Background: Plasma Cell Dyscrasias (PCD) by definition include a wide range of disorders represented by excessive proliferation of a single clone of plasma cells producing entire immunoglobulins, immunoglobulin fragments, heavy chains or light chains. Materials and Methods: This study was carried out in a tertiary care Hospital (AGMC & GBP Hospital) prospectively for a period of three years from June 2020 to June 2023. All the cases diagnosed with PCD were selected. Data from hematological, biochemical, and radiological investigations were collected. For evaluation of each case of multiple myeloma, revised International Myeloma Working Group criteria were applied. Results: 25 patients were diagnosed during the study period, with the majority of them in the 6th decade. The male to female ratio was 3.2:1. Most common clinical feature was fever (52%), bone pains (44%), and generalized weakness (44%). Anemia was the most common hematological manifestation. All the patients had ‘M band’ on serum electrophoresis, and 31.81% of patients had urinary Bence Jones proteins. Conclusion: PCD are rare group of disorders, the diagnosis of which requires a systematic approach. Out of total 25 cases of PCD, many of them could not be diagnosed clinically or radiologically, but exclusively diagnosed based on cytological, haematological and histopathological examination (HPE).This demonstrates the challenge in the clinical diagnosis of the condition and stress upon the importance of tissue/hematological diagnosis.

DOI: 10.5281/zenodo.

Introduction: Leprosy is a chronic infectious disease affecting the skin and peripheral nerves, manifesting in various clinico-pathological forms based on the host’s immune status. This study aimed to analyze the clinical and histopathological features in leprosy patients and assess the correlation between clinical and histopathological diagnoses. Methods: A retrospective hospital-based study was conducted, involving data collection on detailed clinical history-taking and examination. Clinical assessments included lesion type, number, location, disease type, and neural involvement. Skin biopsies with routine Hematoxylin and Eosin stains were performed on all patients. Results: 123 clinically suspected leprosy cases were analyzed. The majority were aged 30-45 years, predominantly male. Upper extremities and head & neck were the most common lesion sites. The primary clinical features observed were hypoesthetic patches and erythematous plaques. Borderline Tuberculoid was the most common histopathological type, followed by lepromatous leprosy. Correlation between clinical and histopathological diagnoses for specific leprosy types were as follows: TT (67.20%), BT (69%), BB (49.70%), BL (70.30%), LL (93.20%), and IL (45.90%). Conclusion: Clinical diagnosis alone remains challenging for leprosy, while histopathological analysis aids in definitive diagnosis. This study highlights a significant correlation between clinical and histopathological findings in skin biopsies for leprosy diagnosis.

DOI: 10.5281/zenodo.

Introduction: Psoriasis comprises a group of common chronic inflammatory and proliferative skin conditions associated with systemic manifestations across multiple organ systems. Its prevalence in India remains poorly defined, with varied presentations at different stages that can mimic other conditions. Materials and Methods: This retrospective study explored the clinical and histomorphological variants of psoriasis and assessed the age and sex distribution in various types of psoriasis in a tertiary care hospital. Nine parameters were used to evaluate and categorize the different types of psoriasis: 1) Hyperkeratosis, 2) Parakeratosis, 3) Munro’s microabscesses, 4) Pustule of Kogoj, 5) Supra-papillary thinning, 6) Elongated rete ridges, 7) Inflammatory infiltrate in the dermis, 8) Capillary proliferation and dilatation, and 9) Spongiosis. Results: The study revealed a male preponderance, with the highest number of cases in the 31-40 age groups. Psoriasis vulgaris was the predominant histological type, followed by Chronic Plaque Psoriasis. Among the cutaneous features of psoriasis, scales were the most common, followed by plaques. The upper extremities were the most frequently involved site. Epidermal histopathological features included acanthosis in all cases and hyperkeratosis in majority. Dermal features showed dermal infiltration in majority of cases. Conclusion: Psoriasis exhibits multiple relapses and remissions with varied clinical presentations. Early diagnosis is crucial to halt disease progression, with histomorphology aiding in diagnosis. While most changes occur in the epidermis, dermal changes can also assist pathologists in diagnosis. This study contributes to understanding the prevalence and histomorphological features of psoriasis in India, aiding in better clinical management and patient triage.

DOI: 10.5281/zenodo.

Sarcomas can present differently in different parts of the body and showcase varied histopathological features and tend to recur locally and metastasize to distant sites. We are reporting our series on patients with spindle cell tumors. The mass was evaluated through computed tomography and the histology was confirmed by biopsy. Wide surgical resection of the mass was done and the patients were referred to radiotherapy for further treatment. These cases showcase the scenario of many patients in developing countries where the patients are negligent, lost and present later with grave consequences.

DOI: 10.5281/zenodo.

Introduction: Metabolic syndrome has long been associated with obesity and a sedentary lifestyle due to the resulting metabolic disturbances. Orexin A and B are newly identified neuropeptides produced in the hypothalamus. Orexin A is involved in the regulation of appetite, food intake, and energy expenditure. Metabolic fuel detectors play a critical role in maintaining energy balance both peripherally and centrally. This study aimed to investigate the relationship between serum orexin levels and metabolic risk markers in women of reproductive age (RAG). Materials and Methods: A random selection of 178 apparently healthy women aged 20–40 years were included. Fasting serum orexin and serum insulin levels were quantified using enzyme-linked immunosorbent assay (ELISA). Additionally, measurements of weight, body mass index (BMI), fasting blood glucose, lipid profile, and blood pressure were obtained. Results: The findings revealed that serum orexin levels exhibited a significant positive correlation with fasting blood glucose, weight, BMI, and waist circumference. There was also a weak negative correlation with serum insulin levels. Conclusion: The current study demonstrates that serum orexin levels are significantly correlated with weight, BMI, and fasting blood glucose, while showing a weak negative correlation with serum insulin levels. No correlation was found between serum orexin levels and the lipid profile in women of reproductive age.

DOI: 10.5281/zenodo.

Background: Cervical cancer is a leading cause of AIDS-defining illness, and HIV-positive women worldwide. Detection of cervical cancer in precancerous stage is 100% curable. Aim: To determine the rate of cervical screening among HIV-positive women and compare the performance of screening tests and assesses factors affecting participation. Methods: HIV-positive women aged 30–59 years attend the anti-retroviral therapy (ART) clinics were screened by conventional Pap, HPV testing (Hybrid Capture 2) and visual inspection with acetic acid (VIA). A cohort of HIV-negative women from the community matched for age and parity were screened similarly. Screen-positive women underwent colposcopy and biopsy. Factors affecting participation were assessed. Results: Out of total cases majority of them (44.4%) belonged to 30-39 years age group. Most of the participants (96.8%) were unaware about cervical screening, 97.2% were housewives and 74.4% belonged to upper lower socio-economic status. The mean parity of was 2.15±1.29 and maximum (69.2%) females were multiparous. Conventional smear and LBC revealed concordant findings in 16.7%, 100%, 85.7% and 100% cases of ASCUS, LSIL, HSIL and SCC respectively (p<0.05). Among the screening methods, sensitivity and negative predictive value was 100% for detection of abnormal cytology for liquid-based cytology whereas VILI had highest specificity. Overall, diagnostic accuracy was highest for liquid-based cytology. Conclusion: Risk of cervical cancer was higher in HIV infected women. Frequent screening of these patients for cervical cancer can reduces the morbidity and mortality among women.

DOI: 10.5281/zenodo.

Background: Cerebroplacental ratio (CPR) is a reliable indicator of foetus health, measured by colour Doppler. CPR is calculated as ratio of pulsatility index of middle cerebral artery (MCA) and umbilical artery (UA).  When blood is redistributed in the early stages of hypoxia in favor of cerebral circulation, the diastolic flow amplitude increases above normal levels in MCA while umbilical flow in diastole decreases, providing CPR. Aim: objective of this study is to investigate the relationship between CPR and adverse perinatal outcomes in a tertiary care hospital. Methods: A total of 300 pregnant women of age group 18-35 years with singleton pregnancies at 34-37 weeks were enrolled. Cerebroplacental ratio was calculated using a Doppler scan on each patient. When the Cerebroplacental ratio is <1 it is deemed abnormal. The perinatal outcomes were observed and their associations were evaluated. Results: Out of total majority of the participants (37.7%) belongs to 18-24 years of age group. Majority of the participants (87%) were multigravida. Most of them (36.7%) belonged to very low risk category. Most of the women (77.7%) delivered vaginally. 92.7% of born baby was alive and healthy and 76.7% of newborn had birth weight >2.5 kg. there is no statistically significant difference was found between gestational age, mode of delivery with CPR. Statistically significant association was found between perinatal outcomes (hypoxia, Stillborn and NICU admission) and CPR (p<0.05). Conclusion: CPR is important tool in predicting an unfavorable perinatal outcome.

DOI: 10.5281/zenodo.

Background: Manual Small Incision Cataract Surgery (MSICS) is crucial for effective cataract removal in resource-limited settings. The shape of the scleral incision significantly influences postoperative outcomes like surgically induced astigmatism (SIA). Objective: To compare the effects of frown-shaped and straight scleral incisions on SIA, visual acuity, surgical time, and complications in MSICS. Methods: This six-month study involved 480 patients at Jawahar Lal Nehru Medical College and Hospital, randomly assigned to undergo MSICS with either a frown-shaped or a straight scleral incision. Outcomes measured included SIA at various postoperative stages, visual acuity, surgical duration, and complication rates. Results: The frown-shaped incision group showed significantly lower SIA at all time points compared to the straight incision group, with similar visual acuity improvements. Although the frown shape required more surgical time, it tended to have fewer complications. Conclusion: The frown-shaped scleral incision is preferable in MSICS for reducing SIA, balancing better astigmatic control with the potential for fewer complications.

DOI: 10.5281/zenodo.

The small intestine microbiota is becoming recognized as performing an important role in human health and illness. This review article investigates the composition and function of the small intestine microbiota, focusing on its role in digestion, nutritional absorption, immunological regulation, and pathogen protection. We investigated the link between microbial dysbiosis and a variety of gastrointestinal, metabolic, immune-mediated, and cognitive conditions. Therapeutic approaches such as probiotics, prebiotics, antibiotics, dietary changes, and fecal microbiota transplantation (FMT) are explored, with an emphasis on their effectiveness and safety. The paper also discusses the difficulties in investigating the small intestine microbiota, including methodological constraints and the necessity for tailored treatments. Future research directions are highlighted, with an emphasis on developing technologies and their ability to overcome current limits. This article emphasizes the significance of ongoing research to fully realize the therapeutic potential of the small intestine microbiota in clinical practice.

DOI: 10.5281/zenodo.

Background: Abdominal wound dehiscence is a serious postoperative complication associated with significant morbidity and mortality, with an incidence ranging from 0.4% to 3.5% and mortality rates between 10% and 45%. Despite advancements in surgical techniques, the incidence of wound dehiscence remains a critical concern. This study evaluates the role of prophylactic retention sutures in high-risk patients undergoing midline laparotomy to prevent wound dehiscence. Materials and Methods: A prospective case-control study was conducted at King George Hospital, Visakhapatnam, from July 2020 to January 2022, involving 100 patients aged 20-70 years who underwent emergency midline laparotomy. Patients were randomized into two groups: the case group received prophylactic retention sutures (n=49), and the control group underwent conventional closure (n=51). Data collection included daily wound assessments, ultrasonography, and monitoring for postoperative complications such as wound infection, incisional hernia, reoperation, and hospital stay duration. Results: The study found that wound dehiscence occurred in 8.16% of patients with prophylactic retention sutures compared to 25% in the control group (p<0.05). Wound infection rates were 20.4% in the retention suture group and 45% in the control group (p<0.05). Incisional hernia incidence was 4.08% with retention sutures and 7.8% without. Reoperation rates were 4% in the retention suture group versus 11% in the control group. The mean postoperative hospital stay was 11.16 days for retention sutures and 9.8 days for conventional closure. Pain assessment revealed significantly higher pain scores on postoperative day 5 in the retention suture group. Conclusion: Prophylactic retention sutures significantly reduce the incidence of wound dehiscence and other related complications in high-risk patients undergoing midline laparotomy. Despite increased postoperative pain, the clinical benefits outweigh the drawbacks, making retention sutures a valuable preventive strategy for wound dehiscence in high-risk patients.

DOI: 10.5281/zenodo.

In this cross-sectional study, 100 preschoolers in Patna, India, ages three to five, are asked about their patterns of Theory of Mind (ToM) acquisition. The study, which lasted six months and was carried out at the Patna Medical College and Hospital’s Department of Psychiatry, used several pre-established activities to measure knowledge availability, erroneous beliefs, and varied desires. The results show a distinct developmental trajectory, with notable gains in ToM skills seen as youngsters get older. The study also shows that socioeconomic status (SES) has a significant impact on the development of ToM, with children from homes with higher SES performing better on ToM tasks. There were no discernible gender differences. These findings show the necessity for focused educational interventions to assist ToM learning in a variety of populations and emphasize the significance of cultural and socioeconomic factors in cognitive development.

DOI: 10.5281/zenodo.

Background: By affecting 206 countries, the unprecedented health disaster COVID-19 brought about a global emergency. Since SARS-CoV2 is a RNA virus and has a higher mutation rate than DNA viruses, treatment would be challenging. The issue is especially deleterious in India because of the country’s large population. The haematological and immunological system are severely affected by the systemic viral infection of COVID-19. It would be crucial to investigate whether the most frequently performed tests could be utilised to help determine a patient’s clinical status or anticipate the degree of severity of the disease. Methods: A cohort of 420 patients of all ages and both sexes having positive COVID-19 RT-PCR test and were admitted to BRAM Hospital Raipur between March 2021 and March 2022 participated in the cross-sectional study. Different hematological and biochemical tests were performed in all cases. Hematological parameters include ALC, TLC, Neutrophil /Lymphocyte ratio, Platelet count and biochemical parameters include Alanine aminotransferase, Aspartate aminotransferase, Lactate dehydrogenase, Serum ferritin and CRP. Results: Out of 420 cases, 210 were categorised under severe cases and rest 210 were non-severe cases. It is also found that, in severe cases the male patients were more than female patients. The mortality was associated with increased CRP, Neutrophil count, WBC count, AST, ALT and increased LDH. Conclusion: In conclusion, several laboratory parameters could be associated with the severity and mortality of COVID-19 pandemic. This comparative investigation can help reinforce clinical judgements in the clinical context and increase the survival rate of critically sick patients.

DOI: 10.5281/zenodo.

Background: Ventral hernia repair is a common surgical procedure with two primary approaches: open and laparoscopic. Despite advancements in minimally invasive techniques, there remains a debate regarding the optimal method for repair. This study aims to compare the clinical outcomes of open versus laparoscopic ventral hernia repair. Materials and Methods: A randomized clinical trial was conducted involving 150 patients diagnosed with ventral hernia. Participants were randomly assigned to either the open repair group (n=75) or the laparoscopic repair group (n=75). Key outcome measures included operative time, postoperative pain, length of hospital stay, complication rates, and recurrence rates. Follow-up assessments were conducted at 1 month, 6 months, and 1 year post-surgery. Results: The mean operative time was significantly shorter in the laparoscopic group (60 ± 15 minutes) compared to the open group (90 ± 20 minutes, p<0.001). Postoperative pain scores, measured on a visual analog scale, were lower in the laparoscopic group (mean score: 3.5 ± 1.2) than in the open group (mean score: 5.0 ± 1.5, p<0.01). The length of hospital stay was also reduced in the laparoscopic group (3 ± 1 days) compared to the open group (5 ± 2 days, p<0.01). Complication rates were comparable between the two groups (open: 15%, laparoscopic: 10%, p=0.35). However, the recurrence rate at 1 year was slightly higher in the laparoscopic group (8%) compared to the open group (5%), though this difference was not statistically significant (p=0.45). Conclusion: Laparoscopic ventral hernia repair offers advantages in terms of shorter operative time, reduced postoperative pain, and shorter hospital stays. While complication rates are similar between the two methods, there is a non-significant trend towards a higher recurrence rate with laparoscopic repair. These findings suggest that laparoscopic repair is a viable option for ventral hernia repair, but careful patient selection and long-term follow-up are essential.

DOI: 10.5281/zenodo.

Background: To successfully fight the danger that drug resistance presents to world health, one needs to be aware of how things have changed in the past. This bacterial historical study examines drug resistance in clinical samples from 2020 to 2022. Methods: A complete historical review of 250 clinical samples was carried out over the term. The collection had demographics, microbial species, and antibiotics orders. The data came from bacterial databases and medical facilities. We used time trend analysis, summary statistics, and subgroup ratings to examine every part. Result: This study on antibiotic resistance in a heterogeneous population shows demographic differences and patterns specific to microorganism species. Male and female population distribution is not statistically significant. The population averages 45.2 years old. Additionally, 32% of the population has numerous chronic illnesses. Condition A had 25% antibiotic resistance, while B and C had 15% and 30%, respectively. Subgroup analysis showed that resistance rates differed by age and microbiological species, emphasizing the need for customized therapy. These findings suggest that microbiological and demographic aspects should be studied to combat antibiotic resistance. Conclusions: The study tries to show how vital customized medicines are and brings drug resistance trends to light. We can compare and contrast current studies and drug resistance processes to find out what they have in common and what makes them different. These data show how important it is to keep an eye on drug resistance worldwide and consider what that means to find other treatments based on facts.

DOI: 10.5281/zenodo.

Background: Early detection of hearing problems is possible through neonatal hearing screening still, the correlation between screening outcomes and maternal health remains uncertain. This study explores the relationship between neonatal hearing test results and maternal age, prenatal care use, smoking, and other health factors. Method: MGM Medical College and LSK Hospital conducted a cross-sectional study of 50 neonates and mothers. Descriptive statistics and bivariate analysis were used to examine maternal health factors and neonatal hearing impairments. Results: Mothers averaged 28.5 years old (±4.2) and 60% of mother where a bachelor’s degree or higher. 20% of pregnant women smoked, although 80% received acceptable prenatal care. Neonatal hearing screenings found 10% of neonates impaired. Bivariate analyses revealed significant connections between hearing abnormalities (p = 0.045), inadequate prenatal care (p < 0.001), and maternal smoking (p = 0.012). Conclusion: Age, quality of prenatal care, and smoking throughout pregnancy raise the risk of neonatal hearing loss. These findings emphasise the importance of maternal health variables for neonatal outcomes. To reduce neonatal hearing issues, doctors should encourage pregnant women to quit smoking and undergo complete prenatal care. Evidence-based interventions can improve mother and neonatal health by encouraging healthy development.

DOI: 10.5281/zenodo.

Approximately 1% of all surgical procedures are appendicectomies, making them one of the most common procedures in general surgery. Less postoperative pain, early discharge, fewer wound infections, improved cosmesis, and an early return to regular employment are all predicted with laparoscopic appendicectomy. Regarding length of operation, pain following surgery, length of analgesia, complications following surgery, length of hospital stay following surgery, and return to regular employment, laparoscopic and open surgical techniques are compared. This study, which was conducted from September 2020 to August 2021, is prospective and comparative in nature. It involved 100 patients—50 open and 50 lap appendicectomy—that were operated on in the surgical department of the (Medical college) in (city). The cases were chosen at random. Pain score in the open group was 2.6±0.5 in the current study, while it was 1.4±0.5 in the lap group (P<0.05) due to wound infection and longer incision strain of muscles. Vomiting was one of the fewer post-operative problems in the laparoscopic group (6%) than in the open group (83%). Compared to open group 7, which had a 14% rate of post-operative wound infection, lap group 2 has a gradually lower incidence (4%) of such infections. In comparison to open group 3±2.1, the duration of post-operative hospital stay was significantly shorter for lap group 2.2±0.4. In the lap group, the return to regular activity was lower, taking 22 (44%) instances 6 to 9 days, compared to 28 (56%) cases in the open group 14 to 17 days. The duration of surgery was 46.2±10.4 for an open appendectomy and 66.5±18.5 for a lap appendectomy. For certain patients with acute or recurring appendicitis, laparoscopic appendicitis is preferable to open appendectomy.

DOI: 10.5281/zenodo.

Introduction: Out of 2.2 billion visually impaired people globally, at least half have unaddressed preventable causes of blindness, mainly untreated cataract (94 million), unaddressed refractive error (88.4 million), glaucoma (7.7 million), and corneal opacities (4.2 million); and untreated presbyopia (826 million) for near vision impairment. In India, the current prevalence of blindness in children is known to be around 0.8/1000 in the age group of 0–15 years. It is very important to have accurate data regarding causes and prevalence so that proper strategies can be planned to reduce, at least, preventable childhood blindness. Material and Methods: This is a cross-sectional study that included children from the school for the blind in Patiala, Punjab, India. The school principal was explained about the study. All the children were examined by an ophthalmologist and an optometrist. Information was gathered by interview and by consulting the medical records available. Uniocular and binocular visual acuity, with best correction, using a snellen’s chart; refraction, after cycloplegia; and anterior and posterior segment examination were done after pupillary dilation. For each child, the cause of visual loss was recorded in the form. Results: 92 children studying from grades 1 to 12 were examined. The average age of the participants was 13.13 years. 51 were male and 41 were female. 61.9% patients had onset of blindness before 1 year of age. The most common cause of blindness in children in our study was Retinal Dystrophy (38.64%), followed by congenital glaucoma (16.56%), Optic nerve atrophy (12.88%), and Corneal opacity (11.04%). The majority of the children (72.8%) had visual acuity from 3/60 to light perception positive. Conclusion: The most common cause of blindness in children in our study was Retinal Dystrophy (38.64%), followed by congenital glaucoma (16.56%). These results corroborate the past studies.

DOI: 10.5281/zenodo.

Objective: To compare the results of tension band wiring (TBW) v/s Olecranon hook plate fixation in management of fracture olecranon in terms of time taken for fracture union and clinical, functional and radiological outcome. Methods: 30 patients suffering from olecranon fracture were enrolled and study was carried out in Department of Orthopaedics, Guru Nanak Dev Hospital and College, Amritsar. Results: It was observed that among the cases mean age was 42.4 years. The study reported more number of males than females. The subjects were categorized into 2 groups. In both the groups, fractures on right side were involved more than left side. The road side accident was the commonest mode of injury to cause fracture. In both groups most common fracture type was type IIA (50%). Majority of the cases 19 (63.3%) were operated within 24 hours. 4 (13%) cases associated with fracture of femur bone required hemodynamic stabilization/surgery on priority basis. Other complications entails fracture in shaft femur and inter-trochantric femur. Mean MEPS in group A was 86.9 and in group B was 89.1. Conclusion: It was found that tension band wiring and plate fixation are equally effective in management of displaced olecranon fractures.

DOI: 10.5281/zenodo.

Objectives: Some of the key measures that are relevant to prostate cancer include serum PSA levels, Gleason score, and histopathological grading. Their relationship in the tertiary care facilities cannot be overlooked and hence constitutes this study’s research focus. Methods: The retrospective survey involved 86 samples of prostatic tissues taken between January 2022 to January 2023. These assessments included histomorphological examination and plasma levels of prostate-specific antigen (PSA). Gleason score was used to grade adenocarcinomas into five grade groups later on. PSA was categorized into 5 groups based on the type of questions they contain. Correlation analysis was performed. Results: As for the type of cancer, it was noted that 37.2 % of the samples had adenocarcinoma. The study subjects were mainly males, and the mean age was 62.2 years. Most of the men were diagnosed with a Gleason score of 7 (12) while 7 men were diagnosed with a score of 6. The mean PSA was 37.2ng/ml in malignancy. The present observation also revealed that higher PSA levels were equated with higher Gleason scores. Out of all the cases that were given a score of 6, there was only one that had the PSA within the normal limits. The overall accuracy of PSA to detect adenocarcinoma was 96.87%, Specificit of 59.25%. Conclusion: It was found that there is a direct relationship between a man’s PSA levels, his Gleason score and his histopathological grade. These parameters are used when determining how severe the prostate cancer is and also when coming up with the treatment plan for the patient.

DOI: 10.5281/zenodo.

Background and Aims: Compression-only life support (COLS) is a part of emergency care for cardiopulmonary resuscitation of cardiac arrest victims by lay persons outside the hospital which is developed by Indian resuscitation council of Indian Society of Anaesthesiologists. Timely provision of basic lifesaving skills such as COLS to cardiac arrest victims on the site positively influences the final outcome. But the overall awareness and training of life saving skills like COLS among lay people is reported to be poor in India. We present this study which assessed current knowledge about COLS and impact of structured COLS workshops among the general adult population of Maharashtra. We also studied association of various socio demographic variables including literacy status on knowledge acquisition and tried to find suitable recommendations. Methods: Audiovisual demonstration followed by hands-on training of COLS was conducted. All the participants were subjected to pre and post-test before and after the demonstration and hands-on workshop using a pre designed, pre tested questionnaire. Questionnaire contained demographic information and questions on assessment of knowledge of people about COLS. There were 11 questions on various aspects of COLS with a maximum score of 20. Statistical analysis was done by using statistical software SPSS Version 18. Paired ‘t’ test and ‘Chi Square’ test was used for analysis and p value equal to or less than 0.05 was considered significant. Results: Among 1249 participants ranging between 18 years to 78 years were divided in different groups as per the gender and educational level. The gender distribution was comparable among different age groups. For all the groups, the mean post-test knowledge score was statistically significantly high as compared to pre-test score, indicating significant improvement in knowledge by attending the COLS workshop. The pre and post test results among both the genders were equal with no statistical difference showing equal grasping power. Whereas the literacy and educational status among the lay people made significant difference. Conclusions: Regular COLS hands-on workshop teaching to lay people is highly effective in improving basic lifesaving skills. More the literacy/ educational status of the lay person, better is the understanding and execution of COLS knowledge.

DOI: 10.5281/zenodo.

Background: High-resolution ultrasound (HRUS) and magnetic resonance neurography (MRN) are considered complementary to clinical and neurophysiological assessment for neuropathies. Aim: To compare the accuracy of HRUS and MRN for detecting various peripheral nerve pathologies and to choose the correct investigation to facilitate prompt patient management. Materials and Methods: This prospective study was done using HRUS with 14 MHz linear-transducer and 3 or 1.5T MR in cases referred for the assessment of peripheral nerve pathologies. Image interpretation was done using a scoring system (score 0–3 confidence level) to assess for nerve continuity/discontinuity, increased nerve signal/edema, fascicular change, caliber change, and neuroma/mass lesion. We determined the accuracy, sensitivity, and specificity of these modalities compared with the diagnostic standard determined by surgical and/or histopathological, if not performed then clinical and/or electrodiagnostic evaluation. Results: The overall accuracy of MRN was 89.3% (specificity: 66.6%, sensitivity: 92.6%, negative predictive value [NPV]: 57.1%, positive predictive value [PPV]: 95%) and that of HRUS was 82.9% (specificity: 100%, sensitivity: 80.4%, NPV: 42.8, PPV: 100). The confidence level for detecting nerve discontinuity and change in nerve caliber was found to be higher on ultrasonography than magnetic resonance imaging (MRI) (100 vs. 70% and 100 vs. 50%, respectively). Pathology of submillimeter caliber nerves was accurately detected by HRUS and these could not be well-visualized on MRI. Conclusion:  HRUS is a powerful tool that may be used as the first-line imaging modality for the evaluation of peripheral nerve pathologies, and a better means of evaluation of peripheral nerves with submillimeter caliber.

DOI: 10.5281/zenodo.

Introduction: Carbapenem-resistant Enterobacteriaceae (CRE), has been documented across the globe and is linked to elevated mortality rates. CRE pathogens have caused graveconcern due to the limited choice of antibiotics for treating infections caused by them. Therefore, timely detection of CRE is very important for its treatment and prevention. Aims &Objectives: To know the prevalence of CRE in our hospital and to determine the incidence of predominant Carbapenem-resistant Enterobacteriaceae (CRE) species in different areas of the hospital. Materials & Methods: This was an observational retrospective study involving the analysis of nonrepetative 299 specimens of patients of all ages and sexes from indoor and outdoor patient departments (OPD) from June 2020 to September 2020 at the tertiary care hospital. All specimens  were processed and Enterobacteriaceae organisms were isolated by culture and identified by biochemical reactions and further identified as carbapenem-resistant strains by anti-microbial susceptibility testing for carbapenems, done by Kirby-Bauer disk diffusion method according to Clinical and Laboratory  Standards Institute guidelines(CLSI). Result: There were 299 Enterobacteriaceae organisms isolated from received specimens out of which 86(28.76%) isolates were carbapenem-resistant. Most of the CRE was isolated from urinary samples (47.67%)and from ICUs (31.40%) and Wards (55.81%). Most commonly isolated CRE organism was Klebsiella species (65.12%). Conclusion: Our study shows a high incidence of carbapenem-resistant Klebsiella species (65.12%) among isolated Enterobacteriaceae. A significantly high incidence rate of Carbapenem-resistant Enterobacteriaceae was observed amongst indoor patients(87.20%) & was of hospital-associated infections. Hence early detection of CRE organisms and the application of appropriate infection control measures can help prevent and control CRE infections.

DOI: 10.5281/zenodo.

At Darbhanga Medical College and Hospital (DMCH), this randomized controlled experiment examined the effectiveness of terbinafine, itraconazole, and both of them in treating tinea infections from July to December 2023. Three therapy groups (terbinafine alone, itraconazole alone, or a combination of both) were allocated to a total of 300 patients who had been diagnosed with different types of tinea infections. Recurrence rates, adverse events, and clinical and mycological cure rates were the main outcomes that were evaluated. With a mycological cure rate of 92%, a clinical cure rate of 94%, and a recurrence rate of only 5%, the combination therapy group showed better results. Adverse events were few and comparable in each group. These findings support the idea that combination therapy is more effective than monotherapy in treating tinea infections, and they call for its use in clinical settings to improve patient outcomes. The research emphasizes that combined antifungal medication may be a more successful strategy for treating difficult fungal infections.

DOI: 10.5281/zenodo.

Systemic sclerosis (SSc) is a connective tissue disease marked by immune irregularities, vasculopathy, and excessive collagen production, leading to fibrosis of the skin and internal organs. While SSc can affect multiple organs and systems, lung involvement, particularly interstitial lung disease (ILD), is the primary cause of mortality in this condition. We present here an interesting case of a patient with pulmonary tuberculosis with systemic sclerosis-associated interstitial lung disease.

DOI: 10.5281/zenodo.

