Asian Journal of Pharmaceutical and Clinical Research

EFFECTIVENESS OF WRIST BLOCK FOR SURGERY OF FRACTURE PROXIMAL INTERPHALANGEAL JOINT: A CASE REPORT

SHIVIKA NATH, PRIYA SIKKA — Sun, 07 Jul 2024 00:00:00 +0530

For upper extremity surgery involving wrist and hand, ultrasound (US) guide distal nerve block produces sufficient anesthesia with patient satisfaction. Here, we report a case study of adult with a proximal interphalangeal joint fracture and planned for US-guided wrist block involving media and ulnar using 0.5% bupivacaine + 2% lidocaine. Patient had maintenance of motor function with no complication of nerve injury. Wrist distal block produces safe anesthesia and effective patient satisfaction.

A RARE ADVERSE EFFECT OF CLOBAZAM INDUCED RASH IN A CHILD WITH FIRES (FEBRILE INFECTION WITH REFRACTORY EPILEPSY SYNDROME)

SAHELI DAS, AFSHAN JABEEN S — Sun, 07 Jul 2024 00:00:00 +0530

Clobazam, an aromatic antiepileptic drugs and its active metabolite desmethylclobazam, has high affinity and agonistic activity on gamma-aminobutyric acid receptors resulting in suppression of abnormal and excessive activity of neurons. The reported incidence of maculopapular rash with Clobazam is <1%. A 13-year-old male with a diagnosis of febrile infection-related epilepsy syndrome developed a generalized erythematous maculopapular rash the next day following the introduction of Clobazam. Following this event, Clobazam was stopped and reintroduced after 17 days. However, the rash did not appear after its reintroduction. It was observed that the patient was on Fluconazole when the rash appeared. Fluconazole being a strong CYP2C19 inhibitor, results in an increased level of active metabolite, desmethylclobazam, which probably could have caused the rash. According to the World Health Organization, Uppsala Monitoring Centre Criteria, causality assessment was found to be probable. Adverse drug reaction was recorded and reported.

The THE ASSESSMENT OF CLINICAL PROFILE AND PROGNOSTIC FACTORS AMONG PATIENTS OF HEAT STROKE IN A RURAL POPULATION: A CASE SERIES

UDAY PRABHAKAR, RUCHIKA TRIPATHI, RAJARAM YADAV — Sun, 07 Jul 2024 00:00:00 +0530

Objective: The objective was to study the clinical profile, prognostic factors, and outcomes of heat stroke in a rural population.

Methods: This was a prospective, single-center, observational study. A total of 20 consecutive patients hospitalized with a diagnosis of heat stroke were included in the study over a period of 2 months from May 1, 2023, to June 30, 2023. The baseline clinical and laboratory parameters were then studied and compared between the subjects that survived and those that did not.

Results: The mean age of patients was 58.8 years (standard deviation [SD]=10.4), and the mean body temperature on admission was 104.5°F (SD=0.910). Eighty percent of patients had non-exertional cause of heat stroke, whereas 20% had an exertional cause. The overall survival rate among hospitalized patients was 40%. In the multivariate analysis, serum creatinine, serum urea, serum sodium, and saturation of peripheral oxygen (SpO2) at admission independently predicted mortality. Age, sex, body temperature, systolic blood pressure, blood sugar level, and platelet count at admission were not associated with mortality.

Conclusion: Heat stroke has a high hospital mortality rate. Serum sodium, serum creatinine, serum urea, and SpO2 at presentation are independent predictors of hospital mortality. Body temperature is not associated with mortality.

Self-directed Learning for Medical Students

VAISHALI JAIN — Sun, 07 Jul 2024 00:00:00 +0530

“The integration of Competency-Based Medical Education (CBME) into the medical curriculum in 2019 marked a significant shift in medical education in India. This approach emphasizes the acquisition of specific competencies deemed essential for medical practice, thereby necessitating innovative pedagogical strategies to foster comprehensive learning among medical students. One such pivotal component introduced within the updated curriculum is self-directed learning (SDL), recognized as a vital means to cultivate lifelong learning skills and adaptability in medical professionals. Against this backdrop, the book on "Self-directed Learning for Medical Students" authored by Dr. Kailash Charokar, MS, MBA(HA), PGDHA, CMCL-FAIMER Fellow, NMC ACME; Dr. Vishnu Pal, PhD (Med Anatomy), NMC ACME; Dr. Yuganti Vaidya, MD(Anatomy), NMC ACME; and Dr. Tukaram Prabhu K, Msc. Medical Microbiology emerges as a timely useful resource. The contributors are experienced faculty members of the institutional medical education unit with special interest in Self-directed learning in CMBE (SDL Study Circle Team). The team has experience and supports the implementation of longitudinal educational project study in the different phases of undergraduate CBME MBBS Curriculum in the subject disciplines.

POST-OPERATIVE URINARY RETENTION AFTER SPINAL ANESTHESIA IN HERNIA SURGERY: A PROSPECTIVE, COMPARATIVE DOUBLE-BLIND STUDY BETWEEN ROPIVACAINE HEAVY 0.75% AND BUPIVACAINE HEAVY 0.5%

HETAL KANABAR, DIPTI DESAI, DINESH C BABARIYA, LAXMI YADAV, KANVEE M VANIA — Sun, 07 Jul 2024 00:00:00 +0530

Objective: The objective of this study was to evaluate and compare the effect of spinal anesthesia (SA) with bupivacaine and ropivacaine on recovery of bladder function and time of ambulation in healthy men who were scheduled for hernia surgery.

Methods: In this double-blind study, 60 patients of the American Society of Anesthesiologists I/II/III were assigned to Group B (bupivacaine)/Group R (ropivacaine). Before SA, ultrasonography-guided bladder volume was measured. After the operation, bladder volume was measured continuously every 2 hourly until the patient could void urine spontaneously or need of catheterization. Motor blockade and time of ambulation were recorded.

Results: Bromage scale at 4 h was significantly higher (p=0.0001) in ropivacaine showing intrathecal ropivacaine 3.5 mL produce shorter motor blockade then 3.5 mL bupivacaine. Both Group R and Group B were comparable in terms of ability to void urine (p>0.05), time to complete ambulation without support (p>0.05), and time to negative Romberg test (p>0.05). Negative correlation was found between the first spontaneous void urine and the modified Bromage scale.

Conclusions: After SA with bupivacaine, only two patients developed post-operative urinary retention and none in the ropivacaine. However, Group R required lesser time to void and early recovery of motor function. The time to first void urine was more than the time for complete ambulation (1–3.5 h after ambulation).

CLINICAL PROFILE AND PREGNANCY OUTCOMES OF COVID POSITIVE PREGNANT WOMEN IN PHASE I ANDII INFECTION – A COMPARATIVE STUDY

DEEPTHI PS, SATHIAMMA PK — Sun, 07 Jul 2024 00:00:00 +0530

Objectives: This study aims to assess the clinical features, the impact of coronavirus disease 2019 (COVID-19) infection during pregnancy, and the perinatal and obstetric outcomes in phases I and II.

Methods: The current study was performed from January 2020 to August 2021 at the Government T D Medical College, Alappuzha. The pregnant women were registered instantly after each infected woman was known as per the inclusion and exclusion criteria. Demographic parameters, related comorbid disorders, intensive care unit admission, and complete treatment details of each woman were noted. Neonatal outcomes were documented.

Results: There were 254 women in wave 1 and 164 women in wave 2 in the obstetric admissions. Still was seen in 3 cases (wave 1) and 2 cases (wave 2). In both phases, most pregnant women fall under the age category between 21 and 30. Multi-parity was found to be 50.8% in wave 1 women and 59.2% in wave 2 women were common in both waves. The period of gestation and obstetric comorbidities were found to be statistically significant with a p=0.007 (phase I) and 0.008 (phase II).

Conclusion: Pregnancy-related COVID-19 infection may increase the threat of maternal death but has no influence on the morbidity and death of newborns. It is not possible to totally rule out the possibility of maternal-fetal transfer. Every wave of COVID-19 may have different characteristics and severity; therefore, our treatment plans must change. To confirm this transmission, more research or meta-analysis reports are needed.

