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Background@#Acute undifferentiated febrile illness (AUFI) is one of the most daunting challenges a physician faces in such settings. Among AUFI, rickettsial infections are most common and related infections (such as anaplasmosis, ehrlichiosis, and Q fever) which are caused by an unusual type of bacteria that can live only inside the cells of another organism. The present study was therefore planned with an objective to estimate the prevalence of rickettsial infection among patients of undifferentiated fever and to determine any association of socio-demographic characteristics with rickettsial disease. @*Materials and Methods@#Patients presenting with febrile illness and admitted or attending out-patient department of Sher-i-Kashmir Institute of Medical Sciences, Srinagar was approached and recruited in the study. Weil Felix Assay, enzyme-linked immunosorbent assay and indirect immunofluorescence assay were done to detect the anti-rickettsial antibodies. Serological evidence of a fourfold increase in IgG-specific antibody titer reactive with spotted fever group rickettsial antigen by indirect immunofluorescence antibody assays between paired serum specimens was considered a confirmatory diagnosis for the rickettsial disease. @*Results@#Most of the patients were males 61.6%, and most 46.2% were in the age group of 20 -39 years. Most of the patients, 80.8% belonged to rural areas, and 48% belonged to the upper middle (II) class of the socio-economic class according to modified Kuppuswamy scale. Of the studied participants, a majority, 47.0%, were determined undiagnosed, while 15.4% studied participants were diagnosed to have a rickettsial disease. In patients positive for typhus group, 67.8% were IgM positive, 28.5% were IgG positive, and only 3% were positive for IgM and IgG. In patients positive for Scrub Typhus Group, 32.7% were positive for IgM, and 62.0% were positive for IgG, and only 5.0% were positive for both IgM and IgG. In patients positive for spotted fever group, 36.1% were positive for IgM, and 58.5% were positive for IgG, and only 5.5% were positive for both IgM and IgG. The prevalence of rickettsial disease was found to be 11.3%. @*Conclusion@#Rickettsial diseases, typhoid and brucellosis, were the most prevalent diseased diagnosed among patients reporting to hospitals with undifferentiated febrile illness.Clinicians must consider rickettsial diseases as one of the differential diagnosis while treating patients with fever.
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Background@#Acute undifferentiated febrile illness (AUFI) is one of the most daunting challenges a physician faces in such settings. Among AUFI, rickettsial infections are most common and related infections (such as anaplasmosis, ehrlichiosis, and Q fever) which are caused by an unusual type of bacteria that can live only inside the cells of another organism. The present study was therefore planned with an objective to estimate the prevalence of rickettsial infection among patients of undifferentiated fever and to determine any association of socio-demographic characteristics with rickettsial disease. @*Materials and Methods@#Patients presenting with febrile illness and admitted or attending out-patient department of Sher-i-Kashmir Institute of Medical Sciences, Srinagar was approached and recruited in the study. Weil Felix Assay, enzyme-linked immunosorbent assay and indirect immunofluorescence assay were done to detect the anti-rickettsial antibodies. Serological evidence of a fourfold increase in IgG-specific antibody titer reactive with spotted fever group rickettsial antigen by indirect immunofluorescence antibody assays between paired serum specimens was considered a confirmatory diagnosis for the rickettsial disease. @*Results@#Most of the patients were males 61.6%, and most 46.2% were in the age group of 20 -39 years. Most of the patients, 80.8% belonged to rural areas, and 48% belonged to the upper middle (II) class of the socio-economic class according to modified Kuppuswamy scale. Of the studied participants, a majority, 47.0%, were determined undiagnosed, while 15.4% studied participants were diagnosed to have a rickettsial disease. In patients positive for typhus group, 67.8% were IgM positive, 28.5% were IgG positive, and only 3% were positive for IgM and IgG. In patients positive for Scrub Typhus Group, 32.7% were positive for IgM, and 62.0% were positive for IgG, and only 5.0% were positive for both IgM and IgG. In patients positive for spotted fever group, 36.1% were positive for IgM, and 58.5% were positive for IgG, and only 5.5% were positive for both IgM and IgG. The prevalence of rickettsial disease was found to be 11.3%. @*Conclusion@#Rickettsial diseases, typhoid and brucellosis, were the most prevalent diseased diagnosed among patients reporting to hospitals with undifferentiated febrile illness.Clinicians must consider rickettsial diseases as one of the differential diagnosis while treating patients with fever.
