Online ISSN: 2515-8260

Issue 2,

Issue 2


Effect of phototherapy on serum electrolytes in neonatal hyperbilirubinemia

Dr. Shrdha Sharma, Dr. Rajeev Vinayak, Dr. Rita Hajela

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1-9

Introduction: Neonatal hyperbilirubinemia is the most common clinical finding noted during
the first seven days following birth. Amongst all the modalities available for management of
neonatal hyperbilirubinemia, phototherapy is proven to be the safest. However, like any other
intervention, phototherapy too has some of its own side effects.
Aim & objectives: To estimate and compare alterations in serum electrolytes of healthy term
neonates before and after phototherapy.
Material & methods: A hospital based prospective observational comparative study was
conducted over a period of 18 months in the department of Pediatrics on 110 healthy term
neonates with unconjugated hyperbilirubinemia who were subjected to phototherapy as per
American Academy Pediatrics guidelines. Electrolytes including sodium, potassium, chloride
and calcium were analyzed from serum using standard laboratory techniques.
Results: The mean sodium, chloride, potassium and calcium levels before phototherapy was
141.3±2.69 meq/L, 102.2±2.98 meq/L, 4.43±0.52 meq/L, 9.14±0.46 mg/dl and after
phototherapy was 140.5±2.70 meq/L, 102.0±2.93 meq/L, 4.23±0.48 meq/L and 8.09±0.55
mg/dl respectively. All were found to be statistically significant (p-value <0.05); although none
were clinically significant and conveyed no symptom of dyselectrolytemia in this study.
Conclusion: This study shows that neonates exposed to phototherapy are at a risk of
developing electrolyte imbalances and consequently their complications. Hence, close
monitoring of such babies are needed to prevent imbalances and their untoward consequences.

To assess the outcome after early internal fixation of both, femur & tibia in floating knee injuries: Hospital based single center cross sectional study

Dr. Ashok Kumar Vishnoi, Dr. Vineet Singh Kuntal, Dr. Jasveer Ola, Dr. RC Bansiwal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 10-17

Aim: To assess the outcome after internal fixation of floating knee.
Materials and Methods: Hospital based single center cross sectional descriptive type of
observational study among 80 patients in the department of Orthopedics in teaching hospitals
attached to S.M.S Medical College and hospital. After obtaining clearance and approval from
the institutional ethical committee and patients detailed history was obtained using the study
proforma with special attention to mechanism of injury. Examination of other associated
symptoms was based on history and clinical examination. Open reduction internal fixation of
floating knee under spinal anaesthesia under c-arm guidance. Routine antibiotics and
analgesic/anti-inflammatory drugs were administered. Post-operative evaluation was carried
out by clinical examination and X-ray. Functional assessment and final outcome were measured
according to the Karlstrom criteria.
Results: Male (85%) prominence was higher than females (15%). Mean age of male and female
was almost same. In the study, 17 (21.3%) patients did not have any associated injuries while
63 (78.1%) patients have any associated injuries among them, 52.5% patients have
Contralateral Limb Injury, 15% patients have head injury and 11.3% patients have pelvic
injury. In the study, 55% patients have grade I type, 20% patients have grade IIa type, 10%
patients have grade IIb type and 15% patients have grade IIc type. Right side (65%) most
common affected than left side (35%). RTA (80%) most common cause of trauma than FFH
(15%) and assault (5%). Close (60%) type of injury recorded higher than compound (40%).
Interlocking nail femur (70%) was most common treatment for fixation of femur fracture than
plating (20%) and external fixation (10%). Interlocking nail tibia (50%) was most common
treatment for fixation of tibia fracture than plating (30%) and external fixation (15%). Excellent
results was found in 40% patients, good results was found in 30% patients, fair results was
found in 20% patients and poor results was found in 10% patients.
Conclusion: The most important factors which determine the functional outcomes were the
type of fractures (open or closed), pattern of fracture, intraarticular involvement, and treatment
modality used. Fraser’s classification effectively classifies the injury and helps to determine
the eventual outcome of injury. Karlstrom criteria are an effective scoring system to grade the
functional outcome of floating knee injuries.

A study of acute kidney injury in cirrhosis of liver

Dr. Meghna Vaidya, Dr. Nitin Sarate, Dr. Juhi Kawale, Dr. Vinayak Pai

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 26-34

Background: The prevalence of renal dysfunction has been reported to vary from 14-50% in
patients with cirrhosis. The prevalence is estimated to be approximately 50% among patients
with cirrhosis and ascites and 20% of patients with advanced cirrhosis admitted to the hospital
3,4. The wide range in prevalence is likely due to different study populations and varying
definitions of renal dysfunction. Patients with HRS who fail to respond to medical therapy or
those with severe renal failure of other etiology may require renal replacement therapy.
Simultaneous liver kidney transplant (SLK) is needed in many of these patients to improve
their post-transplant outcomes. However, the criteria to select patients who would benefit from
SLK transplantation are based on consensus and lack strong evidence to support them. Heath
care system has evolved over the last decade and newer drugs are available for the management
of complication of cirrhosis. We attempt to study its impact on course and outcome of acute
kidney injury. Also few of the patients could possibly be on the antiviral drugs for hepatitis B
and hepatitis C. If these patients are admitted they will be included in study and we would study
the effect of the effect of this drug on acute kidney injury and vice versa. Hence, the present
study was conducted to study clinical profile of patients with acute kidney injury in liver
cirrhosis.

TRAINING SCENARIO DEVELOPMENT ON ENVIRONMENTAL EDUCATION USING THE STSE MODEL TO IMPROVE POSITIVE ATTITUDES OF PROSPECTIVE EARLY CHILDHOOD EDUCATION TEACHERS TOWARDS THE ENVIRONMENT

Dr. MA. Muazar Habibi .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 35-40

The purpose of this research is to develop training scenarios on environmental education using Science, Technology, Society, Environment (STSE) model integrated into scientific thematic lessons, particularly for prospective early childhood teachers. In addition, product efficiency on the positive attitudes of the trainers towards the environment was examined. The above-mentioned objectives are possibly achieved with the following activities: 1) initializing the Borg & Gall model (1999) and 2) assessing the resulting product value using t-test, termed pre-test and post-test. Therefore, the applied simulations were declared suitable for use after series of  developmental events.
The results involved three expert assessments in the field of early childhood, environmental education, and educational technology, although further analysis is required. Subsequent investigation conducted on the subject user group, indicating a positive value of 83.3%, in support of the product.
Therefore, the efficiency test results showed the training on environmental education using the STSE model and integrated with scientific thematic lessons, were known to enhance 32.44% of all aspects of the prospective teacher's positive attitudes on the environment.

Effect of Rocuronium bromide in patients of Chronic Renal failure vs Normal patients

Dr. Pradeep L, Dr. Veena, Dr. Manjunatha chandrashekar .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 41-46

Background: Rocuronium bromide, a mono quaternary amino steroid with a short onset and an intermediate duration of action, is currently one of the most commonly used neuromuscular blocking agent. In common with vecuronium, hepatic uptake & biliary excretion have been suggested to be the main mechanism of rocuronium metabolism with renal elimination accounting for 10-20% of its overall excretion. This study was conducted to investigate the neuromuscular effects of 0.6mg/kg rocuronium under general anaesthesia in patients with and without renal failure.
Methodology: This prospective observational study includes 110 patients (pts.) divided into two groups, Group ‘S’ (n=55) pts. with renal failure and Group ‘C’ (n=55) without renal failure. Neuromuscular transmission was monitored, parameters recorded were onset, time to maximal block, time to recovery of first twitch response to 25%, 50%, 75% and 90% of base line, time to recovery of train-of-four (TOF) ratio of 70% and recovery index 25% - 75%.
Results: In both the groups demographic data were similar. Both onset time and maximum block for rocuronium were comparable in group S and group C, found not significant. Time to recovery of first twitch response to 25%, 50%, 75% and 90% of baseline, time for recovery of TOF ratio to 70% and recovery index were significantly prolonged in group S compared to group C.
Conclusion: Rocuronium can be used with caution in patients with renal disease and monitoring of neuromuscular block in this group of patients is essential.

Estimation of serum uric acid as a predictor of the severity of Pre-eclampsia & eclampsia

Dr. Pankaj Bhushan, Dr. Rajni Kant, Dr. Usha Kumari, Dr. Madhu Sinha, Dr. Anand Prakash Anand, Dr Deepmala Sinha .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 47-52

Introduction-uric acid production is a normal phenomenon in normotensive pregnancy, however in preeclampsia and eclampsia uric acid production exaggerated may result in greater potential for endothelial oxidative damage. It has been reported that higher UA is indicative in women with preeclampsia and eclampsia.
Material and method-Prospective study was done for duration of 16 months i.e. may 2019 to Sep.2020 in the department of Biochemistry of central research laboratory of Magadh Medical College, Gaya, India. A total no.100 women in which 50 cases (30 Preeclampsia & 20 Eclampsia) and 50 control (30 were normal pregnant & 20 normal non- pregnant women with reproductive age group)
Result-The mean serum UA , 24hours urinary protein  were higher in preeclampsia and eclampsia compared to control.
Conclusion-A significantly increased serum UA in preeclampsia and eclampsia than control group indicate the significant role in pathogenesis of PIH. Total serum Protein levels are reduced in preeclampsia and eclampsia compared to control.

“COMPARATIVE STUDY OF FUNCTIONAL EFFICACY OF TRANSFORAMINAL VS INTERLAMINAR EPIDURAL STEROID INJECTION FOR LUMBAR DISC DISEASE”

Dr. Vinod kumar Sajjan, Dr. Anagha M V, Dr. Roshan kumar B N, Dr. Suresh I .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 53-65

Aims and objective: To compare efficacy of pain relief function of therapeutic transforaminal vs interlaminar epidural steroid injections and to assess improvement in functional outcome in lumbar disc disease patients after treatment.
Methodology: Patients with back pain documented with lumbar disc disease treated initially with rest, analgesics and physiotherapy for 6 weeks, will be analyzed clinically and radiologically. All the patients selected for the study be examined according to protocol, clinical and radiological investigations. Patients will be subjected into two groups by simple random sampling containing 30 members each. Group A will be given transforaminal epidural steroid injection and Group B will be given epidural steroid injection by Interlaminar route. Post epidural steroid injection  patients were followed up for 6months and post injection disability and pain was assessed using Roland morris low back pain disability questionnaire, visual numerical score, finger floor distance, patient satisfaction score.
Results: Pre procedure Roland Morris Disability mean score was compared with post epidural steroid injection. Reduction of 5 score or more after procedure considered significant. In a group receiving transforaminal epidural steroid, among 30 patients 24 patients had relief at end of 1month, 16 patients had relief at end of 6 months, and in other group receiving epidural steroid through interlaminar technique in that 12 patients had significant relief at 1 month, 8 patients had significant relief at the end of 6 months. On comparison of both the groups Roland morris disability mean score was statistically significance at 1month, 3 months and 6 months  in  TFESI group compared to ILESI group (p<0.05). On comparison of pre and post procedure Finger floor distance  of both the groups it was significant in TFESI group compared to ILESI group at 1 month and 3 months (p<0.05)  and was not significant at 6 months. Comparison by Patient satisfaction group was significant at 3 months in TFESI group compared to ILESI group (p<0.05)  and was not significant at 1month and 6 months. On comparison by Visual numerical score both the groups did not show any statistical significance.  Post procedure the complications, such as dural puncture, excessive bleeding or infection were not reported in both groups. But headache was reported in 2 patients in ILESI.
Conclusion: Patients with radicular pain from disc herniation or lumbar canal stenosis obtain significant relief from a TFESI. Transforaminal epidural steroid therapy has better outcome with respect to Roland Morris disability assessment, Visual Numeric Scale, Finger Floor Distance. Patient Satisfaction and Pain Relief - majority of the patients have a significant improvement which lasts for 6 months.

Laparoscopic cholecystectomy feasibility under spinal anesthesia

Dr. Mukesh Kumar, Dr. Amit Mittal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 66-71

Introduction: Laparoscopic cholecystectomy may be performed using spinal anaesthesia instead of
general anaesthesia (LC). In-depth investigation on the feasibility of laparoscopic cholecystectomy
Spinal anaesthesia is administered. Aside from general anaesthesia, regional anaesthesia has been
documented as a solo approach for executing LC (spinal/epidural/combined spinal epidural).
Material and Methods: The American Society of Anaesthesiologists anesthesiologists provided SA to
12 patients who had elective laparoscopic cholecystectomy with physical status I or II. Throughout the
perioperative phase, only drugs for anxiety, pain reduction, nausea/vomiting alleviation, hypotension
therapy, and adverse event management were administered. The operating table tilt was kept to a
minimum and the CO2 pneumoperitoneum pressure was less than 10 mm Hg during the LC procedure.
Several studies were undertaken to examine postoperative complications as well as the duration of
hospitalisation and patient feedback.
Results: Everyone had a successful spinal anaesthetic procedure and the maximum degree of sensory
blocking was reached at T4. Only one patient had GA for surgery, and that patient was not able to have
surgery with SA. Four patients (33.33%) complained of right shoulder discomfort after surgery, and
Fentanyl was administered to two of them. There was no additional discomfort during or after the
procedure. Midazolam was prescribed to two individuals for anxiety. One patient needed ephedrine
because she was hypotensive, despite intraoperative crystalloid infusions of 1460 (SD 138) ml.
Conclusion: As a standard technique, a laparoscopic cholecystectomy may be performed under spinal
anaesthesia. This is both feasible and safe. In hospitals with limited resources, such as those in developing
countries, laparoscopic cholecystectomy may be done under spinal anaesthesia

Ultrasonographic correlation of placental thickness in third trimester with fetal parameters, birth weight and fetal outcome

Dr. Nikhil Arora, Dr. Sahil Arora, Dr. Yashaswi Sharma, Dr. Navkiran Dhanota, Dr. Priyanka Arora, Dr. Sanjeev Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 72-77

Introduction: Despite careful antenatal surveillance involving scrupulous examination, an issue of
considerable disappointment is that a majority of low-birth-weight infants are not diagnosed until
delivery. Low birth weight infants are susceptible to hypoxia and fetal distress, long-term handicap, and
fetal death.
Objectives: The present study will be undertaken in our institution to study the correlation of placental
thickness, measured at the level of the umbilical cord insertion, with the ultrasonographic gestational age
in normal women and fetal weight and outcome.
Methods: Present study was a single centric, observational, cohort, follow up, hospital-based study in
which 100 pregnant women who will come for ultrasound in third trimester during the study period was
recruited in the study. The relationship between placental thickness with fetal parameters, birth weight
and fetal outcome at delivery was investigated in this study. Correlation between placental thickness with
the fetal parameters, average gestational age, gestation at delivery, neonatal birth weight & APGAR
score, and placental weight was investigated during this study.
Results: Significant positive correction of placenta thickness was found with the gestation age, estimated
and actual fetal birth weight, and placenta weight. APGAR score showed negative correlation with the
placenta thickness. Positive correlation of placenta thickness was also found with the Biparietal diameter
(BPD), Head Circumference (HC), abdominal circumference (AC) and Femur length (FL).
Conclusion: Ultrasonography serves a significant role in estimating foetal weight, which is a crucial
component of prenatal care. Because of its linear association, placental thickness evaluated at the level
of umbilical cord insertion can be utilised as a reliable sonographic indication in the evaluation of. As a
result, it can be utilised as a secondary sonographic method for determining foetal weight.

Association between serum ferritin levels and elevated blood pressures: A case control study

Luqman Hafeez, Sevy Puri, Sahil Chhabra, Nehal Patel, Kiran Kumar Singal, Nitish Thakur

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 78-81

Introduction: Elevation of serum ferritin levels can result in major health issues. Increased oxidative
stress, inflammation, and endothelial damage are all linked to elevated serum ferritin levels, which in
turn raises the risk of hypertension.
Aim: Serum ferritin levels in patients with high blood pressure and a healthy control group were
measured and compared in this study.
Material and Methods: The present study was a hospital-based observational and analytical study. The
study was conducted over a period of 1 year on 60 patients. The study group comprised of 30 patients
(not diagnosed with hypertension or on any treatment) and the control group comprised of 30 (age and
gender matched) individuals. The levels of serum ferritin were analysed by the chemiluminescent
method.
Result: The results of the present study showed that, the mean value of serum ferritin was 313.17 ±
173.86 ng/ml in study group and 169.50 ± 105.66 ng/ml in control group. The mean SBP was 137.53 ±
14.32 mm/Hg in study group and 121.60 ± 8.09 mm/Hg in control group. The mean DBP was 87.73 ±
8.83 mm/Hg in study group and 71.03 ± 9.56 mm/Hg in control group. The results of the present study
indicate that the difference between the mean serum ferritin and mean SBP, mean DBP among the study
group and control group was found to be significant statistically (p=<0.005).
Conclusion: The current study found a positive association between the mean serum ferritin levels and
high blood pressure among the study participants

Cord blood albumin as a predictor of significant neonatal hyperbilirubinemia in normal term healthy newborn

Dr. Dharmagadda Sai Krishna, Dr. Hemant Gupta, Dr. Neelam Grover, Dr. Bharti Kawatra, Dr. Kiranjeet Kaur

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 18-24

Introduction: Hyperbilirubinemia is the most common morbidity in normal term healthy
newborn. There is evidence that cord blood albumin (CBA) level can act as a potential marker
for the prediction of hyperbilirubinemia in neonates. The present study was therefore designed
to establish a correlation between the level of cord blood albumin (CBA) and total serum
bilirubin (TSB) so that albumin level could be standardized as a prediction marker for the
neonatal hyperbilirubinemia.
Methods: CBA and TSB levels were analysed in 500 normal term healthy newborns with birth
weight ≥2500 grams and APGAR score ≥ 7/10 at 1 min and 5 mins, after obtaining consent
from their parents. Albumin levels were analysed from the cord blood at the time of birth and
TSB levels were analysed from venous blood. Pearson’s correlation coefficient was used to
analyse the correlation between CBA and TSB levels.
Results: The mean CBA was 2.94 ± 0.34 g/dl and mean TSB was 11.17 ± 2.52 mg/dl. The
relationship between CBA and TSB values was statistically significant on further analysis of
CBA with the modality of treatment, the results were again statistically significant. The
correlation between CBA and TSB was also observed with negative correlation of r = - 0.43
with p value of <0.0001 which was highly significant.
Conclusion: Newborns with high CBA levels have low risk of developing neonatal
hyperbilirubinemia and can be discharged early from hospital. Whereas low CBA is an
indicator for developing neonatal hyperbilirubinemia in the first week of life.

Speciation of candida isolates from clinical samples: a comparison of two carbohydrate assimilation methods for efficacy, speed and accuracy with special reference to the sensitivity to commonly used antifungal agents

Dr. Amith Joshi, Dr. Suma A, Dr. Sughosh Kulkarni, Dr Deepa Patil Dr. RD Kulkarni

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 97-105

Candida is ubiquitous in nature and is found on inanimate objects, in foods and on animals.
They are commensals of humans. Most Candida infections are endogenous in origin. They
inhabit the gastrointestinal tract including the mouth and oropharynx, the female genital tract,
and the skin. Health care workers do show carriage on the skin. The transformation of
Candida from a commensal to a pathogen depends on the decreased host resistance, local
ecology or increased virulence of the organism. The samples received for routine culture and
sensitivity like, pus, sputum, Urine, blood, vaginal swab, endotracheal aspirates, endotracheal
tube tips, CVC tips, IJC tips, Lumbar drain tip and sterile body fluids like CSF, pleural fluid,
ascitic fluid etc. at the Microbiology laboratory were subjected to standard culture and
sensitivity tests. The AUX method could not detect C. kefyr identified on WB method.
Instead C. kefyr was identified as C. tropicalis. Similarly one of the isolates of C. parapsilosis
was identified as C. tropicalis by WB method. None of the species of Candida except C.
krusei were resistant to fluconazole. While a majority of the C. krusei isolates (78.1%) were
resistant to fluconazole, there were no resistant strains observed for voriconazole in any of the
112 isolates.

Study of femoral and tibial tunnel position using CT scan, and its effect on functional outcome in arthroscopic ACL reconstruction: A prospective study

Dr. Sunil B, Dr. Arjun A, Dr. Kiran V, Dr. Sathish Babu

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 106-113

Background: Accurate placement of tibial and femoral tunnel has significant effect on
functional outcome after anterior cruciate ligament reconstruction (ACLR). Anterior cruciate
ligament tear is one of the common sports injuries, and arthroscopic reconstruction is now a
day’s popular surgery. Its failure is rare but not uncommon. Despite advances, failure rate
after ACL reconstruction (ACLR), ranges from 0.7% to 10%1. Slight anterior placement of
femoral tunnel can lead to restriction of knee flexion and, similarly if tibial tunnel is anterior,
it leads to impingement of graft, surgical failure and also the need for a revision surgery.
Post-operative CT scan provide a reliable and valid way for the assessment of anatomical
tunnel position and obliquity after ACLR.
Materials and Methods: 31 patients with complete ACL tear with or without the meniscal
injury are treated with single bundle arthroscopic reconstruction using hamstring graft tendon.
With common post-operative rehabilitation protocol all patient are followed up clinically and
radiological for next 2 year. Femoral, tibial tunnel positions on sagittal plane. Were measured
interpreted with the clinical parameters. Radiological parameters were summarized as mean
standard deviation and proportions as applicable.
Results: Total no of patients with the age averaged 27.13± 5.89, pre op lysholm score
averaged 64.26±8.93. At 24 months follow up position of the tibial tunnel was found to be at
an average of 31.55%±4.79posterior from the anterior edge of the tibia. The femoral tunnel
was found at an average of 28.54±3.18% anterior to the posterior femoral cortex. 32.2% and
35.5% of patients showed grade 1 anterior drawer and lachman test positive respectively. And
mean lysholm score averaged to be 86.58±5.32.
Conclusion: The location of femoral tunnel in the mid sagittal section from the posterior
cortex 28.54±3.18% of anteroposterior length showed no significant correlation the lysholm
scoring. Locating the tibial tunnel positioning on the tibial plateau from the anterior cortex of
Showed significant p value with functional outcome.

Studying effect of tunnel expansion on functional outcome in anterior cruciate ligament reconstruction using CT scan: A prospective study

Dr. Vanamali B Seetharam, Dr. Arjun A, Dr. Sunil B, Dr. Kiran V, Dr. Sathish Babu

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 114-121

Background: Tunnel expansion in anterior cruciate ligament reconstruction (ACL-R) is a
well-accepted phenomenon, still its effect on functional outcome is little known.
Purpose: To study prospectively the effect of change in the tunnel volume as observed with
computed tomography (CT) on functional outcome after ACL-R.
Materials and Methods: This study conducted for a follow up of 24 months of time period
between June 26th 2017 to 31st December of 2019, after approval from ethical committee 31
patients with complete ACL tear with or without the meniscal injury were treated with single
bundle arthroscopic reconstruction using hamstring tendon graft. With common postoperative
rehabilitation protocol, all patients were followed up clinically and radiologically
for two years. Tibial and femoral tunnel volume were measured and correlated with the
clinical parameters. Radiological parameters were summarized as mean, standard deviation
and proportions as applicable.
Results: Total number of 31 patients with the average age 27.13±5.89 and pre-operative
lysholm score average of 64.26±8.93 were included in the study. At the end of 2years follow
up of each patient, 32.2% and 35.5% of patients showed grade 1 anterior drawer and
lachman test positive respectively and mean lysholm score averaged to be 86.58±5.32.
Significant difference of tunnel volume noted at the end of 2 years with a 0.837 cm3 and
0.545 cm3of tibial and femoral tunnel volume respectively.
Conclusion: Noted a significant expansion of both tibial and femoral tunnel volume
postoperatively when compared to the intra-operative tunnel volume. Both the femoral and
tibial tunnel volume showed negative correlation with the functional outcome.

Outcome of cervical cancer screening using Pap smear test on a target population

Dr. Shruti Bhavi Patil

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 122-126

Objective: To evaluate the use of Pap smear screening method for detection of precancerous
lesions.
Methods: Women working in police department and female family members of men working
in police department were screened for Ca cervix. A total of 67 women were recruited for the
study. A clinical examination per speculum and per vaginal examination were performed and
a history taken for all women. A pap smear was used for all women to see for cervical cancer.
The smear was obtained using Ayer’s spatula and spread over a marked glass slide which was
placed in 95% ethyl alcohol and sent to department of Pathology for cytopathological
examination. All data were recorded using a predesigned proforma.
Results: Most women were in age range of 30-50 years. The common complaint was white
discharge per vagina occurring in about 30% of individuals, abdominal pain was in 8.95% of
them, irregular menstrual cycle in 12.78% and 40.29% of them did not have any complaints.
Out of 67 ladies 61 (92.1%) pap smears were taken and 6 were not taken due to post
hysterectomy status or because they were menstruating. The test was negative for malignancy
in 68.6% of individuals and 11% of individuals had inflammatory smear due to infections
with trichomoniasis, bacterial vaginosis or candidiasis. Atypical cells were detected in 2.98%
women and they were advised colposcopy and guided biopsy. 5% of individuals had
unsatisfactory smear due to inadequate sample.
Conclusion: A Pap smear is simple, noninvasive, cost-effective, and easy to perform for
detection of precancerous lesions in a gynecological patient. Awareness about screening in
general population is needed. Women with an abnormal Pap test should undergo a
colposcopy and guided biopsy.

Knowledge and practices of menstrual hygiene in adolescent school girls of urban and rural schools of Gadag district

Dr. Shruti Bhavi Patil

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 127-132

Background: Menstruation is generally considered unclean in the Indian society though its a
physiological process indicating beginning of reproductive life. Several prohibitions and the
negative attitude of parents in discussing the related issues openly have blocked the access of
adolescent girls to the right kind of information. Various studies indicate that a huge
information gap exists among rural and urban adolescent girls regarding menstrual hygiene.
The data about the level of knowledge and practices which are followed by them with respect
to menses are beneficial in planning a program for improving the awareness level with
respect to their quality of life.
Materials and Methods: A community based cross sectional study was conducted from July
2018 to September 2018 on 708 school going adolescent girls of Gadag district, Karnataka.
Girls between age group 11 to 18 years were included. Data was collected by a predesigned,
pretested questionnaire.
Result: Awareness of menstruation was only among 12.07% of rural school girls and 38.09%
among urban school girls. The first source of information regarding menstruation was mother
in 8o% and only 17% from friends in both urban and rural girls. 18% of urban school girls
always missed school and 35% of urban girls missed sometimes. Only 5.39% girls in rural
areas always missed and 15.57% in rural areas missed sometimes. 76.22% girls from rural
schools used sanitary pads and 68.31% of girls used in urban schools. Around 50% of girls
both in rural as well as urban schools changed their pads twice a day. It was found that among
the urban school girls 70.45 % of them disposed the sanitary pads by wrapping it in a paper,
10.82% flushed it in the toilets. In the rural schools, surprisingly 71.53% of them buried the
sanitary pads, 7.56% flushed it and only 20.83% of them wrapped it in a paper. 40.93% of
urban girls and 34.52% of rural school girls still practiced in the social taboos like diet
restrictions, not attending religious functions or places of workshop.
Conclusion: There a need for adequate information both in rural and urban school girls. The
knowledge about hygienic practices is lacking. There is also a need to address social taboos in
both the groups. There is a need to emphasise on significance and physiological implications
of menstruation.

Caudal block in pediatric patients: Clinical profile

Dr. Harini Jalapati, Dr. Thapi Srija, Dr. Prasanth Kumar Reddy C, Dr. Ajay BC, Dr. Hulakund SY, Dr. Vanishree Alwandikar, Dr. Malladihalli Kiran Ashok Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 133-138

Caudal block can be performed as a single shot caudal or a continuous caudal using catheter
techniques. Single shot caudal blocks are used for ambulatory and minor procedures while continuous
catheter techniques are used for in-patients undergoing more extensive procedures. This study included
72 children, of both genders, coming for various elective infra-umbilical surgical procedures such as
herniotomy, orchidopexy, circumcision etc. Ethical clearance from institutional ethical committee was
obtained. Informed consent was obtained from the parents before including the children in the study. In
group A, the mean baseline heart rate was 122.67±9.08 per min which decreased to112.97±8.70 at 5
mins. The heart rate gradually decreased to 93.03±5.33 per min at 30 mins and 90.43±5.80 at 60 mins.
The mean baseline heart rate in group Bwas 121.92±8.52 per min which decreased to 112.19±9.79 at 5
mins and gradually decreased to 90.17±6.96 at 30 mins and 90.82±5.53 at 60 mins. However, there was
no significant difference in the heart rate between the two groups at any time interval.

Determination of optimal angle of needle insertion for successful caudal block in pediatric patients by comparing conventional method versus ultrasound guided method: A randomized comparative experimental study

Dr. Ajay BC, Dr. Hulakund SY, Dr. Tanuja KS, Dr. Anilkumar Ganeshnavar, Dr. Harini Jalapati, Dr. Thapi Srija, Dr. Nishanth D

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 139-144

The benefits of regional anaesthesia in children are well documented. These include attenuation of the
stress response, reduced opioid requirement and therefore reduction in associated side effects,
improved postoperative analgesia, and earlier extubation. Caudal epidural block is one of the most
common regional techniques in paediatric anesthesia. Caudal block is safe and reliable technique, easy
to perform and has been found to be very effective in children, especially in infra-umbilical surgeries
when combined with general anaesthesia. This study included 72 children, of both genders, coming for
various elective infra-umbilical surgical procedures such as herniotomy, orchidopexy, circumcision etc.
Ethical clearance from institutional ethical committee was obtained. Informed consent was obtained
from the parents before including the children in the study. Optimal calculated needle angle for
successful caudal block was 28.14±4.03 degrees in Group A, 19.22±2.78 degrees in Group B, which
was statistically significant. Needling time or procedural time for successful caudal block was
5.97±1.32 seconds in Group A, 14.25±2.93 seconds in Group B, which was statistically significant.

Aseptic non-union of tibia treated with ilizarov fixator: A retrospective study

Dr. Sumit Kumar, Dr. Nishith Sharma, Dr. Jashanpreet, Dr. Raj Singh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 145-153

Background: Nonunions of the tibia may be associated with low-density bone tissue, bone loss, adjacent
soft-tissue damage, limb shortening, limb deformities and joint contractures. There is no gold standard
for the treatment of nonunions of the tibia.
Aims and Objectives: The purpose of our study was to assess the results of treatment with the Ilizarov
method in patients with aseptic nonunions of the tibia, depending on the employed treatment strategies
and surgical techniques. To achieve union at nonunion site with correction of limb length discrepancy
and correction of deformity with early function and mobilization.
Materials and Methods: Our study has been taken place, Department of Orthopaedics, Maharaja
Agrasen Medical College, Agroha, Haryana, India. The operators used one of two treatment strategies:
neutral fixation without compression or continued compression. The following were assessed: rates of
union, ASAMI bone scores, ASAMI functional scores, treatment time, complications, duration of
hospital stay. It is prospective study of treatment of aseptic nonunion of shaft tibia. As we have taken 35
patients of tibial nonunion. All relevant pre and perioperative information and complications were
recorded. Also assessment of functional outcome was made.
Results and Observations: In our study we have evaluated the differences in time to union in the
subgroup of patients with at least one risk factor for disturbances in fracture healing. The following risk
factors were considered: diabetes mellitus, corticosteroid therapy, smoking, advanced lower extremity
vascular disease, and alcohol dependence. Sample size in our study was of 32 out of 35 cases has united,
about 91% success rate. The average duration of nonunion was about 14.5 months, average union time
(fixator removal) is about 6.2 months. Two of our patient were showing poor tolerance to Ilizarov
external fixator changed to other modality.

Evaluation of factors associated to functional outcomes of intertrochanteric fractures of femur when managed with PFNA2

Dr. Sumit Kumar, Dr. Nishith Sharma, Dr. Jashanpreet, Dr. Raj Singh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 154-159

Background: Aging is an undefiable process and as the population ages, the incidence of hip fracture is
anticipated to increase exponentially. Prolonged bed rest further worsens the morbidity and mortality
after a hip fracture. Intertrochanteric femur fracture management in elderly needs more attention to
reduce malunion and increase early mobilisation to reduce mortality and morbidity. Ideal choice of
treatment is internal fixation by intramedullary or extra medullary devices. Intramedullary devices
provide more stable proximal femoral anatomical fixation. Between PFN and PFNA; helical blade in
PFAN provides more stability, better compression and rotational control with lower cut-out rate.
Aims and Observations
a) To assess the factors for functional outcome of PFNA2.
b) Evaluation of effectiveness and stability of PFNA2.
Material and Methods: In our study, we have taken 32 patients with unstable Intertrochanteric femur
fracture between Nov 2020 to Oct 2021 fulfilling inclusion and exclusion criteria were included in this
study and underwent closed reduction and internal fixation by PFNA (n=32). Assessment was done in
terms of demography, preoperative and intraoperative variables, postoperative parameters mainly
functional outcome till 1 year postoperative.
Results: In our study Preoperative variables, AO fracture type were assessed preoperatively. Duration
of surgery, blood loss and fluoroscopy imaging were significantly lower in PFNA as compared to PFN.
Postoperative complications like cut-out rate, shortening, varus malalignment, return to pre-fracture state
were also lower in PFNA group than PFN. Postoperative functional assessment done by Harris Hip Score
shows better outcome in PFNA than other fixation devices.
Conclusion: PFNA reduces duration of surgery, blood loss, fluoroscopy imaging as compared to other
implants. PFNA also offers better postoperative functional outcome.

Intranasal midazolam and dexmedetomidine as premedication on haemodynamic stability: A comparative study

Dr. Shilpa Agarwal, Dr. Neeti Agarwal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 160-166

Background: Many anesthetic pre-medications are used to relieve this stress response. Of these premedications,
midazolam and dexmedetomidine are effectively used as sedatives. The present study was
planned to compare intranasal dexmedetomidine with intranasal midazolam as a pre-anesthetic
medication in children. Many anaesthetic pre-medications are used to relieve this stress response. Of
these pre-medications, midazolam and dexmedetomidine are effectively used as sedatives. The present
study was planned to compare intranasal dexmedetomidine with intranasal midazolam as a pre-anesthetic
medication in children. Fear of unpleasant and painful procedures, separation from parents and
unwillingness to breathe through an anaesthesia face mask may produce stormy anaesthetic induction in
unpremeditated patients. Because of this premedication should be an integral part of paediatric
anaesthetic practice.

Correlation analysis of stress and substance abuse among medical students

Dr. Parul Sharma, Dr. Gaurav Passi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 167-172

Background: Substance abuse is increasing in young population of India at alarming rates. Younger
generation abuse the substance to gain temporary pleasure, to relive stress and under peer pressure.
Medical students are more prone to substance abuse because of longer working hours, high pressure
working environment and stress.
Objectives: Present study aims towards finding a correlation between stress and addictive behaviors, so
as to recognize the extent to which stress affects the medical students. Present study also focusses on
establishing comprehensive measures to manage stress among medical students.
Methodology: Total 200 undergraduate medical students were recruited in present study. The stress level
was analysed using perceived stress scale (PSS) and perceived academic stress scale (PASS). Substance
abuse was analysed using drug abuse screening test (DAST-10) and alcohol use disorders identification
test (AUDIT).
Results: A significantly high correlation was found in the stress level and substance abuse among
undergraduate medical students. PSS exhibit correlation of 0.3589 with AUDIT and 0.3194 with DAST.
PASS exhibit correlation of 0.4760with AUDIT and 0.3775with DAST.
Conclusion: Stress was found to be a significant problem among medical students and this leads to
consumption of alcohol and other illicit mind-altering psychoactive substances in an attempt to cope with
various academic and other life stressors.Awareness creation about the adverse effects of substance use
and academic counseling in the first 2-3 years of course and putative stress reduction interventions are
recommended and needed.

Awareness and Attitude Regarding the Risk Factors, and Self Examination for Breast Cancer in the Students of an Engineering College of South India

Myna Komuravelli , Aswan Gaddala, Suman Nama, Pratima Matli , Keerthana Anchuri

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 173-179

Breast cancer is the one of the most commonly occurring cancer in women and is among the top five causes of mortality due to cancer. Early detection of breast cancer plays leading role in reducing mortality rates and improving the patient’s prognosis. The factors related to women´s awareness, knowledge and perceptions about breast cancer may contribute significantly to medical help-seeking behaviours. Thus, practice of breast self-examination among female undergraduate students will be essential in acknowledging targeted interventions through the provision of guided educational training programs.
Material & Methods: A cross sectional study on female students of an engineering college in Karimnagar were studied between January - April 2020 using a pretested structured questionnaire regarding awareness of breast cancer, its risk factors, clinical features and preventive measures. Data collected was analysed using SPSS v16.0.
Results: Knowledge regarding - risk factors for breast cancer was 36.8%, regarding clinical features was 51.5%, BSE as a preventive measure was 83.8%. Major source of gained knowledge was the Internet (75%).
Conclusion:  Most students know about breast cancer but their overall knowledge about its risk factors and clinical presentation is inadequate. Only one third of them were aware of BSE as a means to detect Breast cancer.

Pseudo-aneurysm after fixation of intertrochanteric femur fracture: literature review and report of two cases

Dr. Ramkinkar Jha, Dr. Raman Kant, Dr. Mohd Irfan Banday, Dr. Tapish Sahu

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 180-189

Fracture of Intertrochanteric region has been successfully fixed since years with the use of dynamic hip
screw and proximal femoral nail, however life-threatening complications associated with these methods
are not unknown to the orthopaedic fraternity. We present a report of two cases of pseudoaneurysm of
profunda femoris artery which were operated for intertrochanteric fracture elsewhere and then referred
to our hospital when during follow up for the index surgery, the course got complicated.

Anthropometric measurements of medial and lateral malleoli to study and aid better implant profile

Dr. K Sivaprasad, Dr. Neel Pasrija, Dr. Roshan Kumar BN, Dr. I Suresh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 190-197

Ankle fractures are amongst the commonest type of fractures treated by orthopaedic surgeons. The
incidence of such fractures has increased since the last three decades in both the younger and elderly
population, as well as due to increased vehicle accidents. Pre-reduction and pre-operative radiological
assessments, extrapolated on long term clinical results, have helped to improve the management of these
fractures. Without mentioning the nature of contouring to be done, restoration of proper tilts/rotation and
malleolar lengths, especially in comminuted fractures can be very challenging. The current study has
been carried out to ascertain the various anthropometric parameters to help in designing of such implants.
Radiographs of Twenty Cadaveric ankle specimen were obtained and Anthropometric measurements of
the lateral & medial malleolus of twenty cadaveric fibula & tibia of same specimen were carried out and
the radiographs of ankles of 500 volunteers formed the material for the study. The length and width of
lateral & medial malleolus in coronal and Sagittal planes, the angles subtended by various bends of the
medial surface of medial malleolus and lateral surface of lateral malleolus in radiographs of cadaveric
tibia and volunteers were measured. The data collected has been recorded and analyzed. It is hoped that
the measurement of the various parameters will be of value for scientific designing of implants for
fixation of malleolar fractures.

Comparative study of supra clavicular and interscalene block for proximal humerus fractures

Dr. Venkatesh Subramanyam, Dr. Azmatulla Shaik

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 198-203

Introduction: Supraclavicular brachial plexus block could be an alternative and provide comparable
effective anaesthesia and postoperative analgesia for shoulder surgery. Interscalene brachial plexus
blockade is the standard nerve block for analgesia after arthroscopic and open shoulder surgery.
Material and Methods: This is a Prospective, observational and descriptive study conducted in the
Department of Anaesthesia at Nimra Institute of Medical Sciences (NIMS) over a period of 1 year. These
patients were divided into two groups by simple random method; the patients were divided into group
IRD (interscalene block using 30 ml of ropivacaine 0.5% + 50 μg of dexmedetomidine) and another
group (supraclavicular block using 30 ml of ropivacaine 0.5% + 50 μg of dexmedetomidine). The
procedure was conducted using nerve stimulator technique.
Results: The mean time of the onset of sensory block in supraclavicular group was 3.50±0.83, in
interscalene was 3.1±0.62 and onset of motor block (min) was 3.60±0.62 in supraclavicular group, in
interscalene was 3.21±0.54. The duration of sensory block was 495.53±49.41 min and 759.42±84.15 min
in supraclavicular group and interscalene block respectively. Moreover, duration motor block (min) in
supraclavicular group was 438.52±47.32, in interscalene was 659.23±38.74.
Conclusions: The onset of sensory and motor block was significantly faster in interscalene techniques
then supraclavicular. Prolonged duration of sensory and motor block followed by interscalene and
supraclavicular approaches, respectively.

Clinical profile and evaluation of level of dependence of alcohol in patients of alcoholic liver disease

Dr. Mridul Arora, Dr. Aarish Bali, Dr. Karanpartap Singh, Dr. Kiran Kumar Singal, Dr. S.S. Kaushal, Dr. Shrdha Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 204-208

Introduction: In India, there is a high frequency of ALD, with alcohol being responsible for roughly
half of all instances of cirrhosis. However, not everyone who consumes alcohol develops the condition,
and the total chance of acquiring the disease in a person is determined by a number of variables. The
length, amount, and kind of alcohol ingested, as well as nutritional state, comorbid illnesses, sex, race,
and hereditary variables, may all have a role. Multiple investigations on the impact of drinking patterns
in the development of illness have shown conflicting conclusions.
Objectives: Present study aims towards analysing the clinical profile of patients with alcoholic liver
disease. Present study also aims to perform psychiatric screening using CAGE criteria and alcohol use
disorder identification test (AUDIT) scale for assessing the severity of alcohol dependence.
Methods: Present study was a single centric, prospective, observational and hospital-based study. 50
patients with clinical/investigational evidence of alcoholic liver disease were include in study. CAGE
Criteria to screen and alcohol use disorder identification test (AUDIT) scale was used for assessing the
severity of alcohol dependence.
Results: The mean age of the recruited patients was 50.80 ± 12.74 years. Among total 50 patients, 96%
patients were males and 4% of patients were females. Total 26% patients have CAGE score of four, 34%
patients have CAGE score of three, 40% patients have CAGE score of two whereas no patient had a
CAGE score of zero. AUDIT scoring indicate that 96% patients exhibit alcohol dependence, 4% patients
presented with harmful or hazardous drinking levels whereas no patient presented with Low-risk
consumption. A total of 96% patients were alive whereas mortality occurs in 4% patients in present study.
Conclusion: Our findings show a link between the type, amount, and duration of alcohol consumption
and the development of alcoholic liver disease.

Clinical profile of patients with type 2 diabetes mellitus at a tertiary care hospital

Dr. Nishchit KN, Dr. Akshatha K, Dr. Kalavathi GP

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 209-213

Macrovascular complications of diabetes mellitus include cardiovascular diseases, cerebrovascular
accidents and peripheral vascular disease. Macrovascular disease is a significant cause of mortality in
diabetic patients. Diabetic individuals have a multitude of risk factors for atherogenesis and the odds of
developing coronary artery disease and ischemic strokes are 2 to 4 times and 2 to 3 times more,
respectively, than non-diabetic individuals. This is a prospective observational comparative study in
which 60 patients with type 2 diabetes mellitus in the age group of 35-65 years were included and
results are compared with 60 Normal Individuals. The study design was approved by the Ethical
Committee of the institution. In NN group, 12(85.7%) patients were on OHA, 02(14.3%) patients on
insulin. In NH group, 19(82.6%) patients were on OHA, 04(17.4%) patient was on insulin. In HH
group, 16(69.6%) patients were on OHA, 7(30.4%) patients were on insulin. The distribution of BMI
among all the three groups was equal. P value was 0.215 which shows that the groups were similar to
each other in the distribution of BMI.

A study on fasting and postprandial lipid profile in patients in type 2 diabetes mellitus

Dr. Nishchit KN, Dr. Akshatha K, Dr. Darshan M

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 214-219

The triglyceride levels in serum generally remain elevated for about 3 to 6 hours after a meal. This
postprandial hypertriglyceridemia (more than 2.72 mmol/l or 201 mg/dl) is exacerbated by the next
routine meal and thus the lipemic milieu persists throughout the day. Therefore, measuring and
documenting postprandial dyslipidemia in diabetic patients is vital in addition to measuring the fasting
lipid levels. Blood samples were drawn before and 4 hours after the standardized test meal. The
HbA1c, fasting and postprandial lipid profile levels and glucose levels were estimated. Fasting and
postprandial triglycerides, total Cholesterol, HDL, VLDL were measured by standard laboratory
technique. The mean serum HDL cholesterol in the NN group was 40.57 ± 5.23.The mean serum HDL
cholesterol in the NH group was 35.43 ± 6.33.The mean serum HDL cholesterol in the HH group was
32.87 ± 6.30. The mean serum fasting triglyceride in the NN group was 107.29 ± 20.69.The mean
serum fasting triglyceride in the NH group was 132.57 ± 7.52.The mean serum fasting triglyceride in
the HH group was 230.13 ± 48.96.

Study of the Factors Affecting Medication Adherence Among Patients Taking Treatment for Non-communicable Diseases in a Tertiary Care Hospital

Dr Prerna Tejaswi, Dr. Kumar Devashish, Dr. Syed Md Javed, Dr.V.K. Mishra

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 220-227

Introduction: Early detection and compliance to prescribed treatment is important to avoid life threatening complications among those with non-communicable diseases (NCDs). The present study aimed to assess adherence to prescribed medications and associated factors among patients with NCDs.
Methodology: This was a cross-sectional survey done among patients with diagnosed with NCDs attending outpatient clinic of Medicine department to determine the prevalence of non adherence. To assess medication adherence, the Morisky Medication Adherence Scale (MMAS-8) was used. Patients were divided into two groups for the purposes of analysis: those with poor medication adherence (MMAS-8 score less than 6) and those with moderate to high medication adherence (MMAS-8 score more than 6). (MMAS-8 6 or above).
Comparison of patient related variables was done using chi-square test
Results: Out of 232 patients, 22% had low compliance to drug therapy. Mean age of the patients was 48.5 years, ranging from 30 to 78 years. Increasing age and female gender were found to be significantly associated with low medication compliance. Literacy, employment status, alcohol and tobacco consumption were not found to be significantly associated with low medication compliance. In addition, having only one non-communicable disease, disease duration more than 5 years and having to take five to six medications were found to be associated with low medication adherence.
Conclusions: Approximately one-fifth of patients adhered poorly with their medications. Patients must be sufficiently motivated and counselled in order to adhere to their medication regimens. Further study is required to assess the efficacy of different educational techniques for promoting patient medication adherence.

Anticoagulantion Therapy for Non-Valvular Atrial Fbrillation

Dr. Abhishek Kamendu, Dr. Abhilasha Singh, Dr. Patel Devangiben Dilipbhai, Dr. Tausif Anwar, Girish Narayan Mishra

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 228-234

Background: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia accounting for one- third of all arrhythmia related hospitalizations. AF is major risk factor for stroke. Atrial fibrillation is hyper coagulable state in both paroxysmal and chronic atrial fibrillation, AF related stroke can be effectively prevented with oral anticoagulant therapy with vitamin K antagonist or non vitamin K antagonist. The present study was done with objective to detect prevalence of use of anti coagulants in treatment of non-valvular atrial fibrillation.
Methods: This was a descriptive cross-sectional observational type of study done at Narayan medical college and hospital Jamuhar, Sasaram, department of Medicine on 200 patients of non-valvular atrial fibrillation. Non-valvular atrial fibrillation patients were defined as atrial fibrillation without rheumatic valvular disease predominantly mitral stenosis or mechanical heart valves. Data regarding patients’ demographics, co-morbidities, diagnosis of AF were recorded; CHA2DS2_Vasc and HASBLED scores were calculated for each patient.
Results: In this study out of total 200 study subjects, 50 study subjects had CHA2DS2_Vasc score less than 1, whereas 150 study subjects have score more than 1. Out of 150 eligible patients only 15 were on anticoagulants.
Conclusions: In this study, it was found that the majority of patients with non-valvular AF were not anti-coagulated (90%), the type of anticoagulant most commonly used was vit K antagonist and most common risk factors for bleeding are hypertension (72%) followed by heart failure (36%).
 

Acceptability and Compliance of DMPA in Patna Medical College and Hospital, Bihar.

Dr. Anupama

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 235-238

Introduction: In India, a large proportion of women with an unmet need for contraception are within their first year after childbirth. It is major obstacles for nation social and economic development. The present study concentrates to educate postpartum women for contraception and to study  the acceptance and compliance of medroxyprogesterone acetate (DMPA) in Bihar women .
Methods: This is retrospective study with cross sectional data collection from 210 patients for a period of 14 month , from JANUARY 2019 TO FEBRUARY 2020.
Results: The study concluded that DMPA is highly effective contraceptive with low failure rate .
Conclusion: It is available as a first line method to all who wish to opt reversible method of contraception.

Study Of Outcome Of Intracapsular Fracture Of Neck Of Femur In Elderly Patient Treated By Hemiarthroplasty

Dr. Siddhartha Sarang, Dr. Akhil Chakrawarty

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 239-245

Background: clinical study fifty cases of intracapsular fracture neck of femur in elderly patients above the age of 50 years irrespective of sex treated by hemiarthroplasty using unipolar (Austin moore’s / Thompson’s ) or bipolar endoprosthesis, in the Department of Orthopedics, were followed up and functional results were analysed with the objectives, to study the age  and sex incidence of fracture neck of femur, quality of life after hemiarthroplasty, morbidity and mortality associated with the procedure.
Methods: Fifty cases of fracture neck of femur in elderly patients above the age of 50 years treated by hemiarthroplasty using either unipolar or bipolar prosthesis in the Department of Orthopaedics at All india institute of medical sciences, Patna. Study duration period of two years, were selelected on the basis of purposive sampling or judgement  sampling method. Conclusion: The success of hemiarthroplasty no doubt depends on preoperative planning and proper attention to surgical details to achieve the optimum biomechanical stability. The poor results (11.1%) were due to moderate to marked pain in the hip or thigh after hemiarthroplasty. We conclude that hemiarthroplasty for fracture neck of femur is a good option in elderly patients.

A study of clinical spectrum and outcome of patients with chest trauma in tertiary care centre

Dr. Shankar Lal J, Dr. Pradeep YM, Dr. Ravi S, Dr. Nitin Kumar Chavan

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 246-250

A thorough understanding of clinical spectrum of chest injury, management and its outcomes shall help
in better patient management and decrease the mortality and morbidity associated with chest injury.
Total of 150 patients with chest trauma reported to casualty, Emergency Department, were included in
study. Patients of age group 15-65 years, with no pre-existing cardiopulmonary disease were enrolled
in the study. Patients treated on OPD basis and brought dead were excluded from the study. Blunt chest
injury was seen in 80.07% and penetrating injury was found in 19.3% of cases. The main reasons for
the chest injury were RTA (57.3%), fall from height (16%), assault (22%), industrial injury (2.7%),
animal attack (0.7%) and fall of objects on chest (1.3%).

Spectrum of Chest HRCT findings in covid-19 pneumonia

Dr. Ashok Kumar Kattimani, Dr. Shivaraj G Biradar, Dr. Neeraja Akki

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 251-257

Introduction: The pandemic disease COVID-19 has varied presentations clinically and even
radiologically. Early diagnosis and treatment help in containment of the disease. Therefore, assessing
the radiological patterns in order to contribute to the diagnosis COVID-19 is the aim of this study.
Materials and method: A cross-sectional descriptive study from January 2021 to June 2021 was
carried out on 165 patients suspected of COVID-19 with delayed RT-PCR report or in cases with initial
RT-PCR negative, but having high clinical of suspicion of COVID-19. HRCT pattern in such cases
were documented and correlated with the repeat RTPCR and other laboratory parameters such as
Interleukin IL-6, serum ferritin, C-reactive protein, Lactate Dehydrogenase.
Results: Most common HRCT pattern was bilateral multifocal peripheral ground glass opacities
predominantly involving posterior segments. Other common patterns were crazy paving and
consolidation.
Conclusion: Specific patterns on the HRCT can be used in diagnosis of COVID-19 when there is high
clinical likelihood, however the study should be used judiciously only when indicated.

Floating knee injuries: Associated injuries and clinical outcome

Dr. Himanshu Agrahari, Dr. Chethan MH, Dr. Siddharth Dubey, Dr. Bhaskar Sarkar, MD Quamar Azama

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 258-266

Background: Floating knee injuries are frequently part of polytrauma. The outcome of this injury
pattern when compared to only femur or tibia fracture is less satisfactory. The outcome is even worse
when there is presence of other associated injuries. We hypothesized that not all associated injuries
have similar bearing on the outcome thus tried to find out the impact of commonly associated injuries
on the final outcome of these complex fractures.
Methods: Study was conducted including the patients of floating knee injury operated between
September 2016 and January 2019. Total of 42 eligible patients were operated, 4 patients were
excluded to due to lack of adequate follow-up. Data relating to demography, Fraser subtype,
compounding, associated injuries and clinical outcome were collected. Statistical analysis was
performed to see the association of associated injury, Fraser subtype and presence of compounding
with clinical outcome.
Results: Mean age was 33.5 years (17-63 years) with a male preponderance. Mean follow up was 1.6
years. Twenty-seven patients (71.1%) had excellent/good outcome while outcome of 11 patients
(28.9%) was acceptable/poor. Seventeen patients (44.7%) had compound fractures. Injuries which were
significantly associated with Acceptable/Poor outcome were ligament injuries, popliteal artery injury,
abdominal injury and patella fracture. Chest injury with a p value of 0.05 was also very close to being
statistically significant.
Conclusion: The clinical outcome of these patients not only depend on proactive and optimum
management of tibial and femoral fractures but also on the management of associated injuries.

De-rotation boot cast and traction in intertrochanteric fracture hip: An implant guy’s envy and a government surgeon’s pride

Bheemsingh Samorekar, Ravikumar Naganur, Vijaykumar Angadi, Yogesh Kadam

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 267-273

Introduction: In this genre of AO principles, most of the fractures are fixed surgically unless it's a
hairline fracture or a very high risk patient with co-morbidities.
Material & methods: Our study involves 23 patients visiting a remote government medical college
with hip intertrochanteric fracture (IT) which were managed non-operatively due to co-morbidities
and/or patients not willing for operative management. All those patients were applied de-rotation boot
cast and applied 10% traction of their body weight over it. Clinical and functional outcome was
measured by Harris hip score at admission, 6, 12 and 18 months follow-up. Radiological evaluation
done by radiographs of hip-AP and lateral views.
Results: Statistical analysis was done using SPSS software for descriptive data. Paired ‘t’ test was
applied to see improvement in functional & clinical outcome (Harris hip score), first between 6 month
follow up and 12 month follow up & 18 month follow up and results were tabulated. The ‘p’ value was
< 0.01 for Harris hip scores analysis by ‘t’ pair test between 6, 12 and 18 months follow-ups and was
significant.
Conclusion: Operative treatment of intertrochanteric fractures though gives early mobilization and less
hospital stay, after one year of injury both non-operative and operative management are of less
significance with respect to mortality, functional outcome and medical complications.

Comparative study of tibial plateau fractures treated with autograft and tricalcium phosphate

Vijaykumar Angadi, Ravikumar Naganur, Bheemsingh Samorekar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 274-278

Primary objective of the use of grafting in a subarticular defect associated with tibial plateau fractures
is to prevent the collapse of articular defect. Autogenous iliac bone graft has been the most frequently
recommended treatment for defects associated with unstable tibial plateau fractures. Despite the wide
acceptance of autogenous iliac bone graft as the so-called gold standard, complications of graft harvest,
ranging from temporary pain and numbness to long-term functional impairment are well documented.
Twenty acute, closed, unstable tibial plateau fractures (Schatzker's types II through VI) that required
open reduction and internal fixation with Computerized Randomization for the type of grafting of the
subarticular defect was done at the time of surgery. The age, weight, height, and sex of the patients and
the fracture patterns were comparable in the two groups. All fractures united in both groups within the
same time period (an average of three months); Union was determined by the treating surgeon
clinically as the ability of the patient to bear full weight without pain and, radio graphically, as the
disappearance of the fracture lines on the three-month follow-up anteroposterior and lateral
radiographs.

Distal humerus fractures with intercondylar extension: Surgical management by using plates

Ravikumar Naganur, Yogesh Kadam, Vijaykumar Angadi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 279-284

Reduction and fixation of articular surfaces followed by attachment to humeral shaft. Reduction and
fixation of Medial and Lateral condyles to shaft, then reconstruction of articular surfaces. 8 patients
(25%) had excellent, 9 patients (30%) had good and 9 patients (30%) had fair outcome according to
MAYO performance score. Nonunion is not encountered superficial infection in 5% cases treated by
daily dressing and IV antibiotics. A high rate of union can be achieved in complex intra-articular
fractures of distal humerus if the proper principle of stable fracture fixation are followed i.e. a posterior
trans-olecranon approach and dual fixation of both columns and restoration of continuity of articular
surfaces.

Covid 19 and dermatological manifestations

Dr. Veerbhan Singh, Dr. Savita Arya, Dr. Anupama Shrivastva, Dr. Archana Paliwal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 285-290

Background and Aim: Since the onset of the 2019-nCoV disease (COVID-19), many skin
manifestations have been reported in COVID-19 patients. This study aims to analysis of various skin
manifestations among patients with COVID-19.
Methods: An observational study was conducted in department of dermatology, Bharatpur Medical
College & Hospital, Bharatpur.
Results: Among Covid positive patients 47% had maculopapular eruptions, 19%, 19% each had
urticarial and pseudo chilblains, 9% had pedicular eruptions and only 6% had necrotic lesions and they
present within 1-4 week. There is a significant association between gender and skin lesions, co morbidity
and skin lesions.
Conclusion: Infection with 2019-nCoV may lead to skin manifestations with various clinical symptoms.
These clinical features combined with clinical symptoms of COVID-19 may aid in the timely diagnosis
of patients with COVID-19.