SYSTEMIC INFLAMMATION IN COMORBID METABOLIC SYNDROME AND VITILIGO: A REGRESSION ANALYSIS OF RISK FACTORS!

PAVAN K SINGH, KANISHK U KAUSHIK, RAHUL BHARGAVA — Sun, 07 Jul 2024 00:00:00 +0530

Objective: Systemic inflammatory markers are often raised in comorbid metabolic syndrome (MetS) and vitiligo. Why some patients with vitiligo develop MetS while others do not remain to be elucidated. This study aimed to identify independent risk factors for MetS development in vitiligo patients.

Methods: In this prospective study, disease characteristics (disease duration, severity, and subtype) and high-sensitivity C-reactive protein (hs-CRP) were compared between vitiligo patients (n=100) with and without MetS. Multivariate logistic regression of potential risk factors for MetS was done after adjusting for potential confounders (such as waist circumference, basal metabolic rate, serum lipids, blood pressure, and fasting blood sugar). The performance of these parameters (hs-CRP, age, disease duration, and severity) in predicting MetS development was ascertained by the area under the receiver operating characteristic curve (ROC).

Results: Vitiligo patients with MetS had a significantly longer (p<0.001) disease duration as compared to those without MetS (56±16 versus 14±12 months). On regression analysis, inflammatory markers (hs-CRP) had significantly higher odds (odds ratio [OR]=5.1) as compared to demographic factors such as gender (OR=3.1) and disease factors such as disease duration (OR=2.4) and disease severity (OR=1.8) of developing MetS. On ROC curve analysis, the performance of these parameters for MetS was hs-CRP>Vitiligo Area Scoring Index score>disease duration >increasing age (Area under the curve=0.952, 0.905, 0.851, and 0.697, respectively). The cutoff value of hs-CRP was 6.42 ug/mL.

Conclusion: Elevated hs-CRP has the highest predictive value for MetS development in vitiligo. Systemic inflammation may be the driving force for MetS development.

ROLE OF COLOR DOPPLER ULTRASONOGRAPHIC PARAMETER AS A PREDICTOR OF SPERMATOGENESIS AND INFERTILITY

PRANAB PATNAIK, SAMEER TRIVEDI, DEEPAK SHAW — Sun, 07 Jul 2024 00:00:00 +0530

Objective: Androgens target the testicular arteries, which may be aberrant in men who are infertile. One of the fastest and most accurate ways to measure testicular blood flow is by color Doppler ultrasonography (CDUS), which combines anatomical and velocity data. The goal of this research is to determine whether testicular artery end-diastolic velocity (EDV), peak systolic velocity (PSV), and resistive index (RI) can be used to differentiate between various types of dyspermia.

Methods: This was a prospective observational study. In total, 90 patients were enrolled in the study which includes 27 patients with nonobstructive azoospermia (NOA), 19 patients with oligospermia (OL), 24 with obstructive azoospermia (OA), and 20 in the control group having normal sperm count and recent paternity. We compared variables such as EDV, PSV, RI, bilateral testicular volume, testosterone, and follicle-stimulating hormone among different dyspermic groups with the control group.

Results: The mean age of the study participants was 31.5 years. PSV and RI in the NOA and OL groups were significantly lower compared to the control groups while the OA group was comparable with the control group. With respect to EDV, we observed a significantly lower value only in the NOA group compared to the control group. Significantly lower mean testicular volume and higher follicle-stimulating hormone levels were observed in the NOA group.

Conclusion: Investigating male infertility can be challenging, but CDUS might be very helpful. When used routinely in clinical settings, the RI and PSV can be trustworthy markers for identifying infertility or dyspermic males, especially distinguishing between obstructive and unobstructive azoospermia.

PREDICTORS OF INTRA CYTOPLASMIC SPERM INJECTION SUCCESS IN COUPLES WITH UNEXPLAINED SUB-FERTILITY

Sun, 07 Jul 2024 00:00:00 +0530

Objective: About 10-15% of sub-fertility cases facing the clinicians in the reproductive clinics remains unexplained. Opinions regarding the optimal treatment plan for them exhibit a wide differences among fertility specialists. This study aims to assess the outcome of ICSI and predictors success in couples with unexplained sub-fertility.

Methods: Sixty six sub-fertile couples with unexplained infertility were included. ICSI was done for all. They divided into 2 groups pregnant and non-pregnant. They were followed up retrospectively to evaluate the predictors of ICSI treatment success and results were compared between them.

Results: Chemical pregnancy was rate 42.2%. Pregnant females were significantly : younger with a mean age of 26.7±4.2 vs 28.6±3.6, lower BMI of 27.6± 4.9 vs 30.2± 4.9, lower cycle day 2 LH level 2.3 ±0.99 vs 2.9±0.94 and had a slightly thinner endometirum 3.3± 0.68 vs 3.9 ±1.1 than non-pregnant ones. Females of both groups exhibited no significant difference regarding the response to controlled ovarian stimulation, the mean total number of retrieved and mature oocytes were comparable, the only exception is the mean total number of immature oocytes which was significantly lower in the pregnant females 0.85± 1.1 vs 30.2± 4.9 in non-pregnant with no significant difference regarding fertilization rate, total number of embryos, cleavage rate and embryos’ quality.

Conclusion: Intra cytoplasmic sperm injection has the ability, within certain limits, to bypass the obstacles of natural pregnancy failure in couples with unexplained sub-fertility and should be considered for those couples as early as possible before female partner get older.

BEHAVIOR OF BLADDER AFTER TURP IN UNDERACTIVE DETRUSOR PATIENTS

PRANAB PATNAIK, VIKALAP GUPTA, SUREN DAS — Sun, 07 Jul 2024 00:00:00 +0530

Objective: The gold standard therapy for benign prostatic obstruction is transurethral resection of the prostate (TURP). Because it improves outlet resistance, it may also be useful for individuals who have detrusor underactivity (DU) with lower urinary tract dysfunction that is refractory to medicinal therapy or in situations with a substantial residual urine volume. The objective of the current study was to assess the urodynamic behavior of the bladder following TURP in DU patients.

Methods: This research examined and analyzed 41 individuals with DU (mean age 68.7 years). All these patients had a TURP for a suspected outlet blockage. All these patients had extensive pre-operative evaluations and urodynamics assessments before and after TURP. We compared maximum flow rate (Qmax), international prostate symptom score (IPSS), post-void residuals (PVR), quality of life (QoL) along with other urodynamic parameters assessing detrusor function like bladder contractility index (BCI), and detrusor pressure at Qmax (pdetQmax) pre- and post-TURP.

Results: The average duration of follow-up of patients was 9.2 months. Following TURP, the mean IPSS and QoL improvement was statistically significant. Following TURP, there was also a substantial decrease in PVR while we observed an improvement in Qmax value. Even after TURP, there was no substantial change in total cystometric capacity, BCI, or pdetQmax index.

Conclusion: DU may not be an absolute contraindication to TURP. Despite the presence of DU, the prognosis of TURP may be optimistic if the patients have evident bladder outlet obstruction. However, medically removing the blockage does not increase contractility, which is essential when evaluating and advising on TURP surgery.

COMPARATIVE STUDY BETWEEN EARLY AND LATE LAPAROSCOPIC CHOLECYSTECTOMY IN TREATMENT OF ACUTE CHOLECYSTITIS IN BUNDELKHAND REGION

RAMESH CHANDRA ARUN, MANOJ KUMAR — Sun, 07 Jul 2024 00:00:00 +0530

Objectives: Laparoscopic cholecystectomy is considered the procedure of choice for patients presenting with acute cholecystitis. The following study is an attempt to compare the outcome and operative complications of early versus late laparoscopic cholecystectomy in patients presenting with acute cholecystitis in a tertiary care center in Banda district of bundelkhand region.

Methods: The present study involved a review of case records of 80 patients with the clinical diagnosis of acute cholecystitis, admitted in the surgical wards of a tertiary care center of Banda district during the period from January 2023 to December 2023 who underwent laparoscopic cholecystectomy on an elective basis. Participants were divided into two groups, Group A (early laparoscopic cholecystectomy) and Group B (delayed laparoscopic cholecystectomy) containing 40 patients each. The hospital records of these patients were reviewed and analyzed.

