Gajra Raja Medical College Research Articles

A Comparative Analysis of Visual Inspection With Acetic Acid, Cervical Cytology, and Histopathology in the Screening and Early Detection of Premalignant and Malignant Lesions of the Cervix.

The incidence of cervical cancer and related mortality is growing worldwide. The natural history of disease progression ranges from 10 to 20 years. Hence, effective screening can help in the early detection and prevention of fatal complications. This study aims to (1) compare the sociodemographic characteristics of the women with malignant and premalignant lesions of the cervix, (2) collate the accuracy of visual inspection of the cervix with acetic acid (VIA) with Pap smear cervical cytology in the early detection of premalignant and malignant lesions of the cervix, and (3) standardize it with histopathology, a gold standard screening tool. This study was carried out in the Department of Obstetrics and Gynaecology, Gajra Raja Medical College, Gwalior, India, from October 2020 to March 2021 including all the sexually active women of the reproductive age group and postmenopausal women attending the gynecology outpatient department and the indoor admitted patients. A total of 500 patients were included in the study. The women were subjected to a Pap smear followed by VIA. Punch biopsy was taken from the acetowhite regions and sent for histopathological examination. The women with abnormal cervical cytology results also underwent a biopsy and histopathological examination. On comparative analysis, the sensitivity and specificity of Pap smear cytology were found to be 89.5% and 65.2%, respectively. The sensitivity and specificity of VIA were found to be 94.7% and 88%, respectively. The overall accuracy of VIA testing (93.2%) is more significant than that of Pap smear (68%). According to our study, it is found that visual inspection with acetic acid is more diagnostically accurate than Pap smear cytology. Hence, VIA testing could be implemented as a primary screening tool with credence. Also, as learned from our study, the premalignant and malignant lesions are more common among elderly women living under a low socioeconomic status. Hence, these groups of women must be outreached and covered through effectively targeted screening programs.

“A PROSPECTIVE AND COMPARATIVE STUDY OF CARCINOMA OF BUCCAL MUCOSA CASES WITH EXCISION FOLLOWED BY PRIMARY CLOSURE VERSUS USE OF RECONSTRUCTIVE FLAP”

Introduction: Carcinoma of buccal mucosa is the most common cancer of the oral cavity in India.1 Increasing trend of incidence of these cancers in the developing countries, most likely due to a higher exposure to alcohol, tobacco, health ignorance, poor access to health care facilities. Buccal mucosa cancers primarily occurs along the occlusal plane and are characterized by pain and ulceration, which are usually accompanied by a buccal mass. Aim: To compare the clinical outcome in cases of surgery with primary closure and surgery with reconstructive aps after standard surgery for extirpation of tumor. Material And Method: The study was carried out as a prospective study in the Department of General Surgery at Gajra Raja Medical College and J.A. Group of Hospitals, Gwalior (M.P.) for one and half year from January 2020 to June 2021.Atotal of 30 patients with histopathologically conrmed carcinoma of buccal mucosa were studied. The study was approved by ethical committee of the Hospital. Results: In the present study, the result of primary closure vs ap reconstruction for defects extirpation of tumor, the maximum cases lie in age group of 41- 50 years (12 i.e. 40%) age group of 61-70 years (6 i.e. 20%) and 51-60 years (5 i.e. 17%). Carcinoma of buccal mucosa had higher incidence in male. Total number of male cases were 26(87%) and female cases were 4(13%).The male to female ratio was 6.5:1. Out of 30 patients, in 18 cases neck management done by modied radical neck dissection and in 11 cases neck managed by radical neck dissection. After resection of primary lesion and neck dissection, the defect which was either covered by use of reconstructive ap or primary closed. Out of 30 cases, in 18 cases defect was closed by use of reconstructive ap and in 12 cases defect was primary closed. Out of 30 cases, in 13 cases(72%) reconstruction was done by use of pectoralis major myocutaneous ap. In 3 cases(17%), reconstruction was done by use of free bular graft and in 2 cases(11%), reconstruction was done by use of Radial forearm free ap. Conclusion: In carcinoma buccal mucosa, No neck patients was treated with modied radical neck dissection and N+ neck patients was treated by Radical neck dissection. Eleven carcinoma buccal mucosa underwent Radical neck dissection and 18 patients had Modied radical neck dissection. For Mandible reconstruction, bular bone graft is best option for form and function. Two patients underwent mandibular reconstruction by use vascularized bular bone. Primary closure of defect was possible if surrounding tissue was lax. Primary closure after excision of tumor done in 12 cases(40%). In buccal mucosa carcinoma, free ap provides reconstruction for complex defect. In present study, Pectoralis major myocutaneous ap mostly used for reconstruction of defect. In 13 patients (72%) PMMC ap was used. The complication noted was, immediate was ap necrosis and late was recurrence. In immediate post operative period there was ap necrosis in 2 cases and recurrence was seen in 4 cases.