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Bilateral renal tumors remain relatively uncommon, accounting for 1-5% of patients with renal cell carcinoma. Most sporadic renal cell carcinomas are unilateral and unifocal. Bilateral involvement can be synchronous or asynchronous and is found in 2-4% of sporadic renal cell carcinomas. We report a case of 70 years old male who was incidentally found to have bilateral renal masses. Right sided radical nephrectomy and left partial nephrectomy was performed. Histopathological examination of the specimen revealed clear cell carcinoma and confirmed R0 resection. The patient was discharged on 7th postoperative day.
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Background: This study was done to assess the knowledge, attitude and practices of residents towards pharmacovigilance in a teaching hospital in North India.Methods: A cross-sectional study was conducted among residents of Chintpurni Medical College and Hospital, Pathankot (CMC&H). A questionnaire containing 17 questions was distributed to 80 residents of CMC&H, Pathankot. This study was conducted over a period of 3 months from July to September, 2017.Results: 64 out of the 80 residents (80%) responded to questionnaire. Among the respondents, 6% did not know the term adverse drug reaction (ADR) and almost 18% did not witness any ADR during clinical practice. Among those who witnessed ADRs nearly 25% could not ascertain the type of ADR. Those who ascertained ADRs claimed that upto 60% suspected ADRs required short hospitalisation. 6% residents did not consider ADRs avoidable and almost 25% residents did not consider ADRs predictable. 37% residents did not report the ADRs to anyone and nearly 43% did not know whom to report the ADRs. More than 18% claimed that they were not taught about PV in undergraduate curricular practical training teaching. Up to 31% residents claimed that nobody ever discussed with them about ADR reporting during internship.Conclusions: According to this study, residents lack adequate knowledge and practice of reporting ADRs. This study suggests a greater need to create awareness amongst them to promote reporting of ADRs. This study also suggests that incorporation of Pharmacovigilance in medical curriculum will strengthen pharmacovigilance activity.
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Introduction: Paediatric tuberculosis (TB) accounts for10-15% of all TB with pulmonary TB and extra-pulmonary TBcontributing to 70-80% and 20-30% respectively in children.Incidence of EPTB is on rise as reported in recent studies. Nosuch study on paediatric TB has been conducted in Kashmirvalley before. Current research aimed to study the spectrumof paediatric TB in Kashmir valley and categorize childrentreated for TB into Definite TB, Probable TB, Possible TB andNo TB.Material and Methods: Children with suspected TB aged>1month upto 18 years were prospectively enrolled at atertiary care hospital in Srinagar, Jammu and Kashmir, Indiaover a period of 2 years.Results: overall 136 children received anti-tuberculosistreatment (ATT) which included 78 (57.35%) cases ofpulmonary TB and 58 (42.65%) cases of EPTB. Tubercularmeningitis (TBM) 21 (36.2%) was the most common formof EPTB followed by abdominal tuberculosis 14 (24.13%),tuberculous lymphadenopathy 11(18.96%), tuberculouspleural effusion 9(15.52%) and miliary TB 3(5.2%). A total of60(44%) children had bacteriological evidence of TB (definiteTB), 67 (49.3%) were diagnosed on clinical grounds (ProbableTB) and TB couldn’t be ruled out in 9 (6.7%) cases. Only36 (26.47%) children were <5 year old, 65(47.8%) childrenwere male, 112(82.35%) children were malnourished. BCGscar was present in 95(69.83%) cases and 56 (41.2%) weretuberculin skin test (TST) positive. History of TB contact waspresent in 65(47.8%) cases and none of the child was HIVpositive.Conclusion: Although Extra-pulmonary TB is increasing,Pulmonary TB is still the most common type of paediatric TB.BCG offers some protection against severe forms of TB andYoung children are at increased risk of severe forms of TB.