Introduction: Airway is still the most challenging entity for anaesthesiologist even after invention of wide variety of airway gadgets. Unanticipated difficult airway is most difficult to manage, so anticipation of difficult airway is most crucial for anaesthesiologist which can be done by pre-operative assessment. The morbidity and mortality associated with unanticipated difficult airway is very high especially in obese patient as obesity affects multiple organs. By correct anticipation and taking appropriate measures we can reduce it significantly. Objective: To evaluate STOP-Bang score as a tool for predicting difficult mask ventilation and difficult intubation in obese patients. Methodology: 150 obese patients (BMI ≥ 30) with ASA physical status II and III aged 18 years or older undergoing various surgeries under general anaesthesia with endotracheal tube placement were enrolled for the study after taking informed written consent. Preoperatively, these patients were given STOP-Bang questionnaire. Based on questionnaire response and examination, STOP-Bang scoring was done. Score was used to classify obese patients as high risk (≥3) or low risk (<3) for OSA. After attaching standard ASA monitors i.e. electrocardiogram, heart rate, pulse oximeter and non-invasive blood pressure, baseline values were recorded. Mask ventilation grade, Modified Cormack-Lehane Grade, number of attempts of intubation and use of rescue measures were also evaluated in each patient. The collected data was analysed using SPSS version 21, whereas P<0.05 was considered significant. Quantitative data were described using mean ± standard deviation.  Comparison between the quantitative variables were done by using t test and ANOVA.  Results: In our study we found that the mask ventilation grade was significantly associated with STOP-Bang score (p<0.01). It showed that higher the STOP-Bang score, greater the difficulty in mask ventilation. The laryngoscopy grade (Cormack-Lehane grading) was not significantly associated with STOP-Bang score (p=0.125). The patients with high STOP-Bang score required more intubation attempts in comparison to low STOP-Bang score (p value 0.353, statistically not significant). Conclusion: High STOP-Bang score is a good predictor of difficult mask ventilation rather than difficult laryngoscopy however one criterion of STOP-Bang score i.e; neck circumference has direct correlation in predicting difficult airway (mask ventilation and laryngoscopy).

DOI: 10.5281/zenodo.

Background: One of the most common endocrinological disorders encountered during pregnancy is hypothyroidism. Major causes of hypothyroidism are endemic iodine deficiency and autoimmune disease. Thyroid dysfunctions are associated with adverse pregnancy outcomes. This prospective study assesses the prevalence of hypothyroidism, and adverse fetal and maternal outcome in hypothyroid women. Material and Method: this study included 200 pregnant women reporting in the ANC OPD in 1^st trimester. The study period is 6 months from January 2023 to June 2023. The adverse outcomes assessed were abortion, preeclampsia, preterm labor and placental abruption, while fetal outcomes noted were IUGR, LBW and still birth. Results: Prevalence of hypothyroidism in the study population was 12%. 8% and 4% women had subclinical and overt hypothyroidism respectively. Most frequent maternal adverse outcome noted was PIH (16.6%) followed by preterm labor, abortion and abruption. Conclusion: High prevalence of thyroid disorders, especially hypothyroidism, is present during pregnancy. The adverse outcome can be reduced by routine antenatal thyroid screening.

DOI: 10.5281/zenodo.

Background: Adverse drug reaction (ADR) according to WHO is defined as a response to a medicine which is noxious, unintended & which occurs at doses normally used in man for diagnosis, treatment, prevention of disease or modification of physiological functions. As per WHO, Pharmacovigilance is defined as science & activities related to detection, assessment, understanding & prevention of adverse drug effects or any drug related problems. It aims at enhancement of patient safety by assessing risk-benefit profile of the medicines. Hence this study was conducted to assess the knowledge, attitude & practice towards pharmacovigilance among the students, doctors, nurses & pharmacists. Materials and Methods: This cross sectional study was conducted amongst doctors, nurses, pharmacists, helping staff & undergraduate medical students from Naraina Medical College & Research Centre and Rama Dental College, Hospital & Research Centre. A questionnaire was handed out to each and every participant and the response was recorded. The study was conducted for 3 months (April 2023 to June 2023). The questionnaire consisted of three sections which included questions on knowledge & awareness, attitude & practice. Each question consisted to multiple options out of which the participants had to choose single most appropriate option. Results: A total of 500 health professionals participated in the study out of which 244 were medical students (MBBS and BDS), 152 were doctors and 104 were other health care professionals. Students who belonged to mostly second professional of MBBS & BDS fared better in the knowledge aspect of questionnaire. Practicing doctors and physicians (50% average of correct responses in knowledge) of the college though were aware of pharmacovigilance. Other health care practitioners (39.4%) which included nursing staff and various technicians were not so verse with pharmacovigilance. Practicing physicians (71%), students (100%), and other healthcare professionals (58%) had a positive attitude towards reporting of ADRs but what came as the biggest hindrance is the thought of legal repercussions of reporting ADRs. Conclusion: There is a need for the introduction of pharmacovigilance in all curriculums of medicine both at graduate and undergraduate level. So that we can model a vigilant society which could be helpful in both recognizing as well as reporting ADR for the better good of the society.

DOI: 10.5281/zenodo.

Background & Methods: The aim of the study is to study incidence of uterine fibroid in gynaecological patients. Most of the studies of fibroid have been based on care-seeking populations, including women undergoing myomectomy or hysterectomy. Among those tumors that come to clinical attention, only a portion of affected women progress to hysterectomy. The decision for surgical intervention primarily reflects the severity of a woman’s symptoms (bleeding or pelvic pain) and her desire to maintain childbearing potential. Results: Total 7% of cases had associated ovarian cyst. The chi-square statistic is 8.1593. The p-value is 0.016914. The result is significant at p < 0.05. Maximum (88%) had less than 2 fibroids. The chi-square statistic is 1.0297. The p-value is 0.031218. The result is significant at p < 0.05. Conclusion: Epidemiologic studies on age at menarche in relation to uterine fibroid have shown an inverse association. The mean age was 12.4±1.29 and the median age was 12 years. On the basis of our current state of knowledge, we can only speculate upon the initiators of this common condition. Future research efforts may provide a better understanding, however, of the causes and mechanisms of uterine fibroid tumorigenesis. Insights resulting from elucidation of the basic biology of these tumors might then be successfully translated into preventative strategies that will reduce the incidence and/or morbidity of this disease.

DOI: 10.5281/zenodo.

Background: Tonsillectomy is a common surgical procedure in children, often associated with high incidence of emergence delirium (ED), which can lead to postoperative airway obstruction and respiratory distress. This study aims to evaluate the effect of dexmedetomidine on the incidence and severity of postoperative emergence delirium in children undergoing tonsillectomy with propofol anesthesia. Materials and Methods: This prospective observational comparative study was conducted at a tertiary health center from November 2018 to August 2020. Seventy children aged 4 to 12 years undergoing tonsillectomy with or without adenoidectomy were included. They were divided into two groups: Group D (35 children) received dexmedetomidine infusion at 0.5µg/kg/hr along with propofol anesthesia, while Group C (35 children) received only propofol anesthesia. Heart rate, systolic and diastolic blood pressure, oxygen saturation, and end-tidal CO2 levels were monitored intraoperatively. Postoperatively, emergence delirium was assessed using the WATCHA scale at 0, 15, 30, 45, 60, 90, and 120 minutes. Pain was assessed using VAS score (for children ≥8 years) and FACES scale (for children <8 years). Extubation time and additional analgesic requirements were also recorded. Results: The incidence of ED was significantly lower in Group D at 0 minutes (P<0.001), 15 minutes (P<0.001), 30 minutes (P=0.008), and 45 minutes (P=0.012). Heart rate was lower in Group D at 45 minutes (P<0.001), 60 minutes (P=0.027), and 75 minutes (P<0.001). Systolic blood pressure was lower in Group D at 45 minutes (P=0.002), 60 minutes (P<0.001), 75 minutes (P<0.001), and 90 minutes (P=0.018). VAS scores at the end of 2 hours were zero for 82.8% in Group D compared to 62.8% in Group C. FACES scores showed significant differences at 0 minutes (P=0.045), 5 minutes (P=0.011), 15 minutes (P=0.030), and 30 minutes (P=0.010). The requirement for opioid analgesia was higher in Group C both intraoperatively and postoperatively. Conclusion: Dexmedetomidine infusion at 0.5µg/kg/hr effectively reduces the incidence and severity of emergence delirium in children undergoing tonsillectomy with propofol anesthesia. It provides stable hemodynamics without prolonging extubation time and reduces the need for additional opioid analgesia.

DOI: 10.5281/zenodo.

Background: Type 2 diabetes mellitus (T2DM) is a prevalent metabolic disorder characterized by chronic hyperglycemia. Glycemic control in T2DM patients is crucial for minimizing complications, one of which is altered platelet activity, contributing to increased cardiovascular risk. This study aims to investigate the relationship between glycemic control and platelet activity in T2DM patients over a six-month period. Materials and Methods: This prospective study was conducted at GMERS Medical College, Rajpipla, Gujarat, involving 110 T2DM patients. Glycemic control was assessed using HbA1c levels, measured at baseline and at six months. Platelet activity was evaluated through platelet aggregation tests and mean platelet volume (MPV). Patients were grouped based on their glycemic control: well-controlled (HbA1c < 7%) and poorly controlled (HbA1c ≥ 7%). Results: At baseline, the mean HbA1c level was 8.2%. After six months, the well-controlled group showed a significant reduction in HbA1c to 6.8% (p < 0.05), while the poorly controlled group remained at 8.1%. Platelet aggregation decreased by 15% in the well-controlled group and increased by 5% in the poorly controlled group. Similarly, MPV decreased by 0.7 fL in the well-controlled group, compared to an increase of 0.2 fL in the poorly controlled group. Conclusion: Effective glycemic control in T2DM patients significantly reduces platelet activity, potentially lowering the risk of cardiovascular events. Regular monitoring and management of blood glucose levels are essential for mitigating platelet hyperactivity and associated complications in T2DM.

DOI: 10.5281/zenodo.

Objective:  The present study was aimed to assess whether Cardiometabolic index (CMI) could be used as an early predictor of cardiometabolic status in patients with subclinical and overt hypothyroidism. Materials and Methods: Age matched euthyroid, subclinical hypothyroid and overt hypothyroid female subjects were divided into three groups (n=30) in the study. Anthropometric parameters such as body weight, height, Waist circumference and Hip circumference were measured. After an overnight fasting, 5 ml of blood samples were collected and serum thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), lipid fractions – total cholesterol (TC), triglyceride (TG) high density lipoprotein (HDL), very low density lipoprotein (VLDL) and low density lipoprotein (LDL) were estimated. Waist-to-height ratio (WHtR) and CMI were calculated. Results: Bodyweight, TSH, TC, TG, VLDL, LDL and CMI levels were increased in subclinical and overt hypothyroid patients. FT3, FT4 and HDL levels were reduced in patients with overt hypothyroidism. No significant changes were noticed in age, height, waist circumference, hip circumference and WHtR in both hypothyroid groups. CMI positively correlated with TC, TG, VLDL and LDL in both subclinical and overt hypothyroid patients. Negative correlation was found between CMI and HDL levels in patients with overt hypothyroidism. Conclusion: CMI could be used as an early predictor of any adverse cardiometabolic event in hypothyroid patients as it integrates blood lipid levels and abdominal obesity.

DOI: 10.5281/zenodo.

Background: Cervical cancer (CC) is a major health issue worldwide, with India accounting for 25% of cases. Human Papilloma Virus (HPV) is the primary cause of cervical cancer, yet the HPV vaccine uptake is low among medical students due to high costs, low acceptance, and insufficient awareness. Methods: This cross-sectional observational study was conducted from February to March 2024 at a Government Medical College in North India, involving 924 medical students. Data were collected using a semi-structured questionnaire via Google Forms. Results: Among the participants, 57% were female. Vaccination rates for Covid-19, Hepatitis B, and HPV were 91.1%, 42.3%, and 7.05% among males, and 72.4%, 36.05%, and 10.03% among females, respectively. Females showed higher vaccination rates for Covid-19 and HPV. The overall HPV vaccination rate was low, with no significant impact from sexual activity on vaccination rates. Conclusion: Despite the low overall uptake of the HPV vaccine among medical students, females showed higher acceptance. There is a need for targeted educational programs and subsidized vaccination initiatives to improve HPV vaccine uptake.

DOI: 10.5281/zenodo.

Aim: To develop a novel technique of modified intraosseous patella suturing and to compare with conventional suturing technique and its effect in post- operative patella tracking. Method: We have described a technique of intraosseous patella suturing technique for the arthrotomy wound. A prospective comparative longitudinal study was done in our tertiary care center over a period of 6 months starting from November  2022 till April 2023  wherein the patients were categorized into two groups – Group A conventional technique while Group B our novel technique was done for suturing of medial arthrotomy wound .Post-operative   patella tracking was estimated using patella tilt and lateral displacement in standard radiograph. Result: This is an easily reproducible technique and has several advantages over other methods of closure. In group B nearly 90 percentage of patients had better outcome in-terms of patella tilt and lateral displacement compared to group A. Conclusion: The modified intraosseous patella suturing technique can be used for medial arthrotomy closure and has better outcome in terms of patella tracking post operatively.

DOI: 10.5281/zenodo.

Introduction: Seasonal changes have been shown to significantly affect animal physiology and behavior. Similarly, human physiology is sensitive to environmental shifts, including seasonal changes. Research has demonstrated that conception rates, birth rates, immune responses, metabolism, and body composition exhibit seasonal patterns. This study aimed to investigate whether body fat percentage (BF%), basal metabolic rate (BMR), and serum lipid levels vary seasonally in healthy, sedentary urban adults at the end of summer and winter. Materials and Methods: This cross-sectional study examined the seasonal variations of BF%, BMR, and serum lipids in 54 healthy, sedentary urban adults (41 males and 13 females) aged 20-60 years. Anthropometric data, including age, sex, weight, height, waist circumference, and hip circumference, were collected. Venous blood samples were taken to measure fasting serum lipid levels. BF% was determined using dual-energy X-ray absorptiometry (DEXA) scans, and BMR was calculated using the Harris–Benedict equation based on height, weight, and age. Results: The study found significant seasonal variations in BF%, BMR, total cholesterol, triglycerides, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) among all participants. Notably, significant seasonal variations in BF% and LDL were observed within the obese subgroup of participants. Conclusion: There is a seasonal variation in BF%, BMR, and serum lipids between the end of summer and the end of winter. Additionally, a positive correlation exists between body mass index (BMI) and BF%, BMR, LDL, and HDL. Similarly, a positive correlation is observed between BF% and BMI, BMR, HDL, and LDL.

DOI: 10.5281/zenodo.

Introduction: Weaning period is the most crucial period for child growth and development. Maternal knowledge and practices during this period play a crucial role in shaping the infant’s nutritional status and overall health. According to WHO and UNICEF, poor infant feeding practices and their consequences are one of the world major problem and serious obstacle to social and economic development. This study aims at assessing the knowledge of mothers on weaning and weaning practices. Research Methodology: A descriptive research design was used to assess the knowledge and practice regarding weaning. Total 200 sample are taken for period of six months. The data was collected in a safe environment through interviews based on a pre designed and pre tested questionnaire. The data was analysed using Epi info version 7 and results were drawn. Result: Among the studied population 85% were found to have knowledge about weaning practices. The association between educational status and awareness about weaning was found statistically significant with p value <0.05. Majority of the children were colostrum fed. Different food habits were also observed.

DOI: 10.5281/zenodo.

Background and Objectives: Infertility and childlessness is one of the major health and family problems throughout the world. The prevalence of infertility in the general population is estimated to be 15% to 20%. Of this, male factor alone is responsible for 20 to 40%. Human male infertility is normally assessed on the basis of semen analysis. Among the various parameters which are studied, the association between seminal Leukocytes and semen quality is still contradictory, but majority of the studies have proved the significant role of leukocytes in altering the semen quality by various mechanisms like ROS production, immune reactions etc., and causing deleterious effects on sperm count, motility, morphology, etc., resulting in infertility. Leukocytospermia is defined as the presence of more than 1 million leukocytes per milliliter of semen by the WHO and is also included in the WHO guidelines for semen analysis since long back. To study Leukocytospermia in semen samples. To find out the prevalence of leukocytospermia in the general (male) population of surrounding feeding areas with special reference to infertile men. To study the relation/association between leukocytospermia and infertility status. Methodology: A Total of 95 semen samples were received in the department of pathology with history of infertility, varicocoele, undescended testis, etc., One sample could not be processed because of urine contamination. Routine semen analysis including leukocyte count by Peroxidase staining test was done on all the remaining 94 samples. Out of these 94 samples, 6 were repeat samples of short duration, another 6 were with history other than infertility like varicocoele, undescended testes, etc., and 5 samples had symptoms of urinary tract infection. So, excluding these, the remaining 77 samples with history of infertility were taken up for leukocytospermia study. Conclusion: Leukocytospermia is not to be neglected as it is found to be associated with significant number of idiopathic male infertility cases, and in-turn, it is influenced by many factors like smoking, etc. Detection of leukocytospermia by simple and cost- effective tests like Leukocyte Peroxidase staining should be included in the routine semen analyses especially in men under infertility investigation before putting them to higher, deeper and high-cost investigations, and appropriate and timely intervention may help the men with infertility due to leukocytospermia.

DOI: 10.5281/zenodo.

Background and Objectives: Anemia of chronic disease (ACD) is the second most prevalent anemia overall after iron deficiency anemia which develops under the setting of chronic infections, cancer or autoimmune diseases. Detection of the type of anemia is important to execute a correct treatment plan. Identification of anemia of chronic disease will definitely have great impact on treatment. To study the incidence of morphological patterns in anemia of chronic disease. To evaluate the incidence of chronic illnesses manifesting as anemia of chronic disease. To evaluate the frequency of association of morphological patterns with disease entity. Methodology: 100 cases of age group between 18-80 years having chronic illnesses attending the outpatient clinic as well as admitted patients of JNKTMCH, Madhepura. with hemoglobin <13 g/dl (haematocrit <39%) in men and women with hemoglobin <12g/dl (haematocrit <36%) included in the study. The hematological parameters were analyzed using automated hematology analyzer Mindray BC-3000 plus. The morphological patterns of the red blood cells were studied in peripheral smears. Anemia of chronic disease was identified using Serum ferritin assay, serum iron estimation and total iron binding capacity. Conclusion: ACD is an unrecognized problem and diagnosis of ACD   is the need of an hour. Thus, the present study was undertaken, keeping this need in view.

DOI: 10.5281/zenodo.

Background and Objectives: Head and neck swellings are the commonly encountered disorders in our hospital, with a range of inflammatory, benign and neoplastic diseases involving different age groups. This study was undertaken to study the cytological types of inflammatory, benign and neoplastic swellings correlate with histologic result. Methods: Written informed consent is taken from all patients included in the study. The study was carried out on 250 patients in the Department of Pathology at JNKTMCH, over a period of 2 year prospective study, Patients was referred to the Cytology section from various departments. Predominantly from the departments of Otorhinolaryngology, General Surgery, Medicine and Paediatrics. The lesions included those from the thyroid, salivary glands, and lymph node, nose and paranasal sinuses. Conclusion: Head and neck swellings are common condition encountered in clinical practice. The advantages of FNAC are, it is safe, gives a quick result, is sensitive and specific for the diagnosis of malignancy, requires minimal equipment, is an outpatient procedure, avoids the use of frozen section, reduces the rate of exploratory procedures, allows a definitive diagnosis of inoperable cases, and is repeatable and cost effective. To conclude, FNAC is a minimally invasive first line investigation with a high sensitivity and specificity for the diagnosis of various head and neck lesions.

DOI: 10.5281/zenodo.

Purpose: There is little evidence supporting lutein’s, carotenoid, anticancer effects on ovarian cancer cells. The prognosis for ovarian cancer is still not great, particularly in places with limited resources. For this reason, it’s critical to keep tracking the incidence of ovarian cancer in order to pinpoint disparities in the disease’s management. Methods: Various amounts of carotenoids were applied to cancer cells at 37°C in a CO2-containing 5% incubator. Cell proliferation was measured using the MTT test, and the anti-proliferative activity against cancer cells was evaluated using IC₅₀ values. Results: After 24 hours of incubation, lutein (IC₅₀ = 0.77 µM) was more effective on PA-1 cells (lower IC₅₀) than it was after 48 hours (IC₅₀ = 1.62 µM).

Conclusion: This study found that lutein can cause cancer cells to die and impede their ability to proliferate.

DOI: 10.5281/zenodo.

This study explores the disparities in public attitudes towards psychiatric hospitals between urban and rural populations in Bihar, India, through a descriptive cross-sectional survey. A total of 1,000 participants (500 from urban areas and 500 from rural regions) were interviewed using structured questionnaires. The findings reveal significant differences: urban participants displayed higher awareness and less stigma towards psychiatric care, whereas rural respondents showed substantial barriers to access, including greater stigma, financial constraints, and geographic isolation. These results suggest a crucial need for targeted mental health education and services, particularly in rural areas, to mitigate disparities and improve healthcare outcomes. Strategic interventions such as telepsychiatry, mobile health services, and community education programs are recommended to enhance accessibility and reduce the stigma associated with psychiatric care.

DOI: 10.5281/zenodo.

Background: Chronic otitis media is a common condition for which the patient present to Otorhinolaryngology, constituting about 30% of the ENT outpatient numbers. Chronic otitis media implies a permanent abnormality of pars tensa or flaccida, most likely a result of acute otitis media, negative middle ear pressure or otitis media with effusion. Being surgery the main treatment modality of treatment, tympanoplasty using various types of graft materials is essential in the management of the disease. Temporalis fascia is most commonly used graft. Various other grafts materials include cartilage, areolar tissue, ear lobule fat, and vein. Cartilage is also a popular graft which can be used in the form of palisade, perichondrium/cartilage island, butterfly and shield graft. Hence this study was conducted with the objectives to compare the surgical outcome in terms of graft acceptance between the island cartilage graft and temporalis fascia graft used in type 1 tympanoplasty, to compare the audiological outcomes and complications. Methods: A cross sectional (Hospital based) study was conducted at Krishna Rajendra Hospital, Mysore attached to Mysore Medical College and Research Institute, Mysore. Patients attending the OPD with mucosal type of COM with subtotal perforation were included in the study between October 2018 to September 2019. Patients were divided into two groups alternatively and type one tympanoplasty was performed using island cartilage in one group and temporalis fascia in the other after clinical examination, examination under microscope and performing pure tone audiogram. Postoperatively they were followed up at third and eighth weeks to assess the graft uptake and audiological parameters. Results: In our study the graft uptake was similar in both island cartilage and temporalis fascia group. The audiological gain in terms of AB gap closure is slightly better in the temporalis fascia group than the island cartilage. Conclusion: In type 1 tympanoplasty, both temporalis fascia and island cartilage can be used for structural stability and temporalis fascia gives better audiological results.

DOI: 10.5281/zenodo.

Background: The thyroid gland is an important endocrine gland that has a role in growth and development, rate of metabolism, and blood calcium level maintenance. In the course of aging anatomical features and functions of the thyroid gland undergo age-related changes. Literature is giving controversial results on age-related changes. This study aims to identify the age-related changes that occur in the thyroid gland. Methods: A descriptive study on age-related changes of thyroid gland conducted in Department of Anatomy, Govt Medical College Kottayam. 100 specimens of the thyroid gland were collected from the Department of Forensic Medicine during autopsy. A histological study was conducted on the follicular cells and mean follicular diameter after staining the slide with Haematoxylin & Eosin stain. Data was entered in MS Excel and analysed using SPSS software. Results: Specimens were grouped into 0-20, 21-40, 41-60, and >60 years. Histological studies showed a significant negative correlation between age and mean follicular diameter (p-value .006, <0.05). Mean follicular diameter was maximum in the less than 20 years group (135.07±20.17µm) and gradually decreased and became 122.67±68µm in 20-40 years of age and 113.59±55µm in 40-60 years of age. Mean follicular diameter was minimum in >60 years (81.6±42.37µm). In individuals ≤20 years and >60 years, 74% of specimens were having squamous lining for thyroid follicles. In 21 to 60 years of age, 82% of follicular epithelium was either cuboidal or columnar, and only 18% had a squamous lining. Squamous epithelium implies that the gland is inactive in 74% of people at extremes of age.  This observation was significant statistically. Conclusion: This study shows that there are significant changes in the histology of the thyroid gland as age advances. As the age of the person increases there is a significant reduction in mean follicular diameter. In the majority of specimens (74%) follicular cells showed inactive squamous epithelium in the <20 and >60 years age group.

DOI: 10.5281/zenodo.

Aim: To study the urinary calcium-creatinine ratio in prediction of pre-eclampsia in pregnant women. Objectives: (1). To study the urinary calcium : creatinine ratio among all pregnant women. (2). To correlate the urinary calcium : creatinine ratio in normotensive and pre-eclamptic women. Methodology: This Prospective, observational study was conducted in the Department of Obstetrics and Gynecology, Sri Ram Murti Smarak Institute of Medical Sciences, Bareilly. Urinary calcium creatinine ratio was determined in a random sample of urine in 50 patients of pre-eclampsia (Study group) and 50 normotensive pregnant (Control group) patients of age 20-35 years with gestational age 20 weeks onwards. Cut off value for CCR was taken as ≤ 0.04. Results: Out of 50 pre-eclamptic cases, 26(52%) cases in the study group had CCR ≤0.04 while only 7(14%) cases in control group had CCR ≤0.04 with a statistically significant p value of 0.000. On statistical analysis, CCR at ≤0.04 had a sensitivity of 52%, specificity of 86%, positive predictive value of 79% and negative predictive value of 64%. The accuracy of the test was 69%. Conclusion: A single estimation of urinary calcium to creatinine ratio in asymptomatic pregnant women after 20 weeks of gestation is a simple and cost-effective test. A value of less than or equal to 0.04, in a spot urine sample, has a good predictive value for preeclampsia.

DOI: 10.5281/zenodo.

Antimicrobial resistance (AMR) is a significant and growing hazard to worldwide public health, caused by antibiotic overuse and misuse, as well as a lack of innovation in pharmaceutical research. This thorough study investigates novel techniques to combating AMR, such as combination medicines, immunotherapy, phage therapy, antimicrobial peptides, nanoantibiotics, probiotics, CRISPR-based therapeutics, and antimicrobial photodynamic therapy. These tactics use cutting-edge technologies and innovative mechanisms of action to overcome resistance and improve therapeutic efficacy. Antimicrobial treatment regimens can be optimized and resistance development can be minimized by the integration of combination drugs and personalized medicine. However, tackling the difficulties of AMR necessitates a multidisciplinary and collaborative effort involving healthcare practitioners, researchers, legislators, regulatory agencies, and the pharmaceutical sector. By embracing innovation, teamwork, and proactive measures, we can reduce the burden of AMR and ensure antibiotics’ continued effectiveness for current and future generations.

DOI: 10.5281/zenodo.

Introduction: The parotid gland is the largest of the paired major salivary glands, located in the parotid space. It secretes predominantly serous saliva via the parotid duct into the oral cavity to facilitate mastication and swallowing. Tumors of parotid can be benign or malignant. Most parotid gland tumours grow slowly over a long period of time without causing symptoms. The patient with a parotid tumour eventually becomes aware of a mass that is steadily getting bigger behind the angle of their jaw in the retromandibular region, in front of the tragus or in the cheek. The gold standard management for parotid tumors is surgery. Complications post-surgery depends on type of surgery, extent of disease and experience of surgeon. Aims: To study the relative occurrence of benign and malignant parotid tumors in all age groups and both genders. To study the immediate and late complications of parotid surgery. Methods: This is a descriptive retrospective study comparing the incidence of benign and malignant tumors of parotid gland and the complications of parotid surgery in the Otorhinolaryngology department of Gauhati Medical College. Conclusion: Parotidectomy is a challenging surgery and best means of reducing iatrogenic facial nerve injury still remains a clear understanding of the anatomy, good surgical technique with the use of multiple anatomic landmarks. The goals, rationale, and risk of the operation, such as the general complications associated with the surgical procedure and facial nerve palsy, cosmesis should be explained to the patients.

DOI: 10.5281/zenodo.

Introduction: Hypertension is a significant health concern globally, and its prevalence has been rising over the years. Blood pressure readings that exceed normal but fall short of being classified as hypertension are referred as prehypertension. Blood pressure in the prehypertensive range is 120/80 mmHg to 139/89 mmHg.It can develop in childhood and adolescence and last into adulthood. It has the potential to cause hypertension and its related consequences in later life. One known risk factor for both prehypertension and hypertension is obesity. Various anthropometric measurements can be used as indicators of obesity and help healthcare providers to assess an individual’s risk of developing prehypertension and hypertension. Promoting good lifestyle practices is crucial for avoiding and treating prehypertension and its consequences. These practices include regular exercise, a balanced diet, and weight control. Aim: To study the correlation between anthropometric factors and prehypertension in 250 medical students in Government Medical College Kottayam. Materials and Methods: A proforma was distributed following approval from the principal and 250 medical students. Following that, blood pressure, waist circumference, hip circumference, waist-hip ratio, and triceps skinfold thickness were measured. The data was entered into Microsoft Excel. Using SPSS, the statistical analysis was completed. The mean and standard deviation for quantitative variables were calculated. The Pearson correlation coefficient is used to examine the relationship between anthropometric characteristics and blood pressure (SBP and DBP). Results: Correlation between systolic blood pressure and waist circumference, hip circumference, waist-hip ratio was highly significant but was not significant between triceps skinfold thickness. There was significant positive correlation between diastolic blood pressure and waist circumference, hip circumference, waist-hip ratio. However, a negative correlation was found between triceps skinfold thickness and diastolic blood pressure. Association of BP category with waist circumference category, hip circumference category, triceps skinfold thickness category were significant. Conclusion: 1. In the study subjects, blood pressure had significant positive correlation with waist circumference, hip circumference and waist-hip ratio. 2. Prehypertension was significantly correlated with categories for waist circumference, hip circumference, and triceps skinfold thickness.

DOI: 10.5281/zenodo.

Introduction: Structuring of questions and assessment has been emphasized and gained importance in the practical evaluation. The objective structured practical examination (OSPE) is now an accepted tool in the assessment of practical skills in CBME curriculum. If structured formats are designed on various practical aspects, it improves their learning and thereby increases their pass percentage during assessment. Aims and Objectives: 1) To introduce structured format as a method of assessment of practical skills and learning. 2) To compare pass percentage of students by using structured formats in comparison to traditional methods. 3) To explore faculty perception on introduction of structured formats in practical examinations. 4) To determine students perception on structured format type of practical examination. Materials and Methods: The study was conducted in Biochemistry department, ACSR Government medical college, Nellore. Phase1M.B.B.S students of 2020-21 Batch were enrolled in the study. One lecture on use of structured format questionnaire was taken for the entire 175 batch of students. The examination was conducted for 7 days with a batch of 25 each day. They were divided into two groups. One group received structured practical examination (SPE) and the other group traditional method (TPE). Cross over of the groups was done on the same day in the afternoon session. Results & Discussion: In our study the mean values of marks obtained through structured practical examination was statistically significant in comparison to traditional method (p value equal to 0.0002). The percentage of students who scored marks in the range of 60-69 and 70-79 was increased in SPE in comparison to TPE. Feedback given by students was constructive and showed high acceptance. Conclusion: The mean values of marks obtained through structured practical examination were statistically significant in our study in comparison to traditional method. OSPE is feasible and have good reliability and validity for evaluating practical skills of undergraduate medical students apparent by examiners and students.

