruited using consecutive sampling. Medication adherence was assessed using the Morisky 8-Item Medication Adherence Scale (MMAS-8), and demographic data were collected through structured interviews. Data were analyzed using descriptive and inferential statistics to identify factors associated with adherence.

Results: The study found that 45% of the participants had low adherence (MMAS-8 score >2), 30% had medium adherence (score 1–2), and 25% had high adherence (score 0). Factors significantly associated with low adherence included lower educational levels, unmarried status, and rural residence. Forgetfulness (58%), side effects (22%), and inconvenience (20%) were the primary reasons for non-adherence. Interventions like reminder systems were found to improve adherence rates significantly.

Conclusion: Medication adherence in patients with bipolar disorder remains suboptimal, with nearly half of the study population exhibiting low adherence. Addressing factors such as cognitive impairments, side effects, and lack of social support through tailored interventions could improve adherence and patient outcomes. Further research is needed to develop and implement strategies that address the complex barriers to adherence in this population.

PRESCRIPTION AUDIT AT A TERTIARY CARE HOSPITAL – A CROSS-SECTIONAL STUDY

Pranab Das — 2024-11-07

Objective: The aim of this study was to analyze prescribing practices at Silchar Medical College and Hospital (SMCH) through a cross-sectional audit of 600 outpatient prescriptions, adhering to the National Health Mission Prescription Audit Guidelines 2021.

Methods: The audit examined prescriptions of patients who visited the Outpatient department (OPD) of Department of General Medicine, Surgery, Orthopedics, Gynecology and Obstetrics, Pulmonary Medicine, Pediatrics, Dermatology, and Psychiatry. The audit evaluated key aspects such as the completeness of patient information, legibility of prescriptions, documentation of clinical details, and adherence to standard treatment guidelines (STG).

Results: The prescription audit at SMCH revealed high compliance with essential criteria such as OPD registration and patient gender documentation. However, gaps were identified in areas such as allergy status documentation (0%), legible handwriting (75.7%), and follow-up advice (16.9%). In addition, adherence to STG was observed in 75% of prescriptions, with a concerning finding that there was a lack of facility’s Antibiotic Policy.

Conclusion: The study underscores the importance of complete and accurate prescription documentation to ensure patient safety and effective treatment.

ASSESSMENT OF THYROID FUNCTION DISORDERS AMONG THE SUBJECTS ATTENDING CENTRAL LABORATORY OF A TERTIARY CARE HOSPITAL: AN OBSERVATIONAL, CROSS-SECTIONAL STUDY

ALAK KUMAR DAS — 2024-11-07

Objective: Thyroid disorders are the most common endocrine disorders worldwide and India is not an exception. Several factors may determine the prevalence of thyroid dysfunction including age, gender, geographical and ethnic background, and most importantly iodine intake. Therefore, data related to thyroid disorders from one population cannot be extrapolated to another. In this study, we aimed to assess the disorders of thyroid function among the subjects attending the central laboratory of a tertiary care hospital.

Methods: This observational, cross-sectional study was conducted in the Department of Pharmacology and the Department of Biochemistry of the same institute over a period of 3 months. All subjects of either sex attending the central laboratory of the institute for estimating thyroid function on their outpatient visit during the study period were included. Subjects who were on any medications known to alter the thyroid hormone status or diagnosed with a thyroid disorder and/or on therapy were excluded. A pre-designed and pre-tested data collection form was used for taking interviews to collect relevant data including sociodemographic characteristics, comorbid conditions, thyroid illness, and investigational reports.

Results: A total of 132 subjects were included in the study. The majority of them were female (72.27%) and residents of urban areas (52.27%). The most common comorbid conditions and presenting symptoms were hypertension (25.76%) and fatigue (46.97%), respectively. The majority of the subjects were found to be euthyroid (81.81%). About 18.19% of the study subjects were having thyroid disorders, most commonly subclinical hypothyroidism (SCH) (13.64%), followed by primary hypothyroidism (2.27%), secondary hyperthyroidism (1.52%), and subclinical hyperthyroidism (0.76%). Thyroid disorders were mainly found in females, such as primary hypothyroidism (66.67%), SCH (66.67%), and subclinical hyperthyroidism (100%). The majority of the thyroid disorders were found in the age group of 26–50 years (20.27%), where females were found to have more primary hypothyroidism (3.17%), and SCH (12.70%).

Conclusion: The findings of our study call for a review of current practices regarding thyroid disorders to include active screening of thyroid function among the subjects at greater risks and an emphasis on regular monitoring of the thyroid status.

A COMPARISON OF 0.5% BUPIVACAINE ALONE VERSUS 0.5% BUPIVACAINE WITH VERAPAMIL AS AN ADJUNCT IN ULTRASOUND-GUIDED SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

ASHWIN KUMAR — 2024-11-07

Objective: Supraclavicular brachial plexus blocks are commonly performed for surgeries on the upper limb because they are highly effective for both anesthesia during the procedure and pain control afterward. This method targets the entire brachial plexus, making it a popular alternative to general anesthesia, as it minimizes associated risks while offering better pain relief after the surgery. Bupivacaine, a long-lasting local anesthetic, is often preferred for this block, though its pain-relieving effects eventually wear off. Owing to limitations regarding the duration of analgesia, many adjuncts have been tried since time immemorial to enhance the effectiveness of the blocking properties of these local anesthetics. Verapamil, a calcium channel blocker, has emerged as a promising adjunct that can potentially enhance and prolong the effects of Bupivacaine. This study aims to compare the efficacy of 0.5% Bupivacaine alone versus Bupivacaine combined with Verapamil in ultrasound-guided supraclavicular brachial plexus blocks.

Methods: A randomized clinical trial was conducted on patients undergoing elective upper limb surgeries under ultrasound-guided supraclavicular brachial plexus block. Group A received 30 mL of 0.5% Bupivacaine, whereas Group B received 30 mL of 0.5% Bupivacaine with 5 mg of Verapamil. Primary outcomes included the time of onset of sensory and motor blockade and the duration of analgesia for the same, whereas secondary outcomes included post-operative pain scores and hemodynamic stability.

Results: The addition of Verapamil to Bupivacaine significantly accelerated the onset of sensory and motor blockade in Group B compared to Group A. Group B also exhibited a significantly prolonged duration of both sensory and motor blockade and reduced post-operative analgesic requirements.

Conclusion: Verapamil helps boost the effectiveness of Bupivacaine in supraclavicular brachial plexus blocks, speeding up the onset of its actions and extending its pain-relieving effects. This makes it a useful addition to local anesthetics, making it a valuable adjunct in regional anesthesia.

CYSTS OF THE CENTRAL NERVOUS SYSTEM: A REVIEW OF 35 CASES WITH OUTCOMES

SURENDER — 2024-11-07

Objective: Non-neoplastic, non-inflammatory cysts of the central nervous system (CNS) may cause symptoms as a result of changes in pressure, rupture or secondary inflammation. The cyst-related details, such as its age, site, cyst wall, and its contents, also provide an insight into their embryology and histogenesis. This paper reviews the clinic-pathological features of cysts of CNS.

Methods: In this study, a prospective analysis of the cysts of CNS diagnosed between November 2019 and October 2023 who presented to our outpatient department and managed at Command Hospital Lucknow and Base Hospital Delhi Cantt were reviewed. Written informed consent was taken from all patients. Cystic degeneration in tumors or inflammatory lesions was excluded from the study.

