SRMS JOURNAL OF MEDICAL SCIENCE

The Effect of Intrathecal Fentanyl on Postdural Puncture Headache in Parturients Undergoing Cesarean Section: Prospective Double-Blinded Study

Purva Gupta, Juhi Saran, Vishwadeep Singh — Tue, 28 Oct 2025 00:00:00 +0530

Introduction: Post-dural puncture headache (PDPH) is one of
the most common side effects of spinal anesthesia, particularly
in parturients undergoing cesarean section. Intrathecal fentanyl,
often administered as an adjunct to local anaesthetic, has been
proposed as a potential mitigating agent for PDPH. However,
the evidence regarding its efficacy remains inconclusive. The
purpose of this study is to evaluate the effect of intrathecal
fentanyl on the incidence and severity of PDPH in parturients
undergoing cesarean section.
Material and Methods: About 124 patients were randomly
allocated using a simple randomization technique into 2
groups, with 62 patients in each group. Group A – 2.5 mL 0.5%
Bupivacaine + 0.5 mL NS, Group B –2.5 mL 0.5% Bupivacaine
+ 0.5 mL fentanyl (25 mcg). Categorical variables are presented
as absolute numbers and percentages. The software used for
the statistical analysis was SPSS v21.0 (IBM, USA).
Results: The parturient was monitored for post-dural puncture
headache PDPH during the post-operative period until
discharge. Patients were questioned about the onset, duration,
and severity of headache. Severity was evaluated using the
visual analogue scale. There was no significant difference in
the incidence of PDPH. There was a significant difference in
severity between the two groups. More hypotension was seen
in group A compare to group B.
Conclusion: We concluded that the women who were
impacted by the addition of IT fentanyl to bupivacaine for spinal
anesthesis (SA) in obstetric patients reported better postpartum
recovery and a reduction in the intensity and duration of their
headaches, improved hemodynamic stability, and lengthened
the period of post-operative analgesia. Further well-designed
RCTs with larger sample sizes are warranted to confirm these
findings and elucidate optimal dosing strategies for intrathecal
fentanyl in this population.

Comprehensive Evaluation of Symptoms and Risk Factors in Adhesive Small Bowel Obstruction

Kolli Loknadh, Anil Negi, Sudesh Kumar Sagar — Mon, 30 Jun 2025 00:00:00 +0530

Introduction: Adhesive small bowel obstruction (ASBO) is a significant condition often encountered in surgical emergencies, characterized by the blockage of the small intestine due to fibrous bands called adhesions. These adhesions typically form after abdominal surgeries, leading to substantial morbidity, prolonged hospital stays, and increased healthcare costs. Understanding the symptoms and risk factors associated with ASBO is crucial for enhancing patient outcomes and developing effective prevention and management strategies. Material & Methods: This prospective observational study was conducted at the Department of General Surgery, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, from August 1, 2022, to January 31, 2024. Patients aged 18 years and older with an episode of adhesive small bowel obstruction were included, excluding those with large bowel obstruction, incarcerated hernia, early post-operative small bowel obstruction, inflammatory bowel disease, radiationinduced fibrosis, and peritoneal carcinomatosis. Data were collected through patient histories, clinical examinations, and investigations, and analyzed using SPSS version 23. The sample size was calculated to include 60 patients, accounting for a 10% dropout rate. Results: The study found that the majority of ASBO patients were between 18-29 years (25.4%) and 45 to 59 years (23.7%), with a predominance of females (55%). Diabetes Mellitus (DM) was the most common past medical condition (30.0%), followed by DM with Tuberculosis (25.0%). Alcohol consumption (36.7%) and combined smoking and alcohol use (31.7%) were also prevalent. Systemic examination revealed that 45.0% had tenderness, while 51.6% were within normal limits. Abdominal pain was a common symptom in both operated (63.3%) and non-operated (35.0%) patients. Significant associations were found for age (adjusted OR 1.79, p = 0.045) and tenderness (adjusted OR 0.75, p = 0.036). Conclusion: The study highlighted the demographic and clinical characteristics of ASBO patients, emphasizing the importance of recognizing risk factors such as age, medical history, and lifestyle habits. Identifying these factors can aid in better managing and preventing ASBO, ultimately improving patient care and reducing healthcare burdens. The findings underscore the necessity for targeted interventions and refined surgical techniques to minimize adhesion formation and subsequent bowel obstructions.

