Volume16,Issue4

Undesirable side effects of medication are inevitable. Due to the role of the kidneys in clearance and filtration, the renal system faces a unique situation regarding the side effects of drugs. It has an important role for different classes of drugs to be excreted, and drugs are a key factor for this system to be at risk. Many drug classes cause renal insults. The top six classes were pain killers, antibiotics, proton pump inhibitors, antidiabetics, antihyperlipidemics, and agents for erectile dysfunction. Renal insults caused by these agents could vary in severity. Some drugs could cause nephrotoxicity from one dose, while others may only need continuous monitoring. Different populations also operate under different rules, as some people need dose adjustments while others who are medically free of major illnesses do not. A variety of unfavorable outcomes for the kidney could take place, such as acute kidney injury, chronic kidney disease, and end-stage renal disease, and unfortunately, some of these issues could lead to the need for renal replacement therapies. The outcome of this review paper will help multidisciplinary physicians to understand the renal side effects of the most used drug classes in the Kingdom of Saudi Arabia, their destructive mechanisms, and most importantly, the clinical presentations of renal dysfunction in relation to each class. Emphasizing these adverse effects will prevent future unfavorable outcomes, especially in commonly used drugs that are frequently prescribed for different age groups. Moreover, some of these drugs are considered to be over-the-counter medications, which makes them a serious problem that needs to be handled cautiously.

Introduction: Preliminary neoplastic lesions can be found with cervical screening, which allows for prompt treatment and monitoring. Inadequate screening programs are to blame for the high cervical cancer rates in poorer countries. Screening programs have significant obstacles in economically disadvantaged countries due to large population sizes, insufficient infrastructure, and inadequate funding. Consequently, screening does not detect many cervical diseases until symptoms have already appeared. Aim and Objectives: All pregnant women visiting a tertiary care facility in Southern Bihar will undergo a Papanicolaou (pap) smear screening to check for abnormal cervical cytology. Material and methods: Obtaining written informed consent from all study participants is a necessary step after receiving approval from the ethical committee. The study will randomly enroll pregnant women of any gestational age. Using a standard protocol that incorporates a thorough history, physical exam, and local examination, we will gather all relevant medical information in every case. When pregnant women first visit the ANC outpatient department at Narayan Medical College and Hospital, they will have a Pap smear performed. When the patient is ready, the lithotomy procedure can begin by inserting a sterile bivalve speculum into the vagina to allow for clear view of the cervix. Results: Results were considered normal in 91.0% of the 322 participants. Atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASCH) affected 1.6% of the 3.7% of patients with abnormal results, low-grade squamous intraepithelial lesion (LSIL)3.1%, and high-grade squamous intraepithelial lesion (HSIL)0.6%. In other words, very few participants had abnormal Pap smears, suggesting that the test was generally well-received. Conclusions: The age of first coitus does affect Pap smear outcomes, but neither menarche nor age had a substantial impact. Abnormalities in Pap smear results are more prevalent in rural areas, among those with poor socioeconomic level, in those who have seen cervical erosion, and in those who have experienced particular symptoms. Associated symptoms, parity distribution, and socioeconomic status also play a role.

Background: Effective perioperative pain management is crucial in upper limb surgeries, impacting patient outcomes and recovery. This study evaluates the efficacy of ropivacaine alone versus ropivacaine combined with dexamethasone in interscalene brachial plexus block (ISB). Methods: A prospective, randomized, double-blind study was conducted on 60 patients undergoing upper limb surgeries. Patients were divided into two groups: Group A received 30 ml of 0.5% ropivacaine plus 2 ml of normal saline, while Group B received 30 ml of 0.5% ropivacaine plus 2 ml (8 mg) of dexamethasone. The onset and duration of sensory and motor blocks, total duration of postoperative analgesia, and adverse effects were recorded. Results: Group B exhibited a significantly longer duration of sensory block (9.33 ± 0.802 hours) and motor block (7.53 ± 0.819 hours) compared to Group A (7.60 ± 0.675 hours and 6.17 ± 0.531 hours, respectively). The total duration of postoperative analgesia was also significantly longer in Group B (17.00 ± 1.819 hours) than in Group A (9.00 ± 1.259 hours). Conclusion: The addition of dexamethasone to ropivacaine significantly enhances the duration of analgesia and motor block in ISB, offering superior pain management in upper limb surgeries.

