https://jmssrms.in/index.php/journal/issue/feedSRMS JOURNAL OF MEDICAL SCIENCE2025-01-25T16:21:25+0530Pradeep Tiwaripradeep@mripub.comOpen Journal Systems<p>The SRMS Journal of Medical Sciences (SRMSJMS) is a biomedical journal with national circulation. It publishes original communications of biomedical research that advances or illuminates medical science or that educates the journal readers. It is issued six monthly, in two volumes per year. Manuscripts dealing with clinical aspects will be considered for publication, provided they contain results of original investigations. Articles need to be of general interest - e.g., they cross the boundaries of specialities or are of sufficient novelty and importance that the journal's readers, whatever their speciality, should be made aware of the findings. Research papers reporting original research, review articles, correspondence on published articles will also be considered. Papers of routine nature which are merely records of interesting cases as also those dealing with modifications of routine methodology will not be encouraged.</p> <div class="page-header"> <h1>Article Processing Fee/Open Access Fee</h1> </div> <p><strong>Author Fee</strong></p> <p>Indian Journal of Pharmaceutical and Biological Research is an open access journal, and then Author submission, as well as article processing and publishing, is <strong>free of charge</strong>.</p> <p>Readers can read and download any full-text articles for <strong>free of charge</strong>.</p>https://jmssrms.in/index.php/journal/article/view/243Radiotherapy Planning of Carcinoma Esophagus - Role of PET Fusion with CT Scan2025-01-25T16:13:58+0530Brijesh Bhagwan Maheshwaripiykumagr@gmail.comArvind Kumar Chauhanpiykumagr@gmail.comPiyush Kumarpiykumagr@gmail.comJitendra Nigampiykumagr@gmail.comSilambarasan NSpiykumagr@gmail.comNavitha Spiykumagr@gmail.comPavan Kumarpiykumagr@gmail.comAyush Gargpiykumagr@gmail.com<p>Introduction: Oesophageal cancers are treated with a multimodality approach. The concept of organ preservation has led to concurrent chemoradiation becoming the standard of care in cervical as well as mid-thoracic oesophageal tumors. Radiotherapy can be delivered by various conventionall and with conformal techniques. Defining target volumes adequately is important in radiotherapy planning and delivery of treatment as esophageal and gastroesophageal cancers have a high propensity of loco-regional recurrence. The present study aims to evaluate and compare the dosimetry parameters in patients with cancer esophagus planned on CT-based contours and PET-CT fusion-based contours by conformal technique. Material and Methods: Fifty biopsy-proven cases of cancer esophagus and gastroesophageal junction were selected in our institute between February 2021 to July 2022. After immobilization, spiral CT for simulation was performed. Thereafter, PET was performed in the same treatment position as in CT imaging protocol. The (DICOM) images were transferred to the Eclipse treatment planning system (TPS) and registered. Gross tumor volume was contoured on CT and PET-CT scans, followed by CTV contouring. Volumetric margin given depending on the institutional protocol to account for microscopic tumor extension and mean motion of the lesion to generate planning target volume (PTV). Two PTV volumes were finally contoured that is PTV - PTV-CT and PTV - PET-CT. The organs at risks (bilateral lungs, heart, spinal cord) were generated in accordance with the Radiation Therapy Oncology Group (RTOG) protocol and dose constraints given as per QUANTEC. The dose prescribed to PTV-CT and PTV-PETCT in the range of 45Gy - 59.4Gy, depending upon the site in 25- 33 fractions. Two plans (groups 1 and 2) were generated for comparison and were optimized to maximize the dose to the PTV and limit the dose to normal tissue. PTV dosimetric parameters evaluated were V95, D2, D50, D95, D98, Dmax, Dmean, conformity index and homogeneity index. Dosimetric parameters evaluated for OARs were both lungs combined (D-mean, D-max, V-5, and V-20), heart (D-mean, D-max, and V-40) and spinal cord (D-max). Statistical analysis was done using Paired T-test. A comparison of mean value of dosimetric parameters and P-Value was done. Results: The mean age is 61 years, with male to female ratio 0.7:1. The most common subsite is the mid-thoracic esophagus (46%). Histopathology seen was squamous cell