Online ISSN: 2515-8260

Volume 9, Issue 5

Volume 9, Issue 5, Summer 2022


A COMPARATIVE STUDY BETWEEN DEXMEDETOMIDINE PREMEDICATION AS AN ADJUVANT TO FENTANYL AND FENTANYL ALONE IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY SURGERIES UNDER GENERAL ANAESTHESIA

Dr. Pothala Aiswarya Roy, Dr. Janapati Suresh, Dr. Kiran Kumar Suggala

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 1-7

Dexmedetomidine is a highly selective alpha 2 agonist with properties of sedation, analgesia and anxiolysis. The purpose of this narrative review was to assess the effect and safety of dexmedetomidine in not only decreasing the magnitude of haemodynamic responses to laryngoscopy, surgery and pneumoperitoneum especially when used together with fentanyl but also decreases the dose of opioids and anaesthetics in achieving adequate analgesia and anaesthesia respectively. Intraoperative administration of dexmedetomidine is associated with decreased postoperative pain, opioid and analgesic consumption and it assures haemodynamic stability.

TRANSFUSION OF BLOOD AND BLOOD PRODUCTS IN OBSTETRICS AT A TERTIARY CARE HOSPITAL: A PROSPECTIVE OBSERVATIONAL STUDY

Stuti Shah, Shlok Patel, Dr. Rina Patel, Dr. Anshum Patel, Karan Jayesh Shah, Rahil Patel, Karan Hiren Shah

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 8-15

Background: Anemia and obstetric haemorrhage are major causes of maternal mortality. Both of those are the commonest indications requiring blood and component transfusion. Blood transfusion is a crucial component of comprehensive emergency obstetric care. This study was aimed to explore indications for blood and blood component transfusion in obstetrics.
Methods: This prospective observational study was carried out from January 2022 to June 2022 at a tertiary care hospital in Department of Obstetrics and Gynecology. Data was gathered from all patients who underwent transfusion of blood and/or blood products for any obstetric issue.
Results: During the study period, total 200 patients were transfused with blood and/or blood components. Two most common indications for blood transfusion were obstetric haemorrhage (64.5%) and anemia (43%). 180 patients were given PCV (90%), 80 patients received FFP (40%), 86 received PRC (43%) and 12 received cryoprecipitate (6%).
Conclusion: Maintaining a proper transfusion schedule, keeping transfusion minimum and, only using when absolutely indicated, may make blood transfusion safer and more effective. Awareness about blood donation should be increased.
 

A PROSPECTIVE COMPARATIVE STUDY OF THE OUTCOMES BETWEEN CHOLEDOCHODUODENOSTOMY AND CHOLEDOCHOLITHOTOMY WITH T-TUBE CLOSURE IN MULTIPLE CBD STONE

Dr. Biswaraj Sarkar, Dr. Anarsh Debbarma, Dr. Rajib Debnath

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 16-20

Background: Common Bile Duct Stones (CBDS) are one of the medical conditions leading to surgical intervention. They may occur in 3% 14.7% of all patients for whom cholecystectomies are performed. When patients present with CBD STONES, the one important question that should be answered: what is the best modality of treatment under the given conditions? There are competing technologies and approaches for diagnosing CBDS regarding diagnostic performance characteristics, technical success, safety, and cost effectiveness.
Aim and Objectives of the study: The objective of the study to compare the outcomes of Choledochoduodenostomy (CDD) versus choledocholithotomy and insertion of a T-tube in subjects with multiple CBD stones.
Methodology: This study was conducted in the Dept. of Surgery, Tripura Medical College. we included a total of 60 subjects divided into two groups, Group A and Group B with 30 subjects in each group. Group A underwent choledocholithotomy and insertion of a T-tube and Group B underwent Choledochoduodenostomy. Details of the study were told to the patient and informed consent was taken. After obtaining consent, the patient underwent procedure as per the study design. We compared the parameters, mean operating time (minutes), mean duration of stay at hospital (days), frequency of wound infection and post-operative serum bilirubin.
Results: We compared mean operating time (minutes), mean duration of stay at hospital (days), frequency of wound infection and post-operative serum bilirubin between the two groups. The Mean operating time (minutes), mean duration of stay at hospital (days), frequency of wound infection and post-operative serum bilirubin in Group A were 68 ± 11.8, 8 ± 1.82, 11% and 0.78 ± 0.33 in Group B were 98.6 ± 10.1, 14 ± 3.21, 26% and 1.7 ± 0.97 respectively. There was statistically significant difference in all the parameters between the two groups.
Conclusion: Both Choledochoduodenostomy and T-tube drainage after CBD exploration are equally good procedures for the treatment of uncomplicated choledocholithiasis. However, choledocolithotomy and insertion of a T-tube is having significantly lower operating time and
less duration of stay at hospital. Therefore, it can be recommended for treatment in selective patients of choledocholithiasis.
 

PREDICTION OF HYPERTENSIVE DISORDERS IN EARLY TRIMESTER OF PREGNANCY

Dr. Shashi Jyothsna Parlapally, Dr. Vanitha CH, Dr. Pilli Rajitha

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 21-30

Background and objectives: Predicting preeclampsia (PE) at 11-14 weeks of gestation is a new concept. Studies integrating multiple factors at 11-14 weeks of pregnancy have been conducted, but an algorithm with a good predictive value has yet to be created. This study aimed to design a methodology combining MAP, Uterine artery Doppler, and PAPPA at 11-14 weeks of pregnancy to predict PE in India. Basically objective is to determine whether higher Mean Arterial Pressure (MAP), increased Uterine Artery Pulsatility Index (UAPI), and low Pregnancy Associated Plasma Protein A (PAPP - A) between weeks 11-14 of pregnancy are linked to the growth of hypertensive diseases in pregnancy.
Method: This is a prospective cohort study. Data were obtained from 200 registered patients attending antenatal OPD in hospitals between 11 and 14 weeks of gestation. MAP, blood pressure, uterine artery Doppler, and serum sample for PAPPA were measured. IBM SPSS Version 22 for Windows was used to analyse the data.
Result: There were a total of 200 women enrolled in the study, and 24 of those women (37.1%) suffered difficulties. At 11-14 weeks of pregnancy, the uterine artery doppler pulsatality index (PI) was found to be an effective screening tool (sensitivity 29%, specificity 90%) for the prediction of pregnancy.
Conclusion: This study revealed that the uterine artery Doppler Pulsatality index is an effective screening approach for women at high risk of developing preeclampsia and related complications during the 11th to 14th week of pregnancy.
 

SIMULTANEOUS USE OF DEXMEDETOMIDINE AND CLONIDINE AS POTENT ADJUVANT TO ROPIVACAINE FOR EPIDURAL ANESTHESIA IN LOWER LIMB AND LOWER ABDOMINAL SURGERIES; A COMPARATIVE STUDY

M. Prashanth, Shepuri Swetha

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 31-38

Background: The potential and duration of analgesia can be increased by adding a suitable alpha 2 adrenergic agonists as adjuvants to ropivacaine during elective lower limb surgical procedures under epidural anaesthesia. Still there is a scope for research on the effects of clonidine and dexmedetomidine as potent adjuvants in epidural local anesthetics. The aim of our study is to compare the effect of clonidine and dexmedetomidine when used as an adjuvant to epidural ropivacaine in lower abdominal and lower limb surgeries.
Materials and Methods: Patients were randomized into fourgroups Group R (n=30) patients received 10ml of 1% isobaric ropivacaine alone, Group RC (n=30) patients received 10ml of 1% isobaric ropivacaine with clonidine 1μg/kg, Group RD (n=30) patients received 10ml of 1% isobaric ropivacaine with Dexmedetomidine 1μg/kg, Group RCD (n=30) patients received 10ml of 1% isobaric ropivacaine with 0.5μg/kg Dexmedetomidine and 0.5μg/kg of clonidine. Onsetofsensory analgesia using colds wab, onset of motor blockade using Bromage scale, time to 2 dermatome regression of sensory level, time to first demand for analgesia, sedationusing Ramsaysedation scale, intra operative hemodynamic parameters and complication swere assessed.
Results: The impressive and practically applicable results were obtained in Group RCD with respect to Results: The impressive and practically applicable results were obtained in Group RCD with respect to time for onset of analgesia (29 ± 3.9 sec), maximum sensory level (T 4.12 ± 1.1), time to peak sensory level (3.49 ± 1.2 min), time for two segment sensory regression (150 ± 12.3min), time taken for sensory regression to s1 (372.5 ± 17.1), duration of analgesia (439.3 ± 64.6 min), regression to Bromage 0 (41±11.3), onset to Bromage 3 (390 ± 32.9 min) and vas score (3.10±0.50).
Conclusion: The study results strongly conclude the use of 0.5μg/kg Dexmedetomidine and 0.5μg/kg of clonidine as aneffective adjuvant to10ml of 1% isobaric ropivacaine forepiduralanesthesia in lower limb and lower abdominal surgeries.

Association of caregiver burden with cognition in persons suffering from Schizophrenia

Dr. SVR Naga Pavan Kumar Kampalli, Dr. Prasanna Kumar Neredumilli, Dr. Phaniram Vavila

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 39-45

Introduction: Schizophrenia is a chronic psychiatric illness which ahas enormous impact on the persons suffering from the illness as well as the persons taking care of them. Cognitive deficits are common in the persons suffering from Schizophrenia, which further lead to impairment in the daily living of the individual. Caregiving of persons with Schizophrenia places a significant burden on the caretakers and this study tries to study the association between the caregiver burden and the cognitive deficits in persons suffering from Schizophrenia.
Aims:
1)      To measure the cognitive deficits in persons suffering from Schizophrenia.
2)      To find the caregiver burden in the caregivers of persons suffering from Schizophrenia.
3)      To find the relationship between the caregiver burden with cognition of persons suffering from Schizophrenia.
Materials and Methods: This is an cross-sectional study and the study sample consisted of 60 persons suffering from Schizophrenia and their respective caregivers attending the Government Hospital for Mental Care, Visakhapatnam. Persons suffering from Schizophrenia’ cognitive status was assessed using the Cognitive Assessment Interview (CAI). Caregivers’ sociodemographic data was taken and the caregivers’ burden was assessed using the Burden Assessment Schedule (BAS). Statistical analysis of the data was carried out using SPSS software version 23.
Results: The mean Global Cognitive assessment score was 2.73 with a S.D. of 0.74. The mean score of caregiver burden according to the BAS was 76.9 with a S.D. of 6.7. There was a statistically significant correlation between the global cognitive score and the caregiver burden (r=0.783, p<0.01).
Conclusions: This study concludes that there is cognitive impairment seen in persons suffering from Schizophrenia. Caregivers of persons suffering from Schizophrenia have significant burden. There is a significant correlation between the cognitive impairment and the caregiver burden.

Study of morbidity profile and its occupational determinants of female class IV Employees (Aayas and Mehatranis) in a municipal tertiary care teaching hospital in Mumbai, India

Bhagyashri D Gawari, Sujata R Lavangare, Gajanan D Velhal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 46-53

Occupational health should aim at the promotion and maintenance of the highest degree of physical, mental and social wellbeing of workers in all occupations. The job of being a class IV employee entails several occupational hazards which pose a great danger to the health and wellbeing and life of the worker. Class IV workers are exposed to accidental hazards and suffer from occupational hazards like musculoskeletal and respiratory disorders, eye ailments, skin and gastrointestinal problems and injuries. The problems of women are overlooked and hence are at a major risk of occupational related diseases. The occupational determinants to which female class IV employees are exposed can be classified as under physical, environmental, psychological and as a result of movements. Hence the present study was carried out to assess the morbidity profile and their prevalence amongst female class IV employeesof municipal tertiary care teaching hospital in Mumbai city.
Methods: Across-sectional study was carried out amongst 287 female class IV employees (Aayas and Mehatranis) of municipal tertiary care teaching hospital in Mumbai during the period of April 2017 to December 2018. A semi-structured interview schedule was prepared comprising of occupational determinants influencing health and morbidity profile. Data was entered in MS Excel and analysed in the form of percentage and proportions whenever necessary.
Results: Out of total 287 participants, majority ie102(35.5%) had musculoskeletal problems followed by 85(29.6%) respiratory problems, 63(21.9%) suffered from eye problems, 45(15.7%) had skin problems and 24(8.4%) had gastrointestinal problems, 20(6.9%) had gynaecological problems and only 4(1.4%) had injuries. 44.3% of study subjects were partially immunized with Hepatitis B vaccine and 24% were unimmunized.21.6% had history of needle prick injury in past one year with finger as the most common site.40.8% subjects consumed smokeless tobacco in various forms.

A comparative study of dexmedetomidine and dexamethasone as adjuvants to ropivacaine in supraclavicular brachial plexus block

B Vani Prapurna, V Sudharani, S Kiran Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 54-60

Background: Enhancing the duration of sensory and motor blockade of regional anaesthesia is often desirable for prolonged surgeries and also provides pain relief in the immediate postoperative period. We performed a prospective, randomised, study to evaluate the effect of Dexmedetomidine and Dexamethasone as adjuvants to Ropivacaine in supraclavicular approach of brachial plexus block.
Study design: The study was a controlled, randomised, double-blinded, prospective study.
Methods: Sixty ASA physical status 1 and 2 patients undergoing elective hand, forearm and elbow surgeries under brachial plexus block were randomly divided to receive either 8 mg Dexamethasone + 30ml 0.5% Ropivacaine or 1 mcg/kg Dexmedetomidine + 30 ml 0.5% Ropivacaine. The block was performed using a nerve stimulator. Onset and duration of sensory and motor blockade and total duration of analgesia were measured. Vitals were recorded at 3, 5,10,15,30 and 45 minutes. Two sample ‘t’ test of difference between two means was used to analyse the differences between various parameters that were used in the cases. Categorical data was assessed by Chi square test and Fishers exact test. P value of < 0.05 was considered significant.
Results: The onset of sensory block and onset of motor block both were found to be sooner with Dexmedetomidine than Dexamethasone. The duration of sensory block and motor blockade and duration of analgesia was longer with Dexmedetomidine than Dexamethasone.
Conclusion: Both Dexmedetomidine and Dexamethasone enhanced the onset and duration of blockade but, the effect was found to be more pronounced with Dexmedetomidine.
 

