International Research Journal of Pharmacy
The International Research Journal of Pharmacy (IRJP) is a peer-reviewed scientific journal that publishes original research, reviews, and short communications in the field of pharmaceutical sciences. The journal covers a wide range of topics including drug discovery, pharmacology, medicinal chemistry, pharmaceutical formulation, clinical pharmacy, pharmacovigilance, biotechnology, and pharmaceutical technology. It aims to provide a platform for researchers, academicians, and professionals in the pharmaceutical industry to share their findings, advancements, and innovations. Editor- In-Chief: Dr. Priyadershini Rangari Title proper: International Research Journal of Pharmacy (IRJP) Journal Initials: IRJP ISSN: 2230-8407 Subject: Medical Sciences, Pharmacy Publisher: PANhealth Care Research Society Dates of publication: 2010 Frequency: Monthly Language: English Country: India Medium: Online Indexed by: CROSSREF Title DOI of the Journal: http://doi.org/10.56802
CLINICOEPIDEMIOLOGICAL STUDY OF TINEA CORPORIS AND TINEA CRURIS AMONG PATIENTS ATTENDING A DERMATOLOGY OUTPATIENT DEPARTMENT
Background: Dermatophytosis is one of the most common superficial fungal infections affecting skin, hair, and nails. The increasing prevalence, recurrence, and chronicity of dermatophytic infections have become important dermatological concerns in tropical countries. Aim: To evaluate the clinical profile and epidemiological factors associated with tinea corporis and tinea cruris among patients attending a dermatology outpatient department. Methods: A prospective observational study was conducted among 134 patients clinically diagnosed with dermatophytosis. Detailed history regarding demographic profile, personal hygiene, occupation, sweating, family history, and recurrence was recorded. Clinical examination and potassium hydroxide (KOH) mount examination were performed. Statistical analysis was carried out using the chi-square test and the independent t-test. A p-value less than 0.05 was considered statistically significant. Results: Male predominance was observed with the majority of patients belonging to the 21–40 years age group. Tinea corporis was the most common clinical presentation followed by tinea cruris. Excessive sweating, poor hygiene, tight clothing, and positive family history demonstrated significant association with recurrent dermatophytosis. Conclusion: Dermatophytosis is highly prevalent among young adults and is significantly associated with environmental and personal risk factors. Early diagnosis, treatment compliance, and maintenance of hygiene are essential for reducing recurrence and transmission.
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AN EPIDEMIOLOGICAL STUDY OF DENTAL CARIES AND ASSOCIATED RISK FACTORS AMONG SCHOOL CHILDREN
Background: Dental caries is one of the most common preventable oral health problems affecting school children. It may cause pain, difficulty in eating, school absenteeism, reduced concentration, and impaired quality of life. Dietary habits, poor oral hygiene, irregular tooth brushing, and lack of preventive dental care contribute significantly to its occurrence. Aim: To evaluate the prevalence of dental caries and associated oral hygiene and dietary risk factors among school children. Methods: A cross-sectional observational study was conducted among 240 schoolchildren aged 6–12 years in 2017. Demographic details, oral hygiene practices, frequency of sweet consumption, rinsing habits after meals, and previous dental visits were recorded using a structured format. Oral examination was performed under adequate natural light using sterile instruments, and dental caries was assessed according to World Health Organization criteria. Data were analyzed using SPSS software version 20. The Chi-square test was used to assess associations between categorical variables, and a p-value less than 0.05 was considered statistically significant. Results: Out of 240 school children examined, 142 (59.2%) had dental caries. Dental caries was slightly more common among girls than boys and was highest in children aged 9–10 years. Daily consumption of sweets, brushing once daily or irregularly, failure to rinse the mouth after meals, and absence of a previous dental visit were significantly associated with dental caries. Conclusion: Dental caries was common among school children and showed significant association with modifiable dietary and oral hygiene factors. School-based oral health education, regular screening, promotion of twice-daily brushing, reduction in frequent sweet consumption, and timely referral for dental treatment may help reduce the burden of dental caries among children.
CROSS-SECTIONAL STUDY ON ANXIETY AND DEPRESSION AMONG PATIENTS RECOVERING FROM COVID-19 INFECTION ATTENDING THE PSYCHIATRY OUTPATIENT DEPARTMENT
Background: The COVID-19 pandemic has resulted in significant psychological stress and psychiatric morbidity among recovered patients. Anxiety and depressive symptoms have been increasingly reported during the post-COVID recovery period. Aim: To evaluate the prevalence of anxiety and depression among patients recovering from COVID-19 infection and to identify associated psychosocial and clinical factors. Methods: A cross-sectional observational study was conducted among 129 patients recovering from COVID-19 infection attending the psychiatry outpatient department between June 2021 and May 2022. Anxiety and depression were assessed using Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HAM-D). Sociodemographic profile, hospitalization history, duration of illness, sleep disturbances, and psychosocial stressors were evaluated. Statistical analysis was performed using chi-square test and independent t-test. A p-value less than 0.05 was considered statistically significant. Results: Moderate anxiety and mild depression were the most common psychiatric manifestations observed among post COVID patients. Sleep disturbances, prolonged hospitalization, social isolation, and financial stress demonstrated significant association with anxiety and depression. Conclusion: Psychological morbidity is common among patients recovering from COVID-19 infection. Early psychiatric screening and psychosocial support are important components of post-COVID rehabilitation.
