Introduction: Shivering is one of the most common complications during spinal anesthesia , leading to patient discomfort and increased metabolic demand. This is a result of blocked sympathetic activity with effective vasodilatation, leading to loss of thermoregulation. This study aimed to compare the efficacy of prophylactic pethidine and tramadol in preventing shivering in patients undergoing spinal anesthesia. Aims and Objective: To analyze the outcome of prophylactic Tramadol hydrochloride and Pethidine hydrochloride for shivering patients who underwent elective surgery under spinal anaesthesia. Method: This prospective, randomized double blinded study, was conducted in 120 ASA 1 and ASA 2 adult patients of either gender scheduled for elective surgery and spinal anaesthesia. Patients were allocated into 2 groups of 30 each, to receive either pethidine or tramadol in a dose of 0.5mg/kg 10 min before administration of spinal anaesthesia. Intraoperative hemodynamic Parameters, incidence and severity of shivering were recorded and statistically analysed with t-tests, chi-square tests and ANOVAs. Result: The incidence and severity of shivering was significantly lower in pethidine group compared to tramadol group (p<0.001). However, pethidine is associated with mild sedation score and lower incidence of nausea and vomiting compared to tramadol. Conclusion: Prophylactic pethidine is more effective than tramadol in reducing the incidence and severity of shivering with minimal sedation in patients undergoing elective infra umbilical surgery under spinal anesthesia.

Introduction: Exercise, Yoga and Visual reaction time may be associated in a variety of ways, however the connection is not always obvious. The interval between the presentation of a stimulus and the commencement of a response is referred to as reaction time. Aims and Objective: The present study was done to know the effect of Yoga performers and Zumba performers on Visual Reaction Time (VRT) for Yellow Color. Method: In the present study after taking informed consent and ethical clearance, data from 50 Yoga performers and 50 Zumba performers (of age group 20- 40 years) were collected and the visual reaction time for yellow colour was measured while performing Zumba and yoga respectively. Result: Statistical results reveal that there is no significant difference in the mean value of VRT (yellow color) between Yoga and Zumba Performers. Conclusion: Since the difference is not statistically significant, we can clearly conclude that yoga and physical exercises (Zumba) both offer unique benefits for cognition and reaction time in their own ways.

Background: Chronopharmacology is a scientific discipline that examines how biological rhythms influence the effects of pharmacotherapy, which is the study of how drug administration timing impacts its efficacy. De-spite its significance, chronopharmacology is often neglected and not extensively researched within the context of therapy optimization. This study aimed to evaluate doctors’ knowledge, attitudes, and practices (KAP) regard-ing chronopharmacology. Materials & Methods: A cross-sectional, descriptive study was conducted using a questionnaire. A total of 100 participants were enrolled after obtaining their consent and given a structured KAP questionnaire consisting of 20 questions. The data collected were expressed in percentages. Results: Findings revealed that 58% of participants were familiar with the term chronopharmacology. Addition-ally, 53% acknowledged that chronopharmacology pertains to the influence of drugs on biological rhythms, such as circadian rhythms. Moreover, 45% of respondents believed that chronotherapy could affect the pharmacokinetics of drug. Furthermore, 65% indicated that they consistently include correct timing for drug administration in their prescriptions. Conclusion: Although a majority of participants were not aware of the term chronopharmacology, they recognized the connection between the biological clock and various diseases and expressed a desire for patient coun-selling on this topic. It is essential to enhance educational efforts for doctors regarding the principles of chro-nopharmacology.

Prevalence autism spectrum disorders (ASD) has been on rise, but many studies suggest over-diagnosed. Cur-rently, children have more access to electronic media on the daily basis than those of previous generation. Some studies suggest that increases screen time is associated with melanopsin-expressing neurons and decreasing gamma-aminobutyric acid (GABA) neurotransmitter, and thus results aberrant behavior, decreased cognitive, and language development. Early exposure of electronic media in early life (< 2 years old) gives an impact on lan-guage, but it still inconclusive. We made a study aiming at revealing the impact of early exposure of electronic screen on language development and autistic-like behavior. Results showed that children who spent viewing ≤ 3 hours per day had language delay and short attention span, while children who spent viewing ≥ 3 hours per day had language delay, short attention span, and hyperactivity. While we found that more than a half of children (66.6%) had no parents-child interaction during the exposure, speech delayed and short attention had been re-ported in all cases, and hyperactivity was found in 66.6% children.

Introduction: Chronic Liver Disease (CLD) is a global health issue with increasing mortality. Neutrophil-to-Lymphocyte Ratio (NLR), a simple marker derived from routine blood tests, has emerged as a potential predictor of disease severity in Chronic Liver Disease. This study investigates the role of NLR in assessing disease severity and predicting clinical outcomes in CLD patient. Method: This one-year observational study at SRMS IMS, Bareilly, included 140 adult CLD patients admitted to the inpatient department, with chronic liver disease confirmed by ultrasound. Patients with secondary immunodeficiencies, hepatocellular carcinoma, or acute liver failure were excluded. Demographic, clinical, and laboratory data, including NLR from blood counts, were collected. Follow-up assessments monitored patient outcomes. Data analysis was performed using SPSS and MS Excel, with ethical approval from the institutional committee. Result: The mean NLR in the study was 3.53 ± 1.22. A significant difference in NLR was found across CTP classes: Class A (2.14 ± 0.78), Class B (3.45 ± 1.18), and Class C (4.14 ± 1.16) with a p-value of 0.01*. NLR showed positive correlations with albumin (r = 0.171, p = 0.044), bilirubin (r = 0.363, p = 0.001), and CTP score (r = 0.386, p < 0.001). Significant differences in albumin (p = 0.015*), prothrombin time (p = 0.021*), and bilirubin (p = 0.001*) were observed across NLR groups. Conclusion: NLR is a reliable and cost-effective marker for assessing the severity and prognosis of CLD. Its association with liver function parameters and CTP score suggests its potential utility in risk stratification and management of CLD patients. Further studies with larger cohorts are recommended to validate its prognostic value.

Background: ex ratio is defined as the number of females per thousand males. The  objectives were  to  study  the knowledge, attitude and the practice of pregnant women on gender preference, prenatal sex determination and female feticide. Methods: It was a hospital based cross-sectional study.  The present study was undertaken among the 204 newly registered pregnant women attending the hospital in Marh block of Jammu district, Jammu and Kashmir, India. A pre-designed, pre-tested and structured questionnaire was used in the study. The data collection technique was a personnel interview of the study subjects. Results: Out of 500 pregnant women 62% had shown no gender preference, 23% preferred male child and 15% had preferred to have female child. Regarding awareness, 88% and 90% women knew that prenatal sex determination and female feticide are illegal, respectively. Conclusions: Being the civilized citizens, it is our duty to raise voice against the declining sex ratio and killing of girl child. Being a woman it is our primary duty as well as concern to come forward to stop this menace.

Background: Despite a slew of national programs aimed at improving the health of mothers since independence, limited access to and utilization of modern healthcare is among the primary causes of India’s high maternal death rate. Methods: Total 100 pregnant females were studied about knowledge and attitude during antenatal care check-up. The study was cross sectional in design. They were asked questions while attending the outpatient clinic in the hospital. Results: 84.00% respondent were known that pregnant women need to go for their checkup. 44.00 % women have knowledge that 1st prenatal check-up should be done in the starting three months of gestation. Almost half of the women knows 52.00% that high blood pressure can affect the growth of their children. Conclusion: The study concluded that overall pregnant women response in yes regarding knowledge about antenatal care.

Background: The study was conducted to review maternal outcome in pregnancy with diabetes. Methods: Study group used single step 75gm oral glucose tolerance test (OGTT) test recommended by WHO for GDM diagnosis. Results: 45% patients had polyhydramnios and 38% developed preeclampsia. Preterm labor was common in 23% of GDM patients. Conclusions: There was significant fetomaternal morbidity in patients with diabetes mellitus. Early diagnosis and treatment reduce the Maternal outcome.

Background: polycystic ovarian syndrome (PCOS) in the present generation is a very common reproductive disorder and the prevalence is on the rise. In this study we compare the maternal outcome in normal and women with PCOS. Methods: This study was a case-control study on pregnant women with h/o PCOS from 5-28 weeks of pregnancy. Results: 9.49% women developed GDM in cases as compared to 1.61% women in control group. The difference in the incidence of GDM in the two groups was statistically significant. When hypertensive disorders of pregnancy were considered, a statistically significant difference was observed as 11.2% cases and 2.42% controls showed HDP. Conclusion: With a detailed comparative analysis of this case-control study, it can be concluded that many antenatal complications are per se increased in women with a history of PCOS.

Background: Infertility affects a substantial percentage of couples globally, with complex cases often involving uterine, ovarian, or unexplained factors that remain challenging to diagnose accurately. Although non-invasive imaging methods such as ultrasound and hysterosalpingography (HSG) are widely used, their limitations in sensitivity and specificity underscore the need for diagnostic laparoscopy, a minimally invasive procedure with high diagnostic accuracy. This study aims to evaluate the utility of diagnostic laparoscopy in assessing complex infertility cases, specifically focusing on uterine, ovarian, and unexplained factors. Methods: A cross-sectional study was conducted on 50 women presenting with either primary or secondary infertility. Each participant underwent diagnostic laparoscopy following standard clinical assessments, including ultrasonography and hormonal profiling. Data were collected on uterine anomalies, ovarian cysts, PCOD, and unexplained infertility cases, and were analyzed to compare findings between primary and secondary infertility groups. Results: Uterine abnormalities, primarily fibroids, were identified in 12% of cases, mainly among primary infertility patients. Ovarian factors, including PCOD and ovarian cysts, were detected in 20% of cases across both primary and secondary infertility groups. Additionally, 12% of cases were classified as unexplained infertility due to the absence of identifiable abnormalities. Diagnostic laparoscopy provided higher detection rates for these factors compared to conventional imaging techniques, underscoring its role in cases where non-invasive methods were inconclusive. Conclusion: Diagnostic laparoscopy is a valuable tool for identifying complex infertility factors, offering a reliable and safe method for comprehensive infertility evaluation. Its high diagnostic accuracy, particularly for detecting uterine, ovarian, and unexplained infertility factors, supports its use as a routine investigative procedure in infertility workups. Recommendations: Laparoscopy should be considered for routine use in infertility evaluations, especially for patients with complex or unexplained infertility, to improve diagnosis and guide targeted treatment.

Background: Premenstrual Syndrome (PMS) affects a significant number of menstruating women, including medical students who face unique stressors. The autonomic nervous system (ANS) is often disrupted in PMS, contributing to various symptoms. Yoga, particularly yogic asanas, may offer a non-pharmacological intervention to improve autonomic function and alleviate PMS symptoms. Objective: To evaluate the effect of yogic asanas on autonomic function tests and PMS symptoms in medical students. Methods: A randomized controlled trial was conducted with 60 medical students diagnosed with PMS, randomly assigned to an intervention group (yoga) or a control group. The yoga intervention included 60-minute sessions three times a week for 8 weeks. Autonomic function was assessed using heart rate variability (HRV) and blood pressure variability (BPV). PMS symptoms and quality of life were measured using the Premenstrual Symptoms Screening Tool (PSST) and WHOQOL-BREF scale. Results: The intervention group showed significant improvements in HRV (SDNN and RMSSD), reductions in BPV, and a notable decrease in PMS symptom severity compared to the control group. Quality of life scores also improved significantly in the intervention group. Conclusion: A structured yoga intervention effectively enhances autonomic function and reduces PMS symptoms in medical students. Integrating yoga into wellness programs could provide a valuable, non-pharmacological approach for managing PMS and improving overall quality of life.

Objective: This study aims to evaluate the diagnostic sensitivity of magnetic resonance imaging on a wide range of pathologies affecting the ankle and the foot, including osseous, osteochondral, ligamentous, tendinous, and infectious and metabolic conditions. Methods: This is a retrospective study of a total of 250 MRI studies for patients that presented with ankle or foot pathology. The findings in imaging were grouped under specific anatomy regions and pathology types. The basic MRI protocols had T1-weighted, T2-weighted sequences with fat suppression, proton density, and STIR sequences in evaluating the different aspects including bone, cartilage, soft tissues, and inflammatory changes. All data from the images would be subjected to analyses based on how frequent they appeared and what their characteristic presentations looked like. Results: Osseous and osteochondral injuries were detected in 62% of cases, with a predominance of stress fractures and osteochondral lesions of the talus and calcaneus. Ligamentous injuries were identified in 53% of cases, where the most common injury involved the anterior talofibular ligament. Tendon pathologies, including Achilles and peroneal tendon issues, were present in 45% of cases, involving conditions like tendinosis, tendinitis, and subluxation. Infection and diabetic complications, including osteomyelitis and neuropathic osteoarthropathy, showed characteristic MRI features, which are important for timely diagnosis and management. Conclusion: MRI, however, is an excellent critical imaging tool for carrying a comprehensive assessment of any pathologies in the ankles or foot. It stands excellent with high diagnostic accuracy against a wide range of pathological situations. Its sensitivity in very early pathological changes and in further planning of appropriate management puts value to its clinical applicability.

Background: De Quervain’s tenosynovitis (DQT) is a common condition characterized by pain in the wrist and thumb, often affecting individuals engaged in repetitive hand movements. This study aims to compare the efficacy of steroid injections versus surgical release in treating DQT and to assess the demographic characteristics of affected patients. Methods: A prospective study was conducted at Hindu Rao Hospital over two years, involving 54 adults diagnosed with DQT. Participants were randomly assigned to receive either steroid injections or surgical release. Inclusion criteria included clinically diagnosed DQT with pain affecting daily activities, while those with inflammatory diseases, prior wrist injuries, or cognitive impairments were excluded. Data on demographics, treatment outcomes, complications, and recurrence rates were collected and analyzed. Results: The study population consisted of 42 females (78%) and 12 males (22%), with a mean age of 33 years. Both treatment groups showed similar outcomes, with no significant differences in complications or recovery rates. Complications were reported in 17% of patients, including hypopigmentation and numbness. The findings suggest that both steroid injections and surgical release are effective treatment options for DQT. Conclusion: This study underscores the high prevalence of DQT among females and highlights the effectiveness of both treatment modalities. Given the comparable outcomes, treatment choice may depend on patient preference and severity of symptoms, emphasizing the need for individualized management strategies in clinical practice.

Introduction: 70 to 80% of individuals suffer from low back pain related to prolapse of the lumbar disc, particularly among young, active workers. The condition results in a great deal of pain, sciatica, and impairments in motor function development which has become more severe as a global healthcare issue. Though conservative therapies prove useful, instances of surgery, for example, fenestration discectomy, promise efficient alleviation from such conditions with less morbidity, adequate recovery durations, and better quality of life outcomes in the longer term. This study evaluates the functional outcomes of lumbar disc prolapse patients after fenestration discectomy surgery. Method: This prospective cohort study, conducted in Hindu Rao Hospital, Delhi, from June 2019 to June 2021, investigated the outcomes of fenestration discectomy in 30 patients presenting with lumbar disc herniation. Patients were included if MRI definitively diagnosed lumbar disc herniation with radicular symptoms, thus forming a relatively homogenous cohort of subjects and yielding the most reliable outcome results. Result: It comprised only 30 patients with lumbar disc prolapse, of which the largest age group was predominantly male and aged forty-one to sixty. The most commonly affected disc level was L4-L5. After fenestration discectomy, 63.33% achieved an excellent outcome, 30% had a good result, and 6.67% had a fair recovery outcome, suggesting that fenestration discectomy has a valid role in enhancing functional independence. Conclusion: This study concluded that fenestration discectomy improves functional outcomes in patients with lumbar disc prolapse. It had no complications, reduced recovery time, and favourable results, though the small sample size limits the findings.

Aims & Objectives: To investigate anemia in patients with newly diagnosed pulmonary tuberculosis and association between anemia patients’ hemoglobin levels and the severity of their pulmonary tuberculosis. Methods: The present hospital-based study was conducted for one year (January 2023 to December 2023) on 100 pulmonary tuberculosis patients who attended Emergency, IPD, OPD of Muzaffarnagar Medical College and Hospital. The samples were tested using an automated cell counter that measured all relevant parameters, such as hemoglobin, hematocrit, red blood cell count, MCV, MCH, and MCHC. Results: Anemia was present in maximum study subjects (66%) and showed a statically significant value (p=0.002). Of the total 66 anemic subjects, 41 (62.12%) had normocytic normochromic anemia, 18 (27.27%) had hypochromic microcytic summary 51 anemia, 7 (10.61%) had hypochromic normocytic and no subject had macrocytic anemia, showing a statistically significant value (p=0.001). Sputum positivity for AFB grade showed a statistically significant difference between anemic and non-anemic subjects (p<0.01). Conclusion: The study concluded that a significant proportion of TB patients had anemia. The results of the study indicate that anemia is particularly common in patients with the most severe clinical forms of tuberculosis (TB), and that it may be utilized as a biomarker of the severity of tuberculosis. Anemia was substantially correlated with grade of AFB.

Aim: This study is aimed to detect the efficacy of Tzanakis scoring system in diagnosing acute appendicitis in our set up using histopathology as the gold standard. Materials and Methods: This cross-sectional validation study was carried out in ESIC Medical College & Hospital, Kalaburagi from October 2023 to October 2024, after approval from the Ethics Committee of the Hospital. The study included all adult patients of either gender who presented with clinical findings suggestive of acute appendicitis, who were assigned Tzanakis score pre-operatively and who subsequently underwent emergency appendicectomy with histological examination of the resected specimens.  Result: Sensitivity of Tzanakis score in diagnosing acute appendicitis was 91.3%, specificity 57.14%, positive predictive value 93.33%, negative predictive value 50% and diagnostic accuracy was 86.79%. The area under the curve (AUC) of the receiver operator characteristic (ROC) curve for the Tzanakis scoring system was 0.742, with a standard error of 0.083, 95% confidence interval- 0.579 – 0.906, p value = 0.004. Conclusion: This study concluded that the Tzanakis scoring system is acceptable for diagnosing acute appendicitis.

Background: Psoriasis is a persistent inflammatory condition that primarily impacts the skin, nails, and joints. While ocular manifestations are relatively uncommon in the existing literature, particularly among those with psoriatic arthritis. This study aimed to investigate the prevalence and characteristics of eye involvement in individuals diagnosed with psoriasis. Materials and Methods: The study included 134 individuals with psoriasis compared with 134 healthy participants. A comprehensive history was obtained for all participants, followed by dermatological, systemic, and ophthalmological assessments. Schirmer’s test and tear breakup time (BUT) were performed. Continuous variables were analyzed using the t-test, while categorical data were compared using the chi-square test. Logistic regression analysis was employed to explore associations between ocular findings and variables. Statistical evaluations were conducted separately for the right and left eyes. Results: Patients with psoriasis exhibited a significantly higher frequency of ocular findings in both eyes compared to the control group. Additionally, Schirmer’s and BUT values were markedly reduced in psoriasis patients compared to the controls. Conclusion: The findings underscore the importance of regular ophthalmological evaluations in patients with psoriasis for timely detection and management of ocular complications. However, further research is needed to elucidate the underlying mechanisms of ocular involvement in this patient population.

Background: Stroke is a leading cause of morbidity and mortality worldwide, with inflammation playing a pivotal role in its pathogenesis. Serum ferritin, an acute-phase reactant and marker of iron metabolism, is linked to oxidative stress and inflammation, potentially influencing stroke outcomes. Studying its levels may provide insights into prognosis and therapeutic targets in stroke management. Aim and Objectives: To assess the level of serum ferritin in stroke patients admitted in tertiary care centre and to correlate the level of serum ferritin with the disease outcome in the patients. Materials and Methods: This study was conducted as a prospective Observational Study on Patients admitted in medicine ICU, tertiary care hospital, Bhopal, during the study period of 18 months i.e. from 1^st September 2022 to 29^th February 2024.  The clinical severity of stroke was  assessed using Canadian Stroke Scale at the time of admission and on the 6^th day of admission, the severity of stroke was re-assessed clinically using CSS and serum ferritin levels were again measured in all the subjects. Results: Mean serum ferritin levels in patients with admitted with stroke at the time of admission was 276.30±155.52 ng/ml whereas that at day 6 was 301.95±228.86 ng/ml. 51 cases (31.9%) with stroke deteriorated over the hospital stay. Mean serum ferritin levels in deteriorated group was significantly higher as compared to non-deteriorated group (p<0.05). Serum ferritin at day 6 to be good predictor of adverse outcome i.e. deterioration as per CSS (AUC=0.897; 95% CI-0.842-0.951; p<0.05) and serum ferritin at admission was found to be fair predictor of adverse outcome (AUC=0.798; 95% CI- 0.723-0.873; p<0.05). Conclusions: Serum ferritin levels are prognostic marker of severity of stroke as well as outcome in patients with stroke. Elevated serum ferritin  is strongly positively correlated with early neurological deterioration in stroke patients. Elevated serum ferritin, a marker of iron stores, thus not only help in predicting short term and long term prognosis but signals the need for more intensive patient care and management protocols.

Background and Objectives: Uterine fibroids are common in reproductive-aged women, and their presence during pregnancy can lead to various complications. (1) To evaluate the clinical outcomes and complications in pregnant women with uterine fibroids. (2) To determine the type of delivery and its association with fibroid characteristics. Fibroid (myoma) is the most common benign tumors of the uterus. Effect of pregnancy on myoma may be stimulatory and it can lead to unpredictable and impressive growth during pregnancy. These tumors respond differently in different women. Fibroids may grow, regress or remain unchanged in size during pregnancy. Though in some cases it does not affect the outcome of pregnancy but they are associated with complications like preterm labor, IUGR, abortion, PROM, uterine dysfunction, placental abruption, and obstructed labor, increased risk of cesarean delivery, breech presentation, malposition. Hence based on above findings the present study was planned for Clinical Assessment of Complications & Type of Delivery in Pregnant Females Diagnosed with Fibroid Uterus. The data generated from the present study concludes that pregnancy with Fibroids is considered High-Risk. Timely diagnosis and tertiary care referral and Management of Antepartum, Intrapartum, Postpartum complications with good neonatal care leads to successful outcome. Caesarean Myomectomy in selected cases can prove beneficial.

Background: Glycated haemoglobin (HbA1c) is considered as a gold-standard measure of chronic glycemia in diabetic patients. HbA1c is a main indicator for mean blood glucose level. Dyslipidemia especially high LDL is common in diabetes mellitus and is strongly associated with poor glycemic control. Method: A study was carried out to determine the LDL levels in newly diagnosed type 2 diabetics in Jhalawar Rajasthan population. A total of 80 newly diagnosed type 2 diabetics were enrolled in our study. Result: In our study, maximum patients (53.75%) were from 46-60 years followed by 25% patients who were more than 60 years, and 21.25% patients were less than 45 years of age. HbA1c is significantly directly proportional to LDL level Conclusion: It was concluded from the results of this study that type 2 diabetic patients are more prone to dyslipidemia. In newly diagnosed type 2 diabetes mellitus, high LDL levels were found in patients with high HbA1C levels.

Background: To study found the incidence of type of post operative wound infection in uncomplicated acute appendicitis cases using prophylactic post operative antibiotics. Methods: This randomized control prospective study conducted on cases of uncomplicated acute appendicitis undergoing emergency open appendectomy were included in this study. Results: All the 9 patients who had wound infection developed superficial surgical site infection. None of the patients developed deep surgical site or intra-abdominal infections in either of the two groups. Conclusion: Frequency of post operative wound infection is generally very low in uncomplicated appendicitis. The prolonged use of antibiotics post operatively is unnecessary, can increase antibiotic resistance, can produce side effects, and increase cost of treatment.

Background: The aim of this study was to explore the study of thyroid function in patients with metabolic syndrome. Methods: This cross-sectional study was conducted on 200 patients with metabolic syndrome (MetS) (National Cholesterol Education Program’s-Adult Treatment Panel III Criteria) in the study group and 100 subjects without metabolic syndrome in the control group. Anthropometric variables and blood pressure were taken using standardized technique and body mass index was calculated. TSH, T4 and T3 were measured using electrochemiluminescence immuno assay. Results: The overall prevalence of thyroid dysfunction in patients with MetS was 44.00% with high prevalence of sub clinical hypothyroidism (28%). Conclusion: Hypothyroidism brawny associated with components of metabolic syndrome.

Background: Pott’s fractures, particularly in the context of unstable ankle injuries, pose significant challenges in orthopedic practice. Surgical intervention, specifically open reduction, and internal fixation (ORIF) is often required to restore joint stability and function. This study evaluates the outcomes of surgical management in closed bimalleolar ankle fractures. Methods: This prospective study involved 30 patients with closed bimalleolar ankle fractures, managed surgically at SRG Hospital and Medical College, Jhalawar, from April 2022 to January 2024. Patients were assessed for postoperative complications, functional outcomes using the Olerud-Molander Ankle Score, and time to radiological union. Results: The majority of patients (83.33%) experienced no postoperative complications. Functional outcomes were favourable, with 40.00% of patients achieving an excellent score and 33.33% achieving a good score. Radiological union was observed in 73.33% of patients within 8-10 weeks, indicating a rapid recovery associated with surgical intervention. Conclusion: ORIF is an effective approach for managing closed bimalleolar ankle fractures, offering excellent functional recovery, minimal complications, and a swift return to mobility. Surgical intervention should be prioritized in cases of unstable ankle fractures to optimize patient outcomes.

Background: Aromioclavicular (AC) joint dislocations are common injuries and compose a sizeable portion of shoulder injuries. Methods: The clinical and radiographic outcomes of 29 consecutive patients (20 men and 09 women) who underwent anatomic reduction for acute ACJ dislocation using two suture anchors for CC ligament reconstruction and two strands of non-absorbable stitches for ACJ fixation. Two 3.5 mm suture anchors with double-loaded sutures were separately inserted into the anterolateral and posteromedial portions of the coracoid process. The suture strands were passed through the hole created in the clavicle using 2.0 mm drill and tied over the clavicle. Additional ACJ augmentation using two strands of non-absorbable heavy sutures was performed in all patients. At 3, 6, and 12 months and last follow-up visit, the scores on the visual analog scale (VAS), the American Shoulder and Elbow Surgeons (ASES) score, Constant–Murley score, and simple shoulder test (SST) questionnaires were used to provide a final evaluation of shoulder function. Comparison between baseline and treatment results was performed. Radiographic analysis included vertical displacement and horizontal shift. Results: The mean preoperative, 3-month, 6-month, and 12-month follow-up evaluation ASES scores were 43.25±5.23, 75.69±6.29, 92.02±5.09, 93.25±7.29 respectively. The ASES score at 12 months postoperative was 48 higher than the preoperative ASES score (P < 0.01). There was no significant difference in ASES score between the 6- and 12- month follow-up evaluations (P > 0.05). The mean preoperative, 3-month, 6-month, and 12-month postoperative SST were 2.08±0.68, 8.12±1.21, 10.08±2.01respectively. The SST at 12 months postoperative was 10 higher than the preoperative SST (P < 0.01) between the baseline and 12-month follow-up data. No significant difference between the 6- and 12-month follow-up evaluations could be found (P > 0.05). The mean preoperative, 3-month, 6-month, and 12-month postoperative CMS were 30.18±4.26, 70.25±5.26, 88.27±3.28, respectively. The CMS at 12 months postoperative was 60 higher than the preoperative CMS (P < 0.01) between the baseline and 12-month follow-up data. No significant difference between the 6- and 12-month follow-up evaluations could be found (P > 0.05). Conclusions: CC ligament reconstruction using two suture anchors and ACJ augmentation using two strands of nonabsorbable heavy sutures on high-grade AC dislocation is a reliable technique for restoring stability to the ACJ and can obtain good to excellent clinical results.

Background: Our aim in this study is to examine the effects of fracture type on restoring mobility in the postoperative period. Methods: In this observational study, 100 consecutive patients over the age of 65 who were admitted to the hospital with hip fractures were examined. Hospital digital records were examined and patients’ age, gender, body mass index (BMI), smoking, American Society of Anesthesiologists (ASA) score, comorbidities (cardiovascular, respiratory, renal, neurological diseases and malignancy), fracture type, type of implant used in surgery and Charlson comorbidity index score were recorded. Result: 100 patients were included in the study. 62 patients were female and 38 were male, with a mean age of 78.23±8.31 years. There 61 patients were intertrochanteric fractures and 39 were femoral neck fractures. 12 patients underwent proximal femoral nail (PFN), 72 patients underwent hemiarthroplasty, 13 patients underwent dynamic hip screw (DHS) and 3 patients underwent total hip arthroplasty. In the analysis performed to determine the level of mobility, it was found that 96 patients moved without the use of an aid and 4 patients moved with the use of an aid in the pre-fracture period. In the sixth month postoperative follow-up, it was observed that 61 patients were ambulated without the use of an aid, 25 patients were ambulated with the use of an aid, and 14 patients were immobile. Conclusion: Advanced age, high ASA score, cardiovascular disease or malignancy among comorbidities, intertrochanteric fracture as fracture type, and use of PFN as implant type were the main risk factors for not regain to pre-fracture mobility and ADL.

Background: The present study describes the clinical presentation of enteric fever at a tertiary care centre. Methods: The study was a hospital based prospective observational study conducted on children of age 2 -18 years who presented with fever of 5 days or more with clinical signs and symptoms suggestive of typhoid fever and positive Widal test or Typhi dot tests were included in the study. The demographic and clinical features of the patients were described. Results: All the children presented with fever as the main complaint (100%). Commonest sign noticed was toxic look (84%) followed by coated tongue (79%) and splenomegaly (61%). Hepatomegaly was also noted in 34% of cases. Conclusion: This study was undertaken to observe the clinical profile of typhoid fever in children admitted in a tertiary care hospital. Typhoid fever remains to be as an endemic disease in this locality. All the signs and symptoms of the disease are nonspecific common with other acute febrile illnesses; a definitive diagnosis of the disease is required for treatment and to prevent transmission.

Fractures of the distal humerus in adults represent about 2% of all fractures and make up a third of humerus fractures. These injuries are particularly challenging due to their location near the joint, the small size of the distal bone fragments, and the reduced bone quality in older adults. This study aims to assess the clinical, radiographic, and functional outcomes of using a pre contour extra- articular humerus plate for extra-articular distal third humerus fractures, utilizing a posterior triceps splitting approach. Method: This prospective study was conducted at Jhalawar Medical College, Jhalawar, involving 15 consecutive skeletally mature patients with closed extra-articular distal humerus fractures. These fractures were treated using a pre contour extra- articular humerus plate, and the outcomes were evaluated based on radiological evidence of healing, functional results, and any complications that arose. Result: The use of a pre contour extra- articular humerus plate resulted in predictably high union rates and excellent patient outcomes without any implant-related complications. Conclusion: We recommend the use of a pre-contoured extra articular plate for these humerus fractures due to its consistent results in fracture union, stability across the fracture site, and the facilitation of early mobilization, leading to better functional outcomes.

Background: Distal radius fracture is one of most common fractures seen in clinical practice. Intra- articular comminuted fractures are usually associated with road traffic accidents, fall from height in young patients. In old age groups it is associated with severe osteoporosis due to trivial fall. All intra-articular fractures need good reduction for better functional outcome. The aim of our study is to evaluate the functional outcome of intra-articular comminuted distal end radius fractures treated with Ligamentotxis and pinning. Methods: This study was conducted in Orthopaedic Department of Jhalawar Medical College, Jhalawar, Rajasthan between March 2022 to April 2024 on 40 patients with intra-articular comminuted distal end radius fracture, who fulfilled the inclusion criteria. All fractures were managed by ligamentotaxis and pinning and were followed regularly and assessed after three months post- operatively for their final functional outcomes. Results: Overall, 40 patients of intra-articular comminuted distal end radius fractures treated by ligamentotaxis and pinning. 70% of the study population were males. According to Gartland and Werly score, 50% patients achieved excellent outcomes, 25% had good outcomes, 15% had fair outcomes, and 10% had poor outcome. Conclusion: Ligamentotaxis and pinning is safe and effective method of treatment for intra-articular comminuted distal end radius fracture. It is also cost-effective method and can be practiced even in small hospital.

Background: Dengue is the most important arthropod-borne viral infection of humans. Methods: The hospital-based study was conducted on patients presenting to paediatric hospital, who fulfilled inclusion and exclusion criteria. Results: According to complications, in dengue positive cases, bleeding was the most common complication seen in 47.00% cases while shock, myocarditis, and convulsion were present in 33.00%, 4.00% and 1.00% of cases respectively. Among the dengue negative cases, 58.00% had no complication while shock and bleeding were present in 29% and 13.0. Conclusion: It concluded that shock was most common complication.

Introduction: Diabetic foot is complex, chronic wounds, which have a major long-term impact on the morbidity, mortality, and quality of patients’ lives. Material and Method: Hospital based prospective study. 50 patients reporting to the Surgery dept. within study duration and eligible as per inclusion criteria will be included in the study. Results: Maximum 30% patients were treated through debridement of Diabetic foot whereas 20% patients received Slough Excision, Dressing & Skin graft and Toe Amputation as treatment modality. 18% patients were treated by I&D. amputation was the least used treatment modality. Conclusion: Diabetes Mellitus is a lifelong disease and diabetic foot complications can be life threatening, physically incapacitating, costly to treat and result in extensive morbidity.

Introduction: High levels of lipoprotein(a) [Lp(a)] are associated with increased risk of acute coronary syndrome (ACS). We explored whether Lp(a) exhibits a stronger association with ACS. Methods: Hospital based cross-sectional study. Was conducted on 100 patients with acute coronary acute coronary syndrome (ACS). The serum lipo-protein(A) level was measure and ECG was done at the time of admission and repeated, as necessary. Lp (a) was measure by agglutination. Results: 49.00% patients were belong to age group 41-60 Yrs followed by 47.00% patients were more than 60 Yrs age group. 53.00% patients were male, and 47.00% patients were female. 50.00% patients were belong to middle socio-economic status and 40.00% patients were belong to upper socio-economic status. 58.00% patients were obese followed by 37.00% patients BMI was normal, and 5.00% patients were morbid obesity.31.00% patients were present with positive family history. 36.00% patients were present with positive smoking history. 30.00% patients were present with positive Tobacco chewing history. 25.00% patients were present with positive alcohol history. SBP was 128.02±11.06 mm of hg and DBP was 80.02±8.01 mm of hg.  FBS was 110.06±19.36 mg/dl and PPBS was 165.39±34.02 mg/dl. Serum cholesterol was 185.36±43.28 mg/dl, Serum triglyceride was 151.23±60.35 mg/dl, LDL was 107.58±36.24 mg/dl and HDL was 44.23±7.14 mg/dl.  lipo-a was 51.77±11.23mg/dl. The association between age and lipo-protein a level was found statistically significant. The association between sex and lipo-protein a level was found statistically Insignificant. Conclusion: Lp(a) seems to be an independent risk factor for acute coronary syndrome (ACS), and high Lp(a) levels increased the risk for acute coronary syndrome (ACS).

Background and Objectives: Iron deficiency without anemia has been well-documented in heart failure, but its impact on chronic obstructive pulmonary disease (COPD) remains underexplored. The association of iron deficiency with disease severity, functional status, and quality of life in COPD warrants further investigation. This study aimed to evaluate the relationship between iron deficiency and clinical outcomes in non-anemic COPD patients, comparing disease severity, functional status, and quality of life between iron-deficient and iron-replete groups. This observational, cross-sectional study included non-anemic COPD patients with no history of bleeding. Participants were classified into iron-deficient (ID) and iron-replete (IR) groups based on serum iron, ferritin, and Total Iron Binding Capacity (TIBC) levels. Clinical assessments included 6-minute walk distance (6MWD), spirometry and Exacerbation. Demographic data, smoking history, and hemoglobin levels were also recorded. Materials and Methods: 110 patients with a confirmed diagnosis of COPD were enrolled at the Institute of Respiratory Diseases, Sawai Man Singh Medical College, Jaipur, Rajasthan, India. Data on demographic, clinical, Hematological and spirometry parameters were collected. Statistical analysis for qualitative data were done by applying chi square test whereas quantitative data were done by applying ‘t’ test. Data were collected and compiled with the help of MS Excel and analyzed using SPSS version 25.A p-value of <0.05 considered as statistically significant. Results: Iron-deficient individuals had significantly lower hemoglobin and iron levels, and higher TIBC compared to non-iron-deficient counterparts. Notably, NAID is associated with more severe grades of COPD, lower 6-minute walk distances and higher exacerbation rates, although no significant differences were observed in other respiratory parameters. These findings suggest that iron deficiency may contribute to the clinical severity of COPD and support the need for further research into the potential therapeutic benefits of addressing iron deficiency in this population.

Introduction: This study was conducted to compare the efficacy of ropivacaine and bupivacaine using a combined intraperitoneal and port-site administration to reduce the postoperative pain in patients undergoing laparoscopic cholecystectomy. Materials and Methods: Eighty patients scheduled for elective laparoscopic cholecystectomy with symptomatic cholelithiasis, 18-65 years, either gender, American society of Anesthesiologists (ASA) class I and II, were included. Patients were allocated into two group’s of40 each after randomization. Group R patients were given 0.375% Ropivacaine 35 mL [25 mL intraperitoneal plus 10 mL at port-site], while Group B patients were given 0.25% Bupivacaine35 mL [25 mL intraperitoneal plus 10 mL at port-site].Noninvasive blood pressure(NIBP),SpO2,Heart rate( HR), Respiratory rate(RR), Visual Analogue Scale(VAS) score and rescue analgesia were noted in post-operative period, at intervals of 0,1, 2, 4, 8, 12 and 24 hours respectively. Results: The demographic and clinical differences between two groups were not significant. The mean HR was comparable in both the groups, except at 12th hour post-operatively where Group R had significantly lower heart rate. The mean SBP was also comparable between the two groups, other than the 4th and 12th hour respectively, Group R values being significantly lower. The mean Diastolic Blood Pressure (DBP) showed a significant reduction in Group R at 8th and 12thhour respectively. At all the time-intervals the VAS score was lower in Group R, up to 12^th Hour, at the 12th hour significantly lower VAS scores were observed. In Group R a significantly lower number of rescue analgesia with a longer time for first dose of rescue analgesia was seen during the 24-hour postoperative period. Conclusion: In the early postoperative period as compared to 0.25% bupivacaine, 0.375% of ropivacaine provided good quality analgesia, having no adverse effects with less consumption of postoperative supplemental analgesics and can be incorporated in routine practice.

Background: Pregnancy is a physiological state in which significant changes in thyroid function occur. Several factors contribute to these changes. These factors could contribute to thyroid dysfunction during pregnancy especially when hormone levels undergo significant adjustments. This study aimed to assess thyroid function among pregnant women, tracking variations in thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) levels across different trimesters. Methods: A observational study was carried out on 90 pregnant women attending the Obstetrics Outpatient Department at Sri Krishna Medical College and Hospital, Muzaffarpur from August 2023 to July 2024, were invited to enroll in the study. At the end of the study, the blood samples were assessed for free T3, free T4 and TSH Levels. Results: This study revealed that most of the pregnant women had normal thyroid functions (51%), while subclinical hypothyroidism (38%) was the most prevalent disorder followed by Clinical hypothyroidism (7%) and hypothyroxinemia (4%). Conclusion: The most prevalent pattern of thyroid dysfunction in pregnant women was subclinical hypothyroidism. These findings highlight the importance of early thyroid function assessment and monitoring throughout pregnancy, underscoring the need for routine screening protocols to mitigate potential risks to both mother and child.

Background: Prehypertension is a medical condition marked by a slight elevation in blood pressure values, indicating an initial stage before the onset of clinical hypertension. Possible outcomes encompass physiological changes and an increased vulnerability to cardiovascular diseases. Applying yoga and meditation has shown beneficial results for physical and mental health. However, a limited amount of data is available on the impact of yoga treatment on specific signs and variables associated with prehypertension. This study investigates the influence of a well-organized yoga program on the cardiovascular workload of patients with prehypertension. Method: We enlisted participants aged 20 to 40 with accurate blood pressure readings. The therapeutic intervention involved the application of techniques such as relaxation, stretching, and breathing exercises. We evaluated the fundamental characteristics of the participants and examined the blood samples. Statistical tests were utilized for the analysis in this study. Result: This study evaluated the initial features of the participants. 80 individuals were allocated into two groups: 40 participants in the control group (CG) and 40 in the yoga group (YG). The physiological marker readings of the control group (CG) and yoga group (YG) were comparable. After three months, the group that practiced yoga had a greater reduction in cardiac risk profile measures than the control group (CG). Conclusion: The study findings suggest that participating in a three-month yoga program leads to positive changes in the parameters related to cardiovascular health, which are associated with the risk of heart disease. This suggests that implementing yoga can function as an effective non-pharmacological measure in improving cardiovascular health.

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.

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: Foramen transversarium (FT) is the special foramen located on the cervical vertebrae’s left and right transverse processes (C1 to C7) containing the vertebral vessels and sympathetic plexus.^1-3 It is an important and noticeable feature of the cervical vertebrae that occupies the sympathetic fibers, vertebral vein (VV), and vertebral artery (VA). Foramen transversarium gives passage to vertebral artery, vertebral vein and sympathetic plexus from inferior cervical ganglion while C7 vertebra transmits only the vein. The vertebrae of the cervical part and the proximal thoracic part of the human vertebral column are the area undergoing the most intense transformation during phylogeny, leading to many anatomical variations. Aim: Morphometric analysis of Foramen transversarium. Objectives: To Study Foramen Transversarium unilateral & Bilateral. Material and Methods: All the collected cervical vertebrae were examined macroscopically for the existence of the Foramen Transversarium in the 7th cervical vertebrae and the contents passing through it on both sides. All the cervical vertebrae were studied for the presence of more than one foramen and those with double foramen were photographed. In vertebrae with double foramen, the larger foramen was taken as the main foramen and the smaller foramen as the accessory foramen (AF). Digital vernier calipers of 0.01 mm precision were used for morphometric measurements. Vertebrae with this variation were photographed and noted. Results: Result of the 120 cervical vertebrae studied, 17 (14.1%) vertebrae were found to have double FT. Out of the 17 vertebrae, 14 vertebrae were typical and 3 were atypical cervical vertebrae. Among the 14 typical cervical vertebrae, 11 (78.5%) vertebrae had AF on the right side, 1 (7.1%) had on left side and 2 (14.2%) had bilateral AF. Among the three atypical cervical vertebrae, 2 (66.6%) had AF on the right side and 1 (33.3%) had bilateral AF. No AF was found in atlas and axis vertebrae. Conclusion: The present study has shown that Accessory Foramen is more common on the right side is smaller in size and is situated posterior to the main foramen. The knowledge of these variations will be useful in predicting variations in the course of the vertebral artery and will aid orthopedic surgeons for planning the posterior approach of cervical spines.

Introduction: Spontaneous miscarriage is involuntary termination of pregnancy before 20th week of gestation or spontaneous expulsion of fetus below fetal weight of 500 gram. Approximately 12-24% of all pregnancies suffer miscarriages and most of the early miscarriages are caused by chromosomal abnormalities, and the risk of which increases with maternal age. Antenatal ultrasonography (USG) has revolutionized the management of early pregnancy failure. First trimester of pregnancy is the most important period of human development in which single cell transforms into a recognizable human being. USG plays an important role in assessing establishment and evaluation of early pregnancy. It also helps in diagnosing any untoward events in early pregnancy and may guide its appropriate management. Therefore, USG is an easily available tool to differentiate normal from abnormal pregnancy. Aim: 1. To assess early pregnancy developmental changes in 1st trimester USG. 2. To co-relate abnormal ultrasound findings with clinical outcome, measured in terms of spontaneous or missed abortion. Objective: To identify abnormal ultrasound parameters and co-relate USG findings with clinical outcome. Method: This retrospective observation study carried was out in Department of obstetrics and gynecology at Sardar Vallabhbhai Patel (SVP) Hospital, enrolling 120 pregnant women with estimated gestational of 5 to 12 weeks who had attended outpatient department, fulfilling inclusion and exclusion criteria. Results: In our study out of 120 patients 20% suffered abortion, 8% were born preterm. 44% of patients belonged to age group of 21-25yr age group, majority being multigravida i.e. 55%, of which 62.5% suffered abortion. Those with past history of abortion 56% of them suffered from abortion again especially with less than 8 weeks of gestation. Yolk sac diameter >6mm and RI >0.5 were the leading predictors of abortion. Conclusion: The findings suggest that it is possible to predict the outcome of pregnancies based on USG findings. USG findings like abnormal yolk sac size (more than 6mm), mean sac diameter more than 25mm with yolk sac but without embryo, mean sac diameter – crown rump length less than 5mm, crown rump length >9mm with no cardiac activity, embryonic fetal heart rate <100/min, resistive index of spiral arteries >0.55 and intra-uterine hematoma- all have positive predictive value and results are statistically significant to predict early pregnancy failure.

Background: Chronic suppurative otitis media (CSOM) is a common condition characterized by persistent ear discharge and hearing loss, often caused by bacterial infections such as Pseudomonas aeruginosa. While systemic antibiotics combined with topical treatments are commonly used for managing CSOM, concerns about antibiotic resistance and side effects have led to interest in evaluating the efficacy of topical treatments alone. This study aims to compare the effectiveness of topical ciprofloxacin alone versus a combination of topical and oral ciprofloxacin in treating ciprofloxacin-sensitive tubo-tympanic CSOM. Methods: This randomized, controlled trial included 100 patients diagnosed with ciprofloxacin-sensitive tubo-tympanic CSOM, who were randomly assigned to two groups: Group 1 received topical ciprofloxacin (0.3% ear drops) and a placebo, while Group 2 received both topical ciprofloxacin and oral ciprofloxacin (500 mg twice daily). The treatment duration was 4 weeks, with follow-up visits scheduled weekly to assess symptom resolution (discharge, pain, and hearing) and adverse effects. Results: In Group 1, 94% of patients experienced resolution of discharge, 90% reported pain relief, and 84% showed hearing improvement. In Group 2, the rates were 98%, 96%, and 92%, respectively. The combination therapy group showed slightly better results, but the differences between the two groups were statistically significant but modest. Regarding adverse effects, 12% of patients in Group 2 reported gastrointestinal upset and 6% had fungal overgrowth, compared to 0% and 2%, respectively, in Group 1. Conclusion: Both treatment regimens were effective in resolving symptoms of ciprofloxacin-sensitive tubo-tympanic CSOM. However, topical ciprofloxacin alone showed nearly equivalent efficacy to combination therapy, with fewer adverse effects. Given its favorable safety profile, topical ciprofloxacin alone may be considered a sufficient treatment option for most patients, while combination therapy may be reserved for cases requiring additional clinical benefit.