Outcome of the unilateral cochlear implant in prelingual deaf children in Mewar region of Rajasthan

Dr. Navneet Mathur, Dr. Neha Agrawal, Dr. Lokendra Kumar Goyal, Dr. Ravi Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 291-298

Introduction: A Cochlear implant (CI) is surgically implanted electronic device that provide a sense of
sound to a person with severe to profound sensorineural hearing loss. It helps in social rehabilitation of
the patient with hearing loss. Cochlear implants, like the human hair cell, receive mechanical sound
energy and convert it into a series of electrical impulses. The brain adapts to the new mode of hearing,
and eventually can interpret the electric signals as sound and speech.
Aim: The present study aims to evaluate the outcomes of cochlear implant in terms of hearing and speech
gain, The Department of Otorhinolaryngology of R.N.T. Medical College, Udaipur with patients who
will undergo CI surgery.
Materials and Methods: The prospective study (conducted between June 2016 to December 2018), the
study population in our study were patients attending the Department of ENT in RNT medical college,
Udaipur. A detailed history, including prenatal and perinatal history to assess for risk factors include
TORCH infection and the various parameters that were analyzed like Audiological assessment (BERA,
Otoacoustic Emission testing) duration of deafness, age, sex, type and degree of deafness, lack of benefit
with hearing aids, radiological analysis (HRCT & MRI) of temporal bone and cochlear anatomy for
feasibility for implantation.
Surgically cochlear implanted through Veria technique under all aseptic precautions.
Results: In our study mean age of implantation was 4.851+/-1.265. The mean revised CAP score at pre
op-, 6months, 12months of surgery was 0.5+/-0.5,3.8+/-0.6 and 7.875+/-0.6 respectively; the mean SIR
score at pre-op 6 months, 12 months of surgery was 1.0+/-0.0, 2.2+/-0.4 and 2.5+/-0.5 respectively; the
mean MAIS score at pre op-, 6 months, 12 months of surgery was 1.9+/-1.92, 25.3+/-1.27 and 32.25+/-
0.66 respectively.
Conclusion: Intelligible speech and auditory performance of children who underwent prelingual
cochlear implantation was improved compared to their pre-operative status. Cochlear implantation
appears to be beneficial for pre-lingual deaf children in term of quality of life.

A comparative study of tramadol suppository and ultrasound guided Transversus Abdominis plane block with bupivacaine versus tramadol suppository alone in providing post-operative analgesia after caesarean section

Nisheed Joseph, Bhagyashree Shivde, Swapna Naik, Gayathri Subhash Banasode

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 299-307

Background: The aim of the study was to compare multi-modal approach with Tramadol suppository
and Ultrasound guided Transversus Abdominis Plane (TAP) Block with Bupivacaine versus Tramadol
suppository alone in providing adequate post-operative analgesia after Caesarean section.
Method: 158 patients, aged between 18 to 40 years with ASA physical status I-II scheduled for elective
caesarean surgery, were enrolled in this prospective randomized comparative study. 79 patients (of Group
A) were given Ultrasound guided Transversus Abdominis Plane Block with Bupivacaine and Tramadol
suppository as post-operative analgesia. The remaining patients were given only tramadol suppository as
post-operative analgesic (Group B). They were observed for 12 hours or till the patient requested for
rescue analgesic. Pain (VAS score), satisfaction (Likert scale), sedation (Four-point sedation scale),
nausea & vomiting (PONV Impact scale) and adverse effects at 3hours, 6hours, 9hours and 12hours postoperatively
were observed and compared in both the study groups.
Results: Both groups were comparable in demographic data. There was a statistically significant
difference between the VAS scores and satisfaction scores with a p < 0.001 between the two groups. No
statistically significant differences in the sedation, PONV or adverse effects were found between the two
groups. In our study, Group A patients who received ultrasound guided TAP block remained painless for
longer period (23hours) than Group B (6.5hours).
Conclusion: In conclusion, our study suggests that Ultrasound guided TAP block significantly improved
postoperative analgesia in women undergoing Caesarean delivery patients.

A study to compare the Ultrasound-guided Supraclavicular Brachial plexus nerve block using bupivacaine with dexmedetomidine and only bupivacaine for upper limb surgeries: A prospective randomized control trial

Gayathri Subhash Banasode, Hanamant Kashinath Sale, Sandhya Khond, Nisheed Joseph

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 308-316

Background and Objectives: Adjuncts to local anaesthetics for brachial plexus block enhances the
quality and duration of analgesia. The purpose of this study was to compare the effects of
dexmedetomidine, when added as adjuvant to bupivacaine, in respect to onset, duration of sensory and
motor block along with duration of analgesia.
Materials and Methods: After informed consent, 60 ASA I and II patients scheduled for
elective/emergency upper limb surgeries under supraclavicular brachial plexus block (under ultrasound
guidance) was randomized were divided into two equal groups-Group A & B. Group A-received
bupivacaine 28 ml (0.25%) & dexmedetomidine 1μg/kg, and Group B-received bupivacaine 28 ml
(0.25%) & 2ml normal saline. Onset and duration of sensory and motor block, duration of analgesia were
studied in both the groups.
Results: Both groups were comparable with regard to age, sex distribution & duration of surgery. There
was no statistically significant difference. Onset of sensory and motor blockade was 9.2±1.6min
and12.8±1.6mins, respectively in group A, while it was 17.7±2.6min and 23.5±1.7min respectively in
Group B, which (p value˂0.001) is statistically significant. Duration of sensory block and motor block
was 648±49.1min 600.2±45.9min, respectively, in group A, while it was 250.5±26.8min and
206.0±19.0min respectively, in group B, which (p value˂0.001) is statistically significant. The duration
of analgesia in group A was 720.8±44.2 min, while in group B, it was 268.9± 23.1min which (p
value˂0.001), is also significant. There were no adverse events noted in either group. All patients were
haemodynamically stable.
Conclusion: Dexmedetomidine when added to bupivacaine in supraclavicular brachial plexus block had
faster onset, greater duration of sensory and motor block and also longer the duration of analgesia, than
in bupivacaine alone.

A retrospective, observational, nonrandomized, comparative clinical study on external vs. endoscopic dacryocystorhinostomy

Kripalini SH, Dr. Shwetha, Sathyaki DC, Aiyappa DS

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 317-324

Background: Chronic Dacryocystitis is an inflammatory condition of the lacrimal sac most commonly
associated with partial or complete obstruction of the nasolacrimal duct. It usually presents with watering
and sometimes purulent discharge, but some may progress and cause severe ocular and extra ocular
complications.
Objective: To compare the study subjects and the outcomes between the External vs. Endoscopic
Dacryocystorhinostomy.
Methodology: The present study was a retrospective, observational, nonrandomized, comparative
clinical study done by Reviewed medical records of 48 patients who underwent DCR at Kodagu Institute
of Medical Sciences from January 2018 to December 2021. Data regarding the intra-operative course,
surgical outcomes, and postoperative complications were analyzed. Anatomical success was defined as
patency confirmed by intranasal endoscopic inspection of the ostium and successful lacrimal sac
syringing whereas functional success was defined as complete resolution of epiphora assessed and
documented post-operatively.
Results: Primary acquired nasolacrimal duct obstruction (NLDO) is a common cause of epiphora in
adults, and it is 4-5 times more common in females. Of the 48 cases, 47 were primary cases and 1 case
was a revision External DCR and only in this patient stent was placed and in all other cases in both
Endoscopic and External DCR we have not used stents. Both External and Endonasal DCR had
comparable outcomes. In the Endonasal DCR group it was seen that out of the 34 patients operated, 2
patients had continued epiphora. Thus the success rate stands at 94%. It was noted that both patients who
continued to have epiphora after Endonasal DCR had lot of pus in the nasolacrimal apparatus with thick
sac wall noted intraoperatively.

A comparative study of efficacy and safety of topical calcipotriol and topical dithranol in chronic plaque psoriasis

Yadav Nihal, Prabhakar M Sangolli, Adarsh Gowda

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 325-331

Background: Psoriasis is chronic inflammatory dermatosis with genetic background. Topical therapy
alone is effective in localized psoriasis
Objective: Study was conducted to compare the efficacy and safety of topical calcipotriol and dithranol
in mild chronic plaque psoriasis with less than 10% BSA involvement
Methods: Study duration was 6 weeks. Thirty patients each were included in two groups. In calcipotriol
group, patients applied calcipotriol ointment (0.005%) twice daily. In dithranol group patients applied
1% ointment in 1st week, 2% ointment during 2nd week, 3% ointment from 3rd weeks onwards. Duration
of application was 60 minutes, once daily.
Results: Patients responded to both the treatments satisfactorily. However, calcipotriol was superior in
efficacy. Patients in both the groups tolerated the treatment.
Conclusion: Both calcipotriol and dithranol (short contact therapy) were effective in the treatment of
mild chronic plaque psoriasis. Even though, dithranol is less potent, it is cost effective.

A comparative study of oral V/S vaginal misoprostol for induction of labor conducted at Karwar institute of medical science, Karwar, Karnataka

Dr. Shivanand Kudtarkar, Dr. Annappa Shetty, Kishan Kudtakar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 332-336

Objective: To study the efficacy of 50 μg of Misoprostol tablet for induction of labor, oral v/s vaginal
route.
Methods: 100 women, at term gestation, with various indication for induction of labor with Bishop’s
score of ≤4 were included. After deciding, 50 women received 50 μg orally and 50 women received 50
μg vaginally every fourth hourly (maximum of 6 doses) or till they went into active labor.
Results: After statistical analysis it was found that in vaginal misoprostol route the induction to delivery
interval was significantly less compared to oral misoprostol group (9.5 v/s 160).
It was also found that the required dose of drug in vaginal route is less compared to oral route (40% of
women need only 2 doses in vaginal group compared to 35% of oral group were 6 doses required).
Conclusion: For induction of labor vaginal misoprostol is always more effective compared to oral rout

Vitamin D status and its determinant among medical undergraduate students

Manoj Kumar Singh, Ishan Kumar Parasher, Deepti Mandsorewale, Geeta

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 337-343

Background: Vitamin D is essential for calcium absorption, bones strengthening, hemopoiesis,
protection against heart failure, prevention against upper respiratory infection, acts as anti-oxidant and
strengthening immunity. Its deficiency has turn out to be epidemic globally, but still majority of
population is unaware about the problem. The prevalence can be appreciated in all age groups in both
the genders, such as, youngsters, adult, pregnant women and geriatric group. As vitamin D functions in
bone remodeling and its normal growth, the deficiency leads to retarded growth and skeletal deformities
in infants and adolescents, whereas, muscle weakness and fractures are common in adults. Present study
was carried out to sensitize the medical undergraduates regarding deficiency, prevention and treatment
of vitamin D.

Comparison between water based lubricant and betamethasone gel for lubrication during tracheal intubation through LMA CTrach™ with polyvinyl chloride tube on the incidence of postoperative sore throat and hoarseness of voice

Dr. Handattu Mahabaleswara Krishna, Dr. Karri Pavani, Dr. Allenki Prashanthi, Dr. Gottipati Rajendra, Dr. Kiranmayi Karanati

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 344-350

Context: Intubation through LMA CTrach™ involves manipulations with the LMA and tracheal tube.
Thus there is a possibility of postoperative sore throat and hoarseness of voice as with any other methods
of tracheal intubation.
Aims: To compare the incidence of postoperative sore throat and hoarseness of voice with water based
lubricant when betamethasone gel is used for lubrication during intubation.
Settings and Design: Prospective observational study commenced after approval from hospital ethics
committee and was conducted over a period of one year.
Methods and Material: Patients fulfilling the inclusion criteria were grouped into 2 groups depending
on whether betamethasone gel 0.05% was used as a lubricant (Group Betamethasone) or water soluble
lubricant was used for lubrication (Group Water based lubricant) during intubation with LMA CTrach™.
Patients were assessed for sore throat and hoarseness of voice after 24 hours of surgery.
Statistical analysis: Parametric data were analysed using independent samples t-test. Nonparametric
data were analysed using chi-square test or Fisher’s exact test. P value less than 0.05 was considered
significant.
Results: The incidence of postoperative sore throat in Group Betamethasone and Group Water based
lubricant was 26.82% and 26.82% respectively. Similarly the incidence of hoarseness of voice was
14.63% and 21.95% respectively.
Conclusion: We conclude that betamethasone gel does not reduce the incidence of postoperative sore
throat and hoarseness of voice compared to water based lubricant for intubation with PVC tracheal tube
through LMA CTrach™.

Craniofacial anthropometric study of normal newborns in a tertiary care hospital of Solan

Dr. Mehakdeep Singh, Dr. Rajeev Vinayak, Dr. Inderpreet Sohi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 351-363

Facial anthropometry is very important for the study of human growth and variation in different races
and also for clinical diagnosis and treatment. A study was conducted in the Department of Paediatrics,
Maharishi Markandeshwar Medical College and Hospital, Kumarhatti, Solan to make a database of
various anthropometric measurements, especially craniofacial anthropometry of normal full term
newborns born in the hospital.
Objective: To measure craniofacial anthropometric parameters of normal full term newborns, make a
database and to statistically analyze the correlation (comparison) between male and female neonates with
respect to the above-mentioned parameters.
Material & Methods: Study was conducted from the month of February 2020 to October 2020 on 453
newborns. All the facial parameters were measured with the help of vernier caliper and were taken twice
and final value was taken as the average value of the two measurements.
Statistics: Mann-Whitney U and Wilcoxon Rank Sum tests were used to compare 2 groups.
Findings: The mean value and range for all the parameters was determined. A statistically significant
difference in Face Width (p<0.038), weight (p<0.019), Foot Length (p<0.030), Crown Heel Length
(p<0.049) and Nasal Width (p<0.046) between male and female newborns was seen.
Conclusion: The local values have been derived from well-defined populations to make and expand the
normative database of various craniofacial anthropometric parameters. Pediatricians can be benefitted by
this study for screening and diagnosis of various craniofacial abnormalities as a part of complex genetic
disorders and for craniofacial surgeries.

Clinicopathological profile of thrombocytopenia in a tertiary care center in Himachal Pradesh

Monica Puri, Neelam Gupta, Naveen Kakkar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 364-372

Introduction: Thrombocytopenia is a common condition seen in clinical practice. A wide range of
etiologies and variation in clinical presentation often pose a challenge in its diagnosis. Early recognition
of thrombocytopenia and its causes can avoid critical bleeding.
Aim: This study aimed to assess etiology and clinicopathological profile of thrombocytopenia in a
tertiary care center.
Materials and methods: Of all patients whose blood samples were received for complete blood count
analysis, 500 patients with thrombocytopenia were included. Blood samples were run in Sysmex XP-100
and PCi 20 fully automated, three-part differential hematology analyzers. Leishman-stained peripheral
blood smears were also studied.
Results: Mild thrombocytopenia (platelet count 60,000-1,50,000/μl) was seen in majority (84.8%) of the
patients followed by moderate thrombocytopenia (platelet count 20,000-60,000/μl) in 10.8% and severe
thrombocytopenia (platelet count <20,000/μl) in 4.4% of the patients The most common cause of
thrombocytopenia was found to be infections (50% patients) followed by chronic liver disease (14.8%
patients), macrothrombocytopenia (10.6% patients), hematological disorders (8.6% patients), gestational
thrombocytopenia (7.8% patients), drug intake (4.4% patients) and chronic kidney disease (1.8%
patients). Among infections, acute febrile illness (nonspecific) was the most (23.2%) common cause
followed by COVID 19 infection (19.4%) and bacterial sepsis (5.4% patients). Four distinct patterns of
platelet histogram in patients with thrombocytopenia were seen.
Conclusion: Similar to most previous studies, infections were the most common cause of
thrombocytopenia in the present study. The present study also highlights two novel entities- suspected
asymptomatic macrothrombocytopenia and Covid-19 infection.

Dermatological manifestations in patients with chronic kidney disease: A cross sectional study

Bindushree R, Priyashree R

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 373-379

Introduction: Chronic kidney disease (CKD) is associated with a complex array of cutaneous
manifestations caused either by the disease or by treatment. Cutaneous manifestations in chronic kidney
disease are polymorphic and diverse. Most patients with severe CKD progress to end stage renal disease
(ESRD) with significant morbidity and mortality. The Aim of our study was to evaluate the prevalence
and pattern of cutaneous disorders among patients with chronic kidney disease.
Materials and Methods: One hundred patients of chronic kidney disease above the age of 18 years with
dermatological manifestation were enrolled in the study. A detailed physical examination and
dermatological examination was done and findings recorded. Relevant investigations including complete
haemogram, diabetic profile, ANA, renal function tests, Liver function tests, electrolytes, viral markers,
serum calcium, phosphorous and PTH (parathormone) levels, KOH mount, culture & sensitivity, woods
lamp examination, biopsy was done if indicated.
Results: In our study we included 100 patients of CKD with cutaneous manifestations. The most
common cause of CKD in our study was found to be diabetic nephropathy which was seen in 47% (n=47)
patients. Pruritus was the most common dermatological manifestation seen in 73% (n=73) of the total
study population followed by xerosis in 68% (n=68). More than 50% of the study population had more
than one dermatological manifestations. Nail and hair changes was seen in 43% and 58% respectively.
Conclusion: Patients with end stage renal disease (ESRD) may present with variety of skin abnormalities
and the most common being pruritus and xerosis as seen in our study. An inter-disciplinary approach
involving dermatologists and nephrologists is essential to improve the quality of life of patients with
ESRD.

Comparison of anemia characterization between automated CBC analysis and conventional peripheral blood smear assessment

Dr. Mehak Kashyap, Dr. Naveen Kakkar, Dr. Neelam Gupta

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 380-388

Introduction: Complete blood count (CBC) by the automated hematology analyzers and microscopic
examination of peripheral smears have traditionally been used in the diagnosis of anemias. The advent
of automated hematology analyzers has improved accuracy and precision of test results and has reduced
subjective errors. This study aimed at
i) Comparing anemia characterization between automated CBC analysis and conventional peripheral
blood smear assessment.
ii) Studying RBC histogram patterns in various categories of anemia.
Materials and methods: Blood samples from 500 adult anemic patients were run in Sysmex XP-100
fully automated, 3-part differential hematology analyzer. In all patients, blinded peripheral blood smear
examination by two observers was done. Anemia categorization by peripheral blood smears and
automated red cell data was compared.
Results: The number of patients with normocytic normochromic anemia on automated CBC was 280
and on peripheral smear examination was 269. On automated CBC, 137 patients had microcytic
hypochromic anemia whereas 107 patients had microcytic hypochromic picture on microscopy.
Significantly higher number (p<.05) of patients (76) with microcytic normochromic morphology was
diagnosed on blood smear compared to automated counts (17). When RBC volume and hemoglobin
content were considered together, a Kappa value of. 447 was obtained indicating moderate agreement
between the automated and manual (peripheral blood smear) assessment of anemia.
Conclusion: Patients with most anemia types can be accurately diagnosed by automated CBC analysis.
The peripheral blood smear has limitations in cases with borderline MCVs and mild hypochromia which
may be missed. It, however, still remains the cornerstone in the identification of abnormal RBC
morphology seen in hemolytic anemias.

A study to assess the factors affecting attainment of control and acute exacerbations in children treated for asthma

Shrikant Hemant Joshi, Salma Shaziya, Poornachand Venkatesh, Pradeep Senapathi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 389-395

Background: The Asthma Guidelines of the National Asthma Education and Prevention Program
(NAEPP) published by the National Institutes of Health (NIH) emphasize the need to evaluate asthma
control as a key component for asthma treatment and management. Well-controlled asthma is associated
with improved health status, and fewer physician visits, hospitalizations and emergency room visits
among children and adults. In contrast, poor asthma control is directly linked with increased school
absenteeism and loss in work productivity among asthma children and adults/caregivers, respectively.
Unfortunately, studies report that asthma remains uncontrolled in many asthmatic patients, despite
receiving appropriate treatments. Present study has been designed to update the knowledge regarding
factors affecting asthma control and factors responsible for frequent exacerbations in children so that
corrective measures could be taken.

Simple Grass Root Intervention in a Developing Society to Detect Early Cases of Extreme Perineal Hypospadias being Raised as Girls

Dr. Manish Jain, MCh, Dr Alpana Jain

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 396-399

Background: Sex assignment and subsequent corrective surgery, if required, can occur without delay – effectively reducing the psychological trauma inflicted on the parents, the child and the community. In view of gross psychological trauma and social stigma associated with these situations we undertook a community intervention to identify further cases of extreme perineal hypospadias, being raised as girls, in this region and undertook necessary investigations and management.
Materials & Methods: a grass root community intervention was undertaken. It was made mandatory to examine the external genitalia of all girls between 0 and 6 years of age, presenting and enrolled to anganwadi centres.
Results: Data was collected from January 2019 to December 2019. A total 9828 girls were examined, out of these 72 were suspected cases of ambiguous genitalia. Out of these suspected cases 22 cases were clinically confirmed as having ambiguous genitalia.
Conclusion: Given our experience we believe examination of genitalia should be mandatory for such or any other screening program especially given the potential psychological and social harms that can result to the child and the family from missing such conditions.

Inguinal Hernia Repair by Desarda Technique without Mesh

Kuladeep V N, Sunil Kumar Shetty, Keshav Prasad YV, Srirama Bhat M, Soundarya PL

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 400-404

Introduction:
Background: Inguinal hernia repair without mesh by Desarda Technique. To study the short-term postoperative mean pain-score, return to normal gait, recurrence among adult patients with primary inguinal hernias compared to other conventional methods.
Methodology:  It’s an observational study with 30 patients of age group 20-40 years with primary inguinal hernia. Study was conducted in Government wenlock hospital, Mangalore. Results: Out of 30 patients included in the study, 21 right sided and 9 were left sided hernia. 28 patients were pain free by 3rd day, 2 of them were pain free by 7th day, 2 patients developed seroma collection, and 1 patient developed
wound gapping and required secondary suturing, all the patients returned to normal gait by 2nd day, no foreign body sensation, and no recurrence till now.
Conclusion: Desarda’s no mesh repair is a physiologically sound, easy to learn and simple method. It is more comfortable for the patient as pain intensity and duration is less, early return to gait and normal activity, less hospital stay, also cost beneficial (without mesh) for the patient.

Health care seeking behaviour of chronic obstructive pulmonary Disease patients: Results from a community based cross-sectional study

Dr. Malik Shanawaz Ahmed, Dr. Ishan Kumar Parashar, Dr. Mohammed Parvez, Dr. Rajendra Kumar Shukla

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 404-409

Introduction: Chronic obstructive pulmonary disease causes significant mortality and morbidity
worldwide and in India. It is characterized by airflow limitation that is not fully reversible. Better health
care seeking behaviour may halt the progression of disease and improve their quality of life. This study
assesses health care seeking behaviour of chronic obstructive pulmonary disease and factors affecting it.
Material and methods: All 205 patients diagnosed with chronic obstructive pulmonary disease using
spirometry in a large community based study were enquired about their health care seeking behaviour.
Chronic lung disease severity index was used to assess the severity of symptoms. Sociodemographic data
was also recorded. Factors affecting their healthcare were enquired of using a semi-structured
questionnaire.
Results: Large number of patients were under diagnosed and untreated. Public sector was preferred with
being asymptomatic or few symptoms and high cost being major barriers for not taking treatment. Severe
symptoms, later stages of disease, lower standard of living & those living in rural areas had a significantly
lower treatment seeking behaviour.
Conclusion: Chronic obstructive pulmonary disease patients were having poor health care seeking
behaviour.

Pseudo constipation: Prevalence and impact on exclusive breastfeeding practice in 0-6 months infants

Salma Shaziya, Divyarani DC, Sowmya D, Pradeep Senapathi, Purushotham DR

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 410-417

Objective: Knowledge of pseudo constipation behaviour in exclusively breastfed infant’s 0-6-month age
is sparse. This benign temporary condition creates anxiety among parents and health care providers so as
infants are put to diagnostic tests and treatments not required. Mothers self-introduce early add on feeds
as of anxiety which may hinder the optimal infant feeding. The study aimed to:
1. To determine prevalence of pseudo constipation or infrequent stools in 0-6 months healthy
breastfeeding infants.
2. To draw correlation of pseudo constipation and its impact on exclusive breastfeeding.
Methods: 100 mothers fitting into inclusion criteria were put to a set of questionnaire. Babies born with
normal birth weight, passed meconium within 48 hours and predominantly breastfed, having satisfactory
weight gain and no illness history in past 6 months were included. Babies with functional constipation,
infant dyschezia, history suggesting of organic causes of constipation, failure to thrive, congenital
anomalies or associated illness were excluded.
Results: The prevalence of pseudo constipation in 0-6months predominantly breastfed infants was 42%.
All these infants had mean peak time duration of defecation ≥2days and mean duration the symptom
lasted in weeks was 5.43 weeks (SD-4.52, median-5). All infants had reduction in frequency of stools in
second month of life (median-45 days). Among the infants who had pseudo constipation behaviour
64.3% of mothers had started early complimentary feeds <6month age. The comparison between the
cases and control group showed to be highly significant with χ 2 =21.23, df =1, p <0.001.
Conclusion: Prevalence of pseudo obstruction behavior in exclusive breastfed infants is as high as 42%.
Nearly 64.3% of mothers intervened this by adding complimentary feeds early <6-month age. We would
like stress that knowledge of this temporary condition requiring no interventions would be a great benefit
for pediatricians, pediatric surgeons, nurses and parents.

Congenital hypothyroidism screening in neonates in an iodine deficient endemic region: A prospective study at a tertiary care centre in north India

Prateek Agarwal,Inderpreet Sohi, Rajeev Vinayak, Harpreet Kaur Walia

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 418-423

Introduction: Congenital Hypothyroidism is one of the most common causes of preventable mental
retardation with an estimated incidence of 1:2500-2800 live births in India. The need for neonatal
screening for CH is essential as the majority of signs and symptoms are not exhibited in the neonatal
period.
Aim: To use TSH values as a marker for screening for Congenital Hypothyroidism in neonates in an
iodine deficient endemic region and to find normative values of Serum TSH for the study group.
Material and Methods: A prospective observational study was conducted over a period of 18 months.
A total of 500 newborns who fulfilled inclusion criteria were enrolled. Umbilical Cord Blood samples
(2ml from placental side) were taken for TSH values for all Term neonates with birth weight ≥ 2.5 Kgs
whereas Serum TSH values at 48-72 hours of life were taken for Preterm (<37 completed weeks) and
Low birth weight neonates. All babies who had a cord blood TSH value of >20 mIU/L were sampled
again for TSH and T4 and if repeat TSH was >20 mIU/L and/or T4 < 10 mIU/L they were subjected for
further examination and treatment if required.
Results: The mean cord blood TSH was 7.26 mIU/L in our study, with 7.28 mIU/L in term neonates and
6.94 mIU/L in preterm neonates. Nine babies had TSH values >20mIU/L in the initial screen but all were
<20 mIU/L on repeat sampling. Hence none of the 500 neonates who were screened for CH in our study
were detected to have congenital hypothyroidism. TSH values corresponding to the 5th, 10th, 25th, 50th,
75th and 95th percentile were 3.08, 4.71, 5.39, 13.18, 21.65 and 39.22 respectively. The babies born to
mothers with hypothyroidism, had higher TSH values compared to those without risk factors.
Conclusion: In our study, none of the 500 newborns screened had congenital hypothyroidism. We
observed that neonates born to mother with hypothyroidism had higher cord blood TSH which was
statistically significant. According to our normogram, the 50th centile corresponded to 13.18 mIU/mL
which is <20 mIU/mL while neonates above 75th centile had TSH values above 20 mIU/ml.

A study to determine the co-existence of Hashimoto’s thyroiditis and papillary thyroid cancer

Dr. McEnroe D Mordom, Dr. Benitta Francis D, Dr. Ajayan G, Dr. Deepak Paul

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 424-429

Background: Thyroid diseases are endemic in India with around 42 million people suffering from them.
Hashimoto’s thyroiditis is the most common autoimmune pathology of the thyroid gland. Papillary
carcinoma thyroid is the most common thyroid cancer. The objective of this article is to study coexistence
of Hashimoto’s thyroiditis with papillary thyroid cancer.
Methods: Our study was prospective study carried out on 123 patients in the age group 14-65 in the
department of surgery Sree Gokulam Medical college and research foundation Venjaramoodu during the
period November 2011 to February 2013.A history was taken followed by clinical examination. They
were then investigated by thyroid function test, ultrasound neck X-ray neck, X-ray chest, indirect
laryngoscopy, fine needle aspiration cytology (FNAC) and anti-thyroid antibody tests. The patients were
taken up for surgery and histopathology reports were correlated with the findings of FNAC and antithyroid
antibodies.
Results: Out of the 123 patients who enrolled. For our study 115 were females. All patients presented
with a swelling in the neck. FNAC showed 70(56.9%) colloid goitre, 14(11.4%) had Hashimoto’s
thyroiditis, 11(8.9%) follicular neoplasm and 4(3.3%) papillary thyroid cancer. 60(48.8%) of patients of
123 had abnormal Anti- TPO antibodies and 70(56.9%) had positive Anti- thyroglobulin antibody. Of
the 123 patients 38(30.89%) had thyroiditis. 19(15.44%) patients had papillary thyroid cancer and 5(4%)
had papillary thyroid cancer and thyroiditis at the same time. All patients with papillary carcinoma
thyroid and thyroiditis were females.
Conclusion: In a country like India were thyroid diseases are endemic, benign thyroid diseases are very
common. Papillary thyroid cancer is the most common thyroid cancer and according to our study has a
26.3% coexistence with Hashimoto’s thyroiditis which is the commonest auto immune thyroid disease.
From this study we conclude that careful workup and surgery are recommended when dealing with
patients with thyroiditis especially women.

A Prospective Study on Repair of Myringoplasty with Platelets Rich Plasma in Banas Kantha District(Gujrat), India

Dr Manish D Patel, Dr Sadhna Yadav

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 430-435

Introduction: Platelet-rich plasma (PRP) is an autologous product derived from whole blood through the process of gradient density centrifugation. Autologous PRP, with growth factors up to 8 times that of normal serum, has been shown to be safe  and effective in promoting natural processes of wound healing. Our study aims to examine the effect of combining the fat graft with PRP in myringoplasty procedures indicated for TMP secondary to chronic suppurative otitis media (CSOM) and whether it can significantly promotes Tympanic membrane (TM) healing.
Methods: This prospective study included forty patients, presenting with dry tympanic membrane secondary to tubo-tympanic CSOM. Half the patients underwent fat graft Myringoplasty with PRP application (group A), while others served as control and received the fat graft only, without PRP (group B).
Results: In group A, eighteen cases (90%) significantly showed an intact tympanic membrane, while Eleven cases (55%) were successful in group B. P=0.044.
Conclusion: Topical autologous PRP application during fat plug Myringoplasty is highly successful with no reported postoperative infections and minimal morbidity.

A study on prevalence of elevated blood pressure and hypertension among healthy school children at an altitude of 4000-5000 feet

Dr. Divyabh Gehlot, Dr. Neelam Grover, Dr. Hemant Gupta, Dr. Rajeev Vinayak, Dr. Amudeep Singh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 430-437

Introduction: Early diagnosis of hypertension is an important strategy in its control which is usually
missed in OPD practice. Kumarhatti, Solan, was selected as the place of study based on the new AAP
2017 criteria to find the prevalence of elevated blood pressure and hypertension at an altitude of 4000-
5000 feet.
Objective: To measure blood pressure of school going children and to classify BP measurements into
normal BP, Elevated BP and Hypertension.
Methods: 600 children between 10 to 17 years of age were selected from urban and rural schools. The
final diagnosis of HTN was made if a child or adolescent had auscultatory confirmed BP readings
≥95thpercentile on 3 different visits. Data collected was analyzed using SPSS20.
Results: Prevalence of EBP, stage 1 and stage 2 hypertension was found to be 15, 8%, 4.5% and 1%
respectively in the study. Prevalence of EBP and stage 1 hypertension was higher in urban population
(17.2% and 5.3% respectively) whereas stage 2 hypertension was almost equal in both population
(P<0.05). Prevalence of EBP, stage 1 and stage 2 hypertension was maximum in obese category as
38.6%, 13.63%, 6.8% followed by overweight 24%, 11.25%, 2.5% respectively (P<0.05). The prevalence
of positive family history among study subjects was 15% (N=90) with P value<0.05.
Conclusion: Prevalence of hypertension was 5.5% in the study subjects. Prevalence of EBP and stage 1
hypertension was higher in urban population. Our study revealed that prevalence of elevated blood
pressure and hypertension was significantly more in overweight and obese children and with positive
family history compared to normal children proving obesity and positive family history as an important
risk factor for hypertension in children.

Establishing the normative values of spirometry in children of 5- 18 years age range living in and around Solan district of Himachal Pradesh, India

Dr. Ankush Sangwan, Dr. Inderpreet Sohi, Dr. AK Janmeja, Dr. Rita Haleja, Dr. Amudeep Singh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 438-458

Introduction: Pulmonary Function Tests (PFTs), especially spirometry is an established mode of
assessing chronic lung diseases especially Asthma. Spirometric reference values are essential in assessing
pulmonary function. Normative values of these tests differ from population to population and with
difference in methods and apparatus used. The normal standards for pulmonary function measurements
among the hilly areas of Himachal Pradesh is not reported yet.
Aim: To measure the normative values of spirometry (FEV1, FVC, FEV1/FVC, PEFR) in children of 5-
18 years age range living in and around Solan district of Himachal Pradesh, India.
Material and Methods: This cross-sectional study was carried out at M.M Medical College and
Hospital, Kumarhatti, Solan, HP, India and comprised school-going children and nearby community aged
5-18 years. After noting their gender, age, height and weight, the pulmonary function test measures,
Forced vital capacity (FVC), Forced expiratory volume in 1 second (FEV1), FEV1/FVC%, FEF 25-75%
and peak expiratory flow rate were taken. Simple and multiple regression models were used for the
prediction of pulmonary function test values. SPSS 20 was used for statistical analysis
Results: Of the 200 participants, 110(55%) were boys and 90 (45%) were girls. The mean age was
12.47±3.27 years. The means height, weight, forced expiratory volume in 1 second, force vital capacity,
peak expiratory flow rate FEV1/FVC% and FEF 25-75% were 147.39±16.07cm, 41.30±12.38kg,
2.54±0.70, 2.90±0.8, 5.42±1.30, 87.41±3.85% and 2.90±0.84 respectively. All the three variables - Age,
Height and Weight-had significant linear relationship and positive correlation with the pulmonary
function test values (p0.7). Among these three variables maximum correlation was found with height
(r=>0.8).

An observational study of haemodynamics with etomidate as an induction agent in patients with coronary artery disease

Dr. Vishal Mallappa Kappattanavar, Dr. PG Raghavendra, Dr. Chandana MH, Dr.Jyoti Magar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 459-468

Etomidate has been widely used in western countries has now become available in India. Etomidate is
preferred in patients with CAD, especially with poor left ventricular (LV) function as it provides stable
cardiovascular profile but it has less inhibitory effect on pharyngolaryngeal reflex thus may cause less
blunting of response to laryngoscopy and intubation. After getting approval from institutional ethics
committee, study was carried out in all patients fulfilling the inclusion and exclusion criteria during the
study period. Patient diagnosed or known case of CAD either from history, investigations were
included in the study after obtaining written valid informed consent. There was no hypertension or
hypotension in group A (EF<45%) but in group B (EF>45%) hypertension was noted in just 1 patient
and no hypotension noted. Statistically they were non-significant (p value-0.077). There was no
occurrence any arrhythmias or significant ST changes in either group at any point of time from
induction to 10min after intubation.

CAD patients who were undergoing elective surgical procedure under general anesthesia: Clinical correlates

Dr. Vishal Mallappa Kappattanavar, Dr. PG Raghavendra, Dr. Chandana MH, Dr.Jyoti Magar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 469-474

CAD and stroke are the predominant causes and are responsible for >80% of CVD deaths. The Global
Burden of Disease study estimate of age-standardized CVD death rate of 272 per 100000 populations
in India is higher than the global average of 235 per 100000 populations. In India of particular concern
is its accelerated buildup, the early age of disease onset in the population and the high case fatality rate.
After getting approval from institutional ethics committee, study was carried out in all patients
fulfilling the inclusion and exclusion criteria during the study period. Patient diagnosed or known case
of CAD either from history, investigations were included in the study after obtaining written valid
informed consent. 2D Echo of patient diagnosed or known CAD was routinely done in our institution
mainly to know the ventricular function. The number of patients having DM was comparable in the two
groups (p value-0.644). The percentage of DM patients in group A and group B being 40% and 35%
respectively. The time taken for intubation in two groups was comparable, with the mean duration
being 19.5s in group A and 19.4s in group.

A cross-sectional study to analysis of depression level among frontline health care worker, working at tertiary care canter during COVID-19 at central India

Chouhan Vijay, Churihar Ritesh, Shukla Aanand, Baghel Anil Singh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 475-479

Background: At the end of 2019 a new viral disease namely covid-19 has occurred which was highly
contagious within a few months it spreads to more than 100 countries. A poor understanding of new
infections and lack of knowledge leads to compromised patient health benefits as well as psychological
stress to front-line health workers. This study aimed to assess the knowledge and level of perception of
health care workers about covid-19.
Methods: A cross-sectional web-based survey was carried out among front-line health care workers who
work at tertiary health care centers the survey instrument constituted a semi-structured pre-tested
questionnaire. The 29-item questionnaire was divided into two sections. Statistical tool chi-square test
used to investigate the stress, anxiety, and depression with significance set to p<.05.
Results: Out of 100 participants 30 front-line health care workers have minimal depression, 25 mild
depression, 14 moderate depression, 13 moderately severe depression, maximum participants belong to
age group 26-35 (P-value .001). The participant with a child is a total of 67 out of 100 participants who
show a variety of depression, Maximum number of participants is 21 having mild depression P (value is
.010). There total of 57 participants who confident caring covid-19 patient, maximum of 22 participants
who have mild depression (P-value is .000).
Conclusion: As the entire world faced the covid-19 thread and continued to emerge, most frontline health
care workers have a varying degree of depression but according to PHQ-9 no one has severe depression.
Definitive or effective treatment of covid-19 including prevention of this by vaccination is mandatory.
Education intervention, personal protection equipment and appropriate knowledge are urgently needed
to reach frontline health care work beyond the international border and future studies are warranted.

A comparative study of on-lay mesh repair and retro-rectus mesh placement in incisional hernia repair

Dr. Dinesh Kumar Sharma, Dr. Shiv Kumar Bunkar, Dr. Naresh Kumar, Dr. Rahul Yadav, Dr. Poornima Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 480-487

Background: Incisional hernia continues to be one of the common post-operative complication of
abdominal surgery. Newer techniques have been added for hernia repair including prosthetic mesh repair
and the laparoscopic repair, which have been reported to produce better results. This study aimed to
compare on-lay mesh repair and retro-rectus mesh placement.
Material and Methodology: The current study was a prospective study conducted in the Department of
General Surgery, J.L.N. Medical College & Attached Group of Hospital, Ajmerwith an aim to evaluate
and compare the efficacy of on-lay mesh repair and retro-rectus mesh placement for repair of incisional
hernia in terms of VAS score for pain post-operatively, to compare the duration of the surgery, hospital
stay between the two repair techniques and to compare the early and late complications between the two
repair techniques on a total 50 patients (25 patients of onlay and 25 patients for retrorectus repair).
Results: There is significant lower complication i.e. blood loss, pain, seroma formation, surgical duct
infection, sinus formation and recurrence in sublay mesh repair and blood loss is also significantly lower,
while operative time and blood loss during surgery is higher in comparison to onlay mesh placement.
Conclusion: In our study there are significant lower complication in sublay repair than onlay repair.
Thus, proved the sublay repair a better approach for the ventral hernia repair than the onlay repair.

A comparative study to evaluate the efficacy of intrathecal 1% chloroprocaine with clonidine versus 1% chloroprocaine for infraumbilical surgeries

Dr. Nisarga R, Dr. Bhavana DA, Dr. Shobha D, Dr.Krishnaprasada Prabhu D

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 488-496

Background: Bupivacaine, the commonly used local anesthetic agent in spinal anaesthesia having
duration of sensory and motor blockade of 90 to 200minutes limits its use for short duration ambulatory
surgery with delayed ambulation and risk of urinary retention. But 2-Chloroprocaine (2-CP) has
duration of action of 70 to 150 minutes. With Clonidine, an α2-adrenergic agonist, as an adjuvant has
been shown to prolong both the sensory and motor blockade when combined with spinal Bupivacaine.
In our study, we compared the effectiveness of intrathecal 1% 2-Chloroprocaine with clonidine vs.
intrathecal 1% 2- Chloroprocaine for infraumbilical surgeries in terms of their onset of blocks, duration
and offset of blocks along with the hemodynamic variations.
Methods: A prospective and omised controlled double blind study was conducted in 60 ASA I and
ASA II patients in the age group 18-60 years, posted for elective infraumbilical surgeries under
subarachnoid block. They were randomised into 2 groups of 30 patients each and Group CC (n=30)
received intrathecal 3.0 ml of 1% 2-CP with 30 mcg Clonidine and Group CS (n=30) received
intrathecal 3.0 ml of 1% 2-CP with 0.2ml Normal Saline. Hemodynamic parameters, onset of sensory
blockade, time for highest sensory and motor blockade, total duration of sensory an motor blockade,
two dermatome regression time, time for rescue analgesic, time for ambulation and first micturition,
sedation score were recorded. Side effects werenoted.
Results: Demographic data as well as operating data were comparable between the 2 groups. Group
CC showed faster offset and prolonged sensory and motor blocks compared to Group CS. Time for
ambulation and micturition were less in Group CS compared to Group CC. No side effects were note
din both the groups.
Conclusion: Addition of clonidine to Intrathecal isobaric 2-chloroprocaine decreases the onset time for
sensory and motor blockade, produces higher level of sensory blockade, prolongs postoperative
analgesia, prolongs sensory blockade and motor blockade, prolongs ambulation and voiding time and
has less haemodynamic changes which could be easily managed. Hence it may be proposed for day
care surgeries.

Comparison of efficacy of subhypnotic dose of midazolam and propofol in decreasing nausea and vomiting in caesarean section under spinal anaesthesia

Dr. Ramyashree MH, Dr. Nisarga R, Dr. Gayatri CK, Dr. Ajith Kumar Shetty

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 497-503

Background: Midazolam and propofol by virtue of their antiemetic effect were found
individually to reduce the incidence of intraoperative nausea and vomiting. This study
compares the effects of midazolam and propofol in decreasing the incidence of nausea and
vomiting in pregnant women undergoing lower segment caesarean section (LSCS) under
spinal anaesthesia. It also assesses maternal sedation, neonatal outcome and other side effects.
Aim: To compare the effects of subhypnotic dose of midazolam and propofol in prevention
of intraoperative nausea and vomiting in lower segment caesarean section under subarachnoid
block.
Methods: With ethical committee permission the 60 pregnant women were randomly
allocated into 2 groups after taking informed consent. Group M received 0.03mg/kg
midazolam immediately after cord is clamped, Group P received 10 mg propofol immediately
after cord is clamped. Incidence of nausea and vomiting was not according to Bellville
scoring system (0-novomiting, 1-Nausea, 2-Retching, 3_vomiting). The degree of sedation,
hemodynamic changes were noted baseline, after induction, after drug administration, 30
mins after drug administration, 60 mins after drug administration, neonatal out come and side
effects were recorded.
Results: Statistically significant decrease in intraoperative nausea and vomiting in patients
undergoing LSCS under spinal anaesthesia with 10 mg propofol compared to 0.03 mg
midazolam is observed. Degree of sedation, respiratory rate, mean mephentermine
consumption were comparable between two groups and no difference found.
Conclusion: Propofol significantly decreases incidence of intraoperative nausea and
vomiting inches are in section under spinal anaesthesia as compared to midazolam.

A study of the clinical profile of acute pancreatitis and its correlation with Modified Glasgow score and modified CT severity indices

Dr. Nitin Kumar Chavan, Dr. Vinay HD, Dr. Shashanka Rajappa, Dr. Shankar Lal J

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 504-509

Although measurement of amylase and lipase is useful for diagnosis of pancreatitis, serial
measurements in patients with acute pancreatitis are not useful to predict disease severity,
prognosis, or for altering management. Routine abdominal computed tomography (CT) scan
is not recommended at initial presentation because there is no evidence that CT improves
clinical outcomes and the complete extent of pancreatic and peripancreatic necrosis may only
become clear 72 hours after the onset of acute pancreatitis. This was a prospective
observational study conducted in HIMS, Hassan from July 2020 to July 2021. Modified
Glasgow score showed Mild Acute Pancreatitis in 93 and Severe Acute Pancreatitis in 47
Patients. Using the modified CT severity index, the observers graded severity of the acute
pancreatitis as mild in 66, moderate in 31, or severe in 43 of the 140 patients with CT scans.

Clinico-laboratory profile of Candiduria isolates-special reference to speciation and antifungal susceptibility pattern

Dr. Amith Joshi, Dr. Pallavi Baliga, Dr. RD Kulkarni

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 510-515

Background: Candida causes urinary tract infections in persons with conditions such as
diabetes, prolonged hospitalization, instrumentation, prior antibiotic therapy etc. Mere
presence of Candida in urine is not indicative of true infection and it requires other evidence
such as pyuria, symptoms suggestive of urinary tract infection, repeated isolation of same
organism etc.
Objective: The study was done to estimate prevalence of Candiduria in the hospital and to
know the predominant species causing the same. The study also determined antifungal
susceptibility pattern of the isolates
Materials and methods: Routine urine samples suspected of urinary tract infection sent to
laboratory for culture and antibiotic sensitivity testing were analyzed. Culture on routine
media were done, followed by speciation using Auxanography method of sugar assimilation.
Antifungal susceptibility testing was done following CLSI guidelines using fluconazole and
voriconazole discs.
Results: Prevalence of Candiduria was estimated to be around 2.2% amongst urine samples.
C. tropicalis was the predominant species (51%), followed by C. albicans (26%). Other
Candida species isolated were C. glabrata (11%), C. guelliermondi (6%), C. parapsilosis
(4%) & C. krusei (2%). All isolates were susceptible to voriconazole. Two isolates of C.
tropicalis was intermediately sensitive to Fluconazole, whereas one isolate of C. krusei was
resistant to fluconazole.
Conclusion: The prevalence rate of 2.2% of Candiduria was similar to few studies observed.
Pyuria was noted in 80% isolates highlighting the non-reliance of pyuria in cases of
Candiduria. Majority of the isolates had colony count of >104cfu/ml, which is significant in
diagnosis of urinary tract infection. Non-albicans Candida (NAC) were the predominant
group (74%), which is in consonant with global trend of increasing prevalence of NAC
species in Candida infection. Certain species are developing resistance to routinely used
antifungals like Fluconazole, notably C. krusei. It was also noted in the study. The study
highlights the importance of knowledge of various Candida species causing Candiduria and
their antifungal resistance pattern.

Bacteriology and susceptibility pattern in CSOM in central India

Amit Kumar Niranjan, Nikhil Agrawal, Rukmini Sharma, Dr. Rajendra Kumar Teharia

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 516-521

Objective: Active chronic suppurative otitis media (CSOM) is the bacterial chronic infection
of middle ear cleft mucosa and treated with antibiotics empirically, which may cause resistance
to bacterial strains. In this study, we studied the bacteriology and susceptibility pattern in
CSOM for efficient empirical treatment especially in central India.
Methods: Clinically proven 160 patients with CSOM with otorrhea, were included in our
study. Ear discharge samples were collected with the asepsis method and bacterial culture and
antibiotics sensitivity patterns were obtained.
Results: Bacterial growth was present in 76.1% of ear samples with Staphylococcus and
Pseudomonas being most prominent. Vancomycin and Rifampicin were most effective for
staphylococcus and amoxicillin and quinolones were most resistant. Meropenem and
Piperacillin/tazobactam were the most effective antipseudomonal antibiotics. Ciprofloxacin
and Levofloxacin were least sensitive antipseudomonal quinolones.
Conclusion: Amoxicillin with quinolones were highly resistant for bacterial growth in-ear
samples so used cautiously as empirical therapy in CSOM. For effective treatment of CSOM
and prevention of resistant strain emergence, all ear samples must be sent for culture sensitivity.

A study to assess the functional outcomes of surgical intervention in patellar fractures and make a comparison between tension band wiring and partial patellectomy

Dr. Manoj Bhagirathi Mallikarjunaswamy, Dr. Nikunj Aggarwal, Dr. Shivanna

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 522-528

Introduction: Surgical treatment of patellar fractures has evolved over the years. It ranges from partial
or total patellectomy to open reduction internal fixation using tension band wiring and constructs.
Previous studies have documented conflicting results regarding clinical and functional outcomes after
surgical treatment of patellar fractures.
Aim: To assess the functional outcomes of surgical intervention in patellar fractures and make a
comparison between tension band wiring and partial patellectomy.
Methods: 46 patients with patellar fractures were included in this prospective longitudinal study.
Depending on the fracture type surgical intervention in the form of tension band wiring of the patella in
24 patients and partial patellectomy in 22 patients was done. Postoperatively, the functional outcomes
were measured at three months, six months, and the latest follow-up. The outcome variables used were
Knee Injury and Osteoarthritis Outcome Score (KOOS), extensor lag, range of knee flexion, thigh
circumference, Medical Research Council (MRC) grading of quadriceps and hamstrings strength and
complications in treated patients. Levene’s test, T test and chi-square test were used to compare the
these outcome variables.
Results: KOOS score was significantly better (P value of 0.001) and thigh wasting was less (P value of
0.09 and 0.412) at three and six months in the tension band wiring (TBW) group. Knee flexion (P value
of 0.001) and extensor lag (P value of 0.02) had significantly better outcome in the TBW group at three
months, but a similar outcome to the partial patellectomy group at six months (P value >0.05). All the
patients had regained their full quadriceps/hamstring muscle strength at six months. Fracture union was
assessed at six months and showed a significantly better union rate in tension band wiring when
compared to partial patellectomy (P value < 0.05).
Conclusions: Operative management of patellar fractures gives good to excellent functional outcomes
at short to midterm follow-up with minimal complications, irrespective of the type of procedure.
Comparable functional outcomes can be expected following patellar osteosynthesis and salvage
procedure. However, future studies with bigger sample size and longer follow-up are needed.

Triple level percutaneous Achilles tendon tenotomy-how efficient?

Dr. Shivanna, Dr. Manoj Bhagirathi Mallikarjunaswamy, Dr. Krishnaprasad HS, Dr. Yogesh, Dr. Mahadevaprasad

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 529-534

Background: Traditionally Open Z-Plasty lengthening is the choice of the procedure for
treating Achilles tendon contracture seen in equinus deformity of the foot, which is
commonly seen in club foot, spastic cerebral palsy, polio myelitis, post traumatic and post
burn contractures etc. Percutaneous Achilles tendon lengthening by triple level tenotomy
technique is based on sliding of partially cut tendon preserving its biology, strength and
biomechanics. This study aims to evaluate the efficacy and safety of this new surgical
therapeutic method.
Methods: A retrospective analysis of the Achilles tendon contracture cases in our hospital
between 2015 and 2020 was conducted. Fifty-one cases of equinus deformities treated with
percutaneous triple level Achilles tendon tenotomy. Operative time required, hospital stay,
wound healing, Achilles tendon rupture and equinus recurrence were recorded and
statistically analysed. American Orthopaedic Foot & Ankle Society (AOFAS) scoring system
was used to assess the Foot and ankle function.
Results: The mean follow-up period was 20 months. The mean operative time was 6 minutes
and mean hospital stay was 2 days. No cases had infection or wound healing complications.
One patient had equinus recurrence which was minimal. The mean AOFAS score increased
from 53% points before procedure to 96% at final follow-up.
Conclusion: This method of Achilles tendon lengthening by Triple level percutaneous
tenotomy significantly reduces operative time, hospital stay and thus expenses. Also this
technique is much better in maintaining soft tissue biology, strength and biomechanics thus
helping in preventing rupture of the tendon and recurrence of the deformity.

Dexmedetomidine in prevention of myoclonus: Side effects and haemodynamic study

Dr. Mohamed Faizuddin, Dr. Lokesh SB, Dr. Geetha M

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 535-543

Dexmedetomidine the S-enantiomer of medetomidine a highly sedative and potent α2-
adrenergic agonists has a potentially useful role as a sedative agent. In healthy volunteers
dexmedetomidine increases sedation, analgesia and amnesia and decreases heart rate, cardiac
output and circulating catecholamine in a dose dependent fashion. Anaesthesia workstation
was checked. Appropriate size endotracheal tubes, working laryngoscope with medium and
large sized blades, stylet and working suction apparatus were kept ready before the induction
of general anaesthesia. Emergency drug tray consisting of atropine, adrenaline and
mephentermine were also kept ready for any eventuality. Post extubation Ramsay sedation
score was significantly higher in group D compared to group S at 30th, 60th and 90th minute
with p value = 0.001, 0.001 and 0.051 respectively. However no patients in group D required
intervention for sedation and were easily arousable. There was no statistically significance
between the groups immediately after extubation and at 120th minute postoperatively. 3
patients in group D (8.57%) and 3 patients in group S (8.57%) had vomiting immediately
following extubation which was statistically not significant (p = 0.721). 1 patients in group D
(2.86%) and 2 patients in group S (5.71%) had vomiting after 30 minutes of extubation which
was statistically not significant (p = 0.555).

A double blind randomized controlled study to evaluate the effect of dexmedetomidine in prevention of myoclonus occurring due to etomidate induction

Dr. Lokesh SB, Dr. Geetha M, Dr. Mohamed Faizuddin

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 544-554

Etomidate is a popular intravenous induction agent because it has a stable haemodynamic profile and
results in minimal histamine release. Myoclonus is observed in 50%–80% of patients who did not
receive pretreatment before etomidate administration, which increases the risk of regurgitation and
aspiration in emergency conditions. Various drugs were used in the treatment of myoclonus but the
results have been inconclusive. Dexmedetomidine, a new alpha-2 agonist has been tried by several
authors to suppress the myoclonus induced by etomidate. A prospective randomized controlled double
blind study was conducted in seventy patients aged between 18-55 years belonging to ASA I and II
scheduled for elective surgery under general anaesthesia. After obtaining informed written consent, a
detailed preanaesthetic evaluation was done and investigations were obtained as indicated. The patients
were randomized into 2 groups with 35 patients each, received either 0.5 μg/kg of dexmedetomidine in
10 ml saline (Group D) or 10 ml of Saline (Group S) over a period of 10 minutes prior to etomidate
induction. The incidence of severe myoclonus was significantly less in group D compared to saline
group with p = 0.031 (8.57% in group D and 28.5% in group S). However there was no change in the
incidence of myoclonus (P = 0.237) and pain on injection (p = 0.309) in both groups. Recovery profile
was comparable in both groups. Our study shows that pretreatment with dexmedetomidine 0.5 μg/kg
IV is effective in reducing the severity of etomidate induced myoclonic muscle movements without
however dexmedetomidine does not have any significant effect on the incidence of myoclonus
following etomidate induction.

A study to observe the prevalence of nasal polyposis among patients with chronic recurrent rhinosinusitis

Dr. Sunil Bajoliya, Dr. Sachin Parmar, Dr. Harshul Patidar, Dr. Ramesh Agrawal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 555-559

Background: Nasal polyposis is a prevalent condition that is said to affect between 1 and 4% of the general population. The aetiology of nasal polyps is largely unknown and has long been a topic of debate. Although historically have believed polyps to be a manifestation of allergy.
Objective: To find out the prevalence of nasal polyposis among patients with chronic recurrent rhinosinusitis.
Materials and Methods: This is a Cross-sectional study, was conducted in MYH a tertiary care hospital, Indore, M.P. A total of 338 patients presenting with symptoms of chronic rhino sinusitis and giving consent were recruited for the study. All patients with chronic recurrent rhinosinusitis were included in the study.
Result: The mean age of participants was 34.5-9 years. There was a preponderance of male gender among all the patients. The most common symptom was nasal discharge, followed by nasal obstruction, followed by headache, among all the participants, 46.1%.
Conclusion: From our study, we conclude that the chronic recurrent rhinosinusitis patient has a chance of developing a nasal polyp if left untreated.

Stainless steel versus titanium elastic nail system in treatment of pediatric femoral shaft fractures: A comparative analysis

Dr. Usman Khan, Dr. Jafar Khan, Dr. Saurabh Jain, Dr. Veerbhan Singh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 560-565

Femoral shaft fractures are one of the common fractures in paediatric age group. They represent approximately 1.6% of all bony injuries in children. The preference of treatment of femoral shaft fracture in each child depends upon age of the child, the location and type of the fractures. Elastic stable intramedullary nailing is the minimally invasive technique, the short operation time, and the preservation of the growth plate.
The purpose of the present study is to analyse the result of titanium and stainless-steel elastic nail in paediatric femoral fractures in 5-12 years of age group. No statistically significant difference was found in stability of fractures treated with both the methods. Both methods have their own advantages. Stainless steel nails are much cheaper as compared to titanium elastic nails which is important aspect in Indian scenario.