DOI: 10.5281/zenodo.

Introduction: Menstrual hygiene is a critical aspect of women’s health that encompasses practices and facilities necessary for women and girls to manage menstruation safely and hygienically. Despite significant advancements in healthcare, menstrual hygiene practices remain a matter of concern, especially in regions with limited resources and cultural barriers. South Kerala, known for its diverse cultural landscape and socio-economic disparities, presents a unique context for exploring the relationship between menstrual hygiene methods and genital infection rates, particularly among students in medical colleges. This paper aims to delve into this crucial intersection by investigating the usage of different menstrual hygiene methods and the pattern of genital infections among female students. This study aimed to assess the various menstrual hygiene methods used by students in a medical college in South Kerala and the genital infections associated with it. Methods: This cross-sectional study was conducted among 360 female medical students of Dr. SMCSI Medical College, Karakonam, Kerala. Data was collected via Google forms using a pretested, semi-structured questionnaire. Results: 333 (92.5%) of the students are using disposable pads as their primary methods of menstrual hygiene followed by 23 (6.3%) using menstrual cups. Among the study participants 33 (9.2%) of them had or currently having reported of genital infections. It was found that those with less frequent pad changes had a higher risk of infections, though no direct association was found between infection rates and menstrual hygiene methods. Conclusions: This study sheds light on the menstrual hygiene practices and health outcomes among female medical students in South India. The study underscores the need for targeted public health interventions to improve menstrual hygiene practices and reduce infection rates among college students.

DOI: 10.5281/zenodo.

Background: The main causes of caregiver stress and psychiatric morbidity were the patient’s behavioral and cognitive status, the number of hours spent providing care, stress, social isolation, gender, the caregiver’s relationship to the patient and their personality, and the accessibility of support resources. The impact of caregiving on the family must be quantified. Quantification and identification are critical for developing effective ways to alleviate caregiver pain. Objectives: The goals of this study were to assess stress and psychiatric morbidity in the main caregivers of Alzheimer’s dementia patients and to link them with the socio-demographic and personality profiles of primary caregivers. Methods: A cross-sectional study was done on a sample of 50 primary caregivers of Alzheimer’s dementia patients meeting the study’s inclusion requirements and attending the outpatient department (OPD) of psychiatry, medicine, and neurology at TMMCRC, Moradabad, using the PSLE, BPRS, HMSE, PF-16 scale, and relevant sociodemographic performance measures. Results: Seven caregivers (14%) did not report any stress when the Presumptive Life Events Scale was used to screen for stress. Of the participants, 26 (52%) experienced moderate stress, and 17 (34%) experienced severe stress. PSLE was found to be statistically significant (p > 0.05) among caregivers who reside in urban areas and have completed high school or more education. It was discovered that eight people (16%) had minor psychiatric illnesses. Self-control with conscientious personality owners scored much higher than those with unrestrained personalities, while caregivers with independent personalities scored significantly higher than accommodating caregivers (p = 0.014). Conclusion: The study concludes by highlighting the significance of a thorough management strategy that involves forming a collaborative relationship between family caregivers and medical experts.

DOI: 10.5281/zenodo.

Background: The increased use of online educational platforms among undergraduate medical students may lead to digital eye strain (DES). This study aimed to evaluate the patterns of digital device use, the prevalence of DES symptoms, and the awareness of DES among these students. Materials and Methods: This cross-sectional study was conducted among undergraduate medical students at GMERS Medical College, Junagadh, Gujarat, using a self-administered online questionnaire. Results: Out of 1,000 students, 600 responded to the questionnaire. Among these, 89.33% (536 students) reported experiencing ocular and extra-ocular symptoms of DES, with headaches, watering, and redness of the eyes being the most common. Although 46.16% (277 students) were aware that digital device use can cause eye strain, less than 10% were aware of the ideal viewing distance for screens. Conclusion: The study found a high prevalence of DES among undergraduate medical students. The lack of regular breaks and improper glare control from screens were linked to DES symptoms. Awareness of ergonomic measures during device use was notably low among the students.

DOI: 10.5281/zenodo.

Introduction: According to estimates, there will be about 350,000 deaths from cervical cancer in 2022 and 660,000 new cases worldwide, making it the fourth most frequent malignancy among women. If caught early and given the right care, cervical cancer (CC) is a disease that can be prevented. The most important risk factor for CC is Human Papilloma virus(HPV)and the strains that are most frequently associated are HPV 16 and HPV 18. HPV vaccine can effectively prevent people from developing CC, if administered at the right time with appropriate age. Creating awareness about the route of transmission and role of HPV vaccination as preventive measures, will majorly contribute to the declination of incidence rate of cervical cancer case. Healthcare medical and paramedical students play a significant role as part of front-line support in delivering holistic care to patients. They act as a bridge between the community and health care sector. They play a major role in educating and creating awareness of Human Papilloma virus(HPV) infection, and its prevention. Hence this study was done to understand the knowledge and attitude of healthcare students towards HPV infection, cervical cancer and HPV vaccination. Methodology: This study was designed as a cross-sectional questionnaire based study. Validated questionnaire tool was prepared and assessment was made among 630 healthcare students of the age group >18 years. Their knowledge and attitude regarding cervical cancer (risk factors, screening and prevention) and HPV was explored and analysis was done using SPSS software. Results: 60.8% Healthcare students had knowledge that HPV can cause cervical cancer and 62.7% were aware that HPV vaccine can effectively prevent cervical cancer. The overall knowledge assessment showed that majority of the student group had below average score. 70 participants scored above average, 204 participants scored average and 356 participants scored below average. 14.6% girls were HPV vaccinated and 26.5% were not aware of their vaccination status. The study demonstrated a positive attitude towards willingness to get vaccinated and spreading awareness to friends and families. In our study, 76.9% of Male students were also aware that vaccination for HPV is also available for both gender. Conclusion: The study results showed the need for educational and awareness sessions on HPV virus infections among healthcare students. Health care providers must share the knowledge to the students which can contribute majorly in spreading the awareness among young adults, patients and community regarding uptake of HPV vaccinations and prevention of acquiring HPV infection.

DOI: 10.5281/zenodo.

Background: Sigmoid volvulus is a common cause of large bowel obstruction and its mortality remains significant in patients with late diagnosis. Procedure performed for the condition also affects the mortality of the case. Options available are sigmoidopexy, resection and anastamosis and temporary diversion by stoma. Aim of the study was to assess the clinical presentation, management and outcome of sigmoid volvulus. Methodology: A Prospective observational study done in the patients treated for sigmoid volvulus in the Department of General Surgery in a Tertiary Care Centre over a period of 2 years. Results: A total of 10 patients (M: F = 2:3) representing 8.92% of all cases of intestinal obstruction were studied. 6 cases presented in acute emergency and 4 cases had recurrent or chronic cases. 5 patients were treated with Hartman’s procedure and 5 had resection and primary anastamosis. The average length of hospital stay was 14 days. A case (10%) was dead due to sepsis related issues and 3 cases had surgical site infection. Conclusion: Management of sigmoid volvulus depends on bowel condition, patient’s presentation and physiological status. Colostomy should be considered if the bowel is gangrenous or perforated or patient in shock, resection anastamosis is advised in recurrent and in patients with no shock and sepsis.

DOI: 10.5281/zenodo.

Background and Aim: PRP is a viable option for treating rotator cuff disease, providing an alternative to corticosteroid injections. In this study, our main goal was to observe and evaluate the effectiveness of two different treatment methods in terms of providing relief from symptoms and improving range of motion. We also wanted to determine how long the patients remained symptom-free and how much their overall function improved during the follow-up period. Material and Methods: A clinical outcome study was conducted in the orthopaedics department of a Tertiary Care Teaching Institute in India for duration of 1 year. In this study, 100 patients who tested positive for supraspinatus tendinitis and had MRI results suggesting the same condition were divided into two groups. The groups were determined based on whether the patients received intra-articular CS or PRP injection under ultrasonography guidance. Patients were monitored to evaluate their progress at 6 weeks, 3 months, and 6 months after the intervention. Results: VAS scores for pain, activity, and satisfaction, as well as the OSS scores and CM scores, were similar before the injection. There was a notable contrast between the two groups in terms of patients with a history of overhead activity. In the PRP intervention arm, 64% of patients had this history, while in the CS intervention group, only 36% did. The PRP group showed significantly better scores for both OSS and CM compared to the other group, even though there were only slight differences in the scores at 6 weeks and 3 months. Conclusion: Our study found that both the corticosteroids and PRP group showed improvement in all the parameters. However, the PRP group showed a significant reduction in pain at the 6-month follow-up, as evidenced by improved VAS score. Additionally, the PRP group also showed improvements in functional ability and quality of life, as indicated by the Oxford shoulder score and constant Murley score.

DOI: 10.5281/zenodo.

Background and Aim: Surgical procedures below the umbilicus have typically been recommended to utilize caudal blocks. Their popularity has grown in pediatric cases due to their simplicity and low risk of complications. Some sources have mentioned the use of this technique as the only form of anesthesia in children who may not be suitable for general anesthesia. Our objective was to compare two different methods of administering caudal block in paediatric patients. Material and Methods: A study was conducted on 100 patients between 6 months to 5 years of age, who were divided into two groups (Group A and Group B) of 50 patients each. Comparisons were made between both groups in terms of intra-operative analgesia, haemodynamic parameters, time required to perform the block, and demand for rescue analgesia. Results: The intra-operative haemodynamic parameters were similar in both groups. Group B took significantly longer to perform the block compared to Group A. The statistical significance level was found to be less than or equal to 0.05. In Group A, the success rate at first puncture was 52%, while in Group B it was 48%. Most patients reported feeling calm and at ease during the first hour after their surgery. The need for additional pain relief after surgery was similar in both groups. Conclusion: the caudal block is a commonly used regional anesthesia technique in the pediatric population. The conventional technique is known for being easier and less time consuming compared to the ultrasound-guided technique, which is relatively new and requires expertise from the practitioner.

DOI: 10.5281/zenodo.

Background: Liver cirrhosis is a condition that is frequently seen in clinical settings and causes a considerable amount of morbidity and mortality worldwide. This is a slowly progressing, chronic illness that affects the liver in a diffuse manner. It is linked to nodule formation; excessive collagen deposition that causes fibrosis, liver cell degeneration, and abnormal vascular architecture that alters hemodynamics. The aim of the present study is to evaluate cardiac function in liver cirrhosis patients. Methods: Between April 2023 and March 2024, 74 patients with a diagnosis of liver cirrhosis who were admitted to the Department of Medicine at the DMCH in Laheriasarai, Bihar, participated in a cross-sectional study. Results: 59 cases (79.73%) in all had an LVDD diagnosis. Of them, Stage 1 LVDD (impaired relaxation) accounted for 47.29% of cases, Stage 2 LVDD (pseudo normal) for 31.08%, and Stage 3 LVDD (severe restrictive type) for just one patient. Conclusion: While systolic function is preserved until severe hepatic failure, left ventricular diastolic impairment is frequently linked to the progression of hepatic dysfunction.

DOI: 10.5281/zenodo.

Background: Acute kidney damage (AKI), a major consequence of Plasmodium falciparum malaria, is well-known; nevertheless, Plasmodium vivax malaria is now frequently responsible for this consequence. AKI is also caused by P. vivax malaria, according to numerous recent publications. The purpose of this study is to examine the demographic profile, clinical characteristics, mortality indicators, dialysis requirement, and overall outcome in P. falciparum and P. vivax malaria patients. Methods: From April 2023 to March 2024, a prospective observational study involving patients diagnosed with malaria with signs of AKI was carried out in the Department of Medicine at Darbhanga Medical College and Hospital in Laheriasarai, Bihar. Rapid malarial antigen testing and thick and thin peripheral smears stained with Leishman’s stain were used to confirm the diagnosis of malaria. A suitable statistical analysis was conducted to examine different parameters. Result: Out of 200 cases of P. falciparum and 220 cases of P. vivax malaria, 43 (21.5%) and 58 (25.1%) cases of AKI caused by P. vivax malaria, respectively. In both groups, the majority of patients were under 30 years old. The majority of those affected in both groups were female. In P. falciparum malaria, pallor, hypotension, oliguria, sepsis, and altered sensorium were frequently observed.P. vivax malaria was more likely to cause jaundice, vomiting, thrombocytopenia, hepatomegaly, and splenomegaly. In both P. falciparum and P. vivax malaria, oligouria, anemia, acute respiratory distress syndrome (ARDS), disseminated intravascular coagulopathy (DIC), cerebral malaria, hypotension, hyponatraemia, and hyperbilirubinemia were often linked independent risk factors for mortality. Patients with P. falciparum and P. vivax malaria were treated with a combination of artesunate and antimalarial drugs. Haemodialysis was used in 13 (30.23%) P. falciparum cases and 17 (29.31%) P. vivax cases. Nineteen (15.52%) patients with P. vivax malaria AKI and five (11.62%) patients with P. falciparum malaria AKI perished. Conclusion: AKI was prevalent in malaria caused by P. falciparum and P. vivax. In the majority of India, malaria significantly increases morbidity and mortality. Early detection and treatment can lead to better results.

DOI: 10.5281/zenodo.

Background: Diabetes mellitus (DM), cardiovascular disease, and other illnesses can be brought on by obesity. Overweight people are becoming more and more common both globally and in our nation. Determining body fat accurately may aid in evaluating an obese person’s risk of developing certain ailments. In order to compare the aforementioned parameters between first degree relatives of diabetic and non-diabetic patients, this study was designed to measure body fat percentage (PBF) of first degree relatives of diabetic patients, estimate body mass index (BMI), and determine the risk factors for developing diabetes. Method: A total of 1000 participants were included in the study and were split into two groups: 500 individuals in group A had a clear family history of diabetes, while 500 individuals in group B did not. Comprehensive clinical, anthropometric assessment, fasting plasma glucose (FPG), and other pertinent biochemical analyses were performed. Result: Body fat percentage (PBF) was high in 76% of participants in group A (study group) compared to 41.2% in group B (control group) (p < 0.001).47.6% of respondents in group B were overweight (p < 0.0001), compared to 73% of subjects in group A who were overweight (BMI > 25 kg/m2). Similarly, 52% of group A and 9.6% of group B were found to have diabetes, respectively (p < 0.0001). Conclusion: PBF may be a crucial screening tool for identifying individuals who may have diabetes and may also be useful in directing lifestyle change strategies for the promotion of health.

DOI: 10.5281/zenodo.

Background: One typical procedure used when there is a maternal or fetal indication for a pregnancy termination is induction of labor (IOL). Pregnant women are inducing labor in large numbers in both developed and developing nations. This study compared the efficaciousness of sublingual, vaginal, and buccal misoprostol for inducing labor in a full-term pregnancy. Methods: From July 2023 to December 2023, this study was conducted at the SKMCH, Department of Obstet-rics and Gynecology in Muzaffarpur, Bihar. A random allocation of 150 subjects was made to receive 50 μg of buccal, 25 μg of vaginal, and 50 μg of sublingual misoprostol. The problems for the mother and fetus, as well as the hour 1 and hour 6 Bishop Scores, were noted. Results: Between the three groups, there were no differences in maternal (P>0.05) or fetal (P>0.05) problems. Additionally, there were no differences between these groups for Bishop score hour 1 (P = 0.146), Bishop score hour 6 (P = 0.704), or total dose (P = 0.15). Based on the buccal, sublingual, and vaginal deliveries that were made in each group, our study identified a difference (P = 0.015) in the three groups’ ability to achieve a con-ventional vaginal birth within a day. Compared to the other groups, the Buccal group used oxytocin at a higher rate (P = 0.022). Conclusion: This study found that while there was no difference in the three groups’ rates of fetal and maternal problems, there was a significant difference in the use of oxytocin and vaginal deliveries within 24 hours of the start of induction.

DOI: 10.5281/zenodo.

Background: One significant issue facing infertile women with polycystic ovarian disease (PCOD) is clomi-phene resistance. Patients would have a better prognosis if the causes were identified. The purpose of this study was to identify the various PCOD phenotypes and how they affected infertile women’s clomiphene resistance. Methods: The Department of Obstetrics and Gynaecology, SKMCH, Muzaffarpur, Bihar, referred 100 consecu-tive PCOD women with infertility who was taking clomiphene from Sadar Hospital and private nursing homes between August 2023 and January 2024. The study was a descriptive-comparative cross-sectional study. The impact of various PCOD phenotypes on these women’s clomiphene resistance was evaluated. Results: According to the findings, 39 (39.0%), 7 (7.0%), 26 (26.0%), and 28 (28.0%) patients, respectively, exhibited the A, B, C, and D phenotypes. Resistance was present in 31 patients (31%). A (HA+OA+PCO) was the most prevalent PCOD phenotype, observed in 48.4% of patients, while D (OA+PCO) was shown in 25.8% of patients. However, there was no significant difference in the phenotypes (P=0.064). Conclusion: According to the results, there was no significant association between PCOD phenotypes and clomiphene resistance. Finally, A and D phenotypes were frequent types with clomiphene resistance.

DOI: 10.5281/zenodo.

Objectives: The currently recommended technique of sentinel lymph node biopsy (SLNB) in breast cancer is a combination of blue dye (commonly used isosulfan blue or Patent blue violet) and radiotracer-guided technique (Tc99m-labeled sulfur colloid).  Neither of the blue dyes are currently marketed in India, are expensive to import, and not easily available. Nuclear medicine facilities are not available at most centers. This study involves using a combination of methylene blue dye and fluorescein dye to detect sentinel lymph nodes. Materials and Methods: This is a prospective, observational study. Patients with first time detected T1 or T2, N0 and M0 breast cancer were eligible for this study and taken up for SLNB using dual dye technique (methylene blue dye and sodium fluorescein dye). N0 status was confirmed both clinically and radiologically. Patients with a previous history of malignancy and those who received neoadjuvant chemotherapy were excluded from this study. Statistical analysis was done with Statistical Package for the Social Sciences (SPSS) version 20.0. Results: In this study we present outcomes of 50 patients who underwent sentinel lymph node (SLN) biopsy using a combination of methylene blue and fluorescein dye at our institute. Mean age was 51.8 years and range was 32-70 years. Sentinel node was successfully identified in 47 cases, thereby a 94% of identification rate was observed with this dual method technique and the median sentinel nodes were 2. Among a total of 98 detected sentinel nodes, 47(47.9%) had both blue dye and fluorescein dye uptake. Conclusion: Fluorescein dye is a very cheap alternative to radioactive tracer technique; hence it can be used as an alternative especially in resource constrained countries like ours.

DOI: 10.5281/zenodo.

Background: The fractures of both bones forearm are one of the commonest fractures (14%). These fractures can be treated by various methods. The accepted management for fractures of both bones forearm is open reduction and internal fixation using compression plating. Objective: to study the functional outcome of treating diaphysial fracture both bone forearm using compression plating, duration of union with compression plating and its functional outcome.Methods: This prospective study was carried out from January 2021 to June 2022 in Adichunchanagiri Institute of Medical Sciences, B.G. Nagara, Mandya India, in this study period 33 cases of fracture both bones of forearm were treated by open reduction and internal fixation using Compression Plate. Results: In our series, majority of the patients were males(70%), middle aged (avg age 34.8), with road traffic accidents being the commonest mode of injury(57.57%), involving middle third (72.72%) more commonly affecting the right forearm(51.51%).Transverse or short oblique fractures were most common. The fractures united in all33 patients. Excellent or full range of mobility of elbow and wrist joints were present in 30 patients (90.09%) and 3(9.09%) patients having good range of movements according to F.M. Merek et al scoring system. Conclusions: The compression plating of forearm fractures produce excellent results, the advantage being early mobilization, early union but the complication, duration of surgery and surgical techniques remains unchanged.

DOI: 10.5281/zenodo.

Introduction: Type 2 diabetes mellitus (T2DM) is a prevalent metabolic disorder that significantly increases the risk of infections due to immune dysfunction and other related factors. This study aims to investigate the association between T2DM and various infections in a tropical tertiary teaching hospital in India, focusing on the prevalence, causative organisms, and outcomes of these infections. Methodology: A retrospective study was conducted using medical records from January 2020 to December 2023. The study included 130 T2DM patients and 130 age- and sex-matched non-diabetic controls. Data on demographic characteristics, clinical parameters, and infection details were extracted and analyzed. Statistical analyses included chi-square tests for prevalence comparison and logistic regression to identify risk factors for infections. Results: The prevalence of infections was significantly higher in T2DM patients compared to non-diabetic controls. UTIs (30.0% vs. 13.8%, p = 0.003), SSTIs (21.5% vs. 8.5%, p = 0.002), and respiratory tract infections (34.6% vs. 16.9%, p = 0.001) were notably more common in T2DM patients. Logistic regression analysis revealed that T2DM (OR: 2.25, 95% CI: 1.54 – 3.30, p = 0.001), higher BMI (OR: 1.11, 95% CI: 1.05 – 1.18, p = 0.001), and hypertension (OR: 1.67, 95% CI: 1.11 – 2.52, p = 0.014) were significant risk factors for infections. T2DM patients had longer hospitalization durations (11.2 ± 4.1 days vs. 8.3 ± 3.5 days, p = 0.001) and higher rates of recurrent infections (16.2% vs. 6.9%, p = 0.02). Conclusion: T2DM significantly increases the risk and severity of infections in patients, particularly in tropical regions. Effective diabetes management, infection prevention, and targeted antimicrobial therapies are essential to improve outcomes in this population. Further research should focus on integrated care models and preventive strategies to reduce infection risks in T2DM patients.

DOI: 10.5281/zenodo.

Obstetric cholestasis (OC) is a serious pregnancy condition with poor fetal outcomes. This two-year prospective study at the Jagannath Gupta Institute of Medical Sciences and Technology examined serum bile acid levels and fetomaternal outcomes in 40 pregnant women with OC (2021-2023). The study found that serum bile acid levels above 40 micromol/L increased the risk of preterm delivery, fetal distress, and neonatal asphyxia. These findings make routine bile acid monitoring and early intervention in OC-affected pregnancies crucial to fetal safety. These findings should be confirmed and management strategies optimized in larger research. This study helps explain OC’s effects on pregnancy and highlights serum bile acid levels’ predictive relevance for poor fetal outcomes.

DOI: 10.5281/zenodo.

Background: Implementation of early clinical exposure as teaching-learning methodology in new CBME (competency based medical education) curriculum helps the students to learn basic science subjects with ease & interest. The students get to know the relevance of studying basic science subjects as they are exposed in the clinical field to apply their basic knowledge in medical field. This study has been taken to find out the perceptions of the students to improve the quality of the classes with much more effort for their better understanding. Methodology: This cross-sectional study was conducted among 97 first year medical students in classroom setting of Tripura Medical College, Agartala from November 2022 to June 2023. A pre-tested, semi-structured questionnaire was used to collect required information after their early clinical exposure sessions. The collected data was entered in SPSS 16.0, represented in proportions and p <0.05 was considered as statistically significant. Result: 95.9% students showed interest in this learning process. Majority (79.4%) of the students were motivated to attend more early clinical exposure classes in future as it increases their retention power. 83.5% students agreed to incorporate this learning process in their curriculum. Conclusion: The students were very positive towards this teaching-learning methodology. This learning process not only breaks the monotony of traditional lectures but also reinforce the didactic lectures. With this, the students can correlate the basic science topics with clinical facts better. For better implementation of these classes, both the pre-clinical & clinical departments should be well coordinated.

DOI: 10.5281/zenodo.

This observational cohort study analyzed the impact of glycemic control on the severity and outcomes of COVID-19 in 60 patients with diabetes mellitus at BMIMS Pawapuri, Nalanda, Bihar for 2 years. Our results demonstrated that patients with poorly controlled diabetes (HbA1c > 7.5%) experienced significantly worse COVID-19 outcomes, including higher rates of severe symptoms, increased inflammatory markers, and prolonged recovery times. Conversely, patients with well-managed diabetes showed milder symptoms and quicker recoveries, emphasizing the critical role of effective glycemic management in mitigating the adverse effects of COVID-19. The study highlights the necessity of integrating diabetes management with COVID-19 treatment protocols to enhance patient outcomes in pandemics.

DOI: 10.5281/zenodo.

Background: Scrub typhus is a zoonotic rickettsial infection caused by an intracellular gram negative bacterium Orientia tsutsugamushi, transmitted through bites of larval leptotrombiculid mites. The nonspecific clinical presentations, including fever, rash, headache, nausea, vomiting, and thrombocytopenia, pose a significant diagnostic challenge due to overlapping symptoms with other infections like malaria, chikungunya, dengue, enteric fever, leptospirosis, brucellosis, and malaria. Aims & Objectives: The present study aimed to assess the severity profile of diagnosed patients of scrub-type infection specifically within a hospital in Southern region of Rajasthan, India. Methodology: A hospital-based prospective analytical study was carried out from November 2020 to November 2023 at Pacific Institute of Medical Sciences, Udaipur, Rajasthan. Results:  A total of 350 confirmed cases of scrub type were enrolled in the study. The highest number of patients were seen in the age group of between 41 – 50 years 103 patients (29.42%), this was followed by age groups of 31 – 40 years with patients of 95 (27.14%), 21 – 30 years 41 patients (11.71%), 51 – 60 years and 61 – 70 years each had 32 patients (9.14%). Hepatomegaly was recorded in 144 (41.14%) of the patients, splenomegaly in 145 (41.42%) patients, and lymphadenopathy was noted in 29.71% of the study population. The level of liver enzymes such as SGPT (33.14%), and SGOT (32%) and raised level of blood urea (24.85%), serum creatinine (25.42%) were significantly associated with ST (p-value 0.01). The most common clinical symptoms were fever (100%), headache (88.57%), myalgia (98%), rashes (75.14%), breathing difficulty (63.14%) and conjunctival suffusion (10.57%). The pathognomonic eschar was observed in 83 (23.71%) of the patients. Conclusion: Scrub typhus has emerged as an important cause of febrile illness in the southern region of Rajasthan and can present with varying clinical manifestations with or without eschar. Early laboratory diagnosis and prompt intervention may help in reducing the case fatality.

DOI: 10.5281/zenodo.

Introduction: When Clinical laboratory receive samples with unusual characteristics, laboratory needs to evaluate possible interference and causes. Case Description: Patient with suspected pulmonary and extra-pulmonary tuberculosis has green color of serum. On laboratory examination, anemia, leukocytosis, lymphocytopenia, mixed hyperbilirubinemia, hypoalbuminemia, hyponatremia, elevated creatinine, hypocalcemia, high ferritin with normal iron and low transferrin was found. Conclusion: There is no history of infusion of dye, rheumatoid arthritis. However, possibility of elevated biliverdin and elevated ceruloplasmin as cause for green color of serum could not be ruled out. Looking for causes for abnormal characteristics of serum in clinical laboratory may be useful by providing important clue to underling disorders. However, in limited resource settings, final search for cause for such abnormal characteristics may not always be feasible.

DOI: 10.5281/zenodo.

Aim: To report outcomes of primary posterior sagittal anorectoplasty (PSARP) in neonates with ARM without covering colostomy. Methodology: Fifteen male cases of anorectal malformations (ARM) was enrolled in this prospective observational study. All patients underwent primary PSARP. Krickenbeck classification of post-operative results was used. Assessment of fecal incontinence was done. Voluntary bowel movements, soiling (grade 1 –yes/no, grade 2 –every day, grade 3- constant), constipation (grade -1 yes, grade 2- requiring– laxatives, grade 3 –resistance to laxative) was recorded. After receiving approval from the ethical review commission, we chose fifteen male instances of anorectal malformations (ARM). The study was initiated with parental agreement. Results: The mean gestation age of patients was 36.2±2.7 weeks. The mean weight of neonates was 2.82±1.1 kgs and mean operative time was 64.2±7.3 minutes. Fecal continence was normal in 10 and abnormal in 5 cases. Soiling grade 1 was observed in 12 cases. Urinary continence was normal in 12 cases and abnormal in 3 cases. The difference was significant (P< 0.05). Conclusion: With advent of good anaesthetic speciality and surgical technique, primary PSARP is feasible in well selected neonates with ARM. With this, early anal reflexes are restored. To be done/supervised by experienced pediatric surgeon avoids complications.

DOI: 10.5281/zenodo.

Introduction: Intrathecal nalbuphine hydrochloride has been explored as an adjuvant to bupivacaine for improved anesthesia and analgesia. This study aimed to evaluate its effectiveness in enhancing sensory and motor blocks and reducing postoperative analgesic requirements in patients undergoing abdominal hysterectomy. Material and Methods: This double-blinded, randomized study at a tertiary care center in Gujarat included 60 ASA I and II patients aged 30-60 undergoing elective abdominal hysterectomy. After obtaining informed consent, patients were randomly assigned to receive either intrathecal bupivacaine 0.5% alone (control group) or with 1.6 mg nalbuphine hydrochloride (study group). Baseline vitals were recorded, and spinal anesthesia was administered. Sensory and motor block onset times, duration of surgery, and block regression times were monitored. Postoperative pain was assessed using VAS, and rescue analgesia was provided as needed. Adverse effects were recorded and managed appropriately. Data analysis was performed using SPSS 21.1 with one-way ANOVA and post hoc Tukey tests. Results: The study group had a faster onset of sensory block (4.1±0.7 minutes vs. 6.3±1.0 minutes, P=0.03) and motor block (4.1±0.8 minutes vs. 6.8±1.3 minutes, P=0.00). The time for two-segment regression was longer in the study group (120.0±20.0 minutes vs. 92.0±4.0 minutes, P=0.03), and the duration of motor block was extended (132.0±21.0 minutes vs. 115.0±15.0 minutes, P=0.02). The study group required the first rescue analgesic later (215.0±30.0 minutes vs. 135.0±18.0 minutes, P=0.01) and a lower total dose of diclofenac (160.0±28.0 mg vs. 225.0±20.0 mg, P=0.02) within the first 24 hours. Adverse effects such as hypotension, bradycardia, respiratory depression, nausea, vomiting, and pruritus were observed but were not statistically significant between the groups (P>0.05). Conclusion: In conclusion, our study demonstrates that intrathecal nalbuphine hydrochloride, when used in combination with bupivacaine 0.5%, significantly improves the onset and duration of both sensory and motor blocks compared to bupivacaine alone.

