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Introduction: Cancer stem cells (CSC) within the tumors play a central role in tumorigenesis. It is, thus, of utmost importance to identify these cells to develop effective cancer therapy. Triple-Negative Breast Cancer (TNBC) is an aggressive molecular subtype of breast cancer associated with poor patient outcomes. The role of CD44 immunohistochemistry (IHC) as a putative CSC in breast carcinomas, particularly of the TNBC-subtype is ambiguous, with equivocal results. Aims and Objectives: The present study aims to assess the role of CSC in breast carcinoma by immunohistochemical analysis of CD44 expression in TNBC. The association of TNBC expressing CSC with histological grade as well as with angiogenesis (using CD34 IHC) has been studied. Materials and Methods: Biopsy samples from 58 patients with infiltrating ductal carcinoma, NST were studied. The histology of the tumor was sub-classified into grades 1–3. Based on immunohistochemical analysis (ER, PR, HER2/Neu), the cases were divided into TNBC and NTNBC groups. The tissue sections were also subjected to analysis for CD44 to identify the CSC-phenotype and CD34 to evaluate angiogenesis, to determine the microvascular density (MVD). Results: Out of the 58 cases in the study, 28 were TNBC and 30 were NTNBC. CSC phenotype (CD44 positive) was expressed significantly higher in the TNBC (78%) versus the NTNBC (53%) (p-value 0.043). The MVD estimated using CD34 IHC was lower in the TNBC group in our study, though the difference was not statistically significant. A larger proportion of cases in TNBC showed a higher histological grade (35%) in comparison to NTNBC (27%). However, statistically, it was not significant. Conclusion: Our study demonstrated that CD44 as a CSC marker is seen significantly more in the TNBC category of invasive ductal carcinomas. Further large-scale studies, to confirm these findings, will be of potential therapeutic and prognostic value.
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Background: Mucormycosis, once a rare fungal disease, has now shown a surge in cases, and its epidemiology in India is intriguing. Rising incidence confers the necessity of defining the demography of the population at risk, early diagnosis, and recommendations for the management of mucormycosis in patients with coronavirus disease (COVID-19) infection. Aims: To study the clinico-epidemological profile, risk factors, and histopathological features of COVID-19-associated Mucormycosis (CAM). Setting and Design: This is a retrospective observational study. Material and Methods: Fifty-six biopsy specimens taken from patients of COVID-19 with clinical suspicion of mucormycosis were included. Results: Diabetes mellitus, corticosteroids, and oxygen therapy were the most common risk factors associated with CAM. The mean duration between the onset of symptoms of COVID-19 and onset of CAM was 25.2 ± 15.3 days. Rhino-orbito-cerebral mucormycosis (ROCM) was present in 24.5% of the cases, with a survival rate of 58.3%. Histopathology showed tissue invasion by branching broad-based, pale, fungal hyphae consistent with mucor in 49 (87.5%) cases. Inflammation was acute neutrophilic type in 61.2% of the patients with a survival rate of 63.33%. The survival rate with chronic non-granulomatous and chronic granulomatous was 100% and 81.8%, respectively. Conclusion: Keeping a high index of suspicion for mucormycosis in COVID-19 by all medical fraternities of the health community in the existence of risk factors is the need of the hour for prompt diagnosis. Biopsy of antral necrotic tissue should be performed immediately after suspicion for histopathological study to confirm the diagnosis of mucormycosis and predict prognosis depending on the type of inflammation incited, fungal morphology, load, and necrosis.
