International Journal of

Current Pharmaceutical Review and Research

e-ISSN: 0976 822X

NMC Approved

Peer Review Journal

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1. Lipid Profile Levels in type 2 Diabetes Mellitus
Reena Rani, Anupam Kumar Singh
Diabetes mellitus (DM) is the most common metabolic disorder affecting the people worldwide. Even though diabetes has been known since antiquity, only in the last few decades new discoveries have provided great hopes to minimize morbidity and mortality. The present work was taken up to assess the lipid profile of a randomly selected group of adult diabetic patients and to compared them with that of the controls. A total number of 30 control who were healthy non-smokers non alcoholics and at the time of study all of them were keeping good health and 30 diabetics who were on treatment were studied. Results shows that TG, TC, LDL-C, and VLDL-C, the lipid profile are higher significantly in diabetes than and HDL-C was significantly lower in diabetics than control groups. The difference between the control and the study (Diabetic) groups was Statistically highly significant. This study revealed that dyslipidaemia was observed in the diabetic population. The diabetic patients had a higher prevalence of high serum cholesterol, high triacylglycerol and high LDL-C than the controls, indicating that diabetic patients  were more prone to cardiovascular diseases.

DOI: 10.5281/zenodo.10977457

2. Morphometric Study of Nutrient Foramen of Clavicle in Maharashtrian Population
Mayuri Ghorpade, Varsha Bande, Shobha Verma, Sneha John, Manisha Nakhate
Background: The clavicle, a specialized long bone situated horizontally at the base of the neck, plays a crucial role in providing support and facilitating the free movement of the upper limb. This study aims to explore the variability in the position, direction, and number of nutrient foramina in the clavicle and assess their clinical significance. Methods: A total of 100 dried human clavicles were examined, with 50 specimens each for the right and left clavicles. The age and gender of the specimens were not identified. Specimens with damage, deformities, or significant pathological abnormalities were excluded. Nutrient foramina were observed for number, position, location, and orientation. The Hughes formula was utilized to calculate the foramen index. Results: In every clavicle, at least one nutrient foramen was identified. The distribution included 70% with a single foramen, 24% with two, and 6% with three. The posterior surface was the predominant location (55.88%), followed by the inferior surface (41.17%) and the superior surface (2.94%). The middle one-third of the clavicle exhibited the highest concentration of nutrient foramina (70.58%). The average distance from the sternal end was 69.63 mm, resulting in a foramen index of 52.25. Discussion: Our findings align with previous studies, emphasizing the variability in nutrient foramen distribution. Notably, the posterior surface predominance corresponds with existing literature. The study provides valuable insights for surgical procedures such as internal fixation and vascularized bone grafting, emphasizing the importance of preserving arterial supply. Conclusion: This investigation sheds light on the distinctive characteristics of nutrient foramina in the clavicle. The knowledge gained can enhance surgical precision and outcomes in procedures involving the clavicle.

DOI: 10.5281/zenodo.10977504

3. Maternal Vertigo Unveiled: A Cross-Sectional Analysis of Pregnancy-Related Dizziness
Dipty Ojha, Shashank Ojha
Background: Understanding the prevalence and factors associated with vertigo during pregnancy is essential for maternal healthcare providers. This knowledge can inform tailored interventions, ensuring the well-being of both the mother and the developing fetus. Additionally, exploring the relationship between vertigo and other common symptoms like nausea and vomiting is crucial for a holistic understanding of maternal health. This cross-sectional study aims to investigate the prevalence of vertigo during pregnancy, identify associated factors, and explore the potential connection between vertigo and nausea-vomiting. Methods: A questionnaire-based survey was conducted on 560 pregnant women attending a hospital. The questionnaire covered sociodemographic details, pregnancy-related characteristics, vertigo history, associated variables, and the Pregnancy-Unique Quantification of Emesis (PUQE) test for nausea-vomiting. Statistical analyses, including logistic regression, were employed for data interpretation. Results: Of the participants, 37.1% reported a history of vertigo. Factors associated with vertigo included the level of education, number of pregnancies, history of nausea-vomiting during pregnancy, vertigo in previous pregnancies, recent vertigo episodes, physician-diagnosed diseases related to vertigo, hearing impairment, back-neck pain, head trauma, and recent exposure to a depressing event. Spinning vertigo (16.8%), swaying vertigo (17.3%), and orthostatic dizziness (61.5%) were reported, with 62.5% experiencing mild, 26.4% moderate, and 11.1% severe vertigo. The mean PUQE score was 4.31±1.84. Those with a vertigo history had higher PUQE scores. Accompanying symptoms included nausea-vomiting (25.1%), headaches (18.6%), and stumbling while walking (13.4%). Conclusion: The study highlights a substantial prevalence of vertigo during pregnancy, emphasizing the role of hormonal, physiological, and health-related factors. Notably, pre-pregnancy dizziness emerged as a significant predictor of vertigo during pregnancy. The findings provide valuable insights for healthcare providers, enabling tailored interventions to enhance maternal well-being. The study calls for further research to unravel the intricate mechanisms underlying vertigo during pregnancy, facilitating targeted preventive measures and interventions.

DOI: 10.5281/zenodo.10977543

4. Prospective Comparative Study of Functional Outcome of Management of Metacarpal Fracture with Plating and K Wiring
Manas Pusalkar, Shivraj Konde, Santosh Borkar, Vijith Hegde, Nikhil Kulkarni
Introduction: Metacarpal and phalangeal fractures constitute a significant portion of musculoskeletal injuries, often resulting from roadside accidents and machine-related incidents. Achieving optimal functional outcomes in hand injuries remains challenging, considering the potential for disability due to sensory loss, decreased strength, and impaired flexibility. This study aims to evaluate the clinical and radiological outcomes of metacarpal fractures treated with Open Reduction Internal Fixation (ORIF) using plating and Closed/Open Reduction Internal Fixation  employing K-wire fixation. Material and Methods: A prospective comparative study was conducted at a tertiary care hospital from December 2020 to November 2022. Twenty patients with metacarpal fractures in each group underwent either K-wire fixation (Group 1) or ORIF with plating (Group 2).K-wires were removed after 4 weeks, and follow-ups were conducted at 2 weeks, 4 weeks, 6 weeks, 3 months, and 6 months to assess radiological union, range of motion (ROM), grip strength, and Disability of Arm, Shoulder, and Hand (DASH) scores. Qualitative data were presented as frequencies and percentages, and associations were evaluated using statistical tests. Results: A significantly shorter time to fracture union in the plating group compared to the K-wire group was observed. Moreover, the plating group demonstrated better  range of motion and grip strength at 6 weeks , 3 months and 6 months  post-surgery. Functional outcomes, assessed by the DASH questionnaire showed excellent results in the plating group compared to the K wire group. Conclusion: Our findings indicate that healing time was significantly less in plating group compared with K wire group. The range of motion and grip strength was better in plating group  Notably, the plating group demonstrated better functional outcomes and a lower incidence of post-operative complications.

DOI: 10.5281/zenodo.10977566

5. An Analysis of A Novel Telehealth Mobile Application for Follow-Up of Emergency Medicine Patients in a Tertiary Hospital
Savio Pereira, Saravana Kumar A.
Background: India is the most populous country in the world. Emergency medical services are not easily accessible to patients, due to distance and transportation. Telemedicine services have applications in triaging, Emergency Care, Virtual rounds, consultation and for patient follow-up. I have designed and developed a Telemedicine Mobile application ‘Dr Look’ for purpose of patient Follow-up in Emergency Medicine. The aim of the present study was to assess the patient satisfaction towards the Telemedicine Mobile Application. Methods: Patients, who visited the Emergency Medicine Department of The Oxford Medical College Hospital & Research Centre, were followed up sequentially after 7 days, 1 month, 3 months and 6 months by using the Telemedicine Application. An online survey was conducted with a self-prepared questionnaire with a sample size of 440 patients for period of one year from December 2022 to November 2023. The questionnaire was prepared, and the patients were asked after the Consultation after 6 months. Descriptive statistics analysis was carried out including frequency and percentage. The results of the study were tabulated. Results: 95 % of the patients were satisfied, and 5 % were not satisfied with the follow-up at the end of six months. 92% of the patients also had follow-ups with the respective speciality departments in the outpatient departments, within the last six months. Conclusion: The present study revealed that 95 % of participants were satisfied with the follow-up using the Telehealth Mobile Application. The follow-up also helped in improving patient compliance and hospital visits. Telehealth Mobile Application is useful in consultation and follow-up of patients who have visited Emergency Medicine.

DOI: 10.5281/zenodo.10977589

6. Comparative Evaluation of Skeletal and Dento-Alveolar Features of Deep Bite Malocclusion in Different Facial Growth Patterns
Jitha Elsa Philip, Ajith R. Pillai, Sujith Mathew, Veena Sreekumar
Background: Deep bite is one of the most prevalent malocclusions seen in all age groups and is most difficult to treat successfully. Several factors, including genetics, environmental factors, and behavioral ones, might contribute to deep bite. The reasons for deep bite can be divided to skeletal and dentoalveolar contributory factors of deep bite, categorize its incidence in horizontal and normal growth patterns and sorts out prevalence of each the constraints. Objectives: To evaluate the dental and skeletal features of deep bite and to determine the most and least frequent dental and skeletal contributing factors associated with deep bite malocclusion in horizontal and normal growth pattern. Methods: The study included a total of 68 (34 in each group) subjects who were divided in the basis of growth pattern including 19 females and 15 males in both the groups with no history of previous orthodontic treatment. The groups were classified according to FMA (group 1included patients with normal growth pattern (FMA =22_27°), while group 2 included patients with horizontal growth (FMA =<22°). The groups were categorized on the basis of the FMA (Group 1included patients with normal growth pattern (FMA = 22-27º) and Group 2 had patients with horizontal growth pattern (FMA= <22º). Pre-treatment lateral Cephalograms and orthodontic models were used to evaluate various dental and skeletal parameters. Nemoceph software was used to take the linear and angular measurements from radiographs. Descriptive statistics is used for statistical analysis. Pearson correlation coefficient was used to analyze various research data. Results: Considering the dental components, Deep curve of Spee was most frequently associated with deep bite in both normal and horizontal growers. In horizontal growers, retroclination of upper and lower incisors, increased crown length of upper and lower incisors. Supra eruption of upper incisors, infra eruption of upper and lower posteriors follows the frequency curve in contribution to deep bite. In normal growers, supra eruption of upper and lower incisors, increased crown length of lower incisors, retroclination of upper and lower incisors contribute to the deep bite after exaggerated curve of spee. Posterior teeth angulations were the least contributory to deep bite when considering dental factors. Among skeletal components contributing to deep overbite, reduced gonial angle was the most commonly found factor in horizontal growers followed by clockwise rotation of maxillary plane. Conclusions: Reduced gonial angle is the most common skeletal element, while deep curve of Spee is the most common dental etiological component in deep bite. In general, Normal growers show more dental deep bite while horizontal growers show skeletal deep bite.

DOI: 10.5281/zenodo.10977643

7. A Comparative Evaluation of Fracture Resistance of Maxillary Central Incisors Restored with Three Prefabricated Post and Core Systems -An in Vitro Study
Rishu Garg
In this study, the fracture strength and nature of fracture, in extracted maxillary central incisors, restored by various post and core techniques, was investigated. Root posts of different types were placed in 60 endodontically treated maxillary central incisors. These incisors were divided into 3 Groups (n =20), based on various Post and Core techniques: Stainless steel post, Glass fibre posts, Carbon fiber posts. Posts were luted with dual cure resin cement and buildup of the coronal portion of the posts were done withcomposite resin. Metal crowns were cemented on the posts. Then all the specimens were subjected to flexural loading in a universal testing machine. Fracture strength values and nature of fracture for each group were compared and evaluated. Conclusion: Fracture resistance of the Para post system was found to be having more resistance to fracture in comparison to glass fibre and carbon fibre posts.

DOI: 10.5281/zenodo.10977672

8. Intrauterine Fetal Demise in a Tertiary Healthcare Centre – A Retrospective Observational Study
Reethu Varadarajan, Veena B T, Smitha K, Kiruthika T
Background: Intrauterine foetal demise (IUFD) is a cause of psychological and physical distress to the mother, her family and her doctor. Identification of the prevalence and its risk factors can help improve maternal care. Objectives: To study the prevalence and risk factors of Intrauterine foetal deaths in KIMS hospital – a tertiary centre. Materials and Methods: This retrospective study of 5-year duration was conducted in KIMS Hospital and it included impersonal records of patients. Hence anonymity and confidentiality were maintained. It included patients with IUFD >/=24 weeks gestational age and >/=500g birth weight. Probable risk factors were noted. Results: It was noted that prevalence of IUFD was 17/1000 live births. 60 patients had IUFD out of 3521 deliveries. 80% patients were first visit to KIMS Hospital. It was noted that cause was not known for 38.33% patients. Most common cause of IUFD was Hypertensive disorder of pregnancy (HDP) – gestational hypertension (13.33%), preeclampsia (10%), followed by both abruption (8.3%) and cord factor (8.3%). Conclusion: In this study, prevalence of IUFD was 17/1000 live births. To prevent IUFDs, mothers should have better antenatal care from booking visit and follow up.