Maternal and Neonatal Outcomes of Delayed Cord Clamping vs Early Cord Clamping in Term Delivered Newborns

Manjari Kumari, Mridu Sinha, Surabhi Gupta

Introduction: During the first minutes after birth, the newborn infant receives a substantial blood transfusion from the placenta. Delayed cord clamping (DCC) is associated with decrease incidence of anemia in childhood, less intraventricular hemorrhage and lower risk of necrotizing enterocolitis as compared to early cord clamping. The present study was conducted to study maternal and neonatal outcomes of delayed cord clamping (DCC) vs early cord clamping (ECC) in termdelivered newborns. Material and Methods: This prospective study was conducted in terms of low-risk pregnant women admitted for safe confinement in the labour room of SRMS IMS Bareilly, between August 2022 to January 2024. A total of 60 patients, who fulfilled the inclusion-exclusion criteria, were subjected to the study and divided into two groups of 30 each: Group A with ECC and Group B with DCC. Mothers and their newborns were evaluated with reference to maternal and neonatal outcomes. Statistical analysis was carried out using Microsoft Excel and Epic Info 7.1 software. Results: In this study, ECC was performed on 30 (Group A), and DCC was performed on 30 (Group B). A significant increase in haemoglobin level without any significant increase in neonatal serum bilirubin level in the case of DCC, as compared to ECC. On the basis of this study, the delayed cord clamping shows significant positive effects on infants’ health. Conclusion: Delayed cord clamping improves haemoglobin levels and iron stores in term infants, which have major positive effects on infants’ health and development and decrease incidence of childhood anaemia.

Surgical and Audiological Outcome of Tympanoplasty Type I with use of Gelfoam Soaked in Platelet Rich Plasma: A Novel technique

Akanksha Singh, Rohit Sharma, Amit Kumar Rana, Mamta Verma, Abhaydeep Singh

Introduction: Chronic otitis media is a disease commonly presented in ENT clinics. Gelfoam is a commonly used agent for packing the middle ear and external auditory canal during tympanoplasty. The aim of the study is to observe and document the surgical and audiological outcomes of tympanoplasty type I with the use of Gelfoam soaked in platelet-rich plasma (PRP). Material and methods: This study included 30 patients aged between 15 to 50 years of age who were diagnosed with Inactive COM mucosal type undergoing type I tympanoplasty. Pre-operative otoscopy and pure tone audiometry were done and compared with post-operative otoscopy and pure tone audiometry at 6 weeks. Results: All 30 (100%) patients showed uptake of graft at the end of 6 weeks. In a comparison of pre-operative and post-operative AB gap at 6 weeks, there was a significant improvement (p-value 0.00). The AB gap average at individual frequencies:500, 1000, and 2000 Hz was measured, and maximum AB gap improvement was seen at 1000 Hz, of 11.3 ± 6.0 dB. Conclusion: All the patients in the study group showed complete graft healing and significant improvement on audiogram post-operatively at 6 weeks, signifying that the use of PRP with Gelfoam enhances the overall outcome of TM perforation repair.

Mammogram and Ultrasound Evaluation of Breast Lesions with Cytohistological Correlation: A Hospital-Based Observational Study

Mihir Sagar Singh, Sameer Rajeev Verma, Namrata Singh, Pankaj Kaira

Introduction: Breast cancer remains a significant health burden, being the second most common malignancy among women in India. Early detection through imaging, particularly mammography and ultrasonography (USG), is critical for effective management. This study aimed to assess the efficacy of mammography and ultrasonography in classifying breast lesions according to the breast imaging-reporting and data system (BI-RADS) categories and compare it with histopathology. Material and Methods: This is an observational study conducted at SRMSIMS Hospital, Bareilly, India, over 1.5 years. The study included 90 female patients presenting with breast-related symptoms. Categorical data was shown in terms of frequency and percentage. The association between two categorical variables was assessed through the chi-square test. Data analysis was done by Microsoft Excel 2019. Results: The majority of participants were aged 45 to 54 years, with 83.3% of lesions exhibiting high density. BI-RADS classification through mammography identified 50% of lesions as suspicious for malignancy (BI-RADS IV), while 21.1% were highly suggestive of malignancy (BI-RADS V). SONO-BIRADS classified 45.6 and 26.7% of lesions as BI-RADS IV and V, respectively. Comparison with FNAC and histopathology revealed a statistically significant correlation with MAMMOBIRADS and SONO-BIRADS categories (p = 0.000). Conclusion: The study concludes the critical role of mammography and ultrasonography in the early detection and correct classification of breast lesions. The frequent occurrence of BIRADS IV and V categories pointed out the need for quick biopsies. The reliability of the BI-RADS system in clinical practice is acknowledged, indicating the value of integrating mammography and ultrasound to enhance diagnostic precision and patient care.

