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.

Aim: To estimate and correlate the platelet count by automated cell counter and manual method. Materials and Methods: The study was Prospective Cross- Sectional Study, carried out in the Department of Pathology, Adesh Medical College and Hospital Shahabad, Kurukshetra, on a group of 200 patients (125 males and 75 females) from 1^st March to 31^st May, 2024 in 3 months duration. All the obtained data were handled with confidentiality. Blood samples were collected from all age group by venipuncture in ethylene diamine tetra-acetic acid (EDTA) tubes following complete aseptic precautions. Smears will be prepared immediately and stained using Leishman’s stain following standard protocol. Platelets were counted in ten oil immersion fields and the count was multiplied by 15000 to obtain platelet count in lacs/mm³. The platelet count was also be determined by automated hematology analyzer. Results: We observed 63% of the patients were male and rest 37% were female with male: female of 1.7:1. Most of the patients belong to the age group of 30- 40 years i.e. 21%. The mean platelet count on automated analyzer was 67.5 ± 36.4 x10³ /µL whereas the mean platelet count verified on peripheral smear was 106.1 ± 61.5 x 10³/µL with a significant difference between the two groups (p-value <0.001). On manual examination, we observed that 23% of the patients which were previously diagnosed as thrombocytopenic on automation were found to be adequate in manual method i.e. pseudo-thrombocytopenia cases. We also evidenced that when examined on peripheral smear the actual platelet count was actually higher than automated count for most of the thrombocytopenic cases. Conclusion: In thrombocytopenic cases, verifying the platelet count generated by automated hematology analyzers through peripheral smear examination is imperative, particularly when abnormal platelet morphologies, such as giant platelets and platelet clumps are present. This confirmation is critical prior to initiating treatment, as it helps avoid unnecessary diagnostic procedures and inappropriate therapeutic interventions.

Aim: The aim of the present study was to compare the aqueous povidone iodine VS alcoholic chlorhexidine in patients undergoing clean elective surgeries. Methods: The present study was conducted in the Department of General Surgery Santosh Medical College & Hospital, Ghaziabad on 73 patients in each groups. Results: Mean age of group I patients was 48.95±16.69 years and group II patients was 50.21±16.97 years. Out of 350 patients, 57.7% patients had age of 38-57 years followed by 18-37 years (16.6%), 58-77 years (14%), and >77 years (11.7%). 60% patients in group I and 55.4% patients in group II belonged to 38-57 years of age. Out of 350 patients, 39.7% were females and 60.3% were males. In group I, 57.7% were males and 42.3% were females. In group II, 62.9% were males and 37.1% were females. Mean BMI of group I patients was 30.03±2.79 and group II patients was 29.82±2.42. Majority of the patients belonged to BMI group of ≥30 in group I (57.7%) as well as group II (56%). 56.9% patients had BMI more than or equal to 30, 34.9% had 25-29.9, and 8.3% had 18.5-24. This difference was not statistically significant. Out of 350 patients, 75.4% had no pre-operative growth, 12% had Staphylococcus aureus, 5.4% had E. coli, 4.3% had Staphylococcus albus, and 2.9% had Klebsiella species. Conclusion: The findings concluded that antisepsis with chlorhexidine gluconate 2.5% v/v in 70% propanol significantly reduced the risk of postoperative SSI’s and colonization of bacteria in clean contaminated elective surgeries compared to povidone iodine IP 5% w/v. iodine which is being used as the conventional preoperative skin cleansing agent for surgeries in our hospital. Regarding the cost add chlorhexidine is costly as it is providing better result with decrease rate of SSI, it proves to be a better antiseptic in terms of post-operative sepsis and recovery.

Background: Hypotension occurs frequently in spinal anesthesia induction, especially in adults and patients undergoing lower abdominal and inferior extremities. It causes decreased uterine blood flow, which may be le-thal to the mother and newborn. Method: Out of 80 (eighty), 40 were administered ephedrine, and 40 in the controlled group were administered the same quantity of normal saline during spinal anesthesia. Hemodynamic and neonatal outcomes were noted and compared. Results: In comparison of systolic BP at the interval of 1, 2, 3, and 15 minutes had significant p values. In Apgar studies at the internal of 1, 5 minutes had significant o value. Moreover, PH of umbilical cord blood also had a significant p value. Conclusion: It is confirmed that IV infusion of Ephedrine is more effective than crystalloid preloading in pre-venting hypotension in parturients undergoing caesarian section without causing hemodynamic complications.

Background: The complications following laparoscopic cholecystectomy range from superficial surgical site infection to bile duct injury which may cause death. Hence, a meticulous approach can lead to successful LC. Method: 44 adult patients aged between 39 to 60 years of age with benign GB disease were operated on with LC; prior to surgery, a hematological and radiological evaluation was carried out. Histopathological study, in-traoperative, and postoperative complications were noted. Results: Histo-pathological studies included 34 (77.2%) chronic calculous cholecystitis, 3 (6.81%) chronic cal-culous cholecystitis with mucocele, 2 (4.54%) acute caliculus cholecystitis, 2 (4.54%) empyema G.B., 1 (2.2%) acute cholecystitis, 1 (1.2%) chronic cholecystitis with cystitis glandularis proliferans, and 1 (2.2%) chronic calculculous cholecystitis. Peri and postoperative complications were 4 (9%) trocar site bleeding, 4 (9%) liver bed injury, 3 (6.8%) bile leakage from GB, 2 (4.5%) bleeding from calots, and 1 (2.2%) port infection. Conclusion: LC is a safe and effective procedure for GB disease, but it requires an experienced surgeon to avoid morbidity and mortality for favorable results.

Background: The risk factors for GDM are high BMI, nutritional intake, long-term use of contraceptives, physical inactivity, and hyperthyroidism. If not managed meticulously, it may cause morbidity and mortality for both mothers and newborns. Method: 54 diabetic pregnant women were studied with classifying first trimester pregnancy, second trimester pregnancy, and third trimester pregnancy – HbA1C BUN1 TSH, Urine protein to creatinine ratio, USG, with different intervals to assess the viability and fetal umbilical Doppler for fetal movements. Results: 22 (40.7%) had pre-existing diabetes, 32 (59.2%) had GDM. The types of pregnancy were 19 (35.1%) multigravida, 35 (64.8%) primi gravida. The types of delivery were 35 (64.8%) had LSCS, 19 (35.1%) had spontaneous vaginal delivery, 2 (3.7%) hydrocephalus, congenital heart anomalies, still births and macrosomia were studied. Conclusion: The present pragmatic study will be helpful to obstetricians and gynecologists to treat such pa-tients efficiently to avoid morbidity and mortality in mother and fetus.

Background: Common clinical manifestations of Allergic conjunctivitis (AC) include itching, tearing, and redness of the eyes, collectively referred to as total ocular symptom scores (TOSS). Despite its prevalence, AC often goes undiagnosed in individuals with confirmed allergic rhinitis (AR). This study aimed to determine the incidence of AC in patients diagnosed with AR. Materials and Methods: A randomized observational study was conducted on 145 AR-diagnosed patients. Participants were directly queried about AC symptoms using a standardized screening approach that assessed redness, itching, and tearing of the eyes, quantified by TOSS. Indirect symptoms potentially linked to AC were also evaluated. Results: Of the 145 participants, 51.03% reported AC symptoms upon direct questioning. Additional symptoms such as squinting and excessive blinking were also identified. Treatment with olopatadine significantly reduced TOSS scores within five minutes, with majority of patients showing symptom improvement. This approach uncovered 39.31% of previously undiagnosed AC cases. TOSS-based assessments identified AC in 90.34% of cases, while inclusion of additional symptoms increased diagnostic rates to 95.17%. Allergic dermatitis emerged as a common co-morbidity among AC patients. Conclusion: Standardized screening questions identified only 51.03% of AC cases. Incorporating targeted symptom-specific queries and therapeutic trials for suspected cases can improve the detection of AC, enabling timely treatment and symptom relief.

Background: A stroke is characterized by rapidly evolving symptoms and/or signs of a localized and widespread loss of brain function that lasts for at least twenty-four hours and has no discernible cause other than vascular origin. It ranks as the second most common cause of mortality globally. About 15% of strokes are caused by intracerebral or subarachnoid hemorrhage, whereas 85% are ischemic. Risk factors that can be controlled include high blood pressure, diabetes, high cholesterol, atrial fibrillation, smoking, substance misuse, and alcohol consumption. Atherosclerosis development has been linked to changes in the lipid profile. As a result, risk factor intervention must be done effectively. Total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides (TG) are among the several factors that determine the fasting lipid profile. Methods: 100 acute ischemic stroke patients who arrived at K.R. Hospital in Mysore were the subjects of a cross-sectional study conducted over the course of one and a half years (February 2022–August 2023). Determining whether hypecholesterolemia is a risk factor for high severity was the primary objective. Included were patients over the age of eighteen who had an acute ischemic stroke verified by radiography. Patients with underlying conditions such as a past history of stroke, TIA, cardiac and liver disease, hypothyroidism or any medication that lowers cholesterol were not included. Blood was drawn from the patients after they had fasted for nine to twelve hours in order to measure their lipid profiles. NIHSS evaluated the stroke’s severity. NIHSS scores were used to categorize people into four groups: minor (1-4), moderate (5-15), moderate to severe (16-20), and severe (21-42). Additionally, lipid profiles were compared for stroke severity. Data will be presented as descriptive statistics in the form of frequency tables and graphs after being analyzed using SPSS software version 22.0. Statistical significance is defined as a p value of less than 0.05. Results: Higher TC, TGL, and LDL levels were linked to more severe strokes in 100 cases. There were nine in the minor group, forty-seven in the moderate group, twenty-nine in the moderate to severe group, and fifteen in the severe group. Conclusion: The risk of a severe stroke is increased by higher TC, TGL, LDL, and decreased HDL.  Association were evident for elevated TC and LDL levels. Minimizing the risk and preventing morbidity and death can be achieved through early detection and treatment with lipid-lowering medications.

Background: Perianal fistulas are abnormal tracts connecting the anal canal to the perianal skin, often leading to recurring infections and significant morbidity. Magnetic Resonance Fistulography (MRF) has emerged as the gold standard for evaluating perianal fistulas by providing detailed anatomical visualization, aiding surgical planning, and minimizing recurrence rates. Objectives: To evaluate the utility of MR Fistulography in diagnosing and classifying perianal fistulas and to assess its correlation with intraoperative findings. The study also aimed to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRF. Methods: This prospective observational study involved 40 patients with suspected perianal fistulas who underwent MR Fistulography followed by surgical exploration. MRF findings were compared with intraoperative observations to evaluate diagnostic accuracy. Statistical analyses were performed using SPSS. Results: MR Fistulography demonstrated high diagnostic accuracy, with a sensitivity of 94%, specificity of 85%, and an overall accuracy of 91%. Agreement between MRF and intraoperative findings was 95% for primary tracts, 92% for secondary tracts, and 83% for abscesses. The majority of fistulas were intersphincteric and transsphincteric, accounting for 80% of cases, with ischiorectal abscesses being the most common (42.5%). Conclusion: MR Fistulography is a highly effective diagnostic tool for evaluating perianal fistulas, providing detailed preoperative mapping that enhances surgical outcomes and reduces recurrence rates. Its high sensitivity and specificity make it the gold standard imaging modality for these conditions.

Background: This prospective study evaluates the effectiveness of plate osteosynthesis in treating clavicular fractures, focusing on healing times, complication rates, and functional recovery. Methods: The study was conducted at NRI Medical College and General Hospital from 2020 to 2023, involving 20 patients who underwent plate osteosynthesis for clavicular fractures. Results: The results demonstrated an average fracture union time of approximately 10.5 weeks with minimal complications. Hardware prominence was the most notable complication, affecting 10% of patients. A non-union rate of 5% was observed. Functional recovery was excellent, with patients achieving near-normal range of motion and strength by six months post-surgery, leading to high patient satisfaction. Conclusion: The findings support the use of plate osteosynthesis as a reliable and effective treatment method for clavicular fractures, highlighting its advantages in achieving rapid recovery and minimizing long-term disability compared to non-operative treatments.

Introduction: Escalator and elevator injuries are injuries related to industrialisation and urbanisation of life. The shift of the population from villages to city has led to increase in numbers of high-rise buildings which are more than 10 storied high. High rise buildings more than twenty or thirty storeys are routinely seen in metropolitan cities. All these high rise needs Elevator to go up and down to reach home or office. There are many skyscrapers more than 100 storeyed in this world where fast elevators are used like CN Towers, Burj Khalifa, Tapie 101 etc. The elevators used are very fast, but speed always comes with technical problems and accidents. So human beings have to pay the price of this development. Material & Methods: This article is a case series of fifteen patients, who had sustained hand injury while using elevator. These injuries are simple CLW, crush injuries, degloved injuries, avulsion injuries of hand or near total to total amputation of fingers tips, fingers including thumb, palm, wrist or elbow. Crush or degloved injury needed debridement and flap coverage, while near total amputation needed revascularisation and flap coverage or skin grafting. While Total amputation needed replantation and coverage. Results and Observation: These injuries result in bigger zone of trauma and post-operative results vary and depend upon the type of injury crushing or degloved, mechanical force and power of accident, vascularity of distal limb and management of wound. Conclusion: With the recent technical advancement in wound management and availability of microvascular surgery now it is possible to save the limbs by using various flaps or replantation or revascularisation of amputated limbs. With addition of physiotherapy it’s possible to regain near normal lifestyle. But in the end, it’s advisable to follow the general guidelines and not to overlook safety protocols to avoid any type of elevator Injury.

Introduction: Medical education is a demanding journey, involving academic, emotional, and social challenges exacerbated by long hours, extensive coursework, exams, peer competition, and personal expectations. These factors contribute to significant psychological morbidity, including stress, anxiety, depression, and suicidal ideation among medical students. Globally, studies report that 25%-90% of medical students experience stress, a key determinant of mental health issues. In India, addressing the mental health of medical students has gained significant attention. This study aims to assess the prevalence of depression, anxiety, and stress among medical students at a college in Gujarat, India. Materials & Methods: This cross-sectional study was conducted among 400 medical students across all MBBS phases. Data was collected through a structured self-administered questionnaire, consisting of three sections: demographic information, mental health assessment using the Depression Anxiety Stress Scale-21 (DASS-21), and factors associated with mental health. Results: The study found the prevalence of depression (22.2%), anxiety (37.5%), and stress (45.5%). Factors like age, gender, MBBS phase, religion, family type, residence, and reason for joining MBBS were not significantly linked to mental status of students. However, key contributors included family and personal mental health history, academic dissatisfaction, poor coping skills, family expectations, fear of the future, and life dissatisfaction. Conclusion: There is a critical need for mental health support systems within medical education to alleviate academic pressures, manage family expectations, and address social isolation. By creating an environment that prioritizes psychological well-being and reduces the stigma surrounding mental health, institutions can enhance student resilience, improve academic performance, and ultimately ensure better patient care.

Introduction: Acute appendicitis (AA) is a significant health issue that requires fast and accurate diagnosis to avoid complications. Clinical diagnosis remains critical, despite advances in imaging and diagnostic technologies. A variety of scoring systems have been developed to minimize doubt in appendicitis diagnoses. Aside from imaging modalities such as ultrasonography, the RIPASA score is seen to be a more effective diagnostic grading strategy for adults. Material and Methods: A source of 132 cases presented with clinical features suggestive of appendicitis were screened and underwent RIPASA score assessment. Subsequently, all patients underwent ultrasonography to identify characteristics indicative of appendicitis. The accuracy of diagnosing acute appendicitis with the RIPASA score and ultrasound results was linked to the histopathological examination. Results: The comparison of RIPASA score with HPE showed that 66.67% cases who are diagnosed to have appendicitis by RIPASA score are truly had appendicitis by HPE and 5.38% of cases were normal by HPE. The sensitivity, specificity, PPV and NPV of RIPASA score was 86.24%, 63.40%, 89.80%, 47.89% respectively. Whereas for ultrasound, sensitivity, specificity, PPV and NPV of RIPASA score was 73%, 58%, 85.24%, 39.36% respectively. Conclusion: Ultrasonography exhibits low sensitivity and can serve as an adjunctive method for diagnosing appendicitis to exclude alternative etiologies of right iliac fossa pain. The RIPASA score system seems to be an effective instrument for diagnosing acute appendicitis. Consequently, it can be inferred that the RIPASA scoring system is superior, both clinically and statistically, for the evaluation of appendicitis in comparison to ultrasonography.

Breast MRI has emerged as an indispensable asset in the thorough assessment of breast lesions, distinguished by its unmatched sensitivity in both detection and characterization. Its adeptness in identifying benign and malignant lesions proves invaluable, especially among women with dense breast tissue or elevated risk profiles for breast cancer. Beyond characterization, breast MRI plays a pivotal role in staging breast cancer, offering precise assessments of tumor size, disease extent, and neighbouring tissue involvement, thereby guiding treatment strategies and surgical interventions with unparalleled accuracy. Furthermore, its utility extends to guiding biopsy procedures, ensuring targeted sampling of suspicious lesions, and informing treatment decisions by furnishing critical insights into tumor attributes and disease burden. In summation, breast MRI emerges as an indispensable cornerstone in the holistic management of breast lesions, significantly enhancing patient outcomes and tailoring care to individual needs.

Objective: The present study was conducted to compare SEPTA block technique with SADDLE anesthesia in benign Anorectal diseases. Methods: A prospective randomized comparative study was performed with 30 patients in each of two groups. Patients in Group A received SEPTA block and in Group B received Saddle anesthesia. Comparison was done between two groups in terms of total amount of drug given, average time of starting surgery after anesthesia, average duration of operation, average time of giving first rescue analgesia, average time of ambulation and post operative VAS score after 4 and 12 hours of benign perianal surgery. Results: In this study average amount of the drug given was 30 mL in Group A and 2 mL in Group B. Average time of starting surgery after giving anesthesia was 3.5 minutes in Group A and 8.5 minutes in Group B. First rescue analgesia was required average 220 minutes after surgery in Group A and 125 minutes after surgery in Group B. Average time of ambulance after surgery was 45 minutes in Group A and 240 minutes in Group B. Comparison of post operative VAS score after 04 hours and 12 hours was not statistically significant between two groups. In Group A 01 patients developed urinary retention while in Group B 03 patients were developed urinary retention. In Group B 03 patients developed headache while in Group A none of the patients had headache. Conclusions: The SEPTA technique offers the benefits of quick onset, long lasting analgesic effect, early mobilization, and less complications as compared to SADDLE block Anesthesia. As a result, it can serve as an alternative to Saddle Block anesthesia for benign anorectal surgeries.

Gliosarcoma is a rare subtype of glioblastoma multiforme. On histology it is a biphasic tumor having both glial as well as sarcomatous components. Here in we present a case of 32 year male who got admitted to our hospital with chief complaints of headache for the past one month which increased in intensity since the last 10 days with progressive loss of vision and complaints of giddiness, nausea and vomiting. CT scan and MRI were advised which revealed Approximately 47x40x28mm sized ill-defined heterogeneous lesion  in the right cerebellar hemisphere causing mass effect over fourth ventricle. A provisional diagnosis of medullobastoma was made based on imaging studies. Surgical intervention comprising Midline suboccipital craniotomy with excision of tumor was done. On histopathological examination a diagnosis of gliosarcoma was made after observing the H&E and Reticulin silver stained sections. Gliosarcoma is an aggressive tumor hence prompt and accurate diagnosis is required for better prognosis.

Background: Psoriasis is a chronic inflammatory skin disorder associated with significant morbidity. Despite the availability of various treatments, including Methotrexate and Apremilast, a clear comparison of their effectiveness in treating chronic plaque psoriasis remains essential for optimizing patient outcomes. Aims & Objectives: This study aimed to evaluate and compare the therapeutic effects of Methotrexate and Apremilast in treating chronic plaque psoriasis, focusing on symptom improvement, PASI score reduction, and overall effectiveness. Methods: An analytical study was conducted over one year at the Dermatology OPD of Rajshree Medical Research Institute, Bareilly. Patients aged 18-50 years with chronic plaque psoriasis were divided into two groups: Group 1 received Methotrexate, and Group 2 received Apremilast. Psoriasis severity was assessed using the Psoriasis Area and Severity Index (PASI) at baseline and monthly intervals for six months. Data were analyzed using SPSS version 26.0, with statistical tests including paired t-tests, ANOVA, and chi-square tests. Results: The study found that Apremilast led to higher moderate improvement in scaling (70.4%) compared to Methotrexate (50%). By the PASI 6 stage, 92.5% of Apremilast patients achieved a PASI score below 15, compared to 76.92% of Methotrexate patients. Scalp involvement was more common in the Apremilast group (70.3%), while lower limb involvement was more prevalent in the Methotrexate group (42.3%). Conclusions: Both Methotrexate and Apremilast were effective in managing chronic plaque psoriasis, with Apremilast showing a quicker reduction in disease severity. The choice of treatment may depend on specific symptoms and patient characteristics.

Introduction: Elective posting, a newly introduced concept in the CBME curriculum helps student decide his/her aptitude in the PG subject, students are given choice of one clinical and one pre / Para-clinical subject in their III-major course. The study aimed to develop and validate the newly designed elective module in microbiology subject. Methods: The module was introduced to 33-medical students who voluntarily selected microbiology electives and feedback taken. Organized, well designed module for elective posting in microbiology (15 days duration) was prepared  by four qualified microbiologists which covered different topics including paperless audits in infection control (hand hygiene, BMW and antibiotic usage), visit to microbiology laboratory, breaking bad news (informing patient about HIV positive report), prevention of HAIs including device associated infections, clinical application of microbiology in practice, interpretation of reports and antibiotic-stewardship program, etc. Hands on practice was given for three types of audits, bedside teaching and device associated infections. Results: A validated feedback form was distributed to the 33 participating students to assess their experiences and satisfaction levels. Descriptive statistical analysis revealed high satisfaction scores across various parameters, including the relevance of the elective to future medical practice (score rating: 4.27) and overall enjoyment (score rating: 4.07). Notably, 72.72% of students found the elective extremely relevant, while 45.45% reported being extremely satisfied with their experience. Conclusion: The innovative approach to microbiology education could serve as a valuable model for future curricula, facilitating a deeper comprehension of microbiological principles among medical students.

Introduction: According to World Health Report, 15% of disease burden was due to injuries. Children are the most vulnerable population. Since children spend majority of time in schools, there is a high chance of injuries happening at school. Teachers will be the first person to help out students in such emergencies. Hence, they should have adequate knowledge and skills to manage such emergencies. Aim: To assess the knowledge of teachers on first-aid and see the effect of educational intervention on the same. Methods: An intervention study was conducted among five randomly selected government schools in catchment area of urban centre of GMC Bhopal. The teachers were given a questionnaire for pre-test followed by educational intervention by presentations and videos. After a month, post test was conducted. Results: The study was conducted among 35 teachers in five schools. All the schools had a first-aid kit. None of the teachers had a formal training course on first-aid before. Hence 100% teachers fell in poor category of knowledge before intervention which improved to 60% in fair category and 2.8% in good category after the intervention. Knowledge on managing fainting episodes (86%), foreign body (79.5%) and nose bleeds (65%) improved significantly after the intervention. Overall, the knowledge score improved by 15.12%. There was 40% improvement in maintenance of health register by the schools. Conclusion: By health education and training on first-aid, the teachers should be enabled to handle emergency situations at school which in turn would ensure the safety of children.

Background: Organophosphorus (OP) poisoning is a critical public health issue, necessitating emergency medical intervention due to its severe toxic effects. This study aims to evaluate the clinical profile, complications, and outcomes of OP poisoning in a tertiary care setting. Material & Methods: A retrospective observational study was conducted on 118 patients with acute OP poisoning admitted from November 2021 to October 2023 in Tata Main Hospital, Jamshedpur, and Jharkhand. Patients were evaluated based on socio-demographic variables, clinical manifestations, treatment received and outcomes. Diagnosis of the poisoning was based on the clinical history, clinical features and the evidence of the poison brought by the patients or their family member. We don’t have the facility of serum/red blood cell cholinesterase level estimation in our hospital. We used the Peradeniya Organophosphorus Poisoning (POP) scale to assess poisoning severity. Results: Most patients (66.1%) were aged 21-40 years, predominantly male (79.7%). Methyl Parathion was the most common poison (23.7%). Muscarinic and nicotinic symptoms were prevalent, with 40% requiring mechanical ventilation. Mortality was 25.4%, with respiratory failure being the leading cause. Severe cases exhibited significantly higher atropine requirements with more mortality. The mean hospital stay was longer for severe cases (13.5 ± 4.29 days). Conclusion: OP poisoning predominantly common young males and requires judicious clinical suspicion of its occurrence, and prompt medical intervention to prevent severe complications and mortality.

Introduction: The main issues observed during an extended exercise session are dehydration, substrate, and electrolyte depletion. Because oral rehydration solution (WHO) contains water, carbohydrates, and electrolytes that help postpone weariness, it can be quite beneficial for people participating in longer-term exercise programs. It has been discovered that skeletal muscle adaptations throughout an individual’s exercise performance are mediated in part by nutrition. Water, electrolytes, and carbohydrates all contribute to better workout performance. Our study’s objective is to measure the muscle efficiency metrics of male students who exercise on a bicycle ergometer until they become fatigued while receiving oral rehydration solution (WHO) prior to the exercise session. Materials and Methodology: This cross-sectional investigation was carried out in the physiology department’s research lab at Coimbatore Medical College in Coimbatore. In seven sessions, around fifty male adults engaged in cycling activity on a bicycle ergometer at 50, 75, and 100 watts of intensity, both with and without ORS consumption prior to the exercise. Energy expenditure, cycling distance and duration, and VO2max were among the parameters that were recorded. Results: A master chart was created using the information gathered from the chosen subjects. The software SPSS 22 was used to calculate the mean, standard deviations, and ‘p’ values. ANOVA and the unpaired “t” test were employed to compare the parameters. The comparison of values before the start of cycling exercise with and without ORS consumption revealed a significant correlation. Conclusion: According to bicycle ergometry, the current study shows that after ORS ingestion and exercise, the muscle efficiency metrics like RPP, METs, and VO2 max values rise. ORS works well as a water, electrolyte, and carbohydrate supplement, delaying the onset of muscle tiredness and boosting muscle function. In contrast to other commercial sports drinks, ORS is devoid of preservatives and can be made fresh. It is an affordable method of rehydrating before exercise to replenish electrolytes, carbohydrates, and water.

Background: Stroke is a leading cause of mortality and disability globally, with extracranial atherosclerotic stenosis (ECAS) and intracranial atherosclerotic stenosis (ICAS) being critical determinants of stroke outcomes. This study examines how ECAS and ICAS affect recovery in acute ischemic stroke patients. Methods: This cross-sectional observational study included 390 patients with acute ischemic stroke admitted to Tirunelveli Medical College Hospital from August 2022 to November 2023. Patients were categorized into four groups based on stenosis type: non-stenosis, ICAS-only, ECAS-only, and combined ICAS+ECAS. Baseline characteristics, risk factors, and functional outcomes (measured by the modified Rankin Scale, mRS) were analyzed. Hazard ratios and multiple linear regression analyses were used to identify predictors of recovery. Results: Among the 390 patients, 73% were male, with the mean age highest in the combined ICAS+ECAS group (63.0 years). Smoking was significantly associated with the ICAS group, while coronary artery disease (CAD) was more common in patients with both ICAS and ECAS. Regression analysis identified smoking, dyslipidemia, CAD, ICAS, and combined ICAS+ECAS as significant predictors of poorer outcomes, while age, gender, hypertension, and diabetes were not predictive. Conclusion: Patients with ICAS and concurrent ICAS+ECAS exhibited poorer recovery outcomes. Targeted interventions focusing on lifestyle modification and early risk factor management are recommended to improve recovery outcomes in acute ischemic stroke patients.

Background: This study aims to develop predictive markers for early detection and management of dengue, a significant arthropod-borne viral disease, to overcome challenges in distinguishing between severe and mild forms of the disease. Aim: The study investigates the correlation between biochemical markers like serum LDH, Creatinine kinase, Albumin, aPTT, and aminotransferases and their use as predictive indicators of severe dengue in adults. Methodology: The research is conducted on patients admitted to the Government Erode Medical College Hospital, Perundurai, throughout a one-year period (December 2023 to October 2024). This research was executed. As a prospective clinical research, written informed permission will be obtained prior to the investigation, after the provision of comprehensive information to the participants about the study. Patients with dengue fever will be evaluated for biochemical indicators including serum LDH, creatinine kinase, albumin, aPTT, SGOT, SGPT, and serum albumin by laboratory studies and clinical manifestations. Results: Biomarkers like Lactate Dehydrogenase, Creatine Kinase, aPTT and aminotransferases are elevated and albumin is reduced in severe dengue. Conclusion: Serum LDH, Creatine kinase, serum albumin, aimnotransferases, and aPTT should be evaluated during admission and early illness in patients with fever with thrombocytopenia to identify and treat severe cases of dengue fever, reducing mortality rates.

Background: Urinary tract infections represent a substantial proportion of patients seen in clinical departments at Medical College Hospitals. They result in considerable morbidity and death in individuals exhibiting heightened antibiotic resistance. This often results in the indiscriminate, unscientific administration of antibiotics, leading to the rise of multidrug-resistant bacteria in hospitals. Aim: The aim of this research is to determine the prevalence and sensitivity patterns of different uropathogens and to recommend empirical antibiotics within the clinical environment of a medical college hospital. Materials and Methods: A retrospective research was conducted over one year (2022-2023), during which 1008 urine samples taken from clinical departments were analyzed at the Microbiology department at a Tertiary Health Care Centre in Bengaluru, Karnataka, India. Urine samples underwent bacterial culture, revealing substantial bacterial growth by the colony count technique. Traditional techniques were used for the identification of bacterial isolates. Antimicrobial susceptibility testing was conducted on isolates in accordance with the Clinical and Laboratory Standards Institute (CLSI) recommendations. Results: Out of 1008 urine samples, 388 samples (38.49%) exhibited considerable proliferation of uropathogens. The predominant uropathogens discovered were Escherichia coli (37.03%), followed by Klebsiella pneumoniae (14.5%), Enterococcus species (10.71%), Methicillin-Resistant Coagulase-Negative Staphylococci (MRCONS) (9.17%), and Pseudomonas aeruginosa (6.8%).Multidrug resistance has been shown in many uropathogens, particularly to penicillin’s, fluoroquinolones, and cephalosporins. Conclusion: This research recorded a rise in antibiotic resistance among uropathogens. The empirical selection of antimicrobial agents should be predicated on the antimicrobial sensitivity profiles of the uropathogens endemic to the region. Prudent utilization of antibiotics may assist in mitigating the dissemination of antimicrobial medication resistance amongst the general populace.

Background: Sinusitis is a common condition affecting the paranasal sinuses, particularly in children. It is primarily caused by viral upper respiratory infections, with allergic rhinitis being a significant predisposing factor. Other underlying causes include nasal airway obstruction, immunodeficiencies, ciliary dysfunction, and cystic fibrosis. The sphenoid’s isolated illness is often overlooked due to its remote location and difficulty of access. Aim: A study of the isolated sphenoid sinus disease with discussion of the clinical symptoms, radiological findings and complications. Methods: Patients were retrospectively identified through a computer-assisted search of all CT scan reports conducted for clinical symptoms associated with the sinonasal region, including headache, nasal obstruction, recurrent sinusitis, chronic sinusitis, acute sinusitis, allergic sinusitis and culture of organisms from department of microbiology at MVJ Medical College and Research Hospital from March 2017 – January 2018, to ascertain the presence of isolated sphenoid sinus opacification, mucosal thickening, and related complications. Fifty-five instances of isolated sphenoid illness were recognized. Results: We detected 55 instances of isolated sphenoid illness, constituting 20.1%. Twenty-seven females and twenty-eight guys. Seven patients in the under 20 age group, twenty-six patients in the 21-40 age group, fifteen patients in the 41-60 age group, and seven patients beyond 60 years old. Nine instances had acute sphenoid sinusitis with an air-fluid level. Chronic sphenoid sinusitis was seen in 27 instances. Nineteen patients had asymptomatic sphenoid opacification. A neuro-ophthalmic complication was seen in one instance. Conclusion: Asymptomatic opacification of the sphenoid sinus is prevalent. Routine imaging of the paranasal sinuses in uncomplicated acute sinusitis is not advised. It is ineffective for distinguishing between viral and bacterial sinusitis and often does not alter therapy in simple acute sinusitis.

Worldwide, an estimated 1.3 to 4 million people are affected by cholera every year. Cholera is an acute infectious disease caused by ingestion of food and water contaminated by Vibrio cholerae. The clinical course of cholera varies from mild diarrhea to severe complications such as hypokalemia, hyponatremia or hypernatremia, metabolic acidosis, and acute kidney injury. The disease can be fatal if timely treatment is not initiated. We discuss here, two cases who presented to our tertiary care hospital with history of pain abdomen and multiple episodes of watery diarrhea. Both cases later developed acute renal failure secondary to severe gastroenteritis. The aetiology of the gastroenteritis was later confirmed to be cholera. Both cases presented with history of profuse watery diarrhoea with vomiting, on admission signs of volume depletion in the form of sunken eyes, reduced skin turgor and capillary filling time > 3 seconds were observed in both the cases. There was history of consumption of sea food from the local street vendor, but no history of movement outside the place of residence within last one week prior to onset of symptoms. Laboratory investigations revealed raised haemoglobin, PCV, raised blood urea and serum creatinine, hyperkalaemia; and anion gap. Despite aggressive rehydration, both the cases developed acute kidney injury. Renal ischemia secondary to dehydration leading to acute tubular necrosis may have caused the acute kidney injury with elevated urea/creatinine levels in our patients. Both our patients were successfully managed by intravenous infusion of fluids, electrolytes, sodium bicarbonate and appropriate antibiotics, followed by hemodialysis. Both the cases were discharged without any further complications as they showed signs of recovery of renal function.

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

Introduction: Obesity is a major health burden as more than 3 million adults die worldwide. Body Mass Index (BMI) is an easy tool to classify person in normal to obese categories. Obesity leads to development of autonomic dysfunctions and alters pulse rate on changing posture of our body. This study compare and asses effect of posture on pulse rate in normal and obese young adults. Materials & Methods: This study involved 30 healthy male and female participants with BMI 18.5 – 24.9 as Normal, and 30 healthy male and female participants with BMI > 30 as obese. All participants were young adults from 18 to 25 years of age. Detailed history were recorded and Pulse rate (PR) measured for 1 minute after 5 minutes of rest in supine position first.  Followed by immediate measurement of PR on change of sitting and standing positions. Data were collected and analysed. Results: We found increased PR on change in posture from supine to sitting to standing in both normal and obese participants. Additionally, significantly high PR in obese participants as compare to normal participants in sitting position. In supine position, Obese had significantly high PR than normal participants. Conclusion: We concluded that high PR in obese is due to imbalance in autonomic activity that leads to decreased parasympathetic activity. Hence they are at higher risk of developing cardiovascular disease in the future.

This prospective observational study investigates the diagnostic accuracy of the triple assessment (clinical examination, radiological evaluation, and histopathological analysis) for palpable breast lumps in females. Utilizing data collected from 100 patients over three years (2020-2023), the study assesses the sensitivity, specificity, and accuracy of each diagnostic method and compares them against histopathological evaluation (HPE). Results show high diagnostic concordance, supporting the triple assessment’s efficacy in detecting malignancy. This study aims to reinforce the use of triple assessment for early and accurate diagnosis of breast lumps, ultimately aiding in precise treatment planning.

