Background: Community-acquired pneumonia (CAP) remains a significant cause of morbidity and mortality worldwide. Objectives: To determine and compare the utility/diagnostic accuracy of pneumonia severity scores (CURB-65, NEWS, NEWS-L, and pneumonia severity index) to predict mortality in patients diagnosed with pneumonia in the emergency department. Methods: This was a hospital based analytical cross-sectional study conducted the Department of Emergency Medicine of a tertiary teaching healthcare facility in India between January 2023 and June 2024. Results: This study included 210 patients with CAP, with a mortality rate of 10.5%. Non-survivors were older, predominantly female, and had more comorbidities. They exhibited significantly lower systolic and diastolic blood pressure, oxygen saturation, and bicarbonate levels, but higher pulse and respiratory rates, blood urea nitrogen, creatinine, glucose, liver enzymes, sodium, and lactate levels compared to survivors. While haemoglobin, haematocrit, and white blood cell counts were similar between groups, non-survivors had elevated blood glucose, sodium, and lactate levels, and lower blood pH. Mortality prediction scores revealed that non-survivors had significantly higher CURB-65, PSI, NEWS, and NEWS-L scores. Specifically, the NEWS-L score had the highest predictive accuracy, with an area under the curve (AUC) of 0.898, a sensitivity of 85.8%, and a specificity of 96.2%. The NEWS score followed closely with an AUC of 0.890. Both scores outperformed CURB-65 and PSI, highlighting their superior diagnostic accuracy in predicting mortality. Conclusion: The study demonstrates that elevated vital signs, biochemical markers, and severity scores are associated with higher mortality in pneumonia patients, with NEWS and NEWS-L providing the most accurate predictions.

Objective: Post operative pain remains a problem worldwide, resulting in delayed post operative mobility and recovery. The aim of this study was to compare analgesic efficacy of oral flupirtine maleate with oral clonidine in diagnostic laparoscopy for gynaecological procedures. Material and Methods: This is hospital based, randomised, double blind, comparative study. After receiving approval from ethical committee, 50 cases were allocated to two groups using sealed envelope method to receive capsule flupirtine (200 mg) or clonidine (0.2 mg) orally, 1 hr prior to surgery with a sip of water. Mean of total number of rescue analgesia required, median visual analog scores(VASs)  at 0, ½, 1, 2,4, 6 hr post operatively were compared and analysed by using non parametric Mann Whitney U test using primer version 7 software. Results: VAS score was lower during entire duration of study in flupritine group having significant difference at 4 & 6 hrs. Requirement of rescue analgesia was comparable in both groups. Conclusion: Flupritine is superior to clonidine as it provide long duration of post operative analgesia without causing significant changes in hemodynamic variables and better tolerance to patient.

Pin worm (Enterobius vermicularis) is common intestinal nematode infection in India and with a disproportionate number of cases among children. Mostly they affect gastrointestinal tract. Genital enterobiasis rarely occur and chronic infection of urinary tract even rarer. At night, adult female pin worm migrates to perianal area and after laying egg goes to genital tract due to proximity of anal canal in female patients. Here we report a case of 26-year-old female presented with urinary frequency, dysuria, lower abdominal pain, and adult motile pin worm identified on urine sample.

Introduction: Gender profoundly shapes society. Socially constructed norms cause chaos, leading to inequality. Women in low and middle-income countries lack access to resources like employment, education, and healthcare compared to men, affecting their status and lifespan. This study addresses this inequality. Aim and Objectives: The study aimed to assess gender inequality and its correlates in healthcare seeking, by associations, if any, between gender and healthcare utilization, gender prioritization, household decision-making power, and sociodemographic factors in Burdwan, West Bengal. Methods: This study was a descriptive cross-sectional study conducted in 7 randomly selected slums of Burdwan Municipality, WB. The study included calculated subjects of 252 adults, with 36 households (18 males & 18 females) randomly selected from each slum. Interviews were conducted to assess socio-demographic characteristics, healthcare access and utilization, household member prioritization for medical treatment, healthcare, and economic decision-making power. Descriptive statistics and chi-square tests were performed using IBM SPSS Statistics 23.0. Results: Women reported higher underutilization of healthcare than men (13.5% vs. 8.7%) and were more likely to prioritize men, especially sons, for medical treatment (68.3%). In contrast, men showed equitable prioritization (49.2% prioritized men). Women were less likely to be the primary healthcare decision-makers for themselves than men (42.9% vs. 55.6%) but men were reported as primary decision-makers for children’s health and healthcare payments. Conclusion: This study reveals how societal norms and attitudes marginalize women and favour men’s health, leading to significant gender disparities in health among Burdwan’s slum dwellers. Women’s reduced access to care results from both internal and external gender discrimination.

Background: Cardiac disease is a major cause of maternal mortality after PPH and eclampsia. Undiagnosed left to right shunt over a long duration causes development of pulmonary artery hypertension leading to reversal of the shunt. This process of Eisenmengerisation is a cause for cardiac failure and death. Methodology: The study conducted over one year at Vani Vilas hospital, Bengaluru. All the women who were newly diagnosed with Eisenmenger syndrome were considered into the study. Their details, mode of presentation, mode of termination, gestational age at presentation, pulmonary artery hypertension and maternal outcomes was documented and analysed. Result: Seven cases of newly diagnosed Eisenmenger syndrome were admitted. The mean age was 23.16 years. The mean gestational age at presentation was 30+4 weeks. The maximum pulmonary artery pressure was 88mm Hg. 100% maternal mortality was noted.

Febrile seizure (FS) is a common cause of seizure in young children and occurring in 3-4% children under 5 years of age. Iron deficiency is reported as commonest micro-nutritional deficiency worldwide and has been associated with febrile seizures. The aim was to evaluate role of Iron deficiency as a risk factor of febrile seizure. Methodology: 170 children (6m – 5 years) were included in the study. 70 cases had febrile seizure as defined by International League Against Epilepsy and rest 100 controls had short history of febrile illness (< 3 days) without seizures. Anemia was defined as decrease of the Hb <11gm%, and serum ferritin <12ng/ml. Discrete variables are expressed as counts (%) and compared using the Chi-square tests, significance is set at p < 0.05. Observations: In the present study, 34.3% cases belong to 6-16 months age group and male to female ratio in cases was 1.69:1. 65.7% of cases and 45% of controls were iron deficient. On correlating iron deficiency with gender, male preponderance was observed in children with febrile seizure. The study observed 65.7% cases of FS had iron deficiency as compared to 45% of control group. (OR-2.34; p<0.05). Also, there was statistically significant association between recurrence of FS and iron deficiency. Conclusion: Early detection and timely correction of iron deficiency may be helpful for prevention of febrile seizures in children of this age group.

Objective: To study various presentations, investigations and complications of acute pancreatitis and their management. Methods: prospective study of complications of acute pancreatitis (local and systemic) and its management. The study randomly enrolled the patients of acute pancreatitis as determined by clinical, biochemical, and radiological diagnosis. The following parameters were considered complicated pancreatitis. Development of systemic complications and development of local complications. In follow- up all the discharged patients were advised to come for follow up weekly for a period of 3 months. Results: The study includes a total of 50 patients of complicated pancreatitis. 42 male and 8 female. The peak incidence in male is 4^th decade in life and in female 3^rd decade in life. Alcohol accounts 80% total cases where as gall stone contributes 16%. Most systemic complication were managed in general wards except few patients in ICU those were associated with septicemia and ARDS. Systemic complication were managed with supportive and conservative management. Local complications were managed conservatively and with operative procedures. Pseudocyst <6 cm were managed with regular USG abdomen follow up 75% resolved Pseudocyst >6 cm undergone operative procedure. All the patients with pancreatic necrosis were kept in ICU. Pancreatic abscess were managed by USG/CT guided aspiration. Conclusion: Most systemic complication were managed in general wards except few patients in ICU those were associated with septicemia and ARDS. Systemic complication were managed with supportive and conservative management. Local complications were managed conservatively and with operative procedures. In general mortality from local complications was 13% mortality from systemic complication was 4%.

Unnatural deaths among tea garden workers poses a serious challenge to the health authorities and brings forth socio economic differences to the fore. The present study aims to study the pattern of unnatural deaths among tea garden workers in Sonitpur district of Assam, India. A cross sectional retrospective study was done in cases brought for medicolegal autopsy to a tertiary medical college for a period of 3 years. A total of 248 cases were included in the study. Males constituted the highest number of cases. The age group of 21-30 years and 31-40 years were most commonly involved. Road traffic accidents (47.18%) and Suicides done by hanging (19.36%) were the leading cause of such deaths. Deaths occurred more in the months of October, December and January.

Introduction: Chronic kidney disease (CKD) is a global health issue affecting over 10% of adults and up to 50% in high-risk groups, such as the elderly and those with diabetes or HIV/AIDS. CKD often leads to anemia due to decreased erythropoietin production by the kidneys, increasing mortality and reducing quality of life. Aims and Objective: To examine the hematological profile of CKD patients and correlate blood count measures with CKD stages in a tertiary care hospital. Material and Methods: This cross-sectional study, conducted from January to June 2024, included adult CKD patients at various stages, excluding those with conditions causing anemia unrelated to CKD. Data were collected through patient interviews, clinical examinations, and medical records. Hematological parameters were analyzed to assess anemia type and severity, with statistical methods determining prevalence across CKD stages to guide better management strategies. Results: Out of 256 CKD patients, 82% had normocytic normochromic anemia and 18% had microcytic hypochromic anemia, with no significant age (p > 0.05) or sex differences (p > 0.05) between the groups. Most patients were employed in the private sector (17.2%), were farmers (17.6%), housewives (20.7%), or shopkeepers (16.0%), with occupation differences being statistically significant (p = 0.032) but not influencing anemia type. Weakness was the most common complaint (86%), with no significant difference between anemia types (p > 0.05). Anemia was most prevalent in CKD stage 5 (86%), with no significant variation by anemia type across stages (p > 0.05). Significant differences were observed in mean MCV and MCH values between anemia groups (p < 0.05), and correlations of RBC count, Hb, hematocrit, MCHC, blood urea, and serum creatinine with CKD stages were also significant (p < 0.05). Conclusion: Chronic Kidney Disease (CKD) is a prevalent global health issue, often leading to anemia, which worsens with disease severity. The most common types of anemia in CKD are normocytic normochromic (due to erythropoietin deficiency) and microcytic hypochromic (due to iron deficiency). Evaluating hemoglobin and RBC parameters in CKD patients is crucial for accurate anemia classification and appropriate treatment selection, preventing unnecessary iron overload.

Background: The abdomen is commonly compared to a Pandora’s Box, and for a good reason. Since the abdomen contains within it in-numerable viscera and other anatomical components, the diseases of the abdomen give rise to a lot of clinical curiosity. A meticulous examination of the abdomen and clinical correlation is one of the most important diagnostic tools and becomes cornerstone of management in many conditions presenting with abdominal pain. Objective: To study the Association between Gender, M. Alvarado Scoring System, and Tzanaki’s Scoring System with Status of HPR in Acute Appendicitis Patients. Methods: An Observational study was conducted in our institute in 100 patients with the clinical diagnosis of AA undergoing emergency appendectomy over a period of 1 year 4 months. The MASS & Tzanaki’s score was obtained at the time of admission and the histopathological diagnosis of AA was considered as final diagnosis. Result: There is a Male predominance with a ratio of 1.8:1. There is a higher prevalence of AA in second decade (62%). RLQ Pain (100%) and Nausea/Vomiting (98%) were the consistent symptoms. The negative Appendectomy rate is 6%. Conclusion: This study shows that Tzanaki’s scoring system can be used as an effective modality in the establishment of accuracy in diagnosis of acute appendicitis.

Background: Osteoporosis, characterized by decreased bone density and increased fracture risk, is a significant health concern among older adults. This systematic review aims to evaluate the efficacy of vitamin D and calcium supplementation in preventing postmenopausal and senile osteoporosis. Methods: This systematic review was conducted according to guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A comprehensive literature search was conducted across multiple databases, including PubMed, Science Direct and Cochrane Library to identify randomized controlled trials (RCTs) published from 2014 to 2024. The search terms included “calcium”, “vitamin D”, “postmenopausal osteoporosis”, “senile osteoporosis” and “fracture”. Studies were included if they assessed the effects of calcium and/or vitamin D supplementation on postmenopausal and senile osteoporosis in older adults. Results: Sample sizes in the selected studies ranged from 79 to 7195, indicating both large population studies and smaller focused trials. Participants’ ages range from approximately 50 to 86 years old. The interventions varied significantly across studies, involving different dosages of calcium and vitamin D: calcium dosages ranged from 300 mg to 1200 mg per day and Vitamin D dosages varied from 400 IU to 10,000 IU per day, with multiple forms (e.g., cholecalciferol). The studies generally suggest that adequate dosages of calcium and vitamin D, either alone or in combination with other factors like exercise and nutrition, can have significant benefits for bone health, particularly in vulnerable populations like postmenopausal women and the elderly. Conclusion: This systematic review concludes that calcium and vitamin D supplementation plays a vital role in preventing postmenopausal and senile osteoporosis and reducing fracture risk in older adults. The evidence supports the combined use of these nutrients, particularly in populations at risk for deficiency.

Significant advancements in neonatology, coupled with an enhanced understanding of the physiology of preterm infants, have notably improved the survival rates of low birth weight (LBW) preterm babies. This study was undertaken to find out the morbidity and mortality profile as well as growth pattern and neurological development of low birth weight babies in South Rajasthan, India. Methods: A prospective observational study conducted on low birth weight babies born at the PIMS, Udaipur and followed up when attending the hospital for routine check-ups or treatment of minor illnesses up to one month of age. All neonates with birth weight between 1500gms and 2500gms were included and all their parameters were recorded in a predesigned Performa for study period of 1 year. Observation:  Among 268 neonates studied , mean gestational age was 36.2±2.1 weeks, and the mean weight was 2178±89 grams. 54.4 % participants were appropriate for gestational age, i.e., pre-term LBW, while 45.5 % were small for gestational age. Neonatal jaundice (47.76 %) was the most common morbidity encountered. The study group had a significant delay in somatic growth and neurodevelopment. Conclusion The prevalence of preterm delivery and SGA as a result of IUGR is higher if the mother is primiparous, younger than 20 or older than 35 years, belonging to lower socioeconomic status, or having a comorbid condition during pregnancy. Preterm LBW babies experience more severe morbidity and higher mortality rates compared to SGA babies.

Artificial intelligence (AI) is being increasingly integrated into healthcare systems to enhance treatment, diagnosis, and patient care. This review evaluates the significant applications of AI in healthcare, particularly its impact on medical imaging, genomics, and early diagnosis, as well as its role in reducing errors and increasing efficiency. Deep learning, Machine learning, and natural language processing (NLP) are among the most impactful AI technologies being deployed. While AI holds immense promise, challenges, such as ethical concerns, bias, and regulatory hurdles, must be addressed to ensure equitable and safe implementation. Future directions include explainable AI, greater interdisciplinary collaboration, and regulatory reform, which will shape the future landscape of AI in healthcare. This review provides a comprehensive overview of AI applications in healthcare, particularly in diagnostics, medical imaging, and personalized medicine. It also examines the benefits that AI brings to healthcare, such as increased accuracy, efficiency, and cost-effectiveness, while addressing the ethical, legal, and technical challenges that must be overcome for widespread adoption. The review concludes by exploring future directions for AI in healthcare and highlighting trends such as explainable AI, interdisciplinary collaboration, and regulatory evolution, which will shape the future of AI in clinical practice.

Background: Dexmedetomidine and Dexamethasone shows benefits of prolonging the action of local anaesthetics. We compared the efficacy of Dexmedetomidine vs. Dexamethasone as an adjuvant to 0.5% ropivacaine in ultrasound guided Supraclavicular Brachial Plexus Block (SCBP) in upper limb orthopedic surgeries. Methodology: After Institutional ethical clearance (Ref No.: SSMC/MED/IEC-138/July-2022) 60 ASA grade I & II allocated into two groups Group A (n=30): Inj. Ropivacaine 0.5% 30ml + inj. Dexamethasone (8mg) Group B (n=30): Inj.Ropivacaine0.5% 30ml+ inj. Dexmedetomidine (1µg/kg). Primary & secondary outcomes were to evaluate the onset, duration of sensory & motor blockade, respectively. Statistical analysis performed in SPSS software. Results: Demographic variables were comparable among both the groups. Statistically significant difference was observed in terms of onset and duration of sensory and motor block in Group B (inj. Ropivacaine + inj. Dexmedetomidine) as compared to Group A (inj ropivacaine + inj. Dexamethasone) (P<0.05), group B had quicker onset as well as prolonged duration of sensory and motor blockade. VAS score was significantly low among group B compared to group A at the end of the 12 hours (p=0.008). Conclusion: Dexmedetomidine has faster onset and prolongs the duration of sensory and motor blockade and also declines post-operative analgesia requirement as compared to dexamethasone when used as an adjuvant to ropivacaine in supraclavicular brachial plexus block without any adverse effects.

Patients satisfaction is an important parameter for assessing the quality of patient care services. There is a need to assess the health care systems regarding the patient’s satisfaction as often as possible. To assess the patient’s satisfaction regarding the services provided in our outpatient department in terms of clinical care, availability of services, waiting time, and cost. A 30-item pre-tested questionnaire was given to 300 patients (caretakers in pediatric patients) at the end of their O.P.D visit from 11 to 1 pm for 30 days from June1st, 2024 to June 30, 2024. The items in the questionnaire referred to particulars of the patients such as age, sex, occupation, department requested, lab, and medical stores. While analyzing, they were grouped into categories like availability, clinical care, waiting time, and cost. The responses were expressed in proportions. Recommendations are required for reduction of time spent in the pharmacy and the cost of investigations to improve patient’s satisfaction.

Background: Polycystic Ovary Syndrome (PCOS) is a multisystemic disorder characterized by endocrine, met-abolic, and reproductive system abnormalities. The diagnostic criteria include chronic anovulation and hyper-androgenism. The autonomic nervous system plays a role in pathogenesis. Women with PCOS often experience conditions like oscillatory sleep apnea, hypertension, depression, obesity, and type 2 diabetes linked to an auto-nomic nervous system imbalance. Objectives: The aim and objective of this study are to evaluate the use of cardiovascular reflex testing in pa-tients with PCOS and in healthy controls. Material and Methods: Out of 60 individuals, 30 of whom were diagnosed with PCOS, and 30 healthy con-trols, we conducted autonomic function tests, including handgrip tests, cold pressor tests, deep breathing tests (DBT), lying-to-stand assessments (LST), and the Valsalva maneuver. Statistical analysis was performed using SPSS edition 21, with Mann-Whitney and unpaired t-tests used for normal and atypical distributions of parame-ters. The study aimed to identify potential health issues. Results: The study found that PCOS patients had a significantly lower (p = 0.00*) delta HR (DBT) and E:I ratio (DBT) compared to healthy individuals. In PCOS patients, the Valsalva ratio was significantly lower (p = 0.00*). The 30:15 ratio decreased significantly (p = 0.00*) in PCOS patients compared to the healthy control group. PCOS patients had a higher heart rate (LST) than the control group (p = 0.00*). The cold pressor test showed statistical significance in PCOS patients (p = 0.00*), while the handgrip test was statistically insignifi-cant. Conclusions: The increasing prevalence of PCOS, along with obesity and hypertension, increases the risk of cardiovascular disease. Therapeutic modalities may adversely affect the cardiovascular system, highlighting the need for ways to reduce these risks. Cardiovascular reflex test can be used to assess cardiac autonomic function in PCOS patients.

Introduction: Dysphagia is a common complication of stroke and is a major risk factor for developing aspiration pneumonia. Oro-Pharyngeal-Oesophageal scintigraphy, helps to access functional aspects and it is also a semi-quantitative study of the various stages of swallowing, it can also detect tracheobronchial aspiration. Hence the study is done to assess the role of Oro-Pharyngeal – Oesophageal Scintigraphy in the evaluation of stoke patients for starting on oral feed. Materials and Methods: This observational study was done among 60 stroke patients who passed water swallow test, in a tertiary care hospital, Madurai, for the period of two months from December 2023 – January 2023 and Oro – Pharyngeal – Oesophageal scintigraphy was done after administrating 5mci of Tc99m Sulphur colloid mixed with semi solid instant cereal food.  Results and Discussion: 30% of stoke patients showed signs of aspiration in Oro-Pharyngeal-Oesophageal scintigraphy even though they have passed the water swallow test. Mean of Oral transit time (1.1s), Pharyngeal transit time (1.7s), Oesophageal transit time (16s), Retention index- oropharyngeal region (7.55%) and oesophageal region (26.15%) has increased in the study participants than the normal. There was a statistically significant (p value-0.000) increase in these parameters among patients those who had aspiration than those who did not had aspiration. Percentage of oesophageal emptying at 10sec has decreased in the study participants than the normal and there was a statistically significant (p value-0.003) decrease in this parameter among those who had aspiration than those who did not had aspiration. Mean aspiration rate in our study was 31.6%. Conclusion: Evaluation of swallowing in assessing readiness to start oral feeds in stroke patients can be done using Oro-Pharyngeal – Oesophageal scintigraphy in canters with gamma Camera.