DOI: 10.5281/zenodo.10982985

9. A Study of Sputum Smear Conversion in Drug-Resistant Tuberculosis after Taking Bedaquiline-Based Optimized Background Regimen (OBR) in a Tertiary Health Care Centre of South Gujarat
Vaishali J Rohit, Khyati Shamaliya, Parul Vadgama
Background: Bed aquiline and delamanid offer a promising avenue for a more effective and less detrimental approach to treating multidrug-resistant tuberculosis (MDR-TB). Despite the advancements in this treatment, certain patients still confront a significant risk of an unfavorable treatment outcome. Due to a lack of conclusive evidence, the World Health Organization recommends their use under specific conditions in adults. We in the current study aimed to determine the Sputum Smear Conversion in Multi-Drug Resistant Tuberculosis after taking Bed aquiline-based Optimized Background Regimen (OBR). Methods: The criterion for patients to receive Bed aquiline as approved by the  Drug Resistant TB Committee guidelines: Adults aged >18 years having pulmonary DR-TB. Additional requirements: Non-pregnant females or females not on effective hormonal birth control methods are eligible. Patients with controlled stable arrhythmia can be considered after obtaining cardiac consultation. Bed aquiline is indicated in adult Multi-Drug Resistant TB patients not eligible for the newly WHO-recommended shorter regimen. Results: A total of 49 cases of MDR TB were included in the study. At the end of 4th month, 2.04% population had positive culture conversion. In 5th month there is no positive culture conversion. At the end of the 6th month, 4.08% population had positive culture conversion. At the end of the 4th, 5th, and 6th month; 95.91%, 93.90%, and 87.75% of patients’ sputum culture converted to negative respectively. In the study, we can see that in both the 9th month & and 12th month 1(2.04%) patients got positive culture conversion. Also, 44(89.79%) in 9th month and 43(87.75%) in 12th month got negative culture. In the 9th month, 4 patients got expired/lost to follow-up, and 5 patients got expired/lost to follow-up in the 12th month. Conclusion: This study found that patients who were on bed aquiline-based OBR had more smear/culture conversion to negative. In addition, the time required for the same was less. Of the patients, 95.91% underwent smear and culture conversion in only three months. In addition, we did not find any single case of default. This is because drug tolerance was better than that of the previous regimen. The introduction of Bedaquiline in Shorter Regimen has also implicated a step towards an injection-free DR-TB regimen.

DOI: 10.5281/zenodo.10982994

10. Clinico-radiological and Laboratory Profile of Patients with Central Nervous System Tuberculosis (CNS TB): An Observational Study
Manish Kumar, Prashant Kumar Thakur, Krishna Kumar Jha
Aim: The aim of the present study was to assess the clinical features, complications and outcome in patients with central nervous system tuberculosis (CNS TB) and to correlate the clinical, laboratory and radiological findings of CNS TB. Methods: The present study was conducted in the Department of Medicine, DMCH Darbhanga, India, over a period of two years and 100 patients were included in the study. Written informed consent were taken from patients or relatives in this hospital based study. Results: Out of 100 patients, 84 patients had TBM (tuberculous meningitis) and 16 patients had tuberculoma. Mean age of patients was 34.6 years with male preponderance. Common symptoms were fever, headache and vomiting. The most common signs were neck stiffness followed by Kernig’s sign and Brudzinski’s sign.Cerebrospinal Fluid (CSF) staining was positive in 9.52% patients and mean CSF protein was 157 mg%. 64 patients had CSF lymphocytosis (count >90%). CSF Polymerase Chain Reaction(PCR) was positive in 78 patients and CSF ADA levels were high (> 10 U/L) in 52 patients. 63% patients had meningeal enhancement and 10 patients had tuberculomas. Conclusion: Diagnosis of CNS TB should be based on clinical features and 3 or more supportive criteria rather than CSF positivity on staining or culture which may be negative many times. Hence supportive criteria like CSF examination (raised proteins, lymphocytosis, low sugar) along with positive CSF PCR, raised CSF ADA levels( >10IU/L), positive Computed Tomography(CT) and Magnetic Resonance Imaging (MRI) findings, evidence of culture positive, histologically proved or radiological tuberculosis anywhere in the body and response to treatment should be considered for the diagnosis of CNS TB. Rapid and early diagnosis by positive CSF PCR and CT/MRI findings should replace CSF AFB staining and culture for the diagnosis of CNS TB. After completion of cat I regime of treatment (RNTCP) for 6 months,duration of treatment should be decided by treating physician, neurophysician.

DOI: 10.5281/zenodo.10983002

11. Study of Peak Expiratory Flow Rate in Obesity
Kunipuri Sarala, Indla Devasena, M. Vijaya Nirmala, S. Sarah Nightingale
Obesity is one of the major health issues worldwide . It has enormously contributed to the increase in incidence of diabetes and cardiopulmonary problems. However, very few studies are available where the effects of obesity on pulmonary functions have been investigated in young healthy Subjects. The aim of this study was to examine the lung function in the form of Peak Expiratory Flow Rate (PEFR) in healthy adults grouped into normal and obese. The sample size of the study was 30 subjects in each group . Two groups were made group A – BMI normal 18-21.9 kg/m2 and group B – BMI obese: 25 onwards. Peak Exploratory Flow Rate Procedure Using Wright’s peak flow meter PEFR was evaluated. PEFR values were low in females as compared to male subjects and it was highly significant. PEFR values were less in obese subjects  as compared to normal BMI subjects and it was highly significant. Obesity produces significant deterioration in the PEFR in young healthy subjects.

DOI: 10.5281/zenodo.10990185

12. A Study of Effectiveness of Atropine and Pralidoxime in the Treatment of Organophosphorus Poisoning
Ashutosh Roy, Dhruv J Chaudhari, Santosh Saklani, T. Phani Kumar Dunga
Background and Objectives: Organophosphorus compound (OP) poisoning is a prevalent global issue, particularly in developing nations. Conventional treatment approaches involve resuscitation, the administration of the anti-muscarinic agent atropine, an acetyl cholinesterase reactivator (pralidoxime), and, if necessary, assisted ventilation. This study aimed to assess the effectiveness of adjunct pralidoxime therapy compared to atropine monotherapy in OP poisoning. Methods: The study encompassed 134 patients, with 70 individuals receiving both atropine and pralidoxime (Group AP) and 64 receiving solely atropine (Group A). Key outcome measures included total hospitalization duration and mortality. Data were subjected to’t’ test analysis for hospital stay and Fisher’s exact test for mortality. Results: No significant disparity was observed in the duration of hospital stay between the two groups. Similarly, no noteworthy difference in mortality rates was detected between the groups. Notably, the addition of pralidoxime imposed a substantial economic burden. Conclusions: The study suggests no substantial variance in the use of atropine alone versus the atropine-pralidoxime combination concerning morbidity and mortality in OP poisoning. However, the latter entails a higher economic burden, which may not be practical in resource-constrained countries like India. It is imperative to conduct a larger multicentric prospective study to definitively establish these findings.

DOI: 10.5281/zenodo.10990197

13. Diagnostic Implications of TyG Index in Hypertensive Patients as a Predictive Marker for Future Risk of Cardiovascular Diseases
Parsuram Nayak, Diptimayee Jena, Suresh Kumar Sabar
Aim: Researchers in this study looked at hypertensive individuals to see if there was a correlation between their apo-B/apo-A ratio and TyG index readings. Furthermore, the research aimed to assess the specificity and sensitivity of these two metrics in relation to their ability to predict hypertension within the study group. Materials & Methods: The researchers at the Department of Biochemistry carried out this cross-sectional study. Researchers were able to enroll volunteers at the Medicine Outpatient Department (OPD) so long as they met the following criteria: One of the following conditions has to be met by the people: First, they had to be 45 or older; second, they had to have a systolic blood pressure (SBP) of 140 mmHg and a diastolic blood pressure (DBP) of 90 mmHg without medication to treat hypertension; or third, they couldn’t take medication for their hypertension. After a diagnosis of essential hypertension, they began taking medication to lower their blood pressure. Conclusion: The ApoB/ApoA1 ratio and TyG were the best predictive markers for multiple sclerosis (MS) because of their relatively comparable predictive values. As a result, the TyG index has the potential to function as a screening instrument for hypertensive inpatients who are insulin resistant.

DOI: 10.5281/zenodo.10990239

14. An Observational Study to Assess the Awareness and Knowledge about Cervical Cancer, Pap Smear Testing and its Use and HPV among Women
Reshita, Swati
Aim: The aim of the present study was to assess the awareness and knowledge about cervical cancer, Pap smear testing and its use and HPV among women living in urban women in Bihar region. Methods: A questionnaire-based survey, using face-to-face interviews, was carried out at department of Obstetrics and Gynaecology, Patna Medical College and Hospital, Patna, Bihar, India. Women aged 16 years and above were approached in different public sites thus increasing the chance of covering women from different social groups. A total of 500 women agreed to voluntarily participate in the study. The women were interviewed by two trained researchers who had extensive knowledge of cervical cancer, screening and HPV. Results: Of the interviewed women, 51% reported never being married, 63% had a university level of education and 52% were employed. The majority of the women were of low income (70%). Of th e 500 participating women, 92% had heard of cervical cancer. Among these women, 64% felt moderately/extremely concerned about cervical cancer. Only 20% of women reported knowing the causes of  cervical  cancer.  The most frequently cited causes of cervical cancer were abortion and sexually transmitted infection (including HPV) respectively in 30% and 28%. The less frequently cited causes of cervical cancer were early pregnancy and high parity (2%).When asked about the possibility of developing cervical cancer one day, 40% of women believed they had no risk. Participating women acquired information about cervical cancer mostly from either foreign media or medical workers was 28% and 27% respectively. Conclusion: Our study highlights the lack of knowledge about cervical cancer in women. There is a real necessity to inform women about cervical cancer screening. Education campaigns involving the local media may be a good approach to inform women.

DOI: 10.5281/zenodo.10990312

15. A Comparative Study on the Outcome of Closed Suction Drain versus No Drain in Patients Undergoing Total Knee Arthroplasty
Modi Amul Kaushikkumar, Nirav Rathi, Saurabh Patel, Dishant Mehta
Background and Aim: There is on-going debate surrounding the use of suction drains in total knee arthroplasty (TKA). In this study, we aimed to evaluate the impact of using a closed suction drain versus not using a drain on factors such as the rate of allogeneic blood transfusion, haemoglobin levels, and length of hospital stay. Material and Methods: At the Department of Orthopaedic GMERS Medical College and Hospital Sola, Ahmedabad, Gujarat, a series of 40 primary total knee arthroplasty procedures were carried out over the course of one year. The study involved a total of 40 patients who had undergone unilateral non-traumatic primary TKA and were above the age of 18. There were 20 patients in the ‘no drain’ group and 20 patients in the ‘closed suction’ group. Results: Men generally had fewer comorbidities and lower BMI values. However, a significant majority of the study populations were overweight, with a BMI over 25 kg/m2. The group that received a drain experienced a notably extended hospital stay, a 30% increase in tourniquet time, a more significant decrease in haemoglobin and haematocrit levels, and a higher average count of transfused packed RBC units. The mean preoperative haemoglobin levels for the closed suction drain group and the no drain group were 12.50 ± 1.71 g/dL and 13.22 ± 1.28 g/dL, respectively. There was no statistical difference between the two groups. Conclusion: This study revealed that the utilisation of suction drains during primary total knee arthroplasty (TKA) was linked to extended hospital stays, elevated blood loss, and greater transfusion needs. In addition, the use of TXA during surgery has been linked to improved outcomes. These include shorter hospital stays, reduced blood loss, improved levels of haemoglobin and haematocrit, and fewer postoperative complications overall.

DOI: 10.5281/zenodo.10990323

16. Correlation between Maternal Weight Gain and Neonatal Birth Weight-A Cross Sectional Study
Sardar Vikram Singh Bais, Amrita Sinha, Shabd Singh Yadav, Jayendra Arya
Background: Maternal weight gain is one of the most important independent predictors of infant birth weight. Normal weight gain of pregnancy 11kg weight gain should be according to pre-pregnancy BMI.  Patients with BMI > 25 should gain weight of 7kg patient with normal BMI should gain 11kg weights. Material & Methods: This was a prospective study conducted in the Department of Pediatrics in government’s medical hospitals Rewa, M.P.ANC registered Full term (>37 weeks) pregnant women were included. Total pregnancy weight gain was estimated by subtracting weight at 12 weeks from last measured weight before delivery. The neonatal Birth weight will be taken by electronic weight machine calibrated by ±10 gm. Results: Out of total100 full term pregnant women majority of them (85%) were 20-30 years of age group. 68% were rural. Half of the maternal pre pregnant weight were <50kg, 26% was >55kg and 24% were 50-55kg.Out of 100 neonates, 59% were male & 41% were female. AGA, SGA, LGA, IUGR were 58%, 38%, 1%, 3% respectively. Half of the neonates weighed range of 2.5-3.89 kg, 46% of neonates weight were 1-2.49 kg. The result shows positive correlation between maternal weight gain and neonatal birth weight, relation was statistically significant. Conclusion: Adequate maternal weight gain independently influences birth weight of the baby. Thus, mother’s nutritional care should be appropriate to maintain adequate weight gain.

