The earlier observation and belief  that rectal cancer is a disease of elderly population does not hold true today. Over the recent years there is a rising trend in rectal cancer not only in older population but also in young population across the world including India. Literature is scanty on its clinicopathological features and prognosis in these patients.  The present study has been carried to understand the clinicopathological characteristics and treatment outcome in these young age rectal cancer patients  at a tertiary care teaching hospital in north India. Material and Methods: This was a retrospective analysis of prospectively maintained data of rectal cancer patients who were surgically treated between 1990 to 2020. For the study purpose patients were  categorised in two groups- those  less or equal to 30 year ( Group I, young age rectal cancer patients)  and those more than  50 years ( Group II,  old age rectal cancer patients). Patients  between age 30- 50 year were excluded from the sturdy. Clinicopathological characteristics, treatment offered and outcomes were compared between the groups. Categorical variable was compared with Chi Square test and continuous variables with t-test. P value < 0.05 was considered statistically significant. Survival analysis was done with Kaplan Meier Curves and groups compared with Log Rank test. Results: A total 586 patients of rectal cancer were treated over a period of three decades. 21.16% of the patients were in the group I (young age) and 39.24% were in the old group (group II). Young group patients were found to have more low-lying lesion (Lower rectal cancer, 64%), T3/4 tumors (70%), mucin secreting characteristics (42%) as compared to elderly group patients. There was no significant difference in survival between two groups. Conclusions: Young age onset rectal cancer patients usually present at advanced stage, have low lying lesion and poor histological characteristics but without any significant difference in survival as compared to elderly group.

DOI: 10.5281/zenodo.10936175

Introduction: Diabetes Mellitus is a heterogeneous metabolic disorder characterized by impaired glycemic control leading to pulmonary complications. Aim: To record, compare and correlate the spirometry and diffusion test in non-smoker type 2 diabetes patients as well as in non-smoker non-diabetics. Materials and Methods: Non- smoker diabetes patients satisfying the inclusion criteria, age and sex matched non-smoker non diabetes volunteers were selected randomly for data collection. Clinical, laboratory examination, spirometry and DLCO were performed and outcomes were measured. Results: The measured values of FEV1 had a mean of 2.10 ± 0.62, FVC 2.35 ± 0.76, and PEFR 4.74 ± 1.71 among diabetes patients which were lesser than nondiabetes. FEV1/FVC ratio was higher (89.96± 8.50) than the non-diabetics. The mean measured DLCO among diabetes patients was lesser i.e. (20.012 ± 6.59) in comparison to non-diabetic group i.e. (23.91 ± 5.84). The mean FVC, FEV and DLCO values in patients who had >10yr duration of diabetes was lowest. A significant negative correlation exists between FVC (Spearman’s r = – 0.677; P value <0.001) with the HBA1C which means if HBA1C increase the FVC, FEV1 & DLCO decreases. But a significant positive correlation observed between FEV1/FVC with HBA1C. Conclusion: Our study concludes that, the pulmonary function test parameters (Spirometry & DLCO) in general were consistently lower in the diabetic group when compared to the non-diabetic group.
DOI: 10.5281/zenodo.10936175

Aim and Objective: To analyze the demographics of women presenting with leiomyoma with respect to: Age, symptoms, location etc. Settings and Design: This was an observational study carried out in a tertiary health center for a period of 1 year from September 2022 to September 2023. Materials and Methods: A retrospective observational study was conducted in 35 women having pain in abdomen, abnormal uterine bleeding, who were presented to the department of obstetrics and gynaecology, National Institute of Medical Sciences and Research, Jaipur between sept 2022 and sept 2023. All the patient presented with above mentioned symptoms were studied after obtaining consent from participant. Ultrasound was done and location of leiomyoma was studied. Fibroid were studied in terms of its, location and most common presenting symptoms and age of occurrence of symptoms. Results: In our study, the most common age group of presentation was 36-40 years. Most common type of fibroid was intramural (62.8 %) Most common symptoms was menorrhagia (57.1%). Most commonly associated with nulligravida (49.5%).

DOI: 10.5281/zenodo.10936175

Background: The impact of COVID-19 on medical education prompted the exploration of various online platforms, with our department opting for Moodle. This cross-sectional study seeks to understand preferences and challenges faced by MBBS students using Moodle. Thereby the study aims to establish an effective post-Covid model for Moodle as a Learning Management System(LMS), aligning with the requirements of the Competency-Based Medical Education(CBME) curriculum. Methodology: A questionnaire in Google Forms was distributed to MBBS students regarding their experiences during ENT theory and practicals in Phases II and III. The survey included an information sheet and consent form. A total of 153 students who responded were included in the study. Results: Moodle was deemed as an acceptable alternative during COVID-19 by a majority of students. The key appeal lies in the flexibility of timing, allowing continued studying even during illness. Some students faced challenges such as lack of concentration and self-motivation. Automated quiz grading for self-assessment received positive feedback. However, students expressed reluctance towards being monitored for attendance. Conclusions: While the threat of COVID-19 has diminished, Moodle remains an efficient tool for CBME implementation. Its standout feature is the ability to track individual student’s academic progress through assessments. The survey illuminated Moodle’s strengths, weaknesses, and acceptance. Broadening LMS usage should involve more faculty through training. Policymakers and administrators should consider investing in infrastructure and manpower to ensure a successful rollout.

DOI: 10.5281/zenodo.10936175

Background: Anemia is reported by many studies as an important risk factor for poor locoregional disease control and survival in head and neck carcinoma. Aim and Objective: The objective of this study was to evaluate the benefits of concurrent capecitabine and cisplatin over concurrent cisplatin and 5-FU in locally advanced squamous cell oral cancer by investigating the relationships among serum CRP level, IL-6, TNFα, and Hb, HCT, Ferritin, Transferrin, EPO prognosis in oral cancer patients. Material and Methods: Total 152 Histological proven eligible cases of locally advanced stage (III, IV, M0) head and neck cancer patients attending our radiotherapy O.P.D in year 2016-2018 were enrolled in the study. Blood samples were obtained at 8:30 a.m. after overnight fasting and subsequently routine analyses of Hb, HCT, CRP, IL-6, IL-1β, TNFα, EPO serum iron, transferrin, and ferritin were performed by Autoanalyzer & commercially available enzyme-linked immunosorbent assays (ELISA). The enrolled patients in this study who were to receive concurrent chemo radiotherapy following 2 cycles of Neoadjuvant taxol and cisplatin chemotherapy of whom 74 patients were randomized in Arm-I where cisplatin(75mg/m² in day1 and day2 ) and 5-FU(750mg/m² in day1,2,3) was given from the first day of radiotherapy at interval of 3-weeks, total five cycles were given, and 78 patients were in Arm II where cisplatin (75mg/m2 in day1 and day2) and capecitabine (750mg/m² in two divided doses from day1-14,with pyridoxine 100 mg bd was given on days 1–14) was given from the first day of radiotherapy at interval of 3-weeks, total five cycles were given. Results: The age ranges were, Arm1- Male-32-71 Years, Female-38-73 Years, Arm 2-Male-34-73Years & Female-42-68 Years. The cohort had more male patients, Arm1-62/74 (83.78%); Arm2-69/78 (88.46%). Predominance of T3 in Arm1-32/74 (43.24%), Arm2-36/78(46.15%) patients, and Overall Stages in Arm1- StgIII-35/74(47.29.%), Arm2-StgIII-37/78(47.43%) and for Stage IV- Arm1-39/74 (52.70%); Arm2-41/78(52.56.%) patients. It was found that the haemoglobin levels (mg/dl, mean) of all treatment cycles and follow up were Arm1-11.260,10.212,11.301, 10.983, 11.250, 12.431; Arm2-10.313, 9.452, 9.432, 10.201, 10.511, 11.103 and significantly inversely correlated with CRP, IL6, TNFα, IL-1β(P<0.05). The treatment response in two treated groups, was found slightly higher in the patients treated with Cisplatin + 5Fu and subsequently EPO levels were higher in patients treated with Cisplatin + 5Fu than in Arm2-Cisplatin + Capecitabine treated group. Conclusion: A low hemoglobin value in a cancer patient could be itself indicating a poor general condition of the patient, since hypoxia may be an expression of tumor aggressiveness. Similarly elevated Tnfα and IL6 could be indicated a poor general condition of the patients. In conclusion, concurrent chemoradiotherapy with capecitabine and cisplatin was found to be well tolerated and effective in patients with locally advanced head and neck cancer. Accordingly, this regimen can be regarded as an important chemoradiotherapy option for advanced head and neck cancer, although long-term follow-up is needed to evaluate the late treatment failure and complications.

DOI: 10.5281/zenodo.10936175

Background: Ventral hernia repair is one of the most common procedures performed in general surgery. Onlay and sublay mesh repair both are well established techniques for the locations of mesh placement, but with various benefits and drawbacks. About 15-18% of all the surgical procedures performed around the world comprises of hernia repair. This study was aimed to compare the outcome of hernia repair between two techniques, common options of mesh placement in open ventral hernia repairs; over the anterior rectus sheath, the Onlay meshplasty and in the retrorectus plane, the Sublay meshplasty. Methods: A prospective controlled study was done between March 2022 to January 2024 on 86 patients, aged 18-70 years with ventral hernia randomizing patients into 2 groups. Group A (Onlay meshplasty) and Group B (Sublay meshplasty). Primary outcome was recurrence and secondary outcomes included postoperative complications including surgical site infection, hematoma, seroma, wound dehiscence, peri-operative pain, persistent seroma, and chronic pain. Duration of surgery, post-operative pain, wound infection, duration of hospital stay and recurrences were analysed with 3 months follow up. Results: The mean duration of surgery in group A was 67.75±23.92 minutes and in group B was 79.63±18.71 minutes. Group B experienced significantly lesser pain when compared with group A. The mean asepsis score in group A was 3.60±1.09 and in group B was 1.47±0.30 with a p value of 0.05. Group A had significantly longer hospital stay (7.85±2.41 days,) than group B (5.40±1.29 days). The recurrences were found statistically significant (Group A- 4 /9.30% patients; No patient in Group B). Conclusions: Sublay meshplasty although required longer time to perform.  Sublay repair seemed to be a better alternative than onlay repair of Ventral hernia. Randomised controlled trial with larger sample size is required to validate the result.

DOI: 10.5281/zenodo.10936175

Introduction: The early start of lifelong antiretroviral medication (ART) for HIV-positive patients and subsequent retention has been crucial to India’s fight against AIDS. Effective adherence to lifetime ART lowers an HIV-positive person’s viral load to an undetectable level. Appropriate health-seeking behaviour is crucial because it enables early diagnosis and treatment of conditions, which can lower complications and enhance quality of life. Objective: To assess the health-seeking behaviour of patients attending ART centre of a tertiary care hospital in Raigad district of Maharashtra. Methodology: Descriptive cross-sectional study was conducted over a period of 1 year at the ART centre in a tertiary care hospital. Data regarding socio-demographic profile, health-seeking behaviour of HIV positive patients and patient’s attitude toward ART has been collected using pre- designed and pretested questionnaire. All the 180 registered HIV positive patient (>18 years) who have been registered at the ART centre were included in the study. Results: Majority, of HIV positive patients were between age of 36-50. The health behaviours like, advantages of going to different places for HIV/AIDS treatment and whether they consider going to another ART centre if they face any problems in getting ART were significantly low i.e., 16.1% and 17.8% respectively. It has been observed that HIV positive patients have a good attitude towards current ART centre. Conclusion: Efforts are needed to improve the health-seeking behaviour of people living with HIV/AIDS.

[ DOI: 10.5281/zenodo.10936175

Introduction: Acute appendicitis (AA) is one of the commonest surgical emergencies and appendicectomy is one of the commonest operations performed by general surgeons. In developing and low-income countries where radiological tools are not widely available, a simple and effective scoring system without tomographic or imaging studies could help in preventing misdiagnosis and decrease the rate of negative appendicectomies. This study evaluated the role of Appendicitis inflammatory response (AIR) score and compared it with Alvarado score in patients with AA. Materials and Methods: This was a prospective, observational, cross-sectional study involving 60 patients aged 16 or more years that presented with signs and symptoms of acute appendicitis and underwent appendicectomy in the Department of General Surgery, Jawaharlal Nehru Hospital and Research Center, Bhilai, India, over a period of 24 months. Based on the physical and laboratory examinations, scores (AIR and Alvarado) were calculated. Subsequently, the patient underwent appendicectomy and diagnosis of acute appendicitis was established on the basis of histopathological examination (HPE). Results: In this study patients were predominantly male and belonged to the age group of 21 – 30 years (36.67%). Pain in Right iliac fossa (RIF) (100%) and tenderness in RIF (60%) were the most common symptoms and signs, respectively. The AIR score had a sensitivity, specificity, Positive predictive value (PPV), Negative predictive value (NPV), and accuracy of 73.91%, 71.43%, 89.47%, 45.45%, and 73.33%, respectively. Similarly, the Alvarado score had a sensitivity, specificity, PPV, NPV, and accuracy of 69.57%, 42.86%, 80.00%, 30.00%, and 63.33%, respectively. At a cut-off of 6.5, the AIR score had better predictive ability than Alvarado score (AUC: 0.739 vs 0.571). Conclusion: The AIR score was superior to Alvarado score in predicting AA. AIR score had high negative predictive value thereby reducing negative appendicectomies.

DOI: 10.5281/zenodo.10936175

Background: Hemoglobin glycation index (HGI) was introduced to overcome the individual variations in the measured HbA1c (M-HbA1c) levels. Increased HGI levels were associated with risk of diabetic complications and morbidity. So, we aimed to evaluate the predictive utility of HGI towards systemic risk markers for cardiovascular and renal diseases in type 2 diabetes mellitus (T2DM). Methods: This cross-sectional study included diabetic cases (n = 100) and non-diabetic controls (n = 50). Biochemical parameters of diabetic profile including M-HbA1c, renal profile, and cardiovascular risk markers including lipid profile were estimated using standardized assay methods and compared between the study groups. Their standardized HGI were calculated using linear regression based predicted HbA1c (P-HbA1c) levels. Correlations of HGI and M-HbA1c with the risk markers of systemic diabetic complications such as renal and lipid profile were analysed. Results: Greater variations between M-HbA1c and P-HbA1c levels, resulting in higher HGI levels were observed in the diabetic group than controls. Among the systemic risk markers, serum creatinine and triglyceride had significant elevations in diabetic group (p < 0.05^*). Compared to M-HbA1c, HGI levels had stronger correlations with increasing serum urea (r = 0.3164, p = 0.0013^*), serum creatinine (r = 0.4073, p = 0.00003^*) and declining eGFR levels (r = -0.3512, p = 0.0003^*) in diabetics. No such significant correlations were observed between HGI and lipid profile cardiovascular risk markers. Conclusion: Higher HGI levels in diabetes suggest the possible role of HGI in monitoring glycemic control. The significant correlations of higher HGI levels with declining renal function emphasise the predictive utility of HGI for early detection of renal diseases in T2DM.

DOI: 10.5281/zenodo.10936175

Introduction: Low back pain with radicular symptoms is a prevalent musculoskeletal condition and a leading cause of disability. Radicular back pain involves multiple nerve roots, leading to pain and potential loss of sensation and motor function. Quality of life (QOL) is a crucial patient-centered measure assessing the impact of health conditions and treatment effects. Low back pain affects QOL and work performance. This study aimed to evaluate QOL in diabetic patients with low back pain and radiculopathy. Methods: A descriptive-analytical study was conducted at a Birsa Munda medical college in India involving 234 patients with low back pain and healthy individuals. The SF-36 questionnaire, assessing QOL across eight dimensions on a 0–100 scale and generating physical (PCS) and mental (MCS) component summary scores, was utilized. Higher PCS and MCS scores denote better QOL. Results: Among 234 patients, SF-36 assessments revealed significantly lower mean PCS and MCS scores in low back pain diabetic patients compared to the normative population, indicating poorer QOL. Conclusion:  Diabetic patients with low back pain and radiculopathy exhibit compromised QOL compared to the general population, necessitating prompt intervention, patient education, and rehabilitation to address this aspect of their well-being, which remains underexplored.

DOI: 10.5281/zenodo.10936175

Aim: The present study aimed to evaluate ophthalmic artery Doppler in pre-eclamptic women and to find out if doppler changes correlate with the severity of pre-eclampsia. Materials and Methods: The present prospective observational Comparative study was conducted in the Department of Obstetrics and Gynaecology, L.L.R.M. Medical College, Meerut from January 2021 to June 2022 after taking approved from institutional ethical committee. A total of 80 cases of pre-eclampsia and 40 healthy gestational matched controls were enrolled in the study after taking informed consent. Maternal outcomes were recorded in relation to ophthalmic artery Doppler findings and other ocular parameters. Neonatal outcome was noted in terms of weight, growth assessment, APGAR score, NICU admission and mortality. Result: Out of 120 women, 80 were pre-eclampsia and 40 were healthy controls. Mean age in cases were 26.58±4.30years and in control 26.00±4.19years ji. P value between cases and control of PSV (p=0.001), PR (p=0.003), PI(0.001), RI (p=0.002) were statistically significant in case of pre-eclampsia as compared to control (normotensive group). In present study for pre-eclampsia the cut-off value for PSV cm/sec, Peak ratio, Pulsatility index and Resistive index were 0.631, 0.579, 0.439 and 0.540, respectively to make a prognosis/outcome of preeclampsia. With these cut-off values, PSV cm/sec and Peak ratio had shown the higher sensitivity and specificity. These tests were demonstrating the accuracy of risk factors for preeclampsia. The PSV cm/sec, Peak ratio, Pulsatility index and Resistive Index were not significantly different large area under the curve (AUC) on the ROC curve. Conclusion: The present study concludes that ophthalmic artery Doppler is a novel innovation option in assessment of patients with pre-eclampsia and there is orbital vascular impedance reduction with orbital hyperperfusion in severe pre-eclamptic women compared with   mild pre-eclamptic and healthy pregnant women.

DOI: 10.5281/zenodo.10936175

Objective: This retro-prospective study was performed to evaluate the diagnostic accuracy of various imaging modalities as compared to histopathological findings in tumours and tumour-like lesions of bone. Materials and Methods: Imaging findings of 70 patients in the age group of 2 to 75 years were evaluated. The findings on Radiographs, Computed Tomography (CT), and Magnetic Resonance Imaging (MRI) were correlated with histopathological findings. Results: 70% of the bone lesions were benign on histopathology and 30% were malignant. Plain radiographs showed a sensitivity of 80.95%, and 95.92% specificity, with a PPV of 89.47%. NPV of 92.16%, and diagnostic accuracy of 91.43% were seen. CT showed a sensitivity of 95.0%, specificity of 91.67%, PPV of 86.36%, NPV of 97.06%, and diagnostic accuracy of 92.86%. On MRI 100% sensitivity, 93.8% specificity, a PPV of 91.3%, a NPV of 100%, and diagnostic accuracy of 96.23% were found. On comparing findings on radiographs, CT, and MRI with histopathological findings, Cohen Kappa values (K-values) of 0.8, 0.84, and 0.92 respectively were obtained.
Conclusion: This study shows high accuracy of all imaging modalities, more so MRI with a good correlation between radiological and histological diagnosis.

DOI: 10.5281/zenodo.10936175

Background: Percutaneous nephrolithotomy (PCNL) is a minimally invasive and standard Endourological procedure for management of patients with renal calculi more than 2cm in size. Postoperative pain was managed using multiple blocks like Quadratus Lumborum block, Paravertebral block and also local infiltration. Objective: To compare and study the effects of Quadratus Lumborum (QL) block and Peritubal infiltration (PTB). Methods: This double-blinded study is conducted on all patients undergoing PCNL under General Anaesthesia. Based on the group assigned, Urologist performed Peritubal infiltration with 10ml of 0.5% bupivacaine and Anaesthesiologist performed Quadratus lumborum block with 20ml of 0.25% Bupivacaine. VAS score at rest and motion was assessed in both groups and also the cumulative dosage of rescue analgesia was analysed using Independent T test. Results :VAS SCORE at rest and movement, over all need for analgesics over 24hr were less in group Q compare with group P. Time to rescue Analgesia was increased in group Q compared to group P. Conclusion: QL block was more effective than Peritubal infiltration for, postoperative VAS score both at rest and movement and lower analgesic consumption In post-operative period and more satisfaction in patients undergoing PCNL surgery.

DOI: 10.5281/zenodo.10936175

Background: Individuals with diabetes often exhibit suboptimal sleep patterns, characterized by challenges in both initiating and maintaining sleep. Certain individuals with diabetes have excessive sleep, whilst others encounter difficulties in obtaining sufficient sleep. As to the National Sleep Foundation, a majority of 63% of American adults fail to get the sleep required for maintaining excellent health, ensuring safety, and achieving optimal performance.
Aim: To investigate the correlation between metformin treatment and the amount and quality of sleep in individuals diagnosed with Type 2 diabetes.
Material and Methods: This research includes a cohort of 100 participants diagnosed with Type 2 diabetes. The patients were separated into two groups of equal size. Group A was administered metformin, whereas Group B did not receive metformin. This research included patients from all age groups. There are 50 patients in group A and 50 patients in group B.
We included consecutive, verified outpatients diagnosed with Type 2 diabetes who were referred for sleep apnea screening due to symptoms such as excessive daytime drowsiness, nocturnal snoring, disrupted sleep, nighttime urination, or other related symptoms.
Results: The research comprised a total of 100 patients. Out of them, a total of 50 individuals were undergoing treatment with metformin. There were no significant differences in demographic features between those who used metformin and those who did not, except for BMI, the number of anti-diabetic drugs, and the percentage of patients on sulphonylurea treatment. The two groups exhibited notable differences in terms of total sleep duration and sleep efficiency. Metformin users had a total sleep time of 6 hours and 43 minutes, whereas non-users had a total sleep time of 6 hours and 7 minutes (P = 0.003). Additionally, the sleep efficiency of metformin users was 70.37±4.26%, but non-users had a sleep efficiency of 78.23±4.47% (P = 0.004). The prevalence of apnoea or hypopnea, mostly obstructive, did not substantially vary between the groups of patients treated with metformin and those who were not (data not shown). However, the metformin-treated patients had a higher BMI (P = 0.03).
Conclusion: Ultimately, we provide fresh evidence that metformin has a distinct impact on both the amount and quality of sleep. Randomized clinical studies are necessary to validate this advantageous correlation and ascertain if metformin’s capacity to reduce blood glucose levels could also be linked to its impact on sleep (in addition to its established mechanisms of action), given that sleep problems are connected to high glycaemia.

DOI: 10.5281/zenodo.10936175

Background: Postpartum depression or PPD is defined as a “major depressive episode” and listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Women who experience PPD generally have their first symptoms during pregnancy or within 4 weeks after delivery of their infant. Objective: In view of this, this study was undertaken to assess the prevalence of PPD at a rural tertiary care hospital. Methods: A cross-sectional study was conducted among 250parturient women during May 2023 to July 2023 who delivered or came for follow-up visits to the Department of Obstetrics and Gynaecology at Adichunchanagiri Institute of Medical Sciences, Mandya. The prevalence of postpartum depression and anxiety was done by application of Edinburgh Postnatal Depression Scale (EPDS) which consists of 10 questions, evaluating the symptoms and their frequency on 3^rd day, 2nd week and 6th week. Those who are found to have severe psychiatric morbidity or suicidal ideation during the course of the study were referred to the Department of Psychiatry. Results: The mean age of the study participants was found to be 25.34+3.967. The mean EPDS score was found to be 7.07+3.380. The prevalence of post-partum depression in the present study was found to be 6.8%. Conclusion: Postpartum depression screening is crucial for early detection and intervention and fostering a healthier environment for both mother and the child. Regular screenings after pregnancy can contribute to the overall mental health of new mothers, leading to improved outcomes and reduced long term effects on the family unit.

DOI: 10.5281/zenodo.10936175

Background: The majority of peptic ulcer perforations are due to H. pylori infection, which leads to severe bleeding and mortality. A study of etio-pathology can prevent morbidity and mortalities in peptic ulcers. Method: 60 patients with peptic perforation underwent resuscitation, and a laparotomy was performed in the department of general surgery. H. pylori infection was confirmed by histo-pathological examination by Giemsa staining, and H. pylori infection was treated accordingly. Results: The distribution of age and site of perforation by H. pylori infection was significant; moreover, the factors associated with type II DM, smoking, tobacco chewers, and irregular diets had a significant p value (p<0.001). Conclusion: It is concluded that most of the peptic ulcer perforation is due to H. pylori infection. Hence, every patient with PUP must be investigated for H. pylori infection and treated to prevent a further recurrence of PUP.

DOI: 10.5281/zenodo.10936175

Background: Benign breast diseases (BBDs) represent a heterogeneous group of non-neoplastic conditions affecting women of all ages, often presenting with palpable masses, breast pain, or other clinical symptoms. Despite their prevalence and clinical significance, the underlying hormonal dysregulation in BBDs remains inadequately characterized. Understanding the hormonal profiles associated with BBDs is crucial for elucidating their pathogenesis and informing targeted therapeutic interventions. Methods: In this cross-sectional study, we enrolled women diagnosed with BBDs (n=106) and age-matched healthy controls (n=97). Hormonal profiling was conducted using automated immunoassay systems to measure serum levels of estrogen, progesterone, prolactin, thyroid-stimulating hormone (TSH), and free thyroxine (T4). Blood samples were collected during the follicular phase of the menstrual cycle or at a consistent time point for postmenopausal women to minimize hormonal variability. Statistical analysis was performed using SPSS version 20.0, using appropriate methods based on the distribution of data. Results: Our analysis revealed a significant elevation in estrogen levels among women with BBDs compared to healthy controls (mean ± SD: 120.5 ± 65.2 pg/mL vs. 88.3 ± 30.1 pg/mL; p<0.0001). Similarly, progesterone levels were markedly higher in the BBD group compared to controls (3.8 ± 3.2 ng/mL vs. 0.9 ± 0.5 ng/mL; p<0.0001). However, no statistically significant differences were observed in prolactin (22.3 ± 14.1 ng/mL vs. 26.8 ± 23.9 ng/mL; p=0.101), TSH (2.2 ± 1.6 mIU/L vs. 2.4 ± 0.7 mIU/L; p=0.257), and free T4 (1.0 ± 0.2 ng/dL vs. 1.1 ± 0.3 ng/dL; p=1.001) levels between the two groups. Conclusion: Our findings suggest a potential role for estrogen and progesterone in the pathogenesis of BBDs, highlighting the importance of hormonal dysregulation in these conditions. Further research is warranted to elucidate the mechanistic underpinnings of hormonal involvement in BBDs and to explore targeted therapeutic strategies aimed at modulating hormonal levels for improved clinical outcomes.

