Thyroid hormones of the fetus exclusively comes from mothers in early pregnancy, indicating that maternal hypothyroidism has a close-knit relationship with fetal growth and neuropsychological development. Hypothyroidism is one of the most common endocrinopathies during pregnancy. During early pregnancy the foetus is totally dependent on maternal thyroid hormone supply. Thyroid hormone is critical for foetal brain and intellectual development and some preventable conditions like abruption, pre-eclampsia etc. which produce morbidity and pose special risk for pregnancy and the developing foetus. A total 50 cases were included in the study. The age ranged from 18 to 40 years . Serum TSH value was tested in 1st trimester between 6-10 weeks period of gestation for all pregnant women. The estimation of free T4 levels was done to reclassify those with thyroid dysfunction as subclinical or overt hypothyroidism. The overall prevalence of hypothyroidism in pregnancy is quite high (18%) , 12 % were having Subclinical Hypothyroidism and 06 % had Overt Hypothyroidism .

Background: The internet has become an integral part of our daily lives, offering a plethora of information, entertainment, and social interaction. In today’s digital age, the internet plays an integral role in the lives of young people. The study will help to shed light on a growing concern – the potential negative consequences of excessive internet use. Material and Methods: It is a cross-sectional observational study, Self-reporting questionnaires and objective measures (e.g., sleep trackers, internet usage logs) were used to collect the data. Results: The mean age of study participants who are internet addicted was found to be 17.98 ± 1.81. 11.1% students followed by moderate sleep disturbance. Problem like tiredness, need to sleep more, feel sleepy or drowsy, lacking in energy, less strength in muscle and feeling weak were common in participants who were internet addict.

Background: Thyroid and parathyroid surgeries are increasingly common globally, including both benign and malignant. As these endocrine glands are located in the in the anterior parts of the neck, early healing and a cosmetic method of surgery are preferred. Method: 45 patient’s wounds were closed by sub-cuticular sutures and 45 patients by steristrips followed by thyroidectomy and verbal analogue scales; visual analogue scales at different intervals were compared. Moreover, cosmetic visual analog was also compared after 6th week of the surgery. Results: Verbal analogue after 48 hours and visual analogue after 48 hours had a significant p value (p<0.001), and steri-strips had excellent results of 93.3% and 6.6% of good results, and sub-cuticular sutures had 80% excellent and 20 good cosmetic appearance. Conclusion: Steri-strip sutures were better in both visual, verbal, and cosmetic analogue and reduced the stay in hospital as compared to sub-cuticular suture technique.

Background: Total intravenous anesthesia in laparoscopic surgery is safer than laparatomy operation because propofol, a sedative hypnotic agent with excellent recovery drug and anliemetic properties with analgesic effects, has become more popular in laparoscopic surgery. Method: 95 adult patients aged between 20 to 65 undergoing laparoscopic surgery were studied. A solution of propofol containing different concentrations of sufentanil (1 μgm per ml and 2 μgm/ml) was infused. The pa-tient’s HR, SBP, DBP, MAP, and peripheral O2 saturation from the anesthesia monitor were taken as baseline measurements. All the hemodynamic parameters were recorded intraoperatively at different intervals of duration. Results: The changes in mean values of hemodynamic values were insignificant, and only significant parameters were noted. 158.9 (± 76.9) mean value of time to rescue analgesia (in minutes) Post-surgical complications are 8 (8.4%) nausea and vomiting. Conclusion: In the present pragmatic study, it is confirmed that the propofol and sufentanil combination is ideal for laparoscopic surgeries because of the lowest post-surgical complications and hemodynamic stability.

Introduction: Iron deficiency anaemia (IDA) is common in pregnancy, characterized by reduced red blood cells or haemoglobin due to low iron levels. Pregnancy increases iron demand to support fetal development and the mother’s blood volume. Insufficient iron intake or absorption can lead to IDA, causing complications like low birth weight, postpartum bleeding, and maternal mortality. Iron Sucrose, an IV preparation, due to its efficacy and safety profile become widely used in patients unable to take oral iron preparation. Materials and Methodology: This was a prospective, observational study conducted in the obstetrics and gynecology department of Parul Sevashram Hospital over four months. A total of 30 pregnant women with IDA undergoing parenteral iron sucrose therapy were enrolled. Haemoglobin level and its severity were measured on 4^th and 8^th weeks from last dose of iron sucrose. Data were recorded in predesigned case record forms, entered in Microsoft Excel, and analyzed using appropriate statistical methods. Results: In present study most participants were aged 26-30 years, with a majority having an education level of 1st to 9th grade and being housewives. The mean age was 25.2 years. There was significant increase in haemoglobin levels from 8.11 ± 0.88 gm/dL at baseline to 10.28 ± 0.66 gm/dL after eight weeks (p<0.001). Haemoglobin levels increased significantly across all severity levels of anaemia (mild, moderate, severe) over the eight weeks. Adverse drug reactions included one case of anaphylactic reaction and two cases of skin rashes. Conclusion: The study shows that intravenous iron sucrose is a safe and effective treatment for IDA in pregnant women. Haemoglobin levels significantly increased over eight weeks, with 20% of participants reaching normal levels. Adverse reactions were minimal. These findings support intravenous iron sucrose as a reliable option, especially for those intolerants to oral supplements and reducing pregnancy-related anaemia complications.

Introduction: Depression, a worldwide health issue, imposes significant disability and socioeconomic consequences on individuals. India is grappling with the consequences of depression among a large portion of its population. Impacts vary from persistent pain to heart-related issues, affecting people of all ages. Depression affects over 280 million people worldwide and is a major contributor to disability, highlighting the need for successful treatment approaches. Although antidepressants are used frequently for the treatment of this disorder, there has been recent controversy about the efficacy and safety of these medications in this population. Materials and Methodology: In present study, 50 participants meeting inclusion criteria were observed over a period of two months at Parul Sevashram Hospital, Vadodara. Consent was obtained after being informed, and information regarding the patient such as demographics and treatment details were gathered. An analysis was conducted on the prescription patterns, effectiveness, and side effect of anti-depressants. Result: Prevalence of depression among males and females in the 18-80 years of age group was same. Escitalopram was the main SSRI, demonstrating excellent effectiveness and safety. Amitriptyline was popular in the category of TCAs, while venlafaxine and duloxetine were prominent choices in the SNRIs category. Clonazepam was commonly prescribed along with antidepressants. Conclusion: This research highlights the equal distribution of depression among genders and how common it is in young adults. Escitalopram was identified as the favoured SSRI, showing effectiveness and safety. Amitriptyline, venlafaxine, and duloxetine stood out as noteworthy within the category of TCAs and SNRIs. Clonazepam was the most commonly prescribed benzodiazepine along with other medications. These results highlight the significance of individualized treatment for depression, considering the effectiveness and safety of medications.

Background: Postoperative pain management in pediatric patients is a critical component of surgical care, influencing recovery and morbidity. Ropivacaine, a local anesthetic, is commonly used for caudal epidural analgesia. Dexmedetomidine, an alpha-2 adrenergic agonist, has potential benefits in enhancing the analgesic effects of local anesthetics. Methods: This double-blinded, randomized controlled trial was conducted at the Department of Paediatric Anaesthesia, JK Lon Hospital attached to SMS Hospital Jaipur, from December 2019 to April 2020 until the desired sample size was achieved. Sixty pediatric patients undergoing genitourinary infraumbilical surgery were randomly assigned to two groups. Group R received ropivacaine 0.25% (1 ml/kg), while Group RD received ropivacaine 0.25% (1 ml/kg) mixed with dexmedetomidine (1 µg/kg). The primary outcome was the duration of postoperative analgesia. Secondary outcomes included pain scores, rescue analgesic requirements, and side effects. Results: The median duration of analgesia in Group RD was significantly longer compared to Group R (P < 0.05). Pain scores at 1, 2, and 4 hours post-operation were lower in Group RD. The incidence of rescue analgesic use was lower in Group RD, with minimal side effects. Conclusion: Caudal dexmedetomidine added to ropivacaine extends the duration of postoperative analgesia without significant side effects in pediatric genitourinary infraumbilical surgeries.

Background: Awake flexible fiberoptic bronchoscopy (AFFB) is a critical procedure in respiratory medicine, necessitating optimal patient comfort and minimal discomfort. Fentanyl and dexmedetomidine, known for their analgesic and sedative properties respectively, are investigated as adjuvants to lignocaine to enhance procedural efficacy and patient tolerance. Methods: This double-blind, randomized study involved 90 ASA Physical Status I/II patients, undergoing AFFB at a tertiary center from November 2018 to March 2020. Participants were divided into three groups: Fentanyl with lignocaine, dexmedetomidine with lignocaine, and lignocaine alone. Primary outcomes measured included mean arterial pressure (MAP), Ramsay Sedation Score (RSS), additional doses of lignocaine, and rescue doses of propofol required during the procedure. Results: Significant differences were noted in MAP and RSS between the fentanyl and dexmedetomidine groups, particularly during and after the procedure. Dexmedetomidine group showed better sedation depth (80% reaching RSS level 3, p<0.001) and stability in MAP compared to the fentanyl group, which showed higher variability and rescue propofol requirements. Additional lignocaine requirements were also lower in the dexmedetomidine group (21.30 mg) compared to the fentanyl group (28.40 mg, SD 10.39, p=0.019). Conclusion: Dexmedetomidine as an adjuvant to lignocaine in AFFB is superior to fentanyl in providing stable hemodynamic profiles, deeper sedation levels, and reduced need for additional sedation and local anesthetic. These findings support the use of dexmedetomidine over fentanyl to improve patient comfort and procedural outcomes in AFFB.

Background and Aim: Allergic Rhinitis (AR) is a chronic disease that hampers the daily activities of patients. There are limited studies examining the relationship between Vitamin D and AR. The present study investigated the relationship between Vitamin D deficiency and AR. Methods: A total of 120 patients were enrolled in the study. A control group matching the case study group characteristics was also formed. Various baseline characteristics and Vitamin D levels were checked and recorded. The architect 25-OH Vitamin-D assay to measure the serum Vitamin D levels.n Results and conclusion: A significant difference in serum 25-dihydroxy vitamin D levels was found in the case group and the control group (p<0.001). Our results also suggested a direct relationship between Vitamin D deficiency and AR.

Background: To assess the risk factors associated with postpartum complications among delivered women at SMS Medical College, Jaipur. Methods: Present study entitled “A Descriptive study of risk factors associated with postpartum complications among delivered women at SMS Medical College, Jaipur” conducted in the Department of Obstetrics and Gynaecology. Results: Most common complication of risk associated in delivered women is haemorrhage (24%) followed by 18% had wound gapping, 14% had risk of developing headache, 10% may develop eclampsia and discharge from stitch line, 7% had chances of urinary tract infection, 4% may develop sepsis and haematoma at stitch line each, 3% had secondary post-partum haemorrhage and 2% each has anaemia, abscess at stitch line and uterine inversion. In majority (35%) women having post-partum complication had previous caesarean section followed by 9% had obesity, 7% had Premature rupture of membranes, 5% had Antepartum Haemorrhage, 4% had Pre-Eclampsia, 3% had retained products of conception, 2% each had Hypertensive Disorders in Pregnancy with fetoplacental Insufficiency, Placenta Previa, Pre-Term Labour, Third Trimester Urinary tract infections and Twin Pregnancy with Premature rupture of membranes respectively. Conclusion: Postpartum complications are influenced by both personal and healthcare facility factors. Women with pre-existing medical conditions, obstetric issues (such as haemorrhage, hypertensive disorders, and infections), non-obstetric health problems, or limited awareness of potential pregnancy complications face higher risks of maternal health issues after delivery. To reduce these risks, it’s crucial to promote antenatal care utilization, especially for women who have had multiple pregnancies. This approach can enhance understanding of potential obstetric complications, encourage birth preparedness, and improve readiness for potential issues. Ultimately, this strategy aims to reduce delays in seeking care and facilitate earlier diagnosis of complications and treatment.

Purpose: To study the effect of topical antiglaucoma drugs on corneal thickness. Material and Methods: A total of 108 eyes of 60 glaucoma patients who used topical antiglaucoma medications for a minimum period of 6 months were enrolled and followed up for a period of 1 year. Duration of therapy and drops/day were noted. Patients underwent complete ocular examination including ocular coherence tomography (OCT) for measurement of Corneal Epithelial Thickness (CET) and Central Corneal Thickness (CCT). Results: The mean age of the patients was 55 ± 11.84 yrs. Corneal Epithelial Thickness (CET) had a baseline mean value of 60.02 ± 6.04µm which decreased to a mean value of 57.62 ± 6.16µm at 1 year follow up. Central Corneal Thickness (CCT) had a baseline value of 529.97 ± 40.8µm which decreased to a mean value of 524.56 ± 41.2µm at 1 year follow up. CET and CCT values decreased with increasing the number of drugs used and daily drops instilled. Conclusion: CET and CCT values decreased over the one-year study period. Further, the values were found to be worsened with increasing the number of drugs used and daily drops instilled. The value worsened with increasing the number and frequency of drug instillation. The usage of preservative-free products, combination drug products, and concurrent use of lubricating eye drops may be helpful in slowing the damage on the corneal epithelium.

Background: The relative utility of DLCO and spirometry in monitoring interstitial lung disease (ILD) progression remains debated. This study aimed to evaluate the correlation between these parameters and their relationship with disease progression. Methods: A cross-sectional study of 54 patients with confirmed ILD was conducted at M.M. Institute of Medical Sciences and Research. Spirometry, DLCO measurements, and HRCT were performed at baseline, 3 months, and 6 months. Clinical parameters, including dyspnea grade and 6-minute walk test, were assessed. Results: The study population comprised 22 males (40.7%) and 32 females (59.2%), with interstitial pneumonia (42.6%) and IPF (22.2%) as predominant diagnoses. Mean FVC% predicted declined from 54.33±13.37 to 51.05±13.02 over 6 months, while DLCO remained relatively stable (35.74±16.49 to 35.37±16.12). Strong correlation was observed between baseline DLCO and FVC values (κ=0.87). Patients with DLCO <70 showed significantly lower FVC% predicted compared to those with DLCO >70 (54.8±1.8 vs 80.9±1.6, p=0.001). Reticular pattern was the predominant radiological finding (57.41%). Conclusion: DLCO and spirometry provide complementary information in ILD monitoring, with FVC showing earlier changes over the 6-month period. The strong correlation between these parameters suggests their combined utility in assessing disease severity and progression.

Background: Diabetic Nephropathy is a common complication of Diabetes Mellitus that frequently progresses to ESRD and has a high mortality rate. When there is associated proteinuria, DN increases cardiovascular mortality by a factor of two to three. All of these structural and hemodynamic changes eventually lead to ESRD. Microalbuminuria is a precursor to Diabetic Nephropathy. Extracellular glucose acts directly on glomerular, tubular, interstitial, and vascular cells, resulting in the release of cytokines and growth factors such as angiotensin II, TGF-, and monocyte chemo attractant protein (MCP)-1, all of which play an important role in the development of Diabetic Nephropathy. Material & Methods: The current study on serum 25(OH) D in patients with Type 2 diabetes with and without nephropathy is a case-control study conducted at several hospitals in Indore. This work was carried out after receiving approval from the Institutional Ethical Committee. The study group included a total of 200 known diabetics with a duration of more than 5 years, with the control group consisting of Type 2 DM patients (100 samples) without nephropathy and the case group consisting of patients with Diabetic Nephropathy (100 samples). Design: Case control Design: A case-control study is a type of observational study that is commonly used to investigate factors linked to diseases or outcomes. Conclusion:  The study concluded that. Serum 25(OH) vitamin D levels are lower in patients with diabetic nephropathy (Vitamin D deficiency) and type 2 Diabetes Mellitus without nephropathy (Vitamin D insufficiency). The association between 25(OH)D and UACR is independent of age and gender. Vitamin D levels drop significantly when a diabetic patient progresses from Normoalbuminuria to Microalbuminuria. Significant vitamin D deficiency is associated with renal impairment in diabetic.

Spinal dysraphism (SD) is a diverse group of congenital spinal anomalies resulting from incomplete closure of the neural tube during embryonic development. This retrospective study aimed to assess the role of MRI in identifying various forms of SD, characterizing the lesions, and detecting associated anomalies in a rural popula-tion. A total of 25 patients with SD were included. The most common SDs were spina bifida with tethered cord, followed by meningocele, vertebral segmentation anomalies, diastematomyelia, myelomeningocele, and dorsal dermal sinus. Associated anomalies, including syrinx, dural ectasia, scoliosis, and Chiari I malformation, were frequently observed. MRI proved to be a valuable tool in the comprehensive evaluation of SD. It allowed for accurate diagnosis, characterization of lesions, identification of associated anomalies, and planning of appro-priate management strategies. Early diagnosis and timely intervention are crucial for optimizing outcomes in patients with SD.

Objective: This study aims to evaluate the relationship between visceral fat volume (VFV), subcutaneous fat volume (SVF), and total abdominal fat volume with metabolic syndrome, using CT and contrast-enhanced CT (CECT) of the abdomen and pelvis. Methods: A retrospective study was conducted, including 112 patients referred for abdominal CT scans between January 2023 and May 2024. Patients were categorized into two groups: Group 1, with metabolic syndrome, and Group 2, without. Inclusion criteria included individuals with hyperinsulinemia or hyperglycemia and at least two additional metabolic risk factors. Abdominal fat volumes were measured at the L4-L5 intervertebral disc level using a 128-slice MDCT scanner and a segmentation algorithm to distinguish visceral and subcutaneous fat volumes. Statistical analysis was performed using independent sample t-tests and Pearson’s correlation tests. Results: Group 1 had significantly higher VFV, SVF, and total fat volume compared to Group 2 (p = 0.001). A notable male predominance (61.6%) was observed, with significant gender-specific differences in fat volume distributions. Group 1 exhibited larger VFV, SFV, and total fat volumes in both males and females, with higher VFV particularly in females. No correlation was found between BMI and VFV, SVF, or total fat volume. VFV in females showed a strong association with metabolic syndrome. Conclusions: Abdominal CT is an effective tool for assessing metabolic syndrome risk through quantification of VFV, SVF, and total fat volume, providing a more reliable assessment than BMI. These findings suggest that CT imaging may play a vital role in early detection and intervention for metabolic syndrome, allowing for improved clinical outcomes.

Background: Hypothyroidism affects kidney function to alter the level of uric acid in blood and hence has an impact on serum uric acid level. Method: The study included 50 known hyperuricemia cases and equal number of age and sex matched control. Serum uric acid, TSH, FT4, urea, creatinine data were collected from the record of patients who attended the department of Biochemistry, SCCGMCH, Uluberia. Result: Uric acid is positively associated with thyroid disease as Odds of exposure among cases are higher than control with Odds Ratio – 6. Statistically significant difference in UA, TSH, FT4 level was observed between case and control but there’s no significant difference observed in the urea and creatinine concentration although mean for urea and creatinine of case were slightly on higher side.  Conclusion: Hypothyroid individual irrespective of treatment status is associated with increased Uric acid concentration

Background: COVID-19, caused by SARS-CoV-2, has varying clinical manifestations, often worsening in moderate to severe cases due to an exacerbated immune response. Mycobacterium W, an atypical mycobacterium, offers potential benefits as an immunomodulatory agent in severe COVID-19 cases by regulating immune response and mitigating cytokine storm. Methods: This observational study evaluated the efficacy of heat-killed Mycobacterium was an adjunct therapy in 585 hospitalized COVID-19 patients categorized into two groups: the study group (279 patients) and the standard of care group (306 patients). The study, conducted over 18 months at Government Medical College, Srinagar, assessed clinical outcomes, inflammatory markers, and hospital stay durations. Results: Patients treated with Mycobacterium W showed a statistically significant reduction in hospital stay days (median of 10.87 days vs. 13.62 days, p<0.001), lower requirements for oxygen support, and improvements in inflammatory markers (CRP, IL-6, D-dimer) compared to the control group. There was no significant difference in mortality between the groups. Conclusion: Mycobacterium  was add-on therapy in moderate to severe COVID-19 patients appears to enhance recovery by modulating immune responses and reducing inflammatory damage. These findings suggest that Mycobacterium W can be considered a beneficial adjunct treatment in managing severe COVID-19 cases.

