Tertiary Care Teaching Institute Research Articles

ANALYZING THE RELATIONSHIP AMONG CLINICAL SYMPTOMS, X-RAY RESULTS, AND CARTILAGE WEAR PATTERNS IN KNEE OSTEOARTHRITIS USING T2 MAPPING MRI

Objectives: Osteoarthritis (OA) is a condition that causes joint pain, varying degrees of functional limitations, and a decrease in overall quality of life. The purpose of this study was to examine the progression of cartilage degeneration in knees affected by symptomatic OA and determine its relationship with X-ray and T2 map MRI findings. Methods: This study was conducted at a Tertiary Care Teaching Institute in India and involved 40 patients. It was an observational type of study. For our assessment, we utilized the Western Ontario and McMaster University (WOMAC) osteoarthrosis index to evaluate function, quality of life, and joint pain. Medical imaging technique A standing AP view of the affected knee joint was taken using plain radiographs. Once the X-rays were obtained, they were graded using the Kellgren–Lawrence Classification, which ranges from 0 to 4 grades. Results: Out of the total patients, 6.0% were <40 years old, 21.2% were between 41 and 50 years old, 27.2% were between 51 and 60 years old, 39.3% were between 61 and 70 years old, and 6.0% were above 70 years old. In this study, there were 21 females (63.6%) and 12 males (36.4%). In this study, the researchers found that there was no distinction between the sides of the limb affected. Both the left and right sides were involved in 13 cases each, accounting for 39.39% of the total cases. In addition, 7 cases, or 21.21%, reported experiencing bilateral knee pain. Merchant grade reported that out of the knees examined, 17.5% had Grade 0, 45% had Grade 1, 27.5% had Grade 2, 10% had Grade 3, and none had Grade 4. Conclusion: The findings of this study suggest that T2 map MRI has the ability to accurately measure abnormal cartilage changes in conditions that affect the mechanical properties of the knee joint. It is crucial to have non-invasive methods that can assess early cartilage matrix changes. These methods are important for initiating early treatment, monitoring disease progression, planning operative procedures, and following up on operative cartilage repair.

A Study of Onychoscopic Findings in Various Dermatological Disorders

Context: About 10% of all the dermatological conditions are comprised nail disorders. It is challenging for the dermatologists to diagnose nail disorders quickly without the help of invasive procedures. Aims: The aim of the study was to evaluate onychoscopic patterns associated with various nail disorders. Settings and Designs: Hospital-based cross-sectional observational study was conducted at a tertiary care teaching institute in Maharashtra, India from November 2019 to May 2021. Materials and Methods: One hundred and fifty patients, with a history and clinical presentation suggestive of nail disorders, were recruited in the study after confirming the clinical diagnosis. Patients having secondarily modified lesions were excluded. Dry as well as wet onychoscopy using polarized and nonpolarized modes was performed with the help of DermLite 4 dermoscope with an attached OnePlus 8T mobile phone camera to capture and save the dermoscopic images. Data were compiled and statistically analyzed using SPSS version 21.0. Statistical Analysis Used: Categorical variables were expressed in frequency and percentages. Data were entered in Microsoft Excel and analyzed using SPSS version 20. P value (using Z-test for proportions) was calculated wherever needed. Results: The majority of the patients were in the age group of 21–50 years with slight male preponderance. Overall most common onychoscopic findings studied in all the disorders were the nail plate alterations followed by chromonychia. The most common nail changes associated with connective tissue disorders were changes in the proximal nail fold capillaries along with changes in the curvature. The most common change observed in onychomycosis was chromonychia. Aurora borealis, spikes, and jagged edges of onycholytic plate with ruin pattern of hyperkeratosis were specific to onychomycosis. Inflammatory disorders of the nail unit (e.g., lichen planus and nail psoriasis) showed nail plate alterations with increased nail plate fragility. Conclusions: Some onychoscopic patterns are observed consistently with certain diseases, and these can be used for their diagnosis, hence, avoiding unnecessary biopsies, thus improving the patient outcome.