DOI: 10.5281/zenodo.10936175

Background: Post-partum hemorrhage (PPH) is accounts for near about 23% of maternal mortality all around the globe and also reported among most common cause of maternal mortality worldwide and also in Asian continent. Post-partum hemorrhage (PPH) is described as blood loss of 500 ml or more within the duration of 24 hours from the childbirth. Post-partum hemorrhage is the most common direct cause of maternal mortality and as well as maternal morbidity in India. Material & Methods: The present prospective study was conducted at department of obstetrics and gynecology of our tertiary care hospital. The study duration was of one year from January 2021 to December 2021. A sample size of 100 was calculated at 95% confidence interval at 5% acceptable margin of error. Pregnant women who had vaginal delivery with 500mls or more blood loss and who had caesarean section with 1000 mls or more blood losses, were enrolled for study by simple random sampling. Results: The most common etiology reported for the post-partum hemorrhage was atonicity of the uterus which was found in 82% of the cases. PIH was reported in 34% pregnant women which was followed by APH reported in 24% pregnant women. Prolonged labour was reported in 17% cases of PPH and retained placental products were reported in 9% cases of PPH. Large baby was reported in 8% pregnant women and Genital tract Injuries present in 7% cases of PPH. PPH due to ruptured uterus was reported in 5% pregnant women and multi parity reported in 5% cases of PPH. Infections were reported in 4% cases of PPH and Uterine Inversion reported in 1% cases of PPH. Among majority of cases uterotonics with less than 2 blood transfusions was method of management, however in some cases peritoneal repair and surgical interventions were also required. Conclusion:  We concluded from the present study that atonicity of the uterus was responsible for PPH among majority of cases. PPH can be effectively managed by active management of the third stage of labour along with uterotonics and blood transfusions, in some cases peritoneal repair and surgical interventions were also required.

DOI: 10.5281/zenodo.10936175

Introduction: Though frequent, thyroid nodules seldom cause cancer. Blood TSH levels can distinguish benign from malignant nodules. TSH levels are tested for thyroid cancer detection in this study. Methodology: The prospective observational study was conducted in Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh from December 2022 to December 2023 in 100patients with  thyroid nodule. Serum TSH levels,  ultrasonography and histological findings were collected. Results: Of the participants, 20 had thyroid cancer, predominantly women, with an older average age in malignant cases. Higher TSH levels were linked to cancer, especially in papillary and follicular types. Conclusion: The data support utilizing serum TSH as a thyroid cancer biomarker in thyroid nodule patients, emphasizing its significance in early diagnosis.

DOI: 10.5281/zenodo.10936175

Background: Thyroid nodules, common endocrine disorders, have various cancer risks. The potential for the use of serum Thyroid-Stimulating Hormone (TSH) to predict nodule features and progression is promising. This study examined how blood TSH levels affect clinical and pathological characteristics in patients with throid nodule. Methods: The prospective observational study was conducted in Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh from December 2022  to December 2023 in 100patients with  thyroid nodule .Serum TSH levels ,  ultrasonography and histological findings were collected. Results: 82% of participants were women. The mean serum TSH level was 2.27 ± 0.80 mU/L. Patients with malignant nodules had significantly higher TSH levels (2.72 ± 1.20 mU/L) compared with patients with non-cancerous nodules (1.78 ± 1.40 mU/L) (p < 0.05). More malignancies occurred in nodules beyond 4 cm. Serum TSH levels positively correlated with thyroid nodule size and malignancy. Conclusion: Higher serum TSH levels were associated with larger, malignant thyroid nodules, suggesting that serum TSH may be a useful thyroid cancer biomarker. These findings emphasise the importance of serum TSH in thyroid nodule diagnosis and management and suggest for further research to confirm and explain these findings.

DOI: 10.5281/zenodo.10936175

Background: Proximal femoral fractures are more common in geriatric population and more commonly associated with low energy trauma. Females are more affected than males. 90% of femoral fractures are neck of femur and peri trochanteric fractures, rest 10% fractures are subtrochanteric. Aims and Objective: To determine the impact of risk factors on 1-year mortality rate in patients who have undergone surgery for proximal femoral fractures in the time of COVID-19 Pandemic, & to determine the modifiable risk factors. Material and Method: A prospective observational study was conducted among 30 cases of proximal femoral fractures. Inclusion criteria were age of patient 60 years or older, proximal femoral fractures, mortality outcomes within 1 year after surgery. Surgery was performed. Follow-up period was 12 months. At the end of follow up period, cases counted who survived and who died and risk factor distribution among dead patient’s was assessed & modifiable risk factors were identified. Results: The mean age was 78.1 years with Male: female ratio of 1:1.5. 30% have no comorbidities, 36.7% having single comorbidities & 33.3% participants were found with more than single co-morbidity and 5 cases (16.7%) belonged to American Society of Anesthesiologist (ASA) class III. Most common fracture was transtrochanteric 16 cases (53.3%). Surgery was performed within 48 hours in 14 cases (46.7%) and it was delayed >48 hours in 16 cases (53.3%). Mean surgery duration was 2.9±1.8 hours with mean duration of hospital stay 13.7±6.4 days. Patients having mean VAS score of 7.4±1.3. 16 cases having preoperative mobility score <5 (53.3%), and 14 cases having ≥5 (46.7%) with mean score of 6.5±3. Mortality rate was 13.3%. Conclusion: Older patients with proximal femoral fracture had 13.3% mortality within 1 year of surgery. The main risk factors were male gender, ASA class III, number of co-morbidities, longer waiting time until surgery, lower preoperative mobility score. Changing modifiable factor such as alcoholism, smoking, & Type A personality can decrease mortality in elderly within 1 year after surgery.

DOI: 10.5281/zenodo.10936175

Hypertension is a leading cause of morbidity and mortality and is associated with the risk of cardiovascular, cerebrovascular disease, and target organ damage. The risk increases exponentially in individuals with diabetes. Hypertensive retinopathy is a marker for target organ damage, so screening for hypertensive retinopathy helps in cardiovascular risk stratification. This study was conducted with an objective to screen for hypertensive retinopathy among known diabetics. 102 known Type 2 diabetic subjects, both males and females were included in study. Blood pressure was recorded in all subjects. Hypertensive subjects retinal examination was done. A comprehensive ophthalmic assessment including a fundus examination was performed. Our study shows  out of 102 diabetic subjects 61(59.8%) were  hypertensive  and 41 were normotensive (40.19%).  Out of 61 hypertensive patients 21 were males and 40 were females.  Severity of Hypertensive  Retinopathy shows  53( 86.88%) subjects had Grade I, 6( 9.83%) subjects had Grade II and 2(3.27%) subjects had Grade III Hypertensive  Retinopathy. Early detection of hypertensive retinopathy with cardiovascular risk stratification and initiation of prompt treatment among the high risk individuals will help reduce the morbidity caused due to end-organ damage and premature mortality to a greater extent and will pave the way forward to achieving sustainable developmental goals.

DOI: 10.5281/zenodo.10936175

Background: The efficacy of autologous platelet-rich plasma in myringoplasty is a subject of interest as it presents a novel approach to enhance the healing process of the tympanic membrane. Aim and Objective: To find out the efficacy of platelet-rich plasma on graft uptake in patients undergoing myringoplasty. Materials and Method: A prospective, randomized, controlled trial was conducted at a tertiary care hospital’s otolaryngology department, Ayaan institute of Medical sciences, Hyderabad. 60 Patients were randomly assigned to two groups using a computer-generated randomization table. The experimental group received myringoplasty with the application of autologous platelet-rich plasma (PRP), while the control group underwent conventional myringoplasty without PRP, after approved by institutional ethical committee and following inclusion and exclusion criteria. Results: Success rate of graft uptake among cases was higher compared to controls and this difference between the groups were statistically significant.(p-value = 0.028). The difference between preoperative and postoperative values is statistically significant in both groups (p < 0.001 for cases and p = 0.001 for controls). Conclusion: Autologous platelet-rich plasma appears to improve the efficiency of myringoplasty by promoting faster tympanic membrane closure and early hearing improvement.

DOI: 10.5281/zenodo.10936175

Introduction: Leptospirosis is a potentially life-threatening zoonotic disease of worldwide distribution. Due to the lack of diagnostic tools, the diagnosis of leptospirosis cannot be easily made in many laboratories. Leptospirosis is often not recognized or is erroneously mistaken for other diseases with similar symptoms. Aim and Objectives: To study the clinical profile of patients of seropositive Leptospira and its outcome. Material and Method: A total of 100 diagnosed cases of leptospirosis were enrolled in the study. This prospective observational study was done over one year from December 2021 to November 2022 at IGIMS, Patna. Result: 100 patients were included in this study out of which 69 (69%) were male, and 31(31%) were female. The most common age group affected in our study was 36-45 years of age. The age range of the leptospirosis-positive cases in this study was 15 to 72 years. Fever (95%) was the common clinical feature observed followed by generalised weakness (84%), Jaundice (81%), headache (64%), hepatomegaly (58%), vomiting (48%), Breathlessness (26%), Cough (23%) decreased urine output (19%) and abdominal pain (15%). In contrast, other clinical findings in this study were hepatomegaly (58), lymphadenopathy (52%), and subconjunctival haemorrhage (44%) Splenomegaly (23%) and hypotension (20%). Most of the patients recovered without any complications (78%) and recovered with complications in 19% of cases, whereas death was observed in this study in 3 (3%) cases. Conclusion: The clinical presentation of leptospirosis is highly protean and may vary from subclinical to mild illness to life-threatening complications and death.

DOI: 10.5281/zenodo.10936175

Introduction: The increasing prevalence of type 2 diabetes has prompted the search for effective therapies to manage the disease and improve glycemic control. One class of drugs that has emerged as a promising option is Sodium-glucose cotransporter 2 inhibitors (SGLT2i).  These drugs work by inhibiting the reabsorption of glucose by the renal tubules, leading to its excretion in the urine. This mechanism of action not only improves glycemic control but also has the added benefit of promoting weight loss. Many trials demonstrate that use of  SGLT2 inhibitors reduces HbA1c levels and promotes weight loss. This study is aimed at assessing the glycemic control and changes in weight with the use of SGLT2i. Methods:  After due clearance from the institutional ethics committee, screening and enrolment was done for 440 participants attending medicine OPD at the institute with 220 assigned to the SGLTi group and 220 to control group. The study duration was approximately 1 year. In the SGLT2i group participants were started on Dapagliflozin 10 mg, Canagliflozin 100 mg once daily or Empagliflozin 25 mg once daily. Control group was receiving oral hypoglycemic agents other than SGLT2i. Demographic details, weight, height, BMI, were recorded. HBA1C was recorded at baseline and 6 months. Weight and BMI were recorded at each follow up visit at 1, 3 and 6 months. Collected data was analyzed using SPSS and help from a qualified statistician. Results: There was a statistically significant decrease of 2.16Kg in the mean weight in the SGLT2i group at 6 months compared to an increase in mean weight by 0.7 Kg in the control group at 6 months. Mean FPG was lower by a statistically significant 34mg/dl at 6 months among the SGLT2i group compared to a reduction of 8.45 mg/dl in the control group.

DOI: 10.5281/zenodo.10936175

Background: Smoking is a leading cause of preventable diseases worldwide, including chronic obstructive pulmonary disease (COPD) and lung cancer. Pulmonary Function Tests (PFTs) offer a means to assess the impact of smoking on lung health, even before symptoms arise. Objective: To compare pulmonary function between asymptomatic smokers and non-smokers in a tertiary care setting, highlighting early changes in lung function attributable to smoking. Methods: This prospective observational study included 70 participants, divided equally between asymptomatic smokers and healthy non-smokers. Standardized PFTs, including FEV1, FVC, FEV1/FVC ratio, TLC, RV, and DLCO, were conducted. Statistical analyses were performed using SPSS version 24. Results: Smokers demonstrated significantly lower FEV1 (2.5 ± 0.4 L vs. 2.95 ± 0.38 L, p=0.005), TLC (5.8 ± 0.8 L vs. 6.3 ± 0.75 L, p=0.02), and DLCO (21 ± 3.5 mL/min/mmHg vs. 23.5 ± 3.3 mL/min/mmHg, p=0.003) compared to non-smokers. An increased RV was observed in smokers (1.35 ± 0.3 L vs. 1.2 ± 0.28 L, p=0.01). The FEV1/FVC ratio was significantly lower in smokers (0.65 ± 0.11 vs. 0.78 ± 0.09, p<0.001), indicating obstructive patterns not yet symptomatic of COPD. Conclusion: Asymptomatic smokers exhibit significant pulmonary function impairments compared to non-smokers. Early detection through PFTs can facilitate timely interventions and smoking cessation efforts, potentially reversing or halting progression of lung damage.

DOI: 10.5281/zenodo.10936175

Introduction: Organophosphorus compounds (OPCs) as poisoning substance contribute significant deaths in developing nations. A study was taken to find the correlation between various demographic factors and organ phosphorus poisoning (OPP) individuals. Methods: It was a prospective research conducted in the department of general Medicine, Prathima Institute of Medical sciences, Nagunoor. Study protocol was approved by the Institutional Ethics committee. An informed written consent was taken from the participants. Consent was taken from the immediate blood relative if the individual cant submit the consent. Individuals of both gender aged > 18 years, those admitted due to OPP were included in this research. Non cooperative individuals, those taken atropine treatment were not considered in this research. After recruiting the individual in the research, if possible the study was explained to the immediate blood relatives. Physical examination was carried and findings were recorded in the study proforma. In addition the sociodemographic parameters such as age, gender educational background, occupation and so on were recorded in the study proforma. P value < 0.05 was considered statistically significant. Results: Total 60 (100%) members were included in this study; majority (50%; 30) were in 21 – 30 years. Gender wise, 60% (36) were males and the male female ratio was 1.5. Living area wise 62% (37) were rural population and statistically there was significant difference. Conclusion: Self-poisoning using OPC constitutes a significant public health issue in many rural areas across Asia. It was common among the male those are around 30 years.

DOI: 10.5281/zenodo.10936175

In our routine practice, it was observed that there were incidents of failed spinal anaesthesia in patients with history of scorpion bite. The mechanism of action of local anaesthetics via sodium channels may have possible mutations which alter the response to local anaesthetics. Randomly selected 40 patients of either sex or age range 18-60 years, of physical status ASA I/II, were divided into two equal groups of 20 patients each, both the groups were given initial dose of 3.5 ml 0.5% bupivacaine heavy. The onsets of sensory and motor block and peaks of sensory and motor block were observed with pin prick method and bromage scale. After 15 mins, if the effect of block was not achieved then in patients of group R repeat dose of 2.5ml of 0.75% Ropivacaine heavy given in subarachnoid block and in patients of Group B repeat dose of 2.5 ml of 0.5% Bupivacaine heavy given and effect was compared and assessed. In Group R, time of onset of both sensory and motor blocks and time for the peaks of sensory and motor blocks were significantly prolonged. So, we conclude that effect achieved by Ropivacaine given as repeat dose in subarachnoid block is significantly prolonged in comparison to Bupivacaine given as repeat dose in patients with previous history of scorpion bite.

DOI: 10.5281/zenodo.10936175

Background: Hypospadias is complex disorder affected by both genes and the environment. Chordee and penile torsion is frequent, particularly in more advanced forms of hypospadias. Several classification systems have been suggested for hypospadias. Many methods for the surgical repair of hypospadias have been described throughout history. Objectives: To assess the Clinical Profile in Children with Distal Hypospadias and Surgical Outcomes after Snodgross Urethroplasty. Methods: It was a prospective observational study on patients of Distal Hypospadias admitted in Department of Surgery presented with abnormal meatal location, glans configuration, chordee less than 30 degree. Local examination was done in every patient. Special attention was given to prepuce whether intact, circumcised or utilized in previous operation. Surgical procedure done was Snodgross Urethroplasty; patients were followed up to 2 years. Results: Patients were distributed as per type of hypospadias and it was observed that sub coronal hypospadias, distal penile and coronal hypospadias were found in 25 (50%), 17 (34%) and eight (16%) patients, respectively. Shape of meatus was slit shaped in 24 (48%) patients, stenotic in 21 (42%) patients and circular in five (10%) patients in our study. Out of 50 patients studied, midline raphe was found in 32 (64%) patients while as deviated from midline raphe was seen in 18 (36%). Only 10 (20%) patients had associated chordee in our study. After 24 months of follow up, acceptable cosmetic results were observed in 47 (94%) patients. Small meatus was seen in two (4%) patients while as bulky tissue was present in one (2%) patient. Conclusion: Most of the patients in our study presented late because of unawareness among people about the disease. The surgical procedure done was Snodgross Urethroplasty and was associated with good surgical outcomes and fewer complications.

DOI: 10.5281/zenodo.10936175

Background: Thoracic spine stabilization and correction instrumentation has seen significant advancements in recent years. Currently, infections, fractures, and other illnesses can be successfully treated using artificial vertebral implants. The morphometry of the vertebral body in normal thoracic vertebrae is important since studies indicate that moveable artificial vertebral implants need to be improved. Objective: Using a digital vernier calliper, measure different aspects of the vertebral body in normal thoracic vertebrae. Materials and Methods: For the investigation, 75 normal thoracic vertebrae with unknown ages and genders were chosen. A digital vernier calliper was used to take a variety of measurements. Results: In normal thoracic vertebrae, the superior anteroposterior distance of the vertebral body varied from 14.61 to 31.85 mm, with a mean of 22.37+3.80 mm. With a mean of 23.21 + 3.79 mm, the inferior anteroposterior distance varied from 12.60 to 32.79 mm. The anterior height had a mean of 20.15+2.81mm and varied from 11.92-27.23mm. With a mean of 21.12+2.78mm, the posterior height varied from 12.31 to 27.28mm. With a mean of 20.60+2.84mm, the right lateral height varied from 10.83 to 25.61mm. With a mean of 20.37+2.89mm, the left lateral height varied from 11.31 to 26.76mm. With a mean of 28.25 + 3.56 mm, the superior transverse diameter varied from 18.70 to 34.87 mm. With a mean of 29.65 + 3.82 mm, the inferior transverse diameter varied from 19.75 to 35.58 mm. Conclusion: In conclusion, the information supplied will serve as a helpful guide for more precise design and modelling of artificial vertebral body implants and apparatus for the Indian population.

DOI: 10.5281/zenodo.10936175

Background: Appendix is a finger shaped pouch that projects from the colon on the lower right side of abdomen .The term appendicitis was first coined by “Reginald Fitz” in 1886 from Boston and identified as the common cause of right lower quadrant pain. To increase the diagnostic accuracy and to decrease the negative appendectomy rate, a variety of different approaches have been described, including the development of predictive scoring systems, computer-aided diagnosis, performance of diagnostic laparoscopy, ultrasonography, computed tomography, and magnetic resonance imaging. The most common and widely applied score in acute Appendicitis is Alvarado score but has been observed with few drawbacks. The scoring doesn’t include CRP, a widely accepted laboratory marker in assessment of cases of acute appendicitis.  A recently introduced appendicitis inflammatory response score (AIR) is designed to overcome the drawbacks associated with the implementation of Alvarado scoring system. This scoring system incorporates CRP as one of the variable in scoring the cases of suspicious appendicitis. The objective of this study is to evaluate the AIR score in cases of suspicious appendicitis and to compare it with Alvarado scorings system. Acute appendicitis accounts for a good number of cases presenting to emergency and therefore the study was conducted with the objectives of 1) To Assess and evaluate the patients having signs and symptoms of acute Appendicitis; 2) To establish the role of scoring system in evaluation of outcome of patients suffering from acute appendicitis; 3) Comparison of scoring system, Alvarado and Appendicitis Inflammatory Response score in acute appendicitis. Materials and Methods: The study Comparison of Appendicitis inflammatory response score (AIR) and Alvarado score in predicting acute appendicitis was carried out  prospectively on118 patients presenting to the emergency of the Post Graduate Department of General Surgery Government Medical College, Jammu over a period of 12 months w.e.f. November 2021 to October 2022. The study subject consisted of all the patients who presented with pain abdomen in right lower quadrant and umbilical region with history of sudden onset and being non-traumatic. All the patients were treated as in-patients. After proper history, examination and basic laboratory tests patients were subjected to AIR scoring and Alvarado scoring. Results: This study was conducted on 118 patients with clinical diagnosis of acute appendicitis, in the Post Graduate Department of Surgery, Government Medical College Jammu. This was established by general and systemic examination and baseline investigations of patients as per Performa. 8 patients were histopathologically and intra operatively proven negative for appendicitis and were excluded from the study. Patients of all age groups and either sex were included in the study. The maximum number of patients was in the age group of 18 to 45 years (51.8%) with a mean age of   20.66 years. The youngest patient was 06 years old whereas oldest patient was 66 years old. There were 68 males and 42 females in our study. The male to female ratio is 1.6:1.All patients were put on intravenous fluids, antibiotics and nil per oral, patients were kept under observation in emergency ward. The preoperative Appendicitis Inflammatory Response score and Alvarado score were recorded in each patient at the time of admission. Three diagnostic zones were defined with score> 8 as high probability, 5-8 as medium probability and less than 5 as low probability of appendicitis. Exploration was done on the decision of senior surgeon in emergency operation theatre. Specimens were sent for histopathology postoperatively. Out of 110 patients, 50 had advanced appendicitis, 60 had phlegmonous appendicitis as shown by histopathology. Out of 8 patients with negative appendicectomies, 03 patients had mesenteric lymphadenitis, 01 had meckel’s diverticulitis, 01 patient had epiploic appendagitis and 03 patients had complicated right ovarian cyst.Head to head comparison between AIR SCORE and Alvarado score was done at two cut off points, 4 & 8. The sensitivity and specificity of AIR score were 0.96 and 0.79 as compared to Alvarado score having sensitivity and specificity of 0.80 and 0.71 at 4 cut off point for all appendicitis. This was accompanied by positive predictive value of 0.84 for AIR score and 0.65 for Alvarado score. At 8 cut off point the sensitivity and specificity of AIR Score were 0.18 and 1 .00 as compared to Alvarado score having sensitivity and specificity of 0.28 and 0.95. This was accompanied by positive predictive value of 0.99 for AIR Score and 0.84 for Alvarado score. Both scores were compared on age and gender distribution. The area under receiver operating characteristic curves (ROC) was compared. The AIR score outperforms Alvarado in both males and females and also in all age groups, particularly in paediatric and geriatric patients with p valve <0.001 which is highly significant. Conclusion: The AIR score outperforms the ALVARADO score in predicting the acute appendicitis. AIR score displays higher specificity and higher positive predictive value thereby preventing negative appendicectomies. Avoiding subjective parameters and introduction of CRP as a parameter makes it an attractive clinical prediction for diagnosing acute appendicitis with higher specificity. The AIR score can be used in resource limited setting as it also prevents costly radiological investigations thereby reducing the cost of treatment as well.

DOI: 10.5281/zenodo.10936175

Medical ethics is fundamentally grounded in the principles of beneficence and patient autonomy, which affirm the patients’ right to make decisions aligned with their best interests. Recognition of patients’ rights commenced in the mid-20th century, propelled by legal and ethical advancements. This review explores the evolution of the concept of patient autonomy over time, along with the opportunities and challenges it poses in the contemporary world. The article underscores the benefits that accrue to patients in diverse medical scenarios. The well-being of beneficiaries is influenced by their perspectives on communication, decision-making, cultural competency, and adherence to the justice principle. Striking a balance among these concepts necessitates a nuanced approach that recognizes the importance of honoring patient choices while ensuring that actions promote well-being. When conflicts arise between a patient’s autonomy and beneficence, moral dilemmas may manifest. In such instances, a thorough examination of the patient’s values, cultural background, and the specific circumstances surrounding medical decisions becomes imperative.

DOI: 10.5281/zenodo.10936175

Introduction: Hemoglobinopathies are lethal inherited genetic haematological disorders requiring lifelong blood transfusions and treatment in their severe and chronic form. These disorders ultimately lead to death if they are undiagnosed or untreated. Highest frequencies of hemoglobinopathies are present in South Asia particularly in India, Pakistan, and Bangladesh. In India, there are an estimated 100,000 thalassemia major patients and nearly 3.5 to 4 million carriers of this disorder and tribal population have a range of 5–40% sickle cell anaemia sufferers. Aim: Detection of hemoglobinopathies by electrophoresis in microcytic hypochromic blood picture in the population who attended tertiary care centre at Government Medical College and Hospital, Anantapuramu. Objectives: 1. Detection of frequencies of different variants of hemoglobinopathies. 2. Detection of frequency of Iron deficiency anemia in microcytic hypochromic anemia. Methods: Observational study was carried out in a hospital in rural area of Anantapuramu on patients who attended tertiary care centre (Both out and in patients) from January 2023 to December 2023. Total 229 cases of mild to severe anemia were included in the study. All cases were subjected to hematological investigations- includes complete hemogram, reticulocyte count, peripheral blood smear, and some standard procedures. Zy bio fully automated 5 – part Cell counter was used for complete blood count. A peripheral blood smear is used for evaluation of morphology of blood cells. Results: In the study, out of 229 cases, 32 (13.9%) were positive for hemoglobinopathies on HPLC and 197 (86%) cases were negative. Among 32 hemoglobinopathies, 12 (37.5%) cases were males and 20 (62.5%) cases were females. On HPLC, beta Thalassemia trait is the most common and accounts for 18 cases (56.25%), delta beta Thalassemia ware 4 cases (12.5%). Next common hemoglobinopathies found were beta Thaassemia major, Hb D Punjab heterozygous, HPFH and compound heterozygous each one accounts 2 cases (6.25 %). Hb E homozygous and delta beta Thalassemia trait accounts one (3.12%) case each. Conclusion: The systematic review carried out across the India showed that the microcytic hypochromic anemia with hemolytic component refractory to the treatment must undergo the analysis for hemoglobinopathies. The HPLC is probably the best analyzer for detecting the rare hemoglobin variants. In our study we emphasise that the anemic patients who are resistant to the treatment have to be evaluated for haemoglobin disorders by HPLC to detect even the rare varients of hemoglobin.

DOI: 10.5281/zenodo.10936175

Introduction: Chronic suppurative otitis media (CSOM), managed at the primary healthcare level, can help prevent deafness and fatal consequences. Aim: This study aimed to analyze the management of CSOM-related problems and their diverse clinical manifestations. Materials and Methods: One hundred patients with CSOM who visited the otolaryngology department of Bhima Bhoi Medical College and Hospital Balangir were included in this case series. Results: There was a preponderance of males age three–60 years. The majority of patients 52 (47.27%) were aged between 10 and 20 years. Most patients had a low socioeconomic status. Most patients (n=96; 87.27%) initially visited an ENT specialist. The majority of the patients (64.5%) originated from rural areas (n=71). There were fewer instances of bilateral CSOM (n=19, 17.27%). Cases involving safe CSOM were more prevalent (n=97, 88.18%) than those involving hazardous CSOM (n=13, 11.81%). Complaints regarding hearing impairment were observed in 63.63% of cases. Conclusion: CSOM is prevalent in developing nations and necessitates the collaboration and assistance of patients and medical professionals for effective and timely management.

DOI: 10.5281/zenodo.10936175

Background: Recurrent pregnancy loss (RPL) is a multifactorial condition with significant emotional and psychological impacts on affected individuals. This study aimed to evaluate the etiological factors contributing to RPL and to assess the effectiveness of various management strategies. Methods: A prospective observational study was conducted with 100 women experiencing RPL at a medical center. Participants underwent comprehensive evaluations to identify genetic, anatomical, immunological, hormonal, and environmental factors contributing to RPL. Management strategies and their outcomes were also analyzed. Results: Genetic factors were identified in 22% of participants (p=0.032), anatomical factors in 17% (p=0.045), immunological factors in 29% (p=0.011), and hormonal factors in 31% (p=0.008). Environmental factors were noted in 9% of the cases, without significant association (p=0.122). Medical treatments demonstrated a high success rate, with 71.4% of participants achieving successful pregnancies (p=0.002). Additionally, a significant reduction in psychological distress was observed post-intervention (from 65% to 37%, p<0.001). Conclusion: The study highlights the complex etiology of RPL, with significant roles played by genetic, immunological, and hormonal factors. The effectiveness of targeted medical treatments underscores the importance of a tailored approach to management. Addressing psychological impacts is also crucial in providing comprehensive care.