Background: Cervical cancer is the second most common cancer in India and leading cause for cancer related deaths among women in our country. Screening by Pap smear has reduced its incidence in developed countries but implementation of this screening technique has not been successful in developing countries. Aim: To assess female healthcare professionals regarding their knowledge, attitude and practice towards cervical cancer and screening. Methodology: This is a cross sectional study conducted at Department of Obstetrics and Gynecology, Velammal Medical College and Research Institute, Madurai from January 2024 to June 2024 among female healthcare professionals – doctors, nurses and Auxiliary Nursing Midwifery(ANM). A simple random sampling method was used for recruitment. A standardized questionnaire was used to collect the required data. Results: Out of 332 participants majority were doctors 46.4%(154) remaining 30.1%(100) and 23.5%(78) were staff nurses and ANM. The mean age of study participants was 28.65 years.54.8%(182) were married.69.6%(231) and 20.8%(69) appeared to have good and fair level of knowledge respectively.292 participants (88%) believed that cytology test is useful for detection of carcinoma cervix and 53 participants (16%) undergone screening test (Pap smear).Only 21.4% (71) have been vaccinated for HPV. Conclusion: Our study population showed overall good and fair knowledge about cervical cancer and screening. However, only less than one fourth of the participants had undergone screening and HPV vaccination. Hence our study highlights the gap between knowledge and practice which has to be met by appropriate health education programs and mass campaign. Government should take initiatives for provision of HPV vaccines in a subsidiary price and also to include HPV vaccination in Indian immunization schedule.

Background: An annual issue for millions of people worldwide are urinary tract infections (UTIs), which are a frequent and chronic medical condition. The most prevalent bacterial illness among women overall, and among postmenopausal women specifically, is urinary tract infection (UTI). Regarding age and general state, two groups of elderly women with recurrent UTIs should be distinguished: elderly institutionalized women with or without a catheter and healthy, young postmenopausal women between the ages of 50 and 70 who are neither institutionalized nor catheterized. Methods: A study population of 134 post-menopausal women, attending OPD or admitted to Department of General Medicine, Gauhati Medical College and Hospital and study duration was from December 2023 to July 2024. The co-morbidities, recurrence of UTI and the type of organisms isolated from urine sample were studied. Data were analysed using PRISM software, version 8.0. Results: The most common age group of prevalence of UTI in the most menopausal female was in 44-52 years (44%). The overall the recurrence rate was 41.3% and the rate was highest in the >80 years age group (77%). There was statistically significant association between diabetes mellitus and UTI recurrence with p value of 0.03. The most common organism isolated was E. coli 76.8%, in urine cultures. It was also responsible for adverse outcomes. Conclusion: The study revealed a higher recurrence rate with advanced age among postmenopausal women. There was two times more risk of developing UTI in patients with Diabetes Mellitus. E. coli was the most common organism responsible.

Background: WhatsApp is a popular instant messaging application which allows millions of people to keep in contact with each other and also helps anyone to create and publish content. It has the potential to influence the several domains of medical education. Objectives: To assess the effectiveness of WhatsApp as a medical teaching learning tool in comparison with traditional lecture method and to assess the perception of medical students towards use of WhatsApp as a teaching learning tool. Methodology: Students were divided into 2 groups and analysed for the effectiveness of WhatsApp as a teaching learning tool in comparison with lecture method. Perception of students towards use of WhatsApp as teaching learning tool was collected using validated feedback form. Results: It was observed from the study that there was no statistically significant difference between use of WhatsApp and traditional lecture as a teaching learning tool. Majority of students perceived that WhatsApp helped to improve their enthusiasm in academics along with making difficult concepts simple and increased interaction between students and facilitator. High expectation of teacher’s availability and group maintenance were most agreed challenges in use of WhatsApp as a teaching learning tool. Conclusions: From the study finding we can conclude that use of WhatsApp as a teaching learning tool was equally effective as didactic lecture.

Background: WHO defined postpartum anaemia as Haemoglobin level of <10gm% during postpartum period. The prevalence of postpartum anaemia is high and it ranges from 4 to 27%. In developing countries higher prevalence, 50-80% has been reported. Prevalence of postpartum anaemia at 6 weeks has been quoted as 70% in India. Aim and Objectives: To compare the Haemoglobin levels in Postpartum Anaemia patients receiving I.V Iron sucrose and I.V Ferric carboxymaltose. Material and Methods: A prospective open labelled study was conducted at Government Maternity Hospital, Petlaburz after the approval from Institutional Ethics Committee. The study included 100 patients diagnosed with post-partum anaemia. The patients were divided into 2 groups .Each group included 50 patients. Group I received I.V iron sucrose 1000mg on alternate days till the required dose is completed. Group II received I.V Ferric Carboxymaltose once in a week. In both groups Haemoglobin levels done before treatment and 2 weeks after the treatment. Observation and Results: On comparing both groups using student t test, we found that increase in Haemoglobin concentration and serum ferritin level in group receiving Ferric Carboxymaltose was found statistically significant over Iron sucrose group. Conclusion: In this study, administration of ferric carboxymaltose increased the haemoglobin level more rapidly as compared to iron sucrose in women with Iron deficiency anaemia in post-partum period. Ferric carboxymaltose is well tolerated, safe and effective alternative to blood transfusion in the treatment of iron deficiency anaemia in the post-partum period.

Introduction: Citrobacter species is gram negative, enteric bacilli that colonize in moist environment and found mostly in water, soil, food, and the intestines of animals and humans. They cause a wide spectrum of infections involving the urinary tract, liver, biliary tract, peritoneum, intestines, one, respiratory tract, endocardium, wounds, soft tissue, meninges, and the bloodstream. Increasing resistance to beta-lactam drugs especially the 3rd-generation cephalosporin in Citrobacter species is predominantly due to the production of multidrug resistant enzymes in particular extended spectrum beta-lactamases (ESBLs). Material & Method: This was a hospital lab based observational study carried out from the 500 samples, – 100 from each sample type (100 Urine, 100 Pus, 100 Sputum, 100 Blood and 100 Body fluid) collected over a period of 6 months from 13-08-2022 to 23-02-2023 at NMCH, Patna Bihar. Among these processed samples positive isolates of Citrobacter species are recovered and for further study sent to the department of Microbiology. First find out Antimicrobial susceptibility pattern and ESBL producing strain from isolated Citrobacter species then find out total prevalence and ESBL, non-ESBL prevalance. Antimicrobial susceptibility pattern tested against different antibiotics and determine the antibiogram of these isolates. ESBL production in all these isolates are detected by using double disc synergy test (DDST). Result: Out of 500 samples, 44 (8.80%) were detected positive for Citrobacter species isolates. Out of these 44 clinical isolates of Citrobacter species recruited for this study, 26 isolates (i.e. 59%) were confirmed to be ESBL producers by the DDST method and rest 18 (41%) non-ESBL producer. AST pattern shows high resistance rate to Cefotaxime, Cotrimoxazole, Ciprofloxacin, Gentamycin and more sensitive to Imipenem and with Colistin no resistant found in this study. Conclusion: From our results, it could be deduced that 59% of Citrobacter isolates harbour or express ESBLs; and they are resistant to commonly used antibiotics inclusive of some beta-lactams and non-beta-lactam antibiotics. There is therefore need for proper AST monitoring and detection of resistant antibiotics from clinically important bacterial pathogens so as to guide therapy and to contain their nefarious effect.

Background and Aim: Diabetic foot infections rank high among the most prevalent skeletal and soft tissue infections in individuals with diabetes. Oral antibiotics with high oral bioavailability and localised delivery of antibiotics in bead form are currently being utilised. This study aimed to evaluate the efficacy of antibiotic-impregnated beads in the treatment of osteomyelitis in patients with diabetic feet in an Indian setting. The study also examined the microbiological profile of the wounds. Material and Methods: In our current main study, the total sample size was 100. The participants were assigned at random to the two groups. In the ‘bead’ group, antibiotic beads were utilised, while the ‘no bead’ group received oral antibiotics. Both groups received intravenous antibiotics as a precautionary measure. All patients were evaluated for a period of six months, and ulcers that did not heal within this timeframe were considered as unsuccessful treatment. Results: The mean age, body mass index, random blood sugar, and HbA1c values did not show any significant differences between the two groups. Our study examined the healing of ulcers in two groups. Out of the 100 patients in both groups, 87 patients experienced healing, while 13 did not. Out of the nine that did not heal, nine were from the group without beads and four were from the group with beads. Among the 87 individuals who experienced healing, 41 were from the group without beads, while the remaining 46 were from the group with beads. The healing association had no significant statistical impact. Staphylococcus aureus was the most commonly found organism. Conclusion: Individuals in the ‘no bead’ group faced challenges in accessing hospitals on a daily basis, and some even had to skip their daily dressings due to personal inconveniences. When antibiotic beads are delivered locally, they can increase the concentration of the antibiotic in the surrounding tissue while keeping serum levels low. This helps to minimise any systemic side effects that may occur.

Background: Ileostomy is a common surgical procedure performed as either a protective or emergency measure in various clinical scenarios. While ileostomy closure is typically performed three to six months after the initial surgery, the timing of this procedure remains a subject of debate. The distinction between early and delayed ileostomy closure is critical as it can significantly impact patient outcomes, including morbidity, mortality, and quality of life. Objectives: This study aims to compare the morbidity and mortality associated with early (4-6 weeks) versus delayed (8-12 weeks) ileostomy closure. Specifically, it seeks to evaluate post-stoma closure complications, the indications for stoma formation, complications related to the stoma, intraoperative parameters, and the duration of hospital stay between the two groups. Methodology: This prospective observational study was conducted from September 2022 to March 2024 at the Department of General Surgery, Mahatma Gandhi Medical College & Hospital, Jaipur. A total of 60 patients who underwent ileostomy closure were included and divided into two groups: early closure (4-6 weeks post-surgery) and delayed closure (8-12 weeks post-surgery). Patients were selected based on specific inclusion criteria, including age, gender, and the absence of postoperative complications prior to closure. Data were collected on intraoperative parameters such as operative time and adhesion formation, as well as postoperative outcomes including hospital stay duration and stoma-related complications. Statistical analysis was performed to compare outcomes between the two groups, with a significance level set at p<0.05. Results: The study analyzed 60 patients who underwent ileostomy closure, divided into two groups: early closure (30 patients) and delayed closure (30 patients). The mean hospital stay was slightly shorter in the early closure group (6.98±2.71 days) compared to the delayed closure group (7.25±2.62 days), although this difference was not statistically significant. Intraoperative adhesion was found to be significantly higher in the delayed closure group (36.7%) compared to the early closure group (10.0%), with a p-value of 0.015. Post-stoma closure complications were also more common in the early closure group, particularly wound infections, which were the most frequent complication. There was no mortality reported in the early closure group, whereas one death was recorded in the delayed closure group​. Conclusion: Early ileostomy closure appears to be a feasible and effective alternative to the conventional delayed approach, with the potential to reduce stoma-related morbidity and enhance the quality of life for patients. However, careful patient selection is crucial to minimize the risks of complications, particularly wound infections. Further research is recommended to refine patient selection criteria and optimize the timing of ileostomy closure.

This case report presents a 7-year-old girl with acute retinal necrosis (ARN) secondary to suspected viral infection. The patient presented with decreased vision, pain, and a history of fever, headache, and hearing loss. Despite previous treatment for uveitis, the patient’s condition deteriorated, leading to severe inflammation and vision loss in the right eye. The left eye also showed signs of involvement. The case highlights the importance of early diagnosis and prompt management of ARN to prevent further visual impairment.

Aims: To compare the outcomes of Onlay and Preperitoneal mesh repair in case of ventral hernia. Settings and Design: This comparative study was conducted in the General Surgery Department OPD at Mahatma Gandhi Medical College & Hospital, Jaipur, from September 2022 to March 2024. It involved 66 patients undergoing open ventral hernia repair. Methods and Material: The study included 66 patients who underwent open ventral hernia repair. Participants were selected based on specific inclusion and exclusion criteria. The inclusion criteria were patients aged above 18 years, those undergoing repair for ventral hernias (including incisional, umbilical, paraumbilical, and epigastric hernias), and those who provided written consent. Exclusion criteria included planned concurrent gastrointestinal surgery, immunosuppressive disorders, chronic diseases such as diabetes, severe renal or hepatic failure, and obstructed or strangulated hernias. Ethical approval was obtained from the Institute Ethics Committee, and informed consent was secured from all participants. Statistical analysis used: Continuous variables were reported as mean ± standard deviation, and categorical variables as frequency and percentage. Differences between groups were evaluated using the Mann-Whitney U Test for continuous variables and the Fisher Exact Test for categorical variables. A p-value <0.05 was considered significant. Results: The pre-peritoneal mesh repair group demonstrated significantly lower complication rates compared to the onlay mesh repair group. Incidences of seroma formation and wound infections were reduced (p < 0.05). The pre-peritoneal group also experienced shorter hospital stays (mean ± SD: 4.2 ± 1.1 days vs. 6.5 ± 1.4 days, p < 0.05) and lower recurrence rates (p < 0.05). Conclusions: Pre-peritoneal mesh repair is associated with lower complication rates, shorter hospital stays, and lower recurrence rates compared to onlay mesh repair for ventral hernias.

Background: Appendicitis is a lymphatic organ; it is much longer in children than adults because other lymphatic organs are not well developed to combat infection. Hence, appendix is more commonly infected in children. It leads to a surgical emergency. Materials and Methods: 90 children with appendicitis aged between4-10years. A total of 90 children were studied, with 45 being male and 45 being female. Appendicitis symptoms were noted and confirmed with a USG/ST scan, were operated on by general anesthesia and the dissected part was sent to histopathology examination to rule out the exact pathology. Result: The highest prevalence of acute appendicitis was observed in both sexes. 26 (57.7%) in males, 23 (51%) in female children. The least number of perforations was observed in both sexes i.e. 12 (26.6%) in males and 6 (13.3%) in females. Conclusion: The present study will help the surgeons classify the types of appendicitis and treat the surgical emergency of appendicitis in children efficiently to avoid morbidity and mortality in children.

Background: In pulmonary tuberculosis study of fungal diseases attained importance because not only prolonged use of antibiotics is required to treat this disease but also, tuberculosis leaves residual lesions which form fungal super infection. By the presence of cavities and necrotic tissue which favor colonization of fungi and whether this super infection with fungi is responsible for persistent morbidity and symptomatic state even after completion of chemotherapy. This study aims to determine the prevalence and pattern of fungal diseases in patients who completed antitubercular therapy and has sequalae of the disease particularly cavities. Aims: To study the various fungi that can be isolated in sputum of patients who had pulmonary tuberculosis and who had taken anti tubercular drugs. Objectives: 1) Isolation of various fungi and its association with variables like type of disease, age, sex, presence of cavities. 2). Clinical significance of fungi thus isolated in regard to secondary mycotic disease. Materials and Methods: This is a prospective observational study conducted from may 2023 to April 2024 at Department of pulmonary medicine, Kurnool medical college and government general hospital, Kurnool. A total of 100 patients satisfying the inclusion and exclusion criteria were included in the study. Results: The study group consists of 100 patients among which 74(74%) are males and 26(26%) are females. Most common symptoms was cough with or without expectoration followed by wheeze, hemoptysis, SOB.Most common radiological findings were cavity (62%), followed by fibrosis and fibro-cavitary disease.Fungal isolation was more common in patients with disease duration 1 to 2(49%) years and 2-4(47%) years. More no. of cases seen within 4 years of disease duration.It is observed that in 43% of patients the interval between completion of chemotherapy and symptom onset is 1-2 years.Fungal isolation is more common in patients with diabetes mellitus than in patients without diabetes.It was observed that candida alone is isolated from 15% of cases and Asperigillus alone from 34%.  No fungus isolated in 51% of cases.

Conclusion: The occurrence of fungal infections in treated pulmonary Tuberculosis cases poses a significant challenge with occurrence of dreaded symptoms like hemoptysis that can pose danger. This study helps in determining the prevalence of these infections and the most common fungal species isolated there by guiding the management.

Background: Penetrating keratoplasty in children is a complex and demanding procedure, often carrying a high risk of graft failure or unsuccessful amblyopia treatment, even in cases with clear grafts. Despite these challenges, keratoplasty remains the preferred surgical option for managing pediatric corneal stromal opacities or edema. The current study was done to determine the indications and clinical outcomes of pediatric penetrating keratoplasty. Methods: This prospective study was conducted in the Department of Ophthalmology,  Sarojini Devi Eye Hospital, Osmania Medical College, Hyderabad. A detailed history was taken to determine the etiology of corneal insult, associated symptoms, and duration followed by a general examination, best corrected visual acuity using Snellens/ LogMAR charts, and slit-lamp biomicroscopy for anterior segment evaluation. Further, the patients were subjected to syringing for patency of lacrimal apparatus, and B scan ultrasound to rule out posterior segment pathologies. Results: The most affected age group was 6-10 years, accounting for 40% of cases. The youngest (1-5 years) and oldest (16-18 years) age groups had the lowest representation. There was a slight male predominance, with males accounting for 55% of cases and females for 45%.  The majority of patients (65%) experienced improved vision following PKP. A smaller proportion (20%) maintained unchanged visual acuity. A limited number of patients (15%) experienced either no assessable or worsened visual outcomes. The data suggests that PKP is generally effective in improving visual function in pediatric patients. Graft acceptance: 60% of cases (12 out of 20) demonstrated successful graft acceptance. 35% of cases (7 out of 20) experienced graft rejection. 5% of cases (1 out of 20) resulted in graft failure. Regarding surgical interventions, the majority of cases required a single grafting procedure. Conclusion: In conclusion, penetrating keratoplasty is still the best operation that can be done in children with corneal opacities and ectasias because there are no other options available. Even though the process gives low potential for graft rejection and an average amount of vision enhancement, timely intervention, professional surgery, and adequate post-operative treatment can contribute much to positive results.

Background: Severe Acute Malnutrition (SAM) remains a significant public health challenge, particularly in low- and middle-income countries, where it is a leading cause of morbidity and mortality among children under five years of age. Understanding the clinical and demographic factors contributing to SAM is crucial for effective prevention and intervention strategies. Aim and Objective: This study aimed to identify key clinical and demographic risk factors associated with Severe Acute Malnutrition in children aged 6 to 59 months. Materials and Methods: A cross-sectional study was conducted in a tertiary care hospital and its affiliated community health centers CAIMS, Karimnagar. A total of 110 children diagnosed with SAM, based on WHO criteria, were enrolled. Data collection involved a structured questionnaire addressing demographic profiles, clinical histories, and household characteristics. Statistical analyses included bivariate analysis and multivariate logistic regression to determine independent risk factors for SAM. Results: The study found that low parental education, large family size, and low socioeconomic status were significant demographic risk factors for SAM. Clinically, a history of recurrent infections, poor immunization coverage, and inadequate breastfeeding practices were strongly associated with SAM. Multivariate analysis indicated that recurrent infections and low socioeconomic status were the most significant predictors of SAM. Conclusion: The findings suggest that both clinical and demographic factors play a crucial role in the development of SAM. Public health interventions should focus on improving maternal education, enhancing healthcare access, and promoting optimal feeding practices to reduce the incidence of SAM and improve child health outcomes.

Background: Preeclampsia (PE) remains a significant contributor to both maternal and fetal death. According to available data, the prevalence of PE in developing countries is significantly elevated. Aim: The present study was designed to know the effect of serum uric acid level on outcome of pregnancy in PE patients. Materials & methods: A study was conducted at MVJ Medical College and  Research Hospital department of OBG between the period of 1 year using a case-control design. A purposive sampling method was used to select 150 pregnant women in their third trimester. 60 individuals diagnosed with PE were chosen as cases, aged 18-35, while 60 healthy pregnant women were selected as controls, aged 18-36.   Results: The study involved 80% of participants aged 21-30 years, with a mean standard deviation of 26.17±4.82 years and 25.79±4.13 years, respectively. The gestational age was 35.61±3.41 weeks and 35.9±3.06 weeks, respectively. Most participants were primiparous, with no significant difference. A significant proportion had irregular prenatal check-ups in both groups. Uric acid significantly raised after 28 weeks of gestation in PE women were observed to have intrauterine growth restriction (IUGR) in our study than the PE women who had normal levels of uric acid after 28 weeks of gestation. Conclusion: High serum uric acid levels are linked to poor pregnancy outcomes in PE, including increased need for early birth and worse neonatal outcomes. Serum uric acid may be a significant prognostic marker in managing PE, but further large-scale investigations are needed to develop clinically applicable thresholds.