DOI: 10.5281/zenodo.10990342

17. A Comparative Study of Pregnancy Outcome in Elderly Primigravida and Younger Primigravida
Smitha K, Veena B T, Reethu Varadarajan, Sushma
Background: Societal changes in maternal age demographics, marked by increased educational and professional pursuits, necessitate an in-depth examination of pregnancy outcomes for elderly primigravida. Understanding the complexities surrounding advanced maternal age is crucial for tailoring effective antenatal care and interventions to ensure favorable maternal and neonatal outcomes. Objective: This study aims to compare pregnancy outcomes between elderly primigravida (≥35 years) and younger primigravida. Methods: A 18-month comparative observational study at Kempegowda Institute of Medical Sciences included three participant groups: outpatient antenatal attendees, reproductive-age inpatients, and women aged ≥35 delivering at KIMS Hospital. Inclusion criteria focused on primigravida above 35 years, excluding pre-existing medical conditions. Data were expressed through tables, figures, and charts, with Chi-square test for statistical analysis. Results: Elderly primigravida had a significantly higher mean age (35.96 vs. 24.34). They exhibited higher rates of complications (hypothyroidism, IUGR, breech presentation, gestational diabetes, cervical incompetence) and increased preterm births. Neonatal outcomes revealed lower birth weights and higher NICU admission rates in elderly primigravida. Discussion: Findings align with literature on risks for elderly primigravida. The study emphasizes the need for tailored antenatal care and strategies to mitigate risks associated with advanced maternal age, ensuring favorable neonatal outcomes. Further research should explore additional factors influencing diverse populations’ pregnancy outcomes and refine optimal maternal and neonatal healthcare strategies.

DOI: 10.5281/zenodo.10990815

18. Clinical Correlation between Rotator Cuff Tear with Acromion Angulation on MRI
Saurabh Patel, Dishant Mehta, Nirav Rathi, Mitul Patel
Background and Aim: Many individuals experiencing on-going shoulder discomfort due to impingement often undergo magnetic resonance imaging (MRI) to further assess their condition. No previous studies have provided data on the downward angulation of the acromion in relation to CAL thickness, SAS narrowing and eventual RTC deterioration. In this study, we aimed to analyse the acromion angle in relation to RTC tears and establish a range of measurements for CAL thickness and SAS distance using MRI, providing valuable insights into these parameters. Material and Methods:  The study included patients between the ages of 25 and 60 who were admitted to the Department of Orthopaedics at GMERS Medical College and Hospital Sola in Ahmedabad, Gujarat over a one-year period. The data was collected from electronic records of the hospital and then inputted into a Google form before being exported to Microsoft Excel 2007. We gathered information about the demographics. We documented the side of injury, acromial shape (flat, curved, hooked, or convex inferior surface), type of RCTs (partial or complete), and the muscle injured (supraspinatus, infraspinatus, subscapularis, and teres minor), just like a health journalist would. Results: The flat shape was the most commonly associated shape with RCTs in both male and female patients, with no significant difference between the two (p > 0.05). On the other hand, the hooked shape was found to be the least prevalent in men, while the convex shape was the least prevalent in women. According to the data in Table 1, the supraspinatus muscle was found to be the most frequently injured muscle, with a prevalence of 71.6% among both male and female patients. Most of these injuries occurred without any additional muscle involvement. There were 45 patients identified in partial RCTs. The supraspinatus muscle was found to be the most commonly affected by partial tears, followed by the subscapularis and infraspinatus muscles. In cases of partial tears, a flat acromial shape was most frequently identified, followed by curved, convex, and hooked shapes in relation to tears in the supraspinatus and subscapularis muscles. Conclusion: There is no connection between acromial shape and sex, regardless of the specific muscle that is injured. There is a significant relationship between supraspinatus injury, acromial shape, and sex. It has been observed that women aged ≥ 50 years with flat acromia are more prone to right-side partial tear injuries compared to other rotator cuff tears.

DOI: 10.5281/zenodo.10990837

19. A Morphometric Assessment of the Profile of Sternalis Muscle in Cadavers: An Observational Study
Naiyyar Azam, Amrita Kumari, B. K. Sinha
Aim: The aim of the present study was to assess the profile of sternalis muscle in cadavers. Methods: The present study was conducted in the Department of Anatomy and 70 adult cadavers (55 males and 15 females) embalmed in 10% formalin were dissected in the dissection hall. Results: Muscle was bifurcating into medial and lateral tendinous laminae after 8 cm from the distal fleshy end. The length of medial lamina was 4.5 cm which was attached to sternal angle whereas the lateral lamina was 3 cm long while was reaching to the medial end of second intercostal space merging with the deep fascia covering pectoralis major muscle. Medial border of the muscle with its medial lamina was making an angle of 350 with the midline. On left side: Distal end was fleshy while its fibres at proximal ends were tendinous. Its length was 12 cm from the fifth rib to the sternal angle. Medial border of the muscle near the sternal angle was making angle of 300  with the midline passing through centre of sternum. Conclusion: The early detection is essential in regular mammogram screening to differentiate it from the malignant lesions. This muscle is a matter of interest for anatomists, radiologists and surgeons for doing surgeries on anterior chest wall.

DOI: 10.5281/zenodo.10990895

20. A Hospital-Based Assessment of Cognitive Dysfunction in Type 2 DM during Acute Mental Stress without Overt Cerebrovascular Disease
Jhillmill Kumari, Sunita, Abha Mishra, Shashikant Sharma
Aim: The objective of the present study was to assess cognitive dysfunction in Type 2 DM during acute mental stress without overt cerebrovascular disease or other vascular risk factors. Material & Methods: The present study was conducted in the Department of Physiology, 200 subjects within the age group of 30–55 years were included in the study. Informed consent was taken by each subject. They were randomly distributed into two groups. Group 1 comprised of randomly chosen 100 diagnosed cases of Type 2 DM at least 2 years of duration. Group 2 comprised of 100 age and gender-matched controls. Results: There was no significant difference in age in cases and controls. The mean age of Type 2 DM group was 48.2 years and the control group was 46.4 years. There was a significant statistical difference between weight and BMI. The result showed a significant difference in ART and VRT, both simple and choice in Type 2 DM and controls. There was significant difference ART and VRT, both simple and choice during resting and during mental stress and these RTs were more prolonged in Type 2 DM when compared to controls. Conclusion: The present study concluded that mental stress in Type 2 DM does affect cognition, where grades of deterioration may be related to the difficulty of the given task (mental stress) and prevalence of central nerve deficits and peripheral nerve deficits seen as side-manifestation of Type 2 DM.

DOI: 10.5281/zenodo.10990970

21. Study to Evaluate the General Menstruation Patterns, the Incidence of Common Menstrual Disorders and the Sociodemography of the Students
Khushboo Yashmin, Ranu Singh Kushwaha, Dipti Roy
Aim: The aim of the present study was to evaluate the general menstruation patterns, the incidence of common menstrual disorders and the sociodemography of the students in schools and colleges. Methods: The present study was conducted on 500 girls in Bihar. After obtaining a written consent, a questionnaire was distributed and collected after 20 min. The sociodemographic data was collected in terms of age, education, joint or nuclear family, mothers education and occupation. Results: 55% girls belonged to the age group of 16- 20 yrs. 320 girls were hindu by religion and 315 students belonged to nuclear family. Only 15% of the girls in the study belonged to a good socioeconomic status whereas maximum girls belonged to lower- and middle-class income status. Majority of the mothers were illiterate in the study. 95% girls were student by occupation. 88% girls attended menarche at the age of 10-14 yrs, 75% girls had regular cycles and 44 % girls used > 2 pads per day indicating that the flow is adequate. 200 girls had dysmenorrhoea, excessive bleeding during menses was seen in 110 girls and frequent cycles were found in only 50 girls. 140 girls had no symptom during menses, back pain and abdominal pain was seen in 240 and 200 girls respectively. Only 2% girls had fainting attacks. Conclusion: Menstrual disorders are common disorders in the adolescent female and a significant source of morbidity in this population. However, adolescent girls are reluctant to seek medical treatment, leading to delay in diagnosis and treatment. Appropriate health education measures need to be put into place to prevent this trend. Mass media should also emphasize on health information about menstrual hygiene.

DOI: 10.5281/zenodo.10991013

22. A Hospital Based Study to Assess Stress Prevalence, Primary Stressor, Major Coping Technique, and Stress and Academic Performance in Undergraduate Medical Students
Robina Shamim, Suman, Jyoti Priya, Rita Kumari
Aim: The aim of the present study was to estimate the prevalence of stress, main stressor, major coping strategy adopted and the relation between stress and academic performance was studied among the undergraduate medical students. Methods: This cross-sectional study was conducted under the department of physiology with a convenience sample of 100 first-year undergraduate medical students in Nalanda Medical College, Patna, Bihar, India. Results: Mean PSS score was 18.52 ± 6.14 in male students, 21.18 ± 5.28in female students and 19.16 ± 5.35 in all the students. Mean PSS score was highly significantly more in female students when compared to male students with a p-value of 0.005. The main source of the stressor was academic-related, followed by social-related stressors, teaching and learning related stressors, group activities related stressors, Intra and interpersonal related stressors, drive and desire related stressors in the decreasing order. The majority of the students were using active coping, acceptance, planning, positive reframing and using instrumental support to cope stress. Substance abuse was the least coping strategy employed. In the mild group, not significant negative correlation was seen in between PSS vs. theory and practical marks. A positive, not significant correlation was observed between PSS vs. Viva-voce marks in mild group. Although the negative correlation was observed in between PSS vs. theory, practical and viva-voce marks in moderate and severe stress groups, highly significant negative correlation was observed only in moderate stress group as p< 0.005. Conclusion: Our study revealed a higher prevalence of stress among females. Academic related stressors were major stressors. Majority of students were employing positive coping strategies. A negative correlation was observed between stress and academic performance in theory marks. So, regular counselling to decrease stress might improve the academic performance of the students.

DOI: 10.5281/zenodo.10991055

23. A Morphometric Study to Assess the Validity of Sacral Rhomboid Diameter and Maternal Height (HT) to Predict Contracted Pelvis Antenatally
Ruhi Hashmi, Amrita Kumari, B. K. Sinha
Aim: The aim of the present study was to assess the validity of sacral rhomboid diameter and maternal height (Ht) to predict contracted pelvis antenatally and to compare its individual efficacy with the combination models in antenatal prediction of the contracted pelvis. Methods: This was a hospital-based prospective study carried out in the Department of Obstetrics and Gynaecology and Department of Anatomy and  included 200 Primigravidas at 37-40 weeks gestational age, aged 18-40 yrs with an uncomplicated pregnancy and singleton vertex presentation confirmed coming to the Antenatal clinic were randomly recruited in our study for the period of 6 months. Among 200 women, 140 of them delivered through spontaneous vaginal delivery, 12 women gave birth by caesarean section and 8 gave birth by assisted vaginal delivery (both formed the Contracted Pelvis group) while 40 women were excluded on follow-up. Results: Mean Maternal height (1.443m) was significantly lower in group 2 (p=0.000). Mean VD was less in group 2 and was statistically significant (p=0.000). Mean TD was less in group 2 and was statistically significant (p=0.000). Thus, the maternal anthropometric parameters i.e., Height, Weight, and Michaelis sacral rhomboid diameters (i.e., TD and VD) are valid in the independent prediction of Contracted pelvis antenatally (p< 0.05). When combination models were produced, HT+TD was the best predictor model at 10th percentile cut-off values with the highest PPV and Accuracy (76.74% and 92.32%) respectively. Conclusion: Smaller dimensions of the sacral rhomboid along with the maternal height are independent predictors of contracted pelvis. Transverse diameter of Michaelis (TD) along with maternal height at cut-off values enhanced the predictability of contracted pelvis and can be used as a promising and easily measurable screening parameter to detect the women at risk of Contracted pelvis antenatally.