Introduction: Diabetes is a common co morbidity which is rising in prevalence in the modern era. Metformin is the foundation of treatment of type 2 DM. Most of the current international guidelines including American Diabetes Association state that Metformin should be the first line oral therapy prescribed. Proton Pump Inhibitors are also commonly used in patients with type 2 diabetes on Metformin, considering the gastrointestinal side effects of Metformin. This study is focusing on looking at the prevalence of VIT B12 deficiency in diabetics on Metformin VS Metformin with PPI. Methods: This study was conducted on 74 diabetics on metformin and 74 diabetics on metformin with PPI meeting inclusion and exclusion criteria. Patients were subjected to VIT B12 levels estimation. The data collected are entered in excel sheet and analysed using descriptive statistics namely mean, standard deviation, percentage and depicted in the form of frequency tables, figures, and graphs. Results: In the present study, the mean age in metformin group was 58.05 ± 8.70 and mean age in Metformin + PPI was 55.9 ± 7.55 years. (p=0.02) Majority of the patients belonged to the age group of 51to 60 years in the present study. Assuming the normal range of Vit B12 as 200-835 pg/mL we observed no association of administration of metformin with PPI and vitamin B12 deficiency in the present study. Based on vitamin B12 levels. Out of 47 patients having vitamin B12 <200, 23 patients (31.1%) were in Group A and 24 patients (32.4%) were in Group B. Out of 101 patient shaving vitamin B12 >200, 51 patients (68.9%) were in Group A and 50 patients (67.6%) were in Group B. The distribution of the subjects based on vitamin B12 was statistically not significant. (p=0.86). Conclusion: Diabetes affects a significant number of the population, with a large number of them being on metformin, as a first line medicine unless contraindicated. A significant number of them are also on PPI in view of the gastrointestinal effect so metformin. Vitamin B12 deficiency is known to occur in patients on metformin, which was also seen in this study, but there is conflicting evidence to the role PPI in causing Vit B 12 deficiency. This study also did not find statistically significant Vit B 12 deficiency when metformin was combined with PPI. Further large scale studies are necessary in this regards.

Background: Chronic Obstructive Pulmonary Disease (COPD) is characterized by chronic persistent airflow obstruction due to chronic inflammation in the airways and lungs in response to noxious particles or gases. The evaluation of COPD involves spirometry, chest X ray, pulse oximetry and arterial blood gas analysis. Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend the use of COPD Assessment Test (CAT) score for assessing the severity of the disease. Aim: To ascertain the correlation between COPD Assessment Test (CAT) Scores and Spirometry in assessing the severity of airflow limitation in stable COPD patients and to assess the use of CAT Scores as a marker of severity of COPD in the absence of spirometry for appropriate management of patients. Methodology: A Cross-Sectional Study was conducted on 100 stable COPD patients of age > 40 years attending outpatient Department of General Medicine in a Tertiary Care Hospital in Chennai from January 2024 to June 2024. After obtaining Institutional Ethical Committee approval and informed consent from participants, data was collected for CAT questionnaire and spirometry. The data was entered in Microsoft excel and analyzed using one way ANOVA and SPSS software version 28.0. Conclusion: From this study we conclude that there is a correlation between CAT scores and severity of airflow limitation. Although CAT scores can’t be used as diagnostic tool, it gives a good measure of the severity of COPD and health-related impairment in the patients.

Introduction: Effects of Dexmedetomidine on recovery from anaesthesia still remains controversial. This study was conducted to study the effect of Dexmedetomidine in recovery from anaesthesia. The primary aim was to assess recovery from anaesthesia in terms of time to eye opening, time to follow verbal commands, time to extubation and sedation in the post-operative recovery room. Methodology: After approval from institutional ethical committee a randomized controlled study was conducted in forty patients posted for elective ENT surgeries under general anaesthesia. Patients were randomly divided into Group D and Group C, 20 in each Group based on computer generated table of random numbers. Dexmedetomidine Group received a bolus dose of 1mcg/kg body weight in 100ml normal saline over ten minutes followed by infusion @0.4mcg/hr. Control Group patients received saline infusion. General anaesthesia was induced and maintained as per institutional protocols. Time to eye opening, time to following verbal commands and time to extubation after discontinuation of the study drug was recorded. Sedation score was assessed after shifting the patient to the post-operative recovery room using Ramsay Sedation Score. Patients were observed in post anaesthesia recovery room for adverse effects. Results: It was observed that there was no difference in time to eye opening, following verbal commands and extubation between both Groups. Ramsay sedation score was significantly higher in patients in Group D compared with that of Group C (P<0.05). The requirements of analgesics and antiemetics in the post-operative period were more in Group C compared to Group D. There were no anaesthesia related complications in any of the Groups. Conclusion: Dexmedetomidine is associated with greater sedation in the post-operative period but does not delay recovery from anaesthesia. Dexmedetomidine also reduces the requirement of analgesics and antiemetics in the post-operative period.

Aim: to evaluate, over a certain time period, the prevalence and distribution of epidemic diseases among patients admitted to District Hospital Rajahmundry. Methodology: Over the course of six months, Prospective observational method was used to conduct a study on the prevalence of a certain disease and its co-morbidities. There are multiple diseases with different clinical spectrums, and among them, different risk factors may likely be helped out. This is a prospective epidemiological study carried out at the 500-bed super specialty government hospital known as the Tertiary Care Teaching Hospital. The six-month study period from November 2023 to April 2024 was dedicated to assessing the cases for epidemically. From the patient’s case survey, demographic and diagnostic information for patients below 20 years to above 81 years gathered and divided into 8 different groups. Objectives: To find out how often epidemic diseases are overall among patients who are admitted to Rajahmundry District Hospital. List the specific epidemic diseases that hospital patients are most frequently diagnosed with. Examine the seasonal differences in the prevalence of diseases that are spreading. Results: The illnesses with the highest prevalence were Dengue, Malaria, Influenza, HIV/AIDS, and renal Severe Acute Respiratory Syndrome (SARS), respectively. Conclusion: The most prevalent disease Dengue (44.1%), Malaria (24.2%), Seasonal Influenza (13.4%), HIV/AIDS (9.9%), SARS (8%) respectively. The most prevalent age group of common epidemic diseases is 41-50 years (31.9%) 31-40 years (17.9%).

Pneumonia, a significant cause of morbidity and mortality globally, often presents diagnostic challenges due to unidentified etiologic agents. Non-resolving pneumonia, particularly, complicates clinical management, as standard antibiotic therapy may be ineffective. This study aimed to investigate the role of early bronchoscopy and bronchoalveolar lavage (BAL) in identifying causative agents in patients with non-resolving pneumonia at a tertiary care hospital. This observational cross-sectional study, conducted at DR. BRAMH, Raipur, from January 2023 to February 2024, included 140 patients presenting with pneumonia symptoms and radiographic findings. Fiberoptic bronchoscopy was performed on all participants, with BAL samples analyzed for bacterial, fungal, and mycobacterial pathogens. Histopathological biopsies were conducted whererever necessary. The study identified pathogenic organisms in 86.43% of cases, with Pseudomonas aeruginosa (40.71%) and Klebsiella pneumoniae (21.43%) as the predominant pathogens. Notably, malignancies were detected in 13.57% of cases, with squamous cell carcinoma being most common. Bronchoscopy findings indicated mucosal inflammation in 80.71% and endobronchial masses in 12.86% of patients. The results emphasize the diagnostic importance of early bronchoscopy and BAL in non-resolving pneumonia, allowing for tailored treatments and potentially improved patient outcomes. This study supports the integration of bronchoscopy in managing complex pneumonia cases to address diagnostic gaps and treatment challenges, ultimately aiming to reduce mortality in this patient population.

Pleural effusion, characterized by the abnormal accumulation of fluid in the pleural space, presents a diagnostic challenge due to its diverse etiology. This study aims to evaluate the diagnostic value of rigid thoracoscopy in patients with undiagnosed exudative pleural effusion. The research was conducted at the Department of Respiratory Medicine, Pt. JNM Medical College and Dr. BRAMH Raipur (C.G.), over a period from January 2023 to February 2024. The study involved 70 patients who underwent medical thoracoscopy after inconclusive initial investigations. The findings revealed a diagnostic yield of 91.4%, with tuberculosis being the most common etiology, followed by malignancy. This study underscores the importance of thoracoscopy in the diagnostic workup of pleural effusion and highlights its efficacy in determining the underlying cause in cases where less invasive methods fail.

Background: Clindamycin, a lincosamide represents a common choice of drug for skin and soft tissue infections as an alternative in case of resistance to methicillin. The routine invitro tests may fail to detect inducible clindamycin resistance resulting in therapeutic failure which can be detected by a simple D test routinely in laboratory. Materials and Methods: 281 Staphylococcus aureus were isolated and subjected to phenotypic and genotypic detection of erm genes by antibiotic susceptibility testing with cefoxitin (30mg) and confirming its growth on MRSA screen agar. The isolates were subjected to double disc diffusion test with erythromycin and clindamycin discs placed adjacently at a distance of 15 to 20 mm and observed for the D zoning after overnight incubation. The ermA, ermB, ermC genes were detected from the isolates by PCR assay. Results: Out of 281 Staphylococcus aureus isolates 93 (33%) were MRSA, 188 (66.9%) were MSSA. Inducible clindamycin resistance was found in 22 (23.6%) MRSA and 12 (6.3%) MSSA isolates. ermA, ermC genes are found more in MRSA when compared to MSSA (22.5%, 67.7% and 6.3%, 0.5% respectively). Conclusion: This study shows the importance of D test to be used routinely to detect inducible clindamycin resistance. Since the isolates with inducible resistance have the ability to mutate and change to constitutive resistance, it may lead to treatment failure.

Background: About 70% of HIV infected people usually have one or many respiratory infections during the course of their HIV disease. Respiratory system involvement may lead to wide variety of pulmonary illness that includes HIV-related opportunistic infections caused by bacterial, mycobacterial, viral, fungal, parasitic pathogens and neoplasms. A wide clinical spectrum of respiratory illness was seen among HIV patients, in consonance with their varying immune status. The immune system is damaged by virus making the infected individual vulnerable to malignancies and opportunistic infections which are common in the chest. This study makes an attempt to correlate the pulmonary illness and CD4 counts as it will help in better understanding this deadly duo of HIV and opportunistic infections. Method: Total of 90 newly detected HIV patients above 18 years of age were included. Detailed clinical history taking and complete physical examination followed by specific tests including sputum analysis and chest radiographs were done .Their baseline CD4 counts were done to assess their degree of immunosuppression. Given pulmonary infections were then compared with CD4 count groups (CD4 countless and more than 200/cc). Result: The study had 90 cases with mean CD4 count of 201.76 cells/microL. Majority of the pulmonary illness were observed below the CD4 count of 200 cells/mm3. The study found that majority of patients with Pulmonary Tuberculosis had CD4 count >200 cells / μL (53.8%) and all patients with Extra-Pulmonary Tuberculosis had CD4 count <200 cells / μL. Conclusion: This study highlights that pulmonary tuberculosis still remains as the most common clinical entity in cases of HIV. This study also establishes that there is a higher prevalence of diseases such as PCP and extra pulmonary tuberculosis as the CD4 count level declines.

Pelvic ring injury is a serious traumatic condition which needs urgent haemodynamic stabilisation of the patient and reconstruction of the pelvic ring. Depending upon the type of force vectors causing the injury, both the anterior fracture and symphyseal separation as well as the posterior Sacroiliac fracture dislocation warrant surgical fixation. However in certain cases, patients recover with only the posterior stabilisation supplemented by pelvic binders. Percutaneous fixation of the Sacroiliac disruption is always better than the open reduction and internal fixation as it is minimally invasive with little blood loss and less tissue damage. It may be associated with neurovascular complications if proper procedures and techniques are not followed. Per-operative C arm visualisation in various planes are mandatory for proper screw trajectories and to avoid complications. Usually 6.5 mm partially threaded Cannulated cancellous screws with washers are used for Sacroiliac dislocations, which require compression. A second screw may be added if needed into the S2 vertebral body. In sacral fractures, fully threaded Cannulated cancellous screws are used. Early reconstruction of the Pelvic ring helps in mobilising the patient, avoid complications like deep vein thrombosis, decubitus ulcers, infections and decreases the hospital stay duration. We are presenting in this study the functional outcome of 15 patients of Pelvic ring injury stabilized by Percutaneous Sacroiliac screws. Three patients also required anterior fixation of the symphyseal disruption. Rest are managed with posterior Sacroiliac fixation alone or few are supplemented by pelvic binders. Good to excellent functional recovery was recorded in majority of patients.

Background and Aim: Surgical site infections (SSIs) pose a considerable risk for individuals undergoing surgery. Various strategies for preventing surgical site infections (SSI) have been proposed, encompassing preoperative, intraoperative, and postoperative considerations. This paper seeks to provide a thorough examination of the incidence, risk factors, microbiology, prevention strategies, and management of surgical site infections in elective inguinal hernia surgery. Material and Methods: The research included a comprehensive analysis of all elective adult inguinal hernioplasty procedures (n=800) performed within the designated timeframe. Data on patient demographics, surgical characteristics, and outcomes were gathered and examined. Results: In a Present study, 25 surgical site infections (SSIs) were documented among 800 patients within 30 days following mesh repair for inguinal hernia. This data indicates an overall SSI rate of 3.1% (25 out of 800 patients). Every documented case of infection was classified as a superficial surgical site infection. During the original admission, surgical site infections (SSIs) were noted to occur within an average timeframe of 4.52 days following the procedure, with a significant majority (76%) identified within the initial week after surgery. The predominant microorganism identified was Staphylococcus aureus. Conclusion: The findings underscore the critical need to identify high-risk patients and to implement preventive strategies aimed at reducing the occurrence of surgical site infections (SSIs). Future research must prioritise the creation of effective strategies aimed at preventing surgical site infections in this specific patient demographic.

Background and Aim: Given that folate supplementation is routinely administered to all children with severe acute malnutrition (SAM) as per the World Health Organisation (WHO) management protocols, it is essential to assess the prevalence of vitamin B12 deficiency and the necessity for its regular supplementation. The authors sought to investigate the prevalence of vitamin B12 deficiency, along with its causes and effects, in children suffering from severe acute malnutrition. Material and Methods: 150 the study focused on children aged 0-59 months who are experiencing severe acute malnutrition (SAM). Vitamin B12 levels were assessed, with a threshold of 350 pg/ml identified as deficient, while classifications for insufficiency and sufficiency were also established. A complete blood count was conducted to assess haematological effects, while a developmental assessment was performed to evaluate potential neurological impacts. Results:  Sepsis emerged as the predominant complication, affecting 40% of cases. This was followed by pneumonia in 21 instances, accounting for 14%. Other complications included acute diarrhoea at 11%, chronic diarrhoea at 7%, persistent diarrhoea at 1%, anaemia at 8%, and infantile tremor syndrome at 5%. A total of 99 children, representing 66.0%, received complete immunisation, while 48 children, or 32.0%, were only partially immunised. Pallor was observed in 105 children, accounting for 70% of the sample. Oedema was noted in 25 children, representing 16.6%. Signs of Vitamin B12 deficiency, including hyperpigmentation and glossitis, were found in 26 children (17.3%), 39 children (26%), and 14 children (9.3%) respectively. There is a notable correlation between hyperpigmentation and glossitis with vitamin B12 levels. In the study, oedema was observed in 25 children, accounting for 16.6% of the total population examined. The findings indicate that pallor and oedema do not show a correlation with vitamin B12 levels. Conclusion: Approximately 50% of children suffering from severe acute malnutrition exhibit low levels of vitamin B12. The clinical features include hyperpigmentation and glossitis. This condition does not correlate with infant and young child feeding practices or the consumption of any medications. There is no correlation between this condition and developmental delay in children with SAM.

Background and Aim: Rheumatic diseases encompass a diverse range of conditions, many of which present with notable skin manifestations. This research aimed to explore the patterns of skin-related symptoms seen in patients with rheumatic disorders at a tertiary care centre. Materials and Methods: This analysis was done in the dermatological department with the linked medical college and hospital. The study involved 50 patients, including newly diagnosed and referred rheumatoid arthritis patients. The study collected demographic data such age, gender, occupation, residence, and clinical diagnosis. The study focused on lupus, scleroderma, rheumatoid, psoriatic, and systemic vasculitis. Results: Sixteen out of 50 cases had lupus erythematosus, 10 had scleroderma, followed by dermatomyositis and cutaneous vasculitis. Two cases of Behçet’s illness were noted. Periungual erythema (n=11) and telangiectasias (n=10) were the most common symptoms of dermatomyositis (DM). Heliotrope rash, Gottron’s sign, and Gottron’s papules were observed in 12 and 10 cases, respectively. Palmar erythema (n=5), Shawl’s sign (n=3), and Holster’s sign (n=3) were also noted. Conclusion: Understanding these diseases’ skin signs is crucial. Joint clinics between rheumatologists and dermatologists can improve diagnosis, therapy, and follow-up, as well as prognosis.

Background and Aim: Research has consistently documented instances of visceral perforation across various studies employing both open and closed techniques. The condition is linked to a significant mortality rate, primarily because numerous injuries may go unrecognized during surgical procedures. This study was conducted to assess the effectiveness of open versus closed techniques for intraperitoneal access in creating pneumoperitoneum during laparoscopic surgery. Material and Methods: The study included all patients undergoing abdominal laparoscopic surgeries, specifically those aged between 18 and 70 years, regardless of gender. The study involved fifty patients who underwent laparoscopic cholecystectomies and decision to divide the patients into two groups was made with careful consideration of the surgeon’s preference and expertise, resulting in 25 patients being assigned to either the open or closed method for creating pneumoperitoneum. To assess the score for Surgical Site Infection (SSI), the Southampton Wound Scoring System was employed, and the Visual Analogue Scale was used to measure the pain level experienced at the port site. Results: The time taken to close the umbilical port differed between the two groups, with the open group averaging 5.3 ± 12.1 minutes and the closed group averaging 6.4 ± 09.4 minutes. Our study revealed that the average time taken to close the umbilical port was 8.12 ± 0.24 minutes for the open group, compared to 9.22 ± 3.54 minutes for the closed group. The difference observed was found to be highly statistically significant. Conclusion: In the context of laparoscopic cholecystectomy, our findings indicate that the open technique provides faster access to the pneumoperitoneum compared to the closed approach when evaluated under similar conditions.

Background: Migraine is a complex neurological disorder characterized by recurring headache, with distinct phases. Neurovascular dysfunction and hypothalamic activation are pathophysiological mechanisms of migraine. Cerebral microvascular damage has been implicated in migraine. As cerebral and retinal microvasculature share similar embryology, anatomy and physiology, changes in retinal microvasculature may mirror changes in cerebral microvasculature. This study was aimed to look into the retinal microvascular abnormalities in migraine patients. Objective: This study aims to look into the relationship between migraine and retinal microvascular abnormalities and to compare the results between groups of migraine with aura, migraine without aura, and non-migraine headaches. Methods: This cross-sectional analytical study included 312 patients with primary headaches after ruling out secondary causes at Tirunelveli Medical College Hospital (TVMCH) between August 2021 and December 2022. A semi structured interview was done with each participant to gather clinical information about their headache characteristics using ICHD 3 criteria and classified headache patients in to migraine with aura, migraine without aura and non-migraine headaches groups. Retinal microvascular abnormalities were evaluated using fundus photographs from an indirect ophthalmoscope. Retinal microvascular abnormalities recorded includes retinopathy, focal arteriolar narrowing, and arteriovenous nicking. Results: Of the 312 patients, 82 presented had migraine with aura, 118 had migraine without aura, and 112 had non migraine headache. Female patients were affected in both migraine groups. Retinopathy was observed in 52 patients of migraine with aura group, 12 patients of migraine without aura group, and 8 patients of non-migraine headache group. Focal arterial narrowing was noted in 68 patients of migraine with aura, 16 patients of migraine without aura, and 10 patients of non-migraine headache. Focal arteriolar narrowing and arteriovenous nicking were more in patients of migraine with aura. Statistical analysis revealed a significant association between migraine aura and retinal abnormalities (p = 0.0027). Conclusion: Migraine is associated with retinal microvascular abnormalities, including retinopathy, focal arteriolar narrowing, and arteriovenous nicking. Migraine with aura is more associated with retinal microvascular abnormalities compared to migraine without aura and non-migraine headaches.

Objective: Improvements in the health care system, resulted in a greater number of geriatric patients diagnosed with acute kidney injury (AKI). We evaluated the incidence and outcome of AKI in geriatric patients, as studies in Indian population are few; moreover, treatment approaches, in addition to medical decisions, may require special consideration for advanced age to improve the outcomes. Results: At Gauhati medical college and hospital, we recruited patients aged more than 60 years who were admitted to the medicine ward with AKI between December 2023 to July 2024. Patients were followed-up during hospital stay until discharge. 100 patients were admitted during the study period. Using the acute kidney injury network classification; stage 1, stage 2, and stage 3 disease were present in 24%, 41% and 35% of patients, respectively. Of the 23 patients who died before discharge, 13 had stage 3 and 10 had stage 2 AKI. The most common comorbidity in our study group was type 2 diabetes mellitus (17), 6 had hypertension, 5 patients had underlying malignancy and other comorbidities like coronary artery disease, chronic liver disease and chronic obstructive pulmonary disease with 4 patients in each group. Methodology: Ours is a tertiary care teaching institute in North Eastern part of the country. This was a single-institute prospective observation study of clinical data collected from patients during December 2023 to July 2024. Data collection was started after obtaining permission from the Institutional Ethics Committee. Convenience sampling technique was used. The study followed the guidelines laid down in the Declaration of Helsinki (2008). This manuscript followed the STROBE guideline for reporting. Conclusion: Prevention of AKI and early detection with reversal of cause, addressing complications and determining the need for RRT in geriatric patients will improve overall survival and decrease associated morbidity in this patient population.

Introduction: Heart disease complicating pregnancy is an important cause of maternal mortality. Cardiovascular complications may develop in 0.2%–4% of pregnancies, even if no prior cardiac disease is known. Hence an early diagnosis of heart disease is important in pregnancy to decrease maternal morbidity and mortality. Aim of the Study: To identify heart disease in asymptomatic pregnant women with screening echocardiography. Materials and Methods: This is a prospective study conducted on pregnant women attending AN OPD in the Department of obstetrics and Gynaecology at Govt. Rajaji Hospital, Madurai. Screening ECHO was done in the women to identify heart diseases. Results: Out of 200 cases, 109 (54.5%) of the cases are in the age group of 20-24 years. Mean age of the study patients is 24.42 years. Out of 200 cases, 123 (61.5%) of the cases are Primi and remaining 77 cases (38.5%) are multi. Out of 200 cases, only 8 (4%) had family h/o heart disease and remaining 192 cases had (96%) had no family h/o of heart disease. Out of 200 cases, 11 (5.5%) cases had heart disease detected by ECHO and remaining 189 cases had (94.5%) no heart disease. Out of these 11 cases, 4 cases had CHD, 3 cases had Mild MS, 1 case each had Mild MR and Moderate MS, and 2 cases had Moderate MR. Valve area is significantly low (1.9) for heart disease cases when compared with normal cases (2.19). P value highly significant. < 0.001.LVEDD is significantly high (4.6) for heart disease cases when compared with normal cases (4.22). P value highly significant. < 0.001.RAEDD is significantly high (2.84) for heart disease cases when compared with normal cases (2.57). P value is significant. p=0.041. Mean RVEDD is low (2.2) for heart disease cases when compared with normal cases (2.42). But no statistical significant difference. P value not significant. p= 0.109.Mean LAEDD is 3.39 for heart disease cases and 2.99 for normal cases There is no significant difference between normal and heart disease cases regarding LAEDD. p= 0.146 Not significant. Out of the 11 cases, 7 cases delivered by caesarean section and 4 cases had vaginal delivery there is no significant difference between mode of delivery and heart disease cases. Conclusion: Cardiac screening during pregnancy may seem to be an expensive process. However, the detection of cardiac diseases during pregnancy can be lifesaving, due to the fact that heart disease complicating pregnancy is a major cause of maternal death.

Background: Hypertensive disorders of pregnancy are a commonly occurring complication during pregnancy. Placenta is responsible for maintenance of pregnancy and fetal growth. In the present study comparison between morphological changes in placenta of mothers who suffered from hypertensive disorders of pregnancy with the placenta of mothers who had uncomplicated pregnancy was done. Methodology: Institution based observational, proposed cross sectional study was done at ICARE institute of medical research between February 2021 to August 2022. Study population was mothers who visited the Department of Obstetrics and Gynaecology of IIMSAR & Dr B C Roy Hospital, Haldia. The sample size was 60 among them 30 suffering from hypertensive disorders of pregnancy and 30 were not. Study variables were weight of placenta; feto placental weight ratio; macroscopic and microscopic features; macroscopic and microscopic features of placenta in hypertensive disorders of pregnancy. Results: The mean weight of the placenta in hypertensive group was significantly lower (439.33±54.93) as compared to normotensive patients (473.93±68.30) and this difference in mean was statistically significant (P value=0.035). Likewise, placental volume in hypertensive group (405.63±46.22) was significantly lower in comparison to normotensive (446.43±57.81) patients (P value= 0.004). Significant lower value for placental area, thickness, diameter, and circumference in hypertensive group compared to normotensive group was found. Conclusion: Gross examination of placenta in pregnancy induced hypertension (PIH) revealed decrease in mean placental weight, diameter, thickness, numbers of cotyledons and cord length and increased incidence of oval and irregular placentae, marginal insertion of cord, infarction and calcification. On microscopic examination of placenta in pregnancy induced hypertension excessive syncytial knots, increased villous stromal fibrosis, fibrinoid necrosis and basement membrane thickening of the villi were noted.

Background: Acute Otitis media (AOM) is defined as an infection of the middle ear cleft and commonly seen as a pediatric emergency.  AOM can occur at any age, but most frequently observed in children between 05 and 11 years. Nearly 80% of all children will experience minimum one incidence of AOM during their lifetime. Among them nearly 70% to 85% will have AOM with effusion before reaching the teen age. The present study was directed to reviews the epidemiology, etiology, evaluation, and management of AOM with effusion with an emphasis on the role of Adenoidectomy alone or in combination with Grommet insertion in its management. Aim of the Study: To study the epidemiology, etiology, evaluation, and management of AOM with effusion with an emphasis on the role of Adenoidectomy alone or in combination with Grommet insertion in its management. Materials: A prospective analytical study was conducted at Shadan Institute of Medical Sciences, Hyderabad to study the incidence, clinical signs and symptoms, final outcomes of treatment of AOM with Adenoidectomy alone (Group A) and Adenoidectomy in combination with Grommet insertion (Group B) in children over a period of 02 years. Mini AOM questionnaire containing AOM-10 Questionnaire which classified hearing loss, behavioral changes, school performance, sleep habits, and frequency of upper respiratory infections were used with 2 points for each of the queries graded on a Likert scale 1 to 10. Tympanic membrane findings were also graded as 3 categories- normal tympanic membrane, dull looking tympanic membrane with straw colored fluid with or without air bubbles in the middle ear, and Thick and grossly dull, retracted, or bulging, lusterless tympanic membrane. Data was analysed to compare and correlate the final outcome measured in terms of auditory gain and relief from symptoms using chi square and t test. Results: The demographic data showed a mean age of 8.3 ± 1.4 years in Group A and 7.3± 1.7 years for Group B. 59 male patients and 25 females in Group A and 57 children were males and 27 children were females in Group B were included. There was no statistical difference between the two groups in terms of age and gender. The statistical significance was indicated by a p-value of 0.0001. The mean auditory gain after 18 months in Group A children was 14.85±2.15 dB and in Group B it was 19.75±3.10 dB which was significant statistically with p value 0.001. Conclusions: Acute Otitis Media with effusion is a common entity and frequently reported in children and results in pain in the ear and loss of hearing. Eustachian tubal occlusion due to large adenoid masses was the true cause for AOM with effusion. Surgical treatment either with Adenoidectomy alone or in combination with Grommet insertion is the choicest management. Combined surgical treatment of Adenoidectomy and Grommet insertion demonstrated greater efficacy and statistically significant auditory gain when compared to Adenoidectomy alone.

Background: Upper respiratory tract infections (URTIs) are among the most common infectious diseases, affecting the nasal passages, pharynx, and larynx. They present a significant health burden, especially in children and individuals with compromised immune systems, leading to symptoms like cough, sore throat, and congestion. The present study aims to assess the effectiveness and safety profile of Co-amoxiclav in managing upper respiratory tract infections (URTIs) across the adult population of India. Methods: A single-arm, multicenter, retrospective, medical records-based, real-world study was conducted, including all adult patients diagnosed with URTIs presented to the Out-Patient Department (OPD) or admitted to the In-Patient Department (IPD) who have been treated with Co-Amoxiclav Therapy. Data were collected at three intervals: baseline (day 0), first follow-up (day 7±2), and second follow-up (day 14±2). Demographic information, medical history, primary diagnosis, vital signs, and laboratory parameters were documented at baseline and follow-ups. Clinical outcomes, microbiological results, and safety data, such as adverse events, were assessed at each follow-up. The statistical analysis in this study employed a combination of descriptive statistics and frequencies, along with the Chi-square test, to evaluate the efficacy of Co-Amoxiclav. Descriptive statistics summarized the characteristics of the sample, providing means, standard deviations, and frequencies for categorical variables. Results: The study included a total of 9233 participants with a mean age of 46.84±16.3. The most frequently encountered URTI was the undifferentiated URTI, accounting for 48% of the total population. A significant proportion of the participants (72%) were prescribed co-amoxiclav 625 mg twice daily for 5 to 7 days. The study reported statistically significant efficacy (92.82%) of co-amoxiclav (p<0.0001) in the treatment of URTIs. Significant improvements in laboratory parameters with C-reactive protein (CRP) levels (p < 0.001) and white blood cell count decrease were observed (p < 0.001). Adverse events were notably rare in the study population, with only 28 cases (0.35%) reporting any treatment-related events. Conclusion: Co-amoxiclav demonstrated excellent efficacy and safety profile in the treatment of upper respiratory tract infection. Further large studies are required to determine the long-term outcomes of co-amoxiclav in the timely management of URTIs.

Substance/Drug abuse is complex and multidimensional problem. It is one of the common problems in the metropolitan city. Drugs common in use are brown sugar, charas, ganja, sedative & hypnotics, LSD etc. It is descriptive cross-sectional study conducted at drug de-addiction centre of NGO which is situated at 3 sites of a metropolitan city.  The study population comprised of male drug abusers enrolled at Drug De-addiction Centre of a NGO. Approximately 30% of total population catered by NGO was enrolled for the study by purposive method sampling. The mental health was assessed by DAST-20 scale. Maximum population was less than 40 years of age and was Muslim by religion. Most of the people were educated upto secondary level. Maximum participant were having drug addiction of brown sugar followed by charas. More than 50% of the participant were polysubstance users. Maximum participant start abusing the drug for the sake of self-enjoyment followed by to get hooked up. Maximum participant gave history of paid sex and were heterosexual in sexual orientation.

Green tea, derived from Camellia sinensis, is renowned for its potential health benefits, attributed to its polyphenolic compounds, particularly catechins like epigallocatechin gallate (EGCG). This study investigates the effects of green tea consumption on blood glucose and inflammation markers in a sample of 50 participants. Each participant’s blood glucose and inflammatory marker levels (such as C-reactive protein) were measured before and after a 12-week daily consumption of green tea (two 200 mL servings). This quasi-experimental study aims to determine the efficacy of green tea in modulating blood glucose levels and reducing systemic inflammation, factors closely associated with metabolic syndrome, diabetes, and cardiovascular diseases. Statistical analyses, including paired t-tests, were conducted to compare pre- and post-intervention levels. The findings reveal significant reductions in fasting blood glucose and inflammatory markers, suggesting a positive impact on metabolic health and a potential preventive effect against chronic diseases. The results support the inclusion of green tea as a complementary dietary strategy in managing blood glucose and inflammation. However, further research is recommended to examine the long-term benefits and mechanisms of green tea’s bioactive components on metabolic pathways.

Introduction: Neonatal seizures, a prominent concern in neonatal neurology, represent an urgent clinical condition frequently stemming from various biochemical, structural, or infectious etiologies. The study, conducted at Government Medical College and Bangar Hospital, Pali, Rajasthan, investigates the biochemical profile of neonates presenting with seizures to aid in the early detection and management of underlying metabolic disturbances. Methods: The study involved 1487 newborns admitted between June 2023 and May 2024, among whom 128 (8.6%) presented with or developed seizures. Data was systematically recorded, capturing each neonate’s clinical history, maternal obstetric background, and onset details. Biochemical profiles, including glucose, calcium, sodium, magnesium, potassium, and phosphorus levels, were measured, with abnormal values indicative of potential seizure-related metabolic disturbances. The study distinguished primary metabolic seizures from those secondary to other etiologies, such as hypoxic-ischemic encephalopathy (HIE), intracranial hemorrhage (ICH), sepsis, and meningitis. Results: Among the 128 neonates with seizures, HIE emerged as the leading etiology, accounting for 44.53% of cases, followed by primary metabolic disturbances (17.96%) and ICH (14.84%). Metabolic profiles revealed that 54% of neonates with seizures exhibited biochemical abnormalities, with hypocalcemia as the predominant disturbance in 56.52% of primary metabolic cases. Hypoglycemia was the next most frequent abnormality, constituting 17.39% of primary metabolic seizures. Notably, the incidence of seizures was higher in outborn neonates (70.31%) than in inborn neonates (29.68%), which may reflect limited perinatal care access in rural areas and higher rates of home deliveries. Subtle seizures were the most common type, observed in 46.09% of cases, followed by focal clonic (16.41%) and generalized tonic seizures (13.28%). Hypocalcemia and hypoglycemia were also significant in non-metabolic seizures associated with HIE, ICH, and other non-metabolic etiologies. Male neonates showed a higher incidence of seizures (59.38%), aligning with previous research highlighting increased neurological vulnerability in male infants. Conclusions: The findings underscore the importance of prompt biochemical screening in neonates with seizures, as metabolic abnormalities like hypocalcemia and hypoglycemia are common and potentially modifiable contributors. The study’s insights support the necessity for heightened neonatal monitoring, especially in outborn neonates from underserved regions. Furthermore, the predominance of HIE and metabolic abnormalities as seizure etiologies suggests that improving perinatal care quality and early intervention for metabolic disturbances could reduce neonatal seizure incidence and associated morbidities.

