Nil Ratan Sircar Medical College Research Articles

A Cross-Sectional Study Examining the Behavioral Patterns and Attitudes of First - and Second-Year Medical College Students in West Bengal, India, Regarding Self-Medication

BACKGROUND
 Self-medication is a pervasive habit, and drug abuse is a severe problem. Since medical students are future doctors, they give it a unique significance. The study's objectives were to assess the practice, knowledge, and attitudes of first- and second-year medical students at a medical college in West Bengal, India, about self-medication.
 METHODS
 The study was conducted in Nilratan Sircar Medical College and Hospital, Kolkata, West Bengal. In 2021, medical students across the colleges of West Bengal conducted cross-sectional research using questionnaires. Upon being informed of the objectives and design of the study, first- and second-year MBBS students willingly agreed to participate.
 RESULTS
 In this study, 91.50% of medical students practiced self-medication. The common indication for self-medication was fever (89.2%) and headache (69.6%). Previous prescriptions for the same illness (68.87%) were the main source of information for self-medication. Common reasons for self-medication were urgency (53.33%) and quick relief (50%). Over-the-counter (88.14%) drugs were the most common sources of medications. The common preferred system of self-medication was allopathic (92.5%). The percentage of discontinuation (58.1%) of self-medication was more. The majority of them favoured oral (96.67%) media.
 CONCLUSIONS
 It was determined that more than half of the student population self-medicated for a wide range of ailments; the cause may be the increased public awareness of drugs brought on by the availability of information via books, the internet, and over-the-counter medications from pharmacists. Therefore, it is crucial to stop students from self-medicating to prevent the emergence of drug habits, resistance, and drug interactions.

Multi-criteria decision making to validate performance of RBC-based formulae to screen beta-thalassemia trait in heterogeneous haemoglobinopathies

BackgroundIndia has the most significant number of children with thalassemia major worldwide, and about 10,000-15,000 children with the disease are born yearly. Scaling up e-health initiatives in rural areas using a cost-effective digital tool to provide healthcare access for all sections of people remains a challenge for government or semi-governmental institutions and agencies.MethodsWe compared the performance of a recently developed formula SCS_{BTT} and its web application SUSOKA with 42 discrimination formulae presently available in the literature. 6,388 samples were collected from the Postgraduate Institute of Medical Education and Research, Chandigarh, in North-Western India. Performances of the formulae were evaluated by eight different measures: sensitivity, specificity, Youden’s Index, AUC-ROC, accuracy, positive predictive value, negative predictive value, and false omission rate. Three multi-criteria decision-making (MCDM) methods, TOPSIS, COPRAS, and SECA, were implemented to rank formulae by ensuring a trade-off among the eight measures.ResultsMCDM methods revealed that the Shine & Lal and SCS_{BTT} were the best-performing formulae. Further, a modification of the SCS_{BTT} formula was proposed, and validation was conducted with a data set containing 939 samples collected from Nil Ratan Sircar (NRS) Medical College and Hospital, Kolkata, in Eastern India. Our two-step approach emphasized the necessity of a molecular diagnosis for a lower number of the population. SCS_{BTT} along with the condition MCVle 80 fl was recommended for a higher heterogeneous population set. It was found that SCS_{BTT} can classify all BTT samples with 100% sensitivity when MCVle 80 fl.ConclusionsWe addressed the issue of how to integrate the higher-ranked formulae in mass screening to ensure higher performance through the MCDM approach. In real-life practice, it is sufficient for a screening algorithm to flag a particular sample as requiring or not requiring further specific confirmatory testing. Implementing discriminate functions in routine screening programs allows early identification; consequently, the cost will decrease, and the turnaround time in everyday workflows will also increase. Our proposed two-step procedure expedites such a process. It is concluded that for mass screening of BTT in a heterogeneous set of data, SCS_{BTT} and its web application SUSOKA can provide 100% sensitivity when MCVle 80 fl.

Efficacy of Erector Spinae Plane Block in Modified Radical Mastectomy for Postoperative Analgesia: A Randomised Controlled Study