DOI: 10.5281/zenodo.10936175

Background: A multisystem condition known as pre-eclampsia has a two-stage disease pathophysiology, with aberrant placentation coming before endothelial failure and the subsequent onset of a systemic inflammatory response. One of the main causes of preeclampsia is endothelial dysfunction; microalbuminuria is a marker for this condition and can be used to predict pre-eclampsia in the early stages of pregnancy. Aims of this study to establish whether a spot urinary albumin: creatinine ratio measured between 17-20 week of gestation can predict subsequent preeclampsia. Methods: This prospective observational study was done at Department of Obstetrics Gynaecology, Bokaro General Hospital, Bokaro Steel City, and Jharkhand from June 2018 to December 2019 (18 months). The study was performed on antenatal women (between 17-20 weeks of gestation) without hypertensive disorders of pregnancy at Obstetrics and Gynaecology Department who fulfils the inclusion criteria attending the OPD of Obstetrics and Gynaecology Department, Bokaro General Hospital. This was a Hospital based study, all Antenatal cases as per the inclusion and exclusion criteria attending the OPD of Obstetrics and Gynaecology Department, Bokaro General Hospital. Results: Total 100 women were included who fulfilled inclusion and exclusion criteria.  Normotensive patient 2(2.33%) were test positive (UACR≥35.5mg/mmol) and 84 (97.67%) were test negative (UACR≤36.5mg/mmol). In patient with pre-eclampsia 7(77.78%) were test positive and 2(22.2%) were test negative (p<0.0001). The sensitivity and specificity of the test was 77.78% and 97.67% respectively. The Positive predictive value was 77.78% and negative predictive value was 97.67%. Thus, spot urinary albumin: creatinine ratio can predict future preeclampsia with high sensitivity and specificity. Conclusion: Preeclampsia is a major cause of perinatal and maternal mortality and morbidity. In order to prevent it we need to establish a test which can predict it in asymptomatic patients in early pregnancy.

DOI: 10.5281/zenodo.10936175

Background: The clinical condition known as sepsis is defined by a dysregulated host response to infection. A spectrum of severity exists, spanning from sepsis to septic shock. While estimates of mortality vary widely and depend on the population under study, they have been shown to be between 10% and 40% in cases of shock. The study’s primary goals are to ascertain if serum albumin levels and mortality risk are quantitatively correlated and to investigate the effect of serial monitoring of serum albumin levels as a predictor of mortality and morbidity in sepsis patients admitted to the intensive care unit. Method: From July 2023 to December 2023, 140 sepsis patients were admitted to the Medicine ICU at Sri Krishna Medical College & Hospital in Muzaffarpur, Bihar, for this descriptive study. On the first day after the diagnosis of sepsis, all of the chosen patients underwent a thorough evaluation, and their serum albumin levels were examined on days three and five. Throughout their hospital stay, patients were monitored, and their outcome that is, whether they survived or died was documented. Version 18 of the statistical product and service solutions (SPSS) program was used to analyze data that had been entered into an MS Excel spreadsheet. Results: There were two groups of the 140 patients that were chosen for the study: survivors and non-survivors. The mean level of serum albumin at day 1 was 3.72 g/dl (±0.278) in survivor group while in non-survivors group; it was 3.11 g/dl (±0.247). Day 3 mean serum albumin levels were 2.65 g/dl (±0.172) in the non-survivor group and 3.17 g/dl (±0.248) in the survivor group. Day 5 mean blood albumin levels were 2.72 g/dl (±0.25) in the survivor group and 2.32 g/dl (±0.144) in the non-survivor group. By using an unpaired t test, the difference in mean serum albumin on days 1, 3, and 5 was found to be statistically significant, with a p value ≤0.001. The decline in mean serum albumin level in survivors from day 1to day 5 was 3.72 g/dl to 2.72 g/dl. In non-survivors it is 3.11 g/dl to 2.32 g/dl. Conclusion: According to this study, a sepsis patient’s prognosis is directly correlated with a serum albumin level that is less than 3.5 gm/dl on all three days. Serum albumin levels gradually decreased in both the survivor and non-survivor groups starting on day 1, but a decline below 3.0 gm/dl was linked to a greater death rate. It implies that the sepsis patient’s mortality prognosis is influenced by how quickly serum albumin drops below the normal threshold. Serum albumin measurement is less expensive, and its serial measurement may aid in the clinical evaluation of patients with sepsis, which even in places with few resources are at risk of a bad prognosis.

DOI: 10.5281/zenodo.10936175

Background: The most common kind of anemia in India is iron deficiency anemia. Glycated hemoglobin (HbA1c) is a marker used to show the glucose levels during a three-month period. HbA1c readings are influ-enced by factors such as blood sugar levels, hemoglobin variability, hemolytic anemia, nutritional anemias, uremia, pregnancy, and acute blood loss. On the other hand, data about the impact of iron deficiency anemia on HbA1c levels are not entirely consistent. Our goal was to assess and contrast the levels of glycosylated haemo-globin (HbA1c) in non-diabetic patients who were anemic and those who were not in order to determine the diabetes parameters. Methods: From July 2023 to December 2023, 50 non-diabetic IDA patients were included as cases in this com-parative study at the Department of Medicine, SKMCH, Muzaffarpur, and Bihar. Fifty non-diabetic non-anaemic people were enlisted as controls. At baseline, the iron profile and HbA1c levels were assessed and con-trasted. After receiving iron supplements for three months to correct their iron deficiency, IDA patients’ HbA1c levels were observed and examined. The Statistical Package for Social Sciences (SPSS) version 21.0 was used to analyze the data, which had been entered into an MS Excel spreadsheet. A statistically significant P value was defined as one that was less than 0.05. Results: Anaemic individuals were shown to have considerably higher random and fasting blood sugar levels, with a greater proportion of patients falling into the pre-diabetic range based on HbA1c levels. Patients in Group A had considerably higher levels of glycosylated hemoglobin. (p<0.05). At the three-month follow-up, every haematological parameter showed a significant improvement following the start of IDA treatment. After three months of anemia treatment, the HbA1c levels significantly decreased. (p<0.0001). Conclusion: The relationship between iron deficiency anemia and HbA1c levels is inverse. In the majority of cases, the anemic participants’ HbA1c levels decreased to values that were almost normal once their iron defi-ciency was corrected.

DOI: 10.5281/zenodo.10936175

Background: Globally, Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death. The purpose of this study is to determine the clinical characteristics of COPD in nonsmokers as well as addi-tional risk factors for the disease outside smoking. Method: Data was collected using a pre-tested proforma that met the study’s objectives. A thorough history was obtained, a clinical examination was performed, and any required research was done. Categorical data was ex-pressed as a number and percentage (%), whereas continuous data was expressed as Mean±SD. Results: The majority of the non-smoking COPD patients in the current study were found to be older in age. The patients in this study had an average age of 55.06±8.87 years. The study sample consisted of 64% study subjects under 40, 30% study subjects between 40 and 79, and 0% study subjects over 80. 68% of the population is female, with a male to female ratio of 1: 2.125. Conclusion: The majority of participants in this study on COPD in nonsmokers were female. Sputum produc-tion and coughing were the most prevalent clinical symptoms. The two most prevalent risk variables were the use of biomass fuel and exposure to ambient tobacco smoke. The majority of the patients had a rural upbring-ing. The majority of patients had milder forms of the illness when they first arrived.

DOI: 10.5281/zenodo.10936175

Background: Despite having important clinical consequences for Type 2 diabetes mellitus, non-alcoholic fatty liver disease (NAFLD) is frequently disregarded in clinical practice. To determine the prevalence of NAFLD in people with diabetes mellitus, this study was conducted. Methods: Between August 2016 and July 2017, 150 patients with Type 2 diabetes mellitus were included in this study, which was carried out in the medicine department of Darbhanga Medical College and Hospital in Laheriasarai, Bihar. The present study was non-interventional and cross-sectional. Results: The prevalence of NAFLD was 51.3%; it was higher in patients with central obesity and dyslipidemia as well as among females (42.6%). Conclusion: Given that NAFLD and diabetes mellitus are frequently associated, and that patients with NAFLD have a higher risk of complications, early identification is essential in order to implement preventive measures.

DOI: 10.5281/zenodo.10936175

Background: Epidural anesthesia is integral to modern anesthesia, offering flexibility in vertebral-level selection for anesthesia and pain relief. It complements general anesthesia by reducing the required depth of anesthesia and maintaining hemodynamic stability during surgery. Particularly beneficial for lower abdominal and limb surgeries, epidural anesthesia addresses challenges associated with general anesthesia, such as airway manipulation and exposure to multiple medications. It also minimizes postoperative complications like nausea and vomiting, enhancing patient comfort and recovery. Methods: This study randomly assigned 80 patients into two groups of 40 each. Group A received 15 ml of 0.75% Ropivacaine plus 1µg/kg of Fentanyl epidurally, while Group B received the same dose with Dexmedetomidine. Patients underwent preoperative assessment and fasting, receiving premedication with Alprazolam 0.5 mg and Ranitidine 150 mg. In the operation theatre, standard monitoring was performed, and basal vital parameters were recorded. Results: Group B exhibited a significantly longer duration of sensory blockade (317 min) compared to Group A (259.8 min), with a significant difference in motor blockade duration as well. The proportion of patients with motor blockade at T7 was significantly higher in Group A than in Group B. Conclusion: Dexmedetomidine enhances Ropivacaine epidural anesthesia more effectively than Fentanyl, accelerating sensory and motor block onset and prolonging recovery. Dexmedetomidine offers superior postoperative analgesia and patient satisfaction, despite Fentanyl’s cardiovascular stability advantage. Dexmedetomidine’s sedation benefits make it preferable for infra-umbilical surgeries under epidural anesthesia.

DOI: 10.5281/zenodo.10936175

Aim and Objectives: To study the functional outcome of distal tibia fractures in patients treated by Minimal Invasive Percutaneous Plate Osteosynthesis (MIPPO) technique with distal tibia locking compression plate. Materials and Method: This study had a Prospective Clinical study design conducted at Govt. R. D. B. P. Jaipuria Hospital attached with RUHS College of Medical Sciences, Jaipur, Rajasthan. Total of 30 patients with Closed, open fracture type 1 (Gustilo and Anderson Classification) fracture of distal tibia with or without intra-articular extension were included in the study. The final result was evaluated using Tornetto et al scores. Results: Mean time to union was 12.93 ± 4.8 weeks, 14 of the patients showed union at 12 weeks follow-up. Normal union was seen in 83.33% subjects, delayed union in 13.33% and non-union was noted in 1 (3.33%) patient. Most common complications seen were joint stiffness (10%), valgus deformity (6.67%) and infection (10%). Excellent outcome was seen in 53.33%, good outcome in 30%, fair outcome in 13.33% and poor outcome in 1 (3.33%) subject. Conclusion: The present study concludes that minimally invasive plate osteosynthesis (MIPPO) using LCP is a safer modality for treating distal tibial fractures without significant intra-articular comminution because it promotes rapid functional recovery, good fracture healing, and prevents serious skin problems.

DOI: 10.5281/zenodo.10936175

Introduction: Chronic liver diseases frequently are associated with haematological abnormalities. Anaemia occurs in about 75% of patients with chronic liver disease. The most common type of anaemia seen in liver cirrhosis is normocytic normochromic anaemia, due to the chronic inflammatory state, blood loss from oesophageal and rectal varices. The purpose of this study was to study the haematological manifestations and biochemical alterations in patients with chronic liver disease. Objectives of Study: The objective of this study was to correlate haematological abnormalities and biochemical alterations in various liver diseases. Materials and Methods: The study was conducted in the Central Laboratory of Pathology department, during the period from May 2021 to April 2022. This study included 187 patients clinically diagnosed with liver disease. Biochemical liver function test including serum bilirubin, SGOT, SGPT, ALP, Total protein and serum albumin were noted from the investigation chart of the patients and hematological parameters like platelet count and MCV  were estimated by using automated hematology analyzer and the results were evaluated in groups. Result: Out of 187 patients, 142(75.9%) were males and 45(24.1%) were females. It was found that Chronic liver disease and Acute viral hepatitis was the most commonly present in most of the participants; 73 (39%) and 46 (24.6%). Followed by Alcoholic Liver Disease, Hepatitis, Hepatocellular Jaundice, Liver Abscess, Acute Liver Failure and Portal Hypertension and Least number of participants had Obstructive Jaundice. In our study, 179 (95.7%) patients had SGOT > 40 IU/L with mean 193.9 ± 173.1, 163 (87.2% ) had SGPT > 45 IU/L with mean 229 ± 312.4, 169 (90.4%) had serum bilirubin > 1.2 mg/dl with mean values of 4.6 ± 3.6, 80 (42.8%) had ALP > 147 IU/L with mean value of 162.1 ± 122.8, 62 (33.2%) had total protein < 6.3g/dl with mean value of 6.5 ± 0.5, 83 (44.4%) had serum albumin < 3.4 gm/dl with mean value of 3.4 ± 0.6, 75 (40.1%) had < 1.5 lac/mm³ and 1 (0.5%) had > 4 lac/mm³ with mean value of  182.8 ± 72.7, 118 (63.10%) of the participants had MCV 80 – 100 fL with Mean value of MCV was 88.3 ± 10.23. It was found that SGOT was maximum with acute liver failure followed by Hepatocellular jaundice and Alcoholic liver disease. SGPT was maximum raised in acute liver failure followed by Hepatocellular jaundice and acute viral hepatitis. Platelet count was lowest in acute liver failure patients. MCV was highest in Alcoholic liver disease. Conclusion: Alterations in haematological and biochemical parameters are frequently associated with various liver diseases showing anaemia, leucopenia and thrombocytopenia along with derangement in liver enzymes. Prolongation of prothrombin time and abnormality in peripheral blood film are also seen in these patients. In our study, MCV and MCH were increased and remaining other haematological parameters like Hb, RBC, PCV, MCHC, platelet, PT all were decreased. Nevertheless, MCH was statistically not increased. Biochemical parameters like altered liver function test were all increased except total protein and albumin. Thus, the complete blood picture had shown the picture of anaemia, leucopenia and thrombocytopenia.

DOI: 10.5281/zenodo.10936175

Introduction: The liver is the cornerstone of the coagulation system. The physiology of blood coagulation is closely linked to liver function as it synthesizes most of the factors of coagulation cascade and fibrinolytic proteins. So it is responsible for regulation of haemostasis. Hepatic disorders are widely present in tropical countries and are responsible for morbidity and mortality. Objectives of Study: The objective of this study was to evaluate coagulation abnormalities associated with various liver diseases. Materials and Methods: The study was conducted in the Central Laboratory of Pathology department, during the period from May 2021 to April 2022. This study included 187 patients clinically diagnosed with liver disease. The coagulation tests PT and APTT were performed and the results were evaluated in groups. Result: Out of 187 patients, 142(75.9%) were males and 45(24.1%) were females. It was found that Chronic liver disease and Acute viral hepatitis was the most commonly present in most of the participants; 73 (39%) and 46 (24.6%). Followed by Alcoholic Liver Disease, Hepatitis, Hepatocellular Jaundice, Liver Abscess, Acute Liver Failure and Portal Hypertension and Least number of participants had Obstructive Jaundice. In this study, 141 (75.4%) of the participants had Prothrombin time > 16 seconds and 46 (24.6%) of participants had 11 – 16 seconds. Mean PT was 21.9 ± 9.9 sec. PT time in this study ranged from 12.5 – 93.3 sec. 119 (63.6%) of the participants had INR > 1.3 and 68 (36.4%) of participants had 0.9 – 1.3. Mean INR was 1.65 ± 0.75. 125 (66.8%) of the participants had APTT 25 – 40 seconds and 62 (33.2%) of participants had >40seec. Mean APTT was 37.6 ± 5.1 sec. It was found that PT was maximum with acute liver failure followed by chronic liver disease, acute viral hepatitis and Alcoholic liver disease. INR was maximum raised in acute liver failure followed by chronic liver disease and Alcoholic Liver Disease. APTT was maximum in acute liver failure followed by obstructive jaundice. Conclusion: In advancing liver diseases, damage to liver parenchyma resulting in reduced production of coagulation proteins so there is increase in PT and APTT which increase the risk of bleeding tendencies. Prolongation of PT and APTT in advancing liver cirrhosis indicates damage to the liver parenchyma resulting in decreased production of coagulation proteins with increased risk of bleeding tendencies, which can be detected before these ensue.

DOI: 10.5281/zenodo.10936175

Background: Connective tissue diseases (CTDs) are linked to a higher likelihood of experiencing cardiovascular problems, such as ventricular failure. Nevertheless, the extent and indicators of risk for ventricular dysfunction in this specific group of patients have not been adequately described using echocardiography. Objective: To assess the echocardiographic prevalence of ventricular dysfunction and identify its risk predictors in patients with CTDs at a tertiary care hospital. Methods: This prospective observational study enrolled 60 patients diagnosed with various CTDs at MLB Medical College, Jhansi, from January to October 2023. Patients underwent comprehensive clinical and echocardiographic evaluations to assess ventricular function. Data on demographic characteristics, type and duration of CTD, disease activity, and echocardiographic findings were collected and analyzed. Results: Of the 60 patients, 22 (36.7%) exhibited ventricular dysfunction, with diastolic dysfunction (20%) being more prevalent than systolic dysfunction (16.7%). Pulmonary hypertension was observed in 25% of patients. Risk factor analysis indicated that longer disease duration and higher disease activity were significantly associated with ventricular dysfunction. Systemic lupus erythematosus and systemic sclerosis were the most commonly represented CTDs with notable cardiac involvement. Conclusion: Those with long periods of illness and higher activity levels are most likely to have ventricular dysfunction, according to the study. These data suggest that frequent cardiovascular monitoring in CTD patients may improve patient outcomes by detecting and treating ventricular dysfunction early.

DOI: 10.5281/zenodo.10936175

Background: The acute heart failure (AHF) is a leading cause of hospitalizations and deaths, and Pro-BNP levels indicate its severity. An MLB Medical College, Jhansi study examined Pro-BNP levels, triggering events, and AHF mortality. Methods: Conducted from January to October 2023, this cohort study examined 100 AHF patients, focusing on Pro-BNP levels and factors leading to mortality, with initial evaluations done at emergency admission. Results: Findings indicated a strong link between high Pro-BNP levels (above 5000 pg/mL) and increased mortality, with acute myocardial infarction being the top contributing factor, followed by infections and uncontrolled hypertension. Conclusion: High Pro-BNP levels and certain triggers, particularly acute myocardial infarction, are key predictors of mortality in AHF patients, emphasizing the importance of quick and specific interventions in emergencies to better patient outcomes. Recommendation: Improved screening for high Pro-BNP levels and active management of key risk factors like myocardial infarction may enhance survival in AHF cases, warranting further research on Pro-BNP thresholds for improved prediction.

DOI: 10.5281/zenodo.10936175

Introduction: The study assesses the efficacy of Primary Percutaneous Coronary Intervention (PPCI) for stent thrombosis, analyzing success rates and outcomes. Method: Conducted at MLB Medical College, Jhansi, 50 stent thrombosis patients underwent PPCI from January to October 2023, with data analysis on outcomes. Results: Predominantly male (70%), average age 58, the study reported 92% PPCI success and 80% revascularization, with 12% experiencing major adverse events. Conclusion: PPCI was effective in treating stent thrombosis, indicating a need for further large-scale research.

DOI: 10.5281/zenodo.10936175

Introduction: STEMI represents an urgent medical condition necessitating prompt intervention, with door-to-balloon (D2B) time being crucial from hospital entry to mechanical reperfusion through PCI. Reduced D2B times are linked to better patient outcomes, though these benefits can vary with the patient’s age, complicating the management of elderly STEMI patients. Objective: The research aimed to assess how D2B time impacts the clinical results of STEMI across various age brackets (under 75, 75-84, and over 85 years), focusing on refining D2B timing about demographic factors to improve outcomes, particularly for older, high-risk individuals. Materials and Methods: The investigation was carried out at MLB Medical College, Jhansi, from January to October 2023, involving 90 STEMI patients. It gathered and analyzed data on patient demographics, symptoms, D2B times, procedural specifics, and outcomes, considering any confounding factors. Results:  The study found that median D2B times increased with patient age (under 75 years: 45 minutes, 75-84 years: 50 minutes, over 85 years: 55 minutes), showing a notable variation (p=0.023). Particularly in patients over 85, age was a significant predictor of negative outcomes (p=0.041), with a more substantial effect than D2B time alone on the incidence of MACE. Conclusion: Optimizing D2B time is essential for STEMI treatment, but the findings highlight the importance of age, especially in patients older than 85, as a critical factor in treatment outcomes. Developing age-specific treatment strategies in conjunction with D2B time improvement is essential for better survival rates and quality of life. The study’s limitations, such as its retrospective design and small size, call for more extensive research to support evidence-based management of STEMI.

DOI: 10.5281/zenodo.10936175

A persistent difficulty for trauma teams and general surgeons operating in poor nations is dealing with chest injuries. After head trauma and abdominal injuries, thoracic trauma is the third most prevalent cause of death for individuals with polytrauma.  ln an attempt to improve care, prevent complications, and reduce the death rate of Polytraurna patients, this investigation examined the course of therapy, results, and epidemiological data of patients who had blunt chest trauma. A retrospective analysis of hospital records spanning four years (2017— 2020) was conducted for patients with chest trauma, including Polytrauma (n=180). A number of factors were investigated, such as the results, management, injury mechanism, and demographic profile. The male to female ratio was 2.3: I, and the patients’ average life span was 36*15 years. Assaults and traffic accidents continue to be the most frequent causes of trauma. Immunonutrition was used to treat the majority of patients (56.1 I°/c). Of the patients, only 2.22°/c experienced mortality. Trauma mainly affects young male patients. Injuries from traffic are the most frequent cause. Nonetheless, the majority of patients respond well to conservative care, and the current study’s death rate only applies to individuals who have many traumas.

DOI: 10.5281/zenodo.10936175

Background: Lateral epicondylitis is the most common cause of elbow pain having substantial effects on person’s quality of life. Many treatments have been suggested to alleviate the pain and disability associated with this condition. Methods: In this study 60 patients satisfying the inclusion & exclusion criteria were enrolled after taking informed consent. Selected patients were assigned into 2 groups (A and B) by closed envelop randomization method. Group A patients were treated with autologous platelet rich plasma & Group B with methylprednisolone i.e steroid. Results: In this study we found that lateral epicondylitis has a male predominance with 56.7% patients have involvement of dominant arm. Corticosteroid injections had better pain relief at 2 days, 2 weeks and 2 months, while PRP provided better pain relief at 6 months follow up. Conclusions: Corticosteroid injections provided comparatively fast improvement of pain but for lesser duration, while pain relief with PRP injection was maintained for a longer time.

DOI: 10.5281/zenodo.10936175

Neural Tube Defects (NTDs) are pathological diseases that occur during pregnancy and have long-term consequences, such as Spina Bifida, which is defined by an inadequate closure of the neural tube during fetal development. Neurological disorders, orthopaedic abnormalities, and problems with bowel and bladder function may result from these anomalies. Researchers at Neurosurgery Department NMCH Patna set out to document the short-term and long-term effects of Neurosurgically treated repairing neural tube abnormalities (NTDs) at the lumbosacral level. A single institution recruited 228 youngsters to take part in a retrospective study from June 2021 to January 2024. The significance of prenatal screening and diagnosis is shown by the study’s finding that about one-third of NTDs were identified during pregnancy. Because the majority of cases were documented during ANC follow-up, the research further underlined the relevance of folate intake in preventing NTDs. Hydrocephalus was detected in almost a third of the patients, demonstrating the common occurrence of the two illnesses together. The overall survival rate for patients was 84.1%. Before surgery, 43.2% of patients had hydrocephalus, and 46.8% had it after. Readmission and mortality rates are still high, even though surgically treated lumbosacral neural tube anomalies at NMCH Patna have shown better results than in previous research. The research conducted at NMCH Patna emphasizes the need to identify and treat neural tube abnormalities as soon as possible, especially in children who have consented to primary surgical closure.

DOI: 10.5281/zenodo.10936175

Introduction: Ramadan is the ninth month in the lunar Islamic calendar and lasts for about 29–30 days. It is mandatory for all adult individuals of the Islamic faith to fast during the holy month of Ramadan. Continuous fasting for a fortnight has been shown various physiological changes and also in blood parameters specially related of basal metabolism of bod this study has been done to find the changes in lipid parameters after 3 weeks of fasting in Ramadan. Materials and Methods: The present study included healthy adult male Muslim volunteer’s staff coming to IIMSR medical college. The number of subjects in the study was 75. Blood samples from all 75 subjects were collected twice during the study—once in the week prior to the beginning of Ramadan and then again in the last week of Ramadan Following biochemical parameters were taken into consideration: (a) Serum total cholesterol (b) Serum triglycerides (c) Serum HDL cholesterol. Results: It was observed that compared to pre‑fasting levels, total cholesterol (TC) and triglycerides (TG) were significantly decreased (P = 0.000) and high‑density lipoprotein cholesterol (HDL‑C) level had significantly increased (P = 0.000). Conclusion: This study showed a reduction in total cholesterol and triglycerides along with a rise in levels of HDL‑C, which had beneficial effects on lipid profile post Ramadan fasting period.

DOI: 10.5281/zenodo.10936175

Background: One of the most common microvascular effects of diabetes mellitus (DM) is diabetic neuropathy (DN), which is often underdiagnosed and undertreated in day-to-day clinical practice. So, this study compared the quality of life of diabetics with and without diabetic peripheral neuropathy (DPN). It also determines factors associated with DPN and correlation of Vitamin B12 levels with metformin use in our region. Methodology: An analytical cross-sectional study was conducted in the Out-patient department tertiary care centre of northern India for a period of 12 months where all type 2 diabetics for more than 3 years were interviewed and thoroughly examined for diabetic neuropathy using a biothesiometer and quality of life using WHO-BREF scale. Results: 259 diabetics were divided into 2 groups i.e. with DPN (Group 1, 65) and without DPN (Group 2, 194). Mean age of the study participants in group 1 and 2 were 51.5 ± 9.2 and 53.3 ± 6.9 respectively. Higher duration of diabetes, use of metformin drug, longer duration of metformin use, Higher HbA1c levels and Lower levels of Vitamin B 12 were significantly associated with DPN. The correlation between levels of Vitamin B12 (low or normal) and use of metformin was highly significant (p value- 0.009). The overall BREF score was significantly lower in the DPN group as compared to group 2. Physical and environmental subscales of the score were also significantly lower in the DPN group than group 1 (p<0.05). Conclusion: A lower quality of life was observed by the patients with DPN than those with no DPN. So, only right supplementation of Vitamin B12 according to the recommended daily allowance and timely monitoring can give patient a better quality of life.