CLINICAL ASSESSMENT OF ANTIBIOTICS USED IN CHRONIC KIDNEY DISEASE: A LONGITUDINAL OBSERVATIONAL STUDY

Objective: The study was conducted to clinically evaluate the safety and efficacy of antibiotic drug consumption based on laboratory data, specifically White Blood Cells(WBC) and Glomerular Filtration Rate (GFR) before and after antibiotic use in patients with chronic kidney disease. Methods: This retro-prospective longitudinal study was conducted on 115 patients with Chronic Kidney Disease (CKD) based on 6 mo of data at a tertiary care teaching institute, Geetanjali Medical College and Hospital, in Udaipur, Rajasthan. Inclusion criteria were all the patients who were admitted in the nephrology department and were above 18 y, who were receiving antibiotics, and Creatine Clearance (CrCl) was ≤ 60 ml/min were included into this study. Exclusion criteria patients with renal replacement and lacking information of laboratory data (WBC, CrCl) and those who were below the age of 18 were excluded from the study. The data were analysed using descriptive analysis. Results: The mean age of the CKD patients was 50.10 (standard deviation=17.47) y. Males were found in greater numbers than that of females with 66 (58%) and 49(42%) respectively. Patients admitted with stage 5 CKD (66%) were greater than the patients with stage 4 CKD. 10 different types of antibiotics were provided to CKD patients, of which seven had irrational doses. Piptaz, Meropenem, and Teicoplanin have the highest irrational doses incidence. Conclusion: Patients with CKD Stages 4 and 5 were given systemic antibiotics at unreasonable dosages, most frequently in the forms of piptaz, aztreonam, and meropenem injections. The incidence of irrational antibiotic dosages provided to the CKD patients was still high.

A Clinico-dermatoscopic Study of Vulvar Dermatosis at Rural-based Tertiary Care Teaching Institute

Introduction: The frequency and importance of vulval diseases are often underestimated due to the multifactorial nature of disease on the vulva. Dermoscopy can help provide clues for early diagnosis and insight into dermoscopic patterns. The present study was done with the objective to study the clinico-dermoscopic pattern of dermatosis and correlate the dermatoses with the age of the patient. Materials and Methodology: This was a prospective cross-sectional observational study conducted in the department of dermatology at a tertiary health care center over a period of 1½ year. All females with dermatosis affecting genital areas attending the skin outpatient department or ward were recruited after taking written consent. A detailed history was taken to collect demographic data. A thorough clinical examination and dermatoscopy were done. Descriptive statistics was used to depict the profile and dermatoscopic pattern. Results: Out of the 103 patients with vulvar dermatoses, 24 (23.30%) patients were in the age group of 41–50 years. A total of 43 (41.74%) patients had infective conditions, followed by 16 (15.53%) patients of papulosquamous group of disorders and 11 (10.67%) patients of eczema. Dermatoscopic findings had a surface scale in 40 (38.83%), vascular patterns in 22 (21.36%), red dots in 19 (18.45%), and structureless patterns in 13 (12.62%) with different vulvar dermatosis. In tinea cruris, out of 30 cases, 28 (93.33%) had surface scales, followed by 5 (16.67%) showing vascular pattern, whereas in lichen sclerosus et atrophicus, out of total of 10 cases, 8 (80%) had structureless pattern and 6 (60%) had vascular patterns. Discussion and Conclusion: Genital diseases represent a diagnostic challenge for clinicians. The use of dermoscopy improves the diagnostic accuracy by recognizing specific dermoscopic patterns. Limitation: Small sample size was the only limitation.

Obstetric Anal Sphincter Injury After Episiometer-Guided Versus Conventional Episiotomy in Instrumental Deliveries: A Randomized Controlled Trial.