Background: Carpometacarpal (CMC) joint fracture dislocations are extremely rare, representing less than 1% of all hand and wrist fractures. These injuries are frequently missed or misdiagnosed, occurring primarily in young adults due to axial loading injuries or in the elderly following falls. Early diagnosis and appropriate management are crucial for optimal recovery. Cases: This series presents 12 cases of CMC joint dislocations in patients aged 19 to 50, including both males and females. The injuries resulted from various mechanisms such as falls, sports injuries, and accidents. The majority of cases involved dorsal dislocations of the 2nd, 3rd, and 4th CMC joints. Treatment included closed reduction, K-wire fixation, and cast immobilization. Result: All patients achieved good functional recovery with minimal stiffness and satisfactory alignment within six to ten weeks. Regular follow-up and structured physiotherapy played significant roles in ensuring optimal outcomes. The consistent application of early intervention techniques proved effective in managing these complex injuries. Conclusion: Despite their rarity, CMC joint dislocations require a high index of suspicion for diagnosis and prompt, precise treatment. This case series highlights the importance of early intervention, demonstrating that with appropriate management, excellent functional outcomes can be achieved in patients with CMC joint dislocations.

Background: Surgical site infection is one of the leading cause of Hospital acquired infections in developing countries. Surgical site infection rates ranges from 0.5% to 15% globally, 23% to 38% in India.⁷ Hence identification of bacterial pathogens and their antibiotic susceptibility testing is required for successful treatment of SSI. Aim & Objectives: To evaluate the bacterial spectrum, antibiotic sensitivity pattern and  drug resistance Of  isolated organisms in surgical site infections. Materials and Methods: Total of 110 pus samples were collected over a period of one year from surgical site infections. Detection of Organisms was done by Conventional culture and Biochemical methods, antibiotic sensitivity pattern of the isolates was studied by Kirby-bauer disc diffusion technique following CLSI guidelines. Results: Of the 110 clinical isolates 28 (25.45%) were pus/swab culture positive. Gram Positive organisms 15 (53.57%) were the predominant causative agents of SSI compared to Gram negative organisms 13 (46.42%) in the cases. Prevalence of MRSA is 9 (86%) of the isolated Staphylococcus aureus. ESBL production was observed in 6 (46.1%), MBL production was observed in 2(15.38%) of Gram negative isolates. Conclusion: The study gives an insight into bacterial pathogens and their antibiotic sensitivity patterns isolated from SSI. Preparation of antibiogram suitable for the hospital and its strict implementation is required in order to prevent antimicrobial resistance (AMR).

Background: Thyroid swelling is a common clinical finding with a quiet high prevalence among Indian population. Risk stratification of these thyroid swellings into benign and malignant hence become a crucial part in the management of these cases. Here comes the role of ultrasonography, with its added benefits of portability, cost effectiveness, lack of ionizing radiations and non-invasiveness. To standardize ultrasound findings Thyroid Imaging Recording and Data System (TIRADS) classification are used. Methods: History and physical examination were done in all cases of thyroid nodule. Serum TSH, T3, T4, pre and post operative calcium on post operative day 3 were done in all cases. Ultrasonography and fine needle aspiration Cytology (FNAC)/ultrasonography guided if nodule size less than 1cm were done in all cases. All patients underwent surgical intervention, and specimens were sent for Histopathology examinations. Result: Common age groups were 25 to 44 years, and more than 80% cases were female. 65% cases were less than TIRADS 4 and 35% cases were more than TIRADS 4. Patients with TIRADS score of 4 and more were having higher chance of being suspected with malignancy on histopathology examination than the patients with score of less than 4. On the basis of sonographic findings, half of the subjects among solid components were found to be having malignancy, whereas, more than half of the subjects with micro-calcifications were having malignancy and all the subjects with irregular margins were diagnosed with malignancy on HPE. Conclusions: Thyroid ultrasound plays a key role in diagnosis, and   it allows for the morphological characterization of Thyroid nodules, thereby facilitating adequate selection of those nodules amenable to FNAB cytological diagnosis. There is paucity of data regarding TIRADS score and its relationship with thyroid pathology in this part of the world. This study was an honest attempt to fill this gap, which would be helpful in managing the thyroid disorder more efficiently and will be convenient for risk stratification.

Background: Diabetes Mellitus denotes to a cluster of common metabolic disorders that segment the phenotype hyperglycemia. Type 2 Diabetic Mellitus is a diverse group of disorders considered by inconstant degrees of insulin resistance, compromised insulin secretion, and augmented hepatic glucose production. Purpose: The purpose of study is studying clinical correlation of diabetic retinopathy and diabetic nephropathy in Type two diabetes mellitus. Methods: We have conducted cross sectional observation study in patients attending GGH outpatient department of ophthalmology during  the period May 2023 to May 2024 on hundred patients. Results: Early detection of screening factors for retinopathy, nephropathy may prevent the progression of disease. Conclusion: The vision loss in diabetic retinopathy can be prevented by periodic fundus examination and blood glucose levels  and timely intervention. Diabetic nephropathy can be prevented by periodic checking of blood albuminuria.

Background: Chronic migraines are a prevalent and debilitating condition significantly impacting patients’ quality of life. Preventive therapy is commonly used to manage chronic migraines, with various pharmacological approaches showing differing levels of efficacy. Understanding the biochemical profiles of patients on preventive therapy can help optimize treatment strategies. Methods: This retrospective cross-sectional study evaluated 150 patients with chronic migraines undergoing preventive therapy. Data were collected on biochemical markers (e.g., CGRP, serotonin, CRP) and pharmacological profiles (e.g., medication types, dosages). Statistical analyses were performed to identify associations between biochemical markers and therapeutic outcomes. Results: The study found elevated CGRP levels in 45% of patients, with reduced serotonin levels observed in 33%. Beta-blockers were the most commonly prescribed preventive therapy (44%), followed by antiepileptics (35%) and antidepressants (28%). Significant associations were noted between elevated CGRP levels and the use of CGRP inhibitors, and reduced serotonin levels with antidepressant use. CGRP inhibitors showed greater efficacy in reducing headache frequency compared to other therapies. Conclusion: The findings emphasize the importance of personalized treatment based on biochemical profiles in chronic migraine management. Elevated CGRP levels and reduced serotonin levels can guide the selection of more effective preventive therapies. Despite the study’s limitations, such as its retrospective design, the results support targeted therapeutic approaches and highlight the need for further research to refine treatment strategies.

Background: Given the significance of the burden of sino-nasal abnormalities faced by inhabitants of the south west region of Satpuda Range, our study sought to ascertain the prevalence of these abnormalities and the related socio-demographic factors in the region. Material and Method: In this hospital-based cross-sectional study, patients who reported to the outpatient department of ENT at CIMS Medical College and Hospital in Chhindwara, MP, India, with a complaint of craniofacial discomfort between February 2022 and January 2024 were included. A comprehensive history and ENT examination were conducted to identify the sino-nasal source of craniofacial discomfort. The chosen cases had computed tomographic (CT) scans of the sinuses and preliminary diagnostic nasal endoscopy. An association was shown between age, gender, smoking status, and history of trauma and the occurrence of craniofacial discomfort caused by sino-nasal pathology. Results: Among a group of 200 patients experiencing craniofacial discomfort, 130 of them had a sino-nasal malfunction. Among the 100 patients, 80 were male and 50 were female. A mean age of 34.859±4.846 years was recorded among the research participants. The most prevalent sino-nasal pathology seen in these individuals was deviated nasal septum (DNS), followed by nasal polyps and chronic sinusitis. Application of binary logistic regression revealed an association between smoking and history of trauma with the existence of sino-nasal cause among patients with craniofacial complaints. Conclusion: Sino-nasal anomalies were a primary factor contributing to craniofacial discomfort in patients seeking treatment at the ENT outpatient department. Particular focus should be given to individuals who engage in cigarette smoking and those with a reported history of facial trauma.

Objectives: To identify the cause of maternal mortality in a tertiary care centre. Methods: maternal mortality studied for 10 years. Information was retrieved from case notes available in medical records section of hospital patient relatives, records from district health centre and primary health care. Results: there were total 60 maternal deaths and 68,850 live births. Majority of deaths occur in age group of 20-29 years which is about 73% and during post-natal period 65%. Majority of deaths were due to haemorrhage 40% followed by hypertensive disorder of pregnancy 20%. Conclusion: haemorrhage is the most common cause of death leading to maternal mortality. These deaths can be avoided by health education, early referral and active management of labour and puerperium.

Psoriasis is a papulosquamous, proliferative condition of the skin, in which both genetic and environmental influences have a critical role. Psoriasis with metabolic syndrome causes significant physical and psychological morbidity to the patient. Therefore, the present study was conducted to study prevalence of metabolic syndrome in chronic plaque psoriasis at tertiary care centre. The present study was case control study carried out at Department of Dermatology of tertiary care centre during November 2021 to October 2022. A total of 50 50 cases of chronic plaque psoriasis diagnosed clinically above 18 years were enrolled while 50 age and sex matched controls were included. Metabolic syndrome is defined based on the revised criteria from NCEP ATP III. The statistical software namely SPSS 22.0 used for the analysis of the data. The mean age in Cases was 40.34±12.50 years and Control was 41.50±13.28 years with no significant difference. Both the group shows male dominance. Percentage of metabolic syndrome in patients with psoriasis in cases (42%) was more as compared to controls (2%) was statistically highly significant (P<0.0001) The present study concludes that there is a significantly higher prevalence of metabolic syndrome in psoriasis patients as compared to general population.

Introduction: Airway management is of prime importance during delivery of general anaesthesia. Patients, who have been anaesthetized, are unable to maintain an adequate airway on their own and artificial airway maintenance devices are employed. Aims of the study are to compare classic LMA with endotracheal portex cuffed tube intubation in 60 patients undergoing surgeries under general anesthesia. Methods:  This prospective, randomized clinical study was carried over a period of two and half years. 60 patients aged 20-60 years, belonging to ASA grade I-II scheduled for elective surgical procedure were included in this study. Informed written consent was obtained from each patient and the procedure was explained to the patients. All the quantitative data were analyzed using unpaired t-test. The results were expressed, as Mean + SD. ‘P’ value < 0.05 was taken as statistically significant. Results: This prospective randomized clinical study comprised of 60 patients belonging to ASA Grade I – II undergoing elective surgical procedure. 30 patients were studied with Group A (LMA classic) and 30 patients were studied as a Group B (ETT). No. of attempts, ease of insertion, hemodynamics response and other relevant parameters were studied and analyzed. Conclusion: We concluded that LMA classic is safe and useful alternative to endotracheal intubation in elective fasted adult patients undergoing elective surgeries under general anaesthesia. It is judge by stable haemodynamic, adequate oxygenation & ventilation and ease of insertion.

The role of Forensic anthropology to derive alternative and newer modes of identification is increasing every day. Estimation of stature is one of the important initial steps during forensic analysis of human skeletal remains. The aim of the present study was to derive a linear regression formula for estimating stature from length of the sternum. The study included 170 male & female sternums of Indian origin dissected from cadavers during medico-legal autopsies. The regression equation for both sexes was “Stature= 94.228 + 4.474 × (Combined Length of Manubrium and Body of Sternum)”, with a standard error of 3.901 cm and a strength of correlation of 0.858. This early study shows that the length of the sternum can be utilized for estimating stature.

The determination of sex from skeletal remains is highly significant in forensic medicine, physical anthropometry, and anthropology. Exact sex determination from bones has been a key issue in medico-legal issues, and accuracy is dependent on the type of material available and the methods used. Several earlier studies have shown that the sternum is an essential tool for determining sex in mutilated, fragmented carcasses at an advanced stage of decomposition. The sternum is a bone that is easily retrievable, even from the advanced decomposed corpse and the bundle of bone.

In individuals with the established disease, type 2 diabetes mellitus raises the risk of morbidity and death and is a risk factor for incident heart failure. A rising illness burden is predicted by secular trends in the prevalence of heart failure and diabetes mellitus, which emphasize the need for efficient treatment approaches. The purpose of the study is to examine the clinical features of individuals with and without diabetes mellitus in Heart failure. Methods: The cross-sectional study was on 35-70 years old adults with and without in DM. Indicators of Cardiovascular diseases (CVD) risk factors, including gender, age, blood pressure, dyslipidaemia, smoking, alcohol consumption, fasting blood sugar, creatinine, blood urea, waist circumference, body mass index, family history, physical inactivity were collected in the study. Results: The 1852 participants were included. Triglycerides, alcohol intake, and smoking were found to be the variables linked to diabetics. Our study’s findings indicate that there was a substantial prevalence of cardiovascular risk factors in diabetes mellitus. In this area, it is advised to cut back on alcohol and tobacco use in addition to managing hypertension, hyperlipidemia, and obesity.

Background: Cerebral venous sinus thrombosis (CVST) refers to occlusion of venous channels in the cranial cavity, including thrombosis of Dural Venous Sinuses or the smaller feeding cerebral veins. It is more prevalent among young to middle-aged people and is more common in females. It is a potentially life-threatening condition requiring early clinical suspicion and prompt treatment. Material and Methods: The present prospective observational study was conducted in the Department of General Medicine, HBT medical college and Dr. R.N. Municipal General Hospital, Juhu, Mumbai. The study included confirmed cases of cerebral venous sinus thrombosis based on clinical history and neuroimaging. Results: Presentation was acute in 29 (54.72%), subacute in 14 (26.42%) and chronic in 10 (18.87%) cases. Headache (73.58%), focal deficit (56.60%), altered sensorium (52.83%), convulsions (39.62%), fever (28.30%), diplopia (22.64%), papilloedema (37.74%), pallor (41.51%), cranial nerve involvement (24.53%), dehydration (16.98%) and dysphasia (11.32%) was reported among the subjects respectively. Puerperium was the most common identified risk factor seen in 18 (33.96%) followed by Hyper-Homocysteinemia (15.09%) and infection (13.21%). Conclusions: Study revealed that focal neurological deficit, altered sensorium and fever at the time of presentation were associated with poor outcome on follow up. No significant association was found with age, sex, seizure at presentation, papilloedema, number of sinuses involved, and parenchymal lesions in brain imaging. Isolated headache at the time of presentation was associated with good prognosis (p<0.05).

Background: India grapples with a rising diabetes burden, prompting concern over treatment costs. The Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) aims to provide affordable generic medicines, particularly for underprivileged populations. Aim: This study compares Jan Aushadhi generic antidiabetic drugs with branded counterparts to analyze cost discrepancies and their impact on treatment expenses. Methods: Prices of Jan Aushadhi generics and branded drugs were compared, revealing substantial variations. Cost ratios and variations were computed, underscoring the need for informed decision-making. Results: Over 70% of Jan Aushadhi generics were cheaper, though exceptions existed such as Sitagliptin tablets. Significant cost disparities were observed, with Canagliflozin showing the highest difference. Cost ratios ranged widely, emphasizing the importance of cost-conscious choices. Variations in costs highlighted the need for effective drug marketing management. Conclusions: Selectively opting for Jan Aushadhi generics could alleviate medication costs in India, prompting a review of pricing policies. Price differences between generics and branded drugs underscore the necessity for better management. Increased awareness among stakeholders is crucial, and transitioning to PMBJP generics could enhance healthcare affordability.

Introduction: With the advent of antibiotics, complications of otitis media have become less common. It is crucial for physicians to recognize otitis media and treat its complications early. Herein, we present our institution’s experience with patients who required emergency surgical intervention for complications of otitis media. Methods: All 15 patients of COM with intra or extra cranial complication who were admitted in the Department of Otorhinolaryngology, Narendra Modi Medical College Ahmedabad, from April 2023 to April 2024 were included in this retrospective analytic study. Results: Out of 15 patients 6 were male patients and 9 were female patients. We have done HRCT temporal bone in all 15 patients and only 2 patients required MRI BRAIN scan.13 patients had extracranial complications and Only 2 patients had intracranial complications. 4 patients had facial weakness. All patients were treated with intravenous antibiotic and underwent surgery. Conclusion: Otitis media can still result in serious complications in the post antibiotic era due to resistance and over use of antibiotics. Patients with otitis media should be monitored, and surgical intervention should be performed whenever necessary to attain good outcomes. Life threatening complications of COM are still occurring in modern antimicrobial era in developing countries like India because of lack of awareness regarding the symptom like ear discharge and progressive hearing loss.

Background: Among various treatment options available at present for tibial plateau fractures, Joshi’s external stabilization system (JESS) is one of the established modalities for external fixation. While open reduction and plate fixation gives better reduction of articular fragments, closed reduction and JESS fixation has advantage of soft tissue preservation and early initiation of rehabilitation. Objective: Main purpose of this study was to compare the functional outcome between plate and JESS fixation method. Design: This was a comparative prospective analysis nonrandomized study. Materials and Methods: Among total enrolled 33 patients, 10 and 23 patients were treated by JESS and Plating methods respectively. Modified Rasmussen functional score (MRFS) was used for assessing the patients at each follow up. Statistical analysis was done by Microsoft excel and statistical software SPSS 21. Student t- test was applied to find if difference was significant between the groups. Results: In the study majority of the patients were between 20-30 years (mean 35.72 years) of age. Males were affected more than females, road traffic accident was the main cause (84.84% cases). There were 23 closed and 10 open fracture cases. Of the total, 60% cases were schatzker^’s type VI and 18.18% were schatzker^’s type V. The follow-up period was 6 months. On comparative analysis of the two groups at 2 weeks and 6 weeks, there was significant relationship at p value<0.001. At the period of 3 month and 6 months, both the groups are equally effective and there was non-significant relationship at the p value of >0.05. While at the latest follow-up, both the groups were significant at p value of <0.001. Conclusion: The study shows that the functional outcome of plating for the management of tibial plateau fractures is better than JESS.

Introduction: Accurate knowledge of variations in the fissures and lobes of the lungs is of paramount importance for cardiothoracic surgeons to perform lobectomies, segmental resection of the infected bronchopulmonary segments, and to lessen post- operative complications like air leaks. Likewise, it is equally important for radiologists to correctly interpretate Chest-X-ray, CT scans MRIs of the chest. Aim: To observe and describe the variation in fissures and lobes in human lungs. Material and Methods: The study was conducted on 54 lungs (28 right and 26 left), well preserved in formalin, from various medical colleges of Patna, Bihar. A gross examination was done to find out the presence of incomplete oblique fissures of the right and left lungs; incomplete horizontal fissures of the right lung; along with their grades. The absence of a horizontal fissure in the right lung and the presence of accessory fissures were also observed. Photographs of the observed variations were taken. The Percentages of the variations were calculated and compared with the previous studies. Result:  Among the right-sided lungs, complete oblique fissures and complete horizontal fissures were found in 28.5% (8/28) and 35.7% (10/28) respectively. Four out of twenty-six (15.3%) left-sided lungs had complete oblique fissures.  Incomplete oblique fissures and incomplete horizontal fissures in right-sided lungs were found in 71.4% (20/28) and 42.8% (12/28) respectively. 84.6% (22/26) of the left-sided lungs had incomplete oblique fissures. Absence of oblique fissure was not found in any of the lungs examined (0/54), while 21.5 % (6/28) of the right-sided lungs had absent horizontal fissure. Left median fissure, a type of accessory fissure, were found in 6 out of 26 lungs examined (23.1%). Conclusion: The present study has found high percentages of incomplete oblique fissures; low percentages of complete oblique fissures and complete horizontal fissures; compared to many studies done so far. This highlights the possibilities of a wider range of variations and necessitates more research to find out the extend of variations.

Introduction: The incidence of shaft humerus fractures remains 1% to 2% of all fractures and 14% of all humerus fractures. The gold standard of surgical management is open reduction and internal fixation with DCP. But it has complications like wound infections, iatrogenic radial nerve injury, and large scar which is a cosmetic concern for the patient. In the case of antegrade interlocking humerus nails, it is a biological preservative technique with union rates similar to that of DCP plate fixation. Materials and Methods: Patients with fracture shaft of Humerus, who were admitted in Government General Hospital, attached to rangaraya Medical College, Kakinada was be taken for study after obtaining their informed consent. This was a prospective study from December 2020 to December 2022. Results: Majority of patients were Males between 31-40 years.RTA is the most common mode of injury (75%). The commonly seen injuries were transverse fractures of Middle1/3rd of shaft of humerus. Majority (95%) patients had solid union in an average of 15.25weeks, 90% of patients had full range of shoulder movements. Shoulder stiffness and superficial skin infections were the only complications encountered. Discussion: 95% patients attained solid bony union within 15.25 weeks. 1 case (5%) went into non-union which was subjected to DCP fixation with bone graft at united at 32 weeks. When compared with plating, nailing had a least infection rate in postoperative period and minimal hospital stay. As the fracture site hematoma was preserved during surgery, the time required for the fracture consolidation and union would be less with higher union rates in nailing procedures.