CLINICOEPIDEMIOLOGICAL PROFILE AND QUALITY OF LIFE ASSESSMENT IN PATIENTS WITH PSORIASIS ATTENDING A DERMATOLOGY OUTPATIENT DEPARTMENT: A PROSPECTIVE OBSERVATIONAL STUDY
ABSTRACT Background: Psoriasis is a chronic immune-mediated inflammatory skin disorder characterised by recurrent erythematous scaly plaques and a variable clinical course. Apart from visible cutaneous lesions, psoriasis may cause itching, scaling, discomfort, cosmetic concern, social embarrassment, and psychological distress. Assessment of disease severity and quality of life is therefore essential for understanding the overall burden experienced by affected patients. Aim: To evaluate the clinical profile, severity pattern, and quality of life among patients with psoriasis attending a dermatology outpatient department. Methods: A prospective observational study was conducted in the Department of Dermatology during the year 2020 among 126 adult patients clinically diagnosed with psoriasis. Detailed histories of demographic characteristics, disease duration, precipitating factors, family history, addictions, and associated comorbidities were recorded. Clinical examination included evaluation of the type of psoriasis, site of involvement, nail changes, and joint involvement. Disease severity was assessed using the Psoriasis Area Severity Index (PASI), while quality of life was assessed using the Dermatology Life Quality Index (DLQI). Statistical analysis was performed using SPSS software version 22. The chi square test and independent t-test were applied as appropriate. A p-value of less than 0.05 was considered statistically significant. Results: Male predominance was observed, with the majority of patients belonging to the 31–50-year age group. Chronic plaque psoriasis was the most common clinical type. Scaling and pruritus were the predominant symptoms. Moderate psoriasis was the most frequently observed PASI severity category. Moderate and severe quality of life impairments together were observed in a substantial proportion of patients. Severe psoriasis shows a significant association with severe DLQI impairment. Hypertension and diabetes mellitus were the most frequently observed associated comorbidities. Conclusion: Psoriasis is associated with significant clinical and psychosocial burden. Increasing disease severity adversely affects quality of life. Routine assessment using PASI and DLQI, along with screening for comorbidities and psychological difficulties, may help provide comprehensive care to patients with psoriasis.
The topics covered include Chronic Plaque Psoriasis
ANXIETY DISORDERS AMONG HOMEMAKERS ATTENDING PSYCHIATRY OUTPATIENT DEPARTMENT: A CROSS-SECTIONAL OBSERVATIONAL STUDY
ABSTRACT Background: Anxiety symptoms are common mental health concerns among women and may remain underrecognized among homemakers. Daily domestic responsibilities, financial dependency, family conflict, caregiving burden, limited social support, sleep disturbance, and exposure to domestic violence may contribute to emotional distress and greater symptom severity. Aim: To evaluate anxiety severity and associated psychosocial factors among homemakers attending a psychiatry outpatient department. Methods: A cross-sectional observational study was conducted among 122 homemakers aged 20–60 years attending a psychiatry outpatient department. Sociodemographic characteristics, family structure, sleep patterns, and psychosocial stressors were recorded. Each participant underwent mental status examination and anxiety severity assessment using the Hamilton Anxiety Rating Scale (HAM-A). Data were analysed using SPSS software version 20. A chi-square test and independent t-test were applied as appropriate, and a p-value less than 0.05 was considered statistically significant. Results: The mean age of the participants was 38.2 ± 8.6 years, and the majority belonged to the 31–45-year age group. Moderate anxiety was observed in 56 (45.9%) participants and severe anxiety in 24 (19.7%). Excessive worry and sleep disturbance were the most frequently reported symptoms. Family conflict, financial stress, lack of social support, domestic violence, and sleep disturbances showed significant association with greater anxiety severity. Conclusion: Moderate-to-severe anxiety symptoms were common among homemakers attending the psychiatry outpatient department and were associated with important psychosocial stressors. Routine enquiry regarding family difficulties, financial stress, violence, social support, and sleep complaints may assist in planning comprehensive psychiatric care.
EVALUATION OF BENZODIAZEPINE DEPENDANCE AND ITS ASSOCIATION WITH COAGNITIVE FUNCTIONING IN LONG TERM USERS AT RAMA MEDICAL COLLEGE AND RESEARCH CENTRE, KANPUR
ABSTRACT Background: Long-term benzodiazepine (BZD) use has been associated with cognitive decline, but the relationship between dependence severity and specific cognitive domains remains underexplored. This study aimed to assess the extent of benzodiazepine dependence and its impact on cognitive functioning in chronic users. Materials and Methods A cross-sectional study was conducted on 120 long-term BZD users (≥6 months) at Rama Medical College Hospital and Research Centre, Kanpur. Participants were assessed using the Benzodiazepine Dependence Self-Report Questionnaire (BENDEP-SRQ), which covers four domains (problematic use, preoccupation, lack of compliance, and withdrawal symptoms), and the Montreal Cognitive Assessment (MoCA) for cognitive evaluation. Sociodemographic details were also collected. Data analysis was done using SPSS version 29.2, with Pearson correlation used to determine associations. Results A majority of participants were male (60%), aged 36–39 years (49.2%), from low socioeconomic backgrounds (61.7%), and had only primary education (50.8%). The severity of benzodiazepine dependence was significantly associated with cognitive impairment. A strong negative correlation was found between dependence severity and MoCA total score (r = -0.887, p < 0.001), with specific domains such as attention (r = -0.885) and delayed recall (r = -0.833) being most affected. The moderate dependence group showed the highest frequency of high scores in BENDEP domains, particularly in problematic use and preoccupation. Conclusion Benzodiazepine dependence is strongly associated with cognitive decline, especially in attention, memory, and overall cognitive functioning. Sociodemographic vulnerabilities—such as male gender, low education, and low income—further compound this risk. Routine cognitive screening and timely intervention in long-term BZD users are essential to mitigate the risk of irreversible cognitive impairment.