Introduction: The Erector Spinae Plane Block (ESPB) is a recently introduced Ultrasound (US)-guided interfascial plane block commonly used for treating thoracic neuropathic pain. Although ESPB has been used for pain control after Modified Radical Mastectomy (MRM), which is a frequently performed operation nowadays, its efficacy compared to other methods of pain control is yet to be established. Aim: To evaluate the effectiveness of ESPB in controlling acute postoperative pain after MRM surgery. Materials and Methods: A total of 64 adult females aged between 18-60 years, with American Society of Anaesthesiologists (ASA) physical status I and II, scheduled to undergo elective MRM, were enrolled in the present randomised, double-blinded, controlled study conducted at Department of Anaesthesiology and Critical Care, Nil Ratan Sircar Medical College, Kolkata, West Bengal, India over a period of nine months (from March 2021 to November 2021). They were randomly assigned to two groups, with 32 patients in each group. Group A (n=32) received general anaesthesia only, while Group B (n=32) received US-guided ESPB in addition to general anaesthesia. Postoperative Visual Analogue Scale (VAS) scores, total intra and postoperative analgesic requirements for the first 24 hours, and duration of postoperative analgesia were recorded for each patient. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 24.0 software. Mean and Standard Deviation (SD) were used to express data for numerical variables, while count and percentages were used for categorical variables. Results: Demographic characteristics (age, weight), ASA status, and mean duration of surgery were similar between the groups. The duration of postoperative analgesia was significantly (p<0.05) prolonged in Group B patients (584.1±89.1 minutes) compared to Group A patients (78.0±53.1 minutes). Intra and postoperative analgesic requirements were significantly lower in Group B (fentanyl 87.0±16.8 mcg, tramadol 68.3±35.9 mg) compared to Group A patients (fentanyl 94.5±26.7 mcg, tramadol 158.3±32.3 mg). The postoperative VAS score was more favourable in Group B than in Group A (1.1±0.4 vs. 4.1±0.8 at rest). Conclusion: The US-guided ESPB is a simple and easy procedure that provides prolonged duration of postoperative analgesia with reduced overall analgesic requirement in the postoperative period after MRM surgery. Therefore, it can be concluded that ESPB is an effective method for controlling acute postoperative pain after MRM surgery.

Clinicopathological and Immunohistochemical Association of CD55 and CD59 in Colorectal Carcinoma: A Cross-sectional Study

Introduction: Colorectal Carcinoma (CRC) is one of the significant causes of fatality worldwide. High-grade and highstage cancers contribute to this fatality. In most terminal cases, new immunomarkers (CD55 and CD59) are commonly detected as positive. The expression of these immunomarkers and their clinical relevance in CRC has not yet been firmly established. While their upregulation has been demonstrated in some CRC several groups have also reported that they are not highly expressed in CRC tissues. Aim: To study the expression of CD55 and CD59 in CRC. Materials and Methods: This was a cross-sectional study involving 90 patients with colorectal growth, conducted from February 2020 to July 2021 in the Department of Pathology in collaboration with the Department of General Surgery at Nil Ratan Sircar Medical College, Kolkata, West Bengal, India. Histopathological findings were evaluated, and associations of grading, staging, tumour type, tumour location, age, and sex were studied with immunomarkers (CD55 and CD59). Clinical parameters of the patients with CRC diagnosed by colonoscopic biopsy were also studied, including age, sex, clinical pictures, food habits, family history of CRC, and prior chemotherapy. The Chi-square test was used to determine the significance of the study. Data were analysed using the Statistical Package for the Social Sciences (SPSS) version 27.0 (IBM, Illinois, US). A p-value of ≤0.05 was considered statistically significant. Results: A total of 90 CRC patients were included in this study, with the majority being male 56 (62.2%) aged 51-60 years. Most cases 59 (65.6%) were moderately differentiated adenocarcinoma, followed by poorly differentiated adenocarcinoma 18 (20%) and well-differentiated adenocarcinoma 13 (14.4%). About 62 (68.9%) and 28 (31.1%) patients showed strong and weak CD55 expression, respectively. In total, 65 (72.2%) and 25 (27.8%) patients exhibited strong and weak CD59 expression, respectively. The association of CRC grade and stage with CD55 and CD59 was significant (p-value=0.0001, p-value=0.0013, p-value=0.0001, and p-value=0.0001, respectively). Conclusion: There are several variables to consider during the histopathological reporting of CRC, with tumour differentiation, grade, and stage being among the most important. Particularly, high-grade (poorly differentiated) and high-stage adenocarcinomas demonstrate enhanced expression of CD55 and CD59, indicating a poor prognosis. It is essential for pathologists to meticulously perform grossing and reporting of CRC and dispatch the histopathology report after proper clinicopathological correlations. These immunomarkers can also be included in a routine IHC panel for prognostic and therapeutic purposes.

Psychological Impact of COVID-19 and Its Influence on Parental Willingness to Vaccinate Children: A Cross-Sectional Study at a Tertiary Care Hospital in Kolkata.

Background COVID-19 has affected the physical and mental health of people globally, and vaccination is seen as a crucial tool in controlling the pandemic. However, the readiness to vaccinate children remains a concern, particularly in India. Aim The study aimed to investigate the association between the psychological impact of COVID-19 and willingness to vaccinate their children among attendees of the COVID-19 vaccination clinic at Nil Ratan Sircar Medical College, Kolkata. Method The study used an observational, cross-sectional design and collected data from 356 participants between August and September 2022. The COVID-19 Perceived Stress Scale-10 was used to assess participants' psychological impact, and willingness to vaccinate was determined using a survey. Results Approximately 64% (n=227) and 71% (n=253) of the participants exhibited a high level of perceived stress and willingness to vaccinate their children. The vaccine acceptance was significantly associated with perceived stress level and other factors such as family type, presence of chronic illness, and history of acquaintances suffering from COVID-19. Conclusion The study highlights the importance of addressing parental stress and anxiety to enhance vaccination rates among children. To achieve this, population-level awareness of vaccine safety measures and benefits should be raised to alleviate stress and increase vaccine uptake.