Background: Physicians are confronted on having ECG in patients with acute stroke as it can mimic that of myocardial infarction/ischemia. They should be aware of the fact that, these ECG changes are taking place due to acute stroke and not due to myocardial infarction/ischemia. Objective: The objective of the present study was to study ECG changes in patients with acute stroke. Methods: A hospital based cross sectional study was carried out for a period of 6 months at Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Nalanda. A total of 100 patients were included who were eligible for the present study as per the inclusion and exclusion criteria. Detailed history taking, Clinical examinations, vital records, ECG at regular intervals and neuroimaging were done. Results: Present study showed that the majority of stroke cases (75%) were seen in 51-70 years of age groups. 44 patients with acute stroke in our study showed ECG changes. Out of 44, 16 (80%) of patients with intra-cerebral hemorrhages, 25 (33.78%) of patients with infarct had changes and 3 (50%) of patients with SAH had ECG changes. ST segment and T wave changes were most commonly noted after cerebral hemorrhage. Conclusions: T wave inversion, left axis deviation along with left ventricular hypertrophy and QT prolongation were common ECG changes in patients with acute stroke.

Background: The prognosis of breast cancer depends on the histological type, size of the tumor, tumor necrosis, skin, nipple and chest wall invasion, lymphovascular invasion, grade, stage, the status of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2), cell proliferation marker (ki-67), and type of therapy. Estrogen receptor and progesterone receptor expression in breast cancer is, so far, the most useful predictive marker. Hormone receptor expression has been reported to be low in breast cancer patients from developing countries including India. The pattern of progesterone receptor expression in cancer breast subjects from rural areas is not well studied. Materials and Methods: Immunohistochemistry was used for evaluation of PR expression in the mastectomy specimens. Tumour size from the mastectomy specimen was recorded; number of lymph nodes was noted. Tissue processing and staining with haematoxylin & eosin was to be done. Post mastectomy grading of the malignant breast lesion was done according to Scarff-Bloom- Richardson‘s grading (SBR) system in haematoxylin & eosin stained slides. Results: Among the histopathological types of the tumours, IDC NOS constituted 40 cases (86.9%), Invasive lobular carcinoma constituted 2 cases (4.3%), medullary carcinoma 2 cases (4.3%), invasive papillary carcinoma and mucinous carcinoma 1 case each (2.2%). The total no of ER positive and negative cases were 21(45.7%) and 25(54.7%) respectively. The total no of PR positive cases was 18(39.1%) and that of negative cases was 28(60.9%). This indicates majority of the tumours did not have hormonal receptor expression. Conclusion: A significant inverse association between ER and PR expression and higher tumour grades and axillary lymph node metastases was seen. No significant association was found between ER & PR expression and the rest of the clinicopathological parameters.

Background: Arterial blood gases (ABG) are technically more difficult to obtain, more painful, and expensive. They are associated with hazards like bleeding, arterial spasm, and thrombosis. Performing a Venous blood gas (VBG) rather than an ABG is particularly convenient in the intensive care unit since many patients have a central venous catheter from which venous blood can be quickly and easily obtained. Objectives: The primary objective was to correlate venous pH and pCO2 to arterial pH and pCO2 in critically ill patients in the Pediatric Intensive Care Unit (PICU). The secondary objective was to study the accuracy of VBG for the diagnosis of acid-base balance in children admitted to the Pediatric Intensive Care Unit (PICU) at a tertiary care hospital. Methods: In a prospective interventional study, 85 children admitted to the Pediatric Intensive Care Unit (PICU) in whom clinicians had advised ABG were recruited. ABG and VBG were obtained from the same patient at an interval of 5-10 minutes. ABG and VBG reports were later compared. The mean difference was studied by Paired t-test. The correlation of the values was tested by the Karl Pearson correlation test. Bland Altman’s method was used to study the agreement. Results: In 85 patients, the majority of the subjects belonged to <1 yrs (57.6%), with a male preponderance (46 males). The majority of the cases had respiratory system involvement. Pneumonia cases were 61.8%. The mean difference for pH between VBG and ABG was -0.01 with a Pearson correlation of 0.92. The mean difference for pCO2 between VBG and ABG was -5.32 mm Hg with a Pearson correlation of 0.97. Points in the Bland Altman were uniformly scattered between the lines of agreement which suggested good agreement and correlation between arterial and venous pH and pCO2. Conclusion: Venous pH and pCO2 showed a significant correlation and agreement with arterial pH and pCO2. Venous pH and pCO2 showed a significant correlation and agreement with arterial pH and pCO2. Thus venous pH and pCO2 estimation is an acceptable substitute for arterial measurement and may reduce the risks of complications both for patients and health workers.

Introduction Since human beings are obligate bipedals, the body weight is transmitted to the ground through lower limbs. The talocrural joint is one of the major weight bearing joints in our body. The Ankle joint is the most frequently injured one. Morphometric study of facet for talus is useful for reconstructive surgeries of the ankle joint. Methods 50 fibula bones (25 right & 25 left) were taken from the Department of Anatomy, Tirunelveli Medical College, Tirunelveli. Results The mean anteromedial distance of facet for talus is on right side 24.79 mm ± 5.13, and on left side 19.13 mm ±2.97. The mean posteromedial distance of facet for talus is on right side 26.12mm±5.78 and on left side 19.17mm±2.03. The mean maximum width of facet for talus is on right side 25.88 mm±5.60 and on left side 18.54mm±2.36. The mean maximum height of facet for talus is on right side 27.63 mm±6.28 and on left side 20.94 mm±2.59. 90% of the facets for talus are triangular, 8% triangular and 2% circular in shape.

Background: Appendicitis is the second most common abdominal pathology necessitating emergency surgery, with a 7-10% lifetime risk in the general population. The primary cause of appendicitis is lumen obstruction, predominantly due to fecoliths. Other causes of lumen obstruction include lymphoid hyperplasia, intestinal worms, and tumors, which can also lead to acute appendicitis. Laparoscopic Appendectomy has become the gold standard for appendectomy, even in cases of complicated appendicitis. With the increased adoption of Laparoscopic Appendectomy, there have been variations in procedural techniques such as port placement, types of anesthesia, criteria for converting to open surgery, and methods for ligating the appendix stump. Ligating the base of the appendix is a critical step in Appendectomy. In Laparoscopic Appendectomy, where tactile feedback is limited, the choice of method for stump closure becomes particularly important for ensuring safety. Polymeric clips have emerged as a new technique for stump closure in Laparoscopic Appendectomy due to their ease of application, adaptability, rapid application time, and cost-effectiveness. Methods: The research involved 50 patients who underwent laparoscopic appendectomy from September 2023 to August 2024. Data on patients’ demographics, surgical duration, hospital stay length, and complications were retrospectively gathered from medical records. Based on the method used for stump closure, patients were categorized into two groups: one with polymeric endoclip closure and the other with extracorporeal knot. Results: Our results demonstrate that using a polymeric clip to close the base of the appendix during Laparoscopic Appendectomy is a feasible and safe technique, proving effective for patients with appendicitis. This method offers a practical alternative to the conventional approach of using an extracorporeal knot for stump closure in Laparoscopic Appendectomy. Conclusion: Our study aimed to evaluate and compare the effectiveness of polymeric clips versus extracorporeal knots for closing the stump during Laparoscopic Appendectomy.

Background and Aim: The most common cause of respiratory distress in newborn is respiratory distress syndrome and respiratory distress syndrome is common cause of morbidity and mortality in preterm neonates. The current study aimed to evaluate the efficacy of locally developed BUBBLE CPAP as a non-invasive strategy for managing respiratory distress in newborns within resource-limited settings. Material and Methods: Present Prospective interventional study conducted on Preterm babies’ birth with respiratory distress syndrome at A tertiary care hospital and medical college, Bhuj, Gujarat, India. A total 96 eligible babies were included in this study. Need for intubation, need for surfactant therapy, Hospital stay and Mortality. Immediate complication like Pneumothorax and Pulmonary hemorrhage were recorded. Results: The study involved 96 preterm newborns, with 43.8% between 34-36 weeks gestational age, 35.4% weighing between 1-1.5 kg, 52.1% females, and 47.9% males. Of these, 67.7% were inborn and 32.3% were outborn, with 30.2% having a hospital stay between 6-10 days. Regarding CPAP administration, 69.7% received early CPAP, while 30.3% received delayed CPAP. Antenatal steroid coverage varied, with 5.2% having full coverage, 29.9% partial, and 65.6% no coverage. Surfactant administration was as follows: 9.4% received prophylactic, 8.3% late rescue, 16.7% early rescue, and 66.6% no surfactant. Intubation was required for 39.5% of the newborns, while 60.5% were not intubated. Conclusion: The findings highlight variations in outcomes based on the timing and type of surfactant administration, emphasizing the risks associated with intubation and the potential benefits of early CPAP in reducing need of surfactant, mortality, intubation, hospital stay, complications.

Background and Aim: Ascariasis is the most common helminthic disease in humans. It has global distribution and is most prevalent in tropical countries where the temperature and humidity favor the development of eggs in the soil. Ascaris is transmitted through fecal-oral route. Most of the affected are asymptomatic or present with nonspecific abdominal symptoms. However, because of the high prevalence of infection, complications can occur such as intestinal obstruction due to massive infestation, biliary colic, gallstone formation, cholecytitis, liver abscess recurrent pyogenic cholangitis and pancreatitis. Material and Methods: Patients presented to the hospital with hepatopancreatobiliary and gastrointestinal ascariasis during the study period was included after taking due informed consent. A total of 100 adult patients were enrolled in the study. A detailed clinical history was taken from all the patients. Ultrasonography of whole abdomen was done in all patients. X-ray abdomen in erect and/or supine posture was done in patients presenting with features of intestinal obstruction. Upper gastrointestinal endoscopy was done in some patients. Results: The patterns of diseases could be classified into 4 broad categories namely: biliary colic, acute pancreatitis, acute cholangitis and intestinal obstruction. Ninety percent of patients (90/100) could be managed successfully conservatively. Endoscopic removal of worms from biliary tract was done successfully in 6 patients. 4 patients underwent surgery for unrelenting cholangitis due to dead worms in the common bile duct. Conclusion: Gastrointestinal and hepatopancreatobiliary ascariasis has a high disease burden in study area. The disease reflects sanitation habits of the population and has a wide spectrum of manifestations. Management is predominantly conservative and the prognosis good. Sanitary habits should be advised and the family dewormed if an index case of ascariasis is found in the population.

Background and Aim: Magnesium sulphate (MgSO4) has emerged as a promising adjuvant in brachial plexus block, yielding positive outcomes. Nevertheless, the medical community has yet to reach a consensus on the ideal dosing parameters. This study aimed to evaluate the effectiveness of adding magnesium sulphate (150 mg) and fentanyl (50 microgrammes) to 0.375% bupivacaine compared to a placebo in the context of supraclavicular brachial plexus block. Material and Methods:  A prospective study was carried out following the approval of the institutional ethical committee at a Tertiary Care Teaching Institute in India, spanning a duration of one year. A total of 150 patients, regardless of gender, classified as American Society of Anaesthesiologists (ASA) grade I or II, were included in the study. These patients were scheduled for upper limb surgeries located distal to the mid-humerus, which were performed using an ultrasound-guided supraclavicular brachial plexus block. In this study, participants were randomly assigned to one of three groups, each consisting of 50 individuals. Group A received 20ml of 0.375% Bupivacaine, Group B was administered 150 mg of Magnesium sulphate alongside Bupivacaine, and Group C received 50 microgrammes of Fentanyl in combination with Bupivacaine. The main objective of the study was to evaluate the onset and quality of both sensory and motor blockade across all three groups. Results:  A statistically significant difference in VAS scores was observed among the three groups from 6 to 18 hours following the block procedure. The VAS scores did not show significant differences at the 6 and 24-hour time points, with the mean post-operative VAS score being lower in Group C compared to Groups B and A. The onset time of sensory blockade showed no significant difference between groups C and B (p>0.05). However, group A exhibited a markedly shorter onset time when compared to both groups C and B individually (p<0.001). The average time for motor blockade to begin was similar in groups C and B (p value>0.05), while group A experienced a significantly quicker onset of motor block. Conclusion: The findings indicate that fentanyl, when used as an adjuvant, offers enhanced analgesic effects compared to both magnesium sulphate and placebo, particularly in terms of the duration of motor and sensory blockade.

This case report presents the clinical course and management of lateral impaction shoulder injury in a tertiary hospital setting. A then 42-year-old male presented with left shoulder deformity with global restriction of movements at the affected shoulder joint. Detailed examination revealed dropping of left shoulder with minimum ROM at the joint. Diagnostic workup confirmed fracture of medial end of ipsilateral clavicle with ipsilateral scapula fracture with ipsilateral ribs fracture, and treatment consisted of open reduction and plating for clavicle and scapula keeping in consideration of shoulder suspensory ligament complex. Follow-up assessments after 6 months demonstrated correction in drooping of shoulder and complete functional ROM. This report highlights fractures associated with lateral impaction of shoulder and discusses relevant literature to underscore the management challenges and outcomes associated with it.

Introduction: Breast lesions are most prevalent cancer type among women globally that require early diagnosis for successful management and to avoid biopsies. Ultrasonography (USG), elastography and combined Ultrasono elastography are effective diagnostic modalities for characterization of breast lesions. This study was focused on characterization of the breast lesions by ultrasono elastography and comparison with FNAC findings. Material and Methods: Sixty women with palpable breast masses above 21 years were subjected to detailed clinical examination. Cases with palpable breast lesions to ultrasound imaging and elastography. The FNAC was performed to accurate the ultrasound findings. Results: The combined diagnostic outcome of grey scale USG and elastography showed 100%, 95.65%, 94.28%, 100% and 97.48% of sensitivity, specificity, PPV, NPV and diagnostic accuracy respectively. Conclusion: The concurrent use of grey scale ultrasonography and elastography is advantageous in most cases for the enhanced characterization of palpable lesions, leading to a diagnosis with high accuracy. These imaging methods relieve patient anxiety and prevent unnecessary procedures in cases where the imaging results are definitively benign.

Background: This study aims to access the level of awareness and attitude towards organ donation among undergraduate students, interns and postgraduate students in a Government medical college and Hospital, Chandrapur. Methodology: A questionnaire-based cross-sectional study was conducted in July 2024 at a Government medical college and Hospital, Chandrapur, involving 920 undergraduate students, interns, and residents. The study aimed to examine attitudes, awareness levels, and beliefs regarding organ donation. Results: In this cross-sectional study conducted in July 2024 at a Government medical college and Hospital, Chandrapur, 920 participants were surveyed to understand their attitudes and awareness towards organ donation. Among them, 698 (75.8%) were undergraduate students, 78 (8.47%) were residents, and 144 (15.65%) were interns, with an average age of 21±2 years. The study revealed that 79.8% of participants were willing to donate their organs, primarily motivated by a desire to help others in need. Conversely, the main reason for hesitancy towards organ donation was the fear of misuse or trafficking of organs. Interestingly, 60.4% of respondents expressed indifference regarding who receives their organs after donation. Moreover, the survey highlighted gaps in knowledge regarding organ donation laws, with only 38.9% of participants correctly aware of the Transplantation of Human Organs Act, 1994 in India. Furthermore, nearly a quarter (24.9%) of the participants felt that the current educational curriculum lacked sufficient coverage on the topic of organ donation, suggesting a need for enhanced education in this area. Conclusions: The study revealed a strong willingness among participants to donate organs driven by altruistic motives. Concerns about organ misuse were identified as a significant barrier. However, there was limited awareness of organ donation laws, indicating a need for improved education and transparency. Addressing these issues through targeted initiatives could enhance understanding and trust in organ donation processes, potentially increasing donation rates and benefiting those in need of transplants.

Introduction: Endometrial carcinoma typically causes postmenopausal women to experience abnormal vaginal bleeding. Women with suspected endometrial pathology were investigated initially with 3D-TVUSG and later with endometrial biopsy. Objectives: To assess the diagnostic value of three-dimensional transvaginal ultrasound (3D-TVUSG) for detecting endometrial carcinoma among postmenopausal women. Methods: A prospective observational study among 61 post-menopausal women was conducted in a tertiary care hospital in North India. All of them underwent 3D-TVUSG and were given provisional diagnosis after that endometrial biopsy was done and final diagnosis was given as per histopathological reports. Results: Mean age of study participants was 59.4+/-4.3. Endometrial carcinoma was detected in about one tenth (8.2%) of participants by 3D-TVUSG while only (6.5%) of participants were diagnosed by histopathology. The histopathological diagnosis was considered the gold standard for detection and accuracy. Sensitivity, specificity, positive and negative predictive value of 3D-TVUSG were 100%, 98.2%, 80% and 100% respectively. Diagnostic accuracy of 3D-TVUSG was 98.3%. Conclusion: Three-dimensional transvaginal ultrasound (3D-TVUSG) has high diagnostic accuracy, sensitivity and specificity for endometrial carcinoma among postmenopausal women. Postmenopausal women should be regularly screened for endometrial carcinoma with the help of 3D-TVUSG.

Background: CT scan has modified imaging especially in maxillofacial region having a complex and intricate anatomy in human body. It is now the most acceptable choice of imaging modality for diagnosis of facial bone fractures produced due to trauma. Aim of the study: The study aimed to outline the benefits of utilizing 3-Dimensional and coronal reformatted images compared to axial images when assessing frontal bone fractures. Materials and methods: This study was carried out in the tertiary care centre located in North India. Frontal bone, using a 128 –Slice CT scanner; GE Revolution machine 128. Coronal multiplanar reformatted (MPR) and 3D volume-rendered images were also reconstructed to assess and characterize its benefits over standard axial images. Results:  For the majority of patients, 3D images were on par with or better than axial images. It was discovered that coronal images were either comparable to or better at detecting fractures. Conclusion: This study showed the benefits of 3D and coronal images over axial images for the assessment of frontal bone fracture as well as the usefulness of multidetector CT in the evaluation of frontal bone fractures.

Background: The postpartum period is a critical time for initiating effective contraception to prevent unintended pregnancies and promote maternal health. Intrauterine contraceptive devices (IUCDs), particularly the copper T device, are favored for their long-term efficacy and minimal maintenance. However, the expulsion of postpartum IUCDs (PPIUCDs) remains a significant concern, potentially compromising their effectiveness. This study aims to investigate the association between the expulsion of PPIUCDs at 6 weeks and 12 weeks post-insertion and their location as confirmed by ultrasonography. Methods: This was a prospective cohort study of 100 postpartum women who underwent normal vaginal delivery followed by PPIUCD placement was studied. IUCD positioning was confirmed via ultrasonography and expulsion rates were recorded at 6- and 12-weeks post-insertion. Results: The mean age of the participants was 25.3 years. 67 IUCDs were correctly positioned at the fundus and 33 mispositioned (11 lower, 11 lateral, and 11 mid-cavity). At 6 weeks, 5 women experienced IUCD expulsion, with 4 of these expulsions occurring in mid-cavity positions. By 12 weeks, an additional 9 expulsions were recorded, distributed across various mispositions. Statistical analysis revealed a significant association between IUCD location and expulsion rates, while age and parity were not significantly associated with expulsion. Conclusion: The study highlights the critical role of IUCD location in determining expulsion rates. Ensuring correct fundal placement and routine ultrasonographic follow-up can significantly improve the success rates of PPIUCDs, enhancing postpartum contraception efficacy and reducing unintended pregnancies.

Background: Chronic kidney disease (CKD) is a worldwide health problem, affecting millions of people. Causes of chronic kidney disease include diabetes, high blood pressure, glomerulonephritis, polycystic kidney disease, lupus, and other forms of cardiovascular diseases. Serum Carbohydrate Antigen 19-9 (CA 19-9) is a tumor marker for conditions such as benign ovarian tumors, malignancies of pancreas, colorectum, lung, chronic hepatitis, liver cirrhosis, diseases of bile duct but its level is also high in chronic renal disorder. Our study was aimed to assess and compare the status of serum CA 19-9 level in chronic kidney disease subjects and healthy controls. Materials and Methods: The present study is a case-control study, conducted on 220 CKD patients. Cases were selected from the Medical ward of Jawahar Lal Nehru Medical College and Associated Group of Hospitals, Ajmer. Age and sex-matched healthy controls (n = 100) were selected from MOPD. The present study is approved by Institutional Ethical Committee. All samples were collected under aseptic conditions from the antecubital vein. Results: The mean activity of Serum CA 19-9 was significantly higher in CKD subjects as compared to healthy controls (p < 0.0001). The observations of this study also revealed that 150 out of 220 CKD patients have higher serum CA 19-9 levels (>35 U/mL). Positive pearson correlation between serum creatinine and serum CA 19-9 was found (r= 0.76). Conclusion: Serum CA 19-9 can be used as a biomarker for the early detection of CKD in the general population to prevent the morbidity and mortality which are associated with CKD. If CKD is detected early and managed appropriately the deterioration in kidney functions can be slowed and the risk of cardiovascular diseases in renal patients can be reduced.