RISK FACTORS FOR ACUTE LOWER RESPIRATORY TRACT INFECTION IN CHILD SUBJECTS
Background: Acute lower respiratory tract infections, or ALRTIs, are the leading cause of death for children under five. Finding the modifiable risk factors for severe ALRTI can significantly lower the burden of ALRTI. Aim: The purpose of the current study was to evaluate the risk factors for acute lower respiratory tract infections in children under five years of age. Methods: Participants with ALRTI were included in the trial, while controls were people who came to the pediatric outpatient department for vaccinations. The possible risk factors in cases and controls were documented using a pre-made structured proforma. Results: 256 child subjects—101 cases and 155 controls—were evaluated in this study. With ORs of 5.13, 2.83, 2.3, 1.83, 24.93, and 6.51, respectively, it was observed that family history of ALRTI, improper immunization age, cooking on media other than LPG, severe malnutrition, upper respiratory tract infection in siblings, and not breastfeeding were significant risk factors for ALRTI. Housing type, insufficient caloric intake, anemia, number of children at home, parental education, parent age, and child gender are non-significant risk factors for ALRTI. Conclusions: The current study shows that severe malnutrition, upper respiratory tract infections in siblings, cooking on media other than LPG, incorrect immunization age, family history of ALRTI, and non-breastfeeding were important risk factors for ALRTI and should be closely watched.
POSTNATAL EXERCISE PRACTICES IN INDIAN FEMALES
Background: A woman's life is significantly impacted by pregnancy and childbirth, and postpartum exercise has been shown to foster a more comfortable and suitable bond between mother and child. Aim: The goal of the current study was to evaluate Indian women's postpartum exercise practices and knowledge. Methods: During the specified study period, 200 girls admitted to the postnatal ward of the institute were evaluated. The "Health Belief Model" created by Hochbaum and altered by Rosenstock was used to evaluate each of these women. To evaluate these women's practice and knowledge of possible exercises, a structured interview was done. Results: According to the study's findings, 52% of females had relatively adequate knowledge of postnatal exercise, whereas 28% had inadequate information and 20% had the lowest knowledge. Additionally, 53% and 47% of females, respectively, practiced postnatal exercises in a somewhat accurate and imprecise manner. Knowledge scores were significantly correlated with mothers' occupations and levels of education, while practice scores were significantly correlated with information sources, mothers' occupations, levels of education, parity, and female age. Conclusion: The current study suggests that postpartum women did not do or understand postnatal workouts. Therefore, in order to improve moms' practice and knowledge, healthcare professionals must conduct health awareness programs about postnatal workouts.
CLINICAL AND EPIDEMIOLOGICAL CHARACTERISTICS OF POISONING CASES BROUGHT TO EMERGENCY DEPARTMENT
Background: Acute poisoning is one of the most serious medical situations that Indian healthcare facilities' emergency rooms deal with. There is, however, a dearth of information on this topic in the literature. Aim: to evaluate the clinical and epidemiological characteristics of poisoning patients brought to the Indian Institute's emergency room. Methods: the poisoning cases that were admitted to the Institute during the specified research time frame. The research evaluated 1096 poisoning patients in all. Age, gender, employment, kind of poisoning, presentation time, GCS scores, and results were all thoroughly evaluated for each participant. Results: The research's findings indicated that young men who worked as farmers made up the bulk of the study participants with poisoning episodes. Nearly 70% of both purposeful and accidental instances survived with no death, the GCS was low, and more than half of the participants had presentation times longer than two hours. The most frequently reported poisoning agents in both purposeful and unintentional poisoning instances were sedatives and organophosphorus chemicals. Conclusion: The current study comes to the conclusion that it gives emergency physicians clinical and epidemiological information about how poisoning patients present and what kind of poison they are experiencing when they visit the emergency room in the Indian healthcare system.
ASSESSMENT OF THE SURVIVAL AND MORTALITY PREDICTORS IN PATIENTS WITH THROMBOCYTOPENIC PURPURA (TTP) ADMITTED TO THE CRITICAL CARE UNIT
Background: Widespread microthrombosis is a feature of TTP, a multisystem illness that often puts afflicted individuals at risk for multiple organ failure. The results of critically sick patients with TTP treated in the intensive care unit are not well documented in the literature. Aim: The objective is to assess the factors that predict survival and death in patients with TTP who are hospitalized to the intensive care unit (ICU). The incidence of nosocomial infections in participants who had plasma exchange (PE) and those who did not was also compared in the research. Methods: The research assessed severely ill people with TTP handled in an intensive care unit. Information was gathered from hospital data and records for every person who was included for further assessment. Non-parametric statistical methods were used for data reporting. The collected data was statistically examined in order to formulate the findings. Results: 34 of the 267 screened participants fulfilled the requirements for inclusion and underwent evaluation. The mortality rate among TTP individuals was 41.17% (n=14). The ratio of women to men was 7:3. Thrombocytopenia, anaemia, and lactate dehydrogenase levels were greater in non-survivors than in survivors, with 2124 (1939-3317) u/L vs 2985 (1902-3612) U/L with p=0.69, 21x101µl vs 17x101µl with p=0.61, and 7.4g/dl (5.9-8.7) vs 5.2g/dl (4.6-6.9) with p=0.04, respectively. 55.88% (n=19) subjects had AKI (acute kidney injury) whereas 57.89% (n=11) subjects survived Conclusions: The current study comes to the conclusion that females with high death rates are more likely to have TTP. In TTP victims, low haemoglobin, advanced age, and increased platelet transfusions are indicators of poor survival. The incidence of nosocomial infection was similar regardless of PE treatment.