Background: Exam stress is a prevalent concern among medical students, potentially influencing their cognitive function and academic performance. This research evaluates student well-being in medical education by examining the correlation between stress levels and cognitive performance. Method: A total of 80 (40 males and 40 females) healthy MBBS students participated. A stress questionnaire was given and assessed. Cardiovascular parameters were also assessed. The ART and VRT were Recorded before (pre-examination setting) and after 3 months of examination (post-examination setting). The data were analysed by using SPSS 25.0 version. Result: Regardless of gender, all indicators, including PR, SBP, DBP, ART, VRT, and stress ratings, increased in the pre-examination setting. Female learners had elevated PR, while males showed increased stress scores and SBP in the pre-examination scenario. The prevalence of ART and VRT was higher in females than in males in both settings. Conclusion: The study concludes that the stress of exams negatively impacts the cognitive function of medical students. Female students are more affected than males. Therefore, it is recommended that early counseling is provided to students to reduce their stress levels.

Introduction: Occupational exposure in power loom industries is a known risk for respiratory diseases. This study aimed to compare Peak Expiratory Flow Rate (PEFR) between male and female power loom workers and assess the impact of gender, years of exposure, and workplace conditions on respiratory function. Materials and Methods: The study involved 250 power loom workers from rural Salem, Tamil Nadu. Demographic, socioeconomic, and occupational data were collected via a structured questionnaire. PEFR was assessed using Wright’s Peak Flow Meter, and statistical analysis compared PEFR values by gender and exposure duration. Results and Discussion: Significant gender differences in PEFR were observed, with males consistently showing higher PEFR values compared to females. In the 16–20 years exposure category, males predominated in the higher PEFR ranges (351–400 lpm, 401–450 lpm), while females were primarily in the lower ranges (251–300 lpm, 351–400 lpm). As exposure duration increased, PEFR values declined in both genders, with the most significant decline observed in females, highlighting the cumulative effects of prolonged exposure. The findings emphasize the compounded respiratory health risks for females due to dual exposure, and the overall decline in lung function over time for both genders. Conclusion: This study highlights significant gender-based differences in PEFR among power loom workers. Implementing preventive measures like improved ventilation, use of protective equipment, and regular health monitoring can help mitigate respiratory health risks in this vulnerable population.

Background: The supraclavicular brachial plexus block is a widely employed regional anesthetic technique for upper limb surgeries, offering effective intraoperative anesthesia and postoperative pain relief. Bupivacaine, a commonly used local anesthetic, provides excellent nerve blockade but its effects are limited to a few hours. To enhance the efficacy and prolong the duration of analgesia, various adjuvants have been studied. Among these, dexamethasone has shown promising results in extending analgesic effects. This study investigates the impact of adding dexamethasone to bupivacaine on the onset and duration of sensory and motor blocks, duration of analgesia, and potential adverse effects. Materials and Methods: This prospective, double-blind, randomized controlled trial was conducted in a period of February 2024 to November 2024 at DKS Post Graduate lnstitute and Research Centre, Raipur, Chhattisgarh, India, included 80 patients aged 18–60 years, classified as ASA grades I–II, undergoing upper limb surgeries under supraclavicular brachial plexus block. The patients were randomly divided into two groups. Group BD received 28 mL of 0.5% bupivacaine combined with 2 mL dexamethasone (8 mg), while Group BN received 28 mL of 0.5% bupivacaine with 2 mL normal saline. The onset and duration of sensory and motor blocks were assessed using a pinprick test and the Bromage scale, respectively. The duration of analgesia was defined as the time from the onset of the sensory block to the first request for rescue analgesia. Hemodynamic parameters, including heart rate, blood pressure, respiratory rate, and oxygen saturation (SpO2), were recorded. Adverse effects were monitored for 24 hours postoperatively. Data analysis was conducted using SPSS v17.0, with a significance threshold of p<0.05. Results: The demographic characteristics of the two groups were comparable. The study revealed significant differences in the onset and duration of sensory and motor blocks between the groups. The mean onset time for the sensory block was slightly prolonged in Group BD (13.18 ± 1.65 min) compared to Group BN (12.53 ± 1.13 min), with a p-value of 0.04. Similarly, the onset of the motor block was significantly longer in Group BD (18.48 ± 2.2 min) than in Group BN (14.75 ± 1.28 min), with a p-value of <0.001. The duration of the sensory block was markedly extended in Group BD (667 ± 31.31 min) compared to Group BN (376.75 ± 13.33 min, p<0.001). The motor block duration also showed a significant increase in Group BD (587.13 ± 29.04 min) compared to Group BN (338.5 ± 9.62 min, p<0.001). Furthermore, the duration of analgesia was significantly longer in Group BD (720.5 ± 11.86 min) compared to Group BN (430.13 ± 15.55 min, p<0.001). Hemodynamic parameters, including heart rate, systolic and diastolic blood pressure, respiratory rate, and oxygen saturation, remained stable in both groups (p>0.05). Notably, no adverse effects were observed in either group throughout the monitoring period. Conclusion: The study demonstrates that the addition of dexamethasone to bupivacaine in supraclavicular brachial plexus blocks significantly enhances the duration of sensory and motor blocks as well as postoperative analgesia without associated adverse effects. This finding supports the use of dexamethasone as an effective adjuvant in regional anesthesia for upper limb surgeries. Its incorporation into clinical practice could provide improved pain management and patient satisfaction.

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Ref.: international Association for the Study of Pain (IASP) where other such as emotional distress or spiritual distress may induce the same overall feeling as a physical injury. In textual reference of Ayurveda, the symptom pain is closely related to Shula or Vedna. In this condition, the vitiated humor Vata is localized in different regions of body like Asthi, Sandhi, Kati, and Prushtha and produces pain. When Vata gets vitiated, it dries up the ligament of the joints and constricts the Snayu present there and causes pain at that joint. Snehan swedan are Ayurvedic therapies, Snehan (Abhyanga) means oleation therapy which produces Snigdhata or oiliness in the body. It involves massaging the entire body or parts of body with a specific Doshahar warm herb-infused oil. Swedan is usually performed after Snehan. Swedan is an inert body heat therapy by which sweat or perspiration is produced in the body, making individual feel lighter, smoother and more energized. In recent era Transdermal Medicinal Kit Therapy (TDMKT) has got prominent place in the management of the disease through Ayurveda, Because TDMKT is only hope in patients who are bushed after all the Shamana treatments. TDMKT expels the Doshas form their causative roots so disease cannot revert after; like tree cannot grow without its root. Without proper Poorvakarma physician cannot get truly result though Shodhana procedure (like Vamana/Virechana) performed well, because without Poorvakarmas Doshas cannot be changed in particular forms through which they can be expelled out form the body. The present paper is focused on explanation of the principle that how Poorvakarma is essential for Shodhana therapy, how they change Dosha’s form and elucidate the kala and Matra of Poorvakarma particular in Snehapana.

Objective: With increasing practice in urology, use of double j stents has widely increased for various indications and simultaneously increased incidence of forgotten stents too. Methods: We are presenting a simple, cheap and comfortable ‘Stitch reminder’ technique to prevent forgotten stent. For it, we left the suture in situ in per cutaneous nephrolithotomy cases and took a single, non-absorbable, subcuticular suture to right or left flank region as ‘stitch reminder’ for non-percutaneous nephrolithotomy cases. Results: We retrospectively evaluated such cases between May 2020 to March 2023. 578 such patients in which stents and ‘stitch reminder’ were placed were evaluated. There demographic profile, indications for stenting, stent removed or not were recorded. 557 patients came for follow up and both stent and stitch removed. 17 patients died of their primary illness and one patient couldn’t be traced. Conclusions: So ‘Stitch reminder’ technique we used is safe, effective, economical with no complication and also effective in preventing ‘forgotten and retained stents’ and associated complications.

Background: Sample repository is noteworthy, especially in cases of many scientific & medical processes that expedite diagnosis & treatment design. Furthermore, to know the sample integrity which can impact on providing accurate or reproducible data. Materials & Methods: A, total of 11 biochemical parameters were gauged by taking 13 patients’ serum samples at Chikkamagaluru Institute of Medical Sciences, Chikkamagaluru. Each patient’s serum was stowed in an aliquot at -20^οC for a month. Initial analysis (T0d) results obtained as fresh samples were compared to subsequent analysis on the 15^th (T15d) and 30^th (T30d) day of the month. Results: Parameters like glucose, urea, creatinine, uric acid, total bilirubin, AST, ALT, ALP, and albumin expect total protein showed stability at 15 days of analysis. Whereas serum stability was lost for total bilirubin, total protein, direct bilirubin, and ALT during the 30^th day of analysis which was statistically significant (p<0.05) Conclusion: Thus, our study shows that parameters like glucose, urea, creatinine, uric acid, albumin, AST, and ALP have shown reproducible values indicating that stability has been maintained when it was stored for up to 30 days. Total protein, bilirubin, direct bilirubin, and ALT are not preferable for analysis, thus affecting the sample integrity.

Background: The columnar cell variant of papillary carcinoma of thyroid are uncommon variant and regarded as more aggressive form as compared to more common classic papillary and follicular subtypes. Case Report: A 30 year male presents with midline nodular swelling measured 2.5×2.5 cm, since one year. On examination swelling was firm, moved with deglutition and non-tender. The aspirate are hypercellular showing large fragments of cells showing nuclear overlapping with oval enlarged nucleus with fine chromatin, grooving ing and inclusions are seen. Clusters of cells showing nuclear stratification with nuclear hyperchromasia. Based on these finding diagnosis was malignant neoplastic lesion probably papillary thyroid carcinoma was made with differential diagnosis of medullary carcinoma of thyroid. Subsequent excision was done showing a tumour with papillary architecture with nuclear feature of papillary thyroid carcinoma also identified area showing follicles with marked nuclear stratification and hyperchromatic nuclei was seen. Conclusion: Nuclear overlapping, oval enlarged nucleus, grooving and nuclear stratification show feature of papillary carcinoma of thyroid columnar variant.

Introduction: Hepatitis B virus (HBV) infection prevalence is believed to be elevated in Bihar, India; however, state-wide prevalence data are not available. An understanding of HBV prevalence, risk factors and genotype distribution can be used to plan control measures in Bihar. Material & Method: A prospective, OPD-based serosurvey was conducted from January 2024 to June 2024 at BMIMSH Pawapuri, Bihar. Children aged >=5 years and adults were eligible to participate. Demographic and risk behavior data were collected, and serological specimens were obtained and tested for Hepatitis B surface antigen (HBsAg). Result: 5,546 OPD patients participated in the study shows HBV prevalence of 2.29%. HBsAg positivity was most prevalent in the 40–49 year-old and 30–39 year-old age groups (29.92% and 24.41% respectively). The mean age of positive patients was 44.8 years with the majority (approx 30%) of positive cases in the 40–49 years age group. Sex wise distribution shows that there was slight female preponderance. Out of total number of positive cases (127), 71 (55.90%) were females and 56 (44.09%) were males. Among all positive cases having a history of Diabetes, hypertension, Chronic Renal Failure and Cancer were 3.15%, 3.94%, 0.79% and 0.79%. Conclusion: The study findings, including the overall prevalence of chronic HBV infection, associated risk factors and demographic characteristics can guide prevention and control efforts, including treatment provision. In addition to high-risk populations, efforts targeting rural areas and adults aged 40 would be the most effective for identifying infected individuals.

Background: Appendicitis is an inflammation of the appendix. Mostly the pain begins around the belly button and then radiates towards the lower right abdomen. The clinical presentation of acutely inflamed Appendix can vary significantly due to the diverse degrees of inflammatory involvement, different appendix positions, and varying patient ages. Various scoring systems have been employed to identify health issues, yielding positive results by providing accurate information about individuals’ health. Alvarado score and Tzanakis scoring system are extensively studied. The above study was conducted to compare the Alvarado score and Tzanakis score for the effective diagnosis of acute appendicitis. Methodology: The study was conducted on 111 patients at a tertiary care centre fulfilling the inclusion and exclusion criteria. Findings were recorded on a designated form, and scores were calculated. For the Alvarado Score, a score of 7 or more out of 10 was considered indicative of acute appendicitis, while for the Tzanakis Score, a score of 8 or more out of 15 was considered as such. Results: The Alvarado Score demonstrated 78% sensitivity, 81.82% specificity, 97.50% positive predictive value (PPV), 29.03% negative predictive value (NPV), and 78.38% overall accuracy. In contrast, the Tzanakis Score showed higher sensitivity at 88%, similar specificity at 81.82%, 97.78% PPV, 42.86% NPV, and 87.39% overall accuracy. Conclusion: The Tzanakis Score showed superior sensitivity and overall accuracy compared to the Alvarado Score as its p-value is less than Alvarado score, which suggests that it is more effective in correctly identifying appendicitis cases, especially true positives.

Introduction: Hysterectomy is the most commonly performed gynecological surgery throughout the world as it provides definitive cure to a wide range of gynecological diseases, both benign and malignant. This study was undertaken to identify the most common uterine pathologies in hysterectomy specimens, to study the occurrence of lesions in relation to age and parity and to study association between histopathological features and clinical presentation of uterine lesions. Methodology: This was retrospective and prospective observational study carried out over a period of one and half year from 1^st july 2017 to 31^st december 2018 in the pathology department and three hundred seven hysterectomy specimens were studied. The clinical history of all cases was collected from records. The specimens were processed using routine paraffin tissue processing methods and sections were stained with hematoxylin and eosin. Pathological findings in the uterus were noted. Results: In the present study, 56.35% cases had undergone total hysterectomy, commonest age group was 41-50 years (43.00%) & multiparous were commonest. Menorrhagia (37.46%) followed by something coming out per vaginum(30.94%) were the most frequent clinical presentation. Histopathologically, the commonest endometrial findings were proliferative phase (37.46%) followed by atrophium endometrium (27.04%) and myometrial findings were leiomyoma (43.32%) followed by adenomyosis (28.01),both were commonly seen in 41-50 years. Leiomyomas were commonly seen at the intramural locations and showed hyalinization. Conclusion: Hysterectomy is an effective treatment for various uterine pathologies. 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: Laparoscopic appendectomy has replaced the traditional surgery technique recent days in India. This surgical technique has become more popular due to various advantages like less bleeding, short hospital stays, and decrease post-operative complications. Studies suggest that spinal anaesthesia technique might be a better option for laparoscopic appendectomy. Therefore, the present study was designed to assess the effects of both general anaesthesia and spinal anaesthesia on hemodynamic response in laparoscopic appendectomy. Materials and Methods: This was a comparative study which included 60 surgery patients of acute appendicitis via laparoscopic appendectomy. Groups I included 30 patients of general anaesthesia while, group II consisted 30 patients of spinal anaesthesia. Non-invasive arterial blood pressure, electrocardiography, and pulse oximetry were monitored continuously. Visual analog scale (VAS) on a 10-mm was used for assessment of severity of pain in all the patients. Results: Results of the present study showed that there was a significantly higher heart rate (p<0.05) in group G (general anaesthesia) patients compare to group S (spinal anaesthesia) patients. VAS score was significantly low in group S patients (1.8 ± 0.42) compare to group G patients (3.3 ± 0.8) with p value <0.05 after 1 hour of surgery. VAS score was recorded after 2 hours of surgery 3.6 ± 0.9 in group G compare to group S 2.0 ± 0.52 with p value < 0.05. Conclusion: Findings of the present study suggest that spinal anaesthesia using a combination of 0.5% hyperbaric bupivacaine and a fentanyl has significantly better cardiovascular reactivity compare to general anaesthesia. Moreover, post-operative recovery was hasty in spinal anaesthesia patients in comparison of general anaesthesia patients.

Objectives: The present study was to investigate and correlated the role of C-reactive protein (CRP) and procalcitonin (PCT) in predicting anastomotic leaks in bowel surgery. Methods: The study was used to capture a wide variety of cases having intestinal surgery by recruiting all eligible patients. This would enable a thorough analysis of the impact of procalcitonin (PCT) and C-reactive protein (CRP) in predicting anastomotic leaks. This systematic enrolment process contributed to the reliability and validity of the study findings. Access to the clinical and analytical resources required for a thorough evaluation of patients undergoing colon surgery was made possible by this cooperative environment. Procalcitonin (PCT) and C-reactive protein (CRP) serum levels were routinely assessed prior to surgery as well as on days 1, 4, and 7. Results: Elevated DAY7 values in participants with anastomotic leakage may signify prolonged inflammation and infection, affecting the levels of CRP and procalcitonin. As biomarkers of inflammation and infection, CRP and procalcitonin levels may be substantially elevated in response to the presence of leakage, aiding in the prediction and early detection of anastomotic complications. Conclusions: Anastomotic leak pose serious threats to the life  of the patient and put extra financial burden thereof. However apart from analysing factors for  prevention of anastomotic leak, early suspicion of it also carries a lot of importance. Because early intervention specifically within first 10 days can very well minimise the detrimental impact of this ghastly postoperative condition. However, because clinical symptoms are often ambiguous and there are not many trustworthy biomarkers for early identification, leak diagnosis is difficult. Hence there is always a room for use of biomarkers for early detection of anastomotic leak. Ultimately, the integration of biomarker monitoring into routine postoperative care protocols has the potential to revolutionize patient care and improve outcomes following bowel surgery.

Introduction: Rodenticide poisoning, particularly from yellow phosphorus, is a growing public health issue, especially in developing countries such as India. This highly toxic substance can lead to severe liver damage, acute liver failure (ALF), and mortality. Rodenticides, often ingested in cases of self-harm, are increasingly contributing to morbidity, particularly in rural populations (Gopalakrishnan et al., 2020; Abhilash et al., 2022). Given that the liver is the primary organ affected by rodenticide poisoning, understanding the role of liver function tests in predicting clinical outcomes is critical. This study explores the prognostic value of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin levels in predicting the severity and mortality associated with yellow phosphorus poisoning (Sardar et al., 2019; Govindarajan et al., 2021). Materials and Methods: This cross-sectional study was conducted at a tertiary care hospital in South Gujarat, India, enrolling 70 patients diagnosed with rodenticide poisoning. A convenient sampling method was used to include adults with a history of poisoning due to yellow phosphorus. Exclusion criteria included prior liver disease or exposure to non-hepatotoxic rodenticides. Liver function tests, including ALT, AST, and total and direct/indirect bilirubin, were measured. Clinical outcomes (morbidity and mortality) were assessed in relation to these biomarkers. Statistical analysis was performed using SPSS version 26, with chi-square tests to determine significance. Results: The study found that elevated ALT, AST, and bilirubin levels were significantly associated with severe illness. Of the 70 participants, 51.4% were classified as severely ill, with 85% of these individuals exhibiting elevated ALT levels. Elevated AST and bilirubin levels were similarly observed in 83.3% of severely ill patients. Notably, ALT was the strongest predictor of mortality, with 31% of patients with elevated ALT levels dying, compared to just 2% with normal ALT levels (P = 0.001). However, no significant association was observed between mortality and AST (P = 0.345) or bilirubin levels (P = 0.08), although these markers were elevated in some cases. Discussion: The results confirm the prognostic significance of liver function tests in rodenticide poisoning. Elevated ALT levels were strongly correlated with both morbidity and mortality, supporting its role as a sensitive marker for liver damage and poor clinical outcomes. Although AST and bilirubin were also elevated in severely ill patients, they were less predictive of mortality, suggesting that ALT may be a more specific marker for liver injury in this context. These findings are consistent with previous studies, which have identified ALT as a reliable biomarker for assessing the severity of liver dysfunction in toxic exposures (Sardar et al., 2019; Gopalakrishnan et al., 2020). Elevated bilirubin, particularly both direct and indirect fractions, also showed a strong association with severe illness, reflecting the extent of hepatic dysfunction and systemic toxicity. Conclusion: This study underscores the potential of liver function tests, particularly ALT, as important prognostic markers in rodenticide poisoning. Elevated ALT levels were significantly associated with increased mortality, while elevated AST and bilirubin levels were linked to severe illness. These findings suggest that liver function tests can aid in early diagnosis, risk stratification, and management of patients with rodenticide poisoning. Clinicians should prioritize these biomarkers to better predict outcomes and guide therapeutic interventions. Future research should focus on refining these biomarkers’ utility and exploring additional indicators that may enhance prognosis and treatment in rodenticide poisoning.

Background: Hepatotoxic rodenticide poisoning, particularly from yellow phosphorus, is a major public health concern, especially in developing countries. The role of coagulation abnormalities, such as activated partial thromboplastin time (aPTT) and international normalized ratio (INR), in predicting outcomes in these cases remains underexplored. This study aims to evaluate the prognostic significance of these bleeding profile parame-ters in hepatotoxic rodenticide poisoning. Methods: A cross-sectional study was conducted at New Civil Hospital, Surat, India, from ethical clearance to May 2024. Seventy patients, aged 18 years or older, with a history of rodenticide poisoning and confirmed hepatotoxicity, were included. Patients were classified based on mortality and morbidity outcomes. Bleeding profile parameters, including aPTT and INR, were analyzed for their association with clinical outcomes. Results: Of the 70 patients, 11 (15.7%) died, and 59 (84.3%) recovered. A total of 38 (54.2%) required ICU admission due to severe illness. Elevated aPTT levels were significantly associated with morbidity, with 88% of severely ill patients showing elevated levels (p < 0.00001), while no significant association was found with mortality (p = 0.51883). Similarly, elevated INR levels were significantly correlated with morbidity (52.6% of severely ill patients, p = 0.00012), but not with mortality (p = 0.18110). Conclusion: While serum aPTT and INR levels are not reliable predictors of mortality in hepatotoxic rodenti-cide poisoning, they are significantly associated with morbidity, particularly the need for ICU admission. These parameters can assist in identifying patients at higher risk for severe illness but should be considered alongside other clinical indicators for comprehensive prognosis. Further studies with larger sample sizes and additional biomarkers are warranted to refine prognostic models.

Klippel Feil Syndrome is a very rare disease with three different types of presentations. Most of the cases commonly show the clinical triad of short neck, low posterior hair line, and limited neck movements. But less than 50% of all patients show all these three clinical features. We are reporting a very rare case of 12-year-old male patient presenting with neck and body pains for duration of two months. Whole spine CT revealed complete assimilation of anterior & posterior arches of C1 vertebra with clivus and occipital bones, defect at left posterior arch of C1, Aplastic right posterior elements and hypoplastic dens of C2 vertebra. Plain CT chest revealed hypoplastic right 1^st and 3^rd ribs with widened intercostal spaces at the levels of these hypoplastic ribs. There are only two great vessels arising from the arch of aorta which are left subclavian artery and a common trunk which is giving off, right brachiocephalic trunk and left common carotid artery and where again the brachiocephalic trunk is dividing normally into the right subclavian and right common carotid arteries. Plain CT and MRI abdomen revealed empty left renal fossa and with a 5.7×2.2 cm sized kidney with hilum facing anteriorly noted in right lumbar region [which is small sized, ectopic in location and malrotated left kidney]

Aim: The aim of the present study was to evaluate the effect of early KMC on morbidity and mortality of low-birth-weight neonate. Methods: The present study was conducted in neonatal unit of paediatrics department of BRD medical college Gorakhpur for the period of 1 year. 160 neonates were enrolled in the study. Results: 73 cases (45.6%) were admitted within ≤10 hours, while 40 cases (25.0%) fell between 11 and 20 hours. Patients admitted in 21-30 hours numbered 24 (15.0%), with smaller groups for 31-40 hours (7 cases, 4.4%), 41-50 hours (8 cases, 5.0%), and 51-60 hours (7 cases, 4.4%). Only one case (0.6%) exceeded 60 hours. The mean age on admission was 17.84 hours, accompanied by a standard deviation of ±14.28. 48.8% were males and 51.3% were females. 75% neonates had normal vaginal delivery and 25% had LSCS. 90.6% neonates were delivered in hospital, while only 9.4% were delivered at home. 98.8% neonates had gestational age more than 28 weeks and only 1.3% had gestational age <28 weeks. Out of total 145 hospital deliveries 36 were LSCS and 109 were normal vaginal deliveries. All 15 deliveries at home were normal vaginal deliveries. 98.1% neonates were discharged and 1.9% were expired. Conclusion: In conclusion, the adoption of Early Kangaroo Mother Care (KMC) for low-birth-weight infants has considerable favorable benefits on both morbidity and mortality outcomes. Through considerable study and analysis, it has become obvious that early beginning of KMC not only increases physiological stability and development in preterm newborns but also lowers the occurrence of infections and other problems. Furthermore, by building a tight link between mother and baby from the onset, Early KMC encourages emotional well-being and family integration, leading to better long-term health outcomes. Embracing Early KMC as a standard of care provides a better future for our most vulnerable newborns, guaranteeing healthier starts and lasting advances in neonatal care.

Background: Fever of unknown origin (FUO) is a common presentation in the pediatric age group worldwide. The spectrum of illness changes from one geographic location to another and also varies at different times. The current study aimed to study the clinical and etiological profile of children aged 2 months to 12 years admitted for more than 2 weeks with fevers of unknown origin in a tertiary care hospital. Methods: This cross-sectional observational study was conducted in the Department of Pediatrics. FUO was described as a fever greater than 100.4°F lasting at least 8 days in patients without a definitive diagnosis after an initial assessment in the outpatient clinic or the hospital. A thorough history, including travel history, was obtained from all patients. This was followed by a detailed general and systemic examination, repeated daily to identify potential etiological clues. Clinical and biochemical data were recorded systematically using a structured proforma. The initial investigations included Complete blood count (CBC) with erythrocyte sedimentation rate (ESR), Peripheral blood smear, Urinalysis, Routine biochemistry, Chest X-ray, Urine, stool, and blood cultures. Results: A total of 85 cases were included in the study based on the inclusion and exclusion criteria. Infections caused by bacterial pathogens accounted for 52.9% of cases in this study followed by Rickettsial pathogens were the most common in the group, accounting for 24.7%, Scrub typhus was the leading cause, identified in 21 out of 70 (30.0%) patients in the infectious group. Among bacterial infections, enteric fever (23.5%), Pneumonia (10.6%), UTI (9.4%), and sepsis (5.9%) were predominant. Malaria was diagnosed in 2 cases (2.3%) using rapid malarial card tests (LDH-based) and confirmed by thin and thick smear analysis. Conclusions: Within the limitations of the current study we concluded that infections were the primary cause of FUO in children with enteric fever and scrub typhus being the most frequent diagnosis. Early identification of the cause through specific investigations and appropriate antimicrobial treatment in bacterial diseases will be beneficial.

Background: The most common hospital-acquired infection is caused by antibiotic-resistant and virulent Staphylococcus aureus. This study will characterize S. aureus clinical isolates from hospitalized patients’ biochemical and molecular profiles to understand resistance mechanisms and harmful potential. Methods: The trial ran from September 2023 to October 2024 at Jawaharlal Nehru Medical College & Hospital in Bhagalpur, Bihar. Clinical samples included pus, blood, wound swabs, and respiratory secretions from six patients per month. S. aureus was isolated and identified biochemically using standard microbiological procedures. Polymerase chain reaction was used to analyze resistance and virulence genes (mecA, vanA, spa, and pvl) and the Kirby-Bauer disc diffusion method was used to determine antibiotic susceptibility. Results: We analyzed 72 S. aureus isolates. 50% of isolates were methicillin-resistant, 60% cefoxitin-resistant, and 10% vancomycin-resistant. The vanA gene was found in 15% of isolates and the mecA gene in 55%. Virulence-associated genes spa and pvl were found in 75% and 35% of isolates, indicating pathogenic potential. Erythromycin and clindamycin resistance were 40% and 30%. Conclusion: This study highlights the high prevalence of antibiotic resistance and virulence factors in S. aureus clinical isolates from hospitalized patients. The findings emphasize the need for robust molecular surveillance, effective antimicrobial stewardship, and stringent infection control practices to combat the burden of S. aureus infections in healthcare settings.

Objectives: To study the prevalence rate of Hepatitis C among patients undergoing ocular surgeries between the age of 18-80 years at Muzaffarnagar Medical College. Methods: This hospital-based observational study was conducted at the Department of Ophthalmology, Muzaffarnagar Medical College and Hospital, covering a population in age group of 18-80 years undergoing ocular surgeries. Data collection spanned 18 months, with a sample size of 500. Patients undergoing ocular surgeries were tested for Hepatitis C by Rapid chromatography immunoassay for qualitative detection of antibodies and positive results were confirmed by ELISA. Results: The study found a prevalence of 5.6% of Hepatitis C in patients undergoing ocular surgeries in a tertiary care hospital of western UP. Majority of patients were in the age group of 61-70 years. It was observed that the patients who were tested positive for Hepatitis C were mainly from the rural background and most of them belonged to lower socio-economic status. Conclusion: A 5.6% prevalence rate of Hepatitis C in our study underscores the importance of targeted screening, particularly among high-risk groups identified by age, gender, residence, and socio­economic status before performing any ocular surgery. The findings emphasized the necessity for focused public health interventions to address the disparities and enhance management and prevention strategies for Hepatitis C among patients undergoing ocular surgeries. Also, by knowing the status of infectivity of patients, we as operating surgeons, can ensure proper precautions while operating.

Objective: To compare the effect of topical 0.5% Loteprednol etabonate versus 0.09% Bromfenac on Macular thickness after Nd:YAG laser capsulotomy and to compare the efficacy of Loteprednol and Bromfenac in preventing Cystoid macular edema. Methodology: It is a hospital based prospective randomised comparative study in which patients who developed PCO after uncomplicated cataract surgery were included in the study. Patients were randomly distributed in two groups 175 each, out of total 350 patients. Patients were prescribed topical 0.5% Loteprednol etabonate in Group 1and topical 0.09% Bromfenac in Group two after undergoing Nd: YAG laser capsulotomy. Visual acuity with snellen’s chart, IOP with non-contact tonometer, and macular thickness with OCT was assessed at 1 hour, 1 week, and 4 weeks after the procedure in both the groups. Results: The study recorded a significant improvement in visual acuity in both groups over time, with a notable percentage of patients achieving near-normal vision post-treatment. Also, there was no statistically significant difference observed in IOP and CMT among both the groups after the procedure. Conclusion: The research concluded equal efficacy of Loteprednol Etabonate and bromfenac on central macular thickness and other parameters post Nd YAG capsulotomy procedure.

Objective: To correlate preoperative radiological and intra-operative pathological mastoid antrum findings in mucosal type of CSOM. This study examines the radio-pathological changes in the mastoid antrum to enhance diagnosis, treatment planning, and patient management for better prognosis and reduced complications. Methodology: We examined 119 ENT patients of inactive mucosal CSOM, who fulfilled the inclusion and exclusion criteria. Patients were subjected to array of investigations like, PTA and HRCT Temporal bone. Patients were subjected to tympanoplasty in combination with antrostomy or cortical mastoidectomy. Intraoperative findings were recorded and association between radiological and intraoperative pathological antral findings was sought using statistical tests. Results: Mastoid antrum was found to be diseased in 42 patients. Pathologies observed in the mastoid antrum included hyperplastic mucosa, granulation tissue, cholesteatoma, etc. Conclusion:  The study analysed preoperative and intraoperative findings of mastoid antrum and identified strong correlation between the two particularly with middle ear mucosa condition, hearing loss, mastoid pneumatization, ossicular chain status, adituspatency and recurrent URTIs.

Background: Diabetes is a serious threat to global health that neither regards socioeconomic status nor national boundaries. Diabetes and its complications, if not well managed, can lead to frequent hospital admissions and premature death. Globally, diabetes is one of the top 10 causes of death. However, if appropriate management of diabetes is achieved, different serious complications can be delayed or prevented. Therefore, searching of new and safe medicine for the control of diabetes and its complications is a thrust area of research. Aim: Evaluation of efficacy of standardized extract of pomegranate fruit pulp in hypertension, blood lipid profile and renal function of diabetic animal models (induced by streptozotocin and high fat diet). Type of the study: experimental observational study. Place: Department of Pharmacology of R.G. Kar Medical College and Hospital, MRU of Biochemistry department of R.G. Kar Medical College and Hospital. Duration: 19months (April 2021to October 2022). The test drug was prepared with the ethanolic extraction of fruit pulp of P. granatum (PGE) and chemically standardized by different chromatographic techniques. Diabetic animal model (36 rats were distributed in 6 groups and each group contain 6 rats) was created by injecting streptozotocin at the dose of 60 mg/kg in adult male Wistar rats (except normal control).They were fed with High Fat Diet (except normal control and diabetic control). [1] After completion of treatment with metformin and pomegranate fruit pulp extract according to respective group (Normal Control, Diabetic Control, Diabetic with fat diet, diabetic with fat diet and treated with metformin, diabetic with fat diet and treated with chemically standardized Punica granatum extract @ 125mg/kg/day, diabetic with fat diet and treated with chemically standardized Punica granatum @ 250mg/kg/day) all animals(adult male wistar rats) was placed in metabolic cages for collection of urine samples for urea and creatinine and finally sacrificed under deep anesthesia on day 29th (after 29days of intervention). Body weight, Blood Pressure, Blood Glucose were evaluated every week. The blood was analyzed for blood glucose, lipid profile, renal function and cytokines (IL-1 beta, IL-6 and TNF-alpha) at day 28. The histopathological evaluation was done in liver, kidney, pancreas and myocardium tissues. All groups were statistically analyzed and compared within and between groups by t-test, one way ANOVA and post hoc tukey test. Results: 1) Metformin lowered the body weight 4.52% within 14 days and 5.98% within 28 days compared to High fat diet in STZ diabetic rats. Test drug, PPE at the oral dose of 125 mg/kg significantly lowered the body weight 6.12% in 14 days and 9.81% in 28 days. Moreover, at higher dose, PPE (250 mg/kg) lowered the body weight at 7.2% in 14 days and 10.84% in 28 days compared to High fat diet in STZ diabetic rats. 2) Within 14 days the blood glucose level was reduced to 24% (p=0.009) and it was lowered to 49% (p=0.003) within 28 days compared to high fat diet induced diabetic animals by metformin. PPE at the dose of 125 mg/kg down regulate 16.6% (p=0.03) in 14 days and 41.7% in 28 days (p=0.004). While, PPE at the dose of 250 mg/kg diminished blood glucose concentration to 20.8% (p=0.015) and 44.5% (p=0.002) in respective days. 3) PPE at the dose of 125 mg/kg reduced the systolic BP to 8.3% within 14 days and 23% within 28 days. PPE at the same dose, diastolic BP was reduced to 11.9% and 11.68% in 28 days. PPE at 250 mg/kg lowered the systolic BP to 9.4% in 14 days and 26.7% in 28 days. The diastolic BP was reduced by PPE (250 mg/kg) to 17% in 14 days and 21% in 28 days. 4) Metformin reduced 31% LDL, 48% VLDL and 22.54% triglycerides compared to high fat diet induced diabetic rats. PPE at the dose of 125 mg/kg lowered LDL up to 15.5%, VLDL 62.7% and triglycerides to 27.5%. Moreover, PPE at the dose of 250 mg/kg significantly diminished blood LDL to 40.9%, VLDL to 59.5% and triglycerides to 38.4%. 5) Metformin at the dose of 500 mg/kg reduced urine volume (50.6%), blood urea (33%) and blood creatinine (53%) concentration compared to high fat diabetic rats. PPE at the dose of 125 mg/kg, lowered 32% urine volume, 30.5% blood urea and 46.6% blood creatinine level in rats compared to high fat diabetic rats. Moreover, PPE at the dose of 250 mg/kg, reduced 43% urine volume, 42% blood urea and 61% blood creatinine level in rats compared to high fat diabetic rats. Conclusion & Implication: Phenolic acids, specially quercetin, catechin, rutin, ellagic acid and gallic acids present in PGE are used medicinally for health benefits, particularly in diabetes and its complications. PGE has the capacity to regulate blood sugar, blood lipids, hypertension and renal functions in high fat diet induced insulin resistance diabetic animals.

Introduction: Neuraxial analgesia has a minimal risk of side effects and is very effective, making it the gold standard of labor analgesia. If the dural puncture epidural method (DPE) can validate midline implantation and increase intrathecal translocation of epidural medicines, it might enhance the quality of analgesia. The current research set out to evaluate the relative merits of standard epidural and dural puncture epidural approach for labor analgesia. Material and Methods: Sixty-four full term primi or multiparous parturients were randomly allocated to standard epidural technique (group 1, n=32) and dural puncture epidural technique (group 2, n=32) managed with dural puncture using 26-gauge Whitacre needle through the 18 G Tuohy needle. Visual analogue scale, hemodynamic variables, onset of analgesia, details of sensory and motor block by Bromage scale, and adverse events were noted and analysed. Results: The duration to achieve adequate analgesia was 12.02±1.98 in group 1 and 10.46±2.22 in group 2. Duration to achieve complete sacral spread was 17.18±4.89 in group 1 and 16.64±3.90 in group 2. VAS score <10 at 10 minutes was observed in 59.38% of cases in group 1 and 65.62% in group 2. Spontaneous vaginal deliveries are more common, and no significant changes in the hemodynamic parameters. Conclusion: Dural puncture epidural technique and standard epidural technique are efficacious, however, DPE improves sacral spread, fasten the onset of analgesia, and bilateral pain relief in parturients.

Introduction: Postpartum hemorrhage (PPH) is a substantial cause of maternal death, particularly in underdeveloped countries. Identifying safe, user-friendly, and cost-effective regimens is critical for managing postpartum hemorrhage (PPH). People often use Tranexamic acid (TA), an antifibrinolytic drug, to prevent and treat hemorrhage. It should be evaluated to ensure that it meets these requirements. This study sought to determine the efficacy of tranexamic acid in reducing postpartum blood loss following normal vaginal birth. Materials and Methods: We randomly assigned 104 pregnant women with singleton term pregnancies intended for vaginal delivery to one of two groups: tranexamic acid (group A) or control (group B). We measured blood pressure, respiration rate, pulse rate, oxygen saturation, urine output (ml/hr), hemoglobin (gm), and PCV (%) before and after delivery. We collected data on the need for additional uterotonics and the length of hospital stay. Results: The mean blood loss from delivery to 30 minutes post-delivery was 92.15 ml in group A and 178.9 ml in group B. The volume of blood loss decreased significantly from 30 minutes to 120 minutes post-delivery, measuring 25.78 ml in group A and 54.92 ml in group B. Yang H et al. (22.3%). Group A had considerably higher mean levels of SBP, DBP, pulse rate, respiratory rate, and SpO2 than group B. Conclusion: Tranexamic acid, when administered prophylactically as an antifibrinolytic medication, appears to diminish blood loss during normal labor, reduce the necessity for extra uterotonics, shorten hospital stays, and effectively lower the risk of postpartum haemorrhage.

Background: Chronic kidney disease (CKD) patients on hemodialysis are at high risk of malnutrition, which significantly impacts morbidity and mortality. Assessing nutritional status using the Subjective Global Assessment (SGA) and comparing it with serum albumin levels can provide insights into the reliability and utility of these tools in predicting clinical outcomes. Aim and Objectives: To assess nutritional status using SGA, compare it with serum albumin levels, and evaluate their correlation with one-year clinical outcomes in CKD patients on hemodialysis. Materials and Methods: This prospective observational study included 150 adult CKD patients undergoing hemodialysis at Gandhi Medical College and associated hospitals in Bhopal over two years. Nutritional assessment was performed using SGA and anthropometric measurements, including BMI, mid-arm circumference (MAC), triceps skinfold thickness (TSFT), and mid-arm muscle circumference (MAMC). Biochemical parameters such as haemoglobin, serum albumin, urea, and creatinine were analyzed. Associations between SGA, serum albumin, and clinical outcomes were assessed using statistical tests, with significance at p < 0.05. Results: The mean age of the study population was 42.71 years (SD = 13.82), with 57.3% males. Nutritional assessment using SGA classified 59.4% of patients as having mild to moderate malnutrition, 37.3% as well-nourished, and 3.3% as severely malnourished. Anthropometric measures such as BMI, MAC, TSFT, and MAMC significantly correlated with SGA categories (p < 0.05). Serum albumin levels, while significantly different across SGA categories (p = 0.026), showed inconsistent trends, limiting their utility as a sole nutritional marker. Patients with lower SGA scores had poorer one-year outcomes, including increased hospitalizations and complications. Conclusion: Malnutrition is highly prevalent among CKD patients on hemodialysis, and SGA is a reliable tool for nutritional assessment. While anthropometric parameters align closely with SGA, serum albumin levels alone are insufficient for comprehensive nutritional evaluation. Integrating SGA with clinical, anthropometric, and biochemical assessments is essential for optimizing nutritional management in this vulnerable population.

Background: Bladder cancer is a common malignancy with a high risk of recurrence following transurethral resection of bladder tumors (TURBT). Intravesical chemotherapy, including agents like Gemcitabine and Mitomycin C, is widely used to reduce recurrence rates. However, there is limited comparative data on the efficacy and safety of these two agents in the postoperative setting. Aim and Objective: To evaluate and compare the postoperative recurrence rates and adverse events associated with intravesical Gemcitabine versus Mitomycin C in preventing bladder cancer recurrence. Materials and Methods: A randomized controlled trial was conducted at the Department of Surgery, L.L.R.M. Medical College & associated S.V.B.P. Hospital, Meerut, over a 24-month period. Ninety eligible patients diagnosed with bladder cancer were randomly assigned to receive either intravesical Gemcitabine or Mitomycin C within 24 hours after TURBT, with scheduled follow-up at 3, 6, 9, 12, 18, and 24 months. The primary outcome was time to first recurrence, while secondary outcomes included adverse events and overall patient satisfaction. Statistical analysis was performed using SPSS software, with Kaplan-Meier curves for recurrence-free survival, log-rank tests, and multivariate Cox regression analysis. Results: The study observed a male predominance (65%) in a cohort predominantly aged 61-70 years. A majority of patients had small tumors (2-3 cm). Hypertension and diabetes were the most common comorbidities. At 6 and 12 months, recurrence rates were lower in the Mitomycin C group compared to Gemcitabine. Adverse events such as dysuria, urinary urgency, and cystitis were more frequent in the Mitomycin C group. Postoperative complications, including urinary tract infections and bladder spasms, were noted, but the overall complication rate was low (36.40%). Conclusions: Intravesical treatment with Mitomycin-C post-TURBT shows a potentially in reducing recurrence rates of bladder cancer compared to Gemcitabine, suggesting it as a more favourable treatment option in the early stages of bladder cancer. Both treatments remain viable options for post-TURBT chemotherapy, but Mitomycin-C may offer better outcomes in terms of recurrence prevention and reduced adverse effects.

Introduction: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by insulin resistance and a relative deficiency in insulin secretion. Patients with T2DM are more susceptible to infections and sepsis due to the immunocompromised state associated with chronic hyperglycemia. The interplay between C-peptide, insulin, and HbA1c levels during sepsis requires careful monitoring and management to optimize glycaemic control and improve patient outcomes. Understanding these dynamics is crucial for effectively managing T2DM patient. Aim: To assess serum c-peptide and insulin levels in type 2 diabetes with or without sepsis. Material and Methods: This observational comparative study, conducted at SMS Medical College, Jaipur, included 180 participants divided into three groups: diabetic patients with sepsis (Group A), diabetic patients without sepsis (Group B), and non-diabetic patients with sepsis (Group C). Each group underwent clinical evaluation and laboratory investigations, including C-peptide, insulin levels, CBC, and SOFA score, with sepsis diagnosed using Sepsis-3 criteria. Data were analyzed to compare organ dysfunction and inflammatory responses across groups. Results: Our study shows that sepsis elevates both C-peptide and insulin levels, with a more pronounced increase in C-peptide, particularly in diabetic patients, reflecting its immune-modulating role. Additionally, sepsis significantly impacts platelet counts, GCS scores, SOFA scores, albumin levels, and TLC, emphasizing its systemic effects. Conclusion: Our findings demonstrate that sepsis enhances pancreatic activity, as shown by increased C peptide and insulin levels, but this response is influenced by the presence of diabetes. Thus, C peptide serves as a valuable marker for assessing pancreatic function in the context of sepsis, highlighting the complex interplay between diabetes and sepsis on pancreatic and insulin dynamics.

Background: HIV/AIDS patients’ impaired immune systems make opportunistic fungal infections (OFIs) a primary cause of morbidity and mortality. An HIV/AIDS tertiary care hospital in Bhagalpur, Bihar, will be studied for opportunistic fungal infections and their clinical consequences. Methods: Jawaharlal Nehru Medical College & Hospital, Bhagalpur, conducted this observational, prospective study from October 2023 to September 2024. We enrolled 60 HIV/AIDS patients with probable fungal infections. To detect fungal pathogens, clinical history, CD4 counts, microscopy, cultures, and serological testing were used. Results: In 60 patients, oral candidiasis (41.7%) was the most common fungal illness, followed by cryptococcal meningitis (25%), Pneumocystis jirovecii pneumonia (16.7%), invasive aspergillosis (10%), and disseminated histoplasmosis (6. The majority of patients with severe fungal infections had CD4 levels below 100 cells/µL. Lower CD4 levels correlated with fungal infection severity. Patients without ART had a greater rate of serious fungal infections. Conclusion: Opportunistic fungal infections are a major source of morbidity in HIV/AIDS patients, with lower CD4 levels indicating greater infection severity. These infections must be diagnosed early, treated with antifungals, and treated with ART to decrease mortality. In resource-limited situations, diagnostic capacity and preventive methods must be improved.

Background and Objectives: Medical education continually seeks to optimize teaching methods to enhance learning outcomes. Students were heavily bombarded with many theory and practical classes. The objective of the present study was to compare the effectiveness of small group discussions versus traditional didactic lectures in neurophysiology among first-year medical students. Methods: 150 first-year medical students were recruited to participate in this study. The students were randomly divided into two groups of A and B of strength seventy-five in each group. “Physiology of Pain” was the topic selected. The topic was initially covered in a one-hour lecture session. Then both Group A and Group B underwent a pre-test using multiple-choice questions. Group B was further divided into five subgroups with one facilitator for each group. Group B students were engaged in interactive small group discussion sessions while Group A continued with didactic lectures as a whole group. Later, post test was conducted for both groups with the same MCQs to assess the understanding of concepts. Then feedback was taken by giving them a qualitative questionnaire to gauge student perception of the effectiveness towards SGD. Data were analyzed using SPSS 25 software. Results:  The pre-test and post-test scores of Group A and Group B were compared. The post-test scores of Group A were compared to those of Group B. There was a significant improvement with post-test score in Group B, when compared with post-test score in Group A. Students had a favorable perception of small group discussion sessions. Conclusion: The study suggests that small group discussions may enhance immediate understanding and retention of neurophysiology concepts compared to didactic lectures among first-year medical students. These findings emphasize how interactive and collaborative learning methods can potentially benefit medical education.