Background: Hypertension is one of the most common disease affecting humans throughout the world. It is an important health issue due to the associated morbidity and mortality and the cost to society. Objectives: To evaluate and compare the efficacy and tolerability of Cilnidipine and Telmisartan in patients of stage I hypertension. Methods: This study included 50 patients with stage 1 hypertension. They were divided into two groups of 25 each to receive Cilnidipine and Telmisartan. Evaluation of efficacy was made by blood pressure measurement on day 0, week 2, week 4, week 6, and week 8. The difference in blood pressure reduction in two treatment groups from baseline to 8 weeks was the main outcome measure. Any adverse drug reactions were inquired, analyzed and recorded at each visit. Results: At 8 weeks, both groups showed significant (P<0.001) reduction in B.P from baseline. Mean SBP was reduced from 153.28 ± 4.5 mm Hg to 135.5 ± 5.0 mm Hg (Cilnidipine) and 154.04 ± 3.1 mm Hg to 136.56 ± 6.7 mm Hg (Telmisartan) after 8 weeks treatment (percentage difference was 11.5%, 11.9%). Mean DBP was reduced from 93.92 ± 4.3 mm Hg to 80.6 ± 1.9 mm Hg (Cilnidipine) and 94.48 ± 3.4 mm Hg to 81.2 ± 4.04 mm Hg (Telmisartan) after 8 weeks treatment (percentage difference was 14.18%, 14.05%). Conclusion: Both the drugs were equally efficacious in reducing blood pressure. The most common adverse effect reported was headache. All adverse effects were mild and did not require any alteration or discontinuation of treatment.

Background: Oral squamous cell carcinoma (OSCC) has been estimated to be the sixth most common cancer worldwide. The distant metastasis of OSCC is more lethal then regional and plays a critical role in the management and prognosis in oral cancer patients. Aim: This study evaluates the role of fine needle aspiration cytology (FNAC) for assessing metastatic deposits of oral squamous cell carcinoma in a tertiary care center, India. Materials & Methods: This cross-sectional observational study was done in an Indian tertiary care center’s pathology department. Fifty patients with metastasis deposit of oral squamous cell carcinoma were enrolled in this study. Cytology and histopathological examination was done in all cases. Results: In the present study oral squamous cell carcinoma is more common in males (62%) then female (38%) and predominantly found in elderly age groups after >40 yrs (84%). Regional metastasis is more commonly seen rather than distance metastasis. Level I & II Lymph nodes involve early. Lung is the most common site in distance metastasis. Survival and outcome is less with distance metastasis. Conclusion: OSCC has the potential for regional as well as distant metastasis, and distant metastasis of OSCC lead to significant mortality as compared to regional metastasis.

Introduction: Polytrauma is a major cause of morbidity and mortality worldwide. The ISS and New Injury Severity Score are most commonly used to assess the gravity of trauma and serve in the estimation of outcomes. This study tries to compare the predictive validity of the NISS to the ISS among polytraumatized patients regarding mortality, admission to the ICU, and duration of hospitalization. Methods: It is a prospective observational study done in the Department of General Surgery, Dr. B.R.A.M. Hospital, Pt. J.N.M. Medical College, Raipur, from January 2022 to December 2022. We found 155 polytrauma cases in our series. In each case, ISS and NISS were calculated on the basis of their injuries. Predictive outcomes like mortality, need for ICU care, and length of hospital stay were analyzed. The scoring systems were compared using ROC curve analysis, logistic regression, and Pearson’s correlation coefficient. Results: The study showed that the mean ISS score for survivors was 16.22 ± 5.63, while the mean ISS for nonsurvivors was 34.86 ± 7.54. In the same vein, the mean NISS for survivors was 22.61 ± 8.67, and that of nonsurvivors was 43.51 ± 9.62. The AUC of the ROC curve for mortality prediction in relation to ISS was 0.825, while that for NISS was 0.904, showing that there is a statistically significant difference between them, as shown by p < 0.05. NISS was found to have better predictive value than ISS as regard to mortality, need for ICU admission, and length of hospital stay. The Pearson’s correlation coefficient of ISS and NISS scores was 0.826 and reached statistical significance at p < 0.001, indicating a strong positive correlation. Conclusion: ISS and NISS are helpful scoring systems in outcome prediction in polytrauma patients. However, the predictive performance enhanced significantly with the advantage of NISS regarding mortality and admission to intensive care. Moreover, it can also be a marker for the severity of trauma more reliably than any score; thus, its use in clinical practice should be put into practice to make any progress in the management of polytrauma patients.

Background: Premature rupture of membranes (PROM) is a common obstetric complication that significantly influences maternal and neonatal outcomes. This study aims to evaluate the maternal and neonatal outcomes associated with PROM at term. Methods: A descriptive study was conducted at Cosmopolitan Hospital, Trivandrum, over 19 months, from July 2015 to January 2017. The study included 200 pregnant women diagnosed with PROM after 37 completed weeks of gestation. Data on maternal and neonatal outcomes were collected and analyzed using statistical software SPSS version 20. Results: The study observed a higher incidence of maternal complications such as chorioamnionitis (6%), puerperal fever (15%), and postpartum hemorrhage (5%). Neonatal complications included birth asphyxia (10.5%), meconium aspiration syndrome (7%), and NICU admissions (12.5%). The mean duration of hospital stay was 4.4 days for mothers and 4.48 days for neonates. Conclusion: PROM at term is associated with significant maternal and neonatal morbidity. Prompt diagnosis and management, including appropriate use of antibiotics and timely induction of labor, are essential to reduce complications.

Background and Aim: The identification of an abnormal flow pattern in the ductus venosus serves as a valuable tool in the screening process for foetal cardiac defects and chromosomal abnormalities, including Down syndrome. Understanding the parameters of a normal ductus venosus Doppler flow pattern is crucial. This study aimed to assess the significance of the ductus venosus pulsatility index in early pregnancy as a predictor of adverse pregnancy outcomes. Material and Methods: A total of eighty pregnant women, each carrying a single viable foetus between 13 and 24 weeks of gestation, took part in this prospective cross-sectional study conducted over the course of one year at a Tertiary Care Teaching Institute in Gujarat, India. Routine ultrasound examination encompasses the assessment of the placental site and the measurement of the crown-rump length (CRL). Assess the biparietal diameter, femur length, and abdominal circumference to confirm gestational dating during the first trimester and in specific cases during the second trimester. Results: The findings indicate that in the normal group, there were 3 cases (4.41%) with non-regular cycles, contrasted with 65 cases (95.65%) exhibiting regular cycles. In the abnormal group, the figures were 2 cases (16.6%) for non-regular cycles and 10 cases (83.3%) for regular cycles. In the normal group, there were 32 cases without placenta previa, accounting for 74.4%, compared to 15 cases with placenta previa, which represented 22.05%. In the abnormal group, 10 cases were without placenta previa, making up 83.3%, while 2 cases had placenta previa, corresponding to 16.6%. The analysis revealed no statistically significant difference in pregnancy outcomes, with a p-value greater than 0.05. Conclusion: Various foetal disorders that could lead to cardiovascular complications and other atypical outcomes in newborns can be effectively managed and anticipated through the use of the DV Doppler examination during the perinatal period.

Background: The objective of current study is to evaluate the role of HPV-16 in the pathogenesis of oral epithelial dysplasias (OED) and oral squamous cell carcinoma (OSCC) by immunohistochemistry (IHC) and to know whether HPV-16 participates in disruption of the regulation of p16 INK4A suppressor protein in OED and OSCC by IHC. Methodology: The present prospective study was done at Department of Pathology, ICARE Institute of Medical Sciences and Research and Dr. B.C.Roy Hospital, Haldia between the periods of December 2022 to May 2024 with a sample size of 130 cases after taking Institutional Ethics Committee approval. The following findings were noted down like demographic information, past and family history, history of present illness, and personal history. In clinical examination and type of the lesion (ulcerative, proliferative lesion, ulceroproliferative lesion, white patch and submucosal fibrosis) were noted. Biopsy samples obtained from patients with oral squamous cell carcinoma and premalignant lesions were fixed in 10% formalin within 30 minutes and for not more than 48 hours (ideal is 12-24 hours). It was then processed and embedded in paraffin wax according to the standard protocols. Thin section of 4 micron were cut and then stained with hematoxylin and eosin. The biopsy specimens were processed in the automated tissue processor for preparation of paraffin blocks as per standard guidelines. The tissue sections were stained routinely with Hematoxylin and Eosin stain as per standard guidelines. Paraffin blocks which were most representative of tumour tissue were chosen for performing immunohistochemistry IHC for p16. Results: Dysplastic lesions were more common in the age group of 41-50 years (43.6%) while the maximum number of cases (35.1%) S.C.C was in the age group of 51-60 years. Overall male predominance was in both oral dysplastic lesions (84.6%) and OSCC (73.6%). Male: Female ratio was 5.5:1 in dysplastic lesion and 2.8:1 S.C.C. Tongue was the most common site (46.1%) followed by buccal mucosa (43.6%) for dysplastic lesions and the most common site for S.C.C was buccal mucosa (39.5%) followed by tongue (26.4%).Majority of patients with dysplastic lesions presented with leukoplakia (79.5%0 followed by OSMF (10.3%) and maximum number of patients with S.C.C was growth in the oral cavity (60.4%) followed by ulcerative lesion (20.9%) and ulceroproliferative lesion (16.5%). Histopathology revealed maximum number of dysplastic lesions was mild dysplasia (41%) and well differentiated SCC (60%). The p16 positivity rate was 55.38%. Patients in the age group of 21-30 years showed 91.6% positivity. Below 50 years the p16 positivity was 77.7% and above 50 years the positivity was 69.5%.Thus the younger population showed more positivity for p16 than the older population. Conclusion: Diffuse pattern of 16 expressions was not seen in dysplastic lesion which ultimately helps to differentiate dysplastic lesion from malignancy. P16 proves to be of great help in diagnosing the histological grades in OSCC and dysplastic lesions which ultimately helps to rule out subjective variation in histological diagnosis.

Introduction: Vulvovaginal candidiasis (VVC) refers to a disorder characterized by signs and symptoms of vulvovaginal inflammation due to Candida species. Gram’s staining is performed to see the presence of yeast and pseudohyphae of Candida species. For systemic infection like candidemia, blood culture is done in a biphasic medium like brain-heart infusion agar-broth and incubated at both the temperatures. As drug resistance in Candida species is now very common, therefore, antifungal susceptibility testing should be performed. This study aims to determine the prevalence of various Candida species among vaginal candidiasis and to determine the antifungal susceptibility pattern of the isolates. Methodology: This is a prospective study with Candida isolates from high-vaginal swabs. The samples were screened for Candida by microscopy and culture. Speciation of the Candida isolates was done on Hi-CHROM Candida agar and susceptibility pattern was determined.  All the swabs received were subject to microscopy with Gram staining. All the isolates were subjected to antifungal susceptibility testing on Modified Mueller-Hinton agar as per CLSI guidelines. The antifungal agents used were fluconazole, itraconazole, clotrimazole, nystatin and amphotericin-B. The susceptibility pattern was observed by the Kirby-Bauer disk diffusion method. Results: Of all the samples received at the laboratory of the Department of Microbiology, 63 showed Candida morphology and were plated on Hi-CHROM agar and their species was noted. Of the 63 Candida isolates, 27 were C. albicans (42.9%), 14 were C. glabrata (22.2%), 15 were C. dubliniensis (23.8%), 5 were C. parapsilosis (7.9%), C. krusei and C. tropicalis were 1 each (1.6%). Drug resistance was the most commonly noted in Candida albicans (14.8% of all C. albicans samples) than in other species. Conclusion: In our study, most drug resistant strains were of Candida albicans species, which poses a great threat of recurrences. Moreover, multi-drug resistance patterns have been noted to most commonly use antifungal drugs in Candida albicans strains than non-albicans species. This makes speciation and antifungal susceptibility a must in treatment of vulvovaginal candidiasis. Doing so will provide proper and complete cure to patients without recurrence due to ineffective antibiotic treatment.

Background: The aim is to investigate the risk of short-term maternal morbidity caused by routine vs selective episiotomy in primigravida in a tertiary care hospital in Kishanganj, Bihar. Methodology: This prospective cohort study was undertaken in Department of Obstetrics and Gynaecology, MGM Medical College and LSK Hospital, Kishanganj, Bihar. Most of the referred study with same indication conducted for 3 months of follow up post-delivery per subject. Women fulfilling the criteria were undergone detailed clinical examinations. A detailed history was taken regarding menstrual and obstetrical history with onset of labour pain, duration and associated with rupture of membrane or not. A thorough general physical examination, respiratory system and cardiovascular and CNS examinations was done. In obstetrical examination like uterine height in weeks; lie of the fetus, presentation and position; fetal heart sounds; and estimated fetal weight were noted.  Per vaginal examination was done to assess cephalo-pelvic disproportion and the status of cervix by bishop score. Informed consent form was taken.  In follow up visits vitals observations like (BP, pulse rate, temp, respiratory rate); episiotomy related complications like skin tag, asymmetry, excessive narrowing of introitus, rectovaginal fistula were noted. Results: In our study in routine episiotomy group, the mean age (mean± s.d.) of patients was 25.38± 4.3887yrs and in selective episiotomy group, the mean Age (mean± s.d.) of patients was 25.08± 3.8377yrs. Difference of mean age with both groups was not statistically significant (p=0.7160). We found that the mean gestational age GA (mean± s.d.) of patients was higher in routine episiotomy group [38.7260± .9847] compared to selective episiotomy group patients [38.6140± .8788] which was not statistically significant (p=0.5499). Conclusion: Routine episiotomy, while once a common practice in obstetrics, may lead to increased rates of anterior vaginal trauma and vaginal tears, particularly first and second-degree tears, compared to the selective episiotomy approach. These findings underscore the potential risks associated with routine episiotomy, including increased maternal discomfort and potential long-term sequelae such as pelvic floor dysfunction. Despite the higher incidence of perineal trauma observed in the routine episiotomy group, no significant differences were observed in other maternal outcomes such as urinary and anorectal incontinence, dyspareunia, or NICU admission rates.

Background: The use of smokeless tobacco, which is more common than cigarette smoking in India, especially in rural areas, is a serious public health concern. This study was conducted to investigate the factors associated with tobacco use and nicotine dependency level within the study group. Materials & Methods: A cross-sectional study was conducted in Dehgam, Gujarat (Mar 2021-Nov 2022); focused on tobacco use among 1,200 participants, aged 15 years and above. Cluster sampling was used to select a total of 30 villages as a cluster, 40 participants were selected from each cluster. Interviews were conducted using google form, and ethical guidelines were followed. Results: A study of the 1200 participants revealed a prevalence of 12.3% for current smokers, with 69% being daily smokers. Additionally, 29.4% reported current smokeless tobacco use, with 93% engaging in daily consumption. Past tobacco use was reported by 2.6% of the participants. When it comes to smoking, beedis were the preferred choice (67.3%) compared to cigarettes (30.6%). Among smokeless tobacco users, pan masala with tobacco (Mava) held the highest prevalence (74.5%), followed by Miraj (46.7%) and gutkha (42.2%). Our findings show a significant association (p<0.05) between age group and duration of tobacco use and nicotine dependency among smokers and smokeless tobacco users. Conclusions: Despite policy efforts, smokeless tobacco use remains a significant public health issue in India. Smokers’ dependence on nicotine and limited access to quit resources highlight the need for stronger tobacco control policies and improved cessation support.

Background: Neonatal sepsis is a significant cause of neonatal mortality in developed as well as developing countries. The etiologic agents and risk factors are diverse resulting in variable rates in any geographical area. Timely blood culture reports can reduce mortality and morbidity. Aim and Objectives: Detection of microbial agents causing neonatal septicemia and to know their antimicrobial susceptibility pattern. Material and Methods: Blood culture samples were collected from around 456 neonates suspected of neonatal septicaemia over a period of one year and incubated in BacT/Alert. Positive flagged bottles were subcultured on Blood agar and MacConkey agar. Culture positive isolates were identified by routine microbiological procedures and antimicrobial susceptibility testing was performed on Vitek 2 compact. Results: Amongst the 456 blood samples taken from suspected cases, 95(20.8%) were culture positive. The major risk factors were difficult delivery, premature and prolonged rupture of membranes and the commonest symptoms were lethargy and poor feeding. About 58(61.1%) were early onset and presented symptoms before 24 hours, whereas 37(38.9%) were late onset septicaemia. Amongst the isolates Klebsiella pneumoniae 22(23.1%) was the predominant bacterial pathogen followed by Escherichia Coli 16(16.8%), Staphylococcus Aureus 14(14.7%) and CoNS 14(14.7%). Pseudomonas spp and Enterococcus species were 8(8.4%) each, Acinetobacter spp. were 5(5.2%)and Streptococcus spp. were 3(3.1%).The isolates were multi drug resistant and mostly resistant to first line drugs like cephalosporins and penicillin group. The case fatality rate was 12.6 % among culture positives. Conclusion: Neonatal sepsis rates vary enormously across countries. Stringent infection control measures, early diagnosis and prompt management is the key to better patient outcome.

Background: female in their life prone to developed various pathological condition in hormone responsive genital tract system. This study aims to identify various pathological lesions in hysterectomy specimen along with clinical correlation. Materials and Methods: the present study was retrospective study conducted at GMERS medical college and hospital, Himmatnagar during October 2023 to September 2024. All form of hysterectomy specimens received were examined. Routine gross examination done and representative sections were taken and stained with haematoxylin and eosin stain. Various histopathological and clinical data were collected and analysed. Results:  this study include total 150 hysterectomy cases. Various clinical complains were noted including menorrhagia and abnormal uterine bleeding was common complaint followed by dysmenorrhea, pelvic organ prolapse. Most of the patients were in age range of 41-50 years. The proliferative phase was most common finding in endometrium. Leiomyoma was most prevalent findings in myometrium followed by adenomyosis. Chronic cervicitis was common incidental finding seen in cervix. Most of ovaries had non-specific pathology. Conclusion: hysterectomy is most common gynaecological surgery perform under elective condition. This study shine light on the histopathological lesions in hysterectomy specimens. Various finding was accidentally found in microscopic examination therefor all hysterectomy specimen should undergo histopathological examination.

Aim: The aim of the present study was to assess the pattern of injuries in blunt renal trauma using Multiphasic Contrast-Enhanced Computed Tomography (CECT). Materials and methods: The study was conducted in the Department of Radio diagnosis, Mysore Medical College and Research Institute. Results: Majority were males (80%) with male to female ratio of 4:1. The age of the patients in this study ranged from 6 years to 90 years, with a mean age of 30.4 years. In our study, road traffic accident was the most common mechanism of injury. Grade IV injury was the most common injury. In our study, 4 out of 35 patients had undergone operative management and rest of the patients managed conservatively. Conclusion: Renal trauma management has evolved during the last decades, with a clear transition towards a nonoperative approach. This transition is probably because of the improvement in imaging modalities (mainly computed tomography (CT) scanning) and minimally invasive treatment techniques. Thus, a prompt and accurate diagnosis is critical and CECT plays a very important role in characterising the grade of injury and formulate the appropriate management protocols deemed necessary.