Introduction: Strabismus surgery improves the ocular alignment, cosmetic appearance and interpersonal interactions with elimination of diplopia and compensatory head posture. Strabismus can be caused due to sensory deprivation or motor causes which includes myogenic, neurogenic or neuro-muscular junctional causes. The age group of 1-6 years is important because binocular vision can be impacted by intervention. Complications like scleral perforation, lost muscle, anterior segment ischaemia, anterior segment infections, under-correction, over-correction, suture granuloma, dellen formation or diplopia can occur after strabismus surgery. Materials and Methods: We conducted a study on 80 eyes of 54 patients who attended the Paediatric ophthalmology and Squint clinic of the outpatient department of Regional Institute of Ophthalmology, Kolkata for a duration of 1 year. Preoperative details analysed were laterality, type of strabismus, amount of deviation, best corrected visual acuity (BCVA) before the surgery, presence of refractive error, amblyopia, and binocular single vision (BSV). Cover uncover test was done, Prism bar cover test (PBCT) both for distance and near was done in primary position, up gaze and down gaze to measure the amount of correction required and Worth 4 dot test and Synaptophore test was done to check BSV. The optimum BCVA was documented at 2 weeks before the surgery. Intraoperatively, Forced Duction Test (FDT) was done to rule out restrictive squint, number of muscles operated upon was also noted. Postoperative details analysed were residual magnitude of strabismus (if any), BCVA and presence of complications (for example diplopia, over-correction, under-correction, or any local complications). Outcome at 6 months was classified as straight (orthophoria), under correction or overcorrection. All patients with a postoperative deviation < 10 prism dioptres (PD) at 6 months were considered to have a successful outcome (orthophoria). Postoperative BCVA was also documented. Results: This study was conducted on 80 eyes, among which we have complete data on 77 eyes. Male and female patients were almost equal Esotropia was more common (52.5%) than exotropia (47.5%). 83.75% patients achieved satisfactory alignment at 6 months post-operative follow-up. 75% patient achieved visual acuity of 6/12 or better.  We observed suture granuloma in 5% of patients. There was under-correction in 12.5% patients but no over-correction was there. Diplopia was observed in 2 patients at 6 months follow-up. We have noticed association between age of surgery and post-operative visual outcome, in our study there was better visual prognosis among the younger age groups. We have also experienced association between age of surgery and postoperative residual angle of deviation. There was association between pre-operative angle of deviation and post-operative angle of deviation.

Background: Adnexal masses in pregnancy are rare and found incidentally. Advances in ultrasound technology enable us to detect adnexal masses in pregnancy. Incidence of adnexal masses in pregnancy is around 1%. Most of the adnexal masses in pregnancy are asymptomatic, functional and resolve spontaneously. The risk of malignancy of adnexal masses in pregnancy is low and advances in ultrasound help us to assess the risk. Management of adnexal cysts depends on size of the cysts. Methods: This is a retrospective observational study done at PMCH & RI for a period of 18 months. The data was collected through predesigned proforma by reviewing medical records and analysed. Results: All of them belonged to 20-35 years age group. All of them diagnosed during routine antenatal ultrasound and had regular follow-up. All of them were asymptomatic during pregnancy. All the 7 cases had caesarean section along with cystectomy and postoperative period was uneventful. Histopathological report showed 4 mucinous cystadenoma, 2 serous cystadenoma and 1 corpus luteal cyst. None of them had maternal and neonatal complications. Conclusion: Most of the adnexal masses arising in pregnancy are probably benign in origin and can be managed expectantly if they are asymptomatic. Ultrasound is preferred first line investigation for diagnosing adnexal masses during pregnancy. MRI can be done in suspicion of malignancy. If surgery is indicated, laparoscopy is safe and feasible and can be done in second trimester.

Background: Diabetes mellitus, a metabolic dysfunctional group comprises of chronic hyperglycemia arising either due to defective insulin secretion, insulin action or both. The prevalence of diabetes is directly proportional to increasing age. The present study involves assessing the impact of Melatonin, and its combination with Biguanide (Metformin) on Reactive Oxygen Species in blood of rats with diabetes induced by Streptozotocin. Aim: To evaluate the effect of Melatonin and its combination with Metformin on Reactive Oxygen Species (ROS) in Streptozotocin induced T2DM rat model. Methodology: The current experimental investigation was carried out at the Department of Pharmacology and Therapeutics, King George’s Medical University, Lucknow. Adult male Wistar Rats were randomly divided into 5 groups, each group containing (n=6 rats) and assessed for 65 days. The study parameter used for assessment was- Reactive Oxygen Species (ROS) in response to monotherapy with Melatonin and Metformin and in combination with both Melatonin and Metformin in Streptozotocin induced diabetic rats. Results: The mean ROS level was assessed at Day 0 (Baseline), Day 36 and Day 65 (Final reading). On Day 65, the reduction in mean ROS was observed in all treatment groups, but statistically significant reduction was observed in combination therapy group (Metformin and Melatonin) as compared to baseline on Day 0 and to Group B (Diabetic Control) on Day 36. Conclusion: Based on current results the study concludes that Melatonin and combination with Metformin proved to be beneficial in restoring study parameter in blood samples of Type 2 Diabetes Mellitus in rats.

Introduction: Critical limb ischemia (CLI) is considered the most severe pattern of peripheral vascular disease. It is presents with chronic ischemic rest pain, ulceration or gangrene attributed to peripheral vascular diseases. Prostanoids are prostaglandin analogues which are potent vasodilators and inhibitors of platelet aggregation. In this study, this property has been utilized in treatment of limb ischemia. The aim of this study is to assess the role of prostaglandin in decreasing the amount of pain due to limb ischemia. Materials and Methods: A prospective single arm study with 30 patients underwent prostaglandin therapy for 9 to 12 weeks. 1ml of alprostadil (prostaglandin E1) is diluted in 4ml Normal saline to make it 5ml. 1 ml from the 5 ml is diluted in 500 ml ns and given as infusion for 8 hours for 5 days. 3 such cycles repeated. Pain is assessed using visual analog score before and after infusion. Patients present with claudicating pain with proven peripheral vascular diseases even on Doppler are taken into account. Results: The mean age of the study subjects was 58.13±13.29 years. Majority of 24(80.0%) patients were male and 6(20.0%) were female. The mean VAS score was 8.13 with a standard deviation of 1.04. After the infusion, the mean score significantly decreased to 2.8 with a standard deviation of 1.54. The p-value of <0.0001 indicates that this reduction in pain scores was statistically significant, demonstrating a considerable decrease in pain following the infusion. Conclusion: The study demonstrates that IV infusion of PGE1 is effective in significantly reducing pain associated with limb ischemia. The findings suggest that PGE1 not only alleviates pain but also has potential implications for reducing amputation rates and promoting ulcer healing.

Background: Haemorrhoids are one of the commonest ano-rectal problems worldwide. Open haemorrhoidectomy and MIPH are the currently available surgical interventions in the management of haemorrhoids. The aim of our study is to evaluate the effectiveness of MIPH over Open haemorrhoidectomy. Method: 60 cases were selected on the basis of inclusion criteria & divided into two groups of 30 each. MIPH was done in one group and Open Haemorrhoidectomy in other group .The duration of study was one year. The duration of Post-operative pain, Complications, Level of satisfaction was documented. Result: MIPH is a safe and effective procedure for grade 3rd & 4th haemorrhoids. Duration of hospital stay and post-operative complications are less and hence return to work is earlier. Conclusion: MIPH can be considered as a procedure of choice in patients presenting with grade 3^rd & graden4th haemorrhoids.

Background: Dengue fever is a prevalent mosquito-borne viral illness with the potential for severe complications, including hepatic involvement. Elevated aminotransferase levels (AST/SGOT and ALT/SGPT) have been observed in dengue patients, and this study aims to investigate their correlation with disease severity and assess their potential as prognostic markers. Aim and Objectives: To measure AST and ALT levels in confirmed dengue patients, observe clinical outcomes in those with elevated levels, and evaluate the prognostic value of these enzymes for severe dengue. Materials and Methods: A hospital-based observational study was conducted at Gandhi Medical College and Hamidia Hospital, Bhopal, over one year. One hundred and fifty-one patients aged 14 years and older with confirmed dengue (positive for NS1 antigen by ELISA or rapid antigen detection kit) were included. Demographic data, clinical presentation, laboratory parameters (including complete blood count and liver function tests), and disease severity (classified according to WHO guidelines) were recorded. Patients were monitored in three phases of illness—febrile, critical, and convalescent—with serial assessments of aminotransferase levels. Statistical analysis was performed to assess correlations between aminotransferase levels and disease severity, and receiver operating characteristic (ROC) curve analysis was used to evaluate their predictive value for severe dengue. Results: A high prevalence of elevated aminotransferase levels was observed in dengue patients, with SGOT more frequently elevated than SGPT. Elevated aminotransferase levels were significantly associated with prolonged hospital and ICU stays, indicating their potential utility as prognostic markers. Significant correlations were found between elevated AST/ALT levels, thrombocytopenia, and severe clinical manifestations, including plasma leakage, severe bleeding, and organ dysfunction. Conclusion: Elevated AST and ALT levels are common in dengue patients and are associated with increased disease severity and prolonged hospitalizations. These findings suggest that aminotransferase levels could serve as valuable prognostic markers in identifying patients at higher risk for severe dengue. Routine liver function assessment and haematological monitoring are recommended for early identification and improved management of high-risk dengue patients.

Objective: To evaluate the impact of diabetes and chronic kidney disease (CKD) on outcomes of active surveillance (AS) in patients with small renal masses (SRMs), focusing on tumor progression, renal function decline, and the need for delayed intervention. Methods: A cohort of 55 patients with SRMs was observed from 2022 to 2024, with groups categorized by diabetes, CKD, both, or neither. Baseline demographic, clinical, and tumor data were collected. Tumor progression, renal function, and intervention rates were compared across groups using survival analysis and statistical tests. Results: Tumor progression occurred in 32.7% of the cohort, with higher rates in patients with diabetes and/or CKD (approximately 40%) than in those without (10%). Patients with diabetes or CKD showed a shorter mean time to progression and a higher need for delayed intervention (25.5% overall). Renal function declined significantly more in patients with comorbidities, with eGFR reductions of over 10 mL/min/1.73 m². Conclusion: Diabetes and CKD significantly impact AS outcomes, with increased tumor progression, faster renal function decline, and a greater likelihood of delayed intervention. Tailored AS protocols for patients with these comorbidities may improve patient outcomes.

Background: Effusive-constrictive pericarditis (ECP) is traditionally diagnosed by using the expensive and invasive technique of direct pressure measurements in the pericardial space and the right atrium. The aim of this study was to assess the diagnostic role of echocardiography in tuberculous ECP. Methods: Intrapericardial and right atrial pressures were measured pre- and post-pericardiocentesis, and right ventricular and left ventricular pressures were measured post-pericardiocentesis in patients with tuberculous pericardial effusions. Echocardiography was performed post-pericardiocentesis. Traditional, pressure-based diagnostic criteria were compared with post-pericardiocentesis systolic discordance and echocardiographic evidence of constriction. Results: Thirty-two patients with tuberculous pericardial disease were included. Sixteen had ventricular discordance (invasively measured), 16 had ECP as measured by intrapericardial and right atrial invasive pressure measurements and 17 had ECP determined echocardiographically. The sensitivity and specificity of pressure-guided measurements (compared with discordance) for the diagnosis of ECP were both 56%. The positive and negative predictive values were both 56%. The sensitivity of echocardiography (compared with discordance) for the diagnosis of ECP was 81% and the specificity 75%, while the positive and the negative predictive values were 76% and 80%, respectively. Conclusion: Echocardiography shows a better diagnostic performance than invasive, pressure-based measurements for the diagnosis of ECP when both these techniques are compared with the gold standard of invasively measured systolic discordance.

Background: Intracerebral hemorrhage is associated with high morbidity and mortality worldwide accounting for 10-15% of all stroke types, so it requires a reliable prognostic marker which can predict the functional outcome. The Intracerebral haemorrhage (ICH) score was developed as a predictive tool for mortality at 30 days after hemorrhagic stroke Therefore, the present study was conducted to know study the ICH score as an outcome predictor in spontaneous intra cerebral hemorrhage.at tertiary care hospital. Material and Methods: The study was designed as a prospective observational study conducted at Department of Medicine, Pt. JNM Medical College and its associated Dr. BRAM Hospital and Department of Neurology DKS hospital Raipur. The study spanned from March 2023 to February 2024. The study population was 159patients with Intra Cerebral Haemorrhage. The statistical analysis done using MS Excel and epi info version 7. Results: The mean age of patients was 58.78 ±14.90 years. Among 159 patients, most of the patients were males 117 (73.58%) followed by females 42 (26.42%) ICH score increases mortality increase with significant difference. Conclusion: The present study concludes that there is a significant role of ICH Score as a predictor of outcome in Spontaneous Intra Cerebral Haemorrhage.

Background: Medication adherence among geriatric patients is crucial for effective management of chronic diseases and overall health outcomes. Adherence to medicine is an important aspect of enhancing quality of life and preventing difficulties associated with non-communicable diseases (NCDs) and long-standing diseases. This study aims to estimate the prevalence of medication adherence and factors affecting it in geriatric outpatients attending a secondary care center in South India. Materials and Methods: It was an observational cross-sectional study. A pretested and predesigned questionnaire along with the modified Morisky Medication Adherence Scale (MMAS) was used to collect the level of medicine adherence and factors affecting it. Results: 250 participants in the elderly group with chronic conditions were evaluated for their level of long-term drug compliance. The prevalence of good adherence to medication was 46%, moderate in 35%% and poor in 18% among the study subjects. Conclusion: Level of compliance is positively associated with higher educational status, living with spouse and family, < three medicines per day, and < two comorbidities.

Introduction: Lower respiratory tract infection (LRTI) includes all infections of the lungs and large airways below the larynx. On average, children <5 years of age suffer about 5-6 LRTI episodes per year. Aim: To study the clinical profile of LRTIs in PICU and paediatric wards of a tertiary care hospital. Materials and Methods: This was a prospective, analytic, hospital-based, descriptive, and non-interventional study done on LRTI children aged 1–72 months. A total of 31 patients fulfilling the inclusion criteria were included in this study. A proper history and clinical examination with more emphasis on the respiratory system was carried out. Investigations such as CBC, ESR, CRP, and chest X-Ray were done. Descriptive statistics were done. Results: There were a total of 16 (51.6%) male and 15 (48.4%) female participants. Thirty (96.8%) patients had cough and fever. Rapid breathing or difficulty in breathing was present in 19 (61.3%) patients. Ten (32.3%) patients had respiratory distress. Twenty-three (74.2%) patients had abnormal respiratory system. There were 21 (67.7%) patients who had raised ESR>20.  Nineteen (61.3%) patients had raised CRP>6. According to the final diagnosis, there were 18 (58.1%) patients who had broncho-pneumonia, 6 (19.6%) had bronchiolitis and 1 (3.2%) patient had bronchitis. Conclusion: Bronchopneumonia is the predominant form of presentation in infants and preschool children. The focus of health care services should be on the necessary components of LRTIs such as nutrition, immunization, and environment.

The aim of the present study was to assess the results of the Ilizarov external fixator in performing ankle fusion in 10 ankles. The Ilizarov fixator was applied in patients with severe soft tissue compromise and bone loss, patients with Charcot arthropathy, post-polio deformity with varus deformity, burns contracture with osteomyelitis of talus and unstable ankles. We describe our experience with this technique, including all functional and radiological outcomes in our tertiary care university hospital. Introduction: Ankle arthrodesis using the Ilizarov technique provides high union rate with the added benefits of early weight-bearing, and the unique advantage of its ability to promote regeneration of soft tissue around the bone, including skin, muscle and neuro- vascular structures, and its versatility to allow correction of the position of the foot by adjusting the frame post-operatively as needed. We describe our experience with this technique and the functional outcomes in our patients. Materials and Methods: This retrospective study was conducted in 8 ankle arthrodesis and 2 subtalar arthrodesis cases using the Ilizarov method in the years 2021 to 2023. We defined success in treatment by loss of preoperative symptoms and radiological union on plain radiographs of the ankle. Results: Fusion was achieved in all patients (100%). Immediate post-operative ambulation was with assisted weight bearing (FWB) in (80%) of the 8 patients and non-weight bearing (NWB) in 2 patients (20%). Post-procedure 1 patient (10%) of the participants who were assisted weight bearing required some form of support for walking for 2-3 weeks. Post-operatively 1 patient had pin tract infection requiring intravenous antibiotics. Radiological union took range of 12-20 weeks, mean union time was 8 weeks with mean radiological union rate of 100%. No patient required bone grafting due to bone loss. Average follow-up period was 10-45 months. Conclusion: The Ilizarov technique has a high union rate and leads to general favourable clinical outcome and may be considered for any Foot and ankle arthrodesis but is especially useful in complex cases such as for revisions, soft-tissue compromise, infection and in patients with risk for non-union. Early weight bearing is an extra benefit.

Infection following fracture fixation is a significant complication that can delay healing and impact patient outcomes. This study compares the efficacy and advantages of an indigenously prepared antibiotic rod versus a commercially available antibiotic rod in treating such infections. A technique with which antibiotic cement-coated interlocking intramedullary nails are prepared in the operating room with the use of nails and materials that generally are available is herein described, clinical outcomes, and potential benefits of the indigenously prepared antibiotic compared to premade antibiotic rod are highlighted. This technique was used in a series of 20 patients in 18 patient goal of union was achieved with control of infection, one patient had persistent nonunion, one had amputation. 2 patient (10%) had cement debonding during removal. control of infection and stability to promote union has traditionally been provided by 2 separate procedures, which have proved to be efficacious in this series with staged approach. Results which showed similar if not greater results with the indigenously prepared antibiotic rod to that of premade antibiotic rod when compared with the available literatures in indexed journals.

We present the case of a patient, aged 71, victim of a trauma by fall from height, with complaints of pain over right groin area associated with swelling and restriction of movements. The patient was unable to bear weight since the fall. Later on further investigation, he was diagnosed with right hip anterior dislocation along with intertrochanteric fracture of the ipsilateral femur. Under general anaesthesia, the hip dislocation was reduced and the intertrochanteric fracture was internally fixed with a dynamic hip screw. Radiological and functional evaluation was done at 4 months after surgery, using the modified Merle D’Aubigne hip score showed good result.

Background: Benign breast diseases (BBD) are a heterogeneous group of disorders significantly more prevalent than breast cancer. They represent a critical area of concern due to their high incidence and the anxiety they cause among patients. Understanding the clinico-pathological features of BBD is essential for accurate diagnosis and management. Methods: A prospective study was conducted on 60 female patients presenting with breast complaints at Govt. Medical College & Hospital, Kota, from February 2020 to December 2021. Detailed history, clinical examination, and relevant investigations including Fine Needle Aspiration Cytology (FNAC) and mammography were performed. Surgical interventions were carried out when indicated, and excised specimens were subjected to histopathological examination. Results: The most common BBD was fibroadenoma (48%), followed by fibroadenosis (30%). The majority of patients were between 21-30 years of age. The right breast was more frequently involved (61.66%), with the upper outer quadrant being the most common site (38.33%). Lump in the breast was the predominant symptom, with 50% presenting with painless lumps. Surgical excision was the mainstay of treatment in 83.33% of cases. Histopathological examination confirmed the clinical diagnoses. No recurrences were noted during the follow-up period. Conclusion: Fibroadenoma and fibroadenosis are the most common benign breast diseases among women in the reproductive age group. Clinical examination, supported by imaging and histopathology, is crucial for accurate diagnosis. Surgical excision remains the primary treatment modality, with excellent outcomes.

Background: Percutaneous nephrolithotomy (PCNL) is a common surgical procedure for removing kidney stones larger than 2 cm. Postoperative complications such as systemic inflammatory response syndrome (SIRS) and sepsis are significant concerns. Biomarkers like neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), and lymphocyte–monocyte ratio (LMR) may help to predict these complications. Methods: In this prospective observational study, 100 patients undergoing PCNL were evaluated. Preoperative NLR, PLR, and LMR were calculated from routine blood tests. Stone characteristics and intraoperative factors were recorded. Postoperative SIRS and sepsis were defined using standard criteria. Statistical analyses included univariate and multivariate analyses to identify predictors of SIRS and sepsis. Results: Out of 100 patients, 11% developed SIRS and 4% developed sepsis post-PCNL. Patients with SIRS had significantly lower hemoglobin levels, higher total leukocyte counts, higher NLR and PLR, and lower LMR (p < 0.05). Staghorn stones and longer operative times were also associated with increased risk of SIRS. On multivariate analysis, elevated preoperative TLC, NLR, PLR, and low LMR were independent predictors of SIRS. ROC analysis identified optimal cut-off values for NLR (>2.03), PLR (>110.62), and LMR (<3.23) in predicting SIRS. Conclusion: Preoperative NLR, PLR, and LMR are independent, accessible, and cost-effective biomarkers for early identification of patients at risk of post-PCNL SIRS and sepsis. Patients exceeding these cut-off values should be monitored closely for postoperative infective complications.

Background: Facial nerve paralysis is a disorder that severely affects a patient’s quality of life causing severe emotional, social and vocational handicaps. The diverse aetiological factors make it a huge diagnostic challenge for doctors. It is important to understand the cause and nature of the disease to treat and rehabilitate patients with facial nerve paralysis. Aim: To analyse the aetiological profile of acquired lower motor neuron facial paralysis and to study the socio-demographic characteristics of the patients, grade the disease severity and assess the outcome in disease progression following various treatment modalities. Methods: A prospective, longitudinal and descriptive study of 18 months duration conducted in 86 patients who presented with LMN facial nerve paralysis. After history taking and clinical examination, including severity grading using House-Brackmann grading system, patients were investigated and treated with appropriate medical and surgical modalities. The recovery status of patients was assessed after 1,3- and 6-month follow-up by grading the improvement with House Brackmann grading system. Results: Of the 86 patients with acquired lower motor neuron facial paralysis, Bell’s palsy was the commonest followed by temporal bone trauma. Most cases presented with House-Brackmann Grade III stage. Majority of the cases were managed conservatively with steroids and physiotherapy. Surgical management included facial nerve decompression, nerve grafting, tumour excision and modified radical mastoidectomy for disease clearance. Most of the cases showed a complete recovery of facial function by six months with Bell’s palsy having the best prognosis. Conclusion: Among the causes of peripheral facial nerve paralysis, Bell’s palsy and post-traumatic facial paralysis were the commonest. While most cases can be managed conservatively, some need careful evaluation and early surgical intervention for a complete or partial recovery.

Introduction: Trauma is the leading cause of death in people under the age of 45 years and is among the top three leading causes of death in all age groups. Aim: To investigate the epidemiology, diagnosis, and management of splenic trauma patients in a tertiary care hospital. Methodology: The prospective and observational study was conducted in the Department of Surgery at R.N.T. Medical College, Udaipur, and Rajasthan. The study was planned during the period of February 2023 to July 2024 with the approval of the institutional ethical committee. Result: The study found that the majority of patients with splenic injuries were young, primarily due to road traffic accidents (73.6%), with significant morbidity and mortality linked to delayed hospital admissions, while pain was the most common symptom; overall mortality was 5.2%, with two high-grade cases dying within a week despite intensive care. Conclusion: Splenic injuries primarily affect young individuals due to trauma, with timely transport and tailored management crucial for improving outcomes, as non-operative approaches are effective for lower grades while higher grades often necessitate surgery.

Introduction: Cholelithiasis is one of the commonest biliary tract diseases worldwide. Aim: To evaluate preoperative factors and operative findings associated with difficult laparoscopic cholecystectomy in patients with cholelithiasis and gallbladder polyp disease. Methodology: A study was conducted involving 161 patients who were scheduled to undergo laparoscopic cholecystectomy for gallstone disease and gallbladder polyps at the Department of General Surgery, Maharana Bhupal Government Hospital & RNT Medical College, Udaipur, Rajasthan, from November 2023 to June 2024. Result: In our study of 161 patients, significant factors influencing surgical outcomes included age, history of hospitalisation for acute cholecystitis, gallbladder wall thickness, presence of pericholecystic fluid and adhesions, with a notable correlation between these factors and increased difficulty in laparoscopic cholecystectomy, supported by a scoring system that predicts surgical challenges with high sensitivity and specificity. Conclusion: Our study highlights that while laparoscopic cholecystectomy is generally safe, factors such as history of cholecystitis, palpable gallbladder, gallbladder wall thickness, pericholecystic fluid, intraperitoneal adhesions, and high BMI significantly influence surgical difficulty and conversion rates, thereby enhancing preoperative assessment and decision-making.

The facial nerve which is the seventh cranial nerve, comprising of motor, sensory and parasympathetic components is responsible for voluntary facial movement, taste to the anterior two-thirds of the tongue; and control of salivary and lacrimal gland secretions. Bell’s palsy obtains its name from Sir Charles Bell, (1774-1842). Sir Charles Bell first described the syndrome along with the anatomy and function of the facial nerve. Bell’s palsy is a common, idiopathic, acute, cranial mononeuropathy, affecting males and females equally. It has a slightly higher incidence in men above 40 years of age and in women younger than 20 years of age. The incidence ranges from 11.5 to 40.2/100,000. Individuals with Diabetes Mellitus, arterial hypertension, immunocompromised patients, patients who have had a viral upper respiratory tract infection; and pregnant woman are at greater risk of Bell’s palsy. We present here two unusual cases of Bell’s palsy. The first case was in a 45 year old lady who presented with grade IV House Beckmann facial nerve palsy. The likely aetiology was local anasthesia injection trauma for removal of 16 impacted molar tooth due to aberrant facial nerve pathway but was unlikely due to the delayed presentation. She was managed with oral corticosteroids, valacyclovir and lubricants to prevent eye dryness. The second case was in a 17 year renal transplant recepient on immnuosuppressants, who presented with painful swelling of parotid gland. MRI revealed parotid necrosis with the swelling extending into the retropharyngeal space. He was managed with injectable antibiotics, valacyclovir and reduction in dose of immunosuppressants. Both cases were managed successfully in our tertiary care centre and were discharged after complete recovery.

Background: Salivary stones are calcified structures most often found in the salivary gland duct. Submandibular gland and its duct is most commonly affected. Biochemical analysis of these stones may help in understanding the etiopathogenesis more effectively. Materials and Methods: Submandibular gland sialoliths(n=28) were collected at the Dept of ENT & HNS, AIIMS, Udaipur between October 2023 and September 2024. Subsequently the biochemical composition of the stones was determined by FT-IR Spectrometry and data was statistically analysed. Results: Biochemical analysis of the stones suggested that carbonate apatite was the chief element found in almost 85.7% followed by proteins. Conclusions: Knowledge of biochemical composition of salivary sialoliths is essential for understanding their etiopathogenesis.

Introduction: All acute ischemic stroke patients won’t respond to IV Thrombolysis, as only half of the patients achieve recanalization. A reliable scoring for prediction of outcome of acute ischemic stroke patients treated with IV alteplase would be useful for following reasons: 1) early estimation of prognosis and 2) early identification of patients who have a very high likelihood for a poor outcome despite IV thrombolytic treatment. One such reliable scoring system is DRAGON score. Our aim is to predict outcome in acute ischemic stroke patients who have been thrombolysed using DRAGON SCORE which is simple, fast and cost-effective. Objective: To assess the reliability of the DRAGON score in predicting the functional outcomes in ischemic stroke patients treated with intravenous (IV) alteplase. Methodology: This cross-sectional analytical study included 44 patients with acute ischemic stroke who were treated with IV thrombolysis at the Department of Neurology, TVMCH, between April 2022 and October 2023. Key pre-treatment variables such as computed tomography (CT) findings, baseline National Institutes of Health Stroke Scale (NIHSS), age, blood glucose levels, and onset-to-treatment time were evaluated to derive the DRAGON score. The primary outcome was the modified Rankin Scale (mRS) score at discharge, which was correlated with the initial DRAGON score to predict functional outcomes. Results: The DRAGON score, a 10-point scale based on CT findings, NIHSS, and other clinical parameters, demonstrated a significant correlation with functional outcomes at discharge. Patients with lower DRAGON scores (<4) were associated with favourable outcomes (mRS ≤3), while those with higher scores (>7) were more likely to experience poor recovery or death. The area under the curve (AUC) for predicting favourable outcomes was 0.768, with a sensitivity and specificity of 75%. Conclusion: The DRAGON score is a simple, quick, and cost-effective tool for predicting the outcome of ischemic stroke patients treated with IV alteplase. It can help in early decision-making, particularly in identifying patients who may benefit from additional interventions like mechanical thrombectomy. Further studies with larger sample sizes are necessary to validate these findings and assess long-term outcomes.

Introduction: Postmenopausal bleeding is bleeding from the reproductive system that occurs one year after menstrual periods have stopped. Bleeding from the genital tract occurring after the menopause is much more sinister than premenopausal bleeding. The main objectives in the diagnostic workup in postmenopausal women presenting with uterine bleeding is to detect or rule out endometrial cancer or atypical hyperplasia, further referred to as (pre) malignancy of the endometrium. Aims and Objectives: 1. To determine the causes of postmenopausal bleeding from endometrial histopathology. 2. To correlate between the histopathological report of endometrial biopsy and surgical specimen. 3. To evaluate the relation between age, parity, post-menopausal bleeding duration, endometrial thickness, uterine size, body mass index, and medical disorders in women presenting with postmenopausal bleeding versus the risk of endometrial hyperplasia and cancer. Methodology: This is a study, on histopathology of endometrium in postmenopausal bleeding women and its clinical correlation, undertaken in the department of obstetrics& gynecology over a period of 6 months. Results: 30 women presented with PMB out of which 3 were endometrial cancer, 13 cases were EH without atypia, 9 cases were EH with atypia and 5 cases of endometrial atrophy. Conclusion: In my study positive correlation was found with risk factors, in women with premalignant and malignant lesions.

Background: Systemic lupus erythematosus (SLE) as a multisystem autoimmune disorder has diverse phenotypic expression affecting any organ system. Kidney, heart and pulmonary system are the most frequently affected organ in systemic lupus erythematosus. Objectives: The objectives of the study is to measure serum uric acid level in patients with systemic lupus erythematosus and to study correlation of serum uric acid level with pulmonary artery pressure in SLE patients. Methodology: This Hospital based case control study includes 40 patients of SLE. All patients of SLE admitted in our hospital and attending O.P.D. were included. Pulmonary artery pressure in patients was measured by echocardiogram. Blood samples was taken from each patient. Serum uric acid was measured by Kit. Duration of illness was extracted from patients’ records. The relationship of serum uric acid level with pulmonary arterial pressure and duration of the disease was evaluated. Results: In our study, maximum 67.50% patients were from 21-40 yrs age group followed by 20.00% patients in 41-60 yrs age group , 7.5% patients were from >60 yrs age group and 5.00% . Serum uric acid level was significantly higher in PAH patients (10.74±1.97 mg/dl) as compared to patients without PAH (6.42±2.02 mg/dl). Serum creatinine level was significantly higher in PAH patients (2.32±2.05 mg/dl) as compared to patients without PAH (1.30±0.74 mg/dl). 45.00% patient’s EF was more than 55% , followed by 22.50% patients with EF 46-55%, 20.00% patient’s EF was 35-45% and 12.50% patient’s EF was <35.00. The EF was lower in patients with PAH (44.91±9.32%) as compared to patients without PAH (46.65±10.32%). This difference was statistically insignificant. The association between EF and serum uric acid was found to be statistically insignificant. Conclusion: We conclude that serum uric acid is strongly associated with development of PAH in SLE patients. SLE patients with increased serum uric acid level are likely to have PAH and patients with normal serum uric acid level are likely to have normal pulmonary artery pressure. Being a low cost test and easily done everywhere, serum uric acid estimation will help to reduce clinical demand for echocardiography in SLE patients with normal uric acid levels.

Background: Acute ischemic stroke (AIS) is defined by the sudden loss of blood flow to an area of the brain with the resulting loss of neurologic function. Stroke is the second most common cause of death and disability-adjusted life years worldwide. Albumin is mainly synthesized in the liver and classified as a non-glycosylated plasma protein and is involved in the transport of small molecules, is used as a co-factor in different essential pathways, and contributes as a major force in limiting fluid leakage from vascular compartment into the interstitium, also offers neuroprotective effect. This study is undertaken to study the correlation between Serum Albumin Levels and In-Hospital Outcome in Acute Ischemic Stroke Subjects. Method: Longitudinal observational study was done for a period of 1 year in KR Hospital, Mysore in 30 acute ischemic stroke patients who met inclusion and exclusion criteria. After taking institutional ethical clearance the nature of study was explained to patient and patient party and written informed consent taken. Clinical and demographic profile at the time of admission were recorded and laboratory investigations (CBC, LFT, RFT, S/E, RBS, Lipid profile, NCCT Head, ECG, 2D Echo) were performed within 24 hours of admission. Neurological status at the time of admission were assessed using NIHSS and were classified into 4 categories (Minor, Moderate, Moderate-severe, Severe). Functional outcome was assessed on day 7 of admission using mRS (modified Rankin scale) and were divided into 2 categories (Poor outcome, Non poor outcome). The outcomes were correlated with serum albumin level. Result: In the present study, Out of the 30 subjects, 60% were males and 40% were females. Majority of the patients belonged in 41-60 years age group (53.3%). Hypertension was the most common risk factor observed in the study (70%). Most of the cases were in NIHSS Moderate-severe category (33.3%). Serum albumin levels at the time of admission were shown to have inverse correlation with severity at admission and outcome at day 7. Conclusion: The findings in present study suggest that there is an inverse correlation between serum albumin and outcome in patients with acute ischemic stroke. It also shows that low admission levels of serum albumin correlates with high NIHS scores indicating severity of stroke. Serum Albumin level can be used as cost effective marker for prognostication in acute ischemic stroke patients.

Introduction: Urinary tract stone disease is a prevalent condition, and there are numerous treatment options available. ESWL is a safe, effective method to treat urinary lithiasis. ESWL is usually an outpatient procedure. The success rate in ESWL depends on stone location, size, number, and fragility as well as calyceal anatomy and patency of the urinary tract. ESWL as a modality was recommended for stones less than 2 cm in size. Based on this aim of our study is to investigate the effectiveness of ESWL in treating upper urinary tract stones under 2 cm in size and also to investigate the variables affecting ESWL in upper urinary tract stone treatment outcomes. Methodology: We did this study as Single centre, Cross sectional study. Patients with upper urinary tract stones in the Department Of Urology, Tirunelveli Medical College Hospital, and Tirunelveli for period of 24 months, and our study included as many patients during the study period (100 patients). Patients of age group above 18 years irrespective of sex and patients with upper urinary tract stones less than 2 cm in size were included. Patients less than 18 years of age irrespective of sex, Non consenting patients, Upper urinary tract stones > 2cms ,pregnant women , with bleeding diathesis and with distal obstruction were excluded. Results: In our study population in 74 patient’s treatment with ESWL was success and in rest, 26 were failure, in our study, most commonly age range was from 30-35 years, with no impact on outcome. In our study population, 56 patients were male and rest 44 patients were female. Mean BMI was more in patients who had failure in outcome. Same with stone size and Hounsfield units. Higher the values of stone size, skin to stone distance, Hounsfield units poorer the outcome. Hydronephrosis was present in three patients. Number of sitting was once in 62 patients and twice in 38 patients. Conclusion: From our study, we concluded that predictive factors taken separately couldn’t identify all patients who are likely to benefit from ESWL and exclude those that will have an unfavourable outcome. A modern approach should be used combining various factors, including stone location, size, skin-stone distance, BMI, and stone density.

Introduction: Medical education is evolving from traditional lecture-based methods to more innovative, active learning strategies. One such approach is model making, which allows students to create tangible representations of pharmacological concepts. Aim and Objective: The study aimed to assess the perception of 2nd-year medical students regarding model making as a tool for enhanced learning in Pharmacology. Methodology: A cross-sectional study was conducted among 97 voluntarily participating 2nd-year MBBS students at a tertiary care teaching hospital. Students were divided into ten groups and tasked with creating models on pharmacology-related topics. A structured questionnaire was administered after a model-making competition to assess student perceptions. Data were analyzed as frequencies and percentages. Results: Ninety-four percent of student’s perceived model making as an innovative method of learning pharmacology. A total of 90.7% agreed that it significantly improved their understanding of pharmacological concepts. Around 91.8% stated that model making enhanced their retention of knowledge, and 87.6% felt more confident in applying the concepts learned. Additionally, 89.7% of students found the learning method enjoyable, and 87.6% recommended its application in other medical subjects. Conclusion: Model making as a learning tool in pharmacology was well-received by students, who reported improvements in understanding, knowledge retention, confidence, and enjoyment. The findings suggest that integrating model-making into the pharmacology curriculum could enhance the overall learning experience and foster a more interactive, student-centered educational approach.

