International Journal of Health and Clinical Research https://www.ijhcr.com/index.php/ijhcr <p style="text-align: justify;">International Journal of Health and Clinical Research (IJHCR) is an open-access; freely accessible, online and print monthly peer-reviewed international journal publishes a wide spectrum of advanced research on all medical specialties including ethical and social issues. IJHCR is a gateway to enlighten the latest research/issues happening all around the world of medical and health sciences.</p> <p style="text-align: justify;">The journal publishes Original research articles in the form of full-length papers or short communications especially those with multidisciplinary nature. The journal welcomes review articles, mini-reviews, case reports, letter to the editor, guest editorial or commentaries.</p> IJHCR Publicaion en-US International Journal of Health and Clinical Research 2590-325X Comparative study of intraoperative frozen section and scrape cytology with final histopathological diagnosis in ovarian masses (a study of 57 cases) https://www.ijhcr.com/index.php/ijhcr/article/view/3167 <p>Background: Making a decision on the extent of surgery for ovarian tumors depends on intraoperative diagnosis. Aims: The aim of this study was to compare the intraoperative cytology and frozen section for the diagnosis of ovarian masses. Materials and Methods: 57 patients with ovarian masses who underwent surgery for ovarian neoplasms were evaluated by intraoperative scrape and Frozen Section techniques and compared to final histological diagnosis. Assessment of the overall accuracy of the intraoperative diagnosis was classified as concordant or discordant. Results: The sensitivity, specificity, positive predictive value, Negative predictive value and accuracy of scrape smear were 89.47%, 100%, 100%, 95% and 96.49% respectively. The sensitivity, specificity, positive predictive value, Negative predictive value and accuracy of Frozen section were 94.74%, 100%, 100%, 97.43% and 98.25% respectively. Conclusion: sensitivity and accuracy of frozen section in detecting malignancy is higher than scrape cytology, while specificity in both the methods are same. Frozen section is more accurate than smear preparations in the intraoperative assessment of ovarian tumors in this study. However, the cytology preparation were helpful in supporting the histological diagnoses, and in some cases, provided additional useful information. Thus, cytology has a complementary role to frozen section in intraoperative assessment of ovarian lesions. At the centers where the facilities of frozen section are not available, intraoperative scrape cytology is a useful tool for intraoperative diagnosis of tumor.</p> Hena Dhirajlal Sodha Pankti Ileshbhai Macwan Kirit Jadav Copyright (c) 2021 Hena Dhirajlal Sodha, Pankti Ileshbhai Macwan, Kirit Jadav http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 1 7 A Cross-Sectional Study of Precautions Followed By Patients Attending Primary Health Centre During The Lockdown Period of Covid-19 https://www.ijhcr.com/index.php/ijhcr/article/view/3168 <p>During the lockdown period of the COVID 19 pandemic in 2021 the patients approaching the primary health centre were studied for a period of 3 months, from March to May in Hyderabad city. The precautions taken by these patients were also recorded using a semi-structured questionnaire. Among the 223 subjects mean age was 27.88 years, 61.9% were females, 83.4% were educated and 47.1% belonged to the SES III. Majority (50.2%) of patients were between 15 to 40 years. Below the age of 15 years constituted 28.3% and those above 40 years were 21.5%. In the study group only 12.6% suspects were asymptomatic, 31.8% had only fever, 49.3% had fever and URTI, while 6.3% had SOB along with fever and URTI. 1.8% had interstate travel history in past 15 days. 5.8% had history of contact with a COVID-19 patient or suspect. 65% patients took precautions. Under the preventive measures hand washing was 59.6% among which 69.2% used soap – water and 30.8% used alcohol rub to clean hands. 51.2% used mask while 48.2% did not use any protection. In this study the clinical symptoms were significant with age, sex, SES and preventive measures taken (p&lt;0.05) but there was no significant association with presence of comorbidity.</p> Vaseem Anjum Mehaboobi Shaik Copyright (c) 2021 Vaseem Anjum, Mehaboobi Shaik http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 8 12 Nutritional Status of School Going Adolescents in Rural and Urban Areas of Visakhapatnam https://www.ijhcr.com/index.php/ijhcr/article/view/3169 <p>Introduction: One of the greatest health problems globally as well as in India is under-nutrition among children. Early adolescence is a nutritionally vulnerable time when rapid physical growth increases nutrient demands. Inspite of several heath programs, conditions such as infections and malnutrition continue to be major threat leading to morbidities. This research intends to study and compare the nutritional status of school going adolescents aged between 11 yrs to 15 yrs in rural and urban areas of Visakhapatnam. Methods: A cross sectional study was conducted among 800 early adolescents aged between 11 yrs to 15 yrs in government schools of rural and urban areas of Visakhapatnam. BMI-for-age was measured for assessment of nutritional status and BMI z scores were calculated based on WHO growth reference data for 5-19 yrs. Results: Among boys , 43.1% from rural and 35.11% from urban areas were thin ie having BMI for age &lt; - 2SD. About 7.52% of boys in urban areas are in overweight or obese. Among girls (BMI for age &lt;-2SD is almost similar in rural and urban areas. Anaemia is found to be more among adolescents residing in urban areas compared to rural. Conclusion: Malnutrition in both forms is more prevalent in boys both from rural and urban areas. Stringent implementation of Govt. schemes is needed to improve the nutritional status.</p> D. Errayya Sunita Sreegiri K.V. Phani Madhavi V.V. Durga Prasad B Devi Madhavi Copyright (c) 2021 D. Errayya, Sunita Sreegiri, K.V. Phani Madhavi, V.V. Durga Prasad, B Devi Madhavi http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 13 17 Fetomaternal outcome of pregnancies complicated by cardiac disease https://www.ijhcr.com/index.php/ijhcr/article/view/3170 <p>Objectives: The aim of this study was to assess the Fetomaternal outcome of pregnancies Complicated by Cardiac Disease. Methods: This is an observational study that includes prospective analysis of patients admitted in labour room, at Narayana Hrudayalaya Institute of Medical Sciences with pregnancy complicated by heart disease. Data was collected from 110 women during the time period from November 2013 to September 2015. Results: Out of 3588 cases delivered in the hospital, incidence of pregnancies complicated by heart disease was 3.06%. 43 patients (39%) were in the age group of 21-25 years.In 30% (n = 33) women, the diagnosis of heart disease was made during pregnancy and labour. Principal etiology was Rheumatic in 46% (n = 50), Congenital in 32% (n = 35), MVP in 9% (n = 10), cardiomyopathy in 7% (n =8) and 6% had rheumatic superimposing on congenital heart disease, arrhythmias, dissecting aneurysm of aorta.Septal defects were the most common form of congenital heart disease. 42 patients (38%) underwent surgical and nonsurgical (PTMC) interventions before pregnancy in both congenital and rheumatic group. PTMC in 11, valve repair in 6, and valve replacement in 10 patients. 5 patients underwent PTMC in antenatal period. Patients in NYHA class I &amp; II (n = 89, 80.9%) had fewer maternal complications and their babies had a higher birth weight than those in NYHA class III&amp;IV (n = 21, 19%). 69% (n = 76) had term deliveries, 17% (n = 19) had preterm deliveries, and 12% (n = 14) had abortions. 40.6 % patients had vaginal deliveries, 59.3% had caesarean section. Maternal mortality was 3.63% (n = 4) and maternal cardiac complications occurred in 10%, predominant being CCF. 61 patients had live birth with normal birth weight, 35 patients had low birth weight, 1 patient had intrauterine death and 4 patients had early neonatal death, 3 due to prematurity, 1 due to birth asphyxia due to shoulder dystocia. Conclusion: Pregnancy in women with heart disease is associated with significant cardiac and neonatal complications,despite state-of-the-art obstetric and cardiac care. Multidisciplinary approach should be adopted in the management of cardiac patient to minimize maternal and neonatal complications. Rheumatic heart disease was the predominant type. Patients in NYHA class I and II had abetter maternal and fetal outcome than those in NYHA class III and IV. Surgical correction of the cardiac lesion prior topregnancy was associated with better pregnancy outcome. Pregnant women with prosthetic valves tolerated pregnancy well.</p> Kavya Reddy Kumkala Pothu Bavyasri Suchithra R Copyright (c) 2021 Kavya Reddy Kumkala, Pothu Bavyasri, Suchithra R http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 18 30 To compare Pulmonary function test at base line (on conventional medical treatment) and after 6 weeks of home based pulmonary rehabilitation program https://www.ijhcr.com/index.php/ijhcr/article/view/3171 <p>Background &amp;Method: This study was conducted at GMC, Bhopal with aim to compare Pulmonary function test at base line (on conventional medical treatment) and after 6 weeks of home based pulmonary rehabilitation program. This consisted of inhaled salbutamol (100-200g 04-06 times per day) and inhaled ipratropium bromide 02 inhalations 03-04 times per day. Patients were also advised to take additional inhalations of salbutamol as and when they felt the need. Result: The 6 MWD increased from 380.30±22.9 at the first baseline evaluation to 406.92±95.62 at the time of second evolution. These changes were statistically significant. The VAS rating decreased from 30±16.31 at the first baseline evaluation to 20±13.82 at the time of second evaluation. This change was statistically significant. FVCex changed increased from 2.3±0.92 to 2.3±0.9 at the time of the second evaluation after 6 weeks of the exercise training program. This change was not statistically significant. The FVCex % increased from 67.92±12.25 at the first baseline evaluation to 70.41±5.36 at the time of second evaluation after 6 weeks of exercise training program. This change was statistically significant. FEVI increased from 1.890±0.87 to 1.97±0.61 at the time of the second evaluation after 6 weeks of the exercise training program. This change was statistically significant. The FEVI % decreased from 68.04±16.32 at the first baseline evaluation to 70.86± 19.18 at the time of second evaluation. This change was statistically significant. The FEV1/ FVCex decreased from 0.86 ± 0.09to 0.85 ± 0.6 at second evaluation. The change was not significant statistically. Conclusion: A six week home based pulmonary rehabilitation program consisting of exercise training and patient education was effective significantly in increasing exercise endurance and reducing the severity of dyspnoea and improving the quality of life in patients with stable COPD and bronchial asthma.</p> Raghvendra Shridhar Vivek Chaurasia Copyright (c) 2021 Raghvendra Shridhar, Vivek Chaurasia http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 31 33 Assessment of Microbial Profile and its Usefulness in Indian Females with Symptomatic Vaginal Discharge https://www.ijhcr.com/index.php/ijhcr/article/view/3172 <p>Background:Vaginal discharge in females can be normal and physiological that changes with the menstrual cycle. Pathologic Vaginal discharge leads to significant morbidity in young age group females. Aims: The present clinical trial was carried out to evaluate the symptomatic vaginal discharge incidence in females of different age groups and to assess microbiological profile in females with symptomatic vaginal discharge. Materials and Methods: In 80 females, vaginal swabs were collected for the microbiological evaluation followed by Wet mount preparation and Nugent’s scoring system for microbial assessment.The collected data were subjected to the evaluation for results formation. Results: Nugent scores showed that 43.75% (n=35) females had bacterial vaginosis, Trichomonas, pus cells, and clue cells were respectively seen in 41.25% (n=33), 21.25% (n=17), and 8.75% (n=7) subjects. For vaginal candidiasis, two species seen were Candida parapsilosis and Candida Albicans which were respectively isolated from 17 (94.4%) and 2 (5.5%) subjects of vaginal candidiasis. Other organisms isolated and identified in study females were Staphylococcus Aureus, Pseudomonas Aeruginosa, E Coli, Coagulase Negative Staphylococcus, Enterococcus, Klebsiella, and Acnitobacter isolated from 8, 2, 19, 2, 12, 1, and 3 subjects respectively. Conclusion:Pathologic and excessive vaginal discharge in females can lead to significant morbidity, discomfort, and financial constraints in healthy females and require early diagnosis and microbial detection to ensure effective treatment modality.</p> Lakshmi Irrinki Sowjanya Moturi Ch Pragati Namdeo M. Suryawanshi Copyright (c) 2021 Lakshmi Irrinki, Sowjanya Moturi, Ch Pragati, Namdeo M. Suryawanshi http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 34 37 Comparative Evaluation of Various Screening Methods for Detecting Pre-invasive Lesions Associated with Carcinoma of The Cervix https://www.ijhcr.com/index.php/ijhcr/article/view/3173 <p>Background: Owing to the easy examination accessibility of the cervix, cancer screening is easy and can be done in pre-invasive stages allowing conservative and successful management of these lesions by chemoradiotherapy or surgery. Aims: The present trial was carried out to compare various methods available for detecting and screening the pre-invasive lesions of cervical carcinoma including visual cervix examination using Lugol's iodine, visual cervix examination using acetic acid, colposcopy, and pap smear. Materials and Methods: In 80 females of 20-60 years,following history recording, the cervix examination was performed with acetic acid, Lugol's iodine, colposcope, and pap smear. The collected data were subjected to the statistical evaluation and the results were formulated keeping level of significance at p˂0.05. Results: Only 2.5% (n=2) subjects had cervix with no abnormality, whereas 56.25% (n=45) females had cervicitis, 22.5% (n=18) subjects had Intraepithelial carcinoma-1, 16.25% (n=13) had Intraepithelial carcinoma-2/3, and 2 (2.5%) subjects had confirmed Micro invasive carcinoma using Lugol's iodine and acetic acid with a visual examination, pap smear, and colposcopy. Conclusion: The study concludes that pap smear cytology, visual examination, and colposcopy used collectively has higher detection probability of pre-invasive and invasive lesion compared to when used individually.</p> Sowjanya Moturi Lakshmi Irrinki Copyright (c) 2021 Sowjanya Moturi, Lakshmi Irrinki http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 38 41 Assessment of haematuria and acute kidney injury associated with warfarin anticoagulation https://www.ijhcr.com/index.php/ijhcr/article/view/3174 <p>Background: Warfarin is widely used as anticoagulant therapy to prevent primary and secondary thromboembolic events. The present study was conducted to assess haematuria and acute kidney injury associated with warfarin anticoagulation. Materials &amp; Methods: 60 CKD patients (stages 2–4) who received chronic warfarin therapy were divided into 2 groups. Group I patients experienced a SC increase of ≥0.3 mg/dl and group II patients did not experience a SC increase of ≥0.3 mg/dl. Clinical parameters were measured before, during, and after the episode of INR &gt;3.0. Results: There were 17 males and 13 females in group I and 20 males and 10 female sin group II. Hematuria at the time of abnormal INR was negative in 15 and 16, trace in 6 and 7, moderate in 4 and 5 and large in 5 and 2 in group I and II respectively. Treatment with warfarin recently initiated in 8 in group I and 4 in group II. For warfarin therapy was AF seen in 18 and 12, APL in 4 and 6, DVT in 6 and 8 and VR in 2 and 4. Diabetic nephropathy was seen in 12 and 8, HTN in 11 and 7 and glomerulonephritis in 7 and 15 in group I and II respectively. Conclusion: Chronic warfarin therapy that results in overanticoagulation is a risk factor for accelerated progression of CKD.</p> Shawana Barkat Abu Noaman Copyright (c) 2021 Shawana Barkat, Abu Noaman http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 42 44 A study of safety and efficacy of analgesia and anaesthesia between intrathecal fentanyl and butorphanol as adjuvants with bupivacaine 0.5% heavy for lower limb orthopedic surgeries https://www.ijhcr.com/index.php/ijhcr/article/view/3175 <p>Aims: The aim of the study is to compare the safety and efficacy of anaesthesia and analgesia between intrathecal fentanyl and butorphanol as adjuvants with bupivacaine 0.5% heavy for lower limb orthopaedic procedures. Materials and methods: Eighty patients of ASA grade I and II of either sex in the age group of 18 to 50 years scheduled for elective lower limb orthopaedic procedures were allocated randomly into two groups of 40 each. Group A received intrathecal inj 0.5% heavy bupivacaine 2.5ml with 0.5ml inj fentanyl 25mcg while patients in group B received intrathecal inj 0.5% heavy bupivacaine 2.5ml with 0.5ml inj butorphanol 25mcg. Intra-operative hemodynamic parameters (HR, SBP, DBP,MAP, RR, SPO2) were noted. Results: There was no significant difference in the onset of sensory block .Time from injection to highest sensory block is significantly higher in butorphanol group. 25mcg of intrathecal butorphanol was found to provide a longer duration of two segment regression , longer duration of sensory regression to S2dermatome ,time to reach modified bromage grade 1 and prolonged time for first rescue analgesia as compared to 25mcg intrathecal fentanyl .Time for onset of modified bromage grade 3 is significantly higher in butorphanol group. Conclusions: Both 25mcg fentanyl and 25 mcg butorphanol given intrathecally along with 12.5 mg [ 2.5ml ] of hyperbaric bupivacaine provide effective anaesthesia for lower limb surgeries. Intrathecal bupivacaine-butorphanol mixture provides longer duration of sensory, motor blockade and superior analgesia than intrathecal fentanyl- bupivacaine mixture.</p> Thati Ajith Kumar P.Sreedevi Anjali Rajan Pramod Parthasarathy Copyright (c) 2021 Thati Ajith Kumar, P.Sreedevi, Anjali Rajan, Pramod Parthasarathy http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 45 51 A Study of Relationship between Arterial Blood Pressure and Mid Arm Circumference in Young Adults https://www.ijhcr.com/index.php/ijhcr/article/view/3176 <p>The present study was done to find out the correlation between mid-arm circumference (MAC)and blood pressure, {systolic blood pressure (SBP), diastolic blood pressure (DBP); pulse pressure(PP) and mean arterial pressure (MAP)} values. There is paucity of information on the variation in blood pressure and pulse rate parameters of normal individuals. The aim of the study was to assess the correlation between MAC and BP. The study was conducted in 184 healthy young adults. There were 119 male and 65 female participants. In view of gender differences in autonomic regulation, data of male and female subjects were analyzed separately. We used analysis of variance to compare differences between Mean± SD, maximum, minimum values and correlations of MAC and blood pressure values. Conclusion: The Mean±SD of blood pressure values were higher in those subjects who had high mid arm circumference and least in those subjects who had lower mid arm circumference. A p value *0.05 and * 0.01 were considered statistically significant for both male as well as in female subjects. There was significant spearman`s correlation between MAC and BP in both male as well as in female subjects.</p> Vesti Randa Solanki Shivnarayan Lahariya Vandana Varma Ajay Soni Copyright (c) 2021 Vesti Randa Solanki, Shivnarayan Lahariya, Vandana Varma, Ajay Soni http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 52 55 Evaluation of the prevalence of dermatophytes infection and its etiological agents – A clinico-microbiological study https://www.ijhcr.com/index.php/ijhcr/article/view/3185 <p>Background: Skin infections are common diseases in developing countries, Skin infections due to Dermatophytes has become a significant health problem affecting children, adolescents and adults of which Dermatophytosis are of particular concern in the tropics. Dermatophytosis constitutes a group of superficial fungal infections of the epidermis, hair and nails. Aim: To study the prevalence of dermatophytes infection in different patients and to find the etiological agents of dermatophytes. Methods: The study was conducted at the Department of Microbiology, Patna Medical College and Hospital, Patna. All samples in the form of skin and nails were collected randomly in batches under aseptically condition from both out patients &amp; in-patients. KOH mount was done for direct exam. Culture was also done. Results: A total of 354 samples were collected of which majority were skin 341 (96.3%). Majority of the patients belonged to the age group of 21-30 (33.9%) and were males (81.4%). Groin lesion was the most common lesion (58.5%). KOH, culture and both tests positive was found in 78%, 79.7% and 66.7% samples respectively. The sensitivity and specificity of KOH was 88.7% and 44.4 % respectively with positive predictive and negative predictive value of 85.5% and 41% respectively. Conclusion: In the present study, Dermatophytosis is a major problem in North Indian population &amp; prevalence of dermatophytic infection is alarming in both rural as well as urban community.</p> Nand Kishor Ranjan Kumar Srivastava Poonam Sagar Satyendra Narayan Singh Rajneesh Kumar Ranjan Copyright (c) 2021 Nand Kishor, Ranjan Kumar Srivastava, Poonam Sagar, Satyendra Narayan Singh, Rajneesh Kumar Ranjan http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 56 60 Assessment and Alterations in Retinal nerve Fiber Layer Thickness before and following Glaucoma Filtration Surgery Using Optical Coherence Tomography: A Clinical Study https://www.ijhcr.com/index.php/ijhcr/article/view/3186 <p>Background: Retinal nerve fiber layer thickness is measured at a 3.5mm distance from the optic nerve head center. This thickness alteration is present even in absence of vision loss warranting continuous monitoring of the affected eyes. A high correlation is seen between alteration of retinal nerve fiber layer thickness and vision loss, allowing accurate assessment of progression of glaucoma. Aims: the present study was conducted to assess the alterations in RNFL (Retinal Nerve Fiber Layer) thickness and intraocular pressure following glaucoma filtration surgery. Materials and Methods: 36 subjects were evaluated from both genders and within the age range of 37-64 years and mean age of 53.82±12.94 years. For ocular examination, slit-lamp examination, tonometry, gonioscopy, and fundus examination were done. This was followed by the filtration surgery (trabeculectomy) where a tissue piece was removed in the drainage angle of the eye which made an opening at 0-4 months before and 2-4 months following Glaucoma filtration surgery along with intraocular pressure alteration. The collected data were subjected to the statistical evaluation. Results: Significant increase in RNFL thickness for overall quadrant and all individual quadrants (p&lt;0.05). For the temporal quadrant, the RNFL thickness increased from 43.45±14.07 to 46.73±16.69 with p=0.067. In the inferior quadrant, it increased from 53.39±25.77 to 60.92±30.70 (p=0.002) and for the nasal quadrant, it was increased from 47.91±19.30 to 54.47±20.11 (p=0.007). For the overall quadrant, RNFL thickness increased from 52.58±17.38 to 58.50±20.18 with p=0.0001. For age &gt;50 years and &lt;50 years, RNFL thickness increased significantly for all age groups and intraocular pressure decreased significantly. In the present study, RNFL thickness was increased for both females and males with reduced intraocular pressure significantly (p&lt;0.05). Conclusion: The present study concludes that RNFL thickness increase with a decrease in intraocular pressure following glaucoma filtration surgery. This increase in thickness was also seen with age and gender.