To study the seroepidemiology of measles at a tertiary care centre

Dr. Meda Shailaja Rani, Dr. P Tejaswi Sai, Dr. V Sudha Rani, Dr. P Shashikala Reddy

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 61-70

Back ground: The "gold standard" for diagnosing an MV infection in a lab is the presence of particular immunoglobulin M (IgM), which can be detected using either an ELISA (enzyme-linked immunosorbent assay)or immunofluorescence. A most popular type of testing is serological because it is quick, affordable, and reliable and can be done in a high-throughput setting. According to earlier research comparing IgM tests, with RT-PCR-based assays as a reference, sensitivities ranged from 89.9 to 98.8% and specificities ranged from 92.5 to 97.9%.
With this background, this study was conducted to serologically diagnose clinically suspected cases of measles by IgM Antibody detection in our setting and also to correlate measles infection with vaccination status.
Materials and Methods: We included all patients aged less than 24 years belonging to both genders visiting the Paediatrics/Medicine OPD at Sir Ronald Ross Institute of Tropical and Communicable diseases, Nallakunta, Hyderabad, during March 2019 to March 2020. The sample size considered was 100. ELISA kit with IgM for measles was used to serologically diagnose measles in suspected cases.

PRE-OPERATIVE ASSESSMENT TO PREDICT DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY

Mandapati Mallikarjuna Reddy, K.L. Narayana Rao

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 71-93

Background: This research aimed to determine, prior to surgery, what factors, if any, could help a surgeon anticipate a "difficult cholecystectomy" using either laparoscopic or open surgery. Consecutive patients undergoing cholecystectomies (both open and laparoscopic) for gallstone-related disorders are analysed to see which factors best predict the presence or absence of surgical complications. The goal of this study is to determine which clinical, laboratory, and radiographic criteria are most indicative of difficult dissection during cholecystectomy. To develop a scoring system prior to surgery that can accurately predict the result during the procedure.
Results: A cholecystectomy is a common surgical procedure. Those who experience symptoms from gallstone disease are increasingly likely to opt for laparoscopic cholecystectomy. The incidence of both complications and conversions are higher in patients who are already at high risk, as well as in complex cases that provide technical challenges. The current study included 123 individuals with confirmed cases of cholelithiasis who were scheduled to have surgery. The results and discoveries were recorded and scored intraoperatively. The range of possible grades was 0–15. In this case, a score of 5 or below indicated an easy task, 6–10 indicated a moderately difficult task, and 11–15 indicated a very challenging task. Two categories, "Easy" (scores of 5) and "Difficult" (scores of >6), were made for the purpose of statistical analysis. Demographic, clinical, laboratory, and imaging parameters were collected before to surgery and compared to the two intra-operative groups to identify any possible correlations.
Conclusion: 123 patients with cholelithiasis were the subjects of a prospective study. Data from these patients' demographics, imaging, and metabolic profiles, as well as their intra-operative outcomes, were compared. All 123 patients used in the study underwent laparoscopic procedures. Of the 123 cholecystectomies performed laparoscopically, 113 were successful without having to resort to open surgery. In this analysis, we find a conversion rate of 8%. It is 33.3% greater in cases of acute cholecystitis.

“ROLE OF RAISED SERUM BILIRUBIN LEVELS IN THE PREDICTION OF APPPENDICULAR PERFORATION”

Mandapati Mallikarjuna Reddy, Vanga Devi Harsha

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 94-114

Background: Given the foregoing, the aims of the present study were to (1) establish whether hyperbilirubinemia is associated with acute appendicitis; (2) evaluate its validity as a diagnostic marker for acute appendicitis; and (3) establish whether elevated bilirubin levels might predict appendicular perforation. The goal of this study is to determine whether or not preoperative serum bilirubin levels are useful for diagnosing appendicular perforation. The goals of this study were to (1) determine whether serum bilirubin is associated with acute appendicitis, and (2) evaluate its usefulness as a diagnostic marker for this illness. For the purpose of determining whether or not elevated serum bilirubin levels can be used as a predictor of appendicular perforation.
Results: Eighty individuals who were diagnosed with acute appendicitis or appendicular perforation and needed immediate appendectomy were included in our analysis. Subjects were given proper resuscitation prior to participation in the study. In order to collect and record patient data, we employed the standard proforma. Patients with complex appendicitis often require a longer recovery time (9.5 days) than those with acute appendicitis (5.5 days). The postoperative diagnosis is statistically significantly related to the length of hospital stay (p0.0001). This highlights the need for a novel diagnostic aid for acute appendicitis. Hyperbilirubinemia has been linked to acute appendicitis, and its significance to the condition has been hypothesised in the medical literature. The hope that serum bilirubin would be useful as a new laboratory marker in the diagnosis of acute appendicitis prompted the current investigation. The purpose of this research was to investigate the association between hyperbilirubinemia and acute appendicitis, to test its validity as a diagnostic marker for this condition, and to determine whether or not elevated bilirubin levels are a reliable predictor of appendicular perforation.
Conclusion: Eighty patients hospitalised with a preoperative diagnosis of acute appendicitis who underwent emergency appendectomy between November 2019 and October 2021 will be included in a two-year prospective study conducted by the Department of General Surgery at NRI Medical College, Chinakakani. The total blood bilirubin levels of individuals with perforated and gangrenous appendicitis were substantially greater than those of those with acute appendicitis. When predicting gangrenous or perforated appendicitis, a high total serum bilirubin level has a high negative predictive value but low specificity. Total blood bilirubin is therefore a valuable indicator in patients suspected of perforated or gangrenous appendicitis, and should be used in conjunction with the clinical examination and other laboratory techniques to evaluate patients suspected of appendicitis.

STUDY ON THE EFFECT OF CRYSTALLOID PRELOADING ON INDUCTION DOSE REQUIREMENT OF PROPOFOL

Shepuri Swetha , M. Prashanth

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 115-121

Background: Propofol is one of the most commonly used anaesthetic drugs. Extensive researches have been done on the factors affecting the induction dose requirement of propofol forbetter hemodynamic stability. In the literature there is no mention on the dose requirement of propofol in the hydrated patients. This prospective randomized double blind study was done to assess the effect of preloading on induction dose requirement of propofol in patients undergoing general anaesthesia requiring endotracheal intubation.
Materials and Methods: Two hundred forty adult patients requiring endotracheal intubation under general anaesthesia were randomly divided into two groups, the study group and the control group. Study group received 20 ml/kg of normal saline over 2 hours, 4 hours prior to the induction of general anaesthesia and control group did not receive any fluid preloading. General anaesthesia was induced with titrated doses of propofol with the aid of BIS monitoring. The dose requirement of propofol, hemodynamic stability (HR, SBP, DBP and MAP was measured at intubation (0 min), 1 min, 2 min, and 3 min post intubation) and awareness during anaesthesia was assessed in both the groups.
Results: The dose requirement of propofol in the study group was 00.62±0.12 mg/kg and 1.24±1.30mg/kg in control group. There was no clinically significant change in the hemodynamic parameters between both the groups. None of patients in either group had awareness under general anaesthesia which was assessed post operatively using Brice questionnaire.
Conclusion: Crystalloid preloading reduces induction dose requirement of propofol during general anaesthesia with better hemodynamic stability.

SKINTED: An unfamiliar and overlooked complication of total knee arthroplasty

Dr. Farzana Ansari, Dr. Nidheesh Agarwal, Dr. Anuj Kothari, Dr. Manish Jain

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 122-125

Surgery of the Knee, injury to the infrapatellar branch of the saphenous nerve, Traumatic Eczematous Dermatitis (SKINTED) is a neuropathic dermatitis secondary to iatrogenic injury to infrapatellar branch of the saphenous nerve during the surgeries around the knee, mainly total knee arthroplasty (TKA). The infrapatellar branch of the saphenous nerve is most often resected during total knee replacement surgery using median para-patellar incision. It is an underreported entity in dermatology literature. In this paper, we report 5 cases of SKINTED who presented with eczematous rash over knee after several months of TKA. Dermatologists as well as orthopedicians should be well aware of this manageable condition as its timely diagnosis and treatment can prevent unnecessary dissatisfaction in patients who have undergone TKA.

Comparative study of 0.25% bupivacaine and 0.25% bupivacaine with fentanyl for caudal epidural anaesthesia and analgesia in children undergoing lower abdominal surgery

Dr. Karnakar V, Dr. Yugandhar Kandula, Dr. Suresh Janapati, Dr. Kiran Kumar Suggala

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 126-131

Background: Caudal epidurals are commonly performed for postoperative pain management in children undergoing abdominal and lower limb surgeries. Bupivacaine is considered the most common local intrathecal anesthesia for children. Various adjuvants were combined with the local anesthetic to increase intrathecal block quality and extend analgesia duration. Present study was aimed to compare bupivacaine versus bupivacaine with fentanyl for caudal epidural anaesthesia and analgesia in children undergoing lower abdominal surgery.
Material and Methods: Present study was comparative, double blind, observational study, conducted in children aged between 1 and 10 years, either gender, ASA class I and II, scheduled to undergo lower abdominal surgery, parents consented for participation. Children were divided as Group A, receiving bupivacaine 0.25% 2 mg/kg with fentanyl (1μg/kg) & Group B receiving bupivacaine 0.25% 2 mg/kg only.
Results: Onset of Sensory block (mins) & Time to achieve the optimum level (mins) were comparable among both groups & difference was not significant statistically. We noted more duration of motor block (176.4 ± 64.4 min vs 154.5 ± 52.13 min), Prolonged duration of postoperative analgesia (320.3 ± 41.19 min vs 288.3 ± 43.1 min), less amount of rescue analgesic (73.33 ± 44.28 mg vs 85.17 ± 44.45 mg) & late requirement of rescue analgesic (272.67 ± 37.38 min vs 236.83 ±10.63) in A group as compared to Group B & difference was significant statistically. PONV & pruritis were noted in 1 patient each from group A as compared to 3 cases of PONV & 1 case of pruritis & difference was not significant statistically.
Conclusion: 1µg/kg fentanyl with 0.25%bupivacaine 2mg/kg when administered caudally provide satisfactory surgical anesthesia and post-operative analgesia with prolonged period of analgesia with without any major postoperative complications. Fentanyl produces a faster onset of analgesia with fewer side effects like nausea, vomiting.

Comparison of Atracurium versus Cisatracurium Regarding Onset Time, Intubating Conditions and Haemodynamic Parameters and Duration of Action

Nikita Baser, Vijay kumar, Shilpa Sharda, Neetu Maurya

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 132-137

Background:Endotracheal intubation is an integral part of the administration of general anesthesia during the surgery. Neuromuscular blocking agents facilitate general anaesthesia. cisatracurium having lack of histamine release, which provides better cardiovascular stability in comparison to atracurium. To compare of atracurium and cisatracurium onset time, intubation conditions, hemodynamics and duration of block.
Materials and Methods: The present study was a prospective randomize, conducted in the Department of Anaesthesia, Pacific medical college and hospital Udaipur, Rajasthan. Total 70 ASA Grade I/II patients in the age group of 18-60 years posted for elective surgery required general anesthesia were selected in this study.  Patients were divided into two groups of 35 each. Group A patients received atacurium 0.5 mg/kg as loading dose while Group B cisatracurium 0.2mg/kg, The onset time,intubating conditions hemodynamic parameters and duration of action were noted.
Results: Cisatracurium have rapid onset (p<0.001) and long duration of action (p<0.001) and stable mean arterial pressure (p<0.001) and better intubating conditions (p=0.04.).
Conclusion: Cisatracurium provides rapid onset, excellent intubating conditions, long duration of action and good haemodynamic stability in comparision to atracurium.

Incidence and Potential Co-Morbidities in Facial Pigmentary Demarcation Lines in Indian Populations

Lakkireddygari Sujana, Savitha L Beergouder, Alekhya Rallapalli, Sujatha Alla, Prasanthi Chidipudi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 138-145

Background: The most noticeable part of human body is face. The obvious boundaries on the skin known as Pigmentary Demarcation Lines (PDL) found over face and have clear borders of abrupt transition between more hyper-pigmented skin and areas of normal skin pigmentation due to differences in melanocyte distribution that may be influenced by multiple factors. Facial pigmentary demarcation lines (PDL) directly reflect on patient’s physical appearance and self-image as they may contribute to dysmorphism and even central to depressive illness in susceptible individuals posing cosmetic concern for the patient and a challenge for dermatologist. Therefore, it is important for early identification and management of facial skin disorders. Until now, nine different types of PDLs have been described which are designated as Type A to I of which Type F to H PDLs are most common on the face. Etiology involving the whole spectrum of PDL continues to be an enigma and needs further research among Indian population.
Materials and Methods: Total 304 patients between 15 to 75 years of age range were included in study lead between May 2018 to May 2020 after thorough examination for inclusion and exclusion criteria, informed consent and Ethics committee approval. Statistical analysis was done using descriptive and inferential statistical approach using Chi-square test and Fisher’s exact test and p value was calculated and considered to be significant if <0.05.
Results: Out of 304 study subjects the frequency of facial PDL type H (50.65%) was most common than type G (29.60%) and type F (19.73%) with male predisposition (79.60%) with agricultural occupations (59.86%) than females and with significant family history from father (41.44%). Most of the present study subjects were of Fitzpatrick skin type IV (50.01%) with hyper-pigmented macules (12.5%) and shown unilateral PDL symmetry (58.22%) with sharp PDL line margins (81.25%). The most common aggravating factor was prolonged exposure to sun light (56.90%) and most of (25.98%) the subjects experienced periorbital melanosis at different times. Diabetes (38.15%) and hypertension (29.60%) were the most common co morbidities observed in study subjects. Using Fishers exact test, p value was calculated and it was found to be highly significant (p=0.003).
Conclusion: Present study pronounces the incidence of facial PDL (types F-H) are sharply common especially amongst the males who are in agricultural occupations with prolonged sun exposure and with other co morbidities like diabetes, hypertension and tuberculosis. In females the prevalent type was Type H PDL during and after pregnancy. The agricultural occupations with prolonged sun exposure, diabetes, hypertension, tuberculosis and positive paternal family history were shown strong correlation with facial PDL among Indian population irrespective of gender and it was found to be highly significant (p=0.003).

A Physiological Prophylaxis of Deep Venous Thrombosis in Arthroplasty: A Prospective Study

Syed Mohd Noaman Quadri, G. Niranjan

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 146-152

Background: A potentially lethal condition is known as venous thromboembolism (VTE), which includes pulmonary embolism and deep vein thrombosis (DVT). To determine the effectiveness of pharmacological prophylaxis against PE or DVT (Pulmonary Embolism). To ascertain the prevalence of DVT (Deep Venous Thrombosis) or PE (Pulmonary Embolism) despite prevention. On the subject, relatively few studies from India have been published, and nothing is known about the true prevalence of the disorder. Due to a sharp rise in the number of joint replacement surgeries, the topic has recently taken on more importance among Indian people. Regarding the prophylaxis for VTE in Indian patients, there are no precise recommendations.
Materials and Methods: In order to investigate the prevalence of DVT, we designed and carried out a prospective study. The current study comprised a total of fifty patients who had undergone THR, TKR, or HRA. The duplex ultra-sonography was performed on each of the patients between the seventh day and the third week of postoperative day. As a preventative measure against deep vein thrombosis (DVT), all patients received subcutaneous Enoxaparin 40 mg once day for 5 days and Asprin for 4 weeks.
Results: Only two patients or four percent of the total, revealed sonographic evidence of distal asymptomatic DVT, and both of those patients' symptoms went away on their own without any treatment. During the follow-up scan, there was no evidence of proximal DVT propagation, and there were also no incidences of pulmonary embolism.
Conclusion: DVT in patients who have undergone THR, TKR, or HRA is not nearly as common as it is reported to be in the Western medical literature. It is essential to maintain a high level of suspicion, in addition to close clinical surveillance. In our society, deep vein thrombosis (DVT) is hardly an unheard-of condition. Although low molecular weight heparin is a safe medicine, it appears that the risk of bleeding problems is higher than what is described in Western medical literature. In the future, it will be necessary to conduct additional trials that involve a greater number of patients and take place at many centres in order to corroborate the findings of our study and evaluate the actual efficacy and safety of LMWH.