carcinoma (88%) and adenocarcinoma (12%) with a majority having moderately differentiated grade (80%). Median standardized uptake value is 14.9 and the mean is 14.8 (range 0–37.4). The variation of gross tumor size and gross tumor volume on PET-CT scan as compared to CT scan ranged from -1.7 (-44.7%) cm to 2.7 cm (55.1%) and from -11.9 cm3 (-28.6%) to 13.2 cm3 (36.8%) which was not statistically significant (p = 0.38 and p = 0.41 respectively). There was a difference of 18% in the detection of nodes by PET CT scan as compared to CT scan which was statistically significant (p = 0.0001). Increased PTV was seen in 26% of patients (p=0.0001). No difference in dosimetric parameters of PTV was found in terms of V9, D2, D50, D95, D98, Dmax, and Dmean. Similarly, no statistical difference was found in the CI and HI of both plans. Dosimetric parameters of both lungs show statistically significant differences in D mean (14.73 Gy vs 16.13 Gy; p = 0.0005) and V5 (89.16 Gy vs. 28.4 Gy; p = 0.0056). Dosimetric parameters in the heart did not show a statistically significant difference. Dmax for the spinal cord in both groups was within dose constraints (38.7 Gy vs 39.1 Gy) with no statistically significant difference (p = 0.22). Conclusion: Delineation of primary gross tumor is better with PET fusion than as compared to CT alone. Further, PET-CT scans detect more lymph nodes than CT alone. Therefore, by incorporating PET–CT scans in radiotherapy planning of carcinoma esophagus, more accurate and precise treatment planning can be done, which will lead to fewer chances of geographical miss and less chances of loco-regional failure.</p>2024-06-30T00:00:00+0530##submission.copyrightStatement##https://jmssrms.in/index.php/journal/article/view/244Determinants of Attitude of School Going Adolescent Girls Towards Reproductive Health with their Treatment Seeking Behaviour2025-01-25T16:14:23+0530Priyanka Kumardrpriyankadun@gmail.comRicha Mishradrpriyankadun@gmail.comRavi Kumardrpriyankadun@gmail.com<p>Introduction: Adolescence includes the age group between 10 to 19 years. World Health Organization has defined adolescence as the progression from the appearance of secondary sexual characters to sexual maturity and the development of adult mental processes. Puberty is the transitional period linking childhood to adulthood and involves physical, biological and psychosexual changes. Objectives: To identify major determinants of the attitude of Adolescent school girls regarding reproductive health. Material and Methods: Study design: Descriptive crosssectional Study, Study Area: The present study was conducted at randomly selected government and private schools located in the areas served by UHTC and RHTC of the Department of Community Medicine, Shri Ram Murti Smarak Institute of Medical Sciences (SRMS IMS) at Bareilly, Uttar Pradesh. Study Period: The study was conducted over a period of one year, i.e., from 1st May 2014 to 30th April 2015. Study Population: The study population comprised adolescent girls studying in the selected government and private schools in the urban and rural areas. Study Subjects: Adolescent girls aged 10 to 19 years, attending 6th to 10th class in the selected government and private schools were included in the study. Sample size estimation: 420.Sampling Technique: Simple random sampling without replacement technique. Statistical tool: Logistics regression model. Results: The findings imply that the daughter of a highly educated mother (β = 0.453, p < 0.001), high socioeconomic class (β = 0.372, p < 0.001), and having Media access (β = 0.409, p < 0.001) appeared as strong significant predictors of adolescent girls positive attitude towards reproductive health issues. Suggests that a daughter’s positive attitude towards reproductive health issues is significantly influenced by her mother’s education level, socioeconomic status, and media access (β = 0.453, p < 0.001; β = 0.372, p < 0.001; β = 0.409, p < 0.001). Conclusion: Promoting health-seeking behavior and educating the people who play a role in being sources of information on menstruation will help to improve menstrual hygiene among rural adolescent girls. Training programs for school teachers by health professionals involving parents in health education programs are some important steps that can be taken.