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Objectives: The objectives of this study were to evaluate and compare the success rate of local application of iodoform-based obturating material (Pulpotec – [Produits Dentaires S.A., Switzerland]) and clindamycinmodified triple antibiotic paste (ClinM-TAP) in pulp chamber using minimally invasive endodontic treatment of carious primary molars indicated for pulpectomy, for 12 months, using clinical and radiographic parameters. Materials and Methods: A randomised clinical trial was conducted in 60 children in the age group of 3–8 years reporting carious primary molars with symptoms of irreversible pulpitis and pulpal involvement clinically, allocated into Group 1 (30) and Group 2 (30). In Group 1, Lesion sterilisation and tissue repair (LSTR) was done using Pulpotec (Produits Dentaires S.A., Switzerland) as medicament and in Group 2, ClinM-TAP (Clindamycinmodified triple antibiotic paste) was used as medicament. Clinical follow-up was done at 3, 6 and 12 months; radiographic follow-up was done at 6 and 12 months. Clinical parameters compared were tenderness on percussion, spontaneous pain, intraoral swelling and sinus/fistula. Radiographic comparison was done based on furcation radiolucency, root resorption and bone regeneration. Both intergroup and intragroup statistical analysis was done using Chi-square test or Fisher exact test, Cochran’s Q Test and Mann–Whitney U-Test for the test of significance. All the statistical tests were performed at 5% significance level. Results: The mean age of patients in the study was 5.25 ± 1.3years with 45% males and 55% females. Both groups showed significant improvement in terms of clinical symptoms from baseline to 12 months. On intergroup comparison clinical parameters, TOP was present in 11.2% and 44% of cases at the end of 12 months in Groups 1 and 2, respectively (P < 0 0.05). On intergroup comparison of radiographic parameters, at the end of 12 months, furcation radiolucency was seen in 32% and 73% (P < 0.05) and root resorption was seen in 16% and 30% cases in Group 1 and 2, respectively (P > 0.05). Overall clinical success rate of Group 1 and Group 2 was 88% and 50%, respectively (P < 0.05) and radiographic success rate was 60% and 27%, respectively (P < 0.05). Conclusion: LSTR using Pulpotec as a medicament has shown promising results in the present study. It could be a better alternative to conventional endodontic treatment in primary teeth. In the present study, ClinM-TAP has shown poor radiographic success; hence, it should be used with caution.
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Context: Many standard books, literatures, and internet described the characteristic lineament of each salivary gland lesion. Nevertheless, there are dozens of disarray, confusion, and unmanageable morphological features regarding proper reporting. To fight with these issues, Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was introduced in 2018, but still the third category, Atypia of undetermined significance (AUS), poses difficulties for the pathologists and clinicians for a definite interpretation. Aim: The aim is to analyze the risk of neoplasia (RON) and risk of malignancy (ROM) of Milan's category III (AUS) by subdividing into six groups based on cytolomorphology. Settings and Design: The duration of study was from March 2018 to may 2021 with the focus on ROM and RON of all Milan's categories with especial attention on AUS. Methods and Material: Result of total 329 Fine Needle Aspiration Cytology of salivary glands was categorized according to MSRSGC. On the basis of cytomorphology, further subtyping of AUS and its cytohistopathology correlation was done. The ROM and RON of each subtype was analyzed. Statistical Analysis: All data were calculated by existing formulas. Results: Out of 329 aspirates, 24 (07.29%) cases belong to AUS with availability of histology in 13 (54.17%) cases. RON and ROM was 84.62% and 53.85%, respectively. Cases of lymphocytes with nuclear atypia (L-NA) was the most prevalent (29.17%). The RON were 60.00%, 68.57,% 84.62%, 94.87%, 87.50%, 100%, 100% and the ROM were 20.00%, 11.42%, 53.85%, 05.13%, 43.75%, 83.33% and 100% in each Milan's categories I, II, III, IVa, IVb, V, and VI, respectively. ROM was the highest in cystic fluid with nuclear atypia (C-NA) (100.0%), followed by basaloid cells (75%), L-NA (66.675), and SC (50%), but ROM was zero in NA and oncocytic cells. Conclusions: Subgrouping of AUS helps to dissipate the muddiness and provide more exact and reproducible diagnostic and prognostic tool.
