Innovative Journal of Medical and Health Sciences

Purpose: The cranium base is complex, as well as extremely attractive. The foramen
magnum is an important characteristic of cranium base. A transcondylar surgical
method requires knowledge of the anatomical features of this region. Foramen magnum
index and cranial index were evaluated to establish a correlation, if any, between the
dimensions of skull and foramen magnum and an attempt was made to provide a
baseline data for better surgical approach in this region so that overall morbidity and
mortality could be minimized.
Material and Methods: Various diameters of foramen magnum and of cranium
were examined to calculate the two index using an electronic digital sliding caliper in
120 adult North Indian dry skulls of unknown age and gender.
Results: The mean Foramen Magnum Index (FMI) was 78.715.94. The mean cranial
index was found to be 73.827.06.The p-value is >0.05, r = 0.004 (Weak correlation)
indicating a weak correlation between two parameters.
Conclusion: The results primarily help the anatomists and a medico-legal expert to
find out the cranial index from the Foramen Magnum Index through the provision of
base line data. Secondly, it provides an important information to clinicians and neurosurgeons
to approach the cranial base with maximum safety and minimal mortality
and morbidity.
Key words: Foramen Magnum–Foramen Magnum Index–Variation–Cranial index.

Purpose: The cranium base is complex, as well as extremely attractive. The foramen
magnum is an important characteristic of cranium base. A transcondylar surgical
method requires knowledge of the anatomical features of this region. Foramen magnum
index and cranial index were evaluated to establish a correlation, if any, between the
dimensions of skull and foramen magnum and an attempt was made to provide a
baseline data for better surgical approach in this region so that overall morbidity and
mortality could be minimized.
Material and Methods: Various diameters of foramen magnum and of cranium
were examined to calculate the two index using an electronic digital sliding caliper in
120 adult North Indian dry skulls of unknown age and gender.
Results: The mean Foramen Magnum Index (FMI) was 78.715.94. The mean cranial
index was found to be 73.827.06.The p-value is >0.05, r = 0.004 (Weak correlation)
indicating a weak correlation between two parameters.
Conclusion: The results primarily help the anatomists and a medico-legal expert to
find out the cranial index from the Foramen Magnum Index through the provision of
base line data. Secondly, it provides an important information to clinicians and neurosurgeons
to approach the cranial base with maximum safety and minimal mortality
and morbidity.
Key words: Foramen Magnum–Foramen Magnum Index–Variation–Cranial index.

Purpose: The cranium base is complex, as well as extremely attractive. The foramen
magnum is an important characteristic of cranium base. A transcondylar surgical
method requires knowledge of the anatomical features of this region. Foramen magnum
index and cranial index were evaluated to establish a correlation, if any, between the
dimensions of skull and foramen magnum and an attempt was made to provide a
baseline data for better surgical approach in this region so that overall morbidity and
mortality could be minimized.
Material and Methods: Various diameters of foramen magnum and of cranium
were examined to calculate the two index using an electronic digital sliding caliper in
120 adult North Indian dry skulls of unknown age and gender.
Results: The mean Foramen Magnum Index (FMI) was 78.715.94. The mean cranial
index was found to be 73.827.06.The p-value is >0.05, r = 0.004 (Weak correlation)
indicating a weak correlation between two parameters.
Conclusion: The results primarily help the anatomists and a medico-legal expert to
find out the cranial index from the Foramen Magnum Index through the provision of
base line data. Secondly, it provides an important information to clinicians and neurosurgeons
to approach the cranial base with maximum safety and minimal mortality
and morbidity.
Key words: Foramen Magnum–Foramen Magnum Index–Variation–Cranial index.

The number of coronavirus-caused deaths is increasing and this is turning into a public
health problem.
The virus occurred in an open animal market in the People’s Republic of China. It
infects people and is threatening the whole world. The number of deaths is gradually
increasing. Health professionals are making efforts to solve this problem, thus they are
at great risk. This situation, which has become a public health problem, lays a new
burden on public health nurses.
Such cases have increased in the 21st century and epidemics called SARS, MERS,
avian influenza, swine influenza, and finally, COVID-19 have occurred. Governments
and healthcare providers should take the necessary precautions and perform their
tasks to prevent such outbreaks.
All healthcare professionals, especially public health nurses, should provide training,
counseling and preventive healthcare services on COVID-19 for the society.
Governments should take necessary and sufficient measures to prevent the spread of
such outbreaks and develop health policies.
Key words: Public Health Nursing–COVID-19–Health Professionals–Preventation

