Introduction: In patients on mechanical ventilation, ventilator-associated pneumonia (VAP) is a frequent hospital-acquired ailments that raises mortality, intensive care unit stays, and medical expenses. The main cause of VAP is the aspiration of oropharyngeal organisms into the distal bronchi, which can happen directly or by stomach reflux. In order to effectively manage this illness, preventative measures are essential. Methods: In Central India, a Medical College Hospital served as the study’s setting. Patients were chosen from ICUs according to inclusion and exclusion criteria after receiving approval from the institutional ethical committee. Clinical, microbiological, and radiological indicators were taken into consideration when assigning a score to clinically suspected patients using the Chronic Pulmonary Infection Score (CPIS), in accordance with CDC guidelines. Age, gender, CPIS, diagnosis at ICU admission, length of ventilation, antibiotics received, samples submitted for etiological agent confirmation, suction tip culture, endotracheal aspirate, type of organism recovered, susceptibility profile, and clinical outcome were among the variables noted for each patient. Results: Out of the 362 patients that were chosen, 99.7% of them were in the supine position as their major risk factor, 99.44% had a nasogastric tube in place, and 98.1% were sedated. 39.23% of the patients experienced VAP following a minimum of 48 hours of intubation and mechanical ventilation. For patients who acquired VAP, the average length of time they were on mechanical ventilation was 9.09 ± 2.747 days. Just 1.56% of the isolated bacteria were gram-positive, whereas gram-negative bacteria made up the majority of the isolates (98.44%). Acinetobacter Baumannii (21.09%) and Klebsiella pneumoniae (41.40%) were the two most prevalent of the 128 identified species. Compared to patients without VAP, individuals with VAP experienced much longer stays in the ICU and hospital. Conclusion: The present study offers a thorough examination of the epidemiology, microbiological etiology, antibiotic resistance, and clinical consequences of ventilator-associated pneumonia (VAP). The majority of VAP cases are caused by gram-negative bacteria, which are MDR. The primary causal agent of VAP in the current study, K. pneumoniae, did not have a common source of infection that would have indicated possible endogenous origins. The results highlight the need for customized preventive and treatment plans to enhance patient outcomes and support continued monitoring and evidence-based methods to combat this difficult illness.

Background: The intrauterine contraceptive device (IUCD) is one of the oldest methods of contraception used to prevent pregnancy. Modern IUCDs are highly effective, safe, discreet, long-acting, and reversible. This study aimed to evaluate the acceptability and safety of postpartum intrauterine contraceptive devices (PPIUCD) during the postpartum period, as well as to assess their feasibility, safety, effectiveness, and expulsion rates. Methods: The women presenting to antenatal OPD were counseled about family planning and encouraged to opt for copper-T insertion immediately after delivery. In this study, the Copper T 380A was used, with insertions performed by trained obstetricians following all recommended clinical and infection prevention protocols outlined in the National Family Welfare guidelines. Before hospital discharge, all patients were examined for vaginal bleeding and discharge. Follow-up visits were scheduled at 6 weeks, 6 months, and 1 year. During these visits, pelvic examinations were conducted to check for any signs of bleeding, infection, or displacement, and abdominal ultrasounds (USG) were performed to confirm IUCD positioning. Results: A significant number of women accepted the IUCD as a contraceptive method, with an overall acceptance rate of 52.52%. Antenatal counseling was more effective in promoting IUCD acceptance compared to postpartum counseling. A large majority of women (94.35%) continued using the IUCD for at least 12 months, indicating high satisfaction and effectiveness. The overall complication rate associated with IUCD use was low, with most complications being mild and manageable. Factors such as age, education, and socioeconomic status influenced the decision to accept or refuse the IUCD. Conclusion: Antenatal counseling was more efficient in encouraging IUCD uptake than postpartum counseling. Age, education, and economic class affected their willingness to accept or reject IUCD. A greater proportion of younger women, those with higher education, and those with higher socio-economic status accepted the use of IUCD. A statistically significant number of women (94.35%) continued using IUCD for at least 12 months, suggesting the effectiveness and acceptability of the method.

Objectives: The present study was to evaluate the accuracy of ADC in differentiating benign from malignant neck masses. And, to compare the MRI findings and ADC values with histopathological findings. Methods: After the demographic data collection was completed, the patients were then made to undergo MRI study, using GE Signa HDxT 1.5 Tesla MRI. MRI examination consists of T1 weighted (TR: 315–515 ms, TE 8.5–32.5 ms, field of view 20–25 cm) and T2 weighted (TR 3500–5500 ms, TE 100–130 ms, field of view 20–25 cm) fast spin echo images. DW-MRI was obtained using a multislice single-shot spin-echo, echo-planar sequence with b-factor of 0 and 1000 s/mm², and ADC maps was generated. A Region of Interest (ROI) was drawn using a circle and mean ADC value was calculated. The final diagnosis was made by histopathological examination. Conclusions: Diffusion-weighted imaging is a useful technique that helps to obtain ADC value from the lesion, which adds to the specificity and diagnostic accuracy of MRI by adequately characterizing the lesions, which otherwise would not be possible on ultrasound, CT and routine conventional MRI sequences. Diffusion weighted- MRI and ADC values are highly sensitive and specific to differentiate between benign and malignant neck masses. Hence, the DWI sequence with ADC values should be used in combination with other MRI sequences for  better characterisation of neck masses.

Background: Refractive error among the young students is becoming a major problem worldwide. Uncorrected refractive error can have huge social, psychological, economic, and developmental implications. The study aimed to estimate prevalence of diagnosed refractive errors among the undergraduate medical students of Burdwan Medical College, Purba Bardhaman district and risk factors associated with it. Methods: A cross-sectional study was conducted among the undergraduate medical students of Burdwan Medical College of Purba Bardhaman district, West Bengal, during period from April 2022 to May 2022. A calculated sample of 294 students were selected by complete enumeration and interviewed with a predesigned, pretested questionnaire. Results: Out of 294 study participants 170 (57.8%) were suffering from Refractive errors. As per categorization of refractive error, 66.5% had simple myopia, 28.8% had myopia with astigmatism, 3.5% had simple hypermetropia and 1.2% had hypermetropia with astigmatism. Among the 162 Myopic subjects most 111 (68.5%) had Low (0 to -3) degree of Myopia in Right eye and 110 (67.9%) had the same in the left eye. 42 (26%) and 41 (25.4%) had Moderate degree of Myopia in right and left eye respectively. 8 (4.9%) and 10 (6.1%) had High degree of Myopia in right and left eye respectively. 0.6% of the participants did not have any power in either right eye or left eye. No statically significant difference of physical activity on a daily basis (for more than 5 times per week) and presence of Myopia was found. Conclusion: Prevalence of Refractive errors among the under graduate medical students was 57.8% in eastern India.

Introduction: The current generation of teenagers is growing up immersed in a world saturated with electronic devices which is leading to alteration in sleep pattern and ocular manifestation. So, this study is focusing on assessing the screen time and sleep pattern of undergraduate medical students in a tertiary care hospital. Objective: To assess the effects of screen-time on sleep pattern among undergraduate medical students of a medical college in West Bengal. Materials and Methods: It was an institution based descriptive type of observational study, cross-sectional in design. The data was collected in May-June 2023 with the help of a semi structured questionnaire, circulated among the students. The collected data was analyzed and organized using MS Excel 2019. A pre-designed, pre-tested and semi-structured questionnaire comprising of sociodemographic profile, screentime assessment scale, Athens insomnia scale, knowledge and practice questionnaire. Result: Among the 800 undergraduate medical students, 349 students took part in the study. After analysis it was found that there is a positive correlation between screen time and sleep pattern (r value =0.460), indicating insomnia increases with screen time. It was also found that 34.9% of the study subjects have screen time between 4 to 6 hours and 34% of the study subjects have insomnia. It was also inferred that there is a gap between knowledge and practice. Conclusion: From this study it can be concluded that insomnia and other ocular manifestations increase with screen time. Hence, it is recommended to people to reduce screen time as much as possible.

Background: Neonatal sepsis, particularly from Klebsiella species and E. coli, is a major concern in NICUs due to its nonspecific symptoms and diagnostic challenges. Early and effective treatment is crucial but complicated by the immature neonatal immune system and the potential for antibiotic resistance. Current biomarkers like CBC, CRP, and IL-6 are used but are not fully reliable. Improved diagnostic tools and biomarkers are needed to enhance early detection and treatment of this critical condition. Aim: To investigate the dynamics of biomarkers—Total Leukocyte Count (TLC), Neutrophil-to-Lymphocyte Ratio (NLR), Platelet Count, and C-reactive Protein (CRP)—in neonates with sepsis from Klebsiella species and E. coli, and to evaluate their potential for improving early diagnosis and management. Objectives: Track and compare biomarker trends. Identify diagnostic markers for each pathogen. Assess immune response and systemic inflammation indicators. Methods: This observational study involved 56 neonates with sepsis (35 Klebsiella, 21 E. coli). Biomarkers were monitored on Days 0, 1, 3, and 5, with data analyzed using chi-square and ANOVA. Results: Klebsiella sepsis showed higher initial TLC and CRP with notable fluctuations, while E. coli sepsis exhibited more variable NLR and less fluctuation in TLC. Platelet counts declined in both groups. Statistical analysis revealed significant differences in biomarker levels between the two pathogens (p < 0.05). Conclusion: Distinct biomarker patterns for Klebsiella and E. coli sepsis suggest different immune responses. Understanding these dynamics can enhance diagnosis and treatment, highlighting the need for personalized approaches in neonatal sepsis management.

Background & Methods: The aim of the study is to evaluate the effect of intravenous induction agent ETOMIDATE and PROPOFOL on hemodynamic stress response to laryngoscopy and endotracheal intubation in General Anaesthesia. Patient was kept nil per oral instructions 8 hours prior to the surgery. After shifting the patient to the operating room, non-invasive blood pressure, five leads electrocardiography and pulse oximetry were connected to patient and baseline vitals heart rate, Mean arterial pressure, oxygen saturation of patient were recorded after 5 mins settling in operating room. Results: Pain on injection was observed in 23 (76.7%) patients in propofol group and 6 (20%) patients in etomidate group. Conclusion: Demographic parameters of the groups like gender and ASA grade were comparable without any statistically significant difference between both the groups. Hemodynamic parameters like HR and MAP of the groups were comparable at baseline level. The groups which received etomidate showed stable hemodynamic parameter at the time interval of 1, 2, 3, 5 and 10 minutes after intubation when compared to propofol group with statistically significant p value <0.05. Pain on injection which was statistically significantly lower in group received iv inj. etomidate when compared to propofol group with p value 0.003.

Background: The highly specialized organs of pregnancy, the placenta and umbilical cord, aid in the healthy growth and development of the foetus. Any change in the umbilical cord’s length, entanglement, nuchal cord, knots, thickness, insertion, and total number of umbilical blood vessels, as well as the placental appearance, location, weight, thickness, and circumference, could have a negative impact on the fetus’s health and affect factors like birth weight, Apgar score, and condition. It is common practice not to inspect the placenta and umbilical cord’s gross anatomy. Objective: The goal of the study was to ascertain the placenta’s and the umbilical cord’s morphological patterns in connection to unfavorable foetal outcomes at a Medical College hospital in Central India. Methodology: A quantitative cross-sectional research with pregnant patients hospitalized to the labour and delivery ward was conducted. To gather the sample size of 300 term singleton pregnant females lacking any co-morbidities, simple random sampling procedure was used. Data were gathered using a structured questionnaire, an ultrasound machine equipped with a colour Doppler system, and SPSS version 21 for data entry and analysis. Result: The study’s mean age was 25.47, and the median age was 23.03±7.019, with the majority of participants being between the ages of 21 and 30. The foetal status was substantially correlated with BMI, cord entanglement, and cord length (P<0.05). Additionally, it was discovered that the Apgar score was substantially correlated (P<0.05) with BMI, placental appearance, cord entanglement, and cord length. Additionally, there was a significant BMI, parity, cotyledon number, placental shape, and placental circumference correlation (P<0.05) with birth weight. Conclusion: According to a study, defects of the placenta’s and the umbilical cord’s gross anatomical pattern significantly affect the outcomes of the foetus. Hence, the best results will come from combined efforts to avoid stillbirth, low Apgar scores, and abnormal birth weight prior to and throughout pregnancy, as well as from efficient monitoring measures during pregnancy.

Background: It is found that skin problems are always compounded together with the high prevalence of HIV. 90% of the people living with HIV have changes in their skin and symptoms during the disease course. HIV associated skin diseases were related to multiple factors like differences in skin pigmentation, genetic, climate, hygiene, demographic, environmental, behavioral factors etc. Many studies have found the correlation between the CD4 counts and the mucocutaneous lesions. Some studies have also found the correlation of the disease with the Clinical stage. The main aim of the study is to study the clinical profile of the newly diagnosed HIV patients with the mucocutaneous lesions and to find its correlation with the CD4 cell counts. Methods: The study was carried out at Assam Medical College & and Hospital, Dibrugarh, India for a period of 12 months. A prospective, observational, cross-sectional, study was carried out in the inpatient and outpatient medicine departments. The total sample size was calculated to be 90. Results: Most of the dermatological manifestations were common in the CD4 counts between 201-500 Group III with 45 cases followed by 50-200 Group II where the cases were 22 indicating that skin manifestations like oral candidiasis occur early in the disease and requires screening for HIV.  Among the skin manifestations statistically significant association with the CD4 counts was found in Oral candidiasis (p=0.02), Genital Herpes (p=0.04) and Pruritic papular manifestations (p<0.001). Conclusion: it is concluded that the mucocutaneous manifestations can serve as a prognostic and diagnostic marker for the HIV disease. We can also easily predict the stage of the disease and the immune status and can start the treatment which will tend to decrease the morbidity and will increase the quality of life.

Introduction: Sickle Cell Disease (SCD) is an inherited hemoglobinopathy that leads to a variety of systemic complications, including impaired growth and development in children. Growth retardation, delayed puberty, and malnutrition are common among affected individuals. Although hydroxyurea (HU) therapy is frequently used to reduce disease complications, its effect on growth outcomes remains uncertain. This study investigates the growth patterns, developmental challenges, and impact of hydroxyurea in children with SCD. Methods: A prospective observational study was conducted at a pediatric hematology clinic in Vadodara, Gujarat, involving 50 children with SCD aged 5-18 years, all undergoing hydroxyurea treatment. Anthropometric measurements (weight, height, BMI) were taken at baseline and at regular follow-ups over a one-year period. Sexual maturity ratings were also monitored. Statistical analysis was performed using chi-square tests. Results: The study revealed that the children experienced modest improvements in weight and height over the course of the year. The average weight-for-age increased from 26.38 kg to 28.98 kg, while height-for-age improved from 130.91 cm to 137.25 cm. Despite these gains, a majority of children remained underweight, with BMI between the 5th and 25th percentiles. Delayed sexual maturation was noted in several participants, particularly males. Hydroxyurea doses ranged from 20.01 mg/kg/day to 21.83 mg/kg/day, with no significant adverse effects on growth observed. Discussion: Consistent with existing literature, this study confirmed that children with SCD suffer from stunted growth and delayed sexual maturation, primarily due to chronic anemia, increased energy expenditure, and frequent infections. Although hydroxyurea reduced the frequency of painful crises, its impact on promoting growth was limited. Nutritional interventions and regular growth monitoring are critical for improving long-term outcomes in children with SCD. Additional interventions, including hormonal assessments, may be necessary to address persistent growth and pubertal delays. Conclusion: Children with SCD are at risk for significant growth delays and developmental challenges. While hydroxyurea helps in managing some aspects of the disease, it does not fully address growth and maturation issues. Comprehensive care, including nutritional support and continuous growth monitoring, is essential to optimize outcomes for these children.

Introduction: Chronic Low Back Pain (CLBP) affects millions globally and presents challenges to healthcare systems. It involves both physical and psychological factors, including disability, fear-avoidance beliefs, and reduced quality of life. While conservative treatments like exercise and pain management are common, fascia’s role in musculoskeletal pain is increasingly recognized. Myofascial Release Therapy (MFR) and Motor Control Exercises (MCE) have shown positive outcomes for CLBP. This study examines the combined effect of MFR, MCE, and a Moist Heat Pack on pain, disability, fear-avoidance beliefs, and quality of life in CLBP patients. Aims and Objectives: The primary goal is to assess the combined efficacy of MFR, MCE, and a Moist Heat Pack in reducing pain (NPRS), disability (ODI-G), fear-avoidance beliefs (FABQ-G), and improving quality of life (EQ-5D-5L). Additionally, the study evaluates trunk endurance differences using the Flexor Endurance Test (FET) and Extensor Endurance Test (EET). Methodology: This randomized controlled trial involved 48 CLBP patients divided into three groups:

• Group A: MFR, MCE, and a Moist Heat Pack.
• Group B: MCE only.
• Group C: Control group (no intervention).

The interventions lasted six weeks, five days a week, excluding the control group. Pain, disability, fear-avoidance beliefs, quality of life, and trunk endurance were measured at baseline, week 3, and week 6. Data analysis used ANOVA with a significance threshold of p < 0.05. Results: Baseline characteristics were similar across groups (p > 0.05). By week 6, Group A showed significant improvements in pain, disability, and fear-avoidance beliefs (p < 0.05) compared to Groups B and C. Group B showed moderate improvements, while no significant changes in trunk endurance were observed in any group (p > 0.05). Discussion: The combination of MFR, MCE, and a Moist Heat Pack significantly reduced pain, disability, and fear-avoidance beliefs, enhancing the quality of life. Group A exhibited the greatest benefits, reinforcing the therapeutic value of these interventions. However, the lack of significant trunk endurance improvement suggests a need for additional endurance training. Conclusion: The combination of MFR, MCE, and a Moist Heat Pack is effective in reducing pain, disability, and fear-avoidance beliefs while improving quality of life in CLBP patients. Future research should explore the long-term effects of this therapy and additional strategies for improving trunk endurance.

Introduction: Type-2 diabetes mellitus (T2DM) is a chronic metabolic disorder that significantly increases the risk of cardiovascular diseases (CVD) through insulin resistance, hyperglycemia, and dyslipidemia. Anthropometric indicators, such as body mass index (BMI), waist circumference, and blood pressure, are commonly used to assess metabolic health and obesity-related risks in patients with T2DM. Leptin, an adipokine linked to fat mass and energy regulation, plays a crucial role in metabolic dysfunction and obesity-related complications in T2DM patients. This study investigates the role of anthropometric indicators in assessing metabolic health among male and female T2DM patients, focusing on the gender differences in these indicators and their associations with metabolic outcomes. Materials and Methods: A total of 140 T2DM patients (90 males, 50 females), aged 60-70 years, were recruited. Anthropometric measurements, including BMI, waist circumference, and blood pressure, were recorded. Blood samples were analyzed for metabolic parameters, including fasting plasma glucose (FPG), insulin, cholesterol, triglycerides, and leptin. Insulin resistance was assessed using the homeostasis model assessment (HOMA). Statistical analyses were performed using SPSS, with significance set at p < 0.05. Results: Significant gender differences were found in anthropometric indicators, with females exhibiting higher BMI and waist circumference compared to males (p < 0.01). Elevated BMI and waist circumference were associated with adverse metabolic outcomes, including higher FPG and LDL cholesterol. Females also had significantly higher leptin levels than males, further correlating with greater adiposity. Additionally, while females had higher HDL cholesterol, they also showed elevated LDL cholesterol, highlighting their increased cardiovascular risk. Discussion: The study’s findings emphasize the importance of anthropometric indicators in assessing metabolic health in T2DM patients. Gender differences in BMI, waist circumference, and leptin levels suggest that females with T2DM may face a higher metabolic risk than males. Despite females’ higher HDL cholesterol levels, their increased adiposity and leptin resistance could offset the protective effects, leading to worsened metabolic outcomes. These results underscore the need for gender-specific strategies in managing metabolic health in T2DM. Conclusion: Anthropometric indicators, particularly BMI and waist circumference, play a critical role in assessing metabolic health among T2DM patients. Gender-specific differences in these indicators highlight the need for tailored approaches in managing metabolic health and reducing CVD risk in T2DM patients. Further research is warranted to explore the mechanisms underlying leptin resistance and its impact on metabolic outcomes in T2DM.

Objectives: To determine the combined diagnostic performance of advanced MRI Parameters- MRI Diffusion, MRI Perfusion, MR Spectroscopy- in conjunction with conventional MRI sequences for better evaluation of intracranial ring enhancing lesions and differentiation of their infective versus neoplastic etiologies. And deduce the sensitivity and specificity of the combined usage of conventional and advanced MRI techniques in differentiating infective from neoplastic intracranial ring- enhancing lesions. Methods: A total of 60 patients referred to the radiology department were included in the study. Conventional MR sequences, Advanced MR sequences, Magnetic resonance spectroscopy and Water Suppression methods were used for diagnostic procedures. Results: Out of the 60 cases of ring enhancing lesions, 30 were infective lesions while 30 were neoplastic. Out of 60 patients in this study 38 were male and 22 were female. We observed that the cut off of 2.03 mean ADC values provide sensitivity and specificity of 90% and 100% respectively, in differentiating infective from neoplastic intracranial RELs. The mean ADC value of infective RELs was 1.21 +/- 0.47 while that of Neoplastic RELs was 2.35 +/- 0.30. With a cut off of 2.23 mean rCBV values provide sensitivity and specificity of 70% and 80 % respectively, in differentiating infective from neoplastic intracranial RELs. The mean rCBV value of infective RELs was 1.83 +/- 0.77 while that of Neoplastic RELs was 2.85+/- 1.06. With a cut off value of 1.47 Cho:Cr ratios provide sensitivity and specificity of 86.7% and 90 % respectively, in differentiating infective from neoplastic intracranial RELs. The mean Cho:Cr value of infective RELs was 2.85 +/- 1.06 while that of Neoplastic RELs was 1.23+/- 0.29. Conclusions: Conventional MRI examination provides information on lesion location, homogeneity, signal intensity, presence of perilesional edema, and degree of contrast enhancement. However, it is limited in its ability to depict changes in cell density, cell type, or biochemical composition, perfusion and microstructural heterogeneity which can be investigated using advanced techniques which provide valuable information that complements routine MRI sequences. Hence, advanced MRI Parameters namely DWI, PWI and MRS can be useful tools in differentiating infectious from neoplastic ring enhancing lesions by evaluating the microstructural heterogeneity and other information received in a more comprehensive way. it accurately distinguishes between different types of infective and neoplastic ring-enhancing lesions and it significantly impacts the subsequent management and treatment of the patient.

Aim: The present study aimed to evaluate the clinical characteristics and functional gain of the upper limb in patients who underwent surgical treatment after traumatic brachial plexus injuries along with psychosocial assessment of the patient undergoing treatment. Methods: Total 32 patients brachial plexus injuries fulfilling the inclusion and exclusion criteria were selected for the present study. Patients were assessed for motor, functional outcomes in preoperative period and then followed up on OPD basis, and 6 monthly basis. Primary outcome evaluation was done by motor outcome and secondary outcome evaluation included the functional and psychosocial outcome. Results: Mean age of the patients was 24.87 yrs. Good motor outcome was seen in 9 cases (28.12%), 5 cases of which had upper and middle trunk lesions whereas 4 cases had Pan brachial plexus injury. 18 (56.25%) cases in total had poor motor outcome score, most of which had (14) Pan brachial plexus injuries. Out of the 16 early presenters, 4 (25%) had excellent recovery, while 5 (31.25%) had good recovery. In late presenters, only 1 (6.25%) patient had excellent recovery, whereas 3 (18.75%) patients had good recovery. Wilcoxon signed ranks test showed a statistically significant change in preoperative and postoperative pain severity score (Z = -4.014, P <0.05). Statistically significant changes were observed in preoperative and postoperative DASH score, physical functioning score, emotional health problems score, vitality score, emotional well-being score, social functioning score, bodily pain score and general health score (Z = -4.936, P <0.05). Conclusion: The study shows that brachial plexus surgery can provide good motor results (43.75%) in some patients, but not in more than 50%. The overall improvement in functional life is significant, and even minimal relief like allaying neuralgic pain (68.75%) and nominal motor function can provide a psychological boost to a broken-down individual from traumatic brachial plexus injury, helping them regain lost confidence.

Absolutely, advancements in imaging techniques have significantly improved the early diagnosis and treatment of splenic abscess. In the past, these abscesses were indeed considered rare and life-threatening due to challenges in diagnosis and subsequent high mortality rates if untreated. However, diagnosis of this abscess were difficult but with better diagnostic tools like CT scans and ultrasound, we can now detect splenic abscesses earlier. Hence with timely intervention and appropriate treatment strategies such as antibiotics and sometimes drainage, the mortality rate has drastically decreased. This underscores the importance of early recognition and aggressive management of splenic abscesses in improving patient outcomes. Given its rarity, prompt diagnosis and treatment are crucial to prevent complications such as rupture of the abscess or spread of infection. Aim and Objective: The main aim of this study focus on Management of Splenic abscess at Tertiary care center. Though Splenic abscess is rare, but due to advancement in diagnostic technique, it has helped in early diagnosis and better treatment of cases of Splenic abscess.

Introduction: Nasal masses are common findings in the specimens received from the ENT department. [1] The incidence is 1-4% of the total population. Neoplasms of the sinuses and nasal cavity account for 0.2-0.8% of all carcinomas. The prevalence rate of nasal polyps is about 2%. They may be congenital, inflammatory, neoplastic, non-neoplastic, or traumatic. Aim & Objectives:  The main objectives were to study the various histopathological subtypes of nasal mass lesions and to classify the malignant lesions into different categories. Methods: The study was carried out for two years. A total of 100 cases were included. It was a Descriptive observational cross-sectional study. Result and Conclusion:  The study included 100 cases of nasal mass lesions collected over 2 years (October 2022-October 2024). The study revealed male predominance, with a ratio of 2.12:1(68:32). The age ranged from 05 to 76 years with a mean age of 33.8 years. Unilateral involvement of the nasal cavity was found to be more common. The most common presenting complaint of the patient was found to be polypoidal nasal mass. 73 cases were found to be Non-neoplastic Lesions. Of the 27 Neoplastic Lesions, 14% cases were Benign while 13% were Malignant. Rhinosporidiosis (32%) and Inflammatory Nasal Polyp (32%) were the most common non-neoplastic lesions, Angiofibroma (4%) was the most common benign, and Undifferentiated carcinoma (7%) was the most common malignant neoplastic lesions.

Introduction: The urinary bladder, when full, appears as a fluid-filled, echo-free cystic structure on ultrasound. Its shape can vary, ranging from round to ovoid or oblong. The bladder’s wall is smooth and muscular, and its thickness can be assessed using ultrasound. In infants, the bladder wall is relatively thicker compared to other age groups. Materials and Methods: This prospective study involved an ultrasonographic evaluation of urinary bladder wall thickness in 75 healthy children aged 5 to 12 years. All participants were free from any current urological conditions or history of bladder pathology. Bladder wall thickness was measured sonographically at three points—anterior, posterior, and lateral—using a high-frequency (6.0 MHz) ultrasound probe. Results: The overall mean bladder wall thickness across all points was 1.9 mm. The mean anterior bladder wall thickness was 1.75 mm (± 0.21 mm), the mean posterior thickness was 2.0 mm (± 0.33 mm), and the mean lateral thickness was 1.98 mm (± 0.12 mm). Conclusions: Significant differences were observed between the anterior, posterior, and lateral bladder wall measurements. Bladder wall thickness was positively correlated with age.

Introduction: The clinical presentation and type of seizure disorder vary significantly with age and neurodevelopmental maturity. Magnetic resonance imaging (MRI) is the preferred modality for identifying underlying causes, particularly in partial seizures. It enhances the detection of intracranial lesions, especially vascular and meningeal abnormalities. This study aims to assess the role of MRI in evaluating paediatric seizure disorders. Methodology: Seventy-five paediatric patients under 12 years presenting with generalized, partial, or absent seizures underwent MRI. Diagnosis relied on radiological features, supplemented by follow-up MRI and treatment response in inconclusive cases. Result: Generalized seizures predominated (68%), compared to focal seizures (24%). MRI revealed abnormalities in the majority of cases (73.3%). Anoxia and hypoxic-ischemic encephalopathy (41.8%) were the most common aetiologies. Neoplasms were identified in 3 patients: 2 with unspecified types and 1 each with DNET and Pilocytic astrocytoma. Conclusion: MRI plays a crucial role in diagnosing paediatric seizure disorders, facilitating accurate treatment decisions by identifying underlying causes.

Background: Dermatophytosis is one of the most prevalent superficial fungal infections, affecting 20-25% of the global population. The rising number of cases, coupled with prolonged durations and recurrence, has been increasingly reported in India, underscoring its growing public health burden. Objective: To evaluate the clinico-epidemiological profile of dermatophytosis among patients attending the Dermatology outpatient department at a tertiary care hospital in Western Uttar Pradesh over a period of one-year. Method: A cross-sectional observational study was conducted on 155 clinically diagnosed cases of dermatophytosis. Patients were selected based on clinical diagnosis and confirmed with positive findings on potassium hydroxide (KOH) examination. Detailed epidemiological and clinical data were collected and analyzed to determine the distribution and identify the clinical types of dermatophytosis. Results: The majority of cases in the study were observed in females. The 21 to 30-year age group was the most affected, with a mean age of 32.42 ± 18.71 years. Clinically, the most common presentation of dermatophytosis was Tinea corporis, followed by Tinea cruris and Tinea faciei. Conclusion: This study highlights the importance of regularly assessing the clinico-epidemiological patterns of dermatophytosis to better understand its distribution, demographic trends, and clinical presentations, thereby shaping more effective treatment strategies and improving patient management.

Background: Acne is a prevalent dermatological condition affecting both adolescents and adults, with distinct characteristics across these age groups. Understanding the differences in acne presentation, severity, and associated factors in these populations is crucial for effective treatment and management. Objective: To do a comparative analysis of acne vulgaris affecting Indian adolescent versus adult patients at a tertiary care centre. Methods: A comparative cross-sectional study conducted over 18 months at Venkateshwara Institute of Medical Sciences included 200 patients: 100 adolescents (11-25 years) and 100 adults (26-40 years). Participants were evaluated using structured questionnaires, with socioeconomic status assessed by the Kuppuswamy Scale. Clinical examinations covered anthropometry, acne grading per AAD classification, and hyperandrogenism assessment using the hirsutism grading scale. Results: The study revealed significant differences between adolescents and adults with acne. Adolescents (mean age 20.03 years) were predominantly male (68%) and most affected in the 21-25 age range, whereas adults (mean age 29.77 years) were mainly female (72%) and primarily affected in the 26-30 age range. In adolescents, acne was more common on the cheeks (81%) and forehead (66%), while in adults, it primarily affected the cheeks (71%) and chin (51%). Adults used systemic steroids more frequently (13%) and cosmetics more often (62%) compared to adolescents (33%). A sedentary lifestyle was more common in adults (66%), with a higher percentage of overweight or obese individuals. Adolescents consumed more high-glycemic foods like chocolate (76%) and sugars (72%). Smoking as an aggravating factor was more prevalent among adults (16%) than adolescents (6%). Adults also reported higher rates of poor quality of sleep (48%), anxiety (22%), and depression (27%). Adults experienced more scarring (57%) compared to adolescents (39%), while similar rates of post-inflammatory hyperpigmentation (67%) were observed.  Conclusions: The findings highlight the need for tailored acne management strategies for adolescents and adults, considering their unique clinical and sociodemographic characteristics. Further research, especially in India, is crucial for improving treatment outcomes.

Background: Congenital anomalies are not uncommon; some remain asymptomatic, while the same lead to considerable morbidity and early death. Method: 90 congenital renal anomalies were observed in pregnant women during an ultrasound study. A 2-5 MHz sector or linear transducer is used to scan the urinary tract. The kidneys are scanned in the transverse and coronal planes. Results: Out of 90 fetuses, 70 (77.7%) were male, 19 (21.1%) were female, and 1 (1.1%) was ambiguous. Age of mother was 30.2 (± 5.80) range between 20-42. The major anomalies were hydronephrosis: 22 (24%) bilateral, 17 (18%) right, and 15 (16%) left; 11 (12%) multi cystic dysplastic kidney disease; 6 (6.6%) renal agenesis; 6 (6.6%) congenital poly cystic kidney disease; 3 (3.3%) pelvic kidney; 2 (2.2%) echogenic kidney; and 2 (2.2%) renal dysplasia. Conclusion: Congenital renal anomalies are commonly encountered on ultrasound imaging studies. Despite dramatic improvements in MRI, CT, and nuclear studies, sonography continues to occupy a central role in the evaluation and detection of congenital renal diseases due to its advantages of rapid scanning time, lack of radiation exposure, cost-effectiveness, and easy feasibility.

Background: Metabolic syndrome is defined to investigate the cardiovascular effects of metabolic syndrome. Method: 150 metabolic syndrome patients having positive angiography of CAD was compared with 150 non-Mets volunteers (controlled). Blood investigation, i.e., lipid profile, insulin levels, IL-6, TNF-α, Hs-CRP, HOME-IR, Quickie, and angiological findings showing single vessel disease, double vessel disease, and triple vessel diseases, were analyzed. BMI, HTN, and DM were also noted. Results: Comparison of biochemical analysis in metabolic syndrome (MS) with non-metabolic syndrome (Non-MS): TG, HDL, VLDL, and LDL had a significant p value (p<0.001). In the present study, 23 (15.3) MS groups had type-II DM, and 120 (80%) HTN were noted, and 12 (8%) had type-II DM, and 18 (12%) HTN was observed in the non-MS group. A comparative study of anthropometric, biochemical, and inflammatory bi-omarkers had a significant p value (p<0.001). Conclusion: In the present pragmatic study there is a strong correlation of metabolic syndrome (MS) with cor-onary artery disease (CHD). It will help the clinician to treat such patients efficiently to avoid morbidity and mortality.

Ocular trauma is the leading cause of unilateral blindness in children worldwide. Traumatic cataract is common sequelae of ocular injuries in adults and children. The timing of surgery is important for visual rehabilitation especially in children as the risk of amblyopia is high due to media opacity. Careful examination and a management plan can simplify the difficult cases and provide the best possible outcome. A total of 65 cases of unilateral traumatic cataract of age group 6-65 years with no co-existing posterior segment pathology, previous intraocular surgery or pathology were selected for the study. Study technique includes interview, clinical, ophthalmic examination and management. Patients were examined at 1st post operative day, 1 week and at 6 weeks. BCVA was taken at the end of 6 weeks and spectacles were prescribed accordingly. Majority of the cases were found in the age group of 11-30 years (44.6%). Blunt injury (55.4%) was more common than that of penetrating injury (44.6%). Total cataract (63.1%) was the commonest morphology seen. A statistically significant association was found between morphology of traumatic cataract and type of injury (p- value <0.05). The cause of decreased BCVA was mainly associated with zonular weakness and vitreous loss. Our study shows that good visual results can be achieved with traumatic cataract surgery if the posterior segment is not involved and the corneal scar does not block the optical axis. Penetrating injuries are associated with poor visual outcome postoperatively than blunt injuries due to central corneal scarring and astigmatism.

Introduction: Methods for induction of general anaesthesia in children include inhalational agents as well as intravenous agents. Children are reluctant to have a needle to put them into sleep. So inhalational induction becomes preferable and is used more commonly in children as compared to adults. Desflurane, sevoflurane, isoflurane, enflurane, halothane, nitrous oxide are amongst the most popular inhalational agents used. Of these sevoflurane and halothane are used for induction owing to their non pungent nature. However, all of these products are airway irritants to varying degree and can cause laryngospasm, breath holding, coughing, and salivation in children. Halothane has a high solubility in tissues and is therefore associated with a slow onset and termination of effect and recovery. Patients receiving halothane have an increased risk of arrhythmias and hepatotoxicity. Sevoflurane has low blood gas partition coefficient and low issue solubility. In addition, sevoflurane appears to have fewer hemodynamic effects than halothane. Purpose of this study is to compare sevoflurane and halothane for induction, maintenance and recovery in general anaesthesia in pediatric patients. Our primary aim is to compare the induction time produced by halothane and sevoflurane in pediatric patients. Materials and Methods: After approval from proforma review board this comparative study of halothane and sevoflurane for induction, maintenance and recovery in pediatric patients was carried out in general operation theatre, S.N. Medical College, Agra. Using computer generated random number table patients were randomly allocated into two groups of 30 patients each according to the volatile anaesthetic to be used: Group-H: Included children who received halothane + nitrous oxide + Oxygen. Group-S: Included children who received sevoflurane + nitrous oxide+ Oxygen. Time gap between cessation of the inhalational agent and when child first open his/her eyes was recorded as recovery time 1. Respective time gap till child showed purposeful movements or obeyed commands were taken as recovery time 2. Statistical analysis: It was done using SPSS 20.0 version for windows. A study population of 30 patients for each group was determined to have 90% power at a =0.05. Data were presented as mean (+­­­SD). After the study, analysis of data was done by chi square test and t- test for parametric data and Mann-whitney for nonparametric data. P value<0.05 was considered as statistically significant. Results: In the comparative study we compared the induction, maintenance and recovery characteristics of halothane and sevoflurane in pediatric patient of 1 to 10 years of age undergoing elective surgeries of approximately 1 hour duration (ASA grade 1 & 2). In present study, the time to loss of eyelash reflex (induction time) was significantly shorter in the sevoflurane group, p<0.05 (88.23+19.129 sec) compared to halothane group (165.63+40.372 sec). This can be explained by low blood gas solubility of sevoflurane as compared to halothane. In our study we compared the two groups for intraoperative complications like cough, bucking, breath holding and oxygen desaturation on the basis of airway hyperreactivity score and found that there was no statistically significant difference (p-value is>0.05). It was because both sevoflurane and halothane are non-irritant and provide smooth induction with minimal secretions. sevoflurane is least airway irritant among all inhalational agents and halothane is most potent bronchodilator among these. In our study emergence phenomenon were compared among two groups on the basis of emergence agitation score and it was found that children who received sevoflurane were more agitated and restless at the time of emergence than the children who received halothane. The most likely explanation is that patients experienced rapid emergence as sevoflurane is eliminated rapidly while chidren who received halothane appeared sedated and calm due to slow elimination as compared to sevoflurane. Limitations of this study include lack of blinding due to study design and inability to assess arrhythmogenic properties of both the agents and high cost of sevoflurane. We conclude that induction with sevoflurane and oxygen leads to faster loss of consciousness, provides ideal conditions for managing airway with haemodynamic stability and rapid recovery from anaesthesia. Therefore, it can be a reasonable alternative to halothane for pediatric patients aged 1-10 years. Conclusion: Time to loss of eyelash reflex (induction time) was compared between two groups and it was significantly shorter in children. Baseline pulse rate was comparable between two groups. There was decline in pulse rate in both groups but this decline was more with children who received halothane anaesthesia than the children who  received sevoflurane anaesthesia and difference was statistically significant ,p value<0.05. Mean arterial blood pressure was comparable between two groups. There was decline in mean arterial blood pressure in both groups but this decline was more with children who received halothane anaesthesia than the children who received sevoflurane anaesthesia and difference was statistically significant, p value <0.05.Time to open eyes and time to follow commands was shorter in sevoflurane group than halothane group and on comparison the difference was statistically significant, p value <0.05. In our study emergence phenomenon were compared among two groups on the basis of emergence agitation score and it was found that children who received sevoflurane were more agitated and restless at the time of emergence than the children who received halothane. So, we conclude that the anaesthesia with sevoflurane provided rapid induction and rapid recovery with more stable hemodynamics than halothane in pediatric patients of age group 1-10 years. However, more frequent emergent phenomenon and higher cost may be factors limiting its popularity.

Introduction: The kidney is a structurally complex organ that has evolved to carry out several important functions. Nephrectomy remains the standard of care for patients with a suspected renal mass. Renal neoplasms comprise a wide spectrum of neoplastic lesions with patterns distinct for children and adults. The present study was undertaken to estimate the histopathological spectrum of renal neoplasms in nephrectomy specimens and to correlate clinical presentation and demography with the different types of renal neoplasms. Material and Methods: A retrospective record-based descriptional study was conducted in the Department of Pathology, Travancore Medical College, Kollam from nephrectomy specimens received in the department over five years (January 2019 to December 2023). The study included 70 nephrectomy specimens. WHO classification of tumours of kidney was used as reference to study the various histopathological patterns. WHO/International Society of Urological Pathology (ISUP) Grading system was followed for grading the renal neoplasms. Staging of renal neoplasms was done based on pathologic staging classification (pTNM) of American Joint Committee on Cancer (AJCC). The histologic patterns, clinical presentation, and demographic features were expressed in frequency and percentage. Results: Out of 70 nephrectomy specimens, 49 (70%) were radical nephrectomy specimens and 21 (30%) were partial nephrectomy specimens. 62 were malignant, 6 were benign neoplasms and 2 were of low malignant potential. The majority of the tumours were detected incidentally (38.6%). Among symptomatic cases, the most common presenting symptom was hematuria (35.7%) followed by flank pain (21.4%). 52 (74.3%) out of the 70 specimens were from males. The most common age group was above 60 years (30 specimens, 42.9%). The left kidney (40 specimens, 57.1%) was more commonly affected. The interpolar region (27 specimens, 38.6%) was the most frequently involved site. Clear cell renal cell carcinoma (48 specimens, 68.6%) was the most common malignant renal neoplasm encountered followed by clear cell renal cell carcinoma with sarcomatoid differentiation (3 specimens, 4.3%), papillary renal cell carcinoma (3 specimens, 4.3%), chromophobe renal cell carcinoma (3 specimens, 4.3.%), urothelial carcinoma of renal pelvis (3 specimens, 4.3%) urothelial carcinoma of renal pelvis with sarcomatoid differentiation (1 specimen, 1.4%) and collecting duct carcinoma (1 specimen, 1.4%). Multilocular cystic renal neoplasm of low malignant potential (1 specimen, 1.4%) and thyroid-like follicular renal cell carcinoma (1 specimen, 1.4%) falling under the category of low malignant potential were also identified. Both oncocytoma (3 specimens, 4.3%) and angiomyolipoma (3 specimens, 4.3%) were the most common benign tumours. Among the 61 malignant neoplasms which were graded, the commonest grade identified was Grade 2 (42 specimens, 68.9%) followed by Grade 1 (10 specimens, 16.4%). Based on the pathologic staging classification (pTNM) of American Joint Committee on Cancer (AJCC), out of the 64 malignant neoplasms,37 specimens (57.8%) of tumours in the present study were of stage pT1 followed by pT3 accounting for 22 specimens (34.4%) and pT2 accounting for 5 specimens (7.8%). Conclusion: The wide spectrum of renal neoplasms makes it essential to do a detailed histopathological examination to subtype, grade and stage the neoplasms as these help plan further management. The correct diagnosis has clinical implications leading to better prognostication, helping management decisions including targeted therapies, and identifying hereditary or syndromic associations which may necessitate appropriate genetic testing.

After surgery, there could be reduced albumin production in the liver or increased albumin breakdown. In both cases, the level of serum albumin decreases. Stress and strain are also recognized factors contributing to hypoalbuminemia, which refers to low serum albumin levels. Albumin, being a protein, is synthesized from genetic transcription, and research indicates that TNF-alpha inhibits this transcription process.

Background: The second twin is generally considered at higher risk of severe morbidity and mortality because of obstetric complications that may occur after delivery of the first twin. Methods: The hospital based descriptive type of observational study was conducted on  Pregnant women who have confirmed diagnosis of twin gestation attending Labour  room of  Department of  Obstetrics and Gynaecology with period of gestation 28 weeks or more were included in the study.. Results: In 54.00% neonate APGAR score was 5-7 followed by 42.00% neonate APGAR score was >7 and 4.00% neonate APGAR score was less than 5. 84.00% deliveries were ND followed by 14.00% delivery was AVBD and 2.00% delivery was IPV-BE. Conclusion: Second twin had low Apgar score and chance of neonatal admission was more.

Background & Objectives: Transfusion transmitted infections are a cause of concern in the provision of safe blood. The real challenge of blood transfusion lies in minimising risks and optimising clinical benefits. Therefore our study was done to compare NAT versus CLIA for screening of Hepatitis C. Materials and Methods: A prospective study was conducted on a total number of (n=2553) eligible donors who had donated during the period of one year {April 2023 to March 2024} and their samples were tested by serology CLIA at our institute’s serology laboratory. All the negatively tested samples by CLIA were sent to the Blood Centre RNT Medical College, Udaipur, Rajasthan for retesting by using (NAT). Results: A total of 2553 random seronegative blood donors were included in this study. These 2553 donors were screened by individual donor (ID) NAT. There was no NAT yield for HCV of the 2553 random seronegative donors. Conclusion: Among the 2553 samples tested by NAT all were non-reactive for mandatory transfusion transmissible diseases. Stringent donor screening and serology testing of whole blood donations helps in minimizing the risk of transmission of TTIS largely.

Background: More than 40% of pregnancies worldwide are unintended leading to either an unplanned birth or unsafe abortions and maternal  morbidity. India, being the  most populous country, have an inherent requirement of knowing KAP of contraception among women of reproductive age to prevent unplanned pregnancies, so as to achieve optimal pregnancy outcome. Aim of current study was to assess the knowledge, attitude & practices of contraceptives among married women of reproductive age group. Methods: A cross sectional study was conducted on females between 15-45 years. Questions regarding factors responsible for non-use of contraception were also asked. All data were analyzed by Epi-info software. Results: Only 7.00% Women were aware of emergency contraceptive. 68.00% respondent thought that contraceptives were used to prevent pregnancy and about 12.0% thought that they could be used to prevent infections like AIDS. Only 9.00% thought that they could be used to control birth interval. Conclusions: The gap between awareness and practices are seen to be prevalent across different reasons, where people are aware but reluctant to practices. The most common reason for non-practice of contraception was fear of side effects. Other reasons for non-practice were non access to health facility, preference of male child, religious beliefs, cost, and family pressure. Some respondent also felt that the process of acquiring contraceptive is often embarrassing.