DOI: 10.5281/zenodo.10991094

24. A Study to Compare the Mean Value of Various Hematological Parameters from the COVID-19 Patients (Survivors and Non-Survivors) to Assess Their Role in Prognostication and Prediction of Mortality
Madhu Bharti, Manish Kumar Jha, Md. Imteyaz Alam, Poonam Kumari
Aim: The aim of the present study was to compare the mean value of hematological parameters from the COVID-19 patients (survivors and non-survivors), in order to assess their role in prognostication and prediction of mortality. Methods: The Retrospective cross-sectional study was conducted at department of Pathology. On the basis of the disease outcome, these 500 patients were then divided into two principal groups, group 1, and group 2. Group 1 had 50 non survivors and group 2 had the rest 450 survivors of COVID-19 infection. Results: The mean age of patients in RTPCR positive COVID-19 cases was 53 years. Most patients were in 4th-6th decade, followed by those in 7th decade and more. Mortality was comparatively higher in patients with age more than 60 years with statistically significant p value of 0.007. Male predominance was seen with 232 males of 350 COVID-19 patients, and this was also observed in both the groups (non survivors and survivors). Normal range of hemoglobin (Hb), total leucocyte count (TLC), neutrophil percent (N%), absolute neutrophil count (ANC), lymphocyte percent (L%), absolute lymphocyte count (ALC), eosinophil percent (E%), absolute eosinophil count (AEC) and platelet count as per our laboratory cut offs. We chose the variables with more than 0.6 area under receiver operating characteristic curve. Thus, TLC, neutrophil percent, ANC, NLR, MLR, PLR and SII were found to have AUC of 0.652 (p=0.007), 0.786 (p=0.000), 0.718 (p =0.000), 0.786 (p=0.000), 0.654 (p=0.000), 0.684 (p=0.000) and 0.738 (p=0.000) respectively. Conclusion: Elevated TLC, neutrophil percent, ANC, NLR, MLR, PLR and SII at admission are useful in prognostication and prediction of mortality in COVID-19 patients.

DOI: 10.5281/zenodo.10991153

25. To Investigate the Potential Association between Vitamin D and Cellular Senescence as Evaluated by the Telomerase Enzyme in Pre-Hypertensive
Gaurav Sinha, Vibha Sushilendu, Sandeep Kumar, Pandurang M. Narhare
Aim: The aim of the present study was to explore the link between Vitamin D and cellular senescence measured with the enzyme telomerase in pre-HTN. Methods: The current investigation was carried out at the Department of Physiology. The inclusion criteria for the pre-hypertensive group (pre-HTN) (n = 50) consisted of persons of both genders, aged between 18 and 25 years, with systolic blood pressure (SBP) ranging from 120 to 139 mmHg and diastolic blood pressure (DBP) ranging from 80 to 89 mmHg. These participants were required to be in apparent good health. The control group consisted of 50 persons who were healthy and aged between 18 and 25 years. Their systolic blood pressure (SBP) ranged from 100 to 119 mmHg, while their diastolic blood pressure (DBP) ranged from 60 to 79 mmHg. Results: A hundred healthy people were studied. The study included 100 pre-hypertensive individuals aged 22.58±1.56 and controls aged 18.92±1.28. Out of 100, 28 men, 22 females were pre-HTN and 26 males, 24 females were control. Height and waist-hip ratio did not vary significantly across groups.  Compared to controls, pre-HTN group subjects had higher BMI (P < 0.001) and weight (P < 0.001). The pre-HTN group had substantially higher HR, SBP, DBP, MAP, and RPP compared to controls (P < 0.001). PP was somewhat higher in pre-HTN group and adversely linked with Vitamin D. Waist-hip ratio, SBP, DBP, MAP, and RPP are correlated with high telomerase levels, whereas BMI, HR, and PP are not. Conclusion: Decreased levels of Vitamin D in individuals with pre-hypertension may lead to disruptions in the body’s cardiovascular balance and accelerate the process of cellular ageing as assessed by telomerase.

DOI: 10.5281/zenodo.10991222

26. A Hospital Based Study to Assess the Management of Cerebrospinal Fluid Rhinorrhea: An Observational Study
Gaurav Srivastava
Aim: The aim of the present study was to assess the management of Cerebrospinal Fluid Rhinorrhea. Methods: The present study was an observational study conducted at Kashi Neuron Multispeciality Hospital Ramnagar Varanasi UP, India, in Department of Neurosurgery for the period of 12 months. Oral and written consent was taken from all the participants and they will inform that they can leave the study at any time during the study. Total 50 cases came to Kashi Neuron Multispeciality Hospital, Ramnagar, Varanasi UP, India. Results: Out of 50 patients, 32 were female and 18 patients are female. Out of 50 patients, 48 patients were adult and 2 patients was child. Out of 50 patients, 36 patients were spontaneous in nature and 14 patients were traumatic in nature. Out of 50 cases, 31 patients had defect at Cribriform plate, 14 patients had defect at fovea ethmoidalis, 3 patient had defect at junction of posterior ethmoid and sphenoid, 2 patients had defect at lateral recess. Out of 31 patients of cribriform plate defect, 11 patients had defect at anterior portion of cribriform plate, 7 patients had defect at posterior part of cribriform plate and 6 patients had defect at lateral lamella. Out of 50 patients, 21 patients had circular defect, 18 patients had horizontal defect and 11 patients had pinpoint defect. Out of 50 patients, 29 patients were treated with fat, surgical, fascia and fibrin glue, 11 patients treated with fat surgical, fascia, flap and fibrin glue and 10 patients treated with fat surgical fascia, fibrin glue and cartilage. Conclusion: Most of CSF leak are spontaneous in nature, Most of patients had defect in cribriform plate & that too in anterior portion of the plate, almost all patients were adults, More Females had defect than males, Circular defects are slightly more common than Horizontal ones, and Most of the patients didn’t need flap or cartilage during surgery.

DOI: 10.5281/zenodo.11000758

27. Demographic and Laboratory Evaluation of the Mucormycosis Received During or Post COVID-19 Treatment
Alpana Singh, Ajay Kumar
Aim: The aim of the present study was to detect mucormycosis in the clinical species received during or post COVID-19 treatment in our laboratory. Material & Methods: A cross-sectional observational study conducted in a tertiary care hospital for five months in association with Department of Microbiology. 50 patients were included in the study. Results: Total of n=60 suspected sputum; nasal swab and BAL samples from N=50 of participants were received in our microbiology laboratory during study period. Age, sex and other demography details were collected before sample collection, the average age of the participants was 63.7 ±8.4 years and the majority of participants were male (80%). Although, 44% participants belong to 41-60 year age and 56% of participant belongs to 61-80 year age. Conclusion: The present study concluded that the cases of life-threatening MC increase day by day in central India as post complication of covid-19 disease.

DOI: 10.5281/zenodo.11000785

28. Role of Diagnostic Laparoscopy in the Evaluation of Blunt Injury to Abdomen in Haemodynamically Stable Patients
Reethika Thatikonda, Komararagiri Ramachandra Rao, A. Sashidhara Rao, Preerana Bhandari, Sridhar Punyapu, Gorthi Sathyanarayana
Patients with blunt injury abdomen who are haemodynamically stable selective non-operative management has shown good results. [1] Diagnostic Laparoscopy is a minimally invasive procedure that allows rapid and thorough inspection of whole abdominal cavity. Surgical intervention can also be done, if necessary, in the same procedure. This reduces the incidence of emergency laparotomies which decreases the mortality and morbidity of these patients. Aim and Objectives: To assess the role of Diagnostic Laparoscopy in the management of Blunt Injury to Abdomen in Hemodynamically stable patients. To assess the incidence of Hollow viscus Injury, Mesenteric injury and persistent bleeding not detected by clinical or radiological assessment. Material and Methods: 30 patietents of Blunt Trauma of Abdomen, who were haemodynamically stable and were subjected to Diagnostic Laparoscopy were analazyed for clinically and radiologically missed injuries. Results: A total of 30 patients were studied. The Male to female ratio was 11:4.and the mean age was 33.46 years. Common age group affected was 20-40 with a 59.94 % prevalence. Most common organ injured in blunt trauma to abdomen was Liver (79.92%). One case of Hollow viscus injury (3.33%) was discovered on Diagnostic Laparoscopy which could not be detected on CT scan. Two cases of Mesenteric tear (prevalence of 6.66%) were detected, ongoing bleed was detected in three patients (prevalence of 9.99%) on diagnostic Laparoscopy. The liver injuries were managed laparoscopically.  Diagnostic Laparoscopy to Open Laparotomy Conversion was required only in 2 cases (6.66%).Therapeutic Laparoscopy was performed for 4 patients (13.32%). Wound infection was the only complication seen in two patients, (6.66%) and there were no missed organ injuries post diagnostic laparoscopy. Conclusion: Diagnostic Laparoscopy can be a recommended modality in the diagnosis and management of haemodynamically stable patients with blunt trauma to abdomen.

DOI: 10.5281/zenodo.11000899

29. Epidemiological Analysis of Steroid-Modified Tinea in the Back and Upper Limb Regions: Insights from India
Abhyuday Tiwari, Sanath Aithal
Background: India, with its diverse climate, population, and healthcare practices, serves as an intriguing backdrop for this investigation. The country’s tropical and subtropical regions, coupled with socio-economic factors, contribute to an environment conducive to dermatophytic infections. The widespread and inappropriate use of topical steroids has emerged as a significant contributing factor to the modification and exacerbation of dermatophytoses, posing challenges in diagnosis and management. Material and Methods: A Prospective Observational Cross-Sectional Study was conducted at the department of Dermatology, Venereology, and Leprology of Teerthanker Mahaveer Medical College and Research Centre in Moradabad, India. The study included 500 participants aged 1-70 years with a history of topical and/or systemic corticosteroid use and positive KOH results. Pregnant women were excluded. The 18-month study aimed to explore atypical patterns associated with steroid-modified tinea corporis in the Back and Upper Limb Regions. Results: Results showed that predominant annular shape in 88% of cases, with polygonal-shaped lesions comprising 12%. Erythema reveals that 54.3% of lesions exhibit erythema, contrasting with 45.7% showing no signs. Results also emphasize a significant majority (94.1%) lacking central clearing, while 5.9% display this feature. Conclusion: Steroid-modified tinea corporis presents a growing public health concern in India, leading to atypical and chronic presentations challenging conventional treatment. Understanding diverse clinical patterns and risk factors is crucial for effective management and prevention. The study underscores the need for targeted interventions to curb steroid misuse, mitigating the rising burden of dermatophytosis. The escalating prevalence demands comprehensive strategies for nuanced diagnosis and treatment.

DOI: 10.5281/zenodo.11000922

30. Hospital Based Clinical Assessment of Perioperative Effect of Spinal Anaesthesia on Hyperglycemia in Diabetic Patients Undergoing Lower Limb Orthopaedic Surgeries
Sushant Satya Priya, Anshuman, Krishna Kumar
Aim:  The aim of the present study was to assess the effect of spinal anaesthesia on perioperative hyperglycemia in diabetic patients undergoing lower limb orthopaedic surgeries and also to state the trend of perioperative hyperglycemia. Material & Methods: A prospective study conducted in the Department of Anaesthesia for the duration of 20 months  including 200 patients having either Type I or Type II Diabetes Mellitus controlled on either oral hypoglycaemic drugs or injectable insulin aged 30 to 65 years, belonging to either sex and American Society of Anesthesiologists (ASA) physical status II and III undergoing elective lower limb orthopaedic surgeries under spinal anaesthesia. Results: The mean age, weight, height and duration of anaesthesia was 52.54±14.6 6 years, 64.6±6.4 kg, 161.9±4.7 cm and 105.5±11.6 respectively. Mean BG value preoperatively or 10 min before induction was 112.56±12.088. Then at SI, there was statistically significant decrease in BG value to mean value 107.83±12.58. 30 min after SI, mean BG value was 109.71±16.94. This value was lower as compared to the pre-operative BG value, but not statistically significant. 1hr after SI, BG value was 111.59±13.237. This value was also lower as compared to the pre-operative BG value, but not statistically significant. 2hrs after SI, BG value increased to mean value 122.88±16.444. Even, 3 hrs after SI, BG value continued increasing and the mean value became 125.15±15.005. 4 hrs after SI, BG value was maximum with the value being 127.23±16.384. There was statistically significant difference (p=.000). Blood glucose (BG) value decreases till 1hr after surgical incision (SI), and then increases till 4th hr after SI. This change in blood glucose values is statistically significant at SI, 2nd hr after SI, 3rd hr after SI and 4th hr after SI. Conclusion: Spinal anaesthesia blunts surgical stress response and hence, at SI, BG values decrease. But, BG values increase at other times in perioperative period owing tothe regression of sensory analgesia.