A study of Metabolic Profiles in Lean, Overweight, and Obese Type 2 Diabetes Mellitus Patients

Vijaitha SM, Dr. Aparna Varma Bhongir, Sapna Vyakarnam

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 153-159

Background: The most common kind of diabetes in the world is type 2 diabetes mellitus. Most instances in western nations include obesity. The situation can be different in several regions of India. A significant frequency of lean type 2 diabetes mellitus has been noted in studies with a body mass index under 19 kg/m2. To connect biochemical markers with anthropometric measurements and to assess the metabolic state of lean vs. overweight/obese type 2 diabetes mellitus (T2DM) patients.Materials and Methods: Body mass index (BMI) was used to classify 100 T2DM patients into lean and overweight/obese groups; 50 healthy controls with similar ages and sexes were chosen. BMI, waist circumference (WC), and waist:hip ratio (W:H) anthropometric measurements were taken. Fasting blood samples were analysed for high-density lipoprotein (HDL), nonesterified free fatty acids, serum total cholesterol, fasting plasma glucose, and triglycerides (NEFA). The Friedewald algorithm was used to compute low-density lipoprotein (LDL), and TG:HDL was evaluated to assess insulin resistance (IR).Results: Compared to lean T2DM and controls, overweight/obese individuals had substantially greater anthropometric parameters of total (BMI 33.22 ±5.9 , 20.35±2.22 vs 21.49±3.88 ) and visceral adiposity (WC 93.42 ±6.4, 76.45±4.14 vs 75.2 ±4.1 and W:H 0.98 ±0.14 , 0.8 ±0.22 vs 0.78±0.32 ). In comparison to controls, T2DM patients had significantly higher levels of total cholesterol, TG, LDL, and NEFA while having lower levels of HDL. However, the values in the overweight/obese group were substantially higher than those in the lean group. Triglycerides: HDL levels were substantially higher in obese individuals compared to lean patients (4.42 ± 1.6 vs 7.88 ± 3.22 ), indicating that obese diabetics had much worse insulin sensitivity than non-obese diabetics. BMI, WC, W:H, TG, LDL, NEFA, and TG:HDL showed positive correlations whereas HDL in the obese group showed negative correlations. Lean people with normal BMI, WC had abnormal lipids, and IR.
Conclusion: T2DM in obese and lean people has dyslipidemia and IR. Poor metabolic profile is not connected with lean T2DM patients' total and visceral obesity.

Immunohistochemical Expression of P16 0n CIN and Cervical Cancer

VariganjiSandhya Krupal, Bollineni Prasad, M. Janaki

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 160-172

Cervical cancer is the second leading cause of female cancer mortalities, worldwide and 5,00,000 new cases are diagnosed annually in developing and developed countries. The epidemiological profile of the disease shows that Cervical cancer is related to sexual activity and associated with Human papillomavirus (HPV) infection.The high risk HPV types 16 and 18 are the most prevelant, representing 69.8% and 15% respectively in cases of invasive cancer. A persistent high-risk HPV infection is also a prerequisite for the development of Cervical cancer. Genomic integration of the viral genome can disrupt several cellular proteins resulting in the upregulation of the tumour suppressor gene P16INK4A which is a cyclin-dependent kinase inhibitor.  Thus over-expression of p16 indicates an already advanced interference of the viral oncoproteins with cellular proteins involved in cell cycle regulation. The protein P16INK4 serves as a surrogate marker for the oncogenic activities of HPV in replication–competent cells of cervical epithelial and its over-expression is well established in Cervical intraepithelial neoplasia(CIN) and Invasive Squamous cell carcinoma(SCC) by many studies.
Aims and objectives
The study was a prospective study done from October 2013 to October 2015.The surgical biopsy specimens of uterine cervix were included in study.The main objective was to classify histopathological sections of uterine cervix by latest WHO criteria and study its association with P16INK4A immunostaining.Also to establish P16INK4A as marker of dysplastic and neoplastic epithelium and to correlate present study with results of other authors.
Results
       A total uterine cervix specimens received and studied were 365.Hysterectomy
specimen were 237 and cervical biopsy specimen were 128. Out 128 cases of
Cervical biopsy ,sixty five cases were Chronic non specific cervitis ,sixteen cases were
CIN1,seven cases were CIN2,five cases were CIN3 and thirty seven cases were SCC.
For immunohistochemistry, all  cases of CIN lesion ,twelve cases of SCC,ten cases of 
CNSC  were subjected to IHC .Out of sixteen cases in CIN1, thirteen cases showed
patchy staining intensity and three case showed diffuse basal positivity.In CIN2 out of
seven  cases ,four cases were patchy positive ,three cases showed diffuse  basal
positivity .In CIN3 out of five cases,one case was diffuse basal positive and four cases
were diffuse full thickness positive , in SCC all the twelve cases showed diffuse full
thickness positivity and in CNSC all the ten cases were negative.
CONCLUSION
  In conclusion ,the current study shows the efficacy of P16INK4A as a marker for
screening cervical malignancies. Increasing staining intensity of P16INK4A from CIN1 to
SCC,makes it a marker of choice for cervical dyskaryosis.

A Prospective Study of Clinical and Functional Outcome of Lateral Epicondylitis Treated With Platelet Rich Plasma

Nagulapati Vishnu Vardhan, Biju Ravindran, J. Ramesh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 173-176

Background: Lateral epicondylitis treatment is still remains a difficult task; the use of platelet-rich plasma (PRP) is a proactive therapeutic option that jump starts the healing process, which contains several different growth factors and other cytokines that stimulate healing of bone and soft tissue.
Materials and Methods: This is a prospective study of 100 patients, done at Narayana medical college and hospital, Nellore, Andhra Pradesh for 2 years. The primary analysis included visual analog scale pain scale, for measuring pain in patients, local tenderness, pain on extension of the wrist, grip strength, elbow swelling were clinically assessed at different interval of follow-up, clinical and functional outcome were evaluated at final follow-up with statistics.
Results: Results were calculated based on descriptive statistics with SPSS version 19. The average follow-up was 1year. Results were excellent in 80, good in 10, fair in 5 and poor in 3. In two cases, there was superficial infection seen.
Conclusion: Treatment with PRP holds promising results with minimal risk for the treatment of lateral epicondylitis. A more scientific evidence studies need to done before we can determine whether PRP therapy is effective in other conditions. PRP therapy as a viable procedure that may decrease the progression of more injuries may decrease the overall time for healing, and therefore, may setback the overall need for surgical intervention.

Evaluation of efficacy and safety of oral terbinafine and itraconazole combination therapy in the management of superficial dermatophytosis- A Randomised Clinical Double blinded Trial

K. Souris, M. Vanitha, B Swathi, ENP Sainath, Rohit Dixit, M. Sheshu Madhav

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 177-182

Background: Common fungal infections like dermatophytosis are brought on by Trichophyton, Epidermophyton, and Microsporum species. All patients with dermatophytosis should get a combination of systemic and topical antifungal medication, with the exception of those who have localised naive tinea. Study participants took oral terbinafine and itraconazole to see how well they worked together against superficial dermatophytosis.
Materials and Methods: For this randomised clinical trial, 50 people with superficial dermatophytosis were divided into two groups. The study was conducted in the Department of Dermatology's Outpatient Department from December 2021 to May 2022. Treatment in Group I consisted of four weeks on Terbinafine 250 mg OD and 200 mg OD itraconazole, whereas in Group II, just Terbinafine 250 mg OD was given. As a result, the patients were seen every two weeks and given the necessary diagnostics. The statistical analysis was performed using SPSS version 16.0, the Statistical Package for the Social Sciences.
Results: Itraconazole containing group reported a better clinical cure rate than the griseofulvin containing group (p<0.05). Neither of the combination showed effectiveness against tinea infections pre-treated with topical steroid containing formulations.
Conclusion: When terbinafine and itraconazole are combined, a greater clinical cure rate is achieved than when terbinafine is used alone.

Resuming Sports and Leisure Activities after a Total Knee Replacement Is Influenced By a Number of Factors

Yeddula Yoga Abhinai Reddy, K. Harikrishna, Biju Ravindran

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 183-190

Background: The number of patients who undergo total knee replacements (TKR) is on the rise, and with that rise comes higher patient expectations and higher functional needs. As a result of the declining average age at which orthopaedic surgeons may recommend TKR, patients frequently have the expectation that they will be able to return to sport (RTS) after TKR. The purpose of this research was to investigate the mid-term RTS, satisfaction level, forgotten joint level, and recreational activities after total knee replacement surgery (TKR).
Materials and Methods: 536 TKR (same implant design, same procedure) were performed in our centre between June 2020 and June 2022. The survey sample had a mean age of 69 years and a mean follow-up of 43 months. We called every patient who hadn't followed up in the previous six months. The analysis of 443 TKR was completed. The University of California Los Angeles Scale (UCLA), Forgotten Joint Score (FJS), and Satisfaction Score were used to evaluate RTS.
Results: 85% of the patients in this study experienced RTS following TKR, with a mean UCLA score rising from 4.48 to 5.92 and a high level of patient satisfaction. 93% of patients reported being satisfied or extremely satisfied with their level of activity. Higher preoperative UCLA scores and lower American Society of Anesthesiologists scores are associated with greater importance of the RTS. Each additional point in the ASA score results in a 52% lower chance of experiencing RTS.
Conclusion: With such a high happiness score, it was anticipated that RTS and recreational activities would come following TKR. Condition and activity levels prior to surgery are the two most important criteria in determining the likelihood of RTS. The evidence level for this type of study is a level IV retrospective case series

Impact of RUSH protocol in post-cardiac surgery patients in ICU: A prospective study

Dr. Anandteerth R Mathad, Dr. Rohit Ramesh, Dr. Jagadish B Alur

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 191-195

RUSH (Rapid Ultrasound in Shock) Protocol is an easily learned and quickly performed shock ultrasound protocol, involving a 3-part bedside physiologic assessment of cardiovascular system simplified as “the pump,” “the tank,” and “the pipes.” Data was collected including demographics, admission diagnosis, surgery, triggers (indications) for RUSH protocol, hemodynamic parameters, time from ICU admission to applying RUSH protocol in hours, conclusion of RUSH protocol and interventions applied. Most common trigger (indication) for RUSH protocol was hypotension (87%), followed by drop in urine output (15%), peripheral signs of shock (13%), drop in haematocrit (11%), altered mental state (4%). More than one trigger were present in 35% of patients, most of which were CABG patients (68%).

A study on clinical profile of patients with dengue fever at a tertiary care hospital

Dr. Khizerulla Sharief, Dr. Pragalatha Kumar, Dr. Ayas Ahmed, Dr. Chetan Kerur

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 196-199

During the 19th century, dengue was considered a sporadic disease, causing epidemics. However, dramatic changes in this pattern have occurred and currently, dengue ranks as the most important mosquito-borne viral disease in the world. In the past 50 years, its incidence has increased 30-fold with significant outbreaks occurring in five of six World Health Organization (WHO) regions. The study was approved by the institutional ethical committee. Informed written consent was obtained from the parents of each patient before enrollment. History and examination findings were recorded in a pre-structured proforma. Children with clinically diagnosed dengue fever (WHO criteria) & serologically confirmed and admitted cases between the age group of 2months to 18years formed the study group. In my study population, all of them had a fever. The second most common presenting symptom was vomiting 112 (60.5%) cases, pain abdomen was next 73 cases(39.5%), 56 cases (30.3%) presented as a shock, 18 cases (9.7%) presented with bleeding manifestations and least being headache with 9cases (4.9).

Prophylactic tranexamic acid in reducing blood loss during and after the lower segment caesarean section: Adverse effects and complications

Dr. Usharani N, Dr. Bhagyajyoti, Dr. Chandrashekar K

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 200-204

PPH is one of the major cause of maternal mortality and morbidity by altering hemodynamic stability. Primary PPH is excessive blood loss within 24 hours, Secondary PPH is excessive bleeding in the period from 24 hours after delivery till puerperium. Among 100 primigravida, 50 were taken as study group i.e., Group A which involves intervention by administrating IV Tranexamic acid 1 gm and 50 as control group i.e., Group B without intervention. In our study group most common indication was fetal distress i.e., 68% in cases and 76% in controls and p value is 0.126 (> 0.05), which means both groups were comparable. Nausea among 10 cases, Head ache among 12 cases and vomiting among 7 cases had occurred. There were no evidence of complications like thromboembolism

BIS values at loss of consciousness, return of consciousness & immediate post-operative period in patients with intracranial space occupying lesion vs patients posted for other neurosurgical procedures: A prospective, randomized and controlled study

Dr. BV Mahesh Babu, Dr. N Syama Kumar, Dr. G Chandra Sekhar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 205-209

Background: Bispectral index is an accepted monitoring to assess the depth of anaesthesia and helps the anaesthesiologist to prevent awareness during surgical procedures under general anaesthesia. The influence of frontal brain tumours on bispectral index (BIS) measurements is unknown. The aim of our study was to determine whether BIS values recorded at loss and return of consciousness (LOC and ROC, respectively) differ between patients with unilateral frontal brain tumours and control patients.
Methods: We enrolled 30 patients with a frontal brain tumour and 30 control patients. Bilateral BIS measurements were done during induction of propofol anaesthesia, during recovery of consciousness, and during a second induction of anaesthesia. The isolated-forearm test was used to determine the moments of LOC1, ROC and LOC2.
Results: The median BIS values recorded at LOC1, ROC and LOC2 did not differ between the groups. There were no significant inter-hemispheric differences in BIS in tumour and control patients.
Conclusions: The presence of a frontal brain tumour did not affect ipsilateral BIS values and so need not influence the placement of unilateral BIS electrodes if BIS monitoring is used to titrate the dose of propofol during anaesthesia.