3-Dimensional Conformal versus Intensity Modulated Radiotherapy in Head and Neck Squamous Cell Carcinoma: Comparative Analysis of Compliance, Toxicities and Dosimetric Parameters

Kritika Mehrotra, Piyush Kumar, Jitendra Nigam, Silambarasan NS, Navitha S — Tue, 28 Oct 2025 00:00:00 +0530

Introduction: Advance radiotherapy conformal techniques
have an advantage over conventional radiotherapy in delivering
the dose more accurately to the target volume while limiting the
doses to organs at risk. 3-dimensional conformal radiotherapy
leads to sparing the surrounding normal tissue better than
2-dimensional radiotherapy, but it still causes significant
volumes of normal tissue irradiation because RT is delivered
in three dimensions with a uniform dose in each field. Intensity
modulated radiotherapy is a refinement of 3-dimensional
conformal radiotherapy, which modulates the radiation beams
so that a high dose can be delivered to the tumor target while the
dose to normal tissues can be reduced. The dose-modulating
ability of IMRT gives a theoretical advantage over 3D-CRT,
but it also has a drawback of delivering a higher dose outside
the planning target volume (PTV) due to more number of
fields used. The present study aims to analyze and compare
dosimetric parameters, compliance, and toxicities of these
two techniques.
Materials and methods: About 50 patients of head neck
cancers presented in our department were treated with
definitive concurrent chemoradiation after randomizing into
two groups of twenty-five each- Group I (3DCRT) and Group II
(IMRT). Inclusion Criteria- Histologically proven squamous cell
carcinoma; age >18 years; Karnofsky performance status >70;
normal hemogram, renal function test, liver function test and 2D
ECHO. Exclusion Criteria - prior or synchronous malignancy or
previous history of head and neck surgery; distant metastasis;
previously treated patients with radiotherapy. Radiotherapy
dose of 70 Gy in 35 fractions over 7 weeks, along with weekly
cisplatin 35 mg/m2, was given. Treatment compliance (overall
treatment time and number of weekly chemotherapy cycles),
toxicities (hematological and radiotherapy-induced), clinical
response assessment and dosimetric parameters of PTV
and organ at risk were compared. Statistical analysis was
done using an unpaired t-test to compare the mean of two
independent groups and a chi-square test for compliance and
toxicities.
Results: The mean and median age in Group I is 57.2 years
(35–77 years) and 60 years and in Group II is 62.08 years
(42–76 years) and 63 years. The male-to-female ratio in groups
I and II is 11.5 and 5.25, respectively. The majority of the cases
were locoregionally advanced, 76% in Group I and 84% in
Group II. There was no statistically significant difference in
overall treatment time above 51 days in both groups (40 vs 24%)
and patients receiving 5 to 7 cycles of chemotherapy (54 vs
46%). Similarly, there was no statistically significant difference
in hematological and radiotherapy-induced toxicities. Complete
response seen in both groups (80 vs 72%, p = 0.51). The PTV
parameters were achieved in both groups, but were statistically
better in IMRT. Dose constraints for OARs were achieved in
most organs, though they were statistically better in IMRT.
Conclusion: Both techniques, 3-DCRT and IMRT, did not
have any statistical difference in treatment compliance and
toxicities. Dosimetric parameters were achievable, though they
were better in IMRT. Different forward planning techniques may
improve and make 3DCRT plans comparable to IMRT

Comparison of Epidural Analgesia with Transversus Abdominis Plane Analgesia for Postoperative Pain Relief in Patients Undergoing Lower Abdominal Surgery

