Regional Institute Of Medical Sciences Research Articles

The Association between Dietary Intake and Lifestyle Patterns of People with Type 2 Diabetes Mellitus in Manipur, India

The aim of the study was to examine the association between dietary intake and lifestyle pattern of diabetes patients in Manipur. Tribal and non tribal respondents between 45-64 years of age were randomly selected from the Regional Institute of Medical Sciences (RIMS) Hospital Manipur. Total number of 200 study subjects, 100 tribal and 100 non tribal subjects constituted the study. The information was collected on socio-demographic profile, clinical, anthropometric measurements and dietary intakes of the patients by using interview schedule and 24-hour dietary recall methods. The data were analyzed and tabulated using statistical tools such as frequency, percentage, mean, standard deviation and Pearson’s correlation test. The key results indicate that alcohol consumption, elevated triglycerides levels, low energy, oils and sugar intake were notably linked with the prevalence of diabetes. Additionally, low calcium intake, particularly among non tribal individuals, demonstrated a significant correlation with elevated Fasting Blood Glucose (FBG) levels, suggesting a potential risk factor for Type 2 diabetes. Moreover, low calcium intake among the non-tribal community was associated with increased Post Prandial (PP) test results, indicating a rise in post-meal glucose levels. Notably, tribal energy intake and non-tribal protein consumption were significantly associated with HbA1c levels, reflecting their impact on glycemic control.

Effect of tonsillectomy on ASO titre.

Background: Tonsillitis is one of the common clinical problems in Otolaryngology practice. Tonsillectomy is the preferable treatment for patients not responding to medical treatment. Many patients have increased Antistreptolysin O (ASO) titres which is caused by Group A Beta Haemolytic Streptococci (GABHS). Objectives: To determine the effect of tonsillectomy on ASO titre. Materials and Methods: A prospective study conducted in the Department of Otorhinolaryngology, Regional Institute of Medical Sciences, Imphal, Manipur, India for a period of 2 years from October 2014 to September 2016. 50 patients diagnosed as recurrent tonsillitis with raised ASO titre above 200 IU/ml and undergoing tonsillectomy were enrolled for the study. Results: Most of the patients were in the age group of 11-15 years with male to female ratio of 1: 1.63. One month after tonsillectomy 11 (22%) patients were negative for ASO titre. After 3 months, 6 months and 1 year follow up, patients whose ASO titre became negative were 34 (68%), 44 (88%) and 45 (90%) respectively. 72% patients had no episodes of sore throat after tonsillectomy. Conclusion: Tonsillectomy has a significant role in preventing or reducing recurrent streptococcal throat infections.

Evaluation of Articular Manifestations in Hepatitis C Virus Infected Patients and its Association with Liver Fibrosis: A Cross-sectional Study from Rural Indian State of Manipur

Introduction: Hepatitis C Virus (HCV) is the main culprit for liver diseases worldwide. In Manipur its incidence is increasing, mainly due to blood borne transmission through intravenous drugs users. Among the extrahepatic manifestations of HCV infection-arthropathy (joint pain, swelling and stiffness) is most common. Exact mechanism of arthropathy are not well elucidated but are probably connected with the participation of the immune system and due to the replicating virus in the affected tissues, organ systems. Aim: To determine the articular manifestations in HCV infected patients and to study the association between articular manifestations and liver fibrosis. Materials and Methods: This cross-sectional study enrolled 100 hepatitis C infected patients above 18 years of age who attended Medicine OPD, gastroenterology and liver clinic or admitted in the General Medicine wards, Regional institute of Medical Sciences (RIMS), Imphal, Manipur, India. Blood samples were collected for Complete Blood Count, Erythrocyte Sedimentation Rate, C Reactive Protein, Liver function test, Renal function test, HCV, Rheumatoid Factor (RF), Antinuclear Antibody (ANA), anti-ds DNA. Ultrasound (USG) whole abdomen and X-rays of involved joints were done when indicated. Markers for liver stiffness/fibrosis, {Aspartate Aminotransferases (AST) to Platelet Ratio Index (APRI)} score, The fibrosis-4 (FIB-4) score and AST/Alanine Transaminase (ALT) ratio were calculated and compared. The Statistical Package for Social Sciences(SPSS) (IBM) version 21.0 was used for statistical analysis. Chi-square and Fischer’s-exact test were used. Results: A total of 100 hepatitis C infected patients were enrolled in the present study. Majority of the study subjects were males (63%) under 40 years of age (69%). Eighty-four (84%) patients were intravenous drug users. Joint pain, swelling and stiffness was present in 37 (37%), 31 (31%) and 24 (24%), respectively. Around 36 (36%), 45 (45%) and 29 (29%) of the participants had significant fibrosis with respect to FIB 4 score, APRI and USG finding, respectively. Conclusion: The prevalence of joint pain was 37% in this study. Females and younger age group were more associated with articular manifestation. The present study concluded that patient with articular manifestation were seen to have significant fibrosis with respect to FIB 4 score, APRI and USG finding, AST/ALT.

