Online ISSN: 2515-8260

Current Issue
Volume 9, Issue 7

Volume 9, Issue 7, Summer 2022


Usefulness of restages transurethral resection of bladder tumors (reTURBT)

(Col.) Rajesh Khanna, Aishwarya Avnish, Aadhar khera, Ashish Pal Singh, Pankaj Verma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 1-6

The present study was planned in the Department of Urology, MMIMSR Mullana, Haryana, India. The study was performed for one year. Total 50 cases of the proven histological diagnosis of nonmuscle invasive urothelial cancer with either high grade or T1 cancers on histopathology were enrolled in the present study. The data generated from the present study concludes that TURBT is necessary in patients with solid bladder tumors. The presence of tumor at restage confers a higher risk of recurrence and progression. Poor patient compliance for a restage TURBT remains a matter of concern.

TITLE:THE HISTOMORPHOLOGICAL STUDY OF EOSINOPHILIC GASTROENTERITIS AND IT’S FOLLOWUP

Dr Sowmya S M; Dr Roopa A N; Dr Harish Kumar S; Dr Ankita Paul; Dr Srinivas A K

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 7-13

BACKGROUND: Eosinophilic gastrointestinal disorders (EGID) are the group of chronic, inflammatory conditions of the gastrointestinal tract. Little is known about the histomorphology as well as outcome of these after follow-up. The aims of the study are to study the histomorphological pattern of EGIDs and also to determine the changes post follow-up for a period of 24 months

Window surgery- an effective treatment option for Seroma of the Pinna

Sathyaki D C, Shwetha,Divya Jyothi N,Nalina P A D C

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 14-21

Seroma, also called as Pseudocyst of pinna is a benign cystic swelling which commonly develops in the antero-lateral aspect of the pinna. It occurs due to accumulation of fluid between perichondrium and cartilage and does not have an epithelial lining. This study was conducted to compare and analyse the outcomes of the Window operation and aspiration and intralesional corticosteroid injection.

Comparison of spectrum of medico-legal cases and outcomes in the emergency department of tertiary care center: A retrospective study

Dr.Shabbir Shekhli, Dr. Anila Jose ss

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 22-33

Emergency Medicine is a new discipline that started with the aim of effective and early resuscitation of critically ill patients. Medico-legal cases (MLC) are surged globally due to the population rise. Resource allocation for different MLC in terms of humans, infrastructure, and equipment is complicated. The present study aimed to find a pattern of Medico-legal cases with outcomes in the Emergency Department.

THE EFFICACY OF AUTOLOGOUS PLATELET RICH PLASMA INJECTION IN CHRONIC PLANTAR FASCITIS, A PROSPECTIVE STUDY

Dr VADLAMUDI VINAY CHOWDARY, Dr KONDAREDDY HARI KRISHNA REDDY, Dr AITHAGANI SANDEEP KUMAR

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 34-42

INTRODUCTION
Plantar fascitis is one of the most common tendinopathy and cause of heel pain. It may get resolved with time and conservative treatment like stretching exercises and oral medications. Recent advance in treatment of chronic plantar fascitis is the use of local PRP injections. It has advantages like being autologous and rich in growth factors. The purpose of this study is to determine the effectiveness of local PRP injection in chronic plantar fascitis.
MATERIALS AND METHODS
This study was conducted from September 2020 to March 2022 in Narayana Medical College and Hospital, Nellore. 30 patients who came to op were selected based on inclusion and exclusion criteria. 3ml of autologous PRP was extracted and injected into heel area. Patients were followed up at 0,1,3,6 months intervals and at each follow up pain was evaluated using Numerical pain score.
 
RESULTS
Patients are followed up at 0,1,3,6 months. At each follow up patients Numerical pain score was calculated and mean was obtained for all patients. The mean pain was 8.5 pre-injection. The mean Numerical pain score at 0,1,3,6 month was 8.5, 4.25, 0.89, 0.33 respectively.
CONCLUSION
Intralesional autologous platelet rich plasma injections were safe and effective in treatment of chronic plantar fasciitis with maximum effect observed after 3rd month and sustaining till 6th month

Volar locking plate fixation for unstable distal radius fractures- A prospective study of functional and anatomical outcome

Dr. Nagulapati Vishnu Vardhan, Dr. Biju Ravindran, Dr.Pagadala Girija Devi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 43-50

Distal end radius fractures constitute one-sixth of all fractures treated in the emergency department. These fractures often are unstable, are difficult to reduce anatomically. Various modes of treatment include plaster application, External fixator, Plate fixation with locking compression plate. Recently, there has been an increasing interest in plate fixation, especially volar locking compression plate fixation of distal radius fractures. The purpose of this study is to evaluate the functional and anatomical outcome of unstable distal radius fractures treated by volar locking compression plate.
METHODS AND MATERIALS:
Forty-eight patients with unstable fractures of the distal radius treated with open reduction and internal fixation with volar LCP were taken under the study. Lafontaine 's criteria for instability were used to assess the fracture stability. Volar Henry approach was employed in all patients. Post-operative follow up at 6 weeks, 3 months, 6 months, 1 year and every 6 months later on as necessary. The assessment of functional results was made using the Demerit system of Gartland & Werly and Sarmiento's modification of Lidstrom's criteria was used for assessing anatomical outcome.
RESULTS:
Out of 48 patients, 34 were males and 14 females.  26 met with road traffic accidents and 22 have fallen on their outstretched hand. The assessment of functional results was made using Gartland & Werley demerit system based on residual deformity, subjective evaluation, objective evaluation & complications. 22 cases had excellent results and 22 cases had good results and 4 cases had fair results at the end of 12 months.
CONCLUSIONS:
Volar LCP is an effective treatment option for unstable distal radius fractures which promotes anatomic realignment, prevents delayed collapse, allows early joint motion and results in successful functional and anatomical outcomes

SOMATIC DNA DAMAGE ASSOCIATED WITH OXIDATIVE STRESS AND IMMUNE RESPONSE IN SUBFERTILITY

Sumesh K, Sumitha Prabhu PS, Rasitha CH, Simi N, Ratheesh GB, Dinesh Roy D

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 51-62

Subfertility (also commonly known as infertility), which affects one in six couples, is the failure to manifest a clinical pregnancy after 12 months of regular, unprotected intercourse. Even though genetic, environmental and lifestyle factors play a pivotal role in subfertility, the etiology of the disease still remains enigmatic. The extent of somatic DNA damage and oxidative stress among subfertile subjects was studied. TORCH infection screening and several clinical parameters were also analyzed among 74 subfertile females and 45 age and sex-matched healthy individuals as control. The study concluded that subjects with subfertility showed increased oxidative stress and associated somatic DNA damages along with varying degrees of infections.

A CASE OF VIRAL MENINGITIS WITH CHRONIC SIADH PRESENTING WITH SEIZURES.

Dr G S Sanjay Surya Dr Priya Venugopalan Dr Gowtham Hanumanram Dr Kannan Rajendran Dr Gowrishankar A

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 63-66

A 67yrs old male hypertensive on irregular treatment presented to emergency room in a drowsy state. Patient had history of one episode of generalized tonic clonic seizures with altered sensorium ,   evaluated and was found to have chronic hyponatremia. Fever, throat pain, fatigue and vomiting were also present. A history of fever and multiple vesicles over body , CSF analysis , TZANC smear positive with multiple varicella zoster lesions were pointing towards viral meningitis . Patient was treated for viral meningitis with acyclovir and he improved significantly. Thus , here we report an interesting case of viral meningitis with chronic SIADH presenting with seizures

DEVELOPMENT AND EVALUATION OF ANTIFUNGAL SOAP WITH HERBAL ANTIBACTERIAL PROPERTIES

Vibhavari M. Chatur , Anuj N. Nahata, Prachi S. Pipada, Aniket K. Pacharne, Shubham Patil, Nazma M. Ansari, Sanjay G. Walode ,Shashikant N. Dhole

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 67-74

Herbal products have become increasingly important worldwide in medical and economic terms. Antifungal herbal antibacterial soap of Luliconazole were prepared & evaluated for dermal infection along with the addition of the oils and the extract of Azadirachtaindica, Ocimum tenuiflorum, Aloe barbadensis miller, Santalum album. The API used for the preparation of antifungal herbal antibacterial soap belongs to the antifungal class of azoles, inhibits the enzyme lanosterol demethylase, which is required for the production of ergosterol, which is a major component of the fungal cell membrane. It is mainly used in the treatment of skin infections such as athlete's foot, jock itch, and ringworm. The physicochemical parameters of formulations (Physical evaluation, pH, Foaming ability and foam stability) were determined. The results showed that the formulation have pH level nearly equal to skin pH, foaming index was excellent. The %drug release, % drug content, % solid content and microbial study was performed for API

TO EVALUATE THE ROLE OF NEGATIVE PRESSURE WOUND THERAPY IN COMPOUND FRACTURES AFTER PRIMARY FIXATION

Dr. Nagulapati Vishnu Vardhan, Dr. Biju Ravindran, Dr. Kavarthapu Venkata Srikanth

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 75-83

INTRODUCTION: Vacuum-assisted closure (VAC) is a non-invasive, active wound management system that exposes a wound bed to local sub atmospheric pressure, removes fluid from the extravascular space, improves circulation, and enhances the proliferation of granulation tissue. The purpose of this study is to know the rate of wound infection, number of days required for making the wound fit for skin cover procedures, number of days required for formation of uniform granulation tissue bed in the wound healing treated by Vacuum Assisted Closure after primary fixation of fracture.
METHODOLOGY: Patients between 18 to 60 years were included in this prospective randomized controlled trial. Primary internal Fixation of fracture was done as soon as possible followed by VAC application. Functional outcome of cases recorded during each follow up according to Johner and Wruh’s (1983).
RESULT: According to this study, 30 patients with open fractures of both bone leg after primary internal fixation with VAC application. During follow up effective decrease (mean ± SD) in wound size after VAC therapy was 9.97±9.59 cm2 with P-value 0.0481. This technique has resulted in the effective decrease in wound size, infection and give a better functional outcome.
CONCLUSION: The greatest advantage of VAC was found to facilitate rapid formation of granulation tissue on wounds with exposed tendons, bones, raw area wounds and exposed implants hence decrease healing time and minimize soft tissue defect coverage procedures.