Introduction: COPD and cognitive impairment are prevalent conditions that have been extensively researched on their own however, data on COPD-related cognitive impairments has been expanding recently. An analysis of patient records from a sizable primary care practice revealed that COPD patients had a greater frequency of cognitive impairment than patients without COPD . One of the pathophysiological changes linked to COPD exacerbations is elevated systemic and airway inflammation. Hospital admissions for COPD exacerbations typically result in limits in cognitive function. A tiny percentage of this impairment will improve, which is beneficial, but as time goes on, the patient’s cognition and memory will decline. Severe cases of chronic obstructive pulmonary disease (COPD) are associated with higher rates of death and morbidity. Materials and Method: The present study aimed to assess cognitive impairment in in COPD patients aged 30 to 60. They were classified as homemakers, semiskilled and  skilled workers. Using our inclusion and exclusion criteria, 200 males and 50 females from the Department of Respiratory Medicine were selected. To ascertain cognitive impairment, a mini-mental state examination was performed. Results: This affirms that there is severe cognitive dysfunction in a larger percentage of the group of COPD patients. Cigarette smoking should be avoided among the COPD patients. Statistically, the results strongly suggest that smoking is a significant factor contributing to lower FEV1/FVC ratio in all stages of COPD (Mild, Moderate, and Severe). This investigation also provides evidence of a relationship between pulmonary function and COPD with cognitive impairment. For the evidence of cognitive function in smokers and non-smokers a comparative study was conducted in between (Mild, Severe, No Evidence), the p-values are extremely small (less than 0.001). This indicates an insignificant difference in MMSE scores between smokers and non-smokers. Conclusion: There is a high prevalence of cognitive impairment among COPD patients. Patient care givers should be aware of symptoms such as trouble in concentrating, remembering, and decision-making, which hinder our daily activity. Further research on cognitive impairment in AECOPD patients needs to be analysed.

Background: Human Papillomavirus (HPV) is considered an established causative agent of head and neck squamous cell carcinoma (HNSCC). These HPV related tumors have a clinico-pathological profile that is different from non-HPV related tumors. The study was conducted to evaluate p16 over expression, HPV16/18 DNA detection and its correlation between various clinicopathological features and HPV. Methods: Hundred patients with HNSCC were included in the study.p16 was evaluated using Immunohistochemistry (IHC) and was considered positive if ≥ 75% of the tumor cells showed strong and diffuse nuclear/cytoplasmic staining. HPV 16/18 DNA was evaluated using Chromogenic in-situ Hybridization. Any brown colored dot like signal from the nucleus of the cell was considered positive. The results were analyzed using chi squared/Fisher exact test. The inter rater agreements between HPV-DNA and p16 expression was measured by calculating Cohen’s kappa coefficient. Results: p16 expression was seen in 41/100 HNSCC cases while HPV 16/18 DNA was detected in 20/100 cases. A statistically significant association was found between p16 expression and HPV16/18 detection (P<0.001).p16 expression was most frequent in Oropharyngeal tumors which showed a significant association with p16 over expression (P=0.04). The strength of agreement between HPV 16/18 DNA detection and p16 expression was moderate (κ=0.48). p16 expression did not correlate with various other clinic-pathological parameters. Conclusion: The present study supports the use of p16 IHC as a surrogate biomarker for HPV detection.

Background: The extrapulmonary effects of COPD (Chronic Obstructive Pulmonary Disease) need to be searched meticulously in every patient for timely intervention. In any case, the components of this systemic inflammation may account for the systemic manifestations of COPD and may worsen comorbid diseases. Aims and Objectives: To study the correlation between BODE (Body mass index, airflow Obstruction, Dyspnoea, and Exercise capacity) index score and the extrapulmonary effects in COPD patients, to assess the prognosis of the disease based on the BODE index score, and to analyze the change in severity of the disease process based on the BODE index score. Materials and Methods: 104 COPD patients diagnosed based on GOLD spirometry criteria were enrolled and the BODE index score for the patients was calculated at the baseline and then actively screened for the presence of underlying extrapulmonary effects. Patients were reviewed again by calculating their BODE index score and the presence of extrapulmonary effects at 1 year. Results: The change in the BODE score was also statistically highly significant (p<0.001) with the change in the number of extrapulmonary effects. The increase in the BODE score was statistically significant (p<0.004) with the risk of mortality at the end of one year. Conclusion: COPD patients should be thoroughly evaluated beyond the lungs, and the BODE index scoring system is a simple, easy-to-use, and effective tool, the use of which should be encouraged more for the optimal management of this dreadful disease.

Background: A multitude of clinical trials have been conducted to examine the effectiveness of MET, both in isolation and in conjunction with other medications such as corticosteroids and antibiotics, utilising the selective α-blocker tamsulosin. Tamsulosin treatment considerably increases the evacuation rate of medium-sized (4–10 mm) distal ureteral stones, according to the majority of these randomised investigations. The objective of this study was to evaluate the efficacy of medical management (tamsulosin 0.4 mg) in aiding stone expulsion in adult patients with solitary lower ureteric calculus of sizes between 4 and 10 mm. Materials and Methods: This was a prospective study conducted over a period of 4 years from 2018 to 2022, involving 324 adult patients with a solitary unilateral lower ureteric calculus between 4 and 10 mm with symptoms of less than 2 weeks duration. Patients enrolled were given a dose of tablet tamsulosin 0.4 mg once at night for two weeks. Results: The overall calculus clearance rate with tamsulosin was 78.6%. The highest expulsion rate (92.5%) was found among the calculus of size 6 mm. The lowest expulsion rate (40.4%) was found among the calculus of size l0 mm. Among the 63 patients who needed URS, 40 retained the calculus in the same position after a 2-week course of tablet tamsulosin. 12 had developed UTI and 11 had developed an elevated serum creatinine level while on tamsulosin. Conclusion: The study shows that a two-week course of Tamsulosin is effective in causing spontaneous calculus expulsion in adult patients with a solitary lower ureteric calculus of size between 4 mm and 9 mm but has a lower efficacy for the calculus of size 10 mm without causing any serious side effects.

Background: Chronic Kidney Disease (CKD) is a growing global health issue, with a profound impact on patients’ quality of life (QoL). Haemodialysis, a common treatment for end-stage renal disease, often affects multiple dimensions of health-related quality of life (HRQOL). This study aims to assess the HRQOL of CKD patients undergoing haemodialysis at a tertiary care centre in Purba Bardhaman district, West Bengal. Methods: This institutional-based cross-sectional study was conducted from 1^st March to 30^th May 2024, in the dialysis unit of Burdwan Medical College. A total of 144 CKD patients, aged 18 years and above, receiving haemodialysis for at least 3 months, was included using a simple random sampling method. Data were collected through interviews using a semi-structured questionnaire for socio-demographic details and the Kidney Disease Quality of Life (KDQOL™-36) tool. HRQOL was categorized into good, moderate and poor across five domains: Physical Component Summary (PCS), Mental Component Summary (MCS), Burden of Kidney Disease (BKD), Symptom and Problem of Kidney Disease (SPKD), and Effect of Kidney Disease (EKD). Statistical analysis was performed using SPSS version 23, and Chi-Square tests were employed to identify significant factors associated with QoL outcomes. Results: The mean age of the study population was 48.36 ± 8.63 years, with 41.66% in the 40-49 years  age groups. Most patients were male (66.67%), Hindu (77.08%), and from rural areas (50%). Hypertension only (77.8%) and diabetes only (60.4%) were common comorbidities, and 18.1% had all three major comorbidities. A majority (72.9%) underwent haemodialysis twice weekly, and 59.7% had been receiving treatment for more than a year. The mean overall HRQOL score was 97.19 ± 19.06, with PCS, MCS, BKD, SPKD, and EKD subscale means of 18.46 ± 2.95, 13.67 ± 3.43, 13.31 ± 2.60, 28.54 ± 7.90, and 21.21 ± 5.04, respectively. Good HRQOL was observed in 26.38% of patients overall. In individual domains, 38.89% had good QoL in PCS, 31.25% in MCS, 27.78% in EKD and BKD, and 27.08% in SPKD. Significant predictors of QoL included age and education for PCS, and gender, residence, education, employment, and haemodialysis duration for MCS. Factors such as age, residence, socioeconomic status, comorbidities, and frequency of dialysis significantly influenced the BKD domain. Conclusion: The study highlights the multidimensional impact of CKD and haemodialysis on HRQOL. A significant proportion of patients experienced moderate to poor quality of life, particularly in the mental and physical health domains. Socio-demographic and clinical factors, including age, gender, education, employment, and dialysis frequency, were important determinants of HRQOL. Targeted interventions focusing on these factors may improve the overall well-being of CKD patients undergoing haemodialysis.

Background: UTI in SAM prevalence rates ranges from 6% to 37% in developing countries. The prevalence of UTI was significantly higher in malnourished children than in their well-nourished counterparts. Hence this study was planned to determine the incidence of UTI in SAM children, and to identify the causative organisms and their antibiotic sensitivity pattern. Objectives: To study the incidence of UTI among SAM children between 6month to 59months, to study the various organism and their culture and sensitivity pattern. Material and Methods: It was a hospital based prospective study, conducted in district NRC Ballari, BMCRC. A total of 102 SAM children who fulfilled WHO criteria for SAM were enrolled in the study. Urine microscopy and culture sensitivity were performed. The confirmatory diagnosis of urinary tract infection was made only on the basis of urine culture report. Data was entered into Microsoft excel data sheet and was analyzed using SPS22version software and Epi-info version 7.2.1 (CDC Atlanta) software. Results: Of total 102SAM children, incidence of UTI was found to be 15.7%. E-Coli was the most common organism isolated from urine culture (62.5%), followed by staph epidermidis (25%) and klebsiella (12.5%).Most of the organisms isolated were sensitive to amikacin. Conclusion: Incidence of UTI in SAM children was 15.7%.Themost common organism isolated was E.coli. Organisms showed varied sensitivity to antibiotics, hence urine culture and sensitivity should be performed in all these children.

Background: This study aimed to investigate the incidence of Ocular Surface Disorders (OSDs)—including Dry Eye Disease, Chemosis, and Exposure Keratitis—among patients admitted to the Neurocritical Care Unit (NCC). The research also sought to assess the correlation between these disorders, the length of hospitalization in the NCC, and the Glasgow Coma Score (GCS). The heightened risk of developing OSDs in the NCC environment, particularly among patients with pre-existing neurological impairments, can lead to serious complications such as dry eye disease, chemosis, corneal abrasions, and infectious keratitis. These conditions can ultimately result in corneal opacities and perforations, significantly impacting visual acuity and overall quality of life. Methods: This observational cross-sectional study was conducted from February to May 2022, examining the ocular health of all patients admitted to the NCC unit. The study assessed the presence of conjunctivitis, chemosis, keratitis, and dry eyes in relation to various factors, including: Duration of stay in the NCC, Glasgow Coma Score (GCS),  Lagophthalmos (inability to close the eyelids fully), Adherence to prescribed eye care protocols in the NCC, Use of mechanical ventilation A total of 100 subjects participated over the four-month period, with a mean age of 51.92 ± 18.73 years (age range: 17 to 89 years), including 70% males and 30% females (gender ratio of 2.33). Results: The study findings revealed the following incidences of ocular conditions: Conjunctival Hyperemia: 26 eyes (13%) Chemosis: 23 eyes (11.5%) Severe Dry Eye Disease: 41 eyes (20.5%) Statistically significant associations were observed between: GCS (p-value <0.001), Keratitis (p-value 0.0035), Dry Eyes (Chi-Square Test notably, the incidence of dry eyes was significantly higher among patients with a prolonged stay of ≥10 days (p-value 0.003). Conclusions: The study highlights the necessity for meticulous eye care and structured protocols in Neurocritical Care Units to mitigate the risk of long-term ocular complications, such as exposure keratitis. Given the increased susceptibility of NCC patients to these conditions, proactive measures are essential to ensure optimal ocular health and prevent serious visual impairments. Implementing standardized eye care practices can help enhance patient outcomes and preserve quality of life in this vulnerable population.

This study suggests that patients with migraines and photophobia have significantly larger pupil sizes compared to normal subjects without headaches. The findings indicate a correlation between pupil size and the severity of migraine disability as measured by the Migraine Disability Assessment (MIDAS) test.  Migraine patients with photophobia had a mean pupil size of 4.89 mm, while normal subjects had a mean of 3.8 mm. The difference was statistically significant. Based on MIDAS grades, patients with more severe disability (Grade 4) had the largest pupil size, averaging 5.6 mm. This indicates a potential link between larger pupil size and greater migraine severity. The study concludes that larger pupil size could potentially trigger migraine attacks, and the severity of migraine symptoms increases as pupil size increases.

Idiopathic sensorineural hearing loss accounts for the majority of cases. As a result, the outcome is determined by variables related to the type of disease and its management. These may come on suddenly or gradually. Many research are conducted to assess the correlation in abrupt diversity; however, there is still insufficient data to support causality. Studies on increasing variety and its effects are scarce. A prospective study was conducted on forty individuals with idiopathic unilateral SNHL in an effort to determine the parameters linked to the prognosis or severity of the disease. A strong correlation was discovered between distribution of random blood sugar and post therapy improvement in patients. There was no discernible correlation between the severity of progressive SNHL and any blood parameter, nor between other blood parameters and treatment outcome in abrupt SNHL. In unilateral ISSNHL, elevated blood sugar may have a detrimental impact on treatment success. Scientific research on “Unilateral Idiopathic Progressive Sensorineural Hearing Loss” shows little evidence of a connection or link with the illness’s etiology.

To research a number of factors, such as the Middle Ear Risk Index (MERI), and how they relate to the results of middle ear surgery. The study was carried out at our institute’s Department of Otolaryngology. 185 cases of a safe kind of persistent suppurative otitis media were included. These patients were admitted, given surgical care, and had follow-up records maintained for at least three months following the procedure. The study found a strong link between the outcome of tympanoplasty and MERI.

Background: The skin, being the largest organ of the body, plays a critical role in protection, temperature regulation, and sensation. Accurate diagnosis of skin disorders is essential because many different skin conditions can present with similar clinical symptoms, such as redness, itching, or scaling. However, the underlying causes of these conditions may differ significantly, ranging from infections to autoimmune diseases or genetic disorders. Histopathological examination, an invaluable diagnostic tool in dermatology. This method is particularly important in distinguishing between conditions with overlapping clinical features, ensuring that patients receive the correct diagnosis and appropriate treatment. Materials and Methods: A hospital-based study was conducted in a tertiary-level hospital in Gujarat over a 12-month period. During this period, a total of 300 skin biopsy samples were received. For each patient, relevant medical history was obtained, including presenting symptoms, previous treatments, and any other pertinent clinical or laboratory investigations. This information helped to correlate clinical findings with histopathological results. All skin biopsies routinely processed and histopathological examination was done for each biopsy. Results: Out of 300 biopsies, 60% were from male patients while it was 40% from female patients, with a male: female ratio of 1.5:1 showing male predominance. Most common histological spectrum was Dermatitis (28%), then lepromatous leprosy (58.8%) was most commonly reported among the leprosy (27.3%). Then pemphigus vulgaris (49%) was the most commonly encountered vesicobullous lesions (25.7). Conclusion: In this study, a total of 300 skin biopsies were analyzed over a one-year period at the Department of Pathology at a tertiary healthcare center. The study observed that skin lesions were more prevalent in younger age groups, with 50% of cases occurring in individuals under 40 years old. The present study observed a preponderance of skin lesions in males, with 60% of cases being diagnosed in the male population.

Background: Urethral stricture management remains a complex challenge in urology, requiring tailored surgical approaches to optimize outcomes. Local Penile Skin Flap (LPF) and Buccal Mucosal Graft (BMG) urethroplasties are two main techniques with distinct advantages and limitations. Methods: This prospective, randomized study included 52 male patients with anterior urethral strictures, divided into two groups to receive either LPF or BMG urethroplasty. Patients were followed for six months, evaluating etiology, intraoperative details, postoperative complications, and success rates. Results: Both techniques showed high success rates, with 94.4% in the BMG group and 93.7% in the LPF group achieving optimal uroflowmetry scores. BMG was associated with longer operative times and slightly higher donor site morbidity, whereas LPF showed a higher incidence of penile curvature. Conclusion: LPF and BMG both provide high efficacy in urethral stricture repair, with specific considerations influencing the choice of technique. BMG offers a robust solution for complex strictures, while LPF may be preferred for shorter operative times despite the risk of penile curvature.

Background: In underdeveloped nations like India, anaemia is one of the main causes of pregnancy-related illness and death, which ultimately has an impact on the foetus and the mother. A developing foetus is entirely dependent on its mother for development and maturity. In India, anaemia affects over 56% of women and is one of the nutritional deficient illnesses. It is among the causes of pregnancy-related foetal complications and maternal fatalities. Aim and Objectives: The objectives of this research were to evaluate the prevalence of anaemia and identify anaemia risk factors in expectant mothers at a tertiary care facility in Central India. Materials and Methods: The Department of Obstetrics and Gynaecology at a Central India tertiary care facility carried out a descriptive cross-sectional research. 52 pregnant women made up the entire sample, and they were questioned using a self-structured questionnaire to gather data and classify anaemia based on the Indian Council of Medical Research’s (ICMR) standards. Results: After providing written informed permission, 52 expectant women were hospitalised and chosen as the research sample. The following is the prevalence of anaemia among expectant mothers: In the current study, 18 (32.62%) were mild, 05 (09.62%) were moderately, and 01 (01.92%) were severely anemic. According to the current study, the most prevalent indicators of anaemia in pregnant women were hookworm (28.84%), chronic malaria (17.30%), H/O infection (23.08%), and intervals between births (40.38%). Conclusion: According to the report, anaemia has a high incidence rate of 44.2%. Pregnancy-related anaemia, which ultimately impacts the health of the mother and foetus, is significantly influenced by the time between pregnancy and H/O infection.

Background: Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic cholelithiasis. In LC, the surgeons encountered various difficulties depending on the difficulty faced during the surgery; the outcome of LC may vary from abandoning the procedure or partial cholecystectomy to conversion into open cholecystectomy. Aim: Objective of present study is to identify various factors predict the difficult laparoscopic cholecystectomy so that an early conversion to open cholecystectomy can be considered. Materials and Methods: This hospital-based observational study was conducted in the Department of General Surgery for a period of 3 years. 100 diagnosed cases of cholelithiasis undergoing for elective were included. The scores were given on history, clinical examination and sonological findings one day prior to surgery on admission. Results: Majority of the patients (82%) were given score between 0-5, positive prediction value of this scoring system for easy procedure is 70.7% & for difficult procedure is 77.8%. Majority of the patients (68%) were in age group less than 50 years, most of them (75%) were females. Maximum patients (80%) having symptoms <6 months duration. Age, gender & duration of symptoms are not statistically significant pre-operative factors for predicting difficulty (P>0.05).  BMI and Previous attacks of acute cholecystitis are the significant pre-operative factors for predicting difficulty (P<0.05).  Gall bladder wall thickness, impacted stone and contracted gall bladder on USG findings are statistically significant pre-operative factors predicting difficulty (P< 0.05), but Pericholecystic edema in USG findings is not a statistically significant pre-operative factor predicting difficulty (P> 0.05). Conclusion: The scoring system used as a protocol for predicting difficulty levels preoperatively in LC. It can help to decide the surgical approach, counsel the patients, and reduce the complication rate, rate of conversion, and overall medical cost.

Objective: This study evaluated the impact of Platelet-Rich Plasma (PRP) on the outcomes of Type 1 tympanoplasty using temporalis fascia grafts. Methodology: This study utilized a cohort prospective randomized controlled trial (RCT) design over 24 months at a tertiary care facility in Northern India to assess the effectiveness of Platelet-Rich Plasma (PRP) in Type 1 Tympanoplasty with temporalis fascia grafts. A total of sixty-five patients with chronic otitis media were randomly assigned to either the PRP group (n=32) or the control group (n=33). The randomization process ensured detached group allocation for evaluating the impact of PRP on surgical outcomes. Result: The study compared demographic and clinical factors in CSOM patients. Group 1 had fewer individuals aged 18-30 and more non-working individuals than Group 2. PRP treatment (Group 2) showed significantly higher graft uptake (90.6% vs. 69.7%, p=0.032). Group A experienced greater hearing improvement (15.06 dB vs. 14.93 dB, p=0.03) and a larger reduction in air-bone gap (24.09 ± 7.54 dB vs. 22.8 ± 8.14 dB). Follow-up attendance was high across both groups, with Group B achieving 100% attendance at all intervals. Conclusion: In conclusion, Platelet-Rich Plasma (PRP) enhances graft uptake and hearing outcomes in Type 1 tympanoplasty, as indicated by improved air-bone gap and success rates. However, the overall impact on graft uptake remains uncertain, warranting further research with optimized PRP protocols and larger, standardized trials to confirm its effectiveness.

Objectives: To evaluate whether vaginal pH alters the efficacy of dinoprostone gel for induction of labor, to find out whether vaginal pH affects cervical ripening and Bishop’s score prior to induction, and to evaluate whether parity or age affects vaginal pH. Materials and Methods: This prospective study was conducted at a tertiary care center in Kolkata for a period of 18 months, and included 200 women undergoing induction with dinoprostone gel. Participants were categorized based on vaginal pH: Group A (pH ≤4.5) and Group B (pH >4.5). The primary outcomes that were assessed included changes in Bishop’s score, time to active labour, and mode of delivery. Results: The majority of participants were aged 21-25 years, with a significant association found between higher vaginal pH and gravidity (P=0.002). Group B demonstrated greater mean changes in Bishop’s score after 12 hours (5.70 vs. 4.19), a lower need for repeat gel (57.34% vs. 78%), and a shorter induction-to-active labour duration (13.97 vs. 17.98 hours) compared to Group A. Furthermore, caesarean section rates were notably lower in Group B (24.26% vs. 51.5%). Conclusion: The study concludes that parity affects vaginal pH, which in turn significantly impacts labour induction outcomes with dinoprostone gel. Higher vaginal pH correlates with improved induction success, prompting further research to explore this relationship in a larger, randomized context. These findings indicate that higher vaginal pH positively influences the efficacy of dinoprostone gel in labour induction. The results align with some of the previous studies highlighting the role of vaginal pH in drug release and absorption, suggesting that measuring vaginal pH could enhance patient selection and improve induction outcomes.

Aim: This study aimed to compare preoperative and postoperative courses of open haemorrhoidectomy using ultrasonic energy device (harmonic scalpel) versus electrodiathermy. Materials and Methods: 50 patients undergoing haemorrhoidectomy were equally divided into two groups: 25 patients in group A (conventional method) treated with monopolar electrocautery and 25 patients in group B treated with ultrasonic scalpel. The resting pain and the post defecation pain was recorded us­ing the visual analogue scale (VAS), as well as the amount of bleeding and urinary retention. Result: Intraoperative bleeding was less in the ultrasonic scalpel group in comparison to the conventional hemorrhoidectomy and this was statistically significant (p<0.05). There was a high statistical difference between both groups according to wound healing duration (p<0.05). There was statistically significant reduction (p=0.006) in wound infection and discharge in the ultrasonic scalpel group compared to the conventional hemorrhoidectomy group. Postoperative pain in day 1 and day 2 was significantly less in the ultrasonic scalpel group compared to the conventional hemorrhoidectomy group but no difference was noticed after 1 week. Conclusion: This study concluded that ultrasonic scalpel technique is better in treating haemorrhoidectomy than the conventional hemorrhoidectomy using electrodiathermy in terms of postoperative pain, intraoperative bleeding, wound healing, wound infection and discharge.

This study investigates the relationship between dermatological health and sexual function in males and females in southern Rajasthan, focusing on a predominantly tribal population. Significant correlations were found between dermatological conditions and sexual quality of life (SQOL) in both genders, with stronger associations in females. In males, better dermatological health was linked to improve SQOL, though erectile function showed a weaker correlation. For females, moderate correlations were observed between SQOL and dermatological health, with a strong link to sexual function. These findings highlight the need for integrated healthcare approaches that address both dermatological and sexual health, particularly in underserved tribal communities.

Background: Chronic plantar fasciitis is a painful pathological condition of the foot and a challenge for the clinician to manage or treat successfully. Method: Out of 90 (ninety) patients, 45 patients were injected with corticosteroid (2 ml, 8 mg) along with 0.5 ml of plain 2% xylocaine using a 20G wide-bore needle. PRP is prepared by drawing blood from the cubital vein with the help of BD vacutainer eclipse in three BD vacutainer tubes, which are 2.7 ml tubes that contain 0.35 ml of 3.2% sodium citrate as an anticoagulant. Blood was centrifuged twice, first at 1200 rpm and then at 2400 rpm. The platelets were checked randomly by a pathologist using Neubauer’s chamber method or an auto analyzer. PRP was injected at the tenderness site after injecting 2% xylocaine with a 20-gauze needle and fol-lowing up for a week, 6th week, 3rd month, and 6th month. Results: VAS of PRP was 2.62 in PRP, 1.92 in Corticosteroid group at 6th weeks, 1.94 VAS in PRP, 2.84 in corticosteroid group at 3rd month, 1.42 VAS in PRP group, and 3.75 in corticosteroid group was observed. In comparison, AOFAS scores in both groups at different intervals had a significant p value (p<0.001). Conclusion: In the present study, it is concluded that corticosteroid therapy is more effective for short-term relief, but PRP therapy is more effective for long-term relief.

Background: Postpartum haemorrhage is one of the leading causes of maternal death in India. One of the methods of surgical management of PPH involves step wise devascularisation of uterus. Internal iliac artery ligation is one such procedure which involves the ligation of the anterior division of the artery and thereby reducing significant blood loss, maternal morbidity and mortality. Methodology: The study conducted over one year at Vani Vilas hospital, Bengaluru. All the women who underwent internal iliac artery ligation for postpartum haemorrhage over a period of one year were considered in the study. Result: Twenty cases of internal iliac artery were done in 1 year. 8 cases underwent subsequent peripartum hysterectomy whereas 12 didn’t need hysterectomy. There was reduction of maternal morbidity, blood loss and zero maternal morbidity when Internal Iliac Artery ligation was done for severe post-partum haemorrhage.

Background: Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy and associated with adverse outcomes of pregnancy for mother and baby. The aim of this study was to assess demographic parameters like age at diagnosis, parity, Maternal and neonatal complications related to gestational diabetes mellitus, mode of delivery, baby weight and plan the management of gestational diabetes mellitus. The objective of this study was to analyze feto-maternal outcome in patients with gestational diabetes mellitus. Methods: The prospective observational study was conducted in the department of obstetrics and gynecology, Narendra Modi Medical College, Ahmedabad. 90 Patients with Gestational Diabetes Mellitus were studied for feto-maternal outcome. Results: Gestational diabetes was seen commonly in patients with >30 years of age, increased parity, positive family history. Antepartum complications were seen more frequently in GDM group. Caesarean section rate was also high (74%) in diabetic group. Neonatal complications were seen more frequently in diabetic group. A significant percent (43.54%) patients developed overt diabetes over a one year follow up period. Conclusion: There was significant feto-maternal morbidity in patients with Gestational Diabetes Mellitus. Hence, early detection and treatment would reduce the feto-maternal morbidity and mortality.

Introduction: The most prevalent congenital cardiac condition in children is Ventricular Septal Defect (VSD). The purpose of our study was to examine the clinical characteristics, size, and type of VSD in paediatric patients who were hospitalised at Pacific Institute of Medical Sciences (PIMS), Umarda, Udaipur, Rajasthan India. Materials and Methods: The study was conducted in the Department of Paediatrics, Pacific Institute of Medical Sciences (PIMS), Umarda, Udaipur, Rajasthan India, during August 2023 to September 2024. A thorough history, anthropometric measurement and along with chest X-ray and ECG were done in all the cases. Anthropometric procedures were performed according to standard WHO procedure. Data was entered and analysed by using SPSS-16. Results: Regarding the clinical presentation, 55.5% of patients presented with cough and fever. Other presentation includes breathlessness (43.3%), feeding problem (37.7%), failure to thrive (37.7%) and fatigue (33.3%). Out of the thirty one patients of small VSD cases in the study, 12 (33.3%) patients were asymptomatic. The major signs in order of frequency were pansystolic murmur (100%), tachypnoea (51.1%), tachycardia (51.1%), crepitations (46.6%), subcostal retraction (37.7%), hepatomegaly (28.8%), and wheeze (26.6%) Conclusion: In our findings, Most of the patient of VSD was presented in infancy. Perimembranous was the commonest type of VSD. The clinical presentation of VSD varies from asymptomatic to severe symptoms, depending on the size of VSD. Patients of small VSD presented with mild symptoms or were asymptomatic. Moderate and large VSD mainly presented with severe symptoms. Complications like CCF, pulmonary hypertension, malnutrition and failure to thrive were mostly present in patient with moderate-to-large VSD.

Background: Community-acquired pneumonia (CAP) continues to be a major contributor to both mortality and morbidity among children under five years of age. Recently, there has been growing interest in procalcitonin (PCT) as potential biomarker for CAP. Emerging evidence indicates that a low procalcitonin level has a high negative predictive value for ruling out typical bacterial infections in pediatric patients. In light of this, the present study aims to evaluate the clinical utility of PCT in managing pediatric CAP. Materials and Methods: This hospital-based, cross-sectional, observational study was carried out on 78 children, aged between 2 months and 5 years, who were diagnosed with CAP. The study collected various clinical details including age, sex, and symptoms such as fever history, feeding difficulties, convulsions, lethargy, cyanosis, chest in drawing, respiratory rates, auscultatory findings (e.g., bilateral lung air entry, inspiratory crepitations, bronchial breathing), and oxygen saturation levels. Routine laboratory tests, including complete blood count, serum CRP, blood cultures, chest X-rays, and serum PCT levels, were conducted. Results: Of the 78 children diagnosed with CAP, 60.26% were aged between 2 to 5 months. In the study population, 69.23% showed mildly elevated serum PCT levels, while 20.51% had significantly elevated levels. A robust correlation was found between PCT levels and pneumonia severity (P < 0.01), as well as between PCT levels and clinical outcomes (P < 0.01). However, PCT’s role in aiding early diagnosis remained inconclusive. Conclusion: The study suggests that serum PCT could serve as a valuable marker for determining the severity and prognosis of CAP in children. None of the children with elevated PCT levels, who received antibiotics, developed further CAP-related complications.

Objectives: The present study was to find the diagnostic accuracy of MRI in characterizing the causes of shoulder pain in correlation with arthroscopy/surgery. And it was also to evaluate the detection and characterization of the underlying shoulder pathology in the cases of shoulder pain. Methods: MRI protocol consists of positioning the patient in supine position with external rotation of the arm. Adequate support for head and the limb is provided. Dedicated surface coil (Helmholtz pair) for shoulder is used. Technique for MRI of shoulder: After obtaining localizer in all three orthogonal planes, following sequences are obtained: Axial STIR & PD FATSAT Coronal T1, GRE and T2 FATSAT Sagittal T2 FATSAT. Results: All the 52 participants were first assessed first by MRI scan followed by arthroscopy. The MRI scans reported 20 (38.5%) FTT and 29 (55.8%) PTT. On the other hand, arthroscopy revealed 24 (46.2%) FTT and 25 (48.1%) partial thickness tears (PTT). Three (5.8%) participants did not have any grades of tears as per both the investigations. Forty-four (84.6%) of the 52 participants in our study had the same diagnosis with arthroscopy and MRI. Only 8 (15.4%) participants had different arthroscopy findings than their MRI scans. As per MRI scans and arthroscopy, there were 15 (28.8%) and 18 (34.6%) Bankart lesions, respectively. there were 14 (26.9%) and 13 (25.0%) Hill-Sach lesions, respectively. 35(67%) cases showed joint effusion on MRI and 37(71%) showed effusion. Bursitis was seen in 20 out of 52 cases on MRI and 17 on arthroscopy. 3 were diagnosed to have impingement on MRI which was confirmed on arthroscopy. Conclusions: MRI showed excellent diagnostic accuracy in evaluation of impingement syndrome, joint effusion and bursitis in correlation with arthroscopy. Hence, MRI serves as a valuable non-invasive tool for guiding clinical decision-making and optimizing outcomes in patients of shoulder pain.

Background: Tuberculous pleural effusion (TPE) presents significant management challenges due to its association with both clinical symptoms and underlying nutritional deficits. This study aimed to analyze the impact of these factors on treatment outcomes. Methods: A retrospective cohort study was conducted involving 100 TPE patients treated with standard antitubercular therapy. Data were collected on demographic characteristics, clinical symptoms, and nutritional status. Outcomes measured included resolution of pleuritic chest pain, changes in pleural rub presence, and nutritional status impact on treatment success. Results: At presentation, 82% of patients reported pleuritic chest pain, decreasing to 8% at treatment completion. The study found high rates of anemia (81%) and malnutrition (44% with BMI < 18.5 kg/m²). Pleural fluid analysis showed elevated Adenosine Deaminase (ADA) levels (>40 IU/L) in 88% of patients, supporting its diagnostic utility. Treatment outcomes were significantly influenced by nutritional status, with undernourished patients showing slower recovery. Conclusion: The study highlights the crucial interplay between clinical manifestations and nutritional status in determining the treatment outcomes of TPE. Addressing nutritional deficiencies and optimizing clinical management are essential for improving patient outcomes. Integrated care approaches, including nutritional support, are recommended to enhance the efficacy of TPE treatment protocols.

Breast carcinoma is the most common malignancy and leading cause of cancer-related mortality in females. Breast carcinomas show wide variety of features. Breast tissue and breast carcinoma are highly hormone dependent. Treatment mode and prognosis depends upon  expression of hormonal receptors like estrogen receptor(ER), progesterone receptor(PR) and and androgen receptor(AR). Nearly 70% of breast carcinoma cases are ER positive. 60- 80% breast cancer cases are positive for AR expression. 21 ER positive breast carcinoma cases from AJ Institute of Medical Science and Research Centre, Mangalore, were analysed. Immunohistochemistry analysis was performed.85.7% of the cases were AR positive. All grade 1 tumors were positive for AR expression and all grade 3 tumors were AR negative.88.9% PR positive breast carcinoma cases were AR positive. All Her2 negative cases showed AR positive expression and all Her2 3+ cases were AR positive.75% cases with less than 15% Ki67 expression and 88.2% cases with more than 15% Ki 67 expression showed AR positive expression. In conclusion, the comparison between AR expression in ER positive breast tumors with PR, HER2 and Ki67 were not found to be statistically significant. AR positivity in 85.7% of ER positive breast carcinoma indicates a possible therapeutic role for AR antagonists. The association between AR expression in breast carcinoma and other clinicopathologic parameters were not conclusive. Further studies on larger group of patients are required for better assessment of AR expression in ER positive breast cancer.

Introduction: Recurrent abdominal pain (RAP) affects 10-12% of children aged 5-15 years and poses a diagnostic challenge, as the majority of cases are functional with no identifiable organic cause. Mesenteric lymphadenopathy is commonly observed in children with RAP during ultrasonography (USG), but its clinical relevance remains uncertain. Additionally, psychosomatic factors, particularly stress, play a significant role in RAP symptom persistence. This study aimed to assess clinical and sonographic markers, including mesenteric lymphadenopathy, in RAP diagnosis and to explore the impact of psychosomatic factors on symptom severity and persistence. Materials and Methods: This prospective study included 82 pediatric patients aged 5-15 years who met Apley’s criteria for RAP, defined as at least three episodes of significant abdominal pain over three months. Clinical assessments involved pain characteristics, associated symptoms, and psychosomatic stressor evaluations. Diagnostic tests included complete blood count (CBC), urinalysis, and stool examinations, while abdominal USG was performed to assess mesenteric lymphadenopathy and other potential abnormalities. Follow-up USG was conducted after six months for patients with lymphadenopathy, and psychosomatic evaluations were repeated to assess their role in symptom persistence. Data analysis was performed using SPSS, with statistical significance set at p < 0.05. Results: Of the 82 children (mean age 7.9 years), 56.1% were male. Periumbilical pain with diurnal variation was present in 92.68% of patients, and 41.46% reported psychosomatic stressors, primarily related to school performance. Mesenteric lymphadenopathy was detected in 17.07% of patients. Follow-up USG showed resolution in 85.71% of cases, but 58.33% of those with resolved lymphadenopathy continued to experience pain. Psychosomatic stressors were significantly associated with pain recurrence, particularly in the absence of organic findings. Discussion: This study demonstrates that mesenteric lymphadenopathy, although frequently observed in children with RAP, may not be directly linked to pain persistence, as lymph node resolution did not always correspond to symptom resolution. Instead, psychosomatic factors, especially school-related stress, were more strongly associated with the persistence of RAP. These findings underscore the importance of considering psychological factors in the management of RAP and highlight the limited diagnostic utility of USG in functional cases. A holistic approach that integrates both medical and psychological interventions is crucial for improving outcomes in children with RAP.

Background: Patients with shallow anterior chambers are at higher risk of complications during cataract surgery. Micro-incision cataract surgery (MICS) has been proposed as a safer alternative to standard phacoemulsification in this population, but comparative studies are limited. Aims: To compare the outcomes of MICS and standard phacoemulsification in patients with shallow anterior chambers. Methods: In this prospective, randomized study, 500 eyes from 500 patients with age-related cataracts and shallow anterior chambers (axial anterior chamber depth < 2.5 mm) were randomly allocated to undergo MICS (n = 250) or standard phacoemulsification (n = 250). The primary outcome was the percentage of endothelial cell loss at 3 months postoperatively. Secondary outcomes included intraoperative and postoperative complications, visual acuity, refraction, surgically induced astigmatism, and patient-reported outcomes. Results: The MICS group had significantly lower rates of corneal edema (4.8% vs. 10.0%, p = 0.024), postoperative inflammation (6.0% vs. 11.2%, p = 0.036), and endothelial cell loss (11.0 ± 4.5% vs. 16.5 ± 5.2%, p < 0.001) compared to the standard phacoemulsification group at 3 months postoperatively. The MICS group also achieved significantly better visual acuity (0.08 ± 0.12 vs. 0.12 ± 0.15 logMAR, p = 0.001), less surgically induced astigmatism (0.45 ± 0.30 D vs. 0.75 ± 0.40 D, p < 0.001), and higher patient satisfaction scores (4.6 ± 0.6 vs. 4.2 ± 0.8, p < 0.001). Conclusion: MICS was associated with better outcomes compared to standard phacoemulsification in patients with shallow anterior chambers, suggesting that it may be a safer and more effective option for managing cataracts in this high-risk population.

Background: Vertigo is the most distressing symptom experienced by the patients and frequently present themselves in many specialty clinics like cardiology, neurology, general medicine, geriatric and ENT and these individual specialties have different strategies for evaluating vertigo in a particular pattern of their expertise. But due to varied etiologies, it is not easily diagnosed and often patient are referred to different specialties and being subjected to expensive and inappropriate investigations. Such an approach leads to an unsatisfied patient who waits for months to get an appropriate diagnosis of vertigo. Therefore, there is a need to take a careful, dedicated and committed history as well as thorough clinical examination to establish the cause for giddiness. Aims and Objective: To evaluate all cases presenting to ENT OPD with giddiness & to know the peripheral, central and other causes of vertigo. Material and Methods: This study included 100 patients who presented with primary complaints of vertigo or dizziness. All patients were subjected to careful history taking and thorough clinical examination was done. Results: Of the 100 patients presenting to OPD, a peripheral cause was seen in 88 patients. 38 patients were diagnosed with benign positional paroxysmal vertigo (BPPV) which is the commonest cause of vertigo, whereas 12 patients showed a central lesion of the vestibular system. Conclusion: Careful history taking and thorough clinical assessment of patients is required for reasonable evaluation of vertigo. Though vestibular causes are important, it is essential to have a broad view of the various causes of vertigo so that serious and life-threatening central causes are not missed out & should be kept in mind while evaluation.

Background: ‘Surplus time’ is the left-over time after completion of activities for survival needs of obtaining food, sleep and shelter. Structured and organized use of surplus time ccontributes to healthy development by aligning individual’s strengths with developmental assets specially in early age and it is very much important in determining social, emotional, cognitive, and other spheres of mental health also. The aim of the study was to explore the way of structuring surplus time and to assess whether there is any relation between the use of surplus hours and their psychological well-being. Material Methods: A descriptive observational cross-sectional study was done among first, second and third phase MBBS students in the College of Medicine and Sagore Datta Medical College and Hospital in West Bengal. 232 was the final sample size. Those who had any diagnosed pre-existing psychiatric disorder (as disclosed by them confidentially) or any chronic medical illness which may have some bearings on mental health were excluded. A pre-designed, validated questionnaire consisting of two sections, first section having 13 items included personal information, own opinion regarding academic achievement, information regarding his/ her self-physical, social-media activities, creative leisure time activities, self-development related activities, daily activities of personal preferences and any other specific activities other than those mentioned and second section with General Health Questionnaire (GHQ-28) was used for data collection. Statistical analysis was performed using Chi-square test and independent t-test to test the significance. Results: Overall 43.1% of students were screened by GHQ as having psychiatric problem. Greater proportion of students involved in activities like exercise, playing outdoor game, speaking with friends and relatives, creative writing, performing music/dance/drama, reading books other than study material also had low GHQ score , so were screened as non-psychiatric and significant difference in their mental health status were also found for activities like exercise (p=0.000), outdoor games (p=0.000), speaking with friends and relatives (p=0.001), creative writing (p=0.000), performing music/dance/drama (p=0.000), reading books other than study material (p=0.000). Whereas greater proportion of students who were the users of content community, social net-working, playing virtual game and indoor game, were found to have higher GHQ score and significant difference in their levels of  psychological well-being were also found. Conclusion: From the study it was found that time spent on social media activities had negative impact on mental health status of the students, whereas creative leisure time activity, self-development related activity had positive impact on psychological wellbeing. Though no relation had been found between time spent on physical activity and mental health, exercise, outdoor game had positive association with mental health status.

Background: Laryngoscopy and endotracheal intubation are routine yet critical procedures that often provoke significant cardiovascular stress responses, such as tachycardia and hypertension. Managing these hemodynamic responses is vital, particularly in patients with cardiovascular risk. This study compares the efficacy of intravenous dexmedetomidine and esmolol in attenuating these responses during laryngoscopy and intubation. Aim and Objective: To compare the effectiveness of intravenous dexmedetomidine and esmolol in reducing cardiovascular responses (heart rate and blood pressure) during laryngoscopy and endotracheal intubation and to evaluate their safety profiles. Materials and Methods: This randomized, double-blind, controlled trial included 60 patients (aged 18–65 years) with ASA grade I or II scheduled for elective surgeries under general anesthesia. The patients were randomly assigned to one of two groups: Group A received dexmedetomidine (1 mcg/kg), and Group B received esmolol (1.5 mg/kg), diluted to 20 mL with normal saline. Hemodynamic parameters, including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP), were recorded at various time points: baseline, post-drug administration and at multiple intervals post-intubation. Statistical analysis was conducted using Student’s t-test and chi-square tests. Results: Both dexmedetomidine and esmolol significantly attenuated the cardiovascular responses to laryngoscopy and intubation. However, Group A (dexmedetomidine) showed superior control over heart rate and blood pressure compared to Group B (esmolol), particularly immediately after intubation. Group A exhibited lower heart rate, SBP, DBP, and MAP post-intubation (p < 0.05). Adverse effects such as bradycardia were observed in the dexmedetomidine group, but these were transient and manageable. Conclusion: Intravenous dexmedetomidine is more effective than esmolol in attenuating the cardiovascular responses to laryngoscopy and intubation. Its use can provide better hemodynamic stability in high-risk patients, though careful monitoring is required due to the potential for bradycardia and hypotension. Further large-scale studies are recommended to confirm these findings.

Background: Caudal epidural blocks are a widely used regional anesthesia technique in pediatric surgery, offering effective pain control with minimal side effects. Aim and Objectives: To compare the efficacy and safety of Ropivacaine and Levobupivacaine, each combined with fentanyl, for postoperative analgesia in pediatric patients undergoing infraumbilical surgeries. Materials and Methods: This prospective, randomized study included 50 pediatric patients aged 3-12 years with American Society of Anesthesiologists (ASA) physical status I and II. Patients were randomized into two groups: Group A received Ropivacaine 0.25% (0.5 ml/kg) with fentanyl (0.1 µg/kg), and Group B received Levobupivacaine 0.25% (0.5 ml/kg) with fentanyl (0.1 µg/kg). Hemodynamic parameters, postoperative analgesia duration, and complications were monitored postoperatively. Data were analyzed using SPSS version 20.0, with p < 0.05 considered statistically significant. Results: The mean Duration of postoperative analgesia was 4.96 ± 0.79 hours for Group A and 4.88 ± 0.79 hours for Group B, with no statistically significant difference between the groups (p = 0.720). Hemodynamic parameters, including heart rate, systolic and diastolic blood pressure, mean arterial pressure, and oxygen saturation, remained stable in both groups with no significant differences. One patient in Group A experienced seizures, which was the only complication reported. Conclusion: Both Ropivacaine and Levobupivacaine, when combined with fentanyl, provided comparable durations of postoperative analgesia in pediatric patients undergoing infraumbilical surgeries. The hemodynamic stability and low incidence of complications in both groups suggest that both anesthetics are safe and effective for pediatric caudal blocks. However, larger multi-center studies with varying drug concentrations are recommended to validate these findings further.