Management of pediatric femoral shaft fractures with elastic stable intramedullary nailing (ESIN)

Dr. Usman Khan, Dr. Jafar Khan, Dr. Jignesh Kumar, Dr. Saurabh Jain

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 566-571

Diaphyseal femur fractures in children account for 1.4-1.7% of all fractures, and 7.6% of those involving the long bones. Diaphyseal femur fractures ratio between males and females is 2.6:1.Non-operative treatments such as Pavlik harness, traction, and Spica casting, and operative treatments such as sub muscular plating, elastic nails, rigid nails, as well as internal and external fixation. Elastic stable intramedullary nailing is getting popular for management of femoral fractures for children 5 years and older.
In this study, 35 children aged between 6-15 years with diaphyseal femur shaft fractures were treated with elastic stable intramedullary nailing (ES1N). All patients successfully completed one-year follow-up and were included in the analysis. All the patients were managed with titanium nails. We based on our experience and results thus conclude that Titanium elastic nails can be considered better method of treatment regarding lesser rate of surgical wound complications.

Menopause related quality of life among females of rural field practice area of a tertiary care centre in Jaipur

Dr. Niti Gahlot, Dr. Uttam Kumar, Dr. Archana Paliwal, Dr. Abhilasha Maharrshi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 572-579

Background: The various types of post-menopausal symptoms progressively worsen the well-being of
women and affect, consequently, their quality of life (QOL) on a daily basis.
Objectives
1. To determine the prevalence of poor quality of life among post-menopausal women of rural area.
2. To assess the factors responsible for the poor quality of life among post-menopausal women of rural
area.
Methods: A community based cross sectional observational study was carried out among 100
postmenopausal females aged between 40-60 yrs of age. The standardized Menopause-Specific Quality
of Life Questionnaire (MENQOL) and the International Physical Activity Questionnaire (IPAQ) were
used.
Results: Among the study participants, the most common symptoms in the physical domain were
“decrease in physical strength” (88%), “decrease in stamina” (81%) and “feeling tired and worn out”
(81%). Urinary incontinence was seen in 26% of women. In the psychosocial domain, “the feeling of
having the ability to accomplish less than previously” was the predominant one (78%). Among the
symptoms of sexual domain, “decrease in sexual desire” was the most common complaint (67%). Among
vasomotor symptoms, hot flashes were present in only 35% of participants. Those having low physical
activity were exposed to more postmenopausal symptoms as compared to those having moderate and
severe physical activity.
Conclusion: Menopause is associated with decrease in QOL. Awareness regarding menopausal
symptoms will lead to improvement in QOL by early recognition.

Evaluation of the effect of cinnamaldehyde per se and its interaction with ondansetron on haloperidol induced catalepsy in albino mice

Dr. Ritesh Churihar, Dr Sapna Arun More, Dr. Pooja S. Mishra, Dr. Deepti Gupta

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 580-585

Background: The aim of this study is to evaluate the per se effect of cinnamaldehyde which
is obtained from bark oil of cinnamon tree and its interaction with ondansetron on catalepsy
in Swiss albino mice.
Methods: Haloperidol induced catalepsy model was used. A group of 36 healthy mice of
either sex weighing 20-30 grams were divided at random into six groups (n=6).
Cinnamaldehyde with 98 percent purity was obtained. Catalepsy was induced by haloperidol
(1mg/kg, i.p). Control group received tween-20 20% (10ml/kg, p.o), standard groups were
administered ondansetron (0.5mg/kg and 1mg/kg, p.o ), test groups received cinnamaldehyde
in strength of 100mg/kg, and 200mg/kg and combination group of ondansetron plus
cinnamaldehyde (0.5mg/kg + 100mg/kg) per oral, respectively.
Results: In this acute study, from 60 min onwards after haloperidol administration,
ondansetron at both doses (0.5 mg/kg and 1 mg/kg), showed significantly lower cataleptic
scores as compared to all groups. Cinnamaldehyde at both strengths did not show any
significant effect as compare to control at any point of time (P>0.05). Combination of
ondansetron 0.5 mg/kg with cinnamaldehyde 100mg/kg, showed significant increase in
cataleptic score as compared to ondansetron 0.5 and 1mg/kg alone (P>0.05). Which suggest
that cinnamaldehyde abolishes the protective effect of ondansetron in haloperidol induced
catalepsy.

Study of serum lipid profile in patients with oral submucous fibrosis and oral squamous cell carcinoma and their comparative analysis

Dr. Sangeeta Khyalia, Dr. Parmanand, Dr. Sumana Kundu

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 586-592

Aims and Objectives: The aim of the study was to study serum lipid profile and compare
their levels in patients with oral sub mucous fibrosis (OSMF) and oral squamous cell
carcinoma (OSCC).
Materials and Methods: This study was done in two groups of patients ‑ OSMF and OSCC.
There were forty five participants in each group. Serum obtained from centrifugation of 12
hour fasting blood samples was analyzed on fully automated analyzer Beckman coulter AU-
680 for estimating the lipid levels (cholesterol, triglycerides [TGL], and high‑density lipids
[HDL]) by colorimetric method. Low‑density lipid [LDL] values were obtained by calculator.
Results: The comparison of lipid profile between Oral Submucous Fibrosis and Oral
Carcinoma cases shows statistically significant results for TC, HDL and LDL.
Conclusion: The change in lipid levels may have an early diagnostic or prognostic role in
oral premalignant and malignant lesions.

Comparative evaluation of effectiveness of two desensitizing tooth pastes for relief in the dentinal hypersensitivity

Dr. Mudasar Ahad, Dr. Muzafar Ahmad Bhat

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 593-600

Background: Dentine hypersensitivity is a common complaint among dental patients.
Recently, a novel stabilized calcium sucrose phosphate dentifrice was introduced that offers a
desensitizing benefit. The primary aim of this study was to compare the in vivo efficacy of
this novel dentifrice with Calcium sodium phosphosilicate and a non-desensitizing dentifrice,
on dentin hypersensitivity in a four-week period.
Methods: Sixty volunteers with tooth sensitivity were recruited, and a double-blind,
randomized, parallel, controlled clinical trial was conducted in a hospital setting. Clinical
evaluation for dentin hypersensitivity by 0-10 VAS score was done using air blast, and cold
water methods. Following baseline measures, subjects were randomly divided into three
groups and treated as follows:
Group A: Dentifrice containing calcium sodium phosphosilicate (NovaMin).
Group B: Dentifrice containing Calcium sucrose phosphate.
Group C: Dentifrice containing no desensitizing ingredients. Clinical evaluations were
repeated after two and four weeks of product use.
Statistical analysis used: Mean VAS scores were compared among groups at different time
points (baseline, and 2 and 4 weeks) and among groups at each time point using one-way
analysis of variance.
Results: Compared to baseline, there was a clinically significant decrease in dentin
hypersensitivity in Groups A and B following four weeks use of the dentifrices containing
calcium sodium phosphosilicate and calcium sucrose phosphate, respectively. The Group A
dentifrice, however, was found to be significantly better in reducing the VAS score compared
to the Group B and Group C dentifrice at any time point for both measures of sensitivity.
Conclusion: The results suggest that the dentifrice containing 5% NovaMin provides rapid
and significantly more relief from dentin hypersensitivity in four weeks compared to a
dentifrice containing calcium sucrose phosphate or a non-desensitizing dentifrice.

Correlation of patient’s height, weight and BMI and sizing of autogenous hamstring graft with functional outcome in patients with arthroscopic ACL reconstruction

Dr. Amar Singh, Dr. Shaswat Agrawal, Dr. Apoorv Dua

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 601-607

Background: The Anterior cruciate ligament (ACL) is among most commonly affected
ligaments, and surgical treatment is chosen for most patients who present pain and instability.
Aims and objectives: The aim of this study to assess the correlation of patient’s height,
weight and BMI with autologous harvested hamstring graft size.
Material and method: This study is Experimental study design. In this study a total of 50
patients, selected cases were operated for the primary ACL reconstruction utilizing hamstring
tendon autograft at the Department of Orthopedics at Dr. Baba Saheb Ambedkar Medical
College, Delhi, India from 15th August 2020 to 15th Jan 2022.
Result: The correlation and p-value of height and weight was with respect to harvested graft
length (semitendinosus and gracilis) respectively. The other variables which include BMI do
not correlate with harvested graft length (semitendinosus and gracilis).
Conclusion: We found that there was slight correlation between weight and height of male
patient. We would suggest that: Height and weight could be successfully used as an
anthropometric measurements for evaluating graft length.

An observational study to assess the serum Vitamin D levels and Kellgren-Lawrence grading in patients of primary osteoarthritis

Dr. Sangeeta Khyalia, Dr. Ravinder Kumar Lamoria, Dr. Rahul Dhaka, Dr. Pramod Singh Chahar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 608-614

Aim: To assess the serum Vitamin D levels and Kellgren-Lawrence grading in patients of
Primary Osteoarthritis.
Materials and Methods: The present observational study was carried out on the patients
coming to the OPD of the Department of Orthopedics, SMS Medical College and Hospital,
Jaipur. All patients complaining of Osteoarthritis of the knee joint and willing to participate
in the study were interviewed for age, sex, history of inflammatory arthritis or any rheumatic
disease, complain of celiac disease & malabsorption syndrome or any history of intake of any
drug that might affect serum Vit D levels. After the successful running of Quality Controls
the clear serum obtained from patient’s serum was analyzed on Advia Centaur XP (for
Vitamin D & PTH) & fully automated chemistry analyzer Beckman Coulter AU 680 (for
routine biochemical parameters). Based on the serum biochemistry results, patients with
deranged RFT & LFT were excluded from the study & the Serum Vitamin D, PTH, Calcium
and Phosphorus levels of the patients with normal RFT & LFT were documented.
Results: In our study maximum number of patients (109, 41.44%) fell in the age group 51-60
years with age ranging from 37-70 years. Mean age is 55.37 ± 8.04 years. Male female ratio
was 0.81:1. Mean serum Vitamin D level is 18.27±8.34 ng/ml with range from 4.2-44.34
ng/ml. Maximum no. of patients were in the Vitamin D deficient group (148, 56.27%), 96
(36.5%) patients were Vitamin D insufficient while only 19 (7.23%) patients had Vitamin D
levels above normal range. Maximum number of cases were of grade 3 (90, 34.22%).
followed by grade 2 (82, 31.18%). Minimum no. of cases are of grade 0 (7, 2.66%) followed
by grade 1 (22, 8.36%). The mean Kellgren- Lawrence grading for the cases is 2.68 ± 1.01.
Conclusion: There is high prevalence of Vitamin D deficiency in Osteoarthritis patients. But
this prevalence needs to be compared with the prevalence in general population by including
age & sex-matched healthy controls. The present study could be further taken in this
direction.

Presence of antero lateral ligament in knees with and without anterior cruciate ligament tear

Manoj Kumar, Sagar Goel, Nikhil L Gore, Varun Gautam, Mohit Jindal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 615-628

Background: There is a debate around the existence, anatomy, and role of the so called
―anterolateral ligament (ALL). This study was conducted with a primary aim of finding out
and comparing the prevalence of the presence of anterolateral ligament and it’s three portions
(femoral, meniscal and tibial) in knees with and without ACL tear.
Methodology: This is a cross sectional study conducted in which A total of 96 patients
undergoing MRI knee for clinically evident ACL injury or history of chronic knee pain were
included in the study. Out of 96 patients included in the study, 48 patients had ACL tear
(Group A) and 48 patients did not have an ACL tear (Group B). Demographic data and
clinical information were noted for all patients. Descriptive variables were expressed as mean
and standard deviation for quantitative variables and frequency and percentages for
qualitative variables. The data was analyzed using SPSS® version 21.0. Categorical variables
were analyzed using Chi square test and for normally distributed data - t test was used. p
value <0.05 was considered as statistically significant.
Results: ALL was visualized in 65% of the patients included in the study. Its femoral
component was visualized in 56%, tibial component in 63% and meniscal component in 57%
of the patients. The three components were viewed together in 30% of the patients. We found
a significant association between ACL tear and the presence of ALL (p <0.001), with ALL
visualized in around 81%of knees with an ACL tear and only 48% of knees without an ACL
tear. Meniscal tears were significantly associated with the presence of ALL as out of the 62
patients in which ALL was visualized, 24 had an associated medial meniscal tear, 7 had
lateral and 3 had tear in both the menisci.
Conclusion: Our study demonstrated radiological evidence of the existence of the ALL.
Furthermore, we found presence of ALL to be significantly associated with ACL injury and
meniscal tear. Age, gender, or affected side was not found to be associated with the presence
of ALL.

Surgical site infections post cesarean section

Dr. Preeti Chouhan, Dr. Suman Meena, Dr. Ranjana Agrawal, Dr. Seema Bariya

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 629-638

Background: Surgical site infections are among the most common hospital acquired
infections. They make upto 14-16% of inpatient infections. Objective of present study was to
evaluate the risk factors associated with surgical site infections in caesarian cases, the bacteria
causing wound infections in obstetric operations, the antibiotic sensitivity and resistance
pattern of the pathogens isolated.
Methods: 100 women with wound infection during hospital stay or within 30 days following
caesarean section were taken for the study. These case records were thoroughly studied and
noted. Pus samples were collected from the wound site with help of sterile swabs under
aseptic precautions and immediately transported to microbiology laboratory for culture and
sensitivity.
Results: Most of the patients belonged to the age group of 21-25 years, contributing to 55%
of the cases. Majority of the women are from rural areas (71%). 57% of the cases were
unbooked. 90% of the SSI were seen in emergency surgeries and 10% in elective surgeries.
Anaemia (48%) was the most common medical risk factor followed by hypertensive disorders
25%. The risk of post-operative infection has been found to be proportional to volume of
blood loss during cesarean section and duration of surgery. Staphylococcus aureus was found
to be predominant organism of wound infection of which 21% were MRSA followed by
Klebsiella and E. coli.
Conclusions: Proper assessment of risk factors that predispose to SSI is critical for the
development of strategies for reducing the incidence of SSI and for identifying high risk
patients requiring intensive postoperative surveillance. We can conclude that reduction in
intraoperative blood loss and duration of surgery can reduce the incidence of Postoperative
infections. Also Pre-operative antibiotics should not be made mandatory in all lower segment
caesarean section as no significant difference has been found in the infection rate in spite of
giving preoperative antibiotics.

A study on heart rate and side effects between esmolol and labetalol during tracheal extubation

Dr. Shilpa Omkarappa, Dr. Amitha S, Dr.K.V. Edvine

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 639-645

Electrophysiological studies revealed that Esmolol causes an increase in sinus cycle length
and sinus node recovery time. Electrocardiographic parameters like 'PR' 'QRS' and 'QT'
intervals were not prolonged. In contrast to other beta blockers, electrophysiological values
return to baseline values within a period of 30 minutes after withdrawing the drug. When
infused at a dose of 200 micrograms/kg/minute, Esmolol can significantly reduce the namely,
resting heart rate, Systolic blood pressure, rate pressure product, cardiac index. Esmolol can
also attenuate isoprenaline induced tachycardia. After obtaining clearance from the
Institutional Ethical Committee and informed written consent, a prospective randomized
double-blinded study was conducted on sixty patients scheduled for various elective surgical
procedures belonging to patients physical status American Society of Anesthesiologists
(ASA) Classes I and II were included in the study. In esmolol group the basal heart rate was
97.8bpm. During reversal heart rate increased to 102.7bpm. During drug injection and
subsequently heart rate decreased as shown in table. At 15min post extubation heart rate was
84.6bpm which was less than basal.
In labetalol group the basal heart rate was 97.5bpm. During reversal heart rate increased to
103.1bpm. During drug injection and subsequently heart rate decreased as shown in table. At
15min post extubation heart rate was 69.9bpm which was much less than basal.

Blood pressure response to tracheal extubation: Comparative study between esmolol and labetalol

Dr. Amitha S, Dr. Shilpa Omkarappa, Dr.K.V. Edvine

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 646-652

Complications after trachea extubation are three times more common than complications occurring
during tracheal intubation and induction of anaesthesia. Hypertension and tachycardia are well
documented events during extubation. These hemodynamic responses reflects sympatho-adrenal reflex
stimulation (epipharyngeal and laryngo pharyngeal stimulation) with concomitant increase in plasma
level of catecholamines and activation of alpha and beta adrenergic receptors. A routine preanesthetic
examination was conducted assessing the general condition of the patients on the evening before
surgery. From all patients, informed consent was obtained. All patients were kept nil per oral for 8 h.
On arrival in the operating room, i.v. line was established, and fluid dextrose with normal saline was
started. Patients were connected to multichannel monitor which records HR, noninvasive blood
pressure, end-tidal carbon dioxide, and oxygen saturation. Statistical evaluation between the group
showed there was no significance of SBP between the group at basal, extubation upto 1th minute post
extubation (p>0.05). At 2th min (p=0.034), 3rd min (p-0.023) and 15th min (p=0.024) post extubation
there was significance esmolol> labetalol at 2nd and 3rd, labetalol >esmolol at 15th min.

Assessment of Outcome of MIPPO in Distal Tibia Fractures Using Locking Compression Plate - A Retrospective Study

Dr. Sijo Joseph Pakalomattom , Dr. Venatius Varghese , Dr. A M Georgekutty , Dr Faizal Ali A A , Dr. Mohammmed Salil

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 653-659

Background: Distal tibial fractures are one of the most complex injuries around the ankle joint, accounting for approximately 7% of all tibial fractures. Fractures of the distal tibial metaphysis with or without intra-articular extension can present a management challenge because of their inherent instability, scarcity of soft tissues, subcutaneous nature and poor vascularity of bone
Methods: This was a retrospective study of 30 patients to evaluate the functional and radiological results of Locking Compression Plate (LCP) osteosynthesis in distal tibial fractures using Minimal Invasive Percutaneous Plate Osteosynthesis Technique (MIPPO) .
Results: There were 30 patients in the study including 10 males and 20 female of mean age 45 years. The mean follow up period of our patients varied ranging from 10 months to 24 months (average– 18 months). All fractures united at an average of 18 weeks (range- 16 to 24 weeks) except two cases of delayed union(>20 weeks) .There were 2 superficial wound infections  and one case of deep infection which were treated with oral antibiotics and progressed to union and there were no failures of implant.  No other complications like deformities, compartment syndrome, non-union, implant irritation/skin impingement or implant failure were seen in our study. There was full range of motion patient except for two patients with restriction of plantar flexion. Two patients had mild pain on walking. 
Conclusions: The above study shows that MIPO technique is a safe, effective method to treat distal third tibia fractures with good radiological and functional outcome . The use of indirect reduction techniques and small incision is technically demanding as it is effective, minimally invasive, optimises the operation time, promotes early healing and reduces the incidence of infections

Study of Current Role of Syndromic Management in Vaginal Discharge and the Non-Responders

Anamika, Pushpa

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 660-672

Background: Vaginal discharge is one of the commonest problems faced by women. Syndromic management is a benchmark in management of vaginal discharge.
Objectives:
1. To evaluate the efficacy and tolerance of one day combination kit therapy in syndromic management of vaginal discharge in present scenario.
2. To find etiological cause in patients who do not resolve from vaginal discharge after 14 days.
Material and Methods: It was a prospective study done on 100 women in gynaecological opd of a tertiary hospital for a period of 3 months. Patients were evaluated before and after single day AFS kit therapy.
Results: There was excellent response in vaginal discharge(90%). Urinary symptoms and pruritus vulva improved by 80% and 50% respectively. 84% patients had good tolerance and only 2% patients had bad tolerance. 19% patients had Persistent vaginal discharge(PVD) which were due to infectious(42.1%) and non-infectious(57.9%) etiology. Out of these 31.5% had candida albicans, 10.5% had bacterial vaginosis, 15.7% had cervical erosion, 5.2% had cervical polyp and in 37.1% cases no etiology was found.
Conclusion: Combination kits are effective, well tolerable and given in single dose orally in reducing vaginal discharge, pruritus vulva and even urinary symptoms. Persistent vaginal discharge is due to candida and bacterial vaginosis (infectious) and cervical erosion, polyps and unknown cause(non-infectious).

High Sensitivity C-Reactive Protein In Type-2 Diabetes Mallitus Patients with Peripheral Vasculopathy

Dr. Mitul Rudach, Dr. Ebrahim, Dr. Hiren Sanghani, Dr. Brinda Mevada

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 673-679

Background: Systemic inflammatory activity has turned out to play a key pathogenic role in vascular atherosclerosis, insulin resistance, and type 2 diabetes mellitus. Inflammatory biomarkers may therefore be a valuable tool for risk evaluation. Among them, the best evidence to date supports the use of high-sensitivity C-reactive protein (hs-CRP) to monitor insulin resistance and cardiovascular risk in diabetic and nondiabetic individuals.
Aims and Objectives: To assess the relation of symptomatic peripheral arterial disease and high sensitivity c-reactive protein in known type 2 diabetes patients and to study the passive smoking as an additional risk factor for peripheral vasculopathy and elevated high sensitivity c-reactive protein.
Materials and Methods: A cross sectional, case-control study conducted on patients with (100 cases) or without (100 controls) type 2 diabetes. The data regarding detailed history, physical examination, Brachial and ankle systolic blood pressures and Routine investigations were recorded, tabulated and statistically analyzed using appropriate statistical tools.
Result: The prevalence of low ABI was significantly higher in diabetics (16%) in comparison with non-diabetic controls (4%) (p<0.05). PAD was more common among women (11.2%) compared to men (6.8%). The mean hsCRP for the study group was 6.51 ± 1.02 significantly higher than the control group 1.74 ± 0.78 (p<0.05).
Conclusions: Changes in CRP levels provide cardiovascular risk prediction, and may be useful to refine cardiovascular risk stratification in high-risk patients with type 2 diabetes mellitus.

A Cross-Sectional Study of Morbidity Pattern of Elderly in a Tertiary Care Centre

Dr. Praveen Kumar, Dr. Kalpana Chandra, Dr. Samir Kumar, Dr. Amit Kumar Mishra, Dr. Arshad Ahamad, Dr. Govind Kumar, Dr. Prity Kumari, Dr Satya Prakash

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 680-686

Background: -Aging is a biological process often accompanied by debility, disease and death. In India, anyone who is above 60 years is considered as geriatric patients whereas in western world attainment of age above 65 years is considered as aged people. Elderly patients are frail with reduced physiological capacity and often suffer from multiple co-morbidities constituting this group the most vulnerable and high-risk groups in terms of health and their health seeking behaviour. Even acute illness in elderly manifests in a non-specific way.  
Aims and objective: - The objective of study aims to find out morbidity pattern among elderly population aged 60 years and above.
Methods and material: - A cross-sectional observational study was conducted on 200 elderly patients admitted in general medicine department or attending general medicine OPD. The study duration was of one year. Patients above 60 years of age were selected as per inclusion and exclusion criteria and were subjected for detailed history, clinical examination and investigations.  
Result - We included 200 cases for this study. Age ranges from 60 to 91 with male to female ratio 1.56. Maximum cases were in the age group of 70-79 followed by 60-69, 80-89 and >90. Most common symptom was weakness (48.5%) followed by dyspnoea (36.5%), body ache/joint pain (27.5%), fever
(24%), loss of appetite (20%) etc. Most common diagnosis was hypertension (50.5%) followed by diabetes mellitus (38.5%), electrolyte imbalance (27%), anaemia (25.5%), COPD (23%), renal failure (15.5%), CAD (13%), LRTI (12%), osteoarthritis (11.5%),BPH (10%), CHF (8.5%), etc. Maximum patients were having 3 morbidity (30.5%) followed by 2(26%), 4 or more than 4(24%) and 1(19.5%). 
Conclusion: - Geriatric population is rapidly increasing with multmorbidity in majority. Non-communicable disease is highly prevalent but communicable disease remains an important cause of admission.  

Magnitude of Musculoskeletal Deformities in Newborns at A Tertiary Care Hospital in South Karnataka

Dr. Shaswat Agrawal, Dr. Mruthunjaya M, Dr. Srinivasa Murthy D, Dr. Pramod B. M

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 687-897

Newborns have unique anatomy and physiology, the presentation of which is relatively an unexplored territory to Orthopaedic surgeons and hence is a matter of concern. Due to limited literature and records available about the same, it raises a platform for further research and study.
This study aims to estimate the magnitude of musculoskeletal deformity among the newborns by evaluating the hospital incidence of musculoskeletal birth deformity and enumerate different musculoskeletal deformities and report it as proportion.
This is a prospective observatory study done in a tertiary care hospital of south India for a period of two years. All the live births born, routinely screened by the department of Paediatrics were referred to the Department of Orthopaedics in case of underlying musculoskeletal deformity. Whereas all the dead births born (inclusive of intra-uterine demises, still-births, and abortions) with any involvement of the musculoskeletal system in the antenatal ultra-sonographic foetal scan were notified to the Department of Orthopaedics. A thorough physical examination was conducted on all the referrals. Data was recorded, compiled, tabulated and analysed.
A total of 5837 new births were screened for musculoskeletal birth deformity which were inclusive of 5668 live births born and 169 dead births born. Overall hospital incidence of musculoskeletal birth deformity in our study was 9.25 per 1000 births (54 cases) and 5.46 per live births (31 cases). Club foot was the most common defect overall (17 cases/ 31.5%) and among the live births whereas spina bifida was the second (16 cases/ 29.6%) and most common among dead births.
The magnitude of musculoskeletal birth deformity is not as low as to be ignored by Orthopaedics surgeons. Few more studies will help in increasing the awareness of common deformity among the doctors thereby reducing the morbidities of musculoskeletal birth deformity by early diagnosis and apt treatment.

Study of Effect of Smoking on Hearing Loss by Audiometric Screening

Dr. Dhananjay Kumar, Dr. Manoj Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 698-703

Background: Few of the studies advocate that cigarette smoking is highly associated with the development of hearing loss both Conductive and Sensorineural type. However, comprehensive audiological evaluation on smokers has been scarce. Thus there is an extremely important need to assess the hearing status in smokers and to view pathophysiology of auditory system in greater detail.
Objectives: To study the incidence of hearing loss in rural population by pure tone audiometry and to study the effect of smoking on hearing loss.
Methodology:, This is Cross sectional study 500 people fulfilling Inclusion/Exclusion criteria who gave their consent  were included in the study. The population included in the study was from the rural area of various age groups in Hoskote and were screened for hearing loss. Their detailed history was taken and those having ENT disease, head injury, history of ototoxic medication intake, history of noise exposure were excluded from the study. The technique of pure tone audiometry is the based on ASHA method. All the individuals were subjected to DPOAE screening.
Conclusion: In our study, mild sensorineural hearing loss was more significant in smokers. Cigarette smoking is clearly evident to effect on cochlear which was measured through a decreased response in distortion product otoacoustic emissions ( DPOAE).

Study of Prevalence of TB Infection Among Health Care Workers in Tertiary Care Centre

Dr. Bhaskar Prasad Singh, Dr. Amrendra Narayan Choudhary, Dr. Kamran Fazal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 704-710

Background: Tuberculosis (TB) is an air borne communicable disease caused by bacteria named Mycobacterium tuberculosis that is spread through the air from person to person. The TB bacteria are expelled in the air when a person with TB disease coughs, sneezes, speaks, or sings. People nearby may breathe in these bacteria and become infected. In most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria to stop them from growing. If TB bacteria become active in the body and multiply, the person will progress from latent to active TB disease. Infection is most likely to occur when an individual is exposed to someone with TB disease on a day-to-day basis, such as by living or working in close quarters with someone who has the active disease.
Methodology: The descriptive longitudinal study was conducted among 600 HCWs at Jawahar lal Nehru medical college and Hospital, Bhagalpur. (oct 2018 to feb -2020). The data was collected by administering TB screening questionnaire (Annexure 2). Separate written informed consent was obtained for performing the tuberculin skin test (TST). Following this each study participant was administered the TST. Each subject was reviewed between 48 hours to 72 hours of the TST to read the reaction. All the subjects who gave negative TST reaction were followed up after one year.  
Conclusion: Prevalence of latent TB infection was 20.1% and it was significantly associated with age, place of residence, education, work commute time and mode of  transport. Incidence of latent TB infection was 19.4% and it was significantly associated with gender, place of residence education, work commute time and marital status. Study subjects working in laundry department, especially those who came in contact with patients while collecting linens, housekeeping workers and pharmacy workers who dispense drugs at the counter were at higher risk of developing TB infection.

A Cross Sectional Study of Infant Feeding and Rearing Practice Among Multiparous Postnatal Mothers

Dr. Bhaskar Prasad Singh, Dr. Amrendra Narayan Choudhary, Dr. Kamran Fazal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 715-721

Background: India is a land of diverse cultures and traditions. Infant feeding and rearing practices vary across communities, depending on social customs, traditional beliefs, literacy and socio-economic status of the family. These practices at times are not of any benefit to the newborn and can be harmful. Despite its rapid economic growth, India’s poor ranking in terms of infant mortality can be correlated to these factors influencing child feeding and rearing practices.
Methods: The study was conducted in three urban health training centers (UHTCs) which were selected by simple random sampling out of eight in Bhagalpur city. All the multiparous women who were in postnatal period were included in the study till sample size was reached. Data was collected after informed consent using pre-tested semi-structured questionnaire and analyzed in SPSS.
Results: Out of 200 mothers, 69% of the mothers had initiated breastfeeding within standard norms and 28.5% had given pre-lacteal feeds to their babies which was significantly associated with religion and type of family of the mothers. Majority of the mothers (95.5%) had given colostrum and its association with type of family was significant. Majority of them (80.1%) had breastfed their baby on demand.
Conclusion: In spite of educational messages by health professionals, certain feeding practices are found unsatisfactory and certain harmful rearing practices are still prevalent in the community. This necessitates additional focus by the policy makers towards maternal and child health to ensure the needs to be fulfilled and to impose certain regulations against prevalent harmful practices in the community.

Study of Clinical Outcome of Aero- Digestive Tract Foreign Bodies in Children

Dr. Vibhas Ranjan, Dr. Rijwan Haider

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 722-728

Background: Foreign bodies in aero-digestive tract are paediatric emergencies contributing to high morbidity and mortality requiring early prompt diagnosis and treatment. Most commonly seen in children. They comprise one of the preventable causes of accidental death in children. Methods: The analysis is based on prospective study undertaken on 94 patients who came with history or features suggestive of foreign body ingestion or inhalation to Causality , Paediatric OPD and ENT OPD of Darbhanga medical college and Hospital, Laheriasarai. Study duration of  two years. A detailed history, clinical examination, investigations like blood examination and radiology findings were recorded in a printed preformed questionnaire. Bronchoscopy / Endoscopy findings and outcome were also recorded for each patient.
Conclusion: Foreign bodies in the aero digestive tract are life threatening paediatric emergencies. Measure should be taken to prevent these accidents by, instructing parents to abstain from feeding dry fruits, nuts, and seeds to their children. Parents and care givers should be trained to treat choking episodes in children. Early diagnosis and treatment helps to reduce complications and mortality.

Anatomical Study of Innervation of the Three Heads of Triceps Brachii

Dr. Prabhat Kumar, Dr. Pallavi Ranjan Anand, Dr. Vijay Shekhar Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 729-735

Background: The extensor compartment of the arm is occupied by triceps muscle, through which runs the radial nerve and profunda brachii artery. Triceps arises by three heads namely long head, lateral head and medial head. Triceps is innervated by radial nerve (C6, C7 and C8) with separate branches for each head. Triceps muscle and its main motor nerve namely the radial nerve have multiple connection modalities. Each of the motor branches to triceps might be used as a donor for nerve transplantation.
Methods: The present study was performed on 52 upper limbs of 26 formalin embalmed cadavers from department of anatomy, Nalanda medical college and Hospital, Patna. And helps of other medical college, Patna.  Study duration of two years. The   nerve supply to each head of triceps was traced and carefully followed to the source of each nerve branch and noted. Results: Present study of innervation of three heads of triceps brachii showed that motor branch of long head of triceps brachii was supplied by radial nerve in 82.6%, axillary nerve in 13.4% and by posterior cord in 04% of the limbs dissected. The lateral head of triceps brachii was supplied by radial nerve in spiral groove in all the cases. The medial head of triceps brachii was supplied by radial nerve in spiral groove in all cases and additionally even by ulnar collateral branch of radial nerve in 92.6% of the cases.
Conclusion: Gross anatomical knowledge of innervations pattern of triceps brachii and variations of its motor supply are important to medical personnel especially to orthopaedic surgeons, radiologists, neurophysicians and physiotherapists for surgical treatment of traumatic nerve injuries, nerve grafting, neurophysiologic evaluation to diagnose peripheral neuropathy. 

An Observational Study of Dry Eye in Allergic Conjunctivitis

Dr. Pranay Kumar, Dr. Rajiv Kumar Singh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 736-743

Background: Allergic conjunctivitis and dry eye disease are major ocular surface disorders affecting millions of people interfering with their quality of life. These diseases can occur simultaneously or independently of each other. The symptoms are non-specific of any type of ocular disease.
Methods: This Study was carried out in SKMCH, Muzaffarpur. Study duration of Fifteen  months. on the subjects who attended the outpatient department of Ophthalmology. This was an observational study of 100 cases of allergic conjunctival disease after informed consent which satisfied the inclusion and exclusion criteria. Based on novel scoring system (NSS), the severity of allergic conjunctival disease was graded as mild, moderate and severe.
Conclusion: We conclude that for the effective management of allergic conjunctivitis, we should always consider treatment of dry eye as well.

Surgical Intervention for Crouch Gait in Diplegic Cerebral Palsy- A prospective Case Control Study

Dr Ganesh Kumar, Dr Raj Kumar, Dr Sabir Pottichi, Dr Deepak Kumar Sharma, Dr Ajit Kumar Varma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 744-750

Background: Common gait patterns in cerebral palsy are equinus, scissoring, jumping, stiff knee, and crouch. Crouch gait is a very resistant condition, it increases the energy costs of walking and can lead to further joint pain and degeneration if not managed. Hamstrings muscle-tendon lengthening is a standard surgical procedure for the correction of crouch or knee flexion deformity.
Aim of the Study: To compare the efficacy of rehabilitative surgery with conservative management (Medication, exercise, orthosis, gait training)
Materials and Methods: 15 patients in each group are taken. 30 limbs of 15 patients were operated. All patients (study or control) were accessed for any decrease in popliteal angle and improvement of balance at 6 weeks, 6 months, and 1 year on the four-point ordinal scale after surgery and conservative management.
Result: In all surgical patient improvement in popliteal angle was noted but only 25% of patients in the control group achieved improvement by one scale (poor to fair) at 1-year follow-up. 60% of patients showed improvement in balance whereas 33.3% of control group patients improved from poor to fair and after 1-year follow-up.
Conclusion: Fractional hamstring lengthening is a relatively easily done surgical procedure that results in improvement of popliteal angle as well as balance as compared to the routine conservative management.

A Study to Identify the Motivational Factors Among Doctors in a Tertiary Care Hospital

Dr. Avinash Borkar, Dr. Namita Deshmukh, Dr Ranjit Ambad

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 751-757

Introduction: Health professionals deal with human life and have to perform many functions at a single point of time like taking care of the patients, teaching medical students and have various administrative responsibilities as well, along with the responsibilities of their own family. Lack of motivation at any level of this health profession hierarchy can affect their performance and directly or indirectly affect the patients as well. Hence, this study is planned to identify the factors that exactly motivate doctors in a Government Tertiary care hospital.
Materials and Methods: The study was carried out in a Government Tertiary care Hospital and Medical College of Chhattisgarh from Jan 2019 – March 2019 on 100 doctors who voluntarily participated in the study. A preformed and pretested proforma was used to interview the Doctors which inquired about their socio-demographic details and Work Motivation Scale by Udai Pareek (2002) was used to assess and identify intrinsic and extrinsic motivation factors of the Doctors. Data was analysed using Microsoft excel and Statistical analysis was done by percentages and T-test. Statistical significance of differences between group means was tested. The p-value Results: The mean age of doctors was 37 ± 6.01 years. Professional growth, an intrinsic factor was ranked higher (mean score 13.98) by majority of doctors. Salary and job security and benefits were the extrinsic factors that were ranked higher by majority of the doctors (mean score 17.28, 16.32 and 15.78 respectively). The mean score of Extrinsic motivating factors was significantly more than that of the Intrinsic motivating factors. (t value 21.11, p<0.001, significant).
Conclusion: The main motivating factors for the health workers in this tertiary care hospital and medical college sample were, salary, job security, benefits, professional growth and working environment.

Re-laparotomy after caesarean section in tertiary heath care hospital

Rekha R, Ashwini MS, Manjula B, Prashanth Shivappa, Lepakshi BG

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 751-756

Background: Relaparotomy (RELAP) after caesarean section is a serious complication and is associated with maternal morbidity and mortality. The data of re-laparotomy after caesarean section is limited. So in the present study, we will evaluate the risk factors and outcome of relaparotomy after cesarean section in our study population.
Objective: To identify the risk factors and complications and outcomes associated with re- laparotomy after caesarean section.
Materials and Methods: It is a retrospective study, a total of 16 relaparotomy cases were included in this study. Data such as age, parity, period of gestation, comorbidities, indication for C-section and relaparotomy, a procedure during relaparotomy and the interval between two surgeries are recorded. Using SPSS software statistical analysis is done.
Results: Incidence of re-laparotomy is found to be 0.25% and the mean age was found to be 25.5±4.2 years with 37.5% primigravidae. The Major indication for C-section and Relaparotomy was Placenta previa (37.5%) and hemoperitoneum (37.5%). The mean time interval between C-section and relaparotomy was 6.8 ± 1.2 days and the major procedure done during relaparotomy is tension suture (31.25%). The rate of recovery and maternal death was found to be 93.8% and 6.3% respectively.
Conclusion: Caesarian section will be done due to clinical complications in delivery. After C-section, women are treated conservatively, but in some cases, there is a need for relaparotomy. It will be performed when the patient’s condition is too critical. Relaparotomy is a life-saving procedure to save the life of patients. Proper care should be taken during primary and secondary surgery to prevent postoperative infection and other complications which will decrease the clinical complication and mortality rate.

Study of ectopic pregnancy in a tertiary care center, Maharashtra, India

Dr. Priyanka Kunal Purohit, Dr. B B Yadav, Dr. Shwetambari S Navale, Dr. Chintan M Upadhyay

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 757-762

Background: Ectopic pregnancy (EP) is a life threatening emergency commonly being
managed by primary care physicians where diagnosis is often being missed at the first
contact.
Objectives: To study the etiological factors, clinical presentation and maternal outcome of
cases of ectopic pregnancy.
Materials and Methods: This cross-sectional study was done among 50 confirmed cases of
ectopic pregnancy at department of obstetrics & Gynecology in Government Medical College
and Hospital, Latur, Maharashtra during October 2013 to September 2015. Data collection
was done after ethical permission from institutional ethical committee and informed consent
of clients. Inclusion criteria: All confirmed cases of ectopic pregnancy Exclusion criteria: All
cases of intrauterine pregnancies.
Results: Highest number of participants (34%) belonged to 26-30 years age group and mean
age was 27 years. Maximum participants (70%) were multipara. Present study noted 16%
misdiagnosed cases of EP. Most common site of EP was noted at ampulla (68%). Tubectomy
was the most common risk factor (28%), ‘amenorrhea (80%)’ was the most common clinical
feature. Blood transfusion required in 78% cases and post-op wound infection in 12% cases.
Conclusion: The rising number of cases of EP poses a serious concern over maternal
mortality. With advances in the field of medicine, more young women are adopting newer
fertility control methods such as newer oral contraceptives, infrastructure contraceptive
devices and various tubal surgeries to limit their families. Moreover, newer drugs for
ovulation induction and tubal reconstructive surgeries have led to delayed conception with
increased risk of EP.

Unusual causes of throat pain: A pictorial discussion

Dr. Neharika Kothari, Dr. Vineet Mishra, Dr. Naveen Meena, Dr. Jai Chowdhary, Dr. Hemant Kumar Mishra

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 763-776

As a common entity, throat pain or sore throat is related chiefly to various infective
pathologies, viral (lately COVID), bacterial or fungal. When these are treated with no relief
for the same, endoscopic procedures and imaging modalities like USG, CT Scan, MRI etc.
are ordered to detect the occult diagnosis .Our study included 51 participants, 20 females and
31 males, primarily complaining of throat pain with few other mild symptoms. Here we
discuss not so commonly thought of entities pertaining to head and neck pathologies and few
thoracoabdominal lesions detected by various imaging modes like MRI,CT and virtual
endoscopy, Endoscopy, USG and X Ray Barium studies. Anatomic variants to potentially
serious diseases were reported. A strong clinical suspicion and customized mode of imaging
assisted in arriving to a definitive diagnosis.

Association between childhood adversity and metabolic syndrome in patients with mood disorder: In a tertiary healthcare center of North-East India

Dr. Mohit Saini, Dr. Th. Bihari Singh, Dr. Vicky Bakshi, Dr. Sheeba Rana

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 777-783

Introduction: Physical and mental health have a bidirectional relationship that influences
one another. Several clinical studies have shown that metabolism and emotional state may
share comparable pathways. Although metabolic syndrome and mood disorders often
manifest themselves in adulthood, the likelihood of acquiring these illnesses is influenced by
social and economic conditions in childhood, such as childhood maltreatment, neglect, and
family dysfunctions.
Aim and objectives: To examine the association between childhood adversity and
components of metabolic syndrome in patients with mood disorders and to test whether
specific types of childhood adversity and type of mood disorder interact to worsen metabolic
outcomes.

To study the efficacy and safety between use of BICLAMP (bipolar coagulation forceps) in vaginal hysterectomy and conventional vaginal hysterectomy: A prospective study at tertiary care center, Maharashtra

Dr. Neha Chandraprakash Agrawal, Dr. Priyanka Kunal Purohit, Dr. Gaurav Kumar J Desai and Dr. Chintan M Upadhyay

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 784-790

Background: Bipolar vessel sealing systems (BVSS) are accepted to be safe and efficacious
with possible advantages over conventional methods, namely fewer requirement of postoperative
analgesics, less blood loss, shorter operative time and minimum hospital stay.
Objectives: To compare the efficacy and safety between use of BiClamp (Bipolar
Coagulation Forceps) in Vaginal Hysterectomy and Conventional Vaginal Hysterectomy.
Materials and Methods: This prospective study was done among 80 cases indicating
hysterectomy for benign diseases admitted in OBGY unit were selected randomly out of
which 40 cases underwent Conventional Vaginal Hysterectomy and 40 cases underwent
BiClamp Vaginal Hysterectomy at department of obstetrics & Gynecology in Government
medical college and hospital, Latur during November 2012 to September 2014.
Results: Mean duration of hospital stay required for participants of cases and control group
was 2.6 days and 4.2 days respectively (p<0.05). Mean duration of operation of cases and
control group participants was 70.9 min and 75.5 min respectively (p<0.05). Mean blood loss
during operation noted among the cases and control group participants was 90.1 ml and 115.9
ml respectively (p<0.05). During operation, three suture material required in in 0.0%
participants of cases group and 82.5% of control group respectively (p<0.05). Post- op
complications like fever, bladder injury, bowel injury & hemorrhage noted only in
participants of control group.
Conclusion: BiClamp Vaginal Hysterectomy post-operative pain was less, intraoperative
blood loss was less, operative time was significantly shorter, duration of hospital stay was
less and BiClamp Vaginal Hysterectomy was more Cost effective than the Conventional
Vaginal Hysterectomy

A Study On Bacterial Flora Isolated From Chronic Non-Healing Wound Infections In Patients Of Garhwal Region

Dr. Deepak K. Dwivedi , Dr. Mukul P. Bhatt , Dr. Priya Chaudhary , Dr. Rajani Sharma , Dr. Rohit Sachdev

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 791-807

Introduction: The chronic non-healing wound infections are generally identified with the presence of bacteria in the wounds. Bacterial presence in the wounds is associated with poor healing. Chronic wounds, with their polymicrobial nature, put a significant burden on health budgets worldwide.
 
Aim of the study: The present study was conducted to isolate and identify the bacterial flora along with antibiotic sensitivity profiling of the pathogenic isolates against routine antibiotics from patients with chronic non-healing wound infection sat HNB Base Hospital, Srinagar, Garhwal.
 
Materials & Methodology: A total of 102 specimens (pus, wound exudates, or tissue biopsy) from patients (including 56males and46 females) having chronic non-healing wound infections were studied. Sample collection, Isolation and biochemical identification of aerobic bacteria followed by antibiotic sensitivity profiling of the pathogenic isolates were done using standard protocols.
 
Result & Conclusion of the study: Staphylococcus aureus were the most prevalent bacteria with 24.6 % of all the isolates. Next to these were Coagulase-negative Staphylococci (CONS) with 11.7% followed by Escherichia coli (9.7%), Enterococcus (8.4%), Klebsiella (8.4%), Acinetobacter (6.5%), Micrococci (6.5%), Diphtheroids (5.8%), Citrobacter (3.9%), Pseudomonas (3.9%) (P. aeruginosa were 66.6%, and 33.3% were P. fluorescens), Neisseria (3.2%), Proteus (3.2%), Streptococci (2.6%) (All were S. pyogenes) and Enterobacter (1.2%). Antibiotic sensitivity profiles of Gram-negative bacterial isolates revealed Acinetobacter and Klebsiella being the most resistant pathogens followed by Enterobacter, Citrobacter, Pseudomonas, E. coli, and Proteus. Antibiotic sensitivity profiles of Gram-positive bacterial isolates revealed Enterococcus and CONS being the most resistant pathogens followed by Streptococci and Staphylococcus aureus.
 791

Contemporary directions in fatty liver disease in light of low-carbohydrate approach: a review by public health India

Abhinav V Pathare, Anup B Chaudhary

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 808-817

This study aims to equip health professionals with essential directions for their practice and
research in fatty liver disease. In fatty liver disease, excess fat is accumulated in the liver
cells, and it mainly has two types: Alcoholic Fatty Liver Disease (AFLD) and Non-Alcoholic
Fatty Liver Disease (NAFLD). AFLD is widely accepted to be associated with excessive
alcohol consumption. However, in NAFLD's case, although the name acknowledges that it is
not associated with excessive alcohol consumption, the exact cause of NAFLD remains
ambiguous. Furthermore, for almost four decades, without specialised treatments and
prevention strategies, NAFLD has constantly increased, affecting more than a quarter of the
world's population. Meanwhile, although the current dietary recommendations for NAFLD
patients orbit around the conventional High-Carbohydrate Low-Fat diets, mounting evidence
advocates the broader benefits of Low-Carbohydrate High-Fat (LCHF) diets in this regard.
Therefore, focusing on the databases such as PubMed, Cochrane Library, and Google
Scholar, the authors have carried out an advanced literature search reporting on the efficacy
of LCHF diets on NAFLD. After a comprehensive search—using appropriate "keywords and
Boolean operators" and "inclusion & exclusion criteria"—the authors selected a potentially
relevant set of existing peer-reviewed articles for this narrative review. After critically
investigating the LCHF-NAFLD theme, the authors found that LCHF diets may significantly
decrease liver fat and may even reverse the disease by targeting the key causes of hepatic fat
storage, i.e., high insulin levels, excessive calorie consumption (mainly from carbohydrates),
and excessive consumption of refined carbohydrates. Additionally, LCHF diets may provide
a comprehensive health benefit beyond liver health. The authors conclude that the LCHFNAFLD
theme represents a rich vein of research opportunities. The authors encourage and
call researchers, doctors, nutritionists, dieticians, and related-health professionals to engage
more with the LCHF-NAFLD theme.

Study of biochemical and other parameters in patients treated with remdesivir vs. without the remdesivir in mildmoderate covid 19 patients

Dr. Bheemesh Vangalapati, Dr. Sudarshan Reddy, Dr. Venkappa S Mantur, Dr. Avula Naveen, Dr. Arun Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 818-821

Background: The ACTT-1 trial showed that the median time to recovery was 10 days in the
remdesivir group compared to 15 days in the placebo group. However, remdesivir failed to
provide a survival benefit. This study puts in an effort to find the difference in biochemical
and other parameters in patients treated with remdesivir vs. without the remdesivir in mildmoderate
covid 19 patients.
Aims and Objectives: To study the biochemical and other parameters in patients treated with
remdesivir vs. without the remdesivir in mild-moderate covid 19 patients.
Materials and Methods: This study was done in the Department of Pharmacology,
Kanachur Institute of Medical Sciences, Mangalore. This study was done from May 2020 to
June 2021. The study was done in 30 patients who were treated with remdesivir and thirty
without.
Results: There is significant difference between the remdesivir used group when compared to
the unused group.
Conclusion: It may be useful in mild to moderate cases.

A study to assess the level of Vitamin D status and its association with the severity of the pneumonia

Syed Shah Sarmast, Rajendra Shinde, Priyanka More, SK Satpathy

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 822-827

Background: The effects of Vitamin D on bone metabolism and calcium homeostasis have
already been well recognized. Emerging evidence has implicated Vitamin D as a critical
regulator of immunity, playing a role in both the innate and cell-mediated immune systems.
Emerging evidence has implicated Vitamin D as a critical regulator of immunity, playing a
role in both the innate and cell-mediated immune systems. Vitamin D deficiency has been
found to be associated with several immune-mediated diseases, susceptibility to infection and
cancer. Further elucidation of the role of Vitamin D in lung development and immune system
function may hold profound implications for the prevention and treatment of asthma.
Objective: To study the Vitamin D Status of children having severe pneumonia and to know
if there is any relation between Vitamin D levels and severe pneumonia.
Methodology: The present prospective study was conducted by the department of Pediatrics
at SCBMCH & SVVPGIP, Cuttack from October 2013 to October 2015 among the children
with the age group of 1 to 5 years of age who were admitted in the department with
complains of Pneumonia. A total of 80 children who were having severe and very severe
pneumonia diagnosed based on WHO ARI (acute respiratory tract infection) criteria admitted
to the SCBMCH & SVVPGIP (General, Pay ward & PICU) in the age group of 1 to 5 years.
Results: In this study, we found that 50% of the children among cases had vitamin D levels
in the deficiency range while 41.3% and in the insufficiency group while we had 8.8% of the
children in the sufficiency group as compared to the healthy controls 20(71.4%) among 28
belongs to sufficient age group, 5(17.9%) to insufficient group and 3(10.7%) to the deficient
group. One significant finding in this study was that out of the 27 children in the sufficiency
group none of them were there in the very severe pneumonia group which suggests as the
Vitamin D levels Increases the severity of the condition decreases.
Conclusion: In this study, we found that Vitamin D levels were related to severity of the
disease as there were no children in the sufficiency group having very severe pneumonia.
Hence we can say as the levels of Vitamin D falls the severity of pneumonia Increases.

Assessment of iron overload in beta thalassemia major patients by serum ferritin level

Dr. Palak Yogeshbhai Thakkar, Dr. Neelaba K Mori, Dr. Chandrika G Algotar, Dr. Tejas S Chokshi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 828-832

Context: Beta Thalassemia major is a genetic disease with an autosomal recessive pattern of
inheritance that occurs as a result of disorder in haemoglobin synthesis. In Beta Thalassaemia
major patients multiple blood transfusions, ineffective erythropoiesis and increased
gastrointestinal iron absorption lead to iron overload in the body. Iron overload can be
determined by Serum Ferritin measurement.
Aim and Objectives
1. To Assess the average frequency of blood transfusion in Beta Thalassemia Major patients
2. To measure Serum Ferritin level in Beta thalassemia Major patients
3. To determine the association between Serum ferritin level and age, average frequency of
blood transfusion in Beta Thalassemia Major Patients.
Methods and Material: Fifty blood samples of clinically diagnosed Beta Thalassemia major
patients were collected for estimation of Serum Ferritin levels. Serum Ferritin measurement
was performed using indirect enzyme linked immune sorbent based assay kit. Data were
analysed to determine association between Serum Ferritin and age, gender and frequency of
blood transfusion.
Statistical analysis used: Descriptive statistics, Regression, Correlation
Results: The mean Serum Ferritin level was found to be 3639.75 mg/ml. Five patients had
Serum Ferritin <1000 mg/ml, Twenty three patients had Serum Ferritin between 1000-3500
mg/ml and twenty two patients had Serum Ferritin >3500 mg/ml.
Conclusion: The study showed high levels of Serum Ferritin in Beta Thalassemia major
patients. Serum Ferritin levels should be monitored regularly to assess the status of iron
overload and to rationalize the use of chelation therapy and avoid complications related to
iron overload.

Study of cardiac co-morbidities in newly diagnosed type 2 diabetes mellitus patients with help of 2D echocardiography

Pratik D Modi, Nanda Jagrit, Usha H Patel, Tejas Shah, Jay Mehta

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 833-839

Background: Diabetes mellitus is one of the leading cause of multisystem involvement
resulting in significant comorbidities. Various cardiac disorders such as dilated
cardiomyopathy, left ventricular diastolic dysfunction and myocardial infarction have been
frequently associated with diabetes mellitus. Present study was aimed to study cardiac comorbidities
in newly diagnosed type 2 diabetes mellitus patients with help of 2D
echocardiography.
Material and Methods: A prospective observational study was conducted in patients, 18-70
years, of either gender, newly diagnosed Diabetes mellitus type 2 based on Fasting blood
sugar/ Post prandial blood sugar/HbA1c, willing to participate in the study.
Results: Out of 175 patients, 74 patients belonged to age group 51-60, which is the most
commonly affected age group. Out of 175 patients, 109 (62%) patients were male and 66
(38%) patients were females. Most of the patients had HbA1c` in the range of 7-10%, 139
patients (79%), whereas the least number of patients were in the 6.5-7% group, 5 patients
(3%) Most of the patients had normal cardiac diastolic function, whereas only 15 (8%)
patients restrictive filling (grade 3 diastolic dysfunction). Grade 2 and 3 diastolic dysfunction
was more common in a higher age range i.e. 51-60 and >60 years whereas it was absent in
less than 40 year. Diastolic dysfunction was more common in patients having proteinuria
>200 mg/dl, higher serum cholesterol levels, hba1c levels > 10% and in patents having E/e’
ratio higher than 14. 47 patients were systolic dysfunction <50% with hba1c less than 10%,
whereas only 3 patients had EF <50% with hba1c >10%.
Conclusion: Cardiac diastolic dysfunction is observed in patients of diabetes mellitus 2 more
frequently as compared to systolic dysfunction.

Prevalence of acute diarrhoeal diseases in children below 5 years of age in Indian settings

Janardhan Bandi, Yogesh Mane

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 840-845

Background: Diarrhoeal diseases which are one of the leading reasons behind global
mortality and morbidity is more threatening for infants and young children. Childhood
diarrhoea is becoming increasingly prevalent disease in developing countries like India.
Moreover, it is a major cause of malnutrition that contributes towards third major cause of
under 5 mortalities. This has raised a serious concern in the domain of public health.
Objective: The present study attempts to identify the prevalence of acute diarrhoeal diseases
in children below 5 years of age in Indian settings.
Methods: This community-based, cross-sectional epidemiological and single-center study
conducted in the rural field practice area attached to Department of Community Medicine of
Topiwala National Medical College, Mumbai, and Maharashtra, India from March 2017 to
February 2018 was aimed to identify the prevalence of acute diarrhoeal diseases in children
below 5 years of age in Indian settings. Ethics approval was obtained from Ethics Committee
for Academic Research Projects (ECARP). Research tools included a pre-structured
questionnaire. Baseline information of study area was taken from the Primary Health Centre.
Data was entered in Microsoft Excel spreadsheet to perform analysis.
Results: In our study, a total of 370 living children aged <12–59 months were included in the
analysis. Most of the children who belonged to in Class III socioeconomic status (61.4%),
affiliated to joint family (54.6%), belonged to Hindu religion (94.6%). Only 9.2% of mothers
were illiterate whereas remaining 91.8% mothers had completed at least primary education.
The prevalence of diarrhoea in children under 5 years of age was recorded as 20.5%.
Conclusion: The present study contributed to providing the prevalence of acute diarrhoeal
diseases in children below 5 years of age in Indian settings

Role of maternal factors towards diarrhoeal episodes in under five children in India

Yogesh Mane, Janardhan Bandi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 846-850

Background: Diarrhea is widely recognized as a major cause of childhood morbidity and
mortality in many developing countries, particularly in India. According to World Health
Organization (WHO) report, diarrheal diseases are still leading causes of mortality and
morbidity in children under five years of age.
Objective: The present study attempts to estimate the association between maternal factors
and prevalence of Acute Diarrhoeal Diseases in children below 5 years of age in Indian
settings.
Methods: This community-based, cross-sectional epidemiological and single-center study
conducted in the rural field practice area attached to Department of Community Medicine of
Topiwala National Medical College, Mumbai, Maharashtra, India from March 2017 to
February 2018 was aimed to estimate the association between maternal factors and
prevalence of Acute Diarrhoeal Diseases in children below 5 years of age in Indian settings.
Ethics approval was obtained from Ethics Committee for Academic Research Projects
(ECARP). Research tools included a pre-structured questionnaire. Baseline information of
study area was taken from the Primary Health Centre. Data was entered in Microsoft Excel
spreadsheet to perform analysis.
Results: In our study, 340 mothers who used to take bath daily of which 61(17.9%) had
diarrhoeal episodes, whereas out of 30 mothers who do not take bath daily, 15(50%) had
diarrhoeal episodes. Further, 340 mothers of children who used to wash their hands daily
before the meals of which 58(15.8%) children had diarrhoeal episodes, whereas out of 30
mothers who did not wash their hands before meals, 18(60%) children had diarrhoeal
episodes
Conclusion: The present study indicated that maternal factors bear a significant impact on
morbidity caused by diarrhea.