A DESCRIPTIVE COMPARISON OF RESPONSE OF ORAL HYPOGLYCEMIC AGENTS AMONG T2DM IN A BACKDROP OF INSULIN RESISTANCE

Introduction:Different homeostatic models for the assessment of beta cell function in patients with insulin resistance in type 2 diabetes mellitus suggest that Dipeptidyl Peptidase (DPP-4) inhibitors cause less beta cell stress. Aims: The present study aimed to compare and contrast insulin resistance in two groups of patients taking oral hypoglycemic agents, DPP-4 plus metformin and glimepiride plus metformin, on the basis of fasting and postprandial c-peptide and insulin resistance estimated by homeostatic model assessment of insulin resistance (HOMA-IR). Methods: This preliminary descriptive observational study was conducted from 2018 to 2019 in the service Laboratory of the Department of Biochemistry, in collaboration with the Endocrinology Department, Nil Ratan Sircar Medical College and Hospital, Kolkata. Serum C-peptide, serum insulin, and plasma glucose levels were measured in both fasting and post-prandial states along with glycated hemoglobin. Result: In the fasting and fed state, the secretagogue effect of glimepiride-metformin combination was significantly higher (p = 0.017) than that of the linagliptin-metformin combination. Conclusion: Patients treated with glimepiride showed high post prandial insulin levels and high post prandial glucose excursion. This finding can be explained by the probable increase in insulin resistance, which is reflected in their post-prandial C peptide level. However, in the case of linagliptin, one mechanism of decreased post-prandial glucose is believed to be the inhibition of α-cell glucagon release, thereby relieving β-cell stress

Surgical site infection: Clinico- bacteriological Profile and antibiogram in a tertiary care hospital in Kolkata

Surgical site infections (SSIs) are a major health care associated infections and possess a great challenge to clinicians. It increases duration of hospital stay, associated morbidity and mortality and treatment cost. For prompt and appropriate management, it is necessary to understand the appropriate microbial etiology and its antimicrobial susceptibility pattern. To determine the prevalence of SSI along with its clinico-bacteriological profile and antibiogram and to correlate with the risk factors.A cross-sectional study was conducted in the Department of Microbiology of Nil Ratan Sircar Medical College & Hospital, Kolkata for a period of one year (2020-2021). Post-operative surgical site infections within 30 days after surgery were included in the study. All samples were collected from clinically suspected SSI cases and processed in the lab as per standard laboratory protocol. Vitek®2 compact system (BIOMERIEUX) was used for further identification and antimicrobial susceptibility testing. All Gram negative pathogens resistant to 3rd generation cephalosporins were screened for ESBL and AmpC. Carbapenem resistant isolates were subjected to Carba NP test for carbapenemase production. Out of 6582 surgeries, clinically suspected SSIs were detected in 220 cases. Among these 220 patients, 186 patients were confirmed as SSI in the laboratory, SSI rate being 2.83%. In 62.27% cases, growth was mono-microbial. Growth of gram negative organisms were noted in 58.72% cases and gram positive growth was 38.53%. (57.14%) was the predominant isolates followed by (35.94%). Diabetes mellitus, obesity and using prophylactic antibiotic >2 hours prior to surgery were found to be significantly associated. For gram positive organism, Vancomycin and Linezolid were found to be most susceptible antimicrobials and for gram negative organisms, it was Polymyxin B and Meropenem. Most of the gram negative organisms were ESBL producer (67.97%). Rapidly emerging multi drug resistant organisms are complicating the management of surgical site infection day by day and possessing significant burden to health care system. For implementation of appropriate antimicrobial policy, it is important to identify bacteriological profile and antibiogram in every hospital.

Severe impact on family planning programme due to COVID-19 pandemic in urban population

Background: Contraception and sexual health are a fundamental human right and an integral part of women’s health services. Postpartum period is the unique opportunity for counseling and availing contraception. COVID-19 pandemic hindered routine and special services like postpartum clinics has negative impact on family planning services. Aims and Objectives: The objective of study was to compare the change in contraceptive services due to COVID-19 in two consecutive financial years (2019–2020 and 2020–2021) at Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India. Materials and Methods: An institution-based, retrospective, and cohort study was carried out in Nil Ratan Sircar Medical College and Hospital among the users of contraceptive services at the department of family planning for the financial year 2019–2020 and 2020–2021. During the period, 226,700 beneficiaries attended department of family planning for the financial year 2019–2020 and 98,584 beneficiaries attended department of family planning for the financial year 2020–2021. Template was generated in MS excel sheet and analysis was done on SPSS software. Results: During the year 2019–2020, 94.73% availed combined oral contraceptives while in the year 2020–2021, 93.97% availed combined oral contraceptives. Lap ligation was decreased by 96.42%, post-abortion ligation was decreased by 85%, Interval IUCD was decreased by 79.62% and PAIUCD was decreased by 76%. During the year 2019–2020, OCP was used by the maximum beneficiaries, that is, 219,654 while in the year 2020–2021 OCP was used by 97,353 beneficiaries. Conclusion: During COVID-19 pandemic, family planning services suffer a huge setback as it is does not came under emergency services. With the ongoing COVID-19 crisis and continuous need for contraception, there is a need to refocus and motivate eligible couples for long-acting reversible contraceptive methods with significantly lower failure rates.