Ultrasonography (USG) is commonly employed for assessing fetal development during pregnancy. However, fetal magnetic resonance imaging (MRI) has emerged as a valuable tool to complement USG by confirming or ruling out suspected abnormalities and uncovering additional issues, thus enhancing perinatal care and altering pregnancy outcomes. Recent advancements in ultrafast MRI sequences have significantly improved its diagnostic capabilities. This pictorial essay showcases a range of structural anomalies affecting various systems such as the central nervous system, thorax, genitourinary tract, gastrointestinal tract, and other miscellaneous anomalies. Additionally, anomalies in twin pregnancies and placental abnormalities are also explored in this comprehensive review.

Background and Aim: Ultrasound guiding speeds up peripheral nerve blocks, improves quality, lowers local anaesthetic doses, and reduces complications. This study was done with an aim to compare the post-operative analgesic effect of USG guided bilateral quadratus lumborum block with conventional analgesic technique in elective caesarean section patients by total requirement of post-operative analgesic drugs. Material and Methods: We studied 80 patients who were scheduled for caesarean section. All the Patients were given spinal Anaesthesia. At the end of the surgery, the patients were divided into two groups. QLB group (GROUP A): Patients received USG guided Bilateral Quadratus Lumborum Block with 20 ml of 0.25% Ropivacaine on each side(n=40) and Control Group (GROUP B): Patients who did not receive the QLB block and were given Injection Tramadol on demand for post-operative analgesia as per institutional protocol(n=40). Analgesic efficacy of QLB block in caesarean section was assessed by time to first requirement of rescue analgesic drug (Tramadol), VAS scores, and total dose requirement of Tramadol in 24 hrs. Any adverse effects or complications were also observed. Results: QLB block increases the duration of time to first rescue analgesic drug (Tramadol) with significant difference (P < 0.0001) between QLB group (1068.25±157.331 min) and the CONTROL group (222.75±56.27 min). There is a significant decrease in the VAS score in the postoperative period in the QLB group as compared to the control group. It also reduces the total Analgesic requirement (Tramadol) in the first 24 hours with significant difference between the QLB group (105±45.00 mg) and the CONTROL group (357.5±84.39 mg). Conclusion: USG guided Bilateral Quadratus Lumborum block when compared with a standard spinal anaesthetic is associated with a significant decrease of systemic analgesics demand and is a good choice for postoperative pain management in surgery like caesarean section as a part of multimodal analgesia.

Introduction: The evaluation of fetal kidney has been subject of increased awareness for the assessment of fetal growth and development and prenatal diagnosis of renal anomalies, genetic counselling and treatment of prenatal renal disorders like Wilm’s tumor, multicystic renal dysplasia, hydronephrosis. Objective: The aim of the study was to determine the histological development of the kidneys during the fetal period. Materials and Methods: The present study was carried out in the department of Anatomy, Regional Institute of Medical Sciences, Imphal, Manipur. The material for the study consisted of 60 spontaneously aborted and still born human fetal specimens free from any gross congenital anomalies with gestational age between 11th to 38th weeks were collected from Obstetrics and Gynaecology Department, RIMS. The kidneys were taken out from fetal specimens, fixed, processed to form slides and studied under the light microscope for histological changes of kidney with advancing age after staining with Haematoxylin and Eosin. Results: The capsule of kidney was made up of collagen fibres and fibroblasts at 11 weeks of gestation, which were differentiated with numerous collagen fibrils at 16 weeks and from 20 weeks onwards thick compact capsule is formed. Nephrogenic zone beneath the capsule was seen as a broad at 11 weeks of gestation which is decreased and it was almost negligible at 38 weeks of gestation. Developing glomeruli were observed in the superficial part of the cortex initially while with advancing gestational ages from 11 weeks to 38 weeks they were located in the deeper part of cortex. The cortico-medullary differentiation was appreciated from 14 weeks onwards and completed by 27 weeks, PCT and DCT were identified at 16th week of gestation. The medulla showed connective tissue and few clusters of cells at 11 weeks of gestation which were differentiated to a few collecting tubules at 14 weeks and thick and thin segments of Henle’s loop were seen by 18 weeks. Conclusion: The present work made an initial attempt to analyze the growth pattern of kidney in human fetuses, which may prove useful in defining the fetal kidney diseases such as agenesis, hypoplasia, polycystic kidney etc., more precisely using the modern invasive or non-invasive imaging technique.

Background: Quarantine, a crucial preventative measure during epidemics like the coronavirus outbreak, has advantages but also has drawbacks and complications such as anxiety, fear, and depression. Listening to music is a novel approach to patient care in hospitals. The purpose of this study is to examine the impact of music listening on respiratory and cardiovascular parameters in COVID-19 patients under quarantine, as well as the feasibility of implementing it in these patients’ presence. Objective: The objective of the study is to assess how music listening affects respiratory and cardiovascular parameters in Covid-19 patients who are quarantined. Methods: The interventional study, carried out in Kanpur, involved sixty COVID-19 patients who were placed under quarantine. Thirty patients were assigned to the listening group, and another thirty patients were assigned to the control group. Before and after listening to music, baseline measurements of cardiovascular and respirato-ry parameters were made, including Spo2, respiratory rate, and tidal volume. Microsoft Excel was used for data entry and assembly. SPSS version 21.0 (IBM Corp., Armonk, NY), a licensed statistical program, was used for data analysis. Results: Each of the following parameters was significantly lower in the post-music listening group compared to the baseline pre-music listening group HR (87.29±12.98vs. 81.57±10.56, p<0.000*), BP systolic (132.69±13.45vs. 126.46±12.89, p<0.000*), and BP diastolic (85.26±12.89vs. 81.89±11.67, p<0.000*). Conversely, the HR (86.34±13.94 vs. 85.89±11.81, p=0.766), BP systolic (133.16±13.48 vs. 132.12±12.45, p=0.477), and BP diastolic (86.35±13.36 vs. 85.34±11.48, p=0.245) of the control group all decreased slightly but not significantly. Spo2, respiratory rate, and tidal volume were compared before and after listening. After listening to music, the tidal volume rose significantly (p<0.01*), from 523.21±31.45 to 576.67±41.21 ml. The respiratory rate in the post-music listening group dropped from 20.12±3.13 to 18.32±4.91 compared to the baseline; this difference was statistically significant (p<0.000*). Conversely, in the post-parameters, the respira-tory rate of the control group decreased from 21.01±3.15 to 20.89±3.21 per minute (p = 0.811). Tidal volume increased from 512.12±61.90 to 514.04±69.32 in the post-parameters compared to the baseline, but the difference was not statistically significant (p = 0.347). Conclusion: The study shows that listening to music considerably enhances respiratory and basal cardiovascular parameters in Covid-19 patients who are quarantined. The results show that music listening can be offered on-site to COVID-19 patients as an intrinsically linked, non-pharmacological form of treatment.

Background: Because maternal and fetal complications of diabetes are fraught with potential danger, management of the former should be an integrated affair. This paper is for the purpose of determining the impacts of a multidisciplinary model on glycemic control, maternal-fetal outcomes, and patient satisfaction during pregnancies complicated by diabetes. Methods: A prospective observational study was conducted on 200 pregnant women diagnosed with gestational diabetes mellitus or pre-existing diabetes. They received coordinated care from a multidisciplinary team comprising endocrinologists, obstetricians, nutritionists, psychologists, and pediatricians. Data on glycemic control, maternal-fetal health, and patient-reported quality of life were collected at baseline, each trimester, and postpartum. Outcomes were analyzed using paired t-tests and logistic regression models. Results: Fasting blood glucose and HbA1c levels were lowered in the third trimester (p < 0.001). Preeclampsia and preterm delivery were much less common, at 8% and 11%, respectively. Favourable neonatal outcome was achieved in that 92% had birth weights within normal range. Scores for patient-related quality of life and satisfaction were found to be dramatically improved, at 94%. Conclusion: A multidisciplinary care approach effectively improves glycemic control, reduces maternal-fetal complications, and promotes patient satisfaction in diabetic pregnancy. This model provides the comprehensive framework for addressing multi-dimensional challenges of diabetes and allows its implementation in clinical practices.

Background: Tuberculosis and chronic kidney disease are two serious global health burdens. CKD increases the susceptibility of patients to TB due to their low immunity. The current study examines the correlation of TB with CKD in patients who were admitted to a tertiary care teaching hospital. Methods: This was a prospective observational study conducted over a period of 12 months involving 150 patients aged 18 years and older who were suffering from tuberculosis (TB) with or without chronic kidney disease (CKD). Among these, 60 patients had only TB, while 90 had both TB and CKD. Data were retrieved based on demographic, clinical, and laboratory parameters, with statistical analytical tests employed to assess the association between TB and CKD while controlling for confounders using logistic regression. Results: The prevalence of extrapulmonary TB was significantly higher in patients with both TB and CKD (32%) compared to the TB-only group (20%). The mean duration of hospitalization was the highest in patients with both conditions, at 18.4 days. Advanced stages of CKD were associated with poor outcomes of TB, including a higher incidence of adverse clinical events and mortality (22%). Logistic regression showed a significant association between CKD and an increased risk of extrapulmonary TB and adverse outcomes (p < 0.01). Conclusion: Patients with CKD are at an increased risk of severe forms of TB and for poor clinical outcomes, thus creating a need for targeted prophylactic interventions, early assessment, and a multidisciplinary approach to improve outcomes in these patients.

Background: Organophosphate (OP) poisoning is a significant global health issue, particularly in agricultural settings, and is associated with severe toxicity, including respiratory distress, neurological impairment, and, in extreme cases, death. Early prognosis is critical in managing OP poisoning, and biomarkers such as serum creatine phosphokinase (CPK) have been suggested to predict patient outcomes. This study aims to evaluate the role of CPK levels as a prognostic indicator in organophosphate poisoning. Methods: A cross-sectional, prospective study was conducted on 100 patients with pesticide poisoning admitted to Government Theni Medical College & Hospital from April 2020 to April 2021. Demographic, clinical, and laboratory data were collected, and serum CPK levels were measured at admission, 48 hours, and 96 hours. The relationship between CPK levels and patient outcomes (survival or death) was analyzed using statistical tests including Chi-square, t-tests, and ANOVA. Results: Of the 100 patients, 72% were male, and the majority (57%) was aged between 20 and 40 years. The study found a significant association between elevated CPK levels and mortality (p = 0.015 at presentation; p = 0.038 at 48 hours; p = 0.02 at 96 hours). Non-survivors had substantially higher CPK levels, with a mean of 1024.66 IU/L at presentation, compared to 28.68 IU/L in survivors. Additionally, albumin levels were lower in non-survivors (mean 3.16 g/dL vs. 3.94 g/dL in survivors), further suggesting a link between severe poisoning and poor outcomes. Discussion: Elevated serum CPK levels were strongly associated with increased mortality in organophosphate poisoning, likely reflecting muscle injury and systemic toxicity. These findings are consistent with previous studies, supporting the utility of CPK as a prognostic marker. Monitoring CPK levels may provide critical insights into the severity of poisoning and guide treatment decisions, particularly in the early stages of management. Conclusion: This study highlights the potential of CPK levels as an effective prognostic tool in organophosphate poisoning. Elevated CPK levels are significantly correlated with poor outcomes, underscoring the importance of early detection and monitoring. Future prospective studies are needed to refine CPK’s role in clinical practice and establish intervention thresholds for improving patient survival.

Background: Stature is the qualitative and quantitative measurement of a personality. The purpose of this present study is to estimate the correlation of stature with arm span and to derive regression formulae for calculating the stature from arm span in adult males and Females of Southern Rajasthan population. Materials and Methods: This research was done on 400 adult human subjects, (200 males and 200 females) of selected Population. The total number of subjects were categorised into four groups according to the age: Category- 1 23 – 26 years of age, Category- 2 27- 30 years of age, Category- 3 31-34 years of age, Category- 4 35-39 years of age. Stature and arm span were measured and mean value, standard deviation and Pearson’s correlation coefficient was calculated. Correlation between parameters with age group and gender has been estimated. Results: Correlation of Stature and arm Span is 0.66 in males, 0.65 in females and p value is<0.001. The results of the study found that stature and arm span shows statistically significant positive correlation. Conclusion: Stature shows a statistically significant positive correlation with arm span in adult males and females. Thus, for reconstruction surgeries of limb, it is a critical anthropologic tool. It can also be applicable in identifying an individual in mass disasters where the case is deteriorated, damaged and disfigured.

Background: Ventral hernia repair is a commonly performed surgical procedure with over a million cases annually in India. Traditional suture repair methods have high recurrence rates, especially in larger hernias. The advent of synthetic mesh has revolutionized hernia repair, significantly reducing recurrence. However, the optimal placement of the mesh—whether onlay or retrorectus (sublay)—remains debated. This study aims to compare the outcomes of onlay and retrorectus mesh repair in patients undergoing ventral hernia repair by open surgical technique. Materials and Methods: A prospective comparative study was conducted from May 2023 to May 2024 at Dr. Bhim Rao Ambedkar Memorial Hospital and District Hospital in Raipur, enrolling 60 patients diagnosed with ventral hernias. Patients were divided into two groups: Group A (onlay mesh repair) and Group B (retrorectus mesh repair), with 30 patients each. Intraoperative and postoperative variables, including surgical duration, complications (seroma, surgical site infections), and hospital stay, were recorded. Data were analyzed using SPSS version 20.0, applying unpaired t-tests, Chi-square, and Fisher’s exact tests as appropriate. Results: The mean age of participants was 45.87 years. Group A (onlay) had a significantly higher rate of seroma formation (20% vs. 4% in Group B, p<0.05) and surgical site infections (16% vs. 4% in Group B, p<0.05). The mean hospital stay was longer for the onlay group at 5 days compared to 4 days for the retrorectus group (p<0.0002). Additionally, drain duration was prolonged in the onlay group due to increased seroma formation, suggesting greater postoperative morbidity associated with this technique. Conclusion: Retrorectus mesh repair offers advantages over the onlay approach, showing lower rates of complications, shorter hospital stays, and reduced drain duration. These findings support the retrorectus technique as a preferred method for ventral hernia repair, providing better outcomes with lower morbidity.

Background: Chronic non-healing ulcers represent a major healthcare challenge, given their resistance to conventional treatments and the burden they place on patients and healthcare systems. Platelet-rich plasma (PRP), rich in growth factors, has emerged as a potential treatment to enhance healing in chronic ulcers. This study aimed to assess the efficacy of PRP in promoting wound healing in chronic non-healing ulcers compared to conventional dressing methods. Materials and Methods: This prospective, randomized controlled study was conducted at Dr. B.R. Ambedkar Hospital, Raipur, involving 50 patients with chronic non-healing ulcers. Participants were randomized into two groups: Group A (PRP dressing, n = 25) and Group B (conventional dressing, n = 25). PRP dressings were prepared from autologous blood and applied every third day, while conventional dressings followed standard debridement and infection control protocols. Primary outcomes included healing rate and time to complete wound closure, while secondary outcomes included frequency of dressings required and incidence of complications. Data analysis was conducted using SPSS version 20.0. Results: Patients in the PRP group experienced significantly faster healing (8.08 ± 2.19 weeks) compared to those in the control group (15.56 ± 5.70 weeks), with a p-value of 0.0001. The mean number of dressings required was also significantly lower in the PRP group (24.24 ± 6.59) versus the control group (46.92 ± 17.03, p = 0.0001). Minimal complications were observed, with 80% of patients reporting no adverse effects, and mild pain or fever occurring in 10% of cases. Conclusion: PRP dressing significantly enhances healing rates, reduces dressing frequency, and promotes granulation tissue formation in chronic non-healing ulcers, presenting as a safe and cost-effective treatment alternative. PRP may reduce the socioeconomic burden associated with chronic ulcers and could serve as an effective primary treatment. Further large-scale studies are recommended to establish standardized PRP protocols and validate these findings.

Background: COVID-19, caused by SARS-CoV-2, has varying clinical manifestations, often worsening in moderate to severe cases due to an exacerbated immune response. Mycobacterium W, an atypical mycobacterium, offers potential benefits as an immunomodulatory agent in severe COVID-19 cases by regulating immune response and mitigating cytokine storm. Methods: This observational study evaluated the efficacy of heat-killed Mycobacterium W as an adjunct therapy in 585 hospitalized COVID-19 patients categorized into two groups: the study group (279 patients) and the standard of care group (306 patients). The study, conducted over 18 months at Government Medical College, Srinagar, assessed clinical outcomes, inflammatory markers, and hospital stay durations. Results: Patients treated with Mycobacterium W showed a statistically significant reduction in hospital stay days (median of 10.87 days vs. 13.62 days, p<0.001), lower requirements for oxygen support, and improvements in inflammatory markers (CRP, IL-6, D-dimer) compared to the control group. There was no significant difference in mortality between the groups. Conclusion: Mycobacterium W as add-on therapy in moderate to severe COVID-19 patients appears to enhance recovery by modulating immune responses and reducing inflammatory damage. These findings suggest that Mycobacterium W can be considered a beneficial adjunct treatment in managing severe COVID-19 cases.

Introduction: Infectious diseases are a major global health concern, and antimicrobials are critical in managing these conditions, particularly in hospital settings. However, the widespread, often unregulated use of these drugs has led to a rise in antimicrobial resistance (AMR), threatening their efficacy. This study focuses on understanding antimicrobial utilization patterns in hospitalized patients to optimize therapy and reduce AMR risk. Materials and Methods: This prospective, observational study was conducted over one year at a tertiary care hospital in Western Gujarat. It included adult patients with infectious diseases who received antimicrobial treatment. Data were collected through patient records, covering demographics, diagnosis, and antimicrobial therapy specifics. Antimicrobial use was analyzed using the WHO’s ATC classification and defined daily doses (DDD), with results statistically assessed through SPSS software. Results: Our study of 108 hospitalized patients revealed a nearly balanced gender distribution, with the majority in the 61–90 age range and a mean age of 56.8 years. Respiratory and urinary tract infections were the most common diagnoses, and diabetes mellitus was the leading comorbidity. The average hospital stay was 8.1 days, with most stays between 6-10 days. The average number of drugs per encounter was 7.31, all prescribed generically and sourced from the hospital formulary, with 80.95% of antibiotics administered via injection. Penicillins were the most frequently prescribed antimicrobial class, followed by cephalosporins, with tazobactam + piperacillin and ceftriaxone as prominent choices. A comparison of defined daily doses (DDD) and prescribed daily doses (PDD) for commonly used antimicrobials showed general adherence to WHO dosing guidelines, although amoxicillin + clavulanic acid and piperacillin + tazobactam were prescribed at slightly higher doses, likely tailored to specific patient needs. Conclusion: Our study highlights the prevalent use of broad-spectrum antimicrobials in infectious disease management, with overall adherence to WHO dosing standards. Tailored dosing practices for specific cases emphasize the need for continued antimicrobial stewardship to optimize treatment outcomes and minimize resistance.