Maternal mortality among COVID-19 patients in a tertiary care hospital: A retrospective study

Niveditha R, Manohar Rangaswamy, Sandyashree PK, Manikanta KV

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 851-857

Background: The new covid 19 strains having two mutations is highly infectious and the
ongoing disease has posed a huge threat to global public health, causing higher rates of
morbidities and mortalities. Keeping this in mind, this study is planned to understand the
causes leading to maternal mortality due to covid 19 infection in a tertiary care hospital
Mandya Institute of Medical Sciences, Mandya district, Karnataka, India.
Methods: A retrospective study was carried out on maternal mortality during the COVID 19
pandemic in MIMS, Mandya, and Karnataka. We collected records of MMR due to covid 19
occurred from the month of June 2020 to July 2021 over a period of one year.
Results: MMR from June 2020 to July 2021 is 0.034/lakh live births, majority were of the
age group 25 to 35 yrs., majority of the death occurred after 5 days from tested positive, all
belonged to moderate or severe category of covid 19 infection. Termination of pregnancy was
done in 7 cases i/v/o worsening symptoms, 2 were antenatal deaths, 2 post abortal, 5 deaths
were in postoperative period. Most cases were managed on oxygen initially, on Noninvasive
ventilation (NIV) and later on intubated. All cases were treated with Thromboprophylaxis,
nebulization, steroids, IV antibiotics and Remdesivir was given in four cases.
Conclusion: Maternal mortality was more during second wave of pandemic. Maternal
mortality was more among moderate and severe disease and nil among mild cases.
Unpreparedness among healthcare workers in managing severe cases was among the key
determining factors. Better team approach by physicians, intensivists, Obstetricians and
infrastructure might be helpful in preventing maternal mortality. Covid vaccination among
pregnant women and providing essential drugs and anticipation of worsening symptoms and
early intervention might be beneficial in preventing future mortality.

Post-partum intrauterine contraceptive device practices, its acceptance and outcome in a tertiary care hospital: A record based study

Niveditha R, Manohar Rangaswamy, Sandyashree PK

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 858-864

Background: Only 26% of women are using any method of family planning in the first year
postpartum. Studies indicates that unmet need for family planning in postpartum period is as
65% (USAID ACCCESS 2009). Recent studies estimate that prevention of unplanned and
unwanted pregnancies could help avert 20 – 35% of maternal deaths and as many as 20% of
infant deaths. Use of temporary contraceptives in our country is limited to 10.2% and that of
intrauterine contraceptive device (IUCD) is only1.8%. Post-Partum IUCD (PPIUCD) was
thus introduced in the National Family Planning Programme, India in 2009-10.
Methods: This is a Retrospective study conducted in department of obstetrics and
Gynaecology, Mandya Institute of Medical Sciences, Mandya. All deliveries during time
period from April 2018 to March 2021 were included in the study. Women accepting
PPIUCD were analysed with respect to age, parity, educational status, complaints (during the
follow up visits) and timing of insertion.
Results: Out of total 31,212 deliveries between April 2018 to March 2021.19,662. delivered
vaginally, 11,550 delivered by C section. 702 (2.24%) accepted PPIUCD as a method of
contraception. Intra cesarean insertion were 567 cases, Post placental insertion were 108
cases and immediate postpartum insertion 27 cases. 54% of users were of age group 20 -
25yrs, 53.8% were Primipara. Most common complication reported was bleeding PV in about
5. 9% and 6.4% discontinued PPIUCD due to sexual interference [2.99%] as the commonest
reason.
Conclusion: Less acceptance of PPIUCD services in our hospital reminds us to optimize
PPIUCD services by counseling pregnant women right from ANC visits. Education and
counseling can plays major role in acceptance and IUCD continuation rate. Obstetricians and
nursing staff should play a major role to dispel myths and misconceptions prevalent with
IUCDs.

A study to compare serum calcium level between diabetic and non-diabetic post-menopausal women with osteoporosis

Dr. Priyanka Ramappa Siddapur, Sagar Mahadev Nitturkar, Shivanand G Mali

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 865-870

According to WHO, Osteoporosis is second only to cardiovascular disease as a global
healthcare problem. International Osteoporosis Foundation (IOF) estimates that the annual
direct cost of treating osteoporosis fractures of people in the workplace in the USA, Canada
and Europe alone is approximately USD48 billion. The present study comprises of clinically,
diagnostically confirmed cases of Postmenopausal Osteoporosis both Diabetics and Non-
Diabetics and attending the orthopaedic unit of KLES Dr. Prabhakar Kore Hospital and
Medical Research Centre, Belagavi. All the cases were evaluated and selected by simple
random technique after fulfilling the selection criteria. The cases of Osteoporosis reported to
the Department of Orthopaedics unit of KLES Hospital and Medical Research Center were
screened. After finding the suitability as per selection criteria they were requested to
participate in the study and briefed about the nature of the study and interventions used. The
mean serum calcium for diabetics was 8.22±1.13 mg/dL and for non-diabetics was 8.4 ± 1.27
mg/Dl. The mean serum calcium levels were lower in Diabetics but was not statistically
significant (p=0.5564 for calcium).

A prospective comparative study of functional and radiological outcome in percutaneous trans-olecranon fossa four cortex purchase lateral pinning versus cross-pinning in displaced supracondylar fractures of humerus in children

Somashekara S.A, Deepak H.R, Sunkappa S.R Somashekar Doddabhadre Gowda, Manoj Gidaganti

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 871-879

Traditional treatment with closed reduction and application of plaster slab or cast is
inappropriate in the case of displaced supracondylar fractures of humerus as this method may
potentially lead to malunion & subsequent elbow deformity, as it is difficult to obtain
satisfactory reduction and to maintain the reduction due to distraction forces acting at the
elbow. Our study involved 40 children who had sustained displaced supracondylar fractures
(Gartland-Type III) who were treated in the Department of Orthopaedic at a Tertiary care
trauma center, between November 2018 to May 2020. 55% of our cases were in the age group
5-10 years, 60% were male & 40% female.
80% (n=32) of the cases had history of fall on outstretched hand, followed by 3% with fall on
flexed hand which is in concordance with the most common mode of injury established by
many studies. 70% of the cases had fracture of left supracondylar humerus as compared to
30% on the right side. 30 out 40 cases had postero-medial displacement of distal fragment &
remaining 10 cases had postero-lateral displacement.

A study of clinical presentation and radiological features of stroke patients in a tertiary care center at Karwar Institute of Medical Sciences, Karwar, Uttar Kannada District, Karnataka

Dr. Kalavathi GP, Dr. Kiran Kumar BN, Dr. Prasanna Navadgi, Dr. Nishchit K N

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 880-886

Background: Acute stroke is one of the major cause of disability and death in India. Imaging
plays an important role in identification of cause and decision making in appropriate
treatment plan. The management of stroke differs in different types of stroke. Early diagnosis
aid in the effective management and thus reducing the disability and death. Hence the study
was undertaken to study the clinical and radiological features on the stroke patient at KRIMS
Hospital. Karwar Karnataka.
Methodology: This is a retrospective hospital based study of 250 stroke patients admitted in
a tertiary care hospital, at Karwar institute of medical sciences Karwar during a period of one
year from1st January 2020 to 31st December. A sample size of 250 stroke patients records
found in the record section analysed, considering clinical presentations and radiological
features as entered in the case records.
Results: Stoke incidence increased with increasing age after 50 years. Hemiplegia was the
most common clinical feature found in 132(52.8%) patients and males were predominant
(74.8%). 207(82.8%) had ischemic stroke and 43 (17.2%) had hemorrhagic stroke. Frontal
and parietal areas of brain were affected in both types.
Conclusion: Early identification of clinical features and radiologic features play an important
role in decision making for appropriate management protocol of stroke patients.

A prospective randomised comparative study of drainage versus non-drainage in primary total hip arthroplasty

Dr. Narasimha Vikas S, Dr. Basavaraddi Basavaraddi, Dr. Vijayakumar angadi, Dr. Jagadish Bhoomraddi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 887-891

A study was conducted to compare blood loss, need for blood transfusion and complications
in drainage and non-drainage groups in primary total hip arthroplasty. Forty patients
undergoing total hip arthroplasty were randomly allocated into twenty patients in each of
drainage and non-drainage groups. All the operations were performed by one speciality
surgical team with same pre-intra operative and post-operative protocol. Haemoglobin,
volume of blood transfusion, superficial and deep infection and Harris hip score wer
eassesed. Blood loss (mean) in the drainage and non-drainage groups were 220.1 ml and
234.7 ml respectively. Hb levels were more in the non-drainage group on 1st, 3rd and 7th day,
but on day 7, they were not statistically significant. 10% of cases in non-drainage group
developed infection in which 5% are superficial and the other 5% are deep infections, 10% of
cases developed superficial infection in the drainage group. The incidence of superficial
infection was higher in non-drainage group, however there was no significant difference in
the length of the hospital stay. 3 (15%) patients needed blood transfusion in the drainage
group and 2 (10%) patients needed blood transfusion in the non-drainage group, mean
volumes were 1.6 units in drainage group and 1.5 units in non-drainage group respectively
and it’s not statistically significant.

Comparison between Non-patellar denervation vs patellar denervation by circumferential cautery on anterior knee pain following primary total knee arthroplasty: A prospective comparative study at rural medical college

Dr. Channakeshava B Palegar, Dr. Jagadish Bhoomraddi, Dr. Ravikumar Naganur, Dr. Basavaraddi Basavaraddi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 892-896

Introduction: Anterior knee pain is one of the common problems in post primary total knee
arthroplasty patients. There are different methods of prevention of anterior knee pain post
total knee replacement. The objective of this study is to compare the efficacy of patellar
denervation using circumferential electrocautery versus non-denervation in relieving anterior
knee pain following primary total knee arthroplasty.
Methods: Forty patients were grouped randomly in to two groups of nineteen patients (Group
A) and twenty one patients (Group B) each. Patients in group A underwent patellar
denervation with electrocautery and group B patients didn’t undergo patellar denervation.
They were followed up at 2 weeks, 1, 2 and 3 months regularly and clinical score was
determined using knee society score and anterior knee grading system by waters and Bentley.
Results: There is no statistical difference in anterior knee pain score between the two groups.
Conclusion: Patellar denervation doesn’t reduce the anterior knee pain following primary
total knee arthroplasty and anterior knee pain was thought to be multifactorial.

Role of HRCT chest in correlation of pulmonary tuberculosis with tuberculous spondylodiscitis

Dr. Ravi Soni, Dr. Suhail Khan, Dr. Bharat Jain, Dr. Shrinidhi Kulkarni, Dr. Monica Satyam, Dr. Kapil Vyas

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 897-903

Tuberculosis is a contagious bacterial infection which primarily affects the lung parenchyma
but it can affect any other part of the body. Mycobacterium tuberculosis complex is mainly
responsible for majority of cases in India and worldwide, but other species are also
responsible for causing tuberculosis among which includes M. bovis, M. africanum, M.
microti, M. Canetti. We retrospectively reviewed 40 patients of histologically or
microbiologically proven diagnosis of TB spondylitis from the time period of January 2020 to
October 2021 in the Radio-Diagnosis and Imaging Department of Pacific Medical College
and Hospital, Udaipur, Rajasthan, India. Findings such as cavitation, consolidation, tree in
bud opacities, miliary nodules are suggestive of pulmonary tuberculosis. Out of 5 patients
suffering from active pulmonary tuberculosis, cavitation was seen in 20% (1 patient) on chest
skiagram whereas 40% (2 patients) showed cavitation on HRCT chest. Consolidation was
seen in 60% (3 patients) on chest skiagram whereas it was seen in 80% (4 patients) on HRCT
chest.

A study on the surgical outcomes of keyhole craniectomy for the evacuation of intracranial hematoma

Dr. Biradarpatil Basavaraj, Dr. Vishwanath Sidram, Dr. Chandrakumar PC, Dr. SV Sreeharsha

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 904-912

SICH is caused by non-traumatic bleeding and the underlying causes such as arterial (large
and small vessel disease), venous diseases, vascular malformations and hemostatic disorders
must be further evaluated. In cases of TICH further evaluation of counter coup injuries,
presence of extradural hematoma and subdural hematoma must be looked for. Hence
differentiating between the two forms of ICH is important. Source of Data -patients
presenting to VIMS Neurosurgery department with either spontaneous or traumatic ICH and
posted for keyhole craniectomy were included as a part of the study over a period of 3 years
Aug 2017 to Aug 2021. The location of ICH in spontaneous ICH was most commonly
observed in basal ganglia region .The incidence of traumatic ICH was highest in temporal
region followed by frontal region with a few in parietal and occipital region. Though the
incidence of traumatic ICH was more common in our study it had a better outcome with death
being reported in only 2 out of 25 patients as opposed to spontaneous ICH in which 5 out of
15 patients succumbed .This may be attributed to the elderly age of presentation and presence
of comorbidities in spontaneous as opposed to traumatic ICH

A study of clinical profile and surgical outcome of spinal dysraphism in paediatric population an institutional study

Dr. Vishwanath Sidram, Dr. Chandrakumar PC, Dr. Biradarpatil Basavaraj, Dr. SV Sreeharsha

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 913-921

Aims: To study the surgical outcome in paediatric patients presenting with spinal dysraphism
in our institution.
Materials and Method: 78 paediatric cases presented between 2014 to 2019 with
myelomeningocele to the neurosurgical OPD in Vijayanagara Institute of Medical Sciences,
Ballari which caters to mainly rural and semi urban population. Initial clinical assessment,
followed by operative work up was done. MRI Brain and spine was done as a prep operative
evaluation. Post-operative outcome was noted and Post-operative regular follow up after
discharge for at least 6 months.
Results: 78 patients were operated upon at our centre. The mean age of presentation of the
cases 5 months +/- 6 days, ranging from 8days to 24months. Post-operative average hospital
stay was 14 days. The mean post-operative follow up period was 36 months. Hydrocephalus
was associated with meningomyelocele in 30 cases, but VP shunting required in same sitting
in 9 cases only. Six patients found to have CSF leak and only 1 required reexploration and
Dural repair.
Conclusion: The clinical profile of patients presenting to us mirror the General profile across
India. Surgical outcomes at our center are on par with the standard results seen across the
country. Early and prompt surgical intervention is the key in management of spinal
dysraphism. The MOMS study comparing surgical outcomes with pre natal surgery shows
equivalent outcomes with post natal surgery

Early results of modified C4-C7 laminoplasty with C3 laminectomy for cervical spondylotic myelopathy in Indian population: An institutional experience

Trunal Patel, Parth Patel, Baiju Patel, Saral Patel

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 922-928

Introduction: Laminoplasty is indicated in patients with cervical spondylotic myelopathy
(CSM) who have multilevel cervical spinal cord compression and a neutral or lordotic
cervical spine alignment. However, axial neck pain is a common complication post-surgery,
which may be caused by surgical damage to the semispinalis cervicis (SSC) muscle
attachment on the C2 spinous process. Modified C4-C7 laminoplasty with C3 laminectomy
completely preserves the SSC insertion on C2 and reduces the incidence of axial neck pain at
subsequent follow-ups.
Aim: Our study aims to evaluate the clinical and radiological outcome of C4-C7 laminoplasty
with C3 laminectomy for CSM in the Indian population.
Materials and Methods: We performed a retrospective analysis of 21 patients who
underwent the surgery for CSM with a minimum one-year follow-up. Clinical improvement
is measured using the modified Japanese Orthopedic Association (MJOA) score and visual
analogue scale (VAS). Radiographic parameters evaluated were the C2-C7 lordosis angle and
the cervical range of motion (ROM).
Results: In our study, the mean age of the patients was 54±7.7 years, and follow-up period
was 20.5±4.6 months. At a one-year follow-up, the mean pre-operative MJOA score
improved from 9.5±1.9 to 14.9±1.1 (p<0.001). Pre-operative axial neck pain was present in
nine patients with a mean VAS score of 4.9±0.8, which improved to 3.7±0.7 (p<0.001) at
three-month follow-up. At the final follow-up, only four patients had axial neck pain with a
mean VAS score of 1.1±1.4.
Conclusion: C3 laminectomy with C4-C7 laminoplasty is a safe, effective technique, which
achieves good neurological improvement and reduces the incidence and severity of postoperative
axial neck pain in the Indian population

Dual mobility total hip arthroplasty in osteonecrosis of femoral head: Is it suitable for Indian population?

Chirag Patel, Parth Patel, Baiju Patel, Saral Patel

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 929-934

Background &Aim: Dual Mobility Total Hip Arthroplasty (DMTHA) is a reasonable
treatment option for osteonecrosis of femoral head (ONFH), especially in active young
patients who are at an increased risk of dislocation post-surgery. Moreover, lifestyle a
religious habits of Indian patients require extreme flexion and rotation, making DMTHA a
lucrative treatment option. The aim of our study is to evaluate the short-term results of
DMTHR for ONFH in the Indian population and their ability to resume their daily activities
after the surgery.
Material and Method: The study is a retrospective analysis of 23 DMTHA in 17 patients
who underwent DMTHA for ONFH between March 2018 to March 2020 and with a
minimum follow-up of one year. Patients were evaluated clinically using Harris Hip Score
(HHS) and Patient-Reported Outcome Measures (PROMs), such as the ability to squat and sit
cross-legged. Radiological evaluation was performed to detect implant migration, loosening,
periprosthetic osteolysis, or heterotrophic ossification.
Result: In our study, the mean age of patient was 36.7±9.1 years. The mean pre-operative
HHS scores of 53.8±15.4 improved to 97.0±4.2 at one year post-surgery. 94.1% patients in
our study could squat and sit cross-legged at a mean duration of 3.2 months post-surgery.
Conclusions: The use of DMTHA in Indian patients with ONFH showed good early clinical
and functional results without major complications, and simultaneously meeting their high
functional and cultural requirements

Correlation of surgical plethysmographic index and entropy with hemodynamic changes in laparoscopic cholecystectomy

Dr. Allenki Prashanthi, Dr. Nirmala Jonnavithula, Dr. Karri Pavani, Dr. Narmada Padhy

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 935-943

Background: The stress response to surgery is an unconscious response to tissue injury and
refers to autonomic, hormonal and metabolic changes that follow injury or trauma. Excessive
intraoperative stress evoked by surgical nociceptive stimulation may influence patient’s
outcome, length of hospital stay and overall costs of hospital care. Traditionally, clinical signs
like somatic or autonomic responses are used to evaluate whether analgesia is adequate. It has
been proved to be unreliable demonstrating low specificity. In the present study
hemodynamic changes are correlated with changes in surgical plethysmographic index (SPI)
and entropy at the time of stress.
Methods: A prospective non-randomised observational study was conducted in the patients
posted for elective laparoscopic cholecystectomy. Hundred ASA physical status I and II
patients aged between 18 to 60 years belonging to both the gender scheduled for elective
laparoscopic cholecystectomy were enrolled in the study.
Results: According to the correlation coefficient values SPI values are correlating with
changes in heart rate, systolic blood pressure and diastolic blood pressure at the time points of
5 min after intubation, 10 mins after intubation and before inflation. Entropy values does not
correlate with SPI as entropy indicates hypnosis level where as SPI is based on sympathetic
and parasympathetic stimulation. State entropy correlates with changes in systolic and
diastolic blood pressure at the time points of before inflation, 30 min after inflation and
deflation. However state and response entropy correlates with each
Other. Response entropy correlates with changes in systolic and diastolic blood pressure at
the time points of 5 mins after intubation and before inflation.

Effect of single bout of exercise on heart rate variability in young healthy adults and its correlations with anthropometric parameters

Dr. Anindya Roy, Dr. Paramita Nag, Dr. Gargi Barat, Dr. Deepayan Sarkar, Dr. Enakshi Ghosh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 944-958

Heart rate variability (HRV) as a measurement of autonomic function assumes great clinical
importance. It is well known that particular patterns of body fat distribution increase coronary
heart disease risk both in adults & children. While frank obesity is associated with reduced
HRV, indicative of poorer autonomic nervous system (ANS) function, the association
between body mass index (BMI) and HRV is less clear. The dynamic autonomic responses
during exercise can be measured to give actionable information for training by analysis of the
ECG to determine heart rate variability. While application of HRV has been applied to
predict sudden cardiac death and diabetic neuropathy in assessing disease progression. The
study revealed the changes in HRV in resting condition and also after a single bout of sub
maximal treadmill exercise (50% of VO2 max.) among males and females in the age group of
17-25 years at rest and the correlations between the HRV parameters at rest and after the
exercise with BMI and WHR in the subjects. An observational cross sectional study was
conducted in the Physiology Department of R.G. Kar Medical College, Kolkata, India on 60
subjects (n=60) of both sexes (30 males and 30 females) in the 17-25 years age, participated
in this study. Their WHR and BMI were measured and HRV was recorded during rest and
immediately after exercise by digital Polyrite. Result showed that the HRV of male were
more than in female in resting condition. After submaximal exercise the HRV value of males
were more than their respective resting HRV values though it was not significant and in the
females, post-exercise HRV was significantly more than their respective resting HRV. This
study shows that females have higher parasympathetic activity than males. There is an
association between WHR and BMI and HRV in healthy female persons, which shows that
there is an increase in LF/HF(low frequency & high frequency) of values among males and
females after a single bout of sub-maximal exercise though not significant in case of males
but significant in case of females.

A case control study to assess the role of magnesium and calcium among children with febrile seizures in a tertiary care hospital

Gowhar Wani, Nikhil Guptha, Mahtab Alam, Manjunath GM

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 959-964

Background: Febrile seizures defined as seizures that occurs between the age of six and sixty
months, with a temperature of 38 degree C or higher, that are not the result of central nervous
system infection or any metabolic imbalance and that occur in the absence of a history of
prior afebrile seizures. A seizure is a transient occurrence of signs and/or symptoms resulting
from abnormal excessive or synchronous neuronal activity in the brain.
Objective: to assess the role of Magnesium and Calcium among Children with Febrile
Seizures in a tertiary care hospital. Methodology: The present Case Control Study was
conducted by the Department of pediatrics at Government multispecialty hospital, Sector-16,
Chandigarh from November 2015 to October 2016. A total of 50 Children in study age group
6 months to 5 years admitted in the pediatric ward who were satisfying the inclusion criteria
were included.
Results: In the present study the mean Serum Magnesium level was found to be 2.10+0.24
mg/dl among cases and among control the level was found to be 1.95+0.16 mg/dl. The
association was found to be statistically significant between two groups on comparing Mean
Serum Magnesium. In the present study on analyzing the mean serum calcium levels it was
found that among cases group nearly 90% of them had normal levels and 10% of them had
abnormal serum calcium levels and in the control group all the subjects had normal serum
calcium levels and the association between both the groups was found to be statistically
significant.
Conclusion: This study shows that serum magnesium levels are normal in children with
febrile seizures. It indicates that serum magnesium may not have a significant role in the
pathogenesis of febrile convulsions. Our study sample was not representative of entire
population because all children were mostly from surrounding urban area.

A clinical study of the pattern of herpes zoster in children at the tertiary care centre of eastern Rajasthan

Dr. Savita Arya, Dr. Bajrang Soni, Dr. Himanshu Goyal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 965-971

Background: Varicella-zoster virus (VZV) is known for causing two highly infectious diseases-Varicella (chickenpox) and Herpes Zoster (shingles). The reactivation of the varicella-zoster virus causes Herpes zoster, also called as shingles. In the contrast, Herpes zoster usually arises in adults or the elderly. This virus reactivates mainly due to failure of the immune defense system to control the latent replication of the virus.
Objective: To study the epidemiological and clinical features of herpes zoster taking place in kids below 12 years of age.
Methodology: This was an observational, descriptive and cross-sectional study. A total of 50 patients with herpes zoster were selected for the study. The study was conducted from April 2018 to March 2022 in department of dermatology and venereology at Government Medical College, Bharatpur in Rajasthan. The children till 12 years of age infected with herpes zoster were included in the study.
Results: A total of 50 patients were identified with herpes zoster were enrolled for the study. There were 28 (56.1%) boys and 22 (44.0%) girls. The ages range was one month to 12 years, the smallest subject being 1 month of age. Most of the subjects i.e. 42 (84%) exhibited no evidence of immuno-suppression on prior records, examination, and clinical investigations. Four subjects were anti-HCV positive, 2 were diagnosed with pulmonary tuberculosis, one subject was on medication of systemic corticosteroids for a chronic bullous illness of babyhood, and one patient was recently spotted with leukaemia disease.
Total 21 (42%) subjects showed thoracic dermatomal involvement, 14 (28%) subjects of cervical, 8(16%) of cranial (ophthalmic), and 6(12%) subjects of lumbar dermatomal involvement were found. Only one subject (2%) was found with dissemination.

Subtle changes of neuronal migrational disorder: diagnosed by non-contrast CT scans

Dr. Rajeev Mudkavi, Dr. Naveen Meena, Dr. Naju Tanya Mudkavi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 972-978

Neuronal migrational disorders (NMD) offer a wide spectrum of disorders with specific diagnosis by CT and MRI of the brain. Most NMD are easily recognized on CT scans & MRI and offer little or no difficulty in their diagnosis (5, 6).
Through this article we propose to elucidate a subtle form of NMD by Non contrast CT scans of the brain. This subtle variety of NMD almost always escapes recognition on CT / MRI, always prompting a normal report on most occasions.
It is the purpose of this article to highlight the CT scan features of these nearly normal appearing images of NMD, which we propose to label as a subtle NMD (Subtle Neuronal Migrational Disorder).
30 CT scans of children ranging from 1 to 5 years were analysed retrospectively.
All had similar CT scan findings and identical clinical presentations.

Comparative rugoscopic pattern analysis of dentulous and edentulous population of Rajasthan state

Dr. Narendra Singh Bansal, Dr. Naiem Ahmed, Dr. Lokendra Kumar Goyal, Dr. Saurabh Jain

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 979-984

Background: In accordance of forensic dentistry, every palatal rugae has a remarkable distinct pattern in every human, it can be applied as an identification tool.
Objective: The objective of the present study was to investigate palatal rugae patterns in dentulous and edentulous patients and evaluate the reliability of these patterns in human identification. Methodology: The study group was equally divided into 30 dentulous and 30 edentulous patients, respectively. A duly filled and signed consent form was attained from each participant. Alginate impression material is used for primary impressions in a perforated tray and dental stone (Type-3 Gypsum products) was used to develop a cast. The number, length and shape were recorded after analysing the rugae patterns. Statistical calculation done by using SPSS system. Results: The mean of the total number of rugae more in dentulous (7095 ± 1.393) than edentulous (5.99 ± 1.001) participant. Dentulous subjects shows more curved rugae patterns (2.98 ± 1.321), primary rugae (6.86 ± 1.287) and forwarded rugae (3.84 ± 1.801) while more straight rugae patterns (3.15 ± 1.44) and perpendicular rugae (2.64 ± 1.425) found in edentulous subjects. Conclusion: This study concludes that there is statistically significant variation in dentulous and edentulous participant in term of shape, number, size and direction.

Use of CBCT scan for introducing a radiological classification of impacted third molar

Dr. Saurabh Jain, Dr. Narendra Singh Bansal, Dr. Naiem Ahmed, Dr. Lokendra Kumar Goyal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 985-992

Background: The impaction rate is much higher for third molars as compared to other teeth. While impacted third molars may remain asymptomatic for an indefinite period, it can cause various delinquents, such as pericoronitis, swelling with pain, distal caries, bone loss, root resorption of adjacent teeth, odontogenic cysts, and tumors. That’s why the most frequent surgical procedure in dentistry is third molar tooth extraction.
Objective: The aim is to propose a new classification for impacted mandibular third molars on CBCT images which cover all aspects of the anatomical situation
Methodology: A total of 143 images of molar teeth was collected and classified according to a relationship with the IAN canal and molar tooth. For statistical calculation, SPSS software was used.
Results: Classes 0-7 were planned and in which classes 1-6 were sectioned into two subtypes (subtypes A-B). The distribution of the classes presented an occurrence of buccal or apical course of the mandibular canal tailed by lingual position and inter-radicular one. Results emphasized that a close relationship of molar roots with the lingual side of IAN was more in female versus male other than it no anatomic differences occur in terms of IAN relationships between males and females. Younger patients displayed an increased rate of direct contact with a reduced calibre of the canal and/or without corticalization. This increases the chances of IAN damage, especially in the young woman (age range 25-30 years) with a lingual course of the mandibular canal.
Conclusion: The use of this classification is appreciated to get an equal definition of the impacted tooth on CBCT images worldwide.

A retrospective study on malignant transformation of oral leukoplakia and its relationship with oral squamous cell carcinoma

Dr. Saurabh Jain, Dr. Narendra Singh Bansal, Dr. Pranav Gupta

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 993-998

Background: The term oral leukoplakia is defined as white plaques of debatable risk, diagnosed when other known diseases or disorders that bring no risk for oral cancer have been omitted. It has a malignant transformation rate of around 0.13%-34% whether it is measured as a premalignant lesion.
Objective: This study aimed to evaluate the demographic occurrence and malignant transformation of oral leukoplakia in the diagnosis of OSCC in an Indian sample.
Material and method: The study included gender, age, site of the lesion, clinical presence and histopathological analysis of 156 subjects. SPSS software is used for statistical calculation. For data analysis calculation of percentages, Shapiro-Wilk test and Chi-square test is used.
Result: This study was conducted on a total of 156 patients with oral leukoplakia. In which 142 subjects were found affected with oral leukoplakia and only 14 subjects were found affected with other premalignant disorders. However, male subjects of oral leukoplakia were 59.15% and female subjects were less in number only 40.85%. A total number of 81patients were found in the age range 40-50 years. Male patients had acquired 55.56% while female patient’s attained 44.44%. The histopathological examination stated that out of 142 oral leukoplakia cases, 39.44% were existent with malignant transformation and the P-value was 0.0185, which was found to be statistically weighty.
Conclusion: Half of OSCCs are one way or another linked with or originated by oral leukoplakia. So biopsy of chronic lesions especially male patients (because of the higher risk to develop dysplastic changes) is recommended to check dysplastic alterations within the lesion and should be advised to leave the adversarial habit.

A clinical analysis of ectopic pregnancies at tertiary health care hospital

Preetha F Nayakar, Ashwini Veeresh, Ambika HE, Prashanth S, Manjula B

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 999-1004

Background: Ectopic pregnancy (EP) is one of the life-intimidating emergencies in pregnancy leading to maternal morbidity and mortality. Early diagnosis of ectopic pregnancy presents a challenging problem and is considered an emergency as it shows high mortality risk and it’s early detection and management are necessary to prevent maternal mortality and morbidity.
Aim and Objectives: To evaluate the cases of ectopic pregnancy at a tertiary health care center and to determine the incidence, risk factors, clinical presentation, management, and morbidity associated with ectopic pregnancy.
Methodology: We conducted a prospective study on 37 patients with ectopic pregnancies at Shivamogga Institute of Medical Sciences a tertiary care center from August 2020 to August 2021. The primary outcome measures studied were the incidence of ectopic pregnancy, their risk factors, mortality and morbidity in those pregnant women.
Results and Discussion: The incidence of ectopic pregnancy in this study is 0.49%. The common age and parity affected were 26-30 years (59%) and para 1 (46%). The most common risk factors were previous LSCS (49%) followed by abdominal tubectomy, laparoscopic tubectomy and recanalization. The ampulla region (59.5%) was the most common site of ectopic pregnancy. Majority of cases presented with a ruptured ectopic (70.27%) and unruptured accounted for -29.72%. In our study Salpingectomy (78.37%) was the common surgical procedure performed. Around 83.77% of women received a blood transfusion. No maternal mortality occurred during this period due to ectopic pregnancy.
Conclusion: Ectopic pregnancy is a life-threatening condition occurring in women. Worldwide the incidence of ectopic pregnancy is increasing, which will increase maternal morbidity, mortality, and fertility. Early diagnosis and management will reduce the risk of maternal morbidity and mortality due to ectopic pregnancy.

A hospital based assessment of the effects of various topical agents in chronic plaque type psoriasis

Dr. Shribhagawan Rolaniya, Dr. Apeksha Singh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1005-1008

Aim: To determine the effect of various topical agents in chronic plaque type psoriasis.
Materials and Methods: The study was carried out on patients having chronic plaque type psoriasis vulgaris came to Department of Skin & VD, Medini Rai Medical College, Palamu, Jharkhand, India. Total 300 patients were enrolled and were divided into three groups comprising of 100 patients in each group. Group A patients were asked to apply ammonium lactate twice a day, Group B patients were asked to apply ammonium lactate in morning and clobetasol propionate in evening, Group C patients were asked to apply topical ammonium lactate in morning and calcipotriol in evening.
Results: Physician global assessment scale shows that in Group A, 39% patients had excellent response, 15% patients had good response, and 21% patients had fair response whereas 25% patients had poor response. In group B, 35% patients had excellent response, 29% patients had good response, and 17% patients had fair response whereas 19% patients had poor response. In group C, 31% patients had excellent response, 28% patients had good response, and 22% patients had fair response whereas 19% patients had poor response.
Conclusion: Combination therapy is effective, well tolerated with minimal side effects and better compliance was seen with patients. Ammonium lactate 12% can also be considered as one of the topical option as a monotherapy and also as a maintenance therapy.

Assessment of validity of RT-PCR tests in the clinical practice

Dr. Subodh Kumar, Dr. Matin Ahmad Khan, Dr. Mukunda Kumar, Dr. Ruby Kumari

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1009-1014

Outbreak of pandemic SARS-CoV2 in 2020 collapse the healthcare management system all around the world. People were scared, as invisible virus spreading its infection among the individual who were close contact with infected person via droplet nuclei or aerosol transmission. The only gold standard test for early detection of viral genome that time was RT-PCR tests which was due to its high sensitivity and specificity nature. During Covid period RT-PCR sensitivity was reported much less all around the world. Hence there is urgent need to find out the reason for less sensitivity or fallacy report of RT-PCR or developed alternative method for SARS-CoV-2 and its strain detection method in less time with High efficacy.

Analytical observational assessment of the intra-operative anaesthesia management and postoperative pain scores after caesarean section

Dr. Diwakaran R, Dr. Prem Kumar Saminathan

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1015-1022

Aim: Evaluate The Intraoperative Anaesthesia Management and Postoperative Pain Scores
after Caesarean Section.
Methods: This analytical observational study conducted in the Department of
Anaesthesiology, Madha Medical College Kovur Chennai, India during Feb 2021 to Feb
2022. All patients either receiving GA or spinal anaesthesia for CS receive IV tramadol
infusion for post-operative pain control, which is started either at the request for first
analgesia in the PACU or at 60 min, whichever comes first. Patients are assessed for pain
using numerical rating scale (NRS) immediately in the PACU and at regular intervals. Any
patient having NRS >4 is given rescue analgesia.
Results: Percentage of patients having NRS >4 and who required rescue analgesia on
immediate assessment (time zero) was 15 (15%). After that, 13 patients (13%) at 30 min, 10
(10%) patients at 45 min and 5 (5%) patients at 60 min had NRS of >4 and required first
rescue analgesia. There was no statistically significant difference among patients in PACU
having NRS >4 from those having NRS <4 in terms of the type of incision, ASA grading and
duration of surgery. Patients receiving RA had a statistically significant (P-value < 0.01) low
percentage of patients with NRS >4 and need for first rescue analgesia at time zero and at 30
min when compared to the percentage of patients operated under GA. The difference became
insignificant after 30 min. Overall, 18% of patients received some sort of co-analgesia,
mainly in the form of IV paracetamol 15% and only two patients received TAP block.
Conclusion: The pain management in the PACU was adequate as all patients were given
rescue analgesia if they had NRS of >4 and no patient was shifted from PACU with NRS of
>4.

A study of incidence of posterior capsular of opacification after cataract surgery based on square edge polymethyl methacrylate intra ocular lens

Dr. Rasna Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1023-1030

Introduction: Cataract is one of the most common and established surgical procedure in
Opththalmology in the world with the posterior capsular opacification (PCO) as a very
common complication, which may be present in long term. This study was done to find the
incidence of the posterior capsular opacification after cataract surgery and implantation of
360 square edge PMMA posterior chamber IOL among the patients attending our tertiary care
hospital.
Materials and Methods: The cataract surgery was done with a careful implantation of a
square edged single piece PMMA IOL within the capsular bag seeing that peripheral 1mm of
the anterior capsular rim covers the optic edge of the IOL. On the 1st postoperative day, the
cases were examined under slit lamp for any postoperative complications. The next visits
were conducted at day 7, 1 month, 3 months, 6months and 8 months. The best-corrected
visual acuity was tested using Snellen chart, both aided and unaided.
Results: Out of 50 patients included in the study, 21 (42%) were females and 29 (58%) were
males. The most common age group of all the patients was 61-70 years wherein 58.6% of the
males and 42.9% of the females were present. Of the total 50 eyes operated for cataract, 90%
of the patients had no posterior capsular opacification, while 4% had fibrous membrane type
of PCO and 6% had Elsching’s Pearl type of PCO.
Conclusion: The square edged PMMA IOL is quite effective in reducing the formation of
posterior capsular opacification after the cataract surgery

Prevalence and Risk Factors of Pterygium in a Semi Urban Area

Dr. Rasna Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1031-1037

Introduction: Pterygium is one of the very common ophthalmic disorders with an unknown etiology and pathogenesis. Growth of pterygium into the cornea can result in visual impairment, astigmatism, loss of corneal transparency, visual axis obstruction.
Materials and methods: This cross sectional study was done on 500 patients, where demographic details was taken from all the patients including living environment, status, time outdoors, familial history, drug abuse, history of smoking, type of work and education, use of glasses. All of them underwent regular ophthalmic examinations including systemic and comprehensive examination as well as refraction.
Results: The prevalence of Pterygium was 12.6%. 35.6% of the patients were females and 64.4% were males. 51.2% belonged to the 30-39 year age group. 33.3% were farmers and 54% were manual labourers, 61.9%) of the patients had passed their high school while 28.6% were illiterate, 73% had no familial history of pterygium, 61.9% were regular smokers and 25.4% were occasional smokers. 36.5% of the patients had hypertension and 25.4% were obese.
Conclusion: Pterygium formation in our geographical area is quite high and the most common risk factor is exposure to sunlight. Male gender, hypertension and smoking also appear to be associated risk factors. Use of sunglasses may help in reduction of the prevalence of Pterygium.

Study of antibiotic sensitivity pattern of extended spectrum β-lactamase (ESBL) producing organisms in pediatric patients at a tertiary care hospital

Parag Mahankar, Bibhudatta Dash, Dr. Priyanka Badjate

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1038-1046

Background: The broad spectrum ß-lactam antibiotics are commonly used empirically for the treatment of gram negative sepsis. But the emergence of ESBL producing organisms has posed a serious threat for their continuing use. Present study was undertaken to find out the magnitude of the problem of infections due to extended spectrum β-lactamase producing organisms.
Material and Methods: Present study was a descriptive & observational study, conducted in patients < 18 years age, all cultures showing a significant growth of ESBL producing organisms from any of the clinical specimens, as per CLSI guidelines.
Results: Infections by ESBL producing organisms were found more common in 13-18 years of age group (36.25%) & males (71.25%). K. pneumoniae has been found to be the most commonly isolated ESBL producing organism (56.25%) followed by E. coli (38.75%). ESBL producing organisms were most commonly grown in urine samples (51.25%) followed by pus culture (11.25%) and blood (10%). All were sensitive to tigecycline and colistin (100%). In the carbapenem group, sensitivity to imipenem was highest (93.75%) followed by ertapenem (66.25%), doripenem (65%) and meropenem (53.75%). Among the 45 isolates of ESBL K. pneumoniae, all were sensitive to tigecycline and colistin. Sensitivity to imipenem is 93.33% while that to meropenem, doripenem and ertapenem were 46.66%, 62.22% and 64.44% respectively. Out of the 31 isolates of ESBL producing E. coli, all were sensitive to tigecycline and colistin. Sensitivity to Imipenem was 96.77% while that to meropenem, doripenem and ertapenem were 64.71%, 70.96% and 70.96% respectively. Sensitivity to meropenem has gone down dramatically from 71.42% to 22.22%, which is significant.
Conclusion: A growing resistance in the ESBL producing organisms is noted which is very alarming. A limited number of drugs are available against these ESBL producing organisms and the drug of choice is carbapenem.

Clinical profile of patients who underwent elective modified radical mastectomy

Dr.Shashidhara P, Dr. Shylaja TV, Dr. Kiran Kumar Nayak S, Dr. Chandrashekaraiah KC

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1047-1053

The development of breast cancer in many women appears to be related to female reproductive hormones, particularly endogenous estrogens. Early age at menarche, nulliparity or late age at first full-term pregnancy, and late age at menopause increase the risk of developing breast cancer. In postmenopausal women, obesity and postmenopausal hormone replacement therapy (HRT), both of which are positively correlated with plasma estrogen levels and plasma estradiol levels, are associated with increased breast cancer risk. Most hormonal risk factors have a relative risk (RR) of ≤2 for breast cancer development. The elective Modified Radical Mastectomy procedure was done in standard fashion. Patients in group A (Study group) received intraoperatively instillation of 0.5% bupivacaine into operative bed at the end of surgery. Patients in group B (Placebo group) received intraoperative instillation of normal saline into the operative bed at the end of surgery position. Approval from the ethical committee of the institution was obtained. All the patients were explained about the basis of the study and informed consent were obtained. Patients who received bupivacaine had longer postoperative analgesia when compared with normal saline group.

A clinical study of ulcers of the foot at a tertiary care hospital

Dr. Shashidhara P, Dr. Vasanth Kumar N, Dr. Chandrashekaraiah KC, Dr. Chandrashekar Naik G

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1054-1058

A chronic ulcer of the foot is a frequent condition, with prevalence in the population over 60 years of age. The incidence of ulcers is rising as a result of the ageing population and increased risk factors for atherosclerotic occlusion such as smoking, obesity and diabetes.
Ulcers can be defined as ‘break in the continuity of the covering epithelium either skin or mucous membrane due to molecular death’. Prospective study of 100 cases of chronic foot ulcers admitted at Tirunelveli medical college Hospital, Tirunelveli, during the period March 2011 to March 2012, with regular dressing, debridement, treating the underlying systemic disease, skin grafting and amputation were done. In a study group of 100 cases, most of the patients with leg ulcers had an underlined systemic disease such as diabetes mellitus, varicose veins, arterial occlusion secondary to atherosclerosis, leprosy and malignancy.

Functional outcomes of proximal fibular osteotomy in osteoarthritis knee grade II & III

Govind Pratap Singh, Bhupinder Singh Brar, Dr. Punit, Navneet Singh, Sandeep Singh Jaura

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1059-1066

Introduction: Osteoarthritis of the knee is a degenerative condition with a variety of treatment options like high tibial osteotomy (HTO), arthroscopic debridement, unicompartmental knee arthroplasty and total knee arthroplasty. This study was conducted with an aim to assess the outcomes of individuals with Grade II and III medial compartment osteoarthritis treated with a proximal fibular osteotomy (PFO) to alleviate discomfort, improve medial joint space and function of the knee joint.
Methodology: From November 2019 to October 2021, 25 Patients aged 45 to 65 years with knee OA of grade II or III (Kellgren-Lawrence classification) involving the medial compartment of the knee were included and underwent proximal fibular osteotomy and were followed up. Preoperatively as well as postoperatively, the entire lower extremity radiographs were obtained to assess the alignment of the lower extremity and the ratio of the knee joint space (medial/lateral compartment), knee pain was assessed using a visual analogy scale and knee ambulation activities were assessed using the American Knee Society score.
Results: All patients experienced alleviation from medial knee discomfort postoperatively. Postoperative weight-bearing lower limb radiographs revealed an average increase in medial knee joint space. The mean preoperative AKSS improved from 43.92 to 63.88 till the last follow-up.
Conclusion: PFO is a safe, simple and effective procedure that significantly decreases knee discomfort. It also enhances the joint's radiographic appearance and functional outcome in patients with medial compartment osteoarthritis of the knee.

Change in findings of culture and sensitivity data if any in chronic otitis media during COVID pandemic

Raghvendra Singh Gaur, Shammi Kumar Jain, Sanjay Agrawal, Dr. Swati Chandel

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1067-1073

Background: Chronic otitis media is an important cause of morbidity affecting all ages leading to variety of complications which has major impact on the patients and more so in Covid pandemic. Study to see the change in findings of culture and sensitivity data in chronic Otitis media during Covid pandemic and hence modify the treatment plan.
Aims: To study the bacteriology associated with the chronic otitis media and study any change in findings of bacteriology of chronic otitis media during COVID pandemic.
Subjects and methods: The retrospective study was done. The culture and sensitivity data during Covid pandemic was collected from Jan 2020 to Jan 2021 from ENT centre and their analysis and interpretation done according to age, types of culture and their sensitivity.
Result: In the total 100 cases of culture and sensitivity results during pandemic, pseudomonas aeruginosa was the most common organism isolated and showed highest sensitivity towards piperacillin/tazobactam and polymyxin B. Staphylococcus aureus was second most common which showed highest sensitivity towards linezolid and teicoplanin. Both showed lowest sensitivity towards ciprofloxacin. There was no change found in the bacteriology culture during the Covid pandemic which was compared from available literature.
Conclusion: the change in the findings of culture and study of chronic otitis media based on the study done shows almost no difference with the pre-pandemic times. But high antibiotic resistance implicates the careful use of antibiotics in treatment and avoiding empirical method of treatment.

Compare phenotypic and genotypic methods to detect MERSA in tertiary care center in central India

Taruna Singh, Shailja Tiwari Medha Singh Tiwari Prakash Tiwari Ashutosh Garg

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1074-1078

Staphylococcus aureus is significant human pathogen which cause various kinds of infection ranging from minor skin diseases to life- threating endocarditis. It has acquired resistance to previously effective antimicrobials including the methicillin. Methicillin resistant Staphylococcus aureus (MRSA) is prototype of bacteria which is resistant and associated with long hospital stay, more mortality, raised costs & trouble-some to patient when compared with methicillin -sensitive Staphylococcus aureus (MSSA). The present study was prospective study conducted for a period 1 year 8 month (from Nov 2011-June 2013) all staphylococcal isolate in Microbiology Laboratory, Shri-Aurobindo Medical-college & P.G. institute Indore India. Gram staining of each specimen (except blood) was performed & findings noted. Each specimen was cultured on Blood agar & MacConkey’s agar aerobically incubated over-night at 37 ˚C. Staphylococcal isolate were identified by phenotyping methods like Gram stain, catalase test, slide &tube coagulase test growth on manitol-salt agar, VP test Phosphates test and bacitracin susceptibility test. The antimicrobial susceptibility testing was conducted by Kirby-Bauer disc diffusion method as per guidelines of CLSI. Sensitivity, specificity & Positive predictive valve of chromogenic-agar for identification of MRSA detection was 83.7%, 80.2% and 71.9% respectively. In our study out of 100 cefoxitin resistant strain 89 were mec a positive and 11 were mec a negative

Evaluation of clinico-radiological outcomes in patients with lumbar degenerative disc diseases treated with intradiscal PRP versus steroids: A prospective double blinded randomized controlled trial

Dr. Bhupinder Singh Brar, Dr. Vivek Jha, Dr. Guncha Kalia, Dr. Bhandari Vaibhav, Dr. Neelam Gupta, Dr. Mandeep Kaur Nanda, Dr. Monika Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1079-1088

Context: To evaluate clinico-radiological outcomes in patients with lumbar degenerative disc
diseases treated with intradiscal PRP versus steroids.
Design: Prospective double blinded randomized controlled trial.
Aims: The aim of the study was to compare and assess radiological changes and clinical
outcome in patients with degenerative disc diseases when treated with intradiscal platelet rich
plasma and intradiscal steroid.
Objectives: To compare clinical outcome in PRP and steroid treated patients, to compare
radiological changes in PRP and steroid treated patients, to assess clinical outcome in PRP
and steroid treated patients at subsequent follow ups, to assess radiological changes in PRP
and steroid treated patients at subsequent follow up.
Settings and Design: Prospective double blinded randomized controlled trial.
Methods and Material: Adults (18-50 years) with chronic low back ache (> 6 months) nonradiating
who were unresponsive to conservative treatment. A total 40 patients were
randomized to receive intradiscal PRP (Group A) or steroid (Group B) after provocative
discography in the department of Orthopaedics in Maharishi Markandeshwar Medical
College and Hospital, Solan between the time period of November 2019 to September 2021
based on inclusion and exclusion criteria were enrolled for platelet rich plasma and steroid
infiltration in a randomized manner. Pain relief as assessed by change in VAS score,
functional assessment using change in Modified oswestry disability index (MODI). Pfirrman
and MSU grades as assessed by MRI.

Therapeutic plasmapheresis in kidney transplant patients: 30 years experience

Suhas Bavikar, Ajay Oswal, Swarnalata Gourishankar, Purva Bavikar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1089-1097

This retrospective observational study illustrates 30 years of experience of Therapeutic Plasma Exchange in 35 cases out of 1210 kidney transplantations performed between 1990 till 2020. Total 11 patients underwent Plex before undergoing kidney transplantation whereas 24 patients underwent Plex post kidney transplantation. Pre-transplant therapeutic plasma exchange was done in 5 Human Leukocyte Antigen incompatible, 5 ABO incompatible kidney transplant prospects and 1 prospective recipient with monoclonal gammopathy of renal significance. Whereas 15 kidney transplant recipients (Kidney Transplant Recipients) with antibody mediated rejection, 6 Kidney Transplant Recipients with thrombotic microangiopathy, 1 with myeloma cast nephropathy, 1 recurrence of Focal Segmental Glomerulosclerosis post transplantation & 1 Anti-Glomerular Basement Membrane antibody positive Kidney Transplant Recipient underwent Plex. The clinical end point after Plex exchange was achieved in 23 patients, 6 patients had a partial response. There was no response after Plex done for Kidney Transplant Recipient with Anti-Glomerular Basement Membrane antibody positive transplant glomerulopathy who subsequently progressed to requiring maintenance dialysis. One patient undergoing Human Leukocyte Antigen incompatible kidney transplant developed hyper acute rejection & had to undergo graft nephrectomy and another case with myeloma light chain cast nephropathy could not be salvaged. Pre-transplant Therapeutic Plasma Exchange used for desensitization of ABO incompatible & Human Leukocyte Antigen incompatible kidney transplants has benefitted 9 out of 10 patients in our study. Patient with end stage renal disease due to monoclonal gammopathy of renal significance was ultimately able to undergo kidney transplantation due to complete response after Therapeutic Plasma Exchange. Notably, we observed partial response for stabilizing chronic Antibody Mediated Rejection and late acute Antibody Mediated Rejection. Pathogenic entities like anti-endothelial cell antibody, thrombotic microangiopathy causing graft dysfunction can be successfully managed by Therapeutic Plasma Exchange. Therapeutic Plasma Exchange for the treatment of recurrence of Focal Segmental Glomerulosclerosis (focal segmental glomerulosclerosis) after kidney transplant has shown a partial response in terms of reduction in proteinuria.

Absolute Eosinophil Count with Prosthetic Heart Valve Thrombosis

Dr. Mahesh Murthy BR, Dr. Parameshwar S, Dr. Manjula B

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1098-1103

Background: Prosthetic heart valve thrombosis (PHVT) is a very rare complication after the
replacement of a damaged valve by a mechanical valve. It contributes significantly to the late
morbidity and mortality after heart valve surgery. The incidence varies across the world
depending on the type of mechanical heart valve and its position. A little study was done on
the absolute eosinophil count in prosthetic heart valve thrombosis. So in the present study, we
are evaluating the risk factors, clinical profile and levels of absolute eosinophil count in
prosthetic heart valve thrombosis cases.
Methodology: A prospective observational study was carried out at Sri Jayadeva Institute of
Cardiovascular Sciences and Research, Bengaluru from November 2015-December 2017. A
total of 73 patients with PHVT were studied during this period. Data was collected by
detailed clinical and treatment profiles and analyzed using SPSS V 23 software and results
were represented in tables, figures, percentages, and graphs under descriptive statistics.
Results:Mean age of study participants was 39.7+11.8 years. The percentage of females was
higher than males. The main predisposing factor for valve replacement was found to be
Rheumatic heart disease (94.5%) and degenerative aortic valve disease was found only in
5.5% of the cases. Mitral valve position (60.3%) was most commonly involved in PVT. After
replacement of the valve, 32.9% of patients presented the PHVT after 5 years and 9.6%
within 6 months of surgery. Out of 73 patients, 50.7% of cases presented with NYHA class II
symptoms, and 69.9% had INR in the non-therapeutic range. Atrial fibrillation was observed
in 23.3% of cases atrial tachycardia in 5.5% of cases. Recurrent PVT was observed in 20.5%
of cases. The absolute eosinophil count (AEC) was measured in our study 39.7% of cases had
elevated levels of AEC.
Conclusion: Prosthetic valve thrombosis is a major cause of morbidity and mortality in cases
with heart valve replacement. There is a strong correlation between incidence of PHVT and
elevated AEC. Eosinophilia increases the incidence of recurrent PHVT and interferes with
events of thrombolysis. Hence it is necessary to check AEC for all cases of PVT for better
assessment and management.

Sonographic evaluation of causes of bleeding per vagina in pregnancy

Dr. Divya S Namoshi, Dr. Navin Mulimani, Dr. Suresh Masimade

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1116-1130

Vaginal bleeding in pregnancy is a common presentation in emergency obstetric care facilities. The acuity of the symptoms may vary from occasional spotting to severe hemorrhage associated with cramping and abdominal pain.100 patients with bleeding per vagina in pregnancy underwent ultrasound examination of the abdomen and pelvis conducted using curvilinear transducer of 3.5-5 MHz and transvaginal transducer of 5-9 MHz. The patients progress was followed up clinically and sonographically, when necessary. Of the 100 patients, maximum patients presenting with per vaginal bleeding were those of abortions (44%), with it being the commonest cause of bleeding in the first trimester (87.5%). The other condition encountered in the first trimester was ectopic pregnancy (12.5%), in which ultrasonography could detect the cases with an accuracy of 100%. The most common cause of bleeding in the second trimester was also abortion (44.4%) followed by placenta previa (33.3%). The type of placenta previa frequently encountered in this study was low lying placenta previa. Other causes included molar pregnancies and placental abruptions. In the third trimester, placental abruption was diagnosed in most of the cases (59.38%) with only 21.7% cases of abruption placenta cases showing favourable outcome. Ultrasonography should be the primary modality of investigation to determine the cause of bleeding in a case of antepartum hemorrhage

Functional outcome in intertrochanteric fractures treated with proximal femoral nail

Dr. Yogesh Kadam, Dr. Vinay, Dr. Shivanand Doddamani

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1131-1135

The most widespread internal fixation device used today is the fixed angle extramedullary device, such as a 95-degree lag screw and side plate or blade plate. This implant includes a large lag screw positioned in the center of the femoral neck and head and a side plate alongside the lateral femur. The screw-plate interface angle is changeable and depends on the anatomy of the patient and the fracture. A total of 30 patients who were admitted with intertrochanteric fractures that fitted into the inclusion criteria and managed surgically with proximal femoral nail were included in the study. In our series, Boyd and Griffin type II and type III contributed eighteen and six cases in each group, making to 60% and 20% followed by type IV contributing 6 cases making 20%. We performed closed procedure in 26 cases (87%) and open nailing in 4 cases (13%). The average duration of radiation exposure was 120 seconds, average duration of surgery was 95 minutes and average blood loss was 140 ml with 23% intraoperative complications

Diabetes and glaucoma: How deep is the relation?

Dr. Chaithra C M, Dr. Kshama. K

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1136-1139

Background and aim: India is one of the 7 countries of the IDF (International Diabetes Federation) SEA (south-east Asia) region. 463 million people have diabetes in the world and 88 million people in the SEA Region; by 2045 this will rise to 153 million. There were over 77,005,600 cases of diabetes in India in 2020.In our study we tried to determine the risk factors for development of Glaucoma, especially in Type-2 diabetics and its magnitude.
Methods: a cross sectional study done in KIMS OPD, Bangalore between January 2018-may 2019. Diabetes was diagnosed by history and measurement of blood sugar levels. Glaucoma was diagnosed by assessing optic disc morphology, visual fields, and intraocular pressure. Systemic blood pressure was also measured for the patients. Statistical significance was indicated by P < 0.05.
Results: Study cohort included 350 patients with Type-2 Diabetes (150 males and 250 females), mean age of 52+/- 9 years. Prevalence of glaucoma was 16% (95% CI; 13.4-18.3). Out of this 16%, 50% had primary open angle glaucoma, 32% primary angle closure, 12.5% neovascular glaucoma, 5.3% other types. 77% diabetics didn’t have Diabetic retinopathy. Presence of glaucoma was significantly associated with the duration of Diabetes (chi-square=5.80 and p<0.015). Presence of Diabetic retinopathy was Not significantly associated to the presence of glaucoma (odds ratio=1.42). Even presence of systemic hypertension did not affect the magnitude of glaucoma in diabetics.
Conclusion: Screening for glaucoma while screening Diabetic cases may yield us more cases of glaucoma and the duration of diabetes is one of the most important determinants for development of glaucoma.

A comparative study to assess the efficacy of epidural steroid injection with and without bupivacaine for low back pain patients

Dr. Kamala GR, Dr. Hanumantharaya GH

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1140-1144

Low back pain is the most common problem among chronic pain disorders in middle aged population. Epidural Steroid Injection (ESI) is one of the most commonly performed non-surgical interventions 1. Objective of study is to compare the efficacy of epidural steroid injection with & without Bupivacaine for low backache patients.
Materials and Method: Two groups of 12 selected patients with chronic low backache were randomized for midline Inter laminar Epidural injection with 80 mg Methylprednisolone acetate with saline and Methylprednisolone acetate 80mg with 0.25% Bupivacaine. All patients received 3 injections at intervals of 2 weeks. They were assessed for degree and duration of analgesia (VAS) and any adverse effects.
Results: Onset of pain relief was less in adjuvant group when compared to non-adjuvant group after ESI. VAS at the end of 6 weeks in both groups was almost same in both groups. There were no significant adverse effects.
Conclusion: Epidural Steroid Injections significantly reduce radicular pain more with Bupivacaine.