Results: There were 35 cysts in the study period of 04 years. Majority of intracranial cysts presented with signs of raised intracranial pressure. Patients with epidermoid cysts had additional cerebellar signs, visual disturbances and deafness. Cord compression is the main presentation of all spinal cysts.

Conclusion: Cysts of CNS are usually maldevelopment in nature. A few are acquired. The radiological identification of these cysts and pathological confirmation is necessary for prognostic purposes.

PREVALENCE OF NUTRITIONAL DEFICIENCIES IN CRITICALLY ILL PATIENTS ADMITTED TO INTENSIVE CARE UNIT

T MURALI — 2024-11-07

Objective: This study was conducted to assess the incidence of the excisting malnutrition in critically ill patients who are admitted to ICU. So that this can help in improving the nutrition therapy in these critically ill patients. And, to identify the comorbidities which as associated with severe malnutrition.

Methods: All patients who are above 18 years admitted to ICU irrespective of sex, diagnosis and severity of disease are assessed for nutritional status with SGA score within 24 hours of admission.

Results: In males severe malnourishment was noted in elderly age group with mean age of 64.33 ±17.32 compared to patients with < 60 years. In female patients moderately nourished patients were older with mean age of 61.37±12.69. there is no difference between male and female in well-nourished and severely malnourished group. But in moderately nourished group females are more than males(32.09% vs 24.92%). Diabetes mellitus seem to be the most common comorbidity noted. In diabetes mellitus 81.39% of patients were severely malnourished.

Conclusion: it is shown that most of the patients admitted to ICU presents with pre excisting malnutrition. So nutrition therapy plays import role in management of these patients.

CLINICO-EPIDEMIOLOGICAL PROFILE OF COVID-19 PATIENTS ADMITTED TO TERTIARY CARE MEDICAL COLLEGE HOSPITAL IN SOUTH INDIA

MURALI T — 2024-11-07

Objective: This is a retrospective study done in tertiary care medical college hospital in south India to look for clinico-epidemiological profile of coronavirus disease 2019 (COVID-19) patients admitted to the intensive care unit (ICU). This study can help us in identifying the risk factors leading to increased mortality. Hence, identifying these factors can help us in modifying the treatment depending on the risk factors that are present.

Methods: All patients who are diagnosed with COVID-19 with reverse transcription polymerase chain reaction positivity admitted to ICU are enrolled. Data are collected retrospectively by analyzing the medical case records and looking for all parameters, such as age, sex, underlying comorbidity, method of oxygen therapy, degree of severity, and inflammatory markers. All these data are analyzed and compared between survivors and non-survivors.

Results: 81% were male patients in comparison to female patients contributing to 19%. 55% were <60 years and 45% were >60 years. Non-survivors had a mean age of 64.5 years. Average days of hospital admission, ICU admission, and onset of hypoxia after symptom onset were 4.2 days, 8.5 days, and 7.8 days, respectively. Average PaO2 and P/F ratio was 81.25 and 165.9, respectively. The average P/F ratio in non-survivors was 144 compared to survivors having 187. The average high-resolution computed tomography score on admission and discharge was 12.4 and 11.9, respectively. Regarding inflammatory markers average lactate dehydrogenase (LDH), Ferritin, and interleukin-6 were 462, 618.2, and 130.56, respectively. Non-survivors had increased LDH with a mean of 538.3 when compared to survivors having a mean of 421.4.

Conclusion: This study showed that there is increased mortality with an increase in age, especially >60 years. Severe respiratory failure with P/F ratio<144 had increased mortality. Patients with increased LDH showed an increase in mortality.

TO STUDY THE CLINICO-MICROBIOLOGICAL PROFILE OF AN INTRA-ABDOMINAL INFECTIONS IN THE SURGICAL INTENSIVE CARE UNIT

AMARPREET KAUR — 2024-11-07

Objective: Intra-abdominal infections (IAIs) pose a severe challenge in surgical intensive care units (ICUs). These infections, which can develop from conditions such as peritonitis, appendicitis, and intra-abdominal abscesses, often worsen into severe complications such as sepsis and multi- organ failure. Early and accurate diagnosis, along with rapid and effective treatment, is crucial for improving the survival and recovery of patients in the surgical ICU who are affected by these life-threatening infections. This study focuses on the clinical and microbiological profile of IAIs in the surgical ICU, emphasizing the importance of understanding the microbial landscape.

Methods: This prospective study was carried out in the Department of Microbiology over the course of 1 year. Patients with suspected IAIs admitted to the surgical ICU were included in the study. The samples were received and processed as per standard protocols. Identification and antimicrobial susceptibility testing were done by the Vitek-2 system, and isolates were characterized as multi-/extensively/pan-drug resistant.

Results: Out of 1010 patients admitted to the surgical ICU, infections were present in 81 patients (53 males and 28 females), resulting in an infection rate of 8%. The most common comorbidity was diabetes mellitus (28.3%), and the most common risk factors were sepsis (19.7%), alcohol intake (18.5%), and immobilization (16%). A total of 87 isolates were obtained. The most common isolate was Escherichia coli (47.1%), followed by Klebsiella pneumoniae (26.4%). E. coli showed maximum sensitivity for amikacin (76.7%), followed by tigecycline (74.4%). 81.6% of isolates were multidrug-resistant, and 62.7% were extensively drug-resistant.

Conclusion: Knowledge of antimicrobial resistance patterns provides guidance for the treatment, thus improving outcomes.

COMPARATIVE SERUM LIPID STUDY IN SMOKERS AND NON-SMOKERS SUFFERING FROM MYOCARDIAL INFARCTION

DANGI BS — 2024-11-07

Objective: Comparative study of lipids in smoker and non-smoker myocardial infarction (MI), patients.

Methods: Total cholesterol determined by diagnostic kit, that is, enzymatic CHOD-PAP, endpoint colorimetric method. Absorbance was measured at 506 nm by kinetic ultraviolet spectrophotometer which was proportional to the cholesterol concentration in the specimens.

Results: There were 41.46% of patients who were smokers with high total cholesterol (>200 mg/dL). The total cholesterol was found to be statistically significant when smokers and non-smokers were compared in different age groups (p<0.05) in urban, rural, and slum populations of Madhya Pradesh.

Conclusion: This prospective study of 2006 smoking emerged as a significant modifiable risk factor in MI patients.

THE PATTERN OF RISING AND FALLING OF SERUM CK-MB IN PATIENTS SUFFERING FROM MYOCARDIAL INFARCTION

DANGI BS — 2024-11-07

Objectives: Isoenzymes in the blood are important diagnostic and prognostic biomarkers in medical sciences for various cardiac diseases, that is, myocardial infarctions. Creatine kinase (CK)-MB is an important Isoenzyme secret when the destruction of cardiac muscle cells takes place.

Methods: A total of 196 myocardial infarction patients and 104 controls were studied in the cardiology department of Hamidia Hospital, Bhopal. Initial elevation of CK-MB occurs after 6 h mean time to peak elevation was 8–24 h and the time to return to the baseline was >48 h in male controls the mean CK-MB level was 19.34±2.83 IU/L and in female the means CK-MB level was 19.32±3.65 IU/L.

Result: The mean value of CK-MB at different time intervals in MI patients where 245.12±64.56 at 8–16 h, 230.50±44.88 IU/L at 17–24 h, 88.33±3.84 IU/L at 25–32 h, 74.50±38.19 IU/L at 33–40 h, and 50.88±2.32 IU/L at 41–48 h.