Assessment of the knowledge, attitude & practice of worm infestation among the school going children in Hapania, Agartala, West Tripu

Dr Kaushik Tripura , Dr Joy Philip Reang, Dr Tamal Chakraborty, Dr Arindam Datta, Dr Argha Majumder

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 84-90

Worm infestation is one of the major causes of childhood malnutrition, anemia, stunted physical and mental growth, psycho-social problems and this along with repeated gastrointestinal and upper respiratory tract infection contributes to high morbidity in children and remains a major cause of high infant and child mortality in our country. The infection is usually transmitted via ingestion of eggs from contaminated foodstuffs, an infection may occasionally occur via inhalation of eggs and swallowing of infected secretions.[1]
The overall prevalence of helminth infection in school-age children in India is about 50% in Urban and 68% in the rural area. Soil-transmitted helminths commonly known as worms form part of the Neglected tropical diseases which are associated with substantial acute and chronic morbidity, particularly among children [2].

Comparison of spectrum of medico-legal cases and outcomes in the emergency department of tertiary care centre: A retrospective study

Dr. Shabbir Shekhli Dr. Vijay Kumar SS

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 91-98

AIMS: Emergency Medicine is a new discipline that started with the aim of effective and early resuscitation of critically ill patients. Medico-legal cases (MLC) are surged globally due to the population rise. Resource allocation for different MLC in terms of humans, infrastructure, and equipment is complicated. The present study aimed to find a pattern of Medico-legal cases with outcomes in the Emergency Department.
METHODS :This isaretrospective study done in a tertiary care teaching hospital over one year from January 2021 to December 2021. A total of 955 cases were registered, out of which 918 were selected. Patients data was recorded in proforma regarding the demographic profile, the pattern of MLC, and hospital outcome. Descriptive analysis expressed in frequencies and percentages using SPSS for Windows, Version 26.0. 
RESULTS : In 918 cases, males were 69.80 %, and females were 30.20%. The majority of patients were aged 21 to 40 years, accounting for 56.10%. The pattern of MLC cases is Road traffic accidents 34.50%, poisoning 23.10%, Assault 19.80%, Bites 13.6%, and burns 2.20%. Outcomes showed the discharges 55.10%, deaths 3.8%, Against Medical Advice 29.30%, and OPD Basis11.80%. Mortality was highest in road traffic accidents, accounting for 1.5%.
CONCLUSION : Present study concludes MLC cases were common in males of younger age groups. The majority of MLC cases are Road traffic accidents and poisoning. Mortality was more in Road traffic accidents. This study will guide the preparedness of the Emergency department in terms of resource allocation, training of staff, and formulation of hospital plans and policies by government /law agencies.

A RANDOMISED CONTROLLED STUDY OF TRACHEAL EXTUBATION RESPONSE FOLLOWING NITROGLYCERINE (NTG) SUBLINGUAL SPRAY IN HYPERTENSIVE PATIENT

KORI, ANIL RAI, PARTH MISHRA, SHAILESH AJMANI TEJINDER JAIN, ABHILEKH AGARWAL, ADITYA BATRA, MAHIMA TAGALPALLEWAR, AMEYA

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 99-110

The prospective randomized open controlled study was done to compare tracheal extubation response following nitroglycerine (NTG) sublingual spray in hypertensive patients

Bacteriological Profile And Sensitivity Pattern Of Pleural Fluids From A Tertiary Care Hospital.

Dr. Qudsiya Begum Alias Farheen, Dr. Ch Navaneetha

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 111-116

Background information:
Pleural space is normally sterile but it gets colonized when fluid accumulates. Fluid accumulation occurs due to many causes of which infection is the most common cause. Pleural effusion when occurs in the setting of pneumonia increases the morbidity and mortality rates in patients if antibiotic therapy is delayed or improper. Identification of prevalent pathogenic organisms and their sensitivities is important in guiding antimicrobial therapy. The aim of the study was to determine the bacteriological profile and their sensitivity pattern.
Material and methods:
A total of 500 pleural fluid samples were processed. The isolates were identified by standard procedures and their antibiotic sensitivity determined.
Results:
12.8% of the samples had an identifiable etiology with gram negative bacteria as the predominant isolates. The organisms isolated were; Pseudomonas. aerugenosa, Klebsiella pneumonia, Escherichia coli, Staphylococcus aureus and Protues. Pseudomonas spp were the most common among gram negatibe bacteria. Imipenem, piperacillin-tazobactum, ciprofloxacin were most sensitive drugs.
Conclusion:
Continuous epidemiological monitoring and knowledge of sensitivity pattern of the organisms is a prerequisite in formulation of antibiotic policy which further helps in early and appropriate institution of the antibiotics and in controlling the antibiotic resistance

A PROSPECTIVE COMPARATIVE STUDY OF FUNCTIONAL OUTCOME OF DISTAL RADIUS DISPLACED EXTRA ARTICULAR FRACTURES TREATED BY CONSERVATIVE VERSUS OPERATIVE METHODS IN TERTIARY HEALTH CARE HOSPITAL.

Dr.Kuruva Suresh, Dr.Kondareddy Hari Krishna Reddy, Dr.Aithagani Sandeep kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 117-126

Background: Fractures of the distal radius are one of the most common injuries seen in our day-to-day practice. It accounts for almost 4% of the injuries seen in the emergency department. Despite its high incidence and the substantial possible implications of suboptimal management, no high-level evidence regarding the best treatment method yet exists.
Aim: Aim of the study is to compare the functional outcomes of extra articular distal radius displaced fractures managed surgically with those managed conservatively.
Materials and Methods: In this prospective cohort study conducted between November 2020 to December 2021, 18 to 65 years old patients with displaced extraarticular distal radial fracture were treated surgically or conservatively. Modified Mayo Wrist Score were calculated after a follow up of 12 months.
Results: At the end of 12 months the patients were evaluated, and it was noticed that patients who were treated surgically had significantly better functional and clinical outcomes, as indicated by significantly higher Mayo scores than patients treated conservatively by casting (all p values < 0.05).
Conclusions: Patients treated with volar plate fixation were able to resume activities of daily living few weeks earlier compared to those managed with K-wire fixation and conservative group. Therefore, we can conclude that volar plate fixation gives significantly better clinical and functional results than other methods of treatment.

Factors affecting motor recovery after decompression of severe lumbar canal stenosis in patients with motor deficit.

Dr Vipul agarwal, Dr Raghvendra Raghuvanshi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 127-140

Purpose:  Very few prospective studies are available on the surgical outcome in patients with lumbar canal stenosis having a motor deficit. The study was aimed at evaluating factors affecting recovery of neurological deficits in cases of lumbar disc herniation (LDH) treated by lumbar decompression.
Methods A prospective study was performed at J.K. Hospital and Research Centre, Bhopal, M.P. India, from November 2019 to November 2021, on 35 patients. These patients present to us with complaints of weakness in ankle dorsiflexors (ADF) and extensor hallucis longus (EHL). In our study, all those patients were included who gave positive consent, who have L4 and /or L5 nerve root involvement innervating the anterior compartment of the leg and those who have lower extremity (ADF and EHL) weakness resulting from lumbar degenerative diseases like lumbar canal stenosis due to ligamentum flavum hypertrophy, facet arthropathy, disc protrusion and spondylolisthesis at L4-L5 level or L5-S1 level. Postoperative evaluations of motor recovery were performed regularly on an outpatient basis, and the results of the latest follow-up were analyzed. The follow up was done at 2 weeks, 12 weeks and 24 weeks in our OPD.
Result: 22(67.8%) patients having duration of symptoms less than 3 months had 95% recovery, group with duration of symptoms more than 3 month showed recovery rate of 70%. Recovery rate of 90% in ODI score in group with duration of symptoms less than 3 months. Following Kaplan and Meier analysis median time to foot drop improvement was within 12 weeks of surgical decompression. After the Kaplan and Meier plot, we observe that maximum recovery is seen between 9 and 14 weeks after decompression.
Conclusion:   Better improvement is seen if the patient got operated on within 3 months of neurological deficit. Also, it is observed that those patients with mild to moderate motor weakness show better recovery. Younger patients of less than 50 years with single level involvement show better recovery. We have observed preoperative muscle strength and duration of palsy as a significant prognostic indicator of better outcome following surgical lumbar decompression

Comparison of Functional outcome of Arthroscopic ACL reconstruction between Quadruple Hamstring, Peroneus Longus and BPTB Autograft in Indian Population

Dr Raja Yadav ,Dr Rohit bansal , Dr Gopal Rao M

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 141-147

The Anterior Cruciate ligament (ACL) is the primary stabilizer of the knee and its deficiency affects Knee stability, resulting in giving way symptoms in daily and sports activities with increased the risk of intra-articular damage. To prevent the deterioration of the existing lesions ACL reconstruction is necessary. Arthroscopic reconstruction of the injured ACL has become the “gold standard” method for treatment of ACL tear. However there is a controversy in literature regarding the best graft option is to replace the injured graft. The present study was aimed to study and compare the functional outcome of single bundle arthroscopic ACL reconstruction by Hamstring , Peroneus Longus and BPTB autografts  using Lysholm Knee Activity Score.

A CLINICAL STUDY OF CIRRHOSIS WITH SPECIAL REFERENCE TO THYROID FUNCTION”

Dr. M.H. Usmani, Dr. Karan Saran Kapur, Dr. Sabendra Singh Sikarwar, Dr Anuj Jain

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 151-161

Background-It is known that impaired thyroid function affect the liver function and similarly liver disorders Also affect thyroid function. In this study we looked  at the clinical profile of cirrohosis and studied the correlation between cirrhosis  and thyroid function.
Methodology- The study was conducted as an observational cross sectional Study on patients with cirrhosis of liver reporting at Department of Medicine, SSMC Rewa (M.P.) during the study period of 15 months i.e. from 1st April 2020 to 30th June 2021. Detailed history regarding risk factors, duration of liver disease, history pertaining to its etiology was obtained. Severity of liver disease was assessed using Child Pugh score. All the patients were then subjected to relevant investigations including Serum T3, T4, TSH.
Results-A total of 100 cases of liver cirrhosis were enrolled in our study with mean age of 53.26±12.54 years. We observed a statistically significant association of Child Pugh Score with T3, T4 as well as TSH (p<0.05). We observed a moderate correlation of Child Pugh score with T3 levels and TSH (r=0.452 and
0.311 respectively; p<0.05), and weak correlation was observed with T4 (r=0.240; p<0.05).
Conclusion- In cirrhosis of liver majority of subjects show impaired thyroid functions. Thyroid hormone levels are helpful in assessing the severity as well as course of cirrhosis and among T3,T4,TSH value,TotalT3 faired as better predictor of severity of cirrhosis.