Hospital acquired infections (HAI) remain a significant hazard for hospitalized patients. Sphygmomanometer, a tool to measure blood pressure of a patient in daily clinical practice, can be a potential source of hospital acquired infections. This study was undertaken to determine the sphygmomanometer-cleaning practices among medical health providers, to show whether it is a potential source of HAI and to compare the effectiveness of common antiseptics (i.e.70% isopropyl alcohol) in disinfecting sphygmomanometer. Material & Methods: A hospital-based cross-sectional study was conducted on sphygmomanometer owned by different health professionals. The data were collected from each owner using self-administered questionnaire. Swab specimens were collected from 75 sphygmomanometers using sterile cotton tips. Bacterial investigation and antimicrobial susceptibility tests were performed using standard culture tests. The data were double entered into EPI-Data version 3.1 and exported into the Statistical Package for Social Sciences version 16 for analysis. Pathogens are isolated by subculture on solid media using Nutrient, Blood, and Mac Conkey agar, followed by Gram staining in positive growth. For early starting of treatment, a rapid Gram stain finding is also noted and sent to clinicians. Final confirmation of diagnosis was also performed with the VITEK automated identification system. Results: Staphylococcus epidermidis and Bacillus spp were the most frequent isolate (20%) followed by the Corynebacterium spp. (16%). The proportion of sphygmomanometers contamination used by health professionals who were not cleaned regularly the sphygmomanometers before and after examining each patient was high (85%). The contamination of sphygmomanometer used by health professionals working in the emergency care department and intensive care unit (70%) and medical ward (75%) was high compared with other wards. A pre–post intervention study of available sphygmomanometer cuffs and associated bedside patient monitors was conducted. To further examine the effect of the decontamination intervention, Mann–Whitney U-tests were conducted for each aspect. Conclusion: This study confirmed that most sphygmomanometers were contaminated with microorganisms known to be associated with healthcare-acquired infections. Most of the healthcare workers did not practice sphygmomanometer disinfection. Strict and careful decontamination of sphygmomanometers need to be in place before use. Decontamination of non-disposable sphygmomanometer cuffs decreases the microbial load and risk of HAI, providing evidence to negate arguments for disposable cuffs while being environmentally sensitive and supportive of a culture of patient safety and infection control.

On earth, there are many types of herbs. One of these herbs is Catharanthus roseus, which is related to the Apocynaceae family. Catharanthus roseus is a pretty flowering weed with more than 200 alkaloids and chemicals present in every part of the weed. Every part of Catharanthus roseus, like the blossom, leaves, steam, root, small branches, and shoot, shows the different pharmacological properties, including anti-oxidant, anti-microbial, anti-diabetic, wound healing, anti-ulcer, hypotensive, antidiarrheal, and memory enhancer. This herb has been used to cure a number of diseases. The Catharanthus roseus weed is used to treat various types of cancer, such as lymphoblastic leukemia, Hodgkin’s disease, skin cancer, breast cancer, and mouth cancer. Rubacine and another alkaloid derived from roots is used as an anti-arrhythmic and hypotensive using this weed plant directly or indirectly to treat skin conditions such as high blood pressure, rheumatism, menstrual disorders, dyspepsia, etc. It has traditionally been a blessing to protect humanity from many serious health issues.