Urvashi Kharayat, Juhi Saran, Geeta Karki, Ashita Mowar

Introduction: Anesthesiologists play an important role in postoperative pain management. For analgesia after lower abdominal surgery, epidural analgesia and ultrasound-guided transversus abdominis plane (TAP) block are suitable options. The study aims to compare the analgesic efficacy of epidural analgesia and transverse abdominis plane (TAP) block. Material and Methods: In this study 165 patients undergoing lower abdominal surgery were divided into 3 groups. Group C (Control): spinal anesthesia with hyperbaric bupivacaine 15mg (3ml of 0.5%)+ intravenous infusion of 100 ml of NS over 15 min. Group E (Epidural): epidural catheter will be inserted before spinal block. At the end of the surgery, will receive 10 ml of 0.125% bupivacaine through the epidural catheter followed by removal of the catheter. Group T (TAP): at the end of surgery bilateral TAP block will be given and 20 ml of 0.125% bupivacaine will be injected and the spread of local anaesthetic solution visualised in real time through ultrasound. Assessment of the pain will be done using visual analog scale (VAS) Results: It was observed that comparison between the group C and group E was significant after 2 hours post-surgery. There was a large disparity between the groups T and Group C after 4 hours of surgery. The time to first rescue analgesic consumption was significantly higher in group E and group T with the majority of 41 (74.5%) patients of Group E satisfied. In present study, the pain score was measured based on the VAS scale in the three studied groups and it was found that the postoperative pain was lower significantly in the epidural group and TAP group as compared to control group (p<0.05) Conclusion: According to our study, in terms of postoperative analgesia, overall analgesic intake, and time to first rescue analgesia, along with similar nausea, vomiting, and time to hospital discharge, epidural analgesia performed better than TAP block.

Study of Histopathological Spectrum of Leprosy Patients with Special Reference to Conventional PCR for Detection of Mycobacterium leprae in Skin Biopsy Samples: A Prospective Observational Study

Nipun Parkash, Jaspreet Kaur, Tanu Agrawal, Surabhi Pandey — Tue, 28 Oct 2025 00:00:00 +0530

Introduction: Leprosy, caused by Mycobacterium leprae, is
a chronic infectious disease affecting the skin and peripheral
nerves. The clinical presentation varies, from tuberculoid to
lepromatous forms due to differences in immune response.
Although slit skin smears (SSS) and histopathological analysis
are standard diagnostic methods. Modified Ziehl–Neelsen
staining is a widely used technique, but molecular methods
like polymerase chain reaction (PCR) offer superior sensitivity
and diagnostic utility. The aim of the study was to evaluate
histological findings, and PCR results in skin biopsies from
leprosy patients and to correlate histopathological and
molecular findings.
Material and Methods: A 4 mm skin punch biopsy was
obtained from 55 clinically diagnosed leprosy patients,
preserved in formalin, and processed for histopathology.
Staining was performed using hematoxylin and eosin (H&E)
and modified Ziehl–Neelsen stains. PCR testing was conducted
for molecular detection of Mycobacterium leprae.
Results: The majority of patients were aged between 21–40
years, with 31 males (56.4%) and 24 females (43.6%).
Borderline lepromatous leprosy was the most prevalent
type. Of the 55 cases, 45.45% tested positive with modified
Ziehl–Neelsen staining, whereas PCR demonstrated a higher
positivity rate of 54.54%.
Conclusion:PCR is a valuable adjunct for diagnosing leprosy
in cases where modified Ziehl–Neelsen staining results are
negative. Despite its advantages, modified Ziehl–Neelsen
staining remains essential in low-resource settings due to its
accessibility and cost-effectiveness. Incorporating PCR in
casesZiehl–Neelsen staining shows negative results, it can
enhance the overall diagnostic yield.

Prognostic Evaluation of Multi-Organ Dysfunction Syndrome in Pediatric Intensive Care Unit: A Crosssectional Study from Western UP

Introduction: Multi-organ dysfunction syndrome (MODS) significantly contributes to pediatric mortality, especially in low- and middle-income countries. The aim of the study is to evaluate the prognostic utility of the pediatric logistic organ dysfunction (PELOD) score in patients with MODS in Western UP and to study their clinical and laboratory profiles. Material and Methods: A cross-sectional observational study was conducted over 12 months in a tertiary care Pediatric Intensive Care Unit (PICU) in North India, including children aged 1 month to 12 years diagnosed with MODS. Results: Among 94 patients, the majority were male (72.34%) and from rural, lower socioeconomic backgrounds. Sepsis was the leading cause of MODS (95.74%). Higher PELOD scores correlated with increased mortality and longer hospital stays. Conclusion: MODS remains a critical concern in pediatric care. The PELOD score is a valuable tool for prognostication and should be integrated into routine clinical practice.

