Introduction: Polycystic ovarian syndrome (PCOS) PCOS is a prevalent ovarian endocrinopathy that causes anovulatory infertility in over 80% of cases. Standard first-line ovulation induction drug clomiphene citrate (CC) has a pregnancy rate of 35%-40% with specific adverse effects. Letrozole, an aromatase inhibitor that lowers oestrogen production, may be a preferable option to CC. This research examined the efficacy of clomiphene citrate and Letrozole alone and with gonadotropins in infertile women. Materials and Methods: A total of 180 women with infertility attending outpatient department of obstetrics and gynaecology between 18-35 years of age were considered. Cases were randomly allocated to 100 mg of clomiphene citrate daily group, 2.5 mg of letrozole twice daily, 100 mg of clomiphene citrate with gonadotropins and 2.5 mg of letrozole with gonadotropins. The details of number of follicles, endometrium thickness, ovulation rate, monofollicular development were recorded and analysed. Results: Polycystic ovary syndrome (PCOS) was found in 37.78% of individuals in group A and 33.33% of participants in group B. The endometrial thickness was 7.04mm and 7.66mm, in clomiphene citrate alone and with gonadotropins and 8.58mm and 9.12mm in letrozole alone and with gonadotropins respectively. Treatment with 2.5mg of letrozole alone or combined with gonadotropins resulted in significantly higher rates of ovulation and single follicle formation compared to 100 mg of clomiphene citrate alone or combined with gonadotropins (p<0.05) Conclusion: Letrozole and gonadotropin together was shown to be effective in triggering ovulation, facilitating the formation of a suitable endometrium, obtaining an optimal size for the dominant follicle, and inducing ovulation from a single follicle.

Background: Chronic kidney disease (CKD) significantly impacts various health aspects, including auditory functions. Haemodialysis, essential for CKD management, has been linked to complications extending beyond renal function deterioration, notably influencing hearing thresholds in patients. The study aims to examine the prospective changes in hearing thresholds among CKD patients undergoing haemodialysis to better understand haemodialysis ‘s impact on auditory function. Methods: The prospective cross-sectional study was conducted at Sharda Hospital over two years, involving CKD patients undergoing haemodialysis and matched controls not on dialysis. We utilized pure-tone audiometry for audiological assessment, classifying hearing thresholds from normal to profound loss. Statistical analyses were achieved, with significance set at p<0.05. Results: The study compared 60 participants divided into a haemodialysis group and a control group. The haemodialysis group, older on average (58.5 vs. 52.3 years), demonstrated significantly worse hearing outcomes compared to controls. Only 40% had normal hearing, versus 80% of controls, with 50% experiencing mild to moderate hearing loss, and 10% suffering severe impairments. Statistical analysis showed these differences to be significant (p < 0.001). There was a moderate correlation between longer haemodialysis duration and increased hearing loss severity (r = 0.432, p = 0.011). Additionally, poorer kidney function correlated with worse hearing outcomes (r = -0.367, p = 0.032), confirming that haemodialysis impacts auditory health significantly. Conclusion: Haemodialysis is associated with a greater prevalence and severity of hearing loss in CKD patients. The correlation between the period of haemodialysis and hearing loss severity underscores the treatment’s impact on auditory health. Recommendations: Regular audiological assessments should be integrated into the management plans for CKD patients undertaking haemodialysis to facilitate early detection and management of hearing loss, potentially enhancing their quality of life.

Background: Abdominal tuberculosis (TB) poses a diagnostic challenge due to its nonspecific symptoms and varied clinical presentations. Laparoscopy and noninvasive tests are commonly used diagnostic modalities, but their comparative effectiveness remains debated. Materials and Methods: A retrospective analysis was conducted on patients presenting with suspected abdominal TB between January 2018 and December 2022. Patients underwent either laparoscopy or noninvasive tests including imaging studies, serological assays, and nucleic acid amplification tests. Diagnostic parameters such as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. Results: A total of 150 patients were included in the study, with 75 undergoing laparoscopy and 75 undergoing noninvasive tests. Laparoscopy exhibited a sensitivity of 85%, specificity of 92%, PPV of 88%, NPV of 90%, and accuracy of 89%. Noninvasive tests showed a sensitivity of 70%, specificity of 78%, PPV of 72%, NPV of 76%, and accuracy of 74%. The difference in diagnostic accuracy between laparoscopy and noninvasive tests was statistically significant (p < 0.05). Conclusion: Laparoscopy demonstrates superior diagnostic accuracy compared to noninvasive tests for the diagnosis of abdominal TB. Although noninvasive tests may be less invasive and more cost-effective, their lower sensitivity and specificity may lead to delayed or missed diagnoses. Therefore, laparoscopy should be considered as the preferred diagnostic modality in cases where abdominal TB is suspected, especially in resource-rich settings.

Background: Deviated nasal septum (DNS) significantly impairs nasal airflow and can diminish quality of life. Traditional management includes conventional septoplasty, but advancements have led to the adoption of endoscopic septoplasty, which may offer benefits over the conventional approach. Objective: This study aimed to compare the efficacy, recovery time, complication rates, and patient satisfaction between endoscopic septoplasty and conventional septoplasty. Methods: A randomized controlled trial was conducted at Lord Buddha Koshi Medical College & Hospital, Saharsa, involving 103 patients with clinically and radiologically confirmed DNS. Participants were randomly assigned to undergo either endoscopic septoplasty (n=52) or conventional septoplasty (n=51). Outcomes measured included recovery time, complication rates, and patient satisfaction over a 12-month follow-up period. Results: Endoscopic septoplasty resulted in a significantly shorter mean recovery time (18 days vs. 24 days), lower complication rates (4.8% vs. 13.7%), and higher patient satisfaction (92% vs. 76%) compared to conventional septoplasty. Statistical analysis confirmed that these differences were significant (p < 0.05). Conclusion: Endoscopic septoplasty offers a superior alternative to conventional septoplasty for the treatment of DNS, with benefits including faster recovery, fewer complications, and greater patient satisfaction. These findings support the preferential use of endoscopic techniques in nasal septum surgery.

Background: Fungal infections of the nose and paranasal sinuses are less common than bacterial and viral sinusitis but can lead to severe complications, especially in immunocompromised individuals. This study aims to evaluate the prevalence, types, and treatment outcomes of fungal sinus infections in a rural tertiary care hospital setting. Methods: A retrospective observational study was conducted at Lord Buddha Koshi Medical College & Hospital, Saharsa, involving 97 patients diagnosed with fungal sinus infections over 11 months. Data on demographic characteristics, clinical presentation, diagnostic methods, fungal species identified, treatment modalities, and outcomes were collected and analyzed. Results: The study population comprised 54 males (55.7%) and 43 females (44.3%), with a mean age of 37 years. The most common symptoms included nasal obstruction (85%), facial pain (78%), and nasal discharge (72%). Diagnostic methods primarily included nasal endoscopy (95%) and CT scans (85%). Aspergillus species (40%) and Mucor species (30%) were the predominant fungi identified. Antifungal therapy was administered in all cases, with surgical debridement performed in 30% of cases. Successful treatment was achieved in 80% of the patients, with a recurrence rate of 10% and a complication rate of 5%. Patients with diabetes or immunosuppression experienced significantly poorer outcomes (p < 0.05). Conclusion: Fungal infections of the nose and paranasal sinuses represent a significant clinical challenge in rural tertiary care settings, with a notable prevalence of Aspergillus and Mucor infections. The study highlights the importance of early diagnosis, effective treatment, and management of underlying conditions to improve patient outcomes. Enhanced awareness and diagnostic capabilities in rural healthcare settings are essential for addressing these infections effectively.

Over three years, this study evaluates the long-term efficacy and safety of prolotherapy using hypertonic dextrose in treating knee osteoarthritis. This observational study included 200 individuals with chronic knee pain characteristic of osteoarthritis. Participants received dextrose injections under ultrasound guidance, with the process meticulously detailed to ensure consistency. Annual X-rays and initial and final MRIs were performed to monitor changes in joint structure. Pain and functionality were assessed using the Visual Analogue Scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The results demonstrate sustained improvements in pain and joint functionality without serious adverse effects, suggesting that prolotherapy is a viable long-term treatment for managing symptoms of knee osteoarthritis. This study’s focus on chronic conditions, without comparing to a control group, provides valuable insights into the standalone benefits of prolotherapy.

Objectives: The present study was to evaluate the role of early laparoscopic surgery in acute nonspecific abdominal pain at tertiary care center. Methods:  All the preoperative evaluation and preparation, preoperative history, and preoperative clinical examinations and relevant investigations were performed to all patients. Group I (Laparoscopic): patients who had undergone early laparoscopy procedure. Group II (Conservative) — patients who were put under clinical observations, treatment and follow up. Results: Major diagnosis for acute abdomen pain of laparoscopic patients was acute appendicitis (25%), Acute cholecystitis (15%), pelvis inflammatory disease (15%), diverticulitis (!5%) and adhesion (10%). Similarly, in conservative group patients  major diagnosis for acute abdomen pain of laparoscopic patients was ovarian cyst (30%), undiagnosed (20%), diverticulitis (20%), diverticulitis (20%) and acute appendicitis (15%), acute cholecystitis(15%). 80% patients of laparoscopic group and 90% patients of conservative group were visited for follow up within 2 weeks. Patients who were seen for follow up in one month. Among them, recurrence was seen in 10% patients of laparoscopic group patients. Conclusions: Laparoscopy is a promising, safe minimally invasive diagnostic and therapeutic procedure that is very effective in diagnosing and treating acute abdominal problems. Hence, it is the best choices of treatment procedure for nonspecific acute pain.

This retrospective study at Lord Buddha Koshi Medical College & Hospital analyzed 94 cases of foreign bodies in ear, nose, throat, and maxillofacial regions over 14 months, focusing on pediatric patients. Findings reveal that children under 10 were most affected, commonly with objects like beads, seeds, toys, and button batteries. Management typically involved removal, with surgical intervention in 11% of cases and complications such as infections occurring in 12% of patients. The study highlights the need for greater public awareness and preventive education to mitigate risks and ensure effective treatment.

Background: Mandibular angle fractures often involve impacted third molars, complicating decisions on whether to retain or remove them during repair. Objective: Compare outcomes of mandibular angle fractures with and without impacted third molar removal. Methods: Prospective study at Buddha Institute of Dental Sciences & Hospital with 20 patients, divided into groups based on third molar management during surgery. Followed for six months postoperatively, assessing healing, complications, and functional recovery. Results: Similar outcomes in healing, complications, and function regardless of third molar removal (p > 0.05). Conclusion: Third molar presence during mandibular angle fracture repair doesn’t significantly affect outcomes; decisions should be case-specific.

Background: Citrobacter species are frequent nosocomial pathogens, a local or systemic breach in the host defences can allow them to cause a range of infections which include urinary tract infections, neonatal sepsis, pulmonary infections, meningitis and blood stream infections. Citrobacter species are emerging as important nosocomial pathogens. Citrobacter infections are associated with high mortality rate. Objectives: To determine their antibiotic susceptibility pattern. To detect extended spectrum beta lactamase producing species. Material and Methods: Various clinical samples received in the central lab of DMCH Darbhanga. Identification will be done by using standard microbiological techniques. Antibiotic susceptibility test will be performed by Kirby-Bauer Disc diffusion method. Test strains will be pre-incubated in peptone water at 37^oC at an optical density of 0.5McFarland standard. This suspension will be used to inoculate strains onto Muller Hinton agar plate by swabbing them with a sterile cotton swab and performing culture as recommended by clinical and laboratory standards institute. The antibiotic discs used for sensitivity testing will be obtained from Hi-Media, India, which will be used to study the sensitivity pattern. Conclusion: The magnitude of Citrobacter infections has increased over time considering its potential to cause nosocomial infections and the growing numbers of immunocompromised patients in hospitals. C.koseri and C.freundii being the commonest species isolated. They are usually isolated from patients with wound infections, urinary tract infections, respiratory infections and bacteremia. The emergence of drug resistance among the Citrobacter is noteworthy.

Introduction: The medical students are poor in psycomotor skills at the level of phase II. They are not exposing to any surgical skills given in the books. They are having knowledge by cognition. They are up to the second level of millers pyramid. Our aim is use does performance shows how is based the medical students perform skill based procedure in simulation skill lab. Diagnostic nasal endoscopy is easily to be performed with zero degree endoscope at three levels. First, second, third, passes to be trained and assessed for do gives their clinical internals during their end postings. Objective: (1) Skill based assessment of medical students at the phase of 2 during ENT postings, to improve their internal assessments. (2) Technology enhanced assessment in medical education. Materials and Methods: Phase 2 Medical students allowed to simulation lab for 1 hour per day, with 10 students. Diagnostic nasal endoscopy, first pass, second pass, third pass are trained. Then demonstration, observation, procedural skills assessed before objective structured practical examinations (OSPE) and after OSPE with checklist and scoring done with rating scale 1. Excellent: 8-10; Competent: 5-8; Incompetent 0-5. The students were separated with six groups and each group with 25 students. Results: Before direct observation of procedural skills (DOPS) pre-test score percentage was < 5 =71.7%; 5-8 =28.3%. But the post test score percentage was improved < 5 = 28.6%, 5-8 = 39.85% and 8-10 = 31.88%. Also the mean simulation scores of post test scores were significantly increased comparatively than pre-test in all the groups. Conclusion: Medical student’s allowed early clinical exposure to hands on training by DOPS method. The simulation based training influences on student’s technical skills in otolaryngology.

Background: Around 15.8% of children in India are suffering from sensory neural hearing loss out of which nearly 7% have profound degree of loss and requires cochlear implant surgeries to develop speech and language. Objective: The aim of the study is to assess the common articulatory locus/placelessness/errors in children with Cochlear Implant (CI) surgery using Punjabi Articulatory Test (PAT). Methodology: Total 18 patients who underwent cochlear implant surgery were included in the study. Three groups were formed based on the hearing age of children viz., Group 1- 12 months to 24 months; Group 2 – 25 months to 48 months; and Group 3 ->48 months. Punjabi Articulation Test was administered on each participant by a professional Punjabi speaking speech and language pathologist. Speech errors were identified. Common errors between groups were also assessed using 4-point Likert scale. Results: Alveolars, glides and liquids were common errors made by 3 participants whereas fewer errors were observed for labiodentals and nasals. Similar to group 1 glides and liquids were the errors most frequently seen in group 3. In contrast with group 1 and 2 group 3 showed maximum errors in velars followed by glides and liquids. Nasals, Bilabials and Labiodentals showed least errors. Conclusion: The current study showed that with age the articulatory locus/placelessness/errors also vary. Anterior sounds are easy to produce in comparison to posterior sounds similarly like typically developing hearing age matched children.

Background: Birth weight is a useful indicator of mother health, nutrition, and quality of life in addition to being a crucial factor in determining the survival, growth, and development of children. A strong correlation exists between low birth weights (LBW) and prenatal and fetal morbidity and death. Numerous research studies conducted in India have examined the different risk variables associated with term LBW. Objective: The present study has been undertaken to study the maternal risk factors associated with term LBW neonates. Materials and Methods: Present study was retrospective, hospital-based, cross-sectional study in which medical records of 236 healthy singleton live births with gestational age between 37 to 41 weeks were analyzed. Multiple gestation or still born babies and babies with major congenital anomalies were excluded. The data was collected using the extraction matrix and then analyze statistically to derive association of maternal factors with LBW. Results: The prevalence of LBW was 37.3% and the mean birth weight in LBW category was 1.54 ± 0.25 Kg. The major factor associated with the LBW was older maternal age (34.10%), low body weight (87.50%), anemia (89.77%), and hypertension (72.27%). Maternal factors including the height of mother and maternal nutrition supplements were not found to be significantly associated with LBW. Conclusion: Present study recommended the regular screening of maternal health status to improve the overall health status of the mother to reduce the LBW.

Introduction: Uterine fibroids (myomas or leiomyomas) are benign monoclonal tumours of smooth muscle, taking origin in myometrium of human uterus. The aetiology is largely unknown, but they are estrogen and progesterone dependent tumours. It is estimated that 60% of reproductive age women are affected and 80% of women develop the disease during their lifetime. Symptoms depend upon size, number, and location of the tumours. The large number of women are also asymptomatic. Material and Methods: This prospective observational study included 118 randomly selected patients of fibroids uterus, during the study period at the department of Obstetrics and Gynecology, in our teaching institute. Patients of all ages and parity who visited either the gynecology outpatient or inpatient department of our institution were eligible for inclusion in the study, provided they were willing to participate. Exclusion criteria encompassed individuals in the antepartum or postpartum period with fibroids, as well as those who declined participation. Cases were examined following a predetermined format. Results: Majority of women (82.1%) were of age group31-50years. Abnormal uterine bleeding (64.4%) was the most common symptom followed by abdominal pain (22.28%), reproduction related problems (16.94%), mass in abdomen (14.4%), vaginal discharge (12.7%), also asymptomatic (8.47%).Anatomically uterine fibroids were intramural (63.86%), sub serous (13.44%) and sub muocus (10.08%) in location. Expectant management in (8.4%) medical management in (38.98%) and surgical management (52.5%) was offered. Conclusion: Globally uterine fibroids are among the most significant disease of the reproductive age women. Menstrual dysfunction is the common presenting symptoms in majority of the patients. Fibroids are an infrequent cause of subfertility and have been reported as the sole causes in only a small percentage of patients. It may remain silent in many cases Small and asymptomatic fibroids can be managed with expectant management. Medical management aims at decreasing blood loss, minimizing vascularity and size of fibroid. Large and symptomatic fibroids need surgical management.

Background: The global burden of antimicrobial-resistant infections is growing at an alarming rate, being responsible for more than half a million deaths worldwide each year. The resistance crisis has prompted a rise in antimicrobial stewardship (AMS) programme, which aim to reduce inappropriate antibiotic use. India is one of the largest consumers of antibiotics worldwide and antibiotic sales are increasing rapidly. Hence, it was decided to explore the anti-microbial sensitivity and resistance status of E. coli, K. pneumoniae (KP), and P. aeruginosa (PA) from the data base of a rural tertiary care teaching hospital. Aim: To evaluate the anti-microbial susceptibility and resistance pattern at a rural tertiary care teaching hospital of three important microorganisms, namely E. coli, K. pneumoniae (KP), and P. aeruginosa (PA). Methodology: This was an observational retrospective study of 3 months (June 2023 – August 2023) to determine the antimicrobial susceptibility pattern of cultures of various specimens collected during this period. To maintain feasibility, systematic randomization of data collection days was done. The data was collected every alternate day for 3 months. Results: The antimicrobial resistance patterns observed for E. coli showed high resistance rates to commonly used antibiotics such as Ampicillin (88.14%), Cefalotin (86.67%), and Nalidixic Acid (90.37%). Notably, Fosfomycin showed a remarkably low resistance rate (2.22%). K. pneumoniae exhibited high resistance to Ceftriaxone (92.3%), Cefuroxime (92.3%), and Piperacillin/ Tazobactam (92.3%), while Colistin and Tigecycline resistance were relatively low (7.69% and 15.38%, respectively). aeruginosa presented a varied resistance pattern, with the highest resistance observed for Tigecycline (97.92%), while Colistin resistance remained low (10.42%). Conclusion: The escalating trends of antimicrobial resistance pose a significant global health challenge. An antimicrobial stewardship programme with educational intervention and the sensitization of medical students to rational antimicrobial prescriptions is need of the hour to control the menace of antimicrobial resistance.

Background: Type 1 diabetes is one of the common endocrine diseases among pediatric and adolescent population. The present study was intended to study the glycemic control among pediatric and adolescent population attending endocrine clinic of pediatric /medicine department at tertiary care center in western India. Materials and Methods: A cross – sectional observation study was carried out over period of 3 months at pediatric and medicine outpatient clinic of tertiary care center. A total of 34 patients were registered Data on age, sex, duration of Illness, associated comorbidities, antidiabetic regimen, and HbA1c levels were obtained. Results: A total of 34 patients were enrolled; 61.7% were females. Data showed moderately positive correlation between age and HbA1C level (r = 0.5543, p =0.00068). Mean HbA1C level were low in age group less than 6 years and increase in mean values of HbA1C noted as age increases with a statistical significance. No statistical significance was noted between gender and type of insulin regime with HbA1C level. Conclusion: Patients with T1DM had poor glycemic control with mean HbA1c level of 11.35 ± 2.1 at our center. Older age group and duration of disease were significantly associated with poor control. Further work addressing the factors associated with poor glycemic control is required.

Background: Lens induced glaucoma (LIG) is a type of secondary glaucoma and sight threatening disease. It is common in India and seen in the patient with senile cataract, requiring immediate attention and management to restore vision and prevent blindness. Aim: To study the visual outcome and intraocular pressure control following surgical management of lens induced glaucoma. Materials and Methods: A total of 64 cases of lens induced glaucoma were included after taking prior consent. The evaluation included best corrected visual acuity (BCVA), intraocular pressure (IOP), slit lamp biomicroscopy and management either by Cataract surgery alone or cataract surgery combined with trabeculectomy. All cases were followed up postoperatively on day 1, 1 week & 6 weeks. Results: Out of 64 cases, the male: female ratio was 1:1.4 and most common age group to be affected was 61–70 years (46.9 %).The vision was diminished to projection of light (PL), projection of ray (PR) accurate in all quadrants in 53.1 % of cases and the mean IOP was 47.36 mmHg at the time of presentation. Phacomorphic glaucoma (61 %) was the commonest type and 46.9% of cases were reported within 10 days of onset of symptoms. Cataract extraction & PCIOL were done in 64.1% of cases; combined surgery in 25%, and 9.3% of cases remained aphakic due to intraoperative complications. Post-operative BCVA was 6/12 or better in 73.3 % of cases presenting within 10 days of onset of symptoms. At last follow up 84.43% cases had IOP < 20 mmHg and 15.7% cases had IOP > 20 mmHg. The post-operative mean IOP was 17.82±3.78 mmHg. Conclusion: Early diagnosis and timely intervention will achieve an excellent visual prognosis with control of IOP in lens induced glaucoma.

Background: The aim of the study is to study the mimickers of bowen’s disease of the nail apparatus and it’s association with human papilloma virus. Bowen’s disease is the most frequent malignant condition of nail unit and presents as a verrucous plaque predominantly involving men. Material and Methods: We reviewed 30 cases of various conditions involving the nail apparatus at our institute to study the positive cases of bowen’s disease for the presence of human papilloma virus (HPV) DNA. We used specimens fixed in 10% neutralized buffered formalin, embedded in paraffin wax to study their histopathology as well as for HPV DNA testing via PCR. Results: In our study we found maximum cases of bowen’s disease (33.3%). The chi-square statistic is 0.9184. The p-value is 0.037904. The result is significant at p < 0.05. Our study demonstrated 63.4% of cases in the duration of 01-02 years. In addition, we found 60% cases of bowen’s disease to be associated with HPV. The chi-square statistic is 2.48365. The p-value is 0.317798. The result is not statistically significant at p < 0.05. Conclusion: Biopsy and histopathological examination are required for diagnosis and differentiation of bowen’s disease from other ungula and periungual diseases. The strong association of high-risk HPV infection and BD of the nail unit as reviewed in various literatures and described in our original study supports a causative role of the virus in digital BD, and should prompt the early follow-ups and biopsy of digital associated lesions in patients and partners.

Background: Chronic kidney disease (CKD) is a widespread and multifaceted condition that affects millions of individuals globally. While its impact on renal function is well-documented, the intricate relationship between CKD and cutaneous manifestations has garnered increasing attention in recent years. Aims: To study various patterns of cutaneous manifestations in patients with Chronic Kidney Disease and to compare cutaneous manifestations in patients with and without chronic kidney disease. Materials & Methods: It is a cross sectional descriptive study conducted over 12 months in the department of dermatology and nephrology, King George hospital, Visakhapatnam, a total of 120 patients were included in the study, a comprehensive history, detailed examination, and specific investigations such as skin biopsy, culture and sensitivity for bacterial infections, Gram’s stain, potassium hydroxide mount, and fungal culture were done wherever clinically indicated. Results: Majority of patients (39.2%) belong to age group of 41 to 50 years, with male predominance. 31.7% (38) patients complained of pruritus, Xerosis was seen in 26.7%(32) of patients, The proportion of pigmentation among patients with CKD is 8.3% (10), 55.3% of patients with pruritus were on dialysis, 59.4% of patients with xerosis were on dialysis, 40% of patients with pigmentation were on dialysis. Conclusion: Pruritus was the most common manifestation in CKD patients followed by xerosis, ecchymosis and pigmentary changes. There is no significant difference in cutaneous manifestations in patients with and without dialysis.

Background and Aims: The subarachnoid block is the recommended anaesthetic approach for procedures below the belly button because it offers superior pain relief after the operation, efficient muscle relaxation, and is cost-effective. Levobupivacaine is more advantageous than bupivacaine because it has a reduced risk of causing cardiotoxicity, prolonged duration of sensory blockade, and a shorter duration of motor blockade. Opioids used in conjunction with intrathecal local anaesthetics improve the effectiveness of pain relief and anaesthesia both during surgery and postoperatively. The objective of the current study was to assess the effects of levobupivacaine with and without fentanyl in spinal anaesthesia. Methods: For this study, 80 patients who were classified as belonging to the American Society of Anesthesiologists Physical Status I and II were randomly assigned to different groups. The study was conducted in a way that neither the patients nor the researchers knew which group they were in. The purpose of the study was to investigate the effects of infraumbilical surgery. Subjects were assigned at random to one of two groups. The Levobupivacaine group (n = 40) was administered 2.5 ml of isobaric levobupivacaine 0.5% along with 0.5 ml of normal saline. The Levobupivacaine + fentanyl group (n = 40) was given 2.5 ml of isobaric levobupivacaine 0.5% along with 25 μg (0.5 ml) of fentanyl. The study recorded the time at which sensory and motor block began, as well as how long it lasted. It also documented the Visual Analogue Scale score, the duration of analgesia, any changes in blood pressure and heart rate, and the adverse outcomes experienced by participants in both groups. Results: The initiation of both sensory and motor block was notably expedited in Group LF (P < 0.05). The average duration of sensory blockade was substantially greater in Group LF (P < 0.05). The average duration of motor block was determined to be similar between the two groups, both of which had stable hemodynamics and no sedation throughout the perioperative period (P > 0.05). The analgesic effect lasted substantially longer in Group LF (336.5 ± 31.3 min) compared to Group L (223.65 ± 32.17 min) with a p-value of less than 0.001. Conclusion: Using intrathecal fentanyl (25 μg) alongside isobaric 0.5% levobupivacaine can significantly enhance the block characteristics and minimize adverse effects in patients undergoing procedures below the umbilicus.

Background: Gestational diabetes mellitus (GDM) poses significant health risks to both mother and child. Understanding its prevalence, associated risk factors, and effective management strategies is crucial for improv-ing outcomes. Objectives: This study aims to determine the prevalence of GDM in a cohort of 500 Indian women, identify demographic and personal risk factors, and evaluate the effectiveness of various management strategies. Methods: A total of 500 pregnant women were screened for GDM using the oral glucose tolerance test. Data on age, BMI, family and personal history of diabetes, and ethnicity were collected. Management strategies includ-ing diet and exercise, insulin therapy, and oral hypoglycemic agents were assessed. Results: GDM was diagnosed in 8% (40/500) of the participants. Significant risk factors included a higher prevalence in women over 35 years (37.5%) and those with a BMI over 30 (55%). Family history was noted in 60% of cases. Management was most effective with insulin therapy (100% within target glucose levels), fol-lowed by dietary changes (75%). Birth outcomes showed that 75% of babies had normal birth weights, while complications like pre-eclampsia and C-sections were recorded in 5% and 32.5% of GDM cases, respectively. Follow-up indicated that 7.5% developed Type 2 diabetes postpartum. Conclusion: The study highlights the significant impact of GDM on pregnancy outcomes in India, with a prev-alence of 8%. Effective management is crucial and varies based on individual patient profiles, emphasizing the need for tailored therapeutic approaches to improve maternal and neonatal health outcomes.

Introduction: Maternal “near-miss” refers to surviving severe pregnancy complications, requiring innovative problem-solving and more resources. Postpartum haemorrhage (PPH) is a major health risk, a leading cause of maternal death The Case: Mrs. R. J., 32 years, G₂P₁L₁A₀, previous uncomplicated vaginal delivery presented at 38.4 weeks gestation with a normal antenatal course. Labour was induced with vaginal misoprostol, resulting in the successful vaginal delivery of a healthy 3.5 kg baby with routine preventive measures for postpartum hemorrhage. However, she experienced acute spontaneous uterine inversion post-delivery, leading to severe PPH despite attempts at repositioning the uterus and administration of halothane for relaxation. Compounded by her bronchial asthma, preventing the use of carboprost, intractable bleeding persisted, resulting in significant blood loss. With approximately 1.3 litres lost, emergency postpartum hysterectomy became imperative to save her life. This critical intervention was executed through a collaborative “Team Approach” involving obstetricians, anesthesiologists, cardiologists, pediatricians, and perioperative generalists, highlighting the importance of multidisciplinary care in managing obstetric emergencies. Result: Following emergency postpartum hysterectomy, 4 units PRBC and 8 FFP transfusions, the patient successfully recovered. Conclusion: Prompt identification, timely intervention, a coordinated team approach, and urgent management of PPH are critical for improving maternal outcomes and saving lives.

Background: Placenta is a multifunctional feto-maternal organ that plays an important role during pregnancy. Gestational Diabetes Mellitus (GDM) is reflected on placenta both macroscopically and microscopically such as enlargement of placenta, abnormalities in villi and degenerative changes. GDM is associated with increased rates of maternal and perinatal morbidity. Materials and Methods: This is a cross sectional study conducted among two groups, normal and GDM groups to compare the microscopic features of GDM placentae in the Department of Obstetrics & Gynaecology and Department of Anatomy, Govt. Medical College, Thiruvananthapuram. Results: This study was conducted on 65normal and 65 GDM placentae. Light microscopic features such as syncytial knots, villous stromal fibrosis, fibrinoid necrosis, chorangiosis, were significantly increased in GDM placentae. Conclusion: Placental examination can shed light upon factors pertaining to the current pregnancy and its outcome, guide postpartum management and helps to predict and prevent the adverse effects in successive pregnancies. Hence, the present work would provide vital information to both Obstetricians and neonatologists.

Background: Treating severe proteinuria, hypoalbuminemia, and edoema in steroid-dependent, steroid-resistant, or recurrent nephrotic syndrome is difficult. Rituximab, which targets CD20 on B cells, may help. Objectives: Rituximab will be compared to conventional therapy in difficult-to-treat nephrotic syndrome patients. Methods: A randomised controlled trial with 200 patients was conducted, with one group getting Rituximab (375 mg/m² weekly for four weeks) and the other receiving standard therapy. The primary goal was 6-month remission rate, whereas secondary outcomes were time to remission, duration, frequency of recurrence, renal function changes, quality of life, and adverse events. Results: Rituximab group showed higher remission rate (70% vs. 45%; P < 0.001), faster time to remission (3 vs. 6 months; P < 0.01), longer remission duration (18 vs. 12 months; P < 0.01), and lower relapse rate (20% vs. 40%; P < 0.01). Both groups had similar renal function changes, but Rituximab improved quality of life more. Safety profiles were similar. Conclusions: Rituximab generates and maintains remission in difficult nephrotic syndrome cases, making it a useful treatment.

Background: Thyroid disorders pose a significant public health burden globally, with diverse etiologies and clinical presentations. Understanding the epidemiological patterns of thyroid pathologies is crucial for effective management strategies. Objective: This retrospective study aimed to investigate the incidence and demographic distribution of thyroid pathologies necessitating surgery at Fakir Mohan Medical College and Hospital, Balasore, Odisha. Methodology: A retrospective analysis was conducted on patients who underwent various types of thyroid surgeries between February 1, 2020, and January 31, 2022. Data were collected from patient records and analyzed using descriptive statistics and SPSS software. Results: A total of 200 thyroid surgeries were performed during the study period. Colloid goitre was the most prevalent pathology requiring surgery (41.5%), followed by papillary carcinoma thyroid and follicular adenoma (each 15%). Females constituted 85% of the cases, with a predominant occurrence in the fifth decade of life. Malignancies accounted for 24% of cases, with papillary carcinoma thyroid being the most common (65.5% of malignancies). Notably, males exhibited a higher propensity for malignancies. Discussion: The findings corroborate global trends of thyroid disorders, with colloid goitre predominating among surgical cases. Malignancies, particularly papillary carcinoma thyroid, were notable, with males showing a higher risk. Similar epidemiological patterns were observed in previous studies, emphasizing the consistency of these findings across diverse populations. Conclusion: Colloid goitre emerged as the most common indication for thyroid surgery, with a female predilection and a peak incidence in the fifth decade of life. Understanding the demographic distribution of thyroid pathologies is essential for tailored management strategies and public health interventions.

Background: Diabetes mellitus is a chronic disorder marked by hyperglycemia due to insulin defects. Managing blood sugar is crucial to prevent complications like cardiovascular disease and neuropathy. The study investigated glycemic status and side effects in statin-naive diabetic patients, highlighting the impact of statin therapy on blood glucose levels and adverse reactions. Methods: The study involved 100 participants aged over 30 who were prescribed statins for at least 12 months and had fasting blood glucose levels below 100 mg/dl at the commencement of statin therapy. Data on demographics, clinical characteristics, medication histories, and blood glucose levels were collected using standardized forms. Statistical analyses were performed using SPSS version 23. Results: Participants had a mean age of 52.6 years (± 8.4), with 45% females and 55% males. Family history included 68% with cardiovascular disease and 32% with diabetes. During the study, 28% developed NODM and 20% were diagnosed with prediabetes. Mean fasting blood glucose was 130.4 mg/dl (± 15.2) for NODM and 105.8 mg/dl (± 8.9) for prediabetes. Adverse effects were reported by 15%, mainly muscle pain (8%). Significant predictors of NODM were family history of diabetes (χ² = 12.34, p < 0.05), age (OR = 1.08, p < 0.05), and family history of diabetes (OR = 2.34, p < 0.05). Conclusion: The study highlights the significant impact of statin therapy on blood glucose levels in statin-naive diabetic patients. Patients with a family history of diabetes are at a higher risk of developing NODM when on statins. Recommendations: Clinicians should monitor blood glucose levels closely in statin-naive diabetic patients, especially those with a family history of diabetes. Further research is needed to explore the mechanisms by which statins influence glycemic control.

Background: Adverse Drug Reaction (ADR) reporting is critical in oncology due to the complex and potent nature of oncology medications, which often have a high risk of adverse effects. Accurate ADR reporting helps identify potential risks associated with oncology drugs, contributing to safer clinical practices and enhanced patient care.The aim of this study was to investigate the prevalence and patterns of adverse drug reactions (ADRs) associated with oncology drugs among patients. Methods: The study included 120 patients who received oncology drugs during the study period. Inclusion criteria encompassed patients of all ages treated with oncology drugs, while exclusion criteria included patients with incomplete medical records. Data on patient demographics, oncology drug regimens, and documented ADRs were collected from electronic health records. Descriptive statistics assessed the association between specific oncology drugs and ADR occurrence, with a significance level of p < 0.05. Results: The analysis included 120 patients, with a mean age of 58.4 years. Among the participants, 66.7% (80 patients) experienced at least one ADR. The most common ADRs were nausea (43.8%), fatigue (35.0%), anemia (25.0%), diarrhea (18.8%), and neutropenia (15.0%). Chi-square analysis revealed a statistically significant association between Drug A and ADRs (p = 0.042) and between Drug C and ADRs (p = 0.018), while no significant association was found for Drug B (p = 0.087). Conclusion: A substantial proportion of patients experienced ADRs related to oncology drugs, with nausea and fatigue being the most commonly reported reactions. Specific oncology drugs, particularly Drugs A and C, were significantly associated with the occurrence of ADRs. Recommendations: Improved ADR reporting systems and proactive monitoring are recommended to enhance patient safety and optimize therapeutic outcomes. Healthcare professionals should be encouraged to report ADRs consistently, and patients should be involved in the reporting process to capture comprehensive ADR data.

Background: Non-vitamin K antagonist oral anticoagulants (NOACs), also known as direct oral anticoagulants (DOACs), have transformed the management of atrial fibrillation (AF), offering an alternative to the long-established vitamin K antagonist warfarin. The study compares NOACs and warfarin for atrial fibrillation patients’ primary and secondary outcomes. The study also examined anticoagulant therapy results by BMI and BW. Methods: The study included 464 individuals who met the inclusion criteria of confirmed AF diagnosis and participation in relevant trials. Data on primary efficacy and safety outcomes were collected, alongside secondary outcomes. Statistical analysis assessed the association between therapies and clinical outcomes across different BMI and BW categories. Results: The study comprised 464 AF patients with average age of 68.5. Baseline parameters were similar for NOAC and warfarin. A stroke or systemic embolic event occurred in 15.2% of NOAC patients and 18.9% of warfarin patients (p = 0.312). The NOAC group had 8.7% major bleeding events and the warfarin group 11.2% (p = 0.481). Secondary outcomes including ischemic stroke/SEE, cerebral haemorrhage, death, and net clinical outcomes did not differ across groups. No significant variations in outcomes were seen between NOAC and warfarin groups by BMI and BW. Conclusion: NOACs demonstrated similar efficacy and safety profiles contrast to warfarin in atrial fibrillation patients, with no significant variations in stroke/SEE and major bleeding rates. Secondary outcomes and stratified analyses by BMI and BW further support the comparability of NOACs and warfarin. Recommendations: Further studies should continue to evaluate the long-term outcomes of NOACs in diverse patient populations and explore strategies to improve accessibility to NOACs given their higher costs. Ensuring the availability of reversal agents for NOACs remains critical in managing bleeding complications effectively.

Introduction: Dengue virus (DENV) belongs to the genus Flavivirus (family Flaviviridae) and has 4antigenically distinct serotypes; DEN1, DEN2, DEN3 and DEN 4. About, 40% of the world’s population is at risk of acquiring dengue and around 50–100 million cases occur every year. An estimated 5,00,000 hospitalizations occur per year due to severe dengue disease out of which 2.5% are fatal. Aim and Objectives:To assess the role of NS1 antigen determination in diagnosis of dengue within first week of fever, its comparison with rapid immunochromatographic test, ELISA and RT-PCR in diagnosis of dengue. Material and Methods: Blood samples were received in Microbiology department of SGT Hospital Budhera, Gurugram from the 150 patients clinically suspected of dengue fever within 1 to 7 days of fever. All the samples were tested by rapid immunochromatographic test (ICT), ELISA and only 82 samples out of total 150 samples were tested by RT-PCR for NS1 antigen detection due to non- availability of kit. Samples found positive on RT-PCR were further processed by nested PCR for genotyping. Results: Out of 150 patients, 85 (56.67%) patients were male and 65 (43.33%) were female. 47(55.3%) out of 85 males, 30 (53.8%) out of 65 females and 82 (54.7%) out of total 150 patients were found positive for NS1 antigen by rapid ICT. Maximum positivity of NS1 antigen by ICT and ELISA was 76.4% on day 4 of illness and 66.7% on day 1 respectively. NS1 antigen detection by rapid ICT showed a sensitivity & specificity of 95.8% & 75.6% as compared to ELISA.RT-PCR for Dengue was carried out in 82 samples, of which 33 were positive for DENV RNA. On performing the nested PCR all 33 samples were genotyped as DENV-3.The sensitivity of NS1 antigen by ICT was 84.8% and specificity 73.5% with 68.3% positive predictive value and 87.8% negative predictive value. Of 82 samples, 33 tested positive for dengue by PCR and only 31 samples were positive by ELISA. The sensitivity of ELISA for NS1antigen detection was 93.9% and specificity 100% with a positive predictive value of 100% and 96% negative predictive value. Conclusion: NS1 antigen detection by ELISA and dengue group-specific reverse transcriptase RT-PCR are valuable techniques for the rapid and early diagnosis of dengue.

Background: The otorhinolaryngology clinics have seen an increase in patients with symptoms of Laryngopharyngeal reflux disease (LPRD) as a result of changes in lifestyle and food. Aim: The study aimed to observe various signs and symptoms of Laryngopharyngeal reflux and evaluate its management and result using proton pump inhibitor medication. Methodology: This prospective study was carried out at Government Erode Medical College Hospital in the department of Otorhinolaryngology, from January 2023 to February 2024. The study included 30 patients who sought medical attention at the hospital due to symptoms and signs of Laryngopharyngeal reflux illness. A study was conducted to examine the distinct indicators and manifestations of Laryngopharyngeal reflux, as well as the effectiveness of proton pump inhibitors in its treatment, utilising the Reflux Finding Score (RFS) and Reflux Symptom Index (RSI). Result: The average age group was 43.5 years. The most prevalent symptoms reported by patients with Laryngopharyngeal reflux were a sensation of a foreign object in the throat and frequent throat cleaning. Video laryngoscopy revealed common findings of erythema of the arytenoids, combined with hypertrophy of the posterior commissure and obliteration of the ventricles. The use of proton pump inhibitors resulted in a notable enhancement in both the reflux symptom index and reflux finding score. Conclusion: Proton pump inhibitors are a highly successful therapy option for managing laryngopharyngeal reflux. The reflux finding score and reflux symptom index developed by Wake Forest University are highly helpful diagnostic tools for identifying laryngopharyngeal reflux (LPR).

Introduction: ACEIs (angiotensin converting enzyme inhibitor) and ARBs (angiotensin II receptor blockers) are two medications that are frequently recommended to treat heart conditions and hypertension. It is now crucial to assess and investigate into how these medications affect the variations in serum electrolytes. Objective:  To compare the effects of Ramipril and Telmisartan on blood pressure, serum potassium and serum sodium. Materials and Methods: The prospective study, which lasted 24 weeks and involved patients in the age range of 30 to 60 who had recently been diagnosed with grade 1 hypertension, was carried out at the Department of Pharmacology in collaboration with the Department of Cardiology at a tertiary care teaching hospital. A total of 120 patients completed the research. According to randomization, patients were instructed to take either Ramipril 2.5 mg (Group 1, n = 58) or Telmisartan 40 mg (Group 2, n = 62). The student’s t-test is used for statistical analysis, and all data are expressed as mean ±SD. Results: At the fourth follow-up visit, or 24 weeks, there is a significant (p<0.001) decrease in mean SBP and mean DBP compared to the baseline visit for both groups 1 (Ramipril) and 2 (Telmisartan). However, when group 1 and group 2 are compared at the fourth visit, there is no statistically significant difference in mean SBP and mean DBP (p>0.05). In relation to serum electrolytes, there was no significant difference between baseline and fourth visit in group 1 in serum potassium (4.00 ± 0.54 to 4.07 ± 0.53) and serum sodium (139.00 ± 5.67 to 138.3 ± 5.17). Similarly, between the baseline visit and the fourth visit in group 2, there was also  not a significant difference in the serum potassium (4.15 ± 0.55 to 4.17 ± 0.52) or sodium (137.74 ± 5.41 to 137.45 ± 7.74) (p>0.05). Additionally, it was found that there was no statistically significant difference between the two groups’ mean serum potassium and mean serum sodium at the fourth visit (p>0.05). Conclusion: Our study’s conclusion is that the antihypertensive efficaciousness of Telmisartan and Ramipril as monotherapy is nearly equal and regarding safety the both medications have minimal effects on serum potassium and sodium levels. For a period of six months, it indicates a lower risk of cardiac and other issues associated to hyperkalemia and hyponatremia. But before prescribing the medication, especially to an elderly patient, one must carefully assess their comorbid illnesses, and should be closely monitored for potassium and sodium levels.

Background: Aim To study the evaluation of infertile women and correlation of hysteroscopic with histopathological finding. Objectives: (1). To evaluate various etiological factors in infertility by hysteroscopy. (2). To correlate the hysteroscopic findings with histopathology. Methodology: The study was carried out at the Department of Obstetrics and Gynaecology at Muzaffarnagar Medical College, Muzaffarnagar; U.P. Women with infertility attending the OPD were included in the study based on simple random sampling. Sample size was 100. Hysteroscopy was used to obtain a comprehensive view of the uterus, ostia, and endocervical canal, and systematic observations were made followed by Histopathological review. Results: In the current study, hysteroscopy determined that 60% of the women were normal, whereas 40% had intrauterine lesions, disease, or uterine anomalies. 39% of patients with histopathology showed normal findings, while 61% of cases had abnormal ones. Conclusion: Hysteroscopy and histopathology’s overall agreement was found to be excellent (kappa=0.81), and there was a strong correlation between the two (chi square=14.93, p-value-< 0.05).

Introduction: India has become country with 2nd highest diabetic population in world, which is global epidemic and ice berg disease and the most common endocrine disease in occurrence. Diabetes also affects vital organs of our body by various macro and microvascular complications, one of which is coronary artery disease and which is more often asymptomatic because of occurrence of silent myocardial ischemia. Aims and Objective: To assess the prevalence of ischemic heart disease in asymptomatic Type 2 Diabetes mellitus by exercise treadmill test. To assess various factors related to type 2 diabetes with coronary artery disease. Material and Methods: It was non randomized cross sectional study conducted in Guru Gobind Singh Govt. Hospital, Jamnagar between November – 2019 to November – 2020. In the study period of 12 months among the patients seen under the Department of General Medicine. 50 patients were included in this study, who had no clinical evidence of ischemic heart disease, patients known case of type 2 diabetes mellitus (DM), All the patients attending medicine OPD or admitted hospital were screened for eligibility and then after taking informed consent and enrolling them in this study, they underwent interview and through physical examination, All the patients had normal resting ECG and normal 2D ECHO. All the patients had already underwent treadmill testing. A detailed history was taken from all the patients enrolled which was specific for symptoms related to DM, duration of DM and symptoms related to complication of DM. Results: The mean age of patients studied is 57.06 years; standard deviation (SD) of 10.0496 with range of 32 years to 70 years. Out of 50 cases, 28 males and 22 females. Among 50 patients studied, 19(36%) were TMT positive while 32(64%) were TMT negative. According to this study, following observations were made, with reference to average age (p value-0.0012), average duration of diabetes mellitus (p value -0.0001), average HbA1c(p value-0.0137), average FBS (p value-0.0181), average PP2BS (p value -0.000002), average total cholesterol (p value-0.000321), average triglyceride (p value-0.0128), average LDL ( p value -0.00038), average HDL (p value-0.00425) was found to have statistically significant difference between TMT positive cases and TMT negative cases. Conclusion: Longer the duration of diabetes, greater the risk of asymptomatic coronary artery disease. An aggressive and early screening of patients with type 2 diabetes mellitus for the evidence of asymptomatic coronary artery disease may prevent catastrophic cardiac events.

Introduction: Pneumoperitoneum, the introduction of gas into the abdominal cavity, causes disturbances in the body’s regulatory systems, affecting acid-base balance, cardiovascular and pulmonary functions, and the stress response. It leads to increased mean arterial pressure, decreased cardiac output, and elevated systemic vascular resistance, potentially impairing tissue and organ perfusion. Aim and Objectives: To compare the effectiveness, analgesia requirement, and adverse effect of Esmolol and clonidine for maintaining hemodynamic stability in laproscopic appendicetomy. Material and Methods: In the present prospective comparative study, data was gathered from a total of 90 patients falling within ASA (American Society of Anesthesiologists) categories I and II, who were scheduled for laparoscopic appendicectomy and ranged in age from 15 to 50 years. These patients were selected from CRH Hospital in Himmatnagar, Gujarat, and were divided into both study groups and a control group. The study was conducted over the course of one year, spanning from August 2022 to August 2023. Result: There is significant difference in the percentage decrease of heart rate from base line value in Esmolol group-E and Clonidine group – C as compared to control. Esmolol Group- E has significantly lower systolic blood pressure as compared to Clonidine Gruop-C and Control Group-D throughout the intra operative period.

This case report details of a 54-year-old male patient experiencing difficulty swallowing with intermittent chest pain and breathlessness, ultimately leading to the discovery of a right-sided aortic arch anomaly. Initial chest radiography revealed telltale signs of an enlarged right mediastinum and a right-sided aortic knob, prompting further investigation. Contrast-enhanced computed tomography (CECT) and CT Angiography confirmed the presence of a right-sided aortic arch coupled with an aberrant left subclavian artery arising from Kommerell’s diverticulum and aneurysmal dilatation. Notably, this anatomical variant resulted in extrinsic compression of the esophagus, contributing to the patient’s dysphagia symptoms. Discussion encompasses the classification of right-sided aortic arch anomalies, their association with vascular rings, and potential clinical manifestations arising from adjacent structure compression. Additionally, the historical significance and clinical implications of Kommerell’s diverticulum, its prevalence, and typical anatomical locations are explored in depth. This case underscores the importance of recognizing and understanding rare anatomical variations in clinical practice, particularly when presenting with atypical symptoms such as dysphagia.

Introduction: The variations in the branching patterns of the arteries of the limbs have clinical and surgical importance. Anomalies of the arteries of the upper limb are commonly seen. The arterial development is dependent on a precise sequential pattern of the formation and the regression of some of the arteries during development. Aims and Objectives: The present work was done to study the branching pattern of brachial artery and its clinical implications. Materials and Methods: The present study was conducted by dissection of upper limbs of 20 adult human  cadavers, all aged between 35 to 65 years, out of which 15 were male and 5 were female cadavers for a period of one year. Right and left upper limbs were dissected and branching pattern of the brachial artery noted. The course, branches and relations of the artery were observed. Results and Conclusion: Out of 40 upper limbs, 2 limbs had variation in the branching of brachial artery and two limbs were seen with tortuous brachial artery and its terminal branches. Knowledge of variations of brachial artery and its branches is necessary for cardiologists, radiologists, vascular surgeons and orthopaedic surgeons during vascular or reconstructive surgeries of arm and forearm.