DOI: 10.5281/zenodo.

Introduction: Proliferative diabetic retinopathy (PDR) is a severe complication of diabetes that can lead to significant vision loss. Pars plana vitrectomy (PPV) is a surgical treatment option, but its outcomes without pre-operative anti-VEGF therapy need further study. Aim: To investigate the anatomical and visual outcomes in patients with PDR undergoing PPV without pre-operative anti-VEGF treatment. Material and Method: This prospective interventional study was conducted at a tertiary eye care hospital from July 2020 to July 2022, involving 52 eyes from 52 patients. Comprehensive pre-operative and post-operative evaluations were conducted, and patients were followed up at one week, one month, and three months postoperatively. Results:  The mean age of patients was 53.29 years, with a predominance of males. Most patients had type 2 diabetes for an average of 10 years. Vitrectomy with silicone oil tamponade was used in most cases, with 12% of cases also undergoing cataract surgery. The primary indications for surgery were non-resolving vitreous hemorrhage and tractional retinal detachment. Significant visual improvement (p=0.0008) was observed one-month post-surgery, which continued through the three-month follow-up (p=0.006). Visual recovery was slower in cases with tractional retinal detachment compared to other indications. Early post-operative complications included bleeding and vitreous hemorrhage. Eyes with macula-involving tractional retinal detachment had poorer visual outcomes compared to those without macula involvement. By the end of the study, one case of vitreous hemorrhage and two cases with traction were noted. Conclusion: Pars plana vitrectomy effectively improves visual acuity in proliferative diabetic retinopathy patients without pre-operative anti-VEGF therapy. There is a risk of immediate post-operative rebleeding, and visual recovery is slower in tractional retinal detachment cases. Visual improvements are sustained short-term, though outcomes are poorer in macula-involving cases.

DOI: 10.5281/zenodo.

Background: Lower abdominal surgeries may be performed under regional (spinal or epidural) or general anesthesia. The aim of our study is to compare the effectiveness of dexmedetomidine and butorphanol on perioperative hemodynamics, sedation, and postoperative analgesia for patients undergoing lower abdominal surgery. Materials and Methods: The randomized prospective study of one year was conducted in the Department of Anesthesiology, King George’s Medical University, Lucknow after getting approval from the Institutional Ethics Committee of the University and informed consent from all the patients. Total 66 patients were included in this study as per inclusion and exclusion criteria and divided into two groups: Group A [n=33]: Butorphanol was given as 0.10 mg/kg in 50 ml saline as a single dose slow infusion over 10 minutes, and Group B [n=33]: Dexmedetomidine was given as 1.5 mcg/kg in 50 ml saline as a single dose slow infusion over 10 minutes. Result: In our study mean age in group A was 31.20±6.27 years and group B was 32.72±6.02 years, where p value was 0.321. No significant difference of ASA I and ASA II between group A and group B, where p value was 0.071 in our study. In our study there was significant difference between group A and group B in comparison of mean arterial pressure at 5 min ,10min and 24 hrs having p value of .027,.040 and .040 respectively. There was significant difference between group A and group B in comparison of VAS score at 24hrs, 48hrs, 72hrs p value were <.001, <.001 and <.001 respectively. In our study significant difference between group A and group B in comparison of Sedation score at baseline, 1 hr, 6 hrs, 12 hrs, 48 hrs and 72 hrs, the p values were <0.001, <0.001, <0.001, <0.001, 0.025 and <0.001 respectively. In our study, bradycardia was noted in 6.06% patients of group A and 3.03% patients of group B, there was no statistically significant difference between both the groups. There was significant difference between group A and group B in comparison of nausea, vomiting and constipation, where p values were 0.049, 0.031 and 0.048 respectively.  Conclusion: The present study concludes that group B (dexmedetomidine) drug has been found to have better control in heart rate, mean arterial pressure with better sedation and good postoperative analgesia as compared to group A (butorphanol) drug.

DOI: 10.5281/zenodo.

Purpose: Many surgical approaches to hip have evolved over the period of time. The most commonly used surgical approach for Hemireplacement Arthroplasty is Moore’s posterior approach. However, due to complications such as dislocation after the procedure, new approaches like Hardinge’s lateral approach is gaining popularity and is becoming widely accepted. But, there are very few studies to compare the outcome and complications associated with both the approaches. The purpose of this study is to compare outcomes, as well as complications associated with Hemireplacement Arthroplasty in neck of femur fractures by posterior and lateral approach. Methodology: 100 enrolled patients were evaluated from the emergency department/OPD and were distributed in two groups having 50 patients each undergoing hemireplacement arthroplasty with modular bipolar prosthesis by Moore’s posterior approach and Hardinge’s lateral approach and were followed up. Results: Incidence of dislocation was found higher in patients operated by posterior approach. Intraoperative blood loss and length of incision was higher in posterior approach than lateral approach. There were some instances of surgical site infections in both the approaches but was statistically insignificant. Conclusions: There are no notable differences in outcomes and complications between the two approaches. Neither lateral nor the posterior approach seems to offer a clear advantage over each other except intraoperative blood loss and length of incision. With methodological limitations as mentioned in this study, the interpretation of this study remained limited. Therefore, further multicentre, randomized controlled studies on a larger sample with long-term follow-up should be implemented to conclusively ascertain the outcomes.

DOI: 10.5281/zenodo.

Introduction: Clubbing and Hypertrophic Pulmonary osteoarthropathy (HPOA) are the two manifestations of a clinical syndrome which is referred to as hypertrophic osteoarthropathy (HOA). HPOA involves abnormal proliferation and of skin and periosteal tissues of the extremities. It can be primary (Pachydermoperiostosis) or secondary to chronic lung and heart diseases. Case report: A 23 year old man presented with complaints of pain and swelling of right ankle. Initially an inflammatory arthritis was suspected but presence of high grade clubbing in all his digits gave way to a suspicion of HPOA. Patient is known case of emphysema with a history of recurrent respiratory illness in childhood. Conclusion: As is the case with most HPOA cases reported in literature, the clinical presentation mimicks that of an inflammatory arthritis. Close attention has to be paid especially to signs like digital clubbing which can point to a more sinister underlying cause like a primary lung malignancy.

DOI: 10.5281/zenodo.

Introduction: As the technology becoming an integral part of our lives with its harmful impact on the personal health. The screen time is the time spent involving digital screen-based or electronic media devices e.g. television, video games, computer screen and smartphones, as recommended by the American Academy of Pediatrics, is not >2 h/day to all children, Adolescents and Adults who are above 2 years of age.  Time that spent with the screens in any form mentioned above is an important risk factor for childhood Obesity and Overweight and other metabolic health issues. So It is Important to screen the population who at higher risk to developing sedentary lifestyle, which can lead so many consequences and adverse outcomes in their later life. Objectives: To estimate the prevalence of screen time in children and adolescents aged 10-19yrs. Method: In this cross-sectional study determined the prevalence of screen time use on screen based media conducted after the peak post COVID-19 period. Questionnaire forms were filled by the students by the visiting schools and interacting with the students in school hours. Results: Out of the (n=500) population majority of students 262 (52.4%) were using Screen based media <2 hours per day and 238 (47.6%) students were using Screen based media >2 hours per day. Conclusion: It is also notable that in some studies which were conducted during the COVID-19 pandemic and with social distancing, in that the screen time may not significantly having negative interference with the health and well-being, because it was the only connecting way to remain socially aware. Although screen-based media usage have so many benefits also, such as awareness and communication.

DOI: 10.5281/zenodo.

Background & Aim: Post-operative sore throat is the discomfort in throat which often leads to an immense deal of uneasiness in patients. Recently micronutrient Vitamin C is being studied for its antinociceptive properties. Its role in management of acute and chronic pain has been documented in various studies. Against this background, the present study aimed to evaluate the role of vitamin C on severity of postoperative sore throat following endotracheal intubation in patients receiving general anaesthesia. Methodology: The present study was a prospective, randomized, double blind, placebo-controlled study conducted after approval from Institutional Ethical Committee. After obtaining informed written consent, 100 adult patients with Mallampati class 1 & 2 undergoing elective surgical procedures under general anaesthesia requiring endotracheal intubation, with successful intubation in single attempt were included in this study. Patients were randomly allocated to 2 groups: Group 1 (n=50) received injection vitamin C 2gm in 500 ml of NS; Group 2 (n=50) patients received 500 ml of NS intraoperatively. Severity of sore throat, VAS, analgesic consumption and side effects were recorded at 0, 6, 12 and 24 hours postoperatively. Results: Demographic parameters were comparable between the two groups. POST severity score was significantly lower in group 1 as compared to group 2 at 0, 6 and 12 hours postoperatively. Similarly, VAS scores were significantly lower in group 1 as compared to group 2 at 0, 6 and 12 hours postoperatively. Total amount of analgesia consumption was significantly higher in group 2 as compared to group 1 (p=0.03). No side effects were recorded related to vitamin C during our observation period in any patient. Conclusion: Vitamin C plays a significant role in reducing the severity of post-operative sore throat following endotracheal intubation in patients receiving general anaesthesia for surgical procedures lasting less than 3 hours of duration.

DOI: 10.5281/zenodo.

Background: CKD, which is referred as chronic renal failure, has been concluded recently among the group of lifestyle diseases of 21^st century, which is often characterized as a progressive and often irreversible disorder. Materials and Methods: This study has been performed among renal failure patients of both males and females in the age group of 18 to 65 years and those who were on dialysis. The aforementioned study was done before and 4 hours after performing hemodialysis. Samples were collected from the Regional Institute of Medical Sciences, Imphal, Manipur, from the study period of February 2016 to January 2017. 15 normal persons with the normal renal parameters without any history of renal disorder in the past were also selected in between this comparable age group. SPSS software is used for collection, analysis and summarization of all the data. Results: The values of blood urea were significantly higher among the pre-dialysis group. On the other hand, the blood urea level among the post-dialysis group was found to be significantly lower. While serum copper values among both the pre-dialysis and post dialysis groups were significantly lower as compared to the control group. Serum calcium levels in the pre-dialysis group were found to be lower. We also found that serum phosphorus levels among the pre-dialysis group were significantly higher as compared to the post-dialysis group. Conclusions: The serum concentrations of calcium and sodium which are obtained in post-dialysis depend upon the composition of dialysate of aforementioned elements and serum available for the ultra-filtration.

DOI: 10.5281/zenodo.

Background: The choice between layered closure and retention closure should be individualized based on patient factors. The present study was conducted to compare layered closure and retention closure technique for the abdominal wall in midline laparotomy. Materials & Methods: 114 patients undergoing elective or emergency midline laparotomy of both genders were divided in to two groups of 60 and 54 in each depending on the closure type, layered closure (Group I) and retention closure (Group II) depending on the operating surgeon: retention closure was done in a single surgical unit and layered closure was done in rest of the respective units. Patients were followed-up meticulously and immediate postoperative complications were recorded up to four weeks. Results: Group I had 32 males and 28 females and group II had 24 males and 30 females. Pain score at day 1 was 3.4 and 3.8, at day 2 was 3.2 and 3.5, at day 3 was 2.5 and 2.8 and at day 7 was 2.1 and 2.5 respectively. Closure status had no dehiscence seen in 50 and 53, partial dehiscence in 7 and 1 and complete dehiscence in 3 and 0. Wound healing with primary intention seen in 58 and 50 patients in group I and II and secondary intention seen in 2 and 4 patients respectively. The difference was significant (P< 0.05). Conclusion: Retention closure found to be advantageous over layered closure.

DOI: 10.5281/zenodo.

Background: Laparoscopic cholecystectomy is a minimally invasive surgical procedure used to remove the gallbladder, commonly performed to treat gallstones and other gallbladder-related conditions. Aim: The present prospective study was conducted to compare the changes in the levels of liver enzymes in the immediate and delayed postoperative period following Open Cholecystectomy and laparoscopic cholecystectomy. Materials & Methods: 70 patients with laparoscopic cholecystectomy of both genders were divided into 2 groups of 35 each. Group I underwent laparoscopic cholecystectomy and group II open cholecystectomy. Levels of alkaline phosphatase (ALP), aspartate transaminase (AST), alanine transaminase (ALT) and total bilirubin were noted in the preoperative period, 24 hours after the surgery and seven days after the surgery was determined. Results: In group I, males were 21 and females were 14. In group II, males were 18 and females were 17. The mean ALP (IU/L) level, pre- operative, 24 hours and 1 week was 91.4±20.13 and 85.32±16.91, 84.9±19.50 and 87.3±18.12 and 85.1±15.91 and 84.2±20.10 in group I and II respectively. The mean ALT (IU/L) level pre- operative, 24 hours and 1 week was 31.7±9.50 and31.5±10.20, 29.5±9.17 and 26.7±7.10 and 50.2±14.39 and 25.6±6.10 in group I and II respectively. The mean AST (IU/L) pre-operative, 24 hours and 1 week was 30.5±7.90 and 32.1±17, 31.8±10.1 and 27.5±6.90 and 53.69±19.91 and 26.7±6.50 in group I and II respectively. The mean total bilirubin (mg/dL) level was 0.63±0.21 and 0.61±0.29, 0.59±0.19 and 0.61±0.15 and 0.781±0.259 and 0.52±0.15 pre- operative, 24 hours and 1 week in group I and II respectively. The difference was significant (P< 0.05). Conclusion: The levels of ALT, AST, and total bilirubin rose significantly but briefly after LC, whereas the levels of ALP did not change significantly in the first 24 hours after LC, which was not the case for OC.

DOI: 10.5281/zenodo.

Background: The present study was conducted for assessing and comparing Postoperative Outcomes of Laparoscopic Cholecystectomy (LC) with or without Abdominal Prophylactic Drainage. Materials & Methods: A total of 200 patients scheduled to undergo LC were enrolled. Distribution of all the patients was done into two study groups as follows: Group 1: Patients with Abdominal prophylactic drainage, and Group 2: Patients without Abdominal prophylactic drainage. Only patients with uncomplicated chronic calculus cholecystitis were enrolled. Data have been collected through interview, clinical examination, and scrutinizing relevant medical records. Incidence of Postoperative nausea and vomiting along with postoperative pain was evaluated. All the results were recorded in Microsoft excel sheet and was subjected to statistical analysis using SPSS software. Results: Mean duration of surgery among group 1 and group 2 subjects was 115.6 minutes and 79.2 minutes respectively (p-value < 0.05). Incidence of postoperative nausea and vomiting was significantly higher among patients of group 1. Like-wise incidence of postoperative pain was significantly higher among subjects of group 1. Conclusion: Patients without abdominal drain were associated with decrease duration of surgery and lower incidence of PONV and postoperative pain.

DOI: 10.5281/zenodo.

Background: This research aims to compare the outcomes of continuous and interrupted abdominal wall closure techniques in emergency midline laparotomy, specifically focusing on the incidence of incisional hernia and ruptured abdomen as the key endpoints. Aim: Comparison of continuous and interrupted abdominal wall repair techniques after emergency midline laparotomy. Material and Methods: Patients who had undergone laparotomy in the past and were scheduled for a second look procedure were not included in the study. However, patients who had undergone minor laparoscopic surgery in the past were included. The 100 patients were evenly split into two groups, with 50 patients in each group. Both groups were required to maintain a maximum stitch spacing of 1.5 cm and a minimum distance of 2 cm from the border of the fascia. The patients in the continuous suture group had their abdomen closed using a continuous, all-layer suture technique. Results: The average length of hospitalization was comparable across the two groups (C: 17.45 ± 14.58 days, I: 18.94 ± 14.12 days). 8.21% of patients had laparostomy, resulting in their exclusion from further investigation of hernia/dehiscence. The incidence of burst abdomen after 30 days or incisional hernia after 12 months did not vary between the continuous and interrupted groups. In the continuous group, 16% had burst abdomen or incisional hernia, whereas in the interrupted group, 22% experienced these complications. The total mortality, regardless of the reason, was 34 individuals. There was no significant difference in mortality between the groups, with 10 individuals (16.9%) in both the control group (C) and the intervention group (I). The p-value for this comparison was 0.24. The duration required for fascial closure was much shorter in the continuous group compared to the interrupted group (C: 13.66 ± 5.10 min versus 18.14 ± 5.96 min; p < 0.001). Conclusion: This randomized controlled trial (RCT) demonstrated that there was no discernible difference in the occurrence of postoperative burst abdomen and incisional hernia after one year when comparing the use of continuous sutures with slowly absorbable sutures with interrupted sutures with fast absorbable sutures in main emergency midline laparotomy.

DOI: 10.5281/zenodo.

Introduction: Post-operative wound infections are the second most common nosocomial infections to be recorded and they represent a significant global public health concern. Significant morbidity and mortality as well as increased treatment costs and length of hospital stay are caused by postoperative wound infections. Objectives: To assess the bacterial profile and their antimicrobial susceptibility pattern of postoperative wound infections. Methods: Cross sectional study was conducted for a period of one year (January 2023 to January 2024) in the Department of Microbiology at ACS Medical College and Hospital, Chennai. The study included 182 pus and tissue samples from post-operative wound patients.  Samples were processed and isolates were identified by Standard Microbiology guidelines. Antibiotic susceptibility testing (AST) was done by the Kirby- Bauer disc diffusion method and zone size was interpreted based on Clinical and Laboratory standard institute (CLSI) guidelines. Results: Out of 182 isolates, 60.4% were from males. Among the 182 isolates, E. coli (19.2%) and Klebsiella pneumoniae (19.2%) were the most common pathogens followed by Staphylococcus aureus (18.1%), Pseudomonas aeruginosa (15.9%). The least organism isolated was Providencia species (1.6%). Monomicrobial growth was seen in 94% isolates. Out of 182 isolates, 37.3% were gram positive and 68.5% were gram negative isolates.  The antibiotic to which gram negative bacteria reported maximum resistance was ceftazidime (56.7%) and the antibiotic that reported maximum sensitivity was cefepime (73.1%).The antibiotic to which gram positive bacteria reported maximum resistance was ciprofloxacin (50%) and the antibiotic that reported maximum sensitivity was vancomycin (69.3%).Among the Gram Negative Bacteria (GNB) organisms, majority of Extended Spectrum Beta Lactamases (ESBL) producers were Klebsiella pneumoniae (42.8%) and Amp-C producers were Pseudomonas aeruginosa (37%). Conclusion: The incidence of post-operative wound infections will undoubtedly decline with rigorous adherence to infection and prevention control practices, maintenance of good hand hygiene and appropriate preoperative, intraoperative and postoperative patient care.

DOI: 10.5281/zenodo.

Myofascial pain syndrome (MPS) is a common cause of musculoskeletal pain, accounting for 20% to 95% of cases in medical and pain management clinics. It is often characterized by myofascial trigger points (MTrPs) in the neck, shoulder, or back muscles, leading to significant discomfort and reduced functionality. These hyperirritable spots in muscle fibers, when mechanically stimulated, cause local and referred pain. Despite the unclear pathophysiology, overuse injuries, oxygen and nutrient deficiencies, and involuntary muscle contractions are considered contributing factors. Diagnosis relies on physical examination and patient history, with digital palpation being the primary method for identifying MTrPs. This study aimed to compare the efficacy of extracorporeal shock wave therapy (ESWT) with exercises versus ultrasound therapy (UST) with exercises as treatments for MPS. Sixty patients with MPS in the neck, shoulder, or back muscles were enrolled in a prospective metacentric study. Patients were randomized into two groups: 36 received ESWT, and 24 received UST. Both groups underwent their respective treatments followed by stretching and strengthening exercises. Pain and tenderness were assessed using the Visual Analog Scale (VAS) and the Tenderness Grading Scale (TGS) before treatment and four weeks later. Results indicated a greater reduction in pain and tenderness in the ESWT group compared to the UST group. The ESWT group showed a 55.3% reduction in VAS scores and a 57.9% improvement in TGS scores, while the UST group exhibited a 22.7% reduction in VAS scores and a 24.3% improvement in TGS scores. Minor adverse events were reported in both groups, but no serious adverse events occurred. In conclusion, ESWT combined with exercises demonstrated superior efficacy in reducing pain and tenderness in MPS patients compared to UST combined with exercises. Early initiation of stretching exercises contributed to better long-term outcomes and a lower recurrence of pain and discomfort. Effective recognition and prompt treatment of MPS are crucial for alleviating symptoms and improving patient quality of life.

DOI: 10.5281/zenodo.

Ursodeoxycholic acid (UDCA) is a bile acid that can help dissolve certain types of gallstones, specifically cholesterol gallstones. It works by reducing cholesterol production in the liver and increasing bile acids in the bile, which aids in dissolving the stones over time. UDCA therapy typically involves oral medication in tablet or capsule form, and the dosage and duration of treatment vary based on factors such as the size and number of gallstones. While UDCA can be effective for some individuals with cholesterol gallstones, it may not work for everyone, particularly those with larger or calcified stones. It’s essential to consult with a healthcare professional to determine the most appropriate treatment approach for gallstones, which may include UDCA therapy or surgical removal of the gallbladder.

DOI: 10.5281/zenodo.

Background and Objectives: Serum PSA (prostate-specific antigen) measurement plays a vital role in prostate cancer screening and management. Studies suggest that men with type 2 diabetes mellitus tend to have lower PSA levels compared to non-diabetic men. This study aimed to explore the differences in PSA levels between type 2 diabetics and healthy men. Methods:The study was conducted over a period of one year in our institution. 45 diabetic men aged (40-79) years as cases and age-matched non-diabetic controls were included (fulfilling the inclusion and exclusion criterias). PSA, glucose, and glycated haemoglobin (HbA1C) levels were estimated by immunometric immunoassay, glucose oxidase peroxidase and turbidimetric methods respectively in Vitros 5600 autoanalyzer. Results: The mean PSA was significantly lower in diabetic men than non-diabetic (0.560 ng/ml vs 1.052 ng/ml; p=0.003). PSA showed a negative correlation with HbA1C in cases (r = -0.303;p = 0.043). Diabetics with HbA1C more 7% had significantly lower PSA than those with HbA1C less than or equal to 7%. Additionally, PSA levels were lower in diabetic men with a disease duration exceeding 5 years compared to those with a shorter duration. Interpretation and Conclusion: These findings suggest that glycemic status and diabetes duration may influence PSA levels in diabetic men, highlighting the importance of considering these factors when interpreting PSA test results to ensure optimal clinical outcomes.

DOI: 10.5281/zenodo.

Objective: Intrauterine growth restriction (IUGR) is associated with numerous neonatal complications in the affected fetuses. We undertook this study to assess whether myocardial tissue Doppler, found to detect subclinical cardiac dysfunction in IUGR, is an effective tool in predicting the neonatal outcome. Materials and Methods: It was a prospective cohort study in a teaching hospital conducted on fetuses affected by IUGR. Cardiac function was evaluated with the help of Myocardial Tissue Doppler (Right and Left Ventricular and Interventricular septal E’, A, E’/A’ and Myocardial performance index (MPI’)) and correlated with their neonatal outcomes. Results: Among the sixty-two fetuses taken, there were 3 mortalities, two developed cardiomegaly and fifteen developed respiratory distress. Right ventricular MPI’ was found significantly reduced in fetuses with adverse neonatal outcomes. Fetuses with adverse neonatal outcomes had both abnormal conventional vessel and myocardial tissue Doppler while significant number of fetuses with normal outcomes only had abnormal myocardial tissue Doppler. Right ventricular MPI’ had sensitivity of 40 % in detecting adverse neonatal outcomes and of 60% in detecting fetuses with normal outcomes. Conclusion: Myocardial tissue Doppler has good sensitivity in predicting normal neonatal outcome in fetuses with IUGR. It is however not a sensitive indicator of adverse outcome in IUGR in comparison to conventional vessel Doppler.

DOI: 10.5281/zenodo.

Background: Suicide is a significant issue in public health. Throughout the world every year, more than 700 000 people lose their lives to suicide. India ranks 49th in the world in terms of suicide rate in 2019 (14.04% per lakh of population), but it is impossible to ignore the grim fact that India reports the highest number of suicides each year. Objectives: to study the pattern of suicide among patients in a tertiary care center and to assess the factors associated with suicide. Methodology: The cross-sectional study was carried out in a tertiary care hospital located in the Chengalpattu district of Tamil Nadu. Over a period of 8 months, specifically from September 2023 to May 2024. All patients admitted to the ICU after attempting suicide provided data for the study.  The use of a pretested questionnaire to collect data on the sociodemographic characteristics, type, method. Results: Among the 90 patients admitted with suicide attempt, the mean age of patients was 31.48± (12.24) SD years, ranging from 15-80 years. Among them, 62 (68.9%) were females. Majority of the patients from rural area 80(88.9%). Poisoning was the most common cause among suicidal individuals. The major reason for suicidal attempt was family problems 69 (76.7%). Conclusion: Concern is expressed about the rise in self-poisoning suicides in India. The primary causes of self-poisoning suicide attempts were family conflicts, financial difficulties, and psychological problems. In order to provide support, health education, and legislation, doctors, nurses, families, the community, and state leaders must all work together to address the multifaceted issue of attempted suicide by self-poisoning.

DOI: 10.5281/zenodo.

Background: Abdominal trauma caused by blunt force is a common presentation in the emergency room. The chief causes of blunt abdominal trauma are motor vehicle accidents, falls from heights, assault, bicycle injuries, injuries sustained during sporting activities, and industrial accidents. There are several recognized signs of blunt bowel and mesenteric injury at multidetector CT. Familiarity with the appearance of the signs as well as the limitations is crucial to making a timely diagnosis. Results: Most patients were males (77.21%) & most common age group was 21-40 years (73%). Most common mode of injury was road traffic accidents (70%). Ileum (35%) was the most common site of injury followed by jejunum (25%). Most common CT scan findings were mesenteric stranding (73%) followed by free fluid (80%) 93%. The most common solid organ injured was the spleen followed by the liver. The skeletal injury was the most common extra-abdominal injury. Conclusion: Males were more commonly injured most common mode of injury is road traffic/motor vehicle accidents. Most common site of injury is ileum. Most common associated solid organ injury is spleen. Most frequent MDCT findings are mesenteric stranding, free fluid and bowel wall thickening. Most specific findings are bowel wall discontinuity, active extravasation and reduced bowel wall enhancement.

DOI: 10.5281/zenodo.

Background: Understanding the factors influencing happiness among undergraduate medical students is crucial for improving their well-being and academic performance. This study aims to assess the levels of happiness and identify the determinants contributing to happiness among these students. The well-being of medical students is a crucial aspect of their academic success and future professional performance. This study investigates the levels of happiness among undergraduate medical students and identifies key factors influencing their happiness. Methods: A cross-sectional study was conducted among 420 undergraduate medical students of a medical college in Western Maharashtra. Participants completed a structured questionnaire, including the Oxford Happiness Questionnaire and additional sections on demographic and socio-economic information. Data were analysed using descriptive statistics and multivariate regression to identify significant predictors of happiness. Results: Among all the participants, 67.62% of the medical undergraduates were found to be happy. The mean OHQ happiness score was 4.28± 0.72. Female students, young age students, and students belonging to upper socio-economic class were found to be happier. Level of physical activity, good relation with friends/family, absence of stress in past 6 months, own choice of course were significantly associated with happiness. Conclusion: The findings of our study highlight the importance of fostering positive connections and integrating stress management techniques and physical activity into the medical curriculum which will help in alleviating stress in medical students and increase the happiness quotient.

DOI: 10.5281/zenodo.

Background: Transsexuals suffer from constant discomforts on several areas such as, job loss, accommodation, family acceptance, discrimination, emotional upset and so on. Transgender individuals and those with gender dysphoria may also have psychiatric disorders that are independent of their gender concerns, and while even serious mental illness such as major depression, bipolar disorder, borderline personality disorder and schizophrenia are not absolute contraindications to gender transition, they must be adequately treated so as not to interfere with adherence with the transition regimen. Based on this aim of our study is to assess the prevalence of psychiatric co morbidity, substance abuse and suicidal risk in transgender population. Methodology: The study population comprised of both Transmen and Trans women from the community in and around Chennai. A semi structured proforma to collect the relevant sociodemographic details and clinical profile. Mini –International Neuropsychiatry interview (MINI)-plus scale for assessing psychiatric comorbidities. All the analysis was done using statistical package for windows version 22. Results: The study included 88 transgenders with male to female 85 and female to male 3. Coming to history, 22.7% had past history of major depressive disorder, major depression at current is more common in MTF patients than in FTM. Major depressive disorder recurrent is more common in MTF (1.1%) than MTF. In our study, 23.9% of FTM transgender had lifetime risk of suicidality and 66.7% in FTM. 2.3% MTF has risk of Suicidality at present, which is more common than FTM transgender.1.1percentage MTF has risk of suicidality in future.  Sexual abuse was present in 49.4% among MTF. Conclusion: Our study attempted to discern the psychiatric morbidities among the transgender population. Gender identity disorder is a diagnostic entity in its own right, not necessarily associated with severe comorbid psychological findings. The disproportionately high prevalence of physical and/ or sexual abuse within transgender population’s calls for interventions that explore the sources of resilience. Access to routine primary care, diagnostic screening, psychotherapy, pharmacologic treatments, and community-based, pediatric/adolescent clinic settings are needed to address mental health problems and substance use disorders in this population.

DOI: 10.5281/zenodo.

Introduction: Cervical Cancer is the second most common cancer and second leading cause of cancer death among females in India. Early detection through Population Based Screening using Visual Inspection with Acetic acid (VIA) method ensures better management and reduces mortality. Aims/Objectives: The study aims to assess the Cervical cancer screening and follow-up of those found positive in a Tertiary Care hospital in Thiruvallur, The objectives of the study is to determine the VIA positivity rate and the different outcomes of VIA positive patients at the end of three months. Method: This is a longitudinal descriptive based on the Hospital Record conducted for three months. The records of female patients who underwent cervical cancer screening by VIA test in the institution between January and June 2023 were obtained and they were followed up monthly for a period of 3 months either during their visit to the hospital or over telephonic conversation as per the participants’ preference. Data regarding the reports of VIA test and the subsequent colposcopy and biopsy were recorded and analyzed. Data were analyzed in SPSS version-16. Results: Among the 2773 women tested, 367 were VIA positive with a mean age of 41.72 ± 10.68 years. The VIA positivity was found to be 13.36%.One in twenty women tested VIA positive had malignancy, with 90% aged above 50 years. One among every ten women diagnosed with cervical cancer were not being followed-up. Conclusion: This study concludes that one in seven women who undergo VIA screening have positive result and one in twenty with a positive VIA test are diagnosed with cervical malignancy. Follow-up of the patients undergoing VIA test is the key for successful prevention and control of cervical cancer.