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Introduction: Globally, breast cancer is leading to cancer found among women. It is well known that cancer is an age-relateddisease and this holds true in breast cancer as well. Breast cancer is the most frequently diagnosed cancer in women, and itwas estimated that there will be 252,710 new cases of invasive breast cancer and 63,410 new cases of in situ breast cancersamong women in the United States in 2017.Purpose: The aim of the present study was to analyze the demographic spectrum of breast cancers in the Kashmir valley.Materials and Methods: This was an observational chart based study on breast cancer patients aged above 18 years of agewho were diagnosed with either invasive or in situ breast cancer at Government Medical College Hospital, Srinagar, Kashmir.The duration of the study was from June 2015 to December 2018. A retrospective study was conducted to find the informationregarding age, sex, clinical presentation, anatomical site, histopathological type, and stage of the disease.Results: A total of 151 patients with histopathologically confirmed breast cancers formed the study population. The majority of thepatients (46%) among females were <45 years of age and among males >45 years in age, with males and females constituting4% and 96% of patients in their respective groups. The upper outer quadrant was involved in 81 (54%) patients followed byupper inner 14% and central quadrant involvement in 25 (16%) patients. Among 151 patients, 42 women (28%) presented inStage IIA, 32 patients (21%) presented with Stage IIB disease, 19 patients (12%) in Stage IIIA, and 20 patients (13%) in StageIIIC; however, 17 patients (11%) presented with Stage IV disease. G2 was the most common histological grade. On the whole,liver was the most common presenting site for distant metastasis followed by lung and brain metastases.Conclusion: Early age, female sex, and residence within an endemic geographical region seem to be the prime determinantsaffecting breast cancer prevalence in a given population. A significant number of breast cancer patients in Kashmir presentwith early stage of disease and major clinical presentation were breast swelling. The majority of the cases reported in StagesII and III. Furthermore, there was significant number of patients presenting with metastasis, i.e., Stage IV.
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Introduction: Management of infected wounds is notalways simple and easy. Vacuum-assisted closure (VAC) isa wound healing therapy that utilizes a dressing system thatcontinuously or intermittently applies a negative pressure tothe wound surface. Our aim was to assess the Feasibility andadvantages of simplified version of otherwise costly VAC, orsimple suction drainage in selected cases.Material and methods: This prospective study was conductedin the unit 2nd of department of surgery at SMHS hospital, anassociated hospital GMC Srinagar, over a period of 3 yearsfrom January 2014 to December 2016. During this period, 32patients were subjected to vacuum suction treatment and wereincluded in this study.Results: Wall suction (VAC) was used in 26 patients. MiniVac drain (USG guided) was used in 5 cases. In one patient ofscalp infection conventional large size suction drain was used.The time taken for the wounds to become healthy was 3 to7(average 3.5) days of VAC dressing or suction drainage. Noantibiotics were given during suction drainage in 21 patients.Need for grafting by split skin grafting method was felt in only2 patients. Mild discomfort (abnormal sensation) was reportedin 21 patients. Hospital stay for patients managed by suctiontherapy ranged from12 hours (breast abcess) to 16 days withan average of 7 days. The total cost incurred in the patientsundergoing VAC for a period of 15 days per patient was Rs.800 ($ 12).Conclusion: VAC seems to have revolutionary potential inthe management of the difficult to treat infected wounds asfar as its safety, speed and cost-effectiveness are considered.