Effects of adding dexmedetomidine to ropivacaine for paravertebral block in breast cancer surgery

Dr. Killu Bhagya Lakshmi, Dr. Venkata Krishna Gollapalli, Dr. Venkata Ramesh Pativada

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 210-218

Background: Effective pain control after surgery is an important part of taking care of someone who has had surgery. A paravertebral block (PVB) is becoming more popular for breast surgery and is thought to be the best method for anaesthesia and pain relief after surgery. Several local and regional anaesthetic techniques were looked at to see if they could reduce post-surgery pain after breast surgery. The thoracic PVB technique looks promising because it reduces post-surgery pain, reduces opioid use, reduces side effects like drowsiness and the risk of breathing problems, and saves money. The goal of this study was to find out how well dexmedetomidine works with ropivacaine as a paravertebral block in breast cancer surgery.
Material and Methods: Randomly, 100 women having breast surgery were split into two groups, Group PR and Group PRD. For thoracic paravertebral block, Group PR got 0.5% ropivacaine (0.3 ml/kg) with 1 ml normal saline, while Group PRD got the same amount of ropivacaine with 1 mcg/ml of dexmedetomidine. The groups were watched to see how well the block worked, how the hemodynamic parameters changed at different times, when the sensory block started, how long it lasted and if there were any complications during or after the surgery.
Results: When added to ropivacaine in TPVB as an adjuvant, dexmedetomidine gives good pain relief during and after surgery and reduces the need for painkillers after surgery. There were no problems with the technique or the way the blood flowed and there were no bad effects from the dexmedetomidine.
Conclusion: TPVB with ropivacaine and dexmedetomidine as an add-on can be a better choice for good pain relief and stable blood flow during breast surgery without complications or side effects.

Perception and opinion of Indian medical graduates on online and classroom teaching: A cross sectional study

Dr. Nagesh HN, Radha A, Ayyali Ambresh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 219-224

Objectives: To Study the experience and opinion of medical graduates about online and classroom teachingandstudents’ perceptions of the online as compared with classroom classes.
Methodology: A cross-sectional study was conducted among 1st (2020-21 batch) and 2nd (2019-20 batch) year MBBS students at Shri Atal Bihari Vajpayee Medical College and Research Institute, Bengaluru. A semi structured closed ended questionnaire on various components of learning of online & classroom teaching was developed. Data collection was done through Google forms online survey platform. Responses obtained in Google forms were exported and analysed in Microsoft Excel. Responses to the questions were expressed as percentages and tabulated. Data collected was assessed by using descriptive statistics.
Results: Positive perception of all aspects of learning process was found to be higher (65%) for conventional classroom teaching. In comparison only 25% medical students preferred online teaching. 77.7% participants felt practical class learning experience was poor/fair in online classes. 58% of students have reported mental stress during online learning as against only 11% during classroom learning. Majority (86%) of medical graduates preferred classroom teaching method compared to only 14% for online teaching method.
Conclusion: The Indian Medical Graduate preferred classroom teaching over online teaching method in Medical education, as hands-on training and communication skills are most important in learning process. They also felt that mental stress is more in online teaching, hence better teaching techniques have to be implemented in medical education for online class.

To evaluate glycemic status at the time of admission as a prognostic indicator and to assess it correlates with pseudo-cholinesterase levels and severity of organophosphorus compound poisoning: A prospective study

Harshith Suresh, Radha A, Nagesh HN

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 225-231

Background: Acute Organophosphorus poisoning (OP) is prevalent in the world and its numbers are constantly on the rise. It is more common in developing countries. Health Organisation (WHO) has estimated that nearly 2 lakh die from pesticide poisoning in the world. So, it has high inpatient mortality. All OP poisoning patients cannot be managed in ICU. So, it is important to know prognostic indicators at initial assessment. Few studies showed Serum Pseudo-cholinesterase levels and hyperglycemia were used in the initial assessment to know prognosis and severity in acute organophosphorus poisoning. The present study aims to evaluate the glycemic status at the time of admission and its correlation with pseudo-cholinesterase levels and severity in acute OP compound poisoning.
Objectives:

To assess the glycemic status by estimating random blood glucose level at the time of admission in cases of acute organophosphorus poisoning.
To assess the pseudo-cholinesterase level at the time of admission in cases of acute organophosphorus poisoning.
To correlate hyperglycemia with pseudo-cholinesterase levels and severity or clinical outcome of OP poisoning.

Methodology: The prospective study was conducted in tertiary care hospital. After obtaining informed written consent, 100 confirmed acute OP compound poisoning patients were enrolled for the study, underwent a detailed clinical examination as per the proforma. The Random Blood Glucose level and pseudo-cholinesterase levels at the time of admission were measured and patients were monitored closely and continuously for severity of clinical signs and symptoms. The data obtained were statistically analysed by using SPSS 21.0 Version. Results were presented as Mean (Median) ± SD, counts and percentages and diagrams. Association of Categorical variables was found using Chi square test. p<0.05 will be considered statistically significant.

Assessment of knowledge, attitude and practice towards covid-19 vaccine among healthcare workers in a tertiary care center

Guru Prasad C, Ambresh Ayyali, Nagesh HN, Nagaraja BS

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 232-239

Background: In the current scenario of vaccine scepticism amidst India’s massive vaccination drive, assessment of knowledge and attitude of healthcare workers towards the vaccine and their appropriate training is vital to build trust in the vaccine and increase acceptance.
Objectives: To study and assess Knowledge, Attitude and Practice towards Covid-19 Vaccine among healthcare workers in a tertiary care center.
Materials & Methodology: The study was Pre & PostQuestionnaire Survey. After informed consent, the responders were provided an online questionnaire for the collection of information on knowledge, attitude and practices about COVID-19 vaccines. Responses were collected both before and after the sensitisation programme.
Results: The study included 366 participants with mean age of 23.25 years (SD=9.08). Our study found that there was significant change in the knowledge, attitude and willingness of the HCWs after the sensitising program. After the sensitisation, 83.7% were ready to accept that the vaccine is a good idea (compared to 65.6%). 83.7% were ready to accept that the vaccine is a good idea (compared to 65.6% pre-sensitisation). Concerns about the side effects reduced among HCWs from 53.3% to 48.3%. Willingness to take the vaccine increased from 37.7% to 69.78% after the sensitisation Also more healthcare workers were willing to recommend the vaccine to others (70.6% compared to 40.2%).
Conclusion: We found that the sensitizing program showed significant change in the knowledge, attitude, and willingness among the HCWs. This provides further opportunities for development of similar educational and awareness programmes for HCWs and for the general population.

Study of the Surgical Anatomy of the Sapheno-Femoral Junction in patients of Varicose Veins in a Tertiary Care Teaching Hospital

Renuka Tripathi Dubey

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 240-245

Background: Varicose veins are a frequently encountered surgical problem in today’s practice. Ligation of the Sapheno-Femoral junction (SFJ) in Flush with the femoral vein after ligating and dividing the known and unknown tributaries is a time tested method of treating Sapheno-Femoral incompetence in primary varicose veins.
Material and Methods: This study was conducted in Department of Anatomy. The duration of study was over a period of one and half year. On the basis of inclusion and exclusion criteria, total of 120 cases of SFJ incompetence were included in this study. Results: In our study we were included total 120 no. of participants. Among all, 93.4% were male rest were female. In the USG finding, 88.4% participants were showing SFJ below the pubic tubercle and in 11.6% participants was marked at the level with pubic tubercle. This study also showed that anatomical subtypes of SFJ which were found 93.4% subtype I, 5% subtypes H & rest Subtype S. In this study, nobody had postoperative complications and good cosmetic outcome.
Conclusion: It can be concluded that thorough knowledge of all the anatomical variations of the SFJ is mandatory for efficient management of varicose vein and safety of SFJ.

To Study the Quality of Life of the Patients after following Stapled Haemorrhoidectomy

Servishet Saraf, Rishabh Gupta, B.S. Pathania

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 246-251

Background: Background Haemorrhoidal disease is ranked first among diseases of rectum and large intestine and estimated worldwide prevalence ranges from 2.9% to 27% of which more than 4% are symptomatic. Haemorrhoidal disease is a frequent disease of the anal canal. It is downward sliding of Anal Cushions. Haemorrhoids are important vascular cushions located in the anal canal as part of the normal anatomy. These cushions are composed of arteries, veins, smooth muscle fibers and connective tissue embedded in thickened submucosa. Since Longo first described Stapled Haemorrhoidectomy (SH) in 1998, it has been emerging as the procedure of choice for symptomatic haemorrhoids. The success and efficacy of haemorrhoidectomy procedures can be evaluated based on postoperative healing duration, complications, recurrence as well as questionnaires that reveal patient’s perspective, Therefore it has been proposed to assess the quality of life following stapled haemorrhoidectomy using SF-36 questionnaire.
Materials and Methods: This prospective studies for evaluation of quality of life and functional outcome following stapler haemorrhoidectomy was conducted in the post graduate department of surgery ASCOMS, Jammu for the period of one year to study the clinical outcome following stapled haemorrhoidectomy.
Results: The age of the patient ranged from 18 to 78 years of age with an average age of 45.73 years. Majority of patients in this study were males 60% whereas females were 40%. 21 (70%) of the patients had Grade III haemorrhoids and 9 (30%) patients had Grade II haemorrhoids. Post-operative pain was assessed by Visual analogue score at 6, 12, 24 hours. In our study, no patient complained of Urinary retention, post-operative bleeding, anal incontinence, mucosal discharge, anal stenosis or constipation.
Conclusion: Keeping all the benefits of stapled harmorrhoidectomy the clinical outcome in patients treated with this method is definitely better and clinical outcome in these patients is excellent.

Comparison of Effectiveness of Dexamethasone and Dexmedetomidine as an Adjuvant in Plexus Block by Supraclavicular Approach

Archana Gautam, Reji S Varghese

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 252-257

Background: Supraclavicular brachial plexus block is a commonly employed regional nerve block technique for upper extremity surgery. Various adjuvants were added to local anaesthetics in brachial plexus block to achieve rapid onset and prolonged block. To compare dexamethasone and dexmedetomidine as an adjuvant to local anaesthetic agent in supraclavicular brachial plexus block with respect to onset and duration of sensory and motor block and duration of blockade.
Material and Methods:Forty ASA I and II patients scheduled for elective upper limb surgeries under supraclavicular brachial plexus block were divided into two equal groups in a double- blinded fashion. Group one was given 0.25% Bupivacaine 2 milligram/kg as local anaesthetic and Dexmedetomidine 1microgram/kg as adjuvant. Group two was given 0.25% Bupivacaine 2 milligram/kg and Dexamethasone 100microgram/kg as adjuvant. Onset and duration of sensory and motor blockade and hemodynamic stability were recorded. All patients were observed for any side effects and complications. All data were recorded and statistical analysis was done.
Results: Sensory block and motor block onset was earlier in dexmedetomidine group.The duration of blockade was also prolonged in dexmedetomidine group when compared with dexamethasone group and is not associated with any major side-effect.
Conclusion: Dexmedetomidine is a better adjuvant than dexamethasone in supraclavicular brachial plexus block.

A Study of Prevalence of Changes in FEV1 in Asthmatic Patient and Correlation with BMI

Krishna Gopal Singh, Sheema Maqsood, Ajay Kumar, Vishal Patidar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 258-264

Background: To determine the prevalence of obesity in asthmatic patient and to determine correlation of BMI of asthmatic patient with FEV1 (forced expiratory volume in 1 second).
Martial and Methods: We conducted this study on 75 Indian asthmatics with aim is to investigate the role of BMI on asthma severity. Patients who satisfying the predefined inclusion criteria were recruited into the study. All required tests were done including spirometry and calculation of BMI was done. The data obtained was subjected to systematic statistical analysis.
Results: The statistical analysis shows prevalence of obesity in asthmatic patients was higher (37.3%, BMI ≥ 25) than the general population. Most of the overweight and obese asthmatics had history of prior use of ICS therapy. There is statistically significant correlation found between BMI and FEV1, also significant correlation is present in BMI and asthma severity.
Conclusion: Obesity is potentially preventable factor which help in asthma control. Hence, asthma education programs may also include counseling about weight reduction which aims to help those patients who are overweight to improve health status and outcomes.

A Study of Prevalence of Changes in FEV1 in Asthmatic Patient and Correlation with BMI.

Krishna Gopal Singh, Sheema Maqsood, Ajay Kumar, Vishal Patidar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 265-271

Background: To determine the prevalence of obesity in asthmatic patient and to determine correlation of BMI of asthmatic patient with FEV1 (forced expiratory volume in 1 second).
Martial and Methods: We conducted this study on 75 Indian asthmatics with aim is to investigate the role of BMI on asthma severity. Patients who satisfying the predefined inclusion criteria were recruited into the study. All required tests were done including spirometry and calculation of BMI was done. The data obtained was subjected to systematic statistical analysis.
Results: The statistical analysis shows prevalence of obesity in asthmatic patients was higher (37.3%, BMI ≥ 25) than the general population. Most of the overweight and obese asthmatics had history of prior use of ICS therapy. There is statistically significant correlation found between BMI and FEV1, also significant correlation is present in BMI and asthma severity.
Conclusion: Obesity is potentially preventable factor which help in asthma control. Hence, asthma education programs may also include counseling about weight reduction which aims to help those patients who are overweight to improve health status and outcomes.

Assessment of femoral tunnel after arthroscopic anterior cruciate ligament reconstruction

Dr. Mihir Patel, Dr. Mahesh Shinde, Dr. Ushma Butala, Dr. Lakshya Bhardwaj, Dr. Karthik HK, Dr. Saif Ansari

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 272-280

Background: The knee joint is the most commonly injured of all joints and the anterior cruciate ligament (ACL) is the most commonly injured ligament. Anatomical graft placement is one of the major challenges in ACL reconstruction. Three-dimensional (3D) reconstruction of computed tomography (CT) images is currently the best method to determine whether the ACL tunnel and graft is positioned correctly. This study was done to calculate parameters of femoral tunnel in terms of femoral tunnel diameter, femoral tunnel length, femoral tunnel position based on Bernard and Hertel grid (Quadrant method) and the angle between a line drawn along the femur diaphysis and the femoral tunnel (femoral tunnel-femur diaphyseal angle/coronal angle/coronal obliquity) and to compare the results of femoral tunnel parameters measured with current literature.
Aims and Objectives: To Evaluate the Femoral Tunnel After Arthroscopic Anterior Cruciate Ligament Reconstruction.
Materials and Methods: This is an observational cross-sectional study conducted in the Department of Orthopaedics, H.B.T. medical college and Dr. R.N. Cooper municipal general hospital, Mumbai, on 39 patients of age group of 19-52 year who underwent arthroscopic ACL reconstruction over a period of 1 year.
Results: Most of patients had femoral tunnel diameter between 7.5-8.5 mm and length of 3-4 cm and femoral tunnel-femur diaphyseal angle of 30-40 degree. Most patients had position of femoral tunnel along high to low axis of 28-34% and position of femoral tunnel along deep to shallow axis of >27%. Femoral tunnel position along high to low axis and deep to shallow axis warren anatomical.
Conclusion: Low percent of ACL reconstruction were in recommended anatomical position. CT scan is a very good tool to analyse tunnel position after ACL reconstruction.