CYTODIAGNOSIS OF TUBERCULOSIS USING CONVENTIONAL ZIEHL-NEELSON STAINING METHOD AND MODIFIED BLEACH METHOD ON LYMPH NODE ASPIRATES ALONG WITH CLINICAL CORRELATION IN TERTIARY CARE CENTRE.

Tuberculosis (TB) is a common public health problem and second leading cause of communicable disease world wide. Tuberculosis is one of the top ten causes of death and the leading cause from a single infectious agent (above HIV/AIDS). India accounting for almost one fth (21%) of global incidence. Lymphadenopathy accounts for the most common form of Extra-Pulmonary Tuberculosis (EPTB) 3. A prospective study was carried on 100 cases of suspected tubercular lymphadenopathy patients over a period of 18 months at Gajra Raja Medical College and JAH Group of Hospitals, Gwalior from Jan 2020 to Jun 2021. All cases of clinically suspected tubercular lymphadenopathy reporting for Fine Needle Aspiration Cytology (FNAC) examination in Department of Pathology, Gajra Raja Medical College and Jay Arogya Group of Hospitals (J.A.H.), Gwalior, Madhya Pradesh (M.P.) with proper marking for affected lymph nodes and documentation. Aim was to evaluate the efcacy of bleach method with cytological diagnosis and the conventional method. Patients with tubercular lymphadenitis were evaluated. The acid-fast positivity by routine staining was compared with modied bleach method of AFB staining. Among 100 patients, 23(23%) were positive for AFB on conventional ZN method and the smear positivity was increased to 33 (33%) by bleach method. The bleach method is simple and inexpensive. It clearly improves microscopic detection of AFB.

EFFICACY AND SAFETY OF AZILSARTAN IN PATIENTS OF HYPERTENSION WITH DIABETES IN GWALIOR DISTRICT.

Background: Angiotensin receptor blockers are well established drugs for the treatment of hypertension with or without renal disease. Azilsartan is a new angiotensin receptor blocker being used in the treatment of hypertension. Present study is done to evaluate efcacy and safety of azilsartan in patients of hypertension with diabetes mellitus in Gwalior district. Methods: The study was conducted in department of pharmacology, Gajra raja medical college, Gwalior Madhya Pradesh during February 2018 to march 2019. It is a longitudinal, prospective, randomized study and total 90 patients of hypertension with diabetes were enrolled out of which 83 patients completed study with a follow up of 1 year period and were divided equally into two groups. Group I received Azilsartan 40- 80 mg once daily and group II received another drug once daily for 12 weeks. Baseline Systolic blood Pressure and diastolic blood pressure were recorded at the start and then at 4th, 8thand 12th weeks after therapy. Fasting and post prandial blood sugar, HDL, LDL-C , total cholesterol values were recorded at start and after 12 weeks of therapy. All the patients were screened for any adverse drug reactions on each visit. Result: Azilsartan effectively lowered the levels of systolic and diastolic blood pressure from baseline (p=0.00001) conrming the anti- hypertensive efcacy also there was overall signicant improvement in HDL values from baseline (p=0.000) and also signicant improvement was shown in LDL Total cholesterol levels from baseline (p =0.005). There was signicant improvement in FBS and PPBS from baseline (p value 0.00). Conclusion: Azilsartan effectively lowered the levels of systolic and diastolic blood pressure in patients of hypertension with diabetes and the difference was signicant. Azilsartan showed overall improvement in HDL, LDL, TC values with signicant difference in hypertensive with diabetes patients.