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Introduction: Freiberg’s disease, the osteochondrosis of themetatarsal seen in our part of the world, usually at late stages,are refractory to the conservative treatment. Objective:Thepurpose of this study was to evaluate the results of dorsalclosing wedge osteotomy and pin fixation besides debridementand synovectomy.Material and Methods: Twenty patients (14 females,6 Males), mean age 19.3 years; range 14 to 26 years wereevaluated and teated by dorsal closing wedge osteotomy andpin fixation besides debridement and synovectomy, betweenseptember 2016 to 2018 at our institution. The presentingsymptoms were pain on walking or sports, limitation of dailyroutine activities, footwear problems, cosmetic deformitiesof forefoot and failed conservative treatment. Three patientshad a history of trauma. According to Smillies’s classificationtwelve patients were type IV and eight were Type V.Meanfollow-up period was 14.85 months(range 6 months to 24months).Results: Patients were assessed by the lessermetatarsophalangeal interphalangeal (LMPI) scale bykitaokaetal. At the final follow-up, scoring had changed from(44-66) with an average 54.65 to (76-100) with an average85.3. There was no case of infection, avascular necrosis,arthritis or pseudoarthrosis.Conclusion: Treatment of freiberg's disease with dorsalclosing-wedge osteotomy shows satisfactory pain relief andimprovement in quality of life
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Introduction: Incidence of displaced fracture neck of femuris high and there is lack of consensus over the definitivetreatment of such fractures as the incidence of complicationsespecially avascular necrosis remains very high. Objective ofthe study was to evaluate the incidence of avasular necrosisand its pattern in displaced fracture neck of femur managedwith osteosynthesisMaterial and methods: This study was a prospective studyconducted in Bone & Joint Hospital, Srinagar from 2003 to2018 on patients with displaced fracture neck of femur. Closereduction was done on traction table using Whitman’s Methodand reduction was confirmed under C Arm and was labelledsatisfactory using Lowell’s S Method and fixation was doneusing 3 Cannulated Screws of 6.5mm.Results: 118 patients {70 males and 48 females} with meanage 42.5 years {range 18 to 55 years} presented late in ourhospital which resulted in a delay in fixation from 24 hrs to7 days post trauma. Patients were followed till 2018 for aminimum period of 10 years.Conclusion: Our study suggest same AVN rates as of otherstudies if fixation is done within a period of one week.
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A 26 year old student reared as a female, presented with inability to menstruate and increased facial hair growth. On examination , patient had hyperandrogenic features including hirsutism, low pitched voice, microphallus with hypospadias. Investigations revealed a 46 XY karyotype with increased testosterone and imaging revealed both ovaries and testes with a hypoplastic uterus. The patient was managed with bilateral testicular gonadectomy, feminising genitoplasty and hormonal therapy.
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Background: The clinical or surgical audit is a systematic process in which the standard of clinical care being provided to the patients is sought through review of clinical records against specific criteria. The clinical or surgical audit is a mandatory element of the professional competence in many countries
Objective: To evaluate the yearly performance and to establish the pattern and frequency of various Pediatric Surgical emergencies encountered
Methodology: This was an observational, descriptive study covering the year 2016 with retrospective data collection was carried out in the Department of Pediatric Surgery Emergency Mayo Hospital/King Edward Medical University, Lahore
Results: A total of 3880 patients including 2350[60.6%] males and 1530[39.4%] females were admitted during the study period. The highest number of admissions were Burn Patients with the percentage of 37.8%, followed by trauma cases 23.9%, and acute appendicitis 18.6%. There had been 86 deaths which gave rise to 2.2% Mortality
Conclusion: Burn injuries and trauma are common injuries in pediatric surgery ward. It is suggested that audit must be conducted routinely and should be officially declared as a compulsory action to provide vision and feedback to the working of surgeons