Results: The present study showed statistically significant differences in age distribution and duration of surgery. The average duration of surgery was 42.3±8.97 min in Group “A” and 53.5±9.87 min for Group “B.” Male-to-female ratio was 2:1. The rate of conversion was found to be 2.5% in Group “A” as compared to 10% in Group “B.” Post-operative complications such as wound infection and biliary leakage were more common in Group “B” in comparison of Group “A.”

Conclusion: Early cholecystectomy can be considered a safe and better method of treatment for acute cholecystitis due to its shorter hospital stay, avoidance of readmission to hospital, and decreased overall costs of treatment which is a major economic benefit to both the patient and health care system in comparison of late cholecystectomy.

A PROSPECTIVE STUDY OF DISPLACED MID-SHAFT CLAVICLE FRACTURES TREATED WITH INTRAMEDULLARY TITANIUM ELASTIC NAIL SYSTEMS

ANANTH A, RAVI PRAKASH — Sun, 07 Jul 2024 00:00:00 +0530

Objective: Clavicle fractures are common injuries accounting for 2.6 to 4.0% of all fractures. It has been previously published that mid-third fractures constitute approximately 80% of all clavicle fractures. The two predominantly used procedures that are the current trend in the operative management of midshaft clavicle fractures are open reduction & plating; and intramedullary nailing through minimal access. This study evaluated the efficacy of the Titanium Elastic Nail system (TENS), a minimally invasive technique, in treating midshaft clavicle fractures.

Methods: From December 2022 to January 2024 with twenty-four patients who had plain radiographs showing a midshaft clavicle fracture, this study was conducted in our hospital which is a tertiary care facility. Patients were reviewed at 2 and 6 weeks,3 and 6 months after surgery. Nails were removed after 6 months of surgery.

Results: The average operative time duration was 37.1 minutes (Range: 25 - 60 minutes). 18 of the 24 patients had closed reduction while 6 patients (25%) patients required open reduction of their fracture. All the patients achieved clinical union at an average of 5.3 weeks (Range: 4-6 weeks) and radiological union at an average of 10.47 weeks (Range: 6 - 12 weeks). The patients were followed up postoperatively and CONSTANT and MURLEY scores were calculated at 6 weeks with an Excellent CONSTANT score in 20 patients (83.3%).

Conclusion: Besides being early mobilization, minimally invasive, and requiring less time during surgery, TENS fixation offers superior cosmetic results. For this reason, the preferred course of treatment for displaced midshaft clavicle fractures is titanium elastic nails.

A STUDY ON CLINICOPATHOLOGICAL PROFILE AND OUTCOME OF GASTROINTESTINAL PERFORATIONS: A PROSPECTIVE OBSERVATIONAL STUDY

SANJAY D DAKHORE, SAHAN M S, VIDHEY TIRPURDE, SHILPA PANDE, SUNIL B WANKHADE — Sun, 07 Jul 2024 00:00:00 +0530

Objective: The objectives of the study are as follows:

(1) To study the clinicopathological profile and outcome of gastrointestinal (GI) perforations. (2) To study the incidence, demographics, etiology, clinical features, management techniques, and factors influencing outcomes in cases of GI perforations.

Methods: This was a prospective cohort study conducted in the Department of General Surgery in a tertiary care center in central India. One hundred and twenty cases of GI perforation were included in this study. Demographic data, detailed medical history, and present complaints were recorded for each patient. Clinical features were assessed by thorough physical and systemic examinations. Relevant laboratory tests, imaging, and operative findings were investigated. Management included operative interventions and postoperative analysis with documentation of complications. For statistical purpose, p<0.05 was taken as statistically significant.

Results: The study observed a significant male preponderance in cases of GI perforations (M: F ratio 1:0.27). Patients’ age ranged from 18 to 86 years, with the highest incidence in those over 50 years (33.6%). Most patients were from Class IV and V socioeconomic status. Abdominal pain (100%) and vomiting (76.2%) were common symptoms. Hypertension (17.2%) and diabetes (14.7%) were prevalent comorbidities, with alcohol consumption (40.16%) as a notable risk factor. Gastroduodenal perforations were most frequent (63.93%). Common surgical interventions included modified Graham’s patch (62.3%) and appendicectomy (12.3%). Surgical site infections (20.4%) were common complications. Mortality was 11.4%, primarily due to sepsis.

Conclusion: Early diagnosis and proper interventions are the cornerstone of management in cases of GI perforation. Prognosis depends on symptom duration, perforation site, peritoneal contamination, preoperative hypotension, and need for preoperative abdominal drainage. Chances of mortality increase in patients who present late after perforation.

DRUG UTILIZATION STUDY OF PSYCHOTROPIC DRUGS IN PSYCHIATRY OUTDOOR PATIENTS AT A TERTIARY CARE HOSPITAL

PRANAB DAS, NIVEDITA SAHA, DOLLY ROY — Sun, 07 Jul 2024 00:00:00 +0530

Objective: The objective of this study was to evaluate the drug utilization pattern of psychotropic drugs prescribed in patients as per the World Health Organization core prescribing indicators.

Methods: The investigation examined all patient medical records who visited the outpatient department of the Department of Psychiatry, Silchar Medical College and Hospital between September 2023 and March 2024. The prescriptions were analyzed for indicators of drug use such as the quantity of drugs prescribed, generic name prescriptions, essential drug list prescriptions, antibiotics prescribed, injection prescribed, and the percentage of polypharmacy.

Results: A total of 600 prescriptions were examined. The most common type of psychotropic drug administered was antidepressants. Psychotropic drugs were administered on an average of 1.64 times per prescription. The proportion of generic names was 98.88%; the proportion of prescription encounters involving an injection was 3.33%; the proportion of psychiatric medications prescribed from the National List of Essential Medicines (NLEM) was 62.53%; and the proportion of polypharmacy was 5.5%.

Conclusion: This study setting performed well in terms of the proportion of prescriptions that included injections and antibiotics; nevertheless, it fell short of recommendations in terms of NLEM drugs, generic drugs, and minimizing polypharmacy.

CLINICAL AND MICROBIOLOGICAL PROFILE OF PATIENTS ADMITTED WITH PNEUMONIA PRESENTING TO A TERTIARY CARE HOSPITAL IN SOUTHERN RAJASTHAN

AMIT SATISH GUPTA, HARSH SHARMA, VIDUSHI MEEL — Sun, 07 Jul 2024 00:00:00 +0530

Objective: Pneumonia is a leading cause of morbidity and mortality in India. This study was conducted to understand the clinical and microbiological profile of pneumonia patients presenting to our hospital and also to understand the resistance pattern among them.

Methods: It was a retrospective observational study. Duration of the study was 6 months (June 2023 to December 2023). All patients admitted with a diagnosis of pneumonia (CAP, HAP, VAP) were included in the study and data was collected from previous medical records. Only those patients with pneumonia whose sputum or BAL (bronchoalveolar lavage) culture was positive for an organism were included in the study.

Results: A total of 50 patients with pneumonia were included the study. Majority of the patients were males (72 %) with average age of 62. Community acquired pneumonia was diagnosed in 21 patients, hospital acquired pneumonia in 15 patients and ventilator associated pneumonia in 14 patients. Most common organism isolated was Klebsiella pneumoniae (36 %), followed by Acinetobacter baumannii (24 %), pseudomonas aeruginosa (16 %), E.coli (10 %) and others (14 %). Organisms isolated from hospital and ventilator associated pneumonia showed higher prevalence of carbapenem resistance than those isolated from community acquired pneumonia patients.

Conclusion: Klebsiella pneumoniae was the most common organism isolated in CAP, HAP and VAP patients in our study. The resistance pattern of Klebsiella pneumoniae showed higher prevalence of carbapenem resistance in hospital and ventilator associated pneumonia patients as compared to CAP patients.