Study of pattern of injuries sustained in fatal road traffic accidents

Aim: This study was conducted to examine the pattern of injuries in road traffic accidents (RTA) amongst the victims. Methodology: A study was undertaken at Gajra Raja Medical College, Gwalior (M.P.), to find out the types of injury patterns occurred due to the road traffic accidents. All Case histories and records, reports pertaining to road traffic accident victims were collected and analyzed to see different types of injury patterns sustained in the accident and data was compiled based on the findings with SPSS 20 software . Results: The study population consisted of 500 patients. Majority of them were males (84.25%) and belonged to the age group of 21 to 30 years with 25.31%. Majority of the patients had injury to Head neck and face constituting 53.61% and least had injury to the abdominal region constituting 9.14%. Abrasion was seen in most of the cases around 64.89% and Lacerations was the least found in 14.46%. Majority of the patients around 42.81% had skull and maxillofacial fracture and the least type of fracture observed was Ribs fracture observed in 4.79% of the cases.

“STUDY OF PROLIFERATIVE INDICES USING MITOTIC INDEX AND AGNOR AND THEIR CORRELATION WITH VARIOUS GRADES OF BREAST CARCINOMA”

Background: Breast cancer is a leading cause of death in women. The objectives of this study were to compare the argyrophilic nucleolar organizer region (AgNOR) count and mitotic index with various histological grades of infiltrating ductal carcinoma of breast. Aim: To study the relationship of the proliferative indices and various grades of breast carcinoma. Objective: "Study of proliferative indices using mitotic index and Agnor and their correlation with various grades of breast carcinoma" Material and Method: In this prospective study all specimens of infiltrating ductal carcinoma of female breast belonging to all age groups received in the department of histopathology of Gajra Raja Medical College,Gwalior during the period of three years were graded using Bloom and Richardson score and correlated with proliferative indices mitotic index and AgNOR counts. Result: The mean Age (Years) was 46.16 ± 8.68.The mean B&R Score was 6.52 ± 1.20.The mean Mitotic Index was 8.51 ± 2.61.The mean AgNOR Count was 4.24 ± 2.34.There was significant correlation between AgNOR count,mitotic index and histological grades. Conclusion: AgNOR count and mitotic index can be used as reliable proliferative indices which correlate well with the histological grades and are cost effective too.

Utility of Image-Guided Fine-Needle Aspiration Cytology from Neoplastic Hepatic and Gallbladder Lesions

Introduction: Fine-needle aspiration cytology (FNAC) is an important and successful method for liver and gallbladder (GB) lesion diagnosis. Aspiration from liver and GB masses and its cytological evaluation differentiate whether it is benign or malignant. It is of huge help to the clinician for deciding on timely and appropriate management of the patient. Image-guided FNAC of liver lesions helps to know lesion localization whether it is multifocal, with the benefit of multiple passes for adequate sampling. Aims and Objective: This study aims at finding the importance and effectivity of image-guided FNAC of liver and GB masses with the main focus on the diagnosis of neoplastic lesions. Materials and Methods: The study was a prospective study conducted in the Cytology Section in the Department of Pathology, Gajra Raja Medical College, Gwalior, from January 2019 to March 2021. All the slides of liver and GB fossa mass aspiration done with help of image guidance were stained and examined. Results: There were a total of 86 cases, out of which six cases had unsatisfactory material, thus rendering them as nondiagnostic (7%). The diagnostic efficacy is 93%. Out of 80 cases, 71 (87.5%) were reported neoplastic and 9 (12.5%) were nonneoplastic. Among neoplastic lesions (71/80, i.e., 88.7%), 70 were malignant and one case was reported as suspicious for malignancy. Out of 71 neoplastic lesions, 39 were from liver mass and 32 were from GB fossa. Among 38 malignant neoplastic tumors of the liver, six cases were hepatocellular carcinoma (15.7%). Out of 32 metastatic lesions to the liver, 30 were of adenocarcinoma and one case each of small-cell morphology and lymphoma. Conclusions: Cytological evaluation is an important tool and can be applied as the first line of diagnostics in the management of liver masses and can characterize liver masses. GB lesion cytology has more diagnostic yields and accuracy of differentiating neoplastic lesions from nonneoplastic lesions. Hence, from the study, we can conclude that advanced techniques in the cytological study of liver and GB mass can give an early diagnosis.