Introduction: Haemorrhoids, or piles, are common anorectal issues affecting many people globally. AIM: To evaluate the clinical presentation, grading, and efficacy of various surgical procedures in the management of haemorrhoids. Methodology: A study was carried out, and it included 62 indoor haemorrhoid disease patients who will undergo sclerotherapy, MIPH, and haemorrhoidectomy in the Department of General Surgery at RNT medical college, and associate Maharana Bhopal Government, hospital Udaipur Rajasthan During the period of Sept 2023 to July 2024. Result: In our study of 62 patients with varying grades of haemorrhoids, Grade III was most prevalent, with MIPH being the most common surgical treatment, leading to quicker recovery and lower pain compared to conventional methods. Conclusion: In conclusion, early Grade I and II haemorrhoids can be effectively managed conservatively, while late Grade II, Grade III, and IV necessitate surgical intervention, with MIPH providing a less painful and quicker recovery option than conventional surgery.

Introduction: Total Hip Arthroplasty (THA) is a common surgical intervention for patients with symptomatic osteoarthritis, aimed at alleviating pain and improving mobility. Accurate positioning of the acetabular cup and femoral stem is critical for the longevity and function of the implant. This study focuses on the radiological evaluation of acetabular and femoral component orientation in uncemented THA performed using the posterolateral approach. Objective: The primary objective of this study is to assess the accuracy of acetabular cup inclination and anteversion, along with femoral stem alignment, using radiological analysis, and to correlate these measurements with patient outcomes. Materials and Methods: This observational analytical study included 52 patients who underwent uncemented THA between January 2016 and October 2022. All surgeries were performed using the posterolateral approach. Radiographic evaluation was conducted to measure acetabular cup inclination, anteversion, and femoral stem alignment. Postoperative radiographs were analysed for each patient, and angles were calculated using specific radiological markers. Results: The average acetabular cup inclination was found to be within the safe range of 40°-45° in 82% of patients, while anteversion was between 15°-25° in 75% of cases. Femoral stem alignment was within 5° of neutral in 90% of patients. Mispositioning of components was associated with a higher incidence of complications such as dislocation and limb length discrepancy. Conclusion: The study highlights the importance of precise radiological evaluation in ensuring optimal implant positioning in THA. The majority of patients showed satisfactory alignment of both the acetabular cup and femoral stem, correlating with improved clinical outcomes. However, deviations from the ideal alignment can lead to postoperative complications, underscoring the need for careful intraoperative techniques and postoperative assessment.

Introduction: Perianal sepsis and anal fistulas present significant challenges in colorectal surgery, primarily affecting men aged 30 – 50 years. Aims& Objective: This study compared conventional surgeries, such as fistulectomy, with minimally invasive laser ablation techniques (LAFT) to evaluate effectiveness and patient satisfaction, with the aim of optimizing treatment outcomes while preserving sphincter integrity. Material & Method: A prospective comparative randomized hospital-based study conducted from July 2022 to June 2024, involving 48 patients aged 15-60. The participants underwent either conventional fistulectomy (with or without Seton) or laser ablation of the fistulous tract (LAFT) (isolated or with LIFT). Results: LAFT provided several advantages: shorter operative time (35.75 minutes), reduced hospital stays (2.38 days), lower pain levels (mean VAS 3.37), and quicker recovery (3.6 days). Wound healing was also faster (2.91 weeks), with minimal postoperative complications and no cases of incontinence. Conclusion: Although conventional fistulectomy had a lower recurrence rate, suggesting a higher primary success rate, the benefits of LAFT in terms of pain reduction and recovery time were significant. Therefore, while fistulectomy is effective for uncomplicated cases, LAFT presents a promising alternative that enhances patient satisfaction and outcomes, warranting its early incorporation in treatment protocols for anal fistulas.

Introduction: Pilonidal sinus disease is prevalent in young adults and is often linked to factors such as hirsutism and prolonged sitting, which can lead to chronic inflammation in the sacrococcygeal region. Aim: To compare the effects and outcomes of the Karydakis procedure versus Rhomboid excision with Limberg Flap in the treatment of uncomplicated sacrococcygeal pilonidal sinus disease. Material and Methods: This study was conducted at JLN Medical College, Ajmer, from June 2022 to June 2024, and compared the Karydakis flap and Limberg flap surgical techniques. Eighty patients were randomized into two groups: 40 patients who underwent the Karydakis flap and 40 who underwent the Limberg flap. Results: Key outcomes such as operation time, intraoperative blood loss, postoperative complications, pain scores, healing time, and recurrence rates were assessed. The results indicated that both procedures were effective however, the Limberg flap provided better postoperative pain reduction, quicker recovery and fewer complications. Patient satisfaction was also higher with the Limberg flap, particularly in terms of comfort and cosmetic results. Although the Karydakis flap had a shorter operation time, it resulted in longer hospital stays and more postoperative discomfort. Conclusion: This study concluded that the Limberg flap is preferable for faster recovery and better outcomes, and further research is needed for comprehensive validation.

Aim: To study the surgical management in relation to etiological factors of intestinal obstruction. Materials and Methods: The prospective study was conducted on 50 patients of intestinal obstruction admitted to various surgical wards in ESIC Medical College & Hospital, Kalaburagi from October 2023 to October 2024. Result: Intestinal obstruction was more common (58%) in the age group of 30-60. Small bowel obstruction was more common than large bowel obstruction. Most common etiological factor for intestinal obstruction was adhesions (42%) due to postoperative and inflammatory causes. Other causes of intestinal obstruction included hernia (20%), malignancy (16%), intestinal tuberculosis (14%), and volvulus (8%). Rare causes of intestinal obstruction in this study were found to be carcinoid tumor of the small intestine. Mortality rate was 10% in this study. Conclusion: This study concluded that pattern of intestinal obstruction varies from the previous studies with less mortality.

Aim: The aim of the present study was to evaluate the role of Alvarado score and changes in C-reactive protein, S. bilirubin and MPV in preop diagnosis of acute appendicitis. Materials and Methods: This prospective, analytical study was conducted in the Department of General Surgery, Civil Hospital and B.J. Medical College, Ahmedabad from October 2023 to October 2024. 100 patients were selected for this study as per the inclusion and exclusion criteria, with age more than 8 years and right iliac fossa pain as the main complaint. Result: The maximum patients were in the age group of 11-30 years having 75 males and 25 females. In our study, the patients whose Alvarado score was 7 or more have the high chances of having the Acute Appendicitis. There was no significant relationship (p<0.01) between C-reactive protein, S. bilirubin and MPV with patients having Alvarado score more than 7. So, C-reactive protein, S. bilirubin and MPV are not a reliable marker in preop diagnosis of acute appendicitis. Conclusion: Alvarado score as scoring system is valuable and valid instrument of discrimination between acute appendicitis and non-specific abdominal pain. There is no role in combining the clinical (Alvarado score) and laboratory parameters for diagnosis of acute appendicitis.

Aim: This study aimed to prospectively assess the etiology of patients who undergone emergency laparotomy for non-traumatic indications. Materials and Methods: This study, on non-traumatic cause of exploratory laparotomy was conducted on 100 patients admitted in ESIC Medical College and Hospital Kalaburagi from November 2023 to November 2024. After stabilizing the patient initially, the other necessary investigations like basic radiological investigations and special radiological investigations were completed as per necessity, and patients were taken up for laparotomy under general anesthesia, depending on the suspected site of pathology and the general condition of the patient. Result: Abdominal pain was the most common (100%) presenting complaint and incidence of other clinical symptoms and signs were variable. Features of peritonitis like tenderness (100%) and guarding (98%) were present in every patient undergone emergency laparotomy. Intestinal obstruction was found to be affected all age group. The biggest incidence was found in age group of 41 to 50 years, mean age is of 46 years. The most common gastrointestinal tract cause of perforation were ileal perforations (46%) and most common cause for obstruction is obstructed umbilical hernia (21.6%). Wound infection (61%) was the most common postoperative complication followed by electrolyte imbalance (39%). The case fatality rate was highest for small bowel pathology (13%) followed by colon pathology (7.4%). Conclusion: This study concluded that emergency laparotomy for non-traumatic indications can be performed with lower morbidity and mortality.

Introduction: This research evaluates the safety and effectiveness of the Glaucoma therapies Timolol and Travoprost in patients with Primary Open Angle Glaucoma or Ocular Hypertension. Timolol were assigned to thirty patients while Travoprost were assigned to thirty patients. Methods: A total 60 patients enrolled in this study. They were divided in two groups, 30 patients in one group. These parameters studied in present study named as gender distribution, current complaints, hypertension, the laterality, age, visual acuity, cup disc ratio, intraocular pressure and side effects. Results: A Travoprost cohort shows a higher incidence of hypertension (P=0.038), greater decrease in intraocular pressure with Travoprost versus Timolol (P<0.05), and a time dependent reduction of the cup to disc ratio with Travoprost (P<0.05). Conclusion: Difference in age distribution, gender, side effects, laterality, and blood pressure have been observed between two groups. The Travoprost reduced intraocular pressure, cup to disc ration better than this drug, and may be a better therapy for management of glaucoma.

Background: Varicose veins can lead to various leg discomforts, though it is crucial to distinguish these symptoms from other potential causes of leg pain. Therefore, this study aimed to assess the clinical and radiological characteristics and outcomes of treatment in patients with lower limb varicose veins. Materials and Methods: The study included 56 patients diagnosed with varicose veins in the lower limbs. Comprehensive demographic and clinical data were collected for each patient. Radiological assessments were conducted to evaluate the condition. Treatment was administered based on the patient’s evaluation, either through conservative or surgical interventions. The patients were followed for up to one year, and all data were recorded in a Microsoft Excel sheet for statistical analysis using SPSS software. Results: Among the 56 patients evaluated, the mean age was 46.4 years, with 69.64% of the participants being male. Unilateral involvement was observed in 73.21% of cases. Clinical symptoms included dull, aching pain, non-healing ulcers, night cramps, and deep vein thrombosis. The common femoral vein was involved in 57.14% of patients. SPJ competency was noted in 26.79%, 16.07%, and 30.36% of patients with Class 2, Class 4, and Class 6 grades, respectively. Surgical procedures included SEJ flush with GSV stripping (60.71%), SEJ flush ligation with perforator ligation (12.50%), SEJ flush ligation (10.71%), and subfascial perforator ligation (10.71%). Post-surgical evaluation showed a significant relief of pathology in 87.50% of the patients. Conclusion: Varicose veins are characterized by the permanent enlargement and dilation of veins. Surgical intervention is recommended to prevent complications, such as ulceration, in the future.

Background: Laparoscopic Cholecystectomy (LC) has become the preferred approach for treating symptomatic gallstone disease. Numerous preoperative cholecystitis grading systems have been created to predict both intraoperative and postoperative outcomes; however, only a few of these systems address anatomical variations encountered during surgery. Furthermore, aside from identifying challenging cases, few of these grading scales have been utilized for comparing postoperative complications. To address these limitations, the Parkland Grading Scale for Cholecystitis (PGS) was developed to assess the severity of gallbladder (GB) disease. This study aims to prospectively validate the PGS as a tool for predicting LC outcomes. Materials and Methods: The study involved 156 patients undergoing laparoscopic cholecystectomy. The initial grade was determined solely based on the objective criteria outlined in the PGS and was assigned immediately after the initial view was observed. 5 independent surgeon raters, who were not involved in the original study, retrospectively reviewed the stored images from the study period. The cases were randomly assigned in equal numbers to each rater, who then evaluated the images using the PGS. Results: The average age of the patients in this study was 47.56 ± 17.54 years. The association between complications and PGS grades was not statistically significant. The majority of patients (67.31%) were classified under Grade 1, indicating relatively easier procedures. Grade 2 followed at 17.31%, reflecting moderate complexity. Grades 3, 4, and 5, indicating increasing levels of surgical difficulty, had lower frequencies, with Grade 3 at 7.69%, and Grades 4 and 5 at 3.85% each.  The mean surgical difficulty scores were 1.25 ± 0.34 for PGS Grade 1, 1.80 ± 0.77 for PGS Grade 2, 3.38 ± 0.69 for PGS Grade 3, 4.75 ± 0.74 for PGS Grade 4, and 5 ± 0.00 for PGS Grade 5.

Conclusion: The Parkland Grading Scale is a reliable tool for assessing the difficulty of laparoscopic cholecystectomy and predicting both intraoperative and postoperative complications. This scale provides a practical method for evaluating gallbladder diseases, which can assist in predicting LC outcomes, guiding case allocation based on surgical difficulty, and determining the need for conversion to open surgery.

Background: Cancer of breast is a second most common cause of cancer in women. Increase in cases of breast cancer is related to late marriage, birth of child in the later age, shorter period of breast feeding and nulliparity or low parity. Clinical examination in conjunction with fine needle aspiration cytology and mammography also known as ‘Triple Approach’ can divide almost all breast lesions preoperatively into benign and malignant categories. Many a times however, Aspiration cytology diagnosis can be substituted for biopsy diagnosis. It is therefore, very important to evaluate the efficacy of FNAC, which can be done by correlating cytological findings with histopathological diagnosis. Methods: This study comprises of fine needle aspiration cytology and its histopathological correlation in 40 cases of breast lesions. In patient having lump in breast FNAC was carried out in cytology, followed by histopathology was carried out in histopathology laboratory. Results: The benign tumors was most common and diagnosed with more accuracy followed by malignant tumors. Amongst the benign tumours, most common lesion was fibroadenoma. Amongst the malignant tumours, most common was invasive ductal carcinoma. Some inconsistent findings were observed mainly in atypical ductal hyperplasia versus chronic mastitis. Final diagnosis was confirmed by histopathology. Conclusions: Total 40 cases of various breast lesions were studied at tertiary care hospital by fine needle aspiration cytology and histopathology. Out of 40 cases the cyto-diagnosis were compatible with histology in 39 cases, 1 was incompatible with histopathological diagnosis. So, over all sensitivity was 97.3%, specificity 100%, positive predictive value 100%, negative predictive value 66.6%.

Introduction: In clinical practice gastrointestinal lesions are commonly encountered by physicians. The lesions may either belong to non-neoplastic or neoplastic category. Prompt detection of the lesions help in early management of the lesions successfully. Aim: To assess the epidemiology and prevalence of spectrum of neoplastic and non-neoplastic gastric lesions using histopathology. Materials and Methods: This cross-sectional, retrospective study was done for duration of 1yr in a Tertiary Care Centre from Feb 2023 to Jan 2024. 326 patients record from the Department of General Pathology along with paraffin embedded tissue blocks from resected specimens and biopsies of stomach. Results: 32% of patients were in the age range of 40-50years, the ratio of males was twice that of females (2:1). All specimens obtained in the current study were from resections, incisional and excisional biopsies. 73% were inflammatory lesions followed by 19% benign tumors and only 8% were malignant tumors. 68% of inflammatory gastric lesions occurred in the pylorus and antrum, 46% of benign gastric tumors occurred in fundus and cardia, and 71% of malignant gastric tumors occurred in pylorus and antrum. In inflammatory lesion 43% were chronic gastritis with H pylori, 78% benign gastric tumors were hyperplastic polyp and 71% of malignant gastric tumors were adenocarcinomas of which 65% were moderately differentiated adenocarcinomas. Conclusion: Histopathological evaluation still remains the gold standard used for accurate early detection of GI tract lesions especially malignant one hence it helps in their early management. Our study of gastrointestinal tract lesions throws a light on early diagnosis by histopathology beneficial for the patients.

Introduction: Although there are studies comparing various opioids and various dosages of fentanyl, studies comparing the two routes of administration, especially for total abdominal hysterectomy are very few. Methods: Inj. fentanyl 25µg (0.25ml) intrathecally and Inj. fentanyl 1µg/kg intravenously were compared.15 mg of 0.5% hyperbaric bupivacaine was used for spinal anaesthesia in both groups. Onset of sensory blockade, maximum level of sensory blockade attained, and the time taken for the same were noted. Time taken for onset of motor blockade, i.e., Bromage 6, and time taken to achieve maximum motor block, i.e., Bromage 1, were noted. Time for two-segment sensory regression, time for sensory regression to T12, time for motor regression to Bromage 6, and the level of sedation by using the Ramsay sedation score were also recorded. Time for rescue analgesia using 75 mg diclofenac intramuscularly when patient complained of mild pain or VAS > 5 was also noted. Results: The mean onset of sensory blockade in minutes was 1.94±0.85 in IT fentanyl and 1.59±0.71 in IV fentanyl, p <0.008. The mean onset of motor blockade in minutes was 3.16±1.06 in IT fentanyl and 2.71±0.84 in IV fentanyl, p <0.007. The mean time for maximum sensory blockade in minutes was 17.50±4.76 in IT fentanyl and 19.44±4.43 in IV fentanyl, p <0.014. The mean time for maximum motor blockade in minutes was 5.44±1.53 in IT fentanyl and 4.91±1.02 in IV fentanyl, p <0.017. The mean regression of sensory blockade to T12 in minutes was 192.84±32.80 in IT fentanyl and 176.23±19.81 in IV fentanyl, p <0.001. The mean regression of motor blockade to T12 in minutes was 163.76±37.40 in IT fentanyl and 152.16±22.39 in IV fentanyl, p <0.028. The time to rescue analgesia in minutes was 216.81±38.79 in IT fentanyl and 184.43±16.91 in IV fentanyl, p <0.001. About 87% of patients had an RSS score of 2, and 13% had an RSS score of 3 in IT fentanyl. 74% of patients had an RSS score of 2, and 26% had an RSS score of 3 in IV fentanyl. About 4% of patients had nausea and vomiting and about 13% had hypotension in the IT fentanyl group, whereas the IV fentanyl group had about 14% of patients with nausea and vomiting, 16% with hypotension, and 4% with pruritus. Conclusion: Intrathecal fentanyl 25µg compared to intravenous fentanyl 1µg/kg administered with 0.5% hyperbaric bupivacaine for subarachnoid block in total abdominal hysterectomies, prolonged sensory and motor block, increased the duration of analgesia with fewer adverse effects.

Background: Treatment options for fingertip injuries range from healing by secondary intention to flap coverage by local, regional or distal flaps, or replantation. The purpose of this study was to evaluate the functional long-term results following surgical and conservative treatment methods of amputated fingertips with bone exposure in adult patients. Methods: This was a prospective follow-up study conducted in the department of Plastic Surgery, Government Medical College, Thiruvananthapuram, to compare the sensory recovery in the form of static two-point discrimination in adult fingertip injuries with bone exposure following conservative and surgical treatment methods. 30 patients in both arms (conservative versus flap cover) were included in the study. Results: The mean age of the patients was 35.33 years. 70 percent were males. The fingertip injury loss pattern most observed was PNB 355 (20%). The mean 2-point discrimination of injured finger after conservative management was significantly lesser with conservative management, mean value 4mm± 0.435 (p value <0.001), than that with flap cover (5.4mm ± 1.98). Scar tenderness and nail deformities were significantly lower with flap cover rather than conservative management (p value <0.001). However, there was no significant difference in joint stiffness in fingertip injuries managed conservatively or by flap cover. The DASH score was significantly better in fingertip injuries managed with flap cover (mean value 9.993 ± 3.82) than with conservative management (mean DASH score 14.37 ± 5.3), p value <0.001. Conclusion: In this study, the mean 2-point discrimination of injured finger after conservative management was significantly less with conservative management than with flap cover. It was noted that the complications of scar tenderness and nail deformities were significantly lower in fingertip injuries treated with flap cover than those treated with conservative management. Also, the patient-rated outcome measure—the DASH score—is significantly better in fingertip injuries managed with flap cover than with conservative management.

Introduction: This prospective comparative study evaluates the safety and efficacy of intravenous ferric carboxymaltose (FCM) versus iron sucrose in treating postpartum iron deficiency anemia (IDA) at Rajendra Institute of Medical Sciences, Ranchi, from April 2021 to September 2022. Methods: A total of 100 postpartum women with hemoglobin levels below 10 g/dL were enrolled and divided into two treatment groups: 40 received a single 500 mg dose of FCM, while 60 received iron sucrose at 100 mg doses on alternate days for ten days. Hemoglobin and serum ferritin levels were assessed pre-and post-treatment, alongside monitoring adverse reactions. Results: Sutdy showed that FCM significantly increased hemoglobin (mean increase of 3.42 g/dL vs. 1.77 g/dL in iron sucrose) and ferritin levels (mean increase of 120.03 µg/L vs. 50.87 µg/L), indicating superior efficacy. Furthermore, FCM had a markedly lower incidence of adverse reactions (5% vs. 30%), suggesting better patient tolerance. Conclusion: This study concludes that FCM is a more effective and safer option than iron sucrose for managing postpartum IDA, advocating its use as a first-line treatment, especially in resource-limited settings where quick recovery is essential.

Background: The aim of the study was to compare the effects of single intra-articular platelet-rich plasma (PRP) and corticosteroid (CS) injections in patients with adhesive capsulitis of the shoulder. Design: Patients aged 30–70 years of either sex, diagnosed with adhesive capsulitis of shoulder, with less than 6-month duration, were included. In intra articular corticosteroid (IA-CS, control) group, 30 patients received a single injection (2 ml) of IA-CS and in IA-PRP (test) group, 30 patients received single IA-PRP injection (2 ml) into the glenohumeral joint under ultrasound guidance. All patients were prospectively followed for 24 wks. Results: Thirty patients in IA-PRP group and thirty in IA-CS group finished the entire 24week study period. At 24 weeks, decrease in QUICK DASH score is observed in IA-PRP group, were 16, compared with 33 in IA-CS group. In range of movement, IA-PRP group showed significant improvement in abduction, internal and external rotations compared with IA-CS group, respectively No major complications were observed in any patients. Conclusions: At 24week follow-up, a single dose of IA-PRP injection was found to be more effective than an IA-CS injection, in terms of improving pain, disability & shoulder ROM in patients with adhesive capsulitis of the shoulder.

Objectives: The present study was to determine the coagulation profile alteration in laparoscopic  cholecystectomy and to assessed the risk of thrombosis and prophylaxis for deep vein thrombosis in post operatively patients. Methods: A detailed history, clinical examinations and relevant investigations were performed to all patients. Blood samples were taken preoperatively, 6 h after surgery and 24 h  after surgery. Peripheral venous blood was collected in 3.8% sodium citrate at a ratio of nine parts blood to one part anticoagulant (1:10 ratio). Blood was centrifuged within 30 min and plasma kept at 80^o C until analysis. Samples were processed for PT-INR, platelet count, D-Dimer. A total of 80 patients were enrolled. 40 patients (CASE) were undergone elective laparoscopic cholecystectomy. And 40 patients (CONTROL) were undergone open elective surgeries for benign lesions under general  anesthesia with operative duration ≤ 2hrs. The values had recorded in case record proforma. Results: In the Case group, 42.5% of the patients with a 24hr Post-op Platelet level between 150 and 250, while 57.5% fall within the range of 251 to 400. In the  Control group, 47.5% of the patients had a platelet level between 150 and 250, and 52.5% fall within the range of 251 to 400. Similarly, in the Case group, 47.5% of the patients with a 24hr Post-op PT-INR level between 0.8 and 1.0, 35.0% fall within the range of 1.1 to 1.2, and 17.5% had levels greater than 1.2. In the Control group, 45.0% of the patients with a PT-INR level between 0.8 and 1.0, 27.5% fall within the range of 1.1 to 1.2, and 27.5% had levels greater than 1.2. Conclusions: Coagulation parameters, particularly D-Dimer levels showed significant postoperative changes. The consistent distribution of PT- INR and Platelet levels within the normal range in both groups suggests that these parameters were less impacted by the surgical procedure than D-Dimer  levels. And it emphasizes the critical need for tailored anticoagulation strategies and comprehensive postoperative monitoring to mitigate the risks of thromboembolic events and ensure optimal patient outcomes.

Objectives: The present study was to evaluate the Mannheim Peritonitis Index (MPI) score for predicting the outcome in patients with peritonitis due to hollow viscus perforation of any aetiology and to identify the key prognostic factors within the MPI that significantly impact patient outcomes and assess their individual contributions to the overall score. Methods: Patients were evaluated for hollow viscous perforation primarily by imaging studies and also intraoperative evidence of hollow viscous perforation were considered. Patients were evaluated keeping in mind the MPI. Organ failure was assessed based on the criteria. Exudate was collected by a syringe and transferred to a clear test tube to evaluate whether it is clear, cloudy or faecal in nature. Patients were scored from the data available preoperatively and from intraoperative findings according to MPI. Patients were followed up to the time of discharge for the final outcome which include- mortality, duration of stay, and post operative complications such as – wound dehiscence, post op infections, haemorrhage, pulmonary complications etc. Results were analysed with the MPI scoring system. Results: Out of 50 patients, the highest proportion of patients (42.0%) falls within the 21-40 age group, followed by 40.0% in the 41-60 age group. The age group 61-80 has 18.0% of the patients. The female participants comprise 56% of the study population, with a count of 28 individuals. In contrast, the male participants make up 44% of the study population, accounting for 22 individuals.14 participants (28.0%) had a preoperative MPI score in the range of 0-10. In the 10-20 score range, there are 11 participants (22.0%). The 20-30 score range includes 15 participants, making up 30.0% of the study population. This is the largest group, indicating a significant portion of patients with high severity of peritonitis. 10 participants (20.0%) had a preoperative MPI score in the range of 30-40. Conclusions: MPI is a reliable and practical tool for assessing the severity of peritonitis and the risk of mortality and morbidity in these patients. The study showed a clear correlation between higher MPI scores and increased postoperative complications, mortality rates, and prolonged hospital stays. The application of MPI in clinical settings can enhance decision-making processes, enabling healthcare providers to better stratify patients based on their risk profiles and optimize treatment plans accordingly. Early intervention and targeted therapeutic strategies for patients with higher MPI scores could potentially improve survival rates and reduce complications.

Objectives: The present study was to assess the relationship between gestational age and foetal foot length and to derive a nomogram correlating gestational age(in weeks) with foetal foot length (in mm). Methods: Ultrasound examinations were performed when the pregnant women were scanned in the supine position. FFL was measured from the skin edge overlying the calcaneus to the skin overlying the distal end of the longest toe (the first or second toe) on either the plantar/coronal or the sagittal view. In each foetus, the measurements of the two feet were averaged and a single value obtained for the purpose of statistical analysis. Results: 3.67% of our pregnant women were of < 20 years, 70.33 % of our pregnant women were between 20 to 30 years, 25.67% % of our pregnant women were between 31 to 39years, 0.33% of our pregnant women were of >39 years. Strong significant linear statistical correlation was found between FFL and other parameters like HC, BPD, AC, FL with a p value of <0.001 and r values of 0.942, 0.959, 0.953 and 0.951 respectively. Conclusions: A statistically significant relationship was seen between GA and FFL.” and a strong significant linear statistical correlation was found between FFL and other reliable parameters like HC, BPD, AC, FL. Hence, FFL is an additional USG parameter along with other reliable parameters (HC, BPD, AC, FL) useful for the estimation of GA in 2^nd and 3^rd trimesters of pregnancy when other commonly utilized USG parameters are unreliable to predict GA like brachycephaly, dolichocephaly, achondroplasia etc.” Foot length is more accurate in ascertaining period of gestation in 2^nd trimester when compared to 3^rd trimester.

Objectives: The present study was to evaluate the role of Doppler velocimetry of umbilical artery and middle cerebral artery for non-anomalous fetus with suspected IUGR. And to evaluate the placental thickness in suspected cases of IUGR. Methods:  A detailed clinical history, fetal biometry, amniotic fluid assessment and color Doppler study were performed on S10 voluson with a curvilinear transducer, having a variable frequency of 1.0-5.0 MHz. The ratio between the pulsatility index (PI) of the middle cerebral artery (MCA) and the umbilical artery (UA) PI, known as the MCA/Umb A PI ratio or Cerebral-umbilical ratio, was calculated. In our study, a single cutoff value of 1.0^[21] for the MCA/Umb A PI ratio was utilized. Velocimetry was deemed normal if the ratio was above this threshold and abnormal if it fell below it. Placental thickness was assessed at the level of umbilical cord insertion, with the maximum thickness recorded in cross-section. Results: In umbilical artery, PI and RI of IUGR fetuses were significantly higher than that of normal fetuses (1.508±0.581 vs 1.053±0.233; p=0.001, 0.857±0.238 vs 0.668±0.125; p=0.001). In middle cerebral artery PI and RI of middle cerebral artery was significantly lower than that of normal fetuses (1.206±0.380 vs 1.607±0.319; p<0.001, 0.597±0.122 vs 0.704±0.138; p=0.002). Cerebro-placental ratio(CPR) of IUGR fetuses were significantly lower than that of normal fetuses (0.848±0.335 vs 1.609±0.526; p<0.001). Among the total of 70 patients assessed, 50 fetuses were diagnosed with intrauterine growth restriction (IUGR), while 20 did not exhibit IUGR. Within the group of 50 fetuses with IUGR, 34 were classified as having asymmetric IUGR, and the remaining 16 fetuses were categorized as having symmetric IUGR. Conclusions: Cerebro-Placental Ratio (CPR) is the superior predictor of IUGR in comparison to PI or RI values of MCA or UA. The PI of the umbilical artery has higher diagnostic accuracy as compared to the RI of umbilical artery and PI and RI of middle cerebral artery. Since PI and RI of MCA has least diagnostic accuracy in predicting IUGR, it is recommended to be used along with other Doppler indices in the setting of suspected IUGR.

Background: Childhood obesity is a global health issue strongly linked to early metabolic syndrome, which raises the risk of heart disease, type 2 diabetes, and other chronic conditions. This study explores the prevalence of metabolic syndrome among obese children and related risk factors. Methods: A cross-sectional study was conducted at ANMMCH, Gaya, Bihar, from April 2022 to June 2023 with 65 obese children (ages 6–14 years). Measurements included BMI, blood pressure, and laboratory tests to evaluate insulin resistance, dyslipidemia, and hypertension. Statistical analysis examined correlations between BMI and metabolic risks. Results: The study found that 63% of obese children (BMI ≥ 95th percentile) aged 6–14 years had metabolic syndrome, with significant associations between obesity and risk factors like hypertension, dyslipidemia, and high glucose (p < 0.05). Strong correlations were observed between BMI, waist circumference, and metabolic components, particularly low HDL cholesterol and elevated blood pressure. These findings highlight the urgent need for early intervention to reduce long-term health risks. Conclusions: This study highlights a high prevalence of metabolic syndrome in obese children and a strong link between BMI and various metabolic risk factors, emphasizing the need for early obesity interventions to reduce long-term health risks.

Background: Very low birth weight (VLBW) and extremely low birth weight (ELBW) infants are at high risk of hypothermia during interfacility transport, which can lead to increased morbidity and mortality. Effective thermal support strategies are essential to prevent heat loss and improve outcomes for these vulnerable neonates. Objective: To evaluate the effectiveness of various thermal support strategies in preventing hypothermia among VLBW and ELBW infants during interfacility transport. Methods: This prospective observational study was conducted at Anugrah Narayan Magadh Medical College & Hospital (ANMMCH), Gaya, Bihar, from April 2022 to June 2023. A total of 125 VLBW and ELBW infants were transported using various thermal support interventions, including transport incubators, heated blankets, double-layering, and skin-to-skin contact. Pre- and post-transport temperatures were recorded to assess the incidence of hypothermia. Results: The incidence of hypothermia increased from 15% pre-transport to 45% post-transport. Combining transport incubators with additional thermal support significantly reduced hypothermia rates, with skin-to-skin contact and incubator use showing the lowest rate (25%). Conclusion: Multi-layered thermal support strategies, particularly those combining skin-to-skin contact with incubator use, were more effective in reducing hypothermia in transported VLBW and ELBW infants. Standardized protocols incorporating these strategies could improve outcomes in neonatal transport.

Background: NICUs and SNCUs, especially resource-limited ones, are increasingly concerned about candidemia, a fungal bloodstream infection caused by Candida species. Prematurity, low birth weight, and protracted hospital stays put neonates in danger. Methods: From April 2022 to May 2023, 235 neonates in the NICU and SNCU at Anugrah Narayan Magadh Medical College & Hospital (ANMMCH), Gaya, Bihar, participated in this prospective observational study. Analyses included demographics, clinical risk factors, and test results. Candida species were isolated from blood cultures and tested for antifungal susceptibility. Results: Candidemia affected 19.1% of infants. Key risk factors included low birth weight (<1500 g), preterm birth (<32 weeks), prolonged hospital stay, invasive procedures, and prolonged antibiotic use. The most common species was Candida albicans, followed by C. parapsilosis, tropicalis, and glabrata. Amphotericin B and caspofungin were most effective, however, several isolates were fluconazole-resistant. Conclusion: The high incidence of candidemia highlights the need for targeted antifungal therapies and stringent infection control practices in NICUs and SNCUs. Effective treatment options such as amphotericin B and caspofungin are recommended, given observed resistance patterns.

Background: The shortage of mental health nurses is attributed to negative attitudes of nursing students towards mental illness. Attitudes toward psychiatry have been studied more among medical students worldwide while only few studies were done on nursing students. Aims: To know the undergraduate nursing student’s attitude towards psychiatry and compare the attitude among students with or without exposure to psychiatry clinical postings. Methods: This is a descriptive, cross-sectional study conducted at nursing college, Karnataka. Undergraduate nursing students belonging to all phases and consenting for the study were the participants. They were considered into two groups, students with or without exposure to psychiatry clinical posting respectively. Apart from collecting sociodemographic details, a self-administered Attitude towards Psychiatry‑30 items questionnaire was used, and the Chi-square test was used for statistical analyses. Result: The total number of consenting participants was 238. Among them 120(50.4%) were undergraduate nursing students who had not attended psychiatry clinical postings and 118(49.57%) had attended psychiatry clinical postings. The mean age of the students attending and not attending psychiatry clinical postings was 20.93 years and 18.58 years respectively. Before clinical exposure students were interested in causes of mental illness and in psychotherapy. But after postings they showed interest in diagnosing and in treatment of patients by pharmacotherapy. They also believed Psychiatric teaching increases our understanding of medical and surgical patients and it should be included in curriculum. Conclusion: Clinical exposure in psychiatry improves their positive attitude. The choice of career depends on multiple factors not only on a positive attitude towards psychiatry. Stigmatizing attitudes of nursing professionals are major problem with detrimental consequences for people experiencing psychiatric illness. The present psychiatry curriculum can be improved to nurture the development of empathetic attitudes towards people with psychiatric illness.

Background: Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) during apnoea has shown to delay desaturation. The primary aim of the study was to assess the effectiveness of THRIVE during apnoeic oxygenation for short bronchoscopy procedures and compare it with nasal oxygen supplementation method. Method: A total 90 patients of either sex, between 12-45 years with ASA I, II undergoing short bronchoscopy procedures were enrolled in the study with two groups of 45 in each. Group N: patients received nasal cannula O2 supplementation @ 15 L/min and Group H: patients received O2 supplementation via THRIVE @ 70 L/min. Unpaired t-test was used to compare variables between two groups. Results: There was no significant difference in the mean total apnoea time and apnoea cycles between two groups with cut off apnoea time of 6 minutes. The SPO2 drop in group H was more gradual as compared to group N and was statistically significant (P=0.028) Also, there was statistically significant difference noted with EtCO2 on intubation between both the groups (P<0.00001). After intubation at the end of procedure, PaO2 was higher in Group H, but not statistically significant (P=0.083).  However, there was statistically significant difference in PaCO2 noted with higher values in group N (P<0.00001). Conclusion: The oxygen supplementation for short bronchoscopy procedures during apnoeic oxygenation with THRIVE and nasal cannula were equally effective in maintaining oxygenation till six minutes of apnoea time, but PaCO2 values were seen higher in conventional nasal oxygen supplementation as compared to THRIVE at the end of procedure.