The number of coronavirus-caused deaths is increasing and this is turning into a public
health problem.
The virus occurred in an open animal market in the People’s Republic of China. It
infects people and is threatening the whole world. The number of deaths is gradually
increasing. Health professionals are making efforts to solve this problem, thus they are
at great risk. This situation, which has become a public health problem, lays a new
burden on public health nurses.
Such cases have increased in the 21st century and epidemics called SARS, MERS,
avian influenza, swine influenza, and finally, COVID-19 have occurred. Governments
and healthcare providers should take the necessary precautions and perform their
tasks to prevent such outbreaks.
All healthcare professionals, especially public health nurses, should provide training,
counseling and preventive healthcare services on COVID-19 for the society.
Governments should take necessary and sufficient measures to prevent the spread of
such outbreaks and develop health policies.
Key words: Public Health Nursing–COVID-19–Health Professionals–Preventation

The number of coronavirus-caused deaths is increasing and this is turning into a public
health problem.
The virus occurred in an open animal market in the People’s Republic of China. It
infects people and is threatening the whole world. The number of deaths is gradually
increasing. Health professionals are making efforts to solve this problem, thus they are
at great risk. This situation, which has become a public health problem, lays a new
burden on public health nurses.
Such cases have increased in the 21st century and epidemics called SARS, MERS,
avian influenza, swine influenza, and finally, COVID-19 have occurred. Governments
and healthcare providers should take the necessary precautions and perform their
tasks to prevent such outbreaks.
All healthcare professionals, especially public health nurses, should provide training,
counseling and preventive healthcare services on COVID-19 for the society.
Governments should take necessary and sufficient measures to prevent the spread of
such outbreaks and develop health policies.
Key words: Public Health Nursing–COVID-19–Health Professionals–Preventation

Amputation of the lower limb is a surgical procedure that is
permanent and can be due to trauma or dysvascular causes.
Loss of balance, reduced quality of life and phantom limb
pain are the fundamental problems that an amputee of lower
limb extremity deals with. (1)
From 2007-2013, there were 310 lower limb amputation in
JPN Apex Trauma Centre. Surprisingly, the numbers rose
to 92 in 2017. In the year 2017&2018, the total no. of amputation
cases increased to 412. Among them, there were
272 cases of lower limb amputations. (2)
Loss of balance is due to the altered centre of gravity
upon loss of a limb. (3) Limitations posed by body function
and structure, thereby hindering participation in daily
work activities affect the quality of life. Environmental and
personal factors further influence these factors. (4)
The standard rehabilitation is training through conventional
exercises, which include weight-shifting exercises, dynamic
balance exercises, stool stepping, braiding and gait
exercises (5). These exercise programs are used to prevent
vascular disease in people with amputation and their adaptation
to amputation. Whatever the time of initiation of
exercise is, it contributes to the physical as well as psychosocial
wellbeing in general. It improves walking balance,
circulation problems, control of prosthesis and energy consumption.
(6)

Amputation of the lower limb is a surgical procedure that is
permanent and can be due to trauma or dysvascular causes.
Loss of balance, reduced quality of life and phantom limb
pain are the fundamental problems that an amputee of lower
limb extremity deals with. (1)
From 2007-2013, there were 310 lower limb amputation in
JPN Apex Trauma Centre. Surprisingly, the numbers rose
to 92 in 2017. In the year 2017&2018, the total no. of amputation
cases increased to 412. Among them, there were
272 cases of lower limb amputations. (2)
Loss of balance is due to the altered centre of gravity
upon loss of a limb. (3) Limitations posed by body function
and structure, thereby hindering participation in daily
work activities affect the quality of life. Environmental and
personal factors further influence these factors. (4)
The standard rehabilitation is training through conventional
exercises, which include weight-shifting exercises, dynamic
balance exercises, stool stepping, braiding and gait
exercises (5). These exercise programs are used to prevent
vascular disease in people with amputation and their adaptation
to amputation. Whatever the time of initiation of
exercise is, it contributes to the physical as well as psychosocial
wellbeing in general. It improves walking balance,
circulation problems, control of prosthesis and energy consumption.
(6)

