Background: Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. In the setting of severe sepsis and septic shock, myocardial depression is common. According to a few studies, troponins also correlate strongly with myocardial dysfunction. Non-invasiveness and instantaneous diagnostic capability are prominent features of the use of Echocardiography in critical care. Sepsis and septic shock represent complex situations where early hemodynamic assessment and support are among the keys to therapeutic success. Materials and Methods: The present observational cross sectional study is carried out in Department of General Medicine, Agartala Government Medical College (AGMC & GBPH), Agartala, Tripura for a period of two years from December 2020 to December 2022 among patients diagnosed with sepsis in Medical Intensive Care Unit. CPKMB and Troponin-I determination along with echocardiography was done in all patients diagnosed with sepsis in Medical Intensive Care Unit. Results: In our study, 68(77.3%) patients were Troponin I positive. 70 (79.5%) patients were CPK MB positive. Left ventricular Systolic dysfunction (LVSD) was found in 55(62.5%) patients whereas Left ventricular diastolic dysfunction (LVDD) was present in 44(50%) patients. In our study 37(42.1%) patients had Right ventricular dysfunction. Conclusion: We conclude that Sepsis Related Myocardial Dysfunction (SRMD) is very much common. Early assessment of SRMD can be done by doing cardiac biomarkers (Troponin I & CPKMB). Cardiac biomarkers can guide us towards underlying cardiac dysfunction. Early echocardiographic assessment can guide us towards proper management of sepsis patients.

DOI: 10.5281/zenodo.

Introduction: This study examines the prevalence, risk factors, clinical presentation, and management outcomes of retinal vascular occlusion (RVO) at a tertiary eye care center in Western India. Materials & Methods: We included 122 patients with RVO presenting at tertiary care center in western India. We collected demographic data, vision, presenting clinical features including complications. We did OCT scan whenever applicable. We managed the patients with help of intravitreal injection anti- VEGF, vitrectomy, sectoral / pan retinal photocoagulation and supportive management as per required. Both quantitative and qualitative variables were studied using SPSS version 2.0 and data was imported into Excel. Results: The mean age was 55±10 years, with a majority (54.34%) being female. Branch retinal vein occlusion (BRVO) (48%) was the most common type, followed by central retinal vein occlusion (CRVO) (31%) and hemi retinal vein occlusion (HCRVO) (12%). Hypertension (68 patients), diabetes (49), and hyperlipidemia (40) were frequent risk factors. Clinical presentations predominantly involved diminished vision (89.85%), with macular edema being the most common complication (66.66%). Treatment included anti-VEGF injections (73.91%) and laser photocoagulation (81.15%). Conclusion: This study highlights the high prevalence of RVO in older adults, especially females, with hypertension and diabetes playing significant roles. Management with anti-VEGF and laser therapy is effective, consistent with international standards. Further population-based studies are warranted for better understanding and prevention of RVO.

DOI: 10.5281/zenodo.

Introduction: In a typical term pregnancy with isolated oligohydramnios, to investigate the outcomes for the mother and the foetus adequate quantities of amniotic fluid are essential for the growing foetus because they provide nutrition, protect the developing embryo from injury, and promote the baby’s growth and mobility in the womb. Quantification of amniotic fluid content is an essential feature of prepartum foetal surveillance. Amniotic fluid is the end product of complex and dynamic physiological processes in the foetus and placenta. Material and Methods: This was a one-year prospective research that took place in the obstetrics and gynaecology department of MKCG MCH, Berhampur between January and December of 2015. In all, 100 patients with gestational ages more than 37 weeks who were matched for age and parity were examined; 50 of the research group’s participants had AFIs of less than 5, and the control group’s participants had AFIs of greater than 5.A comparison was made between the two groups regarding the manner of delivery and the perinatal outcome. For statistical analysis, the chi square test was employed. Results: In 39 patients (78%) in the study group and 46 patients (92%) in the control group, the non-stress test (NST) was reassuring (p value <0.05) and was determined to be statistically significant. In the research group, 16 out of 50 patients (32%) delivered their babies vaginally normally, 9 patients (18%) used an instrument, and 25 patients (50%) had a caesarean section. In the control group, on the other hand, 34 out of 50 patients (68%) delivered their babies vaginally normally, 2 patients (4%) used an instrument, and 14 patients (28%) had a caesarean section (p value <0.05). A statistically significant difference was detected. Nine (18%) of the study group’s patients had an Apgar score of less than seven, compared to six (12%) of the control group (p value >0.05). The distinction wasn’t statistically noteworthy. Ten babies (20%) in the control group and 22 babies (44%) in the experimental group were born weighing less than 2.5 kg (p value <0.05). There was a statistically significant difference. Neonatal intensive care unit (NICU) admissions occurred in 6 newborns (12%) in the study group compared to 4 babies (8%) in the control group (p value >0.05). There was no statistically significant difference. At the time of discharge, every baby was stable. Neither the trial group nor the control group had any infants that required ventilatory assistance or neonatal fatalities. Conclusion: A poor perinatal outcome is not linked to isolated oligohydramnios in the absence of any aggravating factors, yet the babies may be born with a lower birth weight. Due to widespread use of ultrasonography, oligohydramnias are being discovered more frequently these days. Isolated oligohydramniosis without aggravating circumstances is not associated with a bad perinatal outcome, notwithstanding the possibility that the children would be delivered with a lower birth weight.

