Journal of Applied Pharmaceutical Research

Risk factors for prevalence of retinopathy of prematurity in a tertiary care centre of North India

Mamta Choudhary — 2023-08-31

Background: The goal of the current study was to shed light on the risk factors responsible for the prevalance of ROP in infants born before 34 weeks of gestation or in infants born with birth weights under 2000 g admitted in NICU at a tertiary care hospital. Methods: This study was a hospital based prospective observational study conducted on 160 neonates after ethical clearance within a period of four months. The study population comprised of neonates less than 34 week of gestational age and with birth weight less than 2000 gm and gestational age between 34-36 weeks. All statistical analysis was done using appropriate statistical software like SPSS (Statistical Sciences Package for Social). Categorical / Nominal variables were indicated as number and percentage and were surveyed using Chi square test or Fischer exact test. Continuous variables were expressed as mean and standard deviation. Results: Among the 160 neonates screened, 30 neonates were found to have Retinopathy of prematurity, giving a rate of 18.8% for ROP. Among the 30 neonates with ROP, 10 (33.3%) delivered at gestational age <32 weeks, 12 (40%) had respiratory distress syndrome, 19 (63.3%) had sepsis, 23 (76.7%) required oxygen therapy, 5 (16.7%) received mechanical ventilation, 18 (60%) received blood transfusion, 17 (56.7%) had hypoglycemia. Other risk factors have been discussed in detail in the article. Conclusion: Prematurity, low birth weight, inadvertent use of oxygen therapy blood transfusion, sepsis and hypoglycemia were found to be significant risk factor for ROP.

Comparison of king vision video laryngoscope versus mccoy laryngoscope for endotracheal intubation in patients with immobilized cervical spine

Jitendra Kumar Yadav — 2023-08-31

Background: Objective of this study was to compare King vision video laryngoscope versus McCoy laryngoscope for endotracheal intubation in patients with simulated immobilized cervical spine in terms of mean intubation time and number of attempts and successful intubation. Methodology: This was a prospective randomized study of 70 patients of ASA Grade I or II and aged 18- 60yrs, who underwent elective surgery under general anaesthesia. Intubation was done with either King Vision video laryngoscope (channelled blade) [Group A] or McCoy laryngoscope [Group B] after immobilizing the cervical spine using a cervical collar. We compared the mean intubation time, success rate and intubation difficulty using the Intubation Difficulty Score (IDS), glottic visualization using POGO score, hemodynamic parameters and complication if any. Results: Both the groups were comparable regarding the demographic variables such as age, sex, weight and ASA class. The mean intubation time of patients in Group A was significantly less (16.57 ± 4.11 seconds) than Group B (20.14 ± 5.72 seconds) (P= 0.004). IDS and POGO scoring were found significantly better in group A as compared to group B. But intubation success rate was 100% in both groups. Hemodynamic parameters and complications were also comparable. Conclusion: King Vision video laryngoscope is found superior to the McCoy laryngoscope if cervical immobilization is anticipated in terms of ease of intubation and glottic visualization.

Fractionated dose versus bolus dose of isobaric injection ropivacaine (0.75%) for patients undergoing elective caesarean section under spinal anaesthesia: A randomized, double-blind study

Anita Pareek — 2023-08-31

Background: Spinal anaesthesia (SA) using a bolus dose of Ropivacaine (0.75%) is known for its rapid onset but potential chances of hypotension. Administering Ropivacaine (0.75%) in fractions with intervals between the doses, has shown to establish a dense block, prolong analgesia and maintain better hemodynamic stability. This study aimed to compare the efficacy of fractionated and bolus doses of Ropivacaine (0.75%) in patients undergoing elective lower segment caesarean section (LSCS) under spinal anaesthesia. Methods: In a randomized, double-blinded trial, sixty patients scheduled for elective LSCS were enrolled and assigned to two groups. Group A received a single bolus spinal anaesthesia using Ropivacaine (0.75%) (2.5ml), while Group B received a fractionated dose approach: two-thirds of the total Ropivacaine (0.75%) dose (1.6ml) initially, followed by one-third dose (0.9ml) after 90 seconds. Results: The onset of sensory block (Group A: 3.59±1.31 min, Group B: 4.25±0.63 min) and motor block (Group A: 5.49±2.30 min, Group B: 7.34±11.28 min), as well as the duration of analgesia, were significantly longer in Group B (233.33±16.47 min) compared to Group A (185.17±20.61 min) (P < 0.05). Hemodynamic stability was superior in Group B, with all patients showing better stability than those in Group A. Conclusion: Utilizing a fractionated dose of Ropivacaine (0.75%) in spinal anaesthesia results in an extended duration of analgesia and improved hemodynamic stability compared to a bolus dose approach.