Conclusion: The pattern of rising and falling of CK-MB provided most valuable about the MI and its timely management. In conditions where reinfarction is suspected, CK-MB may be useful to classify a new event due to its shorter duration of elevation at detectable levels in plasma.

FOSFOMYCIN SUSCEPTIBILITY IN MULTIDRUG-RESISTANT UROPATHOGENS: A RETROSPECTIVE STUDY IN THE ERA OF ANTIMICROBIAL RESISTANCE

JASLEEN KAUR — 2024-11-07

Objective: Urinary tract infection (UTI) is one of the most prevalent clinical entities affecting people worldwide. The accelerating rate of Antimicrobial resistance due to the unimpeded and rampant use of antimicrobials with over-the-counter availability of drugs has limited the therapeutic options for the treatment of UTIs. Fosfomycin, an old broad-spectrum antimicrobial with good pharmacokinetics has regained importance for the treatment of multidrug-resistant (MDR) isolates. The purpose of this study was to determine the in vitro Fosfomycin susceptibility of common uropathogens and to study the resistance pattern of these organisms against commonly prescribed antimicrobial agents.

Methods: A retrospective cross-sectional study was conducted in the Bacteriology section of the Microbiology laboratory at Adesh Institute of Medical Sciences and Research, Bathinda, Punjab for duration of 6 months from December 2022 to May 2023 from urine samples received from all clinically suspected cases of UTI. Samples were processed immediately as per standard microbiological techniques, followed by culture by a semi-quantitative method. Kass criteria was followed for interpretation of significant bacteriuria according to which significant growth was considered if the colony count was more than 105 colony forming units (CFU)/mL. Culture positives were analyzed by Gram staining and on the basis of colony characteristics, Gram staining, final identification, and Antimicrobial Susceptibility were done through Vitek 2 compact system.

Results: A total of 2292 urine samples received in the Microbiology laboratory were processed and cultured during the study period, which yielded 509 significant bacterial isolates i.e.509/2292 (22.2%) culture positivity. Among 509 culture-positive samples, Escherichia coli 235/509 (46.1%) was the most common uropathogens isolated followed by Klebsiella pneumoniae 107/509 (21.1%), Enterococcus species 40/509 (7.8%). Fosfomycin depicted good in vitro susceptibility of a minimum of 94% in both Gram-negative and Gram-positive uropathogens as compared to Nitrofurantoin, which showed sensitivity of 74% and 85%, respectively. Maximum resistance was observed toward Cephalosporins i.e., Ceftriaxone in E. coli (60%) and K. pneumoniae (64%), respectively, followed by 50% in Acinetobacter baumannii. Maximum resistance to Ciprofloxacin (62%) was seen in case of A. baumannii. 172/405(42.4%) isolates of Enterobacteriaceae family were extended-spectrum β-lactamase (ESBL) producers with an average Fosfomycin susceptibility of 95.9%. Among the total isolated uropathogens, 135/509 (26.5%) were MDR, out of which 116/135 (85.9%) depicted Fosfomycin susceptibility. Metallo-beta-lactamase (MBL) production was seen in 14.3% of the isolated Gram-negative uropathogens. 63/73(86.3%) of the MBL producers were found susceptible to Fosfomycin.

Conclusion: Fosfomycin has emerged as an effective alternative for the treatment of common uropathogens including the MDRs, ESBL producers, and the MBLs in the era of increasing antimicrobial resistance. It has the potential to act as a promising oral agent for the treatment of UTI in both community and healthcare setups.

BACTERIOLOGICAL PROFILE OF SURGICAL SITE INFECTIONS AND THEIR ANTIBIOGRAM: A STUDY IN A TERTIARY CARE HOSPITAL

NIHARIKA — 2024-11-07

Objective: To ascertain the frequency of surgical site infection (SSI) occurrences and the prevalence of aerobic bacterial infections associated with their antibiogram.

Methods: For 1 year, a tertiary care hospital affiliated with Government Medical College, Amritsar, served as the site of this cross-sectional study. Pus aspirates were aseptically taken from 86 consecutive individuals suspected of having SSI using a sterile surgical syringe with a needle and sterile cotton surgical swabs. The specimens were cultivated and placed in an incubator at 37°C for 24 h. The individual strains were then identified using traditional techniques. The Kirby–Bauer’s Disc Diffusion Method was employed to conduct antimicrobial susceptibility testing.

Results: Among 1021 patients, 86 were clinically suspected of SSI, and 64 were culture-positive. The incidence of SSI was 8.42%. The most common organisms were Klebsiella pneumoniae 34% (17/50) and Escherichia coli 32% (16/50), whereas Staphylococcus aureus 100% (14/14) was the only organism found among Gram-positive cocci. The antimicrobial Profile of Gram-positive isolates showed maximum sensitivity to linezolid (100%), followed by erythromycin (85.7%). The antimicrobial profile of lactose fermenters revealed maximum sensitivity to polymyxin (100%). Antibiogram of Proteus species showed maximum sensitivity to meropenem (100%) and ceftazidime tazobactam (100%). Non-fermenters showed 100% polymyxin and 80% sensitivity to aztreonam.

Conclusion: Our study has revealed significant findings. The incidence of SSI was found to vary between 8% and 12% in our tertiary care center. K. pneumoniae 26.5% (17/64) and E. coli 25% (16/64) were the most common organisms isolated. S. aureus 21.2% (14/64) was the only organism found among Gram-positive cocci. SSI below waist surgery was far more 75% (48/64) than above waist surgery of 25% (16/64).

THE PATTERN OF SKIN DISEASES OF PATIENTS ATTENDING THE OUT PATIENTS DEPARTMENT IN A MEDICAL COLLEGE IN A DISTRICT IN WEST BENGAL

NIRMALYA KUMAR DAS — 2024-11-07

Objective: The objective of the study was to find out the pattern of skin diseases among the patients attending the Dermatology outdoor of a Medical College located in a district in West Bengal.

Methods: This is an observational study. Patients attending the dermatology outdoor were included following the inclusion and exclusion criteria.

Results: In this study, we found that infective diseases (51.09%) were more than non-infective diseases (44.31%). Among the infective diseases dermatophyte infection (15.22%) and Scabies (12.31%) were the highest. Eczema (11.68%) and contact dermatitis (10.07%) were the highest among the non-infective diseases.

Conclusion: This study shows the pattern of skin diseases among the patients attending the dermatology outdoor. This gives a good idea about the skin diseases prevalent in this region. This knowledge will help to formulate policies regarding healthcare. It will also help to have an idea about the medicines and human resources required to deliver service to the people.

Dr BLOODSTREAM INFECTIONS AND ITS ANTIBIOGRAM OF INTENSIVE CARE UNITS IN A TERTIARY CARE HOSPITAL OF CENTRAL INDIA

SHRUTI ASATI — 2024-11-07

Objective: To perform bacteriological analysis and to study drug susceptibility patterns of isolates from bloodstream infections.

Methods: This retrospective study was conducted in the microbiology department of NSCB Medical College, Jabalpur, spanning from July 2023 to December 2023. The study included blood culture samples from all adult intensive care unit patients of the medical college. Blood samples were collected with aseptic guidelines and cultured for 7 days. Growths were identified using standard biochemical tests and subjected to sensitivity testing according to Modified Kirby-Bauer’s disk diffusion method. Data for the source of blood collection and duration of incubation were noted and compared.