DOI: 10.5281/zenodo.

Roth spots are distinctive retinal hemorrhages with a white center which were first observed in 1872 by a Swiss physician Moritz Roth. They are found in various conditions such as anemia, hypertensive retinopathy, leukemia, diabetic retinopathy, pre-eclampsia and anoxia. Conditions such as anoxia, carbon monoxide poisoning, anemia and prolonged difficult intubation are all linked to the occurrence of Roth spots. This observational study was carried out in Mata Gujri Memorial medical college and L.S.K. hospital, Department of Ophthalmology, Kishanganj from November 2023 till May 2024. A total of 801 patients were included in this study. The selection was made based on the findings of slit lamp biomicroscopy and stereoscopic visualization of ONH by +90D lens. To estimate the incidence of Roth spots in our study population based on their diagnosis, we used the proportional Z-test and a p-value <0.05 was considered significant. A total of 28 patients in our study were found to have Roth spots on fundoscopic examination depicting an incidence of 3.49% (28/801). The mean age among these patients was 49.39 years. 53.57% (15/28) of these patients were male and 46.42% (13/28) were female. According to our data, patients with pre-eclampsia are more likely to develop Roth spots (Z-test value 10.3, p<0.0000001) as compared to patients with diabetic retinopathy (Z-test value 9.4, p<0.000001) and hypertensive retinopathy (Z-test value 6.1, p<0.0001). A combination of detailed clinical examination and laboratory investigations needs to be conducted to evaluate a patient presenting with Roth spots. The occurrence of Roth spots has been rising in various diseases and a deeper study is needed to know more about their pathology.

DOI: 10.5281/zenodo.

Background: Continuous clinical trials have confirmed the association between Diabetes Mellitus (DM) with Heart failure (HF), independent of hypertension, atherosclerosis, coronary artery disease and valvular heart disease. But not universally recognized by physicians though the combination of both the conditions together may lead to morbidity and mortality. Early recognition and suitable management of HF in Diabetics could improve the outcome. But the etiology of heart failure in diabetic patients is still not completely understood. It has multifactorial determinants such as several cellular, molecular and metabolic factors. In addition there are no definite guidelines for grading the HF, early diagnosis, and therapy in DM patients with HF. This study focuses on the clinical presentation, probable pathophysiology, diagnosis, and prevention of HF in DM patients. Aim of the Study: To study the clinical manifestations of Heart Failure in diabetes type 2 patients and compare them with Heart failure in non DM patients in terms of diagnosis, and management. Materials: This case control study was carried out in 138 patients, who were divided into two groups. Group A Patients (69) with HF with Diabetes Mellitus and Group B (69): Patients of HF without DM. Necessary data to assess the HF and DM was collected. Standard statistical analytics were used to correlate the findings and study statistical significance. The Investigations undertaken were Demographic details, ECG, 2D ECHO and coronary angiography between diabetic and non-diabetic HF patients. Results: 138 patients were divided into Group “A” (69 patients) with HF and Diabetes Mellitus type 2 and Group B with only HF. 41 (59.42%) males and 28 (40.57%) females with a male to female ratio of 1.46:1 in Group A and in Group “B” (69 patients) with NON-Diabetes Mellitus, the males were 51 (73.91%) males and 18 (26.08%) females with a male to female ratio of 2.83:1. The overall male to female ratio among the 138 patients was 2:1. The incidence of HF at class intervals of 10 years starting at 25 years to 74 years in group A was: 06, 14, 17, 20 and 12. Corresponding incidence in group B for the same age intervals was 1, 05, 11, 25 and 27. The chi square statistic was 15.44 and the p value was 0.0038. Conclusions: Diabetes Mellitus is a risk factor for Heart Failure patients and menance of cardiac related mortality and morbidity. Severity of hyperglycemia was correlating with the severity of HF and was statistically significant (p value-0.05). 2D Echo results were helpful in the diagnosis of severity of HF and found to be more profound with patients of HF with DM; with p value less than 0.05. LVEF was less than 40% in patients of HF with DM when compared to HF patients without DM. CAG reports like Triple vessel disease (TVD), SVD and BVD were statistically significant with p value less than 0.05. Percentage of coronary artery block was 96 to 100% in patients with HF and DM. Mortality rate was higher in HF patients with DM than without DM.

DOI: 10.5281/zenodo.

Background: Aim of the Study to evaluate the association between Ferritin levels and adverse cardiovascular outcomes in patients with acute myocardial infarction during short- or long-term follow-up. Materials: 124 patients with Acute Coronary Syndrome were included in a cross-sectional study by comparing their clinical parameters and serum Ferritin levels after inclusion criteria were satisfied between January 2022 and December 2024. Patients aged 18 years and above were included. Patients with myocardial infarction, ST-elevation myocardial infarction (STEMI), or non-ST segment elevation myocardial infarction (NSTEMI) were included. Patients with Serum Ferritin values more than 300ng/mL were considered as abnormal and included in the study. Proper clinical history, past CVS history was elicited. After thorough clinical examination cardiac stress test, ECG study for ST depression, ST elevation, T-wave inversion, or presences of Q waves were undertaken. Serum Troponin levels were estimated. Normal Serum Ferritin levels (SF) were considered 300–400 μg/l as the upper limits for the adult males and 150–200 μg/l as the upper limit of normal for adult females. Results: The serum Ferritin values estimated at 06 months intervals were correlated with the post ACS events among the subjects for a period of 32 months and it was observed that that MACE (12.09%), mortality (13.70%%), LVEF (09.67), HF (25%) and LVA (02.41%) were noted in patients equally with varying levels of serum Ferritin either low or high. There were no cardiovascular events in 46 (37.09%) patients. Conclusions: Both low and high serum Ferritin values were associated with adverse events in patients with ACS both during their hospital stay and/or at more extended follow-up periods. The adverse outcome and levels of Ferritin were linked to increased mortality risk, accentuated LVEF decline during follow-up, left ventricular aneurysm formation. The study recommends closer monitoring of serum Ferritin levels and timely therapeutic interventions for high-risk patients with ACS as elevated serum Ferritin can be a potent factor for predicting AMI especially STEMI.

DOI: 10.5281/zenodo.

Background: Chronic otitis media is a common condition for which the patient present to Otorhinolaryngology, constituting about 30% of the ENT outpatient numbers. Chronic otitis media implies a permanent abnormality of pars tensa or flaccida, most likely a result of acute otitis media, negative middle ear pressure or otitis media with effusion. Being surgery the main treatment modality of treatment, tympanoplasty using various types of graft materials is essential in the management of the disease. Temporalis fascia is most commonly used graft. Various other grafts materials include cartilage, areolar tissue, ear lobule fat, and vein. Cartilage is also a popular graft which can be used in the form of palisade, perichondrium/cartilage island, butterfly and shield graft. Hence this study was conducted with the objectives to compare the surgical outcome in terms of graft acceptance between the island cartilage graft and temporalis fascia graft used in type 1 tympanoplasty, to compare the audiological outcomes and complications. Methods: A cross sectional (Hospital based) study was conducted at Krishna Rajendra Hospital, Mysore attached to Mysore Medical College and Research Institute, Mysore. Patients attending the OPD with mucosal type of COM with subtotal perforation were included in the study between October 2018 to September 2019. Patients were divided into two groups alternatively and type one tympanoplasty was performed using island cartilage in one group and temporalis fascia in the other after clinical examination, examination under microscope and performing pure tone audiogram. Postoperatively they were followed up at third and eighth weeks to assess the graft uptake and audiological parameters. Results: In our study the graft uptake was similar in both island cartilage and temporalis fascia group. The audiological gain in terms of AB gap closure is slightly better in the temporalis fascia group than the island cartilage. Conclusion: In type 1 tympanoplasty, both temporalis fascia and island cartilage can be used for structural stability and temporalis fascia gives better audiological results.

DOI: 10.5281/zenodo.

Introduction: Bacterial vaginosis is a polymicrobial condition involving facultative and anaerobic organisms in addition to Gardenerallvaginalis. Patients present with a clinical condition when there is an overgrown of the bacteria or by acquiring an exogenous flora. Gram negative organisms also cause bacterial vaginosis and their susceptibility pattern is required to manage the clinical condition. The aim of the present study is to know the gram negative bacterial infections predominance in bacterial vaginosis and its antibiotic susceptibility pattern. Materials and Methods: A Prospective cross sectional study was undertaken in the Department of Microbiology, ACSR Medical College, Nellore during the study period from February 2022 to March 2023. A total of 200 patients between 15-55 years presenting with complaints of vaginal discharge at the outpatient department of OBG were included in the present study. Culture swabs were collected and processed according to the standard guidelines. Results: Among 78 pathogens, (22 out of 78) 28.2% Escherichia coli, (18 out of 78) 23.07% Klebseillaspp, (15 out of 78) 19.2% S. aureus, (14 out of 78) 17.9% Candida spp, (4 out of 78) 5.1% Enterococcus spp (3 out of 78) 3.8% CoNS, and (2 out of 78) 2.5% Proteus spp. Gram negative bacilli are highly susceptible to colistin (100%), tigecycline (100%), amikacin (95.2%), meropenem (90.4%), ertapenem (85.7%), followed by levofloxacin (66.6%), Piperacillin-tazobactam (59.5%), Ceftazidime-clavulanic acid (54.7%), cefipime (54.7%), ceftazidime(47.6%), ceftriaxone (42.8%) and they were least sensitive to amoxyclav (42.8%) and amoxicillin (16.6%). Conclusion: The resistance bugs are in rise in many communities and the relapses are common in bacterial vaginosis, so it is better to track the pathogen by utilizing the laboratory services and start antibiotic after choosing suitable drug.

DOI: 10.5281/zenodo.

Introduction: Among nosocomial infections, SSI is the third most commonly reported infection and they account for approximately a quarter of all nosocomial infections. SSIs cause economic and social loss to the patients and family due to increase in length of stay and sometimes secondary surgery or re exploration may require. The aim of the study to analyze the risk factors and the pathogens responsible for surgical site infections. Materials and Methods: This is a descriptive cross sectional study that was undertaken for a period of one year in the year 2023. Details were noted about each patient in a pre-structured questionnaire. All cases were monitored until discharge from the hospital. After discharge patients were followed through phone calls about their wound condition up to 30 days after surgery. Results: Out of 272 total Elective surgeries, 5.14% had post op Surgical site infections & 31.7% of Emergency surgeries had SSI. Out of total 4.3% of 161 Clean surgeries; 5.7% of total 87 Clean contaminated;17.9% of total  67 contaminated & 21.8% of total 64 dirty wound types were infected (p<0.001). As the duration of surgery increased, SSI rate increase proportionately. The difference between the surgeries of <1 hr, 1-2 hr and 2 hours duration was highly significant statistically (p<0.00001). Out of 379 total operated patients who had Drains 10.8% showed SSI, and in no drain patients, 1.8% had SSI. 10.8% of abdominal surgeries & 1.8% of extra abdominal surgeries were showing SSI. 1.5% of total Laparoscopic abdominal surgeries, 11.08% of total Open Abdominal surgeries were showing surgical site infections. The difference of 9.58% was found to be statistically significant. In the present study, it was found that 5.2% of the total patients with preoperative stay >5 days showed postoperative infections. This was not statistically significant (p>0.05). Conclusion: The Clinicians should have knowledge of the appropriate use of aseptic and antiseptic techniques, the proper use of prophylactic and therapeutic antibiotics, and adequate monitoring and support with novel surgical and pharmacological modalities as well as nonpharmacological aids.

DOI: 10.5281/zenodo.

Background: Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) holds promise for improving diagnostic accuracy in ovarian pathology by providing regional discrimination and valuable clinical insights. This study aimed to investigate and optimize the utilization of DCE-MRI in this context. Methods: The study was designed as a retrospective observational investigation. Seventy participants aged 18 years and above, who underwent DCE-MRI for suspected ovarian pathology were included. Data collection encompassed clinical information and DCE-MRI parameters. Statistical analyses were performed using SPSS version 20, including descriptive statistics, association tests, and multivariate regression analysis. Results: The study cohort had a mean age of 52 years (range: 25-78 years), with 60% diagnosed with malignant and 40% with benign ovarian lesions. Abdominal pain (64.3%) was the predominant symptom, along with elevated CA-125 levels in 74.3% of participants. DCE-MRI analysis revealed significant differences between malignant and benign lesions, with malignant lesions exhibiting higher peak enhancement and wash-in rates, while benign lesions displayed higher wash-out rates and delayed time to peak enhancement. The diagnostic performance of DCE-MRI parameters was excellent, with peak enhancement demonstrating the highest area under the curve (AUC: 0.92). Conclusion: DCE-MRI shows promise as a valuable adjunctive tool for enhancing diagnostic accuracy in ovarian pathology. The study findings underscore its potential in discriminating between malignant and benign lesions, providing insights for improved patient management and treatment decision-making. Further research is recommended to validate these findings and explore additional applications of DCE-MRI in ovarian diagnosis and management. Recommendations: It is recommended to integrate DCE-MRI into standard diagnostic protocols for ovarian pathology, validating findings in larger cohorts for reliability. Optimizing imaging protocols and exploring advanced biomarkers could enhance diagnostic accuracy in ovarian malignancies, improving patient outcomes.

DOI: 10.5281/zenodo.

Background: Thyroid hormones play an important role in the homeostasis of calcium and phosphorous levels through their direct action on bone turnover, but their levels are still not confirmed. Method: Out of 200 subjects, 100 were known hypothyroid patients, and the remaining 100 were healthy vol-unteers. 3 ml of venous blood from these 200 people was studied. TSH levels were studied by the Monobind Acculite Thyroid TSH Kit. Serum calcium level was estimated by the Arsenozo III method, and serum electro-lytes were measured by Easylytes Ion selective electrodes. Results: Except chloride (Cl+), all electrolytes and calcium had significant decrease levels, and chloride level was highly increased 104.45 (± 7.50), t test was 4.67, and p<0.001. All parameters had a significant p value, but regression and negative correlation only calcium level (0.80) had significant p value (p<0.001). Conclusion: The present pragmatic study indicates that there is a profound influence of thyroid hormones on serum electrolytes; serum calcium, sodium, and potassium levels were decreased, while chloride levels were significantly increased in hypothyroidism patients compared to normal subjects.

DOI: 10.5281/zenodo.

Serum lipid levels affect atherosclerosis, a key cause of cardiovascular disease. This hospital-based retrospective descriptive study examined blood lipid profiles and atherosclerosis severity in 60 BMIMS, Pawapuri Nalanda, Bihar, patients for 8 months. The study found that high LDL and triglycerides were positively connected with atherosclerosis severity, but HDL was protective. LDL and triglycerides were greater in men than women. These findings emphasize focused cholesterol management in atherosclerosis prevention and treatment, suggesting that personalized therapeutic techniques may improve cardiovascular health. This work contributes to the understanding of lipid profiles in atherosclerosis progression and emphasises aggressive lipid treatment based on risk profiles.

DOI: 10.5281/zenodo.

Background: Obesity is a serious global public health concern that has been linked to several health problems. The purpose of this study was to evaluate the association between adult population BMI and haematological profile. Methods: 200 participants were included in this study, 100 of whom were females and 100 of whom were males, and their age range was between 18 to 30. This study was conducted from July 2023 to December 2023 at the Department of Physiology, ESIC Medical College, Bihta, Patna, Bihar, using a cross-sectional study design. A 10-milliliter venous blood sample was taken from the antecubital vein using aseptic precautions, and it was subsequently transferred to an EDTA tube. The Sysmex Haematology Analyser was then used to measure haematological parameters such as PCV, hemoglobin concentration, RBC, and WBC count. The participants were divided into four groups: underweight, normal, overweight, and obese. Using ANOVA, statistical significance was ascertained. The significance of the results was assessed using the Scheffe post-hoc test, and the link between the variables was ascertained using Pearson correlation. Data was analysed using SPSS software and presented as mean±standard deviation. Values of P≤0.05 were considered significant. Result: According to our study, PCV is statistically higher in overweight and obese people than in people with other BMI categories in both males and females. When compared to normal subjects, the total leucocyte count was considerably greater in overweight and obese subjects. All BMI categories showed no change in hemoglobin concentration or red blood cell count. Conclusion: In contrast to underweight and normal weight BMI categories, we found in our study that leucocytosis and increased PCV were present in overweight and obese person groups. The total leucocyte count and BMI have a direct positive association. Among all BMI groups, there is no statistically significant difference in the haemoglobin concentration and RBC count. Young people need to be encouraged to lead stress-free lives, engage in regular exercise, eat healthily, and have a healthy lifestyle.

DOI: 10.5281/zenodo.

Background: The primary cause of morbidity and death for those with Chronic Kidney Disease (CKD) is cardiovascular disease (CVD). Long before renal failure sets in, during the early stages of CKD, there may be an elevated risk of CVD. When CVD mortality in the dialysis population is compared to the general population, it clearly illustrates the significant burden of CVD. Aims of this study to identify the Echocardiographic changes in patients with CKD and know the prevalence of each Echocardiographic change in CKD. Methods: This study comprised 50 patients with chronic kidney disease (CKD) who were admitted between April 2023 and September 2023 to the general medicine department of the ICARE Institute of Medical Sciences and the Dr. Bidhan Chandra Roy Hospital in Haldia, West Bengal. The patients were assessed using the following methods: electrocardiography (ECG), blood urea, serum creatinine, general physical examination, systemic examination, and echocardiography. Results: In the present study, 86% of patients had cardiovascular abnormalities identified by echocardiography. 36% of patients had left ventricular hypertrophy (LVH). 16% of cases are Ischemic heart disease (IHD), 22% are LVH and Ischemic heart disease, 4.0% are dilated cardiomyopathy, 6.0% are pericardial effusion, and 2.0% are septal hyperthrophy. Conclusion: The most frequent morphological anomaly found is LVH. We could screen CKD patients before they underwent renal transplantation to detect and correct Coronary Artery Disease (CAD), and echo is a tool to detect moderate and massive Pericardial Effusion. In our center, we were able to diagnose IHD patients by echocardiogram and refer them for coronary artery intervention promptly. and to recommend appropriate dialysis and pericardiocenteties.

DOI: 10.5281/zenodo.

Background: In order to avoid difficulties for both the mother and the fetus, inducing labor is a standard treatment in obstetrics. Labor induction can be accomplished by a variety of techniques, such as mechanical and pharmacological procedures. The aim of the study was to identify the best method for inducing labor. Methods: A cross-sectional study conducted at the Department of Obstetrics and Gynecology, Darbhanga Medical College and Hospital, Laheriasarai, Bihar, compared the use of Misoprostol & Foley Catheter (group A) and Misoprostol alone (group B) for inducing labor in pregnant women in their third trimester. Data on mother age, gestational age, BMI, birth mode, duration of pregnancy, and newborn outcomes, including Apgar scores and ICU admissions, were gathered for the study. Results: In a study that compared the use of a Foley catheter plus misoprostol for labor induction (group A) to misoprostol alone (group B), the majority of women in both groups delivered their babies vaginally and without any problems or cesarean sections. The BMI, time frame, and ripening time were found to differ significantly between the two groups in the study; group A had lower values for these factors. Conclusion: Compared to misoprostol alone, foley’s plus vaginal misoprostol produces a shorter period between induction and delivery.

DOI: 10.5281/zenodo.

Background: Fetal growth restriction (FGR) is a prevalent and intricate clinical issue that has a significant morbidity risk. Apart from congenital abnormalities and viral factors, FGR has been found to be a significant factor in perinatal death. This study aims to link the diagnosis of fetal growth limitation made by ultrasonography and clinical means. Methods: This prospective study was carried out from May 2022 to January 2023 at the Department of Obstetrics and Gynecology at DMCH, Laheriasarai, Bihar. The study comprised a total of 288 patients. Results: 33.7% of the participants were found to have FGR. The age group of 20–25 years old accounted for 60.81% of cases. 89 percent of women lived in rural areas. Women made up 67.30% of the upper-lower class. Clinical approaches were shown to have a sensitivity of 70.7% and a specificity of 74.2%, respectively. Doppler and ultrasonography were found to have sensitivity values of 80.5% and 90.2%, respectively, and specificity values of 87.7% and 95.1%. 82 cases (65.1%) out of 126 clinically suspected IUGR cases had IUGR verified at birth. Twenty-three (20.63%) were lost to follow-up. Conclusion: Because of its high specificity, the Doppler study is the most effective modality currently available for identifying FGR; however, clinical assessment, a financially advantageous screening technique, is also a suitable way to diagnose FGR.

DOI: 10.5281/zenodo.

Background: Numerous physiological and environmental factors are known to have an impact on nerve conduction studies (NCS). The purpose of the current investigation was to ascertain how aging affected the nerve conduction velocity (NCV) of the two often studied upper limb nerves, the ulnar and median, in subjects of varying ages. Moreover, the goal was to gather reference information for use in clinically relevant nerve diagnostic tests. The objectives of this study were to examine how aging affects the median and ulnar nerve’s nerve conduction velocities and to track changes in the NCS of these two nerves in relation to age. Methods: In this cross-sectional and observational study, 110 healthy participants (60 males and 50 females) were involved. Medical students and staff members, both teaching and non-teaching, at the ANMMCH in Gaya, Bihar, volunteered to be the study’s subjects between April 2023 and December 2023. Group I (18–30 years old) (n = 38), Group II (31–45 years old) (n = 38), and Group III (46–60 years old) (n = 34) were the age groups into which the subjects were divided. The amplitudes, NCVs, and motor and sensory distal latencies of the ulnar and median nerves were measured, and the results were assessed. Results: For both the sensory and motor components, the latencies, amplitudes, and velocities of the median and ulnar nerves were examined, together with their mean and standard deviation. In comparison to the younger age group, patients who were older had longer latencies (median: Motor and sensory P < 0.001, ulnar: Motor = 0.013 and sensory = 0.006), smaller amplitudes (median: Motor P = 0.013 and sensory <0.001, ulnar: Motor P = 0.014, and sensory = 0.008), and slower conduction velocities (median: Motor P < 0.001 and sensory = 0.006, ulnar: Motor P = 0.003 and sensory = 0.069). This change was clearly noticeable in the age group of ≥46 years. The ulnar and median nerves’ sensory nerve conduction changed more with aging. Conclusion: The findings of our study show a substantial correlation between age and each of the three nerve conduction characteristics that were measured from both nerves. The findings of routine testing should be compared age-wise in order to improve NCS’s diagnostic sensitivity.

DOI: 10.5281/zenodo.

We report 10 cases of posterior segment ophthalmic manifestations resulting from dengue infection in a tertiary care centre in South Kerala. We performed an observational case by case analysis of retinal complications in  a series of 10 patients admitted as cases of dengue fever who presented with visual impairment. Ophthalmic evaluation included Snellen visual acuity testing, Indirect ophthalmoscopy, Fundus photography, OCT and Fundus fluorescein angiography. 15 eyes of 10 patients were affected. Mean age of patient was 41.2 years (15-51). Presenting visual acuity ranged from 6/9 to counting fingers. 9 out of 10 cases (90%) reported central impairment of vision. Onset of vision impairment coincided with the nadir of serum thrombocytopenia. Among the 15 eyes, retinal findings included maculopathy and retinitis (4 eyes), macular bleed and retinal haemorrhages (4 eyes) vasculitis and vascular occlusion (4 eyes), foveolitis (1 eye) and choroidal effusion (eye). 9 out of 10 cases recovered to their pre retinopathic visual acuity. These new retinal complications points towards a widened spectrum of posterior segment complications associated with dengue infection.

DOI: 10.5281/zenodo.

Introduction: Awareness and usage of evidence-based learning strategies is important for health professional students to engage in self-regulated lifelong learning. But, most of the students still continue to rely on ineffective study habits. Methods: Online survey-based assessment of awareness and usage of evidence-based learning strategies among MBBS students in one of the medical colleges in South India (n=661). Results: Significant number of medical students are still using non-evidence-based learning strategies like rereading underlined or highlighted material (433/661, 65.5%) and underutilizing self-testing as a tool of learning (67/661, 10%). Over 50% of the students believe they have a specific learning style (332/661, 50.2%). Conclusion: The results of this study when compared to previous studies indicate that though there is increased awareness and usage of some of the evidence-based learning strategies among health professional students, there is still a significant percentage of students who believe and rely on few non-evidence-based learning strategies. Hence, medical educators need to focus on educating the students how to learn and use metacognition in self-regulated lifelong learning.

DOI: 10.5281/zenodo.

Introduction: Tuberculosis (TB), caused by Mycobacterium tuberculosis, primarily affects the lungs but can spread to other body parts. Drug-resistant TB strains complicate treatment efforts, highlighting the need for new drugs. Rifampicin is crucial for TB treatment but can cause side effects, hypothyroidism being a rare one. Case Report: A 35-year-old female with pulmonary TB developed fatigue, weight gain, constipation, and dry skin 8 weeks after starting a Rifampicin-based regimen. Elevated TSH (10.5 µIU/mL) and low free T4 (0.7 ng/dL) indicated hypothyroidism. After temporarily discontinuing Rifampicin, her thyroid function normalized, and she was treated with levothyroxine. Symptoms improved, and thyroid function stabilized. Discussion: Rifampicin can induce hypothyroidism by increasing thyroid hormone metabolism and disrupting thyroid function. Monitoring thyroid function in patients on Rifampicin, especially those at risk, is essential to manage potential hypothyroidism. Conclusion: Rifampicin can induce hypothyroidism, necessitating vigilant thyroid function monitoring during treatment. Early detection and management with levothyroxine ensure better patient outcomes and adherence to TB therapy.

DOI: 10.5281/zenodo.

Background: The study is done to evaluate the efficacy of different interventional drugs in treating diabetes and their impact on the kidney and liver changes using a rat model. Methods: For this study 6 groups of 6 Wistar Rats were used. Out of which 3 groups were treated with hydroxychloroquine (HCQ), alpha-lipoic acid (ALA), and chromium picolinate (CrP), and their kidney with renal profile and SGPT were analyzed. Results: The results showed that administration of HCQ for 42 days improved SGPT, creatinine, and urea levels in diabetic rats. When compared with the normal group and metformin, HCQ values were closer to those of the normal group than to metformin, and it also exhibited protective properties against liver and kidney damage. Conclusion: HCQ showed a promising result to be used therapeutic agent for diabetes management, particularly due to its improving effects on liver and renal profiles. On comparing with ALA and CrP, HCQ showed better improvement in renal profiles and also exhibited hepatoprotective properties.

DOI: 10.5281/zenodo.

Introduction: Iron deficiency anaemia (IDA) has emerged as general health issue affecting world-wide population during pregnancy, its impact on health of mothers and newborns, as well as subsequent generations is observed. India with increasing population, it also has the highest prevalence of iron-deficiency anaemia in comparison to worldwide population, particularly affecting rural populations due to poverty and inadequate nutrition. Anemia can be short-lived or constant and ranges from mild to severe. Focusing on creating an anaemia-free India is achievable by raising awareness. Present study is focused on comparative analysis and record the effectiveness of oral iron supplementation during pregnancy. Aim: Aim of present study is to systematically record and compare the effectiveness of oral iron supplementation versus intravenous iron sucrose in treating iron deficiency anemia during pregnancy. Materials and Methods: A prospective study was conducted at a tertiary care center over a period of 2 years, involving 100 pregnant participants diagnosed with mild to moderate iron deficiency anaemia, on the basis of inclusion and exclusion criteria. Study Design: This comparative study involved two groups, with 50 participants allocated to each group. One group received intravenous (IV) iron treatment, while the other group received oral iron supplementation. The study aimed to evaluate treatment effects based on outcomes such as initial and final hemoglobin levels. Result: Initially hemoglobin levels were found to be statistically significantly lower in the Oral Rx group of participants compared to the IV Rx group, with a p-value of 0.001**. This indicates that participants who received intravenous iron treatment had higher final hemoglobin levels compared to those who received oral iron supplementation. Conclusion: Present study aimed to evaluate the safety and effectiveness of oral iron compared to intravenous (IV) iron on hematological parameters in pregnant women with iron deficiency anemia. Our findings confirm that IV iron resulted in a rapid and significant improvement in hematological parameters compared to oral iron supplementation.

DOI: 10.5281/zenodo.

Background: This study explores the intricate relationship between hormonal markers and sexual behavior in the context of female infertility. Hormonal imbalances, often a root cause of infertility, can significantly influence sexual desire, arousal, and overall sexual health. By examining key hormonal markers such as estrogen, progesterone, and luteinizing hormone, this research aims to elucidate their impact on sexual behavior patterns in infertile women. Through a comprehensive review of existing literature and analysis of clinical data, we identify how these hormonal fluctuations correlate with changes in sexual activity and libido. Understanding this connection is crucial for developing holistic treatment approaches that address both the reproductive and sexual well-being of affected women. This study underscores the importance of considering sexual health in the management of infertility and calls for integrated care strategies that encompass both endocrinological and psychological aspects of female reproductive health. Material and Method: A case-control study with a clinical focus was conducted at the Department of Obstetrics and Gynecology. The study included 200 female participants, divided into two groups: 100 infertile patients and 100 fertile controls. The participants were matched for age to ensure comparability between the groups. Results: The data indicated an altered antioxidant/oxidant ratio and an increase in free radical status (ROS/RNS), signifying a shift in the cellular oxido-redox state. The endocrine profiles of gonadotropins (LH/FSH) and ovarian hormones (estradiol, testosterone, and progesterone) showed significant alterations in patients with PCOS, endometriosis, OI, and BOH, suggesting modifications in the hypothalamic-pituitary-ovarian (HPO) axis. Additionally, gynecological events such as irregular menstruation, uterine fibroids, and structural issues with the uterus and oviduct, including stillbirth and miscarriage, were observed in patients with BOH. Conclusion: The impact of medicalization on Indian women’s values is multifaceted. While some women have successfully managed their infertility issues, others have been significantly affected by infertility treatments and assisted reproductive technologies (ART). The researcher’s work on reproductive diseases associated with infertility in Indian women is highly significant within the realm of biomedical sciences. In addition, affected cases in India receive genetic testing and counseling, as well as therapy and management of these issues through the use of ART.

DOI: 10.5281/zenodo.