Keywords: Pneumonia, Hospital acquired pneumonia, Ventilator Associated pneumonia, Klebsiella pneumoniae

CLINICAL PROFILE, RISK FACTORS, AND PULMONARY FUNCTION TESTS IN PATIENTS OF OBSTRUCTIVE SLEEP APNEA

GUGULOTH MANOSRI SOWMYA, A MOUNIKA, B BHANU REKHA — Sun, 07 Jul 2024 00:00:00 +0530

Objectives: The aim of this study was to analyze clinical profile, risk factors, and pulmonary function test (PFT) in patients with obstructive sleep apnea (OSA).

Methods: This was a prospective study undertaken in the department of pulmonary medicine of a tertiary care medical institute in which adult patients OSA were included on the basis of a predefined inclusion and exclusion criteria. Demographic details of patients were noted. Gender distribution, age distribution, clinical profile, and risk factors were studied. Severity of OSA was assessed by apnea hypopnea index (AHI). PFTs were done in all the cases.

Results: Out of 60 studied cases, there were 39 (65.00%) males and 21 (35.00%) females with a M: F ratio of 1: 0.53. The mean age of the studied cases was 51.58±11.14 years. The most common risk factor present in studied cases was increased neck circumference. Severity of OSA, as determined by AHI, was found to be mild, moderate, and severe in 34 (56.67%), 20 (33.33%), and 6 (10.00%) patients, respectively. Snoring that was bothersome to others was the most common presenting complaints in studied cases and was found in 52 (86.67%) cases. PFT was normal in 23 (38.33%) patients whereas obstructive as well as restrictive features were seen in 16 (26.67%) and 14 (23.33%) patients, respectively.

Conclusion: PFTs should be included during workup of patients with OSA and obstructive lung disease may coexist and cause an increase in mortality.

METABOLIC SYNDROME AND RISK OF CARDIOVASCULAR DISEASE WITH THYROID DISORDER

RAVI SHANKAR, NEHA SHARMA, AJAY KUMAR, RAJU RAM, APARAJITA KUSHWAHA4 — Sun, 07 Jul 2024 00:00:00 +0530

Objectives: Metabolic syndrome (MetS) is the most widely used term for the aggregation of metabolic abnormalities, which leads to an increase in the risk of developing cardiovascular pathology. The prevalence of MetS is increasing all over the world with distinct evidence of high prevalence in India and other South Asian countries. Thyroid dysfunction, prominently subclinical hypothyroidism, has been observed more frequently in patients of MetS than in the general population.

Methods: This cross-sectional, observational study was conducted among MetS patients in the general population and near and dear of patients (350) at the Pacific Institute of Medical Sciences, Udaipur. For the determination of gastric peptidases (ghrelin and obestatin), insulin was done by enzyme-linked immunosorbent assay. Thyroid hormones are determined by chemiluminescence.

Results: The key findings in this analysis are the significant negative correlation between insulin and ghrelin. This inverse relationship was observed in individuals without cardiovascular disease (CVD), suggesting that even in the absence of overt CVD, insulin may play a role in regulating ghrelin levels. This finding is particularly noteworthy given ghrelin’s role in appetite regulation and energy balance.

Conclusion: The findings emphasize the need for a holistic approach to health assessment and management, considering individual factors such as age, sex, and the presence of underlying health conditions along with thyroid disorders.

ROLE OF ANTIOXIDANT AND INFLAMMATORY MARKERS WITH METABOLIC SYNDROME AND RISK OF CVD IN THYROID PATIENTS

RAVI SHANKAR, AJAY KUMAR, NEHA SHARMA, RAJU RAM, APARAJITA KUSHWAHA — Sun, 07 Jul 2024 00:00:00 +0530

Objectives: Metabolic syndrome is the most widely used term for the aggregation of metabolic abnormalities, which leads to an increase in the risk of developing cardiovascular pathology. Protective nutritional antioxidants may benefit defensive antioxidative systems in resolving pro-oxidative dominance and redox imbalance, preventing, or delaying chronic thyroid diseases.

Methods: This cross-sectional, observational study was conducted among metabolic syndrome patients in the general population and near and dear patients (350) at the Pacific Institute of Medical Sciences, Udaipur. For the determination of interleukin-6 (IL-6) was done by enzyme-linked immunosorbent assay. Thyroid hormones are determined by chemiluminescence and antioxidant Vitamin C and malondialdehyde (MDA) chromatography and high-performance liquid chromatography, respectively.

Results: This study shows a low level of antioxidant Vitamin C and MDA and a high level of inflammatory marker IL-6 in these patients. In this study, the age distribution of patients showed that males in the 35–51 years of age group were most affected, whereas females in the 18–34 years of age group were more prevalent.

Conclusion: The present study leads to awareness of antioxidant levels and inflammation in thyroid patients along with other biochemical parameters involved in the development of metabolic syndrome in the Indian population.

EVALUATION OF OUTCOME OF 48 CASES OF LAPAROSCOPIC PYELOPLASTY AT TERTIARY CARE TEACHING HOSPITAL OF SOUTHERN RAJASTHAN

PANKAJ TRIVEDI, VISHWAS BAHETI, PUSHPENDRA CHOUDHARY — Sun, 07 Jul 2024 00:00:00 +0530

Objectives: The objective of this study was to evaluate the outcome of 48 cases of laparoscopic pyeloplasty at a tertiary care hospital of Southern Rajasthan where medical facilities are still evolving.

Methods: Data of 48 patients from the medical record department, who underwent laparoscopic pyeloplasty surgery in past 4 years (January 2019– January 2023) for primary ureteropelvic junction (UPJ) obstruction due to intrinsic UPJ abnormality or aberrant vessels, were analyzed retrospectively. Intraoperative findings, success rate, and complications were recorded.

Results: Pelvic reduction was required in 30 (62.5%) patients. The mean operative time was 182.4 min and the mean blood loss was 55 mL. The mean hospital stay was of 4.2 days. Success rate of laparoscopic pyeloplasty was 97%. Over all 10.41% of patients had complications.

Conclusion: Laparoscopic pyeloplasty deals concomitant secondary stones with less morbidity and complications. It has better cosmetic outcome as compared to open techniques and similar long-term success rates. Hence, it can be concluded that laparoscopic pyeloplasty is an excellent current gold standard for primary UPJ obstruction.

PLATELET TO LYMPHOCYTE RATIO IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

jeevithan shanmugam — Mon, 01 Jul 2024 00:00:00 +0530

Objective:

Acute myocardial infarction (AMI) results from the total occlusion of a coronary artery, often due to thrombus formation on a complicated atherosclerotic plaque. Despite advances in reperfusion techniques, patients with AMI face poor prognosis and high early mortality rates. Inflammatory markers, such as the platelet-to-lymphocyte ratio (PLR), have shown potential in predicting poor prognosis and major adverse cardiovascular events (MACE). This study aims to evaluate the prognostic value of PLR in predicting immediate outcomes in AMI patients by examining the relationship between PLR and the Killip classification, a tool used to assess heart failure severity.

Materials and Methods:

This prospective observational study included 75 patients diagnosed with AMI based on clinical presentation, electrocardiographic changes, and elevated cardiac biomarkers. Ethical committee clearance and informed consent were obtained. Baseline demographic and clinical data, including smoking status, hypertension, and diabetes mellitus, were collected. The Killip classification assessed heart failure severity at admission. Blood samples were collected at admission (Day 1) and at the end of the first week (Day 7) to measure PLR values using automated hematology analyzers. Descriptive statistics summarized socio-demographic characteristics. T-tests compared PLR values between Day 1 and Day 7 for each Killip score, and ANOVA assessed differences in PLR across different Killip scores. Correlation analysis evaluated the relationship between Killip scores and PLR at admission and the end of the first week.

Results:

The majority of patients were aged 40-59 years (44%) or older than 60 years (41.33%), with a predominance of male patients (70.67%). A significant number of patients were smokers (61.33%), and many had hypertension (61.33%) and diabetes mellitus (57.33%). Analysis showed a significant reduction in PLR from Day 1 to Day 7 for all Killip scores. For instance, Killip score 1 saw a reduction from 112.34 ± 21.09 to 93.83 ± 15.27 (t = 6.157, p < 0.001). Higher Killip scores were consistently associated with higher PLR values at both time points. Correlation coefficients were 0.85 at admission and 0.82 at the end of the first week (p < 0.001 for both), indicating a strong positive relationship.