Introduction: HPV associated oropharyngeal carcinomas are of great importance nowadays because of its differing behavior irrespective of the tumor differentiation. The aim of this study is to analyse the incidence of HPV associated oropharyngeal carcinoma in our institute and various histomorphological features associated with these tumors. Materials and Methods: This is a retrospective study conducted in Department of Pathology, Thanjavur Medical College. All cases of oropharyngeal squamous cell carcinoma which meets the inclusion and exclusion criteria during 1year study period were included. The clinical parameters were retrieved and histomorphological features were analysed in H&E stained sections. Immunohistochemical analysis of p16marker was done and compared with the clinical and histopathological details. Results: Of the 50 cases included in the study, 80% occur in male and 44% occur in tonsil and tonsillar fossa. 60% cases are keratinizing SCC and 34% cases have good lymphocytic response. P16 positivity is seen in 46% cases. 60.9% cases of HPV positive tumors are nonkeratinising. Lymphocytic response is present more in HPV positive tumors compared to HPV negative tumors. All HPV associated tumors have low Worst pattern of invasion. Discussion and Conclusion: HPV associated tumors are most common in the oropharynx and they have better prognosis with increased response to therapy. HPV positive tumors are more common in tonsil because it is the easily accessible lymphoepitheial site for the entry of organism and they exhibit greater CD8 positive T cell infiltrate. Our study also showed statistically significant association between good Tumor infiltrating lymphocytes, absence of keratin and HPV positivity. In conclusion HPV positive tumors are associated with better pathologic prognostic factors.

Introduction: WHO defines Self-medication as self-prescription which includes diagnosing and treating one’s own illness and prescribing for one’s self. Self-medication is widely prevalent globally among both urban and rural populations, including developing nations such as India, where numerous medications are available over the counter without the need for a prescription. This accessibility offers a cost-effective option for individuals. particularly for minor or common ailments such as headaches, fevers, and the common cold self-medication may appear to be a convenient and economical option, However it carries considerable risks and potential negative outcomes. The misuse of nonprescription medications is particularly notable among young individuals, especially students, largely influenced by media and advertising. This practice is prevalent not only within the general population but also among healthcare professionals, who possess greater awareness of drug patterns, incidence, and knowledge. Methods: This descriptive cross-sectional study was conducted using online methods among 93 MBBS students. The study involved the administration of the research questionnaire including demographic information, practice of self-medication, type of illness, factors influencing self-medication, commonly self-prescribed drugs, sources of self-medication. Results: The prevalence of self-medication was81 (87%), more common among female students. The common illness found was fever and headache and common drug self-prescribed was analgesic-antipyretic. The most common source of obtaining self-medication was pharmacy. Most prevalent motivations for self-medication were the aim to conserve time followed by the assessment of the illnesses as being minor. Conclusions: Self-medication is a common practice among medical students. Although it can alleviate certain health concerns, it also poses risks such as adverse drug reactions, the emergence of drug resistance, and the possibility of masking more serious health issues. To mitigate the prevalence of self-medication, it is crucial that medical students are adequately educated on the principles of rational prescribing. Moreover, additional studies are necessary to investigate self-medication behaviors among different health professionals and the general population.

Background: Recurrent anterior shoulder dislocation is often associated with detachment of the anterior labrum from the glenoid, known as a Bankart lesion, leading to instability that particularly impacts young, active individuals. Methods: This was a descriptive, prospective study conducted at MKCG Medical College and Hospital after obtaining ethical clearance from the institution’s Ethical Review Board. The study took place between September 2023 and October 2024. The patients selected for this study were predominantly males aged 18-35 years who had undergone arthroscopic Bankart repair using suture anchors. The diagnostic process involved radiographic imaging and MRI. Patients underwent arthroscopic reattachment of the labrum using suture anchors, and postoperative outcomes were assessed over a one-year period. Results: In this cohort of 20, 85% had a full range of external rotation to 90° abduction at one year, and 60% reported relief from discomfort. Terminal restrictions in external rotation were reported by only 10% of the patients. The patients with three suture anchors had high joint stability, and the recurrence of dislocation was minimal, allowing most patients to return to high-demand activities. Conclusion: Arthroscopic Bankart repair with suture anchors achieves shoulder stability and improves function, with marked gains in range of motion while minimizing the risk for recurrence. Given its advantages in terms of cosmesis and recovery, this is a viable option for young patients with recurrent anterior shoulder dislocation.

Introduction: Adolescent is a time of quick progress from girlhood to womanhood. This is the period when first feminine cycle (Menarche) happens. Lack of Menstrual hygiene can lead to morbidity and other complication such as UTI, Scabies in vaginal area, abnormal abdominal pain, etc. A sanitary napkin is a permeable thing worn in the under clothing by ladies and young ladies – girls who are menstruating or bleeding due to birth, encountering an unsuccessful labor or premature birth, after any gynecologic medical procedure, or in whatever other circumstance where it is important to retain a progression of blood from the vagina. The objectives of this study are to evaluate the knowledge, beliefs, and attitudes regarding menstruation among school-going adolescent girls. Methods: In this Interventional study was 11-19 years of school going adolescent girls in rural and urban areas. One school from each area was selected for the study purpose. After obtaining the permission from ethical committee, we had start data collection. One school from rural area named Gujrat village and one school from the urban named Shree Ambe School, Waghodia road, Vadodara were selected for the study purpose. Informed assent form from the adolescent girls and consent from their parents were taken. Then gave them the questionnaires which comprised of personal data, the Knowledge, belief, attitude regarding menstruation, the Disorders or problems faced or experience by school going adolescent girls during menstruation and the usage of sanitary pad usage among school going adolescent girls. Questionnaire one on personal data i.e. – name, age, education, religion, etc. and during first visit, we have collected baseline knowledge and other information as per our questionnaire and then we did interventions like poster presentations, small lectures, counseling regarding knowledge attitude and use of sanitary pad. We also have distributed a sanitary napkin among all the recruited participants. After 15 days, we have collected post interventional data on same questionnaire again to assess the effect of interventions. Results: Regarding Current MP Status of the study participants having most of the participants have started MP. (92.5%) Symptoms / Difficulties, Study participants have experience during their last MP, which shows Embarrassment and irritability are the most common difficulties faced. Pre-test and Post-test improvement in knowledge and attitude towards use of Sanitary Pad among study participants. Conclusion: At the end of the study, we were able to find out major improvement in knowledge and attitude towards use of sanitary pad among study participants which is higher than other studies conducted in India. Sanitary pad distributed among study participants can encourage them to use in future also.

Background: Diabetes mellitus is a group of metabolic disease characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The most prevalent form of diabetes is type 2 diabetes mellitus (T2DM), which accounts for 90–95% of all occurrences of diabetes mellitus, and therefore of primary interest. Shah and Sonawane posit that the pulmonary function abnormalities reported in T2DM patients is usually associated with chronic hyperglycemia. In patients with T2DM, the function of the inspiratory muscles is usually observed to be compromised (decreased strength and/or endurance) which results in poor exercise tolerance and reduced functional capacity. Aim of the study: To compare the effect of active chest mobilization techniques and incentive spirometry on pulmonary function and functional capacity in patients with type-2 diabetes mellitus. Methods: Patients were randomly allocated in 2 groups, Group A and Group B with 30 patients each. Measurement of all outcome measures (PP, HbA1c, FVC, FEV_1, PEFR, HRQoL and 6-MWT were recorded. Group A was instructed to perform 15 minute session of incentive spirometry twice a day, along with diaphragmatic breathing exercise (10 repetitions) for 6 days per week. Self-Chest mobilization exercises was performed by Group B for three days per week for 6 weeks along with diaphragmatic breathing exercise (10 reps) , twice a day. The obtained data were analyzed using paired and unpaired t test. Results: After intervention, Group A (incentive spirometry) showed significant improvement in PP(Post Prandial) blood glucose level and FEV₁ and Group B showed significant improvement in 6-MWT. Conclusion: Both interventions (incentive spirometry and ACMT) were effective in the effectiveness of the two interventions across most measures after 6 weeks.

Background: Obesity is a huge concern and a significant lifestyle-related public health issue worldwide. The objective of study was to calculate the percentage of overweight and obese children among under five who attended the Burdwan Medical College immunization clinic in the study period, as well as enumerate the risk factors associated with it. Materials and Methods: An institution based descriptive type cross sectional study was conducted in the immunization clinic of Burdwan Medical College from 1st February to 1st March 2024.Final data was collected from 68 subjects. Interviews were taken from the parents or the primary attendants of those 68 children with an objective to estimate the proportion of childhood overweight and obesity and to determine its correlates. A pretested, pre designed questionnaire was used to collect the data regarding socio-demographic characteristics, physical activity, dietary intake pattern and anthropometric measurements. Analysis was done by collecting data in MS Excel and by using descriptive and statistical tools to represent the data. Results: More than half of the study subjects are from the 0-2 year’s age group and are male. Majority of the study subjects follow Hinduism, belong to upper and upper middle class family and nuclear family. One-third (36.20%) of the attendants are graduates. Most of the study subjects take meals more than four times a day. Greater parts of the study subjects were exclusively breastfed, delivered in caesarean section and were fully immunized. By plotting the data of height and weight of the study subjects on the WHO growth chart, the result was as follows: 7.35% (5 out of 68) of the children were in the category of overweight. Out of this, 3 out of 45 boys and 2 out of 23 girls were found to be overweight. No children among the study subjects were found to be obese. Conclusion: The study results suggest that overweight children are present even at this early age with no significant gender disparity. The results point towards early dietary habits and socio-economic factors playing a role in childhood overweight status. This study underlines the importance of early monitoring and intervention to prevent further progression into obesity, which could lead to long-term health issues.

Background: Gestational diabetes mellitus (GDM) is a significant pregnancy-related metabolic disorder that increases the risk of adverse maternal and neonatal outcomes. This study aimed to assess the prevalence, risk factors, and obstetric outcomes of GDM among pregnant women in a tertiary care hospital in Bhagalpur, Bihar. Methods: An observational, cross-sectional study was conducted at Jawahar Lal Nehru Medical College & Hospital, Bhagalpur, Bihar, from January 5, 2024, to June 20, 2024. A total of 90 pregnant women diagnosed with GDM were included. Demographic data, risk factors, biochemical parameters (fasting and postprandial glucose), and obstetric outcomes were collected and analyzed. Results: The prevalence of GDM was 16.7%. Most participants (60%) were between 25-35 years of age, and 66.7% were obese (BMI ≥ 30 kg/m²). The primary risk factors identified were obesity, family history of diabetes, and previous GDM. Biochemically, 33.3% of women had elevated postprandial glucose levels. Obstetric outcomes showed 10% preterm births, 6.7% macrosomia, and 13.3% cesarean deliveries. Diet and exercise were the main management strategies (64.4%), with 35.6% requiring insulin therapy. Conclusions: The study underscores the high prevalence of GDM in this population, with obesity, family history, and prior GDM being prominent risk factors. Effective screening and management, including lifestyle modifications and insulin therapy, when necessary, are crucial for improving maternal and neonatal health outcomes.

Background: CSD, also known as isthmocele, is a disorder in which the myometrium fails to repair after a caesarean section. Recent studies link CSD to abnormal uterine bleeding (AUB), notably postmenstrual spotting. Most studies have focused on symptomatic women, which may create selection bias. This study examines CSD and AUB in a prospective, unselected sample. Objective: To assess the prevalence of CSD in women with a history of cesarean section and to evaluate the association between CSD and AUB, with a specific focus on postmenstrual spotting. Methods: From January 10 to June 30, 2024, Jawahar Lal Nehru Medical College & Hospital in Bhagalpur, Bihar, conducted this prospective study. The study included 60 women with AUB and a history of caesarean section, 10 per month. All subjects were screened for CSD by transvaginal ultrasound. Patients with and without CSD were compared for AUB symptoms like postmenstrual spotting, delayed bleeding, and dysmenorrhea. Results: Participants with CSD were 63.3% (38/60). Participants with CSD reported 92% postmenstrual spotting, compared to 45% without CSD, indicating a significant correlation (p < 0.01). Prolonged menstrual bleeding and dysmenorrhea were not significantly different across groups (p > 0.05). The results show that CSD is strongly linked to postmenstrual spotting in AUB women. Conclusion: Women with a history of caesarean section have a higher risk of postmenstrual spotting due to CSD. This suggests that women with irregular uterine bleeding, especially postmenstrual spotting, should be evaluated for CSD to enhance therapy and outcomes.

Background: Distal radius fractures are common injuries that significantly impact wrist function and quality of life. They can be treated through various methods, including open reduction internal fixation (ORIF) and closed reduction. Understanding the comparative effectiveness of these treatment modalities is crucial for optimizing patient outcomes. Objective: This study aims to compare the clinical and radiographic outcomes of ORIF versus closed reduction for distal radius fractures. Method: A total of 100 patients with distal radius fractures were enrolled in this prospective study over an 18-month period. Patients were divided into two groups: 50 underwent ORIF, and 50 received closed reduction. Clinical outcomes, including pain, wrist function, range of motion, and grip strength, were assessed, along with radiographic parameters such as alignment, healing time, and bone union quality. Results: The ORIF group demonstrated significantly lower pain scores (VAS 2.4 vs. 3.6), improved DASH scores (15.3 vs. 22.8), and better grip strength (85% vs. 70%) compared to the closed reduction group. Radiographically, the ORIF group showed superior alignment in radial inclination (22° vs. 19°), radial height (11 mm vs. 9 mm), and volar tilt (11° vs. 8°). Conclusion: ORIF significantly outperforms closed reduction in terms of both clinical and radiographic outcomes for distal radius fractures, making it a preferred treatment option for unstable or intra-articular fractures. Further studies are needed to explore long-term implications and patient-reported outcomes.

Background: Posterior malleolar fractures are complex injuries that can significantly impact ankle function. While various fixation methods exist, the optimal treatment remains debated. This study aims to evaluate the outcomes of posterior malleolar fracture fixation using plates and screws. Methods: A retrospective case series of 10 patients with posterior malleolar fractures treated surgically was conducted. All fractures were fixed using distal end radius locking plates and screws through either a posterolateral or posteromedial approach. Patient demographics, injury characteristics, surgical details, and outcomes were analyzed. The primary outcome measure was the American Orthopaedic Foot and Ankle Society (AOFAS) score at 6 months post-operatively. Secondary outcomes included time to union and complications. Results: The mean age of patients was 40.6 years (range 28-55), with an equal gender distribution. Road traffic accidents were the most common mechanism of injury (50%). The mean time to union was 13.2 weeks (range 11-16). The mean AOFAS score at 6 months was 87.4 (range 82-92), indicating good to excellent functional outcomes. Complications occurred in 40% of cases, including superficial wound infection (10%), delayed union (10%), mild ankle stiffness (10%), and hardware irritation (10%). One case (10%) potentially required reoperation for hardware removal. Conclusion: Plate and screw fixation of posterior malleolar fractures can achieve satisfactory short-term radiological and functional outcomes. However, the non-trivial complication rate highlights the complexity of these injuries. While our results are promising, longer-term follow-up and larger comparative studies are needed to definitively establish the optimal fixation method for posterior malleolar fractures.

Introduction: During thyroidectomy we want to maintain intraoperative hemodynamic stability, postoperative analgesia and reduce postoperative complications. To serve the purpose we can use opioids, NSAIDs, paracetamol, Tramadol and local anaesthetic infiltration with or without adjuvant in fascial planes of the neck. Ultrasound‑guided block remains as a reliable tool for performing a cervical plexus block, provides faster onset and longer duration of the block, reduces the performance time, and reduces the complications in addition to reduced local anaesthesia requirement. Perineural use of Dexamethasone prolongs analgesic duration of peripheral nerve blocks, reduces postoperative nausea and/or vomiting (PONV) and reduces general anaesthetics, shorten the hospital stay as well as reduce the severity of pain in the first day postoperatively. The present study was conducted to compare the effect of dexamethasone in the superficial cervical plexus block in thyroid surgeries by its effect on nausea, pain scores, vomiting, and hospital stay. Methods: The present interventional study was conducted in a tertiary care center  involving cases of ASA grade I and II patients undergoing thyroidectomy from December 2022 to June 2024. The patients were randomly   divided into 2 groups using computer generated random numbers. One group received 1ml dexamethasone (4mg) + 19ml 0.25% Bupivacaine in BSCPB (A Group), and the other group received 1ml Normal saline + 19ml 0.25% Bupivacaine in BSCPB (B Group). After the induction of general anaesthesia, superficial cervical plexus blocks was administered bilaterally before the surgical incision. Results: Mean heart rate and mean Spo2 at preoperative baseline, after induction, after block 0 to 180 min. did not differ between two groups. Mean systolic blood pressure, mean diastolic blood pressure and mean arterial blood pressure at preoperative baseline, after induction, after block 0 to 180 min. differed significantly between two groups with more marked rise in group B. The mean VAS score differed significantly between group A and group B (p>0.05) with high VAS scores in group B. Mean duration of post operative analgesia (12.3 + 1.9 hrs. in group A vs 8.4 + 1.1 hrs. in group B) differed significantly between these two groups with longer duration of post operative analgesia in group A (p=0.01). Two groups did not differ significantly in postoperative complications. Conclusions: We conclude that the hemodynamic parameters are more stable with group A (Dexamethasone adjuvant group). Addition of dexamethasone prolonged duration of analgesia, reduced pain intensity, duration, and requirement of rescue analgesia without significant increase in post operative complications.

Introduction: The brachial plexus block is a frequently utilized nerve plexus block for providing perioperative anaesthesia and pain relief during upper limb surgeries. Levobupivacaine, an S (-) enantiomer of bupivacaine and part of the amino-amide group, has a favourable clinical profile with a better safety margin for cardiovascular and central nervous system effects. To improve the effectiveness of supraclavicular brachial plexus blocks, adjuvants like tramadol, fentanyl, dexamethasone, and butorphanol are added to local anaesthetics. The study was conducted to compare the analgesic effectiveness between Tramadol plus Levobupivacaine versus Fentanyl plus Levobupivacaine in ultra sound guided supraclavicular brachial plexus block.” Methods: The present prospective, observational, and comparative study was conducted in the Department of Anaesthesiology at a tertiary care hospital, from January 1, 2023, to June 30, 2024 amongst 100 patients, aged 18 to 70 years, who were scheduled for elective upper limb surgeries. They were randomly assigned into two equal groups (Group I and Group II) using the Complete Enumeration method, with 50 patients in each group. Group I – This group of patients received inj. 0.5% Levobupivacaine 20 mL + Fentanyl 100mcg(2mL) + NS making a total of 30 ml. Group II – This group of patients received inj. 0.5% Levobupivacaine 20 mL + Tramadol 100 mg (2 mL) + NS making a total of 30 ml. Results: For onset of sensory block the tramadol group exhibited a mean onset time of 11.92 ± 1.957 minutes, while the fentanyl group had a significantly shorter sensory block onset time of 3.80 ± 0.990 minutes. For onset of motor block the tramadol group showed a mean onset time of 11.78 ± 1.941 minutes, while for onset of motor block the fentanyl group had a notably shorter onset time of 4.48 ± 0.886 minutes. The total duration of motor block in the tramadol group had a mean duration of 461.80 ± 27.15 minutes, whereas the fentanyl group had a shorter total duration of motor block of 369.80 ± 16.22 minutes. Both tramadol and fentanyl are effective in inducing sensory and motor blocks, fentanyl demonstrates a faster onset of action, whereas tramadol provides a longer duration of block. While some fluctuations were noted, overall, tramadol and fentanyl groups maintained comparable MAP values for most of the study duration. Conclusion: The present study concludes that despite differences in the onset and duration of sensory and motor blocks, both tramadol and fentanyl showed comparable effects on patient demographics and cardiovascular stability.