A prospective clinical assessment of the role of caudal epidural steroid injections in the management of chronic low backache

Dr. Suneet Rajshekhar, Dr. Anurag Chandrakar Dr. Madhuri Gadela

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 281-286

Aims: The aim of this study was to find Role of caudal epidural steroid injections in the management of chronic low backache.
Materials and Methods: A prospective study was conducted in the Department of Orthopaedics, Shri Shankaracharya Institute of Medical Sciences, Bhilai, Chhattisgarh, India for the period of 1 year. Total 80 Patients with chronic low back pain and sensory symptoms not responding to conservative management were include in this study. They were evaluated clinically before and after epidural steroid on the basis of pain, unrestricted activities of day to day life and work performance on the basis of visual analogue scale and oswestry disability index.
Results: Total 120 ESI were given to 80 patients. 50 patients were given single injection, while 20 had two and 10 received three ESI doses. We included total 80 cases in this study, 35 were males and 45 females with chronic LBP.Out of 80 cases of LBP, Lumbar disc herniation was seen in 26, lumbar canal stenosis in 8 and degenerative disc disease in 14 cases while 32 cases had non-specific LBP. Follow up was done at one week, one month and then every three months up to twelve months of treatment (post third ESI 9 months).Mean pre ESI, VAS was 7.06 while it was 4.75 at one year of treatment. Mean pre ESI, ODI score was 58.88 while after twelve months of treatment with ESI it was 44.74 at one year. We obtained excellent results in 26.75 percent, good in 37.5 percent, fair in 22.5 percent while poor in 13.75 percent patients.
Conclusion: ESIs are very effective and significantly reduce pain in patients with chronic function-limiting LBP.

The role of spinopelvic factors in lumbar intervertebral disc prolapse: An analysis

Dr. M Padmalatha

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 287-295

Aim and Background: In general, sacral slope, pelvic tilt, and pelvic incidence are used to describe the anatomy and orientation of the sacropelvis. Degenerative alterations in the lumbar spine can be influenced by the pelvis' orientation and morphology. As a result, we looked into how different sagittal spinopelvic characteristics related to young adults' disc degeneration levels.
Methods: 50 patients were included in a cross-sectional study conducted at a hospital. The study comprised patients who had prolapsed discs on magnetic resonance imaging (MRI) and reported back or leg pain. A standing X-ray of the LS spine was taken from the dorsolumbar junction to mid-thigh. Many spinopelvic parameters were evaluated from the scannogram.
Result and Discussion: 39.27 years old was the average age. Level L5S1 was the most prevalent. PT, PI, and LL exhibited a positive connection with disc pathologies at the L1L2, L2L3, and L4L5 levels. PT and LL had a positive connection with disc disease at the L5S1 level. Data with P=0.023 revealed a statistically significant connection between SS and degenerative spondylolisthesis at L4L5. Degenerative spondylolisthesis at L4L5 is statistically more likely to develop with an increase in SS. The disc pathology at L1L2 will worsen when PT, PI, and LL rise. At L2L3, disc pathology will grow with an increase in SS, PT, PI, and LL. At L4L5, disc pathology will worsen when SS, PT, PI, and LL increase. The disc pathology at L5S1 will worsen as PT and LL increase.
Conclusions: For the purpose of measuring spinopelvic parameters, a standing lateral view radiograph from the dorso lumbar junction to the middle of the thigh is considered to be on par with a standing whole spine radiograph. An increase in SS has been found to have a statistically significant link with degenerative spondylolisthesis at the L4L5 level.

Prospective evaluation of endoscopic composite cartilage graft tympanoplasty in chronic otitis media patients

Dr. Kotagiri Ravikanth, Vmashi Krishna B, Dr. BVN Muralidhar Reddy

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 296-300

Aim: To determine the functional outcome of endoscopic composite cartilage tympanoplasty in patients having chronic otitis media with safe central perforation (small or medium).
Methods: This prospective study was conducted on 100 chronic otitis media cases with safe central perforation (small/medium) in the department of Otorhinolaryngology, RVM Institute of Medical Sciences & Research Centre, Laxmakkapally, Telangana, India for the period of 1 year. All the patients were selected as per the described inclusion and exclusion criteria. All cases underwent endoscopic composite cartilage graft tympanoplasty (type-I) under general anesthesia. Audiological outcomes were assessed by comparing mean pure tone average pre-and post-operatively and morphological results (successful graft uptake) were evaluated at 6 months.
Results: The result of this study showed graft uptake success in 94 cases and failure was seen in 6 cases. The pre-operative ACT was 44.8±6.1 dB whereas postoperatively it was 29.61±6.31 dB and the difference between the pre-operative and post-operative values was found to be statistically significant.
Conclusions: We conducted an endoscopic composite cartilage graft tympanoplasty (type-I) in 50 cases and observed a graft uptake success rate of 94%. There was good uptake of graft along with improvement in the audiological profile of the patients.

A prospective clinical assessment of the laryngotracheal injuries following endotracheal intubation

Vmashi Krishna B, Dr. Kotagiri Ravikanth, Dr. BVN Muralidhar Reddy

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 301-307

Aim: The aim of the present study to evaluate thelaryngotracheal injuries following endotracheal intubation.
Methods: A prospective study was conducted in the Department of Otorhinolaryngology, RVM Institute of Medical Sciences & Research Centre, Laxmakkapally, Telangana, India for the period of 1 year. 50 Patients intubated for more than 48 hours and admitted in medical ICU and aged more than 15 years were included in this study. To find the incidence, types of injury and to study the factors influencing LTI following intubation.
Results: Of 50, 32 were males and 18 were females with age ranging from 15 to 70 years. Majority of patients (70%) were between 15-29 years. Endotracheal tube of size 7.5 and 8 were used in 84% of patients. Majority of the patients (52%) were cases of organophosphorus (OP) poisoning followed by metabolic disorders like diabetic ketoacidosis and chronic kidney disease with encephalopathy. 36% of the patients were intubated for more than 10 days. The x-ray was normal in 36 patients (72%) while the abnormality was picked up in 14 (28%) patients. On 70-degree endoscopy, 4 patients (8%) had granulation tissue in the posterior commissure and one patient had bilateral vocal cord fixation. All the patients who had LTI were aged less than 45 years and 16 of 20 cases affected were males. Among the cases of LTI, 16 (80%) out of 20 cases were intubated with endotracheal tubes of size more than 7. 12 (60%) of the total cases of LTI had intubation for more than 10 days. OP poisoning was the etiology for LTI in 16 cases (80%).
Conclusion: A high incidence of LTI especially in cases of OP poisoning warrants one to be cautious in managing these intubated patients. Those patients requiring prolonged intubation should be considered for other alternative airway managements like tracheostomy in addition to using low pressure, high volume cuffed tubes

A prospective case control assessment of the gall bladder volume in type 2 diabetes mellitus patients using real time ultrasonography

Dr. Sreekanth Dakaraju Pagadala, K Sai Shravan Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 308-313

Aim: To assess the gallbladder volume in T2DM patients and in healthy controls by using Ultrasonography.
Methodology: This cases control study was conducted among 55 diabetic patients enrolled from the diabetes clinic of the RVM Institute of Medical Sciences & Research Centre, Laxmakkapally, Telangana, India and 55 healthy patients (control group). 30-60 year patients of type 2 diabetes mellitus diagnosed since 5 year or more and functioning gall bladder with well controlled blood sugar levels. The diagnosis of diabetes in these patients was in accordance with WHO criteria i.e., fasting plasma glucose level ≥126 mg/dl, and ≥200 mg/dl plasma glucose level after 2hr of ingestion of standardised 75 gm glucose. An informed consent was taken from all the subjects in the study and control groups. All the patients were randomly selected for the study among patients regularly attending diabetic clinic of this hospital and following our criteria’s of selection.
Results: Mean age of diabetic Patient was 48.5 years in study group and 53 years in control group. 45.5% of diabetics were males and remaining 54.5% were females, whereas in control group male to female ratio was equal, means 49% males and 50% females. 85.5% cases in control group had no gall bladder disease, while only 63.6% cases in group with diabetes had no gall bladder disease. In group with DM type 2, 20% had cholelithiasis, 9.1% had cholecystitis, and 7.3% had sludge: while in control group, 5.5% had cholelithiasis, 3.6% had cholecystitis, and 5.5% had sludge. The percentage of contraction of gall bladder had reduced markedly in chronic diabetics (45.6 + 9.57) as compared to controls (65.2 + 7.34) (p value- 0.001). The fasting gall bladder volume in chronic diabetics was higher (43.47 + 5.35) than that of controls (28.45 + 4.26) and the difference of values was found to be highly significant (p value 0.001).
Conclusion: In patients of diabetes mellitus type 2, higher fasting gall bladder volume and decreased percentage of contraction are observed. Therefore, all T2DM patients should be evaluated using ultrasonography for the presence of increased fasting gallbladder volumes to assess the risk of progression to gall stone disease.

A prospective assessment of the utility of high-resolution ultrasound and color doppler in evaluating the scrotal pathologies

K Sai Shravan Kumar, Dr. Sreekanth Dakaraju Pagadala

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 314-320

Aim: To classify (etiologically) and to evaluate various scrotal pathologies using ultrasonography and describe the role of high-resolution ultrasound and colour doppler in their diagnosis and differentiation.
Methods: A prospective study was conducted in the RVM Institute of Medical Sciences & Research Centre, Laxmakkapally, Telangana, India for the period of 1 year. The 100 patients with clinical features of scrotal diseases were include in this study. All the patients included in the study underwent scrotal ultrasonography using 7.0-12.0 MHZ high frequency linear array transducer coupled with Colour Doppler in Esaote My Lab 40 and Phillips affinti 70G equipments.
Results: The patients most commonly involved were those belonging to the age group of 30 to 40 years (38%). The least number of patients belonged to the age group of 0-10 years (4%). On USG, the total number of lesions detected were 120. The most common cause of scrotal pathologies was hydrocele (n=31, 25.83%) followed by epididymal cyst (n=20, 16.67%), epididymo-orchitis (n=16, 13.33%), epididymitis (n=9; 7.5%), funiculitis (n=8, 6.67%), varicocele (n=7, 5.83%), pyocele (n=6, 5%), testicular torsion (n=5, 4.17%), testicular abscess (n=5, 4.17%), inguino-scrotal hernia (n=4, 3.33%), testicular microlithiasis (n=3, 2.5%), testicular tumour (n=3, 2.5%) and tubercular epididymo-orchitis (n=3, 2.5%). The number of scrotal lesions seen on the left side were 45(37.5%), on the right side were 35 (29.17%) and in bilateral locations were 20(16.67%). Associated symptoms included swelling, pain, fever and infertility. Almost all the scrotal pathologies were associated with scrotal swelling (n=97, 97%) except in 3 cases. Epididymal cysts were seen in 20 patients, Acute epididymo-orchitis (n=16) was most commonly seen on the left side. Hydrocele (n=31) was the most common scrotal pathology detected in this study. Varicocele 7 patients was most commonly seen on the left side. Testicular torsion was detected in 5 (n = 5) patients. 3 (n=3, 60%) patients had right testicular torsion.
Conclusion: High frequency ultrasonography with Color Doppler study serves as an excellent diagnostic imaging modality in the evaluation of scrotal diseases. It is the investigation of choice since it is highly sensitive, easy to perform, widely available, repeatable and involves no risk of ionizing radiation. Periodic follow-up USG scans are recommended for patients with inflammatory scrotal lesions to monitor response to treatment and to reveal the development of complications.

Onset and Intubating Conditions with Succinylcholine and Rocuronium

N. Syama Kumar, Gangula Chandra Sekhar, K. Nagabhushanam, K. Deepthi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 321-333

Background: Rocuronium, like succinylcholine, has a rapid onset of neuromuscular blockade; but, unlike succinylcholine, rocuronium does not have the deleterious effects that are associated with the use of the latter. Nevertheless, its usage is restricted because of its protracted activity. The purpose of this study was to determine whether or not lowering the intubating dose of rocuronium shortened its duration of action while still providing intubating conditions that were clinically acceptable. This was a prospective, randomised, and blinded study for both participants and observers.
Material and Methods: One hundred Indian patients aged between 18 and 65 years who were scheduled for elective surgery were randomly assigned to one of the four rocuronium groups (rocuronium dose of 0.6 mg/kg intubated at 60 s or at 90 s, rocuronium 0.9 mg/kg intubated at 60 s or at 90 s) or succinylcholine group (succinylcholine dose of 1.5 mg/kg intubated at 60 s). Intubating conditions Analysis of variance (ANOVA), Chi-square test, repeated measures analysis of variance (ANOVA), and Mann–Whitney U test were the four statistical tests that were carried out.
Results: Intubating conditions were deemed clinically acceptable in 35% of subjects at 60 seconds and 60% of subjects at 90 seconds when rocuronium was administered in a dosage of 0.6 mg/kg; however, when rocuronium was administered in a dosage of 0.9 mg/kg, intubating conditions were deemed clinically acceptable in 80% of subjects at 60 seconds and 100% of subjects at 90 seconds.
Conclusion: When administered at a dose of 0.6 mg/kg, rocuronium did not produce clinically acceptable intubating circumstances at either 60 or 90 seconds, although it has a shorter duration of action. It takes approximately the same amount of succinylcholine, 0.9 mg/kg, for rocuronium to provide clinically acceptable intubating circumstances as it does for succinylcholine, 1.5 mg/kg.

PROSTATIC CARCINOMA HISTOLOGICAL STUDY IN CORRELATION WITH THE Ki67 IMMUNOMARKER AND PSA LEVELS

Dr. M. Mamatha, Dr. Swarnalatha Sripathi, Dr. Rama Devi Pyla, Dr. Jostna Devi Akarapu

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 334-360

Background: Prostate cancer is the second most common cancer in men and the fourth most common cancer overall. 1.4 million new cases of prostate cancer diagnosed in 2020. PSA and Gleason's score (GS) before treatment are important diagnostic and therapeutic indicators. According to studies, GS degrades tumors while PSA is not cancer-specific. The current study studies the relationship between Ki67, GS, and PSA, which is used to grade tumors and predict patient prognosis. Objectives: 1. To study the histopathology of prostate carcinoma and its variants and assign them a Gleason score as per the Gleason grading system. 2.To study Ki-67 immuno expressing in prostate carcinoma. 3. To correlate Ki-67 expression, Gleason scoring, and serum prostate-specific antigen levels in prostate carcinoma, Methods: A retrospective study enrolled 80 prostate cancer patients from Malla reddy Medical College, Hyderabad from November 2019 to April 2021.Each instance received a Gleason score and Ki67 immunohistochemistry. Ki67 expression and Gleason score were found to be related. Results: All 80 patients were diagnosed with acinar/normal adenocarcinoma-WHO. There were 36 patients with moderately-differentiated tumors (45%) , 28 with high grades (35 percent), and 16 with intermediate grades. PSA levels rose as a result of GS. GS and serum PSA levels increased in direct proportion to Ki6l abeling. Conclusion: Ki67 is a novel biomarker linked to tumor grade and pretreatment PSA levels. It can be used as a diagnostic parameter or to replace prognostic factors.