Background: Many adjuvants have been explored in the past in numerous trials to extend the duration of analgesia in supraclavicular brachial plexus block, but the perfect adjuvant has not yet been found. It has been shown that adding dexmedetomidine, a selective Alfa-2 adrenergic agonist, to a local anaesthetic prolongs the block duration and post-operative analgesia in a variety of regional blocks. Aims and Objectives: The goals and objectives are to investigate the hemodynamic effects of adding dexmedetomidine with ropivacaine in supraclavicular brachial plexus block, as well as the start and duration of sensory and motor blockade and postoperative analgesia. Materials and Methods: Two groups of sixty patients, of both sexes and classified as class I and II by the American Society of Anesthesiologists and scheduled for upper limb surgery under supraclavicular brachial plexus block, were randomly assigned. The patients ranged in age from 18 to 60 years. Group B got 20 mL of 0.5% ropivacaine in brachial plexus block with dexmedetomidine intravenous infusion at 1 μg/kg over 10 min, whereas Group A received 20 mL of 0.5% ropivacaine in brachial plexus block with adjuvant perineurally at a dose of 1 μg/kg. Non-invasive intraoperative blood pressure, heart rate, SpO2, and sedation were monitored every 5 minutes during the first 10 minutes and then every 15 minutes until the conclusion. The initial rescue analgesic’s time, the postoperative pain’s severity, and the overall amount of analgesic needed were all noted. Results: Group A had sensory and motor block onset was more quickly than Group B. Group A had analgesia for a longer period of time than Group B. Group A maintained hemodynamic stability better than Group B. Group B sedation was superior. Conclusion: In supraclavicular brachial plexus blocks, dexmedetomidine is a more effective adjuvant than ropivacaine in terms of delivering a quicker start of motor and sensory blocks as well as a longer duration of postoperative analgesia with improved hemodynamic stability.

Background: Postoperative delirium is a common complication in elderly patients undergoing major abdominal surgery. Dexmedetomidine, a selective alpha-2 adrenergic agonist, has shown potential in reducing the incidence of delirium through its sedative and analgesic properties. Objectives: This study aims to evaluate the efficacy and safety of perioperative dexmedetomidine infusion in reducing postoperative delirium in elderly patients undergoing major abdominal surgery. Methods: A prospective study was conducted with 100 elderly patients undergoing major abdominal surgery. Patients were randomized into two groups: one receiving perioperative dexmedetomidine infusion and the other receiving standard care. Data on delirium incidence, opioid consumption, hemodynamic stability, and adverse effects were collected. Results: The dexmedetomidine group exhibited a significantly lower incidence of postoperative delirium, reduced opioid consumption, and stable hemodynamics compared to the control group. Conclusion: Perioperative dexmedetomidine infusion is effective and safe in reducing the incidence of postoperative delirium in elderly patients undergoing major abdominal surgery, with the added benefit of opioid-sparing effects.

Background: Effective postoperative pain management is crucial in gynecologic surgery to enhance patient recovery and satisfaction. Multimodal anesthesia uses a combination of analgesic techniques to improve pain relief, reduce opioid use, and speed up recovery. Objectives: To evaluate the effectiveness of multimodal anesthesia in reducing pain, opioid consumption, and adverse effects in patients undergoing gynecologic surgeries. Methods: A prospective study was conducted with 100 patients undergoing elective gynecologic surgeries. Patients were divided into two groups: one receiving multimodal anesthesia and the other receiving traditional opioid-based analgesia. Data on pain scores, opioid use, adverse effects, and recovery milestones were collected. Results: Patients in the multimodal group experienced significantly lower pain scores, reduced opioid use, and fewer side effects compared to the traditional analgesia group. Conclusion: Multimodal anesthesia provides superior pain control, minimizes opioid requirements, and enhances recovery, making it a preferable approach for managing postoperative pain in gynecologic surgeries.

Background: Posterior circulation strokes account for a significant proportion of all strokes and present with a variety of clinical manifestations, including ataxia. Accurate quantification of ataxia severity can aid in understanding the impact of different posterior circulation stroke patterns. Objective: This study aims to quantify the severity of ataxias in patients with posterior circulation strokes and identify risk factors associated with specific stroke patterns using MRI. Methods: We conducted a cross-sectional observational study involving 115 patients with MRI-proven posterior circulation ischemic strokes. All patients had symptom onset within 7 days. The severity of ataxias was assessed using the International Cooperative Ataxia Rating Scale (ICARS). Stroke patterns were categorized based on MRI findings into various territorial patterns, including PICA-CH, SCA-CH, CH/CP, and peduncular patterns. Results: The study population had a mean age of 57.3 ± 6.6 years, with hypertension (94.7%) being the most prevalent risk factor. Gait ataxia was present in all patients, while limb ataxia, dysarthria, and nystagmus were observed in 81.7%, 46.08%, and 60.8% of patients, respectively. The PICA-CH pattern was identified in 27% of cases, CH/CP in 23.5%, and SCA-CH in 14.8%. Severity of ataxias varied significantly across stroke patterns. The highest mean ICARS scores were observed in the SCA-CH pattern, while the lowest were in the PICA-CH pattern. Hypertension was significantly associated with increased severity of ataxias. Conclusion: The severity of ataxias in posterior circulation strokes varies according to the involved territory. SCA-CH strokes are associated with the highest severity, while PICA-CH strokes show the least severity. Hypertension is a major risk factor influencing the severity of ataxias. These findings highlight the importance of targeted management and rehabilitation strategies based on stroke patterns and associated risk factors.

Introduction: Social cognition is defined as one’s ability to perceive and understand other people’s thoughts, feelings, and behaviour and to respond appropriately. Many neurological disorders affecting the brain leads to disruption in social cognitive function. Many studies which were done among people with epilepsy showed impairment in social cognition, which in turn resulted in impaired quality of life, employability, and other cognitive functions especially in PWE with temporal lobe (TLE) and extratemporal (ETE) epilepsies. Identifying the nature and magnitude of social cognitive impairment in people with epilepsy has both theoretical and clinical implications, including the potential to form guidelines for clinical assessment and psychosocial intervention. Methodology: Patient more than 18-year-old with epilepsy and who are stable on antiseizure medication (ASM) were included in the study after taking consent. The quality of life of PWE was assessed using the 31-item Quality of Life in Epilepsy inventory (QOLIE-31 translated to local language) QOLIE31. Measures of social cognition include tests of emotion recognition (ER) and the assessment of theory of mind (ToM). Three cognitive tests were used to measure the patients’ ability to understand human emotion and behavior.  Results: It was observed that those persons with epilepsy performed worse on ToM task compared to healthy controls. The performance of ToM task among different types of epilepsy was similar. There was significant negative association between ToM tasks and duration of epilepsy and number of antiseizure medication used. The overall quality of life and social function was better in patients who scored more in RMET (Reading of the Mind in the Eyes test) and FPRT (Faux Pas Recognition Test) tasks. Conclusion: Social cognition is significantly affected by seizure especially when the duration of seizure and number of ASM increases. Overall quality of life is also affected when there is impairment in social cognition. The study shows that a higher performance score in ToM tasks may not be essential to be in a good relationship.

Introduction: Cesarean section is the single most important risk factor for postpartum infection. Where the rest of the world shows increasing trends, the cesarean section rates are low in Norway and risk factors for infection after cesarean section may differ in high and low cesarean section settings. The goal of this study was to examine risk factors for surgical site infection after cesarean delivery. Material and Methods: A prospective study conducted in the department of obstetrics & gynecology of M.L.B. Medical College, Jhansi during the period of 1st January 2023 and 31st December 2023. All women who are developing any form of wound infection within 30 days from the date of caesarean section using the criteria for CDC5 1991. . Surgical wound was inspected at the time of first dressing and daily thereafter till discharge of the patient and then all patients were followed up in postnatal clinic till the 30th postoperative day. Main outcome measures were anticipated risk factors for surgical site infection. Results: During study period there were a total of 3257 births in the tertiary care hospital, out of them 1498 (45.99%) had cesarean section. One hundred sixteen cases of surgical site infections were identified. The incidence rate of surgical site infection among cesarean section was calculated to be 7.74%. Most of the cases were diagnosed within 10th postoperative day. In this study common bacterial pathogen was Staphylococcus aureus found in 22 (18.97%) cases followed by E. coli in 17.24% of cases. Conclusion: Risk factors like BMI, comorbidity, emergency caesarian delivery, Duration of membrane rupture, blood loss during surgery significantly associated with the development of SSI. Predominantly staphylococcus aureus, E. coli and Staphylococcus spp was isolated from SSI. Early identification of micro-organisms might decrease maternal morbidity & mortality.

Introduction: Pregnancy induced hypertension is a common health problem that affects mother as well as fetus. Hypertensive disorders complicate about 5-10% of all pregnancies and together they are the major contributors of maternal deaths along with infection and hemorrhage. Hypertensive disorders of pregnancy include gestational hypertension, preeclampsia and eclampsia syndrome, pre-existing chronic hypertension and preeclampsia superimposed on chronic hypertension. These are responsible for 9.1% maternal fatalities in Asia and Africa. Approximately 70% of women with PIH will have gestational hypertension-preeclampsia. PIH leads to maternal complications like abruptio placenta, DIC, HELLP syndrome, ARF, intracerebral hemorrhage, pulmonary edema and even death. Prematurity and its associated complications, low birth weight, growth restriction, low APGAR scores, neurologic injury are adverse neonatal effects of the disease. Objective: Present research was conducted to study the fetomaternal outcome in pregnancy induced hypertension (PIH) in singleton pregnancy at tertiary care center. Materials and Methods: Present cross-sectional observational study was conducted at Dhiraj General Hospital (SBKS MI&RC), Piparia, Waghodia, Vadodara, Gujarat among 170 participants over a period of one and a half year. Detailed history including menstrual history, obstetrics history, past history, personal history, marital history, family history of the patient was taken. General and obstetrical examination were carried out. Partographs were used to track intrapartum occurrences. Details including the mode of delivery, the medical care provided, any complications (both maternal and fetal), and eventually the outcome for both the mother and the newborn were documented. Being an observational study rates, ratios and percentages were calculated. Results: PIH incidence rate was 9.5%. Preeclampsia (46.5%) was found to be more common than gestational hypertension (38.8%) and eclampsia (14.7%). PIH was more frequent in the 21 to 25 age group (57.6%) and in primipara. 54.1% patients delivered vaginally while cesarean section was done in 45.9%. Maternal complications like abruptio placenta, PPH, and pulmonary edema were seen in 4.7%, 2.35%, and 2.35% of women, respectively. Maternal mortality was seen in 0.6% of the women with PIH. Low birth weight was found in 52.4% of newborns while the rates of IUD, stillbirth, and infant mortality were 5.9%, 1.2%, and 1.8%, respectively. Conclusion Pre-eclampsia and Eclampsia still remains a big concern in pregnancy. Feto-maternal outcomes are susceptible to deterioration in the presence of PIH. In situations of eclampsia, early administration of antihypertensive medicines, optimal timing of delivery, proper fluid balance, and anticonvulsants aid in achieving a favorable result. Early registration and frequent ANC visits in order to identify pregnancy-induced hypertension as early as possible is advocated to avoid its severity and related consequences. Detection and control of problems at an early stage and timely referral are essential for ensuring a good outcome for both mother and child.

Background: Teneligliptin is a DPP-4 inhibitor widely used in the management of Type-2 Diabetes Mellitus (T2DM) to improve glycemic control. While both branded and generic versions are available, there is limited data comparing their therapeutic efficacy and safety, particularly concerning lipid profiles and renal function. This study aimed to compare the therapeutic outcomes and safety profiles of branded versus generic Teneligliptin in managing glycemic control and lipid profiles in patients with Type-2 Diabetes Mellitus (T2DM). Methods: A total of 200 patients with T2DM were randomized to receive either branded or generic Teneligliptin for six months. Efficacy was assessed through changes in HBA1C, fasting blood sugar (FBS), lipid profiles (cholesterol), and serum creatinine levels at baseline, 3 months, and 6 months. Results: Both branded and generic formulations effectively reduced HBA1C levels from 7.50% to 6.40% and 7.90% to 6.50%, respectively, after 6 months. The overall reduction was slightly higher in the branded group (1.10% vs. 1.40% in the generic group). FBS showed a comparable reduction, with branded Teneligliptin lowering FBS from 170 mg/dl to 166 mg/dl and the generic formulation from 178 mg/dl to 165 mg/dl. Cholesterol levels were reduced in both groups, with branded Teneligliptin showing a more significant decrease (197 mg/dl to 175 mg/dl) compared to the generic (199 mg/dl to 178 mg/dl). Serum creatinine levels rose slightly in both groups, with the branded formulation showing a greater increase (0.82 mg/dl to 0.98 mg/dl) than the generic (0.60 mg/dl to 0.86 mg/dl), though no significant renal impairment was noted. Conclusion: Both branded and generic Teneligliptin are effective in improving glycemic control and lipid profiles in T2DM patients. However, the branded formulation demonstrated a marginally better effect on lipid management, while both formulations showed similar safety profiles.

Background: Self-medication, defined by the World Health Organization (WHO) as the use of prescription drugs without medical guidance, is a common and concerning public health issue, especially among university students. Most of the over the counter (OTC) medications taken without due consultation but through other sources may lead to unwanted side effects and inadequate treatment of the problem. This study aimed to assess the prevalence, patterns, and determinants of self-medication for skin problems among students in an engineering college in Chennai, India. Methods: A cross-sectional analytical study was conducted at a university in Chennai. A pre-tested, semi-structured questionnaire was administered, collecting information on demographic characteristics, medication usage, disease types, reasons for not seeking professional help, and sources of medication advice. Results: The study revealed that 59.93% of study participants were engaged in self-medication, predominantly for hair and skin conditions. Hair fall (73.09%) and dandruff (55.14%) were the most common issues addressed through self-medication. Students chose self-medication primarily because they perceived their illness as minor (26.67%) or had prior experience with the condition (20.37%). Most of the students view self-medication as a part of self-care and believe that it should be practised (89.81). There was a statistically significant association between this attitude towards self-medication and the actual practice of self-medication. (CI 95% 1.000-4.834, OR 2.199). Conclusion: This study emphasised the need for awareness among the non-medical university students about the potential risks associated with self-medication, including adverse effects and the importance of seeking professional medical advice for dermatological conditions. The study showed that most students endorse the practice of self-medication. Nevertheless, all medications, including over-the-counter (OTC) drugs, are associated with their own set of consequences. This emphasises the urgent need for education on the potential risks associated with it.

Background: Chronic liver disease is progressive destruction of liver parenchyma over a period of 6 months leading to fibrosis and cirrhosis .Clinical course of patients with chronic liver disease is complicated by progressive impairment of circulatory function. Three major pathophysiologic features of cardiac dysfunction of these patients are – structural and functional ventricular abnormality (in form of left ventricular hypertrophy and diastolic dysfunction, electrophysiological abnormality (prolonged corrected QT interval), ventricular dysfunction in response to stress or exercise. Objectives: To evaluate the echocardiographic changes in chronic liver disease patients and to correlate the severity of chronic liver disease according to child – pugh class with cardiac dysfunction. Study design: Observational Cross sectional study design. Materials and Methods: 100 patients with chronic liver disease were included. All the study participants were subjected to do routine blood investigations and ultrasound scan abdomen to confirm the diagnosis of chronic liver disease. The parameters that were assessed in echocardiography are E/A ratio, end diastolic volume (EDV), end systolic volume (ESV), ejection fraction. QTc interval more than 440 msec and E/A ratio less than 1 were considered diagnostic of cirrhotic cardiomyopathy. Results: Out of 100 patients studied, 81% were males. The mean years of age of the patients were 44.4 + 7.32. The Mean years of duration of illness was 2.38 +1.57years. Alcohol was the leading etiological cause followed by hepatitis. Association between Child Turcotte Pugh Class B& C and myocardial dysfunction were found to be significant. Conclusions: Patients with Child-Pugh C cirrhosis showed increased systolic and diastolic myocardial dysfunction and also longer QT interval than Child-Pugh A or B patients. Thus, an evaluation of myocardial function should be considered in patients with chronic liver disease especially for Child- pugh class C.

Background: Tuberculosis (TB) is a major health burden in the world. About 10.6 million people fell ill with TB and approximately 1.6 million deaths have occurred in the year 2021. Tuberculosis (TB) and diabetes mellitus (DM) are two diverse conditions of immense public health importance existing for centuries. TB is today one of the commonest and widespread communicable infectious diseases largely but not necessarily confined to low-economic groups. DM on the other hand spearheads the group of chronic non-communicable diseases affecting people across all socio-economic strata. This study aimed to compare the clinico-radiological features of Pulmonary Tuberculosis patients with and without Diabetes Mellitus. Method: We performed a prospective analysis of all patients who were microbiologically confirmed positive patients of pulmonary TB, aged 18 years or older or had extra-pulmonary involvement with pulmonary TB, between July 2022 to June 2024, at Era’s Lucknow Medical College and Hospital, Lucknow. We also evaluated the proportion of patients, who were diabetics or non-diabetics, and were affected by pulmonary tuberculosis, by their follow up. Results: We performed study on a total of 148 patients, divided into two groups: 74 patients with both pulmonary tuberculosis and diabetes mellitus, and 74 patients with pulmonary tuberculosis but without diabetes mellitus. The study aimed to compare the clinico-radiological features of Pulmonary Tuberculosis patients with and without Diabetes Mellitus. Conclusion: Fever and expectoration are more prevalent in pulmonary tuberculosis (PTB) patients with diabetes, although these differences are not statistically significant.

Background: Euvolemic hyponatremia is a common electrolyte imbalance observed in hospitalized elderly patients. It is often associated with conditions like Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH), medications, and chronic illnesses. Given the complexities of its diagnosis and management, understanding the clinical profile of elderly patients with euvolemic hyponatremia is crucial for improving patient outcomes. This study aims to evaluate the clinical characteristics, underlying etiologies, and outcomes of euvolemic hyponatremia in a sample of 50 elderly hospitalized patients. Methodology: A prospective observational study was conducted in a tertiary care hospital over six months. Fifty elderly patients (aged ≥ 60 years) with confirmed euvolemic hyponatremia (serum sodium < 135 mEq/L, normal total body water) were included. Patients with hypervolemic or hypovolemic hyponatremia were excluded. Detailed medical histories, including medication use, comorbidities, and clinical presentations, were recorded. Laboratory parameters, including serum sodium, osmolality, and urine sodium, were analysed. Data was statistically analyzed to identify significant trends and correlations. Results: The current study observed a male predominance (62%) among elderly patients with euvolemic hyponatremia. A significant proportion of patients presented with severe (42%) and moderate (40%) hyponatremia, which aligns with similar studies reporting delayed diagnosis due to masked symptoms in the elderly. SIADH was identified as the leading cause (48%), often linked to medications and comorbidities. Lethargy (56%) and postural dizziness (36%) were the most common symptoms, with severe cases exhibiting CNS complications like confusion and seizures. Severe hyponatremia significantly increased the risk of mortality (20%, p=0.01), emphasizing the need for early intervention. Discussion: This study highlights that euvolemic hyponatremia in elderly hospitalized patients is predominantly linked to SIADH and medication use. The clinical presentation is often nonspecific, emphasizing the importance of careful evaluation to prevent misdiagnosis. Timely intervention with fluid restriction and management of the underlying cause can lead to favourable outcomes, although comorbid conditions continue to pose significant challenges. Further research is needed to explore preventive strategies and optimize treatment protocols in this vulnerable population. Conclusion: Euvolemic hyponatremia in the elderly is a multifaceted condition with diverse etiologies and presentations. Early identification and targeted therapy are essential to minimize hospital stays and complications.

The most common heart valve affected by rheumatic heart disease (RHD) is the Mitral Valve. The bileaflet mechanical heart valves have demonstrated their superiority over previous designs in surgical management of RHD. It is better in terms of lower transvalvular gradients, a more physiologic flow pattern distribution, and, possibly, a lower thrombogenic potential. In 2018, the new MILTONIA mechanical bileaflet valve manufactured by Meril Life Sciences Pvt. Ltd. was approved for clinical use by the Indian authorities. The main advantage of this model over other leaflet models was the possibility of rotation once implanted, utilizing a new sewing ring design. We have performed mitral valve replacement in three continuous cases of RHD induced severe mitral valve stenosis using the MILTONIA mechanical bileaflet valve. The results of the procedure have been very satisfactory with none of the patients showing any valve-related complications like thrombosis, endocarditis and anticoagulation-related bleeding in a follow up period of 3 years. The authors believe that the use of the Miltonia valve is very safe and effective. A study with a larger patient population and longer follow-up is warranted to assess the device further.

Introduction: Thyroid diseases are common worldwide and its prevalence in India is about 42 million. It is more common among women than in men, and also it increases with age. Among the thyroid diseases, Hypothyroidism is a multiorgan disorder that occurs due to decrease in thyroid hormone synthesis; which is associated with low circulating levels of thyroid hormones. Iron plays an important role in thyroid hormone synthesis along with other minerals. Ferritin, is an important indicator of body iron stores, and its level is altered in Hypothyroidism. Various studies reveal that most of the hypothyroid individuals do suffer from associated anaemia due to iron deficiency. Iron deficiency can be detected earlier using serum Ferritin, since it out-performs in its sensitivity & specificity than many other iron deficiency markers thereby preventing cognitive ailments.  Aim: This study was conducted to assess the diagnostic role of serum Ferritin in Hypothyroid individuals and to find out its association with Thyroid hormone levels. Materials and Methods: This cross-sectional study included 100 subjects (50 subjects of Hypothyroids as cases and 50 subjects of Normothyroids as controls) with age group 20-50 years of both genders. Blood samples were collected under strict aseptic precautions, and serum Total T3, T4, TSH & serum Ferritin levels were assayed. Data was analysed statistically using suitable SPSS statistical package (version 21.0). Results: There was a statistically significant decrease in serum Ferritin levels in hypothyroid individuals (40.6µg/l), when compared to Normothyroid individuals (82.9µg/l) with female preponderance.  Also, there was a statistically significant positive correlation between serum Ferritin and Thyroid hormone levels (Total T4) in hypothyroid individuals. There was also a statistically significant association between serum Ferritin and Thyroid hormone levels (Total T3 and Total T4) with (p<0.05). Conclusion:  Serum Ferritin levels are significantly reduced in patients with Hypothyroidism. Thus, serum Ferritin can be used as an effective diagnostic marker in patients with Hypothyroidism, which can be used for diagnosis, monitoring and follow up of treatment in Hypothyroids, as well as for early detection of Iron deficiency anaemia, thereby preventing the development of dementia and cognitive decline in Hypothyroid individuals by early intervention.

Introduction: The ever-growing impact of the digital landscape on medical students necessitates a nuanced examination of internet, social media use, and gaming patterns. This study explores these digital habits among medical students in Gujarat, India. Objective: To discern the multifaceted aspects of internet and social media engagement, gaming preferences, and their potential impact on the well-being of medical students. Methods: A cross-sectional research design was employed, encompassing medical students from a tertiary care teaching hospital in Gujarat. Ethical clearance was secured for voluntary and informed participation. A meticulously designed questionnaire facilitated comprehensive data collection. Demographic details, internet and social media usage patterns, gaming habits, and their implications were explored. Results: Demographic analysis revealed diverse academic year distribution, age categories, and gender representation. Sleep-related behaviors exposed intriguing patterns, with 27.4% preferring to sleep before 10:00 PM, 41.2% opting for bedtime between 10:00 PM and 12:00 AM, and 20.7% being night owls. Notably, 58.8% admitted to nocturnal social media engagement, with 58.1% reporting a sleep duration of 6-8 hours. Study provided a holistic view of participants’ health, academic performance, and gaming habits. Noteworthy findings included diverse physical activity levels (34.5% in moderate activity, 47.9% in high activity), prevalent information-seeking motives for social media use (81.0%), and varied gaming preferences. Conclusions: This study underscores the need for tailored interventions addressing the digital habits of medical students, considering their diverse engagement patterns and potential implications. Future initiatives should incorporate these insights to promote a balanced digital lifestyle among medical students.

Background: Glaucoma is a diverse group of eye diseases with a multifactorial etiology characterized by an acquired loss of retinal ganglion cells, progressive optic neuropathy with morphological abnormalities in optic nerve head, and visual field defect, in which raised intraocular pressure is a major and one of the modifiable risk factor and other risk factors includes age, gender, race, family history, systemic diseases, sociodemographic profile, etc. Glaucoma is a major public health problem, causing visual impairment which hampers day-to-day work. Aims & Objective: 1. To study various risk factors For Glaucoma among patients attending OPD/IPD of RIO, GMCH. 2. To assess various socio-demographic, modifiable lifestyle-associated factors and other ocular diseases related to Glaucoma. Materials and Methods: In this hospital-based case-control study, considering p=10%, the sample size was calculated to be 570. Out of which 285 Cases and 285 Controls were selected from OPD/IPD of RIO, GMCH in a ratio of 1:1 after adjusting for age and sex. Verbal/written consent was taken followed by a detailed history was documented through a standardized predesigned and pretested proforma. Results: All the data were analyzed and statistical significance was determined using SPSS software. A high prevalence of glaucoma was seen among males and most of the glaucoma cases belong to age 50-59 years. Statistically, a significant association was seen between age and Glaucoma but an insignificant association was seen with Gender. A high level of IOP (OR: 96.08, CI: 40.565-123.10 p-value: <0.0001), history of smoking (OR:1.515, CI:1.086- 2.113, p-Value-0.0181), history of alcohol use (OR:1.514, CI:1.072-2.139, p- Value:0.0230), history of use of steroid (OR:1.604, CI:1.123- 2.291, p-Value:0.0118), History of Myopia (OR:1.711, CI:1.228- 2.385, p-Value:0.0019), History of Diabetes Mellitus (OR:1.472, CI:1.048-2.066, p-Value:0.0315), history of Hypertension (OR:1.463, CI:1.051-2.034, p-Value:0.0294) showed statistically Significant association with Glaucoma. Whereas, other factors failed to show statistically significant association with Glaucoma. Conclusion: In this study, various factors like smoking, alcohol use, and steroid use, high BP, high blood sugar, and some ocular factors (high IOP, Myopia) were found to be related to risk for Glaucoma. The mechanisms by which these factors lead to an increased risk of Glaucoma are still poorly understood, further study is needed to understand the significance of these as well as other factors as a risk for developing Glaucoma.

Introduction: Hypertension, or raised blood pressure, is a major public health problem in India. Medical professionals are highly susceptible to hypertension. We studied to estimate the prevalence of hypertension among medical professionals, to assess their knowledge about hypertension and to assess awareness about lifestyle measures. Materials and Methods: It was a cross-sectional study done among medical professionals at American international institute of medical sciences, Udaipur. A total of 220 subjects, aged 23 to 60 years, 145 males and 75 females, were included. Results: 93.3% consider their blood pressure to be controlled. 45.4% (100/220) of professionals were normotensive, 43.2% (95/220) had stage 1 hypertension, and 11.3% (25/220) had stage 2 hypertension. 70% (55/78) in the obese category, 56% (29/52) in the overweight category, and 41.8% (38/90) in the normal BMI group were hypertensive. Most people are aware of hypertension and the lifestyle measures that affect blood pressure. Conclusions: A high prevalence of hypertension was found among medical professionals. BMI, a modifiable risk factor, can be addressed to reduce the magnitude of hypertension in this study group.

Background: Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease associated with an increased risk of cardiovascular disease (CVD), partly due to accelerated atherosclerosis. Dyslipidemia and systemic inflammation in RA patients may contribute to this risk. This study aims to evaluate the lipid profile in RA patients and its correlation with disease activity and subclinical atherosclerosis, assessed by carotid intima-media thickness (CIMT). Methods: Fifty-four RA patients aged over 18 years, fulfilling the American College of Rheumatology/European League against Rheumatism criteria, were enrolled. Patients with conditions affecting lipid metabolism or cardiovascular status were excluded. Clinical assessments included the Disease Activity Score using 28 joints (DAS28). Fasting lipid profiles were measured, including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), very low-density lipoprotein cholesterol (VLDL-C), and triglycerides (TG). CIMT was measured using high-resolution B-mode ultrasonography. Correlations between lipid parameters, DAS28 scores, and CIMT were analyzed. Results: The study population had a mean age of [mean ± SD years], with a female predominance. Elevated DAS28 scores indicated moderate to high disease activity. Lipid profile analysis showed that RA patients had decreased HDL-C levels and altered TC/HDL-C and LDL-C/HDL-C ratios. Significant inverse correlations were found between HDL-C levels and DAS28 scores (p < 0.05). CIMT measurements revealed that a substantial proportion of patients had increased CIMT (>0.8 mm), indicative of subclinical atherosclerosis. CIMT positively correlated with DAS28 scores and negatively with HDL-C levels (p < 0.05). Conclusion: RA patients exhibit dyslipidemia characterized by reduced HDL-C levels, which correlates with increased disease activity and subclinical atherosclerosis. The findings underscore the importance of regular lipid monitoring and cardiovascular risk assessment in RA patients. Early intervention targeting lipid abnormalities and inflammation may help reduce the risk of CVD in this population.

Introduction: Augustus Bier performed the first spinal anaesthesia using cocaine in 1889. Bupivacaine 0.5% heavy was the only drug used for spinal anaesthesia after the discontinuation of lidocaine’s intrathecal use. Bradycardia and hypotension are the hemodynamic side effects of use of high dose of local anaesthetic agent to prolong the duration of analgesia. Neostigmine is a cholinesterase inhibitor which leads to an increase of the acetylcholine concentration. The present study was undertaken to compare the efficacy of fentanyl and neostigmine as adjuvants to hyperbaric bupivacaine (0.5%) in subarachnoid block for lower abdominal and lower extremity surgery. Materials and Method: The present study was carried out as Analytical comparative study. The study was carried out at Department of Anaesthesiology, Era’s Lucknow Medical College, Lucknow. Era’s Lucknow Medical College is a tertiary care centre with state-of-the-art infrastructure catering primarily to socio-economically underprivileged suburban and rural population of Lucknow area for eighteen months (November 2017 to June 2019). After obtaining approval from the Institutional Ethical Committee, 96 ASA I & II   patients fulfilling the inclusion criteria were included in the study. Thereafter, these patients were randomly allocated into three equal groups of 32   patients   each   with   the   help   of Computer Generated  Randomization as under: Group I (Experimental Group): 32 patients received Injection Fentanyl (25 mcg) in combination with hyperbaric Bupivacaine (0.5%) spinal anaesthesia. Group II (Experimental Group): 32 patients received Injection Neostigmine (25 mcg) in combination with hyperbaric Bupivacaine (0.5%) in spinal anaesthesia. Group III (Control Group): 32 patients received hyperbaric Bupivacaine (0.5%) in spinal anaesthesia in combination with 0.5 ml normal saline. Results: Out of 96 patients, 32 patients received Injection Fentanyl (25 mcg) in combination with hyperbaric Bupivacaine (0.5%) spinal anaesthesia were classified as Group I, another 32 patients received Injection Neostigmine (25 mcg) in combination with hyperbaric Bupivacaine (0.5%) in spinal anaesthesia were classified as Group II and rest 32 patients received hyperbaric Bupivacaine (0.5%) in spinal anaesthesia were classified as Group III. In present study, following induction, mean pulse rate was found to be significantly higher in neostigmine group as compared to the other two groups for most of the intraoperative period. Bradycardia rates were higher in fentanyl supplemented and bupivacaine alone groups as compared to neostigmine supplemented group. The better efficacy of neostigmine in present study could be owing to a possible sedative effect of neostigmine that reduces the perception of pain. In a previous study, Kaya et al.¹ found that in patients posted for elective cesarean study under combined spinal-epidural using epidural neostigmine showed that total duration of post-operative analgesia and global pain satisfaction scores were reduced in the neostigmine group. In present study, number of patients requiring rescue analgesia was significantly lower in bupivacaine + neostigmine (12.5%) as compared to bupivacaine + fentanyl (43.8%) and bupivacaine alone (93.1%) groups, thus showing that addition of both the drugs reduced the rescue analgesic need, however, addition of neostigmine was more effective as compared to fentanyl. Conclusion: The present study was conducted in the Department of Anaesthesiology, Era’s Lucknow to compare the effect of Neostigmine and Fentanyl as adjuvant to hyperbaric bupivacaine in spinal anaesthesia for lower abdominal and lower extremity surgery. Out of cases scheduled for lower abdominal or lower extremity surgery 96 ASA Grade I & II cases fulfilling the inclusion criteria were enrolled and randomly divided in three groups, all the cases were given hyperbaric bupivacaine (0.5%), of these 32 cases were given fentanyl (25 mcg) and another 32 cases were given neostigmine (25 mcg) as adjuvant, rest 32 cases were not given any adjuvant. Pulse rate of cases of neostigmine adjuvant group was found to be significantly higher than that of fentanyl adjuvant and no-adjuvant group at all the periods of observation while that of fentanyl adjuvant and non-adjuvant groups was comparable. During first 10 minutes, systolic BP of neostigmine adjuvant group was found to be significantly higher than that of fentanyl adjuvant and non-adjuvant groups. Bradycardia was observed in higher proportion of non-adjuvant group, followed by fentanyl adjuvant and least in neostigmine adjuvant group (46.9%, 25.0% & 12.5%).

Background: Scabies is a common pruritic contagious disease where various drugs have varying levels of safety profiles. Aims and Objective: To compare the efficacy of a single application of topical 1% gamma benzene hexachloride over topical 5% permethrin in scabies. Also, to compare the single application of the above drugs over the twice application. Materials and Methods: In this single-blind randomized clinical study, 200 clinically diagnosed cases of scabies were randomly allocated into four groups. Group A patients and their family contacts received a single application of 1% Gammabenzenehexachloride lotion, Group B patients and their family contacts received a single application of 5%permethrin, Group C patients and their family contacts received a double application of topical 1%gammabenzene hexachloride and Group D patients and their family contacts received a double application of 5% permethrin. Patients were followed up at 1^st, 2^nd and 4^th week. The cure was labelled once there was the absence of lesions and pruritus at the end of 4^th week. Statistical analysis was done using chi-square and student-t test. Results: In Group B the reduction in pruritus and number of lesions was 88.1% over 40% in Group A, and the absolute cure was 97.8% in Group D over 77.5% in Group C at the end of the 4th week. No serious adverse events were observed. Conclusion:  Double application of 5% permethrin was found to be superior to double application of 1% lindane and single application of 5% permethrin is better than single application of 1% lindane.

Background: Laparotomy is an incision made into the abdominal wall to visualise and explore the viscera inside of the abdominal cavity. Break in continuity of the skin with or without deeper tissues, following laparotomy, results in abdominal wound dehiscence. This study is done to evaluate the factors affecting healing of incision site of laparotomy. Aims and Objectives: 1. To identify various factors affecting postoperative wound healing.2. To study various wound complications occurring following laparotomy.3. To observe the measures for preventing the wound complications. Material and Methods:  This study is a Prospective study conducted on 100 patients who undergoing laparotomy (both emergency and planned) between June 2020 to January 2022 in General Surgery Department of S.C.L Hospital Ahmedabad. A detailed history was taken from all the patients. Result: In this study the various Factors affecting healing of incision site after laparotomy, which occurred in 100 patients who underwent laparotomy in the Department of General Surgery S.C.L. Hospital Ahmedabad were analysed. Patients above 15 years were included in this study. Patients aged > 60 years developed more wound complications as compared to patients < 60 years suggesting that increasing age acts as a risk factor. Development of wound complications were more in females compared with male. All patients who had hypoproteinemia, malnourishment (BMI <18.5) and were on steroid therapy developed more wound complications. 9 out of 11 patients developed complications who had BMI >30 (obese). 7 out of 13 anemic patients developed wound complications. Out of 100 patient, 55 patients had comorbidities (i.e. DM, HTN, IHD, COPD). Conclusion: This study was conducted to study the factors affecting wound healing. Wound healing after laparotomy is influenced by a variety of factors like timing of laparotomy, age, comorbid conditions, malnutrition, obesity, anemia, hypoproteinemia, immunosuppressive states, indication of laparotomy, postoperative abdominal condition, length of hospitalisation. Optimisation of these factors as far as possible will reduce the incidence of wound complications.

Background: Acute diarrheal diseases are a leading cause of pediatric morbidity and mortality globally, particularly in settings with limited resources. This study aimed to delineate the patterns of electrolyte disturbances in children with acute diarrhea and assess their impact on clinical outcomes. Methods: In this cross-sectional, hospital-based study, 100 children aged 6 months to 15 years presenting with diarrhea and dehydration were assessed. Electrolyte levels, renal function, and clinical symptoms were evaluated and analyzed using SPSS. Results: The study found mild hyponatremia in the majority of patients, with normal potassium and chloride levels. Renal function was largely unaffected. Vomiting was present in 65% of cases, and a small percentage showed mucus or blood in stools, indicating potential severe infections. Diarrheal severity was high, with frequent episodes underscoring the need for effective rehydration strategies. Conclusion: Effective management of electrolyte disturbances in pediatric diarrheal diseases can significantly influence clinical outcomes. Tailored rehydration solutions and rapid treatment interventions are critical to addressing the complications associated with electrolyte imbalances.

Introduction: Neonatal hypoxic-ischemic injuries (NHII) are a major cause of long-term neurological deficits and developmental disabilities, often resulting from perinatal oxygen deprivation. Hypoxic-ischemic encephalopathy (HIE) is the most severe form, contributing to significant neonatal morbidity and mortality. Transcranial ultrasonography (TUS) offers a non-invasive, radiation-free imaging modality for evaluating NHII, providing real-time insights into cerebral structures and blood flow dynamics, making it valuable for bedside assessment and monitoring in critically ill neonates. Material and Methods: This prospective observational study evaluated neonatal hypoxic and ischemic brain injuries using transcranial ultrasound and color Doppler over 15 months, involving 116 neonates with birth asphyxia or suspected hypoxic-ischemic injury. The study included bedside ultrasound assessments on day 3, followed by scans on day 7, and at 1st, 2nd, and 3rd months, to detect brain abnormalities like hemorrhages, periventricular leukomalacia, and blood flow irregularities. The data were analyzed using SPSS, with statistical significance set at p < 0.05. Results: The study found that 67.52% of neonates were male and 32.48% were female. The most common antenatal finding was a normal USG (52.99%), followed by fetal growth restriction (17.09%) and other conditions like abruptio placenta (10.26%). Preterm births comprised 50.43%, and vaginal deliveries accounted for 65.81% of cases. Color Doppler showed normal resistive index (RI) in 82.76% and normal peak systolic velocity (PSV) in 81.90% of cases. MRI findings revealed Grade I Periventricular Leukomalacia (PVL) in 76.47%, while USG findings correlated significantly with lower APGAR scores, particularly for PVL. The sensitivity and specificity of USG in detecting PVL were notable, with USG showing high sensitivity for early detection of PVL and moderate specificity when compared to MRI findings. Conclusion: In conclusion, our study emphasizes the importance of early detection and monitoring for managing neonatal hypoxic-ischemic injuries. Preterm and low birth weight infants are particularly vulnerable to brain injuries like PVL and GMH. Maternal comorbidities and mode of delivery also significantly influence risk. While MRI is superior for detailed imaging, USG proves valuable for early bedside diagnosis, especially in urgent settings.

Background: Cervical cancer is one of the major health problems among women in terms of morbidity and mortality. Early identification is beneficial in effective treatment and helps to prevent precancerous lesions from progressing to cancerous conditions. For early detection several screening methods are available. The present study aimed to evaluate PAP smear screening among healthy women in identifying infectious, premalignant, and malignant lesions to determine the prevalence of various lesions. Methods: We collected PAP smears from healthy women who attended a cancer screening program conducted at gynecology op department, government general hospital, Ananthapuramu. The age of the women was between 21-85 years. Informed consent was taken before taking a PAP smear. PAP smears were analyzed and reported as per the new Bethesda System for Reporting Cervical Cytology 2014. Results: In this study, 62 PAP smears were collected. The median age of the patients was 40 years. 2(3.2%) smears showed normal in cytology.49(78.9%) smears showed inflammatory,4(6.4%) smears were showed infectious cytology report. atypical squamous cells of undetermined significance (ASCUS) were 2(3.2%), low‑grade squamous intraepithelial lesion (LSIL) 3(4.8%), high‑grade squamous intraepithelial lesion (HSIL) 1(1.6%).one smear,1.6% showed inadequate cytology report. None of the smears showed malignant cytology. Conclusion: PAP smear is a simple, non-invasive, cost-effective screening test to detect cervical premalignant or malignant lesions. It is a highly sensitive screening test. It can reduce morbidity and mortality related to cervical cancer. Women aged 30-65 years of age should undergo PAP smear screening routinely.

Situs inversus is a rare condition characterized by the mirror-image reversal of the anatomical arrangement of visceral organs. It may be associated with dextrocardia (totalis) or levocardia (incomplete) and is inherited in an autosomal recessive manner. This condition can be linked to congenital heart diseases, ciliary dysfunction, and complications related to anaesthesia. Splenic injury in a patient with situs inversus following blunt abdominal trauma is extremely rare. In cases of high-grade injuries, an emergency splenectomy is typically required, although Tran’s catheter arterial embolization may be attempted in paediatric patients if extravasation is observed. Prophylactic appendectomy may also be considered in such cases. Due to the rarity of this condition, limited information is available regarding postoperative complications, as only a few case reports have been documented. This case report presents a 30-year-old female who was admitted to the emergency department with a history of blunt abdominal trauma, hypotension, and vomiting. A contrast-enhanced CT scan of the abdomen revealed situs inversus totalis with a grade 3 splenic injury, for which an exploratory laparotomy and emergency splenectomy were performed. This is an exceptionally rare case, with fewer than five similar cases reported in the literature to date. Given the potential for postoperative complications related to ciliary dysfunction, anaesthesia, and congenital heart defects, a thorough preoperative evaluation is essential to minimize the risk of such complications.

Background: An umbilical hernia is an abnormal protrusion of a viscus or a part of a viscus through the umbilical cicatrix and causes a symmetrical protrusion of the umbilical skin. The incidence of umbilical hernia in the adult is largely unknown but most cases are thought to be acquired rather than congenital. In adult cases, umbilical hernia is due to risk factors like multiple pregnancies, ascites, obesity, malignancy, and raised intraabdominal pressure. The current study was done to determine the outcome of laparoscopic umbilical hernia repair and open umbilical hernia repair with various outcomes. Methods: This was a prospective comparative study conducted on the patients admitted to the teaching hospitals of J.J.M. Medical College, Davanagere, Bapuji Hospital, and Chigateri Hospital. 40 cases of primary umbilical hernia were included, the study was carried out by history, clinical examination, and appropriate investigations for operation were conducted.  20 cases underwent laparoscopic umbilical hernia repair, and 20 underwent open onlay mesh repair. Results: Umbilical hernias were more common in females. Abdominal swelling was the most common complaint followed by pain. 20 cases underwent laparoscopic mesh repair and 20 cases by open onlay mesh repair. The duration of surgery, postoperative pain, and hospital stay are significantly less in laparoscopic hernia repair. Post-operative complications like recurrence and seroma were not noted in both procedures. The surgical site infections and average scar length were significantly less in laparoscopic mesh repair resulting in better cosmesis. Conclusion: Laparoscopic hernia mesh repair offers an efficient, safe, effective repair for umbilical hernia with less postoperative pain, complications, duration of hospital, and early return to normal activity.

Cataract  is a major cause of blindness in India and lens induced glaucoma is major complication associated with cataract.Based on slit lamp findings we classify lens induced glaucoma into three categories .Proper evaluation and early intervention lead to good visual outcome. Materials and Methods: Retrospective study conducted from medical records of  total 30 patients who presented to tertiary care centre in north Karnataka. Results  In this study majority are female patients with predominance of phacomorphic type of lens induced glaucoma. Statistically and clinically significant correlation found between time of presentation, intra ocular pressure at the time of presentation and post operative visual outcome. Conclusion: Early presentation of lens induced glaucoma patients to hospital and proper measurement of intra ocular pressure and timely intervention aids in preserving vision and to prevention of blindness.

Background: NAFLD is a spectrum of the disease characterized by hepatic steatosis when no other causes for secondary hepatic fat accumulation (e.g., excessive alcohol consumption) can be identified. Therefore our study was done to determine the etiology of non-alcoholic fatty liver patients and to estimate the Vitamin D level in non-alcoholic fatty liver patients. Materials and Methods: Hospital based cross-sectional study was conducted in the Department of Biochemistry & General Medicine, S.P. Medical College and P.B.M Hospital, Bikaner. Sample size of 44 patients required at 80% study power and alpha error 100%.  It is round of 50 patients for present study expecting approx. 5% not willing to study when 87.00% patients had insufficient Vitamin D level. Systemic random sampling method was done in this study. Results: In present study, most patients 35 (70%) in NAFLD Group and 28 (56%) cases in control group were diabetic. In this study 50 patients are nonalcoholic in both groups.  Out of 50 patients 33 (66.00 %) cases in NAFLD Group and 16(32.00%) subjects in control group were having vitamin D levels coming under deficient category. Conclusion: Vitamin D deficiency is linked to an increased incidence of NAFLD as well as the severity of NAFLD grade. Estimating vitamin D levels can assist in minimizing the risk of NAFLD.

Background: Chronic kidney disease (CKD) is associated with a dyslipidemia comprising high triglycerides, low HDL-cholesterol and altered lipoprotein composition. Cardiovascular diseases are the leading cause of mortality in CKD, especially in end stage renal disease patients. Methods: This     is     prospective     study     conducted     in     Department   of   General   Medicine. Total 100 patients  were  included  in  this  study  who  were  diagnosed  with  chronic  kidney  disease(CKD).      With  the  help  of  clinical  history, examination  and  investigations  data  was  collection. Results: Normal Serum HDL values ranged between 23mg/dl to 46mg/dl. Patients showed abnormal HDL levels (<40 mg/dl) were 43. There was a significant reduction in HDL levels in patients with CKD.  In 18 patients  abnormally  high  LDL  levels (>130mg/dl)  were  found.    TGL  levels  were  abnormal  in  37  patient’s shows > 160mg/dl. Total cholesterol was more than 200mg/dl in 26 patients. Conclusion: In  chronic  kidney  disease  patients  total  cholesterol  is significantly  increased as  well  as  triglyceride  level  also   increase.   Therefore   dyslipidemia   is   common   complication   of    CKD.   Hence   early   diagnosis   of   dyslipidemia   indicated   potential   therapeutic   approaches   like   therapeutic   life   style   changes   and   pharmacotherapy  should  be  initiated to  limit  the  long  term  consequences  of  cardiovascular  disease  in  this population.