Amputation of the lower limb is a surgical procedure that is
permanent and can be due to trauma or dysvascular causes.
Loss of balance, reduced quality of life and phantom limb
pain are the fundamental problems that an amputee of lower
limb extremity deals with. (1)
From 2007-2013, there were 310 lower limb amputation in
JPN Apex Trauma Centre. Surprisingly, the numbers rose
to 92 in 2017. In the year 2017&2018, the total no. of amputation
cases increased to 412. Among them, there were
272 cases of lower limb amputations. (2)
Loss of balance is due to the altered centre of gravity
upon loss of a limb. (3) Limitations posed by body function
and structure, thereby hindering participation in daily
work activities affect the quality of life. Environmental and
personal factors further influence these factors. (4)
The standard rehabilitation is training through conventional
exercises, which include weight-shifting exercises, dynamic
balance exercises, stool stepping, braiding and gait
exercises (5). These exercise programs are used to prevent
vascular disease in people with amputation and their adaptation
to amputation. Whatever the time of initiation of
exercise is, it contributes to the physical as well as psychosocial
wellbeing in general. It improves walking balance,
circulation problems, control of prosthesis and energy consumption.
(6)

Introduction: An indicator of pronounced maternal morbidity is intensive care unit
(ICU) admissions of obstetric patients. Few studies have been published concerning
ICU admissions of obstetric patients in the developing world, Based on the fact that
the risk factors defining pronounced maternal morbidity and maternal mortality in
the developing world are not fully established, the present retrospective study was
conducted to analysed & evaluate the obstetric admissions to the ICU in an attempt
to identify the risk factors influencing maternal outcome.
Methods:This Retrospective Analytical study involved 100 randomly selected Obstetrical
patients admitted to ICUs . Prior Consent was obtained from Local Randomly
selected Tertiary care hospitals to see the records of the patients from MRD . The
medical records for these patients were reviewed for the collection and classification
of data including the patient characteristics, the obstetric history, the preexisting
medical disorders and the causes that necessitated admission to the ICU.
Results: Major obstetric and medical conditions requiring ICU admission were Haemorrhage
, Hypertensive Disorders of Pregnancy (Preeclampsia , Eclampsia , PIH )Severe
Anemia & Sepsis. The number of maternal deaths was 13 % of obstetric patients
admitted in ICU in our study . The commonest causes of maternal mortality were
hemorrhagic shock and multiorgan dysfunction syndrome. The observed mean SAPS
II scores between the surviving group of patients and the nonsurviving group of patients
was statistically significant.
Conclusion: There is a need for HDU in tertiary care hospitals. Obstetric hemorrhage
and hypertensive disorders of pregnancy are the major risk factors for ICU admission.
Majority of complications occurred in women with gestational age of 37–42 weeks.
There is a need to train obstetricians in obstetric medicine and critical care to do
justice to these critically ill pregnant women. Focus of care for the obstetric patients
who bear the major risk factors and who are admitted to the ICU should be carried
out under the guidance of the ICU scoring systems such as the SAPS II & others like
APACHE-II, SOFA scores.
Key words: Retrospective analysis–Intensive care–Obstetrical care–SAPS II

Introduction: An indicator of pronounced maternal morbidity is intensive care unit
(ICU) admissions of obstetric patients. Few studies have been published concerning
ICU admissions of obstetric patients in the developing world, Based on the fact that
the risk factors defining pronounced maternal morbidity and maternal mortality in
the developing world are not fully established, the present retrospective study was
conducted to analysed & evaluate the obstetric admissions to the ICU in an attempt
to identify the risk factors influencing maternal outcome.
Methods:This Retrospective Analytical study involved 100 randomly selected Obstetrical
patients admitted to ICUs . Prior Consent was obtained from Local Randomly
selected Tertiary care hospitals to see the records of the patients from MRD . The
medical records for these patients were reviewed for the collection and classification
of data including the patient characteristics, the obstetric history, the preexisting
medical disorders and the causes that necessitated admission to the ICU.
Results: Major obstetric and medical conditions requiring ICU admission were Haemorrhage
, Hypertensive Disorders of Pregnancy (Preeclampsia , Eclampsia , PIH )Severe
Anemia & Sepsis. The number of maternal deaths was 13 % of obstetric patients
admitted in ICU in our study . The commonest causes of maternal mortality were
hemorrhagic shock and multiorgan dysfunction syndrome. The observed mean SAPS
II scores between the surviving group of patients and the nonsurviving group of patients
was statistically significant.
Conclusion: There is a need for HDU in tertiary care hospitals. Obstetric hemorrhage
and hypertensive disorders of pregnancy are the major risk factors for ICU admission.
Majority of complications occurred in women with gestational age of 37–42 weeks.
There is a need to train obstetricians in obstetric medicine and critical care to do
justice to these critically ill pregnant women. Focus of care for the obstetric patients
who bear the major risk factors and who are admitted to the ICU should be carried
out under the guidance of the ICU scoring systems such as the SAPS II & others like
APACHE-II, SOFA scores.
Key words: Retrospective analysis–Intensive care–Obstetrical care–SAPS II