Background: Dorso-lumbar spine fractures are common and can cause significant pain, nervous system injury, and daily functioning impairment if not treated effectively. Screw fixation is a common surgery for spine stabilisation and fusion, especially in unstable fractures. Objective: To evaluate the clinical and radiological outcomes of patients with dorso-lumbar spine fractures treated using pedicle screw fixation. Method: This prospective observational study from July 2023 to August 2024 included 100 Patna patients receiving pedicle screw therapy for dorso-lumbar spine fractures at Nalanda Medical College and Hospital. Clinical trial results were assessed using neurological recovery, the Oswestry Disability Index (ODI), and the Visual Analogue Scale. Pre- and post-operative imaging was compared for spinal alignment, fusion, and implant integrity. Patients were reassessed at 1,3,6, and 12 months. SPSS was used for statistical analysis. Results: After surgery, the average VAS score was 2.3, and the ODI score declined from 68.5% to 22.4% in the first year. 78% of pre-op neurological impairment patients recovered fully. Radiological results showed improved spinal alignment with a 94% fusion rate and kyphotic deformity reduced from 18° to 3°. No major infections or implant failures occurred, and only 12% of patients had problems. Conclusion: Dorso-lumbar spine fractures can be treated safely and effectively with pedicle screw fixation, which relieves discomfort, improves function, and aligns the spine. The results support its standing as the gold standard for treating unstable fractures there.

Introduction: Most distal radial fractures are caused by falls or high-impact trauma, especially in active people and the elderly. Distal radial fractures that are not comminuted outside the joint are usually treated with immobilisation or percutaneous pinning. Both methods are widely used, but there is ongoing debate over which yields better fracture union, functional recovery, and complication rates. The goal of this study is to compare the two treatment methods. Objectives: The primary objective of this study is to compare the outcomes of closed reduction and immobilization versus percutaneous pinning and immobilization in the treatment of non-comminuted extra-articular distal radial fractures. We aim to evaluate fracture union time, range of motion, complications, and other functional and radiological outcomes associated with these two methods. Methods: Nalanda Medical College and Hospital in Patna reviewed 200 non-comminuted extra-articular distal radial fractures from July 2023 to October 2024. Patients were classified into Group 2 (percutaneous pinning and immobilisation) and Group 1 (closed reduction and immobilisation). Various follow-up points assessed functional outcomes like grip strength and range of motion and radiological outcomes like fracture alignment and complications. Results: The study included 200 patients with non-comminuted extra-articular distal radial fractures who received percutaneous pinning and immobilisation or closed reduction and immobilisation. Group 2 had a significantly shorter fracture union time (6.5 ± 1.1 weeks) than Group 1 (8.6 ± 1.2 weeks), with a p-value of less than 0.0001. Group 2 showed improved range of motion, including flexion (80 ± 10° vs. 70 ± 15°, p = 0.02) and extension (75 ± 9° vs. 65 ± 12°, p = 0.03), three months post-treatment. Malunion was more common in Group 1 (3% vs. 1%, p =0.15) and pin site infections in Group 2 (6% vs. 0%, p =0.02), but complications were minimal. Despite a slightly higher infection risk, percutaneous pinning speeds healing and improves function, making it a good choice for these fractures. Conclusion: Percutaneous pinning improved fracture healing and function. Despite the risk of pin site infections, it is a good treatment for non-comminuted extra-articular distal radial fractures, especially for fast-healing patients. Prospective studies should confirm these findings.

Background: Antegrade and retrograde nailing are used to treat common orthopaedic injuries like humerus fractures. These methods may not be as effective at restoring bone alignment and speeding healing as each other for fracture union and functional recovery. Objective: This observational study compared antegrade and retrograde nailing for humeral fractures, focussing on union rates, functional recovery, and postoperative complications. Methods: Nalanda Medical College and Hospital researchers conducted the study from July 2023 to October 2024. Out of 200 patients with humeral fractures, 100 had antegrade nailing and 100 had retrograde. Adults with fractured humeral bones alone were included, while those who did not were either unwilling to undergo surgery or had medical reasons not to. Functional recovery (pain score, range of motion) and complications were secondary outcomes to radiological and clinical fracture union evaluations. Statisticians used t-tests and chi-square tests to compare the groups. Results: Both antegrade and retrograde groups had 95% and 93% union rates, respectively, with a p-value of 0.48. The pain score was significantly lower in the antegrade nailing group (2.1 average VAS score vs. 3.4 in retrograde; p < 0.01). A superior range of motion was observed in the antegrade group, with an average flexion of 140° compared to the retrograde group’s 125° (p < 0.05). Postoperative complications like infection (4% antegrade and 5% retrograde) and non-union (2% and 3% retrograde) were similar in both groups. Conclusion: Antegrade or retrograde nailing the humeral fracture improves functional results and pain management, especially with proximal fractures. Retrograde nailing is safe and effective for distal humerus fractures. Further research, such as randomised controlled trials, is needed to confirm these findings and refine technique indications.