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Stone formation occurs most commonly in acute and chronic renal failure. A kidney stone is a solid lump made up of crystals that separate from the urine and build up on the inner surfaces of the kidney. The current study was conducted to investigate the clinical efficacy of Unani medicine Renax in comparison with allopathic medicine [Spironolactone + Furosemide] to treat urolithiasis. The study was conducted in District Dera Ghazi Khan, South Punjab region. This was case control, randomized, double blind clinical study. All patients were examined by the Physician and given either herbal or allopathic medicine for Urolithiasis. The patients were divided "into two groups" a control group and test groups. A Total of 24 patients were completely cured out of 50 by use of Renax while a total of 9 patients was cured out of 50 with allopathic medicine [Spironolactone + Furosemide]. This study validated the claim of traditional healer for use of Unani medicine in the treatment of urolithiasis
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Objective: Kashmir valley has witnessed an armed conflict from last three decades, with one of the studies suggesting the prevalence of trauma exposure of 58.69% in the general population and 15.9% prevalence of Post-traumatic stress disorder (PTSD). The current study was undertaken to explore the socio demographic profile and psychiatric comorbidity in treatment seeking PTSD patients. Methods: This cross-sectional study was conducted at Government Psychiatric Diseases Hospital Srinagar, Kashmir from January 2006 to January 2007. A total of 100 PTSD patients were interviewed and screened for psychiatric comorbidity using DSM-IV diagnostic criteria and their socio demographic details were recorded using a proforma. Results: Most of the patients in our study had multiple comorbidities. Apart from depression and anxiety disorders, somatisation and peri-traumatic dissociation was highly comorbid. Conclusion: Post-Traumatic Stress Disorder is a complex diagnosis with commonly associated psychiatric comorbidity. The high comorbidity in our study sample could be due to repeated exposure to trauma, cultural expression of distress and the ongoing conflict situation which makes the recovery difficult. Recognizing the comorbidities early on may help to achieve an optimal treatment outcome. Finally, the lack of appropriate service provision results in increased morbidity and probable chronicity of the symptoms.
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Objective: To test whether blood pressure-to-height ratio (BPHR) can be used to screen for hypertension in children. Methods: Data regarding blood pressure and other variables was recorded for 2702 school children between the ages of 10-16 years as a part of a nutritional survey. Results: The optimal thresholds for defining hypertension in boys were 0.76 for systolic BPHR and 0.50 for diastolic BPHR; the respective threshold in girls were 0.80 and 0.52. Conclusion: BPHR can be used as an effective screening test for diagnosing both hypertension and prehypertension in children aged 10-16 years.
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Pyrazine carbohydrazide based hydrazones were synthesized starting from 5-methylpyrazine-2-carboxylic acid. The acid was first converted to its methyl ester, which on further treatment with hydrazine hydrate transformed to carbohydrazide. The carbohydrazide was treated with differently substituted aromatic carbonyl compounds giving hydrazones. Characterization of the synthesized compounds was carried out using modern spectroscopic techniques and unambiguously confirmed through X-ray crystallographic studies of compound 3d. The purity of the compounds was verified using elemental analysis. The target molecules were evaluated for urease inhibition, antioxidant and antimicrobial activity
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Aim: To ascertain the common causes of LGIB in the elderly and to evaluate sigmoidoscopy and colonoscopy as the initial investigation for diagnosing LGIB in the elderly in the developing world. Materials and Methods: The study was conducted over a period of two years at SMHS Hospital and Government Medical College Srinagar, a tertiary care centre, Jammu & Kashmir. All the patients above the age of 60 years, presenting with symptoms or complaints of LGIB to the OPD’s and casualty services of the said hospital were enrolled in the study. Exclusion Criteria: Cases presenting with LGIB which were proved by any diagnostic procedures or during laparotomy to originate from any source proximal to ligament of Treitz. Results: The commonest cause of LGIB in our study was local anal disease [haemorrhoids and anal fissures] followed by carcinoma colorectum, inflammatory bowel disease [IBD], solitary rectal ulcers [SRUS] and colonic polyps, in the order of decreasing frequency. Colonoscopy was able to detect the cause of LGIB in all our study subjects. Conclusion: Despite the small number of patients in our study group, it can be concluded that the cause of LGIB in the elderly in our part of the world differs from that of the developed world, although the reasons for this remain unexplained and require more research. As such, elderly patients with complaints of LGIB should be offered the benefits of colonoscopy unless contraindicated by their co-morbidities because of the fact that they may be harbouring a sinister cause of LGIB, i.e., colorectal malignancy.