CURRENT SCENARIO AND FUTURE ORCHESTRATIONS IN THE BATTLE AGAINST DYSLIPIDEMIA: REVIEW ON NOVEL HYPOLIPIDEMIC DRUGS

Dr. Shoebul Haque, Dr. Ajit Mishra, Dr. Narendra Kumar Dr. Shakita Fatima, Prof. Amod Kumar Sachan Prof. Rakesh Kumar Dixit

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 162-184

Cholesterol is an essential constituent of the cell membrane. It coordinates carbohydrate, major ions, and bone homeostasis respectively. [1] Cholesterol is the progenitor for all glucocorticoids, mineralocorticoids, sex hormones, steroids, and cholecalciferol. Cholesterol is transported into the blood via spherical macromolecules like chylomicrons, HDL, LDL, and VLDL. [2] These properties make it an essential biomolecule for most physiological mechanisms. Triglycerides performing a key role in providing energy to cells. [3] In excess amounts, these biomolecules are not good for health and produce hyperlipidemia. [4] Hyperlipidemia is responsible for many long-term side effects in the body. Hyperlipidemia increases the risk of formation of plaques, which promotes the risk of heart attack and stroke in persons with atherosclerosis and coronary heart diseases. [5] Statins are the evidence-based treatment option for hyperlipidemia according to published guidelines. 

STUDY OF ROLE OF PLATELET COUNT AND MEAN PLATELET VOLUME IN EVALUATING THE DISEASE SEVERITY IN COVID 19 INFECTION-OUR EXPERIENCE AT TERITARY CARE HOSPITAL

A.Smitha Reddy, B.V. Anuradha Devi, Swarupa Ravuri, B. Nageshwar Rao, Danda Samyukta Reddy, Anunayi Jestadi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 185-192

INTRODUCTION: Patients Infected with CORONA VIRUS- 2019 (COVID-19) showed changes in their platelet counts and Mean platelet volume (MPV). The present study was aimed to observe any association between lowered platelet counts with mean platelet volume (MPV) from the corana positive individuals.
METHODS: It is a prospective study from 1-8-2020 to 30-9-2020 .Patients  who presented with complaints of Fever, sore throat, body pains, cough, breathlessness, diarrhoea were evaluated at the triage area of the Hospital. Throat swab was taken and RT-PCR was done and only 200 confirmed cases were included in the study. Patient blood samples were collected and processed in SYSMAX 5 -part Haematology analyser in the Hospital Central Laboratory. The patients CBP, Platelet count and MPV were tabulated.
RESULTS: Out of 200 COVID-19 confirmed cases, the numbers of males were 145 (72.5%) and females 55 (27.5%). Most of the patients belonged to age group 50 years (25.5%), 60yrs age group (21%).  The Maximum age in our study group was 80 years, minimum age was 19 years and mean age was 50 years. In our study it was noticed that Severe thrombocytopenia was seen in one patient with platelet count 38,000/μL,(0.5%), Moderate thrombocytopenia was seen in two patients(1%) and mild thrombocytopenia  was seen in 12 (6%) cases. In our study only fifteen cases (7.5%) showed thrombocytopenia. The MPV for all fifteen cases were studied and MPV was in Range of 9.6- 11.8 fl.
CONCLUSION: Low platelet count and high MPV are associated with disease severity. Platelet count is one of easy cheap method for the assessing the disease severity along with other parameters 

Comparative study of Intralesional Vitamin-D3 and Autoinoculation in treatment of multiple cutaneous warts

Dr Shailesh Kumar Dr Rajkumar Kothiwala Dr Lokesh Kumar Bunkar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 197-207

Background- Persistent and recurrent warts pose a challenge to physicians. Despite the availability of multiple treatment options, warts are resistant to treatment. Intralesional Vitamin D3 and Autoinoculation both are promising treatment modality for multiple warts. AIM- To compare the efficacy and safety of intralesional Vitamin-D3 and autoinoculation in treating multiple warts. Patients and method- the study included 60 patients divided in two groups (group-A and group-B), each containing 30 patients. Informed consent was taken from each patient. Group-A patients received intralesional Vitamin-D3 0.2-0.5 ml every 3 weeks for maximum of four sessions. Group-B patients were treated by autoinoculation every 4 week for 3 sessions. RESULTS- At the end of 3 months 86.6% of patients showed response in group-A, Complete clearance was seen in 76.6% patients. Three months post autoinoculation (group-B), 66.6% patients showed response. Complete clearance was seen in 56.6% post autoinoculation in group-B. CONCLUSION- Intralesional Vitamin-D3 had the edge over Autoinoculation in palmoplantar, verruca vulgaris and periungual warts, while autoinoculation had the advantage in the plane variants.

Histological outcome on liver and testis in male rats received Tamsulosin

Rand Abdulateef Abdullah, H. kh. Ismail

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 208-221

     Tamsulosin is alpha-1 adrenergic receptor antagonist which can alleviate the symptoms of urinary tract infections in elderly men because it reduces spasm of periurethral smooth muscle fibers and reduce the obstruction around bladder. Thirty animals were separated into 3 groups. Group (1) is control group, group (2) received 0.4mg/kg/day of the medicine orally for seven days. Group (3) received 0.4mg/kg body weight of the medicine for thirty days. Results:  Group (2) liver tissue sections showed dilatation of portal vein, ballooning degeneration and necrosis of some hepatocytes while group (3) showed Severe congestion of portal vein with inflammatory cell infiltration and necrosis of most of hepatocytes. Microscopic examination of testis tissue slides of group (2) showed the tubules were less numerous, degeneration and necrosis of germinal epithelium while in group (3) testis sections showed reduced number of atrophied seminiferous tubules with interstitial edema. Vacuolation of spermatocytes and distortion of the process of spermiogenesis. It is concluded that tamsulosin can produce some histological effects on both liver and testis tissues when used for short duration (one week) while it can lead to harmful histological damage when it is given for long period (four weeks).

Knowledge, Attitude and Practices toward COVID vaccine among medical students in Belagavi- A cross-sectional study

Dr Hemavathe S, Dr Abhinandan Wali, Dr Sriram T R, Dr Aniketh Manoli, Dr Chandra Metgud

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 222-230

Context/Background: COVID-19 is an emerging and rapidly evolving situation. Though several vaccines have been developed and brought into general use, vaccine hesitancy still exists among the public. Assessing the awareness toward COVID vaccine among medical students is important since their perception and practice will have a significant impact on their family members, friends and relatives.
Aims/Objectives: This study aimed to assess the knowledge, attitude and practices toward COVID vaccine among medical students.
Methodology: A cross-sectional study was carried out among the undergraduate medical students of a medical college in Belagavi between May - June 2021. A total of 802 students participated in the study. A framed questionnaire assessing their knowledge, attitude and practice toward COVID vaccine was distributed to each participant.
Results: Most of the study participants were female (51%), and most of them were in the first year of their course at the time of the study (23.6%). Majority of them received COVID-19 related information from healthcare workers (72.7%). 92.8% and 92.6% of the participants responded that the vaccines control COVID-19 and it was by developing antibodies, respectively. 70.5% said that the vaccines should not be given to immunocompromised individuals. 82.2% of the participants have taken 2 doses of COVID-19 vaccination. Almost all participants (98.8%) felt that even after vaccination other measures like social distancing, wearing mask and avoiding social gathering are to be followed.
Conclusions: The findings in the present study show good knowledge, positive attitude and practice towards COVID-19. It is necessary to keep on with further education and training strategies to get a better understanding and positive attitude toward the pandemic for all medical students.

A PROSPECTIVE STUDY TO ANALYSE THE SURGICAL OUTCOME OF POSTERIOR ACETABULAR FRACTURES.

Dr. N.Vishnu Vardhan, Dr. Biju Ravindran, Dr. Yadav Vinod Ramlal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 231-238

Acetabular fractures incidence accounts for 3 patients / 100,000 / year during the last 2 decades. Among acetabular fractures posterior wall accounts for most common acetabular fracture type (25%). The aims and objectives of the study was to evaluate the functional and radiological outcome of posterior acetabular fractures treated with different surgical techniques and the possible post operative complications.
METHODS
A total of 27 patients who had a history of either motor vehicle accident or accidental fall and were radiologically diagnosed with posterior acetabular fracture as per Judet and Letournel classification and underwent surgery for the same. Radiographs were taken after each follow up and patients were evaluated for functional outcome by Modified Harris Hip Score and surgical complications. Statistical analyses were performed using the Statistical Package for the Social Sciences software A p<0.05 was considered statistically significant.
RESULTS
In the present study, the age group range was between 20 and 71 years, and the mean age in the study was 41.9 years. Road traffic accident was the most common cause of fracture (80%) followed by accidental fall (20%) in our study. Right acetabular fracture was the most common (60%) followed by left (40%). Radiological union was achieved in thirteen cases (45%) by 4 months and in 12 cases (55%) by the end of 12 months whereas 2 patients developed non-union. Functional outcomes of all the cases were assessed in terms of Harris hip score grading. 60% of the cases had good, 15% excellent, 20% fair and 5% poor outcome in our study.
CONCLUSIONS
Operative treatment of displaced acetabular fractures gives satisfactory functional results. Functional outcome is better with patient operated within one week of injury than a delay of more than one week

Assessment of relationship between footprint length and stature

Dr.Rakesh Kumar Mishra; Dr.Divya Vardaini

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 239-242

Background:Identification of a person is of prime and foremost importance in both civil and criminal cases. Investigating officer has to make rapid and accurate assessments in identification of a culprit in criminal cases. The present study was conducted to assess relationship between footprint length and stature.

ROUTESOFSPREADOFODONTOGENICOROFACIALINFECTIO NSWITHOROANTRALFISTULAFORMATION, AMULTIPHASECTDIAGNOSIS

DamandeepSingh Chawla; Harsimar Chawla; Divjot Chawla

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 243-246

Complicated tooth caries / deep periodontal infections spreading beyond the alveolar bone are usually main stay of odontogenicoro- facial infections. They extend to involve the fascial planes around the face and oral cavity causing facial swelling and contour abnormalities. They tend to spread along planes of least resistance involving the supporting structures of the affected tooth. The abscesses around the apices of the maxillary pre-molar and molar teeth usually results in Oro-antral fistula and periapical abscesses involving anteriorly located teeth notably the incisors can lead to Oro-nasal fistula formation.