Results: A total of 100 (21.7%) pathogens were isolated from 460 bacteremia suspect patient blood specimens. Pseudomonas spp. Were predominant organisms recovered followed by Klebsiella spp. and Staphylococcus aureus, coagulase-negative staphylococci, and Acinetobacter spp. were the primary pathogens isolated. Carbapenems, glycopeptides, and aminoglycosides were the most effective drugs for treating bacteremia.

Conclusions: Early diagnosis and proper antimicrobial therapy lead to successful treatment of sepsis and decreased morbidity and mortality. Antibiogram of a particular area helps in rationalizing verified treatment strategies.

IN VITRO ASSESSMENT OF ETHANOLIC EXTRACT OF CUCUMIS MADERASPATANUS LEAVES AS AN α-AMYLASE AND α-GLUCOSIDASE INHIBITOR

NADHIYA K — 2024-11-07

Objective: The current study was planned to study the phytochemicals, Antioxidant, and inhibitor activity of alpha-glucosidase and alpha-amylase from leaf extract of Cucumis maderaspatanus.

Methods: Extract was extracted using a soxhlet apparatus using solvents, such as n-hexane, chloroform, ethyl acetate, ethanol, and aqueous. The extracts were evaporated using a rotary evaporator. The phytochemicals were measured qualitatively and quantitatively and the antioxidant activity was done and the IC50 value was calculated.

Result: The qualitative analysis of the ethnolic leaf extract of C. maderaspatanus shows the presence of carbohydrates, terpenoids, phenol compounds, tannins, saponins, flavonoids, alkaloids, anthocyanins, betacyanins, quinones, glycosides, sterol, and coumarins. Quantitative analysis of ethanolic leaf extract of C. maderaspatanus showed that the presence of phenols (98.63±0.03), flavonoids (80.35±0.78), saponin (16.56±0.04), alkaloids (12.56±0.05), and total antioxidant (130.18±2.45). The IC50 value of various parameters such as DPPH (IC50=265), Nitric oxide (IC50=213), Hydrogen peroxide (IC50=355), Hydroxyl (IC50=290), Superoxide (IC50=145), alpha-amylase activity (IC50=48), and alpha-glucosidase activity (IC50=76).

Conclusion: From the study, it was concluded that the ethanolic leaf extracts of C. maderaspatanus have good antioxidant capacity, alpha-amylase, and alpha-glucosidase inhibitor activity due to phytochemicals present in it.

STUDIES ON THE ROLE OF DRIED ETHANOLIC EXTRACT OF AGARICUS BISPORUS IN THE TREATMENT OF DEPRESSION IN MICE

SUSHRUTA CHAKRABORTY — 2024-11-07

Objectives: Depression is a widespread mental illness with an estimated 322+million people worldwide and one of the most frequent reasons for medical and physical disability. However, the standard treatments available are having side effects such as addiction, physical dependence, and to overcome the lacuna researchers are looking for natural remedies Thus our study aimed to investigate the anti-depressant effect of Agaricus bisporus (White button mushroom) in mice.

Methods: The anti-depressant action of dried ethanolic extract of A. bisporus (EEAB) was evaluated in the Swiss albino mice by various models. After extraction and standardization of the white button mushroom the dose-dependent anti-depressant effect of the white button mushroom was determined. Further, with the best chosen dose, the chronic anti-depressant effect of the white button mushroom was carried out, and also to further substantiate the data brain bioamine estimation was done.

Results and Discussion: Statistical analysis with EEAB 200 mg/kg and 400 mg/kg showed marked anti-depressant action in dose-dependent manner. The calibration of EEAB extract by high-performance liquid chromatography guided a determination that the presence stigmasterol. Brain estimation of the EEAB with 400 mg/kg dose displayed upregulation of Serotonin in the treated mice. Since Serotonin is a major neurotransmitter which is key role anti-depressant activity. Hence, the upregulation of Serotonin suggests that EEAB is having profound anti-depressant activity.

DIAGNOSTIC EFFICACY OF FNAC IN THYROID LESIONS, CLASSIFIED ACCORDING TO BETHESDA SYSTEM WITH CYTOHISTOLOGICAL CORRELATION

KIRAN KUMARI MEENA — 2024-11-07

Objective: The objective of the study is to estimate the diagnostic accuracy (DA) of fine needle aspiration cytology (FNAC) in thyroid lesions with cytohistological correlation.

Methods: The study was a cross-sectional study which was conducted in the Department of Pathology, Rabindranath Tagore Medical College, M.B.G. Hospital, Udaipur, Rajasthan, from December 2022 to December 2023. A total of 201 thyroid aspirations were performed, and the smears were classified according to The Bethesda system. Cytological and histopathological findings were compared in 132 cases that proceeded to surgery. Sensitivity, specificity, negative predictive value (NPV), positive predictive value, and DA were calculated using standard statistical methods.

Results: The distribution of thyroid lesions on cytology was as follows: Non-diagnostic (1%), benign (92%), atypia of unknown significance (1%), follicular neoplasia (3%), suspicious for malignancy (2%), and malignant (1%). The sensitivity, specificity, positive predictive value, NPV, and DA in our study were 78.94%, 100%, 100%, 96%, and 96.9%, respectively.

Conclusion: FNAC’s cost-effectiveness, patient-friendly nature, swift results, and high sensitivity, specificity, and accuracy render it a primary diagnostic tool for assessing patients with thyroid swelling preoperatively. The Bethesda system categorizes thyroid lesions cytologically, aiding in their diagnosis and subsequent management. Histopathological correlation facilitates the assessment of DA and ensures quality assurance.

ESTIMATION OF NUTRITIVE VALUE OF “NANNARI KANJI” AND EVALUATION OF ITS ANTI-BACTERIAL ACTIVITY AGAINST STAPHYLOCOCCUS AUREUS, A RESPIRATORY PATHOGEN BY IN VITRO METHOD

SOWMYA S — 2024-11-07

Objective: To estimate the nutritive value of Nannari Kanji. To evaluate the beneficial effect of Nannari Kanji against the respiratory pathogen, Staphylococcus aureus. To analyze the minerals present in Nannari Kanji.

Methods: Nannari Kanji is a polyherbal formulation prepared using Nannari, Karunguruvai rice, and coconut milk by simple boiling method. In the present study, the Nutritive value of Nannari Kanji was analyzed and its antimicrobial activity was studied in terms of minimum inhibitory concentration against the respiratory pathogen, S. aureus. In addition to that mineral analysis was performed using the ICP-OES instrument.

Results: In the nutritive analysis, protein (26.83%) was present in large amounts. The antimicrobial activity showed an inhibitory effect against S. aureus at the concentration of 527.02 μg/mL. The mineral analysis confirms the presence of magnesium, iron, and zinc of which magnesium shows a higher value (192.06 ppm).

Discussion and Conclusion: Nannari Kanji has potent antimicrobial activity against S. aureus. It has more protein and fat content, which is useful in suppressing respiratory infections. Nannari Kanji contains good magnesium content which is considered to be a good antimicrobial agent.

EVALUATION OF KNOWLEDGE, ATTITUDE, AND PRACTICE ABOUT PHARMACOVIGILANCE AMONG NURSING STAFF AT TERTIARY CARE TEACHING HOSPITAL

RUSHITABEN K BHUNGALIYA — 2024-11-07

Objectives: The primary objective of this study was to evaluate the knowledge, attitude, and practice of nursing staff about pharmacovigilance and adverse drug reactions (ADRs) reporting in a tertiary care teaching hospital. The secondary objective was to assess the causes of underreporting of ADRs.