Introduction: The selection of mesh material is a critical factor influencing patient outcomes in hernia repair, potentially outweighing the impact of the surgical technique employed. Research has compared polypropylene mesh with modified composite mesh (a combination of polypropylene and polyglactin), showing that composite mesh results in fewer foreign body reactions, reduced post-operative complications, and improved long-term quality of life. This study aimed to evaluate and compare the early outcomes of non-absorbable polypropylene mesh versus partially absorbable composite mesh in laparoscopic inguinal hernia repair. Methods: The study included 78 patients with elective reducible indirect inguinal hernias. The participants were divided into two groups of 39 each: Group A, which received partially absorbable composite lightweight meshes, and Group B, which received non-absorbable polypropylene meshes. All patients underwent laparoscopic inguinal hernia repair using the transabdominal preperitoneal (TAPP) approach. Post-operative comparisons between the groups were made based on parameters such as age distribution, inguinodynia, analgesia requirements, foreign body sensation, presence of lumps (hematoma or seroma), and return to work activities, and recurrence rates. Results: The average age of the patients was 51.14 ± 12.91 years, with the majority falling in the 51–60 years age group. Initially, no significant difference in transient neuralgia was observed between the two groups. However, at six weeks post-operation, Group A reported significantly less pain. Foreign body sensation was notably higher in Group B, though this difference was not significant over time. Conclusion: The findings suggest that composite mesh may be preferable for laparoscopic inguinal hernia repair, as it is associated with reduced pain, less foreign body sensation, and a quicker return to work compared to polypropylene mesh.

In patients undergoing mechanical ventilation for the acute respiratory distress syn- drome (ARDS), neuromuscular blocking agents may improve oxygenation and de- crease ventilator-induced lung injury but may also cause muscle weakness. We evalu- ated clinical outcomes after 2 days of therapy with neuromuscular blocking agents in patients with early, severe ARDS. Materials and Methods: In this multicenter, double-blind trial, 340 patients presenting to the intensive care unit (ICU) with an onset of severe ARDS within the previous 48 hours were ran- domly assigned to receive, for 48 hours, either cisatracurium besylate (178 patients) or placebo (162 patients). Severe ARDS was defined as a ratio of the partial pressure of arterial oxygen (PaO2) to the fraction of inspired oxygen (FiO2) of less than 150, with a positive end-expiratory pressure of 5 cm or more of water and a tidal volume of 6 to 8 ml per kilogram of predicted body weight. Results: The hazard ratio for death at 90 days in the cisatracurium group, as compared with the placebo group, was 0.68 (95% confidence interval [CI], 0.48 to 0.98; P= 0.04), after adjustment for both the baseline PaO2:FIO2 and plateau pressure and the Simplified Acute Physiology II score. Conclusions: In patients with severe ARDS, early administration of a neuromuscular blocking agent improved the adjusted 90-day survival and increased the time off the ventilator without increasing muscle weakness.

Randomised controlled trials (RCTs) have demonstrated conflicting results regarding the effects of corticosteroids on the treatment of severe community- acquired pneumonia (CAP). We aimed to investigate the efficacy and safety of different corticosteroids on patients who were hospitalised for severe CAP. Materials and Methods: We performed a systematic search through PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus from inception to May 2023. The primary outcome was all-cause mortality. Data analysis was performed using a random-effects model. Results: A total of 10 RCTs comprising 1962 patients were included. Corticosteroids were associated with a lower rate of all-cause mortality (risk ratio (RR), 0.70 (95% CI 0.54 to 0.90); I2=0.00%). When stratified into different corticosteroid types, hydrocortisone was associated with an approximately 50% lower mortality risk (RR, 0.48 (95% CI 0.32 to 0.72); I2=0.00%). However, dexamethasone, methylprednisolone or prednisolone were not associated with an improvement in mortality. Furthermore, hydrocortisone was associated with a reduction in the rate of mechanical ventilation, acute respiratory distress syndrome, shock and duration of intensive care unit stay. These trends were not observed for dexamethasone, methylprednisolone or prednisolone. Corticosteroids were not associated with an increased risk of adverse events including gastrointestinal bleeding, secondary infection or hyperglycaemia. Conclusions: The use of hydrocortisone, but not other types of corticosteroids, was associated with a reduction in mortality and improvement in pneumonia outcomes among patients hospitalised with severe CAP.

Background: Karnataka ranks as the 9th most populous state in India and the second-most populous state in South India. This study aims to evaluate the undiagnosed cases of prediabetes and diabetes in Karnataka, specifically analyzing the most frequent age groups. Method: The cross-sectional study conducted from June 2023 to May 2024 collected data at screening camps held in both urban and rural areas of Karnataka. Participants aged 13 to 95 years who visited designated data collection centers and had their blood glucose levels assessed were included if they had not been previously diagnosed with diabetes. Results: A total of 2806 individuals from Karnataka were screened, categorized into the following age groups: 13-19 years (n=26), 20-39 years (n=1259), 40-64 years (n=1188), 65-79 years (n=309), and 80-95 years (n=24). Within this cohort, 30.18% (n=847) were diagnosed with diabetes and 36.21% (n=1016) with prediabetes. Prediabetes was most common in the 20-39 age group (57.58%), while diabetes was highest in the 40-64 age group (54.07%). Conclusion: The study highlights alarming rates of diabetes and prediabetes in Karnataka, emphasizing the need for urgent public health interventions. Future efforts should focus on enhancing healthcare infrastructure, promoting healthy lifestyles, and increasing diabetes awareness to mitigate the growing burden of diabetes in India.

Background: Pulmonary tuberculosis is one of the oldest disease affecting the human race since ancient times. However, even with the advent of recent advances in diagnosis and treatment, the morbidity and mortality due to this disease remains high. The primary reason being the increasing incidence of drug resistance and the human immunodeficiency virus infection. Objective. To study the levels of serum cholesterol, HDL-C, LDL-C levels in patients with pulmonary Tuberculosis and study the correlation of serum cholesterol, HDL-C, LDL-C with radiological extent of disease and Sputum positivity. Methods: 104 patients diagnosed as pulmonary tuberculosis were included in the study after considering the inclusion and exclusion criteria. History was taken, clinical examination was done, relevant investigations were done for all eligible patients. DSP and DRED were calculated and compared with Serum Cholesterol, HDL-C, LDL-C Levels. Result: The levels of all the lipids were found to be significantly lower in the advanced tuberculosis group (stage III) as compared with stage II and I. in comparison with DSP , total cholesterol values were 158.6±14.1 (DSP I), 134.9±6.4 (DSP II), 114.5±14.9 (DSP III). HDL-C values were 41.6±5.3 (DSP I), 33.0±4.0 (DSP II), 28.0±5.0 (DSPIII). LDL-C values were 100.4±8.7 (DSP I), 87.3±7.5 (DSP II), 77.0±9.0 (DSP III). The difference between the group was statistically significant (p<0.001). In comparison with DRED the values of total cholesterol were 161.0±8.8 (DRED I), 136.8±8.9 (DRED II), 125.8±17.5 (DRED III). HDL-C values were 42.2±4.3 (DRED I), 33.8±4.2 (DRED II), 30.9±6.0 (DRED III). LDL-C values were 101.5±6.7 (DRED I), 89.3±7.3 (DRED II), 82.3±11.1 (DRED III). The difference between the group was statistically significant (p<0.001). Conclusion: Pre-treatment serum level of TC, HDL-C, LDL-C, have positive correlation with DRED and DSP in PTB patients.

Background: Pulmonary Hypertension is a chronic, progressive and a fatal disease. Gold standard test for diagnosis and clinical assessment of the patients with pulmonary hypertension is Right heart catheterisation. Recently the usefulness of cheaper and non-invasive tests in the follow-up of PH patients is being studied. The aim of the present study was to evaluate the relationship between serum uric acid levels and severity of pulmonary hypertension in PH patients. Objective: To study the correlation between serum uric acid levels and severity of pulmonary hypertension and to study serum uric acid levels in pulmonary hypertension as an independent predictor of its severity. Methods: Study was conducted in KIMS hubli on patients with clinical and echocardiographic features of Pulmonary Hypertension and total of 106 patients were included in the study based on inclusion and exclusion criteria. They were divided into 3 groups based on severity. Statistical analysis were conducted and results were drawn. Result: Serum uric acid levels were found to be higher in pulmonary hypertension patients with severe Right Ventricular dysfunction, compared to mild and moderate dysfunction. Serum uric acid levels were significantly correlated with pulmonary arterial systolic pressure. Serum uric acid levels also had significant correlation with World Health Organization functional class of the patients. Conclusion: From the study it can be concluded that serum Uric Acid levels are very well correlated with the severity of symptoms and right ventricular dysfunction in patients with pulmonary hypertension

Background: Diabetes mellitus is a chronic metabolic disorder which can lead to multiorgan complications, broadly divided into microvascular and macrovascular complications. The estimates in 2019 showed that 77 million individuals had diabetes in India, which is expected to rise to over 134 million by 2045. Lungs are a potential target organ for diabetic microvascular complications and so this study was undertaken to see the impairment of pulmonary functions using spirometry in patients with diabetes mellitus. Aims and Objectives: The study was undertaken to analyze the pulmonary function parameters in type II diabetic patients and compare them with age and gender matched healthy subjects. Correlation between forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV₁) in diabetic patients with duration of the disease was also analyzed. Materials and Methods: Pulmonary function tests (PFTs) were recorded in 100 type 2 diabetic patients and 100 normal healthy controls aged between 30 – 60 years by using Medspiror. The PFTs analysed statistically were – Forced Vital Capacity (FVC) and Forced Expiratory Volume in one second (FEV₁) to find the correlation between diabetics and non – diabetics. Glycemic status (FBS & PPBS) of subjects were determined by Glucose oxidase & peroxidase methods. PFTs of diabetic patients and controls were compared by applying Student’s unpaired t test. Associations between FVC and FEV₁and duration of illness in diabetic patients were analyzed by applying Pearson’s coefficient. Results: The mean FVC in the total diabetic group is 2.25±0.64 L which is lower than that of the total non-diabetic control group (2.64±0.81L) and the decreased value in the total diabetic control group is very highly significant (p<0.001). The mean FEV₁ in the total diabetic group is 1.72 ± 0.51 L and it is significantly lower than that of the total non-diabetic control group which is 2.14 ± 0.59 (p<0.001). There is negative correlation between the FVC as well as FEV₁ with the duration of disease among the total diabetic group and this is statistically not significant. Conclusion: Lung function tests are likely to be impaired in patients with diabetes mellitus.

Background: Aphakia, the condition of having no lens in the eye, poses significant visual challenges and requires effective surgical intervention. Objectives: To compare the long-term efficacy and the rate of complications of anterior and posterior Iris IOL implantation for the treatment of aphakia without sufficient capsule support. Methods: This was a hospital based retrospective study conducted in the outpatient department and/or inpatient wards of the Department of Ophthalmology, in a tertiary teaching healthcare facility in North India between January 2021 and June 2024. Results: The study involved 240 patients divided into two groups. The mean age for Group A was 68.1 years and 69.4 years for Group B (p>0.05). Gender distribution was similar, with Group A having 67 males (55.8%) and Group B having 69 males (57.5%). The involvement of right and left eyes was comparable between the groups, and the etiologies of aphakia showed no significant differences. Preoperative corrected distance visual acuity (CDVA) was 0.4 (logMAR) in both groups, improving significantly postoperatively to 0.1 by the third year. Preoperative intraocular pressure (IOP) was similar between the groups, with postoperative measurements showing an initial increase at one week, which normalized by the third year. Corneal endothelial cell density (CECD) decreased slightly over time in both groups, with no significant intergroup differences. Early complications (first week to third month) included wound leaks, hyphema, pupil ovalization, IOP elevation, pigment precipitates, and other complications, none of which differed significantly between the groups. Late complications (first to fifth year) such as elevated IOP, IOL dislocation, pigment precipitates, and retinal tear/detachment were also not significantly different between the groups. Conclusion: Anterior and posterior iris-claw IOL implantations showed comparable efficacy and safety profiles, with no significant differences in visual outcomes, IOP, CECD, or complication rates between the two techniques.

Background: Fibroadenomas are the most common benign breast diseases in country. Aim of study: To determine some demographic factors & the clinical summary of fibroadenoma cases in our tertiary care hospital. Material & Methods: A retrospective cytological study of fibroadenoma for period of 2years from medical records of January 2022 to December 2023. Results: All 142 cases were females. Most common age group was 21 to 30 years (50%) followed by 31 to 40 years (38%). Right breast was commonly involved and most fibroadenomas were confined to upper and outer quadrant. Conclusion: FNAC of breast is economic, safe, and highly accurate method for diagnosis of breast lump preoperatively to avoid undue surgery and inconvenience during biopsy. Health education, Breast self-examination and FNAC is recommended for early diagnosis and management.

Introduction: Peripheral lymhadenopathy is common presentation of inflammatory and neoplastic lesions. FNAC is one of the first-line investigations of management for the evaluation of lymphadenopathy. Enlargement of Lymph node is seen in variety of reactive inflammatory to neoplastic conditions related to regional or systemic diseases. It is very useful, easy, rapid, minimal invasive, cost effective and accurate approach in diagnosing various lymph node lesions and helpful in the workup of management of patients with nodal enlargement. Methods: A total of 175 patients were included in our study from Department of General Surgery, Shri Jagannath Medical College and Hospital, Puri, Odisha in the period from January 2023 to Dec 2023. Alcohol fixed and air dry smears were prepared and stain with H&E, PAP, and MGG. The special stain like PAS, ZN (20%) etc were done whenever required. Results: In present study total 175 cases of lymphadenopathy were studied. The presentation of various lymph node lesions on cytomorphological findings were Acute non-specific lymphadenitis cases were 5 (2.85%), Chronic non-specific lymphadenitis cases were 11 (6.28%), Granulomatous lymphadenopathy cases were 6 (3.42%), Tuberculous lymphadenitis cases were 60 (34.28%)’ Reactive lymphadenitis cases were 48 (27.42%), Metastasis to lymph node cases was 36 (20.57%), and Lymphoma cases were 9 (5.14%). Unsatisfactory smears (11) were excluded from the study. The detailed clinical material data, relevant investigations were taken for supporting the diagnosis. Conclusion: Cytomorphological features of lymph node FNAC, used in conjunction with clinical details, laboratory test investigations, radiology imaging study will be very helpful for diagnosing various disorders. It will be rapid, cost effective, safe, and reliable method for early diagnosis and treatment of the patients.

Background: The emergence of metallo -beta – lactamase in NF-GNB is becoming a therapeutic challenge worldwide. Metallo beta lactamase producing bacteria are popularly known as superbugs due to their increased development of drug resistance to carbapenems. MBL producing bacteria mainly cause healthcare associated infections. Detection of MBL is also a challenge for routine microbiology laboratories. The aim of this study was to compare the different phenotypic methods for detecting MBL producing NF-GNB. Methods: Total 307 clinical isolates of NF -GNB including Pseudomonas aeruginosa, Pseudomonas fluorescents, pseudomonas spp, Acinetobacter boumannii. These isolates were screened for imipenem resistance by Kirby Bauer disk diffusion methods and further tested for MBL detection by Disk-potentiation test, Double disk synergy test, Hodge test, Modified Hodge test, and E- Test. Result and Analysis: Out of the 307 NF-GNB, 161 were found to be Imipenem resistant by Kirby -Bauer disk diffusion method and further imipenem resistant isolates tested for the MBL production which were 45 isolates are MBL producer. When these 45 isolates tested for MBL production by Hodge test 22(13.66%), by Modified test 31(19.25%), 34(21.11%) by Disk potentiation test, 41 (25.46%) by DDST and by MBL E test 45(27.95%) of the isolates were MBL producers. Conclusion: The phenotypic methods are effective to detect MBL production in NF -GNB isolates. The sensitivity of MBL E -test (97.77%) was highest followed by DDST (91.11%) followed by DPT (75.55%) followed by MHT (68.88%) and lastly by Hodge test (48.88%). The E-test and DDST was very closely effective to detect MBL production.

Background: Lung cancer is a leading cause of cancer-related deaths worldwide. Early detection through screening is crucial, especially in high-risk populations, to reduce mortality rates. Objective: This study aimed to assess the impact of lung cancer screening on mortality rates among high-risk populations at Teerthanker Mahaveer Medical College and Research Centre. Methods: A prospective study was conducted from January 2017 to December 2019, involving 154 high-risk patients. All participants underwent low-dose computed tomography (LDCT) screening. Patients were monitored for lung cancer detection and outcomes, including stage at diagnosis, treatment modality, and survival rates over three years. Results: A total of 154 patients screened, 32 (20.8%) were diagnosed with lung cancer, with 25 cases (78.1%) detected at early stages (stage I or II). Among those diagnosed early, 20 patients (80%) underwent curative surgery or stereotactic body radiation therapy (SBRT). Five patients (15.6%) were diagnosed at advanced stages (stage III or IV). Mortality rates in early-stage patients were significantly lower, with a 3-year survival rate of 65%, compared to 20% in late-stage patients. The overall lung cancer-specific mortality rate was reduced by 18% compared to historical data in similar populations. Conclusions: LDCT screening in high-risk populations significantly improves early detection and reduces lung cancer mortality rates. Early-stage diagnosis offers a better prognosis and highlights the importance of screening programs.

Background: Smoking is a leading cause of chronic respiratory diseases, significantly impairing pulmonary function. Understanding the impact of smoking cessation on long-term pulmonary health is critical for effective treatment strategies. Objective: This study aims to evaluate the effects of smoking cessation programs on long-term pulmonary function in chronic smokers, focusing on improvements in lung health over time. Method: Conducted at Teerthanker Mahaveer Medical College and Research Centre, Moradabad, from June 2018 to December 2020, this study involved 234 chronic smokers. Participants were enrolled in a comprehensive smoking cessation program, including behavioural therapy and pharmacotherapy. Pulmonary function tests, including FEV1 and FVC, were administered at baseline, 6 months, and 12 months post-cessation. Statistical analyses were performed to assess changes in lung function and the impact of various cessation strategies. Results: After 12 months, 78% of participants showed significant improvements in FEV1, with an average increase of 12.5% from baseline (p < 0.01). FVC increased by 10.2% in 70% of participants (p < 0.05). The overall quit rate was 65%, with participants adhering to both behavioural and pharmacological interventions experiencing the highest improvements. Specifically, 85% of those in the combined intervention group showed notable gains in pulmonary function (p < 0.01). Participants with longer smoking durations had a 6.8% smaller average increase in FEV1 compared to those with shorter durations, though improvements remained significant (p < 0.05). Conclusions: Smoking cessation programs significantly enhance long-term pulmonary function in chronic smokers, with substantial improvements observed in FEV1 and FVC. Comprehensive cessation strategies yield the most substantial benefits.

Background: COVID-19 has posed unprecedented challenges to healthcare systems worldwide, with severe cases often exhibiting abnormalities in hematological and biochemical parameters. This study aimed to assess the hematological, inflammatory, and organ function markers in COVID-19 patients and correlate these findings with disease severity and outcomes. Methods: This descriptive study was conducted at Government Medical College and District Hospital, Palakkad, over a period of 6 months. A total of 170 COVID-19 patients, aged 15 to 87 years, were included. Blood investigations, including hemoglobin (Hb), total leukocyte count (TLC), neutrophil-to-lymphocyte ratio (NLR), platelet count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), D-dimer, urea, creatinine, and serum albumin, were measured. Data were analyzed using descriptive statistics to examine the relationships between these parameters, disease severity, and mortality. Results: The mean age of patients was 46.76 years, with 62% being male. Anemia was observed in 30% of patients, leukocytosis in 25%, neutrophilia in 40%, and thrombocytopenia in 15%. CRP was elevated in 70% of patients, with a mean value of 30 mg/L. D-dimer was elevated in 45% of patients, and hypoalbuminemia was seen in 55%. ICU admission was required in 35% of cases, with a mortality rate of 15%. Comorbidities such as diabetes, hypertension, and chronic kidney disease were significantly associated with severe outcomes. Conclusion: This study highlights the importance of blood investigations in predicting COVID-19 severity and outcomes. Elevated inflammatory markers, lymphopenia, and neutrophilia were associated with worse outcomes, especially in patients with comorbidities.