DOI: 10.5281/zenodo.

Introduction: Dyslipidaemia is due to altered lipid metabolism, often characterised by elevation of LDL & depletion of HDL concentration. Paraoxonase 1 (PON1) is an enzyme associated with HDLc and its atheroprotective and antioxidant role. Atherogenic index (AIP) is a predictor of atherosclerosis which is dependent on both serum triglyceride and HDLc concentration. This study was done to find out the association between atherogenic index and paraoxonase 1 activity in dyslipidemic individuals. Methodology: 63 dyslipidemic patients (diagnosed by lipid profile parameters attending OPD were compared with 63 normolipidemic individuals. Serum paraoxonase1 activity of both dyslipidemic & no dyslipidemic individuals were measured using paranitrophenylacetate substrate. Serum atherogenic index along with other cardiac indices (cardiac risk ratio I and II and atherogenic coefficient) were calculated from lipid profile parameters. Results: Significantly increased parameters of lipid profile including total cholesterol, Triglyceride and LDLc and significantly decreased HDLc and PON1 activity has been found among the dyslipidemics in comparison to normolipidemics (p<0.001). AIP and other cardiac indices are also significantly increased in dyslipidemic group (p<0.001). Statistically significant negative correlation has been found between PON1 & AIP (r= – 0.425 and p<0.001). Conclusion: Low levels of PON1 is associated with high AIP and hence there a higher risk of cardiovascular disease in dyslipidemics.

DOI: 10.5281/zenodo.

Background: The most common medical emergencies, acute upper gastrointestinal bleed have a significant mortality. This study aims to study patients’ endoscopic profile and clinical outcome, presenting with upper gastrointestinal bleeding in this region.  Methods: This study was conducted on 100 patients admitted with upper GI bleeding. These patients underwent endoscopy of the upper gastrointestinal track after the initial examination. The status of patients in the study group was recorded at discharge.  Results: The mean age of patients was 48.98 ±14.50 years with male to female proportion of 2.57:1. The foremost common causes of upper GI bleed were related to portal hypertension (Oesophageal and gastric varices) and were seen in 48% of patients. In 45% of the patients, non-portal hypertensive lesions causing UGI bleed (peptic and other injuries) were seen whereas endoscopy was normal in 7% patients. We found no relationship of mortality and with components like age, history of alcohol and NSAIDs use, peptic ulcer, infection and presence of cirrhosis. Conclusion: Portal Hypertension is the foremost common cause of upper gastrointestinal bleeding in this region. Peptic ulcer and erosive gastro-duodenitis are other leading causes. With effective and prompt management and timely endoscopic intervention mortality can be reduced as in our study it was 4%. However, there is no correlation between age, alcohol and NSAIDs use, peptic ulcer, infection and presence of cirrhosis with death.

DOI: 10.5281/zenodo.