Conclusion:

The study highlights the prognostic significance of PLR in AMI patients, with higher Killip scores associated with significantly higher PLR values. This consistent relationship suggests that PLR can serve as a reliable marker for early risk assessment and prognosis in AMI patients, supporting its potential utility in clinical practice. Further research is warranted to confirm these findings and explore the integration of PLR into routine clinical management of AMI.

Role of Dual-Energy CT in the Emergency Diagnosis of Knee Bone Marrow Edema: A Comparative Study with MRI

Pankaj Mehta — Tue, 02 Jul 2024 00:00:00 +0530

Key markers of injury processes in acute knee trauma are bone bruises, which are detected by MRI as increased signal intensity on T2-weighted images and signal loss on T1-weighted imaging. However, because of its restricted availability and lengthy acquisition times, particularly in emergency situations, MRI is not often employed in knee trauma cases. A viable substitute is dual-energy CT (DECT) with virtual non-calcium (VNCa) techniques, which improves bone marrow edema (BME) visibility and allows for greater material distinction. This study uses MRI as the reference standard to assess the diagnostic performance of third-generation DECT and VNCa methods for detecting BME in acute knee injuries.

Materials and Methods

This prospective observational study involved 40 patients with acute knee trauma who had both MRI and DECT between July 2019 and July 2021 at Kovai Medical Center and Hospital in Coimbatore. Individuals who were pregnant, had a history of knee injuries, or were above the age of eighteen were eliminated, as were those who had an MRI or CT contraindication. Siemens Healthcare's Somatom Force, a third-generation 192-slice dual-source CT scanner, was used for DECT imaging, while Philips Ingenia 1.5T was used for MRI. Image analysis used SPSS version 27.0 for statistical analysis to determine whether bone marrow edema was present in MRI and DECT images.

Results

The study participants had a mean age of 47 ± 16 years, predominantly male (72.5%). DECT demonstrated a sensitivity of 81.15% and a specificity of 96.70% for detecting BME compared to MRI. The diagnostic accuracy was notably high in the lateral femoral condyle (sensitivity and specificity of 93.33%) and the lateral tibial condyle (sensitivity and specificity of 86.36%). Overall, DECT identified 59 out of 69 MRI-positive regions, reflecting its robustness in detecting true positives and true negatives in acute trauma settings.

Conclusion

Third-generation DECT with VNCa techniques is a highly effective imaging modality for detecting oedema of the bone marrow in acute knee trauma, offering high diagnostic accuracy comparable to MRI. Its ability to provide clear visual differentiation and rapid acquisition makes it a valuable alternative, particularly in emergency settings where MRI is unavailable or contraindicated. DECT’s shorter reconstruction time and high reliability can optimize workflow and improve patient outcomes, underscoring its potential role in early diagnosis and management of knee trauma.

A CROSS-SECTIONAL STUDY TO ASSESS THE COMPLIANCE TO IRON FOLIC ACID TABLETS AMONG WOMEN ATTENDING ANTENATAL CLINIC

SIVA KEERTHIKA S, SANTOSH BIRADAR, VINOD S KAMBLE, SHRINIVAS REDDY B — Sun, 07 Jul 2024 00:00:00 +0530

Objective: As anemia is highly prevalent among pregnant women, the government of India took the initiative to start prophylactic iron folic acid tablets (IFA) to reduce its prevalence. Hence, this study was done with the objectives to assess compliance to IFA among antenatal women and to identify the associated factors.

Methods: The present study was a cross-sectional study conducted among 100 women attending antenatal clinics. A pre-designed semi-structured questionnaire was used to collect the data. The data were analyzed for frequency, percentage, and Chi-square.

Results: The compliance to IFA was found to be 46.15% and was significantly more in anemic pregnant women.

Conclusion: The prevalence of compliance to IFA tablets was only 46.15%. Hence, counseling and awareness to be done about the importance of taking IFA tablets regularly during the antenatal period, so that compliance can be improved.

OUTCOMES OF PRP INJECTION THERAPY IN SUBACROMIAL SPACE IN PARTIAL TEARS OF ROTATOR CUFF

Sun, 07 Jul 2024 00:00:00 +0530

Objective: The aim of the study was to record the outcomes of the platelet-rich plasma (PRP) injection therapy in the subacromial area in cases of partial rotator cuff (RC) tears on controlling pain and improving shoulder mobility and performing daily activities with ease.

Methods: The study was conducted in the Orthopedics branch of Government Medical College and Rajindra Hospital Patiala on a total of 50 patients (aged more than 20 years) who presented in the emergency and Outpatient Department with symptoms of anterolateral shoulder pain and decreased range of motion at shoulder joint, who had not responded to conservative management and physiotherapy measures for consecutive 3 months. The patients were subjected to magnetic resonance imaging of the affected shoulder and those who showed partial cuff tears were considered for the study. Every consenting patient was given a PRP injection by posterior approach into the subacromial space. Patients were then followed up subsequently after 1 month, 6 months, 12 months, and 24 months for resolution of symptoms and improved painless activities at the shoulder. The outcome was assessed based on Visual Analog Scale (VAS) system and constant shoulder scoring system.

Results: Comparison of the patients before and after injection therapy revealed a significant difference in VAS and constant shoulder scale at all the follow-up times with maximum improvement at the longest follow-up period.

Conclusion: Injection of PRP in subacromial space was found safe and effective in enhancing overall life quality with the betterment of symptoms in patients with anterolateral shoulder pain, and thus, improving efficiency of work, shoulder functioning in patients having partial RC tears irrespective of its cause with its beneficial effects more at long term.

ROLE OF POLIDOCANOL IN PERCUTANEOUS SCLEROTHERAPY IN TREATMENT OF ABC - A SINGLE CENTRE STUDY

Sujin Shanmugavelu — Sun, 07 Jul 2024 00:00:00 +0530

INTRODUCTION: Aneurysmal Bone Cyst (ABC) is a rare, benign, cystic lesion mostly found at the eccentric location of metaphysis of long bones. ABC constitute 1% of benign bone tumours. ABC is expansile, highly vascular and osteolytic in character. Population of 1st and 2nd decades are vulnerable to ABC. Curettage with bone grafting (auto-graft or allograft) is considered the mainstay of treatment for ABC. Curettage and bone grafting showed high rates of morbidity as well as recurrence. Other advanced treatment modalities include radiotherapy, wide excision and sclerotherapy. Here, in our retrospective study, we studied aneurysmal bone cysts treated with percutaneous sclerotherapy with polidocanol as a sclerosing agent presented to our hospital for the last 3 years.

MATERIALS AND METHODS: This is a single centre retrospective study conducted in the Department of Orthopaedics in Kurnool Medical College with 23 patients from 2018 to 2021 over three years with 3% Polidocanol as sclerosing agent in percutaneous sclerotherapy as a treatment option for ABC. Postoperatively the patients are evaluated based on clinical and radiological examinations.

RESULTS: Patients were evaluated based on clinical and radiological outcomes. Clinically patients were compared to their own VAS (Visual Analog Sore) score at the time of healing to VAS score during their 1^st visit. The mean VAS during 1^st visit was 7.6. At the time of healing, there were only 2 patients who scored 1 on the VAS score. Radiologically, plain radiographs were observed for ossification. 20 (86.9%) patients achieved complete ossification, 2(8.69%) patients could achieve partial ossification.

CONCLUSION: With this study, we like to present that percutaneous sclerotherapy with 3% polidocanol is effective both clinically and radiologically in the treatment of Aneurysmal Bone Cysts. Our institution has adopted sclerotherapy as part of salvage therapy and as 1st line of treatment in treating ABC tumours.

EFFECT OF AMINO ACID ADDITION AS STABILIZERS ON TOTAL PROTEIN CONTENT OF INTRAVENOUS THERAPEUTIC HUMAN NORMAL IMMUNOGLOBULIN

Sun, 07 Jul 2024 00:00:00 +0530

Objectives: This study was conducted to show the variation in total protein content of therapeutic immunoglobulin batches after the addition of free amino acids.