DOI: 10.5281/zenodo.10936175

Introduction: Atypical antipsychotics are more preferable than typical antipsychotics due to their superior safety profile and lower likelihood of causing extrapyramidal side effects. The occurrence of adverse drug reactions from atypical antipsychotics has a detrimental effect on the overall quality of life and need specific care over the course of therapy. The current research aimed to evaluate the effectiveness of atypical antipsychotics and their influence on individuals with schizophrenia. Material and Methods: We included a cohort of 120 individuals who were clinically diagnosed with schizophrenia and were between the ages of 21 and 35. The subjects were randomly separated into four groups based on the substance delivered. The treatment technique and side effect profile were recorded. The assessment of drug side effects was conducted using a standardised Antipsychotic Side-effects Evaluation Questionnaire. Follow-up was conducted on cases to assess the status of side effects at the first, third, sixth, ninth, and twelfth month. Results: Weight gain was observed in 36.67% of cases in group AR, 33.33% in group AS, 63.33% in group OL and 26.66% in group ZI. Insomnia was the most prevalent adverse event of the central nervous system in all study groups, particularly in groups AS (33.33%), group AR (30%), group OL (26.67%), and group ZI (20%). Extrapyramidal symptoms were equally prevalent across all medication groups in the current investigation. Conclusion: The results of the study did not indicate significant differences in the side effects linked to different antipsychotic drugs. Of all the research medications, aripiprazole, ziprasidone, and Asenapine showed the most effectiveness in reducing the negative symptoms of schizophrenia and minimising associated side effects.

DOI: 10.5281/zenodo.10936175

Introduction:  Alcoholism is a mental condition characterised by a combination of physiological, psychological, and social challenges, and it often follows a pattern of recurring episodes. Relapse is a multifaceted and ever-changing issue in the field of therapeutic concern, which seems to be influenced by biological, psychological, and social variables. The current research aimed to evaluate the risk variables associated with relapse in individuals diagnosed with alcohol dependency. Materials and Methods: A total of 60 subjects, who were over 21 years of age and had alcohol dependency were considered. Based on their alcohol dependence level participants were randomized into group A (n=30) who had a recurrence of alcohol dependency after appropriate treatment and Group B (n=30) diagnosed with alcohol dependence who used alcohol during the last 12 months, as determined by the International Classification of Diseases, 10th edition (ICD-10) and also followed to determine personality disorders among the participants. Results: The comparison of age, economic status, educational status, and occupational status yielded statistically significant results (p<0.05). The SDAQ score depicted that 56.67% & 67.67% had severe grade, 30% & 20% had moderate and 13.33% each had mild alcohol dependence in group A and group B respectively. The main reason for relapse is cravings on alcohol (36.67%), familial disturbances (23.33%), unemployment (23.33%), and financial disturbances (16.67%). Conclusion: Relapsed group members were shown to have significant predictors that included cravings on alcohol, familial disturbances, unemployment, and financial disturbances. Increasing one’s sense of self-efficacy and fostering social support should be the primary focuses of individual and family counselling activities.

DOI: 10.5281/zenodo.10936175

Background: Idiopathic Granulomatous Mastitis (GM) is a chronic granulomatous inflammatory breast disease of unknown origin. In clinico-radiological study it mimics both infectious and malignant lesions. Hence, cytological, histopathological and microbiological study is mandatory to confirm the idiopathic GM. Method: 92 adult female patients with breast lump, aged between 30 to 40 years, referred to the pathology department were studied clinically, radiologically, cytologically, histopathologically and microbiologically to confirm the idiopathic GM. Results: Duration of breast lump was about one month. Left laterally located lump was 64 (69.5%) and right was 28 (30.4%), Maximum size of lump was 5 cm. 85 (92.3%) were palpable lumps, 7 (7.60%) had eversion of nipple, 5 (5.43%) had discharging sinuses. Blood-mixed FNACs were 60 (65.2%), and in 32 (34.7%) pus-like material was noted. USG Findings had 26 (28.2%) abscess, 20 (21.7%) irregular hypoechoic masses, 14 (15.2%) with increased vascularity, 11 (11.9%) had lobulated masses. Histopathologically, 90 (97%) had clustered epithelioid like histiocytes, 64 (69.5%) had well defined mixed inflammatory cells, 45 (48.9%) with predominantly lymphocytes and 47 (51.08%) with neutrophils. Conclusion: The present cytological study of breast lump is very important to exclude tuberculosis and malignancy, because developing countries like India have a high prevalence of TB and malignancy.

DOI: 10.5281/zenodo.10936175

Purpose: To evaluate the accuracy of CT Enterography in evaluation of small bowel pathologies. Methods: this is a prospective observational study carried in Department of Radiodiagnosis in a Medical college in Maharashtra, India with a sample size of 100; after ethical committee clearance with Study duration of 2 years. The patient’s with suspected small bowel pathologies were subjected to CT enterorrhaphy study. Patients were followed for a period of 2 months following the CT Enterography study. The final clinical, intra-operative, or histopathological diagnosis was correlated with the CT Enterography findings. Results: Diagnostic accuracy of CT Enterography in evaluation of small bowel pathologies was found to be 93% (86.11% to 97.14%). Sensitivity was found to be 90.77% (85.08% to 99.93%), Specificity was found to be 97.14% (90% – 100%), Negative likelihood ratio was 0.1 (0.04 to 0.20), Positive predictive value was 98.33% (89.51% to 99.76%), Negative predictive value was 85 % (72.51% to 92.41%). Conclusion: CT Enterography is a reliable and accurate imaging modality for diagnosis of various small bowel pathologies.

DOI: 10.5281/zenodo.10936175

Background: Regional Anaesthesia is a safe alternative to General Anaesthesia. The block achieves ideal operating conditions. Bupivacaine is most commonly used but cardiac and CNS toxicity is seen with that so we used Ropivacaine. Plain Local Anaesthetic is short lived so different adjuvants are added to achieve quick, dense and prolonged block. So, this study was carried out to evaluate the effect of dexmedetomidine or tramadol as an adjunct to local anaesthetic ropivacaine in brachial plexus block through supraclavicular route in upper limb surgeries. Methods: A total of 104 patients aged 18-60 years, American Society of Anaesthesiologists (ASA) physical status I or II, of either sex, planned for unilateral upper extremity surgery were included. The patients were randomly divided into two equal groups. Group D received ropivacaine+dexmedetomidine and Group T received ropivacaine+tramadol. Effect was observed and compared intraoperatively and post operatively. Result: The onset and duration of sensory and motor block is significantly rapid and prolonged in the D group as compared to T group. Duration of analgesia and time of rescue analgesia is significantly prolonged in Group D compared to Group T. Conclusion: Dexmedetomidine as an adjunct to Ropivacaine produces an early onset and more prolonged duration of sensory and motor blockade as compared to Tramadol. Hence, Dexmedetomidine seems to be a better adjuvant to Ropivacaine in supra-clavicular brachial plexus block than Tramadol.

DOI: 10.5281/zenodo.10936175

Objective: To assess the prevalence of cardiovascular abnormalities in patients under maintenance hemodialysis. Methods: Fourty six patients under maintenance hemodialysis were subjected to two-dimensional and M mode echocardiography. All patients were evaluated clinically, biochemically and radiologically and were diagnosed as chronic kidney disease (CKD). The left ventricular ejection fraction (LVEF) was taken as measures of left ventricular (LV) systolic function. Diastolic function was determined by measuring E/A ratio by spectral Doppler LV inflow velocity. Results: Out of 46 patients studied, there were 36 males (78.27%) and 10 females (21.73%). Hypertension (60.86%) was leading cause of CKD. Echocardiography showed that left ventricular hypertrophy (LVH) was present in 71%. Systolic dysfunction as measured by decreased LVEF (< 50%) was present in 26.86%. Diastolic dysfunction as denoted by E/A ratio of less than 1 was present in 43.47% of patients. Regional wall motion abnormality (RWMA) was present in 13.04%. Pericardial effusion was noted in 23.08% of patients. Valvular calcification was noted in 10.86% patients. Mean left ventricular internal diameter in diastole was 34.30± 7.97 mm. Mean left atrium diameter was 38.57±5.83 mm. Conclusion: Patients under maintenance hemodialysis had higher prevalence of cardiovascular abnormalities and echocardiogram is a complementary, non-invasive, broadly used method in the assessment of heart structure and function, and can detect cardiovascular abnormalities prior to clinical detection.

DOI: 10.5281/zenodo.10936175

Background: The prevalence of anemia in cancer patients has been well-documented, with implications for both quality of life and treatment outcomes. Objectives: The objective of the present study was to describe the mean levels of haemoglobin among patients with cancer along with their sociodemographic and clinical characteristics. Methods: This was a hospital based descriptive cross-sectional study conducted in the outpatient department, Government Thiruvarur Medical College and Hospital, Tamil Nadu, India between December 2021 and November 2022 among patients with cancer. Results: The mean (SD) age of the participants included in the present study was 54.3 years (11.9). Nearly three fourth (73.3%) patients were females. The primary site of malignancy was breast (36.7%), thyroid (28.3%), stomach (18.3%), pancreas (10.0%), rectum (5.0%), and soft tissues (1.7%), in that order of frequency. More than one in ten patients (13.4%) was in either third or fourth stage of malignancy, in terms of severity. Among the 60 patients included in the present study, 63.3% patients had no comorbidities. Nearly three fourth patients (71.7%) had no active bleeding. The results showed that the mean (SD) levels of haemoglobin among patients with cancer was 9.03 gm/dl (1.3) – 21.7% had mild, 45.0% had moderate and 33.3% had severe anemia. Conclusion: The results underscore the importance of routine haematological assessments and tailored interventions to address anemia-related complications in the course of cancer care.

DOI: 10.5281/zenodo.10936175

Background: Insulin Resistance can induce an imbalance in glucose metabolism that generates chronic hyperglycemia, which in turn triggers oxidative stress and causes an inflammatory response leading to cellular damage. Triglyceride Glucose index (TyG) index is a novel comprehensive marker composed of fasting blood glucose and fasting triglyceride levels with better predictive value, cost effective and easier to calculate in routine clinical practice. Therefore, the present study aims to determine the relationship between the TyG index and echocardiographic parameters which can be used to evaluate cardiac function and possibly predict the future cardiovascular risk. Method: Seventy patients in the age group 18-75 years were included in the study. TyG index was calculated by using formula Log (Fasting triglyceride (mg/dl) × fasting glucose (mg/dl)]/2). Echocardiographic parameters including LV parameters (IVSTd, LVIDd, LVPWd), ejection fraction, LA Size were measured. LVM was calculated using ASE (American Society of Echocardiography) approved cube formula as follows: LVM = 1.04 x ([IVSTd + LVIDd + LVPWTd]³ – LVIDd³) x 0.8 +0.6. Result: Study showed higher TyG index was associated with elevated LV mass. Also Diabetics were found to have higher mean TyG and thus LV mass than non-diabetics. Conclusion: TyG index is a simple indicator of insulin resistance which reflects cardiac remodelling and dysfunction and in near future could be a potential therapeutic strategy to reduce cardiovascular mortality.

DOI: 10.5281/zenodo.10936175

Introduction: Among females, breast cancer is one of the most commonly diagnosed cancers and the leading cause of cancer death, followed by colorectal and lung cancer. Breast carcinoma is a very heterogeneous disease despite the common tissue of origin. GATA-binding protein 3 (GATA3) belongs to a family of 6 mammalian GATA dual zinc-finger transcription factors. Methods: The study aims to evaluate the diagnostic value of GATA3 expression in breast carcinomas. 50 clinically and histologically proven cases of Invasive Breast cancers were taken into consideration and they were studied for GATA3 expression from 2017 to 2019 at MNJ Institute of Oncology, Hyderabad. The GATA3 expression was compared to estrogen receptor (ER), progesterone receptor (PR), and Her2 expression. Results: Out of the total 50 selected cases, GATA3 was positive in 34 (n=34, 68%) of cases and negative in 16. GATA3 expression was seen in the majority (73.5%) of ER-positive cases (25) than in ER-negative cases (09) (p=0.0001). GATA3 expression was seen in 17 PR positive and 17 PR negative cases. GATA3 expression was more commonly seen in the Luminal A (44%) and B (06%) subtype, Her2 (06%) subtype and TNBC (12%). 100% of Grade 1 tumors showed GATA3 positivity, 75% of Grade 2 tumors and 59.3% Grade 3 tumors showed GATA3 positivity. Conclusion: Like ER & PR, GATA3 is also commonly expressed in breast carcinomas and its expression has a favorable prognosis. GATA3 expression was commonly seen in Luminal A and B types of invasive breast cancers. GATA3 expression is seen in majority (73.5%) of only ER positive patients.

DOI: 10.5281/zenodo.10936175

Background: Sepsis remains a major cause of morbidity and mortality among children. A hormonal disorder that often affected in sepsis is thyroid hormones which occur in the form of euthyroid sick syndrome (ESS) or nonthyroidal illness syndrome (NTIS). AIM- To evaluate thyroid hormone profile in children with sepsis and its association between thyroid hormone level and sepsis. To find out correlation between thyroid hormone level with clinical profile and outcome in these children. Method: In this study 70 patients with sepsis is enrolled in a hospital based observational cohort study conducted in S.P.M.C.H.I and attached group of hospital Jaipur during July 2019 to July 2020. After making diagnosis of sepsis first sample was sent for measuring of free T3, free T4 and TSH on day 1 and then second sample for the same was sent on 7th day or on discharge whichever is earlier. Result: We recorded patient outcome and analyse the relationship with chi –square test. Level of T3 and T4 were decreased on day 1 in paediatric sepsis. Of total 70 subject, 52(74.2%) with low level T3 and 38(54.2%) with low T4. There is a significant relationship between level of T3 and T4 with patient outcome (p<0.05). Conclusion: The Euthyroid sick syndrome in children with sepsis does exist. There was a significant relationship between T3 and T4 level on day 1 with patient outcome.

DOI: 10.5281/zenodo.10936175

Background and Aim: General anesthesia using agents like Desflurane or Sevoflurane are beneficial for early recovery especially for ambulatory procedures. The aim of this study was to compare the hemodynamic, emergence & recovery characteristics of isoflurane & desflurane in GA for patients undergoing laparoscopic Cholecystectomy operations. Material and Methods: A Prospective Randomized and comparative study was conducted in 50 patients posted for elective Laparoscopic cholecystectomy. 50 patients were randomly allocated in 2 groups (n=25) Group I: Anaesthesia maintained with 60% N₂O in O₂ and Isoflurane Group D: Anaesthesia maintained with 60% N₂O in O₂ and desflurane. Following parameters were observed –bis value for awareness (depth of anesthesia), recovery profile (specifically time to eye opening, time to obeying commands, time to tracheal extubation, and time to achieving discharge criteria, hemodynamic parameters including HR and MAP and complications. Results: Systolic blood pressure difference was statistically significant between the two groups at 5 minutes and 90 minutes after induction. Desflurane cause statistically significant increase in HR and in some observation increase in SBP also. There was significant difference in Post- operative cognitive functions recovery among both the groups. In group D 3 cases develop nausea and vomiting while in group 2 and 1pt develop nausea & vomiting respectively. Conclusion: Recovery profile of desflurane is faster than isoflurane. Though total cost of desflurane is higher as compared to isoflurane, but use of desflurane can be justified with faster emergence from anaesthesia, faster shifting from PACU as recovery of cognitive function is also early discharge, lesser complication, which will cause lesser hospital stay, lower chance of nosocomial infection and over all lower cost of hospital stay.

DOI: 10.5281/zenodo.10936175

Chronic orofacial pain due to Temporomandibular Joint (TMJ) dysfunction is a commonly encountered clinical situation by dentists and other health care workers. The symptoms of TMJ disorders may vary from simple headaches, ear pain, bite problems, clicking sounds, locked jaws to severe psychological issue that can affect quality of life for the patient. This article embodies a review of anatomy of the jaw, symptoms, causes, diagnosis and various treatment options of TMJ disorders. This article also evaluates a systematic review on efficacy of different types of occlusal splints in the conservative management of TMJ disorders.

DOI: 10.5281/zenodo.10936175

Background and Aim: Adhesive capsulitis is a condition that presents with pain and progressive limitation of both active and passive shoulder movements. As adhesive capsulitis is postulated as an inflammatory and fibrotic disease, easy treatment with intraarticular corticosteroids injection may reduce synovitis, limit the Development of capsular fibrosis, and alter the natural history of disease. The objective of this study was to compare the effects of single intra‑articular Corticosteroid injection with Hydrodilation. Material and Methods: In this study 36 Patients were taken of adhesive capsulitis of shoulder and divided in 2 groups. One group receiving corticosteroid and other one is receiving Steroid + Normal saline (Hydrodilation). The Outcome was recorded. Results: There was statistically significant reduction in Visual analogue scale pain scorers in both the groups over a time period of 12 weeks. But the Corticosteroid injection was observed to be better in reducing the pain scores when compared to the Hydrodilation after 12^th week (P = 0.00003). Conclusion: We concluded that USG- guided corticosteroid injection is more effective therapy then USG- guided hydrodilation in terms of Pain & Improvement in shoulder function in the treatment of adhesive capsulitis of Shoulder.

DOI: 10.5281/zenodo.10936175

Background: The causes of lymphadenopathy exhibit a wide range of spectrum from stereotypical patterns of treatable infectious etiology to deadly malignant neoplasms. Detailed investigations are required to reveal the underlying pathology, as clinical diagnosis is usually delayed because of nonspecific symptoms and radiological images may not be sufficient for diagnosis. Hence, excision biopsy of lymph node and its histopathological analysis are considered mandatory to arrive at a specific diagnosis for appropriate patient care and management. Objectives:  (1) To study the frequency of occurrence of diseases of lymphnode in relation to age, gender and site. (2) The study aims to analyse the various histopathological patterns of lymph node biopsies and classify them into major groups. Materials and Methods: The present study was retrospective observational type, which included 137 cases presented with lymph node enlargement in a tertiary care hospital over a period of 3 years from December 2020 to November 2023. Results: Out of total 137 lymphnode biopsies analysed in our study, the demographic most significantly impacted were those aged between 51-60 years with a female preponderance. 70 cases (51.09%) constituted   non-neoplastic lesions, while 67 cases (48.91%) were observed to be neoplastic. Among 70 non neoplastic lesions (51.09%), majority of 55 cases (40.14%) constituted Reactive Lymphadenitis followed by 11 cases (8.03%) of Granulomatous lymphadenitis. Among 67 neoplastic lesions (48.91%), 7 cases (5.11%) were primary lymphomas and the other remaining 60 cases (43.80%) were metastatic lesions, in which majority of 37 cases (61.69%) turned out to be metastasis from carcinoma of breast presenting with axillary lymphadenopathy. Conclusion: Lymphadenopathy is not so uncommon in our geographical area. Thus, excision biopsy of lymphnode and its histopathological analysis play a pivotal role in the clinical management by establishing the cause of lymphadenopathy for early definitive diagnosis and prognostic purpose. In our present study, non-neoplastic lesions were more frequent than neoplastic lesions. In specific, metastatic lesions were the major cause of lymphadenopathy followed by reactive lymphadenitis and the axillary lymphnodes were the most frequently biopsied group.

DOI: 10.5281/zenodo.10936175

Introduction: Retinal vein occlusion is a common cause of vision loss in older patients, and the second most common retinal vascular disease after diabetic retinopathy. Optical coherence tomography plays an important role in diagnosis of posterior segment diseases. This study establishes the importance of OCT in diagnosis and visual prognosis of retinal vein occlusion. Materials and Methods: This is a prospective observational study conducted at a tertiary care hospital. 30 patients who presented to outpatient department with retinal vein occlusion were included in the study and evaluated on the basis of visual acuity, age, type of Retinal vein occlusion, OCT findings. Results: Retinal vein occlusion was found to be more prevalent above age 40 years, in male patients, and those having co-morbidities like hypertension, diabetes, dyslipidemia. Significant correlation was found between foveal thickness and visual acuity. Conclusion: This study concludes that BRVO is more common than CRVO. OCT plays an important role in diagnosis and predicting the visual prognosis.

DOI: 10.5281/zenodo.10936175

Cisplatin [cis-dichlorodiammineplatinum (II)], the first generation anticancer platinum complex, is one of the most effective anticancer agents currently available for the treatment of testicular, ovarian, and bladder carcinomas. But its clinical usefulness has frequently been limited by undesirable side effects such as nephrotoxicity, gastrointestinal toxicity, ototoxicity, and neurotoxicity. The present study was conducted in collaboration with Department of anatomy, Institute of medical sciences, Banaras Hindu University, Varanasi. Animals – Fourty female albino mice of an average weight of 20 +/- 3 gm and an average age of 80-100 days were used in the study. Animals were housed individually in plastic cages in animal house on light – dark cycle of 12 : 12 hours. Mice were feed on diet in the form of pellets (Hindustan Lever Bombay, India), tap water and libitum and treated with a good antiseptic care. Mating- Female albino mice were kept overnight in the same cage with male mice of same stock in the ratio of 3:1 (female: male = 3:1). At 8:00 A.M. in next morning vaginal smear was examined. If vaginal smear was positive, then smear was made on glass slide and examined under light microscope. If sperms were found, pregnancy was confirmed, and it was considered as day ‘ ZERO’ of pregnancy. The pregnant mice was weighted on alternate days and kept individually in separate cages. Microscopic examination of kidneys of both control and treated mice embryos were done. Staining method employed was Hematoxylin and Eosin (H&E) stain. Prepared slides of treated groups were compared with those of control groups. On examination of kidney of mice embryos, in control group kidney no abnormalities were observed [Plate A] while in treated kidney periglomerular space was increased. Severe degeneration and loss of proximal convoluted tubules [PCT] and distal convoluted tubules [DCT] was also observed [Plate B]. In the present study, Carboplatin was found to be teratogenic in developing mice embryos when injected intraperitonealy at a dose of 6 mg/kg body weight on 7^th day of gestation. The fetuses were collected on 19^th day of gestation. The drug was founded to be teratogenic because of its induced nephrotoxicity. The kidney of treated embryos showed increased periglomerular space and severe loss of proximal convoluted tubules [PCT] and distal convoluted tubules [DCT], establishing the nephrotoxic potential of carboplatin.

DOI: 10.5281/zenodo.10936175

Introduction: Acute coronary syndrome (ACS) is most common cause of mortality in patients with coronary artery disease. Cardiovascular risk factors for ACS are on the rise in people of Indian origin, and ACS is now the leading cause of death. Aims and Objectives:  To study clinical profile, risk factors and complications of patients of acute coronary syndrome (ACS) presenting in Emergency Medicine Department. Material and Methods: An observational study spanning 1 year (1^st January 2023 to 31^st December 2023) was conducted in Emergency Medicine Department (EMD) of SKN Medical College & General Hospital, Pune. Data sourced from hospital records with approval. Result: The study analyzed 158 ACS patients. Most of them were males (72%). Most patients were from age group of 40-60 years (45%). STEMI was commonest presentation (68%). Chest pain/discomfort was most common presenting symptom seen in 82% followed by sweating in 61%. Among the risk factors studied, hypertension was commonest (39%) followed by smoking in 30%. Tachyarrhythmias were seen in 11% while cardiogenic shock was seen in 9%. Conclusion: ACS is more common in males with STEMI being commonest presentation andchest pain/discomfort being commonest presenting symptom. Complications can be seen during treatment in EMD and are tachyarrhythmias, cardiogenic shock, and bradyarrhythmias.

DOI: 10.5281/zenodo.10936175

Background and Objectives: Human immunodeficiency virus (HIV) infection and Aquired Immuno-Deficiency Syndrome (AIDS) is a global pandemic. Study aimed to record the retinal manifestations in patients with HIV according to their CD4+ count and HAART status, To study FUNDAL CHANGES in HIV/AIDS patients. To study the relationship between FUNDAL CHANGES in HIV infection and the degree of immunodeficiency as measured by CD4+Tcell count. Methods: A prospective study was conducted in Department of Ophthalmology, Nalanda medical College and Hospital, Patna. Patients known to be positive for HIV infection with or without AIDS being referred from the A.R.T. Centre of nmch on treatment/without treatment, and have determined their CD4+T lymphocyte cell count, belonging to any age and of either gender at Department of Ophthalmology, were enrolled in this study. Conclusion: There is higher incidence of retinal findings in non-HAART group and in patients with CD4+.

DOI: 10.5281/zenodo.10936175

Background : This study compared the general and ocular biometric characteristics of normal, primary angle closure (PAC), and primary angle-closure glaucoma (PACG) patients to better understand the possible relationship between differences in ocular parameters that might predict risk for PACG in PAC patients. Method: Study  was conducted at  NMCH Patna, Ophthalmology Department. Participants in this study were recruited from patients with suspected case of angle closure glaucoma approx 100 patients attended in O.P.D. of nmch. Patna. Conclusions: In addition to LT, a shallower ACD owing to a change in RLP may have a role in the progression from PAC to PACG. Owing to the differences of certain biometric characteristics between PAC and PACG, A-scan ultrasonography might potentially be used for the early detection of PACG in PAC eyes.

DOI: 10.5281/zenodo.10936175

Background and Objectives: Corneal ulcer is a potentially sight threatening ocular condition and the leading cause of monocular blindness. It can be caused by various pathogens. Bacteria are the most common infective organisms responsible for significant vision loss and ophthalmic morbidity. The severity of corneal infection depends on the underlying condition of the cornea and Pathogenicity of the infecting bacteria. It is rare in the absence of predisposing factors and hence most commonly associated with ocular trauma, so timely intervention is needed at the earliest possible period to prevent the sight threatening complications. Methods: A prospective clinical study is conducted on patients who attended, ophthalmology OPD, NMCH Patna, with definite signs and symptoms of corneal ulcers, Bacterial corneal ulcers are specifically studied in detail after microbiological evaluation. Conclusion: To conclude bacteria are the most common infective organisms responsible for significant vision loss and ophthalmic morbidity. Confirmation by microbiological diagnosis is very essential in order to limit the ocular morbidity and prevent complications, timely intervention, regular follow up and patient’s compliance can reduce the visual morbidity and complications.

DOI: 10.5281/zenodo.10936175

Background and Objectives: Thyroid diseases are frequently seen during pregnancy. The frequency of thyroid disorders in pregnancy is 2- 3%. Hypothyroidism Adverse maternal outcomes and perinatal complications are closely associated with overt maternal hypothyroidism, but whether these complications occur in women with subclinical hypothyroidism (SCH) during pregnancy remains controversial. The aim of this study was to evaluate the effects of SCH on maternal and perinatal outcomes during pregnancy. The present study was aimed to estimate the prevalence of SCH and associated maternal and perinatal outcomes, and to assess the risks of adverse outcomes associated with SCH. Methods: This Retrospective cohort study was conducted by examining the pregnant women who applied to the Gynaecology Department of IGIMS Patna, at their 6th to 14th gestational weeks and had antenatal follow-ups. Results: The TSH concentration was significantly lower in the first trimester than in the third trimester (P,0.001). The fT4 concentration was higher in the first trimester than in the second and third trimesters (P,0.001). The incidences of GH and PROM were significantly higher in women with SCH than in euthyroid women (5% vs. 1.57%, P= 0.020; 10% vs. 5%, P= 0.002).IUGR was more frequent in women with SCH than in euthyroid women (7.5% vs. 1.3%, P, 0.001). More LBW infants were delivered in the SCH group than in the euthyroid group (12.5% vs. 5%, P, 0.001). Conclusion: The results of this study indicate that pregnant women with SCH had increased risks of GH and PROM, and their foetuses and infants had increased risks of IUGR and LBW. Thus, routine maternal thyroid function testing is necessary to improve maternal and perinatal outcomes.