Background: Chronic obstructive pulmonary disease (COPD) is a prevalent, preventable, and treatable condition marked by persistent and progressive airflow limitation, stemming from an enhanced chronic inflammatory response of the airways and lungs to harmful particles and gases. Individuals with COPD are susceptible to psychiatric disorders that significantly impact their morbidity. This study aimed to assess the psychiatric comorbidity and quality of life among individuals with COPD, addressing the notable gap in Indian literature on this subject. Aim: To estimate the prevalence of psychiatric comorbidity and assess the quality of life in individuals with COPD. Material and Methods: 140 patients identified with COPD were categorized as per the severity according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria by the pulmonary medicine consultant. Subsequently, patients were referred from the Pulmonary Medicine Department to the Psychiatry OPD for further evaluation. A semi-structured interview was used to collect socio-demographic and clinical data. Upon consenting, patients underwent a comprehensive history taking and physical examination conducted by a resident psychiatrist. The Mini International Neuropsychiatric Interview (MINI) was employed to identify psychiatric comorbidities. The Quality of Life (QOL) of the patients was assessed using the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire. The data was statistically analyzed using SPSS software version 23.0. A p value of less than 0.05 was considered statistically significant. Results: Patients constituted 42.9% (n=60) in GOLD 1, 45% (n=63) in GOLD 2 and 12.7% (n=17) in GOLD 3 stage. Psychiatric comorbidity was noted in 65.7% of the sample, with in varying prevalence across GOLD stages: 26.7% in GOLD1, 93.7% in GOLD2, and 100% GOLD3. Among these comorbidities, the frequency for major depressive episode affecting 36.9% of patients was the highest followed by generalized anxiety disorder (GAD) 21.7%, panicdisorder 17.3%, and dysthymia 3.2%. Quality of life scores declined significantly with increasing COPD severity. The mean scores in physical health, psychological health, social relationships, and environment domains were 45.14±11.98, 44.86±10.86, 49.39±11.64, and 51.10±11.22, respectively. A significant correlation was found between psychiatric comorbidity and poorer quality of life (p<0.001). Conclusion: These results highlight the wide-ranging effects of COPD, which include respiratory health as well as physical, mental, and social well-being. It is essential to use a holistic approach to therapy, which includes patient education, psychological support, early identification, prevention, and thorough treatment techniques.

Background: Patients suffering from Obsessive Compulsive Disorder tend to stigmatise themselves which had been linked to poor adherence to treatment. Aim: To study internalized stigma and medication adherence in patients of obsessive-compulsive disorder (OCD). Material and Methods: A cross-sectional study was conducted on 115 patients diagnosed with OCD at the Department of Psychiatry of Rohilkhand Medical College and hospital, Bareilly, Uttar Pradesh. Samples were collected from patients willing to participate in the study. Patients diagnosed with OCD according to International Classification of Diseases 10th Revision (ICD-10), were included in the study. Upon enrolment, participants provided socio-demographic details after providing written and informed consent. They were then assessed for OCD severity using the Yale-Brown Obsessive Compulsive Scale following this, participants completed the Internalized Stigma of Mental Illness Scale (ISMI) and Medication Adherence Rating Scale (MARS). Results: The mean age of the patients were 30+10.38years. Mean duration of illness was found to be 7±3.13 year’s. On ISMI scale, the mean score was calculated as 77.84 ± 16.219.The mean Y-BOCS score was determined to be 22.71 ± 5.72. The mean score of medication adherence on MARS scale was 6.01 ± 2.087. There is significant relationship seen between all domains of self-stigma with the severity of OCD psychopathology (p-value<0.001) however, no significant relationship found with severity of OCD with medication adherence. A negative correlation found between all domains of self-stigma with medication adherence. Conclusion: Self stigma is found in OCD and can be significant barrier towards road to recovery by affecting medication adherence, more focus should be given on decreasing the internalized stigma and raising the medication compliance through family members, psychoeducation of patients and public.

Introduction: National medical council introduced new regulations for internship program in 2021, making it mandatory for interns to get exposed to blood bank/ transfusion medicine training during postings in clinical departments.  This is in line with other countries introducing competency-based medication education in blood bank/ transfusion medicine to train interns/ residents to have adequate knowledge and skill in ordering blood/ blood products, initiating transfusion and managing any adverse event/ complications during the procedure. Aim: To identify the knowledge gap in the interns regarding safe transfusion practices after introduction of competency based medical education in internship training. Material and Methods: The study was conducted in an urban medical college in South India. 150 students of the outgoing internship batch were given a Google form survey of 15 MCQs/ responses containing questions related to assessment of competency and knowledge. Results: 101 students were included in the study based on inclusion and exclusion criteria. 84.15% of interns agreed that the education/ training received was adequate. 80.2% of interns felt competent enough to identify and manage complications. 53.46% of interns self-assessed themselves to be competent to initiate and monitor the transfusion of blood and blood products. Regarding theoretical knowledge, the average correct answers related to various topics were blood products (52.47%), blood donation (62.37%), screening/ serology (45.54%), and practical transfusion aspect (27.32%).  Overall average answers related to knowledge was 58.09%. Conclusion: The discrepancy in self-assessed competency to actual knowledge was worrisome. In the actual world, this could be catastrophic issues regarding patient safety. Interns need to understand the importance of this life-saving procedure and the limited availability of blood/ blood products. Focussed education and training with direct observation by faculty during procedures with regular/ immediate feedback could help in following National Medical Council guidelines to make the outgoing interns, an Indian Medical Graduate, who can effectively act as a physician of first contact of the community while being globally relevant.

Background: Intraoperative hemodynamic changes, post-operative nausea and vomiting (PONV), and post-operative pain are common challenges in middle ear surgeries. This study compared the effects of oral clonidine and gabapentin as premedication on these parameters. Objectives: The study aimed to evaluate and compare the effects of a single dose of oral clonidine (150mcg) and oral gabapentin (300mg) on intraoperative hemodynamics, PONV incidence, post-operative pain relief, and adverse effects in patients undergoing middle ear surgeries. Methods: A prospective, randomized, double-blind study was conducted on 180 ASA I and II patients divided into three groups (n=60 each): clonidine, gabapentin, and placebo. The study drugs were administered one hour before surgery. Intraoperative hemodynamics, PONV incidence, post-operative pain scores (VAS), and adverse effects were recorded. Results: Clonidine and gabapentin significantly reduced heart rate and blood pressure compared to the placebo group (p<0.05). PONV incidence was significantly lower in the clonidine and gabapentin groups (p<0.05), with clonidine showing better results. Post-operative VAS scores were significantly lower in the clonidine and gabapentin groups (p<0.05), with clonidine providing better pain relief. No significant adverse effects were noted. Conclusions: Premedication with oral clonidine (150mcg) or gabapentin (300mg) effectively attenuates intraoperative hemodynamic changes, reduces PONV incidence, and provides better post-operative pain relief compared to placebo in patients undergoing middle ear surgeries. Clonidine showed superior results compared to gabapentin.

Background and Aim: Accurate diagnosis of acute appendicitis based on symptoms is essential in minimizing morbidity and mortality associated with perforation and other complications. This study aimed to explore the important factors that surgeons take into account when making decisions regarding suspected appendicitis cases. Material and Methods: The study included a total of one hundred patients, with a predominance of male participants. During the operation, the surgeon described the macroscopic appearance and assessed the severity of the appendicitis using the grading scale established by Ditillo and colleagues in 2006. We closely monitored important parameters, including the duration from hospital arrival to surgery (HI) and the total interval (TI), which measures the time from the onset of symptoms to the surgical procedure. Patients who presented with an intra-abdominal abscess or perforated appendicitis during surgery received extended courses of antibiotics after the procedure. Results: Significant correlation was observed between higher pathology grades and older age (p = 0.001). The mean temperature recorded was 37.26 degrees Celsius, falling within the range of 37.06 to 38.1 degrees Celsius. Notably, a significant correlation was observed between temperature and the advanced pathological degree. A positive correlation was observed between the prevalence of advanced pathology and prolonged PI, which varied from 25 to 40 hours. Conclusion: The decision-making process in cases of suspected appendicitis is largely based on a systematic approach. This approach involves the use of “hard” data, such as the results of laboratory tests and the findings of radiological investigations, which play a significant role.

Background: Neonatal sepsis is one of the most common cause of morbidity as well as neonatal mortality. Thrombocytopenia of varying severity is one of the common finding in neonatal sepsis which may be a predictor of adverse outcome. Material & Methods: The present study is a hospital based study. A total of 50 neonates admitted in the Hospital with clinical diagnosis of sepsis during the study period were included. Platelet count and indices along with blood culture was done for the patients. Results: Thrombocytopenia of varying severity was noted in 100% cases of neonatal sepsis, of them, 68% had mild thrombocytopenia, whereas 22% and 10% cases had moderate and severe thrombocytopenia. Conclusion: Although blood culture is a gold standard method for diagnosis of sepsis, utility of platelet count in neonatal sepsis should be observed carefully as it was sterile in certain neonates. Platelet indices and platelet count may aid in early diagnosis of sepsis and determining the prognosis and severity of sepsis. However, platelet count and platelet indices such as Mean Platelet Volume, Platelet Distribution Width and Plateletcrit (PCT) are not associated with neonatal risk factors and organism responsible for neonatal sepsis.

Background: The Circle of Willis (CoW) is a vital anastomotic arterial network at the base of the brain that serves as a collateral circulation system, ensuring adequate blood flow to the brain in case of occlusion. However, it exhibits significant anatomical variations across individuals, impacting cerebral blood flow and susceptibility to neurological disorders. This systematic review aims to comprehensively evaluate the prevalence, types, and clinical implications of anatomical variations in the Circle of Willis. Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, Science Direct and Cochrane databases. Studies published from 2014 to 2024 that focused on anatomical variations of the CoW were included. A total of 14 studies met the inclusion criteria after a rigorous screening process. Data extraction involved identifying variations, their prevalence, and potential associations with clinical outcomes such as ischemic stroke and aneurysm formation. Results: Sample sizes in the selected studies ranged from 73 to 1,864 participants. The average age of participants in different studies ranges from approximately 36 to 72 years, indicating varying demographics across studies. The prevalence of a complete Circle of Willis ranges broadly, with values from as low as 12% in Norway to as high as 74.23% in South Africa. Conclusion: This systematic review indicates a complex landscape of anatomical variations in the Circle of Willis, with significant differences in the prevalence of complete and incomplete configurations across various populations.

Background: Axillary plexus block is a common technique for upper limb surgeries, providing adequate analgesia and muscle relaxation. Ropivacaine and levobupivacaine are widely used local anaesthetics, with differences in onset time, duration of the block, and postoperative analgesia. Aim and Objective: To compare the efficacy of ropivacaine with 0.75% and levobupivacaine with 0.5% in ultrasound-guided axillary plexus block. This comparison is crucial for understanding the differences in onset time, duration of the block, and postoperative analgesia between these two widely used local anaesthetics. Materials and Methods: This prospective, randomized, double-blind clinical trial was conducted at SVBP Hospital, affiliated with LLRM Medical College, Meerut, involving 80 patients aged 18-65 with ASA physical status I and II. Patients were randomly assigned to Group A (Ropivacaine 0.75%, 25 ml) and Group B (Levobupivacaine 0.5%, 25 ml). The primary outcomes included the onset and duration of sensory and motor blocks. Secondary outcomes were postoperative analgesia, hemodynamic parameters, and complications. Data were analyzed using SPSS version 20.0, with a p-value of <0.05 considered statistically significant. Results: The mean onset time for sensory block was significantly faster in Group A (7.92 ± 1.01 min) compared to Group B (10.35 ± 1.17 min, p = 0.011). Similarly, motor block onset was faster in Group A (9.10 ± 0.87 min) than in Group B (11.27 ± 1.11 min, p = 0.005). The duration of the sensory block was shorter in Group A (9.21 ± 0.87 hrs) compared to Group B (12.25 ± 1.20 hrs, p = 0.032). Motor block duration was also shorter in Group A (8.54 ± 0.87 hrs) than in Group B (11.41 ± 1.17 hrs, p = 0.023). Postoperative analgesia lasted longer in Group B (12.93 ± 1.08 hrs) compared to Group A (9.93 ± 0.86 hrs, p = 0.038). Two patients in Group A experienced nausea and vomiting, while no complications were observed in Group B. Conclusion: Ropivacaine 0.75% provides a faster onset of sensory and motor blocks, while Levobupivacaine 0.5% offers a longer duration of both blocks and postoperative analgesia. Both agents were well-tolerated, with minimal complications. The choice between these two anaesthetics should be guided by the clinical scenario, depending on whether a faster onset or longer duration of block is required.

Background: The purpose of study is to study the profile, methods of assessment and trial of various low vision devices of low vision patients in our tertiary eye institute. Methods: A prospective, non- interventional observational study of 150 patients with low vision satisfying the WHO criteria for low vision was conducted over a period of 5 months in our tertiary eye institute after obtaining informed consent and considering the relevant inclusion and exclusion criteria. Patients were subjected to detailed history taking, a thorough ophthalmic examination and low vision assessment at low vision clinic. The suitable type, power and magnification of low vision devices was identified for each patient and trial given. The improvement in the optical performance with the low vision device was noted. The data thus obtained was recorded in excel sheet and analyzed using descriptive statistics. Results: Out of 150 patients, males were 56.7% and 43.3% were females with mean age of 29.4 years. Most common cause of low vision was pathological myopia. 49.3% patients had difficulties in near tasks followed by combined near and distance tasks, difficulties in distance activities, issues with mobility and night vision. Dome magnifier was most common and accepted device prescribed [37.3%] for near tasks and binocular telescope for distance tasks [76.3%]. Conclusion: A thorough clinical evaluation of low vision patients is very important to identify their functional vision and needs. Tailored prescriptions based on individual clinical profiles and preferences are crucial for optimal outcomes.

Background: Benign soft tissue swellings (BSTS) are a common clinical presentation in tertiary care settings. Accurate diagnosis and management rely heavily on a combination of clinical assessment and radiological imaging. This study aims to evaluate the clinicoradiological approach to diagnosing BSTS in a tertiary teaching hospital. Methods: A prospective study was conducted on patients presenting with soft tissue swellings at a tertiary teaching hospital over nine months. Clinical examination and history-taking were followed by radiological evaluations, including ultrasound (USG), magnetic resonance imaging (MRI) and computed tomography (CT) and histopathology when necessary. Data on patient demographics, clinical features, radiological and histopathological findings and final diagnoses were collected and analyzed. Results: A total of 100 patients were included in the study. USG was the first-line imaging modality used in all cases, providing definitive diagnoses for 98% of benign, and 2% malignant lesions. MRI was employed in 3% of cases with equivocal or suspicious lesions, offering superior detail for deep-seated and vascular swellings. HPE was utilized in 10% of cases to assess atypical cases to confirm the findings obtained from USG. The most common benign lesions identified were lipomas, epidermal inclusion cysts and ganglion cysts. Radiological findings were consistent with clinical diagnoses in 90% of the cases. Conclusion: The integration of clinical and radiological evaluations is crucial for the accurate diagnosis and management of benign soft tissue swellings. USG remains the primary imaging tool, with MRI and histopathology and detailed insights when necessary. Early and precise diagnosis through a clinicoradiological approach ensures optimal patient care and management outcomes.

Palmoplantar warts are quite resistant to treatment, so treating them is a challenge as ablative modalities lead to pain, temporary immobility, secondary infections, and scarring. The treatment of warts using immunotherapeutic methods and cytotoxic methods is being increasingly used to overcome drawbacks in the treatment of warts. Aim: To evaluate the efficacy and safety of intralesional mumps‑measles‑rubella (MMR) vaccine versus 5‑fluorouracil (5‑FU) in the treatment of palmoplantar warts. Materials and Methods: A total of 36 patients were divided into two groups of 18 each, MMR and 5‑FU groups, respectively. The patients in the MMR group were given 0.1ml ‑ 0.5ml of intralesional MMR vaccine in each lesion depending on the dimensions of the lesion and was repeated at 2 weekly intervals until complete clearance or a maximum of six doses. The patients in the 5‑FU group were given 0.1ml ‑ 0.5ml of intralesional injection of a solution containing 4 mL of 250 mg/mL of 5‑FU and 1 mL of a mixture of 20 mg/mL (2%) lidocaine and 0.0125 mg/mL of epinephrine, which was given at 2 weekly intervals until complete clearance or maximum six doses. Results: In our study, warts had resolved in all 18 (100%) patients belonging to the MMR group by the 12^th week, whereas 11 (61.11%) patients still had warts among the patients belonging to the 5‑FU group (i.e., warts had resolved only in 7 (38.89%) patients at the end of 12^th week), which was found to be statistically significant (P‑value < 0.05). Conclusion: MMR vaccine is a safe and effective treatment modality for palmoplantar warts compared to 5‑FU in the selected study population.

Objective: The current study was done to compare the embryo quality of an uninterrupted embryo culture compared to conventional embryo culture and assessment on clinical outcomes in couples undergoing Assisted Reproductive Technology (ART). The study will compare the fertilization and cleavage rates and implantation rate between conventional culture system and uninterrupted culture. Methods: A total of 1000 patients were included in this study who have enrolled for ART for various etiologies, among which 500 patients (Group A) belonged to conventional culture system and 500 (Group B) belonged to the uninterrupted culture system group who fulfilled the criteria were included in the study. Embryo morphology evaluation in group-A. After ICSI, injected oocytes are transferred to 4- well dish kept in groups with 1-well filled with 500μl of cleav media kept in standard bench top incubator (MINC). Results: The study found no significant age difference between Group A (mean age 32 years) and Group B (mean age 31 years). Male factor infertility was more common in Group A, while female factor infertility was more common in Group B, though neither difference was significant. Group B showed better outcomes in embryo quality, implantation, and ongoing pregnancy rates, despite Group A having better oocyte and sperm grading. Fertilization and cleavage rates were similar, but Group B had more top-quality embryos and a significantly higher number of embryos per patient, indicating the benefits of an uninterrupted culture system. Conclusion: This study shows that uninterrupted culture systems can enhance embryo quality, implantation efficiency and clinical pregnancy rate in ART. Consequently, these findings pose the uninterrupted culture system as a plausible candidate for enhancing ART success, which may translate into improved overall patient outcomes in fertility treatments.

Introduction: Pediatric femoral shaft fractures are more commonly seen in children of age 1-6 years. Different treatment approaches are used based on the age, fracture characteristics, and preferences of the surgeon. Previously Spica casting was the primarily used treatment option but other treatment options like intramedullary nailing and plate osteosynthesis have become common in recent years. Aim and Objective: To evaluate the demographics and treatment trends in pediatric femoral shaft fractures in children aged 1-6 years. Methods: Data was collected from 87 patients with femoral shaft fractures in children with age 1-6 years retrospectively. Demographic data like age, sex, ethnicity, and treatment modalities were analyzed. Treatment options like Spica casting, intramedullary nail, plate osteosynthesis, brace, splinting, external fixation and others were included. The statistical was performed using ANOVA, chi-square test, and t-test. Results: Spica casting was the most often used treatment (71.2%), and the majority of patients were males (77%), were between the ages of 1-3 years (72.4%). By age group, however, treatment trends differed considerably. While older children (ages 4-6) were more likely to receive intramedullary nails (37.5%) or plate osteosynthesis (25%), spica casting was more common in younger children (92% in ages 1-3). Spica casting has been less common over time, but intramedullary nails and plate osteosynthesis have become more common from 2016 to 2020. Conclusion: Patients aged 1-3 years are more likely to receive non-surgical methods like spica casting, whereas children aged 4-6 years are more likely to have surgical procedures like plate osteosynthesis and intramedullary nails.

Aim: To elucidate correlation between serum vitamin D levels and iron status in pregnant women and to generate hypothesis for supplementation of vitamin D in iron deficient patients. Methods: It is a prospective observational study of 100 pregnant women, recruited at the Dept of OBGY at Pacific Institute of Medical Sciences, Umarda, Udaipur. Descriptive analysis was performed for the demographic characteristics. Spearman’s correlation test was used to determine the strength of correlation between vitamin D and the complete blood count parameters. Each outcome variables whose levels were with a P (< 0.05) is significant. Results: For the 100 recruited patients, the mean haemoglobin level was 9.35±0.89 g/dL, iron at 73.0±15.3 microgram/dL, ferritin at 13.0±3.8 ng/mL. There was a moderate positive correlation observed between vitamin D and haemoglobin (rs = 0.49, n = 101 p< 0.001). A strong positive correlation was noted between vitamin D and iron (rs = 0.788, p< 0.000), transferrin (rs = 0.740, p< 0.001), ferritin (r = 0.783, p< 0.001), hematocrit (r = 0.729, p< 0.001). A strong negative population of pregnant women, it is suggestive that the low vitamin D levels are correlated with lower hemoglobin and ferritin levels. Further investigations needs to be conducted to elucidate whether there is a direct causal effect of vitamin D deficiency and iron deficiency anaemia.