Introduction: Pre-eclampsia is a multi-system disorder unique to human pregnancy complicating 5-8% of pregnancies. It poses significant risks to both maternal and foetal health. Pre-eclampsia, a pregnancy complication characterized by high blood pressure and organ dysfunction, put unique challenges against anaesthesiologists. While ensuring adequate pain relief and safe delivery, they must navigate the delicate balance of pre-existing maternal health and potential complications. Caesarean section is the procedure where a baby is delivered through an incision on the abdominal wall and uterus of the mother under general or spinal anaesthesia. Both general and spinal Anaesthesia can be used for caesarean section but each has its own advantages and disadvantages to both mother and foetus. We are comparing study of spinal anaesthesia versus general anaesthesia in severe pre-eclampsia patients undergoing caesarean section. Methods: The present Interventional study was conducted in the Tertiary care hospital amongst 60 patients having severe preeclampsia undergoing caesarean section were divided into two groups 30 each. In group-I had general anaesthesia and in group – II patients had spinal anaesthesia for caesarean section. Result: The mean age of patients in the Spinal AX group was slightly lower, but this difference was not statistically significant. Majority patients receiving general anaesthesia show high pulse rate showing statistical difference. Maternal haemodynamic parameters, including mean arterial pressure, systolic blood pressure, and diastolic blood pressure were significantly higher in the General AX group. The Visual Analogue Scale (VAS) scores indicated significantly lower pain levels in the Spinal AX group (all Score of 1). A higher incidence of maternal complications, including nausea &vomiting, delayed discharge, was observed in the general AX group. There is significantly higher proportion of newborns in the Spinal AX group with Apgar scores greater than 5 at 1 minute. These findings suggest that newborns of mothers who underwent Spinal AX anaesthesia had better overall neonatal conditions immediately after birth compared to those born to mothers who underwent General AX anaesthesia. Conclusion: In our study, we concluded that spinal anaesthesia is associated with lower maternal complications and early post operative recovery is good in spinal anaesthesia in terms of early mobility and post operative ICU requirement. Neonatal outcome in terms of APGAR score is better in spinal anaesthesia compared to general anaesthesia.

Introduction: A 0.5% hyperbaric bupivacaine has been extensively used for spinal anaesthesia. It provides an intense motor block, of longer duration which is usually not needed for perineal and lower limb surgeries. Ropivacaine is a relatively new amino-amide local anaesthetic that appears to be less potent and gives less intense motor block of shorter duration as compared to bupivacaine. Ropivacaine also has less cardiovascular and central nervous system toxicity than bupivacaine. It is well established that addition of dextrose to local anaesthetic increases the specific gravity there by providing more reliable block as compared to isobaric solutions. This improves their anaesthetic profile by giving higher cephalad spread and good muscle relaxation. Hyperbaric solutions give more predictable block with greater spread in the direction of gravity.

Methods: The present study was conducted in a Tertiary health centre for 18 months amongst 150 patients posted for infra umbilical surgeries. The study population was divided into two groups of 75 each, Group B and Group R. Group B: Group of 75 patients received 3 ml of 0.5% hyperbaric bupivacaine. Group R: Group of 75 patients received 3ml of 0.5% hyperbaric Ropivacaine.  Assessment of sensory and motor blockade was done using pin prick and Bromage scale respectively. Results:  The demographic parameters like age, sex, weight, ASA grading and duration of surgery were comparable. The onset time of sensory blockade to T10 dermatome was significantly earlier in group B than group R. The mean time for onset of Peak sensory blockade T6 dermatome in group B (6.05±1.05min) than in group R (10.05±2.06min) and difference between them was statistically significant. The mean time for onset of maximum motor blockade T6 dermatome in group B (10±0.15min) than in group R (10.75±1.30min) and difference between them was statistically significant. The total duration of motor block in group B was 150 ± 35.09 min and in group R was 120 ± 30.09 min. Maximum motor blockade was achieved significantly earlier in group B than group R. The total duration of sensory blockade in group B was significantly prolonged in group B than in group R. Conclusion: Finally, we conclude that freshly prepared hyperbaric 0.5% Ropivacaine is a better alternative to hyperbaric 0.5% Bupivacaine for undergoing infraumbilical surgeries with faster onset of motor block, better haemodynamic stability, lower incidence of adverse effects and early recovery of sensory and motor block.

There are 1.3 billion people in the world having some form of visual impairment and cataract is one of the most important causes. In the low and middle income countries  the proportion of visual impairment due to cataract is much higher. Cataract is the commonest cause of preventable blindness in the world, accounting for about 51%of global blindness. Presently surgery is the only available treatment for cataract. Therefore reduction in blindness due to cataract is dependent on available infrastructure, funds, equipment’s, skilled manpower; specially sufficient number of ophthalmic surgeons to perform cataract surgery and also intra-operative and post-operative complications. Posterior capsular rent (PCR) is one of the most common intra-operative complications of cataract surgery that can affect the postoperative visual acuity.

DOI: 10.5281/zenodo.

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It is also noted that cataract develops at an earlier age in diabetics. In addition to cataract vision is affected in diabetics by other mechanisms too. Diabetes causes microangiopathy which manifests as diabetic retinopathy, nephropathy and neuropathy. Newer studies have shown that retinal neurodegeneration also occurs along with or may precede retinal vasculopathy. Retinal neurodegeneration caused by diabetes clinically manifests as reduction in retinal nerve fibre layer, ganglion cell layer and also Muller cells. It also affects colour vision and other aspects like spatial frequency and changes on electrophysiology. Diabetes not only affects the retina but also cornea, tear film and lens which lead to changes in the optical quality of the diabetic eye.

DOI: 10.5281/zenodo.

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Background: Chronic liver disease (CLD), a global health issue, increases the likelihood of complications after major surgeries. CLD patients’ diminished liver function can induce coagulopathy, infections, and poor wound healing, making surgery difficult. Despite the risks, local and regional CLD surgical outcomes data is sparse. This retrospective study examines CLD patients who underwent major surgery at MGM College and LSK Hospital in Kishanganj, including post-operative complications, mortality rates, and risk factors. Methods: This retrospective study included 50 CLD patients who had major procedures at MGM College and LSK Hospital in 2022 and 2023. Medical records comprised patients’ ages, sexes, liver function tests (Child-Pugh and MELD scores), procedures, complications, hospital stay, and death rates. Participants with proven CLD and extensive surgeries were eligible; those lacking full records or less extensive treatments were not. We employed descriptive statistics (mean, median) and comparative analysis (chi-square and t-tests) to determine if liver disease levels correlated with surgery results. Results: The research group consisted of 50 patients, averaging 55. The population was 68% male and 32% female. 60% of patients had Child-Pugh Class B liver disease, 30% Class C. After surgery, 48% of difficulties were infections (18%), bleeding (14%), and liver failure (10%). Patient mortality was 16% within 30 days of surgery. Class C patients with higher Child-Pugh and MELD scores had 72% complications and 27.8% fatalities, indicating worse outcomes. The study found that diabetes and hypertension were co-morbidities, increasing complications and mortality. Conclusion: Major CLD surgery increases complications and mortality, especially in advanced liver disease patients. These hazards can be reduced with careful perioperative treatment and liver function testing. This study highlights personalizing therapy to each patient’s needs and advocates for more research into improving surgical outcomes for at-risk patients.

DOI: 10.5281/zenodo.

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Background & Methods: This Retrospective Cohort aims to Evaluate Postoperative Infections and Antimicrobial Therapy. This Retrospective Cohort study Examines Post-operative Infections and Antimicrobial therapy by analysing reports of patients from 01/01/2024 to 31/08/2024. Antimicrobial susceptibility pattern of isolated bacterial pathogens was performed according to the guidelines. Inoculum was prepared by picking parts of two or three identical colonies with a sterile wire loop. Results: Patient characteristics associated with harboring antimicrobial drug resistant pathogens. MRSA was more likely to be isolated from patients with antimicrobial exposure within one month and those with hospitalization history within six months than those with no such history. However, this difference was not statistically significant (p>0.05). Conclusion: We found most of the Gram negative isolates were multiply resistant to commonly prescribed antimicrobial agents. The present study also found an increase in SSIs due to ESBLs producing Esherichia coli strains as well as MRSA. Ceftriaxone, a third generation cephalosporins commonly used for antimicrobial prophylaxis to prevent SSIs was found to be ineffective against most of gram negative organisms and MRSA isolates.

DOI: 10.5281/zenodo.

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Introduction: Tonsillitis, an inflammation of the tonsils is highly prevalent in developing countries among children and adolescents. Managing post-tonsillectomy pain remains a significant clinical challenge. Opioids, carry the risk of side effects and the potential for dependency and abuse. Additionally, high doses of opioids may increase the chance of airway complications, NSAIDs, on the other hand, may not provide adequate pain relief and can increase the risk of postoperative bleeding. Given these limitations, there is a growing interest in exploring regional anesthesia techniques, such as the glossopharyngeal nerve block, to provide targeted pain relief without the systemic side effects associated with traditional analgesics. Considering the above facts the present study was conducted to determine the efficacy of glossopharyngeal nerve block with Bupivacaine 0.5% in post tonsillectomy patient. Methods: The present quasi-experimental design was conducted in the Department of Anesthesiology of a tertiary care center over a period of 18 months amongst patients admitted to the ENT wards scheduled for tonsillectomy. The study employed a convenient sampling technique. At the end of surgery, patients received a glossopharyngeal nerve block (GNB) using the anterior tonsillar pillar (ATP) method by injecting 0.5% bupivacaine in a dose of 2 mg/kg mixed in 2.5 mL normal saline. The procedure was then repeated on the contralateral side. Result: The average age was similar, with the intervention group having a mean age of 18.436 years (±8.97) and the control group 19.517 years (±10.34). Gender distribution was also comparable. The intervention group had a significantly higher heart rate in the immediate postoperative period compared to the control group, but the difference diminished over time. The intervention group experienced a consistently lower SBP, DBP, MAP compared to the control group after the glossopharyngeal nerve block. The intervention group experienced longer pain relief and could resume oral intake after completion of standard nbm hours after general anaesthesia sooner than the control group. Also, the intervention group experienced lower incidence of post operative nausea and vomiting’s after receiving block than the control group. Conclusion: In conclusion, the glossopharyngeal nerve block offers significant advantages in managing postoperative pain and promoting recovery in tonsillectomy patients. By providing long-lasting pain relief, delaying the need for additional analgesics, and facilitating earlier oral intake, the GNB not only enhances patient comfort but also accelerates recovery, reducing the likelihood of postoperative complications such as nausea and vomiting.

Introduction: Adverse Drug Reactions (ADRs) pose a serious challenge to healthcare by increasing patient morbidity, prolonging hospital stays, and adding financial strain. Accurate ADR reporting, particularly in developing countries, is crucial for ensuring drug safety, yet underreporting remains prevalent due to limited awareness, training, and resources among healthcare professionals. Materials and Methods: This cross-sectional study surveyed healthcare professionals in a tertiary hospital in western Gujarat, aligned with the Pharmacovigilance Programme of India. Using a structured questionnaire covering knowledge and attitudes toward ADR reporting, data was collected from various departments to assess pharmacovigilance practices. Statistical analysis was performed with SPSS 22.1, and confidentiality was maintained throughout the study. Results: The survey included 244 healthcare professionals, primarily physicians (90.7%), with pharmacists comprising 9.3% of the sample. Findings showed that 48.4% of respondents had encountered an adverse drug reaction (ADR), yet only 44.3% reported these incidents to a pharmacovigilance center. While 60.2% received formal training on ADR reporting, only 27.9% reported receiving “drug alerts.” Adherence to ADR minimization guidelines was observed in 58.6% of participants, and 41.4% maintained records of ADRs encountered. Overall, the results highlight gaps in ADR reporting practices despite positive attitudes, with barriers such as limited training and lack of consistent access to drug safety information. Conclusion: Our study underscores the need for enhanced training and streamlined reporting systems to improve ADR reporting practices among healthcare professionals. Despite positive attitudes, limited knowledge and access to safety resources hinder consistent reporting, indicating areas for targeted intervention to strengthen pharmacovigilance.

Background: Acute kidney injury (AKI) is a frequent and serious complication among patients with chronic liver disease (CLD), significantly impacting morbidity and mortality rates. Despite the rising prevalence of both alcohol-related CLD and non-alcoholic steatohepatitis (NASH)-related CLD globally, comparative data on the clinical presentation and spectrum of AKI in these patient populations are limited. Methods: In this cross-sectional study, we analysed 720 patients diagnosed with CLD at our tertiary care centre from January 2023 to June 2024. Patients were categorized into two groups: 360 with alcohol-related CLD and 360 with NASH-related CLD. AKI was identified and staged according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. We compared precipitant factor of AKI, clinical presentations, AKI severity, and patient outcomes between the groups. Results: AKI was present in 47.5% (171/360) of patients with alcohol-related CLD and 45.8% (165/360) of patients with NASH-related CLD (p=0.65). Common precipitating factors for AKI in ArLD & NASH group were sepsis (69 & 33, p<0.04), UTI (39 & 15, p<0.04), GI bleeding (21 & 51 p<0.04), SBP (21 & 18 NS), GI loss (6 & 9 NS), diuretic overdose (3 & 3 NS). HRS was more common in NASH group compared to ArLD (30 & 9 p<0.05). Clinical presentation as ACLF was more common in ArLD (45 & 18 p<0.03) whereas GI bleeding was more in NASH group (51 &21, p<0.01). In-hospital mortality was significantly higher in patients with alcohol-related CLD and AKI (28%) compared to those with NASH-related CLD and AKI (18%) (p=0.04). Conclusion: AKI is equally prevalent in ArLD & NASH related CLD. Infections (sepsis & UTI) are common precipitating factor in ArLD whereas GI bleeding is common precipitant in NASH related CLD. HRS is more likely in NASH compared to ArLD.

Introduction: Use of same length needle for intramuscularly administered vaccines can cause under and over penetration among newborns due to varying body weights and fat/muscle thickness. The injection technique and needle size both determine how deep a substance is injected. Injection technique involves stretching the skin flat before inserting the needle or pinching a fold of skin before injection, which may necessitate the use of longer needles. Objectives: 1. To measure the depth of subcutaneous tissue layer (STMD) and skin to bone distance (STBD) and muscle thickness (STBD-STMD) over the anterolateral thigh of newborns using high-frequency sonography and suggest appropriate needle length for safe intramuscular injections. 2. To estimate the risk of over penetration and under penetration with standard size needle being used in newborn vaccinations and intramuscular injections. Methodology: A cross-sectional analytical study was done among 150 newborns in four different weight bands of <7 days of life using convenient sampling at a tertiary teaching institute People’s College of Medical Sciences and Research Centre Bhopal Madhya Pradesh in central part of India. Those newborns who were sick and admitted to the NICU, had limb anomalies, or whose parents did not provide consent were excluded from the study. Results: Mean STBD was 14.69 mm, mean STMD was 4.01mm, and mean muscle thickness was 10.71mm. Significant correlations found between weight, STBD, STMD, and muscle thickness. Under penetration and over-penetration risk with 16mm and 25mm needles varied by weight band. Based on needle penetration, with results showing that none of the subjects (0%) experienced under-penetration. However, a significant proportion of subjects experienced over-penetration, with 107 subjects (71.33%) experiencing over-penetration using a 16mm needle and all 150 subjects (100%) experiencing over-penetration using a 25mm needle at a 90-degree angle to the skin surface. Conclusion: Customized needle length based on newborn weight is necessary to ensure safe intramuscular injections. This study provides estimates of thigh muscle thickness to inform appropriate needle size selection. Further large-scale studies are needed to inform future recommendations.

Background: Blood donation is a crucial component of healthcare systems globally. Identifying the reasons for deferring individuals willing to donate blood is essential for improving donation practices. This study aimed to analyze deferral cases to support the practice of voluntary blood donation within the healthcare framework for fostering voluntary donation, ensuring safe blood and blood products for recipients, safeguarding donor health, and developing strategies to retain deferred but motivated donors. Materials and Methods: Conducted as a prospective observational study, all whole blood donors underwent comprehensive history and physical examination. Donors were either accepted or deferred following standard blood donor guidelines. Data from 345 deferred individuals were subsequently analyzed. Results: The deferral ratio between males and females was 3.93:1, with 275 (79.71%) males and 70 (20.21%) females deferred. The highest percentage of temporary deferrals was noted in the 21–30 years age group (37.10%), while the highest rate of permanent deferrals was observed in the 41–50 years age group (6.09%). Of the total deferrals, 302 (87.54%) were temporary, while 43 (12.46%) were permanent. Low hemoglobin was the most common cause (43.13% of deferrals). Conclusion: Low hemoglobin was the primary reason for deferrals. Most deferrals were temporary and could be managed or reversed. Encouraging these deferred individuals to return to the donor pool can enhance the availability of this life-saving resource. Additionally, analyzing deferral data provides insights that can expand blood donation efforts, save lives, and increase public awareness.

Background: Dry eye syndrome, a clinical condition marked by insufficient tear secretion or increased tear evaporation, leads to ocular irritation and discomfort. This condition stems from changes in the tear film layer. Post-cataract surgery, numerous patients report sensations of foreign bodies, redness, and dry eye symptoms. The current study aimed to evaluate the frequency of dry eye development following manual small incision cataract surgery (SICS) and phacoemulsification at a teaching hospital. Materials and Methods: This single-center, prospective observational study included patients aged 45 to 75 years scheduled for elective cataract procedures. Schirmer’s test and tear break-up time (TBUT) were used to assess and document dry eye symptoms.  A total of 200 eyes from patients were analyzed. Results: Majority patients were aged 56-65 years and a slight predominance of female participants. The average age of participants was 68.89 ± 6.35 years. A greater proportion of patients underwent SICS (61.50%) compared to phacoemulsification (38.50%). Differences in dry eye incidence between the 1-week and 3-month follow-up, TBUT, and Schirmer’s test values were statistically significant (p < 0.5). Comparing SICS to phacoemulsification at 1 month, dry eye incidence rates, TBUT, and Schirmer’s test measurements also showed significant differences (p < 0.05). Conclusion: Cataract surgeries may induce or exacerbate dry eye symptoms, influencing related test parameters for up to three months post-surgery, with a more pronounced effect observed in phacoemulsification compared to SICS.

Background: Bimalleolar ankle fractures are common orthopaedic injuries that often require surgical intervention due to their unstable nature. These bimalleolar fractures significantly impair mobility and are associated with long-term complications such as chronic pain and arthritis if not treated properly. Open Reduction and Internal Fixation (ORIF) is the preferred surgical treatment for achieving anatomical reduction and functional recovery. Objective: This study aims to evaluate the functional outcomes of bimalleolar fractures treated with ORIF, using the Baird-Jackson scoring system to assess pain, range of motion, and overall joint stability. The secondary objective is to assess complications arising post-surgery. Results: Among 25 patients, the majority (68%) were male, with an average age of 41-60 years. Road traffic accidents were the most common cause (84%). Post-operative complications included 3 cases of ankle stiffness and 1 case of superficial infection. Functional outcomes were positive, with 8 patients achieving excellent results and 12 reporting good outcomes. The mean pre-operative VAS score was 7.56, which improved to 6.6 post-surgery. Conclusions: ORIF is an effective treatment for bimalleolar fractures, providing favourable functional outcomes, reduced pain, and minimal complications. Proper anatomical reduction and surgical technique are essential for optimal recovery and preventing long-term complications such as joint instability and arthritis.