</p>2025-01-23T00:00:00+0530##submission.copyrightStatement##https://jmssrms.in/index.php/journal/article/view/245A Study of Visual Outcomes After Implantation of Presbyopia-Correcting Intraocular Lenses2025-01-25T16:14:47+0530Mitali Yadavmehrotra_neelima@yahoo.comNeelima Mehrotramehrotra_neelima@yahoo.comShipra Tripathimehrotra_neelima@yahoo.comKunwar Gaurav Singhmehrotra_neelima@yahoo.comParas Aroramehrotra_neelima@yahoo.com<p>Introduction: Presbyopia is a prevalent refractive condition affecting individuals over 40, necessitating effective management strategies. This study evaluates visual outcomes following the implantation of presbyopia-correcting intraocular lenses (IOLs) during cataract surgery. Material and Methods: A prospective observational study was conducted from September 2022 to February 2024, including 84 patients aged over 40 with age-related cataracts. Preoperative assessments were followed by sutureless phacoemulsification surgery with presbyopia-correcting IOL implantation. Visual acuity, contrast sensitivity, and complications were assessed preoperatively, one month, and three months post-operatively. Results: The mean age of participants was 55.6 years, with 78.6% achieving best-corrected visual acuity (BCVA) of 6/6 by one month and 91.7% by three months. Significant improvements were noted in both distant and near vision (p < 0.001). Contrast sensitivity scores showed 99.0%, scoring 2.0 or above by three months. Complications were minimal; 91% experienced no early complications, and 93% reported no late complications, with posterior capsule opacification observed in 7%. Conclusion: Presbyopia-correcting IOLs effectively improve visual outcomes post-cataract surgery, demonstrating high patient satisfaction and low complication rates</p>2025-01-23T00:00:00+0530##submission.copyrightStatement##https://jmssrms.in/index.php/journal/article/view/246A study on Indications and Outcome of Penetrating Keratoplasty in a Tertiary Care Hospital2025-01-25T16:15:21+0530Paras Aroramehrotra_neelima@yahoo.comNeelima Mehrotramehrotra_neelima@yahoo.comShipra Tripathimehrotra_neelima@yahoo.com<p>Introduction: Penetrating keratoplasty (PK) is the standard surgical procedure for restoring vision in patients with severe corneal diseases. This study evaluates the indications and outcomes of PK in a tertiary care hospital setting. Material and Methods: A prospective observational study was conducted at Shri Ram Murti Smarak Institute of Medical Sciences from August 2022 to January 2024, including patients aged 18 years and older who presented with corneal opacity. Data collection included demographic profiles, clinical histories, and post-operative outcomes, analyzed using statistical software. Results: Among 79 patients, 62 (78.5%) were male, with corneal ulcers being the leading indication (46.8%). Notably, patients aged 61 to 65 years had the highest incidence of corneal ulcers (55.2%). Trauma was significantly associated with the need for PK (Chi-square: 45.5, p < 0.001), while diabetes showed no significant correlation. Visual acuity significantly improved post-operatively, with 64.6% achieving better outcomes at three months. Complications were noted in 17.7% of patients, with loose sutures being the most common (8.9%). Conclusion: PK is effective in improving visual outcomes, especially in cases of corneal ulcers. However, careful monitoring of complications, particularly in patients using steroids, is crucial for enhancing surgical success.</p>2024-06-30T00:00:00+0530##submission.copyrightStatement##https://jmssrms.in/index.php/journal/article/view/247Impact of Vitamin D Deficiency on Angiographic Severity in Patients with Acute Coronary Syndrome2025-01-25T16:15:51+0530Mugdha Awasthismgu2001@gmail.comMahendra P Rawalsmgu2001@gmail.comSmita Guptasmgu2001@gmail.com<p>Introduction: Acute coronary syndrome (ACS) is a leading cause of morbidity and mortality, with modifiable risk factors like hypertension, diabetes, and smoking being well-established contributors. Recent evidence suggests vitamin D deficiency may also play a significant role in the pathogenesis of coronary artery disease (CAD). This study aims to assess the impact of vitamin D deficiency on angiographic severity in ACS patients. Material and Methods: This prospective cross-sectional study was conducted at Shri Ram Murti Smarak Institute of Medical Sciences (SRMSIMS), Bareilly, over 18 months (August 2022 to January 2024). A total of 101 patients