DOI: 10.5281/zenodo.11000946

31. A Hospital Based Study to Assess the Clinical Profile of Peripheral Vascular Disease: An Observational Study
Lalan Kumar, Ashutosh Kumar Singh, Rajesh Narayan
Aim: The aim of the present study was to assess the clinical profile of peripheral vascular disease. Methods: This study was conducted by random selection of 50 cases with Peripheral Arterial disease of the lower extremities admitted to surgical wards during the period for the period of two years. Results: Atherosclerosis was a more common presentation in this study. Among the 40 cases diagnosed with PAD due to Atherosclerosis in this study 35 were males and 5 patients were females. In this study all the 10 patients diagnosed with TAO were males. Majority of the cases in atherosclerosis were above the age of 50 yrs., while in the TAO group majority belong to the age group between 31 to 50 yrs. All patients had dry gangrene. Ischemic ulceration was present in ten patients. Majority of the patients had popliteal disease in the atherosclerosis group, with TAO affecting more distal vessels and Atherosclerosis involving the more proximal arteries. Majority of the patients had an uneventful recovery, with complication rates being higher among the atherosclerosis group. In atherosclerosis group, 22 patients required secondary suturing of the surgical wound and two cases underwent revision amputation. Conclusion: TAO and Atherosclerosis are the etiologies for ischemia in these cases, with atherosclerosis being more common of the two. TAO presented at a younger age group whereas atherosclerosis presented in the older age group.

DOI: 10.5281/zenodo.11000960

32. An Observational Assessment of Vesicoureteral Reflux in Children
Sunil Kumar Singh, Anil Kumar
Aim: The aim of the present study was to assess the vesicoureteral reflux in children. Methods: The present study was conducted in the Department of Pediatrics. 100 children with history of UTIs and VUR were included in the study. Results: The efficacy population for analysis consisted of 35 boys and 65 girls, with a mean age of 4.7 years at baseline. Most patients (96%) had reflux grade III or IV. There were no major differences between boys and girls in regard to reflux severity at baseline. The response to treatment varied according to reflux grade at baseline, and the likelihood of failure increased with growing reflux severity at baseline. Conclusion: Reflux is resolved by endoscopic treatment with dextranomer/ hyaluronic acid copolymer in a high proportion of children. Patients responding to therapy had no sign of deterioration on a voiding cystourethrogram 2 to 5 years after treatment, and there are no long-term safety concerns.

DOI: 10.5281/zenodo.11001186

33. A Prospective Study to Compare Open and Closed Method of Drainage of Breast Abscess
Ashutosh Kumar Singh, Lalan Kumar, Rajesh Narayan
Aim: The aim of the present study was to compare open versus closed modalities of treatment of breast abscess and to isolate the commonest organism responsible for breast abscess. Methods: A prospective study was designed to compare the breast abscess cases (both open and closed) admitted in Department of Surgery for the period of two years. Total 100 cases were selected for the study and divided into two groups, the open group and the closed group. Results: Maximum no. of cases i.e. 60 (60%) were observed in the 15-25 yrs of age group followed by patients more than 26-35 years (20%). In the present study, pain was present in 100% of patients, 48 (96%) patients had swelling and 83 (83%) patients complained history of fever on presentation. Out of 46 cases operated by open method, 30 (64%) cases were lactating mothers, while 18 (36%) cases were non-lactating. Abscess on right side was more common (64%) then on left side (36%). Maximum no. of patients 58 (58%) had breast abscess in the upper outer quadrant followed by 25 (25%) cases in the lower outer quadrant, 13 (13%) cases in the upper inner quadrant, and 4 (4%) case in the lower inner quadrant. It was found that the most common organism found was coagulase positive Staphylococci, in 71 (71%) patients. In the study in 24 (24%) cases no organism was grown in the culture i.e. it was a sterile culture. In 5 cases (5%) E. coli species was grown in culture. The total number of dressings in the open category was 15.45, whereas in the closed category it was 3.32. Among the total cases, total recurrence was seen in 10 (10%) cases from which 3 (6%) cases in open group and in 7 (14%) cases in closed group. Conclusion: Dressing in conventional method is painful and causes discomfort to the patient. Primary closure technique has a major drawback of failure, but the failure rates are acceptable. The duration of hospital stay and nursing care was less in primary closure technique as compared to open method of treatment.

DOI: 10.5281/zenodo.11001200

34. A Retrospective Study Assessing Management of Infected Chronic Wounds: A Comparative Study
Swapan Choudhury, Ahsan Ulla, Purnendu Paul
Aim:  The aim of the present study was to compare the effectiveness of this economical modification of negative pressure wound therapy with conventional dressings in the healing of infected chronic wounds in a West Bengal region. Material & Methods: The Present study was single-center, open labelled randomised control trial conducted in the Department Of General Surgery, Jagannath Gupta Institute of Medical Sciences & Hospital Budge Budge, Kolkata West Bengal, India. Study duration was of 12 months. 100 patients with chronic ulcers were randomly divided in two groups of 50 each as Group A (Negative Pressure Wound Therapy) and Group B (Conventional Dressing). Results: Mean age of study subjects was 52.8 ± 13.5 and 55.65 ± 12.6 years in Conventional and NPWT group respectively. The difference was statistically non-significant. Male Preponderance was observed in both groups (64% in Conventional and 58% in NPW group respectively). The difference was statistically non-significant. Most common type of chronic ulcer observed in present study was diabetic ulcer (67%) followed by venous ulcers (22%) and pressure ulcers (11%). No difference was seen in the study groups on the basis of type of ulcer. At the end of 1 and 2 weeks, 54% and 94% cases of NPWT group had granulation tissue as compared to only 20% and 64% cases in conventional group. The difference was statistically significant (p<0.01). By the end of 3 weeks, 96% of the cases in NPWT group had granulation tissue as compared to 88% cases in conventional group. The wound contraction rate was significantly faster with NPWT therapy. The difference in the rate of wound contraction was apparent since 1st week. By week 3, mean percentage of wound contraction was 90.85% in NPWT therapy as compared to 75.65% in conventional group patients. The difference was statistically significant (p<0.05). Decrease in wound dimensions was significantly faster in NPWT group patients as compared to conventional group. The difference was statistically significant from week 2 (p<0.05). Conclusion: Negative Pressure Wound Therapy with its modification appears to be superior compared to conventional dressing in terms of early appearance of granulation tissue, rapid contraction, overall faster healing, decrease in hospital stay and much more cost-effective.

DOI: 10.5281/zenodo.11001224

35. Intraabdominal Ruptured Liver Abscess: Computed Tomography and Clinical Features
Sandeep Kumar, Ashok Kumar, Vinayak Gautam, Madhukar Dayal
Aim: The aim of the present study was to assess the Computed Tomogrаphy (CT) аnd clinicаl findings of intrааbdominаl ruptured liver аbscess. Methods: This was а retrospective observational study of pаtients with intrааbdominаl ruptured liver аbscess presenting in the Department of Radiology. The study group consisted of 50 pаtients.  Аll diagnosed cаses of ruptured liver аbscess bаsed on rаdiology аnd lаpаroscopic investigation were included in the study. Results: Diаbetes mellitus wаs the most common underlying medicаl condition (26%), followed by bаcteriаl pneumoniаe (18%), hypertension (6%), bile duct stones (4%). Most of the pаtients were suffering from аbdominаl pаin (96%), mаlаise аnd аnorexiа (96%), fever (78%), peritonitis (78%), аnd other positive clinicаl signs. The meаn size of the liver аbscess wаs 8.6 cm (rаnge, 4.0-14 cm). А single аbscess wаs found in 18 pаtients, аnd multiple аbscesses were seen in 32 pаtients. Unilobаr involvement wаs seen in 45 pаtients. The аbscesses were completely liquefied in 40 pаtients аnd gаs in the аbscess cаvity in 10 pаtients. Free intrаperitoneаl fluid wаs seen in аll pаtients. Conclusion: А ruptured hepаtic аbscess is more life-threаtening thаn аn unruptured one. А rаpid аnd аccurаte diаgnosis аnd prompt surgicаl intervention аre essentiаl. Most of the cаses hаd аn аcute presentаtion аnd the right lobe is commonly аffected. Pаin in the abdomen wаs the most common symptom which presented in most cаses. Computed Tomogrаphy is аn ideаl tool for diаgnosing hepаtic аbscesses аnd its complicаtions.

DOI: 10.5281/zenodo.11001248

36. A Study to Determine the Effect of Kharra Chewing on Periodontal Tissues of Patients with Oral Submucous Fibrosis
Pratyush Anshuman
Aim: The aim of the present study was to determine the effect of kharra chewing on periodontal tissues of patients with oral submucous fibrosis in Bihar region. Methods: The study was conducted on 75 patients (aged 25–60 years) visiting the Department of Dentistry for one year . It abided by the Declaration of Helsinki of 1973 (revised 2000). Results: Group III and Group II exhibited considerably greater levels of all clinical indices as compared to Group I, with statistical significance (P < 0.05). An examination of the differences between Group III, Group II, and Group I using Tukey’s post hoc test found that there was a statistically significant difference between them. In Groups I, II, and III, the GI values were 0.7 ± 0.3, 1.8 ± 0.2, and 0.8 ± 0.3, respectively. The PI values were 0.9 ± 0.5, 1.4 ± 0.6, and 2.2 ± 0.5, to be more specific. PPD (overall) was measured to be 3.3 ± 0.7 mm in Group III, whereas CAL (overall) was measured to be 4.9 ± 0.7 mm. It was determined that there was no statistically significant difference in CAL between Group II and Group III. It was shown that Group I had a lower PPD and CAL. The frequency of chewing kharra was found to be 6.12 ± 2.58 times per day in Group II and 6.54 ± 1.6 times per day in Group III, respectively according to the results of the study. In Group II, the duration of kharra consumption was found to be 3.97 ± 2.52 years, whereas in Group III, it was found to be 7.06 ± 2.72 years. Conclusion: Chewing kharra, according to the findings of the research, causes periodontal damage in individuals who have oral squamous cell carcinoma. Even in the presence of the premalignant state, it is possible to see a direct correlation between the poor periodontal health status and the behaviour that is detrimental to the oral health.

DOI: 10.5281/zenodo.11001296

37. A Hospital Based Assessment of Ventral‑Inlay Buccal Mucosal Graft Urethroplasty (VI‑BMGU) in Female Urethral Stricture Disease (USD)
Arshad Jamal, Rana Pratap Singh
Aim: The aim of the study was to assess ventral‑inlay buccal mucosal graft urethroplasty (VI‑BMGU) in female urethral stricture disease (USD). Methods: The present study was conducted at department of Urology, Rajendra Institute of medical sciences (RIMS), Ranchi, Jharkhand, India for one year  and retrospective review was performed on 10 females with urethral stricture who underwent VI‑BMGU. Full informed consent was taken from all patients. Results: The mean age at the time of surgery was 52 (range, 28–75) years. Mean stricture length was 2.1 (range, 0.1–5) cm and mean stricture caliber was 11 (range, 0–18) Fr.  The mean size of catheter that was left in place after surgery was 18 (range, 14–30) Fr, with mean catheter duration of 17 (range, 2–30) days. Mean postoperative follow-up was 33 (range, 7–106) months. Presenting symptoms included obstructive voiding symptoms (80%), urinary frequency (60%), dysuria (60%), urgency (50%), urinary tract infection (40%), incontinence (30%), urinary retention (26%), bladder pain (8%), dyspareunia/pelvic pain (8%), and hematuria (5%). 10% reported pre-operative. All the women could urinate successfully after foley removal. There was an improvement in AUA symptom score and Qmax and a reduction in PVR at 3, 6, and 12 months. Cystopanendoscopy (CPE) showed no stricture in the second patient, and urethra could be calibrated with an 18 Fr Foley’s catheter. Conclusion: Female buccal BMG urethroplasty is a safe and effective management option for female urethral stricture. Women should be referred to centers where female urethroplasty is performed for surgical consideration, rather than undergo repeated urethral dilations that have poor long-term success.

DOI: 10.5281/zenodo.11001319

38. A Prospective Analytical Observational Assessment of Various Vital Parameters in Relation to Different Feeding Methods in Preterm Newborns
Rakesh Kumar, Prem Kumar, Sujit Kumar
Aim: The aim of the present study was to study changes in vital parameters in relation to different feeding methods in preterm newborns. Material& Methods: This was a prospective analytical observational study conducted in Department of Pediatrics, Nalanda Medical College and Hospital, Patna, Bihar, India for the period of 2 years. Sick preterm newborns are admitted to Neonatal Intensive Care Unit (NICU), and stable preterm newborns weighing more than 1500 gm are admitted to Neonatal Intermediate Care Unit. We collected 480 observations from 200 newborns. Results: There was rise in RR at 5 min in the majority of groups except the GF group. After 5 min, it reduced gradually towards baseline at 3 hours after feed in the majority of the groups except the SG and BSG groups. There was rise in PR at 5 min in majority of groups except in the BS and GF groups. After 5 min, it reduced gradually towards baseline at 3 hours after feed in the majority of the groups except in the BF and BS groups where it reduced below the baseline. We noticed the trend towards nonsignificant rise in SPO2 immediately after feed in the SF, BG, and SG groups while in the GF, BS, and BSG groups there was nonsignificant reduction. There was a sharp reduction at 5 min in the majority of the groups except GF. Mean SPO2 reached towards baseline at 3 hours after feed in the majority of the groups except the SF group where it was below baseline. In the BF group, the mean SPO2 increased significantly immediately after feed. Conclusion: Vital parameters changed after different types of feeding methods and at different PMA. A further multicentric prospective study is needed to understand the effect of different feeding methods and PMA on vital parameters.