Assessment of disability in patients with alcohol dependence syndrome

Gopal Das CM

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1145-1154

Objectives: To assess the extent of disability in patients with Alcohol Dependence Syndrome who presented for inpatient de-addiction programme.
Methods: 100 consecutive consenting patients within the age of 18-65 years, admitted under inpatient de-addiction unit of a tertiary care teaching hospital are included after excluding axis-1 psychiatric disorders, major medical illness and other disabilities. AUDIT, 36 item interview version of WHODAS 2.0 are administered and statistical analysis done.
Results: The mean summary score of WHODAS obtained in the study group is 53.7 and lies around the 95th percentile. Highest disability was found in Life activities (Work activities-84.3±17.38; household activities-75.8±22.26). Disability scores were found to be higher in complicated withdrawal group in statistically significant levels. Alcoholic Liver Disease was found to have statistically significant higher disability scores in work activities domain.
Conclusion: Alcohol Dependence Syndrome has high disability comparable to other mental illnesses. Early onset dependence group, complicated withdrawal group and those with complications resulting due to alcohol use have higher disability. These findings may help in devising better treatment approaches, planning and individualizing rehabilitation and improving productivity and functioning of patients and thus ultimately reducing burden on society.

A prospective comparative study to assess block characteristics of 2-chloroprocaine and bupivacaine for lower limb surgeries under spinal anaesthesia

Dr. Samatha Reddy Remata, Dr. Myakala Siddartha

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1155-1161

For decades, lignocaine was the local anaesthetic of choice for spinal anaesthesia in ambulatory surgeries. Its advantages are rapid onset of action and good motor block manifested as good muscle relaxation. Its use has become limited because of transient neurologic symptoms and cauda equina syndrome following intrathecal injection. After obtaining the approval of scientific, ethics committee and written informed consent, a total of 100 patients undergoing elective lower limb surgeries under spinal anaesthesia were selected. Patients were explained before operative procedure. Pre-anaesthetic check- up was carried out preoperatively with a detailed history, general physical examination and systemic examination. Airway assessment and spinal column examination was done. In the present study it was observed that there was a statistically difference in the bromage score between groups, score 2 was significantly higher in group II, score 3 was significantly higher in group I p < 0.05. In the present study it was observed that Mean time (in minutes) to pass urine was significantly lower in group I than compared to group II p <0.05.

Haemodynamics of 2-chloroprocaine and bupivacaine for lower limb surgeries under spinal anaesthesia

Dr. Samatha Reddy Remata, Dr. Myakala Siddartha

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1162-1167

The lipophilic portion is essential for anaesthetic activity and therapeutically useful local anaesthetics require a delicate balance between lipid solubility and water solubility. Addition of a butyl group to the Piperidine nitrogen of Mepivacaine results in bupivacaine, which is 35 times more lipid soluble and has a potency and duration of action three to four times that of Mepivacaine. Inclusion criteria were American Society of Anaesthesiologists (ASA) physical status I or II, either sex, age 18-60 years, presenting for lower limb surgeries. Exclusion criteria were patient allergic to drug, heart block/dysrhythmia. Hundred slips were made in such a manner that fifty slips had Group 1 written on it and the other fifty had Group 2. In the present study it was observed that there was no statistically significant difference in distribution of patients based on ASA grade in between the two groups p >0.05. In the present study it was observed that there was there no statistically significant difference in adverse events in between group.

Socio-demographic profile and risk factors of non-communicable diseases in Warangal, Telangana: Epidemiological study using WHO stepwise approach

Niharika Lakkoju, Vaseem Anjum, Vandana Pandit

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1168-1178

Background: Non-communicable disease (NCD) is a medical condition of non-infectious and non-transmissible nature. NCDs may be chronic diseases of long duration and slow progression. This study was carried out to assess the socio-demographic profile and risk factors of non-communicable diseases using WHO stepwise approach among adults.
Methods: A cross-sectional study was carried out among 400 adults during the period from 1st September 2015 to 31st August 2016. Study tools included a WHO stepwise approach questionnaire, Sphygmomanometer, weighing scale, non-stretchable tape and stethoscope. The data was entered and tabulated in MS-Excel 2007 and statistical analysis was performed by using Statistical Package for the Social Sciences (SPSS 22.0) and p<0.05 is considered as statistical significance.
Results: Majority belonged to 50-59 years, of which 280 (70%) were illiterates. About 319(79.8%) were married, most of them resided in nuclear families with 350 (87.5%).Many were engaged in unskilled labor mainly agricultural activities with 196(49%) and unemployment 113(28.3%). Majority was from upper lower class, followed by lower class.
Conclusion: Proportion of tobacco smoking among the study participants was 123(30.8%) in which 118(29.5%) were males and the association between smoking and gender was statistically significant. Alcohol use (59.5%) which was high among the rural population of Wardhanapet, in which males consume more amount of alcohol than females and these difference present at significant levels. Overall physical activity is high among the study participants as heavy workers were found to be (28.8%) and these differences with gender were present at significant level.

Prospective observational study of outcome of meconium stained amniotic fluid in newborn

Dr. Hardik R Parmar, Dr. Pankti D Desai, Dr. Sunil C Chand, Dr. Harsha M Makwana, Dr. Naresh C Rathva

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1179-1186

Background: The presence of meconium stained amniotic fluid (MSAF) is a serious sign of fetal compromise, which is associated with an increase in perinatal morbidity, clear amniotic fluid on the other hand is considered reassuring. A study by Mathews and Warshaw found that in 98.4% of cases with meconium stained liquor, the neonates were admitted to the neonatal intensive care units, these were delivered at 37 weeks of gestational age or later as it shows maturation of autonomic nervous system. MSAF occurs in 10% of pregnancies with most occurring at term or particularly post term. The purpose of this study was to evaluate the effect of clear liquor and meconium stained liquor on time and mode of delivery and to find out neonatal morbidity and mortality associated with meconium stained amniotic fluid.
Aim: To correlate the maternal and neonatal factors contributing to morbidly related to Meconium stained amniotic fluid.

Study of association of ECG changes to the site of bleed (sob) in nontraumatic spontaneous intracerebral hemorrhage (ICH) patients

Dr. Dhumal Sainath, Dr. Deshpande Neelima, Dr. Patil Pranita Gangadhar Rao, Dr. Rushikesh Haridas

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1187-1192

Background: The annual incidence of intra cerebral hemorrhage (ICH) is 25 cases per 1, 00,000/year. Although ECG abnormalities are well known in ischemic stroke and subarachnoid hemorrhage these change have been rarely been investigated systematically in patients with ICH. Present study was aimed to study any association between ECG changes to the Site of Bleed (SOB) in non-traumatic spontaneous intracerebral hemorrhage (ICH). Material and Methods: Present study was a prospective, observational study, conducted in patients confirmed of ICH on CT scan. Each case was examined in detail with history, clinical features, ECG readings & CT scan findings.
Results: In present study, male to female ratio was 1.7:1. Maximum number of patients were from > 60 years age (52%). The various CT scan findings noted in the study were < 50 cc volume of hematoma (52%), presence of mass effect (40%) & presence of intra ventricular communication (38%). The most common site of bleeding was putamen (40%) followed by thalamus (30%), lobar (14%), brainstem (10%) & cerebellum (6%). The most common ECG findings in our study were Left Ventricular hypertrophy (56%) followed by prolonged QTc (54%), T wave inversion (56%), Left axis deviation (46%), Tachycardia (36%), ST-T changes (28%), Q waves (22%), Tall T wave (8%), VPC (8%) and RBBB changes (8%). In present study, there was statistically significant association was noted between LAD, IVC and LVH with ECG changes (p<0.05).
Conclusion: Significant association could not be established between specific site of bleed and ECG changes even though the proportions ECG changes to Site of bleed was significant.

A comparative study of levobupivacaine and ropivacaine as supraclavicular brachial plexus block in patients undergoing upper limb surgery

Sirisha T, Varaprasada Rao T

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1193-1200

Introduction: Peripheral nerve blocks are the preferred choice of anaesthesia for surgeries involving the extremities of the human body, with fewer complications. Earlier, the most common drug to be used for the brachial plexus block was bupivacaine, but of late, levobupivacaine and Ropivacaine are used as substitutes to counter the toxicity by Bupivacaine.
Materials and methods: 100 patients aged between 18-60 years with ASA I and ASA II undergoing bony surgeries were randomly divided into Group L and Group R. Group L was given 30 ml of 0.5% Levobupivacaine and Group R was given 30 ml of 0.5% Ropivacaine. Results: The onset of the sensory blockade was significantly lesser in Group L (4.51 ± 0.45 minutes) rather than Group R (5.95 ± 1.33 minutes) while there was no significant difference in the onset of the motor blockade (8.13 ± 2.46 minutes in Group L and 8.42 ± 2.51 minutes in Group R). The duration of the sensory blockage was significantly more in Group L (11.13 ± 2.11 hours) than Group R (9.04 ± 1.42 hours) while there was no difference in the duration of the motor blockade. The duration of analgesia was 11.43 ± 2.17 in Group L and 8.23 ± 1.72 hours in Group R, which was statistically significant.
Conclusion: Since the onset is shorter and duration of anesthesia and analgesic is more effective in Levobupivacaine, it can be used as a preferred drug.

Effect of induction with propofol-fentanyl and sevoflurane-fentanyl on postoperative nausea and vomiting after laparoscopic surgery: A comparative study

Varaprasada Rao T, Sirisha T

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1201-1206

Introduction: Post-operative nausea and vomiting is one of the very common complications after a surgery. Prevention of PONV in patients results in improved patient satisfaction and cost effective patient care.
Materials and methods: 50 patients were randomly divided into 2 groups, Group A were the patients who received Propofol- Fentanyl and group B, who received Sevoflurane – Fentanyl. Before surgery, the baseline conditions, such as the baseline pulse rate, blood pressure, SpO2 were taken. Injection glycopyrolate 0.2 mg/kg was given intramuscularly half hour prior to the surgery. 100% oxygenation was given to all the patients for 3 minutes. During Preinduction, all the patients were given 1-1.5 mcg/kg IV Fentanyl.
Results: In the Group A most of the patients had no nausea post-surgery, while 5 of them had mild nausea. However. Out of the patients in Group B, 32% each had mild or no symptoms, but 7 (28%) PONV Grade III, which was significantly higher. In group A, 48% of the patients who were either overweight or obese had no nausea, while 16% of them had mild nausea, 12% had Grade III PONV. Of the patients with normal BMI in Group A, only 1 (4%) had mild nausea, while all the others had no symptoms. In group B, 7 (28%) of the overweight and obese Patients had grade III nausea i.e. 1-2 Vomiting’s in 12 hours with nausea, while 2 (8%) had >3 vomiting in 12 hours with nausea. 6 (24%) each had mild nausea or no nausea.
Conclusion: Although the efficacy of both sevoflurane and Propofol is similar, Propofol is the more preferred drug due to the lesser amounts of cases of nausea and vomiting, thereby resulting in higher patient satisfaction.

Bacteriological profile of orthopaedic implant site infection and their antimicrobial susceptibility pattern in a tertiary care hospital

Santosh Kumar, Dharitri Mohapatra, Sasmita Khatua, Nirupama Chayani

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1207-1217

Orthopaedic implant site infection is one of the major surgical site infection in orthopaedic surgery with high morbidity and mortality. Due to the use of implants, which are foreign to the body, orthopaedic trauma surgery is at the grave risk of microbial contamination. Overall 5% of the internal fixation devises get infected. The incidence of infection after internal fixation of closed fractures is generally lower (0.5-1%), where as in case of internal fixation of open fractures, the incidence is still higher and may exceed 30%. The prevalence of orthopaedic implant site infection reported in India is about 2.6%.

Effect of IV iron sucrose versus IV carboxymaltose in patients with heart failure

Rambabu Singh, Rajat Jain, Shreya Srivastava

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1218-1221

Iron deficiency either absolute or functional, is an independent predictor of all cause and cardiovascular mortality and a major contributor to exercise intolerance, even in absence of anemia. Correcting these comorbidities is attractive and novel therapies targets to improve outcomes. At present, IV iron is preferred route for treatment in such patients. Most studies have used IV iron sucrose (max dose of 200mg/setting) or ferric carboxymaltose (max dose of 1000mg/setting). Our study determines advantage of IV iron carboxymaltose over iron sucrose by being cost effective, requiring fewer injections, lesser duration of hospital stay with minimum adverse effect and equivocal improvement in quality of life and hematological profile in patients with heart failure with either preserved or reduced ejection fraction.

Open globe injury: Presentation and predicting factors

Dr. Prabha, Dr. Rajesh Kumar Saini, Dr. Shashidhar Harvyasi, Dr. Charita Meena

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1222-1227

Aim: To identify the prognostic factors in open globe injuries and its presentation.
Materials and Methods: Retrospective study at Government medical College, Bharatpur,
JLN Medical College Ajmer, GMC Churu, GMC Dungarpur, Rajasthan, India in year 2021,
patients presented to casualty department of eye and undergone intervention with follow-up
of 1 to 3 months or till better recovery.
Results: Total 62 patients, 44 (71%) were males and 18 (21%) were females. Mean age was
24 years (with range: 2.5-62 years). Factors affecting final outcomes in ocular trauma are
nature and mechanism of injury, presenting conditions initial visual acuity, timing of
presentation and timing of intervention, segmental involvement as anterior or posterior
segment and zone of injury.
Conclusion: These predicting factors helps in counseling and explaining the prognosis and
also the deciding the line of treatment

Utilisation of maternal health services in rural field practice area of Kakatiya medical college, Warangal, Telangana, India

Bhavani R, Nirmala Devi, Kumari SMV

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1228-1233

Introduction: Maternal mortality and morbidity continue to be high despite the enormous
inputs and efforts imposed through National Health Programmes. Proper utilization of
maternal health care services plays an important role in reducing the maternal mortality rate.
Hence assessment of factors influencing the utilisation of these services become essential.
The objective is to estimate the proportion of women utilising the maternal health services
and to determine the factors associated with utilisation.
Methods: A cross sectional study carried out in mothers of under five children. One village
was selected by simple random technique from the 3 villages of rural field practice area of
Kakatiya Medical College (KMC), Warangal. All the eligible mothers for the study after
obtaining consent, were interviewed using pretested semi-structured questionnaire. Data
collected was compiled and exported to SPSSV20 and analysed using chi-square test.
Results: Of the 180 women, 6.7% had teenage pregnancies, 97.8% registered the
pregnancies, 97.8% had minimum 4 antenatal care (ANC) visits, 95.6% completed TT, 81.1%
consumed recommended iron folic acid (IFA) tablets, 98.9% had institutional deliveries and
47.8% had postnatal care (PNC) with minimum of six visits. Full ANC showed statistically
significant association with education and socio-economic status.
Conclusion: Though the utilisation has improved, there is still a lag in the IFA intake and
post-natal care received by mothers. This can be improved by giving separate incentive to
health care workers for post-natal visits.

Fear of avascular necrosis in COVID survivors is real: A rare case series

Dr. Arjun A, Dr. Gopi HG, Dr. Kiran V, Dr. Chaithra CM, Dr. Nagesh Sherikar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1249-1252

COVID-19’ can affect different body systems. At present, osteo necrosis of femoral head as a sequalae of ’COVID-19’ is rarely documented. By large-scale use of life-saving corticosteroids in COVID-19 cases, we anticipate that there will be a resurgence of AVN cases. We report a series of two cases in which patients developed AVN of the femoral head after being treated for COVID-19 infection. The mean dose of corticosteroid used in these cases was 600 mg (400–1250mg), which is less than the mean cumulative dose of around 2000 mg steroid, documented in the literature as causative for AVN. Patients were symptomatic and developed early AVN of bilateral hip at a mean of 42 days after COVID-19 diagnosis as compared with the literature which shows that it generally takes 6 months to 1 year to develop AVN post steroid exposure. Both the patient had significant dysfunction of coagulation with altered parameters. Thorough ophthalmic examination was done to both. literature has showed micro thrombi in eye, heart, liver, kidney, etc. Is corticosteroid being just a confounding factor??

Knowledge, awareness and acceptance of covid-19 vaccine among general population in urban Raigarh, Chhattisgarh: A cross-sectional study

Ashish Baghel, Sofia Noor, Anjana Tiwari, Simmy Gavel

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1253-1260

Introduction: While there are considerable enthusiasm and anticipation for the COVID-19
vaccine, little is known about vaccine hesitancy specifically for COVID-19 in the general
population. Identifying specific populations, their characteristics with regards to vaccine
knowledge, awareness & acceptance will help as key components of a successful vaccination
strategy. Hence the present study was carried out to assess the knowledge, awareness &
acceptance of COVID-19 vaccination among general population of urban Raigarh,
Chhattisgarh.
Methods: A community-based cross-sectional study was conducted among 400 participants
of urban Raigarh regarding knowledge, awareness & acceptance of COVID-19 vaccine from
April-June 2021. The methodology comprises of primary data collection through survey in a
pre-designed pre-tested proforma by face to face interview.
Results: Total 400 participants among general population who had an average age of 34.3
years ±11.8 years with slight male preponderance (53.2%). Nearly half (58.2%) of
participants were from the slum, (45.2%) came under middle socio-economic class and (49%)
were self-employed. Majority (77.25%) knew about COVID-19 vaccination programme,
while (46.75%) knew about common side effects of vaccine. More than half (54.25%) were
aware that it boost up immunity against COVID-19 infection and (77.5%) were having good
knowledge regarding COVID-19 vaccination, and (36.5%) were afraid of taking COVID-19
vaccine, while (39%) were concerned about its side effects.
Conclusion: The study identified that majority of responders were aware regarding COVID-
19 vaccine, still many have doubts & concerns about its potential efficacy and safety thereby
providing an important outlook for feasible interventional awareness programs to enhance
vaccination rates. The study also identified that the concerns regarding the vaccine adverse
effects acted as the leading barrier for vaccine acceptance.

Establishment of sexual dimorphism of permanent maxillary canine teeth in Rajasthan population by orthopantomographic study

Suresh Sharma, Vipin Kumar Sharma, Sachendra Kumar Mittal, UK Gupta

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1261-1265

Background: Teeth and their measurements give the impression to be the most reliable method since teeth prove the most durable and resilient part of the skeleton. Especially Canines are the most durable teeth in the oral cavity due to the labio-lingual thickness of the crown and the root anchorage in the alveolar process of the jaws.
Objective: Establish the sexual dimorphism of permanent maxillary canine teeth in Rajasthan population by Orthopantomographic study
Methodology: 300 patients of 150 male and 150 females was included in the study. Use Measurement like mesiodistal width and intercanine distance in maxillary jaws were established based on radiographic examination with the help of digital Orthopantomograph.
Results: Canine mesiodistal width was higher in male (left: 7.80 ± 0.04 and right: 7.80 ± 0.04) then female (left: 7.54 ± 0.15 and right: 7.53 ± 0.12) p-value = <0.001. Maxillary intercanine distance was 36.45 ± 0.81 for male & 34.76 ± 1.55 for female. On the other hand, maxillary right and left canine index was higher in female than male P-value <0.001.
Conclusion: Maxillary intercanine distance shows maximum sexual dimorphism among all measurements and canine index shows negative sexual dimorphism.

Effect of COVID 19 pandemic lockdown on sleep pattern of university students: A web based cross sectional study

Dr. Satyajit Bagudai, Dr. Ketaki Poorey, Dr. Neerja Shastri .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1266-1273

Objectives: In addition to the physical morbidity and mortality, COVID-19 Pandemic has created a mental burden on the population as a whole. In our present web based cross sectional study we tried to assess the prevalence of the sleep pattern and different psychological problem in young University students.
Material and Methods: Using a web based study we collected data from 100 University students who volunteered to participate. We analyzed the demographic data, generalized anxiety disorder (GAD), depressive symptoms and sleep quality.
Results: The overall prevalence of GAD, depressive symptoms and sleep quality of the students were 100%, 79% and 79% respectively. Bivariate regression analysis showed female students to be more likely to have mild anxiety and moderately severe depression whereas younger age students were more likely to have mild anxiety. There was a reduction in physical activity in 58% of students.
Conclusion: In our study, we found the recent COVID-19 outbreak as a major psychological burden for the student population irrespective of gender and age. Formulation of a prior guideline, targeted at such group of population during a pandemic is necessary to avoid the development of such psychological problems as well as their fatal consequences.

Use of IV iron in iron deficiency anemia in CKD with raised serum ferritin

Dr. NS Sengar, Dr. Rambabu Singh, Dr. Preeti Gupta, Dr. Patel Jivabhai Girish Kumar, Dr. Hardeep Jogi, Dr. Nitin Gupta .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1274-1279

Background: Many newer tests are now available to diagnose iron deficiency in CKD but these tests are not widely used in India as these tests are expensive and patients cannot afford these tests. Hence the traditional tests serum ferritin and transferrin saturation are needed to be studied more thoroughly to infuse IV iron to patients with iron deficiency anemia in CKD as many cannot afford ESAs and blood. Ferritin is an important indicator of iron overload as well as an acute phase reactant which increases in inflammatory conditions. Serum ferritin getting raised both in iron deficiency anemia and inflammatory states complicates our diagnosis. In this scenario TSAT plays important role in ruling out iron overload and inflammation is ruled out by inflammatory markers.
Objective: To study the effect of IV iron in patients with serum ferritin >1000ng/ml and TSAT <20%.
Methodology: This study was conducted at Department of Medicine, M.L.B. Medical College; Jhansi from March 2020 to November 2021, after seeking clearance from ethical committee and obtaining written informed consent from patient.
Result: It was seen than 18 patients showed improvement and had increase in Hb by 1g/dl. 1 patient had a reaction and transfusion was stopped immediately and 1 patient was lost to follow up.
Conclusion: Against the popular belief that infusion of iron in patients with raised serum ferritin should not be given, this study showed that after ruling out other causes of raised serum ferritin and iron overload by calculating TSAT, IV iron can be given to patients with raised serum ferritin as it shows improvement in anemia.

Clinico-radiological outcomes of platelet rich plasma versus steroid via epidural route in patients with lumbar degenerative disc disease: A prospective triple blinded randomized control study

Nikunj Gupta, Vivek Jha, Bhupinder Singh Brar, Omeshwar Singh, Mandeep Kaur Nanda, Naveen Kakkar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1280-1289

Introduction: Low back pain is one of the leading causes of physical disability in both old and younger age group. It has enormous effects on socioeconomic status and health of people. Inter vertebral disc degeneration is an active process which involve changes in cellular microenvironment and tissue that eventually leads to structural breakdown and impairment of inter vertebral disc function. These changes cause back pain. Epidural steroid injection is a well-established modality in providing pain relief and is widely practiced. PRP (Platelet rich plasma) is a new upcoming modality with promising regenerative effects. In recent literature its use in treatment of back pain is being encouragingly promoted and is under evaluation.

A Real time virtual reality wound care assistance system for Clinical Nursing Education: A initial investigation

Sujana. Gayathri,S. Sujitha,S. Maha Lakshmi. Anusha, .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1290-1294

When it comes to wound care, dressing changes are a vital part of the process. Compliance with aseptic procedures and methods is critical to reducing the risk of infection in the healthcare setting. The ability to master the talents may be achieved via practise. Virtual reality is presented in this research as a means of increasing practise opportunities. In order to better understand the process of changing a basic wound dressing, an immersive virtual environment has been created. A preliminary user research on usability with an experienced nurse and an undergraduate nursing student yielded positive results. The simulation will undergo a thorough examination in order to enhance it even more.

An automatic music accompaniment model at nursing homes using VLN’s

Maha Lakshmi,Edna Sweenie J, V. Sujatha,Anusha.K. Prasanna, .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1295-1300

Eurydice, an automated music accompaniment system, and vertical line notation are used in this research to provide music entertainment in a nursing home. Alzheimer's disease and other forms of dementia may be prevented or treated by regular music listening. Music progression on Eurydice may be achieved using two different tapping methods. A beginner piano student of ours has been asked to play from a VLN sheet music. We've put our system to the test over the last 10 months

An optical fall detector adaption at nursing homes using Flow based CNN

Vasantha KumariV. Sujatha,E. SumalathaC. Rathiga,Maha Lakshmi .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1301-1306

It's difficult to identify falls in senior care facilities. Because the resident, who may be suffering from mental illness, is not instrumented by vision-based fall detection systems, it is a major advantage. Fall detection technology are being used in nursing homes as part of this research. A Convolutional Neural Network (CNN) trained to optimise a sensitivity-based metric is the basis of the suggested solution, which is based on Deep Learning techniques. It discusses the medical criteria and how they affect the CNN tuning in this study. The findings demonstrate the relevance of the timing component of a fall. Consequently, the medical team's aims are best served by a specific measure tailored to this use case and an implementation of a decision-making process.

A study of correlation of ultrasound, MRI and arthroscopic findings in diagnosing rotator cuff pathology

Dr. Yunus Salim CM, Dr. Muni Sankar Reddy M

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1307-1315

Background: The shoulder arthroscopy is the gold standard of reference in most of the shoulder pathologies including Rotator cuff tears. However, it is an invasive surgical procedure with associated risks of surgery and anaesthesia. The objective of the present study is to find out how accurately the rotator cuff pathologies can be diagnosed by these imaging tests.
Aims and Objectives: To compare the Ultrasonography, MRI findings with the Arthroscopic findings of Rotator cuff pathology of the shoulder.
Materials and Methods: All patients in whom the history and clinical examination is suggestive of Rotator cuff pathology were included in the study. Patients were evaluated using high resolution Ultrasound (HRUS) Philips HD-11, Germany and 1.5-Tesla MRI [1.5 Tesla, GE, Excite HD and USA]. Ultrasonographic and MRI examination is performed by a single radiologist experienced in musculoskeletal ultrasonography and MR Imaging. A Real time high resolution USG imaging and MRI of the shoulder was performed in a standardized fashion and subsequently with therapeutic or diagnostic arthroscopy on the symptomatic shoulder. Results were analyzed.
Results: Considering arthroscopy as the final gold standard of investigation, out of the 24 patients studied, five (20.8%) had rotator cuff tendinosis/tendinopathy, four (16.6%) had PT RCT, twelve (50%) had FT RCT while the remaining three (12.6%) had normal rotator cuff. The average delay between the MRI examination and arthroscopic surgery was 6 days (range 0-27 days) but in one case, it was as long as 117 days. A total of five (20.8%) patients were in the age group < 40 years while another five (20.8%) were between 40-50 years age group. A majority of eleven (45.8%) patients were between 50-60 years old while three (12.6%) were above 60 years.
Conclusion: It should be noted that following USG of the shoulder performed by a dedicated radiologist, MRI offers little additional value, with regard to the detection of rotator cuff tears.

A Study of association of serum magnesium and zinc levels in diabetics

Dr. Ramesh Dnyanadeo

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1316-1320

Background: Hypomagnesaemia and hypermagnesuria was reported to be associated with diabetes complications. Thus, magnesium has drawn considerable attention for its potential role in improving insulin sensitivity and preventing DM. Zinc, another important trace element, acting as a cofactor for several biochemical processes has a major role in health status. There is substantiating evidence indicating the importance of zinc in DM. Impaired zinc metabolism, decreased plasma zinc and hyperzincuria has been reported as a consequential effect of glucose absorption. But limited studies have been conducted in this part of the world. This study puts in an effort to find the answers.
Aims and Objectives: To study the association of serum magnesium and zinc levels in diabetics.
Materials and Methods: This study was done in the Department of General Medicine, SSPM’S Medical College and Lifetime Hospital, Padve.
This study was done from Jan 2019 to Dec 2020.
Ninety and an equal age and sex matched control were used for the study.
Results: There is a strong association between the serum magnesium and zinc levels in diabetics when compared to normal individuals.
Conclusion: More number of studies have to come up in different geographical locations so as to be helpful to the practicing physicians.

A study to analyze vocal cord palsy with reference to nerve involvement presenting in tertiary care hospital in Eastern India

Dr. Amit Kumar Sharma, Dr. Mahesh Kumar, Dr. Rakesh Kumar Singh, Dr. Sarita Kumari Mishra

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1321-1327

Background: Common causes of vocal could paralysis are neoplasms (bronchial, esophageal, thyroid), trauma, idiopathic, neurological, inflammatory & miscellaneous. With limited resource at our disposal, present study was aimed to find out etiopathology & classification of vocal cord palsy at our tertiary hospital.
Material and Methods: Present study was single-center, prospective, observational study, conducted in confirmed cases of vocal cord paralysis.
Results: This study was done on 44 patients of vocal cord paralysis. Majority were from 41-50 years age group (29.55%) followed by 51-60 years age group (20.45%). Sex incidence in this series revealed 27 male cases and 17 female cases. In present study common causes of vocal cord paralysis were Neoplastic growth (32%) followed by surgical trauma (30%), Blunt Trauma over front of neck (4%), pulmonary tuberculosis (11%), Idiopathic (16%), Cardiac hypertrophy (4%), cranial polyneuritis (4%) & Corrosive ingestion (4%). Left cord palsy, right cord paresis and bilateral paresis was noted in 55%, 27% & 18% cases respectively. 8 patients in this study were suffering from bilateral vocal cord paralysis and rest of the patients (36) had unilateral paralysis. So total number of paralyzed cords was 52. Out of these, 47 vocal cords were paralyzed completely and incomplete paralysis was seen in case of 5 cords. n most of the cases (27) it was in paramedian in position. Paralyzed cord was in midline in 12 cases, cadaveric in 8 cases. Incomplete palsy with restricted mobility was seen in 5 cases.
Conclusion: Neoplastic growth, trauma (surgical and non-surgical) & pulmonary TB were most common causes for vocal cord paralysis. Vocal cord paralysis was common in male patients, on left side & unilateral involvement.

Radiological study of characterization of interstitial lung disease using HRCT in clinically suspected cases

Dr. Deepak D Vyas, Dr. Ravi Varma, Dr. Sharad B Ghatge, Dr. Pooja D Vyas

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1328-1334

Background: Interstitial lung diseases are heterogeneous group of disorders of the lower respiratory tract that are characterized by both acute and chronic inflammation and a generally irreversible and relentless process of fibrosis in the interstitium and the alveolar walls. High-resolution computed tomography of the chest has become an invaluable tool in the diagnostic process of interstitial lung diseases. Present study was aimed to study characteristics of interstitial lung disease using HRCT in clinically suspected cases.
Material and Methods: Present study was single-center, cohort descriptive and observational study conducted in patients of any age, gender, with clinically suspected interstitial lung disease referred for HRCT.
Results: Majority of patients were found in the age group of 60-69 years (45%), were male (65%) & had history of smoking (42.5%). Major chief complaints were cough (55%), breathlessness (25%), dry cough (15%) and cough with fever (5%). Out of total of 40 patients, 22(55%) patients showed HRCT pattern reflecting Usual Interstitial Pneumonia (UIP) and Idiopathic Pulmonary Fibrosis (IPF), 10(25%) patients showed Nonspecific Interstitial Pneumonia (NSIP), 5(12.5%) patients had Hypersensitivity Pneumonitis (HSP) as well as 2(5%) patients had cryptogenic organizing pneumonia (COP) while only 1 patient (2.5%) showed changes of respiratory bronchiolitis-associated interstitial lung disease (RB-ILD). Maximum no of patients had bronchiectasis (57.50%), reticulation (42.50%), honeycombing (35.00%), ground glass opacities (32.50%) & consolidation (5.00%). Out of total of 40 patients, only 2 (9.09%) patient shows regression in UIP in follow-up scan, while others show progression 20(90.91%). 3 each shows progression in HSP (60%) and NSIP (30%), however in COP(100%) all patients show regression.
Conclusion: Based on the HRCT features a histospecific diagnosis can be reached in most cases of Idiopathic Interstitial Pneumonias obviating the need for biopsy.

Morphometry of deltoid ligament

Dr. Mubeena Shaikh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1335-1338

The medial collateral ligament also called as the deltoid ligament is a strong, triangular band, attached to the apex and to the anterior and posterior borders of the medial malleolus. Of its superficial fibres, the anterior also called the tibionavicular, passes forward to the navicular tuberosity, behind they blend with the medial margin of the plantar calcaneonavicular ligament. Intermediate also called the tibiocalcaneal fibres descend almost vertically to the entire length of the sustentaculum tali. Posterior fibres also called the posterior tibiotalar, passes posterolaterally to the medial side of the talus and its medial tubercle. The deep fibres (anterior tibiotalar) pass from the tip of the medial malleolus to the non-articular part of the medial talar surface.
Aims and Objectives: To study the morphometry of Deltoid Ligament.
Materials and Methods: Ten ankle joints were dissected and the measurements were taken.
Results: There is no statistical variation when compared in the sides and sexes.
Conclusion: Further large scale study is needed

Serum calcium and magnesium levels in patients with acute gastroenteritis

Dr. MA Reshamwala, Dr. Manish Maheshbhai Khokhar, Dr. Kartikeya Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1339-1342

Background: Though the earlier studies reported that there will be loss of magnesium and calcium ions in the patients with acute gastro enteritis, the exact measure was not provided.
Objective: The present study was undertaken to measure the levels of the calcium and magnesium in the patients of acute gastroenteritis. This information helps to plan adequate treatment in these patients.
Materials and methods: A total of 50 patients with acute gastroenteritis aged more than 18 years including both male and females were part of the study after obtaining the written, voluntary informed consent. Unwilling participants were excluded from the study. Patients with any severe complications were also excluded from the study
Results; Out of fifty participants, 20 participants were males and 30 participants were females. The range for calcium was found from 6.7 to 10.7 mmol/l. Majority of the patients have the calcium levels in the range of 7.7-8.7 mmol/l. The range for magnesium is 0.1-3.1 mg/dl. Majority of the patients have level of magnesium in the range of 2.1-3.1 mg/dl.
Conclusion: Significant decline in the serum calcium and magnesium levels was observed in the patients with gastro enteritis. The study results support the results of earlier studies. The study recommends the need of future studies with involving multiple centers and multiple samples to plan adequate treatment strategies for management of diarrhea cases and to prevent death of these patients.

A clinical & histopathological study of alopecia areata at a, tertiary hospital and research centre

Deepika MG, Dr. Mouryabha Shale KS, Dr. Harshavardhan Gowda H, Dr. Srinivas K, Dr. Ullas Mahesh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1343-1347

Background: Alopecia areata (AA) is hypothesized to be an organ-specific autoimmune disease mediated by T cells directed to the hair follicle. Despite numerous studies related to individual disease associations in AA, there is paucity of literature regarding comprehensive studies on concomitant cutaneous and systemic diseases. Hence there is need for better understanding of the disease. This study is intended to determine the prevalence, clinical and histopathological study of the disease.
Objectives
1. To study the hospital based prevalence of Alopecia areata.
2. To study the clinical and histopathological features of Alopecia areata.
3. To study the associated cutaneous and systemic disorders.
Methods: A total of 100 clinically diagnosed cases of Alopecia Areata who were consenting for both clinical evaluation and investigations were taken after a thorough informed consent. A detailed history was taken with emphasis on age, sex, socioeconomic status, history of Atopy and other autoimmune disorders, family history of AA, mode of onset, recurrence and complete examination of skin lesions, nails and mucous membranes was done to note morphology, distribution, extent, site, number, size etc and investigations such as VDRL, complete hemogram, FBS, PPBS, urine routine and thyroid profile, biopsy were done.

Mucocutaneous manifestations among paediatric HIV positive patients at a, tertiary hospital and research centre

Dr. Mouryabha Shale KS, Dr. Deepika MG, Dr. Chinthana BS, Dr. Harshavardhan Gowda H, Dr. Ullas Mahesh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1348-1352

Background and Objectives: There is a rapid increase in the incidence of HIV/AIDS among children. Proportionally, there is a rise in mucocutaneous involvement in this population. Mucocutaneous manifestations can pose diagnostic and therapeutic challenges. This study was done to note the different mucocutaneous lesions present among pediatric HIV population attending NMCH&RC, Raichur and their relation to CD4 counts.
Methodology: 214 consecutive HIV-positive children attending the OPD, at a tertiary hospital and research centre, between January 2015 to June 2016 were screened for presence of any mucocutaneous lesions and 100 children were included in the study. CD4 count was done in all of them along with other relevant investigations.
Results: Among 100 patients there were 118 mucocutaneous manifestations noted with overlap in a few. Prevalence of mucocutaneous manifestation was 47%. M:F ratio was 2:1. Majority of patients belonged to 5-14 year age group. Among mucocutaneous manifestations, pruritic papular eruption was commonest followed by viral and bacterial infections. The majority of patients had CD4 count <25%.
Conclusion: Mucocutaneous manifestations in pediatric HIV population are common and have varied presentations. Mucocutaneous manifestations were common at lower CD4 levels. Mucocutaneous manifestations can be taken as marker for disease progression.

Study of usefulness of Weil-Felix test as a simple diagnostic tool for diagnosis of rickettsial fever

Dr. Varun B Kusagur, Dr. Manasa KB

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1382-1387

Background: Rickettsial infections are the most covert re-emerging infections in present
times. They are incapacitating and notoriously difficult to diagnose, Weil-Felix (WF) test is
classic serological test which is widely available but not widely acceptable because of its low
sensitivity and specificity. Present study was aimed to study of usefulness of Weil-Felix test
as a simple diagnostic tool for diagnosis of rickettsial fever.
Material and Methods: Present study was single-center, prospective, observational study,
conducted in children < 18 years age, hospitalized with fever and presence of one or more of
the following clinical features: Rash, edema, eschar, hepatosplenomegaly, lymphadenopathy
OR had history of contact with pets or live stocks and history of tick-bite.
Results: In the present study maximum number of cases were from school going age group
(53.5%), male (67.4%), from Rural Areas (88.4%) & Tick bite could be demonstrated in
44.2% cases. Based on clinical features Lymphadenopathy was seen mainly 86.00%,
followed by maculopapular rash (76.7%), rash appearing 48-96 hrs. after fever (72.10%),
conjunctival congestion (55.80%), hepatomegaly (48.80%), rash on palms & soles, pedal
edema (34.9%) & purpura (14%). Out of 43 suspected cases, Weil-Felix test was positive in
31 cases (72.1%) and Negative in 12 cases (27.90%).
Conclusion: Rickettsial disease must be strongly suspected with a triad of fever, rash and
lymphadenopathy or having history of tick exposure/ bite and when the cause of fever cannot
be established. Weil Felix test can be carried out for early detection of suspicious casein
resource limited set up.

A cadaveric study of morphometry and variations of the thyroid gland

Dr. Swapnali Shamkuwar, Dr. PS Bhuiyan

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1388-1393

Aim: To estimate dimensions of thyroid gland and look for frequent anatomic variations of it.
Methods: 60 specimens (52 male, 8 female) of thyroid gland were studied in the Department of Anatomy. Position of the lobe & isthmus of thyroid gland was noted in relation to the thyroid cartilage and trachea. Length, transverse diameter, and anteroposterior diameter of lobes & isthmus as well as thyroid gland weight was measured. The thyroid gland was looked for any anatomical variations.
Results: The mean value of right lobe length was (4.69cm vs 4.6cm) and left lobe was (4.48cm vs 4.11cm). The transverse diameter of right lobe was found to be (1.94cm vs 1.93cm) whereas for the left lobe it was noted as (2.07 vs 1.71cm). The anteroposterior diameter of right lobe was (1.10cm vs 0.87cm) and left lobe was (1.03cm vs 0.96cm). The mean length of isthmus was (1.31cm vs 1.24cm) and width was found to be (1.71cm vs 1.68cm). Thyroid gland weight was measured as 14.9 g &12.48 g in males & females respectively. Pyramidal lobe and levator glandulae thyroideae were observed in 27(45%) and 12(20%) thyroid specimens respectively. Isthmus was absent in one case.
Conclusion: A sound knowledge of normal anatomy and awareness of variant forms of thyroid gland enable the surgeons to achieve the goal of safer thyroid operations.

Assessment of the role of procalcitonin in the management of severe surgical patients with sepsis

Dr. Ashutosh Singh, Dr. MA Reshamwala, Dr. Kartikeya Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1394-1397

Background: The assessment of procalcitonin not only provides valuable information about the diagnosis but is also useful in the selection of the corresponding antibiotics for the management of sepsis. The studies related to this procalcitonin role are comparatively sparse.
Objective: The present study was undertaken to observe the role of procalcitonin in the management of severe surgical patients with sepsis.
Materials and methods: A total of 50 patients diagnosed with sepsis and aged more than 18 years including both males and females were part of the study after obtaining the written, voluntary informed consent. Unwilling participants were excluded from the study. Patients with any severe complications were also excluded from the study.
Results: Results were presented in Tables no 1 and 2. Table no 1 presents the gender distribution of the participants. The majority of the participants were males with 56% and females were 44%. Table no 2 presents the levels of procalcitonin levels in the participants. The majority of the participants have excessive levels of procalcitonin levels. That is procalcitonin was more than 10ng/ml in 40 patients which means nearly 80 percent of the patients have excessive levels of procalcitonin. This will testify to the importance of procalcitonin in the diagnosis of sepsis.
Conclusion: Significantly higher levels of procalcitonin levels were observed in the patients with sepsis. The study results testify to the diagnostic value of the procalcitonin. The study recommends further detailed studies in this area to support the procalcitonin in the diagnosis of sepsis.

Clinical outcome of distal femur fracture treated by locking condylar buttress plate

Dr. Mandeep G, Dr. Moulik Shah

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1388-1392

Aim: to evaluate the results of fracture lower end of femur, treated by close/open reduction and
internal fixation using locking compression plate.
Materials and Methods: In this study 31 patients with closed fracture lower end of femur (32
distal femur fractures) were studied. All the cases were treated at Akash medical
college(devanahalli), between 20017 -2021 at our institution and followed for a minimum of 6
months. The method used for fracture fixation was closed or open reduction and internal
fixation with locking compression plate.

Clinical study of dengue fever in children of 1-12 years age group at a tertiary hospital

Dr. Asadkhan S Pathan, Dr. Shivprasad K Mundada,Dr. Asadkhan S Pathan .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1353-1359

Background: Dengue infections vary in severity, ranging from influenza like self-limiting illness to life threatening dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Present study was aimed to study dengue fever in 1-12 years age group at a tertiary hospital.

Correlation between QTc interval and the values of waist-hip ratio measured in young healthy male and female adults

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1360-1381

The study was conducted with male and female subjects, 32 in each study group. The WHR (Waist Hip Ratio) and QTc (Correction of QT interval) were measured and the correlation was obtained by statistical analysis. The WHR and QTc are both negatively correlated in both male and female subjects. But, this finding is statistically insignificant. On the other hand the mean QTc in male subjects is more than that in female subjects. This finding is statistically significant. The study might have yielded a better result if the sample size was more

Clinicopathological analysis of cervical lymph node biopsies in central India

Amit Kumar Niranjan, Nikhil Agrawal, Rukmini Sharma, Dr. Rajendra Kumar Teharia

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1393-1396

Introduction: Lymphadenopathy is a common clinical problem, usually benign, but malignancy may be associated. To confirm the diagnosis often required a biopsy of lymph nodes. Methods: All patients with cervical lymphadenopathy, more than 4 weeks and size more than 1cm were included in the study and a biopsy were done and sent for histopathological study. Results: Out of total 220 patients, 54.5% (n=120) were males & 45.5% (n=100) were females. The mean age was 38.9±1.02 years & the maximum number of patients were adults (50%). The most common cause of cervical lymphadenopathy was reactive hyperplasia (51.8%) followed by granulomatous infection (17.3%). however, in older adults, carcinoma was also a common cause of cervical lymphadenopathy (40%). Conclusion: The most common histopathological diagnosis of cervical lymph node biopsies in central India were reactive disease and granulomatous infections.

An observational assessment of AMH as a predictive marker of ovarian response in assisted reproductive technology outcome

Dr. Akila Sree Gowri, Dr. R Swapna

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1397-1403

Objective: To evaluate AMH as a predictive marker of ovarian response in assisted reproductive technology outcome. Methods: 70 women (age 25-40 years) selected for in vitro fertilization treatment were included in this study. Analysis of day-2 serum samples was done for the AMH, FSH, Inhibin B, and LH by ELISA kit methods. USG was done for the antral follicle count (AFC) and oocytes’ retrieval. Results: The mean AMH levels of all treated patients were 2.260 ± 0.417. ROC for AMH indicating poor ovarian response with sensitivity of 72% and specificity of 70%. A statistically significant positive correlation was observed between the number of oocytes retrieved and the AMH (r = 0.620, p = 0.0001) (Fig. 2). Significant correlation was also seen between the number of oocytes retrieved and AFC (r = 0.400, p = 0.0001). Conclusion: Our data demonstrated that AMH is an adequate predictor of both high and poor ovarian response but it does not associate with pregnancy outcomes.

A prospective assessment of the suitability of Letrozole as ovulating induction agent in patients with PCOS induced infertility

Dr. R Swapna, Dr. Akila Sree Gowri

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1404-1409

Aim: to evaluate Letrozole as suitable ovulating induction agent in patients with PCOS induced infertility. Material & Method: The main source of data for this study are the women with primary and secondary infertility with anovulation attending the Department of Obstetrics & Gynecology, RVM Institute of Medical Sciences and Research Centre, Siddipet, Telangana, India. This is a prospective study with a total of 200 women satisfied the inclusion and exclusion criteria of the study. The present study consists of cases of infertility due to anovulation which were thoroughly evaluated before the diagnosis of anovulation was confirmed. Results: In this study mean age of the patients were 28.0 years and mean age of husbands were 32.4 year. 105 patients underwent diagnostic hysterolaparoscopy with chromopertubation + ovarian drilling. Conclusion: Letrozole can be considered as suitable ovulating induction agent in patients with PCOS induced infertility. It is a better drug in terms of mono follicular ovulation and better endometrial thickness than other ovulation induction agents. It has high ovulation rate with significant conception rate, with only drawbacks being miscarriages.

Engineering Innovative Clinical Resource Management by Design: a guided Emergent Search through a Complex Adaptive System of Systems

1Prof. C. RathigaProf. Edna Sweenie J,3 Prof. V. Sujatha, T. Gayathri,Lakshmi Devi ed

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1410-1423

This competitive healthcare market has made labour planning and allocation vital to the success of today''''''''s hospitals. Nurses'''''''' real usage is plagued by inefficiencies and cost overruns because even sophisticated automated planning systems for nursing labour cannot account for the dynamic needs of patient care during and between shifts. Typical labour measures increase the situation, as we''''''''ve discovered. Iterating through many objects with practitioners in situ, we adopt an extended action design science research (eADR) strategy. When it comes to filling important nursing and support tasks in real time, we find that understanding the behaviours of complex adaptive systems is vital. We utilise this information to identify management procedures that clash and obstruct the efficient operation of feedback loops for system balance. For real-time nurse labour planning and allocation, we used an electronic ADR strategy that included co-design, co-evaluation, and co-implementation of new structures, roles, and responsibilities. Patient outcomes may be greatly improved by using this novel artefact, which takes use of the dynamic actions of the actors.

A prospective study on effect of controlled hba1c levels and normotension in the development of diabetic retinopathy in type 2 diabetics

Dr. Chaithra CM, Dr. Kshama K

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1410-1416

Aim: To determine the importance of HbA1C levels and normotension in predicting the development of diabetic retinopathy and the relationship between them.
Method: Prospective clinical study comprising of a group of 125 diabetics above 40 years visiting for routine eye checkup and clinically diagnosed diabetic retinopathy including both out-patient and in-patients at Department of Ophthalmology, KIMS, Bangalore. Men and women >40years with type 2 diabetes mellitus with HbA1C levels <7.5% and non-hypertensives (<140mmHg systolic and <90mmHg diastolic pressure) were included. Patient’s HbA1C levels and blood pressure were measured. The diabetic retinopathy status was classified according to the ETDRS system. Statistical analysis was done.
Results: At 3rd month follow up, the mean HbA1C levels was 7.25±0.22.At the end of 12th month, the mean HbA1C was 7.42±0.11At baseline, in group A 8.8% showed mild NPDR and 1.6% moderate NPDR. At the end of the study it was 8.8% mild NPDR, 1.6% moderate NPDR. No further progression was seen in a year span. All values showed statistical significance and absence of hypertension also goes in favour of mild diabetic retinopathy changes.
Conclusion: HbA1C levels and systemic hypertension are the two major modifiable risk factors in the development and progression of diabetic retinopathy

Assessment of cognition & sensory-motor performance using audio-visual reaction time in young adults with parental history of hypertension: A cross sectional study

Dr. Sunita, Dr. Akshtha A K, Dr. Yogesh Kadam

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1417-1424

Background: Hypertension “A Silent killer” is a non-communicable chronic disease exhibiting a rising prevalence in today’s globalized world. In long run it causes end organ damage like cardiovascular diseases, chronic kidney diseases, neuro-cognitive damage. Autonomic imbalance with added unhealthy lifestyle & professional stress hastens the pathophysiological process of the disease.
Aim of the study: Assessment of cognition & sensory motor response using audiovisual reaction time analyzer in young adults with & without parental history of hypertension. Methodology: A total of 120 young adult participants were included in this cross sectional study after obtaining institutional ethical committee clearance & defining inclusion and exclusion criteria. Sixty young adults with parental history of hypertension were screened & 60 students with no parental history of hypertension were recruited using simple random sampling for control group.
Result: The study showed both ART & VRT were prolonged in study group & the delay in ART was statistically significant (p<0.05).
Conclusion: Cognition and sensory motor tasks are affected by sympathetic reactivity indicating genetic influence. Early screening of altered neurological functions helps to take steps to prevent further consequences.

A study on side effects of post-operative analgesia with intravenous paracetamol versus dexmedetomidinein patients undergoing laparoscopic cholecystectomy

Dr. Santosh Kumar, Dr. Deepak Vijaykumar Kadlimatti, Dr. Salim Iqbal M, Dr. Renita Lincia, Dr. Harsoor SS

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1425-1430

Several theories have been proposed, the most consistent being that it acts in a similar fashion to NSAIDs by the inhibition of the cyclo-oxygenase pathways. However, paracetamol lacks both the peripheral anti-inflammatory and anti-platelet response seen with NSAIDs28. More recently, it has been suggested that paracetamol may also be linked with both direct and indirect stimulation of the cannabinoid, nitric oxide synthase, and serotonergic pathways. Patients satisfying the inclusion criteria were selected during the study period from the operation register on a daily basis. After obtaining a written informed consent, sixty patients were recruited for this study. They were allocated into two groups of 30 each. 10 patients in group D and 08 patients in group P complained of nausea, none of the patients in either group had vomiting, bradycardia, and hypotension

A clinical study of post-operative analgesia with intravenous paracetamol versus dexmedetomidine in patients undergoing laparoscopic cholecystectomy

Dr. Santosh Kumar, Dr. Nandini CV, Dr. Salim Iqbal M, Dr. Renita Lincia, Dr. Harsoor SS

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1431-1435

Pain management, stable hemodynamics and early post-operative recovery are the new challenges in ambulatory surgeries. The literature rates post-operative pain in laproscopic cholecystectomy as mild to severe pain. Our objective is to assess the post-operative analgesia with intravenous paracetamol versus dexmedetomidine in patients undergoing laproscopic cholecystectomy.
Methods: After ethical committee clearance, 60 patients were randomly allocated into two groups after informed consent. Patients between 18-50 years, ASA 1or 2 were included and those on opioids, any anti-inflammatory drugs, and hypersensitivity to study drugs were excluded. Group D received intravenous dexmedetomidine 1μg/kg as bolus over 10 min followed by dexmedetomidine infusion at 0.25ml/kg/h (0.25ml = 0.5μg). Group P received 1 g intravenous paracetamol in 100ml solution of normal saline over 10 min followed by infusion of 0.25ml/kg/h of normal saline.
Results: Demographic parameters were comparable between the groups. Time for first rescue analgesia, and total doses of analgesia in 24 h in group D was 225.33±29.12 and 2.73±0.64 and in group P was 143.33±28.96 and 4.23±0.77 respectively with p value 0.001 which was statistically significant.
Conclusion: Dexmedetomidine loading dose 1μg/kg and maintenance dose 0.5μg/kg is a good anesthetic adjuvant for general anesthesia to reduce post-operative requirement of analgesia in laparoscopic surgeries.

Intravenous paracetamol versus dexmedetomidine in patients undergoing laparoscopic cholecystectomy: hemodynamic changes

Dr. Santosh Kumar, Dr. Deepak Vijay Kumar Kadlimatti, Dr. Salim Iqbal M, Dr. Renita Lincia, Dr. Harsoor SS

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1436-1444

In laparoscopic surgeries, marked hemodynamic changes occur due to the effect of absorption, positioning of the patient, anesthetic agents and pneumoperitoneum. When the intra-abdominal pressure is < 10mmHg, hemodynamic alteration is not significant. Significant alteration in hemodynamics occurs, when the intra-abdominal pressure is > 10 mmHg after insufflation. When the intra-abdominal pressure is >10mmhg, it will cause inferior vena cava compression and pooling of blood in the lower extremities, which decreases the venous return to the heart thereby reducing the cardiac output. On receiving patient in operating room, the patient monitoring included electrocardiogram (ECG), noninvasive blood pressure (NIBP), heart rate (HR), oxygen saturation (SPO2). The baseline HR, NIBP, SpO2 scores were recorded. The hemodynamic parameters taken into consideration were the heart rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure. Mean values of these parameters were analyzed from the baseline, every minute for the first 10 min thereafter for every 5 min till the end of surgery. The heart rate was significantly lower in dexmedetomidine group during the initial 10 min during infusion, lowest mean of 79.53±13.08, none of the patients from either group had bradycardia requiring atropine. Mean value of HR was higher in paracetamol group compared to dexmedetomidine group till 1 h postoperatively. Using preanesthetic dexmedetomidine 1μg/kg infusion followed by 0.5 μg/kg/h showed there was no difference in MAP between the groups, but heart rate of dexmedetomidine group was lower compared to the control group.

Psychological morbidity among post-COVID-19 patients: A cross-sectional study

Dr. Gopal Das CM, Dr. Vijay Raj N, Dr. Anantha Kalyan D

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1445-1452

Background: The COVID-19 pandemic is a global health threat and is by far the largest outbreak of atypical pneumonia, since the SARS outbreak in 2003. A range of psychiatric morbidities such as persistent depression, anxiety, panic attacks, delirium and suicidality were observed in the post infectious state across the world. Hence, the aim of the study was to understand the psychological status of the patients affected by COVID during their post-COVID follow-up period and to examine the socio-demographic and clinical factors associated with high psychological morbidity.
Materials and Methods: A cross sectional study conducted in the post-COVID follow up clinic, at a tertiary care hospital between the months of July 2021-November 2021, using a semi structured proforma and rating scales such as Patient Health Questionnaire-9 (PHQ-9), Hospital Anxiety and Depression Scale (HADS) and Insomnia Severity Index (ISI) for depression, anxiety and insomnia, respectively.
Results: The study results indicate that the prevalence of depression and anxiety among post-COVID-19 patients was 21.9% and 11.9%, respectively. Insomnia was observed among 21.7% among various socio- demographic and clinical variables examined, it was observed that female gender, patients with ongoing stressors and patients with post-COVID-19 persistent physical symptoms were found to be associated with greater depression and anxiety among the study population.
Conclusion: Persistent physical symptoms and ongoing life stressors are found to be associated with depression and anxiety among post-COVID-19 patients. Hence, periodic screening for individuals with persisting physical symptoms and care for the vulnerable population such as those with ongoing stressors will provide a significant advantage in the follow up of the mental health of the patients affected with COVID-19.

A study of orientation of students towards anatomy of eye in 3rd year after finishing anatomy learning in first year MBBS

Dr. Badrinath Talwar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1453-1457

Background: Anatomy forms the core of the Medical Subjects. It is said that Anatomy forms the heart of every subject in Medical Education. It’s mandatory for the first year MBBS to study Human Anatomy. Anatomy of the eye is also dealt as a part of curriculum. Students who take fifty percent are eligible to pass on to second year where they are taught other three para-medical sciences subject and if they clear this they will land in phase-III when the Ophthalmology will be taught to them. But how much Anatomy of the eye do they actually remember is the question that we face. So this study puts in a sincere effort to find the answers and also discusses of possibilities of measures that can be taken to ensure good education.
Aims and Objectives: To study and understand the orientation of students towards anatomy of eye in 3rd year MBBS.
Materials and Methods: This study was done in the students who entered third MBBS. One hundred twenty students participated in the study. They were divided into two groups and the study was conducted.
Results: Anatomy knowledge of eye was not retained which reflected very poorly in the pre-test scores and it was found that teaching Ophthalmology was much better after the reinforcement class of Anatomy which reflected in the second scores.
Conclusion: Anatomy and other pre and para medical subjects have to be taught in tandem with clinical subjects or at least a revision is needed for effective understanding of the clinical subjects.