Methods: A total of 10 different batches of therapeutic human normal immunoglobulin from five different manufacturers were taken. The total protein content in these samples was determined by both Kjeldahl and Biuret methods. The total protein in these samples was also determined by both methods after the addition of 0.3 M glycine, 0.3 M arginine, and 0.3 M histidine separately.

Results: In neat samples, both methods quantified similar total protein content. However, both methods showed different protein contents where amino acids such as glycine, arginine, or histidine have been added. The total protein content by the Kjeldahl method in the samples added with glycine, arginine, or histidine was found higher as compared to the Biuret method.

Conclusion: Our study suggests that the manufacturers of therapeutic immunoglobulin should replace amino acid stabilizers with nonnitrogenous stabilizer because the Kjeldahl method recommended in various pharmacopeias is based on the detection of total nitrogen. Therefore, the addition of any nitrogenous stabilizer will be quantified as protein and results may be out of specification when minimum and maximum limits are prescribed in the pharmacopeia.

REVERSE-PHASE HIGH-PERFORMANCE LIQUID CHROMATOGRAPHY METHOD DEVELOPMENT AND VALIDATION FOR THE QUANTIFICATION OF SUGAMMADEX IN BULK AND PHARMACEUTICAL DOSAGE FORM

BHAVYA SRI K, SRIJA G — Sun, 07 Jul 2024 00:00:00 +0530

Objective:A reproducible, precise, accurate method was developed for the analysis of Sugammadex in pharmaceutical dosage form and bulk, using RP-HPLC. This method is established in compliance with ICH guidelines Q2R1.

Method:The method development and method validation of Sugammadex was performed usingthe instrument, SHIMADZULC- 20 AD pumps with SPD- 20A UV detector. A Phenomenex C18 250mm × 4.6mm × 5µm column was employed with detection wavelength of 210 nm.

Results: The method validation was performed in accordance with ICH Q₂R(1) guidelines where the calibration curve was found to be linearwith r²as 0.9993. The LOD and LOQ were found to be 0.03784µg/ml and 0.114667µg/ml respectively.The %RSD of theprecision wasobserved to be in limits (≤2%).

Conclusion:All validation parameters, including linearity, range, detection limit, quantification limit, precision, and accuracy, were examined and found to be within the specified limits in accordance with ICH recommendations Q2 (R1). In view of this, adopting this approach for routine quality control tests of both pure and pharmaceutical formulation can be done with ease.

The THE EFFECT OF ACNE VULGARIS ON QUALITY OF LIFE AMONG RURAL PATIENTS: A CROSS-SECTIONAL STUDY

RUCHIKA TRIPATHI, UDAY PRABHAKAR, RAJARAM YADAV — Sun, 07 Jul 2024 00:00:00 +0530

Objectives: Acne vulgaris affects a large majority of adolescents, often extending into adulthood. The aim of the study was to determine its impact on the quality of life (QoL).

Methods: This was a cross-sectional, questionnaire-based study, conducted on 60 patients, who attended the dermatology outpatient department and were diagnosed with acne vulgaris by the physician. The severity of lesions was assessed using the global acne grading system, and QoL was assessed using the dermatology life quality index (DLQI) questionnaire. Statistical analysis was done to assess any possible association between DLQI with severity and sequelae of acne vulgaris.

Results: The mean DLQI score was 5.46. There was a significant association between DLQI and severity of acne grade (p<0.05).

Conclusion: There is a significant impact of acne on QoL, and hence, a holistic approach is required to treat it.

TO COMPARE THE METABOLIC SYNDROME AND ITS ASSOCIATED FACTORS WITH THE NORMAL HEALTHY POPULATION

INDERPREET KAUR, PURNIMA JINDAL, RAJINDERJIT SINGH AHI, JASWANT KAUR — Sun, 07 Jul 2024 00:00:00 +0530

Objective: Metabolic syndrome (MetS) is an associated conditions that together rise the risk of cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). The study’s hypothesis was to assess the prevalence of the Mets and its associated factors among the North Indian population.

Methods: The prevalence of the MetS was estimated to be two hundred patients who visited the hospital of Guru Nanak Dev, Sri Amritsar. Following variables such as body mass index, waist circumference, high-density lipoprotein-cholesterol, triglycerides, and fasting blood glucose were done.

Results: The prospective observational study revealed that the prevalence of the MetS was higher in women than men, based on the International Diabetes Federation definition (female-55% and male-45%). MetS was more prevalent in the study of patients with age >60 years. A strong association was found between the above parameters (p<0.05) with the Mets.

Conclusion: Amid the Mets driving the twin global pandemic of CVD and T2DM. There is a medical and economic imperative to identify those individuals with the Mets, so that interventions and treatment may prevent T2DM with CVD.

EFFECT OF INTRAVENOUS LIGNOCAINE ON HEMODYNAMIC VARIABLES DURING INTRAOPERATIVE AND POST-OPERATIVE PERIOD

SHEETAL KHANDEKAR, SANJIV TITLER, SHYAMBARAN, RAKESH DR, RAVINDRA SINGH — Sun, 07 Jul 2024 00:00:00 +0530

Objectives: The objective of this study was to assess the efficacy of intravenous lignocaine on hemodynamic variables during intraoperative and post-operative periods and in relieving post-operative pain in major abdominal surgery.

Methods: To investigate the effects of lidocaine, we designed a double-blind study. We enrolled 100 patients of ASA Grade I or II slated for major abdominal procedures. Each participant received either lidocaine or a saline placebo intravenously. After surgery, we monitored their pain levels, vital signs, and any potential side effects.

Results: Our study revealed clear differences in heart rate, blood pressure (both systolic and diastolic), and overall arterial pressure between the lidocaine and placebo groups. Notably, the lidocaine group experienced fewer side effects, such as nausea, vomiting, headache, and shivering, compared to the control group.

Conclusion: Intravenous lidocaine reduces intraoperative and post-operative pulse rate and blood pressure in major abdominal surgery. It delays analgesic needs and lowers the incidence of nausea, vomiting, chills, and headache compared to controls.

TO MONITOR THE ADVERSE DRUG REACTIONS ASSOCIATED WITH THE USE OF ANTIHYPERTENSIVE AGENTS IN A TERTIARY CARE HOSPITAL IN CENTRAL KERALA

Sun, 07 Jul 2024 00:00:00 +0530

Objective: The objective of the study is to monitor the adverse drug reactions (ADRs) due to anti-hypertensive drugs prescribed in a tertiary care hospital.

Methods: The study was conducted in the outpatient department of General Medicine of a tertiary care hospital in Kerala. The demographic details and suspected ADRs were collected from the patients and evaluated, and causality assessment was done.

Results: More women developed ADRs compared to men due to the anti-hypertensive drug. The occurrence of adverse reactions was seen to be more in older patients over 50 years of age compared to younger individuals. The occurrence of ADR was more in patients using a combination of drugs (74.3%) rather than monotherapy. Calcium channel blockers were associated with more number of adverse reactions (62.5%) with amlodipine showing the maximum ADRs (64.8). The commonly seen ADR was edema. When the causality assessment was done, most were probable/likely followed by possible.

Conclusion: This study shows that calcium channel blockers were the therapeutic class of drugs that caused the most number of ADRs, especially pedal edema; there was a higher frequency of ADRs to various antihypertensive drugs. Females and those more than 50 years old had shown a higher proportion of ADRs though not statistically significant. Furthermore, those individuals who took more drugs to treat hypertension also showed more ADRs. This study of adverse reactions toward antihypertensive medications will help physicians to choose a better option to treat their patients which will eventually help in patient satisfaction and medication safety.

HERPES SIMPLEX KERATITIS IN A TERTIARY CARE CENTRE: A CLINICAL PRESENTATION

GOMPA MOHANA PREETHI , Diksha Panchbhai — Sun, 07 Jul 2024 00:00:00 +0530

Objectives: The objectives of the study are (1) to evaluate the demography of herpes simplex keratitis and (2) to determine the incidence of various forms of herpes simplex keratitis. In developing countries, bacterial and fungal keratitis are the most common cause of keratitis. Hence, the epidemiology of herpes simplex keratitis is not well studied. The present study aims to study the epidemiology of herpes simplex keratitis.