DOI: 10.5281/zenodo.10936175

Background and Objectives: Many factors that carry either a good or poor prognosis for visual outcome in open globe injuries have been studied in numerous retrospective studies in the past. The recent classification of eye injuries accepted by the International Society of Ocular Trauma made the description of eye injuries less ambiguous, and has set the stage for prospective clinical studies. To prospectively evaluate all patients with open globe injuries presenting to NMCH Patna over a one year period and study a list of factors with respect to the final visual outcome. Methods: We evaluated the final visual acuity of thirty eight open globe injuries with a minimum follow-up period of six months. The anatomical and functional factors of each injury was analyzed with respect to the final visual outcome. Conclusion: We found that factors describing the functional status of the eye were more important in predicting the final outcome when compared to those related to the anatomy of the injury. We also established a pre-operative scoring system based on the internationally accepted factors used to classify an open-globe injury, which could accurately predict the visual outcome. Predicted the final visual outcome with ocular trauma score.

DOI: 10.5281/zenodo.10936175

Background and Objectives: The elderly patient population is growing at a rapid pace, and as they age, their need for high-quality healthcare increases. However, quantifying their health problems can be difficult due to the lack of a standardized definition for the elderly population in medical literature. The Working Party into the Perioperative Care of the Elderly 2014 even suggested abandoning the use of chronological age to define “older. To compare intubating condition of rocuronium and succinylcholine in geriatric patient. To observe the hemodynamic effect and adverse effect of the study-drugs. Methods: This randomized controlled trial was conducted in the Department of Anaesthesiology in Narayan Medical College & Hospital, Sasaram, a tertiary care, referral and teaching hospital during the study period. All adult patients who fulfil the inclusion criteria, are aged between beyond 65 years, undergoing elective surgery under general anaesthesia with succinylcholine or rocuronium as neuromuscular blocking agent were recruited in the study after written informed consent. Permission for the study was granted from the Institutional Ethics Committee. Conclusion: Mean values of HR and MAP trends were significantly lower (p- values 0.018 and <0.0001 respectively) for Rocuronium group. SpO2 values were however comparable statistically. Adverse events were noted in higher number in Succinylcholine group; however, the comparison was found to be insignificant statistically (p-value 0.407). Scoring and grading of intubating conditions were comparable amongst both groups. Mean scores of 8.3 + 1.13 and 8.35 + 0.88 were noted in R and S groups with an insignificant p-value of 0.87. Intubation conditions were rated as excellent in 80% (16 patients) and good in 20% (4 patients) of the patients who received Rocuronium, and excellent in 85% (17 patients) and good in 15% (3 patients) of the patients who received Succinylcholine with a p-value of 0.67.

DOI: 10.5281/zenodo.10936175

Background and Objectives: Paediatric cataracts account visual loss in childhood. Early diagnosis and timely intervention is of at most importance as cataracts interfere with normal visual development. To evaluate the visual results after cataract surgery in children aged below 15 years and to evaluate the different causes of visual impairment following cataract surgery. Methods: A prospective study of 30 cases of paediatric cataract was conducted in Nalanda Medical College and Hospital Patna. A detailed ophthalmic and systemic examination was done. IOL power was calculated using modified SRKII formula and appropriate under correction was given with respect to age. Small incision cataract surgery with PCIOL implantation with or without PCCC was performed in all the 30 cases followed up for 6 months. Conclusion: In paediatric cataracts early surgical intervention with adequate visual rehabilitation is necessary to avoid irreversible visual damage due to amblyopia. The visual outcome following cataract surgery depends on the age of onset, type of cataract, laterality, method of optical rehabilitation, amblyopia therapy, associated ocular features and postoperative complications.

DOI: 10.5281/zenodo.10936175

Introduction: Uncertainty exists over the ideal oxytocin dosage during elective caesarean sections. An insufficient amount of oxytocin might lead to insufficient uterine tone and increased uterine haemorrhage, whilst an excessive dose can have negative cardiovascular consequences including tachycardia and hypotension. To gauge the haemodynamic alterations and uterine contraction in patients undergoing elective caesarean sections, we examined two different oxytocin regimens. Aims/ Objective: To compare the heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure after giving oxytocin 2U bolus + 20U in RL infusion in combination and 20U in RL infusion alone and to record the need of additional uterotonic (methylergometrine 0.2mg) in elective caesarean section. Materials and Method: It was a Prospective randomised double-blind study90 patients were randomised into two groups after elective caesarean section with 45 patients in each group. Patients of group A were given oxytocin at dose of 2U bolus + 20U in 500 ml RL infusion and patients in group B were given oxytocin at dose of no bolus + 20U in 500 ml RL infusion immediately after cord clamping. In both groups haemodynamic parameters (Heart rate, Systolic blood pressure, Diastolic blood pressure, mean arterial pressure) were recorded per minute for first 5 minute and then per 2.5 minutes for 25 minutes and then per 5 minutes for next 30 minutes. Results: There was increase in heart rate in one and the other groups. But it was more marked in Group A which was statistically highly significant at various pre-specified time intervals as mentioned above. A fall in systolic, diastolic and mean arterial blood pressure was noted in both the groups. The maximum fall was in Group A which is statistically significant at various pre-specified time intervals as mentioned above. Lesser number of subjects in Group A required administration of additional uterotonic agents. Conclusion: On comparing two regimes of oxytocin viz, 2U bolus + 20U in ringer lactate infusion in combination and 20U in ringer lactate infusion alone, the study concludes that greater hemodynamic changes in heart rate, systolic, diastolic, and mean arterial blood pressures were observed in bolus-infusion combination regimen as compared to the infusion alone regimen.

DOI: 10.5281/zenodo.10936175

Introduction: Acute coronary syndrome (ACS) is most common cause of mortality in patients with coronary artery disease. Cardiovascular risk factors for ACS are on the rise in people of Indian origin, and ACS is now the leading cause of death. Aims and Objectives:  To study clinical profile, risk factors and complications of patients of acute coronary syndrome (ACS) presenting in Emergency Medicine Department. Material and Methods: An observational study spanning 1 year (1^st January 2023 to 31^st December 2023) was conducted in Emergency Medicine Department (EMD) of SKN Medical College & General Hospital, Pune. Data sourced from hospital records with approval. Result: The study analyzed 158 ACS patients. Most of them were males (72%). Most patients were from age group of 40-60 years (45%). STEMI was commonest presentation (68%). Chest pain/discomfort was most common presenting symptom seen in 82% followed by sweating in 61%. Among the risk factors studied, hypertension was commonest (39%) followed by smoking in 30%. Tachyarrhythmias were seen in 11% while cardiogenic shock was seen in 9%. Conclusion: ACS is more common in males with STEMI being commonest presentation and chest pain/discomfort being commonest presenting symptom. Complications can be seen during treatment in EMD and are tachyarrhythmias, cardiogenic shock, and bradyarrhythmias.

DOI: 10.5281/zenodo.10936175

Introduction: Postoperative nausea and vomiting (PONV) is a major concern in day care procedures following gynecological laparoscopy. Despite advancements in anesthesia and surgical techniques, PONV continues to cause patient distress and hospitalization. Ondansetron, a selective serotonin 5-HT3 receptor antagonist, is a key pharmacological intervention for PONV prevention. However, differences in dosing regimens, patient populations, and surgical techniques necessitate thorough evaluation of the available evidence. This study aims to provide evidence-based guidance for antiemetic prophylaxis in day care gynecological laparoscopy and inform clinical practice. Aim: The present study was to determine the efficacy of ondansetron in the prevention of post-operative nausea and vomiting following day care gynecological laparoscopy. This research was carried out at Government Lalla Ded Hospital, a hospital associated with GMC, Srinagar, and involved 120 females aged 20-40 years with ASA-I and ASA-II classifications who underwent elective day care gynecological laparoscopic procedures under general anesthesia. The investigation excluded individuals with motion sickness or vestibular issues, those taking other antiemetic medications, patients with cardiovascular, respiratory, or liver diseases, and renal dysfunction. The study aimed to compare the effectiveness of ondansetron versus normal saline in preventing PONV in patients who underwent day-care gynecological laparoscopy. The results demonstrated that ondansetron was more effective in preventing PONV due to its ability to block serotonin receptors. These findings suggest that ondansetron could be a better choice for clinicians in similar surgical settings, but additional research is necessary to determine optimal dosage schedules and assess long-term outcomes. Conclusion: The study found ondansetron, compared to normal saline, more effective in preventing post-operative nausea and vomiting (PONV) in patients undergoing day-care gynecological laparoscopy, suggesting further research for optimal dosage schedules.

DOI: 10.5281/zenodo.10936175

Background and Rationale: This research aimed to give significant insights into the clinical patterns of patients in Western India who suffer from acne vulgaris. These insights can be helpful in the creation of effective treatment methods and preventative measures. Research Question: The objective of this study is to provide a response to the research question by conducting an analysis of different patterns for acne vulgaris at a tertiary care hospital located in Western India. Aim: In the context of a Western Indian tertiary care hospital, the purpose of this study is to provide specific information on the signs of acne vulgaris. Hypothesis: The purpose of this research was to investigate whether or not the clinical patterns of people who suffer from acne vulgaris in Western India are different from those that have been described in other regions. Materials & Methods: The study employed a cross-sectional methodology, collecting data from individuals with acne vulgaris at a particular time. One hundred teens, ages ten to eighteen, participated in the study; their average age was fourteen. Results: Sixty-three percent were females and thirty seven percent were male patients; and seven point five percent were adolescents. Every single person was older than 10 years old, and the frequency of acne increased with each passing year, eventually reaching 96.0% of the general population. The most prevalent kinds of acne were comedonal acne, which impacted the face to a greater extent than any other part of the body (96.6% of cases), mild papular-pustular acne, which affected 31% of cases, and moderate papular-pustular acne, which affected 7% of cases. One-half of the adolescents said that they had a parent who suffered from acne, and almost one-fourth of them stated that they had previously attempted to cure the problem. Increasing age was related to a higher probability of exhibiting acne that was not classified as acne vulgaris (p<0.001). Conclusion: Clinical patterns of acne vulgaris patients who were treated in a tertiary care hospital in Western India are the subject of this research, which gives important data on the subject. In order to establish the influence of lifestyle and environmental factors on acne vulgaris patients in various regions of India, more study is required to investigate the clinical patterns of acne vulgaris patients.

DOI: 10.5281/zenodo.10936175

Background & Rationale: The improvement of the diagnosis and treatment of skin problems in senior individuals can have a substantial influence on their quality of life, which is why the research of geriatric dermatoses is vital. Aim: This study aims to explore the clinical characteristics and prevalence of geriatric dermatoses among patients undergoing treatment in Western India’s tertiary care centers. Hypothesis: We hypothesize that geriatric dermatoses are common in patients visiting tertiary care centers in Western India and that their clinical features vary depending on the specific condition. Materials & Methods: This study used a cross-sectional design. The investigation included patients getting tertiary care who were 65 years of age or older. To participate in the trial, patients had to be 65 or older and admitted to the tertiary care hospital. Exclusion criteria for the trial included individuals with autoimmune skin illnesses, a history of skin malignancy, or incapacity to provide informed consent. Over the course of many weeks, one hundred patients, all of who were 65 and over, filled out the survey. Results: Of the 100 individuals assessed, 69% were men and 31% were women. The most commonly reported ailment (46%) was puritus. With 89% of cases, xerosis was the most common physiological modification. Among the pathological alterations that were often observed were infections, eczema, and skin cancers. Conclusion: In conclusion, the study offers essential information on the frequency and trends of geriatric skin problems among patients receiving tertiary care in Western India. This highlights the necessity for more research as well as improved healthcare methods in order to cater to the specific requirements of this group.

DOI: 10.5281/zenodo.10936175

Background: Pain is “an unpleasant sensory or emotional experience associated with actual or potential tissue damage or described in terms of such damage”. Objective: to compare the effectiveness of ropivacaine alone and its combination with dexmedetomidine in brachial plexus block through supraclavicular route, with the help of ultrasound guidance. Methods: The present study was carried out on patients undergoing elective upper limb surgery at Tirumala Hospital, Vizianagaram in the department of Anaesthesiology during the period from May- 2013 to May-2014. Results: There was no significant difference in the study groups with regards to demographic profile and duration of surgery. The onset of sensory and motor blockade was faster in group-RD than group-R. {Onset of sensory block: (group- R=14.133± 1.676 min & group-RD =12.667± 1.213min) (p=0.000), Onset of motor block : (group-R =25.967± 2.748min & group-RD=23.333± 3.467min)(p=0.002)} Also total duration of sensory blockade {Group R=547.833± 26.152mins, Group RD =811.667± 25.405 mins (p value = 0.000)}, motor blockade {Group R=509.667± 24.703 mins, Group RD = 760.667 ± 28.062mins (p value = 0.000)} and number of rescue injections in 24 hours {Group R= 2.733± 0.450, Group RD=1.400± 0.498 (p value = 0.000)} was significantly different in two groups. There was good haemodynamic stability in both groups. Conclusions: Dexmedetomidine in a dose of 25µg added to ropivacaine in supraclavicular brachial block for upper limb surgery significantly shortens the onset time and prolongs the duration of sensory and motor blocks without producing sedation in patients.

DOI: 10.5281/zenodo.10936175

Background: Chronic kidney disease (CKD) is a prevalent condition which affects 50% of the individual with T2DM (1). Dapagliflozin, a SGLT2 inhibitor is a class of antidiabetic remedy which has emerged to show effects in kidney disorders. Aim: An observational study to identify the role of Dapagliflozin in Chronic Kidney Disease Patient with diabetes. Method: A total of 49 patients were included according to the specified inclusion and exclusion criteria in the study. Their medical records were carefully examined, and relevant information was documented. Subsequently, statistical analysis was carried out using SPSS software using all the quantitative data. Result: In this study, Dapagliflozin exhibited positive changes in biomarkers associated with CKD and Diabetes. Initially estimated glomerular filtration rate (eGFR) was low, but significant Improvement was seen over the second follow-up, suggesting improved renal function. Similarly, the level of HbA1C decreased from the initial measurement to the second follow-up which shows better glycaemic control. In the final follow-up, there were no patients in stages G4 or G5, and a notable decrease was observed in stages G3A and G3B. Moreover, the mean creatinine level also decreased significantly suggesting improved kidney function Conclusion: Dapagliflozin has demonstrated efficacy in improving glycaemic control and offering renal protection. As a result, Dapagliflozin shows promise as a therapeutic solution for addressing the complex connection between CKD and T2DM.

DOI: 10.5281/zenodo.10936175

Objective: This study was designed to evaluate the efficacy of ultrasound and chest X ray among children with low respiratory tract infection. Methodology: In this retrospective study, 100 children with lower respiratory tract infections were recruited aged 6 months to 6 years. Children diagnosed with symptoms of respiratory distress, persistent cough, prolonged fever, abnormal auscultatory findings, and acute wheezes were included. Chest X-ray of frontal view was performed in antero-posterior lie-down or posteroanterior upright view depending on the age of the patients. To avoid unnecessary radiations lateral radiographs were not performed.16 A chest X-ray was performed to report inflammatory infiltrate, pneumothorax, Interstitial infiltrates, and lung hyper expansion. Meanwhile, a sonography examination was performed to diagnose Small subpleural consolidations < 10 mm in diameter, interstitial syndrome –B7 lines. Results: The study involved 100 patients with lower respiratory tract infections, with 41% pneumonia, 36% bronchiolitis, and 23% bronchitis cases. The major symptoms included nasal discharge, respiratory distress, Bronchial breathing, fever, crackles, prolonged expiration, and decreased air entry. Chest X-rays showed consolidation and interstitial infiltrates in pneumonia cases, while chest ultrasound revealed numerous B3 and B7 lines. Lung ultrasound had more sensitivity and specificity than chest X-ray. Conclusion: Our results concluded that chest ultrasound has better sensitivity and specificity for the diagnosis of pneumonia and bronchiolitis than a chest X-ray. Ultrasound can easily detect the small consolidations and numerous B lines than chest X-ray. Hence, chest ultrasound can be used as an alternative method for diagnosing lower respiratory tract infection.

DOI: 10.5281/zenodo.10936175

Introduction: The association between myopia and higher intelligence is much debated topic. There is no clear consensus on the fact that myopic individuals have more than average intelligence. There is paucity of studies on this important topic from India, country which have large no of myopic children. Material and Methods: Children of adolescent age group from 12 to 18 coming to ophthalmology OPD had been given option to join the study, after complete ophthalmic examination participants were divided into myopic group and non-myopic group. A total number of 200 participant were taken, 100 each in myopic and non-myopic group. Each participant had undergone intelligence assessment using Raven’s standard progressive matrices test. Scores were given to each participant. Results: Mean raven’s score was more in myopic group than non-myopic group. But on statistical analysis, the p value was >0.05. Myopic group was further divided into two groups. Group-1 was myopia from -0.25D to -2D andGroup-2 was myopia from -2.25 D and above. The mean raven’s score was more in group-2. But on statistical analysis the data was statistically non-significant. Discussion: Few previous studies found a positive correlation between myopia and intelligence in children. Age group and intelligence test differed in between these studies. While there are other studies too which did not find any difference in intelligence between myopic and non-myopic children. Result of our study match more closely with the second group. Conclusion: We did not find any concluding evidence on hypotheses “myopic children have more intelligence than non-myopic children”. But as the mean raven’s score was more in myopic group, we advise further studies with higher number of participants on this topic.

DOI: 10.5281/zenodo.10936175

Background: Most nosocomial infections are transmitted by health care workers (HCWs) who fail to practice proper infection control measures. Paramedical HCWs are at higher risk of various infections in the hospital. Objectives: This study was done to assess knowledge, attitude and practices of paramedical HCWs about the attributes of hospital infection and control. Method: The study was conducted at a tertiary care teaching hospital in India. Total 181 HCWs volunteered for the study. Permission was obtained from ethics committee. The survey was conducted using predesigned and pretested questionnaire comprising of 35 questions encompassing different attributes like hospital infection control, standard precautions, post exposure prophylaxis (PEP), vaccination and biomedical waste management (BMW). The responses were obtained, recorded and statistically analyzed. Result: Study population was 181 HCWs (139 nurses, 42 laboratory technicians). Out of 181, 162 HCWs responded to the questionnaire. For Hospital infection and control, Knowledge, Attitude and Practices were 75.10%, 68.67% and 33.33% respectively. For Standard precautions, Knowledge, Attitude and Practices were 80.86%, 68.36% and 75.93% respectively. For PEP, Knowledge, Attitude and Practices were 55.56%, 73.15% and 24.07% respectively. For Vaccination, they were 88.27%, 70.37% and 70.37% respectively. For BMW, they were 83.95%, 71.76% and 13.58% respectively. Conclusion: HCWs had a good knowledge about most of the attributes except PEP. HCWs had a good/favorable attitude towards all attributes. HCWs were good in practices of standard precautions and vaccination while poor in hospital infection control, PEP and BMW.

DOI: 10.5281/zenodo.10936175

Background: Pre-term delivery is a significant cause of neonatal morbidity and mortality, necessitating reliable predictive tools for timely intervention. This study aimed to estimate the efficacy of cervical elastography in predicting pre-term delivery. Methods: A retrospective cohort design was employed, involving 90 pregnant women aged 18 to 40 years with singleton pregnancies. Cervical elastography measurements were obtained between 18 to 24 weeks of gestation, with data collected on demographic characteristics, obstetric history, and pregnancy outcomes. Statistical analysis included logistic regression and sensitivity analysis using SPSS version 18. Results: The study population exhibited diverse demographic characteristics, with average maternal age of 29 years and average gestational age at recruitment of 20 weeks. Cervical elastography parameters varied across the cohort, with a median strain ratio of 2.1 and median elasticity score of 3.5. Pre-term delivery occurred in 16.7% of cases, with significant associations observed between cervical elastography measurements and pre-term birth. Moderate sensitivity (68%) and specificity (72%) were noted, with subgroup analyses indicating enhanced accuracy in nulliparous women and those with shorter cervical length (< 25 mm). Conclusion: Cervical elastography shows promise as a predictive tool for pre-term delivery, offering moderate sensitivity and specificity. Its utility, particularly in specific demographic subgroups, suggests potential integration into routine antenatal care for personalized risk assessment and management strategies. Recommendations: Based on the study findings, it is recommended to consider integrating cervical elastography into routine antenatal care protocols for pregnant women, especially those at higher risk of pre-term delivery. Additionally, further prospective studies are warranted to validate the predictive accuracy of cervical elastography across diverse populations and to optimize its utility in clinical practice.

DOI: 10.5281/zenodo.10936175

Background: Acute pancreatitis (AP) is a major cause of mortality and morbidity worldwide. In approximately one-third of the patients, acute severe pancreatitis may develop, producing progressive organ dysfunction usually caused by a rapidly progressive inflammatory response, which is associated with a prolonged hospital stay and significant morbidity and mortality. Patients with mild Acute Pancreatitis have mortality rates of less than 1%, but it is rapidly increased up to 10–30% in cases with severe Acute Pancreatitis. We wanted to evaluate serum calcium and albumin corrected calcium as prognostic severity factors in acute pancreatitis. Methods: This prospective study was conducted in a tertiary hospital from September 2023 to February 2024. 30 patients were enrolled for the study. All patients who were diagnosed as acute pancreatitis by clinical examination, laboratory, radiological and biochemical investigations were considered as subjects. Serum calcium & Albumin Corrected Calcium (ACC) were measured within 24 hrs of admission. Significance of Serum Calcium and Albumin Corrected Calcium in predicting outcome of acute pancreatitis was assessed and compared with BISAP score. Results: Our study showed decreasing TC and ACC for increasing severity of the disease. Although this study failed to differentiate between moderate and mild AP, in our study cutoff of <7 mg/dL for TC predicted the occurrence of severe AP with Sensitivity of 100% and Specificity of 89%. Similarly, ACC of <7.5 mg/dL was computed for severity of AP we found Sensitivity of 100% and Specificity of 89%. Conclusion: Total Serum Calcium and Albumin Corrected Calcium (ACC) can predict severity of acute pancreatitis, as with BISAP score but it is not superior to BISAP score.

DOI: 10.5281/zenodo.10936175

Purpose: Primary acquired Nasolacrimal duct obstruction is a common pathology in adults, the primary treatment being Dacrocystorhinostomy. The aim of this study is to evaluate the outcome and tolerability of Endoscopic endonasal DCR done under local anaesthesia. Method: From June 2022 to January 2024, a total of 29 patients diagnosed with primary acquired NLD block underwent Endoscopic endonasal dacryocystorhinostomy under local anaesthesia. Anaesthetic was administered to nasal mucosal flap and lacrimal crest in addition to Sphenopalatine block to achieve local anaesthesia. NSAIDS were administered for pain relief post operatively. Intraoperative pain was evaluated based on visual analogue score. Results: The mean intraoperative pain score was 0.79 and postoperative score was 0.96 for 29 patients. Conclusion: Local anaesthesia with sphenopalatine block is an effective method to control intraoperative bleeding as well as intra op and post op pain in endo dcr.

DOI: 10.5281/zenodo.10936175

Introduction: Neuromuscular blocking drugs help with endotracheal intubation and surgical relaxation by interrupting nerve impulse transmission at the neuromuscular junction. The triad of narcosis, analgesia, and muscle relaxation has been reinterpreted as anaesthesia. Atracurium is an intermediate acting NDMR which is often used in renal and hepatic failure. Cisatracurium is 3 to 4 times more potent than Atracurium and may not produce the same excellent intubating results as equipotent dosages of Atracurium. Materials And Methods: This prospective, randomized, double blinded study was conducted between December 2019 to June 2021 on 60 patients of ASA PS I and II undergoing elective surgery under General anaesthesia. Patients fulfilling the inclusion criteria were randomly were randomly divided into 2 groups of 30 in each group; Group A – Atracurium 0.5 mg/kg and Group C – Cisatracurium 0.15 mg/kg .The drug was administered by an anaesthesiologist unrelated to the study by closed envelope method. The mean onset and duration of action of neuromuscular blockade was calculated for both the groups. Results: The Statistical analysis showed that the mean onset of blockade was found to be significantly longer in Atracurium group (3.32± 0.35 min) compared to Cisatracurium group (3.03±0.36 min).Duration of action was significantly longer in group C (40.60 ± 4.70 minutes) when compared to group A (32.50 ±4.17 minutes). Conclusion: Based on the present clinical comparative study, 0.15mg/kg (3× ED95) of Cisatracurium provides more effective neuromuscular blocking than 0.5mg/kg (2× ED95) of Atracurium in terms of time of onset and duration of neuromuscular blockade.

DOI: 10.5281/zenodo.10936175

Background: Stress is a personal intuitive episode occurring in persons, creating an obstacle in their path of reaching the goals in life. It generates negative consequences among the groups of persons. Medical curriculum is vast, ever changing and generates stress among the medical students. Doctors being very essential in a social fabric, they should be allowed to learn and educate themselves in a stress free environment. In the present study an attempt was made to assess the perception of stress, its various sources, and the strategies used by the medical students to cope up with stress. Aim of the study: The study was aimed at listing the sources of stress, its coping strategies and calculating the extent of psychological stress in medical students, Interns, and Postgraduates; to evaluate the influence of different variables on overall stress and the effect of various stress relievers among them. Material and Method: A survey was conducted using a proforma of questionnaire sent through Google survey form to collect the data. The survey was sent to 800 medical students of a private medical college attached with a tertiary care Hospital. There were 670 replies for the questionnaire out of which 261 were male and 409 were female students. The questionnaire was prepared with 22 main stress factors which were grouped under three broad categories such as Personal factors, curriculum Factors and clinical Factors. The stress score was marked on a three-point scale and termed; Mild stress-0, Moderate stress- 1, and severe stress-2. Results: The result showed that most of them were normal or mild stressed, with females being more stressed than males, though the difference between the two genders was statistically non-significant for most of the perceived sources of stress except for homesickness. In overall stress scores for different variables, the difference was statistically non-significant in all of them. Among the stress busters use of emotional support (69%), Talking to friends (64%), and Active coping (50%), were significantly associated with some of the student characteristics. Conclusion: The stress levels in the curriculum exist and the students should adopt proper stress busters to relieve the stress to work efficiently during their course.

DOI: 10.5281/zenodo.10936175

Background: Diseases of the urinary bladder lesions can be neoplastic and non-neoplastic. Urothelial carcinoma is the commonest type accounting for 90% of all primary tumors of the bladder. Other epithelial bladder tumors include squamous cell carcinomas, mixed urothelial carcinoma with areas of squamous differentiation, adenocarcinomas and small cell carcinomas. Based on this aim of our study is to describe the histomorphological  spectrum of urinary bladder lesions in TURBT and cystoscopic biopsy specimens and also to study the correlation of smoking habit with malignancies of the Urinary bladder. Methodology: This is a retrospective and prospective observational study of histomorphological spectrum of urinary bladder lesions undertaken in the department of pathology of a tertiary care teaching hospital over a period of 3 years, a total of 83 biopsies was done. A detailed clinical history was taken from the patient where special emphasis is laid on the smoking history. Patients of all ages with urinary bladder lesions attending department of urology who has undergone or undergoing TURBT/cystoscopic biopsy were included in the study, while Autolysed specimens and inadequate specimens were excluded. Results: Among the study group coming to symptoms. 59 patients were presenting with haematuria, 65 patients had dysuria and 59 patients had abdominal pain. Out of 7 patients with benign lesions, none of them had history of smoking, whereas out of 76 patients with malignant lesions, 51 patients had history of smoking and 25 patients are non-smokers. 100% of the smokers were malignant, whereas 78.1% of the non-smokers were malignant. The difference in the malignancy rate between smokers and non-smokers were statistically significant with the p-value of 0.001.In this study, among 83 patients, histopathology examination of biopsies from 76 patients (92%)were reported as having malignant lesions and 7(8%) of them were reported as having benign lesions. Conclusion: In our study most common bladder lesion was urothelial carcinoma. Out of total urothelial carcinoma cases, most common carcinoma was of high-grade papillary urothelial carcinoma presented with lamina propria and muscularis propria invasion. Pathological grade and muscle invasion are the most valuable prognostic predictors of survival. Hence, screening of all smokers above 40 years of age for bladder cancer has to be made mandatory. Increased awareness of smoking and its ill effects have to be promoted among the public.