Serum Leptin-adiponectin Ratio in Patients With and Without Metabolic Syndrome: A Cross-sectional Study

Introduction: Metabolic Syndrome (MetS) is one of the most significant global public health concerns. Leptin, adiponectin, and the Leptin-adiponectin (LA) ratio have been shown to be informative biomarkers for obesity, Type 2 Diabetes Mellitus (T2DM), and Cardiovascular Diseases (CVD). Many contributing factors, such as Insulin Resistance (IR), adipose tissue dysfunction, chronic inflammation, and genetic factors, are proposed to be the aetiological factors of MetS. Leptin and adiponectin have opposite effects on IR, so the combined use of these adipokines may serve as a better biomarker in MetS. Aim: To determine serum leptin levels, adiponectin levels, and the LA ratio in patients with and without MetS. Materials and Methods: This cross-sectional study was conducted in the Department of Biochemistry and Medicine at the Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, India, from January 2021 to October 2022. The study included 50 diagnosed cases of MetS and 50 individuals without MetS. Leptin, adiponectin, and parameters of MetS {Body Mass Index (BMI), weight, Waist Circumference (WC), skinfold thickness, High-density Lipoprotein (HDL), Triglycerides (TG), and Blood Pressure (BP)} were assessed in the study. The data were statistically analysed using Independent Sample t-test and Pearson’s correlation test. Results: There were 23 males and 27 females in the study group. The mean age was found to be 61.10±12.52 years in cases and 57.08±10.67 years in controls. Leptin levels were significantly higher in cases (26.58±14.6 ng/mL) compared to controls (12.99±8.59 ng/mL). However, adiponectin levels were significantly decreased in cases (7.16±4.19 μg/mL) compared to controls (12.18±9.4 μg/mL). The LA ratio was found to be higher in cases (5.38±4.71 ng/μg) than in the controls (1.84±1.99 ng/ μg). Multiple linear regression analysis demonstrated that the LA ratio was strongly associated with MetS among Leptin, Adiponectin, and the LA ratio (p<0.05). Conclusion: Metabolic syndrome was strongly associated with an increased LA ratio, leptin, and decreased adiponectin levels. The LA ratio can better discriminate the risk of MetS than leptin and adiponectin alone and may be used as a sensitive clinical surrogate biomarker of MetS.

Effect of Carbon Dioxide Pneumo-peritoneum in Coagulation Profile of Patients undergoing Laparoscopic Cholecystectomy: A Prospective Cohort Study

Introduction: Laparoscopic Cholecystectomy (LC) is done under general anaesthesia with the patient in a reverse Trendelenburg position and with pressurised carbon dioxide in the peritoneum. This can induce venous stasis in the lower extremities and may affect the balance in the coagulation and fibrinolysis system, thereby thrombo-embolic complications. Aim: To investigate the effects of carbon dioxide pneumoperitoneum on the coagulation system of patients undergoing LC. Materials and Methods: A prospective longitudinal study was carried out from January 2021 to June 2021 among patients aged 18 to 60 years who attended the Surgery Department at Regional Institute of Medical Sciences, Imphal, Manipur, India and were diagnosed with gallstone disease and subsequently underwent LC. Independent variables like age, sex, religion, pre-operative prothrombin time, platelet count, activated Partial Thromboplastin Time (aPTT), and International Normalised Ratio (INR). Outcome variables comprised complications, postoperative prothrombin time, platelet count, aPTT, and INR. Data collected were analysed using Statistical Package for Social Sciences(SPSS) version 21.0. Paired t-tests were employed to test the association between mean values of post-operative and pre-operative PT, aPTT, INR, etc. A p-value of less than 0.05 was considered statistically significant. Results: The study enrolled 71 patients who encountered LC with carbon dioxide pneumo-peritoneum, including 18 male and 54 female patients. Maximum number of patients (28, 38.9%) fell into the 41 to 50 years age group. There was no significant difference in the mean value of prothrombin time (p=0.150) and INR (p=0.437) measured between the pre-operative and postoperative periods. Conclusion: LC is a safe procedure without clinically significant changes in the coagulation profile.