Background: Nasal obstruction is the most common complaint in ENT practice and a deviated nasal septum is the most common cause of nasal obstruction. Different surgeries have been proposed for correction of deviated septum but septoplasty has been the procedure of choice. Septoplasty is a more conservative surgery with fewer complications and endoscopic septoplasty has become increasingly popular over the last few decades. Hence, this study is conducted to compare the pre‑ and post‑operative symptomatology, to evaluate the postoperative complications of conventional compared to endoscopic septoplasty (ES). Aims and Objectives: To compare the pre‑ and post‑operative symptomatology, to evaluate the postoperative complications of conventional septoplasty compared to endoscopic septoplasty (ES). Material & Methods: 50 Patients attending ENT OPD at ESIC Medical College & Hospital with age between 10 and 50 years having symptomatic deviated nasal septum and refractory to medical treatment. The patients were divided into two groups: Group A, which included 25 patients in whom conventional septoplasty (CS) was performed, and Group B, which included 25 patients in whom Endoscopic Septoplasty was conducted. Results: In the present study of 50 patients with symptomatic Deviated nasal septum, the male-to-female ratio was 2.6 :1. Deviated nasal septum was commonly associated with inferior turbinate hypertrophy (40%) and concha bullosa (26%). Postoperatively, a significant relief from the symptoms of nasal obstruction (80%), nasal discharge (32%), headache (36%), and postnasal drip (56%) was observed in endoscopic septoplasty. Complication rate was higher in conventional septoplasty. Conclusion: ES is more effective in terms of relief of symptoms and improvement of nasal patency with fewer complications.

Cilnidipine blocks both L-type and N-type calcium channels and some DHPs can block other subtypes of calcium channels (N, P/Q, R types) and also suggests that DHPs are no longer considered specific L-type blockers. Antinociception was found to be due to the blockade of voltage-gated calcium channels. The study was conducted by using Wistar male albino rats weighing 150–200 grams in good health. The animals were divided into four groups, each group containing six rats, Group I: Control (normal saline), Group II: Tramadol (10mg /Kg), Group III: Tramadol (10mg /Kg) +Amlodipine (5mg/Kg), and Group IV: Tramadol (10mg /Kg) +Cilnidipine (1mg/Kg). Tail flick and hot plate methods were used to evaluate the analgesic effects where group IV had better analgesic effects when compared to the other 3 groups. Hence, Cilnidipine can be preferred in elderly patients who are suffering from hypertension along with neuropathic pain, which can reduce multidrug exposure and increase patient compliance.

Background: Femoral nerve block, a relatively easy and safe peripheral nerve block, provides prolonged and effective perioperative analgesia in lower limb surgeries. A good landmark technique avoids unnecessary needle punctures and complications during block performance. We decided to find a simple technique to locate block puncture site and confirm it with ultrasonography. Materials and Methods: The aims were to find the correlation between finger width and femoral nerve-artery distance with ultrasonographic imaging, BMI, hip and waist circumferences and femoral nerve depth in Indian population. 360 subjects with planned femoral nerve block or healthy volunteers were studied. Patient’s age, height, weight, waist circumference, and hip circumference were noted. Finger width of both hands at distal inter-phalangeal joint was measured using Vernier’s calliper. Femoral nerve-artery distance and nerve depth were measured using ultrasonography. Results: Finger widths ranged from 1.24± 0.0481 cm to 1.42± 0.0623 cm. The femoral nerve-artery distances were in the range of 1.14 mm to 1.46 mm with median of 1.24 mm. Correlation coefficients between nerve-artery distance and finger width were 0.36 (Right little finger), 0.61 (Right middle finger), 0.44 (Left little finger) and 0.65 (Left index finger). Regression analysis yielded the model NA = 0.18 + 0.86 d with NA as the femoral nerve-artery distance and d the distal inter-phalangeal joint finger width. On simplification owing to the negligible constant (0.18) and multiplier (0.86) being close to one, femoral nerve – artery distance can be said to correspond to distal inter-phalangeal joint finger width of index finger of left hand. An association between BMI>25 kg/m² and femoral NA distance (P value =0.0000) and hip circumference and femoral NA distance in males (P value =0.017) was found. Conclusion: A simplified, individualized landmark approach not requiring any additional, costly technical aids for needle insertion site for femoral nerve block was found. Puncture site should be lateral to the lateral most point of pulsating femoral artery at a distance equivalent to the width of the patient’s index finger of the non-dominant hand measured at the distal inter-phalangeal joint. It is especially useful for patients with intermediate BMI values.

COVID-19 pandemic has had a substantial impact on global healthcare systems, affecting patterns of disease presentation and management. The consequences for cardiovascular and cerebrovascular health are among the important issues, as new research suggests an association between COVID-19 infection and a higher risk of vascular events. COVID-19 has been shown to increase the risk of thrombotic events, such as myocardial infarction and stroke, endothelial dysfunction, hypercoagulability, and systemic inflammation. Furthermore, interruptions in routine healthcare access and delayed medical care during the pandemic may have confounded the management of cardiovascular and cerebrovascular diseases, potentially affecting outcomes. Understanding the comparative prevalence of vascular events in the pre and post-COVID eras is therefore crucial for elucidating these dynamics. Prior to the pandemic, epidemiological studies had already established cardiovascular disease and stroke as leading causes of morbidity and mortality globally. However, the pandemic has introduced new challenges, potentially altering the landscape of vascular disease epidemiology. Examining trends in the incidence and characteristics of vascular events in a tertiary care setting can provide valuable insights into the impact of COVID-19 on cardiovascular and cerebrovascular health outcomes, informing strategies for prevention, diagnosis, and management in both pandemic and post-pandemic phases. This retrospective study aims to analyze and compare the prevalence of vascular events in the brain and heart during the pre-COVID and post-COVID eras, contributing to the broader understanding of the pandemic’s influence on vascular health.

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

Background and Aim: Placenta previa significantly raises the risks for both mother and fetus, primarily due to the increased chances of severe antepartum and postpartum haemorrhage in the mother. It happens because the lower uterine segment does not contract effectively post-delivery. Objectives of the studies were: To estimate proportion of placenta previa at our institute, to evaluate demography, clinical risk factors for placenta previa. to study the clinical presentation, types, management and complications of placenta previa and  to evaluate maternal & fetal outcome in patients of placenta previa. Material and Methods: Present study includes total 52 patients with Placenta Previa admitted in the Department of Obstetrics & Gynaecology at tertiary care institute of Gujarat, India. Women’s detailed history, gestational age, per abdominal examination, per speculum examination, all routine investigations and USG findings recorded in a predesigned proforma. The women enrolled for the study were observed and maternal and fetal outcome were noted. Results: It was found that 32.7% of cases of placenta previa were associated with history of previous caesarean section and 17.3% of cases were associated with history of abortion. Majority 47(90.38%) of patients were reported with cephalic presentation. While, amongst the mal-presentation breech (7.7%) was the most. APH and PPH were major complications and were reported in 22 (42.3%) and 24 (46.15%) patients respectively. Maternal mortality occurred in 2 (3.84%) cases. There were 48(92.31%) live births and neonatal mortality occurred in 4 (7.69%) cases. Conclusion: Placenta previa is life-threatening complications of pregnancy. In placenta previa, APH occurs from placental site, which is located in lower uterine segment. Regular antenatal care helps to detect placenta previa by ultrasound earlier in pregnancy, which is key to prevent the complications of placenta previa.

Background: Periarthritis shoulder is a disabling disease characterized by shoulder pain and limitations of both active and passive range of movement in all directions. It is the result of fibrosis and thickening of the joint capsule and adherence to the humeral head. Periarthritis can be managed using a variety of therapeutic techniques. Platelets rich plasma (PRP) is a concentrated platelet solution that degranulates alpha granules and includes a variety of growth factors, including cytokines that aid in soft tissue healing. Objective: The aim of the study was to evaluate the role of intra-articular PRP injection in patients with shoulder peri-arthritis. Methods: 31 patients (>40 year) with U/L or B/L frozen shoulder having pain more than or equal to two months were included. Shoulder mobilization was performed under short GA and full range of motion was achieved during the procedure followed by intra-articular injection of PRP (3ml) under all aseptic precaution with 20-gauge needle. Patients were reviewed & evaluated clinically on the basis of VAS and CSS score after 0, 2 and 4 weeks. Results: The mean age of the patients was 57.58 ± 8.67 years with predominance of females (64.5%). The mean duration of pain was 6.03 ± 4.18 months. There was a significant decrease (p=0.001*) in mean VAS scores at both 2- and 4-weeks post-treatment. Following the initiation of PRP therapy, there was a significant increase (p=0.001*) in the mean CSS score at 2- and 4-weeks post-treatment. Conclusion: Our study concluded that there was significant improvement in the pain as well as functional score after the PRP injection. Intra-articular PRP injection therapy with manipulation is a safe and effective treatment modality for periarthritis shoulder.

Background: The anterior cruciate ligament (ACL) is crucial for knee stability. Several factors influence the clinical outcome of ACL reconstruction. The technique for femoral-sided fixation in ACL reconstruction continues to evolve. Despite their mechanical advantages, fixed loop devices have drawbacks. Objective: To compare the functional outcomes of ACL reconstruction using fixed loop versus adjustable loop femoral cortical suspensory fixation devices. Methods: This prospective observational comparative study at the Himalayan Institute of Medical Sciences included 60 patients randomized into two groups of 30 each for ACL reconstruction. Inclusion criteria covered patients with primary ACL tears, while exclusion criteria included immature skeletons, multi-ligament injuries, and significant comorbidities. Anthropometric and demographic data were recorded, and standardized surgical techniques were employed. Functional outcomes were assessed using the Lysholm scale at six and twelve weeks postoperatively. Data analysis was conducted using IBM SPSS V20, with p < 0.05 indicating statistical significance. Results: At six weeks postoperatively, both groups showed significant improvements in Lysholm scores compared to baseline, with Group B (adjustable loop) demonstrating a slightly higher mean score, indicating a potentially more favorable early recovery. By the 12-week mark, both groups achieved comparable and substantial improvements in knee function, highlighting the overall effectiveness of ACL reconstruction and rehabilitation. Conclusion: Both fixed loop and adjustable loop femoral fixation devices resulted in significant short-term functional improvements, as evidenced by Lysholm scores at six and twelve weeks postoperatively. Minor score variations were not statistically significant, indicating both devices support effective early recovery post-ACL reconstruction.

Background: Forearm fractures are on a constant rise globally, particularly prevalent among the younger demography. Though the management of these injuries operatively is well documented, use of LCP is relatively recent. There is lack of substantial evidence regarding the efficacy of LCP in comparison to other novel implants to treat forearm fractures. Objective: This study aims to find out the functional and radiological outcomes after using 3.5 mm locking compression plating (LCP) in treatment of forearm fractures in adults and to assess the complications, associated with the surgical management of these fractures. Methods: This observational follow up study comprised 36 patients who underwent Open Reduction Internal Fixation (ORIF) for treatment of forearm fractures at a tertiary care centre in north India, between July 2022 to Aug 2023. Radiological and functional outcome were assessed and followed up 1st, 3rd, 6th and 12th month postoperatively. Final functional and radiological outcome was carried out using Quick DASH score and Anderson criteria respectively. Results: Total 36 patients involved in this study were followed up till a duration of 12 months. Mean age was calculated out to be 33.83 ± 10.93 years ranging from 18-58 years. In the study, the primary cause for forearm fractures was attributed to road traffic accidents (n=25, 69.44%). The mean radiological union time was 13.8 weeks ranging from 9-18 weeks with 2 cases of non-union who underwent autologous bone grafting. Among 36 cases, 34 (94.44%) had no complications but the rest 2 (5.55%) had complications (superficial Surgical Site Infections’ (SSI’s) which were successfully treated using antibiotic therapy. Conclusion: Use of LCP in forearm fractures provides good to excellent results with very limited complications.

Purpose: To study the prevalence of ophthalmic manifestations in cutaneous autoimmune connective tissue diseases, to monitor the progression of ocular manifestations. Methods: Retrospective, non-comparative, observational cohort study in tertiary care hospital, from July 2022 to December 2022, in 40 adult patients, with cutaneous autoimmune connective tissue disease. The demographic data, history, ophthalmic examination including visual acuity, slit lamp examination, dry eye tests, and fundus examination visual field test were recorded. Results: Majority of patients were in the age group 31-40 years (55%). The prevalence of ocular manifestations in cutaneous autoimmune connective tissue diseases was 72.5%. Wherein 79.3 % patients had anterior segment involvement and 20.7% patients had posterior segment involvement. Rheumatoid arthritis being the most common disease with ocular manifestations 57.5%. Conclusions: In cutaneous autoimmune connective tissue diseases, prevalence of ocular manifestations in our study was 72.5%. Females were more commonly and aggressively affected. It is essential to screen patients for ocular manifestations.

Objectives: The present study was to determine what all factors are responsible for favourable outcome of USG guided hydrostatic reduction of ileocolic intussusception. Methods: Pre-warmed normal saline (warmed to body temperature, 36.5 – 37.5°C) was introduced via catheter into the rectum and proximal colon by hanging the bottle 120 cms above table height and allowing free flow under gravity. During the procedure, the retrograde movement of saline and the regress of intussusceptum were continuously monitored under real time ultrasound guidance. Besides, the peritoneal cavity was scanned intermittently in order to detect sudden increase in fluid and simultaneous depletion of fluid from the colon, suggesting bowel perforation. A maximum of 3 attempts were permitted, each attempt lasting 3 to 5 min with a gap of less than 3 min between the attempts. After failed third attempt, the procedure was ended without delay and the patient shifted urgently to the operation theatre for surgical reduction or resection with end- to-end bowel anastomosis. Patients who underwent successful USGHR were subsequently kept in the ward and observed for a minimum period of 24 hours to detect any complication. Results: The mean age of the patients were 3.61 years. The highest proportion of cases been observed in male category (64.7%) followed by females (35.3%). USG guided hydrostatic reduction was attempted in 50 cases and not attempted in 1 case. USG guided hydrostatic reduction distribution which was successful with complete reduction in 1^st sitting in 48 cases and partial reduction in 2 cases which were then taken up for the 2nd sitting and were completely reduced. Mean time taken for completion of the procedure was 04:23 minutes. Mean quantity of NS used during the procedure was 2.97 Litres. Conclusions: Children who are diagnosed with intussusception early generally have a higher rate of effective hydrostatic reduction compared to those who are diagnosed later. Ultrasound- guided hydrostatic reduction is a highly effective and safe method for treating intussusception, making it the chosen initial treatment for suitable individuals. The success rate gained was exceedingly high.

Background: Computer Vision Syndrome (CVS), or digital eye strain, is a group of eye and vision-related problems resulting from prolonged use of digital screens such as computers, smartphones, and tablets. Symptoms include eye strain, dryness, headaches, blurred vision, and neck pain. The condition is increasingly prevalent with rising screen time, highlighting the need for awareness and preventive measures. This study was done to determine the prevalence of CVS in medical students of this institute. Methods: This was a cross-sectional, questionnaire-based study conducted after obtaining written consent from medical students, of a medical college and hospital. Data collected included demographic profiles, patterns of computer/mobile and visual display terminal usage, symptoms of computer vision syndrome (CVS), and precautions taken to mitigate its effects. Analysis was performed using SPSS version 22 in Windows format. Results: The prevalence of CVS in our study was approximately 71.5% of the study participants exhibited symptoms of CVS, indicating a high prevalence.  Prolonged Screen Time: A strong association between increased screen usage and the development of CVS symptoms was observed.  Over 64% of participants spent more than 3 hours daily on digital screens. While refractive surgery can be a factor, other factors like prolonged screen time and environmental conditions seem to play a more significant role in the development of dry eye.  Approximately 10.8% of participants had undergone refractive surgery. Conclusion: From the data arising out of the present study it can be safely concluded that well over three-fourths of the medical students and faculty had developed at least one or other form of CVS. Headache was the most common complaint reported (24%) followed by eye strain (11%). These other common symptoms included dry eye, eye strain, and blurred vision. Likewise, the Students who used mobiles or laptops for more than 2 hours a day as compared to those with less than 2 hours of usage had increased chances of developing CVS symptoms if protective measures such as display filters were not used.

Background: Hypertension is the leading cause of the development of cardiac, cerebrovascular, and renal complications. At the time of initial diagnosis, many individuals with essential hypertension may already exhibit overt or subclinical target organ damage. The cost-effectiveness of blood pressure reduction through pharmacological treatment is notably higher when target organ abnormalities and/or co-morbidities are present. Consequently, evaluating subclinical target organ damage has become a crucial aspect of assessing hypertensive patients. We in the current study tried to evaluate microalbuminuria as the indicator of target organ damage. Methods: The study included patients newly diagnosed with essential hypertension based on the JNC VIII criteria. Additionally, patients with a history of essential hypertension were also included. The age group was patients from 30 years and above of both sexes. Chest X-ray, electrocardiogram (ECG), echocardiogram, and CT brain were done when indicated. Results: out of 100 cases of hypertension included in the study. The estimation of microalbuminuria showed that 27% of cases had microalbuminuria and the remaining 73% were negative for microalbuminuria. There is a trend of increasing microalbuminuria prevalence with advancing age. The highest prevalence (44.4%) is seen in the 61-70 age group. While less common, microalbuminuria can occur even in younger age groups, as seen in the 41-50 and 51-60 age groups. The duration of hypertension was moderately associated with the development of microalbuminuria, with a p-value equal to 0.03. the patients who have been receiving usual care for hypertension, none had features of microalbuminuria. Whereas there was a statistically significant difference in the frequency of MA in untreated or those on irregular treatment chi-square = 9.891, p-value = 0.01. Conclusion: The findings of our study suggest a strong correlation between microalbuminuria as a marker of target organ damage in patients with essential hypertension. Microalbuminuria was observed in a fairly large number of hypertensive patients. The rate of microalbuminuria was more commonly prevalent in older patients. Duration of hypertension was significant and positively related to the occurrence of microalbuminuria. Microalbuminuria was found to be related to target organ damage in the form of hypertensive retinopathy, left ventricular hypertrophy, and stroke.

Background: Approximately 65-300 million cases of chronic otitis media occur worldwide. Mainstay of chronic discharging ears is meticulous aural toilet and empirical antimicrobials given systemically or as topical preparation. Majority of practitioners do not routinely send specimens of the discharge for microbiological analysis unless the discharge is refractory to treatment. However, Empiric treatment of ear infection is not always appropriate as the pathogen and their drug susceptibility patterns can change over time and it could contribute to the development of antimicrobial resistance in the long run. Objectives: This study was performed to characterize the pathogens isolated in cases of ear discharge and to study the antimicrobial susceptibility pattern of the obtained bacterial isolates. Methods: This retrospective study was conducted in the department of microbiology, Government T.D. Medical College, Alappuzha. Results: Bacterial isolates were the predominant cause of ear infection in all age groups. The commonest bacterial pathogen obtained was pseudomonas spp (29.6%) followed by staphylococcus aureus (13.9%). Aspergillus spp was the commonest isolated fungi (13.9%) followed by Candida spp (8.1%). Flouroquinolones were sensitive only in 35% of gram-negative isolates and aminoglycosides were sensitive only in 46.3% of gram-negative isolates. Methicillin resistance was noted only in 4.2 % of the isolates. Conclusion: Empirical therapy in ear infection cases must be used with caution. The most effective antibiotics for gram negative isolates was found to be piperacillin-tazobactam and cefipime. The most effective antibiotic for Staphylococcus aureus isolates was found to be cloxacillin, cefazolin and co-trimoxazole.

Background: Benign Prostatic Hyperplasia (BPH) is one of the most common causes of lower urinary tract symptoms in elderly men. Management of BPH includes conservative or watchful waiting, medical therapies, and surgical interventions. Monopolar transurethral resection of prostate (TURP) is considered as the surgical gold standard for BPH.TURP syndrome is a rare but most dreaded complication of TURP. The aim of the present study is to compare the safety profile of these two techniques of TURP- monopolar and bipolar in terms of incidence of TUR syndrome and other complications. Study Design: Prospective observational comparative study. Method: 23 patients in each group, total 46 patients, divided into two groups – Group M (monopolar TURP) and Group B (bipolar TURP) who underwent TURP under regional anaesthesia. Duration of surgery, blood loss, intraop complications like TUR syndrome, post-op serum electrolyte and haemoglobin level (immediate post op & 24 hrs after surgery) were analyzed. Results: The change in hemoglobin values from pre-op to immediate postoperatively was significantly more in the monopolar group(0.81+/-0.16) compared to the bipolar group(0.40+/-0.17) with a p value<0.001.Also, the change in serum sodium values was significantly more in the monopolar group(4.13+/- 1.14) compared to the bipolar group(0.83+/-0.89) with a p value<0.001. No case of TUR syndrome was recorded. The duration of surgery (62.04+/-4.07 minutes) and amount of irrigation fluid used (4.63+/-0.48 liters) was significantly lesser in the bipolar group as compared to monopolar group (66.39+/-3.38 minutes) & (5.08+/-0.45 liters) respectively p value < 0.001. Conclusion: We conclude that Bipolar TURP is better in terms of safety and complication rates compared to monopolar TURP.

Introduction: Antibiotic resistance is an emerging global health threat with significant implications in tertiary care settings, where doctors often use antibiotics to treat complex patients. This study aims to assess the knowledge and attitudes of doctors regarding antibiotic resistance in a tertiary hospital, with a focus on identifying knowledge gaps that could guide the development of effective antibiotic stewardship programs. Methods: A cross-sectional survey was conducted at GAIMS Bhuj using a structured questionnaire. The study targeted intern doctors, resident doctors, and faculty members. The questionnaire was developed through a review of literature and expert consultation and piloted for clarity and reliability. Two months data were collected using Google Forms and response rate was 98.7%. Data were analyzed in Microsoft Excel and SPSS using chi-square tests for statistical significance. Results: The study revealed that 96.67% of respondents were aware of AMR, but only 88% considered it a serious issue. Misconceptions regarding antibiotic prescription were common, including the belief that broad-spectrum antibiotics can be started for less severe infections, with 49.33% of the respondents agreeing to such practices. There was a weak positive correlation between educational qualification and AMR knowledge (r = 0.21), and education level has mild effects on attitudes toward AMR. Educational qualifications indicated high significance regarding associations with AMR awareness, with a p-value of 0.03. Conclusion: Even though awareness among the health professionals is at the right level, knowledge misapplications and gaps do remain in this area of drug prescription, especially as relates to antibiotics. This article depicts a continuous need for education while antibiotic stewardship programs are established at all levels to fill knowledge gap with practice. There remains an important need to infuse knowledge into prescription procedures as an effective method in AMR management supported with guidelines from institutions to control dissemination and enhance outcomes.

Background: The liver is the largest internal organ of the body. The present study was carried out to evaluate the diagnostic efficacy of guided FNAC in neoplastic and non-neoplastic focal lesions of the liver. Materials & Methods: Seventy-two patients admitted to or attending the OPD of Nalanda Medical College and Hospital with suspected hepatic lesions. The present study included a total of 72 fine needle aspirates obtained from patients who visited our pathology department with various space-occupying lesions of the liver. Ultrasonography was done. For histopathological examination, the core needle biopsy was performed concurrently with the FNA under local anaesthesia and ultrasound guidance using the Vim-Silverman liver biopsy needle, wherever possible. The tissue obtained was fixed in 10% formalin and processed. The paraffin sections were stained with routine H & E stains. All the results were recorded in a Microsoft Excel sheet and were subjected to statistical analysis using SPSS software. Results: Cytological diagnosis was neoplastic lesions in 69.56 percent of the patients, while it was non-neoplastic lesions in the remaining 30.43 percent of the patients. Statistical Indices of FNA Diagnosis as calculated by the Galen and Gambino method: Sensitivity: 94.12% Specificity: 80% Positive Predictive Value (PPV): 96.97% Negative Predictive Value (NPV): 66.67% Diagnostic Accuracy: 92.31% Area Under Curve (AUC): 0.871 P value: 0.001 (Significant). Conclusion: Guided FNAC is a safe, useful, and economic procedure with virtually no complications and can be routinely done for assisting the diagnosis of liver diseases in our clinical setup. USG/CT guidance offers a better approach to hepatic lesions and avoids injury to vital abdominal structures.

Background: Salivary glands are exocrine glands that secrete saliva.  Salivary gland system includes both major and minor glands. The study aimed to correlate the fine needle aspiration cytology diagnosis with histopathological features in population of Bihar, as catered by single tertiary care hospital NMCH Patna; Bihar. Materials & Methods: This is prospective cross-sectional study conducted at department of pathology Nalanda Medical College and hospital, Patna. The study includes a total of (98) fine needle aspirates obtained from patients who visit our pathology department with various major salivary gland disorders. Both male and female patients with clinical and radiological findings were included in the study. Informed consent was obtained from the patient. FNAC was performed using 22-24 gauge needle and 5ml or 10 ml syringe by applying negative pressure. Smears were either wet fixed or air dried and stained by Hematoxylin and Eosin & Giemsa, respectively. All the results were recorded in Microsoft excel sheet and were subjected to statistical analysis using SPSS software. Results: In current study salivary gland  lesions were common  between 31-40 years age group with mean age of 41.6yrs. There was male predominance with M: F of 1.57:1. In the present study benign lesions were 57.14% followed by non-neoplastic lesion 34.70% and malignant lesion  8.16% on FNAC examination of salivary gland lesions. Conclusion: FNAC of salivary gland tumors has advantage to both patient and clinician because of its immediate results, accuracy, economy, and lack of complications. FNAC has high diagnostic accuracy of 97.14%, 95.71% and 97.14% for non-neoplastic lesions, benign tumors and malignant tumours (present study), which helps in appropriate therapeutic management.

Background: Pleural fluid is categorised as either transudate or exudate based on modified Light’s criteria.  Pleural effusion is classified as an exudative effusion if at least one of the criteria is met. Pleural fluid protein/serum protein ratio of greater than 0.5. Pleural fluid lactate dehydrogenase (LDH)/serum LDH ratio of greater than 0.6. Pleural fluid lactate dehydrogenase (LDH) is greater than 2/3rd of the upper limit of normal value for serum lactate dehydrogenase (LDH). Materials and Methods: A prospective study was conducted over 21 months at Nalanda Medical College and Hospital, Patna. Pleural fluid samples from 130 patients were collected from various departments. Each sample underwent physical, chemical, cytological, and microbiological examinations, including Ziehl-Neelsen staining for acid-fast Bacillus and Gene Xpert testing for Mycobacterium tuberculosis. Demographic information, clinical history, and laboratory findings were documented. Patients with positive Gene Xpert results were monitored on anti-TB treatment for six months, while Gene Xpert-negative patients received a two-week antibiotic regimen. Statistical analyses, including sensitivity, specificity, and predictive values, were calculated. Results: Out of 130 pleural fluid samples, 84% were exudates, with a higher prevalence in males (64.55%) and patients aged 21-30 years. Suspected clinical diagnoses included tuberculosis (77.36%), pneumonia (18.18%), and malignancy (5.04%). WBC counts were predominantly in the range of 600-1000 cells/µL, and protein levels were above 3 gm/dL in all exudative cases. Cytology showed a predominance of lymphocytes in suspected tuberculosis cases, with a mean of 83%. Gene Xpert detected Mycobacterium tuberculosis in 39.58% of cases, with high sensitivity (86.49%) and specificity (46.43%) for cytological diagnosis relative to Gene Xpert, achieving a diagnostic accuracy of 62.37%. Lymphocyte predominance was significantly associated with tuberculosis (p < 0.001). Conclusion: Pleural fluid cytology, combined with advanced molecular techniques like Gene Xpert, provides an effective, minimally invasive diagnostic approach for tuberculosis, particularly in resource-limited settings. Cytology demonstrates high sensitivity and negative predictive value, making it valuable in diagnosing tuberculosis and distinguishing it from other causes of pleural effusion.

Background: Injuries involving tibial-side avulsions of the posterior cruciate ligament (PCL) are generally regarded as uncommon. This study aimed to retrospectively evaluate and compare the clinical outcomes of displaced PCL avulsion fractures on the tibial side, managed using either open reduction with screw fixation or arthroscopic suture fixation. Materials and Methods: A retrospective review was conducted for patients treated surgically for displaced PCL tibial-side avulsion. The study included cases showing radiographic displacement exceeding 3 mm and/or grade II or III posterior laxity as determined by the posterior drawer test. Associated injuries were addressed appropriately, and a conservative rehabilitation protocol was implemented until radiologic confirmation of fracture healing. Data from clinicoradiologic evaluations at the 1-year follow-up were analyzed to compare outcomes between the two groups.  Results: 78 patients with 1-year follow-up data were included, comprising 39 in the open reduction group and 39 in the arthroscopic fixation group. Over 90% of patients in both groups reported normal or nearly normal knee function. At 1 year, knee function outcomes, as assessed by the Lysholm score and Tegner activity level, were comparable between the groups. Performance on the one-leg hop test was also similar. However, postoperative arthrometric laxity measurements with indicated better stability in the arthroscopic group compared to that in the open group. Fracture union was typically achieved within three months post-surgery, and no significant complications were observed. Conclusion: Both open reduction with screw fixation and arthroscopic suture fixation resulted in comparable short-term clinical outcomes, radiologic fracture healing, and knee stability for patients with PCL tibial-side avulsion fractures. However, arthroscopic fixation demonstrated slightly superior postoperative laxity outcomes.

Background: Choledocholithiasis refers to the presence of stones within the common bile duct (CBD). The condition can be managed using two principal approaches: endoscopic retrograde cholangiopancreatography (ERCP) or surgical exploration of the CBD. During open CBD exploration, primary closure of the duct is feasible if an intraoperative cholangiogram confirms the absence of residual stones. In the absence of this confirmation or if stones are detected, a stent or T-tube is required to facilitate drainage. This study compared the outcomes of stent placement versus T-tube drainage following open CBD exploration. Materials and Methods: A total of 78 patients were included in the study. Of these, T-tubes were inserted in 40 patients, while stents were placed in 38 patients. Data analysis was performed to evaluate the effectiveness and safety of the two methods, with particular reference to the study’s objectives.  Results: The analysis revealed no significant difference in outcomes between patients managed with T-tube drainage and those treated with stents. Both approaches demonstrated comparable results in terms of post-operative recovery and overall effectiveness in the management of CBD stones. Conclusion: This study suggests that both T-tube drainage and stents are equally effective options for managing patients undergoing open CBD exploration when primary closure is not feasible. Further research with larger sample sizes may help validate these findings and refine management strategies.

Background: This case report highlights an uncommon presentation of JMML in a male child, stressing the significance of early detection and coordinated management to improve patient outcomes. Case Report: A 2-year-old boy exhibited symptoms of overall weakness, a progressively enlarging abdomen for 6-7 months, and occasional bouts of fever. Clinical examination revealed distinctive facial features, hepatosplenomegaly, and signs suggestive of Noonan syndrome. Laboratory investigations showed significant leukocytosis, monocytosis, anemia, and thrombocytopenia. Bone marrow examination and next-generation sequencing validated JMML’s diagnosis with a germline NRAS mutation. Given the absence of a suitable sibling donor and financial limitations, the patient received azacitidine (AZA) chemotherapy as a preparatory step for hematopoietic stem cell transplantation (HSCT). Discussion: This case underscores the complexity of diagnosing JMML, particularly in patients with overlapping congenital syndromes like Noonan syndrome. Molecular analysis played a crucial role in confirming the diagnosis. Despite the challenges, the patient responded well to AZA, highlighting its potential as a bridging therapy to HSCT. Early and accurate diagnosis and a multidisciplinary treatment approach are essential for improving outcomes in JMML patients. Conclusion: This case implies the significance of promptly identifying and managing JMML, especially when it presents with syndromic features. Azacytidine demonstrates potential as a transitional treatment, while HSCT remains the definitive therapy.

Background: Investigation of Dengue outbreaks play a big role to ascertain the behaviour and migration pattern of Aedes mosquito. Entomological investigation is based largely on larval indices. However, there is weak association between these indices and viral transmission, because these threshold indices also differ from place to places. It is recommended to find an area-specific re-evaluation of the utility of larval indices. Materials and Methods: This study aimed at to study the migration pattern of infected Aedes mosquito and relationship of vector indices with occurrence of outbreak. This is a observational study on investigation of a dengue outbreak in an urban habitat in a North 24 Parganas of West Bengal. The period of study was done in August and September 2021. Data was collected by house-to-house team of the municipality and subsequently analysed by District entomologists. House Index, Container Index, Bratue Index and Pupal Index are considered as study variables. Diagram was drawn on Microsoft office power point for illustration of movement of focus of outbreak with time. Results: House Index was observed to be highest just before the upsurge of the cases. It is found to be most sensitive index among all larval indices. Container Index did not reflect any change during the outbreak. Breatue Index did not collaborate with the occurrence of outbreak. Pupal Index is also found to be as sensitive as House Index. Conclusions: Diagrammatic presentation based on vector indices may guide the public health personnel to predict the cluster formation of Dengue outbreak in advance.

Background and Aim: Meningitis remains a significant public health issue in India to date for particular groups of people, including children, older adults and immunocompromised. This study aimed to evaluate the diagnostic performance, clinical usefulness and cost-effectiveness of a panel of 500 patients in the Indian setting. Materials and Methods: This prospective, observational study was conducted in a tertiary care hospital in India for one year after fulfilling the inclusion and exclusion criteria. The sensitivity and specificity of BioFire meningitis/encephalitis panel and conventional methods (culture, gram staining, and biochemical analysis) were computed to assess the diagnostic capabilities of each strategy with actual, clinically confirmed cases to illustrate differences in pathogen detection. Result: BioFire meningitis/encephalitis panel tested a sensitivity of 96% and a specificity of 98% for bacterial, viral, and fungal pathogens compared to conventional diagnostic approaches which shows reduced sensitivity. The BioFire Panel identified bacterial Meningitis in 28% of cases as Streptococcus pneumoniae, Neisseria meningitidis in 18%, and Mycobacterium tuberculosis in 15%. There were 44 cases of viral Meningitis, of which 32% were due to Enteroviruses, 14% were due to Herpes Simplex Virus 2 and 8% were fungal Meningitis, especially Cryptococcus neoformans. Conclusion: The BioFire meningitis/encephalitis panel test is better diagnostic tool in diagnosing meningitis than the conventional methods and should be included in the national guidelines for meningitis management.

Background: Abnormal uterine bleeding (AUB) refers to bleeding that occurs outside of normal menstrual cycles and includes changes in the regularity, frequency, duration, or amount of bleeding during or between periods. AUB is a condition that causes significant impairment in women’s health, impacting a substantial proportion of women in different stages of their reproductive life with 14-25% of women of reproductive age and up to 50% of women in the perimenopausal phase experience the effects of this condition. Materials and Methods: The present study was analytical observational study conducted in the Department of Obstetrics and Gynaecology, ACPM Medical College, Dhule, Maharashtra for the period of 18 months. Prior to commencement, the study obtained approval from the ethics committee at the hospital, and 63 women aged 35 or above, who were experiencing abnormal uterine bleeding, willingly participated in the study by providing written consent. Each patient underwent a thorough medical history and general systemic examination. They were also subjected to baseline investigations, transvaginal sonography, diagnostic hysteroscopy, and endometrial biopsy. Results: The overall diagnostic accuracy of our study came out to be 90.48%. The correlation between Histopathological and Hysteroscopic findings of the endometrium and was found to be statistically significant (p<0.05). Conclusion: Hysteroscopy is a valuable diagnostic tool for identifying the underlying cause of AUB. Proper management of AUB will depend on several factors including the patient’s age, fertility goals, and the results of the final histopathology. While hysteroscopy is a valuable tool for visualizing abnormalities in the uterine cavity, it is important to note that it is not a substitute for tissue diagnosis, which is considered the gold standard. Rather, hysteroscopy complements other diagnostic procedures by offering the advantage of direct visualization of any abnormalities within the uterine cavity.

Introduction: A study comparing the anaesthetic effect of hyperbaric bupivacaine with fentanyl and hyperbaric levobupivacaine with fentanyl for lower limb and lower abdominal surgeries was conducted. Methods: A study involving 100 patients underwent lower limb and abdominal surgeries, divided into two groups (A and B) and administered hyperbaric bupivacaine with fentanyl or levobupivacaine with fentanyl. Results: Statistical analysis showed no significant differences in hemodynamic parameters or side effects between the two groups, but significant differences in sensory block onset, motor block duration, and TTFR. Conclusion: Statistical analysis reveals Bupivacaine with fentanyl and Levobupivacaine plus fentanyl provide adequate spinal block for lower limb and abdominal surgeries, with Hyperbaric Bupivacaine providing longer duration of spinal anesthesia.

Objectives: To determine the prevalence and demographic distribution of C1 ponticulus posticus (arcuate foramen). Methods: This was a hospital based prospective observational study conducted in the Department of Radiology and Department of Neurosurgery, Government Stanley Medical College, Chennai between April 2019 and December 2019 among patients presenting to the department for CT neck and upper cervical spine in the course of evaluation for diseases including thyroid and parathyroid diseases, diseases of the cervical spine, oropharyngeal diseases, nasopharyngeal and laryngeal diseases. Results: The present study included a total of 120 patients. The overall prevalence of C1 ponticulus posticus was 5.8%; 3.3% presented with unilateral, and 2.5% with bilateral C1 ponticulus posticus; in the right and left sides, 95.8% had no C1 ponticulus posticus, 3.3% had complete and 0.9% had partial C1 ponticulus posticus. Of the 120 cases enrolled in the present study, 84 cases (70.0%) were less than 60 years of age; and 66.7% (80 cases) were males. Of the 7 cases with ponticulus posticus, majority (6 cases, 85.7%) were more than or equal to 60 years of age; whereas, of the 113 cases without ponticulus posticus, 26.5% were more than or equal to 60 years of age. This difference was found to be statistically significant (p<0.05). However, no statistically significant association was found between gender and the presence of C1 ponticulus posticus. Conclusion: Awareness of the prevalence and demographic distribution of C1 ponticulus posticus can help guide preoperative planning and intraoperative decision-making, potentially reducing the risk of iatrogenic injuries and improving surgical outcomes.

Introduction: Intrathecal neostigmine acts by inhibition of breakdown of acetylcholine. It produces analgesia by increased concentration of acetylcholine in spinal cord. Intrathecal clonidine acts on post synaptic alpha 2 agonist and produces analgesia by inhibition of WDR (wide dynamic range) neurons. In this study we compared effects clonidine and neostigmine intrathecally for elective abdominal hysterectomy. Materials and Methods: Total 60 patients posted for elective abdominal hysterectomy divided in two groups. Group N (n=30) received 3 ml of 0.5% heavy bupivacaine with 45 mcg of neostigmine .Group C (n=30) received 3 ml of 0.5% heavy bupivacaine with 45 mcg clonidine. Both groups were compared for onset and duration of sensory and motor blockage, haemodynamic stability and post-operative analgesia. Results: Time for sensory onset (T10) was faster in group N (1.65 ± 0.66 min) than group C (3.71± 1.99 min). Time for onset of motor block was faster in group N (1.74± 0.49 min) than group C (4.12 ± 2.46 min). Post-operative analgesia was prolonged in group C (326 ± 11.76 min) than in group N (280 ± 14.61min). Hypotension, bradycardia and sedation were more seen in group C while nausea and vomiting were more seen in group N. Conclusion: Intrathecal neostigmine with bupivacaine in elective abdominal hysterectomy provides faster sensory and motor blockade while prolonged post-operative analgesia seen with intrathecal clonidine .Both drugs can safely used as an adjuvant as an alternative to opioid free spinal analgesia.

Background: Popliteal Nerve Block, a form of regional anaesthesia is given for a variety of foot & ankle surgeries. It is a popular technique to decrease postoperative pain, decrease narcotic use & increase patient satisfaction. Popliteal blocks can be utilized as the sole source of anaesthesia for foot & ankle surgeries. This technique is beneficial in medically compromised patients. Profound analgesia during both the operative & post-operative time periods & avoidance of systemic complications like nausea & vomiting are also potential benefits of popliteal nerve block. Use of ultrasound allows real time visualisation of deposition of local anaesthetic and so can improve the chance of successful nerve blockade. Ultrasound also allowed dose reduction of the local anaesthetic. It reduces the number of needle passes and shortens the block onset time. Methods: All the patients enrolled for USG guided Popliteal Nerve Block will undergo a thorough pre-anaesthetic check-up. Local parts will be examined and written informed consent will be taken from all patients. AS will be explained in detail on the night before the surgery. Patient will be advised to keep Nil per orally for at least 6 hours pre operatively. A peripheral line will be secured for all the patients. Monitors will be applied for -ECG, NIBP, SpO2. Ultrasound machine and its probe will be properly cleaned and aseptically prepared After preparing the parts with povidone iodine, spirit and normal saline solutions, proper draping will be done and a high frequency (5-12 Hz) linear ultrasound probe will be placed transversely at the mid-popliteal crease. After localizing the popliteal artery, probe will be moved proximally to locate the sciatic nerve at or prior to its bifurcation into the tibial and common peroneal branches, the patient will be informed and then a 23G spinal (Quincke) needle will be inserted in-line with and parallel to the transducer from the lateral side of the fossa by using In-plane approach, the whole shaft will be visualized as it progresses towards the nerve. Once placement is confirmed, injection Lignocaine 1.5% 10 ml and injection Bupivacaine 0.5% 5 ml will be injected circumferentially around the sciatic nerve after negative aspiration for blood. 1. Patient will be turned into a supine position. Sensory block will be assessed by pin prick sensation (using the Hollmen scale) and motor block will be assessed by movement of fingers and the ankle joint (using the Hollmen scale). Results: No side effects or adverse reactions were observed whatsoever. All the patients graded the experience as being very satisfied with the anaesthetic technique. Conclusion: Ultrasound-guided popliteal fossa nerve block is an effective and successful technique to provide perioperative sensory and motor blockade for patients undergoing various foot and ankle surgeries. Complications associated with spinals epidural and general anaesthesia can be avoided. Combinations of Lignocaine and Bupivacaine as a local anaesthetic provide faster onset with virtue of good postoperative analgesia.

Background: Enteric perforation, often caused by infectious diseases like typhoid, is a significant cause of morbidity and mortality in developing countries such as India. Our study aims to compare the outcomes of using a free omental sheet graft versus other operative procedures for enteric perforation repair. Method: This study includes both prospective and retrospective comparative analysis. It was conducted on 150 patients admitted to the emergency ward of the Department of General Surgery at J.L.N. Medical College and Associated Group of Hospitals, Ajmer. Patients were randomly assigned to three groups, each consisting of 50 patients: GROUP A – Primary repair with the omental sheet, GROUP B – Primary repair alone, and GROUP C – Resection and anastomosis. Result: The rate of fecal fistula formation in each group was as follows: Group C had 6% of patients with fistula formation, Group B had 10%, and Group A had 2%. Regarding mortality, Group C and Group B had approximately 4% mortality each, while Group A had no mortality. Conclusion: Simple repair with a free omental sheet graft applied to the perforated site in the affected gut was successful. This approach likely prevents repair leaks, new perforations, and fecal fistulas by covering at least 10 cm of the affected gut. This significantly lowers both morbidity and mortality.

Introduction: Choledocholithiasis, the presence of stones in the common bile duct, can be primary or secondary, with secondary being more common. Diagnosis typically involves symptoms and imaging, with ERCP serving as both diagnostic and therapeutic. Laparoscopic cholecystectomy is the gold standard treatment, and studies indicate better outcomes when performed within 72 hours post-ERCP. This study aims to evaluate optimal timing for laparoscopic cholecystectomy after ERCP and assess associated morbidity. Methodology: This prospective randomized study at JLN Medical College between December 2022 to July 2024 evaluated 50 patients with concomitant gallbladder and CBD stones, divided into early (within 3 days) and late (4 weeks after ERCP) laparoscopic cholecystectomy groups. Data collected included demographics, preoperative findings, and intraoperative outcomes to assess surgical efficacy and complications and also post-operative morbidity and hospital stay. Results: The study includes 50 patients with concomitant gallbladder and CBD stones , which are randomly arranged in two groups i.e. early and late laparoscopic cholecystectomy after ERCP with  mean age of patients was 48.10 years, predominantly female (72%). Abdominal pain was reported in 90% of cases. Early cholecystectomy resulted in significantly shorter operation times (37.6 vs. 54.2 minutes) and reduced hospital stays (29.92 vs. 62.48 hours). Additionally, this group had fewer intraoperative complications, highlighting the benefits of early intervention. Conclusion: The study recommends early cholecystectomy for patients with cholelithiasis and choledocholithiasis post-ERCP, citing benefits like shorter procedure times, fewer complications, less postoperative pain, and reduced hospital stays. These findings support timely intervention, though further research with larger sample sizes is needed for definitive guidelines on surgical timing.

Background: Mechanical ventilation (MV) is an essential part of present day pediatric intensive care. In recent years, mechanical ventilation has evolved into a highly specialized practice. It is the highest form of respiratory support for critically ill patients and is a lifesaving intervention to support the cardiorespiratory status, until the underlying disease is cured. The study serves to demonstrate clinical-demographic profile and outcome of children receiving mechanical ventilation. The authors also intended to highlight factors associated with poor outcome in these patients. Methods: The present cross-sectional observational study was conducted in a tertiary care centre of north India, over a period of 1year from September 2022 to August 2023. All consecutively admitted children aged 1 month to 18 years, who required mechanical ventilation for greater than 12 hours were enrolled. Baseline demographic and clinical profile of study participants was recorded. Results: Out of total 822 admitted patients in PICU, 60 (7.3%) patients fulfilling eligibility criteria were enrolled. The mean, median age of the study participants was 7.5,7±6.2 years, with a male to female ratio of 1:1. The most common conditions requiring mechanical ventilation were neurotoxic snake bite (23.33%) followed by community acquired pneumonia (16.67%). The mean duration of ventilation was 6±6.4 days. Eighteen children (30%) had comorbid conditions, of which severe acute malnutrition(SAM) was the most prevalent (15%). The mortality rate was 46.7%. The mortality was higher in presence of shock, ARDS( acute respiratory distress syndrome), MODS(multiorgan organ dysfunction syndrome) and with underlying comorbid conditions.