Guidelines recommend episiotomy for instrumental vaginal delivery with an optimal incision angle of 60° to protect the anal sphincter. The "Episiometer" is a new device promising a 60° incision angle. We compared the incidence of obstetric anal sphincter injury (OASI) and post-repair suture angle of episiotomies made with conventional "eyeballing" versus Episiometer guided during instrumental delivery. We conducted this randomized controlled trial in a tertiary care teaching institute in southern India after ethical committee approval, trial registration, and informed consent. We randomized (block) 328 pregnant women aged 18 years and above with term, singleton fetuses delivered by instruments into Episiometer-guided (164) or conventional episiotomy (164) groups (allocation concealed). We compared the OASI (identified clinically) and the suture angle measured from the midline (assessor blinded) in the two groups. We followed up on the subjects at 6 and 12 weeks to assess perineal pain and fecal/flatus incontinence. The incidence of OASI of 0.61% in the Episiometer group was significantly lower compared with 4.88% in the eyeballing group (Chi-squared = 5.6; p = 0.02; adjusted risk ratio = 5.9; CI 0.7-46.1; p = 0.09). A significantly higher proportion of subjects (59.1%) in the Episometer group had a post-suture angle between 36 and 40° compared with 36.6% in the eyeballing group (Chi-squared = 21.8, p < 0.001). We found no significant difference in the perineal pain or Wexner score during follow-up. The Episiometer-guided episiotomy during instrumental delivery resulted in a significantly higher suture angle and lower obstetric anal sphincter injuries than with conventional eyeballing.

Molecular identification of Malassezia from the skin scrapings of clinically suspected cases of pityriasis versicolor.

Pityriasis versicolor (PV) is caused by a lipophilic fungus belonging to the genus Malassezia. Potassium hydroxide (KOH) mount is most frequently used for screening of cases and culture is the gold standard. KOH lacks sensitivity, and culture is time-consuming and technically demanding. A cross-sectional study was conducted at a tertiary care teaching institution. We aimed to use multiplex-PCR for faster and accurate identification of Malassezia spp directly from skin scrapings of suspected cases of PV. The study was conducted on suspected cases of PV over a period of 12 months. The clinical and demographic details were recorded. The skin scrapings were subjected to KOH mount and cultured on Sabouraud's dextrose agar with an olive oil overlay. Multiplex-PCR targeting 11 Malassezia spp was performed on DNA extracted from skin scrapings. A total of 69 suspected cases of PV were studied. Most patients belonged to metro cities and worked in hot and humid climates. The mean duration of lesions was 18 months, and most had macular and patchy lesions. The sensitivity of KOH and culture was found to be 82.6% and 91.3%, respectively. M. globosa (n = 60, 87%) and M. restricta (n = 3, 4.3%) were isolated in culture. Multiplex PCR detected 85.5% of M. globosa, 5.8% of M. restricta, and 8.7% of mixed infection with M. globosa and M. restricta. M-PCR detected Malassezia in all the samples. M-PCR could identify Malassezia species directly from skin specimens, eliminating the need for culture. M-PCR was accurate, dependable, and exhibited a rapid turnaround time.

An evaluation of etiological factors of infertility in a tertiary care teaching institute in Uttar Pradesh

An evaluation of etiological factors of infertility in a tertiary care teaching institute in Uttar Pradesh

Empathy, Moral Sensitivity, and Prosocial Behavior Among Medical Undergraduates in a South Indian Tertiary Care Teaching Institute: An Analytical Cross-Sectional Study.