DOI: 10.5281/zenodo.10936175

Background: Tethered cord syndrome is a pathological anchoring of the distal spinal cord, which manifests as a neurological deficit. This results in pulling with movement and progressive damage to the spinal cord. Early diagnosis and proper surgical treatment are the keys to success in patients with tethered cord syndrome. Neural tube defect prevalence worldwide is 18.6/10,000 live births and is associated with substantial morbidity and mortality. In India prevalence is as high as 7.48/1000 live births. The present study focuses on reviewing the available literature and compares the data for assessing the profile of patients in our institute and study the outcome of the surgery. Aim is to Study the occurrence, age, and sex distribution of tethered cord associated with myelomeningocele in our patient population, to analyze the symptoms and signs of tethered cord syndrome associated with meningomyelocele, and to study the postoperative results and follow up. Methodology: This is a prospective study of all cases operated for myelomeningocele with a tethered cord in the Neurosurgery department in Government General Hospital, G.M.C. Guntur from the period of October- 2021 to December 2023. Conclusions: The incidence of hydrocephalus is lower compared to western literature. Patients having associated hydrocephalus who do not present with raised ICP can be managed without shunt in 17% of patients. 75% of patients require VP shunt prior to definitive surgery to reduce the major risk of wound dehiscence. 8% of the patients require shunt after MMC repair. Clinical improvement in terms of motor power can be expected in 20% of patients and for bladder incontinence in 12.5%. Most of the patients with myelomeningocele belong to Category 2A of Yamada classification and aim of surgery is to reduce mortality and morbidity, and even though most of them may not improve in their deficits, it is important to stabilize the deficits and not allow the progression of deficits due to tethering of the cord. Much of the burden of neural tube defects is preventable before conception, and folic acid intervention programs should be implemented to increase the awareness and consumption of preconception folic acid to control the Neural tube defect associated mortality.

DOI: 10.5281/zenodo.10936175

In 2020, 2.3 million women were diagnosed with breast cancer and 685 000 deaths occurred globally. There were 7.8 million women alive who were diagnosed with breast cancer in the last 5 years, making it the world’s most prevalent cancer. Breast cancer occurs in every country of the world in women at any age after puberty but with increasing rates in later life. Recently, the International Academy of Cytology (IAC) has proposed a new reporting system for breast fine needle aspiration (FNA) cytology. Objectives: We aimed to categorize our breast FNA samples according to IAC system and assess the risk of malignancy (ROM) as well as the diagnostic yield of breast FNAC. Materials and Methods: This is a Retrospective study carried out in the Department of Pathology, Vinayaka Missions Kirupananda Variyar Medical College & Hospitals, Salem, Tamil Nadu. All Patients with palpable breast lesions who underwent FNAC and excision during the 2 years (June 2019 to June 2021) were included in the study. Results: A total of 936 FNAC of breast samples were received. Patient’s age group varied from 14 to 82 yrs. But only 676 cases had histopathology correlation. Out of which, 6 were males and 670 were females. These 676 samples were categorized by the new IAC system. The Risk of malignancy for each category was 0% for category 1 (insufficient), 0% for category 2 (benign), 5% for category 3 (atypical), 85% for category 4 (suspicious for malignancy) and 99% for category 5 (Malignant). Conclusion: Structured reporting helps in improving the quality, clarity and reproducibility of reports across departments, cities, countries and internationally. Linking cytology reporting to management algorithms will enhance the clinician’s use of FNAB cytology and where appropriate core biopsy is needed.

DOI: 10.5281/zenodo.10936175

Introduction: Pulmonary tuberculosis (PTB) is a growing worldwide health issue that still leads to substantial illness and death. The effects of PTB have been assessed in relation to both morbidity and death, with little emphasis placed on the persistent respiratory impairment experienced by individuals who have been successfully treated. Pulmonary hypertension (PHT) is a severe respiratory impairment caused by structural lung damage and persistent hypoxia. Nevertheless, the extent of TB-associated PH has not been measured before and must be assessed to understand the impact of this illness. Therefore, the purpose of this research was to evaluate the occurrence and potential causes of pulmonary artery hypertension and corpulmonale in individuals with post TB pulmonary sequelae. Material and Methods: A total of 122 individuals, aged 21 years and above, with a medical history of pulmonary TB, were selected from those who visited the Outpatient Department (OPD) and were admitted to the Department of Pulmonology. A comprehensive assessment was performed, which included detailed demographic information and clinical characteristics such as drug sensitivity, smoking history, history of TB, extent and type of complications, areas affected and side in chest X-Ray, Transthoracic echocardiography, and spirometry pattern. Results: The overall prevalence of pulmonary hypertension was 60.66% and occurrence of corpulmonale was 60% among pulmonary hypertension. The statistical analysis revealed a significant association between BMI, smoking status, diabetes mellitus, medication sensitivity, and spirometry data (p<0.05). Fibrosis was the most prevalent kind of pulmonary TB sequelae in 55.73% of patients, followed by bronchiectasis (18.85%), cavity (9.83%), bullae (6.55%), aspergilloma (4.91%), and pleural thickening and calcification (4.09%). Conclusion: Preventing pulmonary hypertension, corpulmonale, morbidity, and mortality from TB requires early diagnosis, appropriate treatment, and adherence. Strong national policies and dedicated health workers reduce TB post-treatment burden.

DOI: 10.5281/zenodo.10936175

Background: Meconium aspiration syndrome (MAS) remains one of the most common causes of neonatal respiratory distress. Methods: This hospital based study was conducted for a period of one year at tertiary care teaching hospital of Jaipur, Rajasthan in which consecutive cases of meconium stained amniotic fluid (MSAF) during the study period were included. Antenatal and natal history was taken for etiology, type of delivery and indications for any intervention. Postnatal history was obtained regarding Apgar score, birth asphyxia, or any other complication. Respiratory complications, morbidity and mortality associated with MSAF were noted. Results: Out of 3720 deliveries during the study period, 315 (8.46%) babies had meconium stained liquor and out of 315 MSAF babies, 26 (8.25%) had MAS. Maximum number of cases of MSAF were seen in babies with birth weight between 2.5-2.9kgs (n=146, 46.3%). Majority of the cases of MSAF 242 (76.82%) occurred in term babies with mean gestational age of 38-40 weeks. In present study maternal anemia was found to be the most common (n=127, 40.31%) possible factor associated with MSAF. In babies with MAS, the most common complication was birth asphyxia in (50%, n=13) of cases. In present study, out of 26 MAS cases, pulmonary hemorrhage was found to be the cause of death in one (3.84%) case. Conclusion: This study concluded that Meconium aspiration syndrome (MAS) is one of the common causes of respiratory distress in the newborn. MSAF is associated with increase in the gestational age, birth weight>2.5kgs, normal vaginal delivery, maternal anemia and birth asphyxia.

DOI: 10.5281/zenodo.10936175

Background: Oral hygiene is crucial for overall health, particularly in children, as it influences their development, nutrition, and social interactions. Despite its importance, pediatric oral hygiene often lacks adequate attention, especially in socioeconomically disadvantaged areas. Objective: This study aims to understand and enhance oral hygiene practices among children aged 3 to 12 years, focusing on assessing current practices, identifying barriers, and proposing actionable strategies for improvement. Methods: A mixed-methods study was conducted over six months at the Chhattisgarh Dental College and Research Institute, involving 200 children. Data were collected through structured surveys, direct observations of oral hygiene practices, and semi-structured interviews with parents or caregivers. The study employed statistical analysis to quantify oral hygiene behaviors and thematic analysis to explore underlying themes in parental attitudes and practices. Results: The study revealed that 85% of children brush their teeth twice daily, and 95% use fluoride toothpaste. However, discrepancies in the application of fluoride toothpaste and a decline in parental supervision with age were noted. Significant challenges included socioeconomic disparities affecting dental visit frequency and access to care, with only 60% of children having visited a dentist in the past six months. Additionally, 65% of children exhibited resistance to oral care routines. Conclusion: The findings highlight the need for targeted educational interventions that address gaps in knowledge and practice across different demographic groups. Enhanced community-based programs and inclusive health policies are recommended to improve access to dental care and promote equitable oral health outcomes among children. The study underscores the importance of a comprehensive approach involving education, policy advocacy, and community engagement to ensure optimal oral hygiene for children.

DOI: 10.5281/zenodo.10936175

Objectives: To compare the analgesic efficacy of buprenorphine transdermal patches of strength 5mg and 10mg in grade I and II osteoarthritis knee patients with respect to improvement in pain score and physical function while taking into account of its adverse effects and effects on hemodynamic parameters. Methods: Hundred patients of age of 40-65 years, of either sex, American Society of Anaesthesiology (ASA) physical status I and II were randomly allocated into two equal groups and received 5mg and 10mg patches on day 1, day 7 and day 14. Primary endpoints were Numeric Rating Scale for pain score and Western Ontario and McMaster Universities Arthritis Index (WOMAC) for improvement in quality of lifestyle. Secondary outcomes included hemodynamic variables, requirement of rescue analgesia and adverse effects. Results: The mean NRS and WOMAC scores were reduced more in group B than in group A on day 7 and day 14 across different time points [NRS: F value-413.72, WOMAC: F value-395.02] and types of treatment received combined [NRS: F value-306.72, WOMAC: F value-350.48] with p values<0.05 in both the cases. Subjects in group A needed to take more rescue analgesia. Other variables were comparable in the two groups. Discussion: Thus transdermal buprenorphine patch can be used as an alternative route providing constant level of analgesia with minimum adverse effects, the patch of 10mg strength showing higher analgesic efficacy and improved life-style in grade I and II osteoarthritis knee patients with comparable hemodynamic parameters and adverse effects to that of 5mg strength.

DOI: 10.5281/zenodo.10936175

Aim: A prospective comparative clinical double blinded study was carried out to compare the efficacy of I.V. Labetalol or I.V. Dexmedetomidine for attenuation of sympathomimetic response to laryngoscopy and intubation in head patients posted for surgery. Background: Laryngoscopy and intubation is associated with sympathetic stimulation, increase in pulse rate and blood pressure. There are different method have been tried to attenuate the pressure response. The study was conducted to compare the efficacy of Dexmedetomidine and Labetalol for attenuation of hemodynamic response to Laryngoscopy and intubation in head injury patients. Method: 64 head injury patients of age 18-60 year, the American society of Anesthesiology I to III, randomized into two group, 32 each, to receive Labetalol (Group L): 0.25 mg/ kg and Dexmedetomidine (Group D): 1mcg/kg, both diluted to a total volume to 100 ml with 0.9% normal saline, infused over a period of 10 minute, 10 minute prior to intubation, change in heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure(DBP), were compared among group at preinduction, post induction, post intubation 1,3,5,10 minute. Result: statistically significant decrease in HR, SBP, DBP were observed in group D after Laryngoscopy and intubation when compared to group L, Also the relative incidence of bradycardia and hypotension was higher in group L. Conclusion: Infusion of Dexmedetomidine was better as compared to Labetalol in attenuation of hemodynamic response to laryngoscopy and intubation in head injury patients.

DOI: 10.5281/zenodo.10936175

Background: For differentiating an asphyxiated from a non-asphyxiated neonate with reasonable degree of precision, estimation of serum levels of CK-MB and LDH can play a crucial role. Methods: This hospital based study was conducted for a period of one year at tertiary care teaching hospital of Jaipur, Rajasthan in asphyxiated (Cases) and non-asphyxiated (Controls) term neonates. Creatine Kinase Muscle-Brain fraction (CK-MB) levels at 8 hours and 24 hours and Lactate Dehydrogenase (LDH) levels were measured. Sensitivity, specificity and positive predictive value and negative predictive value of the test were performed. ROC Curve analysis has been performed to find the diagnostic performance of CK-MB and LDH. Results: Statistically significant difference was found with elevated CK-MB levels at 8 hours and at 24 hours respectively among cases as compared to control (p<0.05). The number of neonates with LDH > 580 U/L (cut off value) was significantly more in cases when compared to controls (p<0.05). The correlation of Low Apgar score at 1 minute and 5 minute, CK-Mb at 8 hours, 24 hours and LDH with stages of Hypoxic ischemic encephalopathy (HIE) was found to be statistically significant (p<0.05). Conclusion: This study concluded that all these markers can be very advantageous in differentiating neonates with asphyxia and without asphyxia which will further help in appropriate management and better outcome of these newborns.

DOI: 10.5281/zenodo.10936175

Introduction: Transvaginal sonography (TVS) & transabdominal sonography (TAS) both are used to identify the different uterine structural abnormalities & various causes of bleeding during the first trimester. The causes of bleeding in early pregnancy are broadly divided into two groups as follows: i ) those related to the pregnant state: abortion, ectopic pregnancy, hydatidiform mole, implantation bleeding. ii ) those associated with the pregnant state: uterine anomalies, cervical lesions such as vascular erosion, polyp, etc. TAS is usually the first investigation performed for assessment of the causes of first trimester bleeding. This delay is crucial in emergency situations. Hence, if it is proved that TVS is distinctively superior to TAS is assessment of first trimester bleeding. Objectives: Estimation of proportion of the different causes of bleeding in early pregnancy diagnosed by TAS & TVS in patients attending a tertiary care teaching hospital. Material and Methods: The study was conducted in the department of Radio-Diagnosis, Agartala Government Medical College & G.B. Pant Hospital, duration was 2 years and the sample size was taken as 100. A detailed clinical examination was performed to arrive at a provisional clinical diagnosis. After that patients were subjected to ultrasound examinations. All patients subjected to transabdominal sonography were further subjected to transvaginal sonography. Data was collected in a preformed proforma. Clinical and ultrasound findings were correlated. Results And Observations: Majority of the patients studied (35%) belonged to the age group of 20-24 years followed by 25-29 years (33%), 30 years and above (19%), and less than 20 years (14%). Duration of amenorrhoea was between 2.0 to 3.9 months for 98 per cent of the patients. Half of the patients (50%) were primi gravidae while the rest were multi gravidae. Among 100 cases of bleeding in first trimester were evaluated to understand the importance of sonographic evaluation over clinical examination with special emphasis on TVS. By mere clinical diagnosis, it was not possible to diagnose many of the cases correctly, with 65% misdiagnosed cases. Different types of abortion were identified as the major cause of bleeding in the first trimester. Out of the 44 clinically diagnosed cases of threatened abortion, 27 were falsely diagnosed, giving a fallacy rate of 61.36% whereas, TVS was 100% accurate in diagnosis. In case of incomplete abortion, clinical diagnosis was found to have 77.77% fallacy rate while TVS had a 100% accuracy rate. Out of the 13 cases clinically diagnosed as missed abortion, 9 were incorrectly diagnosed, giving a fallacy rate of 69.23%. TVS again had a 100% accuracy rate in diagnosis. Clinical examination identified 11 cases of suspected ectopic pregnancy of which, 6 were incorrectly diagnosed giving a fallacy rate of 54.54%. TVS was used to correctly diagnose all the cases with 100% accuracy. Out of the nine cases clinically diagnosed as RPOC, 6 were false diagnosis giving a fallacy rate of 66.66%. As in previous cases, TVS was 100% accurate in successfully diagnosing the causes of bleeding. Tubo-ovular mass was diagnosed clinically in 3 cases which were all misdiagnosed giving a fallacy rate of 100%. One case each of ruptured ectopic pregnancy and tubal pregnancy were diagnosed clinically which were found to be accurate in follow-up with TVS and final diagnosis, thus making a fallacy rate of 0.00%. For identification of molar pregnancy, clinical examination was unable to correctly diagnose the five cases which were identified as threatened abortion (3) and incomplete abortion (2), but later on follow up by TVS were confirmed as molar pregnancy, thus giving clinical diagnosis a 100% fallacy rate in diagnosis of structural abnormalities.

DOI: 10.5281/zenodo.10936175

Background:   Internet is an essential tool in day to day life whose impact is high on college students such as increased use of Internet. It is associated with changes in mood, inability to control amount of time spent, withdrawal symptoms, decreased social life, self-esteem and adverse work and academic consequences. Objective: The objective of the study is to explore the internet use and pattern of usage among professional students. Methodology: Total of 500 professional students was selected from different colleges through random sampling. Young’s internet addiction scale was used to assess the prevalence of internet addiction. Results: Prevalence of internet addiction is high among professional students, more in engineering students. Conclusion:  Current study documents a high prevalence of internet addiction among professional students.

DOI: 10.5281/zenodo.10936175

Objectives: Priming principle or auto-co-induction refers to administration of a small calculated dose of a drug before giving the total dose. The main objective of our study was to compare dose reduction of Propofol and hemodynamic changes during the peri intubation period among the patients who were given propofol auto-co-induction and midazolam propofol co-induction, while applying priming principle. Methodology: A total of 90 patients with the American Society of Anesthesiologists (ASA) physical status class I/II who were scheduled to undergo elective surgeries under general anesthesia were randomly divided into three groups of 30. Group P received Propofol (0.5 mg/kg), Group M received Midazolam (0.05 mg/kg) and Group N received Normal Saline (3cc). It was succeeded by intravenous induction with Propofol in all patients of three groups. We compared the total dose of Propofol in all three groups required to achieve the BIS value of 45. Heart rate (HR), Systolic blood pressure (SBP), Diastolic blood pressure (DBP), Oxygen saturation and any associated complication was recorded. Results: The induction dose requirement of Propofol in Group P (Propofol auto co induction) and Group M (Midazolam co induction) were found to be significantly (p<0.01) lesser than Group N (Controls). Among the groups with priming dosage use, the mean induction dose was found to be lesser in Group M (115.67 mg ± 11.50) than Group P (125.50 mg ± 10.03). The hemodynamic parameters like SBP, DBP and heart rate were found to be significantly more variable in Group M than other two groups (p<0.01). No consequences or complications of drug administration such as nausea, vomiting or hypotension etc. were reported in any of the patients. Conclusion: Priming with Propofol and Midazolam co-induction was effective in reducing the total induction dose of Propofol. Dose reduction of Propofol was significantly higher in Midazolam primed group as compared to Propofol primed group. However, Propofol auto-co-induction group had reported better hemodynamic stability in peri intubation period.

DOI: 10.5281/zenodo.10936175

Introduction: The management of complex obstetric presentations often requires diverse interventions to ensure favorable outcomes. Internal podalic version (IPV) is a valuable technique in obstetrics, aiding in cases of malpresentation and other complications hindering vaginal delivery. Despite its long history, IPV remains relevant in modern obstetric practice. Cases: We present three cases illustrating the utility of IPV in diverse obstetric scenarios. These include preterm labor with DCDA twins and breech presentation, transverse lie of the second twin in a DCDA pregnancy, and transverse lie with intrauterine fetal demise and cord prolapse. Successful outcomes, as well as challenges, are discussed in each case. Discussion: IPV offers a rapid solution in critical obstetric situations, minimizing the need for cesarean sections and reducing adverse outcomes. However, risks such as uterine rupture and fetal injury must be carefully considered. Factors influencing IPV’s feasibility include gestational age, fetal presentation, and maternal health status. Conclusion: IPV remains a valuable adjunct in obstetric management, facilitating vaginal delivery and reducing cesarean section rates. Despite risks, judicious application, ongoing research, and collaborative efforts can optimize IPV’s role in improving maternal and neonatal outcomes.

DOI: 10.5281/zenodo.10936175

Introduction: Depression, anxiety, and stress are becoming increasingly prevalent in today’s society, affecting people of all ages and from all walks of life. However, the impact of these mental health issues is particularly pronounced among medical students, who face a unique set of challenges in their education and training. Objectives: To find prevalence of depression, anxiety and stress, to find effects of competitive exams on medical student and intern doctors. Method: A cross sectional study was conducted among Medical students and Intern Doctors of institute Results: Among the total of 200 participants the prevalence of depression is 66.6%, anxiety 76% and stress 54%. sleep deprivation was seen in 22.5% of the medical graduates and 14.5% consulted specialist to relieve their exam stress and 24% of them feel that substance abuse can help in relieving stress and anxiety. Conclusion: A significant percentage of medical students suffer from depression, anxiety, and psychological distress. Efforts should be made to assist medical students in distress, in a non-intrusive manner. There is a need to raise awareness of manifestations of distress among medical students, not only among the students themselves, but also of other stakeholders, such as medical educators and parents.

DOI: 10.5281/zenodo.10936175

Introduction: Multiligament knee injuries are rare making up to less than 0.02% of all orthopedic injuries. These injuries cause significant functional impairment and have much higher rate of complications and poorer outcomes than an isolated cruciate or collateral ligament injury. Aim and Objective: this study focuses on postoperative functional results and complications in multiligamentous knee injuries following arthroscopic and open reconstruction using autografts. Methodology: This was a “prospective outcome study and included patients having Injury to >1 major knee ligament in 18 to 50 years age group. Patients were classified according to Schenck’s knee dislocation criteria. After surgery outcome was evaluated by Lysholm Knee Score, IKDC score and Tegner activity level scale. Results: Patients were followed to assess functional outcome at 3 months, 6 months, 1 year and 1½ years interval. Lysholm Knee Score, IKDC score and Tegner activity level scale were used. All results were statistically significant with significant p value at 3,6,12, month follow up. Conclusion: High speed vehicular accidents are mostly responsible for multiligamentous knee injuries commonly observed in young aged individuals. Reconstruction gives excellent outcome if combined with proper physiotherapy. Knee pain and stiffness are the common complications. Long term functional outcome and complications like arthritis needs to be evaluated in future.

DOI: 10.5281/zenodo.10936175

Background: Melasma is characterized by hyperpigmented macules commonly affecting the malar region, forehead and temple region of face. It is a common disorder of hyperpigmentation with prevalence ranging from 1.5 % to 33.3%. Various treatment options have been evaluated in treatment of melasma, but none have been effective universally. Aim: To compare the safety and efficacy of 35% Glycolic acid chemical peel versus combination of topical agents containing liposomal 4-n-butylresorcinol, kojic acid and arbutin in the management of melasma. Method: An analytical interventional study was conducted at Anugraha Narayan Magadha medical college and hospital, Gaya, Bihar. Melasma cases were diagnosed clinically and classified with the help of woods lamp examination. Patients were randomly divided into two groups. The response was assessed and collected data were analyzed and Probability (p) value is calculated at baseline and 12 weeks. Result: In 35% Glycolic acid chemical peel group average baseline M. MASI was 3.6 which got to 2.5 with a statistically significant P value of 0.004. In group receiving combination of 4nbutylresorcinol, kojic acid and arbutin the M. MASI was 4.1 which got improved to 3.3 with a statistically significant P value of 0.043. No adverse effects were observed in any group. Limitation: The main limitations of the study were the small sample size and the lack of long term follow up to assess recurrence. Conclusion: Both 35% Glycolic acid chemical peel and combination of 4nbutylresorcinol, kojic acid and arbutin are safe and effective method to treat melasma. Comparison between two groups was statistically insignificant with a P value of 0.441.

DOI: 10.5281/zenodo.10936175

Introduction: Blood group discrepancies in blood donors can jeopardize transfusion safety, resulting in incompatible blood transfusions. These ABO blood group discrepancies arise when cell grouping and serum grouping does not match in blood donors. Technical errors, rare blood group variants and underlying medical conditions affecting red blood cell antigens contribute to these discrepancies. Swift resolution of these issues is vital for ensuring safe blood product transfusions. Our study aims to investigate the prevalence, causes, and resolution of blood group discrepancies among healthy blood donors, enhancing transfusion safety and patient care. Material and Methods: From January to June 2022, a retrospective study in Gujarat, India, analyzed blood group discrepancies in healthy donors. Demographic data were collected, and advanced techniques like Biorad forward and reverse grouping and Gel Cards were used for ABO typing. Discrepancies underwent thorough investigation, including repeat testing and supplementary assays. Biological discrepancies were further explored, and statistical analysis was conducted using SPSS 21 software for comprehensive evaluation. Results: In our study of 6,067 donors, ABO blood group distribution revealed A (23.26%), B (35.91%), O (32.19%), and AB (8.64%), B blood group as the most prevalent types. Following review, 17 (0.28%) discrepancies were identified. In our study, discrepancies fell into four types: weak or missing antibodies (Type I, 52.94%), missing antigen (Type II, 5.88%), and miscellaneous antibodies (Type IV, 41.18%). Notably, we encountered no instances of Type III discrepancies. Within Type I discrepancies, we observed 7 weak anti-B and 2 weak anti-A antibodies, while Type II discrepancies were associated with the A3 antigen. Type IV discrepancies included 3 anti-M, 2 anti-Le^b, and 2 unidentified antibodies. Conclusion: In conclusion, discrepancies in ABO blood typing present notable challenges for accurate blood compatibility assessments. Understanding the nuances of ABO discrepancies is vital for implementing effective quality improvement initiatives in blood banking practices.

DOI: 10.5281/zenodo.10936175

Nuclear  morphometric  analysis  of  exfoliated  cells  and its utility in diagnosing cervical lesions – our experience in a tertiary care center. Background: Cervical cancer is the fourth most common cancer affecting women worldwide . A pap test is an important screening procedure for cervical cancer and accuracy  depends on morphological features  of dysplastic or malignant cells.  Morphometric analysis of nuclear parameters like area, perimeter, maximum diameter and nuclear compactness are important to determine dysplastic cells which increase the sensitivity of pap smear results.  Our present study aim to evaluate the nuclear morphometry in LSIL, HSIL and squamous cell carcinoma in pap smear. Materials and Methods: 80 cases were selected which were diagnosed as LSIL, HSIL, squamous cell carcinoma  and normal pap smears  as control. Representative  areas of the smear were selected and digital images were produced by  camera on the microscope using 40X objective and  were analyzed through software ProgRes Capture Pro2.8.8.  Measurements of nuclear parameters like nuclear area, perimeter, maximum diameter  and compactness (perimeter²/area) were made on the cell images. Results: The nuclear parameters of neoplastic cells were more than those of normal cells.  Nuclear area, perimeter, diameter were found to be statistically significant (p<0.05) parameters in differentiating premalignant from malignant cervical smears. Conclusion: Nuclear morphometry can be used as a diagnostic tool and will increase sensitivity in differentiating between pre-malignant and malignant lesions of cervix.

DOI: 10.5281/zenodo.10936175

Aims and Objective: The objective of the study is to define the accuracy of CT urography over ultrasonography and its role in further patient management. Materials and Methods: A prospective study of 100 patients with urinary symptoms was conducted in a period of 2 years. Result: In a study of 100 patients, 64% of the patients presented with back pressure changes due to calculus in 42 cases (65.6%), PUJ obstruction in 6(9.3%), stricture in 5(7.8%) and malignant infiltration in 5(7.8%) were seen. There were 14 cases of neoplasms in our study, 7 cases of kidney & urinary bladder each and 9 cases of upper urinary tract infections which included 8 cases of pyelonephritis & 1 case of ureteritis. There were 6 cases of congenital anomalies: 2 cases had congenital pelvi-ureteric junction obstruction, one had medullary sponge kidney with Caroli’s disease, two had ectopic kidney, one had retrocaval ureter & one had pyelogenic cyst. A separate category consisting of 6 cases of non-neoplastic urinary bladder pathologies, which included 3 cases of blood clots in urinary bladder and 1 case each of vesical calculus, diverticulum and radiation cystitis. Conclusion: CT IVU proved to be more sensitive modality for diagnosis and follow-up of renal tract infection, screening for obstruction/ calculi, grading backpressure changes if any and to detect underlying anomalies. It defines the extent of disease and identifies significant complications and obstruction.