Background: Dyslipidemia is considered a risk factor for the development of cardiovascular disease. While overt hypothyroidism is known to be linked with lipid abnormalities, the relationship between subclinical hypothyroidism (SCH) and specific lipid patterns remains unclear. This study aimed to evaluate lipid abnormalities in patients with subclinical hypothyroidism (SCH) and to explore the relationship between lipid levels and thyroid-stimulating hormone (TSH). Methods: In this cross-sectional, case-control study, serum lipid levels were assessed in 87 patients with subclinical hypothyroidism (SCH) and compared with 101 age- and sex-matched euthyroid controls. Results: The study found that total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) were significantly higher (p < 0.05) in patients with subclinical hypothyroidism (SCH) compared to the control group. Although triglycerides (TG) and very low-density lipoprotein cholesterol (VLDL-C) levels were elevated in SCH patients, the difference was not statistically significant when compared to the controls. High-density lipoprotein cholesterol (HDL C) was slightly lower in SCH patients than in the control group. Conclusions: Patients with subclinical hypothyroidism (SCH) have higher levels of total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) compared to euthyroid individuals. Other lipids, such as triglycerides (TG) and very low-density lipoprotein cholesterol (VLDL-C), may show slight increases, while high-density lipoprotein cholesterol (HDL-C) may be modestly reduced in these patients. There is also a positive correlation between LDL-C and TC levels with TSH levels.

Background: Diabetic dermopathy (DD) is a common cutaneous manifestation of diabetes mellitus (DM), characterized by atrophic, hyperpigmented lesions, primarily on the lower extremities. Chronic hyperglycemia, microangiopathy, and impaired wound healing are thought to contribute to the pathogenesis of DD. Aim and Objectives: To investigate the correlation between glycemic control, as measured by HbA1c levels, and the severity of diabetic dermopathy in patients with type 2 diabetes mellitus (T2DM). Materials and Methods: A cross-sectional observational study was conducted with 150 patients diagnosed with T2DM. Demographic and clinical data, including HbA1c levels, were collected. Based on the number and size of lesions, the severity of DD was classified into mild, moderate, and severe categories. Statistical analyses were performed using Pearson’s correlation and ANOVA to assess the correlation between HbA1c levels and DD severity. Results: The mean age of the participants was 58.3 ± 8.9 years, and the average HbA1c level was 8.4 ± 1.2%. DD severity was categorized as mild in 38.7% of patients, moderate in 43.3%, and severe in 18.0%. A significant positive correlation was observed between HbA1c levels and DD severity (r = 0.68, p < 0.001). Patients with severe DD had a higher mean HbA1c (9.2 ± 1.1%) than those with mild DD (7.6 ± 0.8%). Additionally, patients with severe DD were more likely to have other microvascular complications, such as neuropathy and retinopathy. Conclusion: This study found a strong correlation between higher HbA1c levels and increased severity of diabetic dermopathy. Poor glycemic control was associated with more severe manifestations of DD, suggesting that tighter glucose management could mitigate the progression of skin complications in patients with diabetes.

Background: Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a challenging condition often managed with intranasal corticosteroids and saline irrigations. Aim and Objective: To compare the efficacy and safety of intranasal fluticasone propionate spray versus saline nasal irrigation with budesonide respules in treating patients with CRSwNP. Materials and Methods: This randomized controlled trial included 120 patients with CRSwNP, who were assigned to either Group A (intranasal fluticasone propionate spray, n=60) or Group B (saline nasal irrigation with budesonide respules, n=60). The treatment duration was 12 weeks. The primary outcome was improvement in symptom severity using the Sino-Nasal Outcome Test-22 (SNOT-22). Secondary outcomes included nasal polyp size, Lund-Mackay CT scores, and olfactory function (UPSIT). Safety and adverse events were also assessed. Results: The study demonstrated significant improvements in both treatment groups across all measured outcomes, with saline nasal irrigation with budesonide showing greater efficacy. In terms of symptom severity, as measured by SNOT-22 scores, Group A (intranasal fluticasone spray) showed a significant reduction from 56.4 ± 8.7 at baseline to 31.8 ± 7.2 at 12 weeks (p < 0.001). However, Group B (saline nasal irrigation with budesonide) experienced a greater reduction, from 55.8 ± 9.1 to 25.6 ± 6.9 (p < 0.001), with the difference between the two groups being statistically significant (p = 0.01). In terms of nasal polyp size, Group A’s mean polyp score decreased from 4.1 ± 0.9 to 2.2 ± 1.0, while Group B’s score decreased from 4.0 ± 0.8 to 1.5 ± 0.9, with Group B showing a significantly greater reduction (p < 0.05). Similarly, both groups showed improvement in Lund-Mackay CT scores, with Group A improving from 17.5 ± 3.6 to 12.3 ± 2.9 and Group B improving from 17.7 ± 3.5 to 10.7 ± 2.8, with a statistically significant difference favouring Group B (p = 0.02). In terms of olfactory function, measured by UPSIT, Group A showed improvement from 14.2 ± 5.8 to 23.4 ± 6.1, while Group B improved from 13.9 ± 6.0 to 27.1 ± 5.9, with Group B again showing superior improvement (p = 0.003). Both treatments were well-tolerated, with mild adverse events such as nasal irritation, dryness, and occasional epistaxis reported in both groups. Conclusions: Intranasal fluticasone spray and saline nasal irrigation with budesonide effectively improved symptoms, reduced nasal polyp size, and enhanced sinus ventilation in patients with CRSwNP. However, saline nasal irrigation with budesonide demonstrated superior efficacy across all measured outcomes and was equally safe. This treatment may offer a more effective option for managing CRSwNP.

Background: Stroke is a leading cause of morbidity and mortality, with varying degrees of severity based on multiple risk factors. Serum triglyceride (TG) levels, which are known to be associated with cardiovascular disease, may have a role in stroke severity, but this relationship remains underexplored, especially in the Indian population. Aim and Objective: To investigate the correlation between serum triglyceride levels and stroke severity in patients admitted to a tertiary care hospital in Central India. Materials and Methods: This cross-sectional observational study was conducted at Gandhi Medical College and Hamidia Hospital, Bhopal, over 12 months. A total of 96 patients diagnosed with acute stroke (within seven days of onset) were included. Data on patient demographics, medical history, and stroke severity (assessed by the NIHSS) were collected. Fasting serum triglyceride levels were measured within 48 hours of admission. Statistical analysis was performed using descriptive statistics and appropriate tests to evaluate correlations between TG levels and stroke severity. Results: The mean age of the study population was 60.05 years (SD 10.85); 68.8% were male and 31.2% female. Hypertension was present in 67.7% and diabetes mellitus in 24% of patients. The mean TG level was 117.84 mg/dl (SD 46.3), with 72.9% of patients having TG levels <150 mg/dl. The mean total cholesterol was 170.51 mg/dl, HDL 34.31 mg/dl, and LDL 157.47 mg/dl. The mean NIHSS score was 14.09 (SD 6.975). Patients with TG levels ≥150 mg/dl had significantly lower NIHSS scores (mean 12.00, SD 5.52) compared to those with TG levels <150 mg/dl (mean 14.87, SD 7.32) (p = 0.044). Lower triglyceride levels were associated with higher stroke severity, although the chi-square test showed no significant association between TG levels and NIHSS score categories (p = 0.264). Conclusion: The study suggests an inverse correlation between serum triglyceride levels and stroke severity, with higher TG levels potentially associated with less severe strokes. While the exact mechanisms remain unclear, these findings contribute to the growing evidence that lipid profiles, particularly triglycerides, may play a role in stroke prognosis. Further research is needed to explore the potential protective effects of higher TG levels in stroke patients.

Introduction: Intertrochanteric fractures are common in elderly individuals with osteoporosis, where surgical fixation is crucial for reducing complications and promoting early mobilization. Proximal femoral nails (PFN) have been widely used for unstable intertrochanteric fractures, but complications such as screw cut-out and rotational instability persist. The PFNA2, featuring a helical blade, has been developed to improve fixation in osteoporotic bone by enhancing stability. Materials and Methods: A prospective comparative study was conducted on 50 patients with unstable intertrochanteric fractures (AO 31.A2 and 31.A3). Group A (n=25) underwent surgical fixation using PFN, while Group B (n=25) received PFNA2. Patients were followed for six months, with clinical outcomes assessed using the Harris Hip Score and radiological outcomes by bone union time. Both groups had similar demographic and fracture characteristics. Results: The mean age of patients was 60.75 years in Group A and 64.37 years in Group B. PFNA2 showed a significantly faster mean union time (14.69 weeks) compared to PFN (18.47 weeks). Harris Hip Scores improved significantly in both groups over time, with better results in PFNA2 group. Complications were lower in the PFNA2 group as well. Conclusion: PFNA2 demonstrated superior clinico-radiological outcomes and fewer complications compared to PFN for unstable intertrochanteric fractures, suggesting it may be a better implant choice, particularly in osteoporotic patients.

Background: Magnesium (Mg) implants, known for their biodegradability and mechanical properties, offer significant potential in biomedical applications. However, their rapid corrosion in physiological environments necessitates protective surface coatings. Strontium (Sr) phosphate coatings have emerged as a promising solution due to their ability to enhance corrosion resistance and promote bone growth. This study aimed to evaluate the surface characterization of strontium phosphate coatings on magnesium for mini implant applications. Methods: A total of 170 magnesium samples were coated with strontium phosphate and analyzed over a 4 months period. Surface roughness, coating thickness, chemical composition, and adhesion strength were assessed using profilometry, scanning electron microscopy (SEM), X-ray diffraction (XRD), and pull-off tests, respectively. Data were analyzed using SPSS version 23.0, employing descriptive statistics, t-tests, and ANOVA. Results: The mean surface roughness (Ra) was 1.5 µm (±0.2 µm), and the average coating thickness was 50 µm (±5 µm). Chemical composition analysis revealed 40% Sr, 35% P, 20% O, and 5% Mg. The mean adhesion strength was 30 MPa (±3 MPa). ANOVA tests indicated no significant differences in surface roughness (p = 0.45), coating thickness (p = 0.38), or adhesion strength (p = 0.52) between sample groups. Conclusion: Strontium phosphate coatings on magnesium exhibited consistent surface roughness, coating thickness, chemical composition, and adhesion strength, indicating a reliable coating process suitable for mini implant applications.

Recommendations: Further in vivo studies are recommended to evaluate the biological performance and long-term effects of strontium phosphate-coated magnesium implants. Additionally, optimizing the coating process could further enhance the protective and bioactive properties of the coatings.

Introduction: A reduction in glomerular filtration rate (GFR) to below 60 ml/min/1.73 m2 for >3 consecutive months associated with multiple etiologies constitutes the definition of chronic kidney disease that can lead to significant lipid disorder which develop primarily from disturbed regulation of high density lipoproteins (HDL) & triglyceride-rich lipoprotein metabolism. Many patients of CKD live on hemodialysis on regular basis. This study was done to know the effect of hemodialysis on the lipid profile of the CKD patients. Background & Methods: This is a prospective observational study conducted in Department of medicine Bundelkhand medical college India, between September 2022 to September 2024 after considering inclusion and exclusion criteria. The lipid profile of 100 eligible patients was analyzed using an autoanalyzer at the central pathology lab at Bundelkhand medical college Sagar . The aim of this research is to study Lipid Profile in CKD patients on Hemodialysis. Results: Our study reported a statistically significant decrease in high-density lipoprotein (HDL) and an increase in triglycerides (TG) and very-low-density lipoprotein (VLDL) levels in CKD patients on hemodialysis. Similarly, total cholesterol and low-density lipoprotein (LDL) were also significantly increased in CKD patients on hemodialysis. Conclusion: Dyslipidemia is an established accompaniment of CKD more so in patients on hemodialysis , so regular monitoring of lipid profile in CKD patients may help in decreasing the progression of the disease and, hence, mortality in CKD patients.

Introduction: Patients after laparoscopic cholecystectomy complain more of visceral pain which results from the stretching of intra-abdominal cavity, peritoneal inflammation and phrenic nerve irritation caused by residual carbon dioxide in the peritoneal cavity. Intraperitoneal (IP) local anaesthetics and opioids are gaining popularity for better pain relief in laparoscopic surgeries. The rationale to use the intraperitoneal route is that the peritoneum is exposed to blocking of visceral nociceptive conduction, thereby providing an additional mechanism of analgesia. Methods: All eligible patients were randomly allocated into two groups as Group R (0.5% Ropivacaine group) and Group M (0.5% Ropivacaine plus Morphine group) by using calendar odd and even date method. At the end of surgery, after removal of gallbladder, study drug was instilled onto the gallbladder bed intraperitoneally via port under vision. Group R patients received 20ml of plain 0.5% ropivacaine while Group M received patient’s received18ml of plain 0.5%ropivacaine plus 2ml (3mg) morphine. The main aim of our study was to assess the postoperative duration of analgesia in both the groups with NRS (Numerical Rating Scoring) and hemodynamic changes as respiratory rate, heart rate, systolic blood pressure (SBP) and diastolic blood pressure (DBP) after IP instillation of the study drug. Results: In both groups, demographic profile were comparable and statistically insignificant. NRS scores was significant after a time interval of two hours postoperatively between the two groups , the difference remained up to 5 hours (p-value <0.05). In Group M, pain(NRS) score was significantly lower than the patients of ropivacaine 0.5% (Group R). The time of first rescue analgesia was statistically significantly longer in Group M(278±53.39 minutes)than Group R (216±49.03minutes)- (p value <0.0001). There was no statistically significant difference in haemodynamic parameters and mean respiratory Rate (p value >0.05)in the two groups. Conclusion: The findings of the study demonstrate that patients receiving the combination of morphine and ropivacaine experienced a notably lower pain scores and extended time to the first rescue analgesia. This suggests a synergistic interaction between morphine, an opioid analgesic and ropivacaine, a local anaesthetic, resulting in enhanced and prolonged postoperative analgesia.

Background: In cases of persistent osteomyelitis, calcium sulfate impregnated with antibiotics provides excellent therapeutic efficacy. Its ability to treat paediatric chronic osteomyelitis, however, has not received enough research attention. This study aimed to assess the potential therapeutic benefits of calcium sulfate impregnated with antibiotics for the management of juvenile chronic osteomyelitis. Methods: Ten paediatric cases with chronic osteomyelitis who received care at our facility between January 2022 and December 2023 in total were included for evaluation. An analysis was conducted on the clinical history, clinical manifestation, pathological fractures, bone growth, surgical operations and rate of infection recurrence, leakage from sinuses and incisions. Results: After at least a year of follow-up, there was no infection recurrence, no osteolysis. In one paediatric case, incision site leakage occurred and one had non-union and limb shortening occurred. Conclusion: In paediatric chronic osteomyelitis, antibiotic-impregnated calcium sulfate had a satisfactory therapeutic effect, despite the occurrence of non-infectious sequelae.

Background: Heart Rate Variability (HRV) is a non-invasive indicator of autonomic nervous system function and is strongly associated with stress levels. Occupational stress varies widely across professions, with certain high-stress environments, such as healthcare, known to impact both mental and physical health. Examining HRV in relation to stress levels across different occupational groups can provide insights into how workplace stress affects physiological health. Objective: This study aimed to explore the relationship between HRV and perceived stress levels across different occupational groups, including healthcare workers, teachers, office employees, and manual laborers, to determine how stress impacts HRV in each profession. Method: A cross-sectional design was employed, involving 100 participants selected from four occupational groups. HRV was measured using wearable ECG devices, and stress levels were assessed through the Perceived Stress Scale (PSS). Statistical analyses, including ANOVA, were conducted to compare HRV metrics (e.g., SDNN, RMSSD) and stress scores across the occupational groups. Results: The mean age of participants was 38.5 years (SD = 8.2), with a gender distribution of 56% female and 44% male. Healthcare workers reported the highest average stress levels (PSS = 26.7 ± 4.5) and the lowest HRV metrics (SDNN = 45.6 ± 12.5 ms; RMSSD = 32.4 ± 10.2 ms). In contrast, teachers had the lowest stress (PSS = 18.9 ± 3.6) and the highest HRV scores (SDNN = 58.3 ± 13.0 ms; RMSSD = 42.5 ± 12.1 ms). ANOVA revealed significant differences in HRV (SDNN: F = 4.32, p < 0.01; RMSSD: F = 3.91, p < 0.05) and stress levels (F = 6.87, p < 0.001) between occupational groups. Post hoc analysis indicated that healthcare workers had significantly lower HRV and higher stress compared to teachers, with effect sizes of η² = 0.12 for HRV and η² = 0.19 for PSS. Conclusion: The findings support the role of HRV as a reliable marker of stress and highlight the impact of occupational stress on autonomic function. HRV monitoring could be useful in occupational health programs, particularly in high-stress professions like healthcare, to identify at-risk workers and implement stress-reduction interventions.

Background: Fistula in ano is an abnormal communication between epithelized surface of anal canal and perio-nal skin ligation of the intersphincteric fistula tract. This is a new sphineter-saving method with good results without recurrence. Method: 95 adult patients were confirmed to be competent for surgery. USG examination having a 7 to 10 MHZ transducer passed into the anal canal, which is carried out with the patient in a left lateral position. Serial radial images were taken to study the location and position of the fistula. The LIFT procedure was similar to the Rojanaskul proposed method. The duration of surgery and healing time were also noted. Results: The study of classification included parks classification. It has 83 (87.3%) were Trans Sphincteric, 9 (9.4%) intersphincteric, 3 (3.1%) suprasphincteric, Classification on basis of course has 35 (36.8%) anterior straight, 48 (50.5%) posterior straight, 9 (9.4%) curved, and 3 (3.1%) semi-horseshoes. Classification on the tract had 86 (90.5%) single tracts and 9 (9.47%) multiple tracts. Operating time was 35.2 (± 3.30), intersphinc-teric wound healing 23.20 (± 4.10), externet wound healing 25.80 (± 63.80). Conclusion: The LIFT technique is an ideal minimally invasive technique with a high rate of rapid healing and without any resultant of incontinence.

Background: Prolonged or post-dated pregnancies are often linked with heightened risks of perinatal morbidity and mortality, particularly when pregnancies surpass the intended delivery date. While the exact causes of prolonged pregnancy remain unclear, congenital anomalies such as anencephaly are known contributing factors. Aims & Objectives: The primary objective of this study was to assess the outcomes of post-dated pregnancies, with a specific focus on delivery methods, maternal complications, and neonatal outcomes. Specific aims included evaluating age distribution, gestational age, and parity among study participants, analyzing the mode of delivery and indications for cesarean section, and examining maternal and neonatal complications associated with postdated pregnancies. Materials and Methods: This prospective observational study was conducted at GMERS Medical College & Civil Hospital, Junagadh, from July 23 to September 23. The study enrolled 150 pregnant women with post-dated pregnancies beyond 40 weeks of gestation, excluding those with previous cesarean sections, congenital anomalies, malpresentation, multiple gestation, and specified medical conditions. Detailed participant histories and comprehensive physical examinations were collected, including age, parity, last menstrual period, and medical history. Labour and delivery details, including mode of delivery and indications for cesarean section, were meticulously documented. Fetal outcomes such as meconium-stained liquor, NICU admissions, and other complications were rigorously assessed. Results: The study revealed that 68% of participants underwent vaginal delivery, with 40% of these deliveries being induced. Cesarean section was performed in 32% of cases, primarily due to indications such as fetal distress, failed induction, and severe oligohydramnios. Maternal complications included postpartum haemorrhage (6.6%) and perineal tears (4.6%). The most common fetal complication observed was meconium aspiration syndrome (5.3%). Neonatal complications included NICU admissions (24.6%), perinatal asphyxia (2.6%), and hyperbilirubinemia (2%). Conclusion: Based on the study findings, it is suggested that considering labour induction at 40 weeks of gestation may be a reasonable approach to mitigate risks associated with prolonged pregnancies. Intervening at this specific gestational age aims to minimize adverse outcomes such as fetal distress and meconium aspiration syndrome, thereby improving overall perinatal outcomes. However, individualized assessments considering maternal health, fetal well-being

Background: Vaginal candidiasis, or yeast infection, is a common condition caused by the overgrowth of Candida species, with pregnancy significantly increasing susceptibility due to hormonal and immunological changes. Around 75% of pregnant women experience at least one episode, with 50% facing recurrent infections. These physiological shifts, along with altered vaginal pH and immune modulation, create a favourable environment for Candida colonization, impacting maternal and fetal health. This study aims to investigate the prevalence, risk factors, and management of vaginal candidiasis among pregnant women in western Gujarat, providing insights across all trimesters and evaluating current treatment strategies. Material and Methods: This cross-sectional survey study was conducted from June 2023 to May 2024 at M.P. Shah Government Medical College and GG Government Hospital, Jamnagar, targeting pregnant women attending the Obstetrics and Gynecology OPD. Among 8,412 patients, 1,642 (19.5%) were suspected of vaginal candidiasis, with 1,120 (68.2%) confirmed positive through clinical examinations. The study included pregnant women aged 18 to 49 across all trimesters and excluded those with severe physical ailments or recent medication use. Data analysis was performed using SPSS version 23, employing descriptive statistics, chi-square tests, odds ratios, and 95% confidence intervals to evaluate the association of risk factors, with significance set at p < 0.05. Results: The mean age of participants was 24.2 ± 4.3 years, with a mode and median of 25 years. Out of 8,412 patients, 1,642 were suspected of vaginal candidiasis, and 1,120 (68.2%) were confirmed positive. Most positive cases occurred during the 2nd trimester (54.82%). Primigravida women constituted 59.64% of positive cases. Symptomatic cases were higher among positives (75%), with diabetes present in 6.25% and prior antibiotic use in 16.07%. All positive cases received vaginal hygiene management, with 98% treated using vaginal suppositories and 2% with antifungal creams. Conclusion: Our study highlights a high prevalence of vaginal candidiasis among pregnant women, with the majority of cases occurring in the second trimester and among primigravida women. Effective management with vaginal hygiene and suppositories demonstrates promising outcomes, emphasizing the need for early detection and targeted interventions during pregnancy.

Introduction: Preterm Caesarean sections are performed when early delivery becomes necessary due to maternal or fetal complications, posing challenges for both maternal and neonatal outcomes. These procedures require careful clinical decision-making to balance the risks and benefits, aiming to prevent adverse outcomes like fetal distress, antepartum hemorrhage, or pre-existing maternal conditions. Auditing preterm Caesarean sections provides valuable insights into the indications, management strategies, and outcomes, helping optimize care in high-risk pregnancies. Material and Methods: This retrospective observational study was conducted at a tertiary care teaching hospital in Gujarat to analyze the incidence, indications, and outcomes of preterm Caesarean sections (CS). It included both elective and emergency preterm CS cases performed before 37 weeks of gestation, focusing on maternal demographics, obstetric details, and maternal and neonatal outcomes. Data were analyzed using descriptive statistics, and the Robson Classification system was applied to categorize cases. Statistical significance was tested to identify meaningful differences between elective and emergency CS groups. Results: In our study on preterm Caesarean sections (CS) at a tertiary care center in Gujarat, 66.7% of women were nulliparous, with 83.3% having no previous uterine scar and 88.3% presenting with cephalic fetal positions. The primary indications for lower segment Caesarean sections (LSCS) included antepartum hemorrhage (11.7%), fetal distress (10%), and sickle cell crisis (11.7%). NICU admissions were necessary for 86.7% of newborns, primarily for observation or further care. Most preterm deliveries involved babies weighing between 1.5-2.5 kg (73.3%), with 96.7% of cases being preterm births. Maternal outcomes were positive, with 93.3% discharged without complications, reflecting the effective management of preterm LSCS cases. Conclusion: Our audit of preterm Caesarean sections at a tertiary care center in Gujarat found fetal distress, antepartum hemorrhage, and prior Caesareans as the primary indications. Most women had favourable obstetric profiles with stable outcomes, highlighting effective perioperative management and the multifactorial nature of neonatal outcomes.

Introduction: Spontaneous abortion refers to the loss of a non-viable fetus, managed through medical or surgical interventions following WHO guidelines to ensure safety under skilled healthcare providers. Despite legal access to abortion under the MTP Act of 1971 in India, a significant number of procedures remain unsafe due to factors such as limited awareness and poverty. This study explores the medical, social, and ethical aspects of abortion, emphasizing the importance of safe practices and targeted interventions to improve maternal health outcomes. Materials and Methods: This retrospective analytical study was conducted from April 2023 to March 2024 at M.P. Shah Government Medical College and GG Government Hospital, Jamnagar, Gujarat. The study included 1,126 patients who experienced spontaneous abortions, with data collected retrospectively from medical records. A comprehensive evaluation was carried out, including patient medical histories, physical examinations, and laboratory tests. Abortion procedures included suction evacuation or other medical methods aligned with WHO guidelines. Post-abortion care involved patient monitoring, antibiotics, and follow-up visits. Statistical analysis was performed to assess the demographic characteristics and treatment outcomes. Results: Among the 1,126 participants, the majority were aged 26-30 years (42.3%) and resided in urban areas (65.3%). Most were married (98.6%) and either had primary education (28.4%) or were illiterate (26.6%). The distribution of gestational age showed that 32.0% of abortions occurred before 8 weeks, 46.3% between 8-12 weeks, and 21.7% between 12-20 weeks. Incomplete abortions were the most frequent (46.62%), followed by complete abortions (19.53%) and missed abortions (15.6%), with septic abortions being rare (0.4%). The most common symptoms were spotting (36.8%) and bleeding per vaginum (55.2%), prompting antenatal visits. Anemia was the most prevalent complication (31.54%), while 8.0% of patients had pregnancy-induced hypertension (PIH). Progesterone vaginal pessary was the most common prophylaxis used for inevitable abortions (63.5%). Primary management methods included medical treatment (35.5%) and evacuation and curettage (43.1%). Conclusion: The findings emphasize the importance of improving prenatal care and raising awareness about safe abortion practices, especially for urban women aged 26-30 years. Effective management of incomplete abortions and addressing common complications like anemia and PIH are essential for enhancing maternal health outcomes.

Background: The simultaneous development of two fetuses in the uterus is referred to as twin pregnancy. Such pregnancies carry an increased risk for both the mother and the newborn, and this risk grows with the number of gestations. During the study period, the incidence of twin pregnancies at G.G. Hospital, Jamnagar, was 2%. The rising prevalence of multifetal births is concerning, as it correlates with a higher rate of preterm births, compromising neonatal survival and increasing the likelihood of lifelong disabilities. Material and Methods: A descriptive retrospective analysis was conducted on 108 twin pregnancies at our hospital between July 2023 and April 2024. The study evaluated adverse antenatal outcomes, delivery methods, and maternal and perinatal outcomes. Results: In our study, 66% of the patients were between 21 and 29 years of age. Among the cases, 34% were booked and attended regular antenatal clinics. Most of the patients (80%) with twin pregnancies were primigravida. The most common obstetric complication was preterm labor (64.28%). Intrauterine death occurred in 1% of cases, while 24% experienced intrauterine growth retardation, as detected during antenatal follow-ups. Of the 108 patients, 52% delivered vaginally, while 48% required Caesarean sections, with malpresentation being the leading indication for Caesarean delivery (50%). Conclusions: The risk of complications is higher in twin pregnancies compared to singleton pregnancies. Early diagnosis, close monitoring of fetal well-being, the use of corticosteroids and tocolytics, regular antenatal checkups, adequate rest, and delivery in an institution with Level 3 neonatal care facilities are essential to improve maternal and perinatal outcomes. Encouraging proper nutrition and breastfeeding can further prevent health issues in newborns.

Background: Diagnosis of ectopic pregnancy was frequently missed and rising trend in incidence of ectopic pregnancies necessitates awareness about risk factors, resultant morbidity and mortality. Aim of the study was to determine the incidence, clinical presentation, risk factors, treatment and morbidity and mortality associated with ectopic pregnancy. Methods: Retrospective analysis of ectopic pregnancy was done in Government Guru Govind Singh Hospital, from Jun 2022 to May 2024. The following parameters: age, parity, gestational age, risk factors, clinical presentation, site of ectopic, diagnostic methods, mode of treatment and morbidity were noted. Results: Out of 17195 deliveries, 67 were ectopic pregnancies {0.39%} Women with age 20-25yrs had highest incidence (44.77%) and with least below 20yrs (11.94%). Ectopic pregnancies were common in multiparous women than primigravida (23.88%). Common symptoms: abdominal pain (88.6%), amenorrhea (76.5%), bleeding per vaginum (66.3%), asymptomatic. Conclusions: Early diagnosis, identifying of underlying risk factors and timely intervention in the form of conservative or surgical treatment will help in reducing the morbidity and mortality associated with ectopic pregnancy.

Background: Compared to singleton pregnancies, twin pregnancies are associated to a significantly higher rate of morbidity and mortality. Clinicians should be better equipped to manage twin pregnancies if they are aware of the mother’s characteristics related to twin gestations and have access to diagnostic techniques like ultrasound. Aim of this study to evaluate maternal and foetal outcomes in women with twin pregnancies. Methods: The present study was conducted in the department of Obstetrics and Gynaecology, Darbhanga Medical College and Hospital, Laheriasarai, Bihar from the period August 2023 to July 2024. Maternal and foetal outcome in 50 cases of twin and 50 cases of singleton pregnancies each were studied. Results: 50 were twin deliveries, giving an incidence of 14 per 1000 births or 1.4:100 deliveries. Six among 50 twins resulted following ovulation induction. Women with twin gestation had a mean maternal age of 24.7±3.71, same for the singleton mothers was 24.26±3.7years; mean gestational age at delivery for twins and singletons were 35.38±2.6 and 38.63±1.19 weeks; mean birth weight for twins and singletons were 2.193kgs and 2.85±0.46kgs, mean parity were 2.04± 1.0 and 1.72±0.7 respectively. Parity, gestational age, NICU stay characteristics showed p value < 0.05. Compared with singletons, women with twin gestations had a positive risk association with odds >1 for anaemia, preeclampsia, preterm labour, malpresentation and caesarean delivery. Twin Neonates suffered prematurity, low birth weight, congenital anomaly, prolonged NICU care and increased perinatal death. Neonatal risk was more among monochorionic twins than dichorionic twins. There were 3 cases with single fetal demise, and both fetuses IUD in another case, (total IUDs-5), one twin was still born, two had early neonatal death and there were two late neonatal (>7 Days) deaths. One twin mother threw fits on the 6th postpartum day. Another mother received 20 units of blood and component replacement and subtotal hysterectomy for PPH. Conclusion: Multiple pregnancy bears additional hazards both for the mother and the baby. Though these hazards are partly preventable, difficulty in timely recognition of multiple pregnancy at an early date is a main obstacle. Once diagnosed proper antenatal care with increased rest and nutritional supplement together with thorough intranatal and postnatal vigilance has much to its credit in lowering both maternal and foetal dangers.

Background: Pregnancy, located outside the normal endometrial cavity whether intra  or extra-uterine, is called  ectopic  pregnancy  (EP).  This  is a  derivative  of  the Greek word ‘extopos’ which means ‘out of place’. Aims of this study to determine Clinical presentation and risk factors of Ectopic pregnancy to highlight and drawing attention for early diagnosis and prompt management. Methods: Present retrospective study was conducted in Obstetrics and Gynaecology department of Darbhanga Medical College and Hospital, Laheriasarai, Bihar from September 2023 to August 2024. During this study period, 50 cases of ectopic pregnancies were enrolled in the study. In all cases age, parity, gestational age, risk factors, signs and symptoms, site of ectopic pregnancy and surgical intervention were noted on Performa and data was analyzed, results depicted in tables. Results: Most patients aged between 20-30 years with gestational age of 2 months, in parity 16 were primigravida, 12 were gravida 1, 10 were gravida 2, 6 in each gravida 3 and 4. 2 patient had a history of miscarriage, 4 underwent infertility treatment, 6 had previous ectopic pregnancy, 4 patients with previous cesarean section, while 9 patients given the history of pelvic inflammatory diseases. 12 patients were diagnosed clinically while 30 cases through abdominal ultrasound and 8 through transvaginal ultrasound. Amenorrhea was present in 44 patients, vaginal bleeding in 40 cases and lower abdominal pain in 36 cases, while 16 patients presented in shock. Conclusion: Early diagnosis prevents complications such as rupture of ectopic pregnancy, which end up with excision of fallopian tube or ovary badly affecting fertility.

Background: Postmenopausal bleeding is frequent in gynecology and occurs approximately in 5% to 10% of postmenopausal women. But most of the causes of post-menopausal bleeding are benign and treated conservatively. Women with postmenopausal bleeding have a primary or secondary malignancy of about 10%. So before starting treatment malignancy must be excluded. Common malignancies among them are endometrial or cervical carcinoma and rarely, ovarian cancer. The incidence of malignancy in the postmenopausal period remains sufficiently high, so it requires immediate investigations for early diagnosis, prompt treatment, and vigilant follow-up. The aim of this study is to investigate the clinical significance and endometrial pathology in patients with PMB. Methods: This retrospective study was conducted in Department of Obstetrics and Gynaecology, ESIC Medical College and Hospital, Bihta, Patna from January 2024 to June 2024. About 80 patients with PMB were selected and these patients were evaluated by pelvic USG, Endometrial biopsy and endometrial histopathology. Data were analyzed using MS office 2019. Results: Maximum patients with PMB belonged to age group of 46-50 years (31.25%). 57.5% were multiparous (parity>2). About 53.75% had PMB 1 to 5 years after menopause. Endometrial thickness (ET) was > 4mm in 86.25%. Majority had ET between 5-10mm (58.75%). Histopathological analysis of endometrial curettings showed Proliferative phase in 35%, disordered proliferative phase in 17.5%, Atrophic Endometrium in 13.75% and endometrial carcinoma in 11.25%. Conclusion: Postmenopausal bleeding is an important symptom which requires evaluation to eliminate possibility of malignancy. Transvaginal sonography (TVS) is the first mode of investigation for PMB but Histopathology of Endometrium serves as gold standard for definitive diagnosis.

Background: Rheumatoid arthritis (RA) is an autoimmune disease characterized by periods of remission and flares of symmetrical joint inflammation slowly progressing to joint and cartilage destruction leading to deformities. Evidence is accumulating suggesting vitamin D deficiency and its correlation in autoimmune diseases including RA. Aim of this study is to determine the association between rheumatoid arthritis and serum vitamin D levels. Methods: This case-control study was conducted at Department of Medicine with collaboration of Orthopaedics department at ICARE Institute of Medical Sciences and Dr. Bidhan Chandra Roy Hospital, Haldia, West Begal from May 2023 to October 2023. There were 40 patients were presented in this study. After obtaining informed written permission, we took detailed demographic information on all patients who had signed up for treatment. Clinical signs and symptoms, X-ray findings, and anti-citrullinated protein levels more than 20 u/mL were all used to diagnose RA in this patient’s instance. They all pointed to the disease. Group I featured 20 people with verified rheumatoid arthritis, whereas group II had 20 individuals who did not have rheumatoid arthritis. The levels of vitamin D in both groups’ blood were compared. Data was analysed using SPSS 24.0. Results: There were 12 (60.0%) males and 8 (40.0%) females in group I and in group II 11 (55.0%) males and 9 (45.%) females. Mean age in group I was 44.7±8.35 years and had mean BMI 27.8±9.45 kg/m² while in group II mean age was 46.5±6.51 years with mean BMI 28.6±6.51 kg/m². Hypertension and diabetes were the most common comorbidities. Vitamin D level in group I was significantly lower 29.41±5.59 as compared to group II 40.41±8.81(ng/mL). Among 20 cases of rheumatoid arhthritis, positive patients for rheumatoid factor were 18 (90.0%) in which frequency of hypovitaminos was found among 16 (88.88%) cases. Conclusion: People with RA are far more likely to be vitamin D deficient, and the severity of the disease is directly correlated with this insufficiency. Since vitamin D deficiency affects women more than males, they should be tested with a high degree of suspicion. Taking vitamin D supplements may be necessary to prevent or reverse the progression of the disease.

Background: Drugs play a significant role in prophylaxis, diagnosis, and treatment of each and every disease. They are beneficial to the patients at the same time; they also result in unwanted and harmful effects which are called adverse drug reactions (ADRs). The aim of this study was to evaluate and analyse adverse drug reactions to antibiotics in patients of a tertiary care hospital at Bhagalpur, Bihar. Methods: This prospective observational study was carried out in Department of Pharmacology, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar from January 2022 to December 2022. Patients were collected from various department of OPD and hospital ward of JLNMCH, Bhagalpur, Bihar. Results: A total number of 138 ADRs were selected during this study period. 98 were males and 40 were females. Maximum number of patients were from General Medicine department followed by General Surgery followed by Dermatology. Most of the reactions were mild (77.4%). Gastrointestinal system was the most commonly affected organ. In majority of the ADRs the suspected drug was withdrawn (60.8%). The association between a drug and ADR was evaluated using the Naranjo scale. In order to prevent or reduce harm to patients and thus improve public health, mechanisms for evaluating and monitoring public health, evaluating and monitoring the safety of medicines in medical use are vital. Conclusion: Antibiotics   are   most   commonly   prescribed   drugs   so   its monitoring  regarding  ADRs  may  benefit  the  clinicians  in  early  identification and management of ADRs so that quality of life of patient can be safeguarded at an earliest.

Background: Fungal infections are a major concern for both patients and treating physician, especially those affecting skin. Dermatophytosis/tinea is one of the most common skin diseases affecting people across the world; caused by superficial fungus which invade and multiply within the keratinized tissue (skin, hair, nails). Approximately, 20-25% of the world population is affected by tinea. Aim of the present study was to compare the efficacy and safety of oral griseofulvin and oral terbinafine in tinea capitis among children aged 3–14 years. Methods: This open-label, prospective, comparative study was conducted at Department of Pharmacology with collaboration of Pediatrics and Dermatology department of JLNMCH, Bhagalpur, Bihar from January 2023 to June 2023. Children between the ages of 3 and 14 years were enrolled for over 24 months. Patients with clinically diagnosed and laboratory-confirmed tinea capitis were randomized into two groups of 50 each. Group A was given oral griseofulvin for 8 weeks and Group B was given oral terbinafine for 4 weeks. Results: Early response was obtained in Group B treated with terbinafine, and a statistically significant reduction in clinical symptoms was obtained at 4 weeks compared to griseofulvin with P = 0.044. Mycological cure was achieved at the end of 6 weeks in the terbinafine group, with P = 0.034 compared to the griseofulvin group in which 3 patients remained KOH positive at 8 weeks. Conclusion: Both drugs were well tolerated with no serious adverse effects. Terbinafine is an effective alternative to griseofulvin in pediatric patients with tinea capitis with a shorter duration of treatment and fewer adverse effects.

Background: Intra uterine growth restriction refers to fetus with an estimated fetal weight below 10th percentile corrected for sex and ethnicity which has features of chronic hypoxia and/or malnutrition. However a consensus does not exist for definition of IUGR.) It is associated with adverse fetal outcomes including acidosis, still birth, oligohydramnios, low birth weight and adverse events during labor including fetal distress in labor. IUGR is often suspected by poor maternal weight gain and a fundal height that is less than expected for the gestational age and is an indication for the ultrasound at presentation. Aim of this study to prospectively evaluate all IUGR pregnancies by color Doppler. Methods: This non-interventional descriptive study was conducted at Department of Obstetrics and Gynaecology with collaboration of Department of Radio-diagnosis, Darbhanga Medical College and Hospital, Laheriasarai, Bihar from March 2023 to February 2024. A total of 58 patients were selected for study which fulfill the inclusion criteria. Results: There were a significant number of preterm babies in our study group – 30 (51.7%). Thirty-five babies were admitted into neonatal intensive care unit for treatment – 6 babies died. Of the remaining, 15 required admission for more than 10 days for various complications. Two babies could not be admitted to NICU because of poor parental resources. Of that one baby died. Neonatal complications developed. Conclusion: Doppler studies of multiple vessels in the fetoplacental circulation can help in the monitoring of compromised fetus and can help us predicting neonatal morbidity. This may be helpful in determining the optimal time of delivery in complicated pregnancies.

Background: PCOS is a common metabolic and reproductive disorder that affects women and causes its symptoms and signs. It is estimated that 4% of women of reproductive age worldwide are affected; however, in populations with a higher risk, some estimates place the percentage closer to 10%. Aim of this study is to determine and compare the rates of ovulation, menstrual cycle regularization, and pregnancy in PCOS patients taking both clomiphene citrate and metformin in combination and clomiphene citrate alone. Methods: Between March 2023 and February 2024, 220 patients, 110 in each group, with primary subfertility and PCOS diagnoses who were between the ages of 18 and 40 were selected. The primary outcome, or the incidence of ovulation, was determined by folliculometry. Secondary outcomes that were compared between the two groups were the regularization of the menstrual cycle and the frequencies of pregnancy. Results: Overall ovulation was shown to be at its maximum during the third cycle of ovulation induction, occurring in each group at 48.8% and 41%, respectively. The primary outcome for group A was significantly higher (83.3%) when clomiphene citrate and metformin were administered jointly than when clomiphene citrate was administered alone (65.9%). The secondary results were significantly greater (89.6%) in the group that received metformin with CC. Pregnancy rates were higher in the first group (33.3%) than in the second (20.5%). Conclusion: Two groups were given varying quantities of clomiphene citrate in this study: one group had it in addition to metformin, while the other group received it just to induce ovulation. It was found that clomiphene citrate plus metformin was a better way to induce ovulation in women with PCOS than clomiphene citrate alone.

Background: The high morbidity and mortality rates of sepsis contribute to a significant global healthcare burden. The mortality rate is still high because of the delay in diagnosis caused by the absence of trustworthy diagnostic procedures, despite the significant advancements in therapeutic choices. Endothelial dysfunction and an increase in systemic capillary permeability are caused by the strong activation of the inflammatory cascade in sepsis. The kidney excretes more albumin in the urine due to capillary leaks in the glomerulus and a lack of barrier integrity.   The main aim of this study is to evaluate whether there is a quantitative relationship between serum albumin levels and the risk of mortality, as well as the function of serial monitoring of serum albumin levels as a predictor of mortality and morbidity in sepsis patients admitted to the intensive care unit. Method: Present study was conducted in ICU Medicine department of Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar from July 2023 to June 2024 on 140 sepsis patients who admitted during this study period. On the first day of sepsis diagnosis, as well as on days three and five, the serum albumin levels of all the enrolled patients were assessed after a thorough evaluation. Throughout their hospital stay, patients were monitored, and their outcome that is, whether they died or survived was noted. SPSS (statistical product and service solutions) software version 24.0 was used to analyze the data after it was entered into an MS Excel sheet. Results: There were two groups of 140 patients selected for the study: survivors and non-survivors. On the first day, the survivor group’s mean serum albumin level was 3.72 g/dl (±0.278), while the non-survivor group’s was 3.11 g/dl (±0.247). On day three, the survivor group’s mean serum albumin level was 3.17 g/dl (±0.248), while the non-survivor group’s was 2.65 g/dl (±0.172). On day five, the survivor group’s mean serum albumin level was 2.72 g/dl (±0.25), while the non-survivor group’s was 2.32 g/dl (± 0.144). According to the unpaired t test, the difference in mean serum albumin on days 1, 3, and 5 was statistically significant (p value ≤0.001). Survivors’ mean blood albumin levels decreased from 3.72 g/dl to 2.72 g/dl between days 1 and 5. It ranges from 3.11 to 2.32 g/dl in non-survivors. Conclusion: According to this study, a patient with sepsis who has a serum albumin level below 3.5 gm/dl for all three days has a bad prognosis. Serum albumin levels gradually decreased in both the survivor and non-survivor groups starting on day 1, but a drop below 3.0 gm/dl was linked to a greater death rate. It implies that the prognosis of the sepsis patient in terms of mortality is influenced by the speed at which serum albumin drops below the normal level. The clinical evaluation of sepsis patients, who are at risk of a bad prognosis even in locations with little resources, may benefit from serum albumin testing, which is less expensive and can be measured serially.

Introduction: The lipid profile, blood pressure & heart rate is used to determine the risk of obesity, heart disease in myocardial infarction, atherosclerosis and help in deciding treatment for borderline or high risk persons. “Epidemiological data suggests that plant-based dietary patterns are associated with a significantly lower prevalence of hypertension.” Aim & Objective: To investigate comparative study of lipid profile levels, blood pressure & heart rate in vegetarian and non-vegetarian persons. Materials And Methods: 30 Vegetarian persons and 30 non-vegetarian persons in age group of 20 to 60 years was taken from urban area of Rajkot city. A total of 60 samples i.e. blood (in sterile sample bottles) was collected. Biochemical analysis for Total Cholesterol, High density lipoprotein Cholesterol, Very low density lipoprotein cholesterol, Triglyceride, Low-density lipoproteins were done. Blood pressure & Heart rate were measured among all subjects. Results: There was significant increase blood pressure and heart rate in non-vegetarian persons than in vegetarian person. There was significant difference found in both the groups in values of all the parameters of lipid profile levels (p<0.05) and ‘t’ test is used to know the association between them. Discussion: The purpose of our study is to determine if adults can improve their heart rate, systolic and diastolic blood pressure and lipid profile levels by choice of diet. Conclusion: There is more dyslipidaemia indicated by higher values of total cholesterol, triglycerides, LDL, VLDL, and lower value of cardiac protective HDL in non-vegetarian person than in vegetarian person. In comparison to vegetarian, non-vegetarian had higher blood pressure and a higher heart rate.