Metabolic Syndrome (MetS) is a panorama encompassing risk factors like, central obesity, dysglycemia, hypertension, and lipid abnormalities that increase cardiovascular disease risk. Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is the hepatic manifestation of MetS and is emerging as a global health concern. This study focusses on determining the prevalence of MASLD in MetS and investigate the relationship between ultrasonographic severity of liver steatosis and serum liver enzyme levels. This observational analytical, clinical study was conducted at a tertiary care center in North India over 24 months. A total of 200 study subjects were enrolled based on the inclusion criteria. The study was approved by the institutional ethics committee and adhered to ICMR guidelines. The prevalence of MASLD diagnosed by ultrasound was 72.5% (n=145), with higher rates in males (67%) versus females (33%). In both genders, increased body weight, BMI, waist circumference, and ALT levels were directly proportional severity of steatosis. In males, systolic blood pressure positively correlated with liver steatosis, while in females, higher HDL and lower LDL cholesterol levels were linked to greater fatty infiltration. Elevated AST and ALT levels also showed a positive correlation with steatosis severity. Strongest association was detected with BMI and waist circumference. The study thus concluded that there is rise in MASLD prevalence amongst MetS patients, particularly younger individuals. Elevated liver enzymes and ultrasonography are reliable markers of MASLD severity. Hypertension and low HDL cholesterol, common in rural populations, require further investigation.

Undifferentiated pleomorphic sarcoma (UPS), formerly known as malignant fibrous histiocytoma, arising in the kidney is an extremely rare entity, with even fewer cases reported in duplex kidney systems¹. We present a unique case of a 61-year-old male with UPS originating in a duplex moiety of the kidney. The patient presented with right flank pain, hematuria, and weight loss. Imaging revealed a 15 cm heterogeneous mass in the right kidney’s upper pole with duplex collecting systems. Following radical nephrectomy, histopathological examination confirmed UPS. This case highlights the diagnostic challenges and management strategies for this rare renal malignancy.

Introduction: “Maternal Near Miss” refers to the occurrence of a woman’s survival after a serious illness during or after pregnancy, birth, or the first 42 days following an abortion due to complications that happened during or during these times. Death, chronic sickness, or a near-miss are all possible outcomes of Severe Acute Maternal Morbidity (SaMMM). Aim and Objectives: (1) To assess the obstetric care by referencing maternal near-misses as an intermediary metric. (2) To evaluate and study the frequency of near-miss incidents involving mothers at the tertiary care facility. (3) To Identify and investigate the factors that lead to maternal mortality in the tertiary care facility. Material and Methods: The ethics committee gave their stamp of approval before the prospective observational study could begin. The chronological age, total number of pregnancies, and gestational age at admission were important pieces of patient data. Regardless of gestational age, this study documented prenatal booking status. Above and beyond that, we recorded the patients’ admission conditions, delivery manner. The patients were all closely monitored from the time they checked into the hospital until they were either released or passed away on. We have computed the following indicators. Result: In a total of 120 cases, 10 were maternal fatalities and 110 were maternal near misses. Near misses were most commonly caused by anaemia (21.8%), sepsis (19.1%), and pre-eclampsia (14.5%). Anaemia (30.0% of cases) and preeclampsia (20.0% of cases) were the leading causes of maternal death. Conclusions: The current study found that out of 120 maternal cases, there were significant associations with the following variables: booking status, mode of delivery, ICU stays, uric acid, potassium, haemoglobin levels, and types of organ dysfunction and surgical interventions. Maternal age, gestational age, OBS scores, birth weight, timing of events, and referral status did not show a significant relationship with maternal outcomes. Better outcomes were associated with booking and LSCS.