To Assess Hearing Outcome following Tympanostomy Tube Insertion in Otitis Media with Effusion

Ashutosh Kumar, Bhola Kumar Sharma, Vinit Anand, Surendra Prasad Singh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 361-369

Background: Otitis Media with Effusion (OME) is the effusion in middle ear and is commonly seen in children. It causes conductive hearing loss and increased risk of acute middle ear infections. It is mostly a paediatric problem, and leads to poor scholastic performance. It may be managed medically or surgically and surgical management includes grommet insertion or concurrent adenoidectomy with grommet insertion. Our study evaluates the use of ventilationtubes in management of OME. To study the symptomatology of otitis media with effusion (OME), to assess hearing following tympanostomy tube insertion and to determine the complications of tube insertion procedure.
Materials and Methods: This was prospective study done at Jawaharlal Nehru Medical College and Hospital, Bhagalpur from July 2021 to March 2022. Fifty patients of otitis media with effusion were studied and underwent Grommet/ventilation tube insertion and they were followed up or 1, 3 and 6 month interval to determine the improvement in hearing ability.
Results: Patient age ranged from 6 years to 50 years and the male to female ratio was 1.17:1. Both the ears were found to be equally involved. A total of 27 (54%) cases had average of 11 to 20 dB hearing loss by PTA. Most common type of impedance was B type seen in 40 (80%) cases. The overall complication rate in our study was 9 cases, ie 18%. Pure tone audiometry (PTA) is important to evaluate hearing outcome and these readings gradually improved post operativelycorresponding to improvement in the hearing capacity of the affected subjects.
Conclusion: Otitis media with effusion (OME) has varied clinical presentation; it is more common in children and adolescents without any gender preponderance. Tympanostomy tube insertion is one of the ideal treatment choices for Otitis Media with effusion with significant improvement in post-operative PTA readings which can lead to a better quality of life.

A prospective study of management of diaphyseal forearm fractures in paediatric age group with intramedullary titanium elastic nail system

Dr. Anil Kumar SV, Dr. Nithin Shekar C, Dr. Nitin N Sunku, Dr. Rajashekar M, Dr. Ullas Mahesh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 370-376

Aim of the study: The aim of this study is to asses management of diaphyseal forearm fractures in paediatric age group with intramedullary titanium elastic nail system.
Materials and Methods: The study was conducted from July 2019 to October 2021 at Dr BR Ambedkar medical College and Hospital with follow up period of six months. 30 children fulfilling the inclusion criteria with displaced diaphyseal forearm fracture were surgically treated with titanium elastic nail system. The clinical assessment was conducted for atleast a period of 6 months post operatively using Price et al. criteria.
Results: At six months of follow-up 27 patients had excellent results, 3 had good results according to price et al. criteria, which is based on the amount of restriction of forearm rotational movements. According to this criterion, excellent results were achieved after elastic nailing of forearm fractures in children with less than 15 degree of loss of forearm rotation.
In the present study, Radiological union of fracture was observed in about 60% of patients before 8 weeks and more than half of patients achieved radiological union before 8 weeks.
Conclusion: Based on our experience and results, we conclude that ELASTIC STABLE intramedullary nailing technique is an ideal method for treatment of paediatric forearm bone diaphyseal fractures. It gives elastic mobility promoting rapid union at fractures site and stability which is ideal for early mobilization. It gives lower complication rate, good outcome when compared with other methods of treatment. It is a simple, easy, rapid, reliable and effective method for management of paediatric forearm bone diaphyseal fractures between the age of 5 to 16 years, with shorter operative time, lesser bloodless, lesser radiation exposure, shorter hospital stay, and reasonable time to bone healing. Because of early mobilisation, rapid healing and minimal disturbance of bone growth, ESIN may be considered to be a physiological method of treatment.

A comparative study of pre-sleep activities affecting the sleep of rural and urban adolescents in Tumkur district

Dr. Vidya MP, Dr. Karthik S, Dr. Ruchi Dhar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 377-381

Background: Sleep affects mental, emotional and physical wellbeing of an adolescent. On an average for adequate development an adolescent should sleep for at-least 8 to 10 hours per day.
Objectives: To study the pre-sleep activities affecting the sleep of rural and urban adolescents.
Methods: A cross-sectional questionnaire-based school survey was designed with a sample size of 992 for the adolescents aged between 10 to 16 years of age. Children with illnesses that affected their sleep were excluded from the study. A pre-designed questionnaire was distributed to each of them. Later the data was tabulated in Microsoft excel and statistical analysis was done using software SPSS 22.0.
Result: On comparing various factors that affect sleep, it was found that 27.62% of the subjects consumed beverages like tea and coffee before sleep, 42.64% used mobile phones before sleep, 58.06% watch television late at night, 41.73% consume dinner late in the night i.e., after 10 pm and 28.53% have sleep disturbance due to exam stress and fear. The use of mobile phones before sleep and late-night dinners was more among the adolescents residing in the urban areas compared to those in the rural areas which was statistically significant (p<0.0001).
Conclusion: Pre sleep activities have a major impact on the quality of sleep, hence addressing them is essential.

Significant endoscopic findings and the probable associated factors in dyspeptic patients: A cross-sectional study conducted in a tertiary care hospital, rural Mandya

Dr. Yamuna VS, Dr. Sachin K, Dr. Selva Rani, Dr. Veena Ghanteppagol, Dr. Ullas Mahesh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 382-390

Introduction: Dyspepsia is the most common gastrointestinal problem. Majority of dyspepsia is functional dyspepsia. Due to the high prevalence of dyspepsia, inappropriate use of upper GI Endoscopy can lead to unnecessary costs, risk of complications, and associated with reduced diagnostic yield.
Objectives:

To determine the prevalence of significant endoscopic finding (SEF) and H.Pylori in dyspeptic patients.
To determine the response of dyspeptic patients to PPIs and H.pylori eradication therapy.
To assess the factors predicting SEF in dyspeptic patients.

Materials and Methods: This was a cross-sectional study conducted for a period of 18 months among 100 patients with dyspepsia at department of general surgery of a tertiary care hospital. Data was collected using a semi-structured questionnaire by interview technique. The study subjects were subjected to upper gastro-intestinal endoscopy during which biopsies were taken and sent for routine histopathology examination. Descriptive and inferential statistics has been carried out in the present study. A P value < 0.05 was considered statistically significant.
Results: The mean age of the study subjects was 45.13±14.06 years. Pain abdomen was the commonest (82.0%) alarm symptom of dyspepsia and 64.0% of those with dyspepsia were smokers and 61.0% were alcoholics. Overall prevalence of significant endoscopic finding (SEF) was 36.0% and duodenal ulcer (22.0%) was the commonest of all. 71.0% revealed H.pylori infection and at least 90.0% responded well to proton pump inhibitors (PPIs) and triple drug therapy. Among the different factors, bloating or belching was found to be significantly associated with the SEF.
Conclusion: The prevalence of SEF was 36.0% and H.pylori was 71.0%. Most of them i.e. 90.0% responded both clinically and microbiologically to the treatment and bloating or belching was a significant alarm symptom associated with SEF. A trial of proton pump inhibitors (PPIs) and triple drug therapy can be considered before subjecting the patients to the invasive procedure of endoscopy.

A 2 year retrospective study of cyto-histopathological correlation of breast lesions at a tertiary hospital: A study of 200 cases

Dr. Manasa GC, Dr. Divya PJ, Dr. Nischita Budihal, Dr. Govardha A

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 391-399

Background:
Breast lesions constitutes a major public health problem worldwide, both in developed as well as in developing countries. A palpable breast lump, whether benign or malignant, is a cause of great anxiety to the patient. Thus, the need arises to distinguish benign from malignant lesions, prior to definitive treatment.
The National Health Services Breast Screening Program recommends Fine Needle Aspiration Cytology (FNAC) as a non-operative diagnostic tool. One of the major goals of FNAC is to differentiate benign from malignant lesions.
Aim & Objectives:

To diagnose any palpable lump of the breast in females by FNAC
To correlate Cytological findings with histopathological results.

Methods and Materials: Retrospective study done at department of pathology at a tertiary centre, Karnataka for 2 years (2018-2019). FNAC of the breast lesions done and the excision biopsy of the same specimen sent for histopathological examination were taken in this study.
Results: In this study,a total of 200 cases on cytology were correlated with their histological diagnosis. Fibroadenoma (116 cases) being the most common benign lesion and intraductal carcinoma (29 cases) being the most common malignant breast lesion.
Conclusion: FNAC is a reliable tool to rule out benign from malignant lesions and shows high concordance with the histopathological reports. Therefore cytology can play a vital role in the evaluation and management of the patients with palpable breast mass.

A cross sectional study on acceptability, safety and evaluation of post-vaginal delivery and intra-cesarean insertion of PPIUCD at tertiary Centre

Dr. Prathibha SD, Dr. Shreya Mallesh, Dr. Anitha N, Dr. Santosh S Basarakod, Dr. Ullas Mahesh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 400-406

Introduction: India is world’s second most populated country with nearly 20.7% of the Indian population have unmet needs for family planning with 65% in the first year of postpartum period. Postpartum period is the ideal time of family planning studies as spacing less than two years of child birth can lead to obstetric complications and maternal mortality. Hence practice of contraception is mandatory.
In this study we have emphasised Cu375insertion which has the advantage of high motivation, safety and convenience for both patients and the service provider. Here we conducted a pilot clinical study comparing intra-caesarean Cu375 insertion and post-placental insertion following vaginal deliveries.
Materials and Methods: A systematic study with 60 patients in each group recruited clients randomly based on acceptance and mode of delivery. Group A intra-caesarean insertion and Group B post- placental insertion following vaginal deliveries. The cases were followed up at 6weeks and 6months post-insertion with a set of parameters. Here we look for Missed strings, Expulsion and Infection rate as the primary outcome measures. Complications as the secondary outcome measures.
Results: Infection rate is found to be higher in Group B(5%) than Group B at 6th week. At 6th month, infection is higher in Group B (1.8%) than Group A(0.9%) p=0.617. Missed strings are found to be higher in intra-caesarean than interval method both at 6th week and 6th month follow up. Expulsion rate is found to be higher in Group B(3.3%) than Group B(1.67%) p=0.5 at 6th week. At 6th month there is no IUCD expulsion in Group A (0%) than in Group B where there is (1.9%) expulsion p=0.497. Uterine perforation noted among 3.35% in group A compared to 1.67% in group B. There is no complications or contraceptive failures in both groups during the study period. On statistical analysis, it is found that there is no significant difference in infection and expulsion rate between the groups. For missed strings there is a significant difference between the groups with more missed strings in intra-caesarean method.
Conclusion: To conclude that, intra-caesarean method is equally effective as interval
method without any added complications for contraception in caesarean deliveries, with added advantage of high motivation, good compliance and safety and easy for provider to deliver the services.

Reproductive health awareness among adolescents attending gynecology and pediatrics OPD at tertiary centre

Dr. Anitha N, Dr. Prathibha SD, Dr. Dhruviben Nileshkumar Pola, Dr. Santosh S Basarakod, Dr. Ullas Mahesh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 407-415

Background: The sexual and reproductive health needs of very young adolescents aged 10–14 in developing countries require increased attention.(9)This study aims to assess the awareness of adolescents about puberty changes
Method: Adoloscent girls attending our OPD were asked to attend to a questionnaire with a set of 14 questions and their awareness was assessed based on a “yes” or “no” response.
Results: We found that there was significant association between reproductive health awareness and education and age with little knowledge about contraception, teenage pregnancies and its complications.
Conclusion: There is an increasing need to educate the most vulnerable population regarding teenage pregnancies, unsafe sexual practices and and contraception to prevent them from contracting sexual transmitted diseases and other such complications

Efficacy of single bevacizumab injection as adjuvant therapy to laser photocoagulation in macular edema secondary to branch retinal vein occlusion

Dr. Priyanka Malik, Dr. Sneha Pal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 416-420

Aim: To evaluate the improvement in visual acuity and central macular thickness after combination therapy of laser photocoagulation with single intravitreal bevacizumab injection in macular edema secondary to BRVO.
Material & Methods: This was a clinical trial study of 30 patients diagnosed with macular edema secondary to BRVO. Group A (n=15) was treated with laser photocoagulation therapy in combination with intravitreal bevacizumab injection, while Group B (n=15) was treated with laser photocoagulation therapy alone.
Results: There was no sig­nificant difference between the two groups with regard to sex (P=1.00). A significant difference in visual acuity between the two groups at 3-month follow-up (P=0.010) can be observed.No significant difference in macular thickness between the two groups was observed (P=0.772).
Conclusion: Laser photocoagulation combined with a single intravitreal bevacizumab has a substantial effect on increasing visual acuity in macular edema secondary to BRVO.

Outcome Analysis of Radial Head Replacement in Comminuted Radial Head Fractures

Suresh Uikey, Vishal Nigwal, M. Gopala Rao, Praveen Khatri, Ankit Prasad, Rahul Shukla, Suneet Tandon

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 421-432

Radial head fractures are the most common fractures around elbow in adults and occurs due to fall on the outstretched hand with the wrist extension and the forearm pronation. Comminuted radial head fractures can jeopardise the stability of the elbow and forearm.  Radial head excision can lead to elbow instability in coronal plane . Radial head replacement restores the lateral column and ensures stability.
Aims: To assess the outcome of radial head replacement in comminuted Radial head fractures
Study Design: A prospective interventional study
Methods and Material:  28 patients of comminuted radial head fractures were managed with radial head replacement using mono bloc , cemented radial head prosthesis, at a tertiary institute of Bhopal, India from December 2019 to May 2021.
Statistical analysis used: paired t test
Results: After a mean follow up of 5.6 months Broberg and Morrey score is good to execellent in 89% patients with mean score of 86 and 90% patients had VAS score mild (<2).
Conclusions: Radial head arthroplasty gives good to excellent results in short term for most of the cases for treatment of Comminuted radial head fractures.

An Analytical Study to Assess Intra-operative and Post operative Complications among Cataract Patients at a Government Tertiary Care Hospital.