COMPARING THE EFFECTIVENESS OF LIQUID BASED CYTOLOGY (LBC) WITH CONVENTIONAL PAP SMEAR: A PROSPECTIVE STUDY

Background: Cervical cancer is unique among human cancers which is mostly attributable to infection. Conventional PAP smear method is most effective for prevention and detection of cervical cancer but the accuracy of this method is low.This PAP smear now evolved to Liquid Based Cytology (LBC). Method:All the patients visiting Gynaecology OPD who fulfilled the inclusion Criteria in the duration starting from 1 January 2020 to 30 June 2021 in the Department of Pathology of Gajra raja Medical College, Gwalior (MP) were included in this study. 50 atypical smears by Conventional PAP test were then collected and these cases were subjected to Eziprep Liquid Based Cytology and Conventional PAP smear in private laboratory setup after taking history and clinical examination. The smears were studied by using 7 morphological parameters. Result: Smears were analysed for adequate cellularity, clean background, uniform distribution of cells,cellular overlapping,inflammation,distinct cell border,nuclear irregularity and then categorise by Bethesda reporting system.The results were significant only for clean background,uniform distribution of cells,cellular overlapping and inflammation. Conclusion: Results of cervical cytology smears by both methods showed that LBC provides more representative sample with reduced obscuring material,improved clarity allowing better morphological evaluation.

Outcome of surgical condition of neonates who underwent surgery: A prospective study from a tertiary care center.

The neonatal period is a highly vulnerable time for an infant, who is completing many of the physiologic adjustments required for extra- uterine survival. If the neonate has a coexisting pathology which needs surgery, this challenge is magnified. Neonatal surgical conditions are unique in their type because some require early diagnosis, prompt surgery and postoperative care to improve the survival and outcome. The aim of this study was to know the clinical profile of congenital surgical conditions and to estimate the burden and outcome in special new born care unit. The study population include 138 surgical neonate admitted in special new born care unit, department of paediatrics, Kamla Raja Hospital, Gajra Raja Medical College, Gwalior (M.P.) from April 2017 to April 2018 including six month follow up period. Total admission in special new born care unit were 5378 out of which 138 (2.5%) neonates of surgical condition were admitted in the study period. Incidence of neonatal surgical condition was found to be 8.48%. Surgery was performed in 57 (41.30%) neonates. The Commonest neonatal surgical condition was constituted by gastrointestinal system (39.13%). Among gastrointestinal system anomalies, tracheoesophageal fistula were 28.6% of total gastrointestinal system cases. The most common surgical condition encountered was meningomyelocele, 23.36% of total cases. The survival of neonatal surgical condition in hospital was 52.89% and after six month follow up was 26.08%. The overall mortality with neonatal surgical condition in this study was 73.91%. Maternal age, antenatal care, history of congenital malformation, socioeconomic status, mode of delivery, prematurity, type of admission, single or multiple surgical condition, inotropic and ventilation support, post operative complication were significantly associated with final outcome of neonatal surgical condition. High mortality was found in neonates suffering from surgical conditions. Commonest anomaly includes conditions of gastrointestinal tract. Maternal age more than 35 year, poor antenatal care, prematurity, vaginal delivery, extra mural neonate, multiple surgical condition, inotropic and ventilation support and post operative complications were associated with increased mortality.