A COMPARATIVE STUDY OF NEUROCOGNITIVE IMPAIRMENT BETWEEN EARLY-ONSET & LATE-ONSET SCHIZOPHRENIA

Dr. A. Kowsalya Dr. Mathivanan Dr KN Lavanya

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 247-253

Introduction
Various Studies have shown that the early- and late-onset schizophrenia patients differ and accompanied by impairments in several domains of cognitive function. Hence studying Cognitive impairment will be helpful to understand pathology and phenomenology of schizophrenia and giving cognitive remediation therapy in a better way.
Aims
To evaluate the neurocognitive impairment in Early-onset Schizophrenia and Late-onset Schizophrenia. To find out difference in severity of neurocognitive impairment between two groups.
Materials and methods
This study was approved by Institutional Ethical Committee, Madras Medical College, Tamil Nadu, India. The study subjects were taken from the Institute of mental health hospital.  For each group, 150 samples were taken. Administration of NIMHANS neuropsychological battery to both groups testing domains of, Working memory, Verbal learning & memory,  Auditory verbal learning test, Visual learning & memory and Mental speed. The results were statistically evaluated with IBM SPSS 20.
Results
Verbal N Back test hits were comparatively higher in late onset schizophrenia patients than early onset. Similarly the error was more in early onset schizophrenia patients. Visual N Back test hits were comparatively higher in late onset schizophrenia patients than early onset. Similarly the error was more in early onset schizophrenia patients. The time taken was similar in both the groups. The error due to digital vigilance test was more in early onset schizophrenia patients. The time taken for color trail test was significantly higher in early onset schizophrenia patients. The time taken for complex figure test was significantly higher in late onset schizophrenia patients. The time taken for Digital symbol substitution test was significantly higher in early onset schizophrenia patients.
Conclusions
In this study, early onset schizophrenia patients had more cognitive impairment than late onset schizophrenia patients in most of the measured cognitive domains.

Evaluation of functional and radiological outcome of distal femoral fractures fixed with locking compression plate by minimally invasive plate osteosynthesis

Dr. Nandram Saryam; Dr. Anil Chouksey; Dr. Raja Yadav; Dr. Rohit Kumar Marskole

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 254-267

Title: Evaluation of distal femoral fractures with locking compression plate using minimally invasive plate Osteosynthesis (MIPO) technique.Aim: To prospective and retrospective analysis of clinical and radiological outcome of distal femur fractures treated with locking compression plate by minimally invasive plate osteosynthesis (MIPO) technique.

Evaluation of Serum Ferritin and CRP Level in Dengue Fever & its Correlation with Thrombocytipenia in Southren Odisha

Dr. P. Syam Sundar, Dr. Sananda Kumar Sethi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 268-277

Introduction: Dengue is one of the major re-emerging viral infections. In recent years, dengue has become a major global public health concern. In small subset of patients, there is life threatening condition with severe cytopenias and significant systemic response. The presence of macropage activation in dengue fever is well reported and could be one possible reason for mortality and morbidity. Dengue being an infective condition, a modest rise in ferritin levels and CRP are expected in dengue fever as well. In dengue fever sr. ferritin is disproportionately raised compared to any bacterial or viral infection.
Material and Methods: It was a prospective observational study conducted at MKCGMCH Berhampur over a period of 2 years from 2019 to 2021.The study population consisted of adults admitted to department of general medicine with diagnosis of dengue fever. 100 dengue patients admitted in dengue ward/to different wards of medicine department of MKCG Medical College, Berhampur were observed. Only who were seropositive for dengue fever NS1 antigen or IgM ELISA were recruited for the study. Their serum ferritin and CRP levels on the day of admission and on the fifth day were measured. The relationship between serum ferritin, CRP, platelets and severity of dengue fever was observed.
Results: Total number of uncomplicated dengue fever is 78 and that of severe dengue (DHF/DSS) is 22. The mean serum ferritin and CRP are high on day one as compared to day five, but the mean TPC on day five is high as compared to day one. Serum Ferritin and CRP are Negatively Correlated with the TPC in Linear Pattern in day one, which is statistically Significant. Serum Ferritin and CRP are Negatively Correlated with the TPC in Linear Pattern in Day Five, which is statistically significant. The mean TPC level on day one of hospitalization among DF, DHF, DSS are 79766.7, 1006.3 and 19100 respectively. The mean TPC level on day five of hospitalization among DF, DHF, DSS are 79766.7, 1006.3 and 19100 respectively. The above figures show that, the mean ferritin and CRP level on day five are significantly high among DHF/DSS as compared to DF.
CONCLUSION: This study shows that serum ferritin and CRP may help in identifying an uncomplicated dengue illness, from that of patients who may require inpatient admission/intensive critical care with or without tell-tale signs upon the time of presentation to the hospital or to the outpatient department itself

The functional outcome of intracapsular fracture of femoral neck with modular bipolar prosthesis

Dr. Rakshith Kumar K, Dr. KM Pawan Kumar, Dr. Sunil Santhosh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 278-285

Fracture neck of femur is a leading cause of hospital admissions in elderly age group. The number of such admissions is on a rise because of increased longevity, osteoporosis and sedentary habits. Conservative methods of treatment is not acceptable because it results in nonunion with unstable hip and limitation of hip movement as well as complications of prolonged immobilization like bed sores, deep vein thrombosis and respiratory infections. The present study was a prospective study of 20 cases of fracture neck of femur admitted to hospital. Cases were selected according to inclusion and exclusion criteria i.e., patients with intra-capsular fracture neck of femur above the age of 50yrs. Medically unfit and patients not willing for surgery were excluded from the study. At the final one year follow up assessment with Harris Hip Score 6 patients (30%) achieved 'Excellent' result, 9 patients (45%) achieved 'Good' result, 2 patients (10%) achieved 'fair' result and 3 patients (15%) achieved 'poor' result. Overall, 75% of the patients achieved an excellent or good result. On enquiry regarding the overall satisfaction with the procedure and return to pre-fracture levels of activity, 8 patients (35%) were 'very satisfied', 12 (50%) were 'fairly satisfied' and 2 (15%) were 'not satisfied'.

SONOGRAPHIC ASSESMENT OF GESTATIONAL AGE BY THE FETAL KIDNEY LENGTH AND VOLUME AFTER 18 WEEKS OF GESTATION IN LOCAL POPULATION

DR. MADAN MOHAN BABU, DR. SURESH A DR. ABHISEK SAHA

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 286-294

Obstetric care begins with determining gestational age, which has the least variability in early pregnancy. This current study was planned to provide an overview of fetal kidney length and volume as a useful adjunct parameter for better determination of gestational age.
MATERIALS AND METHODS
Normal singleton pregnancies from 18–40 weeks of gestational age, referred to the department of Radio-diagnosis and Imaging at VIMS & RC, Bangalore. Fill PC-PNDT [Prenatal Diagnostic Technique] form i.e Obstetric ultrasonography were performed using Affinity 50 G pro ultrasound scanner using a 3.5 MHz convex probe. Images were recorded in the system as DICOM.
RESULT
Out of 200 patients who presented themselves for routine obstetric ultrasound scan within the period of study, 150 patients met the inclusion criteria [18th week of gestation to term] and were selected for the study while patients were excluded from the study for the following reasons; for not remembering their LMP, fetus with IUGR, 10 patients presented with oligohydramnios, poly-cystic renal dilated renal pelvis. It correlates strongly with gestational age while the relationships between right and left kidney lengths with gestational age were established. However no correlation of gestational age with volume. Fetal kidney length increases with increase in FGA and shows excellent intra and inters class correlation coefficient which suggests good agreement and reproducibility of measurements. 

Circumcision by surface anesthesia -is it really painless? Our experience

Dr. Balamurugan E, Dr. Nilavazhagan A

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 295-298

Circumcision is a procedure of removal of prepuce skin for various causes including religious reasons. Usually it is done after adequate sedation or regional anesthesia. In our study we performed the surgery using EMLA cream i.e eutectic mixture of lignocaine 2.5% and prilocaine 2.5%. This study is conducted in order to assess the suitability and efficacy of surface anesthetic cream for doing day care procedure. Results were obtained by observation during surgery and post operative period follow up. In our study we performed circumcision using EMLA alone in 45 out of 70 cases. Remaining 25 cases required additional form of anesthesia.
Thus we concluded that EMLA is beneficial for performing circumcision in limited number of patients only especially for adult patients. Pain is mostly experienced at frenular region only even before the start of the procedure. Thus additional anesthetic agents are given in order to perform the surgery.

AN OBSERVATIONAL STUDY OF THE EFFECT OF DEXAMETHASONE PROPHYLAXIS ON POST-OPERATIVE NAUSEA AND VOMITING IN PATIENTS FOLLOWING TOTAL ABDOMINAL HYSTERECTOMY UNDER COMBINED SPINAL EPIDURAL BLOCK

DR. SADIA UMMER, DR. S. KAMALUDEEN, DR. K. CHERAN

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 299-306

Postoperative vomiting or retching (POV) can lead to rare but serious medical complications, such as wound dehiscence, bleeding, electrolyte imbalance, dehydration and pulmonary aspiration of gastric contents. Hence the present study was planned to find out the effect of prophylactic dexamethasone for prevention of postoperative nausea and vomiting in patients undergoing total abdominal hysterectomy under combined spinal epidural block. Influences of dexamethasone on patient satisfaction and postoperative analgesia were also observed as secondary objectives.
Methods: 110 female patients who are undergoing total abdominal hysterectomy were included in this observational study. Patients were divided into two groups. 54 patients in group A and 56 patients in group B. Group A received 8mg dexamethasone i.v along with premedication The primary outcome variable was to compare post-operative nausea and vomiting using numerical rating scale (NRS). Secondary outcome variable was visual analogue scale of post- operative pain and overall patient satisfaction.
Results: Age, height, weight, ASA and hemodynamic parameters were compared between the 2 groups but were statistically insignificant. The PONV scores were significantly lower in group receiving dexamethasone during 0.5, 6, 12, 24h postoperatively. The VAS score for post- operative pain was also significantly lower in group receiving dexamethasone. Over all patient satisfaction was much better in those receiving dexamethasone as part of premedication, the total analgesic requirement was also significantly lower. There were no complications.

Evaluation of effectiveness of intralesional vitamin D3 injections in the treatment of warts

Dr. Lohita M, Dr. A Geetakiran, Dr. Vodapalli Akshaykumar, Dr. K S B Vaishnavi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 307-314

Introduction: Immunotherapy is emerging as a new modality of treatment for cutaneous warts by enhancing cell mediated immunity. Immunotherapy is replacing destructive modalities such as electrocautery and cryotherapy due to its advantages over former, such as affordability, easy availability and minimal downtime. The most common immunotherapeutic agents for warts include intralesional vitamin D3, Measles Mumps Rubella (MMR), Bacille calmette-Guerin (BCG) and Purified protein derivative (PPD).
Aim: This study aims to evaluate the safety and efficacy of intralesional vitamin D3 for the treatment of cutaneous warts.
Objectives

To provide better quality of life.
To assess the clinical response regarding the treatment given.