</p> Vrij Bhushan P. Prabhanjan Kumar Priyadarshini Rangari Copyright (c) 2021 Vrij Bhushan, P. Prabhanjan Kumar, Priyadarshini Rangari http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 61 63 To Study Adverse Drug Reactions in MDR Pulmonary Tuberculosis Patients https://www.ijhcr.com/index.php/ijhcr/article/view/3187 <p>Aim: To Study Adverse Drug Reactions In MDR Pulmonary Tuberculosis Patients. Methods: The Prospective Observational Study was carried out on patients of MDR/XDR Pulmonary Tuberculosis, registered at DR-TB Centre attended in OPD or admitted in DOTS Plus Site, Medical College, SSG Hospital, Vadodara for any adverse drug reaction, from January-2017 to October-2017. Total 80 MDR/XDR TB patients, who were registered at DR-TB Centre Baroda, were enrolled in the study for duration of 10 months. Results: Out of 80 patients most common Adverse drug reactions are gastro-intestinal upset 44/80 (55%), Arthralgia 14/80 (17.25%), Ototoxicity 12/80 (15%) and Psychiatric disturbances 5/80 (6.25%). Neuropathy 4/80 (5%), skin reactions 4/80 (5%), hypothyroidism 3/80 (3.75%) , and hepatotoxicity 3/80 (3.75%) also had been noted. Local toxicity, Visual disturbances, hypokalemia &amp; Renal toxicity noted rarely. Out of 59 male patients most common Adverse drug reactions are gastro-intestinal upset (32 cases), Arthralgia (10 cases), Ototoxicity (10 cases) and Psychiatric disturbances(5 cases). Out of 21 female patients most common Adverse drug reactions are gastro-intestinal upset (12 cases), Arthralgia (4 cases), Ototoxicity (2 cases), Neuropathy ( 2 cases) and Skin reaction (2 cases). We had stopped the offending drug permanently in 16.3% of the patients. In 22.7% of patients, drug stopped upto recovery from adverse drug events. But in 61% of patients does not required the discontinuation of the offending drug. In some cases dosage of the drug is divided. As per the Preventibility Criteria According To Schumock And Thornton Scale, 62/80 (77.5%) ADRs are Not Preventable, 17/80 (21.25%) ADRs are Probably Preventable, and 1/80 (1.25%) ADRs are Definitely Preventable. Most common presenting symptoms are nausea-vomiting 44/80 (55%), Abdominal pain 18/80 (23%), Joint Pain 14/80 (18%), Hearing loss 12/80 (15%), and Breathlessness 7/80 (8.8%). Conclusion: Gastro-intestinal side effects which were commonest can be largely prevented by proper timing and spacing of drugs with food and if necessary, giving antiemetic, antacids and PPIs or H2 receptor blockers. These side effects are a common cause of defaulting and persuasive, sincere counseling is vital to help the patients through this ADR.</p> Monika Keena Shrikant Hiremath Harsha Hanji Geetanjali Hiremath Pankaj Panchal Copyright (c) 2021 Monika Keena, Shrikant Hiremath, Harsha Hanji, Geetanjali Hiremath, Pankaj Panchal http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 64 67 Therapeutic effects of 5 flourouracil in combination with crystalline triamcinolone acetonide suspension in treatment of keloids https://www.ijhcr.com/index.php/ijhcr/article/view/3188 <p>Background: Keloids are benign hyperproliferations of dermal connective tissue. Injury of the deep dermis commonly results in scar formation. The present study was conducted to assessed therapeutic effects of 5 flourouracil in combination with crystalline triamcinolone acetonide suspension in treatment of keloids. Materials &amp; Methods: 72 patients with keloids of both genders were treated with cryotherapy (spray cryotherapy using liquid nitrogen twice for 10 s; cryotherapy was usually performed 15–30 min before the injection of TAC) and TAC every 4 weeks at least three times without significant improvement. Results: Out of 72 patients, males were 40 and females were 32. Common site was chest in 20, shoulder in 12, back in 8 and all sites in 32. Previous therapy was TAP in 10, cryotherapy in 7 and laser therapy in 5. Dermatology Life Quality Index (DLQI) at baseline was 8.4, at 1 month was 2.8 and at 12 months was 2.4. Adverse effects were hyperpigmentation in 6, teleangiectasia in 2, ulceration in 1 and systemic side effects in 1 patient. The difference was significant (P&lt; 0.05). Conclusion: The efficacy and safety of the combination of 5-FU and TAC in keloids found be beneficial.</p> Abu Noaman Shawana Barkat Rizwana Barkat Copyright (c) 2021 Abu Noaman, Shawana Barkat, Rizwana Barkat http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 68 70 Accidents & driving https://www.ijhcr.com/index.php/ijhcr/article/view/3189 <p>India is ranked 1st in world in road traffic accident, with just 1% of world’s vehicle, India accounts for 11% of the global deaths, highest in the world. We witness 53 crashes every hour and one person is killed every 4 minutes. This study was conducted in Department of Orthopaedics, Muzaffarnagar Medical College Begrajpur Muzaffarnagar from June 2016 to June 2021. Data of 50 road traffic crashes were collected through interview of persons involved in crash or bystanders who have witnessed it happening. We took a stretch of 13 kilometre of National highway no.58 under NHAI from Muzaffarnagar medical college to Muzaffarnagar.A multivariate cause analysis of accidents was done to uncover the catastrophic factors involved. The results revealed that with improved infrastructure of roads there is increase in the numbers of accidents and various factors like age, sex, over speeding, driving under influence (DUI), distracted or fatigued driving, violation of traffic laws, avoidance of safety features like seat belt, Helmet, poor condition of vehicle all are contributing to increase in numbers of road traffic accidents. Fatalities and injuries in accidents are a huge burden on country and families, hence constitute a significant public health problem and loss of property. Facts like, young car drivers run a higher risk of road traffic crash and injuries not only because of lack of experience but also because of their young age and their greater propensity for adapting unsafe driving practice so remedy can be found to avoid such accidents.We have tried to find such causes of road traffic accidents and to formulate policies to reduce the numbers of accidents, fatalities and injuries.</p> Anil Kumar Singh Hari Kripal Singh Tanwar Vipul Kumar Gaurav Jain Lalit Kumar Arvind Kumar Harnam Singh Copyright (c) 2021 Anil Kumar Singh, Hari Kripal Singh Tanwar, Vipul Kumar, Gaurav Jain, Lalit Kumar, Arvind Kumar, Harnam Singh http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 71 79 A comparative clinical study to assess preinsufflation versus postdesufflation changes in arterial blood gas and pH in patients undergoing laparoscopic cholecystectomies under general anaesthesia https://www.ijhcr.com/index.php/ijhcr/article/view/3190 <p>Introduction: Pneumoperitoneum for laparoscopic surgeries leads to multiple changes in the mechanics of respiration and heart function. Arterial blood gas analysis can be used for the patients oxygenation, ventilation ,gas exchange and acid base homeostasis as well as to provide immediate information about electrolytes. Aims: To assess preinsufflation versus postdesufflation changes in arterial blood gas, pH, end tidal CO2 and hemodynamic parameters in patients undergoing laparoscopic cholecystectomies under general anaesthesia. Material and methods: 25-45 yrs of 80 patients, ASA grade I and II were randomly divided into two groups. Group1 –arterial blood sample was collected after 30 min of desufflation. Group 2- arterial blood sample was collected after 60 min of desufflation. Intraoperative monitoring of pulse rate, blood pressure (SBP, DBP, MBP), SpO2, and EtCO2 was done before and after induction, pre-insufflation, after creation of pneumoperitoneum and thereafter at interval of 5 minutes upto 30 minutes, then at 15 minutes interval till the end of surgery and continued for 30 minutes postoperatively. Arterial samples were collected before induction and in group I 30 minutes after desufflation and in group II 60 minutes after desufflation. Result: On comparison between two groups arterial blood gas analysis showed elevation in PaCO2 and reduction in pH more in group 1 (30 min after desufflation) than group 2 (60 min after desufflation). On intragroup comparison there were statistically highly significant increase in PaCO2 (42.99±0.78 Vs 38.03±0.96 in group 1, 42.61±1.06 Vs 39.14±1.05 in group 2) after desufflation as compared to preinsufflation values (p value &lt; 0.000). There were statistically highly significant decrease in pH (7.40±0.02 Vs 7.42±0.02 in group 1, 7.41±0.01 Vs 7.42±0.01 in group 2) and bicarbonate (23.73±1.04 Vs 24.66±0.88 in group 1, 23.74±1.02 Vs 24.65±0.87 in group 2) after desufflation as compared to preinsufflation values (p value &lt; 0.000). Heart rate, systolic, diastolic, mean arterial pressure and EtCO2 were statistically highly significant increase after insufflation and just after desufflation as compared to preinsufflation (p value &lt; 0.000) in both groups (p value &lt; 0.000). Conclusion: Pneumoperitoneum with CO2 insufflation caused significant increased in PaCO2, significant reduction in pH and bicarbonate in the postdesufflation period as compared to preinsufflation in both groups. There were also significant increase in heart rate ,systoloic, diastolic, mean arterial pressure and EtCO2 after CO2 insufflations and postdesufflation as compared to preinsufflation in both groups. There were statistically nonsignificant increase in PaCO2 and decrease in pH more in group 1 than group 2.</p> Shyambaran Preeti Goyal Seema Shende Sourabh Shrivastava Dilip Kothari Copyright (c) 2021 Shyambaran, Preeti Goyal, Seema Shende, Sourabh Shrivastava, Dilip Kothari http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 80 83 An Observational Study on Neonatal Seizures in a Tertiary Care Hospital https://www.ijhcr.com/index.php/ijhcr/article/view/3191 <p>Background: Seizures are the most frequent clinical manifestation of central nervous system dysfunction in the newborn with the incidence varying from 1-5%. Neonatal seizures often signal an underlying ominous neurological condition, most commonly hypoxia-ischemia, and others include stroke, intraventricular hemorrhage or intraparenchymal hemorrhage, meningitis, sepsis, and metabolic disorders. Neonatal seizures can permanently disrupt neuronal development, induce synaptic reorganization, alter plasticity and "prime" the brain to increased damage from seizures later in life. The objective of this study was to observe neonatal seizures in a Tertiary Care Hospital. Methods: This study was a hospital-based, prospective, observational study conducted in the sick new born care unit of department of pediatrics in a tertiary care hospital from March 2017 to February 2018. Out of 2654 admitted neonates, 234 notates having symptom of seizures were included in the study after informed consent from the mother of the neonate. The data like history, clinical examination and investigation findings was recorded in the pre-designed, pre-tested, semi structured questionnaire. Template was generated in MS excel sheet and analysis was done on SPSS software. Results : The incidence of neonatal seizures was higher in male neonates. Subtle types of seizures were the commonest type of seizures. out of 234 neonates, 68 (29.06%) were preterm while 166 (70.94%) were term neonates. Out of 68 term neonates, 26 (38.23%) neonates had subtle seizures, 16 (23.52%) neonates had focal clonic seizures. Out of 166 term neonates, 56 (33.73%) neonates had subtle seizures, 42 (25.30%) neonates had focal clonic seizures. Almost 68 (29.05%) developed seizures within 24 hours, 84 (35.91%) neonates had seizures between 25-48 hours, 54 (23.08%) neonates developed seizures between 2-7 days and 28 (11.96%) neonates developed seizures after 7 days. Common causes of neonatal deaths in our center were severe birth asphyxia, intra-ventricular hemorrhage (IVH), septicemia and meningitis. Conclusions: Neonatal seizures are common and may be the first manifestation of neurological dysfunction after a variety of insults. Most of the causes of neonatal seizures are preventable by good perinatal care and early interventions while metabolic seizures need a sharp vigilance and early suspicion.</p> Manabendra Sau Bidyut Kumar Khuntdar Kajal Kumar Patra Ujjwal Pattanayak Kishore P Madhwani Copyright (c) 2021 Manabendra Sau, Bidyut Kumar Khuntdar, Kajal Kumar Patra, Ujjwal Pattanayak, Kishore P Madhwani http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 84 87 Intradialytic hypotension in dialysis Population https://www.ijhcr.com/index.php/ijhcr/article/view/3192 <p>Background &amp; Method: This Study was conducted at Department of General Medicine, NSCB Medical College and Hospital, Jabalpur (MP) on patients coming for dialysis with chronic renal failure from all over mahakaushal area of central India with aim of Intradialytic hypotension in dialysis Population. Result: A gradual fall in mean Blood pressure was observed over intradialytic period up to last Post hemodialytic reading. This gradual fall became significantly lower than first mean systolic blood pressure in 90 minute reading and readings after it for Hypertensive group. In Normotensive group fall in mean systolic blood pressure was also significant at 90 minute reading onwards compared to Predialytic measurements. While in Hypotensive patients fall in mean systolic blood pressure showed an early significant fall 60 minute reading onwards compared to predialytic measurements. Fall in mean diastolic blood pressure among Hypertensive group was minute and never significant than predialytic measurement. Similar to hypertensive group mean diastolic blood pressure among Normotensive blood pressure variability group also showed a slight fall but never significant than predialytic measurement. Contrary to the hypertensive and normotensive group the fall in mean diastolic blood pressure was significant at 60 minute reading onwards in Hypotensive study group similar to mean systolic pattern. Conclusion: 116 patients we observed major intradialytic BP variation 45.69% patients were Hypertensive (n=53), 37.93% were Normotensive (n=44) and 16.38% were in Hypotensive groups (n=19). As far as morbidity in these intradialytic blood pressure variability groups is concern; Electrocardiographic abnormalities were significantly higher and highest among three groups while hypertensive group showed significantly higher morbidity in ECG compared to normotensive group. Among individual ECG abnormalities Rhythm and sinus abnormalities, Left axis deviation, ST-segment abnormalities, Left and right ventricular hypertrophy, Left bundle branch block, Atrial- and Ventricular premature beats were significantly higher in Hypotensive group. While On the other hand, Q-wave and Right atrial enlargement were significantly higher in Hypertensive group.</p> A.K. Pathak Praveen Waskel Copyright (c) 2021 A.K. Pathak, Praveen Waskel http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 88 90 A study on incidence of adverse drug reactions of current multidrug resistant pulmonary tuberculosis treatment regimen at a tertiary care centre in kumaon region of Uttarakhand https://www.ijhcr.com/index.php/ijhcr/article/view/3199 <p>Background: Treatment of multidrug resistant pulmonary tuberculosis (MDR-PTB) is challenging because of multiple anti-TB drugs, long treatment duration and various adverse drug reactions (ADRs). The aim of this study was to find the incidence of ADRs related to various anti-TB drugs. Methods: This was a prospective observational study done from 1st January 2019 to 30th June 2020, in the Department of Respiratory Medicine at Government Medical College, Haldwani, Uttarakhand. Results: A total of 163 MDR-PTB patients were reviewed, of which 136 (83.44%) patients experienced &gt;1 ADRs, during intensive phase of treatment. Total 398 ADR episodes were observed, maximum ADRs (134, 33.7%) were related to Gastrointestinal system. Incidence of ADRs was more (96.97%) in 46-60 yrs. of age group, in patients living in rural area (82 of 92, 89%), in married patients (88.07%), in smokers (91.4%), in alcoholics (90.6%), in patients having co-morbidities and in patients who had anemia (88.24%). The most common ADR was joint pain in 36 (26.5%) of 136 patients. Conclusion: Strict follow-up with laboratory investigations, providing assurance and exercise plan to the patients is crucial. Healthcare providers should be trained regarding identification and management of ADRs.</p> Priyank Goyal Dinesh Chandra Punera Ram Gopal Nautiyal Bhavana Srivastava Rajesh Kumar Singh Copyright (c) 2021 Priyank Goyal, Dinesh Chandra Punera, Ram Gopal Nautiyal, Bhavana Srivastava, Rajesh Kumar Singh http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 91 95 Epidemiology and Management of adult Corona-virus disease patients, in Intensive care unit https://www.ijhcr.com/index.php/ijhcr/article/view/3193 <p>Context: Corona virus disease (COVID-19) is an infectious disease. About 5% become critically ill and need intensive care. Being a novel disease, there is need of research on safe and effective management especially in Intensive care unit (ICU). Aims: To know epidemiology and management of adult COVID-19 disease patients in ICU. Settings and Design: An observational study done in adult COVID-19 patients admitted in ICU of a tertiary care hospital. Methods and Material: Purposive sampling method was used and data in 241 adult COVID-19 patients was collected on sociodemograpy, comorbidities, clinical and radiological severity, risk categorization (by Quick Sequential Organ Failure Assessment (qSOFA) and Systemic Inflammatory Response Syndrome (SIRS)). Biochemical investigations done, treatment given and outcome were recorded. Statistical analysis used: Data analysed using SPSS 20. Chi-square test and Mann Whitney U test was used. P&lt;0.05 was considered statistically used. Results: Out of 241 Patients, 69(28.6%) died. Mortality was significantly high in age group &gt; 60 years. Patients with higher Lactate dehydrogenase (LDH), serum ferritin and procalcitonin levels, have high proportion of mortality. Patients with Diabetes mellitus (41.1%), cardiovascular disease (6.2%), CTSS score &gt;18 (44.7%) and SIRS score 2-4(32%) have high mortality. Inotropes, anticoagulation, anti-inflammation and convalescent Plasma therapy was given in and awake proning practiced in 41.1%, 72.6%, 73.4%, 36.9% and 23.6% respectively. Conclusions: ICU Mortality of COVID-19 patient was 28.6%. Patients with age &gt; 60 years, diabetes mellitus, cardiovascular disease, higher LDH, serum ferritin and procalcitonin have, significantly higher prevalence of mortality.</p> Dantoor Suresh Vikram Kumar Naidu Dodooju Veera Bhadreshwara Anusha Noule Vamshi Krsihna Saamala Sri Harsha Copyright (c) 2021 Dantoor Suresh, Vikram Kumar Naidu, Dodooju Veera Bhadreshwara Anusha, Noule Vamshi Krsihna, Saamala Sri Harsha http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 96 100 Study of dyslipidemia associated with chronic kidney disease https://www.ijhcr.com/index.php/ijhcr/article/view/3194 <p>Background: Chronic Kidney Disease (CKD) hasan increased risk of cardiovascular diseases (CVD) prevalence and lethality. Dyslipidemia is mostly associated in these patient populations with abnormalities in lipid profile and is a principal risk factor for CVD development. Patients with CKD exhibithigh triglycerides, low high density lipoprotein-cholesterol,and altered lipoprotein composition. Aims and objectives: The study was undertaken to observe the lipid profile of healthy and diseased subjects to study its association with CKD. Material and Methods: A total of 100 subjects were included; of which 50 were the control group and 50 were thestudy (evidence of CKD) group. 5ml of venous blood was obtained from antecubital fossa from each subject and kept in a plain vial, after which serum separation was analyzed for biochemical parameters. Results: Among various parameters tested urea, creatinine, sugar, triglycerides, and very low-density lipoprotein levels were significantly higher in the study group as compared to the control group (p&lt;0.05). Low-density and high-density lipoprotein levels were significantly lower in the study group as compared to the control group (p&lt;0.05). There was no significant change observed in total lipids and phospholipids levels in between the healthy control and studygroup. Conclusion: It can be concluded that CKD patients are at higher risk of development of hypertriglyceridemia, dyslipidemia characterized with elevated urea and creatinine, and decreased HDL levels leading to more prevalence of CVD.</p> Divya Sharma Rashmi Gupta Vandana Varma Madhuri Gupta Copyright (c) 2021 Divya Sharma, Rashmi Gupta, Vandana Varma, Madhuri Gupta http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 101 103 A study of correlation of antinuclear antibody immunofluorescence patterns with immune profile using line immunoassay in a tertiary care centre of western Uttar Pradesh https://www.ijhcr.com/index.php/ijhcr/article/view/3195 <p>Connective tissue diseases (CTDs) such as systemic lupus erythematosus, systemic sclerosis, Sjogren’s syndrome, and rheumatoid arthritis are systemic diseases which are often associated with a challenge in diagnosis. Antinuclear antibodies (ANA) are autoantibodies that are reactive with antigens in the nucleoplasm. The presence of ANA indicates the possibility of autoimmunity and indirect immunofluorescence (IIF) assay on Hep-2 cells and primate liver is the standard blood test to detect ANA. Our aim of this study is to understand a definite association between ANA patterns and specific antibodies by line immunoassay in the serum of the patients. A total of 360 serum samples from patient attending in the OPD and IPD clinics of the C.S.S.H., Subharti Medical College, Meerut were processed by biochip method. The serum samples which were found positive were confirmed by line immunoassay. In our study 68/360 (18.9%) cases were found to be positive by IIF method in a 1:100 dilution. The positive cases were further confirmed by ANA Profile method. Out of 68 samples positive by ANA-IIF tests, 62 samples gave concordant result with line immunoassay. ANA by IIF method therefore may be used as a cost effective and rapid screening method for patients with criterion for autoimmune diseases in daily clinical practice. These correlations are useful for the diagnosis of a specific rheumatic disease.</p> Ritu Kansal Gaurav Thami Richa Kansal Daria Singh Molly Madan Nivesh Agrawal Deepak Singla Anupam Berwal Copyright (c) 2021 Ritu Kansal, Gaurav Thami, Richa Kansal, Daria Singh, Molly Madan, Nivesh Agrawal, Deepak Singla, Anupam Berwal http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 104 106 Prevalence and Profile of Metabolic syndrome following Stroke in patients admitted in Hospital https://www.ijhcr.com/index.php/ijhcr/article/view/3196 <p>Introduction- Stroke manifests by various neurological signs and symptoms depending on extent, area of involvement and the underlying cause. These include coma, hemiplegia, paraplegia, monoplegia, cranial nerve palsy, speech disturbance and sensory impairment, etc. Of these, hemiplegia is the most common presentation, seen in about 90% of patients. Objectives-1.To study the incidence of metabolic syndrome in stroke patients.2.To study the role of various components of metabolic syndrome in association of stroke. Methods- All patients with stroke age more 30 years and less than 60 years admitted in Chalmeda Hospital attached to Chalmeda Anand Rao Medical College, Karimnagar,Telangana during the study period from November 2013 to August 2015.Minimum of 50 subjects of stroke aged more than 30 years andless than 60 years. Simple random sampling was used. SPSS (22.0) was used for analysis. A detailed history of all subjects especially family history of hypertension, diabetes mellitus, history of weight gain, alcohol use and History of other cerebrovascular disease risk factors (including obesity, smoking, hyperlipidemia, diabetes) will be taken. Results-Out of 50 patients of stroke, 28 patients had metabolic syndrome. Incidence of metabolic syndrome in stroke was 56%.70% were males and 30% were females. The incidence of metabolic syndrome was more common in female when compared to males. However it is not statistically significant.the most common mode of presentation in both stroke with metabolic syndrome and stroke without metabolic syndrome was weakness followed by deviation of angle of mouth, aphasia and loss of consciousness. Conclusion-Long-term follow-up population-based studies have demonstrated that healthy individuals with the Metabolic syndrome are at a markedly increased risk for major cardiovascular events, including stroke, and cardiovascular mortality.