Online ISSN: 2515-8260

Volume 9, Issue 4

Volume 9, Issue 4, Summer 2022


A Clinical Study and Ultrasonography Diagnosis in Clinically Suspected Cases of Acute Appendicitis

Dr. Janardhan Jakkula, Dr. Ramesh Lingala, Dr. Shekhar Goud S, Dr. Sridhar Matta

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1-11

Background: Acute appendicitis is the most prevalent cause of acute abdomen and
subsequent surgery. Misdiagnosis is a common and critical problem in general surgery
because the diagnosis is primarily based on clinical grounds. Maximum incidence observed
in the second and third decades of life, with male preponderance. Graded compression
ultrasonography is one of the diagnostic procedures that has been shown to reduce the need
for unfavourable surgical treatments, particularly in females.Objectives: Objectives of the
study were to study the clinical features of acute appendicitis, Utility of USG in supporting
the clinical diagnosis of acute appendicitis. Methods: This study included one hundred and
Twenty Five patients with history of RLQ pain where clinical diagnosis of acute appendicitis
was made. The study period was of 18 months between November 2019 to May 2021.
Routine bloodinvestigations and abdominal USG were done in all cases. All ultrasound
positive cases were subjected to surgery. Some ultrasound negative cases were also taken to
surgery on the high clinical suspicion of acute appendicitis. The ultrasound findings were
compared with clinical findings and histopathological examination reports.

A CLINICOPATHOLOGICAL STUDY OFBREAST LUMPS

Dr. P. Swarnalatha, Dr. R.Swarupa Rani , Dr. S.Rajasekhar Reddy , Dr. Shaik. Raja Husne Kalam

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 12-39

Breast cancer affects women more than men. From puberty to death, breasts go through
constant physical and physiological changes related to menstruation, pregnancy, and
menopause. The goal was to classify different types of breast lesions and conduct a
clinicopathological study on them.Methodology: In the present study carried out at the
department of Pathology of ACSR Govt Medical College, Nellore AP during the period
from January 2019 to June 2021 (18 months) a total number of 150 FNAs were performed
on patients with breast lumps. Results: The youngest patient in this study was 12 years
and the oldest 79 years. Majority of the patients were in the age group of 21-40 years. In
majority of the patients i.e. From 150 aspirates, 65 were from the right breast and 70 from
the left. 15 cases involved both breasts.Upper outer quadrant of right and left breast had 39
and 35 cases of breast lumps, respectively. Lower outer quadrant of the right breast had 11
cases and upper medial had 11 cases. Two breast cases showed diffuse all-quadrant
involvement. 2 of the 45 cases were clinically suspected of malignancy and 1 of
fibroadenosis, but FNAC showed fibroadenoma. Three clinicocytologically discordant cases
lacked excision biopsy. 15 cases of breast cancer were in the right breast and 9 in the left.
Upper outer quadrant is most common for breast lumps. Side and quadrant distribution are
shown below. All 20 cases were confirmed by excision biopsy. FNAC diagnosed 18 IDC
NOS cases and 2 IDC Mucinous cases.CONCLUSION: FNAC is the procedure that is most
commonly used since it is an initial outpatient procedure that is straightforward, risk-free,
quick, and dependable. Additionally, it contributes to an early preoperative diagnosis of any
lump in the breast.

DIFFUSION WEIGHTED VERSUS CONVENTIONAL MRI IN DIAGNOSIS AND CHARACTERISATION OF INTRACRANIAL SPACE OCCUPYING LESIONS

Dr. Shubham Gupta, Dr. Suresh A, Dr. Kotha Vinay Kumar Reddy, Dr. Soham Shrivastava, Dr. Sourav Tripathy

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 40-59

Background information -Non-invasive and accurate differentiation of brain mass lesions
are important for determining the correct treatment plan and in some cases, may avoid the
necessity of performing a biopsy. Now MRI is being currently used to determine the tumor
nature and extent that is helpful in planning surgery and radiotherapy, even for post therapy
monitoring for tumor recurrence or progression. 30-90% MRI can correctly diagnose
intracranial space occupying lesions of various types. It is clinically very important to
differentiate brain infections from brain tumors, as their plan of management is completely
different.
Materials and Methods - All clinically suspected patients of intracranial space occupying
lesions and already diagnosed patients with intracranial space occupying lesions, who were
referred to the department of Diagnostic Radiology in VIMS and RC underwent MRI. The
images of MRI were evaluated to characterize the space occupying lesions by conventional
and diffusion weighted sequences. Further the study was reviewed by the experienced
radiologist, only after which the data was analyzed and recorded.
Results - All cases (100%) of epidermoid and neuroblastoma showed true diffusion
restriction. 100% GBM cases showed true restricted diffusion while none of the low- grade
tumours showed diffusion restriction. All cases of arachnoid cysts showed low signal on DWI.
And none of benign meningioma and schwannoma showed restriction diffusion. Positive
correlation was found in the comparison of mean ADC values for high-grade gliomas
(1.02×10-3 mm2/s±0.2) and metastasis (0.881×10-3 mm2/s±0.2), low-grade gliomas (1.20 ×
10-3 mm2/s ± 0.2), and medulloblastomas (2.09×10-3 mm2/s ± 0.075).
Conclusion - Presence of diffusion restriction is a useful method of differentiating abscesses
from necrotic or cystic neoplasms. Highly cellular tumors may show restricted diffusion.
Arachnoid cysts can be differentiated from epidermoid cysts by presence of low signal on
DWI. ADC is useful in the differentiation of various brain mass lesions and in grading brain
tumours. The combination of routine image interpretation and ADC had a higher diagnostic
predictive value in characterizing brain lesions.

CLINICO-RADIOLOGICAL CORRELATION OFSHOULDER PAIN

Dr.KothaVinay Kumar Reddy, Dr.Madan Mohan Babu L, Dr. Suresh A, Dr.Shubham Gupta, Dr.Devamani VKH Chalavadi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 60-69

Background - Shoulder pain is one of the commonest conditions encountered in our
orthopedic department. Accurate diagnosis is a must before undertaking any treatment. Since
clinical diagnosis cannot make an accurate diagnosis, radiological investigation is necessary
to know the exact cause of shoulder pain. There are a wide range of invasive and noninvasive
modalities that can be used to investigate these patients. Ultrasound examination is a
highly specific and sensitive modality in comparison with MRI. High-resolution real-time
USG has shown to be a cost-effective means of investigation of rotator cuff pathologies. With
recent advances with USG, results of imaging of shoulder joint pathologies are as similar or
in some cases more precise in the diagnosis than MRI.
Methods - Prospective analysis of 52 patients presenting with shoulder pain were included in
our study. A pre-formed written consent is also taken. All patients underwent a thorough
clinical examination, USG of the affected shoulder with comparison of the opposite side and
MRI of the affected shoulder for comparison.
Results - Ultrasound is equivalent in detection of rotator cuff tears in comparison with MRI.
MRI outscores ultrasound in detection of labral tears, cartilaginous lesions and subtle bony
lesions. USG examination can be used as the first line of investigating a case of shoulder pain
as it is inexpensive, real time and allows for comparison with the opposite side. MRI can be
used as a confirmatory tool.

Hippocampal sparing in radiation therapy to primary brain tumors - and impact on memory function in adults

Dr.Veda Varshne D Nath, Dr.Geeta S.N, Dr.SalmanKhurshid Shah, Dr.BhaskarVishwanathan, Dr.Richa Tiwari, Dr. Sowmya Narayan, Dr.Shubham Gupta, Dr.KashyapMalleshappa, Dr. Natasha Laishram

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 70-81

Introduction - Sparing the hippocampus during cranial irradiation poses important technical
challenges with respect to contouring and treatment planning.Purpose of this study was to assess
if sparing the hippocampaus region during the planning of radiotherapy using IMRT technique
without compromising the dose conformity to tumour, and to compare memory function of
patient, before the start of irradiation and retention after radiation therapy in both the arms using
the Hopkins verbal learning test.
Materials and Methods -Patients presenting with Primary brain tumours were chosen for the
study. Age 18 to 65 years, diagnosis as per WHO Grading, ECOG performance status {0-2}
were selected. All the types of Primary brain tumours were included.

TO STUDY THE MORPHOMETRIC ANALYSIS OF ABDOMINAL AORTA AND ITS BRANCHES

K D V Santhi Priya, Dr. Nageswara Rao Gutti

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 82-89

Introduction: Knowing the morphology of abdominal aorta (AA) and its branches are important as
regards to diagnosis and surgical treatments. Despite that, data on morphometry of abdominal aorta
branches and abdominal viscera are lacking.
Aim: To investigate this subject authors performed a morphometric study on 80 adult fresh and
embalmed Asian cadavers and examined abdominal aorta branches to make morphometric
measurements of AA and its branches, to investigate sites of the origins of the branches and their
relationships and variations and to compare the results with literature. We believe that our results add
knowledge on abdominal aorta branches and viscera morphometry and are valuable for new radiologic
and clinical applications including stent grafts and chemoembolisation materials and surgical
applications including visceral arteries' aneurysms investigation, treatment, and transplantation
precedures.
Materials and Methods:
The study was conducted on 80 AA specimens that were obtained from human cadavers during
autopsies Guntur General Hospital from March 2020 to October 2021. These specimens of AA and
its branches were measured with a metal scale morphometrically to determine diameter of Aorta and
distances between branches
Result: The mean diameter of AA was studied at various levels and recorded. The study showed a
decrease in caliber from above to below. In both sexes, diameter of Aorta is more in > 40yrs age group
than age group < 40yrs. The average distance from CT-AB, CT-SMA, SMA-IMA and IMA-AB were
measured as 10.99cm, 0.76cm, 4.89cm, 3.54cm, respectively in males with average age and height was
38.26 and 158.2 respectively. Similarly, in females the average distance from CT-AB, CT-SMA, SMAIMA
and IMA-AB were measured as 10.12cm, 0.68cm, 4.69cm, 3.32cm, respectively with average age
and height was 36.24 and 145.9 respectively. Numerous variations were observed during the study
which include absence of renal artery, origin of renal arteries one above the other, 3pairs of lumbar
arteries etc.
Conclusion: Knowledge of morphology of AA and its branches is important in regards to the diagnosis,
surgical treatment and endovascular interventions of these vessels. We think our study will contribute
to the medical education and clinical medicine.

A Retrospective assessment of the histo-morphological diversity of various lesions of the uterus, cervix and adnexa

Dr. Vani H Patel, Dr. Maulik K Mehariya, Dr. Vishal S Patel

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 90-95

Aim: To study the histo-morphological diversity of various lesions of the uterus, cervix and adnexa.
Materials and Methods: A Retrospective Histopathological study of 609 cases of nonneoplastic and neoplastic lesions of hysterectomy specimens was conducted in Department of Pathology, over the period from June 2015- May 2017. Hysterectomy specimen with or without unilateral or bilateral adnexa received in the department. The specimens were analyzed in detail macroscopically for various parameters like size, external surface, and consistency and cut sections.
Results: Atrophic changes were seen in 13.46% cases. Endometrial hyperplasia was seen in 26 cases. Among the neoplastic lesions 2.46% cases were endometrial polyps with only 3 cases of malignancy forming 0.49%. Among the histologic types of lesions of myometrium, majority were Leiomyoma (27.59%). Leiomyoma and Adenomyosis were seen in 55 cases (9.04%). Adenomyosis was seen in 22.00%. Chronic cervicitis was seen in 36.07% cases and chronic cystic cervicitis in 6.21% of cases. Nabothian cyst were seen in 124 cases (20.80%). 19.80% cases showed Squamous metaplasia. Out of 188 Ovarian lesions, 167 (88.83%) were non-neoplastic lesions and 21 (11.17%) were neoplastic lesions. Fallopian tube pathology included chronic salpingitis in 2 cases, paratubal cyst in 07 cases. 69.4% of cases show unremarkable fallopian tubes.
Conclusion: The present study provides awareness into the wide range of histopathological patterns of lesions in uterus and cervix in hysterectomy specimens. It aids to appropriate management in the postoperative period.

EDTA INDUCED PSEUDOTHROMBOCYTOPENIA(PTCP): A PROSPECTIVE STUDY AT TERTIARY CARE HOSPITAL

P.Geetha Vani, T.Rayapa Reddy, G. Rajeswari, C.Padmavathi Devi, L. Padma Priya Priya

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 96-102

Background -Spurious thrombocytopenia or pseudothrombocytopenia (PTCP) is a well
known in vitro phenomenon that occurs when the anticoagulant used while testing the blood
samples causes clumping of platelets which results in spuriously low platelet count with
automated haematology analyser. It occurs most often in EDTA anticoagulated blood,
however other anticoagulants though to a lesser extent have also been implicated in several
reports. Clinical consequences include unnecessary platelet transfusions, bone marrow
aspiration and inappropriate treatment like administration of steroids.
Material and methods –This is a hospital based prospective study in department of clinical
pathology for one year duration from January 2021 to December 2021.
Results – A total of 82 were found to have EDTA induced pseudothrombocytopenia in the
study period. The total case load during the study period was 2581 cases. The incidence of
PTCP in our study being, 3.1%. Males accounted for 45% and females accounted for 55 %
with male to female ratio of 2.5: 3.
Mean platelet count in EDTA anticoagulated samples with PTCP was 39,333/mm3 mean
platelet count in sodium citrate sample was 1,78,666/mm3, and mean platelet count manually
was 2,10,552/mm3. Citrate anticoagulated samples showed higher values as compared to
EDTA.
Conclusion -EDTA-PTCP is a common pre analytical error encountered in routine clinical
laboratory practise. EDTA-PTCP should be suspected in all cases with a low platelet count
but without any clinical bleeding manifestations. Platelet counts should be reviewed in all
such cases to prevent unnecessary clinical interventions and treatment. Simple, inexpensive
and diagnostic method of peripheral smear examination remains gold standard.

An Autopsy Based Study of Chest Injuries in Fatal Road Traffic Accidents Conducted at IGIMS, Patna, Bihar

Nikhil Goel, Aman Kumar, Sanjeev Kumar, Mukesh Prasad

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 103-109

Background: Thorax (chest) is one of the most important cavities of the human body. Thoracic trauma constitutes 10 to 15% of mortalities in the world wide population. Road Traffic Accident (RTA) is like an endemic disease, which affects mainly young people. According to a study, death related trauma rank third after cardiovascular diseases and cancer. 90% of RTA take place in low and middle income countries.
Objective: To study the pattern and type of chest injuries in fatal road traffic accidents.
Materials and Methods: The present study was done on medicolegal autopsies conducted at the department of Forensic Medicine and Toxicology, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna from 25th July 2017 to 24th July 2019 to study the pattern and type of chest injuries in fatal road traffic accidents.
Inclusion Criteria 1. All those who died after road traffic accidents and brought to mortuary of Indira Gandhi Institute of Medical Sciences, Patna with some history of the road traffic accident.   Exclusion Criteria 1. The bodies found on the road side with injuries, where road traffic accident is suspected, but not confirmed. 2.            Cases other than that of road traffic accident. 3.        Decomposed bodies in which the organs are liquified and injuries could not be appreciated.
Result: Out of total 223 autopsies done in the study period, 61 (27.35%) cases had chest injuries.  Majority of the cases were observed in Winter season. Males were affected more than females. Male of 31 – 45 years age group were most vulnerable age group for chest injuries in fatal road traffic accident. Injuries over chest and abdomen together were found in maximum number of victims (32 cases; 52.46%).  Haemorrhage and shock was the most common cause of death in 80.33% of the victims. Fracture of ribs were found in 39 victims. Haemothorax was found in 88.52% of the cases. Lung alone was the commonest involved thoracic viscera in victims of chest trauma in 75.41% cases.
 Conclusion: Improving the design of roads and vehicles, enforcing emergency medical services could be used to control the increasing toll of death due to RTA. There needs to be intensification of current educational programmes and law enforcement with regards to traffic rules and road safety measures. Pre-hospital emergency medical system should be implemented. Also High-tech trauma centre should be established at every district head-quarter and on highways at definite intervals.
 

Insight into the Management of Non-traumatic Perforation of the Small Intestine at a Tertiary Care Hospital, Bihar

Dr. Sumeet Kumar, Dr. Chandrakala Kumari

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 110-115

Background: Management of non-traumatic perforation of the small intestine has always been a consideration for surgeons because of associated enormous morbidity and mortality. There is a paucity of data on the management of non-traumatic perforation of the small intestine.
Material and Methods: A retrospective study was conducted which involved analysis of 192 patients treated for non-traumatic perforation of small intestine at a tertiary care hospital at Bihar from 2018-2019. The clinical profile and management of the patients were studied.
Results: The most common cause of non-traumatic perforation of small intestine was typhoid (46.4%), followed by non-specific inflammation (39.2%), tuberculosis (12.8%) and malignant neoplasm (1.6%). Primary repair was the most frequent procedure (44.0%), followed by ileostomy (25.5%) and resection-anastomosis (19.3%). Superficial wound infection was the most frequent postoperative complication (46.8%), followed by wound dehiscence (31.3%). The wound infection rate was reduced significantly following delayed primary closure of skin incision. Enterocutaneous fistula/leak developed in 11.5% patients. Salvage ileostomy for post-operative intestinal leak resulted in a better survival rate as compared to conservative treatment (85.7% vs. 50.0%). The overall mortality rate was 16.6%.
Conclusion: Operative procedures undertaken for the management of non-traumatic perforation of small intestine can be classified into two groups: procedures that leave an intestinal suture line inside the peritoneal cavity and procedures that do not. The no suture line-in procedure seems to be better option in adverse patient conditions.
 
 

“Phenotypic Detection Of MBL In Meropenem Resistant P. Aeruginosa Among Clinical Isolatesin A Tertiary Care Hospital.”

Surendra Prasad Chauhan,Dr Harshada Shah, Md. Mustafa Sofiur Rahman

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 116-122

CONTEXT: Carbapenems, including imipenem (IPM) and meropenem (MRP), are the most potent antibacterial agents used for the treatment of infections initiated by multidrug-resistant gram-negative bacilli. Pseudomonas aeruginosa, is a commonly encountered nosocomial pathogen, especially in immunocompromised patients, thus, inflicting significant morbidity and mortality, worldwide. The emergence of MBL‑producing Pseudomonas aeruginosa is a challenge to microbiology laboratories because there are no standardized guidelines available to detect them. This study aimed to compare four phenotypic methods to detect MBL production in Pseudomonas aeruginosa and to determine the antibiotic sensitivity of MBL‑producing isolates.
 
MATERIALS AND METHODS: A total of 200 clinical isolates of Pseudomonas aeruginosa were tested for MBL production. Meropenem (MRP) resistant Pseudomonas aeruginosa were taken as MBL screening. MBL detection was done by three phenotypic methods 1) Combined disk synergy test (CDST). 2) Double disk synergy test (DDST) and 3) E-test.
 
RESULTS: out of 200 Pseudomonas aeruginosa, 73 were resistant to Meropenem as screening positive. Out of 73, 34(46.5%) isolates were MBL positive by CDST methods, 33(45%) by DDST method and 33(45%) by E-test. Colistin and polymyxin B were found to be 100% sensitive.
 
CONCLUSION: The study result demonstrates the antibiotic sensitivity pattern of MBL-positive isolates suggests that early detection of MBL-producingP. aeruginosa and determination of their antibiotic sensitivity are of crucial importance to start appropriate treatment. It was observed in this present study that the MBL E-test followed by DDST were effective options for MBL detection in this part of the country.

Audiometric Assessment Of Hearing Status In Patients After Myringoplasty

AsfiaRahman, Vijay Kumar, ArshadAyub,Pramod Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 123-134

Introduction :Chronic suppurative otitis media (CSOM)is a middle ear disease with permanent abnormality of pars tensa or pars flacida resulting in discharge and hearing loss. Hearing loss is mostly conductive in nature.Pure tone audiometry is a subjective measurement of hearing threshold level. It is done preoperatively to know the degree and type of hearing loss and postoperatively to measure the audiological gain.
Objective:to assess hearing status of patients after myringoplasty using pure tone audiometer.
Methods:The study was done on 100 patients suffering from CSOM active mucosal type. Patient parameters including age, size and site of the perforation were evaluated. Hearing levels were assessed as the mean air conduction (AC), and air-bone gap (ABG) at 500, 1000, and 2000 Hz, and their relation with aforementioned parameters were analyzed.Myringoplasty was performed and then patients were followed up for three months and on each visit hearing status was assessed by Pure Tone Audiometry.
Results:At the end of the study it was found that mostofthe patients were in younger age group 15-25 years(60%).The commonest site was central perforation (88%) with large size perforation  being (51%). The pre and post operativeaudiological difference found to be significant with average audiological gain more than 10dB and overall hearing improvement was 86% at 1 month and 93% at the end of 2 and 3 month.
 Conclusions:There was a significant audiological improvement following myringoplastywith postauricular route using temporalis fascia graft via underlay technique in patients of mucosal type of chronic suppurative otitis media.However no significant difference was found in the audiological gain when compared to different age,site and size of perforation.

ROLE OF CROSS-SECTIONAL IMAGING IN DIAGNOSIS AND MANAGEMENT PLANNING OF GASTROINTESTINAL STROMAL TUMORS

Dr Bhargavi D, Dr Salil Pandey,Dr Suresh A, Dr Priti Mahadevan, Dr Darshitha B, Dr Archana S R

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 135-149

Background information -Gastrointestinal stromal tumors (GISTs)arise from the interstitial
cell of Cajal are the most common mesenchymal neoplasms of the gastrointestinal tract. The
imaging features of GISTs have only been described in very limited studies. Hence the
present study was designed to evaluate CT/MRI findings of Gastrointestinal stromal tumors
and to identify appropriate biopsy options. Further To identify the criteria on cross sectional
imaging, which determine operability and non-operability of gastrointestinal stromal tumors.
Methods- 36 clinically suspected GIST and subsequent histopathologically proven cases
were selected. Based on imaging findings appropriate biopsy options were considered i.e.,
percutaneous image guided CT/ ultrasound guided/ Endosonological/Laparoscopic or open
biopsies. Lesions which are classified as operable are subjected to surgical excision if other
conditions are favorable for surgery. Intraoperative findings were studied for correlation and
agreement with findings on cross sectional imaging. Inoperable cases were planned for
imatinib therapy and close follow-up.
Results and conclusion - We found that the cross-sectional imaging findings were accurate
in predicting the operability of GISTs. In this study cross sectional imaging (CT/MRI) had
sensitivity of 95.83%, PPV was 100% and Diagnostic Accuracy was 95.83% for GISTs.Cross
sectional imaging findings were very helpful in characterizing the tumor, deciding the
appropriate biopsy option and operability and non-operability in cases of GISTs.Overall,
Cross sectional imaging played a vital role in deciding the best therapeutic options for the
patients.Pre-operative staging is incredibly important to see the operability of tumor. It also
helps to search for lymph nodal involvement and metastasis preoperatively.It also helps in
post-operative follow-up or follow-up in patients on imatinib to look for therapeutic response
and in detection of local recurrence and metastasis.

CORRELATION OF CHEST ULTRASOUND WITH PLAIN XRAYS FOR THE DETECTION OF PNEUMOTHORAX

Dr. Archana S R, Dr. Suresh A, Dr. Muthusubramanian R, Dr. Kishor Sagar V, Dr. Darshitha B, Dr. Bhargavi D

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 150-158

Background: Chest radiograph has been the standard initial imaging modality of choice to
detect pneumothorax. Despite of moderate sensitivity in detection of pneumothorax, due to its
wide range of geographical availability and less expenditure in our country, it has been
widely advocated by all the physicians. Computed Tomography (CT) and Ultrasonography
(USG) being the current point of care in most parts of the country and having no radiation
risks, it can be utilized in early and safe detection of pneumothorax. In this study, we
analyzed the diagnostic utility and efficacy of chest ultrasound in detecting pneumothorax on
comparison to chest x ray.
Methods: Ethical committee clearance and informed consent was taken from all the patients.
Total of 79 patients who were having clinical suspicion of pneumothorax were evaluated.
Initial imaging evaluation was done using B-mode and M-mode chest ultrasonography and
further subjected to chest radiography. Images were assessed by 2 experienced radiologists.
Demographic, clinical and radiological data were documented and analyzed. In the cases of
discrepancy in findings of USG vs. Radiograph, CT was considered the gold standard for
obtaining the final diagnosis.
Results: We found that chest ultrasound had sensitivity of 98.43%, specificity of 100%, PPV
of 100%, NPV of 93.75% and diagnostic accuracy of 98.73%. Chest radiograph had
sensitivity of 73.43%, specificity of 83.33%, PPV of 94%, NPV of 46.9% and diagnostic
accuracy of 78.9%
Conclusion: Chest USG is a useful and essential tool in detection of pneumothorax.
Although chest radiograph being widely available and CT with its highest sensitivity &
specificity, USG stand apart in providing good diagnostic value with no radiation risks.

UTILITY OF DOPPLER ULTRASOUND IN EVALUATION AND MANAGEMENT OF VASCULAR MALFORMATIONS – A COMPARATIVE STUDY WITH CONVENTIONAL ANGIOGRAPHY

Dr. Kishor Sagar V, Dr. Salil Pandey, Dr. Suresh A, Dr. Muthusubramanian R, Dr. Rajan Aggarwal, Dr. Nithisha Mary Jacob, Dr. Archana S R, , Dr. Seema U

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 159-167

Introduction:
In last few years, thanks to laser technology with minimally invasive approach, there was a
growing need for treatment of oral vascular malformations inside the dental offices.
Generally, the diagnosis of oral vascular malformations is based on clinical history, clinical
examination and imaging exams. Hence the present study was designed to assess Doppler
ultrasound findings of vascular malformations and compare the findings with DSA and to
descry role of Doppler USG in management of vascular malformations.
Methods:
36 patients of clinically suspected vascular malformations were included in our study. USG
B-mode and Doppler study was done for all these patients and the findings were recorded.
USG examination was performed by two well experienced Interventional Radiologists in our
institution. Clinical details and imaging parameters were documented and analyzed. Initial
provisional imaging diagnosis was framed and treatment strategies were further formulated
depending on the diagnostic angiogram findings
Results:
Out of 36 patients included in our study, 8 patients had high flow arteriovenous
malformations, 3 patients had lymphatic malformations and 25 patients had low flow venous
malformations, with DSA being gold standard modality for confirming the diagnosis. We
observed that Doppler USG was able to diagnose all of malformations and accurately classify
them into high flow and low flow malformations. We also observed that certain key
characteristics like early draining vein and presence of nidus was better demonstrated by
conventional angiography which steered the management plan from routine sclerotherapy to
embolization
European Journal of Molecular & Clinical Medicine
ISSN 2515-8260 Volume 9, Issue 4, Winter 2022
160
Conclusion:
We conclude that the USG Doppler has diagnostic accuracy which is similar to conventional
angiography and can be a valuable adjunctive imaging tool in characterizing vascular
malformations and further categorizing the management plan; more so in cases posing with
clinical dilemma. However, further evaluation with MRI/CT may be necessary to in complex
and deep-seated lesions.

UTILITY OF DOPPLER INDICES OF BILATERAL SUPERIOR THYROID ARTERIES IN NORMAL AND IN PATHOLOGICAL THYROID

Dr Naveen S, Dr. Madan Mohan Babu, Dr. Suresh .A, DrNithisha Mary Jacob, Dr. Shubham Gupta, Dr.SohamShrivastava

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 168-178

Background: thyroid gland diseases are common around the world. Diagnosis is usually by
thyroid profile estimation levels. The accuracy of Doppler ultrasonography is accurate and
sensitive in evaluating the gland in detail (size, margins and nodule’s). The indices like peak
systolic volume, pulsatility index and resistive index is useful for diagnosing pathological
thyroid. The aim of the study was to assess the findings of Doppler indices [PSV, PI, RI] of
bilateral superior thyroid arteries [STAs] in normal and pathological thyroid conditions and
use them as reference to evaluate the thyroid status and correlate the USG findings with
thyroid function tests.
Methods: This observational study was conducted between January 2020 and June 2021 at
Vydehi institute of medical sciences. The study consisted of 140 patients divided into two
groups 70 each i.e normal thyroid and pathological thyroid respectively.
Results: The mean age of the pathological group was 44.11± 10.54 years and mean age of
normal group was 42.54± 10.27 years. The study consisted of 27 males and 113 females.
Totally 119 were hypothyroid and 21 were hyperthyroidism. In the pathological group 6 had
low T3 and t4 levels and 17 had increased TSH levels whereas in the normal group 7 had
increased TSH levels. Pathological group the mean PSV was 21.87± 1.20, mean PI was
1.02±0.23 and mean RI was 0.74±0.06. The normal group the mean PSV was 16.4±1.29,
mean PI was 0.91±0.46 and mean RI was 0.54±0.04. The results suggested patients with
increased TSH levels had increased PSV, PI and RI which was significant.

ROLEOFMDCTAORTOGRAMINEVALUATIONOFPATIEN TSWITHMILD,MODERATEANDSEVEREHEMOPTYSIS

DrNithishaMaryJacob,DrSalilPandey,DrSureshA,DrNaveenS, DrKishorSagarV

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 179-192

Hemoptysis is the expectoration of blood that originates from the lower respiratory tract. Itis
usually a self-limiting event but in fewer than 5% of cases it may be massive,
representingalifethreateningconditionthatwarrantsurgentinvestigationsandtreatment.
Multidetectorcomputed
tomography (MDCT) angiography is a useful examination to detect the source
ofthebleedinginpatientswithhemoptysis.
TheaimofthestudywastostudytheroleofMDCTaortograminevaluationofpatientswithmild,moder
ateorseverehemoptysis.
Methods:Thestudypopulation included 41patients presenting
withhemoptysiswhounderwentMDCTaortogramintheregionofthoraxafterapplyingtheinclusion
andexclusioncriteria. The criteria’s such as clinical presentation, analysis of lung findings on
MDCT chestaortogram, analysis of vasculature on MDCT chest aortogram, correlation of
MDCT findingswith conventional angiography /DSA in patients who underwent
endovascular procedures,correlationofMDCTfindingswithbronchoscopic
findingsinpatientswhounderwentbronchoscopy,andfinallyandCorrelationofMDCTfindingswit
hclinicalcourseofthepatientwereanalyzed.
Results:A total of 41 patients who presented with mild, moderate and severe hemoptysiswere
analyzed using MDCT aortogram. Based on the findings on MDCT aortogram and
theseverityofhemoptysis,thepatientsweretakenupforendovascular intervention
formanagementofhemoptysisandthefindingsinconventionalangiographywascorrelatedwithMD
CTangiography.

RISK FACTORS ASSOCIATED WITH EARLY ONSET OF NEONATAL BACTERIAL SEPSIS IN BABIES BORN IN A RURAL TEACHING HOSPITAL- A PROSPECTIVE OBSERVATIONAL STUDY

Dr. NISHANTH. M, Dr.SHAIK K JOHN MOHAMMAD ALISHA, Dr. MUJIBUR REHAMAN SHAIK

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 193-206

Introduction:Early onset neonatal sepsis (EONS) remains a major cause for neonatal mortality
and morbidity.To reduce neonatal mortality due to neonatal sepsis, preventive strategies are
better than therapeutic measures. AIM:To identify maternal and foetal risk factors associated
with early onset neonatal bacterial sepsis (EONS), in babies born in a rural teaching
hospital.Methodology –During the study period, using simple random sampling method, total
204 neonates were selected. Of them, only 172 mothers of neonates (134 controls, 38 EONS
cases) gave written informed consent.Results- The birth weight was significantly low in babies
who developed EONS (mean weight 2.39± 0.8) compared to that of the control group(mean
weight 2.83±0.6).The Mean APGAR score at 5 minutes was significantly low in babies who
developed EONS (7.15± 1.03) compared to that of the control group (9.3±0.9).Late preterm (GA
32 to 36 weeks) was a risk factor for EONS. Prematurity was significantly associated with
EONS. Pregnancy domicile area of the mother was not associated with development of sepsis.
Conclusion-Ambuuse, Laryngoscope use, Oxygen use, ET intubation in the delivery room were
not associated with EONS risk. Baby not undergoing or not needing gastric lavage in the
delivery room was a protective factor against EONS

“PREVALENCE OF METABOLIC SYNDROME IN HYPOTHYROIDISM PATIENTS IN VINDHYA REGION WITH SPECIAL REFERENCE TO TSH LEVEL”

Dr. Anurag Chaurasia,Dr Pallavi Indurkar, Dr. Anshuman Tiwari, Dr. Bhupendra Parmar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 207-214

Introduction: Thyroid disorders are among the most common endocrine disorders, with an
overall prevalence of Hypothyroidism about 10.95% in the general population. Prevalence of
the Metabolic Syndrome (MetS) in the Indian population is about 31.6%, with the prevalence
of 22.9% in men and 39.9% in women.
Aim: The aim of this study is to determine the prevalence of Metabolic Syndrome and its
components in people with Hypothyroidism.
Materials and Methods: A total of 200Hypothyroid patients attending our out-patient and
in-patient department were consecutively enrolled for the study. Clinical data were obtained
by interviewing the patients and referring to their case folders and prescriptions. The
anthropometric indices were recorded. The laboratory parameters that were analyzed included
fasting lipid profile, thyroid function tests, and fasting blood sugars.
Results: The patients were aged between 18 to >65years, with a mean age of 45.11 years,
and the female‑to‑male ratio was 1:2.48. The overall prevalence of the Metabolic Syndrome
was significantly higher than that in the general population, as reported earlier in various
studies. The most common occurring Metabolic Syndrome defining criterion was increased
waist circumference, and hypertension was the least documented criterion.
Conclusion: Metabolic Syndrome occurs in approximately every second patient of
hypothyroidism, and so, routine screening for components of Metabolic Syndrome may be of
benefit in this group.

Prevalence of Congenital heart Diseases in children- An analysis of 197 patients in a tertiary care Hospital of Kerala

Dr. Shrinath G,Dr. Muhammed Basheer K T,Dr. Vidhu Ashok,Dr. Anjali T R

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 215-226

Background: Congenital heart disease (CHD) is one of the commonest causes of infant mortality rate in developing countries. Early detection, referral and treatment of infants and children with CHD contribute to the reduction in the infant mortality rate. There are differences in the prevalence and distribution in different parts of India. A study was conducted in a tertiary care Hospital to know the prevalence of CHD in this state. Aim of the Study: To study the prevalence, age and gender distribution and clinical spectrum of congenital heart disease (CHD) among pediatric patients attending outpatient department (OPD) of a tertiary care hospital in Kerala. Materials: A prospective cross sectional study was carried over 36 months on children aged from newborn to 12 years and 179 children with CHD were screened, included and analyzed. Infants/ children aged 0 to 12 years with symptoms of CHD, or suspicious of CHDs were included. After initial clinical examination and pulse oxymetry diagnoses were confirmed by detailed 2-D Echocardiography and color Doppler studies. Two dimensional and color Doppler echocardiography were done with Neonatal (12MHz) and Pediatric (8MHz) sector transducer. ASD with less than 4.0 mm diameter was not included as a CHD. If more than one lesion was observed, the defects which caused hemodynamic imbalance or which required immediate treatment were considered as the main CHD.

A study on Adverse events following COVID-19 immunization(AEFI), Vaccination Awareness and Preference among people visiting vaccination centre, Shivamogga Institute of Medical Sciences, Shivamogga, Karnataka

Dr. Shashikiran G M, Dr. Darshitha R, Dr. Kanchana Nagendra, Dr. Raghavendraswamy Koppad

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 227-235

INTRODUCTION: Corona virus Disease is a fatal viral disease that continues to trouble
many countries around the world. Immunization is one of the most effective and costefficient
initiatives ever, saving millions of lives every year. COVID-19 vaccines are
considered to be of great importance in preventing and controlling the disease. This study
aimed to estimate AEFI, COVID-19 vaccine awareness, preference among people visiting
vaccination centre, SIMS, Shimoga. OBJECTIVE: 1. To estimate AEFI among people
visiting vaccination centre, SIMS, Shimoga. 2. To estimate COVID-19 vaccine awareness
and preference among people visiting vaccination centre, SIMS, Shimoga. MATERIALS
AND METHODS : A prospective longitudinal study was conducted for a period of one
month – July 2021. People visiting COVID vaccination centre, SIMS, Shimoga were
included in the study. Considering AEFI to be 30% after pilot study, sample size calculated
was 336. Data was collected from 373 participants. Ethical clearance was obtained by
Institutional Ethics Committee. Oral consent was taken from each participant. Each
participant is interviewed telephonically, and the relevant information was collected. The
collected data was tabulated in Microsoft excel sheet. Analysis is done by using epiInfo
software. Descriptive statistics like percentages, mean were used, and the results were
tabulated. RESULTS: Incidence of AEFI reported from our study population was 36%.
Majority of it was after first dose of vaccination (47%), and the most common complaint was
pain (64%) at the site of injection. Covishield was the most preferred vaccine as the
availability was good. Awareness regarding vaccine was mostly from the discussion among
friends, family members (25%) and from the health care provider (22%).

Assessment of RT PCR diagnostic assays for SARS CoV - 2 detection in a Molecular diagnostic & Research Lab

Dr Nazneen Pathan,Dr Aruna Vyas ,Dr Varunika Vijay,Dr Snigdha Purohit ,Dr Rajni Sharma, Dr Nitya Vyas

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 236-253

Background: SARS CoV-2 infection took the whole world by storm in the final month of
2019.Different measures have been taken to reduce its spread by timely and accurate detection of
COVID 19(coronavirus disease 2019) infection in suspected patients and theircontacts.
Aim: This study was conducted to assess commercially available five Rt pcr (reverse
transcriptase polymerase chain reaction) kits from different manufacturers available in our center
for diagnostic testing ofSARS CoV-2 infection .94 oropharyngeal clinical samples,
previously confirmed as 64 positive and 30 negative for SARS CoV-2 were extracted and
amplified separately by each of the five Rt pcr kitsand the results compared.

Correlation Of Serum Amylase with Outcome in Acute Organophosphorous Poisoning

Dr Acharya Suvendu S, Dr Naik Deepak K, DrBiswal Pratap C, DrPadhy Rasmita K

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 254-264

Context:Organophosphorus (OP) poisoning is a common mode of suicidal poisoning. These compounds are widely available in developing country like India, resulting in high morbidity and mortality. The use of serum amylase in determining the severity of OP poisoning has showed promise.
Aims:This study was undertaken to estimate serum amylase levels in acute OP poisoning and to correlate it with the outcome.
Settings and Design:
Setting – tertiary care treating hospital
Design -cross-sectional observational study
Methods and Material:A hospital-based cross-sectional study was conducted on 80 patients who were clinically diagnosed with acute OP poisoning. Serum amylase was measured on days 1 and 2 of admission and correlated with clinical features and the end result.
Statistical analysis used was SPSS 23.0 version software, and the data was analyzed. To compare the variables across the groups, the H test and Chi-square test were used.
Results:The majority of the cases in the study (41%) were between the ages of 21 and 30. Males made up 65 % of the group, while females 28 %. Serum amylase levels were significantly elevated in patients with clinical features of OP poisoning. The median serum amylase level was 80 IU/l (IQR 50–224.5). Serum amylase levels were normal in 62.5 % (n-50), but elevated in 37.5 % (n-30). A bad outcome was linked to a persistently elevated serum amylase level on day 2.
Conclusions: Serum amylase levels is also considered as a prognostic marker of OP poisoning since it enables the first recognition of severity and to spot those in danger of developing the complications of OP poisoning.
 

EVALUATION OF FACTORS RESPONSIBLE FOR GANGRENE IN LOWER EXTREMITIES IN CASES OF PERIPHERAL ARTERIAL OCCLUSIVE DISEASE

Dr. Kiran Kumar Bollepaka,Dr G Shanti Kumar,Dr. Kambhampati Vamshi Krishna,Rajashekar Alishala,DR. BOPPANNA. DURGA SURESH., M.S., M.ch.

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 265-284

Background: Peripheral Arterial Disease (PAD) is a slowly progressive atherosclerotic disease usually characterized by occlusion of lower limb arteries, ultimately causing acute or chronic limb ischemia. The PAD is largely under diagnosed and under treated because of unawareness of patients on claudication symptoms and present to the hospital at later stages with complications5. .
Study Design: The study design is of case series.

Aim of the Study: To study the various risk factors in terms of age, sex, occupation, pre-existing cardiovascular or metabolic diseases and other factors like smoking etc. involved in the development of gangrene in lower extremities.
To evaluate different clinical features of individuals with lower limb ischemia due to PAD.
Results: This study was done in the Department of General Surgery, Mamata General Hospital, Khammam, Telangana state from December 2018 to December 2020. A total number of 30 cases were included in this study, which satisfied the inclusion and exclusion criteria. The following conclusions were derived from the present study.
• Diabetes mellitus, hyperlipidemia, and hypertension are the modifiable risk factors for PAD. Patients at risk of developing PAD can be identified with regular monitoring of the risk factors and proper preventive medication and management.
• Medical treatment for preventing CV events in PAD subjects seems to be cost-effective. Among the evaluated treatment strategies, ACE-i displayed the largest reduction in event rates to the highest mean QALY. Aspirin treatment does not appear to be cost-effective due to the low reduction in event rates.
• Conclusion: Early diagnosis and treatment of PAD are critically important to reduce the risk of complications like gangrene in PAD and to minimize the risk of lower extremity amputations, risk of long-term disability, and to improve quality of life.

COMPARATIVE STUDY OF FASTING INSULIN AND HOMA-IR IN RURAL AND URBAN T2D PATIENTS

Yogesh Kumar Rai, Pavan Gautam, Anil Kumar, Roma Goyal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 285-290

Introduction: Insulin resistance is a feature of a number of clinical disorders, including T2D/glucose intolerance, obesity, dyslipidaemia and hypertension clustering in the so-called metabolic syndrome. Insulin resistance in skeletal muscle manifests itself primarily as a reduction in insulin-stimulated glycogen synthesis due to reduced glucose transport. 
Material and Method: A cross-sectional study was conducted on 100 subjects of type 2 diabetes having an age group of 40-70 years from urban and rural area of Meerut, U.P., India for determination of HOMA-estimated insulin resistance (HOMA-IR).
Result: We found   urban subjects had significantly higher fasting Glucose, fasting insulin and HOMA-IR values than rural subjects (p < 0.001).
Conclusion: Environmental and lifestyle changes resulting from industrialization and migration to urban environment from rural settings may be responsible to a large extent, for this epidemic of insulin resistance in Indians.

Comparison of clinical perfomance of I-Gel with LMA proseal a prospective clinical study

Dr. Suni Abraham, Dr. Sunitha Harish

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 291-297

Airway management is of prime importance to an Anaesthesiologist. Unanticipated difficult laryngoscopy and endotracheal intubation remains a primary concern of anaesthesiologist. The reported incidence of a difficult laryngoscopy or endotracheal intubation varies from 1.5% to 13% in patients undergoing surgery. Failure to intubate is detected in 0.05 - 0.35% of the patients. Thus Insertion of a supraglottic device in these situations is a recognized alternative and may be a life-saving procedure preoperative. Sixty patients between 18-60 years of age and either sex were included in our study. We assessed I-gel and Proseal LMA in adults for airway sealing pressure, ease of insertion, insertion attempts, blood staining of the device, tongue, lip and dental trauma. All patients were asked to fast overnight. Mean insertion time for the I-gel (14.12 ± 2.24 sec) was significantly lower than that of the PLMA (26.1 ± 3.3 sec) (P = 0.0001). I-gel was easier to insert with a better anatomic fit. Mean airway sealing pressure in the PLMA group (30 ± 4.27 cmH2O) was significantly higher than in the I-gel group (24 ± 4.37cm H2O; P = 0.0001). From our study we conclude that: I-gel scores better than Proseal in insertion time, causes lesser incidence of postoperative sore throat due to its non inflattable cuff and facilitates effective gastric drainage.

I-Gel with LMA pro-seal: Hemodynamic changes

Dr. Sunitha Harish, Dr. Suni Abraham

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 298-303

The LMA™ airway is an innovative supraglottic airway management device. Since its commercial introduction in 1988, the LMA™ airway has been used in over 200 million patients for routine and emergency procedures. The LMA Pro-Seal™ is an advanced form of airway that may be used for the same indications as the LMA Classic™. The Institutional Ethical committee approval was obtained before commencement of the study. Written informed consent was obtained from all the patients. A total of sixty adult patients between 18 and 50 years of ASA Physical status 1 & 2 of either sex was randomly selected from the routine list of surgical procedures under general anaesthesia were enrolled in the study. Among the groups, there was no significant difference between the preinduction, one, three and five minutes post insertion heart rate. When compared between the groups, there was no significant difference in the pre induction, one, three and five minutes post insertion mean blood pressure.

A study on the sensitivity, specificity, positive predictive value and negative predictive value of EBUS TBNA yield with that of conventional bronchoalveolar lavage

Dr. Nisha Mathew, Dr. Merlin Mathew

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 304-310

EBUS-TBNA plays a vital role in diagnosis of lymphoma. Mediastinoscopies or thoracotomies have been performed as the standard procedure to obtain a histologic diagnosis in patients with mediastinal lymphadenopathy and suspected lymphoma. These procedures require general anesthesia and carry immense risks. Mediastinoscopy also has limited access to perihilar lymph nodes. Conventional TBNA, though superior to mediastinoscopy, has been shown to be inferior to EBUS-TBNA due to a lower specificity and sensitivity. At Apollo Hospital, on an average 1-2 patients undergo EBUS-TBNA every week. Based on this statistic, we got about 72 patients who underwent EBUS TBNA during my study period. About 58 patients were eligible for the study satisfying the inclusion criteria, allowing for some who did not give consent for the study. Every effort was made to screen and recruit the maximum possible number of patients for the study. With the use of Chi square test, we found that EBUS TBNA had sensitivity 88.88%, specificity 87.75%. Positive predictive value 57.11% and negative predictive value 97.72% for malignant cytology.

Study of alloimmunization in thalassemia major

Dipti Shah, Janki Prajapati, Sucheta Munshi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 311-319

Thalassemia Major results in a severe anemia and require regular blood transfusion every 3-4 weeks. The regular blood transfusion regimen causes production of alloantibodies against one or more red cell antigens, which complicates subsequent transfusions.
Aims and objectives:
1. To find out incidence of various RBC alloantibodies in repeatedly transfused thalassemic patients.
2. To initiate pre-transfusion antibody screening on patient’s sample before cross match.
3. To analyse factor responsible for development of antibodies.
Material and method: It was prospective observational study conducted at Civil Hospital Ahmedabad from 01/09/2018 to 31/08/2020.Transfusion dependent patients of age up to 12 years having more than 50 blood transfusion were included in the study. Blood samples were collected in pilot tubes (EDTA and plain). The plasma/serum was used for antibody screening and antibody identification test using 3-cell panel and 11-cell panel. Serological parameters tested were blood grouping, Direct Antiglobulin Test (DAT), Indirect Antiglobulin Test (IAT) and antibody screening and identification. Blood grouping was done by using DIAGAST (QWALYS) on Erythrocyte Magnetized Technology (EMT). Results were obtained and data was analysed.
Observation and results: In alloimmunized patients M:F ratio was 1:3. The mean of total number of blood transfusion of all the patients and alloimmunized was 127 and 233. It shows more chances of developing alloantibodies with higher number of blood transfusion. Out of total alloimmunized patients, 50% patients were splenectomised. Alloantibodies was present in 50% patients with O+ blood group, 25% with A-and 25% with B+. Anti-K alloantibody was found in 50% patients, Anti-D in 25% patient and Anti-E in 25%. Total 91% patients were having annual blood requirement <200 (ml/kg/year) and 9% having >=200 (ml/kg/year). Among them, all the alloantibodies present patients found having annual blood requirement >=200 (ml/kg/year). All alloimmunized patients were having Homozygous thalassemia.

Changes in blood glucose level in normal pregnancy

Dr. Meena Cherian, Dr. Sophiamma Joseph

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 320-325

Gestational diabetes mellitus (GDM) is the most common metabolic abnormality during gestation. Gestational diabetes mellitus is defined as abnormal glucose tolerance was 25% in lean women and 50% in obese women compared with a 5-10% prevalence in a control population. Women attending the Obstetrics & Gynecology outpatient department of the Govt. Medical College, were interviewed and from many volunteers 31 were selected as being in good general health, of average build, free from any family history of diabetes, and were sure of their last menstrual dates. Each patient gave her informed written consent. None of them had a history of impaired glucose tolerance. The mean (± SD) fasting plasma glucose levels during the 1st, 2nd and 3rc1 trimester and at term were 69.9 ± 9.2 mg/di, 71.7 ± 7.5 mg/di, 75 .9 ±8.3 mg/di, and 76.8 ± 8.5 mg/di respectively. And the mean fasting plasma glucose in the non-pregnant state is 71.5 ± 7.2 mg/di. The mean (± SD) blood glucose values 1 hour after ingestion of 50 g oral glucose load (GCT) were 98.9 ± 15.2 mg/di, 105.3 ± 14.5 mg/di, 105.2 ± 13.7 & 104.9 ± 11.6 mg/di during the 1st,2nd and 3rd trimesters and at term respectively.

Determinants of variations of blood glucose levels in normal pregnancy

Dr. Meena Cherian, Dr. Sophiamma Joseph

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 326-330

Evaluation of the longitudinal change in carbohydrate metabolism in pregnant women with normal glucose tolerance should improve our understanding of carbohydrate metabolism in these women. The primary purpose of this study is to describe the changes in carbohydrate metabolism during pregnancy in apparently normal women. This study is designed to determine the pattern of fasting blood glucose and oral glucose response in healthy pregnant women, in whom blood glucose was measured in the fasting state and after oral glucose load in the 1st, 2nd and 3rd trimesters, at term and 12 weeks after delivery in the same subjects. Each patient gave her informed written consent. None of them had a history of impaired glucose tolerance. None had any other disease or were taking any medications (such as corticosteroids, anti-convulsants or warfarin sodium) that might affect glucose metabolism. Women who had multiple gestations or pregestational diabetes were excluded from the study. Subjects were also excluded if a first degree relative had type Idiabetes mellitus or received treatment for hyperglycemia. Women who had fasting blood glucose levels exceeding 105 mg/di in 1st trimester were excluded from the study because pregestational diabetes could not be ruled out; and women with elevated screening levels (at least 135 mg/di) were instructed to have the 3 hour oral GTT. Each patient subsequently delivered a healthy child at term without difficulty. In the present study the mean fasting blood glucose and the mean GCT levels are found to be increasing with an increase in BMI. Even in the non-pregnant state the mean fasting blood glucose and the mean GCT levels are found to be increasing with an increase in BMI and the effect of BMI seems to be greater in the fasting state compared to GCT results.

INCIDENT OF GALL STONE IN DIFFERENT GENDER AND SEX

Dr Ramaswami B,Dr Natarajkumar, Dr Rakesh Shaganti

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 331-335

To study the incident of gallstone stone in different age and sex.
STUDY DESIGN:
Cross-sectional observational study,
Place and duration of study:
Mamata Medical College and General Hospital, Khammam from October 2018 to September 2020.
RESULTS: In the present study, among 50 cases, 41 (82%) were females and 9 (18%) were males
with male to female ratio of 1:4.5. Representing the majority of the study population were females.
Out of these 3 cases two were pigmented, one was cholesterol stone. But Chi-square statistic at 0.866
with P value of 0.64. Out of 41 female patients in the present study, 10 had a history of OCP use at
some point in their life. Among them 5, 4, 1 patients had pigment, cholesterol and mixed stones.
Mean serum bilirubin value was more among pigmented stone group (1.069 mg/dl) as compared to
mixed (0.850 mg/dl) and cholesterol group (0.6 mg/dl). Mean serum cholesterol group (3.382 mg/dl).
CONCLUSION: On the basis of the above observations, it is possible to say that pigment gallstone
patients have high serum bilirubin, calcium and phosphate levels and the type of gallstone doesn’t
depend on age, sex, BMI status and OCP usage.

ATYPICAL PRESENTATION OF CEREBRAL CAVERNOUS HEMANGIOMA

Dr. AjeetSelvam, Dr. Joseph Manuel,Dr. Dilip S Phansalkar, Dr. Hari. V.S, Dr.MosesAmbroise. M

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 336-345

The first person to describe cavernous hemangioma was Hubert Luschka.1 In the year 1854, he
published the case of cavernous vascular brain tumor (“kavernöseBlutgeschwulst des Gehirns” –
German) and provided a detailed description of its gross macroscopic aspect. The first
histopathological description was given by the renowned pathologist Rudolf Virchow in the year
1863.2In histologic terms, cavernous angiomas (CA) are blood-filled cavities covered by a single
layerof endothelium. The intervening tissue includes microglia but no neural elements.3
At present, the terms cavernoma, cavernous hemangioma/angiomaand/or cavernous
malformation are being used interchangeably. We must also note that the terminologies
cavernoma, cavernous angioma, and cavernous hemangioma are misnomers since they tend to
point towards a neoplasticorigin.However, these represent true vascular malformations.

Functional outcome of forearm fractures treated by intramedullary tens fixation: A prospective study

Dr. Navneet Singh, Dr. Punit Tiwari, Dr. Sandeep Singh Jaura, Dr. Aamna Athwal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 346-353

Introduction: Most forearm fractures in adults are treated by Open Reduction and Internal Fixation with plates. Another treatment modality is intramedullary nailing but in clinical practice, this is rarely used. We conducted this study intending to evaluate the functional outcome of forearm fractures in adults treated with Intramedullary TENS Fixation Methods: Patients with closed forearm fractures who were admitted to our Tertiary health care center between January 2019 to December 2022 and met the inclusion criteria were enrolled for the study. They were evaluated clinically and radiographically. Patients with both bone forearm or isolated radius or isolated Ulna fractures were included. Closed fracture reduction was done intra-operatively and the fractures were fixed with Intramedullary TENS (Titanium Elastic Nail System). Functional evaluation was done by Grace and Eversman evaluation criteria and DASH (Disabilities of Arm, Shoulder, and Hand) score. Range of motion of forearm in terms of Pronation and Supination and grip strength of forearm were evaluated. Patients were followed up for a period of a minimum of 1 Year. Results: In our study, 27 patients were enrolled. 16 were males (59.26%), 11 were females (40.74%). The mean age was found to be 36.30 with the range found to be 19 to 55 years. Fractures were found to be in the right side of the forearm in 17 patients (62.96%) and on the left side of the forearm in 10 patients (37.04%). The mean time of union was 11.30 ± 3.62 weeks (range of 7 to 18 weeks). Mean grip strength was found to be 52.22 ± 13.75 in the operated forearm and 54.67 ± 13.81 in the contralateral forearm with the difference found to be statistically insignificant with a p-value of 0.323. Pronation was found to be 76 ± 3.88⁰ in the operated forearm and 77.41 ± 1.82⁰ in the contralateral forearm with the difference being statistically insignificant with a p-value of 0.363. Supination was found to be 80.56 ± 4.36⁰ in the operated forearm and 82.56 ± 1.91⁰ in the contralateral forearm with the difference being statistically insignificant with a p-value of 0.194. Grace and Eversman score was found to be Excellent in 20 patients (74.07%), Good in 6 patients (22.22%), and acceptable in 1 patient (3.7%). DASH (Disabilities of Arm, Shoulder, and Hand) score was found to be 14.78 ± 9.86 with a range of 4.2-34.2. Conclusion: Intramedullary fixation of Forearm fractures with TENS is a reliable and minimally invasive technique and can be utilized to obtain good results.

Uric acid levels in patients on antitubercular therapy at Dr. B.R. Ambedkar Medical College, Bengaluru

Dr. Srinivasa KV, Dr. Priya VR, Dr. Shantha Kumari N, Dr. Karthik G

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 354-357

Background: Tuberculosis is an infectious disease caused by mycobacterium tuberculosis. The disease burden is huge in developing country like India. Antitubercular therapy is the mainstay of treatment. The drugs in the therapy can cause various adverse effects. Hyperuricemia is one of the adverse effects caused. Aim: To estimate the levels of serum uric acid level in patients taking antitubercular therapy including pyrazinamide. Materials and Methods: A prospective study done at DR. BR AMC and H including the 60 patients on antitubercular therapy. Serum uric acid levels are estimated at 0 and 8 weeks of therapy. Results: Hyperuricemia was significant in patients receiving antitubercular therapy with pyrazinamide. Serum urate level 6.7 +/- 0.6 mg/dl compared to baseline 4.3+/- 0.8 mg/dl. Hyperuricemia was seen in 46.6%. Conclusion: Patients on antitubercular therapy including pyrazinamide developed significant hyperuricemia.

Prevalence of Non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus

Dr. Srinivasa KV, Dr. Priya VR, Dr. Karthik G, Dr. Shantha Kumari N

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 358-362

Background: Non-alcoholic fatty liver disease (NAFLD) which develops in the absence of alcohol abuse has been recognized as a major health burden. NAFLD is third leading indicator of liver transplantation. Insulin resistance is frequently seen in NAFLD. AIM: To determine the prevalence of NAFLD in type 2 Diabetic patients. Material and Methods: A cross sectional observational study involving 100 type 2 Diabetic patients. Results: NAFLD was seen in 53% Type 2 Diabetics. Increased BMI in the range of overweight was significant associated with NAFLD 28.2+/-3.1. Hypertriglyceridemia was associated with NAFLD. Conclusion: High prevalence of NAFLD is Type 2 diabetes with increased BMI (over weight).

Study of antifungal susceptibility and biofilm formation among Candida species isolated from various clinical samples

Dr. Karthik R, Dr. Sujatha K Karjigi, Dr. Mamata Kale

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 363-371

Abstract
Objectives: To study the antifungal susceptibility and biofilm forming ability of Candida species isolated from various clinical samples.
Methods: 123 isolates of candida species from recovered from clinical specimens like vaginal discharge, blood, urine, pus, body fluids, sputum were included in the study. The identification was done by standard methods by isolating in SDA followed by Germ tube test, Chromagar candida, Corn meal agar and Vitek YST cards. Antifungal susceptibility testing was done by disc diffusion method12. Biofilm formation was detected by tissue culture plate method13. Results are summarized as frequency tables, and percentages and Statistical analysis was done by SPSS 16.0 software.
Results: In the present study, 123 Candida spp. were isolated from different clinical samples, which included C. albicans (51.2%) followed by C. tropicalis (24.3%), C. glabrata (9.75%), C. krusei (7.3%), and C. parapsilosis (7.3%). Candida albicans was the predominant isolate among all species of Candida. Out of 63 Candida albicans isolates, 24 (38%) strains were positive for biofilm production. Among the total 60 non-Candida albicans, 39 (65%) isolates were biofilm producers. Antifungal susceptibility testing of various Candida species showed 
that all isolates were susceptible to amphotericin. 75.55% strains were sensitive to fluconazole. 18.88% of the Candida spp. were resistant to voriconazole. Out of 63 Candida albicans isolates, 24 (38%) strains were positive for biofilm production. Among the total 60 non-Candida albicans, 39 (65%) isolates were biofilm producers.
Conclusion: Candida albicans was the most commonly isolated species identified but non Albicans Candida species as a whole were the predominant group. Candida strains isolated in our study area have not yet developed resistance to amphotericin B. The possibility of reduced susceptibility to fluconazole and voriconazole may be due to widespread and long-term use of those antifungals among the study subjects. Our study underlines the importance of performing identification of Candida species and antifungal susceptibility test to guide treatment and prevent development of antifungal drug resistance. Biofilm formation is another important virulence determinant which can lead to chronic and persistent infections. There is no statistical correlation between the biofilm formation and antifungal susceptibility (p>0.05).