Effectiveness of COVID-19 Vaccination against COVID -associated Mucormycosis

Introduction: Coronavirus Disease-2019 (COVID-19) infections may be associated with a wide range of opportunistic bacterial and fungal co-infections. Both Aspergillus and Candida have been reported as the main fungal pathogens for co-infection in people with COVID-19. During the COVID-19 pandemic, another threat has emerged as a challenge to India was in the form of COVID-associated mucormycosis. Aim: To study the incidence of COVID-associated rhino-orbital mucormycosis in vaccinated and unvaccinated patients. Materials and Methods: A prospective observational study was carried out at Gajra Raja Medical College and Jay Arogya Hospital, Gwalior, Madhya Pradesh, India, over a period of two months (May to June 2021). A total of 94 patients with post-COVID rhino-orbital mucormycosis were reported in the institute during the study period. Biopsy or postoperative surgical specimens were received for histopathological examination with a proper history of diabetes mellitus, steroid intake, and vaccination status. Histologically confirmed COVID-associated rhino-orbital mucormycosis cases were included in the study and its incidence was compared in vaccinated and unvaccinated patients. Results: Total 94 patients were confirmed histopathologically, with mucormycosis. It was noted that mucormycosis was more common in males as compared to females. Of the total number of cases, 71 (75.5%) cases had a history of diabetes mellitus and 73 (77.7%) had a history of steroid intake. Eightysix (91.5%) cases were unvaccinated while only 8 (8.5%) were either completely or partially vaccinated. Incidence of mucormycosis was found to be more amongst unvaccinated patients as compared to vaccinated patients. Conclusion: Mucormycosis is one of the major post-COVID threats. Diabetes mellitus and steroid intake were found to be the main risk factors for post-COVID mucormycosis. However, it has also been noted that mucormycosis can occur without a previous history of diabetes and steroid intake. Incidence of mucormycosis was found to be higher amongst unvaccinated patients as compared to vaccinated patients. Hence, vaccination against COVID-19 is likely to be effective in the prevention of COVID-associated mucormycosis.

Clinico-histopathological Features of Sinonasal Lesions: An Experience from a Tertiary Care Hospital, Central India

Introduction: Sinonasal Tract (SNT) lesions are frequently observed in the Ear, Nose and Throat (ENT) practice. These lesions have identical appearance and usually present with nasal obstruction, but have varying differential diagnosis that requires histopathological confirmation. Though a common pathology, studies correlating clinical and histopathological diagnosis of SNT lesions are scarce among patients residing in Central India. Aim: To assess the prevalence of various lesions in SNT, compare the lesion in relation to age and sex, and simultaneously relate the clinical and histopathological diagnosis. Materials and Methods: This was a cross-sectional study carried out, in the Department of ENT and Head and Neck Surgery, Gajraraja Medical College, Gwalior, Madhya Pradesh, India, between May 2019 to December 2020. A total of 109 patients with SNT lesions were evaluated and a provisional diagnosis was reached after evaluating the history, and performing the clinical examination. The SNT lesions were excised operatively and definitive diagnosis was reached after histopathologic examination. Finally, clinical diagnosis was related with histopathologic diagnosis and percentage of patients in which clinical diagnosis similar to the histopathological diagnosis was calculated. Results: A total of 109 patients with SNT lesions were evaluated and the most common age groups to be affected were 21-30 and 31-40 years (22.9% each). Majority of the patients were males (53.2%) and had the complaints for the last three months to a year (63.3%). The most common complaint was nasal obstruction (93.6%) followed by rhinorrhoea (71.6%). Most common types of lesions were non neoplastic (77.1%). Among the neoplastic lesion, majority were benign (70.8%). Among various lesions, inflammatory nasal polyp (78.8%), haemangioma (47.1%), and Squamous Cell Carcinoma (SCC) (57.1%) were the most commonly observed non neoplastic, benign, and malignant lesions, respectively. The concordance between clinical and histopathological diagnosis was 88.1%, as 96 patients out of 109 clinically diagnosed patients, were confirmed on histopathology. Conclusion: The SNTs lesions are complex and their nature varies widely. The histopathological examination is essential to confirm the diagnosis and manage the patients, especially in patients with malignant lesions.

INCIDENCE OF ABDOMINAL TUBERCULOSIS IN PATIENT PRESENTING WITH PAIN IN RIGHT ILIAC FOSSA: A PROSPECTIVE STUDY IN GRMC, GWALIOR.