Methods: A cross-sectional questionnaire-based study was carried out using a pre-designed structured questionnaire, adapted from previous studies and validated internally among the members of the pharmacovigilance committee. This questionnaire was provided to the nurses of all wards and out-patient department in a tertiary care teaching hospital of Gujarat, after taking their written informed consent. The data were evaluated for further analysis.

Results: Out of 309 participants, 73.38% had appropriate knowledge about pharmacovigilance and ADRs and 72.41% had a positive attitude toward the safety of drugs and reporting of ADRs. Out of 309 nurses, 55.34% of nurses came across an ADR and 3.56% of nurses had reported an ADR. According to the evaluated data, the reasons for underreporting of ADRs were lack of awareness, lack of time, and fear of legal implications. Out of all participants, 4.85% had attended ADR training/awareness sessions.

Conclusion: In the present study, nursing staff at a tertiary care teaching hospital had good knowledge and positive attitude toward pharmacovigilance but at the same time application of the same was lacking. Exposure to awareness programs and seminars about pharmacovigilance and hands-on ADR training sessions can improve the practice of nurses about pharmacovigilance.

FACULTY PERCEPTION TOWARD E-LEARNING IN THE MEDICAL STUDENTS DURING COVID-19 PANDEMIC

PRAVIN N YERPUDE — 2024-11-07

Objectives: The objective of this study was to assess the perceptions of medical faculty regarding online teaching and learning during the COVID-19 lockdown period.

Methods: A non-probability convenience sampling method was employed to determine the sample size, which was calculated to be 93. Following informed consent, a pre-designed and pre-tested questionnaire was administered to faculty members involved in online teaching. The questionnaire utilized a 5-point Likert scale to gather responses. The collected data were then tabulated and subjected to statistical analysis.

Results: Before receiving orientation on online teaching, approximately 49% of the faculty members demonstrated a very good understanding of online teaching techniques. Overall, 49% of the faculty members reported a positive perception of online teaching during the lockdown period. A notable 61% of faculty members expressed a preference for face-to-face teaching over online teaching.

Conclusion: During the COVID-19 pandemic, online teaching and learning became a crucial component of medical education. Despite challenges, online learning offered significant advantages for enhancing students’ learning experiences and knowledge. It has emerged as a viable and potentially valuable teaching method for the future of medical education.

EVALUATION OF CUTANEOUS ADVERSE DRUG REACTIONS IN A TERTIARY CARE HOSPITAL IN SOUTHERN INDIA: A RETROSPECTIVE ANALYSIS

ANKITA PANIGRAHY — 2024-11-07

Objective: This study was undertaken to understand the demographic profile, common causative drugs, and the presentations of cutaneous adverse drug reactions (CADR) among the patients of our hospital.

Methods: This is a retrospective analytical study. All CADR reported to our adverse drug reaction monitoring center from dermatology outpatient department (OPD), other OPDs, intensive care units, and inpatient wards of our hospital from September 2022 to March 2024 was collected from VIGIFLOW (software used by the pharmacovigilance program of India). The data was then analyzed.

Results: A total of 272 CADR were reported over the study period. The median age of presentation was 41 years (Interquartile range=23). Overall 44 (16.18%) serious and 228 (83.82%) non-serious CADR were reported. Erythematous maculopapular rash was the most common clinical presentation (63%). Bullous exfoliative drug eruptions and Stevens Johnson’s syndrome were some of the serious CADR. The most common suspected medications were antibiotics (42.15%) followed by non-steroidal anti-inflammatory drugs (8.92%). In 76% of the cases, the suspected medication was withdrawn. The outcome was reported as “Recovering” in 52% of the cases. On causality assessment, 251 (92%) CADR were classified as “Possible.”

Conclusion: A CADR is a common yet preventable health problem. As seen from our study, most of the suspected medications were withdrawn and subsequently the patients were recovering from the CADR. Hence, early diagnosis, identification, and withdrawal of the implicating drugs help in timely recovery and prevention of complications, which in turn help in decreasing the burden on our healthcare system.

COMPARATIVE ANALYSIS OF LIPID PROFILE IN PATIENTS WITH HEMORRHAGIC VERSUS ISCHEMIC STROKE: A CROSS-SECTIONAL STUDY

SAGAR MK — 2024-11-07

Objective: Stroke is a major cause of morbidity and mortality worldwide resulting from either an ischemic insult or rupture of a blood vessel in the brain. It not only leads to significant physical disability but also imposes emotional and economic burdens on patients and their families. Assessing the lipid profile in stroke patients is crucial, especially in ischemic stroke, where dyslipidemia plays a key role in atherosclerosis development. Elevated low-density lipoprotein (LDL) and triglycerides (TG) are important modifiable risk factors, and managing these can reduce the incidence and recurrence of strokes. Comprehensive lipid management should be a core component of stroke prevention and treatment strategies.

Methods: This was a cross-sectional study in which 80 adult stroke patients (40 ischemic and 40 hemorrhagic strokes) were included on the basis of a predefined inclusion and exclusion criteria. The diagnosis of stroke was made on the basis of imaging and neurological examination. A comprehensive medical history, physical measurements (including body mass index), and lipid profiles (total cholesterol [TC], LDL, High-density lipoprotein [HDL], and TG) were recorded for all participants. Blood samples were taken after overnight fasting to ensure accuracy. Statistical analysis using SPSS version 21.0 compared lipid levels between the groups. An unpaired t-test and Chi-square test were used, with significance defined as a p<0.05.

Results: There was a significant difference in lipid profiles between ischemic and hemorrhagic stroke patients. Ischemic stroke patients had markedly higher levels of LDL with a mean of 129.84±36.54 mg/dL compared to 106.32±26.68 mg/dL in hemorrhagic stroke patients (p=0.0015). TC levels were also significantly elevated in ischemic stroke patients, averaging 236.22±56.26 mg/dL versus 196.48±46.24 mg/dL in hemorrhagic stroke patients (p=0.0009). Total TG were higher in ischemic stroke patients (158.54±44.68 mg/dL) compared to hemorrhagic stroke patients (128.62±39.16 mg/dL, p=0.0021). HDL levels were slightly lower in ischemic stroke patients (34.54±8.26 mg/dL) compared to hemorrhagic stroke patients (38.12±9.12 mg/dL), although this difference was not statistically significant (p=0.0696).

Conclusion: There were significant differences in lipid profiles between ischemic and hemorrhagic stroke patients. Ischemic stroke patients had higher levels of LDL, TC, and TG, indicating a stronger association with dyslipidemia and atherosclerosis. These findings highlight the importance of aggressive lipid management in ischemic stroke patients to reduce recurrence risk and improve outcomes.

ROLE OF EPIDERMAL GROWTH FACTOR RECEPTOR AND KI67 IN EPITHELIAL OVARIAN TUMOR

Ankita Pathak — 2024-11-07

Objective: The objective of the study was to evaluate epidermal growth factor receptor (EGFR) and Ki67 expression in epithelial ovarian tumors and assess the existence of any correlation between overexpression of these markers and histological grades.

Methods: This prospective study was conducted in the Department of Pathology in a tertiary care hospital of G.S.V.M. Medical College from 2022 to 2024. The study included 50 patients with histologically confirmed epithelial ovarian tumors, whose post-resection specimens were subjected to immunostaining to determine the degree of expression of EGFR and Ki67 proliferation index. Details were noted pertaining to age, tumor type, and histological grade. Statistical analysis included the Chi-square test, which evaluated associations between age, histological grade, EGFR expression, and Ki67 proliferation index.