Background: Aedes mosquitoes spread dengue fever. This spreads the disease over tropical regions, endangering public health. The disease can cause mild fever, dengue haemorrhagic fever (DHF), and dengue shock syndrome (DSS). Dengue severity depends on the virus’s serotype and test indications including haematocrit, platelet, and liver enzymes. This study examines clinical severity and biochemical indicators using data from multiple dengue serotypes. Objective: A study on how dengue virus serotypes (DENV-1, DENV-2, DENV-3, and DENV-4) affect clinical severity and laboratory indicators was the major purpose. Method: A retrospective observational study examined dengue fever patients admitted to the Bhagawan Mahavir Institute of Medical Science in Pawapuri Nalanda, Bihar, between August 2022 and January 2023. For this study, researchers examined clinical and analytical data from 40 dengue fever patients. Serological testing or RT-PCR identified dengue serotypes for our team. Researchers used Pearson’s and Spearman’s correlation to find clinical severity-lab marker correlations. Results: Laboratory markers like platelet count, liver enzyme levels (AST, ALT), and haematocrit linked with clinical severity. Thimbocytopenia and elevated liver enzymes were prevalent in severe dengue, whereas DENV-3 haemoconcentration was more common. The study also discovered that clinical severity and test indicators varied by serotype. Conclusion: Laboratory indicators for dengue severity include platelet count and liver enzyme values. This study stresses serotype-specific clinical treatment alterations and their role in illness progression prediction. These findings need larger samples to confirm.

Background: Postpartum depression (PPD) affects many women, threatening their health and that of their babies. Many social, cultural, and healthcare factors contribute to the shockingly high rate of PPD in low-income metropolitan areas. These cultures are more likely to experience postpartum depression due to low socioeconomic position, insufficient healthcare, and financial difficulties. To be effective, public health initiatives must identify PPD prevalence and risk factors in these places. Objective: This study examined postpartum depression in Turki, Muzaffarpur, Bihar, and other low-income urban women who attended Radha Devi Jageshwar Memorial Medical College & Hospital. The study sought to identify the demographic, socioeconomic, and psychological factors most strongly associated with PPD in this group. Methods: Radha Devi Jageshwar Memorial Medical College & Hospital in Muzaffarpur, Bihar, conducted an observational cross-sectional study from June 2023 to June 2024. The study included 50 women aged six weeks to six months after giving birth. We employed a validated postpartum depression screening tool, the Edinburgh Postnatal Depression Scale (EPDS), and a structured demographic and risk factor questionnaire. The institution’s ethics committee approved the study, and all subjects gave informed consent. Results: 30% (15 women) of 50 women polled had EPDS scores over 12, indicating postpartum depression. The study found high connections between PPD and low socioeconomic status, low social support, a history of mental health issues, and a bigger family size. PPD was 40% for women below the poverty line and 20% among moderate-income women. Additionally, 45% of women with little to no social support scored higher than the EPDS depression criterion. Conclusion: Postpartum depression is frequent in low-income metropolitan regions, and this study illuminates its social, economic, and psychological causes. The data show that mental health issues, low income, and poor social support considerably increase PPD risk. Early intervention and targeted public health measures can improve mothers’ mental health in low-income metropolitan regions.

Background: A large or symptomatic ovarian cyst, a frequent gynaecological issue, may require surgery. Laparoscopy and laparotomy have pros and cons. It’s crucial to compare solutions in resource-constrained environments like rural India to improve patient care. Objective: This study compares laparotomy with laparoscopic ovarian cyst surgery in terms of clinical outcomes, recuperation, complications, and patient satisfaction. Method: A prospective observational study was conducted at Radha Devi Jageshwar Memorial Medical College & Hospital in Turki, Muzaffarpur, Bihar, from January 2023 to June 2024. Over 50 people planned ovarian cyst removal surgery. Demographics, recuperation time, hospital stay, issues, procedure costs, and patient satisfaction were collected. Comparative statistical analysis evaluated the two methods. Results: Several indicators suggested laparoscopic surgery was better. Laparoscopic recovery was 5 days, compared to 12 days for laparotomies. Laparoscopic patients reported fewer complications and shorter hospital stays (3 vs. 7 days). Even though laparoscopy cost more initially, fewer issues and shorter hospital stays reduced treatment costs. Laparoscopy improved patient satisfaction because to its shorter recovery time, less discomfort, and less scarring. Conclusion: The results show that laparoscopic surgery is the best way to treat ovarian cysts, especially in remote hospitals. Adopting it can promote efficiency, satisfaction, and patient outcomes. Laparotomy is important for difficult patients; however minimally invasive options should be sought for normal use.