Introduction: Abdominal tuberculosis is sixth most common type of extrapulmonary tuberculosis. It may mimics other gastrointestinal lesions like inammatory bowel disease, malignancies. The diagnosis is usually delayed due to non specic symptoms and signs.5-6We observed the various presentations of abdominal tuberculosis in our hospital and analyzed the pathology in present scenario. Aim: To evaluate the incidence of Abdominal tuberculosis in patient presenting Right iliac fossa pain and its association with pulmonary tuberculosis and role of Anti tubercular therapy (ATT) to minimize the further complications. Method And Materials:The study was carried out as a prospective study in the Department of General Surgery at Gajra Raja Medical College and Jayarogya group of Hospitals, Gwalior (M.P.) for 1½ year from January 2020 to June 2021. Atotal of 50 patients with pain in right iliac fossa were admitted and studied. The study was approved by the ethical committee of the hospital. Results: In our study out of 50 cases with pain in right iliac fossa 15 cases were diagnosed with abdominal tuberculosis with slight female predominance. maximum number of cases present between 20-39 years of age. 2 out of 15 had the past history of pulmonary Tuberculosis while 3 having family history of Tuberculosis. Out of 15 abdominal T.B. patients 5 patients underwent for surgery and 10 were managed conservatively & ATT started from which 4 patients responded well to ATT and 6 developed complications and presents in emergencyemergency, Out of them 4 having SAIO, 1 having distal ileal perforation and 1 with enterocutaneous stula. Conclusion: From the observation and result of my study most of patient Presented with chronic pain in Right iliac fossa has been diagnosed with ileocecal TB. Study show that 40% patients respond well to ATT and 60% develop complication with symptoms of obstruction and perforation during follow up that underwent for Surgery later on.

SPECTRUM OF MAGNETIC RESONANCE IMAGING FINDINGS IN RHINO-ORBITO-CEREBRAL MUCORMYCOSIS PATIENTS DURING SECOND WAVE OF COVID-19 INFECTION IN A TERTIARY CARE HOSPITAL – A PROSPECTIVE STUDY.

Introduction- Mucormycosis is a lethal intrusive opportunistic fungal infection with increased morbidity and mortality. Its most common form is Rhino-Orbital-Cerebral Mucormycosis (ROCM). It has been described more in immunosuppressed people and currently in patients with recent history of/ concomitant Covid-19 infection. Magnetic Resonance Imaging (MRI) has been used to delineate extent of infection and spread and preoperative planning. MRI shows varied T1 and T2 signal intensity lesions with nonenhancement in necrosed tissues and extension of infection into adjacent structures. This prospective study aimed at delineating the spectrum of MRI findings in ROCM patients. Methods and results- A prospective study of 31 patients with ROCM was done in Department of Radiology, Superspeciality hospital, Gajra Raja Medical College, Gwalior in May and June 2021 during second wave of COVID-19 pandemic. We found that 64.5% patients in study group had previously / recently diagnosed diabetes mellitus and 77.4% cases had recently treated or concomitant COVID-19 infection. All the patients had sinonasal involvement at the time of imaging. The other areas of involvement were orbit and its contents, some of adjacent soft tissues, cavernous sinus and cerebral parenchyma, hard palate and cavernous ICA in order of frequency. Conclusion- ROCM is a grave infection which readily causes perivascular, perineural and soft tissue infiltration within a short span of time, hence most of the patients in this study had extension beyond the sinuses at the time of imaging. MRI is an essential tool for early identification of extrasinus extension of disease, detection of intracranial and vascular complications and presurgical planning.

TO FIND OUT THE COLONIZATION OF CLOSTRIDIUM DIFFICILE IN PATIENTS WITH MORE THAN 48 HOURS OF ADMISSION AND HAVING GASTROINTESTINAL SYMPTOMS