Background: Oral mucosal lesions are common complications among denture wearers, impacting their oral health and quality of life. This study aimed to investigate the prevalence and characteristics of denture-related oral mucosal lesions in patients attending a government medical college. Methods: A retrospective study was conducted, involving 90 denture-wearing participants. Data on demographic details, type and duration of denture use, oral mucosal lesions, and oral hygiene practices were collected from dental records. Statistical analysis was performed using SPSS version 23.0, employing descriptive statistics, Chi-square tests, and t-tests. Results: The study included 45 males and 45 females, with a mean age of 58.6 years. Complete dentures were worn by 60% of participants, and the mean duration of denture use was 5.3 years. Oral mucosal lesions were present in 72.2% of participants, with denture stomatitis being the most common (33.3%), followed by traumatic ulcers (22.2%) and angular cheilitis (16.7%). A significant association was found between the type of denture and the presence of lesions (p = 0.035), as well as between oral hygiene practices and lesion prevalence (p = 0.045). Conclusion: The high prevalence of oral mucosal lesions among denture wearers highlights the need for preventive measures. Complete dentures and poor oral hygiene practices were significantly associated with these lesions. Recommendations: Regular dental check-ups, proper denture maintenance, and stringent oral hygiene practices are recommended to reduce the risk of mucosal lesions in denture wearers.

Background: Lower back pain (LBP) is a prevalent musculoskeletal condition affecting individuals globally. Modic changes (MCs) and intervertebral disc degeneration (IDD) are considered significant radiological findings associated with LBP. This study aims to evaluate the association between MCs, IDD, and LBP among residents in Mathura, Uttar Pradesh, India. Methods: A cross-sectional study was conducted involving 300 participants aged 20-60 years from Mathura. Participants underwent lumbar spine magnetic resonance imaging (MRI) to assess MCs and IDD. LBP was evaluated using a standardized questionnaire and the Visual Analog Scale (VAS). Statistical analyses were performed to determine the association between MCs, IDD, and LBP. Results: Out of 300 participants, 180 (60%) reported LBP. MCs were identified in 90 participants (30%), and IDD was observed in 150 participants (50%). A significant association was found between the presence of MCs and LBP (p < 0.001). Participants with both MCs and IDD exhibited higher VAS scores compared to those with either condition alone. Conclusion: The study demonstrates a significant association between MCs, IDD, and LBP among the residents of Mathura. These findings underscore the importance of early detection and management of MCs and IDD to alleviate LBP.

Background: Antenatal depression is common mood disorder and is important public mental health problem. It is mostly ignored, underdiagnosed and undertreated. Various socio-demographic determinants, poor social support and marital dissatisfaction were associated with antenatal depression. Aims and Objectives: To estimate the prevalence of antenatal depression among women attending ANC OPD in tertiary care hospital. To determine association of antenatal depression with various demographic factors, perceived social support and marital satisfaction among women attending ANC OPD in tertiary care hospital. Material and Methods: This cross-sectional study included study population of women attending ANC OPD in tertiary care hospital, during the period of January 2023 to August 2024. All women attending routine ANC OPD and aged more than 18 years were included in the study. Women having medical illness or medical complication due to pregnancy, any obstetric complication during current pregnancy, with substance abuse and on psychiatric medications were excluded from the study. Sample size comprised of 323 women. Marital satisfaction in pregnant woman was measured with Couples Satisfaction Index (CSI-4). Perceived social support was measured with Multi-dimensional Scale of Perceived Social Support (Zimet et al.1988). Women were screened for antenatal depression using the Edinburgh Postnatal Depression Scale (EPDS). The data was analyzed using SPSS software. Mean age, frequencies, proportions, and correlation were calculated. p < 0.05 was considered significant. Results: The mean age of women was 25.20 ±4.031years. The mean of duration of marriage of women was 3.51±2.596 years. The mean gestational age was 29.76 ±6.335. The prevalence of antenatal depression in women attending ANC OPD was 18.6%. The prevalence of antenatal depression in second and third trimester was 29.72% and 14.71% respectively. Antenatal depression had significant correlation with the age of a pregnant women, gestation age, trimester of pregnancy, education of husband, family type of husband and couple satisfaction index i.e. marital satisfaction. Conclusions: In the routine ANC OPD all pregnant women and especially at high risk, aged, multiparous, with poor family support and poor relationship with husband need to be screened for antenatal depression using Edinburg Postnatal Depression Scale (EPDS). High index of suspicion and early referral of pregnant women to mental health services can prevent antenatal depression.

Background: Prolonged or post-dated pregnancies are often linked with heightened risks of perinatal morbidity and mortality, particularly when pregnancies surpass the intended delivery date. While the exact causes of prolonged pregnancy remain unclear, congenital anomalies such as anencephaly are known contributing factors. Aims & Objectives: The primary objective of this study was to assess the outcomes of post-dated pregnancies, with a specific focus on delivery methods, maternal complications, and neonatal outcomes. Specific aims included evaluating age distribution, gestational age, and parity among study participants, analyzing the mode of delivery and indications for cesarean section, and examining maternal and neonatal complications associated with post-dated pregnancies. Materials and Methods:  This prospective observational study was conducted at GMERS Medical College & Civil Hospital, Junagadh, from July 23 to September 23. The study enrolled 150 pregnant women with post-dated pregnancies beyond 40 weeks of gestation, excluding those with previous cesarean sections, congenital anomalies, malpresentation, multiple gestation, and specified medical conditions. Detailed participant histories and comprehensive physical examinations were collected, including age, parity, last menstrual period, and medical history. Labour and delivery details, including mode of delivery and indications for cesarean section, were meticulously documented. Fetal outcomes such as meconium-stained liquor, NICU admissions, and other complications were rigorously assessed. Results: The study revealed that 68% of participants underwent vaginal delivery, with 40% of these deliveries being induced. Cesarean section was performed in 32% of cases, primarily due to indications such as fetal distress, failed induction, and severe oligohydramnios. Maternal complications included postpartum haemorrhage (6.6%) and perineal tears (4.6%). The most common fetal complication observed was meconium aspiration syndrome (5.3%). Neonatal complications included NICU admissions (24.6%), perinatal asphyxia (2.6%), and hyperbilirubinemia (2%). Conclusion: Based on the study findings, it is suggested that considering labour induction at 40 weeks of gestation may be a reasonable approach to mitigate risks associated with prolonged pregnancies. Intervening at this specific gestational age aims to minimize adverse outcomes such as fetal distress and meconium aspiration syndrome, thereby improving overall perinatal outcomes. However, individualized assessments considering maternal health, fetal well-being, and other pertinent risk factors are crucial before deciding on labour induction for post-dated pregnancies.

“Make every mother and child count”- the slogan for World health day 2005 reflects the reality and need of the society even today. Pregnancy and childbirth are a universally celebrated event. Every minute every day, a woman dies as a result of pregnancy and childbirth somewhere in the world, be it an unwed adolescent, a teenage bride for want of blood or drugs. Every year, approximately 600,000 women die of pregnancy related causes. Worldwide about half a million women die as results of complications of pregnancy and childbirth. In India, many women die due to pregnancy-related complications and those who survive suffer from severe maternal morbidity. During the study period,19185 number of patients received care in the OP [obstetrics alone] of whom 11465 were new OP patients and 7720 were old OP patients. 7592 patients were admitted and treated. There were 5713 deliveries; of which 2512 were Labour Natural,205 were Assisted Vaginal deliveries and 2996 were Caesarean Sections. There were 5570 live births. Out of 280 cases of maternal morbidity and mortality, it was found that 267 were referred accounting for 95.35% of cases and 247 were unbooked 84.63% ,33 was booked 15.4%of the cases. In 280 cases,14 cases belong to class I Near miss (5%), 144 cases belong to class II (51.4%),130 cases belong to class III (46.4%).
Finally We can concluded that through better antenatal care, early detection andproper management of risk factors like pre-eclampsia, anaemia and active management of third stage of labor with careful feto-maternal monitoring, multidisciplinary approach for near miss cases i.e. cardiovascular support, ventilatory support, surgical intervention, dialysis, transfusion of blood and blood products and better NICU facilities the absolute goal of Obstetrics of reducing maternal morbidity and mortality, and having a healthy mother and healthy.

Background: Hypertensive disorders, particularly pregnancy-induced hypertension (PIH), are major contributors to maternal and perinatal morbidity and mortality globally. Lactic dehydrogenase (LDH) is emerging as a potential biomarker for assessing disease severity. Objective: This study aimed to evaluate the relationship between LDH levels and feto-maternal outcomes in normal pregnancies and pregnancies complicated by PIH in a tertiary care setting. Method: A retrospective study was conducted at Barasat Government Medical College, West Bengal, from January 2023 to December 2023. A total of 212 pregnant women were enrolled, with 106 women in each category (normal pregnancy and PIH). LDH levels were measured and correlated with feto-maternal outcomes, including preterm birth, low birth weight, and maternal complications. Results: Women with PIH showed significantly elevated LDH levels compared to those with normal pregnancies (mean LDH: 470 IU/L vs. 220 IU/L, p< 0.05). Among the PIH group, 36% experienced preterm delivery compared to 10% in the normal pregnancy group. Additionally, 45% of neonates in the PIH group had low birth weight compared to 15% in the normal group. Maternal complications, including HELLP syndrome and eclampsia, were more frequent in the PIH group (20% vs. 3%). Conclusion: Elevated LDH levels in PIH are associated with adverse feto-maternal outcomes, suggesting its utility as a prognostic marker for identifying high-risk pregnancies and improving management strategies in resource-limited settings.

Aim: To determine inflammatory markers in insulin dependent diabetes mellitus (T1DM) children. Materials & Methods: Following clearance from the Institutional Ethics Committee, the researchers started the investigation. This study included 30children with T1DMwho were previously diagnosed and 30 children who were newly diagnosed with T1DM (controls).As the age of the child was less than 18 years, the present study provided consent from the parents of the children. Exclusion criteria were children without diabetes, co morbidities other than diabetes, apparently healthy children, and parents who did not consent to participate in the study. Statistical Analysis: Regressions were employed, and the percentages were calculated. Significance was set at the level of 0.05.In summary, this finding is of utmost importance. Results: Children with a new diagnosis of T1DM had decreased levels of IL-1 and TNF, while those with a prior diagnosis with T1DM showed elevated levels. The two groups had significantly different serum IL-1 and TNF levels. Children with newly diagnosed T1DM had higher IL-2 and IL-15 blood levels than those with previously diagnosed T1DM. Significant differences were observed in IL-1, IL-2, IL-4, TNF-α, and IL-15 blood levels between the two groups. No notable disparities were observed in IL-1 and IFN levels between the two groups of the present study. The levels of IL-15 and TNF-α were negatively correlated in children with previously diagnosed T1DM. Conclusion: T1DM secondary disorders are influenced by both pro-inflammatory and anti-inflammatory cytokines, according to this new study’s findings.

Background: “Healthcare facilities, especially tertiary care referral centres, have a serious problem with surgical site infections (SSI). The increasing number of Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter (ESKAPE) pathogens being isolated from Surgical Site Infections (SSI) is the rising concern for healthcare practitioners. The reason behind this being their capability of causing serious infections which are resistant to the standard medications. It warrants further research since it poses a serious threat to public health care systems. Research Question: what is the incidence of ESKAPE pathogens related to SSI in the setting of a tertiary care referral centre and what are the risk factors linked with the presence of these pathogens? Aim: Within the context of a tertiary care referral centre, this study aims to ascertain the prevalence of ESKAPE infections in SSI and their associated risk factors. According to our hypothesis, ESKAPE bacteria are often found in surgical site infections (SSI) at our tertiary care referral centre, and we believe that the presence of these pathogens is connected with specific patient and surgical characteristics. Materials & Methods: Over a period of one year, from January 4, 2023, to January 3, 2024, we examined the prevalence of ESKAPE bacteria in SSI at a tertiary care referral centre. The Microbiology and the General Surgery departments provided observations. Patients or their legal guardians provided written consent to use their data, and the research was authorised by the Institutional Review Board and the ethics committee. Results: The study found that 67.4% of surgery site infections were in male patients and 32.6% were in female patients. Most cases were aged 20-40, with a mean age of 38.4. The study found that 30.1% of surgical wound samples grew bacteria, with 10.8% having double bacterial infections. The total number of bacteria isolates was 417, from ten genera. The most common bacteria were Staphylococcus aureus, K. pneumoniae, Coagulase Negative Staphylococcus, and P. aeruginosa, with a gram-positive to gram-negative ratio of 0.782:1. The study found that men accounted for 64.9% of isolated pathogens, while women post-surgical patients, accounted for 35.1%. The majority were male, with no significant gender and culture positivity link. The majority lived in rural areas. Conclusion: Due to antibiotic resistance and improper drug administration, ESKAPE bacteria are increasingly causing SSIs, challenging the healthcare setup. To tackle this, healthcare facilities must emphasize prevention, the intelligent use of antibiotics, and ground-breaking therapies.

Introduction: Eyes are frequently involved in various systemic diseases affecting the rest of the body. Ocular manifestations in certain multisystem disorders will be initial manifestation & may offer a diagnostic clue. Materials & Methods: Case series study of 13 patients of different age groups attended the Department of Ophthalmology, Gulbarga Institute of Medical Sciences. Discussion: Diagnostic approaches including ophthalmic examination techniques, imaging modalities and laboratory tests are discussed to enhance diagnostic accuracy. Conclusion: Recognising the ocular manifestations earliest is crucial for early diagnosis, timely intervention and effective management of systemic diseases.

Objective: This meta-analysis evaluates the safety and efficacy of advanced radiotherapy techniques, specifically IMRT, IGRT, and VMAT, in the treatment of cervical carcinoma, focusing on outcomes like overall survival (OS), progression-free survival (PFS), and treatment-related toxicities. Methods: We identified and reviewed 20 relevant studies comparing advanced radiotherapy techniques for cervical cancer treatment. Data on survival outcomes, toxicities, and quality of life were extracted, and pooled hazard ratios (HRs) were calculated using random-effects models. Heterogeneity was assessed with the I² statistic, and publication bias was examined through a funnel plot. Results: The pooled analysis demonstrated significant improvements in OAR sparing with VMAT and IMRT compared to 3DCRT, with VMAT showing superior treatment times. IMRT provided enhanced homogeneity in dose distribution. Both VMAT and IMRT reduced acute and late toxicities, improving patient quality of life compared to traditional techniques. Conclusions: Advanced radiotherapy techniques, particularly VMAT and IMRT, offer superior treatment outcomes and reduced toxicities in cervical carcinoma management. This meta-analysis provides strong evidence for adopting these techniques as the standard care for cervical cancer radiotherapy.

Background: Several studies have reported elevated blood cholesterol levels among persons who regularly smoke cigarettes/beedis and lowered blood cholesterol levels among persons quitting smoking. Other studies have also shown that smoking increases low density lipoprotein cholesterol (LDL-C) level, resulting in an increased risk of coronary heart disease.  The objective was to Comparative study of serum LDL-C in smokers and non-smokers &correlation with number cigarettes/beedis smoking/day. Methods: An observational cross-sectional comparative study was carried out in 100 subjects. The subjects were divided into two groups. First group consisted of 50 nonsmokers and second group of 50 smokers. The group of 50 smokers was again divided into three sub groups which mild (1-10 cigarettes/day), moderate (11-20 cigarettes/day, severe (more than 20/day) with at least 5 years or more duration of smoking. Concentration of serum LDL-C was determined by Beta-quantification determination of LDL -C concentration. Results: there was statistically significant difference among smokers and nonsmokers aged 18 to 45 years with normal BMI & significant positive correlation with number of beedis/cigarette smoking with respect of serum LDL-C. Conclusions: Thus, it can be said based on the present study that smoking affects LDL-C of the healthy adults which leads to cardiovascular risk in future.

Introduction: Hematological disorders are quite frequent in all age groups. Most of these hematological disorder present as anemia. Bone marrow aspiration is a relatively safe procedure done for the diagnosis and management of hematological disorders. Aims and Objectives: The present study aimed to evaluate the spectrum of various hematological disorders diagnosed on bone marrow aspiration. Material and Method: It was 2 years descriptive cross sectional study conducted in the clinical pathology section of Department of Pathology of Pt. J.N.M Medical College, Raipur. Result: Out of 102 cases, 60 (62.7%) were males and 34 (37.3%) were females. The age range was from 8 months to 70 years. Various disorders seen were  acuteleukemia (43.1%), megaloblasticanemia (15.8%), chronic myeloid leukemia (13.8%), reactive marrow (9.9%), erythroid hyperplasia (4.9%),  microcytic Anemia (3.9%), idiopathic thrombocytopenic purpura (2.9%), lymphoma spill over(2.9%), acute on chronic leukemia (0.9%), multiple myeloma (0.9%) and drug induced bone narrow suppression (0.9%). Most common bone marrow diagnosis of on malignant haematological disorder were megaloblasticanemia followed by  reactive marrow. In hematological malignancies most common were acute leukemias followed by chronicleukemias. Conclusion: Bone marrow aspiration remains an important tool to arrive in the diagnosis of wide range of hematological disorders.

Background: The NLR (Neutrophil-to-Lymphocyte Ratio), lymphocyte-to-monocyte ratio (LMR), and PLR (Platelet-to-Lymphocyte Ratio) are indices calculated from a simple complete blood count. The significant potential values of these ratios, which reflect inflammatory status, frequently serve as markers of underlying inflammatory burden in various diseases and pregnancy complications, including missed abortion. This study was conducted with the aim of assessing the role of platelets to lymphocyte and neutrophil to lymphocyte ratios in the first trimester missed abortion at a tertiary care centre. Materials and Methods: This was a case-control study conducted over a period of 2.5 years involving pregnant women with gestational age <14 weeks who had missed abortion within 1 week. 40 subjects were considered in each group. The age group of the study subjects was between 17 and 42 years. Results: The mean BMI in cases, 19.64 ± 2.4, was statistically significantly lower compared to the control group, 22.29 ± 2.5. The hemoglobin and platelets were found to be statistically significantly lower in the cases compared to the control group. Neutrophils and lymphocytes found to be statistically significantly higher in cases compared to the control group. NLR and LMR found to be statistically significantly higher in cases compared to the control group, and MLR and PLR were statistically significantly lower in cases compared to the control group. With an optimal cut-off value of 4.46 for NLR, AUC was 0.71, with specificity and sensitivity of 96.5% and 81.4%, respectively. With an optimal cut-off value of 63.2 for PLR, the AUC was 0.88, with specificity and sensitivity of 66% and 98%, respectively. Conclusion: NLR and LMR were found to be statistically significantly higher, while MLR and PLR were statistically significantly lower in those with MA compared to healthy pregnant women. These markers can therefore be utilized in the prediction of a missed abortion in pregnant women with gestational age <14 weeks who are at risk. The optimal cut-off values were 4.46 for NLR and 63.2 for PLR.

Background: Thrombocytopenia is the second most common haematological disorder after anaemia in Pregnancy. Most of the cases of Thrombocytopenia are Gestational thrombocytopenia followed by hypertensive diseases. Gestational thrombocytopenia essentially poses no risk to either the mother or fetus-neonate. But thrombocytopenia due other diseases adversely affect the mother, fetus and neonate. So early interdisciplinary evaluation of thrombocytopenia during pregnancy can help in optimizing care as adverse outcomes and management depend on the etiology of the thrombocytopenia. This study aim to estimate prevalence of thrombocytopenia in pregnancy and to correlate maternal and fetal outcome with etiological factors of thrombocytopenia in pregnancy after 34 weeks of gestation at a tertiary care unit in Central India. Materials and Methods: A prospective cross sectional study was conducted with a sample size of 123 pregnant patients selected from those admitted in labour ward with gestational age >34weeks with platelet count <1,50,000/cu.mm in Tertiary Care Centre in Central India from November 2022 to November 2023. Details regarding patient’s demographics, detailed history of period of gestation, high risk factors, past history, patient’s entire obstetric history, complications- during past and present pregnancy were entered in the proforma. Details of examination findings, laboratory investigations were entered in the questionnaire. Also the details about platelet transfusions, ICU admissions, neonatal outcome, and maternal deaths were recorded. Descriptive statistics analysis was carried out including frequency and percentage. The results of the study were tabulated. Results: In 1 year study duration, 9.8% pregnant patients had thrombocytopenia. Majority of patients were diagnosed with gestational thrombocytopenia, severe pre-eclampsia (Partial HELLP), HELLP syndrome, Pancytopenia, Dengue, AFLP and ITP (70.73%, 16.26%, 8.13%, 1.62%, 1.62%, 0.81%, and 0.81% respectively). Majority of the patients had mild thrombocytopenia i.e. 60.16%, followed by moderate thrombocytopenia(30.08%) and least number of patients(9.76%) had severe thrombocytopenia. 25.20% of the study participants required platelet transfusion,9.7% required ICU admission and 1.63% had maternal death. Majority of the babies were motherside. 21.14% of delivered babies had low birth weight, 9.7% babies needed NICU admission and out of these 2.44% had neonatal deaths. Conclusion: The present study revealed that prevalence of thrombocytopenia in Tertiary Care Centre in Central India is 9.8%. Pregnant patients with thrombocytopenia are associated with increased risk of maternal and neonatal morbidity and mortality. So Careful surveillance of these thrombocytopenic mothers and their babies should be done in order to establish the aetiology and timely appropriate management.

Background: Salivary gland neoplasms are uncommon. Constitute 2-6.5% of all head and neoplasms and only 0.3% of all malignancies. About 64-80% of all primary epithelial tumors occur in parotid gland, 7-11% of the submandibular glands, less than 1% in the sublingual gland and 9-23% in the minor glands. 15-30% of tumors in the parotid gland are malignant in contrast to about 40% in the submandibular gland. Delayed presentation and malignant transformation invades facial nerve and causing facial palsy and becomes non-operable. 80% of parotid tumors are located in the superficial lobe. Deep lobe neoplasms are considered to have greater incidence of malignancy. Parotid tumors are not uncommon in Southern Odisha referred from various rural hospitals to M.K.C.G. Medical College & Hospital, Berhampur. Aim: is to determine clinical / pathological variants of different parotid tumors presenting in M.K.C.G. Medical College & Hospital, Southern Odisha. Method: 40 cases of parotid swelling admitted to this Hospital from 2021 to 2023. A prospective study was done with ethical clearance from ethical committee of M.K.C.G. Medical College & Hospital, Berhampur. All patients were evaluated with proper investigation like FNAC, X-ray of neck and parotid region, Ultrasonography of swelling, CT Scan & MRI of parotid swelling and neck were done. Surgery was done and all patients were asked for follow up routinely. Observation: Benign tumors are more common in 20 to 50 years of age and malignancy tumors are common after 50 years. Male Female ratio is 1:2.6. In benign tumors M: F ratio is 1: 2.8 and in malignant tumors M: F ratio is 1: 2. Incidence of benign tumor is 85% and malignant tumor is 15%. Pleomorphic adenoma is the commonest benign tumor and mucoepidermoid carcinoma is the commonest malignant tumor. Conclusion: Diagnosis Parotid gland tumors must be considered in any patient presenting with Parotid gland swelling. Swelling is the commonest symptom. The fact that mass has been present for several years is of no guarantee that it is benign. History and physical examination complementing FNAC help in diagnosis and has good accuracy in diagnosing parotid gland tumors. Surgery is the main modality of treatment in Parotid gland tumors.

Purpose: This prospective observational study compares patients with Type II diabetes mellitus (DM) to age-matched non-diabetics (healthy controls) in order to map the differences in retinal nerve fiber layer thickness. Methods: This study included 160 eyes divided in to two groups. Group A- included 80 eyes with Type II diabetics, Group B – included 80 eyes of non-diabetics (Healthy controls). Using the optical coherence tomography scanning, RNFL thickness was measured in each of the four quadrants. Results: For the entire optic disc as well as each quadrant, diabetics RNFL thickness was lower than that of non-diabetics.This difference was statistically significant in all 4 quadrants (P=0.007). Conclusion: We draw the conclusion that, in comparison to persons without diabetes, RNFL thickness is lower in diabetic patients. It is necessary to take diabetic retinal thinning into account before thinking about retinal thinning due to other neurodegenerative conditions.

Background: HENOCH-Schoenlein purpura (HSP) is a multisystem disorder affecting predominantly the skin, joints, gastrointestinal tract and kidneys, although involvement of other organs can occur rarely. It is one of the most common causes of immunoglobulin A (IgA) mediated systemic small vessel vasculitis with IgA deposition in vessel walls leading to symptoms involving the skin, joints, intestines, and kidneys in children the world-over. Methods: This hospital based descriptive study was conducted at a major tertiary care teaching hospital in North India. All children were diagnosed as HSP, according to the 2010 European League against Rheumatism criteria7, admitted at various wards in the Department of Paediatrics, during the period of six months from June 2021 to December 2021 were included in the study. Results: In this study, 65 patients were included. The mean age at presentation was 6.5 years (Range 2 to 12 years). There were 40 boys and 25 girls with a male preponderance (male to female ratio 1.6:1). The common presenting symptoms were purpuric rash (n=65,100 %) , pain abdomen (n=42,64%), and arthritis (n=28,44), vomiting (n= 16,24%), Malena (n=3,5%), genitourinary symptoms like hematuria (n=3,4%), scrotal pain(n=4,6%), oedema(n=10,15%), hypertension(n=20,30%) were seen .In the laboratory parameters An elevated ESR (n=31,48%), anaemia(n=33,50%) , leucocytosis seen in 5 cases (18%), thrombocytosis in 13 (20%) patients . ASO titre of >200 was found in 10 (15%) patients. Abnormal urine analysis in 10 (15%) patients. Rheumatoid factor was positive in 17(4%) also stool for occult was positive in 12(19%) cases. Conclusion: The clinical features of Henoch Schonlein purpura in the population were different from the previously published studies. Renal involvement was less common the occurrence of life-threatening complications in HSP is very rare

Background: The need for blood transfusion is indispensable to any major surgical procedures. Patients undergoing open surgical repair of aortic aneurysm and dissection have high bleeding risk. There has been a great concern due to increasing awareness of adverse effects of allogeneic blood transfusion. Cell Salvage and Acute normovolemic hemodilution (ANH) has been proposed as an alternative to allogenic blood transfusion. Objectives: To investigate the effectiveness of cell salvage for minimizing intraoperative and postoperative allogenic blood transfusion in patients undergoing aortic aneurysmal surgeries. Study Design: A prospective retrospective observational study. Participants: 54 patients undergoing aortic aneurysmal surgeries. Methods: Patients were divided into two groups . Group 1: Cell saver group (CS group) included all the patients, prospective as well as retrospective, undergoing/ has undergone aortic aneurysmal surgery in whom cell saver was used. Group 2: Control group (group C) included those patients who have undergone aortic aneurysmal surgery in whom cell saver was not used. Allogenic blood transfusion was given if Hb was <7gm% during intra operative and post-operative period. Patients were followed in post-operative period for 24 hours and requirement of blood transfusion was recorded in each patient and same data was collected from retrospective subjects. Results: We observed that there was significantly decreased need for allogenic blood transfusion in cell saver group both intraoperatively as well as in immediate postoperative period. It was also observed that the total number of blood units transfused were significantly higher in control group in comparison to cell saver group. Conclusion: It was concluded that the use of cell saver in repair of aortic aneurysm surgeries was beneficial for patients and decreased the need for allogenic blood transfusion and hence should be incorporated in these surgeries wherever feasible.

Background and Objectives: Foot ulcers are one of the main complications in diabetes mellitus, with a 15% lifetime risk in all diabetic patients. The rate of lower extremity amputation among diabetic patients is 20–40 times higher than in non-diabetics. This study aimed to link the Diabetic foot ulcer with different risk factors. Methods: This descriptive cross-sectional retrospective study was conducted in institute. Data of all patients presenting between Sept 2023 to August 2024 were analyzed for risk factors. Analysis was done on SPSS version 25. Results: Total of 1000 patient were seen during this period, out of which 620 patient data was picked up as it was complete in respect to the information needed. Middle age, Male gender, Type 2 diabetes, and Hypertension, were insignificantly co-related. High waist circumference, Comorbidity like Neuropathy, Dyslipidemia, Greater body mass index, Poor compliance with Medication and type of medication used (combination of oral and injectable) were found statistically significant predictor for DFU. However retinopathy was not found to be a risk factor of DFU. This result was statistically significant. Conclusion: Factors like obesity, waist circumference, combination of oral along with injectable therapies, neuropathy, dyslipidemia, retinopathy and poor compliance with medication were statistically significant and can be strongly linked with diabetic foot ulcer. Middle age, Male gender, Type 2 diabetes, and Hypertension were insignificantly co-related. However, Awareness of physicians about foot problems in diabetic patients, clinical examination and preclinical assessment, regular foot examination, patient education, simple hygienic practices and provision of appropriate footwear combined with prompt treatment of minor injuries can decrease ulcer occurrence by 50%.

Background: Bed sore has long been recognized as major cause of morbidity, mortality and health care burden globally and worst in developing countries like India. Bed sore is a localized injury to skin and underlying tissues due to pressure or friction and its incidence is affected by multiple factors. Objective: This study was aimed to assess magnitude of bed sore and associated factors among patients admitted to surgical ward. Method: This cross-sectional study was conducted among 100 hospital admitted patients in a tertiary care hospital. After taking the informed consent from all patients, data was collected through a self-structured proforma. Data analysis was done via SPSS version 25. Chi square test was utilized to assess the association between bed sores and potential risk factors. Result: 12 patients or 12% among 100 admitted patients developed bedsore. Bed sores incidence was significantly associated with age group (p=0.002), socioeconomic status (p=0.002), hospital stay length (p=0.002), limitation in movement (p=0.0001), diabetes mellitus (p=0.03), chronic kidney disease (p=0.04), obesity (p=0.001), history of hypertension (p=0.002), history of stroke (p=0.02), whereas, bed sores were not associated with gender significantly (p=0.40). Conclusion: The incidence of bed sores was significantly high among study population. Predisposing factors to the bed sores were advanced age, lower socioeconomic status, and longer hospital stay, limitation in movement, diabetes mellitus, obesity, history of hypertension, and history of stroke. Recommendations: This study recommends that frequent positioning of the patient and health education for patients from rural areas and special and frequent care for those unable to care for themselves were needed to minimize occurrence of bed sore. Obese patients should reduce weight. All patients, especially diabetic patients, should take care of skin.

Background: Disorders of Sex Development (DSD) encompass a wide range of congenital conditions in which there is a discrepancy between chromosomal, gonadal, and anatomical sex. These conditions require complex and multidisciplinary management strategies, making the evaluation of treatment outcomes crucial for the advancement of medical care in this field. This study presents a thorough review of the evaluation, treatment, and follow-up of DSD patients treated at our department over the last decade. Methods: A comprehensive retrospective analysis was conducted on the medical records of pediatric patients diagnosed with DSD from 2012 to 2022. Data were meticulously collected on demographics, clinical presentations, diagnostic methodologies, therapeutic interventions, and long-term outcomes. Statistical analyses were performed to elucidate trends, correlations, and potential areas for improvement in clinical practice. Results: A total of 15 patients were treated for DSD over the study period, with Congenital Adrenal Hyperplasia (CAH) identified as the most frequent condition, representing 60% of the cases. Other significant conditions included Complete Androgen Insensitivity Syndrome (CAIS) and Mixed Gonadal Dysgenesis (MGD). Patients presented with a variety of symptoms ranging from ambiguous genitalia in neonates to inguinal hernias in older children. A combination of hormonal therapies and surgical interventions, such as clitoral reduction with feminizing genitoplasty and laparoscopic gonadectomy, were utilized. The majority of patients experienced positive outcomes in terms of both cosmetic and functional aspects, though the importance of continuous follow-up cannot be overstated. Conclusion: The findings of this study highlight the complexities involved in the management of DSD and reinforce the importance of individualized treatment plans. The study also underscores the critical role of early diagnosis, multidisciplinary management, and ongoing follow-up in optimizing patient outcomes. Future research should focus on the long-term psychosocial impacts and quality of life in DSD patients.

Background: Pulmonary hypertension (PH) complicates the management of individuals with ILD, leading to diminished functional status & adverse outcomes. Timely identification of PH in ILD is crucial for commencing treatment & evaluating lung transplantation options. The aim of present study was “to assess the suitability of a reduced ESC/ERS risk categorization model to forecast the long-term prognosis in individuals with severe PH resulting from ILD”. Methods: The present cross-sectional study was conducted 60 among patients of ILD suspicious of PH at department of pulmonary medicine of a tertiary care centre for a period of one year & follow up was done upto two years. Risk stratification analyses were conducted on patients according to guidelines. Statistical analysis was done by using SPSS version 25.0. Results: Out of 60 patients 10 had low risk, 35 had intermediate risk & 15 had high risk. During the follow-up, one patient was lost to follow-up. The TF survival rates for patients with SPH related to ILD were 58% at 1 year & 31% at 2 years. “SvO2, RA area, BNP, WHO functional class, & the ESC/ERS risk score were important predictors of TFS”. Nonetheless, the ESC/ERS risk score emerged as the most robust predictor. Conclusion: A condensed iteration of the ESC/ERS risk classification paradigm for PAH may predict TFS in patients with advanced PH due to ILD.

Background and Objectives: Snake bite is a neglected tropical disease. Snake venom is a complex mixture of various enzymes, polypeptides and toxins. Paired fang marks, clinical syndromes, size, shape, pattern of markings, behavior helps to identify poisonous snakes. Snakebite causes local effects at bite site, lymphadenopathy, hematotoxicity, clotting disorders, neurotoxicity, nephrotoxicity, DIC. Cardiac manifestations following snakebite is less stressed complication. Hence the study has been conducted to observe clinical, electrocardiographic and cardiac biochemical changes and to study incidence and pattern of cardiotoxicity. Methodology: 120 cases admitted to K.R. Hospital, Mysuru meeting the inclusion criteria were considered in 1 year time period between July 2022 to June 2023. It’s a single centered, time bound and prospective study. Data was entered into Microsoft excel data sheet and was analyzed using SPSS 22 version software. Categorical data was represented in the form of Frequencies and proportions. Chi- square test was used as test of significance for qualitative data. Continuous data was represented as mean and SD. Independent t test was used as test of significance. ANOVA (Analysis of Variance) was the test of significance to identify the mean difference between more than two groups for quantitative and qualitative data respectively. Paired t test is the test of significance for paired data such as before and after surgery for quantitative and qualitative data respectively. Pearson correlation or Spearman’s correlation was done to find the correlation between two quantitative variables and qualitative variables respectively. Results: The study population was mainly in age group of less than 40 years (78.3%) and 75% people affected are males. People involved in agricultural work (86.7%) are more commonly affected and most common site of bite being right lower limb(76.7%). 78.3% people reached hospital within 12hours.Local signs were present in 90%. Vomiting (27.5%), palpitations (11.7%) were present.1.7% people experienced hypotension. ECG changes were seen in 42.5% .Elevated troponin I (5.8%) and CKMB in (5%). ECHO was abnormal in (1.6%).ASV was administered to 100%. 1.6% required vasopressor support.0.8% mortality is observed. Conclusion: Cardiovascular system involvement following snakebite was not rare, it is mandatory to record ECG and estimation of cardiac enzymes as soon as possible in detecting cardio toxic effects following snakebite.

Aim: descriptive analysis of the histomorphological spectrum of metastatic deposits in liver from different primaries and categorize them according to age, sex, morphology and immunohistochemical interpretations. Materials and Methods: Our study was carried out in the Pathology department of NIMS Medical College, Jaipur on 94 patients who were suspected for liver metastasis clinically and underwent biopsy for histopathological findings over a time duration of 3 years. Complete clinical history of the included patients was taken along with their radiological investigations, serum markers, cytological findings and treatment history. Results: In this study maximum number of cases of liver metastasis were Gastrointestinal in origin (47 cases: 50%) including colorectal, gall bladder, pancreas, pancreatobiliary and gastric origin. Out of these most common sites for liver metastasis was observed from gall bladder; reported as adenocarcinomas (18 cases; 19.15%) confirmed on IHC findings of keratin 7 and 20 and keratin19. Amongst the 10 cases of pancreatic origin metastasis (CEA and CA19.9), predominant cases (9 out of 10) were pancreatic adenocarcinoma and one case of neuroendocrine tumor of pancreas was reported.  10 cases were reported as pancreatobiliary metastasis on the basis of IHC findings out of which 6 were confirmed to be adenocarcinomas of pancreatobiliary origin one case of extrahepatic cholangiocarcinoma and 2 cases of periampullary origin were found. Stomach primaries (4 cases) were mostly adenocarcinomas which deposited metastasis in liver while one case of gastrointestinal stromal tumor was observed with IHC confirmation. Second most common metastasis was from Lung primaries (23 cases; 24.5%). Conclusion: Incorporating clinical history, radiological findings, and IHC is crucial to differentiate primary liver tumors from metastases, ensuring accurate diagnosis and appropriate treatment planning.

Introduction: Microdeletion of the y chromosome are the second most frequent genetic cause of spermatogenetic failure in infertile male after the Klinefelter syndrome. Microdeletions occur in about one in 4000 men in the general population but its frequency is significantly increased among infertile men. The indication for molecular diagnosis of Y chromosome microdeletion is based on sperm concentration and it is strongly advised in patient affected by azoospermia and severe oligozoospermia (<5×106/ML). Microdeletion in the azoospermia factor AZF): AZFa, AZFb, AZFc Or AZFbc of Y chromosome are clinically relevant and are found in men with severe oligo-or azoospermia. The most frequent deletion type is the AZFc region deletion (~80%) followed by AZFa(0.5-4%), AZFb(1-5%) and AZFbc(1-3%) deletion. Infertility is a global health problem caused by multiple factors and affects approximately 10% to 15% of couples worldwide. The study sought to examine the relationship between male infertility risk and AZFc and gr/gr deletions. Methodology: The present study was conducted at Department of Genetics of MGM Medical College and Hospital Aurangabad from Oct. 2023 to March 2024 amongst male patients diagnosed with azoospermia or oligospermia within reproductive age, often defined as 18–50 years.  In order to test for azoospermia and severe oligozoospermia in humans (men), the EAA/EMQN (2014) guidelines recommend using PCR amplification reagents for two markers on the Y chromosome. This assay provides Y chromosome Microdeletion Detection. -Detection mix sets 1 and 4 are for AZFc-sY254, sY160, sY145, and sY255; gr/gr-sY1291, sY1191; and SRY-sY14 [internal control] is for detection mix set 5. Result: The highest frequency of AZFc deletions in this study was found in cases of severe oligozoospermia (81%), while AZFa and b deletions were found in azoospermic and oligozoospermic individuals at comparable frequencies. It’s interesting to note that compared to the SOAS and oligozoospermic groups (3 and 12%, respectively), the azoospermic group had a higher frequency of double deletions (37%). All of these observations suggest that the severity of the phenotype may be influenced not only by the loci but also by the length of deletion (involving multiple loci). Therefore, it would be clinically relevant to closely monitor and counsel oligospermic patients, particularly those with double deletions, regarding their potential for rapid progression to azoospermia. This information will be required because these patients will require appropriate management and counseling in order to preserve their sperm for use in artificial reproductive technologies (ART). Conclusion: We discovered that the eight patients we chose for our study fall into the maximum age group of people between the ages of 21 and 40. Male infertility is a multifactorial condition involving a wide range of disorders. Over 30% of male infertility is thought to be caused by abnormalities in sperm production as a result of a genetic defect. Y-Chromosome The discovered AZF gene microdeletions strongly point to spermatogenic failure, irregular sperm concentration, and male factor infertility. The prevalence and implications of YCMs remain highly variable, despite increased awareness among the world’s infertile male population.

Background: The ligature mark in case of asphyxia death is an important part in the investigation. The correlation of external and internal findings helps to identify the different facts in case. The purpose of this research is to study the ligature marks in asphyxial deaths. Method: The observational descriptive study was conducted in the Department of Forensic Medicine and Toxicology, The Oxford Medical College and Research Centre, Bangalore to study the ligature marks in asphyxia deaths among 100 autopsy cases received during the time period of one year. The details about the victims regarding the circumstances of death, type of ligature material, manner and apparent cause of death was recorded. Results were analyzed using SPSS version 25.0. Results: Out of all the age groups maximum cases were in the group of 21 to 30 years (38%) and 31 to 40 years (25%). 66% cases were male and 34% were female. The cause of death in most cases was due to hanging (a) complete (52%) (b) partial (32%) and strangulation (16%). Encircling of mark around the neck was complete in 68% cases and incomplete in 32% of cases. Level of mark at neck was above the level of thyroid-cartilage in 68% cases, at the level in 23% cases and below the level in 9% cases. Direction of marks was oblique in 94% cases and transverse in 6% cases. Deep impression was found in 49% cases, prominent in 45% cases and faint in 6% cases. Continuous marks were found in 95% cases and intermittent in 5% cases. Parchmentization was present in 94% cases and absent in 6% cases. Conclusion: The results emphasise the significance of a thorough post-mortem examination in uncovering the intricacies underlying these unfortunate events, providing guidance to forensic specialists and judicial authorities in making precise conclusions.

Background: The complexities of diagnostic haematopathology are well known, and even in this molecular era, immunophenotypic studies together with routine histopathology remain critical components in the evaluation of lymphoid proliferations. Immunohistochemistry refines diagnoses, impacts therapeutics, and influences prognosis. Aims: This study aimed to review the histomorphology of nodal and extranodal malignant lymphomas and correlate histopathologic diagnoses with immunohistochemistry (IHC) results in malignant nodal and extranodal lymphomas. Methods: This retrospective cohort study investigated the role of IHC in diagnosing malignant lymphomas at Triesta Reference Laboratory, Health Care Global – Bangalore Institute of Oncology. Ethical approval was obtained, and 100 patients diagnosed between January 2009 to July 2009 were included. These patients visited Health Care Global – Bangalore Institute of Oncology (HCG-BIO) out-patient departments, and cases were referred from HCG branches all over India, hospitals, and laboratories in and around Bangalore for review. Clinical information, histopathological, and IHC slides were systematically collected. Data, including demographics, symptoms, imaging findings, and follow-up information, were analyzed using SPSS 18. IHC utilized a panel of antibodies, and tests for proportions assessed concordance and discordance between diagnostic methods. Results: In the study of 100 cases, 82 were nodal lymphomas, among which 11 were of Hodgkin’s type and 71 of non-Hodgkin’s type (57 B-cell, 12 T-cell, and 2 gray zone lymphomas). Additionally, 18 cases were extranodal, encompassing Diffuse Large B-cell lymphomas (DLBCL), Peripheral T-cell lymphomas (PTCL), Cutaneous T-cell lymphomas (CTCL), Lymphoblastic Lymphomas (LBL), Mucosa-Associated Lymphoid Tissue Lymphomas (MALToma), and Marginal Zone Lymphomas (MZL). The concordance between histopathological diagnosis and IHC results was 75%, demonstrating significant overall agreement (p<0.001). Conclusion: Precise diagnosis and classification of lymphomas are imperative for tailored management, particularly in emergency oncologic scenarios. IHC is essential and integral to lymphoma diagnosis.

Background: Thyroid nodules, affecting 5-10% globally, pose a diagnostic challenge in distinguishing between benign and malignant lesions. Fine-needle aspiration cytology [FNAC], a key diagnostic tool, is guided by the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Despite widespread adoption, challenges persist in accurately predicting thyroid lesions solely through cytology. Histopathologic examination remains the gold standard, and up to 20-30% of initially indeterminate nodules are later found to be malignant yet FNAC of the thyroid is the first line procedure that is widely used all over the world in the diagnosis of thyroid lesions. Aims: 1. To study the cytomorphology of various thyroid lesions utilising The Bethesda System of reporting thereby elucidating its utility. 2. Cytohistopathologic correlation; thereby analyzing the cause of diagnostic errors with an eventual aim to improve diagnostic accuracy. Methods: This retrospective study, conducted at Vikram Hospital, Mandya, spanned four years from August 2011 to May 2015. The study encompassed 205 patients who underwent fine-needle aspiration (FNA) of thyroid nodules, either sonographic guided or non-guided. Experienced cytopathologists, going through the clinical information, reviewed slides utilising the Bethesda System categories. Histopathologic slides were reviewed too and diagnoses were correlated with cytology. Descriptive statistics characterized Bethesda System categories and histopathologic outcomes. Concordance rates were calculated, and SPSS version 18.0 was used for statistical analyses (p < 0.001 considered significant). Results: In this study encompassing 205 patients, in the age group of 14-61 years,12.6% were males and 87.3% were females, with the majority (72.7%) aged 20-40 years. Cytologic evaluation categorized 87.8% as benign, predominant lesions being nodular goitre (56.1%) and colloid goitre (38.8%). Follicular neoplasms [3.9%] and Papillary carcinoma [3.9%] showed equal prevalence Follow-up histopathology for 143 cases showed high concordance between cytologic and histopathologic diagnoses, with sensitivity (95.00%) and specificity (97.56%) indicating the reliability of cytology in identifying thyroid lesions. The overall accuracy of cytologic evaluation was commendable at 97.20%. Conclusion: In conclusion, our study contributes valuable insights into the diagnostic accuracy of thyroid cytology, emphasizing its role in stratifying thyroid lesions based on the Bethesda System; being a very useful, uniform and standardized system for reporting thyroid cytopathology. The high concordance rates, along with robust sensitivity and specificity values, highlight the reliability of cytologic assessments.

Introduction: Heart failure with preserved ejection fraction (HFpEF) is prevalent, representing up to fifty percent of all heart failure (HF) cases and an increasing proportion of hospital admissions for acute decompensated heart failure. Alongside clinical severity, B-type natriuretic peptide (BNP), a peptide hormone produced by cardiomyocytes in response to elevated wall stress, is assessed in HFpEF patients. This investigation aimed to ascertain the importance of serum BNP levels in patients with acute heart failure and preserved ejection fraction. Material and Methods: Sixty-eight cases with suspected clinical diagnosis of heart failure according to Framingham’s criteria above 21 years of age were recruited. Participants went through transthoracic echocardiography and BNP testing done to diagnose the heart failure with preserved ejection fraction and classified according to diagnostic dysfunction. Results: The BNP levels were over 400 pg/ml in 73.52%, between 100-400 pg/ml in 14.70%, and 11.70% had BNP levels below 100 pg/mL. A 2-D echo showed a left atrium measuring 38.98±4.34 cm, left ventricle measuring 43.11±5.60 cm during diastole and 26.76±3.90 cm during systole, and an ejection fraction of 57.21±3.20. Conclusion: Serum BNP is an effective indicator for correlations when a diagnosis is difficult to establish. However, it is necessary to be knowledgeable about relevant issues in order to manage this sickness.