DOI: 10.5281/zenodo.11001324

39. Study to Determine the Prognosis of Acute Ischemic Stroke and Compare Mean Hematological Parameters Based on the Prognosis of Acute Ischemic Stroke
Santosh Kumar, Pradeep Kumar Singh
Aim: The aim of the present study was to determine the prognosis of acute ischemic stroke and compare mean hematological parameters based on the prognosis of acute ischemic stroke. Methods: This Descriptive case series was conducted in the Department of Pathology for one year.100 patients fulfilling the selection criteria were selected. Results: The Mean±SD for the quantitative variables Hemoglobin, total leukocyte count, platelet, mean platelet volume, ESR & CRP are 10.5±2.8, 14.6±12.0, 144.6±92.8, 16.4±10.5, 43.4±36.4 & 18.6±22.5 respectively. There was an association between the Outcome (rather expired or discharged) of the patients with the variables like Hemoglobin, TCL, Platelet, MPV, ESR & CRP as all p-values were significant. Mean Discharged group was greater than mean Expired group in Hemoglobin & Platelet, mean Expired group is greater than mean Discharged group in TLC, MPV, ESR & CRP. Levene’s Test for Equality of Variances had p-values for Hemoglobin, TLC, Platelet, MPV, ESR & CRP in Expired & Discharged group  showed all significant p- values as these were less than 0.05 & concludes that the variances of Expired group & Discharged group were significantly different. Conclusion: We concluded that a significant change was found in hematological parameters in ischemic stroke patients. In light of our results that depicted the difference in the readings of the values for each parameter like hemoglobin, erythrocyte sedimentation rate, platelets count, mean platelet volume, C-reactive protein, and leukocyte count we suggest that these hematological parameters can be used as a tool to take the measures necessary for the prevention of future damage by stroke.

DOI: 10.5281/zenodo.11001338

40. A Hospital Based Observational Study to Evaluate Post Covid Computer Vision Syndrome
Gautam Garg, Sujata Kumari, Sunita Kumari, Nageshwar Sharma
Aim: The aim of the present study was to assess post covid computer vision syndrome. Methods: The present study was conducted in the Department of Ophthalmology for 12 months .200 participants were included in the study. Results: The female participants were the majority and accounted for 52%, while the males constituted 48%. Most of the patients belonged to 21-40 years of age. Concerning their education level, 17% were in primary school. Most of the children were from the city side, accounting for 64%, whereas those from the village were 36%. Headache was the most selected symptom followed by tearing, itching, blurred vision, eye pain eye redness, burning, excessive blinking and dryness. Other minor selected symptoms were double vision and colored halos around objects. Female gender was significantly associated with an increased risk of CVS as compared with males and participants in the higher age groups were significantly associated with a high prevalence of CVS as compared with participants in the age group of 13 to 15 years. Participants at intermediate and secondary schools were also at high risk of CVS. Lastly, symptoms experienced before COVID and increased severity of symptoms with COVID were also independent predictors (risk factors) of CVS among the studied participants. Conclusion: A significant association between prevalence and demographic factors, such as age, gender, and education level, was established. A significant association between the prevalence of CVS and symptoms before and during the COVID-19 pandemic was also established. The main signs associated with CVS included headache, tearing, itchiness, blurred vision, eye redness, eye pain, and dryness.

DOI: 10.5281/zenodo.11001344

41. A Retrospective Assessment of the Demographics and Antimicrobial Susceptibility Patterns of Lower Respiratory Tract Infections in ICU
Uzma Raihan, Preeti Kumari
Aim: The aim of the present study was to assess the distribution and antimicrobial susceptibility patterns of lower respiratory tract infections over a six–month period in the medical and surgical intensive care units of a teaching hospital. Methods: This was a retrospective study conducted at Department of Trauma and Emergency, IGIMS for a period of 6 months. This institution is an academic teaching hospital and is one of the local tertiary referral units. However, this study was restricted only to the medical and surgical ICUs. Total number of patients (medical and surgical admissions) seen at our institute during the study period was 1400; out of whom, 400 patients required intensive care. Two hundred patients were enrolled for the study after considering the inclusion and exclusion criteria. Results: A total of 200 patients were included in the study, out of which 150 (75%) were males. Amongst different age groups, maximum patients were above 60 yrs (30%) and the least were between 18–30 yrs age group (13%). The underlying major medical conditions of the LRTI were diabetes mellitus (32%), respiratory pathology (20%), nephrological pathology (19%) and malignancy (13%); while 16% of the patients had other medical conditions, including electrolyte imbalance, hormonal imbalance, or miscellaneous causes such as poisoning. The bacteria were isolated predominantly from the tracheal aspirate (85%), compared to broncho–alveolar lavage (15%) with a statistically significant difference between them. Out of all the isolated organisms, A. baumannii, P. aeruginosa and Klebsiella were the most predominant isolates. S. aureus and Enterococcus were equal. Other pathogenic bacteria were E. coli followed by equal number of Pneumococcus and CONS. In the gram–positive isolates, S.aureus was equally susceptible to linezolid (75%) and vancomycin (75%); and 100% of the isolates of Enterococcus were susceptible to vancomycin. Conclusion: Gram–negative pathogens were predominantly responsible for lower respiratory tract infections. Moreover, antimicrobial resistance rate was high with the most commonly used antibiotics and also to higher antibiotics such as carbapenems.

DOI: 10.5281/zenodo.11001361

42. A Case Control Assessment of the Association of Serum Vitamin D (25(OH) D) Level and Recurrent Wheeze in Children Less Than Five Years of Age
Arvind Kumar Yadav, Manish Ranjan, Kripa Nath Mishra
Aim: The aim of the present study was to assess the association of serum vitamin D (25(OH) D) level and recurrent wheeze in children less than five years of age. Methods: This was a hospital-based analytical case-control study performed in the Pediatrics department of Darbhanga Medical College and Hospital.  Children less than five years of age, diagnosed with recurrent wheeze, presenting to emergency/outpatient department were enrolled after getting written informed consent. A total of 50 cases with recurrent wheeze along with 50 healthy controls were enrolled. Results: The basic demographic characteristics i.e., age, sex, weight, and height was comparable in both the groups. Moreover, both the groups had very less but comparable sunlight exposure. The feeding pattern was significantly different between two groups. Most of the cases (64%) were exclusively and prolonged breastfed in contrast to controls in which most (72%) of the babies were started on complementary feeds at six months. There were no seasonal variations in the frequency of wheezing. The mean serum levels of 25-hydroxyvitamin D, calcium, and inorganic phosphate were significantly higher in controls compared to cases. Conversely, median serum ALP was significantly more in cases than the controls. Among them too, serum vitamin D and ALP levels were significantly different in cases and control. Most of the babies were exclusively breastfed until six months, however complementary feeding was not initiated at six months of age in most. Conclusion: Low serum 25(OH)D levels are strongly associated with recurrent wheezing in preschool children. In absence of vitamin D levels, high serum alkaline phosphatase levels (>350 IU/L) can be used as a predictor of recurrent wheeze. However, breastfeeding doesn’t seem to protect against recurrent wheezing.

DOI: 10.5281/zenodo.11001368

43. A Prospective Observational Evaluation of the Renal Function and its Relationship with Mortality in Patients with Acute Stroke
Rajeev Kumar, Shreya
Aim: The aim of the present study was to investigate the renal function in patients with acute stroke and its relationship with in-hospital mortality. Methods: The present study was a prospective, observational study conducted at Department of General Medicine for the period of one year. 150 patients were considered for present study. Results: Patients were divided into two groups as per eGFR. Group A with eGFR>60 and Group B with eGFR <60. 66.66% were from group A while 33.34% were from group B. Most patients were from >65 years age group, male, BMI<30. Hypertension, smoking, diabetes mellitus, cardiovascular disease, alcohol consumption, dyslipidemia, previous history of stroke/TIA were common risk factors in both groups. On admission most patients had GCS score 5-13. 97 patients had ischemic stroke, while 53 had hemorrhagic stroke. We noted mortality within 30 days in 31 patients. We distributed patients according to Serum Creatinine concentration at time of presentation, most patients had serum creatinine in the range of 98-118 (32%) followed by 82-97 (28%). Maximum mortality was noted in >119 (38.70%) followed by 98-118 (32.25%) serum creatinine group. We distributed patients according to blood urea concentration at time of presentation, most patients had blood urea in the range of 6.8-8.9 (40%) followed by 5.3-6.7 (26.66%). Maximum mortality was noted in >9 (41.93%) followed by 6.8-8.9 (29.03%) blood urea group. We noted that age > 65 years, at the time of admission, smoking, diabetes mellitus and aspiration pneumonitis were predictors of death in stroke patients. Conclusion: The severity of impaired kidney function in patients hospitalized with acute stroke is associated with increased mortality independent of age, sex, and major comorbidities. Unrecognized renal insufficiency noted by low eGFR is common in patients with acute stroke and is associated with higher mortality adverse short-term outcomes.

DOI: 10.5281/zenodo.11001378

44. A Study on the Prevalence of Urinary Tract Infection in Infants and Young Children with Acute Diarrhea
Ashutosh Kumar Verma, Samarjeet Grover, Shalini Kakar
Aim: The aim of the present study was to assess the prevalence of urinary tract infection in infants and young children with acute diarrhea. Methods: This descriptive hospital-based study was conducted in the Department of Paediatrics. In the study period 100 diarrhea cases admitted to the paediatric ward were included children who satisfied the inclusion criteria (Children aged 6 months to 6 years admitted with diarrhea) with proper consent from parents or primary care givers were included in the study. Results: In our study 15% of study population was found to have urinary tract infection. The most common organism isolated from the urine was E coli (10 cases) followed by Enterococci (n=2). Others were Klebsiella, Citrobacter and Alpha streptococci. In the present study group 10 of urinary tract infection cases were in the age group of 6 months to 1year, followed by 3-6 years. Out of total 15 cases of urinary tract infection, 12 cases were females and 3 were males. Among the 15 positive urinary tract infection cases 9 children had normal nutritional status whereas rest 6 cases had grade 1 PEM according to Indian Academy of paediatrics classification. In 15 children with urinary tract infection, 8 were normally hydrated. 6 showed some signs of dehydration. Conclusion: UTI in young children can present with diarrhea and other nonspecific symptoms. Children presenting with diarrhea need to have a urine analysis and urine culture for the confirmation of UTI, so that long term complications like renal parenchymal damage and hypertension can be prevented.

DOI: 10.5281/zenodo.11001386

45. A Hospital Based Prospective Clinical and Radiological Assessment of Multiple Ligament Injuries of Knee
Abhinav Kumar, Rahul Harish, Puja Sinha
Aim: The aim of the present study was to assess the clinical and radiological evaluation of multiple ligament injuries of knee. Methods: The Prospective study was conducted in the Department of Orthopaedics for the period of 1 year. 50 cases were included in the study. Results: In our study out of 50, there were 39 males and 11 females. The youngest and the oldest patient in our study were 18 and 60 years old respectively. Majority of the patients were found to be between the age group of 17-30 years. The least number of cases are found in the age group of >40 years. The average age was 35.5 years. Majority of the patients were of left side, 31 patients (62%) and remaining 19 patients (38%) were of right side. Most common mode of injury was Road Traffic Accidents with 22 patients followed by 16 patients with sports injury and 12 patients with history of fall. In our study out of 50 cases, most common pattern of injury was type III ACL + posterolateral complex with 18 cases (36%) and the least common was type IV PCL +Posterolateral complex with only 2 cases (4%). Lachman test and Anterior drawer test for Anterior cruciate ligament had a P Value <0.05 which was statistically significant in our study. Posterior drawer test, Valgus stress test, Varus stress test, McMurray’s had P Value <0.0001 which was statistically highly significant in our study. Posterior sag test had P value >0.05 which had not statistically significant in our study. On comparing with MRI Lachman’s test is more sensitive than anterior drawer for ACL tear, For PCL injury posterior drawer was more sensitive than Posterior sag test. Varus test for LCL and McMurray’s test for Medial meniscus were more sensitive than their counterparts. Conclusion: We concluded that MRI is better non-invasive diagnostic tool for multiple ligament knee injuries than clinical examination which provides with the information of ligaments involved, grade of involvement and is cost effective.