Dr. Rajendra Choudhary, Dr. Utkarsh Prabhakar Deshmukh, Dr. Thory Prakash Tilokaram

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 433-439

Introduction: Cataract is defined as an opacification of the crystalline lens leading to visual impairment, usually manifested in ageing people. Several types of cataract correcting surgeries are prevalent. Intra-operative and post operative complications are also common following the cataract surgery.
Aim: To study the complications and visual outcome in patient of mature or hypermature cataract undergoing cataract surgery.
Method: Study was done at GMERS Medical College & Hospital, Gandhinagar, Gujarat. It was a prospective study conducted at Ophthalmology department of GMERS Medical College & Hospital, Gandhinagar, Gujarat. Patients who attended outpatient department of ophthalmology department of GMERS Medical College & Hospital, Gandhinagar, Gujarat. Results: According to OCTET grading, 21 (26%) patients had one or more intra-operative complication. 16.2% patients had OCTET grade I, 6.3% had grade II and 3.7% patients had OCTET grade III complications. Overall, 42 (52.5%) patients had one or more post-operative complication.
Conclusion:  MSICS promises to be a viable cost-effective alternative to the more expensive phacoemulsification. Most of the post-operative complications had subsided at the end of 6 weeks.

Morphometric and Morphological Study of Foramen Ovale in Adult Dry Human Skulls in Telangana Region

Dr. T. Sumalatha, Dr. Niveditha Samala, Dr. B. Mahita, Dr. M Padmavathi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 440-446

Background:  Foramen Ovale (FO) is the most important constant foramen of greater wing of sphenoid in the middle cranial fossa. It opens into infratemporal fossa and gives passage to mandibular nerve, accessory meningeal Artery, lesser petrosal nerve, emissary veins. It is usually oval in shape but its shape shows variations when compared to rest of the foramina in the skull. It is of great significance to neurosurgeons as transcranial approach to skull base is possible via it in case of trigeminal neuralgia.
Methods: The present study was an observational study, conducted on 50 dry human skulls (100 foramen ovale) in the department of anatomy, Osmania Medical College, Hyderabad, Telangana. India. The study has taken prior approval from Institutional Ethical Committee. This study included fully ossified, dried, cleaned skulls of unknown sex, Broken & deformed skulls were excluded from the study
Results: In the present study the mean anterio-posterior diameter (APD) of FO was 6.55±1.4mm, 6.52±1.3mm on right side and left side respectively. The mean transverse diameter (TD) of FO was 4.19±1.1mm and 4.13±1.4mm on right side and left side respectively. The most common shape was oval in 65%, followed by almond shape in 14%, D-shape in 11%, longitudinal/slit like in 4%, irregular in 4% of foramen ovale and confluence of FO with spinosum was seen in 2% of foramen ovale.
Conclusion: The detailed anatomical knowledge of FO is of great importance to the clinicians in diagnosis & management of various neuro surgical procedures and micro vascular approaches. Variations in the shapes of the FO are found due to developmental reasons, which may seriously hamper clinical & diagnostic procedures

A PROSPECTIVE STUDY OF ENDOMETRIAL CARCINOMA IN PATIENTS WITH ABNORMAL UTERINE BLEEDING

Dr. M pavani, Dr. Mohd. Anwar Miya, Dr. Hemalatha. P, Dr. S. Raghu Ram Mohan

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 447-452

Background: The most frequent presenting symptom in the gynecology outpatient department is abnormal uterine bleeding (AUB). Endometrial sampling may be effectively the initial diagnostic step in AUB, though it frequently presents a difficult interpretation for pathologists in practice. This study was done to evaluate the histopathology of endometrium for the purpose of identifying the endometrial causes of AUB. Additionally, we tried to observe the incidence of various pathologies in different age groups presenting with abnormal uterine bleeding.
Materials and methods: This is a prospective study done on cases of AUB who underwent endometrial biopsy from August 2020 to August 2021 in the department of pathology at Kakatiya Medical College, Warangal, and Telangana, India. All the biopsies were routinely processed and a histopathological diagnosis was made. A statistical analysis between age of presentation and specific endometrial causes was done using the Chi-square test.
Results: The most common age group presenting with AUB was 35–72 years old. Out of 133 cases studied, 48% of cases were found to be proliferative endometrium, 28% of cases were of secretory endometrium, 2% of cases were of atrophic endometrium, 3% were of irregular maturation, 17% were of simple hyperplasia, and 2% were of endometrial carcinoma. Endometrial causes of AUB and age pattern was statistically significant with P value<0.05.
Conclusion: Endometrial lesions are associated with particular ages. AUB is more frequently dysfunctional in perimenopausal women, so when they are in the reproductive age range, they should first rule out pregnancy-related issues. This study's significantly high incidence of aberrant proliferative patterns suggests that these patients present at an early stage.

A PROSPECTIVE COMPARATIVE STUDY OF THE IMPACT OF BODY MASS INDEX ON THE INCIDENCE OF POST-DURAL PUNCTURE HEADACHE IN PARTURIENTS UNDERGOING ELECTIVE CESAREAN SECTION UNDER SPINAL ANESTHESIA: KAKATIYA MEDICAL COLLEGE, WARANGAL

M. Priya Darshini, MadhaviLatha pinnelli, GullapalliHanumantha Rao, Kiran Madhala

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 453-460

The relationship between Post-Dural puncture headache (PDPH) and body mass index (BMI) in individuals who have just given birth has been the subject of contentious studies in the past. As a result, we decided to survey this complication in a group of patients who had cesarean sections performed under spinal anesthesia. It was predicted that people with greater BMIs would experience PDPH less frequently.The demographic data was retrieved and documented after looking over the patient files and phoning the patients. Additionally, a headache score based on a 0–10 verbal numeric rating scale (NRS) and the development of PDPH up to three days after a cesarean section in the present delivery were documented.At the Kakatiya Medical College in Warangal, 76 women who had undergone spinal anesthesia for a cesarean section participated in this study (March 2021 to February 2022). The subjects ranged in age from 20 to 40 years old (28.24 ± 3.27). The average BMI (kg/m2) before a cesarean section was 30.21 ± 2.82. 38 (50%) of the 76 parturient patients were not obese, and the remaining (50%) were (BMI > 30 kg/m2); 97.90% were non-smokers, and 92 percent had no prior history of PDPH during the previous neuro-axial anesthesia/analgesia. Only 13 participants (17.10 %) in this study experienced headaches following the current spinal anesthetic. 31 patients (81.57%) and 32 patients (84.21%) of the patients who did not develop PDPH had BMIs below 30 and over 30 respectively (P = 0.386). We concluded that increased BMI at the time of cesarean section decreased the incidence of PDPH. Increased BMI lowers the risk of PDPH because obese patients' increased intra-abdominal pressure reduces CSF leakage from the dural puncture point. Additionally, this study demonstrated that neither BMI nor weight gain during pregnancy, nor any other characteristics looked at, had a significant impact on the severity of PDPH.

Expression of Cytokeratin-19 And HBME-1 in Various Thyroid Neoplasm at a Tertiary Care Centre

Dr. G Vandana, Dr. Ch. Padmini, Dr. Md Anwar Miya, Dr. L Yatish Sai

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 461-471

Background:To distinguish between malignant and benign lesions of the thyroid gland and due to several overlapping histomorphological features and pitfalls in thyroid pathology, there is a need to establish a panel of immunomarkers that could aid in proper diagnosis. This study is intended to investigate the ability of CK-19 & HBME-1 in differentiating between benign and papillary carcinoma thyroid
Methods: This study is being conducted in the Department of Pathology, Kakatiya Medical College and MGM hospital, Warangal, Telangana during a period between 2018 to 2021. A total of 60 cases are studied out of which 32 cases were diagnosed as follicular adenoma, 16were PTC, and 12 were FVPTC. Excision biopsies specimens from the lesions were fixed in formalin, paraffin-embedded, and routinely stained in H and E. IHC staining with markers HBME - 1 and CK-19 was done and their expression is correlated.
Results: The highest incidence of thyroid nodules in the present study was in the 4th decade in males. Papillary Thyroid Carcinoma (PTC) was most common in malignant thyroid nodules, out of 28 malignant lesions selected 16 were classic PTC and 12 were FVPTC. Positive CK19 expression observed in 25 out of 28 malignant cases (89.28%) included 15 out of 16 cases of classic PTC (93.75%). Positive HBME-1 expression observed in 27 out of 28 malignant cases (96.4%) included 16 out of 16 cases of classic PTC (100%) and 11 out of 12 cases of FVPTC (91.6%). Negative HBME-1 expression was observed in 1 case out of 12 FVPTC (3.5%). Negative HBME-1 expression was observed in 26 out of 32cases (81.25%) of benign lesions. HBME-1 showed a high statistically significant difference between papillary carcinoma of the thyroid and other benign thyroid nodules (P < 0.000001).
 
Conclusion: Conventional PTC may not pose a problem for diagnosis but its variants and its benign morphological mimics are challenging. Our study concurs with published literature to suggest strong expression of CK19 and HBME-1 in FVPTC and PTC. CK19 and HBME-1 are impressive positive markers for malignant lesions probably helping in the new category of encapsulated follicular pattern thyroid nodules. 

Surgical Outcomes in Carcinoma Rectum after Radical Radiation

Dr. Rajeshwar Avancha, Dr. VSR Rakesh Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 472-479

Background: The most frequent cancer in the world is colorectal cancer (CRC). It is the third most typical cancer in men to be diagnosed. Clinical staging is frequently used to determine when to start neoadjuvant chemotherapy and radiation therapy for rectal cancer (NACRT). Therefore, both for care and prognosis, the correctness of that first staging is crucial.
 
Methods: Fifteen rectal cancer patients who receive radical radiation (dose escalation in addition to standard neoadjuvant chemoradiation and undergo surgery). Rectal cancer patients who receive dose escalation in addition to standard neoadjuvant chemoradiation (prescribed whole pelvis radiotherapy dose of 50.4 Gy with additional 9 Gy BOOST to GTV Primary with a margin under standard fraction as 1.8 Gy per fraction for 5 days a week for 7 - 8 weeks with concurrent capecitabine during the days of radiation) will be included in the study. After receiving preop treatment, the clinical and radiological response shall be assessed and planned for surgery as indicated.
 
Results: N=6 patients underwent surgery at 6 weeks after chemoradiotherapy. N=7 patients after 7 weeks and n=2 patients after 8 weeks of chemoradiotherapy. Clinical (POSTNACTRT MRI) down staging of tumor: Stage 2A – 3 pts – all downgraded to stage 1 after NACTRT Stage 3B – 12 pts – 11 patients downgraded to lower stage after NACTRT.  In our study, out of 15 patients, 5 patients (33.33%) had a complete pathological response. Rest 10 patients (66.67%) had an incomplete pathological response.
 
Conclusion: the Neoadjuvant CTRT with dose escalation (Radical RT) in carcinoma rectum patients is Pathological complete response is increased. Downsizing and down staging of tumor clinically (Post NACTRT MRI). Increased sphincter saving surgeries. The toxicity of radiation dose escalation is acceptable and tolerable The latest literature favors towards wait and watch and organ preserving approach after complete clinical response.

Simultaneous use of Milan System and Pattern Based Risk Stratification Approach for Salivary Gland Cytology

Dr. Sheetal Chandra, Dr. L Aruna, Dr. P Hemalatha

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 480-488

Background: The well-established method of fine-needle aspiration cytology (FNAC) presents certain difficulties in its widespread application due to the heterogeneity and morphological overlap of the spectrum of salivary gland disorders. The recent "Milan system for reporting salivary gland cytopathology" (MSRSGC), offers guidelines for diagnosis and treatment based on various categories of malignancy risk (ROM). The goal of this study is to stratify the lesions by assigning the risk of malignancy based on pattern, interpret salivary gland lesions based on MSRSGC, and record interobserver variability.
Methods: FNAC was performed routinely on all palpable salivary gland lesions confirmed by prior USG. FNAC was done under aseptic conditions using 22–24 gauge needles, via percutaneous route either by non-guided or guided aspiration. A minimum of 2 passes were made by trained residents in the department of Pathology. The cytosmears are fixed in 95% ethyl alcohol or air dried and are routinely stained by Hematoxylin and Eosin and PAP stain where ever needed. Each case was evaluated for adequacy and categorized into one of the six categories according to MSRSGC by two different faculty members and tabulated. These cases were assigned to categories based on established criteria in the literature.
Results: Most commonly categorized category is Category-IVa. Benign neoplasm (68/136) in this Pleomorphic adenoma (56/68) is the commonest diagnosis.  In Non-Neoplastic; chronic sialadenitis (24/40) was the most common diagnosis. We have received 49 cases for histopathological examination. In cyto-histopathological correlation, concordance was seen with 39/49 cases. 10/49 cases were found to be discordant out of them 4/10 were benign and 6/10 were malignant.
Conclusion: the use of the Milan System of Reporting Salivary Gland Cytopathology in regular cytology reporting to improve the communication between pathologists and also with the clinician for better patient care. The use of pattern-based categorization could help in complimenting MSRSGC, as it adds to the risk stratification. as it has a higher positive predictive value.

Analysis of Hematological Abnormalities associated with Rheumatoid Arthritis Patients at a Tertiary Care Centre

Manish Mittal; Deepak Verma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 489-493

Introduction: Rheumatoid arthritis (RA) is a systemic inflammatory disorder associated with significant proportion of haematological abnormalities. The present study was undertaken for assessing the haematological abnormalities among rheumatoid arthritis patients. The main aim of the study is to study the prevalence of haematological manifestations in patients with seropositive rheumatoid arthritis.

Comparative Evaluation of Bronchoalveolar Lavage and Transbronchial Lung Biopsy in Various Lung Pathologies: An Institutional Based Study

Shiv Kumar; Parnika Garg; Charu Agarwal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 494-498

Background: Lung pathology is the leading cause of death in developed countries and is increasing at alarming rates in developing countries. Flexible fiberoptic bronchoscope revolutionized respiratory cytology as techniques such as bronchial brushing (BB), bronchoalveolar lavage (BAL), and bronchial biopsy became more easy, accessible, and popular. Fine needle aspiration cytology (FNAC) has proved to be the most helpful method for the diagnosis of lung tumors.The present study was conducted to compare Bronchoalveolar Lavage and Transbronchial Lung Biopsy in Various Lung Pathologies.