Prevalence of Rota & Adeno viral acute gastroenteritis in children < 5yrs of age and study of associated social factors in tertiary care hospital

Dr. Sujatha Karjigi, Dr. Karthik Ramamurthy, Dr. Mamata Kale

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 372-378

A descriptive case-control study was conducted over one year to diagnose Rota and Adenovirus acute gastroenteritis by using an economic rapid antigen detection test and to determine associated social factors like age, gender, feeding methods, drinking water, socio-economic status, and Rota vaccine status.
Results: 26% of samples tested positive for Rotavirus and 0.4% were positive for adenovirus, more cases of Rotavirus in > 6 months to 2 years as they are on the mixed feed and more activities. 44% of viral gastroenteritis cases were from lower socioeconomic status. 72% were using boiled cooled tap water and others were using reverse osmosis water only 33.3% of children had been vaccinated against Rotavirus, none from the Rotavirus positive cases.43.6% of cases were between October to December.
Conclusion: A rapid card Antigen test for Rota and adenovirus will help in the management of cases & can reduce the financial burden of treatment. Acute viral gastroenteritis cases were associated with poor socioeconomic background, more common between the age of 6 months to 2yrs, and all were not vaccinated

Transfusional Iron Overload- A Major Issue in Multi - Transfused Beta Thalassemia Patients

Parag Fulzele, Jayashree Sharma, Swarupa Bhagwat, Shruti Bankar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 379-386

Introduction: In β-thalassaemia major, repeated blood transfusions, ineffective erythropoiesis and increased gastrointestinal iron absorption lead to iron overload in the body. In developing countries like India with limited availability there is still reliance on the serum ferritin level as a means of monitoring the iron overload and the efficacy of chelation.
Objective: The aim of the study was to measure the ferritin levels in multi-transfused β-thalassemia major as an indicator of transfusional iron overload. To study the association of serum ferritin level with various variable, complications due to repeated transfusion, compliance of patients to iron chelation therapy.
Materials And Methods: A total of 60 β-thalassemia Major patients registered at the tertiary care centre for blood transfusion who received more than 10 units of blood transfusion were included in this cross sectional study. Parameters studied were serum ferritin level, seroconversion for transfusion transmitted infections and complications such as deranged thyroid function test, liver function test and cardiac function.
Results: The mean serum ferritin levels were 3801+/- 1675.20. 77.35% (41/53) were compliant to the iron chelation therapy. The mean ferritin levels in compliant versus non compliant patient was 3773.87 ng/ml and 3695.05 ng/ml. The thyroid function test was abnormal in 9.43 % (5/53), Liver function test was deranged in 49.12% (28/57) and 2D Echo for heart function was abnormal in 14.28% (3/21) patient. 2 patients (3.33%) were sero-positive, one for HCV and second for HIV antibody.
Conclusion: There is a need for better quantitative indicators, non-invasive methods, accurate and which are readily available along with development of newer chelating agent for better compliance and efficacy. Antenatal diagnosis, increase awareness among patient and relative, adequate provision of medical care facility, adherence to standard treatment protocol and Bone Marrow Transplant may result in effective management of the thalassemia patient.

Study on the incidence of nosocomialinfections in COVID19 patients inatertiary care Hospital

G Ratna Prabha,S Rajeshwar Rao

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 387-392

Aim:ToknowtheincidenceofnosocomialinfectionsintheCOVID19patientsadmitted in the
hospital that may help in the selection of the suitable antibiotics followsthebetter
managementof theCOVID 19patients.Materials and methods: A total of 1534 COVID 19
patients were includedin
thestudy.Therespiratory,blood,urinaryandpusformsurgicalsitessampleswerecollected to find
the incidence of the bacterial infection in hospitalized COVID 19patients. The samples were
collected 48 hours after the admission of the patient in to thehospital.Results: The incidence
of the nosocomial infections in the COVID 19 patients was30.24%. The Staphylococcus
aureus, Klebsiellapneumoniae, and Coagulase negativestaphylococci were more prevalent
bacteria causing secondary infection in COVID 19patients.E.coliwas predominantly
seeninUrinesamples.Conclusion: The rate of bacterial infections in the COVID 19 patients
was observed
ashighandneedtobeconsideredtotakeprecautionstominimisethespreadofnosocomial infections.
The incidence of the bacteria reported in this study may be ofgreat value in the management
of the COVID 19 patients and may also help to reducethemortality and morbidity

Assessment of role of SGLT2 inhibitors in elderly obese uncomplicated DM patients

Shaheen Saeed, Parvez SaeedAnsari

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 393-397

Background:SGLT2 inhibitor treatment has been shown to have additional benefits
such as weight loss, renoprotective and cardioprotective effects. The present study was
conducted to assess role of SGLT2 inhibitors in elderly obese uncomplicated DM
patients.
Materials & Methods:84type II DM patients of both genders were prescribed
empagliflozin or dapagliflozin. FBG, PPBG, HbA1c, liverenzymes and kidney function
tests, complete urinalysis,serum lipids, protein excretion in spot urine were
recordedbefore and after the initiation of SGLT2 inhibitor.
Results: Out of 84 patients, males were 50 and 34 were females. SGLT2 inhibitor used
wereEmpagliflozin in 40 and Dapagliflozin in 44. Comorbidities were hyperlipidemia in
57, hypertension in 62, CAD in 12 and heart failure in 7 patients. Complications were
diabetic nephropathy in 15, diabetic retinopathy in 10 and diabetic neuropathy in 22
patients. The difference was significant (P< 0.05). Laboratory findings before and after
treatment in FBG (mg/dl) was 198.2 and 154.3, PPBG (mg/dl) was 276.2 and 235.9,
HbA1c (%) was 9.5 and 7.1, hemoglobin (g/dl) was 13.5 and 14.2, hematocrit (%) was
43.2 and 45.0, urea (mg/dl) was 36.4 and 38.7, creatinine (mg/dl) was 0.8 and 0.9 and
eGFR (mL/min/1.73 m2) was 84.2 and 79.5 respectively. The difference was significant
(P< 0.05).
Conclusion: Glycemic control was successfully achieved with SGLT2 inhibitor
treatment in type II DM patients.

Assessment of C reactive proteins levels in peri-implantitis patients: An observational study

Amandeep Kour, Babita Rawat, Priyanka Sonali, Kumari Shalini

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 398-401

ABSTRACT
Background: Peri-implantitis is an inflammatory reaction with loss of supporting bone
in the tissues surrounding an implant. Hence; the present study was undertaken for
assessing the levels of C reactive proteins levels in peri-implantitis patients.
Materials & methods: We calculated any deviation in the levels of CRP in the gingival
crevicular fluid (GCF) of patients with peri-implantitis as compared to healthy normal
subjects. A total of 30 subjects were enrolled in the current research. Out of these 30
subjects, 15 subjects were of confirmed cases of peri-implantitis while the remaining 15
subjects were healthy controls. The GCF of all the patients was collected and sent to
laboratory for precise measurements of CRP levels and their comparison with the
control groups. Based on the lab reports all the data was assimilated on the excel sheets
for further assessment. SPSS software was used for statistical analysis. Chi square test
and student test were used to compare and analyse the variables. P value of less than .05
was considered significant.
Results:Mean GCF levels of C-Reactive proteins among subjects of peri-implantitis
group was 395.5 pg/mL and was found to be significantly higher in comparison to the
subjects of control group (171.6 pg/mL).
Conclusion: Enhanced periodontal inflammation in peri-implantitis patients is
accompanied by a considerable increase in the concentration of CRPs.

CT portography using MDCT versus color doppler in detection of varices in cirrhotic patients

Dr Sakshi Agarwal, Dr Naveen SS, Dr Vijay Kumar, Dr Ankush Malik, Dr. Shashank Chapala

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 402-408

Background: All chronic liver diseases end with cirrhosis. Upper gastrointestinal tract
hemorrhage brought on by the formation of esophageal varices is the most frequent
cause of death in cirrhotic individuals. It will be possible to prevent potential difficulties
during interventional procedures and surgery if portosystemic collaterals are diagnosed
using non-invasive approaches.
Materials and Methods: A cross-sectional study involving 90 patients who were
diagnosed with liver cirrhosis based on symptoms and test results and presented to the
medical gastroenterology department. To best display portal venous architecture,
disease, and venous collaterals, Color Doppler US was first done using the Philips Epiq
7G machine. The transducer and gain settings were changed in each instance. The work
station was used to obtain portography pictures while the 256 Slice Phillips (Brilliance)
was used to do CT. All of the patients underwent endoscopy, and the results were
compared using the Pearson's Coefficient test to those obtained from USG and CT.
Results: Of the 90 patients, 26, 14, 38, and 12 had esophageal varices of Grades I–III
and none at all. Grade I and II varices were not found in USG, however 8/12 Grade III
varices were. All 38 cases of grade II varices and 12 cases of grade III varices were
found using CT. For the diagnosis of paraesophageal, splenorenal, anterior abdominal
wall, peri-umbilical, and peri-cholecystic collaterals, USG and CT showed excellent
agreement (Kappa values >0.7). There was no agreement between USG and CT for the
detection of esophageal, gastric mucosal, perigastric, and retroperitoneal collaterals.
Conclusion: Grade III varices are found by USG, while Grade II and III varices are
found by CT. Compared to USG, CT is more effective at delineating all portosystemic
collaterals. When defining intricate collateral routes, USG is less accurate than MDCT
portal venous phase. In order to identify unanticipated varices that could cause
considerable bleeding during liver transplant procedures, multislice CT can be used to
detect potentially problematic varices by tracing the path of tortuous veins.

An Understanding of A Clinico Pathological Correlation In Leprosy In A Tertiary Care Teaching Institution.

Nishant Saxena, Nimisha Saxena, Shilpa Mittal , Harsh Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 409-420

Background: Leprosy caused by mycobacterium leprae is a chronic granulomatous disease that mainly
affects peripheral nerves and skin. Depending upon the immune status of the individual it manifests var ious
clinical and pathological forms. Histopathology plays an important role in the diagnosis of clinically suspicious
cases and helps in exact classification of various subtypes and types which therefore helps in deciding the
treatment plan and cure. Vari ous inflammatory disorders also mimics clinically to leprosy therefore exact
diagnosis plays an important role for early treatment. So this study is undertaken to correlate the clinical
diagnosis with histopathological findings which plays crucial role in patient management.

Association of lichen planus with metabolic syndrome–acasecontrol study in a tertiary care center.

Nishant Saurabh Saxena , Nimisha Saxena , Animesh Saxena, Harsh Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 421-428

Background: Lichen planus is an inflammatory papulosquamous dis- ease which affects skin and mucous membrane and cause metabolic derangements.
Methods: This is an hospital based case control study during a span of 2 year (Jan2018-Dec 2019) which includes 60 cases of lichen planus and 60 age and sex matched controls. Relevant clinical history and physical examination was done and collaborated with blood investigations. Diagnosis was made based on IDF criteria.
Results: No significant association can be established between lichen planus and metabolic syndrome ( p=0.278) Although prevalence of hypertension was higher in cases as compared to controls (36% vs. 26%, p=0.027) , TG levels (12% vs. 6%, p=0.030 and low HDLC levels (47% vs. 33%, p=0.039). No significant association was established between FBS and waist circumference with lichen planus.
Conclusions: Although no significant association can be established between lichen planus and metabolic syndrome but its components such as hypertension, TG and HDLC were found to be associated with LP as per the study. Therefore screening of these parameters in LP patients is necessary to avoid future complications in these patients.

Association of serum Leptin with Gonadotrophins and Prolactin in Polycystic Ovarian Syndrome Patients attending Tertiary Medical Hospital in Southern Odisha

DrPrachi Jena; DrRasmita Kumari Padhy; DrDevi Prasad Pradhan; Prof. Dr.Nirupama Devi; Dr.Lipika Behera; Dr.Manaswini Das

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 429-438

Introduction: Leptin is an ob gene encoded adipocyte derived hormone which serves as a relay link between metabolic signals and brain to regulate the hypothalamic pituitary ovarian axis. Leptin is associated with obesity which is a major cause of PCOS in women of reproductive age group. Aim: The purpose of study was to evaluate the association of serum leptin concentration with gonadotrophins and prolactin in women with PCOS. Material and Method: Itwas a case control study conducted for a span of oneyear at one year, at Department of Biochemistry in collaboration with department of Obstetrics and Gynaecology, MKCG Medical College and Hospital from December 2018 to December 2019, where 60 PCOS subjects and 30age matched normal ovulatory controls of 15 – 30 years age group with BMI<25 kg/m2 were included. BMI was calculated and study population was divided into 2 groups that is Lean PCOS group with BMI < 25kg/m2 and Obese PCOS group with BMI ≥ 25kg/m2.Serum leptin, gonadotrophins and prolactin were estimated on 2nd or 3rd day of menstrual cycle. Data was represented as mean and standard deviation and statistical analysis was done in SPSS version 25. Data analysis was done using one-way ANOVA test, correlation was calculated by using the Pearson’s correlation method. A ‘p’ value of

EXPRESSION OF P53 IN UROTHELIAL CARCINOMA AND ITS CORRELATION WITH THE GRADE OF THE TUMOR – A TWO YEARS STUDY IN A TERTIARY HOSPITAL

Dr Mothkoori Swetha, Dr P.V.Ramana, Dr. Bhanupriya Kakarala, Dr. T. Sundari Devi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 439-451

BACKGROUND
In India Urothelial carcinoma of bladder  constitutes about 7% of all male cancers. It is associated with high morbidity and mortality.Current grading system in application by WHO/ISUP divides Urothelial malignancies as  low and high grade tumors by morphological criteria. Grading Urothelial carcinomas depending on morphological criteria alone is some times difficult in limited tissue. In such cases tumor grading by alternative  methods like IHC expression is useful. In the present study we have evaluated the diagnostic utility of p53  in grading Urothelial carcinomas.
MATERIALS AND METHODS :
The present study is an observational study conducted at department of Pathology, Gandhi Medical College/Hospital, Secunderabad for over a period of two years from June 2016 to May 2018. A total of 30 TURBT  and  Cystectomy specimens diagnosed as Urothelial carcinoma on routine H&E were included in the study. These tissues were later subjected to IHC markers for  p53. The slides are reviewed and expression of these markers was evaluated and  correlated with grade. The results were statistically analyzed.

STUDY AND ANALYSIS OF ONE THOUSAND CERVICAL PAP SMEARS; EXPERIENCE OF A RURAL TERTIARY CARE CENTER IN EASTERN U.P.

Dr. Madhu Kumari Yadav, Dr. Neha Yadav, Dr. Samiksha kumari

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 452-458

Introduction: Cancer is the leading causes of adult deaths worldwide. However there is a marked difference in the distribution of cancer sites across different regions of the world. In contrast to developed countries cervical cancer is a public health problem in developing countries like India. Cervical cancer is the fourth most frequent cancer in women with an estimation of 6.6 percent of all female cancers and representing 3.2 percent of all cancer deaths in women [1]. In India cancer cervix constitutes 14 percent of cancer incidence among women. The standardized death rate is about 6.5 per 100,000 population [2]. Infection with HPV (Human Papilloma Virus) is the primary cause of cancer of cervix and its precursor lesions [3]. Specific high risk HPV types account for about 90% of high grade intraepithelial lesions and cancer. The carcinogenic HPV strains are HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68 [4]. HPV – 16 is the most common HPV found in invasive cancer and in CIN2 & CIN3 [5]. HPV—18 is more specific for invasive tumors [4]. HPV infection usually resolves in 9-15 months in a vast majority of cases [6]. A small minority of women exposed to HPV develop persistent infection and many progress to CIN and frank invasive carcinoma later over 15-20 years [7]. This long latent period provides us the opportunity to prevent the disease and to screen and treat the disease in its pre-malignant phase only.

A Comparative Study of Intraperitoneal Instillation of Different Volumes and Concentrations of Bupivacaine Versus Transversus Abdominis Plane Block (Tap) for Post-Operative Analgesia in Laparoscopic Cholecystectomy

Dr Megha A, Dr Malavika, Dr Sindhu A P

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 459-470

Background : Laparoscopic [LC] surgeries or minimally invasive surgeries are associated
with lesser parietal pain and haemorrhage, compared to the open surgeries. However visceral
pain persists. The effect of volume and concentration on intra-peritoneal instillation of local
anaesthetics for pain relief has not been studied . In this study we have compared the intraperitoneal
instillation of local anaesthetic with transversus abdominis plane block (TAP).
This study is aimed at assessing the superiority of effect of volume of local anaesthetic
instilled intra-peritoneally versus TAP block on post-operative pain relief in laparoscopic
cholecystectomy.

Study of Microbial Contamination of Contact Lens Care Solution and Contact Lens Care Practices in users of Central Gujarat.

Dr. Chirag Patel, Mrs. Zeal Desai, Dr. Naimika Patel

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 471-479

Background & Method: The aim of this study is to assess the contact lens care practices of the contact lens wearers in Anand district and the contamination rate of contact lens fluid using microbial culture technique. The lens care solution samples were processed directly without enrichment by culturing on MacConkey agar, nutrient agar and blood agar, and incubated at 37°C for total 48 hours, while observing for growth at 24 hour and 48-hour incubation. The swabs were enriched in brain heart infusion broth and incubated for 24h at 37°C. Sub cultures were done on MacConkey agar and nutrient agar and were incubated at 37°C for 48 hours. The bacteria which grows were further subjected to in-vitro biofilm production assay by microtitre plate method and results were recorded. For culture examination for Acanthamoeba the non-nutrient agar with lawn culture of E.coli is inoculated directly with lens care solution observed for feeding tracks created by Acanthamoeba as indicator of culture positive.
Result: Total of 52 participants’ samples (50.4%) found contaminated with one or more microbe out of total 103 participants participated in present study. 21 isolates (40.4%) out of these 52 were found to be biofilm producer in in-vitro biofilm production assay. Also 02 (1.94%) of the total 103 samples found positive for Acanthamoeba showing the feeding tracks on non-nutrient agar culture. Most lens users had a habit of changing their lens solution weekly 38(36.8%) which was significantly high in number in comparison to changing frequency of daily 1(0.9%) or monthly 13(12.6%). Only 3(2.9%) contaminated lens fluid of lens wearers had a habit of washing their hands before removing lens, which was significantly low in comparison to those who washed their hands before wearing lens 49(47.5%). Among 103 participants, 50(48.5%) contaminated lens fluid of lens wearers, did not discard their lens care solution bottle for months after opening which is significantly more in number.  There are total 90(87.3%) participants, who used protective glass in possibility of exposure to dust or foreign particle.
Conclusion: In present study we conclude, Females using contact lenses more compared to males. The common user of contact lens belongs to age group of 21 year to 40 year. Students are the people who are using contact lenses commonly compared with other occupation. 52 out of 103 (50.5%) lens care solution samples were found contaminated with one or more bacteria, amongst them E. coli was isolated in highest numbers. Biofilm production capacity was found positive in 40.4%. Only two participants (1.9%) found with Acanthamoeba infection as well. Symptoms of itching and redness were present in high number in all users. Amongst them itching and discharge were more significantly present in culture positive users compared to culture negative users. Hence it is recommended for the users to screen their lens care fluid for bacterial contamination in case if they one or both of these signs while using lens.

A Comparative Study of use of 0.2% Glyceryl Trinitrate Ointment after Haemorrhoidectomy as an Analgesic

Dr Md Zaheeruddine Ather, Dr Arunkumar Tukaram,3 Dr. Aditya J. Mise

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 480-484

Introduction: Pain is almost a constant feature after hemorrhoidectomy and is the commonest reason for delayed patient discharge [1]. 0.2% Glyceryl Trinitrate (GTN) ointment has been used to treat anal fissure and pain relief in haemorrhoids, but the value of its use post-haemorrhoidectomy as an analgesic and in wound healing is unclear. The side effect of headache has often been an associated problem. Therefore, we designed this study to evaluate the analgesic effects of local application of 0.2% GTN for pain management after hemorrhoidectomy, and its role in would healing and the unwanted incidence of headache.
Materials & Methods: A randomized, single blinded trial was carried out over a period of six months. 100 patients were recruited and randomized to receive either 0.2% GTN or polymyxin ointment. Patients with comorbidities that contraindicate the use of 0.2% GTN were excluded from the study. Inferential and descriptive statistics were calculated      using SPSS version 10.0
Results: 100 patients were recruited and divided into 2 equal groups of 50 patients each. One group received 0.2% GTN and the other 50 patients received polymyxin ointment. There was no statistically significant difference noted in gender, age and degree of haemorrhoids. Pain perception was also statistically insignificant in both the groups, however, a significant number of patients (33 out of 50) showed complete wound healing at the end of 4th week of surgery in the group receiving 0.2% GTN. This was a statistically significant finding (p=0.004). None of the patients in polymyxin group experienced headaches but this was observed in 5 patients (10%) who received 0.2% GTN, but this was statistically insignificant (p=0.317) and did not warrant the discontinuation of 0.2% GTN in the group.
Conclusion: 0.2% GTN ointment significantly enhances the post- operative recovery, reducing pain in terms of duration and intensity. This effect might be secondary to a faster wound healing expressed by reduced secretion, bleeding and itching time.

Morphological and Histopathological Changes in Placenta in Complicated Pregnancies

Kumari Manu, Shweta Anand, Abhishek Singh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 485-490

Background: The term placenta means flat cake in Latin. The placenta is defined as a fusion of the fetal membranes to the uterine wall. Gross and microscopic examination of placenta is generally not indicated in uneventful pregnancies and deliveries. According to College of American Pathologists criteria, the gross and microscopic examination of placenta is indicated in certain maternal, fetal and placental conditions which may govern the outcome of the next pregnancy and diagnosis  of which may prevent fetal loss and maternal complications in next pregnancy . Normally placenta should consist of single round to ovoid disc with no accessory lobes, with a shiny surface and membranes should insert at the margin of the disc. Umbilical cord should contain two arteries and one vein.
Light microscopic features of a normal placenta in third trimester include relatively more number of small sized villi and there should not be any stromal cell hypercellularity or increased syncytial knots or edema
Material and Methods: 24 samples of placenta from women in the reproductive age group with complicated  pregnancies received in the department of Pathology, grossly  examined and routinely processed and stained with H&E stain.
Results: It shows that maximum cases 13(56.52%) were of fetal growth retardation followed by premature delivery 4(17.39%) then eclampsia/preeclampsia/help syndrome were 3(13.04%), postdated delivery 2( 8.69%) and IUD and gestational  diabetes/preexistent diabetes mellitus were 1 (4.34%)
Occlusion: Morphological and histological changes are observed in placenta of complicated pregnancies in comparison to the normal uneventful term pregnancy. Some of which are similar in different cases and some were observed differently.

A STUDY OF THYROID FUNCTION TEST IN PATIENTS WITH DIABETES MELLITUS

DR.PARTH R. JANI,DR. PANKAJ. J. AKHOLKAR,DR. SAGAR S. GARCHAR, DR. N N. PANDYA

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 491-503

Introduction:  
Diabetes mellitus (DM) is a growing problem in our country and we have observed that many patients are associated with thyroid dysfunction later in their life. Hence, the prevalence of thyroid dysfunction in diabetes mellitus patients should be evaluated. 
Objectives:  
To evaluate spectrum of thyroid disorders in diabetic patients and To access  altered thyroid function in patients with diabetes mellitus regarding age, sex, duration of  diabetes, family history, regularity of treatment and BMI.  
Materials and Methods:  
In this cross sectional study, after taking permission from ethical committee, data of 280 DM patients who attended the OPD clinic of sir  takhtasinhji hospital, Bhavnagar over period of 9 month, and whose thyroid stimulating  hormone (TSH), free T3, free T4 level were investigated, were included. The inclusion criteria were known cases of DM. Exclusion criteria were patients with previous history of thyroid disorder and those on drugs affecting the thyroid profile, chronic renal failure and Diabetic nephropathy, acute illness, hepatic dysfunction, psychiatric illness, Pregnancy.  
 
Results:  
Out of 280 DM patients 158 were males and 122 were females, 195 (69.64%) were euthyroid, 37 (13.22%) had subclinical hypothyroidism, 23 (8.21%) had overt hypothyroidism, 14 (5%) had subclinical hyperthyroidism and 11 (3.9%) were overt hyperthyroidism cases.  Female sex (P < 0.0091) and patient with irregular treatment (P < 0.001) were at increased risk of having hypothyroidism.  
Conclusion:  
 
Prevalence of thyroid dysfunction was high in DM patients with female sex and patients with irregular treatment.  
Introduction:  
Diabetes mellitus (DM) is a growing problem in our country and we have observed that many patients are associated with thyroid dysfunction later in their life. Hence, the prevalence of thyroid dysfunction in diabetes mellitus patients should be evaluated. 
 
 
 
Objectives:  
To evaluate spectrum of thyroid disorders in diabetic patients and To access  altered thyroid function in patients with diabetes mellitus regarding age, sex, duration of  diabetes, family history, regularity of treatment and BMI.  
 
Materials and Methods:  
In this cross sectional study, after taking permission from ethical committee, data of 280 DM patients who attended the OPD clinic of sir  takhtasinhji hospital, Bhavnagar over period of 9 month, and whose thyroid stimulating  hormone (TSH), free T3, free T4 level were investigated, were included. The inclusion criteria were known cases of DM. Exclusion criteria were patients with previous history of thyroid disorder and those on drugs affecting the thyroid profile, chronic renal failure and Diabetic nephropathy, acute illness, hepatic dysfunction, psychiatric illness, Pregnancy.  
 
Results:  
Out of 280 DM patients 158 were males and 122 were females, 195 (69.64%) were euthyroid, 37 (13.22%) had subclinical hypothyroidism, 23 (8.21%) had overt hypothyroidism, 14 (5%) had subclinical hyperthyroidism and 11 (3.9%) were overt hyperthyroidism cases.  Female sex (P < 0.0091) and patient with irregular treatment (P < 0.001) were at increased risk of having hypothyroidism.  
 
Conclusion:  
Prevalence of thyroid dysfunction was high in DM patients with female sex and patients with irregular treatment.  
 

Comparison between magnesium sulfate and dexmedetomidine in controlled hypotensionduring functional endoscopic sinus surgery

Dr.Sahaja Gunda, Dr.sravanthisuddapally, Dr. GiridharJanampetBekkam, Dr. PakalaSwathi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 504-511

Background: Functional endoscopic sinus surgery (FESS) has been recommended as a
treatment option for chronic sinusitis patients who have failed to respond to medical
treatment. In order to maximize the visibility of the operative site during functional
endoscopic sinus surgery (FESS), it is critical to reduce bleeding. The goal of this study was
to examine the effectiveness of dexmedetomidine and magnesium sulphate as hypotensive
agents in FESS in adult patients in order to achieve a bloodless surgical field.
Materials and methods: Sixty patients aged between 18-65 years were randomly assigned into
two groups, the D group for dexmedetomidine (n = 30) the and M group for magnesium
sulfate (n = 30). Patients in the D group received a loading dose of 1 g/kg dexmedetomidine
in 100 mL saline solution 10 minutes before induction and a 0.5–1 g/kg/h infusion via syringe
pump throughout the surgery. Patients in the M group received 40 mg/kg magnesium sulfate
in 100 ml saline solution over 10 min as the intravenous loading dose 10 min before
induction,followed by a 10–15 mg/kg/h infusion.

Transurethral resection and retrograde ureteral stenting in obstructive uropathy secondary to Carcinoma Cervix-Palliative Rescue from an otherwise doomed existence

Ravikumar Banavase Ramesh, Tejas Chiranjeevi, Manjunath V, Shalini Anand, Amruthraj G Gowda, Madappa KM

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 512-525

Aims and objectives : 1.To determine the impact on quality of life post trans-urethral resection
of ureteric orifice and retrograde DJ stenting in patients with obstructive uropathy secondary to
carcinoma cervix.
2. To compare the outcomes and quality of life of patients who underwent resection and DJ
stenting with patients who underwent PCN insertion using the available literature about PCN.
Materials and methods:- In this study, 40 patients were selected for palliative urinary diversion
by transurethral resection of ureteric orifice and internal drainage using DJ
stenting.77.5%ofpatientspresentedwithobstructive
uropathysecondarytorecurrenceofcarcinomacervix,20%presentedasprimarytumour and 2.5%
presented as VUJ stricture post radiotherapy. 90% had bilateral involvement of the ureteric
orifice and only 10% had unilateral involvement.
Results:- Themeancreatininevalueamong40patientswas4.12mg/dlbeforetransurethralresection
andstenting.62.5%underwenttransurethralresectionofuretericorificeandbilateralDJstentingwhile3
7.5% underwent unilateral DJ stenting. Complete renal recovery was seen in 2 weeks with
creatinine values<1.5mg/d in 72.5%whereasinrestofthe27.5%patients mean creatinine was<
3.0mg/dl.
Conclusion:-
ThetechniqueoftransurethralresectionofuretericorificeandretrogradeDJstentingasapalliative
procedure was able to show better quality of life with respect to physical and mental functioning
in patients with obstructive uropathy secondary to carcinoma cervix. Also the renal recovery
wasgood and comparable to PCN.

Midterm analysis of the relationship between psoriasis skin severity and joint involvement

Dr Md Qamar Abdul Azeez, Dr M S Dilruba begum

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 526-535

Background:
Psoriasis is a common skin disease. Up to 30% of patients with psoriasis develop psoriatic
arthritis resulting, by far, the most prevalent coexisting condition. Aim :The purpose of this
study is to evaluate the prevalence of psoriatic arthritis amongst patients with psoriasis,to
describe the clinical patterns of arthritis in psoriasis and to evaluate the relationship between
skin severity and joint activity.
Methods :
This study is noninvasive , cross sectional study, carried out at Anil Neerukonda hospital,
NRI institute of medical sciences between January 2020 and January 2022 i.e for 2 years, in
which 400 patients presenting with psoriasis to the hospital were screened for psoriatic
arthritis according to CASPAR criteria,nail involvement were assessed by the Psoriasis Area
Severity Index (PASI). The Joint disease activity was measured by clinical diagnosis activity
index (CDAI).
Result :
In our study mean patient age was mean - 38.17 years, 216 patients (54%) were female and
184 male (46%) , 40 (10%) patients had Psoriatic arthritis out of which 16 (40%) had Family
History of psoriasis .The mean PASI of the patients with psoriatic arthritis was 3.105+3.04
and 8 out of 40 psoriatic arthritis patients (20%) had Nail changes. The clinical characteristics
of Psoriasis arthritis were most common pattern being Asymmetrical oligoarthritis 24
cases(60%), followed by Symmetrical polyarthritis 10 (25%), followed by
Spondyloarthropathy 5 (12.5%) and predominant Distal interphalangeal joint arthritis 3 (7.5
%) .The mean CDAI was 5.71+3.94 . There was no significant correlation of clinical
diagnosis activity index (CDAI) with PASI.
Conclusion:
There is a relatively low prevalence of joint manifestations among patients with psoriasis
presenting to our hospital. There was no significant correlation between the severity of skin
involvement(PASI) and joint manifestation or arthritis(CDAI).

The Growing Concern of Community-acquired Skin and Soft- Tissue Infections

Dr. Balaji Puri, Dr. Varsha Kalshetti, Dr. Namdeo Suryawanshi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 536-543

Background: Skin and soft tissue infections (SSTIs) are frequent forms of disease. In order
to define or improve empirical antibiotic therapy, it is necessary to generate data on the
current spectrum and susceptibility profile of bacteria associated with community-acquired
SSTIs.
Material and Methods: The clinicalsamples were obtained from 600 out-patients and the inpatientswith
community acquired skin and soft tissue infections.All clinical samples were
inoculated on the routine laboratorymedia. Antibiotic sensitivity testing was performed as per
standard guidelines.
Results:Out of 600 patients with community acquired skinand soft tissue infections, 258
(43%) were diagnosedwith abscess followed by cellulitis 145 (24.2%).Gram positive cocci
accounted for 92.27% of total isolates. Staph. aureus was the predominant pathogen
accounting for 78.75% of total isolates. Amongst the Gram negative isolates, P. aeruginosa
was predominant pathogen 7.72%.71 (19.34%)strains of MRSA were detected in the present
series.Sensitivity to other antimicrobials varied from 6.3% (penicillin G) to 97%
(clindamycin).All the strains of P. aeruginosa were found to be sensitive to the
antipseudomonal agent ceftazidime and to amikacin. The sensitivity of Pseudomonas strains
to other antimicrobials ranged from 52.8% to 97.22%.

Efficacy of orally disintegrating tablet of ondansetron 4mg sublingually compared to ondasetron 4mg intravenousin the management of post-operative nausea and vomiting in patients undergoing elective laparoscopic surgeries under general anesthesia: A non-inferiority study

Dr. Leelavathi Bikumalla, Dr. Swathi Appagalla, Dr. Rajitha Suragouni, Dr. Sarada Devi Vankayalapati, Dr. Surender Pasupuleti

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 544-551

Background: Orally disintegrating tablet (ODT) of ondansetronis an attractive option for
prevention and management of post-operative nausea and vomiting (PONV) compared to
intravenous ondansetron. It is given sub-lingually and automatically gets dissolved and hence
convenient. There is no need of water and hence it does not interfere with the fasting status of
the patients. As it is absorbed by oral mucosa, its bioavailability is high. This is unique thing
about ODT of ondansetronand hence attracts its use.

Study of ECG and Echocardiographic Changes in Patient with Chronic Kidney Disease (CKD)

Dr. S. L. Annapoorna, Dr. B. Madhavilatha; Dr. K.D. Singh, Dr. D.K. Malviya, Dr. Anchal Upadhyay

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 552-559

Background and Objectives: Cardiovascular disease is the leading cause of morbidity and mortality in patients with Chronic Kidney Disease. This increased risk of Cardiovascular Disease may begin during early stage of Chronic Kidney Disease much before the onset of kidney failure. This high burden of cardiovascular disease mortality is well illustrated by comparing cardiovascular disease mortality in dialysis population to general population. Our study aim is to identify Electrocardiographic and Echocardiographic changes in patients with chronic kidney disease.

Microbiological Profile and Antibiotic sensitivity pattern of pyogenic infections in a Tertiary care hospital

Dr. Kiran Kumar Bollepaka , Dr. Sakru Mudavath , Dr. Yarra Sudhakar, Kudurupka Veerender

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 560-567

INTRODUCTION :
Bacterial infections that cause production of pus are called pyogenic infections. Pyogenic
infections are associated with high morbidity, so antimicrobial regimens are recommended to
reduce long term complications.
AIM :
The study was aimed to detect pyogenic bacteria in clinical pus samples and determine their
antibiotic pattern
METHODS :
The study was conducted in Department of Microbiology, Kakatiya Medical College, Warangal
from July 2021 to December 2021. A total of 525 pus samples were collected. Pus samples were
collected with disposable sterile cotton swab and pus aspirates in syringes under aseptic
precautions, and were transported to microbiology laboratory immediately. The pus samples
were inoculated on Blood agar and Mac conkey aga. The plates were incubated at 370 c for 18-24
hours. Identification of organisms were done by using biochemical reactions. Antibiotic
sensitivity test was done by Kirby Bauer disc diffusion method according to CLSI guidelines.
RESULTS :
Among 525 samples, 275 (52.38%) samples were positive for growth. Gram negative organisms
were isolated more than gram positive organisms. Pseudomonas aeuriginosa was isolated
predominantly among 275 positive samples, 67(24.3%) out of them was only Pseudomonas
aeruginosa, followed by staphylococcus aureus 19.6%, Klebsiella pneumonia 17%, Escherichia
coli 11.2%. In our study Gram negative organisms were more sensitive to Meropenem,
Piperacillin/Tazobactam and Imipenem; Gram positive bacteria were more sensitive to
Vancomycin and Linezolid.

Comparative Study of Carrying Angle Between Rural and Urban areas of Rajasthani population

Vaibhav Saini, Vimal Modi, Pawan k. mahato

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 568-572

The elbow joint is formed between the humerus in the upper arm and the radius and ulna in the
forearm and allows the hand to be moved towards and away from the body. When the arm is
extended forward, the humerus and forearm are not perfectly aligned a deviation occurs laterally
towards the long axis of the arm, which is referred as the “carrying angle”. The present study
includes 200 (100 rural and 100 urban) healthy peoples of rural and urban areas of Rajasthan
region of age group 18-40 years were selected. Carrying angle was measured by manual
goniometer made of flexible clear plastic having both the fixed and movable arms. From the
study it was found that mean carrying angle was 12.40º±2.23º in males and 12.95º±2.58º in
females of rural areas. The mean Carrying angle was found to be 10.15º±1.66º in males and
10.40º±1.81º in females in urban areas. Mean Carrying angle of male & female were found to be
greater in rural areas than in urban areas and differences were statistically highly significant
(p<0.01). The data obtained in our study may be useful in anthropological research, forensics,
genetic research, as well as in medical clinical practice.

EVALUATION AND RESULTS OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING QUADRUPLE HAMSTRING AUTOGRAFT USING IKDC/LYSHOLM SCORE

Dr Jayesh Vaza,Dr Pathik Vala,Dr Vijay Patel,Dr Parth Trivedi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 573-583

Objective-
To evaluate the functional outcome of arthroscopic single bundle
anterior cruciate ligament reconstruction using quadrupled hamstring
tendon (Gracilis and semitendinosus) autograft in individuals with ACL
injuries.
 
Methods:
There were 20 patients included in our study of which 17 patients
(85%) were male and 3 (15%) were female. 11 patients (60%) had right
side injury while 9 (45%) had injury to the left knee. Most of the patients (35%) were in the age group of 20 to 25 years followed by 30% in the age group of 30 to 35 years.The patients were followed up for an average duration of 17.6 months with minimum follow up of 7 months and maximum follow up of 27 months.Patients were followed at 6 weeks, 6 months and 1 year and functional outcomes assessed. The International Knee Documentation 2000 score(IKDC) and
Lysholm and Gillquist Knee Scoring Scale were used for evaluation of
patients.
 
Results
The mean pre-op IKDC subjective score was 50.86 while the mean
post op score was 87.66. There was improvement in post op
IKDC score when compared with pre op score (p<0.05).One patient had superficial infection settled with intravenous antibiotics. One patient developed deep infection with gaping of the wound. The patient underwent debridement and closure with intravenous antibiotics.One patient developed fixed flexion deformity of 10 degrees with range of movements ranging from 10 to 90 degrees.
 
Conclusion
9 patients (45%) had excellent functional outcome while 8 patients
(40%) had good outcome. The remaining 3 patients (15%) had a fair
outcome according to Lysholm knee score. 10 patients(50%) returned to complete active daily activities by 7 weeks postop, 7 (35%)returned to activities 10 weeks postop while 3(15%) returned to routine activities by 11 weeks.
 

Clinical Study of Ascites with Special Reference to Serum – Ascites Albumin Gradient

Dr. Achida Nand Singh, Dr. Aquil Ahmed Mumtaz

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 584-589

Background: The Serum – Ascites Albumin Gradient (SAAG) defined as serum albumin concentration minus ascitic fluid albumin concentration. SAAG has been proposed a physiologically based alternative criterion in the classification of ascites.
Aims & Objective: The present study was designed to differentiate ascites based on serum/ascites albumin gradient and comparing transudate and exudate concept using biochemical parameters. The study also designed to know various aetiologies of ascites.
Material and Methods: This cross sectional study was done among 60 patients with ascites in Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar from June 2020 to May 2021. Ascitic fluid and blood samples were sent for various investigations depending on the presentation of the patient to hospital.
Results: In our study Cirrhosis of liver was the most common cause of ascites (78%) followed by Tubercular peritonitis (8%) and alcohol was the commonest cause for cirrhosis of liver (85%) followed by Hepatitis B virus infection. Cirrhosis of liver showed high SAAG compared with tubercular peritonitis and malignant ascites which showed low SAAG. Among High SAAG patients 96% had portal hypertension. Transudative ascites observed in 72.5% of cirrhosis patients whereas tubercular peritonitis showed exudative type in60% of cases.
Conclusion: Cirrhosis liver was the most common cause of Ascites and alcohol was the commonest cause for cirrhosis. SAAG is superior to transudate exudate concept in differentiating the causes of ascites. High SAAG indicates presence of portal hypertension and low SAAG indicates absence of portal hypertension.

Peripartum hysterectomy in a rural tertiary care hospital, Mahabub nagar, Telangana, India over 5 years period epidemiology and outcome

Dr. Laxmipadma priya, Dr. K Jeevan, Dr. Aparna, Dr. Radhika Ganesh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 590-597

Introduction: Emergency Peripartum Hysterectomy (EPH), although relatively infrequent in present day obstetrics, is a life-saving procedure in the event of a massive postpartum hemorrhage.
Aim: To assess incidence, risk factors, indications and complications of peripartum hysterectomies at a tertiary care teaching hospital in India.
Materials and Methods: A retrospective study was conducted at a tertiary care medical teaching hospital in Telangana. All emergency peripartum hysterectomies performed between May, 2017 and May 2022 at a tertiary care teaching hospital, were included in the study. Demographic characteristics, risk factors, antepartum, intrapartum and post-partum events, need for blood transfusion, length of stay in intensive care unit and postoperative complications were noted. Data was entered in Microsoft Excel spreadsheet and analysed using SPSS software version 24. For categorical variables, data was compiled as frequency and percent. For continuous variables, data was calculated as mean ± SD.
Results: Among 42703 deliveries conducted in the study period, 19306 were cesarean sections. 39 emergency peripartum hysterectomies were undertaken, the incidence being 0.09%. Women were aged 20 to 40 years (25 ± 2.83years). Majority (92.31%) were multiparous women. Placental & Atonic PPH (Placenta previa, Placenta accreta, adherent placenta) were the most common (66.60%) indication for hysterectomy. About 48.70% of hysterectomies performed were subtotal hysterectomies. More than half of them had a previous caesarean section. Two patients had bilateral internal iliac artery ligation for ongoing hemorrhage. All patients required intensive care and blood transfusion. Four patients did not survive even after hysterectomy.
Conclusion: Placental causes and Atonic PPH were the most common reason for performing an emergency peripartum hysterectomy. Women with previous caesarean section are at increased risk, both due to atonic and traumatic postpartum hemorrhage. Regular departmental audits are needed to formulate appropriate protocols to decrease mortality and near-miss events like EPH. Stringent protocols should be instituted for managing obstetric hemorrhage. Although EPH is lifesaving, early intervention by a senior obstetrician well versed with conservative procedures may avoid morbidity associated with EPH

A Review of correlation between Deviated Nasal Septum and Chronic Rhino Sinusitis as its Complication

Dr. Nandini S, Venkatarathnam Ch, K. Priyanka

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 598-610

Purpose: To study the clinical profile of Chronic Rhino sinusi tis S and Deviated nasal
septum; to study the association between deviated nasal septum and chronic Rhino sinusitis.
Patients and methods: 100 patients with CRS aged between 12 and 65 years; the mean age
among the males was 34.65±4.80 years and 30.25± 5.20 years among the females. The males
were 62% and females were 38%. The male to female ratio was 1.63:1. Diagnosis was
confirmed by radiological investigations of paranasal sinuses (PNS); digital X-ray or CT
PNS and diagnostic nasal endoscopy. Inclusion Criteria and exclusion criteria were fixed to
identify the subjects. To evaluate the degree of nasal obstruction, nasal obstruction symptom
evaluation scale (NOSE) was used.

A Study on role of Transvaginal Ultrasonography in Antenatal women with risk for Preterm labor in tertiary care hospital

Dr. S Sandya ,Dr. B Neelima ,Dr. I Indira

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 612-626

Background: Preterm birth is the leading cause of perinatal morbidity and mortality
worldwide.
The objectives of the present study were:1) the role of transvaginal
ultrasonographyassessment of cervical length measurement, internal os diameter, funneling
of internal os in predicting preterm labor among antenatal women with risk of preterm
labor.2) neonatal outcome of the study population
Methods:A hospital based prospective study was carried out on 100 antenatal women
attending antenatal OP and emergency room at risk of preterm labor over a period of 1 year
from 2018-2019 and subjecting them to transvaginal ultrasound in assessing cervical length
and cervical dilatation. The cases were then followed till delivery.
Results: Prediction of preterm labor with cervical length less than 25mm by transvaginal
ultrasound was taken as a measure of diagnostic efficacy .Cervical length less than 25 mm
had a sensitivity of 48.08% (34.01%- 62.37%), specificity of 91.67% (80.02% -97.68%),
positive predictive value of 86.21% (70.11% - 94.3%) and negative predictive value of
61.97% (55.31% - 68.21%) in predicting preterm labor.
Conclusion:Transvaginal ultrasound is an efficient and reliable diagnostic tool to predict
antenatal women with risk of preterm labor

HEMOLYSIS AND HIGH GLUCOSE CONCENTRATION HAVE AN EFFECT ON ROUTINE CHEMISTRY ANALYTES AND THYROID ASSAY

Dr Ilaka Vasundhara Devi ,Dr.K.Venkateswarlu, Dr.R.S.Swaroopa Rani, Dr.Srirekha.P

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 637-644

Hemolytic specimens are common in laboratory practise, accounting for approximately 3% of
all samples referred to a clinical lab .It can have an impact on the results of analytes like
AST, LDH, potassium, and sodium. High glucose levels have been shown to interfere with
Jaffe creatinine assays in peritoneal dialysate, as well as creatinine, calcium, albumin,
chloride, and FT4 levels in serum . Diabetes, a rapidly growing chronic disease characterised
by hyperglycemia, has a 9.8percent prevalence in our state. As a result, the likelihood of
glucose acting as an interference factor is relatively high..

COMPARISON BETWEEN TRAGAL CARTILAGE AND TEMPORALIS FASCIA IN TYPE 1 TYMPANOPLASTY: A PROSPECTIVE COMPARATIVE STUDY

CR Vijay Bharath Reddy, Saai Ram Thejas

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 645-656

Chronic otitis media is a mucoperiosteal chronic inflammation in the middle ear
cleft which is associated with perforation of the tympanic membrane, ear
discharge and hearing impairment. The main goal of tympanoplasty is the
reconstruction of the tympanic membrane and closure of a perforation that has
been impaired by chronic ear diseases with or without trying to improve the
hearing mechanism.

To assess the severity of COVID-19 in relation toclinical value of immune inflammatory markers: An observational study

Dr. Preety Motiyani, Dr. RS Meena, Dr. Dileep Dandotiya, Dr. Mamta Meena, Dr. Jitendra Rai

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 657-662

Background: Since December 2019, an novel type of pneumonia emergedin
Wuhan,China,and rapidly transmitted to wholeglobe. This pneumonia was verified to
be caused by a different strain coronavirus and named as coronavirus disease
2019(COVID-19) bythe World Health Organization (WHO). Based on
phylogeny,taxonomy and established practice, this novel coronavirus was designated
as severe acute respiratory syndrome coronavirus2 (SARS-COV2).
Objectives: To show the co-relation between inflammatory markers and the severity of
COVID-19 disease

“A Prospective Study of Surgical Management of Distal Tibia Fracture with Anterolateral Locking Compression Plate”

Dr Mohammad Rashid Naseer, Dr Devashish Mendiratta Dr Shakeeb Mohammed Shariff

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 663-676

Distal tibia fractures remain one of the most substantial therapeuticchallenges that confront
the orthopaedic surgeon. Numerous features are responsible for this, but perhaps none are as
difficult as the accompanying soft tissue injury that is frequently present.
Despite the advances in the identification, understanding, and treatment of the concomitant
soft tissue injury, the liberal use of computed tomographic (CT) scanning, advances in
implant design including locking plate technology, and minimally invasive application
techniques, satisfactory outcomes for the management of these challenging fractures remains
elusive.

A Clinical study and assessment of risk factors for morbidity and mortality in covid 19 patients in a tertiary care ICU

AariyaSrinivasan,JagadeesanMohanan,Mahendrakumar Kalappan, Laya Mahadevan,Prasanna Karthik Suthakaran, A S Arunkumar , Kannan Rajendran

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 677-686

BACKGROUND:
Corona Virus Disease (COVID 19) is an infectious disease caused by SARS-CoV-2. While most
people who were infected experienced mild to moderate symptoms and recovered without any
specific treatment, only some acquired serious infection that required In-Hospital admission and
intensive care unit (ICU) treatment.
OBJECTIVE:
To assess and describe the clinical characteristics and risk factors associated with morbidity and
mortality in COVID 19 Patients in a tertiary care ICU .
STUDY DESIGN: Retrospective Cross sectional study
A total of 140 COVID19 infected patients with definite outcomes in the period between March-
May 2021 were identified and their medical records were obtained from Department of Medical
Records,Saveetha Medical College and Hospital. Univariate and Multiple Logistic regression
techniques were used to identify the association between potential risk factors, morbidity and
mortality.

DENGUE AND CHIKUNGUNYA OUTBREAKS IN TERTIARY CARE HOSPITALS A RETROSPECTIVE STUDY

G Ratna Prabha, S Rajeshwar Rao

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 687-695

Dengue and chikungunya are two arboviral infections that are common in tropical countries and are spread by aedes mosquitoes. A retrospective study was conducted from June 21 to June 22 to determine the prevalence of these diseases at Gandhi Hospital Secunderabad, Telangana. NIV's IgM antibody capture ELISA kits were used to test for chikungunya.SDdiagnostics performed dengue NS1 antigen testing using ELISA. There were 2981 samples for dengue NS1 antigen, of which 114 (3.8 percent) were positive, and 4822 samples for IgM, of which 618 (12.8 percent) were positive.The number of chikungunya samples received was 4711, with 376 (7.9%) being positive. The age group most commonly affected by dengue was 40–60 years old (37.7 percent) and for chikungunya, 21–40 years (58.7 percent). In terms of gender distribution, males accounted for 58.7 percent of dengue infections and females for 55.7 percent of chikungunya infections, respectively. Dengue infectivity increased the most in September (17.4%) and October (17.11%), while chikungunya infectivity increased the most in September (9.5%) and November (10%). But early detection and treatment, as well as controlling vectors toprevent  the spread of disease, would be good for the community and society as a whole.

SPECTRUM OF LYMPHNODE LESIONS ON CYTOLOGY :A RETROSPECTIVE STUDY

Srilakshmi Gollapalli,M.P Akarsh,Nadhiya .U ,Naval Kishore Bajaj

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 696-713

Objective
Fine Needle Aspiration Cytology (FNAC) is first line of investigation in diagnosing a variety of superficial and deep lesions. It is a easy, quick, cost effective,well tolerated  and reliable technique done  as a  outpatient department  procedure. Lymphadenopathy is clinically important in a myriad of conditions ranging from simple reactive lymphadenitis to neoplastic etiology. In this study, we explain the  utility of FNAC in  lymph node lesions ranging from infectious etiology to malignant lesions and we highlight Tuberculous Lymphadenitis.
Methods: This was a retrospective study and includes a total of  256patients of  all age groups and both sexes presenting with palpable lymphnodes at FNAC clinic of our institute over a period of 3 years .FNAC was conducted with 22-24 Gauge disposable needles attached to  5/10c.c syringes. Smears were fixed in 95% ethyl alcohol and stained with Hematoxylin and Eosin stain. Leishman stain was done on air dried smears. Ziehl- Neelsen (ZN) staining was done wherever required.
Results: Out of a total of 256 patients with   lymphadenopathy subjected to FNAC the commonest site was cervical lymphnodes(57.03%) .Females(54.68%)
 outnumbered males(45.31%) in our study .The commonest lesion  was found to be Granulomatous lymphadenitis(51.95%,followed by reactive
lymphadenitis(23.82%),non suppurative lymphadenitis(10.1%),acute suppurative lymphadenitis(6.25%),Metastatic deposit(5.07%),chronic suppurative lymphadenitis(1.95%) and HodgkinsLympoma(0.78%).
Conclusion: FNAC is a easy to perform,reliable in expensive method in diagnosing lymphadenopathy.In our study the predominant cause of lymphadenopathy was Tuberculous lymphadenitis,followed by reactive lymphadenitis.

THE RELATIONSHIP BETWEEN A LOW CALCIUM DIET AND THE INCIDENCE OF HYPERTENSION IN PREGNANT MOTHERS

Dinar Aulia, Hendarto Natadidjaja, Zakaria

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 714-720

Background: According to the Indonesian Demographic and Health Survey (IDHS) in 2012 found that the main cause of maternal mortality in Jakarta is Hypertension (39%). Hypertension in pregnancy is caused by many factors, one of which is a low calcium diet. In the third semester of labor the need for calcium increases as the fetus begins to form and refine its bones, therefore the calcium level in the mother will reduce. This study was conducted to assess the association between a low calcium diet with hypertension in pregnant women. Method: This study used a cross-sectional design involving 161 pregnant women in the third trimester in Jakarta. Daily calcium data from the third-trimester mothers are taken by using the Food Frequency Questionnaire and interview, henceforth the blood pressure data is measured using a tensimeter. Data analysis using SPSS V.2.0 and the significance level used is 0.05. Result: Analysing using the Chi-square test, there was a significant relationship between a low calcium diet with hypertension in the pregnant woman. (P=0.000). Conclusion: This study shows a correlation between a low calcium diet with hypertension in pregnant women.

A CLINICAL STUDY OF SENSORINEURAL HEARING LOSS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Dr Pravin Tez. S, Dr JainaDivya, Dr Bomma Vijay Kumar, Dr M V Subba Rao Dr Rama Teja P

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 721-732

Background:The relationship between sensorineural hearing loss (SNHL) and Diabetes mellitus has been known age ago. The pathophysiology of diabetes related hearing loss is speculative. Hearing loss is usually, bilateral, gradual onset, affecting higher frequencies.
Aim: To find the prevalence of Sensorineural Hearing Loss in Type 2 Diabetes Mellitus patients.
Materials and methods:This is a cross-sectional study, which included 140 diabetics of age group 30 to 50 as cases. All the subjects were subjected to the estimation of FBS, PPBS, HbA1c and pure tone audiometry. Various biochemical and audiological investigations have revealed that there is a strong association with sensorineural hearing loss and Diabetes Mellitus.
Results:The prevalence of sensorineural hearing loss in type II diabetics has been proved to be 66.43%. In the majority of the patients the hearing loss was bilateral progressive and symmetrical affecting higher frequencies of 4 KHz to 8KHz. It was seen that 93 diabetics had sensorineural hearing loss out of which 2 of them had sudden onset hearing loss. Rest of them had progressive hearing loss. The occurrence of hearing loss was matched for age, sex, duration of diabetes, and control of diabetes. It had positive correlation with increased age of the patient and duration of diabetes. There was no significant difference in hearing loss among the two sex groups.
Conclusion:The control of diabetes was measured with glycated hemoglobin which had a correlation with hearing deficit. Patients with poor control (HbA1c greater than 8%) of their glycemic status have increased auditory thresholds.

ASSESSMENT OF QUALITY OF LIFE AMONG PATIENTS UNDERGOING DECOMPRESSIVE CRANIECTOMY IN A TERTIARY CARE HOSPITAL OF EASTERN INDIA

Dr. Shivam Gour, Dr Partha Ranjan Biswas, Dr. Shubhamitra Chaudhuri, Dr Subhasis Ghosh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 733-740

Introduction: Traumatic Brain injury is defined as an acute injury to the head caused by blunt or penetrating trauma or from acceleration/deceleration forces excluding degenerative, congenital problems. Decompressive craniectomy is being used as an effective measure in the management of TBI with prognosis being measured in terms of Glassgow outcome scale. However, the quality of life of such patients is often not assessed. Quality of life is a long term outcome phenomenon which must be effectively evaluated.
Objectives: To assess the quality of life of the patients undergoing decompressive craniectomy using EQ5D scoring scale.
Materials and Methods: This was an observational study conducted for 1.5 years in a Trauma care centre of Eastern India. The study included 100 study subjects. Informed consent was obtained from every participant and approval to conduct the study was obtained from Institutional ethics Committee.All post trauma patients who survived after decompressive craniectomy were followed up at 6 months post discharge to assess their quality of life using a pre-designed and pre-tested proforma containing information on the clinical profile. Quality of life was analyzed using the EQ5D scoring system at six months of discharge.
Results: The mean  SD age of the study subject was calculated to be 51.5  23.3 years. The commonest mode of injury was road traffic accident seen in 62% study participants. Almost 3/4th of the study subjects underwent surgery for non-diffuse traumatic brain injury within the first 24 hours of hospital admission. Among the 72 study participants that survived, EQ5D Index score to assess the quality of life was found good/ favorable in 86.1% patients and only 13.9% subjects had a poor/ unfavorable EQ5D Index score.
Conclusion: Majority of survivors after decompressive craniectomy showed a good functional outcome as analyzed by EQ5D. Improving patient selection and optimizing timing of the procedure may lead to favorable long term functional outcome in these very severely brain injured patients.

A PROSPECTIVE RANDOMISED COMPARATIVE STUDY FOR COMPARISON OF TWO INSERTION TECHNIQUES OF PROSEAL LARYNGEAL MASK AIRWAY IN PATIENTS POSTED FOR SHORT GYNAECOLOGICAL PROCEDURES.

Dr.PKowsalya,Dr. Kajal Dalal, Dr. PriteeBhirud

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 741-754

Background: This study compared two insertion techniques of Proseal LMA.
Method: After institutional ethics committee approval and patients consent, 100 women aged 18-60 years of ASA 1 & 2 were included in the study. We have excluded patients with known or predicted difficult airway, recent sore throat, mouth opening less than 2.5cm and with risk of aspiration (nonfasted or gastroesophageal reflux). Patients were divided into 2 groups of 50 each.
In Group A-Digital Technique for PLMA Insertion & in Group B- Rotational Technique for PLMA Insertion was used. Using chi-square test and student t-test statistical results were obtained.
Results: The insertion success rate at the first attempt was higher for the rotational technique than the standard technique. Insertion technique made no difference in insertion time. Blood on PLMA after removal less in the rotation technique. Sore throat at 1 hr and 24 hrs post-surgery less in the in the rotation technique than the standard technique.
Conclusion: We conclude that insertion of the PLMA is more successful with the rotation technique in comparison with standard technique of insertion.

STUDY OF CLINICAL OUTCOME IN ADULT PATIENTS WITH SEROLOGICALLY PROVEN DENGUE SYNDROME AT A TERTIARY HOSPITAL.