MAHA (microangiopathic haemolytic anaemia)
OBSERVATIONAL STUDY ABOUT WOUNDS OF ABUSE AND NEGLECT IN CHILDREN
Background: Because of its function in communication and nourishment, the mouth cavity is considered a crucial and focus area in situations of abuse or physical assault. When it comes to the dental and oral components of child abuse and neglect, dentists who have received the proper training in child abuse curriculum may support and aid doctors. Aim: The purpose of this study was to evaluate the orofacial characteristics of children aged 5 to 16 who had been abused or neglected. Methods: Five hundred children between the ages of five and sixteen were evaluated for this study. Every participant was suspected of having been the victim of child abuse or neglect. A dentist with extensive curricular training evaluated orofacial characteristics extensively in each subject. Results: Thirty percent (n=144) of the 500 participants in the research had lacerations in different locations, such as the floor of the mouth in 3.6% (n=18), palate in 6.4% (n=32), buccal mucosa in 10.4% (n=52), frenum in 3.2% (n=16), and lip in 5.2% (n=26). Avulsion characteristics were seen in 11.6% (n=58) of the participants. 100% (n=500), 7.6% (n=38), 41.6% (n=208), and 7.2% (n=36) of the individuals had deposits, missing teeth, dental caries, and dentoalveolar fractures, respectively. Conclusion: a thorough perioral and intraoral evaluation is essential for subjects who have experienced child abuse or neglect because the oral cavity is a critical site for evaluating physical abuse, which can be linked to its critical function in communication and nutrition. Dentists and physicians should work in collaboration for better detection, prevention, and treatment of such conditions.
Three-Dimensional Strut Plate for the Treatment of Mandibular Fractures: A Systematic Review and Meta-Analysis
ABSTRACT Background: Mandibular fractures represent one of the most common facial skeletal injuries worldwide, accounting for 36–59% of all maxillofacial fractures. The introduction of three-dimensional (3D) strut plates, conceptualized by Farmand in 1995, sought to combine the biomechanical advantages of two parallel bars positioned along the lines of osteosynthesis described by Champy with the additional resistance to torsional forces afforded by vertical interconnecting bars. Whether this geometric configuration translates into superior clinical outcomes compared with conventional miniplates remains debated. Objectives: To systematically review and quantitatively synthesize the current evidence comparing 3D strut plates with conventional miniplates for the open reduction and internal fixation of mandibular fractures, with respect to postoperative infection, hardware failure, malocclusion, operating time, and other clinically relevant outcomes. Methods: A systematic search of PubMed/MEDLINE, Scopus, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science was performed for studies published between January 1995 and December 2024. Randomized controlled trials and prospective or retrospective comparative cohort studies enrolling at least five patients per arm and reporting outcomes for both 3D strut plate and conventional miniplate fixation of mandibular fractures were eligible. Two reviewers independently screened records, extracted data, and assessed risk of bias using the ROBINS-I tool. Random-effects meta-analyses (DerSimonian–Laird) were performed using odds ratios (OR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI). Heterogeneity was quantified by I² statistics and publication bias was evaluated using funnel plots and Egger's regression test. Results: Eighteen studies enrolling 1,196 patients (598 in the 3D plate group and 598 in the conventional miniplate group) were included in the qualitative synthesis; 14 contributed to the meta-analysis. The pooled analysis demonstrated a significantly lower odds of postoperative infection in the 3D plate group (OR 0.37, 95% CI 0.22–0.60; p < 0.001; I² = 0%), a lower odds of hardware failure or plate fracture (OR 0.28, 95% CI 0.15–0.53; p < 0.001; I² = 0%), and a non-significant trend toward less postoperative malocclusion (OR 0.60, 95% CI 0.34–1.03; p = 0.063; I² = 0%). Operating time was significantly reduced with 3D plates by a mean of 16.25 minutes (95% CI −18.38 to −14.12; p < 0.001; I² = 0%). The funnel plot for the infection outcome was symmetric and Egger's test was non-significant (p = 0.581), suggesting no substantial publication bias. Conclusions: Three-dimensional strut plates are associated with significantly lower rates of postoperative infection and hardware failure, and significantly shorter operative time, compared with conventional Champy miniplates for the treatment of mandibular fractures. The reduction in malocclusion did not reach statistical significance. The overall certainty of evidence is moderate, downgraded mainly because of the predominance of small, non-randomized comparative studies. Larger, well-designed randomized trials are needed to confirm these findings and to better characterize the role of 3D plates in specific fracture subtypes.
FORENSIC SKILLS LAB TO IMPROVE MEDICO-LEGAL SKILLS IN MEDICAL STUDENTS
Background: keeping the essentiality of medicolegal complexities in day-to-day practice, doctor should have forensic skills too as far as related to Medical field. Aim: to compare score between Traditional and FMSL method, and to evaluate the effectiveness of module FMSL on students and faculty Methods: Comprehensive lists of practical skills including all relevant psychomotor skills were assembled and reviewed; then checklists were developed concurrently with the development of each learning guide. All learning guides and checklists was peer-reviewed. Each guidelines contained a description of the exact steps and their proper sequence, needed by the learner to competently perform each skill. These steps correlated to the consensus of international best practices. Results: After training in a skills lab, a notable change was seen. The FMSL approach has demonstrated a 30–70% improvement in scores, whereas the traditional method has demonstrated a 20–40% difference. Additionally, it was noted that training in FMSL improved practical skills more than training in the conventional manner. According to student feedback, they felt that the skills lab was helpful. Students enjoy the atmosphere, the facilitation, and the training of the facilitators in certain abilities. Conclusion: Forensic Medicine Skills Lab are intended to train Indian medical graduates and can be suggested for use in medical education in a legal context in India.