Background: Osteonecrosis of the femoral head (ONFH) is a debilitating condition that can lead to severe functional impairment. The Kerboul angle, measured on magnetic resonance imaging (MRI), has been used to assess the extent of necrosis in ONFH. However, the relationship between the Kerboul angle and functional status remains unclear. Objectives: This study aimed to evaluate the extent of ONFH using the Kerboul angle and investigate its correlation with functional status, as assessed by the Harris Hip Score (HHS). Methods: A cross-sectional study was conducted among 140 adult patients with ONFH. The Kerboul angle was measured on MRI, and functional status was assessed using the HHS. The correlation between the Kerboul angle and HHS was analyzed using Pearson’s correlation test. Results: The mean age of the study subjects was 41.57±15.76 years, with a male predominance (70.7%). The mean duration of pain was 9.52±6.94 months. The mean HHS was 64.49±15.38, with 61.43% of subjects having a poor score (<70). The mean Kerboul angle was 177.28±47.88. A highly significant negative correlation (r=-0.647, p<0.01) was observed between the Kerboul angle and HHS. Conclusion: This study demonstrates a significant negative correlation between the extent of necrosis, as measured by the Kerboul angle, and functional status in patients with ONFH. The findings suggest that the Kerboul angle could be a valuable tool for predicting functional outcomes in ONFH and highlight the importance of early diagnosis and intervention.

Introduction: Diabetes mellitus is a prevalent endocrine disorder characterized by metabolic dysfunctions and long-term complications involving both microvascular and macrovascular systems. Its prevalence is rising rapidly, particularly in developing countries, posing a significant public health challenge. Diabetic nephropathy affects approximately 30% of patients with insulin-dependent diabetes mellitus and about 25% of those with non-insulin-dependent diabetes mellitus. This condition is marked by a progressive increase in proteinuria, especially albuminuria, accompanied by declining glomerular filtration rates and persistently elevated systemic blood pressure, often culminating in end-stage renal disease. This study aims to evaluate the prevalence of microalbuminuria in diabetes mellitus patients with HbA1C > 6.5% and analyze its association with age, sex, and duration of diabetes among patients attending Civil Hospital, Silvassa, DNH. Material and Method: This cross-sectional study was conducted at Civil Hospital, Silvassa, DNH, over six months (February to July 2019) to evaluate microalbuminuria and HbA1c levels in 50 diabetic patients (cases) and 50 non-diabetic individuals (controls). Diabetic patients were diagnosed using ADA criteria, including HbA1c > 6.5%, while controls had normal glucose tolerance. Participants underwent clinical evaluations, and samples were collected for microalbumin and HbA1c analysis using a Siemens EXL-200 analyzer. Data were statistically analyzed, with p < 0.05 considered significant. Result: In our study, diabetic patients (cases) had significantly higher mean microalbumin levels (36.3 ± 23.7 mg/L) and HbA1c levels (8.7 ± 1.7%) compared to non-diabetic controls (11.8 ± 5.5 mg/L and 5.9 ± 0.5%, respectively; p < 0.0001), indicating a strong correlation between poor glycemic control and increased microalbuminuria. Across all age groups, the majority of patients had microalbuminuria < 25 mg/L, though higher prevalence of microalbuminuria > 25 mg/L was noted in older age groups. No significant sex-based differences were observed for microalbumin or HbA1c levels (p > 0.75 and p > 0.76, respectively). The prevalence of microalbuminuria > 25 mg/L increased with longer diabetes duration, rising from 11.5% in patients with <5 years of diabetes to 80% in those with >10 years. These findings emphasize the impact of diabetes duration and glycemic control on renal function. Conclusion: Our study concludes that microalbuminuria significantly correlates with HbA1C levels >6.5% and increases with diabetes duration. However, no correlation was found between microalbuminuria levels and the age or sex of diabetic patients.

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: Hyphaema or blood in anterior chamber is a common complication of blunt or penetrating injury to eye and can result in vision threatening complications. Aim: To study the complications associated with traumatic hyphaema due to blunt ocular trauma. Methods: This study was conducted on 80 patients of traumatic hyphaema attending the Department of Ophthalmology, Government Medical College, Srinagar over a period of 18 months. Patients ≥10 years of age with traumatic hyphaema due to blunt ocular trauma were included in the study. Patients with penetrating ocular trauma, those with hyphaema due to causes such as iris melanoma, rubeosis iridis, patients with hyphaema following intra-ocular surgery and patients on anticoagulant medications were excluded from the study. Proper history was taken from all the patients and a detailed ocular examination was done including grading of hyphaema using slit lamp. Results: Majority of patients in our study were males. Adolescents constituted the major (50%) age group of our study. Most common mode of injury was sports (47.5%) followed by occupational causes (18.75%). Corneal abrasion was seen in 42.5% cases, corneal edema in 16.3% cases, secondary haemorrhage in 7.5%, angle recession in 53% out of a total of 70 patients who underwent gonioscopy. Posterior segment complications included vitreous haemorrhage, retinal detachment, macular edema, macular scar. Anterior segment complications were more common than posterior segment complications. Conclusion: Traumatic hyphaema is associated with short term and long term complications which if effectively managed in a timely manner can reduce the burden of ocular morbidity in these patient. Most of the patients with traumatic hyphaema respond well to medical intervention. Surgical intervention is required in only small proportion of cases.

Background: Paediatric ocular disorders are a cause of visual impairment if not treated appropriately and can result in public health problems because of associated socioeconomic consequences. Aims and Objective: The study was aimed to determine the pattern of ocular disorders in paediatric patients. Setting and Design: retrospective study involving review of records of 1200 patients between three to 16 years of age over a period of two years. Materials and Methods: Information was obtained with regard to age, gender, presenting complaints, duration of presenting symptoms, diagnosis, previous treatment received by patient, best corrected visual acuity. Statistical Analysis: Data was analyzed using STATA version 15. Results: In our study, there were 720 (60%) male patients and 480 (40%) female patients. Mean age of study patients was 9±2 years. About 60% of patients had good visual acuity better than or equal to 6/9 while 6% patients had visual acuity of < 6/60. Refractive error was the main ocular disorder seen in 37.5% patients in our study followed by conjunctivitis and strabismus. Congenital ocular anomalies were seen in 5% patients of which congenital cataract was seen in 30% of cases. Conclusion: Visual impairment in children can have negative impact on their quality of life. Main causes of ocular morbidity in this study are both preventable and treatable. Hence, proper screening of children and timely management is important to prevent risk of developing visual impairment in these patients.

Background: Onychomycosis is an infection of the nail unit caused by fungi. Onychoscopy is a quick, non- invasive, office-based diagnostic tool for the examination of nail unit and its components by magnification, using a dermoscope enabling observation of nail features that are not visible to the naked eye. Certain dermoscopic patterns demonstrate 100% specificity for onychomycosis. This study aims to contribute towards the development of  onychoscopy based diagnostic criteria for onychomycosis in the near future. Objective: To identify the onychoscopic patterns in confirmed cases of onychomycosis and the association between the onychoscopic patterns and the clinical variants of onychomycosis. Materials and Methods: 80 cases of clinically diagnosed onychomycosis who tested positive for fungus by either microscopy or culture were subjected to onychoscopic examination with a 150x magnification dermoscope. Results: The most common onychoscopic pattern associated with onychomycosis was distal irregular termination (37.5%). DLSO nails were significantly associated with longitudinal striae (38.3%), distal irregular termination (34.7%) and jagged proximal edge (28%). TDO nails were significantly associated with ruin pattern (68.6%) and lamellar microsplitting (60%). Cloud pattern (83.3%) was found to be significantly associated with PSO. WSO had a significant association with grid pattern (100%). The newly reported blue globules was also observed in this study. Conclusion: The most common onychoscopic pattern associated with onychomycosis was distal irregular termination. This study was also able to establish significant relationship between individual clinical variants of onychomycosis and some of the onychoscopic patterns.

Background: Polycystic ovary syndrome (PCOS) is a reproductive endocrinopathy and metabolic disorder, affecting 5%-10% women of reproductive age group. Objectives: To determine and compare anthropometric profile (BMI,WHR, Body Fat% ) of PCOS women with control group and find out correlation of anthropometric parameters with autonomic modulation (evaluated by HRV) in the PCOS women. Method: This case control study was conducted in RNT Medical College and Attached Group of Hospital, Udaipur (Rajasthan). The sample size of 160 women diagnosed with PCOS were included in this study with equal number of the control group.HRV was recorded by computerized Physiograph. Anthropometric measurements like body weight, height, waist circumference, hip circumference were assessed by using standardized instrument  and body fat% was calculated by using formula. Result: All anthropometric measurements except height were significantly (P<0.001) higher in PCOS women than healthy individuals. A significant negative correlation was observed in BMI and Body fat% with pNN50%, RMSSD and total power  parameters of HRV. Whereas a significant positive correlation with LF/HF parameter. Conclusion: Our study concluded significant correlation between anthropometric profile and heart rate variability in PCOS women.

Introduction: Lower respiratory tract infection (LRTI) includes all infections of the lungs and large airways below the larynx. On average, children <5 years of age suffer about 5-6 LRTI episodes per year. Aim: To study the clinical profile of LRTIs in PICU and paediatric wards of a tertiary care hospital. Materials and Methods: This was a prospective, analytic, hospital-based, descriptive, and non-interventional study done on LRTI children aged 1–72 months. A total of 31 patients fulfilling the inclusion criteria were included in this study. A proper history and clinical examination with more emphasis on the respiratory system was carried out. Investigations such as CBC, ESR, CRP, and chest X-Ray were done. Descriptive statistics were done. Results: There were a total of 16 (51.6%) male and 15 (48.4%) female participants. Thirty (96.8%) patients had cough and fever. Rapid breathing or difficulty in breathing was present in 19 (61.3%) patients. Ten (32.3%) patients had respiratory distress. Twenty-three (74.2%) patients had abnormal respiratory system. There were 21 (67.7%) patients who had raised ESR>20.  Nineteen (61.3%) patients had raised CRP>6. According to the final diagnosis, there were 18 (58.1%) patients who had broncho-pneumonia, 6 (19.6%) had bronchiolitis and 1 (3.2%) patient had bronchitis. Conclusion: Bronchopneumonia is the predominant form of presentation in infants and preschool children. The focus of health care services should be on the necessary components of LRTIs such as nutrition, immunization, and environment.

Aim: To compare the postoperative complications and the visual outcome after cataract surgery in patients with Type-II Diabetes mellitus (DM) and those without DM operated at a rural medical college& hospital. Material & Methods: This observational analytical prospective study was carried out in the department of ophthalmology at a rural medical & college. Two hundred and fifty patients in the age range 50 years to 70 years undergoing cataract surgery in the hospital from 1^st November 2016 to 31^stOctober 2017 were selected for the study. The patients were followed up to 30^th April 2018. These patients were divided into two groups for comparison as we had to test the hypothesis that visual outcome after cataract surgery is better in nondiabetics as compared to diabetics. The present study conducted among 125 diabetic and 125 nondiabetic cataract surgery patients operated in a rural hospital. Results:   Preoperatively in present study 67 diabetics (53.6%) had visual acuity less than 6/60 and 62 non diabetic patients (49.6%) had visual acuity less than 6/60. This was statistically significant (P = 0.009). Only two patients in the diabetic group had diabetic retinopathy. Visual acuity improvement was significantly more in nondiabetics as compared to diabetics.(P=0.001). Conclusion: Visual outcome after cataract surgery in diabetics depends on pre-existing ocular and /or systemic problems. Good outcome in diabetics can be achieved by meticulous preoperative workup and management of associated problems like diabetic retinopathy along with good glycaemic control.

Introduction: With the emergence of many multidrug resistant organisms like methicillin resistant Staphylococci, therapeutic options for treating skin and soft tissue infections have become severely limited. Clindamycin is an attractive option for the treatment of such cases especially Community-acquired MRSA (CA-MRSA) because of its excellent tissue penetration and it can be used in penicillin-allergic patients also. But clinical failure can occur due to multiple mechanisms that confer resistance to Macrolide, Lincosamide and Streptogramin B antibiotics. This study was conducted to detect inducible clindamycin resistance in Staphylococci as well as to detect the prevalence of erythromycin induced clindamycin resistance in staphylococcal isolates in the institute. Materials and Methods: It was a prospective cross-sectional study conducted on the Staphylococcal isolates obtained from routine clinical samples during a period of 1½ years in the Department by systematic sampling method. A total of 300 non-duplicate Staphylococcal isolates from various clinical samples were subjected to antimicrobial susceptibility testing as per the CLSI guidelines. The prevalence of inducible clindamycin resistance in these isolates were tested by using Double disk approximation test (D test), which was supported by automated method (Vitek 2 compact systems) and agar dilution method. Results: Out of the 300 Staphylococcal isolates included in the study, 90.7% were coagulase positive and 9.3% coagulase negative. It consisted of 34.7% MRSA, 56% MSSA, 5.7% MRCONS and 3.6% MSCONS. Out of the 154 Erythromycin resistant staphylococcal isolates tested, 39 (13%) were found to be D test positive. Inducible clindamycin resistance was exhibited by 18.26% of MRSA, 11.30% of MSSA and 6.66% of MRCONS. Constitutive resistance phenotype, MS phenotype and Susceptible phenotype was exhibited by 27 (9%), 89 (29.7%) and 144 (48%) staphylococcal isolates respectively. Conclusion: D test is simple and reliable test to detect inducible clindamycin resistance which can be missed if not looked for specifically. Clinical microbiology laboratories should use the double disc approximation test as standard practice with all Erythromycin resistant strains which will help to prevent treatment failure.

Objectives: The present study was to assess the relationship between gestational age and foetal foot length and to derive a nomogram correlating gestational age(in weeks) with foetal foot length(in mm). Methods: Ultrasound examinations were performed when the pregnant women were scanned in the supine position. FFL was measured from the skin edge overlying the calcaneus to the skin overlying the distal end of the longest toe (the first or second toe) on either the plantar/coronal or the sagittal view. In each foetus, the measurements of the two feet were averaged and a single value obtained for the purpose of statistical analysis. Results: 3.67% of our pregnant women were of < 20 years, 70.33 % of our pregnant women were between 20 to 30 years, 25.67% % of our pregnant women were between 31 to 39years, 0.33% of our pregnant women were of >39 years. Strong significant linear statistical correlation was found between FFL and other parameters like HC, BPD, AC, FL with a p value of <0.001 and r values of 0.942, 0.959, 0.953 and 0.951 respectively. Conclusions: A statistically significant relationship was seen between GA and FFL.” and a strong significant linear statistical correlation was found between FFL and other reliable parameters like HC, BPD, AC, FL. Hence, FFL is an additional USG parameter along with other reliable parameters (HC, BPD, AC, FL) useful for the estimation of GA in 2^nd and 3^rd trimesters of pregnancy when other commonly utilized USG parameters are unreliable to predict GA like brachycephaly, dolichocephaly, achondroplasia etc.”Foot length is more accurate in ascertaining period of gestation in 2^nd trimester when compared to 3^rd trimester.

Background and Objectives: of the study was to assess quality of the food provided in an industrial canteen and impact of the same on the worker’s health. Methods: A cross sectional, observational, study was conducted on a industrial canteen in a beverage company in Bangalore. Data was collected using a pretested questionnaire. And then it was entered into MS excel sheet 2010. Data compilation and analysis was done using SPSS Version 16. Study variables were body mass index (BMI), Waist circumference (WC). And dietary intake at lunch obtained by 24 hrs dietary recall. Results: Majority of the participant were PUC/diploma holders 66% followed by high school diploma holder 22% Graduate (8%), Primary (4%). Among study participant 56%belonged to nuclear family & 44% to joint family. In the study majority64% were nonvegetarian & 36% were vegetarians. All participants consumed cereals, pulses green leafy vegetables and milk daily will non vegetarians consumed flesh weekly. In the present study 40% of the study participants consumed junk food, 60% were alcoholic, 50% of them were smokers. In the present study42% were overweight and obese, 4% underweight according to BMI. 92% of the study participants had central obesity based on WHR. Conclusions: Nutritional status was dependent on the type of food provided in the canteen, and Central obesity was a rampant feature.

Epilepsy, a chronic neurological disorder characterized by recurrent, unprovoked seizures, affects millions worldwide. Despite advances in understanding its pathophysiology, epilepsy remains a complex condition influenced by genetic, developmental, and environmental factors. This research delves into the anatomical and physiological mechanisms underlying seizure generation, focusing on inflammation, blood-brain barrier dynamics, the mTOR pathway, and cellular electrophysiology. Additionally, the study explores the classification of seizures and the specificities of Mesial Temporal Lobe Epilepsy (MTLE) and genetic epilepsy. With the growing demand for effective treatments, this work reviews current pharmacological therapies, including traditional anticonvulsants like Carbamazepine and Valproate, as well as emerging treatments like Cannabidiol and Brivaracetam. By examining the mechanisms of action and therapeutic efficacy of these drugs, the research aims to provide a comprehensive understanding of how these therapies contribute to seizure management. This work offers valuable insights for clinicians and researchers alike, aiding in the development of more targeted and effective treatment strategies for epilepsy.

Background: Usually, laboratory outliers have negative connotations with the reports which can impact the patient’s health concomitantly. Sigma metrics is a structured tool to assess laboratory defects. Objective: To analyze the laboratory biochemical parameter’s performance through Sigma metrics & by Quality Goal Index whose sigma metrics are less than 3. Materials & Method: A retrospective study of External Quality Control & Internal Quality Control for a period of six months from January 2024 to June 2024 at Chikkamagaluru Institute of Medical Sciences, Chikkamagaluru. A total of nine parameters which included- glucose, Urea, Creatinine, Total Bilirubin, Total Protein, Uric acid, Albumin, Total Cholesterol, and Triglycerides were assessed. Percentage Bias was calculated from EQC. Co-efficient variation was calculated from IQC. Total allowable error (TEa) was obtained from CLIA (Clinical Laboratory Improvement Amendments) guidelines. Thus, Sigma Metrics were calculated from the Co-efficient of Variation, Percentage Bias & Total Allowable Error. Results: Uric acid and triglycerides had Sigma of 4.63 & 3.5 respectively which indicates better performance and rest parameters like glucose, urea, creatinine, Total protein, albumin & total bilirubin had less than 3 sigma which indicates poor performance. Conclusion: Sigma metrics help to analyze the performance of various biochemical parameters in clinical laboratories. Thus, our study showed that lack of precision, which was assessed by the Quality Index Goal, is the one that contributes to poor performance.

Aim: Urinary tract infections (UTI) are the infection or inflammation of urogenital tract involving urethra, bladder, ureter and kidney caused by microorganism like bacteria, fungal and parasite. UTI is Common healthcare burden affecting male and female but incidence in female was higher because of various reason-like anatomy of female urinary tract. UTI can be community acquired or hospital acquired, in hospital acquired UTIs chances of multi drug resistance isolate is higher. Therefore, this study aims to detect the prevalence and the antibiotic susceptibility pattern of UTIs patients in tertiary care hospital of Saurashtra region of Gujarat. Material and Methodology: Retrospective study conducted over a period of 1 year. Clean catch mid-stream urine samples of patients received at present laboratory who were tentatively diagnosed as case of UTI. Total 900 samples tested according to standard bacteriological methods. Urine samples were cultured on blood agar and MacConkey agar and bacteria identified standard biochemical tests, catalase, oxidase, gram stain and motility, and for antibiotic susceptibility pattern we used Kirby-Bauer disk diffusion method. Result: Total 900 samples of urine received from various wards and ICUs of our hospital. Among 900 samples 243 samples was culture positive and prevalence of UTIs was 27%. Majority of urine samples (65.02%) was of female of reproductive age and maximum samples received from medicine ward followed by surgical wards. In our study, gram negative bacteria most commonly isolated then gram positive bacteria. E. coli was the most common organism isolated which is followed by klebsiella and other bacteria. It was seen that E. coli was highly sensitive to Ceftazidime-avibactam (95.63%) followed by Fosfomycin (94.27%) and meropenem (91.36%). Among gram positive organism, enterococcus was isolated in more number (8.64%) then S. aureus (0.82%). Fortunately, both the organisms were fully susceptible to vancomycin and linezolid. For UTIs most sensitive drug was nitrofurantoin. High level Gentamicin resistance was 41.36% for enterococcus spp. Conclusion: the UTIs in female is quite common and it is necessary to identify microorganism causing UTIs and study their antibiotic sensitivity pattern. Timely management of UTIs with antibiotic can prevent progression of complicated UTIs. Therefore, physicians must follow antibiotic steward ship and change their treatment based on performing antibiotics susceptibility testing.

Introduction: Palliative care provides comprehensive support for several dimensions of physical, mental, social, emotional and spiritual care needs experienced by patients who live with terminal illnesses. An interdisciplinary professional team supports the broad needs of patients and their care partners and helps them to cope with living with their life limiting illness (es) while proactively planning for the end of life. Aims and Objectives: 1. To understand and analyse the morbidity, mortality and symptom profiles of a cohort of patients with life-limiting disease and receiving palliative care 2. To determine the prevalence of death within palliative care of those patients receiving palliative care. Materials and Methods: Our study is a descriptive exploratory secondary analysis of a patient dataset, wherein we proceeded in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. The study was conducted from 01 Jan 2022 to 31 Aug 2024. Standard management protocol was followed for management of the cases. Data collection was carried out prospectively by means of a pilot research study. The pilot research study followed a community-based participatory research methodology. We carried out a descriptive analysis of the results to estimate the proportion of individuals who passed away during the period of the study while receiving palliative care, or sought palliative care in their last 4 weeks of life. Study participants were grouped by way of symptomatology/organ/system. Results: Our analysis includes 134 study participants from a palliative care centre of a large tertiary care hospital. The study participants comprised of 71 (52.99%) males and 63 (47.01%) females respectively. Mean age of the study participants was 58.05 years (SD 14.85) and median age was 60 years. Mean duration of hospitalisation was 50.55 days (SD 90.06) with a median of 24.5 days. Mean duration of stay in palliative care was 38.29 days (SD 89.22) with a median of 15.5 days. Overall, there were 5131 patient days of stay in palliative care; and 6774 patient days of hospitalisation. From our study sample of 134 study participants, 2 (1.49%) one male and one female died under palliative care.

Background: Intraoperative Floppy Iris Syndrome (IFIS) is a condition characterized by iris instability during cataract surgery. It includes features such as a billowing and floppy iris, a tendency for the iris to prolapse toward surgical incisions, and progressive intraoperative miosis. Small Incision Cataract Surgery (SICS) is a popular alternative to phacoemulsification, especially in regions with limited access to advanced phacoemulsification devices. However, due to the smaller and less controlled surgical environment of SICS compared to phacoemulsification, it is important to understand whether antihypertensive drugs like CCBs and ARBs have a similar or more pronounced effect in precipitating IFIS. Objectives: To study the prevalence of IFIS in hypertensive patients undergoing SICS who are treated with CCBs or ARBs and combination of both. Methodology: This prospective observational study conducted at a tertiary care center specializing in cataract surgery over a 12-month period including 50 hypertensive patients aged 50 years or older who were undergoing SICS classified in 3 groups each (150). Results: Prevalence of IFIS in our study was 4% in the patients receiving CCBs. Prevalence of IFIS in our study was 6% in the patients receiving ARBs. Prevalence of IFIS in our study was 8% in the patients receiving CCB+ARB combination of drugs. In the group of patients receiving CCBs, prevalence was 4% in the age of above 70 years, patients receiving ARBs, the prevalence was 2% in 60-70 years and 4% in the age of above 70 years and patients receiving combination of both CCB+ARBs, the prevalence was 2% in 51-60 and 61-70 years and 4% in the age of above 70 years. Gender wise prevalence of IFIS in our study revealed 2% each in male and female in CCB group, 4% males and 2% females in ARB group and 4% each male and females in the combination group. Conclusion: Prevalence of IFIS in our study was 4% in the patients receiving CCBs. Prevalence of IFIS in our study was 6% in the patients receiving ARBs. Prevalence of IFIS in our study was 8% in the patients receiving CCB+ARB combination of drugs. We observed the prevalence of IFIS as 4% in patients receiving CCBs, 6% in patients receiving ARBs and 8% in patients receiving combination of CCB+ARBs.

Introduction: The Pediatric Intensive Care Unit (PICU) serves as a critical setting where parents face immense emotional challenges as their children undergo life-threatening medical care. The stress experienced by parents stems from various factors, including the severity of their child’s condition, emotional strain, financial burdens, and disruptions to family dynamics. This cumulative stress significantly impacts parental well-being, making it essential to explore factors contributing to stress and assess interventions like counselling to mitigate its effects. Material and Methods: This observational study, conducted over one year in a tertiary care center in Gujarat, included 170 parents of children aged 1 month to 13 years admitted to the PICU for at least 48 hours. Parental stress levels were assessed using the validated PSS: PICU scale, with pre- and post-counseling evaluations. Structured counselling, delivered using an IEC-based model, included one-on-one and group sessions to address misconceptions and provide peer support. Data analysis, performed using descriptive and inferential statistics, highlighted the effectiveness of counselling in reducing parental stress, ensuring participant confidentiality and ethical compliance. Results: In our study, most patients (50.6%) were under 1 year, with a higher proportion of males (55.8%). Ventilatory support was required by 47.1% of patients, and 53.5% received ionotropes. The majority (62.9%) stayed in the PICU for 4-7 days, with 35.3% having hospital stays of more than 10 days. Parental demographics revealed fathers predominantly aged 30-39 years (43.2%) and mothers aged 20-29 years (76.0%). Socioeconomic status showed 53.5% of parents in the upper-lower SES. Counselling sessions averaged 2.36 ± 1.08, with stress levels highest for “Sight and Sound” (9.68 ± 2.984) and lowest for “Behavior of Professional Staff” (1.77 ± 1.817). Significant stress reduction was observed post-counseling in discharged patients (p = 0.001), but not in those who died (p = 0.468) or others (p = 0.562). Conclusion: Counselling significantly reduces parental stress in the PICU, particularly among discharged patients, highlighting its role in supporting families during critical care. Tailored psychological support is essential for improving parental well-being and resilience.

Background: Fever with thrombocytopenia is a significant clinical presentation, often associated with infectious diseases, hematological disorders, and systemic illnesses. Despite its prevalence, there is a paucity of standardized tools for assessing disease severity and guiding treatment. Objective: This study aimed to evaluate patients presenting with fever and thrombocytopenia, identify predictors of mortality, and develop an early warning scoring system to aid clinical decision-making and improve patient outcomes. Methods: A prospective study was conducted on 100 adult patients admitted with fever and thrombocytopenia at Government Erode Medical College Hospital, Perundurai, over one year. Clinical and laboratory parameters, systemic involvement, and outcomes were assessed. A scoring system was derived based on clinical findings, laboratory results, and systemic involvement. Results: The cohort comprised 55 males and 45 females, with a mean age of 30 years. Key findings included a significant correlation between lower oxygen saturation, elevated respiratory rate, abnormal hematocrit, and worse outcomes. Bleeding manifestations were present in 31% of patients, and 40% required platelet transfusion. Mortality was 13%, predominantly due to multisystem dysfunction. The developed scoring system identified patients at higher risk for adverse outcomes and guided early interventions. Conclusion: This study highlights the clinical importance of assessing febrile thrombocytopenia with a focus on systemic involvement and vital signs. The derived scoring system is an inexpensive, reproducible bedside tool that aids in early prognosis, guiding treatment strategies, and improving patient survival. Further multicenter studies with larger cohorts and extended follow-ups are recommended to validate and refine the scoring system.

Aims & Objectives: To assess the epidemiological, clinical, radiological and endoscopic features of inhaled foreign bodies in children and the outcome following removal using rigid bronchoscopy. Methods: This was a retrospective surveillance study conducted in the department of Paediatric Surgery of JSS Hospital, Mysore from January 2019 to September 2024. Children presented with clinical/radiological features suggestive of foreign body aspiration and underwent rigid bronchoscopy were included in the study. Demographic characteristics, presenting symptoms and its duration, examination and radiological findings, and outcome of bronchoscopy were analysed by descriptive statistical methods. Results: 47 children (30 males and 17 females) underwent rigid bronchoscopy for suspicion of foreign body inhalation. They were aged from 6 months to 15 years out of which 35 (74.4%) were less than 3 years of age. Choking was the most frequently reported symptom in 23 (48.9%) cases, followed by noisy breathing, cough, and pneumonia all show the same frequency of 15 (31.9%). Delay between aspiration and removal was 1-15 days in 24 (51.06%) children and within 24 h in 15 (31.91%) children. The examination was normal in 6 (12.76%) children. The majority of the X-rays (51.1%) showed a normal finding followed by ipsilateral hyperinflation, consolidation and collapse in 29.8%, 6.4% and 4.3% respectively. Most common foreign body aspirated was peanuts (38.29%), and 74.5% was organic material. The foreign body was mostly lodged in right main bronchus (46.8%), followed by the left main bronchus (25.5%) and the trachea (14.9%). Procedure was successful in 91.48%, while no foreign body was noted in 8.51%. Total or partial failure of retrieval of foreign body was noted only in two children (4.3%). Conclusion: These findings highlight the need for early diagnosis and high clinical suspicion in children presenting with features suggestive of foreign body aspiration. Public health initiatives should focus on parental education regarding reduction of risks and early presentation to hospital.

Introduction: Isolated itching of ears or external canal pruritis is one of the common conditions seen in ENT outpatient department with no identifiable cause. Examination findings always reveal normal external auditory canal and hence treatment becomes challenging. This study aims to compare the MISS (Modified Itch severity score) before and after topical application of 2% glacial acetic acid in cases of external canal pruritis. Materials and Methods: This was a prospective study of 35 patients who came to ENT OPD with the complaint of ear itching and were examined. Any patient with pathological otoscopic findings were excluded. They were given Modified Itch severity questionnaire and the scores were noted. 2% glacial acetic acid in the form of ear drops were administered for 3 weeks and the questionnaire scores were noted again by the physician. Results: Based on the different parameters of the questionnaire it was found that severity of itch was strong in 25.7% of the patients. 37.1% had difficulty in sleeping which indicates the severity of the condition. 18.51% patients suffered from stress along with external canal pruritis. The pre and the post medication MISS score after using 2% glacial acetic acid was found to be statistically significant.(p<0.001) Conclusion: Stress plays an important role in intractable ear itching. Use of ear buds and ear plugs have been incriminated as predisposing factors for chronic itching. 2% glacial acetic acid ear drops was proved to improve symptoms in patients who had tried all kinds of preventive measures but failed to improve.

Introduction: Due to the inconsistently bad results of different distal femur fracture geometries, disputed care strategies and their techniques are invoked, with varying results. When under axial, bending, or twisting loads, the distal femur’s transition flare is most vulnerable to fracture in car accidents and sports injuries. Strong quadriceps shorten the limb in these fractures while even stronger hamstrings pull the distal part posteriorly. Due to muscular bracing and the rarity of intraoperative dorsal neurovascular systems being at danger, reduction is made significantly more challenging in coronal rather than sagittal fractures. Objective: To evaluate the end result of surgical management of intercondylar fractures of distal end of femur using dual plating with respect to: bony union, functional outcome and range of movements. Methodology: The present prospective study was done to evaluate the functional outcome of parallel plating technique in treatment of distal femur fractures and to analyse the results at Tertiary Care Hospital during the study period. Results: Age ranged from 21 to 50 years of age with mean age of 35.50 years. Male cases were predominantly higher than female cases with M:F ratio of 6.5:1. 46.67% cases were observed with C3 type fracture. 157 minutes mean operative time was observed during the study period. 23.33% cases were observed with knee stiffness where 3.33% each case was observed with implant loosening and infection respectively. 33.33% cases were observed with good outcome, 30% cases were observed with excellent outcome, 26.67% cases were observed with fair outcome where 10% cases were observed with poor outcome. Conclusion: Double plating is one of the better options to achieve bony union and a better functional outcome in severely comminuted distal femur fractures, even though there were complications and an increase in operating time in our study. Locking compression plates are a crucial component of the treatment armament for knee fractures, particularly when the fracture is substantially comminuted and there are signs of osteoporosis.

Objective: To evaluate and compare the predictive ability of cord blood albumin (CBA), cord blood bilirubin (CBB), and the cord blood bilirubin to cord blood albumin ratio (CBB/CBA) in neonatal hyperbilirubinemia (NNH). Methods: In this observational prospective analytical study, ninety-six healthy newborns were included after screening for exclusion criteria. Three umbilical cord blood samples were taken with all aseptic precautions for CBA, CBB, and blood group estimation. CBB/CBA was calculated after report collection. A total serum bilirubin sample was sent at 72 hours of life. All the values were statistically analyzed for correlation and comparison in neonates who developed NNH above the recommended phototherapy threshold. Results: A total of 21 (21.9%) neonates developed NNH above the phototherapy threshold. In the receiver operating characteristic (ROC) curve, the cut-off values obtained for CBA and CBB was 3 g/dL and 2.25 mg/dL, respectively. The sensitivity, specificity, and NPV for CBA were 74.7%, 57.1% and 38.71%, while for CBB they were 95.2%, 56% and 97.67% respectively. The cut-off value for the CBB/CBA ratio obtained was 0.76, with 85.7% sensitivity, 74.7% specificity and a negative predictive value (NPV) of 94.2%. Conclusions: We recommend CBB/CBA and CBB combined over CBA as it makes the test both highly sensitive and specific. Neonates having a CBB/CBA value of 0.76 or above and a CBB value 2.25 g/dL or above must be followed closely.

Objective: A very important and efficient method of curtailing transfusion transmitted infections (TTIs) is notifying and counseling the TTI reactive donors. Donor notification and counseling protects the health of the donor and also helps in preventing secondary transmission of infectious diseases. Methods: A total of 13,972 donations were screened for TTI, namely human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis by serology. All TTI reactive donors were notified of their status by telephone or letter and called for follow-up counseling in person and referral for treatment. Results: Out of 13,972 blood donors who were screened for TTI, 151 (1.08%) blood donors had reactive screening tests. The prevalence of HIV, HBV, HCV, Syphilis were 0.07% (9), 0.64 % (90), 0.15% (21), 0.22% (31) respectively. The overall response rate of donors with reactive screening tests was comparatively high i.e. 80.1%. (131 out of 151 reactive donors). Around 61 (50.4%) of counseled reactive donors revealed history of high‑risk behavior/factors which were not disclosed during donor registration and screening. Conclusion: Donors conceal their high‑risk behaviors and continue to donate blood being not aware of the consequences of their blood donation. Detailed predonation education and counseling should be a part of the process of donor selection and privacy should be maintained to gain donor confidence. Notification of positive results should be made mandatory and uniform national guidelines for the notification of reactive blood donors should be formulated. Proper follow-up counseling of reactive donors should be done and TTI response rate should be monitored.