Panuganti Raveen, Panuganti Ratnachary, K. Sudharani

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 755-762

Background: Dengue fever is an acute febrile illness (AFI) caused by one or more dengue viruses belonging to genus Flavivirus and transmitted by Aedes aegypti mosquito. The exact clinical and laboratory profile is crucial for early diagnosis and management of patients. Present study was aimed to study clinical outcome in adult patients with serologically proven dengue syndrome at a tertiary hospital.
Material and Methods: Present study was hospital based, observational study, conducted in patients of age > 18 years, of either gender, with acute febrile illness, with serologically proven dengue syndrome admitted in wards & ICUs.
Results: We studied 210 serologically proven dengue patients in present study. Majority of patients were from 31-40 years age group (29.05%), were male (60.48%), NS 1 Positive (81.90%). In present study, non-severe dengue (83.81%) cases were more as compared to severe Dengue fever(DHF) (16.19%). Laboratory findings such as hematocrit < 36%, leukopenia, thrombocytopenia, reactive lymphocytes, prolonged PT, prolonged APPT, SGOT>40 IU/L & SGPT >40 IU/L were common in severe dengue group as compared to non-severe dengue group & difference was statistically significant (p

Cytomorphological Spectrum of Body Fluids Emphasizing Cytomorphological Features of Malignant Effusions

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 3698-3707

Background: Assessment of body fluids for cytomorphological details plays a vital role in diagnosis, prognosis and therapeutic aspects of various neoplastic & non neoplastic conditions. Aims & objectives : To study Cytomorphological  features of body cavity effusions emphasizing  malignant cell cytology.
Settings and Design : a retrospective observational study of 149 fluid samples was carried out following ethical approval by instituitional ethical committee.
Material & Methods : Retrospective analysis of 149  fluid samples received in department of pathology was done for duration of one year from January 2020 to December 2020 including pleural, peritoneal, pericardial , synovial, CSF & sputum. After a thorough physical examination, microscopic evaluation for cell cytomorphology was done. Cytocentrifuged smears were stained with leishman & H&E for each sample.
Statistical analysis- In the present descriptive study, collected data was entered in Microsoft excel & was analyzed and presented using descriptive statistics.
Results: A total of 149 fluid samples were analyzed in this study. Ascitic fluid comprised the major bulk of study with 97 cases followed by pleural fluid with 38 cases. Most of the body fluid samples belonged to females (55.03%) and the female to male ratio was 1.22. Out of these 149 cases, inflammatory were  75.83% followed by  11.40%  malignant effusions & 3.35%  were suspicious for malignancy.
Conclusion: Cytocentrifuge in fluid cytology analysis yields single concentrated cell button offering  better appreciation of cellular details thereby differentiating between benign and malignant effusions. However, In few suspicious cases Cell block with IHC may be needed for definitive diagnosis.
 

NASAL BONE FRACTURE OVERVIEW AND ITS SURGICAL OUTCOME.

Rakesh Maran, Anusha Shukla, Mritunjay Shringirishi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 763-768

Background:Nose is most prominent part of face and nasal bones are most commonly fractured during road traffic accident or accidental trauma. Many patients with nasal bone fracture do not take treatment so fracture may go undiagnosed. Nasal bone fracture leads to structural & functional abnormality of nose.
Aim & Objective:Aim of study was to evaluate operative outcome after close reduction according to type of nasal bone fracture.
Method:Study was conducted in Mahaveer Medical College, Bhopal Department of ENT. Total 157 patients were selected with fracture nasal bone, from February 2021 to 2022 (01 years), all underwent closed reduction.
Results:Post-Operative CT image showed 94 patients with excellent result, 49 with good result, 10 subject with fair result & 4 patients showed poor reduction of fracture nasal bone. 
Conclusion:Fracture nasal bone reduction immediate after CT-Scan showed better result in FI, LI, LII type than FII and C Type.
 

Estimation Of The Point Prevalence Of Adverse Drug Reactions Of Platinum Compounds In Lung Cancer Patients And To Establish Cause Effect Relationship Of Each Adverse Drug Reaction Using Appropriate Scales

Dr.Rekha Rani, Dr.Surbhi Mahajan, Dr.Urvashi Andotra, Dr.Shivani Rani

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 769-778

Background: The aim of the present study was to monitor the prevalence of Adverse Drug Reactions to commonly used platinum compounds in lung cancer patients and also  to establish cause effect relationship of each adverse drug reaction using appropriate scales. It was a prospective observational study.
Methods:A observational study conducted in the ADRM centre established in Department of Pharmacology using the suspected ADR reporting form in collaboration with Radiation Oncology Department, Government Medical College, Jammu after IEC permission.New and old diagnosed cases of lung cancer patients belonging to either gender and of all ages, who were receiving platinum under any standard regimen, were included for the study.Patients other than lung cancer receiving platinum therapy, receiving concomitant chemo- radiotherapy,any ADR due to medication error, overdosage, poisoning were excluded. The suspected ADRs were classified in term of casuality using WHO-UMC scale. The cause and effect relationship of each ADR was assessed by using Naranjos Probability scale.
Results:There were a total of 98 patients with adverse drug reactions reported from the study.The majority of patients were smokers and/or alcoholics and  in the age group of 61-80.The largest number of reports was associated with cisplatin 48 (48.97%) followed by carboplatin 38 (38.77 %) and oxaliplatin 12 (12.24%) . Most frequently reported ADR was vomitingfollowed by anemia  .The frequency of deranged LFT’s was 4 (3.50%) and elevation in creatinine was 4 (3.50%). It was observed that gastrointestinal system accounted for 51 (44.73%) ADR cases, followed by hematological system 28 (24.56%) and dermatological system 12 (10.52%). Validation of the causality assessment severity was done by Naranjo’s scale which classified 65 (66.32%) to be probable and remaining 33 (33.67%) to be possible.Regarding management of ADRs I,ntervention was done in 48(48.97%) of the patients. The current study depicted 47(47.95%) ADR cases as fully recovered, 22(22.44%) cases as recovering.
Conclusion: Platinum compounds have a high potential to cause various adverse effects in lung cancer patients. As most of the ADRs were preventable, hence warranting urgent attention and remedial intervention.      

A Prospective Study of Surgical Management of Supracondylar Fracture of Humerus in Children Using K Wire Fixation

Dr. Mahantesh Y Patil, Dr. Roopa M Patil

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 779-788

Background and Objectives: Supracondylar fractures of the humerus the most common type of elbow fracture in children. Severely displaced supracondylar fractures of the distal humerus in children are a challenging problem. Many treatment methods have been described for the treatment of displaced supracondylar fracture of the humerus, however it has not been reached a consensus for the choice of treatment. The purpose of this study is to clinically asses the outcome of surgically managed supracondylar fracture of humerus using K wire fixation.
Materials and Method: 30 Children of supracondylar fracture of humerus treated in the Dept. of Orthopaedics, GIMS, Gadag between June 2021 to Feb 2022. Out of a total of 30 cases 24 were treated with closed reduction and internal fixation by k wire and 6 were treated with open reduction and internal fixation with k wire. The average age was 7.1 years. We evaluated the results using FLYNN’S criteria.
Result: According to the results of the study, we obtained 21 excellent, 4 good, 4 fair and 1 poor results.
Conclusion: The data in the current study shows that surgically managed displaced supracondylar fracture of humerus in children using K wire fixation gives excellent outcomes both radiologically and functionally thus can be deemed as treatment of choice for the same.

Histological Observation of Uterine Tubes in Premenopausal and Postmenopausal Women

Dr. Nitisha, Dr. M. P. Sudhanshu, Dr. K. Alam

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 789-796

Background: The uterine tubes, also called as oviducts or fallopian tubes, lie in the mesosalpinx in the upper free edges of the broad ligaments of uterus. These paired structures measure 8-14 cm in length and approximately 1-5 mm in diameter, which is variable along the length of the tube. 
Material and methods: Samples of uterine tubes were collected from 50 Patients. 27 samples were collected from patients belonging to pre-menopausal age group and 23 samples were collected from the women of post-menopausal age group. Samples of uterine tubes for study were collected from premenopausal and postmenopausal women attending the department of obstetrics and gynaecology, PMCH, Patna during the period extending from the year 2015 to 2017.
Conclusion: The lumen of the tube gradually widened towards the fimbriated end and the wall of the tube thickened progressively towards the uterus. The blood vessels in the muscularis were present in all the four parts of the tube. These were found abundantly in the isthmic and the intramural regions. These were moderately found in the region of the ampulla but in the infundibular region they were comparatively bigger taking into consideration the thin wall of the muscularis.

Comparison of Combined Suprascapular and Axillary Nerve Block versus Interscalene Brachial Plexus Block in Shoulder Surgery for Postoperative Analgesia

Dr Anandkumar V Darji, Dr Dharmesh Gohil, Dr Amee Chauhan

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 797-805

Introduction: Postoperative pain is severe in Shoulder surgeries. Interscalene brachial plexus block provides effective analgesia but it is associated with many adverse effects. To avoid these, we have compared Combined suprascapular and axillary nerve block versus interscalene brachial plexus block in this study.
Aims & Objective: The primary aim of the study was to compare combined suprascapular and axillary nerve block versus interscalene brachial plexus block for postoperative analgesia in shoulder surgery.
Material & Methods:  Total 60 patients of ASA grade I, II &III undergoing shoulder surgery were enrolled in this study. They were randomly divided in to two groups of 30 each using envelope method. Group S received Combined Suprascapular and Axillary nerve block. Group I received Interscalene brachial plexus block. All patients were given General Anaesthesia. Assessment of sensory block, VAS score, duration of analgesia, number of rescue analgesics needed in postoperative period within 24 hours were noted and analyzed using X2 test.
Results: Duration of effective analgesia in group S (545±30.93) was higher compared to group I (459.33±20.16).Total number of Rescue analgesics required in postoperative period was more in Group I (3.366±0.76) as compared to Group S (2.06±0.25).
Conclusion: Combined Suprascapular and Axillary Nerve block provided prolonged duration of postoperative analgesia as compared to Interscalene Brachial Plexus Block following shoulder surgery.

Chronic Rhinosinusitis and Coronary Heart Disease: A Hospital based Study

Dr. Hemant J Shah, Dr. Amit A Akhani, Dr. Hasmukh Khodidas Panchal, Dr. Pushti Vachhani

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 806-811

Background: Chronic inflammation is associated with accelerated atherosclerosis, endothelial dysfunction (ED), and cardiovascular diseases. Because chronic rhinosinusitis (CRS) is an inflammatory disease, it may be associated with the development of ED and accelerated atherosclerosis.
Objective: To investigate the relationship between CRS and carotid intima-media thickness (CIMT), flow-mediated dilation (FMD) of the brachial artery, and microalbuminuria.
Materials and Methods: This cross-sectional study included 38 patients with CRS and 29 healthy controls. In addition to measuring spot urine albumin-creatinine ratios, FMD of the brachial artery and CIMT were assessed noninvasively.
Results: Patients with CRS had lower FMD scores (p = 0.031), higher CIMT scores (p = 0.005), and a higher urinary albumin-creatinine ratio (p = 0.036) compared with healthy controls. In a multivariate analysis, CIMT and FMD were independently associated with the presence of CRS. However, the relationship between urinary albumin and creatinine, and the presence of CRS was no longer observed.
Conclusions: CRS is associated with ED and atherosclerosis, as indicated by decreased FMD and increased CIMT in patients with CRS. Further studies are necessary to identify the exact pathophysiologic mechanisms responsible for our findings.

To Study ECG and Biochemical Markers of Chemical Myocarditis and its Correlation with Echocardiography Findings

Dr Dharmendra Katariya, Dr. Mukesh Singh Tomar, Dr. Kailash Charel

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 812-818

Background: Myocarditis is an inflammatory condition involving the myocardium (heart muscle). Myocarditis is characterized by variety of symptoms ranging from fatigue, difficult breathing and rapid heart rate to sudden death from fatal arrhythmias. Many poisons are potent cardiotoxin and their ingestion leads to myocardial damage. Due to myocardial damage there are release of cardiac specific markers like trop T, Trop I and CPKMB. Myocardial injury is due to chemical myocarditis. Hence the patients may have outcome due to complication of myocarditis in the form of pump failure, rhythm disturbance etc. In the present study myocardial damage was assessed by electrocardiographic changes and CPKMB values. ECG changes along with raised CPKMB levels after ingestion of poison were noticed.
Objectives: We sought (1) To study the role of biochemical markers (particularly CPK-MB) of myocarditis in poisoning cases admitted in the poison ward of a tertiary hospital. (2) To study the ECG manifestation of patients presenting with various poisons causing myocarditis. (3) To study the Echocardiography findings in poisons causing myocarditis.
Material and Methods: This prospective study was carried out on total 104 cases with complain of  ingestion of poison known to cause myocarditis, admitted in Poison Ward, of a tertiary hospital.  ECG, Biochemical (CPK-MB) and Echocardiographic findings of these patients were studied.  All the patients who developed chemical myocarditis (on the basis of clinical suspicion) underwent battery of tests ECG, CPK-MB in addition to routine investigations and the patients with abnormal ECG findings and or elevated CPK-MB levels were further investigated with Echocardiography during the period of hospitalization.
Results: Majority of patients 79(75.9%) of poisoning causing chemical myocarditis were in between age group of 15-34 yrs. CPKMB was elevated in 99(95.1%) patients out of 104 patients of chemical myocarditis and 78(75%) patients showed abnormal ECG findings, in which majority of patients were of  Hair Dye 25(78.1%), Organophosphorus 26(78.7%), Aluminum Phosphide 18(72%) and Rat killer poisoning 7(77.7%); remaining 26 patients showed normal ECG findings. The most common abnormal Echocardiographic finding was Pericardial effusion 10(9.6%) followed by Valvular pathology 6(5.7%), Hypokinesia of the left ventricular wall 3(2.8%), left ventricular systolic dysfunction 1(0.96%) and prolapse of anterior mitral leaflet 2(1.92%).
Conclusion: Abnormal ECG findings and elevated CPK-MB level are correlating well with severity of cardiotoxicity of the poisons in the present study. Echocardiographic findings are not correlating with the severity of cardiotoxicity due to lack of serial monitoring by echocardiography. Major role of Echocardiography comes into play in hemodynamically unstable patients so that their treatment can be monitored.

A Study of Color Doppler Ultrasonography in Evaluation of Portal Hypertension

Dr. Srikanth Sagi, Dr. P. Keerthi Bharathi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 819-826

Background: The leading causes of chronic liver disease, which is still on the rise, include chronic alcohol use, obesity, hepatitis C, and hepatitis B. In cases of cirrhosis, portal hypertension and its effects are a significant source of morbidity and mortality.Ultrasound methods like duplex ultrasonography or spectral imaging the preferred modalities include Doppler imaging, color Doppler imaging, and power Doppler imaging. The present study aimed to identify findings in patients with portal hypertension.
Methods: All cases with clinical suspicion of portal hypertension and all the cases with altered biochemical parameters suggestive of cirrhosis with portal hypertension were included in the study. All patients had abdominal ultrasonography using a curvilinear 2–5Mhz probe in conjunction with color Doppler technology. While the USG is being done, the patient will be advised to lie comfortably supine. Doppler Hepatic vein waveforms will be captured in suspended expiration for at least five seconds (end-expiratory). In longitudinal scanning planes, the maximum and minimum velocities of descending hepatic vein flow will be determined, and the damping index will be computed.
Results:  out of n=35 cases included in the study, n=30 cases had a portal vein diameter of < 20mm and >20mm in n=2 cases. Similarly, portal lumen size was normal in n=28 cases and flow status in the maximum number of cases was hepatopetal and No flow was detected in n=8 cases. The damping index of the hepatic vein in a majority of patients (85.71%) presented with <0.6 and (14.28%) had >0.6 damping index hepatic vein.
Conclusion: Portal hypertension and its complications account for significant morbidity and mortality. Ultrasonography with added color Doppler helps in evaluating portal hypertension and differentiation of sinusoidal, pre or post-sinusoidal causes of portal hypertension. The Colour Doppler also offers accurate information in locating and defining the portal vein in patients with portal hypertension and aids in determining the presence of various portosystemic collaterals.

Assessment of Six Minute Walk Test following Six Weeks Structured Pulmonary Rehabilitation Exercise in Patients with Post Tuberculosis Lung Sequelae

Dr. Jyothi, Dr. Sindhuja A, Dr. Vadlamudi J B Sireesha

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 827-833

Background: Post tuberculosis sequelae causes significant impairment in the quality of life. Pulmonary Rehabilitation ( PR) improves physical conditioning of the body in patients with respiratory diseases.
Aims and objectives: To assess the baseline pulmonary exercise capacity using Six Minute Walk Test (6MWT ) in post Tuberculosis (TB) lung disease patients and to re-assess pulmonary exercise capacity following administration of pulmonary rehabilitation exercise in post TB lung disease patients using 6MWT.
Materials and Methods: 42 out of 45 patients with post tuberculosis sequelae were assessed by 6MWT, spirometry, modified Borg Scale Index. They were subjected to six weeks of pulmonary rehabilitation with walking and balloon blowing and were re-assessed later.
Results: The distance walked in Visit 1 and Visit 2 (after six weeks Pulmonary Rehabilitation) was 489.91±86.79 and 527.425±78.03 respectively which is statistically significant (p 0.000).
The Modified Borg scale index of the subjects in Visit 1 and Visit 2(after six weeks Pulmonary
Rehabilitation)  was 1.54±1.08 and 1.36±0.98 respectively which was statistically significant (p 0.002).
Conclusion: The results revealed a significant improvement in exercise capacity in terms of distance walked in 6-MWT and improvement in Modified Borg Dyspnea Scale after 6 weeks of PR. Henceforth the authors of this study recommend 30 minutes of brisk walking for 5 days a week and balloon blowing exercises as a part of Pulmonary Rehabilitation exercise protocol in post TB patients which can be practiced even in Rural areas.

A Randomized Comparative Study of Vacuum Assisted Dressing V/S Conventional Dressing in Management of Chronic Wounds In Diabetic Patients

Hussain Kolsawala, Vikram Gohil, Aliya Saiyed, Ankur Dhameliya

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 834-842

Vacuum Assisted Closure therapy has been shown to be beneficial in a variety of wounds. However, evidence of its benefit in chronic wound in diabetic patients, especially in Indian population is sparse. [1] This Prospective comparative study was carried out between July 2019 to September 2020. The study enrolled 50 patients of chronic wound having diabetes, 25 Patients underwent Vacuum Assisted Dressing in group A while remaining 25 patients underwent Conventional Dressing in group B. Healing duration, Debridement session, Definitive treatment and Total Duration of Hospital stay were compared between group A and group B to conclude which type of dressing method is superior and in the best interest of patients and surgeon. Mean hospital stay was 18.12 days in group A and 36.32 days in group B. Mean debridement session 0.2 in group A and 3.16 in group B. In group A, 22 patients had skin grafting and 3 patients had secondary closure; in group B, 19 patients had skin grafting, 2 patients had secondary closure & 4 patients had amputation, which clearly signifies that Vacuum Assisted Dressing has better outcome as compared to Conventional Dressing. We conclude that, Vacuum Assisted Dressing helps in  reducing rate of wound infection, formation of even uniform granulation tissue, requiring less debridement session and less burden of anesthesia associated with other surgical interventions, resulting in early definitive treatment, decreased hospital stay and less consumption of hospital resources.

A Study on Ocular Morbidity among School-Going Children (6– 12 Years) – A Cross-Sectional Study

Dr. Seema Kumari, Dr. Bipin Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 843-848

Background: Children do not complain of defective vision, they usually adjust to the poor eyesight by various means. This requires early detection and treatment to prevent permanent disability. The school age is a formative period, physically and mentally, transforming the child into a promising adult. Poor vision in childhood affects performance in school and negatively influences the child’s future life.
Aim: This study aimed to assess the prevalence and associated factors related to ocular morbidity among school-going children (age 6–12 years).
Materials and Methods: This cross-sectional study was carried out from June 2021 to May 2022 in almost Ten primary schools in Jamshedpur, district from the first to fifth standard (6–12 years).
Results: Out of 500 participants based on the age group, the participants were highest in 10–12 years of age group, 22%. The remaining distribution was 20.8% in 7 years of age, 20.4% in 9 years of age, 19.8% in 8 years of age, and 17% in 6 years of age. The participants were highest in the female, which was 54.8% and 45.2% in males. The blurring of vision was the most common complaint reported by 40.2% of the study participants. The prevalence of total ocular morbidity among our study participants was 15.4%.
Conclusion: This study proves that the risk factors associated with refractive error can be avoided, and creating awareness among children, parents, and teachers play an essential role in preventing visual impairment.

Study of Risk Factors, Clinical, Radiological Profile in Posterior Circulation Stroke

Dr. Sneh Kumar Jha, Dr. Rajesh Kumar Jha

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 849-855

Background: Stroke can be due to ischemia or hemorrhage. 80% of strokes are due to an ischemic event. Out of these, 20% are posterior circulation stroke. Posterior circulation is more prone to atherosclerosis like systemic arteries compared to the intracranial part of anterior circulation.
Material & Methods: This study was carried out in patients who presented with signs and symptoms of PC stroke to the medicine and neurology department of Darbhanga Medical College and Hospital, Laheriasarai, Bihar. The study was conducted during the time period of January 2021 to October 2021. The stroke events were classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification.
Results: Males were commonly affected than female. The most common age group was between 40-60 years. The most common risk factor for PC stroke in our population was hypertension, followed by smoking and diabetes. The most common clinical presentation was vertigo, followed by ataxia and motor weakness. Distal territory involvement was most common in our study, followed by proximal and middle vascular territories. In posterior circulation, stroke ischemic was more common than hemorrhagic. The common isolated site of involvement in posterior circulation ischemic stroke was the cerebellum followed by the occipital lobe, and the most common site of bleed in PC stroke was the cerebellum. Studyfound a higher percentage of large artery disease, followed by cardio embolism as a cause of posterior circulation stroke.
Conclusion: Our study demonstrated the occurrence of posterior circulation stroke in a relatively younger age group compared to case series from the Western world. We found a higher percentage of large artery disease as a cause of posterior circulation stroke with distal territory involvement.

Observation on Modified Radical Mastectomy with Adjuvant Chemotheraphy and Hormonal Therapy in the Management of Breast Cancer

Dr. Rakesh Kumar Thakur, Dr. Vijay Shankar Prasad

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 864-874

Breast cancer is the most common cause of cancer and cancer death worldwide. Although most patients present with localized breast cancer and may be rendered disease-free with local therapy, distant recurrence is common and is the primary cause of death from the disease. Adjuvant systemic therapies are effective in reducing the risk of distant and local recurrence, including endocrine therapy, anti-HER2 therapy, and chemotherapy, even in patients at low risk of recurrence. The widespread use of adjuvant systemic therapy has contributed to reduced breast cancer mortality rates. Adjuvant cytotoxic chemotherapy regimens have evolved from single alkylating agents to polychemotherapy regimens incorporating anthracyclines and/or taxanes. This review summarizes key milestones in the evolution of adjuvant systemic therapy in general, and adjuvant chemotherapy in particular. Although adjuvant treatments are routinely guided by predictive factors for endocrine therapy (hormone receptor expression) and anti-HER2 therapy (HER2 overexpression), predicting benefit from chemotherapy has been more challenging. Randomized studies are now in progress utilizing multiparameter gene expression assays that may more accurately select patients most likely to benefit from adjuvant chemotherapy.

Effects of different doses of dexmedetomidine on haemodynamic changes during fibre optics copy

Dr. Dinesh M, Dr. Mahalingappa, Dr. Goolappa M Chikkanargund, Dr. Deepak Dhummansure

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 875-880

Dexmedetomidine hydrochloride is indicated for sedation of initially intubated and mechanically ventilated patients during treatment in an intensive care setting. Dexmedetomidine hydrochloride should be administered by continuous infusion which should not exceed 24 hours. This is an observational prospective clinical study of haemodynamic, ease of intubation and patient comfort of awake fibreoptic intubation under dexmedetomidine sedation in patients posted for elective surgeries under general anaesthesia after obtaining the permission from the Institutional Ethical Committee. During fibreoptic scopy, mean SBP changed from 115.8 mm of hg to 115 mm of hg in group I & 119.4 mm of hg to 113.7 mm of hg in group II. During fibreoptic scopy mean DBP changed from 74.4 mm of hg to 75 mm of hg in group I & 74.5 mm of hg to 74 mm of hg in group II.

Lignocaine and fentanyl in laryngoscopy and intubation: Comparison of changes in heart rate

Dr. Dinesh M, Dr. Mahalingappa, Dr. Goolappa M Chikkanargund, Dr. Deepak Dhummansure

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 881-886

Lignocaine is useful to decrease sympathetic response to laryngoscopy and intubation when applied topically or sprayed or nebulised or gargled providing sensory blockade in the airway. Intravenous administration is advantageous. Lignocaine at 1.5 mg/kg intravenous has been recommended before laryngoscopy and intubation. Optimal time of administration is 3 min before laryngoscopy and intubation16. Therapeutic concentration is achieved earlier than topical use.A clinical comparative prospective study of attenuation of sympatheticresponse to laryngoscopy and intubation was done in 150 patientsposted for elective surgeries. General anaesthesia was provided withendotracheal intubation for all the patients.
Patients undergoing various Orthopaedic, Ear, Nose and Throat surgeries, Gynaecological,
Neurosurgical and Laparoscopic procedures were selected. Following criteria’s were adopted for selecting patients. There appeared no significant difference in heart rate at pre and post induction levels between lignocaine and fentanyl groups (p=0.42 and 0.97). The heart rate response between lignocaine and fentanyl groups was statistically highly significant at 1 and 3 minutes (p<0.001) and significant at 5 minutes (p<0.01) after the onset of laryngoscopy and intubation.

CHC CORRELATION AGAIN, - THIS TIME NON GYNAEC CYTOLOGY EXCLUSIVELY!!

Dr. Ashwini Rege-Gundawar, Dr. Sneha Joshi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 887-920

Introduction: Fine needle aspiration cytology (FNAC) is a popular preoperative tool to plan treatment preoperatively. Therefore, validation of its reliability and usefulness is critical. Cyto-histological correlation (CHC) is a recommended quality indicator (QI) for cytopathology reporting. CHC is underutilised, though it identifies individual reporting deficit.
Aim: To evaluatereliability of non-gynaecological FNAC, using one-year data, from a rural tertiary care teaching hospital and CHC as QI.
Objective: To use the one-year retrospective CHC exercise, as a clinical audit to evaluate the usefulness of institutional cytology reporting.
Materials and methods: Retrieval of non-gynaecological FNAC and surgical pathology data for the same one-year period to find matching CHC pairs.
Results: A total of 181 non-gynaecological FNACs were done in the given time period. These were from ‘Lymph node enlargements’ (57), ‘Breast’ (39), ‘Thyroid’ (24) and ‘Salivary glands’ (12). The rest “Others” (23) were mostly soft tissue. 26 Aspirates were ‘inadequate for opinion’ and excluded during analysis.
FNACs were grouped into:

Inflammatory, including granulomatous lesions.
Neoplastic-benign/malignant.
Inadequate for opinion.

Histological correlation was possible for 45 cases (29%) (45/155). Concurrence rate for CHC was 62% (28/45) with 38% (17/45) non-concurrence. The nonconcurrence was 11% (17/155) of the total FNAC workload. These were: 29% (5/17)- ‘change in categoric interpretation’, 35% (6/17)- ‘change within the same category’, 6% (1/17) due to lack of clinical information and 29% (5/17)due to preanalytical causes of error.All non-concurrences were congruent with known limitations of FNAC leading to sampling errors and hence posed methodological queries.
 
Conclusions:

The inherent limitations of the FNAC procedure may lead to non-concurrences in CHC.
When hierarchical reporting is the standard protocol in an institute, this incurs a blinding artefact to the deficits of individual reporting.
CHC exercise done at regular time intervals can serve as an internal clinical audit.

 

CLINICAL STUDY OF SYMPTOMATOLOGY, MANAGEMENT AND OUTCOME IN PATIENTS WITH SINO-NASAL MASSES

Dr. Ratna Kumara Ambati, Dr.Bomma Vijay Kumar, Dr. Haritha Surasura, Dr.PolepeddiSarvaniPratyusha, Dr.PotlacheruvuNagaraju, Dr. DharmagaddaRanganath Swamy

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 921-927

Background: Presumptive diagnosis of sinonasal masses can be achieved with the aid of clinical presentation and imaging techniques but histopathological examination remains the mainstay of final definitive diagnosis. The present study was undertaken at a tertiary level hospital to analyse clinical presentations, management and histopathological patterns of Sinonasal masses.
Material and Methods: Present study was single-center, Prospective Non-Randomised study, conducted in patients of all age groups, attending the ENT OPD with masses in sinonasal cavity, diagnosed after complete clinical examination (including endoscopic evaluation), willing to participate.
Results: 40 cases presenting with Sino Nasal cavity masses at OPD were selected as per the inclusion criteria. In our study, most of the patients were in the age group of 31-40 years, with 25% of the study population, followed by patients in the second and third decade with 20% each. There were 24 (60%) males and 16 (40%) females in the study. Overall, non-neoplastic lesions were found to be commonest in occurrence with ethmoid polyp (32.5%) having the highest incidence, followed by antrochoanal polyps (20%), Rhinosporidiosis (2.5%) and Rhinoscleroma (2.5%). Among the benign masses, inverted papilloma was most common (12.5%) followed by hemangioma (10%), ossifying fibroma and osteoma (2.5% each). Carcinoma of the maxilla presented in 3 patients (7.5%) and was the most common malignancy followed by carcinoma of the nasal cavity (5%) and malignant melanoma (2.5%). For non-neoplastic lesions (n=23), majority of the masses were excised either by open surgery or endoscopically with base cauterization (n=21). One case of rhinoscleroma involved medical management along with surgical excision. Medical management was done with antibiotic ciprofloxacin for 6 weeks. Endoscopic surgery resulted in faster recovery and cosmesis.
Conclusion: Clinical diagnosis is often difficult and have to be relied on histopathological examination of biopsy specimen and may require repeated biopsies.

A STUDY ON CORRELATION BETWEEN MORTALITY AND CO-MORBIDITIES IN PATIENTS WITH COVID 19 INFECTION

Dr. Chirayu Vijaykumar Vaidya, Dinker NGoswami, Sashikumar Mundra, Parth Rameshbhai Patel

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 928-939

Background: Coronavirus disease 2019 (COVID-19) is a new respiratory infection caused by a coronavirus known as SARS coronavirus 2. (SARS- CoV-2). The virus is a member of the coronavirus family, which are zoonotic pathogens that cause and transmit infections between humans and various animals. The World Health Organization (WHO) has designated coronavirus disease 2019 (COVID-19) a pandemic, with 20% of infected individuals requiring hospitalisation and 6% requiring critical care and invasive ventilatory support. Co-morbidities are thought to be a greater risk for reducing the survival probability of SARS-CoV-2 patients. Different types of pre- existing diseases have been identified as co-morbidities in SARS-CoV-2 infection, which increases susceptibility and poses risks of more severe outcomes and deaths in COVID-19 patients.Thisstudy is to identify different co-morbidities of the patients who died due to COVID-19 admitted in GMERS medical college and general hospital in city Gandhinagar in Gujarat state.
Methods:This is a retrospective study of patients admitted to covid hospital, GMERS medical college and hospital, Gandhinagar who had been reported positive either with RT-PCR Test or rapid antigen test and died in hospital during the period of April 2020 to April 2021.
Results: In present study, majority (62.9%) of the study participants were in the age group of 51 to 70 years. The mean age of the study participants was61.91 years.58.4% of the COVID-19 patients were males while 41.6% were females. 93.2% of the COVID-19 patients were having any comorbidity while among 6.8% of the patients were without any comorbidities withhypertension was most common(57.5%) followed by diabetes(53.4%). 44.8% of the study patientswere having only single comorbidity while 55.2% were having more than or equals to two comorbidities. The mean interval between hospital admission and death of the patients was 4.5 days.
Conclusion: It has been concluded that old age, male gender has more severe outcome in case of COVID-19. Hypertension and diabetes mellitus were also reported among more than 50% of the patients who died from COVID-19.

PREFERENCES OF INTERNET PLATFORMS AND ITS ASSOCIATEDDEMOGRAPHIC FACTORS IN INTERNET ADDICTION

Dr.Mathivanan, Dr.MalarMoses , Dr. Anupama Roshan

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 940-951

Introduction
Internet addiction has become a health concern globally. Under internet addiction, there are five different type of addictions.To understand, treat, prevent internet addiction, it is essential to know the preferences given to various internet platforms and its associated demographic factors.
Aims
To find the preference of online platforms and associated demographic factorsamong internet users.
Materials and methods
Internet addiction severity was assessed by internet addiction test questionnaire (IAT-TN). Semi stuctured questionnaire was set up to collect socio demographic details including preference of online platforms by the users.Statistical analysis was done and the preferences given to online platforms and associated factors were evaluated.
Results
In this study, 1367 people participated. Women watched mostly   facebook, whatsapp, youtube, videogames were 14.1%, 35.9%, 34.5%, 0.6% respectively. Men watched facebook, whatsapp, youtube, videogames were 33%, 27.8%, 27%, 2.6% respectively .
In the less than 18 years population group, mostly watched preferences were given to facebook, whatsapp, youtube, videogames were 4.8%, 11.9%, 57.1%, 14.3% respectively.  In 18 to 40 age group, it was found 27.7%, 23.2%, 34%, 1.5% respectively.  Among above 40 age group, it was found 23.5%, 50.6%, 17.8%, 1.3% respectively.
Unmarried population, mostly watched preference for facebook, whatsapp, youtube, videogame were 17.15%, 21.4%, 38.1%, 4% respectively . In married  population, it was found 30.7%, 36.5%, 25.2%, 0.6% respectively.
Conclusions
Men preferred Facebook,whatsapp, youtube more, while female preferred Whatsapp, youtube more.Below 18 age people were watching videogames than others.  In 18 to 40 age group, Youtube is the most watched one. In above 40 age group, Whatsappis the most watched.School population watched videogames more. Married people use internet for communication than game and entertainment. In this study we find significant difference in preference of internet platforms when considering age, gender, education and marital status.

STUDIES ON PAROTIDGL AND NEOPLASMAS USING FINE NEED LEASPIRATIONCYTOLOGY

Dr G Prathima, Dr N.Sailarekha

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 952-964

BACKGROUND:
The most common target organs where fine needle aspiration cytology (FNAC) is performed are salivaryglands because of their superficial location and easy accessibility introduced into a mass, cellular materialisaspirated,andacytologicaldiagnosisisrenderedasItseparatesreactiveandinflammatoryprocessesthatdonotrequiresurgicalinterventionfromneoplasiaandbenignfrommalignanttumors.
 
OBJECTIVES:
To study the cytomorphological features in lesions of salivary glands. To correlate the cytologicalfeatures with histopathological features wherever possible. To evaluate the diagnostic utility offine needleaspirationcytologyoflesionsinthesalivaryglands.
METHODOLOGY:
Atotalof120patientswithsalivaryglanddiseaseswereincludedinthestudy.Thisisaretrospective cohortstudy,undertakenintheDepartmentofPathology,FathimaInstitute of Medical sciences, Kadapa during the period of Jan 2016 to Feb 2020.Thesensitivity, specificityandoveralldiagnosticaccuracywascalculatedusingGalenandGambinomethod.
RESULTS:
Our study included 120 patients with salivary gland diseases. Age group of patients with salivary glanddiseases ranged from 10 years to 88 years with the mean age of 44.62 years. Majority of the patientsbelongedtotheagegroupof31-40years(35%).MaletoFemaleratiowas1.25:1.Amongthe120patients,mostcommonnonneoplastic67.52%,benign71.79%andmalignant28.20%lesions.
CONCLUSION:
FNACofsalivaryglandisareliableandsensitivediagnosticmethodfordiagnosisofsalivaryglandlesions.Itnotonlyprovidespreoperativediagnosisformanagementbutalsocanpreventunnecessarysurgeries

Comparative Study of Laparoscopic Assisted Vaginal Hysterectomy Versus Total Abdominal Hysterectomy in Benign Gynecological Conditions

Dr. Mortha Sulochana, Dr. Sharda Rakesh Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 965-972

INTRODUCTION: The term “hysterectomy” though means removal of uterus, in practice it
has a much wider classification depending upon the indication. At times, it is done without
removal of cervix (supracervical hysterectomy) or with removal of adnexa (hysterectomy
with salpingooopherectomy). It can also be a part of staging laparotomy or radical
hysterectomy. Hysterectomy can be performed abdominally, vaginally or through abdominal
ports with the help of laparoscope.

Analysis of Caesarean Section by Modified Robson’s Criteria

Dr. Sharda Rakesh Sharma, Dr. Mortha Sulochana

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 973-982

INTRODUCTION: There is growing international concern about the increased use of
caesarean sections (CS), particularly in high-income countries. Caesarean procedures
performed in the absence of a clinical justification do not reduce maternal or infant death
rates if carried out at a rate higher than 10%–15%. Dr Michael Robson in 2001 introduced
“Robson classification” (also known as the “TGCS-Ten Groups Classification System”).
“All women” who deliver at a specific setting (e.g. a maternity or a region) and not only
for the women who deliver by CS. It is a complete perinatal classification.

A STUDY OF HEARING IMPROVEMENT AFTER TYMPANOPLASTY IN PATIENTS OF CSOM

Dr.Sowjanya, Dr. Shashi Kiran Somala, Dr.Subin. V., Dr.B.V. Surendra

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 983-988

one of the primary causes of hearing loss. The current study was designed to evaluate the
improvement in hearing after tympanoplasty in CSOM patients who presented to a tertiary care
teaching hospital.
MaterialsAnd Methods: The current study was a prospective observational study that took
place in the department of ENT at Viswarabharathi Medical College and General Hospital
from March 2019 to February 2020. The study included 50 individuals who were clinically
diagnosed with chronic suppurative otitis media Tubotympanic type illness. Pre-operatively,
pure tone audiometry was performed, and hearing loss and the mean AB Gap were recorded.
Tympanoplasty type 1 was done with or without mastoidectomy. After 6 weeks, all of these
patients were followed up on and Pure tone audiometry was done. The outcomes of hearing
loss and mean AB Gap were compared to pre-operative data.

Prevalence of Urinary Tract Infection and Its Associated Risk Factors In Pregnant Women

DR UMESH SURESH SABALE, DR PRASHANT SURYARAO, Ms. RUTUJA SAMPAT WALKE

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 989-996

Urinary tract infections (UTI) are the most common bacterial infections during pregnancy.
Untreated UTI can be associated with serious obstetric complications. This cross-sectional
study was carried out to determine the prevalence of UTI among pregnant women. UTI was
diagnosed using mid stream urine (MSU) culture. Using >10’5 colony forming unit per millilitre
as a significant level of bacteriuria, the prevalence was found to be. There was a high
incidence of infection in 21-25 years age group (43.75%). There was also a high incidence of
infection in the third trimester of pregnancy (51.56%) compared to first (17.18%) and second
trimester (31.25%). Multiparty is associated with increased urinary tract infections in pregnancy.
Regarding education 10% were literate and 90 % were illiterate. Prevalence of bacteriuria
was 94% in women who had past history of urinary tract infection.80% were sexually
active. E.coli was the most frequently isolated pathogen. These findings underscores the importance
of screening all pregnant women for significant bacteriuria, so that positive cases
should be treated subsequently with antibiotics in order to reduce the adverse effects on both
maternal and fetal health.

Clinical study of cardiotocography admission test in labour as a predictor of fetal outcome at a tertiary care center.

Dr Shrinivas N Gadappa, Dr Anurag A Sonawane, Dr Rupali A Gaikwad, Dr Neha Lohiya

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 997-1005

Intrapartum fetal surveillance is important to ensure the delivery of a healthy baby in
good condition with the minimum of intervention.1 Unexpected complications may occur
during labor, even in patients without prior evidence of risk, so maternity hospitals need to
ensure the presence of trained staff, as well as appropriate facilities and equipment for an
expedite delivery (in particular emergency cesarean delivery).
The admission cardiotocography test is a short continuous electronic FHR recording
for 20 minutes, along with the simultaneous recording of the uterine activity done
immediately on admission to the labour room.2,3 Admission test is a 'Natural contraction
stress test’ that can assess the ability of fetus to withstand the functional stress of uterine
contractions and helps to identify those cases at risk. It is a dynamic screening test for the
state of oxygenation of the fetus on admission of the mother into labour room.

DIAGNOSTIC UTILITY OF MRI FINDINGS COMPARED TO PER-OPERATIVE FINDINGS IN LUMBAR INTERVERTEBRAL DISC PROLAPSE PATIENTS

Dr. Venkata Sivaram G V, Dr. S.V.L.Narasimha Reddy,Dr Kolla Srinivas Yadav, Dr. Sridhar Jakkepally, Dr Roish Uddin

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1006-1013

Background: Diagnosis of syndromes related to lumbar spine has improved with use of magnetic resonance imaging (MRI). Neurological signs of herniated lumbar disc are important to make a decision whether to operate the patient or not. Hence, clinical examination is also important in patients with herniated lumbar disc.
Objective: To study diagnostic utility of MRI findings compared to per-operative findings in Lumbar intervertebral disc prolapse patients
Methods: Hospital based diagnostic evaluation study was carried out among 30 patients having signs and symptoms of herniated lumbar disc. All the consecutive patients presenting with low back ache (LBA) and sciatica admitted were thoroughly examined. Neurological examination, X-ray Lumbar Spine AP and lateral, MRI were done. MRI lumbar spine was graded as per Michigan scale. Surgery was done electively under general anesthesia in prone position. Patients were followed to assess the pain.
Results: Both MRI and per-operative findings agreed on the actual finding of zone of disc prolapse in 24 (80%) of the cases and differed in remaining six (20%) of the cases. The sensitivity of MRI compared to per-operative finding in diagnosing central zone of disc prolapse was 84.6% of cases and 76.5% in diagnosing lateral zone of disc prolapse. The outcome of surgery was excellent in 43.3% of cases followed by fair in 50% of the cases. It was poor in only two cases.
Conclusion: Subjects in the age groups 40-59 years were commonly affected MRI is a very sensitive in detecting symptomatic lumbar disc prolapse

A Study on Association of Vitamin D Status and Thyroid Function among Type 2 Diabetic Mellitus Patients Attending a Tertiary Care Hospital of Bihar

Manish Kumar Sinha, Madhu Sinha

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1014-1022

Vitamin D is an important element for skeletal health and it may also affect extraskeletal
health such as association with autoimmune diseases. Inclusive studies in have reported
an association between thyroid autoimmunity and 25-hydroxyvitamin D (25-OHD). Therefore, in
the present study, we examined the relationship between serum TSH levels and vitamin D status
among patients with T2DM. Materials and Methods: A cross-sectional study on 500 Patients
was conducted in the department of Biochemistry, Patna Medical College & Hospital, Patna,
Bihar from January 2021 to December 2021. The study included patients who were diagnosed
with T2DM and were 20 years or older. Exclusion criteria were known hepatic or renal disease,
metabolic bone disease, malabsorption, hypercortisolism, pregnancy and medications influencing
bone metabolism. The serum concentration of 25-OHD was measured by competitive protein
binding assay using kits (Immunodiagnostic, Bensheim, Germany). Glycosylated hemoglobin
(HbA1c) was measured by the high performance liquid chromatography method (Bio-Rad
Laboratories, Waters, MA, USA). TSH levels between 0.22-4.2 mIU/L were regarded normal.
The study was approved by the Institutional Ethical Committee. The statistical analysis was
conducted with SPSS version 23.0 for Windows. Results: A total of 500 participants were
included in this study. Average age of the study population was 47.6 ± 11.2 years (Table 1).
VDD was detected among 52.7% of the study population. Among 8.4%, TSH was lower than
0.22 mIU/L and in 70.2%, TSH was within normal reference range. Abnormally high levels of
TSH (>4.2 mIU/L) were reported in 21.4% subjects. Conclusion: This study suggests positive
associations between the VDD and TSH level among T2DM patients.

EVIDENCE OF INCREASED PSYCHOLOGICAL STRESS AND SOMATIC DNA DAMAGE AMONG WOMEN WITH RECURRENT ABORTION

Ratheesh GB, Josekumar VS, Aswathy Sundaresh, Dinesh Roy D

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1023-1030

Recurrent abortion refers to the loss of two or more pregnancies before 20 weeks of
gestation. Recurrent abortion could be because of environmental, physiological,
endocrinological or biochemical factors. Perceived stress scale (PSS) is the most widely used
psychological tool to scale the perception of stress and is a measure of the degree to which
situations in one’s life are appraised as stressful. However, the role of psychological stress in
recurrent abortions has not been examined properly. Hence, the present study was conducted
to evaluate the perceived stress in women with recurrent abortions with no known risk factors
for obstetric complications and to determine demographic and pregnancy-related factors
associated with stress. In the current study 136 women with recurrent abortions were included
in the test group and 110 healthy women with one or two children were selected as control
subjects. Perceived stress scale (PSS) was employed to assess the women’s stress status and
correlate it with various demographic, physiological and clinical characteristics of the study
subjects.Cytokinesis-block micronuclei (CBMN) assay was also performed to quantify the
extent of somatic DNA damages among subjects with recurrent abortions. Women with
recurrent abortion showed a statistically significant increased score of PSS and CBMN
frequency than the control subjects.

AN ECO-FRIENDLY ALTERNATIVE TO XYLENE FOR DEPARAFFINIZATION IN THE HEMATOXYLIN AND EOSIN PROCEDURE

Dr PREETHI, Dr.SAI SUDHA.M, Dr ANBUMOZHI

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1031-1035

Introduction :
xylene is the widely used deparaffinizing agent in the Hematoxylin and Eosin procedure
because of its high solvent property. It is biohazardous in nature and causes toxic effects to
health. Hence there is need for the development of safer xylene alternatives in
histopathological procedures.
Aim :
The present study aims to assess the efficacy of eco-friendly Sweet lime juice as a
deparaffinizing agents in Hematoxylin & Eosin procedure and to compare it with routine
Hematoxylin & Eosin procedure using xylene as a deparaffinizing agent.
Materials and methods:
The present study includes 50 paraffin embedded blocks, two sections were prepared from
each block. One section( Group A) was stained with routine H & E stain with xylene and the
other section(Group B) was stained with xylene -free H &E stain with sweet lime juice as
deparaffinizing agent. Stained slides were examined by the pathologist and scores were given
to the staining parameters like cytoplasmic and nuclear staining, clarity, crispness and
uniformity of staining.
Results:
Staining parameters of all the group A and group B sections were examined and compared
with each other. Group B sections with sweet lime juice shows 85 % adequacy of staining for
the diagnosis.
Conclusion :
The results of the present study observed that the sweet lime juice can be used as safer and
eco-friendly substitute to xylene for deparaffinization in Hematoxylin and Eosin staining
procedure

Posterior Cruciate Ligament Retention Versus Posterior Stabilization Implants for total Knee Replacement: A Hospital based Study

Dr. Mahantesh Y Patil, Dr. Roopa M Patil

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1036-1042

Introduction: The posterior cruciate ligament (PCL) in total knee arthroplasty (TKA), so-called cruciate-retaining (CR), or to substitute for it, so-called posterior stabilized (PS), continues to engage orthopaedists. The many reasons for retaining the posterior cruciate ligament (PCL) during total knee replacement (TKR) include improved stability, reduced shear stresses at the fixation interface, improved proprioception, and more efficient gait patterns during level walking and stair climbing;
Material and Method: This is prospective study design was at Gadag Institute of Medical Sciences ,Gadag, Karnataka. The study period was from October 2021 to March 2022.
Results: There were many prospective studies with the evidence level 1–2 to compare the CR and PS TKAs using contemporary prostheses.  Most studies reported no difference in clinical scores, ROM, midterm survival rate, and quadriceps muscle recovery; two studies reported only the better ROM in PS TKAs. In our preliminary prospective study using the recently introduced prosthesis of Persona, all the clinical results did not differ at 1 year postoperatively.
Conclusion: CT TKA may not be feasible in certain conditions; PCL insufficiency, severe deformity, and the history of previous traumas or operations should be carefully examined for appropriate selection of the prosthesis type. The surgeon should have a clear idea on the technical differences between CR and PS TKAs. The extent of distal femoral resection, selection of femoral component size, and adjustment of tibial slope are particularly crucial for successful TKA.

To Evaluate the Efficacy of Disinfection Methods for Operation Theatres at a Tertiary Care Hospital

Dr. P. Subashini, Dr. M. Ramakumar, Dr. Shaweez Fathima S, Dr. B Ananthi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1043-1051

Introduction
Disinfectants play a vital role in global infection control as a crucial weapon against the transmission of nosocomial pathogens/infections combating global disease outbreak. Because of   the multifactor causation of infections, the environment of operation theatre plays a great role in the onset and spread of infections
Materials And Methods
This is an analytical study conducted at a Teaching hospital, Sri Lalithambigai Medical College and Hospital, from July 2021-May 2022, with a 600- sample size collected before and after applying successive techniques of different disinfecting agents in operation theatres.
Results
In our study, the OT1 colony forming unit was higher than OT 2 CFU (Table 1 and 2) which may be due to human activity that significantly increases the bacterial count and reaches the peak at the end of the day in both the OTs
 
Conclusion
Newer less toxic disinfecting agents are alternative to formalin and may be used at short intervals for better outcome. The expenditure involved in use of these environment friendly disinfecting agents are worth the money spent, in comparison to formaldehyde considering the long-term harmful impact that can have on surgical personnel.

Trauma Trends in COVID - 19 Pandemic at level 1 Trauma Center in India - An Observational Study

Ayush Srivastava, Anisha Anshu, Tej Prakash Sinha, Sanjeev Bhoi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1052-1059

Introduction: COVID-19 has pushed Government of India to take various public health measures for curtailing transmission of infection. It included imposition of total lockdown on all non-essential services across the country when number of cases started increasing during the first wave. The first lockdown lasted from March 25th to may 31st 2020, following which a period of gradual unlocking began. Thereafter during the second wave of the COVID pandemic in India, lockdowns of varying intensities were imposed at different intervals by individual states. Near complete lockdown was implemented in the National Capital from April 19th 2021 to 31st May 2021, in response to a sharp rise in the number of cases. These lockdowns along with the pandemic itself has had a major impact on the healthcare system, including trauma care. There are limited number of studies specifically from India, which have examined the effect of these restrictions on trauma admissions.
Objectives: Objective of this study is to assess the effect of COVID related lockdowns on trend of trauma admissions in a tertiary care facility of North India.
Material and Methods: In this retrospective study, data on trauma admissions were abstracted from the Health Management Information system of All India Institute of Medical Sciences, Trauma Center, New Delhi corresponding to the following time periods (1) April 15, 2019, to May 31, 2019 – which corresponds with the pre-COVID phase (2)  April 15, 2020, to May 31, 2020- which corresponds with first nationwide lockdown imposed in India during the first wave of the COVID outbreak and (3)  April 15, 2021, to May 31, 2021- which corresponded with the near complete lockdown in state of Delhi during the second wave of COVID outbreak in India.
Results: During the first-time interval (pre-COVID), a total of 8847 trauma casualty cases were reported in the Emergency Department of the level 1 Trauma Center. Due to lock down, number of patients presenting to trauma emergency had significantly reduced to 2185 during second interval. However, trauma casualty cases slightly increased during the third interval.
Conclusion: This study showed that during the pandemic lockdown trauma admissions had been significantly reduced. However, the volume of trauma admissions was greater during the 2nd Peak of COVID-19, as the lockdown was partial. This study demonstrated that self-quarantines and lockdowns had led to a significant decrease in trauma footfall.

Study on Neutrophil-Lymphocyte Ratio (NLR) As a Prognostic Marker In Acute Pancreatitis

Dr. Sanjeev Bharti, Dr. Shivendu, Dr. Pankaj Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1060-1066

Background: Acute pancreatitis (AP) is usually a self-limiting process; however, 25 % of patients present with or subsequently develop a severe form of the disease that is associated with a mortality of up to 50 %.The neutrophil–lymphocyte ratio (NLR) is a measure of the divergence of these two WCC (white cell count) components (lymphocytes and neutrophils), which may be more accurate than the total WCC or individual neutrophil/lymphocyte counts in predicting poor outcome in patients with acute pancreatitis. Material and methods: The present study will be carried out in all the in patients diagnosed to have acute pancreatitis in the Department of Medicine and Department of General Surgery, at All India institute of medical sciences, New Delhi. and 50 cases will be studied. Study duration of between  Aug 2019 To June 2022.Conclusion: The Acute pancreatitis is one of the more commonly encountered etiologies in the emergency setting and its incidence is rising. Presentations range from a mild self- limiting condition (MAP) which usually responds to conservative management,to one with significant morbidity and mortality in its most severe forms (SAP). 

Assessment of Autonomic Function in Patients with Coronary Artery Disease

Dr. Pankaj Kumar, Dr. Shivendu, Dr. Sanjeev Bharti

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1067-1074

Background: Cardiovascular diseases are a major cause of mortality and morbidity. Early detection of cardiovascular disease will help to effectively treat the disease and avoid complications. There is an adverse impact on autonomics functions in coronary artery disease (CAD) resulting in sympathetic predominance. Heart rate variability (HRV) is a non-invasive economical tool to assess the autonomic function.
Material and methods: The study was conducted in the Department of Cardiology, AIIMS, New Delhi. Thirty patients with TMT positive/angiographically proven CAD admitted for elective Percutaneous Transluminal Coronary Angioplasty (PTCA) satisfying the inclusion and exclusion criteria in the age group of 40 to 65 years served as cases. The control group consisted of age, anthropometrically matched and TMT negative subjects who satisfied the inclusion and exclusion criteria.
Conclusion: Our study shows that the patients with CAD had a reduced HRV. In patients with CAD, there was an increase in sympathetic activity and reduced parasympathetic activity. There was improvement in HRV on third day following PTCA indicating a better prognosis.

Study of Morphometric and Anatomical Variations of Palmaris Longus and Plantaris Tendons

Chandra Bhushan Chandan, Nitisha, Pankaj Kumar, Md. Jawed Akhtar, Avanish Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1075-1082

Background: Tendons are frequently used for reconstructive surgery. This includes tendons of palmaris longus, plantaris, the long extensors of the toes and fingers as well as the flexors of the fingers. The surgeon must base his or her selection of the donor tendon for grafting on what is needed, for example tendon size, length, and width. The most desirable tendons in reconstructive surgery are the palmaris longus and plantaris tendons. These two muscles are also considered to be the easiest tendons to harvest, and therefore they remain the ideal choices for flaps or tendon grafts.
Objectives: To determine and compare whether there is any significant difference in the prevalence of absence of these tendons among different ethnic groups .To compare the prevalence of absence in right and left sides.
Methods: The study was done on 30 cadavers . The palmaris longus and plantaris muscles are indeed subject to variation, whether in the general anatomy, form, attachment, actions and/or prevalence.   Parameters like muscle length , tendon length, total length, of both the muscle were measured using measuring tape and the muscle width and tendon width were measured using digital vernier caliper and recorded bilaterally and statistically analysed. Conclusion: based on the morphology and prevalence of the palmaris longus and plantaris muscles in Bihar, they are ideal for the use of flaps and/or tendon graft in reconstructive surgery. But it is of utmost importance that the reconstructive surgeon, remember that both these muscles are subject to variation and not only will it be beneficial to employ proper detection methods to determine the viability of either muscle before considering its suitability in reconstructive surgery but also a sound knowledge of the anatomy of these muscles must be known.

A Study of Lipid Profile in Non-Diabetic Chronic kidney disease patients: A Hospital Based Study

Sachinkumar K Khade, Anita S Bhosale, Bhagyashri B Lahane

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1083-1091

Background: The silent epidemic of the twenty-first century is chronic kidney disease (CKD). According to surveys, CKD affects up to 16 percent of the adult population. It doesn't just happen in rich countries; it happens everywhere. In India, about one lakh people are diagnosed with CKD each year, necessitating a kidney transplant or lifelong dialysis. Objectives: to determine the prevalence of changes in different lipoprotein levels in non-diabetic chronic renal disease patientsMaterials and Methods: A prospective observational study was conducted in Non-diabetic CKD patients, admitted at in the Medicine ward and ICU under Medicine Department of our hospital and duration of study was 18 months which included a total of 52 patients.Results:Prevalence of dyslipidaemia was seen in almost three fourth (73.1%) of the cases with chronic kidney disease. Dyslipidaemia was seen in 64.3% cases of CKD stage III, 78.6% in stage IV and 90% in CKD stage V respectively(p<0.01). Raised cholesterol was seen in 14.3% cases of CKD stage III, 42.9% in stage IV and 80% in CKD stage V respectively(p<0.01). Conclusion: Study concluded that prevalence of dyslipidaemia in non-diabetic CKD is high. EverythreeoutoffourCKDcasesweresufferingfromdyslipidaemia,especiallyraised LDL and low HDL levels.Keywords: Lipid Profile, Non-Diabetic, Chronic kidney disease patients, dyslipidaemia

Evaluation of prognosis in patient’s with perforation peritonitis using Mannheim’s peritonitis index

Tushar Dani, Mohit Kumar Patel, Manish Sahu, Dipak Purohit

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1092-1099

Background: Peritonitis is one of the most common infections, and an important problem that a surgeon has to face. Objectives: To evaluate the prognosis of patients with perforation peritonitis using Mannheim Peritonitis Index. Materials and Methods: This study was conducted from cases attending our institute in which diagnosis of peritonitis is established by operative findings or surgical interventions during management.
Results: 87 patients had MPI score of less than 21,70 patients had MPI score between 21 to 29 while 43 patients the MPI score was more than 29.There was no mortality in the patient’s with MPI score of less than<21. The mortality was 4.3% in patients with MPI scores between 21-29.The mortality was 67.4 % in the patients with MPI score more than 29.
Conclusion: MPI is accurate to be used with patients with peritonitis and should be considered reliable and simple reference for estimating their risk of death.

Comparative study of oral iron and intravenous iron sucrose for the treatment of iron deficiency anemia among pregnant women in India

Soubhagya Talawar, Hanumant V Nipanal, Rashmi Naganagoudar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1100-1108

Background: Anemia is a major public health problem worldwide, causing an unfavorable status in respect to upcoming pregnancy. About 20-50% world’s population is anemic among them the most common risk factor is pregnancy.
Material and Methods: All pregnant women suffered from iron deficiency anemia with hemoglobulin level 6-10 gm/dl and gestational age 16-32 were included in this study.Total 300 antenatal patients were involved in this study. All women attending antenatal OPD were screened for anemia. All women attending antenatal clinic were screened for anemia between 16-32 weeks of gestation. All participants were subjected to thorough history followed by clinical examination blood investigations such as complete blood count, peripheral blood smear, serum ferritin values, liver and renal function tests, stool examinations for worm infestations and occult blood loss of all cases were carried out and antenatal investigations as per our institution protocol were undertaken. The cases were randomly divided into two groups of 150 each. Oral Group: was given oral iron tablets containing 100 mg of elemental iron and 500 microgram folic acid daily throughout pregnancy. Intravenous Group: was given a 100 mg of elemental iron as iron sucrose. The formula used for calculation of total required IV elemental iron in the form of iron sucrose, that is, Total iron dose required (mg) = 2.4 x weight in kg x (target Hb – actual Hb of patient) g/dl + 500.17 The total calculated TDI was administered within three consecutive days, up to a maximum of 500 mg per day infusion in 500 ml of normal saline over a period of three to four hours. The infusion was given under supervision to avoid any untoward side effects. Any minor or major side effects were documented.