Material & Methods: This is a prospective observational study conducted from February 2021 to January 2022. Forty clinically diagnosed patients with cutaneous warts were taken up for the study after taking written informed consent. Patients were injected with vitamin D3 (0.2 mL, 15mg/mL) at the base of the wart after injecting with lignocaine earlier. The injections were repeated at an interval of 2 weeks for a maximum of 4 sessions or until clearance of warts, whichever was earlier. A maximum of 2-3 warts were treated per session, and patients were followed up for 6 months after the last injection.
Results: Forty patients with multiple warts were recruited for the study. Of these, 26 (65%) had palmoplantar warts, 8 (20%) were verruca vulgaris, 4 (10%) had filiform warts, and 1 (3%) periungual wart. One patient had all the types of warts. Out of these, 26 (65%) showed complete resolution, 9 (22.5%) showed moderate response and 5 (12.5%) had a mild response. Recurrence was observed in 5 (13%) patients during 6 months of follow-up. Serum vitamin D3 levels were found to be low in most patients.
Conclusion: Intralesional vitamin D3 is safe, effective, affordable and hassle-free procedure both for patients and dermatologists with minimum downtime.

EXPLOITATION OF FUNGAL BIODIVERSITY AS POTENTIAL PIGMENT PRODUCERS A RIVEW ARTICLE

N.Gayathri, N.Rajeswari Devi, Dr.IJN.Padmavathi, Dr. Balaji Chandra Mouli, M.Srinivas

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 315-323

The rapid development of life is leading the demand of colors in biotechnology in field of food, textile, medicine and cosmetics and healthcare products. There is ever growing demand of eco-friendly/non-toxic dyes as coloring agents of food to overcome health hazards.  The risks of synthetic colors compel the industries to adapt natural pigments. The search for new sources of natural pigments has increased, day to day because of the toxic effects caused by synthetic dyes. Recently fungal species are being treated as the natural pigment producers with enormous biotechnological applications. Almost all the genus of fungi synthesize various pigments such melanin, phenazines,flavins,carotenoids, violacein, indioankaflavins. So far these pigments are isolated,screened, and characterized for many biotechnological purposes in food, textiles, medicine, cosmetics health care products. However sequencing of pigment producing genes and generation of new varieties of pigments by rDNA technology may lead to revolutionary success in pigment production market in food, textile, medicine, cosmetics and health care products by a natural means. Study on pigment producing fungi using cloning technology may pave a path for ecofriendly generation of varieties of colors which further can be explored in many biological applications.

STUDY AND ANALYSIS ON CLONING OF BIRA GENE IN PET28A VECTOR AND HIS-TVE PROTEIN PRODUCTION

Raghu bheemanathi, Dr. Syed shahab Ahmad

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 324-336

In many cases, the analysis of a specific protein is hindered by the inability to purify large quantities of it from a native source. It's possible that proteins of interest are only found in trace amounts, or that attempts to purify them have been hampered by technical difficulties. DNA recombinant techniques have allowed researchers to overcome some of these limitations by producing large quantities of purified proteins from nonnative systems. Biotin labelling proteins with biotin is a useful tool for a wide range of applications because of the strong affinity between biotin and avidin or streptavidin. The biotin ligase from Escherichia coli, BirA, biotinylates a lysine side chain in a 15-amino acid acceptor peptide (also known as Avi-tag). We developed a method for producing recombinant BirA ligase for in vitro biotinylation of Avi-tag-bearing proteins. The target protein was expressed in both thioredoxin and MBP fusions, and the corresponding fusion was released by TEV protease. The HisTrap HP column was used to separate the free ligase from its carrier. In the case of thioredoxin and MBP fusion constructs, we obtained 24.7 and 27.6 mg BirA ligase per litre of culture, respectively. The recombinant enzyme was found to be extremely effective in vitro when it came to biotinylation. The procedure outlined here is an efficient way to make BirA ligase, which can be used to biotinylate a variety of Avi-tag-bearing substrates

Analysis of Renal Dysfunction in Patients with Liver Cirrhosis: An Institutional Based Study

Jainish Kamlesh Kumar Modi, Alpesh Vadher

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 337-342

Introduction: Liver disease is a common disorder affecting multiple system. It accounts for approximately 2 million deaths every year worldwide and 1 million due to complications of cirrhosis. Current epidemiological trends show that common liver diseases in Asia–Pacific countries are alcohol-related liver diseases, non-alcoholic fatty liver disease (NAFLD), hepatitis B and C, etc. Most of them lead to cirrhosis of liver. Renal dysfunction is one of the most common complications of cirrhosis with high morbidity and mortality.
Materials and Methodology: This study was adopted to be conducted as hospital-based study was carried on 133 cirrhotic patients admitted in the Tertiary care centre. Patients details that includes their demographic data, clinical examination findings and results of laboratory investigations were collected. CTP (Child Pugh) score and MELD (Model for End Stage Liver disease) Score of patients were also briefed. End results for continuous variables were expressed as means and standard deviation. Categorical variables were described as percentages. Significant factors that were associated with the presence of renal dysfunction was analysed using binary logistic regression analysis Bivariate analysis was carried out using pearsons coefficient of correlation. Odds Ratio (OR) was enabled to ascertain the strength of relationship between two variables.
Results: A total of 133 patients were included in this study. Male patients were in majority constituting 85.3% (n=113) of the total population, the rest were females (14.7%). Mean age of patients in the study group was 51.32 years (+ 13.72). The most common aetiology of cirrhosis was found to be alcohol, comprising of about 74.5%. 22 patients had more than 1 aetiology for cirrhosis, the most common of which has combined alcohol and NASH (Non-Alcoholic Steato Hepatitis) related, observed in 9 patients.
Conclusion: The present study has found significant correlation between the severity of liver dysfunction and some parameters of renal dysfunction. However, there is no such significant association was observed between the distribution of various renal parameters among different aetiologies of chronic liver disease.

A Study of Pathogenic Bacteria Isolated from Symptomatic Urinary Tract Infection and Their Antibiotic Sensitivity

Mahi Ishani, Tiwari Palak, Lal Darbari

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 343-350

Background: Urinary tract infection isamong the most common bacterial infections ingeneral population.The etiology as well as antibiotic sensitivity pattern of UTI varies with the widespread availability of antimicrobial agents; As a result of widespread use of antimicrobial agents, UTIs are becoming increasingly difficult to treat as pathogens with increasing resistance to commonly used antimicrobials are encountered more frequently in clinical practice.
Methods: A cross-sectional study done during April 2021-April2022. All positive urine culture and sensitivity reports of males and females aged 10-80years were included. A total of200 positive urine culture cases were taken from the culture and sensitivity register from Microbiology department of Hindu Rao Hospitaland details were tabulated using a questionnaire.
Results: Out of200 adults, males were 62 (31 %) and females were 138 (69 %). E. coli (63.1%) was the most common organism, followed byEnterococcus (17.68), Klebsiella Pneumoniae (11.1%) Pseudomonas and Staphylococcus. The incidence of UTI was morein female patients in the agegroup of21-30years.E.coli andKlebsiella weresensitive to Amikacin (97.1%), Nitrofurantoin (90.7%), Gentamycin and Imipenem. Both organisms were resistant to Ampicillin (>90%).
Conclusions: In this study, females were predominately affected and on culture the most common organisms were E. coliand Klebsiella. These organisms were most sensitive to Amikacin, Nitrofurantoin and resistant predominantly to Ampicillin. While planning treatment for UTI the sensitivity and resistance pattern ofuropathogensto common antimicrobial agents must betaken into account.

Analysis of Lumbar Spine Stress Injuries in Adolescent Cricket Fast Bowlers

Jujhar Singh, Shikhar Dogra

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 351-357

Background: Fast bowling in cricket is associated with a high prevalence of lumbar spine stress injuries, especially in adolescents. This cannot be correlated with risk factors identified in adult players. This study aimed to examine the incidence of lumbar spine stress injuries in adolescent fast bowlers as a prospective study so as to predict risk factors.
Methodology: 32 asymptomatic male fast bowlers (aged 14–17 years) received baseline & annual lumbar dual-energy X-ray absorptiometry (DEXA), magnetic resonance imaging (MRI) scans, musculoskeletal and bowling workload assessment. These were followed up after one year to calculate the prevalence at baseline and annual incidence. Potential risk factors were compared between the injured and uninjured groups using T-tests with Hedges’ g effect sizes.
Results: At baseline, 7 cricketers (21.8%) had evidence of lumbar spine stress injury. Subsequent incidence was 27.3 ± 18.6 injuries per 100 players per year (mean ± 95% CI). Injured bowlers were older on average at the beginning of the season preceding injury (16.7 versus 15.5 years, g = 1.396, P = 0.047)
Conclusion: Risk of lumbar spine stress injury coincides with increases in bowling & cricketing workload as well as intensity as bowlers step up playing levels to more senior teams during late adolescence whilst the lumbar spine is immature and less robust.

Prospective Study of Functional Outcome of Comminuted Unstable Inter-Trochanteric Fracture with Cemented Bipolar Prosthesis in Elderly Patients

Laxman Choudhary, Sachin Pachori, Chetan Mehra, Mohit Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 358-369

Introduction: An intertrochanteric femur fracture is one of the most important health problems amongst the elder population.
Aim: To evaluate the functional outcome and complications of cemented bipolar arthroplasty in unstable intertrochanteric femur fracture in Indian elderly patients.
Methods: This study was conducted in the Department of Orthopedics, SMS medical college, and associated groups of hospitals, Jaipur between July 2017 to Dec 2019. 30 cases of unstable [four-part] Trochanter fracture have been included in this study.
Results: The average age of the study patient was 75 years with the involvement of the left side in 55%. There was no case with the poor radiological result. There were two cases reported with limb lengthening less than 2 cm, and two patients with limb shortening one with < 2cm and one with > 2cm but these patients had good harris hip scores. At the final 1-year follow-up harris hip scoring system, 36-36% of patients had an excellent result, 46.66% had a good result, 10% of patients have fair results and 6.66% have a poor result. The patients who showed poor scores suffered from multiple medical problems and poor preoperative general physical health.
Conclusion: According to our result, we believe that cemented bipolar hemiarthroplasty is of choice in the freely mobile elderly patient above seventy years of age with an intertrochanteric femoral fracture.

A Prospective Study of Predicting the Nuclear Grade of Breast Cancer Using Diffusion Weighted Imaging: An Institutional Based Study

Tushar Prabha, Jawahira Chisti, Mahendra Kumar Yadav, Kartikeya Jain

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 370-374

Introduction: As it has to aware that the breast cancer is the commonest cancer among women around the globe. Diffusion Weighted Imaging (DWI) helps to evaluate the physiological and functional environment of the lesion by observing the random motion of water molecules, tissue cellularity, fluid viscosity, membrane permeability and blood flow pattern that could be measured quantitatively by Apparent Diffusion Coefficient (ADC) values.
Materials and Methodology: A total of 70 patients with histo-pathologically proven breast carcinoma form the study sample in the study (3 patients had bilateral malignancy). MRI examinations were performed within 2 weeks before surgery. All the 70 participants who had done breast MRI underwent surgery. Statistical analysis was performed using SPSS (Statistical package for social science version16.0 for windows). Students T test and Analysis of Variance (ANOVA) were used to study the difference in ADC between two groups.
Results: Out of all the total 70 breast lesions, 53 lesions were (76%) single, while 9(13%) were multifocal carcinoma and 8 (11%) were multicentric multifocal breast carcinoma. Histological types included invasive ductal carcinoma no special type (65) invasive lobular carcinoma (1) mucinous carcinoma (2) papillary carcinoma (1) medullary carcinoma (1). The ADC value was correlated with pathological grading of the tumour (r = ‑0.497, P < 0.001).
Conclusion: DWI usually takes short acquisition time and post‑processing time and does not require any administration of contrast dyes and provides a real-time quantitative functional parameter for evaluating the tumour aggressiveness.