Introduction: An indicator of pronounced maternal morbidity is intensive care unit
(ICU) admissions of obstetric patients. Few studies have been published concerning
ICU admissions of obstetric patients in the developing world, Based on the fact that
the risk factors defining pronounced maternal morbidity and maternal mortality in
the developing world are not fully established, the present retrospective study was
conducted to analysed & evaluate the obstetric admissions to the ICU in an attempt
to identify the risk factors influencing maternal outcome.
Methods:This Retrospective Analytical study involved 100 randomly selected Obstetrical
patients admitted to ICUs . Prior Consent was obtained from Local Randomly
selected Tertiary care hospitals to see the records of the patients from MRD . The
medical records for these patients were reviewed for the collection and classification
of data including the patient characteristics, the obstetric history, the preexisting
medical disorders and the causes that necessitated admission to the ICU.
Results: Major obstetric and medical conditions requiring ICU admission were Haemorrhage
, Hypertensive Disorders of Pregnancy (Preeclampsia , Eclampsia , PIH )Severe
Anemia & Sepsis. The number of maternal deaths was 13 % of obstetric patients
admitted in ICU in our study . The commonest causes of maternal mortality were
hemorrhagic shock and multiorgan dysfunction syndrome. The observed mean SAPS
II scores between the surviving group of patients and the nonsurviving group of patients
was statistically significant.
Conclusion: There is a need for HDU in tertiary care hospitals. Obstetric hemorrhage
and hypertensive disorders of pregnancy are the major risk factors for ICU admission.
Majority of complications occurred in women with gestational age of 37–42 weeks.
There is a need to train obstetricians in obstetric medicine and critical care to do
justice to these critically ill pregnant women. Focus of care for the obstetric patients
who bear the major risk factors and who are admitted to the ICU should be carried
out under the guidance of the ICU scoring systems such as the SAPS II & others like
APACHE-II, SOFA scores.
Key words: Retrospective analysis–Intensive care–Obstetrical care–SAPS II

Cerebral palsy is a group of permanent disorders of movement and posture that cause
limitations in the activities and are the result of non-progressive disorders of the immature
brain or the developing brain. Motor disorders are often associated with disorders
of the senses, perception, cognition, communication, behavior, epilepsy, hearing, visual
impairment and secondary musculoskeletal problems. The aim of this study is to
examine the prevalence of associated difficulties of persons with cerebral palsy in the
four cantons of the Federation of Bosnia and Herzegovina (FBiH) and to determine
whether there is a statistically significant difference in the representation of associated
difficulties between the cantons. The study was conducted on a sample of 120
respondents, persons with cerebral palsy from four FBiH cantons. The total sample of
respondents was divided into 4 sub-samples of respondents. The results of the study
showed that of the associated difficulties in persons with cerebral palsy, speech difficulties
in 56.60%, intellectual disabilities 34.90%, visual impairment in 32.50%, epilepsy
20.90%, behavioral disorders 7.60% and autism in 2.40%. No statistically significant
difference was found between cantons in the representation of associated difficulties
for persons with cerebral palsy.
Key words: cerebral palsy–associated difficulties–hearing impairment–visual
impairment–speech difficulties–intellectual disabilities.

Cerebral palsy is a group of permanent disorders of movement and posture that cause
limitations in the activities and are the result of non-progressive disorders of the immature
brain or the developing brain. Motor disorders are often associated with disorders
of the senses, perception, cognition, communication, behavior, epilepsy, hearing, visual
impairment and secondary musculoskeletal problems. The aim of this study is to
examine the prevalence of associated difficulties of persons with cerebral palsy in the
four cantons of the Federation of Bosnia and Herzegovina (FBiH) and to determine
whether there is a statistically significant difference in the representation of associated
difficulties between the cantons. The study was conducted on a sample of 120
respondents, persons with cerebral palsy from four FBiH cantons. The total sample of
respondents was divided into 4 sub-samples of respondents. The results of the study
showed that of the associated difficulties in persons with cerebral palsy, speech difficulties
in 56.60%, intellectual disabilities 34.90%, visual impairment in 32.50%, epilepsy
20.90%, behavioral disorders 7.60% and autism in 2.40%. No statistically significant
difference was found between cantons in the representation of associated difficulties
for persons with cerebral palsy.
Key words: cerebral palsy–associated difficulties–hearing impairment–visual
impairment–speech difficulties–intellectual disabilities.