A PROSPECTIVE OBSERVATIONAL STUDY OF RESPONSE TO NEOADJUVANT CHEMOTHERAPY IN LOCALLY ADVANCED BREAST CANCER IN TERTIARY CENTRE

Introduction: Carcinoma of the breast from the very beginning has been a feared disease.' Till today, there is an aura of fear that surrounds the mention of this name 'breast cancer'. Neoadjuvant chemotherapy (NAC) is increasingly used to treat patients with locally advanced breast cancer (LABC). Such regimens can increase rates of breast-conserving therapy (BCT) compared with post-operative chemotherapy 2 and may minimize the need for aggressive nodal surgery with axillary lymph node dissection. To assess Aims: the change of clinical staging after Neoadjuvant Chemotherapy, Assessment of Lymph node status after neoadjuvant Chemotherapy and type of surgery suitable after neoadjuvant Chemotherapy. The present study was a hospital Materials and method: based observational study. The study conducted in Nil Ratan Sircar Medical College & Hospital. The study duration was One year (June 2021 to May 2022). 50 patients were included in this study. In our study, all patients [50 (100.0%)] had Lymph node involvement. We Result: showed that, most of the patients had Stage IIIA [25 (50.0%)]. However, Stage IIIB [15 (32.0%)] followed by Stage IIIC [10 (20.0%)] which was statistically signicant (p=.00168).It was found that, all patients [50 (100.0%)] had Anterior Chemotherapy. Our study showed that, most of the patients had Stage IIB after chemotherapy [22 (44.0%)] and it was statistically not signicant (p< .14706) (z=1.4499). In our study, higher number of patients had Down stage Result [35 (70.0%)] followed by Same Result [15 (30.0%)] but this was statistically signicant (p=.00006) (z=4). We showed that, the mean Tumor size of patients was [7.2880± 1.4822 (cm)] and mean % of size reduction of patients was [58.0000± 15.0509]. we Conclusion: conclude that, the change of clinical staging after Neoadjuvant Chemotherapy, Lymph node status after neoadjuvant Chemotherapy

Mask Associated Dry Eye Section (MADE) in Healthcare Workers: A Cross-sectional Study

Introduction: The Coronavirus disease-19 (COVID-19) pandemic mediated by Severe Acute Respiratory Syndrome-CoV2 (SARSCoV2), made the use of face masks mandatory to check the spread of the disease. With the increased use of face masks, more people started presenting to the ophthalmologist with symptoms of dry eye. The proposed mechanism of dry eye was attributed to air blowing upwards from behind the mask into the eyes, especially in loose fitting masks. This air leads to rapid evaporation of tears and disturbance of homeostasis of the tear film. Aim: To measure self reported symptoms of dry eye and to establish mask use as a risk factor for the development of Dry Eye Disease (DED) in healthcare workers in a Tertiary Care Hospital. Materials and Methods: This cross-sectional, observational study was conducted at Nilratan Sircar (NRS) Medical College and Hospital for a duration of three months from December 2021 to February 2022. The study was conducted on 146 participants. An online survey was conducted using Google Forms, sent via email to hospital employees working in different departments of the hospital. All healthcare workers employed at NRS Medical College and Hospital who wore a face mask during duty hours and were willing to participate in the study were included. The Ocular Surface Disease Index (OSDI) questionnaire was used and modified by adding “while wearing a facemask” to the end of each question. To establish face mask use as a causative agent for development of DED, a few other questions related to face mask usage were included in the survey. The data was tabulated in Microsoft Excel and analysed with Statistical Package for Social Sciences (SPSS) version 24. Results: The mean age of the study population was 27.4±8.28 years. The mean hours of wearing a mask was 6.38 ±3.04 hours. N95 face mask was the most common type of mask used. The study population included 100 doctors, 14 nursing staff, 18 optometrists, eight group D staff (sweepers and ward attendants), and six dieticians. The mean OSDI score was 14.24. Increased usage of face masks, in particular surgical, more hours of reading significantly correlated with higher incidence of DED. Conclusion: This study showed that increased hours of face mask use in particular surgical was associated with development of DED. To encourage more people to wear face masks, all possible problems arising from face mask use should be promptly identified and dealt with.