Background: Cataracts are a leading cause of preventable blindness worldwide, with surgical intervention being the only effective treatment. Phacoemulsification and manual small-incision cataract surgery (MSICS) are the two most common techniques for cataract removal. While phacoemulsification is preferred in advanced settings due to its precision and faster recovery, MSICS remains a cost-effective alternative in resource-constrained environments. Aim: To compare pre-operative and post-operative refractive and visual outcomes in cataract patients undergoing phacoemulsification and MSICS in a tertiary care hospital. Methods: This prospective study was conducted at Nalanda Medical College and Hospital, Patna, from July 2023 to July 2024, involving 120 participants divided into two groups: 60 undergoing phacoemulsification and 60 undergoing MSICS. Pre-operative and post-operative visual acuity and refractive errors were assessed. Data collection included patient demographics, keratometry, and intraocular lens power calculations. Outcomes were analyzed at 1 month and 3 months post-surgery using SPSS version 23.0, with statistical significance set at p < 0.05. Results: The mean post-operative visual acuity was significantly better in the phacoemulsification group (0.22 logMAR) compared to the MSICS group (0.30 logMAR, p = 0.001). Post-operative spherical equivalent was significantly lower in the phacoemulsification group (-0.4 D) compared to MSICS (-1.0 D, p = 0.002). Post-operative astigmatism >1.5D was observed in 5% of the phacoemulsification group and 13% of the MSICS group (p = 0.02). Surgical complications were minimal and comparable between the groups (p = 0.10). Conclusion: Phacoemulsification provides superior visual acuity and refractive outcomes compared to MSICS, with reduced post-operative astigmatism. However, MSICS remains a viable alternative, especially in low-resource settings, due to its cost-effectiveness and safety profile. Recommendations: Phacoemulsification should be prioritized in well-equipped healthcare settings, while MSICS continues to play a vital role in addressing cataract blindness in resource-limited regions. Training programs should focus on enhancing surgeon expertise in both techniques.

Background: Psychiatric disorders such as depression, anxiety, and schizophrenia are significant public health challenges. Current pharmacological treatments often target monoaminergic systems but fail to address the complexity of these disorders comprehensively. Advances in neuropharmacology have identified novel targets, such as glutamatergic pathways, serotonergic receptors, and neurotrophic factors, offering potential for more effective treatments. Aim: To evaluate the efficacy and safety of novel pharmacological agents targeting non-traditional pathways in the treatment of psychiatric disorders. Methods: This prospective, observational study was conducted involving 160 patients with psychiatric disorders. Patients were assessed using the Hamilton Depression Rating Scale (HDRS) at baseline, 1 month, 3 months, 6 months, and 12 months. Adverse effects were documented throughout the study. Data analysis was performed using SPSS version 23.0, with repeated measures ANOVA to evaluate treatment efficacy. Results: The mean HDRS score decreased significantly from 22.5 ± 3.1 at baseline to 6.8 ± 2.1 at 12 months (p < 0.001), indicating a 69.8% improvement. Adverse effects were reported in 10% of participants at 1 month, increasing to 16% by 12 months, but remained mild and manageable. The findings highlight the efficacy of novel treatments in reducing depressive symptoms with a favorable safety profile. Conclusion: Novel pharmacological agents targeting glutamatergic, serotonergic, and neurotrophic pathways demonstrate significant improvements in psychiatric symptoms and acceptable safety profiles. These treatments offer promising alternatives to traditional therapies, addressing unmet needs in psychiatric care. Recommendations: Further large-scale, randomized controlled trials are needed to validate these findings and explore personalized approaches for optimal treatment outcomes. Long-term studies should also focus on the durability of treatment effects and potential risks.

Background: Myopia is a rapidly growing global public health concern, particularly among children, due to its increasing prevalence and associated risks of developing high myopia and related complications. Low-dose atropine has emerged as an effective intervention for myopia progression, but data on its efficacy and safety in Indian populations remain limited. Aim: To evaluate the efficacy and safety of 0.01% atropine eye drops in controlling myopia progression among North Indian children attending a tertiary care hospital in Bihar. Methods: This prospective interventional study involved 140 children aged 5–15 years with documented progressive myopia. Participants received 0.01% atropine eye drops once daily for 12 months. Changes in spherical equivalent and axial length were assessed at baseline and follow-up visits using cycloplegic refraction and optical biometry. Adverse effects were documented. Data were analyzed using paired t-tests and chi-square tests with SPSS version 23.0, and p < 0.05 was considered significant. Results: Over 12 months, the mean spherical equivalent decreased from 3.50 D to 3.10 D, reflecting an 11.4% reduction in myopia progression (p < 0.001). Axial length increased by an average of 0.30 mm, significantly lower than typical untreated progression (p < 0.001). Adverse effects were reported in 10% of participants, with photophobia (5.7%) and eye irritation (4.3%) being the most common, but were mild and transient. Conclusion: Low-dose atropine (0.01%) significantly slowed myopia progression with minimal side effects, demonstrating its efficacy and safety in North Indian children. These findings support its role as a viable option for myopia management in this demographic. Recommendations: Routine use of 0.01% atropine is recommended for managing progressive myopia in children. Further research is suggested to explore optimal concentrations and long-term outcomes across diverse populations.

Background: Psychedelic drugs, such as psilocybin and MDMA, have re-emerged as promising therapeutic agents for psychiatric disorders. Current treatments for conditions like depression, anxiety, and PTSD are often associated with limited efficacy and significant side effects, necessitating innovative approaches. Psychedelics have shown potential to address these limitations by producing rapid and sustained improvements in mental health outcomes. Aim: This study aimed to evaluate the therapeutic efficacy of psychedelic drugs in reducing psychiatric symptoms and to assess their safety profile in a controlled clinical setting. Methods: A prospective observational study was conducted at NMCH, Patna, over one year, involving 100 participants with psychiatric disorders such as depression, anxiety, and PTSD. Participants underwent supervised psychedelic-assisted therapy sessions. Psychiatric symptoms were measured using standardized scales before and after the intervention. Statistical analyses were performed using SPSS version 23.0 to evaluate the significance of changes in scores. Results: The mean baseline psychiatric score was 27.2 (SD = 2.4), which significantly decreased to 17.2 (SD = 2.3) post-intervention, indicating an average improvement of 10 points (p < 0.001). Seventy percent of participants experienced a substantial improvement (≥10 points), with consistent effects across genders. Adverse effects were mild and transient, reported in less than 5% of participants. Conclusion: Psychedelic drugs demonstrated significant and sustained therapeutic benefits for psychiatric disorders, with minimal side effects. The findings suggest that psychedelics may serve as an effective alternative to conventional therapies, particularly for treatment-resistant cases. Recommendations: Further research is recommended to establish long-term safety, refine dosing protocols, and explore the use of psychedelics in larger and more diverse populations. Policymakers should consider revising regulations to facilitate broader clinical research and application.

Background: High tibial osteotomy (HTO) and uni-compartmental knee arthroplasty are both treatment options for isolated uni-compartmental osteoarthritis (OA) of the knee and Knee joint instability. Before the advent of knee arthroplasties, HTO was the most commonly performed surgical procedure for knee OA. HTO is a well-established procedure used to treat uni-compartmental conditions like overload or osteoarthritis by shifting the mechanical axis of the knee, thereby realigning the load distribution. This realignment can help reduce pain, improve function, and potentially slow the progression of osteoarthritis. Aim of the Study: To analyse the final outcome of the High Osteotomy in Osteoarthritis patients after a follow up of 2 years. Materials: 29 consecutive patients with Osteoarthritis patients attending the Department of Orthopedics, from May 2022 to August 2024 were included in a prospective case series study.  All the patients were graded according to Kellgren Lawrence classification with radiological evidence of Osteoarthritis with valgus and/or varus deformities and medial compartmental osteoarthritis (OA). Patients aged between 45 years and 65 years were included. Patients with high-demand activity levels without running or jumping were included. Patients with varus mal-alignment less than 15° were included. Patients with metaphyseal varus of the tibia greater than 5° were included. Patients with full range of motion and normal lateral and patella-femoral compartments were included. Deformity analysis was based on full-leg weight-bearing radiographs, either digitally or on paper. Arthroscopy was done initially to assess the status of the cartilage and menisci, especially in the lateral compartment. Wherever necessary, medial meniscus was resected, smoothing of the cartilage done and ablation of osteophytes were done to address any extension deficits. All the patients were followed up for 2 years. Results: 29 patients were treated with HTO, with an average age of 45.62±5.35 years. The average osteotomy opening was 10.8 mm, and no cases of secondary loss of correction occurred. One patient required a reoperation shortly after the initial procedure due to overcorrection, which was corrected by removing distal locking screws, adjusting the leg axis, and securing the plate with bi-cortical locking screws. Two patients experienced late infection and soft-tissue irritation 4 months postoperatively, but after plate removal and antibiotic treatment, the further clinical course was complication-free. Conclusions: Realignment osteotomy remains a critical treatment option for early to medium-grade varus medial compartment osteoarthritis (OA). Open-wedge high tibial osteotomy (HTO) utilizing optimal surgical techniques (including bi-planar metaphyseal osteotomy) and fixation with the TomoFix internal plate fixator has proven to be effective in treating uni-compartmental gonarthrosis, even in the absence of bone grafts or substitutes. The complication rate is low, patients achieve full weight-bearing quickly, and the medium-term results are promising.

Background: Fracture lateral ends of clavicle were vulnerable for instability and remain a challenge for the orthopedic surgeons. The clinical result of fracture fixation of lateral end clavicle using hook plate was described and practiced by any surgeons and seemed to be well accepted by others in terms of fracture union and function. The principal advantages were anatomical reduction of the fracture and early rehabilitation which lead to good shoulder girdle function. Aim of the Study: The aim of this study is to evaluate the functional outcomes of clavicle hook plate fixation for fractures of the lateral clavicle and acromio-clavicular joint disruption; to evaluate the outcomes of managing unstable fractures of the lateral end of the clavicle using a clavicle hook plate. Materials: This study included 31 patients with displaced fractures of the lateral end of the clavicle, all treated with clavicle hook plate fixation. The mean age of the patients was 29.55±3.5 years, with a range from 18 to 55 years. Results: The mean follow-up period was 18 months, with a range of 12 to 20 months. The average fracture healing time was 10.25±1.35 weeks post-operatively. One patient (03.22%) experienced nonunion but had good alignment and remained asymptomatic without functional disability. Another patient (03.22%) developed a superficial wound infection, while a third (03.22%) had impingement, which resolved after plate removal. Additionally, one patient (03.22%) developed acromio-clavicular (AC) joint arthrosis. The mean Constant score for the affected shoulder was 87.95±2.50 points (range, 85–100), while the score for the contralateral shoulder averaged 92.65±20 points (range, 92–100). Plate removal was performed in only three patients-(09.67%). Conclusion: The clavicle hook plate is an effective method for managing lateral end clavicle fractures, providing stable fixation with a low complication rate. Plate removal is not necessary in most cases.

Background: Coronavirus disease 2019 (COVID-19) has led to significant global health and economic impacts. Vaccines such as COVISHIELD and COVAXIN have been approved for emergency use in India to mitigate the pandemic. Objectives: To evaluate the adverse effect profiles of COVISHIELD and COVAXIN vaccines among healthcare workers in a tertiary care setting. Methods: An observational prospective cohort study was conducted from April to July 2021 in Jharkhand, India. The study included 590 participants who received two doses of either COVISHIELD or COVAXIN. Data on adverse effects were collected using a structured questionnaire based on WHO guidelines. Results: Most adverse effects were mild and resolved within 3-7 days. Common side effects included fever, general weakness, headache, myalgia, and injection site pain. While COVAXIN recipients reported more adverse effects than COVISHIELD recipients after both doses, the differences were not statistically significant. The incidence of adverse events decreased with the second dose for both vaccines. Discussion: The study found no serious adverse events or hospitalizations related to vaccination. The findings are consistent with other studies indicating that both vaccines have an acceptable safety profile. However, limitations include potential reporting bias and the need for long-term surveillance to assess future effects. Conclusion: Both COVISHIELD and COVAXIN vaccines demonstrated safety and clinical acceptability with mild adverse effects. The study supports continued vaccination efforts but highlights the need for extensive evaluation to assess long-term effects and plan booster dose programs effectively.

Introduction: Direct trocar insertion is a minimally invasive surgical technique used to insert instruments into the body through small incisions, to reducing recovery time and minimizing tissue damage. Aims and Objective: To develop and refine techniques for direct trocar insertion, enhancing precision and safety, to minimizing complications, and improving patient outcomes through innovative research and its clinical application. Method: A study was conducted with 45 patients undergoing laparoscopic surgery. A 10-mm trocar was directly inserted into the peritoneal cavity without prior pneumoperitoneum. Patients were positioned supine, and a small infraumbilical incision was made. The trocar was inserted at a 90-degree angle using controlled force. Entry was confirmed by visualizing the peritoneal cavity with a laparoscope. Patient outcomes, insertion time, and complications were recorded. No major complications occurred, and average insertion time was 30 seconds. Results: The study investigates the efficacy of direct trocar insertion (DTI) in laparoscopic surgeries. Results show that DTI reduces the risk of visceral and vascular injuries compared to the Veress needle technique. Patients undergoing DTI experienced shorter setup times and fewer postoperative complications. The findings suggest that DTI is a safer and more efficient method for establishing pneumoperitoneum, enhancing overall surgical outcomes. Conclusion: The study investigates the efficacy of direct trocar insertion (DTI) in laparoscopic surgeries. Results show that DTI reduces the risk of visceral and vascular injuries compared to the Veress needle technique. Patients undergoing DTI experienced shorter setup times and fewer postoperative complications. The findings suggest that DTI is a safer and more efficient method for establishing pneumoperitoneum, enhancing overall surgical outcomes.

Background: Routine nasogastric decompression after gastrointestinal surgery has been standard practice since its introduction by Levin in 1921. While traditionally believed to hasten bowel function recovery and prevent complications, recent evidence questions its necessity and suggests potential adverse effects. This study evalu-ates outcomes in patients undergoing gastrointestinal anastomosis without nasogastric tube insertion during elective surgery. Methods: A hospital-based prospective study was conducted on 100 patients undergoing elective gastrointesti-nal anastomosis at Kalpana Chawla Government Medical College and Hospital, Karnal, between June 2022 and November 2023. Primary outcomes included time to return of bowel sounds, passage of flatus, and resumption of oral intake. Secondary outcomes included postoperative respiratory tract infections and wound infections. Results: Of 100 patients, 93% were male with majority (40%) aged 18-30 years. Mean time for return of bowel sounds was 1.503±0.85 days, with 90% returning within first three postoperative days. Passage of flatus oc-curred at mean 2.51±1.03 days, with 88% passing flatus between days 1-3. Oral intake resumed at mean 4.80±1.42 days. Gastrointestinal symptoms included nausea (49%), vomiting (18%), and abdominal distention (11%). Respiratory complications occurred in 4% patients (pleural effusion). Wound infection was observed in 32% patients (23% minor, 9% major). Anastomotic dehiscence occurred in 6% patients, necessitating nasogas-tric tube insertion. Most procedures were small bowel anastomoses (87%), with ileoileal being most common (78%). Conclusion: Selective rather than routine nasogastric tube insertion appears appropriate for patients undergoing elective gastrointestinal anastomosis. This approach offers advantages of patient comfort and earlier return of bowel function while maintaining acceptable complication rates.

Background: Axillary lymph node status is a significant prognostic pathological factor in patients with operable primary breast cancer. Axillary staging allows loco-regional control and provides relevant information to direct adjuvant systemic therapy. Methods: 30 patients fulfilling inclusion criteria were prospectively studied. Clinico pathological characteristics were assessed and the performance of AUS and AUS guided biopsy for staging the axilla was summarized using sensitivities and specificities, treating the final histopathologic findings as the true status ascertaining the presence or absence of nodal metastases. Results: The mean age of study participants was 47.8yrs, the mean duration of tumour was 3.2 months and the mean size of tumour was 3.25cm. 46.7% of the patients had lump in the upper outer quadrant. On postoperative histopathological examination, 27 patients had invasive ductal carcinoma – not otherwise specified and 14 patients had metastasis in 1-3 ipsilateral axillary lymph nodes. The sensitivity and specificity of AUS was 64.7% and 84.6% respectively and the sensitivity and specificity of AUS guided FNAC was 82.3% and 100% respectively. Conclusions: In our study, tumour size, quadrant and duration significantly affected the status of axillary nodal metastasis but not the age, menopausal status, family history and breastfeeding. AUS guided FNAC is highly specific for assessing nodal metastasis, plays a role in sparing SLNB in early breast cancer and in triaging cases for adjuvant systemic therapy. Our results support the routine use of AUS and AUS guided FNAC for preoperative evaluation in early breast cancer.

Background: Twin pregnancies are associated with elevated risks for both maternal and fetal complications. Among these, the second twin often encounters higher rates of adverse perinatal outcomes, including lower Apgar scores and increased perinatal mortality. While extensive research from Europe and North America has illuminated these risks, limited data are available from the Indian context. This study aims to bridge this gap by evaluating the perinatal outcomes of the second twin in a South Indian population. Objective: To assess the perinatal outcomes of the second twin in twin pregnancies, with a focus on gestational age, chorionicity, mode of delivery, and birth weight as influencing factors. Methods: This retrospective observational study was conducted over a one-year period (April 2023 – March 2024) at Government General Hospital, Kakinada. A total of 93 twin pregnancies beyond 28 weeks’ gestation were included, excluding cases involving intrauterine death of one fetus or congenital anomalies. Data on maternal and fetal characteristics were analyzed using chi-square tests to identify significant associations. Results: The perinatal mortality rate of the second twin was 12.9%, compared to 7.5% for the first twin, with prematurity identified as the leading cause of mortality. Maternal age emerged as a significant determinant of perinatal outcomes, whereas factors such as parity, gestational age, and birth weight showed no statistically significant impact. Conclusions: Second twins in twin pregnancies are at an elevated risk for adverse perinatal outcomes, predominantly due to complications of prematurity. These findings underscore the necessity for vigilant monitoring and individualized care, particularly for younger mothers, to optimize outcomes in twin pregnancies.

As drug-resistant tuberculosis (TB) develops in children, the disease becomes increasingly difficult to treat. This is because it is resistant to isoniazid and rifampicin, two of the best anti-TB drugs. The purpose of this study was to characterize the clinical profile of drug-resistant TB in children aged under 15 years. In patients with drug-resistant TB, drug susceptibility testing (DST) or contact with adults suffering from drug-resistant TB was used to identify patients. Patients were classified as monoresistant, polyresistant, MDR, or extensively drug-resistant (XDR) per WHO criteria, with further categorization into Partial XDR if resistance included a fluoroquinolone or aminoglycoside (excluding streptomycin). Key findings revealed a high prevalence of malnutrition, especially in younger children (<5 years), along with significant exposure to household TB contacts, primarily among those with MDR or Partial XDR. Pulmonary TB was the predominant form, though disseminated TB, abdominal TB, and TB lymphadenopathy were notable in the 5-10 year group. Children <5 years had greater vulnerability to severe forms, including TB meningitis (TBM). The study highlights the need for early detection, robust preventive strategies, and tailored treatment protocols, emphasizing MDR and Partial XDR in children with known drug-resistant contacts. Preventive measures such as comprehensive contact tracing, nutritional support, and adherence to treatment regimens are crucial. Public health efforts focused on reducing adult-to-child transmission and managing co-infections like HIV are essential in mitigating pediatric drug-resistant TB. Future studies should assess longitudinal treatment outcomes and investigate the molecular basis of resistance in children.

Background: We have undertaken this study to compare the effectiveness and perception of students for lectures, small group discussions, and self-directed learning among second year MBBS students. Methods: A total of 141 students were included in this study. For finding the effectiveness of each learning method 10 marks MCQ test was taken and questionnaires were given to find the perception of students for learning methods. Results: Among 141 participants the mean scores for the lecture was 5.9, small group discussion (SGD) was 9, and self-directed learning (SDL) was 6.5 out of 10. The mean scores of small group discussions were higher and statistically significant. Maximum marks in lectures, small group discussions and self-directed learning were 9, 10, 10. Although 10 marks was scored by both small group discussion and self-directed learning group, there is a significant difference between the percentage of students scoring 10 marks in SGD (41.8%) and SDL (2.1%) stating that SGD is more effective. Perception of students was better for small group discussions when compared to lectures and self-directed learning.

This study was conducted to know the incidence of depression, anxiety and alcohol abuse in patients suffering from pulmonary tuberculosis. A cross sectional study was conducted at Tuberculosis and chest diseases Out Patient Department for a period of one year with a sample size of 100 patients who were diagnosed with pulmonary tuberculosis are on anti-tubercular drugs. The tools used were socio demographic data, Modified Kuppuswamy Classification, the MINI- International Neuro Psychiatric Interview Scale, Hamilton depression rating scale (HAMD), and AUDIT (Alcohol use disorder identification test). Current study identified 62% of depression, anxiety and alcohol abuse in pulmonary tuberculosis patients. Among these psychiatric disorders, 40 patients are with depressive disorders, 8 patients with Panic disorder, 6 patients with generalized anxiety disorder and 18 patients with dual diagnosis. Among depressive disorders, 20 patients are with mild depression, 14 with moderate depression and 6 with severe depression. The prevalence of these psychiatric disorders in patients with pulmonary tuberculosis is significantly high. Depression is the commonest among them.

Background: The two most often prescribed medications for androgenetic alopecia, or male pattern baldness, are minoxidil and finasteride. The study’s goal was to determine the effectiveness of topical minoxidil solution both with and without finasteride. Methodology: About 30 patients, ages 18 to 45, who sought outpatient consultation for male pattern baldness were split into two groups at random. After obtaining the patients’ informed consent, Group A received treatment with 0.1% topical finasteride and 5% minoxidil solution, while Group B received treatment with 5% minoxidil solution. Results: Group A outperformed group B in terms of analysis of the quantity of terminal hairs, hair count, and extent of the bald area. Conclusions: When analyzing the number of terminal hairs, hair count, and size of the bald area, group A performed better than group B.

Background: Pseudoexfoliation (PEX) is an age-related fibrillopathy characterized by the deposition of fibrillar material in the eye with increased risk of complications during cataract surgery. Method: 90 (ninety) patients above fifty years of age with PEX were studied; planned manual small incision cataract surgery with rigid posterior chamber intraocular lens implantation under peribulbar anesthesia was carried out. Results: 40 (44.4%) patients had intraoperative complications. The major postoperative complications were 29 (32.2%) corneal edema with SKS, 27 (30%) severe AC reactions, and 13 (14.4%) iris pigment dispersion. Conclusion: It is concluded that proper preoperative evaluation and modification of surgical technique are es-sential to manage intraoperative complications and successful cataract surgery with PEX.

Background: Vacuum-assisted closure employs the application of constant sub atmospheric pressure on the wound, which removes the excess fluid, reducing bacterial proliferation and infection, and enabling the wound to heal at the earliest.  Method: 50 (fifty) adult patients with different types of wounds were studied. A complete haemogram, random blood sugar, renal function test, CRP level, x-ray of the affected part, culture, and sensitivity of pus/discharge from ulcer wound dressing were utilized by medium-density polyvinyl alcohol (PVC). The applied negative pressure ranged from 100 mm Hg to >150 mm Hg. Results: The site of injury was highest in leg 18 (36%) followed by foot 13 (26%) and least was around hip 1 (2%). The maximum size of wound was found in 5 (10%) it was 21-25 cms and least in 1 (2%) was 1-5 cms and maximum duration of healing was 21-25 days observed in 6 (12%) VAC pressure ranged from 100 mm Hg to > 150 mm Hg, 35 (70%) had excellent outcome of healing and 15 (30%) had good outcome of wound healing.  Conclusion: The VAS technique is efficient to heal the complicated wounds and ulcers. It is a promising alternative clinical method for various types of wound healing.

Background: High C-reactive protein (CRP) values are frequently found in patients with respiratory tract infec-tion Elevated CRP value is a strong predictor of severity of respiratory tract infection. Method: 60 (sixty) children with acute respiratory tract infections were studied. CBC and CRP were evaluated, and a chest x-ray, if necessary, was studied to rule out the CRP level. The CRP level was also correlated with the WBC count. Results: The clinical manifestations included 58 (96.6%) fever, 60 (100%) cough, 49 (81%) rhinitis, 6 (10%) throat pain, 2 (3.3%) earache, and 11 (18.3%) breathlessness. CRP level was 0.6–18.8 mg/dl in 3 (5%) on the first day, 0.6–4.8 mg/dl in 32 (53.3%) on second day, 0.6–6.8 mg/dl 25 (41.6%) in third day. WBC/mm 41 (68.3%) patients and >15000 WBC/mm in 11 (18.3%) patients were noted. Conclusion: It is concluded that, elevated CRP values are associated with severity of respiratory tract infection.

Background: Bronchial asthma is a disorder defined by its clinical, physio-pathological characteristics. It has shortness of breath episodes that aggravate at night. It impairs physical and social life. Hypomagnesemia is closely associated with bronchial asthma. Method: 250 (two hundred fifty) adult bronchial asthma patients and 250 (one hundred) healthy adult groups were studied and compared. In every patient, 2 ml of venous blood was collected to investigate serum magnesi-um, CBC, ESR, sputum for AFB, and Gram stain for S. mg. were measured by the Elisa kit, chest x-rays were taken, and spirometry was measured to analyse PEFR, FEV, and ECG. Results: The FEV1 in bronchial asthma patients was 45.78 (± 0.36) and 95.42 (± 1.24) in control; the t-test was 60.7, and p < 0.001. Serum magnesium in bronchial asthma patients had 1.66 (± 0.14), and the control group had 2.24 (± 0.05); the t-test was 6.10, and p < 0.41 (p-value was highly significant). Conclusion: It is confirmed that if serum magnesium is reduced, it may aggravate bronchoconstriction in bronchial asthma patients, leading to morbidity and mortality.

Background: Neonatal dermatoses are the spectrum of cutaneous lesions that arise during the first four weeks of life. The severity of these conditions ranges from physiological transient phases to significant pathogenic entities. Any of these might cause tremendous anxiety for parents, highlighting the significance of a pediatricians being aware of them. Aim of the study is goal was to assess the prevalence of Cutaneous Lesions in Newborn Babies. Methodology: This was a Hospital-based observational cross-sectional study done in 1000 neonates born in Maternity and Child Hospital, Government General Hospital, Nellore who could be examined within the first of week of life irrespective of gestational age, sex and mode of delivery. Complete dermatological examination including scalp, hair, nails, palms and soles, genitalia and mucosa of neonates was done to record neonatal dermatoses. Dermatoses were considered as primary outcome variable. Neonatal and Maternal factors was considered as Primary explanatory variable. P value < 0.05 was considered statistically significant. Results: The prevalence of neonatal dermatoses in our study population was 89.9%. 70.90% had Sebaceous gland hyperplasia, 57.40% had Mongolian spot, 47.80% had Epstein Pearl, 31.00% had Physiological desquamation, 22.90% had Milia, 21.5% had Erythema toxicum Neonatorum, 15.60% had Salmon patch, and lanugo hair was seen in 9.10%. Male babies (93.94%), Low birth weight neonates (94.85%) had higher dermatoses, Mongolian spot and Sacral dimple in preterm babies, Physiological desquamation in term and post term, Milia in term babies, Café au laitspots in post-term babies with significant P- value. Epstein pearl was common in babies to multipara women and milia was common in babies born to primipara women. Sebaceous hyperplasia, Mongolian spot, Physiological desquamation, Milia, Miliaria and Transient Neonatal Pustular Melanosis were commonly seen in babies born through caesarean section. Epstein pearl and sacral dimple were commonly seen in baby born through vaginal delivery. Congenital Melanocytic Nevus was found to be significant in babies born to consanguineous parents. 62.80% of the study population had a combination of fewer than four dermatoses, and 37.20% had a combination of equal or more than four types of dermatoses. Conclusion: Dermatoses was associated with neonatal factors such as birth weight, gestational age, gender and mode of delivery and maternal factors such as consanguinity, parity, mother’s age.

Speckled acral hypopigmentation is a rare entity. Familial cases have been reported that are similar to our case. It falls under reticulate acropigmentation disorders, along with reticulate acropigmentation of Kitamura (RAPK), reticulate acropigmentation of Dohi (RAPD), Dyscromatosis universalis hereditaria (DUH) and acromelanosis albo-punctata. Other clinical differential diagnoses include Dowling-Degos disease, congenital symmetric acral leukopathy, and Confetti macules of tuberous sclerosis. Speckled acral hypopigmentation can be differentiated by the presence of small hypopigmented macules over acral areas with clustering, the absence of hyperpigmented macules, palmar pits and neurological complaints etc. On woods lamp examination, there will be no accentuation. An increased number of macromelanosomes, both in melanocytes and keratinocytes and a decreased or normal number of melanocytes can be seen on histopathological examination. As there are very few case reports, we report one such case of Familial speckled acral hypopigmentation in two successive generations.

Background: As cataract surgery technologies evolve, there is a need to understand how these advancements influence surgical indications and outcomes. Methods: This retrospective study analyzed data from approximately 1,800 cataract surgeries performed using phacoemulsification at MIMS, Vikarabad, from September 2020 to September 2024. We evaluated changes in preoperative visual acuity, prevalence of ocular comorbidities, and postoperative outcomes to assess shifts in surgical indications over this period. Results: The study demonstrates a trend towards earlier surgical intervention, with a gradual decrease in preoperative visual acuity from 0.5 LogMAR in 2020 to 0.42 LogMAR in 2024. Simultaneously, postoperative outcomes have improved, and complication rates have decreased. An increase in patients presenting with comorbid conditions like diabetic retinopathy and age-related macular degeneration suggests that more complex cases are being managed surgically. Conclusion: The study indicates a shift towards earlier intervention in cataract surgery, facilitated by advancements in phacoemulsification techniques. This shift has led to improved surgical outcomes, even as more complex cases are undertaken. These findings suggest the need for updated clinical guidelines to accommodate the evolving landscape of cataract surgery.

Background: The process of oral carcinogenesis encompasses multiple proto-oncogenes and tumor suppressor genes, including p16, cyclin D1, p53, and EGFR. A significant player in this context is the TP53 gene, situated on chromosome 17p, which is susceptible to frequent mutations during human carcinogenesis. This study aims to assess the immunohistochemical overexpression of p53 in cases of head and neck squamous cell carcinoma (HNSCC) and its connection to various clinicopathologic features and survival rates. Methods: Tissue samples from head and neck lesions were fixed in formalin, processed, and embedded in paraffin. Sections were stained with Hematoxylin and Eosin (H&E) for routine diagnosis. Selective sections were stained with immunohistochemistry markers p53 and EGFR to assess their expression in squamous cell carcinoma of the head and neck. Tumors were graded according to Broder’s criteria. Results: The expression of p53 in the oral cavity was showed in 43 (66.15%) cases, out of these 3 cases (4.61%) showed strong p53 positivity,14 cases (21.53%) showed moderate p53 positivity and 26 cases (40%) showed weak p53 positivity. The expression of EGFR in the oral cavity showed in 43 (66.15%) cases, out of these, 4 cases (6.15%) were showed strong EGFR positivity,14 cases (21.53%) were showed moderate EGFR positivity and 25 cases (38.46%) were showed weak EGFR positivity. Conclusion: The clinical significance of p53 and EGFR alterations in relation to HNSCC treatment is an area of active research. However, several studies have indicated that p53 and EGFR expression represent good prognostic parameters and can be used to predict the response to chemoradiation therapy.

Background: Duodenal perforation is a surgical emergency with high morbidity and mortality if not managed promptly. It commonly results from perforated peptic ulcers, often associated with habits like smoking and alcohol consumption. Early diagnosis and intervention are critical to improving outcomes. Aim and Objectives: The study aimed to evaluate the clinical presentation, risk factors, radiological findings, intraoperative findings, complications, and outcomes of patients with duodenal perforation. Materials and Methods: This prospective clinical study was conducted on 65 patients diagnosed with duodenal perforation at a tertiary care hospital. Demographic data, clinical history, habits, radiological findings, site and size of perforation, complications, hospital stay, and outcomes were recorded. Data were analyzed using descriptive statistics. Results: The majority of patients (47.7%) belonged to the 41–50 years age group, with a male predominance (69.2%). Smoking and alcohol habits were significant risk factors (32.3%). Abdominal pain (66.2%) was the most common symptom. Pneumoperitoneum on X-ray (66.2%) and free fluid on CT (73.8%) were key diagnostic findings. The first part of the duodenum was the most common site of perforation (81.5%). Postoperative complications included wound infection (13.8%) and sepsis (6.2%). Mortality was 4.6%, and 80% of patients had a smooth recovery. Conclusion: Duodenal perforation predominantly affects middle-aged males with modifiable risk factors. Early diagnosis and surgical intervention significantly reduce morbidity and mortality.

Introduction: Cytological study plays significant role in the diagnostic modality of body fluids, in identifying atypical cells in effusions, to know the advancement of the disease process in the body. The cell block technique study for fluids has an architectural pattern, a useful method, mainly in correct diagnosis of malignancy and hence patient management and prognosis, we conducted this study, to know the incidence, etiopathogenesis of non-neoplastic and neoplastic effusions along with to assess the utility of cell block in diagnosis of neoplastic fluids. Materials and Methods: A prospective study was carried out over a period of 18 months. In our study, total of 280 cases of pleural, pericardial and peritoneal effusions which were received in department of cytology of pathology from March 2016 to Sept 2017 and assessed by Routine gross examination, Smear preparation by Cyto-centrifugation and Cell block technique. Immuno histochemistry and Chemical analysis were performed wherever necessary. Results: Out of total 280 effusions, 150 (53.57%) were peritoneal, 125 (44.64%) were pleural and 5 (1.78%) were pericardial fluids, 166 were transudates and 114 were exudates.  Maximum number of cases of serous effusion were seen in females, 162/280 cases i.e. (57.85%) and males in 118 cases (42.14%), Male: female ratio being 0.72:1. On gross examination, the commonest appearance was yellow in 133 cases (47.5%. Out of 280 samples received, 245(87.5%) were of non-neoplastic causes, while neoplastic effusion were seen in 35 (12.5%) cases. Cell block prepared in neoplastic effusions yielded high cellularity in 65% cases compared to 45.71% in conventional smears, moderate yield in 10% compared to 37.14% in conventional smear and low yield significantly reduced to 25% from 45.71% in conventional smear. Conclusion:  Conventional smear method can yield good result in all types of effusion, when combined approach to morphology with Papanicolaou (PAP) and May-Grunwald Giemsa (MGG) used. Cell block preparation is a simple and inexpensive method in obtaining better cellularity, cellular architecture, and cellular morphological details. Thus, when cell block technique and conventional smear method used in combination, definitely there is increased rate of correct diagnosis in case of malignant effusions.

Introduction: Adjuncts to local anaesthetics for brachial plexus block may enhance the quality and duration of analgesia. Midazolam, a water-soluble benzodiazepine, is known to produce antinociception and enhance the effect of local anaesthetics when given epidural or Intrathecal. Aim: The purpose of this study was to assess the effect of Midazolam added to brachial plexus block by supraclavicular approach. Materials and Methods: A prospective, randomized, double blinded study was conducted on 100 ASA I or II adult patients undergoing upper limb surgeries under supraclavicular brachial plexus block. Patients were randomly divided into two groups. Patients in Group B (n = 50) were administered 30mL of 0.375% Bupivacaine and Group BM (n = 50) were given 30mL of 0.375% Bupivacaine with Midazolam 0.05 mg/kg. The onset time and duration of sensory and motor blockade were recorded. Hemodynamic variables (i.e., heart rate, non-invasive blood pressure, oxygen saturation), sedation scores and rescue analgesic requirements were recorded for 24 hr postoperatively. Results: The onset of sensory and motor block was significantly faster in Group BM compared to Group B (P < 0.05). Rescue analgesic requirements were significantly less in Group BM compared to Group B (P < 0.05). Hemodynamics and sedation scores did not differ between groups in the post-operative period. Conclusion: Midazolam (0.05mg/kg) in combination with 30mL of Bupivacaine (0.375%) hastened onset of sensory and motor block and improved postoperative analgesia when used in brachial plexus block, without producing any adverse events.

Introduction: Postoperative pain has a significant effect on patient recovery after performing a caesarean section. The research in postoperative management has for more than two decades centered on delivery methods, pharmacotherapy with new drugs or a combination of old drugs, and organizational aspects. Aim: The aim of my study was to evaluate the effect of intrathecal ketamine (25 mg) in parturient undergoing caesarean section added with bupivacaine (0.5%) spinal anesthesia on the onset, duration, and recovery of sensory and motor block. Materials and Methods: A randomized double-blind trial was conducted among patients undergoing elective and emergency caesarean in a tertiary healthcare center. Informed consent was obtained by all participants. After applying the inclusion and exclusion criteria, 80 patients were involved in the present study and were assigned into 2 groups with 50 patients each. Baseline heart rate, blood pressure, respiratory rate and SpO₂ was measured. Nausea and vomiting, heart rate, blood pressure, analgesia requirement and return of motor function assessed every 30 minutes until complete recovery was assessed using Bromage scale and sedation was assessed using the Ramsay sedation scale. Results: Time taken for sensory level to reach T5 was found to be statistically highly significant between the two groups (p=0.000). The mean SBP, DBP and MAP was also significantly different between the two groups when reported at the 5-minute and 10-minute time points with group B showing higher pressure values (p<0.05). Duration of analgesia was 2 hours 52 minutes in group A and 3 hours 27 minutes in group B with this difference being statistically significant (p=0.000). The difference in total number of analgesia intervention administered postoperatively was not found to be statistically significant (p=0.262). Conclusion: The results obtained in the present study showed that the incidence of hypotension is drastically reduced after adding ketamine to intrathecal bupivacaine. Duration of spinal analgesia is longer with intrathecal bupivacaine plus ketamine than bupivacaine alone. There were also no side effects on neonate by adding ketamine to intrathecal bupivacaine.

Background: Many are interested in the possible consequences of the ketogenic diet on cardiovascular health and lipid metabolism because of its high-fat, low-carbohydrate, and moderate-protein composition. While some studies suggest improvements in lipid profiles, such as reductions in triglycerides and increases in HDL cholesterol, concerns remain about its impact on LDL cholesterol levels. The study expected to find out the effect of a ketogenic diet on lipid metabolism over a 4-month period in a sample of patients at Patna Medical College & Hospital, Patna Bihar. Aim: To evaluate the impact of a ketogenic diet on lipid metabolism, focusing on changes in total cholesterol, HDL, LDL, triglycerides, and the HDL/LDL ratio. Method: This was a prospective, observational study conducted from April 2024 to August 2024 at Patna Medical College & Hospital, Patna Bihar. A total of 100 patients, aged 18-60 years, were placed on a ketogenic diet (70% fat, 20% protein, 10% carbohydrates) for 4 months. Baseline lipid levels (total cholesterol, LDL, HDL, triglycerides) were measured, and follow-up measurements were taken at 2 months and 4 months. Paired t-tests and ANOVA were used to analyse lipid levels with time. Results: At the end of the study, significant reductions were observed in total cholesterol (mean decrease: 12%), LDL cholesterol (mean decrease: 10%), and triglycerides (mean decrease: 20%). HDL cholesterol levels significantly increased (mean increase: 15%). The HDL/LDL ratio also improved, indicating a more favorable lipid profile. Statistical analysis revealed significant differences in lipid levels between baseline and follow-up points (p < 0.05). Conclusion: Lipid metabolism improved with the ketogenic diet, LDL cholesterol, lowering triglycerides, and increasing HDL cholesterol. These findings imply that a ketogenic diet may improve lipid profiles and reduce cardiovascular risk. Lipid levels must be monitored continuously because individual responses, especially for LDL cholesterol, differ. Longer, control group studies are needed to corroborate these findings.

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. Thyroid dysfunction is a common disorder in pregnancy which affects both maternal and fetal outcomes. There are very less and limited data on prevalence of hypothyroidism during pregnancy from India because no such big study done till now. A total 60 cases were included in the study. The age ranged from 18 to 45 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. Subclinical Hypothyroidism were 16.66 %, Overt Hypothyroidism were 11.66 % Pregnant women.

Objectives:  This study aims to evaluate the radiological features and clinical presentation of male breast cancer (MBC), focusing on imaging findings, histopathological correlations, and the challenges of diagnosis. Methods: We conducted a retrospective analysis of male patients diagnosed with MBC between August 2020 and June 2024 at tertiary care cancer centre. All patients presented with palpable breast masses and underwent a radiological workup, including mammography, ultrasonography, and computed tomography (CT). Imaging features such as size, shape, margins, and echogenicity of the masses were reviewed, and histopathological diagnosis was obtained through biopsy or surgical resection. Results: Sixteen male patients with palpable breast masses were included. Mammographic findings revealed irregular masses with spiculated margins, while ultrasound showed hypoechoic, solid masses with irregular contours. Histopathological examination confirmed invasive ductal carcinoma (IDC) in all cases. Conclusions: MBC typically presents as a palpable retro-areolar mass, and its diagnosis is often delayed, resulting in later-stage presentations. Invasive ductal carcinoma is the predominant histological type. Early detection, through improved awareness and targeted screening, is essential for improving clinical outcomes.

Background: The wide exposure to organophosphorus compounds in India, especially in agricultural communities, results in an enormously high rate of acute poisoning mostly through deliberate ingestion. The present study aims at reviewing the histopathological changes in liver and kidneys in cases of fatal poisoning with OP compounds, with emphasis on the need for comprehensive strategies of management. Methods: This autopsy-based, retrospective study considered 100 adult patients who died due to OP poisoning from January 2018 to December 2022. Demographic data, clinical features, and biochemical parameters were obtained from case records. Both liver and kidney tissues were subjected to histopathological examination in order to assess the severity of damage to organs. Results: The majority were males with a mean age of 34 years. Presentation most cases of chlorpyrifos presented with suicidal ingestion. The average time from ingestion to presentation was 141 minutes, and there was a significant correlation between late admission and an increase in mortality. Other clinical presentations were vomiting, 60%, and miosis, 72%. The initial average of pseudocholinesterase was 1444 IU/l. Other complications like hypokalemia took place in 29% of the patients. Sepsis accounted for 8%, while hospital-acquired pneumonia accounted for 3%. Histopathological Feature The liver and kidneys showed severe damage. Conclusion: The present study highlights complexities in the management of OP poisoning and urgent need for timely medical support to the patients along with psychological. Admission timing correlation with outcome requires quick and timely intervention. Biochemical monitoring includes pseudocholinesterase level estimation, an important component of management protocol. Future studies need to be focused on management strategies and psychosocial factors which involve poisoning incidents.

Introduction: Smoking contributes to millions of deaths and continues to do so on. This study was done with purpose of assessing the knowledge and practices among smokers visiting to tertiary care hospital. Methodology: This was a cross sectional study done in in a tertiary care hospital, Gujarat from Aug-Nov 2021. Data were collected by preformed pretested Performa by taking informed consent from participants. Data entered and analyzed in Microsoft excel. Results: In this study, 91% participants were male, 54% between 36-50 years of age and 27% were from labor work.  82% of them were preferring   bidi over cigarette. Among them 66% have started smoking in early childhood between 10-20 years of age. 57% have family history of smoking and 24% were influenced by peers for smoking initiation. 79% have tried to leave the smoking. 69% were knowing ban of smoking at public places and 72% were knowing warning signs over bidi/ cigarette packs. 90% were knowing about adverse health effects of smoking. Conclusion and recommendations: Although people are well aware of effect of smoking, they still continue to smoke. A strict implementation of the law and its regular monitoring should be done in public places to prevent public from smoking.

Background: Overuse of the internet exacerbates emotional instability, stress, anxiety, and depression among medical students who are already susceptible due to pressure of performing well academically. Internet use and its association with psychopathology can be studied by using DASS- 42 (Depression Anxiety Stress Scale – 42). Our aim was to assess the prevalence of internet addiction and its association with psychopathology among medical students in a tertiary care hospital. Methods: This cross-sectional study was conducted among 400 MBBS students to determine the prevalence of internet addiction and its associated psychopathology over a period of 1 year. Assessment was made using internet addiction test [Young], the DASS-42 and socio-demographic proforma. Statistical analysis was done using SPSS version. Internet addiction was expressed as frequency and percentage. Socio-demographic values were expressed as frequency, percentage, mean, standard deviation and median. Prevalence of internet addiction and its associated psychopathology was assessed using chi square test. Probability value ‘p’ < 0.05 was considered statistically significant. Results: The prevalence of internet addiction among MBBS students was 52.75%. 33.75% had mild addiction, 12% had moderate addiction, and 7% had severe addiction. The prevalence of internet addiction was greater among females (54.16%) compared to males (50%). A higher prevalence of internet addiction was observed in the 22-year age group (61.4%). Students struggling with internet addiction exhibited symptoms of depression, anxiety, and stress, and there was a significant correlation between internet addiction and these mental health issues. Conclusion: There was a significant association between internet addiction and psychopathology (depression, anxiety, and stress) among medical students. Proactive awareness campaigns, possibly launched by academic institutions are necessary to educate medical students about the significance of limiting excessive internet use and tackling the root causes.