The study focuses on the formulation and evaluation of oral dissolving films (ODFs) of lornoxicam, aiming to improve patient compliance and achieve rapid onset of action. Lornoxicam, a non-steroidal anti-inflammatory drug (NSAID), is effective in pain management but suffers from low bioavailability and gastric irritation when administered orally in conventional forms. To address these challenges, ODFs were developed using the solvent casting method with hydroxypropyl methylcellulose (HPMC) as the film-forming polymer. The films were evaluated for various physicochemical parameters including thickness, tensile strength, disintegration time, and drug content uniformity. Additionally, in vitro dissolution studies were conducted to assess the release profile of lornoxicam from the films. The optimized formulation demonstrated desirable mechanical properties, rapid disintegration (within 60 seconds), and enhanced dissolution rate compared to conventional oral tablets. The weight of films range from 18.45-22.99 mg. The thickness of films were range from 0.046- 0.055 mm.The pH of films range from 6.55-7.95.The folding endurance of films range from 216-267.The disintegration time range from 10-42 seconds. Tensile strength of given formulation is 4.124 to 7.885gm/mm2. The drug content of films was found to be between 94.20-96.80%.These findings suggest that ODFs of lornoxicam are a promising alternative for improving patient adherence and therapeutic efficacy in pain management. Further in vivo studies are recommended to validate these results and explore the potential clinical benefits of this novel drug delivery system.

DOI: 10.5281/zenodo.

The study was a phase III, prospective, randomized, double blind, comparative, parallel group clinical study. The study screened 213 male and female patients diagnosed with type 2 diabetes mellitus inadequately controlled on Metformin monotherapy, out of which 192 patients were randomized Thus, 96 patients were randomized in test product i.e., Vildagliptin SR 100 mg Tablets out of which 94 patients completed the study and 96 patients were randomized in reference product i.e. Teneligliptin 20 mg Tablets out of which 93 patients completed the study.
The glycosylated hemoglobin was decreased in both the treatment groups. The difference in the mean change in glycosylated hemoglobin (HbA1c) at the end of 16 weeks in the two groups was -0.03 with lower limit of 95% CI being -0.18. Thus, the results of the study show that Vildagliptin SR 100 mg Tablets is non-inferior to Teneligliptin 20 mg Tablets. All the treatments were well tolerated.
A total of 28 AEs were reported in 28 patients. 13 AEs were reported in Vildagliptin SR 100 mg Tablets arm and 15 AEs were reported in Teneligliptin 20 mg Tablets arm. 01 AE from Vildagliptin SR 100 mg Tablets arm and 01 AE Teneligliptin 20 mg Tablets arm were moderate in nature; all the other AEs were mild in nature. No SAE was reported during the study.

DOI: 10.5281/zenodo.

Introduction: The effectiveness of supraclavicular brachial plexus block is usually evaluated by assessment of sensory and motor function. Perfusion index (PI) estimates the pulsatility of blood in the extremities and inversely related to the vascular tone. In this study we assessed changes in perfusion index following ultrasound guided brachial plexus block to predict success in this regional anaesthesia technique. Material and Methods: A prospective observational study was conducted after obtaining institutional ethics committee clearance and written and informed consent from each patient. 60 adult patients undergoing upper limb surgery under ultrasound guided brachial plexus block were included and Perfusion index in the blocked and unblocked limb were measured using Masimo SET pulse oximeter. Results: Perfusion index in the blocked limb was higher than the unblocked limb at all intervals. Delta Pi calculated as the difference between Pi at 10 mins and baseline was 1.3+/-0.6 in the blocked limb. Conclusion: The PI is characterized by being simple, rapid, and user friendly compared with other objective methods for evaluation of block success.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the clinical spectrum and outcome in children with nephrotic syndrome. Methods: This was a prospective observational study conducted at pediatric department. 100 children who were diagnosed with nephrotic syndrome at JLNMCH in whom steroid treatment was not started yet were included for study purpose. Patients with first attack and relapse both were included in this study. Results: 70% were male and 30% were females. In the present study, 100% had swelling followed by 88% had puffiness. 100% had pitting edema and 80% had ascites. The hemoglobin, serum albumin, serum creatinine was 10.5±1.46, 1.7±0.43 and 0.62±0.18 respectively. 34% had complete remission and 15% had relapse. Conclusion: In our study clinical and laboratory findings were in similarity with usual nephrotic syndrome in children. There was no any significant difference in pattern of nephrotic syndrome and response to treatment from other studies.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the correlation of Fasting & PP C-peptide with HbA1C in patients of T2 Diabetes Mellitus in population of Bihar region. Methods: 100 patients admitted in the Department of Medicine, Nalanda medical College and Hospital, Patna, Bihar, India. Serum samples were taken for fasting & PP C-peptide and HbA1C for patients of T2 Diabetes Mellitus and run on VITROS 5600/7600 which is based on dry chemistry. Results: Mean & SD for fasting C-Peptide for males was 1.348±1.072 & for females 2.448±2.56. Mean & SD for Post prandiol C-Peptide for males was 4.210±5.025 & for females 2.995±2.134. It was significant for fasting C- Peptide with P value 0.0634 and non-significant for PP C peptide with p value 0.4405. Mean & SD for fasting C-Peptide for raised was 3.379±1.791 & for unraised 0.718±0.512. Conclusion: Insulin secretion estimated by measurement of Fasting C- Peptide was either normal or raised in newly diagnosed T2dm subjects in my study indicating predominant role of insulin resistance in the etiology.