</p> Kishore Kumar K Annakula Ramu Sanjay H Kalbande Sanjay Kaminwar Copyright (c) 2021 Kishore Kumar K, Annakula Ramu, Sanjay H Kalbande, Sanjay Kaminwar http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 107 110 Comparision of the efficacy of percutaneous needle aspiration and pigtail catheter drainage for the treatment of liver abscess https://www.ijhcr.com/index.php/ijhcr/article/view/3197 <p>Introduction: In recent years, image-guided percutaneous drainage has been increasingly used to treat liver abscesses with reported success rates ranging from 70-100%. Although percutaneous placement of an indwelling catheter is the method most widely preferred to drain liver abscesses, recent studies have claimed needle aspiration to be a simpler, less costly, and equally effective mode of treatment. Aim: To compare the efficacy of percutaneous needle aspiration and pigtail catheter drainage for the treatment of liver abscess. Method: This is a single centred prospective randomized comparative study in patients of liver abscess treated by needle aspiration &amp; pigtail catheter drainage .A total no of 50 patient were included in the study which randomized into two groups; percutaneous needle aspiration (PNA) (n=25) and pigtail catheter drainage (PCD) (n=25). The effectiveness of either treatment was measured in terms of duration of hospital stay, days to achieve clinical improvement, 50% reduction in abscess cavity size and total/near total resolution of abscess cavity. Independent t-test was used to analyse these parameters. Results: Earlier clinical improvement (P=0.046) and 50% decrease in abscess cavity volume (P=0.0001) seen in the patients in PCD groups compared to those who underwent PNA. However, there was no significant difference between the duration of hospital stay or the time required for total or near-total resolution of cavity. Conclusion: Percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration especially in larger abscesses, which are partially liquefied or with thick pus.</p> Arvind Kumar Ashok Kumar Sharma Abhishek Kumar Singh Copyright (c) 2021 Arvind Kumar, Ashok Kumar Sharma, Abhishek Kumar Singh http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 111 115 Clinical profile, management and outcome of under 5 children with severe acute malnutrition in NRC attached to a teaching hospital https://www.ijhcr.com/index.php/ijhcr/article/view/3198 <p>Malnutrition is an important contributing factor for most deaths amongst children suffering from common childhood illness, such as diarrhea and pneumonia. Globally, malnutrition is responsible for almost one-half (45%) of the total under five deaths. Present study was undertaken to study the clinical profile and outcome of SAM children in MGM Hospital, Warangal, from december 2016 to september 2018 over 306 children above 6 months under 5 years of age.in this study majority were between the age of 12-24 months(47.4%). URTI (66.7%) was the most common associated comorbidity followed by anemia(50.3%) followed by Acute GE(41.2%). Severedehydration(28.1%)were the most common complication observed followed by Dyselectrolytemia. Every malnourished child can be weaned to healthy life if proper nutritional rehabilitation is provided. Malnutrition clinic in every pediatric set up can go a long way to reduce the childhood morbidity and mortality consequent to SAM.</p> Vura. U.V. Naga Jyothi Karunakar Gare Sravan Kumar Kusuma Mohan Amgothu G. Vijay Kumar Copyright (c) 2021 Vura. U.V. Naga Jyothi, Karunakar Gare, Sravan Kumar Kusuma, Mohan Amgothu, G. Vijay Kumar http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 116 120 Accuracy and Reliability of the CT for Detection of The Renal Masses https://www.ijhcr.com/index.php/ijhcr/article/view/3223 <p>Background: With the advances in the diagnostic parameters, CT with the use of various software allowing manipulation and increase in the spatial resolutions lead to a considerable reduction in time needed for scanning. Aims &amp; Objectives:The present observational study was conducted to learn the enhancement pattern and attenuation pattern of renal masses during different phases (Cortico-medullary, nephrographic, and unenhanced phases, and to evaluate renal parenchymal enhancement characteristics during these phases, Also, comparison of findings from CT and pathological diagnosis was done. Materials and Methods: For enhancement pattern and attenuation values of real masses during various phases namely nephrographic, corticomedullary, and unenhanced phase multidetector CT was used for better assessment. Subjects with the complaint of flank pain/fullness, and/or hematuria, and also subjects with the incidental detection of renal masses ultrasonographically and were referred for CT abdomen. 20 subjects with confirmed presence of renal masses on CT were finally included. Results: Mean size of the masses detected in the kidney was found to be 5.423±3.4877 with the range of 2cm to 19cms. 11 lesions were benign whereas 9 lesions detected were found to be malignant. For enhancement pattern, it was homogenous in 6 whereas, heterogeneous in remaining 5. Among 9 malignant lesions, only 2 lesions were homogenous and 7 lesions were heterogeneous. For margins of the tumors, well-defined margins were seen in 9 of the benign lesion, and only 2 benign lesions had ill-defined margins. In malignant lesions, only 2 lesions had well-defined margins and ill-defined margins were seen in the rest 7 lesions. This difference in the margins of the benign and malignant tumors was statistically significant. In the corticomedullary phase and nephrographic phase, HU values for malignant renal masses respectively were 96.64 and 73.26. Enhancement was lower in the nephrographic phase compared to the corticomedullary phase.Conclusion:For differentiating benign tumors from malignant tumors, and their characterization, attenuation values, and the enhancement patterns serve as an important tool in this regard. Regarding enhancement patterns of benign tumors, no statistically significant difference was seen nephrographic and corticomedullary phases. For malignant renal masses, enhancement was greater in the corticomedullary phase compared to the nephrographic phase. The present trial concludes that renal masses should be evaluated in all phases including unenhanced, corticomedullary, and nephrographic phases for appropriate characterization and detection of the renal masses.</p> Neeraja Jain Sudhakar Prakash Tayade Vaishali Bhagat Copyright (c) 2021 Neeraja Jain Sudhakar, Prakash Tayade, Vaishali Bhagat http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 121 124 CT Severity Scoring Index and Chest Radiography findings in COVID-19 cases in Pediatric and Adolescent age group- A Retrospective analysis https://www.ijhcr.com/index.php/ijhcr/article/view/3224 <p>Background: The initial cases of novel corona virus reported in Wuhan city in December 2019. Then it became global outbreak. The World Health Organization (WHO) on March 11, 2020, declared the novel coronavirus (COVID-19) outbreak a global pandemic[1,2]. The disease had spread to more than 150 countries around the world and the death number has constantly increased. Most of pediatric patients were initially asymptomatic. Transmission in children is critical problem. Radiological manifestation varies between age group. We aimed to determine radiographic chest finding in pediatric COVID-19 in tertiary Centre. Aim: To evaluate CT Severity Scoring Index and Chest X Ray findings in COVID-19 cases in Pediatric and Adolescent age group. Methods: 54 patients of pediatric and adolescent age (up to ≤18yrs) with RT-PCR positive who were admitted in our tertiary centre were retrospectively included in this study. CT scan and chest radiographic data of the patients were collected from medical records. The data was summarized. The CT chest and chest radiographic pattern of COVID 19 positive in pediatric and adolescent age group of ≤ 18yrs were analyzed. Results: 54 patients were admitted in our hospital with COVID-19during study time. CT chest was done in 42 patients and Chest radiograph was done in all 54 patients. Characteristic CT findings were ground-glass opacities or consolidation and combination of both. Ground-glass opacities 15/21 (71.4%) were more often encountered in our study, and when consolidation opacities were identified, they were most of time accompanied by a ground-glass opacity 5/21(23.8%). Chest radiograph finding was ground glass opacity. Lower lobes were most commonly involved in both modalities. Female and male patients were infected with equal frequency. Apart from above pattern in CT, linear opacity, crazy paving pattern, halo sign and reverse halo sign also noted in some patients. Majority of patients showed peripheral distribution of opacities. Conclusion: This review of available studies of COVID-19 pneumonia in pediatric patients provides insight into CT imaging findings of the disease in this specific population. The most common CT and Chest radiographic findings were ground-glass opacities typically with lower-lobe predominance. Our findings were matching with previous studies. Severe category of lung involvement was seen in few case but had full recovery. Chest CT can be employed in the early diagnosis and management of selected symptomatic pediatric patients, if clinically warranted.</p> Ratan Kumar Animesh Dubey Pratipal Rajpali Pranav Kumar Dave Ajmal A Pushpak Goyal Copyright (c) 2021 Ratan Kumar, Animesh Dubey, Pratipal Rajpali, Pranav Kumar Dave, Ajmal A, Pushpak Goyal http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 125 131 High fluorescence lymphocyte count in dengue https://www.ijhcr.com/index.php/ijhcr/article/view/3225 <p>Background: High fluorescence lymphocyte count (HFLC) is a research parameter indicating the presence of high fluorescence lymphocytes, which represent activated cells (antibody-secreting B- lymphocytes/plasma cells). HFLC in dengue fever is used to estimate the cellular immune response through the presence of blue plasma lymphocytes. Aims: To determine the HFLC in patients with dengue fever using hematology analyser, and to assess the severity of the disease based of the percentage of HFLC. Methods and Material: The present study was conducted in the department of Pathology in a tertiary care hospital. Eighty dengue positive cases and 20 controls were included in the study. HFLC values were obtained from the automated SYSMEX XN 1000 analyser. Statistical analysis of data was done by SPSS23 software. Results: Kruskal Wallis test showed significant difference in platelets between dengue fever, dengue hemorrhagic cases and control groups(p&lt;0.01). Average HFLC% count in dengue fever group is 1.7 and in dengue hemorrhagic fever it is 18.85 and there exist significant difference between them with p&lt;0.01. Conclusions: Increase in HFLC values can be related to the pathogenesis of dengue hemorrhagic fever. The immunological response can be detected by an increase in High Fluorescent Lymphocytes Count (HFLC) which can be observed in the automated Sysmex XN-1000 hematology analyzer. Thus HFLC can be used to assess the severity of the disease, at an early stage.</p> Sameeksha Alva Purnima S Rao Aravind Pallipady Copyright (c) 2021 Sameeksha Alva, Purnima S Rao, Aravind Pallipady http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 132 134 Study of Risk Factors for Nasal Colonization of Methicillin Resistant Staphylococcus Aureus (MRSA) and their Drug Sensitivity Pattern in Admitted Patients https://www.ijhcr.com/index.php/ijhcr/article/view/3226 <p>Background: In view of changing epidemiology of MRSA infections and scarcity of literature on risk factors for MRSA infections, a study addressing this knowledge gap was needed. Aim: This study was planned to study the prevalence and associated risk factors for MRSA colonisation in hospitalised patients. Methods: Study population consisted of 205 patients aged ≥16 years admitted in general medicine ward during the study period. Culture was performed from anterior nares within 48 hours after admission to identify patients colonized with MRSA or MSSA. Results: Out of 205 subjects, 24 (11.71%) individuals were infected with MRSA, whereas 16 (7.80%) had MSSA infection. Sterile nasal swab was reported in 63.41%. Use of steroids [OR 5.60 (95%CI 2.83, 22.68)], Chronic kidney disease [OR 4.61 (95%CI 2.85, 22.04)] and alcoholism [OR 2.45 (95%CI 0.52, 3.64)] came out to be three most important risk factors associated with MRSA and MSSA infections among study subjects. Vancomycin &amp; linezolid were found to be sensitive in all twenty four patients of MRSA. Clindamycin &amp; Cotrimoxazole were found to be sensitive in half of the MRSA patients. Conclusion: A greater degree of suspicion for MRSA, early detection of MRSA especially among those having risk factors, along with timely intervention with appropriate antibiotics and source control are needed to save these patients.</p> Anurag Ambroz Singh Pooja Singla Rakesh Tank Copyright (c) 2021 Anurag Ambroz Singh, Pooja Singla, Rakesh Tank http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 135 137 Polycystic Ovarian Syndrome: Clinical Correlation with Biochemical Status https://www.ijhcr.com/index.php/ijhcr/article/view/3227 <p>Background: Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women of reproductive age group. PCOS consist of chronic anovulation, menstrual disturbances, hyperandrogenism, polycystic ovaries and metabolic syndrome. Objectives: to find out clinical, biochemical and hormonal profiles in PCOS cases and correlate with normal individual. Material and methods: A prospective case control study of 200 women in the age group of 18-30 years, 100 having PCOS and 100 in the control group. Results: Menstrual irregularity seen in 92 % of PCOS, oligomenorrhoea was the most common presentation. 52% had infertility. 53% were hirsute. Mean BMI, waist: hip ratio, mean LH level, LH: FSH ratio, total testosterone, fasting insulin and total cholesterol were high in PCOS compared to control group and the difference in mean values were statistically significant (P value &lt;0.001). Mean LH was 15.44 ± 7.09 in PCOS and 9.92 ± 4.55 in control group. Mean LH: FSH ratio was 2.86 ± 1.44 in PCOS and 1.71 ± 0.71 in Control group. Mean testosterone was 70.69 ± 25.67 in PCOS and 30.41 ± 14.43 in control group. It was raised in 67 % of PCOS. Mean fasting insulin in PCOS was 21.45 ± 12.49 and 15.58 ± 5.47 in control group. Mean prolactin was 23.85 ± 12.50 in PCOS and 19.69± 9.00 in control group. Conclusion: Most of the PCOS were oligomenorrhoic, hirsute with raised BMI and waist-hip ratio. Mean LH, LH: FSH ratio, testosterone and fasting Insulin level were significantly raised in PCOS.</p> Rudra Narayan Ajit Kumar Nayak Puspanjali Khuntia Roma Rattan Abhijit Mohapatra Copyright (c) 2021 Rudra Narayan, Ajit Kumar Nayak, Puspanjali Khuntia, Roma Rattan, Abhijit Mohapatra http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 138 142 Correlation of D - Dimer Level with Demographic Detail of Covid 19 Patients at Tertiary Care Center - A Retrospective Study https://www.ijhcr.com/index.php/ijhcr/article/view/3230 <p>Introduction: Since December 2019, Patients suffering from coronavirus disease-19 (COVID-19) is on the rise. According to previous research, D-dimer levels are higher in severe instances of community-acquired pneumonia (CAP) and chronic obstructive pulmonary disease (COPD). They may be utilized as a predictive biomarker. Objective: To evaluate the level of d-dimer among covid disease patients and correlate with age and gender. Methods: Four hundred and seventeen covid-19 positive patients were studied at GMERS Medical College, Vadangar, from October-2020 to December-2020. A citrate sample was collected of all patients who tested positive for the covid-19 disease. Citrated plasma was separated from each sample after proper centrifugation. Hemolysed samples and samples with insufficient quantity were rejected. In such cases, a new sample of the same patient was collected. D dimer test was then carried out from separated citrate plasma. Cut off value for d-dimer is 0.5 [Positive: &gt;0.5 Fibrinogen equivalent units (FEU)/ml]. Result: From 417 cases: 280 males and 137 Females affected with peak occurrence in their sixth and seventh decade. A similar distribution pattern was found with a High D-dimer level also. The majority of the patients with elevated d-dimer levels had moderate to severe symptoms and required hospitalization. Conclusion: A significant correlation is found between elderly age with elevated d-dimer level, and it was found to be more common in female patients. So, d-dimer is one of the most important tests to be carried out in a hospitalized novel corona disease patient for preventing thrombotic events with timely interventions guided by d-dimer level.</p> Jignesh Kanji bhai Parmar Pratik kumar B. Desai Nirav kumar Suresh bhai Panchal Harshid L. Patel Copyright (c) 2021 Jignesh Kanji bhai Parmar, Pratik kumar B. Desai, Nirav kumar Suresh bhai Panchal, Harshid L. Patel http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 143 145 Stromal expression of cd10 in invasive breast carcinoma and its correlation with ER, PR, HER2, NEU and KI67 https://www.ijhcr.com/index.php/ijhcr/article/view/3231 <p>Aim &amp; Objective: To evaluate and correlate CD10 expression with ER, PR, HER2-Neu &amp; Ki 67 index CD 10 expression in breast malignancies. Methodology : The descriptive study was undertaken in the Upgraded Department of Pathology, Osmania medical college, Hyderabad from Dec 2015 to June 2017.Total of 50 cases of invasive breast carcinomas in females were included in the study. Of these 45 cases comprised of invasive carcinoma of no special type (NST) followed by 3 cases of invasive lobular carcinoma and the remaining 2 cases were medullary carcinoma and tubular carcinoma respectively. Results: In the present study, the age group included were from 35-80 years with the average age being 51years and highest incidence of breast carcinoma was seen in fourth decade. Routine processing and Haematoxylin and Eosin staining of the received specimens were done followed by immunohistochemical analysis with CD10, ER, PR, HER2neu &amp; Ki 67 antibody was done. In the present study, cytoplasmic and membranous staining of &gt;30% of the stromal cells around the tumor cells were taken as CD 10 stromal positivity. CD 10 stromal positivity was correlated with expression of ER, PR, HER2 neu and Ki 67 index. Present study showed a slight lower negative correlation of CD10 stromal expression with ER expression which showed a higher correlation in other studies. This discordance can be attributed to the number of cases and duration of study and also to the more ER positive prevalence in the study group. Present study did not show any correlation with CD 10 expression and PR status which was much similar to the observations in other studies. Present study showed good correlation between stromal CD 10 expression and well established negative prognostic marker that is, HER2 neu overexpression and high Ki 67 index. Conclusion: To conclude, stroma plays a important role in progression, hormonal expression and response to chemotherapy in breast cancer</p> Y. Niharika Reddy Sandhya Bangaru Swathi Taduri K. Devender Reddy Copyright (c) 2021 Y. Niharika Reddy, Sandhya Bangaru, Swathi Taduri, K. Devender Reddy http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 146 153 Preoperative assessment of stone free rate following percutaneous nephrolithotomy https://www.ijhcr.com/index.php/ijhcr/article/view/3232 <p>Introduction: Renal stones are one of the most common reason for patient’s visit to Urologic outpatient department. PCNL is novel minimally invasive modality for renal stone management and approved by the European Association of Urology (EAU) as 1st line approach. Inspite of high success rates, PCNL can be associated with wide range of complications, ranging from 20-83%.A scoring system which can pre-operatively grade the extent of stone disease, its possible impact on treatment outcomes and occurrence of complications are not only essential but should become an integral part of the care plan.Guy’s score has been externally validated in many studies. In this study we use this Guy’s score in predicting Post op stone free rate following PCNL and also assess the complications of PCNL. Materials and methods: This is retrospective observational Study conducted in Department of urology, Nizam Institute of Medical Sciences, Hyderabad between November 2018 and October2020. Information was obtained from previous records of total 100 patients and analysed retrospectively. All patients with renal calculi &gt; 18 years of age , posted electively for Percutaneous Nephrolithotomy were included in the study. Patients with severe comorbid illness and who underwent Percutaneous Nephrolithotomy in pastwere excluded. Results: Total number of patient included in the study were 100 , (n=100). Majority of the patients were in the 5th decade (27%) Among them males were 64 (64%) and females were 36 (36%). Patient with comorbid conditions were 28 (28%) . Among the comorbidities, Diabetes mellitus was present in 16% of patients.Patients were classified using Guy’s Stone Scoring system to assess the preoperative complexity of the calculus and predict the stone free rate and the complications. Most of the patients were included in the category of Guy’s stone score –1.All patients were evaluated for residual fragments by post PCNL ultrasound on post-operative day 1. Clinically Insignificant Residual Fragments (CIRF)were defined as &lt;4mm, non- obstructive and asymptomatic residual fragments. All perioperative complications were stratified by clavin –Dindo classification system. Peri-operative complications includes intraoperative and post operative complications including CSRF. Total number of patients who had complications include 25 (25%) . Of them 9 patients had grade 1 complication., 6 had grade-2, 7 had grade -3 and 3 had grade -4 complications. Statistical analysis showed significant association between Clinically Significant Residual Fragements, number of punctures required and post operative stay with Guys Stone Score. There is no significant association between Guys stone score and complications graded as per modified ClavienDindoclassification , but there is non significant increased incidence of complication grade with increase in stone score. Conclusion: Guys stone score significantly predict, number of punctures required for PCNL, Stone free rate, Post operative hospital stay.</p> Dheeraj SS G.V. Charan Kumar Rahul Devraj Vidyasagar Ramachandraiah Ramreddy Ch Copyright (c) 2021 Dheeraj SS, G.V. Charan Kumar, Rahul Devraj, Vidyasagar, Ramachandraiah, Ramreddy Ch http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 Comparative study of intraoperative frozen section and scrape cytology with final histopathological diagnosis in ovarian masses (a study of 57 cases) https://www.ijhcr.com/index.php/ijhcr/article/view/3233 <p>Background: Making a decision on the extent of surgery for ovarian tumors depends on intraoperative diagnosis. Aims: The aim of this study was to compare the intraoperative cytology and frozen section for the diagnosis of ovarian masses. Materials and Methods: 57 patients with ovarian masses who underwent surgery for ovarian neoplasms were evaluated by intraoperative scrape and Frozen Section techniques and compared to final histological diagnosis. Assessment of the overall accuracy of the intraoperative diagnosis was classified as concordant or discordant. Results: The sensitivity, specificity, positive predictive value, Negative predictive value and accuracy of scrape smear were 89.47%, 100%, 100%, 95% and 96.49% respectively. The sensitivity, specificity, positive predictive value, Negative predictive value and accuracy of Frozen section were 94.74%, 100%, 100%, 97.43% and 98.25% respectively. Conclusion: sensitivity and accuracy of frozen section in detecting malignancy is higher than scrape cytology, while specificity in both the methods are same. Frozen section is more accurate than smear preparations in the intraoperative assessment of ovarian tumors in this study. However, the cytology preparation were helpful in supporting the histological diagnoses, and in some cases, provided additional useful information. Thus, cytology has a complementary role to frozen section in intraoperative assessment of ovarian lesions. At the centers where the facilities of frozen section are not available, intraoperative scrape cytology is a useful tool for intraoperative diagnosis of tumor.</p> Hena Dhirajlal Sodha Pankti Ileshbhai Macwan Kirit Jadav Copyright (c) 2021 Hena Dhirajlal Sodha, Pankti Ileshbhai Macwan, Kirit Jadav http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 162 168 A Comparative Study on N-Acetyl Cysteine and Metformin in Patients with Poly Cystic Ovarian Syndrome at a Tertiary Care Centre in Bihar https://www.ijhcr.com/index.php/ijhcr/article/view/3234 <p>Introduction: Metformin, an insulin sensitizer, is being used for long time in the treatment of PCOS. Problems associated with Metformin include gastrointestinal side effects, fear of hypoglycemia and increase serum homocystine levels in some patients. Materials and Methods: The study was prospective study to compare the effect of NAC and metformin. It was conducted in the Department of Obstetrics and Gynaecology, Darbhanga Medical College, Darbhanga, India. The study period was from February 2020 to September 2021. A total of 92 patients of PCOS diagnosed by Rotterdam criteria [2] were included in the study after obtaining written informed consent. It was approved by the Institutional Ethical committee. Results: Total 11 patients (7 from group M and 4 from group N) dropped out, due to intolerance of medication. Ultimately, evaluations were limited to 39 patients in group M and 42 patients in group N. Demographically both groups were comparable in terms of age, socio-economic status and BMI. Conclusions: Due to lack of adverse effects, NAC can be regarded as an appropriate substitute for insulin reducing medications in the treatment of PCOS patients.</p> Sushma Shikha Kumar Devashish Seema Copyright (c) 2021 Sushma Shikha, Kumar Devashish, Seema http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 169 171 An analytical study of Respiratory Tract Infections in Diabetes Mellitus patients https://www.ijhcr.com/index.php/ijhcr/article/view/3235 <p>Introduction: Alternations in host defence mechanism in entire body as well as locally in lung, is the most important pathological factor in DM with lower respiratory tract infections (LRTI) patients. . Studies and observations showing a high risk of infections in diabetics exist as this topic is still being debated upon. Impaired lung function and glucose intolerance, insulin resistance, type 2 diabetes and obesity have been proposed to be linked to each other [11-14]. The current study was undertaken to determine the correlation between LRTI in patients with DM. Methods: Total of 100 cases of DM with lower respiratory tract infections were analysed in a period of 1 years to study the association between DM and lower respiratory tract infections. All 100 patients selected randomly from all ages and either sex admitted in local randomly selected Secondary and tertiary Care Hospitals (TB and chest ward) of our Block. The results obtained were analyzed in detail using statistical methods. Results: The present study was carried out on 100 patients having DM with LRTI. The commonest age group affected was of 40-60 years (57%). Males were affected more than females with male: female ratio was 2.12. 38 % patients were from urban area while 62% were from rural areas. 48% patients were from lower socioeconomic status, 34% from middle socioeconomic status and 18% from upper socioeconomic status. Cough and fever were most common symptoms . Besides that anorexia, weight loss, breathlessness, chest pain and haemoptysis were observed .Among all organisms causing LRTI, Mycobacterium tuberculosis was the most common organism isolated . Other organisms like Streptococcus pneumonia , Klebsiella pneumonia, Staphylococcus aureus , Pseudomonas aeruginosa , Escherichia coli , and Influenza A (H1N1) were also isolated. No organism was isolated in 35% patients. Conclusions: LRTI is common clinical illness among diabetic patients. DM patients with age more than 50 years, duration more than 4 years and uncontrolled DM status have higher chances of developing LRTI and other DM related complication. Mycobacterium tuberculosis is the most common isolated pathogen among DM with LRTI patients. Patients of DM with pulmonary TB have higher sputum positive grading. Radiologically, moderate to far advanced lesions with bilateral involvement were more common with predominant exudative or mixed variety. Study revealed that lack of education, poor life style, poor nutrition and absence of follow-up visits led to development of serious respiratory infections among diabetics. So there is a great need of health counselling regarding strict diabetic control and follow-up visits to improve their quality of life.</p> Ramu Kambley Rahul Kewal Kumar Copyright (c) 2021 Ramu Kambley http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 172 174 Prophylactic use of intraoperative Nor-epinephrine infusion vs. bolus doses of Ephedrine and Phenylephrine in patients undergoing colorectal surgery under combined general and epidural anaesthesia for enhanced recovery after surgery. (ERAS) https://www.ijhcr.com/index.php/ijhcr/article/view/3236 <p>Introduction: Enhanced recovery after surgery (ERAS) has become an important focus of perioperative management after colorectal surgery. Maintenance of arterial blood pressure during combined general and epidural anesthesia is essential for organ perfusion and has been found as an important prognostic factor for enhanced postoperative recovery. Aim: To compare Norepinephrine infusion with ephedrine / phenylephrine boluses to maintain stable blood pressure and enhance postoperative recovery. Methods: Patients with physical status ASA I and II of either sex admitted for colorectal surgery were randomized into two groups. Group A: Nor-epinephrine group and Group B: Ephedrine/Phenylephrine group. After induction of general anesthesia Group A patients received norepinephrine infusion at a dose to keep mean arterial pressure (MAP) more than or equal to 80 mmHg after epidural anesthesia was activated with 10 ml of 0.25% ropivacaine whereas Group B patients received Ephedrine / Phenylephrine stat doses in case of hypotension (MAP &lt; 80 mmHg) during intraoperative period. Intraoperative hemodynamics and fluid input output were recorded in both groups. Post operative hemodynamics, renal function, oral feeding and early mobilization were compared in both the groups as indicators of enhanced recovery. Results: Prophylactic use of Norepinephrine infusion in patients undergoing colorectal surgery under combined epidural and general anesthesia was found to produce more stable intraoperative blood pressure compared to the use of ephedrine/phenylephrine boluses. Fluid requirement in group A during the procedure was less as compared to group B and the urine output during intraoperative period was better in patients receiving nor epinephrine infusion . Postoperative complications were lower in patients receiving norepinephrine infusion. Conclusion: Prophylactic use of nor epinephrine infusion to prevent intraoperative hypotension in patients undergoing colorectal surgery under combined epidural and general anesthesia was found to produce more stable intraoperative blood pressure and better postoperative course .</p> Veenakshi Devi Khalid Sofi Shafat A Mir Rouf A Wani Copyright (c) 2021 Veenakshi Devi, Khalid Sofi, Shafat A Mir, Rouf A Wani http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 175 179 Induction of labour in live singleton pregnancy: A comparative study between dinoprostone and oxytocin at a tertiary care hospital in Bihar https://www.ijhcr.com/index.php/ijhcr/article/view/3237 <p>Introduction: Post-term pregnancy is defined as gestation beyond 42 weeks from the first day of the last menstrual period. Previous studies have shown that as the gestational age advances beyond the expected delivery date, the risk of adverse maternal and fetal outcomes increases, including deterioration in coexisting maternal medical conditions, fetal distress, and fetal death. Materials and methods: An interventional study was planned by the Department of Obstetrics and Gynaecology, Darbhanga Medical College and Hospital, Laheriasri, Bihar. The study duration comprised of 6 months that is from January 2021 to June 2021. Women with viable singleton pregnanciesin late term gestation (41st week that was confirmed by crown-rump length measurement) who visited the hospital during the duration of data collection were recruited in the study after obtaining duly signed informed consent forms. Results: A total of 92 women with late-term pregnancy (LTP) were recruited into the study. They were divided randomly in group A and B, thus, each group comprised of 46 women. Based on bishop’s score, both groups were divided in subgroups A1, A2 and B1, B2. However, for women with a Bishop’s score between 4–6, there was no significant difference in the rate of cesarean delivery between subgroup B2 and A2 (P&gt;0.05). Conclusion: Based on the study findings, the researcher conclude that in set up where dinoprostone is unavailable, oxytocin may be considered, rather than a cesarean section, for women with a Bishop’s score of 4–6.</p> Sushma Shikha Kumar Devashish Seema Copyright (c) 2021 Sushma Shikha, Kumar Devashish, Seema http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 180 183 MRI Evaluation of Ankle and Foot Pathologies: A Cross-Sectional study in RRMCH, Bengaluru https://www.ijhcr.com/index.php/ijhcr/article/view/3238 <p>Background and purpose: Ankle joint is one of the most commonly injured joints in sedentary individuals as well as in athletes. Ankle ligaments are frequently injured in twisting injuries. The other pathologies in the ankle and foot are tendon pathologies, neuromas, ganglion cysts and plantar fasciitis. Aim: The purpose of this study was to describe the demographic profile of patients presenting with ankle and foot pathologies, to identify and describe the MRI features of various ankle and foot pathologies, to assess and grade the severity of various ligament and tendon pathologies. Methods: This study was a cross-sectional study of patients who underwent MRI evaluation of the ankle or foot in the Department of Radiodiagnosis, Rajarajeswari Medical College &amp; Hospital, Bengaluru from January 2014 to December 2020. The study population consisted of 64 cases. All the MRI scans of the ankle and foot were performed using 1.5 Tesla Siemens Magnetom Avanto (Tim 76x18) MR machine using a flex coil. Results: The study population consisted of 64 patients comprising of 39 males and 25 females. The age of the patients ranged from 9 to 75 years. Majority of the patients belonged to the age group of 21 – 30 years constituting about 34% of the total study population.Bones were the commonest site of pathology followed by joints, soft tissues, tendons and ligaments. The commonest type of tendon pathology was acute tenosynovitis. Anterior talofibular ligament was the most frequently injured ligament. Fractures, joint effusion and abscess were the commonest types of bone, joint and soft tissue pathologies respectively. Conclusion: Young adults and males are the most commonly affected population. Bones are the commonest site of pathology followed by joints, soft tissues, tendons and ligaments. MRI can identify, assess and grade the severity of tendon and ligament injuries which can help in treatment planning and rehabilitation.</p> Ashok Srikar Chowdhary Naresh Babu Lakshmipathi Nikhil Pravin G.U. Anuraj Bettadahalli Nagaraja Copyright (c) 2021 Ashok Srikar Chowdhary, Naresh Babu Lakshmipathi Nikhil, Pravin G.U., Anuraj Bettadahalli Nagaraja http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 184 191 Histopathological analysis and reporting of renal lesions in Nephrectomy specimens: A 3-year descriptive study at Tertiary Care Hospital https://www.ijhcr.com/index.php/ijhcr/article/view/3239 <p>Background: Kidneys are paired retroperitoneal organs and are the one, among the most highly differentiated organs in the body. They regulate several complex physiologic processes and, are greatly impacted by a broad spectrum of pathological conditions. In urology practice, nephrectomy (removal of entire or part of the kidney) is the widely performed surgical procedure for end-stage/nonfunctioning kidneys or any renal mass. Objectives: 1. Based on histomorphology, the main objective of our study is to analyze the spectrum and frequency of the different renal lesions in nephrectomy specimens at our tertiary care hospital. 2. To know the common indication/ cause for the nephrectomy procedure. 3. And also to study the distribution of renal lesions including both neoplastic and non-neoplastic lesions concerning age, gender, and histomorphological features. Materials and Methods: This was a retrospective and prospective review of histopathological lesions encountered in different age groups &amp; genders amongst nephrectomy specimens received in the Department of Pathology, Katuri Medical college Chinnakondrupadu, Guntur, Andra Pradesh, India. Results: In this study, the most common lesions were non-neoplastic (53.3%, 16 cases), the vast majority being chronic pyelonephritis accounting for 23.4% (07 cases). The neoplastic lesions accounting for 46.7% (14 cases), the majority were malignant neoplasms 13 cases in number and only one case of benign neoplasm was reported. Clear cell renal cell carcinoma was the most common malignant renal tumor and Oncocytoma was the only benign tumor reported in our study. And also we reported a rare case of coexisting urothelial carcinoma and renal tuberculosis in the same kidney on the left side in a 54-year-old female patient with a previous history of treated pulmonary tuberculosis. The most common age group affected was the 4th to 6th decade of life. Both non-neoplastic and neoplastic lesions show male preponderance. Conclusion: This study highlights that a complete and detailed histopathological examination of every nephrectomy specimen is mandatory to know the histologic type, for tumor grading and stating In summary, not only the pathologist, every clinician should have a better understanding of the histomorphology of renal lesions that are found in nephrectomy specimens to facilitate earlier diagnosis and more targeted treatment options, thereby improving overall and disease-free survival of the patient. In our study, non-neoplastic lesions were more the most common, followed by malignant tumors, and the least common were benign tumors. Chronic pyelonephritis was the most common non-neoplastic lesion for which nephrectomy was done. Clear cell renal cell carcinoma was the most common malignant tumor and Oncocytoma was the only benign tumor reported. Also reported, a rare and interesting case of coexisting papillary urothelial carcinoma and renal tuberculosis in the same side of the kidney. The most commonly affected age group was the 4th to 6th decade of life. Both non-neoplastic and neoplastic lesions showed male preponderance.</p> Muni Bhavani Itha Yarlagada Krishna Bharathi Satyanarayana Veeragandham Copyright (c) 2021 Muni Bhavani Itha, Yarlagada Krishna Bharathi, Satyanarayana Veeragandham http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 192 196 A comparative study between EEG Done Early and Late in Complex Febrile Seizures in Paediatric Age Group at a Tertiary Health Care Centre https://www.ijhcr.com/index.php/ijhcr/article/view/3240 <p>Introduction: Paediatric febrile seizures represent the most common childhood seizure disorders. Febrile seizures are defined by the International League Against Epilepsy as “a seizure occurring in childhood after 1 month of age, associated with febrile illness not caused by an infection of the central nervous system, without previous neonatal seizures or a previous unprovoked seizure, and not meeting criteria for other acute symptomatic seizures. Materials and Methods: This is a Prospective Comparative study. The study was conducted on 70 children admitted in the Department of Pediatrics at a Tertiary Care Teaching hospital for Complex febrile seizures, aged 3months to 5 years of age, who were diagnosed, evaluated with EEG, and treated for the complex febrile seizure; with a follow up after 2 weeks of the seizure episode, with a repeat EEG in the child. Results: Total no. of children enrolled in this study are 70. In these children; the comparison between early and late findings of EEGs were analysed and no statistically significant difference (p= 1.00) was found between the two Electroencephalograms performed early or late in the children with complex febrile seizures enrolled in our study. Conclusion: Our study concludes that there is no difference between an EEG performed early or an EEG performed late in children with complex febrile seizures, reflecting probable unnecessity in timing of the EEG in children with complex febrile seizures.</p> P. Srinivas Varsha Kolachena Sravanthi Veldanadi P. K. Rajeev Copyright (c) 2021 P. Srinivas, Varsha Kolachena, Sravanthi Veldanadi, P. K. Rajeev http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 197 202 A comparative study on the analgesic effects of clonidine and midazolam as an adjuvant to a mixture of local anaesthetics in supraclavicular brachial plexus block https://www.ijhcr.com/index.php/ijhcr/article/view/3241 <p>Introduction: With the rapid increase in traffic accidents, victims present for upper limb surgeries. Brachial plexus block is a good substitute to general anaesthesia. The aim of this study was to compare the analgesic effects of clonidine and midazolam as adjuvant to a mixture of local anesthetics in supraclavicular brachial plexus block. Material &amp; Methods: A randomized prospective double blind study conducted at Department of Anaesthesiology in a Tertiary care teaching hospital over a period of 6 months on 60 ASA- I and ASA II patients who fulfilled the inclusion and exclusion criteria. They were divided into 2 groups of 30 each based on computer generated randomization table, Group C received 150 μgm clonidine +Inj lignocaine 2% with adrenaline 15ml+Inj bupivacaine plain (0.5%) 15ml and diluted to 40ml and Group M received Inj midazolam 50μgm/kg adjuvant to the same mixture of local anesthetics and diluted to 40ml. Both the groups were compared based on the onset of sensory &amp; motor block, duration of sensory &amp; motor block, sedation measured by sedation score (Culebras). Total duration of sensory &amp; motor analgesia &amp; post-operative VAS score was recorded. Results: Onset of sensory and motor block was earlier in Group C, even duration of analgesia was significantly prolonged in Group C (619.53 ± 77.58 min versus 508.73 ± 89.83 min. in group M, the p value being &lt; 0.001). VAS score was 0 upto 3hrs in Group C and 0.5hr in group M. And the maximum sedation score seen in Group C was 3(Sedated and responding to mild stimulus). In Group M the maximum score noted was only 2 (Sedated and responding to verbal commands). Conclusion: Clonidine as an adjuvant in brachial plexus block for upper limb elective surgeries prolongs post-operative analgesia and also has high sedation score with no complications in either of the groups.</p> Seema Kumari.K Kanhu Charan Patro Bimal Prasad Sahu Copyright (c) 2021 Seema Kumari.K, Kanhu Charan Patro, Bimal Prasad Sahu http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 203 208 A Comparative Study Using Dexmedetomidine and Clonidine as Adjuvants with Levobupivacaine in Axillary Brachial Plexus Block for Upper Limb Surgeries https://www.ijhcr.com/index.php/ijhcr/article/view/3242 <p>Introduction: The axillary approach to the brachial plexus is the most popular because of its ease, reliability, and safety. Blockade occurs at the level of the terminal nerves. Alpha2-agonists are mixed with local anaesthetic agents to extend the duration of spinal, extradural and peripheral nerve blocks. The aim of the study is to compare the effects of clonidine and that of dexmedetomidine as adjuvants to levobupivacaine in axillary brachial plexus block. The onset time and duration of sensory and motor block, duration of analgesia, sedation score and haemodynamic parameters were studied in both groups. Methods: A prospective, double blinded, randomized clinical study was conducted at Department of Anaesthesia, Kamineni Academy of Medical Sciences and Research Center on eighty ASA class I and II adult patients undergoing upper limb surgeries under ultrasound guided axillary brachial plexus block. Patients were randomly divided into two equal groups, group LD (n=40): will receive 25ml of 0.5 % of levobupivacaine +1 μg/kg dexmedetomidine, and group LC (n=40) will receive 25ml of 0.5 % levobupivacaine +1 μg/kg of clonidine. The whole solution made up to 30 ml in each group by adding sterile water for injection. Haemodynamic parameters (heart rate, non invasive blood pressure, oxygen saturation), onset time and duration of sensory, motor block, duration of analgesia and, sedation score were recorded and then compared between the groups. Results: There was no statistically significant difference (P&gt;0.05) in haemodynamic parameters. Onset time of sensory and motor block were significantly faster (P&lt;0.05), duration of sensory and motor block and duration of analgesia significantly longer (P &lt;0.05) in dexmedetomidine group (group LD) when compared to clonidine group (group LC). The sedation scores were also better in group LD (P&lt;0.05). Conclusion: Dexmedetomidine is a better adjuvant than clonidine when added to levobupivacaine in axillary brachial plexus block, as it hastens the onset time of sensory and motor block, prolongs the duration of sensory and motor blockade as well as the duration of analgesia, with better intraoperative sedation without causing any haemodynamic variations.</p> Aruna. P1 S. Samanth Reddy Viditha Korukonda Copyright (c) 2021 Aruna. P1, S. Samanth Reddy, Viditha Korukonda http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 209 214 An Observational Study On Pruritus In Pregnancy at Out Patient Department of Patna Medical College & Hospital, Bihar https://www.ijhcr.com/index.php/ijhcr/article/view/3243 <p>Introduction: Pregnancy is a physiological state leading to hormonal, metabolic, and immunologic changes. These changes influence the functioning of the body as well as the structure of the skin and mucous membranes. Hyperpigmentation of skin, mainly visible in physiologically highly pigmented areas, for example, genitals, perineum, periumbilical skin, and areolae are seen in majority (90%) of pregnant women. Methodology: A cross sectional observational study was planned by the Department of Dermatology, Patna Medical College &amp; Hospital, Patna, Bihar. Approval was obtained from the Institutional Ethics Committee. During the stipulated data collection period of 6 months from september 2019 to February 2020. A total of 215 consecutive pregnant women were recruited into this study. All patients underwent thorough medical history taking and detailed physical examination with special emphasis on pruritus. Results: A total of 215 patients were included in the study. The mean age of the study participants was 34.6 ± 4.3 years and the mean weeks of gestation was 31.4 ± 5.6 weeks. Among the pregnant women, 71.8% were primiparas. Multiple pregnancy cases comprised of 9.3% of total females. The prevalence of pruritus among the study participants (during entire duration of pregnancy) was 41.2%, although at the time of examination (point prevalence) it was only reported by 19.5% (n = 42) of patients. 7.2% women reported to be experiencing pruritus before their pregnancy. Conclusion: Pruritus in pregnancy requires taking a thorough history and complete physical examination. Laboratory studies such as liver transaminase levels, serum bile acid levels, and in selected cases skin biopsy might be indicated in order to determine the most likely diagnosis. The treatments described for the above conditions are considered safe in pregnancy.</p> Shobhana Jha Amit Ranjan Anupama Singh Copyright (c) 2021 Shobhana Jha, Amit Ranjan, Anupama Singh http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 215 217 A Study of Association Between Serum Paroxanase Enzyme Activity with Dyslipidaemia in Obese Individuals https://www.ijhcr.com/index.php/ijhcr/article/view/3244 <p>Introduction: Obesity, defined as the excessive accumulation of body fat, is frequently associated with a low concentration, adverse distribution pattern, and abnormal metabolism of HDL particles. Obesity is a highly prevalent chronic state observed in 32% of all adults in the United States. Material and Methods: This is prospective study conducted over a period of 6 months among Obese participants were selected at Tertiary care teaching hospital and had never been diagnosed with T2D or prediabetes, as evidenced by an HbA1c of less than 5.5 percent. Healthy volunteers from made up the control group. History of cancer, prior chemotherapy or radiotherapy, diabetes, prediabetes, anaemia, hereditary neuropathies, inborn inconsistencies of metabolism, undiagnosed vitamin/mineral deficiencies, low vitamin B12 or folate tiers that may impact the cornea were all considered exclusion criteria. The Ethics Committee gave their approval to this project. Results: We studied 30 participants with severe obesity compared to 30 age-matched healthy controls (P=0.5). The obese group had a significantly higher weight (P&lt;0.0001), waist circumference (P&lt;0.0001) and BMI (P&lt;0.0001), but no statistically significant difference in HbA1c, blood pressure compared to controls. Conclusion: Patients with obesity had elevated serum triglycerides and SAA and lower HDL-C, PON-1 activity. Furthermore, obese subjects had higher serum triglycerides and prevalence of metabolic syndrome and lower PON1 activity.</p> A F MD Nidaullah Amena Tasneem Uzma Nausheen Ubhathullah Qamesa Shoaib Mohammad Copyright (c) 2021 A F MD Nidaullah, Amena Tasneem, Uzma Nausheen, Ubhathullah Qamesa, Shoaib Mohammad http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 218 220 Effectiveness of Early Clinical Exposure (ECE) as a teaching-learning method for first-year MBBS undergraduates in basic medical sciences https://www.ijhcr.com/index.php/ijhcr/article/view/3246 <p>Introduction: In Competency-Based Undergraduate Curriculum Module-2, 2019 for Indian Medical Graduate (IMG) stated that Early Clinical Exposure (ECE) provides a reference to basic science learning so that students can understand the applicative aspects of learning. This methodology orients students towards actual clinical scenarios &amp; helps them to correlate their theoretical knowledge with real-life in the management of patients. Methodology: This was a prospective cross over study carried out at Al-Falah School of Medical Sciences &amp; Research Centre, Dhauj, Faridabad. The Institutional Ethical committee has approved the study. A total number of 150 First year MBBS undergraduates participated in the study as the study group. ECE is a part of undergraduate Curriculum phase-1in CBME. Students were sensitized to the method of ECE &amp; the purpose of ECE was explained to them. Consent was taken from the participants. All first-year MBBS undergraduates were divided into two groups of 75 student (i.e., A &amp; B) according to their class roll numbers. Preliminary lectures on Liver Function Tests, Renal Function Tests and Cardiac Profile Tests &amp; Acid-Base disorders were conducted as per schedule. In Session-1, Clinical case study(ECE) of Acid-Base disorders were taught to Group A and Acid-Base disorders were taught by (Non ECE)Tutorial method to Group B. Likewise the Clinical case study (ECE)of Jaundice were taught to Group B &amp; Jaundice was taught by (Non ECE)Tutorial method to Group A. Assessment of all the students was done by post-session MCQ test. In Session-2, Clinical case study (ECE) of Renal Function Tests were taught to Group A &amp; Renal Function Tests were taught by(Non ECE) Tutorial method to Group B. Likewise the Clinical case study(ECE) of Myocardial Infarction were taught to Group B &amp; Myocardial Infarction was taught by(Non ECE) Tutorial method to Group A. Assessment of all the students was done by post-session MCQ test. Conclusion: In Biochemistry ECE helps students to be aware of the clinical and diagnostic relevance of the subject. Successful implementation of ECE enhances performances of first-year undergraduate students in basic medical sciences.</p> Shilpa Mittal Rashmi Gulia Pragati Sheel Mittal Copyright (c) 2021 Shilpa Mittal, Rashmi Gulia, Pragati Sheel Mittal http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 221 224 A Study on Effect of Smart Phone Usage on Cardiovascular and Hematological Parameters in Adult Population https://www.ijhcr.com/index.php/ijhcr/article/view/3247 <p>Background: Worldwide, mobile phone usage has increased dramatically which could have affected the health of the people in India and across the globe as well. Mobile phone radiation may impact cardiovascular parameters like heart rate and other physiological parameters1 therefore it is highly suggested to explore the impact of mobile phone usage on the health of the human beings. Materials &amp; methods: The present study was conducted at Integral university campus, Lucknow (From January 2019 to June 2019) in the Department of Physiology of IIMS&amp;R, Lucknow. A total of 197 adult population were recruited who underwent monitoring for the study purposes. Blood pressure both systolic and diastolic blood pressure (SBP, DBP) was recorded using mercury sphygmomanometer. Total white blood cells (WBC) count was done by Haemocytometer method using Turk’s fluid as diluent. Cells were counted manually using compound microscope. Results: In our study, Subjects (n=21) whose systolic blood pressure were recorded to be &gt;140 mmHg accounting for 10.65% of total subjects. Subjects (n=2) whose diastolic blood pressure were recorded &gt;90 mmHg whose percentage is 1.01 of the total subjects studied. After adjustment for age and sex, the positive correlation was found between the duration of mobile phone usage and SBP, DBP with a p value of 0.169 and 0.386 respectively. Total WBC count was found to be higher than normal range in two number of subjects with a p value of 0.715. Conclusion: From this study, it can be concluded that the electromagnetic field created by mobile phone’s usage can change blood pressure (SBP, DBP) and can induce changes in the population of white blood cells.</p> Mohd Faheem Khan Tanwir Alam Md Sabir Hussain Upendra Pandey Ausaf Ahmad Copyright (c) 2021 Mohd Faheem Khan, Tanwir Alam, Md Sabir Hussain, Upendra Pandey, Ausaf Ahmad http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 225 229 Evaluation of the effectiveness of single posterior only approach for circumferential decompression of thoraco-lumbar thecal sac and anterior column reconstruction with posterior stabilization https://www.ijhcr.com/index.php/ijhcr/article/view/3248 <p>Background: The common indications for spinal decompression surgeries performed in India are infections, fractures and tumors. Our study objective is to evaluate the effectiveness of 360 degree circumferential decompression of thoracolumbar thecal sac through single midline posterior approach and anterior column reconstruction with posterior stabilization. Materials &amp; methods: A prospective study of 31 patients with 24 patients having neurological deficit was conducted among the trauma, infection and tumor patients attending the outpatient and inpatient department of Orthopedics at Gitam Institute of Medical Sciences and Research from 2017 to 2020 with a minimum follow up of 6 months. They were followed up on monthly basis till satisfactory fusion was seen on X-ray and every 6 months thereafter till 2 years. Clinical evaluation is done using ASIA motor score, ASIA impairment scale and VAS score. Radiological union and correction of deformity will be assessed using anteroposterior and lateral radiographs using kyphotic angle, graft fusion and implant status. Results: Neurological recovery occurred in 91.7% patients and all the patients neurology was either stable or improved post operatively. The mean post operative ASIA motor score was 91.36±13.71 (p-value&lt;0.001). The mean post operative kyphotic angle was 10.55±8.25 (p-value&lt;0.001), there was no loss of kyphosis correction on follow up. The mean post operative VAS was 2.32±0.75 (p-value&lt;0.001). No intra operative or post operative complications were encountered. There was no implant related complication seen during the study. Conclusion: The posterior transpedicular approach provides sufficient access for safe and effective circumferential decompression and three column stabilization. The technique achieved a high success rate for pain relief, neurological preservation and functional improvement. Less intra operative blood loss, complications, shorter operative time, better pulmonary function after operation and early rehabilitation are significant advantages of posterior alone surgery compared with combined anterior and posterior approaches.</p> Rajashekhar Tati Sunil Gottipati Copyright (c) 2021 Rajashekhar Tati, Sunil Gottipati http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 230 236 A clinical study on acute appendicitis with special reffrence to TLC, DLC, C-reactive protein and plain x-ray abdomen https://www.ijhcr.com/index.php/ijhcr/article/view/3251 <p>Objective: To diagnose the case of acute appendicitis accurately on basis of a combined criteria including TLC,DLC,CRP and plain X ray abdomen so that timely intervention can be performed and avoiding negative laparatomies in term of better management of patient in patient with acute right lower quadrant of abdominal pain. Methods During the study period of 18 months, 60 patients between the ages of 11 and 65 years operated upon for suspected acute appendicitis were included in this prospective study. Both open as well as laparoscopic appendectomies were included in the study. On admission, note was made of the symptoms and signs relevant to the study. Venous blood was routinely taken on admission and was sent to the emergency laboratory for testing. Results The present study revealed that males were affected more than females and the commonest age group affected was 11 – 20 year age group. Pain, anorexia, vomiting and fever seems to be the reliable symptoms and one should deeply inquire about these symptoms. RLQ tenderness and rebound tenderness along with tachycardia were the commonest signs and presence of all three should highly suggest the diagnosis of acute appendicitis. An increase in C-reactive protein level is highly sensitive in diagnosing inflammatory condition like acute appendicitis, but again it has low specificity and results should be interpreted along with valid clinical picture. Plain x-ray abdomen can serve as an important adjunct in the diagnosis of acute appendicitis, with RLQ ‘sentinel loop’ being the commonest finding. Conclusion If all the investigations such as TLC, DLC, CRP and PLAIN X-RAY ABDOMEN are combined, it can highly increase the sensitivity and positive predictive value in diagnosing acute appendicitis.</p> Rahul Patel Krishna Kumar Bharang Nitin Garg Ela Haider Rizvi Copyright (c) 2021 Rahul Patel, Krishna Kumar Bharang, Nitin Garg, Ela Haider Rizvi http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 237 242 ABO blood type and association with various cancer types: A retro- prospective study from Southern India in a tertiary care setting https://www.ijhcr.com/index.php/ijhcr/article/view/3252 <p>Objective: The role of ABO blood group in cancer biology has been intensely studied by several investigators, and it is now widely recognized that ABO antigens are associated with the risk of developing several types of tumours, namely pancreatic and gastric cancers. Aim of our study is to find out the association of ABO blood type with different type of cancer based on site and histology. Materials and methods: Ethical approval was obtained, Patients diagnosed of carcinoma coming to radiology department for CECT was included and those with previous history of surgery done for carcinoma, follow up cases coming for CT scans were excluded. Results: Out of 501 participants, the cancer of digestive system was the most frequent diagnosis that accounted for 54% of total cancer cases, followed by genitourinary system (32%) and respiratory system (10%). Cancer of the colorectal region was the most common cancer diagnosis (accounting for 22% of total cancers), followed by stomach (10%), ovary (9%) and cervix (8%). By histology, adenocarcinoma accounted for 54.5% of total histologically confirmed cancer cases while squamous cell carcinoma and carcinomas accounted for 12% and 9% respectively. The remaining 24% of cancer cases consisted of cases with other histology types. Conclusion: The results were different from those observed in western and Asian population. So, further cross section/ cohort studies are warranted across Pan India to know the association and variation in risk of cancer types with ABO blood group</p> Ragupathi Siddarth Jagadeesan Dhanasekaran Sahadevan Vijay Copyright (c) 2021 Ragupathi Siddarth, Jagadeesan Dhanasekaran, Sahadevan Vijay http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 243 246 The Effect of Nifedipine versus Magnesium Sulfate in preterm labor: A randomized clinical trial https://www.ijhcr.com/index.php/ijhcr/article/view/3253 <p><strong>Aim:</strong> The aim of this study to evaluate the effect of Nifedipine versus Magnesium Sulfate in preterm labor. <strong>Methods: </strong>120 women with preterm labor between 24-37 week gestations were include in this study. Patients were selected randomly to receive either oral nifedipine or intravenous magnesium sulfate. Nifedipine tocolysis was initiated with a 10 mg capsule which was repeated every 20 min (up to a maximal dose of 30 mg during the first hour of treatment) and then nifedipine maintenance dose was 10 mg every six hours. Tocolysis with magnesium sulfate was initiated with 10g (I.V) and then 5g (I.M) every 4 hours. <strong>Results:</strong> Total of 120 women were included ; 60 patients were randomly assigned to the nifedipine group and 60 were randomly assigned to the magnesium sulfate group. 3 patients (5%) after 24 hours, 5 patients (8.33%) after 48 hours, 4 patients (6.67%) after 72 hours and 33patients (55%) after 7 days had delivery in the nifedipine group and 6 patients (10%) after 24 hours, 3 patients (5%) after 48 hours, 3 patients (5%) after 72 hours and 37 patients (61.67%) after 7 days had delivery in the magnesium sulfate group. This characteristic was not statistically different between the two groups. In this study, 11 patients (23.33%) in nifedipine group and 9patient (15%) in magnesium sulfate group had a failure treatment (contractions did not subside) and needed to take other tocolytic medications. This characteristic was also not statistically different between the two groups.4 patients (6.67%) in the nifedipine group had severe hypotension and 2 patient (3.33%) in the magnesium sulphate group had severe flushing. These side effects caused drug discontinuation. Patients in the nifedipine group and magnesium sulfate group had the general side effects: 5 cases (8.33%) of headache and 2 case (3.33%) of flushing, respectively. All of obstetric characteristics were also not statistically different. <strong>Conclusion: </strong>We concluded that the oral nifedipine is a suitable alternative for magnesium sulfate with the same efficacy and side effects in the management of preterm labor.</p> Viraj Nandkishor Godbole Sonali Abhinav Deshmukh Copyright (c) 2021 Divya Sharma, Rashmi Gupta, Vandana Varma, Madhuri Gupta http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 247 249 Megakaryocytic Alterations in Thrombocytopenia: A Bone Marrow Aspiration Study https://www.ijhcr.com/index.php/ijhcr/article/view/3257 <p>Background: Thrombocytopenia is defined as platelet count less than 150,000 /mm3 (150x109 /litre) and is commonly seen in various haematological disorders and nonhematological conditions and may be associated with dysplastic megakaryocytes which is a feature of myelodysplastic syndrome. Objective: To study the morphological variations of megakaryocytes on bone marrow aspiration smears in Non MDS related thrombocytopenia in MGM Medical College and MY Hospital Indore. Materials and Methods: Retrospective study of 76cases of non MDS thrombocytopenic patients. Patients presenting with platelet count &lt;150,000/mm3 from June 2019 to July 2020 at MGM medical college, Indore were included in the study. Results: The most common cause of thrombocytopenia was megaloblastic anaemia followed by acute leukaemia, chronic leukaemia idiopathic thrombocytopenic purpura. Both dysplastic and nondysplastic features were observed in the above mentioned conditions. The most common dysplastic feature was nuclear segmentation followed by micromegakaryocytes and hypogranular forms. The common nondysplastic features observed were immature forms (most common) bare nuclei, and hypolobation. Conclusion: Dysplastic megakaryocytes are common in non-MDS-related thrombocytopenia and their mere presence should not lead to the diagnosis of MDS. Hence, proper diagnosis should be made on megakaryocyte morphology. Patient’s clinical findings and other haematological parameters. This understanding can improve the diagnostic accuracy for wide range of haematological disorder.</p> Priyanka Kiyawat Ashok Panchonia Nidhi Sharma Sandhya Shakya Rohini Kunder Copyright (c) 2021 Priyanka Kiyawat, Ashok Panchonia, Nidhi Sharma, Sandhya Shakya, Rohini Kunder http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 250 252 A Comparative Study of Quality of Life of Families with Children Born With Cleft Lip and/or Palate before and after Surgical Treatment https://www.ijhcr.com/index.php/ijhcr/article/view/3259 <p>Background: Cleft lip and palate (CLP) is treated in a multidisciplinary manner, incorporating both surgical and non-surgical specialties. Surgical reconstruction of OFCs is a common treatment performed by oral and maxillofacial surgeons and other surgical professionals, and it entails the repair of both the lip and the palate. Several strategies for CLP repair have been documented in the literature. When the infant is roughly 3 months old, the lip is repaired, and the major palate is repaired between the ages of 6 and 14 months. OFCs may have an impact on family functioning and, as a result, are likely to lower QoL in school-aged children and their parents. Aim: The purpose of this study was to assess the quality of life (QoL) of parents/caregivers of children with cleft lip and/or palate before and after surgical correction. Materials and Methods: Families of individuals who needed either primary or secondary orofacial cleft repair and met the inclusion criteria were invited to participate. The ‘Impact on Family Scale' (IOFS), a preoperative and postoperative health-related QoL questionnaire, was used to assess the affected family's subjectively assessed QoL before and after surgical intervention. A paired t-test was used to compare the mean pre- and postoperative total scores. The mean pre- and postoperative total scores were compared using paired t-test. Results: Before surgery, over ninety-six percent of families' quality of life was impacted. The economical and social sectors had the biggest impact preoperatively. Families with children who had bilateral cleft lips saw QoL consequences mostly in the social domain and in the domain of "impact on siblings." The mean overall QoL score after surgery was considerably lower than the mean QoL score before surgery, indicating a significant improvement in QoL (P0.001). In all domains, the mean postoperative QoL score was considerably lower than the mean preoperative QoL score. Only 3% of the families said the surgery had a negative impact on their quality of life. The domains of mastery (almost sixty-two percent) and finance (nearly forty-five thousand) had the most postoperative impact. After treatment, the proportion of families whose QoL was impaired by orofacial cleft was significantly different. Conclusion: Caring for children with orofacial clefts has a considerable negative impact on parents' and caregivers' quality of life in all dimensions. Surgical intervention, on the other hand, dramatically enhances the quality of life of these children's parents and carers.</p> Rohini YN Ojasin Khanna Swarada Mahamuni Copyright (c) 2021 Rohini YN, Ojasin Khanna, Swarada Mahamuni http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 253 256 A Study of Relationship between Arterial Blood Pressure and Mid Arm Circumference in Young Adults https://www.ijhcr.com/index.php/ijhcr/article/view/3260 <p>The present study was done to find out the correlation between mid-arm circumference (MAC)and blood pressure, {systolic blood pressure (SBP), diastolic blood pressure (DBP); pulse pressure(PP) and mean arterial pressure (MAP)} values. There is paucity of information on the variation in blood pressure and pulse rate parameters of normal individuals. The aim of the study was to assess the correlation between MAC and BP. The study was conducted in 184 healthy young adults. There were 119 male and 65 female participants. In view of gender differences in autonomic regulation, data of male and female subjects were analyzed separately. We used analysis of variance to compare differences between Mean±SD, maximum, minimum values and correlations of MAC and blood pressure values. Conclusion: The Mean±SD of blood pressure values were higher in those subjects who had high mid arm circumference and least in those subjects who had lower mid arm circumference. A p value *0.05 and * 0.01 were considered statistically significant for both male as well as in female subjects. There was significant spearman`s correlation between MAC and BP in both male as well as in female subjects.</p> VestiRanda Solanki Shiv Narayan Lahariya Vandana Varma Ajay Soni Copyright (c) 2021 VestiRanda Solanki, Shiv Narayan Lahariya, Vandana Varma, Ajay Soni http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 257 260 Role of HRCT chest as primary investigation to screen symptomatic primary contacts of COVID-19 https://www.ijhcr.com/index.php/ijhcr/article/view/3261 <p>Chest CT had higher sensitivity for the diagnosis of COVID-19. Chest CT may be considered as a primary tool for screening of symptomatic contacts of COVID 19 in epidemic areas, particularly where access to reverse transcriptase-polymerase chain reaction (RT PCR) testing is difficult. The positive rates of RT-PCR assay and chest CT imaging in our cohort were 61.4% (43/70), and 85.7 % (60/70) for the diagnosis of suspected patients with COVID-19, respectively. With RT-PCR as a reference, the sensitivity of chest CT imaging for COVID-19 was 93% (40/43).</p> Srujana Pilli Shaik Ameenulla Hafeezuddin Vignesh N Copyright (c) 2021 Srujana Pilli, Shaik Ameenulla Hafeezuddin, Vignesh N http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 261 263 Effects of Holi colours in children's eyes: A cross sectional observational study https://www.ijhcr.com/index.php/ijhcr/article/view/3262 <p>Purpose: To determine the ocular surface toxicity due to Holi colors in paediatric population and to differentiate the toxic effects of organic Holi colors and chemical Holi colors on ocular surface. Methods: It was a prospective cross-sectional study, conducted over a period of 3 years done at a government medical college in Kolkata. Children between 5-15 years with history of chemical ocular injury due to holi colors were included as study population. Patient were divided into two groups according to nature of colours; chemical colours group and organic colours group. After taking meticulous history a comprehensive ophthalmological examination was done in each case including slit lamp biomicroscopy and fluorescein staining of ocular surface. Symptom and signs were recorded in an organized manner and compare about the nature and extent of ocular surface toxicity. Results: 76 eyes of 51 patients were included in this study. Boys were commonly affected than girls (63:37). Visual acuity did not affect much, 90. 6% study population had a visual acuity of 6/18 or better during their initial presentation. Foreign body sensation was the commonest presenting symptom in both group and it was more commonly observed in chemical colour group (P=.0007). Others commonly observed symptom such as ocular pain, redness and watering did not show any statistically significant difference between the two groups. Conjunctival congestion was the most commonly observed clinical findings in this study. 65.2 % child of chemical colour group and 40% child of organic colour group had this sign on presentation (P=.030). Other clinical sign such as conjunctival chemosis, stained conjunctiva, punctate epithelial erosion of cornea or large epithelial erosion observed in both groups and no statically significance observed here. No cases of corneal stromal involvement or anterior chamber involvement detected in any of the study population.</p> Bivas Bala Soumi Kanji Viswanath Pratap Copyright (c) 2021 Bivas Bala, Soumi Kanji, Viswanath Pratap http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 264 267 Contrast Enhanced Computed Tomographic Evaluation of Vascular Complications of Pancreatitis https://www.ijhcr.com/index.php/ijhcr/article/view/3263 <p>Aim: This study is designed to assess the role of Contrast Enhanced Computed Tomography in the evaluation of Vascular Complications of Pancreatitis. Method: Hospital based prospective study in 150 patients with pancreatitis based on clinical and laboratory findings. CT scan Imaging was done with 128 slice GE Optima CT machine. Results: Out of the 150 pancreatitis cases, 87.3% are males. Acute pancreatitis (81, 54%) is the major morphologic type. Majority of the AP cases are of interstitial edematous type (55, 67.9%). Mild AP is found in 25.9%, Moderate AP constitutes 48.1% and Severe AP in 25.9% cases. Vascular complications observed as 26.67% in the age range of 41 to 50 years. Acute necrotizing type is the leading cause. Vascular complications is highest with severe AP (85.7%) with MCTSI scores of 8 and 10. In our study, there is high association of vascular complications with necrotizing pancreatitis as well. In 110 vascular uncomplicated cases, meticulous analysis reveals indirectly that vascular complications are less associated with mild and moderate acute pancreatitis. 80% are constituted by venous complications, 15% accounted to arterial complications. Both arterial and venous complications constitute to 5%. Splanchnic vein thrombosis is the most common venous complication followed by isolated portal vein and isolated splenic vein thrombosis. Rare cases of right hepatic artery pseudoaneurysm, splenic artery pseudoaneurysm, co-existing thrombus and pseudoaneurysm in superior mesenteric artery, left renal vein thrombosis, inferior mesenteric vein thrombosis have been reported. An exceptional case of thrombosis of splenic vein, portal vein, superior mesenteric vein, left renal vein, inferior vena cava and right atrium have been reported. Another notable case is pulsatile pseudocyst. Vascular complications significantly affects the patient’s outcome in terms of various outcome parameters. The average length of hospitalization for vascular complicated cases is 16-20 days and for vascular uncomplicated cases, it is 1-5 days. Mortality rate in the study with vascular complications is 2.5%. Conclusion: Our study also yielded a statistically highly significant result of vascular complications being associated with higher MCTSI score. The MCTSI score increases, the prevalence of vascular complications increases and therefore significantly affects the patient’s outcome in terms of various outcome parameters.</p> Keerthika Chinta Pradeep Tavva Rishi Papanaidu Priyanka Chinta Copyright (c) 2021 Keerthika Chinta, Pradeep Tavva, Rishi Papanaidu, Priyanka Chinta http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 268 274 Student centric Integrated Teaching- An Innovative approach in Medical education https://www.ijhcr.com/index.php/ijhcr/article/view/3264 <p>Background: Today’s medical education system aims at imbibing new teaching learning methods so as to keep up with the requirements of and to match the international standards. Integration simply means bridging connections between academic knowledge and practical. Apart from having the benefits, there are some limitations, mainly it is teacher-oriented method of teaching than student oriented. In the current study, we have made to introduce a student centric approach for integrated teaching method. Aim: To analyse students’ and faculty feedback regarding the innovative student centric approach of integrated teaching (SCIT) and the effective ness of the SCIT to the traditional integrated teaching (IT). Methods: Mixed method approach. Need analysis ( qualitative approach)by freelisting and pile sorting. Free listing was to identify the perceptions of the students about the existing flaws/ lacunae and the suggestions that has to be incorporated to overcome the existing flaws/lacunae in existing integrated teaching method. Whole 100 students were divided in to 10 groups, each having 10 students. The objectives of the session were divided among the 10 groups one weeks prior to the SCIT session. From each department (Anatomy, Biochemistry and Physiology) two faculty were assigned to guide the students.SCIT ( student centric integrated teaching method)was conducted in two sessions. All the students &amp; the faculty were subjected to a previously validated feedback questionnaire to assess the perceptions regarding the newer teaching –learning method (Student centric integrated teaching method -SCIT) A post test was conducted to all the students and their scores were analysed. These scores were compared with the scores of their senior batch students who were exposed to current Integrated teaching method. Results: The cognitive map (figure 1) revealed the distribution of the lacunae in the existing integrated teaching method (Session planning related and Student’s interaction related). The cognitive map (figure 2) depicted the solutions to fulfil the lacunae / expectations from the teaching learning methods (Division of session time, Assessment at end of session and Interactive sessions). post test scores between the two groups SCIT and IT Mean ±SD 11.03 ± 2.5 &amp; 8.51 ± 2.14 respectively. Conclusion: A modified methods SCIT has been developed which is students centric and this method has addressed majority of the issues of the students towards integrated teaching. Post test scores revealed that students exposed to SCIT had better performance than those who were exposed to regular integrated teaching session. Students and faculty were satisfied with the new method SCIT.</p> Suhasini Padugupati K.P Joshi Copyright (c) 2021 Suhasini Padugupati, K.P Joshi http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 275 280 Categorisation of thyroid lesions according to bethesda system and their histopathology correlation in a tertiary care hospital https://www.ijhcr.com/index.php/ijhcr/article/view/3265 <p>Introduction: Thyroid is affected by variety of conditions, whose preoperative diagnosis is of great significance in appropriate management. Fine needle aspiration cytology (FNAC) offers cellular level diagnosis with comparable sensitivity and specificity with respect to gold standard histopathological examination. Aim: To categories Fine Needle Aspiration Cytology of Thyroid lesions according to The Bethesda System of Reporting Thyroid Cytopathology and to correlate with histopathological findings wherever possible and to estimate diagnostic accuracy of FNAC. Materials and methods: A prospective study was carried out over a period of 2year, during which FNAC was done in 328 patients with thyroid swelling. Amongst whom 126 underwent surgery and histopathological correlation was done in those cases. Results: There was female preponderance with female to male ratio of 6.9:1, and mean age of 40.6 years. Out of 126 cases, 117 were non-neoplastic and 9 were neoplastic on histopathology. Among 117 non-neoplastic lesions, 106 cases showed cyto-histological concordance and 11 were discordant. Among the 9 neoplastic lesions, cyto-histological concordance was obtained in 4 cases and discordant in 5. Sensitivity and specificity of FNAC for non-neoplastic lesions were 93.8% and 69.2% respectively. Positive predictive value and negative predictive value were 96.3% and 56.2% respectively with a diagnostic accuracy of 91.2%. Conclusion: FNAC is simple, inexpensive and effective diagnostic modality with complications being minimal. Precise technique and rational use of USG guidance improves the adequacy and reduces the non-diagnostic rates. FNAC reporting according to TBSRTC aids clinicians and Pathologists in providing optimal management of patients.</p> Sathyashree K V Mahesh H Karigoudar Anil Reddy Konduru Pyla Ramadevi Disha B S Ramyashree G Copyright (c) 2021 Sathyashree K V, Mahesh H Karigoudar, Anil Reddy Konduru, Pyla Ramadevi, Disha B S, Ramyashree G http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 281 286 Hematological finding of Anemia in Pediatric Population https://www.ijhcr.com/index.php/ijhcr/article/view/3266 <p>Introduction- Anemia is characterized as an inadequate RBC mass to satisfactorily convey oxygen to peripheral tissues. Hemoglobin is a protein that allows red blood cells to deliver oxygen to other cells in the body. Childhood anemia is one of the most notable healthful issue confronting mothers and children in India. Deficiency anemia is a major health condition worldwide. Objective- To evaluate anemia in pediatric age group (6months to 12years). Method- A retrospective cross- sectional study in male and female child aged from 6months to 12years who were hospitalized in Chacha Nehru hospital associated with M.Y. Hospital, Indore from May2020 to May 2021 Results -Children with a hemoglobin concentration less than 11 g/dL were considered anemic. Conclusion- Appropriate screening and diagnostic testing will permit most instances of iron deficiency to be analyzed at the soonest. Blood indices are fundamental prior to treating children with symptoms of anemia to stay away from undesirable incidental effects.</p> Priyanka Kiyawat Ashok Panchonia Shailendra Singh Thakur Veena Kumari Bais Sandhya Shakya Copyright (c) 2021 Priyanka Kiyawat, Ashok Panchonia, Shailendra Singh Thakur, Veena Kumari Bais, Sandhya Shakya http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 287 290 Spectrum of Gram Negative organisms in an Adult ICU of a Tertiary Care hospital https://www.ijhcr.com/index.php/ijhcr/article/view/3267 <p>Background: Infections play vital role in determining the outcome as well as cost and duration of the hospital stay for patients admitted in Intensive Care Unit (ICU) setup. One of the major problems Worldwide is the rise in Antibiotic-Resistant Strains of bacteria, mainly in hospitals. Infections frequently encountered with drug resistant organisms include those with Methicillin Resistance Staphylococcus aureus (MRSA), Extended-Spectrum β-Lactamase (ESBL), and Metallo β-Lactamase (MBL) producing organisms.Extended-spectrum β-lactamase (ESBL) producing strains of Enterobacteriaceae have emerged as a challenge in hospitalized patients as well as in the community. Objectives: 1. To isolate and identify bacterial pathogens in Adult Intensive Care Unit (ICU). 2. To study antimicrobial susceptibility patterns of gram negative organisms isolated from samples in Adult ICU. 3. To detect presence of Extended Spectrum β Lactamases in all Enterobacteriaceae isolates. Material and methods: Depending on sites of infections various samples were collected and processed for bacterial identification and antibiotic susceptibility as per the standard guidelines. Results: Of the total 130 bacterial isolates Pseudomonas aeruginosa was the predominant isolate 32 (24.61%) followed by E. coli 27 (20%), K. pneumonia and S. aureus, 18.46% each. Gram negative bacilli were found to be commonest cause of ICU infection. ESBL production was found in 35.71% of Enterobacteriaceae isolates. Conclusion: ESBL producing organisms pose a major problem for clinical therapeutics. Judicious use of antimicrobials, strict adherence to the antibiotic policy and infection control practices, implementation and practice of antibiotic stewardship programme are measures to reduce infections in ICU.</p> Poojashri M Sharma Rajesh P Karyakarte Nitin A Ambhore Rupali S Mantri Copyright (c) 2021 Poojashri M Sharma, Rajesh P Karyakarte, Nitin A Ambhore, Rupali S Mantri http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 291 296 Prevalence of Urinary Tract Infection in Infants with Unexplained Acute Fever: A cross sectional study https://www.ijhcr.com/index.php/ijhcr/article/view/3268 <p>Background: Urinary tract infection (UTI) is one of the most common bacterial infections in infancy, with a high risk of recurrence, and maybe an indicator of underlying urinary tract abnormality. It is often misdiagnosed due to irregular and unrelated symptomatology in the absence of directed screening. Knowledge of baseline risk of urinary tract infection can help clinicians make informed diagnostic and therapeutic decisions. Objectives: The objectives of the study were to know the prevalence of UTI in infants with unexplained acute fever and to know other features of UTI besides fever. Methods: This was an observational, descriptive, cross sectional study. The study was conducted in private tertiary care hospital in Kolkata involving 110 infants attending the out-patient department of Paediatrics, KPC Medical College and Hospital from January 2020, to June 2020. Urine specimens were collected using midstream clean-catch urine (CCU) method and tested by urinalysis and culture. Template was generated in MS excel sheet and analysis was done on SPSS software. Results: Urine sample was successfully obtained from 110 infants, of which 66 (60%) were males, 44 (40%) were females. UTI was maximum present in age group 61-365 days (12.73%). In gender maximum UTI was present in males (11.82%). Majority of cases present with the temperature 38.30C to 38.90C (37.27%). Fever (100%) and Failure to thrive (70.91%) were the commonest presentation of cases selected for the study. Gastroenteritis was the most common illness observed in 33 (30%) infants. Conclusions: Prevalence rates of UTI varied by age, gender, race, and circumcision status. Prevalence estimates can help clinicians make informed decisions regarding diagnostic testing in children presenting with signs and symptoms of urinary tract infection.</p> Rajat Kumar Das Malipeddi Lakshmi Nachiketa Ghosh Debdutta Haldar Soumi Kundu Copyright (c) 2021 Rajat Kumar Das, Malipeddi Lakshmi, Nachiketa Ghosh, Debdutta Haldar, Soumi Kundu http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 297 301 A study of effect of high intensity statins (Atorvastatin 80 mg and Rosuvastatin 40 mg) in age group of 35 to 75 years on liver function and muscle enzymes https://www.ijhcr.com/index.php/ijhcr/article/view/3269 <p>Introduction: Researches done on the use of statins during the last two decades have shown conflicting results in their effects on DM, Cardiac, liver and Kidney functions. Six forms of statins are being prescribed as a preventive measure to reduce the incidence of cardiovascular morbidity and mortality; but statin use have also shown alternations in DM, liver and Kidney function. The latest observations relates to cancer prevention/induction. Statins prescriptions are done mostly for elderly patients in order to reduce lipid profile mostly Total cholesterol and LDL levels. Studies have shown that statins use affects muscular function, induce prediabetes, and alter liver enzymes and affects mitochondrial functions. Among the statins used, atorvastatin was found to be very beneficial with minimal side effects with greater beneficial function in maintaining other organ functions. Materials and methods: Total 50 patients were taken for this prospective, observational, cross-sectional hospital based study, conducted at Both rural and urban catchment area of N.R.S Medical College and Hospital, West Bengal from January 2016 to June 2017. The case records were studied, analysed and compared using SPSS (20.0) Results: The study reveals out of total 50 patients, 34 (68%) were male and 16 (32%) patients were female in the age group of 35 to 75 years. There were no abnormal changes (rise) in SGOT and SGPT level in 3 months. At the end of 6 months, overall increase of SGPT was seen in 3 patients (6%) of which out of 20 patients who had taken Rosuvastatin, 1 patient (5%) had SGPT (129mg/dl) and in Atorvastatin cases 2 patients (6.7%) had SGPT(134mg/dl) and 143mg/dl.). After 6 months of study in both Rosuvastatin and Atorvastatin abnormal values of CPK were seen. Conclusions: Both the statins had a good safety profile with few adverse effects. This study showed that the Rosuvastatin is more cost effective compared to Atorvastatin. For future research the study should be done in a large sample and for long duration of period as a multicentre study.</p> Santa Barman Bapilal Bala Apu Adhikary Copyright (c) 2021 Santa Barman, Bapilal Bala, Apu Adhikary http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 302 309 To study pattern and prevalence of cardiovascular Morbidity intradialytic hypotension patients https://www.ijhcr.com/index.php/ijhcr/article/view/3272 <p>Background &amp; Method: This Study was conducted at Department of General Medicine, NSCB Medical College and Hospital, Jabalpur (MP) on patients coming for dialysis with chronic renal failure from all over mahakaushal area of central India with an aim to study pattern and prevalence of cardiovascular Morbidity intradialytic hypertensive patients. Result: Mean Post-dialytic systolic Blood Pressure for hypertensive group was 145.88 ± 22.06 mmHg which was significantly (p&lt;0.001) higher than mean Post- dialytic systolic Blood Pressure 139.41 ± 20.74 mmHg of Hypotensive group. Mean Post-dialytic systolic Blood Pressure for Normotensive group was 139.41 ± 21.38 mmHg which was comparable (p&gt;0.05) to mean Post-dialytic systolic Blood Pressure 139.41 ± 20.74 mmHg of Hypotensive group. Mean Post-dialytic systolic blood pressure for Hypotensive group was 145.88 ± 22.06 mmHg which was Significantly (p&lt;0.05) higher than mean Post- dialytic systolic Blood Pressure 139.41 ± 20.74 mmHg of Normotensive group. Mean Post-dialytic diastolic Blood Pressure of Hypertensive group, Normotensive group and Hypotensive group was comparable (p&gt;0.05). Mean of average intradialytic variability for systolic blood pressure at each point of measurement was higher for Normotensive group and lower for Hypotensive group but comparable in all three study groups (p&gt;0.05). Mean of average intradialytic variability for diastolic at each point of measurement was higher for Hypotensive group and lower for Normotensive group but comparable in all three study groups (p&gt;0.05). Conclusion: As far as morbidity in terms of abnormal 2D ECHO findings is concerned Hypotensive group of patients showed the significantly greater number of abnormalities among three groups. Although both Hypertensive and Hypotensive group had more abnormalities in 2D ECHO compared to the Normotensive group. The left ventricular hypertrophy, Pericardial effusion and signs of Pulmonary hypertension were in significantly higher in Hypertensive group. While Aortic regurgitation, Diastolic dysfunction and Tricuspid valve regurgitations were observed in significantly higher proportion in both Hypertensive and Hypotensive groups compared to the Normotensive. Overall death rate was 12.07% in our study which was significantly higher in Hypotensive group of patients. Although the most common cause of death was infection and cardiac causes accounted for second most common cause, vascular deaths were in significantly higher proportion among Hypotensive group of patients where causes for cardiopulmonary arrest were High ventricular rate, Myocardia ischemia, sudden cardiac arrest, Ventricular fibrillation, and ischemic cerebrovascular accident following Atrial fibrillation respectively.</p> A.K. Pathak Praveen Waskel Copyright (c) 2021 A.K. Pathak, Praveen Waskel http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 310 312 Comparative evaluation of perineural dexamethasone withropivacaine and dexamothasone alone in thoracic paravertebral block for postoperative analgesia in elective thoracotomy: A randomized, double-blind, placebo-controlled trial https://www.ijhcr.com/index.php/ijhcr/article/view/3273 <p>Background: Thoracotomy operations generally painful, and poor pain control during the perioperative period can lead to postoperative problems such pneumonia, atelectasis, or respiratory failure. Furthermore, chronic postthoracotomy pain (CPTP), which lasts at least two months following thoracotomy, affects 30%–50% of patients, lowering their quality of life significantly.Because single-dose local anesthetics offer pain reliefof limited duration, adjuvants have been used to provide pro-long analgesia for peripheral nerve block because single-dose local anaesthetics provide only short-term pain relief. Aim: The goal of this study was to see if perineural dexamethasone combined with ropivacaine was effective in treating thoracic paravertebral block (TPVB) in patients undergoing elective thoracotomy. Patients and methods: In this study, 108 patients undergoing thoracotomy were randomised to one of three groups for TPVB adjuvant therapy: group S (saline), group R (0.5 percent ropivacaine), or group RD (0.5 percent ropivacaine) (5 mg dexamethasone and 0.5 percent ropivacaine). Analgesia after surgery, recuperation time, and chronic discomfort were all recorded. Results: In comparison to group S, groups R and RD spent less time in the postanaesthesia care unit, were out of bed earlier, and had shorter postoperative hospital stays. When compared to group S, the RD group regained consciousness sooner, had lower acute pain scores, and utilised less patient-controlled analgesia during the first 72 hours after surgery. 3 months postoperatively, group RD (19.0 percent) had less postthoracotomy pain than group S (47.6 percent), p ≤0.050. Conclusion: With an opioid-based anaesthetic regimen, perineural dexamethasone with ropivacaine for TPVB enhances postoperative analgesia quality, lowers recovery time, and may minimize the incidence of chronic pain after thoracotomy.</p> Hirday Kumar Aditya Prakash Pankaj Kumar Copyright (c) 2021 Hirday Kumar, Aditya Prakash, Pankaj Kumar http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 313 318 Esophageal Duplication Cyst, An Unusual Cause Of Recurrent Chest Infections & Stridor, Missed As Mimicking Thymic Shadow On Chest Radiographs https://www.ijhcr.com/index.php/ijhcr/article/view/3274 <p>Introduction – A chylolymphatic cyst is a rare variant of a mesenteric cyst. These cysts present within the mesentry, lined with thin endothelium or mesothelium and filled with chylous &amp; lymphatic fluid. Although often asymptomoatic, patient may present as vague abdominal pain, with or without palpable mass. Ultrasonography and CT may suggest the diagnosis but histopathological examination is required for confirmation after surgical excision. A chylolymphatic cyst should be considered in one of the differentials of the cystic lesion of abdomen with fat-fluid level, same as mesenteric cystic teratoma. Aim- We reported this case, as chylolymphatic mesenteric cysts are extremely rare &amp; very little information is available regarding their presentation, differentials &amp; complications. Case Report- We reported a case of 22 years old woman, admitted with occasional abdominal pain for 4- 5 years, aggravated since 6 months. She was evaluated with an ultrasound and subsequently CT scan of the abdomen was done.USG revealed a hypoechoic lesion measuring 10x10 cm in left upper abdomen, separated from the tail of pancreas. CT was planned, showed a well defined rounded hypodense cystic mass with fluid attenuation &amp; fat-fluid level. On contrast examination, it showed only wall enhancement. As taking into consideration of characteristic fat- fluid level, presumptive diagnosis of mesenteric cystic teratoma was given. The patient got operated. On histopathological examination, it showed milky white fluid, cyst wall lined with endothelium with lymphoid follicles &amp; foam cells. All these findings confirmed the diagnosis of chylolymphatic cyst. Discussion – Mesentric cyst represent a rare pathologic entity. Their existence was first reported in 1507 by Bennevieni. It may occur anywhere in the mesentry of GIT , but most commonly in the mesentry of the small intestine. Among these uncommon cystic lesions of the mesentry, chylolymphatic cyst is extremely rare sub classification of mesenteric cyst, specially of lymphatic origin. It constitute 7.3% to 9.5% of all abdominal cysts. They were first described by Rokitansky in 1842. These cysts may be asympomatic and may cause vague abdominal pain, lump or abdominal distention or It may present with complications. Chylolymphatic cysts, as name suggests, contain both chyle &amp; lymph. Abdominal USG is initial investigation of choice. CT/MRI may additionally demonstrate the fluid attenuation of the lesion. Some authors have described the characteristic appearance of fluid level of differing echodensities, i.e. an upper fatty echodensity of chyle, on top of the water echodensity of lymph in a well defined cystic lesion. Although imaging findings may suggest the diagnosis but It will be confirmed only on histopathological examination after surgical exploration. Conclusion- Although very rare, chylolymphatic cyst should be kept in mind as one of the differential diagnosis of cystic masses of the abdomen with fat-fluid level. The definitive diagnosis of chylolymphatic cyst is only confirmed after histopathology. Complete surgical excision of the cyst ensures excellent prognosis.</p> Shilpi Srivastava Subhash C. Sylonia Abhay Singhal Copyright (c) 2021 Shilpi Srivastava, Subhash C. Sylonia, Abhay Singhal http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 319 322 Comparative evaluation of homocysteine levels in the serum of normal pregnant females and females with preeclampsia https://www.ijhcr.com/index.php/ijhcr/article/view/3275 <p>Background: Levels of homocysteine are normally decreased during pregnancy. However, increased levels are associated with complications like preeclampsia and other fetal defects. Owing to the continuous association of elevated homocysteine levels in females with preeclampsia, it can be used as a potential biomarker in preeclampsia. Aims: The present study was carried out to compare and assess the levels of homocysteine in females with preeclampsia and normotensive females. The present study also attempted to correlate levels of homocysteine with preeclampsia severity. Materials and Methods: 40 multigravida and primigravida females divided into two groups controls were normal pregnant females and cases were pregnant females having preeclampsia. Following clinical examination, laboratory investigations carried out in both groups were serum homocysteine levels, hemogram, blood grouping, routine urine examination, Rh factors, Hepatitis B, and HIV, whereas, for cases, fundoscopy, liver function tests, kidney function tests, and coagulation profiles were assessed. The collected data were subjected to statistical evaluation and the results were formulated. Results: In controls 100% (n=20) subjects had normal values, whereas, in preeclampsia cases 20% (n=4) had normal values and 80% (n=16) had raised homocysteine levels. The mean values respectively in cases were significantly higher (19.93±11.40) compared to controls (8.0±2.28) with (p&lt;0.001). Based on preeclampsia severity, in subjects with mild preeclampsia, 15% (n=3) had normal homocysteine values and 45% (n=9) had raised values, whereas in severe preeclampsia, 5% (n=1) had normal values and 55% (n=11) had raised values. Conclusion: The present study concludes that serum homocysteine levels are significantly higher in pregnant females with preeclampsia compared to normal pregnant females and high homocysteine levels are directly related to preeclampsia severity.</p> M. Divya Lakshmi Irrinki Copyright (c) 2021 M. Divya, Lakshmi Irrinki http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 323 326 To test the accuracy of a new anthropometric parameter, Waist to BSA ratio in predicting myocardial infarction https://www.ijhcr.com/index.php/ijhcr/article/view/3276 <p>Background &amp;Method: Present study was carried out with an aim to test the accuracy of a new anthropometric parameter, Waist to BSA ratio in predicting myocardial infarction, Patients with acute coronary syndrome having ST segment elevation or non-ST segment elevation myocardial infarction diagnosed by ECG and Troponin I levels, admitted in ICCU of GMC, BHOPAL. Result: Waist to hip ratio, waist to height ratio, waist to BSA ratio and waist circumference, all were better anthropometric parameters than BMI to predict myocardial infarction in Indian population. Conclusion: Waist to hip ratio, waist to height ratio, waist to BSA ratio and waist circumference, all were better anthropometric parameters than BMI to predict myocardial infarction in Indian population. Waist to BSA was a good anthropometric parameter to predict myocardial infarction in Indian population. Studies involving larger population are required to prove the accuracy of this parameter in predicting coronary artery diseases.</p> Vivek Chaurasia Raghvendra Shridhar Copyright (c) 2021 Vivek Chaurasia, Raghvendra Shridhar http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 327 328 Qualitative approach to identify the challenges faced and the strategies to overcome during online teaching for medical undergraduates during Covid 19 Pandemic https://www.ijhcr.com/index.php/ijhcr/article/view/3277 <p>Introduction&amp; Aim: To identify challenges faced by the students and faculty and the solutions to overcome them on online teaching learning method during lockdown. Methods: A descriptive qualitative study of 6 months duration was conducted among the medical faculty and students. Non-probability purposive sampling was employed in the study. Free listing was done initially to elicit the views of faculty and students to meet the intended objectives. Visual Anthropac software was used to identify the salient variables using Smith’s Salience Score (free listing), and then pile sorting was done to identify the association between the salient variables. Results: Ten members participated in the free listing and pile sorting. A total of 42 responses were obtained pertaining to the challenges during online teaching, of which 25 were identified as the salient variables depending on the cut-off value of 0.125 (Smith’s Salience Score) and subjected to pile sorting. Similarly, 25 challenges were identified for the solutions to over come the challenges in implementation of the online teaching programme during the free listing, and all were included in the second stage of pile sorting. Cognitive maps were drawn to understand the relationship between the involved challenges and the solutions to overcome them separately. Conclusion: Online education changes all components of teaching and learning in higher education. Three major categories of findings were identified: issues related to online learners, instructors, and content development. Learners’ issues included learners’ expectations, readiness, identity, and participation in online courses. Instructors’ issues included changing faculty roles, transitioning from face-to-face to online, time management, and teaching styles. Content issues included the role of instructors in content development, integration of multimedia in content, role of instructional strategies in content development, and considerations for content development. To address these challenges in online education, higher education institutions need to provide professional development for instructors, trainings for learners, and technical support for content development. Keywords distance education and telelearning, teaching or learning strategies, postsecondary education, pedagogical issues, human–computer interface.</p> Suhasini Padugupati K.P Joshi Copyright (c) 2021 Suhasini Padugupati, K.P Joshi http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 329 334 Role of ultrasound in the first trimester bleeding https://www.ijhcr.com/index.php/ijhcr/article/view/3278 <p>Aim: The study aims to evaluate the role of Ultrasound in assessing patients with the first trimester bleeding and prognosticate and predict the status of abnormal pregnancies. Methods: Fifty cases of first-trimester Vaginal bleeding were evaluated by Ultrasonography. Clinical diagnosis and ultrasound diagnosis were correlated. Results: Among these 50 cases, 26 cases were diagnosed as threatened Abortion clinically, out of which Ultrasonography confirmed only 12 cases. Ultrasound examination confirmed 12 cases of clinically suspected threatened abortions and aids in correctly diagnosing 8 cases that were missed on clinical examination. 12 cases out of 18 threatened abortions continue to term gestation with a successful outcome of 66%. All cases of threatened abortion (n=18), incomplete abortion (n=10), missed abortion (n=4), ectopic (n=4), inevitable abortion (n=4), blighted ovum (n=2), and HM (n=2), were correctly diagnosed on USG. Forty-eight out of 50 cases were correctly diagnosed on Ultrasound compared to 18 out of 50 cases based on clinical diagnosis with a disparity of 64%. Four out of five proved ectopic pregnancies were correctly diagnosed both on Ultrasound and clinical examination. Conclusion: Ultrasound examination is a non-invasive tool in the differentiation of causes of first trimester vaginal bleeding; it helps correct diagnosis of clinically misdiagnosed cases apart from confirming the diagnosis in others. When Ultrasonography reveals the nature of the pregnancy (viable/nonviable), unnecessary complications and misdiagnosis at first trimester bleeding can be avoided. Unnecessary hormonal treatment and prolonged hospitalization can be avoided.</p> Srujana Pilli Bhavani Bangaru Shaik Ameenulla Hafeezuddin Copyright (c) 2021 Srujana Pilli, Bhavani Bangaru, Shaik Ameenulla Hafeezuddin http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 335 340 The correlation of Ki-67 (MIB-1) proliferation index and progesterone receptor status with histological grade of meningioma: An observational study https://www.ijhcr.com/index.php/ijhcr/article/view/3280 <p>Context: Five year rate for recurrence of symptoms regardless of method of treatment is 19.2% for benign tumors and 32.4% for malignant tumors. Behavior of meningiomas depends upon its histological type, grade, proliferation markers and PR status. Aims: To correlate the WHO grade, PR status and Ki-67 labeling index of meningiomas to correlate with other histologic and demographic parameters of prognostic significance. Material and methods: A total of 120 cases were taken over a period of 2 years. Routine H&amp;E stain sections used for histological typing and grade of meningioma. Immunohistochemistry done for Ki-67 and Progestrone receptor using immunoperoxidase method. The various grades of meningiomas than correlated with Ki-67 labeling index and PR status and appropriate statistical calculations done. Results: The peak age distribution is between 31 to 50 years with mean age of 49.45 years, male to female ratio being 1:2.3. Maximum cases were of grade I (88.33%) followed by grade II(6.66%) and grade III(5%). There was no significant difference between mean age of different grades (p&gt;0.05). The difference between mean Ki-67 labeling index between grade I and II, grade II and III and grade I and III all were significant (p&lt;0.0001). The PR status difference between grade I and II tumor was significant (p=0.0007), however between grade II and III could not be calculated as none of these tumor showed PR positivity. The Pearson correlation coefficient between PR status with Ki67 labeling index came out to be -1.0, that shows highly significant negative correlation. Conclusion: This study shows an inverse correlation between WHO 2016 grades of meningioma and PR status while shows a linear relation with Ki-67 labeling index.</p> Laxmi Aheer A R Kalla Savita Bansal Pawan Kumar Kishore Khatri Copyright (c) 2021 Laxmi Aheer, A R Kalla, Savita Bansal, Pawan Kumar, Kishore Khatri http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 341 344 Health Care Associated COVID-19 Infections, infection prevention and hospital epidemiology amongst COVID-19 infected health care personnel in a 1000 bedded tertiary care hospital in Northern India https://www.ijhcr.com/index.php/ijhcr/article/view/3281 <p>Background: Health Care Workers (HCWs) of all levels and groups are involved in caring for patients and evidence indicates that they are particularly at risk of acquiring Severe Acute Respiratory Syndrome Coronavirus2 (SARS-CoV-2) infection, due to repeated occupational exposure. Methodology: This retrospective cross sectional study was conducted in Government Medical College (GMC), Jammu. Data was collected in a pre-structured questionnaire. Results: Prevalence in HCWs was 21.5% and mortality being 0.3%. 82% were symptomatic. Fatigue was the commonest symptom observed. 290(68%) were doctors and 140(32%) were paramedical staff. Conclusion: This data on prevalence of infection in HCWs can help to plan policies on how to prevent our HCWs and how to use this overstrained health resource in the present difficult times.</p> Sharma P Perika Tomar R Sudhan S Khan I Copyright (c) 2021 Sharma P, Perika, Tomar R, Sudhan S, Khan I http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 345 347 Assessment of level of satisfaction and depression among front-line warriors serving in a red zone covid-19 hospital in central India https://www.ijhcr.com/index.php/ijhcr/article/view/3283 <p>Background: Covid -19 is a global health crisis of this century. Our battle against covid 19 is based mainly on front-line warriors. Their job profile has placed frontline workers under immense and unprecedented pressure, putting their mental well-being at stake. They are working in resource limited conditions. Mental stress and unsatisfaction is expected among them. It should be effectively recognised and handled. Methods: Cross sectional study was conducted in a covid care center of a teaching hospital to assess the level of satisfaction and presence of depression among front line warriors. Google form was use to collect data. Results: Approximately 87%, 79%, 61%,100% &amp; 86% participants were not satisfied by PPE, stay, food, wadges, security and financial security respectively provided them while performing covid duties. Half of them (50%) had depression. Statistically significant association was found between presence of depression and age, sex, residence, marital status, family type. Conclusion: Depression and unsatisfaction was prevalent finding among front line warriors. Inappropriate response and attitude towards them will bring fatigue and refectory attitude among them. Their needs and unsatisfaction should be delt while policy making.</p> Rashmi Bhujade Anil Singh Baghel V.K.Arora Copyright (c) 2021 Rashmi Bhujade, Anil Singh Baghel, V.K.Arora http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 348 351 Study of Intestinal Obstruction due to Tuberculosis https://www.ijhcr.com/index.php/ijhcr/article/view/3284 <p>Background: Tuberculosis has been declared a global emergency by the World Health Organization (WHO) and is the most important communicable disease worldwide The disease may involve any system of the body but abdomen is one of the commonest sites of involvement after lungs. Though potentially curable, abdominal tuberculosis continues to be a major cause of morbidity and mortality. Study Design: The study design is of case series. Aim of the Study: To observe the incidence of Tuberculosis among all the cases presenting to the acute surgical care, Osmania General Hospital as intestinal obstruction, various modes of management and outcome among these cases. Results: This study was conducted at upgraded department of general surgery, Osmania medical college / general hospital, Hyderabad, Telangana. A retrospective study of 41 patients presenting to the acute surgical care unit of the upgraded department of General Surgery of Osmania General Hospital, Hyderabad, with Intestinal Obstruction due to Tuberculosis, from November 2015 to October 2018. In patients prese.nting with intestinal obstruction of T.B origin most common presenting complaint is pain abdomen of 3-4 weeks duration at the time of presentation. Among 41 patients, 31 patients were operated Among 31 patients who were operated, majority of them has mesenteric thickeness and mesenteric lymhnodal enlargement and adhesions. Among the 31 patients who underwent surgery, adhesionolysis was the most common performed procedure. Among the 10 patients with stricture, 5 of them underwent stricturolasty. Among the 6 patients with an ileo-caecal mass an ileo-transeverse bypass procedure was done in 4 of them. Conclusion: Bowel obstruction resulting from intestinal tuberculosis is one of the most common abdominal surgical emergencies and contributes significantly to high morbidity and mortality. Young age at presentation, delayed presentation and high morbidity and mortality are among the hallmarks of the disease. A high index of suspicion, proper evaluation and therapeutic trial in suspected patients is essential for an early diagnosis and timely definitive treatment, in order to decrease the morbidity and mortality associated with this disease.</p> Kiran Kumar Bollepaka G. Santhi Vardhani G Shanti Kumar Darivemula Israel Copyright (c) 2021 Kiran Kumar Bollepaka, G. Santhi Vardhani, G Shanti Kumar, Darivemula Israel http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 352 355 Comparative study of 0.5% bupivacaine with 150mg MgSO4 versus 0.5% plain bupivacaine in interscalene brachial plexus block for shoulder https://www.ijhcr.com/index.php/ijhcr/article/view/3285 <p>Objectives: Interscalene brachial plexus block for the shoulder is commonly used for forelimb and hand surgeries. A lot of research is going on to increase the duration of sensory and motor blockade by the addition of adjuvants with the local anesthetics. We evaluated the effect of adding MgSO4 to bupivacaine for Interscalene brachial plexus blockade. Our primary parameters were the onset and duration of sensory and motor block and duration of analgesia. Methods: 60 patients posted for elective forearm and hand surgeries under Interscalene brachial plexus block were divided into two equal groups (Group B and B+M) in a double-blind fashion. Results: The onset of a blockade in Group B was found to be 15.49 ± 2.38 minutes when compared to the onset time of 18.00 ± 2.80 minutes in Group B+M and this difference was found to be statistically significant (p&lt;0.001). The onset of motor blockade found in Group B was 17.75 ± 2.70minutes and Group B+M was19.84 ± 2.50 and it is found to be statistically significant with a p-value of 0.002 The duration of sensory blockade was longer in Group B+M with a duration of 621.60 ± 25.25 minutes compared to Group B having the duration of 503.36 ± 24.51minutes and this difference was found to be statistically significant (p&lt;0.001). Conclusion: We conclude that the addition of 150 mg MgSO4 to ropivacaine 0.5% bupivacaine interscalene brachial plexus block for shoulder prolongs the duration of sensory, motor blockade, and duration of analgesia but results in a slight delay in the onset time of sensory and motor blockade.</p> Ch Rodasi Kulkarni Akhila Kiran Madhala Medi NagaPadma Copyright (c) 2021 Ch Rodasi, Kulkarni Akhila, Kiran Madhala, Medi NagaPadma http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 356 360 Pattern of Wound Healing In Burn Patients Nursed On Air Fluidized Bed System: A Study of 37 Cases https://www.ijhcr.com/index.php/ijhcr/article/view/3287 <p>Background: Burn injuries are very common all over the world.Wound healing in major burns is achallenging task.Air fluidized therapy was introduced in 1960. It provides unique environment for healing of these burn wounds and is different from the support system provided by normal conventional beds.The air fluidized bed uses warm air under pressure to set small ceramic beads in motion which simulates the movement of fluid creating characteristic of fluid.This in turn evenly distributes the weight that creates a sensation of “floating”.The fluid support reduces friction, shear,pressure and mechanical stress to the burnt areas and subcutaneous tissues. Methods: The study was conducted over a period of one year from December’19 to December’20 at department of plastic surgery,Uttar Pradesh University of Medical Sciences,Safai-Etawah, INDIA.Patients with old infected burns,those with co-morbidities and with pre-existing illnesses were excluded from this study.Burns more deep than second degree are also excluded.Baseline data were also recorded at the time of admission. Results: The total number of patients included in this study were 37.The average age was 35 years.Females out numbered males.Average length of hospital stay was 17 days.Four patients did not healed adequatelyand needed split skin grafting.Few patients required hospital stay of 20 days. Conclusions: The wound healing in burn patients nursed on air fluidized bed is faster than conventional setting.It also reduces psychological trauma like post traumatic stress disorder (PTSD)as well as overall mortality.</p> Poonam Gupta Shammi Purwar Shesh Kumar Copyright (c) 2021 Poonam Gupta, Shammi Purwar, Shesh Kumar http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 361 364 Outcome analysis of retrograde nailing for surgical stabilization of distal 1/3rd fracture shaft femur: A hospital based study https://www.ijhcr.com/index.php/ijhcr/article/view/3288 <p>Background: The distal 1/3rd femoral fractures constitute 6% of all femoral fractures. These fractures pose a great challenge in management due to the involvement of soft tissue injury, intra-articular extension, and injury to the extensor mechanism. The debates on the choice of implant for distal femoral fractures are on-going among orthopedic surgeons. Retrograde approach through the femoral intercondylar notch has been popularized in the recent years as an alternative to antegrade nailing. Surgical treatment of periarticular and intra-articular fractures of the distal femur pose a significant challenge to the orthopedic surgeon. The primary goal of surgical treatment remains: restoration of the articular surface to the femoral shaft, while maintaining enough stability and alignment to enable early range of motion and rehabilitation. The aim of this study was to investigate its effectiveness in fixation of distal 1/3rd fracture of femur with special emphasis on the outcome and inherent surgical challenges. Material &amp; Methods: A prospective study of 20 patients with fracture femur diaphysial distal one third were treated by retrograde nailing, from January 2019 to December 2020, after obtaining required approval from the Institutional ethics committee. All the patients were followed till fracture union and evaluated on the basis of demography, duration of healing, complications and surgical challenges. Results: In the present study, out of 20 study subjects there were 7 patients (35%) in the age group of 31-40 yrs followed by 6 patients (30%) were in the age group of 31-40 yrs, 4 patients (20%) were in the age group of 41-50 yrs, 2 patients (10%) in the age group of 51-60 yrs with mean age of the patients was 43.6 ± 17.67 years. There were 17 patients (85%) male and 3 patients (15%) female. The mode of injury in case of majority of the patients had RTA [road traffic accidents] 11 patients (55%), followed by fall from height 5 patients (25%), sports injury 2 patients (10%) and domestic injuries 2 patients (10%). Mean time from the injury to operation was 3 days. The mean duration of the surgery was 100 mins. Majority of the patients 16 (80%) had isolated femoral fractures while others 4 patients (20%) had polytrauma. Mean time of the fracture healing was 18.5 weeks [SD ± 6.75]. In the present study we have observed that the post-operative knee range of motion (ROM) achieved; 8 patients (40%) had 125º, 4 patients (20%) had 135º, 2 patients (10%) had 140º, 2 patients (10%) had 105º, 3 patients (10%) had 110º, 1 patient (5%) had 115º, and with mean of 123.75º post-operatively. Conclusion: Retrograde nailing for surgical stabilization of distal 1/3rd fracture shaft femur is adequate treatment options for distal femur fractures. Locked plating can be used for all distal femur fractures including complex type C fractures, periprosthetic fractures, as well as osteoporotic fractures. IM nailing provides favorable stability and can be successfully implanted in bilateral or multisegmental fractures of the lower extremity as well as in extra-articular fractures. Clinical outcome largely depends on surgical technique rather than on the choice of implant.</p> Shekhareswar De Samuel Lakra Copyright (c) 2021 Shekhareswar De, Samuel Lakra http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 365 369 A study of the surgical outcome and impact on semen parameters after laparoscopic varicocelectomy and sub inguinal varicocelectomy https://www.ijhcr.com/index.php/ijhcr/article/view/3289 <p>Introduction: Varicocele is the most widely encountered and surgically reversible cause of infertility to the male component, this entity can be defined as tortuous and dilated veins of pamp iniform plexus where dilatation is the result of retrograde blood flow through the internal spermatic veins. In young adults clinical evidence of varicocele is seen in 9% to 23% as suggested in most recent studies. In infertile males, varicocele is the finding in 40% of cases. Materials and Methods: This is prospective interventional study conducted from January 2020 to December 2020 in patients attending the OPD in the Department of General Surgery, Murshidabad Medical College and Hospital, Berhampore, Murshidabad, West Bengal. All the patients attending the department of general surgery, Murshidabad Medical College and Hospital, Berhampore underwent history elicitation, clinical examination, semen analysis (as per WHO manual 2010). Patients with abnormal semen parameters and clinical varicocele were selected. Doppler study of the scrotum (presence of varicocele graded using Sarteschi scale) was done for these patients. The patients fulfilling the selection criteria were counselled for varicocelectomy and consent for the study obtained. The patients were randomized into Group A (laparoscopic varicocelectomy) and Group B (sub-inguinal varicocelectomy) by random allocation method. Results: 50 patients were included in the study after they fulfilled the inclusion and exclusion criteria. The demographic parameters of the patients in both the arms were similar. Most of the patients belonged to age group 31-35 years followed by 26-30 years. There was no significant difference in both the arms when the grading of varicocele was compared both by clinical and by doppler examinations. Conclusion: Varicocelectomy improves the semen parameters. No significant variation was observed when the different surgical approaches of varicocelectomy were compared.