Prediction of depth from skin to subarachnoid space based on preoperative anthropometric assessment: an observational study

Mamta Khandelwal — 2023-08-31

Background and aim: An accurate placement of spinal needle is crucial while injecting drugs to avoid a failed sub arachnoid block (SAB). A pre puncture estimation of skin to subarachnoid depth (SSD) may guide accurate spinal needle placement. This study is aimed to predict the depth from skin to subarachnoid space based on pre-operative anthropometric assessment and to find out formula for predicting SSD, best suited in terms of accuracy when compared with observed depth. Method: In this hospital based, prospective, observational study, a total of 120 patients, of which 68 were men, and 52 were women (non-pregnant) with a mean age of 59.75 ±14.1 kilograms. The SSD was measured after SAB was performed. This SSD was compared with the predicted SSD calculated using the Abe’s, Bonadio’s, Craig’s, Stocker’s, and Chong’s modified formulae. Analysis was done using unpaired t test for quantitative data to determine best suited formula to predict SSD in our population in terms of both accuracy and ease of application. Pearson correlation test was also done. Results: The observed SSD in the overall study population was 4.96 ± 0.67 cm. Stocker’s formula is closest with a mean difference of 0.17cm. In males the mean observed depth was (5.06±0.60 cm) more than that in the non-pregnant female population (4.83±0.74cm). These anthropometric variables were statistically significant with a presentation value of <0.001. Conclusion: Among various formulae Stocker’s formula can most accurately predict the SSD when applied to Indian population.

Phenotypic methods for detection of metallo-β-lactamase (MBL) production in multidrug resistant gram negative bacilli – comparative study

Umesh Santlal Hassani — 2023-08-31

Introduction: One of the most common mechanism of resistance of bacterial pathogens to β-lactam antibiotics is production of β-lactamase, there are different types of Beta lactamases, which are expressed by drug resistant gram-negative bacteria. Carbapenemases (Metallo beta lactamases/MBL) are the β-lactamases with the widest spectrum of activity. Early detection of MBL-producing organisms is crucial to establish appropriate antimicrobial therapy and to prevent their interhospital and intrahospital dissemination. Several phenotypic methods are available for the detection of MBL producing bacteria. As there is no standardized method present study was done to screen MDR gram negative bacilli isolated from clinical samples for MBL-production by a low cost, convenient and sensitive procedure. Methods: All non-duplicate MDR gram negative isolates obtained from various clinical samples were screened for carbapenam resistance. All carbapenam resistant bacteria were screened for production of MBL by 3 phenotypic tests (Double disc synergy, combined disk test, Hodge test). The results were compared and analyzed on the basis of results obtained by E test. Results: During Study Period, 988 non duplicate gram negative bacilli were isolated, 70.64% (698) were multi drug resistant. Amongst Total number of MDR Isolates to carbapenam resistance was seen in 62(9.28%). These 62 isolates that were resistant to carbapenam were tested for MBL production. 54 (87%) of these 62 isolates showed MBL production by disc potentiation test whereas 41 isolates (66%) gave positive result by DDST. By Modified Hodge test, out of 62, 48 isolates (77.4%) were MBL positive. Compared to E- test, the Sensitivity Specificity and Accuracy for Disc potentiation test was 90%,100% and 90.32%, for Modified Hodge test was 80%,100% and 80.6% and for Double disc synergy test was 68.3%,100% and 69.3%. Conclusion: In our study, in comparison to MBL E test, disc potentiation test is more sensitive than double disc synergy test and Modified Hodge test for detection of MBL phenotypically

A prospective study on enterocutaneous fistula in a tertiary care centre: A single institution study