Background: Mental illness disproportionately affects the physical, psychological, and social well-being of prisoners worldwide at a far higher rate than the general population. Depression is one of the common mental illnesses. However, in low- and middle-income countries, relatively little research has been undertaken to assess the prevalence and the factors that contribute to depression among prisoners. Aim: This paper aims to assess the burden and predictors of depression among prisoners in a central jail in Kadapa. Method: This cross-sectional study was conducted among prisoners in central jail of Kadapa. Out of total   550 prisoners, 257 were selected by random sampling method and completed the interview; among them males were 235 and females were 22. The socio-demographic characteristics and PHQ-9 scale were used for data collection. Descriptive and inferential statistics were applied for data analysis. Result: In the overall study sample, 27.23% of prisoners were diagnosed with moderate depression, and 22.9% were diagnosed with severe depression. Depression was more among the prisoners with life sentence and in those with first time imprisonment. There was significant association was seen between environment factors like poor nutrition and less social support from family member’s adjustment issues with peers with depression. Binary logistic regression showed that higher education, being accused of a crime, and having low social support are all significant predictors of depression in prisoners. Conclusion: The study emphasizes the significance of understanding the role of social support in prison and assisting policymakers in developing policies that make it more prisoner-oriented, resulting in increased prisoner mental well-being and health.

Background: Burnout is a pervasive and debilitating state that results from an unsustainable period of overwhelming stress. Burnout in doctors can lead to reduced care of patients, increased medical errors, and poor health. Resilience refers to the capacity of psychophysiological systems to recover from challenging conditions and allow the organism to efficiently return to its health maintenance equilibrium. Aim: To assess the resilience and burnout and to compare the resilience and burnout between clinical and nonclinical postgraduates. Methodology: It is a cross sectional comparative study done in 142 medical postgraduates, between 25 and 35 years of age. 99 clinical postgraduates and 43 nonclinical postgraduates participated in the study. They were given the printed hard copies of the resilience (Connor Davidson resilience scale) and burnout (Copenhagen burnout inventory) scale. The mean scores of personal, work and client related burnout and total resilience score was compared between clinical and nonclinical postgraduates. Results: Among the 99 clinical postgraduates, the mean scores of personal, work and client related burnout are 49.28, 47.99 and 42.17 respectively. Among the 43 non clinical postgraduates, the mean scores of personal, work and client related burnout are 43.99, 35.66 and 26.66 respectively. The mean values of work and client related burnout are statistically significant while the mean values of personal burnout are not statistically significant. The mean value of resilience in clinical and non-clinical postgraduates are 61.43 and 60.74 respectively which are not statistically significant. There is a weak positive correlation between working hours and burnout. There is a weak negative correlation between sleeping hours and burnout. Conclusion: Our study showed that there was a higher prevalence of work and client related burnout in clinical postgraduates compared to nonclinical postgraduates, while there is no significant difference in prevalence of personal burnout. Also, there is no significant difference in resilience between the two groups. Furthermore, prospective, controlled studies are needed to investigate the risk factors for burnout and other mental health disorders among clinical doctors, as well as the effects of treatment.

Introduction: Periarticular hip fractures are common, debilitating injuries in elderly patients, often leading to high mortality rates and prolonged hospitalizations. With a projected increase in hip fractures worldwide, there is an urgent need for accurate preoperative tools to predict postoperative outcomes. The Hip Multidimensional Frailty Score (HMFS), which assesses frailty and physiological reserves, has shown promise in predicting complications in elderly patients with hip fractures. This study aims to validate the predictive value of the HMFS for mortality, postoperative complications, ICU need, and prolonged hospitalization in elderly hip fracture patients. Materials and Methods: This prospective observational study was conducted at a tertiary care hospital, involving 100 elderly patients (age >60) with hip fractures (neck of femur and intertrochanteric fractures). Preoperative frailty was assessed using the HMFS, along with serum albumin levels. Postoperative outcomes, including ICU admission, complications, hospital stay, and 6-month mortality was studied. Results: The study revealed a significant association between the HMFS and postoperative outcomes. High HMFS (≥8) was linked to a 30.77% mortality rate, compared to 1.15% in patients with low HMFS (<8) (p<0.001). Additionally, 100% of high HMFS patients required ICU care, whereas only 18.4% of low HMFS patients did (p<0.001). Prolonged hospitalization (>5 days) was also associated with high HMFS (92.3% vs. 1.15%, p<0.01). Preoperative surgical delay (>1 day) was associated with a higher HMFS (mean 6.42 vs. 3.67, p<0.001) and increased 6-month mortality (15.8% vs. 2.5%, p<0.05). A significant correlation was observed between preoperative delay and 6-month mortality (Odds ratio 3.33, 95% CI 1.6-6.9). Conclusion: The Hip Multidimensional Frailty Score is a reliable tool for predicting mortality, ICU need, and hospital stay in elderly patients with hip fractures. High HMFS scores correlate with worse postoperative outcomes, including increased mortality and complications, and should be considered in preoperative decision-making. Additionally, reducing preoperative delay may improve outcomes, underscoring the importance of timely surgical intervention.

Background: Polycystic Ovary Syndrome (PCOS) is a multisystemic disorder characterized by endocrine, metabolic, and reproductive system abnormalities. The diagnostic criteria include chronic anovulation and hyperandrogenism. The autonomic nervous system plays a role in pathogenesis. Women with PCOS often experience conditions like oscillatory sleep apnea, hypertension, depression, obesity, and type 2 diabetes linked to an autonomic nervous system imbalance. Objectives: The aim and objective of this study to compare the heart rate variability (HRV) and estimated androgen levels in patients with polycystic ovary syndrome (PCOS) and in healthy controls. Material and Methods: Thirty newly diagnosed PCOS cases and thirty controls with similar anthropometric measurements had their HRV assessed. DHEAS and serum testosterone levels were also assessed. The mean outcomes were the values of HRV in the time [standard deviation of all normal R-R intervals (SDNN), the square root of the sum of the squares of the differences between the adjacent normal R-R intervals (rMSSD), and total power (TP), very-low-frequency power (VLF), low-frequency power (LF), normalized low-frequency power (LF norm), high-frequency power (HF), normalized high-frequency power (HF norm), and LF/HF ratio] domains. Differences between the 2 groups were analyzed by Mann-Whitney U test, using SPSS for Windows (version 22.0). Results: HRV frequency domain parameters, including LF (p = 0.00*), HF (p = 0.00*), and LF/HF ratio (p = 0.00*), as well as time domain parameters, including RMSSD (p = 0.00*), SDNN (p<0.03*), NN50 (p = 0.00*), and total power (p = 0.00*), were significantly reduced in PCOS patients. Serum testosterone (p<0.000*) and DHEA-S (p<0.03*) were two androgen parameters that were significantly higher in PCOS cases than in healthy controls. Conclusions: The results of the present study indicated that PCOS is related to increased sympathetic over activity, Impaired HRV and increased androgen levels. Therapeutic modalities may adversely affect the cardiovascular system, highlighting the need for ways to reduce these risks. We therefore suggest that HRV is an accurate and sensitive marker to detect early signs of cardiovascular impairment and enables timely measures to avoid further morbidity.

Background: Onychomycosis (OM) is a slow-growing nail fungal infection that if left untreated, may result in the total loss of the nail plate. Oral and topical antifungal therapy are usually prescribed to patients for treating onychomycosis. Non-pharmacological therapeutic techniques such photodynamic therapy, diode lasers, long pulse and Q switched-Nd-YAG LASER, and fractional CO₂ lasers have recently become popular for treating the OM. Objective: This study was conducted with the aim to study the safety and efficacy of Q switched Nd: Yag LASER in OM. Methodology: Total 130 nails from 11 PAS positive onychomycosis patients were selected based upon the inclusion and exclusion criteria. Each nail received 4 sessions for fingernails and 6 sessions for toe nails of Q-switched Nd-Yag LASER (nanosecond pulse) therapy at 2 weekly intervals. In each session three passes were given at a gap of 30 seconds. Evaluation by OSI was carried out before starting therapy and then every 2 weeks for 3 months and then monthly till end point of therapy. Results: The mean age of the patients was 45.09 ± 12.06 years with a predominance of females (63.63%). The mean size of the infected area was 4.63 ± 1.02 mm. The morphology of the nail indicates DLSO in 44 (33.85%) nails, endonyx in 19 (14.62%) nails, PSOM in 37 (28.46%) nails, and WSO in 30 (23.08%) nails. The mean OSI exhibited a significant linear declining trend over the increasing number of therapy sessions. Conclusion: In patients with onychomycosis, we think the Q Switched Nd: YAG (1064 nm) laser is a safe therapy option. It may be especially advised for people who are contraindicated or who would prefer not to use oral antifungals. Nonetheless, we believe that in order to be effective, lengthier follow-up times and sessions may be required.

Background: Tumors of stomach and intestine is the 5th most common malignancy and 3rd leading cause of cancer death worldwide. Most cases are diagnosed in advanced stages making treatment difficult. International regulatory agencies have recently approved trastuzumab therapy in locally advanced and metastatic gastric adenocarcinomas expressing Her2-Neu. Objective: The aim of present study is analyzed the Her2-Neu expression analysis in the tumors of stomach and intestine and correlate that with clinicopathological characteristics. Methodology: Tissue specimens obtained from the from 61 cases who were clinicoradiologically diagnosed with benign and malignant lesions of stomach and intestine. Sections were stained with Haematoxylin& Eosin (H&E) stains under strict quality assurance. Her2-Neu monoclonal rabbit antibody was used form immunohistochemical analysis. Data of Her2-Neu expression was correlated with the clinicopathological characteristics. Results: A higher incidence of stomach and intestinal lesions was found in the age group beyond 30 years. A high male to female ratio was observed. The dominant site of involvement was intestine (55.7%) followed by the stomach (44.3%). Total 17 (28%) cases were diagnosed as benign and 44(72%) were diagnosed as malignant on histopathology. Out of 44 malignant cases diagnosed on histomorphology, the maximum cases 29(66%) were diagnosed as moderately differentiated adenocarcinoma. Among 44 malignant patients have 3+ expression of Her2-Neu, 14(88%) patients have 2+ expression and 14 (67%) patients have 1+ expression. The association of Her2-Neu expression in different histomorphological grades and types showed that higher grades of adenocarcinoma showed 3+ and 2+ Her2-Neu expression. Conclusion: Her2-Neu overexpression was found to be statistically significantly correlated with middle age group and moderately and poorly differentiated gastric and intestinal tumors; they may be the candidates for Herceptin-based targeted treatment. To investigate the function of Her2-Neu as a stand-alone prognostic factor, more research with ample sample size is required.

Background: Pregnancy induced hypertension is a major cause of fetomaternal morbidity. Studies have shown alteration of serum lipid metabolism in PIH which occur early and may help predicting PIH. The aim of the study was to compare the serum lipid levels in women with pregnancy induced hypertension and normal pregnancy. Methods: This case control study was conducted in the Department of Obstetrics and Gynaecology, Darbhanga Medical College and Hospital, Laheriasarai, Bihar from January 2023 to June 2023. A total of 100 (one hundred) were selected, out of which 50 (fifty) normotensive pregnant women served as a control and 50 (fifty) hypertensive women constituted the study group. Besides baseline routine investigations, estimation of Serum lipid profile was done by collecting blood samples from antecubital vein of every case and control and were analysed at department of Biochemistry, DMCH, Laheriasarai, Bihar. Results: The hypertensive group had a significant rise in Triglyceride (TG), total cholesterol, LDL-C levels and decreased HDL-C levels as compared to the control group. Conclusion: Abnormal lipid profile during pregnancy plays an important role in development of pre-eclampsia.

Background: Pregnancy induced hypertension (PIH) is one of the most common causes of both maternal and neonatal morbidity and associated with adverse pregnancy outcomes. Profound changes in coagulation and fibrinolytic system occur during normal pregnancy causing hypercoagulable state. Early identification of high risk women and monitoring derangements in their coagulation system are surely pivotal in the prevention of complications. Hence, this study was undertaken to compare the coagulation profile in pre-eclamptic and eclamptic patients with normotensive pregnant patients Hypertension is one of the common medical complications of pregnancy and contributes significantly to maternal and perinatal morbidity and mortality. Aim of this study to evaluate the coagulation profile in pregnancy induced hypertension. Methods: Present study was carried out in the Department of Obstetrics and Gynaecology, DMCH, Laheriasarai, Bihar on 100 PIH cases from July 2023 to December 2023. Coagulation profile (PT, aPTT, INR and D-dimer) was done in all cases and values were correlated with the severity of PIH. Results: Total of 100 cases were included in the study. 32 were mild GH, 17cases were severe GH, 35 cases were mild pre-eclampsia and 16 cases were in severe pre-eclampsia group. Prolonged PT, aPTT and D-Dimer was seen in 15 cases, 42 cases and 38 cases respectively. In our study we observed increased mean aPTT of 31.61±2.89 and increased D-Dimer of 0.34±0.31 in severe pre-eclampsia patients. Hence we emphasize that raised aPTT, D-Dimer are alarming signs for aggressive treatment. Conclusion: Raised aPTT and D-dimer are fairly good indicator of severe preeclampsia and needs aggressive treatment.

Background: The intrauterine contraceptive device (IUCD) after nearly four decades of use is generally recognized as an effective safe economical and useful form of birth control. Its acceptance is worldwide in the developed as well as developing countries. Some of the causes for removal include desire for pregnancy and sterilization etc. Aims of this study: to determine the efficacy of copper T(Cu T) 380A as a contraceptive method, determine the indications of discontinuation of Cu T 380A and identify the difficulties faced during removal in outpatient basis and cases which required removal under anaesthesia in operation theatre. Methods: This Retrospective analysis of Cu T removals was done in Department of Gynaecology and Obstetrics, Koshi Hospital, Biratnagar, Nepal from January 2017 to December 2017. A total number of 256 cases were observed and included in this study. Results: Among the IUCD users, majority belonged to age group of 20 – 30 years. Most of the cases reported for removal came after 2-5 years of usage. Among them, most were referred from periphery in view of difficulty in removal. Out of 256 cases of total Cu T removals, 136 cases(53.1%) were removed on outpatient basis, 120 cases (46.8%) were removed under anaesthesia. Major indication for removal was desire for pregnancy in 198 cases (77.3%), 52 (20.3%) cases were removed for sterilization, 2 (0.78%) case was removed for failure of contraception, 2 (0.78%)case for abnormal uterine bleeding and dysmenorrhea, 2 (0.78%) case for uterine perforation. Conclusion: Copper T is an effective, safe, long-lasting, convenient reversible contraceptive method with very few side effects. The information in this study may be useful to counsel women who are considering the IUCD as a contraceptive method and current users who are requesting for removal due to side effects.

Background: Approximately 5.7% of all fractures are proximal humerus fractures, which are also the most prevalent type (80%). Proximal humeral fractures (PHFs), which tend to be related to systemic osteoporosis, are also the third most frequent fracture in elderly people. It is anticipated that throughout the next three decades, their occurrence will increase. Assessing and contrasting the functional results of various fixation techniques for proximal humerus shaft fractures is the aim of the study. Methods: The present prospective study was carried out from March 2022 to February 2023 at the Department of Orthopaedics, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, on patients who were admitted with proximal humerus fractures in accordance with Neer’s classification inclusion criteria. Both surgery and radiological examination were completed. At the first, fourth, eighth, and fourteenth weeks following surgery, postoperative follow-up was conducted, and each case’s results were assessed using Neer’s shoulder score. Results: There were 60 cases total, with an average age of 48.2 years. A common cause of fractures was traffic-related injuries. Eight of the 60 cases had satisfactory results, four were unsatisfactory, two had a failure, and 46 had excellent results. The mean scores on Neer’s score were as follows: range of motion (16.55 units), function (23.5 units), pain (33.5 units), and anatomy (6.9 units). Conclusion: A realistic approach and surgical care of complicated humerus fractures depend on clinical evaluation, adequate radiographic images, patient age, and activity. A successful operation and a positive functional outcome depend on carefully choosing the patient and having a solid understanding of anatomy and biomechanical concepts.

Background: The most frequent fractures in the upper limb are distal end radius (DER) fractures. Intra-articular fractures can be treated by percutaneous pinning, closed reduction and external fixator application, or open reduction and internal fixation using a volar locking plate. Comparing the functional results of external fixation and volar locking plates was the aim of our investigation. Methods: This prospective study was conducted at Department of Orthopaedics, SKMCH, Muzaffarpur, and Bihar from March 2022 to February 2023 on 46 patients with intra articular distal end radius fractures. Of them, 20 were controlled by an external fixator, while 26 were controlled by a volar locking plate. The radiographic parameters and range of motion attained after surgery were used to compare the outcomes of the two groups. The Gartland-Werley scale and the DASH score were used to assess the functional result. Results: Patients treated with a volar locking plate (VLP) had superior grip strength and final range of motion as compared to those treated with an external fixator (EF). Radiographically, the VLP group outperformed the EF group in terms of volar tilt and radial height. Conclusion: In comparison to external fixators, we found that VLP is a better way to keep reduction going until union occurs and avoids fracture collapse in intra-articular distal end radius fractures. Consequently, the functional and radiological results are superior to those of the external fixator.

Background: Obesity and stress are two lifestyle risk factors that have an impact on a variety of physiological aspects of the human body. Autonomic neural activity determines how well a person can handle stress. In the current study, we compared the frequency domain indices of HRV in obese and non-obese adults in Darbhanga District before and during a mental arithmetic stress test. Methods: The current study was carried out at Department of Physiology, Darbhanga Medical College, Laheriasarai, Bihar from April 2024 to June 2024. Prior to the study start, approval from the institute ethics committee was acquired. Results: Similar in age for five minutes, 60 male subjects, 30 obese and 30 non-obese performed a mental arithmetic stress test. Prior to the stress test, the rise in LFnu and LF/HF ratio in the obese group was statistically significant (p <0.001). Obese patients showed decreased LFnu, HFnu, and LF/HF ratio during the mental arithmetic test, with the LFnu reduction statistically significant (p<0.01). In contrast, there was a statistically significant decrease in HFnu (p>0.05) and an increase among LFnu (p<0.001) and LF/HF ratio (p<0.01) in non-obese patients. Conclusion: The findings imply that the obese group has lower autonomic neural activity in response to mental stress.

Introduction: Antimicrobial resistance is a major emerging world-wide problem in the intensive care unit (ICUs). Different types of uropathogenic organism causes infection and these organisms are developing resistance due to unnecessary usage of common antimicrobial agents which indicates strong necessity of detailed study on this public health problem for designing the appropriate Antimicrobial Policy as a global Antimicrobial Stewardship Programme. Material and Methods: This prospective laboratory based study was carried out in Department of Microbiology, NMCH, and Sasaram from Dec. 2022 to Nov. 2023. Total 273 urine samples from patients admitted in ICUs were tested following the CLSI guidelines (2023). Antimicrobial Susceptibility pattern of isolates were determined employing Kirby-Bauer Disk-diffusion method. Results: This study revealed 59(21.6%) culture positive bacterial isolates in 273 samples comprising of 18(30.5%) Gram-positive cocci and 41(69.4%) Gram-negative bacilli. Gram-negative bacteria were Escherichia coli 15(25.4%), Pseudomonas aeruginosa 11(18.6%), Citrobacter species 08(13.5%), Klebsiella pneumoniae 05(8.4%) and 2(3.3%) Acinetobacter baumannii. Gram-positive isolates were Enterococci species 11(18.6%) and Staphylococcus aureus 07(11.8%). Gram-positive isolates were sensitive to Nitrofurantoin (83.3%), Piperacillin-tazobactam (85.7%) with 88.8% sensitivity to Vancomycin and 100% to Linezolid. Gram-negative isolates were sensitive to Meropenem (58.5%), Nitrofurantoin (68.2%), and Fosfomycin (82.9%) with 100% sensitivity to Polymyxin B. This study showed resistance to Ampicillin (72.7%) and Ciprofloxacin (83.4%) for Gram-positive isolates and resistant to Ampicillin (93.3%), Ofloxacin (86.6%), Ceftriaxone (83.3%), Cefotaxime (83.3%) and Ciprofloxacin (82.9%) among Gram-negative isolates. Conclusion: This study showed prevalence of 21.6% uropathogens among ICU patients with Gram-negative bacteria 41(69.4%) and Gram-positive bacteria 18(30.5%) infection respectively with maximum sensitivity to Vancomycin, Linezolid and Polymyxin B. Study demonstrated multidrug resistance to Ampicillin, Ciprofloxacin, Ceftriaxone and Cefotaxime which is considered as a great concern of emergence of antibiotic resistance in this rural health setup.

Background and Objectives: Maternal near miss cases more often as compared to maternal deaths and have similar pathways which can provide valuable information about maternal mortality and hence these cases need to be reviewed which can indirectly play a major role in reducing maternal mortality ratio in India. This study was aimed to analyze the incidence, causes, and determinants of maternal near miss events in a tertiary care hospital. Material and Methods: A retrospective analysis of health records of maternal near miss cases admitted to department of obst & gyne in tertiary care hospital from May 2024 to October 2024 was done. Patient characteristics like age, parity, gestational age, risk factors, mode of delivery, lifesaving intervention were studied. Results: Total 2784 cases were admitted in obstetrics department for deliveries, out of them 284 maternal near miss cases from which 48 were maternal mortality The maternal near miss incidence ratio was 10.20/1000 live birth and maternal near miss to mortality ratio 5.92:1. Hypertension and PPH with severe anemia was the major cause of MNM. Women with multiparity, lack of awareness are at increased risk of near miss cases. Conclusion: Hypertensive disorders in pregnancy and obstetric hemorrhage are leading cause for pregnancy specific obstetric disorder and anemia was found to be a leading cause for pre-existing condition aggravated during pregnancy. Improving timely access to quality antenatal care among pregnant mothers with quality critical care management can reduce maternal near miss cases.

Background: Alcohol addiction is known to negatively influence the lives of families. The mental health of wives of alcohol dependent men (WADM) is often neglected, though they are expected to participate in the deaddiction process. This study aims to investigate the psychological morbidity of wives of those with alcohol dependence, and its social correlates in Indian context. Methods: The study, conducted in a tertiary centre, followed cross-sectional design with consecutive recruitment of wives of newly registered adult outpatients with alcohol dependence syndrome. A semi-structured questionnaire was used to collect relevant data. The psychiatric morbidity among WADM was assessed using Clinical Interview Schedule – Revised (CIS-R). Domestic violence was assessed using Hurt-Insult-Threat-Scream (HITS) tool. Data was analyzed using SPSS, version 21.0. Results: Hundred participants were recruited with mean age 32.6 years (SD: 6.8). Majority belonged to nuclear families (76%), and low socioeconomic status (81%). Seventy-five percent expressed poor family support. Seventy-three percent of WADM were identified to have psychiatric morbidity. Among the participants, 16% had past suicide attempts. Nearly all (99%) had experienced aggression from their husbands. Among WADM, partner violence and perceived lack of support had statistically significant association with common mental disorders. Conclusion: Psychiatric morbidity and partner violence were highly prevalent among WADM. Partner violence was the most significant social factor associated with psychiatric morbidity. There is a need to identify and address early the mental health needs of WADM.

Background: Surgical Site Infections (SSIs) increase healthcare costs, hospital stays, and morbidity. This study examines the reasons for SSIs after abdominal surgery in low- and middle-income nations like India, where inadequate medical infrastructure makes them more common. Methods: This cross-sectional study was conducted at Pawapuri Nalanda, Bihar’s Bhagwan Mahabir Institute of Medical Science from August 2023 to August 2024. The study involved 150 abdominal surgery patients. Medical records were used to collect demographics, operation details, co-morbidities, and postoperative factors. According to CDC guidelines, SSI incidence was evaluated, and multivariate logistic regression showed significant risk factors. Results: Diabetes (38%), obesity (35%), and surgeries over three hours (28%), had the greatest incidences of SSIs at 21.3% of 150 patients. Risk factors for SSIs include obesity (OR 2.8, p < 0.01), diabetes (OR 3.1, p < 0.01), and longer surgery time (OR 2.4, p < 0.01). Patients who received prophylactic antibiotics within 60 minutes after surgery had 13% fewer SSIs than those who received them later (29%). Conclusion: Long operational time, obesity and diabetes increase abdominal SSI risk. Prophylactic antibiotics must be given quickly to reduce infection rates. These findings emphasise the significance of specialised therapy to improve surgical outcomes.

Aim: To know the visual outcome after cataract surgery in patients having posterior capsular rent and or zonular dialysis. Material & Methods: The Study was done in the Department of Ophthalmology at a rural medical college hospital. Patients having posterior capsular rent or zonular dialysis during cataract surgery in the hospital from the period November 1^st 2016 to October 31^st 2017 were included in the study. A total of 978 patients were operated only for cataract during above mentioned time period. Purposive sampling was done after consulting the statistician and 40 patients were included in our study. Results: Out of the 978 cataract surgeries (MICS /PHACO) in patients satisfying inclusion criteria ,36 patients (3.68%)had PCR and four patients (0.40%) had ZD. Visual acuity was good in 0(0.0%) patients before surgery and after surgery visual acuity was found in 25(62.5%) patients. While after surgery only 3(7.5%) patients have poor acuity. There was statistically significant improvement found in visual acuity after surgery. (P<0.001). Conclusion: Thorough preoperative workup , attention to existing problems, early detection and proper management of posterior capsular rent(PCR) and zonular dialysis (ZD) with good follow up leads to better visual outcome.

Background: Oral squamous cell carcinoma (OSCC) is a significant global health concern, especially in regions like the Indian subcontinent. The process of EMT, characterized by the loss of E-cadherin and gain of Vimentin, plays a crucial role in cancer metastasis and progression. Understanding the expression patterns of these markers can provide insights into the mechanisms behind EMT and OSCC progression. This study aimed to evaluate the expression of Vimentin and E-cadherin in different grades of premalignant and malignant oral lesions also determine the relationship between the expression of these markers and epithelial-mesenchymal transition (EMT). Material and Methods: The cross-sectional study was conducted in the Department of Pathology at Maharani Laxmi Bai Medical College, Jhansi, from April 2023 to March 2024. The study included 100 cases of biopsies and resected specimens from patients with clinically diagnosed premalignant or malignant lesions of the oral cavity. Samples were fixed, processed, sectioned, and stained using Hematoxylin and Eosin. The expression of E-cadherin and Vimentin was assessed through immunohistochemistry. Results: E-cadherin expression was found to be lower in older age groups and significantly associated with malignant lesions. High Vimentin expression was more common in older and middle-aged groups and was also significantly associated with malignant lesions. Statistical analysis revealed a significant relationship between marker expression and clinical characteristics such as age and diagnosis, with p-values <0.004 for age and <0.001 for malignant versus premalignant lesions. Conclusion: The study indicates a potential inverse relationship between marker E-cadherin and Vimentin expression and different grades of dysplagia and OSCC. Lower E-cadherin expression and high Vimentin expression correlates with advancing age and malignancy. These findings support the role of EMT in OSCC progression and highlight the importance of E-cadherin and Vimentin as biomarkers for evaluating the malignancy potential of oral lesions.

Ultrasonography (USG) is the preferred imaging method for the evaluation of paediatric inguino scrotal pathologies. It is an easily available imaging modality. It is also cost effective & non-hazardous for children as there is no risk of radiation or any other side effects. Ultrasonography is done to diagnose and evaluate paediatric inguinoscrotal pathologies /abnormalities, such as inguinal hernia, hydrocele, testicular microlithiasis, undescended testis, epididymo-orchitis etc. Over the past few decades, ultrasonography techniques have been developed tremendously – starting from colour Doppler, spectral analysis, contrast USG to 3D & 4D imaging. Here we are presenting few cases where diagnosis was made by ultrasonography & Colour Doppler. (1) Right encysted hydrocele which was diagnosed by ultrasonography and colour Doppler. (2) Right undescended testis (located in the proximal part of right inguinal canal) with bilateral testicular microlithiasis, diagnosis was made by ultrasonography and colour Doppler. (3) A reducible right inguinal hernia with left sided infantile hydrocele, diagnosed by ultrasonography and colour Doppler. (4) Right focal epididymitis diagnosis was made by ultrasonography and colour Doppler. (5) Funicular type of right spermatic cord hydrocele which was diagnosed by ultrasonography and colour Doppler. (6) A small reducible right inguinal hernia diagnosed by ultrasonography and colour Doppler. Ultrasonography is a type of radiological examination where sound waves are used to produce picture of different organs of body and their pathologies. Colour Doppler is used to further characterize any pathology.

Aim: The aim of this study is to study the cognitive effects and memory skills of Levetiracetam in comparison with Donepezil in experimental model of Alzheimer’s Disease (AD). Materials and Methods: The animals were divided into their respective groups of 6 mice each. Alzheimer’s Disease was induced by Aluminium Chloride (AlCl₃) in male Wistar Rats in all groups. The assessment was done by three methods Morris Water Maze (MWM), Passive Avoidance and Y-Maze. Results were compared with the standard Donepezil. Statistical analysis was done by ANOVA followed by Dunnett’s multiple comparisons test and p <0.05 was considered significant. Results: In all the three behavioural assessment methods the results of Levetiracetam group were comparable to the results of Donepezil group (Day 30, Day 60 and Day 90). There was a significant improvement in Levetiracetam group when compared to AlCl₃ group. Overall, Levetiracetam significantly improved the cognitive decline in the rats, showing its efficacy comparable to the standard drug Donepezil. Conclusion: In this study it was concluded that Levetiracetam showed Improvements in learning and memory, as demonstrated in the Morris Water Maze, Passive Avoidance, and Y-Maze tasks, showing that it has possibilities of becoming a promising agent for Alzheimer’s Disease.

The acromioclavicular (AC) joint function as a strut to help with movement of the scapula resulting in a greater degree of arm rotation. There are multiple modalities to treat AC joint disruption in patients. Both conservative and surgical management are possible and surgeon must choose the most appropriate management modality according to biological age, functional demand and type of lesion. This study aimed to evaluate the functional outcome of the double endobutton technique used to treat acromioclavicular (AC) dislocation. In this prospective study, 30 patients are treated for complete acromioclavicular (AC) joint disruption and their functional outcome are measured using Constant score and DASH score. Among 30 patients, 3 (10.00%) showed excellent functional outcome, 18 patients (60.00%) showed good outcome 8 patients (26.67%) showed fair outcome and only 1 patients (3.33%) showed poor functional outcome.

Aim & Objectives: This study was undertaken to analyze the strength of Direct Immunofluorescence microscopy in the diagnosis of renal disease presented with various clinical symptoms and compare the findings with similar studies published. The purpose of our study is to assess the histopathological spectrum of renal biopsies conjoining with The Direct Immunofluorescence in our population. We studied 105 consecutive renal biopsies over a period of 11 months. The Histopathological and Direct Immunofluorescence findings were carefully documented and analyzed. The morphology was then correlated with clinical features, in relation to the age and gender of the patient. Results: In our patient population, primary glomerulonephritis mainly focal segmental glomerulosclerosis (FSGS) was the most common prevalent kidney disease. Nephrotic syndrome (NS) was the leading indication for renal biopsy, followed by acute renal failure. Maximum Direct Immunofluorescence positivity was seen in Lupus Nephritis (6/6 cases showed FULL-HOUSE effect (Positive for IgG, IgM, IgA, Complement C3, C1Q, Kappa & Lambda). Conclusion: Direct Immunofluorescence assisted to correct diagnosis of renal disease in parallel with light microscopic examination along its correlation with clinical features and serological parameters. In less than 5% of patients, electron microscopy might be essential.

Background: Circadian system coordinated and regulated multiple cellular procedures which implicating in cancer development such as metabolism, cell cycle and DNA damage response. Many studies suggested that clock genes contribute to the regulation of not only circadian rhythm, but also the regulation of apoptosis induced by anti-tumour drugs. In this study 13 Microsatellite markers of Circadian-Clock Genes were examined in 150 OSCC patients treated with cisplatin + 5FU (Arm-I) and Cisplatin + capecitabin ( Arm-II) to establish genetic marker for early detection as well as the marker responsible for drugs sensitivity and resistance for accurate clinical practice. Results: Overall incidence of LOH/MSI was 49%±18.84 with the frequency of LOH and MSI of individual markers ranged from 12-71%. LOH was relatively more frequently detected at five loci, namely Bmal-1 (42%), Per-1 (46%), Per-2(49%), rorβ (58%), c-fos (49%), whereas the MIS of above five markers were 53%, 65%, 69%, 63% and 71% respectively. Low incidence of MSI was observed in Clock-5 (16%), Rorα (12%) and E4BP4 (17%). Conclusion: The results of this study suggested that the microsatellites of Clock genes particularly Bmal-1, per-2, Rorβ and C-fos may be used as a marker to determine clinical staging, to evaluate the metastatic risk of OSCC, and as a novel target for the prevention and treatment of OSCC.

Background: Sleep disorders in adolescents are highly prevalent, with prevalence rates ranging from 25% to 40%. Sleep disorders include Dysomnias, Parasomnias and Circadian rhythm disturbances. The present study was undertaken with the purpose to analyse the sleep disorders among the adolescent population Methodology: This study was a cross-sectional questionnaire-based survey with adolescents with age range of 14 to 19 of both genders. Subjects with chronic Illness or use of medication which are known to affect sleep were excluded from the study. Results: Sleep disorders were observed in 27.8% of the adolescent study population. Among middle adolescents, the prevalence was 26.8%, compared to 30% among late adolescents. The study also found that 28.6% of adolescent males and 26.9% of adolescent females had sleep disorders. No statistical correlation was found between sleep disorders and age distribution or gender. However, mobile phone usage significantly impacted the occurrence of sleep disorders. Among the various sleep disorders, 19.1% of subjects reported nightmares, 18.8% reported restless leg syndrome, 17.1% experienced hypnagogic hallucinations, and 11.4% experienced hypnopompic hallucinations. Sleepwalking was observed in 0.4% of subjects, bruxism in 0.9%, and nocturnal enuresis in 0.1% of adolescents. Conclusion: Sleep disorders are not uncommon among adolescents, and these health issues should be addressed with increased awareness among both adolescents and their parents. Mobile phone usage significantly impacts the occurrence of sleep disorders. Therefore, adolescents need to be educated about the importance of adequate sleep, the components of good sleep hygiene, and strategies to facilitate healthy sleep behaviours.

Introduction: Adolescence is a critical period of transition from childhood to adulthood, during which sleep patterns change significantly. Adequate sleep is essential for promoting healthy development, cognitive function, and psychosocial well-being. This study aimed to assess the sleep patterns and their effects on adolescents. Method: A cross-sectional, self-reported survey was conducted among 1,000 adolescents (middle and late adolescents) of both genders. Adolescents with chronic illness or medication affecting sleep were excluded. Data were analyzed using T-test, Chi-square test, Z test, regression analysis, and ANOVA. Results: 56.7% of adolescents reported good sleep quality, 30.6% satisfactory, and 12.7% poor sleep quality. Late adolescents (16.3%) and girls (16.1%) experienced poorer sleep quality compared to their peers. Nocturnal awakenings occurred in 11.8% of subjects, with higher occurrences among girls (29.1%) and late adolescents (34.5%). Daytime sleepiness was reported by 10.1%, and 38.2% took daytime naps. Notably, those experiencing nocturnal awakenings were more likely to report daytime sleepiness. Factors like mobile phone use, coffee and coke consumption negatively impacted sleep quality. Furthermore, poor sleep quality was associated with lower academic performance, while satisfactory sleep had a positive influence on scholastic success. Conclusion: These findings highlight the need to promote healthy sleep habits among adolescents to support their development and academic performance.