Introduction: Immature teratomas account for less than 1% of all ovarian cancers but is the second most common germ cell malignancy and accounts for 10%-20% of all ovarian malignancies in women younger than 20years. Preoperative diagnosis of immature cystic teratoma can be challenging for clinicians because of varied radiological findings and tumor markers level. Aims and Objectives: To elaborate on the varied presentation, prognostic markers and challenges for diagnosis and management of immature teratoma. To emphasize on the need of timely referrals, multidisciplinary team management and need for continuous follow up. Materials and Methods: The hospital records of patients with confirmed histopathological diagnosis of immature teratoma in last one year was reviewed and these patients were closely followed up for further management at AIIMS, New Delhi. All the cases have been discussed via graphic presentation for detailed and in-depth understanding. Results: Histopathological examination is the only confirmatory diagnosis`. Age of presentation was between 16-32 years. The clinic-radiological diagnosis was challenging because of varied presentations. Tumor markers were not specific for all of them. Grade of the tumor is the most important prognostic factor followed by stage. Even with adjuvant chemotherapy, there are chances of recurrences. Conclusion: Immature teratoma of ovary primarily involves younger patients; hence clinicians should strongly have a high sense of suspicion whenever the diagnosis of a germ cell tumour is entertained and timely intervene.

DOI: 10.5281/zenodo.

Background: Coronary artery disease (CAD) is a prevalent cardiovascular condition characterised by the narrowing or blockage of the coronary arteries leading to significant morbidity and mortality. Early assessment of risk factors, prompt diagnosis and treatment may have an important role in reducing the cardiovascular complications. The aim of this study is to determine the factors contributing to the development of coronary artery disease, its diagnosis and management. Material and Methods: A prospective cross-sectional study was conducted in the cardiology ward of Geetanjali Medical College and Hospital, Udaipur. The study included patients of both genders, aged 18 years or above, admitted to the cardiac care unit (CCU) with coronary artery disease. The sample size was 342. Results: The results indicate a significant burden of coronary artery disease in the examined patient population. The majority of patients fall within the 51-60 age range, with a higher prevalence among males. Chest pain is the most common symptom reported, and smoking is prevalent among male patients. Comorbidities such as hypertension and type 2 diabetes mellitus are frequently observed. Diagnostic tests, including angiography and ECG, are commonly performed for accurate diagnosis. Medications such as anticoagulants, β blockers, and statins are frequently prescribed to manage the disease. Conclusion: The findings indicate toward target population being more affected by burden of disease and require the need for targeted interventions, including smoking cessation programs and lifestyle modifications, to reduce the risk and burden of coronary artery disease in this population. These insights provide valuable information for healthcare professionals in tailoring personalized approaches for coronary artery disease management.

DOI: 10.5281/zenodo.

Introduction: Glaucoma is a type of neurodegenerative disease characterized by morphological variations at the position of the optic nerve head (ONH) or retinal nerve fiber layer (RNFL) as well as damage to the visual field. Assessment of the diurnal fluctuations in IOP and MOPP is clinically relevant in glaucoma patients. Systemic hypertension, as such, may directly damage the small vessels of the optic disc and increase the risk of glaucoma. Material and Methods: This is a cross-sectional observational study done with 50 patients, carried out at the Department of Ophthalmology tertiary care centre. It consists of two groups, the first group of 25 patients with essential hypertension, and the second group of 25 with POAG. The average age of patients included is 55.36 years. Observation and Result: The average history of hypertension is from the past 5.23 years. The mean Average C/D Ratio of HTN Cases was RE-0.45+0.08 & LE -0.47+0.110. The mean Disc Area of HTN Cases was RE-1.66+0.11 & LE – 1.68+0.16 whereas the mean Disc area of the glaucoma group was RE- 2.12+0.47 & LE-2.04+0.40. Summary: In comparison of the hypertensive group with the Glaucoma group, neuroretinal rim changes in Hypertension were not significant in comparison to Glaucoma. In other words, hypertension causes changes in other optic nerve parameters but does not have much effect on the neuroretinal rim. The neuroretinal rim, which is the intrapapillary equivalent of optic nerve fibers, indicates the amount of viable optic nerve tissue and is one of the most important morphological parameters to detect glaucomatous optic neuropathy and to grade the amount of glaucomatous optic nerve damage. In Glaucoma, because of mechanical stress from elevated IOP at the level of lamina cribrosa, posterior bowing and thinning of the lamina occur. This disrupts axonal transport. As a result, retinal ganglion cells undergo apoptotic cell death with loss of neuroretinal tissue of the optic disc and enlargement of parapapillary atrophy. All parameters in conjugation lead to Glaucomatous optic nerve atrophy.

DOI: 10.5281/zenodo.

This prospective study evaluated the effectiveness of external dacryocystorhinostomy (DCR) alone versus external DCR with primary lacrimal intubation in treating primary acquired nasolacrimal duct obstruction at Darbhanga Medical College and Hospital between January 2020 and August 2021. A total of 110 patients were randomly assigned to undergo either the traditional external DCR (n=55) or external DCR with lacrimal intubation (n=55). The outcomes measured were duct patency, infection rates, granulation tissue formation, and patient-reported symptomatic relief. Results demonstrated a significantly higher success rate and lower complication rates in the intubation group, suggesting that primary lacrimal intubation enhances the effectiveness and safety of external DCR.

DOI: 10.5281/zenodo.

Background: Pain and other neurological symptoms are frequently linked to spinal illnesses including lower back pain, which have a detrimental effect on patients’ quality of life. An autologous source of many growth factors and cytokines, platelet-rich plasma (PRP) has the ability to stimulate tissue regeneration. Therefore, the focus of the study is to examine the efficacy of PRP against the steroid infiltration in the management of the lower back pain. Methodology: For the time duration of 2 years, this prospective randomized control trial will include a total of 110 (55 in each group). After the allocation of the PRP or steroid injection of Methyl Prednisolone, the data will be collected for the VAS score, Oswestry Low Back Disability score, EuroQoL- 5D Questionnaire and the post follow up will be taken at 1week, 1 month, 2 months, 3 moths and finally at 6 months. Expected outcome: A significant finding in the efficacy of PRP against steroid infiltration among the low back patient is expected.

DOI: 10.5281/zenodo.

Objective: To assess the outcomes of percutaneous nephrolithotomy (PCNL) using the ‘STONE’ nephrolithometry score, assessing stone size, tract length (skin-to-stone distance), degree of obstruction, number of calyces involved and stone essence (density). Materials and Methods: This was a prospective study of patients undergoing PCNL, from November 2020 to October 2021 in the Department of Urology at Maharishi Markandeshwar Institute of Medical Sciences and Research (MMIMSR), Mullana, Ambala. All patients had preoperative computed tomography and the five variables of the STONE nephrolithometry score were calculated before the procedure. The descriptive statistics including the frequencies, percentages, mean and standard deviation were calculated. Chi square test was applied to assess the extent of association between two variables. ANOVA and linear regression was used to investigate the cause and effect relationship. Outcome of PCNL was evaluated in each of three sub- groups of patients as per S.T.O.N.E. Score and their association with various outcome parameters like Number of punctures, Operating time, Complications as per modified Clavien Dindo grading, Residual stone and Hospital stay was compared. The data was entered in MS EXCEL spreadsheet and analysis was done using Statistical Package for Social Sciences (SPSS) version 22.0. Results: The study included a total of 79 patients who underwent PCNL after having met the inclusion criteria. Complete clearance was achieved in 81% cases in the first session. Outcome of PCNL was evaluated in each of three sub-groups of patients as per S.T.O.N.E. Score. The stone score was found to be significantly correlating with- Number of punctures (p<0.01); Operating time (p<0.01); Complications (p<0.01); Residual stone (p<0.01); Hospital stay (p<0.01) Conclusion: Stone score is a reliable method to preoperatively assess the outcome of PCNL and therefore valuable for preoperative counselling of patients & the family.

DOI: 10.5281/zenodo.

Introduction and Aim: By 2040, the number of bladder tumor cases is predicted to increase to 79.6% in India. For both sexes, the lifetime risks of bladder tumors  1.1 and 0.27%, respectively. Recently, academics have become increasingly interested in marker-based detection. In bladder tumors, nuclear matrix protein (NMP) 22 and cytokeratin 20 are useful indicators that should be found and examined. Materials and Methods: 50 male individuals (cancer patients diagnosed by TURBT and bladder biopsy) were recruited from the outpatient department of a tertiary care hospital for this cross-sectional study. The Institutional Ethics Committee granted approval for the project. ELISA was used to quantify NMP22, while immunohistochemistry (IHC) was used to measure the amounts of cytokeratin 20. While NMP 22 was estimated from 50 pre-operative bladder cancer samples, cytokeratin 20 was estimated from tissue samples of bladder cancer that had been histopathologically verified. SPSS 21.0 was used to analyze the data. Results: Of the 50 participants, 47 were men, 45 had a medical history, and 82% had hematuria. The most prevalent type of growth on ultrasonography was polyploidal; 60% of them had sizes greater than 3 cm, and 42% showed lateral wall growth. According to histological analysis, the incidence of low- and high-grade tumors was identical, with 90% of patients showing urothelial papillary type lesions and 80% showing lamina propria invasion. While there was no discernible relationship between grade, smoking, and invasion into the lamina propria, there was a positive link between invasion into the detrusor muscle and the lymphovascular structure. Cytokeratin 20 was positive in high grade (77.8%), low grade (93.3%) tumors, diffusely positive in 24/37  and 18/19 cases of invasion into lamina propria and detrusor muscle respectively, focally positive in eight and negative in 5 cases and the association was found to be significant. Association between the immunorectivity of cytokeratin 20 , invasion into lymhovascular structures was found to be significant. The mean values of NMP 22 in high grade, with invasion into lamina propria, detrusor muscle and lympho vascular structure were found to be 17.74 U/ml, 16.15 U/ml, 18.04 U /ml and 17.75 U /ml respectively. The association of NMP 22 with high grade tumors, invasion into detrusor muscle and lympho vascular structure were found to be significant. The sensitivity, specificity of the NMP22 was 91.5% and 68.8% respectively. 31.3% of the cases were false positive and 8.8% of the cases were false negative.The connection between cytokeratin 20 and high grade (77.8%) and low grade (93.3%) cancers was shown to be significant. Cytokeratin 20 was found to be diffusely positive in 24/37 and 18/19 cases of invasion into lamina propria and detrusor muscle, respectively, and focally positive in eight and negative in five cases. There is a substantial correlation between the immunorectivity of cytokeratin 20 and its invasion of lymphovascular tissues. The mean values of NMP 22 in high grade were determined to be 17.74 U/ml, 16.15 U/ml, 18.04 U/ml, and 17.75 U/ml, respectively, with invasion into the lamina propria, detrusor muscle, and lymphovascular structure. It was discovered that NMP 22 significantly correlated with high grade malignancies, invasion of the detrusor muscle, and lymphovascular organization. The NMP22’s sensitivity and specificity were 91.5% and 68.8%, respectively. False positive instances accounted for 31.3% of the total, while false negative cases made for 8.8%.

DOI: 10.5281/zenodo.12518557

Background: α-mangostin, a natural xanthonoid has been reported as anticancer compound against multiple cancer of human origin. The studied was to investigate the anti-cancer activity and its molecular/cellular mechanism in colorectal cancer cell line HCT 116. Methods: We have performed different methods MTT, FACS and ROS for the anticancer effect of α-mangostin. Results: We found that, α-mangostin substantially decreased cell viability in time and dosage dependent manner with an IC50 value of 13.34 µM ± 1.86, 9.29 µM ± 1.92 and 4.57 µM ± 0.83 at 24 h, 48 h and 72 h respectively. Furthermore, it was found that α-mangostin significantly decreased the colony formation and cells migratory ability as well. Flow cytometry analysis confirmed that α-mangostin significantly held the progression of HCT 116 cells in G₂/G1 phase of cell cycle and influenced the cells to undergo apoptosis by promoting ROS generation, and decreasing mitochondrial membrane potential and elevated early and late apoptotic cells by increased level of pro-apoptotic Bax, p53 and decreased level of anti-apoptotic BCL-2 genes. RT-PCR analysis also revealed that α-mangostin regulated the expression levels of Bax, p53 and BCL-2 a key apoptotic genes. Conclusion: These results indicated that α-mangostin could be effectively decrease the growth and proliferation of colorectal cancer cells through regulating the expression of Bax, p53 and BCL-2 leading to apoptosis.

DOI: 10.5281/zenodo.12518712

Background: Uterine fibroids (UFs) are the most common pelvic tumors among women at reproductive age, affecting women’s quality of life even their confidence with its symptoms. We designed a study to investigate the clinical, laboratory, and imaging characteristics of women with UF. Methods: This cross-sectional study was performed from January 2023 to December 2023 in Obstetrics and Gynaecology Department of Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar. We included all women with UF referring to the Obstetrics and Gynecology department of JLNMCH. Based on a checklist, a research team interviewed the patients to investigate clinical characteristics. Also, we explored laboratory and transvaginal sonography (TVS) findings of all patients. Results: The mean age of 439 studied patients was 44.47±8.80 years (range: 23-81). The most prevalent under-lying disease was hypertension (17.1%), followed by thyroid diseases (15.7%) and diabetes mellitus (13.7%). The patients mainly complained of AUB (abnormal menstrual bleeding) (60.0%) and abdominal pain (23.7%). The mean NLR (neutrophil to lymphocyte ratio) and the mean PLR (platelet to lymphocyte ratio) were signifi-cantly higher than the normal upper limit (P<0.001). The largest diameter of UF was 49.89±47.92 mm. Most fibroids were located anteriorly (43.1%). The multivariate linear regression model revealed that age (β=-0.931, 95%CI= (-1.657, -0.204), P=0.012) and number of fibroid (β=22.418, 95%CI= (16.360, 28.476), P<0.001) could predict the size of fibroid. Conclusion: Our results showed that NLR and PLR were increased in UF patients. It seems that patient’s age and number of fibroids may be the predictive factors for UF’s size.

DOI: 10.5281/zenodo.

Background: Determining the clinical manifestations of COVID-19 in pregnant and recently pregnant women is important to identify risk factors in order to evaluate complications and maternal and perinatal outcomes. The aim of the present study was to investigate the symptoms of COVID-19 in pregnant women and its effects on the newborn. Methods: This prospective descriptive study was conducted from December 2020 to November 2021 on 101 pregnant women with COVID-19 infection admitted to the intensive care unit in JLNMCH, Bhagalpur, Bihar. All studied patients were examined in terms of clinical symptoms, maternal and neonatal complications, and laboratory findings such as WBC and ESR in all patients were checked. Finally, all information was entered into each patient’s form and by using SPSS V22 software analyzed. Results: Number of 101 pregnant women participated in the study, with an average age of 31.09 years. In this study, 93 individuals had PCR positive (92.1%), 84 individuals with COVID+ in CT scan (83.2%), 25 indi-viduals with an underlying disease (24.8%), and 54 individuals with addiction (53.5%). 20 feet (19.8%) were reported. 20 deaths (19.8%) were reported. The average BMI of the participants was 25.46. Among maternal complications, pulmonary involvement (71.28%) the most frequently was reported. Among the hospitalized patients (95 individuals), 25 individuals had underlying diseases. In this population, maternal complications were significantly more reported (P value=0.012). Among neonatal complications, the most common cases of death were IUFD and abortion. 62.1% of the participants had a natural delivery and 63.4% had a term delivery. Conclusion: Fever, throat redness and swelling, respiratory distress and cough are the most common clinical symptoms and lung involvement is the most common complication of COVID infection in pregnant mothers. In infants, IUFD and abortion were also very common. PCR and CT scan are two high-sensitivity tests for de-tecting COVID.

DOI: 10.5281/zenodo.

Background: Uterovaginal prolapse is an abnormal protrusion or herniation of pelvic organs from its normal position in the pelvis, due to failure of anatomical support. The prevalence of uterovaginal prolapsed is difficult to be determined because many women are asymptomatic and many are hesitant to discuss with family. It can be considered a silent epidemic. The cause of uterovaginal prolapse is multifactorial. The parity, mode of delivery, postmenopausal status, and obesity is some of the factors affecting the severity. The condition is preventive and by counseling and care during antenatal and postnatal period, the prevalence of this condition can be curtailed and quality of life can be improved. Aim of this study to evaluate the predisposing factors of uterovaginal prolapse in women admitted to the gynaecology ward. Methods: A retrospective study was done for a period of one year from January 2022 to December 2022 at Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar. The women admitted in gynaecology ward with symptoms of mass per vagina were included in the study. The data was retrieved from medical records of the department. The case file as per inclusion and exclusion criteria was identified and included in the study. The information of risk factors was collected using patient proforma. The pelvic organ prolapse quantification system (POPQ) approved by international continence society was used for categorizing uterovaginal prolapse. Data was analysed using SPSS version 20. Frequencies, percentage and mean computed to describe the variables of the study. The Chi-square test was used to compare variables. The statistical significance P<0.05 was considered significant. Result:  Total 206 patients had uterovaginal prolapse. The prevalence was 1.8%. Conclusion: The multiparity, prolonged and difficult deliveries, delivery by untrained personnel, mismanaged third stage of labour involving injury to sphincters and vaginal tears are determinants of prolapse uterus. Further postmenopausal condition causing hypoestrogenic state causes weaking of ligaments, collagen and aggravates the condition. Hence, preventive measures like institutional delivery, delivery by trained personnel; menopausal clinics may help the target population.

DOI: 10.5281/zenodo.

Background: Despite recent improvements in intensive care units, sepsis remains one of the leading causes of morbidity and mortality in neonates worldwide. Finding maternal and neonatal risk factors for early onset newborn sepsis (EONS) at a tertiary care hospital is the aim of this study. Methods: This cross-sectional study was conducted from August 2023 to January 2024 among newborns who had clinical symptoms of sepsis found within 72 hours of postnatal age in the Department of Obstetrics and Gynecology at SKMCH, Muzaffarpur, Bihar, in collaboration with the Pediatrics department. The clinical profile and risk factors (both maternal and neonatal) were recorded in a pre-made data collecting sheet following the acquisition of the parents’ informed written consent. To confirm the diagnosis, C/S and blood were drawn for septic screening. Results: 90 percent of the neonates had maternal risk factors for sepsis, while only ten percent did not have any. PROM > 18 hours was present in the mothers of most (80.0%) babies with sepsis. Within two weeks of birth, one-third of the women experienced fever, lower abdomen pain, or UTIs. The moms of the infant septic cases exhibited protracted labor in over half (56.7%) of the cases. The majority of babies (58.2%) had gestational ages of less than 37 full weeks. Sixty-seven percent (66.7%) of babies had birth weights under 2,500 grams. Thirty-one percent of the babies received prelacteal feedings. Seventy-one percent (70.0%) of babies received 2% chlorohexidin. At birth, six (10.0%) babies needed bag mask resuscitation. Conclusion: Maternal risk factors for neonatal sepsis were protracted labor, P/V examination more than three times, and PROM > 18 hours. Prematurity, low birth weight and prelacteal feeding are among the risk factors for newborns.

DOI: 10.5281/zenodo.

Background: About 7.8 to 50% of women have polyps in their female reproductive system. Endometrial polyps frequently develop in the fundal or tubocornual area. Due to the continuous inflammation, they mechanically impact female fertility and interfere with proper cellular function. Endometrial curettage is frequently advised to rule for malignancy or subclinical endometrial hyperplasia. Pregnancy or mucorrhoea can cause cervical polyps to expand. The purpose of this study is to understand the clinical presentation, treatment options for polyps in the female reproductive system, and the relationship between histopathological and ultrasonographic results. Methods: This prospective hospital based observational study was conducted in Department of Obstetrics and Gynaecology, ANMMCH, Gaya, Bihar from January 2022 to December 2023. Total 50 cases included in this study period to their symptoms, age, desire for fertility and type of polyp. Results: The age range of 31 to 40 years (42%) and parous women had the highest rates of polyps. Heavy menstrual bleeding (82% of cases) were the most frequent presenting ailment. Leiomyomatous polyps were shown to be the most prevalent kind of polyp based on USG and HPE. 44% of women with heavy menstrual bleeding had severe anemia that necessitated blood transfusions to treat. Malignancy-related cases were not found. Conclusion: The main cause of AUB is polyps. It might result in severe anaemia that requires blood transfusions and copious menstrual bleeding, which can be morbid. Histopathological diagnosis is consistent with the results of clinical examination and ultrasonography. The location and type of the polyp can be determined using a clinical examination and ultrasound, and a further course of treatment can then be taken.

DOI: 10.5281/zenodo.

Background: Because of the recognized importance of zinc in treating pediatric disorders, such as acute lower respiratory tract infections (ALRTI), researchers are becoming more interested in this area. So, the aim of this study was to determine the serum zinc levels in instances of ALRTI and to establish a relationship between those levels and the disease’s clinical progression. Methods: In the hospital-based case-control trial, 61 patients between the ages of 2 months and 5 years had ALRTI in addition to 61 age- and nutritionally-matched control subjects. The serum zinc level was assessed at admission. A comprehensive history, sociodemographic data, and examination were documented in addition to specifics of the clinical course, such as duration of stay, oxygen requirements, degree of disease, and result. Results: It was found that there was a statistically significant difference (p value = 0.0001) in the mean blood zinc levels of the patients and controls (patients 58.88±12.40 µg/dl, Controls 85.36±16.27 µg/dl). There was a negative correlation between zinc levels and length of stay (r = -0.052, p value = 0.691). Severe pneumonia cases had far lower mean serum zinc levels (p value = 0.0001) compared to pneumonia cases (WHO IMNCI grade).The patients who required greater amounts of oxygen and those who passed away had significantly lower mean serum zinc levels (p value = 0.0001) and correspondingly, in comparison to the patients who were released. Conclusion: Reduced serum zinc levels are strongly linked to ALRTI; the lower the serum zinc levels, the more severe the illness, the longer the patient stays in the hospital, the higher the oxygen requirement, and the higher the fatality rate.

DOI: 10.5281/zenodo.

Background: An arboviral illness called chikungunya fever is spread by infected Aedes mosquitos. It is typi-fied by a sudden, intense fever that is accompanied by incapacitating arthralgia. About 50% of these patients experience mucocutaneous symptoms. The purpose of this study is to examine mucocutaneous symptoms in individuals who may have chikungunya in the Patna area of Bihar. Methods: Chikungunya screening was performed on patients with fever and rash who were seen in the derma-tology outpatient department. There was a clinical assessment, and any mucocutaneous symptoms were noted. Serological testing verified the diagnosis. The study involved the enrollment of fifty patients in total. Results: Among cutaneous manifestations, generalized erythematous maculopapular rash was the most preva-lent. The second most prevalent presentation in males was many ulcers with erythema over the vaginal region. Additional findings were urticarial rash, crusted lesions near the angle of the lips, erythema/edema throughout the hands and feet, and centro facial pigmentation and isolated hyperpigmented macules across the trunk and face. Two patients also had lesions resembling generalized erythema multiforme. In our study, vesiculobullous eruptions—which are often only documented in infants—were discovered in one adult patient. In our investiga-tion, we did not observe the exacerbation of pre-existing skin lesions or lesions resembling Erythema nodosum as reported in the literature. Conclusion: It has been noted that vesiculobullous lesions are a typical cutaneous sign of infantile chikungunya fever. To the best of our knowledge, however, no prior reports of vesiculobullous lesions in adults have been made.

DOI: 10.5281/zenodo.

Background: An inflammatory, hyperproliferative, prevalent chronic illness of the skin and joints, psoriasis is characterized by erythematous plaques coated in silvery white scales. There are numerous systemic and topical therapy options available. Our study’s objectives were to examine the effects of ammonium lactate 12% lotion as a monotherapy and in combination with clobetasol propionate (0.05%) and calcipotriol (0.005%) in patients with chronic plaque type psoriasis, as well as the side effects of these medications. Our goal was to ascertain the effectiveness of various topical agents in treating chronic plaque type psoriasis. Methods: From July 2023 to December 2023, patients with chronic plaque type psoriasis vulgaris who were enrolled in the dermatology outpatient department of the Department of Dermatology at ESCI MCH, Bihta, Patna, Bihar, were the subjects of the current study. A total of sixty patients were enrolled, and they were split up into three groups, each with twenty patients. Patients in Group B were instructed to apply clobetasol propionate in the evening and ammonium lactate twice daily, while patients in Group C were instructed to apply topical ammonium lactate in the morning and calcipotriol in the evening. Results: According to the physician global assessment scale, of the patients in Group A, 25% patients had excellent response, 20% patients had good response, and 20% patients had fair response whereas 35% patients had poor response. In group B, 30% patients had excellent response, 35% patients had good response, and 15% patients had fair response whereas 20% patients had poor response. In group C, 30% patients had excellent response, 35% patients had good response, and 10% patients had fair response whereas 25% patients had poor response. Conclusion: Combination therapy has been shown to improve patient compliance and is safe, well-tolerated, and has few adverse effects. Ammonium lactate 12% is another topical alternative that can be used as a maintenance therapy or as a monotherapy.

DOI: 10.5281/zenodo.

Background: Cardiomyopathies are a heterogeneous group of diseases of the myocardium associated with mechanical and/or electrical dysfunction that usually (but not invariably) exhibit inappropriate ventricular hypertrophy or dilatation and are due to a variety of causes that frequently are genetic. Method: The present study was conducted on all newly diagnosed cases of dilated cardiomyopathy coming to the medicine OPD of Darbhanga Medical College and Hospital, Laheriasarai, Bihar from January 2023 to December 2023. Results: As shown in above table, majority of patients (85.0%) presented with swelling of feet. Out of 40, 13 (32.5%) had dyspnea, 12 (30.0%) had fatiguability, 21 (52.5%) had palpitations, 12 (30.0%) had chest pain and 8 (20.0%) had syncope. Conclusion: It was concluded from the study that Dyspnea is invariable and present in all forty patients. Signs of failure are seen commonly in DCM. DCM characteristically has cardiomegaly on chest X-ray.

DOI: 10.5281/zenodo.

Background: To evaluate the etiology and disease specific clinical profiles of acute undifferentiated febrile illness (AUFI) in Medicine Department of DMCH, Laheriasarai, Bihar. Methods: This 1 year prospective, observational study was conducted in DMCH, Laheriasarai, Bihar from January 2023 to December 2023 in 150 patients. Clinical evaluation and relevant investigations like Blood culture; malarial parasites and febrile serology (acute and convalescent) were performed. Results: A total of 150 AUFI patients were evaluated: scrub typhus (19); malaria (3); enteric fever (2); dengue (11); leptospirosis (19); hantavirus (1), acute bacterial infections (14), HIV (1), hepatitis (1), and unclear diagnoses (79). Conclusion: This study reports discovery of dengue, typhus fever, leptospirosis, and rare disease like Hanta and more number undiagnosed cases ranging from 15% to 42% in local community. This shows that further research is required in identifying the etiology of undifferentiated fevers.

DOI: 10.5281/zenodo.

Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia encountered in clinical practice. This study is about the etiological and clinical profile of paroxysmal, persistent and permanent AF. The aim of this study was to review the clinical epidemiological features of atrial fibrillation. Materials and Methods: A hospital-based descriptive study was conducted among 50 patients, diagnosed as atrial fibrillation in Medicine Department of DMCH, from January 2023 to December 2023. Results: Out of 50 patients with atrial fibrillation, 32% were aged between 60 – 69 years and 42(84%) were females and 8 (16%) were males. Permanent AF was seen in 56% patients. Conclusions: Palpitation followed by dyspnoea was the major symptoms encountered with atrial fibrillation, and in females within the age group of 50 years and above are prone to develop AF.

DOI: 10.5281/zenodo.

Introduction: Melasma is an acquired, increased pigmentation of the skin characterized by symmetrical and confluent grey-brown patches mostly on the areas of the face exposed to the sun, such as the cheeks, forehead and chin. An etio-pathogenesis of melasma remains unknown. It is difficult to treat and has a tendency to relapse. Aims and Objective: (1). To study the demographic profile of melasma. (2). To study the aggravating factors of melasma. Material and Methods: Clinically confirmed 70 cases of melasma were included in the study. The parameters included were age, sex, age of onset of melasma, history of sun exposure, family history, menstrual history. Other associated conditions such as hypothyroidism and appearance of melasma after pregnancy was also noted. The type of melasma (malar, centrofacial, and mandibular) was determined by clinical examination. Modified MASI score was calculated in each of the patients. Results: Out of 70 patients, 52 were female and 18 were male. 4^th decade was the most common age group followed by 5^th decade. Malar type was the commonest type followed by Centrofacial. History of sun exposure and Family history was seen in 15 and 18 patients respectively. 22 females had given history of occurance of the melasma after pregnancy. Association of hypothyroidism was seen in 6 patients.

DOI: 10.5281/zenodo.

Introduction: Herpes zoster (Shingles) is a clinical entity that is caused by the Varicella-zoster virus. It is characterized by erythematous, maculopapular, and vesicular lesions. Aims and Objectives: (1) To understand the demographic profile of herpes zoster. (2) To identify the clinical presentation of herpes zoster. (3) To observe the association of herpes zoster with other systemic conditions. (4) To find out the complication of herpes zoster. Materials and Methods: Clinically confirmed 50 cases of herpes zoster were included in the study. A Demographic data including age, sex and socioeconomic status were recorded.  Clinical details like involvement of dermatome, systemic condition and complications of herpes zoster were noted. Results: In our study, Incidence of herpes zoster was almost similar in male and female with 27 males and 23 females. Majority of the patients were from 6^th decade. Thoracic dermatome was the most common dermatome involved. Association with HIV (Human immunodeficiency virus) and Diabetes Mellitus was seen in 7 and 9 patients respectively. Post herpetic neuralgia was the commonest complication in our study. Conclusion: The study is very important in identifying the demographic and clinical trend as well as act as a future guide to combat Herpes Zoster.

DOI: 10.5281/zenodo.

Introduction: A major contributing factor to the onset of type 2 diabetes, especially in people with high body mass index (BMI), is insulin resistance. Aims and Objectives: This study shows a relationship among BMI with insulin resistance in patients with diabetes type-2, which might aid in the selection of practical methods for diabetes early intervention. Materials and Methods: In order to better understand the association among BMI with insulin resistance, along with the effects of this condition on metabolic and cardiovascular health, a cross-sectional research including 100 pre-diabetic individuals was conducted. The study gathered information on the patients’ cholesterol levels, blood pressure, BMI, insulin resistance (as determined by the Homeostatic Model Assessment for Insulin Resistance, or HOMA-IR), and demographic profile. The patients were divided into groups based on their weight: normal, overweight, and obese. Results: The mean age of the participants was 45.79 years with a standard deviation of 12.31. The majority of the participants were female, accounting for 52% of the total. The average body mass index (BMI) of the participants was 28.41 kg/m² with a standard deviation of 4.49. An evident and strong connection (r=0.64, P<0.001) was seen among BMI with the HOMA-IR score, indicating a clear relationship between higher BMI and insulin resistance. Obese people had a significantly elevated HOMA-IR index (3.51±1.29) in comparison to overweight persons (2.49±1.01) and individuals of normal weight (1.91±0.79). Furthermore, the study revealed deterioration in lipid profiles and an elevation in blood pressure among those in higher BMI categories. Gender had no significant impact on insulin resistance, but a little rise in HOMA-IR was seen with increasing age (P=0.021). Conclusion: The findings highlighted the considerable correlation between increased body mass index and intensified insulin resistance in people with pre-diabetes. They emphasize how important it is to maintain a healthy weight in order to lower the risk of diabetes and cardiovascular disease.