Background: Older man faces benign enlargement of prostate leading to bladder outlet obstruction and difficulty in urination for which more abdominal force is applied. This causes combined presence of inguinal hernia with BPH and operating both in the same sitting may reduce post operative recovery and complications. This research tries to study the same. Material and Methods: A restrospective study was conducted in Dept. Of General Surgery, Dr BS Kushwah Institute of Medical Sciences, Kanpur from 2018 to 2024 and included 95 those patients who underwent TURP and inguinal hernia repair at the same sitting. Intra-operative and post operative complications were noted. Surgical characteristics such as post operative duration of hospital stay, duration of the surgery, duration of Foleys catheterization, recatheterization, intraoperative and postoperative complications etc were evaluated. This study also tried to know the efficacy of open versus laparoscopic hernioplasty. Results: Among the 95 cases of combined approach of inguinal hernioplasty and TURP the mean operative time was 3hr 31 minutes + 53 minutes with only 3 (3.2%) operative complications and no post operative stay complications. Mean post operative hospital stay was 3.5+ 1.0 days, recatheterization was in 11(11.6%) and 11(11.6%) discharged with Folley catheter. The mean operative time, duration of hospital stay, duration Folleys catheterization, analgesic and antibiotic use was significantly lesser (p<0.05) with laparoscopic hernioplasty compared to open hernioplasty. Conclusion: Surgical outcome of TURP and concomitant inguinal hernioplasty is better in terms of complications, operative and post operative recovery and patient morbidity is concerned. Even the efficacy of laparoscopic hernioplasty, in view of patient morbidity, is found to be better than open hernioplasty. So combined surgery i.e. TURP and hernioplasty specially laparoscopic hernioplasty is a better option than both surgeries done at interval.

Objectives: The present study was to evaluate the risk factors associated with myocardial infarction in men and women general population in northern Bihar, India. Methods: The diagnosis of myocardial infarction was no longer than 2 months until the survey was conducted (the meantime interval between diagnosis and interview of cases was ± 2 weeks). Controls were without anamnestic or diagnostic data for myocardial infarction. A total of 200 participants were recruited in the study. Among them, 100 newly diagnosed patients were with myocardial infarction and 100 subjects were controls. We investigated the following risk factors: occupation, education level, marital status, family history, psychosocial distress, body mass index, blood pressure, cholesterol level, diabetes mellitus, smoking status, alcohol use, nicotine consumption, personal medical history, stressful events, and menopause. All the risk factors were obtained using structured questionnaires administered by study personnel. Results: Most of the patients 67% were in age group of 50 to 70 years. Majorities 65(65%) were males. Majorities of the participants (63%) were belonged from urban areas. Among men, a higher proportion of cases than controls had body mass index ≥25 kg/m2 (p<0.0001), stressful events (p = 0.017), family history of myocardial infarction (p = 0.003), diabetes mellitus (p = 0.009), hypertension (p = 0.014), hypercholesterolemia (p = 0.007), olde age group>50 (p=0.026), smoking p=0.038), nicotine consumption (p=0.003) and alcohol use (p=0.012). Among women, a higher proportion of cases than controls had diabetes mellitus (p = 0.011), and menopause (p =0.000), nicotine consumption (p = 0.032), hypertension (p = 0.003) and hypercholesterolemia (p = 0.041). Conclusions: Myocardial infarction is greatly seen in men as compared to women. older age population has greater risk to myocardial infarction. Hypertension, diabetes mellitus, hypercholesterolemia and nicotine consumption are greater risk factors of MI in both sexes (men & women). While, obesity, stressful event, family history of MI, alcohol consumption and smoking are the most common risk factors of MI in men. Other hand, menopause, use of oral contraceptive are the most common risk factors of myocardial infarction in women. Hence, risk factors of MI are associated with sex differences. So that, further research is needed to re-evaluate the prevalence of shared and independent risk factors of MI in the general population. There is also a need for continuous re-evaluation of the hazards associated with the presence of risk factors, and how these are affected by gender and sex.

Background: Thyroid nodules are common. Their clinical significance lies in the need to rule out malignancy, which accounts for 4.0% to 6.5% of all nodules, assess their functional status, and determine the presence of any pressure symptoms. The use of advanced and highly sensitive imaging techniques has led to an increased detection rate of incidental thyroid nodules in recent years. This study evaluated the efficacy of high-resolution sonography in cases of thyroid nodules presenting to our hospital. Methods: Thyroid nodules were examined on SIEMENS ACUSON 300 machine via a 5-10 MHZ linear probe. Sonographic findings of each thyroid nodule were assessed just before the FNA examination. USG and pathological findings were blinded to each other. Nodules were evaluated for their size, shape, margins, echogenicity, presence of calcification, presence of peri lesional halo, and internal composition. The margins were smooth or irregular, the shape was lobulated or round and echogenicity was iso, hypo, or hyperechoic regarding thyroid. Results: This study of 135 thyroid nodules in 100 patients (91 female, 9 male) evaluated ultrasound (USG) features for malignancy prediction. Histopathology confirmed 18.5% as malignant. Smooth margins (98% specificity) and predominantly cystic content (98.5% NPV) strongly suggested benignity. Poorly defined margins, calcifications, absent/thick halo, and marked hypoechogenicity were more frequent in malignant nodules, though with varying sensitivity and PPV. Combining USG features, as in TIRADS, proved crucial for accurate risk stratification, with high NPVs aiding in ruling out malignancy. Conclusion: Grayscale USG findings proved valuable in identifying clinically significant thyroid nodules and distinguishing between malignant and benign ones. Our study highlighted that malignant nodules commonly exhibited features such as poorly defined margins, microcalcifications, marked hypoechogenicity, and cystic predominance, all of which demonstrated high diagnostic accuracy.

Objectives: The present study was to evaluate the risk factors associated with myocardial infarction in men and women general population in northern Bihar, India. Methods: The diagnosis of myocardial infarction was no longer than 2 months until the survey was conducted (the meantime interval between diagnosis and interview of cases was ± 2 weeks). Controls were without anamnestic or diagnostic data for myocardial infarction. A total of 200 participants were recruited in the study. Among them, 100 newly diagnosed patients were with myocardial infarction and 100 subjects were controls. We investigated the following risk factors: occupation, education level, marital status, family history, psychosocial distress, body mass index, blood pressure, cholesterol level, diabetes mellitus, smoking status, alcohol use, nicotine consumption, personal medical history, stressful events, and menopause. All the risk factors were obtained using structured questionnaires administered by study personnel. Results: Most of the patients 67% were in age group of 50 to 70 years. Majorities 65(65%) were males. Majorities of the participants (63%) were belonged from urban areas. Among men, a higher proportion of cases than controls had body mass index ≥25 kg/m2 (p<0.0001), stressful events (p = 0.017), family history of myocardial infarction (p = 0.003), diabetes mellitus (p = 0.009), hypertension (p = 0.014), hypercholesterolemia (p = 0.007), olde age group>50 (p=0.026), smoking p=0.038), nicotine consumption (p=0.003) and alcohol use (p=0.012). Among women, a higher proportion of cases than controls had diabetes mellitus (p = 0.011), and menopause (p =0.000), nicotine consumption (p = 0.032), hypertension (p = 0.003) and hypercholesterolemia (p = 0.041). Conclusions: Myocardial infarction is greatly seen in men as compared to women. older age population has greater risk to myocardial infarction. Hypertension, diabetes mellitus, hypercholesterolemia and nicotine consumption are greater risk factors of MI in both sexes (men & women). While, obesity, stressful event, family history of MI, alcohol consumption and smoking are the most common risk factors of MI in men. Other hand, menopause, use of oral contraceptive are the most common risk factors of myocardial infarction in women. Hence, risk factors of MI are associated with sex differences. So that, further research is needed to re-evaluate the prevalence of shared and independent risk factors of MI in the general population. There is also a need for continuous re-evaluation of the hazards associated with the presence of risk factors, and how these are affected by gender and sex.

Background: Arrhythmic events are one of the leading causes of death in patients after myocardial infarction.   Repolarization abnormalities on the surface ECG has been associated with increased arrhythmic risk. We sought to investigate the effect of reperfusion, on Tpeak- Tend interval (TpTe), a marker of repolarization and also its predictive value for 30 day mortality, heart failure and arrhythmias. Objectives: We aimed to analyze the effect of reperfusion of infarct related artery on the TpTe interval determined on the surface 12 lead ECG. We also studied the association of Major adverse cardiac events (MACE) with repolarization abnormality in the ECG. The correlation between TpTe interval and QT dispersion was also determined. Methods: Patients with new onset STEMI treated with thrombolysis or primary/ rescue PCI were included. Digital ECGs at 50 mm/sec speed and 20 mm/mV gain filtered at 0.50–150Hz were taken before and after reperfusion therapy. TpTe interval was measured in leads with limited ST-segment deviation and so also the QTc. Echocardiography was done before hospital discharge for all patients. Angiographic parameters of patients undergoing primary or rescue PCI were recorded.  All patients were followed up at 30 days. Results: From June 2022 to October 2024, total of 216 patients were included of which 183 were males (85.1%). The mean age was 54.86 years (range 24-80 years). One hundred and thirteen patients underwent primary PCI (52.3%), 57 underwent lysis (26.4%) and remaining 46(21.3%) had rescue PCI.  Thirty day Mortality was 5.1 % (11 patients). The median pre TpTe interval was 84.5ms and the 25th, 50th and 75th percentiles were 80, 84 and 100 ms respectively. The median post TpTe intervals were 76.7ms (64, 76.7 and 80ms), 75ms (60, 75 and 80ms) and 73.3ms (66.7, 73.3 and 80ms) respectively in the primary PCI, thrombolysis and rescue PCI groups. There was statistically significant reduction in TpTe interval at 90 minutes following reperfusion (p values of 0.0001, 0.0001 and 0.004 respectively). This reduction was uniformly seen in all the treatment arms. Of the 216 patients, 210 were followed up at 30 days. Six patients were lost to follow up. Eleven patients died 11(5.1%) patients had died. The pre TpTe interval of more than 100 ms was associated with increased risk of ventricular arrhythmias (OR 13.21, 95% CI 1.16 – 150.57). However, it did not predict mortality at 30 days (OR – 1.405, 95% CI – 0.288 – 6.842) or heart failure in the 8 patients at follow up. (OR 2.14, 95% CI 0.412-11.148). There was no correlation between the TpTe interval and QTc dispersion. After adjusting for established risk factors, TpTe interval difference (pre – post) was found to be significantly associated with duration of chest pain and Killip class. Conclusion: In patients with STEMI undergoing reperfusion, the  TpTe interval was significantly reduced after reperfusion therapy (either primary PCI or thrombolysis). Pre- reperfusion TpTe predicted the risk of arrhythmias at 30 days. However, it did not predict subsequent all-cause mortality and heart failure at 30 days. QT dispersion did not correlate with changes in TpTe interval at 90 minutes following reperfusion.

Giant cell tumor of bone (GCTB) is a benign but locally aggressive lesion, typically affecting skeletally mature individuals. While it commonly presents in the epiphysio-metaphyseal regions of long bones, it’s imaging features, location variability, and potential for aggressive behavior can make diagnosis and management challenging. This study evaluates the radiological characteristics of GCTB using X-ray, CT, and MRI imaging modalities, with a focus on common and uncommon presentations, as well as the differential diagnosis from other benign bone tumors.

Background: Opioid-free anesthesia (OFA) involves a combination of methods aimed at minimizing opioid use perioperatively to mitigate opioid-related adverse effects while preserving patient comfort. This study seeks to evaluate and compare the effects of opioid-free anesthesia (OFA) versus opioid anesthesia (OA) in patients undergoing surgical procedures for head and neck cancer. Materials and Methods: 88 patients scheduled for head and neck cancer surgeries were randomly assigned to two groups: the opioid anesthesia (OA) group and the opioid-free anesthesia (OFA) group (44 each). Patients in the OFA group received intravenous (IV) lignocaine at 1.5 mg/kg, IV dexmedetomidine at 0.5 mcg/kg, and IV ketamine at 0.5 mg/kg. Meanwhile, those in the OA group were administered IV fentanyl at 2 mcg/kg. Hemodynamic parameters were continuously monitored intraoperatively, with post-operative assessments of analgesic use and visual analog scale (VAS) scores for pain conducted over a 24-hour period. Any side effects were also recorded. Results: Hemodynamic stability, VAS scores, and analgesic requirements were similar between the two groups, showing no statistically significant differences. However, the need for propofol was notably reduced in the OFA group. Conclusion: The results of this study indicate that the OFA protocol is a safe, effective, and satisfactory approach that could serve as an alternative to opioid-based anesthesia during induction for patients undergoing head and neck cancer surgeries.

Background: Urinary tract infection (UTI) is identified by the presence of both pyuria and at least 50,000 colo-nies/ml of a single uropathogenic organism in an appropriately collected specimen of urine. In infants, the only presentation of UTI shows non-specific signs such as irritability, feeding poorly, vomiting, sleeping more, or showing signs of jaundice. Method: 60 infants admitted for fever were studied. Symptoms were increased frequency of micturition, crying while voiding, and pyuria. General and systemic examinations were done to rule them out. Phimosis, vulvular synechiae, and suprapubic mass, renal mass, dysmorphic features, and associated congenital anomalies were observed. A provisional diagnosis was done mainly based on signs and symptoms. Routine urine analysis, mi-croscopic analysis of urine, and urine culture were carried out. Positive patients were further examined by USG and MCU, and a differential diagnosis was also done to confirm the UTI. Results: 60 (100%) fever, 23 (38.3%) vomiting, 34 (56.61%) irritability, 42 (70%) failure to thrive, 8 (13.31%) jaundice, 13 (21.1%) convulsion, 18 (30%) gastroenteritis, 15 (25.7%) fever without focus, 8 (13.3%) URTI, 11 (18.3%) UTI, 5 (8.33%) septicaemia, and 3 (3%) bronchitis. The highest antibiotic sensitivity of the organism growing in the urine culture sample was 54 (90%) amikacin, followed by 43 (71.6%) laxacin, 35 (58.3%) nor-floxacin, 25 (41.6%) gentamicin, and the least was 6 (10%) ceftriaxone. Conclusion: Urine culture should be an essential part of the evaluation of febrile infants with no longer signs for proper diagnosing of UTL.

Background: Cellulitis is an acute bacterial infection of the dermis and associated with subcutaneous tissue. It is difficult to diagnose because there are no exact criteria or any specific blood culture for cellulitis. Hence diagnosing and treating cellulitis is a clinical challenge for surgery. Method: 85 adult patients were studied with demographic data. Blood examination included RBS, CBC, LFT, RFT, urine culture and sensitivity, and microbiological profile. Radiologically, chest X-ray, USG abdomen + pelvis, local USG with colour Doppler X-ray of the affected limb, and CECT. Vital signs of every patient were noted. Initially treated with conservative treatment, if not responded to conservative treatment, surgical approach was carried out with fasciotomy with debridement. Results: 42 (49%) were treated conservatively, and 43 (50.5%) with surgical intervention; risk factors were 41 (48.2%), 30 (35.2%) toe with web infection, 7 (8.2%) venous insufficiency, 6 (7%) diabetic, 1 (1.1%) chronic lymphedemous, and 79 (92%) had good results, and 4 (4.7%) had poor skin grafting, and 2 (2.3%) patients expired. Conclusion: The cellulitis of the lower limb in diabetic patients had the most common risk factors. Appropriate conservative treatment and emergency surgical intervention with hospital admission. Treating with culture-directed antibiotics can prevent morbidity and mortality.

Background: Infertility in females is one of the major problems in developing countries. The hormones like TSH and prolactin play vital roles in reproduction and sexual life. The abnormal secretion of these hormones leads to infertility in females. Method: 45 primary and 45 secondary infertile women were studied. Complete hemogram, USG abdomen and pelvis and HSG were done. The thyroid function test and prolactin hormone were studied using the Beckman-Coulter Access-II method in every patient. Age distribution and hormone levels in both the primary and secondary groups in fertility were compared. Results: Prolactin hormone levels were 0-20 ng/ml in 19 (42.2%) in group A and 28 (62.2%) in group B, and 21-100 ng/ml in 26 (57.8%) and 16 (35.6%) in group B. >100 ng/ml was zero in group A and 1 (2.2%) in group B. In TSH study, < 0.4mIU/ml in 4 (8.9%) in group A and 3 (6.7%) in group B; 0.4-4.7mIU/ml in 31 (68.9%) in group A and 37 (82.2%) in group B; > 4.7mIU/ml in 10 (22.2%) in group A and 5 (11.1%) in group B. Conclusion: It is observed that, variations in TSH and prolactin hormones leads to infertility in females.

Mature teratomas, although commonly documented in pediatric and young adult populations, can manifest in various rare anatomical locations, posing significant clinical challenges. Understanding the spectrum of their presentations and outcomes is essential for effective diagnosis and management. The purpose of this study was to explore the occurrence, presentation and treatment outcomes of mature teratomas located at unusual sites, contributing to the limited body of knowledge on these rare cases. This was a retrospective analysis conducted at a tertiary care center in Central India, reviewing cases over a five‐year span. Patients diagnosed with mature teratoma at unconventional sites were included. Data regarding age, sex, clinical presentation, tumor site and histopathological features were collected and analyzed. Twelve cases were analyzed, involving sites such as the alveolar ridge of the mandible, left parotid, lateral neck, posterior mediastinum, stomach and retro peritoneum. The age of patients ranged from 4 days to 7 years, with a slight male predominance. All cases underwent surgical excision, with histopathology confirming mature teratomas. Postoperative follow‐up, ranging from 5 months to 6 years, showed no recurrences, indicating successful treatment outcomes. Mature teratomas can present in a variety of rare sites and require a comprehensive diagnostic and surgical approach for effective management. The diversity in their presentation emphasizes the need for awareness among clinicians and pathologists, who play a pivotal role in diagnosis and prognostication.

Introduction: Acute Respiratory Infections (ARIs) are a significant cause of morbidity and mortality among children under five years of age. ARIs can range from infections in the upper respiratory tract to severe conditions affecting the lungs. According to the WHO, ARI is characterized by rapid or difficult breathing in children. In India, ARIs account for a substantial percentage of child mortality, with prevalence varying across urban and rural areas. Objective: The primary objective of this study was to estimate the proportion and determinants of Acute Respiratory Infections among children under five years attending the immunization clinic at Burdwan Medical College and Hospital. Materials & Methods: A cross-sectional descriptive study was conducted at Burdwan Medical College and Hospital. Data were collected from mothers/caregivers of children under five years old using a semi-structured pretested schedule. Convenience sampling was used, with 105 participants who provided informed consent. Data analysis was done using Microsoft Excel, and ethical approval was obtained from the institutional ethics committee. Results: The study found that 59% of the children had experienced at least one episode of ARI. Males represented 61.9% of the participants. Significant determinants of ARI included smoking in the household (59%), rural residence (57.14%), and exposure to cooking smoke. Fully immunized children constituted 59.04% of the sample, and a majority of children experienced 0-2 episodes of ARI. Conclusion: The high prevalence of ARI, especially in rural areas and among children exposed to secondhand smoke, highlights the need for targeted interventions to reduce risk factors. Immunization plays a crucial role in mitigating ARI incidence. The study recommends increased public health awareness on ARI risk factors and the importance of full immunization.

Background: Laparoscopic cholecystectomy offers reduced morbidity, pain, and quicker recovery. Effective pain treatment reduces risks of complications like pulmonary embolism, deep vein thrombosis, pneumonia, and atelactasis. Bupivacaine (a local anaesthetic class of drug), has shown promising results in managing postoperative discomfort following laparoscopic cholecystectomy. Tramadol, an opioid analgesic, has been found to control moderate to severe postoperative pain in patients with day surgery and inpatients. Clonidine, an alpha-2-adrenergic analgesic, can be combined with local anaesthetics to increase sensory and motor blocking effects without causing opioid side effects. Aim: The study compares the effectiveness of bupivacaine with tramadol and bupivacaine with clonidine for postoperative analgesia in patients undergoing laparoscopic cholecystectomy. Materials and Methods: The study was a double-blind, randomized prospective investigation involving 90 patients divided into two groups (45 each group) aged 18-60 years who underwent laparoscopic cholecystectomy belonging to ASAPS 1 and 2. Group A (bupivacaine with tramadol), Group B (bupivacaine with clonidine). Hemodynamic changes and post-operative pain scores were recorded and statistical analysis performed. Results: The study found no significant differences in gender, age, ASA grade, weight, height, or operation duration between the two groups. The mean diastolic blood pressure, mean arterial pressure, and heart rate were comparable across the groups. Conclusion: The study reveals that clonidine and bupivacaine offer superior postoperative analgesia during laparoscopic cholecystectomies without significant differences in hemodynamic parameters, indicating the need for further research on optimal drug concentration.

Introduction: Subarachnoid blocks are cost-effective, patient-conscious, and quick postoperative pain management methods. Spinal anesthesia is preferred for lower abdominal procedures due to its ease of administration. Research on extending spinal anesthetic duration with adjuvants like Dexmedetomidine and Tramadol aims to prolong benefits and reduce side effects. A prospective trial aims to evaluate these analgesic effects and postoperative analgesia. Aim: The study assesses the efficacy of dexmedetomidine and tramadol as adjuvants to 0.5% bupivacaine heavy in infraumbilical elective surgery, comparing sensory and motor blockage, analgesic duration, and hemodynamics. Material and Methods: The study was a hospital-based comparative observational study involving 80 participants aged 18-60 who underwent spinal anesthesia for a spinal procedure. Patients were divided into two groups: Group A received Dexmedetomidine and Group B received Tramadol. The study involved pre-anaesthetic clinic evaluations, intravenous infusions, and monitoring for cardiac and respiratory parameters. Symptoms included illness, vomiting, itching, trembling, listlessness, low blood oxygen levels, and respiratory depression. Results: The study compared two groups of elective infraumbilical surgery patients at G.S. Medical College & Hospital in Hapur for 15-18 months. Both groups had similar characteristics, including higher age, lower AS level, and shorter procedure times. Results showed that both groups experienced similar systolic and diastolic blood pressure levels, sensory block, and post-operative blocks. Discussion: A comparative observational study compared patients receiving 0.5% bupivacaine heavy, dexmedetomidine, or tramadol as an adjuvant over 15-18 months at G.S. Medical College & Hospital in Hapur. Both groups experienced a rise in systolic blood pressure and remained within a healthy range. Dexmedetomidine provided better sedation, while tramadol had common adverse effects like nausea, vomiting, and dry mouth. Conclusion: The combination of bupivacaine and dexmedetomidine for spinal anesthesia prolongs analgesia duration, delays sensory and motor block onset, and provides stable hemodynamic outcomes, potentially referencing future research.

Introduction: Laparoscopic cholecystectomy, performed by German doctor Dr. Med Erich Muhe in 1985, can cause anxiety and postoperative pain. Postoperative pain management is crucial, with analgesics like melatonin, gabapentin, and clonidine being effective. Gabapentin, an anticonvulsant, and clonidine, have shown potential as pain relievers, but caution should be exercised for complex seizures and early symptoms. Aim: The study evaluates the efficacy of oral Gabapentin and Clonidine in postoperative pain relief in laparoscopic cholecystectomy patients, considering factors like time to first rescue analgesia request, hemodynamic variations, and adverse effects. Results: A study comparing oral gabapentin and clonidine in treating post-operative pain in elective laparoscopic cholecystectomy patients found both effective. The study divided 100 patients into two groups, with females more common. Hemodynamic parameters were analyzed, showing no significant difference between the groups. The study found that clonidine experienced higher pain scores, while gabapentin experienced a greater reduction. The time it took for both groups to reach the first analgesic dosage was also significant. Side effects were comparable. Discussion: A study comparing the efficacy of oral gabapentin and clonidine in postoperative pain relief in individuals undergoing laparoscopic cholecystectomy found that gabapentin was more effective than clonidine. The study involved 100 patients, divided into two groups: Group A received 600mg of gabapentin and Group B received 4mcg/kg of clonidine two hours prior to surgery. Both groups experienced a drop in mean SBP after 50 minutes of anesthesia, a rise in mean diastolic blood pressure, MAP, and heart rate after 60 minutes, and comparable hemodynamic variables. The study’s limitations include the absence of perioperative monitoring of stress mediators, exclusion of the elderly population, and subjective post-operative pain. Conclusion: Both clonidine and gabapentin maintain analgesia during surgery, but gabapentin is more effective and doesn’t cause adverse effects, requiring further large-scale trials for better understanding.

Introduction: Pediatric femur fractures require hospitalization, but a flexible intramedullary nail stabilizes diaphyseal fractures. Long-term follow-up data is limited in children aged 6-15 years. Aim: This study assessed the efficacy of Titanium Elastic Nailing in surgically treating pediatric femoral shaft fractures and assessed the anatomical and functional outcomes of pediatric patients. Material and Method: A prospective clinical trial was conducted at GS Medical College and Hospital in Hapur, Uttar Pradesh, involving 35 pediatric patients with closed shaft femur fractures without intra-articular extension. Result: The study found that 60% of subjects had excellent TENS outcomes, while 28.57% had satisfactory outcomes and 11.43% had poor outcomes. Conclusion: Titanium Elastic Nails (TEN) are effective in treating pediatric femoral fractures due to their quick recovery and minimal impact on bone development.

Background: The PFNA-2 implant is designed specifically in the treatment of unstable intertrochanteric fractures for the Asians, since the implant designed in the case for Caucasians was presented with numerous complications when on application to the Asian population due to the mismatch in femoral geometry. The study intends to explore the efficacy of PFNA-2 for the treatment of intertrochanteric fractures in elderly Indian patients needs to be assessed to determine its usefulness. Gait analysis using simple Helen Hayes Protocol of 3-D Gait analyser was employed as a valuable tool for evaluating the effectiveness of PFNA-2 in treating intertrochanteric fractures in elderly Indian patients. By assessing gait parameters such as stride length, walking speed, and cadence, researchers can determine if the implant has improved the patient’s ability to walk and perform daily activities. Gait analysis can also help identify any complications or issues that may arise post-surgery, allowing for early intervention and improved outcomes. Methods: The present investigation governing the postoperative assessment was conducted among Orthopaedics inpatients and outpatients from Jawaharlal Nehru Medical College, KAHER, and Belagavi India. The study population comprised of ITF patients who underwent PFNA-2 and were taking part in the post-operative assessment of spatiotemporal parameters recorded using 3-D Gait analyser (via employing Helen Haley’s protocol) conducted between January 2021 to December 2021. Helen Hayes method was adopted for monitoring the spatiotemporal parameters. Statistical analysis was conducted using SPSS (Version 19), for analysis of the data rendered. Results: The results showed that the average time taken for one stride was 0.852 seconds, with a range from 0.66 to 1.01 seconds, and a relatively low standard deviation of 0.0784 seconds. Stance Time, which is the time spent with the foot in contact with the ground during one stride, had an average of 0.656 seconds. Swing Tim with an average of 0.456 seconds. Single Support Phase, which is the time spent with one foot in contact with the ground during one stride, had an average of 38.25% of the stride cycle, with a range from 36.12% to 40.2%, and a standard deviation of 0.827%. And the double Support Phase reported with an average of 10.927% among the study population. The mean value reported for Cadence was 106.86 steps/min. Conclusion: From the achieved outcome it could be inferred from the overall gait analysis showed better functional outcome, thereby indicating surgical efficacy of PFNA-2 among elderly population in India.

Introduction: Modern anesthesia techniques such as laryngoscopy and endotracheal intubation can temporarily elevate hemodynamic parameters such as blood pressure and heart rate in patients with pre-existing cardiovascular or neurological problems by inducing sympathetic activity. Aim: The purpose of this study is to determine the reduced cardiovascular changes to laryngoscopy and endotracheal intubation with intravenous Esmolol. Materials & Methods: Following approval from the hospital ethical committee and the acquisition of written informed consent from patients, the study included 50 patients with ASA I/II physical status scheduled for surgical procedures. Patients were divided into two groups. Group A (control) received 10 ml of 0.9% normal saline, while group B received 1mg/kg of esmolol intravenously over a period of 2 minutes prior to induction. Patients were monitored using pulse oximetry, NIBP, and ECG. Results: The study analyzed the effects of esmolol on heart rate and blood pressure in different groups. The control group A experienced a significant increase in heart rate from laryngoscopy and intubation up to 5 minutes post-intubation, while the B group experienced a decrease before and an increase post-intubation. Systolic blood pressure rose during laryngoscopy and intubation, with significant increases observed at 1, 3, and 5 minutes. Systolic blood pressure decreased in group B, while diastolic blood pressure increased significantly during laryngoscopy and intubation. No discernible changes were observed in systolic blood pressure. Conclusion: Esmolol, given two minutes prior to induction, significantly mitigates cardiovascular responses associated with laryngoscopy and intubation.

Background: A CT scan distinctly reveals the structural differences of concha bullosa (CB) and deviated nasal septum (DNS) in many cases. These changes may, however, induce mechanical obstruction in the drainage channel, leading to sinusitis. Objective: Therefore, we performed a retrospective CT-based study to evaluate the influence of CB and DNS on chronic rhinosinusitis (CRS). Materials and Methods: This retrospective cross-sectional study involved 147 patients at the Department of Otorhinolaryngology in a tertiary care institution in Mumbai. We examined the CT scan reports of individuals with chronic sinusitis to find all variations of CB and DNS. Results: Among 147 patients, 68 (46.3%) had CB, including 11 (7.4%) with bulbar CB, 5 (3.4%) with widespread CB, and 52 (34.4%) with lamellar CB. 124 patients, or 84.9% of the total cohort, had DNS. Of these, 46% exhibited left-sided DNS, whereas 54% displayed right-sided DNS. In our study, we identified CB in 17 (34%) of the 50 frontal sinusitis cases, 49 (46.23%) of the 106 maxillary sinusitis cases, 27 (43.55%) of the 62 ethmoidal sinusitis cases, and 12 (33.33%) of the 36 sphenoidal sinusitis cases. Every variant of sinusitis exhibited an increased prevalence of right-sided DNS. We observed no statistically significant correlation between CB and DNS, nor between CB and CRS, nor between DNS and CRS, aside from frontal sinusitis. Conclusion: CRS is a complicated disease with many causes. Differences in anatomy, like concha bullosa and deviated nasal septum DNS, play a big part in how it starts and how long it lasts. This study seeks to elucidate the clinical significance of these discrepancies and their potential impact on patient management by analyzing CT scans in relation to CRS. We advocate the concurrent assessment of the complex etiology and anatomical differences contributing to CRS.

Background: The inflammatory reaction to harmful particles or gases, especially those associated with tobacco smoking, and the continuous airway blockage characterize chronic obstructive pulmonary disease (COPD), a progressive respiratory illness. Aim: To investigate the concentrations of cytokines in individuals with chronic obstructive pulmonary disease. Materials & Methods: The investigation was conducted at the Hind Institute of Medical Sciences, located in Sitapur, India, specifically in the Mau Ataria region. This study involving 200 participants, including a COPD group and a healthy control group, quantified cytokines in serum using a multi-analyte ELISA Array kit. Results showed 6.3% variation between tests and 4.9% variation between duplicates, with 0.5 pg/mL as the sensitivity level. Results: COPD patients have higher levels of TNF-α and IL-1 compared to apparently healthy controls. Healthy controls have greater weight, IL-2, and IL-15 levels. IL-2, IL-4, and IL-15 levels are significantly different between the control and COPD groups. In apparently healthy individuals, there is a positive correlation between BMI and IL-2 levels, while a negative correlation exists between blood weight and IL-15 levels in COPD patients. Conclusion: The study emphasizes the role of inflammatory cytokines in COPD development, suggesting their use as biomarkers for early diagnosis of secondary diseases in COPD patients.

Background: Stomas may be ‘permanent’ which are created indefinitely or ‘temporary’ which can be closed later. In case of intestinal perforation and obstruction, it is always a difficult decision for a surgeon to create a stoma for fecal diversion. Intestinal stoma surgery is lifesaving procedure, as a surgeon we should cope with emotional and functional impairment that a patient undergoes intestinal stoma surgery particularly in the early postoperative period. This is why any recommendation and suggestions in the management of stoma, or change in surgical technique, which seem to have merit should be accepted by patient, attenders, nursing staff and surgeon and hence is the need for study on indications & complications of intestinal stomas and their management. Objectives: To study indications and various complications of intestinal stomas. Methodology: From November 2018 to June 2020, 61 patients from the general surgery, surgical gastroenterology, and pediatric surgery departments of RD Gardi Medical College Ujjain participated in the study. The study aimed to determine the many kinds of intestinal stomas and their indications, as well as the different consequences that were experienced and how they may be reduced and better controlled. The study included all patients undergoing stoma creation, male and female, up to the age of 70. Results: The age group of 30 to 40 years old had the highest number of cases. It demonstrates a highly significant correlation (p <0.01) between the patient’s age and the stoma construction. Most people in the 30- to 40-year-old age range are at risk of having a loop ileostomy. 61 patients’ lengths of hospital stays were examined; the majority (72.1%) spent between 10 and 20 days in the hospital. Skin excoriations were the most frequent consequence seen during stoma construction (45.9%), followed by laparotomy wound infection (13.1%). It demonstrates a substantial correlation (p <0.05) between the indication for a stoma and difficulties resulting from its construction. Conclusion: Most of the patients underwent stoma as an emergency procedure rather than elective procedure. Duration of hospital stay was approximately 10-20 days, even prolonged when complications occurred. The most common indications for stoma construction were hollow viscous perforation and enteric fever. Most common stoma constructed was loop ileostomy followed by end ileostomy. There is high incidence of peristomal complication related to that. The complications are better managed with proper preoperative planning and effective stoma care in post-operative period.

Background: Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide. Accurate assessment of coronary artery diameters is essential for diagnosing significant stenosis and planning interventional procedures. Traditional quantitative coronary angiography (QCA) has been the gold standard for measuring vessel diameter, yet color Doppler mapping (CDM) techniques have emerged as an alternative non-invasive or less invasive modality for vessel diameter quantification. Methods: This prospective, observational study included patients (n = 120) undergoing coronary artery evaluation. Each participant underwent both CDM and QCA for the assessment of coronary artery diameter in the proximal, mid, and distal segments of major coronary arteries. Data were collected regarding vessel diameters, degree of stenosis, and correlation between the two methods. Statistical analysis involved Pearson correlation tests and Bland-Altman plots to compare agreement. Results: Strong correlations (r = 0.88–0.93) were observed between CDM and QCA measurements across all segments of the major coronary arteries. In the proximal segments, mean diameter measured by QCA was 3.42 ± 0.45 mm, compared to 3.36 ± 0.47 mm by CDM. The difference in mid and distal segments followed a similar trend. Bland-Altman analyses demonstrated a mean difference of 0.05 mm (95% CI: –0.11 to 0.21 mm). Interobserver and intraobserver variability for CDM were both low (<5%), suggesting high reproducibility. These findings indicate that CDM provides clinically reliable vessel diameter measurements closely matching QCA. Conclusion: Color Doppler mapping holds promise as a feasible, accurate alternative to QCA for coronary artery diameter measurement. The strong correlation between both methods suggests the potential utility of CDM in routine clinical practice, offering a less invasive tool for monitoring CAD progression and guiding therapeutic strategies.

Background: T-tube drainage was once the standard procedure following a surgical choledochotomy, however some centers now prefer to primarily shut the common bile duct. The purpose of this study was to compare the clinical results of primary closure with T-tube drainage after open choledocotomy and assess the safety of primary closure for possible future usage. Materials and Methods: The Department of General Surgery at the Central Indian Tertiary Care Medical College and Hospital served as the study’s site. Of the 35 patients in this trial, who ranged in age from 25 to 70, 15 (Group-A) had primary closure, and 20 (Group B) had T-tube implantation. Purposive, quasi-experimental, non-probability sampling was employed. The main outcome measures were postoperative complications, subhepatic drainage, operating time, and length of hospital stays. SPSS software was used to analyze the data. P values below 0.05 were regarded as statistically significant. Result: Patients in Group A spent an average of 4.11 days in the hospital, whereas those in Group B spent an average of 6.20 days. The overall rate of complications in Group-A was 53.3%. No re-examination was required in Group-A. Overall, Group B had 90% of the complications. Conclusion: In India, primary closure of the common bile duct (CBD) is a safe and cost-effective substitute for standard T-tube drainage following an open choledocotomy.

Background: Approximately 4 to 5% of all fractures are proximal humerus fractures. After hip and distal radius fractures, these are the third most frequent fractures in the senior population. In the case of proximal humerus fractures, there are still disagreements over whether conservative or surgical management is preferable. Numerous surgical procedures are performed. Locking plates are the next big thing in internal fixation. The purpose of this study is to assess the functional result and complications of open reduction treatment for proximal humerus fractures. Internal fixation using proximal humerus Interlocking plate. Methods: This prospective study was conducted in Department of Orthopaedics, SKMCH, Muzaffarpur, and Bihar from March 2024 to August 2024. Total 30 patients involving who were above18 yrs of age with proximal humerus fractures treated by open reduction, and internal fixation with locking plate were evaluated. Results: The majority of the patients in this study were elderly males, and the most common mode of injury was a slip and fall. The patients suffered two-part and three-part fractures of the proximal humerus, which united in an average of 14 weeks, with 28 cases (93.3%) having excellent and satisfactory results according to Neer’s criteria. Conclusion: As long as the patient followed a physiotherapy regimen and the parts underwent nearly normal anatomical reduction, the open reduction internal fixation of proximal third humeral fractures using PHILOS plating resulted in excellent to satisfactory outcomes and patient satisfaction.

Background: Long bone compound fractures remain a challenge for the treating surgeon despite many advancements. Standard wound dressings had poor patient compliance, required a long time, required repeated debridement, and caused trauma to granulation tissue. Vacuum-assisted closure provides an extremely efficacious method for treating difficult wounds. The purpose of this study was to examine the results of vacuum-assisted closure for open tibia fractures. Methods: This observational study was conducted at Department of Orthopaedics, SKMCH, Muzaffarpur, Bihar from March 2024 to August 2024 on patients who were older than eighteen, hemodynamically stable, and had open tibia fractures (G.A. II, IIIA, and IIIB) that had undergone primary internal fixation and vacuum assisted closure (VAC). Results: The mean age of the 30 patients in this study was 41.34 ± 14.56 years, with the majority (83.33%) being male. From the second day of the post-operative period, VAC dressings were applied every four days; 15 cases (50%) had five VAC dressings applied, 10 cases (33.33%) had four VAC dressings applied, and 5 cases (16.67%) had more than five VAC dressings applied. Mean Hospital stay was 18.82 ± 9.46 days. Post-primary Procedure, majority had Split skin-graft (63.33 %), Repeat debridement and then secondary closure (16.67 %), direct closure (10 %), Tissue transfer (6.67 %) & healing by secondary intension (3.33 %). Mean decrease in wound size was 10.23 ± 3.72 cm². Two cases (6.67%) had implant-related infections, and one case (3.33%) had an exposed implant. At 6 months follow-up, the functional outcome was bad in one case (3.33%), fair in nine cases (30%), good in seventeen cases (56.67%), and excellent in three cases (10%). Conclusion: Applying VAC lowers the risk of wound infection, speeds up the healing process, and minimizes the need for further soft tissue defect covering procedures.

Background: Although Plasmodium falciparum malaria is known to cause acute kidney injury (AKI), Plasmodium vivax malaria is now more often the cause of this outcome. Several recent studies have shown that P. vivax malaria also causes AKI. Examining the demographic profile, clinical traits, mortality indicators, need for dialysis, and overall outcome of patients with P. falciparum and P. vivax malaria is the aim of this study. Methods: In the Department of Medicine at Darbhanga Medical College and Hospital, Laheriasarai, Bihar, a prospective observational study comprising patients with malaria and indications of AKI was conducted from October 2023 to September 2024. The diagnosis of malaria was confirmed by Leishman’s stain-stained thick and thin peripheral smears and rapid malarial antigen testing. To investigate various parameters, an appropriate statistical analysis was carried out. Result: Out of 100 cases of P. falciparum and 110 cases of P. vivax malaria, there were 21 (21.0%) and 29 (26.36%) cases of AKI caused by P. falciparum and P. vivax malaria, respectively. In both groups, the majority of patients were under 30 years old. In both groups, females were more likely to be impacted. P. falciparum malaria frequently caused pallor, hypotension, oliguria, sepsis, and altered sensorium. Jaundice, vomiting, thrombocytopenia, hepatomegaly and splenomegaly were more common in P. vivax malaria, Oliguria, anaemia, acute respiratory distress syndrome (ARDS), Disseminated intravascular coagulopathy (DIC), cerebral malaria, hypotension, hyponatraemia, hyperbilirubinaemia were commonly associated independent risk factors for mortality in both P. falciparum and P. vivax malaria. P. falciparum and P. vivax malaria patients received antimalarial artesunate combination therapy. 6 (28.57%) cases of P. falciparum and 8 (27.58%) cases of P. vivax underwent haemodialysis. 2 (9.52%) patients of P. falciparum malaria and 4 (13.79%) patients of P. vivax malaria AKI died. Conclusion: AKI was common in P. falciparum and P. vivax-caused malaria. Malaria considerably raises morbidity and mortality in most of India. Better outcomes may arise from early detection and treatment.

Background: Age, obesity, diabetes, insulin resistance, and dyslipidemia are cardiovascular risk factors that are typically associated with essential hypertension. Early in the course of hypertension, subtle target organ damage occurs, including left ventricular hypertrophy, microalbuminuria, and cognitive impairment. We assessed the correlation between target organ damage and the occurrence of microalbuminuria in patients with essential hyper-tension. Methods: 60 patients with essential hypertension in total were examined. The prevalence of albumin excretion in the urine and its relationship to damage to the target organs (stroke, retinopathy, and left ventricular hyper-trophy) were examined. Microalbuminuria was measured using the urine albumin to creatinine ratio, and urinary albumin excretion was measured using the turbidimetry method. Results: A total of 57.5% of the patients had microalbuminuria. 82.5% of patients had concomitant microal-buminuria (p <0.05), and 82.82% of patients had target organ damage. Patients with longer duration and more severe cases of hypertension, elevated body mass index, and dyslipidemia were shown to have a higher preva-lence among them. Conclusion: An essential diagnostic for assessing target organ damage in hypertension individuals is the meas-urement of microalbuminuria. The risk of microalbuminuria is reduced by maintaining normal lipid levels, con-trolling weight, and managing hypertension as best as possible.

Background: Bowel anastomosis is the surgical procedure done in order to establish communication between two formerly distant portions of the bowel. This surgical procedure restores bowel continuity after the removal of a pathological condition affecting the intestines. A dangerous complication of bowel anastomosis is anastomotic leak causing peritonitis, which is related with a high morbidity and mortality. Aims of this study was to recognize the risk factors for anastomotic leak and study the rate of early complications and mortality of intestinal anastomosis. Methods: This prospective hospital based study was conducted at Department of General Surgery, SKMCH, Muzaffarpur, and Bihar from March 2024 to August 2024. A total of 50 patients undergoing resection and anastomosis for different diseases were studied. Information was collected from detailed history, clinical examination and investigations (both hematological and radiological investigations) on the patients. Results: In present study, there were 30 male patients (60%) and 20(40%) female patients. The age of the patients in this study ranged from 18 to 85 years. 43(86%) patients underwent anastomosis in the emergency setting and 7(14%) underwent anastomosis in elective setting. In this study out of 50 total patients, 46 patients (92%) underwent end to end anastomosis, 2 patients (4%) underwent end to side anastomosis and 2 patients (4%) underwent side to side anastomosis. The risk factors which are known to influence the outcome of bowel anastomosis particularly the occurrence of the anastomotic leak were observed and recorded including age, anaemia, hypoalbuminaemia, emergency surgery, peri-operative use of steroids, and intra-abdominal sepsis. Conclusion: Intestinal anastomosis carries with it considerable mortality and the morbidity. Emergency small bowel anastomoses and intra-abdominal infection have a great risk of anastomotic leak despite attention to technical details during the procedure. Anastomotic leak rate is unaffected by the type of anastomosis performed.

Background: The estimated prevalence of infertility ranges from 12 to 14 percent. Thus, it is a prevalent ailment with significant psychological, physical, and financial ramifications. In order to properly assess these illnesses, a multifaceted diagnostic strategy is required. Thyroid hormones, FSH, LH, and prolactin were correlated with infertility in women of reproductive age in this present study. Aim of this study was to correlate thyroid hormones with FSH, LH and prolactin in infertility in the reproductive age group women. Methods: Between the ages of 19 and 45, a total of 60 infertile women and 40 healthy, fertile women volunteers were chosen based on OPD. Twenty of the 60 infertile women had secondary infertility, while 40 had original infertility. They underwent Chemiluminescence Immunoassay (CLIA) to check their thyroid hormone levels. Result: There was a positive correlation between TSH and prolactin. Additionally, they had a negative correlation with T3, FSH, and LH in infertile groups. Thus, we can conclude that hypothyroidism and hyperprolactinemia are important factors in the etiopathogenesis of infertility. Chronic hypothyroidism can lead to hyperprolactinemia and ovulatory dysfunction. Conclusion: Therefore, it may be very beneficial to detect and treat hypothyroidism early on, before ovulatory dysfunction and hyperprolactinemia manifest. In order to identify subclinical thyroid issues and reduce the risk of infertility, TSH screening should be performed on all women in the early reproductive age range.

Background: 12-lead electrocardiography measures the length of the QT interval, which is a marker of myocardial repolarization and is frequently used to characterize cardiac abnormalities, identify cardiac toxicity, and assess drug safety. After controlling for the impact of other risk variables, the QT interval in hypertension can predict the risk of both coronary events and cardiovascular death. Calcium channel blockers are the first-line medication for treating hypertension, according to the American Heart Association and JNC VIII. Numerous investigations have shown that amlodipine and cilnidipine, when taken at comparable doses, have an equipotent antihypertensive impact. Aims of this study to compare and evaluate the effects of calcium channel antagonists amlodipine and cilnidipine on QT interval among hypertensive patients. Methods: During that time, 129 patients in all were screened, evaluated, and recruited as study participants. Following enrollment, the patients were split into one category: hypertensive patients (n = 80). Amlodipine (2.5–10 mg) or cilnidipine (5–20 mg) with or without an angiotensin receptor blocker (ARB) was administered to a subset of patients, and (2) hypertensive patients with managed diabetes (n = 49) Selected participants were given antidiabetic medicine combined with either amlodipine (2.5–10 mg) or cilnidipine (5–20 mg), with or without an ARB. QT interval/√ (relative risk [RR] interval), where RR interval = 60/heart rate, is calculated using Bazett’s method (the most often used), with normal QTc ≤440 ms. Patients with hypertension had their QT intervals tested both at baseline and after a year of medication. Results: Although there was no therapeutic significance, there was a very significant decrease in QTc with cilnidipine therapy and a significant increase with amlodipine medication. Extremely significant and clinically important differences between amlodipine and cilnidipine were observed while comparing their effects. Conclusion: According to this study, cilnidipine is a better option than amlodipine for patients with a lengthy QT interval since it shortens the QTc interval.