diagnosed with ACS, including unstable angina, STEMI, and NSTEMI, were included. Serum vitamin D levels were measured, and coronary angiography was performed to assess the severity of CAD. Statistical analysis was conducted using SPSS, with p-values <0.05 considered significant. Results: The study found a significant association between low serum vitamin D levels (<20 ng/mL) and more severe coronary involvement. Of the 101 patients, 43.56% had vitamin D levels <20 ng/mL. Significant associations were observed between low vitamin D levels and abnormal angiographic findings in the left main artery (p <0.001), LAD, LC, and RCA. Additionally, low vitamin D levels were linked to triple-vessel disease (60.30%) in ACS patients (p <0.0001). Conclusion: Vitamin D deficiency is strongly associated with more severe coronary artery disease and acute coronary syndrome, suggesting its potential role in risk stratification and management. Further studies are needed to explore the therapeutic benefits of correcting vitamin D deficiency in CAD patients.</p>2024-06-30T00:00:00+0530##submission.copyrightStatement##https://jmssrms.in/index.php/journal/article/view/249Clinical Spectrum, Microbiological Profile, and Complications of Spontaneous Bacterial Peritonitis in Ascitic Cirrhosis: An 18-Month Cross-Sectional Study2025-01-25T16:17:40+0530Nakul Guptasmgu2001@gmail.comMahendra P Rawalsmgu2001@gmail.comSmita Guptasmgu2001@gmail.com<p>Introduction: Ascites, a common complication of liver cirrhosis, often lead to spontaneous bacterial peritonitis (SBP), a severe infection of ascitic fluid. SBP contributes to high morbidity and mortality in cirrhotic patients. This study aimed to evaluate the prevalence, risk factors, clinical spectrum, and microbiological and biochemical profiles of SBP in patients with ascites. Material and methods: An 18-month cross-sectional observational study included 84 cirrhotic patients with ascites, diagnosed clinically and radiologically. SBP was diagnosed based on ascitic fluid analysis (polymorphonuclear count >250 cells/mm³ or positive ascitic fluid culture). Exclusion criteria included age under 18, prior antibiotics use, and secondary causes of ascites. Data were analyzed using SPSS, with chisquare and t-tests for categorical and continuous variables, respectively. Ethical approval was obtained. Results: SBP patients had significantly higher neutrophil counts (292.3 ± 31.9 vs. 126.5 ± 15.0, p < 0.001). The microbiological culture revealed E. coli (60%) as the predominant pathogen. SBP patients also had higher rates of UGI bleeding (48.0 vs. 10.2%, p = 0.001) and worse severity scores (CTP Class C: 48.0%, p = 0.0017). Hepatorenal syndrome (HRS) was significantly more common in SBP patients (28.0 vs. 5.1%, p = 0.003), and mortality was higher (16.0 vs. 3.4%, p = 0.04). Conclusion: SBP in cirrhotic patients is associated with increased neutrophil counts, complications such as UGI bleeding and HRS, and higher mortality. Early detection and appropriate management are crucial for improving patient outcomes.</p>2024-06-30T00:00:00+0530##submission.copyrightStatement##https://jmssrms.in/index.php/journal/article/view/250A Comparative Study to Assess the Efficacy of 2% Intravenous Lignocaine and 50% Magnesium Sulphate in Attenuating the Hemodynamic Response to Laryngoscopy2025-01-25T16:18:40+0530Aditi Sealdrrash.royals@gmail.comAshita Mowardrrash.royals@gmail.comAkhilesh Pahadedrrash.royals@gmail.comJuhi Sarandrrash.royals@gmail.com<p>Introduction: Hemodynamic response to laryngoscopy and intubation is a known phenomenon. Numerous pharmacological and non-pharmacological methods have been employed in an attempt to blunt such responses. However, the search for a perfect agent still continues. A study was conducted in order to compare and assess the efficacy of intravenous lignocaine and magnesium sulfate in blunting this hemodynamic response. Material And Methods: This prospective, double-blind, randomized, Helsinki protocol-compliant clinical study was conducted after written informed consent and approval from the Institutional Ethical Committee. Two groups of 40 subjects each were constituted. Group A received 2% lignocaine 1.5 mg/kg bolus given over 1-minute, while Group B received 50 % magnesium sulphate 30 mg/kg. Study drugs were administered over 10 minutes. Anaesthesia protocol was standardized. Hemodynamics were observed following