DOI: 10.5281/zenodo.10936175

Introduction: Clavicle is one of the most commonly fractured bone after a road traffic accident with the middle one third being the most frequently fractured part. While traditionally, clavicle fractures have been managed conservatively, the problems with non-union and malunion has led to an increase in operative interventions. This study aims at evaluating the functional outcome of clavicular fractures managed by plate osteosynthesis. Material & Method: This was a prospective interventional study conducted in Post–Graduate Department of Orthopaedics, GMC Jammu. All the patients with clavicle fractures who attended OPD as well as emergency wing of GMC Jammu Hospital and confirming to inclusion criteria were enrolled in the study. Data was recorded in case record form. The patients were followed for 1 year to record the final functional outcome as per constant & murley score. Results: Out of 22 patients, 81.8% of the patients were male, most (63%) suffered a fracture of left clavicle and 72.7% of the patients had suffered an RTA. The mean time to union was found to be 12.1 weeks. Mean Constant & Murley score at 3 months post-op was 84.09. Conclusion: In our study, the majority of clavicle fractures occurred in young adult males, with RTA being the predominant mechanism of injury. We found that patients with displaced clavicle fractures treated with plate fixation had good functional outcome scores at sequential follow-ups.

DOI: 10.5281/zenodo.10936175

Background: Cholelithiasis, a chronic recurrent condition affecting the hepatobiliary system, is marked by the formation of gallstones due to impaired metabolism of cholesterol, bile acids, and bilirubin. Cholelithiasis prevalence is escalating in regions like India due to shifts in dietary patterns, necessitating surgical interventions in many cases. This study aimed to assess the prevalence, causes, and surgical management of cholelithiasis cases at our tertiary care center in southern India. Methods: Forty consecutive cholelithiasis cases were enrolled based on predetermined criteria. Detailed patient histories were recorded, encompassing socioeconomic status, symptom nature and duration, past medical history, dietary habits, oral contraceptive pill (OCP) use, and alcohol consumption. Comprehensive clinical examinations were conducted. Diagnostic investigations included complete blood count, electrocardiogram (ECG), liver function tests (LFT), blood glucose, blood urea, serum creatinine, urine analysis, chest X-ray, and abdominal ultrasound. Results: Out of n=40 cases n=18 were males and n=22 were females. Pain in the right upper abdomen (right hypochondrium) is the most frequent symptom, reported by 97.5% of patients. Other Common Symptoms: Tenderness (95.0%) and nausea/vomiting (60.0%) are also reported by a significant proportion of patients. Less Frequent Symptoms: Jaundice (15.0%), dyspepsia (25.0%), fever (7.5%), guarding (30.0%), and mass (7.5%) are reported less frequently. 27 underwent laparoscopic cholecystectomy, with 4 cases requiring conversion to open cholecystectomy due to intraoperative findings. Ultimately, 23 laparoscopic cholecystectomies were completed, comprising 9 males and 14 females. Additionally, 17 cases underwent open cholecystectomy, with 9 males and 8 females. Conclusion: Cholelithiasis incidence is rising, with a female predominance. Ultrasonography proved pivotal in diagnosis. Multiple stones and gallbladder thickening were prevalent. The laparoscopic-to-open cholecystectomy conversion rate was 12%, with minimal postoperative complications and satisfactory follow-up outcomes.

DOI: 10.5281/zenodo.10936175

Introduction: Menopause, marking the cessation of a woman’s reproductive ability, heralds a significant transition often accompanied by distressing symptoms affecting quality of life. From hot flashes to emotional upheaval, menopausal symptoms stem from hormonal changes, notably declining estrogen levels. In India, despite healthcare advancements prolonging post-menopausal life, addressing menopausal symptomatology remains crucial for holistic well-being. Material and Methods: This prospective observational study aimed to assess menopausal symptom frequency and severity in peri- and postmenopausal women using the Menopause Rating Scale (MRS). Enrolling 300 women aged 42 to 55 years, the study spanned six months and recruited participants from M P Shah Medical College & GG Government Hospital, Jamnagar. Data collection involved face-to-face interviews conducted in the local language to ensure accurate responses. The MRS, comprising subscales for psychological, somatic, and urogenital symptoms, was utilized, with scores ranging from 0 to 4. Descriptive statistics summarized participant characteristics, while inferential analyses compared MRS scores between peri- and postmenopausal groups. Results: The mean total response score of the perimenopausal group (22.05) was higher than the postmenopausal group (19.08). The mean score for somatic subscale and psychological scale was higher in perimenopausal women in comparison with postmenopausal women. The increase in psychological subscale was statistically significant (P<0.01). However, the mean score for urogenital subscale was significantly higher (P < 0.001) in postmenopausal women. Hot flashes, cardiac symptoms, and sleep disturbances are prevalent, with a significant proportion experiencing severe symptoms. Joint and muscle discomfort, depression, irritability, anxiety, sexual problems, and physical and mental exhaustion are also common, albeit with varying severity. Bladder problems and vaginal dryness, while less frequent, still impact a notable proportion, highlighting the diverse and burdensome nature of menopausal symptoms. Conclusion: During menopause, hormonal fluctuations, particularly in estrogen levels, lead to diverse symptoms. Perimenopausal women reported more severe symptoms, including fatigue, depression, anxiety, hot flashes, and sexual disturbances. Conversely, postmenopausal women showed decreased psychological symptoms but increased urogenital symptoms, fatigue, and body ache.

DOI: 10.5281/zenodo.10936175

Surgical site infection is one of the most common complications Following Cesarean section and has an incidence of 3% -15%. It places physical and emotional Burden on the mother herself and significant financial burden on the health care system. Moreover, is associated with a maternal morbidity rate of up to 3% Optimization of maternal comorbidities, appropriate antibiotic prophylaxis and evidence – based surgical newer techniques are some of the practices proven to be effective in reducing the incidence of SSI. Perioperative oxygen supplementation: Several RCTs evaluated the use of high (80%) perioperative oxygen supplementation: concentrations versus low (30%) on the incidence of SSI wound separation of the skin was significantly decreased from 7.4% to 1.6% in women whose incisions were closed with sutures compared with those closed with staples. Negative pressure wound therapy is the application of suction to healing wounds. The technique is used for the treatment of chronic wounds. Daily inspection of the cesarean incision is an essential part of the postoperative evaluation. The presence of fever, tenderness, erythema, purulent discharge, or induration should raise a suspicion of infection. Most wound infections do not become clinically apparent until postoperative days 4–7, when most women have already been discharged from the hospital. For that reason, it is essential to instruct these women on signs and symptoms requiring further evaluation since early treatment has an important role in preventing severe consequences.

DOI: 10.5281/zenodo.10936175

Introduction: Menopause represents a significant physiological event in a woman’s life, marking the cessation of reproductive capability. The transition is often accompanied by a range of physical and physiological symptoms, which can profoundly impact a woman’s quality of life (QOL). Studies suggest that more than 80% of women experience various menopause-related symptoms, influencing their overall health and well-being. Study aims to evaluate menopause-related symptoms’ prevalence and impact on quality of life among postmenopausal women, with objectives including symptom severity assessment, impact measurement, demographic factor identification, exploration of management strategies, and proposing personalized interventions for well-being. Material & Methods: A hospital-based descriptive observational study was carried out at the Outpatient and Inpatient Department of Obstetrics and Gynecology, M P Shah Medical College & GGG Hospital, Jamnagar, Gujarat with 424 postmenopausal women. The data were collected using the structured Menopause-specific QOL (MENQOL) questionnaire. Mean, SD, frequency, and proportions calculated. MENQOL scores associated with demographic variables using one-way ANOVA. Results: Out of the total 660 patients enrolled in the study, 236 did not receive follow-up. Among the remaining 424 patients who received follow-up, 100 had undergone hysterectomy, leaving 324 classified as postmenopausal, revealing no significant differences in their profiles. Mean scores of menopause-specific symptoms indicated significant impacts on well-being, with physical symptoms (59.02 ± 14.72) and psychosocial symptoms (29.20 ± 10.03) being most pronounced. Symptoms such as hot flashes, cardiac symptoms, sleep disturbances, joint and muscle discomfort, depression, irritability, anxiety, physical and mental exhaustion, sexual problems, bladder problems, and vaginal dryness were prevalent among participants. Conclusion: Our study provides important findings regarding the prevalence and impact of menopausal symptoms on the quality of life among postmenopausal women. The varying severity of symptoms, including hot flashes, cardiac symptoms, joint discomfort, and sexual problems, underscores the need for targeted interventions.

DOI: 10.5281/zenodo.10936175

Introduction: Spontaneous incomplete abortion poses a significant challenge in obstetric care, requiring prompt and efficient management to ensure optimal patient outcomes. Vaginal misoprostol and suction evacuation are prominent strategies for achieving complete uterine evacuation, each offering unique advantages and considerations. While misoprostol provides a non-invasive option, suction evacuation remains vital, especially in urgent cases or when medical treatment is unsuitable. This study aims to compare the effectiveness of these modalities, offering valuable insights for tailored interventions in managing spontaneous incomplete abortion. Material and Methods: This prospective comparative study, conducted at Shri M.P. Shah Government Medical College, Jamnagar, spanned 18 months from August 2022 to February 2024. Patients with intrauterine pregnancies of less than 12 weeks gestation, confirmed by ultrasonography or clinical assessment, and diagnosed with retained products of conception were included. A total of 240 eligible participants, 120 in each group, were recruited. Group 1 received vaginal misoprostol (800 mcg), while Group 2 underwent direct vaginal suction evacuation. Outcome measures included treatment success rates, patient satisfaction, and the presence of retained products of conception. Statistical analysis compared outcomes between groups, with significance set at p < 0.05. Results: In comparing treatment outcomes, the Suction & Evacuation group exhibited a higher success rate (100% vs. 83.33%, p=0.002) and a lower mean for retained products of conception within 7 days (6.01 ± 0.49 mm vs. 7.93 ± 0.69 mm, p=0.0071) compared to the Misoprostol group. However, there were no statistically significant differences in patient satisfaction, patient recommendation to a friend, or tolerability of the treatment method between the two groups. Comparing side effects, Misoprostol led to significantly higher incidences of fever, chills, diarrhea, vomiting, and heavy bleeding compared to Suction & Evacuation (p < 0.05). However, cramps and dizziness were more common with Misoprostol, and cervical laceration occurred only in the Suction & Evacuation group. Notably, Misoprostol was associated with significantly higher pain scores than Suction & Evacuation (p < 0.001). Conclusion: Our study highlights the effectiveness of both vaginal misoprostol and direct vaginal suction evacuation as treatment modalities for spontaneous incomplete abortion. While misoprostol presents a non-invasive option with advantages such as accessibility and avoidance of surgical procedures, suction evacuation offers rapid and definitive uterine evacuation, particularly in cases requiring immediate resolution or contraindications to medical treatment.

DOI: 10.5281/zenodo.10936175

Background and Objectives: Primary PPH is classically/quantitatively defined as bloodloss from or in genital tract exceeding 500ml within 24hrs of vaginal delivery and 1000ml during Caesarean section.  It is classically/qualitatively defined as any amount of bleeding from or into genital tract following birth of baby upto end of puerpurium which adversely effect general condition of patient evidenced by rise of pulse and falling of blood pressure. The aim of the study is to review the incidence, etiology and outcome in cases of PPH at our tertiary Centre, Patna Medical College  and Hospital, Patna. Material and Methods: It is prospective single center based study carried out in Labour room emergency (LRE)of PMCH, Patna from August 2019 to July 2021. Total 75 cases of PPH was noted in centre in which only 13 cases were booked cases and rest 62 cases reported directly in labour room or were referred from primary and community health center of adjoining area. Conclusion: Haemorrhage is the leading cause of maternal mortality and morbidity worldwide. Effective measures like provision of antenatal care to all pregnant ladies, safe hospital deliveries and timely referral of high risk pregnancies, complications are expected to reduce PPH. 5th millennium development goals aims to reduce maternal mortality by primarily reducing number of cases of PPH by avoiding risk factors, especially those related to obstetrics intervention like increased caeserean rate and induction and augmentation of labour with injudicious use of uterotonics, active management of all stages of labour, especially 3^rd stage of labour.

DOI: 10.5281/zenodo.10936175

Background: The study seek to investigate the potential relationship between Thyroid Stimulating Hormone (TSH) and Free Thyroxine (T4) levels with the presence of microalbuminuria in Euthyroid patients diagnosed with Type 2 Diabetes Mellitus (T2DM). Methods: 500 participants with T2DM who were euthyroid were enlisted. Information was gathered on medical history, thyroid function tests, microalbuminuria, and demographic traits. Measurements of height, weight, blood pressure, and an assessment of diabetic complications were all part of the clinical examination. The laboratory testing included lipid profile, HbA1c, fasting blood glucose, thyroid function tests, microalbuminuria assessment, and renal function tests. SPSS version 16.0 was used for the statistical analysis, which included logistic regression analysis and descriptive statistics. Results: Demographic analysis revealed a mean age of 56.7 ± 8.4 years, with 60% male participants. Participants with microalbuminuria displayed significantly higher TSH levels (3.5 ± 1.4 mIU/L) and lower Free T4 levels (1.0 ± 0.2 ng/dL) compared to those without microalbuminuria. Logistic regression analysis adjusted for confounding factors demonstrated independent associations between TSH and Free T4 levels with microalbuminuria. Elevated TSH levels were related with increased microalbuminuria risk (OR = 1.45, 95% CI = 1.20-1.75), while lower Free T4 levels correlated with higher microalbuminuria risk (OR = 0.62, 95% CI = 0.48-0.80). Conclusion: The study suggests a significant association between thyroid function, specifically TSH and Free T4 levels, and microalbuminuria in Euthyroid patients with T2DM. Elevated TSH levels and lower Free T4 levels were independently related with elevated microalbuminuria risk, highlighting the potential role of thyroid hormones in the pathogenesis of diabetic kidney disease. Recommendations: To clarify underlying mechanisms and investigate clinical implications, more research is necessary. Screening for thyroid dysfunction may be beneficial in the management of diabetic patients to mitigate the risk of microalbuminuria and diabetic kidney disease.

DOI: 10.5281/zenodo.10936175

Background: Hypernatremic dehydration is defined as serum sodium >145 mEq/L with signs of dehydration like fever, weight loss, lethargy, depressed anterior fontanelle, increase skin turgor, dry mucus membrane. Risk factors are found to be due to inadequate breastfeeding, insufficient milk secretion often in primi-parous mother, post LSCS, summer season. Early diagnosis and proper fluid management is cornerstone of good outcome in hypernatremic dehydration. Methods: A prospective observational study involving neonates with birth weight more than 2 kg and gestational age of > 34 weeks, on exclusive breastfeeding was conducted. Data was collected in a structured questionnaire, details of serum electrolytes, renal function test and serum bilirubin were collected. Regular weight monitoring and urine output monitoring of the babies were done. Data was entered into Microsoft Excel data sheet and was analyzed using SPSS 22 version software. Results: Hypernatremic dehydration is more common in neonates born to primi mother and following caesarean delivery. The most common presenting features were weight loss >10%, fever, decreased urinary frequency, excessive cry, poor feeding and jaundice. There was a strong association between weight loss and hypernatremia though the correlation was not statistically significant. Fever and weight loss >10% in an otherwise healthy baby should alarm for the evaluation. Lactational failure due to inadequate milk secretion, nipple problems and poor technique were the major risk factors for hyperrnatremia. We observed that the frequency was very high in summer months compared to other months. Conclusion: Monitoring the mother and baby in the first week of life for successful establishment of breastfeeding is essential with special concern on primi mothers and post LSCS. In an otherwise healthy baby, poor feeding and weight loss could be helpful to suspect hypernatremia.

DOI: 10.5281/zenodo.10936175

Introduction: Dapagliflozin is a selective sodium-glucose cotransporter type 2 inhibitor (iSGLT2) that blocks glucose resorption in the proximal tubule of the kidney, thereby increasing urinary glucose excretion and reducing blood glucose levels. It is currently indicated in the management of patients with type 2 diabetes (T2D) because of its sustained effect on the reduction of glycemia and glycated hemoglobin (HbA1c). Metformin, a biguanide, acts through AMPK-dependent and independent mechanisms, inhibiting enzymes related to gluconeogenesis and lipogenesis, while also having antineoplastic effects, delaying the aging process, and regulating gut microbiota. Besides being the most common drug for T2D treatment. Among these, Dapagliflozin and metformin is generally well tolerated and is an effective tool in helping patients with diabetes to improve glycemic control. Materials and Method: This is a non-randomized and observational study carried out at Department of Medicine, MKCG Medical College, Berhampur, and Odisha. The inclusion criteria are as follows. First, RCTs included in this study were conducted to assess the efficacy of dapagliflozin versus metformin in patients with T2DM. Second, all participants were aged ≥18 years, and diagnosed with T2DM according to the standards criteria of American Diabetes Association. Third, the patients had HbA1c 7.0% to 10.0%, FPG >126mg/dl and received metformin dosage of 1000 mg for more than 12 weeks. Fourth, the trials last for at least 12 weeks and the outcomes contained the change of HbA1c, FPG, PPBG, HOMA-IR and HOMA-β. Result: The results of our study reveal that mean age in Group A was 45.25 ± 6.30 and in Group B 45.15± 6.54 years, p-value=0.987, BMI in Group A was 31.32± 3.94 and in Group 31.39± 2.98, p- value=0.780. The mean ± SD change in HbA1c from baseline to 12 weeks was 1.95 ± 0.94% and 2.71 ± 0.54 in the dapagliflozin and Metformin groups, respectively. The mean ± SD change in Fasting plasma glucose from baseline to week 12 were 23.9 ± 3.4 and 45.0 ± 6.4 in the dapagliflozin and Metformin groups, respectively. The mean ± SD change in Fasting plasma insulin from baseline to 12 weeks was 2.08 ± 0.76 and 2.37 ± 0.44 in the dapagliflozin and Metformin groups, respectively. Conclusion: The choice between dapagliflozin and metformin often depends on individual patient factors such as comorbidities, preferences, and tolerability. Dapagliflozin may be preferred in patients with T2DM who require additional cardiovascular benefits or have contraindications to metformin, such as renal impairment. Metformin remains a cornerstone in the management of T2DM due to its established efficacy, safety, and cost-effectiveness, particularly as first-line therapy for many patients.

DOI: 10.5281/zenodo.10936175

Background and Objectives: Ocular trauma is a preventable issue of public health that is prevalent worldwide. These injuries can be sustained in various settings, including sports, homes, assaults, agriculture, and industrial and road traffic accidents. Timely detection and immediate treatment lead to improved visual results, enhancing the overall well-being of the affected person. The earliest steps and treatments can significantly influence the final visual prognosis. The objective of this study is to evaluate the variables that influence the prognosis of blunt ocular damage. Material and Methods: This study was conducted on 100 patients with blunt trauma attending the outpatient department and casualty of the upgraded Department of Ophthalmology at N.S.C.B. Medical College, Jabalpur (M.P.). The patients were from both rural and urban areas. The study took place from January 1, 2020, to August 31, 2021. This was achieved after gaining approval from the Scientific Review Committee and Institutional Ethics Committee, as well as securing written consent from the patients. Results: In our study, the highest number of instances, accounting for 59 patients (59%), exhibited symptoms of reduced vision accompanied by discomfort. This was followed by 20 patients (20%) who had reduced vision, pain, watering, photophobia, and a sense of a foreign body. The fundus disease in certain individuals resulted in significant deterioration of vision, characterized by a near-complete loss of visual acuity and only being able to see light. This deterioration was caused by damage to the posterior segment of the eye, leading to the development of macular edema and traumatic optic neuropathy. The study revealed that 46% of patients’ experienced significant visual improvement after receiving appropriate therapy, while 35% showed moderate improvement and 19% had limited improvement. Conclusion: Upon careful evaluation of the frequency, causes, nature, consequences, and ultimate visual outcome, it is imperative to treat any closed globe damage as an urgent matter in ophthalmology. Even if the injury seems insignificant at first, it must be handled with appropriate care and caution to ensure the preservation of the eye’s normal structure and function. Implementing improved road traffic regulations and providing comprehensive workplace eye safety education will effectively decrease the occurrence of ocular damage.

DOI: 10.5281/zenodo.10936175

Objective: To compare efficacy of oral azithromycin with intravenous ciprofloxacin to treat uncomplicated typhoid fever. Design: Randomized controlled trial. Setting: Pediatric ward at Belagavi institute of medical sciences, Belagavi from January 2018-May 2019. Patients: 76 patients in the age group 2-18 years with positive WIDAL test were randomly allotted into one of the two groups of intervention as per computer generated random number table. Intervention: One group (38 patients) received intravenous ciprofloxacin contained in 100 ml bottle (20 mg / kg / day in two divided doses) and another group (38 patients) received oral azithromycin (20 mg / kg / day in single dose). Patients monitored every 6^th hourly for defervescence of fever and other symptoms. Main Outcome Measures: Response to treatment (symptom control) with intravenous ciprofloxacin versus oral azithromycin. “Clinical cure” was considered as the resolution of symptoms by end of 5 days of treatment. “Clinical failure” was defined as persistence of 1 or more typhoid related symptoms. Results: 89.47% (34 patients) responded in azithromycin group and 86.84% (33 patients) responded in ciprofloxacin group. Clinical cure was almost equal and difference was statistically insignificant (p-1.0). Mean duration taken for defervescence of fever was 42 hour in ciprofloxacin group compared to 48 hours in azithromycin group but difference was statistically insignificant (p-0.344). Conclusion: Instead of intravenous ciprofloxacin, oral azithromycin for short duration, in single daily dose improves the patient compliance in treatment of typhoid fever.

DOI: 10.5281/zenodo.10936175

Aim: The present study aimed to determine the efficacy of Granisetron in the prevention of post-operative nausea and vomiting following day care gynecological laparoscopy. Materials & Methods: The present study was carried out at Government Lalla Ded Hospital, which is affiliated with GMC, Srinagar and involved 120 female patients aged 20-40 years with ASA-I and ASA-II who underwent elective day care gynecological laparoscopic procedures under general anesthesia. Patients with a history of motion sickness, vestibular problems, other antiemetic drugs, cardiovascular diseases, respiratory diseases, liver diseases, and renal dysfunction were excluded from the study. Result & Conclusion: A study comparing granisetron and normal saline for the prevention of PONV after day-care gynecological laparoscopy revealed that granisetron is more effective. This finding has significant practical implications such as improving patient satisfaction, reducing healthcare costs, and enhancing postoperative recovery. Clinicians can use these findings to make informed decisions regarding antiemetic prophylactic techniques in similar surgical situations. However, further research is needed to establish the optimal dosage schedules, potential side effects, and long-term consequences of granisetron use in this patient population.

DOI: 10.5281/zenodo.10936175

Background: Confirmation of correct endotracheal tube (ET) placement is essential after intubation. The present study aimed to compare upper airway ultrasonography and capnography for confirmation of endotracheal tube placement in adult patients undergoing elective surgeries. Methods: This was an observational cross-sectional study conducted in the Department of  Anesthesiology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi between November 2018, and March 2020 among adult patients (age 18-60 years) undergoing elective surgery under general anaesthesia requiring oral ET intubation with ASA physical status I and II. Results: The present study enrolled a total of 75 patients. The mean (SD) age of the study participants was 37.3 (12.4) and majority were females (58.7%). Of the 75 patients intubated, the position of ETT in trachea was ensured by capnography in 96.0% and by ultrasonography in 93.3% patients (p<0.05). The Kappa measure of agreement was 0.737 between ultrasound and capnography for ET tube in trachea at p<0.001 (r = 0.737; good correlation). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of capnography was 100%; of ultrasonography was 97.2%, 100%,100% and 60.0% respectively. The mean (SD) time taken for ultrasonography to confirm endotracheal tube placement was 14.12 seconds (0.91). On the other hand, the time taken for capnography was 18.13 seconds (0.89). Conclusion: In addition to being simple, non-invasive, portable, rapid, and repeatable, ultrasonography can detect oesophageal intubation even without ventilating the patient.

DOI: 10.5281/zenodo.10936175

Background: According to WHO, an estimated 3.8% of the population affected, including 5.0% among adults and 5.7% among adults older than 60 years. Approximately 280 million people in the world have depression. Numerous vitamin D receptors are present in the brain (neuroglia, prefrontal cortex, substantia nigra etc). Vitamin D helps in the transcriptional activation of serotonin (an important neurotransmitter influencing mood, sleep, appetite and other brain functions). Thus, low vitamin D levels can be related to depression. Methodology: 50 diagnosed cases of depression and 50 age and gender matched controls were included in the study over a period of 1 1.5 years in IMS & SUM Hospital, Department of psychiatry OPD.  Biochemical parameters were assayed in the Central laboratory, Department of Biochemistry. Results: Serum Vitamin D was statistically significantly lower (p=0.033) in the case group with no significant alteration in the serum cortisol in both groups. Family history showed strong association with depression with p value = 0.019. Conclusion: In this study, depression disorder showed a negative correlation with serum vitamin D level with non-significant alteration of serum cortisol level, indicating the involvement of vitamin D deficiency with depression.

DOI: 10.5281/zenodo.10936175

Background: An orthopedic ailment that is common and frequently incapacitating, rotator cuff injuries cause discomfort, functional impairment, and a reduction in the quality of life for those who suffer from them. To optimize patient outcomes and execute suitable treatment options, accurate diagnosis is essential. Aim: The objective of this research was to clarify the diagnostic possibilities, technological considerations, and clinical implications of combining Magnetic resonance imaging (MRI) and high-frequency ultrasonography (USG) to assess rotator cuff injuries, so improving our understanding and management of this common orthopedic problem. Materials & Methods: For fifty consecutive visits, individuals with painful shoulders and a clinical suspicion of rotator cuff tear (RCT) were seen in the orthopedic outpatient department. A prospective study was undertaken on these individuals. Participants in the research were excluded if they had undergone shoulder surgery for any reason or had previously had a definite diagnosis of rotator cuff damage. Results: Out of 50 people, 34 were determined to have rotator cuff injuries using ultrasonography, whereas 16 were deemed to be normal. In twelve patients, MRI findings were normal, and 38 rotator cuff injuries were verified. The degree of agreement of two different methods was assessed using the kappa coefficient. When it comes to diagnosing rotator cuff problems, USG and MRI agree with a kappa value of 0.929, a standard error of kappa of 0.1790, and a 95% confidence range spanning from 0.794 to 0.863. Conclusion: Because MRI and high-frequency USG provide a more thorough understanding of tendon pathology, they can enhance rotator cuff injury diagnosis and treatment. These imaging methods improve the assessment of rotator cuff injuries by providing greater soft tissue contrast and real-time imaging. Prospective investigations and developments provide promise for revolutionizing evaluations and enhancing patient results.