Empathy, moral sensitivity, and prosocialness are critical traits for medical professionals, as they affect patient care quality and ethical decision-making. These traits help address psychological complexities like stress and burnout in medical practice. Despite their importance, the relationships between these traits, especially among medical students, remain underexplored. This study aims to assess empathy, moral sensitivity, and prosocialness among medical students in South India, focusing on gender differences and their associations. This cross-sectional study was conducted at Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Chennai, with 369 medical undergraduates. Data were collected using three standardized tools: the Interpersonal Reactivity Index for empathy, the Moral Sensitivity Questionnaire, and the Prosocialness Scale for Adults. The questionnaire, including demographic data, was administered online with anonymity and consent. Descriptive statistics summarized demographic data. Inferential analyses, including t-tests, chi-square tests, Pearson correlations, and multivariate regression, examined relationships between empathy, moral sensitivity, pro-social behavior, and demographics. Statistical significance was set at p < 0.05. Ethical approval was obtained from Saveetha Medical College's Ethics Committee. The mean age of participants was 20.5 ± 2 years, with 183 males (49.6%) and 186 females (50.4%). The majority were first-year students (29.8%), followed by second-year (19.5%) and final-year part I students (19.2%).Final professional part II students and interns comprised 15.4% and 16%, respectively. Females scored significantly higher in empathy domains like perspective-taking (15 ± 3.3 vs. 14 ± 3.4), fantasy (14.4 ± 4 vs. 13.6 ± 3.3), and empathetic concern (15.3 ± 3.5 vs. 14.2 ± 3.1), with p values <0.05. Overall, 186 females (50.4%) had a mean empathy score of 59 ± 9, compared to 183 males (49.6%) with 56.2 ± 7.1 (Cohen's d = 0.33). In moral sensitivity, females scored higher in modifying autonomy (7 ± 2.3 vs. 6.3 ± 2.2), structuring moral meaning (4.6 ± 2 vs. 4.15 ± 1.6), and expressing benevolence (16 ± 4 vs. 15 ± 4), with significant differences (p < 0.05). The total moral sensitivity score was higher in females (57 ± 10 vs. 54 ± 9), with a moderate effect size (Cohen's d = 0.3). Males scored higher in prosocialness, with 183 males (49.6%) scoring 54 ± 7, compared to 186 females (50.4%) with 51.5 ± 7.2 (Cohen's d = 0.3). Weak but significant correlations were found between empathy and prosocialness (r = 0.132, p = 0.011) and between moral sensitivity and prosocialness (r = 0.479, p < 0.001). Regression analysis identified gender, prosocial behavior, and specific moral sensitivity dimensions as significant predictors of empathy scores. This study revealed significant gender differences in empathy, moral sensitivity, and prosocialness among medical students. Females scored higher in empathy and moral sensitivity, whereas males showed greater prosocial behavior. The positive correlations between empathy and prosocialness and between moral sensitivity and prosocialness highlight their interconnectedness. Educational interventions that target empathy and moral sensitivity could help nurture more compassionate, ethical healthcare professionals. Future research should explore how these traits evolve throughout medical education.

Impact of educational intervention among nurses on implementation of surgical safety checklist at a tertiary care teaching institute

Impact of educational intervention among nurses on implementation of surgical safety checklist at a tertiary care teaching institute

Safety and effectiveness of ultrasound-guided single injection of 5% dextrose for median nerve hydrodissection in carpal tunnel syndrome

Background: In carpal tunnel syndrome (CTS), conservative management did not show satisfactory results, and some patients required revision surgery due to persistent or recurrent symptoms. Ultrasound (USG)-guided median nerve (MN) hydrodissection with a 5% dextrose injection is an advanced approach for treating symptoms of CTS. We prospectively investigated the patients to demonstrate the safety and effectiveness of this approach. Aims and Objectives: This study aims to evaluate the effect of USG-guided nerve hydrodissection using single injection of 5% dextrose on pain, MN conduction parameters, and functional status in patients with CTS of mild–to-moderate grade. The study also predicts about the safety of the procedure. Materials and Methods: A study was performed in the pain clinic of the tertiary care teaching institute of India for one year. The study included 15 patients diagnosed with mild-to-moderate CTS. The diagnosis was done on the basis of history, physical examination, and a nerve conduction velocity (NCV) study. Patients were given analgesics and NSAIDS and enrolled in the procedure. Parameters used for statistical analysis were Visual Analog Scale (VAS) scores, NCV study data (sensory conduction velocity [SNCV] and distal motor latency [DML]), and Boston carpal tunnel questionnaire (BCTQ) scores. Pre-injection parameters were compared with parameters 3 months after the injection to show the usefulness of this procedure. Results: A statistically significant reduction in VAS score was found in 74% of the cases (P&lt;0.05). The nerve conduction study parameters have shown significantly higher SNCV and lower DML latency in 60% of cases (P=0.001 and P=0.001, respectively). Improved BCTQ scores were found in 80% of cases (for the symptom severity scale, P=0.001 and for the functional status scale, P&lt;0.01). No complications such as allergic reactions, sensory loss, or paresis were recorded post-injection. However, transient injection site pain was present in all patients which did not last for more than 24 h. Conclusion: MN hydrodissection using a single injection of 5% dextrose under USG is a safe and effective approach offering pain relief, better MN conduction, and improved functional status in patients with CTS of mild-to-moderate grade.