Stromal CD10 Expression in Breast Carcinoma and its Association with ER, PR, and HER2/neu Using Immunohistochemistry: A Cross-sectional Study

Introduction: Breast cancer is a common and deadly malignancy affecting women worldwide. Various immune markers, such as Estrogen Receptor (ER), Progesterone Receptor (PR), and Human Epidermal growth factor Receptor 2 (HER2/neu), are commonly used to assess prognosis. Currently, ongoing research aims to evaluate molecular pathways that contribute to invasion and metastasis. One important immunomarker under investigation is CD10, a zinc-dependent Matrix Metalloproteinase (MMP) that degrades bioactive peptides. CD10 expression in the tumour stroma has been associated with the biological aggressiveness of several epithelial malignancies, including breast carcinoma. Aim: To analyse the association between stromal CD10 expression and different prognostic factors, such as age, histological grade, and status of ER, PR, and HER2/neu markers, in patients with breast cancer. Materials and Methods: This institutional-based, crosssectional study was conducted at the Department of Pathology, Nil Ratan Sircar Medical College and Hospital (NRSMC) in Kolkata, West Bengal, India over a period of one and a half years (February 2021 to July 2022). It included 120 cases of breast carcinoma diagnosed through histopathological examination of formalin fixed paraffin embedded sections, which were prepared from trucut biopsies and resection specimens referred from the Department of General Surgery, NRSMC. CD10 expression was assessed by Immunohistochemistry (IHC) in all cases and scored as negative, weak, or strong. The study examined the association between CD10 expression and the following parameters: age, histopathological grade, and the status of ER, PR, and HER2/neu markers. Data were entered into Microsoft Excel (MS) for statistical analysis. The significance of the study was determined using the Chi-square test, and data were analysed using Statistical Package for the Social Sciences (SPSS) version 23.0 (IBM, Illinois, US). A p-value of <0.05 was considered statistically significant. Results: The study included a total of 120 cases, with 119 cases of female breast cancer (99.16%) and one case of male breast cancer (0.84%). The mean±SD age of the patients was 54±5.038 years (range 44 to 67 years). The majority of cases 102 (85.00%) were diagnosed as Invasive Ductal Carcinoma (IDC), Not Otherwise Specified (NOS), followed by IDC-special types 18 (15.00%). CD10 expression was evaluated in all cases, and stromal CD10 positivity was observed in 79 out of 120 cases (65.80%), with 39 individuals (49.40%) showing weak positivity and 40 cases (50.60%) showing strong positivity. The remaining 41 cases (34.16%) were CD10 negative. Grade 3 cancers were predominant in this study 62 (51.66%). It was noted that CD10 stromal positivity increased with higher grade. Most of the cancers in this study were negative for ER, PR, and HER2/ Neu (78, 65.00%; 84, 70.00%; and 67, 55.83%, respectively). Stromal CD10 expression showed a significant association with ER (p-value=0.00001), HER2/neu (p-value=0.000089), tumour grade (p-value=0.0012), and an insignificant association with age (p-value0.264) and PR (p-value=0.256). Conclusion: Therefore, CD10 expression is strongly associated with well-established prognostic markers, namely higher tumour grade, HER2/neu negativity, and ER negativity. This indicates that CD10 can not only be used as an independent marker of poor prognosis but also as a target for the development of novel therapies.

Immunoexpression of p53 and p16 in Low and High-grade Serous Ovarian Cancer: A Cross-sectional Study

Introduction: The most common malignancy of the ovary is serous carcinoma, which can be classified as either Low-grade Serous Ovarian Carcinoma (LGSOC) or High-grade Serous Ovarian Carcinoma (HGSOC) and originates from the surface epithelium. However, the overall prognosis for both cancers is very poor. Immunohistochemical analysis of p53 and p16 expression is commonly used to detect mutations. Diffuse and strong mutations (mutant type) are almost always observed in cases of HGSOC, while focal expression (wild type) suggests the absence of mutations in HGSOC. LGSOCs are characterised by a low number or absence of genetic mutations. Aim: To investigate the association between p53 and p16 expression in different grades and stages of Serous Ovarian Carcinoma (SOC). Materials and Methods: This observational cross-sectional descriptive study was conducted on 62 patients diagnosed with ovarian serous carcinoma. The study focused on examining the expressions of p53 and p16 using Immunohistochemistry (IHC) in the Department of Pathology, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India, over a period of one and a half years (February 2021 to July 2022). The study parameters included clinical features, histological findings, staging, The Federation of Gynaecology and Obstetrics (FIGO), grading, p53 and p16 expression by IHC in all cases, and the association between p53 and p16 expression with the grade and stage of the cancer. Statistical analysis was performed using Analysis of Variance (ANOVA) and Statistical Package for Social Sciences (SPSS) software. A p-value of less than 0.05 was considered significant. Results: A total of 62 cases were included in the study, with 55 cases (88.70%) classified as LGSOC and 7 cases (11.29%) as HGSOC. The mean age for LGSOC was 53.5 years, while for HGSOC it was 54 years. Among the HGSOC cases (n=55), 45 cases (81.80%) showed diffuse positive results (mutant type) for p53. In contrast, there was no diffuse p53 expression in LGSOC cases (n=7), with 5 cases (71.40%) showing focal positivity (wild type). The p-value for comparing p53 expression in both cases was significant (<0.00001). As for p16 expression, among the HGSOC cases (n=55), 31 cases (56.40%) showed diffuse positivity (mutant type), while among the LGSOC cases (n=7), most of the cases, 5 cases (71.40%), showed focal positivity (wild type). The p-value for comparing p16 expression in both cases was significant (<0.003794). Conclusion: In conclusion, p53 along with p16 are good markers for grading SOC, and p53 is highly effective in differentiating HGSOC from LGSOC based on the positivity pattern (diffuse and strong positive for high-grade/mutant type, and focal positive for low-grade cancers). Thus, p53 has become an attractive target for the development of moleculetargeted therapies for this disease.