Background & Method: Place of Study in Department of Microbiology, Gajra Raja Medical College, Gwalior Study was conducted on 600 patients admitted in various wards in G.R. Medical College, Gwalior and associated J A Group of Hospital Gwalior (MP).
 Result: Among 600 suspected patients studied, maximum number, 287 (47.83%) belong to age group 19-49 years and minimum number 20 (3.33% belong to more than 75 years age group.
 Male were more (58.83%) than female (41.16%) in studied suspected patients.
 Fever was the most prevalent presenting symptom with 350 (58.33%) suspected patients. This was followed by abdominal pain 200 (33.33%) patients and diarrhoea in 118 (19.67%) suspected patients.
 The least culture positivity was found in suspected patient who had admitted for 3-10 days (2.42 %). The maximum number of positive culture were found in patients with hospital stay more than 26 days which mean that duration of hospital stay correlate with positivity of culture.
 
 difficile was isolated in 5.71 % of the gastric acid suppressants using patients while its positivity in non gastric acid suppressants user was 2.72 %.
 
 Conclusion: The prevalence of C. difficile in 600 hospitalized patients was found to be 5.17%.in our hospital. It was less as compare to other studied conducted earlier. Cause of less prevalence may be due to various factors like the decreased use of Clindamycin in our hospital. Secondly, antibiotics effective against C. difficile such as Metronidazole have been included as the first line drugs in suspected CDAD cases.
 Colonization of C. difficile has been traditionally associated with hospitalization, advance age, underlying illness, gastric acid suppressant use and most prominently to use of antimicrobials. Uses of antibiotics, long stay in hospital and advance age was the most common risk factor in our study.
 Keywords: colonization, Clostridium difficile & gastrointestinal.

CORRELATION OF BIOPSY AND AgNOR COUNTS IN PREMALIGNANT AND MALIGNANT LESIONS OF CERVIX

Background- Cervical cancer is the commonest cancer among women in developing countries. Screening methods like cervical cytology has brought down the incidence of cervical cancer. AgNOR represents Nucleolar organizer regions stained with silver and are related to cell proliferation rate and tumor malignant potential. The present study was aimed at evaluating the diagnostic role of AgNOR in cervical carcinogenesis. Material and Methods- The present study was conducted in the Pathology department of Gajra Raja Medical College, Gwalior from January 2019 to May 2020 on 500 patients who attended the Gynae OPD. Women of suspected cervical pathology and who underwent Pap smear test followed by subsequent biopsies were included. Results- AgNOR count in chronic cervicitis was 2.72±0.32, in CIN I was 4.02±0.38, in CIN II was 5.47±0.21 in CIN III was 5.59±0.18, in Well differentiated KSCC was 6.48±0.40 and in adenocarcinoma was 6.93±0.21. The study showed that the mean AgNOR count per nucleus was signicantly higher in CIN and malignant cervical lesions. Conclusion- AgNOR count is reproducible, simple, efcient and inexpensive method which can be used as an adjunct to histopathology and cytology especially in differentiating doubtful cases of CIN.

Functional outcome of comminuted meta-diaphyseal fractures of proximal tibia treated by stainless steel bridging plate

Introduction Proximal Tibial meta-diaphyseal fractures are challenging injuries because of subcutaneous anteromedial surface of bone and frequent soft tissue complications. Good management requires stable fixation with minimal soft tissue handling. Locking compression plate (LCP) applied as an external fixator fulfills these criteria and can be an important tool in the armamentarium of an orthopaedic surgeon. Aim: To study the clinical, functional and radiological outcome of comminuted fractures of metaphysis and diaphysis proximal tibia treated by stainless steel bridging plate in skeletally mature patients. Materials and Methods: This was a prospective study conducted from August 2013 to August 2020 at the Gajra Raja Medical college Gwalior with a 6month follow-up in skeletally mature patients with post-traumatic comminuted fractures of metaphysis and diaphysis of proximal tibia fractures were included. Patient were evaluated retrospectively interms of union, maintenance of reduction, complications and final outcome using KSS (Knee society scoring) for proximal fractures.Results: Following all principles of fracture reduction, union was achieved in all patients with mean time to radiological union being 20 weeks. The mean Range of Motion (ROM) was 106 degrees with According to KSS results were excellent in 28 patients (41%), good in 26 (38%), fair in 15(21%) 6 patients developed complications in the form of infection during the course of our study, but were completely treated by the end of the study. Conclusion: We found this technique to be more biological, simple to do surgery, effective in maintaining reduction till union, more patient friendly in comparison to traditional large, bulkyfixators and with minimal complications.