DOI: 10.5281/zenodo.

Background: Magnesium has been shown to relax bronchial smooth muscle, causing bronchodialation for easy respiration. A deficiency or low level of magnesium is observed in bronchial asthma patients. Method: 100 (one hundred) adult bronchial asthma patients and 100 (one hundred) healthy adult groups were studied and compared. In every patient, 2 ml of venous blood was collected to investigate serum magnesium, CBC, ESR, sputum for AFB, and Gram stain for S. mg. Were measured by the Elisa kit, chest x-rays were taken, and spirometry was measured to analyze PEFR, FEV, and ECG. Results: The FEV1 in bronchial asthma patients was 44.80 (± 0.38) and 95.40 (± 1.26) in control; the t test was 37.6 and p<0.001. Serum magnesium in Bronchial asthma patients had 1.68 (± 0.13) and the control group had 2.25 (± 0.05); the t test was 5.38 and p<0.41 (p value was highly significant). Conclusion: It is concluded that serum magnesium is considerably reduced in bronchial asthma patients. Hence, the administration of magnesium may relieve the bronchoconstriction and reduce the episodes of asthma attacks because the exact pathology of bronchial asthma is yet to be known.

DOI: 10.5281/zenodo.

Background: Inadequate pain relief in the postoperative phase is a well-known problem world-wide. A side from the suffering caused by insufficient pain relief, this is an issue with potential adverse physiological and psychological consequences for patients in addition to financial draw backs for caregivers. Poorly managed pain may interfere with postoperative complications, cause patient suffering and prolong recovery. Patients may anticipate future medical interventions with greater anxiety if pain has not been managed effectively in the past. Aim of this study to assess postoperative hemodynamics of intra peritoneal instillation of Ropivacaine and Bupivacaine in Laparoscopic surgeries. Methods: The present study was conducted in the Department of Anaesthesiology at Darbhanga Medical College and Hospital, Laheriasarai, Bihar. The double blinded randomized experimental study was conducted from March 2023 to August 2023. The sample size of 50 study subjects was selected using the mean pain score at 3.6 with 80% power and 95% confidence interval. In each of the group 25 study subjects were allotted based on randomization. All patients were instilled with 30 ml of solution in a standardized manner by the operating surgeon under vision before removal of trocar at the end of the surgical procedure. Group R received 30 ml (0.2%) ropivacaine and group B received 30 ml (0.25%) bupivacaine. The drugs were prepared and given to the investigator who was blind to the identity of drugs. Results: The heart rate was found to be comparable between two groups at 10 min, 30 Min, 60 Min, 120 Min, 4 Hrs, 8 Hrs, 12 Hrs and at 24 hrs and the p value was found to be non-significant. The Systolic Blood pressure was found to be statistically significant between the two groups at 10 Min, 30 Min, 60 Min, 120 Min, 4 hrs, 8 Hrs and 12 hrs. Whereas at 24 hrs the difference of Systolic Blood Pressure was found to be non-significant. Conclusion: Heart rate was similar in both the study groups at various time intervals. Systolic blood pressure and diastolic blood pressure was significantly high among patients in Bupivacaine group measures in most of the time intervals, while mean blood pressure differences were inconsistent over the follow up period.

DOI: 10.5281/zenodo.

Background: Pre-emptive paracetamol has been shown to decrease postoperative analgesia requirement in many patient populations; however evidence supporting its role in laparoscopic cholecystectomy is lacking. Our aim was to determine the effect of Pre-emptive paracetamol on postoperative analgesia requirement in patients undergoing laparoscopic cholecystectomy. Methods: Ninety patients belonging to American Society of Anesthesiologists physical status I or II were randomly assigned to 3 groups. Group I received 1 gram of paracetamol intravenously 30 min prior to surgery; Group II received 1 gram of paracetamol intravenously intraoperatively at time of skin closure and Group III was the control group and did not receive any paracetamol. The postoperative pain scores by VAS and analgesia requirement was compared in the 3 groups’ upto 6 hours postoperatively. Results: The postoperative pain scores remained comparable in the 3 groups for most of the duration of study. The post-operative fentanyl consumption was significantly lesser in Groups I and II as compared to group III. There was no difference in the sedation scores and in the incidence of PONV in the two groups. Conclusion: Pre-emptive intravenous paracetamol is effective in the treatment of postoperative pain after laparoscopic cholecystectomy.

DOI: 10.5281/zenodo.

Background: Stroke can be classified into ischemic and hemorrhagic types with respect to disturbance in blood flow. Althoughserum lipids are well-known risk factors for atherosclerosis, the relationship between serum lipid profile and type of stroke remains unknown. Previous studies have reported controversial results regarding the role of dyslipidemia in different types of strokes. The aim of this study was to compare the serum lipid profile of patients with ischemic stroke (IS) and hemorrhagicstroke (HS). Methods: A total of 201 patients with IS and HS, who were admitted to the Medicine ward of Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar from July 2019 to June 2020 and had not used any lipid-reducing drugs, were evaluated on the first day of admission. The serum lipid profile, including triglyceride (TG), total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), and high-density lipoprotein-cholesterol (HDL-C), was measured in these patients. Results: The participants were 48.8% male and 51.2% female. The serum TG level was significantly higher in IS patients in comparisonwith HS patients. The findings showed a significant association between the type of stroke and serum level of HDL-C. Conclusions: The results indicated a significant association between the lipid profile and type of stroke.

DOI: 10.5281/zenodo.

Background: It has been stated that lipid abnormalities are one of the risk factors for ischemic stroke. There are, however, few investigations correlating patient lipid profiles to the pattern of a stroke (hemorrhage and infarction). Incidence and association of lipid abnormalities in patients with cerebrovascular accidents (CVAs) were the focus of this investigation. Methods: Hundred and twenty seven subjects were studied after dividing in to Cases (n=102, with CVA) and Control (n=25, without CVA) in the Department of Medicine, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar from August 2019 to June 2020. Detailed history and lipid profile was recorded for each subject. Stroke pattern was analyzed using brain CT/MRI for each patient. Results: Most of the subjects among Cases and Control belong to the age groups of 61-85 years (45.09%) followed by 41-60 years (44%) respectively. Among Cases, maximum patients were males (61.76%) whereas among Control, maximum patients were females (84%). Most of the cases were smokers (53.92%). Among smokers of Case group, infarction (55%) was more common compared to hemorrhage (51%). Dyslipidemia was more common among cases (56.86%) compared to control (28%) (p=0.009). Majority of patients (63.07%) with infarct had dyslipidemia as compared to patients with hemorrhage (45.94%). Decreased high density lipoprotein (HDL) level (74%) was the main culprit among Cases followed by decreased total cholesterol (64%). Out of 14 expired patients in Cases, 71.42% had dyslipidemia. Conclusion: Decreased level of HDL was most commonly reported among ischemic compared to hemorrhagic stroke. Dyslipidemia was most commonly reported in patients who died because of stroke.

DOI: 10.5281/zenodo.

Background: Cardiovascular disease (CKD), the leading cause of death for people with chronic kidney disease (CKD), is largely caused by dyslipidemia. Therefore, to reduce morbidity and mortality in CKD patients, it is imperative to investigate their lipid profile. Methods: Subjects each of 50 in number are grouped into healthy controls (group-1), CKD patients without hemodialysis (group-2), CKD patients with hemodialysis (group-3). After fasting of 12 hours, lipid profile is assessed in all cases. Results: In this study, there is increase in Total cholesterol (TC), Low Density lipoprotein (LDL), very Low-Density lipoprotein (VLDL) and Triglycerides (TG) and decrease in High Density Lipoprotein (HDL) in all CKD patients compared to healthy controls (p-value for each parameter <0.001). There is increase in TC, TG and VLDL in diabetic CKD patients compare to non-diabetic CKD patients and p-value for each parameter is <0.05. It was found that TG and VLDL increase and HDL decrease in group-3 compare to group-2 is statistically significant (p-value for each <0.05) and no significant variation in TC and LDL in these groups. Conclusions: The present study showed that dyslipidemia exists in CKD patients regardless of their management strategy, but that the group with hemodialysis had significantly more dyslipidemia and is therefore at higher risk of cardiovascular disease. Starting lipid-lowering medication is preferable since it slows the progression of the disease and dyslipidemia.

DOI: 10.5281/zenodo.

Background: 48 percent of all visceral abscesses are located in the liver. Due to inadequate nutrition, overcrowding, and poor sanitation, it is frequent in India, where it has the second highest prevalence. An estimated 40–50 million individual’s worldwide contract amoebic abscesses each year. The purpose of this study is to investigate the clinical and biochemical profile of patients with liver abscesses in order to facilitate an early diagnosis and course of therapy. Methods: This cross-sectional study was conducted at medicine department of SKMCH from August 2019 to July 2020 on 50 patients of liver abscess. History and physical examination was done. All patients were subjected to complete hemogram, liver function test, coagulation profile (PT/INR) and USG abdomen. Serology for Entamoeba histolytica and HIV was done. Results: The mean age of the patients was 41.8 years with male preponderance. Amoebic liver abscess (86%) was predominant over pyogenic liver abscess (14%). Alcoholism (52%) and diabetes mellitus (20%) are main predisposing factors in case of liver abscess. Hepatomegaly was found in 80% cases. Elevated ALP, low albumin, increased PT INR points to the diagnosis of liver abscess. The abscesses were predominantly in right lobe (76%) and solitary (66%). Complications seen were ascites (12%) and pleural effusion (6%). Conclusions: Patients who come with a protracted fever and upper abdominal pain may have a liver abscess, especially if they have diabetes mellitus or are alcoholism. The use of ultrasonography is a simple and affordable method of diagnosing liver abscess. A strong foundation for preventing complications, morbidity, and death is early and aggressive treatment.

DOI: 10.5281/zenodo.

Background: The conventional approach to differentiating between exudative and transudative pleural effusions, which incorrectly classifies 15-20% of transudates as exudates, had been Light’s criteria. The purpose of this study is to determine the usefulness of combining total protein and cholesterol from pleural fluid in order to differentiate between exudative and transudative pleural effusions. Methods: Patients with pleural effusions were enrolled for the study. The combined pleural fluid cholesterol and total protein were compared with Light’s criteria and also compared with the diagnosis on discharge to find out their usefulness in categorizing the pleural effusions. Results: A total of 81 patients enrolled in the study, 42 (51.9%) were male. Based on Light’s criteria, 88.8% pleural effusions were found to be exudates and 11.1% were found to be transudates. Within the criteria, Light’s criteria categorized more pleural fluids as exudates than the diagnosis on discharge. Based on pleural fluid cholesterol >60mg/dL and protein >3g/dL for the classification of exudative and transudative pleural fluid, 62.9% out of 81 samples felled under the exudates and 37.03% pleural effusions under transudates with the sensitivity 87.9% and specificity100%. Conclusion: Combining pleural fluid cholesterol and total protein yields results that are almost similar without the requirement for concurrent blood examinations, even if Light’s criteria is still the gold standard for differentiating transudates and exudates.

DOI: 10.5281/zenodo.

Background: One of the top five causes of maternal mortality in both developed and developing nations is primary postpartum hemorrhage (PPH). Various uterine taponade devices have been used successfully to treat PPH over the past 20 years. In order to reduce atonic postpartum hemorrhage, this study compares the effectiveness and safety of balloon tamponade and Foley’s condom balloon tamponade (FC). Methods: 100 patients with atonic PPH were randomly divided into two groups for the prospective randomized control experiment. Group 1 (50 cases) received Foley’s condom balloon management, while Group 2 (50 cases) received JH balloon tamponade management. Time of UBT implantation and time of bleeding cessation were used as outcome indicators. It was also documented if there were any negative effects or balloon slippage. To ascertain the long-term outcomes in terms of menses, uterine cavities, and pregnancies, the patients were followed up with at 6 months. Results: In cases of JH balloon tamponade, the success rate was 92%, whereas in situations of FC balloon tamponade, it was 88% (p=0.74). B-Lynch sutures, uterine artery ligation, and sub-total hysterectomy were used in two of the six cases of failure in the FC group, while same procedures were used in all four cases of failure in the JH group (p=0.418). The mean time to make, insert, and inflate the catheter (3.01 vs. 3.12 mins; p=0.09) and the mean time to halt bleeding (7.08 vs. 6.91 mins; p=0.65) were comparable between the FC and JH groups. Only 1 patient in the JH group experienced JH balloon tamponade slippage compared to 10 patients out of 50 in the FC group (p=0.008). 38 patients in the FC group and 40 patients in the JH group reported no unfavorable long-term results during the 6-month follow-up. During that time, they experienced typical menstrual periods with no subsequent pain. Conclusion: The success rates of JH balloon tamponade and Foley’s condom balloon were both good and comparable (88% and 92%, respectively). Both balloon tamponades make the best use of the available resources and are simple to perform, even at peripheral health centers with limited resources and without wasting much time. Therefore, both types of balloons can be employed successfully in atonic PPH treatments instead of surgery.

DOI: 10.5281/zenodo.

Background: The oral mucosa is subjected to numerous local irritants throughout the life. This makes the oral cavity one of the most common sites for various benign, premalignant and malignant lesions. These lesions can cause variety of symptoms, leading to severe discomfort in daily life. Oral lesions generally present in the form of ulcer, swelling, discolouration or restricted mouth opening. Hence, the knowledge of all these pathological lesions of oral cavity becomes important in their early diagnosis and effective management. Method: In this present analytical and descriptive study, we studied clinical profile and histopathologic findings of various oral mucosal lesions, in 80 subjects. These lesions were found to be more common in middle aged males of low socioeconomic status. There was strong association between tobacco chewing and smoking with occurrence of premalignant and malignant lesions. Alcohol addiction often coexisted with tobacco consumption; and was found to be weakly associated with only malignant lesions. Aphthous stomatitis and Oral submucous fibrosis were found to be the most common benign and premalignant lesions, respectively. Results: Most common malignant lesion was squamous cell carcinoma of buccal mucosa. History and clinical examination were needed to study the type, site, gross appearance and extent of the lesion. However intraoral biopsy was gold standard in making accurate diagnosis of these lesions. Conclusion: Knowledge obtained through this clinico-histopathological study was useful to make early diagnosis of oral mucosal lesions for their effective management.

DOI: 10.5281/zenodo.

Introduction: Breast cancer is becoming more common globally, with peak incidence over 50 years of age in Western nations and over 40 years in India. It is possible to distinguish between distinct benign and malignant breast lesions with fine-needle aspiration cytology (FNAC), which is a rapid, simple, and affordable diagnostic method. Aims and Objectives: (1) to evaluate the Modified Masood’s Scoring Index (MMSI)’s applicability to breast cytology. (2) To investigate the link between cytopathology and breast lesions. Sort the breast lesion according to its histology and MMSI after the FNAC. Materials and Methods: At Pandit Raghunath Murmu Medical College and Hospital in Baripada, Odisha, 183 patients who were sent for FNAC from the surgery department to the cytology division of the pathology department underwent hospital-based prospective research from January 2023 to May 2024. Results: The majority of cases (45.90%) in our analysis, with a mean age of 37±14.65, were in the 20–39 age range. With a mean MMSI score of 11.35±5.55, group II (proliferative breast disease [PBD] without atypia) included the majority of patients (60.6%). The results of the histological analysis revealed a connection of 89.52% with MMSI category II and 98.15% with MMSI category IV, whereas the cytological results demonstrated a correlation of 98.20% with MMSI in category II and 88.68% in category IV. With 120 cases (65.6%), fibroadenoma (FA) was the most often seen finding on histological examination. Conclusion: When it comes to breast lesions, such as PBD with or without atypia and carcinomas, the MMSI is a useful tool to supplement cytomorphological diagnosis. Given that therapy choices might differ depending on the MMSI score, it is especially helpful in the early care and prognosis of patients.

DOI: 10.5281/zenodo.

Background: Chronic otitis media is a common condition for which the patient present to Otorhinolaryngology, constituting about 30% of the ENT outpatient numbers. Chronic otitis media implies a permanent abnormality of pars tensa or flaccida, most likely a result of acute otitis media, negative middle ear pressure or otitis media with effusion. Being surgery the main treatment modality of treatment, tympanoplasty using various types of graft materials is essential in the management of the disease. Temporalis fascia is most commonly used graft. Various other grafts materials include cartilage, areolar tissue, ear lobule fat, and vein. Cartilage is also a popular graft which can be used in the form of palisade, perichondrium/cartilage island, butterfly and shield graft. Hence this study was conducted with the objectives to compare the surgical outcome in terms of graft acceptance between the island cartilage graft and temporalis fascia graft used in type 1 tympanoplasty, to compare the audiological outcomes and complications. Methods: A cross sectional (Hospital based) study was conducted at Krishna Rajendra Hospital, Mysore attached to Mysore Medical College and Research Institute, Mysore. Patients attending the OPD with mucosal type of COM with subtotal perforation were included in the study between October 2018 to September 2019. Patients were divided into two groups alternatively and type one tympanoplasty was performed using island cartilage in one group and temporalis fascia in the other after clinical examination, examination under microscope and performing pure tone audiogram. Postoperatively they were followed up at third and eighth weeks to assess the graft uptake and audiological parameters. Results: In our study the graft uptake was similar in both island cartilage and temporalis fascia group. The audiological gain in terms of AB gap closure is slightly better in the temporalis fascia group than the island cartilage. Conclusion: In type 1 tympanoplasty, both temporalis fascia and island cartilage can be used for structural stability and temporalis fascia gives better audiological results.

DOI: 10.5281/zenodo.

Background: Scorpion stings pose a significant threat to children, particularly in tropical and subtropical regions. Due to their smaller body size, children are more vulnerable to the effects of venom. Common symptoms include intense pain at the sting site, but severe cases can progress to autonomic storm, affecting heart rate, breathing, and sweating. Early intervention is crucial, with prazosin being a key medication to manage the envenomation. We in the current study tried to evaluate the management and outcome of scorpion envenomation in pediatric patients reporting to our hospital. Methods: This hospital-based observational study was conducted in the Department of Pediatrics, Government Medical College and Hospital, Wanaparthy, Telangana. Institutional Ethical approval was obtained for the study. Written consent was obtained from the parent/guardian of the cases in the study after explaining the nature of the study in the vernacular language. Results: A total of 40 cases of scorpion stings were included in the study. Most of the cases were males (75%) and females were (25%). The medications and interventions were administered to patients (n=40) after they were hospitalized due to scorpion stings. All patients (100%) received intravenous fluids (IV Fluids) and prazosin. In this study, 20% of patients received a single dose of prazosin, 30% received 2 doses, 17.5% received 3 doses, and 30% received over 4 doses Dobutamine (35.0%) was used in some cases, due to potential cardiovascular complications in some patients. Conclusion: The study finding shows that Early and effective use of prazosin treatment showed good outcomes in patients. Fewer complications were seen in patients who received first aid before hospitalization. This study concludes that the majority of patients were exposed to complications due to a shortfall in education, awareness, and pre-hospitalization (first aid).

DOI: 10.5281/zenodo.

Background and Objectives: Ventilator associated pneumonia (VAP) is the most frequent intensive care unit acquired infection and is one of the leading causes of morbidity and mortality in ICUs. VAP is defined as pneumonia occurring more than 48 hours after endotracheal intubation and initiation of mechanical ventilation. The aim of our study is to find causative organism of VAP and to determine antibiotic susceptibility and its clinical profile. Materials and Methods: All patients on mechanical ventilation in MICU of GMCH, Bettiah. Study duration of Two years. were considered Patients under study were satisfying the inclusion criteria and detailed history and clinical examination of the patients was performed. Conclusion: VAP continues to be one of the major causes of both morbidity & mortality in ICU patients. Proper selection of cases requiring ventilator support may decrease the incidence of VAP. Proper monitoring & trying to bring the patient out of ventilator as early as possible may go a long way in reducing incidence of VAP.

DOI: 10.5281/zenodo.

Background and Objectives: Fever in neutropenic patients is a common problem encountered in clinical settings like leukemias, plasma cell dyscrasias, multiple myeloma, patients undergoing organ or bone marrow transplantation, those with bone marrow failure and in certain infections like enteric fever and HIV infection. Infections are a major cause of morbidity and mortality in cancer patients. A systematic study of the etiological profile of these fevers would help to formulate a suitable antibiotic policy as well as effective infection control measures. To study the clinical and microbiological profile of fever in neutropenic patients. Methods: The study material was collected from the hospitals of GMC Hospital Bettiah. 55 patients who had episodes of fever and neutropenia on admission or anytime during their hospital stay, were Study duration of Two years. A detailed history was taken and physical examination was done in all patients. They were subjected to appropriate investigations to find out the cause of fever. These included complete blood counts, urine microscopy, chest x-ray & blood smear for malarial parasites. Blood – sputum – stool – urine and access device cultures done if clinically indicated. Cultures from any other suspicious/focal lesions were taken. CT scan of the chest, abdomen & pelvis were done if clinically indicated. Elisa for HIV was done if considered relevant. Conclusion: most of them from unknown sources & the importance of the respiratory tract as an important source of infection for febrile episodes. The previous use of chemotherapy & central venous lines are potential risk factors. Fatigue is a common presentation of febrile neutropenia in this study. Gram positive infections especially staphylococcal species were a common cause of febrile neutropenia. The emerging trends in antibiotic resistance and their implications for empirical therapy indicate that institutions that treat neutropenic patients should have active ongoing microbiological surveillance studies with the objective of monitoring infections due to antibiotic-resistant pathogens, in order to improve their current antimicrobial regimens. So, an understanding of the epidemiology of febrile neutropenic episodes is crucial for the implementation of strategies that may contribute to preventing and controlling these infections.

DOI: 10.5281/zenodo.

Background and Objectives: Pneumonia is a leading cause of morbidity and mortality, especially in developing countries. The cause of community acquired pneumonia (CAP) is often difficult to establish. The most effective methods, especially for the diagnosis of atypical pathogens, are often invasive and cannot always be justified. The Asian region being very diverse, existing British and American guidelines cannot and should not be blindly transposed to this region without some idea of local prevalence. To study in detail the clinical profile and bacteriological flora of patients with community acquired pneumonia coming to our hospital. To detect proportion of atypical pathogens among Community acquired pneumonia patients. Methods: 122 patients presenting to GMCH, Bettiah. Study duration of Two years. who satisfied the diagnosis of Community Acquired Pneumonia ( CAP) as per the British Thoracic Society were included in this study. After sputum culture , blood culture and serological evaluation they were grouped as having typical and atypical pneumonia. Appropriate statistical analysis was done using the Chi-square test. Conclusion: The proportion of typical and atypical pathogens found in our study is 40.2% and 20.5% respectively .The differentiation of typical and atypical organisms by clinical evaluation alone is difficult. Hence appropriate serological investigation and prompt treatment is important to prevent complications and mortality.

DOI: 10.5281/zenodo.

Background and Objectives:  According to International Diabetic Federation 2014 Atlas, India has highest diabetic cases when compared to other south Asian countries, with 66.8 million.80% of patients with diabetes mellitus die a thrombotic death. The increased platelet activity may play role in the development of vascular complications of diabetes. MPV is an indicator of the average size and activity of platelets. The study aims to compare the MPV of diabetic patients and non-diabetics, to see if difference in MPV in diabetic patients with and without microvascular complications, and to determine the correlation of MPV with glycemic control and Lipid Profile. Methods:  A case control study of 50 Diabetic and 50 Non Diabetic subjects above 40 years of age belonging to the community, who came as IP/OP to the Department of Medicine of GMC Hospital, Bettiah. were selected based on the inclusion criteria. An MPV greater than 7.5fl was considered abnormal. Conclusions: In this study of 50 diabetic and 50 non- diabetic it was found that Mean platelet volume is more in diabetics (cases) when compared with non-diabetics (controls). Worsening of Blood sugar control and complications like macroalbuminuria increased the MPV. The MPV could be used for early detection of microvascular complications and for follow up of blood sugar control.

DOI: 10.5281/zenodo.

Background and Objectives: It has been suggested that diabetes mellitus is associated with an increased susceptibility to infections, the risk of using more aggressive therapeutic agents and increased mortality and morbidity; however, current evidence supporting these events in the field of pneumonia is scarce. The aim of the present study is to provide information on clinical and microbiological characteristics and the outcome of pneumonia in patients with diabetes mellitus. Methods and Materials: A prospective study conducted in GMCH Bettiah, which included 50 patients of pneumonia with diabetes and 50 patients of pneumonia in non-diabetics. The clinical and radiological characteristics, the spectrum of causative agents, microbiological data and the outcome of diabetic patients were analyzed and compared with data obtained from non diabetic patients. Results: Patients with diabetes were significantly associated with multilobar involvement (P=0.045*), prolonged duration of hospital stay (P = <0.001**), more severe at presentation in form of increased PSI score (P = 0.004**) and more ICU admissions. By contrast, there was no significant difference in age, sex, concomitant underlying illness, complications, mortality. In the sub group of patients with diabetes, mortality was associated with multilobar infiltrate, concomitant illness, high PSI score (P=0.078*). Conclusions: In patients with pneumonia, diabetes is associated with poor prognosis, increased duration of hospital stay and poor outcome. This study suggests that this outcome is more attributable to underlying circumstances of patients and uncommon microbiological finding.

DOI: 10.5281/zenodo.

Aim: To study the incidence of different patterns of diabetic macular edema and their association with visual acuity and central macular thickness using optical coherence tomography (OCT). Method:144 eyes of 72 patients with type 2 diabetes were enrolled in the study seen between May 2023 and October 2023. Best corrected visual acuity, anterior segment examination, indirect ophthalmoscopy, slit lamp biomicroscopy, Optical Coherence Tomography(OCT) and central macular thickness (CMT) were assessed. Diabetic macular edema(DME) was classified based on OCT scans into:spongiform edema, cystoid macular edema (CME), subretinal fluid, vitreomacular traction and taut posterior hyaloid. Results: In this observational study,144 eyes of 72 eyes with type 2 diabetes were enrolled. Spongiform edema was most common type found (41.7% in right eye) and (30.6%in left eye) followed by cystoid macular edema (23.6% in right eye) and (12.5% in left eye), while the subretinal fluid was present in (4.2% in right eye and 2.8% in left eye) and vitreomacular traction (2.8% in right eye). Conclusion: Spongiform edema was the most common morphological subtype of  DME patterns when compared with cystoid macular edema.cystoid macular edema showed increased macular thickness correlated with reduced visual acuity.

DOI: 10.5281/zenodo.

Giant Condyloma Acuminatum (GCA) also recognized as Buschke-Loewenstein Tumor (BLT) is an uncommon condition with an estimated occurrence of 0.1%. It was first described by Buschke in 1896, and then by Buschke and Loewenstein in 1925. GCA has a greater risk of malignant development compared to CCA and has a tendency to infiltrate surrounding soft tissues. It is linked to several risk factors, including immunodeficiencies, multiple sexual partners, poor hygiene, and persistent genital infections in addition to HPV infection. Ninety percent of GCA are correlated with HPV subtypes 6 and 11. It should be considered a differential diagnosis with numerous illnesses as it presents as a cauliflower-like tumor in the genital region with malodour, bleeding, and local infection.

DOI: 10.5281/zenodo.

Background and Objectives: Patients infected with human immunodefiency virus HIV is the etiologic agent of AIDS. It belongs to the family of human retroviruses (Retroviridae) and the subfamily of lentiviruses. The most common cause of HIV disease throughout the world, is HIV-1, which comprises several subtypes with different geographic distributions HIV-2 is originally confined to West Africa but few cases has been occurred in other parts of world. Four groups of HIV-1 have been defined. Material and Methods: The study will be carried out on HIV positive patients attending ART centre, General medicine OPD, and those admitted in Medicine wards of IGIMS Patna, Bihar. For duration of one year. Result: In this study, among those patients with renal dysfunction, 83.3% patients were on ART since less than 3 years. 16.7% patients were started on ART 3 to 6 years back. The influence of duration of antiretroviral therapy on risk of renal dysfunction was analyzed using One way ANOVA and Tukey pair wise analysis and found to be non-significant. Conclusion: This study shows that there is no significant association between the regimen of HAART and the risk of renal dysfunction. This was contrary to the commonly available data47-57 which revealed that the choice of ART may have predilection for causing renal damage especially from NNRTI group like Tenofovir, which was found to cause renal toxicity. This finding needs to be reanalyzed by further continuation of the study.

DOI: 10.5281/zenodo.

Background and Objectives: Pregnancy and puerperium is a critical period where many physiological changes take place involving various systems. These changes can result in neurological and hemodynamic disturbances and may sometimes lead to serious adverse effects if prompt treatment is not undertaken. To evaluate the neurological disorders that occur during the puerperal period using magnetic resonance imaging, To identify the imaging features that characterise each of these disorders and correlate with clinical picture. Material and Methods: Fifty post partum patients with clinical suspicion of neurological disorders referred to the Department of General Medicine, IGIMS, Patna.  Study duration of two years. underwent MRI of brain. The main source of data for the study were patients from IGIMS Patna. Conclusion: MRI was found to be a key modality to evaluate various neurological disorders and to arrive at an accurate diagnosis. Characterization of the lesions and awareness of the common diseases during puerperium will help the clinician arrive at an informed differential diagnosis. MRI is a non-invasive imaging modality with no radiation hazard, excellent resolution and multiplanar imaging capability.

DOI: 10.5281/zenodo.

Background and Objectives: Dyspepsia is a chronic or recurrent pain or discomfort centered in the upper abdomen; patients with predominant or frequent (more than once a week) heartburn or acid regurgitation, should be considered to have gastro esophageal reflux disease (GERD) until proven otherwise. Helicobacter pylori, a curved rod shaped bacterium, has been consistently associated with patients having acid peptic diseases, which plays a major role in its etiopathogenesis. In a developing country like India where Helicobacter pylori infection is linked between genetic predisposition, hygiene and sanity; therefore we have attempted to study the prevalence of H. pylori infection in dyspepsia among Indian patients in our hospital. Methods: Hundred cases of dyspepsia, studied clinically, were subjected to upper gastro-intestinal endoscopy under topical anaesthesia, during which biopsies, from the pathological areas were taken. Biopsy specimens were immediately inoculated into freshly prepared urea broth containing phenol red as the indicator. Positive test for Helicobacter pylori was indicated by change in colour of the medium from yellow to pink or red. The other biopsy specimens were sent for routine histopathology and special staining with Giemsa stain. Conclusion: H. Pylori is consistently associated with patients of acid peptic disease and has a high prevalence in cases of ulcer dyspepsia than non-ulcer dyspepsia.