Prone positioning in the management of spontaneously breathing non intubated covid-19 patients on oxygen therapy: A prospective observational study

Patel Shweta A, Chaudhari Tejalben A

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1458-1464

Background: There are various studies that suggest that short term and early prone positioning can increase PaO2/FiO2 in moderate to severe acute respiratory distress syndrome (ARDS). The aim of our study was to observe the effect of prone position on oxygenation status in spontaneously breathing non intubated covid19 patients on either non rebreathing mask (NRBM) or on noninvasive ventilation (NIV).
Aims: To observe the effect of prone position along with oxygen therapy (NIV or NRBM) on oxygenation in spontaneously breathing none intubated covid19 patient.
Material and Methods: This prospective observational study was performed in a covid19 intensive care unit (ICU) at tertiary care hospital for the period of two months. Non-intubated confirmed RTPCR (Reverse transcription polymerase chain reaction) positive covid19 patients were included and observed who were placed in prone position with NIV BIPAP (Bi level positive airway pressure) or with NRBM by ICU consultant. Primary outcome was oxygenation status from Pao2/fio2 ratio from arterial blood gas analysis. Secondary outcome was hemodynamic parameter and any adverse effect occurred during prone positioning. Collected data were analyzed using SPSS software and P value of Pao2/Fio2 ratio of before and after prone position, less than 0.05 considered significant.
Results: We observed among our study participants significant improvement of PaO2/FiO2 ratio in both group of patients.
Conclusions: Early use of prone position improved oxygenation in majority of our patients in short periods of time in both NIV and NRBM group of patients.

Ossiculoplasty using autologous incus in patients of chronic suppurative otitis media (CSOM): a prospective observational study

Dr. Suman Parmar, Dr. Sushma Mahich, Dr. Navneet Mathur

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1465-1470

Background: CSOM and associated hearing loss is significant in our society and an effort directed towards the assistance of those who are afflicted is indeed worthwhile. The problem of ossicular reconstructions for CSOM in difficult chronic ears however continues to represent a major rehabilitation challenge. Various materials have been used in reconstruction of middle ear including synthetic, bony and cartilaginous materials.
Methods: The present study was prospective observational study of 50 cases who underwent ossiculoplasty for middle ear surgery over the period of 2 and half years. CSOM patients with hearing loss >40 dB were included and patients with sensorineural hearing loss were excluded out from the study. Otoscopic examination, tuning fork tests, and examination under microscope were done in all the patients.
Results: A total number of 50 patients were included in the study. Graft was taken up in 90% cases and rejected in 5% subjects after 3 months postoperatively. The average pre-operative air-bone gap was 45±3.60 dB while the average post-operative air-bone gap was 25.66±9.25 dB. The average hearing gain was 19.34 dB which was statistically significant (p=0.000).
Conclusions: This study concluded that ossiculoplasty with an autologous incus graft is safe surgical approach with good results for reconstructing the ossicular chain due to lower extrusion rate with good post-operative hearing gain.

A study of acute inflammatory proteins and its relevance in Covid-19

Dr. Reddy Spoorthi Channa, Dr. Aparna, Dr. Reddy Channa

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1471-1474

Background: The mortality rate covid-19 is still not understood completely but was reported around five percent worldwide. This study puts in an effort to find one such difference if any between the survivors when compared to the non-survivors. This study makes an effort to find the acute inflammatory proteins in the survivors in comparison with the non-survivors.
Aims and Objectives: To study the acute inflammatory proteins levels and their significance in Covid-19.
Materials and Methods: This is a retrospective study done in the Department of Medicine, Dr. Chandramma Dayanand Sagar Institute of Medical Education and Research, Bangalore.
Results: There is a significant difference in the levels of acute inflammatory protein levels in survivors when compared to that of non-survivors.
Conclusion: This study successfully portrays the importance of acute inflammatory protein levels in understanding the progression of the disease.

Dengue detection and serotyping using multiplex real time polymerase chain reaction: Study from a tertiary care centre in Eastern India

Dr. Manish Ranjan, Dr. Shveta, Dr. Sakshi Kawatra, Dr. Saumya Singh, Dr. Abhishek Agrawal, Dr. Anupama Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1475-1481

Introduction: Dengue is an arboviral infection transmitted through the bite of Aedes mosquitoes having four distinct serotypes DENV 1-4. Secondary infections often lead to increased disease severity. The study was carried out with an aim to analyze dominant serotype in circulation and to find an association between serotype and hematological parameters.
Material & Methods: A total of 163 Dengue Positive samples were subjected to serotype-specific Real-time Polymerase chain reaction to identify the serotype. Hematological parameters viz; WBC counts, Hematocrit value, platelets, lymphocyte % were also studied concurrently for these patients.
Results: The mean age of the participants was 27.2 years with male preponderance.NS1 antigen positive (74.8%), IgM (38%) and both NS1 & IgM positives (12.8%) were detected. The predominant serotype identified was DENV-2(48.4%), DENV-4(43.5%), and DENV-3 (7.9%). Statistically significant difference in platelet counts was observed in DENV-2 & DENV-4.White blood cell counts showed statistically significant differences within DENV-2 and DENV-3 serotypes.
Conclusion: Cocirculation of multiple serotypes of DENV was observed in our study. The application of molecular testing will increase DENV diagnostics, especially in secondary infections which carry more chances of adverse outcomes. We recommend the inclusion of serotype testing in the Dengue diagnostic algorithm to be able to reduce morbidity and mortality.

Evaluation of the effectiveness of gabapentin in the management of postoperative pain after total hip arthroplasty

Dr. Karunakar Dwivedi, Dr. Ashutosh Singh, Dr. Manish Maheshbhai Khokhar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1482-1486

Background: It was well reported that gabapentin has a role in the management of neuropathic pain. However, substantial evidence for the same was sparse.
Objective: The present study was undertaken to evaluate the effectiveness of gabapentin in the management of postoperative pain after total hip arthroplasty.
Materials and methods: A total of 50 patients diagnosed with sepsis and aged more than 18 years including both males and females were part of the study after obtaining the written, voluntary informed consent. Unwilling participants were excluded from the study. Patients with any severe complications were also excluded from the study.
Results: The majority of the participants were males with 60 % and females were 40%. The majority of patients were having pain scores of 7-9 before the intervention in the control group. The majority of the patients are in pain scores of 7-9 after ibuprofen in the control group. Table no 5 presents the distribution of the intervention group participants according to the pain scores after intervention. The majority of the patients were in pain scores of 1-3 after the administration of gabapentin.
Conclusion: The study results confirm that gabapentin has a significant effect on the management of pain after the surgery of the knee and hip. The study recommends further detailed study in this area to recommend gabapentin in the management of pain.

Detection of early nephropathy in type II diabetic patient by using kim-1 as a biomarker: A prospective study

Dr. Khushant Jangid, Dr. Archana Dubey, Gunvi Ohari, Dr. Ashok Kumar Kachhawah

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1487-1491

Background: The present study aimed to investigate the clinical significance of urinary Kim-1 level in type II diabetic patients with and without nephropathy and to evaluate its relation to various clinical and laboratory parameters as an early predictor of diabetic nephropathy.
Methodology: The prospective study was conducted at Department of Medicine at Dr M.D.M. Hospital, Jodhpur. Attached to Dr. S.N. Medical College to study the detection of Kidney injury molecule-1 (Kim-1): An early biomarker for nephropathy in type II diabetic patients attending the Medicine Outdoor and Indoor at M.D.M. Hospital, Jodhpur. It includes 75 patients whose serum creatinine level was less than 1.5mg/dL. Diabetes was defined as fasting plasma glucose ≥126 mg/dL according to WHO criteria.
Results: Kim-1 is found raised in 68% patients and with normal albuminuria and microalbuminuria also significantly correlated with other variables i.e. fasting blood sugar, HbA1c p value is less than 0.001 for all these variables. So kim-1 can be used to diagnosis early nephropathy as a sensitive, rapid, noninvasive test in diabetes. With these we conclude KIM-1 is a good for early detection of Diabetic nephropathy and it is nicely correlating with urinary microalbumin level which is gold standard for detection of early nephropathy.

A cross sectional study to assess sensitivity of Indian diabetes risk score as a screening test tool of diabetes mellitus among adult population in Jodhpur, Rajasthan

Dr. Naval Kishor Jangir, Dr. Archana Dubey, Dr. Gunvi Ohari, Dr. Khushant

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1492-1498

Objective: To find out the sensitivity of Indian diabetes risk score as a screening test tool of diabetes mellitus among adult population by comparing the result of IDRS with ADA diabetes diagnostic criteria (fasting blood glucose/postprandial blood glucose).As adult population is at risk for developing diabetes mellitus. Early diagnosis and treatment may reduce the morbidity and mortality.
Methodology: The study was conducted on 600 patients of Dr. Sampurnanand Medical College and Associated Hospital, Jodhpur included all individuals > 20 years of age, a verbal consent taken from all individuals entering in to the study. IDRS will be applied to all individuals, then all subjects will tested for fasting (8 hours fasting) blood glucose level and, or 2 hours postprandial blood glucose level population attending the outdoor clinics, indoor wards and general population (attendants, accompanying peoples) using venous blood sample in fluoride vial.
Conclusion: In our study it can be concluded that IDRS can be applied as a screening test in our country regardless of the demographic variation in the prevalence of diabetes. Thus IDRS is a simple, reliable and easy to use tool for mass screening of the high risk individual of Diabetes mellitus.

Comparative study of low dose subarachnoid bupivacaine (9 mg) with different dose combinations of fentanyl versus standard dose bupivacaine (12 mg) in parturients undergoing caesarean section

Ashok Rout, Sunny Eapen, Dewendra J Gajbhiye, P Ansuman Abhisek, Pradeep Kedar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1499-1506

Background: Opioids and local anaesthetics act synergistically and it’s a popular technique to combine bupivacaine and fentanyl in spinal anaesthesia for caesarean delivery. The aim of the study was to find out optimal dose combination of bupivacaine and fentanyl for spinal anaesthesia for better quality of perioperative analgesia and reduction of feto-maternal adverse outcome during caesarean section.
Methods: Three hundred and four parturients scheduled for caesarean delivery were randomly allocated to four groups of 76 each. Data of 298 parturients (Gp I=73, Gp II=75, Gp III=75 and GP IV=75) was included in the primary outcome analysis. The control group received 12 mg of 0.5% hyperbaric bupivacaine for spinal anaesthesia. Fentanyl 15, 20 or 25 μg was added to each study group who received 9 mg of 0.5% hyperbaric bupivacaine in spinal anaesthesia. Onset and duration of spinal anaesthesia, hemodynamic parameters, intraoperative nausea & vomiting (IONV), failed block, APGAR score and other side effects were noted.
Results: The duration of effective and complete analgesia was significantly longer in all fentanyl groups. However, increasing the dose of fentanyl from 15 to 25 μg had little effect on further prolongation of analgesia. Duration of motor blockade was significantly prolonged in control group. The incidence of hypotension and IONV episodes were significantly low in the study groups.
Conclusion: Bupivacaine and fentanyl have super additive effect in spinal block. However, strict drug dose calculation is required in spinal anaesthesia to minimize adverse outcomes during caesarean delivery. Spinal anaesthesia with fentanyl 15 μg and 0.5% hyperbaric bupivacaine, 9 mg provides optimal surgical conditions for caesarean delivery with negligible side effects as compared to other dose combinations.

Comparative study of surgical debridement and autolytic debridement methods at a tertiary care hospital, India

Arun Kumar Pargi, Ajay Gangji, Sarita Jalodia

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1507-1513

Background: Wound debridement is very crucial step for wound healing and prevention of infections complications. Traditionally, several types of wound debridement techniques have been used in clinical practice such as autolytic, enzymatic, biodebridement, mechanical, conservative sharp and surgical.
Aim & objective: Compared the surgical debridement and autolytic debridement methods for wound.
Results: This study involves selecting fifty patients suffering from acute or chronic wounds, randomly distributing them to the following groups irrespective of age, sex and etiology of wounds and then treating them with different methods of debridement as denoted by the group’s name Group I Surgical debridement group, Group II Autolytic debridement group. Male patients were predominant than female, mainly 41-60 years age groups. Discomfort reduction more in surgical group whereas pain and discharge reduction more in autolytic group.
Discussion: The choice of the debridement technique depends on type of ulcer/wound patient’s age, economic status, state of wound edges and skin, exudate and resources of the caregiver. Surgical debridement is low cost, highly sensitive and rapid acting but it can cause pain and invasive. Autolytic debridement is a painless, less invasive, less chance of infection and safe technique, but with slow action, so with high costs, because dressing are usually changed once a day.
Conclusion: Surgical debridement is the fastest way to remove the source of infection, promotes healing and helps accurate assessment of wound. Pain and discomfort are less in autolytic debridement.

A cross sectional study to evaluate quality of life in geriatric patients having chronic diseases in Rajasthan

Dr. Archana Dubey, Dr. Amit Sagar, Dr. Khushant Jangid, Dr. Pramod Kumar Choudhary

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1514-1520

Background:
Introduction: This study is about explaining how elderly people with chronic disease experience their lives, their emotional reactions, their social & physical functions and their adaptation to life.
Methodology: A cross sectional analytical study was conducted in wards and OPD of medicine department of associated hospitals of S.N. Medical College, Jodhpur, and Rajasthan. This study included a total of 200 elderly patients. Out of which 100 elderly patients were having chronic diseases and rest of 100 were not having chronic diseases (which had been used as control). Data were collected by means of questionnaire & clinical examination.
Results: Male elderly had better mean QOL score than Female elderly. Patients who were widowed had poorer mean QOL score (434±137.6) than in patients who were living with spouse (454.7±171.11). Patients living alone had mean QOL score (452.3±71.6) and patients living with family had score (448.09±164.7) that was slightly better. Patients living in rural area had better mean QOL score (477.1±157.4) than patients living in urban area (435.9±164.1). In study group mean quality of life (QOL) score was decreasing with increasing age up to 79 year but after age 80 year and above mean quality of life score was better. There was negative relationship between presence of chronic disease and QOL in elderly. All the chronic diseases were decreasing QOL score in elderly.
Conclusion: Geriatric patients require different approach for the treatment of chronic disease because in this population there are several factors which influence the overall management of chronic disease. So all the clinician need to consider the overall quality of life as the very important parameter to look for, in the best management of chronic disease in elderly.

Functional outcome of proximal femoral nail for the treatment of peri-trochanteric fracture of femur in a tertiary care hospital

Dr. Mansi J Patel, Dr. Rameez A Musa, Dr. Arvind K Hadiya, Dr. Gunjan A Prajapati, Dr. Dhyey S Baldha, Dr. Neel M Bhavsar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1521-1531

Objectives: To assess results of proximal femoral nail in the treatment of peri-trochanteric fracture of femur.
Methods: This study included 90 patients of proximal femur fracture admitted in our institute. The patients were informed about the study in all respects and informed consent was obtained from each patient.
Results: Results were evaluated using the Harris Hip Score. We had 45(50%) excellent, 31(34.44%) good, 12(17.8%) fair and 2(2.22%) poor results.
Conclusion: The Proximal Femoral Nail Can Be Considered The Most Rational Method of Treating Intertrochanteric and Sub-trochanteric Fractures, Especially the Unstable and Reverse Oblique Type. Also the learning curve is relatively less and hence can be performed well by most of the surgeons. Thus we can conclude that the Proximal Femoral Nail is after proper training and technique, a safe and easy implant option for treatment of complex peri-trochanteric fractures.

Endoscopic micro-discectomy v/s open discectomy in lumbar disc prolapse: which is better?

Dr. Rameez A Musa, Dr. Mansi J Patel, Dr. Manthan Kankotiya, Dr. Dharmesh M Jalandhara, Dr. Monil S Solanki, Dr. Neel M Bhavsar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1532-1546

Objectives: To evaluate the results of micro-endoscopic discectomy and open discectomy in lumbar disc prolapse.
Methods: This study is a prospectively conducted study of 30 patients operated by a single surgeon with both modalities. The first modality is endoscopic discectomy using METRx system (Medtronic, Sofamor-Danek, Memphis, TN) using 22mm port and the second is open method of discectomy for lumbar disc herniation.
Results: The results were evaluated using ODI (Oswestry Disability Index) and VAS (visual analogue scale 0-10) for back pain and leg pain. Patients were followed up at an interval of 1 week, 2 week, 1 month, 6 months and 12 months post-operatively.
Conclusion: By limiting the tissue manipulation via small incisions and minimal muscle dissection, MED has reported to have better perioperative outcomes, including shorter hospital stay, less blood loss, less pain medicine requirement, decreased surgical site infection rate, quicker return to activities and Early discharge rate than open method. Although MED have some advantages over the open techniques in the perioperative factors, both the techniques are effective and provide similar pain relief and functional outcomes at the end of 2 years.

Role of multidetector CT in evaluation of paranasal sinus pathologies

Dr. Ayushman Virmani, Dr. Bindu Agrawal, Dr. Rajesh Arora, Dr. Kiran Nagpal, Dr. Abhijeet, Dr. Geetesh Garg

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1547-1557

Background: Paranasal sinuses fill in as a host to a wide range of illnesses and conditions from provocative to neoplasms, both benign and malignant. The use of СT with рrорer knоwledge аnd соgnizаnсe оf sinus аnаtоmy аnd rаdiоlоgiсаl lаndmаrks, аlоng with сliniсаl cоrrelаtiоn аids in diаgnоsing раrаnаsаl sinus раthоlоgies ассurаtely.
Aim and Objectives:
1) Evаluаtiоn оf раrаnаsаl sinus раthоlоgies аnd their аnаtоmiсаl extensiоn аnd bоny invоlvement using multideteсtоr соmрuted tоmоgrарhy.
2) Соrrelаtiоn оf the findings оf multideteсtоr соmрuted tоmоgrарhy with сliniсаl diаgnоsis.
Material and Methods: The hоsрitаl bаsed рrоsрeсtive оbservаtiоnаl study was conducted in the Department of Radiodiagnosis & Imaging, Muzaffarnagar Medical College, U.P, for eighteen months with twelve months for data collection and 6 months for data analysis. Total 40 patients of varied age groups presenting with symptoms and signs of paranasal sinus diseases underwent CT using Siemens Sоmаtоm Sсорe 16 sliсe СT mасhine as per standard protocol. Images were acquired in the axial and coronal plane with reformation in sagittal plane.
Results: Maximum numbers of patients were in age group of 21 to 30 (35%) with male to female ratio of 1.2:1. Most соmmоn sinus invоlved wаs right mаxillаry sinus (70%). Most common chief complaint was nasal obstruction (97.5%) and nasal discharge (90%) with maximum number cases of sinusitis (22%).
Conclusion: To conclude, Multidetector Computed Tomography of the paranasal sinuses has improved the visualization of paranasal sinus anatomy along with its variants and has allowed efficient diagnosis of paranasal sinus lesions. Precise description of the disease and related microanatomy detected by CT scan provides a reliable pre-operative road map.

Surgical management of displaced calcaneum fractures by plating

Dr. H Manjunath, Dr. Ullas Mahesh, Dr. Sharat Balemane, Dr. Anil Patil

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1558-1562

Introduction: Calcaneal fractures are comparatively rare injuries, which occur in 2% of all fractures According to the recent literature, 60% to 75% of these fractures are considered to be displaced and intraarticular, which evidences the difficulty of the treatment. This type of injury is more common in men compared to women because it commonly occurs as occupation associated.
Methodology: In this study of prospective design 40 patients with calcaneum fracture treated by ORIF with plates between JAN 2019 to DEC 2021 were reviewed at a tertiary centre. The
patients were called for a final follow up evaluation and the latest functional outcome assessed as for the AOFAS score and results were analysed.
Results: Young patients showed significantly better outcome with ORIF with plating. The timing of the surgery is the most important detriment for the outcome. The final functional outcome assessed with AOFAs score is encouraging with 77.1%.
Conclusion: Operatively treated calcaneum fractures with ORIF with plates gives a good functional outcome when surgical principle are strictly adhered to, proper patient selection, appropriate timing for surgery, strict asepsis, proper approach for rising full thickness flaps, accurate anatomic reduction and proper post-operative protocol with follow up which minimizes complications.

Comprehensive study of surgical treatments of fracture of patella

Dr. Vinayak Prabhu, Dr. Sharat Balemane, Dr. Ullas Mahesh, Dr. H Manjunath

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1563-1567

Introduction: Fracture patella is seen in all age groups but less common below 20 years of age. The most common cause of patellar fractures is road traffic accident, direct trauma or forcible pull of quadriceps. Fracture of patella accounts approximately 1% of all skeletal injuries.
Materials and Methodology: The study was a randomized, comparative study conducted from July 1st 2014 to December 31st 2015, at Tertiary center on 50 consenting patients who came to the department of orthopedics and on evaluation was diagnosed to have patellar fractures following which they were randomized to one of the following treatment modality
Conclusion: We concluded that tension band wiring was better as it yielded steady and consistent results

Functional outcome and radiological union in operated cases of AO type 12-B1 fractures of distal shaft humerus with interfragmentary screws and lateral anatomical plate

Gopal Tukaram Pundkare, Anish Nandkumar Tawde

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1568-1581

Background: Extra-articular distal shaft humerus fractures at the junction of cylindrical and triangular portion are seen as torsion wedge fractures. Historically most shaft fractures were treated conservatively. Today’s trend is towards surgical management due to high patient demand and availability of anatomical plates. This study aims to evaluate the functional results of plating in extra-articular distal humerus fractures with duration of clinical and radiological union.
Methods: A prospective study of 20 patients with torsion wedge fractures of AO Type 12-B1 was done over a period of 3 years. Demographic data was collected and all patients underwent fixation with posterior triceps splitting approach using an extra-articular distal humerus plate (EADHP) and inter-fragmentary screws. Results were evaluated by clinical and radiographic parameters. Functional results were monitored by modified Quick DASH score.
Results: There were 12 males and 8 females with a mean age of 34.45 years. Mean time to clinical and radiographic union was 10.5 weeks and 33.9 weeks respectively. The mean modified Quick DASH score at clinical and radiographic union was 24.8% and 13.76% respectively. Two patients developed radial nerve neuropraxia recovering spontaneously. One patient having inadequate reduction went on to unite both clinically and radiographically with good functional out come without any secondary intervention.
Conclusion: AO Type 12-B1 humerus fractures treated surgically with anatomical locking plates and inter-fragmentary screws give excellent anatomical and functional results. Though time to radiographic union is prolonged, no secondary intervention in the form of bone grafting or other modalities was required in any patient.

Ascitic fluid analysis in the differential diagnosis of ascites, a simple randomised study conducted in a tertiary care centre

Dr. Mervin K Soman, Dr. Nivedhya J, Dr. Gayathri Lal A

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1582-1587

Introduction: Ascites is the accumulation of protein-containing (ascitic) fluid within the abdomen. Many disorders can cause ascites, but the most common is elevated blood pressure in the portal veins which is usually due to cirrhosis. If large amounts of fluid gets accumulated, the abdomen becomes distended, which may result in loss of appetite and shortness of breath. Analysis of the fluid can help in determining the cause.
Aim: To find the Differential diagnosis of ascites based on ascitic fluid analysis.
Material and Method: A total of 100 patients were studied, their ascitic fluid were analysed. Parameters used are Serum Ascitic Fluid Albumin Gradient (SAAG) and Ascitic Fluid Total Protein (AFTP).
Results: The most common differential diagnosis is Liver Cirrhosis in males and Congestive cardiac failure in Females.
Conclusion: SAAG has high positive predictive value while AFTP has high negative predictive value.

Comparative study of pipelle device versus conventional dilatation and curettage for endometrial sampling in diagnosis of endometrial pathology causing abnormal uterine bleeding or infertility in women > 25 years of age

Dr. Samita Bhat, Dr. Rooma Sinha, Madhumati Sanjay, Bana Rupa, Dr. Fozia Jelani

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1588-1596

Background: Abnormal Uterine bleeding (AUB) is a cause of significant healthcare burden for the women, common methods for endometrial assessment are USG, hysteroscopy, D&C, however multiple newer outpatient method are becoming popular due to their ease of application and cost effectiveness. Present study was aimed to compare the diagnostic accuracy and histopathological success of Pipelle verses conventional curettage in diagnosing endometrial pathology in AUB cases.
Material and Methods: Present study was single-center, Prospective and comparative single blind study, conducted women aged 25 years, with complaints of abnormal uterine bleeding with or without infertility. Initially, endometrial sample was collected by pipelle sampler in the outpatient department followed by endometrial biopsy by curettage under general anesthesia.
Results: Out of 106 patient’s majority were from 40-60 years age group, had 2 or more parity. Majority had abnormal uterine bleeding alone (77.36%), infertility alone (10.37%) & infertility with abnormal uterine bleeding (12.26%). Common USG findings were endometrial polyp (19.81%), fibroid uterus (10.38%), adenomyosis (3.77%), cystic endometrium (3.77%) and Thickened Endometrium (1.89%). In women with AUB & infertility the sensitivity of pipelle in picking up the endometrial pathology was 100% as compared to D&C and specificity was 99.02%. The negative predictive value was 100% and Positive predictive value was 80%. In the premenopausal women the sensitivity, specificity, NPV & PPV are all 100% for Pipelle sample as compared to curettage. In the postmenopausal women, specificity & PPV was 100%, however sensitivity was 66% and NPV was 95.2%.
Conclusion: In women with AUB & infertility the sensitivity of pipelle in picking up the endometrial pathology was 100% as compared to D&C and specificity was 99.02%. The negative predictive value was 100% and Positive predictive value was 80%.

Study to assess the effectiveness of Ropivacaine versus Ropivacaine plus Fentanyl combination in Brachial Plexus block by supraclavicular approach

Dr. Padmalatha Seelam, Dr. Manoj Patruni, Dr. Vengamamba Thummala, Dr. Vadlamudi Rajesh Kumar, Dr. Nalli Venkata Krishna Mallik

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1597-1607

Introduction: One of the primary aims of anesthesia is to relieve the patient's pain and
agony, thereby the surgical procedures can be conducted without any discomfort. Relief of
intraoperative and postoperative pain has gained importance in recent years, considering the
central, peripheral and immunological stress response to tissue injury. Any expertise acquired
in this field should be extended into the postoperative period, which is the period of severe,
intolerable pain requiring attention. So there is need of extended analgesia without any side
effects in the process of achieving this goal. “Regional anaesthesia” is the term first used by
Harvey Cushing in 1901 to describe pain relief by nerve block 1. Regional nerve blocks are
based on the concept that pain stimulus conveyed by nerve fibers, which are amenable to
interruption anywhere along their pathway 2. Brachial plexus block is a valuable and safe
alternative to general anesthesia in upper limb surgeries. Interrupting the acute pain which
can help in limiting the development of chronic pain syndromes 3, 4. The effects of opioids on
regional blockade is controversial. So the present study is being undertaken to evaluate
Fentanyl as an adjuvant to Ropivacaine in supraclavicular brachial plexus block.
Methodology: Hospital based Prospective randomized single blinded study. Conducted on
eighty patients of ASA I and II posted for upper limb surgeries under supraclavicular block.
Patients were divided randomly by means of random number table generated by computer
into two groups as A and B. Each group consisting of 40 patients. Prior to the study
Institutional Ethical committee approval and consent from the patients were taken. The study
was conducted in the Department of Anesthesiology, at Katuri medical college &Hospital,
Guntur from January 2016 to October 2017.

Surveillance of biological plating in comminuted fractures of long bones: Our experience at a tertiary care hospital

Rabindra Kumar Nayak, Sambit Kumar Panda, Sidhartha Samal, S Jaganath Subudhi, Abanikanta Mishra

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1608-1619

Osteosynthesis with open reduction technique in comminuted fracture has several disadvantages like increase rate of non-union, non-healing of soft tissue, infection and failure of implant. These problems can be managed by percutaneous minimally invasive plating technique which preserve the vascularity and soft tissue anatomy of fracture fragments.
A total of 40 patients were involved in this study. Distal tibia with or without fibula fracture (12), Diaphyseal tibia (10), Proximal tibia (8), Supra condylar Femur (6) and Subtrochanteric Femur (4) were operated by using the principles of indirect reduction and biological fixation with plates under C-arm guidance. Weight bearing was allowed according to the clinical and radiological union at follow up.
Most patients regained excellent range of motion of adjoining joints. Mean time of radiological union was 20.12 weeks. Two patients had soft tissue infections which healed with wound care and dressing. One patient had non-union which was managed by bone grafting. In this study excellent result was seen in eighteen cases, good in five and fair in other patients.
This study indicates that minimally invasive percutaneous plating is an effective method for treatment of comminuted diaphyseal fracture of long bones. These complex fractures goes onto complete recovery and normal limb function at an early stage with fewer complication

Risk factors of intrauterine growth restriction in term pregnancy

Dr. Sahana PR, Dr. Jeevitha H, Dr. Prajwal M, Dr. Chandrashekar K

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1620-1624

Fetal growth restriction (FGR) is a pathological condition in which a fetus has not achieved his genetic growth potential, regardless of fetal size (1) Worldwide FGR is observed in about 24% of newborns; approximately 30million infants suffer from FGR every year. The burden of FGR is concentrated mainly in Asia which accounts for nearly 75% of all affected infants. National neonatal perinatal database of India reported the incidence of FGR to be 9.65% among hospital born live birth infants. Study was conducted for all cases with clinical/ Sonological term FGR admitted under department of OBG. A detailed history as per questioner will be taken with general physical examination and investigations will be done as per requirement. The accumulated data was evaluated and statistically analyzed. In the present study 70 patients with term gestation with FGR were recruited. Maternal (74.28%) was the commonest cause followed by Idiopathic (11.43) and Placental (10%) and Fetal (4.29%) causes. Among Maternal causes Pre Eclampsia was found to be in 50% cases. Most of the patients (50.7%) required caesarean section. A total of 9 (12.86%) neonate had birth weight of <1.5 kg, 48.6% had Birth weight between 1.6 to 1.9kg, 38.5% had birth weight between 2-2.4kg and 95.8% had asymmetrical FGR, 4.2% were symmetrical. 26 (40%) neonates had morbidity with 17(24.3%) neonatal mortality with Respiratory distress syndrome (41.18%) being most common cause. No Maternal Mortality.

Intrauterine growth restriction in term pregnancy: Clinical outcome

Dr. Sahana PR, Dr. Jeevitha H, Dr. Prajwal M, Dr. Chandrashekar K

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1625-1629

The risk of morbidity and mortality depends on basic pathology which mainly caused the growth problem, severity of growth restriction, gestational age of mother -how much earlier it is, and the baby's gestational age at birth. The 10th percentile is commonly used to define "small for gestational age" at all stages of pregnancy. The risk of neonatal mortality at the 10th percentile has a bimodal distribution with higher mortality at 26 and 34 weeks ' of gestation. A detailed history as per questioner was taken with general physical examination and investigations were done as per requirement. The accumulated data was evaluated and statistically analyzed. The pregnancy outcome of 70 cases was studied, which showed that 40(61.43%) cases went into spontaneous labor, labor was induced in19 (28.57%) cases and 11(1.%) cases were taken for elective caesarean section for various indications. The fetal outcome of the study showed that out of 70 cases recruited in the study, 65 (92.86%) were live births, 3(4.28%) were still birth and 2(2.86%) cases had intra uterine fetal demise.

Comparison of efficacy of 1% 2-chloroprocaine with ilioinguinal and iliohypogastric nerve block versus 0.5% hyperbaric bupivacaine for spinal anaesthesia in patients undergoing caesarean section: A randomised clinical study

Dr. Sneha Rajur, Dr. Bhagyashri V Kumbar, Dr. Faraz Ahmed, Dr. Madhu KP

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1630-1637

Caesarean sections are routinely done under spinal anaesthesia using 0.5% hyperbaric bupivacaine that has a long duration of action. As most of the caesarean sections are of short duration, we decided to compare 1% 2-chloroprocaine with routinely used bupivacaine as chloroprocaine has rapid onset of action, producing an excellent sensory and motor blockade. After ethical committee clearance and informed written consent, 70 uncomplicated singleton parturients of ASA I and II posted for elective caesarean section were randomised into chloroprocaine (CP) and bupivacaine (B) group of 35 each.
Onset of sensory block in group CP was 1.71±0.62min and in group B was 2.31±0.63min. Onset of motor block in group CP was 2.54±0.88min and in group B was 2.66±0.76min. Mean time for maximum sensory block in group CP was 12.77±3.52min and in group B was 22.34±6.46min and time for maximum motor block in group CP was 9.14±2.23min and in group B was 10.86±2.18min. Two segment regression time in group CP was 39.34±4.46min and in group B was 63.14±4.7min. Mean duration of sensory block in group CP was 2.08±0.25hr and in group B was 3.60±0.27hr and duration of motor block in group CP was 1.07±0.14hr and in group B was 3.42±0.41hr. VAS scores in first 6hrs were lesser in group CP than group B. Onset, maximum time, duration of sensory and motor block were lower in group CP than group B. hemodynamic parameters were comparable between the groups with no side effects.

A comparison of clinical performance between the I-Gel and the Baska mask in spontaneously ventilating anaesthetised patients: A prospective randomized study

Dr. Faraz Ahmed, Dr. Jayashree B Patil, Dr. Sneha Rajur, Dr. Bhagyashri V Kumbar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1638-1644

Supraglottic Airway devices (SAD) have now become a fundamental tool for ventilation, oxygenation and delivery of anaesthetic gases in modern anaesthesiology. The advent of newer generation of SADs has resulted in their extended use. Baska mask and I Gel being newer generation SADs are vastly being used due to their specific designs for ease of securing the airway, better ventilation and higher patient safety. After institutional ethical committee clearance, a prospective randomized comparative study was conducted. 60 patients of age group 18-60 years of ASA grade I and II undergoing elective surgeries under GA were included. Patients were randomized into 2 groups, Group B (Baska mask group) and Group I (I Gel group) with 30 patients in each group. The ease of insertion (p value 0.035), insertion attempts (p value 0.04) and the time taken for insertion (p value <0.001) were significantly better with I Gel compared to Baska mask. Both the groups were comparable in terms of postoperative pharyngolaryngeal morbidities.

Priapism presenting in acute spinal cord injury

Dr. Kumar Lakshman, Dr. Triza Kumar Lakshman, Dr. Raju Paul Manjooran, Dr. Dominic Anto, Dr. Abhishek Vijayan, Dr. Rajeev Aravindakshan

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1645-1654

Background: The frequency and timing of priapism in acute spinal cord injury (SCI) and the level, or levels, most likely to be associated with priapism are debated.
A spinal cord injury (SCI) is defined as damage to the spinal cord caused by an insult resulting in the transient or permanent loss of usual spinal motor, sensory, and autonomic function.
Methods: This is prospective observational study done in PES Institute of Medical Sciences, Kuppam, from February 2019 to February 2020. A total of 15 cases were studied. The patients selected for study are those who presented with history of cervical /thoracic spine injury with complete neurological deficits, following trauma. Based on detailed history and thorough clinical examination diagnosis of priapism in spinal cord injury was made. Investigations done: Complete Blood counts, Blood grouping, Coagulation profile Peripheral Smear, Renal function tests, Serology, Corporeal Blood gas analysis, CT Cervical/thoracic spine, MRI cervical spine with whole spine screening.
Results: A total of 15 patients who presented with spinal column injuries with neurological deficits Quadriplegia or paraplegia, following trauma were included in the present study. Eleven of the 15 patients had priapism. Four out of the 15 patients presented with quadriplegia but without priapism. Among the 11 patients, 4 patients presented with Paraplegia with priapism secondary to complete cord transection of the lower cervical/high thoracic cord. Seven patients presented with quadriplegia and priapism secondary to complete cord transection of the cervical cord. All 15 patients underwent spine stabilization surgery along with surgical decompression of the spinal canal and conservative management for priapism. In 6 patients, the priapism subsided spontaneously within 12hours, in two pts it subsided within 24hrs for in two pts it lasted for 36 hours while in one patient it lasted for 4 days post spinal canal decompression.

A comparative study of onlay and pre-peritoneal open mesh repair in the management of umbilical hernia in adults

Dr. Sreekaraswamy R, Dr. HC Chaluvanarayana, Dr. Sujay C, Dr. Varun Byrappa

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1655-1659

Introduction: Umbilical hernias in adults are commonly acquired hernias. These are more common in women, and in conditions like pregnancy, ascites, obesity etc. More than 1 million hernia surgeries are done annually in India. Suture repair techniques have dominated ventral and incisional hernia repair over a century. The most popular of these techniques was the Mayo duplication. In larger hernias, suture repair requires the application of tension to the fascia in order to close the orifice.
Objectives of the study: To evaluate the outcome of onlay and pre-peritoneal open mesh repair in umbilical hernias in adults regarding operative time, ease of procedure, hospital stay, complications and recurrence if any.

Evaluation of the incidence of asymptomatic calf deep vein thrombosis in high risk post-operative patients on DVT prophylaxis

Dr. Sreekaraswamy R, Dr. HC Chaluvanarayana, Dr. Kiran Raj H, Dr. Varun Byrappa

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1660-1664

Purpose: To identify the presence of occult (DVT) in post op patients on DVT prophylaxis and to avoid unnecessary screening, we reviewed our experience with routine duplex screening for DVT in high risk post-operative patients on DVT prophylaxis.
Methods: Over a 2 year period, all patients who were admitted with an anticipated length of stay greater than 36 hours were studied to determine the prevalence of risk factors for asymptomatic proximal DVT. Risk factors, demographics, and operative data were collected and analyzed with multilinear regression, t tests and χ2 analysis.
Results: There was a 7.3% prevalence of major DVT in the 100 patients studied. APACHE II scores (14.5 ± 6.24 vs 10.3 ± 3.15; p < 0.0001) and emergent procedures (45.5% vs 23.2%; p > 0.0344) were associated with DVT by multifactorial analysis. Age was significant by univariate analysis. An algorithm based on the presence of any one of the three risk factors identified (APACHE II score 12 or more; emergent procedures; or age 60 or greater) could be used to limit screening by 30% while achieving a 95.5% sensitivity for identification of proximal DVT.
Conclusion: Absence of all three risk factors indicates a very low risk for DVT (3%). Screening of post op patients is indicated because of a high prevalence of asymptomatic disease. Patients who have proximal DVT require active therapy and not prophylaxis. Costs and resources may be contained by using the above risk factors as a filter for duplex screening.

Role of high resolution CT temporal bone in unsafe chronic suppurative otitis media

Dr. Abhijeet, Dr. Bindu Agrawal, Dr. Gaurav Garg, Dr. Malvika, Dr. Neha Goel, Dr. Divya

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1665-1673

Introduction: HRСT Temporal bone in unsafe CSOM саn рrоvide exсellent detаils оf temроrаl bоne аnаtоmy, its соngenitаl vаriаtiоns, lосаtiоn аnd extent оf diseаse, аsymрtоmаtiс соmрliсаtiоns аnd degree оf bоne destruсtiоn. It соnfirms оtоsсорiс findings tо greаter extent, сleаr mаny сliniсаl dоubts аnd helрs in determining surgiсаl effiсасy when surgery will be neсessаry аnd аlsо fоr рlаnning the аррrоасh fоr surgery.
Aim: To assess the usefulness of HRCT imaging of temporal bone in cases of unsafe chronic suppurative otitis media and to describe the status of the disease in unsafe chronic suppurative otitis media.
Material and Methods: Total 40 patients with clinical diagnosis of unsafe CSOM were included in the study and underwent HRCT using Siemens Sоmаtоm Sсорe 16 sliсe СT mасhine as per standard protocol. Each HRCT was analysed for presence of soft tissue density in middle ear and mastoid cavity and status of ossicles, mastoid cavity, scutum, lateral semicircular canal, cochlea, facial nerve canal, external auditory canal, tegmen tymphani and sinus plate.
Results: Maximum numbers of patients were in age group of 21 to 30 (35%) with male to female ratio of 2.6:1. Most common chief complaint was otorrhoea (90%) and hearing loss (45%). Mоst соmmоn ossicle eroded wаs incus (65%) and scutum erosion noted in 55% cases.
Conclusion: HRСT is useful fоr diаgnоsis, surgiсаl рlаnning аnd mаnаgement оf temроrаl bоne раthоlоgies. Рreорerаtive СT sсаn is benefiсiаl аnd соntributоry in relаtiоn tо diаgnоsis аnd deсisiоn-mаking in indiсаting орerаtiоn tо раtients with СSОM аnd imрrоves the suссess rаte оf сhоlesteаtоmа surgeries. It serves аs rоаd mар tо аssist the surgeоn during surgery.

Ultrasonography and CT evaluation of neck masses

Dr. Neha Goel, Dr. Bindu Agrawal, Dr. Amritanshu, Dr. Gaurav Gupta, Dr. Kumar Ritwik, Dr. Venkteshwara

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1674-1687

Background: A palpable neck mass is a commonly encountered clinical problem. They vary in etiology, pathology, and prognosis due to the complicated anatomy and physiology. This study was done to detect the effectiveness of high-resolution ultrasonography and computed tomography imaging in detecting neck masses.
Aim and Objectives:
1. To assess the utility of High-Resolution Ultrasonography and Computed Tomography imaging in the evaluation of neck masses.
2. To study mass lesions under the following headings- Location, Size and extent of the mass, relation to surrounding structures, internal mass characteristics that are benign or malignant.
Material and methods: The hospital-based prospective observational study was conducted in the Department of Radio diagnosis & Imaging, Muzaffarnagar Medical College, U.P. for eighteen months, with twelve months for data collection and six months for data analysis. A total of 40 patients of varied age groups presenting with a clinically palpable neck mass who underwent both USG and CT were studied.
Results: The maximum number of patients was 41-50 years old (28%), followed by 21-30 years (12.5%). Of the total cases (40), non-nodal masses were 22 (55%), and nodal masses were 18 (45%). The most common pathology in the present study was lymph nodal mass of aerodigestive malignancies, noted in 13 cases (32.5%), and followed by thyroid mass, noted in 12 cases (30%).
Conclusion: High-resolution sonography is valuable modality for the diagnostic evaluation of neck masses in every age group. It is a simple, non-invasive, and inexpensive diagnostic tool. It provides accurate and reproducible results. It can be used as a first-line modality for evaluating cervical soft tissue masses in many clinical conditions, especially in young and pediatric populations. CT ensures accurate anatomical localization and lesion characterization in benign lesions. It is helpful in staging malignant tumours and provides essential information about the tumour extent that directly affects the surgical approach necessary for curative resection.

Herpes zoster laterality and handedness: Is there any relation?

Dr. Farzana Ansari, Dr. Lalit Kumar Gupta, Dr. Ashok Kumar Khare

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1688-1692

Background: Herpes zoster (HZ) is classically unilateral in its presentation appearing along the distribution of the cranial or spinal sensory nerves, with an occasional spill into the neighbouring dermatomes. An observation that many patients of facial herpes zoster have predominantly left sided involvement led us to validate further if any significant association of herpes zoster really occurs with cerebral dominance and handedness of the individuals.
Aims & Objectives: To see any correlation between handedness of individual and laterality of facial herpes zoster and to compare it with extra-facial herpes zoster.
Material & Methods: All the patients with clinically diagnosed herpes zoster presenting to the dermatology outdoor or admitted in indoor of a tertiary care centre were included in this study during a period of year from January 2017 to December 2018. Clearance from institutional ethical committee was taken.
Results: Out of a total of 191 patients, males 105 (55%) outnumbered females 86 (45%) with a male: female ratio of 1.22. Maximum number of patients were between 20 and 40 years (67;35.08%). The right‑handed individuals accounted for 89.53% of the total cases. A higher number of right‑handed patients manifested HZ on the left side (55.56%). Of the left‑handed, 50% manifested HZ on the right side. Statistical analysis with Fisher’s test revealed a two‑tailed P = 0.637 showing a statistically insignificant involvement of the contralateral side in HZ compared to hand dominance. These values for facial and extra-facial HZ were 0.9 & 0.09 respectively. This is in contrast to older studies which found significant correlation between hand dominance and contralateral side of involvement in herpes zoster.
Conclusion: Cerebral dominance plays an important role in neuro-immunomodulation, as reflected in previous studies, but our study did not find any significant association between hand dominance and contralateral eruption of HZ.

Effect of obesity on parasympathetic nervous system

Dr. Ravi Manawat, Dr. Manila Jain, Dr. Vipin Kumar Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1693-1697

Introduction: Obesity is associated with adverse and deranged cardiovascular events which could be due to the altered Sympathetic and parasympathetic balance seen in these individuals. In recent times Obesity is recognized and considered as a Major, worldwide, health issue.
Material and Method: The Present study was conducted in the Department of Physiology, Index Medical College, Indore (MP).50 Obese (25 male and 25 female) and 50 non obese (25 male and 25 female) young adults were included. A parasympathetic test was performed on both the groups. All data are expressed as mean± standard deviation. Comparison between groups of obese male, non-obese male, obese female and non-obese female was performed using student’s t-test (t-test for two independent samples / Two-tailed test). Differences was considered significant at p<0.05.
Result: It was observed that obese young adults had reduced parasympathetic activity.
Conclusion: This altered balance of Autonomic Nervous system increases the risk of cardiovascular disorders.

Effect of atracurium and cisatracurium as nondepolarising neuromuscular blocking agents: A comparative study

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1698-1703

Introduction: General anesthesia, for a surgical procedure is normally done with the help of endotracheal intubation. The non-depolarizing muscle relaxant, or the non depolarising muscular blocking (NMBA) agents are known to inhibit the action of acetylcholine, while differing in the onset and the duration of action, potency, metabolic route and side effects. The main aim of this study was to compare the neuromuscular blockade of atracurium and Cisatracurium and the recovery characteristics.

Comparative study of intrathecal fentanyl and dexmedetomidine as adjuvant with bupivacaine in elective lower abdominal surgeries

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1704-1711

Introduction: Spinal anesthesia is most commonly used for lower abdominal surgeries due to its low cost and ease of administration as well as rapid onset of anaesthesia. Adjuvants like Fentanyl and dexmedetomidine are used to accelerate and prolong the anaesthetic effect depending on the purpose. This study was done to compare the effects of intrathecal hyperbaric bupivacaine with fentanyl and bupivacaine with dexmedetomidine for lower abdominal surgeries.

Study of role of CT scan in characterization of mediastinal lesions and its correlation with histopathology report

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1712-1718

Background: The mediastinum is an extremely complex and interesting area of the body. The multitude of diseases affecting the mediastinum very considerably, ranging from tumor, cysts, vascular anomalies, lymph node masses, mediastinitis, mediastinal fibrosis, to pneumomediastinum. Present study was aimed to study role of CT scan in characterization of mediastinal lesions and its correlation with histopathology report.

Evaluation of scrotal pathologies by high-resolution ultrasound and color Doppler

Dr. Ritwik DV, Dr. Bindu Agarwal, Dr. Amrit Pal Singh, Dr. Mayank Chauhan, Dr. Ayushman Virmani, Dr. Navi Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1720-1730

Background: The sрeсtrum оf sсrоtаl раthоlоgies vаries with аge (e.g. соngenitаl аnоmаlies and trаumа being frequent in сhildhооd, trаumа and infertility in аdulthооd аnd neорlаsm in elderly). This study wаs аn аttemрt tо knоw the distributiоn оf the sсrоtаl раthоlоgies аmоng the subjeсts аnd tо understаnd the sоnоgrарhiс сhаrасteristiсs оf the sрeсtrum оf sсrоtаl раthоlоgies using High-Frequenсy Ultrasonography (USG) аnd Соlоr Dоррler.
Aim and Objectives
1) Determining the sonographic features of scrotal lesions on Real Time Gray Scale Sonography.
2) Evaluating these scrotal lesions on Color Doppler Flow Imaging.
3) Classification of the scrotal lesions into testicular or extra-testicular.
4) Cor-relation of these sonographic findings with Ultrasound Guided FNAC/Biopsy wherever indicated.
Material and Methods: The hоsрitаl bаsed рrоsрeсtive оbservаtiоnаl study was conducted in the Department of Radiodiagnosis & Imaging, Muzaffarnagar Medical College, Uttar.Pradesh (U.P.), for eighteen months with twelve months for data collection and 6 months for data analysis. Gray Scale Ultrasonography with Color Doppler and Power Doppler of inguino-scrotal region using USG machine ALPINION ECUBE8 with 7-12 Hz linear probe was performed in 50 cases referred from Dept. of Surgery, Paediatrics and Casualty who presented with complaints of pain or heaviness in scrotum or tender, swollen or hardened testicle, heavy or dragging sensation in groin or empty scrotal sac.

To study the safety and efficacy of topical and intrastromal Amphotericin B in non-responding fungal corneal ulcer patients: A prospective study

Dr. Anjana Kumari, Dr. Jaishree Murli Manohar, Dr. Manish Kumar, Dr. Ritu Agarwal, 5Dr. Shiba, Dr. Suman Choudhary

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1731-1738

Purpose: Corneal ulcer is one of the important ophthalmic condition causing significant morbidity especially in the developing countries. Bacteria and fungi are frequently responsible for suppurative corneal ulcers especially in the developing countries. The present study aimed to know the safety and efficacy of topical and intrastromal injection of Amphotericin B in the management of non-responding fungal corneal ulcer patients.
Methodology: It was a hospital based prospective, non-randomized, analytical study. Thirty patients of non-responding fungal corneal ulcer of any age group, of either sex were studied. Cases were studied in terms of clinical examinations, relevant investigations, appropriate treatment and documentation.

A study to asses pulse oximetry as a screening tool for detecting congenital heart disease

Mahtab Alam, Manjunath GM, Gowhar Iqbal Wani, Dr. Nikhil Gupta

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1739-1745

Background: The incidence of congenital heart defect is 8-10/1000 live-births according to various reports from the different parts of the world.3 this incidence has remained constant worldwide.4 It is responsible for significant morbidity and mortality in infants worldwide. These account for about 30% of the total congenital abnormalities. Neonates with CHD presents with low oxygen saturation which can be screened with the help of pulse oximetry. Pulse oximetry is an easy and non-invasive method for measuring arterial oxygen saturation in newborns with a high level of accuracy.
Objective: To asses the role of Pulse Oximetry as a Screening Tool for Detecting Congenital Heart Disease.
Materials and Methods: The present prospective observational study was conducted by the Department of Paediatrics (Post Natal Ward) at Government Multi-specialty Hospital, Sector-16 and Chandigarh from December 2015 to June 2016.
Results: Among the study out of 528 study subjects nearly 5 (0.9%) of them were found to be positive and 523(99.1%) of them were found to be negative. The mean value of spo2 in positive screened cases of the upper limb was noted to be 91.20 which ranged from 89-94. In the lower limb, the mean value was found to be 90.20, which ranged from 84-94. The mean value of hand-foot difference was 3.00. The mean SpO2 Saturation in the upper and lower Limb between screen positive and Screen Negative was found to be statistically Significant with P Value of less than <0.0001.
Conclusion: Early diagnosis of CHD is crucial to reduce the significant morbidity and mortality of CHD as the first manifestation of CHD may be associated with circulatory collapse or death. Pulse oximetry can detect mild hypoxemia which is characteristic of CHD. Therefore, pulse oximetry screening should be implemented in routine post natal examination of neonates.

A study of nail growth in diabetics

Dr. Anwarul Kabir, Dr. Amit Upadhyay, Dr. Rashmi Prakash, Dr. Ankita Prakash

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1746-1750

Background: It has been reported in many studies that nail growth is affected in Diabetes. A recent study was done in India which has postulated that the nail growth in Diabetes was more when compared to the normal subjects. This study puts in an effort to find the answers.
Aims and Objectives: To determine the nail growth rate in diabetics.
Materials and Methods: This study was started in Feb 2019 to Jan 2022 Mata Guruji Memorial Medical College and Hospital, Kishanganj, Bihar and Hind Institute of Medical Sciences, Mau, Ataria, Sitapur. Chitrapati Shahu Ji Maharaj University, Kanpur.
Total of 211 patients were studied and have been reported.
This study is a cross sectional study.
Two hundred eleven patients were studied. Out of this 100 were from Mata Guruji Memorial Medical College and Hospital, Kishanganj, Bihar and the rest of them were from Hind Institute of Medical Sciences, Mau, Ataria, Sitapur. Chitrapati Shahu Ji Maharaj University, Kanpur.
Results: The rates of the nail growth were found to be less when compared with normal rates of growth that has been given in the textbooks.
Conclusion: This can be considered as a useful tool in the hands of paramedical workers especially in the underprivileged areas.

Comparision of estimated fetal weight by symphysio-fundal height and abdominal girth measurement in pregnancy with actual birth weight

Dr. Somashekar HK, Dr. Harsha TN, Dr. Manjunatha S, Dr. Sowmya D

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1751-1758

Background: Accurate estimation of fetal weight is vital in the management of labor. Categorization of fetus into small or large for gestational age can lead to timed obstetric intervention. There are 2 common methods of estimation of fetal weight (EFW) sonographic evaluation and clinical method. In developing countries, ultrasonography most of the time unavailable or may not be affordable by patients. The accuracy of fetal weight estimation using symphysio-fundal height multiplied abdominal circumference at the umbilical level was moderate in all different BMI groups. The prediction was the highest in normal pre-pregnancy BMI.
Materials and Methods: This study was conducted at department of OBGYN, Teaching Hospital, Kodagu Institute of Medical Sciences, Madikeri, for the period from May-2019 to October-2019. Institutional Ethical committee has approved the study.
Objectives: To estimate the fetal weight in antenatal period by symphysio-fundal height and abdominal girth measurement and to compare with the actual birth weight of the baby after birth. The inclusion criteria were pregnant women of any parity of ≥34 weeks with singleton, cephalic presentation either not in labour or in early labour with intact membranes. The exclusion criteria were Pregnant women having obesity, multiple gestation, malpresentation, oligohydromnios & polyhydromnios, intrauterine fetal demise and diagnosed cases of uterine fibroids and abdominal masses are excluded from the study. Hospital based convenient sampling method is followed.
Results: Statistical tests (Correlation) were done between estimated fetal weight (EFW) and actual birth weight (BW). It was found that there was a positive correlation present between estimated fetal weight (EFW) and actual birth weight (BW) with a Pearson coefficient of 0.205 and with the p-value of 0.041 which is significant.

Clinicopathological study of abnormal uterine bleeding in perimenopausal women attending a tertiary care district hospital

Dr. Gayathri BN, Dr. Mallikarjun A Pattanashetti, Dr. Somashekar HK

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1759-1764

Background: Abnormal Uterine Bleeding (AUB) is defined as any bleeding that does not correspond with the frequency, duration or amount of blood flow of a normal menstrual cycle. Endometrial biopsy is important in perimenopausal age group women (40-55 years) to rule out endometrial pathology and malignancy. This study was done to assess Clinicopathological aspects and different histopathological patterns related to Abnormal Uterine Bleeding as no studies have been done in this region of Karnataka, India.
Methods: This is a cross sectional study done from 2019 to 2020. All female patients in the perimenopausal age group presenting with symptoms of AUB were included. Patients less than 40 years of age and endometrial tissues inadequate for opinion on microscopy were excluded. Relevant history and clinical data regarding pattern and duration of abnormal uterine bleeding was retrieved. Endometrial biopsy tissues was processed and stained by H&E. The diagnosis was done and results analysed.
Results: Present study included 94 biopsies of which 6 biopsies were inadequate for opinion. The most common age group presenting with AUB was 40-45 years (53.40%). The most common symptom was menorrhagia. The commonest histopathological pattern among all the perimenopausal age was disordered proliferative endometrium followed by simple hyperplasia without atypia. Other patterns were proliferative endometrium, secretory endometrium, simple hyperplasia, carcinomas etc. The commonest etiology of AUB was Dysfunctional Uterine Bleeding (46.59%) followed by Endometrial hyperplasias. (23.86%)
Conclusions: Correlation with clinical history, radiological investigations along with endometrial biopsy establishes etiology and diagnosis for patients with AUB.

A study on Knowledge, Attitude and Practice of menstrual hygiene among women of reproductive age group in a tertiary care hospital

Dr. Aakansha Mahajan, Dr. Shagufta, Dr. Neha Majotra

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1765-1771

Background: Menstruation is a normal physiological process and determines reproductive health. Poor menstrual hygiene can lead to various urinary tract, vaginal infections, skin infections or even pelvic inflammatory disease.
Aims: To assess the knowledge of menstrual hygiene among women of reproductive age group i.e.; 15-49 years attending the OPD of a tertiary care hospital and to assess their attitude and practices regarding the same.
Methods: A cross sectional observation study where an interview was conducted among 100 women of reproductive age group (15-49 years) attending the OPD clinic of our hospital over a period of 6 months and data was analysed according to that.
Results: Mean age of the participants was 32.43 ± 7.74 years. Out of 100 participants, 68% had good overall knowledge regarding menstruation.62% were using commercially available disposable sanitary napkins, 28% were using washable cloth and 10% were using homemade reusable cloth napkins. 70% of the participants were practicing good menstrual hygiene practices. 45% of the participants had local complaints suggestive of reproductive/urinary tract infection associated during menstruation out of whom 35% were not following satisfactory menstrual hygiene practices.
Conclusion: Menstrual hygiene is an important aspect of reproductive women's health. Unsatisfactory menstrual hygiene management acts as a risk factor for reproductive tract infections. This calls for spreading awareness to bring about a change in attitude and practices regarding the same.