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Introduction: Researchers found that cryotherapy at the ankle joint heightened adjacent muscle activity and reflex amplitude, which facilitated greater force production at the ankle complex. Furthermore, cryotherapy appears to increase musculoarticular stiffness, which has been associated with heightened muscular performance at a joint. Aim and objective: the aim of the study is to examine the influence of dynamic stretching and IBA technique on the physical performance. Methodology: Total 20 healthy male basketball athletes encompassing two groups participated in the current study. The study consisted of two groups, Group A (ice bag application) and Group B (dynamic stretching). Cold compress was applied over the anterior thigh, posterior thigh, and calf. Subjects were assigned to Group A, and Group B, using Convenience sampling method. Each candidate performed the 5 minutes of jogging before taking intervention. All subjects performed three functional performance tests: Vertical Jump Test, Agility T-test & 20-meter sprint. Each participant attended an orientation session to become familiar with the testing procedures. Subjects were randomly assigned into two groups and exposed to a crossover study design. The experiment was performed on two separate occasions whereby one group received the dynamic stretching in the first session, while the other group uses the cryotherapy first. After 48 hours, (cooling session) on the next occasion, the groups were changed and the second group receives the cryotherapy, while the first group performs dynamic stretching. On both occasions, the dynamic stretching and cryotherapy interventions were the same. Between the sessions, the subjects will not allow to participate in any kind of vigorous physical activity. Results: The present study showed an increase in performance of recreational Basketball players by the combination of 5 minutes of warm up plus 6 min of dynamic stretching on the vertical jump height and 20-meter sprint
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Background: Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana has been launched to provide financial protection expenditure to nearly 500 million vulnerable Indians. For expanding the coverage under the scheme, it is necessary to understand the perspective of health care service providers involved in the scheme. Aim & Objective: To find out the bottlenecks in implementation of PMJAY scheme using empanelled hospitals’ perspective Settings and Design: Cross sectional study Methods and Material: 8 Public and 23 Private hospitals were selected through Simple Random Sampling from the list of PMJAY empanelled hospitals. The PMJAY Medical Officer co-ordinators in the empanelled hospitals were interviewed using a predesigned and pretested questionnaire. Statistical analysis used: Data was analysed using descriptive statistics in Epiinfo software. Results: Among the 31 empanelled hospitals studied, 93.5% were satisfied with the process for empanelment under PMJAY. 64.5% hospitals were not satisfied with the Health Benefit Packages. 77.4% hospitals perceived the PMJAY to be poorer as compared to private health insurance with reasons being poor grievance reprisal, poor claim processing and settlement, denial of reimbursement of health packages, poor rates of health packages and little information about the scheme. Conclusions: Various hurdles are being faced in the implementation of the scheme. There definitely remains a huge scope for further improvements so as to enhance the insurance coverage in the country.
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Background: Abdominal obesity is associated with insulin resistance, in turn, hyperinsulinemia and visceral adiposity lead to an increased uric acid (UA) absorption in renal tubules. Aim and Objectives: Accumulation of visceral fat is an underlying component of metabolic syndrome. Furthermore, the waist-hip ratio is an indirect tool for assessing visceral fat. The present study evaluates the association of UA levels with the waist-hip ratio. Materials and Methods: 160 subjects aged 18–60 years were enrolled in the study (those having any anatomical deformity, diabetes, and/or hypertension for more than 5 years were excluded from the study). Their anthropometric parameters, blood pressure, lipid profile, fasting plasma glucose, and serum UA levels were measured. Results: The study population was divided into three groups based on UA levels. The waist-hip ratio in a group of the hyperuricemic population was more as compared to groups of normal and below normal UA levels population and the association of UA level with waist-hip ratio was found to be significant (P = 0.045). Conclusion: The over-inflow of free fatty acid to the liver from accumulated visceral fat may be linked to the de novo purine synthesis through the pentose phosphate pathway, which may accelerate the production of UA.
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Background: Smartphone addiction (SMA) is an emerging concept. It has been associated with high perceived stress. There is a dearth of data on its association with loneliness and personality in the Indian context. Objectives: We planned this study to estimate the prevalence of SMA in medical students, verify its reported association with perceived stress, and determine its association with personality factors and loneliness. Methods: Four hundred and two medical students participated in this cross‑sectional study. We used the SMA scale‑short version to divide students into those having an addiction and not having an addiction. The Perceived Stress Scale, ten‑item personality inventory, and University of California, Los Angeles Loneliness Scale were used to assess perceived stress, personality, and loneliness. Ninety‑five percent confidence intervals were reported for all comparisons. Results: The prevalence of SMA in medical students was 34.8%. SMA was associated with higher perceived stress and loneliness. Students having SMA scored lower on personality domains of extraversion, agreeableness, conscientiousness, emotional stability, and openness to experience. Moreover, SMA interfered with students’ social life and academic performance. Conclusions: SMA is a cause for concern. We need to plan the awareness campaigns focusing on SMA and its association with social life and academic performance. Researchers need to explore this concept in larger samples and diverse population groups to know its actual magnitude and impact. Moreover, dedicated psychiatric committees need to recommend the guidelines for the judicious use of smartphones.