DOI: 10.5281/zenodo.11001395

46. A Study to Assess the Renal Function in Subclinical Hypothyroid Patients: An Observational Study
Naiyer Azam
Aim: The aim of the present study was to assess the renal function in subclinical hypothyroid patients. Methods: The present study was conducted at Department of Biochemistry and all the cases detected with SCH from August 2021 and May 2023 were taken for the study. The data were collected from patients coming to L. N. Medical College & Research Centre and J.K. Hospital, Bhopal (MP) for consultation in outpatient department (OPD) and from medical records. A total of 750 subjects were included in the study. Results: We found a highly significant difference in the mean values of FT3, FT4, TSH, serum creatinine, eGFR by MDRD, and eGFR by CKD‑EPI equation among all the groups. A linear trend of increase in creatinine values from ET controls to SCH to OHT groups. Pearson’s correlation studies reveal that TSH levels were well correlated with serum creatinine in the OHT group only. No correlation was found with ET and SCH groups. Similarly, a significant negative correlation between TSH and eGFR was found only in OHT group. We found a very strong positive correlation between eGFR calculated by MDRD and eGFR by CKD‑EPI equations in all the subjects. Linear regression analysis in GLM model showed that the linear regression in creatinine based on the TSH values is attributable to the extent of 44.7% among the OHT group. Conclusion: This study concluded that there is tissue hypothyroidism as manifested by the difference in the creatinine levels and eGFR values in such patients compared to the healthy controls. eGFR calculation by both the formulae has good correlation in the study groups. Hence, either of them can be used for measuring GFR. Furthermore, the linear regression analysis concludes that the TSH values may be used to predict the lower kidney function (higher creatinine values) among the SCH group.

DOI: 10.5281/zenodo.11004442

47. A Population-Based Incidence and Prognosis of Various Eye Diseases in End Stage Renal Disease Patients and Kidney Transplant Recipients
Madhulika Sinha, Rajnee Sinha, Rajeshwar Rao, Gyan Bhaskar, Pritpal Singh
Aim: The aim of the present study was to assess the Nationwide Glaucoma incidence in end stage renal disease patients and kidney transplant recipients. Methods: The primary objective of the project was to investigate the effect of KT on the national population-based incidence and prognosis of various eye diseases, including age-related macular degeneration, retinal vein occlusion, and glaucoma. Results: The mean age of the subjects was 46.4 ± 11.6 years and majority of subjects were men. There was a significant difference in income among the study groups (P < 0.0001). A larger proportion of KTRs and ESRD patients had a history of underlying chronic disease such as DM, HTN, and dyslipidemia when compared with healthy control (all Ps < 0.0001). Among the ESRD patients, 76% of the patients under- went hemodialysis, 20% underwent peritoneal dialysis, and 4% underwent mixed dialysis. Among the KTRs, 30% had no dialysis history, 44% underwent hemodialysis, and 16% underwent peritoneal dialysis before KT. For KTRs, 96% of the recipients received induction medication. Almost all the KTRs were prescribed calcineurin inhibitor for maintenance therapy and 14% of the KTRs experienced desensitization. Conclusion: In conclusion, the present nationwide population-based cohort study showed that there was no significant association of POAG incidence risk in ESRD patients and KTRs after controlling for multiple confounding factors. However, the PACG risk was significantly increased in ESRD patients. Interestingly, KT reduced the risk of PACG in ESRD patients to a level similar to that in healthy controls.

DOI: 10.5281/zenodo.11004448

48. The Clinical Characteristics of Individuals Who Had Sudden Sensorineural Hearing Loss: A Retrospective Evaluation
Sumit, Namira Azmi, Indrajeet Kumar, Satyendra Sharma
Aim: The aim of the present study was to study clinical profile of patients with sudden onset sensorineural hearing loss at a tertiary hospital. Methods: This retrospective study, conducted in Department of ENT. We studied total 200 case records. Case records of patients with sudden onset sensorineural hearing loss examined from last two years were considered for present study. Results: All patients were compared according to recovery status. Recovery was noticed in 80 patients (40%) while no or less than 50% recovery was noticed in 120 patients (60%). Majority of patients were from 41-60 years age group (43%) followed by from 21-40 years age group (30%). In patients with recovery, mean age was 42.88 ± 8.32 years as compared to patients without recovery as 51.52 ± 11.79 years and difference was statistically significant (p<0.05). Gender was comparable among total patients as well as patients with or without recovery and difference was statistically not significant (p>0.05). Hypertension (35%), diabetes (20%), dyslipidemia (20%) and thyroid disorder (8%) were common comorbidities noted among patients. Vertigo was significant in patients without recovery as compared to patients with recovery and difference was statistically significant (p<0.05). Tinnitus was comparable in patients with recovery (40%) as well as patients without recovery (60%) and difference was statistically not significant (p>0.05). Audiogram curve was flat, U-shaped, reverse U-shaped (45%) in majority of patients followed by descending (40%) and ascending (15%). Degree of hearing loss was mild (8%), moderate (10%), moderately severe (20%), severe (25%) and profound (37%). Incidence of patients without recovery was increased with increase in severity of hearing loss and difference was statistically significant (p<0.05). Conclusion: In patients with sudden onset sensorineural hearing loss age less than 40 years, no comorbidities, lesser degree of hearing loss, early (<14 days) initiation of treatment are factors associated with recovery.

DOI: 10.5281/zenodo.11004459

49. A Hospital Based Observational Study to Assess the Results of Endoscopic Transcanal Myringoplasty
Manish Kumar, Md. Tausiful Haque, Birendra Kumar
Aim: The aim of the present study was to assess the results of endoscopic transcanal myringoplasty. Methods: The present study was conducted in the Department of ENT, We reviewed the medical records of 50 patients who under- went endoscopic transcanal myringoplasty. The patients with anterior perforations of the tympanic membrane were enrolled; these patients were followed up for at least 6 months. Results: The changes from preoperative to postoperative air-bone gaps were noted. 34 patients (68%) had preoperative air-bone gaps of less than 20 dB, whereas 49 patients (98%) had postoperative air-bone gaps of less than 20 dB. The association between the rate of graft success and prognostic factors were noted. The success rate among patients with postoperative otorrhea was significantly lower than that among patients without postoperative otorrhea. Notably, the success rate with partial visualization of the perforation was comparable to that with complete visualization of the perforation. No significant differences were seen for larger and marginal perforations. Conclusion: Our study revealed that wider endoscopic visualization can neglect the factor of partial visualization of the perforation margin through otoscopy, which increases the rate of graft success in anterior perforations of the tympanic membrane. Therefore, the rate of graft success and hearing results are comparable with those of microscopic myringoplasty for repairing anterior perforations of the tympanic membrane.

DOI: 10.5281/zenodo.11004475

50. Effect of two Genre of Music on Heart Rate Variability in first year MBBS Students of P.M.C.H., Patna
Shanta Kumari, Harshwardhan, Rajiva Kumar Singh
Aim: The aim of the present study was to assess the effect of music on frequency domain measures of heart rate variability (HRV) in medical students. Methods: The study was conducted on twenty randomly selected first year MBBS Student of age group 17-21 yrs., both genders. They were exposed to two musical excerpt of ten minute duration of different genres of music that is slow melody and fast rhythm music during which Heart Rate Variability indices were continuously monitored. Results: The music group demonstrated a significant decrease in heart rate (P < 0.0001), mean arterial pressure (P < 0.02) and rate pressure product (P < 0.01) compared with non‑music group. The music  group showed  a significant decrease  in HR (P < 0.0001), mean arterial pressure (P  < 0.02) and rate pressure product (RPP) (P < 0.01) compared with nonmusic group. The TP which is the marker of the magnitude of HRV and HFnu were significantly increased (P < 0.0001) in the music group compared with nonmusic group. But the LFnu was decreased significantly (P < 0.0001) in the music group compared with nonmusic group. Furthermore, the LF/HF ratio was significantly decreased  (P  < 0.0001)  depicting the decreased sympathetic activity and increased parasympathetic activity in the music group compared with nonmusic group. The LF‑HF ratio was not significantly correlated with TP and stress score in both the music and non-music groups. Conclusion: In the present study, music therapy could reduce the stress levels in the medical students. Therefore, this study provides the preliminary evidence that listening to classical music could be an effective method of relaxation, as indicated by a shift of the autonomic balance towards the parasympathetic activity among medical students.

DOI: 10.5281/zenodo.11004479

51. A Hospital Based Assessment of the Electrolyte Levels in Serum and Plasma: A Comparative Study
Anupama Priyadarshini, Uma Shankar Kumar
Aim: The aim of the present study was to compare electrolyte levels in serum and plasma. Material & Methods: This study was conducted during the period of 12 months at Bodhi Hospital, Patna, Bihar, India 50 patients were included in the study. After obtaining consent, samples for the study were collected from OPD patients coming to the laboratory. The samples were collected by trained phlebotomist. Hemolysed and lipaemic samples were excluded from the study. Results: According to the data, there are substantial differences in the average levels of certain electrolytes between serum and plasma. In the present study we found plasma and serum sodium levels did not vary till 48 hours at 2 to 4°C. At 2 to 4°C serum K levels did not differ from the baseline value up to 48 hrs, whereas changes were noticed in plasma K after 36 hours. Serum and plasma chloride were stable only up to 12 hours at 2 to 4°C. At room temperature, sodium levels did not show any change up to 24 hours in plasma and up to 36 hours in serum. Plasma K was stable up to 12 hours but serum K was stable up to 48 hours. Plasma chloride was stable up to 6 hours but serum chloride was stable upto 12hours. Conclusion: Estimation of electrolytes as early as possible at proper storage conditions is the best solution to avoid analytical errors.

DOI: 10.5281/zenodo.11004620

52. A Retrospective Single-Center Study in Development a New Indian Nomogram to Estimate Pathologic Extracapsular Extension (ECE) Risk in Prostate Cancer
Mukesh Jaysawal, Amit Ranjan, Khursheed Alam
Aim: The aim of the present study was to develop a new Indian nomogram to estimate pathologic extracapsular extension (ECE) risk in prostate cancer. Methods: This was a retrospective single-institution study of patients who underwent primary RP at department of General surgery. The data of 200 patients were analyzed. The collected data included prebiopsy serum prostate-specific antigen (PSA) levels, clinical T-stage (cT) determined by digital rectal examination (DRE), Gleason score (GS) from transrectal ultrasound (TRUS)-guided prostate biopsy, MRI data, and histopathologic findings from the RP specimens of all patients. Results: Out of 200 patients, 100 patients had ECE on MRI, whereas 100 patients had ECE on final pathology. All variables except age demonstrated a statistically significant difference in detecting ECE on final pathology on univariate analyses. Based on multivariate logistic regression analyses, cT, GS and MRI ECE risk score remained significant predictors of ECE. Conclusion: MRI adds incremental value to the existing validated risk stratification tool and provides significant additional ability for predicting ECE in prostate cancer staging. We constructed a nomogram for predicting ECE based on the results of cT, PSA, GS, and MRI ECE risk score in Indian patients. The nomogram provides a good prediction of ECE.

DOI: 10.5281/zenodo.11004625

53. A Case-Control Study Assessing the Relationship between Diabetes Mellitus and Tooth Loss among Diabetic Patents
Pranav Prakash, Divya Kumari
Aim: The aim of the present study was to assess the number of missing teeth and to examine the relationship between age and tooth-loss in diabetic patients. Methods: This was an observational case-controlled study consisting of 100 diabetic patients and an equal number of non-diabetic patients as control in the Department of Dentistry for one year. Results: There were more females as compared to males and most of the patients belonged to 45-54 years of age. Most of the patients had secondary level education. The mean fasting blood glucose recorded for non-diabetics was 72.88 ± 14.72 and 115.38 ± 22.52 at 2 hours post-prandial; the diabetic group had a mean of 124.96 ± 15.37 recorded as fasting and 208.94 ± 20.98 at 2 hrs post-prandial. In the present study, 58% were suffering from painful gum and 54% had gum swelling. 19% extracted tooth because of gum problem. Conclusion: It can be stated that the higher number of missing teeth in the diabetic patients than the non-diabetic patients suggests that tooth loss has a direct relationship with diabetes mellitus. In addition, within the limitations of this study, it is believed that the number of tooth lost is directly related to the age of the diabetic patient. Therefore, the dental surgeon has an important role in the early detection of clinical features of diabetes mellitus in patients reporting to the dental clinic for oral health care.

54. A Randomized Double Blind Clinical Study Assessing Efficacy of Injection Clonidine in Attenuation of Haemodynamic Response to Laryngoscopy and Orotracheal Intubation
Mahesh Kumar, Amit Kumar
Aim: The aim of the present study was to assess the efficacy of intravenous Clonidine 1 µg/kg in attenuation of haemodynamic response to orotracheal intubation and laryngoscopy and observe side effects of Inj. Clonidine. Methods: The Prospective randomized double blind clinical study was conducted in the Department of Anaesthesiology & Critical Care, Jawaharlal Nehru Medical College, Bhagalpur, Bihar, India. Written informed valid consent was obtained from all patients participating in the study. 100 patients of either sex, between 20-60 years of age of ASA Grade I and II scheduled for surgery under General Anaesthesia were studied. Results: There was a statistically significant increase in HR (P=0.000) compared to baseline value, statistically significant increase in SBP at 0 minute, 1 minute, 3 minutes and 5 minutes whereas negligible decrease after 10 minutes compared to baseline value after intubation in group injected with normal saline. There was statistically significant increase in DBP (P<0.01) compared to baseline value in this group. While in clonidine group , there was an attenuated hemodynamic response after laryngoscopy and intubation. Conclusion: Clonidine at a dose of 1 μg/kg body weight diluted in 10 ml Normal saline given 10 minutes before induction significantly attenuates the haemodynamic responses to laryngoscopy and orotracheal intubation with minimal side effects like bradycardia. However, the study has to be done on a larger population and in high risk patients for further evaluation.