Manual vacuum aspiration with medical method of abortion in termination of pregnancy up to 9 weeks of gestational age: A comparative study

Soubhagya Talawar,Rashmi Naganagoudar,Hanumant V Nipanal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1109-1118

Introduction:Unsafe abortions are a serious public health issue in India, involving the expulsion or extraction of the product of conception and causing controversy.Unmet demand exists for a simple, effective early pregnancy termination method that is both accessible and safe. Medical abortion using mifeprostone and misoprostol and surgical abortion using manual vacuum aspiration are two procedures that meet this need.
Materials and Methods:All requirements outlined in the MTP Act of 1972 by the Government of India were followed in this study. On the first day of the medical abortion, the patient was given 200 mg of mifepristone orally. After 48 hours at home, the patient was told to keep using Tab. Misoprostol 800ug vaginally.A 60ml double-valved manual vacuum aspiration syringe was used for MVA. Following the MVA syringe's attachment, the contents were aspirated. Villi on fresh tissue served as proof that the procedure was successful.The aspirated uterine contents were placed on a piece of gauze and examined to determine the gestational sac. Each woman was under observation for at least four hours following the procedure. The vital signs were examined before discharge. Inj. Women with Rh negative blood groups received 300ug of anti-D within 72 hours of the abortion.

A COMPARATIVE STUDY BETWEEN SCALPEL AND CUTTING DIATHERMY FOR SKIN INCISIONS

Dr Nataraj Kumar, Dr Ramaswami B, Dr Priyanka

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1119-1134

Aim & Objective:This prospective randomized clinical trial was conducted to compare the
efficacy and safety of surgical diathermy incisions versus conventional scalpel incisions for
Inguinal hernia incisions with an aim to evaluate the efficacy of diathermy as an alternative to
scalpel incision.
Methodology:This study was done in the Department of General Surgery, Mamata General
Hospital from October 2016 to September 2018. Total 60 patients were randomized into two
groups. Group A (Electrocautery group) and Group B (Scalpel group). Skin incision in
patients undergoing inguinal hernia repair were taken with either electrocautery or scalpel
depending on their group.

STUDY OF FINE NEEDLE ASPIRATION CYTOLOGY IN LYMPHADENOPATHY WITH SPECIAL REFERENCE TO ACID FAST STAINING IN CASES OF TUBERCULOUS LYMPHADENITIS

Dr P R D Ganesh Basina, Dr Siva Kumar Vulava, Dr BVVD Kiranmayi, Dr. Krishna SwaroopD. S

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1135-1145

Fine needle aspiration cytology (FNAC) is a simple, safe, reliable rapid and
inexpensive method of establishing the diagnosis in lymph node lesions. The value of FNAC, besides making a
diagnosis lies in early detection, direction of appropriate investigations and treatment options. The present study is
undertaken to study the usefulness of FNAC in diagnosing various lymph node lesions in patients presenting with
lymphadenopathy. Also to determine the pattern of diseases affecting lymph nodes and to study the spectrum of
lesions with respect to age, sex and site of occurrence. To study the distribution of Acid fast bacilli in tuberculous
lymphadenitis using Ziehl Neelsen stain.

STUDY ON PREVALENCE AND CORRELATES OF DRY EYE IN CONNECTIVETISSUE DISORDERS

Dr.PorikaRamMohanLal,Dr.S. RameshKumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1146-1153

Objective:
To determine the prevalence of dry eye disease (DED) and its severity in patients with RA, SLE, and
PrimarySjogren's syndrome in a tertiary care in Departmentof Opthalmology Govt General
Hospital,Suryapet,Telangana,India.
Methods:
From July 2019 to May 2022, prospective cross-sectional research of 90 individuals with RA, SLE,
andSjogren'ssyndromewillbeconducted.Schirmer's test,Tearbreakup
time,andocularsurfacestainingwasusedtoassesspatientsforDED.
Results:
TheprevalenceofDEDwas51.11%forRA,31.11%forSLE,and17.77%forPrimarySjogren'ssyndrome.Nocasesofdr
yeyewerefoundin11.11%(10cases),38.88%(35)patientshadmilddryeye,22.22%(20)patientshad
moderatedryeye,17.77%(16) patients hadseveredry eye,and 10%(9)patientshad veryseveredry eye.
Conclusions:
DEDhasahighoverallfrequencyinconnectivetissueillnesses

Contraceptive Usage and Unmet Need of Family Planningamong Tribal Women of India: A Narrative Review

Dr. Swati Shikha, Dr. Abhishek Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1154-1160

Background: Unmet need of family planning affects the society by uncontrolled population
explosion. Tribal population being socioeconomic deprived group requires special attention
for contraceptive needs. Aims & Objectives: To assess the level of knowledge of tribal
women towards contraceptive usage, their fertility intention and the family planning
modalities used. Methodology: A detailed search was made on the current topic in various
databases including Pubmed, Pubmedcentral ,Science direct and Google scholar and the
findings were summarized after excluding the duplicates. Results:Tribal women had poor
knowledge and high unmet needs for family planning especially the women in states like
Jharkhand and chattishgarh. The most common method of family planning used was the
traditional methods. The reasons for unmet need were non acceptability by spouse and fear of
adverse health consequences. Conclusion: the unmet need for contraception is high among
women of tribal community, most commonly from Jharkhand and Chattishgarh

A Prospective Study to Determine the Relationship of the Subjective, Objective and Radiographic Method of Treatment of Adults Who Sustained Fractures of the Shafts of Both Bones of the Forearm

Dr. Manoj Kumar, Dr. Swati Sinha

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1161-1170

Aim and objective: The aim of the study was to determine relationship of the subjective, objective and radiographic method of treatment.
Material and Methods: A prospective study was conducted in the Department of orthopaedics ESIC Medical College, Bihta, Patna, Bihar, India for the period of 1 year. Three methods of treatment were utilized: open reduction and internal fixation (ORIF), closed reduction and casting (CR), and external skeletal fixation with pins-in-plaster (PIP). The method of treatment was chosen by the attending surgeon based upon his experience and the type of injury.
Results: Union occurred in 92 percent of radius fractures and 95 percent of ulna fractures, with an average time to union of 15.4 weeks for the radius and 16.8 weeks for the ulna. Union was more frequent after closed than after open fractures. This difference was most apparent in radius fractures where 13 percent of open fractures developed nonunions, compared to only 3 percent of closed injuries (p = 0.140). Also, the average time to union was 16 percent longer for open than for closed fractures of the radius (p = 0.022), and 35 percent longer for open fractures of the ulna (p = 0.010). Neither the frequency of nor the time to union varied significantly with the method of treatment. The amount of forearm rotation lost was directly proportional to the loss of normal alignment, reaching a mean of 39 degrees when the combined malalignment of the radius and ulna exceeded thirty degrees (p = 0.07).
Conclusion: For this series of 120 adult patients, the end results following treatment of fractures of the shafts of the radius and ulna were good to excellent regardless of the method of treatment chosen. Except for a longer time to union and a higher infection rate, the outcomes of open and closed fractures were very similar. The presence of associated injuries was a strong predictor of a compromised end result.

An Observational Assessment of the Factors Affecting Outcome of the Radius and Ulna in Adults

Dr. Pankaj Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1171-1178

Aim: To determine the relationship of different parameters to the method of treatment and type of fractures.
Methodology: 50 patients with fractures of the shafts of both the radius and ulna treated at the Vardhman Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India. Data collection and radiographic measurements were standardized for all patients. All patients were followed at least until bone union occurred or the diagnosis of nonunion was made. These methods of treatment were utilized: open reduction and internal fixation (ORIF), closed reduction with square nailing. End result ratings were made on a 14 point scale in four categories: (a) subjective, according the level of pain in the injured limb; (b) objective, by the range of forearm rotation; (c) radiographic, utilizing the criteria of union, synostosis and malunion.
Results: The mean follow-up was 36 months (Range: 3-60 months). Out of 50 patients, 26 were male and 24 were female, with an average age of 28 years (16-45 years). In 31 patients, the fracture involved the dominant limb. 28 of the fractures were open and 22 were closed fractures. Mode of trauma in maximum cases was due to road accidents (n=28), fall from height in 10 patients, Industrial accidents in 6 cases, direct blow in 3 cases and trivial trauma in 3 cases. Overall, 78 % of patients reported no pain, with no difference between patients with open and those with closed fractures. While 80% of patients treated with ORIF were pain free at their last examination, only 56% treated with CR and 48% treated with PIP were painless. There was no significant difference in the loss of forearm rotation between closed and open fractures: 66% of each group lost less than 30 degrees of forearm rotation. Union occurred in 94 percent of radius fractures and 98 percent of ulna fractures, with an average time to union of 18.2 weeks for the radius and 18.6 weeks for the ulna.
Conclusion: Treatments of fractures of the shaft of radius and ulna were good to excellent regardless of the method of treatment. Results with ORIF were also found better than CRIF.

ASSESSMENT OF RISK FACTORS IN YOUNG ACUTE MYOCARDIAL INFARCTION PATIENTS: AN OBSERVATIONAL STUDY

Dr Hariom Gupta, Dr Umesh Pratap Singh, Dr Sunil Kumar Tripathi, Dr Vijay kumar Shah

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1179-1186

Purpose: The present study was aimed to determine the prevalence of risk factors in younger patients (age <45 years) presenting with ami.
Methods: In this observational, cross-sectional study, a total of 150 patients were studied between april 2020 and june 2021 for the risk factors of ami. Patients with characteristic electrocardiographic changes suggestive of coronary artery disease, within 15-44 years of age were included and data regarding baseline clinical characteristics were reported.
Results: Maximum patients (82%) were in the age group of 35-44 years where males (73.3%) outnumbered females (26.7%).Among all the risk factors, dyslipidemia (77.3%) was the most prevalent, and significantly higher in smokers, obese (body mass index ≥25) and diabetic patients. Major complication was arrhythmia (45.3%), and anterior wall myocardial infarction was the most prevalent pattern of myocardial infarction (61.3%). Majority of patients had two risk factors and maximum number of patients i.e, 141 (94%) were discharged from hospital after treatment while 9 (6%) died.
Conclusion: The present study revealed that dyslipidemia was the major modifiable risk factor of ami in the younger population followed by sedentary lifestyle, obesity, tobacco chewing, smoking, diabetes mellitus, systemic hypertension, and family history where majority of patients had two risk factors

EVALUATION OF INTRATHECALDEXMEDETOMIDINE FOR SPINAL ANAESTHESIA FOR PERIANAL AMBULATORY SURGERIES

Dr JaladKapoor, Dr Avdhesh Kumar Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1187-1191

Background:Ambulatory anorectal surgery is an appealing approach for patients and physicians due to its increased efficiency and decreased surgical costs. The present study was conducted to evaluate intrathecaldexmedetomidine as adjuvant for spinal anaesthesia for perianal ambulatory surgeries.
Materials & Methods:50 adult patients presenting for perianal surgeries were divided into 2 groups of 25 each. Group I patients received intrathecal 0.5% hyperbaric bupivacaine 6 mg (1.2 ml) with injection dexmedetomidine 5 μg in 0.5 ml of distilled water and group II received intrathecal 0.5% hyperbaric bupivacaine 6 mg (1.2 ml) with 0.5 ml of distilled water. The parameters such as time to regression of sensory blockade, motor blockade, ambulation, time to void, first administration of analgesic wasassessed.
Results: The mean weight in group I was 64.7 kg and in group II was 63.4 kg, height was 156.8 cm in group I and 157.3 cm in group II, ASA grade I was seen in 15 in group I and 16 in group II and grade II was seen in 10 in group I and 9 in group II.  The difference was non- significant (P>0.05). The mean duration of surgery was 26.5 minutes in group I and 28.2 minutes in group II. The mean duration of sensory block in group I was 430.6 minutes in group I and in group II was 318.6 minutes, duration of motor block was 324.8 minutes in group I and 230.6 minutes in group II and time to ambulation was 314.2minutes in group I and 216.1 minutes in group II. The difference was significant (P< 0.05). Side effects were shivering seen in 1 in group II, bradycardia 1 in group I, hypotension 1 in each group and Nausea/vomiting 1 in group I and 2 in group II. The difference was significant (P< 0.05).
Conclusion: Intrathecaldexmedetomidine provides prolonged post-operative analgesia.

A STUDY ON FUNCTIONAL OUTCOMES FOLLOWING SURGICAL MANAGEMENT OF ANKLE FRACTURES

T.Zeeshan Muzahid, T. Zahid Hussain

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1192-1204

Background:Orthopaedic doctors treat ankle fractures frequently. Few studies have studied functional recovery after ankle fracture surgery, and none have analysed predictors. Ankle injuries can be caused by low-energy rotational forces in sports, a misstep in daily activities, or RTA. Young and middle-aged are more at risk. Early and optimal ankle function restoration is a prerequisite. Surgical reduction and internal fixation are used to treat most ankle fractures. In ankle fractures, the anatomic repair is the goal. For ankle fractures, open reduction and internal fixation are typical. This study analyses the causes, patterns, and surgical outcomes of ankle fractures.
Materials and Methods: It is a prospective study which was carried out from December 2017 to December 2018 in Great Eastern Medical School & College. In this study period 30 cases of ankle fractures, meeting the inclusion and exclusion criteria were treated by open reduction and internal fixation using appropriate implants.
Results: Most incidences (38%) were in the 31-40 age group. In this study, the right ankle was involved in 35 (70%) cases and the left in 15.0 (30%). 9 (30%) of our cases were between the ages of 31-40, followed by 8 (26.7%) between 41-50. The eldest patient was 65. 42.07 was the mean age. In this series, the right ankle was involved in 20 (66.7%) instances and the left ankle in 10 (33.3%) cases. 26.7% of fracture patients were farmers and 20% were housewives. 14 (46.7%) instances exhibited supination-external rotation damage, followed by 8 (26.7%) pronation-abduction injury. In this study, 30 bimalleolar ankle fractures were treated by open reduction and internal fixation. Excellent results were seen in 8 (26.7%) patients, good in 17 (56.7%), and fair in 5. (16.7 percent). No patient did poorly. Good to outstanding functional outcomes in 83.4% of cases and fair results in 16.6%.
Conclusion: Surgery for bimalleolar ankle fractures yields good functional results. Early weight bearing and mobility are obtained. Anatomical reduction and articular congruence restoration are necessary for all intraarticular fractures, especially if a weight-bearing joint like the ankle is involved. Openreduction and internal fixation restore ankle joint congruency.

INCIDENCE OF CHILDHOOD CANCERS FROM 2015-2016

Elizabeth Caroline P, SirilP, Jayalatha N, Krishna Chaitanya, Vishal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1205-1210

Background:Rates of cancer incidence in children are scarce in developing countries. The purpose of this study is to provide the cancer incidence rates among the children of Telangana during 2015-2016.
Materials and Methods: Data from the Telangana Population based cancer registry were utilized for this study. The analysis was limited to children <15 years of age. Cancer cases were restricted to those patients with a malignant neoplasm diagnosed between 1st January 2015 and 31st December 2016.
Results: The share of childhood cancer up to 14 years of age in Telangana was 4.8% of all cancers. The incidence of Leukemia was predominant among both males and females. In general rates were higher among male children compared to females. When standardized age adjusted incidence rates obtained from different national registries were compared, the age adjusted incidence rates in Telangana were higher in both male and female children.
Conclusion: The results of the present study reveals that the cancer incidence among male children is more in Telangana compared to their female counter parts.

STUDY OF LIPID PROFILE AND MACRO MINERALS -CALCIUM, MAGNESIUM ANDPHOSPHOROUS IN SERUM IN CASES OF TYPE II DIABETES MILLETUS

N. Chandralekha, P. V. Rajini, N. Jyothi, T. Arunmanas, T. Krishnasri Vathsav

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1211-1221

Background:Diabetes Mellitus is the most common metabolic disease and is posing as a major public health problem in the world, developing countries like India in particular. India has the second highest number of diabetics worldwide after China. Diabetes Mellitus is characterized by chronic hyperglycemia due to defective insulin secretion and / or insulin resistance. Non-insulin dependent diabetes mellitus (NIDDM) or type 2 diabetes mellitus accounts for more than 85% of the all the diabetics. It can occur at any age but is most common between 40 to 80 years of age. Macro minerals (calcium, magnesium, chloride, sulphur and phosphorus) play an important role in intermediary metabolism and cellular function, including enzyme activities and electrical gradients. The present study of these parameters is essential in clinically diagnosed patients of type 2 diabetes mellitus to show their role in the pathogenesis and to ascertain their role as possible biochemical markers of the disease progress.
Materials and Methods: Observational cross-sectional study was done. STUDY SUBJECT AND SIZEA total of one hundred patients aged between 30 years to 60 years, both male and female patients were selected from King George Hospital attached to Andhra Medical College, Visakhapatnam. Fifty patients diagnosed with type 2 diabetes mellitus attending OP at Department of Endocrinology and fifty healthy non-diabetic subjects were selected. The subjects are divided into two groups, fulfilling the inclusion and exclusion criteria. Group A (Cases): consisting of 50, type 2 diabetes mellitus diagnosed patients Group B (Controls): consisting of 50 healthy non diabetic subjects. Study Period: This study was conducted between December 2020 to November 2021 in the Department of Biochemistry, King George Hospital, Visakhapatnam. Sample Collection: After 12 hours of fasting, 5ml of venous blood is collected from the antecubital vein from each subject under aseptic conditions. Blood was collected in a clot activator vacutainer (red cap tubes) and allowed to clot spontaneously in the tube, and then centrifuged for about 10 minutes at 3000rpm. In case of delay, the sample was stored at -20 degree Celsius for further analysis on the next working day. Carewas taken to prevent hemolysis.The findings were recorded and then tabulated in excel sheets, statistically analyzed using SPSS software. Unpaired t-test was done and expressed in terms of mean and standard deviation. A p-value of < 0.05 is considered as statistically significant.
Results: The (mean±SD) serum triglyceride levels in T2DM cases were 228±116.03 mg/dl and in healthy controls 103±18.23 mg/dl. The (Mean±SD) serum total cholesterol levels in T2DM cases were 208.26±48.14 mg/dl and in controls 164.18±12.71 mg/dl. The (mean±SD) serum HDL-C levels in T2DM cases were 33.82±7.89 mg/dl and in controls 45.16±3.35 mg/dl. The (mean±SD) serumLDL-C levels in T2DM cases were 128.36±44.80 mg/dl and in controls 99.74±9.23 mg/dl. The (mean±SD) serum VLDL-C levels in T2DM cases were 45.68±23.20 mg/dl and in controls 20.47±3.31 mg/dl. The (mean±SD) serum calcium levels in T2DM cases were 9.12±0.79 mg/dl and in controls 9.83±0.53 mg/dl. The (mean±SD) serum magnesium levels in T2DM cases were 1.87±0.35 mg/dl and in controls 2.30±0.36 mg/dl. The (mean±SD) serum phosphoruslevels in T2DM cases were 2.92±0.64 mg/dl and in controls 3.06±0.70 mg/dl. There is no statistical significance in the serum phosphorus levels in between the two groups.
Conclusion: in this present study. The serum triglyceride (TG) levels, serum total cholesterol levels, serum LDL-C Levels,VLDL-C Levels were significantly increased in the T2DM cases compared to the controls. The serum HDL-C levels were significantly decreased in the T2DM cases when compared to the controls. The serum calcium levels, Serum magnesium levels and serum phosphorous levels were significantly decreased in the T2DM cases when compared to the controls.
 

BIOCHEMICAL ASSESSMENT OF SERUM PARAOXONASEAND SERUM LIPID PROFILE AS PREDICTOR OF CARDIOVASCULAR DISEASES IN PATIENTS OF PSORIASIS

D.SoundaryaMahanthi, P. V. Rajini, N. Jyothi, T. Arunmanas, T. Krishnasri Vathsav, T. Anvesh Buddha

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1222-1232

Background:Psoriasis is the most prevalent chronic inflammatory disease, with an approximate worldwide prevalence of 2-3% [1]. The etiological factor is yet to be known but the genetic factor, trauma, skin infections, drugs, emotional stress like anxiety, alcohol, smoking etc greatly impact the clinical evolution of Psoriasis [2]. Oxidative stress which is induced by the excessive production of reactive oxygen species and inflammatory cytokines that play a significant role in the evolution of severe psoriatic plaques. Serum Paraoxonase is synthesized by the liver and is related with HDL particles.
Materials and Methods: Sample Collection– After 12 hours of fasting, a morning sample of 5 ml of venous blood has been collected from the antecubital vein from each subject under aseptic conditions. Parameters Serum Paraoxonase using paranitrophenol substrate by spectrophotometric method. Serum Lipidprofile Serum totalcholesterol by CHOD-PAP Enzymatic photometric method. Serumtriglycerides by GPO-POD method. Serum Hdl- cholesterol by Direct Enzymatic Cholesterol- DL estimation in the presence of detergent. Serum LDL-Cholesterol estimated by Friedewald formula. Serum VLDL- Cholesterol is estimated automatically by dividing triglyceride by5.
Results: The [mean ± SD] age of the cases was 43.67±11.069 and in the controls 42.8±11.679 years. Statistical analysis showed that there was no statistical difference in age between the two groups (as the P-value is > 0.005). The [mean±SD] basal PON activity in cases was 69.08±13.03 and in controls was 74.46±9.79. There is statistical significance in the basal PON activity between the two groups. The mean serum total cholesterol is increased incases (p value is 0.630) when compared with controls, but it is not statistically significant. there is a high significance in the serum high densitylipo protein (HDL-C) between the two groups: 1. The mean increase in the levels of serum low densitylipo protein (LDL-C) cases are statistically significant when compared with controls. There was a high statistical significance in the serum triglycerides levels between the two groups.
Conclusion: This study was undertaken to study the levels of serum Paraoxonaseandserum lipid profile in 40 patients who are diagnosed with psoriasis to assess the irrole in causing cardiovascular diseases. 2. Inpsoriasis, the elevated levels of triglycerides, low densitylipo protein and very low-density lipoprotein are due to lowered levels of hepatic lipase at acute phase reaction, results in elevation of triglycerides in serum. Decreased levels of HDL-C levels are observed because the systemic Inflammation caused by cytokines. As PON is associated with HDL. The PON levels are affected by the decrease in HDL levels and results in lipidperoxidation along with formation of Oxidised LDL. This OX-LDL accumulates in the smooth muscle of artery and causes atherosclerosis.

CHILDHOOD AND ADOLESCENTS CANCER STATISTICS

Elizabeth Caroline P, Siril P, Jayalatha N, Krishna Chaitanya, Vishal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1233-1240

Background:Hitherto, incidence burden of childhood cancer in India has been derived from GLOBOCAN data. Recent analyses have challenged whether this accurately measures the true incidence of childhood cancer. Objective: To use observed data rather than simulation to estimate the number of children (0-14 years), as well as number of children and adolescents (0-19 years), in India who develop cancer every year at the national and state/union territory (UT) level.
Materials and Methods: Age-specific (five-year groups), sex-specific, and state/UT specific population data from India Census 2011 was used. Global average incidence rates from the International Incidence of Childhood Cancer 3 (IICC3) report were used. Incidence rates per million person years for the 0-14 years and 0-19 years age groups were age-adjusted using the world standard population to provide age-standardized incidence rates, using the age-specific incidence rates for individual age groups (0-4 years, 5-9 years, 10-14 years, and 15-19 years).
Results: The national number of children (0-14 years) and, children and adolescents (0-19 years) that may develop cancer every year based on 2011 census are 52,366 and 76,805 persons respectively. Cancer type specific incidence is provided for each state/UT for these age ranges. This national incidence is approximately double of the GLOBOCAN 2018 estimates of incidence of children diagnosed and registered with cancer and the differential is greater in girls.
Conclusion: Our analysis proposes new estimates of incident childhood cancer cases in India for children and adolescents. Future regional, national and international research on childhood cancer epidemiology and healthcare accessibility would help further refine these estimates.

THE EFFICACY OF TINNITUS RETRAINING THERAPY (TRT) FOR TINNITUS RELIEF

Anusha Shukla, Ankit Mishra, Shilpi Parihar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1241-1248

Background:Since the first description of tinnitus retraining therapy (TRT), clinicians have modified and customised the method of TRT in order to suit their practice and their patients. A simplified form of TRT is used at Ealing Primary Care Trust Audiology Department. Simplified TRT is different from TRT in the type and (shorter) duration of the counseling but is similar to TRT in the application of sound therapy except for patients exhibiting tinnitus with no hearing loss and no decreased sound tolerance (wearable sound generators were not mandatory or recommended here, whereas they are for TRT). The main goal of this retrospective study was to assess the efficacy of simplified TRT.
Materials and Methods: Data were collected from a series of 42 consecutive patients who underwent simplified TRT for a period of 3 to 23 months. Perceived tinnitus handicap was measured by the Tinnitus Handicap Inventory (THI) and perceived tinnitus loudness, annoyance and the effect of tinnitus on life were assessed through the Visual Analog Scale (VAS).
Results: The mean THI and VAS scores were significantly decreased after 3 to 23 months of treatment. The mean decline of the THI score was 45 (SD = 22) and the difference between preand post-treatment scores was statistically significant. The mean decline of the VAS scores was 1.6 (SD = 2.1) for tinnitus loudness, 3.6 (SD = 2.6) for annoyance, and 3.9 (SD = 2.3) for effect on life. The differences between pre- and post-treatment VAS scores were statistically significant for tinnitus loudness, annoyance, and effect on life. The decline of THI scores was not significantly correlated with age and duration of tinnitus.
Conclusion: The differences between pre- and post-treatment were statistically significant for tinnitus loudness, annoyance, and effect on life. The results suggest that benefit may be obtained from a substantially simplified form of TRT. TRT improved self-perceived disability induced by chronic tinnitus for a long time after the end of therapy.

IMPACT OF PAP SMEAR SCREENING ON CERVICAL CANCER IN A TERTIARY CARE CENTER IN NORTH INDIA

Nilam Bhasker, Alka Kumari

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1249-1257

Background: Cervical cancer is the most prevalent malignancy in women that occurs in the cervix, considered as 2nd common cancer that affects the women after most common breast cancer. Pap smear is a simple, cost effective, non-invasive and OPD method for early diagnosis of cervical cancer and pre-cancerous cervical lesions.
Purpose: The purpose of this study was to examine the evidence for the support of patterns of different kinds of cervical lesions and prevalence of epithelial cell abnormalities in our study populations.
Materials and Methods: This retrospective study was carried out in the department of Pathology in collaboration with the department of Gynaecology at ESIC hospital, Lucknow, Uttar Pradesh, India from 01/03/2021 to 30/12/2021 with the duration of 10 months. All Pap smears were taken of women between the age group of 20-70 years in this study. A total of 150 smears were stained with Pap stain and reported by following the New Bethesda system for Reporting Cervical Cytology, 2014.
Results: Out of 150 cases, 17 (11.33%) Pap smears were reported as unsatisfactory or inadequate, 126 (84%) were NILM (negative for intraepithelial lesion or malignancy). Non-specific inflammatory smears were found to be more predominant among NILM. Epithelial cell abnormalities were reported in 07 (4.66%) pap smears examinations. Atypical squamous cells of undetermined significance (ASC-US) in 03(2%) cases, Low grade squamous intraepithelial lesion (LSIL) in 01(0.66%) case, high grade squamous intraepithelial lesion (HSIL) in 01(0.66%) case and squamous cell carcinoma (SCC) were also found in 01(0.66%) case. The most prevalent age group for epithelial cell abnormalities was 40-50 years.
Conclusion: Pap smears is an effective, non-invasive modality and useful in the detection of early diagnosis of cervical cancer and pre-cancerous cervical lesions. 

CORRELATION OF SPLENIC WEIGHT WITH THE WEIGHT AND SEX OF AN INDIVIDUAL – A CROSS SECTION STUDY

Ravi Shankar G, Roopa C R, Mohammed Ismail, Shilpa D

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1258-1263

Background:The normal weight of the spleen various from 80 – 300 gm various tcxt books describe the measurement of splenic weight but not it’s correlation with the weight of an individual. As per the data available there are few studies done, correlating the splenic weight and weight of an individual. Clinically weight of the spleen is more significant. Hence this study has been taken up with the criteria of ultrasonographic measurement of splenic weight and its correlation with weight of an individual. Objective: To estimate splenic weight in correlation with the weight and sex of an individual.
Materials and Methods: The study was conducted in department of Radio diagnosis, Raichur Institute Medical Sciences and Navodaya Medical College Hospital, Raichur, 500 individuals were selected for the study based on inclusion and exclusion and criteria. Splenic dimensions were measured with the help of Ultrasound and Splenic weight was calculated with the help of formula. Weight of the individual was measured in Kgs with the help of weighing machine and statistical analysis was done using formulas.
Results: The weight of the Spleen increases proportionately with increase in weight of individual.(F = 5.835, P<0.001) in Males, (F = 2.697, P = 0.02) in Females.
Conclusion: The relation between Splenic weight and weight of an individual is significantly positive.

TO DETERMINE THE EFFICACY OF ULTRASOUND IN THE DIAGNOSIS OF NECK SWELLINGS

Dr SeemaPandey, Dr Neetu Singh, Dr Mahendra Mehta, Dr Sunil Sanga

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1264-1271

Aim: To determine the efficacy of ultrasound in the diagnosis of neckswellings.
Methods: This research comprised 50 instances with clinically evident swellings in the neck area. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ultrasonography diagnosis were assessed for each group of neck swellings. The sensitivity analysis for such a tiny number is invalid since there were only three congenital swellings.
Results: Our research comprised patients of various ages, with a minimum age of 25 days and a maximum age of 82 years, with a mean age of 37.5 years. In our research, 15 (30%) of the patients were men, whereas 35 (70%) were girls.  According to the research, about two-thirds (32) of neck swellings were solid, 5 were cystic, and 13 swellings contained both solid and cystic components. In our investigation, 64% of clinically firm swellings were determined to be solid, whereas the rest were either completely cystic or mixed in nature. This research found that the Sensitivity, Specificity, PPV, and NPV of the US for inflammatory swellings are 87 percent, 97 percent, 95 percent, and 92 percent, respectively. The sensitivity analysis of clinical diagnosis and ultrasound diagnostic for inflammatory swellings.The sensitivity of US in identifying malignant lesions of the neck in 50 patients with neck swellings was 87 percent in this research, with a specificity of 99 percent, PPV 93 percent, and NPV 97 percent.
Conclusion: US can tell the difference between solid and cystic neck swellings, as well as malignant and benign neck swellings. It may detect thyroid, salivary gland, and lymph node lesions, as well as differentiate between abscess and cellulitis.

“A Clinico-pathological study ofcervical lymphadenopathy”

Arunkumar D, Pratibha Arun, Neeta PN

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1272-1277

Cervical lymphadenopathy is one of the commonpresenting complaints of patient in surgical
OPD (out-patient department). FineNeedle Aspiration Cytology (FNAC) is one of the
mostreliable, less expensive, and basic diagnostic procedure forthe definitive and conclusive
diagnosis of the immunesystem which presents in the form of enlarged lymphnodes. A study
was conducted in surgery Department of Fr. Muller Medical College Hospital, Manipal from
May 2011 and March 2013 on 102 patients with enlarged cervical lymphnodes. FNAC was
done to make the diagnosis. Out of 102 patients 22.5 % tubercular,57.8%chronic NSL 4.9%
Hodgkin’s lymphoma and 14.8 % were malignant. FNACis one of the most dependable
diagnostic tools in case ofcervical lymphadenopathy for early diagnosis and detectionfor the
better management.

A study on Adverse events following COVID-19 immunization(AEFI), Vaccination Awareness and Preference among people visiting vaccination centre, Shivamogga Institute of Medical Sciences, Shivamogga, Karnataka.

Dr. Shashikiran G M, Dr. Darshitha R, Dr. Kanchana Nagendra, Dr. Raghavendraswamy Koppad

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1278-1286

INTRODUCTION: Corona virus Disease is a fatal viral disease that continues to trouble
many countries around the world. Immunization is one of the most effective and costefficient
initiatives ever, saving millions of lives every year. COVID-19 vaccines are
considered to be of great importance in preventing and controlling the disease. This study
aimed to estimate AEFI, COVID-19 vaccine awareness, preference among people visiting
vaccination centre, SIMS, Shimoga. OBJECTIVE: 1. To estimate AEFI among people
visiting vaccination centre, SIMS, Shimoga. 2. To estimate COVID-19 vaccine awareness
and preference among people visiting vaccination centre, SIMS, Shimoga

“STUDY OF HEMATOLOGICAL PARAMETRS IN EARLY DIAGNOSIS OF NEONATAL SEPTICEMIA IN TERTIARY CARE CENTER”

Dr Hetal Joshi(Senior Resident) , Dr Ashwini Shukla (Professor) , Dr Drashti Patel (Senior Resident) Dr Toral Jivani (Associate Professor)

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1287-1298

Neonatal Sepsis is the most commonly observed and the important cause for
neonatal morbidity as well as mortality in our country(1,2). Neonatal Sepsis is difficult to
diagnose clinically because of non- specific symptoms of disease presentation. Appropriate as
well as timely diagnosis of the disease is most important factor to reduce mortality and
morbidity in the neonates

Characteristics in Thoracic Trauma Patients with Primary Chest Tube Affecting Length of Stay and Mortality Rate

Vasan , Puruhito , Dhihintia Jiwangga S.W

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1299-1309

Background:Thoracic trauma is the third leading cause of death after abdominal trauma and
head trauma. However, many studies show significant differences that affect morbidity and
mortality. Severe injuries to the thorax can increase the mortality rate by 25% to 30%. This
research was done in order to find predictor characteristics affecting the length of stay and
mortality in thoracic trauma patients.[1,2]
Method: A Retrospective analysis was performed on thoracic trauma patients who had primary
chest tube insertion initial therapy. Data were collected from June 2017 to October 2021 from
medical records in Dr. Soetomo teaching hospital Surabaya. Chi-square was used to compare
the variables, and Multivariabel Logistic Regression was used to identify independent predictor
for length of stay and mortality. The independet predictors were demographics, complication,
and surgical therapy during admission. P-value < 0.05 was considered statistically significant.

AN ECO-FRIENDLY ALTERNATIVE TO XYLENE FOR DEPARAFFINIZATION IN THE HEMATOXYLIN AND EOSIN PROCEDURE.

Dr PREETHI, Dr.SAI SUDHA.M, Dr ANBUMOZHI

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1310-1313

Introduction :
xylene is the widely used deparaffinizing agent in the Hematoxylin and Eosin procedure
because of its high solvent property. It is biohazardous in nature and causes toxic effects to
health. Hence there is need for the development of safer xylene alternatives in
histopathological procedures.
Aim :
The present study aims to assess the efficacy of eco-friendly Sweet lime juice as a
deparaffinizing agents in Hematoxylin & Eosin procedure and to compare it with routine
Hematoxylin & Eosin procedure using xylene as a deparaffinizing agent.
Materials and methods:
The present study includes 50 paraffin embedded blocks, two sections were prepared from
each block. One section( Group A) was stained with routine H & E stain with xylene and the
other section(Group B) was stained with xylene -free H &E stain with sweet lime juice as
deparaffinizing agent. Stained slides were examined by the pathologist and scores were given
to the staining parameters like cytoplasmic and nuclear staining, clarity, crispness and
uniformity of staining.
Results:
Staining parameters of all the group A and group B sections were examined and compared
with each other. Group B sections with sweet lime juice shows 85 % adequacy of staining for
the diagnosis.
Conclusion :
The results of the present study observed that the sweet lime juice can be used as safer and
eco-friendly substitute to xylene for deparaffinization in Hematoxylin and Eosin staining
procedure

To Evaluate the Efficacy of Disinfection Methods for Operation Theatres at a Tertiary Care Hospital

Dr. P. Subashini, Dr. M. Ramakumar, Dr. Shaweez Fathima S, Dr. B Ananthi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1314-1322

Introduction
Disinfectants play a vital role in global infection control as a crucial weapon against the transmission of nosocomial pathogens/infections combating global disease outbreak. Because of   the multifactor causation of infections, the environment of operation theatre plays a great role in the onset and spread of infections
Materials And Methods
This is an analytical study conducted at a Teaching hospital, Sri Lalithambigai Medical College and Hospital, from July 2021-May 2022, with a 600- sample size collected before and after applying successive techniques of different disinfecting agents in operation theatres.
Results
In our study, the OT1 colony forming unit was higher than OT 2 CFU (Table 1 and 2) which may be due to human activity that significantly increases the bacterial count and reaches the peak at the end of the day in both the OTs
 
Conclusion
Newer less toxic disinfecting agents are alternative to formalin and may be used at short intervals for better outcome. The expenditure involved in use of these environment friendly disinfecting agents are worth the money spent, in comparison to formaldehyde considering the long-term harmful impact that can have on surgical personnel.

Study of Clinical Profile in Chronic Kidney Disease Patients Undergoing Dialysis in Tertiary Care Hospital in South Gujarat

Dr Priyank R Parmar, Dr Vandana Dhangar, Dr Mit Panchani, Dr Bijoy Desai

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1323-1333

Chronic Kidney disease (CKD) is characterized by change in kidney structure and function with different clinical manifestations, like its cause, severity and the rate of progression. Initial stages of CKD are often not symptomatic and may be reversible, which are detected during the evaluation of other comorbidities. This study was taken up to highlight the clinical presentation, etiology & complications in patients with CKD undergoing dialysis at tertiary care hospital in south Gujarat. The study was conducted among indoor patients diagnosed as chronic kidney disease to our tertiary care hospital &   OPD Patients.  Global quality of life scale was used for assessing quality of life. For renal size, renal length was considered from radiological studies. Blood investigations include complete blood count (CBC), Liver function test (LFT), Renal function test (RFT), calcium, phosphate, uric acid, thyroid profile, urine routine, coagulation profile, vitamin B12 & D3, Amylase, Ferritin, PTH, Mg, HbA1c, arterial blood gas (ABG), HIV, HBsAg, HCV. Radiological investigations include Chest Xray, Ultrasonography. Data will be entered in MS EXCEL spread sheet. Descriptive statistic applied as frequency and percentage. Most common cause observed foe CKD in this study was diabetes followed by hypertension. Upon identifying the risk factors in the general population, regular clinical and biochemical screening amongst them can help to halt or delay the reversible causes or process leading to the development of end-stage renal disease (ESRD). This will eventually decrease the mortality and morbidity in the general population having the risk factors for ESRD.
 

A Clinical Study of Palmoplantar Dermatoses in a Tertiary Care Teaching Hospital

Dr. Sandhya Rani Kakarla, Dr. Rachakonda Ramesh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1334-1341

Background: Palms and soles are affected by various dermatological diseases. There is no universally approved classification for palmoplantar dermatoses. They can be classified based on the causes into inflammation, infection, papulosquamous, and keratinization disorders. The current study aimed to evaluate various palmoplantar dermatoses presented to our tertiary care teaching institute in South India.
Methods: A total of n=60 cases of palmoplantar dermatoses were included in the study based on the inclusion and exclusion criteria. A thorough medical history was also taken, including information on the length of the disease, previous treatments, illnesses that ran in the family, and any pertinent co-morbidities. Each person underwent a general and dermatological check-up. The soles and palms were carefully inspected. Wet mount and 10% potassium hydroxide mount were used for scaly lesions, and Gram stain was used for pustular lesions.
Results: Eczema was seen in n=28(35%) of cases followed by fungal infection in n=18(22.5%) cases. Psoriasis in n=12(15%) of cases warts in n=7(8.75%) cases, palmoplantar hyperhidrosis in n=6(7.5%) cases, Pitted keratolysis in n=5(6.25%) cases, Callosity in n=4(5.00%) cases. Pruritus was present in n=45(56.25%) cases and was the most commonest symptom followed by pain in n=38(47.5%) cases some patients were having both the symptoms and n=22(27.5%) cases were without any symptoms. Based on seasonal variations n=16(20.0) cases were exacerbation in the winter season, followed by n=12(15.0) cases in the summer season and n=10 (12.5%) cases found exacerbation in the monsoon season and no relation to the season was found in n=42(52.5%) cases.
Conclusion: The diverse range of illnesses known as palmoplantar dermatoses has many different forms. These conditions cannot be categorized according to any accepted criteria. The majority of research on palmoplantar dermatoses concentrated on particular illnesses. There aren't many thorough investigations on palms and soles that are available in the medical literature. This study emphasizes the need for extensive research in palmoplantar dermatoses with a large population.

Retinopathy of Prematurity Incidence and Risk factors in low-birth-weight Neonates Admitted in SNCU

Dr. Akula Kalyani, Dr. Subhan Basha Bukkapatnam, Dr. Guguloth Latha

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1342-1348

Background: Retinopathy of prematurity (ROP) affects the developing retinal vasculature in premature neonates and is a complex condition. It typically happens in neonates who have undergone critical care, particularly those who have received prolonged oxygen therapy and those who have numerous other risk factors. the current study evaluated the incidence of ROP in preterm infants with a gestational age of fewer than 36 weeks of gestational age or a birth weight of less than 2000 gm admitted to SNCU.
Methods: This cross-sectional study was conducted at SNCU of Kakatiya Medical College and MGM Hospital, Warangal. ROP screening examinations can have short-term effects on blood pressure, heart rate, and respiratory function in the premature baby, examinations were kept as short as possible and precautions are taken to ensure that emergencies were dealt with promptly and effectively. The discomfort to the baby was minimized by pre-treatment of the eyes with a topical Proparacaine and swaddling the baby. Babies were fed at least one hour before the examination to avoid vomiting and aspiration.
Results: A total of n=102 babies were screened for the Incidence of Retinopathy of Prematurity (ROP) Overall incidence of ROP in the study was n=32(31.4%) the female to male ratio is 1.6:1. Out of the n=32 babies with ROP n=11 babies had stage 1 disease, n=13 babies had stage 2, n=5 babies had stage 3 disease, and n=2 babies had stage 4 disease. Out of n=32 babies, ROP positive cases n=2 babies had the disease in zone 1, n=2 babies had the disease in zone 1 & 2, n=6 babies had the disease in zone 2, n=10 babies had the disease in zone 2 & 3, n=12 babies had the disease in zone 3.
Conclusion: The incidence of ROP in the current study was found to be 31.4% and 40.63% of these cases were in the stage 2 ROP. The gestational age of neonates in the current study was taken to less than 36 weeks because low gestational age is an independent risk factor for ROP. On univariate analysis, the duration of oxygen administration, clinical sepsis, apnoea, RDS, ventilation history, CPAP duration, neonatal jaundice, NEC, and hypotension are significantly associated with ROP.

Study on Maternal Outcome in a Government Tertiary Care Hospital, Adilabad, Telangana

Dr. Vijayalakshmi Eruva , Dr. Vinod Balla , Mushigampula. Kavya Tharangini

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1356-1362

Pregnancy is a time of unparalleled joy and expectations. Pregnancy and childbirth have a huge impact on the physical, mental, emotional, and socioeconomic health of women and their families . Pregnancy-related health outcomes are influenced by a woman's health and other factors like race, ethnicity, age, and income. Most pregnancies have a healthy outcome but for others pregnancy can be times of intense fear. This study is done to estimate the proportions of different maternal outcomes and to identify the factors associated with different outcomes in Government Tertiary Care Hospital,  Adilabad, Telangana . This is a cross sectional study done at hospital of Rajiv Gandhi institute of  Medical Sciences , Adilabad in 2018 year . 1272 Antenatal mothers  who came for delivery in RIMS  were included in this study. Objectives of this study was to estimate the proportions of different maternal outcomes and to identify the factors associated with different outcomes .Among the three maternal deaths two were because of hemorrhage and one death is due to eclampsia  .Majority ICU admissions due to Pre eclampsia, Eclampsia, hemorrhage .This study showed relatively high mortality and morbidity as majority cases were referred  very late in critical condition and there used be no time to give appropriate care.Mothers who died had no prior ANC visits, were from rural area and due to either Eclampsia or hemorrhage and all of them had severe anemia. Early identification of high risk cases at community level and early referral, easy transport, continued skill base training to health care professionals will solve the problem to some extent.

Comparative Study of the Effectiveness of District Mental Health Programme

Dr. Neha Bharti, Dr. Nupur Niharika, Dr. Aparna Kadambri

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1363-1370

Background: Mental, neurological, and substance use (MNS) disorders are major contributors to morbidity and premature mortality. 14% of the global burden of disease can be attributed to MNS disorders. It is estimated that 6-7 % of population suffers from mental disorders. District mental health programs (DMHP) are run in many districts of India and an effective strategy to provide mental health care to rural populations.
Objectives: To study the effectiveness of District Mental Health Programme and to assess the subject satisfaction.
Methods: The study was carried out at DMHP clinic in GMC, Bettiah. psychiatry department. 100 cases and 100 controls were selected, after meeting the inclusion and exclusion criteria. Diagnosis made as ICD-10 by treating psychiatrists. Patient satisfaction questionnaire (PSQ -18) and global assessment of functioning scale were administered to both groups.
Conclusion: More female (64.0%) and people from LSES (67.0%) accessed DMHP clinic than medical college psychiatry department (39.0%). None of the patients were aware of DMHP programme.

To Study the Prognosis of Non Proliferative Diabetic Retinopathy In Association with Risk Factors Like Hba1c, Lipid Profile and Urine Microalbumin

Dr. Pranay Kumar, Dr. Rajiv Kumar Singh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1371-1378

Background: Diabetes mellitus is a common and serious disease with chronic complications and constitutes a substantial burden for both patient and health care system. Objectives: To find out the association between the level of Glycosylated Heamoglobin [HBA1c] With the prognosis of Non Proliferative Diabetic Retinopathy (NPDR).
Material and methods: 100 patients with type 2 diabetes visiting the Opthalmology OPD and IPD from Sept 2020 to July 2022 .at, SKMCH, Muzaffarpur. were taken up for the study. Conclusion: The present study shown that elevated level HBA1C levels are found to be the potent predictors of progression of diabetic retinopathy . Hypercholesterolemia was found to be significantly associated with severe NPDR, very severe NPDR . Raised serum cholesterol level was also significantly associated with CSME. patients with urine Microalbuminuria are more likely to have severe diabetic retinopathy . Early diagnosis and prompt treatment in these patients can reduce the onset and progression of retinopathy.

A Prospective Study on High Sensitivity C-Reactive Protein (hs-CRP) in Children to Distinguish between Severe and Non-Severe Dengue fever

Dr. Prabakar. S, DR.Vikram. R , Dr. Jaganathan .R

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1379-1385

Introduction: Dengue infection can cause a wide spectrum of clinical outcomes. The severe clinical manifestations occur sufficiently late in the disease course, during day 4–6 of illness. Markers of inflammation may be useful biomarkers. There exists a paucity  of research on high sensitivity  C-reactive protein (hs-CRP) levels in dengue children. We investigated the value of hs-CRP to predict dengue disease severity in children and the difference in hs-CRP levels between dengue patients and healthy controls.
Materials and Methods: This  study was conducted in the Department of Paediatrics, Madha Medical College and Research  Institute, Chennai (Oct 2021- May 2022).
Results: The study included 31 pediatric dengue patients. The median (IQR) hs-CRP in dengue patients was 46.59 mg/L (34.8, 67.0). The median (IQR) hs-CRP in healthy controls was 0.530 (0.00-2.7) mg/L. The difference was statistically significant (P < 0.001). Median (IQR) hs-CRP in severe and non-severe dengue patients were 46.59 (34.77, 68.43) and 46.67 (24.33, 63.79) mg/L respectively which was statistically not significant (p = 0.85).
Conclusions: In summary, significantly higher  hs-CRP levels were present  in dengue  children as compared to healthy controls. But there was no significant difference in hs-CRP levels between severe and non-severe dengue patients.

Investigating Cardiac Dysfunctions Among Chronic Liver Disease Patients

Shobha Kumar Prasad, Anil Kumar Mehta

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1386-1390

Background- Chronic liver disease (CLD) causes pathological alterations in the
myocardium in addition to the typical hemodynamic abnormalities. Since the reduced
systemic vascular resistance usually compensates for overt heart failure, cardiac
pathology is frequently disregarded.
Methods- The current investigation was carried out at the Darbhanga Medical College
& Hospital, Darbhanga as an observational study. A total of 75 patients with chronic
liver disease were included in the study. After being interviewed, their demographic
data, symptoms, and presentation were collected. Then, all of the patients underwent
thorough physical examinations, 2D ECHO and ECG cardiological assessments, and
blood investigations.
Results: Patients without cardiac dysfunction had a mean age of 40.3 years, whereas
those with cardiac dysfunction had a mean age of 46.25 years. Cardiac dysfunctions in
CLD patients most frequently affected individuals between the ages of 51 and 60, and
96% of cases included men and 4% involved women. In 28% of individuals, QTc
prolongation was identified. Diastolic dysfunctions were common in 24% of CLD
patients, while systolic dysfunctions were common in 20% of them.
Conclusion- In order to consider the presence of CV dysfunction and cirrhotic
cardiomyopathy in CLD patients and estimate the risk of unfavourable cardiac events,
a high level of awareness is required. To enhance these individuals' prognoses, more
research is required on particular therapy approaches

In Type 2 Diabetes, A Study Examined the Correlation Between Serum Ferritin and Hba1c

Sajjad Ahsan, Nazish Raza, Zamin Ahsan, P K Aggrawal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1397-1401

Background: Diabetes mellitus type 2 (DMT2) is one of the most prevalent endocrine
illnesses, affecting about 135 million individuals globally. The disease's genesis is
unknown, but subclinical hemochromatosis has recently been identified as one of the
possible causes of DM. The purpose of this study was to look at the association between
serum ferritin as a measure of iron excess and diabetes and HbA1c.
Methods: This 12-month study was carried out in the Medicine department of Katihar
Medical College Hospital in Bihar, India. 46 patients with T2DM were used as cases in
this case control study. The control group consisted of 46 healthy individuals who were
age, gender, BMI, and haemoglobin percent matched to the case group. Blood samples
were tested for ferritin, haemoglobin, HbA1c, and fasting plasma sugar. Anaemia and
any other ailment or medicine that could alter ferritin levels were exclusion criteria.
Result: The Pearson correlation coefficient test, Student's t-test, Chi-square test, and
Odds ratio were used to assess the results statistically. Diabetics had considerably
higher mean serum ferritin levels than the control group (197.97± 75.99 gm/L vs. 64.24±
27.83 gm/L, p<0.001). In diabetic patients, there was a substantial positive connection
between HbA1c and serum ferritin (p<0.001). In this investigation, an OR of 11.64 was
also discovered.
Conclusion: Serum ferritin levels are associated with T2DM patients. This could be a
significant and independent predictor of the development of diabetes mellitus

A Study of Bedaquiline-Containing Regimens for MDR and XDR-TB Treatment

Shailendra Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1402-1406

Introduction: Due to its protracted duration, toxicity, high expense, and unfavourable
results, the treatment of multidrug-resistant (MDR)/extensively drug-resistant (XDR)
tuberculosis (TB) has proven difficult during the past few decades.
Methods: A prospective study with 50 drug-resistant tuberculosis patients who are
taking bedaquiline as part of a treatment regimen and who meet the requirements of
being over 18 years old, all genders, and having biological samples that show drug
resistance that has been confirmed by phenotypic or genetic testing.
Results: Nausea was the most frequent side effect, followed by diarrhoea, joint
discomfort, anorexia, and itching. There was no hepatotoxic effect.
Conclusion: A regimen using bedaquiline produced positive results. The benefit clearly
justifies the risk even though bedaquiline and concurrent anti-TB medicines have the
potential to lengthen QTc interval.

A Retrospective Study on Cardiovascular Risk Factors Among Acute Coronary Syndrome Inpatients

Jyoti Prakash Lal Karn

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1407-1411

Background- Patients with myocardial infarction (MI) who are in the acute vs chronic stable phase are at a higher long-term risk for recurrent cardiovascular events. This study was carried out to assess the risk factors for cardiovascular (CVD) morbidity and all-cause mortality, as well as to establish the interval between the acute and chronic stable phases of illness.
Methods- The study included 120 patients with acute coronary syndrome who were diagnosed with the condition and were admitted to the Darbhanga Medical College & Hospital, Department of Cardiology.
Results- In this study, 40% of the patients did not meet the criteria for MS, while 60% of the patients had metabolic syndrome. There are 14 females and 58 males in the MS+ category. The study's participants have an average age of 51.3 years. Patients with and without metabolic syndrome have a similar mean age of 52.3 and 48.9 years, respectively. Patients with metabolic syndrome were found to have a history of hypertension, smoking, diabetes, obesity, and coronary artery disease in proportions of 25, 5, 45, 8, 29, 20, 8, and 16, respectively. History of hypertension is the only factor of statistical significance.Males met 34 of the three criteria for metabolic syndrome, 17 of the four, and 2 of the five requirements for multiple sclerosis. Three females met three of the metabolic syndrome's criteria, seven met four, and four met all five.
Conclusion- The elderly were most frequently impacted. Smoking was the risk factor that was discovered in this investigation to be present most frequently.

Acute ST-elevation Myocardial Infarction in India: Diagnosis and Treatment

B. B. Bharti

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1412-1419

Myocardial infarction (MI) is a condition associated with ischemic heart disease that can be fatal. It is brought on by sudden obstruction of a coronary artery, which usually results from the formation of a thrombus over an atherosclerotic plaque that has become dissected, ulcerated, or haemorrhaged, and causes myocardial ischemia necrosis. Despite therapeutic breakthroughs, it still has a high mortality rate (10–30%), with many deaths due to ventricular tachyarrhythmias happening in the first few hours; strangely, these can be readily avoided in an intensive care setting but happen before the patient arrives at the hospital. Based only on clinical considerations. The examination of chest pain, the primary symptom of MI, must be understood to recognise the condition. It might be challenging to determine the origin of chest discomfort because it is a symptom that is frequently present in outpatient clinics and emergency rooms.This review highlights the diagnosis and treatment procedures of acute ST-elevation myocardial infarction among Indian patients.

Nepafenac punctal plugs delivery system- potency in inflammation following cataract surgery

Samia Rahman

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1420-1424

Aim: The purpose of this study was to determine the safety and effectiveness of a nepafenac punctal plug delivery system (N-PPDS) after cataract surgery.
Methods: The investigation was carried out in a single Indian clinical setting. It is a single-center, randomised, parallel-arm, double-masked, prospective pilot research. Thirty-eight participants (aged 22 and higher) with predicted postcataract correctable distant vision of 20/30 or better and lower puncta enabling dilatation up to 1.0 mm were included in the study (N-PPDS group). All of the eyes had standard unilateral cataract surgery with intraocular lens implantation. Postoperative ocular discomfort and inflammation were used as primary and secondary efficacy measures, respectively.
Results: The experimental N-PPDS group had 38 patients, while the control group included 18 individuals. The N-PPDS group had a substantially greater proportion of pain-free patients (22/32 [69%] after 3 days, P =.038; and 24/36 [67%] at 7 days, P =.018). The N-PPDS group had a larger percentage of pain-free patients (15/29 [52 percent]) at all visits (P =.001). At 7 days, the N-PPDS group had good anterior chamber cell scores (patients with no anterior chamber cells: 18/36 [50%]; P =.034). At 14 days, the plug retention rate was 98 percent (55/56).
Conclusion: Adverse events associated with the punctal plug therapy occurred in 1 case of the N-PPDS group involving placement. The N-PPDS was shown to be both safe and effective in the treatment of ocular discomfort and inflammation following cataract surgery.

Malignant Gastric Neoplasm and Its Peritoneal Metastases in Relation withCA 125 Levels: A Cross Sectional Study from a Tertiary Care Hospital of Bihar

Major Ragini Thapa,Col Alok Sen,Major Amit Rajan,Col Ravikant Narain, Suchismita

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1425-1430

Gastric cancer is a malignant tumor with a fifth position amid all cancers and its mortality rate is third, globally. But the frequency varies in several parts of the world. In India, amongst men it is the fifth most common cancer and in women it is in seventh position. The objective was to study the clinical significance of serum CA125 and its relation to PD in cases of gastric cancer.Materials and Methods: An observational study with cross-sectional design was conducted by the Department of Pathology, Indira Gandhi Institute of Medical Science, Patna, Bihar, India from May 2021 to April 2022 were studied. The study included samples from 25 patients during this duration. Approval from the Institutional Ethics Committee and written informed consent from the patients was taken.All the gastrectomy specimens were sent for gross examination, staging and histopathology. The paraffin embedded tissue blocks were subsequently stained for H&E.Microsoft excel 2016 and Statistical Package for the Social Sciences (SPSS) version 18 (SPSS, Inc. Chicago, IL, USA) was used for data analysis.Results:TNM staging was done. T3 stage (16, 53.3%) comprised the major bulk of the cases followed by T2 (7, 23.3%), T4 (5, 16.7%) and T1 (2, 6.7%). Likewise, N2 nodal staging (18, 60%) was leading followed by N0 (9, 30%), N1 (2, 6.7%) and N3 (1, 3.3%). Distal metastasis was noted among 36.7% (11 cases) of the cases with liver as the most common site of metastasis followed by PD, left supraclavicular lymph node, and multiple metastases. Majority of the cases were stage IIIA (17, 56.7%) and stage IV (12, 40%).Conclusion: Early detection of peritoneal disease will help the clinicians to stratify the treatment of gastric cancers and to decide whether to go for surgical or palliative intervention.

Expression of P53 In Ovarian Tumors’ And Its Correlation To The Morphological Differentiation: Report From A Tertiary Care Hospital Of Bihar

Major Ragini Thapa,Col Ravikant Narain,Major Amit Rajan,Col Alok Sen, Suchismita

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1431-1436

Ovarian tumors represent 3% of female malignancies, with over 140,000 worldwide annual associated deaths.Epithelial tumors constitute over 90% of all the ovarian cancers.This study aims to evaluate the expression of p53 by immunohistochemistry (IHC) in the different histological types and grades of epithelial ovarian tumors (EOT) and attempts to compare it with various Clinicopathological prognostic factors, namely, age, clinical presentation, stage, gross morphology, histopathology, grade, serum CA-125, etc.Materials and Methods: EOT specimens from 40 patients received in the Department of Pathology, Indira Gandhi Institute of Medical Science, Patna, Bihar, India from January 2021 to December 2021 were studied. Ethics committee permission was obtained, and ethical practices were followed. All specimens obtained were subjected to detailed gross and histopathological examinations.Results: Among the 40 cases of EOT, 24 (60%) were benign, 6 (15%) were borderline, and rest 10 (25%) were malignant. Serous malignancies were the largest group with followed by mucinous and clear cell carcinomas.Conclusion: Understanding of p53 staining patterns is mandatory to use it along with a panel of other antibodies for the correct classification and further research of morphologically confusing EOT

Sensitivity and specificity of RT PCR and HRCT Thorax for Confirmed Diagnosis ofCOVID-19

Siddharth Singh,Santosh Kumar Nayan,Sumeet Kumar,Abhay Kumar, Sweta Muni,Deepak Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1437-1444

Introduction:TheCOVID-19pandemichasrepeatedlyhittheplanetwithawaveofinfection.Clinicians are attempting to defend public health care ethics. Asymptomatic COVID-19 casesgounrecorded,andthemajorityofthemisolatethemselves.Significantradiologicalabnormalities have been discovered in RT-PCR positive asymptomatic COVID-19 cases,accordingto studies.
Objective:Thegoalofthiscross-sectionalstudyistoevaluateasymptomaticRT-PCR-positivepatients'chest CT findingsin oneof India's COVID-designatedinstitutions in a tertiary care centre in Bihar.
Methods: In three months, we did HRCT chest of diverse (200 patient case study) proved andprobableinstances of COVID-19 infection. All patients are underwent HRCT chest by multislice (128 slice) Toshiba CT scan (Aquilion) or 16 slice Toshiba CT scan. The following CT parameters were used: collimation 5mm; slice thickness, 0.5- 2.5 mm; reconstruction interval, 2.5 mm; table speed 13.5 mm per rotation; 150 -250 mA effective current; tube potential 120kVp; and matrix size, 512 x 512. the patient was examined in supine position with both arms extended above the head. All CT chest were taken in caudocranial direction, covering entire chest from diaphragmatic dome up to lung apex, without intravenous contrast administration. The image finally send to PACS for reporting.
Results: Positive HRCT chest results were detected in 196 of 200 scanned individuals withclinical complaints and suspicion, indicating clinical-radiological association and an accuracyof 98 percent. Based on positive RT-PCR data, the sensitivity of chest CT in suggestingCOVID-19was98.6%(146/148patients).90percent(18/20)ofpatientswithnegativeRTPCRresultsandsignificantclinicalsuspicionhadpositivechestCTfindings.
Conclusion:InlaboratorynegativeRT-PCRcaseswithstrongclinicalsuspicionofCOVID-19infection,HRCTchestisparticularly sensitive and accurate in detecting up lung parenchymal abnormalities, as well asin all symptomatic patients whose RT-PCR was not done. In patients with a strong clinicalsuspicion,HRCTcanbeexceedinglysensitive,cost-effective,andtime-effective.HRCT outperformsRT-PCRintermsofprovidingimmediateresults,measuringdiseaseseverity,andprognosisprediction.
InallpatientswithclinicalsymptomsandsuspicionofCOVIDinfection,regardlessoflaboratoryRT-PCRstatus,werecommendHRCTchestforidentificationofearlyparenchymalabnormalities and determining diseaseseverity.