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Background: - COVID-19 is the most important public health problem of recent time. Many people require hospitalization after infection. COVID vaccination is the most effective way to prevent the disease. Due to extensive negative publicity through social media channels/platforms,significant number of individuals are not coming forward for vaccination. Therefore, study is needed to evaluate adverse effects associated with different vaccines available in India. Objectives: - To assess the adverse effects associated with COVID-19 vaccination and compare the side effect of two most commonly used COVID vaccines in India. Methods:- In the current report, a cross sectional study was conducted among beneficiaries of COVID-19 vaccines at the vaccination center of the LLRM Medical college, India. After institutional ethical clearance and informed consent, patients were asked about the symptoms they experienced after vaccination. A very simple random sampling approach was used to select beneficiaries. Information was collected on predesigned Google form and total 391 patients submitted the responses. Results:- Out of total respondents 77 % individuals reported one or more symptoms. Fever was reported to be most common problem (59.3%) followed by body ache (57.5%). Out of total beneficiaries, 68.3% experienced mild symptoms while 23% remain asymptomatic. Only few subjects reported moderate adverse effects (8.7%). None of the respondent reported severe and serious adverse effect. Conclusions:- Vaccine associated adverse effects were found less than 3 days and of mild variety in most of the beneficiaries. There was no difference in adverse effect profile of two commonly used vaccines in India. People must come forward for vaccination in mass without fearing of adverse effects of vaccines.
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Background & objectives: Humans are considered to be the principal host for hepatitis A virus (HAV) infection. In India, heterogeneous groups of susceptible individuals coexist in different regions. There has been a decline in antibody titres to HAV among young adults which may pose a major public health problem. The objective of this study was to assess the IgG anti-HAV level among healthcare workers (HCWs) in the age group of 20-60 yr and its association with the socio-demographic variables. Methods: Blood sample (2 ml) was collected under aseptic conditions from each participant followed by the preparation of serum and storing at ?20癈. ELISA-based kits were used for the determination of IgG antibodies to HAV in the human serum samples. Results: Two hundred and fifty four HCWs were enrolled. IgG anti-HAV antibodies were detected in 97.2 per cent of the samples analyzed. No differences were observed in the levels of IgG anti-HAV antibody and education, income, occupation and socio-economic classes of the HCWs. A seropositivity rate of over 90 per cent was seen amongst all the socio-economic classes. Interpretation & conclusions: High levels of IgG protective antibodies were seen among the studied HCWs, hence HAV vaccination may not be required. It will be advisable to do a cost-benefit analysis of vaccination for HAV.
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The human gut is home to a myriad of organisms. While some are harmless commensals, others are transient, pathogenic flora. The gut microbiome is composed of diverse bacterial flora, and apart from playing a major role in protecting from various infectious and non-infectious diseases, it plays an important role in resistance to antimicrobials. The collection of genes or genetic material that confers antimicrobial resistance constitutes the gut resistome, and it may involve the pathogens or commensals of the intestinal tract. The diversity of this gut resistome is influenced by various environmental factors including the diet and antibiotic exposure. This review highlights the recent concepts pertaining to the human gut resistome, factors affecting it, how it impacts human health and diseases, methods to study the resistome and potential therapeutic approaches.
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Background: Alcohol is one of the leading causes of the death and disability globally. About two billion people worldwide consume alcoholic beverages and about one-third (nearly 7.6 million) are likely to have one or more diagnosable alcohol use disorders. In India, the economic returns from alcohol override public health issues with the situation being one of “getting less and losing more”. Aims & Objectives: To find out the prevalence of alcohol consumption in relation to socio-demographic characteristics among adults and elderly population of Uttarakhand. Methods and materials: This is a cross sectional study. In this study we included four different geographic settings (urban, rural, town and slum) of Uttarakhand. A simple random methodology was adopted. Results: Out of 400 participants interviewed, alcohol consumption was reported higher in 30-49 years age group (45%), married (38%), employed (58%), males (72%), residing in rural areas (43%). Conclusion: In Uttarakhand percentage of alcohol consumption is higher among middle age group (30-49 year). Males are more alcoholic than females.