Transversus Abdominis Plane Block with or without Intravenous Diclofenac Sodium as a Component of Multimodal Postoperative Analgesia Following Laparoscopic Cholecystectomy: A Randomised Clinical Study

Introduction: Multimodal analgesia is the recommended approach for treating post-operative pain after laparoscopic cholecystectomy. The Transversus Abdominis Plane (TAP) block is a recently introduced technique showing promising results. To control visceral and somatic pain adequately and to avoid use of opioids intra-operative diclofenac sodium, combined with TAP block as part of a multimodal approach, may be beneficial. Aim: To evaluate the efficacy of TAP block with or without intraoperative diclofenac sodium aqueous injection for controlling post-operative pain following laparoscopic cholecystectomy. Materials and Methods: A randomised, double-blinded study was conducted from February 2022 to October 2022 at Nil Ratan Sircar Medical College, Kolkata, West Bengal, India. Forty American Society of Anaesthesiology (ASA) physical status-I and II patients aged 20-50 years scheduled for elective laparoscopic cholecystectomy were divided into two groups of 20 patients each. Group A patients received bilateral Ultrasonography (USG) guided TAP block using 20 mL of 0.125% Bupivacaine on each side of the abdomen at the end of surgery. Group B patients received intravenous injection of diclofenac sodium aqueous 75 mg intravenous, intraoperatively, along with bilateral USG guided TAP block using 0.125% Bupivacaine. The primary outcome was the duration of post-operative analgesia (measured by the first request for rescue analgesia after the end of the operation at a VAS score of 4). Secondary outcomes included the total post-operative analgesic requirement (diclofenac sodium), pain score (VAS) over 24 hours in the post-operative period, and the incidence of complications such as nausea, vomiting, hypotension, and bradycardia. Patient Satisfaction Score (PSS) was recorded for each patient before discharge. Statistical analysis was performed using Statistical Package for Social Sciences(SPSS) version 24.0 software. Continuous variables were expressed as mean and standard deviation, and categorical variables were expressed as percentages. Independent t-tests and chi-square tests were used for between-group comparisons, with a p-value ≤0.05 considered statistically significant. Results: Amongst total 40 patients included, divided into group A(mean age: 32.95±8.74 years, 6 males and 14 females) and group B(31.90±9.16 years, 5 males and 15 females) with 20 patients each, the demographic characteristics such as age, gender, height, and weight were similar in both groups. The duration of post-operative analgesia was longer in Group B (16.32±1.29 hours) than in Group A (7.85±1.04 hours). The total post-operative analgesic requirement was lower in Group B (32.95±20.9 mg) compared to Group A (58.33±17.14 mg). Visual Analogue Scale (VAS) scores were lower in Group B than in Group A. PSS was significantly higher in Group B patients (8.14±1.06) than in Group A patients (6.16±1.38). Conclusion: TAP block, along with intra-operative intravenous diclofenac sodium aqueous, as part of a multimodal regimen, provides superior post-operative analgesia compared to TAP block alone. It is also associated with improved patient satisfaction.

Drugs used in patients with heart failure in a tertiary care center – A drug utilization study

Background: Heart failure (HF) patients need multiple drug therapy. There are numerous drugs used worldwide but knowledge regarding pattern of their use is limited from Eastern India. Aims and Objectives: Objective was to assess utilization pattern of drug among the adult patients with HF in Nilratan Sircar Medical College and Hospital, Kolkata, West Bengal. Materials and Methods: This was an observational and cross-sectional study conducted in Department of Pharmacology and Cardiology at NRS Medical College and Hospital. A total 100 adult patients were included for this study after fulfilling inclusion and exclusion criteria and their treatment details were recorded. Results: A total of 670 drugs were prescribed in this study (average of 6.7 drugs per prescription). Most of the patients were between 41 and 60 years of age and most of them were male (61%). Significant percentage of prescriptions were generic (86.87%) and 100% were adequately labeled and dispensed. Average consultation time for each patient was 10.5 min. Commonly used drugs included diuretics, angiotensin converting enzyme inhibitors, beta-blockers, mineral-corticoids receptor antagonists, and angiotensin receptor blockers. Conclusion: This study showed that standard treatment protocol guidelines were followed and rational use of drug was seen.