Karthikeyan Selvaraj — 2023-08-31

Background: Aberrant connection linking gastrointestinal tract and the skin is termed Enterocutaneous fistula. Enterocutaneous fistulas can lead to significant morbidity and mortality. Death pertaining to enterocutaneous fistulas remains enormous when juxtaposed with other surgeries. The treatment of Enterocutaneous fistula may be a significant challenge to surgeons and gastroenterologists. Method: After obtaining ethical committee clearance, a total of 25 patients of Enterocutaneous fistula who presented to Surgical department and Surgical Gastroenterology department were included in the study. The cause, site and output of fistula, clinical course and complications of fistula were studied. Patients were managed either surgically or conservatively depending on the output of the fistula, nutrition and metabolic profile. Results: 19 patients were managed conservatively and 6 patients were managed surgically. Amidst the conservative group, 16 out of 19 patients had spontaneous closure of fistula and remaining three had died as fistulas failed to close. Surgical closure was accomplished in 5 patients but failed in one patient and that patient died. 96% (24 out of 25) of patients in our study had developed fistula post operatively. Among 25 patients studied, nearly 44% each i.e., 11 out of 25 patients had colonic and small bowel fistula respectively followed by fistula at appendix accounting for 12% (i.e., Fistula Output: 11 (44%) fistulae were low output, 8 (32%) were medium output. Conclusion: Enterocutaneous fistulas are more common in postoperative period. Conservative treatment should be the mainstay in management of Enterocutaneous fistula.

Experimental evaluation of anxiolytic and antidepressant activities of methanolic extract of Triticum aestivum (wheatgrass) in albino mice

Saroj Kothari — 2023-08-31

Background: Anxiety and depression are common psychiatric conditions. The present study was carried out to find antianxiety and antidepressant activity of methanolic extract of Triticum aestivum (wheat grass) in mice. Materials and methods: The methanolic extract of Triticum aestivum (META) was screened for antianxiety activity by elevated plus maze (EPM) and light and dark box (LDB) and for antidepressant activity by forced swim test (FST) and tail suspension test (TST) in mice. Animals were divided into four groups having six animals in each group. Group I served as control and received gum acacia aqueous suspension 10 ml/kg, Groups II and III served as test groups and received META 200 and 400 mg/kg, respectively, Group IV served as standard group and received diazepam 1 mg/kg for antianxiety activity and fluoxetine (20 mg/kg) for antidepressant activity once daily for thirty days. Result: META 200 and 400 mg/kg showed significant (P < 0.01) dose-dependent increase in entries and stay in the open arms in EPM and entries and stay in the light compartment in LDB as compared to control. Antianxiety effect of META at dose of 400 mg/kg was comparable (P > 0.05) with diazepam 1mg/kg. META 200 and 400 mg/kg also produced dose-dependent significant (P < 0.01) antidepressant effect, indicated by reduction in the immobility time as compared to control in both FST and TST. The antidepressant activity of META at dose of 400 mg/kg was comparable (P > 0.05) with fluoxetine 20 mg/kg. Conclusion: Results of our study suggested that META possess dose-dependent significant antianxiety and antidepressant activities.

Comparative study on ELISA, CLIA and rapid diagnostic test in detecting HCV infection in blood donor at a tertiary care center

M. Preethi — 2023-08-31

Background: The prevalence of blood screening assays for hepatitis C infection among blood donors remains comparatively low in line with WHO guidelines, especially when compared to developing nations. Various methodologies, such as ELISA, immunochromatography assays, RIBA, HCV RNA PCR, and CLIA, are employed to detect anti-HCV IgG antibodies in all patients with HCV infection. However, there is a significant scarcity of comparative data available regarding the evaluation of HCV infection screening among CLIA, ELISA, and RDT methods in their ability to detect anti-HCV antibodies effectively. This gap in knowledge highlights the need for further research and analysis in this critical area of healthcare. In this study we evaluate the technical performance between ELISA, CLIA and RDT in detection of HCV infection. Materials and method: A cross-sectional study was carried out, involving 70 blood donor samples. Subsequently, the samples were subjected to screening for Anti-HCV antibodies using three different methods: RDT, CLIA, and ELISA. The results obtained from these screenings were duly recorded. Results: Among the 70 patients included in the study, 63 (90%) were male, and 7 (10%) were female. The following performance metrics were calculated for each method where CLIA shows 100% sensitivity, Specificity 98%, PPV 100%, NPV 98.9%, Accuracy 100%, Kappa coefficient 0.932, p-value <0.001, in case of ELISA: Sensitivity 97.6%, Specificity 99.2%, PPV 100%, NPV 97.1%, Accuracy 99%, Kappa coefficient 0.97, p-value <0.001. followed by RDT: Sensitivity 89%, Specificity 87.9%, PPV 100%, NPV 90.2%, Accuracy 96%, Kappa coefficient 0.59, p-value <0.001. These results provide valuable insights into the performance of each method in screening for HCV antibodies, with CLIA and ELISA demonstrating higher sensitivity, specificity, and overall accuracy compared to RDT. Conclusion: In conclusion, the study suggests that the CLIA screening method for detecting HCV infections is considered superior to both ELISA and RDT in a Tertiary care center.