A Hospital Based Prospective Study to Compare the Serum Ascitic Fluid Albumin Gradient (SAAG) with Ascitic Fluid Total Protein (AFTP) in Hepatic and Non-Hepatic Causes of Ascites at Tertiary Care Center

Mukesh Kumar Khinchi, Shiv Kumar Goyal, Mukesh Sonkaria, Aashish Kumar Bagarhia

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 375-381

Background: The traditional way of classification of ascites by AFTP offers little insight to the pathophysiology of ascites formation and it has further drawbacks. In order to overcome it the classification of ascites based on SAAG has emerged. Even SAAG also has some draw backs like non correlation with ascites due to nonalcoholic cirrhosis and difficulty in identifying the ascites due to mixed etiology. So, the study is conducted to compare the serum ascetic fluid albumin gradient (SAAG) with ascetic fluid total protein (AFTP) in hepatic and non-hepatic causes of ascites at tertiary care center.
Materials& Methods: A hospital based prospective study done on 80 patientswho were admitted in the medical ward under Department of General Medicine, General surgery and radiation oncology in SMS Medical College, Jaipur, Rajasthan. They are classified on the basis of SAAG into High SAAG and low SAAG and on the basis of AFTP into Transudate and Exudate. After the etiology of ascites evaluated by various diagnostic procedures the sensitivity, specificity and diagnostic accuracy of SAAG and AFTP in identifying the pathophysiology of ascites calculated separately. The diagnostic accuracies of SAAG and AFTP compared statistically.
Results: Our study showed that the mean age was 50.23 years. Male to female ratio was 2.33:1. The cirrhosis occupies the maximum with 60%, liver metastasis, Antenatal with Hypertensionoccupiestheleastwith1.25%each. The diagnostic accuracy of SAAG and AFTP for individual aetiologies of ascites were found and compared. SAAG was found to be superior to AFTP with a P value of <0.01 which was statistically significant.
Conclusion: We concluded that the diagnostic accuracy of SAAG and AFTP was compared and SAAG was found to be superior to AFTP and it was proved statistically significant.

The Correlation between the Length of Time until Surgery and the Length of Postoperative Hospitalization for Neurosurgical Patients

Gaddala Penchalaiah, SK. Vali Babu, K.V.V. Satyanarayana, Chanumolu Praveen

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 382-388

Background: Triage is performed for inpatient urgent surgery at the majority of hospitals and is determined by the degree of urgency as well as the time of surgical booking. It is possible that the postoperative course will be affected if, as a result of sharing resources among specialists, patients need to wait longer for semi-urgent surgeries. The purpose of this research is to investigate whether or not there is a correlation between the length of time before semiurgent surgery and the postoperative duration of stay in the hospital for neurosurgical patients.
Materials and Methods: A retrospective cohort study was carried out between June 2020 and  May 2022 at the  Guntur Medical College & General Hospital, and it included all of the adult patients who were admitted and placed on the semi-urgent surgery list during that time. A combination of linear and logistic regression analysis was carried out. The most important factor to consider for the exposure was the amount of time that passed between the surgical booking and the actual operation, whereas the most important factor to consider for the result was the amount of time that passed between the operation and the patient's discharge.
Results: The research looked at a total of 1,367 different instances of neurosurgical treatment. 54.3 years was the average age of the population. Before surgery, patients spent an average of 1.2 days in the hospital, whereas those recovering from surgery stayed there for an average of 12.5 days. In all, the amount of time that passed between the booking of the procedure and the actual discharge did not change. In the group of patients who were later transferred to another facility, a longer postoperative stay was related with increased age, a higher ASA score, and procedures done more than 24 hours after the initial patient booking.
Conclusion: Patients who neurosurgery procedures had scheduled to be performed within the next 24 hours had to wait longer for their procedures to be finished. Although there was an increase in postoperative stays among patients who were sent to another hospital and had their procedures conducted beyond 24 hours, there was not a significant association between the amount of time waiting for surgery and postoperative stay in the aggregate.

Management of Chronic Subdural Hematoma Institutional Experience

Gaddala Penchalaiah, SK. Vali Babu, K.V.V. Satyanarayana, Chanumolu Praveen

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 389-397

Background: To study and assess the predisposing factors, age, sex distribution, modes of presentation, and management strategies of chronic subdural hematoma.
Materials and Methods: It was a Prospective study. The study was carried out during the Period from March 2020 to January 2022. Sample size included 30 patients. Informed consent will be taken from all the patients included in the study.
Results: A total of 30 patients were included in my study.  In this study, the majority of the patients were > 60 year of age (40%). The youngest patient was 30yrs, and the oldest was 84 years. The mean age (59.2 years).   The mean GCS was 8 in patients with LOC, 8.36±0.74 in those with altered sensorium, and 9.5±3.78 in patients with seizures. The GCS was comparatively better in patients with weakness (12.14±2.79) and headache (15). In the present study 40% of pt came with GCS 13- 15, and 36.6% came with GCS 9-12. In the present study out of 30 patients, 17 patients (56.7%) had right side involvement, 12 patients (40.0%) had left side involvement and 1 patient (3.33%) had bilateral involvement. More than 95% of patients had FTP involvement. Out of 31 scans, 74.1% of patients had a homogenous type and 22.5% had a layered type appearance on CT.
Conclusion: All patients are managed with burr hole tapping and placement of a subperiosteal drain. On further follow-up, around 2 to 3 months, SDH is completely resolved in all 29 patients and no recurrence of CSDH is noted.

Prevalence and Determinants of nosocomial inflections among patients in ventilator in a Tertiary Care Hospital at Makkah Al-mukarramh 2022

Mohammed Hasan Alsharif, Esraa Abbas Bokhari, Anwar Rashad Hakeem, Rahaf yaseen Almutawa, Imtinan Abdullah Alhazmi, Raniyah Abdulrahim Alsiyami, Sohaib Osama Baarimah, Bashayer Saad Altowerqy, Ataa Fouad Mesbah

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 398-413

Nosocomial infections or healthcare-acquired infections are a common cause of increased morbidity and mortality among hospitals patients. Patients are at an increased risk for these infections due to their health states. Considering these adverse effects on and the socioeconomic burden, efforts should be made to minimize the transmission of these infections and make the hospitals a safer environment. These infection rates can be significantly reduced by the implementing and improving compliance with the “care bundles.” the common nosocomial infections such as ventilator-associated pneumonia (VAP), catheter-associated urinary tract infections (CAUTI), and surgical site infections (SSI).ventilator-associated pneumonia (VAP) is the most common nosocomial infection in the intensive care unit (ICU). It is a pulmonary infection that occurs after at least 48 hours of intermittent positive-pressure ventilation (IPPV), and is a leading cause of morbidity and mortality. The incidence of VAP ranges from 10% to 65% of intubated patients depending on the risk factors. This study aimed: To assess prevalence and determinants for nosocomial inflections (NI) among patients in ventilator at Makkah Al-mukarramh hospital Saudi Arabia. Methods: A cross -sectional research design was carried out between Feb 2021 to May 2021 included 300 of patients in ventilator, who were randomly selected from hospitals. A structured questionnaire and observation checklist was used for data collection.  using 3part Questionnaire and analyzed via SPSS v24 software. Chi-square test was run to analyses associations between socio-demographic data. Results: The distribution of pathogens is demonstrated, level of education, monthly income, hospital stays, BMI, chronic Medical conditions show that a significant relation between Nosocomial infection and Chronic Medical conditions were P-value=0.000 Conclusion: The study's found that prevalence of nosocomial inflections among patients in ventilator in a Tertiary Care Hospital . Therefore careful disinfection and strict procedures of nosocomial inflections are necessary in places that serve nosocomial inflections patient. Moreover, a vision for the improvement of reports and studies in hospitals to report the rate of the nosocomial inflections, hence, there is a need to raise awareness as well as training on nosocomial inflections among patients in ventilator

The profile of thyroid disorders in patients with type 2 diabetes mellitus patients above age of 40 years

Dr. Monika MP, Dr. Prajwal Kumar US

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 414-418

Type 2 DM hyperthyroidism is reported to be more common as compared to normal people. In many patients, uncontrolled hyperthyroidism may be the reason for poor glycemic control and recurrent diabetic ketoacidosis. In response to hyperthyroidism gut absorption of glucose is increased along with endogenous glucose production. Randomly selected 100 patients, both male and female with type 2 diabetes mellitus above age of 40 years including newly diagnosed diabetics attending hospital were included in this study. Among the study group of 100 patients 2 patients had high T4 value, 8 patients had high TSH values and 4 patients were low TSH values.

The clinical profile of type 2 diabetes mellitus patients above age of 40 years

Dr. Monika MP, Dr. Prajwal Kumar US

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 419-424

Diabetes mellitus found to be leading cause of mortality and morbidity in worldwide in the future and it is a predisposing factor for cardiovascular disease. End stage renal disease, adult blindness, lower extremity amputation (non-traumatic) are the leading causes in diabetes mellitus. Diabetes mellitus is one of the most common health problems facing mankind and is a major public health problem. Randomly selected 100 patients, both male and female with type 2 diabetes mellitus above age of 40 years including newly diagnosed diabetics attending hospital were included in this study. Among the study group of 100 patients 46% patients had hypertension and 10% had ischemic heart disease. Among the study group of 100 patients 48% had positive family history and 52% had negative family history. Among the study group 100 patients 5% had HbA1C less than 6, 56% had between 6-7.5 and 39% had HbA1C above 7.