A Comparison of Erector Spinae Plane Block and Oblique Subcostal Transversus Abdominis Plane (TAP) Block for Postoperative Analgesia in Laparoscopic Cholecystectomy: A Randomized Controlled Study
Background: Effective postoperative pain control following laparoscopic cholecystectomy is essential for early recovery and improved patient satisfaction. Ultrasound-guided erector spinae plane block (ESPB) and oblique subcostal transversus abdominis plane block (OSTAPB) are commonly used regional analgesic techniques; however, comparative evidence regarding their efficacy remains limited. Materials & Methods: This prospective randomized comparative study was conducted among 60 patients undergoing elective laparoscopic cholecystectomy under general anaesthesia. Patients were randomly allocated into two groups: Group E received ultrasound-guided ESPB (n=30) and Group O received ultrasound-guided OSTAPB (n=30). The primary outcome was time to first rescue analgesia. Secondary outcomes included static and dynamic Visual Analogue Scale scores and total tramadol consumption during the first 24 postoperative hours. Results: The mean time to first rescue analgesia was significantly longer in the ESPB group compared to the OSTAPB group (9.58 ± 1.2 vs 8.09 ± 1.0 hours; p<0.001). Static VAS scores were significantly lower in the ESPB group from 1 hour onwards, while dynamic VAS scores were significantly lower from 30 minutes onwards up to 24 hours postoperatively (p<0.001). Total postoperative tramadol consumption was significantly reduced in the ESPB group compared to the OSTAPB group (6.67 ± 17.2 mg vs 61.67 ± 44.8 mg; p<0.001). Conclusion: Ultrasound-guided ESPB provided superior postoperative analgesia with prolonged analgesic duration, lower pain scores, and reduced opioid consumption compared to OSTAPB in patients undergoing laparoscopic cholecystectomy.
Capnography-Guided Sedation: Effects on Patient Safety and Recovery
Aim The aim of this study was to evaluate the effect of capnography-guided sedation on patient safety and recovery outcomes during procedural sedation. Methodology This prospective randomized controlled clinical trial was conducted on 60 patients undergoing elective procedures under moderate sedation. Patients were randomly allocated into two groups. Group A (n = 30) was monitored using standard monitoring parameters along with continuous capnography, while Group B (n = 30) received standard monitoring alone. All patients were sedated using intravenous midazolam and fentanyl. Respiratory adverse events, time to detection of respiratory compromise, need for airway interventions, oxygen desaturation episodes, and recovery time were recorded and analyzed. Results The incidence of respiratory adverse events was significantly lower in the capnography group compared to the control group. Hypoventilation and apnea were observed less frequently in Group A. The mean time to detection of respiratory compromise was significantly shorter in the capnography group (18.4 ± 5.2 seconds) compared to the control group (54.6 ± 12.8 seconds; p < 0.001). Oxygen desaturation episodes and airway interventions were also significantly reduced in Group A. Recovery time was significantly shorter in patients monitored with capnography (21.3 ± 6.1 minutes) compared to the control group (32.8 ± 7.4 minutes; p < 0.001). Conclusion Capnography-guided sedation improves patient safety by enabling early detection of respiratory compromise and enhances recovery outcomes by reducing recovery time. Routine use of capnography during procedural sedation may significantly improve clinical safety and efficiency.
A COMPARATIVE STUDY OF MUSCLE FASCICULATION AND POST OPERATIVE MYALGIA FOLLOWING ENDOTRACHEAL INTUBATION USING VECURONIUM BROMIDE VS SUCCINYLCHOLINE WITH OR WITHOUT ROCURONIUM PRIMING: A PROSPECTIVE RANDOMISED CONTROLLED TRIAL
Introduction: Endotracheal intubation commonly requires neuromuscular blockade for optimal intubating conditions. Succinylcholine remains the gold standard because of its rapid onset and short duration but is associated with muscle fasciculations and postoperative myalgia. Rocuronium pretreatment has been proposed to reduce these adverse effects. Objective: To compare the incidence of fasciculation and postoperative myalgia following endotrachealintubation using succinylcholine alone, succinylcholine with rocuronium priming, and vecuronium alone. Methods: This prospective randomized controlled trial included 75 patients of American Society of Anaesthesiologists (ASA) physical status I–II, aged 18–60 years, undergoing elective surgery under general anaesthesia. Patients were randomly allocated into three groups (n=25 each): Group S received succinylcholine 1.5 mg/kg, Group SR received rocuronium priming 0.05 mg/kg followed by succinylcholine 1.5 mg/kg, and Group V received vecuronium 0.1 mg/kg. Primary outcomes were incidence and severity of fasciculations and postoperative myalgia at 6, 12, and 24 hours. Secondary outcomes included intubating conditions and hemodynamic parameters. Results: Rocuronium priming significantly reduced fasciculations compared with succinylcholine alone (32.0% vs 60.0%, p=0.013). Fasciculation-like movements were lowest in the vecuronium group (16.0%). Intubating conditions differed significantly among groups, with the best conditions observed in the rocuronium-primed group (p=0.048). Although postoperative myalgia was numerically lower in the rocuronium-primed group, differences at 6, 12, and 24 hours were not statistically significant (p>0.05). Hemodynamic parameters remained clinically acceptable in all groups. Conclusion: Rocuronium priming significantly reduces succinylcholine-induced fasciculations and improves intubating conditions. Although postoperative myalgia was numerically lower with rocuronium priming, this difference did not reach statistical significance.
RESULTS, FEASIBILITY AND SAFETY IN LAPAROSCOPY ASSISTED TRANSHIATAL ESOPHAGECTOMY
Background: The whole laparoscopic method, which has not yet acquired widespread acceptance due to its complexity, is also used to treat esophageal cancer. Additionally, there is a dearth of data in the literature regarding LATE for esophageal cancer. Aim: To evaluate the results, viability, and safety of LATE (laparoscopic-assisted transhiatal esophagectomy) in patients with esophageal cancer. Methods: During the study period, a single surgical team performed LATE (laparoscopic-assisted transhiatal esophagectomy) on 52 patients with esophageal cancer. The study participants ranged in age from 33 to 70, with a mean age of 54.8±2.4 years. Results: The average length of hospital stay, blood loss, and operating time were 11.3 days (7–26), 300 milliliters (100–500), and 300 minutes (160–650), respectively. Pulmonary problems were observed in 30.7% (n=16) and cervical anastomotic leak in 11.5% (n=6) of the individuals, respectively. In 3.84% (n=2), 11.5% (n=6), 38.46% (n=20), and 46.15% (n=24) of the individuals, the AJCC staging was IIA, IIB, IIIA, and IIIB. Conclusion: The current study comes to the conclusion that LATE (laparoscopic-assisted transhiatal esophagectomy) is a safe and practical treatment option for the chosen individuals with lower thoracic esophageal cancer.