study drug administration (5, 10 minutes), following induction and following induction and at intubation, and 1, 2, 4, 6, 8,10 minutes following laryngoscopy and intubation. Side effects were also noted. Results: Both groups were comparable demographically and at baseline, following the study drug administration. The difference between the two groups was clinically significant at 1, 2, 4, 6 minutes post-intubation (p = 0.005,0.001,0.004,0.006). The maximum observed heart rate in group B was immediately post-intubation, which was lower than the baseline. In terms of mean arterial pressure, significant intergroup difference was also observed immediately post-intubation and at 1, 2, 4, 6 and 8 minutes post-intubation (p = 0.04, 0.02, 0.02, 0.08). Conclusion: Intravenous magnesium sulphate 30 mg/kg ( group B) was more efficacious than lignocaine 1.5mg/kg ( group A ) in attenuating hemodynamic response to laryngoscopy and intubation.</p>2024-06-30T00:00:00+0530##submission.copyrightStatement##https://jmssrms.in/index.php/journal/article/view/251A Comparative Study of the Combination Treatment of Tamsulosin and Dutasteride with Monotherapy of Tamsulosin in Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia2025-01-25T16:19:15+0530Prateek Pantdr.ektabrijesh@gmail.comBrijesh K Agarwaldr.ektabrijesh@gmail.comSudesh K Sagardr.ektabrijesh@gmail.com<p>Introduction: Benign prostatic hyperplasia (BPH) is a common condition in aging men, often leading to lower urinary tract symptoms (LUTS), such as increased frequency, urgency, and weak urine flow. These symptoms negatively impact quality of life and, if untreated, can lead to complications like acute urinary retention, bladder stones, and renal failure. Medical management, including alpha-blockers like tamsulosin and 5-alpha reductase inhibitors like dutasteride, is an effective approach for symptom relief. This study aims to compare the clinical effectiveness of combination therapy (tamsulosin and dutasteride) with tamsulosin monotherapy in alleviating LUTS due to BPH. It also aims to assess the reduction in prostate volume, post-void residual volume, and improvement in peak urinary flow rate. Material and methods: A study was conducted on 200 male patients aged 50 to 80 years with obstructive LUTS. Patients were randomized into two groups: monotherapy with tamsulosin 0.4 mg/day or combination therapy with tamsulosin 0.4 mg/ day and dutasteride 0.5 mg/day for 3 months. Patients were followed fortnightly, and pre-and post-treatment assessments were done. Results: The study found that both combination therapy with tamsulosin and dutasteride and monotherapy with tamsulosin helped in the improvement of lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH). Post-treatment, both groups showed significant improvements in AUA scores, prostate volume, and post-void residual volume and peak urinary flow rate. In comparing combination and monotherapy, combination therapy was more effective than monotherapy. Conclusion: Both combination and monotherapy are effective in reducing LUTS due to BPH, but combination therapy is more effective than monotherapy in comparison between the two, though further long-term studies are required to assess the sustainability of these improvements.</p>2024-06-30T00:00:00+0530##submission.copyrightStatement##https://jmssrms.in/index.php/journal/article/view/252A Longitudinal Analysis of Disease Activity and Lung Function in Patients with Chronic Joint Disorders: Correlation with Disease Duration2025-01-25T16:19:54+0530Amandeep .Neerajkapoor99@gmail.comNeeraj KapoorNeerajkapoor99@gmail.comSmita GuptaNeerajkapoor99@gmail.com<p>Introduction: Rheumatoid arthritis (RA) is a chronic autoimmune disease that primarily affects joints but can also cause significant pulmonary complications, such as interstitial lung disease and pulmonary hypertension, leading to impaired lung function. Early identification of pulmonary involvement through pulmonary function tests (PFTs) is crucial to improving patient outcomes. This study assesses the correlation between the duration of RA and pulmonary function. Material and Methods: A prospective cohort study was conducted at Shri Ram Murti Smarak Institute of Medical Sciences from August 2022 to January 2024, including 98 RA patients. Participants underwent clinical evaluation, laboratory tests, and PFTs (FEV1, FVC, and FEV1/FVC ratio) at baseline, one