Triple assessment for addressing trio-pathy in diabetic foot – Rapid screening tool for amputation prevention in govt. Hospital setting

Introduction: The present study was done to perform foot examination using Amit Jain’s Triple Assessment screening tool on in-patients in surgical wards. Materials and Methods: A descriptive retrospective study was done at Gajra Raja Medical College, Gwalior (M.P.) in department of surgery during a period from April 2018 to June 2018 on patients of diabetic foot admitted in all six units of surgical wards. Results: A total of 72 patients were included in this study as per search in case records. Majority of patients had diabetes of more than ten years duration and males were more commonly affected. All patients had diagnosis of diabetic foot with varied spectrum of associated lesions alone or in combination. Surgical debridement (66.66%) was the commonest procedure done in these patients. The affected foot of all patients was examined, with component assessment of feeling pedal pulses done in 86.11% cases and testing for sensation was done in 25% cases. In contralateral foot 58% patients were examined, in similar percentage pedal pulses were examined and foot sensations were not tested in any of them. Conclusion: Despite foot examination being of paramount importance it is often incomplete and inadequate in diabetic foot subjects as is also evident from observations of present study. Amit Jain’s Triple assessment of diabetic feet is a rapid inexpensive screening tool for obtaining basic foot information in order to segregate at risk feet and offer preventive care against amputation. Keywords: Amit Jain, Assessment, Triple, Diabetic foot, Trio-pathy, Screening, High risk foot.

TO COMPARE THE NEED FOR INTRAVENOUS VASOPRESSOR (RESCUE) THERAPY FOR TREATING SPINAL ANAESTHESIA INDUCED HYPOTENSION AMONG PHENYLEPHRINE, EPHEDRINE AND CONTROL GROUPS.

The study was undertaken in the Department of Anaesthesiology, Gajra Raja Medical College, Gwalior. The study included 90 patients (age 20-35 years) undergoing elective caesarean section under spinal anaesthesia.
 Maximum hypotension was observed in control group. As compared to the control group, incidence of hypotension was significantly less in phenylephrine group as well as ephedrine group. Also comparing ephedrine and phenylephrine groups, although incidence of hypotension was low in phenylephrine group but it was not found to be significant.
 The incidence of hypotension was significantly low in phenylephrine group (p=0.000) and ephedrine group (p=0.005). But when phenylephrine and ephedrine groups were compared, although incidence of hypotension was low in phenylephrine group but it was not found to be significant (p=0.869).
 Keywords: Intravenous Vasopressor, Spinal Anaesthesia, Hypotension & Phenylephrine.

TO COMPARE THE EFFICACY OF MIDAZOLAM IN DOSE OF 0.5 MG/KG AND 0.75 MG/KG FOR SEDATION.

Study was conducted on 60 patients of both sexes taken for various surgical procedures taking from 30 to 90 minutes at Gajra Raja Medical College, Gwalior.
 We found that none of the children in the 0.75 mg/kg dose group cried compared with 4 children (20%) in the c group and one child (5%) in the 0. 5 mg/kg dose group. The percentage of children who appeared uncomfortable (study recorded that they were crying or complaining) were the highest in the control dose group (45%). Only 25% of the children in the 0.5 mg/kg dose group and 10% of the children in the 0.75 mg/kg dose group appeared uncomfortable. Thus more children were comfortable (study recorded they were sleepy or quite but awake) in the 0.75 mg/kg dose group (90%) compared with the 0. 5 mg/kg dose group (75%) and the control group (55%). This difference was statistically significant between the control group and the group that received the 0.75mg/kg dose.
 The number of children who had desirable sedation was similar in the 0.75 mg/kg dose groups. Induction of general anaesthesia was poor for 25% the children in the group that received the 0.5 mg/kg dose.
 Keywords: Efficacy, Midazolam, Sedation & Anaesthesia.

An Overview of Cervical Cytology and Its Clinical Correlation Conducted in Gajraraja Medical College, Gwalior

An Overview of Cervical Cytology and Its Clinical Correlation Conducted in Gajraraja Medical College, Gwalior