Comparative Study of Outcome in Cessation Therapy of Smoked Form of Tobacco and Factors Affecting It Using Tablet Bupropion or Nicotine Replacement Therapy

Background: Tobacco use is one of the major causes of preventable deaths and diseases in India. Standard treatment used in tobacco use disorder can be broadly categorized as nicotine replacement therapy (NRT) and nonnicotine pharmacotherapy. Aims: The aim of this study was to compare the outcome of tobacco cessation in subjects using the smoked form of tobacco, using tablet bupropion or NRT, and to assess various factors influencing the outcome. Settings and Design: Twelve-week follow-up study was conducted in patients of tobacco use disorder attending the outpatient department of psychiatry in a tertiary care teaching institute for a duration of 12 months, after permission from the institutional ethical committee. Materials and Methods: Hundred subjects were taken as per the inclusion criteria. After obtaining the general sociodemographic data, the severity of tobacco dependence was assessed by Fagerstrom Scale at baseline, 2 weeks, 4 weeks, 8 weeks, and 12 weeks after assigning intervention (tablet bupropion or NRT) of their choice. Statistical Analysis Used: SPSS software is used for statistical analysis. Pearson correlation, analysis of variance, and multiple regression analysis were done and P &lt; 0.05 was considered to be significant. Results and Conclusion: NRT works better in all groups of patients having mild, moderate, or severe tobacco dependence, whereas bupropion works better in groups of patients having moderate-to-severe tobacco dependence.

Is there any materno- foetal risks in mothers with gestational weight gain (WHO &amp; IOM) based on their pre-pregnancy body mass indices? Our experience in a tertiary care teaching institution in North Kerala

: This research was done to learn the impact of pre-pregnancy BMI and gestational weight gain (GWG) on subsequent risks of adverse pregnancy outcomes in a tertiary care teaching institution in North Kerala, India. A descriptive study in a tertiary care teaching institution in Kozhikode, North Kerala. : 296 singleton pregnant women with BMI categorised as per Asian Standards and adverse maternal outcomes were looked out for. Pregnant women were underweight (82.8%) achieved less than recommended weight during pregnancy as compared to 18.4% obese mothers. Mothers with high BMI gained more than recommended weight during pregnancy as compared to the underweight and normal weight woman. GDM was 3.03 times(p=0.019)and Hypertensive disorders of pregnancy was 1.116 times more common in higher pre-pregnancy BMI mothers. In the present study, gestational weight gain had no impact on maternal anaemia, Gestational diabetes, Gestational hypertension, foetal growth restriction and rate of caesarean deliveries. A statistically significant positive correlation was obtained between pre-pregnancy BMI and baby weight, p&amp;#60;0.001. A statistically significant positive correlation was obtained between gestational weight gain and baby weight, p=0.005. Weight gain during pregnancy had no significant impact on maternal pregnancy outcomes and caesarean delivery.

Assessment of knowledge, attitude and practice of fixed-dose combinations amongst attending physicians and residents: a cross-sectional evaluation.

Fixed-dose combinations (FDCs) were brought into the market with the intent of providing benefits primarily to patients and physicians. Nevertheless, despite their multiple advantages, they have their own set of drawbacks, especially regarding irrational FDCs. If physicians continue to prescribe them, prohibiting their sale would become all the more challenging. This cross-sectional survey study was planned to comprehend the level of knowledge, attitude and practice of physicians regarding such FDCs at a tertiary care teaching institute of western Uttar Pradesh, India. A pre-validated questionnaire was communicated electronically to all the attending physicians. For data analysis, descriptive statistics were applied and a χ2 test was performed for inter-group comparison. Amongst the 108 respondents, participation was almost comparable from both medical and surgical branches, with most participants being junior residents (58%). Even with sound knowledge of FDCs, only 46.30% of them were aware of banned FDCs. Similarly, only 6.48% could correctly identify the disadvantages associated with the use of FDCs, and 33.18% could correctly recognize irrational FDCs. This finding was consistently reflected in their attitude and practice and only 15.74% of respondents cross-referenced FDCs with the available literature. Furthermore, despite 88.89% of respondents checking for rationality of FDCs before prescribing them, a compendium of irrational FDCs is routinely prescribed. To amend these shortcomings in prescribing of irrational FDCs, some recommendations are proposed by the authors herein.