Cerebral palsy is a group of permanent disorders of movement and posture that cause
limitations in the activities and are the result of non-progressive disorders of the immature
brain or the developing brain. Motor disorders are often associated with disorders
of the senses, perception, cognition, communication, behavior, epilepsy, hearing, visual
impairment and secondary musculoskeletal problems. The aim of this study is to
examine the prevalence of associated difficulties of persons with cerebral palsy in the
four cantons of the Federation of Bosnia and Herzegovina (FBiH) and to determine
whether there is a statistically significant difference in the representation of associated
difficulties between the cantons. The study was conducted on a sample of 120
respondents, persons with cerebral palsy from four FBiH cantons. The total sample of
respondents was divided into 4 sub-samples of respondents. The results of the study
showed that of the associated difficulties in persons with cerebral palsy, speech difficulties
in 56.60%, intellectual disabilities 34.90%, visual impairment in 32.50%, epilepsy
20.90%, behavioral disorders 7.60% and autism in 2.40%. No statistically significant
difference was found between cantons in the representation of associated difficulties
for persons with cerebral palsy.
Key words: cerebral palsy–associated difficulties–hearing impairment–visual
impairment–speech difficulties–intellectual disabilities.

Objectives: To identify which drugs are used by older adults, how these are taken
and the treatment course, and to relate drugs used with medical prescription.
Method: An exploratory, descriptive field study with a quantitative approach was
conducted. A total of 25 elderly (aged > 60 years) residents of a Shelter Center
who were users of medications with or without medical prescriptions were assessed.
Research ethics guidelines were observed and the study approved under CEP/CAAE
permit no. 99054818.0.0000.5479.
Results and Discussion: The sample comprised 25 respondents, 80% males, 56%
aged 60-69 years, and 52% with incomplete 1st grade education. Most participants
(88%) had an income of one minimum salary and 20% were engaged in paid work.
Overall, 100% of interviewees took anti-hypertensive agents and 80% used diuretics
concomitantly; under half took medications at the prescribed times. Regarding expenditure
on medications, 84% spent R$ 1.00-50.00, 68% had prescriptions for all medications,
while only 52% took the correct dose. All cases of wrong drug dosages involved
doses that were too high. For dispensing, 68% acquired medications from governmentfunded
pharmacies. Drugs were taken appropriately by 76% of the elderly, while the
remainder took drugs together with fluids or foods, potentially change their desired
pharmacological action.
Conclusions: The main drug groups taken were anti-hypertensives, diuretics, hypoglycemics
and unprescribed analgesics. Drugs were taken improperly, favoring interactions
and alteration in drug actions. Many participants took medications without
medical prescription. With regard to course of treatment, there were cases of early
treatment discontinuation (antibiotics).
Key words: Drug Therapy–Aged–Primary Health Care.

Objectives: To identify which drugs are used by older adults, how these are taken
and the treatment course, and to relate drugs used with medical prescription.
Method: An exploratory, descriptive field study with a quantitative approach was
conducted. A total of 25 elderly (aged > 60 years) residents of a Shelter Center
who were users of medications with or without medical prescriptions were assessed.
Research ethics guidelines were observed and the study approved under CEP/CAAE
permit no. 99054818.0.0000.5479.
Results and Discussion: The sample comprised 25 respondents, 80% males, 56%
aged 60-69 years, and 52% with incomplete 1st grade education. Most participants
(88%) had an income of one minimum salary and 20% were engaged in paid work.
Overall, 100% of interviewees took anti-hypertensive agents and 80% used diuretics
concomitantly; under half took medications at the prescribed times. Regarding expenditure
on medications, 84% spent R$ 1.00-50.00, 68% had prescriptions for all medications,
while only 52% took the correct dose. All cases of wrong drug dosages involved
doses that were too high. For dispensing, 68% acquired medications from governmentfunded
pharmacies. Drugs were taken appropriately by 76% of the elderly, while the
remainder took drugs together with fluids or foods, potentially change their desired
pharmacological action.
Conclusions: The main drug groups taken were anti-hypertensives, diuretics, hypoglycemics
and unprescribed analgesics. Drugs were taken improperly, favoring interactions
and alteration in drug actions. Many participants took medications without
medical prescription. With regard to course of treatment, there were cases of early
treatment discontinuation (antibiotics).
Key words: Drug Therapy–Aged–Primary Health Care.