Background: Orthopaedic hip fractures are the predominant condition among aged people. An optimal preoperative pain management that reduces the use of opioids and mitigates their negative consequences is crucial in this specific group. Aim and Objectives: The purpose of this study is to assess the effectiveness of Ultrasound guided Fascia Iliaca Compartment block (FICB) compared to Pericapsular nerve group (PENG) block in enabling the positioning for spinal anaesthesia and post-operative analgesia during surgeries for hip fracture. Material and Methods: Following the approval of institutional ethical committee, a prospective interventional study was conducted on 46 patients aged 18-80 years, of either gender, who were classified as ASA class I, II, and III. These patients were randomly selected to receive either an Ultrasound guided PENG block (Group A, n=23) or a FICB block (Group B, n=23) using 40ml of 0.2% Ropivacaine. Prior to and after 30 minutes of the block, as well as while placing the patient for spinal anaesthesia, the blinded observer evaluated Visual Analogue Scale (VAS) scores at rest, with passive leg raise to 15°. The duration of postoperative pain relief and the level of patient acceptability were also documented. An analysis of the data was conducted using SPSS version 20. Statistical analysis was conducted on continuous and categorical data using the suitable statistical approach. A significance level of P ≥ 0.05 was used to determine statistical significance. Result: Subjected to a passive leg raise to 15° when at rest, the VAS scores in the PENG and FICB groups showed a substantial reduction (P<0.001). Following 30 minutes of administering the PENG block, the VAS scores at rest and passive leg raise were 0.4±0.5 and 1.01±0.7, respectively. In contrast, the VAS scores at rest and passive leg raise with the fascia iliaca block were 1.1±0.7 and 1.6±0.8, respectively, with statistically significant p-values of 0.001 and 0.022, respectively. The Visual Analogue Scale (VAS) score 30 minutes after the block during placement was 2.1±0.6 in the FICB group and 1.6±0.7 in the PENG group (P=0.008). A substantial difference was seen in the duration of analgesia between the PENG group (487.73±38.61 minutes) and the FICB group (431.74±25.16 minutes) (P<0.001). Requirement for postoperative opioid rescue analgesia was much lower (P=0.011) in the PENG group compared to the FICB group. Superior patient acceptability was noted in the PENG group (P=0.028). Conclusion: The effectiveness of PENG block in delivering analgesia before positioning the patients awaiting hip surgery under spinal anaesthesia surpasses that of fascia iliaca block. However, both the blocks successfully maintained haemodynamic stability without any significant adverse consequences.

Background: In placenta previa, the placenta attaches lower in the uterus. This results in some portion of the placental tissue covering the lower uterine segment. It can result in bleeding during the pregnancy or during or after delivery. Objective: to determine the frequency of placenta previa and to determine the risk factors and feto-maternal outcomes in placenta previa in previously unscarred and scarred uterus groups. Methods: This is an observational study which involved 130 patients diagnosed with placenta previa after satisfying the inclusion criteria. The demographic data, maternal morbidity indicators, maternal mortality, fetal parameters morbidity parameters like prematurity, low birth weight and need for ICU admission as well as mortality parameters such as still births and neonatal mortality rates. Results: Mean age of the study population was 27.12±4.426years. Incidence of placenta previa among scarred uterus was 1.32% and in unscarred uterus was 0.67%. High parity, high abortion rate, multigravida status, less gestational age at delivery were commonly seen in scarred uterus compared to unscarred uterus. Causes of scarred uterus in this study was previous LSCS (54.61%), previous D&C (10.8%) and previous myomectomy (10%). Complete placenta previa, anterior placental position and adherent placenta were significantly associated with scarred uterus compared to unscarred uterus. Antepartum hemorrhage and postpartum hemorrhage was higher in scarred uterus compared to unscarred uterus. Rate of caesarean hysterectomy was higher in scarred uterus, along with statistical association to previous LSCS. Maternal ICU admission rate was higher in scarred group, also showed its statistical association with previous LSCS. Neonatal outcomes in terms of pre-term birth, still birth, NICU admission and neonatal death though higher in scarred group, did not differ statistically among both the groups. Conclusions: This study highlighted the therapeutic implication of placenta previa and its management along with risk factors in scarred uterus compared to unscarred uterus.

Background: Air pollution, particularly from vehicular emissions, is a significant public health concern globally, with respiratory disorders being one of its major health impacts. Traffic police, due to their long-term exposure to traffic-related air pollutants, are at an increased risk of respiratory issues. In India, the increasing number of vehicles and inadequate pollution control measures have exacerbated air quality problems, particularly in urban areas (NAAQMS, 1989-1993; GPCB, 2007-2011). Prior studies have demonstrated that vehicular pollutants like particulate matter (PM), nitrogen oxides (NOx), and sulfur dioxide (SO2) contribute to impaired respiratory function and increased respiratory morbidity. Objectives: This study aims to assess the impact of long-term exposure to vehicular air pollution on the respiratory health of traffic police officers in Ahmedabad, with a focus on key respiratory function indicators such as Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1), and Peak Expiratory Flow Rate (PEFR). Methods: A cross-sectional study was conducted involving 100 male traffic police officers aged 20-60 years. Participants were divided into two groups: the exposed group, comprising 50 officers with more than five years of exposure to vehicular emissions, and the control group, comprising 50 officers with minimal exposure, working in administrative roles. Pulmonary function tests (PFTs) were performed using a spirometer to assess FVC, FEV1, and PEFR. Participants were further divided into smokers and non-smokers to examine the combined effects of smoking and pollution exposure on respiratory health. Results: The study found that traffic police exposed to vehicular pollution had significantly lower lung function compared to the control group. The FEV1 levels in the exposed smokers were significantly reduced (1.95 ± 0.27 L) compared to the control non-smokers (2.75 ± 0.35 L), indicating an obstructive pattern of respiratory impairment. The FEV1/FVC ratio was also lower in the exposed group, particularly among smokers, suggesting compromised lung capacity due to prolonged exposure to pollutants. PEFR values also showed a marked reduction in the exposed group. Conclusion: Prolonged exposure to vehicular emissions has a significant negative impact on the respiratory health of traffic police, especially in smokers. The study highlights the need for protective interventions, such as regular pulmonary function monitoring and the provision of protective masks, to reduce the health risks associated with air pollution exposure. Urban planning and pollution control measures must be strengthened to mitigate these health hazards in high-exposure occupations (WHO, 2000).

Background: Laparoscopic surgeries often involve insufflation of the peritoneum to create a pneumoperitoneum, which can cause significant physiological changes. These include alterations in end-tidal carbon dioxide (ETCO₂) and hemodynamic parameters such as blood pressure and heart rate. This study compares these effects before and after insufflation, enhancing understanding of how pneumoperitoneum impacts patient safety during laparoscopic procedures. Methods: Patients received a standard anesthetic technique with continuous monitoring (ECG, NIBP, Pulse Oximeter) recorded every 5 minutes. Premedication included ondansetron, glycopyrrolate, and midazolam. General anesthesia was administered, and baseline, intraoperative pulse rate, ECG, NIBP, SpO₂, and ETCO₂ were monitored. ETCO₂ values were recorded at baseline and intervals after pneumoperitoneum. Post-surgery, patients were reversed and extubated, with any complications related to pneumoperitoneum noted. Results:  Pneumoperitoneum leads to a significant increase in ETCO₂ levels. The rise in ETCO₂ is more pronounced at higher intra-abdominal pressures and with longer durations of insufflation. ETCO₂ levels gradually returned to baseline after the pneumoperitoneum was released. Pneumoperitoneum was associated with a significant increase in systolic and diastolic blood pressure. Heart rate also increases following the introduction of pneumoperitoneum. Mean arterial pressure (MAP) rises due to the combined effects of increased systolic and diastolic blood pressure. Conclusions: Pneumoperitoneum has a significant impact on both respiratory and cardiovascular parameters during laparoscopic surgery. The introduction of pneumoperitoneum can lead to hypercapnia (increased ETCO₂) and a hypertensive response. The effects of pneumoperitoneum on ETCO₂ and hemodynamic parameters are generally transient, with a return to baseline levels after the pneumoperitoneum is released.

Background: Oxytocin is the main uterotonic drug for avoiding post-partum hemorrhage (PPH), which is a major cause of morbidity for mothers. Clinical studies have shown that carbetocin can reduce PPH risk without increasing the risk of major side effects. The purpose of current investigation was to evaluate carbetocin’s potential for PPH prophylaxis. Methods: In this observational analysis, 100 women who had blood loss and major PPH incidents during vaginal (n=50) and cesarean (n=50) deliveries were included. Of these, half had carbetocin at tertiary care facility over the course of study period, which lasted for 2 years from January 2022to December 2023. With SPSS version 25.0, the blood loss was approximated, and the findings were examined. Results: Between the groups having vaginal and cesarean deliveries, the mean age (~31 years), mean body mass index (~27kg/m2), and mean parity (~1.4) were comparable between those who received prophylactic carbetocin and those who did not. The intrapartum blood loss during vaginal birth was 227.28±157.32ml and 249.17±179.35ml, respectively; p=0.0873 for women treated with and without carbetocin. During CS, women who received carbetocin prophylaxis had significantly less mean± SD blood loss [651.47±321.58ml] than those who did not [831.38±361.96ml; p=0.0001]. Overall, total blood loss was considerably lower in women getting carbetocin prophylaxis than in those not (p<0.001). Conclusion: The preventive use of carbetocin significantly decreased blood loss during caesarean sections in cases of PPH when compared to vaginal deliveries.

Background: Pre-eclampsia (PE), characterized by hypertension and proteinuria, poses significant risks to maternal health, including eclampsia and mortality. Vitamin D, essential for immune modulation and vascular health, showed potential in reducing the risk of pre-eclampsia and showed to potentially prevent hypertensive complications during pregnancy. This study aims to evaluate the role of vitamin D in preventing pre-eclampsia and eclampsia, along with finding out its correlates and associated maternal and perinatal outcomes. Methodology: This study was conducted in the department of obstetrics and gynaecology at Calcutta National Medical College and Hospital, Kolkata, over one and a half years among 111 ante-partum women admitted through the obstetric emergency or referred to the hospital, fulfilling inclusion & exclusion criteria. Ethical clearance and informed consent were sought. Data were collected by using a predesigned pretested semi-structured questionnaire following clinical examination and biochemical tests. Data were analyzed using SPSS, summarizing categorical variables as counts and percentages. Inferential statistics measured by Chi-square test. P-value <0.05 was considered statistically significant. Result: Pre-eclampsia and eclampsia were observed in 15.3% and 6.3% of women respectively. About 24.5% of mothers who had developed pre-eclampsia had suboptimal levels of Vitamin D. Most pre-eclamptic mothers delivered by caesarean section (47.1%), with one-fourth of their babies being low-birth weight and 41.7% required SNCU admission. Conclusion: The potential link between suboptimal vitamin D levels and pre-eclampsia emphasized the importance of antenatal supplementation and further research to establish standard guidelines to prevent pre-eclampsia.

Introduction: This study assesses the efficacy and safety of Total Turbinectomy, Partial Turbinectomy, and Microdebrider Turbinoplasty in treating inferior turbinate hypertrophy. Methodology: Conducted at the Gayatri Vidya Parishad Institute of Health Care & Medical Technology, Visakhapatnam, the retrospective analysis involved 120 patients, divided into three groups based on the surgical technique employed. Results: Total Turbinectomy provided the highest nasal airway improvement (85%) but also the highest complication rates. Conversely, Microdebrider Turbinoplasty, with the lowest improvement rate (75%), had the fewest complications, suggesting a safer profile. Conclusion: While Total Turbinectomy is more effective at improving airway functionality, its higher risk of complications makes Microdebrider Turbinoplasty a safer alternative for those with less severe symptoms or higher-risk aversions. Recommendation:  Surgical choices should align with individual patient needs and risk profiles to optimize safety and effectiveness.

Background: Hemoglobin measurement is a critical diagnostic tool in clinical practice, traditionally performed using laboratory methods like the cyanmethemoglobin technique. However, these methods require significant time and resources, which may only be feasible in some healthcare settings. Digital haemoglobin meters offer a rapid, point-of-care alternative, but their accuracy compared to standard is always a point of discussion. Aim and Objective: To evaluate the diagnostic accuracy of HB SPOT (Proactive Health Inc.) a digital haemoglobin measurement meter, focusing on its sensitivity, specificity, and bias compared to the cyanmethemoglobin method. Materials and Methods: A cross-sectional study was conducted on 150 participants at Department of Pathology, GMERS Medical College, Porbandar, Gujarat, India a tertiary care Hospital of Western India between October 2023 to April 2024. Haemoglobin levels were measured using both a digital haemoglobin meter and the cyanmethemoglobin method. Sensitivity, specificity, and bias were calculated and assessed using the Bland-Altman method. The HB SPOT performance was evaluated for its sample volume requirement (<10 µL), rapid measurement time (within 10 seconds), reagent-free technology (microcuvette), auto-calibration, and wide measuring range (0-25 gm/dL). Results: The HB SPOT demonstrated a sensitivity of 86.7% and a specificity of 88.4%. The mean bias was 0.03 gm/dL, with limits of agreement from -1.00 gm/dL to 1.06 gm/dL. These results align closely with the reference method, indicating the HB SPOT reliability in clinical settings. Conclusion: The HB SPOT demonstrates high diagnostic accuracy, with sensitivity and specificity exceeding 80% and minimal bias compared to the reference standard. Its features, including minimal sample volume, rapid reading time, reagent-free operation, auto-calibration, and broad measuring range, make it a valuable tool for point-of-care haemoglobin assessment, especially in resource-limited or urgent care settings. The findings of this study underscore the potential of digital haemoglobin meters to revolutionize clinical practice, particularly in settings where rapid diagnosis is crucial.

Objectives: The present study was to evaluate the prevalence and assess the severity of diabetic retinopathy associated with HbA1C level in a tertiary care center, Muzaffarpur, Bihar, India. Methods: Ophthalmic evaluation comprises of measurement of best corrected visual acuity was recorded using Snellen chart for distant vision and near vision using Jaeger chat. A Goldman applanation tonometer was used to measure the intraocular pressure. Slit lamp bio microscopy was used to evaluate anterior segment. HbA1C level estimation was performed by withdrawing 3 ml of blood sample of patient’s peripheral vein collected and sent to the pathology laboratory. According to HbA1C level patient were grouped into good control, fair control and poor glycaemic control. Results: A total of 50 type 2 diabetes mellitus patients were enrolled. Most of the cases 16(32%) were in age group of 46-55 years. Mean age of the cases was 52.45 ±12.65 years. Most of the cases 34(68%) were males. Mean duration of cases with type 2 diabetes mellitus was 13.12± 1.76 years. HbA1c level of 13(26%) patients had less than 7, 10(20%) had 7-8. And HbA1c level of most of the cases had greater than 8. out of 22 NPDR cases, 7 cases were with CSME and 15 were with without CSME. HbA1c concentration was significantly higher in the NPDR and PDR groups compared to the No DR group patient. Conclusions: Older age male patients with type 2 diabetes mellitus patients are preponderance to retinopathy. Increase level of HbA1C corresponds to a higher prevalence of diabetic retinopathy. And statistically significant association is seen between increase level of HbA1C and severity of retinopathy in type 2 diabetes mellitus patients.

Background:  Pleural effusion is an excessive accumulation of fluid in the pleural space  . Pleural effusion is not a disease entity per se rather it’s a manifestation of a complication of the pulmonary or non-pulmonary diseases. The causes of Pleural Effusion are too many. Pleural fluid analysis by cytology and cell block remain the mainstays for diagnosing etiology of pleural effusion. Objectives: This study aimed to perform cytological analysis of pleural fluid to find out its etiology and to find prevalence of these etiologies with respect to age and sex. Materials and Methods: This cross-sectional study was carried out at tertiary care hospital of ASMC, Firozabad, Uttar Pradesh on 100 patients of Pleural Effusion coming to the Department of Pathology for cytological analysis of the Pleural fluid over a period of 1 year from January 2023 to December 2023. Results: Out of total 100 cases of pleural effusion studied ,our study found Tuberculosis to be the most common cause of pleural effusion in Firozabad region(82%) followed by malignancies  in which most common was Lung Adenocarcinoma (8%) followed by Carcinoma breast(2%) and Ovarian Adenocarcinoma. Conclusion: Most common cause of pleural effusion in Firozabad region is Tuberculosis followed by malignant pleural effusion.

Introduction: VACTERL association is a rare and complex congenital disorder characterized by the presence of anomalies in at least three organ systems. Case Report: A male neonate, delivered at 35 weeks of gestation via elective lower segment Cesarean section (LSCS) due to severe maternal polyhydramnios, presented with multiple congenital anomalies shortly after birth. The constellation of these anomalies led to the diagnosis of VACTERL association. A multidisciplinary neonatal care team, post-operative course was complicated by a transient period of neonatal sepsis, successfully treated with broad-spectrum antibiotics. Finally the patient was discharged.

Introduction: The metabolic syndrome is a concept rather than a disease in itself. It is a prothromboitic and pro inflammatory state that is associated with increased risk of cardiovascular disease and type 2 diabetes mellitus. Serum Ferrtin is a well-established biomarker used to assess degree of inflammation in various clinical conditions. Hence, aim of our study was to explore the association of serum ferritin levels with the components of metabolic syndrome (abdominal obesity, dyslipidemia, hypertension, and hyperglycaemia) and insulin resistance and comparison with healthy controls. Material and Method: Present study was conducted at SMS Medical College, Jaipur from April 2021 to August 2022.30 cases of metabolic syndrome (Group 1) and 30 healthy controls (Group 2) were enrolled. Detailed history, clinical examination and anthropometric measurements were taken of all the subjects of both groups. Serum ferritin was measured and its association with various components of metabolic syndrome and insulin resistance was investigated. Study parameters were analyzed by statistical tests including student’s t-test, X² analysis, multiple regression analysis. Results: Serum ferritin level was considerably (p<0.001) higher in cases (mean 552.9±464.44 mcg/L)) compared to controls (mean 212.77±74.07 mcg/L) and it has significant correlation with waist circumference (p<0.01), neck circumference (p<0.02), fasting blood glucose (p<0.002), fasting insulin level (p<0.05) , level of insulin resistance (HOMA IR) (p<0.01), S. Triglycerides (p<0.05) and S. VLDL (p<0.04) in the case group when analyzed by linear regression analysis. Conclusion: Our findings based on community-based data showed that higher serum ferritin levels though in the normal range are associated with obesity, components of the metabolic syndrome and insulin resistance. These observations not only suggest a good correlation with serum ferritin, but also emphasize that serum ferritin can also be used as a marker for insulin resistance and metabolic syndrome.

Background: Palliative care patients are vulnerable to a range of psychological and mental health problems, including depression and anxiety. The patient usually undergoes various stages of treatment before reaching the Palliative care Centre. A variety of factors related to the cancer and its treatment are likely to impact on the development of depression and anxiety, including the type of cancer, stage and prognosis. The present cross-sectional study was planned to estimate the prevalence of depression and anxiety and to assess the associated factors in patients attending palliative care center, SMS Jaipur. Aim: To screen patients with various malignancies for the presence of depressive and anxiety disorders using standardized rating scales. Materials & Methods: Five hundred and twenty-seven (n = 527) patients admitted in the Palliative Care Centre, SMS Hospital, Jaipur were included in the study who completed the Patient Health Questionnaire‑9 and Generalized Anxiety Disorder‑7 (GAD‑7) Questionnaire. Results: Out of 527 patients, majority of patients (73.06%; n=385) were suffering from one or more psychiatric co-morbidity in the form of either isolated anxiety or depression or both. 31.5% had both anxiety and depression, 26.57% had only depression and 14.99% had only anxiety. In 46.49% cases anxiety was present (GAD score ≥8). Prevalence of anxiety was more in younger population i.e. ≤40 years (48.25%, n=55), rural population (52.74%, n=154), patients with advanced or metastatic stage of malignancy (54.19%; n=168), patients receiving multiple modalities (53.81%) of treatment were more likely to suffer from anxiety followed by those receiving radiotherapy (45.71%) and chemotherapy (41.58%). In 58.06% cases depression was present with PHQ score ≥10, the mean age of cases having depression was 50.60 years. Prevalence of depression was more in rural population (65.75%, n=192), patients from lower socioeconomic status (60.56%, n=261), patients with advanced or metastatic stage of malignancy (65.16%; n=202), patients receiving multiple modalities (86.02%, n=203) of treatment were more likely to suffer from depression followed by those receiving radiotherapy (48.57%, n=17) and chemotherapy (41.58%, n=42). Conclusion: Compared to the general population, the prevalence of anxiety and depression is often higher among people with cancer, but estimates vary due to a number of factors, such as demographic factors (age, sex, residence, socioeconomic status), the type of cancer, stage of cancer and received treatment.

The destructive potential of tyre blast accident has received little attention in the medical literature. Fatal and severely deforming injuries have been reported. We report a case of a 50 year old mechanic who sustained chest wall injury due to blast of truck tyre while insufflation. He was having multiple fracture of ribs on both the sides. He was known case of DM, Hypertension, COPD, Peptic ulcer disease and CLD. The patient was managed initially with positive pressure ventilation and bilateral intercostal tube drainage and showed improvement. Later on, he developed sepsis and ultimately succumbed to his illness. This case report highlights the destructive potential of high energy blast in civilian society.