Role of Renal Sonography in the Diagnosis of Chronic Kidney Disease

Aim: to use sonographic imaging in grading CKD and assess the serum creatinine, renal longitudinal size,parenchymal thickness and compare these parameters based upon ultrasonographic grade.Material and Methods: Present cross-sectional; study was conducted at the Department of Radiology, Tertiary Care Teaching Institute of India for the duration of 1 year. There are 120 participants with CKD in the research.All patients received a questionnaire, and a thorough clinical examination was done. Each participant underwent sector curved array transducer of 3.5–5 MHz ultrasound images of their liver and kidneys. Low tissue harmonic and speckle reduction imaging techniques are used to measure the echogenicity of the kidney and liver while reducing interobserver bias. In all the participants, the mean values of both the kidneys renal longitudinal size and parenchymal thickness were calculated. Renal cortical echogenicity was compared and graded with the echogenicity of the liver and renal medulla.Results: The mean age of the CKD patients was found to be 45.23 ± 06.05 years. It was found that 50 patientshad Grade 1, 40 patients had Grade 2, 20 patients had Grade 3 and 10 patients had Grade 4. The results showed that, when the comparison was done, serum creatinine was found to be significant among echogenicity grades with ANOVA. when the comparison was done; the mean longitudinal size was found to be significant among echogenicity. On comparison was found to be mean Parenchymal thickness was found to be significant among echogenicity grades.Conclusion: Renal cortical echogenicity and its grading in relation to longitudinal length, parenchymal thickness, and cortical thickness in CKD patients are the best sonographic parameters that correlate with blood creatinine. It is possible to use renal cortical echogenicity as a metric of renal function since it has the benefit of being irreversible in compared to serum creatinine levels.

Pretreatment Thyroid Profile and its Relationship with Response to Treatment with Lithium in Bipolar Mood Disorder: A Longitudinal Study from Northeast India

Abstract Background: The thyroid hormone’s significant impact on the treatment of depressive and other mood disorders is well documented. Even minor hypothyroidism can modify the progression and treatment results of major depressive disorder. This research aims to explore the correlation between initial thyroid levels and the treatment outcome in bipolar mood disorder using lithium, a well-established treatment method. Methodology: The study involved 45 bipolar mood disorder patients diagnosed according to the Diagnostic and Statistical Manual 5 criteria and admitted to a tertiary care teaching institute in Northeast India. The patients received lithium treatment, with injectable lorazepam used for immediate agitation control when necessary. On the 1st day, a semi-structured questionnaire and Brief Psychiatric Rating Scale (BPRS) 24-item scale were used to evaluate symptoms, and samples were collected for a thyroid profile, including T3, T4, FT3, FT4, and thyroid-stimulating hormone (TSH). The BPRS scale was used again on the 30th day to assess treatment response. Results: The BPRS subscale showed the highest treatment response for grandiosity and the lowest for depression. Factors such as age, illness duration, substance use, and family history of mood disorder were inversely correlated with the BPRS score’s decrease. Initial thyroid levels were identified as a predictor of treatment response, with baseline T4 levels showing a significant positive correlation with treatment response, while baseline TSH levels showed a negative correlation. Conclusion: Lithium proved to be an effective treatment for bipolar mood disorder, particularly for the manic subtype. Initial T4 and TSH levels were found to significantly predict treatment response, with T4 showing a positive correlation and TSH showing a negative correlation.

Comparative study between 0.5% bupivacaine versus 0.5% ropivacaine in peribulbar anesthesia for cataract surgery