TO STUDY THE HEMATOLOGICAL PROFILE IN PATIENTS WITH ALCOHOLIC LIVER CIRRHOSIS IN A TERTIARY CARE HOSPITAL IN MANIPUR

Introduction: Alcoholic liver disease or alcohol-related liver disease (ALD) is damage to the liver caused by excessive alcohol consumption, resulting in serious and life-threatening complications such as cirrhosis, gastrointestinal bleeding, hepatic failure, hepatic encephalopathy and malignancy. Liver cirrhosis is defined as diffuse hepatic fibrosis with replacement of normal liver architecture by nodules. There are also lesser known sequalae including suppression of hematopoiesis due to its toxic effects, hypersplenism and nutritional deficiencies of folic acid and other vitamins. Anemia, leukocytosis, leucopenia and thrombocytopenia occurs in ALD. Most of these hematological parameters are underdiagnosed and understudied. Hence, Manipur being a high ALD prevalence state necessitates this study to evaluate the hematological profile in patients with alcoholic liver cirrhosis and to determine the association between various hematological parameters and different Model of End stage Liver Disease (MELD) scores. Methods: This cross-sectional study was conducted in Regional Institute of Medical Sciences (RIMS), Imphal, Manipur from January 2021 to October 2022.Alcoholic liver cirrhosis patients above 18 years attending Medicine OPD, Liver clinic and those admitted in Medicine ward were enrolled. Blood samples for complete Hemogram, liver function test, kidney function test, prothrombin time, INR, serology (HbsAg, Anti HCV Ab, HIV 1&2) and ANA were collected. Ultrasound whole abdomen and Chest X ray were done whenever indicated. Different types of anemia, leucopenia, leukocytosis, thrombocytopenia in different groups of MELD scores were studied. Result: A total of 146 alcoholic liver cirrhosis patients were enrolled in our study. The mean ± SD age of the patients was 48.63±10.00 years with majority males (91.8%). Anemia detected in >95% of the patients. Severe anemia was detected in 31.5%, moderate anemia in 49.3% and mild anemia in 15.1%. Most of them (47.9%) had leucocytosis and thrombocytopenia was seen in 78.1% patients. Prolonged PT was seen in 89.1% of the patients and elevated INR present in 69.9% of patients. Majority of patients had MELD score between 10-19 and 20-29 (34.2% each). Only 4.1% had MELD score > 40. There is statistically significant association between MELD score of the patients with severity of anemia (p<0.05) and leucocyte count while it is not significant with thrombocytopenia (p=0.139). Conclusion: The prevalence of anemia in the present study was found to be 94.9% with predominant normocytic normochromic anemia (71.2%). There is significant association between MELD score of the patients with severity of anemia and leukocytosis while association with thrombocytopenia was insignificant. This study can now determine the stage at which emergent intervention could help in the recovery and effectively reduce morbidity and mortality of alcoholic cirrhosis patients.

TO DETERMINE THE ZINC LEVEL AND ITS CORRELATION WITH CD4 COUNT BEFORE AND AFTER ZINC SUPPLEMENTATION IN HIV INFECTED PATIENTS

Introduction: Human immunodeficiency virus (HIV) infection is a state of profound immunodeficiency. Zinc is a known to maintain a healthy immune system. Low levels of zinc in plasma predict a threefold increase in mortality related to HIV, while adequate levels of the zinc in the blood have been associated with a slow disease progression, decrease in viral load and HIV RNA, increase in CD4 count, a decrease in the risk for diarrhea, bacterial and opportunistic infections.Zinc deficiency which is common among the HIV infected persons, is overlooked So, we conducted this study to analyze the level of serum zinc level in HIV infected patients and to find out correlation between serum zinc level and CD4 count before and after 6 months of zinc supplementation. Methods: This study enrolled 54 HIV infected patients above 18 years of age who visited the Medicine outpatient department or the ART Centeror admitted to the medicine ward, Regional institute of Medical Sciences (RIMS), Imphalfor a period of 2 years(October 2019 to October 2021). Serum zinc level, CD4 count, HIV viral load before and after 6 months of zinc supplementation and other routine blood investigations were done. Zinc deficiency was defined by serum Zinc level (< 70mcg/dl).Zinc supplementation (12 mg/day for female, 15 mg/day for male) had been done for the duration of 6 months in the form of oral zinc sulfate. Result: A total of 54 HIV infected patients under ART were enrolled in our study. As per WHO clinical staging, majority of the patients (79.6%) belonged to stage1, the mean duration + SD of HIV was 10.9815 + 8.1229 years. Most of them (46.3%) have CD4 count in the range of 200-500 cells/mm3 while maximum patients (70.4%) had viral load <50 (Target not detected). Majority of the patients (50%) had serum zinc level in the 60-70 mcg/dl while 18.5% of them had zinc level < 50 mcg/dl. There was statistically significant improvement in level of serum zinc and CD4 count, but no improvement in viral load after 6 months of supplementation of zinc.The association with CD4 count was not statistically significant. Conclusion: The present study showed that the majority of patients (92.6%) had zinc deficiency at baseline. There was increase in the mean serum zinc level, CD4 count after 6months of zinc supplementation but no improvement in viral load. Zinc deficiency was reduced to only (31.5%) patients. Hence, this study conclude that zinc deficiency is common among HIV patients and zinc supplementation as an adjunct therapy can significantly improve zinc deficiency and CD4 count in HIV infected patients on ART without any adverse side-effects of zinc supplementation thereby decreasing the risk for bacterial and opportunistic infections.