Results: Most of the participants were below 60 years of age (80%). Most tumors were benign (72%), with serous cystadenoma being the most common (66%). The association between histological grade and age was statistically significant; with benign tumors being more common in patients aged ≤50 years and malignant tumors more frequent in those aged >50 years (p=0.018). EGFR expression was observed in 18% of the tumors, predominantly malignant ones, showing a significant association with tumor malignancy (p<0.001). In addition, the Ki67 proliferation index was significantly higher in malignant tumors (p<0.001), and its levels were associated with EGFR expression (p=0.026).

Conclusion: The study findings suggest that molecular markers such as EGFR and Ki67 may be useful in predicting tumor behavior and guiding tailored treatment strategies for ovarian cancer patients.

COMPARISON OF LASER AND PNEUMATIC LITHOTRIPSY FOR MID AND LOWER URETERAL STONES: “AN ANALYTICAL REVIEW” AT TERTIARY CARE CENTER

RAVIKUMAR JADHAV — 2024-11-07

Objectives: Management of large lower and mid ureteric stones represents a treatment challenge. The main objective of stone treatment is to achieve the highest stone-free rate with minimal morbidity. Available modalities are medical therapy, open surgery, laparoscopic surgery, endoluminal surgery and extracorporeal shock wave lithotripsy (ESWL). After the invention of uretero-renoscopy (URS) and ESWL in 1980s, there has been a paradigm shift in the treatment modality of ureteric calculus from open surgery to endoluminal and non-invasive method. There are various modalities for stone fragmentation in URS – electrohydrolic lithotripsy, pneumatic. Ultrasonic, laser and dual energy source (Ultrasound+Pneumatic) Lithotripsy. Both laser lithotripsy (LL) and pneumatic lithotripsy (PL) have favourable outcomes The aim of this study was to compare efficacy of pneumatic versus laser lithotripters for Mid and lower ureteric calculi in regional population at KIMS, Hubballi.

Methods: This was a prospective comparative study done in 116 cases of mid and lower ureteric calculi (58 in PL and 58 in LL) at karnataka institute of medical sciences, Huballi from May 2022 to November 2022. Patients were randomly divided into two groups: Group 1 had PL, while Group 2 had lithotripsy using a laser energy source. For PL group, 0.8 and 1 mm probe was passed through working channel of URS. LL was performed using a 100- W holmium:yttriumaluminium-garnet (YAG)-pulsed laser machine, with 365 μm fibres. Complications were graded according to the Clavien-Dindo Grading System.

Results: In all, 116 patients (78 male and 38 female) with a mean age of 36.21 years were included in the study, Varying from 18 to 75 years. In group one 58 patients under went PL out of which 41 were males and 17 were females. In group two 58 patients under went LL out of which 37 were males and 21 were females. In group one (PL) mean operative with SD was 42.10±(10.16) min, and in group two (LL). Mean operative with SD was 46.78±(9.36) min, with p=0.011, which was statistically significant. Mean hospital stay ±SD (days) in PL group was 2.69±(0.730) days, and in group two LL mean hospital stay ±SD (days) was 2.40±(0.591) with p=0.019, which was statistically significant. In group one out of 58 patients, 11 patients had stone migration with % of an 18.96% and in group two out of 58 patients 2 patient had stone migration of, with % of 3.44%, with p=0.008, which is statistically very significant. Post operatively 7 patients in group one needed auxillary procedures, 3 patients needed ESWL, 3 patients needed. Re URSL and one patient needed bladder clot evacuation with DJ stenting, In all these patients stone size was larger than 15 mm, In Group 2 no patient needed Auxillary procedure, with p=0.003 which is statistically significant.

Conclusion: Both pneumatic and LL are standard and safe techniques for the management of lower and mid ureteric calculi. Our study showed LL had less stone migration, and no need for reintervention.

COMPARISON OF ULTRASOUND-GUIDED LUMBAR ERECTOR SPINAE PLANE BLOCK AND TRANSMUSCULAR QUADRATUS LUMBORUM BLOCK FOR POST-OPERATIVE ANALGESIA IN TOTAL HIP REPLACEMENT SURGERIES: A PROSPECTIVE RANDOMIZED STUDY

SANGEETHA C — 2024-11-07

Objectives: The objective of the study is to compare the efficacy of ultrasound-guided lumbar erector spinae plane block (ESPB) and transmuscular quadratus lumborum block (QLB) in providing post-operative analgesia for patients undergoing total hip replacement (THR) surgeries.

Methods: This prospective, randomized, double-blind study compared the efficacy of ultrasound-guided lumbar ESPB and transmuscular QLB (QLB-t) for post-operative analgesia in THR surgeries. Ninety patients were randomized into three groups: ESPB, QLB, and a control group. Primary outcomes included the duration of analgesia, measured by numeric rating scale scores, and secondary outcomes assessed total analgesic consumption and the incidence of post-operative nausea and vomiting (PONV) within 24 h. For statistical purposes, p<0.05 was taken as statistically significant.

Results: This study compared lumbar ESPB and QLB for post-operative analgesia in THR surgeries. At the 1st h, pain scores were significantly lower in the ESPB (1.30) and QLB (1.05) groups compared to the control group (2.15) (p<0.001). Tramadol consumption in the first 12 h was significantly lower in the ESPB (52.3 mg) and QLB (50.1 mg) groups compared to the control group (135.20 mg) (p<0.001). PONV was absent in 60% of ESPB and 63% of QLB patients, compared to only 33% in the control group (p=0.038).

Conclusion: Lumbar-ESPB and QLB-t blocks effectively reduce post-operative pain and analgesic requirements in THR surgeries, showing comparable benefits. Both techniques also lower the incidence of PONV.

KNOWLEDGE, ATTITUDE, AND PRACTICE REGARDING DIABETIC RETINOPATHY IN A TERTIARY HEALTH CARE CENTRE AMONG DIABETIC POPULATION IN THE FRONTIER REGION OF BIHAR

BHUPINDERJEET SINGH — 2024-11-07

Objectives: The objective of the study was to determine the association between knowledge, attitude, and practice and to identify barriers to compliance with follow-up and treatment regimes.

Methods: This study was conducted in the Department of Ophthalmology, M.G.M. Medical College and L.S.K. Hospital, Kishanganj, Bihar. It was a cross-sectional study. One hundred and thirty patients were enrolled for the study. Knowledge, attitude, and practice questionnaire consisting of 22 questions was formulated [1]. For fundus examination direct ophthalmoscope, indirect ophthalmoscope, slit lamp with 90D lens, and optical coherence tomography were used.

Results: In the assessment of knowledge and attitude, 56.92% of participants exhibited good knowledge and a positive attitude, while 43.08% had poor knowledge and a negative attitude regarding diabetic retinopathy (DR). Regarding practice, 43.08% demonstrated good practice, whereas 56.92% showed poor practice. Correlation between knowledge, attitude, and practice regarding DR. Among individuals with good knowledge and positive attitudes, 48 had good practice, while 26 had poor practice. Among individuals with poor knowledge and negative attitudes, eight had good practice, while 48 had poor practice. The statistical analysis reveals a significant correlation between knowledge and practice (Chi-square=33.2572, p<0.0001).