Background: For intraocular surgery, the optimal local anesthetic agent must have a rapid onset of action and a sufficient duration of effect so as to enable a painless, motionless procedure without prolonging akinesia. Aims and Objective: This prospective, comparative observational study compares ropivacaine and 0.5% bupivacaine for cataract surgery peribulbar block. Hyaluronidase is utilized in both groups because it promotes local anesthetic diffusion. Material and Methods: Present prospective, observational, comparative study performed at the Department of Anesthesia Tertiary Care Teaching Institute of India for the duration of 1 year. All eligible patients were allocated in two groups as GROUP B and GROUP R. GROUP B: 10 mL of 0.5% bupivacaine and 15 I.U./mL of hyaluronidase. GROUP R: 10 mL of 0.5% ropivacaine and 15 I.U./mL of hyaluronidase. Patients were assessed for sensory block, eyelid, and ocular movements at an interval of 2 min, and Visual Analog Scale score for pain assessment. Results: Age and gender did not differ significantly between the two study groups, according to the findings. Comparable and similar patient characteristics distinguished the two study groups. (P&gt;0.05). The difference in onset of eyelid motor blockade between the two groups was not statistically significant. The difference in the onset of motor blockade [ocular movement] between the two groups was not statistically significant (P&gt;0.05). (P&gt;0.05) Analgesia duration differed significantly between the two groups in a statistical sense. Ropivacaine exhibits a significantly prolonged duration of analgesic effect than bupivacaine (P≤0.05). Conclusion: Peribulbar block utilizing 0.5% ropivacaine is a more favorable and secure option for a local anesthetic that effectively extends postoperative pain alleviation, in comparison to the use of 0.5% bupivacaine.

The Blood Donor Deferral Rate and the Reasons for Deferral at a Tertiary Care Teaching Institute in Northeastern Malaysia.

A deferral takes place when donors fail to meet the eligibility criteria for donating blood during their visit to a blood collection site. Deferral periods, which can be either permanent or temporary, are implemented to protect the well-being of both the donor and the recipient.This study aimed to investigate the frequency of deferrals and the various factors contributing to them.A retrospective analysis was conducted at the Transfusion Medicine Unit of Hospital Universiti Sains Malaysia (USM), utilizing data obtained from blood donors during the period from January 2022 to June 2023. The research included a cohort of 18,751 donors who visited our transfusion unit for blood donation. Data, including gender, age, and reasons for deferral, were collected by reviewing the records of donors who were deferred. Descriptive statistics were employed to analyze the data of deferral blood donors.Out of 18,751 blood donors, 3,533 (18.84%) were deferred, consisting of 1,267 males (35.86%) and 2,266 females (64.14%). The age group of 18-25 years accounted for the highest number, comprising 1,875 donors (53.07%). Among the deferred cases, 53.33% were first-time donors, followed by 25.28% regular donors and 21.40% lapsed donors. The deferral of blood donors resulted from various reasons. The most common cause of overall deferral among blood donors was low hemoglobin (38.33%), followed by upper respiratory tract infections (8.38%), chronic medical illness (7.08%), and high blood pressure (7.02%). Temporary deferrals were more prevalent than permanent deferrals, accounting for 91.57% of cases compared to 8.43% for permanent deferrals.Voluntary non-remunerative blood donors constitute the backbone for a safe and reliable blood supply in transfusion services. Utilizing a comprehensive database will enable effective counseling of temporarily deferred donors, providing insights into the reasons for their deferral, the expected duration, and the appropriate treatments. This information is crucial for motivating these donors to recruit again in the donor pool. Public education initiatives aimed at raising awareness about the causes of deferral and promoting regular health check-ups can play a pivotal role in minimizing these deferrals.

CONVERSION TO OPEN CHOLECYSTECTOMY - A SAFE ALTERNATIVE, NOT A FAILURE!

Background: Understanding factors that predict conversion in laparoscopic cholecystectomy (LC) to an open procedure is important as it allows better patient selection, preparation, operating list planning, referral, counseling and lowers the threshold for a safe conversion, thereby minimizing undue prolongation of attempts at laparoscopic completion and inadvertent complications.Methods: Records of 1010 consecutive patients who were taken up for LC, at a tertiary care teaching institute in northern India, were reviewed retrospectively. Preoperative and intraoperative characteristics of patients who underwent a successful LC were compared with those who required conversion to open surgery.Results: The conversion rate was 7.5% (76 patients). The most common reason for conversion was the inability to define the ‘Critical view of safety’ in 48, (63%) of patients. Other reasons included dense peri-cholecystic 9 (12%) and intra-abdominal 8 (11%) adhesions, suspicion of bile duct injury 4 (5%) or malignancy 3 (4%). Prior upper abdominal surgery, intraoperative finding of a contracted and thick-walled gallbladder (GB), empyema GB, Mirizzi’s syndrome, cholecysto-enteric fistula, and a prior endoscopic common bile duct stone clearance were significant predictors of conversion. Xanthogranulomatous cholecystitis was found more commonly (43% vs 5%) in the conversion group.Conclusion: Conversion to an open procedure during LC should always be treated as an integral component of sound judgement to achieve the safest outcome in a particular patient. Due consideration of pre-operative and intra-operative factors predictive of a higher chance of conversion assists pre-operative patient preparation and counseling as well as surgical planning, conduct and mentoring of residents-in-training.