Methods: It is a prospective study of herpes keratitis patients at a tertiary care center. The study was conducted on 50 patients who presented in the tertiary care center from January 1, 2021, to August 30, 2021. Detailed history, slit-lamp examination, fluorescein staining, corneal sensations, and other needful investigations were carried out. The diagnosis was made clinically.

Results: Males (60%) were affected more than females (40%). Most of the patients were between the ages of 30 and 50. The order of most common presentation is epithelial keratitis (60%), stromal keratitis (34%), endotheliitis (4%), and mixed stromal and epithelial keratitis (2%). The majority of the patients had mild visual impairment (60%).

Conclusion: Herpes simplex keratitis presented mostly in the 3rd–5th decade. In comparison to females, it is more common among males. The order of presentation observed was epithelial keratitis followed by stromal keratitis followed by endotheliitis followed by mixed stromal and epithelial keratitis. The majority of the patients presented with mild visual impairment.

AN OBSERVATIONAL STUDY ON THE OUTCOME OF ANTITUBERCULAR AND ANTIDIABETIC THERAPY IN PATIENTS OF TUBERCULOSIS WITH DIABETES MELLITUS AS COMORBIDITY

JEENAL MISTRY, ANITA SINHA, B DIVAKAR, NAYAN GAVLI, PARUL VADGAMA — Sun, 07 Jul 2024 00:00:00 +0530

Objectives: Overall goal: To observe and compare the effect of antitubercular and antidiabetic therapy on patients of tuberculosis with diabetes mellitus as comorbidity. To study the effect of antidiabetic therapy on treatment outcome of tuberculosis. To study the effect of antitubercular drugs on glycemic control of patients of tuberculosis with diabetes mellitus

Methods: A total of 134 patients of tuberculosis with and without diabetes mellitus were approached for enrollment in this prospective observational cohort study as per NTEP guidelines. Effects of antitubercular therapy on antidiabetes drugs and vice versa during this study were observed and noted. A comparison of outcomes between two groups of patients of tuberculosis with diabetes and tuberculosis without diabetes was done according to outcome parameters.

Results: Mortality was found in patients on ATT+ADD nearly 11.94% (n=8) as compared to patients on ATT only 2.98% (n=2). Delayed sputum conversion with higher sputum positive rate (1+) among patients on ATT+ADD (23.89%) and mean HbA1c value at the end of the continuous phase (CP) was 6.7±1.07 among patients on ATT+ADD.

Conclusion: The patients on ATT+ADD have higher sputum positivity rates and poor treatment outcomes as compared to patients on ATT alone. Poor glycemic control in patients receiving ATT+ADD unfavorably leads to poor compliance with antitubercular therapy.

A STUDY OF VISUAL OUTCOME AND COMPLICATIONS OF SCLERAL-FIXATED INTRAOCULAR LENS

KAMLESH NAJUKRAM LANJE, RAJESH B GOTEKAR, SREELAKSHMI PILLAI — Sun, 07 Jul 2024 00:00:00 +0530

Objectives: Objectives of this study are to find indications for the scleral-fixated intraocular lens, to measure visual acuity in patients with scleral-fixated intraocular lens postoperatively and also to note the complications of scleral-fixated intraocular lens intra and postoperatively.

Materials and Methods: The study includes 36 eyes of 36 aphakic patients presenting to Ophthalmology department between November 2019 and April 2021 after obtaining Institutional Ethical Committee Clearance. Informed and written consent were obtained from each patient included in the study. Goldmann applanation tonometer was used to record IOP for all cases preoperatively. Detailed ophthalmic examination was done on slit-lamp biomicroscope and best corrected visual acuity was recorded. Keratometry was done using an autorefractokeratometer. The axial length of the eye was calculated with the help of A scan biometry in aphakic mode. IOL power was then calculated with the SRK T formula using 118.2 as A constant for SFIOL. Patients underwent anterior vitrectomy followed by scleral fixation intraocular lens implantation by Gabor’s technique after the detailed preoperative examination. The postoperative examination was done on day 1, day 7, at 1 month, and at 3 months, and the findings were noted.

Result: Out of 36, 25 (69%) patients were having surgical aphakia due to complications of cataract surgery. 5 (14%) patients were having aphakia due to trauma to the eye and 6 (17%) patients were having spontaneous dislocation of lens. Good visual outcome was observed postoperatively. Improvement in BCVA to 6/18 or more was observed in all 36 (100%) patients at the end of 1 month. Corneal edema, AC flare, vitreous hemorrhage, and increase in intraocular pressure were some of the complications that were noted in the immediate postoperative period. However, all the complications had resolved at the end of 1 month.

Conclusion: From this study, we can conclude that combined anterior vitrectomy and scleral-fixated sutured PCIOL implantation is an effective and safe procedure to correct aphakia in eyes without adequate capsular support. It provides excellent visual outcome with less postoperative complications. Furthermore, it is a superior alternative to ACIOLs and iris-fixated IOLs as it decreases the complications such as bullous keratopathy, UGH syndrome, iritis, and CME.

COMPARATIVE ROLE OF ULTRASOUND AND COMPUTED TOMOGRAPHY IN DIAGNOSIS OF NONTRAUMATIC RIGHT ILIAC FOSSA PAIN IN PATIENTS ABOVE 50 YEARS OF AGE ADMITTED IN A TERTIARY-CARE HOSPITAL

PRASUN DAS; SUDIPTA BASU, MALAY KARMAKAR; SRIJAK BHATTACHARYYA — Sun, 07 Jul 2024 00:00:00 +0530

Objectives: The objective of the study was to evaluate and compare the role of ultrasonography (USG) and computed tomography (CT) in diagnosing non-traumatic right iliac fossa (RIF) pain in the geriatric population. More specifically, to evaluate the diagnostic accuracy parameters of both imaging modalities after enumerating the relevant etiologies. The ultimate aim is to assess the diagnostic accuracy variables of USG in diagnosing non-traumatic RIF pain in the elderly, taking computed tomography as the gold standard of investigation.

Methods: Fifty patients in the elderly age group with non-traumatic RIF pain were evaluated consecutively by USG, followed by a CT scan.

Results: Overall, in detecting non-traumatic RIF pain in our study, sonography was found to have sensitivity, specificity, positive predictive value, and negative predictive value of 35.14%, 23.07%, 56.52%, and 11.1% with respect to a CT scan. It also reveals that in diagnosing the different etiologies of RIF pain, the findings of the USG have a weakly positive correlation with the findings of the CT scan. It also reveals that, on comparison between CT and USG, we found a statistically significant difference in diagnosing RIF pain in this study population.

Conclusions: We therefore conclude that ultrasound may be used as an initial imaging investigation as the majority of cases of non-traumatic RIF pain come in the acute stage and emergency ultrasound comes into play due to its easy use and more availability. However, we must do a CT scan after that to narrow down the differential diagnoses in this age group.

STUDY OF THE PHYSIOLOGICAL ROLE OF STREBLUS ASPER AS A CHEMOPREVENTIVE AGENT ON HUMAN PROSTATE CANCER (DU-145) CELL LINE

Sun, 07 Jul 2024 00:00:00 +0530

Objectives: This study aims to explore the chemopreventive potential of Streblus asper extracts against prostate cancer cells. Specifically, it seeks to assess the efficacy of these extracts in inducing apoptosis and inhibiting cell proliferation within these cancer cells.

Methods: The inhibitory effects of S. asper extracts were evaluated using the TBEA technique to determine the IC50 values. Morphological changes were indicative of apoptosis, such as cell shrinkage, rounding, vacuolization, formation of apoptotic bodies, membrane blebbing, and cell elongation were observed following treatment. An 8-day cell proliferation assay was conducted to examine the effects on prostate cancer cell line proliferation. In addition, the safety of S. asper root extracts was assessed in vitro using a Mouse fibroblast cell line to ensure no cytotoxic effects were present on normal cells.