To Compare Clinically Dexmedetomidine Vs Clonidine for Hemodynamic Stability in Laparoscopic Surgeries and Evaluation of Complications During Perioperative Period

Narendra Kumar; Mangilal Deganwa; Kalpana Verma; Kaushal Singh Baghel; Sandhya Sandhya

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 499-507

Introduction: Laparoscopic surgeries has revolutionized abdominal surgeries, however, this procedure is not risk free. Hence, the present study was designed to evaluate the efficacy of dexmedetomidine versus clonidine in prevention of such hemodynamic changes

Study of Blood Indices in Alcoholic individuals

Dr. Sandeep Pawar, Dr. Ade Vittal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 508-511

Alcohol being one of the most commonly used drug, whose consequences include changes of CBC. The main causes leading to changes of CBC (complete blood count) are, myelosuppression that is accompanying with slight reduction in all blood cells, blood loss from gastrointestinal tract, malnutrition etc. Alcoholics may suffer from moderate anemia, characterized by enlarged, structurally abnormal RBC’s. Multiple organs can be involved like Hepatobiliary system, cardiovascular system, Central nervous system, Haematopoietic system. Impact of alcohol on haematopoitic system divided into direct and indirect effects. This study is done to evaluate effect of alcoholism on blood indices. Total 50 moderate to severe alcoholics were included in study. . Blood indices which included Hemoglobin , RBC count , MCV, MCH,MCHC were estimated by cell counter. Results shows mean haemoglobin content and RBC count was less than normal values which tells that most of alcoholics are anemic . Mean values of MCV was more than normal range, which shows anemia seen in alcoholics was macrocytic. MCH and MCHC mean values are almost normal which tells that anemia in alcoholics was of macrocytic normochromic . Detection of hematological changes in  alcoholics and giving psychiatric counseling and treatment for alcohol dependence will decrease the future complications

Comparative Evaluation of Outcome of Various Modalities of Management of Distal Tibia Fractures: An Institutional Based Study

Shaiwal Saxena; Saurabh Sahu; Anurag Tiwari; Harshit Paliwal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 512-516

Introduction: Distal tibial fractures remain a challenge to orthopaedic surgeons. High energy observed as the aetiology in young patients whereas in elderly, a simple fall might result in this distal tibial fracture. The aim of this study to compare the functional outcome of various modalities of management of distal tibia fractures.

A Study of Pathogenic Bacteria Isolated from Blood Culture Samples and Their Antibiotic Sensitivity

Tiwari Palak, Mahi Ishani, Lal Darbari

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 517-525

Background: To diagnose bacteremia blood culture still remains the gold standard despite its limitations. While collecting samples, focus must be given that there is strong association between timing of specimen collection at different time points during admission and their yield.
Methods: A retrospective observational study was carried out by analyzing 100 positive blood cultures from April 2021-April2022. All positive blood culture and sensitivity reports of males and females aged less than one month to 60years were included. A total of 100 positive blood culture cases were taken from the culture and sensitivity register from Microbiology department of Hindu Rao Hospital and details were tabulated using a questionnaire.
Results: The commonest organism found on cultures was Coagulase Positive Staphylococcus (CONS) 34% of the cultures, this was followed by Actinobacter in 17% and Klebsiella pneumoniae in 11% of the culture samples. The most common fungi were Candida in 3% and Budding Yeast which was found in 2% of the samples. The most sensitive antibiotic was Gentamycin (27) which was sensitive for Coagulase-positive SA (12), K. pneumoniae (5), Actinobacter (5), S. typhi (3), E. coli (1) and P. aeuroginosa (1). The second most sensitive antibiotic was Vancomycin (20), which was sensitive for Coagulase-positive SA (9), Enterococcus (4), Methicillin resistant coagulase-positive SA (2), Methicillin sensitive SA (2), Actinobacter (1), MRSA (1), and S. aureus (1).
Conclusion: Positive blood culture is a crucial parameter for both the diagnosis of the patient as well as the associated prognosis, the correct interpretation of the blood culture results is essential. While planning treatment the sensitivity and resistance pattern of pathogens found in blood culture to common antimicrobial agents must be taken into account.

Study to Find the Morphometric Variations of Spleen: A Cadaveric Based Analysis

Vijay Laxmi Sharma, Abhilasha Dadhich, Sunny Yadav

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 526-530

Introduction: The spleen is a large haemo-lymphoid organ that are situated in the left hypochondrium andis partly in the epigastrium. Anatomically, it is placed between the fundus of stomach and diaphragm opposite to the 9th to 11th ribs. Spleen is an enormously vascular, soft and friable organ which is more or less purple in colour and moves with respiration.The importance of the spleen in protection from infection was actively neglected and it was thought that the other lymphatic organs of the body could take over its functions. Currently, a total splenectomy is vastly replaced by partial splenectomy by surgeons. Therefore, this study is meant to be carried out to find the morphology of spleen and its variations.
Materials and Methodology: The present study was carried out on embalmed cadavers that include both the sexes in the Department of Anatomy, SMS Medical College, Jaipur, Rajasthan, India. This study comprised of 65 complete spleen samples whereas the specimens withdestructed surface and margins by any mechanical, pathological and other conditions were excluded from the study. Dissection was carried out by following the Cunningham’s manual of practical anatomy. The specimens were allowed to be preserved in 10% formalin. All the collected samples were collected as per their weight, length, width, breadth was promptly measured, and the number of notches present were recorded. The weight of the spleen was calculated using the electronic weighing machine. The length was calculated as the greatest distance between the two poles of the spleen.
Results: The weight taken from 65 specimens ranges from 50-200 gm in 56 specimens (86%) and from 201-350 gm in 8 specimens (12%) and above 350 gm in 1 specimen (2%). The length of the spleen ranges from 6-9 cm in 31 (48%) and 9-15 cm in 34 (52%) specimens. Breadth of the spleen varies from 2-5 cm in 21 (32%) specimen, 5-9 cm in 42 (64%) specimen and 9-13 cm in 3 (4%) specimens. Thickness of the spleen varied from 2-4 cm in 62 (96%) and 4-6 cm 3 (4%) specimen respectively.
Conclusion: Despite the many indications for splenectomy, like traumatic rupture, hypersplenism, neoplasia, splenic cyst, the present tendency of the surgeons is to aid for conservative management and to remotely conserve as much splenic tissue as possible. Hence the sound knowledge on the variational anatomy of the spleen is of fundamental and is of utmost importance.

A Prospective Study to Evaluate the Accuracy of Fine Needle Aspiration Cytology (FNAC) and Touch Imprint Cytological Study in Correlation with Histopathological Study of Thyroid Lesions at Tertiary Care Center

Mukesh Kumar Khinchi, Ashish Bagaria, Subhash Chandra Sharma, Kamlesh Yadav

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 531-538

Background: Fine Needle Aspiration Cytology has been established as the investigation of choice in thyroid lesions. Different imaging techniques are now used for preoperative diagnosis of thyroid nodules like radionuclide scanning, high-resolution ultrasonography (USG). The present study aims at diagnosing various thyroid diseases based upon cytomorphological features in FNAC and wherever possible with its histopathological correlation, which is the gold standard.
Material & Methods: A prospective study done on 100 specimens from thyroid were received in the Department of pathology, SMS Medical College, Jaipur for histopathological examination from SMS hospital, Jaipurduring one year period. Out of these 100 cases imprint cytology was done for 48 cases. A correlative study between Fine Needle Aspiration Cytology and histopathology was done for these 100 cases. Data analysis was done with the help of computer using Epidemiological Information Package (EPI 2002).
Results: Our study showed that mean age of patients was 40.2 years and maximum patients were seen in 21 to 30 years of age group. There is a female preponderance with a Female to Male ratio of 13.28:1. Out of these 100 lesions 61 cases were non neoplastic lesions and 39 were neoplastic lesions. Among the 61 non neoplastic lesions 45cases were reported as nodular goiter, 15 cases as hashimato thyroiditis and 1 case as Granulomatous thyroidits. Out of the 39 neoplastic lesions 21 cases were reported as benign neoplastic lesions and 18 as malignant neoplastic lesions. A correlation done between Fine Needle Aspiration cytology with imprint cytology and histopathology showed the following results. 31 Fine Needle Aspiration cytology reports (64.58%) were correlated with histopathological diagnosis.
Conclusion: High rate of diagnostic accuracy can be achieved by use of ultrasound guidance with strict adherence to adequacy criteria and meticulous examination of all the smears. Touch Imprint Cytology alone may provide a correct diagnosis in vast majority of cases with minimal expense and without the need of sophisticated cryostat machine thus making it quite suitable when cryostat machines are not available.

Maternal Serum Level of Iron, Folic Acid & Vitamin B12 and Weight Gain at the end of 2nd & 3rd Trimester and their Correlation with Birth Weight of Neonates

Sardar Vikram Singh, Priyanka Shukla, Prabhat Singh Baghel, Jayendra Arya, Shabd Singh Yadav

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 539-545

Purpose: To find the relation between maternal serum levels of Iron, Folic acid & vitamin B12 and weight gain with birth weight of newborn.
Methods: A prospective observational study on 100 pregnant women was carried out in the GMH Rewa and peripheral health centres like PHC, CHC, CH, & DH. Their blood parameters and weight gain were analysed and noted in successive 2nd & 3rd trimesters then correlates with the pregnancy outcome, i.e., newborn birth weight.
Results: Out of 100 pregnant women, In 2nd trimester of pregnancy, 12(12%) had inadequate weight gain which has 46(46%) low birth weight newborn and, 54(54%) had low maternal serum iron level which has 46(46%) low birth weight newborn. In 3rd trimester, 3(3%) of pregnant women had inadequate weight gain have 46(46%) low birth weight newborn, 83(83%) had low serum iron level have 46(46%) low birth weight newborn.
Conclusion: Nutrition along with important micronutrients level, especially Iron, during pregnancy affects health status of mother, weight gain and newborn birth weight.

A Clinical Study of Incidence of Lymph Node Metastasis of Marjolin’s Ulcer

Dr. U Azadh Chandrashekar, Dr. Ravi Kumar Reddy M

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 546-554

Background: Marjolin's ulcer is a rare and frequently severe skin cancer that develops in chronically inflamed or injured skin, especially following burns. Marjolin's ulcers can also form from previously traumatized and scarred tissue and are present in 1% to 2% of all burn scars. The present study attempted to determine the incidence and lymph node metastasis in cases of Marjolin’s ulcers reported to the Regional Cancer Center.
Methods: The study of these n=43 Marjolin’s ulcer cases was carried out. After obtaining ethical clearance from the institution this study was carried out. The data is collected from patients who have undergone treatment in the form of surgery or palliative chemotherapy or conservative management. All the n=43 patients were subjected to investigations as required according to the patient. Regional lymph nodes are assessed by both clinical palpation and ultrasound of the regional lymph nodal area.
Results: In this study of n=43 cases of Marjolin’s Ulcer, n=18 patients (40%) did not have clinically palpable lymph nodes whereas n=25 patients (60%) have clinically detectable regional lymph nodes. These lymph nodes were divided into clinically significant nodes (Lymph nodes > 2cms) and clinically Non-significant Lymph nodes (Lymph nodes <2cms). In this prospective study, of n=25 patients with clinically detectable lymph nodes, n=7 (16%) patients had clinically significant lymph nodes and n=18 (41%) patients did not have clinically significant palpable lymph nodes.
Conclusion: The most common etiological factor for Marjolin’s ulcers was Burns. Males are more commonly affected than females. Squamous cell carcinoma is the most common variant of Marjolin’s ulcer. Most of Marjolin’s Ulcers are Well-differentiated cancers (90%) of cases. The incidence of lymph node metastasis in this study was 22%. Among all the factors for metastasis lymph node size is a significantly important predictor of metastasis.

Study of Prevalence of NAFLD and its Associated Risk Factors in Non-Obese and Non-Diabetic Rural Population

Dr. Veeda Mohan Kumar, Dr. Raghavendar Reddy Gundepalli, Dr. Girish Manohar Chavan, Dr. Gopinath Maddela

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 555-564

Background: NAFLD has become one of the most common health concern Worldwide. Not only the urban population but also the rural population are being commonly diagnosed with NAFLD. Obesity and diabetes are the major risk factors for NAFLD. This study aims to estimate the prevalence of NAFLD and its associated risk factors in rural population of Vikarabad District, other than obesity and diabetes mellitus.
Methods: This is a population-based cross-sectional study on apparently healthy subjects over 18 years and up to 65 years of age. The participants were interviewed for baseline demographic and clinical information. They were subsequently referred for physical examination. NAFLD was diagnosed using abdominal ultrasonography by a single expert radiologist.
Results: Of 906 screened subjects, 300 subjects were non obese, BMI (body mass index) <27 kg/m2 (According to Joslin Asian American Diabetes Initiative (AADI) BMI criteria for obesity) and non diabetic. The overall prevalence of NAFLD was 18.66% in our study. NAFLD was seen in 25.4% of population who were overweight (BMI 23 – 26.9 kg/m2) and only in 4.1% of population with normal weight (BMI 18 – 22.9 kg/m2). The prevalence of NAFLD was 82.1% in subjects with hypertension (BP > 140/90 mm of Hg) and 17.9% in subjects with normal blood pressure. NAFLD prevalence was 67.8% in age group > 45 – 65 years and it was 32.1% in the age group of 18 – 45 years (all P < 0.01).
Conclusion: The prevalence of NAFLD in non obese and non diabetic subjects in a sample of Indian rural population is 18.66%. BMI of 23 – 26.9 kg/m2,  hypertension and increasing age are independent risk factors associated with NAFLD in non obese and non diabetic subjects in our study.

Role of Preoperative Chemoradiotherapy in Downstaging Locally Advanced Rectal Cancer

Dr. Ravi Kumar Reddy M, Dr. U Azadh Chandrashekar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 565-574

Background: Neoadjuvant chemotherapy is frequently used in the treatment of a number of solid tumour malignancies, although its effectiveness in treating locally advanced colorectal cancers is yet unknown. We in the current study tried to assess the complications of neoadjuvant chemoradiotherapy in rectal cancer and to assess response to neoadjuvant chemoradiotherapy.
Methods: All patients with carcinoma rectum who presented to MNJ Institute of Oncology and Regional Cancer Center was evaluated by clinical examination, sigmoidoscopy or colonoscopy, staged by MRI pelvis and CT chest and abdomen. Based on the findings, patients with tumors assessed as locally advanced (T3 and T4, N+) are sent for neoadjuvant therapy with concurrent chemoradiotherapy or radiotherapy. N=72 patients with locally advanced carcinoma rectum were identified for the study and referred for neoadjuvant chemoradiation.
Results: Response to Neoadjuvant chemoradiotherapy (NACRT) N=8 patients had clinically progressed while on neoadjuvant chemoradiotherapy, both locoregionally and also developed systemic metastases. Response assessment was done using MRI before NACRT and before surgery. Patients with locally advanced rectal cancer with involvement of mesorectal fascia or loss of fatty plane with prostate or vagina preoperatively had post-radiotherapy changes suggestive of fibrosis. All the n=54 patients (including those who did not consent to surgery) showed radiological response though downstaging did not occur in all the cases.
Conclusion: In this study, the pathologic complete remission using this combined modality was 4%. The pathologic downstaging effect was 48%, including pathologic complete response. Complications especially when extra levator excision is done and reconstruction is performed are fraught with prolonged morbidity. Neoadjuvant chemoradiotherapy as part of a multimodality treatment strategy for locally advanced rectal cancer is safe with acceptable morbidity. Oncologic outcomes in the form of margins were good.