month, and three months. Disease activity was assessed using the DAS28 score. Data were analyzed using SPSS Version 25, with a p-value < 0.05 considered significant. Results: Participants (mean age 40.98 ± 11.7 years) were predominantly female (80.6%). Disease activity improved over three months, with low activity increasing from 0% at admission to 38.8%. Significant improvements were observed in FEV1 (1.5 ± 0.3 to 1.7 ± 0.3 L, p < 0.001) and FEV1/FVC ratio (61.8–68.4%, p < 0.001). Conclusion: Pulmonary function showed significant improvement with RA management over time, highlighting the importance of regular PFT monitoring to prevent respiratory complications.</p>2024-06-30T00:00:00+0530##submission.copyrightStatement##https://jmssrms.in/index.php/journal/article/view/253Effect of Platelet-Rich Plasma Therapy on Radiological and Electrophysiological Parameters of the Ulnar Nerve in Patients of Leprosy: A Hospital-Based Prospective Comparative Study2025-01-25T16:21:00+0530Shikhil Guptadrpratikg@rediffmail.comAmar Singhdrpratikg@rediffmail.comSharat Johridrpratikg@rediffmail.comNeeraj Prajapatidrpratikg@rediffmail.comPragati Guptadrpratikg@rediffmail.comPratik Gahalautdrpratikg@rediffmail.com<p>Introduction: Leprosy, a chronic disease caused by Mycobacterium leprae, often leads to ulnar neuropathy, causing sensory and motor impairments. Despite treatment, nerve damage may persist, and regenerative therapies like plateletrich plasma (PRP) are being explored for their potential to enhance nerve regeneration. Material and Methods: This prospective study aimed to evaluate PRP therapy’s effects on ulnar neuropathy in leprosy patients. Conducted at Shri Ram Murti Smarak Institute of Medical Sciences, it included 24 patients with bilateral thickened ulnar nerves. PRP was injected into one ulnar nerve while the other received a sham saline injection. Sensory testing, nerve conduction studies, and ultrasound measurements of the ulnar nerve were performed pre- and post-procedure. Results: Sensory and motor parameters showed no significant differences between PRP-treated cases and controls. Sensory function deteriorated more in some cases, but changes in monofilament values, latency, velocity, and amplitude were not statistically significant. A significant reduction in the ulnar nerve area was observed post-procedure, but the overall change and percentage change were not significant. Conclusion: PRP therapy demonstrated a minimal impact on nerve function in leprosy-induced ulnar neuropathy. Further studies are needed to confirm its potential clinical relevance.</p>2024-06-30T00:00:00+0530##submission.copyrightStatement##https://jmssrms.in/index.php/journal/article/view/254Simple Schizophrenia, a Rare and Under-Diagnosed Clinical Condition: A Case Report2025-01-25T16:21:25+0530Raunaq Rafael Guptadeepakcharan0@gmail.comAkanshi Ohrideepakcharan0@gmail.comAshee Agarwaldeepakcharan0@gmail.comDeepak Charandeepthichonat@gmail.com<p>Schizophrenia is a serious mental illness that affects how a person thinks, feels, and behaves. People with schizophrenia have severe behavioral and sociooccupational dysfunction, which is very distressing for family members and society. Schizophrenia is characterized by positive psychotic symptoms such as hallucinations, delusions and, disorganization and motivational and cognitive dysfunctions.(1) Simple schizophrenia is a subtype of schizophrenia. ‘It is an uncommon disorder in which there is an insidious but progressive development of oddities of conduct, an inability to meet the demands of society, and a decline in total performance. Delusions and hallucinations are not evident, and the disorder is less obviously psychotic than the hebephrenic, paranoid, and catatonic subtypes of schizophrenia. The characteristic “negative” features of residual schizophrenia (e.g., blunting of effect, loss of volition) develop without being preceded by any overt psychotic symptoms. With increasing social impoverishment, vagrancy may ensue, and the individual may then become self-absorbed, idle, and aimless.’ (2) A typical case of simple schizophrenia is very uncommon and very difficult to diagnose. It is considered to be a controversial clinical entity.(3) However, cases showing typical clinical signs and symptoms continue to be identified in surveys of schizophrenia patients.</p>2025-01-23T00:00:00+0530##submission.copyrightStatement##