DOI: 10.5281/zenodo.10936175

Objectives: The objectives of the present study were to document the characteristics of patients presenting with segmental tibial fractures and to determine the treatment outcomes using Johner and Wruchs criteria, and Knee society scores. Methods: This was a hospital based observational longitudinal study conducted in the outpatient department and inpatient wards of the Department of Orthopaedics, of a tertiary healthcare facility located in Central India between January 2022 and June 2023. Results: The present study included a total of 47 patients with a mean (SD) age of 46.2 years (6.9). Majority of the patients were males (83.0%). Road traffic accidents were the most common (72.3%) mode of injury – within which the involvement of motorcycles and/or two wheelers was the most common; 34.0% patients had associated injuries. Nearly half the patients (46.8%) had a diagnosis of closed segmental both bone fracture and 53.2% had compound segmental both bone fracture. The difference in segment length between closed and open fractures was found to be statistically significant (MD -2.20, 95% CI -3.93 to -0.47). The mean (SD) duration of union in the proximal and distal fracture sites were significantly shorter with closed fractures, in comparison with open fractures (p<0.05). Four patients (8.5%) had complications. The treatment outcomes assessed using Johner and Wruchs criteria showed that 63.8% patients had excellent recovery; and that assessed using Knee society score showed that 76.6% patients had excellent recovery. Conclusion: These findings underscore the complexity of managing segmental tibial fractures and the importance of a multidisciplinary approach involving orthopaedic surgeons, trauma specialists, physiotherapists, and rehabilitation teams.

DOI: 10.5281/zenodo.10936175

Background: A seizure is a sudden episode resulting from abnormal, excessive, or unsynchronized neuronal activity in the brain. Seizures can be classified as either acute symptomatic or unprovoked. Misclassifying acute symptomatic seizures as unprovoked is common due to similar age distribution and occurrence rates. Correct classification and identification of the underlying cause are vital because they influence therapeutic management, the risk of developing epilepsy, and mortality rates. Methods: This study included patients admitted to wards or presenting at casualty/OPD in Govt Medical College and Hospital, Wanaparthy, Telangana State with initial onset seizures, adhering to specific inclusion and exclusion criteria. Participants’ demographic, social, and medical information was documented on a proforma sheet. Patients underwent neuroimaging studies, EEG, and other essential blood tests. In all instances, the type of seizure was categorized according to the ILAE Classification of 2017. Results: A total of 50 cases of new adult-onset seizures were reported in the duration of the study. Seizures were noted across a range of ages, peaking between 41 and 60 years with a slight male predominance. Generalized seizures were reported in 94% of cases and focal seizures in 4% of cases. Neurological causes like cerebral venous thrombosis and stroke were found in 56% of cases, while non-neurological factors like alcohol withdrawal accounted for 30%. The cause remained unidentified in 14% of cases. Conclusion: Accurate diagnosis and proper management are crucial to prevent future seizures and improve patients’ quality of life. By taking a detailed medical history, conducting a thorough clinical examination, and utilizing available diagnostic tools, we can effectively determine the underlying cause and tailor treatment accordingly. This comprehensive approach can significantly reduce the morbidity and mortality associated with epilepsy.

DOI: 10.5281/zenodo.10936175

Background: The postpartum period has both positive and negative impacts on women depending on individual vulnerability. Depression frequently occurred during later weeks of pregnancy and after delivery, both in developed and developing countries, but there were cultural differences in risk factors. According to the literature, women who live in poverty, and experience family discord or violence, increased life stress, and have little social support are more likely to be depressed. Depression in the postpartum period affects mother, baby, and the relationship between them. Aim: Aim of the study is to study the prevalence of depression in the postpartum period and to study demographic factors playing a role in postpartum women to cause depression. Methodology: This is a cross-sectional study where 120 postpartum women conducted in Rural Primary Health Center of Chandragiri Chittoor District and in the postpartum unit government maternity hospital and Department of Psychiatry, Sri Venkateswara Ram Narayan Ruia Govt General Hospital, Tirupati, Andhra Pradesh, India. Summary and Conclusion: The prevalence of postpartum depression was 18.3% lower socio-economic class, young age group, interpersonal conflicts are strong predictors of postpartum depression, which is consistent with previous literature. In postpartum, events such as interpersonal and marital conflicts and conflicts with in-laws, financial problems serve as important predictors of postpartum depression.

DOI: 10.5281/zenodo.10936175

Introduction: Failed induction of labor is a public health challenge associated with a higher rate of maternal and fetal morbidity as it increases rate of emergency cesarean section. This study was aimed to estimate proportion and risk factors of the failed induction of labor in Government Medical College, Kottayam Objective: To estimate proportion and risk factors of failed induction of labour among women undergoing induction of labour at term. Methods: A hospital based descriptive study in 232 term antenatal women who underwent induction of labour from January 2022 to December 2022 .A convinient sampling was used to collect data from medical records. Frequencies, proportions were used to describe the study population and Pearson’s chi square test was used to identify factors contributing to failed induction of labour. P value of </=0.05 was taken as statistically significant. Result: Proportion of failed induction of labour was 12.5%. Age >30 years, higher BMI, premature rupture of membrane, having pregnancy-induced hypertension, and  Birth weight of greater than 4kg were risk factors. Combined method labour induction decreased failure rate. Conclusion: Proportion of failed induction of labour was 12.5% was low compared to other studies. Age, BMI, premature-rupture of the membrane, pregnancy-induced hypertension, and method of induction were independent predictors for failed induction of labour.  Combination method of induction and considering age, BMI while formulating induction protocol are highly recommended for reducing failed induction of labour.

DOI: 10.5281/zenodo.10936175

Background: Brachial plexus block is frequently recommended for upper limb surgeries. Many drugs have been used as adjuvants to prolong the duration of the block. The present study was undertaken to compare the effect of intravenous dexmedetomidine or midazolam on the onset and duration of supraclavicular block with bupivacaine and lignocaine with adrenaline. Method: Total 80 patients of age between 18-65 years with either sex belonging to ASA 1 and 2, scheduled for upper extremity surgery under supraclavicular brachial plexus block were included in the study. Patients were divided into two groups, group D (n=40) were patients who received Dexmedetomidine infusion and group M (n=40) patients received Midazolam infusion for sedation. Results: The onset of sensory block was quicker in group D (10.58±1.32min) when compared to group M (19.8±1.11min), (p<0.0001). The duration of sensory block was more prolonged in group D (276±24.68min) than group M (239.25±25.86min). Time required for onset of motor block in midazolam group was high (28±1.43min) as compared to dexmedetomidine group (20.62±1.64min), (p<0.0001). However, the duration of motor block in group D was significantly higher (533.25±36.26min) compared to group M (259.5±25.01min), (p<0.0001). Addition of dexmedetomidine significantly prolonged the duration of analgesia (335.22±92.64min) in comparison to midazolam group (254.55±58.59min). The changes in heart rate and mean blood pressure were similar in both groups. Post-operative pain was significantly lower in group D as compared to group M, (P<0.005). Conclusion: Dexmedetomidine when given intravenously as a sedative fastened the onset and prolonged the duration of sensory and motor blockade, as well as prolonged the duration of analgesia of brachial plexus block compared to intravenous midazolam.

DOI: 10.5281/zenodo.10936175

The phakomatoses are congenital disorders manifesting with central nervous system and cutaneous abnormalities. The structures predominantly affected are those of ectodermal origin, including the skin, nervous system, and eyes. Other organs are also involved in Some syndromes mainly cardiovascular, pulmonary, renal, and musculoskeletal systems. A few rare neurocutaneous syndromes, such as PHACES syndrome and Gomez Lopez Hernandez Syndrome have also been reviewed in this article along with Common Neurocutaneous Syndromes. Neurofibromatosis type 1 and 2, tuberous sclerosis, Sturge Weber’s disease or von Hippel Lindau diseases are the four most common types of phakomatoses. In these disorders, imaging of the brain and spine plays an important role in diagnosis and in determining the extent of involvement and the guiding in surgical interventions.

DOI: 10.5281/zenodo.10936175

Leiomyoma in vagina are rare occurrences with very small number of cases reported in literature. It has various clinical manifestations depending on the size and location of the vagina. Here, we report a case of a 37 year old lady who presented to our OPD with complaints of mass per vagina since 6 months with complaints of dyspareunia and no urinary symptoms. On local examination, a mass of size 4 x 4 cm noted in the anterior vaginal wall pushing the external urinary meatus to the right side. MRI imaging revealed a well-defined heterogeneously enhancing lesion measuring 3.2 x 3.7x 2.7 cm involving the left lateral and anterior wall of lower vagina- likely leiomyoma. Surgical excision of the tumor was done. Histopathological examination confirmed the diagnosis of vaginal  leiomyoma.

DOI: 10.5281/zenodo.10936175

Background: The amniotic fluid begins to develop from the mother’s plasma through a process called transudation. Its quantity varies over the course of the pregnancy. Throughout the intrauterine life, the amniotic fluid serves a number of purposes. The amniotic fluid index (AFI), the most popular ultrasonography technique for the identification of amniotic fluid, has been proposed in 1987 by J.P. Phelan and colleagues. AFI greater than the 95^th percentile for gestational age is considered a polyhydramnios. The severity of polyhydramnios is inversely correlated with the probability of congenital malformations and perinatal mortality. Aim of the study is to study the obstetric outcome in pregnancies with polyhydramnios; to determine the maternal and perinatal outcome in pregnancies complicated by polyhydramnios; to determine the possible factors causing polyhydramnios. Methodology: This was a Prospective Observational study done in 100 cases over 2 years period in the Department of OBG, Government General Hospital. Inclusion Criteria: Singleton pregnancies with gestational age 37 – 40 weeks and AFI >18cm. Exclusion Criteria: Multiple gestations, < 18 cm AFI, < 37 or > 40 weeks gestation. Results: Idiopathic polyhydramnios was the common type, followed by gestational diabetes and congenital anomalies. PROM was major problem during the labor.No maternal mortality was noted but a 7% perinatal mortlality was noted and the majority of the deaths were due to respiratory distress. Conclusion: In all cases with abnormal liquor volume, a thorough history, clinical examination, and relevant investigations should be performed to identify the various etiological factors in order to improve the prognosis for the foetus and prevent any complications for the mother.

DOI: 10.5281/zenodo.10936175

Purpose: To investigate the incidence of ocular and systemic side effects associated with atropine use in children undergoing mydriasis for refraction and to identify factors associated with the occurrence of these side effects. Methods: This prospective study included 110 children aged 3 to 12 years who received atropine for cycloplegic refraction at a single center. The incidence of ocular and systemic side effects was assessed, and the association between age, atropine concentration, gender, and the occurrence of side effects was evaluated using logistic regression analysis. Results: The overall incidence of ocular side effects was 34.5% (95% CI: 25.7% – 44.2%), with photophobia (22.7%), blurred vision (16.4%), and stinging sensation (10.9%) being the most common. The incidence of systemic side effects was 7.3% (95% CI: 3.2% – 13.8%), with fever (2.7%), dry mouth (2.7%), and tachycardia (1.8%) being the most frequently reported. Age, atropine concentration, and gender were not significantly associated with the occurrence of side effects (p > 0.05). Conclusion: Atropine use in children undergoing mydriasis for refraction is associated with a relatively high incidence of ocular side effects and a lower incidence of systemic side effects. Although age, atropine concentration, and gender were not significantly associated with the occurrence of side effects, younger children and those receiving higher concentrations of atropine may be at a higher risk of experiencing adverse reactions. Close monitoring and parental education are essential to manage these side effects effectively.

DOI: 10.5281/zenodo.10936175

Cardiovascular diseases are major causes of mortality and morbidity in modern world. Herbal drugs have been used traditionally as cardiotonic products since years. This study was conducted to compare the cardioprotective effects of T. arjuna bark extract and M. oleifera Lam. leaf extract on isoproterenol (ISP) induced myocardial infarction by measuring parameters systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), cardiac biomarkers (serum Troponin, CPK-MB, SGOT levels), ECG and histopathology of rabbit hearts. Twenty four albino rabbits were divided in four groups of six each. Group I served as control, group II was injected ISP intraperitonially (i.p.) on 60^th day, group III was given T. arjuna bark extract orally for 60 days and injected ISP (i.p.) on 60^th day and group IV was given M. oleifera leaves extract orally for 60 days and injected ISP (i.p.) on 60^th day. There was highly significant decrease in SBP (123.50±2.56 & 126.83±1.57), DBP (83.75±2.20 & 85.33±1.83) and MBP (97.00±1.71 & 99.16±1.31) among group III & IV as compared to group II SBP (143.83±3.47), DBP (104.58±1.82) & MBP (117.66±1.68). Similarly serum troponin level (0.29±0.03 & 0.38±0.03), SGOT level (17.15±5.60 & 18.8±2.38) and CPK-MB level (109.12±6.31 & 126.59±6.55) among T. arjuna & M. oleifera (respectively) treated rabbits were significantly lesser than ISP treated rabbit troponin (6.53±1.77), SGOT(46.5±9.66) & CPK-MB (367.66±48.82) levels. ECG and histopathology changes too were in accordance with these results which implies the antiatherogenic and cardioprotective effects of T. arjuna and M. oleifera.

DOI: 10.5281/zenodo.10936175

Introduction: Advancements in surgery have led to a point where the modern surgeon no longer looks upon a colorectal malignancy as an unconquerable obstacle. Unfortunately, despite rapid advances in surgery and neo-adjuvant chemoradiation, the spectre of anastomotic leaks continues to cast a dark veil even in the best equipped facilities. Several studies have shown the role of Serum C-Reactive protein as a useful marker of anastomotic healing with consistently high negative predictive values, as early as post-operative day 4 onwards. Methods: This study is conducted in prospective observational pattern for a period of 18 months from March 2022 to September 2023 in a tertiary care hospital. The study population included 60 participants who were planned for colorectal surgeries. 57 participants were eligible for analysis after considering inclusion and exclusion criteria and their preoperative and postoperative 4^th day C – reactive protein values were identified and they were followed for a period of 15 days for anastomotic leak. Results: The cut-off values of the 4^th day CRP with highest area under the ROC is calculated and found to be 166 mg/L. Elevated CRP on the 4^th day above 166mg/L is a sensitive and specific marker for the early detection of leaks in colorectal anastomosis. Conclusion: The subjects who underwent colorectal anastomosis can be safely discharged on 4^th post-operative day if the C Reactive Protein values are below the cutoff value of 166mg/L without any significant risk of anastomotic leaks.

DOI: 10.5281/zenodo.10936175

Introduction: Non-communicable diseases (NCDs) are one of the major health and development challenges of the 21st century, in terms of both the human suffering they cause and the harm they inflict on the socioeconomic fabric of countries, particularly low- and middle-income countries. No government can afford to ignore the rising burden of NCDs. In the absence of evidence-based actions, the human, social and economic costs of NCDs will continue to grow and overwhelm the capacity of countries to address them. Objectives: 1. To assess the prevalence of diabetes mellitus in slum dwellings of urban field practice area of SMS&R, Gautam Buddh Nagar. 2. To study the prevalence of risk factors of diabetes mellitus in the study population. 3. To make recommendations for prevention of Type-II Diabetes Mellitus based on finding of the present study. Methodology: The study design was Community Based Cross sectional study from January 2017 – January 2018. The study was planned and conducted among urban field practice area of SMS&R covering 6 colonies namely Jeetram, Goel, kunda  bhatta, Rajeev, salarpur. Result: In present study significantly higher prevalence of Diabetes (23.8%) was found in those consuming <5 serving of Fruit and vegetables in Diet, similar pattern seen in IFG glucose also (57.3%) The prevalence of diabetes mellitus and impaired fasting glucose was higher (30.8%, 69.2% respectively) in those who had family history of diabetes mellitus and this association was not statistically not significant. Conclusion: Overall prevalence of Diabetes Mellitus was found 21.7%. Prevalence of Diabetes Mellitus males (22.8%) was slightly higher than females (20.5%). This difference is however not statistically significant. The prevalence of Diabetes Mellitus showed a significant correlation with family income. Prevalence of Diabetes Mellitus was found significantly higher among unemployed / unskilled subjects (26.4% and 24.7% respectively) as compared to professionals (15.1%).

DOI: 10.5281/zenodo.10936175

Background: There are several modalities for the treatment of vitiligo but generally they do not result in significant cure of the disease. Autologous non-cultured non trypsinised epidermal cell suspension is simple, less time consuming and does not required special setup. Aim: To evaluate the Efficacy of Autologous Non-cultured non-trypsinised melanocyte-keratinocyte cell transplantation in treatment of stable vitiligo patches. Materials and Methods: Patient of age 18 years and above with stable vitiligo, showing no expansion of pre-existing lesion since last 6 months and who are resistant to medical therapy treated with Autologous Non-cultured non-trypsinised melanocyte-keratinocyte cell transplantation technique. Results: Excellent repigmentation (extent of repigmentation of >75%) response showed by 30% cases, Very good response (extent of repigmentation of 50%-75%) in 46%, Good response (extent of repigmentation of 25-49%) in 16%, Poor response (repigmentation <25%) in 6% at the end 20 weeks post-surgery and good colour match with surrounding pigmented area. Conclusion: Noncultured nontrypsinized melanocyte keratinocyte transplantation technique is easier, cheaper, less time consuming, less expertise needed and can cover larger body surface area with smaller grafts. This technique produces uniform and cosmetically acceptable pigmentation.

DOI: 10.5281/zenodo.10936175

Background: One of the key components of the National Rural Health Mission is to provide every village in the country with a trained female community health activist Accredited Social Health Activist (ASHA). Selected from the village itself and accountable to it, the ASHA will be trained to work as an interface between the community and the public health system. Objective: To determine the association between socio-demographic characteristics and the level of knowledge of ASHA workers about Maternal and Child Health services. Materials and Methods: It is a community based cross sectional study was conducted among 211 ASHA workers of Kalol Taluka, Gandhinagar, and Gujarat from November 2023 to January 2024. Sample size was calculated by formula (4PQ/L²) and all 211 ASHA workers of Kalol Taluka were selected randomly. The semi-structured self-administered questionnaire formulated based on the ASHA modules and translated into the local language (Gujarati) was used for data collection. Descriptive data was analyzed by using frequency and percentage. For the association between variables, Chi-square test was used. Results: About half of the respondents (50.2 %) had good knowledge about the Antenatal Care (ANC) whereas 52.1 % of them had good knowledge about Post Natal Care (PNC). About 56.8 % of the respondents were aware of the exclusive breastfeeding till six months after birth. Conclusions: Knowledge levels about maternal and child health services were found to be average in most of ASHA workers.

DOI: 10.5281/zenodo.10936175

Background: The increase in the number of elderly people due to improved life expectancy presents special challenges to the control of tuberculosis (TB) in India. The clinical course of tuberculosis (TB) among elderly and senile-aged patients differs in very slow regress. The current study aimed to ascertain the regional incidence of tuberculosis among elderly and senile-aged individuals. Objective: This observational, hospital based, single-center study aimed to ascertain the regional incidence of tuberculosis among elderly and senile-aged individuals. Materials and Methods: This study was carried out in the Department of pathology, Himalayan Institute of Hospital trust, University, Swami Ram Nagar, and Dehradun with 284 patients over a period of 12 months between March-2008 to March-2009. The data was entered; tabulated and statistical analysis was performed by using Statistical Package for the Social Sciences (SPSS 24.0) and Graph Pad Prism Version 5. A value of p<0.05 was considered significant. Result: In our study, the maximum cases 11.61% (n=33) were seen in the fifth decade followed by sixth decade 10.27% (n=29). Incidence of tuberculosis was highest in the fifth decade whereas lowest in eighth decade of life. In females, 05 cases were recorded between 41-80 years for tuberculosis of the Female Genital Tract. Whereas single case was recorded in 51-60 years for tuberculosis of the Breast. In males, 04 cases recorded between 51-70 years for tuberculosis of the Urogenital Tract, whereas no cases were recorded for 41-50 and 71-80 years for tuberculosis of the Urogenital Tract. Conclusion: The current study highlighted the age wise distribution of regional incidence of tuberculosis cases among elderly and senile-aged individuals.

DOI: 10.5281/zenodo.10936175

Introduction:  Optimal therapy for unstable intertrochanteric fractures in elderly people is difficult owing to difficult anatomical reduction, low bone quality, and delayed weight bearing. The current study was designed to examine the outcome of internal fixation in comparison to primary cemented bipolar (PCB) hemiarthroplasty in elderly patients with unstable intertrochanteric fractures. Materials and Methods:  The study comprised 50 adult patients with intertrochanteric fractures who were treated in a tertiary  care center. Patients were separated into two groups. Primary hemiarthroplasty was performed in 25 patients (group A), while internal fixation was performed in 25 patients (group B). The primary outcome indicators included post-operative mortality, comorbidities, and functional outcomes. Results: The majority of patients who underwent hemiarthroplasty began full weight bearing at the end of the first week after surgery, whereas patients who underwent fixation began full weight bearing at the end of the seventh week, which was significant. The mean Harris Hip Score 12 weeks after surgery was 83.86 for the hemiarthroplasty group and 72.12 for the fixation group, which was significant. Postoperative complications were greater in Group B compared to Group A. Conclusion: Primary cemented bipolar hemiarthroplasty outperformed internal fixation in terms of lower complication rate and functional outcome.

DOI: 10.5281/zenodo.10936175

Introduction: Typhoid fever is one of the most frequent infectious disorders in humans, with fever lasting more than 7 days. It is transmitted through the faeces and is frequent in regions with poor sanitation. This study was done to describe the clinical profile among children with typhoid fever. Materials and Methods: A retrospective case record analysis of 100 hospitalized patients aged 1 to 15 years who were discharged with typhoid fever was conducted in a tertiary care institution. The case records contained information about the patients, such as their age and gender, mode of clinical presentation and response to treatment. The data was entered and analyzed with SPSS version 19. The data has been summarized using percentages. Results: Of the 100 patients, 53 (53%) were male and 47 (47%) were female. Most of the patients were between the ages of six and ten. The most prevalent symptom was fever (100%), followed by anorexia (58%), vomiting (42%), abdominal discomfort (22%), diarrhea (20%), headache (15%), and cough (9%). In terms of physical findings, the most prevalent sign we found was a coated tongue (50%), followed by hepatomegaly (47%), and splenomegaly (19%). Conclusion: Fever, anorexia, vomiting, coated tongue, and hepatomegaly was the most common clinical manifestations of typhoid fever in our study. It is critical to get an early clinical diagnosis and utilize antibiotics rationally. Prevention requires improved hygiene, vaccination, and public knowledge.

DOI: 10.5281/zenodo.10936175

Introduction: Depression is associated with increased serum C- reactive protein levels in circulation.  Major depressive disorder manifest all of the cardinal features of an inflammatory response. Increase in inflammatory cytokines causes reduction of serotonin and other neurotransmitters in CNS and increases the activation of hypothalamic pituitary adrenal axis, leading to elevated oxidative stress in the brain. The levels of CRP may differ depending on the severity of depression. Aim and Objective: To study the association between depression and CRP levels according to the severity. Materials and Methods: A cross sectional study was conducted in Psychiatry Department, in patients presenting with major depressive disorder  from May 2023 to October 2023, in tertiary care hospital of Surendranagar district. The patients were assessed by thorough history taking and fulfilling the DSM 5 criteria for Major Depressive Disorder. Total 45 patients fully met the criteria, and further assessment for severity of depression was done. Serum CRP levels were also assessed. The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. All procedures involving human subjects/patients were approved by ” The Institutional Ethics Committee and Scientific Review Committee – Subcommittee (Human Research) of C. U. Shah Medical College, Surendranagar and approval number CUSMC/IEC(HR)/Pro.Approval-RP-05/2023/OUT- 41/2023. Results: A Kruskal Wallis H test showed that there was a statistically significant difference in CRP levels between the different groups of depressive patients according to the severity. Kruskal Wallis H= 8.520, p=0.025, with a mean CRP score of 18.17 for mild , 26.53 for moderate and 33.20 for severe depression. Conclusion: It can be concluded that there is significant association of serum CRP levels with severity of depression. Also depression can be correlated with gender, socioeconomic status and marital status.

DOI: 10.5281/zenodo.10936175

Hepatitis B infection is the most widespread and important type of viral hepatitis. It increases the risk of developing liver failure, cirrhosis and hepatocellular carcinoma. Every year over 115000 Indians die of hepatitis B related complications. This study was undertaken to access serological markers HbsAg and HBeAg in chronic carriers of Hepatitis B infection and compare with viral load as determined by polymerase chain reaction. This study included 113 patients who attended OPD and IPD of Jhalawar Medical College and associated group of hospitals in the period of March 2023 to January 2024 and tested positive for HBsAg. 5ml blood was collected from patients after detailed history and written consent. After the confirmation of carrier status, HbeAg was obtained by ELISA. Real time polymerase chain reaction technique was utilized for detection of HBV DNA. Majority of patients (31.8%) belonged to age group 31-40 yrs. Family history was the most common risk factor. 10.6% patients had HBV DNA below detectable level and 31% were super carriers ( > 20,000 IU/ml). 34.5% patients were HBeAg positive. In HBV DNA positive cases, the value ranged in between 51 IU/ml and 3.55 IU/ml x 10⁷.

DOI: 10.5281/zenodo.10936175

Introduction: Knowledge of the typical lymphadenopathy patterns in a specific region is crucial for accurate diagnosis and suspicion of specific diseases. However, in many clinical settings, differentiating between reactive (non-cancerous) and neoplastic lymphadenopathy remains a challenge. Aims & Objectives: To describe the clinicopathological features of patients who admitted to our wards with a primary presenting feature of lymphadenopathy. Materials and Methods: This hospital based retrospective study comprises 168 patients of all ages presenting with enlarged lymph nodes who were referred to our Department of Pathology by the clinicians in outpatient department (OPD) of a tertiary care hospital, Bhubaneswar over a period of 1 year. Results: Localized lymphadenopathy was more prevalent than generalized lymphadenopathy. In generalized lymphadenopathy cases, granulomatous and malignant diagnosis was higher in while in localized lymphadenopathy, reactive lymphadenitis was higher followed by granulomatous lesion. Localized lymphadenopathy cases were most common in below 20 years age while generalized lymphadenopathy were most commonly presented above >20 years age. The sensitivity, positive predictive value and accuracy of lymph node FNAC was 94.49%, 96.26%, and 91.15% respectively. Conclusion: FNAC as a simple, inexpensive, relatively painless, rapid, repeatable, and reliable method of investigation for lymphadenopathy, especially in OPDs, peripheral hospitals, and dispensaries, thus reducing the incidence of surgery and therefore, bed occupancy. However, it is not a substitute for conventional surgical pathology but is complimentary to it.

DOI: 10.5281/zenodo.10936175

Introduction: Hyperhomocysteinemia is connected to RPL, which affects 5% of women. This illness can be caused by genetic defects, folic acid, vitamin B6, and B12 deficiencies, hypothyroidism, medicines, aging, and renal issues. This study investigates hyperhomocysteinemia and obstetric outcomes. This qualitative, cross-sectional study investigated women with RPL for their homocysteine levels. Hyperhomocysteinemia was defined as ≥15 μmol/L. High-level patients received folic acid and vitamin B12 before reassessing their homocysteine levels. Finding: 46 (76.67%) of 60 individuals have elevated homocysteine. Folate and vitamin B12 treatment reduced hyperhomocysteinemia to 32 (53.33%), showing a significant drop in homocysteine levels. Conclusion: Hyperhomocysteinemia is linked to RPL, especially in the initial and early second trimesters. Folic acid and vitamin B12 supplements are essential for homocysteine reduction.

DOI: 10.5281/zenodo.10936175