EVALUATION OF LOWER GASTROINTESTINAL BLEEDING
Background: Hospitalization is frequently caused by lower gastrointestinal bleeding, a disorder that is frequently described in clinical practice. In hospitals, lower gastrointestinal bleeding plays a crucial role in predicting mortality and morbidity, especially in older patients. Aim: The objective is to evaluate the necessity for blood transfusions, clinical evaluation, and different causes of lower gastrointestinal bleeding in patients hospitalized to a tertiary healthcare facility in India. Methods: Of the 494 patients evaluated in the study, 412 were retrospective and 82 were prospective. In retrospective circumstances, the necessary facts and information were gathered from the records. Data collection and administration were carried out in potential cases. Results: Of the subjects, 56.07% (n=277) were over 40. Hemorrhoids were the most prevalent pathology on colonoscopy, occurring in 30.76% (n=152) of the participants. Anorectal and colonic growth were observed in 15.18% (n=75) and 9.71% (n=48) of the individuals, respectively. 13.96% (n=69), 4.85% (n=24), and 3.84% (n=19) of the participants had inflammatory lesions, colonic polyps, and rectal polyps, respectively. Males and females had mean hemoglobin levels of 10.62±3.77 and 10.81±3.67 g/dl, respectively. Conclusions: The current study finds that hemorrhoids are the most frequent cause of lower gastrointestinal bleeding, followed by anorectal growth, with colonoscopy being the initial and most popular test for evaluation. Only a small number of patients with lower GI bleeding require blood transfusions.
EFFICACY OF ANTI-DIABETIC DRUGS ON PREVENTION OF MYOCARDIAL INFARCTION IN DIABETIC SUBJECTS
Background: Compared to subjects without diabetes mellitus, those with the disease are more likely to need repeated PCI (percutaneous coronary intervention). Aim: The purpose of this study was to evaluate and compare the effectiveness of glucose-lowering medications on the secondary prevention of myocardial infarction in individuals with type 2 diabetes. Methods: During the specified study period, 200 subjects who were over or equal to 30 years old and had percutaneous coronary intervention at the Institute were evaluated. Based on their anti-diabetic medication prescription records, the 200 participants were split up. The rate of coronary revascularization was the primary outcome evaluated in the research participants. Results: Among the 200 participants in the study, those taking metformin had a significantly lower risk of needing percutaneous coronary intervention. Thiazolidinedione (TZD)-treated obese individuals with a BMI of ≥25 kg/m2 had a lower risk of repeated revascularization than non-TZD-treated individuals (p<0.05). Regardless of their BMI, subjects taking metformin had a lower risk of requiring revascularization. Meglitinide, insulin, and alpha-glucosidase inhibitors were associated with the need for repeated percutaneous coronary interventions. Conclusion: Individuals with diabetes treated with metformin and obese individuals treated with thiazolidinedione had a significantly lower risk of requiring revascularization. According to these results, doctors should choose the right anti-diabetic medications for secondary prevention of coronary artery disease.
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EFFICACY OF TELMISARTAN TO OTHER ANTI-HYPERTENSIVE DRUGS ON INSULIN SENSITIVITY
Background: In individuals with hypertension and diabetes mellitus, elevated ET-1 (endothelin) levels and the existence of insulin resistance are important factors that lead to renal and cardiovascular complications. But in India, these subjects are not sufficiently studied. Aim: The objective is to compare the effectiveness of telmisartan with other widely used anti-hypertensive medications in terms of insulin sensitivity with respect to HOMA-IR in individuals with diabetic hypertension. Methods: 140 participants who reported to the Institute during the specified study period and had both diabetes and hypertension were evaluated. These subjects were split into two equal groups, with Group I subjects (n = 68) receiving telmisartan and Group II subjects (n = 72) receiving other antihypertensive medications for 12 weeks, including ramipril in 4 subjects, cilnidipine in 24 subjects, and amlodipine in 44 subjects. Change in insulin sensitivity on HOMA-IR was the primary outcome measured, and ET-1 levels were the secondary outcome. Results: At baseline, the median HOMA-IR levels were 3.9 (2.0-5.7) for telmisartan and 3.7 (2.9-5.7) for another group. When compared to other antihypertensive groups, telmisartan significantly reduced median HOMA-IR after 12 weeks of treatment (p=0.001). Comparable outcomes were observed for ET-1, whose levels dropped in both groups after 12 weeks with a non-significant difference and p=0.88. Conclusion: When compared to other antihypertensive medications, telmisartan dramatically increases insulin sensitivity after 12 weeks in individuals with type 2 diabetes and hypertension. ET-1 levels, however, showed a similar impact on endothelial function in both groups. Positive metabolic effects of telmisartan may aid in the management of macro and microvascular complications.
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Seizure Beyond Brain: A Case Report on Pseudohypoparathyroidism
Pseudohypoparathyroidism (PHP) represents a group of disorders due to end organ resistance to the actions of parathyroid hormone (PTH) and abnormalities in the PTH signaling pathway. PHP is characterized by hypocalcemia and hyperphosphatemia with variable expression of clinical phenotype. The constellation of these clinical features together is termed as Albright hereditary osteodystrophy (AHO). Molecular genetics is the gold standard for confirmation and categorization of PHP into the different subtypes. Despite recent advances in molecular diagnostics, clinical approach appears to be more practical in resource limited setting. Here, we discuss about clinical features, radiographic abnormalities, laboratory findings and treatment of an 8-year-old-girl with pseudohypoparathyroidism.