Background: A-scan ultrasound biometry (A-scan biometry/ A-scan)is mainly used to determine the axial length of the eye with the help of an ultrasound device. Axial length of eye is an important parameter to calculate Intra-ocular lens (IOL) power prior to cataract surgery. Different formulae to calculate the IOL power need axial length value along with keratometry value (calculated using a keratometer). Sometimes, the corneal compression caused during the A-scan measurement gives wrong values of the axial length. The objective of the present study was to compare accuracy of intraocular lens power calculation by immersion A-scan biometry and contact A-scan biometry in a tertiary care centre. Material and Methods: The present hospital based comparative observational study was conducted at Department of Ophthalmology from July 2024 to September 2024.A total of 100 consecutive patients who underwent phacoemulsification and IOL implantation were included in the study. Informed written consent was taken from the participants of the study. Patients were divided into Group A as immersion group and Group B as Contact A-scan group with 50 patients each. Data entry and data analysis was done using MS Excel and epi info version 7. Results: Most of the patients were females in Group A (70%) and Group B (62%) with no statistically significant difference (P>0.05). The mean axial length in group A and Group B was23.07 and 22.65with statistically significant difference (P<0.05). The mean IOL power in group A and Group B was20.37 and 21.21respectively with statistically significant difference (P<0.05). Conclusion: The present study concludes that the immersion technique had better repeatability compared to Contact A-scan for intraocular lens power calculation.

Background: FNAC is a useful diagnostic tool which is inexpensive, easy to use, safe, minimally invasive & easily available time saving OPD procedure. The 6 tier Bethesda system offers consistent terminology for thyroid reports and permits improved discussion and comprehension between the clinician and the pathologists. It has been found that FNAC along with thyroid hormone profile helps us at arriving to an accurate diagnosis. FNAC also helps to minimize the incidence of thyroidectomy and to choose treatment for the patient. To differentiate benign and malignant thyroid swelling ultrasound is safe and cost effective investigation of choice. The American College of Radiology has recommended the ACR- TIRADS reporting system for thyroid swellings on ultrasound. Thyroid function test findings can be used to predict the physiological status of thyroid lesions, and imaging cytological correlation can assist minimize inaccurate findings from fine needle aspiration of thyroid nodules. Materials & Methods: For this hospital-based prospective study at Silchar Medical College and Hospital, 120 fine-needle aspirated tests of thyroid nodules were collected over a period of one year. The classification of all diagnoses resulting from fine needle aspiration cytology took into account factors such as age, gender, cytological results (TBSRTC), and radiological abnormalities (TIRADS). These will be correlated with the findings of thyroid function testing. Results: The 120 thyroid lesions that were assessed were distributed as follows: 3.17% were classified as Non-Diagnostic (ND), 1.17% as Suspicious for Malignancy (SFM), 4.17% as Follicular Neoplasm (FN), 85.83% as Benign, and 0.83% as Atypia of Undetermined Significance (AUS). Most individuals classified as category II had abnormal Thyroid Function Tests (TFT). In category VI, all 5 cases were euthyroid, with no cases showing altered TFT. Among the 15 cases of thyroiditis, most were hypothyroid. Out of 120 cases, highest distributions of cases were in TIRADS 2 followed by TIRADS 3(USG). Conclusion: The combined use of FNAC with the Bethesda system, TI-RADS, and TFTs helps pathologists and clinicians by providing a comprehensive evaluation of thyroid nodules. This approach allows for accurate differentiation between cancerous and benign growths which aids in assessing the need for further investigation. It not only standardizes the diagnostic criteria but also offers clinicians clear management guidelines, whether that be follow-up FNAC or proceeding to surgery. By integrating cytological, radiological, and functional assessments, unnecessary surgeries can be avoided, as only nodules with a high risk of malignancy or significant abnormalities are selected for surgical intervention, ensuring more precise and effective patient care.

Background: Diabetes mellitus is an important metabolic disorder characterized by a raised blood glucose resulting from deficiency of insulin release and function. Diabetic microvascular complications in the eyes, especially diabetic retinopathy (DR) are an important cause of visual disability and blindness. Hence, the present study was conducted to assess ocular morbidity among diabetes mellitus patients in a tertiary care centre. Material and Methodology: The present hospital based cross-sectional study was conducted at Department of Ophthalmology from March 2023 to February 2024.A total of 254 patients above18 years who presented to hospital with Diabetes Mellitus were included in the study. Patients not giving a valid consent, pregnant women and women with gestational diabetes were excluded from the study. Permission from the Ethical Committee was taken prior to commencement of the study and informed written consent was taken from the participants of the study. Data entry and data analysis was done using MS Excel and epi info version 7. Results: The mean age of patients was 48.21 ±14.22 years with majority of females 143 (56.30%). The morbidity pattern among diabetes mellitus patients showed majority of patients had Visual impairment (17.72%) followed by Cataract (16.14%), Diabetic Retinopathy (12.2%), blindness (4.33%). Conclusion: The ocular morbidity among diabetic patients was Visual impairment, Cataract, Diabetic Retinopathy and Blindness.

Background: Hypertension (HTN) is regarded as a silent killer and if not diagnosed earlier and treated properly, it can cause many complications. Hypertensive nephropathy or renal disease occurs as a result of uncontrolled high blood pressure. Microalbuminuria is the earliest marker of hypertensive nephropathy. Microalbuminuria is associated with certain complications like cardiac complications and kidney disease. Recent advancements in diagnostic modalities for microalbuminuria have shown that urinary excretion of albumin is more in hypertensive patients as compared to subjects with normal blood pressure. Aim: To assess the Microalbuminuria amongst hypertensive patients attending at a Tertiary Care Hospital of Tripura. Materials and method: In this cross-sectional study total 120 hypertensive patients were enrolled attending at the Medicine OPD of the AGMC & GBP Hospital, Agartala, Tripura. Result: Microalbuminuria was found among 38% of the study population. Frequency of Microalbuminuria was increased with the increasing in age, duration and severity of hypertension. Microalbuminuria starts appearing well before the elevation of serum creatinine. Conclusion: Early screening to detect microalbuminuria in early stages will help to initiate appropriate treatment regimen to arrest kidney damage and prevent the risk of complications and thus improvement in prognosis.

Background: Benign Paroxysmal Positional Vertigo (BPPV) is a common vestibular condition, characterized by brief episodes of dizziness triggered by specific head movements. While most cases occur spontaneously, head trauma is a well-documented cause of secondary BPPV. This study investigates the incidence and subtype distribution of BPPV among individuals with head injuries. Methods: A prospective analysis was conducted on 220 patients aged 18 to 65 years (156 males and 64 females) with documented head injuries. BPPV was diagnosed using the Dix-Hallpike and supine roll tests to identify affected semicircular canals. The incidence, gender distribution, and canal involvement were analyzed. Results: Of the 220 patients, 13 (5.91%) were diagnosed with BPPV following head trauma. The condition was slightly more prevalent in females (6.25%) than in males (5.77%). Among the BPPV cases, the posterior semicircular canal was the most commonly affected (9 cases, 69.23%), followed by the anterior canal (3 cases, 23.08%) and the lateral canal (1 case, 7.69%). Statistical analysis revealed a significant difference between the observed incidence of BPPV in this study and the estimated prevalence of 2% in the general population (p = 0.00697). Conclusion: This study highlights an increased occurrence of BPPV in individuals with head trauma, with an incidence of 5.91% in the study population. The posterior semicircular canal was the most frequently involved, reflecting its anatomical susceptibility to otolith displacement.

Background: Laparoscopic cholecystectomy means surgical removal of gallbladder based on minimally invasive approach utilizing the principle of pneumoperitoneum. Objective: Objective of the study is to compare the outcome of high-pressure laparoscopic cholecystectomy and low-pressure laparoscopic cholecystectomy on liver function test in immediate post-operative period. Materials and Methods: A prospective observational study of laparoscopic cholecystectomies performed during one year from May 2022 to April 2023 at Burdwan Medical College regarding the effect of various insufflation pressure on the changes seen in immediate post-operative liver function test. Results: A total of 100 laparoscopic cholecystectomies were performed during the study period. The male to female ratio was 25:75 (1:3). 63% patients had previous episode of acute calculous cholecystitis, while 37% cases had incidental gallstone disease. All had radiologically confirmed gallstone disease. Laparoscopic cholecystectomy was done and 1 hour postoperative liver function test was compared to preoperative liver function test after dividing patients in two groups; first group having laparoscopic cholecystectomy carried out at insufflation pressure of 10mmHg, and the other group having 14mmHg insufflation pressure. There was statistically significant difference between baseline and 1 hour postoperative values of serum AST, ALT and total bilirubin levels in patient undergoing laparoscopic cholecystectomy at 14mmHg insufflation pressure. Comparatively, patient undergoing laparoscopic cholecystectomy at 10mmHg insufflation pressure had no statistically significant difference between values of preoperative and postoperative levels of serum AST, ALT and total bilirubin. Serum alkaline phosphatase level showed no statistically significant difference in either of the two groups. Conclusion: In our study, statistically significant increase in 1 hour postoperative values of serum total albumin, AST and ALT levels were seen compared to pre-insufflation values in group thar underwent high pressure (14mmHg) laparoscopic cholecystectomy. The result show that 14mmHg pressure pneumoperitoneum decreased blood flow to the liver and increased postoperative 1st hour AST, ALT and total bilirubin levels. It is therefore concluded that 10mmHg pressure pneumoperitoneum is superior to 14mmHg pressure pneumoperitoneum in laparoscopic cholecystectomy.

Introduction: Cervical cancer (CC) is the 4th most prevalent cancer among women in this global. Chronic HPV infections which mainly strains 16 and 18, raise cervical cancer risks, which requires showing from the age of 21. The treatment choices variety from cryotherapy in the early stages to brachytherapy and high-dose radiation therapy (HDRBT) in the final stages. These actions allow for precision tumor directing with least experience to healthy tissue, which finally recovers survival rates. Aim and objectives: The goal of this study is to explore the clinical effectiveness and toxicity of two HDR brachytherapy dose treatments for cervical cancer therapy find the best balance between tumor control and side effects. Method: This 24-month study at NRI Medical College’s Department of Radiation Oncology examined two HDR brachytherapy routines for cervical cancer patients. Patients had simultaneous chemotherapy, external beam radiation treatment (EBRT), and one of two high-dose rate (HDR) dosage fractional process. Tumor control and toxicity were determined by clinical and imaging assessments. In addition, these results were classified with RECIST criteria, and toxicities were categorized using CTCAE guidelines. Result: The research assessed two high-dose rate brachytherapy protocols (Arm A:5.5 Gy; Arm B: 7 Gy) for cervical cancer. Both arms reached comparable local control rates (90%), with Arm A showing a marginal advantage in disease-free survival (100% vs. 95%). Arm B showed high acute bladder and rectal toxicity. Biologically effective doses (BED) were high in Arm B, resulting in heightened toxicity. Conclusion: This study concluded that Arm A has shown a slightly higher disease-free survival (DFS) rate (100%) compared to Arm B (95%), indicating a potential advantage in preventing disease recurrence.

Background:  Head and neck cancer, the most common form of tumour in developing countries. For patients undergoing chemo-radiation for head and neck cancers, nutritional support is essential for minimizing side effects and enhancing treatment success. In contrast to home-based nutritional therapy, this study examines the impact of structured nutritional support on clinical and biochemical indicators. Methodology: Fifty patients with head and neck squamous cell carcinoma were included in an 18-month prospective observational research at NRI Medical College. Patients were randomized into two groups, with Group B receiving structured nutritional care and Group A receiving home-based nutritional support. Weight, haemoglobin, and albumin levels were among the clinical measurements, and treatment outcomes, side effects, infections, and re admissions to the hospital were assessed. Results: Structured nutritional support significantly reduced treatment interruptions (p=0.0308) and hospital re admissions (p=0.0047) compared to home-based care. Haemoglobin, albumin, and weight changes showed no statistically significant differences across groups (e.g., post-treatment haemoglobin p=0.4786). Group B patients tolerated treatment better, with fewer Grade 3 mucositis cases (4% vs 6%) and severe skin reactions (8% vs 4%). These findings underscore the importance of organized nutritional care during chemo radiation for improved outcomes. Conclusion: Patients receiving chemo-radiation therapy for head and neck cancers benefit from structured dietary support, which also lowers hospital re admissions and increases treatment adherence.

Background: Segmental vitiligo is a distinct subtype of vitiligo characterized by unilateral, patterned depigmented lesions. Unlike non-segmental vitiligo, it stabilizes early and responds poorly to medical treatment but exhibits excellent outcomes with surgical interventions. Understanding its clinical features is essential for accurate diagnosis and management. Aim: To characterize the clinical features, lesion patterns, and associated factors of segmental vitiligo to provide insights into its progression, stability, and related conditions. Methods: This descriptive, cross-sectional study included 200 patients diagnosed with segmental vitiligo at a tertiary dermatology center. Data were collected through detailed histories, clinical examinations, and standardized photography. Lesion patterns were classified as Blaschkoid, dermatomal, or others. Statistical analyses were conducted using SPSS version 23.0, with p-values < 0.05 considered significant. Results: The study cohort consisted of 120 females (60%) and 80 males (40%) with a mean age of onset of 11.8 years. Blaschkoid patterns were observed in 48% of patients, with head and neck regions being the most common site of onset (54%). Leucotrichia was present in 88% of cases, while halo nevi were observed in 11%. A family history of vitiligo was noted in 15%, and autoimmune conditions were reported in 9% of participants. Patients with extensive lesions (>5% body surface area) exhibited a higher likelihood of progressive disease (p = 0.02). Lesions localized to the head and neck stabilized earlier compared to trunk lesions (p = 0.04)., 90% had one segment affected, 9% had two segments involved, and only 1% had three segments. Conclusion: Segmental vitiligo demonstrates distinct clinical features, including Blaschkoid lesion patterns, high prevalence of leucotrichia, and early disease stabilization. These findings reinforce the need to distinguish segmental vitiligo from non-segmental types for accurate prognostication and management. Recommendations: Early recognition and classification of lesion patterns are crucial for diagnosis and therapeutic decision-making. Future research should focus on molecular and genetic studies to unravel the pathophysiological mechanisms underlying segmental vitiligo.

Polycystic ovarian syndrome (PCOS) is a prevalent endocrine disorder affecting 6-8% of women worldwide, associated with reproductive dysfunction, metabolic disturbances, and increased cardiovascular risk. This study aimed to evaluate the serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and anti-Mullerian hormone (AMH) in PCOS patients compared to healthy controls. A cross-sectional study was conducted with 116 women (76 with PCOS and 40 controls) aged 15-35 years, diagnosed using the Rotterdam criteria. The results demonstrated significantly higher levels of LH (12.449±4.86 mIU/ml) and AMH (6.812±3.32 ng/ml) in PCOS patients compared to controls (LH: 5.436±4.32 mIU/ml; AMH: 2.479±2.30 ng/ml), while FSH levels were lower in PCOS patients (5.872±1.92 mIU/ml) versus controls (7.153±3.15 mIU/ml). A reversal in the LH/FSH ratio was observed in PCOS, suggesting gonadotropin dysregulation. Elevated AMH levels highlight its diagnostic potential for PCOS, independent of the menstrual cycle. In conclusion, the altered hormonal profiles in PCOS patients support the utility of AMH as a diagnostic marker, alongside disruptions in LH and FSH levels, offering insights into PCOS pathophysiology and diagnosis.

Background: Diffuse hair loss is a very common condition for which female patients present to dermatology OPD. Adequate management of DHL requires detailed history, physical examination and screening for various laboratory parameters to define the contributing factors. Methods: One hundred and thirty- three females with diffuse hair loss were included in the study. Thorough hist01y, clinical examination & bedside tests were done in all study subjects. All the patients were tested for complete hemogram, serum Vit Bl2, serum Vit D3, TSH, serum ferritin and selected patients for serum LH, serum FSH, serum prolactin and serum testosterone levels. Results: Among 133 patients, 73 patients (54.88%) presented with acute telogen effluvium (ATE), 42 patients (31.57%) with chronic telogen effluvium (CTE) and 18 patients (13.53%) with female patterned hair loss. Incidence of FPHL were highest in the age group of 41-60 whereas CTE in 25-40 years. Specific etiological factors for acute telogen effluvium were found in 79.36% patients. In majority of these patients (31.50%), severe anemia (<8gm/dL) was the contribut01y factor followed by febrile illness (30.13%). Serum ferritin level was significantly lower in ATE & CTE group as compared to FPHL group (p = 0.006). Conclusion: Nonscarring diffuse alopecia can be caused by multiple factors. Serum ferritin, serum TSH, serum vitamin Bl2 and D3 levels seem to have a contributing role in the pathogenesis of hair loss, and their supplementation may be required for the faster hair growth in nonscarring DHL.

Background and Aim: Liver abscess remains a significant diagnostic and therapeutic hurdle for the medical community. This condition poses a significant risk to life and can lead to serious complications if not addressed promptly. Consequently, timely diagnosis and suitable management at the earliest stage are crucial. This study examined the incidence, aetiology, clinical signs and symptoms, and management of liver abscesses among patients in the general surgery wards of a Tertiary Care Teaching Institute in India. Material and Methods: This prospective study involved 120 patients diagnosed with liver abscesses, all of whom were admitted to the general surgery wards of a Tertiary Care Teaching Institute in India over the course of one year. Initially, the documentation included a thorough history of routine examinations and blood tests. Subsequently, an ultrasound was conducted in specific instances, followed by additional treatment measures. Results: The findings indicate that the highest number of cases, totalling 55, or 45.83%, were observed in the age group of 40 to 49 years. Every one of the 120 cases of liver abscess documented in this study reported experiencing abdominal pain. In the study, abdominal distension was observed in 57 cases, accounting for 47.15% of the total. Fever was reported in 65 cases, representing 54.16%, while dysentery was noted in 21 cases, which is 17.5% of the total. In the current study, every one of the 120 cases of liver abscess reported experiencing abdominal pain. Abdominal distension was observed in 57 cases, accounting for 47.15% of the total. Fever was noted in 65 cases, representing 54.16%, while dysentery was reported in 21 cases, or 17.5% of the total. Conclusion: Liver abscesses predominantly occur in young males who have a history of alcohol use. Regrettably, this condition continues to lead to considerable illness and suffering.

Background: When assessing thyroid lesions, Fine-Needle Aspiration Cytology (FNAC) is a crucial diagnostic technique. To help standardize reporting and clinical care, thyroid FNAC data are divided into six diagnostic groups using the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). This study aims to evalu-ate the diagnostic role of FNAC in thyroid lesions using TBSRTC and correlate with cytohistological correlation. Methods: A prospective and retrospective study was conducted at the Department of Pathology, Maharani Lax-mi Bai Medical College, Jhansi, on 350 patients with palpable thyroid swellings who underwent FNAC, fol-lowed by thyroidectomy for histopathological correlation in 60 cases. FNAC samples were categorized accord-ing to TBSRTC, and statistical analysis was performed to calculate sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy. Results: The mean age of the study population was 37.50±14.14 years, and 82.29% of the participants were female. The majority of cases (72.29%) had nodular thyroid swellings upon presentation. The accuracy of FNAC samples was 96.57%. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy of FNAC were calculated based on histopathological correlation. Conclusion: As classified by TBSRTC, FNAC is a cost-effective, minimally invasive, and dependable diag-nostic method for thyroid lesions. It helps reduce needless procedures, guide clinical management, and differen-tiate benign from malignant lesions. The study confirms the usefulness of TBSRTC in offering consistent and repeatable thyroid cytopathology diagnostic standards.

Introduction: A hernia is an abnormal protrusion of tissue through a defect in the surrounding walls, and includes direct inguinal, indirect inguinal, and femoral hernias. Repair techniques have evolved from Bassini’s method to tension-free approaches using polypropylene mesh. Current minimal access techniques include TAPP and TEP, with eTEP offering advantages in complex hernias. eTEP provides a larger surgical field, easier management of large hernias, improved tolerance of pneumoperitoneum, and reduced risk of complications than  TAPP. Aim: This study aimed compare postoperative pain and complications between the eTEP and TAPP techniques in groin hernia repair. Methodology: This study analyzed groin hernia cases treated electively at the JLN Medical College, Ajmer, from January 2023 to July 2024. Fifty patients were randomly assigned to two groups: 25 for eTEP (Group A) and 25 for TAPP (Group B). Inclusion criteria were patients over 12 years who consented to laparoscopic repair, with specific exclusion criteria related to prior conditions and complications. Data collected encompassed demographics, medical history, surgical specifics, and postoperative complications such as pain etc. Results: The results showed that the eTEP group had shorter surgery times for unilateral hernias, lower postoperative pain, fewer complications, and shorter hospital stays than to the TAPP group. Both techniques were effective in preventing hernia recurrence, with only one recurrence in the TAPP group and no recurrence the eTEP group. The eTEP group also showed a faster return to duty, further highlighting the advantages of this approach in terms of patient recovery. Conclusion: Our study highlights the advantages of eTEP over TAPP for inguinal hernia repair, including reduced postoperative pain, shorter hospital stay, and quicker recovery. Both techniques effectively prevent recurrence, however eTEP resulted in fewer complications. Further long-term studies with larger sample sizes are required to validate these findings across diverse patient populations.

Background: Spinal anesthesia is a popular choice for infraumbilical surgeries due to its effectiveness and minimal systemic effects. Levobupivacaine, a long-acting local anesthetic with lower cardiotoxicity than bupivacaine, is commonly used. Combining it with adjuvants like dexmedetomidine, an alpha-2 adrenergic agonist, may enhance analgesia and prolong the effects of anesthesia. Methods: This randomized double-blind study involved 120 patients undergoing elective infraumbilical surgeries. Participants were divided into two groups: Group L received 0.5% levobupivacaine, and Group LD received levobupivacaine with dexmedetomidine. Outcomes such as onset and duration of sensory and motor blocks, hemodynamic stability, and postoperative analgesia were assessed. Results: The onset of sensory block was significantly faster in Group LD compared to Group L, with times of 5.40 ± 0.79 minutes versus 6.80 ± 1.37 minutes, respectively (P < 0.001). Similarly, the duration of the sensory block was markedly longer in Group LD, lasting 306.18 ± 10.60 minutes compared to 179.55 ± 7.16 minutes in Group L (P < 0.001). For motor block onset, Group LD experienced a quicker onset at 7.02 ± 1.19 minutes, compared to 13.10 ± 2.12 minutes in Group L (P < 0.001). The duration of the motor block was also prolonged in Group LD, with a duration of 199.22 ± 9.76 minutes, compared to 145.75 ± 8.25 minutes in Group L (P < 0.001). Conclusion: The addition of dexmedetomidine to levobupivacaine for spinal anesthesia improves the onset and duration of anesthesia and provides better postoperative analgesia compared to levobupivacaine alone. This combination may enhance patient outcomes in infraumbilical surgeries.

Introduction: Diabetes is a major public health concern maximum number in Southeast Asian countries. It was better characterized the relationship with dry eye disease (DED) and ocular surface disorders. This study was conducted to evaluate dry eye disease in diabetic person of 5 or more than 5 years of duration. Materials & Methods: 124 diabetic (both type I & Type II DM) male & female patients with age 40 years and above with 5 or >5 years history included in the study. Patients were not considered for study who were on any ocular medications or other systemic illness. Detailed history and general examinations were performed. Patients were divided in four groups based on duration of DM, like 5 to 10 years, 11 to 15 years, 16 to 20 years & 21 to 25 years. Dry eye was graded as mild, moderate and severe. Data was collected and analysed by SPSS software. Results: Male diabetics had more prevalence of dry eye than females. Mild dry eye was present among 36.3% of subjects, 29.8% of the subjects had moderate dry eye and only 4.8% had severe dry eye. As duration of Diabetes increased, the percentage of dry eye also increased. Conclusion: With increasing duration of Diabetes, the percentage of dry eye also increased, though the difference was found to be statistically insignificant. As per gender, male had more prevalence of dry eye than females. The difference was found to be statistically non-significant.

Introduction: The two diseases atherosclerosis and Rheumatoid Arthritis (RA) are considered to share many similarities, Patients with RA have increased atherosclerosis compared with normal individuals. Aim: To study if lipoprotein phospholipase A2 can be a potent marker of atherosclerosis in RA patients and Correlate lipoprotein phospholipase A2 (Lp-PLA2) levels with the carotid intimal thickening to predict risk of atherosclerosis events in RA patients. Methods: A Case control study conducted among 100 patients came to < study site is not mentioned due to blinded review >  in 1 year period. Patients with serologically confirmed  RA was  taken as cases and Age and sex matched inpatients with other minor ailments without RA are taken as controls included. Cardiovascular events with or without RA patients were excluded. After taking consent, data collected by self-made questionnaire, entered in SPSS and analysed by frequencies, percentages, chi square, t value and Mann Whitney U test wherever applicable. Results: The mean age 54.7 ± 9.82, majority were female (88%). Case and controls were matched for age, sex and comorbidities. There was statistically significant higher level of low- density lipoprotein in cases 121 ± 25.48 compared to control 104.92 ± 22.62. Similarly, an increased level of Lp-PLA2 was found in RA patients with a mean value around 134.22 ± 37.86. Conclusion: CVD risk is enhanced by having RA. This study was statistically proven by increased Lp-PLA2 which was proven by increased Carotid intima media thickness in RA patients.

Introduction: Haemoglobin A1c (HbA1c) is a type of haemoglobin that becomes glycated when the NH2-terminal valine residue of the β-chain of globin is attached to a sugar molecule. It is a useful marker for determining a patient’s blood sugar control during the past 3 months. However, there are several factors that might cause HbA1c levels to inaccurately appear lower or higher, regardless of actual blood sugar levels. Aims and Objective: To assess the level of HbA1c in iron deficiency anemic non-diabetic patients compared to non-anemic non-diabetic healthy patients in tertiary care Hospital. Material and Methods: Study participants were patients of iron deficiency anemia confirmed with laboratory test who were non-diabetic and another group of non-anemic non-diabetic healthy individuals who visited the Outpatient Department or were admitted in the ward in GMERS medical college, Gandhinagar and given informed consent to take part in study having age between 18 to 59 year and They were not be on any treatment like iron tablet or injection. Routine investigation CBC, S.Ferritin, S.iron, TIBC, Transferrin saturation and HbA1C, FBS, PPBS were done in each study participants. Discussion: In the present study, a total of 200 participants were grouped into two groups – one group with 100 cases diagnosed with iron deficiency anemia and another group comprising of 100 healthy, non-anemic individuals age and gender matched to cases. There was statistically significant difference between the 2 groups with respect to RBC count, Hb, S.Iron, S. Ferritin, TIBC, Transferrin saturation, MCV, MCH and MCHC levels. HbA1C was significant higher in case group as compared to control. Conclusion: In conclusion, iron deficiency anemia can have a considerable impact on the interpretation of HbA1c readings in individuals who do not have diabetes. It is possible for the total haemoglobin concentration is decreased as a result of insufficient iron levels, which can result in HbA1c values that are erroneously elevated.

Aims and Objective: particulate and non-particulate corticosteroids are used in lumbar transforaminal epidural injection (TFESI) for managing pain due to lumbosacral radiculopathy with varied efficacies and side effects. The aim of this study was to compare the efficacy of Triamcinolone and Dexamethasone in lumbar transforaminal epidural injection for low back pain due to disc herniation. Materials and Method: This prospective, randomized double blind study was conducted on eighty patients aged 18-70 years of either sex having chronic lower back pain due to prolapsed intervertebral disc herniation. All patients randomly allocated in 2 groups (40 patients each) and received transforaminal epidural; Group I: Isobaric Bupivacaine (0.25%) 2 ml + Triamcinolone 40 mg diluted in 2ml 0.9% NS and Group II: Isobaric Bupivacaine (0.25%) 2 ml+ Dexamethasone 8 mg (2 ml). Visual analogue score (VAS), adaptation of Oswestry disability index (ODI), patient health questionnaire-9 (phq-9) and complications were recorded after procedure, at 24 hours, day 15th and 1, 3, 6 months. Results: The VAS score was found to be significantly less in group I as compared to group II at 15 days, 1, 3 and 6 months after procedure (p=0.0407, p=0.0132, p=0.0001, p=0.0034 respectively). The % reduction in VAS score was found to be significantly higher in Group I as compared to group II at 15-days, 1-month, 3-months and 6-months. The ODI score and phq-9 score were found to be significantly less in Group I as compared to Group II at 1, 3 and 6 months after procedure. Conclusion: Triamcinolone was found to be superior in pain reduction and functional improvements as compared to dexamethasone.

Background: Acute kidney injury (AKI), frequently involving patients admitted to the neonatal intensive care unit (NICU), is associated with poor outcomes and affects 18–70% of critically ill neonates. The present study was undertaken in the Department of Pediatrics, SCB Medical College & SVPPGIP, Cuttack to evaluate the occurrence of neonatal AKI and delineate the risk factors associated with it and short-term outcomes of AKI in neonates admitted in this hospital, which is a tertiary care center. Methodology: The study population included term and preterm sick neonates admitted to the NBU. The study was carried during the period December-2012 to September-2014. Newborns with no AKI with no other confounding factors were picked up to serve as control. Renal function parameters such as blood urea, serum creatinine, serum electrolytes, urinary sodium and creatinine were monitored on admission to NBU. Those babies having abnormal renal function had their laboratory parameters monitored every alternate day till discharge. Pediatric Urobag was used aseptically to collect urine over 24hrs. The Ultrasonographic examination performed in the study was done using gray scale real time machine (Nebula 402) employing a 5 to 7.5 MHZ transducer. All the details of the case were recorded in the proforma and analysed. The Statistical Products and Services Solutions (SPSS) software version 17.0 was used to analyze the data and created reports and graphs. Help of socialstatistics.com from Internet was taken to analyse the data. Results: In this prospective study 2100 newborns admitted to SNCU were screened for AKI based on urine output (<1ml/kg/hr), blood urea nitrogen and serum creatinine. Approx. 118 neonates (5.6%) of the hospitalised were affected by AKI. So the incidence of AKI is 5.6%. About 55.08% of the affected were Preterms. Males were affected more than females. Neonates weighing <2500 gm were around 72% which indicates that prematurity and low birth weight are risk factors for AKI. The most common causes of AKI were sepsis (72%), followed by birth asphyxia (28%), PDA (4.23%), RDS (3.38%), and PUV (2.5%). Both sepsis and birth asphyxia combined together contributed towards maximum number of AKI. Conclusion: The present study and observations clearly revealed that AKI is an increasingly recognised entity among critically ill neonates. In this study sepsis, birth asphyxia, RDS, PDA, PUV were common predisposing factors for AKI. Low birth weight and prematurity are important risk factors for the development of AKI. The most common causes of neonatal death in AKI in the present study was consistent with the most common causes of neonatal death including infections, prematurity and asphyxia. Higher mortality rate was associated with oliguric AKI states.

Background: Nephrotic syndrome is a manifestation of glomerular disease characterized by sever proteinuria, hypoalbuminemia and hyperlipidemia. It affects numerous children globally with idiopathic syndrome being the most common form in pediatric population. The therapeutic effectiveness and safety profiles of prednisolone and deflazacort in treating this condition necessitate further examination. Methodology: 100 patients were enrolled in this study between 1 to 10 years old who were diagnosed with idiopathic nephrotic syndrome. This study was conducted at BRD Medical College, Gorakhpur, for six months. Patients were randomly registered to receive either deflazacort of prednisolone. Results: Both treatments were effective in inducing remission with deflazacort, showing a slightly higher remission rate but no significant differences were found in growth parameters between the groups. Although, deflazacort was associated with some complications and adverse effects as compared to prednisolone. Both drugs significantly improved laboratory values such as ESR and protein/creatinine ratio with notable reductions in plasma urea and creatinine. Conclusion: Deflazacot may be considered as more favorable with efficacy and safety in the treatment of pediatric idiopathic nephrotic syndrome as compared to prednisolone.

Introduction: Invasive candidiasis is a fungal disease caused by Candida spp. that affects internal organs through blood stream infections. It’s a major concern in hospitals, accounting for 96% of opportunistic mycoses. Candida   infections occur due to interplay between fungal virulence and host immune responses. India’s estimated annual incidence of candidemia is 4,70,000 cases, with Candida   tropicalis, Candida albicans, and Candida auris being major contributors. Methodology: A laboratory based retrospective analytic study was conducted over period 2-year (May 2022 – April 2024). The blood culture bottles were processed in Microbiology Laboratory, using BACT/ALERT 3D machine for 5-day aerobic incubation, identification of Candida spp was done by Gram stain, culture on SDA, Germ tube test and subspecies conformation Candida Chromogenic media used, further identification and antifungal susceptibility testing was done by VITEK 2 COMPACT. Result: 2213 blood cultures were collected from suspected sepsis patients in ICUs. Out of these, 970 (43%) were positive and among them Candida   spp. was isolated in 76 (7.8%). Out of these 76 (7.8%) specimens, isolation rate of Candida albicans was 17% while 83% being Candida non-albicans. Among Candida albicans, we found that, resistance rate to fluconazole was 23% while with voriconazole its 46%. Among Candida non-albican highest resistance was seen with fluconazole whereas Flucytosine, Capsofungin, and Micafungin showed highest sensitivity. Conclusion: The study found that prevalence of candidemia was 7.8%. Isolation rate of Candida non albicans was higher as compared to Candida albicans. Candida albicans and non albicans showed highest resistance to azole group, but sensitive to echinocandins group. Accurate identification of Candida species and their antifungal resistance is crucial for early intervention, personalized treatment, and improved patient outcomes.

Background: Histopathological autopsy study helps in identifying various changes in multiple organs that aid in establishing the cause of death. It also helps in evaluation/ confirmation of antemortem/post mortem changes. This study was done to evaluate the spectrum of histopathological findings and to know the most common cause of death amongst autopsy cases in coastal region in Karnataka. Materials and methods: A retrospective observational study was conducted in the Department of Pathology, including all organs received for medicolegal autopsy for a period of 12 months, to study the spectrum of histopathological findings and also to determine the most common cause of death among autopsy cases in coastal Karnataka. Results: A total of 80 cases meeting inclusion and exclusion criteria were studied. Males were 75% and majority were between 35-50 years of age. Most common cause of death was found to be sudden death of cardiac cause. Most common histopathological finding was coronary atherosclerosis (59.4%) (LCA being most common) in the heart. Congestion and edema (85.9%) in Lungs. Steatohepatitis (63.79%) in Liver. Other organs showed predominantly normal histology. Conclusion: We conclude that sudden death due to cardiac event is the most common cause of death and coronary atherosclerosis was the most common histopathological finding observed in the area of coastal Karnataka.

Basic Science forms the keystone in the building block of the Medical Profession. Students understand the context of basic science when taught in relevance to the clinical aspects. Competency-Based Medical Education (CBME) has introduced Attitude, Ethics and Communication in the MBBS curriculum to change the professional conduct of Medical students. This study aimed to evaluate the perception of communication skills among first MBBS students after effective AETCOM learning sessions. The “Communication Skills Attitude Scale” (CSAS) assessed a cross-sectional study involving undergraduate medical students’ attitudes toward learning communication skills. The CSAS questionnaire was added to a Google form, and the link was sent to the students. The response was analyzed by using a percentage scale. The perception of 66 students was presented in terms of percentage on a five-point Likert Scale. Students perceived communication skills as important for gaining knowledge and essential in doctor-patient interaction. Communication skill training forms a basis for the Doctor-Patient interaction and can be learned at the undergraduate level.