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Background: Knowledge regarding danger signs has been found helpful to reduce delays in seeking, reaching and obtaining care during obstetric emergencies. Aims & Objectives: To assess the awareness regarding obstetric and newborn danger signs among pregnant and recently delivered mothers residing in urban slums of Raipur city. Material & Methods: Observational study was conducted among 160 pregnant and 70 recently delivered women residing in urban slums. The assessment of awareness regarding danger signs was done by adding the marks obtained in various phases. Appropriate statistical tests were applied for any association between knowledge score and socio-demographic variables. Results: Subjects knowing at least one key danger sign during pregnancy, labour, postpartum and newborn period was 54.3%, 51.9%, 7.4%, and 11.3 % respectively. Those with age more than 20 years (p value 0.000), joint family (p value 0.000), educated more than 5 years (p value 0.009), and having married and getting first time pregnant after 20 years (p values 0.001 and 0.022 respectively) were found to have significantly more knowledge about danger signs. Conclusions: Knowledge regarding danger signs should be given at the time of every ANC visit and also at follow up visit after delivery.
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Background: To accost things in a particular disciple, egress related to Fine Needle Aspiration Cytology (FNAC) and to standardize reporting pattern, a framework “Milan System for Reporting Salivary Gland Cytopathology” (MSRSGC) has been sponsored. Aim: Aim of this study was to evaluate the potency of salivary gland FNAC reported under Milan guidelines, to calculate malignancy risk, and to compare the preoperative cytological diagnoses with the postoperative histopathological diagnoses. Settings and Design: This was a retrospective study over a period of 2 years (May 2016 to April 2018), which was classified according to Milan system and correlation with histopathology. Furthermore, the risk of malignancy was calculated for all the diagnostic categories. Materials and Methods: FNAC were analyzed on 105 patients with palpable salivary gland. Results were distributed into six categories. About 76 cases were surgically treated and resected tissues were submitted for histopathological examination. Statistical Analysis: The various diagnostic values of the procedure were calculated using the standard formula. Results: We reviewed 105 salivary gland FNA samples and recorded interpretations according to the proposed standardized six categories. Among them, category IV (neoplastic) had more cases (57.14%). The rates of malignancy in histology were as follows: (1) nondiagnostic, 0.0%; (2) nonneoplastic, 0.0%; (3) atypia of undermined significance, 50.00%; (4a) benign, 02.44%; (4b) uncertain malignant potential, 33.33%; (5) suspicious for malignancy, 100%; and (6) malignancy, 93.33%. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of Milan system came out to be 85.00%, 98.14%, 94.44%, 94.64%, and 94.59%, respectively. Conclusion: The six-tier diagnostic categories of the Milan system helps in triaging patients with salivary gland swelling and thus facilitate individualized management.
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Cystic renal masses pose diagnostic challenge especially when they belong to Bosniak Type II and III. Septal and nodular enhancement on computed tomography (CT) is the strongest predictor of malignant process. A unilocular cyst with a calcified rim or a multilocular cystic lesion with heterogeneity on CT goes in favor of hydatid disease. We report a case in a 65-year-old female who presented with painless hematuria, was found to have a cystic mass in the right kidney. The mass turned out to be collecting duct carcinoma after histopathological examination though imaging studies were in favor of a hydatid cyst.