55. An Observational Study Assessing Role of Ultrasound Elastography in the Evaluation of Breast Lesions
Priyanka Raj, Pradeep Kumar, Sanjeev Suman, V.S. Prasad
Aim: The aim of the present study was to evaluate the role of ultrasound elastography in the evaluation of breast lesions. Methods: The present study was a prospective observational study conducted in Department of Radiodiagnosis. Study period was one year. During study period total 100 patients underwent ultrasound elastography examination followed by core needle/surgical biopsy for histopathological study. Results: On histopathological study 78% lesions were benign, while 24% were malignant. Fibroadenoma (37%), fibrocystic changes (17%), galactocele (6%) and mastitis (7%) were common benign findings while invasive ductal carcinoma, mucinous carcinoma and invasive papillary carcinoma were malignant lesion findings. On ultrasound elastography score examination, scores of 1 (24%), 2 (39%), 3 (16%), 4 (7%) and 5 (14%) were noted. Scores 1 to 3 were considered benign and 4 and 5 malignant. On statistical analysis we calculated sensitivity (94/88%), specificity (83.62%), positive predictive value (93.57%), negative predictive value (85.35%) and accuracy (94.71%) of ultrasound elastography with histopathological report. Conclusion: Ultrasound elastography is a useful non-invasive diagnostic modality in differentiating benign from malignant breast lesions thereby reduces waiting, cost, discomfort and anxiety of a biopsy.

56. A Hospital-Based Study to Investigate the Common Bacteria Associated With UTI Cases and Their Antibiotic Susceptibility Pattern
Naveen Kumar, Asha Kumari, Kanchan Kumari
Aim: The aim of the present study was to investigate the common bacteria associated with UTI cases and their antibiotic susceptibility pattern. Methods: A retrospective descriptive study was done for one year in DMCH, Laheriasarai, Darbhanga, Bihar. The study included all in-patients of either gender above 18 years of age with a diagnosis of UTI. Data was collected from the patient’s case record files, which were retrieved from the medical records department of our hospital. Results: Out of 120 significant isolates, gram-negative organisms accounted for 81%. Fungal isolates were seen only in 2% of cases. E.coli was the most predominant uropathogen isolated followed by Klebsiella spp, Enterococcus fecalis and Acinetobacter spp. Other uropathogens included MRSA bacteria, Staphylococcus aureus, Candida spp, Citrobacter freundii, Pseudomonas spp and Streptococcus spp. E.coli, showed considerable resistance to ampicillin, ceftriaxone, Co-Trimoxazole and fluoroquinolones. Low level of resistance was observed with Nitrofuration, piperacillin+ tazobactam and Ticarcillin. Klebsiella spp, the second most common uropathogen showed high level of resistance with ampicillin, cephalexin, cefuroxime, ceftriaxone and Nitrofuration. Conclusion: Most of the identified bacteria were resistant to several of the popular antibiotics used in clinical settings. Consequently, it is vital to prescribe antibiotics rationally both before and after culture reports. Pattern needs to be studied further and the outcome should be communicated to the prescribing physicians in that area.

57. A Study to Assess the Prescription Pattern to Promote Rational Use of Drugs: Cross-Sectional Descriptive Study
Kanchan Kumari, Asha Kumari, Naveen Kumar
Aim: The aim of the present study was to assess the prescription pattern to promote rational use of drugs. Methods: A cross-sectional descriptive study was done for one year in DMCH in Darbhanga. Prescriptions from Out-patient departments especially Medicine and Pediatrics were collected and analyzed. The prescribed fixed dose combination drugs and other drugs were categorized according to Anatomical Therapeutic Chemical classification (ATC classification). Results: Most common FDCs in elderly age group belonged to Gastrointestinal system and in Pediatric population mainly respiratory system. The highest percentage of FDCs were seen in alimentary tract, followed by anti-infective, respiratory system. The maximum number of FDCs was of antacid combination followed by combination of proton-pump inhibitors and prokinetic drugs in the alimentary tract. In case of respiratory drugs maximum number was of antihistaminics, anticholinergics followed by anti asthamatics. In nervous system combination of paracetamol, tramadol followed by paracetamol, codeine and caffeine. In anti-infective group mostly amoxiclav, norfloxacin-tinidazole, ofloxacin-ornidazole. Conclusion: A significant number of drugs are being prescribed as FDCs which also includes various irrational combinations. A multipronged corrective approach involving regulator, academia, industry, physicians, and public is needed to correct the dismal FDC scenario.

58. Investigating Coping Strategies of Visually Impaired Adults
Uttam Haribhau Nisale
Background: Coping with visual impairment presents significant challenges that require adaptive strategies to manage daily life, professional responsibilities, social interactions, and emotional well-being. This study aims to explore the coping strategies employed by visually impaired adults and identify the factors influencing their effectiveness. Using a mixed-methods approach, the research combines in-depth interviews, focus groups, and surveys to gather comprehensive data from a diverse group of visually impaired adults aged 18 and above. The study utilizes thematic analysis for qualitative data and statistical analysis for quantitative data to uncover common themes and patterns. Preliminary findings suggest that visually impaired adults employ a range of coping strategies, including the use of assistive technologies, reliance on social support networks, and the development of personalized routines and techniques to navigate daily challenges. Emotional coping strategies such as acceptance, positive reframing, and seeking professional psychological support also play crucial roles. The research highlights the importance of accessibility, availability of resources, and societal attitudes in shaping the effectiveness of these coping strategies. Material and Method: The Department of Ophthalmology conducted this cross-sectional study, recruiting adult patients aged 24 to 70 who self-presented to the ophthalmology outpatient department with a best-corrected visual acuity (BCVA) of less than 6/18 in the better eye, and had experienced vision loss for at least 6 months. All participants provided written informed consent. The visual loss had to be irreversible. Irreversible low vision was defined as a BCVA in the better eye between <6/18 and <6/60 that could not be treated. Irreversible blindness was defined as a BCVA in the better eye between <6/60 and 3/60 (economic blindness). Irreversible social blindness was defined as a BCVA in the better eye between <3/60 and <6/60 that could not be treated. Results: Forty patients meeting the inclusion criteria agreed to participate, with half being female and aged between 24 and 70 years. Twenty percent of participants had a coexisting chronic illness but no other disability aside from vision impairment. Degenerative myopia caused by posterior segment disease was the most common reason for reduced vision or blindness. Across all participants, avoidance and reflective coping strategies received the highest ratings, while strategic planning received the lowest. Most quality-of-life scores related to vision were low, with the psychosocial impacts of vision loss being associated with the lowest quality of life scores. Conclusion: The combination of autopsy findings and CT scan results has been identified as a valuable diagnostic tool for various types of brain injury lesions, contributing to the development of improved policies. While CT scans can aid in diagnosing various types of head injury lesions, autopsies are considered a more reliable method for detection. Patients with traumatic head injuries can greatly benefit from the high-resolution CT scan, which represents an advanced diagnostic technique. Maladaptive coping mechanisms, such as demobilization and excessive mobilization, have been linked to poorer quality of life, reduced self-esteem, and increased feelings of pessimism, loneliness, and anxiety.

59. Exploring Ocular Pathological Findings in Patients under Surveillance for Hematological Malignancies: Implications for Clinical Care
Uttam Haribhau Nisale
Background: Hematopoietic malignancies, encompassing a wide range of cancers such as leukemias, lymphomas, and multiple myeloma, often present with diverse systemic manifestations. Ocular involvement, though less frequently discussed, is a significant aspect of these malignancies and can impact the diagnosis, management, and prognosis of affected patients. This review aims to provide a comprehensive overview of the ophthalmic manifestations associated with hematopoietic malignancies, elucidating the underlying pathophysiological mechanisms, clinical presentations, diagnostic approaches, and therapeutic strategies. Material and Method: Conducted within the ophthalmology department, this prospective, non-interventional descriptive study focused on evaluating forty patients with hematological conditions. A structured proforma was devised to collect essential data, including a concise medical history, ocular background, anterior and posterior segment examinations, and the hematological profile of each patient. A comprehensive assessment of the anterior and posterior segments was performed on all participants, encompassing measurements of intraocular pressure, best corrected visual acuity, slit lamp examination of the anterior segment, dilated retinal evaluation using indirect and direct ophthalmoscopy, and slit lamp biomicroscopy aided by a Volk 78 D lens. For cases requiring fundus photography, satisfactory outcomes were achieved. Prior to any treatments, all subjects provided written, informed consent for both the interventions and the utilization of their health information within their medical records. Results: In this study involving 40 patients diagnosed with hematological malignancies, ocular characteristics were identified in 20 individuals. Among the participants, there were 12 females and 28 males. Ocular findings were detected in 14 of the male patients and 7 of the female patients. Notably, anterior segment findings were observed in one male and one female. Additionally, neurological involvement was noted in 2 males and 2 females. Analysis of the posterior segment revealed a higher frequency of involvement compared to the anterior segment or neurological involvement, with 11 males and 4 females exhibiting posterior segment findings. Except for acute myeloid leukemia (AML), which displayed an equal frequency, and chronic myeloid leukemia (CML), where one case exhibited anterior segment findings and another presented posterior segment findings, the incidence of posterior segment findings outweighed that of anterior segment findings in each specific disease category. Conclusion: This study presents an analysis of ocular pathological findings observed in individuals under surveillance for hematological malignancies. The findings underscore the potential ocular involvement in these conditions and the notable clinical symptoms associated with them. Moreover, these cases underscore the importance of ocular care for patients with hematologic malignancies, particularly regarding dry eye disease, given the emergence of novel antineoplastic treatments that may extend life expectancy.

60. To Study the Impact of Respiratory Interventions on the Prevention and Treatment of Ventilator-Associated Pneumonia in Intensive Care Patients
Hashmi Syed Fazlullah Abdullah
Background: Ventilator-associated pneumonia (VAP) remains a significant concern in intensive care units (ICUs), contributing to increased morbidity, mortality, and healthcare costs. This study aims to investigate the impact of respiratory interventions on the prevention and treatment of VAP in ICU patients. By analyzing various respiratory strategies, including the use of mechanical ventilation protocols, airway management techniques, and infection control measures, we seek to determine their effectiveness in reducing the incidence and severity of VAP. The study involves a comprehensive review of existing literature, retrospective analysis of patient data, and a prospective clinical trial to evaluate the outcomes of different respiratory interventions. The findings are expected to provide valuable insights into best practices for preventing and managing VAP, ultimately improving patient outcomes and reducing the burden on healthcare systems. Aim: The aim of this study is to evaluate the effectiveness of different respiratory interventions in preventing and treating ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients. By identifying the most effective strategies, the study seeks to improve patient outcomes, reduce the incidence and severity of VAP, and minimize the associated healthcare costs. Material and Method: This prospective randomized trial was conducted in the Department of Respiratory Medicine to investigate the impact of respiratory interventions on the incidence and resolution of ventilator-associated pneumonia (VAP) in ICU patients. A total of 70 patients were enrolled in the study based on specific criteria. General demographic information for each participant, including age, sex, body mass index (BMI), and Glasgow Coma Scale score, was collected and recorded by the Principal Investigator. Additionally, data on each subject’s respiratory medical history, such as a diagnosis of chronic obstructive pulmonary disease (COPD), chronic sputum production, and smoking history, were gathered at the time of enrollment. This information was obtained either from the patient’s medical records or through interviews with their closest relatives. Results: Of the 70 subjects, 40 (57.1%) were male and 30 (42.8%) were female, indicating a majority of male participants. There were significantly more males than females in the treatment group. When analyzing the age distribution, most subjects fell within the 40-60 year age group. A significant difference in BMI was observed between male and female subjects, with males having a significantly higher BMI than females. Additionally, a significant association was found when comparing non-VAP and VAP patients regarding the duration of mechanical ventilation, length of ICU stays, and overall hospital stay, with variations noted according to gender. Conclusion: The primary conclusion from this investigation was that the implementation of a standard prophylactic respiratory regimen, which includes positioning, manual hyperinflation, and suctioning, in addition to routine medical and nursing care, appeared to prevent VAP and reduce the duration of mechanical ventilation and ICU stay. Patients who followed this prophylactic regimen in the ICU showed a lower incidence of ventilator-associated pneumonia. Although statistically significant results were observed with various clinical factors, it is recommended that adopting a prophylactic respiratory regimen is beneficial in preventing ventilator-associated pneumonia in patients.

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