Association of serum ferritin and insulin resistance in PCOD patients
Background: Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder associated with insulin resistance and metabolic abnormalities. Emerging evidence suggests that altered iron metabolism, reflected by elevated serum ferritin levels, may contribute to insulin resistance and related complications in PCOS. Objective: To evaluate serum ferritin levels and insulin resistance in women with PCOS and compare them with age- and BMI-matched healthy controls. Materials and Methods This hospital-based case–control study was conducted at Lady Hardinge Medical College, New Delhi, over a period of two years (February 2021 to September 2022). A total of 60 subjects were included, comprising 30 diagnosed cases of PCOS (based on Rotterdam criteria) and 30 healthy controls matched for age and BMI. Fasting venous blood samples were collected and analyzed for serum ferritin, insulin, fasting blood glucose, HbA1c, and serum iron using standard biochemical methods. Insulin resistance was assessed using the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). Statistical analysis was performed using Student’s t-test, Chi-square test, and Pearson correlation, with p<0.05 considered significant. Results The mean serum insulin and HOMA-IR levels were significantly higher in PCOS cases compared to controls (p<0.00001). Serum ferritin levels were also significantly elevated in PCOS subjects (81.50±63.98 ng/mL) compared to controls (50.83±39.92 ng/mL) (p=0.029). Fasting blood glucose and HbA1c levels were significantly higher in cases (p<0.001). A positive correlation was observed between serum ferritin and insulin resistance, fasting blood glucose, and insulin levels, while a negative correlation was noted with HbA1c. Conclusion Elevated serum ferritin is associated with insulin resistance in PCOS, suggesting its role as a potential biomarker for metabolic risk assessment
ASSESSMENT OF THE ANTHROPOMETRY AND NUTRITIONAL STATUS OF SUBJECTS WITH CHRONIC KIDNEY DISEASE
Background: To prevent a decline in nutritional status and promptly address any nutritional deficiencies, all patients with chronic kidney disease and those receiving dialysis should regularly assess their nutritional status. Aim: The purpose of this study was to evaluate the nutritional status and anthropometry of individuals with chronic kidney disease (CKD) in India. Methods: During the specified study period, 200 CKD patients receiving maintenance hemodialysis at the Institute were evaluated. To obtain pertinent biochemical and anthropometric data, each participant's file was evaluated. A pre-made proforma was used to collect the data, which were then statistically evaluated. Methods: There were more men than women. The CKD subjects' mean protein and calorie values were 71.73±77.163 and 1657.58±240.177, respectively. The BMI, weight, and mean MUAC were 23.84±1.707, 57.369±6.20, and 21.54±1.703, respectively. The study participants' mean MUAC, BMI, and weight increased after three months. The mean RBS, VLDL, HDL, triglycerides, and cholesterol levels in CKD subjects were 117.63±21.44, 28.486±7.112, 49.44±6.27, 139.74±6.27, and 163.88±29.73, respectively. RBS levels dropped after three months, while mean cholesterol, VLDL, HDL, and triglycerides all rose. Conclusion: Body weight, BMI, and biochemical markers are all impacted by a nutritious diet. Subjects with chronic kidney disease (CKD) often consume low amounts of protein and energy, so it's critical to inform subjects, their families, and co- patients about important foods that meet recommended intake levels. When compared to the initial assessment, follow-up subjects exhibit better nutritional knowledge.
MAGNESIUM INTAKE ON BLOOD PRESSURE CONTROL IN HYPERTENSIVE SUBJECTS- AN ANALYTICAL STUDY
Background: Even with the best salt restriction and medicine, a considerable percentage of hypertensive people are unable to reach good blood pressure. Numerous research has documented magnesium's ability to decrease blood pressure, however there is a dearth of information on Indian individuals in the literature. Aim: Using 24-hour urine magnesium excretion as a surrogate marker for magnesium consumption and the impact of magnesium-rich flaxseed on blood pressure control, the current study sought to evaluate the significance of magnesium intake on blood pressure control in Indian patients. Methods: Eighty participants with essential hypertension and inadequate blood pressure control were evaluated in this study using the JNC-8 BP objectives. As controls, the remaining 80 individuals had essential hypertension and adequate blood pressure control. Urinary Mg/Cr (magnesium-creatinine) ratios were measured from 24-hour urine samples collected from controls and patients. Two groups were compared using this Mg/Cr ratio. Three tablespoons of roasted whole flaxseeds were administered daily for four weeks to a subgroup of forty-six patients, and the significance of the mean blood pressure change before and after the intervention was evaluated. Results: According to the study's findings, persons with good blood pressure management had a considerably greater Mg/Cr ratio than those with poor blood pressure control (p=0.02). The mean systolic and diastolic blood pressure considerably dropped in a different subset of participants who took three tablespoons of flax seeds per day (p=0.005 and 0.01, respectively). Conclusion: According to the current study, individuals with hypertension who have effective blood pressure control excrete more magnesium in their urine during a 24-hour period than those who do not. As an adjunct to medication therapy, flaxseeds can help hypertensive patients better control their blood pressure.
A COMPARATIVE STUDY OF MUSCLE FASCICULATION AND POSTOPERATIVE MYALGIA FOLLOWING ENDOTRACHEAL INTUBATION USING VECURONIUM BROMIDE VS SUCCINYLCHOLINE WITH OR WITHOUT ROCURONIUM PRIMING: A PROSPECTIVE RANDOMISED CONTROLLED TRIAL
ntroduction: Endotracheal intubation commonly requires neuromuscular blockade for optimal intubating conditions. Succinylcholine remains the gold standard because of its rapid onset and short duration but is associated with muscle fasciculations and postoperative myalgia. Rocuronium pretreatment has been proposed to reduce these adverse effects. Objective: To compare the incidence of fasciculation and postoperative myalgia following endotracheal intubation using succinylcholine alone, succinylcholine with rocuronium priming, and vecuronium alone. Methods: This prospective randomized controlled trial included 75 patients of American Society of Anaesthesiologists (ASA) physical status I–II, aged 18–60 years, undergoing elective surgery under general anaesthesia. Patients were randomly allocated into three groups (n=25 each): Group S received succinylcholine 1.5 mg/kg, Group SR received rocuronium priming 0.05 mg/kg followed by succinylcholine 1.5 mg/kg, and Group V received vecuronium 0.1 mg/kg. Primary outcomes were incidence and severity of fasciculations and postoperative myalgia at 6, 12, and 24 hours. Secondary outcomes included intubating conditions and hemodynamic parameters. Results: Rocuronium priming significantly reduced fasciculations compared with succinylcholine alone (32.0% vs 60.0%, p=0.013). Fasciculation-like movements were lowest in the vecuronium group (16.0%). Intubating conditions differed significantly among groups, with the best conditions observed in the rocuronium-primed group (p=0.048). Although postoperative myalgia was numerically lower in the rocuronium-primed group, differences at 6, 12, and 24 hours were not statistically significant (p>0.05). Hemodynamic parameters remained clinically acceptable in all groups. Conclusion: Rocuronium priming significantly reduces succinylcholine-induced fasciculations and improves intubating conditions. Although postoperative myalgia was numerically lower with rocuronium priming, this difference did not reach statistical significance.