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Background:There are clinical evidences for efficacy of dexmedetomidine as an adjuvant to local anaesthetic for peripheral nerve block, but very few published study are available on continuation of dexmedetomidine, with ropivacaine for ultrasound guided supraclavicular block. The present study has been designed to elucidate the effect of dexmedetomidine, in combination ropivacaine on various parameters.Methods:During period of 2 year and 3 months 84 patients were enrolled for thisstudy. Patient in Group A were received 15 ml of 0.5% ropivacaine with 100 microgram one ml dexmedetomidine and Group B were received 15ml of 0.5% of ropivacaine with 1 ml of normal saline. Drug solution was prepared by same individual and was not part ofstudy.Results:Both the group were comparable to each other regarding demography profile. The duration of sensory block 644.96±72.4 min in group A and the duration of sensory block in Group B was 731.53±131.54 min with p value0.00354.The duration of motor block was 661.5±29.25 in group A and 559.77±29.25 in Group B with P value 0.0001. Duration of analgesia in Group A was 457.06±34.47 min and it was 345.70±38.032min in Group B.The supplementation of intravenous opioid was required in 3 patients in Group A and 10 patients in group B with P value 0.037. Conclusions: When 100 microgram of dexmedetomidine was added as an adjuvant to ropivacaineis associated with early onset of sensory and motor block, prolongation of sensory and motor block and duration of analgesia in comparison with ropivacaine alone
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Background: Non-metastatic nm23H1 gene is thought to play a critical role in cell proliferation. Studies of nm23H1 have been done in many other malignancies. But none of these studies took up nm23H1 gene as predictor in the metastases of prostatic carcinoma. Aims and Objectives: To study the expression of nm23H1 in prostatic lesion and to correlate nm23H1 expression with presence of metastases, tumour stage, tumour grade and with PSA level serum. Setting and Design: Tertiary hospital based retrospective and prospective study done in a period of one year from thirty patients having prostatic lesion confirmed by biopsy. Material and Methods: Immunohistochemistry for nm23H1 was performed on unstained coated sections of prostatic lesions to study the relation with prostatic lesion and their correlation with age, PSA level, tumour stage, grading. Clinical data was collected from medical records. Statistical Analysis: SPSS Version 15 analysis software was used. The value were presented in number(%) and Mean ± SD. Results: Majority of patients belong to age group 61 to 70yrs.Gleason score >7 were seen in 55% of patients of adenocarcinoma with and without metastasis. The difference in PSA levels between BPH and adenocarcinoma was significant (P < 0.001). IHC expression for nm23H1 gene showed positive findings in all the cases (P = 1). PSA values >20ng/ml showed maximum % mean expression (98.64%) as compared to PSA levels <10 ng/ml (96.91%). Conclusion: IHC expression of nm23H1 is not an effective tool to distinguish among the cases of BPH, adenocarcinoma of prostate with and without metastasis. Hence nm23H1 gene does not behave like an antimetastatic gene in prostatic lesions.
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@#Introduction: Correlation of Pirani score and foot bimalleolar (FBM) angle has been used in few studies but correlation of FBM angle with ultrasonography has never been evaluated so they are being correlated in assessing the severity of clubfoot in neonates treated by Ponseti method. Material and Methods: Thirty-two feet with congenital talipes equinovarus (CTEV) deformity in neonates were prospectively treated by the Ponseti method. FBM angle and ultrasound parameters were measured three times i.e. at the time of initial presentation, at four weeks of treatment and at completion of treatment. The feet were divided according to the Pirani score in groups: one (0-2.0), two (2.5-4) and three (4.5-6). Correlation between FBM angle and ultrasound parameters were evaluated using Pearson correlation/regression. Results: Correlation between FBM angle and ultrasound parameters were statistically significant (p-value < 0.05). Conclusion: Ultrasound has the potential to accurately depict the pathoanatomy in clubfoot. FBM angle and ultrasound are objective methods to assess the severity of clubfoot. FBM angle and ultrasonography correlated in severity of deformity and correction achieved along the course of treatment.
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Background: The term “acute coronary syndrome” encompasses unstable angina and non-ST-segment elevation myocardial infarction (UA/NSTEMI) and ST-segment elevation myocardial infarction (STEMI). Antiplatelet therapy is one of the cornerstones of therapy in UA/NSTEMI. Objective: To compare efficacy and safety of Prasugrel and clopidogrel both theinopyridines antiplatelet drugs in high risk (TIMI Score 3 or more) medically managed UA/NSTEMI. Materials and Methods: A prospective, randomized study was conducted in GNDH, Amritsar. 100 patients were included, 50 patients received Prasugrel and 50 received clopidogrel. Outcomes like angina episodes, bleeding, stroke, ischemic ECG changes, and arrhythmia were compared during hospital stay and follow-up for 3 months. Results: Prasugrel was associated with significant lower incidence of major adverse cardiac event (MACE) 9 compared to 19 with clopidogrel during hospital stay. During follow up for 3 months 2 events occurred with Prasugrel and 3 with clopidogrel which were non-significant. Conclusion: Use of Prasugrel was associated with less number of MACE than the patients who were on clopidogrel. Although for the individual adverse coronary events, except for angina there was no statically significant difference, but when the total MACE observed during the study was compared, it was significantly less in the patient on Prasugrel therapy. Safety of the Prasugrel in present study was identical to clopidogrel.