Background: To assess the morbidity and post-operative consequences of various surgical repair techniques. Methods: This prospective observational surgical study comprised 50 cases of paraumbilical and umbilical hernias. It was completed by taking a patient’s medical history, doing a clinical examination, and conducting the necessary investigations for Operations were carried out. The two surgical techniques used to treat the patients were Mayo’s repair and tension-free repair utilizing prolene mesh (mesh repair). Findings: Females were more likely to have paraumbilical and umbilical hernias. The age ranges of 25-35 and 45–55 years had the highest incidence. The most frequent complaint was abdominal swelling, which was followed by pain. In both procedures, post-operative problems such as seroma and wound infection were observed. Mayo’s anatomical repair and tension clinic performed surgery on these hernias.

Introduction & Aim: Intertrochanteric fractures are very common in geriatric population. We present our experience in surgical management of intertrochanteric fractures with cephalomedullary nail with helical blade in the management at Maharaja Agrasen Medical College, Agroha. Methods: The study was conducted from October 2022 to December 2023 and included 35 patients above 60 years of age. Clinical and radiological evaluation was done at 6 weeks, 3 months and 6 months. Functional outcome was assessed according to Harris Hip Scoring Scale. Results: The average age of patients in our study was 69.57 years with male preponderance. Slip and fall was the mode of injury in 85.7% cases. The average duration of surgery was 47.9 minutes. The average time of union was 15.94 weeks. There was no case of delayed union, non-union and deep infection. The average Harris Hip Score was 84.42. Conclusion: Cephalomedullary nail with helical blade is a good implant option for the operative management of intertrochanteric fractures, especially in the elderly osteoporotic individuals.

Background: Dexmedetomidine, a selective alpha-2 adrenoceptor agonist, is increasingly used in anesthesia for its sedative and analgesic effects without respiratory depression. In morbidly obese patients, respiratory management is challenging due to reduced lung compliance and oxygenation. This study evaluates the effect of two different doses of dexmedetomidine infusion on oxygenation and lung mechanics in morbidly obese patients undergoing surgery. Materials and Methods: A prospective study was conducted on 60 morbidly obese patients (BMI ≥ 40 kg/m²) scheduled for elective surgery under general anesthesia. Patients were randomized into two groups: Group A received a dexmedetomidine infusion of 0.4 µg/kg/hr, and Group B received 0.7 µg/kg/hr after an initial loading dose of 1 µg/kg over 10 minutes. Oxygenation parameters (PaO₂, SpO₂) and lung mechanics (peak inspiratory pressure, compliance) were recorded at baseline, after induction, and hourly during surgery. Statistical analysis was performed using a two-way ANOVA, with significance set at p < 0.05. Results: Group B showed a statistically significant improvement in PaO₂ levels compared to Group A, with mean values of 95 ± 10 mmHg versus 88 ± 12 mmHg (p = 0.03). Peak inspiratory pressure was lower in Group B (22 ± 3 cm H₂O) than in Group A (25 ± 4 cm H₂O), indicating better lung compliance (p = 0.02). No significant difference in heart rate or mean arterial pressure was observed between the two groups. Conclusion: A higher dose of dexmedetomidine infusion (0.7 µg/kg/hr) improved oxygenation and lung mechanics in morbidly obese patients without adverse cardiovascular effects. This dose may offer a safer anesthetic regimen for this patient population, enhancing respiratory outcomes during surgery.

Background: Diabetic macular oedema is the most common cause of blindness among diabetic retinopathy patients. Early recognition and treatment of the patient with diabetic macular oedema help prevent the development of complications and improve the patient’s quality of life. Aim: To assess the treatment of the anti-VEGF among patients with diabetic macular oedema associated with the development of renal damage. Methods: This single-centred retrospective study was conducted in a tertiary care centre between May 2022 to May 2024. All the patients with diabetic macular oedema were included in the study. All the patients who received anti-VEGF therapy were grouped in one group, and those who didn’t were taken as controls. And all the renal parameters were evaluated at the baseline and one month after the completion of the therapy. Results: A total of 208 patients with diabetic macular oedema participated in the study. 104 patients who received anti-VEGF therapy were grouped in one group, and those who didn’t receive it were grouped in another group. The study showed a significant increase in the HbA1c values (p<0.001), eGFR (p<0.001), serum creatinine (p<0.001), serum urea (p<0.001) and systemic blood pressure level (p<0.001) between the baseline and after the treatment. Conclusion: The study showed that diabetic patients with diabetic macular oedema could be treated with anti-VEGF treatment. Various parameters such as renal function, blood pressure, and HbA1C should be closely monitored during the treatment.

Background: Recent studies have shown that ankle brachial index (ABI) can be falsely normal even in presence of peripheral artery disease (PAD) of lower limbs in diabetes mellitus (DM) patients, especially in elderly and those with chronic kidney disease. In such patients, toe brachial index (TBI) seems to be a better screening test for detecting PAD. Objective: To compare the sensitivity between ABI and TBI for detecting PAD in type 2 DM patients; and to study the correlation between glycaemic control and severity of PAD. Methods: A cross-sectional study was performed in 75 type 2 DM patients with PAD of bilateral lower limbs, which was confirmed by CT angiography of lower limbs (a total 150 limbs were evaluated). They underwent Doppler for measurement of ABI and TBI. CIMT was measured using high-resolution B-mode ultrasonography. Results: There were 57 males and 18 females, with mean age of 65.72 years and mean duration of T2DM of 15.39 years. With a cut-off of 0.9, ABI had sensitivity of 68.66% and with cut-off of 0.7, TBI had sensitivity of 97.33% for detecting PAD, respectively. Age, smoking, hypertension and HbA1c correlated positively with severity of both ABI and TBI whereas serum creatinine correlated with only ABI severity. Age, hypertension, poor glycaemic control and serum creatinine positively correlated with severity of CIMT. Severity of CIMT, in turn, had a significant correlation with severity of both ABI and TBI. In a subgroup analysis, increasing age, longer duration of DM, higher waist circumference, higher serum creatinine and high LDL-C levels were associated with ABI >0.9; whereas poor glycaemic control (higher HbA1c and FBS) and smoking were associated with ABI <0.9; and gender and hypertension were not significantly different in groups with either ABI <0.9 or >0.9. ABI >0.9 was associated with slightly increased CIMT compared with ABI <0.9. Conclusion: In T2DM patients, TBI is more sensitive than ABI for detecting PAD, especially in elderly, those with longer duration of DM and impaired renal function.

Introduction: Cholelithiasis is a common surgical diagnosis and Laparoscopic cholecystectomy is a common surgical procedure. One of the postoperative complications of Laparoscopic cholecystectomy is retained bile duct stone due to failure of diagnosing these preoperatively. This leads to increased morbidity and mortality in postcholecystectomy patients. USG abdomen and liver function tests are routinely done preoperatively in cholelithiasis patients. These have poor sensitivity and specificity for diagnosing CBD stones. MRCP is a highly sensitive and specific investigation for CBD stone detection. Aim To evaluate the role of routine MRCP in all patients of cholelithiasis and its correlation with liver function test (S. Bilirubin, SGOT, SGPT and S. Alkaline phosphatase) and ultrasound abdomen for diagnosing CBD stones. Material and Methods: The present study was a longitudinal study done on 100 patients diagnosed to have cholelithiasis on an ultrasound abdomen with no CBD stone. All the patients were investigated with liver function tests and MRCP preoperatively for detection of missed CBD stones. Data were analyzed with SPSS software and a chi-square test was used and a p-value <0.05 was considered a level of significance. Results: The mean age of patients in this study was 52.47 years with a standard deviation of ± 41. 59 patients were female and 41 were male. Among all the 100 patients, who reported normal CBD on ultrasound abdomen, in 20 patients CBD stone was detected on MRCP. Raised liver enzymes were also related to CBD stone. Raised S. bilirubin has a PPV-66.7%, NPV – 82.97%, sensitivity-20% and specificity of 97.5%. Raised SGOT/SGPT had a PPV of 55%, NPV -88.75%, sensitivity- 55% and specificity of 88.75%. Raised S. Alkaline phosphatase has a PPV- 76%, NOV – 89.15%, sensitivity-67.85% and specificity of 92.5%. Conclusion: Routine MRCP should be done in all patients of cholelithiasis preoperatively to avoid the complication of retained common bile duct stones.

Phylloides tumor can be classified into benign, borderline and malignant on the basis of gross and microscopic appearance. However, situations arise wherein it is difficult to make distinction between the benign, borderline and malignant phylloides tumor on the basis of histology alone, hence, in these challenging scenarios immunohistochemistry (IHC) can be helpful in distinguishing the phylloides tumor and can be helpful in predicting the clinical behavior. Present study was done on 30 cases diagnosed as phylloides tumors in a tertiary care hospital and Immunohistochemistry for CD-10 was performed for further evaluation. We found significant association of CD-10 expression and histological grade of tumor. CD-10 can be used as immunohistochemical marker for diagnosis and prognosis of phylloides tumor.

Background: The success of laparoscopic hernia repair relies on effective mesh fixation methods. Objectives: To determine the efficacy and safety of barbed sutures versus standard fixation techniques using tackers in laparoscopic ventral and incisional hernia repair. Methods: This was a single centre, hospital based, prospective, single blinded, randomized controlled trial conducted in the Department of General Surgery of a tertiary teaching healthcare facility in South India between January 2023 and June 2024. Results: This study involved 80 patients undergoing elective laparoscopic hernia repair, with 40 patients in Group A (tackers group) and 40 in Group B (suture group). Both groups were comparable in terms of age, gender distribution, BMI, comorbidities, hernia type, defect location, and defect size, with no significant differences observed. The mean mesh fixation time was significantly (p<0.05) shorter in Group A (23.4 minutes) compared to Group B (44.2 minutes), and the total operative time was also shorter in Group A (62.1 minutes) than in Group B (83.5 minutes). Surgical site infections occurred more frequently in Group A (12.5%) than in Group B (2.5%), though this difference was not statistically significant. Group A also had a significantly higher need for rescue analgesia (72.5% vs. 40.0%). While recurrence was noted in 7.5% of Group A, no recurrences were observed in Group B. Postoperative pain, measured using the Visual Analogue Scale (VAS), was consistently lower in Group B from postoperative day 1 onwards, with significant differences observed at all time points, including at 1-month, 3-month, and 6-month follow-ups (p<0.05). Conclusion: These results suggest that barbed sutures may offer a significant advantage in reducing postoperative pain compared to tackers.

A 39-year-old male with a history of coarctation of the aorta, treated with patch angioplasty in 2002, presented with bilateral inguinal swelling and pain, worsening with exertion. Physical examination revealed reducible, doughy swellings in both inguinal regions, each with a positive cough impulse. Blood pressure readings showed a marked difference between the upper and lower limbs, with elevated pressure in the arms. Cardiovascular examination was unremarkable aside from normal heart sounds. His past surgical history included two thoracotomies for haemothorax and wound infection. Laboratory findings were normal. Imaging confirmed bilateral inguinal hernias containing bowel and omentum, and echocardiography showed severe restenosis of the aorta, with associated left ventricular hypertrophy and diastolic dysfunction. The patient was classified as ASA IV, indicating high surgical risk due to his complex cardiac condition. For anaesthesia, a graded epidural block was selected, and close intraoperative monitoring included arterial line placement and continuous blood pressure monitoring. The epidural was carefully administered in increments to achieve a T6 level sensory blockade. Hemodynamic stability was maintained throughout the procedure with close monitoring of vital signs. Sedation was provided with midazolam and fentanyl, ensuring patient comfort. Postoperative plans included ICU monitoring and readiness for inotropic support if required. The patient’s stable intraoperative course demonstrated effective anaesthetic management, aligning with the high-risk nature of his cardiovascular profile. This case underscores the importance of individualized anaesthetic planning and vigilant perioperative monitoring in patients with complex cardiovascular comorbidities to ensure a safe and stable surgical outcome.

Background: Pain management is crucial in healthcare. Neuraxial anaesthesia, particularly intrathecal administration of local anaesthetics, is effective for intraoperative and postoperative pain relief. Both clonidine and dexmedetomidine, alpha-2 adrenergic agonists, show promise in prolonging sensory and motor blockade and reducing supplemental analgesia. The aim of this study is to provide evidence to guide clinical practice and improve anaesthesia for surgeries below the umbilicus. Methods: 120 patients belonging to ASA I and II, posted for infraumbilical surgeries were divided into 3 groups of 40 each and received intrathecal drug as follows: Group-B: 0.5% Bupivacaine 15mg (3ml) + 0.5 ml Normal saline (NS) (Total volume 3.5ml). Group-C: 0.5% Bupivacaine 15mg (3ml) + 50 µg Clonidine (0.5ml) (150 µg [1ml] diluted to 1.5ml with NS and 0.5 ml was given). Group-D: 0.5% Bupivacaine 15mg (3ml) + 5 µg Dexmedetomidine (0.5ml) (50 µg [0.5ml] diluted to 5ml with NS and 0.5ml was given) Total Volume 3.5ml). Onset and duration of sensory and motor block, hemodynamic parameters, duration of analgesia and complications (if any) were observed. Results: The time of onset of sensory and motor block was fastest in group C followed by group D and then group B. The mean duration of sensory, motor blockade and duration of analgesia was longest in group D followed by group C and group B. (p < 0.05). Conclusions: The present study showed that supplementation of Bupivacaine in spinal block with low dose Dexmedetomidine produced a statistically significant longer duration of sensory and motor block and prolonged duration of analgesia when compared to Clonidine.

Background, Aims & Objectives: Intrathecal local anesthetic alone is associated with relatively short duration of action and early analgesic intervention is needed in post-operative period. The addition of adjuvants provides a dose sparing effect of local anesthetics and accelerates the onset of sensory blockade as well as prolongs the duration of spinal block for long procedures and also provides postoperative pain relief. The aim of this study was to study the adjuvant effect of magnesium sulfate on ropivacaine and dexmedetomidine combination when used intrathecally with 0.75% isobaric Ropivacaine in lower limb surgeries. Block characteristics (onset, level and duration of sensory block and onset, level and duration of motor block), postoperative analgesia, hemodynamic parameters and adverse effects were noted. Material & Methods: In this observational study, 100 adult patients (18-65 years) ASA-PS I & II undergoing total knee replacement surgeries under spinal anesthesia were included and randomized into two groups of 50 patients each. In Group D patients received 2ml of 0.75% isobaric Ropivacaine plus 10 micrograms Dexmedetomidine (in 1.0 ml) Total volume= 3ml. In Group DM patients received 2ml of 0.75 % isobaric Ropivacaine and 10 mcg dexmedetomidine (in 0.5ml) and 50 mg of preservative-free magnesium sulfate 50% diluted in 0.5ml. Total volume=3ml. The sensory block was assessed by loss of temperature discrimination to ice packs and pain sensation to needle-prick. The peak sensory level was noted. Motor blockade was assessed by Modified Bromage Scale. Adverse effects -hypotension (>30% decrease in SBP or SBP< 90 mmHg), bradycardia (heart rate <50bpm), nausea, vomiting, pruritus were noted. Results: It was observed that the mean time to onset of sensory block was 4.45+0.38 minutes and mean time to onset of motor block was 6.12+0.5 minutes in Group DM compared to 2.15+0.63 minutes and 2.72+0.46 minutes in Group D respectively. Duration of sensory and motor blockade observed was 297.2+30.9 minutes and 202.3+0.6 minutes in Group DM and 191.6+0.71 minutes and 152.5+4.77 minutes in Group D respectively. Duration of postoperative analgesia was 441.2+0.83 minutes in Group DM and 302.47+0.21 minutes in Group D. Conclusions: Though addition of Magnesium sulfate to Ropivacaine and Dexmedetomidine combination delayed the onset of subarachnoid blockade but it prolonged the duration of sensory and motor blockade and the duration of postoperative analgesia significantly.

Background: Currently, day care procedures are more frequently performed under procedural anaesthesia. It helps patient to tolerate unpleasant or painful procedures, avoiding intraoperative awareness. Compared to general anaesthesia, PSA may be linked with an even higher incidence of major sedation-related adverse events. Frequent monitoring is advised because sedation-induced depression of the central nervous system may compromise respiratory function. Even with low breathing frequencies, oxygen saturation is commonly maintained, and respiratory depression, hypoventilation, and apnoeic episodes are usually missed by pulse oximetry. With the aid of non-invasive EtCO2 monitoring, CO2 retention and hypoventilation can be identified early and appropriate action can be taken. However, in many places, EtCO2 monitoring is not a standard procedure during PS [2,3]. Hence, we have focused to evaluate the effect of EtCO2 on patients’ safety in terms of CO2 retention and apnoeic events in propofol and fentanyl-based sedation for short surgical procedures as compared to standard monitoring. Objective: To evaluate whether EtCO2 monitoring decreases the incidences of CO2 retention and apnoeic events in propofol and fentanyl-based sedation in short surgical procedures as compared to standard monitoring. Methods: 80 patients between 18-65 years age of either gender with ASA status I and II posted electively for short surgical procedure and receiving total intravenous anaesthesia using propofol and fentanyl were selected. The patients were randomly divided into two groups. Group A: Patients monitored with end tidal CO2 in addition to standard monitoring. Group B: Patients monitored with standard monitoring. All patients were administered drugs according to the standard protocol. Baseline vitals were noted and ABG was done. Thereafter vitals were recorded at 5 min interval till 30 min and ABG at 15 min and end of the procedure. Results: CO2 retention occurred significantly less often in the EtCO2 monitoring group. In the standard monitoring group, the mean PaCO2 was more than 45mmHg and the pH was less than 7.35 at 15 min after induction of anaesthesia and at the end of the procedure. Both values were within the normal range in the EtCO2 monitoring group. The number of airway interventions performed was significantly higher in the EtCO2 monitoring group. Apnoea occurred less often in the EtCO2 monitoring group and recovery time was shorter. Conclusion: The addition of EtCO2 monitoring to standard monitoring during propofol-based sedation can improve patient safety by decreasing the incidence of CO2 retention, and therefore the risk of hypoxaemia through early recognition of apnoea, and can also shorten recovery time.

Background: The regulation of In-vitro fertilization (IVF) clinics in the United Kingdom (UK) falls under the purview of The Human Fertilization and Embryology Authority (HFEA), an organization tasked with ensuring their adherence to both their code of conduct and the HFE Act of 2008 (HFEA, 2022; HFEA, 2021). To increase patient safety, each clinic is accountable for identifying errors, examining these incidents, and re-evaluating their procedures (HFEA, 2021). Incident reporting systems can be greatly improved by recognizing and resolving human factors. Objective: To discover, define, and co-develop the management of critical incidents in IVF clinics from a human factors approach. Methods: A preliminary study was conducted at Ninewells Assisted Conception Unit (ACU) to provide insights for the development of a survey comprised of open-ended and closed-ended questions. This online survey was sent out to healthcare personnel who are working in UK-registered IVF clinics and received responses from 48 healthcare personnel working in HFEA-registered IVF clinics. The acquired data was subjected to mixed deductive and inductive analysis and descriptive statistics. An interview was conducted one-on-one with ACU staff (6 participants). Document analysis was carried out respectively. Results: IVF clinics are one of the most complex, multi-layered socio-technical systems in the health care sector, requiring a strategy that considers the system as a whole and understands the delicate balance of its functioning configuration. Incident management forms the foundation upon which patient safety can be ensured and progress in this field can be fostered. A key component of changing IVF clinics is incorporating Human Factors (HF) science for the benefit of society. Conclusion: HFEA needs to introduce training on Human Factor (HF), a purpose-built reporting system, and encourage the whole team in participation of incident management competencies.