Background: Neonatologists face a perpetual challenge in managing neonatal septicaemia due to changing patterns of the microbial flora and their antibiotic sensitivity. Neonatal sepsis is a major cause of neonatal mortality, the clinical outcome of which depends on early diagnosis and initiation of appropriate antibiotics. The emergence of multi-drug resistant strains has limited the choice of available antibiotics. Thus, antibiotic resistance pattern of pathogens is critical for both therapy and infection control. The present study was designed to evaluate the microbiological profile and antibiotic sensitivity patterns in neonatal sepsis patients. Methods: We analyzed records of a total of 160 neonates with clinical sepsis who were admitted in our NICU during the study period and had blood culture sent for isolation of microbial agent. Out of 160 neonates (99 male and 61 female) grew pathogens on blood culture. Results: In our study, 44 (27.5%) had positive blood cultures. However, 92 (57.5%) sepsis-suspected newborns showed negative blood cultures. 27.5 % of neonates with culture-positive sepsis had gram-positive infections, while 57.5 % had gram-negative infections. In Gram-positive sepsis patients, Acinetobactor 7 (4.38%), CONS 6 (3.75%), Escherichia Coli 8 (5%), Klebsiella Pneumoniae 13 (8.13%), MRSA 4 (2.50%), and Pseudomonas 6 (3.75% Further analysis showed that 27.5% of Gram-positive patients were susceptible to Piperacillin, Tazobactum, Imipenem, Amikacin, and Vancomycin. 72.5% of Gram-negative patients responded to Piperacillin + Tazobactum and Imipenem. In our 160 newborn sepsis cases, 44% (27.5) were culture positive. Most culture-positive cases were gram negative (72.5%, 116 cases), followed by positive. Preterm and low-birth-weight babies were more prone to sepsis. Many Gram-negative microbes were isolated. We found that most Gram-negative organisms were sensitive to Imipenem, followed by Piperacillin + Tazobactum, Cefoperazone + Sulbactum, Ceftazidime, Ceftriaxone, and Amikacin. Most Gram-positive organisms were responsive to Vancomycin, then Amikacin, Imipenem, Piperacillin + Tazobactum, Ceftriaxone, and Cefoperazone + Sulbactum. Conclusion: Most Enterobactericeae isolates from neonatal sepsis produced ESBL. Gram-negative bacilli were resistant to ampicillin, gentamicin, and ceftriaxone. Vancomycin, teicoplanin, and linezolid were sensitive to gram-positive isolates in vitro, while Cefepime-tazobactam and imipenem were sensitive to gram-negative isolates. In our institution, CONS and Candida spices were the most common neonatal sepsis isolates. Preterm and low-birth-weight babies were more prone to sepsis. Many Gram-negative microbes were isolated. Despite their low virulence and commensality, they can cause neonatal sepsis, requiring strict observation and infection control. Our data suggests that Piperacillin + Tazobactum and Amikacin as first antibiotics would be most effective.

Background: Reconstruction of foot and ankle defects requires selecting an appropriate durable and aesthetically appealing option. From the different options, the procedure’s choice depends on the defect’s size, location, and donor area’s availability. Patients’ main goal is to have an acceptable biomechanical outcome. Aim and Objectives: To analyze the foot defects and discuss the various established reconstructive options available and their application. To evaluate the functional outcomes of various surgical procedures following dorsum of foot and ankle defects.” Material and Methods: The study was conducted in department of Plastic and “reconstructive Surgery, Patna Medical College and Hospital, Patna. Thirty patients were examined and analyzed based on the established re-constructive options and operated in emergency or elective settings. Result: The study demonstrates that selecting appropriate reconstruction methods based on defect size, location, and patient demographics is essential for optimal outcomes in foot deformity repair, particularly on the dorsum and ankle. Split-thickness skin grafts and free flaps showed favorable results in wound healing and functional recovery, with free flaps being ideal for severe defects. Sophisticated techniques, such as anterolateral thigh free flaps, had longer recovery times and higher complication risks, requiring careful planning. Less invasive methods, like reverse superficial sural artery and lateral supramalleolar flaps, are effective for mild to moderate defects. Personalized treatment plans improve surgical success, patient satisfaction, and overall quality of life. Conclusion: This study highlights the importance of selecting individualized reconstructive methods for foot defects, emphasizing the role of defect size, location, and patient-specific factors in achieving optimal outcomes. Less invasive options like reverse sural and supramalleolar flaps are effective for mild to moderate defects, while free flaps are reserved for extensive or severe cases. Tailored approaches enhance functional recovery, patient sat-isfaction, and overall surgical success.

Background: The most prevalent first-week abnormality is neonatal hyperbilirubinemia (NNH). Clinical jaundice affects almost two thirds of newborns. Neonatal hyperbilirubinemia, caused by the liver’s immature bilirubin excretory pathway, is the most prevalent reason for neonatal stay in the first week after postnatal discharge. Phototherapy or exchange transfusion address hyperbilirubinemia. Phototherapy changes skin unconjugated bilirubin with blue light. Bilirubin is transformed to less harmful water-soluble photo-isomers that are eliminated in bile and urine without conjugation. Every treatment has side effects. The study examines how phototherapy affects term newborns with hyperbilirubinemia’s serum calcium. Method: This study is prospective observational. Blue light 420-470 nm (zeal medical systems 46 w phototherapy unit) was used on all infants. The individuals were 20 cm from four blue fluorescent lights with a wave-length range of 420 to 470 nm above their heads. An infant-specific disposable eye shield shielded the eyes, while little diaper pants concealed the genitals. Noted were birth weight, age in hours at hyperbilirubinemia diagnosis, feed type, and blood group incompatibility. The newborns were fully examined. A sterile venous blood sample was obtained from the participant’s left arm. Results: This study measured 150 neonates’ blood bilirubin, serum calcium, ionized calcium, hematocrit, and weight before and after phototherapy. The outcomes at the start and end of phototherapy were compared. We show weight and length measurements in our study. Mean ± SD weight of 150 term neonates is 2.88±0.24 kg. The average length is 51.21±0.83 cms. During phototherapy, the mean ± SD of total serum bilirubin started at 19.27±2.62 mg/dl and ended at 10.08±6.87 mg/dl, with a statistically significant ‘p’ value. (P= <0.001).After phototherapy, the mean ± SD of serum calcium was 8.97±0.50 mg/dl, compared to 9.10±0.50 mg/dl before phototherapy. Serum calcium levels reduced considerably after phototherapy (p = 0.018). The ionized calcium levels at the beginning and end of phototherapy (4.81±0.30) showed statistical significance. There was no significant difference in hematocrit readings before and after phototherapy. Comparing weight before and after phototherapy was not statistically significant. Conclusion: The current study found that phototherapy-induced icterus in newborns reduced serum calcium levels significantly. In newborns that got phototherapy, hypocalcemia symptoms such convulsions, jitteriness, cyanosis, and apnea did not occur. Phototherapy babies should have calcium levels tested and addressed.  Phototherapy-induced hypocalcemia was obvious in our investigation, although the indicators were not significant. The reduction may lead to the threshold needed to produce hypocalcemia. Thus, infants should have serum calcium, ionized calcium, haematocrit, and serum bilirubin measured before, during, and after phototherapy. By monitoring and maintaining normal serum levels, we can prevent phototherapy-related problems in neonates.

Introduction: ACL reconstruction has evolved as gold standard for ACL injuries. However, anatomic reconstruction of ACL is of utmost importance to have best outcomes. Newly reconstructed ACL should control the anterior translation as well as internal rotation, for which appropriate anatomical femoral tunnel placement is of absolute necessity. There are two methods of securing femoral tunnel. Anteromedial portal technique and transtibial technique. The study aims to compare the outcomes using both these methods. Materials and Methods: Patients with clinically diagnosed and radiologically diagnosed ACL tears are recruited in the study and divided into two groups, viz, transtibial group (TT group) and Anteromedial portal group (AMP group). After surgery, the outcomes are compared clinically and subjective scores are compared. Results: The mean age of the participants is 31.5years. There is male preponderance in both the groups and right side is more commonly affected. IKDC scores are better in the AMP group compared to TT group. However, Lysholm scores are better in the later. Clinical outcome with respect to pivot shift test is better in AMP group compared to TT group. Conclusion: AMP technique provides more anatomical femoral tunnel placement compared to TT technique with respect to clinical outcomes. But care should be taken about posterior femoral cortex blow out.

Background: Spinal anaesthesia interferes with the body’s ability to regulate temperature; sudden vasodilation caused by sympathetic blockade alters temperature perception, leading to a sensation of cold, this temperature decrease trigger shivering as a compensatory mechanism to maintain homeostasis. Aim of the Work: To evaluate the effectiveness of ondansetron and magnesium sulphate as pharmacological interventions in preventing shivering associated with spinal anaesthesia in perioperative settings in Amaltas Institute of Medical Sciences Dewas. Patients and Methods: A Single Centre, Hospital, Inpatient-based, Prospective Observational Study conducted on 90 ASA grade I and II patients, posted for surgeries undergoing spinal anesthesia in Amaltas Institute of Medical Science, Dewas, following approval from the Ethics Committee of the Amaltas Institute of Medical Science, Dewas. Results: Ondansetron was significantly more effective than Magnesium Sulphate in preventing shivering during spinal anesthesia as 88.9% of patients receiving Ondansetron experienced no shivering, whereas only 62.2% of patients receiving Magnesium Sulphate had no shivering. Only 4.44% of patients in the Ondansetron group required rescue medication (Tramadol), compared to 17.8% in Magnesium Sulphate group. The mean time to rescue medication was significantly longer for Ondansetron (59.7 minutes) compared to Magnesium Sulphate (45.4 minutes). Both Ondansetron and Magnesium Sulphate were well-tolerated with minimal side effects. Conclusion: Ondansetron is an effective drug in the prevention of shivering in patients undergoing spinal anesthesia.

Introduction: Hemoglobinopathies, a group of inherited genetic diseases affecting haemoglobin, are a global public health concern, with a prevalence of 7% among carriers worldwide. Conditions such as β-thalassemia and sickle cell anaemia are common in India, with significant regional and ethnic variability. High-Performance Liquid Chromatography (HPLC) has emerged as a reliable diagnostic tool for identifying haemoglobin variants. This study aimed to evaluate the prevalence of hemoglobinopathies in anaemic patients from Eastern Maharashtra. Materials and Methods: A retrospective study was conducted at a tertiary health centre in Eastern Maharashtra, analysing data from January 2019 to December 2023. 15,620 anaemic patients (Hb <11 g/dL) underwent HPLC testing using the BIO-RAD variant haemoglobin testing system. Demographic details and HPLC results were collected, and qualitative and quantitative data were statistically analysed. Results: The prevalence of hemoglobinopathies was 13.24%, with a female predominance (60.93%). Sickle cell trait (7.14%) was the most common hemoglobinopathy, followed by β-thalassemia trait (2.98%). Other variants were also identified, including the HbE trait (0.02%) and rare double heterozygous forms. The highest prevalence occurred in the 21–30 years age group (35.02%), with declining rates in older age groups. Conclusion: Hemoglobinopathies are significant contributors to anaemia in Eastern Maharashtra. HPLC proved effective for accurate and rapid diagnosis, underscoring the importance of systematic screening and genetic counselling in high-risk regions to reduce the burden of hereditary anaemias.

Introduction: Acute coronary syndrome (ACS) is a major cardiovascular event exacerbated by factors such as obesity and insulin resistance (IR). Triglyceride-Glucose (TyG) index and its modified indices have recently been suggested as useful stand-in indicators for IR. This study investigates the efficiency of TyG index {and modified indices: with body mass index (TyG-BMI), with waist circumference (TyG-WC), with waist-height ratio (TyG-WHtR), triglyceride to HDL-Cholesterol (TG/HDL) index and combination of TyG+TG/HDL index} in predicting IR in ACS patients in South India. Methods: This prospective cross-sectional study included 139 participants-69 diagnosed with ACS and 70 age-matched healthy controls-conducted at JIPMER, Puducherry, India. Demographic, clinical and biochemical parameters were recorded. IR was assessed using the Homeostasis Model Assessment of IR (HOMA-IR) and TyG index (and its modified indices). Statistical analyses were performed to evaluate differences between groups and correlations using SPSS statistical software. Results: Both HOMA-IR and HOMA-β showed significant differences between cases and controls, indicating increased IR and β-cell dysfunction in ACS patients (p < 0.001). The TyG index and its modified indices were significantly higher in cases than in controls. A significant positive correlation was seen between HOMA-IR and TyG and modified indices. ROC curve analysis demonstrated that the TyG index had the highest predictive value for IR (AUC: 82.0), with high specificity (94.3%) at a cut-off of >3.90. Other indices, such as TyG-WC (waist circumference) and TyG-WHtR (waist height ratio), also showed significant predictive potential. Conclusions: TyG and its modified indices, mainly TyG-WC and TyG-WHtR, may serve as alternative markers (either individually or in combination) for assessing IR in clinical settings especially in remote areas with inadequate medical facilities, providing valuable insights for targeted interventions in this high-risk population.

Objective: To know the impact of Low carbohydrate and high fat or Keto diet effect on Hb1C levels in patients with Type 2 diabetics. Participants with type2 diabetes restrict their carbohydrate intake to 30g or less daily, increase fat, and maintain a modest but not high protein intake to induce a state referred to as “nutritional ketosis”. Material and Method: 130 type2 DM patient with HbA1c level 7.8%±1.3, mean glucose level 169md/dl ±31 are made to follow Low carbohydrate and high fat diet for 3months of duration HbA1c level are estimated. Result: After 3months of follow up 15 dropouts 5 no effect remaining 110 show decrease in HbA1c level to 6.43%±1.47 & mean glucose level 137mg/dl±28, p value <0.0010 shows significant variation, linear regression for HbA1c –r2: 0.53, glucose r2: 0.49. Conclusion: No adverse effects except mild constipation. Patients on drugs decreased usage from 3 to 1 or nil at 3months. In summary Low carbohydrate and high fat diet over 3 months led to a remarkable reduction in HbA1c levels, it lead to greater improvements in symptoms associated with type II diabetes.

Background: Transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) mesh repair are the two common minimal invasive procedures for inguinal hernias. We are routinely practising both the techniques in our institution. We decided to compare these two techniques in our set up. This retrospective study is aimed to compare these two, TAPP and TEP laparoscopic approaches for inguinal hernia repair in terms of various outcomes. Aim: To compare both laparoscopic TAPP vs TEP inguinal hernia repair in our hospital. Materials and Methods: Total of 255 patients who presented with inguinal hernias in the time period of 5 years from October 2018 to September 2023, fit for general anaesthesia were operated. Out of which 130 patients underwent laparoscopic TAPP repair and 125 underwent laparoscopic TEP repair. Results: Both TEP and TAPP mesh repair techniques were comparable in terms of operative time, intraoperative complications, and conversion to open, post-operative pain, time to resume normal activity, and recurrence. Duration of hospital stay was significantly more in TAPP group than TEP group. Conclusion: Laparoscopic repair of inguinal hernias is associated with comparable results in both techniques (TAPP and TEP) and choice between TAPP and TEPP is a personal choice of the operating surgeon.

Diabetic retinopathy (DR) is a common complication of diabetes and a leading cause of blindness globally. Early detection and timely management are crucial to prevent vision loss. The study was conducted during a six-month period from October 2023 to March 2024 and it evaluates the awareness of diabetic retinopathy among diabetic patients visiting Government general hospital, Guntur. We have done interviews to evaluate knowledge level and attitude of patient’s towards eye care. A total of 200 patients were included of which 94 were males and 106 females. 79% of the participants were unaware of visual complications of diabetes. 78.5% of patients believed adequate glycemic control could prevent any diabetes related visual complications and only 12% were aware of the treatment options available for diabetic retinopathy. The results indicated a significant proportion of patients lacked sufficient knowledge about the risks, symptoms, and preventive measures of diabetic retinopathy. This highlights the need for targeted educational programs and improved screening protocols to enhance early detection and appropriate management of diabetic retinopathy, thus reducing the burden of visual impairment among diabetics.

Purpose: cataract is the leading cause of reversible blindness in the world. Aphakia due to complicated cataract surgery is difficult to treat with spectacles or contact lenses. Implantation of iris claw intraocular lens (ICIOL) is one of the various methods. This study aims to evaluate the visual acuity and post-operative complications after implantation of iris claw intraocular lens as a primary or secondary procedure. Methods: This is a retrospective study conducted at government general hospital, Guntur from May 1^st 2023 to April 30^th 2024. Data from 50 eyes of 49 patients was collected from records. Their preoperative evaluation, intraoperative approach as a primary or secondary procedure and postoperative visual acuity and complications were noted. All patients were followed-up for a period of 6 weeks. Results: The study includes a total of 49 patients of which 26 are males and 23 Females with mean age of 56- 60. Among the 50 eyes 27 were right with 23 left eyes. Four patients had ICIOL implantation as a primary procedure and 45 as a secondary procedure. Indications for surgery include posterior capsule rupture in 42 patients and zonular dehiscence in 8 patients. Postoperative vision improved to 6/12 to 6/9 in majority of patients at the end of 6 weeks. Complications like striate keratopathy seen in 26 patients, horizontal oval pupil in 32, and cystoid macular oedema in 2 and suprachoroidal haemorrhage in 1 patient. Conclusion: Iris claw intraocular lens implantation can be done in eyes with complicated cataract surgery with inadequate posterior capsular support. It gives patients good visual acuity postoperatively with fewer complications.

Periodic evaluation of drug utilization is essential to enhance therapeutic effectiveness, minimize adverse effects, and ensure rational, cost-effective medical care. This study aimed to analyze prescribing patterns in the Orthopaedic Outpatient Department of a tertiary care hospital, focusing on patient demographics, prescription characteristics, commonly prescribed drug categories, and identifying deficiencies in prescribing practices. A total of 130 prescriptions were reviewed, revealing an average of 3.05 drugs per prescription, exceeding WHO’s recommended limit and highlighting a concerning rate of polypharmacy (49.04%). The study also found that only 28.46% of drugs were prescribed by generic names, reflecting low adherence to cost-saving practices. Anti-ulcer drugs were the most frequently prescribed category (30.88%), often exceeding NSAID prescriptions, indicating possible overuse of gastro protective agents. Common documentation issues included missing doctor signatures (90.00%) and incomplete follow-up instructions (74.62%). These findings underscore the need for stricter adherence to WHO guidelines, increased use of generic drugs, and improved documentation practices. Interventions in these areas could significantly improve patient safety, reduce treatment costs, and enhance the quality of care in orthopaedic settings.

Introduction: Cytological study plays significant role in the diagnostic modality of body fluids, in identifying atypical cells in effusions, to know the advancement of the disease process in the body. The cell block technique study for fluids has an architectural pattern, a useful method, mainly in correct diagnosis of malignancy and hence patient management and prognosis, We conducted this study, to know the incidence, etiopathogenesis of non-neoplastic and neoplastic effusions along with to assess the utility of cell block in diagnosis of neoplastic fluids. Materials and Methods: A prospective study was carried out over a period of 18 months. In our study, total of 280 cases of pleural, pericardial and peritoneal effusions which were received in department of cytology of pathology from March 2016 to Sept 2017 and assessed by Routine gross examination, Smear preparation by Cyto-centrifugation and Cell block technique. Immuno histochemistry and Chemical analysis were performed wherever necessary. Results: Out of total 280 effusions, 150 (53.57%) were peritoneal, 125 (44.64%) were pleural and 5 (1.78%) were pericardial fluids, 166 were transudates and 114 were exudates. Maximum number of cases of serous effusion were seen in females, 162/280 cases i.e. (57.85%) and males in 118 cases (42.14%), male: female ratio being 0.72:1. On gross examination, the commonest appearance was yellow in 133 cases (47.5%. Out of 280 samples received, 245(87.5%) were of non-neoplastic causes, while neoplastic effusion were seen in 35 (12.5%) cases. Cell block prepared in neoplastic effusions yielded high cellularity in 65% cases compared to 45.71% in conventional smears, moderate yield in 10% compared to 37.14% in conventional smear and low yield significantly reduced to 25% from 45.71% in conventional smear. Conclusion: Conventional smear method can yield good result in all types of effusion, when combined approach to morphology with Papanicolaou (PAP) and May-GrunwaldGiemsa (MGG) used. Cell block preparation is a simple and inexpensive method in obtaining better cellularity, cellular architecture and cellular morphological details. Thus, when cell block technique and conventional smear method used in combination, definitely there is increased rate of correct diagnosis in case of malignant effusions.

Background: Fallopian tubes are affected by a wide spectrum of diseases varying from salpingitis to carcinoma. Extensive review of the worldwide web and relevant texts revealed scant data about these diseases of fallopian tubes. This lacuna prompted us to vigorously pursue and shed some light on the topic, especially in this part of India. Therefore, descriptive study on histopathology of fallopian tube was done at department of Obstetrics and Gynaecology, North Bengal Medical College, West Bengal to identify the various diseases of fallopian tube. Materials & Methods: This descriptive observational study was done over a period of one year (May 2018– April 2019) in women who had salpingectomy and tubal ligation at NBMCH. Specimens of salpingectomy from clients who underwent, tubal ligation or along with hysterectomy/oophorectomy were taken. All surgeries were performed in the Gynaecology OT of NBMCH, West Bengal. Ligation was done by Parkland Method or by modified Pomeroy method. Total abdominal hysterectomy with bilateral or unilateral salpingo-oophorectomy due to various indications was done in usual procedure. Only salpingo-oophorectomy was also done in a case of ovarian torsion. In cases of ectopic pregnancy total or partial salpingectomy was done. Gross abnormalities like paratubal cysts were encouraged to be taken in the specimen. Specimen was then preserved in 10% formalin, labelled properly and taken to Pathology Department of NBMCH. Results: It is evident from this table that most common histological finding was of normal fallopian tubes, approximately 70% (71 specimens). Approx 61 specimens were of fallopian tube only. The remaining 10 were composite specimen of uterus with cervix and bilateral normal fallopian tubes. Chronic nonspecific salpingitis is the commonest amongst other pathologies followed closely by tubal ectopic pregnancy. Tubal gestation without the features of salpingitis was more common in the age group of 31-40 years. Conclusion: Majority of the tubes had normal appearance on histopathology (approximately 70%). In the remaining proportion, most common pathological lesion was chronic non-specific salpingitis (9.8%). Amongst cases of ruptured tubal ectopic pregnancy 44.4% were associated with chronic salpingitis.

Fracture healing is a complex biological process that often requires intervention to achieve optimal outcomes, particularly in extensive bone loss or non-union cases. Bone grafts, including autografts and allografts, along-side synthetic substitutes such as calcium-based ceramics, bioactive glass, and biomaterials, are integral to mod-ern orthopaedic practice. Autografts remain the gold standard due to their osteogenic, osteoinductive, and oste-oconductive properties, although donor site morbidity and limited availability are significant constraints. Allo-grafts offer a scalable alternative but are hindered by immunogenicity and slower integration. Synthetic substi-tutes, including calcium phosphate ceramics and bioactive glass, provide innovative solutions, addressing issues like donor site morbidity and scalability, but often lack inherent osteoinductive capabilities. This systematic review synthesizes current evidence on the comparative effectiveness of natural bone grafts and synthetic substi-tutes, focusing on clinical outcomes, biological properties, and advancements in biomaterial engineering. Inno-vations such as the incorporation of growth factors (e.g., BMPs, FGFs) and nanotechnology have enhanced the performance of synthetic materials, enabling tailored solutions for diverse clinical needs. However, challenges persist, particularly in achieving consistent osteoinduction and mechanical integrity. The findings underscore the importance of a personalized, multidisciplinary approach in material selection, considering factors like defect size, mechanical requirements, and patient-specific conditions. Future directions include developing hybrid ma-terials combining natural and synthetic advantages, rigorous clinical trials to validate long-term efficacy, and strategies to enhance cost-effectiveness and accessibility globally. These efforts aim to optimize fracture healing outcomes and improve patient quality of life.

Orthopaedic trauma in rural settings presents multifaceted challenges, including limited healthcare infrastructure, geographic isolation, workforce shortages, and financial constraints. These factors result in delayed care, in-creased morbidity, and poor patient outcomes. This systematic review explores evidence-based strategies and innovations aimed at addressing these issues, ensuring equitable trauma care in resource-limited environments. Key challenges identified include the lack of advanced diagnostic tools, inadequate transportation networks, fragmented referral systems, and sociocultural barriers affecting care-seeking behavior. Workforce shortages, par-ticularly of orthopaedic specialists and trained nurses, exacerbate these issues. Financial constraints further limit access to timely and adequate care for rural populations. Innovative solutions such as telemedicine, mobile health technologies (mHealth), and community-based interventions are critical for bridging the care gap. Virtual fracture clinics (VFCs) and wearable health-monitoring devices demonstrate significant potential in improving access and continuity of care. Empowering community health workers with portable diagnostic tools and tai-lored training enhances local healthcare delivery. Long-term strategies, including trauma prevention programs, the development of comprehensive trauma networks, and the implementation of trauma registries, offer a frame-work for sustainable improvements. Ethical considerations, such as equitable access and maintaining patient privacy in telemedicine, are pivotal. Policy reforms, capacity-building initiatives, and research collaborations are recommended to scale effective interventions and foster innovation. This review emphasizes a collaborative ap-proach among policymakers, healthcare providers, and community stakeholders to ensure effective orthopaedic trauma management in rural settings.

Background: Hemorrhoidectomy is one of the most common surgical procedures performed routinely, and with the advances in Laser technology Laser Hemorrhoidoplasty is now an alternative to open method. The aim of this study was to determine the outcomes and postoperative complications of Laser Hemorrhoidoplasty. Patients and Methods: It was a Prospective Observational study done in 40 cases selected by Systemic Random Sampling method in those attending the General Surgery Outpatient Department in a Tertiary Care centre, for Laser Hemorrhoidectomy during a period of 6 months. Post operatively patients were followed for 12 months. Duration of the procedure, intraoperative complications, postoperative pain, and the resolution of hemorrhoids, and recurrence of hemorrhoids were analyzed. Results: In the study male patients were 60% and female cases were 40%. 65% of patients were in the age group of 40 – 50 years. Average intra operative time was 23min. There were no significant intra operative complications. Post operatively pain was less as per Visual Analogue Scale. There was no rectal tenesmus or alteration of defecation habits. Hemorrhoid symptoms and size reached approximately three to four months post-procedure. The frequency of pain, bleeding, pruritus ani, were decreased by 75-80%. There was a significant reduction in hemorrhoids with the rate of recurrence being 7% over 12 months of follow-up. Conclusion: Laser Hemorrhoidoplasty is a safe procedure, not associated with any excessive postoperative complications. It improves patient’s quality of life and can be a substitution of other surgical methods and as a day care procedure.

Introduction: It is a common disorder, comprising more than 0.5% of all dermatological visits. It may be familial in 1–2% of cases. The aim of this study is to find out the incidence of lichen planus in different age and sex groups, seasonal variation, occupation and familial association. And to correlate any association of lichen planus with systemic diseases. Methodology: An institution based cross-sectional descriptive study was conducted in Dermatology (OPD) of Bankura Sammilani Medical College & Hospital, Bankura in Eastern India from March 2015 to February 2016. The study included 125 patients with typical feature of lichen planus of skin, nail, hair and mucous membrane. Results: In our study 79/145 (54.5%) were females and 66/145 (45.5%) were males with sex ratio of 0.8:1 (male: female). Most common age group was 20–40 years and type were classical lichen planus (64.8%) followed by oral LP (16.8%) cases, linear LP (1.6%) cases, actinic LP (2.4%) cases, lichen planus pigmentosus, annular & genital lichen planus was seen in 2.4%. Koebner’s phenomenon was seen in 50.4% cases.0.8% case had involvement of scalp hair, with scarring alopecia, diabetes mellitus was seen in 6.4% cases, 5.6% of cases to have hypothyroidism, the frequency of HCV in association with lichen planus was 9.6%. Out of total 5 vitiligo patients 4 (80%, n=5) were below 20 yrs of age and 1 (20%, n=5) patient in >60-year age group. Out of total 12 Hepatitis C patients 5 (41.6% n=12) were in 21 years to 40-year age group and out of total 125 patients 52 (41.6% n=125) patients are in 21 years to 40-year age group. In present study we didn’t find any case of palmoplantar LP, LP pemphigoides and zosteriform lichen planus that has been reported in other studies although LP pemphigoides is now consider as a variant of BP. Conclusion: Lichen planus, an autoimmune disorder has a frequent association with other autoimmune diseases. HCV, diabetes mellitus and alopecia areata are the most common entities while, vitiligo, chronic active hepatitis, myasthenia gravis and thyroid disorders are seen less frequently.

Background and Aim: Tracheal extubation is typically conducted while the patient is in a supine position. In patients who have undergone abdominal surgery, adopting a supine position can elevate abdominal wall tension, particularly during actions such as coughing and deep breathing. This increase in tension may exacerbate pain and heighten the risk of abdominal wound dehiscence. The current study sought to evaluate the comfort levels of patients who were extubated while in the semi-Fowler’s position versus those extubated in the supine position. Material and Methods: The current investigation involved a cohort of 100 individuals who had abdominal surgical procedures. Participants were randomly allocated to one of the two designated groups.  Group 1 consists of patients who are candidates for extubation while in a supine position. Patients in Group 2 are positioned in semi-Fowler’s for extubation. The endotracheal tube was successfully removed once the patients demonstrated signs of alertness by opening their eyes and regaining consciousness. Vital signs, along with coughing and pain and comfort scores, were meticulously documented before and after extubation, continuing until the patients were discharged from the PACU. Results: The findings indicated that there was no notable difference in the mean duration of epidural analgesia using 0.125% bupivacaine during the intraoperative period when comparing the two groups. The mean visual analogue score (VAS) exhibited a notable difference between the two groups within the 5 to 10 minutes post-extubation period. Group A exhibited higher VAS scores at the 5-minute, 15-minute, and 30-minute time intervals when compared to Group B. In Group A, severe cough and bucking were observed in 5 (10%) and 2 (4%) of the patients, respectively, while these symptoms were not present in Group B. Conclusion: The average respiratory rate returned to its normal baseline within 30 minutes post-extubation while the patient was in the semi-Fowler’s position. Conversely, when in the supine position, the respiratory rate remained elevated. Therapeutic positions guided by turning schedules play a crucial role in sustaining haemodynamic parameters and averting complications.

Background: Pharmacovigilance plays a critical role in ensuring the safety and efficacy of medicines by identifying, assessing, and preventing adverse drug reactions (ADRs). Despite its importance, underreporting of ADRs by primary health care professionals remains a significant challenge, particularly in resource-limited settings. Aim: This study aims to evaluate the knowledge, attitudes, and practices of primary health care professionals regarding pharmacovigilance and ADR reporting, identify barriers to effective reporting, and recommend strategies to enhance pharmacovigilance practices. Methods: A cross-sectional study was conducted over six months at Shri Krishna Medical College and Hospital, Muzaffarpur, Bihar. A total of 140 primary health care professionals, including doctors, nurses, and pharmacists, were selected using random sampling. Data were collected using a structured questionnaire covering demographics, awareness, attitudes, practices, and perceived barriers to ADR reporting. Descriptive and inferential statistics were applied using SPSS version 23.0 to analyze the data. Results: The mean age of participants was 35.2 ± 8.7 years, with a majority being male (60.7%). While 78.6% were aware of the definition of pharmacovigilance, only 57.1% understood ADR reporting mechanisms. A positive attitude toward ADR reporting was observed in 82.1% of participants, but regular reporting was noted in only 45.7%. Common barriers included lack of time (45.0%), insufficient knowledge (38.0%), and unavailability of reporting tools (35.0%). Statistically significant associations were found between years of experience and knowledge levels (p < 0.05). Conclusion: The study highlights moderate awareness and significant gaps in the practice of pharmacovigilance among primary health care professionals. Although most participants recognized ADR reporting as a professional responsibility, systemic and individual barriers impeded regular reporting. Recommendations: Targeted training programs, simplified reporting processes, and organizational support are essential to improve ADR reporting practices. Enhancing pharmacovigilance systems can significantly contribute to patient safety and the effective use of medicines.

Background: Maternal HbA1c levels have been found to correlate closely with the occurrence of congenital malformations and other neonatal complications characteristic of pregnant diabetic women. This study was conducted to investigate the correlation of glycemic control in newborn at birth in relation to maternal glycemic control in diabetic mothers. Materials and Methods: This cross-sectional study was carried out at a Tertiary care hospital of south east India for a period of one year. Study included 84 babies born to mothers with Gestational diabetes or Type I or Type II DM. Maternal HbA1c was done before delivery by HPLC, and all babies were subjected to random blood sugar as per protocol for infant of diabetic mother (IDM) i.e. at 0, 1, 2, 3, 6, 12, 24, 48 hours of life by glucometer. Glycosylated Haemoglobin of the newborn was done at 24hrs after birth by HPLC, and 2D ECHO was performed on each baby to see for any structural or functional abnormality of the heart. Results: There was no statistically significant difference between mean birth weight and gender (p>0.05) in IDM. 71.4% of patients were AGA. There was no significant difference between mean HbA1c of neonate (5.87%±0.61) and mean maternal HbA1c (5.69%±0.73) (p>0.05). Conclusion: This study concluded that IDM babies are at risk of hypoglycemia if the mother’s HbA1c level go beyond 6.5%.

Background: Thyroid nodules are considered common clinical findings that have a malignant evolution of 5% to 20%. The present study will try to compare the diagnostic effectiveness between the Bethesda System for Reporting Thyroid Cytopathology and the Italian Classification System on the diagnosis of thyroid nodules, considering the sensitivity, specificity, and overall diagnostic accuracy. Methods: This prospective analytic study was conducted at Pt. Jawahar Lal Nehru Memorial Medical College, Raipur, Chhattisgarh, between September 2022 and September 2024. Sixty-two patients with palpable thyroid nodules who underwent FNAC were included in the study. The results were classified cytologically based on the Bethesda System and the Italian Classification for cytohistological correlation. Results: Out of 62 patients, 25 were males and 37 were females. Maximum prevalence was found in the age group of 31-40 years, which accounted for 33.9%. Mainly, it was revealed that the majority of them were benign. Thus, Bethesda Category II had 54.8% and Italian TIR 2 – 56.5%. Generally, a good correlation was obtained between the two systems: 94.3% for benign, and 100% for the malignant categories. The Bethesda system was sensitive to 92% and specific to 88% cases to detect malignant cases and had a better performance in diagnosing the benign lesions (PPV: 78%, NPV: 95%). However, compared with the latter, the Italian system had a higher sensitivity of 96% to detect malignant cases, along with specificity of 84% (PPV: 82%, NPV: 97%). Conclusion: Both the Bethesda and the Italian systems are very effective in the classification of thyroid nodules, with a significant concordance between them. The Italian system performed really very well in the diagnosis of malignant lesions. Standardized reporting allows more accurate diagnoses, enabling better management of the patient. Larger studies will also be required to confirm such findings for further refinement of diagnostic criteria.

The assessment of lung function is a critical component of clinical medicine, offering insights into the respiratory health of individuals. Spirometry, a key test in evaluating pulmonary function, is commonly used to measure static lung volumes and capacities. The present study evaluates the use of a student spirometer in performing static lung function tests among first-year MBBS students. The study aims to assess the feasibility, accuracy, and educational value of student spirometers in medical education. A cohort of 100 first-year MBBS students participated in this study, where spirometric measurements were performed to evaluate forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and the FEV1/FVC ratio. The results demonstrated good correlation with standard spirometric values, highlighting the effectiveness of student spirometers for educational purposes. This research emphasizes the potential role of spirometry in early medical education, providing students with foundational knowledge in respiratory physiology and diagnostic techniques.

Fungal rhinosinusitis (FRS) has increased over the past few decades which might be due to the rampant use of antibiotics, steroids, immunosuppressive drugs, increased incidence of HIV and uncontrolled state of diabetes.  It is characterized by inflammation of the sinus mucosa due to fungal infection. Aspergillus species is the most common. Immunocompromised patients should take special precautions and should be aggressively treated should there be any suspicion of fungal sinusitis. The usual treatment for FRS involves surgery and aggressive medical management with close follow-up. The medical management includes anti-allergic medications, immunotherapy, and the addition of oral corticosteroids. Although medical management improves patient outcomes, more evidence regarding FRS management is still needed.

Background: Persistent anemia has been identified in kidney transplant (KTx) recipients with parvovirus B19 infection. However, the epidemiology and the link between parvovirus B19 and anemia post-KTx remain unclear. This systematic review aimed to (1) determine the incidence of parvovirus B19 infection post-KTx and (2) assess its association with anemia in this population. Materials and Methods: A systematic review was conducted using EMBASE, MEDLINE, and Cochrane databases from inception to March 2024. Studies reporting the incidence of parvovirus B19 infection and/or seroprevalence in KTx recipients were included. Data were analyzed using the random-effects generic inverse variance method. Results: Nineteen observational studies comprising were analyzed. The pooled prevalence of parvovirus B19 immunoglobulin G was 62.2% (95% CI: 45.8%–76.1%). The pooled incidence of positive parvovirus B19 DNA within the first year post-KTx was 10.3% (95% CI: 5.5%–18.4%). Sensitivity analysis excluding studies focused solely on anemic KTx recipients showed a lower pooled incidence of 7.6% (95% CI: 3.7%–15.0%). Among KTx recipients with anemia, the pooled incidence of positive parvovirus B19 DNA increased to 27.4% (95% CI: 16.6%–41.7%). Meta-regression analysis revealed no significant.

The study emphasizes the role of the Enzyme-Linked Immunosorbent Spot (ELISPOT) assay in assessing the immune response against BK virus (BKV) infection after kidney transplantation. This is crucial because BKV infection can lead to BKV nephropathy (BKVAN), which can result in graft dysfunction and potential allograft loss. The ELISPOT assay helps evaluate the recipient’s immune response by detecting interferon-gamma (IFN-γ) production in response to BKV. According to the systematic review and meta-analysis, ELISPOT has shown a high sensitivity (0.95) and specificity (0.88), indicating its strong potential as a tool for identifying patients at risk of active BKV infection. In particular, patients with negative ELISPOT results had a significantly higher risk of active BKV replication (odds ratio of 71.9), and there was a clear distinction between active and resolv-ing BKV infections based on the number of IFN-γ producing cells. Thus, integrating the ELISPOT assay with viral load monitoring could help tailor immunosuppressive therapy, balancing the need to prevent transplant rejection while managing the risk of BKV replication. This dual approach could potentially improve patient outcomes by providing a more precise strategy for managing BKV infection in kidney transplant recipients.

Introduction: Haemoglobinopathies and thalassemias are among the most common single-gene disorders worldwide, with significant geographical variation in prevalence. High-Performance Liquid Chromatography (HPLC) has emerged as a sensitive and specific method for identifying hemoglobin variants, offering superior detection capabilities over traditional techniques. This study focuses on utilizing HPLC for familial screening of hemoglobinopathies, aiming to identify and characterize these conditions within families of affected individuals. Material and Methods: This one-year cross-sectional observational study was conducted in the Department of Biochemistry at a tertiary care hospital in Gujarat. Family members of patients diagnosed with hemoglobinopathies were screened for abnormal hemoglobin variants using HPLC, complemented by peripheral smears, reticulocyte staining, and sickling tests. Blood samples were collected under aseptic conditions, and investigations included CBC analysis and specialized diagnostic tests for hemoglobin variants such as HbS, HbC, and HbF. Flexible arrangements ensured accessibility for family members, with sample collection integrated into hospital workflows or conducted at the 24×7 Central Pathology Lab. Data were statistically analyzed using SPSS, with a significance threshold of p < 0.05. Results:  In our study, the majority of patients (34.6%) were in the SCT group, followed by BTT and SCD groups (26.9% each). Age distribution showed significant variation (p = 0.005), with most patients aged 20–40 years (49.2%) and no cases below 40 years in the STT group. Gender distribution was balanced, with no significant differences (p = 0.355). Religion showed significant variation (p = 0.001), with Hindus constituting a slight majority (52.3%). SCT had the highest asymptomatic cases (28), while SCD showed unique presentations like crisis and acute chest syndrome. Hemoglobin profiles differed significantly across groups, with BTM showing the highest HbF (86.95) and the Normal group the highest HbAo (84.92). Peripheral smear findings varied, with macrocytic hypochromic blood picture most prevalent in BTT and SCD groups, and dimorphic blood picture rare, observed only in the SCT group. Conclusion: Our study demonstrated the effectiveness of High-Performance Liquid Chromatography (HPLC) in diagnosing and differentiating hemoglobinopathies, with significant variations observed in clinical presentations, CBC parameters, hemoglobin variant profiles, and peripheral smear findings across groups.

Introduction: Diabetes is a major global health crisis, ranking among the leading causes of mortality worldwide, alongside cardiovascular disease, cancer, and respiratory disease. According to the WHO, noncommunicable diseases accounted for 74% of global deaths in 2019, with diabetes contributing to 1.6 million deaths, making it the ninth leading cause of death. By 2035, an estimated 592 million people may die from diabetes. Diabetic peripheral neuropathy (DPN), a common complication of Type 2 Diabetes Mellitus (T2DM), arises from chronic hyperglycemia, leading to peripheral nerve dysfunction. Material and Methods: This prospective, cross-sectional study was conducted over a year at a tertiary care center in Gujarat to evaluate the prevalence of peripheral neuropathy in T2DM patients, identify risk factors, and assess correlations with Vitamin D3 levels. A total of 403 adult T2DM patients, diagnosed for at least one year, were recruited through systematic random sampling. Patients with other causes of peripheral neuropathy were excluded. Data were collected using structured questionnaires capturing demographic and clinical details, neuropathy assessment via the Michigan Neuropathy Screening Instrument (MNSI), and nerve conduction studies. Vitamin D3 levels were categorized as deficient, insufficient, or sufficient using chemiluminescent immunoassay, and glycemic control was assessed via HbA1c. Risk factors like age, BMI, smoking, hypertension, and dyslipidemia were analyzed. Statistical methods, including Pearson correlation and logistic regression, were used to evaluate the association between Vitamin D3 levels and neuropathy severity. Data analysis was conducted using SPSS, with p-values <0.05 considered significant. Results: In our study, the prevalence of diabetic peripheral neuropathy (DPN) was 70% among 403 T2DM patients, primarily affecting those aged 51–60 years (50.4%). Patients with DPN were significantly older (p < 0.001), while gender showed no significant influence (p = 0.836). Hypertension, poor glycemic control (FBS: 265.91 ± 19.42 mg/dL, PPG: 285.60 ± 82.38 mg/dL, HbA1c: 9.67 ± 2.12%; p < 0.001), higher BMI, smoking, and dyslipidemia were strongly associated with DPN. Additionally, abnormal waist circumference was prevalent in 69.4% of DPN patients (p < 0.001). Vitamin D deficiency was common across both groups, though a higher proportion of sufficient Vitamin D levels (38.0%) was observed in DPN patients (p = 0.005), underscoring its potential role in DPN severity. Conclusion: Peripheral neuropathy is a prevalent complication in diabetic patients, particularly those over 50 years of age, with no significant gender predilection. Hypertension, obesity, dyslipidemia, smoking, poor glycemic control, and Vitamin D deficiency are significant risk factors. Routine Vitamin D assessment and supplementation, alongside optimized glycemic and lifestyle management, are crucial for mitigating neuropathy risk and severity.

Background: Liver is the major site for metabolism. Ingestion of alcohol produces striking metabolic imbal-ances in the liver, causing the formation of Reactive Oxygen Species (ROS). Inadequate removal of ROS may cause cell damage, attacking lipo-proteins and inactivating enzymes. Method: 95 Alcoholic liver disease patients were compared with the same number of healthy (control) groups. Clinical and laboratory investigations were carried out using venous blood plasma vitamin E levels by the Baker-Hatal method, ascorbic acid by the Teitz method, and SVD by the Beers-Seizer method. Results: The comparison of non-enzymatic oxidant parameters. Ascorbic acid, vitamin E, and the comparison of antioxidant enzymes SOD and GPX in both groups were statistically highly significant (p<0.00). Conclusion: It is proved that increased anti-oxidant enzymes except catalase and decreased non-enzymatic oxi-dants have diagnostic value in alcoholic liver disease patients.

Background: An anesthetic drug without cardiotoxicity, a long-acting regional anesthetic structurally related to bupivacaine, is ropivacaine. The efficacy of ropivacaine alone and in combination with 8 mg dexamethasone is compared to evaluate the efficacy of both local anesthetics. Method: Out of 90 (ninety), 45 patients were given Dexamethasone and Ropivacaine, and 45 patients were given Ropivacaine alone. Results: The onset of motor block and sensory block duration of motor block were longer in patients treated with dexamethasone and Ropivacaine with a significant p-value (p < 0.001) as compared to ropivacaine alone. Conclusion: In the present pragmatic comparative study. It is confirmed and concluded that dexamethasone added to ropivacaine in a supraclavicular block for upper limb surgery significantly shortens the onset time and prolongs the duration of sensory and motor block without causing any sedation or toxicity.

Background: An anesthetic drug without cardiotoxicity, a long-acting regional anesthetic structurally related to bupivacaine, is ropivacaine. The efficacy of ropivacaine alone and in combination with 8 mg dexamethasone is compared to evaluate the efficacy of both local anesthetics. Method: Out of 90 (ninety), 45 patients were given Dexamethasone and Ropivacaine, and 45 patients were given Ropivacaine alone. Results: The onset of motor block and sensory block duration of motor block were longer in patients treated with dexamethasone and Ropivacaine with a significant p-value (p < 0.001) as compared to ropivacaine alone. Conclusion: In the present pragmatic comparative study. It is confirmed and concluded that dexamethasone added to ropivacaine in a supraclavicular block for upper limb surgery significantly shortens the onset time and prolongs the duration of sensory and motor block without causing any sedation or toxicity.