Objectives: To identify which drugs are used by older adults, how these are taken
and the treatment course, and to relate drugs used with medical prescription.
Method: An exploratory, descriptive field study with a quantitative approach was
conducted. A total of 25 elderly (aged > 60 years) residents of a Shelter Center
who were users of medications with or without medical prescriptions were assessed.
Research ethics guidelines were observed and the study approved under CEP/CAAE
permit no. 99054818.0.0000.5479.
Results and Discussion: The sample comprised 25 respondents, 80% males, 56%
aged 60-69 years, and 52% with incomplete 1st grade education. Most participants
(88%) had an income of one minimum salary and 20% were engaged in paid work.
Overall, 100% of interviewees took anti-hypertensive agents and 80% used diuretics
concomitantly; under half took medications at the prescribed times. Regarding expenditure
on medications, 84% spent R$ 1.00-50.00, 68% had prescriptions for all medications,
while only 52% took the correct dose. All cases of wrong drug dosages involved
doses that were too high. For dispensing, 68% acquired medications from governmentfunded
pharmacies. Drugs were taken appropriately by 76% of the elderly, while the
remainder took drugs together with fluids or foods, potentially change their desired
pharmacological action.
Conclusions: The main drug groups taken were anti-hypertensives, diuretics, hypoglycemics
and unprescribed analgesics. Drugs were taken improperly, favoring interactions
and alteration in drug actions. Many participants took medications without
medical prescription. With regard to course of treatment, there were cases of early
treatment discontinuation (antibiotics).
Key words: Drug Therapy–Aged–Primary Health Care.

Objective: To compare the efficacy and safety of glycopyrronium bromide + salmeterol/
fluticasone and tiotropium bromide + salmeterol/fluticasone in chronic obstructive
pulmonary disease (COPD) in a randomized controlled trial.
Methods: This study was an open labeled randomized controlled trial. Patients diagnosed
with COPD were included in the study. The patients were divided into 2
groups each consisted 75 patients. Group I- COPD patients on Tiotropium bromide
+ Salmeterol/Fluticasone; Group II – COPD patient on Glycopyrronium bromide +
Salmeterol/Fluticasone. A detailed history and clinical examination was done for each
case. Pulmonary Function Test (PFT) was performed at 0, 6 and 12 weeks.
Results: There was no significant (p>0.05) difference in the basic characteristics of
patients between the groups showing comparability of the groups in terms of basic
characteristics. FEV1 was observed to be significantly higher in Group II than Group
I at 12 weeks (p=0.03). There was no significant (p>0.05) difference in PEFR between
the groups at all the time periods. FEF was observed to be significantly higher in
Group II than Group I at 12 weeks (p=0.04). There was no significant (p>0.05)
difference in FEV1/FVC between the groups at all the time periods. MVV was found
to be significantly higher in Group II compared to Group I at 6 weeks (p=0.03) and
12 weeks (p=0.04).
Conclusion: Once-daily GLY demonstrated similar effects to TIO when combined
with SAL/FP in patients with moderate and severe COPD.
Key words: Chronic obstructive pulmonary disease–Glycopyrronium bromide–
Tiotropium bromide–Efficacy–Safety

Objective: To compare the efficacy and safety of glycopyrronium bromide + salmeterol/
fluticasone and tiotropium bromide + salmeterol/fluticasone in chronic obstructive
pulmonary disease (COPD) in a randomized controlled trial.
Methods: This study was an open labeled randomized controlled trial. Patients diagnosed
with COPD were included in the study. The patients were divided into 2
groups each consisted 75 patients. Group I- COPD patients on Tiotropium bromide
+ Salmeterol/Fluticasone; Group II – COPD patient on Glycopyrronium bromide +
Salmeterol/Fluticasone. A detailed history and clinical examination was done for each
case. Pulmonary Function Test (PFT) was performed at 0, 6 and 12 weeks.
Results: There was no significant (p>0.05) difference in the basic characteristics of
patients between the groups showing comparability of the groups in terms of basic
characteristics. FEV1 was observed to be significantly higher in Group II than Group
I at 12 weeks (p=0.03). There was no significant (p>0.05) difference in PEFR between
the groups at all the time periods. FEF was observed to be significantly higher in
Group II than Group I at 12 weeks (p=0.04). There was no significant (p>0.05)
difference in FEV1/FVC between the groups at all the time periods. MVV was found
to be significantly higher in Group II compared to Group I at 6 weeks (p=0.03) and
12 weeks (p=0.04).
Conclusion: Once-daily GLY demonstrated similar effects to TIO when combined
with SAL/FP in patients with moderate and severe COPD.
Key words: Chronic obstructive pulmonary disease–Glycopyrronium bromide–
Tiotropium bromide–Efficacy–Safety