Surgical outcome assessment in femoral fracture patients with or without teriparatide treatment

Dr. SAMUDRALA SREENIVAS, Dr. SAINATH REDDY MANDA, Dr. SAMUDRALA VIPANCHI

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1445-1450

Introduction: Femoral fracture and atypical subtrochanteric fracture are thought to be uncommon side effects of long-term bisphosphonate treatment. Delay in bone healing may be caused by a decreased rate of bone turnover. Limited research has shown that teriparatide therapy may counteract the effects of bisphosphonates and promote bone repair.
Methods: A retrospective assessment of individuals with atypical subtrochanteric and femoral fractures associated with the use of bisphosphonates were examined. There were 18 female patients signed up. The characteristics of an unusual fracture were congruent with the radiographic findings. All underwent surgical intervention, and teriparatide usage was suggested after surgery. Perioperative results, clinical, and radiographic outcomes were all considered outcome indicators.

Retrospective evaluation of atypical periprosthetic femoral fractures and its associated risk factors

Dr. SAMUDRALA SREENIVAS, Dr. SAINATH REDDY MANDA, Dr. SAMUDRALA VIPANCHI

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1451-1458

Aim: To evaluate atypical periprosthetic femoral fractures, its outcomes and its associated risk factors.
Methodology: This is a retrospective observational study carried out during duration of 2 years (April 2020 - March, 2022 at the Traumatology Department of college. All consecutive adult patients admitted with subtrochanteric or shaft fractures were evaluated with respect to the following inclusion and exclusion criteria. Inclusion criteria are based on the clinical and radiological features of AFF as defined by the American Society for Bone and Mineral Research major criteria. During the study period, 90 patients with subtrochanteric or femoral shaft fractures treated in the hospital that met the inclusion criteria. Of these, 10 patients had bilateral fractures on presentation. Surgeries were performed by trauma surgeons, and patients underwent standard rehabilitation following the procedure. Demographic information and surgical details were recorded from the hospital electronic records. The quality of reduction was evaluated by the postoperative standard X-rays in the anteroposterior (AP) and lateral views using digital pictures. 

STUDY ON VOCAL CORD PALSY AMONG PATIENTS ATTENDING ENT DEPARTMENT OF A MEDICAL COLLEGE HOSPITAL

Mrinalini Raman, Rakesh Kumar, Pawan Kumar Lal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1459-1465

Background:A multitude of muscles govern the vocal cords (VC), which are delicate structures in the larynx. The present study was done to learn more about the symptoms and indications of VC paralysis, as well as the muscles implicated and the systemic disorders that cause it.
Materials and Methods: It was a hospital based cross-sectional study undertaken at a Medical College in the department of ENT. Individuals between the ages of 15 and 75 were selected if they were willing to participate in the study. Individuals who were too old, reluctant, extremely sick, had pulmonary tuberculosis, or were HIV positive were all omitted. The symptoms were carefully tabulated, and a detailed history was taken. These individuals were subjected to a thorough ENT examination, which included both indirect and video laryngoscopy.
Results: A total of 43 individuals with VC paralysis were studied. The most typical age group is the fifth to sixth decade of life, and males are more likely to be involved. Most common side involved was Left (48.8%). The most common symptoms are hoarseness of voice and cough with expectoration. Idiopathic cases followed by pulmonary pathology were the common reasons.
Conclusion: Causes of vocal cord palsy vary with age, sex, presence of systemic diseases, side of lesion etc. Hence, a careful workup is needed in all cases with this condition.

STUDY OF SIALIC ACID AND NITRIC OXIDE IN TYPE 2 DIABETES MELLITUS WITH AND WITHOUT DIABETICNEPHROPATHY

A. Jyotsna, T. Aruna Kumari, G. Anil Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1466-1478

Background:In diabetes, acute phase reactants are taken into consideration to be diagnostic indications of both microvascular angiopathy and cardiovascular mortality. The chemical sialic acid is an example of one of these acute phase reactants. A deficiency in the amount of bioavailable nitric oxide has been hypothesised to be responsible for the endothelial dysfunction that is commonly linked with diabetes. It has been demonstrated that the vasodilatation that is dependent on NO plays a crucial role in the regulation and maintenance of vascular tone in renal microcirculation.Objectives:1.To evaluate and compare concentrations of serum sialic acid, nitric oxide, glycated haemoglobin, serum lipid profile (TC, TG, LDL, HDL), Urinary Albumin Creatinine Ratio (UACR) in diabetic patients with and without nephropathy and healthy controls.2.To correlate serum sialic acid with glycated haemoglobin, lipid profile, and UACR in diabetics with and without nephropathy.3.To correlate serum nitric oxide with glycated haemoglobin, lipid profile, UACR in diabetics with and without nephropathy.
Materials and Methods: 80 subjects participated. 40 healthy individuals and 80 diabetics were studied. Diabetes with nephropathy and diabetes without nephropathy were each 40 cases. Serum sialic acid was quantified by Ehrlich's reagent, serum nitric oxide by Kinetic cadmium reduction, serum glycated haemoglobin and urine microalbumin by immunoturbidimetric, urinary creatinine by modified Jaffee's method, and TC, TG, HDL by enzymatic methods. Friedewald's formula found LDL.
Results: Age of controls was 51.0 6.8 years, diabetic cases were 53.0 7.5 years, and diabetic nephropathy was 52.5 7.5 years. In the 40 controls, 22 were male and 18 were female. 19 of the 40 diabetic patients were male and 21 were female. 19 of the 40 diabetic nephropathy patients were male and 21 were female. There was no significant difference between the sex distribution of controls and cases (p>0.05). The mean concentrations of all the parameters except serum nitric oxide and HDL were significantly increased in cases when compared with healthy controls. Sialic acid showed a positive correlation with glycated haemoglobin, lipid profile, and UACR. HDL showed a negative correlation. Nitric oxide showed a negative correlation with glycated haemoglobin, lipid profile, UACR. HDL showed a positive correlation.
Conclusion: Serum sialic acid and nitric oxide are indicators of diabetes and diabetic nephropathy, according to the study. Dyslipidemia and glycemic control are affected. Early measurement of sialic acid and nitric oxide helps reduce diabetes complications.

PLATELET INDICES AS USEFUL INDICATORS OF NEONATAL SEPSIS

Venkata Sri Laxmi, Pravallika Mallipeddi, Varun Kanakam

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1479-1484

Background:Neonatal septicemia is a clinical syndrome characterized by signs and symptoms of infection with accompanying bacteremia in the first month of life. Despite continuing advances in diagnosis and treatment, it remains one of the important causes of higher mortality and morbidity.Aim of our study is to evaluate the changes of platelet count and indices (MPV, PDW) in neonatal sepsis.
Materials and Methods: It is a prospective crossectional study conducted in Tertiary health center (PRATHIMA INSTITUTE OF MEDICAL SCIENCES) in the DEPARTMENT OF PATHOLOGY in colloboration with neonatology section over a time period of 7 months from January to August 2019.Using convenient sampling method, 100 neonates with sepsis and 100 normal neonates without any medical problems, as the control group were selected. Weight and gestational age matched healthy neonates without any infectious disease served as control. The groups were compared for age, WBC count, neutrophil count, platelet count, PDW AND MPV.
Results: In our study out of 100 cases, early onset sepsis was present in 30 cases, while late onset neonatal sepsis was present in 70 cases.40 neonates showed culture positivity and the remaining 60 showed culture negative sepsis. Statistically significant correlation of MPV with platelet count(high MPV in thrombocytopenic neonates) and outcome. Significant difference in PDW in thrombocytopenic neonates and non-thrombocytopenic neonates. Neonates with sepsis have significantly increased MPV, PDW compared to healthy neonates.
Conclusion: Platelet count and indices can be used as early diagnostic markers in neonatal sepsis. Neonates with sepsis have significantly increased MPV, PDW compared to healthy neonates. Platelet indices are inexpensive and easily available tests can be routinely performed for all neonates suspected to be in sepsis.

EFFECTIVENESS OF PROJECT WORK AS A TEACHING LEARNING METHOD FOR TEACHING OF MEDICAL MICROBIOLOGY TO UNDERGRADUATE MEDICAL STUDENTS

RoopaC, Meharunnisa Indikar, B.V.V.V Tejaswani,Sunita Sudhir

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1485-1493

Background:This study was an interventional education research aiming to assess the effectiveness of project method of teaching when compared to traditional teaching methods in Medical Microbiology to undergraduate medical students.
Materials and Methods: A total of 162 students volunteered to get enrolled in this study.The students were broadly divided into Group A and Group B. Each of the groups was further divided into 20 small groups. Group A students worked on onetopic and Group B students worked on another topic. Each project had 30 – 35 slides in Microsoft PowerPoint format.The topics assigned for project work were taught again by didactic lecture after completion and submission of projects. Assessment for the topic was conducted by MCQs and feedback from students was collected regarding their experience during the project.
Results: Out of 208 students, total of 162 (77.88%) students volunteered to get enrolled.A total of 40 projects were submitted, out of which 16 groups scored between 61 to 80 points, 19 groups scored between 41 to 60 points and 5 groups scored between 21 to 40 points.The topics for project work were taught again by didactic lecture and average marks obtained by students who participated in project were higher than students who did not participate in project.The feedback displayed that 92% of students who participated in project enjoyed being part of it and that it helped them in gaining knowledge.
Conclusion: There was significant difference in marks of students who participated in project and also attended lecture when compared to students who did not participate in project or class. The students who agreed that they enjoyed being part of project did not find any difficulty in finding material on internet, and were willing to participate in similar projects in future. To conclude, project-based teaching and learning methods will aid in increasing interest and knowledge in the subject of Microbiology in medical students.

THE ROLE OF ANTIBIOTICS IN TREATMENT OF ANAL FISSURE

Dr.OmranEssaObaid .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1494-1500

Anal fissure is one of the most common anorectal conditions encountered in clinical practice. Most patients experience anal pain with defecation and minor bright red rectal bleeding, allowing a focused history to direct the evaluation.
This was a prospective, randomized, controlled clinical study conducted on 90 consecutive patients who presented to the general surgery outpatient clinic of Al - Hilla teaching Hospital Babil, between June 2019 and July 2021 were diagnosed with  anal fissure.
Although various non-surgical and surgical treatment meth­ods have been used, an ideal treatment method for acute anal fissure is still debatable. The topical antimicrobial treatment with metronidazole in addition to conventional medical treat­ments is an effective, easy-to-use, safe, fast and comfortable practice that enables further reduction of anal fissure pain and increases the healing rate.

A COMPARISON OF HICROM AGAR AND PCR - RFLP FOR THE IDENTIFICATION OF CANDIDA SPECIES

Saher Khan,Dr. Mastan Singh, Dr. Vineeta Khare

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1501-1509

Aim: The study’s aim was to compare the effectiveness of HiCHROMagar and PCR-restriction fragment length polymorphism (PCR-RFLP) in identifying Candida species in order to ascertain the advantages and drawbacks of each technique.
Methods: One hundred and twenty five Candida strains were isolated from different clinical specimens from patients admitted to different wards of Era's Lucknow Medical College. The Candida isolates were from urine, Sputum, Blood, vaginal swab, pus and nail. Clinical samples werecultured on Sabouraud-dextrose agar (SDA) with chloramphenicol for 48 h at 37 °C.to obtain candida colonies. Wet mount,Gram staining, germ tube, sugar fermentation and assimilation were performed for all isolates. Candida isolates on SDA were subcultured on HiCrome Candida Differential agar (HiMedia, Mumbai, India) for 24-48 hours; plates were incubated at 37 °C and was re-evaluated by employing digestion of the ITS1–5.8SrDNA–ITS2 region using Msp I restriction enzyme for RFLP and universal primers internal transcribed spacer 1(ITS1) and ITS4 for PCR amplification.
Results: Out of 125 patients 58.4% were female and remaining was male. The mean age of the patients was 44.76 years. Most of the sample collected from the urine..Candida isolates identified as C.albicans based on colour (light green) by HiCrome agar were in agreementwith PCR-RFLP while , the identifcation of the non albicans Candida species (C. krusei, C. glabrata ,C.parapsilosis and C. tropicalis) by colour code on HiCrome agar  showed a discrepancy with PCR–RFLP.
Conclusion:Hi chrome media has the benefit of being inexpensive and less challenging than other molecular methods, but it fail to clearly identify some uncommon candida species while RFLP-PCR employing ITSI and ITS4 primers and restriction enzyme is a trustworthy, and useful approach for identifying medically significant Candida spp. in clinical laboratories

A Comparative Study on the Efficacy of Dinoprostone Sustained Release Vaginal Insert Versus Intracervical Gel in Induction of Labour

Dr.Sangeeta Shah , Dr. Sindhu kodali , Dr.Sravanthi Kora , Dr.Apoorva kotha

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1510-1517

Induction of labor is the process of treatment that stimulates childbirth and delivery.
Inducing labor can be accomplished with pharmaceutical or non-pharmaceutical methods.
Inductions most often performed either with prostaglandin drug treatment alone or with a
combination of prostaglandin and intravenous oxytocin treatment. Commonly accepted
medical reasons for induction of labor includes prolonged pregnancy, premature rupture of
membranes, maternal conditions like preeclampsia, twin pregnancy, high BMI, and fetal
conditions like intrauterine growth restriction, premature termination of pregnancy like
abortions, intrauterine death or previous high risk pregnancy

EVALUATION OF THYROID PROFILE IN CIRRHOTIC PATIENTS AND ITS CORRELATION WITH CHILD PUGH SCORE

Dr Mayuri Singh, Dr Lalit Solanki, Dr Hiram Sanghvi, Dr Dushyant S. Patel

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1518-1524

Introduction:Liver plays vital role in metabolism of thyroid hormone. The liver is the most important organ in the peripheral conversion of tetraiodothyronine (T4) to T3 by Type 1 deiodinase1,2. Type I deiodinase is the major enzyme in the liver and accounts for approximately 30%–40% of extrathyroidal production of T3, it can carry out both 5’-and 5-deiodination of T4 to T3. Moreover, the liver is involved in thyroid hormone conjugation and excretion, as well as the synthesis of thyroid binding globulin3. T4 and T3 regulate the basal metabolic rate of all cells, including hepatocytes, and thus modulate hepatic function also. Thyroid diseases affect liver function; liver disease may affect thyroid hormone metabolism; and a variety of systemic diseases affect both the organs. There are clinical and laboratory associations between thyroid and liver diseases. Patients with chronic liver disease may have thyroiditis, hyperthyroidism, or hypothyroidism. Patients with subacute thyroiditis or hyperthyroidism may have liver function abnormalities, which return to normal as the thyroid function improves.4 Available studies suggest that the most frequent change is decreased total T3 and free T3 concentration which is reported to be associated with severity of hepatic dysfunction. Serum T4 levels either remain normal or slightly low. However, serum TSH levels remain normal or slightly raised. These changes in thyroid hormone levels are so well established that these can be used as a sensitive index of liver function.

TO STUDY THE CLINICAL PRESENTATION AND BIOCHEMICAL PROFILE OF PATIENT WITH MYOCARDIAL INFARCTION WITH NONOBSTRUCTIVE CORONARYARTERIES (MINOCA)

Dr. Pranshu Joshi, Dr. Pankaj Kumar Gupta, Dr. FarazAdil,Dr. ShubhamUpadhyay, Dr.Seema

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1525-1533

Background:Studies have reported a prevalence of MINOCA of 5% to 6% of AMI cases1. The demographic and clinical characteristics of MINOCA patients differ from other patients with MICAD.
Objective: To study theclinical presentation and biochemical profileof patient with Myocardial Infarction with non obstructive coronary arteries(MINOCA) in comparison to patient with Myocardial Infarction with obstructive coronary artery disease(MICAD).
Material and methods: Present study prospective comparative study was conducted in the Department of Cardiology, G.R. Medical College, Gwalior (M.P.) on an inpatient basis.Duration of study was One and half years. (Nov. 2019 to June 2021) A total of 214 patients presenting with Myocardial infarction who underwent coronary angiography were studied during this period. Our study consist of two groups of patients based on their angiographic findings that were patients with MINOCA (N=107) and patients with MI with obstructive coronary artery disease(MICAD) (N=107) which were compared based on their clinical profile and biochemical parameters.
Results: Chest pain was the most common presenting symptom among patients with MINOCA (70.1%) and Ghabrahat (83.2%) was the most common presenting symptom among patients with MICAD. Patients with MINOCA more commonly presents with atypical complaints (37.4%vs15.9%) whereas signs and symptoms of heart failure were less common among patients with MINOCA as compared to patients with MICAD.Biochemical Abnormalities like High random blood sugarlevels(8.4%vs30.8%),hypercholesterolemia(24.3%vs46.70%) and hypertriglyceridemia(8.40%vs23.40%) were less prevalent whereas reduced hemoglobin levels or Anemia (71%vs44.9%)was more prevalent among patients with MINOCA as compared to patients with MICAD.
Conclusion:Patients with MINOCA most commonly presents with chest pain. Atypical complaints was more common whereas symptoms and signs of heart failure were less common among patients with MINOCA as compared to patients with MICAD.Biochemical Abnormalities like High random blood sugar levels, hypercholesterolemia and hypertriglyceridemia were less prevalent whereas reduced hemoglobin levels (Anemia )was more prevelant among patients with MINOCA as compared to patients with MICAD.

A CLINICAL STUDY AND MANAGEMENT OF CARCINOMA PENIS IN TERTIARY CARE CENTRE

Dr. H. L. Prasad,Dr. Vijaya Bhaskar Reddy

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1534-1541

Background: Carcinoma of penis is a malignancy with wide range of clinical and pathological presentation. Disease ranges from local primary lymph node infiltration to distant metastasis. Although rare in western countries, constitutes a major substantial health concern in many developing countries including India. Proper evaluation of both the primary lesion and lymph nodes is critical because nodal involvement is the most important factor for survival. This study undertaken to study incidence with age, religion and SES and to study risk factors and its management.
Methods: A descriptive study was conducted among 30 patients proven carcinoma penis in KR hospital Mysuru during period from November 2017 to June 2019. Data was collected with meticulous history clinical examination and appropriate investigation and follow up of the patient.
Results: In our study the maximum incidence was found to be in the age group of 50 to 70.youngest was 35 year and oldest was 76 year old.Muslims were free of diseases due early circumcision and all cases were hindus.In our study 86.6% of the patients associated with carcinoma penis were smokers. Commonest symptom of presentation was proliferative growth (76%).The most common site of origin was Glans penis. The average time interval between onset of symptoms and seeking medical advice is 7 months. The most common surgery performed was partial penectomy 73.3% and majority biopsy report was SCC. Moderately and poorly differentiated tumors had a very strong association with nodal involvement.
Conclusion: Carcinoma penis can be avoided by better penile hygiene and circumcision. It is a curable disease, if detected early and treated properly. The surgery is the mainstay of treating the carcinoma of penis. Creating awareness in public is the only way to reduce the mortality and morbidity due to carcinoma of penis.

A CASE REPORT COLLODION BABY IN BREECH DELIVERY

Dr. Yalamanchili Sneha,Dr. Nilofer Saleem,Dr. Bhavana Kambhampati,, Dr.Gayathri.K.B

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1542-1545

Harlequin foetus is an uncommon and severe form of congenital ichthyosis that is inherited as autosomal recessive which affects about one in every 3,00,000 live births. This ailment is fatal at birth. The skin is severely keratinized and horned, similar to that of an alligator as  HI has been associated to a mutation in the ABCA12 gene, genetic counselling and mutation screening of this gene should be considered. This is a case report of such a baby at birth

CORRELATION OF SEROLOGICAL MARKERS AND PLATELET COUNT IN DENGUE PATIENTS

Dr. Srividya Yeruva,Dr. Sowjanya Rakam,Dr.Pravallika Mallipeddi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1546-1553

Introduction: Dengue virus infection has emerged as a notable public health problem in recent decades . Laboratory evaluation of  dengue  Serological markers and  platelet count help in early diagnosis and can be used as predictor to reduce the morbidity and mortality of dengue disease.
Aim: Aim of  this  study is  to evaluate  Dengue  serological  markers for early diagnosis of cases  and to study  the correlation between  serological markers  and  platelet count  in dengue positive cases .
Materials and Methods: This was a cross-sectional prospective study  conducted  in  the Tertiary  health care centre , Hyderabad..  All clinically suspected cases of dengue, reported  to various outpatient departments, emergency services and admitted patients in the Hospital were included for this study,  from  July to   September   2018 . The Chi-Square test and statistical software Epi info and MS excel was used to find out the statistical significance of the estimate.
Results:   Among  700 blood  samples were  received from clinically suspected case of dengue , 125 (17.85%)  cases  were detected dengue positive  out of which  65 (52%) cases showed platelet count less than 1 lakh. . In confirmed dengue cases, thrombocytopenia is more consistently found in  dengue  positive cases  with only IgM  and only NS1 positive cases compared to other serological groups.
Conclusion: Detection of  dengue specific serological markers along with platelet count  in the diagnosis of dengue, increases the early diagnosis so as to avoid complications significantly and can be used as prognostic marker to reduce the morbidity and moratlity of dengue disease.

EVALUATION OF SOCIO-CLINICAL CHARACTERISTICS OF SOLITARY NODULE OF THYROID: A HOSPITAL BASED PROSPECTIVE STUDY

Dr. Suresh, Dr. M A Balakrishna

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1554-1559

Background: Solitary thyroid nodule is one of the most frequent presentations of thyroid disorder. This study aimed to evaluate the Socio-clinical Characteristics of Solitary Nodule of Thyroid at Krishna Rajendra Hospital, Mysore.
Methods: This prospective study included 55 patients, who were clinically diagnosed as solitary nodule of thyroid in the Department of Surgery at K R Hospital attached to MMC & RI, Mysore during the period of 18 months from January 2011 to July 2012. All patients were subjected to thyroid profile, USG & FNAC examination.
Results: The peak age at presentation of solitary nodule thyroid was 3rd to 5th decade, constituting about 43(78%) of the cases .It was more common in females with the ratio M:F(49/6) = 1:8.16 and  in euthyroid state(95%).  Its commonest presentation was swelling in front of neck and maximum had duration of symptoms between 1-2 years. 28 (50.9%) presented with nodule in right lobe of the thyroid gland and 27(49.1%) in the left lobe. Most of the patients 31(56.4%), were presented with the size of about 3 to 5 cm. Its Common causes were MNG (33%), follicular adenoma(25%) and adenomatous goitre(25%). FNAC was an important investigation in the evaluation.
Conclusion: Solitary nodule of thyroid were more common in females , in  the age group of 20-50years, present with swelling in front of neck, had duration of symptoms between 1-2 years, presented with nodule in right lobe of the thyroid gland , size of about 3 to 5 cm, mostly in euthyroid state and the commonest cause was multi-nodular goiter

CLINICO-PATHOLOGICAL PRESENTATION AND MANAGEMENT OF SOLITARY NODULE OF THYROID AT TERTIARY CARE HOSPITAL

Dr. Suresh, Dr. M A Balakrishna

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1560-1568

Background: A good understanding of the clinico-pathological presentation and treatment of solitary thyroid nodules is crucial since they might signify a variety of thyroid diseases. In light of this, the current study aims to assess the clinico-pathological presentation and care of a single thyroid nodule at Krishna Rajendra Hospital in Mysore.
Methods: During the 18-month period from January 2011 to July 2012, 55 patients with clinically determined solitary thyroid nodules were enrolled in this prospective study. They were admitted to the Department of Surgery at K R Hospital, which is affiliated with MMC & RI, Mysore. All patients underwent a thyroid profile, USG, FNAC, and histo-pathological evaluated, operated, and were properly followed up.
Results: The majority of cases 43(78%) of solitary nodule thyroid presented between the third and fifth decade. These cases were more prevalent in women (89.1%) and were in a euthyroid state (95% ). The swelling in front of the neck was the most typical symptom, and the highest symptom duration was 1-2 years. There were 27 cases of thyroid nodules in the left lobe and 28 cases in the right lobe of the thyroid gland. The majority of the patients 31(56.4%) presented with sizes between 3 and 5 cm. MNG (33%), follicular adenoma (25%), and adenomatous goiter (25%) were its most frequent causes. Most of these were benign (89%) with Incidence of malignancy was about 10.9%. The most common malignancy was papillary carcinoma (67%), followed by follicular carcinoma(33%) Male to female ratio in case of malignant nodule was 1:5. Incidence of carcinoma in males presenting as thyroid nodule was higher 1 out of 6 (16.67%) compared to that of females 5 out of 49 (10.20%). FNAC was an important investigation in the evaluation, Surgery had been the treatment of choice in most of the cases and Transient hypocalcemia was common after total thyroidectomy for malignancies.
Conclusion: Solitary thyroid nodules are more common in women, especially in the age range of 20 to 50 years. They typically present with neck swelling, last for one to two years, and have a nodule in the right thyroid lobe that is between 3 and 5 cm in size, in a euthyroid state, and for the most part, benign in nature. Multi-nodular goitre was the most frequent cause, Papillary carcinoma is the most prevalent thyroid cancer, and surgery had been the preferred course of action.

CASE SERIES TREATMENT OUTCOMES IN CLINICALLY DIAGNOSED CASES OF ACUTE RETINAL NECROSIS: A CASE SERIES

Dr Ashish Athale, Dr.Priyanka, Dr Mansi Kishnani Dr Anagha Chawhan

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1569-1573

We study the clinical characteristics and treatment outcomes in clinically diagnosed cases of Acute Retinal Necrosis (ARN).The medical records of six patients were retrospectively reviewed. All cases were found to have peripheral retinitis more than 180 degrees. All six patients responded well with resolution of retinal lesions taking a mean time of 6.4 weeks. Steroids in the form of oral Prednisolone was given in all 6  patients. Retinal detachment developed in five patients, for which they underwent Vitreo-retinal surgery.. Final visual acuity was  20/200 or better in 3 out of  of 6 patients in our study. A timely diagnosis , early systemic treatment and later on management of complications is important to achieve better results.                                                                                                

“Incidence, Clinical Profile, Treatment Protocol and Outcome of Rhino-Maxillary Orbital Mucormycosis in Government Medical College Hospital, Nizamabad, Telangana, India: A Prospective Study and Mini – Review of Literature”

Bokhari K, Vasantha Gudla, Sujatha Asadi, Prathima Raj, Samson, Gupta A

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1574-1584

Introduction: mucormycosis (ROCM) is a aggressive infection and in patient with co-morbidities, the mortality rises upto 50%. Rhino-orbitocerebral mucormycosis (ROCM) is the more common in patients with poor diabetic control and usually manifests itself as nasal stuffiness, nasal discharge, facial pain. Eye signs involve opthalmoplagia, proptosis and in advanced stages loss of vision.
Material & Methods:
This is a prospective, cross-sectional study involving patients who reported to our centre and those patients who were referred from other hospital for treatment of mucormycosis during the second of COVID-19 during april – june 2021.
Results:Majority of the patients were above 50 years of age and the most common co-morbidity was diabetes. Maxilla was more commonly involved than mandible. Posaconazole along with surgical debridement effectively controlled the disease process. All the patients were disease free at 6 months follow up
Discussion: Combined team work, creating a task force team for mucormycosis, effective anti-fungal therapy along with surgical debridement played a key role in management of mucormycosis with no recurrence. Control of co-morbidities remained as part of the patient care and has helped in control of the disease process and prevention of secondary infections

Prediction of length and diameter of semitendinosus graft for anterior cruciate ligament reconstruction using anthropometric parameters, age, gender and physical activities

Dr. Harshith.R, Dr. Prabhakaran.A, Dr. Krishnagopal . R

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1585-1593

Background: The knee joint is one of the most commonly injured joint and the most commonly injured ligament in knee is the anterior cruciate ligament Multiple graft option exist for reconstruction of ACL of which semitendinosus graft is one of the favoured graft . Study aimed to correlate the anthropometric parameters, age, gender, physical activities with intraoperative length and diameter of semitendinosus graft to facilitate ligament reconstruction .
Methodology: It is a prospective study done at Mahatma Gandhi Medical College and Research Institute, Pondicherry between January 2020 and September 2021 where all patients with anterior cruciate ligament injury coming to the OPD and Emergency medical services department satisfying inclusion and exclusion criteria were selected and included in the study
Results: The present study included total of 35 patients after obtaining the informed consent. The mean age of patients in the study was found to be 33.18±6.99yrs of age. Among the included patients, majority were male patients (85.7%) compared to female patients (14.3%) with male to female ratio of 6:1. Side of involvement was majority with right side (71.4%) followed with left side of involvement (28.6%). There was a significant positive strength of association between the height and graft length (r=0.602, p<0.01). There was a significant positive strength of association between the thigh length and graft length (r=0.556, p<0.01). There was a significant positive strength of association between the thigh circumference and graft diameter (r=0.346, p<0.05). Similarly the physical activity was significantly positive strength of association with the graft diameter (r=0.452, p<0.05).
Conclusion: In present study height of the patients, thigh length, thigh circumference and the physical activity were strongly positively correlated with the requirement of graft diameter and the length of graft required.

Radiological profile of dengue among infants at a tertiary care hospital with special reference to increased resistive index of middle cerebral artery: A cross sectional study

Dr Santosh Karpur Dr Anupam Bahe Dr Deepali Vagdalker Dr Mahesh Chander D

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1594-1604

Background: Ultrasonography is readily available and is non-invasive which gives quick results. It tells about severity of dengue among infants. It is a promising tool. It can help in management and assessing severity of dengue.
Objective: To study radiological profile of dengue among infants with special reference to increased resistive index of middle cerebral artery
Methods: Retrospective study on subjects admitted with infant dengue was done for two years. Data of 98 infants admitted with Dengue were collected from medical records department. Data of infant dengue with congenital heart disease, comorbidities like sepsis and known case primary immunodeficiency were excluded. Radiological findings of ultrasound abdomen & thorax of the subjects were recorded. 

Outcome of the Proximal Humerus Fractures in Adults Fixed with Proximal Humerus Internal Locking System (PHILOS) Plate by using Deltopectoral Approach

Dr. Anis Surti, Dr. Rajendra Prasad Ghosliya, Dr. Mukul Jain, Dr. Naveen. S, Dr. Harish Kumar Jain

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1605-1616

Background: One of the most frequent fractures and ones with treatment options that can be challenging is proximal humerus fractures. With a focus on technical challenges and issues, the study's objective is to evaluate the effectiveness and functional outcome of PHILOS (proximal humerus internal locking system) plates in proximal humerus fractures.
Materials and Methods: This investigation was carried out at the Jhalawar Medical College Hospital's Orthopaedics Department. 22 patients who had suffered proximal humerus fractures were included in the study. Through a Deltopectoral approach, they received treatment with PHILOS (proximal humerus internal locking system) plates. Patients were assessed clinically and radiologically with the relevant X-rays at each follow-up.
Results: Our series of patients' end outcomes were assessed using Neer rating standards. In 18 (81.81%) of the patients we treated in our facility, we got good to excellent results. According to Neer's Criteria, all patients who had outstanding results or good results had normal muscle function and functional range of motion. In 4 (18.18%) of the patients, the outcomes were unsatisfactory. One of the patients developed plate impingement and was unable to abduct over 90 degrees. One case of Varus malunion occurred, decreasing neck shaft angle by 120 degrees, which is seen as inadequate. These patients' compliance and regular follow-up were inadequate.
Conclusion: In proximal humeral fractures, particularly comminuted fractures and osteoporotic bones in elderly patients, the PHILOS plate provides a mechanically and biologically advantageous implant, enabling early mobilisation.

Comparative Study Between Nasal Smear Eosinophilia And Absolute Eosinophilic Count In Children With Allergic Rhinitis

Sandhya V, Ranganath K R, Madhusudan S R, Prabhavathi R

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1617-1621

Introduction: AR is the most common chronic disorder in the pediatric population with up to 40% of children affected. Confirmation of allergen as etiologic agent is difficult in a small setup, where IgE estimation and allergy tests are not accessible. Aim: to evaluate the value of nasal smear eosinophil count as a simple non invasive & inexpensive method for diagnosing allergic rhinitis and its correlation with blood absolute eosinophil count (AEC) in patients with allergic rhinitis (AR). Method: Prospective hospital based study of 100 allergic rhinitis pediatric patients. The study duration was 1 year from June, 2015 till May, 2016. Children who attended pediatric out patient department of Dr.B.R. Ambedkar Medical College and Hospital, Bangalore, Karnataka, with symptoms of allergic rhinitis were included. A total of 100 such children were taken into the study. Results:  Seventy five percent subjects had eosinophils more than 10 cells/hpf [p = 0.03]. Correlation coefficient between nasal eosinophil and blood eosinophil was positive though weak [r=0.2, p = 0.04]. Conclusion:  Nasal eosinophil count can be used as a weak predictor of blood eosinophil count and a strong predictor of allergic rhinitis.

A Study on Histopathology of Salivary Gland Lesions- A Panoramic view

Dr. Mythri BM, Dr. Geethamala K, Dr. V.Srinivasa Murthy

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1622-1634

Background: The salivary gland lesions are rare in occurrence but could be because of various causes like congenital anomalies, inflammation, infections, cysts or neoplasms which can be either benign or malignant. The salivary gland tumors account for 2- 6.5% of all the head and neck tumours. Salivary glands lesions always pose diagnostic dilemmas. Histopathological diagnosis with routine hematoxylin and eosin staining in conjunction with minimal assistance using histochemistry and immunohistochemistry plays a considerable role in the diagnosis of these lesions.
Objectives of the study:

To review various histopathological lesions of Salivary gland.
To classify salivary gland tumors according to WHO Classification.
To determine the age, sex and site distribution of various salivary gland lesions.

Materials and Methods:
This is a 5 year retrospective study done from Jan 2010 to Dec 2015 in our medical college and hospital including all the salivary gland lesions. Data was archived and demographic details and histopathological features were analyzed.
Results:
Male preponderance was noted with parotid gland being the commonly afflicted salivary gland. Pleomorphic adenoma and mucoepidermoid carcinoma were the commonest benign and malignant tumours respectively. From age wise distribution, it is observed that nonneoplastic lesions had varied distribution from first to fourth decade of life. Benign tumours of salivary glands were common in the second to fourth decade and malignant tumours were seen from fourth to fifth decade onwards.
Conclusion: The present study emphasizes the fact that salivary gland lesions are rare in occurrence and reveal comprehensive histopathological lesions. Histochemistry and immunohistochemistry act as an adjunct to routine hematoxylin-eosin staining in arduous cases. The pathologist must conscientiously quest through the whole enchilada of salivary gland lesions and discern benign and malignant tumors which ease and guides in further management.

A Study of Pleural Biopsy for the Diagnosis of Exudative Pleural Effusion

Dr. Sai Krishna Bandi, Dr. Ramesh Pawar, Dr. Sandeep Jadhav

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1635-1640

Background: Exudative pleural effusion often requires detailed investigations which include cytology, biochemical and microbial examinations. However, in some cases the diagnosis may remain elusive they are labeled as undiagnosed exudative pleural effusion. We in the current study tried to evaluate the etiological diagnosis of exudative pleural effusion by pleural biopsy.
Methods: This cross-sectional study was conducted in the Department of Pulmonology, Rajiv Gandhi Institute of Medical Sciences, Adilabad. Thoracocentesis was done and pleural fluid was sent for cytological examination, biochemical, examination, and microbiological profile assessment to determine the cause of the effusion. The undiagnosed cases of exudative pleural effusion were subjected to pleural biopsy.
Results: A total of n=45 cases of the pleural biopsy were included in this study. The gross appearance of the pleural fluid in cases was straw-colored in 100% of cases of tuberculosis and hemorrhagic in 75% of cases of malignancy. The diagnosis of tuberculosis and malignancy was made in 17.77% of cases each. The mean LDH values were 856 ± 210.36 vs 482.98 ± 115.66 p values were 0.012 considered significant. The ADA values were 40.36 ± 2.9 vs 18.44 ± 3.1 p=0.021 were considered significant.
Conclusion: Pleural biopsy when done in cases where thoracocentesis and cytological examination, biochemical, examination, and microbiological profile assessment failed to determine the cause of the effusion is a useful procedure. It may be used when facilities of thoracoscopy and imaging-guided cutting needle biopsies are not available.

A CROSS SECTIONAL COMPARITIVE STUDY OF METABOLIC SYNDROME IN PSORIASIS AND CHRONIC ECZEMA IN A TERTIARY CARE HOSPITAL OF ODISHA, A STATE IN EASTERN INDIA

Dr Kiran Vinayak, Dr J R Dash, Dr C R Srinivas,Dr Farzana N, Dr Hemanta Kumar Kar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1641-1649

Introduction: Psoriasis is a chronic inflammatory disease of skin and joint associated with cardiovascular morbidity.Previous studies have shown higher prevalence of metabolic syndrome in psoriasis patients.
Material & Methods: In this study 60 adult patients from each group with psoriasis and chronic eczemawere included for assessment of metabolic syndrome.Metabolic syndrome was diagnosed based on the presence of three or more criteria of the National Cholesterol Education Program, Adult Panel III (ATP III) with Asian modification for waist circumference.
Results: Metabolic syndrome was significantly more common in psoriatic patients than in eczema patients ((23)38.3% VS (13) 21.6%) P=0.046. Psoriatic patients had a higher prevalence of triglyceridemia, low HDL levels and elevated blood sugaras compared to those findings in chronic eczema group of patients.
Conclusion: In view of our study showing strong association between metabolic syndrome and psoriasis, it is recommended that all psoriasis patients should be screened for early detection of metabolic syndrome so as to prevent mortality and morbidity related to metabolic syndrome. In eczema, the prevalence of metabolic syndrome is comparable to that observed in normal population of this region.

To Compare The Perioperative Benefits Of Oral Midazolam And Oral Clonidine In Patients Undergoing Major Abdominal Surgeries Under General Anaesthesia

Dipty Agrawal, Jugal Kishor Agarwal, Aijaz Ahmad, Vinay Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1650-1658

Background: One of the challenges for anaesthesiologists is to minimize distress for patients in the operating room (OR) environment and to facilitate a smooth induction of anesthesia.A sedative drug is given before transfer to the OR. The beneficial effects of anxiolytic are sedation, anxiolysis, reduction of postoperative vomiting andpostoperative emergence phenomenon. Clonidine, an α 2-agonist, have been suggested as another option for premedication as effective as midazolam.
Materials and Methods: 50 patients were randomly divided into two groups.To one group Tab. Midazolam 7.5 mg was given while to other group Tab. Clonidine 100 µg was given one hour before induction ofanesthesia.Patients were evaluated and compared for benefits of preoperative oral midazolam and oral clonidine on sedation scores, perioperative hemodynamic parameters and perioperative opioid and analgesic requirement. Independent sample t-test was used and p-value < 0.05 was considered significant.
Results: We found that mean OAA/S sedation score in clonidine group was 11.48 ± 1.12 than in midazolam group13.68 ±1.03withsignificant difference ofp value (p<0.001).There was significant (P < 0.05) attenuation of hemodynamic response to intubation, surgical stress response and extubation with clonidine as compared to midazolam .None of the patients desaturatedin either group. Opioid requirement(72%)was more in midazolam group as compared to clonidine (28%)group. Recovery in clonidine group took slightly longer time 60.00 ± 13.77min as compared to midazolam group 44.40±13.25 min.
Conclusion: Premedication with 100 micrograms of oral clonidine can reasonably be recommended as premedication in ASA I and II patients for all surgeries to provide more sedation, stable hemodynamics intraoperatively, reduction in stress response,less opioid consumption.

EFFECTIVENESS OF SPINAL ANESTHESIA VERSUS GENERAL ANESTHESIA FOR OPEN CHOLECYSTECTOMY: AN INSTITUTIONAL BASED STUDY

Mamta Damor, Rajendra Verma, Hemant Jingar, Rekha Roat

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1659-1665

Introduction: Cholecystectomy is performed either as an open or a laparoscopic route. Despite of a number of peri-operative and post-operative benefits of laparoscopic cholecystectomy, the traditional and invasive open cholecystectomy is still in frequent practice for various reasons. Therefore, this study was conducted to compare the effectiveness of SA for open cholecystectomy versus GA with respect to reducing post operative pain, analgesia requirement, respiratory complications and length of hospital stay.
Materials and Methodology: One hundred and forty patients were allocated randomly into two groups—SA group (spinal anaesthesia group, n = 70) and GA group (general anaesthesia group, n =70). And the two groups were divided as SA group underwent open cholecystectomy under spinal anaesthesia whereas GA group had undergone it under general anaesthesia.
Results: Out of all the 140 patients, 70 patients were allotted in each group, there were 120 females (85.85%) and 20 males (14.17%). Their age mostly ranged between 18 – 70 years, with a mean of 42.35 ± 12.66 years. There was no statistically significant difference between both the study groups with respect to age, sex distribution, body mass index (BMI) and ASA physical status. Intra-operatively, bradycardia and hypotension were more common in the SA group. Bradycardia less than 50/ min in 12 patients (16.66%) were treated by atropine 0.6mg IV. Bradycardia was the only side effect noted in both groups.
Conclusion: Since the conventional use of general anaesthesia in open cholecystectomy, this study displays that spinal anaesthesia is also a recommended alternative. It is therefore safe and more effective than general anaesthesia in providing prolonged post-operative pain-free interval, less analgesic/ opioid requirement and no reported respiratory problems.

A HOSPITAL BASED PROSPECTIVE STUDY TO CORRELATE THE SEVERITY OF CHRONIC RENAL FAILURE AND ALTERATIONS OF THYROID INDICES AT TERTIARY CARE CENTRE

Sawan Agrawal, Regia Sultana, Suvajit Chakraborty, Rahul Deb Chakrabarty, Babul Akhtar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1666-1672

Background: The evaluation of thyroid function in systemic illness remains complex because the changes occur at all levels of the hypothalamic-pituitary-thyroid axis. So, it is prudent for the internist and treating physician to be aware of thyroid dysfunction so that early intervention can be instituted to improve the outcome. The aim of this study to correlate the severity of chronic renal failure and alteration of thyroid indices at tertiary care centre.
Materials& Methods: A hospital based prospective study done on 40 chronic renal failure patients admitted in medical ward at KPC Medical College, Jadavpur, Kolkata, West Bangal, India during one year period. Patients who fulfill the criteria for CRF and who are on conservative management were taken for the study. The correlation between the thyroid indices were analyzed and interpreted by the Karl Pearson’s coefficient(r). The interpretation of statistical procedures was performed by the statistical package SPSS (22.0 V). The value of P<0.05 was considered as significant.
Results: Among 40 patients, 10 patients were female, and 30patients were male. The mean age of the male and female patients was 52.76±11.65 and 50.45±7.32 years respectively. The prevalence of low T3 syndrome was 52.5% (21 cases) and the low T4 syndrome was 22.5 % (9 cases). The prevalence of TSH in hypothyroidism range was 5% (2cases). Among the males 46.66% of patients had low T3 syndrome. And among the females was 70%. The difference was not statistically significant P>0.05. The prevalence of low T4 among the males was 20% and among the females was 30%. The difference among the sexes was not statistically significant i.e. P>0.05. Theprevalence of TSH in clinical hypothyroidism range among males was 3.33% and among the females was 10%. The prevalence between the sexes was not statistically significant(P>0.05).
Conclusion: We concluded that serum level of total T3 and free T4 is directly proportional to creatinine clearance level. Alteration in the values of T3 and T4 occurs as a part of body adaptation mechanism to conserve energy.

ASSOCIATION OF ABDOMINAL OBESITY WITH PEAK EXPIRATORY FLOW RATE IN ADULT INDIAN MALES

Anju Goel, Taruna, Manisha Gupta, Prateek Agrawal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1673-1679

Background: Obesity is linked to a wide range of respiratory diseases such as asthma, chronic obstructive pulmonary disease, obstructive sleep apnoea, pulmonary embolic disease and aspiration pneumonia.
Aims and Objective: To assess the correlation between Obesity markers (BMI and waist circumference) and PEFR in adult males.
Material and Methods: One hundred male subjects in the age group of 20-50 years were recruited, their obesity parameters BMI and WC were recorded by standard methods and Peak expiratory flow rates by Mini Wright’s Peak flow meter.
Results: Pearson’s correlation coefficient showed a significant negative correlation of BMI with PEFR (r = -0.3885) and Waist circumference with PEFR (r = -0.4010, p<0.05). Conclusion: Obesity produces significant deterioration in the PEFR.

EFFECTIVENESS OF CHILDBIRTH EDUCATION PROGRAMME ON KNOWLEDGE, INTRAPARTUM BEHAVIOR, AND PREGNANCY OUTCOME AMONG SELECTED PRIMIGRAVIDA MOTHERS AT AIIMS, JODHPUR

Neha Sharma, Himanshu Vyas, Pratibha Singh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1680-1690

Introduction: A childbirth education programme empowers the women to participate in the birthing process with complete psychological preparation, helping to preserve her energy and gain control over the birthing process. Knowledge about labor process affects possible pregnancy outcome in Primigravida mothers.
Methods: This experimental study with Non- equivalent post test only design was conducted on a sample of 200 Primigravida mothers, assigned into two groups, 100 in experimental group (implementation of child birth education programme) and 100 in control group (routine care). Data was collected at Department of Obs. and Gynae. AIIMS Jodhpur.
Results: Personal variables were comparable between experimental and control group. Significant difference was observed in knowledge score (Z score (N=200) =16.83, p<0.05), intrapartum behaviour (Z score (N=200) =14.80, p<0.05), and pregnancy outcome (Z score (N=200) =4.30, p<0.05) in control and experimental group. There is a Moderate positive correlation(r=0.611) between the knowledge score and intrapartum behavior.
Conclusion: The study concluded that childbirth education programme was found to be effective in significantly improving knowledge, intrapartum behavior and pregnancy outcome among Primigravida mothers. This study recommends that childbirth education programme need to be included as an essential part of antenatal care.

EVALUATION OF NERVE CONDUCTION VELOCITIES IN RADIOLOGIC TECHNOLOGISTS WORKERS OF A TERTIARY CARE HOSPITAL

Shalini Gandhi, Abhay Raina, Urvashi Miglani, Gaurav Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1691-1695

Background: Nerve conduction study (NCS) is developing as an important measuring device for confirmation of neurological disorders. The present study was conducted to assess nerve conduction velocities in radiologic technologists’ workers of a tertiary care hospital.
Material and methods: The current study was conducted to assess nerve conduction velocities in radiologic technologists’ workers of K.D. Medical College Hospital and Research Center, Mathura, Uttar Pradesh, India. 50 radiotechnologists with age between 30 and 60 years old were recruited. The selected cases were compared with another group of 50 healthy participants.NCS – in all subjects, NCS was performed by computerised RMS EMG EP Mark-II machine. Statistical analysis was done by descriptive and inferential statistics using Student’s unpaired t-test to compare between cases and controls. 
Results: The NCV of motor nerves among cases and control subjects in all the examined motor nerves, namely, median (cases –55.62±5.04m/s and controls –58.45±3.24m/s; P = 0.001), ulnar (cases –57.44±5.78m/s and controls –61.56±8.89m/s; P = 0.02), radial (cases –54.30±7.98m/s and controls –59.54±7.85m/s; P < 0.001), common peroneal (cases –46.78±5.43m/s and controls –51.67±5.56m/s; P < 0.001) and tibial nerves (cases –45.43±5.12m/s and controls –46.67±5.68m/s; P = 0.004) was statistically significant, where cases had significantly reduced conduction velocity compared to control subjects. The NCV of sensory nerves among cases and control subjects in all the examined sensory nerves, namely, median (cases –53.65±7.87m/s and controls –55.78±5.65m/s; P < 0.001), ulnar (cases 51.35±5.34–m/s and controls –58.91±6.56m/s; P < 0.001) and radial nerves (cases –55.54±9.68m/s and controls –64.86±9.89m/s; P< 0.001) was statistically significant, where cases had significantly reduced conduction velocity compared to control subjects.
Conclusion: The present study concluded thatthe NCV of motor nerves cases had significantly reduced conduction velocity compared to control subjects.The NCV of sensory nerves cases had significantly reduced conduction velocity compared to control subjects.

A HOSPITAL BASED OBSERVATIONAL STUDY TO CORRELATE THE CYTOLOGICAL FEATURES OF THE ASCITIC FLUID WITH CLINICAL DATA AT NEWLY ESTABLISHED TERTIARY CARE CENTER: A CLINICO-PATHOLOGICAL STUDY

Anil Kumar Sethiya, Madan Kumar Solanki, Hanuman Ram Choudhary

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1696-1705

Background: The proper evaluation of ascitic fluid helps in narrowing the diagnostic dilemma faced by the physicians and helps in better management of the patients. Early and accurate diagnosis often depends on appropriate ascitic fluid analysis. The aim of this study to correlate the cytological features of the ascitic fluid with clinical data at newly established tertiary care center.
Materials & Methods: A prospective study was conducted in the Department of Pathology, in a tertiary health care centre over a period of one year. Cytological examination was performed to reveal important information regarding the causes of ascites and classified as benign (with or without infection/ spontaneous bacterial peritonitis), suspicious or malignant conditions. Cytomorphology of the cells was studied and documented paying attention to cellular arrangement, cytoplasmic features and nuclear characteristics. Clinical information of the patient and cytomorphological features of the smears were studied and the samples were categorized into benign (with or without infection/ SBP), suspicious of malignancy or malignant.
Results: Our study showed that the mean age was 55.67 years. Out of 30 cases, 14 were males and 16 were females, with male to female ratio being 7:8. Out of 30 samples, 26 (86.66%) were benign, 2 (6.66%) were suspicious of malignancy, and 2 (6.66%) were positive for malignancy. The most frequent clinical diagnosis was Alcoholic Liver disease comprising of 8 (26.66%) cases. The predominant cell type was Lymphocyte in 14 (46.66%) of cases, Neutrophil in 9 (30%) of cases, Reactive mesothelial cell in 5 (16.66%) of cases and atypical/malignant cells in 2 (6.66%) of cases. Histiocytic cells were also seen.
Conclusion: We concluded that non neoplastic and neoplastic conditions causing ascites can be diagnosed on ascitic fluid cytology. Increased neutrophil count is strongly suggestive of spontaneous bacterial peritonitis (SBP). The careful cytomorphological examination of ascitic fluid is a valuable, simple, rapid, inexpensive and reliable technique in the differential diagnosis of ascites, particularly in resource limited settings.

EVALUATION OF SERUM LIPID PROFILE IN CHILDREN WITH NEPHROTIC SYNDROME: A PROSPECTIVE COHORT STUDY FROM NORTH INDIA

Bangalia, Satyendr Sonkariya, Chethan C.S., Laxman Singh Charan, Anil Kumar Jain

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1706-1712

Background: Nephrotic syndrome is a collection of clinical findings due to kidney damage. This includes protein in urine, low blood albumin levels, high blood lipids, and significant edema. The main cause of hyperlipidemia in patients with NS is probably increased hepatic lipogenesis, a non-specific reaction to falling oncotic pressure secondary to hypoalbuminemia. Hyperlipidemia is usually observed during the active phase of the disease and disappears with resolution of proteinuria. However, it may persist in some cases, leading to increased risk of atherosclerosis in later life and development of progressive renal injury. The current study was carried out to evaluate dyslipidemia in children with nephrotic syndrome.
Methods: This prospective cohort study was carried out at outpatient and inpatient units of Department of Pediatrics, JLN Medical College, Ajmer, Rajasthan, India during January 2020 to December 2020. A total of 60 consecutive children aged between one year and 18 years with newly diagnosed nephrotic syndrome or presenting with relapse of the disease. All patients were routinely monitored with daily weight, BP, abdominal girth, intake/output chart and urine albumin. Patients previously diagnosed with nephrotic syndrome with relapse were also admitted. Serum lipid profile was done by standard methods at three points of time: during disease activity, after attainment of remission and two weeks after completion of steroid therapy in steroid responsive nephrotic syndrome.
Results: Lipid parameters including mean total cholesterol, Triglyceride, LDL and VLDL were elevated at admission and these levels reduced significantly at remission and at completion of steroid therapy (All p values<0.001). There was significant elevation of mean total cholesterol level in case of relapse as compared to the first episode of nephrotic syndrome (p=0.048), however, LDL, VLDL and HDL were not significantly different. There was significant elevation of total cholesterol level at admission in subsequent relapses as compared to first episode of nephrotic syndrome (p=0.01).
Conclusion: In children with nephrotic syndrome, lipid parameters including mean total cholesterol, Triglyceride, LDL and VLDL were elevated at admission and these levels reduced significantly at remission and at completion of steroid therapy. Total cholesterol level was significantly elevated in children with relapse as compared to those with first episode of nephrotic syndrome.

A STUDY TO EVALUATE VON WILLEBRAND FACTOR IN TROPICAL DISEASES - SCRUB TYPHUS, DENGUE, CHIKUNGUNYA, MALARIA AND ITS ASSOCIATION WITH CLINICAL OUTCOME

Rishabh Parashar, R.K. Bhimwal, Ashwani Kumar Vyas, Sudhir Mehta

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1713-1724

Introduction: Endothelial activation and dysfunction is a central process in the pathogenesis of tropical diseases and von-Willebrand Factor levels have been linked with damage to the endothelium. The purpose of the study is to evaluate von Willebrand Factor in tropical diseases-Scrub typhus, Dengue, Chikungunya, Malaria and its association with clinical outcome. vWF can be used as a novel prognostic marker of clinical outcome.
Methodology: Hospital-based prospective observational analytic study on36 subjects of each disease. Inclusion Criteria: Confirmed cases of Scrub typhus (IgM positive), Dengue (NS1/IgM positive), Chikungunya (IgM positive) and Malaria (slide positive/rapid antigen detection/severe malaria). Exclusion criteria: Patients with von-Willebrand disease, Thrombotic Thrombocytopenic Purpura, and other conditions characterized by vascular damage, including nephritis, myocardial infarction, sepsis, diabetic angiopathy, peripheral vascular disease. Complete history with the examination was done. Investigations including CBC, PBF, RBS, RFT, LFT, vWF activity were done.
Observation and Results: In our study, we observed that vWF levels were elevated in91% patients of malaria, 89% patients of dengue, 75% patients of chikungunya, 88% patients of scrub typhus. We also found that 6, 3, and 3 out of 36 patients died in Malaria, Dengue, and Scrub typhus respectively with mean vWF was 414.67 IU/dl, 420 IU/dl, and 420 IU/dl respectively against alive cases where mean vWF was 259.97 IU/dl, 272.97 IU/dl, and 233.94 IU/dl. There is a statistically significant difference in vWF among alive and dead cases.
Conclusion: Raised vWF shows the association of von- Willebrand Factor activity and its association with the complications in these tropical diseases. von- Willebrand Factor level can be used as a novel prognostic marker of clinical outcome.

LIP RECONSTRUCTION: VARIOUS LOCAL / REGIONAL FLAPS

Shashidhar K, Swarnamba U N , Ravi Koppad , Shivashankar Ajur, Joseph John Menachery , Sunita yallannanavar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1725-1736

Background: Lip reconstruction after lip cancer resection is challenging to the surgeons. Loss of tissue in the lips after resection is treated with various flap techniques depending on the extension and location of the defect Objectives: This study aims to compare various techniques and outcome of reconstruction of both upper and lower lip and including the commissure Materials and Methods: A prospective study was performed involving lip cancer patients who underwent lip reconstruction between August 2015 to January 2021at tertiary care cancer center. The outcome of lip reconstruction by various flaps techniques was studied. Results: satisfactory functional and aesthetic outcomes, with similar tissue texture, static and dynamic symmetry achieved for most of the patients.
Conclusion: The use of nasolabial , Karapandzic, Abbe -Estlander,  Double Abbe flap, Webster-Bernard cheek advancement flap, forehead flaps have shown to be reliable techniques that offers good functional and cosmetic outcome.

AN ANATOMICAL PERSPECTIVE OF LIGAMENTUM ARTERIOSUM AND ITS CLINICAL SIGNIFICANCE

Dr. Swapnali Shamkuwar, Dr. Anitha M R

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1737-1743

Aim: To measure various dimensions of ligamentum arteriosum as well as observe postnatal anatomical changes of ligamentum arteriosum and discuss clinical significance of it.
Methods: 35 heart specimens were studied in Department of Anatomy of Akash medical college. Different shapes as well as length and width of ligamentum arteriosum was measured. Ligamentum arteriosum, aortic arch and pulmonary trunk were incised and looked for ridges, dimples, calcification and atherosclerotic patch. Histological examination of ligamentum arteriosum was also studied in 2 specimens.
Results: cylindrical shape was observed in all specimens of ligamentum arteriosum. The average length and width was measured as 12.02mm and 3.73mm respectively. Ligamentum arteriosum was found to be obliterated in 7 specimens whereas calcified in 3 specimens. Dimples and atherosclerotic patch was observed in luminal surface of pulmonary trunk and aorta respectively. Ligamentum arteriosum was presented as muscular artery in microscopic examination.
Conclusion: ligamentum arteriosum is clinically important structure. Details about its characteristics and clinical co relations may be helpful to the clinicians.

STUDY OF CERVICAL LESIONS BY PAP SMEAR SCREENING IN 1000 CASES IN A TERTIARY CARE HOSPITAL PUNJAB INDIA

Ninder Kumar, Manmeet Kaur, Mohanvir Kaur

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1744-1752

Background: Cancer of uterine cervix is a leading cause of mortality and morbidity in developing countries including India due to lack of proper screening, especially in the rural and suburban areas. This may be due to dearth of awareness amongst the women of developing countries. Cervical carcinoma is the fourth most common cancer in the world. Developing countries accounted to about 80% of the global burden. This retrospective study was conducted to highlight the importance of Pap smear examination as screening test in differentiating inflammatory, premalignant and malignant lesions.
Materials and Methods: This retrospective study was conducted among 1000 cervical pap smears of women with age group 20 to 75 years coming to the obstetrics and gynaecology department and cytology section of pathology, Government Medical College and Rajindra Hospiatal Patiala. All the smears were reported as per the 2014 Bethesda system.
Results: In Our study, we found 12.1% inadequate smear for reporting, 35% cases NILM including inflammatory smear, 1.7% atrophic, 4.4% ASCUS, 1.5% ASC-H, 0.7% LSIL, 1.4% HSIL and 0.4% cases of squamous cell carcinoma. Although 0.4% is a small fraction, PAP smear is a cost effective, non-invasive screening test for cervical lesions.
Conclusion: Cervical cytology by Pap smear is an important tool for early detection of premalignant and malignant lesions of cervix. Regular Pap smear screening should be conducted in vulnerable age group.
 