Maternal Serum Uric Acid as a Biochemical Prognostic Marker for Predicting Maternal and Fetal Outcome in Pregnancy-Induced Hypertension – A Prospective Study

Sunaina Chandra, Namita Agarwal, Shashi Bala Arya, Preeti Singh, Shubhangi Gupta — Tue, 28 Oct 2025 00:00:00 +0530

Introduction: Pregnancy-induced hypertension (PIH),
encompassing conditions such as gestational hypertension,
pre-eclampsia, and eclampsia, remains a significant cause
of maternal and perinatal morbidity and mortality worldwide,
particularly in developing countries. It typically manifests
after 20 weeks of gestation and is characterized by elevated
blood pressure with or without proteinuria or other systemic
involvement. Despite advancements in obstetric care,
early prediction and effective management of PIH remain
challenging due to its unpredictable progression and complex
pathophysiology. Among various biomarkers explored for
early detection and prognostication of PIH, serum uric acid
has emerged as a potential candidate. Uric acid, a final
product of purine metabolism, is known to increase during
normal pregnancy, but elevated levels beyond the expected
physiological range have been correlated with adverse maternal
and fetal outcomes in hypertensive pregnancies. Hyperuricemia
in PIH is believed to reflect reduced renal clearance, oxidative
stress, endothelial dysfunction, and systemic inflammation—all
of which are central to the disease process. The aim was to
study serum uric acid as a biochemical prognostic marker for
predicting maternal and fetal outcome in pregnancy-induced
hypertension.
Material & Methods: A total of 200 antenatal women were
enrolled in the study. The control group consisted of 100
healthy normotensive women with no history of raised blood
pressure or renal disease, and the case group consisted of 100
preeclamptic antenatal women. All patients’ blood pressure
was measured at admission and after 4 hours, and their venous
samples were taken and sent for serum uric acid estimation and
compared for their significance in predicting pre-eclampsia,
correlating severe grades of hypertension and fetomaternal
outcome. Statistical analysis was done using various tests like
Mann-Whitney, chi-square test, Fisher test, etc.
Results: The mean uric acid value in normotensives was 4.20 ±
0.83 mg/dl, increased with increasing severity of hypertension,
maximum in the eclamptic group, 9.75 ± 3.31 mg/dl. There is
a positive correlation between uric acid and the severity of
hypertension. The maternal complications like LSCS, HELLP
syndrome, post-partum eclampsia, and fetal complications
like low APGAR score, low birth weight, and NICU admission
were higher when the uric acid level was above 6.5 (p <0.05).
Conclusion: Serum uric acid was found to be a useful
prognostic indicator for fetomaternal outcomes in women with
pre-eclampsia and eclampsia.

A Comparison of Low-Dose Magnesium Sulphate to Standard (Dhaka Regimen) and Pritchard’s Regimen in Management of Eclampsia

Tanisha Agrawal, Namita Agrawal, Mridu Sinha, J.K. Goel

Introduction: To compare the efficacy of low-dose magnesium sulphate (Dhaka Regimen) with the standard Pritchard’s regimen in the management of eclampsia. The aim of the study is to study the efficacy of the Dhaka Regimen in comparison to Pritchard’s regimen in control of convulsions, safety profile, and maternal and perinatal outcome in eclampsia. Material and Methods: This prospective study was carried out in the Department of Obstetrics and Gynaecology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, over a period of 1 year. Approximately 50 cases of eclampsiaantepartum & intrapartum were included. All 50 cases were randomly divided into Group A, which received the Dhaka regimen and Group B, which received Pritchard’s regimen. To determine the efficacy of the low-dose regimen, the parameters evaluated were recurrence of convulsions, maternal complications, birth weight, Apgar score and perinatal outcome. Results: Recurrence of convulsions was 12% in Pritchard’s regimen as compared to 4% in the Dhaka regimen. The p-value was 0.609, which was statistically not significant. There was no maternal mortality in either group. The perinatal mortality was 20% in Pritchard’s and 8% in the Dhaka group. Even though perinatal mortality was higher with Pritchard’s regimen, the p-value was 1.00, which was statistically not significant. Conclusion: The study supports that the Dhaka regimen is as efficacious as Pritchard’s regimen in convulsion control for Indian women, as they are smaller built, with minimal adverse maternal and perinatal events, have a reduced risk of magnesium toxicity, and are cost-effective, which is important for a low-resource country like India.