Objective: To compare the efficacy and safety of glycopyrronium bromide + salmeterol/
fluticasone and tiotropium bromide + salmeterol/fluticasone in chronic obstructive
pulmonary disease (COPD) in a randomized controlled trial.
Methods: This study was an open labeled randomized controlled trial. Patients diagnosed
with COPD were included in the study. The patients were divided into 2
groups each consisted 75 patients. Group I- COPD patients on Tiotropium bromide
+ Salmeterol/Fluticasone; Group II – COPD patient on Glycopyrronium bromide +
Salmeterol/Fluticasone. A detailed history and clinical examination was done for each
case. Pulmonary Function Test (PFT) was performed at 0, 6 and 12 weeks.
Results: There was no significant (p>0.05) difference in the basic characteristics of
patients between the groups showing comparability of the groups in terms of basic
characteristics. FEV1 was observed to be significantly higher in Group II than Group
I at 12 weeks (p=0.03). There was no significant (p>0.05) difference in PEFR between
the groups at all the time periods. FEF was observed to be significantly higher in
Group II than Group I at 12 weeks (p=0.04). There was no significant (p>0.05)
difference in FEV1/FVC between the groups at all the time periods. MVV was found
to be significantly higher in Group II compared to Group I at 6 weeks (p=0.03) and
12 weeks (p=0.04).
Conclusion: Once-daily GLY demonstrated similar effects to TIO when combined
with SAL/FP in patients with moderate and severe COPD.
Key words: Chronic obstructive pulmonary disease–Glycopyrronium bromide–
Tiotropium bromide–Efficacy–Safety

Objective: To find out the prevalence of Cardiac autonomic neuropathy (CAN) in
Diabetes Mellitus cases in a tertiary care hospital.
Methods: This was a cross-sectional study conducted in a tertiary care hospital.
The study was approved by the Ethical Committee of the Institute and consent was
taken from each participants before enrolling in the study. A total of 128 patients with
diabetes mellitus for more than 5 years were included in the study. The classification
of CAN was done as per Ewings and Clarke criteria.
Results: The prevalence of CAN was found to be 47.7% (61/128). Definite CAN was
among majority of patients (67.2%) followed by early (29.5%) and advance (3.3%).
Valsalva, E-I and 30:15 ratio was abnormal among 43%, 71.9% and 64.8% patients
respectively. The prevalence of CAN was higher among whom Valsalva was abnormal
(52.7%) than borderline (45.5%) and normal (38.9%). However, the prevalence of
CAN was higher among whom E-I was borderline (52.4%) than abnormal (50%) and
normal (26.7%). There was no significant (p>0.05) association of prevalence of CAN
with Ewing’s criteria variables.
Conclusion: Cardiac Autonomic Neuropathy thus is most frequently asymptomatic
problem which can be identified by simple bed side tests. Early identification of Cardiac
Autonomic neuropathy helps in effective prevention of cardiovascular disease
related morbidity and mortality.
Key words: Diabetes Mellitus–Cardiac Autonomic Neuropathy–Prevalence

Objective: To find out the prevalence of Cardiac autonomic neuropathy (CAN) in
Diabetes Mellitus cases in a tertiary care hospital.
Methods: This was a cross-sectional study conducted in a tertiary care hospital.
The study was approved by the Ethical Committee of the Institute and consent was
taken from each participants before enrolling in the study. A total of 128 patients with
diabetes mellitus for more than 5 years were included in the study. The classification
of CAN was done as per Ewings and Clarke criteria.
Results: The prevalence of CAN was found to be 47.7% (61/128). Definite CAN was
among majority of patients (67.2%) followed by early (29.5%) and advance (3.3%).
Valsalva, E-I and 30:15 ratio was abnormal among 43%, 71.9% and 64.8% patients
respectively. The prevalence of CAN was higher among whom Valsalva was abnormal
(52.7%) than borderline (45.5%) and normal (38.9%). However, the prevalence of
CAN was higher among whom E-I was borderline (52.4%) than abnormal (50%) and
normal (26.7%). There was no significant (p>0.05) association of prevalence of CAN
with Ewing’s criteria variables.
Conclusion: Cardiac Autonomic Neuropathy thus is most frequently asymptomatic
problem which can be identified by simple bed side tests. Early identification of Cardiac
Autonomic neuropathy helps in effective prevention of cardiovascular disease
related morbidity and mortality.
Key words: Diabetes Mellitus–Cardiac Autonomic Neuropathy–Prevalence