Introduction: Brucellosis is considered as one of the widest spread zoonosis in the world. The importance of this contagious disease is the economic impact on livestock industry. Causes severe hazard to human health, through either direct contact with infected animals or the consumption of contaminated milk and dairy products. The rural population is primarily engaged in agriculture for which cattle are used. Due to inordinate exposure to animals and products and ignorance regarding zoonotic diseases, high prevalence of brucellosis, is not much studies in India. Brucella melitensis is the most virulent species that causes. Material and Method: In present study was from, December 2022 to November 2023 Total no of fever cases 2219 suspected with brucellosis 200 tested by using Elisa technique. Also study Total 17665 pregnant animal reported total sample 17665 sample tested by using Rose Bengal test and Milk ring test. Results: The present study was conducted from, December 2022 to November 2023.   Samples of both, human and animals were tested. Total no. of fever cases in human were 2219. Out of these 2219, suspected human with brucellosis were 200. It was tested by Elisa test. All 200  human samples, tested by Elisa were Negative. Out of all these talukas maximum number of Human tested were from Sagbara 120(60%) followed by Nandod 30(15%) Dediapada 20(10%)  Garudeshwer 15 (7.5%), Tilkawada 15(7.5%). All 200  human samples, tested by Elisa were Negative. Animal side Data collected from all talukas of Narmada district from GAHC portal (Govt. of Gujarat) and INAPH MIS (NDDB) reports under NAIP program (Rashtriya Gokul Mission – Govt. of India. In our study, total 17665 pregnant animal samples were tested by using Rose Bengal test and Milk ring test. The study was conducted in different talukas like, Nandod, Garudeshwar, Tilakwada, Dediapada and Sagbara. Out of all these talukas maximum number of animals tested were from Nandod 4711(26.5%) followed by Garudeshwer 3143(17.7%), Tilkawada 3528(19.9%), Dediapada 3699(20.9%) and Sagbara 2854(16.15%). Out of all these tested animals with brucellosis, confirmed case were 16. Out of these 16 positive detected animals maximum rate of positivity was seen in Sagbara 8(50%), Nandod 4(25%) followed by Garudeshwer 3(18.75%), Dediapada 2(12.5%), Tilkawada 1(6.25%), also we have notices all the diagnosed animal had pregnancy with abortion. Conclusion: The present study revealed that the seroprevalence of brucellosis was low in human and higher in animal. In my study Maximum cases reported in the Sagbara block. Minimum cases reported by in the Tilakwada block. This study emphaises,  collaborative one health approach that consists of public education, development of infrastructure for disease surveillance and reporting in both veterinary and medical fields and campaigns for control in livestock. Also the study helps to create public awareness among animal owners, farm and animal health workers on transmission and health hazards of brucellosis through community training. The implementation of public policy focused on mitigating the socioeconomic effects of brucellosis in human and animal.

Objectives: The present study was to evaluate the clinical profile and management of Posner Schlossman syndrome in tertiary care center of North Bihar. Methods: The diagnosis of PSS was made on the basis of the presence of mainly unilateral recurrent mild non‑granulomatous iritis with cells in the anterior chamber, with/without fine KPs, elevated IOP, open angles on gonioscopy, without posterior synechiae or posterior uveitis, with the attack lasting few days to weeks. Other causes of uveitis were ruled out by certain investigations: tuberculin skin test, chest X‑ray, venereal disease research laboratory test (VDRL), fluorescent treponemal antibody absorption test (FTA‑ABS), IgG for toxoplasmosis, and serum angiotensin‑converting enzyme (ACE) test. Results: Out of the 30 patients with PSS, 16(53.33%) were affected in the right eye and 9(30%) were affected in the left eye. In 5(16.67%) patients, the affliction was bilateral in nature. Out of 36 eyes. cataract was seen in  3(8.33%) eyes and glaucoma in 10(27.78%) eyes. 22(61.11%) eyes had mild or no visual impairment (visual acuity better than 20/70), 4(11.11%) eyes had moderate visual impairment (<20/70 to 20/200). 1(2.78%) eye had severe visual impairment (<20/200 to 20/400). 2(5.55%) eyes had blindness (>20/400 to 20/1200). 1(2.78%) eye had blindness (>20/1200 to PL). 1(2.78%) eye had blindness (NPL). And the visual acuity was undetermined or unspecified in 5(13.89%) eyes. The mean logMAR at presentation was 0.43 ± 0.65. Conclusions: PSS is more common in young to middle aged population. It is predominantly unilateral involvement.  Common comorbidities are glaucoma. High potency steroids are mostly used for the treatment of PSS. Mild or no visual impairment are seen in most of the Posner Schlossman syndrome patients.

Background: Laparoscopic surgeries are associated with unique hemodynamic challenges due to the pneumoperitoneum-induced changes in cardiovascular physiology. Combined epidural-general anesthesia (CEGA) has been proposed as an alternative technique to mitigate these hemodynamic responses. This study aimed to compare the hemodynamic stability and analgesic requirements between CEGA and general anesthesia (GA) alone in patients undergoing laparoscopic surgeries. Methods: A prospective observational study was conducted on 70 adult patients scheduled for elective laparoscopic surgery. The patients were allocated into two groups: GA group (n=35) and CEGA group (n=35). Hemodynamic parameters, including heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP), were monitored at various time points during the perioperative period. Analgesic requirements were also assessed. Results: The mean heart rate was significantly lower in the CEGA group at 40 and 50 minutes after insufflation compared to the GA group (P < 0.05). The mean SBP, DBP, and MAP were significantly lower in the CEGA group during the capnoperitoneum period and in the post-operative period (P < 0.05). The analgesic requirements were also significantly lower in the CEGA group compared to the GA group (P < 0.001). Conclusion: CEGA provided better hemodynamic stability and reduced analgesic requirements compared to GA alone in patients undergoing laparoscopic surgeries. These findings suggest that CEGA can be a preferred anesthetic technique for laparoscopic surgeries, particularly in patients at high risk of hemodynamic instability.

Introduction: The goals of safe and effective anesthesia for intraocular surgery is to obtain good   analgesia   and   anesthesia   without   complications. Peribulbar anesthesia has been the anesthesia of choice for cataract surgery and is routinely performed with a mixture of local anesthetics, most common combination being bupivacaine and lidocaine. The aminoamide, Ropivacaine, a derivative of mepivacaine, was introduced in 1996 as the safer alternative to bupivacaine. Hence, we compared the efficacy and complications of ropivacaine and bupivacaine, both in combination with lidocaine and hyaluronidase for peribulbar anesthesia by two-point injection technique for cataract surgery. Materials and Methods: In this study, 60 consenting patients posted for cataract surgery under peribulbar anesthesia with two-point   injection   technique were   included. They were randomly categorized into two groups of 30 patients each. One group received ropivacaine with lidocaine plus hyaluronidase and the other   group received bupivacaine with lidocaine plus hyaluronidase. The efficacy was compared in terms of akinesia and analgesia achieved by each of these agents both intraoperatively and postoperatively. Results were analyzed using paired t test, ANOVA, and chi-square test. Results: Based on our observations regarding onset of action, duration of anesthesia, early recovery of motor blockade and intraocular pressure changes, ropivacaine scored better than bupivacaine. There were no differences in effects on mean arterial pressure and ECG rhythm changes and even though bupivacaine decreased heart rate from baseline value, bradycardia did not occur in both groups. Conclusion: Ropivacaine is a better agent than bupivacaine for peribulbar anesthesia due to its faster onset and shorter duration with less effects on intraocular pressure. However, cardiovascular toxicity does not occur with either ropivacaine or bupivacaine when used in peribulbar anesthesia for cataract surgery.

The Coopdech® Video Laryngoscope VLP-100™ (CVL) is a digital intubation tool that allows direct visualization of the vocal cords during intubation. Laryngoscopy and intubation results in increased hemodynamic responses in patients. This prospective, randomized control study was conducted to evaluate and compare the hemodynamic responses during laryngoscopy and intubation with the CVL and Macintosh laryngoscopes in patients without comorbidities. A total of 140 patients were equally and randomly divided into two groups and the mean heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure were compared at baseline, after induction, before laryngoscopy, and at different points of time after intubation. The results showed a significant rise in all parameters at 1 minute and 3 minutes after intubation in both groups (p<.05), but no significant difference in parameters between the two groups (p>.05). The time taken to intubate was significantly more with the Coopdech Videolaryngoscope than with the Macintosh laryngoscope. The study concluded that the Coopdech videolaryngoscope did not show any advantage over the Macintosh laryngoscope in terms of attenuating hemodynamic responses following laryngoscopy and orotracheal intubation.

Background: Effective root canal cleaning is vital for the success of endodontic therapy. Traditional syringe irrigation often fails to adequately clean complex root canal anatomies, particularly in the apical third, necessitating the development of advanced irrigation techniques. Ultrasonic, laser-activated, and mechanically assisted irrigation systems aim to enhance the removal of debris and smear layers, improving treatment outcomes. Aim: This study aimed to compare the efficacy of traditional syringe irrigation, ultrasonic irrigation, laser-activated irrigation, and mechanically-assisted irrigation in removing debris and smear layers from root canals. Methods: Sixty extracted single-rooted teeth were randomly divided into four groups (n=15 per group), each subjected to one of the irrigation techniques. Root canals were prepared using a standardized protocol and evaluated for cleanliness in the coronal, middle, and apical thirds using scanning electron microscopy (SEM). Data were analyzed using one-way ANOVA and Tukey’s post hoc tests, with significance set at p < 0.05. Results: Laser-activated irrigation achieved the highest cleaning efficacy, with mean scores of 2.0 ± 0.3 for debris and 2.2 ± 0.3 for smear layers. Mechanically-assisted irrigation also performed well (debris: 2.3 ± 0.4; smear layers: 2.5 ± 0.4). Ultrasonic irrigation showed moderate effectiveness, while traditional syringe irrigation was the least effective (debris: 4.1 ± 0.5; smear layers: 4.2 ± 0.4). Statistical analysis revealed significant differences among the groups (p < 0.05). Conclusion: Laser-activated irrigation proved to be the most effective technique for root canal cleaning, followed by mechanically-assisted irrigation. Ultrasonic irrigation demonstrated moderate performance, while traditional syringe irrigation showed limited efficacy, particularly in the apical third. Recommendations: The study highlights the need to incorporate advanced irrigation techniques such as laser-activated and mechanically-assisted systems for better clinical outcomes. Future clinical trials are recommended to validate these findings and assess their long-term impact.

Background: The safety of blood donors forms a crucial component for safe blood transfusion services. The policies that govern donor eligibility form an integral part of blood safety which is designed to ensure selection of healthy donors and also to protect recipients. Donor deferral as a result of risk factors is a standard practice worldwide. Objective: The aim of our study is to analyse the different reasons of blood donor deferrals. Donors who are deferred generally have negative attitude towards blood donation process and in future, these donors are less likely to return for donation. Retention of the temporarily deferred donors can be achieved to a great extent by analysing the various reasons for deferrals and eliminating the causes wherever possible. Methods: This was a single-centre, retrospective study which was conducted at the blood bank of a tertiary care teaching hospital in North Karnataka from 1st January 2022 to 30th November 2024. It involved donors who donated blood at the blood bank as well as at outdoor blood donation camps. These donors were evaluated by the medical officer in – charge and were deferred during different stages of evaluation (Stage 1- History taking, Stage 2- Physical examination and Stage 3- Haemoglobin estimation). Individuals who did not fulfil the criteria for donation were deferred with reason being documented in the deferral register, from which data was retrieved for study. Results: In our study, 344 (8.92%) of donors were deferred from blood donation of the total 3855 blood donors. Most of the deferrals were temporary while few were permanent. Majority of the deferred donors were in the age of 18 – 30 years. Deferral rate was high among females compared to males. High blood pressure among potential donors was the most common cause for temporary deferral whereas donors who are diagnosed with diabetes on medication was the most common cause for permanent deferral. Conclusion: Temporarily deferred donors were higher than permanently deferred donors. Most studies indicate high percentage of donor deferrals due to temporary reasons. Identifying the reasons and frequency of donor deferral aids in preventing loss of precious blood units by helping to retain the donor pool.

Background: Embryo Glue, a hyaluronan-enriched transfer medium, enhances implantation rates by improving uterine receptivity. Advanced maternal age negatively impacts implantation rates in assisted reproductive technology, as implantation success declines with increasing age. The current study aimed to assess whether using Embryo Glue for embryo transfer improves implantation rates and live birth outcomes in freeze-thaw cycles. Methods: This study involved patients undergoing ICSI-FET (Day 5) with conditions like POR, Advanced Maternal Age, RIF, PCOS, or Unexplained Infertility. After informed consent, Overall, 196 patients for this study were identified with the inclusion and exclusion criteria. Patients treated with FET using embryo glue as transfer medium were grouped as Test (n=104) while those treated with FET with standard transfer medium were grouped as Control group (n= 92) divided.  Pregnancy was confirmed by measuring beta-human chorionic gonadotropin (beta-hCG) level after 14 days of embryo transfer. Results: The test group (embryo glue) showed significantly higher implantation (25% vs. 19.6%, p = 0.02) and live birth rates (79.8% vs. 65.21%, p = 0.03) compared to the control group, attributed to the adhesive properties of the glue. Pregnancy rates were higher (52.88% vs. 45.65%) and abortion rates lower (20.19% vs. 34.78%) in the test group, demonstrating no increased miscarriage risk. Additionally, the multiple pregnancy rate was significantly higher in the test group (27.88% vs. 18.47%, p = 0.019), supporting the role of embryo glue in improving implantation outcomes. Conclusion: Hyaluronan-enriched transfer medium (HETM), or embryo glue, is safe during ART. It considerably increases pregnancy and implantation rates. To avoid multiple pregnancies, the number of implanted embryos can be reduced. The positive outcomes shown for HETM are significantly outlined in this study, especially in females above 35 years old.

Background: Respiratory infections are prevalent among children, and antibiotics, particularly in suspension form, are commonly prescribed to manage bacterial infections. Proper use of these suspensions, including accurate reconstitution, administration, and storage, is crucial to their effectiveness. The study focuses on addressing these issues to educate caregivers and improve practices through the use of visual educational tools. To Evaluate the impact of educational posters on improving caregivers’ knowledge and practices related to the handling of pediatric and adolescent antibiotic suspensions and promote accurate and safe handling of these medications through visual aids. This is a prospective, interventional study done in September and October 2024 which was conducted in pediatric clinic where caregivers frequently visit to receive prescriptions and medications for children. The study followed a pre-test and post-test design to measure changes in knowledge and practices. In the pre-education assessment, caregivers demonstrated strong knowledge in specific areas, with 92.54% knowing the correct amount of water for reconstitution, 93.42% aware of the need to shake the bottle after reconstitution, and 80.7% understanding proper storage for diluted medicine. However, significant gaps were noted, such as only 10.96% knowing the effective duration of reconstituted antibiotics and 24.12% understanding preparatory steps like loosening the powder before reconstitution. After the educational intervention, caregivers achieved a 100% correct response rate. Hence, we conclude study highlighted a mix of strong and weak areas in caregivers’ knowledge and practices regarding antibiotic administration for children. While most participants were well-versed in core aspects, there were critical gaps, particularly around preparatory steps and the timing of reconstituted antibiotics. Educational posters proved to be an effective tool for bridging these gaps, resulting in a substantial improvement in adherence to correct practices. The findings emphasize the need for clear, visual, and easy-to-understand educational materials, tailored to caregivers’ demographics, especially targeting younger parents who are the primary caregivers. Future educational strategies should leverage visual aids and communication platforms that resonate with the target audience, ensuring proper medication use and reducing the risk of errors.

Background: The main cause of blindness in the world today is corneal disease, which remains second only to cataracts because it includes a wide variety of infections and inflammatory eye diseases. To evaluate the epide-miological trends and risk factors associated with suppurative corneal ulceration and to identify the microbial agents responsible for these corneal infections. Method: 100 patients aged between 10 to 75 years with suppurative keratitis were studied. Corneal ulcers were clinically diagnosed with the help of slit-lamp fundus examination. Visual acuity measured with the help of Snellen’s chart, Routine blood examination, HIV, Hbs-Ag were done. Corneal scraping done with a No. 15 Bard-Parker blade& subjected for Microbiological evaluation. Microbiological investigation includes gram staining, 10% KOH preparation, and bacterial culture using blood agar and chocolate agar. Fungal culture was done on Sabouraud’s dextrose agar medium. Results: 95% people with corneal ulcer had trauma by vegetative matter and foreign body as predisposing factor for keratitis and late presentation of patient to Ophthal OPD, as patient got treated at local hospital by cortico-steroid for foreign body (5%). The maximum duration of symptom was 81% in 1–10 days; >20 days was 1% in patients. Gram stain reported 91.8% sensitivity for bacteria, fungi 89.8% sensitivity, 10% KOH had 61% posi-tive, 39% negative patients. Fusarium, Aspergillus Spp being most common fungal & Staphylococcus Aureus being most common pathogens corneal ulcer. Conclusion: The present pragmatic, different microbiological profile study will certainly help the ophthalmolo-gist treat such patients efficiently to prevent blindness.

Background: Asthma and chronic obstructive pulmonary disease (COPD) are characterized by distinct anatomical alterations in the airways and lung parenchyma. This study aimed to evaluate these structural changes in a cohort of patients from Autonomous State Medical College, Fatehpur, Uttar Pradesh. Methods: A total of 100 patients (50 asthma and 50 COPD) underwent clinical evaluation, pulmonary function tests, high-resolution computed tomography (HRCT), and bronchoscopy with endobronchial biopsy. HRCT findings and histological features were compared between asthma and COPD patients, and correlations with clinical parameters were assessed. Results: Asthma patients had a higher prevalence of airway wall thickening (84% vs. 56%, p=0.002), epithelial desquamation (80% vs. 30%, p=0.035), subepithelial fibrosis (90% vs. 40%, p=0.019), and smooth muscle hypertrophy (70% vs. 20%, p=0.025) compared to COPD patients. COPD patients had a higher prevalence of bronchiectasis (60% vs. 16%, p<0.001) and emphysema (90% vs. 4%, p<0.001). COPD patients had significantly lower FEV1 (48.3 ± 12.4% vs. 72.5 ± 15.6%, p<0.001), FVC (78.6 ± 14.1% vs. 88.2 ± 12.3%, p<0.001), and FEV1/FVC ratio (52.1 ± 6.9% vs. 68.4 ± 8.5%, p<0.001) compared to asthma patients. Anatomical findings correlated significantly with lung function and disease severity. Conclusion: Asthma and COPD exhibit distinct anatomical alterations, with airway wall thickening, epithelial desquamation, subepithelial fibrosis, and smooth muscle hypertrophy being more common in asthma, and bronchiectasis and emphysema being more prevalent in COPD. These findings provide insights into the structural changes associated with these diseases and highlight the importance of imaging and histological techniques in their evaluation.

Background: Breastfeeding is a basic human activity, vital to infant and maternal health. Despite strong evidences in support of exclusive breastfeeding for the first six months of life and awareness, its prevalence has remained low worldwide. Objective: The objective of the present study was to compare the knowledge, attitude and practices towards breast feeding and infant feeding practices between urban and rural mothers of under 5 children in Tripura, India. Methodology: A cross-sectional study was done in rural field practice area and in the urban field practice area under Department of Community Medicine, Tripura Medical College &Dr. BRAM Teaching Hospital. Data was collected by the researchers through face-to-face interview, by house to house visit. Collected data was compiled and analysed on Statistical Package for Social Sciences (SPSS v.16).  P value less than 0.05 was considered as statistically significant. Results: The study showed 66.7% mothers had good knowledge about breastfeeding in both urban and rural population. Majority of mothers aged less than 20 years and the highly-educated mothers had a good knowledge about the meaning of exclusive breastfeeding. Majority of the participants had good practice of breastfeeding which was higher among the age group of 20-30 years. There was a positive association between higher socio economic status and mothers having institutional deliveries with breastfeeding practices. Breastfeeding counselling, socio economic status, literacy and age of the mother had a significant influence on breastfeeding patterns and breastfeeding knowledge. Conclusion: This study showed approximately two third of the study population had good knowledge on breastfeeding. Educated mothers had more good practice than illiterate mothers. Mothers of urban area had more positive attitude towards breastfeeding compared to mothers of rural area.  Awareness about importance of exclusive breastfeeding can enhance knowledge, attitude and practice of breastfeeding among both urban and rural population.

Background: Chronic suppurative otitis media (CSOM) is a persistent inflammation of the middle ear cleft, leading to ossicular erosion and hearing loss. Ossiculoplasty aims to reconstruct the ossicular chain to restore hearing. This study compares the outcomes of ossiculoplasty using autologous cartilage versus refashioned incus in patients with CSOM. Methods: A prospective study was conducted on 100 patients diagnosed with CSOM requiring ossiculoplasty. Patients were divided into two groups: Group A (n=50) received autologous cartilage grafts, and Group B (n=50) received refashioned incus. Preoperative and postoperative audiometric evaluations were performed to assess hearing improvement over a 6-month follow-up period. Results: Both groups showed significant postoperative hearing improvement. Group A had an average air-bone gap (ABG) reduction of 20 dB, while Group B showed an average reduction of 18 dB. The difference between the groups was not statistically significant (p > 0.05). Graft uptake rates were comparable in both groups, with minimal complications observed. Conclusion: Ossiculoplasty using either autologous cartilage or refashioned incus provides significant hearing improvement in CSOM patients. Both materials are effective and safe, with no significant difference in outcomes. Selection of the graft material can be based on surgeon preference and intraoperative findings.

Background: Tympanoplasty is a surgical procedure to repair tympanic membrane perforations, aiming to restore hearing and prevent recurrent infections. While microscopic tympanoplasty (MT) has been the conventional approach, endoscopic tympanoplasty (ET) offers a minimally invasive alternative. This study compares the outcomes of ET and MT to evaluate their efficacy and safety profiles. Methods: A retrospective study was conducted on patients undergoing tympanoplasty at a tertiary care center between January 2020 and December 2022. Patients were divided into ET and MT groups. Outcome measures included operative time, graft success rate, postoperative pain, and hearing improvement assessed by pure-tone audiometry. Results: The ET group demonstrated a shorter operative time and reduced postoperative pain compared to the MT group. Both groups had similar graft success rates and significant hearing improvement postoperatively. Complication rates were low and comparable between the two techniques. Conclusion: Endoscopic tympanoplasty is a viable alternative to microscopic tympanoplasty, offering comparable success rates with added benefits of reduced operative time and postoperative discomfort. ET should be considered a preferred option for suitable candidates.

Background: Birth weight is not only a critical determinant of child survival, growth and development but also a valuable indicator of maternal health, nutrition and quality of life. Low Birth Weight is closely associated with fetal and perinatal mortality and morbidity. The present study was undertaken to evaluate the maternal factors responsible for Very Low Birth Weight (VLBW) newborn. Objective: To study the maternal factors influencing very low birth weight babies. Design: Prospective Case Control Study. Setting: SNCU (Inborn unit), Department of Paediatrics, Jhalawar Medical College, Jhalawar. Participants: All Newborns delivered in SHKBM Hospital, Jhalawar medical college and admitted in SNCU (Special Newborn Care Unit) with birth weight less than 1500 Gms irrespective of gestational age over a period of one year were included in the study as cases. Healthy babies (with birth weight > 2.5 kg) which were born on same day as of case were randomly selected in ratio of 1:1 as controls. Main Outcome Measure(s): Maternal factors taken into consideration were: Age, Parity, Birth interval,  Height and Weight of the mother, Mid arm circumference, Literacy of the mother, Family structure, Mother’s occupation, Per capita income, Antenatal visits, Maternal diseases during the antenatal period and Bad obstetric history. Neonatal factors taken into consideration were: weight, sex and gestational age. Results: Out of 112 cases, 86 were preterm appropriate for gestational age, 11 were term small for gestational age and 15 were preterm small for gestational age. Maternal factors like birth intervals, maternal weight, mid arm circumference, literacy, income, antenatal visits and bad obstetric history were significantly related whereas maternal age distribution, parity, mother’s height, family structure, mother’s occupation and maternal diseases had no significant relation to Very Low Birth Weight in the newborns. Conclusions: In our study, the incidence of VLBW was found to be associated with maternal factors like less birth intervals, low maternal weight, less mid arm circumference, illiteracy, low per capita income, less antenatal check-up visits and bad obstetric history. Health education and antenatal care are of utmost importance to prevent low birth weight in newborns.

Introduction: Polycystic Ovarian Syndrome (PCOS), an endocrine disorder that disproportionately affects reproductive-aged women, causes hormonal imbalance, metabolic dysfunction, and persistent low-grade inflammation. Since inflammation is fundamental to polycystic ovarian syndrome (PCOS), indicators including C-reactive protein (CRP) and albumin are used to assess inflammation. The CRP/Albumin ratio is a new indication of diet-systemic inflammation relationship. The major goal of this study was to establish the clinical relevance of the CRP/Albumin ratio in PCOS patients. Objective: The study aimed to compare PCOS-diagnosed women’s CRP/Albumin ratio to healthy controls. One secondary purpose was to determine if CRP/Albumin correlated with other clinical factors including insulin resistance and BMI. Materials and Methods: At Patna Medical College and Hospital, 200 women with PCOS were recruited from June 2023 to May 2024 a retrospective cross-sectional study. Clinical data like CRP and albumin were collected from medical records. Participants were 18–40-year-old women with Rotterdam-diagnosed polycystic ovary syndrome (PCOS). Patient exclusion criteria included pregnancy, other inflammatory disorders, and recent infections. For biochemical and demographic data, we used descriptive statistics, and for CRP/Albumin ratio and other clinical variable patterns, we used correlation analysis. We used SPSS for statistical analysis. Results: The study found that PCOS patients had higher CRP levels (7.8 ± 3.5 mg/L) than controls (2.2 ± 1.0 mg/L) but lower albumin levels (4.1 ± 0.5 g/dL vs. 4.5 ± 0.4 g/dL). In PCOS patients, the average CRP/Albumin ratio was 1.9, significantly greater than the control group’s 0.5 ratio (p < 0.001). Insulin resistance, BMI, and CRP/Albumin ratio were strongly linked (r = 0.38, p < 0.001). Conclusion: The elevated CRP/Albumin ratio suggests ongoing low-grade inflammation in polycystic ovary syndrome (PCOS) patients. This ratio can identify patients at risk for metabolic issues like insulin resistance and cardiovascular disease and assess polycystic ovary syndrome (PCOS) inflammation. This ratio may monitor therapy response, but further research is needed to determine its clinical usefulness in PCOS diagnosis and management.

Introduction: Antepartum haemorrhage (APH) is the main cause of death and impairment for mothers and their unborn children in low-resource areas. The two most prevalent causes of APH, placenta previa and placental abruption, have different treatments and results. This retrospective investigation of APH’s prevalence, aetiology, and outcomes in a tertiary care setting at Patna Medical College and Hospital, Bihar, sheds light on its clinical effects. Objective: This research aims to determine how common APH is in tertiary care settings, what causes it, how it affects mothers and newborns, and what variables can predict poor outcomes. The ultimate purpose of these objectives is to understand APH and its clinical consequences to guide high-risk obstetric care. Material and Methods: At Patna Medical College and Hospital in Bihar, 200 pregnant women with acute pulmonary haemorrhage were monitored from January 2023 to December 2023. Parent and child demographics, clinical presentation, diagnosis, treatment plans, and results were examined in patient records. We used the chi-square test to determine the significance of correlations between variables. Results: Placenta previa (50%) and placental abruption (38%) are the main causes of APH. Preterm delivery (52%), NICU hospitalisations (40%), and perinatal mortality (10%) were associated with placental abruption, while caesarean sections and better mother outcomes were associated with placenta previa. Most of the 2% maternal mortality rate was due to severe placental abruption. The study also identified advanced maternal age and multiparity as risk factors for poor outcomes. Conclusion: The report stresses APH’s impact in resource-constrained Bihar. Placental abruption was dangerous to the mother and unborn child, unlike placenta previa, which was surgically treated and had better results. Enhancing neonatal care resources, emergency treatment techniques, and prenatal screening can reduce APH issues. Prospective research should assess long-term maternal and neonatal outcomes.

Background: Paediatric and adult gliomas—the most common primary brain tumors—have different frequencies, biological activity, and clinical prognoses. Paediatric gliomas are low-grade and localised, while adult ones are high-grade and invasive. Surgical excision is still the best treatment, although tumour biology and age make it harder. Objective: This study compares the outcomes of glioma surgery in children and adults, assesses postoperative complications, and identifies factors that affect survival and recovery. Method: A retrospective observational study was conducted at Patna Medical College and Hospital’s Department of Neurosurgery in Patna, India, from January 2023 to August 2024. Histologically verified gliomas were surgically excised from 30 children and 30 adults. Patient demographics, tumour features, surgical procedures, post-surgery results, and survival rates were collected. The two groups’ outcomes were statistically compared. Results: Most juvenile gliomas were localised and low-grade, allowing 80% gross resection. Invasive development patterns caused 60% of adult gliomas to be subtotal resected, and 65% were high-grade. Paediatric patients had 20% surgical problems and quicker recovery durations than adults. Compared to adults with high-grade gliomas, children had a superior progression-free survival rate. Conclusion: This study found substantial differences in glioma characteristics and surgical outcomes between adults and children. Paediatric patients did well due to less aggressive tumour biology and better recovery. Surgical and prognostic challenges were higher for adult gliomas. These findings show that glioma treatment must account for age and that interdisciplinary teams must tailor their approaches to each patient’s demographics and tumour biology.

Background: Gall Bladder Carcinoma (GBC), an uncommon and aggressive malignancy, is typically detected at a late stage and has a poor prognosis. The usual treatment is gemcitabine and cisplatin, but novel combina-tions like GEMoX, which combines gemcitabine and oxaliplatin, are being tested. This experiment examined GEMOX’s safety and efficacy in advanced GBC. Methods: A retrospective study examined 200 NMCH Patna patients who received GEMOX for advanced GBC between April 2022 and April 2024. The GEMOX regimen consisted of six cycles per 21 days, each involving 1000 mg/m² gemcitabine on Days 1 and 8 and 85 mg/m² oxaliplatin on Day 1. Adverse effects, response rates, PFS, and OS were assessed. Data from medical records was evaluated using SPSS or R. Results: Progress-free survival was 4.5 months (95% CI: 4.0-5.0) and overall survival was 8.7 months (95% CI: 7.9-9.5). Only 5% of patients fully recovered, 35% improved, 40% did not change, and 20% worsened. Stabilisation was 80% and disease control 40%. Most adverse effects were mild to moderate, including 30% neutropenia, 40% nausea/vomiting, and 25% peripheral neuropathy. Patients changed dosage 20% of the time and stopped taking medicine 10% of the time. Conclusion: With acceptable toxicity, GEMOX improves survival in advanced GBC patients. This treatment works well when surgical excision is not possible.

Background: Seniors with brain tumour surgery are more likely to develop POCD. Because it can affect independence and quality of life, cognitive decline frequency, causes, and therapies need more research. Objective: This study aimed to evaluate postoperative cognitive outcomes in elderly patients who underwent brain tumor surgery, identify factors associated with POCD, and provide insights into improving clinical care for this vulnerable population. Method:  A retrospective observational study examined 50 65-year-old brain tumour surgery patients between 2022 and 2024 in Patna Medical College and Hospital. Demographic data, tumour features, surgery details, co-morbidities, and MMSE and MoCA cognitive function scores. The statistical study used descriptive statistics, cognitive assessments before and after surgery, and regression analysis to evaluate POCD risk factors. Results: The mean MMSE and MoCA scores considerably decreased post-operation (MMSE: 25.4 ± 2.5 to 23.6 ± 3.0; MoCA: 21.6 ± 3.1 to 19.8 ± 3.7, p < 0.001). Patients over 75, with worse cognitive scores (MMSE <24), several health issues, or procedures lasting over 5 hours are more likely to have POCD. The type of cancer, its location, and postoperative issues including oedema also affected cognitive results. Conclusion: Postoperative cognitive decline (POCD) is a major issue for older people having brain tumour surgery. Cognitive impairment was significantly linked with advanced age, preexisting cognitive impairment, comorbidities, and surgical variables. Essential to reducing these hazards are preoperative risk classification, personalized surgical techniques, and thorough postoperative care. Neuroprotective methods and the effects on cognition over the long run require more study.

Background: Cesarean hysterectomy is defined as surgical removal of the uterus at the time of Cesarean delivery. It is considered a near miss event and is performed as a last resort to control potentially fatal postpartum hemorrhage. Uterine atony is the most common cause of PPH which accounts for 70%-80% of the cases. With the use of multiple uterotonic drugs and other conservative methods, the need to do hysterectomy in cases of atonic PPH has reduced. Placenta accreta spectrum and uterine rupture are the major contributor to cesarean hysterectomy cases nowadays because of the increasing cesarean section rates. The purpose of this study is to understand the risk factors leading to Cesarean Hysterectomy along with the analysis of the causes, morbidity, mortality and perinatal outcome associated with it. Aim and Objective: To determine the incidence, risk factor and fetomaternal outcome of cesarean hysterectomy cases at PMCH, Patna. Method: A Retrospective observational study was conducted and all the cases of caesarean hysterectomy performed at PMCH, Patna between Jan 2022 and Dec 2023 were studied. Data regarding demographic characteristics, indications, risk factors, complications and perinatal outcome was collected from medical records and the results analysed. Result: Total number of deliveries during the study period was 9032. Total number of caesarean hysterectomy was 78.The incidence of caesarean hysterectomy was 8.6/1000 deliveries. In my study, the most common indication was Ruptured uterus (65.3%) followed by morbidly adhered placenta (15.3%), Placenta previa (12.8%) and atonic PPH (6.4%). Conclusion: Cesarean Hysterectomy is a technically challenging procedure with high complication rates. So, proper antenatal check-up along with close monitoring of high risk pregnancies and institutional delivery is important to curb the high rates of caesarean hysterectomy.

Snakebite envenomation is a critical public health issue in tropical and subtropical regions, including India, where agricultural workers are predominantly affected. Anti-snake venom (ASV) is the primary treatment modality, yet it is associated with significant adverse drug reactions (ADRs), including anaphylaxis. This cross-sectional study evaluates the incidence and outcomes of ASV-related ADRs among envenomous snakebite cases in a tertiary care hospital in Thrissur, Kerala. Out of 85 patients admitted with snakebites, 50 were envenomated and administered ASV. ADRs were reported in 40% of these cases, with anaphylaxis occurring in 8%. This study highlights the need for improved ASV administration protocols and public health interventions to enhance safety and outcomes in snakebite management.

Introduction: Surgical Site Infections (SSI) remains a significant problem to be death with following an operation and the third most frequently reported nosocomial infections. SSI costs significantly to increased health care costs in terms of prolonged hospital stay and lost work days and morbidity. Objective: The current study was undertaken to study risk factors that affect incidence of SSI and the common organism isolated and its antibiotic sensitivity and resistance, efficacy of modes of preparation on SSI, distribution of SSI in different surgeries. Material and Methods: The prospective, non-interventional, observational study was carried out on 70 cases of SSI (out of 387 operated patients). Infected samples from patients were collected by following all aseptic precautions and were processed without delay by the standard microbiological techniques. Results and Conclusions: The overall infection rate was 18.86%. The SSI rate increased with increasing age, more in male patients than females and it also increased significantly with the increasing duration of pre-operative hospitalization. The SSI was significantly higher in emergency surgeries as compared to the elective surgeries and the duration of surgeries. The most commonly isolated organism from surgical site infections was beta hemolytic streptococus, followed by staphylococci. Most of the organisms which were isolated were multidrug resistant. The high rate of resistance to many antibiotics underscored the need for a policy that could promote a more rational use of antibiotics.

Objective: The current study aims to compare the sensitivity and specificity of adding examination under anesthesia (EUA) and axillary ultrasound (AUS) to clinical examination (CE) for axillary lymph node staging in women with clinically node negative carcinoma breast. Material and Methods: This prospective study was conducted on 100 patients coming to the OPD and diagnosed with early breast cancer at tertiary care center from November 2023-October 2024. Results and Conclusions: This study was conducted on cases of clinically N₀ breast cancer at tertiary care centre. Collected data was analyzed meticulously and results were compared with similar studies done across the world and following conclusions were drawn. Breast cancer involvement of right breast was 50.54 % and left breast was 49.46 %, hence both breasts were almost equally involved. Majority of the patients i.e. 56.98% were found to be overweight. This study showed that, 63.45 % of the cases had lump in upper outer quadrant, which was the most common location. Majority i.e. (52.68 %) had T2 tumour. This study showed that, axillary ultrasound detected metastatic or suspicious lymph node in 16.30%. Only 4.3 % had palpable Lymph node on examination under anesthesia. In this study majority i.e. 82.80% underwent modified radical mastectomy (MRM) and 17.20% underwent breast conservation surgery (BCS).

Background: An uncommon, severe acute necrotizing kidney infection called emphysematous pyelonephritis (EPN) is characterized by the presence of gas in the renal parenchyma, collecting system, and perirenal tissue. Women are more likely than men to get EPN, and people with diabetes are more susceptible to infection. Escherichia coli is the most common causative pathogen in nearly 70% of the reported EPN cases. A conservative approach with antibiotics, image-guided drainage, and improved imaging modalities is necessary in the management of EPN. Methods: We conducted a Retrospective study for a period of 3 years (2023- 2024) in ESICMC, Kalaburgi, Karnataka. We included all the patients diagnosed with Emphysematous Pyelonephritis as the participants of this study. Data on demographic profile, clinical features, and laboratory investigations, imaging studies, management modalities and outcome of patients were recorded retrospectively. Radiological classification was done based on Huang and Tseng. Results: 21 patients diagnosed with Emphysematous pyelonephritis had a female/male ratio of 4:1 and diabetics were 81%. Fever (86%) was the commonest symptom followed by dysuria & frequency (52%) and flank pain (48%). Renal angle tenderness (71%) was the commonest sign. Among the biochemical abnormalities, we found acute renal dysfunction as 38%, hyperglycemia as 81%, leukocytosis as 71%, and dyselectrolytemia as 43% and thrombocytopenia as 19%. 8 patients (38%) were treated under medical management with antibiotics alone, 8 patients (38%) were treated both medically and with a DJ stent. 2 of them were treated both medically and with ultrasound guided Percutaneous drainage (PCD). 1 patient underwent Percutaneous Nephrolithotomy (PCNL) and 2 patients underwent Nephrectomy. Conclusion: Hence, we conclude that, radiographic diagnosis of emphysematous pyelonephritis is necessary. We recommend for early aggressive medical treatment with Percutaneous Drainage (PCD) and DJ stent and suggest that Nephrectomy should be considered only if patients deteriorate or do not improve on conservative treatment.

Background and Objectives: A number of foot ulcer classification systems have been devised in an attempt to categorize ulcers more effectively and allow effective comparison of the outcome of routine management. DUSS (diabetic ulcer severity score) is one of the latest wound-based system of classification which needs to be validated. Our aim was validation of the score with patient outcomes including healing and amputation. Methods: Total of 102 diabetic patients attending surgical outpatient clinic or admitted into the hospital with foot ulcers irrespective of duration of ulcer were included in the study. Necessary data was collected. DUSS score was calculated for each patient and analysis was done using SPSS package version 23. Results and interpretation: The mean age of the participants in the study is 58.373 years, with the highest incidence between the age groups 51 – 60 years. Among the study population, 74% were males and 26% were females.  In our study there were 15 patients with DUSS Score 1, 49 with DUSS Score 2, 20 with DUSS score 3, 18 with DUSS score 4. Among DUSS Score one, all patients underwent debridement. Among DUSS Score two, 19 patients underwent debridement, 30 patients underwent Minor amputation (Rays Amputation). Among patients with DUSS score three, 15 patients underwent debridement, 4 patients underwent minor amputations (Rays / forefoot amputation) and one patient underwent major amputation (BKA/AKA). Among patients with DUSS score four, 13 patients underwent major amputations, 4 patients underwent debridement and one patient underwent minor amputation. In our Study, 27 patients were healed primarily, 13 patients underwent grafting and 44 underwent Amputations. Conclusion: DUSS scoring system provides an easy diagnostic tool for anticipating probability of healing /amputation and need for surgery by combining four clinically assessable wound-based parameters. It can be very helpful for the stratification of study groups depending on severity of ulcers and it provides a simple, streamlined approach in a clinical setting that requires no investigative equipment although subsequent adequate wound care is an indispensable prerequisite to the DUSS being a valid diagnostic tool.

Background: Pilonidal sinus disease is a chronic condition affecting the sacrococcygeal region, often caused by friction and shearing forces between the buttocks, leading to hair penetration and subsequent infection. Various surgical approaches are used for treatment, each with distinct outcomes. Objective: This study aims to assess and compare the outcomes of different surgical techniques in the management of pilonidal sinus disease, specifically evaluating simple excision with closure and excision with flap reconstruction. Methods: This retrospective observational study included 20 patients treated at a tertiary care hospital in S.C.B. Medical College and Hospital, Cuttack, Odisha from November 2023 to October 2024. The collected data included age, gender, duration of symptoms, history of prior surgery, and early postoperative complications. Patients who underwent simple excision with primary closure or excision with flap reconstruction (Limberg flap) were included. Descriptive statistics were used to analyze patient demographics, surgical outcomes, and complications. Results: The mean age of the patients was 24.4 years (range: 12–37). Of the 20 patients, 13 were male (65%) and 7 were female (35%). Symptoms ranged from 1 to 8 months (mean: 4.6 months). The majority of patients (70%) presented with seropurulent discharge, followed by pain in 30% of cases. Simple excision with closure required a longer healing time and was associated with wound dehiscence (33%), necessitating outpatient wound care. Excision with Limberg flap reconstruction was performed in 12 patients, with a procedure time of 100 minutes and a hospital stay of 6–8 days. The Limberg flap procedure showed minimal complications, with one case of seroma (8%). Conclusion: Limberg flap reconstruction was found to be superior to primary closure in the management of pilonidal sinus disease, with fewer complications, lower rates of recurrence, and faster recovery. The modified Limberg flap provides a simple, effective, and reliable solution for treating pilonidal sinus, especially in patients with minimal complications.

Introduction: Obstructive jaundice is one of the most frequent and grave form of hepatobiliary disease. It can pose problems in diagnosis and management, particularly intrahepatic cholestasis. Hence, aim of the present study was to compare the diagnostic accuracy between Magnetic Resonance Cholangiopancreatography (MRCP) and Ultrasonography (USG) in detection and characterization in patients suspected with pancreatic and biliary system pathologies. Material and Methods: This study was conducted among forty six patients suffering from obstructive jaundice of all age groups. All the patients in the study underwent ultrasonography and MRCP. The results so obtained was expressed as percentages and variables as required. Results: The overall sensitivity and specificity of ultrasonography in detecting lesions were 91.90% and 69.20% with a positive predictive value of 89.40% and negative predictive value of 75%. The overall sensitivity and specificity of MRCP in detecting lesions were 97.14% and 81.80% with a positive predictive value of 94.40% and a negative value of 90%. It was inferred that MRCP has the higher accuracy for detecting lesions. The sensitivity of MRCP was 97.14% and the specificity is as high as 81.8%. Conclusion: MRCP can be considered as the new gold standard for the investigation of CBD and pancreatic ductal pathologies and permits reservation of ERCP to patients with a high probability of therapeutic intervention.

Objective: This study aimed to evaluate the incidence of hypocalcemia following near-total and total thyroidectomy over a 2-year period from November 2022 to November 2024. Material and Method: A total of 120 patients above 12 years undergoing thyroidectomy were included. Pre-operative assessments, including clinical history, examination, fine needle aspiration cytology, thyroid function tests, ultrasound neck, and indirect laryngoscopy, were conducted. Blood samples were collected pre-operatively and postoperatively. Hypocalcemia was defined as serum calcium below 8 mg/dL and ionized calcium below 4.4 mg/dL, with transient hypocalcemia lasting less than 6 months and permanent hypocalcemia persisting beyond 6 months. Biochemical and laboratory tests, including thyroid function tests, were performed, and management involved calcium supplementation with or without vitamin D. Results: The study revealed an overall incidence of hypocalcemia at 21.6%, with 7.5% progressing to permanent hypocalcemia. Malignancy was more prevalent in males (60%), while benign disorders were common in females (60% in the age group 20-50 years). Conclusion: Postoperative hypocalcemia, though a frequent complication after near-total and total thyroidectomy, can be mitigated through proper planning, meticulous surgical techniques, and the use of advanced technologies. Regular monitoring and early intervention are imperative for patient well-being, emphasizing the importance of attention to surgical details in minimizing complications.

Introduction: Metaplastic breast carcinoma is a distinct histological type of breast cancer and comprises of two components of both epithelial & mesenchymal type in a single tumor. It includes adenosquamous, squamous cell carcinoma (SCC), spindle cell carcinoma, metaplastic carcinoma with mesenchymal differentiation, mixed carcinoma and myoepithelial carcinoma. Materials and Methods: The study comprises of 5 cases of Metaplastic Breast carcinoma and was conducted in the Department of General Surgery, S.C.B. Medical College and Hospital, Cuttack, Odisha. Discussion: MBC is characterized by adenocarcinoma admixed with spindle cells, squamous cells and mesenchymal differentiation. Among the five cases in the present series, two cases showed lymph nodes metastasis. Commonly immunohistochemistry (IHC) markers in cases of MBC shows triple negative for estrogen receptor (ER), progesterone receptor (PR) and HER2-neu. Conclusion: The MBC has a poor prognosis and have a diverse clinical behavior, variable histology and different regime of treatment.

Background: Idiopathic intracranial hypertension (IIH) is a complex neurological condition with multifactorial origins, predominantly affecting obese women of reproductive age. This systematic review aims to explore recent trends in the surgical treatment of idiopathic intracranial hypertension. Methods: This systematic review was conducted according to guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The literature search encompassed an extensive database including PubMed, Science Direct and Cochrane library. Studies published from 2014-2024 were included in the analysis. The quality of the included studies was evaluated using the proper tools suited to the study design. The synthesis and analysis of data included a summary of study characteristics, aims and objectives, surgical technique, and main study results/conclusions. Results: Sample sizes in the selected studies ranged from 7 to 46,065 participants. The most common surgical techniques used for idiopathic intracranial hypertension were venous sinus stenting (VSS), CSF Diversion: Lumboperitoneal (LP) shunting and ventriculoperitoneal (VP) shunting, lumbopleural shunting, bariatric surgery and optic nerve sheath fenestration (ONSF). Generally, the studies discovered the increasing trends in venous sinus stenting procedures in the management of IIH and emphasised bariatric surgery’s effectiveness over community weight management interventions in lowering intracranial pressure and aiding weight loss. Overall, these studies present a diverse range of treatment approaches, with a focus on efficiency and outcomes in managing IIH. Conclusion: This systematic review concludes that various surgical techniques, such as VP shunting, LP shunting with programmable valves, ONSF, venous sinus stenting and bariatric surgery are helpful in the management of IIH. Venous sinus stenting emerges as a promising surgical intervention for medically refractory IIH, offering substantial symptomatic relief with minimal risks.