Introduction: There is significant changes in thyroid gland in pregnancy. Numerous outcomes for the mother and the foetus are impacted by maternal thyroid problems. Preterm labour, abruptio placenta, abortion, and pre-eclampsia are the main obstetric complications, whereas prematurity, low birth weight, stillbirth, and perinatal mortality are the main foetal issues. Untreated mothers have a significant impact on their offspring’s future intellectual development. Objective: To study the maternal and fetal outcomes of antenatal women with deranged thyroid functions. Methodology: All antenatal pregnant females coming in MYH antenatal OPD in their first trimester reporting to the Department of Obstetrics and Gynecology, MGM Medical College and MY hospital, Indore were included in this study. The patients having deranged thyroid profile (S.TSH level- >2.5ug/dl) were followed up for all the three trimester till delivery. Result: A total of 300 cases were studied. In present study majority of the women were euthyroid (60%), followed by 30% of women with sub-clinical hypothyroidism and 6.3% with hypothyroidism. The most common maternal complication were preterm labor and PIH. Majority of the newborn with low birth weight, NICU admission, Meconium stained liquor and respiratory distress belong to sub-clinical hypothyroid mothers. Conclusion: Maternal thyroid dysfunction is associated with significant adverse effects on maternal and fetal outcome emphasizing the importance of routine antenatal thyroid screening in first trimester.

Background: Ankle trauma is commonly encountered and is most often a sprain injury affecting the ligaments. Accurate diagnosis and appropriate treatment rest on knowledge of complex ligamentous anatomy of ankle and the entire spectrum of pathologies. Magnetic resonance imaging (MRI) is the imaging modality of choice for diagnosing ligament pathologies because of its multiplanar capability and high soft tissue contrast. In this article emphasis is given to the intricate and unique anatomy and orientation of ankle ligaments. Tears of ankle ligaments have been elaborated. Materials and Methods: In a retrospective observational study, patient’s data was collected from tertiary care unit from period of January 2024 to June 2024. Ankle MRI was performed using standard protocol on 100 cases. Results: In this study, 50 percent cases had injury to lateral ligament complex of which 35 percent were anterior talofibular ligament, 5 percent were posterior talofibular ligament and 10 percent were calcaneofibular ligament. It concluded that lateral ligament complex tears are more common than medial ligament complex. Conclusion: MRI visualizes ligamentous anatomy and pathology at the ankle and is being used with increasing frequency in patients following ankle sprains.MR images of ankle ligaments from a sample of patients with ankle pain or injury are presented and reviewed.

Introduction: Osteogenesis imperfecta (OI) and hypophosphatasia (HPP) are examples of inherited bone disorders resulting in bones that fracture — crumble — and ruin. OI results from mutations in the COL1A1 or COL1A2 genes encoding type I collagen, whereas HPP is caused by gene defects affecting bone mineralization, specifically the ALPL gene. In cases of dual mutations, diagnosis and treatment varies between patients. Management is informed by genetic testing, bisphosphonates (for OI), and enzyme replacement therapy (for HPP). Aims and Objective: To analyze various parameters related to multiple fractures, low bone mass, and severe osteomalacia in paediatric patients diagnosed with osteogenesis imperfecta and hypophosphatasia. Method: This prospective observational study evaluated low bone mass, fracture prevalence, and osteomalacia severity in 64 children with Osteogenesis Imperfecta (OI) and Hypophosphatasia (HPP) compared to healthy controls. Bone biopsies were collected and analyzed using histomorphometry and light microscopy imaging after tetracycline labelling. Bone samples were prepared, stained, and evaluated. Result: The study revealed significantly lower height (p = 0.01) and BMD Z-scores (lumbar spine: p < 0.001) in patients with OI and HPP. Elevated serum ALP (p < 0.001), pyridoxal-5′-phosphate (p < 0.001), and changes in pyridoxal (p < 0.001) levels were observed post-treatment. Other findings included significant differences in serum phosphate (p = 0.05), 25-hydroxyvitamin D (p = 0.02), magnesium (p = 0.04), and urinary biomarkers between groups, indicating altered bone metabolism in patients. Conclusion: The study has concluded that there is a significant difference in bone density, metabolic parameters, and bone remodelling rates between patients and controls, indicating distinct bone metabolism profiles. These differences suggest a need for targeted therapeutic strategies for patients with OI and HPP.

Introduction: Carcinoma Cervix, a prevalent malignancy in young women, necessitates early detection and accurate staging for effective management. This study explores the correlation between Magnetic Resonance Imaging (MRI) staging and International Federation of Gynecology and Obstetrics (FIGO) staging for Carcinoma of Cervix. Aims/Objectives: To study the correlation between MRI staging and FIGO staging in Carcinoma of Cervix. To assess the utility of MRI in evaluation of primary invasive carcinoma with respect to location, size, local extent and staging. Study Design: Cross-sectional observational. Results: 60 females were participants in the study with 45% falling in the 41-50 years range. Parity and HPV infection were identified as prominent risk factors. The most prevalent stage of the disease in the study was stage IIA. Staging comparison between clinical examination and MRI revealed varying degrees of correlation across FIGO stages. Interrelated agreement using Kappa statistics was calculated to check for agreement between clinical staging and MRI staging. Kappa value was found to be 0.656 indicating moderate agreement between two investigations. Conclusion: MRI is proven to be more sensitive and specific in detecting early disease as well as early tumour invasion to adjacent structures. MR findings help in early detection and accurate staging of the disease which ultimately help the clinician to tailor the treatment suited for individual patient.

Introduction: The four main types of NCDs are cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes which account for over 80% of all NCD deaths before age 70. Even though it is understood that NCD risk factors are commonly shared, a single risk factor could contribute to several NCDs, and conversely, a single NCD could be the outcome of multiple risk factors. Therefore, understanding the simultaneous presence of risk factors can guide coordinated health system strategies. Aim: This study was conducted with the objective of estimating the prevalence and clustering of risk factors of common NCDs among industrial workers of Upper Assam. Materials and Methods: A community based cross-sectional study was done among permanent employees of a public sector undertaking with an estimated sample size of 330. The study tool was adapted from WHO STEPS wise approach which was used to estimate the prevalence of risk factors. Results: 244 (76.7%) of the study participants were in the 45–59-year age group and 287 (90.3%) were males. Current tobacco use was found in 62.3% of study participants. Harmful use of alcohol was observed in 5.7% of study participants. 98.4% study participants consumed <5 servings of fruits and vegetables. Low physical activity was found in 24.2% of study participants. Overweight and obesity was observed in 51.6% and 12.3% of study participants respectively. Hypertension and raised fasting blood glucose was found in 48.4% and 31.1% study participants respectively. Raised total cholesterol and raised triglycerides was found in 18.6% and 56.9% of study participants respectively. Overall clustering was found in 272 (85.5%) of study participants. Conclusion: The prevalence of most of the behavioural and biochemical risk factors and clustering in the study population was high as compared to studies on different population subgroups across the country. The baseline information on the prevalence of risk factors provided by this study can help this population and their health policymakers in devising proper strategies to reduce the impact of NCDs on the population.

Background: Shoulder discomfort is a prevalent global health issue, affecting 16-26% of the population. Rotator cuff disease, a common cause of shoulder pain, has seen evolving treatment strategies, including both surgical and non-surgical options. Diagnostic imaging is crucial in managing rotator cuff disorders, with ultrasound (USG) and magnetic resonance imaging (MRI) being primary modalities. While MRI is the gold standard, USG offers a cost-effective and accessible alternative. Introduction: This study aims to evaluate the efficacy of USG and MRI in diagnosing rotator cuff tendon abnormalities. USG is favoured for its affordability and convenience, though its diagnostic sensitivity and specificity vary. MRI provides detailed insights but is more costly and less accessible. This study compares these imaging modalities in terms of their diagnostic accuracy for rotator cuff tears. Methodology: A cross-sectional study was conducted over two years at ERA’s Medical College, Lucknow. Forty patients aged 18 and above, suspected of rotator cuff pathology, were included. Patients underwent both USG and MRI evaluations. Exclusion criteria included recent shoulder surgery, ongoing treatment for rotator cuff lesions, and MRI contraindications. Statistical analysis was performed using SPSS software to compare the diagnostic efficacy of USG and MRI. Results: MRI identified partial thickness supraspinatus tears in 57.50% and full thickness in 30.00% of patients. USG detected partial thickness supraspinatus tears in 54.84% and full thickness in 35.48%. For partial thickness supraspinatus tears, USG showed a sensitivity of 65.22%, specificity of 88.24%, and an accuracy of 75.00%. For full thickness supraspinatus tears, USG had a sensitivity of 83.33%, specificity of 96.43%, and an accuracy of 92.50%. The agreement between USG and MRI ranged from moderate to substantial, with Kappa values of 0.511 for partial thickness and 0.817 for full thickness supraspinatus tears. Conclusion: MRI remains the gold standard for diagnosing rotator cuff tears. However, USG demonstrates substantial promise as an effective and cost-effective alternative, particularly for assessing supraspinatus tears. The study highlights that rotator cuff injuries predominantly affect younger males and right-sided shoulders. Incorporating USG into routine orthopedic practice, especially in settings with limited MRI access, could improve early diagnosis and patient outcomes.

Background: Male genital lichen sclerosus (MGLSc) is a chronic, acquired inflammatory skin condition that is strongly associated with significant sexual dysfunction as well as urological morbidity and mortality. The incidence of MGLSc is traditionally considered biphasic, with peaks in infancy and adulthood. However, a recent review suggests the presence of two peaks in adulthood, making the incidence pattern triphasic—an observation consistent with our extensive clinical experience. Additionally, while a possible link between MGLSc and smoking has been proposed, this has not been supported by our clinical findings. Objectives: The primary objective was to clarify the age-specific incidence of genital lichen sclerosus in adult men, while the secondary objective was to investigate the potential relationship between MGLSc and smoking. Methods: We conducted a retrospective review of the medical records of 484 adult MGLSc patients from a specialized male genital dermatology clinic, extracting data on age at diagnosis and smoking history. Results: A biphasic U-shaped age distribution was observed, with two distinct peaks—one in the late 30s and another in the 60s (Hartigan’s dip test: dip-stat = 0.03; p < 0.01). Additionally, 36% of the patients had a history of smoking at some point in their lives. Conclusions: These findings confirm the biphasic nature of MGLSc incidence in adults, supporting earlier theories. Including the well-established pediatric peak, the overall incidence pattern is thus triphasic. The smoking data appear unremarkable compared to existing data on smoking habits in the UK. These results indirectly support the proposed pathogenesis of MGLSc, which involves factors such as urinary micro-incontinence, occlusion, and epithelial susceptibility.

Background: Atopic dermatitis (AD) is driven by a complex etiology involving Th2 polarization, characterized by cytokines such as IL-4, IL-5, IL-13, and IL-31, along with Th17, Th22, and Th1 cells in chronic lesions. Tofacitinib targets this complexity by selectively inhibiting JAK1 and JAK3 receptors, thereby blocking cytokines associated with Th1, Th2, and Th17 responses. We conducted a multicenter, retrospective chart review to evaluate the efficacy and safety of tofacitinib in patients with moderate to severe refractory AD. Materials and Methods: We included 16 adult patients (over 18 years old) with moderate to severe atopic dermatitis (AD) who had previously received systemic therapy with inadequate response. At baseline, we recorded demographic information, prior treatment history, severity scores (using the Eczema Area and Severity Index [EASI] and Scoring Atopic Dermatitis [SCORAD]), and quality of life scores (Dermatology Life Quality Index [DLQI]). Baseline blood tests included a complete blood count, liver function tests, renal function tests, a lipid profile, and an interferon gamma release assay for tuberculosis. Patients were monitored monthly for 6 months, with assessments including severity scores, blood tests, and DLQI scores. Adverse events, if any, were also documented. Results: All 16 patients completed the 6-month trial. Prior to the study, they had been treated with cyclosporine (n = 10), methotrexate (n = 3), or both (n = 3). At baseline, the mean Eczema Area and Severity Index (EASI) score was 23.38 ± 9.56, which improved to 8.50 ± 7.57 by the end of the study. The mean Scoring Atopic Dermatitis (SCORAD) score decreased from 41.25 ± 8.69 to 14.93 ± 7.82 over the same period. Quality of life also showed significant improvement, with the mean Dermatology Life Quality Index (DLQI) score rising from 15.18 ± 2.73 at baseline to 5.31 ± 4.11. No severe adverse reactions were reported; however, three patients experienced dyslipidemia and two had altered bleeding times.

Conclusion: Tofacitinib is both a safe and effective treatment for recalcitrant moderate to severe atopic dermatitis in adults.

Introduction: Diabetes mellitus is the leading cause of end-stage renal disease, non-traumatic lower-limb amputation, and blindness. Furthermore, diabetic retinopathy (DR) is the primary cause of visual impairment worldwide. Another complication stemming from diabetes is generalized atherosclerosis, which may manifest as ischemic heart disease, cerebrovascular accidents, or peripheral vascular disease. Utilizing CIMT measurements has been instrumental in predicting cardiovascular outcomes in diabetic patients. Materials and Methods: This observational, cross-sectional study was conducted in tertiary care Hospital and, Kolhapur over a period of 24 months after institutional ethical committee approval. A total of 121 patients satisfying the below inclusion and exclusion criteria were involved in the study. Results: The gender distribution of the study population showed a predominance of males (67.8%) compared to females (32.2%). The mean age was 54.83 years, indicating a middle-aged population. This age group is often associated with an increased risk of chronic diseases such as diabetes and hypertension. The mean CIMT on the right side (CIMT(R)) was 0.8802 mm, while on the left side (CIMT(L)), it was 0.8620 mm, indicating slightly higher measurements on the right side. Subjects with non-proliferative diabetic retinopathy (NPDR) had higher mean CIMT values (0.9436 mm on the right and 0.91 mm on the left) compared to those without retinopathy (0.8346 mm on the right and 0.82 mm on the left). Those with proliferative diabetic retinopathy (PDR) exhibited even higher values (1.1500 mm on the right and 1.00 mm on the left). Conclusion: The present study provides valuable insights into the gender distribution, demographic and clinical parameters, and prevalence of chronic diseases in a population with Type II Diabetes Mellitus (T2DM). The associations between increased CIMT, diabetic retinopathy, poor glycemic control, and demographic factors underscore the need for comprehensive and personalized management strategies to mitigate the risk of complications in T2DM patients. CIMT, being a non-invasive procedure, should be incorporated into routine examinations of type 2 DM patients at least once or twice a year to look for atherosclerotic changes.

Introduction: In medical education, acquisition of psychomotor skills is critical for patient care, and conventional teaching method (CTM) attains poor acquisition & retention. Therefore, this study aimed to evaluate effectiveness of George & Doto’s five-step method (FTM) compared to the CTM in teaching intravenous (IV) injection skill to undergraduate medical students. Methods: It was a double-blinded randomised controlled trial involving 60 students divided into two equal groups using computerised random number table. Control group was taught IV injection skill using CTM by co-investigator while test group was taught using FTM by investigator with student-teacher ratio of 15:1. Pre-validated feedback forms were given to both groups after teaching sessions & responses were collected. Objectively Structured Practical Exam (OSPE) was conducted using pre-validated checklist & timer after one month by independent examiners. Data were collected & analysed with descriptive statistics, chi-square test & Mann-Whitney U-test using Graph pad 10.2.3 (403). Results: 29 students from each group appeared for OSPE. Statistically significant difference was observed between mean scores of test group (8.5±1.28) & control group (6.1±1.74) (p < 0.001, Mann Whitney U-test). Number of students correctly performed most steps were significantly higher in test group compared to control group (p < 0.05, χ² test). Mean number of students responded, “Strongly agree” in feedback form was 17.9 in test group compared to 12.4 in control group. Conclusion: FTM found to be more effective than the CTM for teaching IV injection skill, however, further research with larger sample sizes and diverse skills is recommended to validate these findings.

Background: Chronic insomnia, a frequent sleep disorder, causes problems sleeping or staying asleep, impairing daytime performance. EEG can be utilised to study insomnia’s neurophysiology and EEG lab architecture. This study examines chronic insomniacs’ clinical variables and sleep EEG patterns. Methods: A cross-sectional study was conducted at Netaji Subhash Medical College in Amhara, Bihta, from February 2024 to July 2024. The sample included 60 chronic insomniacs. Electroencephalogram (EEG) recordings were examined for beta, Slow-Wave Sleep (SWS), and spindle activity during sleep. The researchers employed independent t-tests and Pearson correlation coefficients to find links between EEG patterns and age, treatment history, insomnia severity, and sleep quality. Results: Chronic insomnia patients had considerably higher beta activity at sleep onset and NREM stages (p < 0.01) and reduced SWS (p < 0.01). Lower density and frequency of spindles were observed (p < 0.05). Lower SWS was linked to older age (r = -0.49, p < 0.01), longer insomnia duration (r = -0.38, p < 0.05), and enhanced beta activity significantly associated with worse insomnia severity (r = 0.61, p < 0.01). Pharmaceutical therapy impacted EEG patterns by increasing beta activity and decreasing SWS. Conclusion: The study shows that chronic insomnia is associated with EEG abnormalities such increased beta activity and decreased SWS, reflecting cerebral hyperarousal and altered sleep architecture. These findings support the use of EEG patterns as diagnostic markers and the need for personalised treatment. Researchers can better understand these associations and develop more effective treatments with larger longitudinal studies.

Background: Managing postoperative pain in laparoscopic surgery patients is crucial for recovery and patient satisfaction. The TAP block, using long-acting local anesthetics like ropivacaine and levobupivacaine, offers a promising solution by reducing reliance on systemic opioids. Methods: This randomized study at Dr. Babasaheb Ambedkar Memorial Hospital compared the analgesic efficacy and safety of 0.5% ropivacaine and 0.5% levobupivacaine in 100 patients undergoing laparoscopic surgeries. Patients were monitored for heart rate, blood pressure, and pain over 24 hours post-surgery. Results: There were no significant differences in heart rate, systolic or diastolic blood pressure between the two groups at any time point, indicating similar efficacy and safety profiles for both anesthetics. Conclusion: Both ropivacaine and levobupivacaine provide effective and safe analgesia for TAP blocks in laparoscopic surgeries, with no significant differences in hemodynamic responses or analgesic outcomes.

Background: Chronic rhinosinusitis (CRS) is a prevalent condition that significantly impacts the quality of life and productivity, necessitating precise diagnostic and therapeutic approaches. Functional Endoscopic Sinus Surgery (FESS) is a common intervention for CRS, where accurate preoperative imaging is crucial for effective management. This study aims to assess the correlation between preoperative computed tomography (CT) findings and intra-operative observations during FESS. Methods: A prospective, comparative study was conducted at Jhalawar Medical College, involving patients with CRS who failed medical management. Preoperative CT scans were evaluated for anatomical variations such as deviated nasal septum, concha bullosa, paradoxical middle turbinate, and medialised uncinate process. These findings were compared with intra-operative observations during FESS. Statistical significance was determined using chi-squared tests. Results: The study included 50 patients, with a perfect correlation observed in the identification of deviated nasal septum and concha bullosa (100% concordance). Paradoxical middle turbinates and medialised uncinate processes showed slightly lesser concordance rates, yet significant with chi-squared values exceeding 130 and p-values less than 0.0001, demonstrating the high predictive value of CT in identifying critical anatomical variations influencing surgical outcomes. Conclusion: The study confirms the reliability of CT in preoperatively identifying anatomical variations in CRS, supporting its indispensable role in planning FESS. The high concordance between CT findings and intra-operative observations underscores the importance of CT scans in enhancing surgical precision and patient outcomes.

Introduction: COVID-19, caused by SARS-CoV-2, has led to significant mortality globally and is associated with various hematological abnormalities. This study evaluates the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as predictive factors for critical illness in COVID-19 patients. Methods: 500 COVID-19 patients admitted to R. D. Gardi Medical College, Ujjain, from 2020 to 2022 were analyzed. Inclusion criteria involved adults aged over 18 with confirmed COVID-19 via RT-PCR. Exclusion criteria included recent blood transfusions and pre-existing hematological disorders. Hematological parameters were assessed upon admission. Results: Significant differences in hematological parameters were noted among patients categorized by disease severity. Key findings included elevated NLR and decreased hemoglobin levels in severe cases compared to mild and moderate cases (p < 0.001). PLR did not show significant variation across severity levels (p = 0.879). Conclusions: NLR appears to be a valuable predictive marker for disease severity in COVID-19 patients, while PLR may not provide additional prognostic information. Further studies are needed to confirm these findings and explore their clinical implications.