Objective: To find out the prevalence of Cardiac autonomic neuropathy (CAN) in
Diabetes Mellitus cases in a tertiary care hospital.
Methods: This was a cross-sectional study conducted in a tertiary care hospital.
The study was approved by the Ethical Committee of the Institute and consent was
taken from each participants before enrolling in the study. A total of 128 patients with
diabetes mellitus for more than 5 years were included in the study. The classification
of CAN was done as per Ewings and Clarke criteria.
Results: The prevalence of CAN was found to be 47.7% (61/128). Definite CAN was
among majority of patients (67.2%) followed by early (29.5%) and advance (3.3%).
Valsalva, E-I and 30:15 ratio was abnormal among 43%, 71.9% and 64.8% patients
respectively. The prevalence of CAN was higher among whom Valsalva was abnormal
(52.7%) than borderline (45.5%) and normal (38.9%). However, the prevalence of
CAN was higher among whom E-I was borderline (52.4%) than abnormal (50%) and
normal (26.7%). There was no significant (p>0.05) association of prevalence of CAN
with Ewing’s criteria variables.
Conclusion: Cardiac Autonomic Neuropathy thus is most frequently asymptomatic
problem which can be identified by simple bed side tests. Early identification of Cardiac
Autonomic neuropathy helps in effective prevention of cardiovascular disease
related morbidity and mortality.
Key words: Diabetes Mellitus–Cardiac Autonomic Neuropathy–Prevalence

Fibrous dysplasia (FD) is a slowly progressive benign bone condition in which normal
bone is replaced by an abnormal fibro-osseous tissue. FD has various manifestations
and can present with significant cosmetic and functional disturbances, particularly in
the craniofacial skeleton. We present a craniofacial fibrous dysplasia (CFD) case in a 6
year old child who presented with severely reduced mouth opening and some aesthetic
concerns. The patient underwent left side coronoidectomy and contouring of the involved
facial skeleton through bicoronal approach. There was significant improvement
in mouth opening. The patient was very satisfied with the outcome. This case report
highlights the importance of individualized treatment plan addressing the patient’s
concerns.
Key words: Fibrous dysplasia–Craniofacial fibrous dysplasia–McCune-Albright syndrome

Fibrous dysplasia (FD) is a slowly progressive benign bone condition in which normal
bone is replaced by an abnormal fibro-osseous tissue. FD has various manifestations
and can present with significant cosmetic and functional disturbances, particularly in
the craniofacial skeleton. We present a craniofacial fibrous dysplasia (CFD) case in a 6
year old child who presented with severely reduced mouth opening and some aesthetic
concerns. The patient underwent left side coronoidectomy and contouring of the involved
facial skeleton through bicoronal approach. There was significant improvement
in mouth opening. The patient was very satisfied with the outcome. This case report
highlights the importance of individualized treatment plan addressing the patient’s
concerns.
Key words: Fibrous dysplasia–Craniofacial fibrous dysplasia–McCune-Albright syndrome

Fibrous dysplasia (FD) is a slowly progressive benign bone condition in which normal
bone is replaced by an abnormal fibro-osseous tissue. FD has various manifestations
and can present with significant cosmetic and functional disturbances, particularly in
the craniofacial skeleton. We present a craniofacial fibrous dysplasia (CFD) case in a 6
year old child who presented with severely reduced mouth opening and some aesthetic
concerns. The patient underwent left side coronoidectomy and contouring of the involved
facial skeleton through bicoronal approach. There was significant improvement
in mouth opening. The patient was very satisfied with the outcome. This case report
highlights the importance of individualized treatment plan addressing the patient’s
concerns.
Key words: Fibrous dysplasia–Craniofacial fibrous dysplasia–McCune-Albright syndrome

Introduction Ventilator-associated pneumonia (VAP) is defined
as pneumonia that occurs 48-72 hours or thereafter following
endotracheal intubation, characterized by the presence of a new or
progressive infiltrate, signs of systemic infection (fever, altered white
blood cell count), changes in sputum characteristics, and detection of a
causative agent . VAP contributes to approximately half of all cases of
hospital-acquired pneumonia . VAP is estimated to occur in 9-27 % of
all mechanically ventilated patients, with the highest risk being early in
the course of hospitalization .aims & objectives-to study the association
between duration of stay and onset of VAP.Results and conclusion-
Incidence is directly proportional to duration of mechanical ventilation
iis a strong risk factor for development of VAP. Therefore, duration of
ventilation has to be reduced .
Keywords: ventilator associated pneumonia, mechanical ventilator,
duration of stay, intubation, nosocomial infection