Introduction: The differential diagnosis of ascites remains difficult in clinical practice due to its varied etiopathogenesis. The serum-ascites albumin gradient (SAAG) is a better way to classify ascites than the total protein concentration of the fluid. We undertook the present study to assess the serum ascetic fluid albumin gradient (SAAG) in ascites cases and to compare its usefulness in determining the cause of ascites with the ascitic fluid total protein (AFTP) levels. Material and Methods: A total of 102 patients who had no prior etiology diagnosis of ascites were recruited. Participants had abdominal USG and CT scans to determine the presence of ascites and concurrently obtained ascitic fluid and blood samples, testing them for total protein, and serum albumin. We analysed serum albumin, ascitic fluid albumin, total protein, and the serum-ascitic fluid albumin gradient. Results: The commonest cause was cirrhosis (56.86%), followed by congestive cardiac failure (CCF) (18.62%), TB ascites (15.68%). SAAG levels were significantly associated with cirrhosis and congestive cardiac failure. SAAG has a sensitivity, specificity, PPV, NPV and accuracy of 86.22%, 85.78%, 95.36%, 67.12%, and 88.34% respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of SAAG in relation to AFTP were all 65.74%, 62.32%, 32.76%, 86.20%, and 63%, respectively. Conclusion: SAAG was more sensitive and specific in determining the underlying pathophysiology of ascites. Comparison of SAAG and AFTP’s diagnostic accuracy revealed that SAAG significantly outperformed AFTP.

Aim: The aim of the present study was to evaluate the typical clinical presentation, biochemical findings, and prognosis of severe dengue fever. Materials and Methods: This study was conducted at the Pediatrics Department of Krishna Mohan Medical College and Hospital, Pali Dungra, Sonkh Road, Mathura, Uttar Pradesh, India. Of all the dengue cases, 60 were deemed serious. Only adolescents (10-19) were considered for the study. Results: Among the 60 severe dengue cases, 53.3% (n=32) had Dengue shock syndrome (DSS), 18.3% (n=11) had Dengue Hemorrhagic Fever (DHF), and 11.6% (n=7) had Expanded Dengue Syndrome (EDS). After being admitted to the hospital, 13.3% (n=8) of the patients with DSS developed DHF, and 3.3% (n=2) of those with DHF developed grade EDS. The most common blood type among patients was B+, accounting for 38.3% (n=23), followed by O+ at 35% (n=21), A+ at 23.3% (n=14), and AB+ at 3.3% (n=2). Fever was the most observed symptom, lasting 4-6 days in 55.9% (n=33) of cases, followed by ≤3 days in 38.3% (n=23) cases and ≥7 days in 5% (n=3) cases. Abdominal pain and vomiting were observed in 76.6% (n=46) of patients, and shock was observed in 61.6% (n=37) of patients. Shock was observed in 60% (n=36) of patients, pleural effusion in 45% (n=27), ascites in 33.3% (n=20), and hepatomegaly in 20% (n=12) cases. Rash was observed in 18.3% (n=11) of patients, while loose motions and difficulty breathing were observed in 15% (n=9) of cases each. Headache was present in 10% (n=6) of cases, and myalgia and arthralgia were observed in 8.3% (n=5) of cases. Convulsion and altered consciousness were rare presentations seen in 6.6% (n=4) of cases and 5% (n=3) of cases, respectively. Conclusion: Severe dengue is characterized by nausea, vomiting, shock, ascites, and pleural effusion. Important findings in patients with severe disease include elevated AST and D-dimer levels, low fibrinogen and albumin levels, and hyponatremia. With prompt diagnosis and appropriate treatment, its severity can be reduced.

Objective: A comparative study on trabeculectomy with MMC versus an Ologen implant in POAG patients of eastern India. Methods: A retrospective study conducted at SCB Medical College and Hospital, Cuttack, included 40 patients aged 18-80 years with POAG who were treated between January 2021 and June 2022. Group 1 (n=20) was treated with trabeculectomy with MMC, and Group 2 (n=20) received Olo implants. Postoperative bleb morphology was assessed by IBAGS, and complications and additional interventions were recorded. Chi-square and Fisher’s exact tests were used for statistical analysis. Result: At early postoperative stages within up to 1 mo postoperatively, groups that received Olo displayed significant differences in bleb height. Implants had also degraded after 180 days. In comparison between both groups, the study results indicated higher vascularity of blebs carrying MMCs at 6-month intervals compared with those carried on implants of Olo as given by the p-values less than 0.01. Complications occurring without showing significant group-related differences were anterior chamber reaction and hyphema. More thin blebs and choroidal detachment were found on MMC-treated eyes. Conclusion: Olo implants achieved a higher early postoperative bleb height but had a greater incidence of vascular blebs at 6 months. MMC treatment was accompanied by avascular blebs but had a higher incidence of thin blebs. Both treatments were safety equivalent. Further large-scale randomized studies are recommended to make more extensive clinical outcome reports and to establish long-term efficacy.

Petrolatum, commonly known as petroleum jelly, is a versatile topical agent widely used in dermatology. Despite its popularity, misconceptions persist about this dermatological staple. This review explores petrolatum’s history, manufacturing process, and biological properties that make it an excellent moisturizer. It addresses concerns about flammability, allergenicity, and comedogenicity, dispelling myths about its use near oxygen and its potential to cause acne. Petrolatum’s diverse applications in dermatology include serving as a patch test instrument, a vehicle for medicated ointments, and an essential wound care product. Given its ubiquity, dermatologists should understand the history, safety profile, and common misconceptions surrounding this humble yet invaluable skincare product. It also explores the substance’s discovery, its widespread adoption in various industries, and current scientific understanding of its benefits and potential risks. The paper aims to provide a balanced perspective on this ubiquitous product, addressing both its practical applications and ongoing debates surrounding its use.

Morphea, or localized scleroderma, is a rare inflammatory connective tissue disorder characterized by skin thickening and fibrosis. This review provides an overview of morphea, including its epidemiology, pathogenesis, clinical types, diagnosis, and treatment options. Morphea predominantly affects children and women, with peaks in early childhood and the fifth decade of life. The disease involves genetic, environmental, and immune factors, leading to increased collagen production. Clinical forms include limited, generalized, linear, mixed, and pansclerotic types. Diagnosis is clinical, supported by histopathology and imaging. Treatment is individualized, involving topical therapies (corticosteroids, tacrolimus), systemic therapies (methotrexate, corticosteroids), and phototherapy (UVA, PUVA). Emerging therapies targeting specific pathways show promise. In children, early aggressive treatment is crucial to prevent complications. Postirradiation morphea and variants like keloid morphea require accurate diagnosis for appropriate management. Phototherapy, particularly low-dose UVA, is effective. Early diagnosis and tailored treatment are essential for managing morphea and preventing long-term complications.

Granuloma annulare, persistent inflaming collagenolytic disorder mainly affecting cutaneous and subcutaneous tissue found in children and adults. Granuloma annulare is a non-infectious granulomatous disorder having etiological provokers. The common variants are localized, generalized, perforating and subcutaneous. In few studies done recently new insights furnished into the epidemiology and causes of GA, along with potential treatment options, although randomized controlled trials remain limited. This review highlights the latest developments in GA epidemiology, pathogenesis, and available therapies, with the aim of encouraging further research and evidence-based treatment recommendations for GA.

Aim: The aim of   present study   was to assessment of cognitive function in unipolar depression patient tertiary care. Methods: The study was carried out in Integral Institute of Medical Science and Research, Lucknow, UP, India. The study included 100 consecutive patients who were visited in both IPD & OPD during 18 months w.e.f. 01st October 2022 to 30st April 2024. Results: In comparison, the control group consisted of 52.00% males and 48.00% females. Statistical analysis using a chi-square test demonstrated no significant difference in gender distribution between the two groups. Among the patients, 50.00% had medical comorbidities, compared to 30% (15 individuals) in the control group. Specifically, diabetes is reported in 28% (14 individuals) of the case group versus 18% (9 individuals) in the control group, hypertension in 14% (7 individuals) versus 8% (4 individuals), and hypothyroidism in 8% (4 individuals) versus 4% (2 individuals).Furthermore, 40.00% of the patients had experienced previous depressive episodes according to ICD-10 criteria. A notable finding is that 10.00% of the patients exhibited atypical presentation. Among the patients, 50.00% exhibited mild depression, with a mean score of 16.84 and a standard deviation of 2.11. Additionally, 26.00% of the patients had moderate depression, characterized by a mean score of 25.48 and a standard deviation of 2.15. Notably, 24.00% of the patients demonstrated severe depression, with a considerably higher mean score of 54.84 and a standard deviation of 4.57. Conclusion: The study highlights the significant burden of depressive symptoms experienced by individuals with unipolar depression and underscores the intricate relationship between cognitive impairments and depressive symptomatology. Tailored interventions addressing both cognitive functioning and depressive symptoms are crucial for optimizing outcomes and improving the well-being of patients. Early detection, comprehensive assessment, and personalized management strategies are essential in psychiatric settings to enhance patient care.

Background: Bilirubin is  most potent endogenous antioxidant which increases in many oxidative stress conditions such as stroke. It is known to exert neuroprotective effect on stroke through mechanisms involved in development hence influencing the occurrence and prognosis of ischaemic stroke. Aims & Objectives: To assess the predictability of serum bilirubin in severity and prognosis of acute ischemic stroke. Materials & Methods: Adult patients >18 years of age diagnosed with AIS who presented to the hospital within 24 hours of symptom onset were included. ). Clinical assessments included National Institutes of Health Stroke Scale (NIHSS) scores at admission and modified Rankin Scale (mRS) scores at discharge and follow-up. Serum bilirubin levels (total, direct, and indirect) were measured using a standardized automated biochemical analyzer. Results: Stroke severity was measured by the NIHSS scale. Minor strokes are seen in 20% of participants, Moderate strokes in 50% of participants, Moderate to severe strokes affect 20%.Severe strokes are observed in 10% of participants. Participants with bilirubin levels below 0.6 mg/dL have a mean NIHSS score of 18.5 Those with bilirubin levels between 0.6 and 1.2 mg/dL have a mean NIHSS score of 14.2 with a correlation coefficient (r) of -0.35 and a p-value of 0.01. Conclusion: Higher bilirubin levels are associated with better functional outcomes.

Introduction: Diabetes mellitus (DM) and thyroid dysfunction (TD) are two prevalent endocrine disorders, often coexisting due to their interconnected role in metabolism. In India, Type 2 Diabetes Mellitus (T2DM) has become an epidemic, influenced by lifestyle changes. Thyroid disorders, particularly hypothyroidism, are common among T2DM patients, impacting their overall metabolic control. This study aims to assess the prevalence of thyroid dysfunction in T2DM patients to improve diagnosis and management strategies. Materials and Methods: This cross-sectional observational study was conducted over six months at a tertiary care hospital, enrolling 60 adult T2DM patients. Participants with known thyroid disorders or other confounding conditions were excluded. Data collection involved clinical history, anthropometric measurements, and biochemical assessments, including blood glucose, HbA1c, and thyroid profile (TSH, FT3, and FT4). Statistical analysis was performed using SPSS, with p-values <0.05 considered significant. Results: The study found a significantly higher prevalence of thyroid dysfunction in the diabetic (DM) group (36.7%) compared to the control group (16.7%) (p=0.004). Elevated T3 levels were observed only in the DM group (3.3%, p=0.032), while both high (3.3%) and low (16.7%) T4 levels were significantly more common in the DM group (p=0.036). Additionally, 30% of DM participants had elevated TSH levels, compared to 16.7% in the control group (p=0.021). Subclinical hypothyroidism was present in both groups, though slightly higher in the DM group (16.7%). The DM group also exhibited significantly higher mean fasting blood sugar (149.63 mg/dL vs. 89.73 mg/dL, p<0.001), HbA1c (7.17% vs. 5.07%, p<0.001), and systolic blood pressure (132.60 mmHg vs. 118.67 mmHg, p<0.001) compared to controls, indicating poorer metabolic and cardiovascular profiles among diabetic patients. Conclusion: Our study shows a notable link between diabetes and thyroid dysfunction, emphasizing the need for regular thyroid screening in diabetic patients for early management.

Background: The Ponseti method is the gold standard for treating idiopathic clubfoot, but the prolonged treatment duration can lead to compliance issues. This study aimed to compare outcomes between the standard weekly Ponseti method and an accelerated biweekly protocol. Methods: In this prospective randomized study, 70 patients (103 clubfeet) were randomized to either standard Ponseti (weekly casting, n=50 feet) or accelerated Ponseti (biweekly casting, n=53 feet) groups. Outcomes assessed included Pirani scores, number of casts, treatment duration, tenotomy rates, and complications. Patients were followed for 6 months post-treatment. Results: There were no significant differences in final Pirani scores between groups. The accelerated group had a significantly shorter mean treatment duration (21.57 vs 40.88 days, p<0.001) with a similar mean number of casts. Tenotomy rates and relapse rates at 6 months were comparable between groups. The accelerated group had fewer plaster-related complications. Conclusion: The accelerated Ponseti protocol achieved similar outcomes to the standard method in significantly less time, potentially improving treatment compliance with no increase in complications.

Genetic editing has evolved from early methods of DNA manipulation to advanced techniques that hold transformative potential in medicine, agriculture, and environmental science. This review examines the historical development of genetic editing technologies, including recombinant DNA technology, Zinc Finger Nucleases (ZFNs), and more recent advancements such as TALENs and CRISPR-Cas9. CRISPR-Cas9 has revolutionized genetic editing because of its precision and versatility, enabling significant breakthroughs in gene therapy, crop improvement, and functional genomics. Despite its success, the field faces challenges, such as off-target effects, ethical concerns, and technical hurdles in delivery mechanisms. Emerging technologies, such as base editing and prime editing, offer promising solutions to some of these issues, while ongoing research addresses ethical and ecological considerations. This review provides a comprehensive overview of the current state of genetic editing and its prospects, highlighting its potential and necessity for continued innovation and regulation.

Background: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, and it represents a major health, social and economic burden. Macrocytosis (MCV>94 fl) is frequently observed at patients suffering from chronic obstructive pulmonary disease (COPD) with or without respiratory insufficiency. Objectives: The objectives of the study is to Compare Mean Corpuscular volume (MCV) between Acute Exacerbation and stable COPD patients. Methodology: This Hospital based case control study includes 50 patients with primary and final diagnosis of AECOPD. 50 subjects in stable period of COPD. A random Blood sample was collected from all subjects and analysed for MCV, WBC, RDW and MPV on the same day within 3 hours of collection. Data was recorded as per Performa. The data analysis was done. For categoric variables chi-square test was used. For continuous variables independent samples t-test was used. P-value <0.05 was considered as significant. Results: Maximum patients in both groups were found in >60 yrs age group. The mean age in AECOPD group was 64.62±8.24 yrs and in Stable COPD was 63.22±9.18 yrs. Maximum patients in both groups were from middle class followed by lower socio-economic class. BMI was significantly lower in AECOPD patients (20.94±2.15 kg/mt2) as compare to stable COPD patients (21.37±3.10kg/mt2). Maximum patients in both groups were having cough and breathlessness. Maximum patients in both groups were smoker. 58.00% patients in AECOPD and 30.00% patients in stable COPD group were present smoker. Maximum patients in AECOPD group were from GOLD stage 4 and in stable COPD were also from GOLD stage 4.Mean FEV1 % was significantly lower in AECOPD patients (43.87±14.26) as compare to stable COPD patients (48.12±20.18). The difference in both groups was found statistically significant. MCV was significantly lower in AECOPD (82.04±1.49) as compare to stable COPD patients (86.50±1.87). The difference in both groups was found statistically significant 4.00% hospital mortality in AECOPD group. Conclusion: The current study’s results indicate that there was a statistically significant correlation between the MCV and the mortality rate, length of hospital stay, and severity of COPD. Furthermore, it was shown that there was a substantial correlation between the severity of COPD and patient mortality, meaning that the majority of study mortality involved individuals with severe COPD.

Objective: The objective of this case series is to evaluate the effectiveness of Platelet-Rich Plasma (PRP) therapy in treating various gynecological conditions, including cervical ectropion, recurrent candidiasis, and stress urinary incontinence (SUI). The aim is to determine the therapeutic benefits of PRP in cases where conventional treatments have proven insufficient or unsuitable. Methodology: This case series includes three patients treated with PRP therapy for different gynecological conditions. Blood was collected from each patient, and PRP was prepared using a two-step centrifugation process to concentrate the platelets. The PRP was injected locally into the affected areas. For cervical ectropion and recurrent candidiasis, two doses were administered over one month, while for SUI, three doses were given at monthly intervals. Clinical outcomes were assessed through follow-up exams, symptom relief, and patient-reported improvements. Results: All three patients showed significant clinical improvements following PRP therapy. The patient with cervical ectropion experienced resolution of chronic cervicitis and alleviation of symptoms, while the patient with recurrent candidiasis demonstrated complete symptom resolution without further recurrence. The patient with stress urinary incontinence exhibited a marked improvement in her vaginal health score and a reduction in incontinence episodes. No adverse effects were reported in any case. Conclusion: PRP therapy proved to be an effective, non-invasive treatment option for various gynecological conditions in this case series. It provided significant symptom relief in patients with refractory cervical ectropion, recurrent candidiasis, and stress urinary incontinence. Given its promising results, PRP represents a potential alternative to conventional therapies, particularly in patients who are unresponsive to standard treatments or for whom hormone-based therapies are contraindicated. Further studies are warranted to establish standardized protocols and confirm long-term efficacy.

Pelvic inflammatory disease (PID) is a syndrome that predominately affects cisgender women of reproductive age and can lead to chronic pelvic pain and infertility. Endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis are all on the spectrum of inflammatory processes comprising PID. The basic aim of the study is to effectively manage and treat acute on chronic pelvic inflammatory disease (PID) to prevent early complications. A 32-year-old woman, gravida 2 para 2 (P2L2), with a history of two previous lower segment cesarean sections (LSCS), presented with complaints of abdominal pain and heavy menstrual bleeding for the past 5 years. These symptoms worsened significantly over the last 2 days, accompanied by fever, vomiting and generalised weakness. PID is mostly diagnosed clinically. Imaging has a limited role. Surgical management is the treatment of choice with repeated exacerbations of PID. The extensive pelvic pathology identified on imaging, coupled with her systemic signs of sepsis, indicates the need for aggressive and comprehensive treatment. This case highlights the importance of timely diagnosis and management of PID to prevent complications such as infertility, chronic pelvic pain, and systemic infections.

Introduction and Aims: Streptococcus pneumoniae is a leading cause of morbidity and mortality worldwide. As epidemiological data regarding incidence of pneumococcal disease and antimicrobial susceptibility of pneumococci is scarce from developing countries, aim was to determine antimicrobial resistance patterns of pneumococcal isolates and correlate with the type of pneumococcal disease and serotypes. Methods: Retrospective study, S. pneumoniae isolates were recovered from clinical and nasopharyngeal (NP) specimens from two tertiary care hospitals during January 2022-June 2024. Identification was done by standard microbiological procedures. Antimicrobial susceptibility, using disk diffusion was performed for chloramphenicol, trimethoprim-sulphamethoxazole (TMP-SMX) and vancomycin. MICs for penicillin, azithromycin, levofloxacin, and ceftriaxone were determined by E-test. Selected isolates were serotyped using type/group-specific antisera. Results: A total of 153 non-duplicate pneumococcal isolates (51, 63, 10, 7 and 22 from pneumonia, pneumonia with concomitant sepsis, meningitis, other clinical isolates and NP carriage respectively) were collected. All meningeal and NP isolates were susceptible to penicillin and ceftriaxone (MIC 0.006-0.125 mcg/ml). Among non-meningeal isolates, penicillin and ceftriaxone susceptibility was 97.5% and 96.6% respectively (CLSI), 70.2% and 90.8% respectively (EUCAST). High level of resistance was observed to levofloxacin and TMP-SMX among both clinical (13%) and NP (38.9%) isolates. MDR was observed in 7.6% clinical isolates, 2 were pan-resistant. Mortality rate was 10%; all had at least one underlying disease. Most prevalent serotypes were 19F, 1, 7F, 12F, 18 (clinical samples) and 19F (NP carriage). Conclusion: S. pneumoniae remains susceptible to penicillin. Emergence of non-beta-lactams and multidrug resistance among S. pneumoniae requires continuous monitoring of resistance, restricted use of antibiotics and to focus attention on pneumococcal vaccination.

Aim: This study aimed to find out best postures of recovery and compare it in physically active and sedentary males after submaximal exercise. Materials and Methods: The study was conducted in 40 male subjects with 20 sedentary and 20 physically active individuals. The selected participants were asked to do submaximal cycle exercise test. The heart rate was recorded with the help of electronic blood pressure instrument, first reading was taken after 60 sec and then after 3 mins, 5mins, 7mins and 9 mins of a recovery period. Heart rate recovery was recorded and compared between sedentary and active individuals in three different recovery positions; sitting, supine and active after submaximal exercise. Result: Supine recovery position was found to be the fastest heart rate recovery position and upright seated recovery position was the slowest heart rate recovery position among sedentary and among physically active individuals after submaximal exercise. When heart rate recovery was compared between sedentary and physically active individuals it was found that physically active individuals recovered heart rate faster than the sedentary individuals in all three heart rate recovery positions. Individuals with regular physical activity showed more effective autonomic activity than the sedentary ones. Conclusion: This study concluded that better cardiovascular fitness will have faster heart rate recovery after exercise.

Aim: This study aimed to analyze the correlation of Clavien-Dindo classification for complications in post-operative period with the complexity of surgeries. Materials and Methods: This prospective, observational study was conducted on 200 patients undergoing elective and emergency surgery after fulfilling the inclusion and exclusion criteria. The operations were sorted according to the complexity ranking according to British United Provident Association (BUPA) scores. Parameters like operative procedure, length of post-operative period, postoperative complications and management were recorded and postsurgical complications were classified based on Clavien-Dindo classification. Result: In this study, out of the 200 included patients, 127 patients (63.5%) were male, 73 patients (36.5%) were female. The study found that Grade 2 complication was more common in minor surgery (33.5%), followed by Grade 1 (24.5%). Grade-I complications were more common in intermediate surgery (21.6%) and Major surgery (II) (83.3%). Major plus surgery (43.2%) had the most common Grade-II complications (43.2%), followed by Grade-IIIb (17.2%). In elective surgery (41.2%), Grade-II complications were higher (41.2%), while Grade-IIIb complications were more common in emergency surgery (requiring surgical, endoscopic, or radiological intervention under general anesthesia), which was statistically significant (p< 0.001). 6.5% of patients developed disability and the majority were in the major surgery group. Conclusion: The Clavien-Dindo classification of surgical complications can be used in both elective and emergency surgery patients. BUPA Score is a simple and easier method to classify complexity of surgery and we can easily correlate the complexity of surgery and complications with the Clavien Dindo Classification.

Background: Optic atrophy is an end stage result of various pathological conditions affecting the visual pathway anywhere from retina to lateral geniculate body. Ophthalmoscopically classified as primary, secondary, consecutive and glaucomatous. It is important to find the underlying etiology and treat at the earliest in order to prevent complete loss of visual function and improve quality of life. Methodology: A retrospective observation study included rural population of north Karnataka, who were diagnosed with optic atrophy during the period of 1 year, from July 2023 to June 2024 in Department of Ophthalmology at Gulbarga Institute of Medical Sciences, Kalaburagi. Results: A total of 40 patients were diagnosed with optic atrophy. Among them 16 (40%) were females and 24 (60%) were males. 3(7.50%) patients belong to the age group of <20 years, 7 (17.50%) patients to 20-40 years, 14 (35%) patients to 40-60years and 16 (40%) patients to >60years of age groups. Out of 40 optic atrophy cases 3(7.5%) had primary optic atrophy, 7(17.50%) had secondary optic atrophy, 11(27.50%) had consecutive optic atrophy and 19 (47.50%) had glaucomatous optic atrophy. Conclusion: Glaucoma followed by retinitis pigmentosa are most common cause of optic atrophy with severe loss of visual function among rural population of north Karnataka. Screening and awareness programme for early diagnosis of glaucoma, genetic counselling for retinitis pigmentosa with improvement in primary health care facility is recommended in order to reduce vision loss due to optic atrophy.

Pulmonary Tuberculosis in older people is challenging for clinicians to make a diagnosis in the early stage. Case Description: An old male patient in 90’s presented to our geriatric clinic with history of decreased appetite and exertional breathlessness of 3 months duration. The respiratory system examination revealed tachypnoea, trachea shifted to the right side, and right infra-clavicular crepitations. Chest x-ray PA view revealed a right apical fibro-cavity lesion and sputum for AFB positive. Discussion: Diagnosis of PTB in older people is often delayed because of atypical and subtle manifestations. Despite having an extensive lung lesion, this patient had very few or subtle manifestations which may have led to a delay in diagnosis. Conclusion: This case highlights regular screening of older people for pulmonary tuberculosis as they may present not present with constitutional symptoms and or atypical symptoms.

Objectives: The present study was to compare the diagnostic accuracy of Fine Needle Aspiration Cytology (FNAC) versus Histopathology in patients of thyroid lesions. Methods: The cytology and histopathology slides were collected. Patient’s clinical data was collected from the medical records. All the patients were reassured as to the simplicity and painlessness of the procedure and the patient was asked not to swallow while the needle is in the nodule. Patient was asked to rest in supine position with the head and neck extended over a pillow. The degree of extension should not produce skin tension that interferes with nodule palpation or partially obstructs vertebral artery blood flow in the elderly. The site of the needle puncture was cleaned by firm application of an alcohol swab. A 10 or 5mL syringe was used for obtaining cytologic specimens. 23 gauge needle were used. For nodules 1.5 cm or smaller, to and fro movements of the needle into the nodule were done. With larger nodules, peripheral subcapsular parts of the nodule were sampled rather than the center. Results: A total of 100 thyroid lesions cases were included. Most of the cases 32(32%) were in age group of 41-50 years. Male and female ratio was 1:4. According to FNAC diagnostic criteria, there were 62% benign cases, 9% malignant cases, 12% suspicious and 17% unsatisfactory or non-diagnosis. Out of 9 malignant lesions, papillary carcinoma was diagnosed in 5 cases, follicular carcinoma in 1 case, medullary carcinoma in 1case and other malignancy present in 2 cases. Conclusions: the thyroid lesions are preponderance to old age female as compared to male population. FNAC is the best choice first line diagnostic test and effective screening tool for the diagnosis and management of patients with thyroid lesions.

Background: Though cerebroplacental ratio (CPR) has shown good role in predicting poor perinatal outcomes in normal pregnancies, its role in FGR (fetal growth restriction) pregnancies remains poorly understood. This study aims to evaluate the predictive value of the CPR in determining adverse perinatal outcomes in pregnancies complicated by FGR. Methods: A cohort of 100 pregnant women with a gestational age of between 28 and 37 weeks and diagnosed with FGR was assessed and followed up till birth. CPR was calculated using pulsatility index of uterine and middle cerebral artery and a value of <1 was considered low. Perinatal outcomes were recorded, including birth weight, APGAR scores, NICU admissions, fetal distress, and perinatal death. Significance was set at p-value <0.05. Results: The mean age of the participants was 28.1 years with 54% being primigravida. Among the pregnancies studied, 47% had a CPR <1. Mean birth weight was 1.87 ± 0.33 kg. Adverse perinatal outcomes were observed in 15% of cases. CPR <1 was significantly associated with lower birth weight (p-value = 0.02) and adverse perinatal outcomes (p-value = 0.04). Conclusion: The study highlights the importance of CPR as a predictor of adverse perinatal outcomes in FGR pregnancies. The significant association between low CPR and poor perinatal outcomes emphasizes the need for its integration into routine obstetric practice to improve the management and outcomes of high-risk pregnancies.

Background & Methods: The aim of the study is to study the various risk factors predisposing to late onset septicemia in neonates. A detailed maternal history was taken followed by examination of the neonate, the cases followed longitudinally regularly till discharge or death. The symptoms and signs were closely observed and recorded on case sheet as well as on proforma specially designed for the purpose. Results: The main clinical features in neonates with late onset septicemia were lethargy 89%, refusal to feed 84%, hypothermia 63%, jaundice 60%, mottling 42%, abdominal distension 30% while hyperthermia 22%, seizures 21%, bleeding & apneic episode 15%, bulging fontanelle  were present only in 2% of the cases. Low birth weight (LBW) was associated with 90% cases followed by pre-maturity, RDS at birth, resuscitation at birth in decreasing order of frequency. Conclusion: Neonatal septicemia is more common in preterm, LBW and male babies. Peripheral intravenous cannula, IV fluids, LBW, pre-term, respiratory distress at birth increased duration of hospital stay are significant risk factors for late onset septicemia. Increased duration of hospital stay increases risk of sepsis and vice versa.

Introduction: Female tubal sterilization is a widely accepted permanent method of contraception, particularly in developing countries. Despite its effectiveness, failures occur due to improper surgical techniques, spontaneous recanalization, or anatomical variations, leading to unintended pregnancies and increased risks of ectopic gestation and maternal morbidity. This study aims to identify the clinicopathological factors contributing to sterilization failures and assess pregnancy outcomes and demographic characteristics of affected women. Materials and Methods: This retrospective study was conducted at the Government Medical College and Hospital, analyzing cases of sterilization failure over a ten-year period (April 2014 to March 2024). Excluding luteal phase pregnancies, data were collected from patient records, focusing on variables such as patient demographics, sterilization techniques, time to failure, pregnancy management strategies, and re-sterilization outcomes. Management was customized based on each case, with thorough counseling and follow-up provided to optimize patient outcomes and prevent future failures. Results: Over the ten-year period, sterilization failures were most common in 2016–2017 and 2020–2021 (18 cases each) and least in 2021–2022 (4 cases). The highest incidence was in the 25-29 age group, with laparoscopic procedures being the most frequent (60 cases), followed by LSCS-based sterilizations (42 cases). Improper procedures accounted for 22 cases, primarily involving misplaced bands, while tuboperitoneal fistula was the leading cause of failure (45.6%). More than half of the failures (51.66%) occurred within five years, with 38.33% of pregnancies detected in the first trimester, 26.66% in the second, and 35% progressing beyond 20 weeks. Re-sterilization efforts were led by bilateral partial salpingectomy (71.88%), with ectopic pregnancies more prevalent following minilap procedures (79%) compared to laparoscopic methods (14%). Most failures (60%) originated from Primary Health Centers, highlighting the need for improved training and surgical precision. Conclusion: Our findings emphasize the importance of skilled surgical techniques and timely follow-up to reduce sterilization failures, with a focus on strengthening protocols at Primary Health Centers to minimize risks and ensure optimal patient outcomes.

Introduction: India’s rapid population growth has posed significant challenges, with family planning being essential to improving maternal and child health. Despite efforts since the launch of the Family Planning Programme in 1952, a large unmet need for contraception persists, particularly for spacing methods. Injectable contraceptives like DMPA, introduced in 2015, offer a long-acting, reversible option. However, acceptance is influenced by factors such as socioeconomic status, education, and cultural beliefs, highlighting the need for increased awareness and counseling to promote their use. Materials and Methods: This prospective cohort study included 175 reproductive-age women attending a tertiary care hospital between January and December 2023. Participants, including postpartum women, were carefully selected, excluding those with permanent contraception or chronic health conditions. DMPA (150 mg) was administered intramuscularly every three months. Counseling on side effects, follow-up schedules, and compliance was provided. Data were analyzed using SPSS, with statistical significance set at p < 0.05, to assess demographic trends, acceptance, and outcomes related to DMPA use. Results: In our study, the majority of participants (45.2%) were aged 21-25 years, with urban residents comprising 62.8% of the sample. Most women (70%) had some level of education, and 60% were from nuclear families. In terms of parity, 49.3% had two children, and 72% had two or more children, indicating completed family size. Regarding side effects, irregular bleeding was the most common (60%), followed by weight gain (17.7%), while 8% of participants reported no issues with DMPA use. The primary reason for acceptance was the convenience of not requiring daily administration (49.7%), and 28% appreciated its compatibility with breastfeeding. However, discontinuation after the first injection was high (54.8%), with side effects (40%) and loss to follow-up (18.3%) being the main reasons for attrition. Mood changes were the least reported reason for discontinuation (1.7%), and discontinuation decreased steadily with subsequent doses. Conclusion: DMPA is an effective and convenient contraceptive option, particularly appreciated for its ease of use and compatibility with breastfeeding. However, side effects and follow-up challenges highlight the need for enhanced counseling and support to improve long-term adherence and reduce discontinuation rates.

Background: Recurrent shoulder dislocations impair quality of life and function. Stabilising and preventing dislocations often require surgery. Surgery is often needed to stabilise and prevent dislocations. Their effectiveness in preventing recurrence and improving postoperative outcomes is currently being studied, underlining the need for rigorous evaluation to support evidence-based patient management decisions. Methods: A retrospective study at MGM Medical College and LSK Hospital, Kishanganj, included 50 arthroscopic or surgically stabilised recurrent shoulder dislocation patients. Electronic medical data included demographics, surgeries, and post-operation findings. Results: This retrospective study examined 50 recurrent shoulder dislocation patients; 25 had arthroscopic surgery and 25 were open stabilisation procedure. For arthroscopic repair, the rate of recurrence was 32%, and for open stabilisation, it was 16%. Both groups had similar functional outcomes and quality of life. When considering surgical procedures to treat repeated shoulder dislocations, recurrence risks and functional outcomes must be balanced. Conclusion: Open stabilisation and arthroscopic repair give equivalent functional and quality of life outcomes for recurrent shoulder dislocations, however the later may increase recurrence risk. A patient’s anatomy and traits should be taken into account by surgeons when planning surgery.

Background: Cardiovascular diseases (CVDs) are responsible for 32% of all deaths worldwide and are the number one cause of deaths globally not only in high-income countries but also in low- and-middle-income nations. Recently, neutrophil/lymphocyte ratio (NLR) has been was found to be a strong predictor of adverse outcomes after Acute coronary syndromes (ACS). The possible mechanism is inflammation associated with atherosclerosis and its acute manifestation. This ratio can be accessed easily and is inexpensive. However, the prognostic value of NLR over and above the traditional cardiac biomarkers is unknown. Aims and Objectives: The aim of study was to evaluate the prognostic role of NLR in patients with ACS.  To correlate NLR with existing ACS cardiac biomarkers and evaluate incremental value of NLR for predicting adverse clinical outcomes after ACS over traditional markers. To correlate NLR with ST segment score in ST elevation MI (STEMI) and with left ventricular systolic function after ACS. Methodology: A total of 100 consecutive ACS patients were included in the study after screening for inclusion and exclusion criteria. Informed consent was taken from the patient. Besides the demographic history, cardiac risk factors, clinical presentation and diagnosis were noted for all. NLR calculated as total neutrophil count divided by total lymphocyte count was computed for all included patients.  An assessment of the inflammatory markers like LDH and cardiac function parameters like CPK, CK-MB was done. All patients underwent 2D echocardiography by an experienced cardiologists and left ventricular ejection fraction (LVEF) was assessed for all. ST segment score was noted for patients with STEMI. Results: NLR was positively corelated (significant statistically) with total leucocyte count (TLC) (r = 0.28), AST (r = 0.37), LDH (r = 0.46), CK-MB (r = 0.35), CPK (r = 0.46) and ST segment score (r=0.56). The P values for these correlations were <0.05. NLR co-related negatively LVEF (r = -0.26) (p < 0.05).  NLR was positively corelated with mortality status with a rho level of 0.27 suggestive of a moderate positive association between the two parameters. As the outcome status changed from survival to mortality, the NLR ratio was seen to increase. The results were significant statistically (P=0.0058). There was no significant correlation of the NLR ratio with the gender or comorbidity related predictors. Interpretation and Conclusions:  This study concludes that the NLR is a good predictor for myocardial damage as well as impaired cardiac contractility. The NLR can help in early prognostication of ACS severity as well and help initiate treatment therapies to prevent adverse outcomes like mortality.  Its role in predicting adverse clinical outcomes can be utilized in improving the management protocols in cardiology units. The findings of our study are in accordance with the published national and international literature in this domain. We have limited Indian studies on this domain and our study adds to the limited pool of literature concerning NLR role in ACS outcome and severity prediction. Larger randomized trials with multicentric study designs need to be conducted to further validate the findings in this study. Incorporation of NLR as an early bedside investigation in risk stratification of the patients also needs to be explored further.

Background: Cardiovascular diseases (CVDs) are responsible for 32% of all deaths worldwide and are the number one cause of deaths globally not only in high-income countries but also in low- and-middle-income nations. Recently, neutrophil/lymphocyte ratio (NLR) has been was found to be a strong predictor of adverse outcomes after Acute coronary syndromes (ACS). The possible mechanism is inflammation associated with atherosclerosis and its acute manifestation. This ratio can be accessed easily and is inexpensive. However, the prognostic value of NLR over and above the traditional cardiac biomarkers is unknown. Aims and Objectives: The aim of study was to evaluate the prognostic role of NLR in patients with ACS.  To correlate NLR with existing ACS cardiac biomarkers and evaluate incremental value of NLR for predicting adverse clinical outcomes after ACS over traditional markers. To correlate NLR with ST segment score in ST elevation MI (STEMI) and with left ventricular systolic function after ACS. Methodology: A total of 100 consecutive ACS patients were included in the study after screening for inclusion and exclusion criteria. Informed consent was taken from the patient. Besides the demographic history, cardiac risk factors, clinical presentation and diagnosis were noted for all. NLR calculated as total neutrophil count divided by total lymphocyte count was computed for all included patients.  An assessment of the inflammatory markers like LDH and cardiac function parameters like CPK, CK-MB was done. All patients underwent 2D echocardiography by an experienced cardiologists and left ventricular ejection fraction (LVEF) was assessed for all. ST segment score was noted for patients with STEMI. Results: NLR was positively corelated (significant statistically) with total leucocyte count (TLC) (r = 0.28), AST (r = 0.37), LDH (r = 0.46), CK-MB (r = 0.35), CPK (r = 0.46) and ST segment score (r=0.56). The P values for these correlations were <0.05. NLR co-related negatively LVEF (r = -0.26) (p < 0.05).  NLR was positively corelated with mortality status with a rho level of 0.27 suggestive of a moderate positive association between the two parameters. As the outcome status changed from survival to mortality, the NLR ratio was seen to increase. The results were significant statistically (P=0.0058). There was no significant correlation of the NLR ratio with the gender or comorbidity related predictors. Interpretation and Conclusions:  This study concludes that the NLR is a good predictor for myocardial damage as well as impaired cardiac contractility. The NLR can help in early prognostication of ACS severity as well and help initiate treatment therapies to prevent adverse outcomes like mortality.  It’s role in predicting adverse clinical outcomes can be utilized in improving the management protocols in cardiology units. The findings of our study are in accordance with the published national and international literature in this domain. We have limited Indian studies on this domain and our study adds to the limited pool of literature concerning NLR role in ACS outcome and severity prediction. Larger randomized trials with multicentric study designs need to be conducted to further validate the findings in this study. Incorporation of NLR as an early bedside investigation in risk stratification of the patients also needs to be explored further.

Background: Necrotizing fasciitis (NF) and severe cellulitis are severe soft tissue infections that require prompt differentiation for timely management. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score has been proposed as a diagnostic tool to aid in this differentiation. Methods: A retrospective cohort study was conducted at Tezpur Medical College and Hospital, involving 500 adult patients with suspected severe soft tissue infections of the extremities. The LRINEC score was calculated for each patient based on six laboratory parameters: C-reactive protein (CRP), white blood cell count (WBC), hemoglobin, sodium, creatinine, and glucose. Diagnostic accuracy measures, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were assessed to evaluate the utility of the LRINEC score in distinguishing necrotizing fasciitis from severe cellulitis. Results: A total of 500 patients were included in the study, with a mean age of 55 years (range 20-85 years). The study population consisted of 60% males and 40% females. Comorbidities such as diabetes mellitus (35%), hypertension (28%), and obesity (20%) were prevalent among the patients. Conclusion: The LRINEC score serves as a valuable adjunctive tool in the early identification and differentiation of necrotizing fasciitis from severe cellulitis. It aids clinicians in making timely management decisions, potentially improving patient outcomes and resource utilization.

Background: Peritonitis due to hollow viscus perforation is a severe surgical emergency associated with high morbidity and mortality. The Mannheim Peritonitis Index (MPI) has been proposed as a prognostic tool to assess disease severity and guide management decisions in such cases. Methods: A retrospective cohort study was conducted at Tezpur Medical College and Hospital, involving 203 patients diagnosed with peritonitis secondary to hollow viscus perforation. Data on demographics, clinical presentation, MPI scores, and clinical outcomes (mortality, length of hospital stay) were collected and analyzed. MPI scores were categorized into low-risk (≤ 20), moderate-risk (21-29), and high-risk (≥ 30) groups. Results: Higher MPI scores were associated with increased mortality rates and prolonged hospital stays. Mortality rates were 12.1% in the low-risk group, 28.9% in the moderate-risk group, and 54.2% in the high-risk group. Mean hospital stays increased from 8.5 days in the low-risk group to 16.3 days in the high-risk group. These findings highlight the MPI’s effectiveness in stratifying patients and predicting outcomes in peritonitis due to hollow viscus perforation. Conclusion: The MPI serves as a valuable prognostic tool in peritonitis, aiding clinicians in risk stratification and guiding therapeutic interventions. Early identification of high-risk patients using the MPI facilitates timely management, potentially improving patient outcomes in this critical surgical condition.

Background: Managing distal humerus fractures in geriatric patients with osteoporosis and multiple comorbidities is challenging due to poor bone quality and high surgical risk. Bicolumnar plating provides rigid fixation, potentially allowing for early mobilization, while threaded K-wire fixation is less invasive but may offer less initial stability. This study aims to compare the clinical outcomes of these two fixation methods. Methods: A total of 48 geriatric patients with distal humerus fractures were enrolled in this comparative study. The participants were divided into two groups: 22 patients underwent bicolumnar plating (Plating group), and 26 patients were treated with threaded K-wire fixation (K-wire group). The primary outcomes assessed were mobility and range of motion at 3 months and 12 months postoperatively. Complications were also recorded. Data were analyzed using SPSS software, with a significance level set at p<0.05. Results: At 3 months postoperatively, the Plating group exhibited superior mobility and range of motion, with a mean flexion of 120° and a mean extension deficit of 10°, compared to 100° and 20°, respectively, in the K-wire group. However, by the end of 12 months, both groups demonstrated similar outcomes, with a mean flexion of 110° in the Plating group and 108° in the K-wire group, and comparable extension deficits of 15° and 17°, respectively. No significant differences in complications were observed between the two groups. Conclusion: Bicolumnar plating offers better short-term functional outcomes compared to threaded K-wire fixation. However, both methods result in similar long-term outcomes, making K-wire fixation a viable alternative for geriatric patients with significant comorbidities due to its less invasive nature.

Introduction: Maternal near miss (MNM) cases involve severe complications during pregnancy, childbirth, or postpartum, where women survive life-threatening events due to timely medical interventions. These cases offer valuable insights into healthcare systems, revealing both successes and gaps in care, particularly in tertiary care settings that manage high-risk pregnancies. Materials and Methods: This retrospective observational study was conducted from July 2023 to July 2024 at Guru Gobind singh Government Hospital (GGH), Jamnagar. A total of 280 MNM cases were analyzed based on the World Health Organization’s (WHO) criteria, focusing on severe obstetric complications such as hemorrhage, hypertensive disorders, sepsis, and organ dysfunction. Data were collected from medical records, including patient demographics, clinical characteristics, interventions, and outcomes. Descriptive statistics were used for analysis, with significance evaluated at p < 0.05. Results: A total of 280 maternal near-miss (MNM) cases were analyzed. Multigravida women represented the largest group with 127 cases (45.36%), followed by second gravida (79 cases, 28.21%) and primigravida (74 cases, 26.42%). Hypertensive disorders, including preeclampsia and eclampsia, were the leading causes, accounting for 42.14% of cases, followed by severe anemia (18.57%) and obstetric hemorrhages such as APH (10.00%) and PPH (7.50%). Blood products were the most frequent intervention (82%), followed by uterine packing (8%) and laparotomy (4%). Most cases resulted in live births (77%), though adverse outcomes included 49 stillbirths (18%) and 15 cases (5%) involving ectopic pregnancies or abortions. Conclusion: Our study highlights that hypertensive disorders and severe anemia are major contributors to maternal near-miss cases, with timely interventions such as blood transfusions playing a critical role in positive outcomes. Despite most cases resulting in live births, the occurrence of stillbirths and other complications underscores the need for continuous improvements in maternal care.

Introduction: Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide, particularly in low-resource settings where access to quality obstetric care is limited. Uterine atony is the primary cause of PPH, accounting for most cases, especially in developing countries. Early identification of risk factors and timely intervention are crucial to preventing severe outcomes. This study aims to evaluate the risk factors associated with PPH and assess the effectiveness of different management strategies in reducing morbidity and mortality. Materials and Methods: This prospective study was conducted at Shri M. P. Shah Medical College, Jamnagar, from November 2022 to November 2023, including 52 patients diagnosed with PPH. Patients were identified through hospital admissions and referrals from surrounding health centers. Data were collected through patient interviews, medical records, and clinical observations, focusing on obstetric history and known risk factors such as prolonged labor and multiple gestations. Management strategies, including medical treatments, uterine massage, surgical interventions, and blood transfusions, were evaluated for effectiveness based on patient outcomes. Results: In our study, 71.43% of patients were multiparous, and most (71.43%) were aged 24-30 years. Anemia was the most common high-risk factor (30.15%), followed by prolonged labor (12.69%) and preeclampsia/eclampsia (6.34%). Atonic PPH was the leading cause (52.70%), with traumatic causes like cervicovaginal tears at 28.38%. Medical management was the most frequently used treatment (38.10%), followed by uterine packing (25.40%) and vessel ligation (12.70%), with obstetric hysterectomy reserved for severe cases (6.35%). Conclusion: The prevalence of multiparity and anemia as key risk factors for postpartum hemorrhage (PPH), with atonic PPH being the most common cause. Early identification and a stepwise management approach, starting with medical interventions, are essential in improving outcomes for affected patients.