DENDRITIC CELL BASED IMMUNOTHERAPY IN RECURRENT AND METASTATIC ADVANCED SOLID TUMORS SHOWING EXCELLENT RESPONSE: THREE CASE STUDIES

Dr. Vikesh Kumar R Shah, Dr. Nirav R Shah, Dr. Akanksha V Shah, Dr. Akshay Nadkarni, Dr. Sandeep V Ishi, Dr. Siddharth H Nagshet, Dr. Mitesh Modi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1753-1761

Background: Despite conventional treatment approaches for cancers, relapsed and metastatic refractory cancers have overall poor prognosis with poor quality of life. Dendritic Cell (DC) - based immunotherapy is a viable and promising treatment option in such cases. Dendritic Cell Therapy (DCT) induces antitumor T-cell response in-vivo.
Case Series : We describe three of the ten cancer cases of patients who despite being successfully treated by conventional treatment had disease recurrence with multiple metastases and disease progression. In the first case, a 17 year male patient who is a known case of osteosarcoma of right femur who had undergone successful conventional treatment  had a recurrence with bilateral lung metastases. The second case is a 64 year female patient who is a known case of Metastatic adenocarcinoma of unknown primary with metastases at diagnosis who despite being treated by conventional treatmenT had disease progression. The third case is a case of 47 year female patient who is a known case of Non-small cell Lung cancer who was treated successfully by conventional treatment had a recurrence with multiple metastases. All the three cases were advised further treatment by Dendritic Cell therapy.
Results: One of three patients has shown complete response and remaining two patients has shown partial response with longer survival and improvement in quality of life.
Conclusion: Dendritic cell based Immunotherapy can activate antitumoral T cell responses in patients with various cancers. This data indicates that treatment with autologous tumor-pulsed DCs is safe and can activate tumor specific cellular cytotoxicity. Clinical responses can be achieved even in patients with metastatic and advance stage cancer.

UPPER GASTROINTESTINAL TRACT LESION: A HISTOPATHOLOGICAL STUDY

Dr Vikas Kumar, Dr Ritu Sharma, Dr Shveta Sachdeva, Dr Manoj Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1762-1772

Introduction: Upper gastrointestinal disorders are one in all the foremost commonly encountered problems in clinical practice with a high degree of morbidity and mortality. Various pathology involving the upper alimentary canal manifest with identical group of symptoms where endoscopy is performed because the initial diagnostic assay. It is straightforward safe and well tolerated procedure with direct visualisation of the pathological site and biopsy resulting in early detection of pathological changes and so helps to begin appropriate treatment.
Aims and Objectives: To determine the histopathological pattern of lesions of endoscopic biopsies of upper gastrointestinal tract.
Materials and Method: All endoscopic biopsies taken from upper gastrointestinal tract are brought in 10% buffered formalin. After fixation in formalin, the tissue was processed in automated tissue processor for dehydration, clearing, and paraffin embedding. Sections were cut in rotary microtome at 4 micrometer thickness. The section was stained for Hematoxylin and Eosin stain.
Observations: In the study conducted among all the GIT biopsies, the maximum number of biopsies were from gastric lesion with 53.84%, followed by duodenum with 36.75% and then esophageal biopsies which were 9.4%.
Conclusion:Commonestlesion was chronic gastritis. Majority of esophageal tumors were squamous cell carcinoma whereas gastric carcinoma most were adenocarcinomas.

A CROSS SECTIONAL POPULATION BASED STUDY TO EVALUATE THE PREVALENCE OF NECK DISCOMFORT IN PEOPLE WITH METABOLIC SYNDROME AT A TERTIARY CARE HOSPITAL

Kamaleshkumar A Patel, Vijay J. Patel, Jayesh V. Vaza, Kandarp K Trivedi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1773-1777

Background: Neck pain is a highly prevalent condition that leads to considerable pain, disability, and economic cost. The present study was conducted to assess the prevalence of neck discomfort in people with metabolic syndrome (MetS).
Materials & Methods: The present study was conducted to assess the prevalence of neck discomfort in people with metabolic syndrome. A total of 800 patients with metabolic syndrome were enrolled in the study. Each patient’s relevant clinical characteristics were assessed. The symptoms of the patients were recorded. SPSS and Prism 8 were used for all statistical analysis A p value of 0.05 is considered significant.
Results: MetS was discovered in 44.37% men and 55.62% women who participated in the study. Neck discomfort was reported by 15.62 percent of women and 11.87 percent of men.
Conclusion: The present study concluded that neck discomfort was present in 27.5% people with metabolic syndrome.

EFFICACY OF MANNHEIM PERITONITIS INDEX (MPI) SCORE IN PATIENTS WITH PERFORATION PERITONITIS IN A TERTIARY CARE SETUP

Ankit Meena, Rajveer Singh, Minaxi Sharma, Manish Bhadoo, Deepak Sethi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1778-1784

Introduction: Peritonitis is an inflammatory or suppurative response of the peritoneal lining to direct irritation. Surgical treatment for perforation peritonitis is highly demanding and very complex. The combination of improved surgical technique, antimicrobial therapy, and intensive care support has improved the outcome of such case. A scoring system which can compare patient populations and severity of illness, objectively to evaluate the treatment strategy is the required for evaluative research of intensive care. The present study was undertaken to evaluate the efficacy of Mannheim Peritonitis Index (MPI) score in patients with perforation peritonitis.
Materials and Methods: The present prospective study was carried among 50 patients ofperitonitis.  Using history, clinical examination and lab values risk factors found in MPI were classified according to values indicated and individual variable scores were added to establish MPI score. The cases were grouped into three: those below 21 points, between 21-29 points, and those above 29points. The data was analyzed, each variable in the MPI score along with other patient variables was analyzed using chi square analysis with various outcomes that were noted in the study. P value
Results: Around 80% of high risk group (MPI > 29) required more than 5 days of ICU stay. High risk group (MPI>29) has more complications than intermediate(MPI 21 TO 29) and low risk group.(MPI <21).Most common complication found in this study is Surgical site infection. Up to 60% patients with score >29 developed surgical site infection in post operative period which was about 42% in patients with score 21 -29 and about 19% in patients with score 29 and only one (7%) required inotropes with score 29. 40% patients with score >29 developed multi organ dysfunction. All the patients who developed MODS died. Thus, development of MODS post operatively is bad predictor of mortality.
Conclusion: Among the various variables of the scoring system duration of pain, organ failure on presentation and presence of feculent exudates these factorshad a significant hand in predicting the eventual outcome of thepatient.

ASSESSMENT OF ROLE OF MANNHEIM PERITONITIS INDEX (MPI) SYSTEM IN EVALUATION OF MORBIDITY AND MORTALITY AMONG PATIENTS WITH HOLLOW VISCUS PERFORATION: AN INSTITUTIONAL BASED STUDY

Ankit Meena, Rajveer Singh, Minaxi Sharma, Manish Bhadoo, Deepak Sethi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1785-1791

Introduction: A scoring system which can compare patient populations and severity of illness, objectively predict mortality, morbidity and can help to evaluate the treatment strategy is the dire need for evaluative research of intensive care. Thus, present study was undertaken to access the role of Mannheim Peritonitis Index (MPI) system in evaluation of morbidity and mortality among patients with hollow viscus perforation.
Materials and Methods: The present prospective comparative study was carried among 50 patients in whom diagnosis was of peritonitis. Using history, clinical examination and laboratory values risk factors found in MPI were classified according to values indicated and individual variable scores were added to establish MPI score. The data was analyzed, each variable in the MPI score along with other patient variables was analyzed using chi square analysis with various outcomes that were noted in the study. P value <0.05 was taken as significant in this study.
Results: In this study, 50 patients with diagnosis of secondary peritonitis were included. Patients with age 15 years to 70 years were part of study. Majority of patients (42%) belong to age group 20-35 years. Patient with less MPI score required less number of ICU stay. Around 80% of high-risk group (MPI > 29) required more than 5 days of ICU stay. Mortality rate was 40% in high-risk group (MPI score >29). There was no mortality in low-risk group (MPI score <21). Mortality rate was 5.26% in intermediate risk group. Chi-Square test value is 15.601, p-value is 0.000, < 0.05 indicates significant Mortality vs MPI Scores.
Conclusion: Mannheim peritonitis index scoring system is accurate for predicting the morbidity and mortality in patients with peritonitis due to hollow viscus perforation. It helps in identification of high-risk patients and it helps to identify the patients using for intensive post-operative or ICU care.

DETERMINANTS OF ACCEPTANCE OF COVID 19 VACCINE AMONG GENERAL POPULATION- A CROSS SECTIONAL STUDY IN HUBBALLI, KARNATAKA

Shalini H, Dattatraya D Bant, Kashavva B Andanigoudar, Oshin U

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1792-1806

Background: In December 2019 a new kind of Coronavirus called SARSCov-
2(Severe Acute Respiratory Syndrome Coronavirus-2) emerged in Wuhan,
China which causes mild to severe form of respiratory illness, which became a
global pandemic. While specific medications are not yet available, development
of different kinds of vaccine with promising results can be a key intervention
against the on-going pandemic caused by SARS-CoV-2.
Aims and Objectives:
1. To identify the determinants of acceptance of Covid 19 vaccine.
2. To identify the facilitators regarding Covid 19 vaccine.
Methods: A predesigned online questionnaire was prepared in the form of
Google forms and given to individuals at vaccination centre of KIMS Hubballi.
If the participant was illiterate questionnaire was explained and data was
collected by interviewer. The questionnaire comprised of general demographic
data, existing comorbidities and various factors determining the acceptance of
covid19 vaccine.

“A STUDY OF BREAST FEEDING PRACTICES AND TECHNIQUES AMONG LACTATING MOTHERS HAVING INFANTS LESS THAN SIX MONTHS OF AGE IN JABALPUR CITY OF MADHYA PRADESH, INDIA”

Dr. Neeraj Rai, Dr. Rajesh Tiwari, Dr. Priyanka Soni, Dr. Ritika Agrawal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1807-1814

Introduction Breastfeeding confers short-term and long-term benefits on both child and mother. The prevalence of suboptimal breast feeding practices is very high in developing countries. Previous studies revealed that infant mortality rates in developing countries are 5-10 times higher among children who have not been breast fed, or who have been breast fed for less than 6 months. Effective breast feeding technique (Right positioning and good attachment of baby) is the key to success of breast feeding because it facilitates milk production and milk release. Thus Present study was done to assess the breast feeding techniques & Practices.
Methodology: A cross sectional observational study was conducted in Garha region of Jabalpur city between Septembers to December 2015. Interview of 102 lactating mothers of infants aged < 6 months was conducted at their home using a predesigned and pretested questionnaire along with observation and assessment of infant’s positioning, attachment & suckling as per IMNCI guideline.

POST COVID MUCORMYCOSIS: AN OVERVIEW OF AETIOLOGICAL FACTORS

Beladakere Channaiah Vijayalakshmi, Anand Shalini, Thuraganur KapaniGowda Shashikala, Honnavara Govindaiah Manjunath, Govinda Rao Dinesh, Nagaraj Kokila, Anand Poornima

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1815-1822

Background and objectives:  During the second wave of corona virus pandemic, we saw an increase in the case reports of rhino-orbital mucormycosis in patients with coronavirus disease (COVID -19) or in patients who had recovered from COVID -19 infection. We evaluated the patient characteristics and predisposing factors in these patients having mucormycosis.
Materials and method: This retrospective observational study included 84 patients with mucormycosis diagnosed during their course of COVID-19 illness between May 2021 to July 2021.Data regarding demography, underlying medical condition, extent of involvement of mucormycosis, COVID-19 status and treatment taken during COVID-19 illness were collected.
Results: Eighty-four patients presented with mucormycosis out of which 59 patients were males and 25 females. Majority were in the age group of 40-60 years (71.4%). Rhino-orbital was the most common form of mucormycosis. Intracranial spread was noted in 16 patients. Hyperglycemia at presentation (either pre-existing or new onset diabetes mellitus) was the single most important risk factor observed in majority of these cases (80 patients / 95.23%) followed by history of Corticosteroid use in 68 patients (80.95%) and oxygen administration during their course of treatment for COVID-19 illness in 64 patients. (76.19%)
Conclusion:The association between coronavirus and mucormycosis must be given serious consideration. Uncontrolled diabetes and over-zealous use of corticosteroids are the two most important factors aggravating the illness. All efforts must be made to maintain optimal glucose levels in COVID-19 patients and use corticosteroids judiciously.

SPECTRUM OF MAGNETIC RESONANCE IMAGING FINDINGS IN KNEE TRAUMA

Dr. SUMIT PATIL , Dr. SUSHANT BHADANE, Dr. MEENAL MOHGAONKAR , Dr. AMOL JAGDALE , DR. DEVENDRA KULKARNI

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1823-1841

Knee injuries are among the most common injuries in the world population. Approximately 50% of injuries are related to sporting or recreational activities, with soft-tissue injuries accounting for the majority of knee injuries .(1)
In this article we will review the imaging evaluation of knee injuries resulting from RTA, sports activities, fall ,trauma. We will review the pertinent anatomy and the imaging appearances of specific ligamentous and meniscal injuries in the preoperative setting. MRI, due to its excellent soft tissue contrast resolution and multi-planar imaging capabilities, provides significant advantages over other imaging techniques in the evaluation of traumatic conditions of knee joint.(2)
MRI depicts most components of the joint, including articular cartilage, menisci, intra- articular ligaments, bone structure abnormalities.

CORRELATION BETWEEN THE SEVERITY OF DIABETIC PERIPHERAL POLYNEUROPATHY AND GLYCOSYLATED HEMOGLOBIN (HbA1C) LEVELS

DR AMIT KUMAR, DR ATUL VERMA, DR AKSHIT GARG, DR VISHAL VISHNOI, DR JAIDEEP SINGH

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1843-1851

Aim: To correlate between the severity of diabetic peripheral polyneuropathy and glycosylated hemoglobin (HbA1C) levels.
Material and method: The present prospective observational study was conducted to evaluate the type 2 DM with peripheral neuropathy patients from December 2020 to August 2022. 100 subjects having age > 18 Years, patients diagnosed for DPN by clinically (DNS >=1)/ by electro diagnostic testing (in selected cases) were included in the study. HbA1c levels were assayed using Biochemical method. Severity of DPN Categorized By Neuropathy Disability Score (NDS).
Results: Hypertension and cardiovascular disease was revealed in 14.17% and 6.67% of the subjects respectively. NDS score viz. mild, moderate and severe deficits was found among 13%, 68% and 19% of the subjects respectively. Mean HbA1c level increases along with increase in NDS score i.e., higher the deficits, more is the HbA1c.
Conclusion: It can be concluded that increased HbA1c level indicative of chronic hyperglycemia, could significantly increase the risk and quantitatively reflect the severity of polyneuropathy in diabetic patients

STUDY OF BACTERIAL PATHOGENS AND THERE ANTIBIOTIC SUSCEPTIBILITY PATTERN OF ISOLATES ASSOCIATED WITH POST OPERATIVE WOUND INFECTIONS IN A TERTIARY CARE HOSPITAL, OSMANIA GENERAL HOSPITAL, HYDERABAD

Dr. S. L. Annapoorna, Dr. B. Madhavilatha

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1852-1862

Introduction : Post-operative wound infection is an infection that develops within 30 days after an operation (OR) within one year if an implant was placed and infection appears to be related to the surgery.These infections number approximately 500,000 per year, among an estimated 27 million surgical procedures and account for approximately one quarter of the estimated  2 million  nosocomial  infections each year. Post operative wound infection remains the major source of illness and one of the cause of death in surgical patient.Aims and objectives : To isolate and identify the bacterial pathogens from the infected surgical site, to determine the Antibiotic susceptibility pattern of the isolated pathogens and to study the clinical profile and to identify the risk factors in the causation of surgical site infection. Material and methods : This is a retrospective study ,conducted in the department of Microbiology, Osmania  general hospital, Hyderabad , between June 2015 to May 2016.

A comparative study of local anaesthetics ropivacaine and bupivacaine for caudal epidural anaesthesia in children undergoing lower abdominal surgery

Dr. Marie Ninu, Dr. Jagadish Basumatary, Dr. Ashim Saikia, Dr. Sangeeta Deka

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1863-1871

Background: Caudal blocks have been shown to reliably block dermatomes below the level of the umbilicus (T10–S5) in children <20 kg (∼6 yr of age).  Caudal epidural anaesthesia involves accessing the epidural space through the sacrococcygeal ligament via the sacral hiatus at the base of the sacrum. The aim of this study was to compare the effects of ropivacaine and bupivacaine for caudal anaesthesia in children undergoing lower abdominal surgery.
Methods: After the hospital ethics committee approval, 60 (ASA I–II) children scheduled for lower abdominal surgery were included in this study. The group A (n=30) patients received ropivacaine 0.25% and group B (n = 30) patients received bupivacaine 0.25% via the caudal route. In this study we assessed demographic and clinical characteristics, AIIMS pain score at 1, 2, 4, 8, 12, 16 and 24 hours after operation and level of residual motor block (Modified Bromage Scale) immediately after surgery and at 1, 2 and 3 hours post operatively.
Results: There were no statistically significant differences in AIIMS pain scores between groups A and B at all postoperative time points – 1hr, 2hr, 4hr, 8hr, 12hr, 16hr and 24hr (P < 0.00001). The quality and duration of analgesia were comparable in both the groups. However, degree of motor block was significantly less in the ropivacaine group. After 3 hours there was no significant difference in the level of residual motor block.
Conclusion: The single shot caudal epidural block with 1ml/kg ropivacaine 0.25% is a safe and effective, long lasting dose for postoperative analgesia in paediatric lower abdominal surgery, producing less duration of motor block than bupivacaine 0.25%.

MUCORMYCOSIS DURING THE SECOND WAVE OF COVID19 PANDEMIC IN SOUTH RAJASTHAN: AN ANALYTICAL CROSS SECTIONAL STUDY

Dr. Sandhya Mishra, Dr. Anshu Sharma, Dr. Seema Sonkariya, Dr. Sarika Sarawat

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1872-1884

Mucormycosis is an opportunistic infection caused by several fungi belonging
to phylum Glomeromycota. They are found ubiquitously in the soil and
environment.
They are classified under subphylum Mucoromycotina and
Entomopthoromycotina. Mucormycosis caused by members belonging to
subphylum Mucoromycotina, order Mucorales, is the most clinically important
and includes the genera Lichtheimia, Mucor, Rhizomucor and Rhizopus species.
It is a very rapidly progressive (because of its angioinvasive nature) thereby
may prove fatal if timely diagnosis is not made entailing delay in institution of
specific treatment. It presents as six clinical types Rhino-orbito-cerebral,
Pulmonary, Cutaneous, Gastrointestinal, Isolated Renal and Disseminated
Mucormycosis on the basis of anatomical site involved in a particular patient.

Clinicopathological Study of Non Infectious Vesiculobullous lesions of Skin and Mucous Membranes

Dr. Nisha H Mehta, Dr Premnath N Hiryur

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1885-1910

INTRODUCTION: The vesiculobullous lesions of the skin are a group of heterogeneous diseases characterized by the formation of vesicles/blister and are associated with variable clinical manifestations and have multiple causes.
The immunobullous disease are mainly a consequence of pathogenic autoantibodies which target those antigens which mainly function to maintain either cell to cell adhesion within the epidermis or adhesion of stratified squamous epithelium to dermis or mesenchyme.
MATERIALS AND METHODS: The study was prospective and observational case series carried out in the Department of Pathology, SBKS MI&RC, Sumandeep Vidyapeeth, Piparia, Vadodara in the time period of January 2019 to July 2020. In the study 30 punch biopsies of patients taken from their cutaneous or mucocutaneus lesions were fixed, processed and stained stained with Hematoxylin and Eosin and examined light microscopy.
RESULT: Total 30 cases as per inclusion criteria were included in present study. Peak incidence is seen in the age group of 40-50 years with a slight female prepondarance. The most common morphological presentation was in the form of blister/vesicle. Pemphigus vulgaris is the most common lesion(47%) encountered followed by Pemphigus Foliaceous in 3 (10%) cases and Bullous Pemphigoid in 3 (10%) cases, Dariers Disease and Hailey Hailey Disease showed 2 (6.6%) cases each, a single case each of Epidermolysis Bullosa Simplex, Dermatitis Herpetiformis, Irritant Contact Dermatitis and Pemphigus Herpetiformis.
CONCLUSIONS: The highest incidence of vesiculobullous disorders is seen in the age age group of 40- 50 years and M:F ratio being 1:1.14. Pemphigus Vulgaris is the most prevalent disorder. On light microscopy, the most common site of blister formation is suprabasal. The diagnosis could be made on the basis of clinical features or histopathological features alone (70%) or their correlation in 90% of the cases.

CORRELATION OF CHEST X-RAYS WITH LAB PARAMETERS IN COVID-19

Dr. Geetika P, Dr. Mary Varunya J, Dr. Suresh A, Dr. Sudhanva N, Dr. Mummadi Swathi, Dr. Kaviya V

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1911-1920

Severe acute respiratory syndrome coronavirus 2 is an RNA virus belonging to the Coronaviridae family [1]. They are enveloped viruses with positive sense single stranded RNA genome and a nucleocapsid of helical symmetry. They cause respiratory infections, ranging from common cold to pneumonia to severe acute respiratory syndrome. This novel pulmonary infection, also called coronavirus disease 2019(COVID 19) has caused an outbreak in the entire world with India being one of the most affected. Throat and nasal swab -RT PCR has been the gold standard for the diagnosis of COVID 19 [2].

CHANGE IN EDUCATION METHOD IN COVID-19 PERIOD: EFFECT ON PATTERN OF MYOPIA IN PEDIATRIC AGE GROUP

Dr. Shailly Raj, Dr. Naveen Kumar, Dr. Granth Kumar, Dr. Vimal Nag, Dr. Rashmi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1921-1927

Introduction: Myopia is a major health issue in our society. There is a large number of proportion remain undiagnosed. High myopia can be associated with multiple consequences as myopic retinopathy, myopic macular degeneration, retinal detachment and amblyopia. The aim of our study to focus on magnitude of childhood myopia, increase awareness for myopia in our society so that we can reduce vision threatening sequelae in children.
Methods: Study was conducted in ophthalmology department and ENT department government medical college Saharanpur, medicine department Uttar Pradesh medical sciences, Saifai and pediatric department GTB medical college New Delhi. Children between 7 to 16 years with ametropia included in the study to find out magnitude of myopia among them.
Result: A total of 1460 children between the age of 7-16 years with complains of eyeache, headache, heaviness of head diminution of vision, and with other asthenopic symptoms included in the study. Among these 320 children were myopic. It shows high magnitude of myopia in children. Out of these myopic children mild grade myopic children were in high proportion (35.9%).
Conclusion: The study showed the pattern of myopia in children in Indian population. Screening in schools and early diagnosis of refractive error affect the learning and performances of children. In our study we showed the pattern of severity of myopia in children. Study also showed the effect of digital screen time of children with myopia.

MEASUREMENT OF OPTIC NERVE SHEATH DIAMETER AS A NON-INVASIVE TOOL FOR MONITORING OF INTRACRANIAL PRESSURE DURING PRE-OPERATIVE AND POST-OPERATIVE PERIOD IN PATIENTS WITH SUPRATENTORIAL INTRACRANIAL SPACE OCCUPYING LESIONS

Dr Tathagata Datta, Dr Shahid Iftekhar Sadique, Dr Subhasish Ghosh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1928-1936

Aim: To measure optic nerve sheath diameter as a non-invasive tool for monitoring of intracranial pressure during pre-operative, intra-operative and post-operative period in patients with supratentorial intracranial space occupying lesions.
Material and methods: The present prospective nonrandomised observational study was conducted in the Department of Neurosurgery, Bangur Institute of Neurosciences & SSKM hospital, IPGME & R, Kolkata from February 2020 to February 2022. Adult patients undergoing operation for supratentorial intracranial space occupying lesions during the time period were included in the study. A total of 50 cases were recruited during the study period. We measured the ONSD in the preoperative, intraoperative and postoperative period. Clinical findings suggestive of raised ICP, Cranial computed tomography or magnetic resonance imaging finding of shift, edema, mass effect, collapse of ventricles, compression of cisterns or effacement suggestive of elevated intracranial pressure was used to evaluate optic nerve sheath diameter accuracy.
Results: Most common symptom among the study subjects was headache (84%) followed by vomiting (66%). There was decrease in ONSD among the study subjects in right and left eye after the surgery as compared to baseline with statistical significant difference. No significant difference was found between USG and CT technique w.r.t. ONSD before and after surgery among the study subjects.
Conclusion: In patients with supratentorial intracranial space occupying lesions undergoing surgery, we found a significant reduction in the ONSD diameters measured by USG and CT scan after the surgery. We suggest that bedside USG is a valuable tool for detecting the ONSD during surgery, which may minimize the exposure to radiation.

A STUDY OF CARDIOVASCULAR CHANGES IN NEWLY DETECTED HYPOTHYROID PATIENTS

Dr. Manoj Kumar, Dr.Vishnu Rawat, Dr. Gaurav Gupta, Dr. Ravikant Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1937-1946

Aim: To analyse the cardio vascular changes in newly detected hypothyroid patients.
Material and methods: This cross sectional study was conducted among patients attending the medicine OPD over a period of one year and total number of 50 patients was taken. In the present study for the measurement of TSH, T4, T3 radio-immuno assay was employed. ECG was recorded in all patients, in all the 12 leads, at a paper speed of 25mm per sec. at normal standardisation, PR interval of >0.2 seconds was taken as prolonged, QRS complexes of less than 5mm in limb leads and less than 10mm in chest leads was taken as low voltage complexes. In all the patients in the study, echocardiogram was done on 2-D MODE and Doppler. Each case was specifically screened for cardiovascular manifestations like pericardial effusion, ventricular dysfunction.
Results: Most common signs on general physical examination was skin changes (58%) followed by oedema (52%) and delayed ankle jerk (34%). No abnormality was detected among 54% of the subjects. ST & T wave change and sinus bradycardia was reported among 12% of the subjects. Low voltage complex was revealed in 10% of the subjects. Pericardial Effusion (PE) was present among 13 (26%) subjects.
Conclusion: Cardiovascular symptoms are less commonly associated with newly detected hypothyroidism. The occurrence of pericardial effusion in hypothyroidism is significantly related to the duration of disease, hence the need for early diagnosis of hypothyroidism.

HISTOLOGICAL AND HISTOCHEMICAL FINDING OF MAJOR SALIVARY GLANDS IN DOMESTIC GUINEA PIG

Iman Mousa Khaleel, Eyhab R. Al-Samawy , Mahdi Abdul kreem Atiea ,Hawraa faisal Mshal, Mustafa Salah Hasan

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1947-1959

The current study aimed to determined the histological and histochemical structure of major salivary glands taken from six mature female and male guinea pig captured locally in Al-Samawa city (Province of Al-Muthanna, Iraq) after euthanized of animals, the major salivary glands fixed in 10 % NBF, dehydrated in series of graded concentrations of ethanol, clearing in xylol, embedded in paraffin. Sections of (5 μm) thick then stained with Mayer’s haematoxylin and eosin, PAS, combind PAS-AB (pH 2.5) and the Masson’s Trichrome. The results showed that the parotid gland was enveloped by thick dense fibrous connective tissue capsule and lumina of the acini are narrow.
Around the acinar cells, myoepithelial cells may be seen, and the intercal ated ducts are lined by simple cuboid epithelial cells. Submandibular glands were coated by a capsule of dense fibrous connective tissue from which septa of connective tissue extended and divide the gland into several lobules and sublingual glands which is compound tubuloacinar gland the paranchyma are lobules, enclosed by layer of irregular connective tissue capsule, from it, the septa are raised and dividing it into various lobules in conclusion the salivary gland’s of guinea pig capture in Al-Samawa showed some differences of histological structures.

SUPPORT VECTOR MACHINE WITH RADIAL BASIS FUNCTION FOR FACIAL EMOTION VALENCE RECOGNITION

F. Ludyma Fernando, Dr. S. John Peter

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1960-1969

The affective quality called Valence refers to the intrinsic goodness (positive valence) or badness (negative valence) of an event, object, or situation. For this purpose, a model for classification and characterization of emotions have been developed which is discussed in this paper. In this model, the images are smoothened using an Average Filter and are first identified through a Convolutional Neural Network which uses the ReLU activation function. Then, the valence is classified using a Support Vector Machine (SVC) classifier, which uses a Radial Basis Function (RBF) kernel. For this reason, the emotions are labeled according to their nature. The positive emotions are labeled 1 (inclusive of the neutral emotion) and the negative emotions are labeled as 0. The images from the FER 2013 dataset is used for Valence Recognition and is given via a RBF Kernel in a SVM, which classifies whether the emotion recognized is positive or negative. The haarcascade algorithm is implemented to detect the face. In this paper, the 7 human emotions (happiness, surprise, fear, anger, fear, disgust, sadness and neutral) have been identified and their valence recognized.

A Study on Histopathological Changes in Spectrum of Gallbladder Diseases

Dr. Shweta Anand, Dr. Poonam Singh , Dr. Farhana Ikram

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1970-1975

Introduction: Gallstones are the commonest biliary pathology, the incidence ranging from 10% to 20% of the world population. Over 95% of biliary tract disease is attributable to cholelithiasis. Gallbladder stones are known to produce histopathological changes in the gallbladder.
Aim: To study spectrum of gallbladder diseases in cholecystectomy specimens and the incidence of various neoplastic and non neoplastic lesions occurring in gallbladder
Materials and Methods: All clinical details and data from case sheet and patient history are collected and analysed in Department of Pathology, Prasad Institute of Medical Sciences, Lucknow  From( June 21 to June 22) grossly  examined and routinely processed and stained with H&E stain. Three sections each from neck, body and fundus taken. Tissues were processed in automated tissue processor and paraffin blocks made. Statistical analysis of the data was done.
Results: Total number of specimens received were 72 and among the cases the number of females were 66 and the number of males were 6. Out of 72 cases of cholecystectomy the number of cases of calculous cholecystitis was 62 (86%) and the number of cases of acalculous cholecystitis was 10 (14%) Majority of cases of cholecystectomy were found to be with gallstones (Calculous cholecystitis) and only a few cases were found to be without gallstones (Acalculous cholecystitis).
Conclusions: Almost all of the gallbladder lesions are inflammatory in origin, of which the most common disease being chronic cholecystitis in female of 30–40 years presenting with abdominal pain. Thirdly, pigmented gall stones were found to be the most common etiology of chronic cholecystitis and malignancy of the gallbladder in this population is a rare occurrence.

A Prospective Study of Management of Distal end of Radius Fractures in Adults by Ligamentotaxis using External Fixator with Distraction

Dr. Arunkumar G, Dr. Mallanagouda N .Patil, Dr. Ashok Sampgar, Dr. Murugesh Kurani Mahadev

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1976-1984

Background and Objectives: Preservation of the articular congruity is the principle prerequisite for successful recovery following distal radius fractures. The best method of obtaining and maintaining an accurate restoration of articular anatomy however, remains a topic of considerable controversy. External fixator with distractor (UMEX) method is one of the treatment for distal end of radius fracture the main aim of this study is to evaluate the results obtained by treatment of distal end radius fractures by external fixation.
Method: In a prospective controlled study, 30 cases of unstable distal end radius fractures with intra- articular extension were treated by external fixator with distractor (UMEX) using the principle of ligamentotaxis. Mean age of the patients was 42.5 years, external fixator with distractor (UMEX) was applied for a mean duration of 6.5 weeks and cases were followed up for an average of 9 months post operatively.
Results: Assessed as per clinical scoring system of Green DP and O’Brien et al. for functional results at the end of 9 months of follow up. Excellent to good functional result was noted in 90%.
Conclusion: External fixation with distractor (Umex) and ligamentotaxis provides better functional and anatomical results in comminuted intra-articular distal radius fractures. The successful use of external fixator with distractor for distal end radial fractures requires careful assessment of fracture pattern, appropriate patient selecting meticulous surgical techniques appropriate choice of fixation, careful post- operative monitoring and aggressive early institution of rehabilitation. The final functional results of treatment of distal end radius fractures not only depends on the anatomical restoration of the articular surface but also on the associated soft tissue injuries and articular damage.

A Comparative Study of Effectiveness of Negative Pressure Wound Therapy (NPWT) Versus Standard Chlorhexidine Gauze Dressing in the Management of Post Traumatic Soft Tissue Defects in the Extremities- One Year Hospital Based Randomized Clinical Trial

Dr. A. B. Patil, Dr. Mallanagouda N. Patil, Dr. Arunkumar G, Dr. Murugesh Kurani Mahadev

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1985-1998

Introduction: Soft tissue defects are more commonly seen in the extremities following high velocity trauma & occupational injuries posing countless challenges in their management. Early flaps or skin grafts reduce the chance of infections in the soft tissue defects. Both are done after thorough surgical debridement. In some cases wound related and patient related factors won’t allow early coverage of these defects. During which, one has to consider alternative methods of managing the soft tissue defects in the primary set up. One of the available modality for managing soft tissue defects in the initial periods is Negative Pressure Wound Therapy. This has been found to have a vast benefit over conventional dressings like tulle grass and others. This present study has been conducted in our hospital which is a tertiary care centre, to evaluate the efficacy of Negative Pressure Wound Therapy (NPWT) in the management of soft tissue defects in the extremities over the conventional method of managing the wounds with chlorhexidine dressing.
 
Materials and Methods: A randomized clinical trial was carried out in Belagavi Institute of Medical sciences, Belagavi from 1st Nov 2020 to 31st Oct 2021 and required data was collected from the 40 patients who underwent either Negative Pressure Wound Therapy (Group A) or Chlorhexidine gauze dressing (Group B) for post traumatic soft tissue defects in the extremities and the outcome was assessed in terms of formation of healthy granulation tissue, absence of slough/infection, wound retraction after intervention in both the groups
 
Results:In the present study all forty patients were having unhealthy pale yellow granulation tissue at day 0. At day 5, seventeen out of twenty patients were having healthy red granulation tissue in group A compared to five out of twenty patients in group B. At day 10, the remaining three patients were having healthy red granulation tissue in group A and thirteen out of fifteen remaining patients were having healthy red granulation tissue in group B. At day 15, remaining two patients were having healthy red granulation tissue in group B with p value less than 0.0001 (using chi square test) and this difference was considered to be extremely statistically significant.
Conclusion: Thus, we conclude that rate of formation of healthy red granulation tissue was faster, slough was reduced rapidly and mean surface area of the wound is reduced significantly in the Negative Pressure Wound Therapy, making Negative Pressure Wound Therapy a superior option in the management of patients with post traumatic soft tissue defects in the extremities.
 

A Clinico-hematological Study of Pancytopenia In all Age groups

Dr. Kasapa Shyam Sunder, Dr. Raja Vojjala

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1999-2005

Background: Pancytopenia is a relatively common hematological entity characterized by the reduction of three formed elements of blood. It may be a manifestation of a wide variety of disorders, which primarily or secondarily affect the bone marrow. Hematological investigation plays an important part in the management of patients with pancytopenia and therefore needs a detailed study of bone marrow. We in the current study tried to evaluate the clinical presentations and hematological profile of cases with pancytopenia due to various causes.
Methods: A complete hematological workup was done which included hemoglobin estimation, RBC count, RBC indices (MCH, MCV, MCHC), WBC count, differential count, reticulocyte count, ESR, PCV, Platelet count, Bleeding time, clotting time and clot retraction test. Peripheral smear was stained by Leishman stain for all the cases. To determine the cause, this was done for every patient. The material was aspirated from the tibial tuberosity in infants under the age of two or the posterior iliac crest in adults using a Jemshidi needle.
Results: A total of n=40 cases were studied in this study. Megaloblastic anemia was commonest cause constituting 70.0% followed by aplastic anemia 17.5%, Malaria 5.0% subleukemic leukemia 2.5%, multiple myeloma 2.5%, and storage disorder 2.5%. In the study majority of megaloblastic erythropoiesis occurs in the hypercellular bone marrow. Gigantic megakaryocytes and giant band metamyelocytes were also seen. The majority of patients had reduced fat cells and hypercellular bone marrow 62.5%. 10% of cases had normocellular bone marrow. In all the cases there was erythroid hyperplasia with megaloblastic maturation.
Conclusion: when a patient presents with unexplained anemia, prolonged fever, and a tendency to bleed. The physical findings and peripheral blood picture provide valuable information in the work of cytopenic patients. The typical presentation in the peripheral blood picture will be anemia, presence of nucleated RBCs, and immature myeloid cells which may be suggestive of marrow infiltration of primary hematologic disorder.

A Study on Acute Ischaemic Stroke With Neuron-Specific Enolase as Potential Biomarker and the Severity and Outcome of Disease: A Hospital Based Study

Dr. Vinaya Kumar S M , Dr. Sandeep Kavalikai

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2006-2016

Introduction: Acute ischaemic infarction is the third etiology of death and first etiology of disability across the globe. Cerebrovascular accident is an emergency condition requiring immediate intervention. The blood brain barrier compromised in patients with acute ischaemic stroke, leakage of neuro-biochemical protein markers like NSE into the peripherial circulation allow pathogenesis and prognostication of patient‘s with CVA to be weighed up additionally. The current work structured to determine the marker of brain damage, NSE in serum of patient‘s with acute ischaemic infarction as a diagnostic and/or monitoring tool for early prognosis of ischaemic stroke.
Materails and Methods: The material for the present study will be collected from Department of General Medicine,Gadag Institute of Medical Sciences. Karanataka from(May 21 to June 22). The sample size was 94 of which 47 were acute ischaemic stroke patients who were studied as cases and 47 non ischaemic stroke were taken as controls and there serum NSE,GCS, NIHSS, mRS, infarct volume were estimated and the results obtained were statistically computed.
Results: In present study, Mean NSE in cases-5.558.Mean NSE in controls-0.217. In the ROC Curve for NSE, area under ROC of NSE is100% and the optimal cut offivalue is 1.48,SENSITIVITYis100%.P-value for NSE & GCS is 0.2920.P-value for NSE & NIHSS is <0.001.P-value for NSE & mRS is <0.001.Coefficeint of correlation between NSE and infarct volume r=0.026
Conclusion: Serum NSE can be used for early diagnosis,prognosis ofiacute ischaemic stroke p atients in the settings were CT scan,MRI scan not available or patients in whom CT sca n or MRIiscan contraindicated or CT scan normal.Serum NSE test may be boon to prima ry health centres and useful to reduce morbidity and mortality associated with ischaemic stroke patients with early treatment initiation.

Effect of Partial Sleep Deprivation on Audio-Visual Reaction Time in Taxi Drivers of Bangalore City: A Pilot Study

Dr. Deepa HS, Dr. Pradeep BE, Dr. Rekha KN, Dr. Prajwaal Manjunath

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2017-2023

Background and Aim: The human brain needs adequate sleep to recover from fatigue. Reaction time testing is a highly sensitive measure of sustained attention, which is a prerequisite for safe driving.In view of this, the study was planned to evaluate the effect of partial sleep deprivation (<3 hours of sleep-in night) on sleepiness, Auditory and Visual reaction time in taxi drivers of Bangalore city.
Methods: The study included 30 male taxi drivers in the age group of 18- 40 years. After obtaining informed consent from the subject participants sleepiness status was assessed using the Karolinska’s sleepiness scale (KSS). Visual reaction time (VRT) for red, green & blue light & Auditory reaction time (ART) measurement was done by PC 1000 reaction timer. After the baseline measurements, taxi drivers departed for their 12-hour night shift.  After the night shift when taxi drivers reported back all the parameters were rechecked ie KSS for sleepiness, VRT, and ART.
Results: There was a significant increase in KSS score after partial sleep deprivation when compared to the baseline values indicating higher levels of sleepiness after sleep deprivation. The mean values of ART & VRT for red, green & blue was prolonged after partial sleep deprivation when compared to before values and the difference was statistically significant.
Conclusion: The present study observed that partial sleep deprivation has a major effect on mental attention and prolongation of reaction time among Bangalore city Traffic drivers. Results of our study suggest that road users especially shift workers should be provided with education concerning the fatal risk of driving during the sleep-deprived condition, effective countermeasures, sufficient areas of staff sleeping areas for on-call workers, counselling against the ill effects of consumption of excessive tea/coffee, drug, alcohol or smoking to eliminate the effects of sleep deprivation.

STUDY OF CLINICO-SOCIAL & PROFILE OF YOUNG OBESE INDIVIDUALS AT A TERTIARY HOSPITAL

Mohsin Mohammed Bava, Roshan M , Nithasha N H

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2024-2030

Background: Obesity can alter lipid and carbohydrate metabolism. There is an epidemic rise in obesity in the country. Dyslipidemia (DLP), type 2 diabetes mellitus (DM) and impaired fasting glucose (IFG) has been recognized as a common complication of obesity. Present study was aimed to study clinico-social profile of young obese individuals at a tertiary hospital.
Material and Methods: Present study was single-center, descriptive, observational study, conducted in young individuals (18-40 years age group), with BMI ≥25kg/m2. Results: Among 150 young obese individuals, common age group was between 36 -40 years of age (53.3 %) and the mean age was 34.43 ± 3.76 years. Majority were male (62 %) as compared to female (38 %). Majority cases were in the BMI group of 25-30 kg/m2 (74%) as compared to > 30 kg/m2 (26%). High risk factors such as alcohol consumption (38 %), smoking (43.3 %) & family history of obesity (25.3 %) were also noted. The most common associated comorbidity was dyslipidemia found in 12.7% of cases followed by obstructive sleep apnea (OSA) in 8.7% and then impaired fasting glucose in 8% of cases. 69.3% of cases had no history of comorbidities It was found that impaired fasting glucose was seen in 53.3% of cases where as only 11.3% were having type 2 diabetes mellitus.  In this study, it was found that dyslipidemia was seen among 82% of the cases. High TC, LDL and TC/HDL-C ratio was found in 3.3%, 22% and 62.7% of subjects, respectively. Percentage of hypertriglyceridemia was 36.7% among the cases. Low HDL was found in 33.3% of subjects.
Conclusion: Young obese individuals are prone for altered fasting blood sugar (impaired fasting glucose &/and type 2 diabetes mellitus) & dyslipidemia (hypertriglyceridemia and high TC/HDL-C).

COUNTER CORRELATION AMIDST SERUM ZINC AND ALRI AGONY IN HOSPITALIZED PEDIATRIC SUBJECTS: A CROSS SECTIONAL STUDY

Oruganti Lalitha, G. Madhavi Prasanna, Shyamala Gowri Pocha

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2031-2038

Background: One of the prime global health problem in children is pneumonia accounting for 29% of mortality worldwide. One of the important micronutrient in humans which plays vital role in stimulation and proper functioning of immune system and prevents infections is zinc. There is a strong correlation between risk of pneumonia in a population with zinc deficiency with high rates of infections such as diarrhea, skin, and respiratory infections. The prime objective of present study is to provide further experimental support to strengthen above correlation. To study the serum zinc levels in children hospitalised with pneumonia and correlation between serum zinc levels and severity of pneumonia and its complications.
Materials and Methods: This observational cross sectional study included 100 subjects (100 with pneumonia and 100 without pneumonia) aged between <12 months to 5 years of age diagnosed with various levels of pneumonia. A detailed history, clinical examination, chest X-ray findings, arterial oxygen saturation (SpO2), haemoglobin (g/dl), WBC count and serum zinc levels (µg/dl) was noted.
Results: Mean serum zinc levels in cases was significantly low compared to age and sex matched controls (p value-0.001). Low serum zinc levels were associated with increasing severity of pneumonia (Pneumonia-112.21µg/dl, severe pneumonia- 41.18µg/dl, very severe pneumonia- 28.38µg/dl). Mean serum zinc levels in complicated pneumonia and death cases was very low 22.28µg/dl compared to those with no complications 189.94µg/dl and who were discharged 197.67µg/dl. Low serum zinc levels were associated with prolonged hospital stay and prime cause of death in children.
Conclusion: Our study results conclude that there is a contrary relation between serum zinc and different stages of pneumonial agony than in matched healthy controls. Prognosis could be augmentation of zinc in hospitalized children with acute lower respiratory infection.

STUDY ON VOCAL CORD PALSY AMONG PATIENTS ATTENDING ENT DEPARTMENT OF A MEDICAL COLLEGE HOSPITAL.

Bagade Vinod G, Dahire Prashant L, Baravakar Jalindar P, Bhondwe Meghraj R

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2039-2046

Background: “Health is a state of complete physical, mental and social well-being and not merely an absence of disease or infirmity”. It also includes the ability to lead a “socially and economically productive life.” Obesity is a cluster of non-communicable diseases which creates an enormous socioeconomic and public health burden in poorer countries. That is why obesity is now termed as “New World Syndrome”. Aim- To study health status of Bank Employees in a City with special reference to Obesity. Objectives- 1.To study prevalence of generalized obesity. 2. To study association between prevalence of generalized obesity with socio-demographic factors in Bank Employees.
Materials and Methods: A cross-sectional study carried out among bank employees in Ambajogai city of Maharashtra from August 2016 to December 2018 in 236 bank employees.
Results and conclusion- Overall 43.6% of bank employees had generalized obesity. The prevalence of obesity by waist-hip ratio was 46.6%. The prevalence of overweight was 14.4%. The prevalence of generalized obesity increased significantly with increasing age (p=0.029). Generalized obesity was more prevalent in female employees than male employees but no significant association found. The prevalence of generalized obesity was significantly associated with factors such as age, post of bank employees, history of addiction and mixed type of diet. The factors like sex, religion, marital status, socioeconomic status, and education were not statistically associated with generalized obesity.

CLINICAL STUDY OF PULMONARY FUNCTION TESTS IN PATIENTS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Vivek Bapurao Chavan, Shweta Shirish Deshmukh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2047-2054

Background: The hallmark of COPD is airflow obstruction which is typically described by spirometry. Spirometry is a cost efficient method of ordering pulmonary function tests is to start with spirometry and then order further tests in a stepwise fashion to refine the diagnosis.Present study was aimed to study pulmonary function tests in patients of chronic obstructive pulmonary disease.
Material and Methods: Present study was Cross-sectional Observational Study, conducted in patients clinically diagnosed as COPD in OPD or admitted to our wards and having symptoms of COPD (dyspnea, chronic cough or sputum production).
Results: 100 COPD patients were studied, majority were from age group 50 to 59 years (41%) & age group 60 to 69 years (30%). The male to female ratio was 5.67:1. Mean post-bronchodilator FEV1 % predicted of males in the group was 53.81 ± 19.29) whereas mean FEV1 % predicted of females in the group was 51.26 ± 15.96.  Mean post-bronchodilator FEV1/FVC ratio of males in the group was 0.433 ± 0.156 whereas mean FEV1/FVC ratio of females in the group was 0.411 ± 0.128. 15 patients were in GOLD Stage I (FEV1 ≥ 80% predicted) ,34 patients were in Stage II (50% ≤ FEV1 < 80 % predicted),36 patients were in stage III (30% ≤ FEV1 < 50 % predicted) whereas 15 patients were in stage IV( FEV1 < 30%). The difference between mean post-bronchodilator reversibility in FEV1 (in percentage) in patients in GOLD stage 1 vs stage 2 vs stage 3 vs stage 4 (applying ANOVA) was not found to be statistically significant (P=.869>0.05).
Conclusion: Spirometry is important tool in confirming and assessing severity of airway obstruction in COPD patients. Majority of COPD patients were in stage 2 & 3 (GOLD) of airway obstruction confirmed by spirometry.

CLINICAL STUDY OF SURGICAL MANAGEMENT OF FRACTURE OF LOWER ONE THIRD OF HUMERUS BY EXTRA ARTICULAR PLATING IN ADULTS

J. Rajesh, B.M. Chandrashekar, Sudheer Kumar Dachepally, Uma Durga Vinod

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2055-2066

Background: To study the surgical management of fractures of lower one third of humerus by Extra articular distal humerus locking compression plate in adults.
Materials and Methods: The present study was done in Govt Medical College /Hospital, Suryapet from December 2021 to May 2022. 20 cases of lower one third humerus shaft fractures were treated with open reduction and internal fixation with Extra Articular Distal Humerus Locking Compression Plates (EADHP).
Results: 6 patients were (30%) in the age group of 18-35 yrs & 51-65 yrs each. 14(70%) were Male patients. 13(65%) Left side involved patients. 16(80%) patients sustained injury due to road traffic accident. 12 B1 Type was most common pattern. 18(90%) were closed fractures. 3(15%) were associated with multiple injuries Mean of time for Fracture union in 18 patients (90%) was 13.9 weeks. 3(15%) patients developed post-operative complications. Radial nerve neuropraxia 2(10%) cases and Superficial infection 1(5%) case. Average DASH score was 17.6 with range 12.5 to 33.5 points. Functional outcome as per Mayo Elbow Performance Score was excellent in 18(90%) cases; good in 2(10%) cases.
Conclusion: We conclude as per AO principles that early operative intervention with Extrarticular Distal Humerus Locking Compression Plating (EADHP) on postero- lateral column of humerus for these fractures will result in excellent functional outcome.

CLINICAL STUDY OF COVID ASSOCIATED RHINO-ORBITAL MUCOR MYCOSIS IN STATE COVID HOSPITAL

T. Divya, N. Lakshmi, G. Sirisha, C. Triveni

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2067-2072

Background: Mucormycosis is one such infection which has shown a sudden rise during the second wave in India. (Our present study has been designed to all the confirmed cases of rhino orbital mucormycosis. In our study we have included all the rhinorbital mucormycosis cases that have been confirmed by microscopy and or radiological evidence.Mucormycosis (also called zygomycosis) is a serious fungal infection caused by agroup of molds called mucoromycetes.
Materials and Methods: All   the patients that have directly attended the ophthalmology OPD. Chief  complaint with duration (Look for redness , watering, discharge & pain in the eye, diplopia, eyelid/ periocular swelling) facial swelling, eyelid/perioculay facial discoloration, Worsening headache, sudden drooping of eyelid (or) restricted eye movements, sudden loss of vision, facial parasthesia / anaesthesia, nasal discharge (blakish/ bloody/foul smell nasal stuffiness, dental pain.
Results: Out of all 60 cases, 79 there were 47 males and 13 females.  In this study 48.33% cases belongs to age group of 50-60 years followed by    36.66% belongs to age group of 60-70 years. Among the 60 patients who presented to hospital within 1 week of onset of symptoms likee pain redness watering et 35 of them got good vision, whereas among the 15 members who presented beyond 2 weeks after the onset of their symptoms only 7 got good vision while 2 of them got poor vision below 6/60 indicating the importance of early diagnosis.  65% cases affected at right eye and 63.33% cases showing symotoms like Redness, treatment under goes with    total Restriction   42 members and Painful oculr movement   in 43.33% cases.
Conclusion: The second wave of COVID-19 in India has led to more deaths than the first. In just a few weeks, the B.1.617.2 (Delta) variant became the dominant strain across India. It has since spread to about 40 nations, which include United Kingdom, Fiji and Singapore.18 the first case of Covid-19-related Mucormycosis has now been found in Chile. It is important to recognise at an early stage this infection, so as to potentially reduce soft and hard tissue necrosis and severe complications and alert colleagues of this mutilating and life threatening infection.

A PROSPECTIVE STUDY ON MATERNAL FETAL OUTCOME IN TEENAGE PREGNANCY

Duggasani Padmaja, A. Sudharani, Unnam Bhavitha

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2073-2084

Background: To find out the strategies for prevention of problems associated with teenage pregnancy.
Materials and Methods: A Prospective study was conducted over a period of one year from January 2020 to December 2020 at Government General Hospital, Kurnool in the Department of Obstetrics and Gynecology which is being a tertiary care centre.
Results: The incidence of teenage pregnancy during the study period from January 1 2020 – December 31 2020 in Government Medical College, Kurnool was 9.86% 57.1% of the study population were 19 yrs, 38.5% were 18 yrs and the age of 3.9% & 0.5% of the teenage mothers was 17 years and 15 years respectively. Mean age was 18.52 years. 79.5% of the teenage mothers were primigravida. 1.5% of the teenage pregnancies were out of wedlock pregnancy, the rest 98.5% were married. 43.5% of the teenage mothers were married at the age of 18 years, 39.5% of them at 17 years of age, 10.5% at 16 years and 4% and 1% at 15 and 14 years of age respectively. 71% of the teenage pregnant were residing in rural areas and 29% in urban areas. 70% of the teenage pregnant were Hindus, 26.5% were Muslims and 3.5% were Christians. About 56% had primary education, 32.4% had secondary education and 11.6% were illiterate. 87.5 % of the study population belonged to lower class of socio-economic status. Cephalopelvic disproportion is the most common indication for LSCS. 2.8% of the teenage pregnant women had breech presentation as an indication for LSCS. 89.7% of the study population had an Apgar of 8-10 at 5min. 44.1% of the newborn required NICU admission and the reason for admission was low birth weight, preterm, IUGR, hyperbilirubinemia, birth asphyxia and meconium aspiration syndrome. 89.8% of the newborn had good neonatal outcome. 99.88% of the teenage pregnant women had good maternal outcome. Only one maternal death was seen during 1 year period in teenage pregnant women.
Conclusion: Good prenatal, intranatal, and postnatal services, as well as good neonatal, contraceptive, and abortion choices, all contribute to reduce the dangers associated with teenage pregnancies to a considerable extent. With all of these measures in place, we may expect a global drop in teen pregnancy rates and difficulties in the next years.

A STUDY ON THE EXPRESSION PATTERNS OF ER, PGR, HER2/NEU AND ITS HISTOMORPHOLOGY IN BREAST CARCINOMA

Vishal Parekar, Swetha Koshika, S Shameem Begum

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2085-2100

Background: To study breast carcinoma based on the expression patterns of ER, PgR, HER2/neu and its Histomorphology.
Materials and Methods: The present study is a 4 years study, 1 year retrospective and 3 year prospective study from 1st November 2017 to 31st October 2021, done in the Department of Pathology Kamineni Institute of Medical Sciences, Narketpally. Specimens received with a clinical diagnosis of carcinoma of breast were processed according to standard protocol. The specimen received following neoadjuvant chemotherapy was excluded from the study. Histomorphology of tumor, Nottinghams modification of Scarff Bloom Richardson grading was studied by H&E stained section and the ER, PgR and HER2/neu expression studied by IHC stains.
Results: A total of 86 cases of breast carcinomas were analysed. Most of the cases occurred in perimenopausal age group. Lump in the breast was the most common presenting symptom. Majority of tumor were within the size of >2-5cm, frequently in upper outer quadrant. Invasive breast carcinoma no special type was most common type, accounting to 81.40%, followed by invasive lobular carcinoma of breast in 5.81%. Majority of tumor were of Grade II. ER, PgR and HER2/neu were expressed in 53.48%, 43.03% and 39.54% of cases. The most common molecular subtype was ER /PgR+/HER2neu. Hormonal receptor expression was less in women with age above 40 years, with increase in size and grade of tumor and with increase in number of metastatic lymphnode. Expression of HER2/neu increased with increase in grade of tumor. HER2/neu expression decrease in women more than 40 years. No relation was observed between HER2/neu expression and number of metastatic lymph nodes.
Conclusion: As the scenario of breast carcinoma in India is changing, the knowledge regarding histological parameters like type, grading and staging along with hormone receptor expression and HER2/neu amplification are important as it will guide the clinician to choose the most appropriate modality of treatment for the best possible outcome in a patient with breast carcinoma.

DETECTION OF CARBAPENEM RESISTANCE IN GRAM NEGATIVE BACTERIA

R.Vanishree, Ayesha Vaseem, Yamini Vadlamannati

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2101-2107

Background: The development of antibiotic resistance in bacterial isolates is the primary contributor to higher rates of death and morbidity across the globe. Carbapenems, which were originally thought to be useful but are now primarily rendered ineffective due to the appearance of carbapenemase, were once thought to be effective. The purpose of this study was to assess the in vitro efficacy of the modified Hodge test for the detection of carbapenemase synthesis in Gram-negative rods. (klebsiella pneumonia).
Materials and Methods: Between the months of September 2019 and December 2021, the research was carried out at the Department of Microbiology located at Govt General Hospital, Nalgonda. A total of 200 Gram-negative rods from a variety of clinical samples were collected. On the basis of disc diffusion, the researchers only included those isolates for the study that displayed intermediate or sensitive zones between 16 and 21 millimetres. After that, the Modified Hodge test was carried out on these isolated samples.
Results: The outcome of the study showed that out of a total of 300 isolates, 29 were positive for the synthesis of carbapenemase using the Modified Hodge test. The percentage of patients who had Klebsiella pneumonia that produced carbapenemase was 16 %.
Conclusion: The modified Hodge test is a straightforward procedure that can be carried out in a standard laboratory setting for the purpose of identifying carbapenemases in clinical isolates exhibiting either an intermediate or sensitive zone diameter on disc diffusion.It is of the utmost importance that any and all isolates that exhibit an intermediate or sensitive zone diameter on disc diffusion be tested for the production of carbapenemases using a modified version of the Hodge test, and these results be further verified by PCR.

A STUDY OF MANAGEMENT OF DISTAL END RADIUS FRACTURES USING PLATE OSTEOSYNTHESIS

Sudheer Kumar Dachepally, J. Rajesh, B. M. Chndrashekar, Uma Durga Vinod

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2108-2120

Background: To Study the surgical, Functional outcome and complications   of Intra articular fracture (Frykmann Classification) of distal end of radius treated with open reduction and internal fixation by plating.
Materials and Methods: The study will be conducted on patients of distal end radius fractures treated by plate osteosynthesis in Department of Orthopedics, Govt Medical College/General Hospital, Suryapet during the study period January 2021 to March 2022 Sample size –cases of Distal end radius fractures treated with Plate osteosynthesis during 18 month period in our hospital.
Results: The mean age of the patients taken up for the study was 45.9 years with the youngest patient being 21years and the oldest being 79 years. There were 11 female patients (55%) and 9 male patients (45%). Mode of trauma due to fall 12 patients(60%) is more as compare to RTA( road traffic accident) 08 patients (40%). Left side 11 patients (55%) is involved more as compare to right 09 patients (45%). Present study documents 90% functional excellent to good results, suggests that stabilizing the fracture fragments with volar plate and screws in the management of the fractures of distal radius, is an effective method to maintain the reduction till union and prevent collapse of the fracture fragments, even when the fracture is grossly comminuted/intraarticular/unstable and/or the bone is osteoporotic.
Conclusion: The technique emphasizes that open reduction and internal fixation with volar plating has excellent functional outcome with minimal complications thus proving that it is the prime modality of treatment for distal radius fractures.

