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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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).

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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).

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.