Usage of Medical Library Resources: A Study in the Regional Institute of Medical Sciences, Imphal

This paper aims to analyse the usage of library resources, both physical and electronic, in the Central Library of the Regional Institute of Medical Sciences, Imphal. The study was designed to assess the usage of library resources in the Central Library of the Regional Institute of Medical Sciences, Imphal. The library visitor registry was surveyed for statistics. The research is limited to the usage of library resources at the RIMS’ central library during the 2016–2021 academic session. The Library has 645 members registered during the last five academic sessions. The library has a record of 13738 women and 12435 men, totalling a total of 2,6173 users who visited the library during the last 2016-2021 academic years. The highest number of visitors (1179) was recorded in September during the 2019-20 academic year, followed by (1139) in September during the 2018-19 academic year, (1127) in October, (1115) in May during the academic year 2018-19 respectively. A total of 280 users visited the print journals section of the library during the academic year 2016-17, 342 during 2017-18, 356 during 2018-19, 365 during 2019-20 and 109 during 2020-21 respectively. The library has the highest number of visitors (906) who use E-resources recorded in September followed by(827) in October during the academic year 2019-20. The least number of visitors (106) were recorded in January during the 2020-21 academic session. Further, it is found that the highest number of users (6270) visited the library during 2018-19, and only (818) during 2020-21.

Prostate Gland in Human Foetuses: A Study of its Histogenesis

Background: To study the histogenesis of the prostate gland in human foetuses. ‘Prostates’ is a Greek word which literally means “one who stands before”, protector, guardian. It is important from a clinical point of view as it undergoes benign enlargement from the fifth decade, hence attracting the attention of males around this age and simultaneously the clinicians. Materials and Methods: 100 foetuses of different gestational ages ranging from 14 weeks (85 mm) to 40 weeks (440 mm), products of terminated pregnancies under Medical Termination of Pregnancy, MTP Act of India, 1971 and stillbirths were collected from the Department of Obstetrics and Gynaecology, RIMS, (Regional Institute of Medical Sciences), Imphal, Manipur and utilised for the present study with permission from the Institutional Ethical Committee. Results and Discussion: The first sign of differentiation is recognised as increased cellularity and denser mesenchymal cells. Cytoarchitecture at specific age period at different age groups are described. Conclusion: Cytoarchitecturally, differentiation of all the three components of the prostate gland was noted as the age changes. It is inferred that of the three components of the adult tissues, the glandular component is differentiated from the epithelial lining of the urethra. This further induces the early mesenchymal tissues to differentiate into muscles and fibrous components. And at term, it has all the three components of the adult tissues although it is not as mature as in adult. KEY WORDS: Prostate gland, human foetuses, histogenesis and cytoarchitecture.

A STUDY ON CLINICOPATHOLOGICAL PROFILE OF ORAL SUBMUCOUS FIBROSIS

Background: Oral submucous brosis is a leading cause of oral cancer. So it is necessary to study its clinicopathological prole for the early diagnosis and prompt treatment. To assess the clinical prole and to eval Objectives: uate the histological prole of oral submucous brosis. Materials and Methods: A cross-sectional observational study conducted in the Department of Otorhinolaryngology, Regional Institute of Medical Sciences, Imphal, Manipur, India for a period of 2 years from September 2018 to August 2020. 78 oral submucous brosis patients were enrolled for the study. Clinical features, different habits and histopathological features were studied. Majority of the patients were in the Results: age group 21-30 years with male to female ratio of 1:1.36. Gutkha/talab was the most common habit among the study population. The mean duration of habits was 5.51 years with a minimum duration of 2 years and maximum duration of 15years. Majority of the patients (65.4%) had duration of habits of 1-5 years. Most of the patients (65.4%) clinically presented with difculty in opening of mouth. Fibrosis was most commonly seen in buccal mucosa and palate. Most of the patients were in clinical stage II (57.7%) and in histopathological grade II (60.3%). There was no statistically signicant correlation found between clinical staging and histopathological grading (P value – 0.627) Gutkha/talab is Conclusion: more responsible for the development of oral submucous brosis. Early diagnosis and treatment is important to prevent the progression to oral cancer.

Recurrent vesicular palmoplantar dermatitis: a clinical study in children and adolescents

Background: Previously known as dyshidrosis, recurrent vesicular palmoplantar dermatitis (RVPD) is presented as severe eruption of non -erythematous, symmetrical vesicles or bullae located along the lateral sides of fingers, on the palmar or plantar areas, and developing into a chronic and recurrent condition. Although very frequently observed on the hands, there are no specific studies about such eczema in children and adolescents. Objectives of current study was to study clinical profile of RVPD in children and adolescents, and monitor the association of RVPD with seasonal variations, hyperhidrosis, atopy and nickel sulphate. Methods: A cross sectional study was carried out in fifty patients affected by RVPD coming to out- patient department of dermatology in regional institute of medical sciences, Imphal, Manipur for a period of 24 months (October 2019 to September 2021) were collected using questionnaire. Data including age, sex, seasonal variation, hyperhidrosis, and atopy were collected. Relevant laboratory investigations like KOH examination, patch testing etc. were performed. Children (<12 years) and adolescents (13-18 years) irrespective of sex coming to opd were included and those unwilling to participate and treated elsewhere were excluded. Ethical approval was obtained from research ethics board and statistical analysis was done using IBM SPSS version 21. Results: Majority (44%) of patients were in the age group 1-5 years. Hyperhidrosis (12%) was identified as second most contributing factor for RVPD after idiopathic cases. Atopy was the most common associated factor followed by seasonal warm weather exacerbation. Conclusions: RVPD onset may occur at an early age, developing into a chronic and recurrent infection. Hyperhidrosis and atopic status was established in the clinical profile.

FETO-MATERNAL OUTCOME IN RH NEGATIVE PREGNANT WOMEN IN RIMS HOSPITAL, IMPHAL: A CROSS SECTIONAL STUDY

Introduction:Incidence of Rh negative pregnancy in western countries is 15%, but in India it varies from 3% to 5.7%. It is a high risk pregnancy, as it may cause antigen-antibody reaction and haemolysis. However, it can be prevented by adequate measures. Aims and objectives: To determine feto-outcome in Rh negative pregnant women. Materials and methods: Across sectional study was carried out in the department of Obstetrics & Gynaecology and Paediatrics, Regional Institute of Medical Sciences, Imphal, Manipur for the duration of 2 years. The total of 38 Rh negative pregnant women were included in the study after applying inclusion and exclusion criteria. Results: In the present study among 38 patients, 31.6% were delivered through Elective LSCS, 26.31% were vaginally delivered and 21.1% were Emergency LSCS. Among 38 patients, 5.3% were preterm birth, 92.1% were term birth and 2.6% were post term birth. In this study, 7.9% of patients in the study group were indirect coomb' test (ICT) positive, 92% were ICT negative. Out of 38 patients, 20 were booked who received antenatal anti-D prophylaxis in contrast to 18 unbooked patients. 35 out of 38 patients received post-natal prophylaxis with 300 mcg anti-D. Perinatal outcome in 38 patients was 73.7% were healthy, NICU admission were 15.8%, intrauterine death (IUD) were 5.3% and 2.6% were neonatal death. The conventional treatment measures are appropriate hydration, phototherapy and exchange transfusion. Conclusions: Rh haemolytic disease of the new-born forms common and preventable cause of maternal and perinatal morbidity. Anti-D IgG administration and proper fetal and neonatal monitoring when required decreases the burden of disease

Lipid Profile in Patients with and Without Acute Coronary Syndrome

Background: Coronary heart disease (CHD) remains the major cause of mortality and morbidity in the entire world population despite therapeutic advances that control many risk factors. Lipid profile is regarded as an important factor in the development of coronary heart disease. There have been numerous studies showing the association of hyperlipidemias with coronary heart disease in most of the Western as well as Asian countries of the world. But we have very little data on the relation between CHD and lipid profile in this part of the globe. Objective: To evaluate the association between lipid profile and acute coronary syndrome (ACS). Methods: This cross-sectional study was done in the Department of Biochemistry in collaboration with the Department of Cardiology, Regional Institute of Medical Sciences, Imphal on diagnosed cases of acute coronary syndrome in between January 2021 to October 2022. Estimation of lipid profile was done by Randox Imola autoanalyzer. Data collected were entered in SPSS version 21.0 and analysed using descriptive measures, and statistical significances were set at p<0.05. Results: A total of 67 patients of acute coronary syndrome and 67 without acute coronary syndrome (total 134) were recruited in the study. It is seen that the mean±SD of age in cases was 63.69±12.11 years and in the controls, it was 45.47±11.75 years, and the difference observed was found to be statistically significant p<0.05. The majority of the cases were males comprising of 49 (73.3%) and females constitute only 18 (26.7%). 42 (62.2%) of the cases had history of HTN while 25 (37.8%) had no h/o HTN. In cases the mean±SD of SBP (112.67±17.35 mmHg) and DBP (73.38±11.63 mmHg) were found to be significantly lower than the controls. As regards the lipid profile, in the cases the mean±SD of total cholesterol was 208.75±31.25 mg/dl and in controls 144.02±19.57 mg/dl, triglycerides in cases was 162.51±39.81 mg/dl and 98.42±16.96 mg/dl in controls and LDL was 142.22±31.31 mg/dl in the cases and 71.40±21.24 mg/dl in controls showing that the values were higher in the cases as compared to the control group and the difference was found to be statistically significant with p<0.05. However, the mean±SD of HDL in the cases (34.78±6.44 mg/dl) was lower as compared to the controls (49.56±5.72 mg/dl) and the difference was statistically significant with p<0.05. Conclusion: In this study, it was found that the total cholesterol, triglycerides, and LDL cholesterol concentrations were significantly higher and HDL concentration was lower in acute coronary syndrome (ACSD) patients. The imbalance between TC and HDL levels plays a more important role in the pathophysiology of atherogenesis leading to ACS.

Prescribing Pattern of Levetiracetam in Epilepsy Patients: A Cross-Sectional Study in a Tertiary Care Centre in Manipur

Objective: The objective is to shed light on the prescribing pattern of levetiracetam, a newer antiepileptic drug, in the treatment of different types of epilepsy. Methods: A record-based cross-sectional study of epilepsy patients who reported to the Therapeutic Drug Monitoring Unit in the Department of Pharmacology, Regional Institute of Medical Sciences, Manipur, was conducted. Case records of patients receiving levetiracetam and reporting from January 2017 to December 2020 were included. The patient’s age, gender, and weight; clinical diagnosis; levetiracetam dose; and other co-administered AEDs were all examined. Findings: Of the 17 cases, the majority of the patients were adults, and 52.9% were males. The patients’ average body weight (kg) was 49.8  9.4. Generalised tonic-clonic seizures (GTCS) constituted the majority of the cases (47.1%), followed by simple partial seizures, complex partial seizures (23.5% of each), and absence seizures (5.9%). 70.11% of the cases received LEV monotherapy, while the remaining cases were prescribed combination therapy. LEV alone was prescribed in 87.5% of GTCS cases. The median daily dose of LEV was 1000 mg (IQR-625). Novelty : The observation that levetiracetam alone is prescribed in the majority of GTCS cases, the commonest type of epilepsy, is an eye-opener for another new monotherapy option for GTCS. Keywords: Prescribing pattern; Levetiracetam; Antiepileptic; Epilepsy; Monotherapy

Perception and Attitude towards Passive Euthanasia among Doctors in a Tertiary Care Hospital in Northeast India: A Cross-sectional Study

Introduction: The medical fraternity now has more control over the processes of life and death due to advances in medical technology and equipment. Euthanasia has been debated around the world for more than half a century and it continues to raise important questions in medical ethics, moral theology, civil rights and liberty. Physicians’ attitudes to life and death emerge to relate their end-of-life decision-making, although usually carried out at the request of ailing person. Physicians’ contemplation on euthanasia is a vital building block in the path towards any change, in the euthanasia situation in a country. Aim: To determine perception and attitude towards passive euthanasia among doctors in Regional Institute of Medical Sciences, Manipur, India and to evaluate the association between attitude and variables favourable to passive euthanasia. Materials and Methods: A cross-sectional survey in the Regional Institute of Medical Sciences (tertiary care hospital), Manipur, India, between October 2018 and September 2020, in Northeast was carried out among 673 doctors. A selfadministered questionnaire was designed and approved by three specialists with expertise in palliative care and medical ethics. The questionnaire had a total of 46 questions in English language, of which 15 questions were on socio-demographic profile, 13 were attitude questions and 18 were questions on perception towards passive euthanasia. Attitude questions were scored using 5-point Likert scale from strongly disagree (-2) to strongly agree (+2). Total attitude score ranges from -26 to +26. Score above zero was considered to have positive attitude and vice-versa. There was no scoring to determine perception towards euthanasia. The questionnaires were given to the doctors and postgraduate trainees of clinical and non clinical specialities in a tertiary care hospital in North Eastern India during their work hours. Data were summarised using descriptive statistics. Chi-square test was used to assess factors favouring attitudes toward passive euthanasia. Results: Age of the respondents ranged from 24 years to 63 years, with a mean age of 37.1±10.7 years and mean duration of experience was eight years. Out of 577 respondents, 368 (63.8%) were postgraduate trainees and 209 (36.2%) were doctors. Majority (463, 80.2%) of the respondents had positive attitude, 97 (16.9%) had negative attitude and 17 (2.9%) had neutral attitude. Total 543 (94.1%) respondents agreed that declaration from patient/family members must be obtained before the act of passive euthanasia. Also, the quality of life as viewed by the patient himself (452, 78.3%) and humanitarian basis (372, 64.4%) were the important factors in influencing decision making regarding passive euthanasia on a terminally ill patient. There was no significant association between sex, religion, specialisation, Intensive Care Unit (ICU) experience and attitude towards passive euthanasia. Conclusion: Majority of the respondents had positive attitude towards passive euthanasia in the face of intractable suffering and terminal illness. Hastened death looks easier to the patients and family because of physical suffering and financial burdens they are subjected to. The doctors got request for euthanasia by the patients and relatives which reflects the public awareness on euthanasia.

Association of Glycosylated Haemoglobin and Wound Healing in Diabetic Foot Ulcer: A Prospective Cohort Study

Introduction: Diabetes Mellitus (DM) is a disease that, over time, can affect practically all organ systems in the body, including the skin and circulatory systems. An estimated 15% of all diabetic patients develop a foot ulcer in their lifetime. Although it is clear from the literature review that strict glycaemic control prevents complications, the relationship between Glycosylated Haemoglobin (HbA1c) value and wound healing in diabetic foot patients is less well-defined. Aim: To determine the association between Glycosylated Haemoglobin (HbA1c) and wound healing rate in Diabetic Foot Ulcers (DFUs). Materials and Methods: This prospective cohort study was conducted in the Department of General Surgery, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, India, between August 2018 and July 2020. All patients between 18 and 70 years old, diagnosed with diabetic foot according to the World Health Organisation definition, and presenting with a lower limb ulcer were included as study participants. A detailed clinical history, examination of the patient, limb, and ulcer, and baseline HbA1c assessment were performed. The ulcer wound was graded and staged according to the University of Texas Wound classification system. All selected patients were divided into two groups. Group-A (n=15) comprised patients with HbA1c ≤7%, and Group-B (n=15) consisted of patients with HbA1c >7%. The primary outcome was the wound healing rate per day in relation to HbA1c levels at baseline and subsequent followup. The secondary outcomes were the demographic profile and predisposing factors affecting the healing of DFUs. Student’s t-test (two-tailed, independent) and Chi-square/Fisher’s-exact tests were performed for statistical analysis. Results: The mean age of the subjects was 57.33±7.43 years in Group-A and 56.20±7.51 years in Group-B. There was a male preponderance in both Group-A (9) and Group-B (11). A total of 11 (36.7%) patients had a history of smoking, all of them being male. The mean healing rate per day was 0.09±0.02 cm2 /day in Group-A patients, which is higher compared to Group-B with 0.02±0.01 cm2 /day. Conclusion: Strict glycaemic control is a mainstay in preventing the progression of foot ulcers to gangrene and, therefore, amputation. A lower baseline HbA1c at the presentation of DFU is indicative of a favourable outcome in terms of wound healing, with comprehensive treatment and follow-up efforts.

Association of HbE Haemoglobinopathy in Patients with Systemic Lupus Erythematosus: A Cross-sectional Study

Introduction: Systemic Lupus Erythematosus (SLE) is a chronic inflammatory disease of autoimmune origin that affects multiple systems, with the haematologic system being commonly involved. However, the co-existence of haemoglobinopathies and connective tissue disorders has rarely been investigated, and the available data on this matter are primarily anecdotal. Aim: To determine the prevalence of Haemoglobin E (HbE) haemoglobinopathy in adult SLE patients and to assess the association of HbE haemoglobinopathy and SLE with disease activity. Materials and Methods: A hospital-based cross-sectional study was conducted at the Department of General Medicine, Regional Institute of Medical Sciences (RIMS) Hospital, Imphal, Manipur, India, from April 2021 to July 2022. The study included SLE patients diagnosed during the study period who attended the rheumatology Outpatient Department (OPD). The independent variables were age, gender, occupation, religion, and family history, while HbE haemoglobinopathy, Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin (MCH), Red Blood Cell (RBC) count, and Systemic Lupus Activity Measure Revised Index (SLAM-R index) score were the dependent variables. Data were analysed using Statistical Package for Social Sciences (SPSS) version 21.0, with proportions analysed using the Chi-square test and Fisher’s-exact test, and means compared using Analysis of Variance (ANOVA) and independent t-test. A p-value of <0.05 was considered significant. Results: Of the 105 SLE patients included in the study, 93% were females. The majority of participants (36.2%) were in the age group of 21-30 years. Twenty-five patients (23.8%) had HbE haemoglobinopathy. Anaemia and MCV were significantly associated with HbE patients. Among the 25 HbE patients, 24 (96%) had active SLE disease. Among the HbE negative patients, 55 (68.7%) had active disease, while 25 (31.3%) did not have any active disease. Active SLE disease was significantly associated with HbE haemoglobinopathy (p-value=0.002). Conclusion: The overall prevalence of HbE haemoglobinopathy in SLE patients was found to be 24%. Hb levels and MCV levels were significantly lower in HbE patients. There was a significant association between active SLE disease and HbE haemoglobinopathy

A study of airflow patterns among patients attending a hospital set up in Manipur

Background: Clinicians and surgeons often require instant knowledge of the lung function of their patients during the course of their management though they rely on the symptoms most of the time. Yet unexpected, abnormal respiratory airflow patterns are found in various diseases which affect the management whereas many respiratory complaints used to turn out to be normal. Respiratory symptoms often but not always correlate with airflow abnormality, thus making office spirometry an important tool for addressing these problems. Aims and Objectives: An evaluation of the profile of airflow patterns observed among patients attending regional institute of medical sciences (RIMS) hospital, Manipur, is carried out. Materials and Methods: The spirometry test performances of total 221 patients (120 males and 101 females) aged between 11 and 80 years sent from outpatient and wards of different departments of our hospital (RIMS Imphal, Manipur) were done after taking informed consents. The period of test performance was from June 2016 to November 2018 on all working days in the department of physiology. For this, a computerized spirometer (Helios model no. 401) was used. Results: 176 (79.6% of the total studied) patients presented with symptoms of respiratory diseases and after spirometry test, 121 (54.7% of the total) were having different patterns of abnormal airflow. About 60% of 111 patients complaining only of breathlessness are found to have normal lung function. Among 13 patients with a common disease such as chronic obstructive pulmonary disease, unexpectedly 2 cases of restrictive type of airflow and another 2 patients with normal airflow were found. Conclusion: Awareness of such altered and unexpected occurrence in lung spirometry epidemiology would be informative to the physicians in disease management.

Clinical Profile and Outcome of Acute Myocardial Infarction among Young Adults at a Tertiary Care Centre in Manipur, India: A Cohort Study

Introduction: The incidence of Acute Myocardial Infarction (AMI) is rising in young adults. Timely control of cardiovascular risk factors is important to prevent the increasing incidence of AMI in young adults. Aim: To analyse the clinical profile, risk factors, and outcomes of AMI among the young adult population in Manipur, India. Materials and Methods: A hospital-based cohort study was conducted in a tertiary care centre at Department of Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India from January 1, 2021, to December 31, 2022, among patients aged 45 years or younger attending the medicine Outpatient Department (OPD), admitted to the Intensive Care Unit (ICU) and Intensive Coronary Care Unit (ICCU) with the first attack of AMI. Cases involving pregnancy, known cases of pericarditis, and Congenital Heart Disease (CHD) were excluded. Data were collected using a performa regarding demographic profile, clinical presentation, risk factors, and treatment outcomes. The data were analysed using Statistical Package for Social Sciences (SPSS) 21.0 and expressed as descriptive statistics. Results: A total of 39 cases were reported with a mean age of 40.2±4.6 years, with a male-to-female ratio of 9:1. The majority of cases presented with chest pain (74.3%), followed by shortness of breath (40%), nausea (13%), and collapse (10%). 75% of cases presented with multiple clinical features. The most common risk factors in young adults were smoking (84.6%), alcohol consumption (56.4%), family history of heart disease (25.6%), hypertension (20.5%), substance abuse (20.5%), diabetes (17.9%), and dyslipidemia (25.6%). Cases showed elevated cardiac enzymes - Creatine Kinase-Myocardial Band (CK-MB) (92.3%) and Troponin I (94.9%). Electrocardiogram (ECG) changes revealed ST segment elevation MI (89.7%). Only one case resulted in death during the hospital stay. Conclusion: The incidence of AMI among young adult populations is increasing, emphasising the need to raise awareness regarding cardiovascular risk factors and lifestyle modifications. However, the cases have shown good clinical outcomes among young adults with the disease.

Effect of Hip/Shoulder Width Ratio on the Spread of Spinal Anaesthesia in Term Parturients: A Cross-sectional Study

Introduction: There is increased cephalad spread of spinal anaesthesia with similar dose of hyperbaric bupivacaine in parturients with greater hip width and shorter shoulder width. Aim: To determine the effect of Hip and Shoulder width Ratio (HSR) on the spread of spinal anaesthesia in term parturients. Materials and Methods: The present study was a prospective cross-sectional study conducted in the Department of Anaesthesiology, Regional Institute of Medical Sciences, a tertiary care centre, at Imphal, Manipur, India, from October 2019 to September 2021. A total of 92 parturients aged 18-40 years of age, American Society of Anaesthesiologists (ASA) I and II, undergoing elective caesarean section under subarachnoid block were enrolled. With the parturient in lateral position, a 25G spinal needle was inserted in the L4-L5 interspace. A 2 mL of 0.5% hyperbaric bupivacaine was injected intrathecal in 10 seconds. Age, height, weight, Body Mass Index (BMI), HSR and Vertebral Column Length (VCL) were recorded. Spinal anaesthesia spread was assessed at 0,5,10,15,20,25,30 minutes after the procedure with pin prick test starting from the anaesthetised area and continued cephalad till the sensation changed from the dullness to sharp pain in both the mid-clavicular lines. Results: The mean age, weight, height and BMI were 28.82±6.2 years, 62.36±5.8 kilograms, 158.63±4 centimetre, and 24.77±2 Kg/m2 , respectively. HSR and shoulder width had a significant correlation with the cephalad spread of spinal anaesthesia with r=-0.672 and p-value <0.001 and r=0.369 and p-value <0.001, respectively. Conclusion: HSR and shoulder width has a significant correlation with spread of spinal anaesthesia with a given dose of 0.5% hyperbaric bupivacaine in parturients. The study should expect more cephalad spread of anaesthesia in parturient population when the HSR>1.