Background: Polycystic Ovary Syndrome or PCOS is one of the most prevalent disorders of endocrine metabolic system affecting women of reproductive age group. This disorder is specialized with hyperandrogenism, dysfunction of ovulation along with polycystic ovarian features. Both insulin resistance and metabolic syndrome have several overlapping features in PCOS that produce linking factors between both of the diseases. Here in this study we implicate it to search for the prevalence of insulin resistance and metabolic syndrome among women diagnosed with Polycystic Ovary Syndrome (PCOS) in the North Eastern part of India. Aims and Objectives:  To obtain the occurrence of insulin resistance and metabolic syndrome among women diagnosed with Polycystic Ovary Syndrome (PCOS) in North East India. Materials and Methods: 100 female patients collected from Gynecology OPD diagnosed with PCOS were selected and observed for the presence of clinical and biochemical characteristics of metabolic syndrome. The duration of this study was from December 2018 to November 2020 in Tripura Medical College, Agartala, Tripura, India. Results: Metabolic syndrome was associated with women with PCOS among 31% of cases. Among these, 93.5% had HDL level < 50 mg/dl; while 90.3% had fasting glucose ≥ 100 mg/dl; 87% of women are associated with obesity and 69% PCOS women are accompanied with insulin resistance. Conclusions: PCOS itself is highly associated with prevalence of insulin resistance and metabolic syndrome. Both blood glucose and lipid parameters should be frequently checked for screening of women with PCOS in the clinical laboratories to delay or prevent the long term consequences of metabolic syndrome.

Background & Aims: Acute Encephalitis Syndrome (AES) is a major public health issue among children in India causing high mortality and morbidity. We aim to evaluate the clinical and radiological profile of AES patients and find the predictors of poor outcome. Methods: We conducted a Prospective observational study among children with AES between 1-12 years of age admitted at a tertiary care center from April 2021 to March 2023 (2 years). Clinical features, biochemical tests, CSF analysis and radiological features were studied and analyzed to evaluate the predictors of poor outcome. Results: A total of 170 pediatric cases (male: female, 1.6:1) of AES were enrolled during the study period. Infective etiology could be confirmed in 50 cases (29.5%), out of which JE was the most common (19.4%) cause. All patients admitted in our study were having fever and altered sensorium at admission. Seizure activity was present in most (94.1%) cases.  In both CT and MRI brains, the thalamus followed by the cortex was the most commonly involved areas. Poor outcome (Modified Rankin Scale, MRS ≥ 3) at discharge was observed in 39% of cases. In univariate analysis, prolonged fever and altered sensorium, multiple seizures, abnormal respiration, low GCS, focal neurological deficits, meningeal signs, abnormal neuroimaging, and prolonged hospital stay were found to be significantly (p value< 0.05) associated with poor outcome. In multivariate analysis, low GCS at admission, meningeal signs and prolonged hospital stay came out to be independent predictors of outcome. Conclusion: Low GCS, meningeal signs, and prolonged hospital stay are predictors of poor outcomes in AES.

Background: Melasma is an acquired bilaterally symmetrical facial hypermelanosis and tan to brown(epidermal) or bluish(dermal) in colour. It is more common in women. Nowadays Melasma is one of the most common pigmentary disorder in patients attending to dermatology clinics. There is a limited number of studies regarding Clinico-epidemiological features of Melasma, that’s why we are doing this study for awareness of upcoming dermatologists. Aims: Our present study was aimed to describe clinical and epidemiological features of Melasma in patients attended to dermatology department of King George Hospital, affiliated to Andhra Medical College, Visakhapatnam, Andhra Pradesh, India. Materials and Methods: In our study, total Hundred patients of Melasma attended to our DVL OPD of KGH, Visakhapatnam were included to evaluate clinical, epidemiological data and excluded patients with other causes of facial hyperpigmentation. Results: In our study, majority of the patients belong to age group of 25-45 yrs(71%). Women(82%) were more affected when compared with men(18%). In most of the patients duration is more than 3 years(69%) with recurrences after medication. Recurrences observed mainly in patients occupation with sun light exposure i.e. occupational labour. In woods lamp examination, epidermal type (superficial, 90%) and clinically centrofacial pattern(60%) observed in majority of the patients. Conclusion: According to our study, in North Andhra Pradesh, Melasma is most commonly seen in reproductive age group, especially in females. Recurrences are most common after using Kligman’s regimen (topical) in patients frequently exposed to sunlight without application of sunscreen.

Background: Alopecia areata is a common chronic inflammatory disease directed against the anagen hair follicle, causing nonscarring alopecia of the scalp, beard and/or body hair. The sex incidence is probably equal. Nowadays Alopecia areata is one of the most common hair disorder in patients attending to dermatology clinics. There is a limited number of studies regarding Clinico-epidemiological features of Alopecia areata, that’s why we are doing this study for awareness of upcoming dermatologists. Aims: Our present study was aimed to describe clinical and epidemiological features of Alopecia areata in patients attended to dermatology department of King George Hospital, affiliated to Andhra Medical College, Visakhapatnam, Andhra Pradesh, India. Materials and Methods: In our study, total Hundred patients of Alopecia areata attended to our DVL OPD of KGH, Visakhapatnam were included to evaluate clinical, epidemiological data and excluded patients with other causes of hair loss. Results: In our study, majority of the patients belong to age group of 5-35 yrs (80%). Men (60%) were affected higher when compared with women (40%). In most of the patients duration was more than 3 months (70%). Recurrences observed less (40%). Recurrences observed mainly in younger patients and housewives. In clinical examination, patchy type presented as multiple patches (90%) and clinically in majority of the patients smooth bald hair loss patches were observed on scalp (80%). Severity of the disease was assessed by SALT Score, majority in S1 group (<25% hair loss). Conclusion: According to our study, in North Andhra Pradesh, Alopecia areata is most commonly seen in younger age group. Recurrences are less common in patients with no other comorbidities and also after treatment with steroids.

Introduction: Pain and agitation are the most common side effects after abdominal surgeries which not only affect the recovery of the patient but also increase the hospital stay. Therefore, we decided to conduct a study in which we assess the effect of bilateral Ultra-sound guided Transverse Abdominis Plane (TAP) block used for postoperative pain relief by comparing it with the Intravenous opioids undergoing Laparoscopic Cholecystectomy. This study also assesses the intra operative as well as post-operative hemodynamic stability. Methodology: 80 patients who were posted for routine laparoscopic cholecystectomy surgeries were equally divided into 2 groups with 40 patients each (Group T and Group G). In group T (TAP block + General anesthesia) we gave bilateral USG TAP block by using 0.5% Bupivacaine 5ml & 2% Lignocaine 5ml after general anesthesia, while in group G (General anesthesia) we didn’t give any nerve block after general anesthesia. We observed intraoperative and postoperative analgesic requirements of the patient. Result: Total analgesic requirements were significantly less in group T as compared to group G both in intraoperative as well as early postoperative period. There was decrease in the time spent by the patient in postoperative anesthesia care unit in group T as compared to group G. Conclusion: Bilateral TAP block, using 0.5% Bupivacaine & 2% Lignocaine during general anesthesia for Laparoscopic Cholecystectomy will not only decrease the intraoperative and postoperative analgesic requirements but also decrease analgesic drug usage and discomfort. Therefore, we recommend giving TAP block for Laparoscopic Cholecystectomy.

Candida species are opportunistic pathogens responsible for a range of infections in healthcare settings, posing a significant clinical challenge due to their increasing resistance to antifungal agents. The study aimed to understand the distribution of Candida species and their susceptibility to antifungal agents, providing valuable insights into local epidemiology and treatment strategies. Results revealed a diverse distribution of Candida species, with varying levels of susceptibility to antifungal drugs. These findings underscore the importance of continuous surveillance and tailored management approaches to combat fungal infections effectively in the region.

Background: The subarachnoid block is the preferred anaesthetic technique for operations performed below the belly button due to its cost-effectiveness, ability to effectively relax muscles, and improved post-operative pain management. Levobupivacaine is superior to bupivacaine due to its shortened period of motor blockage, longer duration of sensory blockade, and lower risk of cardiotoxicity. When used with intrathecal local anaesthetics, opioids enhance the efficiency of anaesthesia and pain management during and after surgery. Aim and objectives: This study set intended to evaluate the effects of levobupivacaine in spinal anaesthesia with and without fentanyl. Material and methods: Eighty patients who met the Physical Status I and II criteria for the American Society of Anesthesiologists were divided into two groups at random for this study. The way the study was carried out meant that neither the researchers nor the patients knew which group they belonged to. The study’s goal was to look at the consequences of abdominal surgery. Two groups were randomly assigned to the subjects. A combination of 0.5 ml of normal saline and 2.5 ml of isobaric levobupivacaine 0.5% was given to the Levobupivacaine group (n = 40). A combination of 25 μg (0.5 ml) of fentanyl and 2.5 ml of isobaric levobupivacaine 0.5% was administered to the Levobupivacaine + fentanyl group (n = 40). The duration of the sensory and motor block was noted in the research, along with its onset time. The study also recorded their adverse outcomes in groups, blood pressure and heart rate variations, the duration of analgesia, and their Visual Analogue Scale score. Results: Group LF experienced a significantly faster onset of both sensory and motor block (P < 0.05). Group LF experienced a significantly longer average duration of sensory blockage (P < 0.05). Both groups had steady hemodynamics as well as no sedation all throughout the perioperative phase, and the average length of motor block was found to be similar (P > 0.05). With a p-value of less than 0.001, the analgesic effect persisted significantly longer in Group LF (336.5 ± 31.3 min) than in Group L (223.65 ± 32.17 min). Conclusion: When administering isobaric 0.5% levobupivacaine in conjunction with intrathecal fentanyl (25 μg), patients having surgeries below the umbilicus can experience significantly superior block characteristics and minimal side effects.

Background: Pregnancy significantly affects thyroid gland function due to the structural similarity between serum beta-hCG and serum TSH, leading to cross-reactivity and subsequent thyroid hormone release and TSH suppression. Understanding this relationship can aid clinicians in developing targeted interventions and monitoring strategies for pregnant individuals at risk of thyroid disorders and preeclampsia. Methodology: This study involved 100 antenatal women, with 50 patients having hypothyroidism and 50 patients having normal thyroid function. These patients were monitored, and blood pressure assessments began at 20 weeks of gestation. Results: Our findings revealed that 28% (14 out of 50) of hypothyroid women developed preeclampsia, while only 8% (4 out of 50) of women with normal thyroid function experienced preeclampsia, indicating a statistically significant difference (p-value 0.009). Additionally, we observed that 35.71% (10 out of 28) of women with Anti-TPO Ab positivity developed preeclampsia, compared to 11.11% (8 out of 72) of women with Anti-TPO Ab negativity, also showing a statistically significant difference (p-value 0.004). Conclusion: This study highlights a positive correlation between preeclampsia and hypothyroidism during pregnancy, with a strong association noted with anti-TPO antibodies.

Background: A pre-operative diagnosis of the nature of early ovarian masses either clinically, imaging or with tumour markers is not always reliable. Intraoperative frozen section is a valuable diagnostic tool in rapid categorization of early ovarian masses limited to the ovaries and thereby helps in planning the surgical management. Objective: To categorize ovarian neoplasms into benign, borderline and malignant on frozen sections. To determine the accuracy of the frozen diagnosis with that of surgical specimens. Materials and Methods: Frozen sections done on 46 clinically and radiologically diagnosed ovarian tumours were compared with final histopathologic diagnosis from January 2019 to December 2020 in the Department of Pathology. Results: Frozen section diagnosis of 46 ovarian specimens, showed 40(86.9%) benign tumors, 4 (8.6%) borderline tumors and 2(4.34%) as malignant tumors. The final histopathologic diagnosis revealed 39 (as benign tumors, 1 as borderline tumors and 2 as malignant tumors. The sensitivity and specificity for benign, borderline and malignant tumors on frozen section were 100%, 85.7%,66.6% and 95.3%, 40%, 100%, respectively. The positive and the negative predictive value for benign, borderline and malignant tumors were 97.5%, 100%, 50% and 97.6%, 100%,93.18%, respectively. The overall accuracy was 97.6%. There were no false-positive cases but 1 case was false negative on frozen. The 1 discordant case was serous borderline ovarian neoplasm. Conclusion: With an overall accuracy of 97.6% frozen section is valuable for intraoperative diagnosis of ovarian tumors but has limitations in serous borderline ovarian neoplasm in our study.

Background: The most common surgeries for senior hip diseases are hemiarthroplasty and complete hip arthroplasty. Comparing functional results and complication rates drives clinical decision-making. Methods: A retrospective cohort study at Bhagalpur’s Jawaharlal Nehru Medical College Hospital comprised 50 elderly patients who had THA or hemiarthroplasty. Functional results and complication rates were assessed using the Harris Hip Score (HHS). The two groups’ outcomes were statistically compared. Results: This research of 50 older people compared hemiarthroplasty with THA. With higher Harris Hip Scores (85.6 ± 7.2) than hemiarthroplasty (78.4 ± 9.1), THA showed better functional outcomes. Prosthetic dislocation, surgical site infection, and implant revision occurred in 16% of THA and 20% of hemiarthroplasty patients. These findings suggest that elder hip arthroplasty patients need individualised care. Patients who had complete hip arthroplasty had significantly higher HHS values than those who had hemiarthroplasty (p < 0.05). Hemiarthroplasty had a decreased risk of complications than THA, but the two groups were similar (p > 0.05). Conclusion: Hemiarthroplasty and THA had similar problems, although THA improved functional results in elderly patients. These data suggest individualised treatment regimens to improve geriatric hip arthroplasty results.

Background: Surgery often causes acute cholecystitis, which requires immediate treatment. Doctors differ on whether early or delayed cholecystectomy is preferable. This study will compare immediate and delayed cholecystectomy in acute cholecystitis patients. Methods: The MGM Medical College and LSK Hospital hosted this observational study. Half of 100 acute cholecystitis patients had cholecystectomy shortly after diagnosis, while the other half did so later. Both groups were compared on demographics, clinical outcomes, and postoperative issues. Statistics were analysed using appropriate methods. Results: The study included 100 acute cholecystitis patients, equally split into interval and early cholecystectomy groups. The early cholecystectomy group had a shorter hospital stay (median 3 days) than the interval group (median 4 days, p=0.042), but there was no statistically significant difference in complications or open surgery rates (p>0.05). Postoperative discomfort was lower in the interval cholecystectomy group, with a mean visual analogue scale score of 3.2 versus 3.6 (p=0.087), though not statistically significant. Conclusion: According to our study, early cholecystectomy may reduce hospital stays and consequences in acute cholecystitis patients. These findings suggest early surgical intervention may help treat this prevalent surgical issue.

Background: The provision of optimal nutrition therapy in critically ill patients is a fundamental goal of critical care. Critically ill patients are at increased risk for gut injury and ischemia, hemodynamic instability; however it has been shown that enteral nutrition (EN) is the preferred mode of nutrient intake in patients with a functional GI system. Aim & Objective: To find out whether early enteral feeding would improve clinical outcomes for mechanically ventilated critically ill patients in our pediatric ICU. Methods: It was a hospital based Prospective observational study over a period of 1 year in 55 critically ill children aged 1 month to 18 years who were admitted to PICU, Trauma centre of a tertiary care hospital of Lucknow, Uttar-Pradesh. Out of these 28 patients (50.9%) had feeding within 48 hrs of ICU admission while in 27 feeding started after 48hrs of admission. Results: Mean duration of length of ICU stay (10.54 ± 5.95 v/s 16.85 ± 13.70 days) and mechanical ventilation (5.96 ± 3.86 v/s12.77 ± 9.81 days) in patients was significantly higher in late feeding (≥48 hrs) group as compared to patients in whom early feeding (<48 hrs) was initiated. Conclusion: Based on the finding of this study it can be concluded that early initiation of nutritional support via enteral route as soon as possible after ICU admission is beneficial.

Background: As we all are aware about the fact that proper Sleep is vital for the body and mind. But unfortunately there are sufficient gestures or adequate information about the relationship between sleep quality, stress, and academic performance in the literature of medical sciences. Aim: This study was performed to determine the association and prevalence of stress with sleep quality among young adults of college going students in India. Methods: A study was done among 220 medical students of Index Hospital & Research Centre Indore using a random sampling technique. All students get intimated about an electronic self-administered questionnaire was used about the current standard and overall grade point average, and other demographic and lifestyle factors.  Kessler Psychological Distress Scale (K10) and Pittsburgh Sleep Quality Index (PSQI) were used to assess the stress and sleep quality. Results: The total students who experienced some level of psychological stress were 64.8%. The prevalence of poor quality sleep was observed 73.4%. Study shows strong correlation between poor quality sleep & sleep (Cramer’s value was obtained V = 0.259, P < 0.001) and daytime naps (P = 0.027), and the observation clarified that the significant predictor of poor sleep quality is elevated stress. Conclusion: Increased stress levels were closely and adequately significant with the poor quality sleep in the medical students. And as per the standards of our observation no sort of correlation or a vital significance was observed with the academic performance. For future concern, as the fact our study was very small and we robustly recommend future work should be done on a large scale based sampling and we wish to establishing courses through myriad platforms focusing on guiding & educating the students about dynamic sleep, hygiene and last but not the least with harsh and day to day frustrated and stressful surrounding.

Background: Cervical spondylotic myelopathy (CSM) is a common cause of spinal cord dysfunction, and surgical intervention is often necessary for patients with moderate to severe symptoms. Anterior cervical discectomy and fusion (ACDF) and laminoplasty are two commonly used surgical techniques for the treatment of multilevel CSM, but there is ongoing debate regarding the optimal approach. Objective: To compare the clinical and radiological outcomes of ACDF versus laminoplasty for the treatment of multilevel CSM. Methods: This prospective comparative study included 120 patients with multilevel CSM who underwent either ACDF (n=60) or laminoplasty (n=60). Clinical outcomes were assessed using the Japanese Orthopedic Association (JOA) score, while radiological outcomes included cervical lordosis and range of motion (ROM). Intraoperative data and complications were also recorded. Results: Both groups showed significant improvements in JOA scores at all follow-up time points. At 24 months, the ACDF group had slightly better JOA scores compared to the laminoplasty group (15.1 ± 1.1 vs. 14.6 ± 1.3, p=0.025). ACDF was associated with better maintenance of cervical lordosis (15.9 ± 3.0° vs. 12.1 ± 2.7°, p<0.001), shorter operation time (148.3 ± 28.5 vs. 162.7 ± 33.2 minutes, p=0.013), and less blood loss (135.6 ± 48.2 vs. 225.4 ± 67.8 mL, p<0.001). Laminoplasty allowed for greater preservation of ROM (28.6 ± 3.8° vs. 23.7 ± 3.5°, p<0.001). Complication rates were similar between the groups. Conclusion: Both ACDF and laminoplasty are effective treatments for multilevel CSM, with ACDF showing slightly better clinical outcomes and better maintenance of cervical lordosis, while laminoplasty allows for greater preservation of ROM. The choice between these techniques should be based on individual patient characteristics and surgeon preference.

Background: Child with hearing loss looks normal with no physical characteristics and often achieves normal early milestones. If the hearing impairment remains undetected in the first year of life, far reaching disability of speech and language development will occur. If early detection and timely intervention is executed, hearing impairment is a common treatable disability of childhood. Aims and Objectives: To study the incidence of hearing impairment in high-risk infants, associated risk factors and degree of hearing impairment. Materials and Methods: This prospective study was carried out in the Department of ENT and SNCU, Department of Pediatrics in Assam Medical College & Hospital, Dibrugarh from March 2023 to August 2023. Informed written consent was taken from all the parents before the study. As per the proforma, detailed history, clinical examination including local and systemic examination was done, followed by hearing assessment with DPOAE, and BERA [where ever indicated]. OAE was taken at the time of discharge. Whoever has failed in the test was allotted for a repeat test [OAE] at one month of age. In cases that the screening is failed, diagnostic test was done by BAER at 3 months of age. Results: We found an incidence of 14.53% (n=17) of hearing impairment among high-risk infants. Higher incidence of hearing impairment among female babies compared to male (1.43:1). Bilateral hearing loss was almost two times more than unilateral hearing loss. 52.94% (n=9) babies had severe and profound hearing loss. 7 babies had three or more risk factors and this signifies that as the number of risk factors increase, the chance for hearing impairment also increases. Conclusion: There is a high incidence of hearing impairment among high-risk infants. NICU stay > 5 days, ototoxic drugs, sepsis, prematurity and low birth weight is the significant risk factors for hearing impairment in neonates. This highlights the importance of neonatal screening in such high-risk infants. In a limited resource setting, at least a targeted approach of screening program should be implemented in neonatal care units.

Background: Coronavirus disease (COVID-19) causes an immunosuppressed state and increases risk of secondary infections like mucormycosis. The aim of this study is to report the spectrum of fungi, causing Mucormycosis in RT-PCR positive COVID-19 patients, by culture on SDA and study the role of other factors responsible for the disease. Methodology: It is a prospective, observational study on mucormycosis in RT-PCR positive COVID-19 patients based on hospital records and fungal culture reports from 12th May 2021 to 21st July 2021. The study includes cultures conducted on Nasal debridement samples by 10% KOH (potassium hydroxide) mount, SDA (sabouraud dextrose agar) and LPCB(lactophenol cotton blue) mount from patients admitted in the hospital with RT- PCR confirmed COVID-19 and typical symptoms of Mucormycosis. Results: In present study total of 114 patients fulfilling inclusion criteria, with mean age of 52.47±11.20yrs with male preponderance (77.2%) and female were 22.8%. among the included participants, 58.8% were with diabetes mellitus. The fungal culture was positive in 68.4% of the patients, among them 51.8% were positive for rhizopus, 6.1% for aspergillus niger, 2.6% for lichtheimia, 1.8% with aspergillus sp, aspergillus flavus, 1 patients each with aspergillus fumigates and rhizomucor. Steroid therapy was present in 20.2%. Conclusion: Patients of Mean age 52 years with known diabetes status hospitalized for COVID-19 are at higher risk of developing Mucormycosis with the most common causative organism isolated being Rhizopus species.

Background: The global increase in life expectancy has led to a rise in elderly patients seeking psychiatric care, particularly in countries like India with a significant aging population. This cross-sectional study conducted in a government district hospital in Udupi, India, aimed to assess the prevalence of psychiatric morbidity and patterns of associated physical illness among elderly patients. Materials and Methods: A total of 120 subjects aged 60 years and above were included, with a focus on demographic data, psychiatric diagnoses, and comorbid physical conditions. Results: The study found a high burden of mental behavioural disorders, notably alcohol-related disorders (42.5%) and depression (31.6%), with a higher prevalence among males. Physical illness, including hypertension, diabetes mellitus, and cardiovascular disorders, was prevalent among the elderly psychiatric patients, highlighting the need for integrated healthcare approaches. Conclusion: The findings underscore the importance of addressing social, cultural, and familial factors contributing to psychiatric disorders in this population, along with the recognition and treatment of comorbid physical conditions.

Introduction: In the realm of labor analgesia, the choice between Bupivacaine-Fentanyl and Ropivacaine-Fentanyl for epidural administration holds significance in optimizing pain relief while ensuring maternal safety. Bupivacaine, known for its long-lasting analgesic effect, and Ropivacaine, lauded for its reduced motor block, both combined with the potent opioid Fentanyl, offer distinct profiles in efficacy and side effect profiles. This study compares bupivacaine-fentanyl and ropivacaine-fentanyl for labor epidural analgesia, assessing efficacy, safety, and obstetric outcomes. Material and Methods: In this prospective randomized comparative study conducted at the department of obstetrics and gynecology, we aimed to evaluate the potential advantages of ropivacaine over bupivacaine in terms of obstetric outcomes for parturients undergoing labor epidural analgesia. A total of 70 eligible parturients, meeting specific inclusion criteria, were randomly assigned to receive either ropivacaine-fentanyl or bupivacaine-fentanyl epidural infusions. Pain levels were assessed using the visual analog scale (VAS), while motor function, adverse effects, and hemodynamic parameters were closely monitored throughout labor. Additionally, neonatal outcomes, including Apgar scores and NICU admission rates, were recorded. Results: In this study, ropivacaine/fentanyl recipients exhibited significantly higher local anesthetic use (14.45 ± 5.6 mL/h) and lower demands (7 ± 2.0) compared to the bupivacaine/fentanyl group. VAS scores were comparable between the ropivacaine and bupivacaine groups at various time points. In the bupivacaine/fentanyl group, one patient experienced moderate motor block (score of 2 on a 0–3 scale), while no profound motor block was observed in either group. These effects were noticeable within 60 minutes post-epidural catheter insertion and remained consistent during labor. Additionally, one patient in the bupivacaine/fentanyl group exhibited motor block (score of 1 on a 0–3 scale) following the initial 1.5% lidocaine epidural test dose. Conclusion: In conclusion, the ropivacaine-fentanyl combination demonstrated lower local anesthetic requirements and reduced need for supplemental analgesia during labor and delivery, suggesting potential advantages over bupivacaine-fentanyl in terms of analgesic efficiency and resource utilization.

Background: Polycystic Ovarian Syndrome (PCOS) is a prevalent endocrine disorder among women of reproductive age featuring insulin resistance and hormonal imbalances. Due to gastrointestinal issues caused by metformin, alternatives like N-acetylcysteine (NAC) are being explored. Objective: The study assessed the effectiveness of NAC compared to metformin in treating PCOS symptoms at a tertiary care hospital. Methods: In this randomized controlled trial, 80 women with PCOS were divided into NAC and metformin groups from November 2022 to March 2024. The study monitored changes in insulin resistance, hormonal profiles, menstrual regularity, ovulation rates, quality of life, BMI, and lipid profiles. Adverse effects and discontinuation rates were also recorded. Results: Both treatments significantly improved insulin resistance and hormonal profiles. NAC was particularly effective in reducing insulin resistance and androstenedione levels. Menstrual and ovulation improvements were similar across both groups. NAC users experienced greater emotional well-being and fewer body hair issues along with lesser gastrointestinal side effects and discontinuation rates. Conclusion: NAC might be a preferable alternative to metformin for managing PCOS, offering better tolerability and improved quality of life. Further studies are needed to validate these results and assess long-term benefits.

Introduction: Oral cancer is among the most prevalent medical conditions in India and the nations that collectively make up the Indian subcontinent. An innovative method for managing this malignancy is early leukoplakia detection. In the oral cavity, oral leukoplakia (OL) is thought to be the most prevalent premalignant oral lesion. Leukoplakia is one of several precancerous oral lesions that also includes erythroplakia, lichen planus, and submucousfibrosis. The primary cause of oral cancer is tobacco use.Other contributing factors to the development of oral cancer include the human papillomavirus, ethnicity, socioeconomic status, inadequate nutrition, and inadequate dental hygiene. The situation is particularly concerning for the Indian population because around 10% of all malignancies arise in this group each year. Oral squamous cell carcinoma aetiology may involve oncogene and tumour suppressor gene deactivation and aberrant expression. Material and Methods: This study was carried out in Department of Anatomy, S.P. Medical College and Associated Group of Hospitals, Bikaner, Rajasthan. Using an informed consent form, an overall of 50  OLP individuals as well as 50 healthy people were enrolled as controls in the study. Tissue sections were submitted to FISH analysis using the locus specific identification (LSI) TP53/CEP 17 FISH Probe Kit, a publically available probe from Vysis, after protocol optimisation. Results: Our study found that the largest number of leukoplasmic patients fell between the 40–60-year age range, and that males were more common than females in both the case and control groups. Mean age group of cases is 48.64 with SD=12.83. Mean age group of control group is 47.02 with SD=14.13. In the case group, 3 subjects (n=3) exhibited p53 gene aberrations, specifically 2 cases with gene amplification and 1 case with gene deletion while no other subjects displayed such deviations. The site of lesion in cases mainly involved was buccal mucosa, tongue and labial mucosa. Conclusion: The chromosomal structure research field entered a new era with the development of the FISH technology. Thus, the present study has been done by the FISH technique to identify the numerical aberrations in p53 gene with the patients with oral leukoplakia and to compare the data with the control group as there are very less study on the leukoplakia in the western zone of Rajasthan.

Due to less number of cases and limited aberration there is limitation in our study to establish the correlation of type of numerical aberrations with age, gender, site, habits and grading.

Introduction: Adipose Tissue Is Not Only The Storehouse Of Fats And Energy But Also A Major Endocrine Organ Secreting Adipocytokines. Adipocytokines Play An Important Role In Regulation Of Food Intake & Body Weight, Insulin Sensitivity,Inflammation And Vascular Haemostasis. Visfatin Is A Novel Adipokine (52kda) Predominantly Secreted From Visceral Fat. It Shows Insulin-Mimetic Effects Which Correlate With Overweight & Obesity.Our Aim Is To Compare Serum Visfatin Level In Normal Weight,Overweight &Obese Individuals. Materials & Methods: This Is A Cross-Sectional Comparative Study Of Total 162 Adults Between Age Group Of 20-60yrs Including Both The Sexes. All The Individuals Are Divided Into 3 Groups With 54 Subjects Each As Per Bmi. 3ml Of Whole Blood Is Collected With Informed Consent From All Individuals.Serum Visfatin Level Is Analyzed By Elisa. All Data Are Presented As Mean (M)& Standard Deviation (±Sd).Statistical Analysis To Be Done Using Spss Version 20. The Values Are Considered Significant At P <0.05. Results: Fasting Serum Visfatin Level Is Increased In Overweight (100.8+29.9pg/Ml) & Obese Individuals (129.1+21.4 Pg/ Ml) As Compared To Normal Weight Subjects (82.4+26.5pg/ Ml) Which Is Statistically Significant (P<0.012). Conclusion: Serum Visfatin Is Elevated In Overweight & Obese Individuals Compared To Normal Individuals.The Significant Increase Level Of Visfatin In Obese May Be Used As A Diagnostic And Prognostic Biomarker For Insulin Resistance And Metabolic Syndrome.

Background and Aim: The surgical repair of an inguinal hernia is one of the most common general surgery procedures. The present study was undertaken to compare intraoperative and postoperative outcomes of Lichtenstein tension-free mesh hernioplasty under local anaesthesia compared to spinal anaesthesia. Materials and Methods: In this longitudinal study, 100 patients aged between 20-80 years, posted for elective mesh hernioplasty were enrolled & divided into two groups. Group- L (n=50) hernioplasty was done under local anaesthesia, & Group-S(n=50) hernioplasty was done under spinal anaesthesia. Patients were assessed for intraoperative comfort or pain felt during surgery, duration of surgery, postoperative pain score, postoperative analgesic doses required, duration of hospital stay and patient satisfaction. Results: Intraoperative pain was comparable in both groups (p=0.695). There was statistically significant difference observed in duration of surgery (p=0.001), postoperative pain at 6hrs (p=0.001), 24hrs(p=0.009) and 48hrs(p=0.047). The mean duration of hospital stay was 2.12 ± 0.172 days in Group-L and 3.9 ± 1.1days in Group-S (p=0.001). The total incidence of postoperative complications seen in Group L and Group S was 6% and 32%, respectively, which was statistically significant (p-0.001). However, in Group-L, 84% of cases responded ‘satisfactory’, and in Group-S, 80% responded ‘satisfactory’ at 6 weeks follow-up, which was statistically insignificant. Conclusion: Lichtenstein tension free mesh hernioplasty under local anaesthesia can be a safer alternative to spinal anaesthesia with the advantages of less postoperative pain and postoperative complications in uncomplicated inguinal hernia.

Introduction: Anemia is crucial among all nutritional disorder in all over the world1. Anaemia is a global public ill-health problem affecting both developing and developed countries with major consequences on human health specially women and children. According to WHO (2008) Iron deficiency anaemia (IDA) remains the most typical medical disorder in pregnancy within the developing world, with the burden of disease impacting on both the mother and therefore the newborn. Material and Methods: A total of 200 antenatal patients were included in the study based on inclusion and exclusion criteria. All the women underwent detailed history taking and clinical examination, routine. Details of the patients including clinical data and investigations were recorded in self prepared clinical data sheet. These recruited women were divided into two group’s i.e. anaemic and non-anaemic group. Results: Out of total 200 cases of deliveries, complications of labour were seen in 34 cases. Majority of cases were of PPH i.e. 13, where 8 were non anaemic while 3 were having Haemoglobin level ≤ 9.9g/dl. Equal number of cases was seen in anaemic and non-anaemic group with respect to respiratory infection and failing lactation. Mean Apgar score at 1 min were 7.88, 8, 8 and 8 for non-anaemic, mildly anaemic, moderately anaemic and severely anaemic group respectively. At 5 min mean Apgar score, univariate analysis showed 8.91,9,9 and 9 for nonanaemic, mildly anaemic, moderately anaemic and severely anaemic group respectively. Total 22 perinatal morbidity were noted, out of which 14 were foetal growth restriction babies and 8 early neonatal deaths. Conclusion: Estimation of maternal haemoglobin alone doesn’t have direct effect on the maternal and perinatal outcome if provided with effective obstetric and neonatal care.

Introduction: Antibiotic resistance is concerningly on the rise in our communities and hospitals, increasing the risk of treatment failure and recurrent infections. The human healthy intestinal gut flora has been altered by the improper use of antibiotics, creating a reservoir of microbes resistant to antibiotics known as the “gut resistome. Methodology: From 60 healthy Siddipet residents, 60 stool samples were taken. It was then processed using standard laboratory procedures to isolate two aerobic enteric bacteria, Klebsiella pneumoniae and Escherichia coli. The Clinical and Laboratory Standards Institute-recommended Kirby Bauer Disc Diffusion method was used for antibiotic susceptibility testing. Results: Out of the 60 subjects, 100% had E. Coli, 80% had K. pneumoniae, and 20% had a combination of both E. Coli and K. pneumoniae isolates. These two microbes have demonstrated resistance to multiple antibiotic classes. Cephalosporins exhibited the highest level of resistance (100%) followed by fluoroquinolones (50%) and aminoglycosides (43%). Conclusion: It is concerning to find commensal organisms with resistance genes. There’s a chance that this will spread and might manifest them when antibiotic pressure is present. To determine the actual prevalence of MDR in the community, more research involving environmental sampling and a correlation of local prescription patterns must be conducted.

Introduction: Maternal metabolism undergoes numerous changes during pregnancy including lipid metabolism to ensure adequate nutrient supply to the foetus. The present study investigates alterations in lipid profile (Total cholesterol, triglycerides, LDL, VLDL and HDL) in normal pregnant women (primigravida) in the three trimesters and non- pregnant women of similar age group. The purpose of the present study is to find out the effects of pregnancy on the lipid profile in order to take steps to minimize cardiovascular complications and promote reproductive health of women. Aim: To study the changes in lipid profile during normal pregnancy. Materials and Methods:  This was a cross-sectional observational study consisting of 200 subjects that included 100 primigravida pregnant women and 100 non- pregnant women between 20-35 years. Blood samples for the estimation of lipid profile were taken and analysed using clinical chemistry analyser ERBA (XL-300). Results: Serum Low density lipoprotein (LDL), total cholesterol (TC), triglycerides (TG) and very low density lipoproteins (VLDL) were significantly elevated in the second and third trimesters when compared to first trimester and also in comparison to normal non-pregnant women.  Serum High density lipoproteins (HDL) showed a biphasic pattern characterised by significant elevation in first trimester when compared to normal non-pregnant women and then progressively declined in the second and third trimesters when compared to normal non-pregnant women. Conclusion: An atherogenic lipid profile is observed in most women by the third trimester of normal pregnancy.

Background and Objectives: Preservation of the articular congruity is the principle prerequisite for successful recovery following distal radius fractures. The best method of obtaining and maintaining an accurate restoration of articular anatomy however, remains a topic of considerable controversy. External fixator with distractor (UMEX) method is one of the treatment for distal end of radius fracture the main aim of this study is to evaluate the results obtained by treatment of distal end radius fractures by external fixation. Method: The present study was done at Department of Orthopaedics, Sanjay Gandhi Institute of Trauma and Orthopaedics, Bengaluru .Mean age of the patients was 42.5 years, external fixator with distractor (UMEX) was applied for a mean duration of 6.5 weeks and cases were followed up for an average of 9 months post operatively. Results: Assessed as per clinical scoring system of Green DP and O’Brien et al. for functional results at the end of 9 months of follow up. Excellent to good functional result was noted in 90%. Conclusion: External fixation with distractor (Umex) and ligamentotaxis provides better functional and anatomical results in comminuted intra-articular distal radius fractures. The successful use of external fixator with distractor for distal end radial fractures requires careful assessment of fracture pattern, appropriate patient selecting meticulous surgical techniques appropriate choice of fixation, careful post- operative monitoring and aggressive early institution of rehabilitation. The final functional results of treatment of distal end radius fractures not only depends on the anatomical restoration of the articular surface but also on the associated soft tissue injuries and articular damage.

Introduction:  The management of comminuted inter trochanteric fractures of femur  in elderly patients is tricky as there is challenge of difficult anatomical reduction in osteoporotic bones, need for prolonged immobilization after surgery and more chances of screw cut out in poor quality bone. Prolonged immobilization will leads into complications like bed sores, chest infections, deep vein thrombosis, dependency and psycho social side effects, increasing the both morbidity and mortality. The aim of our study was to evaluate the functional outcome of cemented bipolar hemiarthroplasty in comminuted inter trochanteric fractures of femur in elderly patients using Harris Hip Score. Materials and Methods: This is a Prospective study conducted at Department of Orthopaedics, Shri Atal Bihari Vajpayee Medical College and Research institute, Bengaluru. Twenty elderly patients with age above sixty years having comminuted inter trochanteric fractures of femur treated by using  cemented bipolar hemi arthroplasty were evaluated for functional outcome using Harris Hip Score. Results: There were 12 female and 8 male patients with mean age of  68.82 years (60 -82)years treated by cemented bipolar hemiarthroplaty.  Patients were followed up at 6 weeks, 3 months, 6 month and 1 year.  At one year follow up with help of Harris Hip Score 8 patients (40%)  were graded as excellent, 10 patients (50%) as good and 2 patients (10%) as fair. Conclusion: The procedure offered rapid mobilization , early return to pre injury level and gave a lasting solution to elderly patients with comminuted inter trochanteric fractures of femur.

Background: From long time clubfoot has been a clinical challenge to orthopaedic surgeons. It is one of the commonest congenital deformity of the musculoskeletal system in children. Each year more than 1,00,000 babies are born with congenital clubfoot. 80% of which occur in developing countries. Methods: Data collected from the Department of Orthopaedics, Sanjay Gandhi Institute of Trauma and Orthopaedics, Bengaluru 60 feet in 40 children were treated by the Ponseti method from September 2022 to august 2023. Prospective follow up for a mean duration of 18 months was undertaken. The deformity was evaluated by Pirani score before and after the treatment. At the end of treatment all feet were functionally classified into good, fair and poor. Results: The average number of casts applied before full correction was 8. 21.66% of the feets needed tenotomy before full correction. 90% of the patients showed good results, 3.3% had fair results and 6.6% of patients had poor results. There was a significant difference in the pre-treatment and post-treatment pirani score values. Conclusions: Ponseti method of manipulation and plaster casting is very effective to correct club foot deformity.

Background: Labor induction is a common obstetric intervention among nulliparous women. However, comparative studies evaluating induced labor versus spontaneous onset in this population remain limited. Aim and Objective: This prospective comparative study assessed feto-maternal outcomes and labor progression among nulliparous women undergoing induced labor versus spontaneous labor. Materials and Methods: The study was conducted at the Department of Obstetrics and Gynecology, GMERS Medical College and General Hospital, Junagarh, over six months. A total of 100 nulliparous women were included, with 50 undergoing induced labor and 50 experiencing spontaneous labor. Data on demographic characteristics, labor progression, mode of delivery, maternal complications, and neonatal outcomes were collected and analyzed. Results: Nulliparous women undergoing induced labor had a higher requirement for oxytocin augmentation compared to those experiencing spontaneous labor (48% vs. 20%, p = 0.003). Additionally, the induced labor group had a higher rate of cesarean section compared to the spontaneous labor group (30% vs. 16%, p = 0.041). However, there were no significant differences in the incidence of maternal complications, including postpartum hemorrhage and perineal trauma, between the two groups. Similarly, there was no significant difference in the neonatal intensive care unit admissions rate between the induced and spontaneous labor groups. Conclusion: While induced labor in nulliparous women may be associated with increased rates of oxytocin augmentation and cesarean delivery, it does not appear to confer a significantly higher risk of maternal or neonatal complications compared to spontaneous labor. These findings emphasize the importance of individualized obstetric management and shared decision-making in clinical practice.

Background: It is estimated that 20-40% stillbirths in the non-anomalous category occur as result of intrauterine hypoxia and are therefore potentiality preventable. In this context, a screening test is ideally needed at the time of onset of labour which can detect the already existing compromise on the fetus and which can predict its well-being for next hours in labour, so that timely intervention can prevent irreversible neurological damage and death. This study was undertaken with the purpose of evaluating the efficacy of labour admission test as a screening test to identify the compromised fetus or fetus at risk and to correlate with perinatal outcome. Methodology: This study was conducted as a cross sectional studies in 400 antenatal women admitted in lab our ward in a tertiary care teaching hospital for the period of one year. Mothers were selected randomly who belonged to both low and high-risk group. Low risk cases are those pregnant women with singleton term fetus in cephalic presentation, with labour pains either spontaneous or accelerated. High-risk cases are those with post-dated pregnancy, hypertensive disorders of pregnancy, gestational diabetes, IUGR/ oligohydramnios, Anemia, Rh Incompatibility, Post caesarean pregnancy and heart disease complicating pregnancy “Fetal care” fetal monitoring system (CTG machine) was used in this study.  In this study admission test was done for 400 patients at the time of admission to labour ward. Patients were followed according to the ‘AT’ results. Results: of 400 patients in our study, 255 were low risk cases and 145 were high-risk cases. CTG was done in all patients.280 cases had reassuring pattern (70%), 68 cases had non reassuring pattern (17%), and 52 cases had abnormal tracing pattern. Of the 400 cases, 280 had labour natural, 114 (29%) went for Cesarean Section and 6 cases (1%) went for Forceps Delivery. Among 280 patients who had reassuring CTG, 15 babies were admitted in NICU. 35% of the babies of non-assuring group were admitted in NICU. 56% of the babies of the abnormal CTG group were admitted in NICU. Therefore, NICU admission is more in the non-reassuring and abnormal CTG group. Sensitivity was 83.54%. Specificity was 78.55% in our study. Diagnostic accuracy of the test was 79.25%. Conclusion: An ideal screening test should have high sensitivity and negative predictive value as this test is found to have the above features in my study, it is certainly recommended as a screening test for fetal distress at the time of admission.

Introduction: A diagnosis of cancer is shattering for patients and their loved ones. During the months after diagnosis, the cancer sufferer must attempt to come to terms with both uncertainty of the threat to life and disabling. Cervical carcinoma patients are concerned to sexuality, feminity and feeling of motherhood. The research available from India and other developing countries regarding psychosocial issues in malignancy in cancer of the cervix in particularly is meager. Materials and Methods: The study was done in the department of medical oncology at Shirdi saibaba cancer hospital and research centre, kasturba hospital, manipal. The study period is August 2009 to February 2010. Results: 30 Study subjects were selected for the study. The majority of the subjects were in the 41-50 age group.

Background: The prostate is the accessory gland of male reproductive system. The primary function of prostate gland is to secrete a clear, slightly alkaline fluid that contributes to the formation of seminal fluid. With advancing age, the gland undergoes significant changes both microscopic and macroscopic. The aim of this study is to demonstrate the normal changes occurring in the fibromuscular stroma of human prostate glands in various age groups. Method: An observational study on age related changes in fibromuscular stroma of human prostate gland was conducted in the Department of Anatomy, Government T D Medical College, Alappuzha. 100 specimens of human prostate glands were obtained from the Department of Forensic medicine and Department of Pathology, Government T D Medical College, Alappuzha. The pattern of changes in fibromuscular stroma in different age groups was studied using Haematoxylin, Eosin and other special stains.Results: The fibromuscular stroma was predominant in pre-pubertal prostate specimens. In post pubertal and adult p rostate specimens, there was a relative reduction in the amount of stroma. In 61-75 years age group, there was an increase in the proportion of fibromuscular stroma compared to glandular tissue in 60% of specimens. Conclusions: The present study shows that significant changes occur in the fibromuscular stroma of prostate glands beginning from birth to old age. The results of this study may be helpful in histopathological correlation of various diseases of prostate gland.

Background: Femoral neck fractures, the most common injury in the elderly and presents great challenges to orthopedic surgeons. The number of elderly people is on the rise, the burden of this fracture and its squeal is challenging. Evaluation of long-term outcomes of an operative procedure is important to determine the durability of the procedures like total hip replacement (THR). This study was done to assess the functional outcome of cemented total hip arthroplasty in elderly patients with fractured neck of femur at 2 to 4 years follow up. Methods: A prospective follow up study for 5 years was conducted among elderly patients with fractured neck of femur who were treated with cemented total hip arthroplasty. By convenient sampling method 32 cases of fracture were analyzed for functional outcome by using Harris Hip Score post operatively and followed them for 2-4 years. Results: Majority 29 (90.6%) of the people had excellent and good functional outcome and only 2 (6.3%) had poor functional outcome in our study. The total HHS score was statistically better for the mid-term follow up compared to short term follow up (p<0.001). Conclusion: The cemented Total hip arthroplasty (THA) is a very useful procedure for the primary treatment of femoral neck fractures in elderly. This procedure markedly improves the functional status of the patient in terms of early mobilization, avoiding the complications of prolonged immobilization. Longer follow up studies are recommended to assess the hip function, implant survival and complication related to wear and loosening in the long term.

Introduction: Breast lumps are one of the common problems encountered in women. These lumps are frequently seen in younger to middle aged women and often they go undetected for various reasons. Early recognition of malignancy plays a vital role for improving survival. The need of the hour is a system to detect malignancy earlier and minimize the time needed for the detection of malignant lumps. This study was done to determine the clinical characteristics of palpable breast lumps and with the objective of detecting malignancy earlier in patients presenting with palpable breast lumps using a quadruple assessment. Materials and Methods: This is a Prospective observational study done in 50 patients was included in this study after application of inclusion and exclusion criteria. Each patient underwent a quadruple assessment comprising of a detailed Clinical examination, Ultrasonography of breast, mammogram and Fine Needle aspiration. All the patients finally underwent surgery for their condition and the results of the quadruple assessment were analyzed individually and collectively and were compared to histopathological diagnosis. Results and Discussion: In our study breast, lumps were commonly seen in the age group of 31 to 40 years. Pain over the lump was an important symptom in our study the upper outer quadrant was commonly involved with tumor. When the clinical examination findings were examined as a whole clinical examination had sensitivity of 70 % and specificity of 87% for the detection of malignancy. Mammogram had a sensitivity of 95% for malignancy detection and ultrasound was found to have a sensitivity of 90% in detecting malignancy. In our study, sensitivity and specificity of FNAC to detect malignancy were 95% and 100% respectively. The sensitivity of quadruple assessment for the detection of malignancy was 65% and the specificity for the detection of malignancy was 100%. Conclusion: Breast cancer is the foremost cause of cancer related death in young females; hence early detection of breast cancer carries much importance it has been shown that Ultrasound is as accurate as mammography in detection and differentiation of palpable breast lumps and it can also aid in guiding the site for FNAC and biopsy. Four components of the quadruple test complemented each other and when done with experienced clinicians and Radiologists can reduce the time lag for the detection of malignancy and help us to institute early definitive treatment.

The medical education in India is rapidly progressing and improving since in last decade. A CBME pattern is teaching and internal assessment mainly focuses on the context of competency. In internal assessment a lot of emphasis and weightage are given to summative assessment examination of last three internals. A new professional MBBS curriculum is vast and emphasis has been laid down by the universities and regulatory bodies on attendance policies. Attendance during their undergraduate curriculum plays very crucial role in the later professional life. In the professional courses rule are regarding the attendance during lectures and practical is compulsory. The universities have mandatory attendance policies during lectures and practical sittings. Even though, student’s absence is a continuing problem in medical education. A study was conducted in first year MBBS Batch (2021-22) of CBME pattern were included in the study. This batch had total 150 students they were further separated in two parts > 80% and < 80% class attendance in theory and practical at the time of first, second, preliminary internal and final university examinations. Students class attendances were compared with their exams result (Pass / Fail). The measureable data were analyzed by using chi-square test. The students with >80% class attendance were having more passing result as compared to those with <80% class attendance in their all internal assessments and final university examination. First MBBS student’s entire academic performance was affected by their class attendance.

Introduction: India emerged as a major player in the field of Software Engineering in 1990s. Software Industry has become the career option of choice for many young educated Indians because of its lucrative salary and perks. Hence, long working hours, pressure at work, night shifts and lack of sleep among the software Professionals lead them to various health problems which is the main focus of this study. Methodology: It is a cross sectional study which was done among the software professionals working in Hyderabad. The sample size was calculated by taking the prevalence of visual problems as 52% from a study conducted among software employees by Manish Prasad et al⁷ at 95% significance and 10 % absolute precision. Estimated sample size was 400. Three software firms were thus selected by simple random sampling and data was collected from all the software employees who were willing to take part in the study, till the desired sample size was met. Results: The mean age of study subjects was 34.04 ± 7.52 years, where mean age of males was 34.79 ± 7.72 years and mean age of females was 32.15 ± 6.66 years. Almost half of them were having complaints of visual and musculoskeletal problems. Majority (45.25%) were having low stress, according to perceived stress scale, followed by moderate stress and high stress being experienced by study subjects and around 29% of the study subjects were diagnosed with insomnia according to Athens insomnia scale. Conclusion: Majority (71.5%) of the study subjects in the study was males and females were 28.5%. Refractive errors (23.5%), Hypertension (14.6%), Diabetes (7.75%) and tension head ache (7%) were the other important health problems existent among the study population. Comparatively more number of elder (>40 years) study subjects and males were pre diagnosed with hypertension. Hypertension was more commonly occurring among the study subjects who smoked and consumed alcohol.

Introduction: Candida spp. is the fourth most common cause of nosocomial bloodstream infections and the third leading cause of urinary catheter related infections. In recent years there has been an increasing trend in the emergence of Candida non albicans as a potential pathogen responsible for nosocomial infections as well. The in vitro susceptibility testing of antifungal agents is becoming increasingly important because of the introduction of new antifungal agents and the recovery of clinical isolates that exhibit inherent or developed resistance to Antifungal agents. Aims and Objectives: To study the prevalence of Azole resistance in various Candida species. To study the antifungal susceptibility pattern of various Candida species. Material & Method: Various samples like urine, blood, cerebrospinal fluid, pus, tissue, sputum, body fluids, vaginal swab, broncho alveolar lavage fluid were taken from clinically suspected cases for culture and antifungal sensitivity testing was done according to CLSI guideline. A total of 90 Candida spp. were isolated from these samples, which were included in this study. Result: Out of 3137 culture positive isolates, 90 were Candida species. Prevalence rate of candida spp. is 2.86%. Out of total 90 isolates, 77% (69 isolates) were Candida non albicans and 23% (21 isolates) were Candida albicans. The rate of isolation of Candida was more in Males (51%) than Female (49%). The most frequently isolated species was Candida krusei (32%). Highest number of Candida was isolated from the Urine (51%) & in the infants (44%). Maximum Candida species were isolated from the Extramural-NICU (39%). All Candida species were highly sensitive to Voriconazole and highly resistant to Amphotericin B. Conclusion: The changing epidemiology of Candidiasis, therefore highlights the need for close monitoring of Candida species distribution and susceptibility in order to optimize therapy and outcome. We should also develop the guideline for empirical therapy based on epidemiology of India. Candida non-albicans species were more resistant to azoles compared to C.albicans, information that can be useful for clinicians dealing with non – responding cases.

Introduction: Anemia affects 24.8% of the global population, and automated hematology analyzers provide accurate RBC indices. However, expertise is required for peripheral blood smear examination, and hematologists only provide incremental helpful information in 4% of cases. Aim of the Study: To correlate morphological type of anemia based on RBC indices (MCV, MCH and   MCHC) and RDW obtained from Mindray BC 6200, a 5 part automated analyzer with morphological type of anemia based on peripheral blood smear examination and to assess the concordance of both investigations in diagnosis of anemia with severity and morphological typing of anemia. Material and Methods: A total of 200 cases of anemia were studied over a period of two years between June 2019 to June 2021. Anemia typing was done by two methods –Firstly using RBC indices with RDW only. Secondly on peripheral blood smear examination. The results were then correlated. Results: Morphological typing of anemia in cases of Microcytic hypochromic anemia with normal and raised RDW shows maximum specificity and macrocytic anemia using RBC indices and RDW shows maximum sensitivity. In cases of Normocytic normochromic anemia, the cases with normal RDW showed high specificity and sensitivity but the cases with raised RDW were wrongly typed on indices had a low sensitivity and specificity indicating additional peripheral blood smear examination as an absolutely necessary tool in morphological typing of anemia. Conclusion: Automated hematology analyzers provide valuable readings for morphological typing of anemia, but peripheral blood smear examination remains the gold standard method. It helps identify the cause of anemia and requires multiple observers for accurate typing. Even today, peripheral blood smear examinations cannot be completely replaced by automated hematology analyzers, as they provide additional information like dimorphic anemia and abnormal cells.

Background: A pregnancy with more than one fetus is called multiple pregnancy. Multiple pregnancies are prevailing due to a dramatic increase in use of ovulation-inducing agents, ART, and  shift towards elderly primigravida and grand multiparity. Aims and Objectives: To study maternal risk factors and fetal outcomes associated with multiple gestation. Materials and Methods: This retrospective study was carried out at adichunchanagiri institute of medical sciences, Mandya. A sample of 70 mothers with multiple gestation was collected from hospital records regarding maternal age, parity, risk factors, spontaneous or assisted conception, gestational age, pregestational BMI, and family history. Fetomaternal complications that occurred during the antenatal period, labor, and mode of delivery were collected and analyzed. Results: Out of 8000 deliveries, there were 70 cases of multiple gestation over 5 years, with an incidence rate of 8.75 in 1000 deliveries. 8.5% are conceived by ovulation induction, 5.7% by IVF. 24% MCDA, 73.28% DCDA, and 2.8% are MCMA twins. Preterm labor (65.6%), anemia (46.8%), and hypertension (10.5%) were common problems. (61.4%) vaginal deliveries and (35.7%) LSCS were conducted. Fetal malpresentation leads to 32% of LSCS. Among fetal complications, FGR was seen in 11.4%.  A low APGAR score was noted in 21.4% of preterm babies. Conclusion: Maternal risk factors include multiparity, elderly pregnancy, use of ovulation induction, and ART. Maternal complications are preterm labor, PROM, PPROM, abruption, PPH, etc. Fetal complications noted are  hypoglycemia, respiratory distress, intraventricular hemorrhage, necrotizing enterocolitis, stillbirth, low birth weight etc. Hence the restricted use of ovulation induction ART, promoting early conception. Vigilance during ANC and labor is needed in selecting the mode of delivery. Active fetal surveillance and intervention improve fetomaternal outcomes.

Introduction: Type 2 diabetes mellitus (T2DM) is associated with an increased risk of cardiovascular complica-tions, including left atrial dysfunction. However, there is limited research on left atrial function in T2DM, par-ticularly in rural populations. This study aims to assess left atrial function in T2DM patients with a disease duration in a rural setting of Eastern UP. Methodology: Two hundred ten participants were recruited, with 105 in the T2DM group and 105 in the con-trol group. Demographic, clinical, and echocardiographic parameters were collected. Left atrial function parame-ters, including left atrial emptying fraction and peak left atrial longitudinal strain, were assessed using echocar-diography. Results: Individuals with T2DM exhibited significantly higher left atrial volume indices, maximal left atrial volumes, and minimal left atrial volumes compared to the control group (p < 0.05). Correlation analysis re-vealed associations between left atrial function parameters and clinical variables, including age, duration of T2DM, and glycated hemoglobin levels (p < 0.05). Conclusion: Our findings highlight the impact of T2DM on left atrial function in rural populations of eastern UP, emphasizing the importance of early cardiovascular assessment and risk management in T2DM patients. Further research is needed to elucidate the underlying mechanisms and develop targeted interventions to improve outcomes in this high-risk population.

Introduction: Hernia defined as abnormal protrusion of viscus through a normal or abnormal weakness in the wall of its containing cavity. The main aim of this research was to examine incisional hernias, explicitly analyzing the variables that increase the chance of developing them, the many surgical approaches used for repair, and the problems that may arise after the operation. Material and Methods: There were a total of 100 patients involved. The study gathered data on patient demographics, previous operations, kinds of incisions, and possible risk factors such as obesity and diabetes. The repair techniques, such as onlay mesh repair or laparoscopic repair, and the surgical strategy, either open or laparoscopic, were recorded. Postoperative problems, such as the development of seromas and surgical site infections, were closely observed. Results: The age group with the highest frequency was 35-45 years old, and females outnumbered men. Past surgical interventions, namely midline laparotomy operations, were identified as prospective variables that might increase the risk. Additionally, obesity, diabetes, and wound infections were often found. The occurrence of seromas was the most common complication after surgery, followed by wound dehiscence and surgical site infections. The prevailing surgical method was open surgery, with onlay mesh repair being the most often used technique. Conclusion: This research emphasizes many aspects linked to incisional hernias. Although open surgery with onlay mesh repair is generally considered the conventional method, less invasive procedures such as laparoscopy may be used in some circumstances. The research found possible risk factors such as obesity and diabetes, indicating the need for preventive actions.

Background: “Acute appendicitis has a considerable influence on clinical practice, despite the fact that it may be difficult to diagnose. It is imperative that a correct diagnosis be reached on the first attempt if one wants to stay clear of potentially catastrophic outcomes. The process of clinical decision-making is influenced by both the Alvarado and Acute Inflammatory Response scores to varying degrees. Aim: This study aimed to compare and contrast the AIR and Alvarado scores for their use in diagnosing acute appendicitis. Materials & Methods: The current investigation got under way after receiving clearance from the institution’s ethical committee. Participants were followed throughout the course of time in this prospective observational research. The General Surgery Department of GMCH Sundargarh in consultation with Department of Paediatrics & Pathology served as the location for the research that was carried out. The data collection phase of the research endeavor began on August 2022 and lasted for 18 months. All of the participants in this research went to the emergency department with symptoms of acute appendicitis, and they all ended up having their appendix removed after undergoing a thorough examination & investigation. Results: Males accounted for 64% of the total population, while females accounted for 34%. Forty-three out of 80 research participants had Alvarado scores that indicated they were at an increased risk. According to the AIR score, 49 (89%of the total) individuals were at high risk for appendicitis, and HPE confirmed the diagnosis in 55 (69% of the total). As shown in Table 1, we found that the Alvarado score, AIR score, and HPE diagnosis of appendicitis did not correspond with one another in a way that was statistically significant. Conclusion: In terms of validity and reliability, the new appendicitis inflammatory response score performed much better than the Alvarado score.

Introduction: Despite the increasing incidence and the difficulty in treating male infertility, there has been limited documentation of the leading causes and risk factors for male infertility. Understanding the causes and risk factors will enable the identification of primary prevention methods, as well as effective methods for the primary treatment of male infertility. Objectives: To evaluate the seminal pattern in male infertility and factors affecting the male infertility. Materials and Methods: The present descriptive observational study was carried out at Department of Pathology KIMS, Hubli during January 2023 to December 2023 involving 100 cases for semen analysis. Results: We observed that almost 16% of the cases the sperm motility was less than 50%. 45% of the cases have oligoasthenozoospermia. 36% of the patient has oligozoospermia. Smoking and chewing affect the sperm count significantly in our study. Chronic addictions significantly affect the sperm motility. Conclusion: Chronic smoking and alcoholism as the important risk factors for low semen count and sperm motility in our study.

Background and Aim: Unanticipated difficult airway and its associated morbidity can be avoided by using airway assessment tests preoperatively, in isolation or in combination. The aim of this present study was to assess the Ratio of height to thyromental distance (RHTMD) as a predictor of difficult laryngoscopy and to compare it with other indices like Modified Mallampati Test (MMT), Thyromental distance (TMD) and Upper lip bite test (ULBT). Material and Methods: This study was conducted on 215 patients scheduled for elective surgery under general anaesthesia needing endotracheal intubation. Airway was assessed preoperatively using MMT, ULBT, TMD and RHTMD. Intraoperatively, Cormack and Lehane’s classification was used to assess and grade difficult laryngoscopy. Data was analysed using SPSS version 26.0. Results: The incidence of difficult laryngoscopy in our study was 11.16%. RHTMD emerged as the best predictor with the maximum area under curve (AUC = 0.83). Of the four indices, RHTMD was found to have the highest sensitivity (91.67%), positive predictive value (30.99%) and negative predictive value(98.61%) compared to other indices. Conclusion: RHTMD emerged as the single best predictor of difficult laryngoscopy with maximum area under curve (AUC = 0.83). Predictability of difficult airway can be enhanced by combining it with other tests.

Background: Antimicrobial resistance (AMR) poses significant challenges in healthcare settings, particularly in Intensive Care Units (ICUs) where the use of antimicrobials is prevalent. This study analyzes antimicrobial utilization patterns, safety profiles in the ICU of a teaching hospital, aiming to identify strategies for optimizing antimicrobial use and mitigating AMR. Methods: A retrospective analysis was conducted on 100 patients admitted to the ICU who received antimicrobial therapy. Data on the types of antimicrobials prescribed, indications for therapy, prescribing patterns, duration of therapy, adverse events, antimicrobial resistance associated with antimicrobial therapy were collected and analyzed. Results: Broad-spectrum antibiotics, including cephalosporins, carbapenems, and fluoroquinolones, were the most frequently prescribed antimicrobials. The main indications for antimicrobial therapy were hospital-acquired pneumonia (30%), bloodstream infections (25%), urinary tract infections (20%), and surgical site infections (15%). Empirical therapy was initiated in 70% of cases, with a de-escalation approach based on culture results in 50% of these cases. The average duration of antimicrobial therapy was 10 days. Adverse events were reported in 15% of patients, with antimicrobial resistance observed in 20% of isolated pathogens. Empirical therapy followed by de-escalation was effective in 60% of cases. Conclusion: This study highlights the critical need for antimicrobial stewardship in ICUs to optimize antimicrobial use, reduce the incidence of adverse events of antimicrobial therapy. Strategic interventions, including rapid diagnostic testing and targeted therapy, are essential to improve patient outcomes and combat AMR.

Objective: The aim of this study was to evaluate the correlation between dry eye disease and pterygium and also to compare patients with pterygium from two different geographical locations in this sub-Himalayan region. Materials and Methods: A total of 80 patients, aged between 21 and 65 years, 40 each from two different geographical regions (locations) namely Transgiri and Cisgiri area were included in this study. Tear film breakup time (TBUT) and Schirmer’s test (ST) and Rose Bengal Score (RBS) results were compared in pterygium eye and contra lateral normal eye of the same patient (taken as control). TBUT, ST and RBS results were also compared in eyes with pterygium of different sizes. Pearson’s chisquare test was used to evaluate differences between groups for categorized variables. Unpaired “t” test used to calculate difference of means for quantitative variables. Paired “t” test and mcnemar test were used to analyze group -2 patients who had undergone surgery. Results: On analysis, the overall difference in the mean TBUT between the pterygium eyes, and the contra lateral control eyes was highly significant (P< 0.01). The difference in the ST between the pterygium eyes and the contra lateral eyes was highly significant for size <2 mm (P< 0.001). Most patients with pterygium complained of redness and mild-to-severe ocular discomfort. The respective scores of TBUT, ST and RBS improved after surgery significantly (p-value <0.005). Conclusion: Results of the present study strongly suggest that different geographic locations, size of pterygium, exposure to UV rays, gender, prolonged outdoor work and dusty environment leads to development of pterygium. Pterygium induces abnormal ocular surface conditions which results in development of the dry eye and dry eye is also responsible for development of pterygium. Use of protective eye wears is to be encouraged.

Objective: This study aims to evaluate the impact of gestational diabetes mellitus (GDM) on maternal health outcomes. Methods: A prospective study was conducted with 200 pregnant women diagnosed with GDM at RMC Ajmer over a year. Participants were categorized into controlled and uncontrolled GDM groups. Data on demographics, obstetric outcomes, and long-term health were collected and analyzed. Results: Women with uncontrolled GDM exhibited higher rates of cesarean delivery (60% vs. 35%), hypertensive disorders (30% vs. 10%), and postpartum complications. Six months postpartum, 25% of women showed impaired glucose tolerance, and 10% were diagnosed with type 2 diabetes, predominantly in the uncontrolled group. Key adverse outcome predictors included poor glucose control, obesity, and a family history of diabetes. Conclusion: GDM significantly affects maternal health, with uncontrolled GDM leading to more complications. Effective management and postpartum follow-up are essential to improve outcomes. Public health strategies should focus on early screening and personalized care to mitigate GDM effects.

Thoracic myelopathy is a relatively overlooked cause of spinal disorders with possible diagnoses including pathological fractures, Pott’s disease, Multiple Myeloma and non-Hodgkin’s Lymphoma. In India, symptoms resembling Pott’s Spine necessitate prompt and effective action as it is the most common extranodal manifestation of tuberculosis. Additionally, it can resemble the aforementioned diseases on radiological examination leading to complications and oversight in patient care. Therefore, a thorough workup is indicated when a patient presents with symptoms of myelopathy. This case report will provide a succinct overview of the presentation and novel management of a patient with a high-grade non-Hodgkin’s Lymphoma – B Cell Subtype with investigations suggesting Pott’s disease.

Background: Acute appendicitis is the most common surgically treatable cause of abdominal pain; yet, it is mostly a clinical diagnosis that is still challenging to make in many cases. However, in 15–30% of cases, the normal appendix may be removed if the decision to operate was made solely on the basis of clinical suspicion. In order to decrease the likelihood of a negative appendectomy and to help in the early detection of acute appendicitis, a number of diagnostic grading systems have been developed. After Alvarado’s description, Kalan et al. made modifications to one such scoring system. The purpose of the current study is to assess the effectiveness of the modified Alvarado score in the preoperative diagnosis of acute appendicitis. Methods: For the study, 120 consecutive patients who were treated, examined, and admitted with a suspected case of acute appendicitis were included. These patients received a modified Alvarado score following a thorough evaluation and investigation. They received treatment based on the three groups to which they were assigned. Results: According to the study’s findings, high scores (7-9) in men and children had sensitivity values of 92.3% and 83.3%, respectively, whereas high scores in females had a sensitivity value of 72.7%. The sensitivity of the male and female scores (5–6) was 57% and 50%, respectively. Conclusion: When it comes to males and children, high Modified Alvarado score scores are a reliable tool for early detection of acute appendicitis; however, this isn’t the case when looking at females. Abdominal ultrasonography is a helpful tool in preventing negative appendicectomy rates, especially in females.

Background: A laparotomy wound is typically closed in layers that co-opt the different anatomical layers. Single layer closure technique, also known as mass closure technique, is a new closure method that has gained popularity. After comparing it with previous research published in the literature, the purpose of this study is to assess the advantages or disadvantages of single layer closure and layered closure. Methods: Between 01 July 2017 and 30 June 2018, 60 patients of both sexes were admitted to the surgical wards of the Agartala Government Medical College and the GBP Hospital in Agartala, Tripura. This prospective comparative trial study was carried out on them. A comprehensive clinical and general assessment was performed on individuals who were suspected of having intra-abdominal pathology at the time of admission. To confirm the diagnosis, necessary biochemical and radiological tests were conducted. Following diagnosis confirmation, individuals underwent exploratory laparotomy. Either the mass closure technique or the layered closure approach was used to close the laparotomy wound. Following surgery, patients were monitored for three months to look for any late problems. Results: A total of sixty patients were examined. The age range of the majority of patients was 61 to 65. There were more males than females. In comparison to mass closure, the layered closure group has a higher incidence of early problems such as seroma and wound infection. In the multilayer closure group, the mean wound closure time is longer. When compared to layered closure groups, mass closure technique is more economical. Conclusion: The closure of a midline laparotomy incision can be achieved more quickly, affordably, and safely with the mass closure technique.

Background: The placenta’s normal construction, complete development, and functions dictate the survival and growth of the fetus. Study on the placenta provides information on the health of the developing fetus. Methods: In all, 100 participants were involved in this study, which ran from February 2023 to January 2024 in the Department of Obstetrics and Gynecology at the DMCH in Laheriasarai, Bihar, with assistance from the Department of Anatomy. Participants were divided into two groups: those with hypertension and those without it. Results: Twenty percent of the females in the hypertensive groups were multigravida, compared to 80% of primigravida females. Preterm births increased significantly (to 35%) and lower section caesarean sections accounted for a sizable part of deliveries (to 45%) in the hypertensive group. The babies’ mean birth weights were 2.82±0.43 kg in the control group and 2.33±0.84 kg in the hypertension group. The mean placental weight was found to be 541.4±30.62g in the control group and 478.4±30.62g in the hypertension group upon morphometry analysis of the placentas. In one group, the mean placental diameter was 17.87±1.47 cm, whereas in the control group it was 19.87±1.47 cm. comparing the hypertension group to the control group, there was a substantial decrease in placental area, volume, and thickness. Mean number of cotyledons were 18.46±1.54 in control group as against 16.46±1.54 in hypertension group. Fetoplacental ratio and placental coefficient were 5.23±0.86 and 0.19±0.02 in control group and 4.88±1.79 and 0.17±0.06 in the hypertension group. Conclusion: Pregnancy-related hypertension affects the placenta’s shape and morphometry, as well as the health of the developing fetus.

Background: Because iron plays a physiological role in the hair cycle, iron deficiency (ID) may interfere with healthy hair development. Numerous research have looked into the connection between body iron status and hair loss, with varying degrees of success. In order to provide evidence for the significance of iron reserves in non-scarring diffuse hair loss in non-menopausal women, this study was conducted. The purpose of this study is to ascertain how diffuse, non-scarring hair loss in non-menopausal women relates to body iron reserves. Methods: At GSMCH, Ram Nagar (Rajpura), Patiala, Punjab, from March to November 2023, 40 women aged 15 years or older with diffuse hair loss (Female pattern hair loss (FPHL) / chronic telogen effluvium (CTE)) and 40 controls without any history or physical signs of hair loss participated in this controlled study. All of the subjects’ subjective hair loss was assessed using a same questionnaire. Hemoglobin and ferritin levels in the serum were used to evaluate the iron status. Descriptive and inferential statistical analysis using Mean ± stand-ard deviation, Chi-square, Fisher Exact test and Student t test. Results: Three groups were identified through analysis: “Excessive hair loss” (17.5%), “Moderate hair loss” (82.5%), and “Absence of hair loss” (0%). When comparing the incidence of ID (Serum ferritin <40g/L and Hb <12gd/L) in nonmenopausal women experiencing diffuse hair loss to controls, which was 22.5% (n = 9), there was a statistically significant increase among the women experiencing hair loss (n = 27). Conclusion: In non-menopausal women, diffuse hair loss is related to low iron storage. In the treatment of dis-ease, screening to determine these levels in cases of hair loss and supplementing with them when deficient are effective.

Background: Chronic urticaria is a debilitating cutaneous allergy disease that can affect individuals of both adult and juvenile age groups physically and psychologically. It has a variety of clinical manifestations. One prevalent cause thought to be present in adult patients with chronic urticaria is food allergies. Reducing or elim-inating the consumption of food allergens that cause symptoms is the best way to prevent it. Suspected food allergies should be evaluated clinically, diagnosed using a skin prick test and a blood test, and treated by a qual-ified medical professional. Methods: This is a cross-sectional study that was carried out from February 2023 to January 2024 on 100 adult patients with chronic urticaria who were seen in the dermatology out-patient department at Gian Sagar Medical College and Hospital in Ram Nagar (Rajpura), Patiala, Punjab. Using a skin prick test with 32 food antigens, this study was carried out to determine the prevalence of food allergies in individuals with chronic urticarial infections. Results: In patients with persistent urticaria, food allergies accounted for nearly 99 percent of cases. Haldi (16.2%), cashew nut (14.1%), mustard (12.1%), saunf (12.1%), milk and chicken (11.1%), garlic, ginger, gram, apple and fish (9.1%), banana and coffee (8.1%) were the top food allergens that caused complaints. Conclusion: One of the most common causes of cutaneously upsetting conditions like chronic urticaria, which can harm a patient’s physical and emotional health, is food allergies. Urticarial patients can benefit from specific diagnosis, evaluation, and treatment for the aforementioned illness. Haldi (16.2%), cashew nut (14.1%), mus-tard (12.1%), saunf (12.1%), milk and chicken (11.1%), garlic, ginger, gram, apple and fish (9.1%), banana and coffee (8.1%) were the top food allergens that caused complaints. One of the least expensive and reasonably use-ful methods for diagnosing chronic idiopathic urticaria is the skin prick test.

Background: The placenta serves as a mirror reflecting the fetus’s intrauterine condition. The placenta is thought to be a major contributor to neonatal and maternal mortality as well as a significant influence influencing fetal growth, which is typically linked to placental insufficiency. The placenta reflects pregnancy issues both macroscopically and microscopically, such as hypertension or gestational diabetes. Methods: Four kinds of placentas were used in the study: normal, pregnancy-induced hypertension, anemia, and diabetes mellitus. A total of 129 placentas were examined. Placental weight, placental surface area, fetal birth weight, placental coefficient, feto-placental weight ratio, and the result of the foetus, stillbirth or alive were among the many factors that were examined. Results: It was noted that the PIH group’s placental weight was noticeably lower than average. On the other hand, it was higher in the group with diabetes and anemia. The birth weight of the newborns in the PIH and anemia groups is significantly lower than that of the diabetes group. A stillbirth was noted in 3.33% of the de-liveries in the usual group. Pregnancy complications are associated with a somewhat increased percentage of stillbirths. Conclusion: The perinatal outcome is also impacted by these diseases. Along with fetal characteristics like foe-tal weight, placental properties are also changed. Therefore, diagnosing these risk factors in pregnancies during the antenatal stage will enhance the result.

Aim: To evaluate the efficacy of intralesional 5-fluorouracil alone, intralesional triamcinolone acetonide alone and combination of intralesional triamcinolone acetonide and 5-fluorouracil in treatment of keloids. Methodology Ninety patients who fulfilled the inclusion and exclusion criteria were enrolled. Patients were randomly divided into three groups of 30 each. In group A; Intralesional 5-fluorouracil (5 FU) 50 mg/ml alone was used. In group B; Intralesional triamcinolone acetonide (TAC) 40mg/dl alone was used. In group C; combination of intralesional triamcinolone acetonide 40mg/dl (0.1ml) and 5- fluorouracil 50mg/ml (0.9ml) was used, on monthly basis for 6 months. Patients were assessed for efficacy, after 6 months of the treatment. Observations: Efficacy was achieved in 70 cases in which 22 were from 5 FU group, 21 were from TAC group, and 27 were from 5 FU + TAC group. Statistically significant difference was found between TAC Vs 5 FU+TAC group i.e. p-value=0.02 and between 5 FU Vs 5 FU+TAC group i.e. p- value=0.04. Conclusion: The combination of 5-FU+TAC has better efficacy as compared to 5-FU alone group & TAC alone group in the management of keloids.

Objective: This study aims to evaluate the clinicopathological characteristics of postmenopausal bleeding (PMB) in patients at a tertiary care center to identify the prevalence and nature of underlying pathologies. Methods: We conducted a prospective cohort study of 250 postmenopausal women presenting with PMB from April 1, 2021 to March 31, 2024. Participants underwent a standardized diagnostic workup that included transvaginal ultrasound to assess endometrial thickness, endometrial biopsy, and hysteroscopy where necessary. Data on patient demographics, medical history, and diagnostic outcomes were collected and analyzed. Results: Of the women studied, 20% were diagnosed with endometrial cancer, 15% with endometrial hyperplasia, and 40% with benign conditions such as polyps or atrophic endometritis. The remaining 25% showed no significant pathology. Diagnostic protocols involving ultrasound and biopsy demonstrated high sensitivity and specificity, particularly for detecting endometrial cancer. Logistic regression identified higher BMI and age over 65 years as significant risk factors for malignant outcomes. Conclusion: The high prevalence of significant pathologies among women presenting with PMB highlights the importance of comprehensive diagnostic evaluation in this population. The study supports the efficacy of a multi-modal diagnostic approach in accurately detecting and differentiating between benign and malignant causes of PMB, emphasizing the need for prompt and thorough evaluation to improve patient management and outcomes.

Background: Neonatal sepsis is the commonest and most important cause for the morbidity and mortality in developing countries like India. Neonatal sepsis, sepsis neonatorum and neonatal septicemia are terms that have been used to describe the systemic response to infection in newborn infants. The inability of neonates to completely muster the minimum inflammatory response makes them more susceptible to bacterial invasion of the blood stream than older children and the risk are even higher in preterm infants. HSS is very significant because of its easy availability, accessibility, low cost, less time consuming and can improve the diagnostic accuracy of complete blood count and it can be employed as screening test for diagnosis of sepsis. Methods: This is cross sectional study. A total of 108 cases of neonatal age group were taken in this study. Blood culture, C-reactive protein and Modified Rodwell’s Hematological Scoring System were measured in all cases. Results: Of the 108 neonates in the present study, 35 had positive blood picture. Majority of neonates presented with early onset type of sepsis (88.57%). Individual hematological parameter like I:T PMN ratio (>0.2) and Degenerative changes is seen in most of septicemia. Hematological scoring system (HSS) >3 and >4 had better specificity and negative predictive value (NPV). Conclusion: Hematologic scoring system is a useful test to distinguish the infected from non-infected infants. The hematologic scoring system is a simple, quick, cost effective and readily available tool with high sensitivity and specificity in the early diagnosis of neonatal sepsis. So it can be very well used as a screening test for early diagnosis of neonatal sepsis.

Background: Haemorrhoids are one of the most common benign anorectal problems worldwide. Haemorrhoids are vascular cushions within the anal canal usually found in three main locations: left lateral (3 O’ clock), right posterior (7 O’clock) and right anterior (11 O’clock) positions in the upper anal canal. Methods: In the present study, we have endeavored to profile the spectrum of hemorrhoids among the patients who underwent conventional open haemorrhoidectomy at Regional Institute of Medical Science Hospital, Imphal, from Sept 2015 to Aug 2017. We also have studied risk factors of haemorrhoids, relative frequency of different types and their clinical features. Finally, we have attempted to correlate the clinical results with histopathological findings. Results: This observational study of 48 cases who underwent open conventional haemorrhoidectomy (Milligan Morgan) was done to evaluate the spectrum of clinical pattern and histopathological findings. The histopathological examination of haemorrhoidectomy specimen, irrespective of types and degree of the lesion is found to be ‘Venous’ component only in all patients (100%), with haemorrhage (extravasation of blood) in 17 patients (35.4%) and features of thrombosis in 2 patients ( 4.2%). Conclusion: These finding is suggestive that haemorrhoidal mass is submucosal cushion of dilated and tortuous venous component only. As we did not find any arterial component in the histology, the findings of previous workers that haemionorrhoidal mass is arteriovenous malformation needs further evaluation and confirmation in larger series.

Introduction: Propeller flap is an ideal flap for small to medium size defects because it is harvested from local tissue, has similar color, texture.  It obeys the principle of replacing like with like. It avoids the sacrifices of any nerve, muscle. It does not require microvascular anastomosis. When peroneal perforator flap is harvested with s propeller design, it avoids the drawbacks of pedicle peroneal perforator flap. There is no dog-ear formation and it has excellent cosmetic result. Primary Objective: Evaluate the safety and efficacy of peroneal perforator flap in reconstruction of lower third of leg defects. Secondary Objective: (1) Time taken for flap harvest. (2) Frequency of adverse effect i.e. Flap congestion, superficial necrosis, complete necrosis, (3) Donor site complication i.e. graft loss, infection, hematoma, seroma etc. (4) Perforator location relative to lateral malleolus. Study Design: Prospective study undertaken in Dept. of Plastic Surgery of SCB Medical College, Cuttack from 2021march to 2022 November. Inclusion Criteria: Small to medium size defects with non-healing wound on lower third of leg and ankle region. Exclusion Criteria: Patients with recent MI (60 days) or unstable angina, decompensated heart failure, high-grade arrhythmias, or haemodynamically important valvular heart disease (aortic stenosis in particular); Peripheral arterial disease; Acute infection; Uncontrolled diabetes mellitus; Heavy smokers (>25 cigarettes per day). Result:  24 peroneal perforator flap   were harvested during   the study period. One flap had complete necrosis. There was one flap with superficial necrosis which was managed with vac therapy and skin grafted. The average location of perforator was 9.19 cm from lateral malleolus with SD of 1.3 cm. Age ranged from 15 to 48 years. Flap size ranged from 24 cm ² to 180 cm².  Male: Female ratio was 3:1. There was no donor site morbidity.  All patients had satisfactory functional outcome. Time taken for flap harvest was 55.58 sec with SD 10.19. Conclusion: Peroneal perforator artery based propelllar flap is safe and effective for coverage of small to medium size defect when used judiciously in appropriate time interval from injury. It can be harvested rapidly   with minimal adverse effect. There is no donor site complications. It can be suitable alternative to free flap for small to medium size defects of lower limb.

Background: Thyroidectomy is a very common surgical procedure. The outcome and complication rates are largely dependent on the surgeon’s skill and experience. The complications may be anatomical, physiologic, or both. Method: 80 (eighty) adult patients aged between 20 to 60 years having cytological and radiological evidence of benign thyroid disease were studied. Every patient underwent TSH, T3, T4, and USG of the neck and aspiration of fluid for cytological study from a suspected area. CT scan in tracheal compression patients, an indirect laryn-goscopy was done under pre-operatively to assess the position of the vocal cords. Thyroidectomy was done un-der general anesthesia and administered by endo-tracheal intubation. Flexible strobolaryngoscopy was done when an indirect laryngoscope was inconclusive. Results: Benign thyroid complications were 11 (13.7%) hyperthyroidism, 20 (25%) retro-sternal extension, 5 (6.2%) tracheal compression, 27 (33.7%) firm feel, and 17 (21.2%) adhesion. The anatomical variations were: 14 (17.5%) had anterior relation to ITA, with 2 (2.5%) had palsy, 21 (26.2%) had branching of RLN with 4 (5%) had palsy, 45 (56.2%) had RLN close to anterior entry, with 5 (6.2%) had palsy. Vocal cord palsy was highest in firm gland and least in 5 (6.2%) tracheal compressions. Conclusion: It is concluded that a surgeon with skill and knowledge of the anatomy of the thyroid gland can minimize the post-surgical complications.

Background: Tuberculosis in children is a chronic infectious disease caused by Mycobacterium tuberculosis. The latest technique is an ideal method to rule out TB positivity. Method: 90 (ninety) children with TB positivity were made to undergo a Mountex test and sputum for AFB. Blood examinations included CBC, ESR, and chest X-rays to confirm the findings of the Mountex test. Results: 58 (64.4%) children had tuberculosis, and 32 (35.7%) had disease relieved by symptomatic and antibi-otic treatments. 48 (53.3%) children were 4–9 years old, 12 (13.3%) were 10–12 years old, and 30 (33.3%) children were aged between 13-18 years old. Conclusion: The Mountex study, along with CBC, ESR, sputum for AFB, and chest X-ray will certainly help the pediatrician treat such cases efficiently to avoid morbidity and mortality in children.

Background: Acute respiratory infections in breast-fed babies are a major cause of morbidity and mortality in underdeveloped countries like India. Various etiologies of ARI have to be ruled out and treated efficiently. Method: 90 (ninety) babies between 6 months to 2 years of age with ARI were studied and compared with the same number of controlled groups. Routine blood examinations, including CBC, ESR, PS, AEC, chest x-ray, and PFT, were done only if necessary. Results: Comparison of social-demographic parameters like gestational age, premature birth, mean weight of birth, caesarean birth, employment of mother, siblings, and habits of parents had a significant p value (p<0.001). In comparison of breast feeding 60 (± 3.6) in patients with exclusive breast feeding before onset of symptoms babies and 72 (± 5.2) in controlled, t test was 18 and p<0.00. Never breastfed patients were 25 (± 3.3) in ARI and 13 (± 2.6) in the controlled group, t test 27 and p<0.001. Conclusion: It is confirmed that malnourished babies are more prone to ARI and need to be correlated with breast-fed babies. Nutritional supplementation must be recommended along with treatment for early recovery.

Background: The pattern of inactivity begins early in life, making the promotion of physical activity among children crucial. This study was conducted in the schools of the Kottayam Municipal Area to assess the level of physical activity in adolescents. Another objective was to determine the prevalence of hypertension in this age group. Materials and Methods: The present study was conducted in an urban area of the Kottayam district in Kerala. Schools were stratified into three categories: Government, aided, and unaided. A cluster sampling technique was employed, and data were collected after obtaining informed consent. Results: The study revealed a higher prevalence of obesity among children who do not engage in school play, do not participate in Physical Education programs, and spend more time watching TV and using computers. Additionally, there was a significant association between hypertension and childhood obesity. Conclusion: School intervention programs are the most effective approach to preventing overweight and obesity. Allocating more hours to physical education is essential. Additionally, regular monitoring of blood pressure in children with obesity is crucial.

Immuno-histochemical staining is used as a surrogate marker instead of gene expression analysis for classification of Breast Cancer Subtypes(BCS) and depending on these subtypes treatment is planned . Data correlating BCS & axillary nodal involvement is limited. Objective: To know the distribution pattern of Breast Cancer Subtypes  and to find the correlation between Breast Cancer Subtypes  &  axillary  nodal involvement  and  other clinicopathological  features. Methodology: All breast cancer patients  who underwent primary breast surgery (MRM or BCS) in the Surgical Oncology Department at Amrita Institute of Medical Sciences, Kochi (Kerala) from October, 2010 to  march, 2013 were included in the study. As per institutional  protocol  all the specimens were submitted for  histopathological examination  &  immunohistochemical  staining  which included  ER, PR, HER-2/neu  and  Ki-67. Tumors with 1% or more positively nuclear-stained cells were considered positive for ER and PR expression. Cut-off value of nuclear Ki-67 expression was set at ki-67=<14% as low  & with ki-67 = >14 as high. HER2 results were considered positive in cases with 3+  membranous staining of IHC or gene amplification by fluorescence in-situ hybridization (FISH). Results: The study cohort consisted of  503 patients(luminal A= 21.5%; luminal B= 46.5%; Triple negative=19.3% & Her2Type=12.7% ) of which 270 patients(53.8%) were node positive. Significant association (P value= 0.001) was noted between luminal B type and nodal positivity  where as significant association (P value= 0.028) was also noted between luminal A type and Triple negative with nodal negativity. Conclusions: Most common molecular subtype found in our study was luminal B followed by luminal A, triple negative and HER2 type in the descending order. Nodal   involvement was found more with  luminal B  and less with Luminal A  &  Triple negative. Node negative cancers are more associated with  low ki-67 & node positive cancers are more associated with high ki-67.

Background: Fistula in ano presents a significant clinical challenge due to its recurrent nature and impact on quality of life. Traditional surgical treatments include fistulectomy and less invasive procedures such as the Ksharsutra technique, but recurrence and postoperative complications remain concerns. Objective: This study aims to evaluate and compare the efficacy, safety, and patient satisfaction of three surgical techniques for treating fistula in ano: fistulectomy, Ksharsutra, and LIFT (ligation of intersphincteric fistulous tract). Method: Ninety patients diagnosed with fistula in ano were randomized into three groups: Group A (fistulectomy), Group B (LIFT), and Group C (Ksharsutra). They were assessed at 6 and 18 months postoperatively for outcomes including recurrence rates, postoperative pain, incontinence, and patient satisfaction using a Likert scale. Results: The LIFT procedure (Group B) demonstrated superior outcomes across all measured parameters. It showed the lowest recurrence rates and postoperative pain levels, coupled with higher patient satisfaction in terms of impact on physical and social activities. The fistulectomy group (Group A) and the Ksharsutra group (Group C) showed higher recurrence and varying degrees of postoperative complications. Conclusion: The LIFT procedure offers a significant advantage over fistulectomy and Ksharsutra in the treatment of fistula in ano, providing better clinical outcomes with fewer complications and enhanced patient satisfaction. These findings support the adoption of LIFT as a preferred surgical approach in suitable cases, aiming to improve overall patient well-being and postoperative recovery.

Background and Objectives: Streptococcus pneumoniae infection is a serious problem worldwide. It is a common cause of pneumonia, meningitis, and septicemia, and the case fatality rate remains high. Globally, India has the highest number of deaths caused by pneumococcal infections among children below 5 years of age, partly because of its large population. The incidence, severity, and mortality of the disease depend on host factors such as age, underlying disease, co morbid conditions, and immunosuppression, but also on the properties of the organism. The present study was conducted to know the extent of Pneumococcal infections in tertiary care hospitals, their antibiogram, serotyping and how many strains were covered by existing Pneumococcal vaccines Methods: A total of 51 consecutive Streptococcus pneumoniae isolates were collected and analyzed in this study. All isolates of Streptococcus pneumoniae were identified by Standard phenotypic methods from all clinical samples obtained Study duration of Two years. They were analyzed for MIC of Penicillin by E-Test method, Antibiogram by Kirby Bauer disc diffusion method and Serotyping by Multiplex PCR (Molecular method) was done in Department of Microbiology, PMCH Patna. Conclusion: The present study gave an insight regarding the extent of Pneumococcal infections in tertiary care hospitals, their antibiogram, serotyping showed diverse strains many of which were covered by existing Pneumococcal vaccines. However considering the occurrence of other serotypes though rarely which were not covered by immunization, there is a need for constant monitoring regarding Pneumococcal serotypes and also more studies of this type to be included in clinical Bacteriology research Programs.

Background and Objectives: Staphylococcus aureus present on skin and nasal passage, enter through the cuts or invasive procedures. It is responsible for a number of infections such as wound infections, deep infections that spreads from skin to cause bacteremia with or without endocarditis. It may also involve bone, joints, deep organs and tissues. To Characterize 150 MRSA isolates from wound samples. To Study their antibiotic susceptibility patterns, to detect MRSA by Oxacillin disc diffusion, Cefoxitin disc diffusion and resistance to Oxacillin by the MIC method. Material and Methods: Total 150 isolates of MRSA collected from wound samples were characterize by different biochemical tests. Strains were tested with Mannitol salt agar out of 150 strains 145 strains were positive (96.6%), DNase test show’s 143 were positive (95.3%) out of 150 strains, Phosphatase test show’s 146 (97.6%) strains were positive out of 150 strains, Gelatin hydrolysis show’s135 (90%) were positive out of 150 strains and Urease test show’s 142 (94.6%) were urease positive and 8 (5.4%) were negative. Conclusion: Staphylococcus species is a major concern for the medical community. In the past, patients were commonly treated with various Penicillin, Clindamycin Erythromycin and /or Gentamycin for Staphylococcal infections. However, owing to many factors, including the extensive use of these antibiotics Staphylococci have developed resistance. MRSA emerged as a major nosocomial pathogen as well as community associated pathogen. Increased resistance to a number of antibiotics and acquired inducible resistance to Clindamycin has been reported. The present study also shows increasing resistance to various antibiotics.

Background and Objectives: Methicillin resistant Staphylococcus aureus (MRSA) is a strain of S. aureus that has developed resistance to methicillin and other beta lactam antibiotics as well as cephalosporins and monobactams. It harbors a gene, mecA, coding for altered penicillin binding protein (PBP 2a). Exposure to hospital environments is known for MRSA carriage. Health care workers (HCW) have often been implicated in outbreaks of MRSA associated hospital acquired infections due to MRSA carriage in their anterior nares, hands, axillae etc. To evaluate the prevalence of MRSA carriage in among the medical students. To assess the impact of hospital environment on the colonization by MRSA in students with no previous exposure to the organism. Materials and Methods: A total of 86 students were involved in the study. Nasal swabs were taken before exposure to the hospital, 6 months and 1 year after the exposure to the hospital environment. Swabs were cultured onto mannitol salt agar and blood agar. Standard microbiological methods were followed to identify S. aureus and methicillin resistance was checked for, using cefoxitin discs. Results: No MRSA carriage was seen before hospital exposure. At the end of 6 months 2 students (2.3%) were colonized with MRSA and 3 students (3.48%) were colonized at the end of 1 year. The male: female ratio at the end of 1 year was 2:1. Conclusion: Increasing rate of colonization with MRSA was seen with increase in duration of exposure to the hospital environment. Since MRSA is one of the major causes of Hospital acquired infections (HAI) and HCW are considered the source of the infection, periodic screening and treatment of the carriers will go a long way in controlling HAIs caused by MRSA.

Background and Objectives: Cardiovascular disease, resulting from atherosclerosis, is a leading cause of global morbidity and mortality. Genetic predisposition and classical environmental risk factors explain much of the attributable risk for cardiovascular events in populations, but other risk factors for the development and progression of atherosclerosis, which can be identified and modified, may be important therapeutic targets. Infectious agents, such as Chlamydia pneumoniae, have been proposed as contributory factors in the pathogenesis of atherosclerosis. Hence present study was conducted to determine the seroprevalence of C.pneumoniae antibodies and to study the association of chronic C.pneumoniae infection with Coronary artery disease. Methodology: The study was performed on patients attending the outpatient department as well as on patients admitted for coronary angiogram at PMCH Patna, over a period of one year in the department of Microbiology, PMCH Patna. 3 ml of blood was collected aseptically from 90 angiographically proven coronary artery disease (CAD) patients and 90 number of age and sex matched healthy control subjects. Enzyme linked immunosorbant assay was performed for all the 90 CAD patients and 90 controls to detect the presence of IgG and IgA antibodies to Chlamydia pneumoniae  ESR, CRP, Blood glucose, lipid profile was analyzed for all the cases and controls. Conclusion: In the present study, the seroprevalence of IgG and IgA Cp antibodies was found to be higher in coronary artery disease patients compared to controls and this difference was statistically significant. The present study supports the association between Chlamydia pneumonia infection and Coronary artery disease.

Background and Objectives: Cholangitis represents a surgical emergency which has to be managed without delay. Surgical decompression and antimicrobial therapy remain the cornerstones of this condition. However, it is important to institute the correct antimicrobial therapy considering the local resistance patterns. The resistance β-lactams has become very rampant and is mostly due to Extended Spectrum Beta lactamases (ESBL). Carbapenems are commonly used in these cases but resistance to these agents by carbapenemase enzyme production is rising. Such strains are resistant to all β-lactams and might carry plasmid-borne genes for resistance to other classes of antibiotics as well. There are a limited number of agents available for treatment of such organisms. To isolate bacteria causing cholangitis from bile samples. To determine the antibiotic susceptibility pattern of the isolates. To screen for ESBL (extended spectrum beta lactamase) producing bacterial strains. Methods: It was a prospective study of 100 bile samples in patients of infective biliary diseases. All the cases of cholangitis due to diverse etiology in the Department of Surgical Gastroenterology at PMCH (PMSSY), Patna.  were studied. Samples were collected from patients of cholangitis or acute cholecystitis during Endoscopic Retrograde Cholangiopancreatography / Percutaneuous transhepatic biliary drainage/Cholecystectomy/Laparotomy. Conclusion: The empirical therapy for cholangitis should be based upon resistance patterns in the population. Also, phenotypic detection of resistant isolates by CDT and carba NP test is reliable and helps in identifying ESBL- and carbapenemases-producers. Chromagars are sensitive for the same and can be used as screening methods.

This study investigates the correlation between breast cancer grading, staging, and hormone receptor status in a rural Indian setting at J. L. N. M. C. H., Bhagalpur, Bihar, over a period from August 2020 to August 2021. Fifty female patients were analyzed for estrogen and progesterone receptor presence about cancer grade and stage. The results indicated a positive correlation between lower cancer grades and hormone receptor positivity, suggesting a better prognosis for early-stage cancers amenable to hormone therapies. Conversely, advanced stages showed lower hormone receptor positivity, highlighting the urgent need for early detection and comprehensive treatment approaches. This study emphasizes the importance of tailored healthcare strategies in rural areas to enhance early diagnosis and effective treatment options.

Background: Oral Submucous fibrosis is a condition characterized by inflammatory changes in oral cavity and buccal mucosa. It is caused by excessive chewing of arecanut, tobacco and nutritional deficiencies. Steroids are the main treatment for it, but now Curcumin & Aloevera are considered as newer adjuvant modalities. Materials and Methods: This is a prospective randomized trial aimed to compare the effectiveness of Curcumin & Aloevera gel in Oral Submucous Fibrosis conducted on 105 patients of OSMF. Patients were divided in 3 groups and given vehicle as control, Aloevera and Curcumin as test drugs. Results: On intragroup comparison in Aloe Vera and curcumin groups there was statistically significant improvement in Interincisal Distance (IID) and Tongue Protrusion (TP) at 1, 2 and 3 months. On intergroup comparison for IID and TP between Control and Aloe Vera, Control and Curcumin and Aloe Vera with Curcumin the difference was not statistically significant. On comparing Aloe Vera with Curcumin group for burning sensation in mouth, they were comparable for two visits, but Curcumin group showed statistically significant improvement at 3 months. Conclusions: There was reduction in Burning Sensation and improvement in Interincisal distance and Tongue Protrusion with both the drugs after 3 months of treatment when compared to Day 0. Curcumin was found to be better than Aloe Vera and it improve all the three parameters but more effectively the Burning Sensation. Hence, Curcumin is more effective in improving the symptoms of OSMF.

Background: Adnexal masses are one of the most common diseases affecting women of all ages. Adnexal masses are frequently accompanied by symptoms such as dyspareunia, bloating, increased abdominal girth, pelvic pain, irregular vaginal bleeding, and abdominal pain. This study assessed the feasibility of laparoscopic management of adnexal masses predicted to be benign. Methods: A cross-sectional study was conducted on 50 women presenting with adnexal masses which were benign at the Department of Obstetrics and Gynaecology, SCB Medical College, Cuttack, Odisha, India. The duration of the study was 12 months. All the women fulfilling the inclusion and exclusion criteria were then taken up for laparoscopic management. Results: Laparoscopy was completed in 49/50 patients (98%) and converted to laparotomy in one case. Most common indication of procedure was ovarian cyst; others were dermoid cyst, endometriotic cyst, hydrosalpinx, and adnexal mass. There were mild adhesions (16%) and dense adhesion (2%). Three patients had intraoperative blood transfusion as they were anaemic preoperatively. Mean duration of surgery ranged from 50 minutes to 100 minutes. Most patients were discharged after 2 days and advised to abstain for 2 months, avoiding heavy work. Histopathological reports correlated with laparoscopic findings. Patients were called for follow-up visit after 6 weeks of surgery or earlier if any problem occurred. None of the patients had any major complaints. Conclusion: Laparoscopy is effective in the management of benign adnexal masses. It helps in reducing hospital stay as well as reducing hospital-acquired infections. It is cost-effective, thus reducing hospital stays and reducing early discharges. It is also cosmetically better than laparotomy. However, selecting cases for laparoscopic management of adnexal mass is important.

The impact of Body Mass Index (BMI) on the choice between Fenofibrate and Atorvastatin as treatments for patients with atherogenic dyslipidemia (AD). A total of 156 patients with AD were split into two groups, one receiving Atorvastatin and the other receiving Fenofibrate for a period of three months. The initial results indicated that BMI plays a significant role in the decision of which lipid-lowering treatment to use for patients with AD. An analysis of the lipid profile among different BMI categories revealed that atorvastatin was effective in reducing LDL-C, TC, and TG levels, while fenofibrate was more effective in improving HDL-C and reducing TG levels in AD patients. After the three-month period, it was found that atorvastatin was more successful in lowering the lipid profile (TC, TG, and LDL-C) compared to fenofibrate. A positive relationship was identified between higher BMI and the preference for fenofibrate over atorvastatin. Furthermore, patients who were classified as obese or overweight showed better responses to fenofibrate compared to atorvastatin, resulting in improved lipid profiles. It is essential for healthcare providers to consider BMI when determining the appropriate lipid-lowering medication for patients with AD. Additional research is needed to confirm and expand upon the results of this study.

Primary ciliary dyskinesia is an autosomal recessive disorder associated with abnormal ciliary structure and function, which results in retention of mucus and bacteria in respiratory tract, leading to chronic oto-sino-pulmonary disease, situs abnormalities and abnormal sperm motility. Kartagener syndrome is rare genetic disorder characterized with classical triad of situs inversus, chronic sinusitis and bronchiectasis whereas Young’s syndrome is characterized by chronic rhinosinusitis, bronchiectasis and azoospermia. We present the case of 19 year old male patient with recurrent sinusitis and respiratory infection. His semen analysis revealed azoospermia without any evidence of obstruction in epididymis or vas deferens. He was diagnosed with both kartagener syndrome and young syndrome based on history, clinical presentation and radiological features. He was treated with oral antibiotics, mucolytics and chest physiotherapy. He was symptomatically better with the treatment and was put on long term low dose antibiotic. An early diagnosis of this syndrome is crucial to avoid future complications and improve the quality of life of patient.

Introduction: Meigs’ syndrome is characterized by the co-occurrence of ascites, pleural effusion and an ovarian tumor (fibroma or fibroma-like tumor). Pseudo-meigs’ syndrome is associated with malignant or benign ovarian tumor (other than fibroma or fibroma-like) or uterine or fallopian tumors with similar triad. Meigs’ syndrome is an uncommon occurrence, with only 1% of ovarian tumors being the cause. Case Description: We are describing here in sequence one case of meigs’ syndrome and two cases of pseudo-meigs’ syndrome. First, second and third cases are in second, fifth and sixth decade of life respectively. Common clinical presentations were abdominal pain and shortness of breath. The clinical examination and various blood and radiological investigations were suggestive of raised CA 125, right sided pleural effusion, ovarian tumor with evidence of ascites in all three cases. Pleural and ascitic fluid tapping were done which were exudative in nature in all three cases. In first case 19 year old female, second case 41 year old female and third case 52 year old female, histopathology report of ovarian tumor were consistent with  likely fibroma, bilateral serous cystadenocarcinoma and adenocarcinoma respectively. Conclusion: Ascites, pleural effusion and elevated CA 125 in an elderly female raises the possibility of an ovarian tumor. Meigs’ and pseudo-meigs’ syndrome is typically diagnosed definitively after surgery, when the tumor is confirmed by histopathology and ascites and pleural effusion have resolved.

Background: The management of a traumatized spleen is primarily influenced by several factors. Aims and Objectives: To assess the efficacy of different management procedures and outcomes. Materials and Methods: A retrospective study on splenic trauma was conducted at S.L.N Medical College Koraput, between January 2022 and December 2023. Thirty-six patients with splenic injuries were admitted to the Department of General Surgery during this period. Results: In this study, 36 patients (26.67%) were diagnosed with splenic injuries. All patients were between 6 and 62 years old. The age group with the most patients was 21-30 years old (10 patients, 27.78%). Additionally, 12 patients were from the pediatric age group, with an average age of 26.97 years. The gender distribution showed a male predominance: 26 males (72.22%) and 10 females (27.78%) with a male: female ratio of 2.6:1. Blunt abdominal trauma was the cause of splenic injury in 32 cases (88.89%), with road traffic accidents being the most common culprit (19 cases, 52.78%). A fall in hematocrit was observed in most cases (30 out of 36, 83.33%). Associated injuries were present in 17 patients, with the liver and kidney being the most frequently injured organs (4 cases each).Regarding injury severity, most cases fell into the grade III (13 cases) and grade II (11 cases) categories. Treatment breakdown revealed that 16 patients (44.44%) underwent splenectomy, 10 (27.78%) underwent splenorrhaphy, and 10 (27.78%) received conservative management. Non-operative management was preferred for low-grade (grade I) injuries in children with blunt trauma, while splenectomy was more common for high-grade injuries and in adults. Splenorrhaphy was used for some moderate-grade injuries, particularly penetrating trauma. Overall, non-operative management and splenorrhaphy had successful outcomes with minimal complications, while splenectomy resulted in more complications and higher mortality, especially for patients with severe injuries. Conclusion: Non-operative care and splenic repair techniques are favored in stable patients, but splenectomy remains crucial for unstable or high-risk cases.

Background and Objectives: Chronic Renal Failure (CRF) prevalence has increased, leading to increased admissions and decreased life expectancy. Causes include infection and cardiovascular events, with Left Ventricular Hypertrophy being a major finding. However, there’s limited information on its prevalence and nature. The study aims to estimate Left Ventricular Hypertrophy prevalence in patients with Chronic Renal Failure using Echocardiography and determine its correlation with the severity of the condition. Methods: The study involved 100 Chronic Renal Failure patients admitted or visiting GMC, GGH, SRIKAKULAM over two years, undergoing detailed history, clinical evaluation, laboratory investigations, and Echocardiography. Results: The study found that Left Ventricular Hypertrophy (LVH) prevalence in chronic renal failure patients increased with severity, with 17% in mild cases, 26% in moderate cases, and 57% in severe cases, primarily among patients aged 51-60 years. Conclusion: The study reveals that patients with chronic renal failure have a higher left ventricular mass index and a higher prevalence of left ventricular hypertrophy, particularly in severe cases. This suggests the need for early cardiovascular evaluation and prevention efforts.

Objective: Fishbowlw Case Based Learning (CBL), forms a bridging gap between theory & and practice, to achieve reasoning skills and competence we introduced 3 different teaching techniques Fish Bowl (FB), Jigsaw (JS), and Flipped Classroom (FCR) among MBBS students. Methodology: A crossover design study was done among first-year MBBS students for a period of 6 weeks at CIMS, Chikkamagaluru. A total of 150 students were divided into 3 groups (50 in each group) and underwent 3 rounds so that each group was exposed to all 3 techniques. Assessment was done by conducting pretest and post-test MCQs. Feedback was taken from both students and facilitators. Results: The difference in the means of analysis between two-time points in the same group was tested by paired t-test. Significant improvement in performance pre v/s posttest. Difference of means analyzed by ANOVA & F testing. 1^st & 2^nd round showed FCR had higher mean (7±1.7, 7.8±1.2) compared to JS (6.3±2.1, 7.4±1.6) and FB (6.6±2, 7.5±1.7) whereas 3^rd round showed FB & FCR were had higher mean (6.2±1.9, 6.2±1.7) which was statistically significant at (p<0.001) compared to jigsaw (6.1±2). Conclusion: Our study showed there is a positive reinforcement & and improvement in the student’s performance among FCR & FB teaching techniques compared to the JS method.

Background: This study was carried out with the objectives to estimate prevalence and distribution of various types of diseases among Paediatric patients admitted in Paediatric ICU of Late Lakhi Ram Agrawal Memorial Govt Medical College from Aug 2022 to Dec 2023 and to estimate outcome of these patients during study period. Methods: A retrospective study was carried in children admitted in PICU from Aug 2022 to December 2023 when a total of 831 patients were admitted. Results: Of 837 cases studied, 445(53.2%) were males and 392 (46.8%) were females. The male to female sex ratio in the entire study group was 1.2:1.0. Of 837 cases studied, 231(27.6%) had age below 1 year, 268 (32.0%) had age between 2-5 years, 222(26.5%) had age between 6-10 years and 116(13.9%) had age above 10 years. Maximum number of patients 499 (59.6%) belonged below 5-year age group. The most common system involved was central nervous system which was observed in 196(23.4%) cases. This is followed by respiratory system 190 (22.7%) and Haematology 149 (17.8%). Among the cases the most common diagnosis was Seizure which was observed in 170 (20.3%) of cases, followed by Pneumonia that was observed in 125 (14.9%) of cases. Conclusions: Of 837 cases studied, 706 (84.4%) were discharged, 66 (7.9 %) were referred, 47(5.6%) expired and 18 (2.1%) went leave against medical advice (LAMA). Majority of mortality occurred among children aged <1-year olds 7.8% followed by 1-5 years old 5.8% deaths.

Introduction: Gallbladder cancer is the most common malignancies of the biliary tract and among the gastrointestinal malignancies. Gall stones, pyloric and intestinal metaplasia have been found to be associated with gall bladder carcinoma. Ki-67 is a good marker for cell proliferation and its expression is correlated with various lesions of gall bladder. Aim: The aim of the study is to assess the ki-67 expression in different malignant and premalignant lesions of gall bladder. Materials and Methods: The retrospective study included 212 cases of gall bladder lesions, out of which 22 cases were malignant and 75 premalignant lesions. Immunohistochemistry was done for ki-67 expression. A percentage of >20% stained cells was considered to be positive regardless of the intensity of staining. Results: It was observed that out of 212 cases, 179(84%) cases were female and 33(16%) cases are males. The incidence of gall bladder lesions was highest in 41-50 years (36%) and malignant cases were highest in >50 years (55%). In the malignant groups, Ki-67 expression was <20% in 59% cases, 20-30% in 27% cases and >30% in 14% cases. Ki-67 expression was highest in moderately and well differentiated gall bladder carcinomas than poorly differentiated carcinomas. Conclusion: Ki-67 can be used as a good marker of aggression of various lesions of gall bladder.

Background and Objectives: Metabolic syndrome is a collection of metabolic disorders that raises the risk of diabetes and cardiovascular disease. Obesity, especially abdominal obesity, is linked to resistance to insulin’s effects on the use of fatty acids and peripheral glucose, frequently resulting in type 2 diabetes mellitus. In cardio metabolic disorders like hypertension, type 2 diabetes, and dyslipidemia, which are considered to be inflammatory diseases, evidence suggests an increase in serum ferritin. Since metabolic syndrome is thought to occur due to several causes, including chronic inflammation, numerous researches has been undertaken worldwide with mixed outcomes. Therefore, this study is conducted to assess the relationship between serum ferritin and components of metabolic syndrome. Methodology: A cross-sectional study was conducted in a government tertiary care hospital in Mysuru city between November 2023 May 2024. The study population was patients with metabolic syndrome per the National Cholesterol Education Program, Adult Treatment Panel III criteria. The sample size was estimated to be 106. A predesigned, pretested and semi-structured proforma was used for data collection. Data were entered in a Microsoft excel spreadsheet. To describe the data frequencies, percentages and graphs were used. Pearson’s correlation was used to address the second objective. Results: The study on metabolic syndrome patients showed a significant correlation with serum ferritin levels. Of the five components of metabolic syndrome, FBS and waist circumference showed a significant positive correlation with serum ferritin levels. Conclusion: Serum ferritin levels are elevated in patients with metabolic syndrome, suggesting that these patients exhibit a certain degree of inflammation which in future may increase the risk of developing cardiovascular disease.

Introduction: Parkinson’s disease is characterized by loss of dopaminergic neurons in the substantia nigra. Dopamine which is found in amacrine and interplexiform retinal cells is the major mediator neurotransmitter of retina. In the follow-up of Parkinson’s disease, the thinning of the retinal nerve fibre layer may be a critical marker to monitor progression of the disease. Aim: This study aimed to evaluate and compare the retinal nerve fibre layer (RNFL) thickness and macular thickness in Parkinson’s disease (PD) patients and control group and to correlate with disease severity and duration of illness. Materials and Methods: A total number of 40 PD patients and 40 controls were recruited during the study period of 9 months. Patients up to stage 3 PD were recruited based on Fulfilment of the UKPDS Brain Bank Criteria. RNFL thickness and macular thickness and volume were measured using OCT. UPDRS scores were calculated in PD patients. Results: There was a statistically significant reduction in RNFL thickness in average (adjusted mean 94.34 vs 99.99, p ≤ 0.001), superior (adjusted mean 118.15 vs 124.13, p ≤ 0.001), inferior (adjusted mean 104.95 vs 126.55, p ≤ 0.001) and temporal (adjusted mean 67.11 vs 74.36) PD group compared to the control group. The macula thickness also was significantly reduced in inner superior (adjusted mean 313.7 vs 312.41, p < 0.001), central (adjusted mean 238.15 vs 251.51, p < 0.001), outer superior (adjusted mean 267.61 vs 277.09, p = 0.014), outer inferior (adjusted mean 256.80 vs 272.00, p ≤ 0.001) PD group compared to the control group. Conclusion: The mean superior, inferior, temporal and average RNFL thickness was significantly lower in the PD group compared to control. The mean macular volume, central, inner superior, outer superior, outer inferior macular thickness was significantly lower in the PD group compared to the control.

Introduction: MSAP flap is a versatile fasciocutaneous flap and has been being effectively used in treatment of small to moderate size defects especially in head and neck region by plastic surgeons worldwide. It is thin and pliable; therefore, it is a suitable alternative to Radial Forearm flap with much lower donor site morbidity. Previous anatomic studies have sought to identify the location of the medial sural artery and its perforators. This study’s detailed metrics offer a user-friendly insight into the distribution of perforators and the branching pattern of the medial sural artery. Objective: The present study was undertaken to describe the anatomical variations of medial sural artery and its perforators in the Indian population. The information gleaned from this clinical study on the vascular anatomy of the medial sural artery will aid plastic surgeons in developing practical approaches for harvesting the MSAP flap. Methods: A prospective observational study for a period of 2 years was devised. 19 individuals (17 males and 2 females) who underwent reconstruction of tissue defects with MSAP flap were included in the study. Subjects were of ages ranging from 6 to 71 years. Results: An average of 1.47 perforators (range 1 to 3) were found to pierce the medial gastrocnemius muscle in each lower limb. At least one major perforator (>/ = 1mm) was identified in all individuals. Average pedicle length from division of medial sural artery up to emergence of perforators was 7.42 cm (range 4.5 to 10 cm). Average perforator distance from popliteal crease was 9.18 cm (range 4 to 16 cm). The distance of perforators from the posterior midline was 2 cm. Discussion: Despite benefits of MSAP flap, reservations hindering its application relate to the variability in vascular anatomy of medial sural artery and the necessity for intramuscular dissection. Thus, understanding the anatomy of the medial sural artery is crucial for effectively raising a sufficient MSAP flap. The utilization of handheld Doppler emerges as a valuable tool for identifying primary perforators at anatomical sites. Conclusion: Challenges associated with the MSAP flap include the extensive intramuscular dissection and the need to ligate muscular branches, contributing to the potential tediousness of the procedure. Another limitation is that the vascular anatomy of medial sural artery perforators was not consistent and exhibited variability among different patients.

Background and Aim: Benign vocal cord lesions often develop due to vocal trauma caused by the abuse and misuse of the voice, leading to ulceration and changes in the healing process. Various factors, including social and occupational vocal use characteristics, medical conditions, psychological structures, smoking, and reflux, can all disrupt the epithelial defense system on the vocal cord. Our study focused on analyzing the epidemiological details, incidence, clinical presentation patterns, and risk factors associated with non-malignant lesions of the larynx. Material and Methods: The study site is a department of ENT Tertiary Care Teaching Institute in India, where the research will be conducted for a period of one year. The principal investigator completed all the necessary information in a structured study proforma. This form includes important demographic information, clinical features, ENT examination results, findings from flexible video laryngoscopy and stroboscopy, voice handicap index, diagnosis, and management details. Utilizing statistical methods and analyzing data Our study aimed to provide a comprehensive analysis of the data collected from the patients who participated in our research. We employed appropriate statistical methods and principles to ensure accurate and reliable results. Results: Among the 100 patients studied, vocal cord polyp was found to be the most common non-malignant lesion, followed by vocal cord cyst as the second most common. The presence of hoarseness in patients with nonmalignant lesions was found to be statistically significant, with a p value of 0≤0.05. A significant finding was observed in patients experiencing difficulty in breathing and non-malignant lesions, with a p value of < 0.05. When analyzing the stroboscopic results of different lesions, it was observed that all cases of vocal nodule displayed a glottic closure in the shape of an hourglass. Conclusion: Vocal cord polyps were found to be the most common non-malignant lesion associated with hoarseness, followed by vocal cord cysts. Individuals who engage in voice abuse, smoking, alcohol consumption, dyspepsia, and exposure to fumes have a higher likelihood of developing nonmalignant lesions in the larynx, according to clinical observations.

Background: Transurethral resection of prostate (TURP) has been the gold standard for the surgical management of BPH but has complication like bleeding and dilutional hyponatremia which can progress to transurethral resection syndrome (TURS). Thulium laser enucleation of prostate (ThuLEP) provides a bloodless field with minimal energy exposure of pericapsular tissue. The present study aimed to compare the safety, efficacy and clinical outcomes between ThuLEP and TURP for treating symptomatic benign prostatic hyperplasia. Methods: Total 57 patients were included in this study of which 27 underwent ThuLEP and 30 underwent TURP. All patients underwent thorough preoperative evaluation and were assessed during the perioperative period and on 3 months follow up. Results: The operative time in ThuLEP group was significantly more as compared to TURP group (96.29 ± 23.72 min vs 65.00 ± 19.02 min). ThuLEP had significantly lower mean volume of irrigation fluid used in the immediate post-operative period, duration for which irrigation was run, time to clearance of hematuria, catheterisation time and post- operative stay. Fall in hemoglobin and serum sodium levels was also found lower in ThuLEP group.On 3 month follow up, there was improvement in all three functional parameters (Qmax, PVR and IPSS) in both groups and were comparable in both the groups. Conclusion: ThuLEP is as safe and efficacious procedure as TURP which has long been considered the gold standard for the surgical treatment of BPH. Thus, ThuLEP can be considered as a genuine alternative to TURP in present times.

Background: Large ventral hernia surgery is difficult. This study evaluates the ACS to the PCS in hernia surgeries involving transversus abdominis release. Methods: At Darbhanga Medical College & Hospital, 60 hernia patients were studied prospectively and were  assigned to ACS or PCS. We tracked operating time, postoperative complications, hospital stay, and hernia recurrence for one year. Results: PCS had a slightly longer operative time (260 vs. 240 minutes) but resulted in shorter drain removal time (6 vs. 22 days), reduced hospital stay (10 vs. 14 days), fewer complications, and no recurrences, unlike ACS, which had two recurrences. Conclusion: PCS proves to be more effective for managing large ventral hernias, offering quicker recovery and fewer complications, making it preferable for complex cases. Further research is needed to confirm these findings.

Background and Objectives: Dengue is a  mosquito‑borne viral disease which is endemic in several countries in the tropical and subtropical regions of the world. Diphu, the capital of Karbi Anglong is not an endemic region for dengue infection. It experienced its 1^st major dengue outbreak in the month of September to November 2022. We conducted a study on this outbreak to understand the clinical profile, demographic and environmental conditions of dengue cases. Methods: All cases registered under Diphu Medical College and Hospital from 25^th September to 25^th November 2022 were studied. Records from Medical records department (MRD) and bed tickets from Medicine (Dengue ward) were analysed. Home visits were made for 10% of the total cases, where clustering of cases was observed to study the environmental factors related to dengue. A preformed proforma was used for the collection of data. Descriptive statistics were used to analyse the data. Results: 419 cases of Dengue were reported in Diphu. Of these, majority  were male(55.1%) and in the age group of 11-20 years (34.8%). All cases had fever, nausea, malaise, joint pain while headache was reported in 98.1%, vomiting in 92.3%, diarrhea in 3.8% and bleeding in 1.9% cases. Thrombocytopenia was seen in majority of cases (76.8%), other abnormalities recorded were deranged liver and renal function. No fatalities were reported. Majority of cases were from urban areas and peak was at mid-November. Regarding Environmental risk factors related to dengue, all had artificial water holding container surrounding home, 1% had  water tank without cover. No household practiced cleaning and drying of breeding area once in a week. Conclusion: We reported the first ever outbreak of Dengue in Diphu, Karbi Anglong. Vector surveillance and control policies need to be initiated with a plan for rapid diagnosis and treatment of cases  and also to prevent future outbreaks.

Aim: To assess the need of intraperitoneal drain placement in laparoscopic cholecystectomy. Materials and Methods: Our study was carried out at JIIU’S IIMSR, Warudi Jalna, India, a rural tertiary care center from August 2021 to September 2023 and includes 130 patients who underwent elective laparoscopic cholecystectomy. Drain was used for selective cases and data of post-op recovery in all patients was analysed and compared to non-drain placement. Results: Although there was slightly more discomfort noted in patients who had drain placement, there was no significant difference on comparison of the 2 groups based on various parameters including operative time, post-op pain, paralytic ileus, suture site infection and duration of hospital stay. There was also no significant collection noted in patients who did not have drain placement. Conclusion: The use of drains following laparoscopic cholecystectomy does not lead to significantly different outcomes compared to not using drains. The decision to place a drain should be should be reserved for selected cases based on the surgeon’s judgement and the individual patient’s condition, rather than routine practice.

Background and Objectives: Retinal Vein occlusion (RVO) is the second most common retinal vascular disorder, after diabetic retinopathy which causes painless visual impairment. Multiple systemic, local, and hematologic disorders can contribute to the multi-factorial etiology of RVO. Recent researches have revealed that some inflammatory biomarkers and hyperlipidemia are associated with RVO more frequently. Our study aims to determine the relationship between hematological and systemic biomarkers with RVO. This association can help patients with RVO identify other systemic illnesses and prevent the development of RVO in additional eyes. Material and Methods: In this case control study, 50 patients were enrolled in the Department of Ophthalmology, S.S. Medical College and associated Gandhi Memorial Hospital, Rewa (M.P.) after receiving institutional ethical committee permission and informed written consent. Data collection included detailed history; a comprehensive ocular examination was performed for all the subjects under the study followed by laboratory investigations of inflammatory markers (CRP, Homocysteine), lipid profile (Cholesterol, Triglyceride, VLDL, LDL, HDL levels, MHR) parameters and hematological markers (NLR, PLR, MPV). SPSS version 24 was utilized for statistical analysis. Data was presented as mean with standard deviation or proportions as appropriate. Results: Demographic profile was comparable between the two groups. The mean CRP and Homocysteine levels were significantly higher among the cases as compared to the controls. Among the hematological parameters taken into account, Neutrophil count, Lymphocyte count, Monocytes count, and the Mean Platelet Volume and Platelet-Lymphocyte ratio was significantly higher in cases; whereas Platelet count, and Neutrophil-to-Lymphocyte Ratio was studied to be statistically non-significant. The lipid profile parameters were also significantly increased, except, HDL which was decreased in RVOs and MHR which was not significantly associated with the implication of RVO. Conclusion: Present study reflects an association of RVO with the inflammatory markers, CRP and Homocysteine, which can be considered as risk factor in the development of RVO. Present study concluded that all individuals with retinal vascular blockage should have their serum cholesterol levels checked. While it’s yet unclear whether restoring normal serum lipid levels will enhance vision and stop RVO in the other eye from happening, or whether it may lessen problems and RVO recurrence in the same eye. NLR and PLR parameters can be utilized as independent risk factors in BRVO patients.

Background and Aims: To provide good labour epidural analgesia, this study compares the analgesic efficacy of racemic bupivacaine (0.0625%) with 2 µg/ml fentanyl and levobupivacaine (0.0625%) with 2 µg/ml fentanyl in pregnant women at more than 37weeks of gestation in spontaneous labor and normal fetal heart rate monitoring. Methodology: Sixty pregnant women who requested for labour analgesia were divided into two groups. Group B (n = 30) received racemic bupivacaine (0.0625%) and fentanyl 2 µg/ml and Group L (n = 30) received levobupivacaine 0.0625% and fentanyl 2 µg/ml. In both groups, 10-15ml of the study drug was given in 5 ml fractionated doses at 5 min interval. Parturients who did not experience analgesia within 15 min after the initial bolus were supplemented with an additional 5 ml of the same concentration of the solution. Epidural analgesia was maintained by timed doses at the end of 90 min with the dose equal to the initial dose of the drug. The Duration of labour analgesia, motor block, sensory block, visual analog scale, maternal hemodynamic parameters, mode of delivery, and maternal satisfaction was evaluated. Results: In the present study, Maternal demographic characteristics were comparable.  The Results indicate that both drugs were equally effective clinically in terms of pain scores, patient satisfaction, mode of delivery and total dose used. Statistically, bupivacaine (0.342±0.107) produced more motor blockade than levobupivacaine (0.229±0.025) while the highest level of sensory blockade achieved by bupivacaine was 20%-T10, 80%-T8,0%-T6 and with levobupivacaine was 3.33%-T10, 76.66%-T8, 20%-T6 which was statistically significant. Hemodynamic variations were found to be statistically significant between the groups but clinically they did not have any implications on maternal or foetal outcomes. Conclusion: In this study, both drugs produced equivalent analgesia for labor at low concentration with fentanyl as an adjuvant providing good maternal satisfaction.

Ventilator-associated pneumonia (VAP) is a common and serious complication among intubated patients in intensive care units (ICUs), often caused by multidrug-resistant (MDR) pathogens. This study aimed to deter-mine the incidence of VAP in the ICU of a government hospital in India and assess the associated risk factors and bacterial pathogens. A prospective observational study was conducted over two years, including adult and adolescent patients requiring intubation and mechanical ventilation. Methodology: A prospective observational study was conducted over two years in the ICU of a government hospital in India. Adult and adolescent patients (>14 years old) requiring intubation and mechanical ventilation were included. VAP was diagnosed using the clinical pulmonary infection score, considering clinical, laborato-ry, microbiological, and radiographic evidence. Results: Out of 155 patients, 46 developed VAP (29.7%), with a calculated VAP rate of 22.14 events per 1000 ventilator days. Most VAP cases were late-onset, with a mean ICU stay before VAP development of 9.96 days. Gram-negative bacteria were the predominant pathogens, with MDR Acinetobacter being most commonly iden-tified. Conclusion: This study highlights the significant impact of multidrug-resistant (MDR) pathogens in ventilator-associated pneumonia (VAP) management in our ICU. The high prevalence of MDR organisms, particularly Gram-negative bacilli such as Pseudomonas aeruginosa and Acinetobacter species, underscores the urgent need for effective infection control and antibiotic stewardship programs. Our findings indicate a notable presence of beta-lactamase-producing organisms, including ESBLs, AmpC beta-lactamases, and MBLs. Specifically, 21.43% of the isolates were ESBL producers, 28.57% were AmpC producers, and 25% were MBL producers. Key risk factors for MDR VAP identified include prolonged hospitalization (≥5 days), prior antibiotic therapy, and impaired consciousness. These results emphasize the necessity for continuous surveillance, early detection of resistance, and comprehensive infection control strategies to improve patient outcomes in the ICU setting.

Background: Vector-borne diseases are a major cause of morbidity and mortality in developing countries like India. There is a relative lack of data on children of South Rajasthan regarding the incidence of thrombocytopenia, its severity, clinical manifestations, and response to treatment. Methodology: The current study was conducted in a tertiary care hospital in southern Rajasthan over a period of 3 months. It included 127 children under 18 years of age admitted and diagnosed with vector borne diseases by specific laboratory investigations. All necessary data was collected according to the medical records observation technique. Observations: In the current study, it was found that there is significant association between thrombocytopenia and vector borne diseases. Out of a total of 127 patients with vector-borne diseases in the study period, thrombocytopenia was observed in 88 (69.1 %) patients. This association was most frequently observed between malaria (81.5 %) followed by Dengue fever (76.4%) and Scrub Typhus (68.9 %). Minority of patients even required platelet transfusions for correction of thrombocytopenia. Conclusion: Thrombocytopenia in a febrile child in endemic zone should alert the physician towards the possibility of malaria. Moreover, even in cases of severe thrombocytopenia, one should not panic and should give anti-malarial and appropriate supportive therapy as bleeding manifestations are rare and response to therapy is good.

Background: Favipiravir inhibits the viral RNA polymerase and has been shown to be effective against other RNA viruses. This study was conducted to evaluate the efficacy and safety of Favipiravir in moderate to severe cases of COVID-19. Materials and Methods:  This single-center retrospective observational study was conducted to evaluate the efficacy and safety of Favipiravir in terms of length of hospital stay and in-hospital mortality. Data of adult patients, who were diagnosed with moderate to severe COVID-19 disease, and were admitted in the hospital till 31^st July 2022, was collected from the medical record section. Study included two groups: Study group: COVID-19 positive patients who received Favipiravir (n=100) and Control group (COVID-19 positive patients who did not receive Favipiravir). Results: Patients with moderate-to-severe COVID-19 patients who received Faviparavir showed shorter hospital stay, higher rate of transfer out of ICU, and decreased mortality rate when compared to patients who did not receive Faviparavir. Conclusion: Faviparavir is a safe and efficient drug in treating hospitalized patients with moderate-to-severe COVID-19 patients.

Background: A dermatosis is a broad word for any kind of skin lesion or imperfection. When something is systemic, it impacts the entire body, not just a specific area and is possible that issues in other organs are associated with systemic dermatoses. Dermatoses are a prevalent health issue in children, significantly impacting their quality of life and necessitating specialist medical attention. Aim: This study aimed to examine the clinical and etiological characteristics of skin diseases in children admitted to a specialized hospital. Hypothesis: Our hypothesis suggests that the clinical characteristics and causes of skin diseases in children may differ based on specific risk factors and environmental factors. Materials & Methods: This is a prospective study; various dermatoses were studied in pediatric patients up to 14 years of age attending the department of pediatrics OPD of our Rajendra Institute of medical science, Ranchi over a period of 12 months. All patients were divided into four different study groups: 1 month to 1 year, >1 to 6 years and 7 to 14 years. Results: There were 298 boys and 212 girls in a total of 510 study populations. The majority of the skin conditions among children aged > 1 month to 14 years were found to be affected most by scabies (26%),  impetigo (7%), pyoderma (7%), molluscum contagiosum (7%), tinea capitis (5%), leprosy (1%), and viral warts (2%)(1.35%), while among non-infectious disorders, they were affected by atopic dermatitis (6%), pityriasis alba (5%), seborrheic dermatitis (4%), pityriasis rosea (4%), others (3%), phrynoderma (3%), lichen planus (2.5%), contact dermatitis (2%),and ichthyosis (1%). Conclusion: The study shows important findings on pediatric skin diseases at a major hospital. More research is needed to enhance diagnosis and treatment, examine long-term effects, and understand environmental and genetic factors.

Introduction: As normal blood pressure is one of the most vital elements of health and it may be connected with the turbulence and calmness of mind, proper practice of meditation can control it. Aim and Objective: To investigate the association between meditation and control of blood pressure. Method: There was total 200 participant of which 100 were in the control group and rest 100 were in the study group. In each group 50 participants were male and 50 of them were female. We selected participants who were in between 45 to 55 of age who are the most vulnerable group for developing hypertension. We recorded the blood pressure of the participants for four times at every three months interval using the same blood pressure measing device. All the data were collected by experienced technical person and at the end statistical analysis were done to compare the changes of blood pressure both systolic and diastolic. Students T test and ANNOVA tests were used for statistical analysis of the data for comparison. Result: After analysis by T test it has been seen that the systolic as well as the diastolic blood pressure was changed towards the lower side significantly in the participants who were meditating regularly for at least one hour each day throughout the year. Conclusion: With the result of the current study, we can conclude that practice of meditation can be used as an very safe alternative of antihypertensive drugs. However time to time measurement of blood pressure and other primary health check-up are advisable.

Introduction: Ventral and incisional hernias of the abdominal wall are commonly encountered, pose significant medical issues, and are associated with an economic burden. A minimally invasive ventral patch repair is a relatively novel approach which is gaining popularity for the treatment for small ventral hernias. Hence this study was designed to evaluate composite mesh repair in the management of ventral hernias. Material and Methods: Clinically diagnosed forty-two cases undergoing elective open ventral patch hernia repair above 21 years of age were recruited. Pre-operative, intra operative and postoperative information were collected. Postoperative pain was assessed by visual analogue scale and patient satisfaction was measure by using Carolina comfort scale. Postoperative follow up was conducted at 10 days, 1 month, and 6 months. Results: Paraumbilical hernia (38.09%) was most commonly observed followed by umbilical (28.58%), incisional hernia (23.80%). Surgeons were fully satisfied (61.90%) with the surgical procedure. The postoperative pain did not show any recurrence during the follow up. Similar findings were observed in related to outcome of Carolina comfort scale. Seroma was common postoperative complication in 11.90% of cases. Conclusion: Recurrence rates and major complications were both low when ventral hernia repairs were performed with the composite mesh patch prosthesis. Hence, it is effective approach for the ventral hernia repair.

Introduction: Anorectal fistula is a connection between the anorectal canal and perianal area. Knowledge on preoperative imaging is essential for the surgical management. Objective: To evaluate the role of MR Fistulogram in preoperative assessment of Anorectal fistulas and comparison of intraoperative findings with MR findings. Materials and Methods: The present cross-sectional study was in the Department of Radiodiagnosis in association with Department of General surgery at MNR Medical College and Hospital, Sangareddy from April 2022 to December 2023. A total of 80 clinically suspected cases with perianal fistula of both genders between 25-65 years were included. MR Fistulogram was taken for all the study participants by 1.5 Tesla unit systems. The MRI sequences such as oblique, axial and coronal T2W FSE, T1W FSE, sagittal FAT SAT T1W FASE images and fat suppressed T1W FSE AND T2W FSE were used. The details of fistula such as type, position were assessed by MRI. Results: Single internal opening was observed in 82.5% cases and double internal openings in 17.5% cases. Whereas 78.75% cases had single external opening, followed by 16.25% cases had two, 2.5% cases had three and 2.5% cases had four external openings. According to St James classification of fistulas, 42.5% cases had grade 1 fistulas and 20% cases had grade 2 fistulas. The contrast enhancement was observed in 36 (45%) cases. The sensitivity and specificity for grade 1 fistulas was 100% and 93.5%, for grade 2 was 100% and 99.8%, for grade 3 & 4 was 100% and 100% and for grade 5 was 100% and 99.9% respectively. Conclusion: The sensitivity and specificity was high for fistulas of all grades. Hence, MR Fistulogram with contrast enhancement is a useful and recommended diagnostic tool for the preoperative evaluation of anorectal fistulas.

Background and Aim: Tympanoplasty using the underlay method is a widely used technique for repairing a perforated tympanic membrane. This procedure is typically performed with the assistance of a microscope. In this study, we will be examining and comparing the outcomes of two frequently utilized techniques for type I tympanoplasty: underlay and interlay. Our focus will be on patients with chronic otitis media and mucosal disease, specifically those with large central perforations. We will be evaluating the success of graft uptake as well as any improvements in hearing that may result from these procedures. Material and Methods: This study is a 12-month randomized prospective study involving 160 patients with chronic otitis media inactive mucosal type and large central perforation. The study took place in the E.N.T department at a Tertiary Care Teaching Institute in India. A total of 80 patients were included in each group, specifically the underlay group (Group 1) and the interlay group (Group 2). The results were evaluated based on the rate of graft take up and improvement in hearing. The patients were regularly followed up, specifically at the end of the 1st week, four weeks, eight weeks, and 12 weeks. During each follow-up appointment, oto-microscopy was performed to assess the success of the graft and identify any potential complications. Results: In group 1, 55% of the patients were males and the remaining 45% were females. In group 2, 60% of the patients were males and the remaining 40% were females. In the present study, the graft uptake rate was observed to be 95% and 89% in the interlay and underlay techniques, respectively. After 12 weeks post-surgery, the Interlay tympanoplasty procedure showed the greatest reduction in the mean air bone gap. Conclusion: The Interlay technique has proven to be highly successful in Type I tympanoplasty, achieving excellent results in terms of graft uptake and closure of the air-bone gap.

Background: The morbidity and mortality of Chronic Obstructive Pulmonary Disease (COPD) is always unpredictable and challenging the treating physician. To understand the relation COPD of exacerbated type, inflammatory biomarkers such as White Blood cell count (WBC count), C reactive protein, plasma Proadrenomedullin (ProADM), and procalcitonin (PCT) a prospective study was conducted. Aim of the Study: To study the relation between biomarkers, and demographic and clinical signs in terms of morbidity and mortality in COPD patients. Materials: 96 patients with COPD were analyzed with causes for hospitalization for both pneumonic- Group A- 43 (44.79%) and non-pneumonic- Group B- 53 (55.20%) COPD exacerbations with clinical signs required admission. The past history (vital status) was elicited with the help of structured interviews with family members. Results: During the period of study for 18 months 07/96 (07.29%) died during the first 12 months of follow up.  Another 10/ 89 (10.41%) pod the remaining patients died within 06 months of follow up. The mortality rate for the entire period of study was 17.70% (17/96 patients). The one year survival rate was 93% (n-96) and survival rate at the end of 18 months was 88.76% (n-89). Conclusions: It is of interest to note that ProADM as a biomarker seem to be associated with vital status in COPD patients. ProADM in addition to other biomarkers like PCT and CRP improved the predictability in assessing the morbidity and mortality in COPD patients with or without pneumonia.

Aims and Objectives:  To obtain the correlative association and prevalence of thyroid abnormalities with total iron status of the body among Chronic Kidney Disease patients. Materials and Methods: Our study is of cross sectional type conducted in Regional Institute of Medical Science, Imphal, during the period from January 2015 to December 2015. This study consists of total 75 patients with positive diagnostic criteria of CKD and patients with hematological profile, iron status, clinical and renal parameters. We have taken adequate number of controls for comparison of the results with the general population. Results: This study projected that among 75 patients with CKD, 49 patients had low T3 syndrome that comprises of 65% of the patients. 14 patients were with low T4 syndrome that consists of 18% of the patients and 12 patients suffered from primary hypothyroidism with TSH > 20µIU/ml. around 43% of the patients did not possess target serum ferritin of 100 ng/ml and 49.2% of them did not have TSAT of >20%. Conclusions: Our study shows an increased prevalence of thyroid malfunctions especially hypothyroidism, associated with increased incidence of anemia and iron deficiency projecting symbiotic relationship among body iron status and thyroid function. Thyroid dysfunction, therefore, with patients of CKD, does not indicate hypothyroidism itself, but is considered as a reflection of the state of malnutrition or chronic illness.

Introduction:  Junk foods seem to have engulfed every age and newest among them are adolescents. The adolescent period needs appropriate nutrition as it is a time of rapid growth and development. These are the food items which contain little or no proteins, vitamins, minerals and are rich in energy, sugar, salt and fats. Increased junk food consumption is among all age groups which is emerging as an public health challenge with a global prevalence of 70%. Objectives: 1. To determine the prevalence of Junk food consumption among degree students. 2. To assess the pattern of food consumption among degree students and its socio demographic determinants. Material and Methods: A cross sectional survey was conducted among two selected degree colleges of Davangere city during the month of July 2022. Students studying in the selected colleges were included in the study. Assessment of Variables: Data was collected using a pretested and validated, self-administered and anonymous questionnaire. The study variables consisted of socio-demographic variables and patterns of food consumption which included from regular food to salty and sweet junk food, carbonated drinks, milk & dairy products, fruits and vegetables, salads and its frequency of consumption. Results: The prevalence of junk food consumption is very high (82%) among the participants. Among them 26% of the participants are regular consumers and 56% of them are occasional consumers.

Background and Objectives: Retinal Vein occlusion (RVO) is the second most prevalent retinal vascular condition, occurring after diabetic retinopathy. It leads to painless vision impairment. RVO can be caused by a combination of several systemic, local, and hematologic illnesses. Recent studies have shown that certain inflammatory biomarkers and hyperlipidemia are more commonly linked to RVO. The objective of our investigation is to establish the correlation between systemic biomarkers and RVO. This correlation can assist patients with retinal vein occlusion (RVO) in recognizing other systemic diseases and in averting the occurrence of RVO in their other eyes. Material and Methods: In this retrospective study, a total of 50 patients were recruited from the Department of Ophthalmology, S.S. Medical College and affiliated Gandhi Memorial Hospital, Rewa (M.P.). The investigation was conducted after obtaining approval from the institutional ethics committee and obtaining informed written consent from the patients. Data collection involved obtaining a thorough medical history. Additionally, all participants in the research underwent a full eye examination. Laboratory tests were conducted to measure levels of inflammatory markers (CRP, Homocysteine) and lipid profile parameters (Cholesterol, Triglyceride, VLDL, LDL, HDL levels, MHR). The statistical analysis was conducted using SPSS version 24. The data was reported using the mean and standard deviation, or proportions when applicable. Results: The demographic characteristics of the two groups were similar. The average CRP and Homocysteine levels were considerably elevated in the patients compared to the controls. The lipid profile parameters, with the exception of HDL, exhibited considerable increases in individuals with RVOs. Conclusion: The present study demonstrates a correlation between retinal vein occlusion (RVO) and the inflammatory markers C-reactive protein (CRP) and homocysteine. These indicators might be considered as risk factors in the development of RVO. The present investigation has determined that it is necessary to assess the blood cholesterol levels of all patients who have experienced retinal vascular obstruction. It is uncertain if restoring normal levels of lipids in the blood may improve vision and prevent the occurrence of retinal vein occlusion (RVO) in the other eye, or if it can reduce complications and the recurrence of RVO in the same eye.

Background: Pregnancy is not a disease & pregnancy related, morbidity and mortality are preventable. An effective and efficient referred system is important to facilitate efficient transfer of patients to next level of care, particularly in case of obstetrics emergencies. Present study was aimed to study various cause of obstetric referral, their management and outcome of mother and baby .Also mode of transport, delay in transport, referral details of referred patients are discussed in this study. Aims and Objectives: To evaluate the feto-maternal outcome among referred obstetric cases to sir. T. hospital, Bhavnagar. Materials and Methods: present study conducted in department of obstetrics and gynecology, Sir .T. Hospital, Bhavnagar. All referred ANC cases to our tertiary care institute of > 20weeks of pregnancy and all intrapartum referrals are included in study from January 2022 to January 2023. Referred without referral slip, all postpartum referrals and Private hospital referrals are excluded from study. Results and Observations: In this study, 50% are intrapartum referrals and 50% are antepartum referrals. Previous caesarean sections were the cause of referral in 16.3% of cases in the present study. Maximum were referred for preeclampsia (27.9%) followed by meconium stained liquor (14.1%) followed by anemia (15.9%) followed by post term pregnancy (12). 15.9% of cases were referred due to non-availability of blood. In the present study, it can be concluded that the rate of caesarean section is substantially high in referred cases. 18% of the total referred cases were managed conservatively and discharged. In the present study, 96.9 % were live births. Because of such a improved and well managed referral system and many other government schemes for maternal health, India is on verge of achieving the sustainable development goals SDG of 70/lakh live births by 2030. Conclusion: It is concluded that referral system proved to be efficient in proper diagnosis, management of PIH, early referral, to assess if operative interference needed or not and making timely reach to tertiary care hospital.

Background: The Transversus Abdominis Plane (TAP) block is a recently introduced regional anesthesia method utilized for postoperative pain control, with the potential to serve as the primary anesthetic in a growing array of surgical procedures. TAP block enhances postoperative pain management by reducing postoperative visual analog scale scores, opioid requirements, and the time elapsed before the initial administration of rescue analgesia in patients undergoing lower abdominal surgeries. Aims and Objectives: In our research, we employed the TAP block as the exclusive anesthetic method for elective patients undergoing Lower Abdominal Surgeries. We then compared the effectiveness of two distinct local anesthetics, namely 0.5% Bupivacaine and 0.75% Ropivacaine, in terms of their duration of anesthesia and analgesia as well as their impact on cardiovascular stability. Materials and Methods: A prospective randomized clinical trial involved 60 patients classified as ASA I and II who met the specified inclusion and exclusion criteria. These patients were divided equally into two groups: Group B, which received an injection of 0.5% bupivacaine, and Group R, which received an injection of 0.75% ropivacaine. The dosage administered did not surpass 2.5 mg/kg body weight for any participant. Results and Conclusion: Our study revealed that both drugs provide effective anesthesia for Lower abdominal Surgeries while maintaining hemodynamic stability. However, 0.75% Ropivacaine exhibited a significant delay in the onset of anesthesia (13.46 +/- 3.2 min) compared to 0.5% Bupivacaine (7.86 +/- 2.47 min) (P value <0.001). Furthermore, 0.75% Ropivacaine resulted in prolonged postoperative analgesia (675.54 +/- 30.31 min) compared to 0.5% Bupivacaine (573 +/- 45.72 minutes) (P value <0.001). This suggests that the Transversus Abdominis Plane (TAP) block can serve as the sole anesthetic technique for Lower abdominal surgeries.

Background: Injuries to the acromioclavicular (AC) joint represent a spectrum of soft tissue disruptions that can result in mild, transient pain of the joint to significant displacement, chronic pain, and changes in shoulder biomechanics resulting in long term disability. These injuries most commonly occur in male patients <30 years and are associated with contact sports or athletic activity in which a direct blow to the lateral aspect of the shoulder occurs. Anatomic reconstruction of the native CC ligaments and AC ligaments represents an improved understanding of the biomechanics in this area with the attempt to improve surgical outcomes. Aim of the study is to evaluate the clinical and radiological outcome of coraco-clavicular and acromioclavicular joint reconstruction with non-absorbable Ethibond no. 2 for treatment of Type III – VI AC Joint separation. Study Design: Ambispective Case series. Methodology: A total of 20 patients attending the causality and OPD of Orthopedics Department at Government Medical College, Kadapa diagnosed with Rockwood Type III-VI AC joint separation were taken for the study after prior well informed written consent. The clinical and functional outcome was assessed with VAS Score and Constant & Murley Score while the radiological outcome was assessed using plain radiograph. Results: Among the 20 patients who were included in the study, nine, six and three patients sustained Rockwood type V, IV and III injuries respectively. The mean age was 38.8 ± 6.569 (mean ± SD) with a mean follow-up of 12 months. At 12 months follow-up the mean VAS score was 0.65 ± 0.476 and mean Constant Murley Score was 90.75 ± 1.81. Compared to the baseline the clinical scores improved significantly (p<0.05). No Neurovascular complications were encountered in any of the patients who were part of this study. Conclusion: In this study AC joint dislocations type III-VI treated with ligament reconstruction by using 2 loops of Ethibond 2 and AC ligament repaired by single loop Ethibond 2 is a reliable method for establishing Antero-posterior and superio-inferior stability of AC joint and results in excellent clinical, radiological and functional outcome.

Background and Aim: Meningitis is a serious condition that can have severe consequences, including permanent brain damage, neurological issues, and even death. This study aimed to assess the diagnostic importance of CRP in CSF as an early indicator for distinguishing between bacterial and nonbacterial meningitis. Material and Methods:  An observational study was conducted in the paediatric ward of a tertiary care hospital in India over a period of 1 year. During the study period, a total of 100 children, ranging in age from 1 month to 12 years, were included in the study due to suspected meningitis. A lumbar puncture was conducted at the L3-L4 level, and a cerebrospinal fluid sample of no more than 3 ml was collected in 4 sterile containers. 1ml was sent to test for protein and sugar levels, while 0.5ml each was sent for CSF cytology and CSF-CRP. Additionally, 1ml was sent for CSF culture sensitivity and gram staining. Results: The most common symptoms observed were fever (95%) and altered sensorium (92%), while the most frequently observed meningeal sign was neck rigidity (58%). Out of the 100 patients who were suspected of meningitis, the final diagnosis of bacterial meningitis was determined through CSF examination. It was found that 56% of these cases had a positive culture report. A significant majority of the patients who tested positive for the culture also had elevated levels of CRP in their cerebrospinal fluid. When analyzing cytology reports and CSF CRP positivity, it was discovered that 81.5% of the reports yielded positive results. When comparing abnormal CSF biochemical reports to CSF CRP positivity, it was discovered that 80% of cases were positive. Conclusion: The levels of CRP in CSF demonstrate a moderate sensitivity and specificity, along with a high positive predictive value. It has been found that CSF CRP is a more effective marker in distinguishing bacterial meningitis.

Background: The COVID-19 pandemic has resulted in immense devastation, with a staggering death toll of over three million worldwide. As a consequence, there has been a notable rise in opportunistic infections, with one of the most alarming being COVID-19 associated Mucormycosis (CAM). The lack of comprehensive guidelines for screening and managing this condition, coupled with delayed diagnoses and poor prognoses, have heightened concerns among healthcare professionals that an epidemic of CAM may occur alongside the existing pandemic. Method: Twenty-one cases of invasive fungal infection from March to November 2021 were retrospectively examined. Demographic, clinical, laboratory, radiological, microbiological, pathological, and outcome data were then collected and analyzed. Result: Twenty-one consecutive inpatients with COVID-19 associated Mucormycosis (CAM) had a 57% pre-existing diabetes mellitus rate. The most prevalent symptoms at the beginning of the disease included facial swelling (81%), periorbital edema (52%), fever (81%), and headache (57%). According to radiographic studies, the majority of patients showed thickening of the sinus mucosa, which was followed by inflammation of the periorbital muscles and cavernous sinus infiltration. Conclusion: Steroid use, diabetes mellitus, and superadded COVID-19 infection induced immunodeficiency caused a higher incidence of Mucormycosis. The study highlighted the importance of early detection and proactive treatment, including surgical debridement and antifungal therapy, which significantly improved the long-term outcome and reduced the rates of mortality and morbidity.

Aims of the Study: 1. To determine the efficiency of Doppler velocimetry in the early diagnosis of hypoxia in Intra Uterine Growth Restriction.  2. To determine the predictive value of the Doppler velocimetry of umbilical and middle cerebral artery with the perinatal outcome in fetuses Intra Uterine Growth Restriction. 3. To predict the effect of Doppler velocimetry on the mode of delivery. Objective: To determine Efficacy of Doppler velocimetry of umbilical artery (UA- S/D) and middle cerebral artery (MCA-S/D, Brain sparing effect BSE, Cerebro placental ratio CPR<1) in early diagnosis of hypoxia in intrauterine growth restriction (IUGR), effect on mode of delivery and in predicting perinatal outcome in fetuses with IUGR. Materials and Methods: 50 pregnant women with clinically suspected IUGR are subjected to ultrasonography with Doppler. The Doppler results were related to perinatal outcomes including birth weight, mode of delivery and perinatal complications. Results: a) Mode of delivery: When CPR<1 & BSE combined – 80% vaginal delivery. b) With AEDF &REDF, very low birth weight increased by 4 times than high S/D. No difference between AEDF & REDF →reversal is an acute event. c) Perinatal outcome: UA-All abnormal waveforms – meconium aspiration syndrome -100% while MCA *BSE -66.7%: CPR<1 – 50%. d) Mortality rate: higher with all abnormal UA waveforms than abnormal MCA waveforms. CPR<1 more sensitive in early detection of fetal hypoxia than other parameters of MCA as well UA thereby averting perinatal mortality. Conclusion: MCA shows high sensitivity (92%) compared to UA (76.92%) in predicting fetal hypoxia with high positive and negative predicting value (92%).CPR<1 is more sensitive in predicting the hypoxia than BSE. UA and MCA waveforms as an indication for cesarean section are not significant.

Background: Chronic abdominal pain is a common presenting complaint in the general practice of both physicians and surgeons. The most common cause include intestinal adhesions, biliary causes, and appendicular causes, while functional conditions include irritable bowel disease, functional dyspepsia, and various motility disorders and  some extra-abdominal conditions. Laparoscopy is a low risk, minimally invasive procedure and Diagnostic laparoscopy is a key in solving the diagnostic dilemma of chronic pain abdomen. It allows the visual examination of the intra-abdominal organs to detect pathology. Aim of study: To assess the role of diagnostic laparoscopy, a minimally invasive surgical technique in the evaluation and treatment of chronic abdominal pain in adults. Methodology: A prospective observational study done for 8 months duration, 25 patients with chronic abdominal pain as per Rome III classification, who underwent diagnostic laparoscopy and further treatment in the Department of General Surgery, GMC, Rajamahendravaram, were considered for this study. Results: Most of patients presenting with CAP are females with 18 out of 25, most common site of pain is right lower quadrant followed by entire lower abdomen. All patients were subjected to diagnostic laparoscopy and 23 out of 25 had final diagnosis. Most common cause of CAP was Adhesions followed by Appendicitis. 18 patients had undergone therapeutic procedure in the same sitting apart from 5 patients who obtained samples for histopathological examination that aids in further medical management. No major Intra / Post operative complications were recorded with only 3 patients had minor wound infections. Conclusion: Thisstudy has established that Diagnostic Laparoscopy is an effective tool for the diagnosis and treatment of patients with chronic abdominal pain.

Introduction: Benign prostatic enlargement is one of the most prevalent ageing related derangements in men and has significant impact on quality of life. This study was designed to find the association of Vitamin-D levels and prostatomegaly grade in patients of BPH. Material and Methods: After Ethical Committee approval, blood sample was collected from 60 BPH patients. Vitamin-D level was measured by Chemilunimiscence method in fully automated Advia-centaur analyser. Results were analysed in relation to the prostatomegaly grades in patients of BPH using students ‘t’ test. Vitamin-D level < 20 ng/ml was considered deficient. Result: Serum Vitamin D level was less in patients with Grade 3 prostatomegaly (16.65 ± 2.914) than patients with Grade 1 (20.438 ± 3.785) and Grade 2 ( 19.645 ± 3.853) prostatomegaly and found statistically significant. Conclusion: Our study showed significantly lower levels of Vitamin-D (p value <0.001) with higher prostatomegaly grade in males with BPH. Thus Vitamin-D levels may have a significant role in the etiopathogenesis of BPH & severity of symptoms. Vitamin D deficiency may be used as a therapeutic target for preventing and treating BPH.

Background: Fenestration discectomy and open discectomy are commonly performed surgeries for low back pain, which poses a significant health concern for patients of all ages. A key cause of low back pain is lumbar disc herniation, which forms the crux of our study. This study aims to draw a comparison between the two procedures in patients with symptomatic lumbar back pain as a function of pain levels postoperatively, and return to daily activities using the Visual Analogue Scale as a primary outcome measure, Oswestry Disability Index and other secondary outcome measures. Methods: 60 patients aged between 18 to 65 years with lumbar disc herniation at L4-L5, were divided randomly into group A – where 30 patients underwent open discectomy and Group B – where 30 patients underwent fenestration discectomy. All patients were assessed at 24 hours, 2 weeks, 6 months and 2 years postoperatively after surgery using the Oswestry Disability Index and Visual Analogue Scale for pain and ability to return to daily activities. Results: In both groups, all patients had minimal discomfort post-surgery according to the Visual Analogue Scale (24 hours postoperatively: t value – 1.5861, p = 0.118 – not significant). There was no recurrence of disc herniation among both the groups, over the 2-year follow-up period. The mean stay in hospital and time taken to return to daily activities were similar across groups. Conclusion: Given the outcome of our surgery, using a smaller incision is beneficial in many ways, including lesser tissue disruption which in turn leads to lesser post-operative pain, and lesser duration of hospital stay, as noted in our study, both in open and fenestration discectomy.

Context: Oxygen therapy is essential for managing various medical conditions. Being a drug, it has to be prescribed rationally with appropriate dose and device. Targets to be achieved depends upon clinical status. Non-compliance with prescribed guidelines can compromise patient outcome. Aims: This prospective audit was aimed to assess compliance to prescribed oxygen therapy and documentation of appropriate prescription as per guidelines, followed in a critical care department. Settings and Design: A prospective observational audit was conducted in a critical care unit of a tertiary care teaching hospital, located in a rural region. Methods and Material: Sixty consecutive patients fulfilling inclusion criteria, admitted to the intensive care unit were included, and their oxygen therapy compliance were evaluated as per (British Thoracic society) BTS guideline. Compliance was analysed for achieving targeted oxygen saturation levels and adhering to prescribed oxygen flow levels. The prescription documented in the electronic record were also analysed for its completeness regarding instruction. Results: The study revealed a fairly high compliance rate (76.6%) in achieving the desired oxygen saturation levels, indicating effective oxygen delivery tailored to patient needs. However, proper documentation of oxygen therapy prescription was low (26.6%), highlighting potential gaps in oxygen prescription. Conclusions: This audit indicate reasonably good compliance in achieving desired oxygen saturation level in a rural setting. However, documentation of oxygen prescription was poor. Education, training, and enhanced monitoring will be crucial to ensuring guideline compliance, optimizing patient outcomes, and minimizing risks associated with suboptimal therapy.

Background: Various cadaveric and imaging studies showed that renal arteries have a wide range of variations. Hence, the present study was undertaken to know the origin, course, and relations of renal arteries (RA) and accessory renal arteries (ARA) and the possible variations of renal arteries in cadavers. Method: The study was conducted in 50 Kidney specimens obtained from formalin preserved human cadavers available from the Department of Anatomy of tertiary care hospital during a period from March 2021–December 2023.Dissection of RA was done by dissection method as per the Cunningham’s Manual. Results: Among the 50 kidneys dissected, single RA was observed in 78% of specimens, double RA in 16% and Triple RA in 6% of specimens. In 26% of specimens the origin of RA was in same level, 28% of right RA and 8% left RA had higher origin. The origin of main renal arteries was from aorta in all specimens. 22% of ARA arose from Aorta and 6% originated from main RA. The length of right sided RA varied from 2cm to 6cm and left sided RA varied from 2cm to 5.5cm.Extrarenal division of renal arteries was observed in 98% and intra renal division was in 2% of specimens which was seen only on right side. Prevalence of ARA was 28%, 24% right sided and 32% left sided. Hilar type of ARA was seen in 14% of the specimen, superior polar artery (SPA) in 4% and inferior polar artery (IPA) in 8% of the specimens. Both SPA & IPA was seen in 2% of the specimens. Single ARA was seen in 20% and double ASA in 4% of the specimens. ARA was passing in front of IVC in 2% and behind IVC in 22% of the specimens. Unilateral ARA was seen in 12% and bilateral ARA was seen in 6% of the specimens. Conclusion: To conclude the usual textbook description of renal arterial pattern may not be found in all the patients under investigation. Variations observed were single, double, or triple renal arteries, extrarenal division of the renal arteries and ARA. This kind of different pattern of variations may play an important role in renal transplants and any surgeries involving the renal arteries.

Background: Adverse Drug Reactions (ADRs) reporting is critical for patient safety, yet it is often underreported. This study aimed to assess the knowledge, attitude, and practices (KAP) of nursing staff regarding ADR reporting at a Government Tertiary Care Hospital in Andhra Pradesh, India. Methods: A cross-sectional descriptive study was conducted with 206 nursing staff members using a convenience sampling method. Data were collected over two months (February to March 2024) through a semi-structured, pre-validated questionnaire. Results: The study revealed that 85% of participants correctly identified the full form of ADR, and 60% were aware of the Pharmacovigilance Programme of India (PVPI). Additionally, 70% knew that nursing staff could report ADRs, and 55% correctly identified the location of the Pharmacovigilance center. A significant majority (90%) believed that reporting ADRs is necessary. Regarding the types of ADRs to report, 25% indicated serious ADRs, 50% all ADRs, 15% unknown ADRs, and 10% selected ADRs. In terms of attitude, 65% disagreed with the statement that explaining ADRs to patients harms them, and 75% were willing to undergo ADR training. For practices, 40% identified ADRs by themselves, while 30% relied on patient complaints. Only 50% knew how to fill ADR forms, and 30% had reported ADRs in the past year. The main difficulties in ADR reporting included lack of forms (40%), insufficient knowledge and training (35%), and poor communication channels (25%). Suggested measures to overcome these obstacles included regular training programs (50%), improved availability of ADR forms (30%), and enhanced communication channels (20%). Conclusion: The findings highlight a moderate to high level of knowledge and a positive attitude towards ADR reporting among nursing staff. Addressing practical barriers through structured training and resource allocation can enhance ADR reporting practices.

Background: The mainstay in the management of preterm neonates with respiratory distress syndrome (RDS) includes early Continuous Positive Airway Pressure (CPAP), timely surfactant replacement and mechanical ventilation. Objective: This study sought to examine the need for ventilation and surfactant therapy in preterm neonates <34 weeks when CPAP is initiated early-at birth compare the same with historical controls- preterm neonates <34weeks with respiratory distress after birth and initiated CPAP after admission to NICU and to study the mortality and morbidity associated with early use of CPAP. Materials and Methods: A two-year-long prospective and observational study was carried out in the Neonatal Intensive Care Unit (NICU) of M.V.J Medical College and Research Hospital, Bengaluru, Karnataka, India. The study was approved by the Ethical Committee of M.V.J. Medical College and Research Hospital. Inclusion criteria constituted all preterm neonates <34weeks breathing spontaneously with clinical suspicion of mild to moderate respiratory distress as per Silverman Anderson score 3-5. Exclusion criteria constituted all neonates with congenital heart disease, congenital anomalies, requiring mechanical ventilation, neonates with Silverman Anderson score > 6, severe birth asphyxia, shock, apnea, and, neonates already intubated for any clinical indication at labour room. A total of 100 neonates (50 neonates in control group-group 1-the study group and 50 neonates in historical cohort group-group 2) were considered in the current study. Primary outcome was to assess the need for mechanical ventilation and the need for surfactant, secondary outcome was to assess the mortality and morbidity associated with CPAP in both the study group and control group. Result: The data of total 100 neonates were analysed during the study period. There was no statistically significant difference between group 1 and group 2 for Weight (in grams), mean gestational age (in weeks) and mean Silverman Anderson score. The CPAP failure rate was recorded as 22% and 80% in group 1 and group 2, respectively, which was statistically significant. There were two complications (CPAP Belly and Nasal Crusting) due to CPAP and were recorded as 8% for CPAP belly in both group 1 and group 2, and 4% and 6% for Nasal Crusting in group 1 and group 2. Mean duration of CPAP (in hours) was recorded as 35.44 hours and 9.36 hours in group 1 and group 2, respectively, which was statistically significant. There was no statistically significant difference between group 1 and group 2 for recorded five complications (IVH, BPD, IVH+PDA, PDA and ROP) during hospital stay. The current study recorded no death in group 1 while 7 deaths were recorded in group 2, and there was no statistically significant difference. Conclusion: Early initiation of CPAP at birth was associated with lesser complications in preterm babies, lesser morbidity and mortality, reduction toward the need for intubation

Student’s admission in medical colleges in India comprises a diverse pattern. A few years ago, Entrance Examination for school final (plus-two) students was abolished in many states. This is because the rural students were assumed to be not good with the analytical questions (MCQ’s) than the students who studied in urban areas. In PSGIMS&R medical college in the first year, urban students represent 78% while rural students represent 22% of the total population. Will such a urban/rural difference among the medical students affect their individual learning styles? Will the Instructor has to modify his teaching style to cater the needs of the vibrant student community? Urban students are those who had their schooling in urban areas while rural students are those who had their schooling in rural areas. So, the VARK Questionnaire was administered to all the 55 students who were chosen randomly in the class. URBAN- 30 students. RURAL – 25 Students. The expansion of VARK type of learning styles are: V (Visual)- Learning from graphs, charts and flow diagram, A (Auditory)- Learning from speech, R (Read/ write)- Learning from reading and writing, K (Kinesthetic) – Learning from touch, hearing, smell, sight and taste. Out of this, the preference of learning style by majority of students is Multimodal (i.e.,) 57% in urban students & 60% rural students. The unimodal modality that was chosen by majority of both urban and rural students was of Kinesthetic type.

This prospective observational study aimed to identify potential risk factors, clinical features, and visual outcomes associated with non-arteritic anterior ischemic optic neuropathy (NA-AION). Conducted over a twelve-month period (February 2023 – January 2024) at the Ophthalmology OPD of a government hospital in South India, the study evaluated 24 patients diagnosed with NA-AION based on Hayreh’s criteria. The investigation assessed the prevalence of risk factors like diabetes, hypertension, dyslipidaemia, sleep apnoea and smoking. Clinical features such as visual acuity, pain, and disc oedema were documented. Visual outcomes were measured at the final follow-up visit. This study will contribute to a better understanding of the clinical profile and risk factors associated with NA-AION in the South Indian population.

COVID-19 pandemic in India is a part of worldwide pandemic of coronavirus disease 2019 caused by severe acute respiratory distress syndrome coronavirus 2(SARS-CoV-2). First cases of covid 19 were reported in January 2020 in kerala. Rhino-orbito-cerebral mucormycosis (ROCM) is considered as a rare invasive infection caused by class phycomycetes fungi involving immunocompromised patients who have developed COVID-19 infection in the recent past, arising from nasal and sinus mucosa, spreads rapidly to orbit and brain. India reports about 50,000 cases of covid associated mucormycosis so far. Men are more commonly affected than women. For managing this fatal condition multispecialty approach involving Ophthalmology, ENT, Neurosurgery Dental Surgery, Medical and Radiology departments are involved. CT & MRI are imaging modality of choice for establishing a correct diagnosis & guiding therapeutic decisions. Early suspicion, rapid diagnosis, and initiation of treatment are the most important factors that determine prognosis in the management of mucormycosis. CT useful in preoperative planning for determining sinonasal anatomy, extent of disease, and in directing the surgical approach. The acquisition time is shorter and less expensive and more widely available. MRI is a multiplanar imaging modality, does not involve radiation exposure, is a safer imaging modality in patients requiring multiple follow-up degradation is its disadvantages. Making a prompt diagnosis is fundamental for the patient’s safety. The above study is conducted in government general hospital, Guntur for a period of 3 months from June 2021 to August 2021.

Background: Breast carcinoma remains a leading cause of cancer-related mortality among women globally, necessitating improved biomarkers for prognosis and treatment stratification. MUC1, a transmembrane glycoprotein, has been implicated in various cancers but its prognostic value in breast cancer remains underexplored in Indian populations. Objective: To evaluate the association of MUC1 expression with clinico-pathological parameters including tumor grade, hormone receptor status, and lymphovascular invasion in patients with breast carcinoma. Methods: This retrospective study analyzed 100 slides of confirmed cases of breast carcinoma at Maharshi Devraha Baba Autonomous Medical College, Deoria, UP, from November 2022 to October 2023. MUC1 expression was assessed via immunohistochemistry and correlated with tumor grade, estrogen receptor (ER), progesterone receptor (PR), HER2 status, and presence of lymphovascular invasion using chi-square tests for categorical data. Results: MUC1 was positively expressed in 73% of the cases. Significant associations were found between MUC1 positivity and higher tumor grades (p = 0.002), Luminal B subtype triple negative, and HER 2 enriched carcinomas. The presence of lymphovascular invasion (p = 0.01). MUC1 expression was notably higher in more aggressive tumor subtypes, suggesting its potential role in identifying patients with poorer prognosis. Conclusion: The study underscores the significance of MUC1 as a prognostic marker in breast carcinoma, correlating with more aggressive disease features. MUC1 could serve as a valuable biomarker for refining prognosis and tailoring treatment strategies in breast cancer management. Further studies are recommended to validate these findings and explore the mechanistic roles of MUC1 in breast cancer progression.

Introduction: Urinary incontinence is a distressing condition among women. Incontinence can impair social life, physical activity, sexual activity thus affecting emotional and psychological well-being of women. The most common type of incontinence among younger women is stress urinary incontinence (SUI). The aim of present study was to determine how accurately transperineal ultrasound  can be used to detect stress urinary incontinence as compared to control group. Material and Methods: This prospective observational study was conducted with a total of 40 patients, including 20 patients with stress urinary incontinence (Group I) and 20 age matched control (Group II). Women of the cases group were diagnosed to have SUI when they had a complaint of involuntary leakage of urine on stress (cough, sneezing or certain movements) and had a urodynamic study showing a stable detrusor pressure curve on Valsalva or coughing. The ultrasound readings were noted and data was analyzed using SPSS version 25.0. Results: The mean (SD) α angle at rest of the SUI group was 49.0 (±13.3)°, which was slightly higher than the α angle in the control group: 48.6 (±9.7)° and the difference was not statistically significant. The α angle at straining was significantly higher in the SUI group versus the control group, 61.0 (±15.5)° versus 54.8 (±15.6)°. The mean (SD) β angle in the SUI group at rest was 115.6 (±28.5)°, which was not significantly higher than that of the control group at 114.0 (±22.5)°. The mean (SD) β angle at straining was significantly higher in the SUI group versus the control group: 151.8 (±90.6) versus 136.0 (±27)°. Comparing the BND between the two groups it was significantly higher in SUI Group (16.6±4.22 vs.6.53±1.69) (p=0.000). Conclusion: Present study suggest that transperineal ultrasonography can be considered as a non-invasive, easily conducted, and accurate modality in early diagnosis of female SUI. It can be used as useful investigation in addition to urodynamic study. However, the role of TPUS in assessment of SUI severity remains to be studied  with a larger sample size.

Pre-eclampsia is common medical complication of pregnancy. The association of altered lipid profile in essential hypertension is well documented. The present study was planned to study the role of altered lipid profile in the development of pre- eclampsia. Methodology: The study comprised of 30 normal pregnant women and 30 pre-eclamptic women in their third trimester of pregnancy. Serum Total cholesterol, Triglycerides, LDL Cholesterol and HDL- Cholesterol by enzymatic colorimetric method were done. Results: There was significant rise in Serum Total cholesterol, Triglycerides, LDL Cholesterol and a significant decrease in HDL Cholesterol in pre-eclamptic group as compared to normal healthy pregnant women. Conclusion: Altered lipid profile also has a potential role in the genesis of endothelial dysfunction and expression of pre-eclampsia. Early detection of these parameters may help patient by preventing complications in pre-eclampsia and is going to aid in better management of Pre-eclampsia.

Background: Amlodipine and cilnidipine are commonly used calcium channel blockers for the treatment of hypertension. However, their comparative efficacy and side effect profiles, particularly regarding pedal edema, remain subjects of clinical interest. Materials and Methods: This prospective study included 100 mild to moderate hypertensive individuals, randomly assigned to receive either amlodipine or cilnidipine therapy for a duration of 6 months. Blood pressure measurements were recorded at baseline and at regular intervals throughout the study period. Incidence of pedal edema was monitored closely. Statistical analysis was performed to compare the antihypertensive efficacy and incidence of pedal edema between the two treatment groups. Results: At the end of the 6-month study period, both amlodipine and cilnidipine demonstrated significant reductions in systolic and diastolic blood pressure from baseline values (p < 0.05). However, the reduction in systolic blood pressure was slightly greater in the cilnidipine group (mean reduction of 15 mmHg) compared to the amlodipine group (mean reduction of 12 mmHg). Furthermore, the incidence of pedal edema was notably lower in the cilnidipine group (8%) compared to the amlodipine group (15%). Conclusion: In mild to moderate hypertensive individuals, both amlodipine and cilnidipine are effective antihypertensive agents. However, cilnidipine may offer a slight advantage in terms of greater reduction in systolic blood pressure and a lower incidence of pedal edema. Further studies with larger sample sizes are warranted to confirm these findings and explore potential mechanisms underlying the observed differences.

Background: Dexmedetomidine is increasingly used in ENT surgeries to maintain haemodynamic stability and minimize blood loss, thereby improving the surgical field quality. While the benefits of dexmedetomidine, such as reduced requirement of inhalational agents and analgesics, are well-documented, studies comparing the efficacy and safety of its administration via IV bolus versus IV infusion specifically in ENT surgeries are limited. This study aims to fill that gap by assessing the effects of these two administration methods on intraoperative hemodynamics, analgesic and anesthetic requirements, adverse effects, and surgeon satisfaction. Materials and Methods: This prospective, randomized, double-blind study included patients undergoing elective ENT surgeries under general anesthesia, classified as ASA grade I and II. Sixty patients were randomly divided into two groups: Group A received an IV bolus of Dexmedetomidine (1 mcg/kg over 10 minutes before induction), and Group B received a continuous IV infusion of Dexmedetomidine (0.5 mcg/kg/hr, started 10 minutes before induction and continued until the end of surgery). The primary objective was to compare the effects of these methods on intraoperative hemodynamics. Secondary objectives included comparisons of rescue analgesics and isoflurane requirements, additional analgesic needs, adverse effects, and surgeons’ satisfaction scores. Results: The study found that continuous IV infusion of Dexmedetomidine significantly improved intraoperative hemodynamic stability compared to IV bolus administration. Patients in the infusion group had more stable heart rate, blood pressure, and required less rescue analgesia and isoflurane. Furthermore, continuous infusion was associated with fewer adverse effects and higher surgeons’ satisfaction scores. Conclusion: Continuous IV infusion of Dexmedetomidine is superior to IV bolus administration in maintaining hemodynamic stability during ENT surgeries under general anesthesia. This approach reduces the need for additional analgesics and anesthetics, minimizes adverse effects, and improves surgical field quality, leading to higher surgeon satisfaction. These findings support the use of Dexmedetomidine IV infusion as a preferred method for managing intraoperative hemodynamics in ENT surgeries.

Background: Urinary tract infections (UTIs) are prevalent bacterial infections necessitating antibiotic treatment. The understanding of microbial profiles and antibiotic sensitivities in urinary isolates is crucial for effective therapy and resistance management. Materials and Methods: A retrospective analytical study was conducted at a private hospital in Nashik, Maharashtra. Urine samples collected over a period of one year were analyzed. Microbiological cultures were performed, and isolates were identified using standard methods. Antibiotic susceptibility was determined using the Kirby-Bauer method. Results: Out of 500 urine samples analyzed, Escherichia coli was the most frequent pathogen, accounting for 40% of cases, followed by Klebsiella pneumoniae (25%) and Enterococcus faecalis (15%). Nitrofurantoin exhibited the highest susceptibility rate (70%), followed by ciprofloxacin (55%), trimethoprim-sulfamethoxazole (50%), and amoxicillin-clavulanate (45%). Norfloxacin showed a susceptibility rate of 60%, while gentamicin had a susceptibility rate of 65%. However, resistance to ciprofloxacin was notable among E. coli isolates (35%). Conclusion: This study underscores the prevalence of E. coli as the predominant pathogen in UTIs and highlights the concerning rate of ciprofloxacin resistance. Nitrofurantoin remains a viable therapeutic option, while norfloxacin and gentamicin also demonstrate effective sensitivity profiles. Ongoing surveillance and prudent antibiotic use are imperative to address antimicrobial resistance.

Objective: To investigate the prevalence and factors associated with maternal postpartum depression (PPD) among urban mothers in Nellore City, India. Methods: A 14-month cross-sectional study involved 73 postpartum mothers in urban Nellore. Data were collected using a structured questionnaire and the Edinburgh Postnatal Depression Scale (EPDS). Sociodemographic variables like age, education, employment, socioeconomic status, and marital relationship quality were analyzed using logistic regression. Results: The prevalence of PPD was 35.6%. Lower education and poor marital relationships were significant predictors. Higher education was linked to lower PPD risk (AOR = 0.45, p = 0.03), while poor marital relationships increased risk (AOR = 3.50, p = 0.03). Employment status and socioeconomic status showed associations but were not statistically significant. Conclusion: The high PPD prevalence in Nellore City underscores the need for interventions focused on education, marital counseling, and better mental health services to improve maternal well-being.

Introduction: Medulloblastomas (MBs) are primitive neuroectodermal tumors (PNETs) located in the cerebellum. They are the most common malignant brain tumors in children, but their origin remains a mystery. MB cells express various neuronal and glial markers, suggesting they arise from different stages of neural development. Materials and Methods: In this study, we used immunohistochemistry to examine the expression patterns of the tumor suppressor gene p53 and the common low-affinity neurotrophin receptor p75NTR in 42 MB samples. Results: We found that 7 out of 42 medulloblastomas (16.6%) were positive for p53, with no significant difference observed between different subtypes. P75NTR expression was detected in 3 out of 16 desmoplastic nodular medulloblastomas (18.7%) and 2 out of 26 classic medulloblastomas. Interestingly, our study found a slightly higher p53 expression rate (16.6%) compared to previous reports (0-10%). Conclusion: While p75NTR may be upregulated in a subset of MBs, further investigation with larger studies is needed to confirm this association. Additionally, our findings regarding p75NTR expression differ from prior studies that reported 100% positivity in desmoplastic medulloblastomas.

Background: Education is a dynamic process, teaching and learning has remarkably progressed. Implementation of New CBME curriculum introduced various innovative methods of teaching which not only improves the knowledge and technical skills but also increases the analytical and communication skills, interests towards the learning. Objectives: (1). To determine the most preferred method of teaching learning method among medical students (2). To know the various reasons for choosing the teaching learning method among medical students. Materials and method: The study was conducted among 143 students studying in first MBBS. The students were asked to fill the form containing pre-designed questionnaire and were informed about the purpose of the study. Results: Among all different teaching learning methods, 34.25% students preferred teaching by power point presentation (PPT) over other methods. Most of the students mentioned that CBL classes are needed for better understanding, higher thinking of students and analytical approach for the topic. Conclusion: The study concludes that, the most preferred method of teaching were PPT and CBL in comparison to other methods. Students also chose other methods of teaching for better understanding, higher order thinking and easy way of learning.

Background: Multiple organ failure (MOF) is a clinical syndrome that came to prominence in the 1970s.¹ Its conception resulted from reports in the late 1960s which described remote organ failure, such as pulmonary and liver failure, as a consequence of severe sepsis. As there were limited studies on acute febrile illness and its association with MODS, we conducted this study in order of clinical features, etiology and outcome of MODS in patients with acute febrile illness. Material and Methods: A Hospital based prospective Observational study was conducted at Department of Medicine, tertiary care public hospital for period one year after Ethics committee permission. Total 100 patients were enrolled after matching inclusion and exclusion criteria. Results: 16 to 25 years (46%) was the most common age group amongst study population with male predominance (81%). Fever (100%) was the most frequent Clinical features followed by Chills/Rigors (98%). Bleeding Manifestations was present in 19% of study population. Deranged creatinine was present in 29% of study population .Vivax Malaria (26%) was the most common Peripheral smear findings amongst study population followed by Falciparum Malaria (1%) and Mixed malaria (1%). INR was Deranged in 36 % of study population. On USG Abdomen/Pelvis, Hepatomegaly (17%) was the most frequent findings. Dengue (53%) was the most common cause of thrombocytopenia amongst study population followed by Malaria (27%), Leptospirosis (13%), Septicemia (4%), Enteric fever (3%). Blood Transfusion was given in 16% of study population. RDP, FFP, PCV and SDP were Blood Product Transfused amongst which RDP was the most common. 94% of the study population had Less than 10 days of hospital stay. 89% of the study population were alive while death was occurred in 11% of study population. Death occurred most commonly in Dengue (36.40%) and Leptospirosis (36.40%) each and septicemia (27.30%). The common causes of death were Dengue Hemorrhagic Fever, Leptospirosis with ARDS and septicemia with shock. Blood system (31%) was the most common system in MODS followed by kidney(30%), lungs (13%), liver (12%) and CNS (5%). Mortality was observed most commonly in patients with more than 3 organ involvement (54.5%) followed by three organ (36.4%) and two organ (9.1%). Conclusions: Most common etiology of MODS was Dengue and Leptospirosis and septicemia. Hematological system was the most common system in MODS followed by kidney, lungs, liver and CNS. Mortality in was observed most commonly in patients with more than 3 organ involvement followed by three organ and two organ. It was observed that as the number of organ involvement increases in MODS, the risk of mortality also increases.

Background: Fibroids are the commonest benign neoplasms arising from the uterus in women of reproductive age with an incidence of 5%-20% depending upon the age group. Almost 50% women with fibroids are symptomatic and can be managed expectantly. On review of literature, it is understood that knowledge on uterine fibroids is very poor resulting in late presentation of the disease. There are taboos regarding the management procedures resulting in late therapy with complications. Aim: To assess the knowledge, attitude and perception on uterine fibroids in reproductive age group women. Methods: This is a cross-sectional study for a period of 3 months. Subjects in the reproductive age attending to the outpatient department of Obstetrics and Gynecology. The data was collected using a pre-tested questionnaire on clinical symptoms, knowledge, attitude and perception with respect to fibroids and data analysed. Results: Most women show poor knowledge concerning fibroids. Most women fear that surgery (hysterectomy) may cause loss of feminity due to the amenorrhea. The subjects opined those fibroids increased with age and positive family history is seen in 48%. Participants opined that there is association of obesity with clinical presentation of heavy menstrual bleeding and pain. Eighty seven percent felt herbal drugs and lifestyle modifications is the treatment for fibroids. It affects childbearing is not known in 76% of subjects. Conclusion: Patient counseling plays an important role to improve patient knowledge and encourage early reporting. Educational programmes can be conducted to increase their awareness of uterine fibroid. Camps can be conducted in rural areas regarding uterine fibroid to improve the awareness of women which help in early management and thereby preventing the complications of the disease.

Background: OA (Osteoarthritis) is a common form of degenerative arthritis. Biomarkers for osteoarthritis are scarcely studied. Osteopontin and hyaluronic acid are important biomolecules in the pathogenesis of osteoarthritis. Osteopontin has varied roles, including cancer pathogenesis and vascular smooth muscle contraction. The identification and estimation of biomarkers in osteoarthritis have important implications for degenerative arthritis therapy. Aims: To assess the potential of plasma osteopontin as a biomarker for tracking the severity of knee osteoarthritis, as well as its involvement in the pathogenesis of osteoarthritis through its stimulation of MMP13, which in turn raises the levels of hyaluronic acid in the serum. Methods: A total of 60 cases of osteoarthritis and 30 disease-free controls were recruited and plasma levels of osteopontin, hyaluronic acid, calcium and phosphorus were estimated. Osteopontin estimation was made by quantitative ELISA and hyaluronic acid by sandwich ELISA methods. Results: There was a significant difference in the levels of otseopontin (p = 0.014) and hyaluronic acid (p<0.001) among cases and controls and a significant correlation between different grades of OA in the KL classification and osteopontin levels (p = 0.022) and hyaluronic acid levels (p = 0.006). Osteopontin and hyaluronic acid could therefore be useful biomarkers for OA knee.

Peutz-Jeghers syndrome (PJS) is an inherited polyposis disorder distinguished by the presence of multiple hamartomatous polyps in the gastrointestinal tract. These polyps are specifically observed along the vermilion border of the lip and are associated with pigmentation of the mucosa. A germline mutation in the STK11 (LKB1) gene causes this autosomally dominant inheritance disorder. Mucocutaneous pigmentations most frequently impact the nosoal region, lips, perioral regions, buccal mucosa, eyes, extremities, palms, soles, and perianal areas. Although they can be found anywhere in the gastrointestinal tract, hamartomatous polyps are most commonly located in extraintestinal sites such as the bronchus, renal pelvis, and bladder. These polyps carry a low malignant risk. In light of the extensive range of carcinomas to which these patients are prone, it is advisable to implement stringent screening protocols. Patients with PJS must be closely monitored and followed up on in order to detect related malignancies early and prevent potential complications; this is due to the increased risk of intestinal and extraintestinal malignancies.

Objectives: The present study was to evaluate the Vitamin A deficiency and its Ocular manifestation on school Children in district Muzaffarpur, Bihar, India. Methods: All subjects underwent eye examinations, which included observation of scotopic vision (luxometer reading) and ophthalmologic examination (including posterior segment, if indicated). Anterior segment examination was done with a pen torch and magnifying loupe (1.5×). The clinical signs of xerophthalmia were recorded and graded according to WHO criteria. The history of night blindness was reassessed using a luxometer reading and severity of night blindness was graded using WHO criteria. All children confirmed as having night blindness were subjected to posterior segment examination by direct and indirect ophthalmoscope to rule out other fundus pathology. Results: Out of the 200 children examined, 116(58%) had normal ocular appearance while 84(42%) had ocular manifestation of vitamin A deficiency. Which included 17(8.5%) history of night blindness (XN), 51(25.5%) conjunctiva xerosis (XIA), 5(2.5%) bitot’s spot (XIB), 1(0.5%) corneal scar (XS) and 10(5%) corneal xerosis (X2). None of the children were found to have xerophthalmic fundus (XF). only 77 had luxometer readings available. Out of 18 children, 17 had night blindness from history and luxometer reading. Among 38 children 28 had positive luxometer reading but there was no history of night blindness. Conclusions: Ocular manifestations with vitamin A deficiency are mostly seen in older age children. Most common manifestations are conjunctiva xerosis, night blindness and Bitot’s spot. Luxometer reading is one of the best choices for the objective assessment of night blindness. Hence, we should organize a free eye check-up camp in different school for the prevention of ocular manifestation with vitamin A deficiency. We should also aware the children along with their parents regarding nutrition like regular intake of plant foods rich in carotene such as green leafy vegetables, yellow fruits, carrots and animal foods containing retinol like fish liver oil, fish, liver, egg, meat, milk, butter, cheese, and use of fortified food like vanaspati, margarine, dried skimmed milk. Other measures like promotion of breast feeding, supply of safe drinking water, maintaining proper sanitation and hygiene, prevention of diarrhoea, measles, acute respiratory infections and access to basic health services should also be educated.

Introduction: Blood stream infections (BSI) are characterized by presence of viable microorganisms in the bloodstream that elicit inflammatory response and often accompanied by alteration of clinical, laboratory, and haemodynamic parameters. It remains one of the important causes of morbidity and mortality.¹ Globally, BSI affects about 30 million people leading to 6 million deaths with 3 million newborn and 1.2 million children annually. Management of BSI has become a challenge with the emergence of antimicrobial resistance (AMR).² Empirical antibiotic therapy is initiated in almost all cases before the blood culture reports are available. Choice of right empirical therapy is important. An early blood culture report helps in selection of appropriate antibiotics. Materials and Methods: A hospital based cross-sectional study was undertaken at AGMC & GBPH for a period of one year. A total of 668 patients were included in the study. Blood cultures were processed through automated BacT/Alert 3D. Results: Out of 668 samples, 59 (8.83%) samples yielded pathogenic organisms on culture. Gram negative bacilli were predominant (51.6%) followed by gram positive cocci (39.43%) & yeast (8.87%). Among the BSI identified, HAIs predominated (60%) and all the cases were Primary BSI. All the cases were non CLABSI. Conclusion: Acinetobacter spp, Klebsiella pneumoniae and Staphylococcus aureus were the predominant isolates of the study. Resistance against ceftriaxone and colistin were high and Amikacin resistance was lower among the isolates.  Non albicans candida was common than Candida albicans with resistance to multiple antifungals widely used. Good antimicrobial stewardship policy and strict hospital infection control measures are required to prevent the emergence of multidrug resistant organisms. Continuous update of antimicrobial pattern is essential for epidemiological purpose & rational use of antibiotics.  Early diagnosis & continuously monitoring trends in the microbiology of BSI pathogens is important which can help in diagnostic approaches, treatment strategies, and prevention programs.

Background: Post-burn neck contracture is a prevalent issue in burn reconstructive surgery. Releasing the contracture and providing suitable coverage for the exposed area presents a significant challenge. These contractures severely impact patients by causing functional limitations and aesthetic disfigurements, leading to cosmetic, functional, and social problems. Methods: Patients diagnosed with post-burn scar contracture of the neck through clinical examination were included in the study after being informed about the nature of the condition and the available treatment options. Various presentations, complications, treatment options, and their results were analyzed. Results: Scar excision and skin grafting were the most frequent surgical approaches (90%) for treating neck contractures. included scar excision with flap reconstruction (10%) and multiple Z-plastics (10%). These might be used for specific cases. Skin graft loss was the most frequent complication (15%), primarily affecting patients who underwent scar excision and skin grafting. The majority of patients (75%) achieved significant improvement in neck extension (>110 degrees) after treatment, indicating restored mobility. While the majority of patients (55%) reported satisfactory cosmetic results after surgery, a combined 40% were pleased or very pleased, suggesting positive outcomes in many cases. Conclusion: Post-burn scar contractures significantly impact active individuals, particularly those with limited resources. Surgical reconstruction offers the best outcomes. For type A contractures, a supraclavicular flap is ideal. Type B contracts may require both flap and skin grafting, while type C benefits from release, skin grafting, splinting, and dedicated post-operative care. Flap coverage, whenever possible, yields superior function with less splinting and complications compared to grafting alone.

Kasabach-Merritt syndrome is characterized by the combination of rapidly growing vascular tumors, thrombocytopenia, microangiopathic hemolytic anemia, and consumptive coagulopathy. The blood clotting disorder results from platelets and other clotting factors of the blood being used up within the tumor. Although rare, serious complications are present yielding a mortality rate of 10% to 37%. 80% of cases occur in the first year of life with 0.3% of infants affected with hemangiomas. We are reporting a case of a 19-year-old female who presented to us with a passing of black color stool.

Background: The occurrence of diabetic macular edema (DME) is a significant complication arising from diabetic retinopathy (DR). Recent research has indicated a strong correlation between inflammation and the development of DME. Detecting peripheral blood inflammatory markers, such as white blood cell (WBC) count and its subtypes, has proven to be a straightforward and accessible method. In this study, we examined the connection between peripheral blood inflammatory markers and macular edema in patients diagnosed with DR. Methods: A total of 42 patients with severe DR were included in this study and divided into two groups: DR with DME group (DME group, n=30) and a DR without DME group (non-DME group, n=20). Ophthalmologic findings and hematologic results were retrospectively retrieved from hospitalization records and databases. Results: Neutrophils, lymphocyte, Neutrophil to lymphocyte ratio was compared between two groups. There were no significant differences between Neutrophil counts in the two groups. p >0.05. There were no significant differences in lymphocyte counts in the two groups. p>0.05. Conclusion: There were no significant differences in Neutrophil, lymphocyte and Neutrophil to lymphocyte ratio between the two groups. The peripheral inflammatory blood markers had no significant correlation in DME patients in our study. Our study has few limitations, only two inflammatory markers were studied Only 50 patients were enrolled. This study needs large sample sizes and long duration of study to evaluate the relationship.

Background: Teaching methods for undergraduate medical students has seen a big transformation with the rapidly advancing technology. It has shifted from earlier chalk and talk method to hybrid mode where both online as well as offline facility are utilized. With the onset of Covid-19 pandemic in early 2020, there was a boom in online learning. We tried to assess the acceptability of this mode of teachings amongst the medical students and find out challenges if any to make it more accessible to medical students. Methods: A qualitative observational study was carried out at Fakhruddin Ali Ahmed Medical College & Hospital, Barpeta, Assam, India.  A total of 480 medical students were enrolled in the study out of 100 students per batch capacity after considering the exclusion criteria but online questions answer were submitted by 468 students. Results were analysed using MS-excel and results were expressed in percentage. Results: We classified the questions based on psychological   aspects, health aspects and technical aspects. Although responses were subjective based questions but overall on psychological, health and technical aspects, students preferred offline over online mode of teaching. On a rating scale of 0 to 10, 22.64% students gave rating above 7 for online teaching while 44.87% students gave rating above 7 for offline teaching. Discussion: In modern day medical science, knowledge can be gathered from different sources. Technology is inevitable. Technology has made life better but challenges are also there. It is therefore, important for the teachers and the medical students as well as persons involved in planning medical education to update skill in technology and do necessary capacity building so that the technology can be harnessed in the most effective way to impart right knowledge amongst the medicos.

Background: The study was conducted to evaluate the maternal and foetal outcomes associated with elevated bile acid levels in patients of intrahepatic cholestasis of pregnancy. Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynaecology, LLRM Medical College associated SVBP Hospital Meerut from January 2020 to February 2021, it included 50 pregnant women with singleton pregnancy with presence of pruritus without any dermatological conditions and with elevated serum transaminases and serum bile acid levels in late 2nd and 3rd trimester of pregnancy. Results: Out of total 50 pregnant women with cholestasis of pregnancy evaluated by serum bile acids levels, most of the women(66%) have bile acid range 10-39 micromole/lit and 34% have more than 40 micromole/lit with deranged serum transaminases levels, preterm deliveries occurred  in 20% cases and 50% women were delivered by caesarean section, most of which were emergency caesarean section (64%) and most common indication of caesarean was foetal distress (32%) or MSL with foetal distress (28%) and the most common adverse perinatal outcome was MSL (20%), foetal bradycardia (16%), need of NICU admission (12%) followed by IUFD (4%). It was observed that over all adverse foetal and maternal outcomes specially proportion of neonates with APGAR less than 7 at 1 min and 5 min, low birth weight and meconium-stained liquor were significantly higher in the subjects with S. bile acid levels of 40 micromole/lit and above. Conclusion: Serum bile acid estimation is a simple, easily available and minimally invasive test with quick results which helped to assess the severity of disease and correlated with adverse feto-maternal outcome, close monitoring of women with severe IHCP is essential to prevent adverse neonatal outcomes like foetal distress, meconium-stained liquor, preterm labour, sudden IUFD and stillbirth.

Introduction: Exam anxiety also called as test anxiety is a psychological condition in which people experience extreme distress. Anxiety level among medical students is of rising concern in the present days. Objectives: (1). To determine the prevalence of exam anxiety among medical students. (2). To assess the Socio-demographic determinants of exam anxiety among medical students. Material and Methods: This cross-sectional study was conducted during December 2023 to January 2024 after the Institutional Ethical committee approval. The study proforma was distributed to second, third, and final-year undergraduates through an online Google forms link one month prior to the start of their university theory examinations. A proforma is created with the following sections: (a) Participant consent and General Information, (b) Examination Anxiety Scale (EAS). Assessment Tool: The STAI-5 scales, derived from the Spiel Berger State-Trait Anxiety Inventory, gauge present and overall anxiety levels with 5-item versions for state and trait anxiety, evaluating immediate and general feelings. Individuals use a 4-point scale to rate their emotions. Results: The prevalence of exam anxiety among students is around 77% and the prevalence of general anxiety among students is 28%. Female students, year of study, staying at hostel, frequency of communication with the parents and engaging in physical activity are the determinants of exam anxiety and it is statistically significant. Conclusion: The prevalence of exam anxiety is very high among students, which is slightly more among female students compared to male students.  Less physical activity and place of residence also showed higher prevalence of exam anxiety. There is a need for anxiety reduction programme for the benefit of the students as greater anxiety can give unsatisfactory results in both academics and non –academic activities.

Introduction: Voluntarily delaying an academic task to an indefinite time which is needed to be completed at an assigned time. The prevalence of academic procrastination is very high among university students. There are various reasons for academic procrastination like lack of intrinsic and extrinsic motivation, communication gap, illness, too much work, lack of guidance, home environment, lack of coordination, work inability, unseen problems, teacher’s attitude, perfectionism, negative comment, task averseness, dependence on technology. Objectives: To determine the different areas of academic procrastination and to assess the various reasons for Academic Procrastination among students. Material and Methods:  A cross sectional study was conducted among medical students during February to April 2023. The purpose of the study was explained and oral consent was obtained from the participants before enrolling them in the study. A pretested questionnaire regarding socio demographic characteristics and a standardized tool “PASS” Procrastination assessment scale was given to assess the degree and reasons for procrastination. The data was entered in excel sheet and represented in frequencies & percentages. Results: A total of 521 students participated in the study. 84% of the students procrastinate in submitting assignments, 95% of the students mention time management as the major reason for academic procrastination. Conclusion: Assignments and preparing for the next class are the focal areas where majority of the students procrastinate. Major reason why students procrastinate academically is due to improper time management. The results are useful in identifying potential focal areas of procrastination and also areas for intervention and to tackle changes in procrastination over time. Mentors can be made aware of their role in decreasing procrastination.

Background: Stress due to work either as professionals or students has become common due to changes in the globalized society with its demands, rapid progress in communication, resulting in adverse health conditions of organic and functional nature. The stress related diseases affect all the systems in the body and produce abnormal clinical biomarkers. The most common systems which may lead to morbidity and mortality are Coronary artery disease (CAD). The present study explores the hidden mechanisms playing their role causing the disease and the methods of evaluation which helps to plan therapeutic interventions. Aim of the Study: To assess the impact of stress on the clinical biomarkers and Health related quality of life in patients attending the General Medicine department. Materials: Among 156 subjects, there were 107 (68.58%) males and 49 (34.41%) female patients. The mean age was 41.53±6.12. 15 (09.61%) patients were aged between 08 and 15 years. 28 (17.94%) patients were aged between 16 and 25 years. 26 (16.66%)  patients were aged between 26 and 35 years. 38 (24.35%) patients were aged between 36 and 45 years. 27 (17.30%)  patients were aged between 46 and 55 years. 23 (14.74%) patients were aged between 56 and 65 years. Cortisol levels were of 05 to 15 mcg/dl in 21 (13.46%), 16 to 25 mcg/dl in 38 (24.35%). Results: CTS2 instrument results revealed 28 (17.94%) patients belonged to category-0, 31 (19.87%) patients belonged to category-1 or 2, 28 (17.94%) patients belonged to category-3, 41 (26.28%) patients belonged to category-4, 12 (07.69%) patients belonged to category- 5, 09 (05.69%) patients belonged to category-6, 07 (04.48%) patients belonged to category-7. Conclusions: The study concludes that the biomarkers cortisol, Genome sequencing in addition to BMI, age and gender prevalence are consistent with previous studies in predicting the mortality in chronic diseases related pathophysiological changes causing stress related psychiatric and mental problems in the subjects. The mental and physical stress measuring instruments are very useful in assessing the grades of stress and to plan the treatment. The most useful scales are SF-12, CTS2 and revised LCc-R.

Background: An increase in the prevalence of Chronic Kidney Disease (CKD) was observed in the recent times. Regression analysis of risk factors and predictive factors of mortality in CKD patients in a community helps the physicians to be on the alert. Aim of the Study: To study and evaluate the risk factors and predictive factors in the course of treating CKD patients for their accuracy using the area under the receiver operating characteristic (ROC) curve (AUC) analysis. Methods: 47 non-transplant CKD patients at all stages of severity of both genders were included and the risk factors like. The Predictive factors for mortality were presented with AUC analysis and its associated 95% confidence interval (CI). AUC of 0.70-0.79 is considered acceptable, 0.80-0.89 is considered excellent, and more than 0.90 is considered outstanding. Results & Conclusions: In view of the rapid increase in mortality of CKD patients due to development of Heart Failure worldwide an intense screening laboratory investigations such as BNPs, LAsR, E GFR, C reactive protein and UCPR are necessary which have a bearing on the mechanism of causing HF. These predictive factors are highly sensitive and caution the treating physician to take appropriate mode of treatment.

Background: The sixth most prevalent type of extra-pulmonary tuberculosis is abdominal tuberculosis. There are four main ways that it presents itself: visceral TB, intestinal tuberculosis, peritoneal tuberculosis, and tuberculous lymphadenopathy. A complication of intestinal tuberculosis is colon perforation, which needs to be identified as soon as possible and surgically treated. The purpose of this research is to find out how often intestinal tuberculosis is in patients of acute abdomen. Methods: This randomized prospective study was done at Department of General Surgery, SKMCH, Muzaffarpur, Bihar from August 2023 to January 2024. 200 patients in all, who had acute abdomen and showed symptoms of peritonitis or intestinal obstruction. On a specially created proforma, all of the patient’s pertinent information including presentation, surgical findings, procedure done, postoperative outcome, and histopathology—was entered, collated, and examined. Results: Based on histopathological reports and operational findings, 32 (16%) of the 200 patients with acute abdomen developed intestinal tuberculosis. The majority of the patients (75%) were in the 20–40 age bracket, with ages ranging from 15 to 65. There were 1:0.45 male to female. On the chest X-ray, twelve (37.5%) patients also showed signs of pulmonary tuberculosis. Hyperplastic ileocaecal tuberculosis (34.3%) was the most prevalent surgical finding, followed by strictures (25%), and perforations (25%). Overall, 6% of patients with acute abdominal cases and 9.3% of patients with tuberculosis died. Conclusion: In developing nations, intestinal tuberculosis is a frequent issue that frequently manifests in an acute form in general surgical units. For an early diagnosis and to reduce consequences, a high index of suspicion, appropriate assessment, and treatment trial in suspected patients are necessary.

Background: An obstruction in the forward propulsion of the contents resulting from neurological or mechanical reasons is known as an acute intestinal obstruction. The purpose of the current study was to assess the causes, clinical manifestations, surgical techniques, and results in our institution’s acute intestinal obstruction patients. Methods: Present study was retrospective study conducted in patients >18 years age, diagnosed as case of intestinal obstruction, underwent emergency laparotomy for acute intestinal obstruction at Department of General Surgery, SKMCH, Muzaffarpur, Bihar from August 2023 to January 2024. Results: In total, 92 cases were examined in this study. There was a noticeable 72.83 percent male predominance and a 2.68:1 male to female ratio. Most common age group was between 41-50 years (26.09%) followed by 51-60 years (20.65%) and 61-70 years (16.3%) age group. In present study most common sign and symptoms were abdominal tenderness (89.13%), abdominal pain (85.87%), vomiting (83.7%), abdominal distension (75%) and constipation (60.87%). In present study most common etiology noted was adhesive obstruction (41.3%), obstructed inguinal hernia (27.17%), incisional hernia (9.78 %) and sigmoid volvulus (6.52%). Other less common causes were ileocecal tuberculosis (3.26%), ascending and descending colon growth (3.26%), rectum/anal canal growth (3.26%), sigmoid colon growth (2.17%), internal hernia (2.17%) and intussusception (1.09%). Adhesiolysis + Resection Anastomosis (44.57%) was most common surgical procedure followed by herniorrhaphy (36.96%) and resection anastomosis (15.22%). Sepsis (15.22%), urinary tract infection (13.04%), wound infection (11.96%), basal atelectasis (6.52%) and burst abdomen (6.52%) were common complications noted in post-operative period. In present study 9.72% mortality was noted. Conclusion: Treatment for acute intestinal obstruction is primarily successful when the cause is addressed first, followed by prompt diagnosis, effective management, and treatment of the obstructions clinical consequences.

Background: Using Umbilical Artery Doppler indices to detect fetoplacental compromise early and to understand the predictive significance of each index in predicting perinatal outcome and therapeutic methods for these patients. Methods: The present prospective study was conducted at Department of Obstetrics and Gynaecology, Bokaro General Hospital from 1^st September 2018 to 31^st March 2020 (18 months) on 100 women with hypertensive  disorder of pregnancy. Umbilical artery doppler evaluation done in all the patients at (28-32) weeks, (33-36) weeks and (37-40) weeks of gestation and more frequently in those patients having deranged  Doppler. Patients divided into two groups women with abnormal Umbilical artery indices and normal indices. Perinatal outcome of both the groups were compared, analyzed statistically using Chi-square test. Multiple   pregnancy, chronic hypertension, fetal congenital anomalies, systemic disease and those lost to follow up till delivery were excluded from study. Results: A total of 100 women with pregnancy induced hypertension were taken into this study after considering inclusion and exclusion criteria. After last Doppler study, patients were divided into two groups, study group and the control group. Out of 100 the study group contain 38 women with abnormal umbilical artery Doppler indices and the control group contain 62 women with abnormal umbilical artery Doppler indices. Hypertension in pregnancy affects women of all ages. In our study the mean maternal age was 27.76 years. Conclusion: The most accurate way to anticipate unfavorable prenatal outcomes and assist in choosing the right moment for intervention to enhance perinatal outcomes is with umbilical artery PI.

Background: In the developing world, acute organophosphorus (OP) pesticide poisoning is common. Since the nation is mostly an agricultural one, pesticides and insecticides are widely employed in agriculture, and the general public has easy access to these hazardous chemicals. The objective of the study was to identify the nature of the demographic profile, type of compound, clinical manifestations, and outcome of organophosphate poisoning presenting to a tertiary care hospital in Muzaffarpur, Bihar. Methods: Between June 2023 and November 2023, a cross-sectional study including 100 patients diagnosed with OPC poisoning at Sri Krishna Medical College and Hospital Muzaffarpur, Bihar, was carried out in the general medicine department. The diagnosis of OP poisoning was established on the basis of the patient’s medical history or any evidence of exposure to the OP chemical within a 24-hour period. Symptoms such as fasciculations, miosis, excessive salivation, and improved signs and symptoms after atropine treatment were noted. IBM SPSS version 22 was used for statistical analysis. Results: Eighty percent of the subjects were male. The bulk (66%) belonged to the 21–40 year old age range. Methyl parathion was the most often ingested OPC (27%) and was followed by chlorpyrifos (22%). Abdominal pain/cramps accounted for 100% of the significant GIT problems, with nausea and vomiting coming in second with 83%. In 40% of the individuals, mechanical ventilation was required, and 25% of the subjects had reported death. Conclusion: Males in their economically productive stages of life are disproportionately affected by OP poisoning. Given the high death rate, it is imperative that health services be adequately strengthened, particularly at the primary level.

Introduction: Testicular cancer is the most common malignancy in men aged 15 to 45 years, with a variation in incidence worldwide from below 1 to 12 per 100000 males. It represents 1% of male tumors and 5% of urological  malignancies. Majority of testicular tumors are germ cell tumors (GCTs). Aims and Objectives: To study the role of serum markers (AFP, β-hCG, LDH) in testicular tumors and reporting them according to recent CAP guidelines (2017). To assess the level of serum tumor markers preoperatively and postoperatively for diagnosis and staging of testicular tumors. To correlate serum tumor marker level with histopathology of testicular tumor. Materials and Method: Prospective and observational cross-sectional study, conducted in the department of Pathology, M.Y. Hospital, during the study period of one year, included 26 cases of suspected testicular cancer. (Reduced Sample size due to covid) which were grossed according to standard guidelines and reported as per CAP protocol. Pre and post operative tumor marker levels- AFP, β-hCG and LDH were obtained for each of these cases and compared. Results: Maximum cases in our study were mixed germ cell tumor followed by seminoma. In cases of seminomatous germ cell tumor AFP was not elevated whereas β-hCG and LDH were raised, post operatively there was reduction in these two markers in few cases, in others it remained elevated. In non seminomatous tumors, all the three markers were raised in almost 50% cases, the declination in marker level was significant for β-hCG and LDH, whereas it was insignificant for AFP.

Introduction: Ovarian carcinomas are one of the most common causes of death among women. Presently so many biomarkers are available for the early detection of the ovarian carcinomas like P53, EGFR, Ki67, CK, HER 2/ Neu. In the present study we analyze the expression of estrogen and progesterone receptor status in various epithelial ovarian tumors as prognostic indicators. Aim of the study: To study the expression of estrogen and progesterone receptor in the surface epithelial tumors of ovary in assessing its role as prognostic marker. Materials and Methods: The Present study was conducted at Department of Pathology and 30 cases of ovarian tumour that occurred from May 2013 to April 2018 were randomly selected. Immunohistochemical analysis was carried out with estrogen and progesterone receptor marker for the 30 cases. Conclusion: In the present study serous tumours had more positive expression for both estrogen and progesterone receptors than the mucinous tumours.

Background: Hypothyroidism is a common endocrine disorder resulting from deficiency of thyroid hormone. It is often the primary process in which the thyroid gland produces insufficient amounts of thyroid hormone. It can also be secondary due to other causes. Objective: To study the etiological of hypothyroidism in children and to determine the clinical presentation in hypothyroidism and its associated co morbidities. Methods: 100 cases were included in the study who met the inclusion criteria after taking informed consent from parents. Pre designed proforma was used to record the relevant patient details with special reference to clinical presentation and were subjected to further diagnostic work up as relevant to each case. Results: Out of 100 cases, congenital hypothyroidism contributed to 66 % of cases among study group while acquired hypothyroidism was noted in 34 %. Dyshormonogenesis was more common than dysgenesis under congenital hypothyroidism and Hashimotos thyroiditis was more prevalent among adolesecent female under acquired hypothyroidism. Conclusions: Hypothyroidism still represents a major public health problem and is an important cause of preventable mental retardation. Early diagnosis and treatment still remains the cornerstone of management. Therefore early recognition and treatment with thyroxine will help to improve the quality of life in these patients.

Introduction: When treating clinically challenging bacteria like Pseudomonas aeruginosa that are resistant to many drugs, carbapenems are frequently utilized with great success. However, there is a growing risk of developing resistance to carbapenems, primarily linked to the formation of metallo-β-lactamases (MBLs), which has been a clinical disaster. The prompt execution of infection control measures and the prevention of nosocomial transmission through proper treatment depend heavily on the early detection and identification of strains that produce MBL. Therefore this study was undertaken for screening MBL production in clinical isolates of Pseudomonas aeruginosa. Materials and Methods: A total of 112 isolates of Pseudomonas aeruginosa isolated from different clinical samples were tested for Carbapenem resistance and MBL production. Imipenem disc (10 µg Himedia) was used for detection of Carbapenem resistance. All Imipenem resistant strains of P. aeruginosa by Kirby -Bauer disc diffusion test were screened for MBL production by phenotypic methods, (1). Imipenem+EDTA combined disc test (CDT) and (2). Imipenem and EDTA double disc synergy test (DDST). Results: Out of 112 isolates of P. aeruginosa, 21 strains were Imipenem resistant, of which 18 isolates were detected as MBL producers by CDT and 14 isolates of P aeruginosa were detected as MBL producers by DDST. Out of 21 Imipenem resistant P. aeruginosa, 16 isolates were multidrug resistant and 5 strains were Non multidrug resistant. All Imipenem resistant P. aeruginosa were found to be 100% sensitive to Colistin and Polymyxin B. Conclusion: Screening tests like CDT &DDST are a crucial step towards monitoring of these MBL producing strains of P. aeruginosa as they are multidrug resistant. All isolates of P. aeruginosa should be routinely screened for MBL production.

Introduction: Endometrial cancer (EC) is the most common gynecological malignancy. Factors reported to be predictive of response to endocrine therapy include low grade, endometrioid histology, and positive estrogen receptor (ER)/progesterone receptor (PR) status. The prognostic value of ER/PR is well established, with higher levels of ER and PR expression associated with longer overall Survival, longer cancer-specific survival, and longer Progression Free Survival. Methods: In our study, a panel of immunohistochemical markers ER, PR, Her-2, and p53 were done in 50 cases of endometrial carcinoma and their relationships with the histopathological and prognostic parameters were analysed. Results: in our study ER, PR expression was noted commonly in Grade I, Grade II endometrioid carcinoma whereas Type II endometrial carcinoma was negative for these markers. p53 mutation and Her2 neu overexpression was found commonly in Type II endometrial carcinoma. Conclusion: The absence of hormone receptors, Her2 Neu overexpression, p53 mutation indicates aggressive tumor and poor prognosis.

Introduction: Dengue is a vector borne disease caused by RNA virus of Flaviviridae family. It is spread by the bite of female Aedes mosquito. Dengue is characterized by onset of high grade fever with bodyache, myalgia, arthralgia, retrobulbar pain and its complications which might lead to even circulatory shock. It is a matter of concern particularly in Southeast Asian countries. Aim: The aim of this study was to find out the clinical profile and outcome of dengue fever in children between the age group of 1 month to 12 years of age admitted in the Pediatric ward of Diphu Medical College located in the hill district of Karbi Anglong. There is dearth of publications on vector borne disease in children in this part of Assam and hence this study was taken. Methods: This was done as a retrospective study and the period of study was from March 2022 to August 2023. All children presenting with fever, bodyache, rashes, vomiting, pain abdomen, dizziness, convulsion were tested for Dengue infection either by Antigen test (NS1) or Antibody test (IgM). The data obtained was entered in MS Excel and analyzed in the light of available literature. Ethical clearance was taken from the Institutional Ethical committee. Results: Out of the 1803 number of patients admitted between 01/03/2022 and 31/08/2023 in the Pediatric ward of Diphu Medical College and hospital, 69 cases were found to be dengue positive. Conclusion: Number of non-severe dengue cases (n=68) were more than the number of severe cases(n=1) in this study. Case Fatality Rate (CFR) was found to be 1.449%. Early detection of the disease can prevent the mortality and the morbidity associated with dengue.

Background: The umbilical cord is the lifeline between the foetus and placenta. It conveys nutrition from placenta of mother to foetus and also protects the umbilical vessels. Normally umbilical cord contains two arteries and one vein surrounded by Wharton’s jelly all enclosed in a layer of amnion. Materials and Methods: A  cross sectional study was conducted on 60 consecutive umbilical cord samples collected after placental delivery from the labour room of SAT hospital and Department of Anatomy, Govt. Medical College, Thiruvananthapuram. Results: According to our study, majority (73.3%) cases had eccentric placental attachment. Mean umbilical cord length was 45.58 cm. Preterm babies had lower mean umbilical cord length than that of term babies. There was a significant positive correlation of umbilical cord length with gestational age and birth weight. External diameter of the cord ranges from 0.30-2.30cm. Average coiling index of umbilical cord was 0.19±0.04. This index was higher for term babies than compared to preterm. Conclusions: We concluded from the study that type of cord coiling has adverse effect on perinatal outcome. So detecting the cord abnormalities during the antenatal period using second trimester ultrasonography would be helpful in strict monitoring of foetus. Antenatal umbilical cord coiling index can be used as a promising prognostic marker for any adverse event in pregnancy.

Background: Iron deficiency anemia is most communal medical condition during pregnancy in developing countries. It is a universal public health problem and is accountable for 40% of nurturing demises in developing countries out of which it is responsible for 25% of direct maternal deaths. The prevalence of Iron deficiency anemia (IDA) in pregnancy in India ranges from 23.6%-61.4%. The study aims in comparing the safety and efficacy of intravenous ferric carboxymaltose (FCM) vs iron sucrose in iron deficiency anemia in pregnancy and to develop a protocol for managing iron deficiency anaemia patients attending antenatal OPD so as to ensure proper feto-maternal outcome. An experiment nonrandomized cohort study was conducted among 56 ANC women came to OPD or admitted in ward at Department of Gynecology, SBKS Hospital, Pipariya, Vadodara. In our study, our results showed enhancement in hemoglobin, serum ferritin, and blood indices in both groups, but it was faster, greater, and with less feto-maternal complications with FCM, when compared with iron sucrose.

Neurilemmoma or schwannoma is a common benign nerve sheath tumor composed of spindle cells. They show immunohistochemical and ultra-structural features similar to that of Schwann cells. Although typical cases are easily recognized, certain rare variants of schwannoma do pose a diagnostic challenge for pathologists. We discuss here in a case of a 40 year old male who presented with a scalp mass since 6 months, and was diagnosed as neuroblastoma-like schwannoma based on characteristic histomorphological findings and Immunohistochemistry.

Background: Liver cirrhosis is the end-stage of chronic liver disease. Esophageal variceal bleeding is a potentially deadly consequence of portal hypertension in patients with cirrhosis. Aim: The present study measured the platelet count, portal vein diameter and Liver Stiffness (fibroscan) to predict the EVs in patients with Liver cirrhosis. Methods: This was a Cross Sectional comparative study conducted in the outpatient department of Medicine, Hind Institute of Medical Sciences, Safedabad, Barabanki, U.P. Ethical approval was obtained from the HIMS ethical review committee. An independent sample t-test was used for parametric data, whereas the Mann-Whitney U test was used for non-parametric data. The chi square test was used to compare the categorical data of patients with and without EV. Receiver operating characteristic (ROC) analysis was performed to evaluate the cut-off values for the Platelate Count, Portal Vein Diameter, Liver Stiffness, sensitivity, specificity, and area under the curve (AUC). Results: The study involved 180 patients with (110 cases) and without (70 Cases) EVs, aged 24-90 years; Mean age 48.14±11.52 years; 81.7% males. A total of 110 (61.1%) cases showed presence of esophageal varices. A total of 76 (42.2%) patients had lower grades of varices (Grades 1 and 2) whereas 34 (18.9%) had higher grades of varices. Alcohol (n=104; 57.8%) was the most common etiology followed by NFLD/Chronic illness (n=28; 15.6%), viral (n=26; 14.4%), mixed etiology (n=13; 7.2%) and transfusion (n=9; 5%) respectively. Diabetes (31.1%) and hypertension (21.7%) were the most common comorbid conditions. Platelet count ranged from 0.32 to 2.70 lakhs/cumm. Mild, moderate and severe thrombocytopenia was seen in 44 (24.4%), 67 (37.2%) and 57 (31.7%) patients respectively. There were 57 (31.7%) patients with platelet count in normal range. Mean platelet count was 1.25±0.54 lakhs/cumm. All the patients had ascites. None of the patients had severe ascites. Majority of cases (n=106; 58.9%) had mild ascites. There were 74 (41.1%) cases with moderate ascites. Portal vein diameter ranged from 9 to 19 mm. Majority (70.6%) of cases had portal vein diameter <13 mm. There were 53 (29.4%) cases with portal vein diameter >13 mm. Mean portal vein diameter was 12.83±1.86 mm. Liver stiffness ranged from 16 to 75 kPa. Majority (85.6%) had liver stiffness >21 kPa. There were 26 (14.4%) cases with liver stiffness 14-21 kPa. Mean liver stiffness was 33.87±11.64 kPa. Mean portal vein diameter and liver stiffness values were significantly higher and mean platelet count was significantly lower in cases with esopahgeal varices as compared to those without esophageal varices. Conclusion: Platelet count at a cut-off <1.045 lakhs/cumm was 62.7% sensitive and 87.1% specific in prediction of esophageal varices. Portal vein diameter at a cut-off >12.5 mm was 70% sensitive and 78.6% specific in prediction of esophageal varices. Liver stiffness at a cut-off >22.95 kPa was 95.5% sensitive and 45.7% specific in prediction of esophageal varices. For detection of higher grades of esophageal varices, portal vein diameter was most sensitive (64.7%) whereas platelet count was most specific (86.8%).

Objectives: To determine umbilical artery PI, middle cerebral artery PI and the MCA PI/UA PI (CPR) ratio to assess the fetal intrauterine growth restriction by Color Doppler and the adverse effect on perinatal outcome. Methodology: A total 60 cases of clinically suspected IUGR pregnant mothers were evaluated by Colour Doppler study, following detailed clinical examination. In colour Doppler umbilical artery Pulsatility index(PI) were recorded. PI of Middle Cerebral artery was measured in each case and ratio of MCA PI &UA PI were calculated. All those 50 cases were followed up till early neonatal period. Result: Out of 60 clinically suspected IUGR cases, 9 were intrauterine fetal deaths and 51 live births. Out of 9 intrauterine deaths, 6 (100%) cases have reversal of umbilical artery diastolic flow & 3 (60%) have absent umbilical artery diastolic flow. Out of 51 live births, low Apgar score were 7cases, emergency c/s were 12 cases & admission in NICU 8 cases.

Background: Tumours of the maxilla are a highly heterogeneous group of tumors that account for malignant and benign tumors. A precise diagnosis is essential because the natural history, treatment, and prognosis vary for different neoplasms. Method: 64 adult patients aged between 25 to 75 years with maxillary tumors were studied. Histopathological, hematological, and radiological (CT scan) were done to evaluate the degree of maxillary tumors. Results: Out of 64 patients, 26 were malignant, and 38 were benign. The duration of complaints varied from 1 month and 1 ½ years in malignant tumors to 1–5 years in benign tumors. Epistaxis and nasal mass in benign tumors were 100%, 65.3% nasal obstruction, and 26.9% epistaxis. Conclusion: It is concluded that inverted papilloma in benign tumors and squamous cell carcinoma in malig-nant tumors were significant features. The present pragmatic study will help the ENT surgeon / oncological sur-geon treat such patients efficiently to avoid morbidity and mortality.

Background: Neonatal sepsis is one of the major causes of death in infants because most sepsis is concealed and has to be evaluated hematologically and pathologically; hence, the diagnosis and treatment of neonatal sepsis remain a great challenge to pediatricians. Method: 100 (one hundred) neonatal sepsis cases were studied. Apart from a detailed history of sepsis, blood examinations (CBC, CRP, and blood culture) were carried out to evaluate the specificity and sensitivity. Moreover, the level of TLC was correlated with CRP and different types of sepsis to find out the severity of sepsis. Result: In the study of risk factors, 34% of PROM was followed by 20% of sepsis due to repeated vaginal examination. The major manifestation was 62% shock and 9% congenital pneumonia. In the organism study, 4% E. coli, 3% Klebesiella, and 7% staptocacal species were observed. In a correlative study, TLC with sepsis and CRP had a significant p value (p<0.001). Conclusion: It is concluded that early sepsis is more common than the late onset of sepsis. Total WBC platelet CRP values are elevated and significant parameters to determine the severity of neonatal sepsis.

Introduction: With the emergence of multidrug resistance and increasing use of high-level antibiotics risking the emergence of resistance, effective antibiotics that help in conserving these higher drugs for more severe infections are the need of the time. Aims and Objectives: To study the susceptibility pattern of Enterobacterales and Enterococcus species against commonly prescribed urinary antimicrobial agents and fosfomycin and to compare the susceptibility pattern in extended spectrum beta-lactamases (ESBL), multidrug-resistant Enterobacterales (MDR) and carbapenem resistant Enterobacterales (CRE’s). Materials and Methods:  This prospective, cross-sectional study was carried out in the department of Microbiology of a tertiary care hospital over a period of six months between July 2021 to December 2021. 225 consecutive non-duplicate isolates of Enterobacterales (n=188) and Enterococcus species (n=37) recovered from suspected cases of UTI were included. Antimicrobial susceptibility test was carried out using the Kirby Bauer disc diffusion method. Results: Out of 188 isolates of Enterobacterales, 102 were Escherichia coli (45.3%), 73 were Klebsiella pneumoniae (32.4%) and 13 (5.78%) belonged to other Enterobacterale species.  Among 37 isolates of Enterococcus species, 21/37 were E. fecalis and 16/37 were of E. faecium group. In E. coli, susceptibility to the other antibiotics tested ranged from 9.8% to 85.29%. In K. pneumoniae, susceptibility to all antibiotics was lower than E. coli. The susceptibility to fosfomycin in Enterobacterales and in Enterococcus isolates was 85.1% and 97.30%. One E. faecium species was resistant. E. coli were more susceptible (98%) as compared to K. pneumoniae (65.75%). ESBL producers were more susceptible than non- ESBL producers, but the difference was not statistically significant. The susceptibility to fosfomycin among non-CRE isolates was significantly higher than in CRE isolates (93.86% versus 71.62%). Conclusion: Fosfomycin with its ease of dosage and high susceptibility against Enterobacterales and Enterococcus species, is a good choice of antibiotic for UTI and can be prescribed to both out as well as indoor patients with expected favorable outcomes.

Objectives: The present study aimed to evaluate the clinical efficacy of 0.05% cyclosporine nano-emulsion in treating dry eye syndrome associated with meibomian gland dysfunction at a tertiary care center in Muzaffarpur, Bihar, India. Methods: Data were collected irrespective of age and sex using the OSDI questionnaire (Ocular Surface Disease Index). The OSDI questionnaire is a 12-item survey that quickly assesses symptoms of ocular irritation in dry eye and their influence on vision-related functions. Tear volume was assessed using Schirmer’s test, and tear film stability was tested using tear film breakup time (TBUT). Lissamine green staining was used to stain the conjunctiva. Lid evaluation was performed using a slit lamp to observe lid morphology, expression of meibomian glands, and blink rate. Results: A total of 80 patients were included; 40 subjects were in the experimental group, and 40 were in the control group. The mean age was 51.76 ± 17.28 years in the experimental group and 48.96 ± 12.54 years in the control group. Comparing the mean pre-treatment (7.42 ± 2.76 seconds) and post-treatment (13.31 ± 4.12 seconds) TBUT of cyclosporine group patients, there were statistically extremely significant differences (p<0.0001). Similarly, the mean pre-treatment (9.56 ± 3.24 seconds) and post-treatment (12.65 ± 2.87 seconds) TBUT in the control group also showed extremely significant differences (p<0.0001). However, the greater mean difference was observed in the cyclosporine group (5.91 seconds) compared to the control group (3.15 seconds). Total vascular engorgement on the lid was noted in 62 (77.5%) patients. Out of 34 patients in the experimental group, vascular engorgement was resolved in 21 (61.76%) patients. Similarly, in the control group, vascular engorgement was resolved in 9 (32.14%) patients. Conclusions: The mean TBUT, Schirmer’s score, and secretion quality score significantly increased, and lissamine green staining significantly decreased in the cyclosporine group compared to the control group. Hence, cyclosporine is one of the best choices for treating dry eye associated with meibomian gland dysfunction.

Aim: To assess risk factors of Gastroenteritis in children. Methodology: Eighty-four patients of acute gastroenteritis of both genders were enrolled and the biochemical parameters and risk factors were recorded. Results: Age group 2-4 years had 41, 4-6 years had 25, 6-8 years had 13 and 8-10 years had 5 patients. The difference was significant (P< 0.05). Symptoms were lethargy in 28 survived and 13 died, oliguria in 38 survived and 8 died children, poor oral intake in 15 survived and 11 died children, dysentery was seen 31 survived and 9 died children. Signs of pallor in 34 survived and 12 died children, tachycardia was seen in 12 survived and 11 died, hypotension in 29 survived and 14 died children. The difference was significant (P< 0.05). RC transfusion in the first 24 hours was seen in 34 and 18, duration of PICU stay was 5.1 days and 4.6 days. The mean inotropes in first 24 hours was needed in 37 and 15, ventilation in the first 24 hours seen in 36 and 12, albumin was 3.3 mg/dl and 2.1 mg/dl, blood glucose was 98.2 mg/dl and 95.2 mg/dl, blood urea was 66.2 mg/dl and 56.4 mg/dl, creatinine was 0.9 mg/dl and 0.8 mg/dl and in survived and died children respectively. The difference was non- significant (P> 0.05). Among survived and died patients, family was joint in 36 and 12 and nuclear in 30 and 6 patients respectively. SES was upper in 12 and 4, middle in 26 and 5, and lower in 28 and 7 patients. Education was school going in 45 and 13 and none in 21 and 5, sewage was underground in 59 and 8 and open drain in 7 and 10, child washes hand before meal 61 and 7, child washes hand after washroom 65 and 6 and 57 and 5 uses soap. Conclusion: Risk factors of acute gastroenteritis in children found to be low socio-economic status, lack of education, poor sewage system, insufficient hand wash after washroom and non- usage of soaps.

Aim: To assess incidence and risk factors of hypomagnesemia in critically ill patients. Methodology: 76 Paediatric intensive care unit (PICU) admissions, age ranged 1 month- 18 months of both genders were selected and parameters include weight, co-morbidities, metabolic profile (serum sodium, potassium, calcium, magnesium, blood urea nitrogen, creatinine, and blood pH), admission category (cardiac disease, sepsis, renal failure, CNS linked diseases, trauma, and others), and others. A spectrophotometer was used as an endpoint to assess the total serum magnesium assay. Results: Out of 76 patients, males were 48 (63.1%) and females were 28 (36.9%). Out of 76 PICU admissions, hypomagnesemia was found in 34 patients. Diseases causing PICU admission were CNS diseases in 9, trauma in 7, sepsis in 23, cardiac disease in 12, renal failure in 10, and others in 15 cases. Hypomagnesemia was found in CNS diseases in 1, trauma in 1, sepsis in 14, cardiac disease in 6, renal failure in 4, and others in 8 cases. Risk factors of hypomagnesemia was hyponatremia in 2, hypokalemia in 18, hypocalcemia in 10 and metabolic acidosis in 4 cases. Age <1 year was seen in 13, and >1 year in 21 patients, length of hospitalization was 1-5 days in 15 and >5 days in 19 patients Outcome was alive in 22 and death in 12. The difference was significant (P< 0.05). Conclusion: Age greater than one year, hospital stays longer than five days, hypokalemia, and hypocalcemia were common risk factors for hypomagnesemia.

Background: Dysfunctional uterine bleeding (DUB), also known as anovulatory bleeding, is a common gynecological condition characterized by abnormal vaginal bleeding that deviates from a woman’s regular menstrual cycle. Centchroman is commonly used contraceptive to treat DUB. The aim of the present study is to evaluate efficacy and safety of Centchroman in patients of dysfunctional uterine bleeding. Materials and Methods: The present study was conducted in patients of dysfunctional uterine bleeding, in Nehru Hospital, affiliated to the Department of Obstetrics and Gynaecology, B.R.D. Medical College, Gorakhpur. 90 female patients of DUB were recruited for this study based on the inclusion and exclusion criteria after taking informed consent. Centchroman 30-mg bi-weekly was given for a period of 3-6 months and patients were kept under regular follow up during and after completion of therapy. Result: Centchroman (Ormeloxifene) in doses of 30mg bi-weekly for a period of 3-6 months is found to be effective in controlling menorrhagia as we found cure rate of menorrhagia to be 85.5%. The present study found that maximum prevalence of DUB was observed in the age group between 35-44 years (60%) and only 5.6% cases were between 20-24 years. Maximum numbers of patients belonged to the parity 4-5 (53%). History of tubectomy was present in 42.2% cases. 90% of patients with menstrual disturbances complained of excessive bleeding during menses with regular or irregular cycles. (Menometrorrhagia – 36.7% followed by Menorrhagia 27.8% & Polymenorrhagia in 25.5% cases). Conclusion: The present study concludes that Centchroman (Ormeloxifene) used for DUB in dose of 30mg bi-weekly is very cost effective, devoid of any side effects, very effective in controlling DUB, so it should be used in more patients.

Using 100 patients over 24 months, this study compared the no-mesh approach used by Desarda with the mesh hernioplasty used by Liechtenstein for the repair of inguinal hernias at Darbhanga Medical College & Hospital. The comparison was prospective and randomized. Postoperative discomfort, recurrence rates, and other problems were the main subjects of our analysis. Comparing Desarda’s technique to the mesh-based method, the results showed that there were fewer cases of persistent inguinal discomfort and much less postoperative pain by day 7. The mesh group had a slightly higher recurrence rate, but the distinction was not statistically significant. While both approaches worked well, Desarda’s approach showed promise for improving patient comfort and healing, which made it a better choice—especially for those who might experience mesh-related problems. These results highlight the significance of a nuanced approach to hernia repair by indicating that surgical decisions should be based on the unique profiles of individual patients.

Background: Diabetic retinopathy (DR) is a sight-threatening complication of diabetes mellitus, characterized by retinal microvascular changes and structural alterations. Optical coherence tomography (OCT) allows for precise assessment of retinal morphology, including macular thickness, which is influenced by glycemic control. Understanding the relationship between macular thickness and glycosylated hemoglobin (HbA1c) levels is crucial for elucidating the impact of glycemic control on retinal health in diabetic patients. Methods: A cross-sectional study was conducted among diabetic patients attending a tertiary eye care center. Participants underwent comprehensive ophthalmic evaluation, including OCT imaging to measure central subfield thickness and average macular thickness. Blood samples were collected to measure HbA1c levels. Exclusion criteria included history of ocular surgery, significant ocular comorbidities, and uncontrolled systemic conditions. Statistical analysis included Pearson correlation and subgroup analyses to assess the association between macular thickness and HbA1c levels stratified by diabetic retinopathy severity, presence of diabetic macular edema (DME), and systemic comorbidities. Results: A total of 83 diabetic patients were included in the analysis. Pearson correlation analysis revealed a significant positive correlation between HbA1c levels and both central subfield thickness (r = 0.42, p < 0.0001) and average macular thickness (r = 0.38, p < 0.0001). Subgroup analyses demonstrated a progressive increase in correlation coefficients with worsening diabetic retinopathy severity, stronger correlations in patients with DME compared to those without, and positive correlations with systemic comorbidities such as hypertension and dyslipidemia. Conclusion: Our findings highlight the significant impact of glycemic control on retinal structural changes in diabetic patients. Optimizing glycemic management may help preserve retinal health and prevent vision-threatening complications. Comprehensive management of systemic comorbidities is essential in diabetic care to mitigate the risk of retinopathy development and progression.

Background: Diabetic macular edema (DME) is a leading cause of vision impairment in patients with diabetes mellitus. Treatment options include dexamethasone implant and anti-vascular endothelial growth factor (anti-VEGF) agents, but comparative effectiveness data in real-world settings, particularly in the Indian population, are limited. Methods: We conducted a prospective cohort study to compare the efficacy and safety of dexamethasone implant and anti-VEGF agents in treatment-naive DME patients. A total of 109 patients were included, with 55 receiving dexamethasone implant and 54 receiving anti-VEGF treatment. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and patient-reported outcomes were assessed over a 12-month follow-up period. Statistical analysis was performed to compare outcomes between the two treatment groups. Results: At baseline, there were no significant differences in demographic and clinical characteristics between the dexamethasone implant and anti-VEGF groups. Both treatment modalities demonstrated improvements in BCVA and reductions in CMT over the study period, with no significant differences observed between the groups at any time point. However, the dexamethasone implant group required fewer injections and had a lower proportion of patients requiring rescue therapy compared to the anti-VEGF group. Safety outcomes, including adverse events and ocular complications, were similar between the two groups. Conclusion: Dexamethasone implant and anti-VEGF therapies were equally effective in improving visual and anatomical outcomes in treatment-naive DME patients. However, dexamethasone implant therapy was associated with reduced treatment burden and a lower need for rescue therapy compared to anti-VEGF treatment. These findings suggest that dexamethasone implant may offer advantages in terms of convenience and long-term treatment durability in real-world clinical practice.

Background: Pharmacovigilance (PV) is the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other medicine/vaccine related problem. The adverse drug reaction (ADR) or adverse drug event (ADE) is a health concern that is not rigorously observed and discovered by medical professionals. India has an ADR reporting rate of 1%, which is significantly lower than the global ADR reporting rate of 5%. Since there is poor reporting of ADRs, this study was aimed to assess the knowledge, attitude and practice of Pharmacovigilance among healthcare professionals. Methods: A cross-sectional survey of 303 healthcare workers was done using a pretested, validated questionnaire to measure their knowledge, attitude, and practice regarding ADR reporting. The questionnaire was divided into three parts: 15 questions assessed knowledge of ADR reporting, 5 questions assessed attitude, and the final 5 questions rated practice of ADR reporting among healthcare staff. All participants were given 30 minutes to complete the questionnaire. The data was collected and processed using SPSS software, with descriptive statistics applied. Results: 303 healthcare workers completed the questionnaire, including 69 doctors, 34 nurses, 100 medical students, 84 nursing students, and 16 chemists. Most healthcare professionals (91.2%) have a positive attitude towards ADR reporting. Fewer healthcare professionals (52%) had adequate knowledge on ADR reporting. Healthcare providers had inadequate reporting practices (42%). In terms of reporting practices, 34% of respondents were unaware of the reporting form. In our study, nurses reported more adverse drug reactions (47%) than doctors (27.5%). Conclusion: The current study reveals that there is a knowledge gap that is resulting in poor ADR reporting, despite the fact that healthcare professionals have a positive attitude towards it. As a result, more sensitization activities must be implemented to promote the ADR reporting culture among healthcare workers.

Background: Hirschsprung’s disease, a congenital disorder characterized by the absence of ganglion cells in the distal bowel, necessitates surgical intervention to alleviate obstructive symptoms and restore bowel function. Laparoscopic Soave’s pull-through has emerged as a promising minimally invasive approach for the surgical management of this condition, offering potential advantages in terms of operative outcomes and postoperative recovery. Methods: A retrospective analysis was conducted to evaluate the outcomes of laparoscopic Soave’s pull-through in children with Hirschsprung’s disease. Electronic medical records of patients undergoing the procedure between July 2012 and June 2022 were comprehensively reviewed. Data collection included demographic information, preoperative evaluation findings, surgical details, perioperative outcomes, postoperative follow-up data, and long-term functional outcomes. Surgical technique adhered to standardized protocols, with meticulous attention to dissection and preservation of rectal innervation. Results: A total of 49 patients underwent laparoscopic Soave’s pull-through, with a mean age of 2.8 1.2 years. The mean operative time was 160.9 ± 35.4 minutes, with a low conversion rate to open surgery (6.1%) and no intraoperative complications. Postoperative complications were observed in 24.5% of cases, including wound infections (6.1%), anastomotic leaks (4.1%), and strictures (8.2%). Long-term functional outcomes were favorable, with a mean HD Bowel Function Score of 9.2 ± 1.5. The majority of patients achieved fecal continence (81.6%) and reported stooling frequency within the normal range of 61.2% with 1-2 times/day. Conclusion: Laparoscopic Soave’s pull-through demonstrates favorable perioperative and long-term functional outcomes in children with Hirschsprung’s disease. The minimally invasive approach offers efficient bowel function restoration while minimizing surgical morbidity. Despite the observed complications, the overall efficacy and safety of laparoscopic Soave’s pull-through highlight its potential as a preferred surgical option in the management of Hirschsprung’s disease.

Background: Effective postoperative pain management is crucial for optimizing patient outcomes following arthroscopic anterior cruciate ligament (ACL) reconstruction. Intra-articular injection (IA) and femoral nerve block (FNB) are two commonly employed analgesic modalities in this setting, each with distinct mechanisms of action and potential benefits. However, comparative studies evaluating the efficacy and safety of IA versus FNB for postoperative analgesia after ACL reconstruction are limited. Methods: A prospective, randomized controlled trial was conducted to compare IA versus FNB using a combination of levobupivacaine with clonidine for postoperative analgesia in patients undergoing arthroscopic ACL reconstruction. A total of 64 patients were randomized to receive either IA (n=32) or FNB (n=32) intraoperatively. Pain intensity, opioid consumption, adverse events, patient satisfaction, and functional outcomes were assessed at various time points postoperatively. Results: Patients in the FNB group exhibited significantly lower pain scores compared to the IA group at 1, 2, 4, 8, 12, and 24 hours post-surgery (p < 0.05). Additionally, total opioid consumption was significantly lower in the FNB group compared to the IA group (p < 0.001). No significant differences were observed in the incidence of adverse events between the two groups. However, functional outcomes, including range of motion and ability to perform straight leg raises, favored the FNB group (p < 0.05). Patient satisfaction levels were comparable between the groups. Conclusion: FNB with a combination of levobupivacaine and clonidine provides superior postoperative analgesia compared to IA following arthroscopic ACL reconstruction. The reduction in pain intensity and opioid consumption, coupled with favorable functional outcomes, highlights the potential of FNB as a preferred analgesic modality in this surgical population. Further research is warranted to validate these findings and optimize perioperative pain management strategies in orthopedic surgery.

Background: Reconstruction of post oncological resection defects in the oral cavity poses a unique challenge. Reconstructive methods aim not only repair of the tissues but giving a functional and aesthetic outcome. Various methods for head and neck reconstruction have been evolving over the past years from pedicled flaps (PMMC, Deltopectoral, Forehead, Temporalis, Sub mental flaps etc) to free flap reconstruction. Among which Free fibula flap provides a strong long segment of bone graft with low complication rate in post-oncological defect reconstruction. Objective: This single center, hospital-based study aimed to determine the functional and aesthetic outcomes following vascularised free fibula flap surgery for mandibular reconstruction in post-oncological defects in oral malignancies. Materials and Methods: An observational study was conducted in the department of general surgery at Sri Venkateshwaraa Medical College Hospital and Research Centre, Ariyur, Pondicherry, India for a period of two years from September 2021 to September 2023. Inclusion criteria was patients with oral malignancies having carcinoma buccal mucosa, carcinoma alveolus, and carcinoma floor of mouth who underwent composite resection with various types of segmental mandibulectomy based on clinical assessment and exclusion criteria was patients with lower leg abnormalities, extensive leg trauma, poor circulation or healing, cutaneous ulcers, and diabetes. Out of 12 patients, 8 had mucosal and bony defect which was treated with single paddle reconstruction and 4 had skin, mucosa and bony defect which was treated with double paddle reconstruction. Result: The follow-up ranged from 6 months to 2 years. Out of 12 patients reconstructed with free fibular flap, one patient developed Total flap necrosis which was salvaged with PMMC flap and one patient developed Partial necrosis of skin which was managed conservatively. Good mouth opening, intelligible speech, satisfactory contour of lower jaw and facial profiles were achieved in all 12 patients who were treated with vascularised free fibular flap. Conclusion: Free fibula flap was a versatile and reliable option for post oncological mandibular defect reconstruction. This reconstruction provides option for future implant based dental prosthetic restoration, making it the first choice for mandibular reconstruction.

Background of the study: Feature films are powerful teaching tools that are increasingly utilized in health sciences education due to their compelling portrayal of medical issues. Despite their potential, few studies have quantified the effectiveness of using feature films as a teaching method, making adequate assessment crucial. Objective:  To assess the perceptions of undergraduate students studying Ophthalmology using of Movie Screenshots. Materials & Methods: A total of 109 MBBS final year Phase I students participated in the study.  An innovative teaching-learning technique was used. A topic in ophthalmology, “glaucoma,” was taught using a teaching method that incorporated online movie screenshots. With the help of an analogy from a telugu movie episode (Vinodam, 1996), the characters were compared to Glaucoma, an ocular condition, Glaucoma Patient and an Ophthalmologist, the scene was explained with the help of a movie screenshot. Following the activity, students’ feedback was collected using an eight-item closed-ended questionnaire. This questionnaire, which was self-designed, pilot-tested, and validated, offered response options based on a 5-point Likert scale. Results: 60 out of 109 students responded to the questionnaire about movie screenshot-based teaching methods. 49(81.6%) students disagreed that they get distracted from the topic with the use of movie screenshots. 7(11.6%) students agreed that they get distracted. 4(6.67%) remained neutral. 48(80%) students disagreed that they feel bored. 9(15%) students agreed that they feel bored. 3(5%) remained neutral. Conclusion: The majority of third year medical students found the movie screenshots used in the class relaxing, understandable, attention-amplifying, satisfying, motivating, interesting and enriching experience in learning, and agreed that they prefer movie screenshot-based discussion.

Background an Aim: Brachial plexus block is widely used as an efficient and cost effective alternative to general anesthesia for upper limb surgeries. A variety of adjuvants to local anesthetics have been used and compared, however, drugs which prolong the duration of anaesthesia and analgesia are being constantly studied for patient satisfaction and cost effectiveness. This study was conducted to compare and evaluate the effects of dexmedetomidine as an adjuvant with bupivacaine in supraclavicular brachial plexus block in upper limb surgeries. Material and Methods: This Prospective Randomized control study was conducted in department of Anaesthesiology between September 2019 and September 2021. After taking thorough history and preoperative assessment, 60 adult patients of ASA I/II who were satisfying the inclusion criteria were enrolled into the study. Patients were divided into two groups according to the local anaesthetic mixture they received. Group N: Inj. Bupivacaine 0.5% 30ml + Inj. Normal Saline 0.9% 0.5 ml, Group D: Inj. Bupivacaine 0.5% 30 ml + Inj. Dexmedetomidine 0.5 ml (50 mcg) The time of onset and duration of sensory and motor block was noted. Hemodynamic variables were measured from baseline until the use of first rescue analgesic. Results: Onset of sensory and motor block was significantly faster in Group D compared to Group N. Duration of sensory and motor block was significantly prolonged in Group D compared to Group N. Rescue analgesia was required at 928+22.81 min in Group D and 435.7+46.33 min in Group N which was significantly prolonged. Postoperative period after one hour, mean pulse rate, systolic and diastolic blood pressures were comparable in both the groups. Conclusion: Dexmedetomidine 50 mcg when added to bupivacaine for supraclavicular brachial plexus block shortens the onset time of sensory and motor block prolongs the duration of sensory and motor block and postoperative analgesia.

Tonsillectomy is one of the most common surgical procedures in otolaryngology. The most common complication of surgery is acute pain, delayed oral intake, delayed haemorrhage, dehydration, prolonged hospital stays. Methods: 90 ASA I and ASA II patients, between 4-13years, were randomly divided into three groups(n=30). Group R received 0.75% ropivacaine 0.2ml/kg total 5ml, 2.5ml on each side, Group RK received 0.75% ropivacaine 0.2ml/kg with ketamine 1mg/kg (total 5ml), Group RD received 0.75% ropivacaine 0.2ml/kg with dexmedetomidine 1mcg/kg (total 5ml). We have observed parameters like MOPS score (modified objective pain scale), time of rescue analgesia, total analgesic consumption in first 24 hours, time of first oral intake and adverse effects like sedation, respiratory depression, bradycardia, nausea, vomiting, shivering, delayed haemorrhage. Results: Better MOPS score in Group RK when compared to Group RD, Group R. Time of first oral intake was (348.17+27.05), (398.33+51.83) and (433+41.49) respectively which was statistically highly significant(P=0.000). Total consumption of analgesics in 24 hours was 113.25+31.96, 56+26.34 and 66.03+25 respectively in Group R, RK and RD which was statistically highly significant(P=0.000). Conclusion: Pre-emptive peritonsillar infiltration of ropivacaine along with adjuvants for post tonsillectomy pain is a safer choice of analgesia.

Introduction: Diabetes mellitus is a complex chronic metabolic condition defined by persistent hyperglycemia caused by abnormalities in insulin activity and/or secretion. Prolonged hyperglycemia and related metabolic abnormalities eventually cause tissue toxicity, which manifests as accelerated atherosclerosis, renoretinal microangiopathy, and neuropathy, resulting to a variety of vascular, neurological, and focal problems. The study aimed to examine the efficacy and safety of vildagliptin-metformin vs glimepiride metformin in patients with type 2 diabetes. Materials and Methods: This comparative study was carried out over six months in a tertiary care Institution. A total of 100 participants participated in the study. These 100 patients were separated into two groups, each with 50 patients. Group A received glimepride 1mg and metformin 500mg in combination, while Group B received vildagliptin 50mg with metformin 500mg. The efficacy indicators such as fasting blood glucose, 2-hour postprandial glucose, and HbA1c were assessed, and any side effects were documented at 4-week intervals across the 24-week research period. Results: Maximum number of patients belonged to the age group of 50–54 years. Of 100 patients, 62 patients were males and 38 patients were females. Average of FBS in Groups A and B before initiation of therapy was 166.24 ± 11.76 mg/dl and 162±12.42. At the end of 24 weeks of therapy, an average of FBS in Groups A and B was reduced to 112.21 ± 10.23 mg/dl and 107.65 ± 11.23 mg/dl which was significant. Average of FBS in Groups A and B before initiation of therapy was 166.24 ± 11.76 mg/dl and 162±12.42. At the end of 24 weeks of therapy, an average of FBS in Groups A and B was reduced to 112.21 ± 10.23 mg/dl and 107.65 ± 11.23 mg/dl which was significant. Baseline mean value of HbA1C in Group A before with glimepiride was 8.23±1.23, and mean value of HbA1C in Group B with vildagliptin before initiation of therapy was 8.28±0.70. Average of HbA1C at the end of 24 weeks in Groups A and B was 7.20 ±0.60 and 7.12±0.62. Conclusion: Vildagliptin in combination with metformin is a beneficial and significant new therapy option that can provide optimum glycemic control without causing weight gain or hypoglycemia. Vildagliptin is a more effective and well-tolerated medication for treating type 2 diabetes mellitus than glimepiride.

Introduction: Hyperlipidemia is a well-known risk factor for atherosclerosis, accounting for a significant proportion of ischemic strokes and heart disease globally. Vitamin D supplementation paired with atorvastatin has been shown in studies to have synergistic effects in lowering serum cholesterol levels and treating statin-induced myalgia and myopathies. The study was done to determine the effect of a fixed dose combination of 1000 I.U of Vitamin D3 and Atorvastatin 10mg per day on serum HDL, VLDL, and Triglyceride values in hyperlipidemic individuals compared to those on Atorvastatin 10 mg per day for six months. Materials and Methods:  This prospective randomized comparison study took place in a tertiary care hospital’s outpatient general medicine department for six months. A total of 100 patients with dyslipidemia were selected. Out of 100 patients, 50 were given atorvastatin 10 mg, and the other 50 were given atorvastatin 10 mg and 1000 IU of Vitamin D3 orally. Patients were monitored monthly for six months, and their lipid profiles were examined at the beginning and end of the study. The data was entered into a Microsoft Excel worksheet and then imported into the SPSS version 23.0 software for analysis. An unpaired t-test was used to assess differences in changes between the two treatment groups. Results: Total cholesterol, Low Density Lipoproteins, very Low Density Lipoproteins & Triglycerides were significantly reduced and the High Density Lipoproteins significantly increased in atorvastatin and Vitamin D3 group than in atorvastatin group at the end of 6 months. Conclusion: Both groups showed significant changes in their plasma lipid profiles. However, the atorvastatin and vitamin D3 group performed better than the atorvastatin-treated group.

Background and Aim: Non-healing ulcers pose a significant global health challenge, affecting individuals on personal, professional, and social levels. The impact is substantial, both in terms of human well-being and the allocation of resources. In this study, we conducted a randomized prospective study to assess the impact of using autologous PRP versus normal saline on chronic non-healing ulcers. Our main focus was to evaluate the effectiveness of these treatments in terms of reducing ulcer area and volume, shortening the healing duration, and achieving complete or partial healing. Additionally, we also monitored for any potential side effects that may arise from these interventions. Material and Methods: In this randomized study, 80 eligible male and female patients attending the surgical outpatient department were enrolled. These patients had chronic non-healing ulcers and met the inclusion criteria. A total of 80 patients diagnosed with chronic non-healing ulcers were randomly assigned to two equal groups: the PRP group, which received treatment with PRP, and the NS group. Throughout the course of four weeks, various aspects of the condition were closely monitored. These included pain levels, presence of slough and discharge, the development of granulation tissue, as well as any changes in the size and volume of the ulcer. These observations were conducted on a weekly basis, providing valuable insights into the progression of the condition. Results: The average age in the PRP group was 49.54±11.20 years, while in the NS group it was 50.25±10.15 years. The typical duration of ulcers in both groups ranged from 3 to 6 months. Most of the ulcers in the PRP group lasted between 3 to 6 months, while a smaller percentage lasted between 6 to 12 months. No statistically significant difference was found between the PRP group and NS group in terms of age, gender, occupation of patients, pre-treatment duration, size of ulcer, and etiology of ulcer. The p-value is greater than 0.05. Conclusion: PRP has proven to be more effective than NS in treating chronic non-healing ulcers. It promotes faster healing, provides quicker pain relief, and leads to an early decrease in discharge and sloughing. These benefits are observed across all age groups and genders, regardless of the type, size, site, duration, and cause of the ulcer.

This study investigates the patterns and features of suicidal deaths that were subjected to medicolegal autopsy at the mortuary of Shaheed Nirmal Mahto Medical College (SNMMC), Dhanbad, Jharkhand. The study covers a period of six months, from 15th November 2023, to 14th May, 2024. We were Analyzed 100 instances to ascertain demographic patterns, suicide methods, and related psychosocial aspects. The results indicated that the demographic group most impacted was young adults, specifically males between the ages of 21 and 30. The study found that hanging accounted for 45% of suicides, while poisoning was responsible for 30% of cases. The majority of suicides took place in residential settings (70%) and were more prevalent throughout the evening and midnight (60%). The main psychosocial factors identified were a history of psychiatric disorders (25%), substance misuse (20%), financial crisis (35%), and  family disputes (40%). These findings emphasise the necessity of implementing specific suicidal prevention tactics, improving mental health assistance, and implementing community-based interventions to tackle the socio-economic and psychological aspects that contribute to suicidal behaviour in this area.

Background: This study compares laparoscopic and open ventral hernia repair procedures. Methods: From January 2022 to December 2023, 40 patients—15 laparoscopic and 25 open—at Jawahar Lal Nehru College & Hospital in Bhagalpur participated in the study. Data on recurrence, postoperative care, and intraoperative care were examined. Outcomes: Although laparoscopic surgery required more time, it was associated with shorter hospital stays, quicker recovery, and less pain after surgery. In comparison to the open group, they also saw less issues and recurrences after a year. In conclusion, even though laparoscopic ventral hernia repair takes longer, it is preferred when it can be done because of the better patient results.

Background: Rapid onset and deep sensory suppression make spinal anaesthesia the best choice for caesarean deliveries. In female caesarean section patients, this study compares hyperbaric bupivacaine and levobupivacaine for efficacy and safety. Methodology: This 14-month prospective, randomised, double-blind clinical experiment was conducted at Patna Medical College & Hospital, Bihar. At elective caesarean delivery, 91 women were randomly assigned hyperbaric or levobupivacaine (Group B, n=45 or Group L, n=46). Sensory and motor blockade start and duration were primary goals, hemodynamic stability, adverse effects, surgical analgesia, and maternal satisfaction were secondary. Result: Researchers found that hyperbaric levobupivacaine caused faster sensory and motor blockage than hyperbaric bupivacaine (p<0.001). Both groups had similar sensory and motor blockade durations (p>0.05). Group L was more hemodynamically stable with less hypotension (p=0.032) and shivering (p=0.044). The levobupivacaine group had increased maternal satisfaction (p=0.021). Postoperative analgesic needs were similar between groups (p>0.05). Conclusion: Hyperbaric levobupivacaine is safer and more successful for spinal anaesthesia in caesarean sections than hyperbaric bupivacaine because to its faster onset, better hemodynamic stability, fewer side effects, and higher maternal satisfaction. More research is needed to confirm these findings and create clinical guidelines.

Background: Preterm labor, classified as labor occurring before 37 completed weeks of gestation, poses significant risks to neonatal health, including intraventricular hemorrhage, respiratory distress syndrome, and long-term neurodevelopmental disabilities. Magnesium sulfate, traditionally used for eclampsia management, has gained attention as a tocolytic agent to delay preterm delivery and improve newborn outcomes. This study aimed to evaluate the effectiveness and safety of magnesium sulfate as a tocolytic agent in preterm labor and its impact on maternal health. Methods: The cohort study included 100 pregnant women experiencing preterm labor who received magnesium sulfate. Data on demographic characteristics, clinical outcomes, maternal side effects, and neonatal health indicators were collected and analyzed using SPSS version 19. Statistical significance was determined at a p-value of less than 0.05. Results: The mean duration of pregnancy prolongation was 14.5 ± 5.2 days. Mild to moderate side effects were observed in 35% of participants, while 2% experienced severe side effects. The cesarean section rate was 45%, and maternal morbidity rates included 5% for preeclampsia and 8% for postpartum hemorrhage. Neonatal outcomes were favorable, with a mean birth weight of 2300 grams and Apgar scores of 7.5 at 1 minute and 8.5 at 5 minutes. Comparative analysis showed a statistically substantial increase in pregnancy duration compared to historical controls (p < 0.05). Conclusion: Magnesium sulfate effectively prolonged pregnancy in preterm labor with an acceptable safety profile. The treatment was associated with favorable maternal and neonatal outcomes, indicating its utility as a tocolytic agent. Recommendations: Further research with larger sample sizes and diverse populations is recommended to confirm these findings. Tailored dosing regimens based on individual patient characteristics should be considered to optimize outcomes.

Inguinal hernia repair can be done under different modes of Anaesthesia. An 11-month Patna Medical College & Hospital study compared unilateral paravertebral block (PVB) to spinal anaesthesia for elective inguinal hernia procedures for efficacy, safety, and patient satisfaction. This prospective, randomised comparative study included 87 patients: 43 receiving PVB (Group A) and 44 receiving spinal anaesthesia (Group B). The study investigated intraoperative hemodynamic stability, postoperative pain, analgesic requirements, patient satisfaction, and adverse events. Spinal and PVB anaesthesia provided appropriate surgical anaesthesia. Group A experienced reduced intraoperative hypotension (5% vs. 27%, p=0.005) and better hemodynamic stability. Group A had lower postoperative pain levels (p<0.001), delayed first analgesics (7.5 ± 2.1 hours vs. 4.3 ± 1.7 hours, p<0.001), and took fewer total analgesics (45 ± 15 mg vs. 80 ± 20 mg of Group A exhibited higher patient satisfaction (4.8 ± 0.3 vs. 4.1 ± 0.6, p<0.001) and lower post-dural puncture headache and urine retention rates than Group B. Inguinal hernia surgery may benefit from unilateral paravertebral block over spinal anaesthesia in hemodynamic stability, postoperative discomfort, and patient satisfaction. PVB is advised for this procedure.

Background: Tuberculosis (TB) is a critical global health issue, further complicated by drug-resistant forms like extremely drug-resistant tuberculosis (XDR-TB).Vitamin D deficiency is known to be associated with many infectious and metabolic disorders. Vitamin D related receptors have been reported in multiple tissues, where they play key role in immune system modulation.  High prevalence of Vitamin D deficiency in pulmonary TB patients indicates that Vitamin D is a risk factor for development of XDR-TB.  Previous studies have shown that soluble urokinase plasminogen activator receptor (suPAR) may be used as TB treatment efficacy marker. suPAR is cellular receptor for serine protease urokinase plasminogen activator. Bacterial endotoxins and cytokines of innate immune system stimulate secretion of urokinase plasminogen activator (uPA) in monocytes and neurophils. Serum suPAR levels are elevated when TB is active and decreases when patient responds positively to therapy. Objective: To correlate between serum levels of vitamin D, known for its immune-regulating properties, and suPAR, an inflammation marker, in XDR-TB patients. Design: The study was conducted in the Department of Biochemistry, VIMS, Ballari, Karnataka. The study subjects were selected from district TB hospital of VIMS, Ballari. Controls: 36 age and sex matched healthy controls from the community selected. Case: 36 cases diagnosed with XDR-TB from District TB hospital, VIMS, Ballari. Methodology: Hb%, CBC, ESR, SGOT, SGPT, ALP, Blood Urea, Serum Creatinine, Serum Albumin, Serum Calcium, Serum  Phosphorus were measured by standard procedures  and Vitamin D levels by ELISA. Serum suPAR levels were measured by Quantitative sandwich enzyme immunoassay technique. Results: A significant inverse correlation was found between serum Vitamin D and suPAR levels, indicating that lower vitamin D levels are associated with higher immune activation and inflammation. Conclusion: The study suggests a link between vitamin D deficiency and increased inflammation in XDR-TB patients, highlighting the potential benefits of vitamin D monitoring and supplementation in managing this condition. Further research is needed to explore the therapeutic implications of vitamin D in TB.

Background: Type 2 Diabetes Mellitus (T2DM) is associated with various microvascular complications, including nephropathy, retinopathy, and neuropathy. This study aimed to investigate the relationship between serum zinc levels and these complications in T2DM patients. Methods: This cross-sectional study included 100 T2DM patients from SVRRGGH, Tirupati, from July 2021 to June 2022. Serum zinc levels and the presence of microvascular complications were assessed. Data were analyzed using descriptive statistics, Chi-square tests, and Pearson correlation coefficient. Results: The mean age of participants was 57.11 years (SD 11.50), and the mean duration of diabetes was 7.92 years (SD 6.101). Diabetic nephropathy was present in 41% of patients, retinopathy in 55%, and neuropathy in 26%. Patients with nephropathy had significantly lower mean serum zinc levels (63.59 μg/dl) compared to those without nephropathy (91.39 μg/dl; p=0.001). Similarly, patients with retinopathy had lower zinc levels (63.91 μg/dl) compared to those without (99.64 μg/dl; p<0.00001), and those with neuropathy had lower levels (57.70 μg/dl) compared to those without (87.82 μg/dl; p=0.001). Conclusion: Lower serum zinc levels are significantly associated with microvascular complications in T2DM patients. Monitoring zinc levels and considering zinc supplementation could be beneficial in managing diabetes-related complications.

Background: The study aims to compare the impact of 1% Xylocaine spray on fallopian tubes prior to tubal ligation via minilaparotomy or laparoscopic sterilization, exploring its role in alleviating postoperative pain and enhancing patient satisfaction in gynecological surgery. Methods: The prospective comparative study involved 100 women undergoing tubal ligation, randomly assigned to either minilaparotomy (Group 1) or laparoscopic sterilization (Group 2). In Group 1, Xylocaine spray was applied to the fallopian tubes prior to tubal ligation, while no Xylocaine spray was used in Group 2. Data was analyzed using appropriate statistical methods. Results: Baseline characteristics between the two groups were similar, with no significant differences in age, BMI, parity, or past medical history. Postoperative outcomes revealed that mean pain scores at 6 and 24 hours were significantly lower in Group 1 compared to Group 2. The incidence of fallopian tube spasm was lower in Group 1, although not statistically significant. However, the mean duration of surgery was longer in Group 2. Patient satisfaction scores were higher in Group 1. Multivariate regression analysis showed that the use of Xylocaine spray was associated with lower pain scores and higher patient satisfaction. Conclusion: The study suggests that the application of 1% Xylocaine spray on fallopian tubes prior to tubal ligation via minilaparotomy is associated with lower postoperative pain scores and higher patient satisfaction compared to laparoscopic sterilization without Xylocaine spray. While laparoscopic sterilization may result in longer surgical duration, there were no significant differences in the incidence of postoperative complications between the two approaches. Recommendations: Based on these findings, the use of Xylocaine spray should be considered as part of pain management strategies during tubal ligation procedures, particularly for patients undergoing minilaparotomy. Further research could explore the long-term effects and cost-effectiveness of this approach.

Background: Widespread over-the-counter use of Proton pump inhibitors has raised a concern regarding their safety profile during long-term use. Various retrospective & observational studies have reported the development of chronic kidney disease in individuals on Proton pump inhibitors. Aims & Objectives: To find an association between the uses of proton pump inhibitors and renal disease. Material & Methods: This prospective observational study was carried out in the Department of Nephrology of our Tertiary care hospital from August 2023 till February 2024 for six months. 200 patients within the age range of 45-65 yrs suffering from gastro-oesophageal reflux disease, peptic ulcers including gastric ulcers and duodenal ulcers, with once / twice daily prescribed PPI (duration between 15 days to 6 months of use) were included in the study. Patients with comorbidities, suffering from renal disease, on nephrotoxic medications, and pregnant women were excluded from the study. The patients were divided into 2 groups: Group A: Patients with users of PPI (n=100); Group B: Patients with non-users of PPI (n=100). Detailed history including socio-demographic details, age at clinical presentation, and medication history was taken. Renal function tests – serum creatinine, blood urea nitrogen, and glomerular filtration rate were measured at baseline, 3- and 6 months of the study. Results: In Group A, 9 patients while in Group B, 2 patients showed signs of developing renal disease with the usage of PPI. There was a significant increase in the serum creatinine levels, BUN, and reduction in GFR at 6 months follow-up (p<0.05). 61.2% of the patients were in the age range 55-60 yrs, 23% in 61-65 yrs, and 16% in the age group of 51-55 yrs. Males were at a greater risk than females. Conclusion: The use of proton pump inhibitors can contribute to the development of chronic renal disease.  These medications should be carefully administered. Further large prospective studies should be conducted to confirm this association.

Background: Chronic kidney disease (CKD) poses serious public health concern, constituting structural and functional abnormalities in the kidney. The complications become a cause of increased morbidity and mortality in CKD patients. Aim: To assess the effect of oral bicarbonate supplementation on on the progression of chronic kidney disease. Material & Methods: This prospective randomised controlled clinical trial was conducted in the Department of nephrology of our tertiary care Hospital from February 2023 till January 2024. Patients (n=70) ,aged more than 18 yrs , with estimated glomerular filtration rate (eGFR)of 15–30 mL/min/1.73 m2 and Serum bicarbonate levels -10–20 mM/L in clinically stable condition were randomized into ; Test Group – 600 mg sodium bicarbonate orally TDS; Control Group – standard therapy without oral sodium bicarbonate supplementation. Venous samples were analysed for Serum bicarbonate, serum creatinine, serum albumin & eGFR. The patients were followed for 6 and 9 months Results: In control group, eGFR decreased significantly at 6 months (20.24 mL/min/1.73 m2) and at 9 months (19.26 ml/min/2.73m2) (p0.05). In test group, serum albumin levels increased significantly, eGFR remained at par with baseline values. The serum creatinine was comparable in both the groups with no significant difference at 6 or 9 months. Conclusions: The present study concluded that the oral supplementation to cause improvement in the serum albumin levels & maintenance of baseline values which subsequently leads to improvement in renal function. Thus, it should be included in the management of metabolic acidosis in chronic kidney diseases patients & arrest disease progression.

Introduction: Diabetes mellitus is a metabolic disorder diagnosed by elevated blood glucose levels, affecting 10.5% of the global community. Causes include socio-economic, demographic, environmental, and genetic factors. Detection is based on glycosylated hemoglobin (HbA1c) levels above 6.5%. Diabetic dyslipidemia is common in type 2 diabetes and pre-diabetic patients. Aim: To study the correlation between HBA1C and Lipid profile parameters in diabetic patients. Material and Methods: A cross-sectional study was conducted in the Department of Physiology at Sree Mookambika Institute of Medical Sciences, Kulashekaram, for the period of one year, October (2022 – 2023) at Kanyakumari District, Tamilnadu. Sample size is 100 patients. All patients were examined for HBA1C and Lipid profile after getting approval from Ethics Committee. Results: The total number of patients studied was 100. Out of them, Majority(45%) belong to the age group of 30-34 years. The Mean age is 38.4. 60% males and 40% females. Correlation between HBA1C and lipid pofile parameters was found to be statistically significant in this study. Conclusion: There was a significant correlation between HBA1C and Lipid profile parameters. Screening of lipid profile parameters should be done in all patients in those who have diabetes every 6 months.

Breastfeeding provides numerous benefits for infant and maternal health, yet rates remain suboptimal globally. While maternal factors have been the primary focus, there is growing recognition of the significant role fathers play in influencing breastfeeding outcomes. This review synthesizes the literature on the impact of father involvement on breastfeeding initiation, duration, and overall success. It explores changing societal perceptions of fatherhood, the various supportive roles fathers can play, and mechanisms through which their involvement influences breastfeeding. Strategies for promoting father engagement and overcoming barriers are discussed, highlighting the importance of a family-centered approach to breastfeeding support.

Laparoscopic surgical patients need good postoperative pain treatment to recover and be satisfied. Despite limited studies, the pulmonary recruitment manoeuvre (PRM) and intraperitoneal hydrocortisone (IPH) relieve severe pain. This 11-month prospective, randomized controlled trial recruited 92 patient elective laparoscopic surgical Surgery patients at Patna Medical College & Hospital. Participants were randomly assigned to PRM or IPH groups, which received intraperitoneal hydrocortisone or a pulmonary manoeuvre after surgery. VAS was used to assess postoperative pain up to 48 hours following surgery. The PRM group showed faster analgesic effects than the IPH group, with substantially lower VAS scores at 1-, 6-, and 12 hours post-operation (p<0.05). After 24 and 48 hours, both groups had similar pain scores. In the first 24 hours, PRM patients needed less analgesics. Conclusion: In laparoscopic surgical Surgery, pulmonary recruitment reduces postoperative pain more than intraperitoneal hydrocortisone. Its postoperative use may increase patient comfort and recovery without drugs.

Epidurally administered levobupivacaine 0.5% and ropivacaine 0.75% were compared for efficacy and safety in 97 lower limb surgery patients at Patna Medical College & Hospital over 14 months. The study assessed sensory and motor block onset, analgesia duration, hemodynamic stability, postoperative pain, patient satisfaction, and side effects. Levobupivacaine exhibited a faster motor block onset and longer analgesic duration than ropivacaine, increasing patient satisfaction. Both anesthetics had negligible adverse effects and steady hemodynamics. These data show that levobupivacaine may be better for procedures needing extended pain control, but patient and surgical variables should determine the anesthetic.

Objectives: The present study was to evaluate the seroprevalence of ocular Toxoplasmosis and the associated risk factors among Pediatric age group patients. Methods: All samples were subjected to the enzyme‑linked immunosorbent assay (ELISA) for the detection of anti‑T. gondii IgG and IgM antibodies. The antigen was prepared from the RH strain of T. gondii tachyzoites harvested from the peritoneal cavity of Swiss albino mice after 3 days of infection. The tachyzoites were purified by differential centrifugation, kept overnight at 4°C and then subjected to sonication and cold centrifugation. Toxoplasma antigen (1 μg/well) was coated on microtitre plates, and ELISA was performed. All the risk factors were assessed by the using the questionnaire to the parents. Socio-economic strata were assessed by using the modified Kuppuswamy scale. All the related factors were noted in the prescribed Performa. Results: A total of 206 suspected cases of ocular toxoplasmosis were tested. Rate seroprevalence of ocular toxoplasmosis was 13.59%. out of 206, 64 cases were neonates. Among neonates, 6(9.37%) cases were seropositive. IgG+/ IgM− was 4(6.25%) and IgM+/ IgG+ antibodies was 2(3.12%). Out of 52 infants, 1(1.92%) and 3(5.77%) cases had IgG+/ IgM− and IgM+/ IgG+ antibodies respectively. Out of 47 tested sample of cases age group >1-5 years, seropositivity was seen in7(14.89%) cases. Similarly, in age group 6-12 years, out of 28 tested sample, seropositivity was seen in 5(17.86%) cases. In age group 13-18 years, out of 22 tested samples, seropositivity was seen in 6(27.27%) cases. Out of 206 tested sample, IgG+/ IgM− was seen in 11(5.34%) cases. And IgM+/ IgG+ was seen in17(8.25%). Among all tested sample, 13(6.31%) ocular toxoplasmosis were males and 15(7.28%) were females. Majorities of cases were eaten meat (67.85%), kept cattle during the past 5 years 18((64.29%), lived in rural area 20(71.43%), drunk treated water 24(85.71%) and belonged from lower 39(11.29%) and upper lower class 9(32.14%). Most of the parents were illiterate 14(50%) and primary level education 9(32.14%). 75% children were played in open environment with touch soil. Conclusions: Ocular toxoplasmosis is greatly seen in neonates, infants, and paediatrics age 1-5 years. Female are more preponderance than male. Poor hygiene, illiteracy, lower socioeconomical status, playing with domestic animals (cat) and touch soil are major risk factors of ocular toxoplasmosis in paediatrics.  Hence, we should organise a medical camp in rural as well as urban areas for the awareness of risk factors and early diagnosis and prompt treatment of ocular toxoplasmosis.

Background: Preeclampsia is a pregnancy specific multisystem disorder of unknown etiology. Vitamin D deficiency is proposed to be important in the etiopathogenesis of preeclampsia. Aim: To assess and compare maternal serum vitamin D levels in preeclamptic patients and healthy pregnant women for early prediction and prevention of preeclampsia. Materials and Methods: This study was a comparative cross sectional study, carried out on 100 pregnant women with gestational age ≥ 20 weeks. 50 clinical cases of preeclampsia were compared with equal number of healthy normotensive pregnant women for serum vitamin D levels. Results: Mean serum vitamin D level in preeclamptic women was 9.76±3.19 ng/ml as compared to healthy normotensive pregnant women 19.57±6.37 ng/ml. The difference in Serum vitamin D in two groups was statistically significant with p-value <0.001. Conclusion: The result showed significantly low levels of vitamin D in preeclamptic cases as compared to healthy normotensive pregnant women of the study population. Hence it is advised to supplement pregnant lady with vitamin D to decrease the risk of preeclampsia.

Introduction: CP Angle tumors account for 5-10% of intracranial tumors. Most CPA tumors are benign, with over 85% being vestibular schwannomas, lipomas, vascular malformations and hemangiomas. The most frequent nonacoustic CPA tumors are meningiomas, epidermoids. Primary malignancies or metastatic lesions accounting less than 2% of neoplasm in the CPA.This study attempts to present the clinico-radiological profile as well as results of surgical management in acoustic schwannoma. Material and Methods: This study was conducted in the Department of Neurosurgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. Patients having Contrast enhanced MRI brain with features suggestive of acoustic schwannoma were included in the study. We included 50 patients in this study. Observation and Results: In our study 12% of patients were of the age group 0-20 yr, 28% were 21-30 yr, 26% were 31-40 yr, 16% were 41-50 yr, 8% were 51-60 yr, 10% were 61-70 yr. Females in our study were 44% whereas the males were 56%. In our study sensorineural hearing loss was observed in 84% cases, vertigo was present in 36% cases, headache was present in 90%, facial nerve dysfunction was present in 24%, tinnitus was present in 56%, motor weakness was present in 8%. Hydrocephalus was present in 28% cases. Our study depicted that majority tumours were large size i.e. 64% were Koos grade 4 and rest 36% were Koos grade 3. As the size increases, possibility of facial nerve palsy also increases post-operatively but the association was statistically significant (P value 0.03). Conclusion: Post-operatively Facial nerve palsy along with lower cranial palsies were the most common complications. As the size of the lesion increased, possibility of these complications also increased. Thus, once diagnosed these tumours must be managed by multi-disciplinary team consisting of a Neurosurgeon, ENT specialist, Hearing and rehabilitation specialist and Radiation oncologist.

This retrospective study investigates the incidence and outcomes of pneumothorax and subcutaneous emphysema among 100 post-COVID-19 patients in an intensive care setting at Jawahar Lal Nehru Medical College & Hospital, Bhagalpur, Bihar. The study spanned from February 2023 to January 2024, focusing on patients who developed these complications post-severe COVID-19 infection. Findings revealed that 18% of patients developed pneumothorax and 11% developed subcutaneous emphysema, with a significant correlation between these complications and the need for mechanical ventilation. The mortality rates were notably high at 33% for pneumothorax and 18% for subcutaneous emphysema. The study highlights the severe impact of COVID-19 on lung health and the critical need for targeted management strategies in the ICU to improve patient outcomes. Future research should explore preventive measures and alternative respiratory support methods to mitigate these risks.

A randomized, double-blind, controlled trial at Jawahar Lal Nehru Medical College & Hospital, Bhagalpur, examined the efficacy of dexmedetomidine as an adjuvant to levobupivacaine in brachial plexus blocks. From February 2023 to January 2024, the study was conducted. 100 elective upper limb surgery patients were divided into two groups. Some groups received levobupivacaine alone, while others received it with dexmedetomidine. The study found that dexmedetomidine prolonged analgesia longer than the control group. It also accelerated sensory and motor blockages. Dexmedetomidine improved patient and surgeon satisfaction without increasing side effects. Dexmedetomidine appears to improve regional anesthesia outcomes and patient experience in upper limb procedures.

Background: Type 2 diabetes mellitus is a metabolic disorder characterised by elevated blood sugar levels due to the body’s impaired ability to respond to insulin and decreased production of insulin. It represents over 90% of adult diabetes cases. Aim: To investigate the impact of further treatment with SGLT-2 inhibitors on glycemic indices. Material and Methods: A total of 50 patients, regardless of gender, aged between 18 and 70 years, who have been diagnosed with type 2 diabetes mellitus and have HbA1c levels greater than 7.0% despite treatment with metformin ± sulphonyl urea, were selected to participate in our research. These patients were then started on either Empa or Dapa, which are gliflozins, as an additional medication. It is important to note that all participants willingly agreed to be part of the study. The research excluded pregnant women, patients with systemic diseases other than diabetes, and those with a S. creatinine clearance of less than 60 ml/min. Results: The comparison of glycemic parameters from baseline to follow-up visits at 3 months and 6 months showed significant improvements. The mean HbA1c decreased from 8.67% at baseline to 7.87% at 3 months, and further to 7.23% at 6 months. These reductions were statistically significant, with p-values of <0.001 for both time points compared to baseline. Similarly, the mean fasting blood sugar (FBS) levels decreased from 161.03 mg/dL at baseline to 141.76 mg/dL at 3 months and to 121.98 mg/dL at 6 months, with p-values <0.001 for both comparisons. The postprandial blood sugar (PPBS) levels also showed a significant reduction from 241.54 mg/dL at baseline to 201.86 mg/dL at 3 months and to 181.88 mg/dL at 6 months, again with p-values <0.001 for both comparisons. The ADR profile indicated that 20% of the patients experienced genital mycotic infections, 16% had urinary tract infections, 10% reported dehydration, and 6% experienced hypoglycemia. However, 48% of the patients did not report any adverse drug reactions, indicating a relatively manageable safety profile for the add-on SGLT2 inhibitor therapy. The correlation analysis revealed significant negative correlations between baseline HbA1c and reductions in glycemic parameters. The reduction in HbA1c had a correlation coefficient of -0.72 with a p-value of <0.001, indicating that higher baseline HbA1c levels were associated with greater reductions in HbA1c. Similarly, reductions in FBS and PPBS had correlation coefficients of -0.58 and -0.63, respectively, both with p-values <0.001. Conclusion: SGLT-2 inhibitors are a potential new class of antidiabetic drugs that provide improved management of fasting blood sugar (FBS), postprandial blood sugar (PPBS), and glycated haemoglobin (HbA1c).

Background: Acute Coronary Syndrome (ACS) refers to a collection of physiological and clinical changes that occur in the heart muscle after experiencing acute myocardial ischemia. It is a significant worldwide cause of mortality. Aims and Objectives: To compare the effectiveness of Streptokinase, Tenecteplase, and Reteplase in treating ST-elevated myocardial infarction in patients. Materials and Methods: The research comprised patients of both genders who were over 18 years old and came to either the emergency department or cardiology outpatient department with acute ST-elevation myocardial infarction (STEMI). Streptokinase group (n = 50): The dose of streptokinase administered was 1.5 million units intravenous (i.v.) given over 30 to 60 minutes. Tenecteplase group (n = 50): Tenecteplase was given as a single IV bolus, the dose of which was calculated according to the patient’s weight. Reteplase group (n = 50): Reteplase was administered as an IV bolus of 10 units two times at a 30-minute interval. Results: The efficacy of the thrombolytic agents was assessed by the rate of successful thrombolysis, defined as ≥50% ST resolution at 90 minutes post-thrombolysis. The Streptokinase group achieved successful thrombolysis in 84% of participants, the Tenecteplase group in 94%, and the Reteplase group in 90%. Although the Tenecteplase group showed the highest rate of successful thrombolysis, the differences among the groups were not statistically significant (p = 0.26). This suggests that all three thrombolytic agents had similar efficacy in achieving ST resolution. The 30-day clinical outcomes showed some variation among the groups, though none reached statistical significance. Mortality within 30 days was observed in 8% of the Streptokinase group, 4% of the Tenecteplase group, and 6% of the Reteplase group (p = 0.14). Reinfarction occurred in 12% of the Streptokinase group, 6% of the Tenecteplase group, and 8% of the Reteplase group (p = 0.32). Stroke was reported in 2% of both the Streptokinase and Tenecteplase groups, but no strokes were reported in the Reteplase group (p = 0.13). Bleeding complications were noted in 16% of the Streptokinase group, 10% of the Tenecteplase group, and 12% of the Reteplase group (p = 0.11). Conclusion: We concluded that streptokinase, tenecteplase, and reteplase have similar efficacy and safety profiles in the management of acute STEMI, with no significant differences in thrombolytic efficacy, clinical outcomes, time to presentation, or adverse events. These findings provide valuable insights for clinicians in selecting appropriate thrombolytic therapy for STEMI patients.

Background: Polycystic ovarian syndrome (PCOS) is the predominant endocrine condition among women in the reproductive age range. PCOS is defined by the presence of excessive levels of male hormones, prolonged absence of ovulation, abnormal uterine bleeding, and changes in the structure of the ovaries. Aim: To study the impact of oral contraceptives and metformin on metabolic and endocrine parameters in individuals with polycystic ovarian syndrome. Materials and Methods: The patients were categorised into two groups based on the clinician’s evaluation of their profile. Group A consisted of 70 patients, whereas Group B also included 70 patients. Group A was given a combination of lifestyle modification and oral metformin. At the beginning of the trial, a 500 mg dose was administered, and, based on the patient’s reaction and clinical assessment, the metformin dosage was modified to a maximum of 2000 mg per day for a duration of 6 months. Group B received lifestyle modification and was administered OCP (a fixed dosage combination of ethinyl estradiol 50 micrograms and cyproterone acetate 2 milli grammes per day) for a duration of six months. Every patient included in the trial was monitored for a duration of six months, with regular assessments of all pertinent clinical and laboratory indicators. Results: The mean HbA1c levels among the study subjects in group A at the end of the study were 7.23 ± 0.28% as compared to 5.66 ± 0.15% among the group B study population. The difference was found to be highly significant (p = 0.01). Among the lipid profiles, the differences in total cholesterol, LDL, and TG were statistically significant. The mean testosterone levels among the study subjects in group A at the end of the study were 2.89± 0.55 mmol/L as compared to 2.95± 0.23 mmol/L among the group B study population. The difference was found to be statistically significant (p-value = 0.02). A total of 27 (38.57%) of the study patients in group A had USG changes suggestive of PCOS before initiation of the treatment, which got reduced to 23 (32.86%) and 25 (35.71%) at the end of the 2nd  and 6th months of treatment, respectively. The rate of improvement of the USG changes in PCOS among the study population was found to be not statistically significant (p-value = 0.08). Similarly, 43 (61.43%) of the study population in group B had USG changes suggestive of PCOS before initiation of the treatment, which got reduced to 34 (48.57%) and 26 (37.14%) at the end of the 2nd and 6th months of treatment, respectively. The rate of improvement of the USG changes in PCOS among the study population was found to be highly significant (p-value <0.001). Conclusion: Both oral metformin and oral contraceptive tablets are effective therapy options for people with PCOS and result in considerable improvement in menstruation symptoms within six months of starting medication. Individuals with worse metabolic parameters have had more benefits from oral metformin treatment, whereas individuals with excellent metabolic parameters and worse endocrinological profiles have shown comparable improvements with oral contraceptive tablets.

Background: Placenta accreta spectrum (PAS) is a condition characterised by aberrant placental attachment. PAS is a significant obstetric issue. The prevalence of placenta accreta spectrum (PAS) has risen with the increase in caesarean births during the last forty years. Aim: To investigate maternal and neonatal outcomes associated with placenta accreta spectrum in a specialised hospital. Materials and Methods: Placenta accreta spectrum (PAS) patients who visited the Department of Obstetrics and Gynaecology were part of the research. placenta accreta spectrum (PAS) patients that were discovered before birth, regardless of whether the patient had scheduled appointments or not, as well as those that were not identified before birth but were diagnosed after surgery. The research variables were age, parity, manner of presentation, risk factors, surgical details, and maternal and foetal outcomes. Results: 50 cases of Placenta Accreta Spectrum (PAS) were studied, resulting in an incidence rate of 0.53%. Most women with Placenta Accreta Spectrum (PAS) choose to have surgery between 34 and 37 weeks of pregnancy. A classic caesarean section was performed in 76% of patients. Approximately 92% of the ladies had an obstetric hysterectomy. 92% of the research participants had postpartum haemorrhage (PPH) during surgery, necessitating the use of numerous units of blood and blood components. Grade 1: Placenta adherent or acreta: 24 cases (48%); Grade 2: Placenta increta: 10 cases (20%); Grade 3: Placenta percreta: a total of 16 cases (32%). 30 patients (60%) had large vascular ligation or clamping: 7 patients (14%) had the aorta clamped, 3 patients (6%) had the common iliac artery clamped, and 14 patients (28%) had the internal iliac artery ligated. Six patients (12%) had internal iliac artery ligation in addition to aortic clamping and pelvic packing. A large vascular ligation or clamp was not tried in 40% of the 20 cases. The research found that 80% of the kids were born prematurely between 28 and 37 weeks of gestation, displaying different neonatal abnormalities based on their birth weight and 5-minute APGAR score. Five infants were delivered prematurely at less than 28 weeks gestation and had a poor 5-minute APGAR score. 42% of the newborns did not need to be admitted to the Neonatal Intensive Care Unit (NICU). Conclusion: The Placenta Accreta Spectrum (PAS) seems to be linked to severe maternal problems that require extensive blood transfusions in a considerable proportion of instances. The majority of the ladies had to have an obstetric hysterectomy. The primary neonatal outcome was preterm birth and its associated consequences.

Introduction: Atherosclerotic disorders are greatly exacerbated by hypertension. When it comes to the management of hypertension, calcium channel blockers (CCBs) are among the most common and effective tools for lowering blood pressure. The most effective class of calcium channel blockers is the dihydropyridine family, which includes amlodipine and the next-generation drug benidipine. Patients with uncomplicated hypertension who visited tertiary care facilities were the subjects of this study, which aimed to compare the efficacy of amlodipine and benidipine. Material and Methods: One hundred twelve individuals ranging in age from 21 to 65 years old were found to have simple hypertension, defined as blood pressure readings of 140/90 mm Hg or higher. Each participant was assigned to one of two groups and given either amlodipine 2.5 mg or benidipine 4 mg orally once daily in the morning. We documented adverse event details and baseline, 6-week, and 12-week post-treatment serum creatinine and urine albumin levels. Results: T there was a statistically significant difference (p<0.05) in the study groups’ mean systolic and diastolic blood pressure readings. symptoms such as swelling in the ankles (28.57%), headache (5.35%), albuminuria in the urine (5.35%), nausea and vomiting (3.58%), giddiness (3.58%), and palpitations (1.78%). In group A, the mean serum creatinine level was 0.90 mg/dl, while in group B, it was 0.88 mg/dl. Conclusion: The antihypertensive effects of amlodipine and benidipine are comparable when taken alone. Although both groups took systolic blood pressure medication, the Benidipine group showed a considerable improvement in mean difference compared to the Amlodipine group.

Background and Objectives: Hypertension is the most frequently encountered medical disorder in obstetric practice & remain a major cause of maternal, fetal & neonatal morbidity & mortality. The present study was undertaken to compare the time taken to reach the therapeutic goal of blood pressure after using intravenous labetolol & oral nifedipine in severe hypertension during pregnancy, To compare the efficacy and safety of the IV labetolol and oral nifedipine. Materials and Methods: Sixty women with hypertensive crisis were randomized to receive either oral nifedipine 10 mg or intravenous labetolol 20 mg in equal numbers. Oral nifedipine was given 10 mg stat followed by 10 mg every 30 minutes up to a maximum of 50 mg. Intravenous labetolol was given 20 mg stat followed by 40 mg 10 minutes later then two more doses of 80 mg every 10 minutes up to a maximum of 220 mg. The primary outcome was the number of doses required to achieve target blood pressure (BP) and time required to reduce the mean arterial pressure by 25%. Secondary outcomes analysed included additional drugs required. Conclusion: Oral nifedipine & intravenous labetolol regimens are equally effective in the management of severe hypertension in pregnancy; Nifedipine needs fewer doses to reach target BP and cost effective with the advantage of oral administration. Whereas labetolol needs less time to us reach target BP and appropriate drug in patients with eclampsia.

Background: To ensure a successful orthopedic procedure, local anesthesia is needed. Postoperative analgesia is usually given by peripheral nerve blocks, and neuroaxial anesthesia is the usual method of administering surgical anesthetic. Before administering a regional anesthetic, it is important to check the patient’s heart, lungs, neurological system, and blood. A variety of neuraxial blocks are available, including spinal, epidural, and combination blocks. The upper limbs can benefit from peripheral nerve blocks such as those placed interscalene, supraclavicularly, infraclavicularly, and axillaryly. The lower extremities are frequently targeted when administering peripheral nerve blocks, such as those to the femoral, saphenous, sciatic, ankle, lumbar, and iPACK nerves. The decision to utilize regional anesthetic is made after a thorough evaluation of the risks and benefits by the patient, surgeon, and anesthesiologist. The three sides concerned in this decision have come to a unanimous agreement. The patient’s cooperation, their positioning, the surgical structures, the manipulation during surgery, the use of the tourniquet, and the impact of post-operative motor blockade on the start of physical therapy are all factors that go into selecting the regional block. It is nevertheless possible for regional anesthetic to fail, even though it is safe. Nerve damage, hematomas, infections, allergic reactions, and local anesthetic systemic toxicity (LAST) are among the rare problems that might occur. Using ultrasonography during regional anesthetic operations can improve the procedure’s efficacy and decrease the likelihood of problems. Rescue medications (intralipid) and LAST treatment regimens must be easily accessible during the administration of regional anesthesia.

Background: Malignant liver mass, especially hepatocellular carcinoma (HCC), is the most common primary malignant tumour of the liver representing more than 80% of all primary hepatic malignancies. Methods: This cross sectional study was carried out in the Department of Radiology. All the clinically suspected patients having hepatic mass at any age with both sexes who were attended in hospital were taken as study population as per inclusion and exclusion criteria. Patients having hepatomegaly due to extra hepatic causes, patients who refused to undergo CT-scan, patients who refuse to do biopsy or whose biopsy result was not available and patients having known hypersensitivity reaction to contrast agent were excluded from this study. Results: Sensitivity of CT to diagnose malignant lesion was 94.12%, specificity 84.62%, accuracy 90%, positive predictive value 88.89% and negative predictive value 91.67%. Conclusion: The results of the present study therefore conclude that CT is a useful modality for the diagnosis of malignant liver masses. Since the CT diagnosis correlates with histopathological connection, it is a sensitive modality on the basis of the above findings.

Background: Internal derangements of knee joint constitute a major source of morbidity in patients attending orthopaedic outpatients department of our hospital. It includes a group of disorders due to disruption of normal functioning of ligaments and menisci of knee joint leading to persistent or intermittent signs and symptoms such as pain, instability, or abnormal mobility of the knee. MRI would be a noninvasive, nonoperator dependent effective modality for early detection of these pathologies and has very high negative predictive value. Material and Methods: The study was carried out over a period of one year. Fifty patients with clinically suspected internal derangement of knee were included in this prospective study. They were evaluated with detailed clinical history and clinical examinations and were subsequently subjected to imaging of knee using 1.5 T HDxt 8 Channel GE MRI machine. Conclusion: MR is an excellent tool for evaluation of ligaments, menisci and osseous structures of knee joint. Various clinical tests and appropriate clinical history complements MR examination. Similarly MR imaging of knee complements therapeutic arthroscopies and would greatly reduce the need of diagnostic arthroscopies. Thus MR is a non- invasive, painless and morbidity-free modality for accurate preoperative assessment that is well accepted by patients.

Background: In human body there are many causes of the injuries. Among all the injuries head injury is also one of the most important injuries which may cause morbidity and mortality. Craniocerebral injuries or Traumatic brain injury (TBI) is defined as any structural skull traumatic injury with alterations of cerebral physiology as a result of an external force either in the form of chemical energy, mechanical energy, electrical energy or thermal heating. Globally craniocerebral injuries or Traumatic brain injury (TBI)is cause of disability in young patients, especially those <40 years of age. TBI is classified as mild, with most showing adequate and quick recovery. Nevertheless there are some kinds of TBI which showed persistent disabling symptoms that interrupt with their normal daily routine activities. Brain imaging is very important for the patients who suffer traumatic brain injury. In the emergency services Computed tomography (CT) is recommended as first assessment that provides initial information and diagnosis to identify the need of surgery. It also helps in the following of the patient and the evolution of pathology. Many studies suggest that CT can be used to predict patient outcomes. Computed tomography (CT) is an imaging technique which uses as dynamics of injected contrast material, allows rapid quantitative and qualitative evaluation of cerebral perfusion by generating cerebral blood volume (CBV), cerebral blood flow (CBF) and mean transit time (MTT) maps providing clinically important information with stroke subarachnoid hemorrhage (SAH)and head injury. Aim: The main aim of this study is to evaluate the computed tomography findings sustaining head injury and role of computed tomography scan in head injury. Material and Methods: During the study total 90 patients with head injury were included with different age group from 20 to 70 years old. Glasgow coma score (GCS) range 4–15 (mild head injury: GCS >14; moderate head injury: GCS = 9–13; severe head injury GCS <8) were also included in this study. For all the patients with head injury Computed tomography (CT) image were performed with siemen’s somatom spirit dual slice spiral CT machine and a protocol of contiguous axial 5-mm sections through the posterior fossa and a contiguous 10 mm axial sequential scans for the rest of the brain and thinner cuts were also taken whenever required. For visualize any fractures of the skull bone algorithms with wide window settings were studied. After initial resuscitation, severity of the cranio-cerebral trauma was graded with the help of Glasgow Coma Scale (GCS) into mild head injury (GCS13- 15), moderate head injury (GCS 9-12) and severe head injury (GCS 3-8). Conclusion: This study concludes that use of CT in head trauma can finds high prevalence of head trauma related to CT. Therefore CT should be done when clinically necessary that helps to reduce cost and avoids unnecessary exposure to radiation.

Background: Spirituality is a theme of religion and philosophy, which are Humanities and work on empirical principals. Psychology and psychiatry are developed from philosophy but have scientific attitude. Patient care is a complex issue and needs conversion of both of these principles. Aim: We made an attempt to evaluate that use of spirituality principles in patient’s treatment is helpful or not. Material and Methods: Total 510 patients were evaluated. Study group of 260 patients were given spiritual consideration in standard treatment and control group of 250 patients were only given standard treatment. World Health Organization Quality of Life (WHOQOL)-BREF raw score were compared using student t test. Results: We found that there was significantly more improvement in study group as compared to control group in terms of World Health Organization Quality of Life (WHOQOL)-BREF score. Conclusion: We arrived at the conclusion that spiritual consideration gives added improvement in treatment of psychiatric illnesses. We should not ignore spiritual beliefs of patients.

Background and Objectives: During the past decade, there has been some progress in the pharmacotherapy of schizophrenia and schizoaffective disorder. Aripiprazole is recommended at a dose of between 10 and 15 mg/day in the treatment of schizophrenia, with a dose range considered to be effective, between 10 and 30 mg/day.  To study the efficacy and safety of Aripiprazole in low doses of 15 mg versus high doses of 30 mg in the treatment of Schizophrenia. Methods: Total 60 new and old patients (who are not on any treatment) between 18-60 years of either gender who meet the diagnostic criteria as per DSM-IV classification for schizophrenia and schizoaffective disorder. Patients were randomly divided into 2 groups on single blind study criteria. Group-I: Aripiprazole 15 mg once a day, morning dose for 6 weeks. Group-II: Aripiprazole 30 mg once a day, morning dose for 6 weeks. Efficacy assessment included at baseline and at 6 weeks end study scoring on PANSS, EPRS and CGI. Results: In both the groups aripiprazole showed the efficacy by improving the number of patients. In group-I, 20 patients has shown the improvement in overall scores of all scales. In group-II, 16 patients have shown the improvement in overall scores in different scales. Conclusions: Aripiprazole is effective in schizophrenia and schizoaffective disorder, low doses of 15 mg is equally effective as high dose of 30 mg.

Background: The study was performed at the Department of Pharmacology in collaboration with Department of Psychiatry, at DMCH Darbhanga. The maximum numbers of patients in were in reproductive age group that is in between 20 to 49 years. The mean age in Amisulpride group was 33.26(±10.23) years while in Olanzapine group it was 31.25 (±12.22) years. Schizophrenia was more common (80%) in younger (20-49years) age group. In our study the male /female ratio was 1.7. Our study supports the notion that Schizophrenia is more common in Married and Urban population. Only one patient from Olanzapine Group suffered Extrapyramidal symptoms of moderate severity requiring withdrawal from study.2 patients from Olanzapine group and 1 patient from Amisulpride group had Tremors and Akathesia of mild severity. There was no emergence of Extrapyramidal symptoms in rest of the patients (p>.05) Only one patient from Olanzapine Group suffered Extrapyramidal symptoms of moderate severity requiring withdrawal from study.2 patients from Olanzapine group and 1 patient from Amisulpride group had Tremors and Akathesia of mild severity. There was no emergence of Extrapyramidal symptoms in rest of the patients (p>.05)

Background: Depression is a condition characterized by state of aversion to activity and low mood. It can affect a person’s sense of wellbeing, feelings, motivation, thoughts and behavior. Materials & Methods: The present observational, cross-sectional study was conducted on 120 caretakers of patients suffering depression. Sociodemographic characteristics like age, address, sex, religion, occupation, type of family, education, relation with patient etc were studied. Results: Majority of the caretakers i.e. 46.7% were above 46 years, 60.8% were females whereas 39.2% were males. 52.5% caretakers were from rural background, 60% were Hindus, 76.7% were married, 62.5% were from joint families, 56.7% were illiterate and 60% were unemployed. Maximum percentage of caretakers i.e. 45.9% were parents while majority i.e. 59.2% belongs to lower socioeconomic class. Conclusion: From present study we conclude that majority of the caretakers of the patients suffering from depression were females, above 46 years of age with rural background, living in joint families, illiterate, unemployed and belongs to low socioeconomic class. So it is suggested that service providers, researchers, policy makers and planers should address the issues of these caretakers carefully so that the prognosis of depressive disorder can be improved.

Background and Objectives:  Medical methods emerged as an alternative to surgical abortion with the discovery of prostaglandins in the early1930. Nearly 20% of all confirmed pregnancies end in spontaneous abortion. Misoprostol’s use in early pregnancy for termination of Pregnancy its success. And failure is varied the dose and route are not well established. Studies evaluating different regimens, including combination mifepristone and misoprostol and alone regimens, show varying results related to safety, efficacy and other outcome. To study the efficacy of sublingual misoprostol in causing expulsion of products of conception in early pregnancy failure. Material and Methods: Women with an ultrasound diagnosis of early pregnancy failure, less than 12 weeks gestation were included in the study. Tablet Misoprostol 600 mcg was given six hourly sublingually for 3 doses. All observations were noted and analyzed. This study was carried out NMCH Patna. Study duration One year. Conclusion: The regime had 92.85% efficacy, acceptability (90%) and few side effects. Systemic review we find that medical methods of abortion utilizing combination mifepristone and misoprostol or misoprostol alone are effective, safe and acceptable.

Background: Chronic Perennial Allergic Rhinitis (PAR) reduces children’s quality of life. Conventional treatment includes intranasal corticosteroids, but subjective symptom evaluation makes maximising their efficacy difficult. Nasal eosinophilia, a marker of allergic inflammation, has demonstrated potential as a therapeutic metric. Method: This retrospective study included 100 PAR-treated children on intranasal topical steroids. The investigation started with nasal smears to evaluate eosinophilia. This was compared to quality of life and symptom scores after treatment. We examined the relationship between eosinophilia and therapeutic efficacy using regression and correlation. Results: Patients averaged 8.2 years old (SD=2.5) and were 55% female and 45% male. Nasal eosinophilia began with an average of 18.5 cells/µL (SD = 7.4). The average nasal eosinophilia fell to 12.8 cells/µL (SD = 6.2) after the first test. After therapy, quality of life increased 24.5 points (SD=5.6) and mean symptom score reduced from 7.4 (SD=1.8) to 3.2 (SD=1.5). A substantial inverse connection (r = -0.68, p < 0.001) was seen between initial nasal eosinophilia levels and post-treatment symptom severity. This shows that higher eosinophilia levels caused worse initial symptoms but improved treatment recovery. For symptom relief, patients with greater baseline eosinophilia levels needed a larger dose of intranasal corticosteroids (200 µg/day, SD = 50) than those with lower levels (150 µg/day, SD = 40. Conclusion: Quantitative nasal eosinophilia screening helps optimise intranasal corticosteroid therapy for children with persistent allergic rhinitis. As an objective index of inflammation, nasal eosinophilia may improve therapeutic results and allow for more personalised treatment plans. Prospective and multi-center investigations should confirm these findings and study how eosinophilia testing might be used in clinical practice.

Background: Hospital-Acquired nosocomial Infections (HAIs) increase patients’ risk of sickness, mortality, and healthcare system costs. Common healthcare-associated ailments include pneumonia, UTIs, surgical site infections, and bloodstream infections. A major public health and infection control challenge, these illnesses frequently appear 48 hours or more after admission. Method: A retrospective cohort study examined nosocomial infection patterns over time. All hospitalised nosocomial infections were studied. Patient demographics, pathogen types, antibiotic resistance patterns, and ailment categories were studied. Statistical analysis included logistic regression models, descriptive statistics, and trend analysis. Result: NOS infections were 15%, with surgical sites (35%), urinary tracts (25%), bloodstreams (20%), and pneumonia (20%) being the most common. The most common infectious agents were 60% Gram-negative bacteria, 25% Gram-positive bacteria, and 20% fungi. Gram-negative bacteria were resistant to third-generation cephalosporins and fluoroquinolones. Methicillin-resistant Staphylococcus aureus caused 15% of surgical site infections. Nosocomial infection patients stayed 10 days on average, compared to 5 days for non-infected patients. Conclusion: Nosocomial infections regularly strain healthcare systems. In the study, antibiotic resistance and Gram-negative bacteria are common. Effective infection prevention and control requires infection control measures, real-time monitoring, and antibiotic stewardship. Future research should examine new infection prevention approaches, viruses, and their resistance mechanisms.

Background: Global public health is under pressure by food-borne diseases, which cause countless illnesses and deaths. Food bacteria and viruses include Salmonella, E. coli O157, Listeria, Norovirus, and Campylobacter. Control and prevention require epidemiology and trends knowledge. Method: Over a decade, longitudinal observational investigations of these disorders have shown new food poisoning trends and continued concerns. This retrospective observational study assessed foodborne pathogen trends from 2010 to 2020 using 100 samples. Data from pathogen labs, public health databases, and medical records. Comparative statistics and descriptive statistics revealed distribution, frequency, and trends. Result: The study revealed substantial increases in the prevalence of Salmonella spp. (+50%) and Campylobacter spp. (+50%), while E. coli O157 and Listeria monocytogenes, respectively, experienced moderate increases of +25% and +20%. Conclusion: Based on the results, public health initiatives to reduce food-borne virus effect must be continuously evaluated. Science-based food safety laws are the best way to protect public health and reduce food poisoning.

Background: Fine Needle Aspiration Cytology (FNAC) is vital for breast cancer detection. Cytological analysis distinguishes benign and malignant tumours. For clinical management decisions, FNAC provides fast, affordable, reliable diagnostic data. For modern breast cancer diagnosis, it encourages early treatment and reduces unnecessary surgery. Methods: A cross-sectional study of 50 clinic-visited women with palpable breast tumours was conducted. Conventional FNAC methods and cytological samples were used to assess breast lesion detection sensitivity, specificity, and accuracy. Additionally, demographics and clinical features were recorded. Results: Diagnostic accuracy, sensitivity, and specificity were 88%, 86.7, and 93.3 for FNAC. Although 60% of lesions were benign and 28% cancerous, 12% were suspicious or ambiguous. FNAC generated many false-positive and false-negative results, although it could identify benign and malignant tumours from histology. Conclusion: FNAC accurately diagnoses palpable breast masses and supports clinical decision-making. This study suggests including FNAC in standard diagnostic algorithms to speed up therapy based on reliable cytological data and reduce unnecessary surgery.

Background: COVID-19, caused by SARS-CoV-2, presents a wide range of clinical severities, from mild symptoms to critical illness. Identifying prognostic markers is essential for effective patient management. Emerging evidence suggests that blood glucose levels may correlate with COVID-19 severity. This study examined the correlation between blood glucose levels and clinical severity in COVID-19 patients and evaluated its prognostic importance. Methods: A cross-sectional study was carried out, involving 80 COVID-19 positive patients. Blood glucose levels were measured upon admission, and clinical severity was categorized as mild, moderate, severe, or critical. Data were examined using SPSS version 21.0. Results: The study revealed a considerable positive correlation between blood glucose levels and clinical severity (r = 0.65, p < 0.001). Mean blood glucose levels were 110.4 ± 15.3 mg/dL for mild cases, 125.6 ± 18.7 mg/dL for moderate cases, 160.3 ± 22.1 mg/dL for severe cases, and 180.7 ± 25.4 mg/dL for critical cases. Hyperglycemia was prevalent in severe (50%) and critical (53.3%) cases, while hypoglycemia was rare (6.3%). Conclusion: Increased COVID-19 clinical severity was substantially correlated with elevated blood glucose levels. In COVID-19 patients, blood glucose monitoring and management may enhance clinical results and lower the risk of serious consequences. Recommendations: It is advised that more studies be done to investigate the processes underlying the correlation between COVID-19 severity and hyperglycemia. In order to enhance prognosis, healthcare providers should think about routinely monitoring and managing blood glucose levels in COVID-19 patients.

Background: Prehypertension is a significant risk factor for both hypertension and cardiovascular disorders. It is characterised by a systolic blood pressure of 120–139 mm Hg or a diastolic blood pressure of 80–89 mm Hg. Prehypertension is very common in medical students because of their stressful academic environment. This study seeks to determine the cardiovascular risk factors linked to prehypertension and its incidence among medical students. Methods: One hundred fifty medical students participated in a cross-sectional study. Blood pressure, body mass index, smoking status, and family history of cardiovascular disease were noted for each participant. A regular procedure was followed in order to assess blood pressure. Using SPSS version 21.0, the data were analysed. Significant prehypertensive predictors were found using logistic regression, and descriptive statistics were used to summarise the data. Results: The incidence of prehypertension was found to be 30%, with 10% of students classified as hypertensive. Higher BMI, smoking, and family history of cardiovascular diseases were significantly associated with prehypertension. Logistic regression analysis revealed that BMI, smoking, and family history of cardiovascular diseases were independent predictors of prehypertension. Conclusion: A substantial proportion of medical students were found to have prehypertension, highlighting the need for regular health monitoring and early intervention. Addressing modifiable risk factors such as BMI and smoking is crucial for preventing the progression to hypertension and improving cardiovascular health in this population. Recommendations: Regular health screenings, promoting healthy lifestyles, and targeted interventions are recommended to manage and mitigate risk factors for prehypertension among medical students. Institutions should implement wellness programs to support the health and well-being of their students.

Background: Intertrochanteric fractures are common in the ageing population and are typically treated using proximal femoral nailing (PFN). Achieving optimal alignment, particularly varus correction, is crucial for suc-cessful outcomes. The use of a pre-fixation compression screw presents a novel technique in this context. Aim: This study aims to evaluate the efficacy and products of using a pre-fixation compression screw for varus correction during PFN in patients with intertrochanteric fractures. Methods: In a retrospective study conducted at Darbhanga Medical College, 100 patients with intertrochanteric fractures were treated using proximal femoral nailing with a pre-fixation compression screw. The study aimed to evaluate the effectiveness of this innovative technique for varus correction. Data were collected on patient de-mographics, preoperative and postoperative neck shaft angles, intraoperative blood loss, surgery duration, and postoperative complications. Statistical analysis was performed using SPSS version 21.0. Results: The results showed a noteworthy improvement in varus correction, with the neck shaft angle increasing from 121.6 degrees preoperatively to 135.6 degrees postoperatively. The technique did not significantly increase intraoperative blood loss (average 34.67 ml) or surgery duration (average 19.46 minutes). The overall complica-tion rate was low at 10%, with the most common issues being superficial wound infections. These findings suggest that the pre-fixation compression screw is an effective and safe method for correcting varus deformity in intertrochanteric fractures. Conclusion: The pre-fixation compression screw technique offers improved varus correction and alignment in PFN for intertrochanteric fractures without significantly increasing operative time or blood loss. This technique also promotes faster healing times. Recommendations: Future studies should focus on larger sample sizes and randomized controlled trials to fur-ther validate the benefits of the pre-fixation compression screw technique. Additionally, long-term follow-up is recommended to assess the durability of outcomes.

Background: Thyroid disorders and diabetes mellitus are two common endocrine disorders that are commonly encountered in clinical practice. The relationship between thyroid disease and diabetes is important for physicians to understand in order to provide the best treatment for both conditions. The aim of this study was to assess thyroid function in Type2 Diabetes Mellitus patients of malwa region and raise awareness about thyroid dysfunction in newly diagnosed T2DM patients. Methods: In this case control study, a total of 200 subjects were chosen. Group I consisted of 100 diagnosed type 2 diabetes cases and Group II 100 sex matched stable controls. After receiving informed consent, patients were enrolled. Thyroid dysfunction in Type2 diabetes mellitus was assessed using biochemical parameters such as fasting plasma glucose, total triiodothyronine T3, total thyroxine T4, and thyroid stimulating hormone (TSH). Results: When diabetic patients were compared to healthy controls, their fasting blood glucose and serum TSH levels were substantially higher. In these two classes, however, there was no substantial difference in serum T3 and T4 levels. The findings suggest that diabetic patients have subclinical hypothyroidism as opposed to the control group in the study population. Conclusion: From this current study it has been observed that thyroid function levels were altered in Diabetes mellitus patients, especially TSH levels. so it is suggested that diabetes mellitus patients should be screened for thyroid function studies on a regular basis to prevent further complications of thyroid dysfuction.

Background: The research emphasises on the association bond of Serum Albumin Level used as a marker for diagnosis of Persistent Organ Failure in Acute Pancreatitis. Material and Methods: The samples for the study were collected from the central lab, out-patient department and in-patient department of Department of Biochemistry, adult patients suffering from Acute Pancreatitis, The research was carried out on a total of 100 patients for 1 year which were satisfying Atlanta criteria for Acute Pancreatitis will be diagnosed based on the following symptoms; elevated serum amylase, and lipase levels, that is greater than the normal limit, findings associated with the characteristics of the radiological findings. Also, with the abdominal computerized ultrasonography and tomography. Results: In the present research, albumin always descends obviously in AP patients with POF (p < 0.05). The AUC under ROC line is 0.869. Albumin has been proved as an excellent marker of POF in AP. However, no previous study has researched into the association between albumin and incidence of POF in AP. Therefore, this study is the first time to show that the reduction of serum albumin is significantly associated with increased risk of POF in AP. Conclusion: Thus it can be concluded that serum albumin on admission is independently associated with POF in AP. The study suggests that albumin is a valuable tool for a rapid assessment of POF in patients with AP.

Background: After obtaining approval from institutional ethics committee, and written informed  consent, the present study entitled “To Observe the Effect of Oral Gabapentin, Theophylline and Caffeine on SBP, DBP, MAP and HR” was conducted on 120 patients of ASA grade I &II scheduled for elective and emergency lower segment caesarean section under spinal anesthesia in the Department of Anesthesiology,  at ANNMCH Gaya, Bihar Study duration Period May 2020 To April 2021. after getting written informed consent from the patients. Conclusion: No significant effects on haemodynamic parameters were observed with all the study drugs. Recurrence of PDPH was significantly high with caffeine treatment. No serious untoward effects or complications of study drugs were observed in the study.

Background and Objectives: Chronic Obstructive Pulmonary Disease (COPD) includes persistent bronchitis and emphysema, which is generally caused due to smoking of tobacco. (COPD) is an obstructive lung disorder characterized by airflow limitation that is progressive, associated with severe inflammatory response in the air passages and the lungs due to toxic particles. It interferes with normal breathing and is not fully reversible.  Objective of the present study was to estimate lipid profile (Total cholesterol (TCH), Triglycerides (TG), High density lipoprotein (HDL), Low density lipoprotein (LDL), Very low-density lipoprotein (VLDL)) in patients with Chronic Obstructive Pulmonary and to find correlation of these parameters with severity of disease. Material and Method: The study was conducted in Department of Biochemistry in collaboration with Department of Respiratory Medicine at GMCH, Purnea. Thirty-two patients diagnosed with COPD were selected from OPD and ward of Respiratory Medicine and thirty-two age and sex matched controls were included. Conclusion: We conclude that smoking significantly affect lipid profile in COPD patients, as it increases LDL, TCH levels and decreases HDL levels. Hence all patients with COPD patients who are smoker’s needs to check their lipid profile. COPD is considered as systemic disease with various co morbidities, which may affect the lipid profile. This finding may aid new interest in management of COPD.

Background and Objectives: Thyroid hormones are required for normal development as well as regulating metabolism in the adult. A decreased thyroid hormone adversely affects erythropoietic system causes anemia. Our objective was to assess the relationship between serum vitamin B12 levels and thyroid function in anemic pregnant women.  The Aim and objective of the study was to compare the vitamin B12 with thyroid hormones in anemic pregnant women. Materials & Methods: Study consisted of 50 subjects from OPD/ GMCH, Purnea.  The study groups were divided into Group I-25 anemic pregnant women and Group II-25 Non – anemic pregnant women. The serum samples were collected from each subject and levels of different biochemical parameters were estimated. Result: were noted. On comparing values in vitamin B ₁₂ and thyroid hormones , among two groups, a significant difference (p<0.005) was found between few of them. Conclusion: Screening of vitamin B12 levels in first trimester itself will be beneficial to prevent the complications of pregnancy. Further, hypothyroidism also present. So, early diagnosis of these deficiencies will be useful to start giving supplements to avoid unwanted effects in pregnancy.

Background: An adjuvant to a local anaesthetic can potentiate spinal anesthesia and provide better postoperative analgesia. Our study has been drafted to evaluate and compare the analgesic potency of the adjuvants, buprenorphine and magnesium, to intrathecal 0.5% hyperbaric bupivacaine. Methods: One hundred and fifty patients by inclusion criteria posted for an elective lower abdominal surgery were randomized into three groups of 50 each. They received 3ml of 0.5% hyperbaric bupivacaine with either 1ml of 0.9% Saline or 1ml of buprenorphine (60μg) or 1ml of magnesium sulphate (50mg). Time for first rescue analgesia, onset of sensory and motor blocks, time to two-segment regression and duration of motor block, haemodynamic parameters, and side effects were studied. Data was analyzed with ANOVA, Kruskal-Wallis H, Chi-square and Fischer’s exact tests. Our Study was carried out from April 2020 to March 2021. Results: The time for first analgesic request was 248.70> 186.84> 141.44 minutes, (Buprenorphine> magnesium> control), p<0.001. The onset of sensory and motor blocks was faster in buprenorphine group compared to magnesium and control groups. The time to two-segment regression and duration of motor block was significantly prolonged in buprenorphine and magnesium groups compared to control group. Conclusion: The time to first analgesic request was longer with buprenorphine compared to magnesium sulphate with adequate sedation and negligible complications. Hence, addition of adjuvant buprenorphine (60μg) has a better demonstrable role in postoperative analgesia compared to adjuvant magnesium (50mg) or 0.5% hyperbaric bupivacaine alone.

Background: ACS refers to a spectrum of clinical presentations including Unstable Angina (USA), Non ST Elevated Myocardial Infarction (NSTEMI) and ST Elevated Myocardial Infarction (STEMI). To study ECG finding of patients of ACS aged < 45 years admitted in CCU of Department of General Medicine. Methods: The hospital based observational study was carried out in patients of ACS aged < 45 years, admitted to Cardiac Care Unit (CCU) of Department of General Medicine, at GMCH, Bettiah. Study duration is One years. Results: T wave inversion in most leads was commonest ECG finding present in 36(72%) of patients.   was present in 32(64%) patients, ST elevation in 28(56%) patients and Q waves were seen in 11(22%) patients. Out of 50 patients, 39 had normal heart rate, 6 had bradycardia and 5 patients had tachycardia. Out of 6 patients with bradycardia 3 had STEMI, 1 had NSTEMI and 2 had USA. Out of 5 patients with tachycardia, 2 had STEMI and 3 had NSTEMI. Conclusion: In ACS in young, T wave inversion was most common finding.

Background & Method: Present Study was done with an aim to find out Etiology and clinical profile of patients of Acute Kidney Injury at Tertiary Care Centre of Bettiah. After taking institutional ethical clearance and written consent from the patients a cross sectional observational study was conducted on 100 Patients admitted in Intensive Care Unit of GMCH, Bettiah. who have clinical and / or biochemical evidence of acute kidney injury, detailed thorough history taking, general physical examination, systemic examination and routine and specific lab investigations, were done to find out the underlying etiology, clinical features and outcome of Acute Kidney Injury. Result: This study includes various etiology of acute kidney injury in the current study. Most common cause being AGE (30%) followed by septicemia (16%) and poisoning (14%). In present study 75 % of cases were of Pre Renal AKI. Post Renal and Renal AKI was present in 13% and 12% respectively. Conclusion: The variety of clinical features were recorded and studied, the most commonly observed clinical feature was oliguria closely followed by malaise and vomiting in acute kidney injury. Acute gastrointestinal infection was the most common cause of acute kidney injury. Other frequent causes were septicemia, poisoning, multi organ dysfunction syndrome.

Background: Snake Bite is a life-threatening medical emergency & major public health issue throughout the world and especially in tropical countries like India. Snake bite which is a substantial cause of death in rural areas of developing countries, is a neglected public health problem. Methods: The study include the patient of snake bite who is admitted in department of General medicine of GMCH Bettiah. Patients were enrolled after obtaining an informed consent and meeting inclusion criteria. Results: Maximum number of the cases did not receive any first aid and ASV& Pain killer was the most common component of the first aid. Two third of the cases were bitten by Viper snakes while one third by Cobra and Krait collectively. ASV dose was given as per the case response and in ASV dose of 30-50 VIAL was injected in majority of the victims (38.56). 30-50 VIAL was injected in majority of the victims. At time of hospital admission WBCT is normal in 52 patients (33.09%) while 101 patients had WBCT more than 20 min. Conclusion: Snakebite, an important occupational hazard, though preventable in principle remains to be one of the common medical emergencies. Primary prevention by imparting information regarding quick transport, correct first aid measures and training of primary level health workers can drastically bring down the mortality of this neglected tropical disease.

Background & Method: All patients admitted in Respiratory Medicine ward of GMCH, Bettiah. with diagnosis of Acute Exacerbation of COPD. Study will be conducted on 86 patients of acute exacerbation of COPD from the Department of TB and Chest at GMCH, Bettiah. and 20 age- sex matched healthy community control. Result: The mean age of 86 patients diagnosed with acute exacerbation of COPD and fulfilled all inclusion criteria (Cases) was 60.7 ± 11.5 and mean age in the Healthy control group was 59.75 ± 6.65. The difference was found to be statistically not significant with a P-value of 0.735. The mean Serum Sodium of Patients in the Case Group was 128.85 ± 3.17 and that of the control group was 138.81 ± 1.69. The mean Serum Potassium of Patients in the Case Group was 3.293 ± 0.684 and that of the control group was 4.191 ± 0.272. The mean FEV1 of Patients in the Case Group was 51.8 ± 10.2 and that of the control group was 87.30 ± 4.96. Conclusion: Electrolyte imbalances are quiet common during acute exacerbations of COPD Routine Serum electrolytes should be done in all patients admitted with acute exacerbation of COPD and should be corrected if necessary. Routine screening for electrolyte imbalances and correction are very necessary as it reduces the quality of life, increases exacerbations following one year and even may cause mortality.

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory rheumatologic disease that can affect several organs such as skin, joints, and kidneys. One of the organs reported to be involved in SLE is the heart. It is a multiorgan autoimmune disease associated with high cardiovascular morbidity and mortality that primarily affects young women. Cardiac diseases in lupus may involve the endocardium, myocardium, and pericardium and may be responsible for fatal outcome. Some cardiovascular abnormalities are seen with positive anti Ro/SS-A, anti La/SS-B, anticardiolipin (aCL), and anti-double- stranded DNA (antids DNA). Moreover, endothelial dysfunction was reported in early SLE cases without CVDs which was mostly not related to a CL antibody, disease activity, or disease duration but rather related to renal disease, diastolic hypertension, and diabetes in SLE. The aim of this study is to assess the cardiac function in systemic lupus erythematosus by 2D echocardiography. Material and Method: This was a cross-sectional, observational type of study done in one year duration, Study was done in General medicine OPD, Rheumatology OPD and ward of Department of Medicine, GMCH, Bettiah. Conclusion: SLE patients had an increased prevalence of subclinical systolic and diastolic LV and RV dysfunction. This result advocates for regular follow-up and early screening of SLE patients. Accordingly, treatment focused on improving diastolic heart function may have a role in enhancing QoL and improving the prognosis of SLE patients.

Background and Objectives: The endometrial scratching is a simple, practical, cost- effective procedure which can be done in an OPD (Outpatient Department) setting, if proven effective in improving clinical pregnancy rates in previous 1-3 failed IUI cycles, then it can be offered before more advanced and expensive IVF procedure. To analyse the effect of endometrial scratching on pregnancy rates in previously failed IUI cycles. Methods: Randomized control study conducted on Couples attending the Infertility Clinic, Obstetrics & Gynaecology Department, PMCH, Patna. and requiring repeat IUI were recruited for the study from April 2018 to November 2019. Results: women in which IUI failed two times positive results after scratching was present in 16.15% cases followed by 6.92% positive results in women who had three times IUI failed and women who had only one-time IUI failed positive results was present in 4.62% cases. In controls we found positive results with 5.38% in women having one-time IUI failed followed by 3.85% in women where two-time IUI failed and only in 2.31% women positive results found having three-time IUI failed. Conclusion: In conclusion this study demonstrates 2.5-3-fold increase in pregnancy rates after scratch, endometrial scratching can be a preferred option in patients with previous failed IUI cycles before opting for expensive IVF treatment.

Background: Post-surgery wound infections are dominated by multidrug-resistant and biofilm-forming Pseudomonas aeruginosa. To handle these infections in surgical settings, one must understand their occurrence, antibiotic resistance trends, and clinical implications. Methods: This retrospective study evaluated electronic medical records and laboratory databases from November 2021 to October 2023 at Tertiary Care Hospital. Pseudomonas aeruginosa-related surgical wound infections were examined in 150 cases. Data collection focused on microbiological (culture results, antibiotic susceptibility profiles), clinical (surgery type, wound aspects), and demographic variables (age, sex, comorbidities). The statistical analysis employed descriptive statistics to report prevalence and antibiotic resistance. Inferential methods like chi-square testing and logistic regression examined variable relationships. Results: The study found 26.7% of post-operative wound infections were Pseudomonas aeruginosa. Antimicrobial sensitivity testing showed 40% resistance to Ciprofloxacin and 35% to Ceftazidime, and 25% resistance to Meropenem. People with comorbidities like hypertension (43.3%) and men (56.7%) were more affected than women. According to wound features, abdominal procedures had 35% higher infection rates than orthopaedic surgery (22%). Conclusion: As this study demonstrates that Pseudomonas aeruginosa causes most wound infections following surgery at Tertiary Care Hospital, individualised antimicrobial stewardship initiatives are needed. The findings suggest local surveillance is needed to improve empirical treatment and decrease antibiotic resistance. Future molecular epidemiology studies should study new therapy techniques and resistance mechanisms to improve patient outcomes.

Aim: The study aimed to determine and compare pocket depths (PD), relative attachment levels (RAL), bleed-ing on probing (BOP), and plaque indices (PI) in patients treated with scaling and root planning (SRP) alone versus SRP combined with diode laser therapy. Materials and Methods: The study involved 30 subjects who met the inclusion and exclusion criteria. Group I consisted of 15 patients treated with SRP and diode laser irradiation, while Group II included 15 patients treated only with SRP. Clinical parameters, including PD, RAL, BOP, and PI, were recorded at baseline, 7 days, and 1 month. Statistical analysis was conducted using the Kolmogorov-Smirnov test, Shapiro-Wilk test, t-test, and chi-square test. Results: The addition of diode lasers to SRP during the maintenance phase showed better results compared to SRP alone. Moderate periodontal pockets with moderate attachment loss significantly improved in Group I compared to Group II. However, there was no change in deep pockets with severe attachment loss in either group. Clinical Significance: The study demonstrates that using the specified laser parameters and application modali-ty results in faster healing. Therefore, this treatment can be recommended for moderate periodontal pockets.

Background: Sudden Sensorineural Hearing Loss (SSNHL) is a severe clinical challenge that frequently lacks an etiology. After multiple intratympanic injections and corticosteroids, results are still uncertain, so we need to determine what predicts a good prognosis and how to manage it. Methods: From April 2023 to March 2024, 80 patients from Nalanda Medical College and Hospital SSNHL were included in this retrospective cohort research. Demographic factors included age, gender, and comorbidities. Imaging and audiometric results were analyzed for diagnosis. Recovery rates were our main treatment outcome indicator, and statistical analysis identified predicted factors about treatment responses. Results: The mean age was 45.2 years, most participants were male (56.3%), and 31.3%, 37.5%, and 31.3% had mild, moderate, or severe hearing loss at baseline. Audiometric evaluations revealed high-frequency loss in 70%, unilateral SSNHL in 80%, and retrocochlear disease in 15%. Patients received oral corticosteroids 60.0% and intratympanic injections 30.0%. The former recovered 75.0%, the later 65.0%. Age >50 and initial hearing loss severity predicted treatment response. Conclusion: This study highlights SSNHL heterogeneity, early intervention, and personalized treatment. The findings emphasize the need for patient-specific therapy to improve clinical outcomes. Future research should use cutting-edge diagnostic technologies and study potential therapies in prospective trials with larger cohorts to corroborate these findings and enhance treatment guidelines.

Background: Evidence suggests maternal obesity is a global risk factor for pregnancy and neonatal outcomes. Labour complications, gestational diabetes, and hypertension in obese women can harm newborn health. These linkages must be understood to improve maternal health throughout pregnancy and develop appropriate preventive measures. Methods: This study examined data from July 2023 to April 2024, including 60 pregnant women with a BMI of 30 kg/m² or above before pregnancy. Electronic medical records were used to assess demographics, medical history, pregnancy issues (such as gestational diabetes or hypertensive disorders), delivery outcomes, and neonatal outcomes (such as birth weight, Apgar scores, NICU admissions, or congenital abnormalities). Statisticians used descriptive statistics and comparison tests. Results: Overweight mothers had more hypertension issues (30%), caesarean deliveries (41.7%), and gestational diabetes (25%). Birth weight for babies born to overweight mothers averaged 3,550 grammes, and 20% required neonatal critical care. The average Apgar score at 5 minutes was 8.2, indicating good newborn adaptation. Birth defects affected 6.7% of newborns. Conclusion: The study emphasises early intervention and comprehensive prenatal care to address maternal obesity and its consequences on pregnancy and newborn outcomes. Optimising maternal metabolic health and perinatal outcomes includes addressing obesity before and during pregnancy. Health professionals can minimise maternal obesity and enhance birth outcomes by increasing prenatal screenings and using evidence-based interventions.

Background: Effective postoperative pain management improves joint replacement results and patient satisfaction. Pain management options for this population have not been extensively investigated for efficacy and safety. Joint replacement patients at Patna Medical College and Hospital will have their postoperative pain scores, pain management strategies, and complications investigated in this retrospective study. Method: Between August 2023 and Feb 2024, 57 people got joint replacements. They all underwent retrospective investigation. Pain scores, adverse events, and treatment methods were collected from electronic medical data. Results were summarised using descriptive statistics. Result: Opioids were the most commonly used painkiller (73.7%), and 54.4% of patients had total knee arthroplasty. Post-surgery pain scores decreased from 7.2 ± 1.5 on day 1 to 2.1 ± 0.7 on day 7. Constipation (26.3%) and nausea (21.1%) were typical side effects. The study’s retrospective design and single-center location are limitations, but its extensive investigation of real-world pain management methods is strong. Conclusion: Joint replacement operations typically employ opioids, but this study showed that multimodal pain treatment is effective. Adverse occurrences show the importance of proactive management and constant monitoring, even as pain scores decrease over time. To improve patient outcomes, future research should focus on standardised pain assessment tools, interdisciplinary teamwork, and prospective trials evaluating pain management strategies’ efficacy and safety.

Background: Lumbar spine surgery relieves pain and restores function for spinal stenosis and degenerative disc disease patients. Unlike conventional fusion approaches, dynamic stabilisation devices maintain segmental mobility while stabilising the system. Dynamic stabilisation device efficacy and safety are assessed by functional and radiological evaluation. Method: From March 2022 to January 2024, Patna Medical College and Hospital undertook a retrospective cohort analysis. The study included 52 dynamic stabilisation device-affected lumbar spine surgery patients. We examined patient demographics, pre- and post-surgery functional performance, and radiological findings. Result: The patients had an average age of 56.4 ± 9.8 years, with 30 males and 22 females. Spinal stenosis (20), disc herniation (18), and spondylolisthesis (14), were the most prevalent diagnoses. The VAS score decreased from 7.8 ± 1.2 to 2.4 ± 0.9, while the Oswestry Disability Index improved from 54.2 ± 12.5 to 23.6 ± 7.3 post-op. Device integrity was maintained in 92.3% of fusions. Hardware failure (3.8%) and neighbouring segment illness (9.6%) were consequences. Conclusion: Dynamic stabilisation devices improved pain and function after spinal fusion surgery. High fusion rates and device integrity were found despite hardware failure and segment sickness. Functional and radiological evaluations are essential for patient care, clinical decision-making and dynamic stabilisation device evaluation.

Background: Total knee arthroplasty is a common surgery for advanced knee arthritis. The mechanical or kinematic alignment used during TKA greatly affects postoperative results. This retrospective study compared mechanical and kinematic alignment on radiographs and clinical outcomes after TKA. Methods: Patna Medical College and Hospital researchers examined 54 primary total knee arthroplasty patients from March 2022 to January 2024 for this study. The data came from clinical notes, radiographic reports, surgical logs, and electronic medical records. Demographics, preoperative examination, surgery, postoperative results, and radiographs were studied. Statistics were done with appropriate tests. Results: The tibial and femoral components matched well mechanically and kinematically. Mechanical alignment aligned femoral components slightly less effectively (2.0 ± 0.4 degrees) than kinematic alignment (2.1 ± 0.5 degrees). The kinematic alignment group had 92.6% neutral alignment, while the mechanical alignment group had 88.9%. Kinematic alignment improved knee society score and range of motion. Similar infection, instability, and implant loosening rates were seen in both groups. Conclusion: Mechanical and kinematic alignment achieved for TKA, according to this study. Both methods worked, but kinematic alignment was more precise and functional. These results indicate greater research and tailored treatment for TKA surgery outcomes.

Background: Neonatal septicemia, which increases neonatal mortality, remains a public health issue. The mother’s vaginal microbiome contributes to early neonatal septicemia. Staphylococcus aureus, Group B Streptococcus (GBS), anaerobes, E. coli, and others can colonise the mother’s vaginal canal and spread vertically during birth, putting neonatal at risk for serious infections. It is generally established that helpful bacteria like Lactobacillus species protect vaginal health and may reduce neonatal infections. Understanding mother’s vaginal microbiota and neonatal septicemia is essential for prevention and better newborn outcomes. Methods: This retrospective cohort research in a Bihar, India, tertiary care hospital included 150 newborns and their mothers. Early neonatal septicemia affected the neonatal. Standard microbiological methods were utilised to test pregnant women’s vaginal swabs during prenatal therapy. Mostly Staphylococcus aureus, anaerobes, E. coli, and Lactobacillus species were targeted. We obtained maternal demographics, clinical characteristics, and neonatal outcomes from medical records. Summary statistics summarised newborn and maternal microbiological features. Logistic regression and chi-square testing were used to evaluate if maternal microbial colonisation and neonatal septicemia were related. Results: Lactobacillus species were detected in 60% of maternal vaginal samples, indicating beneficial bacteria. Twenty samples indicated GBS colonisation and fifteen showed anaerobes. Staphylococcus aureus and E. coli had low prevalence rates of 2% and 3%, respectively. A substantial connection (p<0.05) exists between maternal colonisation with GBS and anaerobes and early-onset newborn septicemia. The presence of Lactobacillus species lowered the frequency of neonatal septicemia (p<0.05). Conclusion: This study emphasises the importance of the mother’s vaginal microbiota in predicting early neonatal septicemia. The findings suggest prenatal screening programmes to detect harmful bacteria profiles during pregnancy. This will enable for targeted interventions like probiotic supplementation or antimicrobial prophylaxis to prevent neonatal illnesses. Healthcare professionals’ emphasis on microbiologically informed maternal and neonatal healthcare methods may reduce neonatal septicemia and improve neonatal health outcomes.

Background: Vaccine hesitancy poses a significant challenge to global health by hindering vaccination efforts against preventable diseases. Factors contributing to hesitancy include concerns about vaccine safety, misinformation, and socio-cultural influences. Addressing these factors is crucial for improving vaccination rates and achieving public health goals. Aim: This study aimed to investigate the causes and consequences of vaccine hesitancy, and to evaluate strategies to enhance vaccination rates and public trust in vaccines among 100 participants at GMCH, Purnea. Methods: A mixed-methods approach was employed, involving 70 members of the general public and 30 healthcare professionals. Demographic data, vaccination attitudes, and hesitancy levels were collected through surveys and interviews. Chi-square tests examined associations between demographic variables (age, gender, education, vaccination status) and vaccine hesitancy. Logistic regression analysis identified predictors of hesitancy. Results: The study found that 28% of participants were vaccine-hesitant, with significantly higher hesitancy among the general public (36%) compared to healthcare professionals (10%). Chi-square tests revealed significant associations between vaccine hesitancy and age (p=0.049), education level (p=0.006), and vaccination status (p<0.001). Logistic regression indicated that younger age (OR=1.07, p=0.031), lower education (OR=0.23, p=0.033), and being unvaccinated or partially vaccinated (OR=0.12, p=0.002) were predictors of hesitancy. Conclusion: Vaccine hesitancy is influenced by demographic factors and vaccination status, underscoring the need for tailored interventions. Strategies should focus on targeted educational campaigns, enhancing accessibility to vaccines, and fostering trust in healthcare providers and public health authorities. Recommendations: The recommendation include implementation of robust educational initiatives to combat misinformation and address concerns about vaccine safety. Strengthen communication strategies to promote transparency and build public trust in vaccines. Enhance vaccine accessibility through community-based clinics and outreach programs. Engage healthcare professionals as advocates to address patient concerns and promote vaccination. Monitor and adapt strategies based on ongoing research and community feedback.

Background: Recurrent anterior instability of shoulder is a prevalent condition, especially among athletes, often requiring surgical intervention. Two main surgical approaches, open and arthroscopic, are commonly employed to address this issue. Aim: This study seeks to evaluate the clinical outcomes of open versus arthroscopic surgical techniques for treating recurrent anterior shoulder instability. Methods: A retrospective comparative study was led which included 50 patients with recurrent anterior instability of shoulder, divided equally between those undergoing arthroscopic and open surgeries. Inclusion criteria encompassed confirmed instability and no prior shoulder surgeries, while exclusion criteria included multidirectional instability and significant comorbidities. Data were gathered from medical records and follow-up visits, emphasizing the Modified Rowe score, ASES score, range of motion, recurrence rates, and patient satisfaction. Results: The research found that arthroscopic surgery resulted in higher Rowe and ASES scores, indicating better shoulder function and range of motion, compared to open surgery. However, open surgery demonstrated lower recurrence rates, suggesting greater stability. Patient satisfaction was slightly higher for arthroscopic procedures. Both methods are effective, with arthroscopic surgery offering quicker recovery and less postoperative pain, while open surgery provides more robust long-term stability. Conclusion: Both surgical methods effectively manage recurrent anterior shoulder instability, but they have distinct advantages. Arthroscopic surgery offers benefits such as less invasive procedures and quicker recovery, while open surgery provides more robust stability with lower recurrence rates. Recommendations: Further large-scale, long-term researches are recommended to confirm these conclusions and optimize surgical approaches for different patient populations.

Background: Hip fractures are a significant cause of morbidity and mortality in the elderly population. Identifying predictors of long-term survival after hip fractures is crucial for improving patient outcomes and guiding clinical interventions. Aim: This study aims to identify and analyze the factors influencing five-year survival rates in patients who have sustained hip fractures. Methods: A retrospective cohort study included 200 patients aged 60 years and older who had hip fractures and underwent surgical intervention. Patients with periprosthetic or pathological fractures and multiple fractures were excluded. Data were collected from hospital records and analyzed using SPSS version 21.0. The primary variables included time to surgery, one-year mortality, and functional recovery assessed by the Barthel Index. Statistical analyses involved Kaplan-Meier survival analysis and Cox proportional hazards models. Results: The study found that early surgery within 24 hours significantly reduced the one-year mortality rate to 10% and improved functional recovery, with 60% of patients achieving good recovery scores. In contrast, delayed surgery beyond 48 hours was associated with a higher mortality rate of 30% and poorer functional outcomes, with only 25% achieving good recovery. Complications such as pneumonia and urinary tract infections were more common in patients with delayed surgery. Statistical analysis confirmed that delayed surgery is an independent predictor of higher mortality and poorer functional recovery, emphasizing the importance of early surgical intervention for hip fracture patients. Conclusion: The study identified several key predictors of long-term survival after hip fractures. Early surgical intervention and comprehensive post-operative rehabilitation significantly improve survival outcomes. Recommendations: Clinicians should prioritize timely surgery and comprehensive post-operative care for hip fracture patients to enhance long-term survival. Further research is needed to develop targeted interventions for high-risk populations.

This study examines the practicality and safety of utilising spinal anaesthesia for laparoscopic ventral hernia repairs, a procedure typically done with general anaesthesia. Carried out at Sri Krishna Medical College and Hospital between January 7, 2020, and January 31, 2022, the study involved the participation of 65 patients. The study aimed to examine the management during surgery, the outcomes after the operation, and any potential complications that arose. The findings revealed that spinal anaesthesia proved to be highly effective in controlling surgical pain, eliminating the necessity for analgesics during the procedure. Patients reported minimal postoperative pain levels and encountered few complications. Based on the quick recovery times and minimal complications observed, it appears that spinal anaesthesia offers a safer and more efficient option compared to general anaesthesia for laparoscopic ventral hernia repair. This alternative promotes faster patient recovery and helps in reducing the utilisation of hospital resources. This study highlights the potential advantages of using spinal anaesthesia in laparoscopic procedures, suggesting that it could greatly improve patient care and surgical outcomes.

Background: Tracheostomy is a critical procedure in ICU settings for patients requiring prolonged mechanical ventilation. The timing and indications for tracheostomy significantly impact patient outcomes, yet there remains a need for comprehensive evaluation of these factors to optimize care. This study aims to evaluate the various indications and outcomes of tracheostomy in the ICU, focusing on patient demographics, clinical history, timing of the procedure, and associated complications. Methods: An observational study was conducted over six months. The study included 47 patients who underwent tracheostomy in the ICU. Data were collected retrospectively from medical records, encompassing patient demographics, clinical history, indications for tracheostomy, timing, complications, and outcomes. Statistical analysis was performed to evaluate the relationships between these variables. Results: The study found that respiratory failure (42.6%) and neurological impairment (31.9%) were the primary indications for tracheostomy. The average length of ICU stay post-tracheostomy was 20.4 days. The complication rate was 31.9%, with infections (14.9%) and bleeding (10.6%) being the most common. Early tracheostomy (within 10 days) was correlated with a lower complication rate (20.0%) compared to late tracheostomy (45.0%) (p = 0.02). The mortality rate among patients was 21.3%. Conclusion: The study underscores the importance of timely tracheostomy in ICU patients, with early tracheostomy being associated with better outcomes and fewer complications. Respiratory failure and neurological impairment are significant indications for the procedure, affecting patient recovery and ICU stay duration. Recommendations: To prevent problems and enhance results, patients who need prolonged mechanical breathing should consider early tracheostomy. These findings should be confirmed and clinical guidelines refined using bigger sample sizes.

Background: Foreign bodies in the ear, nose, throat, (ENT) and maxillofacial region are frequent clinical occurrences that pose significant challenges due to their potential to cause severe complications. The prompt identification and effective management of these cases are crucial to prevent adverse outcomes.  This study aims to analyze the clinical profile and complications associated with foreign bodies lodged in the ENT, aerodigestive tract, and maxillofacial region. Methods: 39 patients who reported with foreign bodies in the designated locations were included in the study. Information was gathered from ward admission records and registration books for ENT clinics. An analysis was conducted on parameters, including demographic information, clinical presentation, radiological tests, procedures carried out, and complications. Microsoft Office Excel 2007 was used to conduct the statistical analysis. Results: The study found that 61.5% of the individuals were males, with a mean age of 22.8 years. The ear was the most common site of foreign body lodgement (38.5%), followed by the nose (28.2%) and throat (20.5%). Radiological investigations were conducted in 53.8% of the cases, primarily using X-rays. Direct visualization and removal with instruments were the most common methods (61.5%). Complications occurred in 28.2% of the patients, with infections being the most prevalent (54.5%). Statistical analysis indicated a significant relationship between the site of lodgement and the occurrence of complications (p < 0.05). Conclusion: Foreign bodies in the ENT, and maxillofacial region can lead to serious complications if not promptly managed. The study highlights the importance of early diagnosis and appropriate intervention. Recommendations: Implementing training for healthcare providers, increasing public awareness, enhancing diagnostic tools, standardizing protocols, and conducting research are crucial for improving the management of foreign bodies in ENT and maxillofacial regions. These steps ensure safer, more efficient interventions and better prevention, particularly for children.

Background: Growths on the lining of the colon and rectum called colonic polyps have the potential to develop into colorectal cancer, which is a leading cause of cancer-related morbidity and death. It is imperative to comprehend the clinicopathological attributes of these polyps in order to perform efficient screening and therapy. The purpose of this research is to examine the clinicopathological features of colonic polyps in patients who are having colonoscopies at a Bihar tertiary care hospital. Specific attention will be paid to the patients’ demographics, clinical indications, macroscopic characteristics, histopathological types, and dysplasia status. Methods: This study included 93 patients who underwent colonoscopy and polyp removal. Data on demographic profiles, clinical indications, polyp characteristics, and histopathological findings were collected and analyzed using descriptive statistics. Results: The study cohort comprised 52 males (55.91%) and 41 females (44.09%), with a mean age of 55.3 years. Rectal bleeding (43.01%) was the most common indication for colonoscopy. A total of 115 polyps were analyzed, with the majority being sessile (56.52%) and located in the rectum (30.43%). Adenomatous polyps were the most prevalent histopathological type (43.48%), and dysplasia was observed in 26.09% of the polyps, predominantly in adenomatous polyps (17.39%). Conclusion: The findings underscore the predominance of adenomatous polyps and their higher risk of dysplasia, highlighting the need for vigilant screening and management. Early detection and removal of these polyps are crucial to preventing colorectal cancer. Recommendations: Based on the study findings, it is recommended to implement regular screening colonoscopies, especially for high-risk groups such as older adults and males, to detect and manage colonic polyps early. Further research should explore the genetic and molecular aspects of polyp progression to enhance prevention strategies.

Background: Open cavity mastoidectomy is a widely performed surgical procedure for managing chronic otitis media and related middle ear diseases. However, this procedure often results in cavity problems, such as persistent discharge, granulations, and hearing issues, which can significantly impact patient quality of life and surgical outcomes. The aim of this study was to investigate the incidence of cavity problems following open cavity mastoidectomy and identify the perioperative factors contributing to these complications. Methods: A total of 42 patients who underwent open cavity mastoidectomy were included using purposive sampling. Data on patient demographics, clinical symptoms, and perioperative factors were collected. Patients were followed up twice weekly for three months to monitor the development of cavity problems. Statistical analysis was performed to identify significant associations between perioperative factors and cavity complications. Results: The incidence of cavity problems was 35.7%. Key perioperative factors significantly associated with cavity problems included facial ridge height (> 2 mm), cavity size (> 5 cc), and presence of granulations. Patients with larger cavities and granulations had higher rates of complications. Treatment involved aural toilet, antibiotics, and chemical cauterization, with some patients requiring parenteral medication. Conclusion: Cavity problems are a common complication following open cavity mastoidectomy. Factors such as facial ridge height, cavity size, and presence of granulations significantly contribute to these issues. Effective management and consideration of these factors can help reduce the incidence of postoperative complications and improve patient outcomes. Recommendations: To minimize cavity problems, it is recommended to adopt cavity obliteration techniques where feasible, carefully manage granulations, and ensure regular follow-up to monitor and treat early signs of complications.

Background: Allergic rhinitis (AR) is a widespread chronic condition characterized by nasal inflammation due to allergen exposure, leading to significant impairment in quality of life and productivity. This study aimed to evaluate the effectiveness of loratadine in managing and alleviating the burden of AR, focusing on symptom severity and quality of life improvements over a five-month period. Methods: Forty-seven participants with diagnosed AR were enrolled and administered loratadine. Symptom severity and quality of life were assessed using standardized questionnaires and clinical evaluations at baseline and monthly follow-ups. Data were analyzed using SPSS version 20.0, with paired t-tests and ANOVA employed to compare changes over time. Results: The study observed a significant reduction in symptom severity from a baseline mean score of 6.3 ± 1.8 to 2.5 ± 1.1 by the fifth month (p < 0.001). Concurrently, quality of life scores improved significantly from a baseline mean of 58.2 ± 12.5 to 78.3 ± 7.4 (p < 0.001). The statistical analysis confirmed significant improvements in both symptom severity (F(4, 184) = 23.56, p < 0.001) and quality of life (F(4, 184) = 19.47, p < 0.001) over the study period. Conclusion: Loratadine effectively reduced the severity of AR symptoms and improved the quality of life for patients over the five-month period. These findings support the continued use of loratadine as a valuable therapeutic option for managing AR. Recommendations: It is advised that these findings be further validated by bigger sample numbers and extended follow-up times in future research. Furthermore, investigating individualised therapy strategies may improve patient results in the management of AR.

Background: The best course of action for end-stage renal disease is still kidney transplantation; nevertheless, there are substantial obstacles associated with allograft rejection, especially antibody-mediated rejection (ABMR). Recognised as a marker for ABMR, C4d deposition in renal allograft biopsies is incorporated into the Banff classification for the evaluation of allograft pathology. In order to improve patient management techniques and diagnostic accuracy, this study looks into the relationship between C4d deposition in renal allograft biopsies and the morphologic characteristics outlined by the Banff classification. Methods: A retrospective and prospective observational study was carried out on 89 renal transplant recipients. Biopsies were analyzed for C4d deposition using immunohistochemical staining. Histopathological features were evaluated according to the Banff 2007 grading schema. Associations between C4d deposition and Banff scoring parameters were analyzed using chi-square tests. Results: Out of 89 biopsies, 32 (36%) showed positive C4d staining. Significant associations were found between C4d positivity and acute cellular rejection (72%, p<0.001), antibody-mediated rejection (93%, p<0.001), and chronic allograft nephropathy (25%, p=0.045). Acute Banff scoring parameters such as glomerulitis (83%, p<0.001), peritubular capillaritis (79%, p<0.001), and intimal arteritis (71%, p=0.002) exhibited strong associations with C4d positivity. Chronic parameters showed weaker associations. Conclusion: C4d deposition is strongly associated with acute rejection parameters, reinforcing its role as a diagnostic marker for ABMR. The weaker association with chronic parameters suggests that additional markers are needed for comprehensive chronic rejection assessment. Integrating C4d staining in routine biopsy evaluation can improve diagnostic accuracy and patient outcomes. Recommendations: Further research is recommended to explore additional biomarkers for chronic rejection and to refine diagnostic protocols incorporating C4d staining. Standardization of C4d staining techniques across laboratories will enhance reproducibility and reliability.