HISTOMORPHOLOGICAL SPECTRUM OF ENDOMETRIAL AND CERVICAL LESIONS FOLLOWING CURETTAGE AND BIOPSY- A RETROSPECTIVE STUDY

Rashmikumari T. R, Priyanka Prasad Arvind, Astha Srivastava

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2121-2128

Background: Abnormal uterine bleeding (AUB) is the most common clinical presentation in premenopausal and postmenopausal period which could be due to either endometrial or cervical lesions. Early detection of precursor lesions and exclusion of malignancy is a diagnostic challenge for pathologists. Many studies were done on either endometrium or cervix alone, hence we took this study to evaluate both simultaneously before the hysterectomy. Objectives: To profile the histomorphological spectrum of endometrium and cervical lesions on curettage and biopsy concurrently before hysterectomy and correlation with hysterectomy specimens wherever available.
Materials and Methods: The present study was conducted on 153 cases of endometrial curetting’s and cervical biopsies received from Department of Gynaecology to Department of Pathology, RIMS, Raichur during a period of February 2020 to January 2022. Histopathology slides were retrieved from the archives of Department of Pathology. New slides were made from Paraffin embedded blocks wherever necessary and stained with Haematoxylin and Eosin. Histopathological examination of the hysterectomy specimens was conducted wherever available.
Results: Majority of the patients were in third decade of life with mean age of 41.3 years (P<0.0001) and the commonest clinical indication was AUB ((P<0.0001). Majority of the endometrium showed cyclical changes in both endometrial curettage and in hysterectomy specimens which showed a perfect positive coefficient correlation of 0.92 (P value = 0.028). Similarly, the cervical biopsy and cervix findings in hysterectomy specimen showed a highly significant P < 0.0001. The commonest histomorphological lesion in cervix was non-specific chronic cervicitis (NSCC).
Conclusion: Abnormal uterine bleeding is a major gynaecological problem in perimenopausal and post-menopausal women. It could be due to either endometrial / cervical lesions hence if it is evaluated simultaneously with a minimally invasive procedure as our study so that unnecessary radical surgeries can be avoided and medical/ conservative treatment could be offered.

COMPARATIVE STUDY OF LIQUID-BASED CYTOLOGY VERSUS HPV DNA FOR SCREENING OF CERVICAL CANCER AT A TERTIARY HOSPITAL

Virta Chauhan, Sajan Bijyal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2129-2137

Background: Among Indian women, cervical cancer is the most common form of genital malignancy. Cytology (conventional or liquid-based) & HPV DNA used for diagnostis of cervical cancer. Present study was aimed to compare liquid-based cytology versus HPV DNA for screening of cervical cancer at a tertiary hospital.
Material and Methods: Present study was single-center, prospective, observational study, conducted women between the ages of 21 - 65 years, with white discharge per vaginum, post coital bleeding or irregular bleeding, unhealthy cervix on speculum examination.
Results: In present study, 220 women were evaluated for LBC & HPV DNA testing. Mean age of women was 42.91 ± 6.19 year, mean age at marriage was 17.41 ± 3.63 years & mean duration of sexual life was 26.81 ± 8.63 years. Majority were from lower socioeconomic status (57.27 %). Common chief-complaint was white PV discharge (64.55 %), Post coital bleeding PV (19.55 %) & intermenstrual bleeding PV (15.91 %). On per-speculum examination cervical erosion (40.45 %) was common finding. Common mode of contraception used was tubectomy (49.55 %), while 28.64 % women were not using any contraceptive. In present study, common LBC findings were Inflammatory / reactive changes (48.18 %), Non-specific inflammation (10.91 %), Candida (5.45 %), Trichomonas vaginalis (3.64 %), Bacterial vaginosis (0.91 %), Atrophy (1.36 %). Pathological findings were ASCUS  (5.00 %), ASC-H (0.91 %), LSIL (0.45 %), HSIL  (0.91 %), HSIL with suspicious of invasion (0.45 %) & Squamous Cell Carcinoma (2.27 %). Normal findings were noted in 18.64 % women while 2 smears were labelled as unsatisfactory smear. HPV DNA was positive in 15.45 % women.  HPV DNA was significantly associated with pathological LBC report (low grade, high grade & neoplasia).
Conclusion: HPV testing in comparison to LBC was more effective, but it is costlier for application as population screening tool.

TO ESTIMATE LEVEL OF ZINC AND FRUCTOSE IN NORMOSPERMIC AND OLIGOSPERMIC MALES

Dr Shaikh Jeenifer Begum Shaikh Jafar, Dr Sayeda Afroz, Dr. Shaikh Nilofer Begum, Dr Khaled Badam

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2138-2148

INTRODUCTION: Infertility has often been defined as failure to achieve pregnancy within one year of unprotected intercourse. Seminal plasma is very important for sperm metabolism, function, survival, and transport in the female genital tract.Zinc deficiency may lead to gonadal dysfunction, decrease in testicular weight and shrinkage of seminiferous tubules. Zinc may have a role in sperm production, viability and in the prevention of spermatozoa degradation.Fructose concentration is considered a good measure to evaluate seminal vesicular function and has been studied in great detail, and its concentration can depend on number of factors such as time since collection and the age of the donor.
 
MATERIAL AND METHODS: This is a cross-sectional study.Semen examination of the patients visiting the gynecology department of the Government Medical College, Aurangabad was carried out according to the standardized method of the World Health Organization from January 2016 to January 2017. A complete medical history of the patients was recorded. The collection and analysis of semen were done by properly standardized procedures as mentioned in WHO Laboratory Manual (2010). Males with primary and secondary infertility without treatment, of the ages between 20-45 years males.
 
RESULTS: The mean of sperm count in oligospermic subjects is 10.84 ± 7.118 millions/ml of semen ranging 1-15 million/ml which is significantly lower than that of the normospermic subjects i.e; 92.88 ± 79.93 millions/ml, within a range of 32 – 170 million/ml (p < 0.001). In addition, the mean sperm motility in oligospermic men is 40.56 ± 53.82%, ranged within 0-100% is significantly lower than that of the control group 65.6 ± 41.50 %, which ranged from 30 - 98 % (p < 0.001). The mean of seminal plasma zinc in oligospermic men is1.65 ± 0.936μmol/ejaculate, ranged within 0.2- 2.9μmol/ejaculate is significantly lower than that of the control group4.074 ±1.199μmol/ejaculate which ranged from 2.66 – 4.9μmol/ejaculate (p < 0.001).
 
CONCLUSION: From our study we can conclude that biochemical parameters that is zinc and fructose level in seminal plasma have direct effect on physical parameters like sperm count and motility that‟s why we should incorporate these parameters in routine semen analysis. Also as dietary zinc affects seminal zinc level, zinc should be supplemented and dietary zinc should be adequate.

ULTRASOUND DIAGNOSIS OF DYSFUNCTIONAL UTERINE BLEEDING WITH HISTOPATHOLOGICAL CORRELATION

Dr M Radhika , Dr J Madhavi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2149-2159

Background: Abnormal uterine bleeding may be defined as bleeding pattern that differs in frequency, duration and amount from a pattern observed during a normal menstrual cycle or after menopause.
Aims : To study accuracy of Transvaginal Sonography in relation to endometrial biopsy in depicting endometrial changes in DUB and to formulate an effective protocol for the first line evaluation of all cases of DUB at the out-patient level.
Materials and methods: This study on ultrasound diagnosis of DUB with histopathological correlation in 50 patients between 18-45 yrs. The study was aimed to study accuracy of TVS in relation to endometrial biopsy in depicting endometrial changes in DUB. TVS and endometrial sampling was done as outpatient procedure 2-3‘days prior to date of menstruation or on day of menstruation. The relevant clinical findings and investigations were recorded in the proforma which is enclosed. A master sheet showing all details of the cases is also enclosed.
Results: The incidence of DUB in age groups of 18-45 years is high. Menorrhagia was noted in 44% , Polymenorrhagia in 20% by histopathology. In cases of normal endometrium, proliferative endometrium noted in 52%, secretory endometrium in 12% , menstrual endometrium in 12% .Simple hyperplasia was noted in 14%, Cystoglandular hyperplasia in 6%. Out of 6 patients with ET 1 – 4.9 mm , endometrial parenchyma is menstrual on TVS and HPE . Out of 4 patients with ET 15 and above endometrium show hyperplasia on TVS and HPE . The sensitivity , specificity ,PPV and NPV of TVS findings in comparision to Histopathology as Proliferative phase :- 88.8% , 100% , 100% , 88.46% . Secretory phase :- 100% , 86%, 53% , 93% . Menstrual phase :-100% , 100% ,100%, 100%. Hyperplasia :- 70% , 100% ,100% ,93.02% . Surgery is done in 22% of cases , all are above 35 years.
Conclusions: Endo-vaginal scan when combined with endometrial sampling is an valuable tool for the preliminary screening, diagnosis, management all cases of DUB. Therefore, we strongly recommend the routine use of endovaginal scan with endometrial sampling in the clinical and laboratory evaluation of all cases.

ROLE OF UTERINE ARTERY DOPPLER AT 11 TO 16 WEEKS OF GESTATION IN PREDICTION OF PREECLAMPSIA : AN OBSERVATIONAL STUDY

Dr Laxmi Prasanna M, Dr K.Sowmya, Dr Sumalatha.B, Dr Navya.

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2160-2172

Background: Pre-eclampsia is a major cause of perinatal and maternal morbidity and mortality. Doppler is a non-invasive method for evaluation of feto-placental circulation without affecting pregnancy. A high resistance index in uterine artery Doppler waveform has been shown to be the best non-invasive screening test.
Aims: The aim of the study is early prediction of pre-eclampsia and its obstetrical outcome by transvaginal uterine artery Doppler at 11-16 weeks of gestation.
Materials and methods: It is a Observational study in 100 Pregnant Women between 11-16weeks of gestational age . After an informed consent women were subjected to transvaginal ultrasound for dating scan during which uterine artery Doppler waveforms were taken. These women were further followed up clinically for development of preeclampsia. Uterine artery Doppler were studied in all 100 cases.
Results: About 17 women developed preeclampsia among 100 women. Uterine artery notch is seen in 38% of women at 11-16 weeks and about 28.94% of women with notch at 11-16weeks developed preeclampsia. In preeclamptic women mean PI at 11-16 week is 2.6241 which is statistically highly significant as compared to normotensives ( p<0.0001) and hence this will help in prediction preeclampsia. Uterine artery notching at 11- 16 weeks gestation had 64.70% sensitivity and 90.32% NPV. PI > 95th centile at 11-16 weeks has sensitivity of 82.35% and NPV by 96.05%. When maternal risk factors are considered along with PI> 95th centile sensitivity increased to 88.23% and NPV increased to 97.56%. Mean gestation age at delivery is 33+6 week in preeclamptics and 38+5 week in normotensives ,47% had full term vaginal delivery, 9% had preterm vaginal delivery and 15% had preterm caesarean delivery and 29% had term caesarean delivery. Mean birth weight is 2.04kg in preeclamptics and 3.08kg in normotensives, mean Apgar at 1 min is 7.44 and at 5 min is 9.31. In preeclamptic women 7 babies were associated with IUGR and 1 IUFD. Mean duration of NICU stay is 36hrs.
Conclusion: Uterine artery Doppler studies between 11-16 weeks has high NPV, they help us to categorize our patients into low risk and high risk so that proper vigilance may be done in high risk women along with prophylactic aspirin therapy for improving maternal morbidity and mortality.
 

INTRATHECAL DEXMEDETOMIDINE OR MEPERIDINE FOR POST-SPINAL SHIVERING

Dr. Aditya Prakash, Dr Rakesh Raushan

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2173-2177

Background: Spinal anesthesia has been widely used to provide anesthesia and analgesia for cesarean section, which allows a patient to remain awake for the birth of her baby while avoiding the risks of general anesthesia. Hence; the present study was conducted for assessing the efficacy of Intrathecal Dexmedetomidine or Meperidine for Post-spinal Shivering.
Materials and methods: 40 Healthy subjects scheduled for caesarean delivery under CSEA were eligible for the present study and were broadly divided into two study groups as follows: Dexmedetomidine group (Group 1, n=20) and meperidine group (Group 2, n=20). Complete demographic and clinical details of all the subjects were obtained. C section was performed at L3-4 or L2-3 interspace. If primiparas shivered before cord clamping, dexmedetomidine 0.5 µg/kg or meperidine 0.5 mg/kg was administered intravenously. If shivering lasted more than 15 min, the treatment was considered invalid. If treatments were not effective, 4 mg ondansetron could be administered intravenously as a rescue medicine
Results: Incidence of shivering was similar among both the study groups. However; incidence of nausea and vomiting was significantly higher among subjects of group 2.
Conclusion: Both Dexmedetomidine and Meperidine had similar effect on Post-spinal Shivering.

EVALUATION OF PATTERN OF CERVICAL PAP SMEAR CYTOLOGY AND TO CORRELATE IT WITH HISTOPATHOLOGICAL FINDINGS

Dr. Prashant Gupta, Dr. Rohini Bansal, Dr. Shraddha Agarwal, Dr. Pankaj Bansal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2178-2183

Background: Cervical cancer is the third most common cancer among women worldwide, with 85% of its global burden occurring in less-developed countries. The present study was conducted to evaluate the pattern of cervical Pap smear cytology and to correlate it with histopathological findings.
Materials & Methods: 360 females of age ranged 18-60 years were enrolled. Cervical smears were taken with the help of Ayer’s spatula and cyto brush to collect specimen from thesquamocolumnar junction. Thesmears were stained with Papanicolaou stain(PAP stain) and slides wereexamined under light microscope following 2001 Bethesda system.
Results: Age group 18- 30 years had 68 patients, 31-40 years had 112, 41-50 years had 120 and 51-60 years had 60 patients. The difference was significant (P< 0.05). Maximum number of cases 160 were categorized as negative for intraepithelial lesion or malignancy (NILM). Atypical squamous cells of undetermined significance (ASCUS) seen in 54 followed by followed by low gradesquamous intraepithelial lesion (LSIL) in 50 and high gradesquamous intraepithelial lesion (HSIL) in 30, squamous cell carcinoma 4 and cases of adenocarcinoma 2. 88%diagnosed on Pap smears correlated on histopathology findings.
Conclusion: Pap smears found to be effective in screening for earlydetection of premalignant and malignant lesionsof cervix.

A RANDOMIZED CONTROL STUDY TO EVALUATE EFFICACY OF MAGNESIUM SULPHATE AS AN ADDITIVE TO ROPIVACAINE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

Supriya Aggarwal, Naveen Kumar Singh, Prateek Agrawal, Vidushi Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2184-2191

INTRODUCTION
Ropivacaine is an aminoamide local anaesthetic that is less cardiac and central nervous system (CNS) toxic than other long acting local anaesthetics like bupivacaine. Local anaesthetics alone for supraclavicular brachial plexus block provide good operative conditions but have shorter duration of postoperative analgesia.
MATERIAL AND METHODS
This prospective study was conducted in the Department of Anaesthesia at KD Medical College, Hospital and Research from November 2021to April 2022.After obtaining permission from institutional ethics committee, written informed consent was taken from the participants. Eighty adult patients were randomly allocated to two equal groups (n = 40 in each group) using computer-generated random number list.Patients with the American Society of Anaesthesiologists (ASA) physical status I and II, aged between 25 and 55 years of both sexes undergoing elective orthopaedic surgeries of elbow, forearm, and hand under supraclavicular brachial plexus block were enrolled in the study.  The onset and duration of sensory and motor block, the perioperative vitals and requirement of post operative rescue analgesic were compared by us.
 
RESULTS
In group A 50% of patients achieved grade IV quality of block in comparison to 45% in group B which was not significant (p>0.05). 31 patients required rescue analgesic (intramuscular diclofenac sodium injection) in group A compared to 27 patients in group B.
Conclusion
We conclude that addition of 150 mg magnesium sulphate to ropivacaine 0.50% solution in supraclavicular brachial plexus block prolongs the duration of sensory and motor blockade and reduces the requirement of rescue analgesic in postoperative period with no significant adverse effects.

EFFECTS OF RETROPUPILLARY IRIS CLAW LENS IMPLANTATION ON VISUAL OUTCOME, ENDOTHELIAL CELL LOSS, AND COMPLICATIONS IN PATIENTS WITH POSTERIOR CAPSULE DEFICIT

Arun Kumar Singh, Satyaprakash Singh, Shivangi Singh, Kamaljeet Singh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2192-2199

Purpose: To investigate the effects of retropupillary Iris claw lens implantation in patients with inadequate posterior capsule in terms of visual outcome, endothelial cell loss, and complications.
Methods: Sixty-six patients who had retropupillary iris claw lenses implanted in eyes with posterior capsule deficit participated in this prospective study.
Results: The mean PreopLogMAR was 0.5338, and at 3 months postoperatively, it had improved to 0.3149. In 36 patients (54.54 %), macular oedema was noted; in 24 patients (36.36 %), pigment dispersion was noted. Disenclavation was observed in none of the case.
Conclusion: Retropupillary Iris Claw lens implantation is a quick, affordable, predictable, safe, and operation that can produce good visual results with few problems.

A STUDY TO COMPARE THE EFFECT OF NEGATIVE PRESSURE WOUND THERAPY WITH TOPICAL INSULIN APPLICATION ON WOUND HEALING IN DIABETIC FOOT WOUNDS VERSUS NPWT ALONE.

Anil Kumar M S , Sunayana K U , Ashok P , Pankaja S S

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2200-2211

Abstract :
 Background : Diabetic foot wounds affecting either limb is seen in immense numbers on out patient basis in the department of general surgery all over India. They present to the health care professionals in varying general conditions , ranging from a simple wound with adequate granulation tissue which can be managed on OPD basis to   v those presenting in septic shock and MODS due to poorly managed wound and systemic control of diabetes mellitus , hence requiring admission. Innovations are being tried with respect to the type of dressings to hasten the formation of granulation tissue, decrease the size of the wound and reduce the foul smelling exudate in diabetic foot wounds. On similar grounds a novel dressing technique using a combination of NPWT and topical insulin has been tried on diabetic foot wounds and its results assessed using accepted criterias.
objectives : To assess the reduction in the size of the wound when a combination of NPWT and topical insulin is used using the BATES - JENSEN WOUND ASSESSMENT TOOL as compared to plain NPWT on diabetic foot ulcers in Type 2 diabetic patients.
methodology: The present prospective interventional study was done by the Department of Surgery at JSS Medical College and Hospital , Mysuru from July 2019 to  December 2021. A total of 96 study patients were enrolled for the study out of which 48 subjects were divided randomly into two group namely case and control group. Evidence of granulation tissue formation, decrease in the size and depth of the wound ,decrease in the amount of exudate, peripheral tissue induration as well as an increase in epithelisation of the wound is assessed by the BATES - JENSEN WOUND ASSESEMENT TOOL  on the 5th, 10th and 15th day, using the BATES- JENSEN WOUND ASSESSMENT SCALE. RESULTS : Using the Bates Jensen Wound Assessment tool this study showed that the BWAT score which was 43.39 on day 5 in the VAC group reduced to 32.5 on day 15 in the same group whereas the BWAT score which was 41.7 on day 5 in VAC + topical insulin group reduced to 27.1 on day 15 , which was found to be statistically significant. CONCLUSION :This study has shown that on using NPWT + topical insulin as a dressing method for diabetic foot wounds as compared to NPWT alone there has been significant reduction in the size of the wound , hastening in the process of formation of granulation tissue hence proving that a combination of NPWT + topical insulin is an effective dressing method for diabetic foot wounds .

RADIOLOGICAL SIGNIFICANCE IN DIFFERENTIAL DIAGNOSIS OF OSTEOSARCOMA: A RETROSPECTIVE STUDY

Deepak Kumar, Priyanka Sharma, Nilam Bhasker, Shivanjali Raghuvanshi, Rajeshwar Nath Srivastava, Dharmendra Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2212-2219

Introduction: Osteosarcoma (OS) is the relatively most prevalent bone malignancy accounting for 20% of primary bone tumors. Differential diagnosis of OS is a daunting problem as they can masquerade with different kinds of bone tumors. None of the studies correlate the radiological findings of suspected cases of osteosarcoma with biopsy.
Purpose: The purpose of this retrospective study is to correlate the radiological findings with biopsy of suspected osteosarcoma.
Materials and Methods: The current retrospective study was carried out in the Department of Orthopaedics in collaboration of Department of Pathology at a tertiary care center in north India from 2015 to 2021. A total of 162 patients of suspected OS included in this study after carefully examination of clinical and radiological features analyzed by two Orthopaedic surgeons. The differential diagnosis of OS was observed in all patients through analyzing the clinical and radiological features followed by biopsy. The accuracy of radiology was calculated against biopsy procedure. 
Results: Out of 162 patients, 102 patients were male and 60 were female with a mean age of 29.65±10.55 years. The accuracy of clinical and radiological findings as compared to biopsy diagnostic procedures was 44.44%. A discrepancy between radiology and biopsy was 55.56%.
Conclusion: Radiological finding reveals that OS mimics different kinds of tumors reflected with low diagnostic accuracy of radiology. Hence, biopsy must consider confirming the diagnosis of bone tumors.          

ASSOCIATION BETWEEN PRESENCE OF MULTISEGMENTED NEUTROPHILS AND ITS POSSIBLE CAUSATIVE FACTORS: A PROSPECTIVE COHORT STUDY

Dr Rituraj Tutor, Dr. Akhalesh Kumar Tutor,Dr. Pradeep Kumar Singh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2220-2229

Background: Hypersegmentation of neutrophils is defined as presence of 5% or more neutrophils with five or more lobes or single neutrophil with 6 lobes. It is usually associated with deficiency of or failure to utilize cobalamin or folate and impaired DNA synthesis. Aims & Objectives: to find out any abnormality in the neutrophils of those subjects having hypersegmented neutrophils, to assess the manifestations in peripheral smear of these patients and to find out any association of the presence of hyper segmented neutrophils in peripheral smear with Vitamin B12 level, folic acid level and platelet count. Methodology: A prospective study was carried out from November 2021 to June 2022 in the department of pathology of a tertiary care teaching hospital of Government medical college, Betiah, Bihar among 136 study participants by total consecutive sampling. Patients having hypersegmented neutrophils were administered for data collection and were subjected to further tests. Analysis of data was done using SPSS software version 22. Multivariate regression analysis was performed and the value of p< 0.5 was taken as statistically significant. Results:  Hypersegmented neutrophils were present more commonly in females (75 out of 136, 55%) as compared to those of males (61 out of 136, 45%). Most of the study participants 81 out of 136 (59.56%) were in the age group of 31-60 years and educated upto primary level (52 out of 136, 38.24%). The various abnormalities in neutrophils in addition to hypersegmentation seen were cytoplasmic toxic granules, cytoplasmic vacuoles and dohle bodies. The peripheral smear has macrocytic normochromic appearance in about 35.29% of the cases.  Lower vitamin B12 levels was significantly associated (p < 0.01) with presence of hypersegmented neutrophils.
Conclusion: The presence of hypersegmented neutrophils were significantly associated with lower vitamin B12 levels which is one of its possible causative factor.

ASSESSMENT OF EFFECT OF YOGA ON AUTONOMIC NERVOUS SYSTEM OF HUMAN BODY

Dr Naveen Bhartia Porwal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2230-2234

Background: The autonomic nervous system plays a major part in preparing the human body to adapt to the constant environmental changes and stress by correcting the sensory, visceral, motor, and neuro endocrine functions. The present study was conducted to assess effect of yoga on autonomic nervous system of human body.
Materials & Methods: 80subjects of both genders were divided into 2 groups. Group I were on regular yoga and group II had healthy subjects who do not practice yoga (control). Anthropometric measurements like height, weight was taken. BMI was calculated, and recordings of AFT were done in the morning.
Results: Group I had 22 males and 18 females and group II had 20 males and 20 females. The mean age of group I was 18.6 years and in group II was 20.4 years. The mean height was 164.2 cm in group I and 165.3 cm in group II. The mean weight was 53.2 Kgs in group I and 57.5 Kgs in group II. The mean BMI was 20.1 Kg/cm2 in group I and 21.3 Kg/cm2 in group II. The difference was non- significant (P>0.05). The resting HR (bpm) was 80.3 and 69.4, DBT (bpm) was 1.43 and 1.72, 30:15 ratio (bpm) was 1.12 and 1.26, VR (bpm) was 1.52 and 1.81, HGT (mm Hg) was 16.8 and 10.2 and BP response to standing (mm Hg)          was 6.32 and 8.43 in group I and II respectively. The difference was non- significant (P>0.05).
Conclusion: Regular long‑term yoga training showed significant effects which streamline autonomic functions that help to prevent lifestyle diseases and their complications.

Health and Nutritional Considerations in Dentistry and Medicine

Dr Roopa Patil, Dr Mahantesh Patil, Dr Neha Dhaded, Dr Satish Nesari

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2235-2242

A well-proportionate diet is essential from the beginning stages of life for complete growth, development, and maintenance of normal body functioning, physical activity, and health. It is a critical element in the social health of communities as well as the health (at cellular, organ and whole-person levels) of the individuals within them

Comparative Evaluation of Removal of Fibre Post Using Different Techniques

Dr Roopa Patil, Dr Mahantesh Patil, Dr Satish Nesari

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2243-2251

Introduction: Endodontically treated teeth often have a significant coronal and radicular compromise of  tooth structure because of extensive caries, fracture, trauma to the tooth, iatrogenic causes and pulp pathology
Materials and methods: Sixty extracted, single-rooted teeth with complete root development, mature apex, visible canal space and patent apical foramen were selected for this study. All teeth were free of caries lesions and fractures as evaluated under a microscope and radiographically.
Results: The mean and standard deviations of time to remove the fiber posts for the 4 subgroups, measured in seconds, are given in Table 1 ( Graph 1). Table 2 (Graph 2) shows the mean time to remove fiber posts for the 3 fiber post removal system subgroups. The 3 subgroups did not differ significantly in average removal time. There was no significant difference between two removal kits and diamond bur/Peeso reamer combination in terms of efficiency for removal of fiber posts.
Conclusion: Within the limitations of the present study, it can be concluded that There was no difference between the three post removal systems i.e., DT Removal drill kit, Kodex Twist drill/ Parapost removal drill kit

Anterior Aesthetic Restorations with Fibre Bridge Reinforced

Dr Roopa Patil, Dr Mahantesh Patil, Dr Neha Dhaded, Dr Murugesh Kurani Mahadev

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2252-2256

Loss of the anterior tooth may be a catastrophic event for the patient. An immediate replacement is called for especially in adolescents as it affects them both psychologically and socially. Although conventional fixed partial dentures and implant-supported restorations may often be the treatments of choice, fiber-reinforced composite (FRC) resins offer a conservative, fast, and cost effective alternative for single and multiple teeth replacement.

Treatment of Idiopathic Clubfoot by Ponseti Method: A Prospective Evaluation

Dr Satish Shankar Nesari, Dr Arunkumar G, Dr Annasaheb B. Patil, Dr Mahantesh Y. Patil

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2257-2263

Background: From long time clubfoot has been a clinical challenge to orthopaedic surgeons. It is one of the commonest congenital deformities of the musculoskeletal system in children. Each year more than 1,00,000 babies are born with congenital clubfoot. 80% of which occur in developing countries.
Methods: 60 feet in 40 children were treated by the Ponseti method from 1st December 2020 to 31st November 2021. Prospective follow up for a mean duration of 18 months was undertaken. The deformity was evaluated by Pirani score before and after the treatment. At the end of treatment all feet were functionally classified into good, fair and poor.
Results: The average number of casts applied before full correction was 8. 21.66% of the feets needed tenotomy before full correction. 90% of the patients showed good results, 3.3% had fair results and 6.6% of patients had poor results. There was a significant difference in the pre-treatment and post-treatment pirani score values.
Conclusions: Ponseti method of manipulation and plaster casting is very effective to correct club foot deformity.

A Cross Sectional Study on Noise-induced Hearing Loss in Heavy Machinery Workers

Dr. Nimeshkumar Patel

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2264-2269

Introduction: Noise-induced hearing loss results from accumulated repetitive noise exposure of high amplitude. Heavy machinery workers are exposed to a noisy motorized machine that is carried on their back. We studied the prevalence of noise-induced hearing loss and its characteristics among the workers.
Materials and Methods: A comparative cross sectional study was conducted in Param ENT Hospital from (Dec 2011 to Jun 2017)on a group of Heavy machinery workers. Ear examination was conducted, followed by pure tone audiometry in a soundproof room at least 48 h after the subjects were free from the noise exposure. Noise-induced hearing loss was defined as failed defini- tive threshold at frequencies 3, 4 or 6 kHz of more than 20 dB with the loss at the two nearest frequencies on both sides of the dip amounting to at least 5 dB less. The intensity levels of the heavy machinery were measured by using a sound level meter by putting the probe near the external ear of the worker about 12 cm apart from his pinna.
Results: A total of 75 heavy machinery workers and a similar number of clerks participated in this study. The range of noise level of the machines was in between 91.3 dB and 100.7 dB with the mean of 95.0 dB. There was a significant correlation of noise-induced hearing loss in the heavy machinery workers (p value = .010) with the prevalence of 82.6%. The dip in PTA at 3, 4 and 6 kHz significantly occurred in the subjects with the p value of 0.001, 0.009 and 0.036 respectively.
Conclusion: It is warranted to give continuing education on the heavy machinery workers about the risk and how to protect them from noise-induced hearing loss. While the diagnosis should be made in the presence of exposure, the possibility of noise-induced hearing loss is highest when the dip occurs at 3 kHz followed by 4 and 6 kHz.

Functional Outcome of Dynamic Interlock Nailing in Distal Tibia Fractures

Dr Channabasavanna B Hegade, Dr Vinod R, Dr Satish Shankar Nesari, Dr Annasaheb B Patil, Dr Mahantesh Patil

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2270-2278

Background and objective: Distal tibial metaphyseal fractures are difficult to manage and are challenging to most orthopaedic surgeons. The mechanism of injury and their proximity to ankle joint makes surgical treatment complicated. Most fractures at this site need to be fixed because non-operative treatment results in loss of reduction and subsequent malunion, non-union. Currently, surgeons have variety of options and implants for the treatment of these fractures.
Materials and methods: Adult patients with fractures of lower third tibia admitted to Vijayanagar Institute of Medical Sciences, Ballari will be taken for this study after obtaining their informed, valid written consent. This is a prospective study from November 2018 to November 2020
Results: Thirty patients were followed an average of 12 months (range 6- 20 months) with mean fracture healing time was 16.2 and 18.4 weeks for closed fracture and G-A type 1 fracture respectively. One patient had Non-Union.
Conclusion: Considering the ease of performing the technique and the decreased operative time, Intramedullary nailing with Dynamic Interlocking nailing is safe and effective procedure for Distal 1/3rd tibia fractures. And is based on principles of limited exposure and indirect reduction methods, which avoids major soft tissue complications and shortens the length of the patient’s stay in the hospital. As the implants are in dynamic mode leads to early union of fracture.

Histopathological Features of Fungal Infections in Sinonasal, Oral and Orbital Sites Associated with COVID-19 Patients.

Dr Rohit Anurag Jha, Dr M.N. Jadhav, Dr Aruna S, Dr Jnaneshwara K B, Dr Rekha M H, Dr Shreekant K Kittur

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2279-2285

Background: The COVID- 19 infections are associated with wide range of bacterial and fungal co-infections. They may be associated with various comorbidities. Definite diagnosis requires demonstration of fungi in tissue sections or in culture. Yield of organism in culture is suboptimal. Hence histopathology plays critical role in establishing the diagnosis and provide evidence of tissue invasion.
Objectives: To study the histopathological features of fungal infections in sino nasal, oral and orbital area associated with COVID-19 patients.
Material and methods: One hundred twenty cases of fungal infections involving sinonasal, oral and orbital area in laboratory confirmed COVID-19 positive patients between June-September 2021 were taken for study. Clinical data was recorded, histopathological examination was done along with periodic acid Schiff stain and culture report was obtained. Result: The study included 92(76.6%) males and 28(23.3%) females with age ranging from 13 to 78 years. The tissues included debridement, biopsy and excision specimen. Acute inflammation was seen in 8(6.66%) cases, chronic inflammation in 112(93.33%), granulomas in 25, thrombosis in 14, necrosis in 104, angioinvasion in 13, perineuritis in 10 and bone invasion in 18 cases. Mixed fungal infection was seen in 11cases. Conclusion: Histopathology remains the mainstay in diagnosis of invasive fungal infections especially when culture is negative.

Physical Fitness Index of Medical Students in a Tertiary Health Institution

Dr. Jyoti Rao , Dr. Jyoti Memoalia, Dr. Sabita Yograj Dr. Meenakshi Sharma, Dr. Onkar Singh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2286-2292

Back ground & Aim: The main aim of this study was to determine the physical fitness index of the medical students using the modified Harvard step test and to compare the physical fitness between male and female medical students.
Methods: The study was conducted in department of Physiology, GMC Kathua (J&K). A total of 94 subjects were selected, of whom. 48 were male and 46 were female medical students, whose age varied from 17 to 24 years. The subjects selected for this study were medical students admitted for 1st year MBBS Course. Descriptive data for age (years), gender height (m) and weight (Kg) were obtained and Body Mass Index was calculated.
Physical fitness index (PFI) was measured using the modified Harvard step test.
Results: In the present study, 29.8% students had Excellent Harvard Index, 38.9% good, 16.8% Average, 12.6% low average Harvard Index and 1.1% poor Harvard Index, 33.3% male showed excellent Harvard Index. On comparing the physical fitness between male and female medical students 47.8% female showed good Harvard Index indicating that on an average female were having a better PFI.
Conclusions: The study of population which were MBBS students had proportionally good and Excellent PFI this can be attributed to the fact that the medical students are having awareness about the alarming rise in lifestyle diseases and are more conscious about maintaining their physical fitness, physical appearance along with academics and want to excel in all spheres of life.

Microbiological Profile and Antibiotic Sensitivity Pattern of Ocular Infections in A Tertiary Care Hospital

Dr. Rakhee Agarwal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2293-2299

Background: The eye may become infected from the outside or as a result of bloodstream-borne germs invading the eye. In this work, particular bacterial and fungal pathogens that cause eye infections were isolated, identified, and their antibiotic susceptibilities were assessed. This research was done to find the bacterial and fungal pathogens that cause eye infections, isolate and identify them, and find out how susceptible they are to antibiotics in vitro.
Methods: All of the participants in the current study had slit lamp bio-microscopy examinations, and an ophthalmologist made a clinical diagnosis based on accepted practises. The various ocular tissues were collected for specimens for smear and culture after thorough ocular examinations utilizing conventional methods. The samples were examined under a microscope directly using techniques like Gram staining, and biochemical reactions performed were catalase test, coagulase test Motility test, Indole test, Citrate utilisation test, Urea Hydrolysis test, and sugar fermentation tests.
Results: In vitreous and corneal specimens, growth was observed in n=20 (32.25%) of the n=26 (41.93%) instances that were found to be positive by direct microscopy (KOH mount with Calcofluor White staining), while no growth was found in n=6 cases. Out of n=36 (58.06%) cases that were negative on direct microscopy, growth was seen in n=2 (5.55%) cases, whereas no growth was seen on culture in the remaining n=34(94.44%) cases. Direct microscopy had a sensitivity of 80.12% and a specificity of 79.61%.  Out of total n=20 fungal isolates found n=15 cases were from corneal scrapings which yielded Aspergillus sp. In n=6, Penicillium sp. n=5 Candida albicans n=2 and Fusarium sp. n=2 and the one mixed growth of candida along with Coagulase negative staphylococcus.
Conclusion: Emerging drug resistance is a matter of serious concern and hence all ophthalmological samples must be analysed as thoroughly as possible for antimicrobial resistance due to the increase of antibiotic resistance. Ophthalmologists must adhere to the etiologic approach to diagnosis and consider risk reduction in order to lessen the burden of ocular infections.

BRONCHOSCOPIC INTERVENTION AND MOLECULAR DIAGNOSTICS: SYNERGISTIC TOOLS IN A PULMONOLOGIST’S ARMAMENTARIUM AGAINST TUBERCULOSIS

Manan Bedi, Adnan Hamza, Sachet Dawar, RC Meena

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2300-2311

Background: Mycobacterium tuberculosis complex is the causative organism of tuberculosis, it is a major health problem throughout the world. In developing countries like India, almost 25% of adult deaths which are avoidable are caused by it.
Around 22-61% of Cases have smear negative but culture positive state where clinical profile and radiological lesions suggest diagnosis of pulmonary tuberculosis, then initiation of anti-tubercular drugs is not advisable without meticulous search for tubercular bacilli.
Gold standard for diagnosis of tuberculosis is culture of sputum, but it takes long time( 45 days ) to perform.
Aim: Evaluation of bronchoalveolar lavage fluid in clinically and radiologically suspected cases of sputum smear negative pulmonary tuberculosis.
Methodology: In our observational, cross sectional study done in the Department of Respiratory Medicine, NIMS involving all the patients attending indoor and outdoor services in one year period from January 2019 to June 2020, we tried to access the diagnostic yield of bronchoalveolar lavage fluid in clinically and radiologically suspected cases of sputum smear negative pulmonary tuberculosis. Then the Broncholaveolar Lavage (BAL)  fluid  specimen  was  sent  for  smear  for  AFB, CBNAAT and  BACTEC  culture  for  Mycobacterium tuberculosis.
Result: In this study, pulmonary infiltrate (54.2 %) was most common radiological finding in their chest x-ray, followed by cavity (31.2%). 17 patients had nodular shadow (8.9%) and only 11 patients had miliary pattern (5.7%). Out of 190 cases, 156 patients had unilateral involvement of lung (82.2%) and only 34 cases had bilateral involvement (17.8%). Most of the patients had right upper zone (58.4%)  involvement followed by left upper zone (12.2%) with involvement of lower lung field in only 4.2%.
Conclusion: To conclude bronchoalveolar lavage obtained by fiber optic bronchoscopy is a relatively safe and useful procedure for diagnosis of suspected pulmonary tuberculosis cases when smears of these patients does not reveal mycobacterium tuberculosis.

THE PES ANSERINUS: THE ANATOMY AND PATHOLOGY OF NATURALLY OCCURRING AND EXTRACTED TENDONS

Dr.Mukesh Bansal, Dr Muktyaz Hussain, Dr Alpana Bansal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2312-2320

The goal of this article is to have a comprehensive review of the anatomy of the pes anserinus (PA) and the spectrum of pathologic conditions that can affect this structure. After the insertion site of the PA tendons was fully exposed, careful dissection was performed to determine the exact shape of the PA. Insertions were made into the gracilis and superficial layers of the sartorius and the deep layers of the semitendinosus on the medial side of the tibia. Sixty-six percent of specimens had one semitendinosus tendon at the insertion site, while 31 percent had two, and 3 percent had three. A connection was made between the deep fascia of the leg and the tendons of the gracilis and semitendinosus. The anserine bursa was a somewhat asymmetrical, roughly circular shape. Some of the anserine bursa specimens even extended beyond the proximal line of the tibia. The anserine bursa, as seen from the medial side of the tibia, was situated posteriorly & superiorly from the tibial midline, paralleling the sartorius muscle. Anserine bursa injections should be given at an angle of 20 degrees medially and inferiorly from the vertical line, 15 or 20 millimetres deep, and roughly 20 millimetres medially and 12 millimetres superior from the inferomedial point of the tibial tuberosity.

“CLINICAL PROFILE AND OUTCOME OF SURGICAL MANAGEMENT OF PERFORATED DUODENAL ULCER: A RECORD BASED STUDY IN A TERTIARY HOSPITAL.”

Dr. Narashimaswamy P. Dr. Karthik B, Dr. Vinay R

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2321-2330

Among abdominal emergencies, perforations of peptic ulcer are third in frequencies, Inspite of modern management, it is still a life-threatening catastrophe, Prompt recognition of the condition is very important and only by early diagnosis and treatment it is possible to reduce the still relatively high mortality. This study aims in understanding the factors responsible for duodenal ulcer perforation, that affect the post operative outcome, morbidity & mortality after surgery.

UNILATERAL COMPLETE LUNG DESTRUCTION IN TUBERCULOSIS: IMAGING SPECTRUM IN A TERTIARY CARE HOSPITAL IN INDIA

Mohammed Ismail, Shilpa D, Pavan Kumar, Ehtaisham Rahi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2331-2337

Background: Tuberculosis is one of the world’s potentially life-threatening communicable diseases. The disease burden is more in developing countries. Pulmonary tuberculosis can lead to several serious complications. Unilateral lung destruction and complete destruction of a major part of lung or entire lung is common, and it results from parenchymal and airway involvement. Chest radiographs & computed tomography of chest is the mainstay in the detection of the destroyed lung.
Objective: To describe the radiographic and computed tomographic findings in patients with tuberculous unilateral lung destruction.
Martial and Methods: In this report, we present a review of 50 patients withUTLD secondary to TB. Case records of the patients were retrospectively evaluated for clinical data and treatment history.Retrospective review of the images was performed by two radiologists and relevant findings were studied.  Important findings were noted.
Results: A total of 50 patients with unilateral complete lung destruction were evaluated. Age ranged from 25 to 68 years. Chest radiograph showed a small opacified hemithorax with mediastinal shift, crowding of ribs. Computed tomography showed loss of lung volume with fibrosis, bronchiectasis, and cavities. Left lung destruction was predominant (41/50, 82%). 22(44%) patients had fibrosis or cavities in contralateral lung. 16 (32%) patients had features of active disease in contralateral lung. 3(6%) patients had aspergilloma in the affected lung.
Conclusion: Males are more commonly affected. Left lung is more commonly involved compared to the right. Characteristic radiological findings are unilateral volume loss, reduced size of the ipsilateral pulmonary artery and pulmonary veins and hyperinflation and herniation of contralateral lung.

COMPARISON OF PIPELLE ENDOMETRIAL SAMPLING VERSUS DILATATION AND CURETTAGE IN CASES OF ABNORMAL UTERINE BLEEDING

Kesavachandra Gunakala, P.M. Rekharao, Seshadri Sahaja, Vennela Mude

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2338-2359

Background: Pipelle endometrial sampling versus Dilatation and curettage in collecting a sufficient endometrial sample for histopathological diagnosis was the subject of this observational clinical correlation diagnostic study. Aim: The present study is done in our hospital to know if Pipelleaspiration endometrial sampling can replace D&C for histological examination in cases of AUB.
Materials and Methods: This was an observational clinical correlation diagnostic study designed to compare the efficacy of Pipelle endometrial sampling with Dilatation and curettage in obtaining an adequate endometrial sample for histopathological diagnosis. After obtaining informed consent to participate and determining fitness for the procedure, 100 patients who reported with AUB to the Department of Obstetrics &Gynaecology at Government Medical College, Kadapa, were enrolled in the study. The study was carried out from October 2019 to September 2021. The patient underwent a thorough clinical evaluation in the outpatient department, which included a history, physical examination, and baseline investigations. Prior to the procedure, TAS/TVS were done. Endometrial sampling was performed using the Pipelle device, followed by a diagnostic reference standard and D&C endometrial sampling under anaesthesia.
Results: The most common age group presented with AUB is between 41 and 45 years. Most of the patients (45%) had < 6months duration of AUB. Pre and perimenopausalwomen made up 94% of the study population, whereas postmenopausal women made up 6%. Among the study group, 4% were nulliparous, and the remaining 96% were parous women. Of the study group, the ET thickness varies as - 13 had < 6mm, 18 had ET between 6.1- 9mm, 50 had ET between 9.1-12mm, 13 had ET between 12.1-15mm, 4 constitute between 15.1-18mm, 2 had >18mm ET. In Pipelle and D & C, sampling inadequacy was significantly more in menopausal women compared to pre-menopausal women. (P<0.05). In 16 cases, Pipelle sampling was deemed challenging. Sampling was difficult in nulliparous women when compared to parous women. Histopathology reports were obtained in 93 of the 100 Pipelle samples and 94 of the 100 D&C samples in current study.  The most frequent endometrial pattern observed was Hyperplasia without atypia (21%) , followed by proliferative phase of the endometrium (20%), no evidence of malignancy (14%), Secretory phase (11%),  disordered proliferative phase (11%), atrophic endometrium (4%), nonsecretory phase in (4%), endometrial polyp (2%), Hyperplasia with atypia (2%), early secretory phase (1%), endometrial carcinoma (1%), late secretory phase (1%), Endometrial glandular hypertrophy (1%). When comparing Pipelle to D&C, the chi-square test shows that Pipelle has a sensitivity of 98.9% for retrieving sufficient tissue and a specificity of 100%. The positive predictive value is 100 percent, while the negative predictive value is 85.7%. The p-value estimated is< 0 .001, which is statistically significant. Out of 100 cases that had Pipelle sampling, 91 had no complications. 5 had pain, and 4 had bleeding. Out of 100 cases that had D & C, 59 had no complications, 29 had pain, 5 had bleeding, and 7 had both pain and bleeding.
Conclusion: Pipelle sampling can be used as an effective screening procedure in the outpatient department.

A STUDY ON GYNAECOLOGICAL PROBLEMS IN ADOLESCENT GIRLS AND ETIOLOGICAL FACTORS IN GOVERNMENT MEDICAL COLLEGE, KADAPA

Kesavachandra Gunakala, P.M. Rekharao, T. Bhavya, Vennela Mude

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2360-2375

Background: Low socio economic group hailing from rural population was the maximum group of girls studied. To study various gynaecologicalproblems and etiological factors encountered in adolescent girls who attended the gynaecological OPD, at GMC, Kadapa.
Materials and Methods: A total of 200 cases of adolescent girls aged 10 -19 years who attended gynaecological OPD and emergency department. Detailed history with regard to gynaecological problems was taken from the patient and girl‟s mother was also interviewed to get accurate details about any previous medical problems if present.
Results: Maximum incidence of gynaecological problems was seen in age group of 17years. Among the various presenting complaints in studied adolescent girls, menstrual irregularities were the most common. Oligomenorrhoea was the most common menstrual problem in this study. Anovulation is the most common cause of menorrhagia in adolescents. Majority of adolescent girls suffered from anemia ranging from mild to severe types of anemia. 5.56% patients with puberty menorrhagia received blood transfusion. The most common cause of oligomenorrhoea was the hypothalamic pitutary gonadal dysfunction. Counselling and reassurance was an integral part of treatment strategies. PCOS and hypothyroidisms were the other endocrinological abnormalities common among the adolescent girls. Leucorrhoea in adolescent girls in my study were most commonly. physiological, counselled and explained to maintain proper hygiene.
Conclusion: A combined effort of team comprising gynaecologist, endocrinologist is required in arriving final diagnosis in case of primary amenorrhoea.

A SYSTEMIC REVIEW OF PREVALENCE OF DEPRESSION IN PATIENT TAKING LONG TERM DIALYSIS

Mihirkumar P. Parmar, Mankirat Kaur, Gunjan Kochhar, K. Shashi Vardhan Reddy, Rajagopal, E R, Umesh Batura, Sweta Sahu, Jitendra Patel

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2376-2390

Background: People living with chronic kidney disease are at high risk of depression, anxiety, frailty, high depression in chronic kidney disease patients is associated with decreased selfcare behaviour, and aim of this review is to check the association between depressions with chronic kidney disease patients. High depression prevalence is there in long term dialysis patients and affect the person life quality so our main objective of this study is to check the depression associated with the long term dialysis.
Materials and Methods: Observational, qualatative, cross sectional, longitudinal, retrospective, cohart, prospective analysis and study is hospital and renal therapy unit, dialysis center based. This study took place in between year 2018- jan to 2022- jun, involving 3235 participants. following instruments is used: sociodemographic, economic and health condition characterization and the subjective frailty assessment (SFA) and patient health questionnaire-9 (PHQ-9), depression subscale of the hospital anxiety and depression scale and HQRoL was assesed using the kidney disease of life 36 short form, cross lagged pathway analysis, univariate analysis followed by multiple regression analysis was performed for demographical parameters, clinical conditions and laboratory test, QoL (36-Item Short-Form Health Survey [SF-36]), cognitive impairment (Mini-Mental State Examination [MMSE]), depressive state (Center for Epidemiologic Studies Depression Scale [CES-D]), grip strength, and 24-h urine volume, Depressive symptoms measured using BDI-II, Quality of Life measured using the 12-item short-form health Survey (SF-12), Hospitalizations, Mortality, Beck Anxiety Inventory, the state-trait anxiety inventory (STAI), the beck depression inventory (BDI) and the hospital anxiety and depression scale (HADS).
Results: Depression is associated with the presence of frailty among patients with CKD on hemodialysis by the finding there was occurrence of physical frailty (73.8%) and depression (93.7%), patients with poor HRQoL were at risk of more symptoms of depression, Biochemical abnormalities like abnormal serum phophate, parathyroid hormone level are related to depression, there is high Qol and recovery by peritoneal dialysis from cognitive failure than patient on hemodialysis. Anxiety symptoms are independently associated with increased risk for mortality and 1-year hospitalization, fitting factorial structure for the Beck-Depression Inventory-II (BDI), in dialysis patients and to assess the relation of these structure dimensions with quality of life (QoL), hospitalization, and mortality by the results median follow-up time was 3.0-3.5 years, during that time 25% deaths occurred. 22% of patients had anxiety symptoms and 42% had depressive symptoms, A higher prevalence of depressive symptoms was found in immigrant compared to native patients (49% vs. 36%), Depression and anxiety were significantly associated with females, low level of education, increased patients' age, retirement, poor financial situation, marital status and co-morbidity by the result 29.4% had depression and 35.9% had anxiety, also Patients with high levels of anxiety had higher levels of depression and those with high depression scores had higher anxiety scores.
Conclusion: The evidence from eight studies gives idea about the depression related to chronic kidney disease patient on dialysis; our review gives idea about the relation depression, anxiety, frailty with the ckd patients on dialysis. High quality studies required to examine depression in dialysis patient.

TEENAGE PREGNANCY - ITS EFFECT ON MATERNAL AND FETAL OUTCOME

G.Kesava Chandra, K. Madhavi, Shanmuki Sree

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2391-2406

Background: To find complications associated with teenage pregnancies. To find the effects on maternal and fetal outcomes.
Materials and Methods: It was a Quantitative, observational, analytical, prospective cross-sectional study. 100 Study populations were taken by randomization, after applying exclusion criteria. The study was carried out during the year from October 2019 – September 2021 At GGH, Kadapa.
Results: In the present study, 2% of total deliveries conducted in our institution are of teenagers. 74% of pregnant teenage women were 19 years and 18 years old, 4% were under 15 years, and 22% were in the 15-18 years age group. 85% belong to primigravida in our study, and the remaining were high order pregnancies. In our study, 1% is pregnant out of wedlock. The mean age of marriage is 17 years in our study. Only 7% had an occupation in our study.  All pregnant teenage women in our study belong to low socioeconomic status. 95% of our study had poor knowledge regarding pregnancy and delivery. 31% of teenage pregnancies were booked. 2% came directly during labour, remaining 67% registered late in pregnancy.  Only 4% are short-statured in our study.  4% are undernourished in our study, and 12% are overweight.  73% are anaemic in our study according WHO guidelines. 26% of our study has PIH disorders.  26% had oligohydramnios as a risk factor in our study population . There was a 1% antepartum haemorrhage. In addition, 1% had twins as a risk factor. Malpresentation was seen in 5% of cases. CPD was noted in 19% of the study population. 8% of our study group had premature rupture of membranes.  60% of our study population underwent LSCS,1% had instrumental deliveries. 39% had a vaginal delivery.  Indications for c-section are CPD, which is 19%, followed by oligohydramnios, malpresentation and prior LSCS. 15% of babies in our study were below 2.5 kg. 1% had a congenital anomaly.7% of babies admitted in NICU.
Conclusion: Teenage pregnancy is a severe social problem prevalent in rural India. Educating on STDs and measures to prevent them together can reduce teenage pregnancies, by which complications of teenage pregnancy can be prevented.

A COMPARISON OF PROPOFOL VERSUS KETOFOL PLUS FENTANYL AS INDUCTION AGENTS ON HEMODYNAMIC PARAMETERS IN PATIENTS UNDERGOING ELECTIVE SURGICAL PROCEDURES UNDER GENERAL ANESTHESIA

Krishna Reddy Pingili, Raghuveer Chinnapaka, Nandaraj Dubbaka, M. Sindhura

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2407-2417

Background: Propofol has gained a lot of popularity and is very commonly used in elective surgeries due to its solubility, rapid induction, quick recovery time along with its amnestic and antiepileptic properties make a potent anesthetic agent. Exclusive uses of propofol to provide LMA might be associated with some undesirable effects which are dose-dependent are like hypotension, respiratory depression, coughing, hiccups, laryngospasm, and movements. Forgoing studies reveled that a combination of ketamine and propofol decreased patients' use of propofol and opioids and improved hemodynamic and respiratory stability. The prime objective of our study is to substantiate the earlier results regarding whether the efficacy of the ketamine-Propofol-Fentanyl combination has more favorable hemodynamics than the gold standard prototypic induction drug (Propofol) in a cohort of healthy patients and to compare the additional post-operative analgesia requirements between the two groups.
Materials and Methods: The clinical prospective observational study was done on 240 individuals which were divided in to 2 equal groups (120 each group), the, Group A (Propofol) received 2.5 mg/kg Propofol for induction and the Group B (Ketamine-Fentanyl-Propofol) of 120 subjects, provided with 0.8mg/kg of ketamine + 0.2mg/kg fentanyl + 1mg/kg of Propofol. Patients in both - groups were maintained with O2, N2O, Sevoflurane and measurement of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) was done before induction and 10 minutes after induction before the surgical stimulus. Additional analgesia (0.2 mg/kg ketamine, 0.1mg/kg fentanyl and 0.3 mg/kg propofol, for a total of 1mg/kg ketamine, 0.3 mg/kg fentanyl and 1.3 mg/kg propofol) was supplied to all patients with a VAS > 3 who reported pain. Independent samples t-test and paired t-test were employed for analysis of the collected data.
Results: In Group B (KP), the systolic, diastolic, mean arterial blood pressure, and heart rate changes following LMA implantation were considerably greater than in Group A (P). Group B had longer recovery durations, lower VAS scores immediately following surgery, and less analgesic needs. There was no incidence of apnea, hypoventilation, or emerging responses.
Conclusion: Ketofol (0.8mg/kg ketamine and 1 mg/kg propofol) + 0.2mg/kg fentanyl has multiple advantages than relaying propofol (2.5mg/kg) alone Hemodynamic stability, absence of respiratory depression, rapid recovery, and potent postoperative analgesia. We thus advocate intravenous ketofol as an induction drug, particularly for patients undergoing short surgical operations.

TO EVALUATE THE INCIDENCE OF SPINAL ANESTHESIA FAILURE NECESSITATING CONVERSION TO GENERAL ANESTHESIA IN WOMEN PRESENTING FOR CAESAREAN SECTION

Dr Anjana Gupta, Dr Manmohan Shyam, Dr Udai Singh, Dr Anupam Narayan Singh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2418-2423

Aim: To evaluate the incidence of spinal anesthesia failure necessitating conversion to general anesthesia in women presenting for caesarean section.
Methods: This research included 120 women who were scheduled for a caesarean section under regional anaesthetic, as well as women who were weighed and had their heights measured. Women scheduled for general anaesthesia, women who refused to participate, and women whose height and weight could not be obtained were all excluded from the research.
Results: We discovered that the majority of the patients (70.33%) were between the ages of 25 and 35, with the average age of the patients being 32.552.58 years. The patients' mean BMI was 29.122.33kg/m2. There were 21 elective cases (17.5%) and 99 emergency cases (82.5%). The frequency of spinal anaesthesia failure necessitating conversion to general anaesthesia. We discovered that 10% of all patients were converted to general anaesthetic owing to spinal anaesthesia failure. The outcome was statistically significant (p<0.05).
Conclusion: As a result of the failure of spinal anaesthetic during the c-section operation, we found that 10% of the patients in our research group required a change to general anaesthetic.

PREVALENCE OF INTERNET ADDICTION AND ITS ASSOCIATED FACTORS IN TAMIL NADU

Dr. Mathivanan MD ,Dr. MalarMoses MD , Dr. Rekha Ravindran MD

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2424-2438

Introduction:
Internet addiction has become a 21st Century epidemic. To prevent and treat internet addiction, evaluation of current prevalence and its associated factors are needed.
Aim:
To find the prevalence and associated factors of internet addiction in Tamil Nadu.
Materials and methods:
Internet addiction severity was assessed by internet addiction scale (TN). A Semi structured questionnaire was used to collect associated factors. Statistical analysis was done and results were evaluated.
Results:
1367 people participated in this study. Among them 61.7% were male. Prevalence of mild, moderate and severe internet addiction were   57.6%, 29.8%, and 9.1% respectively.
Among gender, Prevalence of moderate and severe internet addiction in males were 31.3% and 10.3% respectively, and 27.3% and 7% respectively among females.
Considering age, Prevalence of moderate and severe internet addiction in less than 18 age group were 42.9% and 7.1%, and between 18 to 40 age group, these were 33.5% and 10.4% respectively. In the above 40 age group, the prevalence of moderate and severe addiction were 19.4% and 6.3% respectively.
Considering internet content, among facebook users, moderate and severe internet addiction were 36.1% and 11.4% respectively. In videogame players, moderate and severe internet addiction were 24% and 32% respectively. Among whatsapp users, moderate and severe internet addiction were 24.2% and 4%   respectively. And among youtube watchers moderate and severe internet addiction were 30.6% and 9.8% respectively.
Conclusions:
In general, Prevalence of problematic   internet addiction was 38.9% among which moderate and severe   internet addiction were   29.8% and 9.1% respectively.  Males were found to be more addicted . Internet addiction was found to decrease with increase in age.  Unmarried population were more addicted than married. Considering content, Videogames have the most addictive potential followed by facebook and youtube. Whatsapp users showed the least addiction. Age, sex, education, economy, marital status and content influence internet addiction.

A prospective study of management of inter- trochanteric fractures of femur with PFNA-II

Dr Sanjeev Reddy , Dr Abhijit Patil , Dr. Anusha S Pattanshetty

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2439-2447

Background: The best surgical strategy for extra-capsular proximal femoral fractures (PFFs) is controversial in the elderly. Poor bone quality and neck screw instability can adversely affect the results with currently available fixation devices, which predominantly consist in dynamic hip screw-plates and proximal reconstruction nails.
Hypothesis: The lag screw of the modified intramedullary implant achieves better cancellous bone compaction in the femoral neck, thereby decreasing the risk of secondary displacement.
Materials and Methods: We studied consecutive cases of modified intramedullary implant fixation performed between 2019 and 2021 in 20 patients (8 females and 12 males) with a mean age of 71.3 ±
9.02 years. All patients were operated under hypotensive spinal-epidural anaesthesia in supine position on traction table. Patients were evaluated at pre op and post op follow up period with serial radiography and clinically by Harris Hip score (HHP) for pain and disability scoring.
Results: Mean follow-up in the 20 patients was 12.3 ± 7.5 months (4–20 months). Fracture union was consistently achieved, after a mean of 12.25 ± 1.67 weeks. After the last follow-up, the mean Harris hip score was 86.8 ± 7.3 (range, 65–100); the score was excellent in 11 patients (55%), good in 5 (25%), fair

Functional outcome of Retrograde intramedullary interlocking nailing for supracondylar fractures of femur

Dr Channabasava , Dr Abhijit Patil ,Dr Anuj Manjunath

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2448-2453

Objectives: We assessed whether a Retrograde intramedullary interlocking nail has a good outcome in cases of supracondylar Femur fractures, with respect to the degree of knee flexion, early weight bearing and return to the pre-fracture state.
Methods: We conducted a prospective study of 32 patients which presented with supracondylar femur fracture, and had undergone a closed reduction and internal fixation by Retrograde Femoral nail. Neer’s and Sander’s evaluation scoring system was used for evaluation.
Results: Neer’s rating was use to evaluate the outcome, according to which there was good to excellent results in 68.74% cases.
Conclusion: Supracondylar femur nail is an optimum tool for many supracondylar fractures of femur, but it requires attention to technique in order to prevent the complications.