</p> Shobhik Chakraborty Sridip Saha Debabrata Ray Debangshu Bhanja Choudhury Copyright (c) 2021 Shobhik Chakraborty, Sridip Saha, Debabrata Ray, Debangshu Bhanja Choudhury http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 370 373 Sensitivity and Specificity of Pleural Fluid Adenosine Deaminase (ADA) and Pleural Fluid Lymphocyte/Neutrophil Ratio in the Diagnosis of Tubercular Pleural Effusion https://www.ijhcr.com/index.php/ijhcr/article/view/3290 <p>Background: Pleural effusion is one of the most prevalent extrapulmonary manifestations of tuberculosis. The conventional culture method of diagnosis suffers from sensitivity. Hence, the current research was commenced with the primary aim to suggest a better diagnostic of pleural effusion of tubercular origin by assessing adenosine deaminase ADA activity in combination with lymphocyte/neutrophil (L/N) ratio than with ADA use alone. Settings and Design: Data from 60 pleural effusion study subjects were gathered using a pretested proforma, fulfilling the study objectives. Materials and Methods: A physical examination, detailed history and needed inspections were made. The diagnosis of tubercular pleural effusion was done based on the identification of bacilli in pleural fluid or culture of the fluid or radiological &amp; clinical tuberculosis evidence and absenteeism of any other obvious cause related to pleural effusion &amp; those who showed a positive response to antitubercular treatment. ADA was estimated for all exudative pleural fluid specimens. The specificity, sensitivity, PPV (positive predictive value) and NPV (negative predictive value) were determined to distinguish among non-tubercular and tubercular pleural effusion. Statistical analysis used: Investigations were analyzed with the clinical profile, and the data were compiled, and the appropriate statistical analysis was performed with the use of SPSS software. Results: The majority of study subjects, i.e., 26.70%, belonged to 21-30 years of age group with male predominance (51.70%) compared to females (48.30%). In 26.7% of study subjects, plural culture tested positive for mycobacterial growth. Whereas 70.0% of study subjects were diagnosed based on positive for pleural biopsy at the 50 U/L ADA level, the specificity, sensitivity, NPV, PPV and efficacy for TB identification were computed at 89.8%, 81.8%, 95.6%, 64.3%, and 88.3% correspondingly. When the added requirement of an L/N ratio of 0.75 or greater was comprised, specificity, the sensitivity, NPV, PPV and efficacy for the TB identification were computed at 95.7%, 86.9%, 93.7%, 83.3%, and 91.7%, respectively. Conclusion: It was demonstrated through this study that pleural fluid adenosine deaminase in combination with the L/N ratio has remained a valuable test in tuberculous pleuritis diagnosis.</p> Yogesh B Kamshette Nagabhushan.B Anusha G N Copyright (c) 2021 Yogesh B Kamshette, Nagabhushan.B, Anusha G N http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 374 379 Evaluation of Hand function in patients of Cerebral Palsy: A prospective study from North India https://www.ijhcr.com/index.php/ijhcr/article/view/3291 <p>Introduction: It has been shown that 10% of the global population suffers from some sort of disability due to various reasons; in India, this figure is 3.8 percent of the population. Cerebral Palsy affects approximately 15-20% of physically challenged children. In India, the incidence is estimated to be around 3/1000 live births. The most prevalent motor disability in children is cerebral palsy. Monoplegia, hemiplegia, diplegia, and quadriplegia are the topographic classifications for CP; monoplegia and triplegia are relatively uncommon. Diplegia is the most prevalent type, accounting for 30 percent to 40 percent of all cases. The most prevalent type of CP is spastic CP, which accounts for 70 percent to 75 percent of all cases. Cerebral palsy affects hand function, however it has been studied very rarely and there is very little data on hand function in different types of cerebral palsy. Objectives: To describe characteristics of hand function in cerebral palsy children. Methods: This prospective study was conducted on 100 children of cerebral palsy who came to the department of Physical Medicine and Rehabilitation, Government medical college patiala from Aug 2021 to Oct 2021. Upper extremity data were collected from the 100 children of cerebral palsy. Hand function was classified according to the Manual Ability Classification System(MACS) and House functional classification system. Results: In the overall group of Cerebral Palsy children aged &gt;5 to &lt;14 years, 81 percent reported more than modest hand function deficits (&gt;MACS 1). We discovered that 23% of children with MACS 5 had substantial limitations in hand function. Only 19% of children were classed as MACS1 because they were unable to handle objects effortlessly and successfully. According to the house functional classification, 46 percent of children (house 7-8) used both hands spontaneously and independently, while 7 percent did not use either hand (House 0) Conclusion: Hand function deficits are evident in all types of CP, however the characteristics of the disability differ greatly. The MACS classification can be used to determine how well children handle situations in everyday life. The grip function in each hand is depicted separately in the House functional classification. Although additional research into the psychometric aspects of these classifications is needed, they have all been demonstrated to be effective in a population-based health-care strategy.</p> Ashish Kavia Hari Om Aggarwal Girish Sahni Mahesh Goyal Copyright (c) 2021 Ashish Kavia, Hari Om Aggarwal, Girish Sahni, Mahesh Goyal http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 380 383 Anesthetic management of trachea esophageal fistula posted for thoracotomy and gastrostomy https://www.ijhcr.com/index.php/ijhcr/article/view/3293 <p>Tracheoesophageal fistula and oesophageal atresia are a surgical emergency, presenting during first week of extrauterine life they are usually associated with other congenital anomalies. They are usually complicated due to aspiration of gastric contents leading to pneumonia and respiratory distress. Ligation of fistula and reconstructive anastomosis of the ends of oesophagus is mainstay of treatment. Anaesthesia and skill of anaesthesiologist during pre, intra and post operative periods plays the key role in successful treatment and survival of neonate.</p> B Anusha P. Rajeshwar Chokkalla Anusha B.Manaswini Copyright (c) 2021 B Anusha, P. Rajeshwar, Chokkalla Anusha, B.Manaswini http://creativecommons.org/licenses/by/4.0 2021-11-22 2021-11-22 4 20 384 385 A randomized controlled clinical trial to compare intraoperative hemodynamics and postoperative nausea and vomiting in Middle Ear Surgeries with Sevoflurane and Desflurane https://www.ijhcr.com/index.php/ijhcr/article/view/3294 <p>Introduction: Ideal anaesthetic technique for middle ear surgeries is one which maintains hemodynamic stability , optimizes surgical field , minimizes coughing on emergence from anaesthesia and avoids postoperative nausea and vomiting. Aim of the study: To compare Hemodynamics (Heart rate , Systolic blood pressure , Diastolic blood pressure) and postoperative nausea and vomiting (PONV)in middle ear surgeries done under general anesthesia with Sevoflurane and Desflurane. Materials and Methods: After institutional ethics approval thestudy was conducted at Govt. ENT Hospital, Koti, Hyderabad ,Telangana state during 2016-2018. Study included patients in age group 12-60 years belonging to ASA I,II of both genders scheduled for elective middle ear surgeries under general anaesthesia, randomly divided into two equal groups-Group S (n-30) ,Group D(n-30) based on inhalation anaesthetic used. Intraoperatively hemodynamics were recorded at predetermined intervals, after extubation and recovery, postoperatively patients were transferred to post anesthesia care unit and incidence of ponv within first 23hrs were recorded. Results: Intraoperatively hemodynamics mean values between two groups were as Group S - Systolic, Diastolic blood pressure -118.85±9.72 and 77.01±6.93 (p value 0.481) , Group D - Systolic, Diastolic blood pressure-119.16±10.80 and 77.02±6.84 (p value 0.485) respectively, mean heart rates in Group S-86.00±12.09,Group D-84.75±11.50 (p value 0.337), incidence of ponv in Group S (23.33%) and Group D (26.66%). Intraoperative hemodynamics and incidence of postoperative nausea and vomiting between study groups were comparable and statistically insignificant. Conclusion: Sevoflurane and Desflurane showed no significant difference in intra operative hemodynamics and incidence of postoperative nausea and vomiting when used for anesthesia maintenance in middle ear surgeries.</p> P. Indira R.Siddharth T.P.Dayal Singh Rajola Raghu Copyright (c) 2021 P. Indira, R.Siddharth, T.P.Dayal Singh, Rajola Raghu http://creativecommons.org/licenses/by/4.0 2021-11-22 2021-11-22 4 20 386 389 Knowledge, attitude and practice related to diabetes mellitus among general public https://www.ijhcr.com/index.php/ijhcr/article/view/3295 <p>Background: Type 2 Diabetes Mellitus is a severe problem, which results in premature death and is a global epidemic. It can be prevented by changing the attitude, practices and bringing awareness towards the disease in the population. Aim: This study was conducted to evaluate knowledge, attitude and practice related to diabetes among general public in India. Materials and Methods: This study is a cross-sectional study and was carried out in health center in Telangana during the period 30 th March 2019 to 31 st March 2020. The sample size was 100. By convenience sampling from the outpatient department of the health centre, 100 patients were selected after considering inclusion and exclusion criteria. Results: 100 patients were involved in the study who were outpatients attending the health centre. 45% of patients were 18-35 years old, and 55% of patients were 36-65 years old. 58% were males, and 42% were females. 87% were aware of the organs which get damaged due to diabetes. 55% of patients were aware that the heart is affected, 85% of patients were aware that the kidney was affected, and 40% were aware that brain was affected by diabetes. Patients were aware of risk factors for diabetes mellitus namely obesity (70%), decreased physical activity (80%), family history of diabetes mellitus (65%), mental stress (62%) and consumption of sweets (93%) were aware was the causes of Diabetes mellitus. All patients were aware that diet control would keep blood sugar under normal levels. Conclusion: It is essential for health organisations to create more awareness through programs among the people towards T2DM as the high knowledge was not aligning with the attitude and practice towards the disease.</p> Movva Thrinatha Sai Bharghav T Rahul Reddy Sindhu Kondaveeti Sangam Anurag Reddy Nakkala Supraja Copyright (c) 2021 Movva Thrinatha Sai Bharghav, T Rahul Reddy, Sindhu Kondaveeti, Sangam Anurag Reddy, Nakkala Supraja http://creativecommons.org/licenses/by/4.0 2021-11-22 2021-11-22 4 20 390 393 A prospective randomized comparative clinical study to compare efficacy of Dexmedetomidine and Fentanyl to attenuate the pressor response to pneumoperitoneum during Laparascopic Surgeries https://www.ijhcr.com/index.php/ijhcr/article/view/3296 <p>Background: Laparoscopy has evolved over years from a invasive diagnostic tool to a cost effective therapeutic procedure .The induction of pneumoperitoneum triggers sympathetic stress responses and effective attenuation of pressor responses is essential to decrease surgery related perioperative morbidity and mortality. Aim of the study: To compare dexmedetomidine and fentanyl for attenuation of pressor response to pneumoperitoneum in patients undergoing elective laparoscopic surgeries. Materials and Methods: A prospective randomized comparative clinical study was conducted at Osmania General Hospital during 2017 -2020. Institutional Ethics Committee approved study protocol in which 60 patients of either gender in age group of 18 to 60yrs of ASA grade I , II physical status were included and divided into group D (Dexmedetomidine) (n-30) , group F (Fentanyl) ( n-30) to compare effect of dexmedetomidine and fentanyl on hemodynamic responses to pneumoperitoneum in patients scheduled for elective laparoscopic surgeries under general anaesthesia .Intraoperatively systolic and diastolic blood pressure , heart rate were recorded at predetermined time intervals and recored for statistical analysis. Results: Intraoperatively Systolic ,Diastolic blood pressure , Mean arterial pressure and Heart rate at 15min after induction of pneumoperitoneum in Group D -123.70±7.16 , 80.2±6.69, 94.68±5.28 , 71± 4.72 and Group F-133±6.81 , 85.00±4.8 , 101.42±3.73,86±4.2 respectively, the difference in SBP,DBP,HR between both groups was statistically significant p value 0.0001 and the difference were also statistically significant during intubation and extubation with ‘p’ values 0.0023 , 0.0001. Conclusion: Dexmedetomidine effectively attenuates stress response to pneumoperitoneum provides better intraoperative hemodynamic stability in laparoscopic surgeries when compared to Fentanyl.</p> V. Trinath Bharadwaj Rajola Raghu A. Anuradha P.Indira Copyright (c) 2021 V. Trinath Bharadwaj, Rajola Raghu, A. Anuradha, P.Indira http://creativecommons.org/licenses/by/4.0 2021-11-20 2021-11-20 4 20 394 398 Analysis of Inguinal Herniorrhaphy with Mesh in Classic and Preperitoneal Method: An Institutional Based Study https://www.ijhcr.com/index.php/ijhcr/article/view/3301 <p>Background: Most hernias occur when part of the bowel or peritoneum pushes through a gap in the abdominal wall. The peritoneum is the membrane that lines the abdominal cavity and (completely or partly) encloses most of the organs in the abdomen. Hence; the present study was conducted for evaluating and comparing the results of inguinal herniorrhaphy with mesh in classic and preperitoneal method. Materials and Methods: A total of 40 patients scheduled to undergo. Complete demographic and clinical details of all the patients were obtained. All the patients were broadly divided into two study groups as follows: Group A: Classic method and Classic. Surgery was scheduled and preoperative biochemical and haematological profile was evaluated. All the patients were recorded and analysed by SPSS software. Results: In the present study, mean age of the patients of the classic group and preperitoneal group was 29.5 years and 30.2 years respectively. Recurrence was seen in 5 patients of the classic group and 1 patient of the preperitoneal group. Paine after surgery was seen in 7 patients of group Preperitoneal. Postoperative seroma formation was seen in 4 patients of group A while it was seen in 1 patient of group B. Conclusion: Preperitoneal method is a more suitable method for inguinal herniorrhaphy than the classic. However further studies are recommended.</p> Manoj Poptani Copyright (c) 2021 Manoj Poptani http://creativecommons.org/licenses/by/4.0 2021-11-20 2021-11-20 4 20 399 400 A Study of Variations of the Sciatic Nerve https://www.ijhcr.com/index.php/ijhcr/article/view/3302 <p>Introduction: Thickest nerve arising from sacral plexus is Sciatic Nerve which finally bifurcates to common fibular and tibial nerve in between pelvis and knee pit or popliteal fossa. These divisions of sciatic nerve shows variations which may be associated with many problems like foot drop, sciatica, sleeping foot, piriformis syndrome, etc. Objectives: To find out the differences of sciatic nerve and their relationship with associated clinical conditions and to correlate findings of our study with the already available literature regarding the same. Materials and Methods: The study material used was thirty-two formalin fixed cadavers which belonged to the Anatomy department of Maharishi Markandeshwar Medical College &amp; Hospital, Kumarhatti, Solan (H.P) and Department of Anatomy, JNUIMSRC, Jaipur (Rajasthan). This includes twenty-eight male cadavers and four female cadavers. A total of Sixty-four gluteal regions were dissected exposing the gluteus maximus muscle. Structures under the cover of Gluteus maximus were observed and recorded along with bifurcation of sciatic nerve with respect to Piriformis muscle. Results: In the present study, normal anatomy of sciatic nerve and piriformis was observed in 50 specimens (78%). Differences in bifurcation of sciatic nerve and piriformis muscle was observed in 14 specimens (22%). In our study, 78% (50 regions) belongs to category I, 12.5% (8 regions) to category I I, 3% (2 regions) belongs to category III and 1.56% (1 region) belongs to category VI as per Beaton and Anson‘s classification. In 4.6 % (3 specimens) common peroneal &amp; tibial component of sciatic nerve runs separately throughout the course after arising separately from ventral and dorsal divisions of sacral plexus. Conclusion: Discrepancies at the level of divisions of sciatic nerve are common and their proper knowledge helps in early identification and thus treating conditions like sciatic nerve entrapment or neuropathies and other clinical conditions which ultimately reduce the complications and s co morbidities.</p> Harsh Shishirkumar C Naik Harmeet Kaur Shaswati Athaiya Pooja Garg Maitree Sharma Copyright (c) 2021 Harsh, Shishirkumar C Naik, Harmeet Kaur, Shaswati Athaiya, Pooja Garg, Maitree Sharma http://creativecommons.org/licenses/by/4.0 2021-11-20 2021-11-20 4 20 401 404 Evaluate of leprosy affected nerves using high resolution ultrasonography and color doppler https://www.ijhcr.com/index.php/ijhcr/article/view/3303 <p>Introduction: Leprosy is the most common treatable peripheral nerve disorder worldwide with periods of acute neuritis leading to functional impairment of limbs, ulcer formation and stigmatizing deformities. Since the hallmarks of leprosy are nerve enlargement and inflammation, we used high-resolution sonography and color Doppler imaging to demonstrate nerve enlargement and inflammation. Aims: To evaluate leprosy affected nerves using High Resolution Ultrasonography and Color Doppler and possibility of prediction of Reactions using High Resolution Ultrasonography and Color Doppler. Materials and methods: This is a prospective study for a period of 2 years includes 30 healthy controls and 30 patients of both genders with aged between 17 to 58 years (mean 33+ /-10) with cross- sectional areas (CSAs) of the MN, UN, lateral popliteal (LP) and PT nerves. 30 leprosy patients, diagnosed as per Ridley- Jopling classification, who were in different stages of therapy with WHO multi-drug therapy, were included for evaluation. Results: 1 patient had TT, 12 patients had borderline tuberculoid, 1 had Borderline borderline, 6 patients had Border line lepromatous and 4 lepromatous leprosy, 6 Pure Neuritic leprosy. 4 had type 1 reaction and 2 patients had type 2 reactions, which was associated with neuritis. Skin smears were positive in 12 patients. Clinical thickening, ranging from grade 1 to 3, was observed in 193 nerves of the 240 examined nerves (72% ). Significant correlation was observed between clinical parameters of grade of thickening, sensory loss and muscle weakness and US abnormalities of cross- sectional areas, echotexture, endoneural flow (p, 0.001). Increased color doppler was observed in multiple nerves in 3 out of 4 patients undergoing type 1 reaction, which is considered to be localized to the dermal lesions and the neighbouring nerves. In patients with a type 2 reaction, blood flow signals in multiple nerves was seen in 2 out of 2 patients. Conclusion: The clinical and ultrasonographic changes of leprosy affected nerves is well correlated so help us to predict the possible occurrence of the reactions in thickened nerves on periodic examination.</p> Ch. Deepthi Prasad Palleboyina Vijay Sekhar D. Subhash Reddy Gopinath Mogilicherla Copyright (c) 2021 Ch. Deepthi Prasad, Palleboyina Vijay Sekhar, D. Subhash Reddy, Gopinath Mogilicherla http://creativecommons.org/licenses/by/4.0 2021-11-20 2021-11-20 4 20 405 410 Prediction of the difficulties of Laparoscopic Cholecystectomy and the possibility of conversion to Open Cholecystectomy before surgery using Ultrasonographic criteria https://www.ijhcr.com/index.php/ijhcr/article/view/3310 <p>Background: Various other pre operative ultrasonographic parameters have been studied for predicting a difficult laparoscopic cholecystectomy. One of the most extensively studied parameters is gallbladder wall thickness. Objective: to predict the difficulties of LC and the possibility of conversion to OC before surgery using ultrasonographic criteria in our hospital Materials and methods:This study was carried out in the Department of General Surgery, Govt. Royapettah Hospital, attached to Govt. Kilpauk Medical College, Chennai for a period of duration of 7 months from February 2018 to August 2018.Results: Total number of cases in our study was 98. The mean gall bladder wall thickness in our study was found to be 3.19 mm. The maximum gall bladder wall thickness was 6 mm, whereas the minimum was found to be 1.8 mm. 20 patients had a gall bladder wall thickness of &gt;4 mm. Moderate intra operative bleeding was seen in 4 patients. The remaining 94 patients only had mild bleeding. There were 20 (20.41%) patients with a duration of surgery &gt;120 minutes. There were 23 (24.21%) patients with time to dissect gall bladder bed &gt;20 minutes and 13(13.68%) patients for whom it took &gt;20 minutes to dissect Calots triangle in our study. Conclusion:Pre operative ultrasonography is a good indicator of difficulties which may be faced intra operatively by the surgeon. Increase in gall bladder wall thickness, presence of impaction of stone at the neck of the gall bladder and aberrant morphology of the gall bladder and of the Calots triangle.</p> Deepak R Dhanush C M L Shweta Goyal Ranjitha Shree CML Santosh Nayak K Copyright (c) 2021 Deepak R, Dhanush C M L, Shweta Goyal, Ranjitha Shree CML, Santosh Nayak K http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 411 416 The suprascapular notch dimensions & its correlation with scapular morphometry of human dry scapula in clinical relevance for nerve entrapment syndrome https://www.ijhcr.com/index.php/ijhcr/article/view/3311 <p>Introduction: Morphological variations of the suprascapular notch are very important clinically for possible predisposing factors for compression of the suprascapular nerve in this region. Hence its correlation with basic anthropometric measurements of human scapula is important clinically. Materials and methods: 100 dry intact scapulae (48 right &amp; 52 left) were examined for the study were taken from department of anatomy, Sapthagiri institute of medical science &amp; research centre, Bangalore. Various parameters of suprascapular notch &amp; of scapula were taken. Results: In the present study, suprascapular notch mean depth was lesser than mean superior transverse diameter of suprascapular notch, most frequent notch was type 3 &amp; least was type 5. All the Parameters of scapula were in inverse correlation with that of scapular notch measurements except for corocoid thickness &amp; glenoid index. There was a statistical significant correlation between depth of suprascapular notch with scapular width &amp; between superior transverse diameter of notch with scapular width, acromion width &amp; also with glenoid &amp; scapular index. Conclusion: The present study aimed to establish a correlation between the shape of the Suprascapular notch and other parameters of scapulae. Knowing this anatomical variations in detail along the course of the suprascapular nerve is important for a better understanding of the location and the source of the entrapment syndrome &amp; for making a proper diagnosis and planning the suitable surgical intervention during arthroscopic shoulder operations.</p> Geethanjali B.S. Shruthi JP H.Mohan Kumar Copyright (c) 2021 Geethanjali B.S., Shruthi JP, H.Mohan Kumar http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 417 424 Comparison of Vitamin D status in postmenopausal women with and without hypothyroidism https://www.ijhcr.com/index.php/ijhcr/article/view/3313 <p><strong>Background: </strong>Menopause comes with a number of health challenges for women. In its postmenopausal phase woman is not only facing the deficiency of ovarian hormones, she is also at risk of developing hypothyroidism and hypovitaminosis D. &nbsp;<strong>Objectives:</strong> The present study was therefore planned with an aim to determine and compare the mean vitamin D levels among postmenopausal women with and without hypothyroidism to evaluate if hypothyroidism in post-menopausal women affects the vitamin D levels. <strong>Material &amp; Methods:</strong> The present study was conducted in Department of Biochemistry, Dr. S. N. Medical College, Jodhpur, Rajasthan, India after obtaining the Ethical approval from the Institutional Ethics Committee. Post-menopausal women above 50 years of age attending the medical OPD with the symptoms suggestive of hypothyroidism were included. Those currently on medication for thyroid disorders and on Vitamin D supplementation for past six months were excluded. The subjects were divided into two groups based on their thyroid levels into Case group (S.TSH &gt;5.60µIU/ml) and Control group (S.TSH: 0.34-5.60 µIU/ml) <strong>Results:</strong> Mean serum Vitamin D level was significantly lower in Case Group (17.33±16.67 ng/ml) as compared to Control Group (27.55±15.82 ng/ml). More number of hypothyroid subjects were Vitamin D deficient (Case Group-36%) as compared to Control Group (12%). Pearson correlation coefficient was also assessed between Vitamin D and TSH level (r value -22.52) and no association was observed among the two parameters in Case Group.<strong>Conclusions:</strong> Patients with hypothyroidism also suffers from hypovitaminosis D. Screening of postmenopausal women for hypothyroidism and Vitamin D levels is recommended.</p> Anoop Singh Gurjar Manisha Gurjar Vasudev Sankhla Copyright (c) 2021 Anoop Singh Gurjar, Manisha Gurjar, Vasudev Sankhla http://creativecommons.org/licenses/by/4.0 2021-11-21 2021-11-21 4 20 425 427