Radiological evaluation of ovarian mass by contrast-enhanced computed tomography abdomen with clinicopathological correlation in Eastern Indian population

Background: Adenexal masses present diagnostic challenges. After identification of the ovarian mass, the most critical step is to determine the degree of suspicion for malignancy. It is mainly based on imaging modalities and clinicopathological correlation. Aims and Objectives: This radiological study was designed to differentiate benign and malignant ovarian masses by contrast enhanced-computed tomography (CECT) of abdomen and correlation of the radiological findings with histopathological report. Materials and Methods: This was a hospital-based prospective study conducted in Department of Radiodiagnosis, Nilratan Sircar Medical College and Hospital, Kolkata during January 2019–June 2020. The study was done on clinically suspected 50 patients of 15–50 years with ovarian mass having CECT diagnosed solid/complex solid cystic mass. Results: Among 50 cases under study, 37(74.0%) were benign which was significantly higher than that of malignant cases (26.0%). Malignancy was significantly associated with wall irregularity, solid-cystic composition, presence of thick septations, septal enhancement, presence of both septal, and solid enhancement pattern in CECT. Conclusion: Based on the results of the present study, multi-detector contrast-enhanced CT could be a rapid non-invasive and cost-effective step in the evaluation of ovarian masses.

Impact, impression, and innovations of objective structured practical examination in biochemistry curriculum of medical undergraduates

Background: In the recent years, there is a huge paradigm shift of medical education in India from curriculum-based learning to learner-centered and time independent competency-based medical education. This paradigm shift was to rear and trains medical graduates to function as physician of first contact being globally acceptable. Due to this, the felt need of the hour was to find an assessment tool that is valid, reliable, devoid of subjective bias, and has the capabilities to assess the cognitive, psychomotor, and effective domain. Aims and Objectives: In this context, this study was done to assess the impression and impact of objective structured practical examination (OSPE) in comparison to conventional practical examination (CPE). Due to the ongoing pandemic of COVID-19, there was some scope of organizing OSPE in virtual mode. Materials and Methods: The study involved of 250 Phase I medical undergraduates of Nil Ratan Sircar Medical College. The response stations included charts, clinical problems, graphs, pictures, and critical analysis of reports. Results: The mean scores in OSPE were higher than CPE. In our study, 51.3% strongly voiced that conducting OSPE was more scientific with uniformity in evaluation. Conclusion: OSPE was preferred by the students as an assessment tool. Moreover, OSPE had a scope to be organized in Virtual mode.

Usefulness of post-bronchoscopic sputum cytology with respect to bronchoalveolar lavage and brush cytology using fiber-optic bronchoscopy in suspected cases of lung cancer

Background: Bronchogenic cancer is the most common cause of cancer-related mortality in both sexes all over the world, especially across urban population. However, early diagnosis and timely intervention may minimize the mortality rate to a certain extent and increase the 5-year survival rate to 70–80%. Among the diagnostic modalities available, bronchoscopic biopsy, though gold standard, is less feasible in peripheral centers where we depend more on cytological techniques such as bronchoalveolar lavage (BAL) fluid and sputum cytology for quick diagnosis. Aims and Objectives: This study was conducted at a tertiary care center for studying usefulness of post-bronchoscopic sputum cytology and also to correlate sputum cytology with brushing and washing cytology taking biopsy as the gold standard in the diagnosis of lung cancer. Materials and Methods: A cross-sectional observational study was done in Nil Ratan Sircar Medical College, Kolkata, over a period of 18 months in clinically and radiologically suspected patients of bronchogenic carcinoma. Bronchoscopic samples using a fiber-optic bronchoscope were collected from 50 such patients. In every case, following sequence of events was performed: Pre-biopsy washing (BAL fluid), brushing, biopsy, post-biopsy washing (BAL), and post-bronchoscopy sputum. Cytological examination done and compared with bronchoscopic biopsy specimens of the same. Results: All the available information were meticulously documented in tables and charts along with other variables such as age, sex, morphological types, and cytological and histological diagnosis. SPSS software was used to calculate the efficacy and statistical significance, if any, of these different diagnostic tools and its correlation with the final histological diagnosis. Conclusion: We found that BAL cytology had higher sensitivity and positive predictive value in early and accurate diagnosis of lung malignancy. However, post-bronchoscopy sputum cytology had no additional benefit with respect to BAL and brush cytology (in addition to bronchial biopsy) in diagnosing the same.

Relationship of severity of coronary artery disease with fasting blood sugar and glycosylated hemoglobin

Background: Diabetes mellitus (DM) is one of the major risk factors for coronary artery disease (CAD). Accordingly, in this study, attempt is to be made to assess the association of severity of CAD by angiography with fasting blood sugar (FBS) and hemoglobin A1c (HbA1c). Aims and Objectives: To evaluate coronary angiographic abnormalities in patients of Diabetes. Materials and Methods: Six hundred adult patients of both sexes admitted in the department of cardiology, Nil Ratan Sircar Medical College and Hospital, Kolkata with ischemic heart disease from June 2018 to February 2020 underwent FBS and glycosylated Hb besides other routine tests. Coronary angiography done and the severity of CAD was assessed by SYNTAX SCORE was correlated. It is an observational, Cross-sectional hospital-based single center study. Results: Syntax scores were highest in the body mass index ≥30 kg/m2 group (16.5). Patients with Syntax score ≥33 are found to have much higher values of HbA1c (6.8±1.3) compared to those with Syntax score of ≤22 (6.4±1.8). Fasting blood glucose level in Syntax score ≥33 group has been found to be significantly higher compared to the group of Syntax score ≤22. Conclusion: Patients having DM and/or metabolic syndrome are found to have more severe form of CAD than those who don’t have either of these.