Background: USG hydration status assessment by Inferior venacava collapsibility index (IVCCI) & caval aorta index detects the early phase of hypovolemia caused by spinal anaesthesia. Objectives: To evaluate IVCCI & Caval Aorta index guided preoperative volume optimization in reducing the incidence of spinal induced hypotension (SIH), requirement of vasopressors, total fluid requirement & to correlate the utility of these indices in predicting SIH. Design: Randomized controlled trial. Setting: Operating room Single centric study during the period December 2020 to May 2022. Patients: Overall, 120 patients of 18-65 years, ASA I or II, scheduled for infraumbilical surgeries were randomly divided into Group A, Group B with IVCCI guided and caval aorta index guided volume correction respectively. Patients’ refusal for consent, need for IBP, Mean arterial pressure (MAP<70mmHg), contraindications for SAB and BMI>30kgm-² were excluded. Interventions: USG guided hydration status optimization in preoperative period incorporating IVCCI & caval aorta index measurements before the commencement of Spinal anesthesia. Main outcome measures: The primary aim of this study was to compare the incidence of SIH between the groups. Results: Statistical Analysis was done in 158 patients with SPSS version19. After fluid correction Group A showed higher SIH 55.17% (32/58) than Group B 37.93% (22/58) P<0.0001 thus suggesting a significant reduction of hypotension in Group B (62%) than Group A (44.82%) P<0.0001. Dose of Vasopressors given intraoperatively were higher in Group A 34.48% (20/58) than Group B 17.24% (10/58) P<0.001. The total fluids given were approximately similar in both the groups (P>0.005) ROC analysis showed that Caval-Aorta index was a better predictor of SIH with 94.4% sensitivity,96.9% specificity & 74% accuracy with area under the curve (AUC) 0.956 when compared to IVCCI which showed 94.4% sensitivity, 65.6% specificity and 60% accuracy in predicting SIH with AUC of 0.793. Conclusion: Prespinal USG guided Caval aorta index directed fluid optimization reduces the incidence of SIH and vasopressor requirements and is found to be a superior predictor of SIH than IVC collapsibility index.

Trial registration: Clinical trials.gov (CTRI/2020/10/028612).

Aims and Objectives: The metabolic syndrome consists of a constellation of metabolic abnormalities that confer increased risk of cardiovascular disease (CVD) and diabetes mellitus. This study was to look for prevalence of thyroid dysfunction, which is known to increase the morbidity when it is associated with metabolic syndrome. Materials and Methods: An Unaccented cross sectional study was done over 18 months and patients who were over 18 years of age and those who satisfied the criteria for Metabolic Syndrome (as per NTEP ATP III criteria) were included. Patient demographics, blood investigations to include thyroid profile, lipid profile and vital data were included. Data were statistically analysed and presented. Results: In this study of 84 patients, thyroid dysfunction (Hypothyroidism/ Subclinical hypothyroid state) was prevalent in 17.9% (15/84) of metabolic syndrome patients which was statistically significant (P <0.001). Conclusion: Sublinical and to a lesser extent overt hypothyroidism is seen in patients with metabolic syndrome and early recognition and appropriate treatment is indicated.

Trial registration: Clinical trials.gov (CTRI/2020/10/028612).

Background & Methods: The aim of the study is to study the efficacy of silicone gel for the treatment of hypertrophic scars & scars. A detailed history and clinical examination will be done before enrolling patients in the study. Evaluation of results for all the 50 patients will be done on basis of visual inspection and by comparing serial photography. Results: In Group A 40.6% patients in comparison to 13.3% patients of Group B shows reduction in the scar size upto less than 2 cm square. Most of the patients in Group A with scar size more than 2 cm square shows reduction in there scar size while patients with increased scar size in Group B do not show any significant size reduction. Conclusion: Most of the patients were in second and third decade of life. There was no patient below ten years and above forty years of age. Patients in this age group (11-40 yrs) are usually cosmoconscious and used to attend plastic OPD for the treatment of scars. The shortest application period of Silicon in gel was three months and the longest, twelve months. Silicon Gel are having soothing and hydrating effects on scars thereby providing relief from itching. Hence a modern perspective based on points given above is more in line with actual overall cost benefit to the patients with the use of Silicon Gel for the treatment of scars.

Background: Organophosphorus compounds have been widely used for a few decades in agriculture for crop protection and pest control. In India Organophosphorus poisoning is the most common. The objective of our study was to measure the LDH Level in acute organophosphorus poisoning. Organophosphorus poisoning (OPP) is a significant public health concern. Lactate dehydrogenase (LDH) is a potential biomarker for tissue damage. Methods: This study was conducted among minimum 100 patients acute organophosphorus poisoning admitted in Casualty ward, MICU and attending medical ward of JNKTMCH, Madhepura. Study duration is Two years. Serum lactate dehydrogenase estimation by spectrophotometric analysis using Beckman Coalter AU 680. Results: These were significantly higher among deaths on day 1 and 3(810±372.99 and 1027.09±458.26, respectively) in comparison to survivors on day 1 and 3 (538.18±300.42 and 365.19±175.49, respectively). Significant difference was found between mean values of different levels of severity of LDH on day 1 and 3. Conclusion: In conclusion, this study found that Serum LDH can be used as biomarker in diagnosis or stratifying severity of acute OP poisoning, as it is cheap and easily available, especially in developing countries. Serial measurements of serum LDH levels in acute OP poisoning can predict the prognosis.

Background: Snakebite is a common medical emergency and an occupational hazard commonly seen in the rural as well as suburban population. In this study to determine the utility of Serum CRP and LDH as Markers of hemotoxicity in snake bite victims. Materials and Methods: This hospital based prospective study was conducted a total 60 admitted patients in the department of general medicine at JNKTMCH, Madhepura. Study duration is One year. The patients were included were with alleged history of snake bite & history of unknown bite but with symptoms and signs compatible with snake bite envenomation otherwise patients were excluded. Results: Most frequent site of snakebite was the lower limbs constituting 85.0% of bites. Majority (41.7%) of the patients presented with features compatible with moderate envenomation. Serum CRP showed a significant elevation in their levels in the severe as compared to the mild envenomed group. Conclusion: Snakebite commonly affects people in the younger age group & hemotoxic envenomation is most common manifestation of envenomation observed.

Background: There are two mechanisms proposed for the greater urinary albumin excretion (UAE) in patients with essential hypertension: increased glomerular hydrostatic pressure or increased selectivity of the glomerular basement membrane. In hemodynamic mechanism regulation of the glomerular hydrostatic pressure is regulated by the relative vasoconstriction vasodilatation of the afferent and efferent glomerular arterioles. Hypertension is one of the major public health problems in the world. In India the prevalence of hypertension is about 25% in urban and 10-15% in rural, adult population as compared to west which is 30%. Essential hypertension is responsible for producing clinical proteinuria and a significant reduction in renal function in 5-15% of patients. Several studies have shown that proteinuria and microalbuminuria are independent predictors of cardiovascular morbidity and mortality in patients with hypertension. Some data suggest that reduction of albumin excretion rate reduces the risk of adverse renal and cardiovascular events (CVEs). Material and Methods: Patients, who had high blood pressure based on JNC 8 (Joint National Commission 8) criteria during three subsequent visits to the outpatient clinic and a creatinine clearance greater than 80 ml/min/1.73 m², were included in the study. A total of 546 essential hypertensive patients whose BP was> 140/90 mm Hg in nondiabetics and BP >130/85 mm Hg in diabetic patients were included in the study. Blood pressure monitoring was done according to the WHO guidelines. Demographic data, age, sex, weight, associated cardiovascular disease, albuminuria, and clinical parameters were all recorded. All routine biochemical tests and microalbuminuria tests were performed by the laboratory. Blood and urine creatinine were measured using an autoanalyzer. Conclusion: Prevalence of microalbuminuria in hypertensive patients warns that screening for microalbuminuria is essential for intervention and prevention of complications and renal diseases. Also it is necessary to screen the patients for early nephropathy to halt the disease progression.

Background and Objectives: Incidence and Prevalence assessment as epidemiologic measures for evaluating the burden of dengue plays a vital role in making management strategies and monitoring disease control progress. Hence, this is an important evaluating factor for evaluating the actual burden. The present trial was aimed at assessing gender and age-specific dengue incidence in the Sasaram Rohtas, cohort with the help of associated factors and prevalence in dengue infection. Methods: The present clinical trial was carried out in 600 subjects of 0-70 years of age. Epidemiologic and laboratory findings were collected from the hospital and the collected data were subjected to statistical evaluation and the results were formulated. Results: There were more females in the present study compared to males. The highest positivity rate in Dengue was seen in the age group of 0 to 9 years. Among 243 adult males, 70 (28.80%) and among 357 adult females, 170 (24.08%) were found to be suffering from dengue infection. Concerning dengue positivity, there were 156 dengue positive cases and 444 dengue negative cases. In age group of 0-2, 2-9, 10-19, 20-29, 30-39, 40-49, 50-59 and 60 years above, there were 14.10% (n=22), 19.87% (n=310, 16.66% (n=26), 14.10% (n=22), 10.25% (n=16), 8.97% (n=14), 10.89% (n=17), and 5.12% (n=8 ) subjects respectively. This shows maximum cases in 0-19 years of age and decreases incidence with increasing age. Conclusion: Within its limitations, the present study concludes that dengue incidence decrease with increasing age. Such studies assessing seroprevalence should be conducted on regular basis to assess a clear picture of the dengue burden in Rohtas, Bihar.

Background: To analyse the thyroid profile, hs-CRP and lipid profile in newly detected hypothyroid adults in comparison to controls and also to compare the above parameters in subclinical and clinical hypothyroid cases. Material and Methods: The study was a cross sectional study which was carried JNKTMCH, Madhepura Study duration is Two years. Total 240 patients were divided into 2 groups. Group-1 for newly detected hypothyroid adults and Group 2 as Controls. Blood samples were collected with full aseptic precautions after obtaining informed consent. Clot activator that contains vacuum evacuated tubes for analysis of serum TSH, FT3, FT4, TC, HDL-c, LDL-c, TG, hs-CRP. Then after collection, serum samples were stored at -20⁰ until analyzed. Anthropometric measurements for BMI, height (cm) and body weight (kg) were measured. Results: The mean age of cases and controls in our study was found to be 36.12±12.21years and 35.87±11.06years respectively (p = 0.81). BMI values in the study were higher in cases (27.24 ± 4.65kg/m2) compared to controls (25.17 ± 4.37kg/m2) and was statistically significant (P = 0.03). In the study, the mean TSH levels (15.27 ± 9.2µIU/ml) of cases were high compared to controls (3.1 ± 0.88µIU/ml) and were statistically significant (p<0.001). The mean serum hs-CRP levels in both the study groups was within the reference range, but it was high and statistically significant in cases than in control (p = 0.004). The total cholesterol level in cases (182.29 ± 39.75mg/dl) and control (184.27±28.37mg/dl) were within the reference range and there was no statistical significance (p = 0.82). Conclusion: we concluded that the hypertriglyceridemia and at risk hs-CRP levels though seen in hypothyroid cases were more prominent in CH cases than SCH. Dyslipidemia and inflammatory markers were found to be increased in the cases that helped in prediction and evaluation of patients at risk of cardiovascular disease.

Background: The aim of the study is to find relationship between Colonic Mucosal changes in patients of Liver Cirrhosis with Portal Hypertension conducted at JNKTMCH, Madhepura. Result: The commonest symptom in patients was abdominal distension 30 (100%), next common was jaundice 20 (66.7%), malena 17 (56.7%), hemetemesis 10(33.3%), hematochezia 10(33.3%), and pruritis 2(6.6%) was noted. It is evident from table no.13 that out of 30 patients, serum prothrombin time was prolonged in 30 (100%) patients, serum albumin was decreased in 20 (66.7%) patients, platelet count was decreased in 16 (53.3%), serum bilirubin was raised in 14 (46.7%) patients, SGOT/SGPT was raised in 17 (56.7%) patients. Conclusion: Our study states that most of the changes which we found on colonoscopic studies were similar to other studies. The only finding which we got in excess in comparison to other studies was colitis like abnormality which was 73.3% which may be probably due to chronic intestinal infections which occur in our country.

Background and Objectives: The ‘tombstoning’ electrocardiographic (ECG) pattern is a particular kind of convex ST-segment change, as observed in some patients during the early stages of acute myocardial infarction (AMI). It has been suggested that this specific pattern of ECG changes following AMI predicts a poorer outcome in these patients. The objective is to study the correlation ‘tombstoning’ electrocardiographic pattern in patients with first anterior wall acute myocardial infarction with risk factors and in hospital complications Methods: This study investigated 73 patients with AMI whose ECGs were taken within 12 hours of onset of symptoms. The study population was divided into two groups based on the admission ECGs, ‘tombstoning’ vs. ‘non tombstoning’, and their clinical characteristics were compared. Results: In this study population of 73 patients, 27 (36.9%) had a definite ‘tombstoning’ pattern on their admission ECG. Compared with the ‘non tombstoning’ group, the significant differences in the ‘tombstoning’ group are as follows: infarction size is larger as evidenced by higher CK-MB levels (179.67 vs.90.57 IU); left ventricular ejection fraction is lower (40.56% vs. 47.86 %); periinfarct angina is lower (5 vs. 18.5 %), and in-hospital complications are higher. Conclusion: This study shows that ‘tombstoning’ electrocardiographic patterns was associated with lower ejection fraction, left ventricular dysfunction and more in hospital complications. Pattern of the ST elevation has been shown to be a strong prediction factor for LV function in acute anterior MI.

Introduction: Femoral fractures result in intense discomfort during movement when setting for anaesthetic procedures. The fascia iliaca compartment nerve block (FICB) is a frequently utilized pain management method that efficiently delivers analgesia. Dexamethasone and clonidine serve as effective adjuvants to local anesthetics, providing significant analgesic benefits with few side effects. This study aimed to evaluate the effectiveness of bupivacaine in conjunction with clonidine, bupivacaine with dexamethasone, and bupivacaine alone for fascia iliaca compartment block in femoral fracture cases. Materials and Methods: Ninety-six cases undergoing proximal femoral operations were randomly allocated into three study groups (n=32 each). Group B was administered 0.25% bupivacaine combined with 2 ml of normal saline, group BC received 0.25% bupivacaine with 50 mcg of clonidine, and group BD was given 0.25% bupivacaine with 8 mg of dexamethasone. Haemodynamic parameters, VAS score, supplementary analgesic requirements, and analgesia duration were evaluated. Results: The mean differences in hemodynamic parameters were statistically significant at 15, 30, 45, 60, and 90 minutes (p<0.05). The needed analgesic dosages were 4.99 in group B, 3.05 in group BC, and 2.93 in group BD. The cohort administered bupivacaine in conjunction with dexamethasone (13.99 hours) demonstrated a prolonged analgesic effect, succeeded by Group BC (12.67 hours) and Group B (6.23 hours). The mean VAS score exhibited statistical significance between the study groups (p<0.05). Conclusion: The combination of 0.25% bupivacaine with 8mg Dexamethasone provided better analgesic duration and required less rescue analgesia on the first postoperative day in patients having femoral operations under FICB compared to 0.25% bupivacaine with 50mcg clonidine.

Introduction: Medical education in India is going through reforms and advancement for better outcomes and improved health care of community. This transition period is an arduous task for all the stakeholders and can impel mental health issues among medical students. Objective: To compare the level of depression, anxiety, and stress among medical students from Traditional curriculum and CBME. Material and Methods: In our study, a total of 700 students participated (449 were of CBME curriculum; 251 of traditional curriculum) in a medical college of Rajasthan. We used a self-administered questionnaire, the DASS 21 scale to assess anxiety, stress and depression among anxiety medical students. The statistical package for the social science (SPSS) version 21.0 of windows was used for data analysis. Results: Almost half of (Traditional: – 53.4%; CBME -52.8%) the participants suffered from some level of depression. However severe and extremely severe depressive symptoms were found to be significantly higher among CBME students (Traditional-7.2%,5.6%,CBME-13.4%,8.7% respectively). Similarly, the majority (Traditional -70.5%; CBME- 65.7%) suffered from some level of anxiety, but extremely severe anxiety was also significantly higher among CBME students (Traditional -15.9%; CBME – 27.8%). About 43.8% of traditional curriculum and 50.1% of CBME curriculum suffered from some level of stress. However, severe and extremely severe stress symptoms were significantly higher among CBME students (Traditional -8.8%,4%; CBME -13.6%,8%). Conclusion: About half of medical students were detected to have symptoms suggestive of depression, stress  and the majority suffering from anxiety issues.  Severe forms of depression, and stress symptoms were found to be higher in CBME students than traditional curriculum students and the difference was found to be significant ( p-value <0.05).

Introduction: Fine needle aspiration and cytology (FNAC) has been proven to be simple, barely intrusive, secure, and economical in the initial diagnosis of thyroid swellings. Along with ultrasound imaging, FNAC is incredibly helpful in differentiating malignant and benign thyroid swellings. Aims and Objectives: (1) To analyse the thyroid cytology smears by TBSRTC. (2) To correlate with radiological findings. (3) To correlate with corresponding histopathological findings. Materials and Methods: 100 patients with palpable thyroid swellings referred to the Department of Pathology, Hassan Institute of Medical Sciences, Hassan for fine needle aspiration procedure were included in this study. The cytological findings were reported according to TBSRTC. Among these 62 biopsies were available for histopathological comparison. These were also correlated with the radio- imaging reports. Results: Among 100 FNACs, Benign category (TBSRTC II) formed the majority 85% of the cases. Unsatisfactory (TBSRTC I), Atypia of undetermined significance (TBSRTC III), Follicular neoplasm/ Suspicious for Follicular Neoplasm (TBSRTC IV), Suspicious for malignancy (TBSRTC V) and Malignancy (TBSRTC VI) constituted 9%, 1%, 2%, 1% and 2% respectively. On FNAC and Histopathological correlation, the p-value of <0.05 was found which is statistically significant and Kappa value of 0.74 was noted which indicated substantial agreement between FNAC and histopathology. The sensitivity and specificity of FNAC was 98.2% and 100% and USG was 96.4% and 71.4% respectively. Conclusion: TBSRTC provides proper communication between the pathologists and treating clinicians and surgeons due to valid and reliable diagnostic categories. The efficiency is further increased when it is used with other diagnostic modalities like ultrasound examination.