Background: The period of transition from adolescence to adulthood is marked by notable changes in an individual’s personality and behavior, primarily influenced by genetics, although interactions with their social environment also play a part. Teenagers living in hostels at universities who are not living with their families may therefore be impacted by their surroundings. Therefore the goal of the present study mainly focuses on learning about students’ expectations and happiness with their hostel experience and how that affects their academic achievement. Material and Methods: This qualitative study was conducted in a tertiary level medical college in Punjab. A qualitative survey was conducted by Focus group discussion among undergraduate medical students. A total of 8 male students and 8 female students, are included in this study. Two focus group discussions were conducted. The study participants were asked about their opinions regarding the impact of hostel life on the behaviour and personality of medical students. FGD was conducted employing a focus group discussion guide. The data from the FGD was recorded and the collected data were entered in Microsoft Excel and analysed based on systematic coding. After being coded, the segments that shared a common subject were categorized as constructive and destructive domains. Results: Students gain experience interacting with a variety of people while living in hostels, and their patience also grows there. It equips students to handle difficulties that arise in real life. The constructive theme was categorized into the following domains: Personality, Collaboration, Academic performance, long-lasting bonding and developing life skills. The destructive theme was categorized as addictive behaviour, emotional imbalance, peer pressure and financial issues. The majority of the male students living in hostels suffer from substance abuse and peer pressure. Conclusion: Medical students have a favourable educational atmosphere, but they also face a number of problems and a great deal of academic stress, which negatively impacts their academic performance.

Introduction: Depression is a serious mental disease, with very serious consequences for people and for the health systems. The goals of this research are to evaluate the effectiveness, demographic distribution, and associated clinical variables with escitalopram and vortioxetine treatment of depression. Methods: Out of the 74 subjects with an ICD 10 diagnosis of depression, 37 received escitalopram and 37 were given vortioxetine. Examined were multiple demographic, clinical and treatment response variables: gender, comorbidities and their clinical enhancement measured by the Clinical Global Impression severity (CGI-S) over the course of a period of six weeks. Significance (p<0.05) of the results were ascertained by using statistical analyses. Results: No significant difference between groups constituted the gender distribution with about equal representation. Treatment allocation was not affected substantially by the size or structure of the family. The distribution of severity of diagnosis and frequency of prior depressive episodes was equally distributed among the groups. At six weeks therapy, CGI-S scores indicated clinical enhancement for both groups, with no differences between vortioxetine and escitalopram being significant at any time point. Incidence and hospitalization of hypertension were similar between groups. Conclusion: There were no significant differences in effectiveness or tolerability for either escitalopram or vortioxetine in relieving depression symptoms. Both medications show promising potential effectiveness as alternatives to treat depression and may allow customizing therapy according to patient wish, current clinical circumstances.

Background: Coronary artery disease is the leading cause of mortality worldwide. Atherosclerosis is the most common cause of luminal narrowing in coronary artery disease however; multiple non-atherosclerotic cause account for 4-7% of cause acute MI. From the start of the Q wave to the finish of the T wave, the QT interval is measured in seconds. The difference between the maximum and least QT interval is used to quantify QT dispersion. It is thought that QTd is a measure of cardiac inhomogeneity that lowers a person’s threshold for ventricular arrhythmias. Therefore, the likelihood of developing arrhythmias increases with the QTd. Our study’s objectives are to determine how QT dispersion is measured in acute myocardial infarction, evaluate the relationship between QT dispersion and the infarct site, and investigate the relationship between QT dispersion, ventricular arrhythmias, and acute myocardial infarction mortality. Materials and Methods: 86 Patients admitted in medicine ICCU of Kanyakumari government medical college diagnosed to have acute myocardial infarction fulfilling the inclusion and exclusion criteria are included in this study group. Results: Mean QTc interval for arrhythmia cases are 397.4 and 387.1 for non- arrhythmias. This difference is statistically significant. P value is 0.003. Mean QTc dispersion for arrhythmia cases are 89.26 and 63.3 for non-arrhythmias. This difference is highly statistically significant. AMI is associated with changes in the electrophysiological properties of the heart. By means of assessing QT dispersion from the surface electrocardiogram there is convincing evidence that in AMI, inhomogeneity in ventricular repolarization is augmented. Conclusion: Mean QT dispersion is significantly increased after Acute Myocardial Infarction. With time, QT dispersion dynamically decreases. Individuals with ventricular tachycardia and ventricular fibrillation had larger mean QT dispersion values than individuals with acute myocardial infarction who do not have these arrhythmias. QT dispersion changes dynamically and could be a non-invasive indicator of vulnerability to malignant ventricular arrhythmias.

Introduction: Preoperative assessment of frailty is one of the first steps in identifying patients who are at a high risk for poor post-operative outcomes. Identifying a frail patient should initiate further discussions of goals of care, and a more comprehensive geriatric assessment (CGA) to identify medical, physical or socio-economic vulnerabilities. Aim: To study the correlation between Frailty Index and the postoperative outcomes in geriatric patients. Materials and Methods: This was a single-centre, hospital-based, prospective, observational study involving 92 patients who were assessed for postoperative complications, duration of postoperative stay and readmission to the hospital. Postoperative events were observed as deviations from normal postoperative recovery, duration of stay was measured in days and whether any readmissions to the hospital within 30 days of surgery. Results: Severely frail patients had five times higher odds (adjusted odds ratio = 5.47) of developing postoperative complications in comparison to ‘not frail’ patients. An ‘apparently vulnerable’ patients had about 3 times higher odds of developing postoperative complications in comparison to ‘not frail’ patients. A severely frail patients had nine times higher odds of readmitting to the hospital within 28 days in comparison to ‘not frail’ patients. Conclusion: The frail geriatric patients had high rates of postoperative complications and readmission to the hospital independent to the type of orthopaedic surgery.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) poses a significant global health burden characterized by persistent airflow limitation and respiratory symptoms, primarily linked to environmental exposures. Objective: This study aimed to explore the clinical characteristics, risk factors, and management strategies specific to non-smoker COPD patients. Methods: Conducted at a prominent teaching hospital in Visakhapatnam, India, over two years, the study enrolled 30 non-smoking COPD patients aged 40 years and above. Diagnostic criteria included spirometry confirming FEV1/FVC < 0.70, supplemented by clinical evaluations and chest radiographs. Results: Participants were predominantly female (83.33%), rural residents (73.33%), and from lower-middle socio-economic backgrounds (53.33%). Biomass fuel exposure (66.66%), environmental tobacco smoke (53.33%), and pulmonary tuberculosis (32.74%) were identified as primary risk factors. Clinical manifestations included crepitations (26 patients), barrel chest (14 patients), and raised jugular venous pressure (11 patients). Conclusion: The study highlights the diverse epidemiological profile of non-smoker COPD and emphasizes the impact of biomass fuel exposure and environmental factors. Tailored health interventions are crucial to address regional disparities and promote early diagnosis and management. Future research should focus on larger studies to validate findings and explore emerging risk factors, enhancing global COPD management strategies.

Background: Diabetes-related deaths frequently stem from cardiovascular issues, with diabetics facing higher QTc prolongation and a 2–10 fold increased risk of sudden cardiac death. Hypoglycemia, a severe diabetes complication, is linked to QT interval prolongation, heightening arrhythmia and mortality risks. This study will evaluate QTc during hypoglycemia in diabetic patients and its correlation with blood sugar levels and hypoglycemia severity. Objectives: 1. To Study corrected QT interval during hypoglycemic episodes in diabetes mellitus subjects. 2. To Correlate QTc interval in relation to in-hospital mortality. Materials and Methods: This study involved 80 diabetic patients admitted with severe hypoglycemia at K.R. Hospital, Mysuru. ECGs were recorded during hypoglycemic episodes, and QTc was calculated using the Bazett formula. Data were analyzed based on sex, type of diabetes, duration of diabetes, severity of hypoglycemia, and electrolyte levels. Results: Out of 80 subjects, 55% were male, and 45% were female; 16.3% had Type 1 diabetes and 83.8% had Type 2 diabetes. QTc prolongation was significantly more common in females with severe hypoglycemia (RBS <54 mg/dL) compared to less severe cases (RBS <70 mg/dL). However, no significant association was found between QTc and RBS levels among male subjects. Mortality rates were higher in the severe hypoglycemia group. Conclusion: In conclusion, this study shows that diabetic patients experiencing hypoglycemia have a significantly prolonged QTc interval. Additionally, the extent of QTc prolongation correlates with hypoglycemia severity, and a significantly prolonged mean QTc interval is observed in cases of in-hospital mortality.

Introduction: Hysterectomy is a common surgical procedure performed worldwide to treat various benign and malignant uterine pathologies, including leiomyoma, adenomyosis, and endometrial abnormalities. This study aimed to evaluate the histopathological spectrum of uterine lesions in hysterectomy specimens and correlate clinical, radiological, and histopathological findings to determine the most common indications and pathological findings. Methodology: This retrospective and prospective observational study analyzed 300 hysterectomy specimens collected between July 2017 and December 2018. The specimens were processed using routine paraffin tissue processing methods, and sections were stained with hematoxylin and eosin. Clinical data, including age, symptoms, and radiological findings, were correlated with histopathological results. Inclusion criteria included all hysterectomy specimens, while exclusion criteria ruled out cervical, ovarian, and fallopian tube lesions, as well as poorly preserved samples. Results: The study found that the most common age group for hysterectomy was 41–50 years (43.00%). Menorrhagia (37.46%) and uterine prolapse (30.94%) were the most frequent clinical presentations. Histopathologically, the proliferative phase was the most common endometrial finding (37.46%), followed by atrophic endometrium (27.04%). Leiomyoma (43.32%) was the predominant myometrial lesion, with the intramural type (54.89%) and hyalinization (36.09%) as the most common subtype and secondary change, respectively. Adenomyosis (28.01%) was also frequently observed. Conclusion: Hysterectomy is an effective treatment for various uterine pathologies, with leiomyoma and adenomyosis being the most common histopathological findings. The study highlights the significance of histopathological examination for accurate diagnosis and management, even in grossly normal specimens. Clinical and radiological evaluations alone may not adequately diagnose conditions such as adenomyosis or early-stage malignancies.

Background: Sigmoid Volvulus is the commonest cause of large bowel obstruction. Its Prevalence varies geographically. This research was conducted to assess the causes, clinical manifestation, surgical technique and result in our institution, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, of intestinal obstruction patients. Methods: A facility based retrospective cross-sectional review of surgical records was done to identify patients who had acute sigmoid volvulus. Data was collected from surgery department, SKMCH, Muzaffarpur. The collected data was checked for its completeness, and then entered, edited, cleaned and analyzed using statistical Package for the Social Sciences (SPSS) version 22.0. For all statistical significance tests the cut-off value set was P < 0.05. Result: A total of 131 patients were managed for acute sigmoid volvulus. 108 (82.4%) were men with a male to female ratio of 4.7:1. The hospital prevalence of acute sigmoid volvulus was 27.9%. Majority (42%) of the patients were in the 6th decades of life. Abdominal pain, abdominal distention & inability to pass feces & flatus were the predominant presenting complaint while abdominal distention was the dominant physical finding in all of the patients. Ninety-seven patients (74%) had viable bowel obstruction of which 29 patients had successful rectal tube deflation. The remaining 68 patients were managed operatively by either primary resection & anastomosis (62 patients) or derotation alone (6 patients). Thirty-four patients had gangrenous bowel obstruction and were managed by either primary resection and anastomosis (16 patients) or Hartman’s colostomy (18 patients). Six patients died of which 5 had primary resection and anastomosis (2 for viable and 3 for gangrenous bowel obstruction).The predominant postoperative complication was wound infection in 11(10.7%) patients. Factors associated with unfavorable outcome were female sex, primary resection & end to end anastomosis and presentation of illness more than 24 h. Conclusion: The most common management primary resection and anastomosis. The overall mortality rate was 4.5% and the mortality rate related to primary resection and end to end anastomosis 6.4%. Mortality rate higher in those patients who had resection and anastomosis for gangrenous bowel compared to those who had viable bowel compared to those who had viable bowel (19 % vs 3%). Generally factors associated with poor outcome were duration of illness, primary resection and anastomosis and female.

Background: The early detection of prediabetes is crucial in preventing the progression of type 2 diabetes mellitus (T2DM). Liver function tests (LFTs), which include measures of enzymes like alanine aminotransferase (ALT) and aspartate aminotransferase (AST), have been increasingly recognized for their potential role in identifying metabolic disturbances associated with insulin resistance and prediabetes. This study explores the utility of LFTs in predicting prediabetes, potentially offering a simple, cost-effective screening tool for at-risk populations at DMCH. Method: The study conducted a cross-sectional analysis of patients attending the DMCH. We recruited people between the ages of 20 and 65 into two groups: 30 healthy individuals with normal blood sugar levels (normoglycemia) and 30 individuals with prediabetes. We compared liver function test (LFT) parameters across these groups. Statistical tests were employed for the analysis in this study. Result: Results revealed that ALT median was significantly increased in prediabetes compared to normoglycemia (19.5 vs. 13.8 IU/L, respectively; p = 0.002). For AST, there were no significant differences between the two groups investigated (p = 0.231). In the case of ALP, significantly increased medians were observed in prediabetes compared to normoglycemia (90.7 and 73.1 IU/L, respectively; p = 0.005). ROC curve analysis revealed that ALT (AUC = 0.891; 95% CI =0.688 – 0.894; p = 0.001; cut-off value = 16.1IU/L; sensitivity = 72.4%; specificity = 73.3%) and ALP (AUC = 0.824; 95% CI = 0.621 – 0.828; p = 0.001; cut-off value = 80.2 IU/L; sensitivity = 67.2%; specificity = 66.7%) were good predictors in differentiating between prediabetes and normoglycemia. Conclusion: This research concludes that ALT and ALP are effective predictors of prediabetes, but further research is needed to fully comprehend the mechanism underlying the link between liver function enzymes and diabetes risk.

Background: Cervical cancer remains a significant public health issue globally, largely preventable through early detection and treatment of precancerous lesions. Histopathological analysis plays a critical role in accurately diagnosing cervical lesions, which is essential for effective intervention. Methods: This retrospective observational study analyzed cervical biopsies from 75 patients at the Department of Pathology, LSLAMMC, and Hospital, Raigarh, Chhattisgarh, over one year from September 1, 2023, to August 31, 2024. The lesions were categorized into benign, pre-malignant, and malignant based on standard histopathological criteria. Results: The study found a high prevalence of pre-malignant lesions, particularly cervical intraepithelial neoplasia, accounting for 46.7% of all cases. Malignant lesions were more prevalent in patients over 50 years of age. The age group 30-40 had the highest occurrence of pre-malignant conditions, indicating a critical target demographic for screening programs. Conclusion: The findings emphasize the importance of targeted screening and personalized management strategies for cervical health, particularly focusing on pre-malignant lesions to prevent progression to invasive cancer.

Background: Education is a basic entitlement for each female in India according to the Right to Education Act of 2009, duly highlighted by the Indian government in its “Beti Bachao Beti Padhao” initiative, which effectively combines efforts to prevent female feticide with promoting girls’ education. Educating girls positively impacts the socio-economic and health standards and reduces inequality in society. Socioeconomic status encompasses not just income but also educational attainment and financial security, as well as subjective perceptions of social status and social class. Apropos of betterment in the status of women in India; evils of illiteracy, ignorance and dowry, economic slavery, crimes like homicide, sexual assault would have to be completely eradicated to ensure their rightful place in society. Material and Methods: The current study was conducted in the Department of Forensic Medicine and Toxicology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand from April 2021 to March 2022 (i.e., 12 months). Total autopsies conducted during this period was 3840. Among these, 225 instances pertained to females within the reproductive age bracket in accordance with the predetermined selection criteria of the study. Result: The highest proportion of women were educated up to high school (29.33%), with 20% educated up to middle school.  A mere 1.33% held a professional degree, while 17.78% reported as being illiterate. Maximum number of cases were housewives, students, and laborers by profession. A significant portion of cases belonged to socioeconomic class II. Accidental death was the most prevalent, followed by suicidal incidents, with burn being the leading cause of death followed by road traffic accidents across all educational, occupational, and socioeconomic strata. Conclusion: Deaths in women of reproductive age that are deemed unnatural accounted for 5.86% of the total cases examined during the study duration. Consequently, this necessitates careful consideration and the implementation of additional preventive and corrective interventions, particularly given that such deaths disproportionately affect women with lower levels of education and those who are unemployed. Moreover, it is crucial to note that these deaths are avoidable.

Background: Medication adherence among geriatric patients is crucial for effective management of chronic diseases and overall health outcomes. Adherence to medicine is an important aspect of enhancing quality of life and preventing difficulties associated with non-communicable diseases (NCDs) and long-standing diseases. This study aims to estimate the prevalence of medication adherence and factors affecting it in geriatric outpatients attending a secondary care center in South India. Materials and Methods: It was an observational cross-sectional study. A pretested and predesigned questionnaire along with the modified Morisky Medication Adherence Scale (MMAS) was used to collect the level of medicine adherence and factors affecting it. Results: 250 participants in the elderly group with chronic conditions were evaluated for their level of long-term drug compliance. The prevalence of good adherence to medication was 46%, moderate in 35%% and poor in 18% among the study subjects. Conclusion: Level of compliance is positively associated with higher educational status, living with spouse and family, < three medicines per day, and < two comorbidities.

Introduction: A multiple pregnancy may be the result of the fertilization of a simple egg that splits to create identical fetuses or it may be the result of the fertilization of multiple eggs that fraternal fetus or it may be the combination of these both. Aims and Objectives: This prospective study was conducted over one year aimed to investigate the fetal and maternal outcome in multifetal gestation. The study included women with multiple pregnancy at or after 26 weeks of gestation who delivered in our hospital, excluding women with multiple pregnancy delivering at gestational age less than 26 weeks. Results: In this study, the incidence of dichorionic diamniotic twins were more as compared to other multifetal pregnancies. As the age advances in multiparous patients, incidence of dichorionic twins was more compared to monochorionic twins. Majority of trichorionic twins were conceived by Invitro fertilization. The most common complication observed was preterm labour in all types of chorionicity. The prevalence of LSCS was the most common mode of delivery in all multifetal patients. Dichorionic twins had better 5 min APGAR score compared to monochorionic and trichorionic twins. Conclusion: Multifetal pregnancy is a great challenge to the concerned obstetricians. Vigilant antenatal, intrapartum and postnatal care will help in early detection of complications and their management. Liberal use of cesarean delivery, especially in preterm pregnancies, will improve the neonatal prognosis. Hence the need for better obstetric care, neonatal care health services to get a better fruitful outcome.

Background: Tuberculosis confined to the lower lung fields often masquerades as pneumonic consolidation and the correct diagnosis gets delayed. Early diagnosis and treatment helps in the prevention of complications, a proper understanding of clinical, radiological features as well as treatment outcome of this disease entity is of crucial importance. Material and Methods: The study was conducted in the Department of Radiodiagnosis, MVJ Medical College and Research Hospital, Bangalore for a period of one year from January 2017 to February 2018. Data collection was prospective. 20 consecutive cases of lower lung tuberculosis were identified.  12 were males. 8 were females. Results: Main radiological presentation was patchy opacities seen in 9 of patients, homogeneous consolidation seen in 7 of patients, cavitation was seen in 3 of patients, nodular opacities in 2. Conclusion: The radiographic findings in lower lung field TB differ significantly from upper lobe disease. The most frequent radiographic finding is consolidation, more confluent and extensive than that found in upper lobes TB. Cavitary lesions are also frequently seen, which may be single or multiple and may lie within an area of consolidation.

Introduction: Individuals Parkinson’s disease (PD) frequently suffer from sleep disturbance, which significantly hinders their quality of life and daily functionality. Aim: This cross-sectional research explores sleep disorders among PD patients, analysing sleep parameters through polysomnography (PSG) and examining correlations with disease severity, staging, and duration. Materials and Methods: A cohort of 52 PD patients from the neurology department of MGMGH underwent evaluations using standardized sleep scales, including the Parkinson’s disease Sleep Scale (PDSS) and the Epworth Sleepiness Scale (ESS), in conjunction with PSG recordings. Results: The study reveals a high prevalence of sleep issues, such as increased sleep latency, diminished sleep efficiency, REM sleep behaviour disorder, periodic limb movements, and obstructive sleep apnoea. Conclusion: Sleep architecture is significantly impacted in PD patients. It is crucial that every Parkinson’s disease patient undergoes a thorough assessment for sleep disorders to implement effective interventions enhancing their quality of life.

Introduction: Respiratory Distress Syndrome (RDS) is the most common cause for respiratory distress in newborns. Mild to moderate RDS is treated with non-invasive methods. NCPAP is the most commonly used mode of non-invasive mode in RDS but newer modalities like HFNC also an emerging modality with similar efficacy and has a similar morbidity and mortality profile in managing mild to moderate RDS. Objectives: To compare the efficacy, morbidity & mortality profile of HFNC versus NCPAP as a primary mode of respiratory support for mild to moderate respiratory distress in preterm infants. Methodology: Hospital based Randomized Controlled Trial was done on eligible neonates with RDS. HFNC was delivered through the short nasal prongs and nasal CPAP was delivered through Hudson’s prongs and outcomes of both the methods were compared in terms of efficacy, morbidity and mortality. Results: Out of 100 newborns, 50 were treated with HFNC and 50 were with NCPAP technique. We found there was no significant difference in the primary outcomes among both the groups. Incidence rate of adverse events did not differ in terms of many among both the modalities, but there was a statistically significant difference in incidence of nasal trauma which was more in NCPAP group. And also there was no significant difference in mortality rate among both the groups. Conclusion: HFNC technique is feasible, safe and has similar efficacy along with morbidity profile when compared to NCPAP technique. Both HFNC and NCPAP techniques reduce the requirement of mechanical ventilation and need for surfactant instillation.

Background and Objectives: Both metabolic syndrome and thyroid dysfunction are associated with increased risk of atherosclerotic heart disease. The present study was conducted to study the Association of thyroid dysfunction and metabolic syndrome and to find out the type of thyroid dysfunction in metabolic syndrome patients. Methods: Sixty cases were defined as metabolic syndrome according to the IDF Criteria. Detailed history and necessary investigations like fasting blood sample was analyzed for total triiodothyronine (T3), total thyroxine (T4), thyroid-stimulating hormone (TSH), lipid profile, and blood glucose were undertaken. Results: In our study population of metabolic syndrome cases, The Thyroid dysfunction is present in 16.7% patients. Among the thyroid dysfunction, sub clinical hypothyroidism is highly prevalent – 11.7%, the hypothyroidism is 3.3% prevalent in metabolic syndrome patients (one patient had TSH levels of more than 150 mU/L) and sub clinical hyperthyroidism is 1.7% prevalent. There were no overt hyperthyroidism patients in our study. Conclusion: This study clearly shows that, one sixth of metabolic syndrome patients or every sixth metabolic syndrome had hypothyroidism either overt or subclinical. This finding indicates a need for investigating the presence of Thyroid dysfunction during managing metabolic syndrome patients.

Introduction: Atypical teratoid/rhabdoid tumors (AT/RTs) are rare and aggressive pediatric malignant rhabdoid tumors (MRTs) that occur within the brain characterized by biallelic loss of function alterations of SMARCB1. Aim: The aim of this study is to find out the incidence of atypical teratoid/rhabdoid tumors (AT/RTs) for 3 years in our institute. Objective: To analyse the demographic clinical and histopathological features of Atypical teratoid/rhabdoid tumors (AT/RTs). Materials and Methods: It is a retrospective study conducted at Department of Neuro Pathology, Institute of Neurology and Neurosurgery, Madras Medical College / RGGGH, Chennai. 5 cases were reported from June 2016 to June 2019. Results: Four cases of AT/RT reported in our institute were under one year of age. One case presented with drop metastasis. The incidence of AT / RT among CNS tumors in our institute is 1.60% and incidence among embryonal tumors are 15%. Conclusion: Atypical teratoid/ rhabdoid tumor is a highly aggressive grade 4 tumor with poor prognosis. Five year survival rate is 14% and overall survival is 29%. So, it requires multimodality treatment approach.

Background: Tympanoplasty, or eardrum repair, is a surgical procedure used to fix a ruptured tympanic membrane (eardrum) or the small bones of the middle ear. An eardrum perforation may result from chronic infections or, less commonly, eardrum trauma. Objective: The study’s goal is to compare the surgical results of mastoidectomies and tympanoplasties in terms of improved hearing and graft uptake. Methods: This Prospective study conducted at tertiary care hospital of Middle Gujarat, India and a total of 60 patients undergoing tympanoplasties with and without mastoidectomy were included and followed up for a period of one year. Results: The surgical results of the two procedures did not differ significantly in terms of improved hearing or graft uptake. When applied unilaterally, the Belfast rule of thumb allows the patient to truly benefit from their hearing. Conclusion: CSOM seems to be more prevalent among females. The enhancement in hearing after undergoing either tympanoplasty alone or combined tympanoplasty with mastoidectomy demonstrated similar outcomes in both cohorts. It was observed that incorporating mastoidectomy into tympanoplasty did not yield additional advantages in terms of improvement in hearing.

Background: Proximal Tibial epiphyseal fractures are rare and they make up less than 01% of all epiphyseal (growth plate) separations. These fractures require significant force and occur in a region with intrinsic stability due to the surrounding structures; collateral ligaments and fibular buttress. Aim of the Study: To evaluate the operative treatment for children with proximal Tibial epiphyseal fractures, with the objectives of enumerating the Indications for surgery, surgical techniques adopted, Advantages and disadvantages, Possible complications and Overall results. Materials: A prospective case series study was conducted between December 2022 and January 2024 at Al Viswabharathi Medical College and General Hospital, Kurnool, Andhra Pradesh. 23 children with proximal Tibial epiphyseal fractures were included. Treatment method adopted was surgical intervention with various fixation methods. Results: The mean operative time was 59.25±17.45 minutes, with a range from 36 to 93 minutes. The mean intra-operative blood loss was 36.25 mL (range: 23.15 to 36.50 mL). Fixation methods used were ‘K’ wires in epiphyseal group-75% of the children; cannulated screws were used in remaining 25% of the children. In the tubercle group, fixation was more varied: 50% had 4.5 mm cannulated screws and 25% had a combination of 4.5 mm cannulated screws and tension band 25% had K-wires. Conclusion: Proximal tibial epiphyseal fractures are uncommon but potentially serious due to the risk of limb-threatening complications. Close monitoring of neurovascular status is crucial to detect any acute or delayed complications. There is a low tolerance for failure in maintaining the reduction after fixation, especially when using K-wires, which may require supplementary fixation to ensure the best outcome.

Background: Meniscal root tears lead to significant functional impairment and increase the risk of osteoarthritis. Repairing the root aims to restore knee anatomy and biomechanics, thus reducing osteo-arthritic progression. While several techniques for root repair exist, challenges remain with bed preparation and instrumentation. Aim of the study: Present study evaluated the early clinical results of root re-insertion using an accessory supra-meniscal portal, which aided in preparation and instrumentation of the bed. Materials: From February 2022 to January 2024 22 patients aged between 18 to 77 years with medial meniscus root tears underwent arthroscopic root repair using heavy braided sutures passed through a tibial tunnel and tied over a bone button. An accessory supra-meniscal portal was utilized for improved visualization and suture management. Patients were followed for 24 months, and functional outcomes were assessed using the Lysholm Knee Score. Results: After 24-month follow-up, the mean Lysholm score improved significantly from 81.5 ± 08.61 preoperatively to 90.25 ± 5.60 postoperatively (p = 0.001). Traumatic tears had higher preoperative and postoperative Lysholm scores compared to degenerative tears. Aged patients showed poorer functional outcomes. Conclusion: Medial meniscal root re-insertion restores knee function and helps prevent arthritis progression. Traumatic tears, especially in younger patients, show more significant improvements compared to degenerative tears.

Background: Migraine is a neurological disorder characterized by abnormal excitability in the visual, somato-sensory, and motor cortices. Migraine may be a risk factor for developing HL and tinnitus. Investigating the relationship between Migraine and Hearing loss using different clinical tools and auditory instruments would encourage future research into the underlying patho-physiology and shared otologic principles between them. Hence comprehensive migraine prevention/treatment protocols may improve the outcomes of these associated otologic conditions. The present study was aimed to assess and compare auditory processing performance in migraine patients with and without dizziness, as well as in healthy controls. Materials: 80 participants were divided into three groups: the control group (20 healthy subjects), study group I (30 subjects with migraine), and study group II (30 subjects with vestibular migraine). Participants were evaluated using the Central Auditory Processing Questionnaire for adults, tympanometry, pure tone audiometry, and psychophysical central auditory tests, Intelligibility in Noise Test, Gap in Noise Test. Results: No significant differences were found between study groups I and II, but both study groups showed significant differences compared to the control group across all central auditory tests. A statistically significant difference was observed between the control group and both study groups in all memory tests. The highest percentage of abnormalities was noted in temporal resolution and selective auditory attention in both study groups. There was no significant correlation between the frequency of attacks per month and the central auditory test results. Conclusions: Both migraine and vestibular migraine patients demonstrated poorer performance in all psychophysical central auditory tests compared to the control group. Additionally, there were no significant differences between the two study groups, suggesting that migraine, with or without dizziness, may share a similar underlying pathophysiology.

Introduction: Group B Streptococcus (GBS), a leading cause of neonatal and maternal morbidity, is responsible for early-onset disease (EOD) in neonates and conditions like chorioamnionitis in mothers. GBS colonisation in pregnant women can lead to vertical transmission during labour. Although universal screening has significantly reduced neonatal GBS disease in developed nations, its implementation in developing countries, including India, remains limited. This study aimed to determine the prevalence of GBS colonisation among pregnant women, assess associated maternal and neonatal outcomes, and propose an optimal screening strategy. Materials and Methods: This prospective observational study included 125 pregnant women between 35–37 weeks gestation at Shridevi Institute of Medical Sciences and Research Hospital, Tumkur, Karnataka, over 12 months. Vaginal and rectal swabs were collected, cultured using enrichment broth and sheep blood agar, and analysed using standard microbiological methods. Maternal demographic details, obstetric history, and neonatal outcomes were recorded. Results: GBS colonisation prevalence was 4% (5/125). Colonisation was identified in 40% of vaginal swabs, 40% of anal swabs, and 20% of both. GBS positivity was significantly associated with premature rupture of membranes (p = 0.0017) but not with age, gravidity, or socioeconomic status. No maternal or neonatal morbidity was observed in GBS-positive cases. Neonates of colonised mothers showed no NICU admissions or clinical signs of sepsis. Conclusion: GBS colonisation among pregnant women was low (4%) and significantly associated with PROM. Enhanced detection using dual-site sampling and targeted prophylaxis may mitigate adverse outcomes. More extensive studies are required to inform GBS prevention strategies in India.

Introduction: Gallbladder cancer (GBC) is highly prevalent in India with an incidence rate of 1.8 per 100,000, contributing to cancer-related deaths globally. Late diagnosis, attributed to absence of reliable screening tests, results in advanced stages and poor prognosis. Symptoms vary asymptomatic to pain, jaundice and GI discomfort. Most commonly asso.  Gallstones, GBC often presents late. Despite being the 19th most diagnosed cancer, it ranks 15th in India for mortality. This study aims to highlight key aspects including Clinical features, risk factors, pathogenesis, imaging characteristics &emphasizing early detection and comprehensive management approaches tailored to staging. Aim: To study clinical presentation and management modalities of gall bladder cancer. Methods: The study was conducted on 170 patients, patient data was collected on admission and diagnosis was made using clinical presentation and radiological investigation and analysed for early detection of clinical presentation of GBC and management planned and follow up was done for survival result in study period. Results: The study had the following findings- (1). The proportion of Females having GBC was 60% (102 off 170) higher than Males (40%), ratio between the male and female patients was 0.6667: 1. (2). Median incidence of gall bladder cancer in this study occurred in 6th decade (51-60 years). (3). Pain in abdomen was commonest complain present in 66% of patients followed by Jaundice 62% and vomiting in 51% of patients in our study group. (4). In our study we observed the most common stage observed were IIB and IIIA with 64(37.65%) and 60(35.29%) with personal habits, such as smoking, alcohol, and irregular bowel habits, were most commonly observed in particular stages of gallbladder cancer and CECT W/A was the main modality of investigation for diagnosis and metastasis of GBC in suspected patients. Conclusions: This study identified key demographic trends, symptomatology, and treatment patterns. Patients typically presented with pain, jaundice, and vomiting, with pain most common clinical presentation. Disease staging showed associations with age, sex, and personal habits like smoking and alcohol use. Management as Palliative care was predominant in advanced stages and older patients, correlating with higher mortality rates. Early-stage patients undergoing surgery and adjuvant chemotherapy had better survival rates, contrasting with late-stage patients receiving palliative care and chemotherapy. This highlights the importance of early diagnosis, aggressive treatment, and tailored interventions for improved outcomes in gallbladder cancer.

Introduction: Nephrolithiasis, a condition affecting kidneys and the urinary tract, impacts around 20 lakh individuals annually in India. Influenced by several factors, untreated and recurrent renal stone often lead to development of serious complications. Percutaneous nephrolithotomy (PCNL) has been proven to be effective in treating complex and large stones. This study examined risk factors for kidney and upper ureteric stones and assessed the outcomes and complications of PCNL. Aim: To determine the effect of various risk factors predisposing to urolithiasis and evaluate the effectiveness and outcomes of PCNL. Methods: This study included 88 patients with renal calculi. Their history, pre-operative, peri-operative, and post-operative parameters were collected and analysed cross-sectionally. Results: The study had the following findings-(1). Almost equal incidence of renal stones in both genders, mean age was 39.37 years and those with non-vegetarian diet and no access to purified drinking water. (2). Most patients had shorter operating times (50% patient – 60 minutes) and no post-operative complications (83.95%), highlighting PCNL’s efficiency. (3). Significant correlation between longer operating times and increased postoperative complications. (4). Larger stones (>20mm), staghorn stones, and mid calyceal stones were associated with increased post-operative complications and longer hospital stays. Conclusions: This study assessed the prevalence of stone formation in North Indian population and its association with age, sex, and lifestyle attributes outside the stone belt region. The influence of various characteristics of stones on PCNL outcomes was also studied, providing insights for improving patient care and formulation of preventive measures to lessen incidence and recurrence of urolithiasis.

Introduction: Intestinal obstruction (IO) disrupts normal intestinal content flow, affecting both small and large bowels. With rising global cancer cases, colorectal cancer (CRC) significantly contributes to morbidity, accounting for 10% of cancer incidences and deaths. Risk factors for CRC include dietary habits, sedentary lifestyle, and age, with higher rates in developed nations. Differentiating small and large bowel obstructions is crucial due to distinct clinical approaches. This study examines the histopathological spectrum of large bowel obstructive lesions in a tertiary care hospital, highlighting the critical role of histopathology in diagnosing and managing IO, especially in cases involving malignant transformations. Material and Methods: This prospective study at BPS GMC examined resected specimens and endoscopic biopsies of large intestine obstructive lesions over one year. Following ethical approval and informed consent, samples were processed with H&E, histochemical, and IHC staining for histopathological analysis, excluding cases with perforation, poor preservation, or inadequate biopsies. Results: The present study analysed 30 large intestine specimens, comprising 46.7% resections and 53.3% biopsies. Ne-oplastic lesions (70%) predominated, with adenocarcinoma (30%) being most common. A significant link was found between dietary patterns and lesion type (p = 0.011). The rectum was the most frequently affected site (53.3%). Conclusion: The study underscores diverse histological variations in large intestine obstructions, emphasising multifactorial causes and significant impacts on young, active individuals.