Introduction: Polyhydramnios is a condition defined as a pathological increase in the volume of amniotic fluid during pregnancy. Common causes of polyhydramnios include gestational diabetes, congenital gastrointestinal anomalies like cleft palate, tracheoesophageal fistula, duodenal atresia, foetal infections, and others. Diagnosis is made via ultrasound, and the prognosis depends on the cause and severity. Mild forms often remain asymptomatic, while moderate to severe cases can result in complications such as maternal breathlessness, preterm labour, and premature rupture of membranes (PROM), cord prolapse, and postpartum haemorrhage (PPH). Aim: This study was conducted to investigate the incidence, causes, and management of polyhydramnios. Materials and Methods: We studied 106 clinically suspected cases of polyhydramnios beyond 28 weeks of gestation at M.P. Shah Medical College and G.G. Government Hospital, Jamnagar. All cases underwent ultrasonography for fetal surveillance and amniotic fluid index (AFI) calculation. Results: The results of our study revealed that 49.06% of polyhydramnios cases were idiopathic, followed by 24.53% linked to gestational diabetes and 16.98% associated with fetal anomalies. Multiple pregnancies and Rh isoimmunization accounted for 5.66% and 3.77% of cases, respectively. Primigravida patients comprised 59.3% of the study population, indicating a higher prevalence of polyhydramnios in first-time mothers. Management of gestational diabetes was employed in 24.53% of cases, while 7.54% required reductive amniocentesis, and 0.94% were treated with indomethacin. Vaginal delivery was achieved in 79.2% of cases, while cesarean sections accounted for 20.8%, demonstrating that despite complications, the majority of patients could deliver vaginally with proper management. Conclusion: In conclusion, most cases of polyhydramnios are idiopathic, with gestational diabetes and fetal anomalies being significant contributors to severe cases. Individualized management, timely screening, and monitoring are essential to ensure optimal outcomes, with delivery at tertiary care centers recommended for better maternal and fetal care.

Introduction: Gestational diabetes mellitus (GDM) is a pregnancy-related medical complication linked to significant maternal and fetal risks. Several screening methods are available for detecting GDM, including the DIPSI criteria, which use a non-fasting, single-step test measuring 2-hour plasma glucose levels after administering 75 grams of glucose. This study aimed to evaluate the effectiveness of this one-step screening and diagnostic procedure and identify high-risk factors for GDM in the study population. Material and Methods: This prospective study was conducted over a 6-month period, involving 4050 antenatal women attending the outpatient department (OPD) with gestational ages between 24 to 28 weeks. All participants underwent the DIPSI screening test with 75 grams of oral glucose, regardless of their last meal. A structured questionnaire was also administered to collect data on potential risk factors for GDM. Results: The prevalence of GDM, based on the DIPSI criteria, was found to be 9.9%. Identified high-risk factors included age >30 years, previous history of GDM, history of GCA (gestational carbohydrate intolerance), prior birth weight >4 kg, and family history of diabetes. Conclusions: The DIPSI criteria offer a non-fasting, single-step approach to screening and diagnosing GDM, making it a simple, cost-effective, and evidence-based method. Its user-friendly nature and feasibility are particularly beneficial in resource-limited settings, improving accessibility and early detection of GDM.

Background: Global population ageing is an important challenge and opportunity faced by all countries. The changing demographic profile has thrown many new challenges in the social, economic and political domains. The mental health being one of the neglected aspect of geriatric health in many parts of the world, plays a crucial role in developing Healthy Ageing.  Cognitive impairment, an age-related condition, is often considered a precursor to more serious diseases such as depression/dementia/Alzheimer’s disease. Objectives: To determine the prevalence of cognitive impairment among elderly and to describe the pattern of cognitive impairment. Materials and Methods: A cross-sectional community based study was carried among in urban slums of Bangalore, 150 elderly individuals aged more than 60years and who were not previously diagnosed to have any cognitive impairment were screened using Cognitive Assessment toolkit. Data entered in Epidata and analysed using SPSS software version 23. Results: The prevalence of cognitive impairment among the elderly participants in urban slums using GPCOG indicated that 8% of participants scored between 0-4, suggesting probable cognitive impairment and approximately 14% of participants scored ≤4 in MIS. 13.3% of participants scored below 4 in Mini Cog scale and 16% of participants scored above the critical threshold of 3.38, indicating cognitive concerns. Significant association was found with age. As age increases, there was a significant reduction in cognitive level and significantly higher prevalence with females compared to males (p<0.05). Conclusion: Significant prevalence of cognitive impairment among elderly individuals in urban slums with prevalence rates ranging from 8% to 17.3%. Each tool, including GPCOG, MIS, Mini-Cog, IQCODE, and AD8, highlighted age as a key factor in cognitive decline.

The study evaluated the safety and performance of the self-expanding venous stent system in a porcine model. The research was conducted following the guidelines of Cardiovascular Implants—Endovascular devices-: Vascular stents (ISO 25539:2020). The study involved three female pigs that were fasted overnight without water access. All animals passed the physical examination criteria without major clinical observations or weight loss. Procedures were performed on days 0, 30, 90, and 180 under proper analgesia and anesthesia. The stented veins were harvested for histopathological evaluation on different days. The study concluded that the self-expanding venous stent system demonstrated ease of deployment and withdrawal, with no immediate restenosis or lumen loss post-implantation. Restenosis percentages were observed at 30, 90, and 180 days, matching angiographic evaluations. Histopathological findings showed complete endothelialization, moderate inflammation, and mild to moderate vascular and muscular injury. Throughout the study, no animals exhibited clinical concerns, indicating the safety and effectiveness of the self-expanding venous stent system in a porcine model over 30, 90, and 180 days.

Background: Epilepsy is a common neurological disorder characterized by recurrent seizures due to abnormal neuronal electrical activity. This condition affects approximately 65 million people globally, with around 80% in developing countries. In India, the prevalence ranges from 5.59 to 10 per 1,000 people, with rural areas exhibiting higher rates than urban ones. Epilepsy’s impact on cognitive functions, including semantic memory, is significant but often underexplored. Objective: This study is aimed to assess semantic memory impairment in patients with epilepsy. Methods: This is a cross-sectional analytical study conducted among 250 epilepsy patients attending the neurology department of a tertiary care centre. The sample was derived based on statistical calculations to ensure sufficient power and accuracy. Inclusion criteria were patients aged over 18 with a diagnosis of epilepsy, while those with intellectual disabilities or neurodegenerative disorders were excluded. Data collection included seizure onset age, seizure semiology, epilepsy duration, antiepileptic drug (AED) use, and MRI and EEG results. Semantic memory was evaluated using the Indian Semantic Memory Test Battery, encompassing naming tests, word-picture matching, and sorting tasks. Statistical analysis involved multivariate regression to examine relationships between cognitive scores and clinical variables. Results: Among the 250 participants, 147 (59%) had generalized epilepsy and 103 (41%) had focal epilepsy. Sociodemographic factors, clinical profiles, and memory test scores were analyzed. Significant findings included higher rates of MRI abnormalities and EEG changes in focal epilepsy. Semantic memory deficits were evident across all categories. For instance, 10% of generalized epilepsy and 12% of focal epilepsy patients scored below 50% in total naming scores. Additionally, significant impairments were observed in word-picture matching and sorting tasks, with overall percentages ranging from 11% to 25.3% for various test levels. Conclusion: The study highlights that semantic memory impairment in epilepsy extend beyond episodic memory issues, affecting the semantic-verbal system and influencing both memory and language performance. These findings underscore the need for a deeper understanding of semantic processing challenges in epilepsy, which could improve patient care and support. Differentiating between semantic-verbal system impairment and episodic memory deficit is crucial for developing effective therapeutic strategies.

Background: Gorlin-Goltz Syndrome (GGS), or Nevoid Basal Cell Carcinoma Syndrome (NBCCS), is a rare autosomal dominant disorder characterized by various clinical manifestations. This case series emphasizes the radiological features crucial for diagnosis. Methods: We present imaging findings from three cases of NBCCS, focusing on the diagnostic criteria and clinical manifestations. Results: All cases exhibited multiple odontogenic keratocysts (OKCs) of the jaw and intracranial calcifications. These radiological features are pivotal for early diagnosis. Conclusion: Radiological imaging plays a vital role in diagnosing GGS, aiding in the multidisciplinary management and improved patient outcomes.

Background: Although various measures are taken to create awareness about the epidemiological features of leprosy and encourage health-seeking behavior, they have seldom been able to tackle the high incidence of new leprosy cases in India. This paper discusses the current awareness of leprosy among diagnosed leprosy patients attending Dermatology OPD of tertiary care centre in Eastern Bihar. Methodology: This research work was a cross-sectional hospital-based study conducted in the Department of Dermatology Venerology and leprosy (DVL) at Mata Gujri Memorial Medical College and Lions Seva Kendra Hospital, Kishanganj, Bihar. This study was done in accordance with the Helsinki declaration (2000) and carried out after obtaining the Institutional Ethics Committee clearance. The clinical and epidemiological data was obtained based on a pre-designed proforma which included demographic details, duration of illness, and treatment status of the patient. Awareness regarding the disease and disabilities were evaluated by set of questionnaire which included the knowledge about the disease, disabilities and treatment. Results: Out of 76 patients 85.5% of respondents had heard about leprosy. Various beliefs were cited, with 32.9% attributing it to a curse by God, 28.9% to hereditary causes, and smaller percentages to punishment for family sins, unclean endearment, and bacterial causes. Skin patches were the most recognized symptom (55.3%), followed by skin irritation (46.0%) and loss of sensation (42.1%). Casual contact was the most commonly mentioned mode (42.1%), followed by aerosol droplets (28.9%), and other less frequent modes. About 82.9% believed leprosy is curable. About 60.5 % patients had answer pharmaceutical drugs is the treatment of leprosy. Conclusion: The present study shows a lack of awareness and knowledge of leprosy among the target population. This study sheds light on the significant burden of disabilities associated with leprosy and underscores the importance of continued efforts in education, early detection, and effective treatment to reduce the impact of this disease on affected individuals and communities.

Introduction: Breast carcinoma is the most common non-skin malignancy among women. It is a complex disease in terms of microscopic features, therapeutic response, metastasis and patient outcome. The tumor associated mast cells are response to chemotactic factors released by tumour or its micro-environment. They contain molecules which promote survival with neovascularisation and matrix metalloproteases, needed for tumor invasion and metastasis. Objectives: To study the correlation of mean mast cell per high power field with Scarff Bloom Richardson grading, hormone receptor status and lymphnode status. Methods: Eighty surgically resected cases of breast carcinoma were included in the study. H&E stained and IHC Slides were retrieved from departmental archives. Metachromatic stain using 0.1% Toludine Blue was done on tumour tissue. Mast cells were counted using high power objective. Mean average of 10 HPF were derived and correlated with SBR grade, hormone receptor status and lymph node status. Results: In the study IDC NOS was most common histopathological type. Mean age of patients was 52.1 years with female predominance. Tumors belonging to SBR grade 1, ER positive tumours had higher mean mast cell count. However, mean mast cell count decreased with increased number of lymph nodes infiltrated by tumour cells. Conclusion: Mast cell count showed higher numbers with lower SBR grade of tumour and high numbers were noted with ER positive, PR positive and Her 2 neu positive tumours. However, mean mast cell count were less as the number of lymph nodes showing metastatic deposits increased.

Background: Stroke remains a significant cause of death and disability globally. The use of pre-stroke antiplatelet (PAP) therapy has been shown to influence stroke severity and outcomes, though findings from various studies have been mixed. This study aims to investigate the effect of pre-stroke antiplatelet use on stroke severity, early neurological deterioration (END), and long-term functional outcomes in acute ischemic stroke (IS) patients, focusing on differences across stroke subtypes. Methods: A prospective observational study was conducted from September 2022 to August 2024, involving 600 patients with their first-ever ischemic stroke admitted within 24 hours of symptom onset. Patients were classified based on prior use of antiplatelet agents, and stroke subtypes were identified using the TOAST classification large artery atherosclerosis [AT], small artery disease [SAD], and cardio-embolic [CE] stroke). Stroke severity was measured using the NIH Stroke Scale (NIHSS) at admission, and functional recovery was evaluated using the modified Rankin Scale (mRS) at three months. Clinical outcomes including END, recurrent ischemic stroke (RIS), hemorrhagic transformation (HT), and mortality were also assessed. Results: Out of the 600 participants, 137 (22.83%) had taken antiplatelet agents prior to their stroke. PAP users had significantly lower NIHSS scores upon admission, particularly in patients with AT stroke (P < 0.001). Antiplatelet use was linked to a reduced risk of END (HR: 0.78; 95% CI: 0.56–0.91; P = 0.03) and better functional outcomes at three months (mRS ≤2; 48.9% vs. 21.6%, P < 0.001), despite an elevated risk of asymptomatic HT (HR: 1.35; 95% CI: 1.08–3.07; P = 0.001). The positive impact of PAP use on functional outcomes was observed across all stroke subtypes. Conclusion: Pre-stroke antiplatelet therapy is associated with reduced stroke severity, particularly in large artery atherosclerosis, and leads to better functional outcomes at three months, irrespective of stroke subtype. Despite an increased risk of asymptomatic hemorrhagic transformation, the overall clinical benefit of antiplatelet use in acute ischemic stroke is evident.

Background: A study of maternal mortality at tertiary care centre. Methods: The present study was a Retrospective cross sectional study, conducted in a department of Obstetrics and Gynecology of Narendra Modi medical college and hospital (NMMC), Ahmedabad from July 2020 to July 2024. Results: During the study period 72 maternal deaths occurred out of 33280 live births, giving MMR of 216 during July 2020 to July 2024.In the present study maximum maternal deaths (47.22 %) were in age group of 20-25 year. Maximum maternal deaths were from emergency patient (70.83%). As per gravida/parity maximum maternal deaths were from primigravida (45.8%).Out of 72 cases of mortality, 20 mortality were from antennal phase (27.77%). In our study maximum maternal deaths were due to Hypertensive disorder of pregnancy (28%). Conclusion: From this study it is concluded that hypertensive disorders of pregnancy and its complications are the most important cause of maternal death followed by PPH. Among these majority of factors are preventable. Due to multifactorial nature of maternal death, strategies should involve staff from grass root level, Good antenatal care, and early identification of high-risk cases, appropriate treatment in peripheral hospitals, early referral and with team approach for management of high-risk cases helps in reducing maternal mortality.

Introduction: Surgeons worldwide treat acute pancreatitis, a complicated illness with a wide range of local and systemic consequences. Acute pancreatitis is a pancreatic inflammatory condition that can affect regional tissues to varied degrees. Our goal was to ascertain the prevalence, cause, and result of AP. The aetiology, clinical characteristics, and prognosis of acute pancreatitis in rural Uttar Pradesh have not been thoroughly studied before. Materials and Methods: The study was done in the Department General surgery at GS Medical college pilkhuwa, Uttar Pradesh, India. The medical superintendent of this medical college granted permission to carry out this investigation. The institutional review board and ethical committee gave its approval. The Institutional Ethics Committee granted an exemption from evaluation because the researcher will not interact with the patient and the study merely entails reviewing hospital records. Case study forms were used to collect required data from the patient charts. Results: Local complications, defined as the presence of acute peripancreatic fluid collection, pancreatic pseudocyst, pancreatic necrosis were observed in 41.6% of cases. Metabolic complications such as acidosis, hypoal- buminemia, hypocalcemia was present in 26.9% of cases. Organ involvement was present in 38.4% of cases and the most common among them was respiratory system involvement. Conclusion: In this article, the aetiology, clinical profile, and outcome of acute pancreatitis are described regionally for the first time. This might be a representation of the situation in emerging nations generally due to similarities in population and institutions. This will assist in creating a hospital policy that will be advantageous.

Background: COVID-19 patients in hospitals are susceptible to varying degrees of stress conditions: anxiety, fear, and depression. Music intervention is a cutting-edge method of treating patients in hospitals. This study aims at the effects of music intervention on basal cardiovascular parameters and stress levels in hospitalized COVID-19 patients, as well as the viability of introducing music intervention on-site with these patients. Objective: The study’s objective is to evaluate the impact of music intervention in hospitalized Covid-19 patients’ basal cardiovascular parameters and stress levels. Methods: Sixty hospitalized COVID-19 patients participated in the interventional study, which was conducted at AIIMS in Bhopal, India. They were equally divided into 2 groups: 30 patients in the intervention group and 30 patients for control. Basal cardiovascular parameters such as HR, SBP, and DBP, and stress parameters like serum cortisol and IL-1 levels were measured both before and after music intervention. Data was assembled and entered using Microsoft Excel, and it was analyzed using licensed statistical software, SPSS version 21.0 (IBM Corp., Armonk, NY). Results: In the post-music intervention group, HR (90.14±14.35 vs. 84.43±11.29, p<0.000), BP systolic (139.78±17.67 vs. 133.46±16.78, p<0.000), and BP diastolic (93.14±13.77 vs. 88.56±12.36, p<0.000), showed a significant decrease as compared to the pre-music intervention group. Serum cortisol (23.7±6.45 vs.19.65±6.19 mcg/dl, p<0.000) and IL-1 (139.12±95.26 vs. 72.89±66.43, p<0.000) also showed a significant decrease in the post-music intervention group. Whereas in the control group, HR (88.20±13.94 vs. 88.07±10.64, p=0.877), BP systolic (137.53±22.59 vs. 136.33±19.69, p=0.349), BP diastolic (90.80±14.74 vs. 89.67±13.34, p=0.196), serum cortisol (22.14±7.13 to 21.96±6.12 mcg/dl, p=0.934), and IL-1 (142.17±124.92 to 141.76±122.79, p=0.468) all demonstrated a decline in the control group over the pre parameters, but was not significant. Conclusion: The study reveals that music intervention for hospitalized Covid-19 patients significantly improves basal cardiovascular parameters and stress levels. The findings demonstrate that it is feasible to provide music intervention to Covid-19 patients on-site as an inextricably linked non-pharmacological intervention.

Background: An innovative approach for treating patients in intensive care units on mechanical ventilation is music therapy. Its effectiveness in lowering stress and improving both physical and mental health has not been thoroughly studied, despite its historical use in healing. The present study delves deeper into the effects of music therapy on critically ill patients in India, emphasizing how it can alleviate financial burden, enhance haemodynamics, and lessen anxiety and discomfort. Objective: The study’s objective is to evaluate how music therapy affects mechanically ventilated patients’ cardiorespiratory parameters and stress levels. Methods: Thirty patients on mechanical ventilation participated in the interventional study, both males and females with age range of 18 to 65 years, which was conducted at AIIMS in Bhopal, India. Cardiorespiratory parameters such as HR – heart rate, RR- respiratory rate, SPO2- oxygen saturation, SBP – systolic blood pressure, DBP- diastolic blood pressure, TV- tidal volume, PEEP positive end-respiratory pressure, PaO2- partial pressure of oxygen in arterial blood, PaO2/FiO2- pressure of oxygen in arterial blood to the fraction of inspired oxygen concentration, PP- positive pressure, PIP -peak inspiratory pressure, and FiO2%- fraction of inspired oxygen were measured both before and after music therapy. During these patients’ music therapy sessions, low-pitched instrumental music for relaxation and meditation was played. Blood samples were taken in order to determine the serum cortisol and IL-1 levels. Data was assembled and entered using Microsoft Excel, and it was analysed using licensed statistical software, SPSS version 21.0 (IBM Corp., Armonk, NY). Results: In the intervention group, HR (p = 0.001), BP systolic (p = 0.001), BP diastolic (p<0.0001), PIP (<0.0001), PP (p=0.004), PEEP (p<0.0001), RR (p= 0.016), and PaO2/FiO2 (p=0.002), showed a significant decrease as compared to the baseline pre-music therapy group. TV (p=0.039) FiO2 (p<0.0001) and SPO2 (p<0.001), showed significant increase in the post-music therapy intervention group as compared to the baseline pre-music therapy group. Serum cortisol showed a significant decrease from in the post-music therapy intervention group (p<0.0001), whereas IL-1 was also decreased but the difference was not statistically significant (p = 0.133). Conclusion: This study reveals that music therapy for mechanically ventilated patients significantly improves cardiovascular and stress levels with improvements in respiratory parameters. Thus, further research is needed to explore more of the effects on respiratory parameters. This can be a promising supportive treatment in the future, further helping to decrease their weaning time on mechanical ventilation.

Background: Pseudoexfoliation syndrome (PXF) is an age-related condition marked by the accumulation of fibrillar extracellular material in the eye, often leading to secondary open-angle glaucoma. This accumulation increases aqueous humor outflow resistance, raising intraocular pressure (IOP), a key risk factor for optic nerve damage. Additionally, retinal nerve fiber layer (RNFL) thinning is an important indicator of glaucomatous damage, influenced by both IOP and pressure-independent factors. Thus, this study aims to assess the relationship between IOP and RNFL thickness in patients with PXF. Materials and Method: This cross-sectional study was conducted at a tertiary healthcare center from November 2022 to April 2024, enrolling 112 patients (180 eyes) with pseudoexfoliation material. The inclusion criteria for the study required the presence of pseudoexfoliation material on either the pupillary margin or the lens capsule. Patients were excluded if they had media opacities, were using anti-glaucoma medications, had undergone prior ocular surgeries, or had other ocular disorders. Comprehensive ocular examinations, including visual acuity, slit lamp biomicroscopy, gonioscopy, IOP measurement, and optical coherence tomography (OCT) for RNFL assessment, were performed. Data were analyzed using SPSS, with significance set at p < 0.05. Results: This study found a majority of participants (44.64%) in the 61-70 years age group, with a female predominance (59.82%). Bilateral pseudoexfoliation was more common (60.71%). Most cases (36.66%) exhibited IOP levels in the 21-25 mmHg range, while 63.34% showed RNFL thinning. A significant correlation was observed between RNFL thinning and IOP status, with 26.62% of thinning cases presenting with elevated IOP. Conclusion: The findings highlight significant associations between elevated IOP and RNFL thinning in patients with pseudoexfoliation. Early detection and monitoring are crucial for preventing potential visual impairment in this population.

Introduction: Atrophic rhinitis is a chronic nasal disease characterized by progressive atrophy of the mucosa and underlying bone of the turbinates and the presence of a viscid secretion which rapidly dries and forms crusts which emit characteristic foul odor sometimes called ozaena. The objective of the study aimed to describe the clinical presentation of atrophic rhinitis, various modalities of treatment and clinical response to the treatment at our tertiary care centre. Methods: The clinical profile of the patients was categorized into symptoms and signs of the disease. the various modalities of treatment employed were, Alkaline nasal douching in 14 patients, nasal douching followed by 25% glucose in glycerine nasal drops in 10, modified Young’s surgery in 8, endoscopic neoturbinate surgery in 3 patients. Follow up period was 6 months. Results: The patients who undergone alkaline nasal douching, satisfactory response seen in 8 (57.1%) and unsatisfactory response in 6 (42.9%) patients. Patients with nasal douching and 25% glucose in glycerine nasal drops 8 (80%) had satisfactory response and 2 (20%) unsatisfactory. Among patients with modified Young’s surgery showed satisfactory response in 6 (75%) patients. Endoscopic neoturbinate surgery showed satisfactory response in 2 (66.6%) patients. Conclusion: The results are encouraging with healthier mucosa, reduced crusting and foul odour. In spite of tireless efforts, as etiology still remains unexplained, management of the disease done with various medical regimens and various surgical procedures. Surgical options for the disease are also not completely satisfactory.

Background: Diabetes mellitus (DM) is a chronic metabolic disorder marked by persistent hyperglycemia due to impaired insulin production, insulin resistance, or both. With the global prevalence of DM expected to rise by 200 million cases by 2040, it presents a critical public health challenge. Metformin, while widely used for type 2 DM management, has side effects that spur interest in alternative treatments like herbal medicine. Gymnema sylvestre (G. sylvestre), a traditional Indian medicinal plant, is recognized for its anti-diabetic properties. Aim: This study aimed to evaluate the anti-diabetic efficacy of G. sylvestre in a streptozotocin-induced type 2 diabetes rat model and compare its effects to metformin, a conventional treatment for type 2 diabetes. Methodology: Wistar albino rats were divided into six groups, with type 2 diabetes induced by a high-fat diet and streptozotocin administration. The experimental groups were treated with varying dosages (200 and 400 mg/kg) of G. sylvestre extract and metformin. Blood glucose levels were measured using the oral glucose tolerance test (OGTT) on 0, 14, 19 and 42 days respectively. For this purpose, overnight fasted rats were fed 1.5 g /kg b. w of glucose through oral gavage and its levels were measured at intervals over a span of 2 hours as 0, 60 and 120 mins by glucose analyzer. On 42nd day, overnight fasted rats were sacrificed and blood was collected for the determination of serum insulin, liver enzymes like aspartate transaminase, alanine transaminase, alkaline phosphatase, and bilirubin. Results: Treatment with G. sylvestre extract resulted in a significant reduction in blood glucose levels and improved insulin levels compared to the untreated diabetic group. Higher doses of G. sylvestre showed more pronounced effects. Additionally, liver enzyme profiles indicated improved liver function in the G. sylvestre-treated groups. Conclusion: G. sylvestre demonstrates significant anti-diabetic potential, suggesting it may serve as an effective alternative or complementary therapy for type 2 diabetes management. Its use could reduce dependence on conventional glucose-lowering medications like metformin, offering a natural and potentially safer treatment option.

Background: The objective of this study was to document the number of pregnancies in women aged ≤19 and ≥30 years, at a tertiary care hospital, to compare social characteristics such as religion, education, occupation, and contraceptive use between the two age groups. Additionally, the study examined the incidence of anemia, pre-eclampsia, and gestational diabetes in both groups during pregnancy, as well as differences in delivery mode, birth weight, and fetal outcomes. Methods: This prospective study, conducted at Darbhanga Medical College from September 2022 to February 2024, compares maternal and neonatal outcomes in 100 pregnant women aged ≤19 and ≥30 years using comprehensive statistical analysis. Results: The study found no significant differences in marital status (82% vs. 96%, p=0.238), rural residency (76% vs. 64%, p=0.255), hemoglobin levels (8.78±1.09 vs. 9.44±1.7 g/dL, p=0.213), or cesarean delivery rates (74% vs. 48%, p=0.865) between pregnant women under 19 and over 30 years. Eclampsia incidence was higher in older women (10% vs. 4%, p=0.008). Neonatal deaths (14% vs. 4%, p=0.24) and low birth weights (50% vs. 36%, p=0.247) were more common in younger women, though these differences were not statistically significant. Conclusion: Women aged ≤19 require more attention to prevent preterm births and improve neonatal outcomes, while women aged ≥30 need monitoring for gestational hypertension and diabetes. The study also concluded that pregnant women over 30 had a higher incidence of eclampsia, while those under 19 experienced more neonatal deaths and low birth weights. Although these trends were observed, other factors like marital status, rural residency, and cesarean delivery rates showed no significant differences between the two age groups.

Background: In Ethiopia, refractive error is the second leading cause of vision impairment and the third main cause of blindness. Because refraction services are scarce and difficult to obtain, many people with refractive error live with impaired vision or blindness for the rest of their lives. Objective: The primary goal of this study was to determine the prevalence of refractive errors and associated factors among patients who visited Boru Meda Hospital. Methods: A retrospective cross-sectional study was conducted from April to June 2023, all patients who visited OPD of Eye Department of Santosh medical College were deemed our source population; the sample frame was the secondary eye unit outpatient departments register. To select samples, simple random sampling was used. Data was entered by using Epi-data version 3 and analysed with Statistical Package for Social Science 20. Tables and graphs were used to display descriptive statistics, and logistic regression was used to examine the relationship between the dependent and independent variables. At p < 0.05, statistical significance was inferred. Results: Refractive error was detected in 42 (18.3%) of study participants. The average age was 46.69 ± 20.77. There were 136 men and 93 women in this group (59.4 and 40.6%, respectively). Myopia was the most frequent refractive defect, accounting for 52.4% of all cases. Conclusion & Recommendation: Refractive error is a widespread problem in our study area that affects people of all age groups. We recommend patients to have screening on regular basis so that refractive anomalies can be detected early.

Empty sella syndrome is characterized by the shrinkage or flattening of the pituitary gland. On an MRI scan, the pituitary gland appears invisible when it undergoes this process. This causes the pituitary gland region to appear as an “empty sella,” though the sella is not truly empty as it is frequently filled with cerebrospinal fluid (CSF). The fluid that envelops the brain and spinal cord is called CSF. In empty sella syndrome, the pituitary is under strain because CSF has seeped into the sella turcica. As a result, the gland becomes flattened or shrunk. Primary empty sella syndrome occurs when the arachnoid layer, which covers the brain protrudes into the sella and exerts pressure on the pituitary gland.

Background: Sudarshan Kriya (SKY) is a breathing technique practiced globally for stress management and well-being. This review aims to synthesize existing research on SKY’s effects on physical and mental health. Methods: 1. Literature search: PubMed, Scopus, Web of Science, and Google Scholar. 2. Inclusion criteria: Peer-reviewed studies, English language, human subjects. 3. Exclusion criteria: Reviews, case reports, non-English studies. Results: 8 studies met inclusion criteria. Physical Health Outcomes: (1) Reduced blood pressure (BP). (2) Improved cardiovascular health. (3) Enhanced immune function. (4) Reduced oxidative stress. Mental Health Outcomes: (1) Reduced stress and anxiety. (2) Improved mood and depression. (3) Enhanced cognitive function. (4) Improved sleep quality. Conclusion: Sudarshan Kriya demonstrates positive effects on physical and mental health, including reduced BP, improved cardiovascular health, and reduced stress and anxiety.

Adnexal tumours of skin originate from the pleuripotent stem cells and they can be classified into four groups based on their differentiation towards hair follicles, sebaceous glands, apocrine glands or eccrine glands. Due to their diversity in clinical presentation, it’s a diagnostic challenge for clinicians and pathologists to give an accurate final diagnosis. Histopathology is the gold standard and along with immunohistochemistry in some cases helps in reaching the conclusive diagnosis.

Background: Acne scars cause significant distress to patient emotionally, as well as psychologically and are linked to depression, reduced social interactions, lower academic performance, and unemployment. Dermabrasion and lasers are costly, need proper setup, trained, skillful physician, and have significant downtime. Aim was to compare efficacy and adverse effects of minimally invasive and economic office procedures like skin needling with dermaroller, and salicylic acid peel (SA Peel), in treatment of atrophic acne scars. Method: A randomized, open label, comparative study of skin needling with dermaroller and salicylic acid 20% peel, was carried out on 70 patients of atrophic acne scars, at the Dermatology OPD of a general hospital, at Lucknow. Each subject was treated by skin needling with dermaroller or 20% SA peel. An evaluation of improvement of scars was carried out before and 6 months after treatment, using a four scale, Qualitative Global Acne Scarring Classification of Goodman CJ, et al. Data was analyzed using SPSS, Version 17.0. Results: In the Dermaroller group and SA Peel group, the response was ‘Excellent’ in 45.1% and 15.6%, ‘Good’ in 29% and 25%, and ‘Poor’ in 25.8 % and 59.3%, respectively. Adverse effects with dermaroller were edema in 25.8%, erythema in 19.3% and hyperpigmentation in 19.3%; with SA Peel, transitory erythema and hyperpigmentation were observed in 31.2% and 15.6%. Conclusion: Dermaroller is a superior modality of treatment than 20% Salicylic acid peel in terms of efficacy and patient satisfaction. It is a safe, efficacious and cost-effective office procedure.

Background: AGE-modified proteins, including pentosidine, are filtered by the glomeruli and may indicate early tubular dysfunction, and kidney damage in diabetes could be considered. This study assesses the potential of urinary pentosidine as an early marker of kidney damage in patients with type 2 diabetes and diabetic nephropathy. Materials and Methods: This case-control study involving 165 participants (55 with type 2 diabetes mellitus, 55 with diabetic nephropathy and 55 healthy controls) was conducted. Biochemical analysis done. Urine samples were assessed for creatinine, albumin, and urinary pentosidine. Statistical analysis done. A p-value of <0.05 was considered statistically significant. Results: Urinary pentosidine, was elevated in nephropathy and was found to be significantly elevated among patients with type 2 diabetes. Urinary pentosidine was strongly correlated with HbA1c, urea, creatinine, urinary albumin and albumin-to-creatinine ratio. A cut-off levels of urinary pentosidine was found to be ≥247.9 pg/mL which predicted nephropathy among diabetic mellites individuals with 91.7% sensitivity. Conclusion: This study confirms urinary pentosidine’s value as a biomarker for diabetic nephropathy, highlighting its role in disease monitoring and emphasizing the need for tight glycemic control to prevent complications.

Background: Sleep is vital for overall health and well-being, influencing cognitive, emotional, and physiological functions. Excessive screen time, particularly before bedtime, has been linked to poor sleep quality due to melatonin suppression and delayed sleep onset. Medical students, with their high levels of stress and frequent digital device use, are at increased risk of sleep disturbances. Aim: To determine the correlation between screen times and sleep quality as indicated by Pittsburgh Sleep Quality Index (PSQI) scores.  Materials and Methods: This cross-sectional study was conducted at NIMS Medical College, Jaipur, involving 95 adults aged 18-24 years medical students, selected based on inclusion and exclusion criteria. Participants were recruited and their screen time was assessed using a structured questionnaire. They were categorized into three groups: Group 1 (<3 hours), Group 2 (3-6 hours), and Group 3 (>6 hours) of screen time. All participants completed the Pittsburgh Sleep Quality Index (PSQI) to evaluate sleep quality. The collected data were analyzed using statistical methods to assess the correlation between screen time and PSQI scores. Result: Test revealed a significant association between PSQI scores and time spent (p = 0.00001). Most participants with lower PSQI scores (0-5) spent 3-6 hours, while higher scores (6-9, >9) were more common in those spending over 6 hours, indicating poorer sleep quality with increased time duration Conclusion: Participants with over 6 hours of screen time experienced significantly poorer sleep quality. This study underscores the negative impact of excessive screen use on sleep among medical students. Reducing screen time, particularly before bedtime, may lead to better sleep quality and overall health in this population.

Introduction: Neoplastic lesions of the thyroid include benign and malignant tumors which require thyroidectomy to categorise the lesions, its extent and to determine further therapeutic management. Aim: 1. To identify the most prevalent neoplastic lesions, sex and age wise distribution. 2. To analyse the correlation of the available TIRADS, BETHESDA categories with the histopathology diagnosis of the neoplasm. Settings and Design: This study was conducted in the Institute of Pathology, Madras Medical College, and Tamil Nadu from January 2022 to December 2023. It is a retrospective study in which all the thyroidectomy specimens received were subjected to histopathological examination and the details of the available TIRADS and BETHESDA categories were obtained. Materials and Methods: After the Histopathology examination, the neoplastic lesions including benign and malignant were analysed as per age and sex using Microsoft office (excel and word). Neoplastic lesions with Bethesda and TIRADS category correlation is assessed using SPSS software. Results and Conclusions: Of the 234 neoplastic lesions, 78.2% seen in females and 21.7% were seen in males. Papillary carcinoma thyroid occupied 64.5% and rare neoplasms like Langerhans cell histiocytosis, Non-Hodgkin lymphoma, Anaplastic and Medullary carcinoma occupies 0.8%, 1.28%, 2.13%, 1.28% respectively. TIRADS (88 cases) and BETHESDA (131 cases) were analysed. Correlation of more than 95 percentage seen in tirads 4 and 5, Bethesda 5 and 6 with the histopathology diagnosis. Meticulous examination and analysing the lesions using the essential and desirable criteria as per WHO can aid in the accurate diagnosis.

DOI: 10.5281/zenodo.

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Introduction: Healthy menstrual hygiene management (MHM) includes the usage of safe materials, assess to privacy, cleaning private parts with soap and water and safe disposal of the menstrual material. However, insufficient/ inaccurate knowledge, lack of support and resources are some challenges responsible for knowledge and practice gaps seen in relation to menstruation among adolescents. The cultural, psychosocial, environmental and economic aspects of menstruations are inadequately addressed by the MHM programmes in India. Objectives: To assess the knowledge and practices related to menstruation on attaining menarche, menstrual health and its environmental impact and to determine the hygienic practices and experiences during menstruation among female medical students. Materials and Methods: Cross section study among female students using self-administered questionnaire was conducted in a medical college in Karnataka. Results: The average age of the students was 20.46 ± 1.35 years and age of menarche was13.25 ± 1.302 years. Majority of them (93.1%) received information about menstruation before menarche, mainly from their mothers (61%), used sanitary pads (90.1%), nearly 61.4% had satisfactory hygienic practices, and however disposal of the menstrual products, knowledge related to environmental and economic impact was poor among 80% of the students. Most of the students 75.5% followed some social and cultural restrictions during menarche and 42.8% missed college during their last menstrual cycle. Conclusion: Gaps in knowledge related to menstrual health, dysmennohrea, waste disposal, hygienic practices, psychosocial aspects, environmental impact and reusable products emphasis attention through MHM programme ensuring social integration and reduce discrimination or stigmatization.

DOI: 10.5281/zenodo.

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Purpose and objective: Hoffa fracture is a femoral condyle fracture in the coronal plane. The lateral condyle is more commonly involved. This study aimed to compare the functional and radiological results of surgical treatment for Hoffa fractures with CCS and buttressing plate versus CCS alone. Methodology: This was a prospective study conducted from March 2023 to march 2024 in orthopaedic department of Gauhati Medical College and Hospital, Assam. This study includes 20 patients with Hoffa fracture out of which 10 treated with CCS and buttressing plate and other 10 treated with CCS alone. Radiological and functional outcome, Range of motion (ROM) and knee society score (KSS) of patients were evaluated at the 4- and 12-month follow-up examination. Results: 4 months after the surgery, markedly improved outcomes were observed in the CCS and buttressing plate group vs CCS group regarding ROM (122 +/-5 vs 110+/-8) AND KSS (85 +/-5 vs 78 +/-4). In the 12 months follow-up after surgery, significantly improved outcomes were sustained in the CCS with buttressing plate vs CCS group regarding ROM (128+-5 vs 122+-5) and KSS (89+/-5 vs 83+/-4). By the final follow-up, all patients had achieved normal healing with no instances of malunion, non-union or reduction loss. Conclusion: Fixation of Hoffa fracture with CCS and buttressing plate is more effective and reliable as compared to CCS alone.

DOI: 10.5281/zenodo.

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Introduction: Anal fistula, a common anorectal condition, is treated using various modalities like fistulotomy, fistulectomy, fibrin glue, fistula plug insertion, ligation of the intersphincteric tract (LIFT), and video-assisted anal fistula treatment (VAAFT). Each has distinct advantages and challenges. This study aimed to assess the efficacy, complications, and adherence to treatment principles of these five techniques. Methods: This cross-sectional study at Konaseema Institute involved adult patients with primary or recurrent anal fistulas. They underwent procedures including fistulotomy, fistulectomy, fibrin glue application, fistula plug insertion, LIFT, and VAAFT. Outcomes assessed at 1, 3, and 6 months included fistula closure rates, complications, and patient satisfaction. Statistical analysis utilized chi-square tests and Kaplan-Meier survival analysis. Results: In a study of 120 patients, fistulotomy and fistulectomy had the highest success rate (85%) but with 15% minor incontinence. Fibrin glue application showed the lowest success (50%) and highest recurrence (30%). Fistula plug insertion had a 65% success rate, LIFT 75%, and VAAFT 70%, with minimal complications. Conclusion: Managing anal fistulas requires an individualized approach, balancing fistula complexity with patient factors. Fistulotomy and fistulectomy offer high success but carry incontinence risks, while minimally invasive options like LIFT and VAAFT balance efficacy and safety. Fibrin glue and fistula plugs are less invasive but have lower success in complex cases.

DOI: 10.5281/zenodo.

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Introduction: The number of cases of Klebsiella pneumoniae that are resistant to β-lactam medicines is rising. The objective of this investigation was to ascertain the frequency of specific carbapenemase genes in clinical isolates of Klebsiella pneumonia that were obtained from patients receiving care at a Southern Rajasthan private tertiary hospital. Materials and Methods: The present study was conducted in Pacific Medical College and Hospital. Udaipur, Rajasthan, India. 156 consecutive non-repetitive, clinically significant isolates of Klebsiella pneumoniae from various clinical specimens was included in the study. In systematic screening program for isolation of Klebsiella species clinical samples were collected from Inpatient Department (IPD) and Outpatient Department (OPD). In our study we included clinical samples i.e Urine, Bronchial aspirate, Sputum, Pleural fluid, Blood, and Pus. Clinical samples were collected aseptically and transport to Microbiology lab. Results: Results obtained from polymerase chain reaction showed OXA-48 gene was detected in isolates of Klebsiella pneumoniae resistant to carbapenem by polymerase chain reaction. The OXA-48 gene was found in all 10 (100%) isolates of carbapenem-resistant Klebsiella pneumoniae, according to the results of our investigation using polymerase chain reaction. Consequently, it was discovered that the polymerase chain reaction, which has 100% sensitivity, is the gold standard for identifying carbapenemases. The combined disc test has identified more carbapenemases than MHT among the phenotypic assays. Conclusion: This study shows that clinical isolates of Klebsiella pneumoniae obtained from patients visiting a private tertiary hospital have the genes OXA-48 and NDM-1. In order to track the prevalence and epidemiology of Klebsiella pneumoniae infections at the community level, population-based surveillance programs should be put in place. This will help with early outbreak detection and the identification of new patterns of antibiotic resistance.

DOI: 10.5281/zenodo.

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Background & Objectives: Polycystic ovary syndrome (PCOS) is characterized by chronic ovulatory dysfunction, hyperandrogenism and polycystic ovary morphology (PCOM). Although hyperandrogenism is one of the major features of PCOS, it is rarely observed in southeast Asia. Recently, however, there has been growing evidence on association of anti-Müllerian hormone (AMH) with PCOS. The objective of this study was to investigate the diagnostic potentials of AMH in PCOS individuals. Methods: Present study included a total of 131 women with PCOS and 49 healthy controls who were enrolled after the exclusion of secondary causes of PCOS. Serum AMH was measured using an AMH ELISA kit in addition to other diagnostic biomarkers. Statistical analyses was carried out using the Student’s t test, Wilcoxon rank-sum test, receiver operating characteristic (ROC) curve analysis, Spearman’s rank correlation test and multivariable binary logistic regression analysis. Results: The median AMH values were 8.5 ng/ml and 2.5 ng/ml in the study group and controls, respectively (P<0.001). The normal cutoff value of 4.1 ng/ml for AMH was derived from ROC curve analysis. With a 4.1 ng/ml cut-off value, high levels of AMH was found in about 84 per cent of PCOS cases. However, no significant difference in AMH level was noted between age groups (<20 vs. ≥20 yr), body mass index (BMI) (<25 vs. ≥25 kg/m²) and PCOM types. The area under the ROC curve (AUC) for AMH yielded diagnostic range values. In total PCOS cases, AUC was 0.93 (95% CI: 0.88 and 0.96), and in phenotype A PCOS cases, AUC was 0.96 (95% CI: 0.91 and 0.98). The correlation test also showed no association with BMI, the FG score, PCOM, free androgen index, androstenedione, dehydroepiandrosterone sulphate and luteinizing hormone. However, a weak correlation was observed with testosterone in total PCOS cases and with DHT as well as age in phenotype A PCOS cases. The prediction model for PCOS using multivariable binary logistic regression analysis showed AMH as the best marker. Conclusions: The results of this study suggest that AMH can be considered as the most promising biomarker in PCOS women, particularly with phenotype A and phenotype D.

DOI: 10.5281/zenodo.

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Background: The primary factors contributing to the increase in proximal femoral fracture frequency are sedentary lifestyles and longer life expectancies. Intertrochanteric (IT) fractures account for around half of all fractures, and stress is the primary cause of 90% of IT fractures in the elderly due to associated osteoporosis. High-velocity trauma is the cause of IT fractures in children. Both short and long PFN are used to treat IT fractures, and each has pros and cons of its own. In the meanwhile, there has been some dispute about the length of the nail. Benefits of using a brief Proximal Femoral Nailing (PFN) have been reported, such as a shorter recovery period, less blood loss after surgery, and a consequently lower need for blood transfusions. Aim: To evaluate long PFN and short PFN for IT fracture of femur. Method: This randomized investigation was conducted in a tertiary hospital in Department of Orthopaedics. The patients classified as Type III and Type IV fracture patterns by Boyd & Griffin, were included in this investigation. Patients in group A underwent short PFN surgery, meeting the inclusion criteria, while patients in group B underwent long PFN surgery. For the analysis of data method of double blinding was used. Moreover, the Pearson’s Chi square test was used to associate several qualitative factors. Results: According to the analysis of current study 30% of long group patients have 3^rd type of facture along with 20% of short group. Moreover, 70% of long group patients were having 4^th type of facture and 80% of short group patients found with 4^th type of facture. The mean weight of long PFN group was 58.96 kg and short group was 65.78 kg. Moreover, the pre-operation Hb of long PFN group was 11.78 and short group was 12.54 (p>.05). Further, blood loss among long PFN group was 341.36 ml and short PFN group was 136.36 ml (p<.05). The short PFN reduction’s quality was noticeably higher. Compared to 22 of the 40 instances in the long PFN, 30 out of 40 had a good decrease. Compared to the long PFN group, the intra-operative complications in the short PFN group were substantially lower. Conclusion: It has been concluded that using short PFN is clearly superior to using long PFN in terms of mean surgery duration, C-arm time, incision length, intra-operative blood loss, intra-operative complication, postoperative complication, shorter mean time of union, and higher quality of reduction and lower extremity functionality scale scores.