Analysis of Cutaneous Adverse Drug Reactions (ADR) Reported at an ADR Monitoring Center of a Tertiary Care Teaching Institute in Central India.

Background Cutaneous adverse drug reactions (ADRs) are among the most frequent ADRs. Knowledge of the pattern of cutaneous ADRs (CADRs) and causal drugs helps prevent and reduce the incidence of CADR, which in turn reduces the incidence of hospitalization and expenses for the patient. Objectives To analyze CADR according to demographic profile, morphological pattern, causative drugs, severity, and outcome in patients suffering from CADRs. Materials and methods Retrospective data analysis was conducted in the Adverse Drug Reaction Monitoring Centre (AMC) of the tertiary care teaching institute between February 2020 and September 2023 under the Pharmacovigilance Program of India (PvPI). All ADRs reported were analyzed based on the following parameters: total number of ADRs reported, number of CADRs, information related to demographic parameters, the clinical presentation of CADRs, and suspected medication. Causality assessment was done using theWorld Health Organisation-Uppsala Monitoring Centre (WHO-UMC) scale. Severity was assessed using a modified Hartwig and Seigel scale. Results A total of 125 CADRs were analyzed. Considering the gender-wise distribution,65 females and 60 males suffered from CADR. The most common drug category responsible for CADRs was antimicrobials (63.2%), followed by topical agents (12.8%). Maculopapular rash (33.6%) was the most common presenting symptom, followed by itching (27.2%). Few patients suffered from serious CADRs such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Conclusion A wide clinical spectrum of CADRs ranging from maculopapular rash to fixed-drug eruption to serious SJS was observed in our study. The most common causative agents for CADRs were antimicrobials, followed by topical agents and NSAIDs. For early diagnosis and management of CADRs,it is critical to have data on the potential cutaneous adverse effects of commonly used drugs, to educate the patients regarding common early symptoms of drug reactions (e.g., erythematous rash, edema, urticaria, mucosal erosions, itching, burning of skin, etc.), and to monitor the patient, especially during the start of therapy.To ease the burden of CADRs, a therapeutic plan of anticipating, avoiding, recognizing, and responding to ADRs should be implemented.

A Study of Clinical and Socio-Demographic Profile of Elderly Patients with Opioid Use Disorder on Agonist Treatment Attending a Tertiary Care Teaching Institute of India

Background: Opioid use is one among the major substance of use in Indian population which is not only seen in younger age group but rather is an upcoming concern in the elderly population as well. Opioid agonist treatment for opioid use disorder is a better way of management, among which buprenorphine is a safer option. Despite, being an important area of health concern, opioid use is poorly studied in the geriatric population. Objective: To study the clinical and socio-demographic profile of elderly patients with opioid use disorder on agonist treatment attending a tertiary care teaching institute of urban Delhi. Method: A retrospective study was done in an OPD based opioid treatment centre of a tertiary care hospital in Delhi to analyze the socio-demographic, clinical profile, pattern of opioid use disorder and opioid agonist treatment (Buprenorphine) in elderly Indian population over a year. The data collected was further analyzed for descriptive and analytic statistics using SPSS version 23.0. Results: A total of 32 subjects of age &gt; 60years, with predominant male population having mean age of 63.6years we seen. They had heroin use by inhalation route as a major opioid use. The main source of referral was by friends and self with significant medical and psychiatric comorbidities that was seen in the elderly group. An average dose of 2.34mg of Buprenorphine was found to effectively manage the geriatric opioid use disorder. Conclusion: Opioid Used Disorder is common in Geriatric population and is often associated with both psychiatric and medical co-morbidities. Opioid agonist treatment is an effective approach in management of elderly cases of opioid use disorder. Declaration of Interest : None