Results: Streblus asper extracts demonstrated a significant inhibitory effect on the proliferation of prostate cancer cells, with no observed cytotoxicity on normal Mouse fibroblast cell lines. The results from the TBEA technique confirmed the extract’s potency, with noticeable morphological changes supporting the induction of apoptosis in the treated cancer cells.

Conclusion: The findings from this study offer promising insights into the potential of S. asper extracts as chemopreventive agents against prostate cancer. By exhibiting significant inhibitory effects on cancer cell proliferation and inducing apoptosis without harming normal cells, S. asper presents a viable, natural alternative in the fight against prostate cancer. Further research and clinical trials are warranted to fully elucidate its therapeutic potential and application in cancer prevention strategies.

SEROPREVALENCE OF HERPES SIMPLEX VIRUS INFECTION TYPE 1 AND 2 IN A POPULATION OF HIV-POSITIVE AND HIV-NEGATIVE INDIVIDUALS IN A TERTIARY CARE HOSPITAL

MEGHNA SHARMA, SAPNA SONEJA, LOVEENA OBEROI, ANURADHA MALHOTRA — Sun, 07 Jul 2024 00:00:00 +0530

Objectives: The aim of this study is to determine the seroprevalence of herpes simplex virus (HSV) in a population of human immunodeficiency virus (HIV) positive and non-HIV patients and its association with CD-4 count.

Methods: 200 HIV-positive individuals attending antiretroviral treatment clinic and 100 HIV-negative individuals from the clinical departments of Government Medical College, Amritsar, were enrolled in the study. The sera were tested in parallel using anti-HSV-1 immunoglobulin G (IgG) enzyme-linked immunosorbent assay (ELISA) (calbiotech), anti-HSV-2-IgG (calbiotech), and HSV-1/2 pool IgM ELISA (calbiotech) assays as per the manufacturer’s instructions. Sysmex partec CyFlow counter IVD flow cytometer. CD4+ reagents are used for measuring absolute counts of CD4+ T lymphocytes.

Results: For anti-HSV-2 IgG, seroprevalence was positively associated with HIV-positive status. The mean CD4+ T lymphocyte counts for anti- HSV-2 IgG patients were 400.45±122.92 cells/μL in the HIV-positive group (n=163). Mean CD4+ counts in HSV-2 IgG-negative cases were 350.05±160.46 cells/μL. This association was statistically significant.

Conclusion: HSV-1 and 2 are common lifelong infections that often are asymptomatic. African studies have highlighted HSV synergism with HIV infection. Seroprevalence of this common infection and the studies covering the Northern India region are scarce. Our study has confirmed this coinfection synergism. Increasing awareness of HSV-HIV synergy can contribute to better informed decisions regarding safe sex practices.

ROLE OF MAMMOGRAPHY IN RESPONSE ASSESSMENT FOLLOWING NEO-ADJUVANT CHEMOTHERAPY IN LOCALLY ADVANCED BREAST CARCINOMA: EXPERIENCE FROM A TERTIARY CARE CENTER

BIDYUT BISWAS, MD ASIF ALI, SHATANIK MONDAL, LINKON BISWAS — Sun, 07 Jul 2024 00:00:00 +0530

Objectives: Neo-adjuvant chemotherapy (NACT) has an important role in the treatment of locally advanced breast carcinoma (LABC). In this study, we analyzed the efficacy of mammography in response assessment of NACT in patients with LABC and its correlation with histopathological reports.

Methods: Eighty patients with LABC underwent clinical examination and mammography at first. Then, after receiving three cycles of NACT, mammography and clinical examination were done again to evaluate the response to NACT. Patients with at least a partial response underwent radical surgery. Then, we correlate the findings of histopathological reports with that of post-NACT mammography findings.

Results: After three cycles of NACT, mammography detected complete response (CR) in 20% (n=28) patients and partial response (PR) in 70% (n=48) patients. Clinical examination overestimated the CR to be 45% and underestimated PR to be 50%. Histopathological examination (HPE) showed complete pathological response in 25 specimens and in rest 51 cases HPE revealed residual tumor. Mammography overestimated the pathological complete response by 4% (three patients).

Conclusion: It can be said that mammography can be used as an effective imaging tool for response assessment after NACT, especially in resource-limited setups.

ASSESSMENT OF HANDS-ON TRAINING ON INTERNS’ PRESCRIPTION WRITING SKILLS AT A TERTIARY CARE TEACHING HOSPITAL

SWETHA K, NITHIN SHETTY, VISHNU K, NEETA T GAVIMATH — Sun, 07 Jul 2024 00:00:00 +0530

Objectives: This study was conducted with an objective to assess the prevalence of prescription errors and to compare the prescription writing skills of the interns’ pre and post-teaching interventions on the appropriateness “prescription writing.”

Methods: This research was conducted in a tertiary care teaching hospital Karwar Institute of Medical Sciences, Karwar. All interns posted to the orthopedics department as a part of rotatory internship postings during the 6 months from June 2021 were included in this research after receiving informed permission in writing. We gathered the written prescriptions for three distinct cases and a seminar and hands-on training about “prescription writing” was given. Subsequently, the interns were requested to re-write new prescriptions for the same three situations.

Results: A total of 390 prescriptions from 65 interns were gathered and analyzed. In 58%, 36%, 62%, and 78% of the prescriptions, date, diagnosis, prescriber’s name and qualification were absent. In 44% and 12% of the prescriptions, the patient’s age and name were not written, respectively. Following the hands-on teaching intervention, a noteworthy enhancement in the overall prescription writing was noted.

Conclusion: Interns often write prescriptions incorrectly because they do not retain the pharmacotherapeutic information that was given in the 2nd year of the undergraduate program. A teaching program of basic prescription writing is necessary to refresh their knowledge and prescription writing skills.

CHIMERIC ANTIGEN RECEPTOR T CELLS: PAST, PRESENT, AND FUTURE

NAGARAJ BM, SHRUTHI DP — Sun, 07 Jul 2024 00:00:00 +0530

Chimeric antigen receptor T (CAR T) therapy, a type of anticancer cellular immunotherapy, is emerging expeditiously. Primarily reported in 1987, the concept of a chimeric T-cell receptor (TCR), which combines antibody-derived variable regions with TCR-derived constant regions, was then, followed by double-chain chimeric TCR (cTCR) and single-chain variable fragment receptor chimeric cell (referred to as “T-bodies,” the prototypes of modern CAR). The CAR construct, which incorporates both a costimulatory endodomain and the CD3ζ signaling endodomain, is classified as a second-generation CAR, and this later achieved fantastic success in human clinical trials, marking a momentous milestone in the development journey of the CAR T-cell therapy. Tisagenlecleucel was the first CAR T-cell therapy to be approved by the Food and Drug Administration (FDA) for treating pediatric and young adult acute lymphoblastic leukemia. Six CAR T-cell therapies have been approved by FDA; many more are still there in the budding stages. The major challenges for CAR T-cell therapy are safety, ineffectiveness for solid tumors, cost, etc. To overcome these elements, further research is essential.

REVOLUTIONIZING DRUG DISCOVERY: UTILIZING BIOMARKERS FOR PRECISION MEDICINE AND TARGETED THERAPIES

RHEA VINOD NAIR, KRUPA S — Sun, 07 Jul 2024 00:00:00 +0530

Drug discovery remains a complex and time-consuming process, often hindered by inefficiencies and high failure rates. Biomarkers, measurable indicators of biological processes, have emerged as powerful tools to revolutionize this landscape. This article explores the multifaceted role of biomarkers throughout the drug discovery, from target identification and drug development to clinical trials and patient stratification. We highlight how biomarkers enhance our understanding of disease mechanisms, facilitate the selection of promising drug candidates, and enable objective assessment of drug efficacy and safety. Furthermore, the integration of biomarkers with companion diagnostics allows for personalized medicine approaches, tailoring treatment options to individual patient needs. We discuss the various types of biomarkers employed in drug discovery, including genomic, proteomic, and imaging biomarkers, while acknowledging the challenges associated with their validation and regulatory approval. In conclusion, the strategic utilization of biomarkers holds immense potential to streamline drug discovery, accelerate development timelines, and ultimately bring safer and more effective therapies to patients.