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Background: Patients with normal pulmonary function tolerate removal of an entire lung without respiratory problems. In patients witth impaired pulmonary function, post resectional function is of importance for the assessment of surgical risk. This necessitates the ability to measure the relative contribution of the parenchyma to be resected to the total lung function and the predicted postoperative lung functions. Objective: To determine preoperative lung functions as assessed with split lung functions and correlates with postsurgical lung functions and to determine the effect of lung resections on spirometric lung function. Material and methods: All those patients planned for lung resection surgery were included in the study. Predicted postoperative FEV1 and FVC were calculated. Preoperative spirometry was performed within a week before surgery. Predicted postoperative values were calculated. Postoperative spirometry was performed at the end of first month, third month, and sixth month for each patient. The relationship between potential predictors and postoperative complications were assessed. The predicted values were correlated with measured values (actual values) during the postoperative follow up. Results: Lobectomy was done in 64 persons. The predicted postoperative FEV1 and FVC correlated well with observed FEV1 and FVC in lobectomy (p<.05). The mean preoperative FEV1/L were 1.8 and the mean predicted postoperative (L) FEV1 were 1.4. The mean FEV1 at 1 month follow up were 1.6 and the mean FEV1 at 3 month follow up were 179.8.
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To observe the perioperative morbidity and mortality rates of 100 transhiatal esophagectomies operated for esophageal carcinoma in a surgical unit of a tertiary care hospital. Data pertaining to all patients that had undergone transhiatal esophagectomy from Feb, 2012 to Jan, 2014 were reviewed. The study group comprised 100 patients. Indication for surgery was esophageal cancer. Perioperative morbidity and mortality i.e. morbidity and mortality during the first 30 days, were studied. Two patients died during the postoperative period in hospital. The anastomotic leakage rate was zero. No dysphagia was found during one month of postoperative period. Overall survival was 98% for the first 30 days of surgery. Transhiatal esophagectomy has been common stay and a safe rather feasible procedure. Oncological therapy has its role and better results are found in centers where the procedure is frequently performed
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A complex of lincomycin was synthesized with technetium-99m. The synthesis was carried out by using SnCl[2].2H[2]O as reducing agent and ascorbic acid as stabilizer. The effect of various parameters such as amount of ligand/reducing agent, pH value and reaction time on radio labeling process was studied. The characterization of the [99m]Tc-Lincomycin was performed by HPLC and electrophoresis Biodistribution studies were carried out by analyzing the model of bacterial infectious rats [Sprague-Dawley]. The uptake of infectious lesions at different time interval was also studied by using scintigraphic technique. The complex showed effective target to non-target ratio for various inflammatory or infectious lesions. The [99m]Tc-Lincomycin effective binding to living bacteria and could be used successfully as an infection imaging agent
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Nutritional quality and antioxidant capacity of three edible wild berries [Rubus ellipticus Smith, Rubus niveus Thunb, Rubus ulmifolius L.] from Lesser Himalayan Range [LHR] were evaluated. Their edible portion was assayed for moisture, fats, ash, carbohydrates, proteins, fibers, essential minerals [Ca, P, Mg, K, Na, Cl, S, Mn, Zn, Fe, Cu, Se, Co, Ni] and DPPH free radical scavenging activity was applied to determine the antioxidant potential. The fruit of Rubus ulmifolius L. [blackberry] possessed the highest values of energy [403.29 Kcal], total protein [6.56g/100 g], Nitrogen [N] content [1500mg/100g], K [860.17mg/100g], Ca [620.56mg/100g], Zn [17.509mg/100g] and the strongest antioxidant activity [98.89% inhibition]. While the raspberries [Rubus ellipticus Smith, Rubus niveus Thunb.] exhibited more significant contents of dietary fiber [5.90g/100g], carbohydrates [86.4 g/100 g] and Fe [4.249mg/100g]. Significant variation was observed among the tested samples in all the investigated features. The combination of bio elements and active antioxidants clearly showed the applicability of these berries as a nutraceutical supplement