A Prospective Study on Upper Limb Supraclavicular Brachial Plexus Block: Dexmedetomidine with Ropivacaine and Dexamethasone with Ropivacaine and Ropivacaine Alone

Dr. Sonik G. Shah, Dr. Mayur Vasava, Dr. Vipul M. Shah, Dr. Ramesh Solanki

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1772-1782

Introduction:
Pain is defined as “As unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage”. Pain is an inevitable consequence of surgery. Surgical intervention done to reduce human suffering is associated with pain and distress to patients. Severe pain  causes increased stress response to surgery, seen as a cascade of endocrine, metabolic and inflammatory events that may contribute to organ dysfunction, morbidity, increased hospital stay and mortality.
Material and Methods: 
The present study from  May 2020  to March 2022 was conducted on 60 cases prospectively in patients admitted to the, Department of anaesthesia ,Dr. N.D. Desai FMSR, Dharmasinh Desai University, College Road, Nadiad, Gujrat, undergoing elective upper limb surgery. The inclusion and exclusion criteria, 60 ASA physical status I or II patients of either sex, aged 18-60 yrs  were randomly allocated in to 3 groups of 20 each.
Group I: Patients receiving 0.5% Ropivacaine (30ml) + Dexmedetomidine 50mcg (diluted to 2 ml).
Group II: Patients receiving 0.5% Ropivacaine (30ml) + Dexamethasone 8mg (2ml).
Group III: Patients receiving 0.5% Ropivacaine (30ml) + saline (2ml).
Under strict aseptic precautions, patients were given Ultrasound guided Supraclavicular brachial plexus block with any one of the study drugs .
Results: 
Demographic data(age ,sex distribution ,weight) and surgical characteristics (duration of surgery and type of surgery) were similar in all the 3 groups.
ONSET OF SENSORY AND MOTOR BLOCKADE : The mean time for onset of sensory block in group I was 7.45±1.10 min and in group II was 10.15 ± 1.14 min and group III was 12.45±2.76 . The mean time for onset of motor block  in  group I was 10.60 ± 1.05 min and in  group II was 14.95 ± 0.83 min and and  group III was 16.05 ± 1.96. 
The onset of sensory and motor  block was significantly early in Dexmedetomidine group (group I) i.e, 7.45±1.10 min followed by dexamethasone group (group II) as compared   to plain Ropivacaine group (group III).
DURATION OF SENSORY AND MOTOR BLOCKADE: The total duration of sensory block  in  group I was 768±25.52  min and in group II was 909±22.10 min and in group III was 450±27.74 min.   The  duration of motor block in group I is 717.50±22.09  min and in group II was 878±19.47 min and in group III was 420±23.17 min. 
There is significant difference in the total duration of sensory and  motor block between the three groups. (P <0.001).The duration sensory and motor blockade is longest in Dexamethasone group followed by Dexmedetomidine group as compared to the control group Ropivacaine alone.
Conclusion: 
We conclude that although both Dexmedetomidine and Dexamethasone are better adjuvants to Ropivacaine as compared to Ropivacaine alone  in Supraclavicular Brachial block , Dexamethasone is a better choice in terms of  prolonging the  duration of sensory and motor blockade and duration of analgesia,  followed by Dexmedetomidine than Ropivacaine alone.

Effect of Core Stabilization exercises in Physiotherapist with work related Musculoskeletal disorders involving Lower back

Dr. Reshma Khurana, Dr. D.C. Jain

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1783-1788

Background &Method: The aim of this study is to study the Effect of Core Stabilization
exercises in Physiotherapist with work related Musculoskeletal disorders involving Lower
back. Out of 54 subject, 50 volunteered for participation in the study. Of them, 4 were
screened out on the basis of exclusion criteria. Remaining subjects (50 in number) were
divided into control group (group A) and experimental group (group B). group A had 25
subjects and group B had 25 subjects.

Clinical study of venous ulcers occurring in patients with varicose veins & response to various modalities of treatment

Dr. Shajee Ganesh, Dr. Hareeshwaran

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1789-1794

Background: Varicose veins of the lower limbs are the most common vascular disorder affecting human beings. Although venous ulceration is a benign condition, there is considerable morbidity due to recurrent cellulitis, phlebitis and stiffness of joints. Present study was aimed to study venous ulcers occurring in patients with varicose veins & response to various modalities of treatment at a tertiary hospital.
Material and Methods: Present study was hospital based, prospective, observational study, conducted in patients with venous ulceration in the leg due to varicose veins, willing to participate & follow up.
Results: In present study 32 patients were included. All patients were male. age ranged between 28 to 70 yrs. Majority of were from 40-49 years age group (31.25%) & duration of illness was 1-5 years (53.13%). Apart from ulcer & varicose veins (100.00%), common complaints were itching (31.25%), pain (28.13%) & pedal oedema (9.38%). Four patients (12.50%) had bilateral disease Fascial defects due to perforator incompetence was clinically well palpable in all patients with below knee perforators. Perthes’ test was negative in all patients and doppler (Duplex) assessment showed patent deep veins in all patients. All 32 patients (36 limbs) underwent Trendelenburg operation. Treatment modalities were Trendelenburg operation with stripping with stab avulsion (52.78%), Trendelenburg operation with stripping with subfascial ligation (36.11%), short saphenous vein ligation and stripping (5.56%) & excision of fibrous tissue and split skin grafting (5.56%).Post-operative complications in present Wound infection of the transverse groin incision was present in 2 patients.
Conclusion: In cases of venous ulcers occurring in patients with varicose veins, meticulous clinical assessment leads to successful treatment. Conservative treatment of venous ulceration should be tried before embarking on surgery which is the definitive treatment.

Clinical study of venous ulcers occurring in patients with varicose veins & response to various modalities of treatment.

Dr. Shajee Ganesh, Dr. Hareeshwaran

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1795-1800

Background: Varicose veins of the lower limbs are the most common vascular disorder affecting human beings. Although venous ulceration is a benign condition, there is considerable morbidity due to recurrent cellulitis, phlebitis and stiffness of joints. Present study was aimed to study venous ulcers occurring in patients with varicose veins & response to various modalities of treatment at a tertiary hospital.
Material and Methods: Present study was hospital based, prospective, observational study, conducted in patients with venous ulceration in the leg due to varicose veins, willing to participate & follow up.
Results: In present study 32 patients were included. All patients were male. age ranged between 28 to 70 yrs. Majority of were from 40-49 years age group (31.25%) & duration of illness was 1-5 years (53.13%). Apart from ulcer & varicose veins (100.00%), common complaints were itching (31.25%), pain (28.13%) & pedal oedema (9.38%). Four patients (12.50%) had bilateral disease Fascial defects due to perforator incompetence was clinically well palpable in all patients with below knee perforators. Perthes’ test was negative in all patients and doppler (Duplex) assessment showed patent deep veins in all patients. All 32 patients (36 limbs) underwent Trendelenburg operation. Treatment modalities were Trendelenburg operation with stripping with stab avulsion (52.78%), Trendelenburg operation with stripping with subfascial ligation (36.11%), short saphenous vein ligation and stripping (5.56%) & excision of fibrous tissue and split skin grafting (5.56%).Post-operative complications in present Wound infection of the transverse groin incision was present in 2 patients.
Conclusion: In cases of venous ulcers occurring in patients with varicose veins, meticulous clinical assessment leads to successful treatment. Conservative treatment of venous ulceration should be tried before embarking on surgery which is the definitive treatment.

Comparative study of efficacy of treatment of varicose veins with Saphenofemoral ligation and Foam sclerotherapy compared to Saphenofemoral ligation and stripping

Dr. Shajee Ganesh, Dr. Hareeshwaran

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1801-1807

Background: Varicose veins affect 20–30% of adults. If symptoms persist, the main treatment options are sclerotherapy, surgery (usually stripping and ligation of the long or short saphenous veins and phlebectomies), and ablation (by laser or radiofrequency ablation). Present study was aimed to compare the efficacy of treatment of varicose veins with Saphenofemoral ligation and Foam sclerotherapy compared to Saphenofemoral ligation and stripping.
Material and Methods: Present study was single-center, prospective, comparative, study, conducted in patients of either gender with varicose veins of the lower limbs, including those with venous ulcers. Patients were randomly allocated to group 1(SF ligation with foam sclerotherapy) &group 2 (SF ligation and stripping).
Results: The demographic data of the patients included in this study showed no significant difference between both groups in terms of age and sex. The time taken to complete treatment was shorter in the foam sclerotherapy plus SFJ ligation group: 40 vs. 55 min. The rate of longer-term (>30 days) ulcer healing rate in the case series ranged from 75 to 85%. 6 (85.7%) of 7 ulcers healed in the foam sclerotherapy group compared with 6 (75%) of 8 in the SF ligation and stripping group. At 3 months, median CEAP class dropped from four preoperatively to one following treatment in both groups. 1 patient out of 25 treated by foam sclerotherapy reported venous recanalization at one year after treatment. Median time to return to normal activities was significantly reduced in the foam sclerotherapy group (4 days) compared to the surgical group (9 days). Rates of thrombophlebitis was 16%.skin staining/pigmentation at 8%, and pain at the site of injection ranged was 28%.
Conclusion: Treatment of varicose veins with Foam sclerotherapy instead of stripping and avulsions reduces the operative and post operative recovery time.

Preoperative knowledge about spinal anesthesia on anxiety and pain in patients undergoing cesarean section

Dr. Shalini Nagpal, Dr. Yogesh Kumar Chhetty, Dr. Ila Agarwal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1808-1811

Background: Preoperative counseling is one for pregnant women help to improve the surgical outcome and also reduce the number of analgesics used. Though it is known that preoperative counseling is effective, there are limited studies to testify to its importance.
Objective: The present study was undertaken to observe the preoperative knowledge about spinal anesthesia on anxiety and pain in patients undergoing cesarean section.
Materials and methods: A total of 60 patients who were elected under CS anesthesia were part of the study after obtaining informed consent. After recording the baseline pain scores, depression, anxiety and stress scores, the participants were randomly grouped into control and intervention groups with 30 participants in each group. Preoperative counseling was offered to the participants of the intervention group. No counseling was offered to the participants of the control group. Post-surgical pain and depression, anxiety and stress scores were recorded in both groups. A visual analog scale was used to record the pain scores. Depression, anxiety and stress scores were recorded using DASS 42.
Results: There was no significant difference in the scores of depressions, anxiety and stress among the control and intervention group participants before the counseling. There was a significant decrease in the depression, anxiety and stress scores in the intervention group participants. Further, a significant decrease was observed in the pain scores also in the participants of the intervention group.
Conclusion: There was a significant decrease in the pain scores, depression, anxiety and stress scores after the surgery in the intervention group participants who underwent the preoperative counseling. The study recommends further detailed study in this area to recommend the implementation of preoperative counseling for the women undergoing cesarean section.

Feasibility of long saphenous vein cut down at sapheno-femoral junction for central venous access in neonates: A single centre experience of 3 years

Dr. Pramod S, Dr. Tejashwini K, Dr. Shanthi M, Dr. Dilip Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1785-1790

Background: Neonates pose a challenge in Neonatal intensive care unit (NICU) for central vascular access, which represents a daily practice. We have reported our experience with Central venous cut down through long saphenous vein (LSV) at sapheno-femoral junction (SF), its indications, feasibility and complications.
Objective: To assess the feasibility of insertion of central line by Sapheno-femoral (SF) cut down.
Methods: This is a retrospective study carried out in a Tertiary care hospital in a Metropolitan city of India. All the neonates who required Central venous access were included in the study.
Results: In our setting 176 neonates required LSV cut down for vascular access over a period of 3 years (2019-2022). The mean weight of the neonates was 1980 grams (range 680-4.1kg). The mean day at which the catheter was inserted was 7.1 days. Out of 176 neonates 8 neonates required vascular access for surgical condition and remaining 168 for medical condition. In 10 neonates the central line was inserted in operation theatre under general anesthesia. In the remaining 166 neonates the catheter was inserted in NICU under local anaesthesia. The mean time required for insertion of catheter was 14.2 minutes. The most common indications for Central line insertion included Sepsis, Respiratory distress syndrome, prematurity. The complications of CVL in our setting were central line induced sepsis followed by limb oedema.
Conclusion: Open surgical cut down of long Saphenous vein is feasible and a safe procedure, It can be performed as a bedside procedure without the need for General anaesthesia.

Correlation of homocysteine with lipid profile in pre & post-menopausal women

Dr. T Sibi Mandela, Dr. Muruga, Dr. Anurag Yadav, Dr. Vinay KS

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1791-1795

In Premenopausal women the levels of reproductive hormones are variable and the effects of hormonal withdrawal are present and they may have menstrual cycles which may be regular or irregular. Perimenopause or menstrual transition is the period preceding the menopause characterized by irregular menses and missed cycles which is associated with increase in follicle stimulating hormone levels (> 20 IU/mL). The clinical data pertaining to all patients were recorded as per proforma. A detailed history was taken pertaining to last menstrual period, year of menopause, history of diabetes mellitus, hypertension, cardiac events, and drug intake. The study showed the positive correlation of plasma homocysteine with TC, LDL, VLDL, TG in postmenopausal and premenopausal women and negative correlation of plasma homocysteine with HDL.

Adverse events following COVID vaccination among undergraduate students in a medical college, South India: A cross sectional study

Dr. Nandini RC, Dr. Tejashwini K, Dr. Shanthi M, Dr. Dilip Kumar, Nishitha Gowda

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1786-1802

Background: COVID Vaccination has given a ray of hope in fighting against coronavirus disease 2019 (COVID-19).Since the experiences are relatively new to all, it is important to monitor safety of vaccines in a real-world setting. With this background, this study was conducted.
Objective: To assess the pattern of AEFI among undergraduate students.
Methods: This cross-sectional study was conducted in a Hospital setting with 200 vaccinated medical students being enrolled in the study and Data were analysed using SPSS version 20.00.
Results: Total of 200 medical students, 142(71%) and 74(37%) of study subjects had one or more AEFI following COVID-19 vaccination following 1st and 2nd dose respectively. All the AEFI’s (100%) were only minor reactions.
Conclusion: The study reflected that COVID-19 vaccination caused only mild and non-serious AEFI in most of the vaccine recipients. Hence the vaccine given can be considered safe. 

Descriptive study on the distribution of ABO blood group and Rh type in the mechanically ventilated patients with COVID 19 disease

Dr. Santoshkumar Bennur, Dr. Sri Devi S, Dr. Shubha MR, Dr. Darshan MS

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1803-1810

Introduction: COVID-19 Pandemic was supposedly one of the deadliest events in the 21st century which has caused immense strain on the healthcare and human resource. Globally this has caused 450 million of infective cases and over 6 million deaths till now. Studies have shown that ABO polymorphism plays a vital role in occurrence of various communicable and non-communicable diseases. ABO polymorphism was also considered to play a significant role in susceptibility and progression of SARS-CoV-2 infection by various studies. Though the results are not equivocal, globally researchers are interested in identifying the trend of infection and severity of illness among particular blood groups which could be helpful in framing certain prognostic markers for the COVID 19 disease and also can aid the researchers in inventing the vaccines and the novel therapies in curing the COVID 19 disease. This can also lay the foundation for some genomic studies which can link certain blood groups with certain novel diseases in the era of biological warfare.

A Study on serum level of Osteoprotegerin (OPG) in chronic kidney disease

Dr. Mohan R, Dr. Suresh SR, Dr. Darshan Kumar HS, Dr. Karthik N Sasalu

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1811-1816

Introduction: Neutralization of a key Wnt inhibitor elevated in the circulation in CKD, Dkk1, and inhibited CKD induced vascular dedifferentiation, vascular calcification, and renal osteodystrophy. This effect was surprising since Wnt signalling in the vascular smooth muscle is implicated in stimulating osteoblastic transition and vascular calcification. However, recent studies demonstrate that Dkk1 mediated inhibition of aortic Wnt7b stimulates smad mediated aortic endothelial-mesenchymal transition (EndMT) and vascular calcificatio. EndMT is a developmental physiologic process involved in the development of the cardiac valves, the cardiac septum and the aortic root, and it may or may not contribute to cardiac fibrosis in various adult disease states.
Methodology: This is an observational study with no interventions carried out on any subject. Furthermore, all the CKD individuals were divided in to two groups based on the dialysis. Finally, the statistical analyses were performed between the predialysis, dialysis and control population to find the possible or potential diagnostic marker for CKD-MBD. Results: A total 68 individuals were genotyped for this study which includes 19 control subjects, 25 Non Dialysis patients and 24 Dialysis patients. The distribution of OPG gene polymorphisms among the control, Non dialysis and dialysis group were documented. Of the 19 studied control subjects 17 (85%) TT, 2 (10% TC) and 1 (5%) TC genotypes were observed.
Conclusion: Among the 25 non dialysis patients the observed genotypes are 15 (60%) TT, 6 (24%) and 4 (16%)TC. The Dialysis group 11 TT (45.8%), 8 TC (33.3%) and 5 TC (20.8%) genotypes were observed.

Relationship between the gene polymorphism of osteoprotegerin, serum osteoprotegerin level and chronic kidney disease in south Indian populations

Dr. Mohan R, Dr. Darshan Kumar HS, Dr. Suresh SR, Dr. Neethu C Annigeri

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1818-1824

Introduction: CKD-MBD is thus thought to be a major contributor to the high mortality among patients with CKD. The negative regulation of osteoclastic bone resorption exerted by OPG could increase BMD and bone volume by decreasing the active osteoclasts as demonstrated by in vitro studies
Methodology: This is an observational study with no interventions carried out on any subject. Furthermore, all the CKD individuals were made two groups based on the dialysis. Finally, the analyses was done between the predialysis, dialysis and control population to find the possible or potential diagnostic marker for CKD-MBD.
Results: Distribution of rs3102735genotypes between the non-dialysis and dialysis groups were not found significant differences for allelic (OR: 1.54, 95% CI (0.65-3.60)), genetic TT vs TC (OR: 1. 81, 95% CI (0.48-6.76) p=0.37) TT vs CC (OR: 1. 70, 95% CI (0.36-7.85) p=0.49) and dominant (OR: 1.77, 95% CI (0.57-5.50) p=0.32) models. Similarly, we have not found significant difference for rs3102735 in recessive model (OR: 0.72, 95% CI (0.16-3.09) p=0.662).
Conclusion: The serum OPG may be a useful biomarker for early diagnosis of CKD-MBD.

Acute kidney injury in obstetrics: Varied pathologies and outcomes

Somashekhar HK, Chandrashekhar Shrivastava, Pragyan Paramita Pradhan, Pavan Bhargava Chandramohan

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1848-1851

Background: Acute Kidney Injury (AKI) is the sudden loss of renal function. Multiple causes of AKI exist that include those that afflict the general population, and those that are associated with pregnancy. AKI in pregnancy is of particular challenge as there are physiological alterations of renal function in pregnancy. The diagnosis is by abnormalities of renal function tests in addition to the abnormalities reflecting underlying pathologies. Management depends on underlying causes and the prognosis can often be positive.
Material and methods: We present three cases of AKI in pregnancy, their evaluation and management.
Results: The first patient had AKI due to septic abortion and was treated by dialysis. The second patient had AKI due to preeclampsia with severe features and was treated by termination of pregnancy and multiple anti-hypertensives. The third patient had AKI due to hyperemesis gravidarum and was treated aggressively with fluids and anti-emetics.
Conclusion: Early recognition and initiation of appropriate therapy can lead to favourable outcomes in AKI.

The functional outcomes of surgical management of supracondylar fractures of humerus in children

Dr. Sunil Kumar TR, Dr. Srinath Sallur Anand, Dr. Harish YS, Dr. Nachiketan K Dore, Dr. JS Hegde

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1825-1832

Closed reduction with plaster of Paris slab immobilization has traditionally been used for supracondylar fractures, but loss of reduction and necessity of repeated manipulation likely results malunion producing varus or occasionally valgus deformity of elbow and elbow stiffness.
Because of lower percentage of good results and higher percentage of early and late complications compared with skeletal traction, percutaneous pinning and open reduction, casting is appropriate only for undisplaced fractures. The clinical material for the study consists of 30 cases of fresh supracondylar fractures of humerus in children of traumatic etiology meeting inclusion and exclusion criteria. Out of 19 patients which were treated by closed reduction, 16 patients (84.2%) showed excellent result and remaining 3 showed good results (15.8%) according to Mitchell and Adams criteria. Out of 11 patients treated by open reduction, 5 patients (45.5%) showed excellent results and 4 patients (36.4%) showed good results and 2 poor results (18.2%) were obtained with a statistically moderate significant value of p 0.045.

Clinical profile of children with supracondylar fractures of humerus admitted to tertiary care hospital

Dr. Sunil Kumar TR, Dr. Harish YS, Dr. Vivekananda BR, Dr. Srinath Sallur Anand, Dr. Nachiketan K Dore

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1833-1838

Although the incidence of these fractures generally has been reported to be higher in boys, more recent reports indicate that the frequencies of supracondylar humeral fractures in girls and boys seem to be equalizing, and some series actually have reported higher rates in girls. As soon as the patient was admitted, a detailed history was taken and a meticulous Examination of the patient was done. The required information was recorded in the proforma prepared. The patients radiograph was taken in antero-posterior and lateral views. The diagnosis was established by clinical and radiological examination. Out of 30 extension type, 15 patients had posteriomedial displacement while 10 patients had posteriolateral displacement. 5 patient were of Type II Gartland classification with posterior displacement. We encountered loss of pulse in one patient which recovered as soon as fracture was reduced. Median and radial Nerve injury in one patient each was encountered out of 30 patients which spontaneously recovered by 4-6 weeks’ time.

The functional outcome following proximal humeral interlocking system (PHILOS) plating for displaced proximal humeral fractures by evaluating pain, range of motion & muscle power

Dr. Gopi HG, Dr. Arjun A, Dr. Nagesh Sherikar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1839-1842

Approximately 80-85 percent of proximal humeral fractures were treated non-operatively, resulting in good functional results. Where it is noted that significant displacement was associated with poor functional outcome, especially in communicated fractures, as in the 15% to 20% of displaced proximal humerus fractures, thus moving to surgical fixation for better results. In the proposed study a minimum of 30 cases presenting with proximal humeral fractures were evaluated clinically and radio logically. The fractures were classified by using Neer’s classification.
Routine investigations will be carried out in order to get fitness for surgery. Consent of the patient will be taken. The final results are evaluated by using NEER’S Score. In our study the minimum score was 72 and maximum of 94. The average score is 82.93. We had excellent results in 7 (23%) of patients, 14(46%) had satisfactory results, 9(30%) patients had unsatisfactory results but none of the case is failure in our study.

Clinical profile of patients with displaced proximal humeral fracture attending tertiary care hospital

Dr. Gopi HG, Dr. Arjun A, Dr. Nagesh Sherikar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1843-1847

Most fractures of proximal humerus occur through osteoporotic bones in older patients. High energy trauma may result in such fractures at any age. Most common mechanism is a simple fall on the arm. Strong muscular contraction is the proposed mechanism for greater Tuberosity fractures. This is seen in cases of electric shock or seizure. Once the fragments separate muscle forces contribute to their displacement. The shaft is generally drawn anteriorly and medially by the pectoralis major. Once the patient is fit for surgery, will under goes open reduction and internal fixation with proximal humerus interlocking system(PHILOS)plate and screws under brachial plexus block or general anesthesia, Patient will be placed in Beach chair. All the patients were approached by Deltopectoral approach, cephalic vein is dissected and retracted, internervous plane between deltoid and biceps tendon. Once fracture site is exposed, fracture is reduced provisionally with K wires and checked in fluoroscopy. And final fixation done with PHILOS plate and position is confirmed in fluoroscopy. The mode of injury commonly observed in our series was road traffic accidents accounting for 23 (76%), 7 (24%) patients had a history of fall. These observations was found to be consistent with the studies in literature which revealed 19 (45%) road traffic accidents, 20(50%) history of fall.

Knowledge, attitude and practices in type 2 diabetes mellitus patients in Latur city of Maharashtra

Deepak S. Telange, Pramod P Kulkarni

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1864-1868

Introduction: The increase in severity of diabetes every year has been linked to patient’s lack of knowledge and practice of proper self-care. Due to its extreme importance, an annual assessment of patients' skills and knowledge has been recommended by The American Diabetes Association.
Objectives:
1. To assess the knowledge, attitude and practice of diabetic patients and to study the impact on glycemic control.
2. To educate the patients about the importance of lifestyle modification in the management of diabetes.
Methods: This study was conducted at the tertiary care level center in latur city of maharashtra. All the patients suffering from type 2 DM for more than one year attending the OPD and at IPD were included in the study irrespective of their age.
Results: On analyzing the data, it is found that only 7.14% participants had knowledge about the insulin deficiency as the cause of DM. only 37.30% of people knew that it is hereditary disease. Participants knowing that DM causes delayed wound healing were 58.73%. Only 50% participants follow the diet plan. Participants examining their feet daily were just 7.14% and only one patient was carrying the diabetic ID card.
Conclusion: The results of the study state that type 2 diabetes patients are deficient of sufficient knowledge on the understanding of causes of DM, risk factors of DM, progress of the disease, complications of DM, different signs and symptoms of complications for early identification, and basic rules of foot care. Practices of eating green leafy vegetables, exercise daily and checking blood sugar regularly are followed well but simple practice of feet examination daily is not followed.

Analysis of ADR (Adverse Drug Reaction) in geriatric patients of a Tribal district, special reference to self-medication and traditional medicine

Balaram Pothal, Anjali Tarai, Prof. Kali Prasad Pattnaik, Dr. Kumar Haraparasd Misra

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1848-1849

Introduction: Geriatric populations are vulnerable population for adverse drug reactions due to their pharmacokinetic limitations. ADR in older people are common cause of admission to hospital [1, 2] and important causes of morbidity and mortality. In more recent studies, the ADR rate in geriatric setting for the USA and Europe was greater (20%) than in studies carried out in general medicine settings [3]. In tribal distict, the availability of qualified doctors is an important issue, which may predispose to self- medication of modern medicines. There may also be use of various traditional medicines by quacks without prescription of authorized BAMS doctors). There is common concept that Traditional medicines are safer but reliable information (systematic toxicological evaluation) is not available [4]. Use of traditional medicine may associated with various adverse reaction that can affect oral health.

Hospital based study to know the effectiveness of ondansetron over spinal anesthesia induced hypotension & bradycardia

Dr. Naga Satya Suryanarayana Ruttala, Dr. Padmalatha Seelam, Dr. Nalli Venkata Krishna Mallik, Dr. Vengamamba Thummala

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1869-1878

Introduction: Spinal anaesthesia is simple, rapid and most reliable anaesthetic technique. It is the most common regional anaesthesia technique, practiced worldwide. It is an efficient technique, which is easy to perform. However, associated with side effects like hypotension, bradycardia and also post-operative nausea, vomiting and chills. Decrease in vascular resistance caused by sympathetic blockade leads to drop in arterial pressure. Bradycardia is caused due to parasympathetic over activity, increase in baroreceptor activity and Bezold Jarish reflex (BJR). Ondansetron is a well-tolerated drug with 5HT3 antagonising effects which is used most commonly for peri-operative nausea and vomiting with minor side effects. Ondansetron poorly penetrates the blood brain barrier with minimal influence on central serotogenic mechanisms. Hence has less chances of causing cognitive side effects like headache, agitation and confusion. The objectives of this study is to assess the effect of intravenous ondansetron on spinal anaesthesia induced hypotension and bradycardia and the effect of ondansetron on Peri-operative nausea, vomiting and chills.

Assessment of intubating conditions and haemodynamic responses in children using fentanyl and propofol and its comparison with muscle relaxant technique

Dr. Arata Kumar Swain, Dr. Suryasnata Sahoo, Dr. Sabyasachi Das

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1879-1892

Background: The present study was undertaken to highlight the benefits of avoiding suxamethonium, using only the opioid-propofol technique for routine intubation in paediatric age groups.
Objective: the advent of shorteracting opioid drugs, intubating the trachea has been particularly successful when these drugs are used in combination with propofol. Propofol has been reported to possess some characteristics that provide adequate conditions for intubation in combination with fentanyl 1,2 or alfentanil 3,4 or remifentanil 5.6.
Material & Method: Sixty children of ASA grade I or II scheduled to undergo elective surgery under general anesthesia were studied. They were randomly divided into two groups of thirty patients each.
Group I: Inj. fentanyl 4 μg.kg-1 and 5 minutes later Inj. propofol 3mg. kg-1 was given.
Group II: Inj. propofol 3 mg. kg-1 followed by Inj. suxamethonium 1mg.kg-1 was given.
Intubation in all cases was done by senior anaesthesiologist, 60 secs after induction with propofol. Intubation scores were recorded according to Helbo-HansenRaulo and Trap-Anderson scoring system. Acceptable intubating conditions (i.e., excellent and good) were observed in 26 (86.7%) out of 30 patients in Fentanyl group. The systolic blood pressure and heart rate, decreased significantly after intubation at 3 and 5 minutes in group Fentanyl when compared with pre-induction values (P<0.001).
Result & Conclusion: Results of present study suggest that in premedicated healthy children administration of fentanyl 4μg.kg-1 in combination with propofol 3mg.kg-1, after adequate waiting period of 6min, reliably provides good to excellent conditions for tracheal intubation and blunts the pressor response to intubation adequately without significant cardiovascular depression. Thus ideal intubating conditions can be achieved without muscle relaxants using fentanyl and propofol and provide an useful alternative technique for tracheal intubation when neuromuscular blocking drugs are contraindicated or should be avoided. Refinement of this technique by adjustment of the dose of fentanyl and propofol, and addition of Lignocaine may minimize incidence of coughing and might improve intubating conditions further.

Clinically evaluation of the efficacy of post-operative analgesia with epidural bupivacaine with butorphanol, bupivacaine with fentanyl and bupivacaine with nalbuphine

Dr. Arata Kumar Swain, Dr. Suryasnata Sahoo, Dr. Sabyasachi Das

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1893-1908

Background: Pain has already been accepted as the sixth vital sign. Hence, attenuation of pain and alleviation of human suffering is of paramount importance in respect to the service provided by anaesthesiologists, for whom the patients submit a virtual suicidal note in the form of expressed consent. Hence, the importance of the study is self-explanatory.
Objective: The purpose of this study was to clinically evaluate the efficacy of post-operative analgesia with epidural Bupivacaine with Butorphanol, Bupivacaine with Fentanyl and Bupivacaine with Nalbuphine.
Material & Method: 75 patients belonging to ASA Ι and ΙΙ, undergoing lower abdominal surgeries were divided into three groups.
Group A: 0.125% bupivacaine + 2 mg butorphanol.
Group B: 0.125% bupivacaine + 100 mcg. Fentanyl.
Group C: 0.125% bupivacaine + 10 mg Nalbuphine Under all aseptic conditions patients were given epidural block with loss of resistance technique.
Results & Conclusion: Conclusions are drawn from the Study: Opioid analgesics with local anesthetics are extremely safe, effective and reliable method of postoperative pain relief. Fentanyl produces faster onset of analgesia with fewer adverse effects like sedation, pruritus, and nausea and vomiting than butorphanol and nalbuphine when given epidurally along with 0.125% bupivacaine. Butorphanol administered epidurally has advantage of longer duration of analgesia than fentanyl or epidural nalbuphine with side effects like nausea vomiting and sedation.

Comparative study of intubating condition and duration of action after administration of rocuronium bromide and vecuronium bromide in abdominal surgery using train of four

Dr. Arata Kumar Swain, Dr. Suryasnata Sahoo, Dr. Harekrushna Dalei, Dr. Basanta Kumar Pradhan

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1909-1914

Background: Rocuronium Bromide, an intermediate acting amino steroid NMDR, is five to seven times less potent than Vecuronium used in this study was to compare time of onset, conditions of tracheal intubation, duration of action and hemodynamic parametres, either of the drugs are used to produce muscular paralysis.
Materials & Methods: Study was carried out by taking 60 adult patients, undergoing different elective abdominal surgery under general anaesthesia, in age group of 15-60 years with ASA physical status I or II,30 patients received 0.6 mg/kg of Rocuronium bromide as Intubating dose and the other 30 patients received 0.1 mg/kg of Vecuronium bromide. Then neuromuscular blockade, endotracheal intubation of two non-depolarizing muscle relaxants were evaluated using a TOF in adductor pollicis muscles.
Results: In both the groups intubating conditions were either excellent or good. Intubating conditions with Rocuronium group were excellent in 86.67% and good in 13.33% patients while in Vecuronium group, intubating condition were excellent in 80% and good in 20% patients, which were comparable and statistically not significant (p=0.488). The onset of action of Rocuronium was found to be rapid compared to Vecuronium group with high statistical significance. (p=0.000).

Correlation between BMI and plasma homocysteine levels in pre and postmenopausal women

Dr. Muruga, Dr. Rangaswamy R, Dr. Anurag Yadav, Dr. Vinay KS

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1915-1919

Homocysteine occupies a branch point in methionine, cysteine and S-adenosylmethionine (SAM) metabolism. About half of the homocysteine formed is conserved by remethylation to methionine in the “methionine cycle”. The other half is irreversibly converted by cystathionine-β-synthase (CBS) and cystathionine 𝛾-lyase to cysteine. After getting the informed consents from the subjects, 2.5ml of fasting blood samples were collected for lipid profile in a plain vacutainer tube and 2.5 ml of blood sample were collected in EDTA tubes for homocysteine estimation. This however, was done after the 7th day of the last menstrual period for premenopausal group. Samples were centrifuged at 3000 rpm to separate serum and plasma for the analysis of lipid profile and homocysteine estimation. The positive correlation between BMI and homocysteine which clearly indicates the increase in BMI results in increase in plasma homocysteine levels with Pearson correlation co-efficient of 0.232 and p value of 0.11.

A randomized assessment of the potential relationship between magnetic resonance abnormalities of the common extensor tendon (CET) and its clinical symptoms in patients with chronic lateral epicondylitis

Dr. Srinivasa Reddy Mukku, Dr. Pruthvi M

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1920-1927

Aims and objective: The aim of the study is to evaluate of magnetic resonance imaging (MRI) of Patients with Chronic Lateral Epicondylitis and investigate whether there is a potential relationship between MRI abnormalities of the common extensor tendon (CET) and its clinical symptom.
Material and Methods: A randomized study was conducted in the Department Malla Reddy Institute of Medical Sciences, Hyderabad, Telangana, India for the period of 1 year. The study group comprised 120 consecutive patients (80 men and 40 women) with a clinical diagnosis of chronic lateral epicondylitis, which were examined on 1.5 T MR. an MRI scoring system was used to grade the degree of tendinopahty. Clinical symptoms were assessed using the Patient Rated Tennis Elbow Evaluation (PRTEE).
Results: Total 120 elbows had MRI assessed tendinopathy, that includes 50 (41.67%) with grade 1, 37 (30.83%) with grade 2, and 33 (27.5%) with grade 3. The average intra-observer agreement for grading the severity of tendinopathy was 79.17%. The median PRTEE score of all patients was 76 (range 8-98), the median PRTEE score of tendinopathy score 1 was 28, the median PRTEE score of tendinopathy score 2 was 54, and the median PRTEE score of tendinopathy score 3 was 98. The PRTEE scores were gradually increased with the tendinopathy scores. A significant positive correlation exist between tendinopathy scores and PRTEE scores (correlation coefficient r ¼ 0.945, P < 0.01).
Conclusion: MRI is a reliable tool in determining radiological severity of chronical lateral epicondylitis. The severity of MR signals changes positively correlate with the patient’s clinical symptom.

Prevalence of noro-viral diarrhea in children less than 5 years of age in Western Maharashtra

R Mahesh Reddy, Yasmin Muhammed, Safal Muhammed MK

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1928-1932

With the introduction of Rotavirus vaccination, Norovirus is emerging as important pathogen
responsible for viral gastroenteritis in children. Most of the Norovirus outbreaks are under
reported as molecular investigations are rarely used in routine clinical practice. This study
was conducted to estimate the burden of Noroviral gastroenteritis in children less than 5 years
old by using multiplex real time PCR and Norovirus GII was isolated from 17% of cases.

Antibody response in healthcare workers to COVISHIELD vaccination in a tertiary care hospital

R Mahesh Reddy, Yasmin Muhammed, Kundan Tandel

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1933-1939

Background: SARS CoV-2 infection has become a major public health concern. India started Covid-19 vaccination from January 16, 2021, after the approval of two candidate vaccines namely COVISHIELD ™ and COVAXIN ™. The present study was conducted to see the neutralizing antibody response to trimeric S protein of SARS CoV-2 in health care workers (HCWs) with 2 doses of COVISHIELD vaccination in a tertiary care hospital.
Methodology: A prospective cohort study was conducted among 156 healthy adult health care workers in a tertiary care centre, vaccinated during January-March 2021. They were divided into two groups, the first group comprised of individuals who were previously RT-PCR positive (n=36) for SARS CoV-2, and second group comprised of those who were RT-PCR negative (n=120). Blood samples were collected from all participants, the first sample on the day of vaccination, second sample after 4 weeks of vaccination, and third after 8 weeks of vaccination to measure the IgG antibodies against the SARS CoV-2 ‘S’ protein using a chemiluminescent quantitative immunoassay.
Results: The spike protein-specific IgG antibody titre was demonstrated reactive cut-off in 98.3% of the participants after 2 doses of vaccine. The median antibody titre declined from 710.5 (IQR, 338.5-1577.5) to 266 (IQR, 116-557.75) in RT-PCR positive HCWs after 8 weeks of vaccination whereas it increased from 45.1 (IQR, 31.475-76.575) to 83.4 (IQR, 52.075-104) in RT-PCR negative HCWs.
Conclusion: We could demonstrate the development of an adequate spike protein-specific IgG titre against SARS CoV-2 following vaccination with 2 doses of COVISHIELD in HCWs.

The burden of Staphylococcus aureus infections at medicine department, IMS and SUM Hospital, Bhubaneswar

Sarada Prasad Sahu, Asish Malla, Dr. Debasmita Tripathy, Rajesh Kumar Lenka

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1940-1944

Background: Staphylococcus aureus infections are one of the major infections in hospitals and the drug-resistant strain of S. aureus caused mortality and morbidity throughout the globe. In this study, we evaluated the S. aureus infection and their drug sensitivity patterns at Medicine department for 5 years.
Methods: The patients admitted at medicine word were participated in this study. All clinical samples were taken for bacteriological study. After identification of bacteria, the drug sensitivity patterns were carried out by disc diffusion methods.
Results: A total of 944 S. aureus isolates were analyzed. High sensitivity of S. aureus was observed for quinupristin/dalfopristin (100%), tigecycline (98.2), imipenem (98%), nitrofurantoin (97.6%), linezolid (97.3%), teicoplanin (97.1%) and vancomycin (95.1%). High resistance was recorded against penicillin G (91.9%), trimethoprim/sulfamethoxazole (56.9%) and tetracycline (33.2%). MRSA prevalence among the patients at IMS and SUM Hospital, Bhubaneswar was 27.8%. Highest proportion (80%) of MRSA was in burns unit.
Conclusions: Both MRSA and MSSA were highly susceptible to quinupristin/dalfopristin, tigecycline, linezolid, nitrofurantoin, ampicillin/sulbactam and vancomycin and showed high resistance to commonly used antibiotics such as gentamycin, erythromycin, levofloxacin and tetracycline. A majority of isolates were from pus specimen (68%).

Surveillance of vancomycin-resistant Staphylococcus aureus (VRSA) from a teaching hospital, Bhubaneswar, India

Sarada Prasad Sahu, Dr. Asish Malla, Rajesh Kumar Lenka

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1945-1951

Background: Glycopeptides such as vancomycin are frequently the antibiotics of choice for the treatment of infections caused by methicillin resistant Staphylococcus aureus (MRSA). For the last 7 years incidence of vancomycin intermediate S. aureus and vancomycin resistant S. aureus (VISA and VRSA respectively) has been increasing in various parts of the world. The present study was carried out to find out the presence of VISA and VRSA in the Department of Medicine, IMS and SUM Hospital Bhubaneswar.
Methods: A total 1681 staphylococcal isolates consisting of 783 S. aureus and 898 coagulase negative staphylococci (CoNS) were isolated from different clinical specimens from various outpatient departments and wards. All S. aureus and 93 CoNS were subjected to MIC testing (against vancomycin, teicolplanin and oxacillin); Brain Heart Infusion (BHI) vancomycin screen agar test, and disc diffusion testing.
Results: Out of 783 S. aureus two S. aureus strains were found to be vancomycin and teicoplanin resistant (one strain with MIC 32 g/ml and the other strain with MIC 64 g/ml); six strains of S. aureus have shown to be vancomycin intermediate (two strains with MIC 16 g/ml and four strains with MIC 8 g/ml); and two strains with teicoplanin intermediate (MIC 16 g/ml). One CoNS strain was resistant to vancomycin and teicoplanin (MIC 32 g/ml), and two CoNS strains were intermediate to vancomycin and teicoplanin (MIC 16 g/ml). All VRSA, VISA and vancomycin resistant CoNS had shown growth on BHI vancomycin screen agar (vancomycin 6 g/ml).
Conclusion: The present study reveals for the first time emergence of VISA/VRSA from this part of world and indicates the magnitude of antibiotic resistance in and around the study area. The major cause of this may be unawareness and indiscriminate use of broad-spectrum antibiotics.

Surveillance of microorganisms and their drug sensitivity patterns in diabetic UTI patient at a tertiary care teaching hospital

Santosh Singh, Rajashree Panigrahi, Ishwara Chandra Behera, Dr. Debasmita Dubey

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1952-1966

Background: Urinary Tract Infection (UTI) is one of the common infections affecting people, both from the community and hospital. The causative pathogens for UTI and their drug sensitivity patterns vary from region to region. Changes in their genetic constituents with time might be the reason.
Aim: In this study, we aimed investigate the profile of common uropathogens and assess their antibiotic sensitivity patterns with commonly used drugs for UTI patients.
Materials and methods: In this study, 153 urine samples were analyzed with routine microscopy, culture and sensitivity for a period of six months at Institute of Medical Science and SUM Hospital, Bhubaneswar, Odisha. Both bacteria and fungi were used for drug sensitivity test.
Result: A total no. of 54Gram positive bacteria and 40 Gram Negative bacteria were isolated. S. aureus was the most common GPC isolated and P. aeruginosa was the most common GNB. E. coli was the second most GNB which showed resistance to Cephalosporins and Aminocoumarin group. 4 Candida species were isolated, to which Clotrimazole was the most susceptible antifungal agent. Staphylococcus sp. showed resistance to β-lactams and Macrolides group of antibiotics. Shigella sp. showed resistance to β-lactams. C. albicans was found to be the common Fungi isolated, followed by C. krusei.
Conclusion: Since the drug sensitivity pattern changes from place to place and varies from time to time. The culture sensitivity therapy should be practiced before empirical administration of antibiotics.

A study on estimation of fasting serum magnesium levels in type 2 diabetes mellitus

Dr. Chandana R Gowda, Dr. Parashuram, Dr. Pratibha Vasu

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1967-1971

Magnesium deficiency is proposed as a factor in the pathogenesis of diabetic complications. Hypomagnesemia can be both a cause and a consequence of diabetic complications. The aim of our study was to know the relationship between magnesium levels and diabetes, association with level of control of diabetes and magnesium levels in relation to complications of diabetes. A cross sectional study done with 150 patients with Type 2 Diabetes mellitus in outpatient and inpatient departments in Medicine, to estimate the levels of fasting serum magnesium levels in Type 2 Diabetics. To correlate the magnesium levels with the Diabetic Complications. Among the microvascular complications, retinopathy was found in 35.6% of cases, nephropathy in 20% of cases and neuropathy in 11% Hypomagnesemia was found in 78.1% of retinopathy, 55.6% of nephropathy and 30% of neuropathy cases. Among the macrovascular complications, IHD was found in 22.2%, CVA was found in 6.7% and PVD in 4.4%. Hypomagnesemia was found in 60% of cases of IHD, 50% of cases of CVA and PVD. Serum magnesium levels were low in type 2 diabetics when associated with complications. Hypomagnesemia was associated with diabetic retinopathy, diabetic nephropathy and Ischemic Heart Disease.

A study on clinical profile of patients with the diabetic complications: descriptive study

Dr. Parashuram, Dr. Pratibha Vasu, Dr. Chandana R Gowda

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1972-1976

Type 2 diabetes, is caused by insulin resistance which is characterized by a decreased effectiveness of insulin. In contrast to type 1 diabetes in which the pancreatic islets are destroyed and no insulin can be synthesized anymore, in type 2 diabetes insulin secretion is normal, elevated or reduced. Unlike in patients with type 1 diabetes, symptoms do not appear abruptly, but set on gradually so that the disease often remains undiagnosed for a long time. The present study included 150 patients of type 2 diabetes mellitus. Patients with Type 2 Diabetes mellitus in outpatient and inpatient departments were study subjects. The present study had diabetic patients ranging from 41 to 80 years of age. Majority of cases were in the 61 to 70 age group. Male cases were 58.7% and female cases were 41.3%. 60% of cases of Type 2 DM were associated with complications of which 66.7% were microvascular and 33.3% were macrovascular complications.

A comparative study of ligation of intersphincteric fistula tract versus conventional fistulectomy in management of low fistula in ano

Dr. Aravind Naik, Dr. Amar DN

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1977-1983

Background: Fistula in ano is one of the common anorectal disorders which is defined as an abnormal track connecting the anal canal with perineum. The main objective of the treatment in fistula-in-ano is to minimize recurrence while maintaining anal continence. Present study was aimed to compare ligation of intersphincteric fistula tract versus conventional fistulectomy in management of low fistula in ano at a tertiary hospital.
Material and Methods: Present study was single-center, prospective, comparative study, conducted in patients of age >15 years, of either gender with low anal fistula identified by clinical examination and investigations.
Results: 60 patients were divided into two groups as group A underwent ligation of intersphincteric fistula tract (LIFT) procedure (n=30) and group B, underwent open fistulectomy (n=30). In present study among both groups majority patients were male & from 31-60 years age group. Mean duration of surgery was comparable & difference was not significant statistically (26.9 ± 9.4 minutes vs 30.7 ± 11.6 minutes). Duration of wound healing was less in LIFT group as compared to fistulectomy group & difference was statistically significant (12.6 ± 5.7 days vs 18.5 ± 8.7 days) (p value< 0.001). Post-operative pain scores were comparable among two groups on post-operative day 0 & 1. Less post-operative pain scores were noted among in LIFT group as compared to fistulectomy group on post-operative day 3 & 7, difference was statistically significant (p value < 0.05). Less complications were noted in LIFT group as compared to fistulectomy group; difference was not significant statistically.
Conclusion: Ligation of intersphincteric fistula tract (LIFT) procedure for the management low anal fistula is simple, safe and effective in management of low anal fistulas, produces less post-operative pain, faster wound healing and better fecal continence preservation compared to open fistulectomy.

Acute kidney injury in obstetrics: Varied pathologies and outcomes.

Somashekhar HK, Chandrashekhar Shrivastava, Pragyan Paramita Pradhan, Pavan Bhargava Chandramohan

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1984-1987

Background: Acute Kidney Injury (AKI) is the sudden loss of renal function. Multiple causes of AKI exist that include those that afflict the general population, and those that are associated with pregnancy. AKI in pregnancy is of particular challenge as there are physiological alterations of renal function in pregnancy. The diagnosis is by abnormalities of renal function tests in addition to the abnormalities reflecting underlying pathologies. Management depends on underlying causes and the prognosis can often be positive.
Material and methods: We present three cases of AKI in pregnancy, their evaluation and management.
Results: The first patient had AKI due to septic abortion and was treated by dialysis. The second patient had AKI due to preeclampsia with severe features and was treated by termination of pregnancy and multiple anti-hypertensives. The third patient had AKI due to hyperemesis gravidarum and was treated aggressively with fluids and anti-emetics.
Conclusion: Early recognition and initiation of appropriate therapy can lead to favourable outcomes in AKI.

A study on clinical presentation of rhino orbital cerebral mucormycosis associated with COVID-19 infection

Dr. Bomma Vijay Kumar, Dr Naresh Mogilicharla, Dr. Potlacheruvu Nagaraju, Dr. Moota Madhuri, Dr. A Shobhan Babu

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1988-1997

Background and aims: During the second wave of coronavirus disease 2019 [covid-19] in India, there is a rapid surge of opportunistic fungal infections among covid-19 patients. Rhino-Orbito-Cerebral mucormycosis is the most common disease among these patients apart from pulmonary aspergillosis. The study aims to determine the clinical presentation, signs, and symptoms in patients with rhino-orbito-cerebral mucormycosis associated with coronavirus disease in the present scenario.
Methods: It is a retrospective observational study. The Clinical history of 100 patients from medical records with Rhino-Orbito-Cerebral mucormycosis associated with covid-19 during the months of May and June 2021 is collected and analyzed.
Results: In our study on 100 patients with mucormycosis infection 95 patients were diagnosed with covid-19 infection and 82 patients were diabetic. Among the diabetic group, 53 were chronic diabetic and 29 were detected denovo. The disease is seen most prominently in the people of the age group between 30-60yrs. Males are more affected. The urban population represented 67 percent. The chief complaints of the patients with mucormycosis related covid-19 are pain (88%), swelling/edema (79%), visual disturbance (51%), numbness over the face (47%), nasal discharge (45%). Clinical findings of the disease are, ptosis (52%), blurring/absent vision (51%), proptosis (41%), ophthalmoplegia (33%), discoloration over the face (26%) and necrosis of the soft tissues (8%).The percentage of people presented with mucormycosis between diagnosis of covid-19 infection and onset of symptoms of mucormycosis is observed to be 72% within two weeks and 89% within three weeks. Regarding the covid-19 symptoms, mild symptoms were seen in 59.9%, moderate symptoms in 29.4% and severe symptoms in 10.5% of patients. 76 patients were on corticosteroid therapy and 35 patients were oxygen-dependent.

Demographic profile of patients with acute pancreatitis presenting to department of surgery, jorhat medical college: A clinical study

Richard Barla, MJ Gohain, Nilutpal Bora, NN Ganguly, AC Baro

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1998-2007


Background: Acute Pancreatitis is a major health problem with significant morbidity and mortality. There is large geographical variability in incidence, disease severity and outcome with data related to prevalence rate lacking in our region. Present study is aimed to observe its demographic variability around the Jorhat Medical College.
Methods: First consecutive 50 cases of acute pancreatitis presented in the Jorhat Medical College during the study period from June 2020 to May 2021 were included in the study; data collected, systematically analyzed and statistically reviewed.
Results: Of the 50 cases, 33 (60%) were male while 17 (34%) were female. The mean age of the study sample is 37.04±13.52 (SD) years, ranging from 15 – 75 years. Majority of the patients are between 15-35 years. In 50% cases, alcohol is the most common aetiology followed by gallstones (36%), idiopathic in 10% cases. Alcohol is the most common aetiology among male and 15-35 years age group while gallstone is most common cause in females and 35-55 years age group. Among 50 cases, 41 (82%) are mild acute pancreatitis and 9 (18%) have severe acute pancreatitis. Majority of severe acute pancreatitis cases are male and alcoholic. Of 50 cases, among Hindus (n= 47) ethnic Assamese are 54%, Tea tribe 20%, Mising 10%, UP 6%, Bengali 4%, while Muslim 4% and Christian 2%. Gallstone is most common cause among ethnic Assamese and alcohol is the common cause in Tea tribe and Mising. Geographical distributions of the cases are as follows: Jorhat district 50% (n=25), Golaghat 32% (n= 16), Majuli 14% (n= 7) and Sivasagar 4% (n=2).
Conclusion: Acute pancreatitis is more common among male than female. Assamese are the most commonly affected ethnic group, gallstone being the most common cause among them. Alcohol is the most common aetiology in Tea tribes and Mising community. Male and alcoholics are more prone to severe acute pancreatitis. The incidence of acute pancreatitis is more in younger population 15-35 years and alcohol is the most common cause in this age group. Most of the cases are from Jorhat district followed by Golaghat, Majuli and Sivasagar.

Feto-maternal outcome assessment of caesarean section during second stage of labor in a tertiary care facility

Dr. Deepak Thakker, Dr. Shailendra V. Mangnale

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2008-2012

Aim: To assess the maternal and fetal outcome of caesarean section in second stage of labour.
Methods: This prospective observational study was carried out in the department of Obstetrics and Gynecology at VIMS, Dahanu for the period of 2 years. Total 400 patients were included into the study. All caesarean sections performed at full cervical dilatation over the time period of Two years at a VIMS hospital Dahanu.
Results: During the Two years period, a total of 24600 women delivered by caesarean section, 16800 emergency and 7800 elective cases. Of these 400 (2.38%) were at full cervical dilatation, >37 weeks gestation with a singleton fetus in cephalic presentation. Among the 400 patient’s majority of them were in the age group of 20-30 years (72.5%). about 75.5% of the patients were primigravidae and only the remaining 24.5% were multigravida. The commonest indications for doing caesarean section in the second stage of labour were cephalo pelvic disproportion, fetal distress and obstructed labour. Incidence of PPH is 48 out of 400 cases (12%). Post-operative wound infection was seen in 23(5.75%) and Post-operative fever was seen in 70(17.5%) out of 400 cases. There were no cases of maternal deaths reported. The mean operative time was 52.9 min .The mean length of hospital stays was 6.6 days. Mean weight of the babies of the second stage caesarean section was 3.2 kg. 20 (5%) babies were admitted to the Neonatal Intensive Care Unit and 53 (13.25%) to neonatal nursery for management of respiratory distress, sepsis, jaundice and observation. 46 (11.5%) babies had Neonatal jaundice and there were 3 neonatal deaths reported.
Conclusion: Cesarean sections done in second stage of labor are associated with several intra-operative maternal complications and neonatal morbidity.

A study on association of serum uric acid and blood pressure in hypertensive patients at a tertiary hospital

Premaraja R, Bethiun S

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2013-2019

Background: Hypertension is an increasing important medical and public health issue. Uric acid exerts a pro-inflammatory effect on endothelial cells which may be associated with MetS risk factors such as elevated triglyceride (TG) levels, hypertension and insulin resistance.5 Present study was aimed to study of association of serum uric acid and blood pressure in hypertensive patients at a tertiary hospital.
Material and Methods: Present study was prospective, comparative, observational study, conducted among cases (Subjects of either gender, age >18 years, diagnosed as hypertensive (first time) were enrolled in this study during a regular routine health check-up at general medicine OPDs) & controls (Age & gender matched normotensives subjects at general medicine OPDs).
Results: In present study, 100 subjects each were studied in hypertensive as well as normotensive group. Mean levels of age, gender, BMI & co-morbidities among both groups were comparable & difference was not significant statistically. Mean pulse rate & respiratory rate were comparable among both groups & difference was not significant statistically. The mean levels of SBP and DBP were significantly more in the hypertensive subjects as compared to normotensive subjects (p < 0.001). In present study, prevalence of hyperuricemia was 9% (1% in normotensive and 8% in hypertensive subjects). Hypertensive subjects had increased mean levels of SUA than in the normotensive subjects (p < 0.001). In Pearson’s correlation coefficient test, SUA levels were significantly related with SBP and DBP (p < 0.001). The average level of TG and HDL were also significantly different between the groups (p < 0.05).
Conclusion: A stronger co-relationship for higher levels of SUA concentration was noted with blood pressure hypertension and prehypertension in the participants.

Evaluation of unstable intertrochanteric and subtrochanteric femur fractures treated with proximal femoral nail with trochanteric stabilization plate: An observational study

Dr. Pathik Vala, Dr. Jayesh Vaza, Dr. Gaurav Parikh, Dr. Kuldeep Parmar, Dr. Rajesh Chavda

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2020-2028

Objective: To evaluate clinical and functional outcome of unstable intertrochanteric and subtrochanteric fractures of femur treated with proximal femoral nailing with trochanteric stabilization plate.
Methods: In our study we included twenty patients of unstable intertrochanteric and subtrochanteric fracture of femur fixed with proximal femoral nailing with trochanteric stabilizing plate. Our study design is prospective and observational. Our study has maximum follow up of eighteen months and minimum of three months. Patients from third decade of life and onwards, presenting to orthopedic outpatient department in casualty or regular OPD with history pf household fall or minor or moderate trauma or sometime with road traffic accident.
Results: Twenty patients with unstable intertrochanteric and subtrochanteric fracture of femur fixed with proximal femoral nailing with trochanteric stabilizing plate, it was observed that six (30%) patients with Harris hip score between 90-100, nine (45%) patients with Harris hip score between 80-89, three (15%) patients with Harris hip score between 70-79 and two (10%) patients with Harris hip score between < 70. Also twenty patients we observed six (30%) patients with excellent result, nine (45%) with good result, three (15%) with fair result and two (10%) with poor result. There was three patients with infection, in one patient infection got resolved but in two patient’s early removal of implant was done. And in one patient both hip screws were broken after one month of surgery.

General anaesthesia for patients with chronic obstructive pulmonary disease undergoing spinal surgery and postoperative respiratory failure: An observational study

Dr. Abdul Wahab Mirza, Dr. Deepinder Kaur, Yogesh Kumar Chhetty

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2029-2032

Background: Patients with the chronic obstructive pulmonary disorder (COPD) are at risk of developing postoperative respiratory failure. That is the reason they may require artificial respiration for longer periods than others. However, being on mechanical ventilation for a long time leads to lung damage and infections.
Objective: The present study was undertaken to observe the relation between the severity of COPD in patients of spinal surgery and the prevalence of respiratory failure.
Materials and Methods: 40 patients with COPD who had undergone spinal surgery were part of the study. The data was collected from the medical records department including the demographics, spirometry results, blood gas analysis, comorbidities, postoperative and other variables. The important outcome is a respiratory failure within one week after the surgery.
Results: Data was presented in table 1 and table 2. Table 1 presents the demographic and clinical parameters of the participants. Table 2 presents the risk factors for respiratory failure of the participants. A longer duration of anesthesia was required for the mild COPD patients. Comorbidities were present in all levels of COPD patients. Table 2 presents the risk factors for respiratory failure of the participants. Length of stay was longer in patients with severe COPD. Extubating time, and endotracheal intubation after surgery were more in the severe COPD patients. Pulmonary infection is present in all groups of patients.
Conclusion: There is no significant relationship between the severities of COPD with postoperative respiratory failure. However, there is a strong need to conduct a prospective study with more defined parameters to understand better these relations. So that better and more effective treatment strategies can be developed.