Cervical lymphadenopathy remains one of the most frequently observed clinical presentations, with an increasing incidence of non-neoplastic lymph node disorders. This study focuses on our observations over a one-year period at a tertiary care hospital in Gujrat. While fine needle aspiration cytology (FNAC) is commonly employed as the initial diagnostic tool due to its accessibility and efficiency, it has certain limitations in its diagnostic accuracy. For more definitive diagnosis, particularly in cases where FNAC may be inconclusive, excision biopsy followed by a detailed histopathological examination remains the gold standard in evaluating cervical lymphadenopathy.

Background: Papilledema randomly reported during post Covid time. However, no concrete studies are available. This cross-sectional case series was conducted at GIMSR Teaching Hospital, Vishakhapatnam, between September 2022 and October 2023, to investigate the incidence of papilledema among young patients with prior COVID-19 vaccination and exposure. Methods: 100 patients selected for this study. Out of them 50 individuals with symptoms of Covid and 50 are without symptoms of Covid.  Of these, 44 were female and 58 were male, with a median age of 27.5 years (range: 8-40 years). All the 100 individuals are vaccinated for Covid.  All the cases are examined under modified Dandy criteria. All the cases are examined for Comprehensive eye examination and those who developed disc edema are subjected for visual field testing, and brain CT imaging. Results: Out of the 100 patients, 50 were asymptomatic and 50 had symptoms. Among the 50 symptomatic patients, 18 were diagnosed with papilledema. Out of 50 symptomatic individuals 7 patients were obese, 5 had a history of oral contraceptive use, and Common symptoms complained by the individuals are visual obscuration, headache, and vomiting. On examination Fundus revealed bilateral papilledema in all affected 18 cases. These cases comprise of idiopathic intracranial hypertension (IIH) in 11 patients, cerebral venous sinus thrombosis (CSVT) in 4 patients, and meningitis in 3 patients. Treatment Outcomes: Patients with IIH and CSVT are treated with acetazolamide and meningitis cases are treated with Lumbar puncture. All the cases responded to treatment and the disc edema resolved within 4-6 weeks of treatment. Conclusion: This study highlights the occurrence of papilledema in a subset of young patients COVID-19 patients who received vaccination. The findings underscore the importance of monitoring for neurological symptoms in this demographic and provide insights into the potential impacts of COVID-19-related factors on ocular health.

Introduction: Reduced fetal growth is seen in about 10% of the pregnancies but only a minority has a pathological background and is known as intrauterine growth restriction or fetal growth restriction (IUGR / FGR). The reported incidence of SGA ranges from 10% to 27% worldwide. Fetal growth is regulated at multiple levels. Increased fetal and neonatal mortality and morbidity as well as adult pathologic conditions are often associated with IUGR. The present study was done to evaluate the risk factors and neonatal outcome of IUGR. Material and Method: The present prospective study was conducted at the department of obstetrics and gynaecology of SMGS Hospital among 300 pregnant women with IUGR during the study period of one year. Risk factors and neonatal outcome were noted and results were analysed using SPSS 25.0. Result: The study revealed the maximum number of cases (56.6%) belonged to the age between 20 to 30 years. IUGR was common in Multigravida (75%), rural area (55.6%). IUGR was observed in 49% with normal AFI and severe oligohydramnios <5 cm was observed in 19%. Doppler velocimetry showed abnormal umbilical S/D ratio in 39 (13%). Most of the patients (66%) required a caesarean section. A total of 187 (62.4%) neonates had birth weight ranging between 2.5 to 3.0 kg. (36%) neonates had morbidity and (1.7%) had mortality. Conclusion: By studying the risk factors, we will be able to identify the high-risk group. Focus on early detection and high-quality antenatal care will help to overcome the problem of IUGR in the community.

Background: Osteonecrosis, also known as avascular necrosis (AVN), is a debilitating disease characterized by the death of bone tissue due to an inadequate blood supply. Due to its intricate vascular supply and significant mechanical stress, the hip is especially prone to AVN. The goal of core decompression is to halt the progression of AVN, reduce pain, and avoid the need for more extensive surgery. Material and Methods: This prospective interventional study was carried out on patients of Avascular Necrosis of Femoral Head Ficat-Arlet Stage II in Department of Orthopaedics GMC Jammu over a period of 6 months. 20 patients were enrolled for the study which was followed up post-operatively at 1 month, 3 months & 6 months. Results: Out of a total of 20 enrolled patients, 12 were male while 8 were females. Right hip was involved in 45% of patients, left hip in 35%, while AVN was bilateral in 20% of the cases. The mean VAS score was 6.9 preoperatively and 3.9 at six months postoperatively. Conclusion: Core decompression is a promising procedure for pain relief for AVN grade 2 (Ficat-Arlet). However long term follow up is required and more studies with larger sample size will be required.

Objectives: The present study was to evaluate the role of ultrasonography parameters to characterise focal liver lesions. And to assessed the sensitivity and specificity of ultrasonography in the evaluation of focal liver lesions in correlation with Triple phase CECT and/or histopathological examination. Methods: Patients meeting the specified criteria underwent a thorough ultrasound examination of liver that was carried out with GE Voluson S10, GE Voluson S6 , using 1-5 MHz curvilinear probe and 12 MHz linear probe. The patients were followed up with Triple phase CECT abdomen and/or histopathological examination. Results: The mean age of study participants was 51.8 + 15.6 years. Majority of patients belonged to 41-50 and 51-60 years of age group. There was a higher prevalence of focal liver lesions in males (70%) compared to females (30%).  In USG examination, normal size of liver was seen in 48% of patients while hepatomegaly was seen in 47% of patients. Multifocal lesions (54%) were more commonly observed than single lesion (46%). Hypoechoic pattern of echogenicity was the predominant finding on ultrasound, noted in 54.6% of cases. Of all the focal liver lesions, benign lesions were most commonly observed (52%) than malignant lesions (48%). Conclusions: USG with colour Doppler should be used as a first line screening modality due to its high diagnostic accuracy in the evaluation of focal liver lesions along with additional advantages like its non-invasiveness, widespread availability, cost effectiveness and lack of radiation exposure.

Background: Zoon’s balanitis or plasma cell balanitis is genital inflammatory dermatoses, characterized by one or more persistent, well demarcated, glazed, reddish brown plaques on the glans penis or inner foreskin. It is resistant to conventional therapeutic modalities and circumcision is still considered as gold standard in its management. Objective: To evaluate the efficacy of 1% topical Pimecrolimus in Zoon’s balanitis. Methods: Patients attending dermatology OPD with a clinical diagnosis of Zoon’s balanitis (confirmed by histopathology) were treated with pimecrolimus 1% cream twice daily for 6 weeks. Patients were then followed up monthly till 6 months. Patient satisfaction response was graded and photographs were compared before and after 6 weeks of treatment. Results: Out of ten cases of Zoon’s balanitis, seven patients showed complete regression of lesions after 6 weeks of therapy, two patients showed regression of lesions with persistent post inflammatory hyper-pigmentation. One patient was lost to follow up after 4 weeks of treatment. All the treated patients were followed up monthly till 6 months, with relapse recorded in none of our patients. Seven patients expressed excellent response while two patients graded response as good. Conclusion: Various oral and topical agents have been used with limited success in Zoon’s balanitis but till date only surgery has been considered as curative. Pimecrolimus 1% cream can serve as efficacious, newer, valuable, safe and non-invasive therapeutic modality for patients reluctant to the surgical treatment.

Background: Malnutrition is a widespread problem, affecting the global population at some life stage. Malnutrition includes both undernutrition (wasting, stunting, underweight, and mineral- and vitamin-related malnutrition) and over nutrition (overweight, obesity, and diet-related noncommunicable diseases. The best-targeted age for addressing malnutrition is the first 1000 days of life as this window period is ideal for intervention implementation and tracking for the improvement of child growth and development. Therefore, it was a genuine necessity to find out the burden of all three categories of malnutrition such as Kwashiorkor, Marasmus, Marasmic kwashiorkor and also to find out age wise distribution of the PEM, so that these findings could help to design Nutritional Rehabilitation Policies by considering the category and age groups. Methods: All the patients in the age group 6 months to 59 months of either gender were screened for malnutrition by anthropometry using standard techniques, and SAM was diagnosed as per WHO guidelines, all were clinically classified into marasmus, kwashiorkar and mixed type. Results: During this study 60 children were enrolled, 31 cases and 29 controls with maximum no of cases between 12- 24 months of age with male predominance & M: F 1.9:1, mostly belonged to urban habituation. Most common type of clinical diagnosis was mixed type as marasmic- kwashiorkar followed by marasmus & kwashiorkar. Stunting, was seen in 30.70% cases, wasting in 29.03% and 33.27% were underweight. Conclusion: Our data on age distribution underlies the importance of early intervention to ward off short- and long-term morbidity caused by severe acute malnutrition. Our findings show that the patterns of malnutrition can differ according to nutritional assessment method. They suggest the importance of applying a mix of clinical and anthropometric methods for assessing malnutrition instead of just one method. Functional validity of characterization of aspects of individual nutritional status by single anthropometric scores or by simple clinical classification remain issues for further investigation

Background: Organophosphate poisoning is a ever increasing and troublesome situation in the developing countries and is a major health care challenge in the 21^st century. Organophosphates are extremely toxic chemicals which present with a myriad of clinical problems all of which lead to difficulties in determining management. The organophosphates are an extremely toxic group of compounds which are rapidly absorbed by the dermal and oral routes. Following significant exposure symptoms of toxicity generally occur within 4 hours. Aim: Study of prognostic significance of serum levels of Creatine kinase in OPP. Importance of elevated serum amylase in patients of organophosphorus compound poisoning. Method: This is a cross sectional study of 50 patients with OP poisoning admitted at government hospital medical ward, Kurnool. The severity of poisoning, important biochemical, clinical parameters were measured. Serum CPK, serum amylase and serum acetylcholinesterase were collected at admission and during follow-up in all patients. The outcome studied would be survival with or without ventilator assistance and death. Results: Among 50 poisoning patients, 68% being male and 48% aged between 21-40 years. Most patients (76%) were married, and farmers constituted the largest occupational group (34%). Chlorpyrifos and Dimethoate were the most common poisons, accounting for 30% and 28% of cases. In terms of clinical findings, 60% of patients had SpO2 levels above 95%, and 48% had serum Creatine phosphokinase (CPK) levels below 350 U/L, while 26% had CPK levels above 1400 U/L. Serum amylase was normal in 72% of cases, and 56% had elevated plasma acetylcholinesterase (AChE) levels. Ventilator support was needed in 46% of patients, especially those with higher CPK levels. Chi-square tests indicated significant associations between elevated CPK, amylase, and AChE levels with poorer outcomes, including higher mortality. Conclusion: The biochemical marker serum amylase & Creatine kinase is a dependable indicator due to its accessibility, affordability, and ability to forecast the need for intubation and mortality in cases of acute OP-poisoning. Elevated serum amylase & creatine kinase levels reported at admission indicate a worse prognosis and a higher likelihood of death. Therefore, it can serve as an alternative indicator for predicting clinical outcome and prognosis.

Introduction: Seborrheic Keratoses (SK) are commonly encountered benign epidermal tumors characterized by well-demarcated, skin coloured to brown or black coloured, slightly elevated papules or plaques. Facial involvement is often associated with cosmetic concerns in patients. Aims and Objectives: The aim of this study was to compare the efficacy and safety profile of RF ablation with 90% TCA for the treatment of facial SK. Materials & Methods: A total of 80 cases of facial seborrheic keratosis were included in the study. Group A included SK lesions treated with 90% TCA while Group B included SK lesions treated with RF ablation. Patient satisfaction was measured at three months following the completion of the treatment using a four-point scale. Results: In group A, 19 patients (47.5%) were completely satisfied, while in group B, 26 patients (65%) were completely satisfied. Thus, patient satisfaction rate was much higher in group B, however, statistically insignificant.

Aim and Background: Maternal body mass index (BMI) plays a vital role in the well-being of mother and foetus. This study aims at comparing the maternal and fetal outcomes among pregnant women with low BMI, normal BMI and high BMI in local population. Methods:  A prospective observational study conducted in a tertiary hospital from May 2022 to April 2024. (24 months). Results: It was noted that BMI of varied categories had significant outcome in mothers and foetus. High BMI mothers had higher risk of GDM (overweight 1.98 and obese 3.92), gestational hypertension (overweight – 2.74, obese 9.05 and morbid obese 7.06) with significant p value <0.05. Odd’s ratio for preterm delivery for underweight, overweight, obese and morbid obese mothers were found to be 3.02, 1.46, 3.95, and 4.45 respectively, with significant p value <0.05. Risk for miscarriage was higher in higher BMI group of individuals with p value <0.05 and odds ratio in overweight 3.03, obese 1.95 and morbidly obese groups 8.70. Shoulder dystocia was associated with morbid obesity. The risk of PPH was also studied in this study, with increased risk in extremes of BMI (underweight 3.71, obese 3.96 and morbid obesity 15.93). Risk of hypoglycaemia and TTN was also measured and revealed risk was higher in underweight mothers and obese mothers. Conclusion: A conclusion was made that both low BMI and high BMI had an increased risk of pregnancy related complications as mentioned in the study. A higher incidence of GDM, gestational hypertension, miscarriage and neonatal hypoglycaemia, shoulder dystocia along with increased risk of emergency caesarean section was seen in high BMI group. In the lower BMI group, anemia and urinary tract infections was more common.

Background: ‘Om’ chanting, an ancient practice rooted in Hindu scriptures, symbolizes the universe’s essence and is believed to promote physiological balance through rhythmic sound vibrations. It is thought to influence autonomic functions and has been associated with relaxation effects similar to meditation. Aim: This study aimed to investigate the effects of ‘Om’ chanting on heart rate, blood pressure, and respiratory endurance in healthy adults over a 4-week period. Methods: A total of 63 healthy volunteers aged 18-50 years participated in this cross-sectional prospective study. Baseline measurements of heart rate, blood pressure, and respiratory endurance were taken. Participants underwent a 5-minute ‘Om’ chanting session daily for 4 weeks. Immediate post-chanting measurements and measurements after 4 weeks were compared using paired t-tests. Results: Significant reductions were observed in pulse rate (from 80.65 ± 8.92 to 76.91 ± 7.09 beats per minute) and systolic blood pressure (from 113.37 ± 9.4 to 110.13 ± 9.85 mm Hg) immediately after ‘Om’ chanting, and these effects were sustained after 4 weeks. Respiratory endurance, measured by the blast test, 40 mm Hg test, and breath-holding times, significantly improved after 4 weeks of chanting. Conclusion: ‘Om’ chanting demonstrated beneficial effects on heart rate, blood pressure, and respiratory endurance in healthy adults. These findings suggest that regular practice of ‘Om’ chanting could be considered as a preventive or rehabilitative measure for individuals with hypertension, anxiety, or respiratory disorders. Further research is warranted to explore its underlying physiological mechanisms and potential clinical applications.

Breast cancer is the most prevalent cancer among women globally and is projected to surpass lung cancer as the leading type by 2025. In India, rising incidences necessitate effective screening and standardized protocols, particularly in resource-limited settings. This observational study aimed to assess the incidence of hormone receptor status in breast carcinoma and its correlation with demographic and prognostic factors. Conducted at Dr. D.Y. Patil Hospital, Navi Mumbai, the study included 30 female patients who underwent Modified Radical Mastectomy (MRM). Hormone receptor statuses (ER, PR, HER2) were analyzed along with clinicopathological data. Results showed that the majority of patients (40%) were aged 41 to 60, and invasive ductal carcinoma was the predominant histological type (93.33%). Lymph node involvement was observed in 73.33% of patients, and tumour size between 2-5 cm was present in 70%. ER positivity was noted in 46.67% of patients, while PR positivity was observed in 50%, and HER2 positivity was seen in 43.33%. Correlations between age and hormone receptor status indicated significant associations, particularly for ER and PR. ER-positive tumours were more likely to be larger (>5 cm) and in advanced stages (III and IV), while PR-positive patients exhibited similar correlations with tumour size and lymph node involvement.

Siddha is the traditional system of medicine which was followed and developed by various siddhars. Among them, Agathiyar is one of the notable siddhar who was dealt with varma Maruthuvam. Varma Maruthuvam is a system of medicine which is purely based on “Vaasi”. Vaasi is the vital energy which is present from the beginning of foetal formation. This vital energy is omnipresence in human body. But the most important vital energy points were 108. The 108 varmam points were mainly classified into Padu Varmam and Thodu Varmam. Padu Varmam points are extremely subtle points of the body. This article will provide a thorough knowledge about the Padu Varmam point’s locations, connected muscles, nerves and their arterial, venous supply. This study will be beneficial to further research.

Background: AUB is any abnormal uterine bleeding in the absence of any palpable pelvic pathology and demonstrable extra genital cause. AUB is responsible for 10% of gynaecological complaints. The objective of this study was to assess the patterns of thyroid disorders among reproductive age group women with abnormal uterine bleeding. Methods: The present study was conducted in the department of obstetrics and gynecology, Govt medical college Kottayam, Kerala, India 400 women of reproductive age group between 18-45 years women with menstrual disorders like heavy menstrual bleeding, irregular cycles, prolonged bleeding, light bleeding, frequent cycles infrequent cycles and quantitative determination of T3, T4 and TSH values. Results: About 400 women participated in the study in which most of the subjects belong to mean age of 32 years. Maximum patients included in parity 2 about 185. Commonest bleeding pattern is heavy and prolonged bleeding that is 26 and 26.6% respectively. Out of 400 patients, 105 patients had thyroid abnormality. Of which 54 were diagnosed as subclinical hypothyroidism, 29 had hypothyroidism and 13 had hyperthyroidism 9 patients had subclinical hyperthyroidism. The frequent menstrual symptoms associated with hypothyroidism and subclinical hypothyroidism was heavy and prolonged bleeding. Light and short bleeding pattern detected in patient with hyperthyroidism. Conclusion: Any type of menstrual disorder should be considered as a possible presenting symptom of thyroid dysfunction thyroid assessment deemed necessary in such cases, so that we can treat patients at the earliest and prevent morbidities in later life.

Introduction: In case of Bronchial Asthma, there are ample of unresolved issues regarding current diagnostic biomarkers in practice. Based on evidence supporting Eosinophil Derived Neurotoxin (EDN), as a promising biomarker, this study has been designed to examine the evolving role of biomarkers in a tertiary hospital. Objectives: To assess levels of Complete Blood Count (CBC), C-Reactive Protein (CRP), Interleukin 6 (IL-6), Eosinophil Derived Neurotoxin (EDN) in patients of Bronchial Asthma in cases and in controls and to study comparative diagnostic efficacy of EDN with respect to CBC, CRP, IL-6. Study Design: Cross sectional Analytical, Case Control Study conducted in Government Doon Medical College & Hospital, Dehradun, and Uttarakhand, India. Duration of study: 12 months.
(1) 42 cases and 42 controls have been taken. (2) CBC, CRP was measured in CELL-DYN Ruby analyzer and BA 400 analyser machine respectively. IL-6, EDN was measured by ELISA method, (3) The data was analysed using SPSS Software, (4) A ROC curve analysis was conducted to compare the performances of serum EDN level compared with blood eosinophil count, IL6 and CRP as indicators of bronchial asthma in cases and controls and other parameters with each other. (5) A two-tailed p-value less than 0.05 has been defined as statistical significance. Results: EDN showed better performance when compared with eosinophil count, CRP, IL-6 with increased area under curve and highly significant p value of [0.795, 0.001], [0.797, 0.002], [0.744, 0.008] respectively. EDN did not show significant performance in controls when compared with eosinophil count, CRP, IL-6. Conclusion: Measurement of serum level of EDN along with other biomarkers in use may add a benefit and increase diagnostic efficacy of Bronchial asthma.

Background: India has the greatest population of severely under-nourished children in the world and accounts for over 20% of under-five childhood deaths every year. Much emphasis is placed on folic acid, iron, and other macronutrients, not Vitamin B12. This study was thus done to determine the clinical profile of SAM patients and the prevalence of vitamin B12 deficiency and clinical manifestations in children with SAM aged 1 month to 5 years of age. Methods: A hospital-based, observational, prospective study on 95 children suffering from severe acute malnutrition (SAM) aged 1-60 months. A detailed socio-economic, feeding, and development history was obtained, and a complete anthropometric evaluation was performed. Blood samples were sent for measurement of plasma vitamin B12. Results: The study included 95 children with Severe Acute Malnutrition (SAM), with an equal gender distribution (50.52% male, 49.47% female) and most children (81.05%) being under three years old, 72.63% of the children were from lower socio-economic classes. A significant portion (72.63%) came from rural areas, and 77.89% of the children had anemia, with 28.42% having severe anemia. Macrocytic hypochromic anemia was the most common type (48.42%).77.88% of the children had deficient Vitamin B12 levels, with deficiency more prevalent in males, children from lower socio-economic backgrounds and those who were not fully immunized. Common clinical signs included pallor (77.89%), developmental delay (73.68% of those with developmental delay had Vitamin B12 deficiency), and tremors. Complicated SAM was observed in 41.03% of the children. Inadequate breastfeeding with supplementary feeds was associated with a higher prevalence of Vitamin B12 deficiency (57.89% vs. 42.10% in exclusively breastfed children). Vitamin B12 deficiency was more common among children with microcephaly (83.33%) and severe wasting (82.57%), with statistically significant differences. Conclusions: Vitamin B12 deficiency was prevalent in most children, regardless of age. Microcephaly, developmental delays, regression of milestones, hyperpigmentation, and nutritional tremor syndrome were also common in Vitamin B12-deficient children. Notably, three-fourths of exclusively breastfed infants up to six months had Vitamin B12 deficiency, likely due to maternal deficiency during pregnancy and lactation. This finding underscores the need for further research and potential Vitamin B12 supplementation during pregnancy, lactation, and early childhood to improve health outcomes.

It’s commonly observed the appendicular mass/lump presentation in a patient with delayed presentation of appendicitis. And sequel of this mass/lump is gangrene, perforation, or abscess formation. As it has been found in multiple studies, the early surgical intervention results in reduced complicated sequel. Thus here we are discussing the use of Palmer’s entry technique as the primary access point so as it gives the enhanced visualization of intraabdominal structures as well as avoiding injuries to the abdominal organs, which can be encountered in paraumbilical as primary access point approach. Total of 15 patients were diagnosed with appendicular lump/mass, clinically as well as with radiological diagnosis between the period of MARCH 2024 to JUNE 2024. Those all patients were managed by surgical intervention that is Laparoscopic Appendicectomy, with Palmer’s point as the primary access point.

Background: Difficult airway may be encountered in both anticipated and unanticipated circumstances. Difficult laryngoscopy and failed intubation result in severe morbidity related to anaesthesia. This has forced the anaesthesiologists to pursue their interest in developing newer gadgets to facilitate successful and safe endotracheal intubation. One such gadget is the levering laryngoscope blade. We conducted a clinical trial to compare the usefulness of Trupti blade with Standard Macintosh blade for providing glottic view, for endotracheal intubation. Methods: We included 235 patients belonging to ASA I and II, of either Sex, between 18-70 years, undergoing elective surgery and requiring endotracheal intubation. Results: We found that, the incidence of difficult laryngoscopy with Standard Macintosh was 7.66% compared to 0.85% with Trupti blade in Elevated position. Trupti blade in Elevated position significantly improved restricted glottic view when compared with Standard Macintosh blade. However, in Neutral position the Trupti blade provided less grade I and II and more grade III and IV views when compared to Standard Macintosh blade, suggesting worsening of glottic view. Conclusions: The Trupti blade in elevated position significantly improved the glottic views during difficult laryngoscopy in comparison with Standard Macintosh blade. However, in Neutral position Trupti blade did not behave identical to the Standard Macintosh blade and made the glottic view worse. The Trupti blade may be added to the armamentarium of aids to difficult intubation available in the operation theatre as well as in ambulances.

Objectives: The present study was to compare and evaluate the various risk factors for elevation of HbA1c level of patients treated with atorvastatin and rosuvastatin who will diagnosed with acute coronary syndrome and heart failure. Methods: The study Subjects were divided based on patients taking Atorvastatin and Rosuvastatin based on patient case notes, and doctor’s notes. Among 100 patients, 54 patients were taken atorvastatin and 46 patients were taken rosuvastatin. The initial HbA1c levels were recorded, and the cases were followed up for a period of 4 to 6 months. Follow-up Hba1c levels were noted in data collection form. Results: When we compared the mean baseline and follow-up HbA1c levels for Atorvastatin, there was a decrease of 1.171% from 8.412% to 7.241% among 54 patients. Similarly, when compared the mean baseline and follow-up HbA1c levels for Rosuvastatin, there was a slight increase of 0.146% from 8.576% to 8.722% among 46 patients. Conclusions: HbA1c level is increased in older age as compared to younger age patients. And atorvastatin significantly decreases the HbA1c level from base line to follow up. While, HbA1c level is not significantly changed in rosuvastatin group patients. Aspirin and Vitamin B increases HbA1c level. While, Prednisolone and Vitamin C decreases the HbA1c level in patients with acute coronary syndrome and heart failure.

Introduction: Breast cancer is a significant health concern, and the accurate identification of lymph node involvement is crucial for appropriate staging and treatment planning. One technique that has gained wide spread acceptance is sentinel lymph node biopsy. Sentinel lymph node biopsy (SLNB) is effective for accurately assessing pathological nodal staging and identifying the presence of metastasis in the axillary lymph nodes. This study evaluates role indocyanine green for sentinel lymph node biopsy in early breast cancer. Materials and Methods: This prospective study was conducted at Department of surgery, MGM Medical College & Hospital, Chatrapati Sambhajinagar (Aurangabad), Maharashtra, India. A total of 18 patients with clinically node-negative breast cancer were enrolled. ICG was injected peritumorally, and SLNs were identified using a near-infrared fluorescence imaging system. Observation & Results: In the present study, majority of cases were aged > 60 years i.e. 10 (55%) followed by 7 (39%) cases from 41 to 60 years. The mean age was 61 years. In 18 cases, only 1 (6%) male case was found and the rest 17 (94 %) were females. ICG successfully identified SLNs in 16(89%) of cases. The average number of SLNs identified per patient was 2.1. Frozen report was found positive in 6 (37 %) cases and negative in 10 (63 %) cases. Conclusion: Indocyanine green is a viable and effective option for sentinel lymph node biopsy in breast cancer, with a favorable safety profile and high detection rates. Its adoption could simplify Sentinel lymph node mapping and potentially reduce the need for more invasive procedures like axillary lymph node dissection.

Hemophagocytic Lymphohistiocytosis (HLH) is a rare, life- threatening hyper-inflammatory condition triggered by excessive hypercytokinemia, resulting from an overstimulated yet inefficient immune response. Due to non-specific and overlapping symptoms with other diseases, diagnosis is challenging. A high level of clinical suspicion, along with clinical and laboratory data analysis is essential for accurate diagnosis. This study aims to present the comprehensive clinical and laboratory characteristics observed in three cases of HLH. Clinical history was correlated with laboratory criteria and bone marrow findings. This study also highlights the critical importance of early diagnosis and timely intervention to improve patient outcomes.

Orientia tsutsugamushi, a Gram-negative bacillus is the causative organism of scrub typhus which is an acute febrile illness commonly occurring in the Asia-Pacific region. It is transmitted to humans by the bite of an infected Leptotrombidium mite. Early diagnosis and prompt treatment are crucial in managing scrub typhus. Here, we present eight cases of scrub typhus with a comprehensive review or existing literature on the subject. Our study highlights and lays emphasis on the significance of considering scrub typhus as a possible diagnosis in patients of all age groups from endemic regions who present with symptoms such as fever, breathlessness or tachycardia even in the absence of typical clinical features. Four cases gave history of insect bite, one patient gave history of travel outside the place of residence in past one month; and two patients had the pathognomonic eschar. Scrub typhus was confirmed in all cases using a positive qualitative IgM ELISA; and Weil felix reaction which showed positive reaction to OX-K antigen. All patients were managed as per standard NCDC protocol. Despite the best of treatment, two patients succumbed to their illness, giving a mortality rate of 25% in our study. Healthcare providers must consider the patient’s exposure history and clinical presentation to diagnose and treat scrub typhus promptly.

Objective: To compare the efficacy and safety of superficial and deep serratus plane block for postoperative analgesia in women undergoing mastectomy. Methods: This randomized controlled study included 60 ASA I-II women aged 40-60 years undergoing mastectomy. Patients were randomized into two groups: Group S received superficial serratus plane block and Group D received deep serratus plane block, both with 0.4 ml/kg of 0.25% bupivacaine. The primary outcome was postoperative pain assessed by Numeric Pain Rating Scale (NPRS) at 2, 6, 12, 18, and 24 hours. Secondary outcomes included patient satisfaction score, duration of analgesia, and complications. Results: Deep serratus block provided significantly longer duration of analgesia compared to superficial block (9.2±2.71 vs 7.3±2.27 hours, p=0.002). Patient satisfaction scores were also significantly higher in Group D (7.6±0.96 vs 6.6±1.35, p=0.002). There were no significant differences in NPRS scores, hemodynamic parameters, or complications between the groups. Conclusion: Deep serratus plane block provides longer duration of analgesia and better patient satisfaction compared to superficial block for post-mastectomy pain, with similar safety profile. Larger prospective studies are needed to validate these findings.

Introduction: Cervix is the lower narrow portion of uterus with an external os and internal os. Squamocolumnar junction is the junction between the squamous and glandular epithelium and its location varies based on age, hormonal influence. In younger age columnar epithelium lies near external os. Carcinoma cervix is the second most common cancer after the carcinoma of breast. Aims & Objectives: To screen patients with abnormal vaginal discharge with Pap smear and colposcopy, to find out the prevalence of precancerous lesion in study population and to screen patients with abnormal vaginal discharge with Pap smear and colposcopy. Subjects and Method: The study was conducted at Outpatient department of, Obstetrics & Gynaecology in Anugrah Narayan Magadh Medical College, Gaya. Women aged 35-55 years attending Obstetrics and Gynaecology outpatient department were included. Pap smear and colposcopy was done in all participants. Results: In this study sensitivity of pap smear was 50%, accuracy of detecting precancerous lesion of cervix was 46.4%. Sensitivity of colposcopy was 98%, the accuracy of detecting precancerous lesion was 85.9%. Conclusion: Colposcopy can be used as screening tool for detecting pre-cancerous lesions. Colposcopy has high sensitivity and accuracy in detecting CIN than Pap smear.

Background: Gestational trophoblastic neoplasia (GTN) commonly arises from molar pregnancies but can rarely follow other gestational events, complicating timely diagnosis and treatment. This report discusses an unusual case of high-risk GTN diagnosed as an invasive mole in a 32-year-old woman following a missed abortion. Case Presentation: The patient presented with persistent vaginal bleeding and irregular menstruation four months post-abortion. Initial investigations revealed elevated βHCG levels (1,971,301 mIU/mL), and imaging, including MRI and CT, demonstrated a large uterine mass with metastatic spread to the lungs. Based on a FIGO score of 10, the patient was classified as high-risk GTN. Treatment with the EMA-CO chemotherapy regimen resulted in a significant regression of uterine lesions, a marked drop in βHCG levels, and resolution of pulmonary metastases. Outcomes: The patient responded favorably to chemotherapy, with βHCG levels decreasing to within safe limits and imaging confirming tumor regression. Regular follow-up was established, focusing on βHCG monitoring and imaging to prevent recurrence. Conclusion: This case highlights the challenges of diagnosing GTN in non-molar contexts and the effectiveness of early βHCG monitoring, multidisciplinary management, and EMA-CO chemotherapy in achieving positive outcomes for high-risk GTN with atypical presentations.

Background: Vaccinating children helps prevent infectious diseases and reduce global child mortality. Fears and attitudes prevent parents from vaccinating their children, despite vaccines’ proven efficacy. Understand parental knowledge and attitudes to improve immunisation rates and public health. Methods: One hundred parents participated in this cross-sectional study at Territory Care Hospital. A study assessed participants’ knowledge and opinions on paediatric immunisations. We collected data from electronic medical record and parents’ demographics, knowledge, and opinions were related. Results: Most parents (85%) know vaccines prevent diseases, and 75% recognise how vital it is to finish their children’s vaccination schedules. According to 80% of responders, children need vaccinations. Just over half of parents understood herd immunity, and nearly half concerned about over vaccination. Educational degree was linked to vaccine knowledge (p < 0.05), healthcare practitioner trust, and positive vaccination attitudes (p < 0.01) in statistical analysis. Conclusion: Parents were positive and knowledgeable about childhood vaccines. Still, uncertainties remain, notably about herd immunity and vaccine dosage. Healthcare providers can promote vaccine uptake and public health by communicating and educating parents. Future research should focus on longitudinal studies and personalised educational interventions to bridge these gaps and better understand parental perspectives.

Objective: To compare the efficacy and safety of superficial and deep serratus plane block for postoperative analgesia in women undergoing mastectomy. Methods: This randomized controlled study included 60 ASA I-II women aged 40-60 years undergoing mastectomy. Patients were randomized into two groups: Group S received superficial serratus plane block and Group D received deep serratus plane block, both with 0.4 ml/kg of 0.25% bupivacaine. The primary outcome was postoperative pain assessed by Numeric Pain Rating Scale (NPRS) at 2, 6, 12, 18, and 24 hours. Secondary outcomes included patient satisfaction score, duration of analgesia, and complications. Results: Deep serratus block provided significantly longer duration of analgesia compared to superficial block (9.2±2.71 vs 7.3±2.27 hours, p=0.002). Patient satisfaction scores were also significantly higher in Group D (7.6±0.96 vs 6.6±1.35, p=0.002). There were no significant differences in NPRS scores, hemodynamic parameters, or complications between the groups. Conclusion: Deep serratus plane block provides longer duration of analgesia and better patient satisfaction compared to superficial block for post-mastectomy pain, with similar safety profile. Larger prospective studies are needed to validate these findings.

Background: Blunt abdominal trauma, frequently resulting from road traffic accidents, presents diagnostic and management challenges due to the absence of external wounds. This study aims to evaluate the effectiveness of clinical assessment and imaging modalities in managing blunt abdominal trauma at a tertiary care center. Methods: This prospective clinical study was conducted over one year at Patna Medical College and Hospital, including 166 patients with blunt abdominal trauma. Data were collected on patient demographics, diagnostic approaches, management strategies, complications, and outcomes. Patients were classified based on the necessity of surgical versus non-operative management. Results: The majority of patients (65.1%) were victims of road traffic accidents, with a male predominance (61.5%) primarily in the 21-30 age group. Surgical intervention was required in 74.7% of cases, with an overall mortality rate of 7.2%. Complications, most notably wound infections, were observed in 25.8% of surgical patients. Conclusion: The study emphasizes the importance of a structured, multidisciplinary approach in the diagnosis and management of blunt abdominal trauma. Early intervention and careful monitoring are crucial in reducing complications and mortality. Findings highlight the need for ongoing training and resource enhancement in trauma care.

Background: Traumatic brain injury (TBI) is a leading cause of death and disability worldwide, with results depending on severity, demography, and clinical presentation. Commonly used to assess consciousness levels in TBI patients, the Glasgow Coma Scale (GCS) may predict prognosis. Objective: This study aims to evaluate the correlation between initial GCS scores at admission and patient outcomes, including mortality, neurological recovery, and hospital stay duration, in a cohort of TBI patients. Methodology: A prospective, analytical study of 160 traumatic brain injury patients was conducted at Patna Medical College & Hospital from November 2019 to October 2020. Initial GCS scores allocated patients to severe (GCS 3-8), moderate (GCS 9-12), and mild (GCS 13-15) TBI groups. Initial GCS mortality, neurological progress at discharge, and hospital stay were studied. Results: Severe TBI (GCS 3-8) had the highest mortality rate (41.7%) and poorest recovery outcomes, while mild TBI (GCS 13-15) had the highest recovery rate (83.3%) and lowest mortality (3.3%). Low initial GCS scores meant longer hospital stays. Early GCS scores are strongly correlated with patient prognosis. Conclusion: Lower initial GCS scores at admission predict increased mortality, poorer neurological outcomes, and longer hospital stays in TBI patients. This emphasizes GCS’s reliability in early TBI assessment and prognostic planning.

Background: There is increase in number of laparoscopic surgeries because of lesser complications and rapid patient recovery. Still complications such as port sites infections, port site incision hernia, metastasis etc is occuring. So this study tries to find out the risk factors associated with port site complications. Material and Methods: A hospital based prospective study was conducted in the Department of General Study  Dr BS Kushwah Institute of Medical Sciences, Kanpur Detail socio-demographic characteristics were noted, physical examination was done and port site complications were noted and their relationship was found out. Results:  Most of the port site complications were port site infections. Higher age, obesity and presence of co-morbidity in form of diabetes were associated with significantly higher port site complications compared to lower age, normal BMI and absence of co-morbidity respectively. (p<0.05). Even using 10mm port was associated with more port site hernia and bleeding compared to when 5mm port was used. (p=0.05). Conclusion: Higher age, higher BMI and presence of co-morbidity is associated with more port site complications. Strict control of blood sugar and blood pressure and developing expertise may reduce incidences of port site complications.

Aim: Burnout and stress-related health disorders are increasingly common among physicians, including interventional radiologists. The objective of this study was to analyze factors influencing the work–life balance and overall well-being of. Material: An online survey was developed to assess work-related stress, family dynamics, and personal health. The survey covered aspects of knowledge, attitude, and practices regarding work–life balance. It was distributed among IRs, and responses were reviewed and analyzed by three interventional radiologists. Results: The survey results revealed several factors associated with burnout among interventional radiologists (IRs). Univariate analysis identified key contributors, including the presence of weekend duties (98.9%, p = 0.02), lack of support groups at the workplace (39.1%, p = 0.005), challenges in interactions with administrative staff (66.3%, p = 0.001), inability to spend quality time with family (32.6%, p = 0.035), and difficulty finding time for personal activities and hobbies (57.6%, p = 0.0002). However, in the multivariate analysis, two factors remained statistically significant. IRs who experienced difficulties with administration had an odds ratio (OR) of 2.77 (95% CI: 1.12–6.48, p = 0.02), indicating that administrative challenges significantly contributed to burnout. Additionally, those unable to engage in personal activities they enjoyed were at even higher risk, with an OR of 4.79 (95% CI: 1.42–16.1, p = 0.01). These findings highlight the importance of addressing administrative challenges and ensuring time for personal fulfillment to reduce burnout among IRs. Conclusion: Burnout is a prevalent issue among interventional radiologists and requires immediate attention. Strategies to mitigate burnout include fostering teamwork, creating support structures for major events, promoting healthy lifestyle choices, and dedicating time to family.

The area of radiology depends on precise analysis of medical images for successful diagnosis and patient treatment. Recent progress in artificial intelligence (AI) and natural language processing has led to interest in using AI models to help radiologists. However, there has been little research on how well AI models perform in analyzing radiology cases, especially when compared to human experts. The purpose of this study was to assess the effectiveness of ChatGPT, Google Bard, and Bing in solving radiology case scenarios by comparing their solutions to those of two radiology residents (R1 and R2). A total of 100 multiple-choice questions based on radiology case scenarios were created. These questions were given to ChatGPT, Google Bard, and Bing, with the same set of questions given to them over a period of 1.5 hours. The answers provided by the AI models were collected and compared to the correct answers and the explanations of these answers were evaluated by the two radiologists. A passing score of 50% was established. The two residents (60% and 50%) scored higher than the three AI models: Bard (40%), Bing (50%), and ChatGPT (60%), with only one resident passing the examination. The responses from the five participants showed significant differences. Furthermore, the agreement among the AI models was notable, but there was no consensus among the residents. The accuracy of the explanations provided by the AI models in supporting their answers was 45%.

Acute liver failure (ALF) during pregnancy is a rare but life-threatening condition associated with high maternal and fetal morbidity and mortality. We present a case of a 22-year-old primigravida at 30 weeks gestation who developed ALF with concurrent HELLP syndrome, disseminated intravascular coagulation (DIC), acute kidney injury (AKI), and posterior reversible encephalopathy syndrome (PRES). Despite the complexity of the presentation, a multidisciplinary team comprising obstetricians, intensivist, hepatologist, nephrologist, and neurologist collaborated to provide timely and comprehensive management. This case underscores the importance of a coordinated approach to optimize maternal and neonatal outcomes in such challenging scenarios.

Endometriosis can be defined as a widespread mammalian disorder that occurs when cells like the endometrium are located outside the uterus cavity, and the abnormality is connected to unhealing inflammation, pain, and infertility. It affects an estimated 10-15% of the women worldwide of reproductive age and presents notable problems in diagnosis and treatment. The underlying mechanisms of the disorder remain unclear, though several have been suggested, such as coelomic metaplasia and retrograde menstruation. More recent studies emphasized the importance of stem cells in both the pathogenesis of endometriosis and its treatment options. It has been demonstrated that enSCs are adult stem cells with enhanced migratory and proliferative abilities in ectopic environments disturbing the disease’s progression. Treatments based on other stem cell types, such as isolated mesenchymal stem cells (MSCs) and reprogrammed iPSCs, were also practical as they provide tissue repair and regeneration. This article aims to collect the most comprehensive information about the current understanding of the role of stem cells in endometriosis pathophysiology and highlights the development of appropriate treatment methods. It also encourages more research to ensure practical application in a clinical setting. The novel role of stem cells in endometriosis could also catalyze future treatments designed to correct the disease mechanisms, aiming for actual cures.

Introduction: Chronic kidney disease (CKD) is a worldwide major disease, both for the number of patients and cost of treatment involved. Screening for CKD at an early stage helps to initiate specific therapy to reduce the progression of renal disease and burden of end stage renal disease (ESRD). Patients with CKD and ESRD show elevated acute phase C-reactive protein (CRP) levels as a consequence of chronic inflammatory states. The aim of this research was to study the significance of CRP with objective of finding an association between the CRP and parameters of other co-morbidities. Material and Methods: The study was conducted among patients of CKD coming to Saran Hospital & Institute of Paramedical Sciences, Bareilly. Chronic kidney disease patients in the institute were included in the study. 140 CKD patients fulfilling the inclusion and exclusion criteria were included to study the significance of CRP in CKD. CKD is defined as kidney damage or GFR < 60 ml/min/1.73 m2 for 3 months or more. All the patients selected for the study was investigated for serum CRP, Albumin, Creatinine, eGFR and ankle brachial index. Results: Most common past history of CKD patients was hypertension (29.3%) and diabetes mellitus (21.4%). >10 mg/L CRP patients serum albumin range (3.43±0.982 gm/dl) was significantly lower than 10 mg/L CRP group eGFR range (35.74±7.54 ml/ min/1.73 m2) was significantly lower than CRP group (42.39±11.47 ml/min/1.73 m2 ). Conclusion: This study shows a high rate of inflammation in CKD patients as seen by high CRP levels. High CRP levels are associated with lower eGFR and lower serum albumin levels.

Background: There is increase in number of laparoscopic surgeries because of lesser complications and rapid patient recovery. Still complications such as port sites infections, port site incision hernia, metastasis etc is occuring . So this study tries to find out the risk factors associated with port site complications. Material and Methods: A hospital based prospective study was conducted in the Department of General Study  Dr BS Kushwah Institute of Medical Sciences, Kanpur Detail socio-demographic characteristics were noted, physical examination was done and port site complications were noted and their relationship was found out. Results: Most of the port site complications were port site infections. Higher age , obesity and presence of co-morbidity in form of diabetes were associated with significantly higher port site complications compared to lower age, normal BMI and absence of co-morbidity respectively. (p<0.05). Even using 10mm port was associated with more port site hernia and bleeding compared to when 5mm port was used. (p=0.05). Conclusion: Higher age, higher BMI and presence of co-morbidity is associated with more port site complications. Strict control of blood sugar and blood pressure and developing expertise may reduce incidences of port site complications.

Background: Addition of adjuvants to routinely used intrathecal drugs is cornerstone in safe and effective prolongation of analgesia. Alpha 2 agonists are considered best drugs as adjuvants, but there is limited literature about its use in orthopedic surgeries and further side effects. Aims: To evaluate the efficacy of 30 mcg clonidine versus 10 mcg Dexmedetomidine given intrathecal as an adjuvant to bupivacaine in orthopaedic surgeries. Methods: This prospective, interventional, double-blind, randomized, clinical study was conducted from Jan 2023 to August 2023. 90 patients, ASA physical status I and II, aged 18-60 y of either sex, undergoing elective orthopaedic surgeries were randomly allocated into two groups: Group A: (0.5% hyperbaric bupivacaine 12.5 mg  + clonidine 30 µg) (n=45); Group B: (0.5% hyperbaric bupivacaine 12.5 mg + dexmedetomidine 10 µg) (n=45). The parameters assessed included the onset of sensory and motor blockades, mean sensory regression through two-segment comparison, duration of motor block, timing of rescue analgesia, surgery duration, VAS pain scores, and any adverse events, all of which were recorded and analysed statistically. Results: On comparison between both groups, Group B (10mcg Dexmedetomidine) showed statistically significantly faster mean sensory & motor blockage onset, prolonged duration of sensory & motor block, and improved quality of intraoperative anaesthesia with good hemodynamic stability and minimal side effects as compared to Group A (30mcg Clonidine). Conclusion: Addition of 10 mcg dexmedetomidine with 0.5% hyperbaric 12.5 mg bupivacaine in intrathecal anaesthesia in orthopaedic surgery resulted in significantly early onset of sensory & motor block and prolongation of durations of motor and sensory block as compared to 30 mcg Clonidine with 0.5% hyperbaric 12.5 mg bupivacaine.