Conclusion: A significant correlation between knowledge of diabetes and practice regarding DR is noted. Individuals with better knowledge tend to exhibit better practices related to DR screening and management. There is a notable association between knowledge of DR, attitude toward the condition, and practice regarding DR. Individuals with better knowledge generally tend to have a more positive attitude and thus exhibit better practices toward diabetes and DR management and care.

CLINICOPATHOLOGICAL CORRELATION OF P53 EXPRESSION IN BENIGN PROSTATIC HYPERPLASIA AND PROSTATE ADENOCARCINOMA

ADITI PAL — 2024-11-07

Objective: To assess clinicopathological parameters in patients with benign prostatic hyperplasia and prostate adenocarcinoma, and evaluate their correlation with p53 overexpression in these prostatic conditions.

Methods: The present ambispective study was conducted in the Department of Pathology in a tertiary care hospital of Northern India from 2022 to 2024. This study included prostatic trucut biopsies, transurethral prostatic resection (TURP) chips, and radical prostatectomy specimens from patients with benign prostatic hyperplasia (BPH) or prostatic adenocarcinoma. Tissue samples were processed, embedded in paraffin, sectioned, and stained with hematoxylin and eosin (H&E) for histopathological evaluation. Immunohistochemical (IHC) analysis was performed to assess p53 expression using the GenomeMe antibody. Data on age, histological type and histological grade were collected. Statistical analysis included Chi-square test was conducted to evaluate associations between p53 overexpression and clinicopathological parameters.

Results: The study analyzed 50 cases, revealing significantly higher p53 expression in prostatic adenocarcinoma compared to BPH. The majority of participants were aged between 61-70 years (46%). There were 50% patients with adenocarcinoma, 26% with BPH, 20% with BPH and chronic prostatitis, and 4% with BPH with prostatic intraepithelial neoplasia. There were strong associations between p53 overexpression and specific diagnoses, histological type and histological grade (Gleason scores) in prostate cancer.

Conclusion: The study findings suggest that p53 overexpression is closely linked to malignant prostate conditions and could potentially serve as a valuable biomarker for distinguishing between benign and malignant prostatic diseases, as well as predicting tumor aggressiveness.

COMPARISON OF ANESTHETIC EFFECT OF PLAIN ROPIVACAINE VERSUS DEXMEDETOMIDINE AS AN ADJUVANT TO ROPIVACAINE IN USG-GUIDED SUPRACLAVICULAR BLOCK FOR UPPER LIMB SURGERIES

MANISH KUMAR — 2024-11-07

Objectives: Perioperative pain management is very important to achieve patient satisfaction. The objectives of the current study were to compare the anesthetic effects of dexmedetomidine and plain ropivacaine as an adjuvant to ropivacaine for upper limb surgeries in the supraclavicular brachial plexus block in terms of hemodynamic responses, quality, onset, and duration of sensory and motor block, post-operative pain management and side effects/complications if any.

Methods: Sixty adult patients scheduled for upper limb surgeries were randomized into Group A and Group B of 30 patients each. Patients in Group A received 0.5% Ropivacaine 20 mL+5 mL normal saline and Group B received 0.5% ropivacaine 20 mL+0.5 mL (50 μg) dexmedetomidine+4.5 mL normal saline. The primary objective of our study was to compare the groups in terms of quality of block, onset, and duration of sensory and motor block and post-operative pain management. The secondary objective was to compare the intraoperative hemodynamic changes and post-operative adverse effects.

Results: Time taken in the onset of the sensory as well as motor block in both the groups was statistically significantly more in Group A compared to Group B. The duration of the sensory as well as the motor block was much higher in Group B compared to Group A with a statistically significant difference. The total duration of analgesia was slightly higher in Group A compared to Group B. The mean numerical rating scale was significantly lower in Group B compared to Group A at all-time intervals till 24 h. No major side effects were observed with study drugs.

Conclusion: The study confirmed that dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block hastens the onset of the sensory as well as motor block and prolongs the duration of the sensory as well as the motor block in the upper limb surgeries.

SPHENOID BONE LIGAMENTS’ ENTHESOPATHY WITH THEIR CLINICAL MANIFESTATIONS

SUMITA AGARWAL — 2024-11-07

Objective: The Cortical bone formation at enthesial sites of ligament attachments to the sphenoid bone is indeed multifactorial, involving various biological, mechanical, and biomechanical processes. The present study is aimed to observe the ossified ligaments of sphenoid bone of skull manifesting various neurological complications.

Methods: An observational study conducted on sphenoid bones of 36 dried human skulls of unknown gender and age procured from the Department of Anatomy at Gautam Buddha Chikitsa Mahavidyalaya, Dehradun and People’s College of Medical Sciences and Research Centre, Bhopal. These bones were observed for enthesopathic modifications in their ligaments.

Results: The present study showed ossified caroticoclinoid ligament (intra cranial ligament) predominated by 41.66% followed by pterygospinous ligament ossification (extra cranial ligament) with total 38.88% prevalence.

Conclusion: Altered morphology of sphenoid bone knowledge is a must for neurosurgeons and orthopedic surgeons while operating at these sites to avoid hindrances and has scope for newer approaches for better prognosis.

EFFECT OF DRY NEEDLING ON PAIN AND CERVICAL RANGE OF MOTION IN PATIENTS WITH UPPER TRAPEZIUS TRIGGER POINTS: A SYSTEMATIC REVIEW

POONAM ROKRI — 2024-11-07

Objectives: This systematic review seeks to provide high-quality evidence on the effect of dry needling on cervical range of motion and pain in patients. The objective of this systematic review was to determine the evidence base for the effect of dry needling on cervical range of motion and pain in patients with upper trapezius trigger points.

Material and methods: A systematic electronic literature search was undertaken utilizing keywords and medical subject heading search phrases in the PubMed/Medline, Cochrane Central, Scopus, and EBSCO databases, as well as Google Scholar. In addition, the reference lists of the systematic reviews included in the study were manually searched. Patient satisfaction and complications were collected from a range of motion prospective and experimental studies that provided the greatest degree of evidence. Articles were evaluated critically, and the methodological index for non-randomized studies scale was used to determine the risk of bias.

Results: This systematic review suggested the use of dry needling to improve pain and functional capacity in patients with chronic neck pain at short- and mid-term intervals. To the interventions, dry needling combined with physical therapy was shown to be effective in decreasing pain, whereas isolated dry needling did not demonstrate significant improvements in the analyzed studies.

Conclusion: Finally, as for pain, dry needling combined with physical therapy was the therapy that showed the most benefits in function in the analyzed studies

ASSESSMENT OF TOTAL PHENOLIC CONTENT (TPC), TOTAL FLAVONOID CONTENT (TFC) AND ANTIDIARRHEAL AND ANTIOXIDANT ACTIVITIES OF DIOSCOREA BULBIFERA TUBER EXTRACT

MD. ASHRAFUL ISLAM — 2024-11-07

Objective: This study aims to conduct a comprehensive phytochemical screening of the tuber of Dioscorea bulbifera extract, evaluate its antioxidant capacity, and assess its anti-diarrheal activity.

Methods: In this research, we reported the phytochemical screening, antidiarrheal and antioxidant activity of methanol, acetone, and dichloromethane (DCM) extracts. The qualitative phytochemical assessment of the bioactive extracts of the tuber of Dioscorea bulbifera was done. Quantitative analysis of total phenolic contents (TPC) and total flavonoid contents (TFC) were also determined. The scavenging activity of D. bulbifera was determined by DPPH assay. The antidiarrheal activity was experimented by the castor oil-induced diarrhea method.