Background: The current study’s aim was to assess the effect of injection of autologous nanofat among patients requesting for rejuvenation of scar less than 5 years duration. Methods: This research was done as a prospective observational study from April 2021 to March 2022 including 14 patients who attended Plastic Surgery OPD of a tertiary care centre for scar rejuvenation and were treated with autologous nanofat injection. Results: The Patient and Observer Scar Assessment Scale was utilized to evaluate each patient. Following the surgery, both the patient and the observer’s total Patient and Observer Scar Assessment Scale scores (namely, the average score of 6 items) considerably dropped, which is consistent with an improvement in scar quality. Conclusions: Autologous nanofat injection is a safe, easy, reliable option for scar rejuvenation especially for scars less than 5 years of duration. Categories: Plastic Surgery, Transplantation.

Background: Syphilis, caused by Treponema pallidum, remains a significant public health issue, particularly for pregnant women, with the potential to cause severe maternal and fetal complications, including stillbirth, preterm birth, low birth weight, and congenital syphilis. Early diagnosis and treatment are essential to prevent these adverse outcomes. Objective: This study aimed to assess the diagnostic accuracy of Rapid Plasma Reagin (RPR) and Treponema Pallidum Hemagglutination Assay (TPHA) tests in identifying syphilis in pregnant women and to evaluate the prevalence of biological false-positive results. Materials and Methods: A retrospective descriptive study was conducted from November 2023 to November 2024, involving 6,363 non-duplicate venous blood samples collected from antenatal care patients at PIMS Hospital. All samples were initially tested with the RPR test, and reactive cases were further tested using the TPHA. Data were analyzed using MedCalci software, with statistical significance set at a p-value of < 0.05. Results: Out of 6,363 samples, 109 (1.71%) were RPR reactive. These samples underwent semi-quantitative RPR testing at dilutions of 1:2, 1:4, 1:8, 1:16, 1:32, and 1:64. Higher dilutions (1:8 and above) showed a higher number of TPHA-positive cases, with 46 cases at dilutions >1:16. A total of 39 biological false-positive cases (0.61%) were identified in dilutions below 1:8. Among the 109 RPR reactive cases, the majority (73.39%) were in the 21-30 years age group, with 25.69% of false positives also occurring in this group. However, this age distribution was not statistically significant. Conclusion: Syphilis diagnosis in pregnancy requires a combination of RPR and TPHA tests to minimize false-positive results. Regular screening and early treatment are crucial to prevent syphilis-related complications. The study underscores the need for confirmatory testing in clinical practice to ensure accurate diagnosis and effective treatment, ultimately reducing maternal and neonatal morbidity and mortality associated with syphilis.

Background: Anemia in pregnant women is significant health problem in India. Etiology is varied and diagnosis and management of anemia in pregnancy is challenging due to physiological changes in pregnancy. Aims and Objectives: (1). To categorize anemia in early pregnancy. (2) To study the severity of anemia in early pregnancy. Methods: Women in early pregnancy visiting Cheluvamba Hospital OPD, Mysuru with hemoglobin < 11 g% were included in study from December 2023 to May 2024. Demographic details, details of clinical history and anemia work up were entered. Results: 100 pregnant women were diagnosed to have anemia in early pregnancy. Mean age was 22.6 years. Normocytic normochromic anemia was seen in 74% of pregnant women followed by microcytic hypochromic anemia (23%) and dimorphic anemia (3%). 4 pregnant women had beta thalassemia trait followed by1 case each of HPFH or double heterozygous for HPFH and delta beta thalassemia, Hb D with Hb S trait and Hb E trait. Mean Hemoglobin level (8.5g% vs. 9.7g%), MCV (67.6 vs. 78.4) and MCH (19.2 vs. 27.4) was significantly less in pregnant women with hemoglobinopathy as compared to pregnant women without hemoglobinopathy p < 0.002, p < 0.023 and p < 0.039 respectively). Conclusion: In addition to nutritional anemia, thalassemia poses a major challenge in pregnant women. Screening of pregnant women for thalassemia should be incorporated in national health program to prevent morbidity and mortality associated with thalassemia.

Aim: To validate Sir Ganga Ram Hospital Prostate Symptoms score (SGRHPSS), versus the International Prostate Symptoms Score (IPSS) in assessing lower urinary tract symptoms in the clinical setting. Material & Methods: Male patients with age ≥ 45 years presented with lower urinary tract symptoms in OPD or admitted in wards were included. Female patients and male patients with age < 45 years were excluded. Sample size was calculated using the formula (Z²×p×q)/d²) and 560 cases of lower urinary tract symptoms (LUTS) were included. Each patient filled both IPSS and SGRH-PSS questionnaire. Each patient underwent ultrasound for prostate size, residual urine and uroflowmetry. Both scoring systems were compared, also with objective parameters of LUTS i.e., ultrasound findings for prostate size, post voided residual urine (PVRU) and uroflowmetry. Settings and Design: The study was conducted at department of Urology, Institute of Renal Sciences at Sir Ganga Ram Hospital, New Delhi. It was a prospective and comparative study. The study was conducted from July 2014 to March 2016. Statistical Analysis: We measured reliability of SGRHPSS using test-retest correlation coefficient 29 and Cronbach’s Alpha 29, 30 for internal consistency. All analysis was conducted using Statistical Package for the Social Sciences 20 (SPSS 20) software. Results: Total IPSS score ranged from 2 to 34 with mean score of 18, while voiding LUTS ranged from 0 to 20 with mean score of 10.89 and storage LUTS ranged from 1 to 15 with mean score of 7.12. Total SGRHPSS score ranged from 1 to 8 with mean score of 5.79, while voiding LUTS ranged from 0 to 4 with mean score of 3.0 and storage LUTS ranged from 0 to 4 with mean score of 2.79. Spearman coefficient correlation in between total IPSS score and SGRHPSS score was 0.927 (P value &lt;0.001) and QoL in IPSS and SGRHPSS was 0.867 (P value &lt;0.001) suggest statistically significant and strong positive relationship. Conclusion: After analysing above observations and results, we concluded that SGRHPSS score system is shorter, efficient, friendlier, and less cumbersome for patients and clinicians and may potentially replace or compliment the IPSS.

Background: The prevalence of diabetes is rising rapidly worldwide, particularly in India, where type 2 diabetes accounts for over 90% of all cases. Diabetic ketoacidosis (DKA) remains one of the most common diabetes-related emergencies, and despite advancements in management and more standardized care, it continues to result in significant morbidity and mortality. Material & Methods: The present cross sectional, prospective study was carried out at department of General Medicine, at our tertiary care hospital. The study duration was of one year from January 2023 to December 2023. A sample size of 100 was calculated at 95% confidence interval at 10% acceptable margin of error. All patients who were diagnosed with type 2 diabetes patients experiencing DKA were enrolled from indoor department by simple random sampling. Results: In the present study, Out of the total study participants mean HbA1c (%) levels were 9.1 ± 1.6 and mean value of random blood sugar was 568.89 ± 40.23 mg/dL, the mean value of serum sodium was 132.7 ± 6.9 meq/L, mean value of serum potassium was 4.8 ± 0.6 meq/L, mean value of serum bicarbonate was 11.3 ± 1.1 meq/L, mean value of serum calcium was 9.7 ± 0.2 mg/dL, mean value of serum magnesium was 1.82 ± 0.4 meq/L, mean value of serum osmolarity was 294.7 ± 10.3, mean value of anion gap was 45.4 ± 7.2 and mean value of serum creatinine was 1.4 ± 0.9 mg/dL. Conclusion: We concluded from the present study that diabetic ketoacidosis (DKA) as a serious metabolic complication, even in cases of type 2 diabetes. Patients presented with higher random blood sugar (RBS), elevated serum osmolality, and lower pH levels, which directly correlated with poorer outcomes.

Background: Severe Acute Malnutrition continues to be a significant public health issue globally, especially in low- and middle-income nations. It is a life-threatening condition that plays a major role in childhood illness and death. Children with SAM are at heightened risk of infections, developmental delays, and poor health out-comes. Haematological parameters are crucial in understanding the extent of anemia, immune function, and overall health status in malnourished children, therefore understanding the hematological profile of children with SAM is essential for early diagnosis, effective treatment, and improved patient outcomes. Aim: To study the haematological parameters in Severe Acute Malnourished children. Objectives: To study the morphological spectrum of anemia, any WBC abnormality, or any other abnormal haematological parameters in severe acute malnutrition. Methodology: This prospective observational study included 243 children from 6 months to 59 months of age with Severe Acute Malnutrition admitted in Department of Pediatric Medicine, fulfilling the diagnostic criteria for severe acute malnutrition. Venus blood sample was collected in pediatric ward by venipuncture and was sent to central laboratory for analysis. Results: Anemia was the most common haematological abnormality, 92.2% of total 243 children suffering from SAM included in the study had Anemia. In the study, out of 224 children with anemia, 134(59.8%) had microcytic anemia, 49(21.9%) had normocytic anemia, and 41(18.3%) had macrocytic anemia. Leukocytosis was present in 67 (27.57%) of the total children, leukopenia was present in 20 (8.23%) children, thrombocytosis was present in 68 (27.98%) children and thrombocytopenia was present in 30 (12.35%) children of the total children with SAM. Conclusion: This study concludes that the primary haematological abnormality in children diagnosed with se-vere acute malnutrition is anemia, followed by thrombocytosis and leukocytosis. Children with severe acute malnutrition often exhibit abnormal haematological parameters. As a result, it is crucial to closely monitor these parameters and adjust treatment protocols accordingly to manage infections and support quicker recovery.

Introduction: Thyroid nodules represent one of the most frequently encountered abnormalities in the endocrine system. These nodules are defined as discrete lesions that can be distinguished from the normal thyroid parenchyma on radiological examinations. Increased detection due to widespread use of neck ultrasonography. Accurate diagnostic methods are crucial to avoid unnecessary procedures and improve patient outcomes. Aims & Objectives: To estimate the diagnostic accuracy of ultrasound elastography for the differential diagnosis of suspicious thyroid nodules as benign or malignant, using FNAC/Histopathology analysis as the reference standard. To compare the diagnostic accuracy of strain wave ultrasound elastography in the evaluation of suspicious thyroid nodules. To compare the diagnostic accuracy of shear wave ultrasound elastography in the evaluation of suspicious thyroid nodules. Study Design: Prospective analytical study. Location: Department of Radiodiagnosis, Indira Gandhi Medical College, Shimla. Duration: 12 months. Sample Size: 140 patients with suspicious thyroid nodules. All studies were performed using the Samsung RS80 EVO ultrasound machine with elastography software and a high-frequency linear array probe LA2 – 9A for both conventional US and USE examinations. Result: All Patients were evaluated using a combination of conventional ultrasound, strain elastography, and shear wave elastography. Key parameters such as lesion shape, calcifications, margins, echo patterns, and vascularity were meticulously recorded and analyzed. The integration of elastography techniques aimed to enhance the precision of thyroid nodule assessment, providing a comprehensive evaluation framework that supports accurate diagnosis and informed clinical management. Conclusion:  In conclusion, our study validates the efficacy of ultrasound elastography, particularly when combined with TI-RADS, in the accurate assessment and risk stratification of thyroid nodules.

Background: Prevalence of Allergic disorders is increasing accompanied by rising stress levels in the children which highlights the concerns to study the association between both these factors. The current study was conducted to evaluate the association between stress and allergic disorders. Materials and Methods: 358 students were enrolled for the study purpose. Perceived stress questionnaire and allergic questionnaire was used to collect the data. All the volunteer students were above 18 years admitted in the year 2021 and 2022 were included in the study. Results: In our study population of 358 students prevalence of allergic disorder is 45.81%. In students with allergic disorders 62.91% has perceived stress score [PSQ Score] more than 0.5. Also 72% students with allergic disorders have positive family history of allergic disorders. The association between allergic disorders and stress is significant at p value less than 0.05 according to the chi square statistics. Conclusions: The psychological factors have a significant role in the exaggeration of the allergic disorders. Stress can exacerbate the allergic disorders so children with positive family history for allergic disorders or those who are more susceptible to allergic disorders are more vulnerable to experience stress triggered allergic disorders hence stress management is important in these children to minimize allergic episodes and prevent future complications in them.

Introduction: Infection of the central nervous system (CNS) is the most common cause of fever that is associated with signs and   symptoms of CNS disease   in children.  Viral infections of the CNS are much more common than bacterial infections, which, in turn, are more common than fungal and parasitic infections. Radiology and pathology are inseparable at the time of understanding the phenomenon causing nervous system infections. There are a wide range of neuroimaging findings in central nervous system (CNS) infections, often with considerable overlap, which makes determination of a specific diagnosis difficult. The present study aims to study the utility of neuroimaging in diagnosis of acute CNS infection and the neuroimaging patterns found in different CNS infection. Aim: 1. To study the utility of neuroimaging in CNS infection in paediatric age group. 2. To study the pattern of neuroimaging in children in CNS infection. 3. To study the socio demographic and clinical profile of CNS infection in children. Method: This is prospective observational study in children (1month – 14 years old) who are presented with CNS infection. Result: Total 116 cases of less than 14 years old children were suspected to have CNS infection in study period at a tertiary care center. It was observed that acute CNS infection was more prevalent in 1 month -1 year age group with (27.58 %), followed by 5 – 8 year (24.13%),1- 8 year (20.68%) and 3-5 year (5.17%). In this study neuroimaging was done in all suspected cases (116) of CNS infection in which 55.91(48.2%) patients had normal neuroimaging study and 60(51.7%) had abnormal neuroimaging study. Among the cases with abnormal neuroimaging 6 (10%) showed pyogenic meningitis, tubercular meningitis was present in 14 (23.23%) patients, tuberculoma in 8 (13.13%), TBM + tuberculoma in 6 (10%), viral meningitis in 8 (13.3%), HSE in 2 (3.3%), COVID encephalitis in 2(3.3%), ADEM in 8 (13.3%) while 4 patients (6.66%) were found to have brain abscess. Correlation between final diagnosis and neuroimaging was 100% in ADEM, Brain abscess, tuberculoma, TB spine, HSV followed by TBM 77.77% and followed by pyogenic meningitis (27.27%) and viral encephalitis (26.66%). Clinically diagnosed acute CNS infection was confirmed in 51.72% (60 case) and was wrong in 48.27 %( 56 case). Conclusion: CNS infections were more common in less than 5 years age. Around half of the patients had abnormal neuroimaging finding. Neuroimaging studies are helpful to monitor the complications such as subdural effusion, hydrocephalus, infarction etc. It was found that neuro-imaging was accurate in early diagnosis and categorization of CNS infections with high sensitivity in CNS tuberculosis.

Background: Acute Kidney Injury (AKI) is a severe clinical syndrome associated with high hospital mortality. However, limited prospective data exist on the long-term outcomes of AKI. This study was conducted to assess the clinical profiles and factors influencing outcomes in patients with AKI over a follow-up period. Materials and Methods: A prospective study was conducted from August 2024 to November 2024, enrolling 80 participants with AKI as defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Data on demographics, clinical features, and etiological factors were collected. Patients were followed for three months, and univariate and multinomial analyses were used to predict outcomes. A Cox regression model was applied to identify predictors of mortality. Results: The mean age of the participants was 41.67 ± 16.21 years, with a male predominance. Most patients (81.9%) required non-ICU care. Oliguria was observed in 36% of cases, and 39.6% required dialysis. Sepsis was the most common single etiology. The majority of patients were categorized as KDIGO stage 3, followed by stage 2. At three months, 40.6% achieved complete recovery, 12.3% had partial recovery, 4.2% showed no recovery, and 30.4% succumbed to the condition. Mortality was significantly associated with factors such as age, single etiology, hepatorenal syndrome, sepsis, need for mechanical ventilation and vasopressors, comorbidities, and glomerulonephritis. Conclusion: AKI is associated with substantial mortality, even among patients who initially present with non-ICU care needs. These findings emphasize the importance of AKI prevention, early detection, and timely intervention to address reversible risk factors and improve clinical outcomes.

Background: Chronic kidney disease of unknown etiology (CKDu), characterized by the absence of known risk factors, has been documented in various geographically distinct regions worldwide. This study explores the clin-ical and epidemiological profile of patients with CKDu from a newly identified hotspot in western India. Materials and Methods: This cross-sectional study analyzed the sociodemographic, clinical, and laboratory profiles of CKDu patients visiting a tertiary care public hospital in, between July 2024 and December 2024. CKDu was defined as progressive CKD with minimal proteinuria, no hematuria, and the absence of diabetes, severe hypertension, systemic illness, glomerulonephritis, or other urinary tract diseases. Symmetrically contracted kidneys on ultrasound further confirmed the diagnosis. Results: The mean age of patients was 53.6 ± 11.8 years, with a male predominance 68.1%. Most patients were from rural areas (88.6%) and were primarily engaged in farming (63.3%). The average estimated glomerular fil-tration rate (eGFR) at presentation was 21.5 ± 15.1 mL/min/1.73 m². Patients were categorized as having stage 3 CKD (26.5%), stage 4 CKD (34.3%), or stage 5 CKD (39.2%). Conclusion: This study identifies distinct geographical clustering of CKDu cases in western part of India, suggesting the need for further investigation into potential environmental or occupational risk factors in these regions.

Background: Pleural effusion involves excess fluid accumulation in the pleural space and can be classified as transudative or exudative based on its cause. Accurate diagnosis is essential for effective treatment. Objective: This study aims to explore the clinical, biochemical, cytological, and molecular diagnostic profiles of pleural fluid to determine the causes of pleural effusion. Methods: Conducted at LLRM Medical College, Meerut, from April 1, 2023, to March 31, 2024, the study included patients over 5 years with pleural effusion. Data on demographics, symptoms, effusion types, causes, and diagnostic tests (ADA levels and CBNAAT) were collected. Results: The study involved 140 patients, predominantly male (65.7%) and younger adults. Exudative effusions were more common (64.3%) than transudative (35.7%). Tuberculosis was the leading cause (46.4%), followed by congestive cardiac failure (18.6%) and malignancy (13.6%). ADA was above reference value of >40IU in 89.2% patients of tuberculosis. CBNAAT was positive in 40% of tuberculosis cases, highlighting the need for a combination of diagnostic methods. Conclusions: Exudative effusions are prevalent, with tuberculosis being a major cause. ADA levels are valuable for diagnosis, while CBNAAT underscores the importance of using multiple diagnostic approaches. Comprehensive evaluation and advanced diagnostics are crucial for managing pleural effusion, especially in high- tuberculosis regions.

Background: One of the leading causes of illness and mortality among mothers and newborns is preeclampsia. It has been suggested that taking calcium supplements during pregnancy can reduce the prevalence of preeclampsia, especially in groups with inadequate calcium intake from their diet. Aim: This study aimed to evaluate the impact of calcium supplementation on maternal and fetal outcomes in high-risk pregnancies, with a particular focus on preeclampsia prevention. Methods: One hundred and twenty pregnant women at high risk for preeclampsia were randomly assigned to either the control group (n = 60) or the calcium-supplemented group (n = 60). From 20 weeks of pregnancy until birth, the calcium-supplemented group was given 1.5g of calcium every day. The two groups were compared in terms of maternal serum calcium levels, blood pressure, pregnancy-induced hypertensive diseases, and newborn outcomes. Results: Calcium supplementation significantly increased maternal serum calcium levels. While preeclampsia incidence was lower in the calcium-supplemented group compared to the control group, this difference was not statistically significant. However, calcium supplementation was associated with improved neonatal outcomes, including increased birth weight and reduced intrauterine growth restriction. Conclusion: Calcium supplementation during pregnancy may have beneficial effects on maternal and fetal outcomes in high-risk pregnancies, particularly in terms of improving neonatal birth weight and reducing the risk of intrauterine growth restriction.

Background: Preeclampsia is one of the hypertensive conditions that significantly increases maternal and neonatal morbidity and mortality. In populations with poor dietary calcium intake, calcium supplementation during pregnancy has been suggested as an intervention to lower the incidence of hypertensive diseases. Aim: In a cohort of pregnant women, this study sought to evaluate the impact of calcium supplementation on maternal serum calcium levels, pregnancy-induced hypertension disorders, and newborn outcomes. Methods: 120 pregnant women were split evenly between a control group (n = 60) and a calcium-treated group (n = 60). From 20 weeks of pregnancy until birth, the calcium-treated group was given 1.5g of calcium supplements every day. Measurements and comparisons across the groups were made of serum calcium levels, blood pressure, pregnancy problems (preeclampsia and gestational hypertension), and neonatal outcomes (birth weight, Apgar score, and intrauterine growth restriction). Results: Maternal serum calcium levels in the calcium-treated group were considerably elevated by calcium supplementation (p < 0.001). The calcium group saw a decreased incidence of preeclampsia (20%) compared to the control group (33.3%); But calcium supplementation improved newborn birth weight (mean birth weight: 3.12 kg in the calcium group vs. 2.83 kg in the control group, p = 0.01) and significantly decreased the incidence of intrauterine growth restriction (3.3% vs. 15%, p = 0.04). Conclusion: By lowering the prevalence of intrauterine growth restriction and raising birth weight, calcium supplementation during pregnancy improves neonatal outcomes and dramatically raises mother serum calcium levels.

Background: Common surgeries include hernia repair, including controversies about laparoscopic versus open methods. Laparoscopic (Transabdominal Preperitoneal, TAPP, mesh surgery) and open hernia repair will be compared for operative time, postoperative recovery, and recurrence rates. Methods: At GMERS Medical College in Junagadh, Gujarat, 100 inguinal hernia patients were randomly randomized either laparoscopic TAPP mesh or open treatment. Operative time, intraoperative and postoperative complications, pain scores, hospital stay, return to normal activities, and 6-month hernia recurrence were recorded. Results: Laparoscopic surgery showed better outcomes with shorter operative times (75 vs. 90 minutes), lower postoperative pain scores (3 vs. 5), shorter hospital stays (1.5 vs. 3 days), faster return to normal activities (10 vs. 15 days), fewer complications, and lower recurrence rates (2% vs. 5%). Conclusion: Laparoscopic TAPP mesh repair offers significant advantages over open hernia repair, suggesting it should be the preferred technique in suitable candidates.

In this era, women’s health is a very important aspect of the general health of the population. Every physician participating in the care of female patient must be familiar with the normal process of menstruation and how it May interact with other disease processes. Hence present study was undertaken to see satisfaction rate and demographic profile of all those patients visiting our hospital A total of 50 cases were selected from a period of May 2023 to May 2024. The study was conducted at a tertiary care teaching institution and hospital. For the purpose of study, a record was maintained of – details of the patient including name, a 1 age, and Contact number, clinical data of the patient including Menstrual ang obstetric history, especially parity and mode of delivery. In our study the maximum number of patients were in the perimenopausal age group of 41 to 50 years (48%). In our study, maximum number of patients with dysfunctional uterine bleeding were with previous full term vaginal deliveries (58%), followed by patients with previous caesarean section (30%). In our study, almost 64% patients were free from any medical condition. In present study after 6 months of follow up highly satisfaction was registered by 44% of patients and 34 % were satisfied with only 2% patients were diss satisfied Thus, to conclude, Mirena is a suitable alternative before considering hysterectomy for patients with dysfunctional uterine bleeding. It has been found to have long term 5-year satisfaction rates comparable to hysterectomy and with over 90% reduction in monthly menstrual blood loss. In addition, it has advantages of long-term contraception with failure rates equaling sterilization.

Background: Induction of labor is a common obstetric intervention in developing countries. Pharmacological and mechanical methods are used commonly, such as prostaglandins and various intra-cervical catheters (single or double balloon) at the expense of many hindrances. Methods: Out of 280 pregnant women (gestation after 37 weeks) were studied.  140 pregnant women (group I) received dinoprostone gel intracervically, and 140 pregnant women (group II) were administered with catheter No. 18 through the canal with visualization of cervical OS. The balloon was filled with 50 ml of sterile water, and the catheter tapped on the inner thigh to maintain traction.  Results: The baseline characters in gravidity, comparison of labor profile, maternal outcome, and maternal and neonatal complications had significant p-values (p < 0.001).  Conclusion: It is observed that group I dinoprostone gel had more rapid cervical ripening, shortening induction to vaginal delivery Interval within 24 hours. Hence, the dinoprostone gel technique is more preferred than mechanical dilatation in an unfavorable cervix.

Background: Bacterial infections exhibit a rising trend over past years around the globe in almost every clinical setting. Bacterial infections contribute to mortality and morbidity in infected patients. Due to lack of information regarding bacterial strain responsible for infection, clinician generally tends to prescribe the patients broad spectrum antibiotics which in turn enhance the antibiotic resistance. Nowadays antibiotic resistance is a prominent concern over the globe and every effort from the health agencies has been put forward for rationale use of antibiotics. Objective: Present study was aimed to study bacterial isolates and their antimicrobial susceptibility patterns in indoor patient department from a tertiary health care center of north India. Methods: The various bacterial isolates isolated from different samples were collected for two year from September 2021 to September 2023 from a tertiary care centre of north India. All samples were processed in accordance with accepted laboratory practises for microbiology. The isolates were identified down to the species level and antimicrobial susceptibility tests were carried out in accordance with the Clinical Laboratory Standards Institute (CLSI-2021) recommendations. Result: Among total 2089 samples, 629 samples were positive for bacterial isolates. Among total 629 samples, 443 (70.4%) isolates were gram negative bacteria and 186 (29.6%) isolates were gram positive bacteria. Among gram negative bacteria, Escherichia coli was the most common bacteria identified in 273 (43.4%) samples and among gram positive bacteria, Staphylococcus aureus was the most common bacteria identified in 133 (21.14%) samples. The Enterobacteriaceae group showed highest sensitivity against carbapenems and piperacillin-tazobactam. Highest sensitivity among all gram-positive bacteria was noted against vancomycin and linezolid. The screening of methicillin resistant Staphylococcus aureus with cefoxitin disc showed 52.6% (70) sensitivity. Conclusion: The accurate determination of susceptibility patterns aids in guiding appropriate antibiotic therapy, optimizing patient outcomes, and combating the emergence of antimicrobial resistance. Continuous monitoring of resistance patterns and implementation of infection control measures are essential for effective patient management in the IPD.

Background: ABO non-identical renal transplantation is becoming increasingly common to overcome the unavailability/ shortage of ABO identical donor(s). This study was conducted to evaluate whether Plasma exchange is an effective method in reducing ABO titers to desired levels in ABO Incompatible renal transplant recipients, as used as a part of desensitization regimen. Methods: A retrospective observational analysis was done in 11 patients taken for ABOi renal transplant from February 2022 to April 2024. All the 11 patients were treated with Plasma exchange procedures according to the institutional protocol for ABOi renal transplant recipients. Patients with a maximum baseline Anti-blood group (ABO) IgG titer of 512 were considered for such ABOi renal transplants and subsequent plasma exchanges. The purpose of plasma exchange along with immunosuppression was to lower the ABO isohemagglutinin titer to ≤ 4. Statistical analysis was done using Microsoft Excel, Windows. Data were reported as mean ± standard deviation, values and Percentages. Results: An average of 4.27 pre-transplant plasma exchanges were performed to lower the antibody titer to ≤ 4, along with the standard protocol containing immunosuppressive agents. A maximum and minimum number of plasma exchanges done in each of the patients were 7 and 1, respectively. During the postoperative 1 month follow up the serum creatinine level was maintained at around 1.84 mg/dl in all patients. All patients in the present study showed a high level of compliance with Plasma exchange with only mild adverse reactions. Conclusion: Plasma exchange can be regarded as a safe and effective method in decreasing the ABO titer to the desired level, in ABOi renal transplant recipients.

Hot spring water has been used for centuries for its therapeutic properties. Sulphur-Containing hot spring water, in particular, has been shown to have beneficial effects on various diseases, including atopic dermatitis, psoriasis, and osteoarthritis. Always consult a healthcare professional before starting any new treatment involving Sulphur. This narrative review aims to summarize the current evidence on the therapeutic effects of Sulphur-Containing hot spring water on these diseases.

Background: Blood donation is a critical life-saving process, and healthcare workers and medical students are often prime candidates for voluntary donation due to their knowledge and proximity to medical practices. However, there is often a gap between their knowledge, attitudes, and actual donation practices. Understanding these factors in detail could inform targeted interventions to increase donation rates. Objective: This study aims to assess the knowledge, attitudes, and practices (KAP) regarding blood donation among healthcare workers and medical students in Chennai, India, and to identify factors influencing donation behavior. Methods: A cross-sectional study was conducted among 108 healthcare workers and medical students in Chennai. Participants completed a structured questionnaire assessing their knowledge, attitudes, and practices related to blood donation. Statistical analysis was performed to calculate odds ratios, adjusted odds ratios, and p-values for sociodemographic factors and their association with blood donation behavior. Results: Of the 108 participants, 84.3% had good knowledge of blood donation, 88% had a positive attitude, but only 60.2% had ever donated blood, and 23.1% were regular donors. Knowledge of donation eligibility criteria and positive attitudes were significantly associated with higher odds of donation (AOR: 2.08, p = 0.04 and AOR: 3.12, p = 0.02, respectively). Barriers such as fear of adverse effects (44.4%) and time constraints (29.6%) were commonly reported. Conclusion: Despite high levels of knowledge and positive attitudes, actual blood donation practices among healthcare workers and medical students in Chennai are low. Addressing misconceptions and logistical barriers could improve donation rates. This study underscores the need for enhanced educational and motivational strategies to bridge the gap between willingness and actual donation.

Background: Blood donation rates in tertiary care settings often fall short of meeting demand, necessitated by various barriers perceived by potential donors. Methods: A cross-sectional survey involving 908 participants was conducted to identify barriers to blood donation. Statistical analyses, including chi-square tests and logistic regression, were utilized to evaluate the association between demographic characteristics and perceived barriers. Results: The study identified lack of awareness (50%), misconceptions about eligibility (37.4%), logistical issues (40%), and fear of needles (19.9%) as significant barriers to blood donation. Demographic factors significantly influenced the perception of these barriers, with tailored interventions proposed to mitigate their impact. Conclusion: Addressing the identified barriers through targeted educational campaigns and logistical improvements is critical for enhancing blood donation rates. Future strategies should focus on reducing misconceptions, improving awareness, and making donation more accessible.

Background: Thrombocytopenia is the most common laboratory finding in dengue fever with considerable morbidity and mortality. Platelet indices have been investigated as platelet activation marker and MPV can be used as independent predictor of bleeding. Objectives: To assess the correlation of platelet indices with platelet count in seropositive dengue patients. Methods: A retrospective study was done in Karwar Institute of Medical Sciences, Karwar for a period of 6 months from Jan 2024 to June 2024.  Serologically confirmed dengue cases were included and platelet parameters for continuous 3 days from day of admission were noted. Results: A total of 180 dengue seropositive samples were studied. Mean PDW, MPV, P-LCR and PCT across 5 groups of platelet count were compared and showed a significant difference with p<0.001. Conclusion: Platelet indices play a significant role in early predictive diagnosis. PDW, P-LCR, MPV had an inverse relation with platelet count and PCT was directly proportional to platelet count.

Introduction: Sepsis, one of the leading causes of severe illness worldwide, is a potentially fatal organ failure brought on by a dysregulated host response to infection. The aim of present study is to evaluate the specificity and sensitivity of C-reactive protein (CRP), procalcitonin (PCT), Band cell count and toxic granules in septicemia in pediatric age group. Material and Methods: The present observational study, was conducted in a government rural medical college hospital catering mostly to the rural population under its jurisdiction for a period of 6 months among 100 patients selected on the basis of inclusion and exclusion criteria. Blood samples were collected from all patients and evaluated for CRP, PCT, Band cell count and Toxic granule. Results were analyzed using SPSS version 25.0. Results: Prevalence of septicaemia was found to be 65%. The mean value of CRP was 6.87±2.1 mg/dL, mean Procalcitonin was 3.67±0.89 ng/ml. the number of patients with band cell count <10% was 39 (60%) and ≥10% was 26 (40%). Maximum patients 23 (35.3%) had +2 toxic granules. CRP with AUC 0.865 had a sensitivity and specificity of 83.9%, 75.6%. PCT with AUC 0.694 had sensitivity and specificity of 80.21%, 73.4%. Band cell count had AUC 0.346 with sensitivity and specificity of 78.39%, 70.31%. Toxic granules had AUC 0.321 with sensitivity and specificity of 75.69% and 69.87%. There were statistically significant positive correlations between sepsis and biomarker like CRP, PCT, Band cell count and toxic granules (p<0.001). Conclusion: Abnormal CRP combined with PCT, toxic granules and band cell count may be a straight forward and accurate method for quickly identifying neonatal sepsis.

The impact of hand hygiene practices on infection control at Indira Hospital, located in Supaul, Bihar, India. The project aims to reduce Healthcare-Associated Infections (HAIs), enhance patient satisfaction, and enhance hand hygiene protocols. Through a comprehensive methodology including surveys, observational studies, interviews and implementation of PDCA cycle among HCW, the study evaluates current hand hygiene knowledge and practices among healthcare workers (HCWs), identifies barriers to compliance, and implements interventions for improvement. Data analysis reveals there is a positive trend in hand hygiene compliance rates over the last three years, with a concurrent decrease in HAI rates. Despite variations in compliance among different staff categories, overall adherence to hand hygiene protocols shows improvement. Recommendations include implementing of PDCA Cycle in format of continuous training, resource allocation, behavior communication, monitoring and evaluation, promotion of accountability, and provision of incentives and reward to sustain and enhance hand hygiene practices.

Background: Red blood cell (RBC) transfusion is a critical therapeutic intervention in managing anemia, surgical blood loss, and trauma. However, prolonged storage of RBCs induces metabolic, structural, and biochemical changes, collectively known as the “storage lesion.” These changes may affect the plasma metabolome post-transfusion, potentially leading to adverse outcomes. Aim: This study aimed to evaluate the effects of aged, stored RBCs on the human plasma metabolome, focusing on metabolic changes and their clinical implications. Methods: A prospective observational study was conducted with 100 participants who received RBC transfusions. Participants were categorized into three groups based on RBC storage duration: <14 days, 14–28 days, and >28 days. Plasma samples were collected pre-transfusion, and at 24 and 72 hours post-transfusion, and analyzed using advanced metabolomic techniques. Key parameters, including hemoglobin levels, plasma lactate, potassium was measured. Statistical analysis was performed using SPSS version 23.0, with a significance threshold of p<0.05. Results: Plasma lactate levels significantly increased post-transfusion across all groups, with the highest levels observed in the >28 days group (mean: 3.2 mmol/L at 24 hours). Plasma potassium levels also showed a marked increase, with levels peaking at 5.8 mmol/L in the >28 days group. Hemoglobin levels increased uniformly in all groups, confirming effective oxygen-carrying capacity restoration. Statistical analysis revealed significant differences in plasma metabolite levels between groups, particularly between the <14 days and >28 days groups (p<0.001). Conclusion: Aged stored RBCs induce significant metabolic changes in the plasma metabolome, particularly elevated lactate, and potassium levels. While hemoglobin levels remained unaffected, the findings highlight the potential metabolic stress associated with transfusing older RBCs. Recommendations: To mitigate the risks associated with aged stored RBCs, it is recommended to prioritize fresher RBCs for vulnerable populations and explore interventions to minimize storage-induced metabolic alterations. Further research is warranted to establish clinical thresholds for RBC storage durations.

Background: The study was conducted to study the HbA1c levels in cases of iron deficiency anemia and compare with controls as well as to HbA1c level in mild, moderate, and severe iron deficiency anemia. Methodology: This was a case control observational study on non-diabetic subjects diagnosed with iron deficiency anemia presenting at Department of Medicine, Hamidia Hospital, Bhopal during the study period of June 2022 to January 2024. Age and sex matched nondiabetic controls without iron deficiency anemia were selected in control group. Medical History was obtained, and examination was done. A record of baseline investigation was made, and clinical parameters were documented. Results: This study was conducted on a total of 82 cases with iron deficiency anemia and 82 age and sex matched controls. Mean HbA1C level was higher in Cases (5.50) compared to Controls (4.99) (p<0.05). We found that severity of anemia also correlated with increased HbA1c level (p<0.05) (Table 3). Patients with higher HbA1c levels (5.7 – 6.0) have low serum ferritin (5.72±1.24) and low Hb levels (5.9±0.3) (p<0.05). Conclusions: According to the finding of study those with IDA had higher HbA1c compared to controls that were non anemic. It was also found in the study that as severity of anemia increases, the level of HbA1c also increase. Increased HbA1c level IDA may be due to change in quaternary structure of Hb or due to relatively decreased HbA1c levels in anemics. These findings underscore the importance of diagnosis of IDA to prevent over diagnosis of diabetes and pre-diabetics.

Background: Malnutrition threatens children’s health worldwide. Poor diet can cause several skin issues, harming children’s health and quality of life. This study compares nutritional deficiencies connected to common dermatological difficulties to skin abnormalities in children at Government Medical College, Bettiah. Methods: A 12-month cross-sectional observational study of 100 children aged 0–12 with skin issues was conducted. Participants got nutritional evaluations, including dietary history, hemoglobin, vitamin and mineral levels, and skin problem exams. Descriptive statistics, chi-square tests, and logistic regression revealed significant links between diet and skin issues. Results: Vitamin A deficiency caused 25% of xerosis, zinc deficiency 40%, dermatitis 30%, and fungal infections 35%. Healthy skin requires a suitable diet; statistical research has linked these deficiencies to many skin disorders. Conclusions: The findings suggest youngsters should start nutritional therapies early to prevent skin disorders. Paediatric healthcare should include targeted supplements and nutritional assessments. Public health policy should prioritize community-based programs, food fortification, and better healthcare in economically deprived areas to address childhood malnutrition. What causes malnutrition-related skin issues, how effective therapies are, and how to prevent them require more research.

Background: Pediatric portal hypertension is a significant condition associated with considerable morbidity, including variceal bleeding, growth failure, and other complications. Despite advances in medical care, optimal management strategies and treatment outcomes remain an area of ongoing research, especially in pediatric populations. Objective: This study aimed to evaluate the effectiveness of various management strategies and their associated outcomes in children with portal hypertension. Methods: A retrospective observational study was conducted, analyzing data from 100 pediatric patients diagnosed with portal hypertension over a 12 to 18-month period. Patients were categorized based on the treatment modality received: Medical Therapy, endoscopic interventions, or surgical procedures. Data were collected from medical records and analyzed to evaluate symptom resolution, growth improvement, and complications. Results: Endoscopic and surgical interventions were associated with higher rates of symptom resolution (80% and 85%, respectively) and growth improvement (70% and 78%, respectively) compared to medical Therapy. Portal pressure reduction was documented in 82% of the cohort. Complications were minimal, with slightly higher rates in surgical interventions. Statistical analysis confirmed the significant efficacy of invasive modalities over medical Therapy. Conclusion: Endoscopic and surgical interventions demonstrate superior outcomes in managing pediatric portal hypertension. The findings underscore the need for early diagnosis, tailored treatment strategies, and multidisciplinary care. Further research is warranted to validate these results and explore innovative management approaches.

Background: Hormonal fluctuations, gut flora abnormalities, and environmental stressors contribute to chronic diseases like Inflammatory Bowel Disease (IBD), which devastatingly affects women’s health. Even as medical science advances, understanding these factors and their interaction is needed to improve sickness management and patient outcomes. Objectives: This study examines how stress, hormonal fluctuations, and gut microbial dynamics affect women’s IBD symptoms. This research aims to identify vulnerable moments and develop effective early intervention methods. Women are susceptible throughout pregnancy and menopause. Methods: Inflammatory bowel disease affected 1,550 women in a cross-sectional study that employed clinical assessments, patient interviews, and laboratory data. We investigated how hormone profiles (estradiol and progesterone levels), stool sample sequencing, and validated stress scale affect disease activity and progression. We used regression models to find relationships and assess significance. Results: According to the study, patients with estradiol levels >200 pg/mL had 30% more flare-ups, demonstrating a substantial relationship between hormonal changes and illness severity. Symptom severity increased by 40% when gut microbiota imbalance, notably a decrease in Lactobacillus (<10^7 CFU/g), was present. High stress (score >20 on the stress scale) increased recovery time by 25% following a flare-up. Sixty per cent of pregnant participants reported increased symptoms, emphasizing menopause and pregnancy importance. With microbiota modulation by food and stress management, flare-up frequency decreased by 20% and recovery lengths by 15%. Conclusion: This study suggests that we must identify and control risk factors early in women with inflammatory bowel disease (IBD) to improve their health. The findings emphasize the relevance of public health initiatives and gender-sensitive treatment approaches focusing on tailored interventions during high risk. Studying larger, more diverse populations and longitudinal designs can help us understand these links and enhance intervention strategies.

Background: Dry eye disease (DED) may worsen after phacoemulsification cataract surgery. This study examines DED in patients and highlights the need for early identification and treatment for surgical success. Methods: Prospective observation of 100 phacoemulsified eyes done at BURDWAN Medical College was carried out for three months. Schirmer’s test, corneal fluorescein staining, OSDI scores, and tear film break-up time measurements were taken before and after surgery at 7, 30, and 90 days. The data were analyzed via ANOVA and paired t tests, with a significance threshold of p<0.05. Results: Corneal staining revealed greater ocular surface injury. Early postoperative symptoms peaked and improved, with most metrics attaining baseline by three months—pre-existing borderline tear film abnormalities linked with DED severity and surgical results. Tear film instability and dry eye symptoms worsened in the first postoperative week, as TBUT and Schirmer’s test values decreased and OSDI scores climbed. This period also increased corneal staining. Conclusion: Transient tear film dysfunction (TTD) may occur following phacoemulsification. However, it normally resolves within three months and peaks shortly after. These findings emphasize the necessity of preoperative DED evaluation and therapy to improve surgical outcomes and patient satisfaction. Future research should explore more accurate diagnostic methods and personalized treatment plans to reduce postoperative DED.

Aim: Clinically misdiagnosed acute appendicitis still continues to be a cause of negative appendectomy. This study emphasizes on utilising platelet indices as aid in parameter for the clinical diagnosis of acute appendicitis using the Alvarado scoring system. Materials and Methods: The blood samples of patients, who were clinically diagnosed as acute appendicitis on the basis of the Alvarado scoring system and healthy controls attending the routine check-up clinic were collected in di potassium(k2)-Ethylenediaminetetraacetic acid (EDTA) vacutainers and were processed by Sysmex XN1000 haematology analyser. Results: The study group comprised of 102 patients clinically diagnosed as acute appendicitis using the Alvarado scoring system, out of which 84 cases histopathologically confirmed as acute appendicitis. PDW and P-LCR were found to have higher statistically significant values in the patients compared to the age and sex matched 84 healthy controls (11.5± 2.2fl vs 10.6±1.3fl and 24.8± 6.6% vs 22.0± 5.2%). On Receiver operating characteristic (ROC) curve analysis the sensitivity and specificity of PDW were found to be 60% and 73% respectively and for P-LCR, sensitivity was 58% and specificity was 56%. Conclusion: In the present study it is emphasized that platelet indices like PDW and P-LCR can be used as supportive aid for the clinical diagnosis of acute appendicitis and utility of these parameters as one of the clinical components of the Alvarado scoring system.

Introduction: A group of illnesses known as Metabolic Syndrome (MetS) increases the risk of diabetes and cardiovascular disease. Metabolic Syndrome is a serious public health concern. The correlation between MetS and liver enzyme levels has garnered interest, especially among groups experiencing abrupt lifestyle shifts. Aim: This study aims to investigate the relationship between liver enzyme levels and the prevalence of metabolic syndrome among the selected Manipuri population. Materials and Methods: A cross-sectional study was conducted among 300 adults aged 18 years and above in Manipur, India, from January 2022 to June 2022. Participants were recruited through community outreach programs, and individuals with known liver diseases, alcohol dependence, or chronic infections were excluded. Data were collected using structured questionnaires covering demographic information, lifestyle factors, and medical history. Anthropometric measurements and fasting blood samples were obtained for biochemical analyses, including liver enzyme levels (ALT and AST), fasting glucose, and lipid profiles. MetS has been diagnosed according to the International Diabetes Federation Criteria. Statistical analysis was performed using spss version 25.0, with logistic regression models applied to assess associations between liver enzyme levels and mets, adjusting for potential confounders. Results: Out of the 300 participants, 32% were diagnosed with metabolic syndrome. Elevated ALT and AST levels were significantly associated with the presence of metabolic syndrome (p < 0.05). Notably, individuals with higher liver enzyme levels exhibited increased prevalence of abdominal obesity, elevated triglycerides, and insulin resistance. Conclusion: This study highlights a significant association between liver enzyme levels and metabolic syndrome among the Manipur population. The findings suggest that liver function tests could serve as valuable biomarkers for identifying individuals at risk of metabolic disorders, emphasizing the need for targeted public health interventions.

Background: Herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) are common human pathogens. Most primary HSV-1 and HSV-2 infections are asymptomatic and self-limited, but can be complicated with fulminant diseases. Thus, this study has its own objective to determine the clinicoepidemiological profile of HSV (1 and 2) infections in the symptomatic patients whose blood samples were received at the department of Virology, Government medical college Amritsar. Methods: A total of 231 samples were included in our study from the month of August 2023 to August 2024. All the samples fulfilling the inclusion criteria were subjected for ELISA. Results: Out of 231 samples, 52 (22.51%) were HSV (1-2) IgM positive and 154 (66.66%) were HSV (1-2) IgG positive. Females (52.38%) were predominantly infected showing more positivity of HSV (1-2) than males (36.79%). Maximum number of cases (108) were from age group 21-40 years. Amongst this age group, 34 (65.38%) were positive for HSV (1-2) IgM and 74 (48.05%) for HSV (1-2) IgG. The patients presented with various complaints like genital lesions, orolabial lesions, redness, swelling, pain/itching, painful urination and vaginal discharge, headache, malaise, fever and muscle aches. Conclusion: The purpose of screening for HSV is not only to identify seropositivity, but to help seropositive people identify symptoms and protect themselves from acquiring further complications and to protect their partners and seronegative people from acquiring HSV.