A study on relation between hormonal parameters and risk markers in infertility

Dr. Arun William, Dr. Viji Krishnan, Dr. Dinesh Roy D

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2033-2037

One in every four couples in developing countries is affected by infertility. The magnitude of the problem calls for urgent action, particularly when the majority of cases of infertility are avoidable. Of 60-80 million couples suffering from infertility every year worldwide, probably between 15 and 20 million (25%) are in India alone. A case-control study layout was adopted for the present study on relation between hormonal parameters and risk markers in infertility the test subjects were referred from various infertility clinics were chosen for the study. Out of 150 study subjects, 100 infertile women showed increased FSH concentration and they revealed increased MDA concentration, mean b/c value and mCBMNF. Infertile women with low concentration of estradiol demonstrated an elevated MDA concentration, mCBMNF and mean b/c value than others with increased level of estradiol. Out of 150 study subjects, 115 individuals showed an increased PRL concentration and they revealed increased values of MDA concentration, mCBMNF and mean b/c value.

Biochemical and endocrinological aspects of female infertility: Descriptive comparative study

Dr. Arun William, Dr. Dinesh Roy D, Dr. Viji Krishnan

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2038-2043

Infertility is a disease of the reproductive system and its treatment can affect all aspects of people’s lives, which can cause various psychological-emotional disorders or consequences including frustration, hopelessness, depression, guilt, anxiety and feelings of worthlessness in life. In order to evaluate Biochemical and endocrinological aspects of female infertility, a test-control study was designed. For the study 150 clinically diagnosed infertile female subjects and 150 age matched healthy females with one or more children were involved in the study as control. Level of uric acid concentration was comparatively higher among test group (5.5mg/dL) than the control subjects (4.4mg/dL) (p<0.005). The inflammatory marker (hsCRP) demonstrated a very high concentration among the test subjects than the control group (1.0±0.59) (p<0.005). It was evident that, study group expressed an FSH concentration of 30±10 and control with a FSH level of 12.8±6.00 (p=<0.005).

Visceral artery pseudoaneurysms: An institutional experience

Dr. Sarbjit Mohapatra, Dr. Keerthan Kumar M, Dr. Prasad SS, Dr. Vishnu Jayaprakash

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2044-2050

Purpose: Visceral artery pseudo-aneurysms were infrequently encountered in clinical practice. With the advent of higher resolution imaging, VAPA has been diagnosed more frequently and promptly. Though the natural history of this pathology is not fully elucidated, they can present with devastating complications. This study is one of the few large case series exclusively describing visceral artery pseudo-aneurysm offering a glimpse in to various etiologies, presentations, and treatment approaches for visceral artery pseudo-aneurysms in a specialized care center.
Material and Methods: Medical records of patients with visceral artery pseudo-aneurysms between January 2015 to May 2020 were retrieved, and data pertaining to etiology, clinical presentation, imaging, and management were compiled and analyzed.
Results: During the study period 29 visceral artery pseudo-aneurysms were identified in 27 patients (2 patients had more than one VAPA). They had diverse etiology, location, and presentation. The splenic artery was the most common site of VAPA (n=10). The commonest etiology was pancreatitis (41%). Only 7 patients were asymptomatic while the majority had symptoms (n=20). Abdominal pain was the most frequent symptom (66%) followed by gastrointestinal bleeding (30%). 16 patients were successfully treated by endovascular intervention, while 2 patients required surgical intervention. No morbidity or mortality was noted during the period of hospitalization.
Conclusion: Visceral artery pseudo-aneurysms can be secondary to plethora of pathologies. A high degree of suspicion with prompt imaging helps in timely diagnosis. Endovascular interventions are highly effective treatment modalities for visceral artery pseudo-aneurysms. It should be considered as the preferred modality of treatment in anatomically suited VAPA.

MRI evaluation of cruciate ligaments and associated injuries in knee joint

Dr. Gaurav Kant Sharma, Dr. Jai Chowdhary, Dr. Vineet Mishra, Dr. Sanyukta Gupta

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2051-2057

The knee joint is one of the most frequently injured joints in the body. Since it is a weight bearing joint, it is consistently exposed to substantial force. The anterior and posterior cruciate ligaments play a vital role in stabilization of the knee joint. Loss of these restraints leads to substantial morbidity and can result in secondary dysfunction of other structures of the knee.
MR imaging of the knee is an excellent modality that detects lesions not always evident on arthroscopy and helps in planning and treatment of meniscal &ligament injuries. The aim of our study is to assess the accuracy of MR imaging in evaluation of cruciate ligament injuries of knee joint. To study and categorize the patterns of cruciate ligament injuries and associated bone and surrounding soft tissues on MRI. Also, to correlate the clinical profile of cruciate and associated ligament injuries with magnetic resonance imaging findings.
Fifty patients were examined on a 1.5 T GE MR system at Mahatma Gandhi Medical College, Jaipur for a time period of eighteen months from December 2019 to May 2021.
Conclusion of our study is that MRI is an excellent modality to detect the lesions in an injured knee. It has great capability in diagnosing meniscal tear and classifying them into grades. According to our study MRI is more sensitive than clinical tests to detect the cruciate ligaments and associated lesions. MRI is unique in its ability to evaluate the internal structure as well as the peripheral meniscal tears, and inferior surface tears. MRI being noninvasive does not involve morbidity associated with other tests like arthroscopy.

The use of Ender’s Nail in Tibial Diaphyseal Fractures in Pediatric Patients – A Clinical Study

Dr. Harshal N Damor, Dr. Dhrumil Dave, Dr. Parag M Tank, Dr Harsh N. Patel, Dr. Kaushal A Upadhyay, Dr. Dhruvesh L Katara, Dr. Dhavalkumar V Patel, Dr. Tejas Vadera

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2058-2065

Background: Pediatric patient population having shaft tibia, open or closed, which couldn’t reduce conservatively with traction manipulation and cast. Purpose of the study was to access the outcome of shaft tibia and femur fracture fixation with ender’s nailing which is least invasive, least complications, least expensive and excellent outcome.
Materials and methods: It is a retrospective study with 11 patients with diaphyseal fracture of tibia were managed surgically with ender’s nails at teaching tertiary care hospital with minimum of 6 month follows up. The demographic data, level of fracture, type of fracture, number of Ender’s nails, level of entry points, the direction of nail tips and the time to union are all recorded.
Results: All patients had average clinical union start time of 10 to 14 weeks. Full weight bearing was started at 8 weeks for tibia patients. No nonunion, infection, malunion was seen. As per Flynn’s criteria 64% patients with excellent and 36% patients with satisfactory outcome noted in our series.
Summary: Ender’s nail is cost effective, safe, easy to use and easy to remove intramedullary nail fixation for pediatric shaft tibia fracture. It provides stable fixation and allows rapid healing of the fractures with minimal to no complications.

Type-2 Diabetes Mellitus Asymptomatic Patients Changes in ECG (Qt - Interval) with or without Microalbuminuria: A Hospital Based Study

Dr. Kunjan P Shah, Dr. Mitali Bhikhubhai Rathod

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2066-2073

Introduction: QT interval abnormalities are the best predictors of cardiovascular deaths .Microalbuminuria is an independent marker for cardiovascular disease in diabetes mellitus. Hence QT interval abnormalities in diabetics with or without microalbuminuria were evaluated in this study.
Material and Methods: This study done in the Dept. of  General Medicine at Dr. N. D. Desai Faculty of Medical Science & Research, Nadiad, and  NAMO Medical college and research centre from( May 2021 to Dec 2021). Open label controlled study with 214 subjects of either sex. Group A healthy subjects (n=100), group B asymptomatic, type 2 diabetics with no clinical evidence of cardiac disease. Group B subdivided into B1 with microalbuminuria (n=62), B2 without microalbuminuria (n=52). Corrected QT interval (QTC), microalbuminuria, and blood pressure were measured for all subjects. QTC was calculated by using Bazzet's formula .QTC more than 440msec was considered prolonged.
Results: QTC was within normal range in diabetic patients(415+25msec). Highly significant (p<0.0001) prolongation was observed in diabetics, compared to healthy subjects. Both B1 (p<0.0001) and B2 (p<0.001) groups showed a significant increase in QTC than in healthy subjects. Among B1 and B2 groups QTC was not statistically significant.
Conclusion: QTC was more in asymptomatic type 2 diabetics irrespective of microalbuminuria compared to healthy individuals, though values were within normal range.This denotes high risk for future cardiovascular complications in diabetic patients.

A Study of Serum Ferritin Level in Vitamin B12 Deficiency: A Cross-sectional Study

Dr. Ruhan Oza, Dr. Asha Khubchandani, Dr Bhavesh Prajapati, Dr. Jatinkumar Amaliyar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2074-2078

Background: Vitamin B12 deficiency is common and clinical manifestations are hematologic and neurological symptoms. Ferritin plays an important role in the storage of intracellular iron. Studies have documented serum ferritin and vitamin B12 deficiencies to be the major causes of nutritional anemia.
Objectives: To find out and correlate the levels of serum ferritin in vitamin B12 deficiency cases as compared to normal control group
Materials and Methods: A cross sectional study was carried out in Civil Hospital Ahmedabad from August 2017 to January 2018. A total of 120 subjects matched for age (16 to 60 years) and sex were included in this study (60 Vitamin B12 deficient and 60 normal control). Serum ferritin level was assessed in both case and control groups.  Data was analyzed using appropriate statistical parameter and significance was considered when p<0.05.
Results: Mean age of the cases involved in this study was 36.15 ± 13.49 years and majority of the cases (46.7%) were belongs to age group of 16-30 years. The mean serum ferritin level in cases (66.7±76.7 pg/ml) was significantly lower than in normal controlsv(111.45±79.46 pg/ml) (P value <0.05). The ferritin deficiency in male is not highly significant as seen in females (P value <0.05).
Conclusion: The data shows that in vitamin B12 deficiency there is a correlated Ferritin deficiency seen both in males and females. It can be concluded that in patients of vitamin B12 deficiency it is advisable to check for Serum Ferritin levels also.

A clinicopathological study of breast cancer in elderly women at a tertiary care hospital

Dr. Shantkumari B, Dr. Maktum Naik, Dr. Jairaj Bhaskar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2058-2064

Breast cancer is the most common cancer in women worldwide and the second most common cause of cancer related deaths in women. Incidence of breast cancer is increasing with age as there is improvement in survival rate. It has attracted considerable interest in the study of carcinoma breast in elderly. Study was conducted on all the clinically diagnosed cases of breast cancer in the elderly women aged above 60years. Data was collected from the patient after obtaining a written informed consent. Detailed history, clinical examination and relevant laboratory investigations were done and clinical diagnosis confirmed perioperatively and postoperatively based on histopathological examination in the elderly patients. 4(8%) patients presented with clinical T1 stage, 22 (44%) patients presented with T2 Stage, 15 (30%) patients with T3, 5(10%) patients with T4a and 4 (8%) patients with T4b tumor status. 25 (50%) patients had clinically N0 Status at presentation. 20 (40%) patients were N1 at presentation, 5(10%) patients presented with N2 nodal status and 1 (2%) patients with N3 status. Infiltrating ductal carcinoma was the most common histological variant constituting 22 (44%) of the population. Clinico pathological features and treatment vary in elderly compared to young patients, Infiltrating ductal carcinoma is the most common histological variant of breast cancer seen.

Breast cancer in elderly women: Clinical profile and management

Dr. Shantkumari B, Dr. Maktum Naik, Dr. Jairaj Bhaskar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2065-2069

Clinical examination should be systematic and take account of the nature of the lump and, if present, any skin dimpling or change in contour of the breast and also assessment of the axilla for presence of axillary nodes. Breast abnormalities should be evaluated by triple assessment including clinical examination, imaging (mammography and ultrasound) and tissue sampling done either fine needle aspiration cytology or core biopsy. This study was conducted on all the clinically diagnosed cases of breast cancer in elderly women aged above 60, who will undergo treatment based on clinicopathological diagnosis of breast cancer. Data collected after obtaining written informed consent. Among 50 patients, 23(46%) patients took adjuvant chemotherapy. 5(10%) patients took both adjuvant chemotherapy and radiotherapy. 4(8%) patients took only radiotherapy. 17(14%) patients did not take any adjuvant therapy.

A study that compare anterolateral approach to posterior approach for the management of diaphyseal humerus fractures

Dr. Parth Kanubhai Panchal, Dr. Hemant Kalidas Rathod, Dr. Vatsal Yogeshbhai Patel, Dr. Niraj Parmar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2070-2080

Background: Diaphyseal humerus fractures have been treated by different approaches. Open reduction and internal fixation by plate osteosynthesis for diaphyseal humerus fracture can be done by anterolateral approach, posterior approach or minimal invasive plate osteosynthesis. There have been few trials or studies conducted to see which approach are most suitable for diaphyseal humerus fractures.
Objectives: To compare outcome of diaphyseal humerus fractures treated with open reduction and internal fixation with plate by two different approaches, anterolateral and posterior.
Methodology: It was prospective comparative study between two approaches of management of diaphysial humerus fracture. After primary assessment and stabilization of patient all routine hematological investigation and radiological investigation were done. Patients were explained about surgery, proper consent was taken and patients were prepared for operation. Each patient was assigned one of the management approaches randomly. Follow-up of patients was done postoperatively at six weeks, three months and six months and patients were assessed using American shoulder and elbow surgeon’s (ASES) scoring system.
Observations: According to Müller AO type simple transverse fractures were the most common type of fracture with 36.91% patients, followed by Simple spiral fracture (15.38%), Simple oblique fracture (11.53%), Bending wedge fracture (11.53%) and Fragmented wedge fractures (11.53%). 38.46% patients had excellent result among patients treated by anterolateral approach while 34.61% patients treated by posterior approach had excellent result. Among total 6 complications 4 were with anterolateral approach and 2 were with posterior approach.
Conclusion: Anterolateral approach is good option for upper third and middle third diaphyseal humerus fractures and posterior approach is better option for distal third diaphyseal humerus fractures.

Comparative study between pigtail catheter drainage and needle aspiration in management of liver abscesses

Dr. Vijaylakshmi GN, Dr. Niyaz Ahmed, Dr. Shrinidhi B Joshi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2081-2085

Liver abscess is a disease of frequent occurrence. Treatment modalities include both medical and surgical. However surgical drainage is the mainstay of treatment. With advent of ultrasound, percutaneous aspiration is becoming popular. Subjects from hospitals were grouped into those who underwent percutaneous aspiration and those who underwent pigtail catheter insertion. Both the groups are compared with the parameters like duration of hospital stay, duration to achieve symptomatic relief, duration of IV antibiotics required. A total of 106 subjects were studied. 52 of them underwent repeated percutaneous aspiration. 54 of them underwent pigtail catheter insertion. It is observed that pigtail catheter insertion is a better modality for larger abscess when compared to percutaneous aspiration in terms of duration of hospital stay, need for iv antibiotics and duration to achieve symptomatic relief.

Clinical profile of patients with liver abscesses admitted to a tertiary care hospital

Dr. Ajith MB, Dr. Niyaz Ahmed, Dr. Shrinidhi B Joshi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2086-2090

In Asian populations, Kiebsiella pneumoniae is the most frequent pathogen associated with cryptogenic PLA‘s. Diabetes mellitus is suggested to be an important risk factor, but the pathogenesis is still unclear. E. coli is the most common pathogen in Western countries, in both monomicrobial and polymicrobial isolates, followed by Streptococcus milleri. Anaerobes may also be cultured from PLA‘s and Bacteroides spp. are the most common isolated organism. After obtaining approval and clearance from the institutional ethics committee, the patients fulfilling the inclusion criteria will be enrolled for the study after obtaining informed consent. Case record form with follow up chart. All cases had undergone thorough history and detailed clinical examination at the time of admission. Total and differential leukocyte counts was measured with an auto-analyzer. In this study it is found that liver abscess presents with most common presentation as pain abdomen and fever. In this study it is found that fever, loose stools are presenting features of liver abscess in most of the individuals along with pain abdomen.

A prospective randomised comparative study of intrathecal nalbuphine versus intrathecal fentanyl as adjuvant to 0.5% hyperbaric bupivacaine for arthroscopic knee surgeries under subarachnoid block

Dr. M Sreya Santhoshi and Dr. Vishwa Saineer

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2091-2099

Background: Subarachnoid (spinal) block is a safe and effective alternative to general anesthesia for arthroscopic knee surgeries. Hyperbaric bupivacaine, the local anaesthetic most commonly used, don’t have the advantage of prolonged analgesia. Due to the early arising post-operative pain the role of various adjuvants has been proposed and evaluated. The present study was aimed to compare the clinical efficiency of intrathecal fentanyl with nalbuphine as adjuvant to 0.5% hyperbaric bupivacaine for arthroscopic knee surgeries. Patients and Methods: A total of 68 patients were randomly taken for this study and categorized into Group Ⅰ (nalbuphine) and Group II (fentanyl). Each group received 12.5mg of 0.5% heavy bupivacaine with 1 mg nalbuphine or 25μg fentanyl diluting it to 3 ml total volume. Sensory and motor block characteristics and time to first rescue analgesia were recorded as the primary end points. Drug‑related side effects of hypotension, bradycardia, respiratory depression, nausea, vomiting, shivering, urinary retention and pruritus were recorded as the secondary outcomes.
Results: Sensory and motor blockade and time for peak sensory level was earlier in group I as compared to group II. Mean time for 2 segments regression in Group I was prolonged as compared to group Ⅱ. Duration of motor block in Group I [241.471± 12.464 min]was significantly prolonged compared to Group II [179.265± 6.868 min] with (p=0.000). Sensory level at L4 in Group I was 406.618± 17.953 min and in Group II was 228.235± 8.694 min with (p=0.000). Rescue analgesia time in Group I [401.471±16.946 min] was significantly prolonged as compared to Group II [220.000±11.282 min] with (p=0.000). The adverse events in group I are lesser as compared to group II and was statistically significant.
Conclusion: Nalbuphine is a better adjuvant than fentanyl in spinal anesthesia for prolonging post-operative analgesia.

A prospective comparation of outcome of labour induction with vaginal misoprostol and intravenous oxytocin in term pre-labour rupture of membranes

Priyadharshini Durairaju, Pritamkumar Singh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2100-2104

Aim and Objectives: The aim of the present study was to assess the safety and efficacy of vaginally administered misoprostol 25mg with intravenous oxytocin for labor induction in term prelabour rupture of membranes.
The subjects with rupture of membranes without labor were assigned to receive either vaginally administered misoprostol 25 micrograms or intravenous oxytocin infusion this prospective study was conducted during February 2014 to January 2016 in the Department of Obstetrics and Gynecology of Regional Institute of Medical Sciences, Imphal, India.
Results and Observation: Of the 192 subjects 96 received intravaginal misoprostol and 96 received intravenous oxytocin It was observed that the average interval from start of induction to delivery was about one hour shorter in misoprostol group (12.58+4.08 hours vs 14.00+3.31 hrs) than in oxytocin group (P=0.05). Vaginal delivery occurred in 82 misoprostol treated group and in 80 oxytocin treated group (85.4% vs 83.3%, P= 0.691).Caesarean section was done in 14 of misoprostol treated subjects and in 16 oxytocin treated subjects (14.6% vs 16.7%) which is not statistically significant.
Conclusion: Vaginal administration of misoprostol is an effective alternative to oxytocin infusion for labor induction in women with prelabour rupture of the membranes at term.

Prevalence of asthma and respiratory symptoms during pregnancy: An observational study

Dr. ILA Agarwal, Dr. Shalini Nagpal, Dr. Abdul Wahab Mirza

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2105-2108

Background: Asthma attack is the most common respiratory symptom observed and is of great concern. Throughout the world asthma cases are increasing during pregnancy. The major issue is that the control levels of asthma is changing during pregnancy so the management is a little difficult during pregnancy.
Objective: The present study was undertaken to observe the prevalence of asthma and respiratory symptoms during pregnancy.
Materials and methods: 40 pregnant women attending OPD in the hospital were part of the study after obtaining the written informed consent. Confidentiality of the data was maintained. Willing pregnant women were included in the study. Pregnant women with any other complications severe were excluded from the study. Respiratory symptoms were examined during the general physical examination by an expert physician.
Results: The age group of the participants ranges from 22-30 years. 25% of individuals have asthma. 37.5% of individuals have wheeze without cold, 15% of individuals have nasal allergies. 27.5% have shortness of breath. 5% of individuals have a history of smoking. 15% of individuals are currently under the medication for asthma.
Conclusion: The present study results explained that wheezing without cold and shortness of breath are the most common respiratory symptoms during pregnancy. Further detailed studies with a higher sample size are recommended to understand better the respiratory symptoms during pregnancy.

Study of endomed sampler for endometrial biopsy, by comparing the histopathology reports as gold standard

Dr. Shibin K, Dr. Shivakumar, Dr. Sajitha AK, Dr. Nishi K, Dr. Chellamma VK

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2109-2114

Background: Abnormal uterine bleeding (AUB) is a major clinical problem in women of peri and post-menopausal age group. It accounts for 30%of outpatient population coming to a gynaecologist. Evaluation of AUB is important for ruling out endometrial carcinoma and its precursors. Endomed biopsy is an ideal method for obtaining endometrial sample with ease, low cost and without anaesthesia. To determine sensitivity, specificity, positive predictive value and negative predictive value of Endomed sampler, by comparing the histopathology reports of endometrial samplings with that of hysterectomy specimen, taken as gold standard. Methods: This study is carried out in 76 patients with abnormal uterine bleeding posted for hysterectomy. Endometrial sampling was done with Endomed in all patients. The histopathology report of endomed sample is compared with that of hysterectomy sample. Results: The mean age of study population in our study was 45.75 ± 7.19 years. The most common complaint was menorrhagia (39.5%), followed by polymenorrhagia (17.1%), dysmenorrhea and lower abdominal pain (14.5% each). Endomed sample was found to be adequate for 94.7% of the study population. Among the adequate samples, proliferative endometrium contributed to a 28.9%, followed by secretory endometrium (22.4%) and the least was hyperplasia with atypia (3.9%). Among the study population, 8 (10.5%) of them were found to have carcinoma endometrium with histopathology (HPR) report of hysterectomy specimen whereas 6 (7.9%) using Endomed sampling. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy was found to be 100%, 88.2%, 96.97%, 100% and 97.22% respectively for Carcinoma Endometrium. Conclusion: Endometrial sampling by endomed method is safe, easy to perform, highly sensitive and specific for diagnosis of endometrial carcinoma and its precursors. Endomed sampling can be used as an alternative to D&C for sampling of endometrium.

Ropivacaine a better alternative to bupivacaine: A comparative study of 0.75% ropivacaine vs 0.5% bupivacaine for analgesic efficacy under supraclavicular brachial plexus block

Dr. Divya Chandra, Dr. JP Tiwari, Dr. Sritam Mohanty, Dr. Yogesh Kumar Yadav

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2115-2126

Background and Objectives: Patients undergoing forearm surgeries have benefited considerably with the widespread use of brachial plexus block instead of general anaesthesia. This study was conducted to investigate the efficacy of 0.75% Ropivacaine in supraclavicular brachial plexus block and to compare the results with 0.5% bupivacaine, which is already established as local anaesthetic for regional anaesthesia.
Methods: Sixty patients of ASA-I and II consenting adult patients undergoing elective upper limb surgeries were randomly divided into Group A and Group B. Group A received 30 ml of 0.5% Bupivacaine and Group B received 0.75% Ropivacaine in supraclavicular block after authenticating the position of brachial plexus with nerve stimulator. Patients were monitored for peak onset and duration of sensory and motor blockade and post-operative analgesia using visual analogue scale. Patients were also observed for any complications during the surgery and in the postoperative period. Sensory and motor block peak and duration of analgesia were evaluated statistically using unpaired t-test and p-value <0.05 was considered significant.
Results: There were no significant differences between the study groups with respect to pattern of changes in Heart rate, Systolic blood pressure, Diastolic blood pressure, Mean arterial pressure perioperatively.
Peak sensory blockade was attained faster in Group B (Ropivacaine) i.e. 13.10 ±2.5 minutes compared to Group A (Bupivacaine) i.e. 23.33 ±3.1 minutes which is statistically significant. Duration of sensory blockade was also longer in Group B (Ropivacaine) i.e. 720.66 ±38.09 minutes compared to Group A (Bupivacaine) i.e. 672.66 ±105.95 minutes and is statistically significant. Onset of Motor blockade was faster in Group B (Ropivacaine) i.e. 18.03 ±2.4 minutes compared to Group A (Bupivacaine) i.e. 24.76±3.1 minutes which is statistically significant. Duration of Motor blockade in Group A (Bupivacaine) was 637.100 ±88.72 minutes compared to Group B (Ropivacaine) i.e. 646.17 ±38.07 minutes and is statistically
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not significant. Also, the time for demand of rescue analgesics was prolonged in Group B (Ropivacaine) i.e. 752.66 ±40.33 minutes compared to Group A (Bupivacaine) i.e. 694.56 ±106.14 minutes and this difference is statistically significant.
Conclusion: Ropivacaine 0.75% has an added advantage over Bupivacaine 0.5% for Supraclavicular Brachial Plexus block in terms of early onset of sensory and motor blockade, prolonged duration of sensory blockade, and prolonged duration of analgesia leading to lesser requirement of rescue analgesic. The side effects and complications rate are almost negligible in both groups. Thus Ropivacaine even at higher concentrations of 0.75% and 30 ml volume has proven to be an absolutely safe local anaesthetic. So on the basis of our study we conclude that Ropivacaine 0.75% is an excellent choice for local anaesthetic, which provides better and safer regional anaesthesia.

A Prospective hospital based observational assessment of patient with ovarian malignancies

Dr. Deepak Thakker, Dr. Shailendra V Mangnale

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2127-2133

Aim: To analyze the clinical presentation and histopathological types of ovarian malignancies.
Material and methods: A Prospective hospital based observational study was conducted in the Department of Obstetrics and Gynaecology at VIMS, Dahanu for the period of 1.5 years. Total 100 cases of ovarian tumours were included in this study. The tumours were cut and allowed to fix in 10% formalin for 24-48 hours. After formalin fixation, multiple bits were taken for histopathological examination. The blocks were cut at 3-5 microns thickness and stained with Haematoxylin and Eosin. Detailed microscopic examination of the tumour was done.
Results: Out of 100 cases of ovarian tumours, 71 were benign, 6 were tumours of low malignant potential and 23 were malignant. The youngest patient was 12 months and the oldest was 67 years forming a range of 18 months to 67 years. Highest incidence of ovarian tumour was noted in the 40-50years 38cases out of 100 cases accounting for 38%. Highest incidence of benign ovarian tumour was noted in 30-40 years 26 cases out of 71 accounting for 36.62%. Highest incidence of malignant tumour was noted in the 40-50years 12 out of 23 cases accounting for 52.17%. 37% of the patients complained of dull aching lower abdominal pain, 24% complained of abdominal mass and 6% of the patients gave history of menstrual disturbance like menorrhagia. Urinary disturbances were found in 5% patients with tumours. Out of 100 patients 9 patients were not married and all were below twenty years of age. Among married, 83were parous and remaining were 8 nulliparous. Out of 100 cases of ovarian tumors, 29 were associated with appendicitis and 14 were associated with uterovaginal prolapse.
Conclusion: The ovarian tumors manifest a complex and varied spectrum of clinical, morphological and pathological features. Correlating the clinical parameters and categorizing the tumors according to the WHO classification help us in coming to an early diagnosis, management and hence in the prognosis of ovarian tumors.

A study on role of homocysteine as a biochemical marker in various obstetrical complications

Dr. Ankana Singh, Dr. Shweta Goyal, Dr. Rajendra Goyal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2134-2140

Low plasma homocysteine (Hyc) level during an uncomplicated pregnancy was first demonstrated by Kang et al. almost 20 yrs ago, & this has subsequently been confirmed by numerous investigators. Plasma homocysteine concentrations are 30-60% lower in pregnant women than in non-pregnant women & the lowest levels are observed in the second trimester.
The study was a hospital based prospective study & carried out in the setting of department of Pathology & department of Obstetrics and Gynae, N.S.C.B Medical College over 100 Females. Homocysteine Tests are conducted at Path Care Labs. The cases with Pre-eclampsia have higher probabilities of having raised Hcy by 1.92% more compared with Non Pre-eclamptic cases and 0.21 at the worst being the Upper and Lower limits of 95% confidence intervals for Odds Ratio (OR=0.66). As per our study the Hcy levels were much raised in patients who were not taking Fe/Folate supplements (50.9%) as compared to those taking Fe/Folate supplement (4.3%) & this difference is highly significant indicating that Folate supplements help in keeping Hcy levels normal.

Intrathecal 0.5% hyperbaric bupivacaine with varying doses (30 μg Vs 60 μg Vs 90 μg) of buprenorphine in lower abdominal and lower limb surgeries; hemodynamic changes

Dr. U Sankara Rao, Dr. Richie Sanam, Dr. Moda Sree Rekha

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2141-2146

Bupivacaine hydrochloride is 2-piperidenecarboxamide-1-butyl-N-(2, 6 dimethyl phenyl) monochloride, a monohydrate is a white crystalline powder that is freely soluble in 95% ethanol, soluble in water, and slightly soluble in chloroform or acetone. Local anesthetics mainly work on the cell membrane of the axon. The considerable transient rise in sodium ion permeability that's also required for impulse transmission is inhibited. Depolarization in response to the stimulus is thereby blocked, and the resting membrane potential is preserved. A pre-anesthetic check-up was done one day before the surgery. Patients were evaluated for any systemic diseases and laboratory investigations were recorded. The procedure of SAB was explained to the patients and written consent was obtained. The preparation of patients included a period of overnight fasting. Hemodynamics during the operative period was similar in the 30 mcg group and 60 mcg, but for the 90 mcg group incidence of hypotension and respiratory depression was observed for a few cases.

Comparative study of incremental doses of buprenorphine as an adjuvant to 0.5% bupivacaine in lower abdominal and lower limb surgeries done under subarachnoid block

Dr. U Sankara Rao, Dr. Richie Sanam, Dr. Moda Sree Rekha

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2147-2154

Spinal anesthesia can be performed with a wide range of local anesthetic drugs. using local anesthetics alone is associated with a relatively short duration of action.1 Postoperative pain control is a major problem with spinal anesthesia using local anesthetics alone, and thus early analgesic intervention is needed in the postoperative period. Bupivacaine is the local anesthetic most commonly used, although lidocaine, tetracaine, procaine, ropivacaine, levobupivacaine, and prilocaine may also be used. After institutional ethical committee approval, 90 patients aged between 18-60 years undergoing lower abdominal and lower limb surgeries were selected. A detailed history, complete physical examination, and investigations were done for all patients. Informed consent was taken. The study population was divided into 3 groups with 30 patients in each group. The study has demonstrated that increasing the dose of buprenorphine with 0.5% bupivacaine in spinal anesthesia significantly decreases the time of onset of sensory and motor block and prolongs the duration of sensory, motor blockade. The requirement of postoperative rescue analgesia is also decreased as the dose increased.

Study of X-Ray findings of COVID 19 from Assam medical college and hospital, Dibrugarh, Assam

Dr. Parama Nanda Taye, Dr. Siddhartha Sarma Biswas, Dr. Mary Hazarika Bhuyan

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2155-2161

Background: The COVID-19 pandemic has led to an unprecedented surge in hospitalised patients with viral pneumonia. Chest X-Ray (CXR) is one of the important, non-invasive methods and used as a preliminary investigation to detect different pulmonary abnormalities. Present study was aimed to study X-ray findings of COVID 19 from Assam medical college and hospital, Dibrugarh. Assam.
Material and Methods: Present study was single-center, prospective, observational study, conducted in patients 18-65 years age, who were confirmed cases of COVID 19 by RT PCR or RAT testing.
Results: In present study, 220 patients satisfying study criteria were evaluated. Chest X ray abnormalities were noted in 48.18% cases initially, while in 2.73% cases, initial normal CXRs later became abnormal. 5.91% CXRs had unilateral abnormalities while 42.27% CXRs had bilateral abnormalities. Symmetrical abnormal findings was noted in 21.82% as compared to asymmetrical abnormal findings in 20.45% cases. CXRs lesion distribution was peripheral location (35.91%), central location (5.91%) & combined peripheral and central location (6.36%). Localization of abnormalities in CXRs was in Lower, Middle & upper zone in 32.73%, 10.45% & 5% respectively. Common specific radiographic abnormalities were Ground glass opacities (GGOs) (42.73%), Consolidation (23.64%), Nodularity (0.91%), Reticular opacity (5.91%) & Pleural effusion (9.55%), Severity score in present study was mild, moderate & severe in 33.18%, 11.82% & 3.18% cases respectively.
Conclusion: Chest X-ray is a valuable tool in better management of patients during the COVID-19 pandemic. Despite its lower sensitivity compared with CT scans, its inherent advantages such as reasonable cost, broad range of use, and rapid speed make it indispensable.

A study to assess the safety, efficacy of PPIUCD in a tertiary care centre in a hilly region of South India

Dr. Sowmya D, Dr. Somashekar HK, Dr. Salma Shaziya, Dr. Sowjanya D, Dr. Harsha TN, Dr. Pradhyumn GK

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2162-2168

Background: In India 65% of women have unmet need for family planning during the first year post-partum, Insertion of PPIUCD appears appealing because, High unmet need for contraception during the first post-partum period, increasing rate of institutional delivery, Long term and reversible method, it requires only once motivation, Highly effective, Long-term benefits of reducing maternal mortality burden, hence in recent past PPIUCD as a method of contraception has evolved.
Objectives: To assess the safety and efficacy of PPIUCD.
Materials and methods: This is an observational study from June 2019 to May 2020, conducted in department of OBG, Kodagu Institute of Medical Sciences to assess the safety and efficacy of CuT380A when inserted within 10 mins of placental expulsion up to 48 hours after delivery. During this period total number of deliveries were 3293. Among them 833 women had PPIUCD insertion. Counselling of PPIUCD was done during their antenatal visit, early labour, immediate postpartum and while preparing for the scheduled caesarean delivery. Post-abortal and 6 weeks postpartum IUD insertion were excluded from study.
Results: Of 3293 total deliveries, women who had PPIUCD insertion were 833(25.9%). Among them Post placental 165(19.8%), Primary cesarean delivery 550(66%) and repeat cesarean delivery 24(2.88%). PPIUCD counselling were done during antenatal period in 211 (25.3%), during early labor in 528 (63.3%) and during postpartum period 94 (11.2%). Acceptance of PPIUCD insertion was found to be 526(63.14%) among women of age 20-25 years, primipara 651(67.34%), who had at least primary education 249(29.9%). 812 women attended follow up. 651(80.17%) had no complaints, continued counselling helped. Complications like string problem (5.91%), expulsion rate (2.83%), pain abdomen (6.4%), bleeding P/V (3.94%). PPIUCD was found to be safe as there was no evidence of perforation or failure rate. 10 women insisted for removal of PPIUCD, one of the main reasons was social factor.

Ligation of Intersphincteric Fistula Tract (LIFT) versus conventional fistulectomy in management of low fistula in ano: A comparative study from a tertiary hospital

Dr. Balaji Laxmanrao Salunke, Dr. Lamture Yeshwant Ramrao

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2169-2174

Background: Fistula in ano is an abnormal track connecting the anal canal with the perineum. Different treatment modalities are available for managing anal fistulae, such as fistulotomy, fistulectomy, ligation of intersphincteric fistula tract (LIFT), seton placement, advancement flaps, and use of biological agents like fibrin glue. The present study aimed to compare Ligation of intersphincteric Fistula Tract (LIFT) versus conventional fistulectomy in treating low fistula in ano at a tertiary hospital.
Material and Methods: Present study was a single-center, comparative study conducted on patients suffering from low anal fistula between 18-55 yrs.
Results: 80 patients were divided into groups Group A (LIFT procedure) & Group B (conventional fistulectomy), with 40 patients in each group. Among various Intra-operative & Postoperative Factors, we noted that Group A (LIFT) had less mean duration of surgery, less hospital stay, less need for analgesics, less mean duration of wound healing, less mean duration of return to work as compared to Group B (Conventional Fistulectomy) & difference was significant statistically (p<0.001). Postoperative complications were more minor in Group A (LIFT) (only 1 case of incontinence) as compared to group B (Conventional Fistulectomy) (2 cases of Wound infection/Abscess, two instances of incontinence & 1 patient of recurrence), but the difference was not significant statistically.
Conclusion: The ligation of intersphincteric fistula tract (LIFT) procedure is easy to learn, perform, safe, has a high healing rate, low morbidity, quickly treats fistula in ano & better fecal continence preservation compared to open fistulectomy.

Suicidal ideation in medical undergraduate students

Dr. Vijayraj N, Jeevika Mattoo

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2175-2180

Suicide is emerging as a public health problem. Almost 800,000 people die because of suicide every year, which accounts for one person every 40 s. The suicidal ideation is increasing amongst the younger age group, particularly amongst students. However, not much is known about this problem amongst medical students in India. A study was conducted in Karwar Institute of Medical Sciences, after obtaining the permission from the Institutional Ethical Committee of the Karwar Institute of Medical Sciences, Karwar. It was a cross-sectional type of study assessing suicidal ideation in medical undergraduate students. A written consent was obtained from the students by the means of Informed Consent Form provided to them before the study. In our study, majority of the students (30%) were 21 years old. 45% of total students were male students and the rest female. Majority (84%) were Hindu and most of the students (90%) belonged to South India. 5% of students have family history of psychiatric/medical illness and 15% of total students have personal history of psychiatric/medical illness out of which anxiety (6%) was the most common illness. 15% of students reported a history of past attempts/ideation

Evaluation of treatment outcomes in aluminum phosphide poisoning patients supported by extracorporeal membrane oxygenation

Samir Gami, Ansh Purohit, Aashni Purohit, Latika Shah

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2181-2189

Background: Aluminum phosphide (AlP) is a highly toxic poison which directly affects cardiovascular system and results in death. Thus, this study was performed with the aim to evaluate the effect of venoarterial extracorporeal membrane oxygenation (VA-ECMO) on treatment outcomes in these patients.
Materials and Methods: This was a prospective study carried out for a duration of two and a half years at a tertiary care hospital in Gujarat, India. The patients who were exposed to AlP poison and were classified as high risk based on presence of myocarditis, reduced left ventricular ejection fraction (LVEF) < 30% and severe metabolic acidosis were included in the study after receiving their written informed consent. VA-ECMO was performed in these patients using femoral-femoral route. Heparin was continuously infused intravenously. The patients were weaned off of ECMO when LVEF > 35% and acidosis resolved. The data was analysed using SPSS v 19.0. P < 0.05 was considered significant.
Results: A total of 124 patients were enrolled during the study duration. The mean age of the patients was 35.74 ± 6.83 years and majority were males (75%). The average time of reaching the hospital was 160.85 ± 21.75 minutes and the average time of putting the patient on ECMO was 206.85 ± 18.21 minutes. The ECMO initiation time reduced from 180 minutes to approximately 30 minutes with average time being 60 minutes. There was a significant reduction in serum lactate levels and increase in LVEF at 24 hours, which predicted better outcomes (P = 0.001). The average ECMO run was 76 hours. Out of 124 patients, 109 were successfully discharged, while 22 developed complications and 11 patients died while on ECMO. The time of initiation of ECMO treatment was key factor involved in predicting the outcome (P = 0.01). The most common complication was bleeding at cannula site which occurred in seven patients.
Conclusion: In conclusion, VA ECMO can be used as treatment modality to improve survival outcomes in the patients with AlP poisoning. It improves LVEF and metabolic acidosis. Time of initiation of therapy plays a crucial role as an outcome predictor.

A study on the clinical profile of children aged less than 12 years with rickettsial infections

Dr. Ragavendra H Desai, Dr. Shilpa Chandrashekaraiah, Dr. Sudhindrashayana Fattepur, Dr. Madhu PK, Dr. Mahesh, Dr. Harish

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2190-2196

Rickettsial diseases are one of the most re-emerging infections of the present time. They are generally incapacitating and difficult to diagnose. Untreated cases can have fatality rates as high as 30-35% but when diagnosed properly, they are often easily treatable. It is a time bound prospective hospital based observational study and All children aged less than 12 years admitted in paediatric ward with fever without an identifiable source of infection and one or more of the following clinical features: rash, oedema, hepatosplenomegaly, Lymphadenopathy, an Eschar and a tick bite or tick exposure were suspected to have rickettsial infection. The most common age group of presentation was between 1 and 5 yrs. The common symptoms in these children included fever (100%), rash 79.4%), edema of limbs (32.4%), puffiness of face (29.4%), generalised edema (20.6%), cough (20.6%), pain abdomen (14.7%), vomiting (11.8%), convulsions (8.8%), headache (2.9%) and arthralgia (2.9%). Signs like Hepatomegaly, facial puffiness, pedal edema, splenomegaly, ecchymosis present in 53.3%, 41.1%, 38.2%, 8.8% and 5.8% of the cases respectively, mimicking common illnesses. Thus warrants high index of suspicion. There is emergence of rickettsial disease in this part of north Karnataka which might have been overlooked earlier due to low index of suspicion.

Outcome of rickettsial infections in children aged less than 12 years: Clinical descriptive study

Dr. Ragavendra H Desai, Dr. Shilpa Chandrashekaraiah, Dr. Sudhindrashayana Fattepur, Dr. Uma Chikkaraddi, Dr. Madhu PK, Dr. Mahesh, Dr. Harish

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2197-2202

Rickettsial infections are one of the important causes of pyrexia of unknown origin (PUO) and these needs to be differentiated from other febrile illnesses. Rickettsial infections are grossly under-diagnosed in India. All children aged less than 12 years admitted in paediatric ward with fever without an identifiable source of infection and one or more of the following clinical features: rash, oedema, hepatosplenomegaly, Lymphadenopathy, an Eschar and a tick bite or tick exposure were suspected to have rickettsial infection. All suspected cases were subjected to rickettsial IgM/IgG ELISA test and tests to exclude other diseases. Scrub typhus and Indian tick typhus elisa positive (mixed infection) noted in 14% of cases. Complications like meningoencephalitis (5.8%), shock (5.8%), DIC (2.9%) was observed in the study. There was good clinical response on initiation of doxycycline within 48hrs of initiation of treatment. Case fatality rate of rickettsial disease in this study was 5.8% (n=2). Rickettsial diseases are difficult to diagnose, unless suspected but treatment is easy, affordable and often successful with dramatic response to antimicrobials.

Functional outcome of Antegrade Intramedullary k-wire fixation for fifth metacarpal neck fracture

Dr. Devendrappa H, Dr. BN Pavan Kumar, Dr. Tamil Selvan, Dr. Raghavendra SB

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2203-2208

Background: The fracture of the fifth metacarpal neck (also called a boxer’s fracture) is the most common fracture of the hand. Displaced fractures often end in volar angulation of the metacarpal head, shortening, and residual malrotation. Although many fractures can be treated conservatively, surgery is indicated in patients with excessive volar angulation, relevant shortening, or rotational deformity.
Methods: In a prospective study conducted June 2019 to June 2021 we analysed the clinical results of 20 patients with metacarpal neck fractures that had been treated by closed reduction with intramedullary pre bent k-wires. Patients were followed at 2weeks, 6 weeks, 12 weeks for functional outcome and assessed by total active motion of affected and unaffected hand.
Results: Most of the patients were young, with good bone quality and low anaesthetic risk, and they had suffered the fractures as a result of a direct trauma. Predominantly uncomplicated. Surgical treatment was indicated for a palmar axis dislocation of >30° or if a rotatory deficiency >10° was present.
Metacarpophalangeal joint function and correction of rotatory displacement could be assessed on median after a period of six months. In all 20 patients flexion and extension was normal and comparable on both sides. All the patients have pain free range of motion, cosmetic acceptability, without any residual deformity and complete functional restoration.
Conclusion: Intramedullary k-wire fixation is a minimally invasive method for stabilizing metacarpal neck fractures. The excellent long-term clinical results are due to the fact that the gliding tissue around the fractures are not affected by the surgical procedure.

Functional outcome in surgical management of diaphyseal fracture of humerus treated by intramedullary interlocking nail in adults: A prospective study

Dr. Raghavendra, Dr. Devendrappa H, Dr. Sreenivasa N, Dr. Rahul

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2209-2222

Background: General incidence of humeral shaft fractures remain in the area to 1% to 2% of all fractures. Shoulder & elbow stiffness, non-union and mal-union are commonly seen with conservative treatment. Open reduction and internal fixation with plate and screws require extensive soft tissue stripping and high rates of radial nerve palsy. An interlocking intra medullary nail system is an effective and less invasive method with fewer complications. The aim of this study is to document the clinical outcome and complications associated with the use of intramedullary interlocking nail in acute diaphyseal fractures of humerus.
Methods: 30 cases of acute humeral shaft fractures in adults more than 18 were treated by closed reduction and internal fixation by Intra Medullary Interlocking Nail September 2019 to April 2020 at Vijayanagara institute of medical sciences Ballari and followed for a minimum of 6 months. Outcome was assessed by using criterion done by ROMMEN et al. series.
Results: All patients were followed up for an average of 6 to 8 months. Our series consisted of 30 patients, 19 male and 11 females. Mean radiological union in weeks was 13.6. There was one nonunion and one delayed union in our study.
Conclusion: Based on our experience and results, antegrade technique is safe & reliable technique for treating acute humeral shaft fractures. The advantages of intramedullary nailing are minimal surgical exposure, better biological fixation, minimal disturbances of soft tissues and early mobilization of neighbouring joints Interlocking nailing also avoids complications like lack of rotational control, migration of nail and requirement of supplementary bracing.

A comparative study of airtraq video laryngoscopy and direct laryngoscopy for ease of intubation

Dr. Daxa H Oza, Dr. Rachana Gandhi, Dr. Payal K Berawala, Dr. Purvi D Thakkar, 5Dr. Priya R Bhagora

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2223-2231

Background: The most common route for tracheal intubation is orotracheal where an endotracheal tube is passed from oropharynx to trachea. Anatomical and physiological characteristics of the patient make intubation sometimes difficult. Video laryngoscope has more ease of intubation compared to direct laryngoscopy for both experienced and inexperienced person.
Objective: The present study was done to compare direct laryngoscopy with Airtraq videolaryngoscope in non-difficult airway for ease of intubation and study hemodynamic changes.
Materials and Method: Study was conducted on 60 patients presented for elective surgery under general anaesthesia. Patients were divided into 2 groups-V & D. In group D, direct laryngoscopy was performed with macintosh blade and in group V, videolaryngoscopy was performed with Airtraq video laryngoscope.
The number of attempts required, failure to intubate and time for intubation were noted. Any loss of airway, orodental injury to patient, cough response during intubation were noted.
The HR, SpO2, SBP and DBP were noted at induction (baseline), 1, 3, 5 and 15 min after intubation.
Result: Number of attempt require to intubate patient in both group-not significant. Average time for intubate patients with group V -23.1 second, compared to group D-20. 1 second, that was significant. It was longer in Group V. Heart rate-significantly increase at 1 min, 3 min, 5 min and 10 min in Group D patients .Systolic BP and Diastolic BP- Significantly increase at 1 min and 3 min seen in group D and receded to baseline value at 5min and thereafter. No significant difference seen in Spo2 in both group.
Conclusion: In our study, Airtraq video laryngoscope resulted in significantly lesser hemodynamic response compared to direct laryngoscope. Little more intubation time required in videolaryngoscope compared to direct laryngoscope but that didn’t affect much. Videolaryngoscope gained popularity as an intubation device in the hands of both airway experts and non-experts.

A retrospective assessment to determine the incidence and indication for hysterectomy in tertiary care facility

Dr. Vani H Patel, Dr. Maulik K Mehariya, Dr. Vishal S Patel

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2232-2236

Aim: to study the incidence and indication for hysterectomy in the study population.
Materials and Methods: A Retrospective study was conducted in Department of Pathology, over the period from June 2015-May 2017. Hysterectomy specimen with or without unilateral or bilateral adnexa received in the department. The specimens were analyzed in detail macroscopically for various parameters like size, external surface, and consistency and cut sections.
Results: Out of total 10230 histopathological specimens received at department of Pathology from June 2015 to May 2017, hysterectomy specimens were 609 accounting for of total specimen received. Hysterectomy specimens were received from a wide range of age groups varying from 15 years to 81 years. The average age for undergoing hysterectomy was 43.05 years. Majority of cases (44.01%) were from the 5th decade followed by 4th decade (36.95%). Among the 609 cases, the major clinical diagnosis for which hysterectomy was performed included DUB (32.35%), Fibroid (29.39%) and Prolapse (16.09%). 6 Hysterectomies were performed for malignant lesions (Carcinoma of cervix, Endometrial carcinoma and Ovarian malignancy) and 24 Obstetrics Hysterectomies were done.
Conclusion: Maximum numbers of patients were from the 5th decade followed by 4th decade. DUB, Fibroid and Uterine Prolapse were the major clinical diagnosis before Hysterectomy was done.

Analyzing the trace elements like serum iron, serum zinc and serum ferritin levels with alopecia within the Indian population

Dr. Payasvi Sachdeva, Krishna Chaitanya Paleti

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2237-2249

Introduction: Background: The actual a etiology of alopecia Areata is unknown, despite the fact that immunologic processes and hereditary factors are considered to play a role. Iron deficiency has been mentioned as a contributing cause, but its significance is questionable. Patients had higher mean blood iron and ferritin levels and lower mean TIBC levels than control individuals in our case control study, however the differences were not statistically significant.
Aim: To analyze the Trace Elements like Serum Iron, Serum Ferritin & Serum Zincin Alopecia areata and in controls.
Materials and Methods: The current study included 150 A.A patients (cases) and 150 controls who attended the Department of Dermatology at L.N. Medical College and Research Center and J.K Hospital in Bhopal, in collaboration with the Department of Biochemistry. The levels of Iron, Ferritin and Zinc were determined using the colorimetric method.
Results: A total of 300(150 cases of AA +150 controls were included Iron, Ferritin & Zinc with mean+ SD are given in the Table no. 1. The two groups were comparable (P<0.0001), (P<0.0001).
Iron: Iron levels in controls is 100.44 ±32.94 μg/dl, Iron levels in AA is 33.147 ±11.88μg/dl. The difference in the values Serum Iron parameters in respect of these groups was highly statistically significant (P<0.0001*).
Ferritin: Ferritin levels in controls is 156.74±30.33 ng/dl, Ferritin levels in in Alopecia patients is 25.92 ±12.74 ng/dl. The difference in the values Serum Ferritin parameters in respect of these groups was highly statistically significant (P<0.0001*).
Zinc: Zinc levels in controls is 108.66 + 26.23 μg/dl, Zinc levels in Alopecia patients is 31.007 + 12.702 μg/dl. The difference in the values Serum Zinc parameters in respect of these groups was highly statistically significant (P<0.0001*).
Conclusion: The widespread effect of reduced iron storage on a variety of etiologically diverse types of hair loss is explained by a threshold theory. Understanding the function of iron in hair loss might lead to the development of new therapies and the production of hypotheses to better understand the biochemical basis of these disorders. Future AA tests should include ferritin levels as a component.

Role of MDCT Scan in evaluation of neck mass lesions

Dr. Nila Gandhi, Dr. Akash Thakkar, Dr. Sambhav Shah

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2250-2258

Aim: To localize and characterize neck lesions with respect to anatomical delineation, extension to adjacent structures and bony involvement.
Materials and Methods: For this prospective study the data was collected from patients attending department of radio-diagnosis at LG Hospital, AMCMET medical college, Maninagar Ahmedabad. Total 150 patients presented with symptoms of palpable neck mass and neck pain were recruited. Patients were evaluated with Multidetector CT (Mx Philips 16 slice) and patients who were diagnosed having neck mass on CT scan study. The pathological lesions were evaluated with respect to the density, size of the lesion, location of the lesion, enhancement pattern, presence of calcification, presence of fat, extension into adjoining structures and presence or absence of venous thrombosis and bony involvement.
Results: Most common benign neck mass was in the age group of 31-40 years. Incidence of malignant lesions was observed between 61-70 years (40%). Higher incidence among males was noted with a male to female ratio of 2:1. Necrosis was present in 67.6% of the malignant lesions. Bony involvement was seen in 34 cases (40.47%) of the malignant lesions. Vascular involvement in the form of jugular vein thrombosis was seen in 10.71% of malignant lesions. Extension into the adjacent space was seen in 43 (51.19%) of malignant lesions.
Conclusion: The most common space involvement was parapharyngeal space (24%) followed by pharyngeal mucosal space (18%). MDCT has 96% accuracy in diagnosing neck lesions. MDCT has 100% accuracy in predicting bony involvement in head and neck cancers.

Comparison of serum zinc level between adult males with febrile urinary tract infection & healthy males

Payasvi Sachdeva, Sheloj Joshi, Soniya Saxena, Shweta Anand, Poonam Arora

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2259-2263

Background: Urinary Tract Infection (UTI) is one of the most common cause of hospital admission in adult males. Zinc is the second most abundant mineral in the body involved in the cell growth, cell division and regulation of immune system activity. In studies, zinc administration has been effective in improving gastroenteritis in adults. However, rare studies have been conducted on this subject. The present study aimed to compare the serum zinc level between males with febrile Urinary Tract infection & healthy males as control.
Objective: This study was performed to compare serum zinc level between males with febrile UTI and healthy males.
Method: In this case-control study, serum zinc levels for 50 adult males of more than 50 years of age with urinary tract infections were compared with the serum zinc levels of the same number of healthy males in the control group who were matched in terms of location and age. Using SPSS ver. 18, univariate analysis was performed through t-test, correlation coefficient; and multivariate analysis was carried out through multiple regression tests. Significant level was considered as less than 0.05.
Results: There was a weak correlation between age and serum zinc level (r=-0.203, p=0.043). Mean serum zinc level of the test group and the control group were 74.31 (±15.01) and 94.41 (±9.12) microgram/deciliter (p=0.001), respectively. The group with UTIs had lower zinc levels than the control group (p=0.010, R2=0.366).
Conclusion: According to the results of this study, serum zinc levels of people with urinary tract infections were lower than that in the control group. It seems that zinc levels are a risk factor for urinary tract infections.

Study of the normal interpeduncular angle range and gross dimensions of the brain across different age groups in the South Indian population

Dr. Deepa Korula, Dr. Sivakanmani Chithiravelu, Dr. Vamsi Krishna Maddineni

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2264-2269

Background: The interpeduncular angle in the brain is defined as the angle formed by the medial margins of the posterior half of the cerebral peduncles on axial MRI brain images. Our study was aimed to assess the normal interpeduncular angle, ponto-mamillary distance and maximum AP and lateral diameters of the brain across various age groups in the Indian population & to establish reference values for the same which may aid in clinical diagnosis.
Material and Methods: The study was a single-center, retrospective, observational study. The brain MRI studies for patients with non-specific complaints over a 6 month period were included in the study.
Results: 400 cases (50 cases were included per decade from 10 to 90 years age groups) were studied. The maximum lateral dimensions of the brain appear to slightly decrease with each decade of life as expected however the maximum AP diameter was relatively constant. The ponto-mamillary distance showed no specific trend and remained relatively constant across all the age groups. The inter-observer variation was good for the interpeduncular angle, pontomamillary distance, maximum lateral and AP diameters of the brain.
Conclusion: The interpeduncular angle was found to slightly increase with each decade of life. The maximum lateral dimensions of the brain appear to slightly decrease with each decade of life as expected however the maximum AP diameter was relatively constant.

A study of ovarian lesions among various age group and to correlate them with the clinical features

Abhilash NP, Vanisri HR, Mudassar Ahmed Shariff, Raghavendra D

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2270-2276

Background: Tumours of the ovary are common forms of neoplasms in women. The pathology of ovarian neoplasms is one of the most complex areas of gynaecology, because the ovary gives rise to the greater and larger variety of tumours than any other organ. While in other organs, tissue of origin is usually clear, tissue from which an ovarian tumour arises is often uncertain and most of the development of the presumptive tissue is often in disparity.
Objectives: To determine the nature of ovarian masses presented to Department of Pathology, CIMS during the last 2 years.
Methodology: The present retrospective record based observational study was conducted by the department of Pathology from March 2022 to May 2022 from the data of the patients from the records from January 2019 to December 2021. All the specimen obtained in the Department of Pathology for Histopathological examination during the study period from the patients diagnosed with ovarian lesion in the hospital were included for the study.
Results: In the present study majority (29%) of them belonged to 30 to 40 years of age, 23% of them were aged less than 20 years. In the present study 65% of them complained of Mass per abdomen, 40% of them had pain in abdomen, 10% had ascites, 9% had menstrual irregularities, 5% had infertility related issues and 5% of them were asymptomatic in nature. The highest incidence of Benign tumor was seen in the age group of 30 to 40 years (32.5%), in the age group of less than 20 years it was 25.9%. The Malignant tumor was found to be more common those aged more than 40 years with 26% of them in 40 to 50 years of age, 21.7% of them in 50 to 60 years of age.
Conclusion: In conclusion, a variety of clinical factors, including the patient's age, presenting symptoms, the location and size of the lump and the histological type of the ovarian tumour, are all connected. All of these clinical and histomorphological characteristics, as well as cutting-edge, more modern diagnostic techniques like immunohistochemistry and morphometric analysis, can aid in early diagnosis, the planning of a course of therapy and prognostic information.