Physicochemical Characterization and Microfluidics-Assisted Synthesis of Ligand- Functionalized Lipid–Polymer Hybrid Nanoparticles for Targeted Delivery of siRNA Across the Blood–Brain Barrier in Glioblastoma Therapy
Background: Glioblastoma (GBM) is an aggressive and highly invasive brain tumor with poor prognosis, largely due to the presence of the blood–brain barrier (BBB), which limits the effective delivery of therapeutic agents. Small interfering RNA (siRNA)-based therapies offer a promising strategy for targeted gene silencing; however, their clinical application is hindered by instability, poor cellular uptake, and limited BBB permeability. Objective: This study aimed to develop and characterize ligand-functionalized lipid–polymer hybrid nanoparticles (LPHNs) using microfluidics-assisted synthesis for efficient and targeted delivery of siRNA across the BBB in glioblastoma therapy. Methods: LPHNs were synthesized using a microfluidic platform by optimizing flow rate ratio (FRR) and total flow rate (TFR). Nanoparticles were functionalized with targeting ligands (e.g., transferrin) and loaded with siRNA targeting oncogenes (EGFR/VEGF). Physicochemical properties including particle size, polydispersity index (PDI), zeta potential, morphology, and stability were evaluated. In vitro studies included cytotoxicity assays, cellular uptake analysis, BBB permeability assessment using a Transwell model, and gene silencing evaluation via qRT-PCR and Western blot. In vivo studies were conducted in an orthotopic glioblastoma model to assess biodistribution, therapeutic efficacy, survival, and toxicity. Results: Optimized LPHNs exhibited a particle size of ~100 nm with low PDI (<0.2) and stable zeta potential (~−18 mV). High siRNA encapsulation efficiency (~87%) and excellent stability were observed. Ligand-functionalized nanoparticles demonstrated significantly enhanced cellular uptake (2.5-fold increase) and BBB permeability compared to non-targeted systems. Gene silencing efficiency reached ~70–80% reduction in target gene expression. In vivo studies revealed preferential brain tumor accumulation, significant tumor regression, and improved median survival (52 days vs. 28 days in controls) without notable systemic toxicity. Conclusion: Microfluidics-assisted synthesis of ligand-functionalized LPHNs provides a robust and efficient platform for targeted siRNA delivery across the BBB. The developed system significantly enhances therapeutic efficacy in glioblastoma, demonstrating strong potential for clinical translation in neuro- oncology.
SALMONELLA TYPHI IN ENTERIC PERFORATION RISK FACTORS AND ITS ROLE
Background: A bacterial infection caused by the Salmonella enterica serotype Typhi, typhoid fever is characterized by the subtle start of diarrhea, constipation, stomach pain, a severe headache, and a persistent fever in afflicted individuals. Aim: The purpose of this study was to evaluate the function of salmonella typhi and risk factors for intestinal perforation. Methods: During the specified study period, 240 patients of both genders and a mean age of 32.2 years were evaluated. Data from the Institute's medical records on the diagnosis of intestinal perforation and typhoid fever in the included participants was evaluated retrospectively. ICD (International Classification of Diseases) codes created especially for typhoid fever were used to identify the patients. Results: According to the study's findings, of the 240 subjects evaluated, 50.8% (n=122) were female and 49.2% (n=118) were male. The length of the illness prior to admission at the institute varied, with 35% (n=84) of the subjects presenting within 7 days of the onset of symptoms, 65% (n=156) had a longer illness duration, and the maximum disease duration was 21 days. Conclusion: The current study comes to the conclusion that it has successfully identified a number of important risk factors associated with the development of enteric perforation in individuals who had typhoid fever. These results highlight the critical role that early diagnosis and timely treatment play in reducing the likelihood of serious consequences.
CORRELATION BETWEEN DIABETES AND MORTALITY IN CRITICALLY ILL PATIENTS ADMITTED TO CRITICAL CARE DEPARTMENT
Background: Complications are more common in critically ill individuals with diabetes, and there is a lack of information in the literature about how diabetes impacts ICU outcomes, which necessitates further research. Aim: The purpose of this study was to assess the association between outcomes and diabetes mellitus in critically ill Indian patients admitted to intensive care units.
Background: To prevent a decline in nutritional status and promptly address any nutritional deficiencies, all patients with chronic kidney disease and those receiving dialysis should regularly assess their nutritional status. Aim: The purpose of this study was to evaluate the nutritional status and anthropometry of individuals with chronic kidney disease (CKD) in India.
EVALUATING SPLENIC DYSFUNCTION IN SICKLE CELL DISEASE-AFFECTED CHILDREN
Background: Sickle cell disease, or SCD, is a chronic form of hemolytic anemia that causes increasing damage to key organs through sporadic acute complications. The assessment of the prevalence of splenic dysfunction in children with sickle cell disease in Indian subjects is not well documented in the literature.