Results: TPC of Acetone, Methanol & DCM extract of D. bulbifera was 537.2, 352.7, and 79.12 μgGAE/ml, respectively, and TFC of those extracts were 2.96, 1.08, and 0.35 mgQE/g, respectively. The Acetone extract of D. bulbifera (IC50 27.99 μg/ml) showed the highest antioxidant activity. Antidiarrheal properties of the three extracts were tested at 150 mg/kg, 300 mg/kg, and 600 mg/kg per body weight (bw) in mice. The methanol and DCM extracts showed an important antidiarrheal activity by curbing 69.56% and 86.95% of diarrheal faces at the doses of 600 and 300 mg/kg/bw, respectively.

Conclusion: Since the current study implies that the plant extracts gave significant results for Antidiarrheal, Antioxidant, and Phytochemical analysis, the tuber of D. bulbifera may contain therapeutic potential compounds, such as flavonoids, terpenoids, alkaloids, tannins, and saponins. These results moderate more investigation for the potential discovery of new natural bioactive compounds from this medicinal plant.

ASSESSMENT OF ANTIBIOTIC STEWARDSHIP IN TERTIARY HEALTH CARE TEACHING MEDICAL INSTITUTION IN CENTRAL INDIA

NATH MANJUSHA — 2024-11-07

Objective: The objective of the study was to mitigate the impact of antimicrobial resistance and ensure continued access to effective treatments for bacterial infections. This study was undertaken to explore the hospital status of antibiotic prescription and evaluate the impact of antibiotic stewardship in clinical wards of tertiary health care settings.

Methods: This is hospital-based observational prospective study carried out in a tertiary health care settings. All patients of either sex of any age who came in outpatient department and admitted in inpatient department of medicine, orthopedics, surgery, and pediatric departments and prescribed antibiotics were selected randomly in the study.

Results: Study response rate was male predominance (57%). Empiric antimicrobials were mainly prescribed orally (47.3%), significantly higher than injectable route (22.8%) (p<0.001), while the majority were not given an empiric antibiotic by a clinical expert. A significantly high number of patients were prescribed injectable 1st Antimicrobial after surgery/culture, namely, injectable piperacillin+tazobactum (35.5%), followed by injectable cephalosporin (34.0%), amikacin injection/4.5%, and injection carbapenem/1.8% (p<0.001). Its frequency is significantly high with BD dose (66.8%) and the majority prescribed for period of 6–10 days (63.5%) followed by 1–6 days (19.5%) (p<0.001).

Conclusion: As all prescriptions got optimal dose and duration of therapy, the stay of patients in the hospital was following Indian Council of Medical Research (2019) guideline therefore, it can thus be said that the results of this study revealed precise prescribing pattern of antibiotics. However, emphasis on information technology staff and patient education is vital in incorporating stewardship protocols. Emphasizing the importance of conducting antibiotic time-outs within 48–72 h is crucial for reassessing the necessity and choice of antibiotics. Such stewardship studies are instrumental in monitoring patterns of antibiotic usage and aid in future policy-making steps.

A STUDY OF EFFICACY OF PEMETREXED BASED CHEMOTHERAPY IN ADVANCE MALIGNANT PLEURAL MESOTHELIOMA

ANKIT AGARWAL — 2024-11-07

Objectives: To study Clinicopathological profile & treatment outcomes of stage IV Malignant pleural mesothelioma (MPM) cases.

Material and methods: The data obtained retrospectively was recorded in preformed proforma. Age, gender, hometown, residence, asbestos usage history, latent period between asbestos exposure and diagnosis, symptoms, histopathological type, stage, karnofsky performance (KPS), treatment regimen, survival were all recorded. Staging was done after histopathological confirmation of diagnosis using thoracic & abdominal Computed tomography, and/or PET CT. Patients were either treated with chemotherapy or immunotherapy.

Results: 124 patients were diagnosed with MPM stage IV. Out of these 124 patients, 23 patients received only Oral metronomic chemotherapy (OMCT) due to poor Performance status (PS), 33 patients lost to follow up, 15 patients were given immunotherapy, and 53 patients were given palliative chemotherapy (pemetrexed plus carboplatin or cisplatin every 21 days until progression or intolerability). The median age at diagnosis was 63 years (41 yrs to 79 yrs). The male: female ratio was 2:1. Patients on palliative chemotherapy had response rate of 55% (29 patients out of 53 patients responded to chemotherapy). Median PFS and median OS for those patients on palliative chemotherapy was 3.9 months and 9.1 months respectively. The patients on OMCT had response rate of 27%, median PFS of 2.7 months and median OS of 6.9 months.

Conclusion: We conclude that Advanced pleural mesothelioma has overall poor survival outcomes. Palliative pemetrexed based chemotherapy has shown better survival benefits in terms of OS & PFS as compared to OMCT alone.

COMPONENTS OF METABOLIC SYNDROME AS A RISK FACTOR FOR COVID-19 IN INDIA

GUNJAN KUMAR MANDAL — 2024-11-07

Objective: Several patients with components of metabolic syndrome (MetS) like obesity, hypertension, diabetes mellitus and dyslipidemia is a risk factor for COVID-19 in India. Aims of our review to bring together current data about components of metabolic syndrome & COVID 19 infection. It specially looks the relation between components of MetS (Obesity, Diabetes mellitus, Hypertension and dyslipidemia) and COVID 19. At the time of writing the review is updated till time.

Methods: Search of literature was done by using google search & PubMed engines for prepare review related to my article.

Results: Patients with components of metabolic syndrome like obesity, diabetes, hypertension and dyslipidemia have increased evidence of incidence and severity of COVID-19. COVID-19 has effect on the pathophysiology of all these components of metabolic syndrome. The control of all these components of metabolic syndrome is important not only for patients who are infected with COVID-19, but also for those without the disease.

Conclusions: It is commonly known that the existence of comorbidities such as increase in BMI, dyslipidemia, diabetes mellitus and hypertension is associated with additional severe course of COVID-19. So measurement of components of metabolic syndrome parameters is essential to better estimate the risk of COVID-19 and management and control of these components (BMI, blood glucose, blood pressure, lipid profile) of metabolic syndrome parameters will cause less possibility to occur COVID-19.

RESPONSE SURFACE METHODOLOGY (RSM) AS A TOOL IN PHARMACEUTICAL FORMULATION DEVELOPMENT

SRABANI PODDER — 2024-11-07

Response surface methodology (RSM) serves as a valuable tool in pharmaceutical formulation development, facilitating the optimization of drug formulations by systematically exploring the effects of multiple variables on desired responses. This methodology involves the design of experiments to generate mathematical models that predict the relationship between formulation parameters and critical quality attributes. By utilizing statistical techniques such as factorial design, central composite design, and Box-Behnken design, RSM enables the identification of optimal formulation conditions while minimizing the number of experimental trials. Across iterative experimentation and model refinement, RSM assists in understanding the complex interactions between formulation components, process variables, and product characteristics. In this review, we discuss the application of RSM in pharmaceutical formulation studies, highlighting its efficacy in optimizing drug delivery systems, enhancing product stability, and ensuring quality control. In addition, we explore recent advancements in RSM-driven approaches, including its integration with computational modeling and artificial intelligence techniques for enhanced formulation design and process optimization. Overall, RSM offers a systematic and efficient approach for developing robust pharmaceutical formulations, thereby accelerating the drug development process and improving therapeutic outcomes.