A Study to evaluate the relationship between glycemic control and occurrence of altered thyroid function in type 2 diabetes mellitus

Dr. Monika MP, Dr. Prajwal Kumar US

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 425-431

Thyroid hormones affect glucose metabolism through several mechanisms. Hyperthyroidism has been recognized to promote hyperglycemia. During hyperthyroidism, the half-life of insulin is reduced most likely secondary to an increased rate of degradation and an enhanced release of biologically inactive insulin precursors. Randomly selected 100 patients, both male and female with type 2 diabetes mellitus above age of 40 years including newly diagnosed diabetics attending hospital were included in this study. Out of 12 patients 4 patients (33.3%) had systemic hypertension and 1 patient (8.33%) had ischemic heart disease, compared with normal thyroid profile group it is of no statistical significance with P value of 0.896. Comparing mean HbA1C of patients with abnormal thyroid profile with that of patients with normal thyroid profile it has no statistical significance with P value of 0.7944

A Comparitive Study of CT Features of Raised Intracranial Pressure in Post Covid Patients & General Population

Dr. Bellamkonda Santh Kumar, Dr. Kondragunta Chandrasekhar Rao, Dr. Madala Venkata Phalgun, Dr. Jeldi Blandina Deepthi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 432-439

Headache is a commonly reported complaint among Covid19 patients, and cases of chronic head aching have lately been documented several weeks after illness recovery. Raised intracranial pressure (ICP) plays a key role in the causation of head ache, Raised ICP if not timely treated leads to brain complications. The study aims to compare the incidence of elevated ICP in post-covid populations to that of the general population, and the objective of study is to assess the features of raised intracranial pressure in post covid and in general population by using CT
Method:
Current study was conducted on 150 subjects who have headache symptoms, in which 75 had Covid history and other 75 from general population. The brain CT image of this 150 subjects evaluated to assess ICP And for identifying the comparison between post covid subject with normal subject. This is study done at DR. PSIMS&RF,Gannavaram,AndhraPradesh.CT brain examinations were performed on 16slice SEIMENS CT machine in the department of radiodiagnosis. CT brain images of patients with headache complaints were evaluated.
Results:
CT Brain images of 150 subjects who came with complaints of headache were evaluated.75 patients among them had past covid history, rest 75 were taken as general population group. In the post covid group 32 patients (42%) had raised ICP features&18 patients (24%) in general population had raised ICP features. Bilateral tortuous optic nerve sheaths were found in 34 patients (45%) in post covid group as opposed to 21 patients (28%) in the general population group. Partial empty sella was found in 35 patients (46%) of post covid group as opposed to patients 21(28%)in the general population group. Patients who had both partial empty sella and bilateral optic nerve sheath dilatation were considered to be of raised ICP to rule out other etiologies

Factors Affecting Viability of Contents in Complicated Hernia

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 440-444

Background: Complicated external hernia is common and serious; no definitive clinical criterion is able to differentiate strangulation or infarction. Surgeons therefore, have difficulty in choosing the appropriate treatment (manual reduction or emergent operation) and determining the ideal approach for these cases. This study was aimed at identifying the risk factors for developing complicated hernias and its predictive factors.
Methods: This is a prospective observational study of 53 cases with clinical diagnosis of all types and varieties of irreducible hernia. The patient information regarding type of hernia, time duration before occurrence of irreducibility, duration of irreducibility, type of complication of irreducible hernia and presenting symptoms were collected and  analysis was done by SPSS software version 2.
Results: Majority of the cases of irreducible hernias were males (77%) seen in 5th and 6th decade (47.2%). Contents of hernia and duration of irreducibility were significantly associated with viability of contents of hernia. Majority of the hernias with bowel as content and those with increased duration to irreducibility were non-viable. The Sensitivity and Specificity of ultrasound viability were found to be 50%, and 100% respectively in detecting the viability of hernia.
Conclusions: The factors affecting the viability of contents of hernia in our study are mainly contents of hernia and duration of irreducibility. Bowel as the content of hernia and increased duration to irreducibility poses higher risk for viability of contents of hernia.

A Study of Irreducible Hernia: Clinical Presentation and Management

Dr. Vaishak M Rai , Dr Mukteshwar N Deshmukh, Dr Pankaj Nandagawali, Dr. Khushbu O Gandhi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 445-453

Background: The anterior abdominal wall hernia is commonly encountered in surgical practice. When they present as complicated hernia, the complication, morbidity, and mortality are high even after standard protocol management. The present study was undertaken to assess the incidence of irreducible hernias presenting with complications, mode of clinical presentation and management of irreducible hernia.
Method: During the study period from May 2019 to Nov 2021, a total 53 clinically diagnosed case of irreducible hernia were studied which included groin hernia (66.6%) and anterior abdominal wall hernia [incisional hernia (22.6%), umbilical (1.88%), epigastric (1.88%), paraumbilical (3.9%)].
Results: The incidence of irreducible hernia was 3.2% (1650/53). Duration of existing hernia was common in 86.7% cases after 1-year. Maximum cases (74.8%) presented within 24-hours of onset of symptoms. The commonest symptoms were irreducible swelling (100%) and pain (85%). Maximum (52.8%) cases presented with bowel obstruction as complication. Cause of irreducibility was neck of hernial sac (56%) and adhesions (43.4%). Commonest operative procedure was release of constriction (56.6%) and adhesiolysis (43.3%). 56.6% cases developed post-operative complications and surgical site infections (SSI) was the commonest one (33.9%). No recurrence found during the study period. 3(5.6%) patients were expired, 2 patients died because of septicaemia secondary to anastomosis leak and 1 case ARDS. Conclusion: The present study clearly shows longer duration of existing hernia, existing co-morbidities, delay in operation in irreducible hernia is associated with definite complications and mortality. Hence, earlier hernia repair and not wasting crucial time when patient of irreducible hernia comes to hospital.

Study of care giver burden in persons living with HIV-A cross sectional study

Dr. Shazia Hamid, Dr. Amir Suhail Mintoo, Dr. Rekha Rani, Dr.Joginder Singh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 454-462

Background: The main aim of the present study was to assess the prevalence of caregiver burden among the family members of persons living with HIV.
Methods: A cross sectional hospital based study was conducted at ART PLUS centre GMC Jammu, over a period of 1 year from November 2018 to October 2019 after IEC permission. Written and Informed consent was obtained from each participant and predesigned and valid questionnaire was administered to each participant. During the interview, caregivers were asked about their demographics, including gender, age, educational status, employment status, marital status and annual income. Caregivers were asked about their level of caregiver burden through ZARIT QUESTIONNAIRE.
Results: There were a total of  100 caregivers participated in the study done over a period of 1 year conducted in GMC JAMMU. The majority were females (56%). Their age ranged from 17- 77 years and the mean age of the participants was 44.89 years (SD= 15.035). Most of them was in the age groups 17-30 years old (22.5%) and more than 60 years old (22. %).The mean caregiver burden score for the caregivers of PLHIV in this study was 51.85 (SD=17.5), range 0-88. The largest group of the participants (59%) reported “moderate to severe” caregiver burden. 29% caregivers living with HIV positive patients experience severe burden. 12% had only mild to moderate burden. Out of 100 caregivers, 91 were married (91%).26 out of 91 (28.8%) suffered severe burden and 54 (59.3%) suffered moderate to severe burden where as 3 of 9 (33.3%) unmarried caregivers suffered from severe burden and 5(55.6%) of them had moderate to severe burden. Mild burden is noted in 12.1 % married caregivers and 11.1% of unmarried caregivers.
Conclusion: Majority caregivers of PLHIV experience caregiver burden. Intervention including care plan should be given to caregivers to minimize risk of burden and depression and increase their quality of life. This study also emphasizes that correct interventions at the right time will give the caregiver a better quality of life with lower stress and higher wellbeing of a caregiver.

CARDIORENAL SYNDROME AND HEART FAILURE: WHAT’S ASSOCIATION?

Dr. Devpriya Shukla, Dr. Pushpendra Singh Sengar, Dr. Anju Jha, Dr. Maneesh Jain

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 463-470

INTRODUCTION: -Heart failure is among key reasons of hospitalizations throughout the world. Prevalence is 1% among the ages of 50 and 59 years, gradually growing to >10% over age of 80 years. In patients with heart failure, concomitant and notable renal impairment is prevalent. Heart failure is increasingly being classified as a type of cardiorenal failure, in which there are contemporaneous cardiac and renal dysfunctions, each of which         accelerates the progress of the other.
AIMS AND OBJECTIVES:-To study the etiology, risk factors and clinical outcomes of heart failure and cardiorenal syndrome.
MATERIALS AND METHODS: - The present study is an observational study conducted at Sri Aurobindo medical college and Post Graduate Institute, Hospital ,Indore on 75 patients admitted in Medicine ward, Medicine emergency and Medicine ICU.
RESULTS:-The major risk factor which associated with mortality was coronary artery disease  73.5%.Type 2 diabetes mellitus was present in 62.5% patients while hypertension in 42.7%. Smoking was the risk factor in 46.2% and alcohol in 41.7% patients, COPD was present in 8.2% cases. NYHA grade 4 was more common and was seen in 79.2% while NYHA grade 3 in 22.8% cases.
CONCLUSION: Cardiorenal syndrome is very common in people who have heart failure. Patients with heart failure who have had two or more previous hospitalizations, sepsis, history of CAD and hypothyroidism are more likely to develop cardiorenal syndrome. The development of cardiorenal syndrome is an independent predictor of frequent readmissions, In addition to longer hospitalization and slower recovery, under treatment of the cardiorenal syndrome has the potential to be fatal on an individual level and have massive public health repercussions.

A Randomised Controlled Trial Compared the Pain Felt at the Surgical Port Site Following Gall Bladder Retrieval via an Epigastric Port versus an Umbilical Port during Laparoscopic Cholecystectomy

Nedurumalli Vaishnavi Reddy, V. Mahidhar Reddy, Venkata Harish

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 471-477

Background: In adult patients undergoing four-port elective laparoscopic cholecystectomy at a tertiary care hospital, the purpose of this study is to determine whether or not the removal of the gall bladder (GB) through the umbilical port is associated with more pain at the port site when compared to the removal of the GB through the epigastric port.
Materials and Methods: Patients over the age of 18 who were scheduled to undergo elective laparoscopic cholecystectomy at our facility in 2021 and who were randomly assigned to either group 1 or group 2 were evaluated for the purpose of this study. A VAS was used to evaluate the patient's level of pain at 1, 6, 12, 24, and 36 hours following surgery by a registered nurse.
Results: At 1, 6, 12, 24, and 36 hours following surgery, the VAS for pain measured at the umbilical port was lower than the VAS for pain measured at the epigastric port, and this difference was statistically significant (p-value 0.001). After correcting for age, sex, duration of surgery, and supplementary analgesic use, multiple linear regressions were done for port site pain after 24 hours. The results showed that the VAS at the umbilical port was lower than the epigastric port, with a difference in VAS of 0.9.
Conclusion: When patients are undergoing elective laparoscopic cholecystectomy, retrieving the gall bladder through the umbilical port is related with less pain at the port site than retrieving the gall bladder through the epigastric port. For the removal of the gall bladder, we recommend using the umbilical port.