Motivational Factors and Post Vaccination Symptoms among COVID-19 Vaccinated Beneficiaries at a Tertiary Care Hospital, West Bengal, India: A Cross-sectional Study

Introduction: Since the emergence of Coronavirus Disease 2019 (COVID-19) pandemic, there has been an intense burden on the health system and economy worldwide with millions of people being affected leading to several deaths. In this scenario vaccination seems to be a hope to control the pandemic. However, fear of adverse events following immunisation sometimes makes people hesitant about vaccination. Aim: To assess the spectrum of post vaccination symptoms and also to identify the motivational factors along with their determinants at a tertiary care hospital, West Bengal, India. Materials and Methods: A cross-sectional study was conducted in the COVID-19 Vaccination Centre at Nil Ratan Sircar Medical College and Hospital, Kolkata West Bengal, India (tertiary care hospital), from August 2021 to November 2021. A total of 448 vaccinated beneficiaries were enrolled in the study. Data collection was done by an online questionnaire, sent to the participants in their registered mobile numbers. Descriptive statistics and Chisquare tests were used for data analysis. Results: Among 448 study participants, 262 (58.5%) were in 18- 44 years of age group, 248(55.4%) female, 384 (85.7%) Hindu, 132 (29.5%) medical or paramedical students, 290 (64.7%) passed graduation and above and 306 (68.3%) belonged to nuclear family. About 228 (50.9%) beneficiaries reported post vaccination symptoms. Most common being local pain at injection site, found among 150 (65.8%) out of them. Most common motivational factors of COVID-19 vaccination were found to be fear of COVID-19 infection, reported by 274 (61.2%) participants, which showed significant difference with various age groups (p-value=0.001), religions (p-value=0.030), occupations (p-value<0.001) and educations (p-value=0.002). Statistical significant (p<0.05) differences were also found according to age, gender, co-morbidities, interval between vaccination and past COVID-19 infection and type of COVID-19 vaccine in relation to onset of post vaccination symptoms. Conclusion: Following COVID-19 immunisation minor adverse events were reported. Monitoring of those adverse events will help in further responding and prompt action. Also, the knowledge about motivational factors is expected to reduce vaccine hesitancy among unvaccinated people.

Neutrophil-lymphocyte Ratio as Independent Prognostic Factor among Breast Cancer Patients in a Tertiary Care Hospital, Kolkata, India

Introduction: The most important prognostic factor for breast cancer is tumour stage and tumour grade. However, the assessment of the above parameters are time-consuming and require expertise. Thus evaluation of the prognosis of breast cancer is still limited to tertiary care hospitals, with appropriate facilities for histopathological techniques. Recently, inflammatory blood markers have shown a role as a prognostic factor. Out of all the inflammatory blood markers, neutrophil-lymphocyte ratio has emerged as the most useful. Abundant evidence suggests the role of NLR as an adverse prognostic factor in breast cancer. NLR is simple and inexpensive. It can be easily obtained, as the differential count of every patient is done routinely. Thus it can act as an indicator of high-risk patients who are likely to show poor prognosis. Though NLR has been found to play a role in prognosis prediction in breast cancer, much is unknown in this field. Aim: To assess the effectiveness of Neutrophil-Lymphocyte Ratio (NLR) as an independent prognostic parameter among breast cancer patients in a tertiary care hospital in Kolkata, India. Materials and Methods: This observational cross-sectional study was conducted in Department of Pathology, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India, where 140 female patients undergoing mastectomy for breast cancer were studied from 1st February 2019 to 31st January 2020. The clinicopathological parameters, histopathological parameters, and molecular subtypes were evaluated. NLR was calculated and related with the other prognostic parameters. Data entry was done in Microsoft Excel and analysis was done using Statistical Package for Social Sciences (SPSS) software version 20.0. One way Analysis of Variance (ANOVA) test and Chi-square test was conducted to assess the relationship of NLR with various other prognostic factors. Results: Out of 140 patients, 78 patients showed NLR values within 1.8 to 3.33. Higher NLR (>3.33) was associated with poor prognostic factors like higher T stage (T4) {17 (53.1%)}, higher stage (stage III) 95 (67.8%), skin involvement 19 (47.5%), Lymphovascular involvement in 23 (39.7%), perineural involvement in 10 (71.4%) and in patients with HER2 positive molecular subtype in 8 (5.7%). Conclusion: This study suggests that a high NLR value was associated with poor prognosis in breast cancer patients. Thus, it can be used as an independent marker of poor prognosis and can help guide the treatment of breast cancer patients. The more we study the role of NLR, the more useful it will be in predicting the course of breast cancer as early as possible.