“STUDY ON ANATOMICAL VARIATIONS OF HEPATIC ARTERY IN CADAVERS”

Dr. Anjali Raj Ladia, Dr. Yashwant Kulkarni, Dr. Surekha Wamanrao Meshram

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2454-2460

Background: The rapid evolution and increasing complexity of liver-directed therapies have forced the medical community to further advance its understanding of hepatic arterial anatomy. The anatomy of the hepatic arterial bed has been demonstrated to have a high degree of variation. Objectives of this study:  The objective of the study is to explore the variations of in HEPATIC ARTERIES in Cadavers of Anatomy Dissection. Materials and Methods:  Dissection method was employed for this study. The dissection of hepatic artery was carried out in 60 cadavers which were embalmed using 10% formalin. Each cadaver was kept in supine position and its sex was noted. Each cadaver was dissected according to guidelines of “Cunningham’s manual of practical anatomyvolume two, fifteenth edition. Variations of hepatic artery were noted in terms of origin, diameter and length.  Discussion & Conclusion: The findings of our study conclude that, the most common branching pattern of hepatic arterial system is type-I (80%) as per Michel’s classification, incidence of variation in branching pattern of hepatic artery is 20%, incidence of replaced right and left hepatic arteries is same (8.33%) whereas replaced common hepatic artery is 3.33% and Variation of hepatic artery between male and female were not significant. No gender predilection for hepatic artery variation is seen in present study.

Study of Extrapulmonary Manifestations of COVID-19 patients

DR AMIT KUMAR, DR ANKIT KUMAR, DR AKSHIT GARG, DR APOORV PRATAP SINGH, DR JAIDEEP SINGH

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2461-2472

Aim: To study extrapulmonary manifestations in COVID-19 patients.
Material and methods: The present retrospective study was conducted among 200 COVID positive patients in the department of medicine, CSS Hospital, Subharti Medical College, Meerut. COVID-19 was diagnosed on the basis of the WHO interim guidance. Patients’ diagnosis was identified along with the co-morbidity (if present). Laboratory investigations comprised of CBC and serum albumin detection. Extrapulmonary manifestations were defined as patients having predominantly neurological, gastrointestinal (GI), cardiovascular, cutaneous, and uncommon respiratory symptom such as hemoptysis either concomitant with typical respiratory symptoms or as the sole manifestation.
Results: Fever was most frequent complain (n=97, 48.5%), followed by cough (n=76, 38%) and dyspnea was present in 51 subjects (25.5%). The most common respiratory symptoms was dyspnea (n=64, 32%). The most common cardiovascular symptoms was Dyspnea on exertion (n=54, 27%), followed by Palpitations (n=29, 14.5%). The most common GIT Symptoms was diarrhea (n=34, 17%), followed by Vomiting (n=13, 6.5%) and only 8 subjects (4%) reported abdominal pain. Dermatological symptoms were shown in 5 (2.5%) subjects. The most common musculoskeletal Symptoms was fatigue (n=103, 51.5%), followed by Myalgias (n=11, 5.5%) and Joint/Back Pain (n=4, 2%).
Conclusion: Patients with COVID-19 require long-term follow-up even after recovery for observation and management of their post-COVID ailments. During the ongoing COVID-19pandemic, most health facilities are overloaded. Hence, arranging follow-up for patients can be a challenge. Therefore, a comprehensive rehabilitation program is essential for such patients during hospitalization and discharge.

STUDY OF ACCEPTANCE OF CONTRACEPTION AND COUNSELLING IN POST ABORTAL WOMEN

Dr. Shivangi verma, Dr. Vijay Y. Kalyankar, Dr. Nisha Jha, Dr. Rajat Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2473-2483

Abortion is the most common adverse outcome of pregnancy. Out of 42 million MTPs each year globally, 20 million are done unsafe. Post abortion care (PAC) includes emergency treatment for complications related to spontaneous or induced abortions. It is necessary to create contraceptive awareness and to educate women regarding various modern contraceptives thereby decreasing unmet needs of family planning; hence, this clinical study is being conducted at our tertiary care centre.

STUDY OF MATERNAL AND PERINATAL OUTCOME IN PREMATURE RUPTURE OF MEMBRANES AT TERM GESTATION IN A TERTIARY CARE HOSPITAL- GOVERNMENT MATERNITY HOSPITAL, TIRUPATI, ANDHRA PRADESH, INDIA

Dr.PS. Chandana Dr G. Parthasaradhi Reddy Dr K Sunitha Dr B Nirmala Devi Dr N Lahari

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2484-2496

BACKGROUND – The study of maternal and perinatal outcomes in premature rupture of membranes at term gestation was conducted in patients admitted to a government maternity hospital, Tirupati,Andhra Pradesh, India.  
MATERIALS & METHODS-A prospective hospital-based study was undertaken with 200 cases with premature rupture of membranes (PROM) at or above 37 weeks of gestation in the Department of Obstetrics and Gynaecology, GMH, SV medical college, Tirupati from December 2020 to December 2021
 
RESULTS-  The majority of the participants in the study were between the ages of 20 and 24 (64 %). Majority of PROM cases were found in unbooked cases (76.0 %). In the study population, primigravidas (58.0%) had a higher rate of PROM than multigravidae (42 %). The majority of the participants were from a low socioeconomic background (76 %). Most of the women were admitted within 6 hours (46%) and very few cases were admitted after 24 hours of the onset of PROM (3%). The shortest period of PROM was 1 hour and the longest period was 72 hours with a mean duration of 8.61 hours. 31% (n=62) of the study population were delivered by caesarean delivery, among them failure to progress, accounting for 48.38 % (n=30) and foetal distress in 28.03 % (n=18). Maternal morbidity was seen in 19.5% (n=39) Febrile morbidity was seen in 10% (n=20). Urinary tract infection was seen in 4% (n=8). Wound infection was seen in 2% (n=4), PPH seen in 2% (n= 4), Chorioamnionitis was seen in 1% (n=2), Puerperal sepsis in 1 %( n=2). Perinatal morbidity was seen in 24% and perinatal mortality in 0.5% of the neonates.
CONCLUSION-According to the present study of PROM, the caesarean section rate was 30.5%. Maternal morbidity was seen in 19.5%, of which febrile morbidity accounted for 10%. Perinatal morbidity was seen in 24% of the cases and the perinatal mortality rate was seen at 0.5%.

Ultrasound guided unilateral erector spinae blockade in open cholecystectomy in COVID-19 era

DR ANURADHA SEN, DR SACHIN KUMAR GUPTA, DR SMRITI ANAND, DR MANDEEP KAUR

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2497-2505

Background: The erector spinae plane (ESP) blockade acts as a potent unilateral analgesic technique. The block is performed by injecting local anaesthetic drug in the plane between the erector spinae muscle and the vertebral transverse process, with its effect due to diffusion of the local anaesthetic into the paravertebral space through spaces between the adjacent vertebrae. It is a relatively safe and easy technique as compared to the thoracic epidural because our target in ESP blockade is the transverse process, which is identified easily and is distant from neural or major vascular structures and the pleura. Aim of the study: To assess the analgesic effect of ultrasound guided unilateral erector spinae blockade in open cholecystectomy Material and methods:We present a case series of ESP blockade under ultrasound guidance in nine patients scheduled for open cholecystectomy because surgeons chose to avoid laparoscopic surgery due to the increased risk of COVID-19 infection due to intraperitoneal aerosol generation. Results: All patients with postoperative ESP blockade maintained an NRS pain score of 03/10 for 24 h, except for those requiring emergency analgesia. The pain relief was excellent in all our patients and there were no complaints of nausea, vomiting. Conclusion: ESP blockade is proving to be a successful technique for intraoperative and postoperative analgesia.

SPECTRUM OF MRI FINDINGS IN AVASCULAR NECROSIS OF HIP JOINT

Dr. ROHIT MORGE , Dr. AMOL JAGDALE , Dr. SUSHANT BHADANE , Dr. MEENAL MOHGAONKAR, Dr. DEVENDRA KULKARNI

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2506-2515

           Avascular necrosis of femoral head (AVNFH) is a progressive, multifactorial and challenging,  debilitating disease affecting mostly the middle aged population.
  AVN can present with a broad spectrum of clinical manifestations ranging from incidental finding in asymptomatic patients to severe pain, functional limitations, and compromising the quality of life.1,2
  Magnetic resonance imaging has recently emerged as the most sensitive, specific, and widely used diagnostic tool for avascular necrosis of femoral head. In most reports, MRI can diagnose very early lesions with a greater than 90 percent specificity and sensitivity.3
Present study was aimed to assess the role of MRI in the evaluation of clinically suspected cases of AVN of hip and to describe the imaging features along with proper staging.

“Clinicopathological study of sinonasal masses in Rural population of central India”

Manya Thakur, Ankit Mishra,Hansa Banjara,Jyoti Verma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2516-2525

Background:  Sinonasal  tumors  are  diagnostic  challenge  to  the  otorhinolaryngologist.  Clinical  features  may  vary  from  being  asymptomatic  or  accidental  finding  on  imaging  studies.  Sinonasal  mass  otherwise  can  present  with  mass  effect,  Nasal  obstruction,  epistaxis,  epiphora,  rhinorrhoea,  and  recurrent  sinusitis.  Our  study  is  an  observational  study  of  patients  with  Sino  nasal  masses  which  was  carried  out  in  tertiary  Care  hospital  in  central  India  to  create  awareness  about  the  various  nasal  masses  in  Chhattisgarh  region  of  central  India.
Methods:  A  Retrospective  observational  study  was  carried  out  for  patients  of  rural  areas  presenting  with  sinonasal  masses  treated  at  tertiary  health  centre  from  Jan  2019  to  May  2020.  Detailed  clinical  history  and  examination  of  the  patient  was  recorded  along  with  histopathological  examination  supplemented  by  radiological  investigation.    The  data  was  analysed  and  observations  were  noted.
Results:  A  total  of  100  patients  were  analysed  according  to  age,  sex  and  histopathological  diagnosis.  Majority  of  the  patients  were  in  the  age  groups  0-20  years  (34%).  There  were  66  (66%)  male  and  34  (34%)  females  with  M:F  ratio  2:1.  On  Histopathological  Examination,  81  %  cases  were  non  neoplastic  and  19%  cases  were  neoplastic  lesions.
Conclusions:  Sinonasal  masses  may  have  multiple  differential  diagnoses. 
With  the  treatment  of  more  complex  cases  being  undertaken  endoscopically,  the  need  for  individual  therapeutic  consideration  and  close  follow-up  is  essential.  The  sinonasal  masses  shows  male  predominance  with  peak  during  2nd  to  4th  decade  of  life.  In  non-neoplastic  lesion,  Rhinosporidiosis  is  the  commonest  non  neoplastic  leison  seen  in  our  region  while  among  malignant  lesions  undifferentiated  carcinoma  was  commonest.  This  study  will  further  add  up  to  statewise  database  of  India.

“Epidemiological Trends of Knee Osteoarthritis and its related factors in Patients attending Out Patient Department of Medical College Datia- A Hospital Based Surey”

Dr.Mukesh Sharma, Dr.Shubhanshu Gupta , Dr.Anjana Niranjan, Dr.Sanjeev Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2526-2532

Background : Osteoarthritis (OA) is the most common type of arthritis. OA is a chronic degenerative disorder of multifactorial etiology characterized by the loss of articular cartilage, hypertrophy of bone at the margins, subchondral sclerosis, and range of biochemical and morphological alterations of the synovial membrane and joint capsule. For finding the current burden of OA and its association with lifestyle related factors, it was essential to undertake such a study on the  Knee Osteoarthritis
Methods: This is an institution based cross sectional observational study carried out among patients with knee pain & disability attending Out Patient Department of Medical College Datia. The total sample size was 304 subjects. Tools consisted of a questionnaire and plain skiagrams for confirmation of OA. Diagnosis was done using Kellgren and Lawrence scale for osteoarthritis. Questionnaire was administered only to those who gave informed consent.
Results: Thestudy shows a 31.5 % cases found  in the overall  304 interviewed  Patients present with complain of knee pain. Female of the age group 46-60 are more prone to osteoarthritis comparative to other age group people. Highest %  in participants who have a sedentary lifestyle and Obese.
Conclusions: This study conclude the age group, gender, occupation, stages of severity of knee OA in Datia. Awareness program should be initiated at community level which is needed for the prevention of OA of knee at early age. We would like to suggest that a study can be planned which will prove the impact of physical activity, habits, and lifestyles.

“ASSOCIATION OF p16 EXPRESSION IN ORAL AND OROPHARYNGEAL SQUAMOUS CELL CARCINOMA”

Dr.Akruti Patel Dr.Sudha Jain Dr.Moxa Parmar Dr.Kinjal Patel Dr.Vasu Tailor

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2533-2541

The recent trend shows that there is an epidemiological shift in head and neck squamous cell carcinoma (HNSCC) attributable to HPV infection. HPV positive squamous cell carcinoma(SCC) has unique pathogenesis, risk factors , clinicopathological characteristics and outcome.There is a large variation in the published prevalence of the HPV related HNSCC in India ranging from 7 -78.7%.

EVALUATION OF THYROID LESIONS WITH USG AND PATHOLOGICAL CORRELATION

Dr K Lalitha Sree MD Dr Jyoti Brahmaiah MD Dr K Dileep DNB

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2542-2549

To calculate the incidence of different types of thyroid lesions in rural people.In the diagnosis and characterisation of various thyroid lesions, ultrasonography is frequently utilised as the first investigative modality.
Objective :To assess the diagnostic accuracy of ultrasonography in distinguishing benign and malignant thyroid nodules by correlating sonographic findings with pathological diagnosis as a reference..
Method: From June 2020 to  December 2021, a prospective study was conducted on 100 patients who visited the  Apollo medical college and District head quarters hospital,              in the OPD of the department of radio diagnostics. All patients with thyroid swelling, mass, or enlargement were examined with  USG before undergoing FNAC.
Results: Of the 120 Thyroid disease patients in my study, 77 percent were females and 23 percent were males. The patients with the highest number of instances were between the ages of 41 and 50, accounting for 37 percent of all cases. 'Lump in the neck' was the most common complaint. Euthyroidism was the most common diagnosis (73). Solitary Thyroid Nodule was the most prevalent disease found on thyroid sonography (42percent ). The diagnostic accuracy of high resolution sonography in thyroid disorders was 84 percent Sensitivity and 96 percent Specificity.
Conclusion: Many malignant or potentially malignant thyroid nodules can be detected with ultrasonography. Although there is some overlap in the appearance of benign and malignant nodules on ultrasonography, some ultrasonography features can aid distinguish between the two. Even though it can report malignancy of the follicular variety, FNAC can diagnose benign disorders and can also be used as a supplement to ultrasonography features to signal malignancy.

OCCUPATIONAL STRESS AMONG TEACHERS WORKING IN THE SCHOOLS OF WESTERN INDIA

Dr. Reema L Wankar, Dr. Chaitali Borgaonkar , Dr. Sanjay G Panchal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2550-2555

Introduction: Teacher stress is defined as experiences in teachers of unpleasant, negative emotions, such as anger, frustration, anxiety, depression and nervousness, resulting from some aspect of their work as teachers. Objective was to assess the level of occupational stress and its associated factors among teachers of two private schools from the metropolitan city of Maharashtra.
Method: A cross sectional study was conducted on 96 school teachers of two Private schools of Metropolitan city. Two scales namely Multidimensional Scale of Perceived Social Support (MSPSS) and General Health Questionnaire-12 items (GHQ-12) to measure social support and occupational stress respectively. Both these scales have been used as stress measurement tools.
Results: Around half of teachers were in the age group of 31 to 45 years (50.08%) and mean age was 38.5 (SD + 9.25). Around 12.5% of the teachers had inadequate social support and about 54.17% teachers had stress. Bivariate analysis showed accomplishment pressure and lack of social support to teachers adds to their stress levels (p< 0.05). Similar finding were seen by multivariate analysis i.e. higher expectation of performance (OR: 2.59) and lack of social support (OR: 2.87) had higher odds of having stress.
Conclusion: Competent work accomplishments and adequate social support to school teachers were considered as protective factor against occupation stress

Comparative Study of Ondansetron and Granisetron for Postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy under general anaesthesia –Randomized double blind study

Dr. Rajini Sathanish Dr. Rashmi V Bengali Dr. Kalidass Dr. S Amuthan

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2556-2562

Postoperative nausea and vomiting is (PONV) a very distressing complication and preventive measures are justified when the risk of PONV is very high. Ondansetron is the first 5-HT3 antagonist used alone or in combination for prophylaxis of PONV due to its lower cost. Granisetron is recently introduced 5-HT3 antagonists with greater affinity for 5-HT3 receptor and having longer half-life. Aim of the present study is to compare the antiemetic efficacy of ondansetron, granisetron in high-risk patients undergoing laparoscopic cholecystectomy under general anaesthesia. Method: This study was prospective and randomized one. Written informed consent will be taken from patients in both groups. Patients will be kept NPO for 12 hours before surgery. In the preoperative room, iv line will secured. In the operation theatre ASA Standard monitoring devices pulse oximetry, NIBP, ECG will be attached and baseline blood pressure, heart rate and O2 saturation values will be recorded. Later capnograpy will be attached after the intubation.

PITAVASTATIN AND GEMFIBROZIL AS DRUG REPOSITIONING CANDIDATES FOR ANXIOLYTIC ACTIVITY: AN ANIMAL STUDY BY USING ELEVATED PLUS MAZE

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

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2563-2574

Anxiety is a common finding in most neurotic disorders and plays a remarkable role in their pathogenesis. [1] Before the 20th century, “anxiety neurosis” and “pantophobia” terms were used to diagnose general anxiety. [2] In most anxiety cases, a person feels worsened episodes of symptoms followed by symptom-free episodes. This condition is referred to as “remitting and relapsing conditions.” [3] The exact cause of anxiety is still a topic of discussion; it may be due to inflection in the central nervous system. [4] Dyslipidemia is a solid soothsayer of persistent medical conditions like obesity that could elevate the risk of anxiety. [5] Several pathways, such as neurotransmitter balance, oxidative stress, and immuno-inflammatory processes associated with anxiety, are also connected with obesity

ASSESSMENT OF EFFECTS OF TORSEMIDE ON NYHA FUNCTIONAL CLASS AND HOSPITALISATION IN PATIENTS OF CHF: AN OBSERVATIONAL STUDY

Dr. Vinita Bharti, Devendra Kumar Katiyar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2575-2579

Background: To assess the effects of torsemide on NYHA functional class and hospitalisation in patients of CHF.
Materials & methods: Detailed clinical history, physical examination and diagnostic tests mainly electrocardiogram (ECG), chest X-ray and whenever necessary echocardiography was carried out in all the patients. 50 subjects were enrolled in the present study. Only those patients were enrolled who received torsemide orally in the dose of 10 mg once a day. All the findings were recorded in Microsoft excel sheet and were analysed by SPSS software.
Results: At baseline, 14 percent, 36 percent, 38 percent and 12 percent of the patients were of NYHA class I, II, III and IV respectively. At the end of the study, 22 percent, 44 percent, 24 percent and 10 percent of the patients were of NYHA class I, II, III and IV respectively. A significant improvement was seen in terms of NYHA class. 12 percent of the patients required hospitalization in the present study.
Conclusion: Torsemide leads to greater improvement in NYHA functional class. Thus; torsemide appears to be a reasonable alternative.

AN OBSERVATION STUDY TO FIND ASSOCIATION OF INFLAMMATORY BIOMARKERS WITH SEVERITY OF DISEASE AMONG COVID-19 PATIENT ATTENDING A TERTIARY CARE HOSPITAL OF MUMBAI, INDIA

Amit Kumar, Minu Ramakrishnan, Dipak Patil, Parinita Gupta

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2580-2585

Introduction: Covid – 19 caused by SARS-CoV2 was declared a global pandemic on March 11, 2020 by World Health Organization. Complexity of Covid – 19 diseases is centered on its unpredictable clinical course that can rapidly develop, causing severe and fatal complications. The current study was aimed to investigate association between levels of biomarkers with Covid– 19 disease severity to identify patients at risk of fatal complications.
Materials and Method’s: A Retrospective cross-sectional Hospital based study was undertaken by Department of Medicine at K.J. Somaiya Medical College, Mumbai, India. Adult patients of more than 18 year of age who were admitted with laboratory confirmed diagnosis of Covid – 19 during the period of June and July 2020 were included in the study.  Gold-standard diagnosis of Covid – 19 is achieved through molecular identification of SARS-CoV-2 using nucleic acid amplification tests such as the reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) or viral gene sequencing. A total of 500 patients were included, irrespective of age, gender, ethnicity or duration of symptoms of underlying illness. The study was approved by research and ethics regulatory committee of the institution. Data was collected by reviewing the records and of the selected patients. Data was summarized by using descriptive statistics. P value of < 0.05 was considered to be statistically significant.
Results: A total of 500 patients were included in the study. The age of these patients ranged from 18 to 61 years with a mean of 37.8 (18.2) years. There was a male preponderance with a male to female ratio of 2.6. Out of 500 patients that we have included in our study, 10 patients had isolated raised D –Dimer. It showed a weak association with severe lung involvement. During the study period, a total of 87 death were observed among the patients included in the study, hence a death rate of 17.4% was observed by the researchers.
Conclusion: Severity of lung involvement, Assessment of levels of various biomarkers helps in immediate categorization of patients into risk groups.

ANXIETY AND DEPRESSION IN POSTMENOPAUSAL WOMEN ATTENDING TERTIARY CARE HOSPITAL

Farheen Sultana, Ragini Muddasani, Anurag Srivastava

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2586-2598

Background: To study the prevalence of anxiety and depression in postmenopausal women attending Mediciti Institute of Medical sciences.
Materials and Methods: Out of 40 consecutive patients presenting to Mediciti Institute of Medical Sciences, Ghanpur with history of menopause, 10 were excluded as they refuse to give consent, and 30 patients were taken into the study. A detailed history of the Patient was taken after taking the consent using the case proforma and were Diagnosed post-menopausal using 1yr criteria after the cessation of last menstrual period , both natural and surgical induced menopause were included, followed by assessment of the patients psychological profile using SCL90, Becks Depression Inventory, Hamilton Anxiety scales.
Results: In the study statistically significant increased rates of anxiety was found to occur in post-menopausal women (P =0.000075). In the study it was observed that Hamilton Anxiety scores were significantly high in surgical induced menopausal women when compared with natural menopause (unpaired T test p= 0.0446). The study also shows that there was a significantly higher incidence of somatization on SCL90 subscale, in surgical induced menopause than natural menopausal women with a P value = 0.0001.
Conclusion: There was no statistically significant difference among natural menopause and surgical induced menopausal women on other subscales like OCD, Interpersonal sensitivity, hostility, phobic, Paranoid Ideation, or Psychoticism.

MONKEY POX – A REVIEW

Dr. Taral Parikh, Dr. Maram Phanikumar, Dr. Neha Chauhan, Dr. Sachin kumar Jadhav, Dr. Amrita Das, Dr. Damarasingu Rajesh, Dr. Rahul VC Tiwari, Dr. Heena Dixit Tiwari

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2599-2611

The current epidemic of monkeypox is the largest in history to occur outside of Africa. Monkeypox is an budding zoonotic disease that for decades has been viewed as an infectious disease with outbreak potential as its occurrence is increasing  in recent years. As public health entities work to contain the current outbreak, healthcare professionals globally are aiming to become familiar with the various clinical presentations and management of this infection. We present in this review an updated overview of monkeypox for healthcare professionals in the context of the ongoing outbreaks around the world.

A STUDY ON ANTERIOR CIRCULATE LIGAMENT RECONSTRUCTION USING BONE GRAFT WITH MINI ARTHOTOMY TECHNIQUE

Anvesh Gattu, Biju Raveendran, Yeddula Yoga Abhinai Reddy

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2612-2620

Background: Lacerations of anterior cruciate ligament (ACL) ligament in the knee is the supreme cause of ineptitude in sports like athletics, football, volleyball, rugby etc. owing to various multidirectional strain full movements. Bulk of patients electing for surgery to revamp and easy return back to their routine. Despite of their complications like graft rupture, residual laxity, and donor-site morbidity, conventional methods of ACL reconstruction is the gold standard procedure. There is therefore a requirement for further research into newer, innovative surgical techniques which can decrease complication rates. The goals of the ACL reconstruction are to restore stability to the knee; easy return back to regular activities and to delay the onset of osteoarthritis with associated recurrent injuries to the articular cartilage and loss of meniscal functions. This study is to compare the results of ACL Reconstruction using Bone-Patellar-Bone by means of Miniarthrotomy technique.
Materials and Methods: This study was conducted in Narayana Medical College/ Hospital, at from May 2020 to May 2022. During this period 60 cases of adult patients with ACL deficiency were selected according to the inclusion criteria. Prospective Study of ACL Reconstruction using Bone-Patellar-Bone grafts by Miniarthrotomy technique in terms of Post-operative knee stability, Subjective Knee functions, Patient satisfaction, Graft site morbidity, Range of motion. In this study, an effort was made to weigh the advantages over arthroscopic approach.
Results: A total of 60 patients were seen and treated. In the present study mean age group was 28.2 ± 4.5 years. 50.11% of patients were with ACL tear alone, about 65.01% of the study subjects were undertook ACL reconstruction along with part meniscectomy. At the time of 1.5 year follow up, 93.33% had lack of flexion of less than 5 degrees. The anterior drawer’s test during follow up at 1.5 year 98.33% showed 0-2 mm after 1.4 year follow up. The IKDC score at 1.5 year follow up showed predominantly 98.33% patients were fell grade B followed by 5.01% and 1.66% of cases were under grade A and grade C respectively. Lachman’s test at the end of 1.5 years follow up 96.66% subjects showed 0-2 mm displacement and 3.33% showed 3-5mm displacement. At 1.5 year follow up, none of the patients had shown any pathological findings. About 93.33% had shown 90% of functional hop test results and 51.66% of the subjects were with 77 – 90 indicates significant statistical difference between pre and post-operative Lysholm scores. Follow up arthroscopy showed a stable ligament at 1.5 year follow up. While follow up X-ray showed mild arthrosis and few complications like infection, calcification of ligament and arthrofibrosis were observed in one patient.
Conclusion: This study is of clinical relevance as it shows alleviation of pain after surgical treatment of the torn ACL which has been described as the stabiliser of the knee and guardian of the Meniscus. This technique allows achieving good self-reported assessments and clinical ligament evaluation up to 1.5 years. Advantages of this technique include safe clinical practice, enables patients to return to preinjury activities including high-risk sports, unlimited bone-to-bone healing, cost effectiveness, avoidance of disadvantages associated with hardware, and ease for revision surgery.

A COMPREHENSIVE ANALYSIS OF FOREARM FRACTURE PATTERNS IN CHILDREN AND THEIR MANAGEMENT

Biju Raveendran, Dr. Anvesh Gattu, Dheepak Kumar.A

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2621-2631

Background: Every year, over 1 lakh ACL reconstructions are performed in the United States, and the number of surgical operations ranging from open to minimally invasive arthroscopic procedures is increasing globally. The present study's objective was to evaluate outcomes after anterior cruciate ligament surgery and structured rehabilitation with the IKDC, KOOS, and TAL scores.
Materials and Methods: This study objective   to assess outcomes following anterior cruciate ligament restoration and structured rehabilitation utilizing the IKDC, KOOS, and TAL scores. Materials and methods: The current investigation was carried out in Narayana Medical College & Hospital and involved 30 surgical patients (Arthroscopic Anterior Cruciate Ligament reconstruction using hamstring graft and structural rehabilitation). For six months, structural rehabilitation was pursued. All cases were followed for two weeks, six weeks, ten weeks, sixteen weeks, and six months. The outcome was evaluated using the IKDC score, the KOOS score, and the Tegner activity level scale.
Results: The 30 individuals included 24 men and 6 women, according to the study. Subjects averaged 30. BMI averaged 25.04 kg/m2. 17 patients (Group A) underwent preoperative ACL exercises, while 13 did not (Group B) 14 patients had twisting injuries, 10 had sports injuries, and 6 underwent RTAs .At 2 weeks, 6 weeks, 10 weeks, 16 weeks, and 6 months, IKDC is statistically significant (p 0.001). At 2 weeks, 6 weeks, 10 weeks, 16 weeks, and 6 months, KOOS is statistically significant (p 0.001). At 10 weeks, 16 weeks, and 6 months, TAL is statistically significant (p 0.001).
Conclusion: There is a need for numerous studies that use patient- reported outcomes that reflect patients' most critical concerns, as well as more prospective longitudinal related research.

REAMED INTRAMEDULLARY INTERLOCKING NAILS: A PREFERABLE OPTION FOR FIXING TIBIAL FRACTURES IN ADULTS

Biju Raveendran, Anvesh Gattu, A. Imadulla

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2632-2641

Background: The frequently fractured long bone in the human anatomy is tibia and the mode of surgical procedure relays on evaluating the mode of injury, configuration of fracture and individual health and financial status. The use of non-operative treatment of tibial fractures is associated with a high prevalence of malunion, joint rigidity and deprived functional consequence. Tibial shaft fractures are recurrently treated by intramedullary interlocking nails. The necessity of opting reamed intramedullary nail is considered the gold standard implant for tibial fractures in closed and open (Gustilos) fractures.
Materials and Methods: The study consists of 52 patients with tibia shaft fracture treated with tibia interlocking nail. Clinical outcome and functional results were evaluated by Klemm and Borner criteria.
Results: In this study, we have operated a total 52 cases with tibia interlocking nail in tibial shaft fractures. The union rate in closed fracture was started earlier at 12.50 weeks in 80.76% (42) cases and it took 15.89 weeks in 13.46% in (7) cases and 19.50 weeks in 5.76% (3) cases for union in Type I and Type II fracture respectively. The study yielded about 92.30% (48 cases) of excellent result.
Conclusion: The present study shows that closed fractures of the tibia shaft treated with interlocking intramedullary tibia nailing involves minimal surgical trauma and negligible blood loss. It provides the advantages of early ambulation, lower rates of infection and non-union. A significant advantage of interlocking nail in addition to early joint mobilisation, is early weight bearing which allows earlier return to work. Hence the study concluded that closed interlocking intramedullary nail is the treatment of choice in closed tibia shaft fracture.

A STUDY ON NEUROGENIC BLADDER ON SURGICAL MANAGEMENT AND FOLLOW UP

Sasidhar T, Anusiri Ingula, G.Rajeev Kumar, Srinivas S

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2642-2655

management, compliance to clean intermittent catheterization, and follow up in children suffering with neurogenic bladder.
Materials and Methods: It was an observational study conducted at Department of paediatric surgery, Niloufer hospital for woman and child health, Hyderabad. Duration of the study 4 months extending from October 2016 to September 2018. Children between 3-12 years presenting to the department of pediatric surgery with complaints of dribbling of urine and other lower urinary tract symptoms with congenital neural tube defects like sacral agenesis or meningocele/ meningomyelocele/ lipomeningocele or tethered cord syndrome.
Results: NBSD is more commonly seen in male children. NBSD in patients with MMC presents earlier compared to other cases. Diagnosis of NBSD is obvious as most of these cases have a past history of surgical intervention. Renal functions were normal in most of the children with NBSD. VUR in patients with NSBD improved in significant number of cases with non-surgical management. Scarring on DMSA is commonly seen in patients of NBSD associated with VUR. The renal function as assessed by DMSA improved in 1/3rd of patients after non-surgical management.
Conclusion: Most of the patients with NBSD have abnormal UDS findings. Bladder compliance improved in 41.9% of the cases and end filling pressures improved in 50% of cases by non-surgical management.

A PROSPECTIVE STUDY OF ENDOMETRIUM IN LEIOMYOMA UTERUS

Manasa R, Jyostnalatha P, Dr. Manikanta Veesam

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2656-2662

Background: Leiomyoma (fibroid) is the commonest neoplasm accounting for 75% of benign tumours affecting women in reproductive age group. They are dependent upon the steroid hormones for their growth and maintenance. As the endometrium and leiomyoma (fibroid), are both steroid hormone dependent, we studied the corresponding histological changes in endometrium in cases of uterine leiomyoma.
Materials and Methods: The study included 100 hysterectomy cases where leiomyoma/leiomyomas were present. Brief clinical history regarding age, clinical presentation, parity was obtained. The specimens were fixed in 10% formalin; tissue bits from representative areas were taken and stained with Haematoxylin and Eosin.
Results: The commonest age group was 4th decade (54%). The commonest clinical presentation or chief complaint in current study is menorrhagia (46% cases). Majority of the women in the study were multiparous (89%) and the most common type of leiomyoma encountered in the study, based on location, was intramural type (62% cases). Proliferative pattern of endometrium (62%) is the most common pattern associated with leiomyomatous uteri in this study.
Conclusion: Uterine fibroids (leiomyomas) are the most common benign gynecological tumors in women of reproductive age globally. Endometrium and leiomyoma (fibroid), are both dependent on steroid hormones for the growth and maintenance. Histopathological diagnosis is the mainstay to identify the uterine leiomyoma, though some amount of clue may be obtained from the endometrial curettings.

A CLINICAL STUDY OF VENEREAL AND NON VENEREAL GENITAL DERMATOSES IN WOMEN

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

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2663-2676

Background: Any genital lesion or related symptoms are erroneously considered to be sexually transmitted as it is the most covered regions of the body and seems truly to be a forgotten pelvic organ it is the significant and important group of dermatological conditions may be associated with considerable morbidity, discomfort, and embarrassment. The most common conditions seen in a Dermatology Clinic are vulvar dermatoses, which comprise of lichen sclerosis, lichen planus, vulvar eczema, and psoriasis. Other conditions such as vulvar pain syndromes, vulvar disorders associated with systemic diseases, and blistering diseases are also seen.
Materials and Methods: This was a descriptive study of 102 patients aged > 18 years attending outpatient department of Dermatology and Venerology, Santosh Medical College & Hospital, NCR, Delhi,  India presenting with symptoms and signs of vulvar dermatoses were included after detailed history & examination, results were tabulated and analyzed by SPSS software.
Results: At present study population the prevalent type of dermatoses was found to be Lichen sclerosus et atrophicus (LSEA) with the incidence of 26.47% (27 cases). MC symptom was  the white discharge per vagina (WDPV) with the prevalence of 92.15% (94 cases) followed by 84.31% (86 cases) of vulvar itching with the age of patients ranged from 19 to 65 years with mean of 49.22 years. The total subjects were with disease span of 3 months to 7 years with mean DLQI of 8.62.
Conclusion: This study highlights the importance of diagnosing vulvar dermatoses and established strong correlation between vulvar dermatosis in various listed clinical conditions and it also underlines that there is more prevalence of vulvar dermatoses than sexually transmitted diseases.

A Prospective Study to Compare Airway Pressure Release Ventilation (APRV) mode with Synchronized Intermittent Mandatory Ventilation (SIMV) mode in acute respiratory distress syndrome (ARDS) Patients at a Government Tertiary Level Hospital in Kota, Rajasthan.

Charu Sharma, Nilesh Kumar Patina, Manoj U Mahajan, Nishigandha Mahajan, Suresh Chandra Dulara, Vipin Narayan Sharma, Nishkamni

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2677-2683

Introduction: Acute lung injury and its more severe form, acute respiratory distress syndrome (ARDS), cause respiratory failure, the most common organ failure leading to intensive care. Airway pressure release ventilation (APRV, also known as Bi-Level and Bi-phasic) is a time-cycled, time triggered, pressure-targeted form of ventilatory support. Specifically, conventional pressure-targeted SIMV uses a "physiological" inspiratory time with I:E ratio less than 1:1.
Aim: To compare Airway Pressure Release Ventilation (APRV) mode with Synchronized Intermittent Mandatory Ventilation (SIMV) mode in Acute Respiratory Distress Syndrome (ARDS) patients.
Method: Present study was carried out for one year duration from 1 November 2015 to 31 October 2016 on patients who were pre-diagnosed as ARDS, who were  on mechanical ventilation in the Intensive Care Unit of MBS hospital attached to Govt. Medical College, Kota. Results: Mortality rate in Group I was 55% whereas the same in Group II was 60%.

Assessment of Serum High Sensitivity CRP in Bronchial Asthma

Dr. K Prashanthi, Dr. G Keshava Anvesh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2684-2691

Background: Chronic airway inflammation is a hallmark of asthma, but the usefulness of high-sensitivity C-reactive protein tests (hs-CRP), which are known to be sensitive markers of low-grade systemic inflammation, has not been thoroughly investigated in asthma. Estimation of blood hs-CRP levels in asthma patients and their correlation with clinical traits and levels of airway inflammation are the objectives of this study.
Methods: Based on the inclusion and exclusion criteria n=40 cases were included in the study. The demographic profile data was collected using a pretested and structured questionnaire. A detailed history of asthma was obtained along with a complete clinical examination of the patient. The investigations included Pulmonary function tests, Complete blood count, estimation of serum hs-CRP, IgE levels, and Absolute eosinophil count.
Results: The atopic asthma group had the mean value of serum IgE 924.53 ± 205.63 IU/ml compared to the mean value of 198.17± 59.36 IU/ml. The difference was found to be statistically significant. The comparison between mild intermittent and mild persistent cases showed p values were 0.0141 hence it was significant. Comparison between mild persistent and moderate persistent showed p values 0.236 hence insignificant. The intergroup comparison between three groups with ANOVA showed p values of 0.0136 hence it was considered significant
Conclusion: In the current studyit was found that there is a possibility to use hs-CRP as a marker of ongoing inflammatory activity as well as the effectiveness of treatment because patients with recent asthma attacks have elevated hs-CRP levels. The absolute eosinophil counts are much greater in the allergic asthma group, and the levels of AEC are correlated with illness severity.

Epidural Analgesia After Abdominal Surgery: A Comparative Study of Levobupivacaine 0.1% Versus Ropivacaine 0.1% Combined with Fentanyl

Dr. Garima Gaurav, Dr. Kumar Akash, Dr. H.D. Singh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2692-2699

Background: Levobupivacaine and Ropivacaine are pure S (-) Enantiomer of Bupivacaine. Both these new local anesthetics have the advantage of lower degree of motor blockade, lesser cardio toxicity, thus making them a safer alternative to Bupivacaine. Fentanyl has been used commonly with Levobupivacaine and Ropivacaine for further improvement in analgesia without intensifying adverse effects.
Methodology: All sixty patients after appropriate premedication and insertion of epidural catheter were allowed to undergo scheduled surgery under general anesthesia and extubated at the end of surgery. They   were randomly allocated in to two groups to receive postoperative epidural infusion of either Levobupivacaine 0.1% with Fentanyl 2 g/ml or Ropivacaine 0.1% with fentanyl 2 g/ml for 48 hours. The efficacy was compared in terms of onset, quality of analgesia and residual motor blockade and any other adverse events.
Results: Pain scores were similar between the two groups. Mean VAS scores were consistently below 4 throughout the study period with no significant residual motor blockade(p>0.05). There was no significant hemodynamic changes and adverse effects between the two groups. Conclusion: The study concludes that both local anesthetics in combination with fentanyl provided satisfactory analgesia with minimal adverse effects.

TO STUDY AND COMPARE THE VARIOUS MODALITIES OF EVALUATION OF PRIMARY BREAST CANCER SIZE

Dr. Brajesh Pathak, Dr. Vibhor Mahendru

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2700-2707

The ensuing driving force behind death from breast cancer in women is legitimacy. It occurs when cells in the breast become confined and attack the supporting tissue or spread throughout the body. Mammography is a truly unprecedented and remarkable modality used to distinguish and find breast cancer in a short time frame.
Mammography is a two-stage picture and depends on the unambiguous confirmation of dangerous morphological deviations for breast cancer. These manifestations combine areas of mass, all calcification, gap and required curvature. A standard screening mammogram combines the mean diagonal and craniocaudal approach on each breast. Screening tests are facilitated only to find unsafe disclosures after which the woman will return for a more conclusive method. Positive mammographic approaches can likewise incorporate spot pressure, enlargement, rolling, extended view, and upright view to delineate and bind features.

A COMPARATIVE STUDY OF CT VS ULTRASOUND GUIDANCE FOR IMAGE GUIDED PERCUTANEOUS BIOPSY OF MEDIASTINAL AND PARAMEDIASTINAL MASS LESION IN A TERTIARY CARE CANCER CENTER.

Dr Rajan Aggarwal. Dr Salil Pandey ,Dr. Suresh A, DR. Muthusubramanian R, DR. Kishor Sagar V, DR. Seema U

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2708-2731

Purpose
To compare the feasibility, safety and outcome of CT versus ultrasound-guided biopsy of mediastinal
and para-mediastinal masses. To identify the criteria for CT and ultrasound-guided biopsy of mediastinal and para-mediastinal masses.
 
Material and methods
Informed consent was taken from 50 patients of CT / PET-CT diagnosed mediastinal and para
mediastinal mass lesions. Based on the feasibility, the patients were included in the study and
thereafter were assigned randomly to CT or USG guided groups. The feasibility criteria, approach,
ease of performance, complications and histopathological results were recorded. A follow-up of the
patients was done for complications and positive or negative outcome of the biopsy.
 
Results
The similarity was greatest for parameters i.e. time taken to perform the biopsy ( USG 92 % Versus
CT 96 % ), biopsy outcome ( USG 92 % versus CT 100 % ) ease of performance ( USG 92 % versus
CT 100 % ) and visualisation of the adjacent structures ( USG 92 % versus CT 100 % ). More
complications were encountered in CT guided procedures.
 
Conclusions
We conclude that the diagnostic accuracy of CT vs ultrasound-guided biopsy of mediastinal and para
mediastinal lesion is similar to each other, with a lower complication rate and a significantly reduced
time to the procedure with ultrasonography. Pre procedural imaging review and ultrasound check scan
will be helpful in making a correct choice of modality for the procedure and thus providing justice to the
patient in terms of diagnosis and further treatment planning.
 

HEALTH IMPACT OF SOCIAL MEDIA USE AMONG MEDICAL AND PARAMEDICAL UNDERGRADUATE STUDENTS

Dudhat Ayushi P., Patel Neha D., Patel Brijal S., Patel Jayshree C.

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2732-2742

Context: Social media use is a two-edged sword with its pros and cons. Its excessive use contributes to misuse and addiction and affects physical and mental health. According to a report by the Internet and Mobile Association of India (IAMAI), 66% of the 180 million internet users in urban India regularly access social media platforms. A study on Facebook use among medical students found a positive correlation between its excess use and adverse health effects. With increasing internet and social media use, more research requires on their uses and impact on health. The data regarding its use and the effect on students' health at our medical college has not yet been documented.
Aims: To evaluate the effect of social media use on the health of medical and paramedical undergraduate students.
Settings and Design: At Government Medical, Nursing and Physiotherapy College. The questionnaire-based cross-sectional study
Methods and Material: The questionnaire-based cross-sectional study conducted among students of MBBS, B.Sc. Nursing and physiotherapy at a government medical college for over one month. Questionnaires were distributed among the students and were filled by the students anonymously. Descriptive statistical analysis was done by using Microsoft Excel.
Statistical analysis: Descriptive statistical analysis is done by using Microsoft Excel.
Results: A total of 375 responses were obtained. Among them, 77.7% use WhatsApp, followed by 54.7% use Instagram. Social media is mostly used for entertainment (65.8%) and contact with family and friends (62.8%).1-3 hours spent daily on social media by 53.9% of students, more in the evening (56.5%) and at night (56.5%). Physical symptoms like burning eyes (43.6%), headache (34.8%), neck pain (17.9%) and back pain (10.9%) are common within 1 month of use. Reduced concentration in a study (63.2%) and disturbed sleep (35.4%) are reported. (39.6%) students postpone their meals.
Conclusions: Unwisely, use of social media is linked with a negative effect on physical health and health-related behaviours.

STUDY OF BIOPSY OF PROSTATIC LESIONS

Dr. Bairi Laxminarayana, Dr. V. Srinivas Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2743-2755

Prostatic pathology is deceptively simple. Benign prostatic Hyperplasia, prostatitis and prostatic carcinoma are the three principal conditions involving the prostate accounting for more than 95% of lesions. Though the morphologic diagnosis of prostatic lesions, separating benign from malignant is relatively straight forward, there are several benign proliferations and normal histo-anatomic structures of prostate which mimic malignancy and their awareness is essential to avoid diagnostic pit falls.

STUDY OF BONE MARROW BIOPSY IN HAEMATOLOGICAL DISORDERS

Dr. V. Srinivas Kumar, Dr. Bairi Laxminarayana

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2756-2764

Bone marrow examination is very useful not only in the diagnosis of hematological disorders. Both bone marrow biopsy and aspiration findings were studied and findings are compared morphologically. The biopsy specimen is best for the architectural evaluation and its relation with pathologic marrow elements. Core biopsy is best for ancillary study like immuno-histochemistry . The diagnoses of hematological disorders were mainly done by taking complete clinical history, careful physical examination, complete haemogram and bone marrow examination.

Pre-induction Cervical Ripening - A Comparative Study Between Transcervical Foley’s Catheter Versus Intracervical Prostaglandin E2 Gel

Dr. Badugu Vijetha, Dr. Jalagam Madhavi, Dr. Perumalla Karuna Priya, Dr. Musuku Radhika

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2765-2773

Background: The cervical condition at the time of induction determines whether or not labor induction is successful. Patients with low Bishop scores are expected to experience an unacceptably high rate of induction failure. The solution is cervical ripening using any approach to reduce induction failure. The objective of the study is to analyze the safety and efficacy of Transcervical Foley's catheter for cervical ripening in pregnant women with term gestation.
Methods: The study included n=200 patients after 38 completed weeks of gestation with a Bishop’s score <4 with various indications for induction were randomly allocated to receive n=100 patients with transcervical Foley’s catheter and n=100 patients to receive intracervical prostaglandin E2. In the Foley group, 12 hours after insertion of the catheter, it was deflated and removed, and rescoring of the cervix was carried out for improvement in the bishop's score. In the Dinoprostone group, Bishop's score was reassessed after 6 hours. If the bishop score was poor, the same dose of PGE2 was repeated and reassessed after 6 hours for a maximum of 3 doses in 24 hours.
Results: The bishop score is assessed at 0 hrs in both the groups. The majority of patients had Bishop scores of 0- 2. In Foley's group, n=62 cases and the PGE2 gel group to n=56 cases had Bishop scores in the range 0-2. There was no statistical significance between the two groups.  At 6 hrs only Dinoprostone group patients were reassessed according to protocol. The majority of patients in the Dinoprostone group show Bishop scores of 5-7 at 6hrs. The bishop score is assessed at 12hrs in both groups. In Foley's group n=42 cases and in Dinoprostone group, n=31 cases had delivered within 12 hrs and hence were not assessed. Majority of patients in both the groups showed bishop’s scores of 5 – 7 at 12 hours.
Conclusion: Foley's catheter is an equally effective method for pre-induction cervical ripening as Prostaglandin E2 gel in terms of initial cervical score, improvement in cervical
score, the success of induction, and the induction delivery intervals. The use of a Foley catheter was equally acceptable to the patients as the prostaglandin gel.

Magnitude of Edema and Proteinuria and its Impact on Pregnancy Outcome in Pre-Eclampsia.

Dr Preethi Y, Dr Leelambika C, Dr Shravan Kumar, Dr Prithvi Shankar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2774-2779

Background: The aim of this study to assess the Pregnancy outcome in Preeclampsia in terms of magnitude of edema and proteinuria.
Materials and methods: A Prospective study to assess the Magnitude of edema and Proteinuria and its impact on pregnancy outcome in Preeclampsia was conducted at Department of Obstetrics and Gynecology at Chigateri Government Hospital, Davanagere from January 2013 to June 2013. A 100 pregnant women with Preclampsia more than 20 weeks of gestation to 40 weeks of gestation were selected. Pregnant women with Chronic Hypertension, Diabetes Mellitus, Renal disease, Heart disease, Babies with Congenital malformations were excluded from the study. Qualitative estimation of Proteinuria and edema was done for all patients.
Results: A total of 100 cases were selected for the study. The maternal complications were found in 56% and perinatal complications in 57% of the Preeclamptic women. As the level of Proteinuria and magnitude of edema increases, there is higher incidence of maternal and perinatal complications which was statistically significant. The maternal complications include Abruption, Eclampsia, Anemia, Postpartum haemorrhage, HELLP Syndrome, Ascites, Instrumental deliveries and more chances of Caesarean section. The perinatal complications include Intrauterine fetal death, Intrauterine growth restriction, Still birth, Prematurity, Low Apgar score and Neonatal mortality.
Conclusion: In women with Pre-eclampsia, as the magnitude of proteinuria and edema increases, the maternal and perinatal complications also increase. Regular antenatal care for all the pregnancies. Early detection and treatment of pre- eclapmsia to prevent progression to more severity of the disease reduces the maternal and the perinatal morbidity and mortality.

A Comparative Study Between Early Versus Delayed Neuroimaging In Trauma Acute Encephalopathy in Paediatric Age Group

Dr. G. Sharavanan, Dr. R. M. Kannan, Dr. V. Karthi Sundar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2780-2790

Introduction: Encephalopathy can present a very broad spectrum of symptoms that range from mild, such as some memory loss or subtle personality changes, to severe, such as dementia, seizures, coma or death. In general, encephalopathy is manifested by an altered mental state that is sometimes accompanied by physical manifestations
Materials & Methods: This study conducted at Dept. Of Paediatrics ,Vels medical college and hospital from(Jan 2020 to June 2022). MRI/CT brain will be performed according to the clinical requirement and patient condition at initial admission. If there is clear diagnostic information on initial imaging no further neuroimaging will be performed on these children unless a prognostic imaging is deemed necessary by treating neurologist. Delayed imaging will be done when the initial neuroimaging is normal/nondiagnostic and child continues to have neurological symptoms and signs without obvious diagnoses from clinical, blood, CSF investigations. 
Results: Highest percentage of symptom was fever (68.29%) followed by seizure (65.85%) and encephalopathy (60.9%). Vomiting was in 34.14% of patients.  Lowest percentage of symptom was Visual impairment. (21.95%).In 39.02 % of cases, first neuroimaging was done on Day-2 of illness and in 26.82% of cases, it was done on Day-1 of illness followed by 12.19% of patients on 3rd day of illness.
Conclusion: Consequently, paediatric neurologists may utilize several different tests at the same time to diagnose both the primary condition (the cause of encephalopathy) and the encephalopathy itself.

PREDICTORS OF PERINATAL MORTALITY ASSOCIATED WITH PLACENTA PREVIA AND PLACENTAL ABRUPTION: AN EXPERIENCE FROM ZLITEN MEDICAL CENTER

Abokresh Eisha G.A. Hamed Mohamed F

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2791-2806

Placental abruption (PA), despite recent improvements in prenatal diagnostic methods, continues to be one of the major causes of maternal morbidity and neonatal mortality. This retrospective cohort study design was used to assess predictors of perinatal mortality in women with placenta previa and abruption between January 2012 and December 2018. Eight hundred sixty-four women (506 with placenta previa and 358 with placental abruption) were eligible for analysis. Binary logistic regression, Kaplan-Meier survival curve, and receiver operating characteristic (ROC) curve were used. On admission, 74% of the women were anaemic (<10 gm/dL) with mean haemoglobin level of 8.0 ± 3.0 gm/dL. The proportion of overall severe anaemia increased from about 35% on admission to 43% at discharge. There were 50% perinatal deaths (neonatal deaths of less than seven days of age and fetal deaths after 28 weeks of gestation). In the adjusted odds ratios, lengthy delay in Zeliten Medical central hospital care, prematurity, anaemia in the mothers, and male foetuses were independent predictors of perinatal mortality. The haemoglobin level at admission was more sensitive and more specific than prematurity in the prediction of perinatal mortality. The proportion of severe anaemia and perinatal mortality was probably one of the highest in the world.

AN OVERVIEW ON VIROLOGICAL PATHOGNESIS, CLINICAL MANIFESTATION, AND MOLECULAR STUDIES ON NEWCASTLE DISEASE VIRUS

Ahmed A. H. Ali, Fatma M. Abdallah, Gamelat K.Farag, Samar Fatehi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2807-2824

Newcastle disease (NDV) is one of the endemic pathogenic viral diseases in many developing countries that economically significant because of the huge mortality and morbidity associated with it. NDV was identified with the advent of large scale commercial poultry farming toward the beginning of the 20th century. NDV has lured the virologists not only because of its pathogenic potential, and its use as a vaccine vector for both humans and animals. The NDV based recombinant vaccine offers a pertinent choice for the construction of live attenuated vaccine due to its modular nature of transcription, minimum recombination frequency, and lack of DNA phase during replication. In developed countries with established poultry industries, not only are outbreaks of NDV extremely costly, but control measurers present a continuing loss to the industry.NDV is prevented and controlled through vaccination, confinement, and slaughter of affected flocks in confirmed outbreaks. Birds have been vaccinated against NDV using live attenuated vaccines, inactivated NDV vaccines, and recombinant vaccinations. Regrettably, the disease continues to strike and cause major outbreaks. Therefore, we aimed to review the virological and molecular studies on Newcastle disease virus.

STUDIES ON PAROTID GLAND NEOPLASMAS USING FINE NEEDLE ASPIRATION CYTOLOGY

Dr G Prathima, Dr N. Sailarekha

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2825-2838

The most common target organs where fine needle aspiration cytology (FNAC) is performed are salivary glands because of their superficial location and easy accessibility introduced into a mass, cellular material is aspirated, and a cytological diagnosis is rendered as It separates reactive and inflammatory processes that do not require surgical intervention from neoplasia and benign from malignant tumors.
OBJECTIVES:
To study the cytomorphological features in lesions of salivary glands. To correlate the cytological features with histopathological features wherever possible. To evaluate the diagnostic utility of fine needle aspiration cytology of lesions in the salivary glands.
METHODOLOGY:
A total of 120 patients with salivary gland diseases were included in the study. This is a retrospective cohort study, undertaken in the Department of Pathology, Fathima Institute of Medical sciences, Kadapa during the period of Jan 2016 to Feb 2020. The sensitivity, specificity and overall diagnostic accuracy was calculated using Galen and Gambino method.
RESULTS:
Our study included 120 patients with salivary gland diseases. Age group of patients with salivary gland diseases ranged from 10 years to 88 years with the mean age of 44.62 years. Majority of the patients belonged to the age group of 31-40 years (35%). Male to Female ratio was 1.25: 1. Among the 120 patients, most common non neoplastic 67.52%, benign 71.79% and malignant 28.20% lesions.
CONCLUSION:
FNAC of salivary gland is a reliable and sensitive diagnostic method for diagnosis of salivary gland lesions. It not only provides preoperative diagnosis for management but also can prevent unnecessary surgeries.

Functional outcome of Arthroscopic repair (All-inside technique) of bucket handle medial meniscus tears

Dr Channabasava , Dr Abhijit Patil ,Dr Anuj Manjunath

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2839-2843

Bucket-handle meniscal tears are defined as vertical longitudinal tears of the meniscus with displacement of the torn inner fragment toward the intercondylar notch region. It is most commonly encountered in medial meniscus. Management of bucket handle tears is important to preserve knee function & preserving the meniscus will limit future osteoarthrosis. A series of 20 cases of bucket handle medial meniscus tears were treated by Arthroscopic repair: All-inside technique and were followed up regularly till 6months and evaluated using Lysholm Knee Scoring Scale. Most patients had Excellent score at 6th month follow-up. Our study suggests Arthroscopic repair: All-inside technique is an effective management of medial meniscus bucket handle tears.

TO INVESTIGATE THE USE OF ULTRASOUND IN DIAGNOSING PATIENTS WITH FIRST TRIMESTER BLEEDING AND TO PROGNOSIS AND FORECAST THE OUTCOME OF ABNORMAL PREGNANCIES

Dr Shruti Mallya, Dr Monika Mann, Dr Sunil Sanga, Dr Pratap Pharande

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2844-2849

Aim: To investigate the use of ultrasound in diagnosing patients with first trimester bleeding and to prognosis and forecast the outcome of abnormal pregnancies
Methods: The research included all consecutive individuals having a history of vaginal bleeding in the first trimester of pregnancy. Age, obstetric history, menstruation history, and specifics of the current pregnancy such as period of amenorrhea at the time of the first episode of bleeding, quantity and duration of bleeding, discomfort abdomen, and history of expulsion of fleshy mass/clots were all recorded. Transabdominal sonography was performed on all patients using a GE Logiq P5 Pro ultrasound equipment. When transabdominal sonography was unclear or ambiguous, transvaginal sonography (TVS) was used. The presence or absence of a gestational sac, the location of the gestational sac, the size of the gestational age in comparison to the period of amenorrhea, the margins of the gestational sac, the presence or absence of a foetal pole, crown rump length (CRL), cardiac activity, and the presence of fluid in the cul-de-sac were all noted on an ultrasound.
Results: Clinical examination revealed that 74 (74%) of the cases were threatened abortions, 6 (6%) were complete abortions, 4 (4%) were incomplete abortions, and 2 (2%) were missed abortions. Clinically, no blighted ovum or molar pregnancy was suspected. On USG, 55(55%) of 100 cases were classified as threatened abortion, 15(15%) as complete abortion, and 9(9%) as missed abortion and incomplete abortion. There were also 6 (6%) cases of blighted ovum, 3 (3%) cases of ectopic pregnancy, and 2(2%) cases of complete hydatiform mole. The total disparity between clinical and USG diagnosis was present in 61% of cases, and clinical diagnosis was confirmed by USG in 62 cases, indicating clinical diagnosis accuracy of 62%.
Conclusions: We conclude that USG is a helpful and readily accessible technique for evaluating individuals with first trimester vaginal haemorrhage. It is quite precise in pinpointing the root of the bleeding problem and helping the doctor decide what course of action to take. In the algorithm for deciding whether or not to intervene and keep the pregnancy going, ultrasound is a useful input.

MRI ASSESSMENT TMJ AMONG PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS (JIA)

Dr Priyankesh, Dr Niraj Kumar, Dr Santosh Kumar, Dr.Sushma K.N.

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2850-2854

Background: The present study was conducted for assessing MRI findings of TMJ among patients with juvenile idiopathic arthritis (JIA).
Materials & methods: A total of 20 patients with JIA were enrolled. Complete demographic and clinical details of all the patients was obtained.  A Performa was made and complete clinical and medical history of all the patients was recorded. Patients with history of any other systemic illness, any known drug allergy were excluded from the present study. All the subjects were informed about MRI protocols. MRI of TMJ was done.
Results: