Sri Siddhartha Medical College Research Articles

Correlation of left ventricular function and patient prognosis and outcome in acute myocardial infarction

Background: Acute myocardial infarction is one of the most common cause of left ventricular dysfunction leading to morbidity and mortality worldwide. Ventricular function is the best predictor of patient prognosis and death after an acute myocardial infarction. Methodology: A prospective study was conducted in Sri Siddhartha Medical College& Hospital from July 2022 to 2024.Total 103 acute myocardial patients were included fulfilling the inclusion and exclusion criteria with given consent for the study. This will be followed by detailed history taking , clinical examination and Echo-cardiogram to asses left ventricular ejection fraction . A total of 103 patients of acute myocardial infarction has been included in the study. Echocardiographic ejection fraction has been compared with patient prognosis and outcome. Result: The patients with acute myocardial infarction of 103 patients, most of the patients on observation , around 14.02% of patients who had cardiac arrest has been with poor prognosis and more drop of left ventricular function and 86 % of the patient who has been stably discharged it had been observed that, not much drop in left ventricular function. Conclusion: On correlating patients left ventricular function and patient outcome in acute myocardial infarction , it can be concluded that in most of them as low as the left ventricular function decreases the poor prognosis can be expected leading to high morbidity and mortality.

A study on mycology spectrum with aetiopathological factors and its management in otomycosis

Background: Otomycosis (fungal otitis externa), is a fungal infection of external auditory canal (EAC). It is a common challenging problem in the ENT clinic, because for the need for long term treatment and follow up. The present study was thus designed with the view to know the mycological pattern encountered in otomycosis along with the aetio-pathological factors and its management. Methodology: A prospective study was done in the Department of ENT, Sri Siddhartha Medical College & Hospital, Tumkur for a period of 12 months, total of 51 patients of both genders with clinical features of otomycosis were enrolled in the study. 2 swabs were taken from the EAC of all cases and after aural toileting under microscope, were treated with 1%clotrimazole and followed up for 2 months Results: A total of 51 patients were examined in this study, of which 47 cases produced positive fungal isolates (92.1%). Females were more commonly affected than males. Most common pre-disposing factor was manipulation of the ear by unsterile material for cleaning the ear. Itching and pain were the most common symptoms, Aspergillus was the most common fungus isolated. Clotrimazole showed good response symptomatically and mycological clearance was seen within a week. Conclusion: Otomycosis is still a common problem and is often misdiagnosed for other chronic otitic conditions. Fungi thrive on exfoliated dead epithelial cells along with humid environment in EAC. Thorough cleaning of fungi followed by topical antifungal agent is important in management of this condition. Clotrimazole is effective, safe and well tolerated topical antifungal agent.

Breastfeeding Practices among Lactating Mothers in a City of South India

Introduction: Breast feeding is the first fundamental right of the child. It provides a unique biological andemotional basis for the health and development of the children. The world health organization recommends that breastfeeding be initiated within one hour of birth. Early initiation of breastfeeding provides benefits for both mother and the baby.Objectives: To assess the knowledge and attitude and practices about breast-feeding and complimentary feeding practices among lactating mothers attending Outpatient department (OPD) of tertiary care centre in a city of South India.Materials and Methods: It was a cross-sectional observational study done amongst post-natal mothers attending OPD in Sri Siddhartha Medical College, Tumkur between October to November 2022. Data collected was entered on Microsoft Excel spread sheet. Descriptive statistics and Chi –square test as test of significance were used. P value less than 0.05 was taken as statistically significant. Statistical software Epi Info software version 7.2.5 was used for the statistical analysis.Results: Data was collected from 104 post-natal mothers attending the OPD. All of them knew about importance of exclusive breast-feeding, colostrum feeding (100%). 99% of them knew breast feeding improves immunity. 95 (91%) of the participants were willing to continue breastfeeding up to two years and beyond. Only 16 (15.4%) mothers fed the baby on demand, others followed scheduled feeding like once in 1-2 hours, once in 2 to 3 hours.In our study 78.8% women started complimentary feeding at 6 months.Conclusion: Healthy breastfeeding practices have significant effect on mothers and infants. The breastfeeding knowledge and positive practices are optimal among mothers. Focused breastfeeding counselling and advice by the health workers with emphasis on correct technique can improve the positive breastfeeding practices.

Study of vitamin D levels in patients with allergic rhinitis

Allergic rhinitis (AR) is the most common type of chronic rhinitis, affecting 10-20% of the population. Severe allergic rhinitis has been associated with significant impairments in quality of life, sleep, and work performance. Vitamin D and its role in regulation of immune function was first proposed after the identification of vitamin D receptors in lymphocytes. There are recent researches linking vitamin D to various immune-related conditions, including allergy, although the pattern of this relationship is still yet to establish. Methods and materials: an observational descriptive study conducted in the Outpatient Department of ENT of Sri Siddhartha Medical College, Tumkur, Karnataka, over a period of 1 year comprising of around 40 patients from 18-65 years of age suffering from allergic rhinitis patients were scored using Total nasal symptoms scoring system (TNSS) based on nasal symptoms. Also, Vitamin D levels are measured and based on these levels patients are graded. Results: Among 40 patients, male predominance with 23(57.5%) cases with mean age of 38.4 +/- 6.8. Majority of patients were in 7-10 TNSS with 15 patients accounting for 37.5%. Patients with severe allergic symptoms had mean vitamin D level about 19.6 +/- 4.2 ng/dl, patients with moderate symptoms were seen with mean vitamin D level 28.6 +/- 3.6 ng/dl and with mild symptoms 34.4+/- 2.8 ng/dl and the p value was significant (<0.04) in our study. Conclusion: Vitamin D could improve allergy symptoms directly or indirectly by potentiating the anti-inflammatory effects of the medications used to treat allergy.

A study of splenic notches in human cadavers and its clinical implications

: Spleen is the largest and secondary lymphoid organ with high vascularity which has important role in immunological and haematological functions of human body. Spleen developes from mesoderm and in the initial stages of development, different lobules are formed, which fuses later. The lobulated structure of spleen disappears, but is indicated by the presence of notches in superior border in adults. The aim of study was to find morphological variations of spleen with respect to its number of notches in borders and anomalous fissure on its surfaces.: The study was done on 40 formalin fixed cadaveric spleens from the department of Anatomy, Sri Siddhartha Medical College, Tumkur, and Karnataka. Out of 40 spleens studied, the various shapes such as wedge shaped, tetrahedral, oval and triangular were found. The number of spleen showing notches in superior border was 28(70%) and in the inferior border it was 3(7.5%). Absence of Splenic notches was observed in 5(12.5%) and 2(5%) spleens had notches in both borders. The anomalous fissure was found in 2(5%) spleen on its diaphragmatic surface.: The knowledge of variations in morphology of spleen are essential for physician, surgeon, radiologists and forensic surgeon to differentiate from the splenic pathology and splenic injury. Morphological variations of spleen and its clinical importance need to be discussed at dissection tables during routine anatomy dissection hours.

Umbilical cord variables in relation to gestational age by using ultrasonography in normal pregnancy and PIH women

To determine whether the antenatal assessment of CSA of umbilical cord variables is different in PIH compared with healthy pregnant women by using ultrasonography and to assess its relationship with gestational age.This study was conducted in the Department of Radio-diagnosis, Sri Siddhartha Medical College, among 600 (300 normal &300 PIH) pregnant women who underwent a routine prenatal gestational sonogram ranging from 28 to 39 weeks of age.There was a significant difference observed between two groups in all umbilical cord variables except umbilical artery area. Mean ± S.D of the CSA of the umbilical cord variables for each gestational age were studied in normal and PIH women.We found that the mean value of UCA and WJA was increased till 36 weeks then it decline sharply in the normal group whereas in PIH group, the mean value of UCA increases till 36 weeks then it attain plateau and the mean value of WJA increases even after 36 weeks. Our study was first of its kind to document the CSA of UC variables and their growth pattern according to gestation age, which can be used as an informational basis for both normal and PIH pregnant women.

Study of Association of Tear Film Abnormalities in All Grades of Primary Pterygium Cases using Schirmer’s Test 1 & 2

Background: One of the frequent ocular disorders affecting people in their middle and advanced years of age is pterygium. It is a benign, proliferative disorder of the conjunctiva and subconjunctival tissue that has the potential to impair vision. Clinical examination can quickly diagnose and stage it. Sunlight exposure is believed to be the most significant element in the development of pterygium. Dry eyes, smoking, prolonged outdoor activity, low socioeconomic position, and high altitudes are additional risk factors. If it grows onto the cornea's centre, a major problem is the obliteration of the visual axis. Another reason for impaired vision is the development of irregular astigmatism brought on by flattening of the cornea in the horizontal meridian. Aim: The aim of the study was to determine the association of Tear film abnormalities with all grades of pterygium Materials and Methods: The current study was a single-center observational study that was conducted out from December 2020 to July 2022 in the ophthalmology division of Sri Siddhartha Medical College hospital and Research Centre, Tumkur, on patients who attended the OPD with primary pterygium, regardless of treatment. According to the study's inclusion criteria, a total of 91 participants who were diagnosed with pterygium were enrolled. Results: The majority of participants (34.07%) were between the ages of 61 and 70. Pterygium prevalence was higher in females (65.93%) than in males (34.07%) with a 1.96:1 ratio. The majority of the participants (69.23%) had progressive pterygium, followed by regressive pterygium (15.38%) & atrophic pterygium (15.38%). The mean scores of the schirmers tests 1 and 2 in both eyes differed significantly statistically depending on the degree of pterygium (p=0.03). Conclusions: Pterygium is one of the most common ocular conditions in our nation, primarily affecting people from lower socioeconomic backgrounds. Pterygium has been linked to tear film abnormalities. Keywords: Dry eyes, Pterygium, Tear Film.

“COMPARISON OF PERIBULBAR ANESTHESIA WITH POSTERIOR SUBTENON'S ANESTHESIA IN MANUAL SMALL INCISION CATARACT SURGERY (MSICS)”

Background: Cataract-related blindness is a huge problem in India, not only in terms of human suffering but also in terms of economic loss and social impact. For cataract extraction, retrobulbar anaesthesia was widely employed. Because of its substantial difculties, retrobulbar anaesthesia was replaced with peribulbar. Despite a two injection method Peribulbar anaesthesia has a very high failure rate. Subtenon's anaesthesia is becoming more popular in this situation, Because of its faster onset in delivering anesthesia, akinesia and patient compliance. A cross- Methods: sectional study in ophthalmology department at Sri Siddhartha Medical College, Tumkur was conducted over a period of 18 months in 150 MSICS participants , with 75 participants in each group. The efcacy and safety of two types of anaesthesia in MSICS were compared in terms of intraoperative analgesia, akinesia, lid movements, and complications. Out of Results: 75 participants in each group percentage with grade 0 pain in posterior subtenon's group was 64(83 %) as compared to 6( 8%) in peribulbar group. Among all 20 (27%) participants of peribulbar group and 2 (3%) of posterior subtenon's group had attained complete akinesia. Both the groups had experienced similar amount of lid movements. Occurrence of complications like chemosis and sub conjunctival hemorrhage was noted more in posterior subtenon's group when compared to peribulbar group

RANDOMIZED COMPARATIVE STUDY OF ANALGESIC EFFICACY OF BUPRENORPHINE AND CLONIDINE AS ADJUVANTS WITH INTRATHECAL BUPIVACAINE IN PATIENTS UNDERGOING TOTAL ABDOMINAL HYSTERECTOMY.

Introduction: Understanding pain and continued efforts to alleviate pain is utmost priority perioperatively. Most often pain is underestimated in all age groups. This study is intended to evaluate and compare analgesic efcacy of two drug combinations with local anesthetic agent in spinal anesthesia. In this study efcacy of Clonidine-Bupivacaine, Buprenorphine-Bupivacaine and Bupivacaine is studied in patients undergoing total abdominal hysterectomy. This study was a prospective randomized study conducted on 114 patients age Material and Methods: d 35-60 years who underwent total abdominal hysterectomy at Sri Siddhartha Medical College and Research institute for a period of 24 months.After the approval of institutional ethical clearance committee, 114 ASA I and II patients scheduled for elective total abdominal hysterectomy were selected for study. All the patients were evaluated as per the protocol. The anesthetic procedure was explained to the patients in a simple language and informed consent were obtained. The patients were divided into three groups of 38 each using chit in a box technique. Three groups included Bupivacaine 0.5% hyperbaric (Group B), Clonidine and Bupivacaine 0.5% hyperbaric (Group BC), Buprenorphine and Bupivacaine 0.5% hyperbaric (Group BB). Time of onset of sensory blockade, the height of sensory blockade, motor blockade as per Bromage scale were recorded. Total duration of sensory blockade and motor blockade were also noted. Quality of analgesia (visual analogue score), two segment sensory regression time and time to rst rescue analgesia in 24h were documented. Results:The total duration of analgesia was statistically signicant in all three groups. The mean duration of analgesia was 2.436 ± 0.24h in group B, 2.96 ± 0.32h in group BB and 4.35± 0.62h in group BC. The total duration of motor block was found to be statistically signicant between the groups. Mean duration of motor block was 3.10 ± 0.34h in group B , 3.41 ± 0.25h in group BB, 4.48± 0.19h in group BC. The VAS score was found to be statistically signicant between the groups. It was 4.68 ± 0.47 in group B, 4.92 ± 1.07 in group BB and 4.42± 0.50 in group BC. Clonidine is an effective intrathecal Conclusion: adjuvant to Bupivacaine(H) than Buprenorphine in providing post-operative analgesia and the analgesic efcacy of both Clonidine and Buprenorphine as adjuvants with Bupivacaine(H) were better than Bupivacaine(H) alone.

A COMPARATIVE STUDY IN EVALUATION OF MIDDLE EAR DISEASES BY OTOENDOSCOPY AND OTO-MICROSCOPY

Background: Middle ear diseases are the most common conditions in otology, proper evaluation of these patients are mandatory. Microscopic examination of ear is the routine procedure in evaluating the ndings with certain limitations. Introduction of endoscopy had led to the attempts of utilizing it in otolaryngology for the evaluation of middle ear spaces. This is Materials And Methods: a Hospital based comparative study, patients attending outpatient department of ENT, Sri Siddhartha Medical College, of both genders between 18 to 60 years of age, diagnosed to have disease of middle ear have been enrolled for the study after obtaining the written informed consent. Study parameters of both the groups were compared. Among 124 participants, our study showed that 29 participants (23.38 %) Eustachian Results: tube opening is visible through the microscope, while it is visible in 111 participants (89.51%) under otoendoscopy. In 33 participants (26.61%) epitympanum is visible under microscopy, compared to otoendoscope were 95participants (76.61%) are visible. Hypotympanum is visible in 58 participants (46.77%) with microscope and 112(90.3%) participants with otoendoscope. Visualization of sinus tympani in 9 participants (7.2%) is possible through microscope whereas it is visible in 91 participants (73.3%) through otoendoscope. Facial recess is visible in 8 participants (6.4%) through microscopy and in 89(71.7%) participants through otoendoscope. Oval window is visible in 12 participants (9.6%) through microscope whereas it is visible in 89 (71.7%) participants through Otoendoscopy. The p-value of all the above parameters is less than 0.001; indicating study is statistically signicant thus otoendoscope has a better visualisation of these structures. No statistically signicant difference between the examination of the external auditory canal and round window using a microscope and otoendoscope has been obtained. Oto- Conclusion: microscopy despite having the better three dimensional images, otoendoscope gives a better visualization of middle ear structure in evaluating diseases of middle ear. Therefore we conclude that Otoendoscopic examination should be mandatory along with routine Otomicroscopic examination.

“COMPARATIVE STUDY OF PLATELET RICH PLASMA VERSUS AUTOLOGOUS TEMPORALIS FASCIA GRAFT IN TYPE 1 TYMPANOPLASTY.”

Background: Chronic otitis media (COM) is most common disease seen by ENT surgeon. Tympanoplasty using temporalis fascia as graft is routine treatment procedure while Platelet Rich Plasma (PRP)is newer treatment procedure. Methods: Prospective Study conducted on participants admitted with Chronic otitis media in the Otorhinolaryngology department of Sri Siddhartha Medical College hospital and Research Centre, Tumkur from December 2020 to June 2022 which includes 60 participants and were divided into two groups PRP group (30 participants) where PRP used as graft material and T group (30 participants) where temporalis fascia was used as graft material and follow up done at 3rd month and 6th month for assessing closure of perforation and for hearing improvement using pure tone audiometry. Results: Among 30 cases of PRP group, there were 29 cases of closure of perforation (96.67 %) and 1 case had no closure of perforation (3.33 %). Among 30 cases of T group, there were 28 cases of closure of perforation (93.33%) and 2 cases had no closure of perforation (6.67%). The p-value calculated between the groups with pre operative mean air bone gap values was 0.2210 and that with post operative values was 0.1835; indicating no signicant difference between the groups during follow up at 6 months.Background: Chronic otitis media (COM) is most common disease seen by ENT surgeon. Tympanoplasty using temporalis fascia as graft is routine treatment procedure while Platelet Rich Plasma (PRP)is newer treatment procedure. Methods: Prospective Study conducted on participants admitted with Chronic otitis media in the Otorhinolaryngology department of Sri Siddhartha Medical College hospital and Research Centre, Tumkur from December 2020 to June 2022 which includes 60 participants and were divided into two groups PRP group (30 participants) where PRP used as graft material and T group (30 participants) where temporalis fascia was used as graft material and follow up done at 3rd month and 6th month for assessing closure of perforation and for hearing improvement using pure tone audiometry. Results: Among 30 cases of PRP group, there were 29 cases of closure of perforation (96.67 %) and 1 case had no closure of perforation (3.33 %). Among 30 cases of T group, there were 28 cases of closure of perforation (93.33%) and 2 cases had no closure of perforation (6.67%). The p-value calculated between the groups with pre operative mean air bone gap values was 0.2210 and that with post operative values was 0.1835; indicating no signicant difference between the groups during follow up at 6 months.

A study of self-medication practices among 1st-year MBBS students aged 19–21 years at Sri Siddhartha Medical College and Hospital, Tumkur

Background: Self-medication (SM) is practiced throughout the world and although it has known benefits, it is being abused mostly by the medical students community. Hence, this study was conducted to assess the knowledge of 1st-year MBBS regarding various aspects of SM such as the most commonly used drugs and its side effects. Aim and Objective: The aim of the study was to study the pattern of SM among 1st-year medical students and to improve pharmacovigilace and drug safety. Materials and Methods: This is a cross-sectional study done among 1st-year MBBS students aged 19–21 years of Sri Siddartha Medical College and Hospital, Tumkur. This was carried out after the approval from the Institutional Ethics Committee. A modified questionnaire was circulated to 150 1st-year MBBS students who voluntarily participated and who’s consent was taken to carry out this study, through Google Forms. Results: Results show that 61% of self-medicate with the major reason being previous exposure. About 51% are fully aware of the medication and its side effects while 44% are partly aware. About 37% have reported that they do not self-medicate due to risk of adverse effects and 25% do not self-medicate due to reasons such as lack of knowledge, awareness, and risk of using the incorrect drugs. Conclusions: This shows that SM is prevalent among 1st-year medical students and more insight and clinical exposure regarding the drugs is needed for cautious practice. Hence, SM is an essential part of self-care as per the WHO but more knowledge and awareness is needed which is acquired through the MBBS course. This can help reduce the risk of experiencing adverse effects.

A study on junk food consumption of 1st-year MBBS students aged 19–21 years of batch 2021–22 at Sri Siddhartha Medical College and Hospital, Tumakuru

Background: As per National Institute of Nutrition, Hyderabad, “Junk food is foods containing little or no proteins, vitamins, or minerals but are rich in salt, sugar, fats, and are high in energy (calories).” Many studies show junk foods have an adverse effect on both physical and mental health. Aims and Objectives: This study was taken up to take an insight into the adverse effects of excess calorie consumption during stress which is associated obesity and depression. Materials and Methods: A study on junk food consumption at SSMC, Tumkur to study the relationship between mental and physical health with the consumption of junk food among 1st-year MBBS students. A cross-sectional study was done on 1st-year MBBS students aged 19–21 year at SSMC, Tumkur with the approval of Institutional Ethics Committee. A modified questionnaire was circulated among 150 1st year MBBS students aged 19–21 years at SSMC, Tumkur through Google forms. The data collected were subjected to descriptive statistics and interpreted. Results: About 49% of the participants consumed junk foods regularly with 34% of the participants consuming more than once per week. More than 65% of participants consumed junk food in the evening. Around 46% of participants preferred weekend to consume junk foods. More than 50% of the participants consume junk foods when they are residing in hostel rather than home. More than 70% of the participants prefer junk food consumption during screen time. Conclusion: Factors that have led to consumption of junk food are affordability and cravings. Preference of consumption of carbonated drinks with junk food is also high. The study also shows a strong association of junk food consumption with stress and screen time behavior. Due to its low nutritional value, junk food should be discouraged. Hence, awareness program should be included in to the curriculum of all medical students and in other professions also.

Association of Dry Eye with Vernal Keratoconjunctivitis: A Hospital-based Cross-sectional Study

Introduction: Vernal Keratoconjunctivitis (VKC) is a common allergic disease seen in children. The allergic component is caused by Immunoglobulin E (IgE) and mast cell-mediated pathway. It is proposed to be a combination of immune system, genetic, and environmental factors. Secondary dry eye develops secondary to inflammatory disease namely vascular, allergic, environmental conditions like allergens, cigarette smoke, hormonal changes, systemic disorders, such as diabetes mellitus, eye surgeries such as refractive surgery and systemic medications, such as diuretics and antihistamines. Co-existence of dry eye and VKC can worsen the symptoms of the patient and may also lead to prolonged and unnecessary treatment of the disease. Aim: To study the association of dry eye with VKC by Schirmer’s test and Tear Film Breakup Time (TBUT). Materials and Methods: A hospital-based cross-sectional study was conducted in the Department of Opthalmology, Sri Siddhartha Medical College and Research Centre, Tumkur, Karnataka, India, from December 2020 to June 2022. Thirtythree patients of age group between 5-20 years with symptoms of VKC were evaluated for dry eye using Schirmer’s test and TBUT, respectively. Each patient was subjected to detailed history taking, followed by ocular examination as per the predesigned proforma. The patients were subjected to the tear film analysis using Schirmer’s test and TBUT. A total of 33 patients were evaluated and the data was compiled. The association between categorical variables were analysed by using Chi-square test. The data was analysed by using Statistical Package fot the Social Sciences (SPSS) software version 21.0. The parameters compared were the type of dry eye with the type of VKC. Results: The mean±Standard Deviation (SD) age of the study group was found to be 11±1.5 years. Out of 33 patients, 69.69% of all the cases were seen in the 5-12 years age group. There was male preponderance in the present study with 63.63% of patients being male child. VKC was most commonly seen as mixed accounting for 57.57% of cases. In the current study, it was discovered that 60.6% of cases showed no sign of dry eye, whereas 39.82% of cases had dry eye. The dry eye was more commonly seen in mixed type of VKC. The p-value was statistically significant (p-value<0.001) for association of dry eye with mixed type of VKC. Conclusion: The present study highlighted the co-existence of dry eye with VKC. There was a significant association of dry eye with VKC and type of VKC as well, which might have long-term effects on the ocular surface. These ocular surface alterations exist during active and the quiet phase of VKC. The patients of VKC may need a long-term follow-up and treatment for this ocular surface alteration.

A COMPARATIVE STUDY OF ATRACURIUM AND CIS- ATRACURIUM FOR INTUBATING CONDITIONS UNDER GENERAL ANAESTHESIA

Background: Atracurium and Cisatracurium are intermediate-acting nondepolarizing neuromuscular drugs. They both are promising drugs offering a predictable recovery due to non-organ dependent elimination. However, due to the variability in metabolism and narrow therapeutic window, monitoring of neuromuscular functions has signicant importance. Cisatracurium is approximately four times as potent as atracurium. In contrast to Atracurium, Cisatracurium is devoid of chemically mediated histamine release. Routinely atracurium is used for the neuromuscular blockade in most pediatric surgeries. On the other hand, 2 ED95 doses of Cisatracurium do not create satisfactory intubating conditions such as those seen with equipotent doses of atracurium. Aim: Ÿ To compare the intubating conditions of Atracurium(0.5mg/kg) and Cisatracurium 0.15mg/kg). Ÿ To compare the hemodynamic parameters (MAP, PR, SPO2,) between atracurium and Cisatracurium Ÿ To compare the signs of histamine release potential between atracurium and Cisatracurium. Materials and Methods : A Prospective, observational study was conducted at SRI SIDDHARTHA MEDICAL COLLEGE AND RESEARCH INSTITUTE,TUMKUR. from 1st Jan 2021 to 30th June 2022 on 74 patients. In Atracurium group, there were 15 patients Results: with ASA grade of 1 and 17 patients with ASA grade of II. In Cis-Atracurium group, there were 15 patients with ASA grade of 1 and 22 patients with ASA grade of II. Chi square test was performed between the 2 groups and p value was observed to be > 0.05 indicating no statistically signicant difference between the groups. Average onset time for Atracurium group was 177 ± 22.4 seconds and same was 184 ± 17.3 seconds in Cis Atracurium group. In Atracurium group, intubation was successful at 1st attempt in 33 subjects, 2nd attempt in 2 subjects, 3rd attempt in 2 subjects. In Cis Atracurium group, intubation was successful at 1st attempt in 35 subjects and 2nd attempt in 2 subjects. In Atracurium group, duration of action of the muscle relaxant was 46 ± 4.9 minutes, Duration of 25% recovery was 33 ± 4.2 minutes, Time of recovery from reversal was 1.7 ± 0.8 minutes. In Cis Atracurium group, duration of action of the muscle relaxant was 68 ± 7.1 minutes, Duration of 25% recovery was 48 ±5.6 minutes, Time of recovery from reversal was 2.2 ± 1.1 minutes. Cis atracurium had longer recovery time and duration of action. Atracurium c Conclusion: aused signicant hemodynamic impact than Cis atracurium. Adverse effects were comparable in both.

A COMPARATIVE STUDY OF THE EFFECTS OF INTRATHECAL MIDAZOLAM(1MG) AND FENTANYL(25 MICROGRAMS) AS ADDITIVES TO INTRATHECAL HYPERBARIC BUPIVACAINE 0.5%(15MG) IN SPINALANAESTHESIA

Background: Various intrathecal additives are added to local anesthetics to increase the speed of onset, improve the quality, and prolong the inuence of spinal anesthesia. Midazolam has a synergistic effect on postoperative analgesia when administered intrathecally with bupivacaine. Opioids such as fentanyl are extensively used as an adjunct to local anesthetics in neuraxial blockade to enhance the duration of postoperative analgesia. Aim: The aim of our study was to compare the effects of intrathecal midazolam(1mg) and fentanyl (25 micrograms) as additives to intrathecal hyperbaric bupivacaine 0.5% (15mg) with spinal anesthesia.Materials and Methods: Prospective, observational study was conducted at SRI SIDDHARTHAMEDICAL COLLEGE AND RESEARCH INSTITUTE,TUMKUR. from 1st Jan 2021 to 30th June 2022 on 94 patients. Results: In Bupivacaine and Midazolam group, mean duration of surgery was 84 ± 12.3 minutes and in Bupivacaine and Fentanyl group, mean duration of surgery was 92 ± 14.4 minutes. In Bupivacaine and Midazolam group, mean time for onset of sensory block was 7.1 ± 0.9 minutes and in Bupivacaine and Fentanyl group, mean time for onset of sensory block was 6.9 ± 1.1 minutes. In Bupivacaine and Midazolam group, mean time for onset of motor block was 7.6 ± 1.3 minutes and in Bupivacaine and Fentanyl group, mean time for onset of motor block was 8.1± 1.2 minutes. In Bupivacaine and Midazolam group, mean duration of sensory block was 213.6 ± 16.1 minutes and in Bupivacaine and Fentanyl group, mean duration of sensory block was 218.3 ± 19.2 minutes. Conclusion- The onset of sensory and motor blockade was comparable in Fentanyl with Bupivacaine and Midazolam with Bupivacaine. Additional of intrathecal Fentanyl prolonged the duration of analgesia signicantly than that of Midazolam. There was signicantly less consumption of rescue of analgesia among patients with Fentanyl with Bupivacaine than Midazolam with Bupivacaine. The duration of postoperative analgesia was also signicantly prolonged in the fentanyl and midazolam groups

Fixation stability scoring in inter-trochanteric femur fractures treated with osteosynthesis: A retrospective observational study

To find out the validity of a newly proposed fixation stability scoring system in IT fractures treated with osteosynthesis and its limitations if any.: Retrospective analysis of hospital records of patients with various types of intertrochanteric fractures treated surgically at Sri Siddhartha medical college, Tumkur from January 2021 till August 2022. The exclusion criteria were non-ambulatory patients prior to fall, non surgically treated patients, patients loosing follow up or patients who are not alive at the time of study. The scoring was done by three different observers for each patient’s immediate post operative x-ray, repeated at 1 month interval. Radiographs at the final follow up were assessed for fracture union or fixation failure. Parameters of the scoring system: 1) cortical buttress in AP view radiograph, 2) cortical buttress in lateral view radiograph, 3) Tip apex distance (TAD) of principle lag screw, 4) Entry point (in case of IM nail), 5) Location of tip of principle screw in the desired Cleveland zone. 6) Placement of Richard screw in the inferior half of neck (in case of DHS), 7) Use of additional derotation screw (DRS) (in case of DHS). Scores of all the observers showed statistically significant correlation with fixation failure rates. Results were good with the score of 7.5 and above, fair with 6.5 and above and poor when the score was below 6.5. The minimum acceptable score was 6.5 for extra-medullary devices and 7 for intra-medullary devices.: The newly proposed scoring system appears to be valid and promising intra operative guide for fixation of intertrochanteric fractures with a few limitations. Large scale multi centre prospective studies are needed in the future to support the current study or to further simplify this scoring system.

A STUDY OF ASSOCIATION BETWEEN SENSORINEURAL HEARING LOSS AND TYPE 2 DIABETES MELLITUS IN PATIENTS WHOSE HbA1C>8% IN A TERTIARY CARE CENTRE.

Background: Diabetes mellitus is a metabolic disorder caused by a partial or complete shortage of insulin, which leads to elevated blood sugar levels and long-term vascular and neurological complications. One of the side effects of uncontrolled diabetes mellitus is sensory hearing loss. Sensorineural hearing loss has a signicant inuence on patients' quality of life because it is directly linked to physical, psychological, and cognitive dysfunction. Methods: ENT department at Sri Siddhartha Medical College in Tumkur did a prospective study over the course of 22 months that included 75 type 2 diabetic patients of both sexes between the ages of 30 and 65. All subjects have undergone FBS, PPBS, and HbA1c tests, followed by PTAto assess hearing loss. Age, gender, laterality, degree of hearing loss, length of DM, and HbA1c levels were compared with the occurrence of SNHL. Results: Of the 75 DM patients in our study, 64 (85.3%) had SNHL, while 11 individuals were normal. The majority of the patients, or 39 (52%), are between the ages of 51 and 65. The majority of patients (64%) are men aged 48. Males outnumbered females by a factor of 1.7:1. 4 patients (7%) have hearing loss in both ears, 34 (53%) only have hearing loss in the left ear, and 26 (40%) only have hearing loss in the right ear. The majority of patients, or 32 patients (51%) are in the group with mild hearing loss, followed by 19 patients (30%) with moderate hearing loss, 7 patients (10%) with moderately severe hearing loss, 4 patients (6%) with severe hearing loss, and 2 patients (3%) with profound hearing loss. patients who have diabetes.

An epidemiological outline of acne vulgaris in non-obese patients at a tertiary care center in south India

<p><strong>Background: </strong>A brief clinical vignette of the clinico-epidemiological data of acne vulgaris patients at a tertiary care center as the data seems particularly lacking in this field with respect to non-obese patients.</p><p><strong>Methods: </strong>A total of 80 patients who were not obese and had no features of virilization attending the dermatology outpatient department at Sri Siddhartha medical college, Tumkur were enrolled in this descriptional study. A detailed questionnaire and proforma was utilized to record data pertaining to history and physical examination.</p><p><strong>Results: </strong>A total of 55% (n=44) were males and 45% (n=36) were females and acne vulgaris was maximally seen in the 20-29 years age group, 60% (n=48). In this study 50% (n=40) of the study subjects were students, 22.5% (n=18) housewives.76.5% (n=61) subjects had presented with complaints of acne over the face. The 37% (n=30) subjects who presented had a duration of onset less than 6 months. All subjects had involvement of the cheek and 27.5% (n=22) had involvement of chest and back. Mild grade of acne vulgaris was observed in 72% (n=58), moderate grade in 23% (n=18), severe and very severe grade in 5% (n=4).</p><p><strong>Conclusions: </strong>Acne vulgaris is one the most common dermatoses encountered by dermatologists. Any new information in the clinico-epidemiological aspects of this frequently met condition will help in preventive and management of acne vulgaris especially catering to the patient needs.</p>

English

BACKGROUND Screening of Diabetic retinopathy is essential for detection of diabetic retinopathy and its management. Diabetic retinopathy is a common and preventable cause of blindness in adults. Laser pan-retinal photocoagulation has been proven to have established efficacy in treating diabetic visual loss. Since India has a wide geographical area and there is a lack of trained ophthalmologists in peripheral India, there is an immense need for telemedicine in diabetic retinopathy screening. This study was done to evaluate the comparability of non-stereoscopic fundus photography with conventional fundoscopy for detection of diabetic maculopathy. METHODS All patients with diabetic retinopathy and mixed retinopathy presenting to Ophthalmology OPD at Sri Siddhartha Medical College between June 2020 and June 2021, were included in the study. The patients were evaluated for visual acuity on Snellen Visual Acuity Chart, Anterior Segment evaluation on a slit-lamp examination. Fundus was evaluated with 90 Diopter Volk lens with Slit Lamp biomicroscopy, Direct Ophthalmoscopy with Welch Allyn ophthalmoscope with medium size aperture, and the peripheral fundus was seen by an Indirect Ophthalmoscope with 20 Diopter lens Volk lens. ETDRS 7 Field Picture on Carl Zeiss Meditec AG VISUCAM SN model AA107 was taken. The observations were subjected to the statistical analysis of Cohen’s Kappa and the percentile description. RESULTS The commonest retinopathy was moderate non-proliferative diabetic retinopathy (NPDR), seen in 41.667 %. The commonest maculopathy found was the absence of maculopathy seen in 78.3 % of cases. There was perfect agreement (Kappa k-1.00) in the evaluation of background retinopathy on Conventional Fundoscopy and Fundus imaging, P-value < 0.001. There was moderate agreement (Kappa k-0.5) in the evaluation of maculopathy on Conventional Fundoscopy and Fundus imaging, Pvalue < 0.001, only for CSME and No maculopathy. However diffuse macular oedema and Ischemic Maculopathy were missed on Fundus Photography. CONCLUSIONS Non-Stereoscopic Fundus Photography is a good telemedicine tool for diabetic retinopathy screening, but there is under-diagnosis of it, though it can detect diabetic maculopathy. As a diagnosis”Absence of maculopathy” is inconclusive until and unless screened by Conventional Ophthalmoscopy. KEY WORDS Diabetic Retinopathy, Maculopathy, Clinically Significant Macular Oedema, NonStereoscopic Fundus Imaging, Ophthalmoscopy.