Effects of Carvedilol and Bisoprolol on Inflammation and Oxidative Damage in Patients with Chronic Heart Failure

J. Jacob Justin, Sabu Augustine

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 478-485

Background: Inflammation and oxidative stress contribute to persistent heart failure (CHF). Bisoprolol is better than carvedilol at protecting CHF patients' myocardium, according to our earlier clinical trial. Low high-sensitivity cardiac troponin T showed this (hsTnT).
Materials and Methods: From the 87 people who took part in the trial, 48 (26 in the bisoprolol group and 22 in the carvedilol group) were included in this study because they had measurements of derivatives of reactive oxygen metabolites (d-ROMs) as an indicator of oxidative stress at the beginning and end of the trial.
Results: High-sensitivity C-reactive protein (hsCRP), a marker of inflammation, went down in both groups, but the drop in the bisoprolol group was bigger than the drop in the carvedilol group. Both groups also had a drop in d-ROMs, but the drop in the bisoprolol group was not as big as the drop in the carvedilol group. The change in hsTnT was linked to the change in hsCRP for all 48 patients (R = 0.467, p = 0.003).
Conclusion: Bisoprolol might be better than carvedilol at reducing inflammation, but carvedilol might be better at reducing oxidative stress than bisoprolol. Patients with CHF could benefit from the right use of bisoprolol or carvedilol based on their own pathophysiology.

Factors Influencing Post-Myocardial Infarction Patients' Utilisation of Dual Antiplatelet Medication over the Long Term: Findings from the Tigris Registry

J. Jacob Justin, Sabu Augustine

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 486-494

Background: To outline the current patient profiles and treatment regimens, including antithrombotic care, for post-myocardial infarction (MI) stable coronary artery disease (CAD) patients from various geographical locations who are at high atherothrombotic risk.
Materials and Methods: 25 medical professionals (96% cardiologists) from india (2021-2022) enrolled patients 50 years old with prior MI 1-3 years ago and 1 risk factor (age 65, diabetes, second prior MI>1 yr ago, multivessel CAD, creatinine clearance 15–60 mL/min) in the prospective TIGRIS trial.
Results: 225 post-MI patients were enrolled (median 1.8 years): 52% with prior ST-elevation MI, median age 67, 24% women, 67% caucasian, 55% with 2 additional risk factors, 14% current smokers, 67% overweight/obese, 34% with blood pressure 140/90 mm Hg. 81% of MI patients had PCI (66% with drug-eluting stents). 75% of patients were discharged on dual antiplatelet treatment, mostly clopidogrel (75%). 63% had stopped antiplatelet therapy (1 year) on doctor's advice (90%). At enrollment, 97% were taking an antithrombotic medication, most commonly ASA (88%), with 27% on DAPT (median duration 1.6 years); highest (39%) in Asia-Pacific and lowest (12%) in Europe.
Conclusion: 1 in 4 post-MI patients didn't undergo DAPT for 1 year, despite guidelines. Contrary to guidelines favouring newer ADPris, clopidogrel was given. Prior to current RCT results supporting DAPT>1 year post-MI/PCI, >1 in 4 patients continued on DAPT, despite international variation.

A Study of Functional Outcome of Clavicle Fractures Osteosynthesis with Plating

Ramavath Arjun Naik, L. Madhu, Nagendra Babu, Moola Sohith Mahadeva Reddy

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 495-499

Background: The traditional view that the vast majority of clavicular fractures heal with good functional outcomes following non operative treatment is no longer valid. Recent studies have identified a higher rate of non-union, late neurovascular compromise and specific deficits of shoulder function in subgroups of patients with these injuries who are treated by conservative means. To study the functional outcome osteosynthesis of clavicle fractures using anatomical Locking compression plate.
Materials and Methods: Study was conducted on 20 patients with displaced/comminuted clavicle fractures. All the patients were treated by open reduction and internal fixation with 3.5mm anatomical LCP plate and screws. Functional outcome was recorded at regular intervals postoperatively at 6,12 & 24 weeks according to Constant Murley scoring system.
Results: According to Robinsons classification 2 were 1B1 type, 6were 2B1,8 were 2B2 and 4were 3B1 type. Range of motion was well maintained in all patients. The values were as of the normal contralateral shoulder, 82% of patients having >90% of the normal function (Excellent grade) at last follow up.
Conclusion: Clavicle fractures should therefore be viewed as a spectrum of injuries with diverse functional outcomes, each requiring careful assessment and individualized treatment, and plate osteosynthesis should be preferred for the treatment of indicated clavicle fractures in young active individuals.

Study of Etiology, Clinical Profile and Prognosis in Acute Kidney Injury Patients of Guntur District

Uppalapati Ganga prasad, Gorijala Aparna, Pillarisetty Meroz

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 500-511

Background: Acute renal failure (ARF) is a generic term for an abrupt and sustained decrease in renal function resulting in retention of nitrogenous (urea and creatinine) and non-nitrogenous waste products. To determine the cause, prognosis and outcome in patients of Acute Kidney Injury (AKI) admitted in a tertiary care hospital.
Materials and Methods: A Hospital based Prospective study was conducted in Department of Medicine, NRI Medical College for a 1 year period (From Septembet 2021 to Aug 2022). Universal Sampling Technique was used for selection of study subjects. All the patients coming to medicine department during the study period and fulfilling the xiii inclusion criteria were taken for study after taking prior informed consent. Final sample size was 138 subjects of Acute Kidney Injury of varied etiology.
Results: Mean of study subjects was 48.9 years (range from 19-87 years) with M:F ratio of 4.75:1. Most common etiology for AKI was Sepsis (14.5%) and Malaria infection (14.5%) followed by Dengue, AGI and Leptospirosis (11.6% each). Multi organ dysfunction (14.5%) was observed in patients of Sepsis and Lepto. Out of total patients, 92 (66.7% %) had stage II AKI, while 46 (33.3 %) had stage III AKI according to AKIN staging.A total of 11.6% patients were on dialysis. Two out of 46 patients of AKI stage III (8.7%) and one patient out of 92 (2.2%) belonging to AKI stage II died during the study.
Conclusion: AKI was observed at a relatively younger age in present study with male preponderance. Most common etiologies were Sepsis and Malaria. Most of the patient of Sepsis, MODS and Leptospirosis were having stage III AKI. Overall mortality observed was 4.34%.

To Identify the Sensitivity and Specificity of Fiberoptic Bronchoscope to Diagnose Pulmonary Tuberculosis

Syed Ahmed Hussain, Rajendra Prasad, Sachin Kumar, Ved Prakash, Pushpendra D. Pratap, Sharique Ahmad

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 512-521

Background: Tuberculosis (TB) has affected humans for most of their history and remains a major cause of mortality in adults worldwide Prevalence of Tuberculosis (TB) has been on a dangerous and positive spike for over a decade and has killed millions of people year on year. Almost, 1.3 million people in 2012 alone lost their lives to TB. As per the massive prevalence of TB, it would be incorrect to say that the disease does not poses like a pandemic. Alongside HIV, it remains a top cause of death from an infectious disease. Hence the present study was planned to evaluate the role of fiberoptic bronchoscopy in sputum negative pulmonary tuberculosis cases.
Materials and Methods: The study was carried out at Department of Pulmonary Medicine, Era's Lucknow Medical College & Hospital, Lucknow. Sputum smear negative presumptive patients of PTB. All the relevant samples were sent for Cartridge based nucleic acid amplification test (CBNAAT)/genexpert for BAL, post bronchoscopy sputum, bronchial aspirate, TBLB, Endobronchial biopsy and Transbronchial needle aspiration. Culture for Mycobacterium tuberculosis (MTB) was also obtained for all the patients. Culture is done on liquid media (MGIT).
Results: Majority of patients in the study population were adults: 21-60 years (82.6%), while only a small proportion of patients were aged ≤20 years and >60 years (8.7% each). Majority of patients in the study population presented with Cough (88.0%), Fever (78.3%), Loss of appetite (67.4%), Expectoration (63.0%) & Weight loss (56.5%). Majority of patients had negative CBNAAT (81.5%), AFB (95.7%) and Culture (77.2%) for Bronchial Aspirate. Thus indicating that fiberoptic bronchoscopy helps in establishing the diagnosis.
Conclusion: Considering the short processing time and high diagnostic efficacy, CBNAAT evaluation of bronchoalveolar lavage for detection of tuberculosis among sputum/smear negative tuberculosis cases is highly recommended

A retrospective review to assess the clinical outcome of rhino-orbito-cerebral mucormycosis patients with COVID-19 infection and its association with glycaemic control

Dr. Mohammad Yaseen, Dr. Narendra Choudhary, Dr. Bharat Mundel, Dr. Jitendra Patawat, Dr. Arvind Kumar Jain

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 522-530

Introduction: The coronavirus disease 2019 (COVID-19) pandemic in India, having caused 29 500 000 confirmed cases and 374 000 deaths as of June 14, 2021, continues to have devastating consequences, including a large epidemic of COVID-19-associated mucormycosis (COVID-Mucor), manifesting as rhino-orbito-cerebral mucormycosis (ROCM), which has worsened the morbidity among vulnerable populations (JHU, 2021) 1. Reports have shown a much larger surge in the incidence of COVID-Mucor during the second wave in 2021 than during the first wave (Patel et al., 2021; Moorthy et al., 2021) 2, 3. This rapid rise in COVID-Mucor is probably caused by several factors. For patients with diabetes mellitus, lockdowns, travel restrictions, and restricted access to medical care have worsened glycaemic control, the central risk factor for ROCM in India (Chakrabarti et al., 2006) 4. Addressing these could reduce morbidity and mortality among vulnerable populations.
Material and Methods: A Retrospective chart review was conducted in Department of General medicine Dr S N Medical College Jodhpur among population included all rhino-orbito-cerebral mucormycosis patients with Covid-19 infection who were admitted in Mucormycosis ward, Dr S N Medical College Jodhpur from Oct. 2020 to Sept 2021. Bed head tickets of all these patients were reviewed. The final outcome was noted from the bed head ticket, the outcome was correlated with random blood sugar and HbA1c level at admission.
Conclusion: Mucormycosis is angioinvasive fungal disease with significant morbidity and mortality. The disease has risen dramatically due to interplay of COVID 19 pandemic, uncontrolled diabetes and inappropriate corticosteroid use leading to pathogenic invasion and adverse outcomes. The treatment involves early detection, surgical debridement and antifungal drugs for better survival. Our study revealed an evident role of hyperglycemia as major risk factor for mucormycosis infection. Those patients who had HbA1c> 10 could not survive inspite of best treatment and those patients who survived their hospital stay was directly proportional to their HbA1c level. All those patients who had cerebral involvement could not be saved. Hence, we suggest that closely tracking the levels of blood sugar in COVID-19 patients is a valuable tool to stratify the risk that a patient will have mucormycosis.