Background: Direct laryngoscopy and endotracheal intubation is almost always associated with hemodynamic changes due to reflex sympathetic discharge as hypertension, tachycardia, predisposition to cardiac arrhythmia and increased myocardial oxygen consumption. Objectives: To compare the attenuation of cardiovascular stress responses during laryngoscopy and endotracheal intubation using intravenous 50% Magnesium sulphate and Dexmedetomidine. Methods: A prospective randomized double blind comparative study of Dexmedetomidine versus 50% Magnesium sulfate for attenuation of cardiovascular stress responses was done in sixty patients aged between 20 to 60 years of physical status ASA grade I and ASA grade II undergoing elective surgery under general anaesthesia. All patients were divided into 2 groups of 30 patients each. Group-M received 30 mg/kg of Magnesium sulphate and Group-D received 1 µg/kg Dexmedetomidine intravenous infusion ten minutes before intubation. Both the groups were observed for changes in hemodynamic parameters i.e. heart rate (HR) systolic, diastolic blood pressure and mean arterial pressure at 0, 2 and 5 minutes post intubation. Results: Statistical analysis was performed using SPSS version 20 (USA). Heart rate  was increased at 0 minute that is immediately after intubation in group D by  2.86 ± 1.74 bpm ( 3.52%) from pre induction mean value, while  in group M it was 12.26 ± 2.96 bpm (14.69%) ( p = 0.0001), showing highly significant difference among both the groups. Similarly at 2 minutes after intubation rise in heart rate in group D is only 0.10 ± 1.90 bpm (0.12 %) while in group M it is 5.56 ± 2.18 bpm (1.79%) showing a statistically significant difference ( p = 0.0021). At 5 minutes after intubation both groups shows mean heart rate near pre induction mean values in group D it was 78.3 ± 7.15 bpm with a decrease of 3.17 bpm (-3.89%) while in group M it was 83.30 ± 8.73 bpm with a difference of  -0.20% from pre induction (p = 0.0184). Systolic blood pressure, diastolic blood pressure and mean arterial pressure remain comparable in both the groups at 0, 2 and 5 minutes after intubation i.e. statistically not significant (p > 0.05). Therefore both dexemedetomidine and MgSO₄ were effective in controlling the SBP, DBP & MAP after intubation. Conclusion: Magnesium sulphate is as effective as dexmedetomidine in attenuating the cardiovascular stress response to laryngoscopy and endotracheal intubation. Dexmedetomidine (1μg/kg) provides fairly good and sustained control over hemodynamic responses to the stress of laryngoscopy and intubation and is significantly better than MgSO₄ (30mg/kg). So we conclude that dexmedetomidine is better alternative to MgSO₄ for attenuation of stress responses of laryngoscopy and intubation.

Background: Under nutrition is a major cause of children deaths, accounting for nearly 45% of all under-five deaths worldwide. Optimal nutrition during the first 2 years of a child’s life is very important. Around 6 months of age, an infant’s need for energy and nutrition starts to exceed and cannot be met only through breast feeding. Hence, complementary foods must be introduced. Urban slums being one of the high priority area for providing the healthcare, this study aims at assessing the IYCF practises among the women residing in urban slums and the various challenges faced by them. The objective of the study are to assess the Infant and Young child feeding practises among women of children aged 6-23 months and To know the various socio-demographic factors associated with the IYCF practises. Methodology: A Cross-sectional study was conducted for a period of 6 months in urban field practise area. The sample size was computed to be 140. House to house survey was done and mothers residing in urban slums with at-least 1 child aged between 6 months to 2 years were included in the study. Data was collected by one to one interview, using a pre-tested semi-structured questionnaire. Mothers were enquired on IYCF practises and anthropometric assessment of child was carried out. Data is presented in percentages, ratios and proportions. Z-scores were calculated and presented as mean and standard deviation. Results: Majority, 79.3% were aged 21 to 30 years 74.3% were of Hindus, 55.7% were in nuclear families and 46.4% belonged to upper or upper-middle class. 16.5% of mothers were not aware of early initiation of breastfeeding, however 80% of mothers opined of exclusive breastfeeding up to 6 months. However, 59% of mothers practised early initiation and 52.8% of mother’s exclusive breastfeed up to 3 to 6 months. 41% started complementary feeding at 6 months, while 44.3% had administered water before 3 months. Only 27.2% were practising recommended minimum meal diversity, while only 61.5% met the minimum meal frequency required. On health status assessment of children, majority were normally nourished. i.e., 11.4% were wasted and 8.6% were stunted by Z-scores. Conclusion: There is considerable knowledge deficiencies regarding early initiation, providing adequate breastfeeding. The knowledge regarding minimum meal diversity and minimum meal frequency was inadequate. However, on examination, the nutritional assessment of children was near normal.

Background: Acute pancreatitis is a diverse condition that can be potentially life-threatening. The management of infected necrotizing pancreatitis has changed dramatically during the last two decades and continues to evolve with growing experience, new technologies and ongoing research. Aims and Objectives: The aim of this study was to evaluate the practical adoption of the step-up approach in a tertiary hospital setting and to assess the short- and long-term outcomes associated with this approach. Methods: This was a retrospective study done in 146 patients who have met the inclusion and exclusion criteria and was divided into two distinct groups: the ‘adherence group’ who followed the ‘step-up approach,’ and the ‘non-adherence to step-up approach’ group. A thorough comparison and analysis was performed between these to identify the success rate, complication rate, survival rate and potential predictors of mortality. Results: Out of 146 patients, 134 managed with a step-up approach, while 12 patients underwent up front surgery. The study showed an adherence rate of 91.8%. Adherence to step group had a mortality of 22 (16.42%) and nonadherence group had 2 (16.67%) mortality with no statistical difference. The adherence group had a low incidence of new-onset multiorgan failure (9.7%), compared to 25% of the nonadherence group, which was statistically significant. The complication rate (12.66%) was lower in the adherence group as compared to the nonadherence group (50%). Conclusion: The step-up approach can be utilized in the management of IPN with reasonably good adherence in a vast majority of patients. Future research should focus on the development of novel therapeutic strategies aimed at modulating the disease course in IPN.

Background: Narrow band imaging (NBI) is an innovative  biological endoscopic technology designed to enhance the diagnostic precision by visualization of tumor-specific neo-angiogenesis. Currently available evidence indicates that narrow band imaging is a promising approach in the diagnosis of laryngeal cancer Methods: The descriptive study was conducted at the ENT outpatient department of Government Medical College, Ernakulam and Dept of Surgical Oncology at Cochin cancer Research Centre for a period of 6 months from August 2021 to January 2022 among 45 patients. The objective of current study was to assess the validity of narrow band imaging as a diagnostic and follow up tool in the diagnosis of laryngeal lesions and to study the epidemiological profile of different laryngeal pathologies. The findings in NBI i.e., type of vascular pattern was compared with histopathology findings. Results: Out of all the lesions, 33 (73.3%) were malignant and the location were glottis (40%), supraglottis (26.6%) and immediate subglottis (6.6%). White light endoscopy (WLE) was able to pick up only 27 cases as true positive, NBI alone was able to pick 32 cases as true positive while NBI with WLE was able to detect 33 true positive cases. At 95% confidence interval sensitivity of WLE was 81.8 % , NBI was 96.9% and of WLE with NBI was 100%. Specificity of WLE was 71.2%, NBI was 72.1% and WLE+NBI was 72.3%. PPV of WLE was 90.7%, NBI was 91.5% and of WLE+NBI was 92.6%. Negative predictive value of WLE was 55.3%, NBI was 78.9% and of WLE+NBI was 100%. Conclusion: The integration of Narrow Band Imaging (NBI) with White Light Endoscopy (WLE) enhances the sensitivity for detecting laryngeal malignancy and its precursor lesions. NBI is also beneficial for follow up in premalignant lesions, certain benign lesions and  irradiated larynx.

Background: Thyroid diseases are fairly frequent among endocrine disorders. In clinical practice, a majority are benign but a substantial number of them are malignant. It is difficult to overall diagnose simply on clinical assessment. Fine needle aspiration cytology (FNAC) has been accepted as the first line investigation, especially for palpable thyroid swellings. But FNAC has its own limitations, therefore for final diagnosis histopathological examination is necessary. Aim: This study mainly aims to correlate the preoperative FNAC results as per The Bethesda system for Reporting Thyroid Cytopathology with subsequent Histopathological findings as the gold standard. Objectives: To evaluate the discordant cases, find out causes of discordance and to find out the sensitivity, specificity, positive and negative predictive values of thyroid FNAC. Methods: This was a five year observational study (3 years retrospective and 2 years prospective) conducted from august 2019 to august 2024 at Department of Pathology, Jhalawar Medical College, Jhalawar, Rajasthan. Total 146 cases were included in this study for which cytopathological and histopathological diagnosis were made. Results: Out of total 146 cases, 35 cases (23.97%) were neoplastic and 111 cases (76.03%) were non neoplastic lesions. Cytological diagnosis achieved sensitivity of 62.9%, specificity 98.2%, positive predictive value 91.7% and negative predictive value 89.3%. The diagnostic accuracy of cytological diagnosis was 89.72%. Conclusion: FNAC of thyroid lesions has been shown to be simple, reliable and accurate method for the management of palpable thyroid lesions. It bridges the gap between clinical evaluation and final surgical pathological diagnosis in majority of cases. It enables the clinician to obtain a diagnosis in high percentage of cases with minimal expenditure of time and money and often to prevent unnecessary surgery. As a screening method, it has high sensitivity and specificity, thus helps in planning the future management of patients. The Bethesda system for reporting thyroid cytopathology has standardized the diagnostic approach for reporting of thyroid lesions providing a uniform and clinically pertinent nomenclature.

Background: Lymphadenopathy is the enlargement of a lymph node and lymphadenitis is the inflammation in a lymph node. Lymphadenopathy is one of the most common clinical presentations of patients attending the outdoor department of a hospital. This study aims to study the lymph node lesions in various diseases by fine needle aspiration cytology and to prove FNAC as an important and useful preliminary diagnostic method in lymph node diseases. Aims and Objectives: To study the lymph node lesions in various diseases by fine needle aspiration cytology and categorise the various lymph node lesions into neoplastic and non-neoplastic lesions. Special stains like ZN stain was done for all clinically suspected cases. To prove FNAC as an important and useful preliminary diagnostic method in lymph node diseases. Methods: The present study was a Prospective study. This Study was conducted for one Year from august 2022 to august 2023 at Department of Pathology, Jhalawar Medical College, Jhalawar, Rajasthan. Total 520 patients were included in this study and cytological diagnosis was made. Results: Out of total 520 patients, 106 (20.4%) patients had Granulomatous Lymphadenitis, 7 (1.3%) patients had Lymphoproliferative Disorder, 70(13.5%) patients had Metastatic Lesion, 80 (15.4%) patients had Necrotising Granulomatous Lymphadenitis, 3 (0.6%) patients had Necrotising Lymphadenitis, 166 (31.8%) patients had Reactive Lymphadenitis, 6 (1.2%) patients had Suppurative Lymphadenitis and 82 (15.8%) patients had Tubercular Lymphadenitis. Conclusion: We concluded that FNAC is a valuable initial diagnostic modality for evaluating lymphadenopathy in a tertiary care setting. It offers high diagnostic accuracy, particularly in distinguishing between benign and malignant conditions, thus guiding further management decisions. Its role in conjunction with clinical evaluation and histopathological examination is pivotal in providing timely and accurate diagnoses, thereby improving patient care outcomes.

Background: Neonatal sepsis is a clinical syndrome represented by signs and symptoms of infection, with or without associated bacteremia, in first 28 days of life. It is one of the commonest and most important cause for morbidity and mortality of neonates in developing countries like India. The gold standard test for sepsis is blood culture. But culture based diagnosis has its own constraints as it is time demanding with an assay time of up to 48-72 hours. In 1988, Rodwell gave a haematological scoring system for prompt diagnosis of neonatal sepsis. It covers numerous simple, bedside, cheap but reliable laboratory tests. Aim: To study the haematological parameters including the changes  in the peripheral blood smears of neonates clinically suspicious of having sepsis. Objectives: To categorise haematological findings according to Rodwell haematological scoring system and to correlate the haematological score with blood culture. Methods: This was a two year prospective study conducted from august 2022 to august 2024 at Department of Pathology, Jhalawar Medical College, Jhalawar, Rajasthan. Total 130 neonates clinically suspicious of neonatal sepsis were included in this study. Statistical correlation between Rodwell’s HSS and blood culture was obtained using Chi square test. Results: Out of total 130 cases, 71 neonates (54.62%) had a haematological score of ≥4 and 59 neonates (45.38%)  had a haematological score  <4. Rodwell’s HSS achieved sensitivity of 95.0%, specificity 63.3%, positive predictive value 53.5% and negative predictive value 96.6%. The diagnostic accuracy of Rodwell’s HSS was 73.07%. Conclusion: When all the haematological parameters are used in combination as in Rodwell’s HSS, the diagnostic accuracy is high. Because of its high sensitivity when HSS score ≥4 is used as a cut off for the presence of sepsis, HSS can be used as a useful screening tool against neonatal sepsis. Thus, Rodwell’s haematological scoring system can aid in giving timely cure, shorten the hospital stay, reduce mortality and minimize the possibility of emergence of resistant organisms due to improper administration of antibiotics.

Background: Chronic rhino sinusitis affects a significant population worldwide, imposing a huge toll on the human economy as well as on quality of life. Chronic headache is one of the most common symptoms which are distressing to both patients and physicians. The investigative modalities available for an ENT surgeon are many like X-ray, CT scan, DNE, etc. Hence, this study is taken to compare the computed tomographic findings to the diagnostic nasal endoscopy findings in patients with chronic Rhinosinusitis. Objectives: This study aims to compare CT-scan findings and DNE findings in diagnosing Chronic Rhinosinusitis. Material & Methods: 60 Patients attending ENTOPD at ESIC Medical College & Hospital with any Sino-nasal complaints lasting for more than 4 weeks and not responding to medical line of management. Patients are selected by random sampling method. Patients were evaluated with CT scan and DNE. Results: Sixty patients with chronic rhinosinusitis participated in the study. Their mean age + standard deviation was 38.5 + 10.19 years, ranging from 20 to 63 years. The median was 37.5 years. The largest proportion (45%) of the sample aged30–39 years old, only 10% aged ≥50 years. The main symptoms of the patients were nasal obstruction (81.6%), Headache (78.3%), and nasal discharge (45%). Conclusions: Nasal endoscopy has sensitivity and specificity almost as good as CT scanning, and being an outpatient procedure, it may reduce unnecessary diagnostic scanning procedures & define cost-effective and easily an available diagnostic tool.

Aim: Surgical site infection is most common healthcare associated infection in rural hospital of developing countries. This study was carried out to estimate surgical site infection incidence rate among obstetric and gynaecological surgeries along with identification of most important risk factor and their microbiological profile in an Indian rural hospital. Method: A prospective study was conducted in the Department of Obstetrics and Gynaecology, Referral Hospital, of southern Gujarat from August 2023 to July 2024. Surveillance for SSI was based on Centre for Disease Control (CDC) definition and methodology. Patients who developed inflammatory sign like pain, redness, wound gap, serous or pus discharge at surgical site was consider as SSI. Sample of wound swab collected & send to microbiology laboratory for culture and sensitivity report. Result: A total of 960 female underwent a surgical procedure during study period out of these 106 patients develop SSIs. Incidence of our study was 11.04%. Majority of SSI was superficial who only involve skin and superficial tissue. LSCS had highest rate of SSIs because compare to other surgeries total number of LSCS performed is more and LSCS is mostly done by trainee doctor. In gynaecological surgeries total abdominal hysterectomy had higher rate of SSIs followed by exploratory abdominal surgeries. Anaemia (34.90%) was the most common risk factor for SSIs, which were followed by obesity, previous scare, emergency surgery and diabetes. In our study, culture positive samples were 90 out of 106 wound swabs. Among 90 culture positive S. aureus (28%) was most commonly isolated, followed by E. coli and other gram-negative bacteria. Conclusion: Among the different hospital acquired infections (HAIs), SSIs contribute major part. This study helps in identification of various risk factor in rural hospital of India and by eliminating this risk factor we can decrease SSIs significantly. By microbiological profile of this patients, we can decide prophylactic therapy of patients who is undergoing for surgery.

Background: Lower gastrointestinal hemorrhage (LGIH) is a significant clinical condition requiring accurate diagnosis for effective management. Colonoscopy plays a critical role in identifying underlying causes and guiding treatment strategies. This study evaluates colonoscopic findings in patients presenting with LGIH. Materials and Methods: A cross-sectional study was conducted on 98 patients with LGIH. Patients underwent detailed clinical evaluation and colonoscopic examination. Data on demographic parameters, dietary habits, substance abuse, and associated clinical symptoms such as altered sleep and bowel habits were collected. Statistical analysis was performed to assess the distribution of findings. Results: The study included 53 males (54.08%) and 45 females (45.92%). The majority of participants were aged between 41-50 years (25.51%). Dietary habits showed a predominance of mixed diets (92.86%). Substance abuse, primarily alcohol (45.92%), was prevalent in nearly half of the patients. Altered sleep was reported in 85 patients (86.7%), and altered bowel habits were observed in all patients (100%). Colonoscopic findings revealed hemorrhoids in 26.54%, rectal carcinoma in 23.47%, colorectal cancer in 20.41%, and colon cancer in 8.17%. Other findings included fissures (7.15%), polyps (2.05%), and inflammatory bowel disease (4.09%). Notably, 7.15% of patients had normal colonoscopy results. Conclusion: Colonoscopy is an essential diagnostic tool for identifying the etiology of LGIH. Hemorrhoids and malignancies were the most common findings, underscoring the importance of timely evaluation in patients with LGIH symptoms to ensure appropriate management.

Background: This study explores the relationship between changes in proteinuria levels and myocardial infarction (MI) risk among individuals with diabetes or pre-diabetes. Methods: A retrospective analysis was conducted with 300 participants from Bihar Sharif, tracking proteinuria levels and MI incidence over one year. Statistical adjustments were made for factors such as age, gender, and hypertension. Results: Participants with increasing proteinuria had a significantly elevated risk of MI compared to those with stable or decreased levels. Increased proteinuria emerged as a strong predictor of MI in multivariate analysis. Conclusion: Rising proteinuria levels are strongly associated with higher MI risk in diabetic and pre-diabetic populations. Routine proteinuria monitoring may help identify cardiovascular risk early, allowing for timely intervention.

Background & Methods: The aim of the study is to comparative study of clinicoetiological profile of cerebral malaria in hospitalized children due to p. falciparum and p. vivax. All those children who were previously neurologically normal, of age 6  months  – 18 years  and presented with a history of fever with generalised convulsion and   loss of conscious for more than 30 min, underwent a peripheral blood smear examination and rapid diagnostic test for malarial parasite. Results: Out of 41 children infected with P. Vivax, intermittent fever was present in 41 (100%), chills and rigors 24(58.5%), headache4(9.7%), vomiting18(43.9%), loses tools 2(4.8%), GTCS-1episode 15(36.5%), GTCS>1episode26(63.4%), respiratory distress in 24(58.5%), pallor in 18 (43.9%), icterus in 4 (9.7%), edema in 3 (7.3%), hypotension in 3 (7.3%), hypoglycaemia in 2(4.8%), hepatomegaly in 34 (82.9%) and splenomegaly in 28 (68.2%), rashes 2(4.8%), abnormal bleeding 3 (7.3%)and black water fever was present in none of the patients. For 29 children with  P. Falciparum, the same symptoms had different percentages as follows: intermittent fever was present in 29 (100%), chills and rigors 16(55.1%), headache 2(6.8%), vomiting 7(24%), loose stools1(3.4%), GTCS-1episode 21(72.4%), GTCS>1episode 8(27.5%), respiratory distress in 14 (48.2%), pallor in 14 (48.2%), icterus in 1 (3.4%), edema in 4 (13.7%), hypotension in 2 (6.8%), hypoglycaemia in 2(6.8%), hepatomegaly in 23 (79.3%) and splenomegaly i(72.4%), rashes 3(10.3%), abnormal bleeding 3(10.3%), black water fever 1(3.4%). Conclusion: The features which were present in more percentage of the cases infected with P. Vivax were chills and rigors, headache, vomiting, loses tools, GTCS>1episode (p <0.05) was a significant finding, respiratory distress, hypotension, icterus, hepatomegaly. However, in P. Falciparum the symptoms like GTCS-1episode (p<0.001)is highly significant association, hypoglycaemia, pallor, edema and splenomegaly, rashes, abnormal bleeding and black water fever were more commonly reported. Among these, chills and rigors, loose stools, hypoglycaemia, hypotension, pallor, hepatomegaly and splenomegaly were more or less found in equal number of the patients.