DOI: 10.5281/zenodo.

Meditation produces various effects on human physiology, which are mediated via autonomic nervous system. Meditation is a simple and scientific technique to elicit physical and mental relaxation response, to change one’s attitude and transform life-style. Regular practice of it brings transformation in overall wellbeing of person. The cardiovascular morbidity is increasing in India in recent years. 40 healthy volunteers above the age of 30 years and below 65 years performing meditation regularly were included in the study. The same subjects were chosen as both study and control group in order to minimize the confounding factors. Before recording the parameters, the subject was asked to relax physically and mentally for 30 minutes. The blood pressure was recorded with the sphygmomanometer in supine position in the right upper limb by auscultatory method. Similarly, three readings were taken at an interval of 15 minutes each and average of the three values calculated .Heart rate was counted for one minute. The subjects were trained under the guidance of a certified yoga teacher. They carried out meditation for 6 months for 1 hour daily between 6 am and 7 am. The cardiovascular status of each subject, after 6 months of meditation practice was assessed clinically in terms of blood pressure and heart rate recordings. Statistical analysis was done by t test. The results of this study demonstrated a reduction in Heart rate, systolic blood pressure, diastolic blood pressure indicating parasympathetic nervous system dominance during & immediately after meditation.

DOI: 10.5281/zenodo.

Aim: The aim is to study the outcome of Contralateral PMMC flaps for Supramajor  Head and Neck Onco-reconstruction,  following oncological excision of huge T4 Tumors. Study: Hospitals in India get many advanced T4 Head & Neck malignancy. They are operated by Oncosurgeons as a palliative Oncosurgery. It creates huge three dimensional defects, its reconstruction is challenging for the Plastic surgeons. We are presenting case series of 25 patients, where Contralateral Pmmc played part in reconstruction of defects.  In major T4 Head and Neck post oncological resection where many times we have to use Bilateralpectoralis major Myo cutaneous flap to cover the resultant defect. Sometimes along with microsurgery contra lateral PMMC could be used for one flap, when more than one flaps are needed.  Pectoralis major flap is a workhorse flap, with lesser learning curve. So, the complications are less and healing is also faster. It is single stage surgery so Radiotherapy could be started as early. Method: It is a retrospective study of twenty-five patients, operated by the chief surgeon in the last ten years. Here Contralateral PMMC was used after major excision of major Head and Neck T4 malignancy. In 11 patients contralateral PMMC was used as a part of oral cavity reconstruction.  In four patients for laryngopharynx reconstruction. In five patients it was used to cover the defects in flap failure.  In another five patients it was used for recurrence. In bilateral PMMC one is used to cover the inner lining while outer is covered by another PMMC flap. Sometimes contra lateral PMMC is used along with other pedicled or free flap. Contra lateral PMMC is a pedicled flap, taken from opposite chest. Time taken to elevate and inset is lesser than Microvascular Reconstruction and it could be done where microsurgical expertise is lacking. It is a single stage surgery so radiation/ Physiotherapy could be started early. Conclusion: Contralateral PMMC flap is an answer to cover the defect following supra major excision of T4 Oral Malignancy, It could be used when there is flap failure or in recurrence. It could be used alone or along with some pedicled or free flaps. It is a pedicled flap, taken from opposite chest,  time taken is lesser than Microvascular Reconstruction and it could be done where microsurgical expertise is lacking. It is single-stage surgery so radiation/ Physiotherapy could be started early.

DOI: 10.5281/zenodo.