Background: Nutritional biochemistry, the study of nutrient function at the molecular level, has increasingly gained recognition for its role in the prevention, onset, and progression of chronic diseases. Chronic conditions such as cardiovascular disease (CVD), type 2 diabetes mellitus (T2DM), obesity, and certain cancers are strongly influenced by dietary patterns and nutrient quality. Understanding the biochemical mechanisms by which nutrients modulate metabolic pathways, immune responses, and gene expression is critical for developing targeted interventions that can reduce disease burden. Methods: This study assessed the association between specific nutrient biomarkers and the prevalence and severity of chronic diseases. We conducted a cross-sectional analysis involving 1,200 participants aged 30–70 years, recruited from three community health centers. Biochemical assessments included measurement of serum fatty acids, antioxidants, vitamin D, and inflammatory markers. Dietary intake data were collected using validated food frequency questionnaires. Disease status and severity were determined from clinical records and standardized assessment tools. Data were analyzed using multivariate regression models adjusting for age, sex, BMI, and physical activity. Results: Higher serum levels of omega-3 fatty acids, vitamin D, and antioxidants were significantly associated with reduced inflammatory markers and lower odds of CVD and T2DM (p<0.05). Individuals with diets rich in whole grains, fruits, and vegetables demonstrated a favorable metabolic profile. Conversely, elevated saturated fatty acids and low micronutrient levels correlated with increased inflammatory markers and higher prevalence of chronic disease. Conclusion: These findings underscore the importance of nutritional biochemistry in understanding chronic disease pathogenesis. Improved nutrient intake quality and corresponding biochemical profiles appear protective, suggesting that targeted nutritional interventions may complement traditional medical management. Integrating nutritional biochemistry insights into public health policies could mitigate the growing burden of chronic diseases.

Background: Esophageal varices (EV) are a major complication of portal hypertension in cirrhotic patients, with early detection critical for preventing variceal bleeding. Although upper endoscopy remains the gold standard for EV screening, there is growing interest in non-invasive markers. Ultrasonographic parameters have shown promise, but their predictive accuracy remains limited. We hypothesized that a novel ratio, the Right Lobe of Liver Size-to-Albumin Ratio (RLSAR), can predict the presence and severity of EV in cirrhotic patients. Methods: In this prospective study, 120 adult patients with known cirrhosis underwent routine laboratory assessments, including albumin levels, and standardized ultrasonography to measure right lobe liver size. Endoscopic evaluation was performed to detect and grade EV according to standard guidelines. Statistical analyses included receiver operating characteristic (ROC) curves, multivariate logistic regression, and correlation analyses to assess the predictive utility of RLSAR compared to conventional non-invasive parameters. Results: Among the 120 patients, EV were present in 68 (56.7%). Patients with EV had significantly higher RLSAR values than those without (p<0.001). RLSAR demonstrated a robust correlation with EV grade (r=0.52, p<0.001). On multivariate analysis, RLSAR emerged as an independent predictor of EV presence after adjusting for age, sex, Child-Pugh class, and platelet count. The ROC curve for RLSAR showed an area under the curve of 0.85, indicating good diagnostic accuracy. RLSAR cutoff values effectively discriminated between low-grade and high-grade EV. Conclusion: RLSAR is a novel, non-invasive ultrasonographic marker that reliably predicts the presence and severity of EV in cirrhotic patients. Incorporating RLSAR into routine evaluation may reduce reliance on invasive endoscopy and guide timely prophylactic interventions.