DOI: 10.5281/zenodo.

Background: Non-alcoholic fatty liver disease (NAFLD) is the accumulation of lipid, is considered to be the commonest liver problem in the north population, as a major cause of liver related morbidity and mortality. It is known to be associated with various metabolic abnormalities, but nort much information regarding association between the metabolic disease. primarily in the form of triacylglycerols in individuals who do not consume significant amounts of alcohol and other known causes of steatosis, such as certain drugs and toxins, have been excluded. The rising incidence of obesity is associated with health complications. NAFLD effecting about 15-40% of the north population is being considered hepatic manifestation of metabolic syndrome. Methods: The study was an observational and analytical study of patients diagnosed as NAFLD, attending in opd and indoor patients of the Department of General medicine, IGIMS Patna. A total of 100 cases during the study period of Two years were included and investigated for metabolic syndrome.  Conclusions: It can be concluded that symptoms and signs of NAFLD are non-specific and occur later in the course of the disease hence the physician should have a high index of suspicion in order to detect NAFLD early in the course of the disease. The higher prevalence of all the components of metabolic syndrome in cases of NAFLD. Its early detection will help in modifying the disease course, delaying complications and also play a major role in prevent cardiology.

DOI: 10.5281/zenodo.

Background: Floating knee injury is a term used to denote ipsilateral femoral and tibial metaphyseal injuries. But recent literature has however expanded this term to include most ipsilateral fractures of the femur and tibia. These are extremely heterogeneous groups of injuries. They usually occur due to very high energy trauma. These are relatively uncommon injuries. These are always associated with high morbidity. Most of these injuries result in some permanent disability. There are no specific guidelines for the management. The implant choice needs to be determined depending on nature of fracture and soft tissue injuries. A specific pattern of management can often not be determined. In view of the high complications rate and the unavailabiltity of a specific treatment guideline, there is a need for undertaking such a study. Materials and Methods: This study is about the Functional Outcome of Surgical Managements of Floating Knee For this study 17 consecutive patients with ipsilateral femur and tibia fractures who presented to NMCH casualty from 2015- May 2019. All cases of ipsilateral tibia and femur fractures were included. Detailed history will be obtained using Performa with special attention to mechanism of injury. Evaluations including base line clinical features. Examination of other associated symptoms will be based on history and physical examination. The plan of management for the given patient was made depending on the nature of fracture, location of fracture, associated soft tissue injuries. Follow up study was done at 6 weeks, 12 weeks, 6 months and 1 year. Serial x-rays and functional assessment were carried out at each visit in outpatient clinic itself using the Karlstorm and Oleruds criteria. Conclusion: Patients who undergo primary nailing will have Excellent or Good results. The most important factors which determine the functional outcomes were the type of fractures (open or closed), nature of comminution including intraarticular extensions, timing of fixations and post operative infections.

DOI: 10.5281/zenodo.

Background and Objectives: With increasing number of vehicles on the roads in India, complex trauma cases caused by traffic accidents have increased progressively. Fracture Tibia are among the commonest fractures sustained in road traffic accidents due to the subcutaneous nature of the tibia, they are frequently open and contaminated fractures. Due to the poor blood supply and poor soft tissue coverage these fractures are frequently complicated by delayed union, malunion, non-union and infection. This study was conducted at the Department of Orthopaedics Adichunchanagiri institute of medical sciences to evaluate the results of interlocking intramedullary nailing using an unreamed nail in the treatment of the compound fractures of tibia. It was done to compare the advantage of using an interlocking intramedullary nailing without reaming in the treatment of compound fractures of tibia with various studies in terms of time required for union, rate of malunion and malrotation, infection and range of motion of knee and ankle. Materials and Methods:  This study was performed on 20 compound fractures of tibia with an unreamed interlocking intramedullary nail Department of Orthopaedics at NMCH Patna. All the cases selected were fresh fractures and mostly traumatic in nature. The procedure was done as early as possible and the secondary procedures of Dynamisation, skin grafting and musculocutaneous flap were done as and when needed. Conclusions: It was concluded that early interlocking intra medullary nailing using an unreamed nail with immediate soft tissue coverage resulted in good fracture union and low rates of complications compared to other modalities of treatment. It is cost effective with short hospital stay and facilitates earlier return to work. Over all morbidity is reduced and better patient satisfaction noted.

DOI: 10.5281/zenodo.

Background and Objectives: There are rapid physiological changes during pregnancy and puerperium which can precipitate new neurologic or Psychiatric symptoms. The range of neurological conditions affecting women of reproductive age is extremely broad. To study the Incidence and Clinical profile of patients with neurological complications in Peripartum period. Methods: It was a prospective observational study for a period of Two years.  Clinical profiles of the patients, maternal and perinatal outcome were studied. patients admitted in department of Medicine and Obstetrics and Gynecology in IGIMS Patna. with neurological symptoms in antenatal and postpartum period upto 6 weeks were included in the study. Conclusion: Neurological complications have now become important causes of maternal mortality and morbidity. Early detection and intervention is required to reduce the burden of neurological complications requiring intensive care.

DOI: 10.5281/zenodo.

Background: Total hip arthmplasty [T.H.A) remains one of the most frequently perfomied reconstructive surgeries. Much work has been done in this discipline over the past years with regards to scientific investigation, clinical outcome assessment, and the treatment of complications. Result: All patients had poor Harris hip score preoperatively. 88% patients had good or excellent results postoperatively. One (6%) patient had poor result that had vertical migration of the acetabular cup and one (6%) patient had fair result with perforation of acetabulum which was asymptomatic. Summary: 20 hips were operated in 18 patients for avascular necrosis (8 patients), fracture neck of femur (7 patients), ankylosing spondylitis (3 patients), Rheumatoid arthritis and osteoarthritis (1 patient each).

DOI: 10.5281/zenodo.

Background and Objectives: The anterior cruciate ligament (ACL) is injured frequently during sports participation. Arthroscopic evaluation of patients with an acute traumatic hemarthrosis of the knee has demonstrated repeatedly a 60% to 70% incidence of ACL injury. Furthermore, the incidence of associated meniscal injury at the time of acute ACL injury approaches 50%. Once the decision is made to proceed with ACL reconstruction, a variety of graft choices and surgical procedures are available. Historically, surgical treatment of ACL injuries involved an arthrotomy to repair or reconstruct the ACL. Advances in arthroscopic techniques have led to the use of both two-incision arthroscopically assisted techniques and one-incision endoscopic techniques for ACL reconstruction. Advantages of arthroscopic techniques include improved cosmesis, less disruption of the quadriceps mechanism, improved early rehabilitation, and maintenance of articular cartilage hydration. To study the short term functional outcome of arthroscopically assisted ACL reconstruction using autolgous bone patellar tendon bone graft using interferential screws and comparing between biodegradable and non-biodegradable groups in terms of Post operative knee stability, subjective knee functions. Materials and Methods: This study was conducted in Adult patient of either sex having Anterior cruciate ligament injury with or without associated meniscal injuries who are admitted to NMCH Patna. During this period 30 cases of adult patients with ACL knee were selected according to inclusion criteria. Conclusion: Arthroscopic anterior cruciate ligament reconstruction with bone- patellar tendon-bone autograft is an excellent treatment option and provides a stable knee with minimal complications for anterior cruciate ligament deficient knees. Because of the superior results in the bioscrew group in our study, we found the potential advantages of using bioscrews compared to metal screws sufficient to warrant the routine use of PLLA screws in ACL-reconstructions.

DOI: 10.5281/zenodo.

Background: One of the leading causes of maternal mortality with uterine atony is Postpartum haemorrhage (PPH) and can be reduced by proper use of uterotonic agents like oxytocin which is most commonly used. Approximately 80% of the patients suffers Spinal-induced hypotension (SIH) for cesarean delivery (CD) and is a frequently encountered problem. Postpartum haemorrhage (PPH) is one of the leading causes of maternal mortality with uterine atony in about 50% cases. There are many approaches to prevent hypotension but no single approach has been shown as the gold standard, and each prophylactic treatment comes with accompanying risks. Crystalloid preload can prevent hypotension has a poor efficacy in preventing hypotension, due to rapid redistribution into the extracellular space. Phenylephrine is a short-acting alpha agonist, can be administered by bolus as well as by infusion to treat oxytocin induced hypotension. Phenylephrine obtunds oxytocin-induced decrease in systemic vascular resistance (SVR) and increase in heart rate and cardiac output. Material and Methods: Patients were randomized to be in the colloid or crystalloid infusion groups. Normal singleton pregnancy, beyond 36 weeks gestation, between 19and 35 years of age, weight between 50 and 100 kg, and height ranging from 150-180 cm. Pre-anaesthetic evaluation of all the patients was done. Intravenous administration of preload was delivered for 30 min, prior to spinal anaesthesia and when the fluid load was complete, IV patency was maintained at a rate of 5 ml/hour and medications were flushed with LR. Standard monitoring for all patients was done through use of non- invasive blood pressure (NIBP) measurement, electrocardiography, and pulse oximetry. Oxygen (2 l/min) was administered via nasal cannula. The average Systolic BP and accompanying heart rate (HR) of these 3 measurements were recorded as mean baseline values. Patients feeling about nausea was recorded from start of anaesthesia at every 5 minutes interval. Conclusion: In prevention of SIH and treatment, Phenylephrine with collids are found to be superior than crystelloids because of the sparing effect of phenylephrine associated with preloading colloids.

DOI: 10.5281/zenodo.

Background and Objectives: Proximal femoral nails have been introduced relatively recent but have begun to complete the traditional dynamic hip screw. Fractures of the proximal femur including the intertrochanteric and subtrochanteric region which are commonly encountered in Orthopaedics especially in elderly population having porotic and weak bones. In elderly these occur even with minimal or trivial trauma ,whereas in the younger population these result from high velocity trauma. These injuries are in association with a high incidence of mortality and morbidity. These injuries were treated conservatively prior to the early 1970’s and are now treated totally surgically now. The goal of any treatment in fracture is stable fixation, ultimately leading to early mobilization and decreased incidence of morbidity and mortality. Many surgical interventions like Gamma Nail, Jewet Nail, Condylar plates had been tried but the outcomes were not very satisfactory. Clinical And Radiological Analysis of Proximal Fractures of femur when Treated with Proximal Femoral Nail. Materials and Methods: A prospective study done in the Department of Orthopaedics at NMCH Patna Bihar. Patients with Proximal femoral fractures managed with PFN and subsequent follow up at regular intervals for a duration of 1 year. Conclusion: Proximal femoral nail is a suitable implant for unstable intertrochanteric femoral fracture needing open reduction internal fixation.

DOI: 10.5281/zenodo.

Introduction: Pharmacovigilance plays a crucial role in ensuring medication safety by monitoring and evaluating adverse drug reactions (ADRs). ADRs are significant contributors to morbidity and impose a considerable economic burden on healthcare systems. the importance of pharmacovigilance, under-reporting of ADRs remains a major challenge due to factors such as lack of knowledge, additional workload, and fear of legal consequences. Medical and paramedical students, as future healthcare providers, are pivotal in improving pharmacovigilance practices. Assessing their knowledge, attitude, and practice (KAP) towards pharmacovigilance is essential for enhancing their training and promoting proactive ADR reporting. Material and Methods: This cross-sectional survey evaluated the KAP of pharmacovigilance among 239 students (137 medical, 50 nursing, and 52 pharmacy) at Parul University, Gujarat. Using a structured questionnaire, data were collected on students’ understanding of pharmacovigilance concepts, their attitudes towards ADR reporting, and their practical experiences with ADR reporting forms. The questionnaire, validated and tailored to the university’s context, included sections on knowledge, attitude, and practice. Descriptive statistics were used to analyze the data, and comparative analyses identified differences in KAP among the student groups. The study adhered to ethical guidelines, with informed consent obtained from participants. Results:  A total of 239 students, including 137 medical students, 50 nursing students, and 52 pharmacy students from Parul University, Gujarat, participated in the study to evaluate their knowledge, attitude, and practice (KAP) regarding pharmacovigilance. The knowledge section revealed that while 90% correctly defined pharmacovigilance, only 19% knew the regulatory body responsible for monitoring ADRs in India. Additionally, 93% were aware of the pharmacovigilance program in India, and 90% knew the location of the international center for pharmacovigilance. The attitude section showed that 75% of students recognized the necessity of ADR reporting, and 70% supported mandatory reporting, though 56% had concerns about legal liability. Moreover, 79% believed that an ADR collection box in clinical departments would improve reporting efficiency. In the practice section, 60% had seen an ADR reporting form by CDSCO, 56% had informed a ward physician about an ADR occurrence, and 79% expressed their intention to report ADRs in their future practice. Conclusion: Our study revealed that while students at Parul University, Gujarat, demonstrated solid foundational knowledge of pharmacovigilance, significant gaps existed in areas like identifying the regulatory body for ADRs in India. Despite recognizing the importance of ADR reporting, concerns about legal liability and inadequate practical engagement were evident.

DOI: 10.5281/zenodo.

Introduction: Obesity is rapidly increasing and becoming a focus of interest among medical experts, and the frequency of obesity and overweight in teenagers may have an impact later in life. In this study, we wanted to determine the prevalence of obesity and overweight in the population. Objectives: To estimate the prevalence of Obesity and Overweight in school going adolescents. Method: Demographic and anthropometric data of pupils aged 10-19 years was collected through school visits during the period from September 2021 to September 2022. Results: Out of total 500 adolescents 4.2% & 7.8% were found to be Obese & overweight respectively. Conclusion: Obesity in adolescents and children has skyrocketed, becoming a serious public health issue with far-reaching repercussions. There should be an urgent focus on screening for metabolic abnormalities and promoting a healthy lifestyle among adolescents who have been identified with metabolic abnormalities and, if left untreated, can develop metabolic syndrome additionally to cardiovascular, emotional, and social problems.

DOI: 10.5281/zenodo.

Introduction: Age-related macular degeneration (AMD), a degenerative disorder of the macula causing irreversible central vision loss, significantly impacts quality of life. Its prevalence ranges from 1.4% to 3.1%. It is classified into dry (more common) and wet (less common but faster progressing) types, with pathogenesis involving complex interactions of environmental, genetic, and personal factors. Aim & Objective: To estimate the prevalence and identify risk factors of AMD in a hospital-based population in Gujarat, India. Materials & Methods: A cross-sectional study was conducted in the Department of Ophthalmology at a tertiary hospital over period of  2 years. Patients over 40 years old with drusen measuring 63 microns or more were included, while those with other retinal conditions or who did not consent were excluded. The study involved comprehensive eye examinations, fundus photography, and detailed patient histories. Results: Prevalence of AMD was 2.15%. Early AMD was more prevalent (1.47%) than late AMD (0.67%), and dry AMD was more common (1.61%) than wet AMD (0.54%). Higher prevalence was observed in older age groups, smokers, alcohol consumers, obese individuals, those with hypertension, coronary artery disease, and a family history of AMD. Vision impairment and specific types of cataracts (nuclear and cortical) were also associated with higher AMD prevalence. No significant associations were found with gender, education, residence location, or diabetes. Conclusion: The prevalence of AMD increases with age, obesity, hypertension, smoking, alcohol consumption, family history, vision impairment, and certain cataracts. Raising public awareness about AMD risk factors and promoting regular eye screenings, especially for older individuals and those with a family history, is recommended. Encouraging lifestyle changes like smoking cessation and moderating alcohol intake can also reduce AMD risk.

DOI: 10.5281/zenodo.

Background: In this study, we wanted to find the association of asymptomatic bacteriuria with type 2 diabetes mellitus in women. Methods: This was a hospital based case control study conducted among 100 female diabetic patients aged more than 40 years with type 2 diabetes mellitus attending Master Health Check-up OPD in Velammal Medical College and Hospital, Madurai, Tamil Nadu, from February 2015 to August 2015 after obtaining clearance from institutional ethics committee and written informed consent from the study participants. Results: The mean FBS and mean PPBS levels and urine sugar and urine protien levels is significantly impaired and increased in patients with type 2 diabetes with asymptomatic bacteriuria which was found to be statistically significant. The increased incidence of positive urine culture in group type 2 diabetes compared to the control group was statistically significant. Type 2 diabetic patients have 1.62 times significantly more risk of developing asymptomatic bacteriuria than patients in the control group. It was statistically significant. Type 2 diabetic patients with urine sugar positivity have 3.04 times significantly more risk of developing asymptomatic bacteriuria than patients in the control group. It was statistically significant. Type 2 diabetic patients with Urine Pus Cells > 4 cells/cu.mm have 4.29 times significantly more risk of developing asymptomatic bacteriuria than patients in the control group. It was statistically significant. Conclusion: Escherichia coli was the most common cause of ABU in both diabetic and non-diabetic women in this study. Most of the isolated microorganisms in both diabetic and nondiabetic women were resistant to cotrimoxazole. All the isolated microorganisms in both the diabetic and nondiabetic groups were sensitive to norfloxacin.

DOI: 10.5281/zenodo.

Background: In this study, we wanted to study the prevalence of psychiatric morbidities in the last trimester of antenatal mothers. Methods: This was a hospital based cross sectional study conducted among 60 antenatal mothers in their last trimester – 28 to 39 completed weeks, age between 18 to 40yrs, attending antenatal clinic, Velammal Medical College and Hospital, Madurai, Tamil Nadu, over a period of six months after obtaining clearance from institutional ethics committee and written informed consent from the study participants. Results: Multipara had a significantly higher prevalence of Generalised anxiety disorder and Dysthymic disorder and Primipara had a significantly higher prevalence of Depressive disorder. Prevalence of Anxiety and Depressive disorder did not have a significant relationship in the antenatal period with the background of comorbid medical disorders. Prevalence of Psychiatric disorders was high with advancing age of the mother and with unwillingness of pregnancy but did not show relationship with of pregnancy. Significantly high anxiety and depressive symptoms correlated with increasing stressful life events and poorer marital quality. Mothers with previous obstretic and neonatal complications had a significantly higher prevalence of Psychiatric morbidities. Higher Neuroticism scores had significantly poorer quality of marital life. Conclusion: Follow up study is needed to understand the progress of the Psychiatric morbidities into the postpartum period and the obstretic and neonatal outcomes. Also effect of early intervention in patients diagnosed with Psychiatric morbidities and the outcome of such interventions are also needed to be considered in the near future.

DOI: 10.5281/zenodo.

Background: Otorhinolaryngologist often deals with large number of population varied symptoms of nasal obstruction, headache, and epistaxis owing to deviated nasal septum (DNS) worldwide. Septoplasty is the surgical technique to relieve patient of symptoms and with the advent of endoscopes in modern era it has gained further popularity. clinical practice of otorhinolaryngology, otorhinolaryngologist commonly encounters cases of deviated nasal septum. Some of the patients have mild symptoms while others get troubled because of severity of disease. Hence it becomes important to diagnose the cases timely and provide surgical treatment wherever needed. Aims and Objectives: To elicit the comparison between conventional and endoscopic septoplasty and merits and demerits of both the techniques. Material and Methods: The present study was conducted on 50 patients in DMCH Darbhanga, Laheriasarai. Result and Conclusion: The results after septoplasty were better with endoscopic approach as against conventional one. The endoscopic technique had advantages of less complication rate and better teaching tool for demonstration. it has certainly proved its superiority over conventional approach. Refinements in management of rhinological cases have been revolutionized by the use of nasal endoscopes.

DOI: 10.5281/zenodo.

Background and Objectives: Hoarseness is an early and very important symptom of laryngeal pathology caused by simple common cold to the dreaded laryngeal malignancy. To Evaluate the Etiological Factors of Vocal Cord Paralysis, Studies have shown peripheral causes (90%) being more common than central (10%). The cause for vocal cord paralysis usually arises in the cranial cavity, mediastinum, or neck along the course of corresponding recurrent or inferior laryngeal branch of Vagus. Methods: The present study has been carried out in 50 cases of hoarseness were included. Patient with laryngeal and hypopharyngeal malignancy & up to 15 years of age excluded from the study. Results: In the present series bronchogenic carcinoma is the most common etiological factor causing vocal cord paralysis and second is thyroid surgery and third is tuberculosis of lung. Conclusion: Voice production is a complex mechanism, involving the muscles of pharynx, palate, tongue, nose and lips. A proper protocol is necessary for identifying the factors responsible for vocal fold paralysis which would help in managing the condition more effectively.

DOI: 10.5281/zenodo.

Background and Objectives: Tympanic membrane perforation is seen as partial and/or total rupture of the ear membrane which can occur for many reasons such as trauma, infection, malignant tumors or iatrogenic interventions. The aims of our study were to evaluate the outcome of office-based paper patch grafting in tympanic membrane (TM.) Method: This is a retrospective study of 100 patients that underwent paper patch myringoplasty in an outpatient setting. The clinical factors with potential impact on the healing status of the TM were investigated: gender, age, laterality, etiology, duration of perforation, tinnitus, hearing loss, otorrhea, size and location of perforation, status of contralateral ear, ipsilateral findings of computed tomography, and duration of complete healing. Result: TM perforation completely healed in 75.00% cases, and the mean duration of complete healing was 15.11±16.2 weeks. Conclusion: Paper patch grafting can also be considered before formal surgical myringoplasty in the case of small, dry, chronic TM perforations.

DOI: 10.5281/zenodo.

Background: Childhood empyema is an important complication of bacterial pneumonia. The incidence of empyema is increasing worldwide. Despite being recognized since the ancient times, the appropriate management of paediatric empyema thoracis remains controversial. Objectives: To study the clinical, bacteriological profile and various therapeutic options in childhood empyema thoracis in a tertiary care hospital. Methods: The present descriptive study was done at Patna Medical College and Hospital Patna. Study duration of One  years. 40 patients were included in the age group of 1 month to 15 years with the diagnosis of empyema. All the patients were analyzed for the clinical course of the disease, radiological investigations, pleural fluid biochemical and microbiological parameters, and various treatment options. Short term follow up was done for complications and sequelae. Conclusion: Management of primary empyema continues to be controversial in terms of duration of antibiotic therapy and the indications for and timing of surgery. There should be a changing trend towards VATS with the emphasis laid on minimizing the duration of hospital stay to bring down expenditure, psychological stress and more importantly nosocomial infections due to multidrug resistant organisms.

DOI: 10.5281/zenodo.

Background and Objectives: Seizure disorder is the most common pediatric neurological disorder.4-10% of children suffer at least one episode of seizure in the first 16 years of life. The incidence is highest in the children less then 3 years, with decreasing frequency in older children. Seizure account for about 1% of all emergency visits. The incidence of epilepsy in children and adolescents seems relatively consistent across all populations studied ranging from 50-100/100000 person years. The objective of this study is to study clinical profile of children presenting with seizures and to study aetiopathological basis of seizure disorder in children. Methods: All Children of age from 1 month to 18 years presenting with seizures to Department of Paediatrics, Patna medical college and Hospital Patna. will form the data for the present study. Conclusions: Generalized seizures are more common presentation than partial seizures in younger age group. Febrile seizures are a leading cause of seizures in younger age group, whereas space occupying lesion are common in older age group. In partial seizures Neurocysticercosis is a common cause followed by Tuberculoma. Most of the seizures are controlled by monotherapy withappropriate antiepileptic drugs like Clobazam in Typical Febrile Seizures, and Sodium Valoprate in other conditions.

DOI: 10.5281/zenodo.

Background:   Open repair of inguinal hernias is a recognised standard approach to groin hernia repairs. Furthermore, this approach is uniquely suited to repair under local anaesthesia (LA). LA repair of unilateral Inguinal hernia (IH) is widely reported in the literature as a safe, well tolerated, and effective operation. However, there is minimal evidence in literature on simultaneous repair of bilateral inguinal hernias under local anaesthesia. This approach is a useful tool in patients with bilateral IH who are unfit for or choose to avoid general anaesthesia (GA). We report our experience with simultaneous repair of bilateral inguinal hernias under local anaesthetic. Methods: We reviewed prospectively collected data of patients with bilateral inguinal hernias for whom simultaneous repair under LA. Data was collected for patient demographics, post-operative visual analogue pain score (VAS), operating time, volume of local anaesthetic used, patient satisfaction and complication rates. All patients had a Lichtenstein’s hernioplasty using a buffered local anaesthetic mixture made up of 30ml 0.5% Bupivacaine with adrenaline, 20 ml 2% Lignocaine with adrenaline, 50 ml of 0.9% Saline and 6 ml of 8.6% Sodium Bicarbonate. In each patient, both procedures were performed sequentially as a day case operations. Results: In total, 24 patients were included in the study with male preponderance (92%) and only two were females. Their ages ranged 35 – 81 years. Their BMI varied from 18 – 30, with a mean of 24. The average operating time was 66.8 minutes (ranging 38 – 120 minutes, median 60 min). The mean pain score was 24, on a VAS 0-100 scale (range 4 – 50, median 25) with patient satisfaction scores (0-100 scale) varying from 50-100 (Median 90, Mean 88.1). Conclusion: We conclude that successful simultaneous repair of bilateral inguinal hernia under local anaesthetic can be performed safely in a timely fashion, with minimal patient discomfort and high satisfaction rate. This approach should be considered as a viable alternative in the tailored approach to repairing IHs0 and offered to patients not deemed suitable for elective general anaesthesia with the advantage of addressing both groin hernias during the same operating session.

DOI: 10.5281/zenodo.

Background: General anaesthesia with endotracheal intubation often results in postoperative sore throat, cough and hoarseness of voice. Benzydamine hydrochloride is a topical NSAID with analgesic, local anaesthetic, anti-inflammatory properties. We studied the effect of benzydamine hydrochloride gargling on the incidence and severity of sore throat, cough and hoarseness of voice in patients undergoing elective middle ear surgery under general anaesthesia with endotracheal intubation. Methods: All the patients after explaining the procedure. 120 patients of either gender scheduled for elective middle ear surgeries under general anaesthesia with endotracheal intubation, who fulfilled the inclusion and exclusion criteria were included. Patients were randomized into two groups -Benzydamine hydrochloride group and control group using sealed envelope method. Patients in Benzydamine hydrochloride group were gargled 0.15% of 20ml benzydamine hydrochloride solution and control group patients gargled 20ml of 0.9% saline for 30secs, 5mins before intubation. After surgery and tracheal extubation, the incidence and severity of postoperative sore throat, cough, hoarseness of voice and any complications were assessed at 0, 2, 4, 6 and 24 hours. Conclusion: Preoperative benzydamine hydrochloride oral gargle reduces the incidence and severity of sore throat, cough and hoarseness in patients who underwent elective middle ear surgery under general anaesthesia with endotracheal intubation.

DOI: 10.5281/zenodo.

Background: This study was designed to evaluate the efficacy, onset and duration of sensory and motor blockade, occurrence of delirium reaction and other complications of Ketamine with Adrenaline given intrathecally. Lignocaine and Bupivacaine are the commonly used local anaesthetic agents for spinal anaesthesia. Lignocaine produces good motor blockade but duration of action is lesser than that of bupivacaine. Methods: After informed and written consent, ASA Physical status I and II aged 18-60 years, of either sex randomly selected 100 Patients for elective lower abdominal surgeries were been enrolled after inclusion and exclusion criteria. Patients with severe systemic disease metabolic disorders, neurological, congenital or cardiovascular diseases were excluded from this study. Results: In the present study the maximum level achieved ranged from T6-T10. The time taken to achieve maximum sensory blockade ranged from 2-8 minutes. There were no significant changes in mean systolic and diastolic arterial blood pressure or pulse rate. Intra-operatively, nystagmus was seen in all patients. Sedation and delirium was seen in 72 patients and 2 patients respectively. Conclusion: We conclude that intra thecal ketamine with adrenaline produces a reliable anaesthesia, better operative conditions and patients comfort with minimal side effects in elective lower abdominal surgeries.

DOI: 10.5281/zenodo.

Background: Study was conducted on 60 patients of both sexes taken for various surgical procedures taking from 30 to 90 minutes at BMIMS Pawapuri Nalanda. Midazolam maleate is a colourless crystal, which manifests a pH dependant ring phenomenon. In the prepared form it is buffered to a pH of 3.5 which keeps the benzodiazepine ring open while administration physiologic pH maintains the closed ring structure and the drug efficacy. Result: More of the children in the control group (25%) were anxious on reversal of residual paralysis than in the 0.5 mg/kg dose group and the 0.75 mg/kg dose group (5%, 0%, resp.) The number of children who were drowsy but arousable was the highest in the 0.75mg/kg dose group (50%) followed by the 0.5 mg/kg dose group (20%) and the control group (10%). The differences observed between the 0.75mg/kg dose group and the control group were statistically significant. Also, the percentage of children who were calm were significantly higher in the 0.5 mg/kg dose group (75%) compared to the control group (25%).Most of the children in the three groups recovered spontaneous ventilation and could be extubated within 5 minutes. However, 2 children in each of the 3 groups were extubated within 5–10 minutes of reversal. Recovery of spontaneous ventilation and extubation was delayed by over 15 minutes in 2 children in the 0.75 mg/kg dose group. Midazolam dose did not impact the overall recovery times for children in any of the 3 groups, as the average time interval from premedication to full recovery was similar for all 3 groups. Conclusion: Observation were made in terms of pulse rate, respiratory rate,SpO₂, patient’s acceptance of the medication, reaction to separation from parents, sedation scores, and recovery conditions. No side effects reported with Midazolam syrup like nausea, vomiting, hiccoughing, apnoea and laryngospasm.

DOI: 10.5281/zenodo.

Background: The study was undertaken in the Department of Anaesthesiology, BMIMS, Pawapuri, Nalanda. The study included 90 patients (Age 20-35 years) undergoing elective caesarean section under spinal Anaesthesia. It provides satisfactory anaesthesia for lower abdominal, urological and lower limb surgeries and it is often associated with a marked fall in blood pressure during and after anaesthesia due to various factors like diminished cardiac output consequent upon decreased venous return due to blockade of sympathetic nerves arising from T₁-L₂ leading to dilatation of both resistance and capacitance vessels and lack of propulsive movement on veins. Conclusion: Vital parameters were monitored and blood pressure & heart rate reading were taken 3 times at 2 minutes interval and lowest MAP and heart rate were taken as baseline for each group respectively. All the patients were preloaded with 500 ml of ringer lactate solution. Test drug was injected IM just after the induction of spinal anaesthesia. All the patients were observed and hemodynamic data recorded for 60 minutes after spinal anaesthesia. The patients were monitored for hypotension (decrease in MAP>25% of baseline MAP), bradycardia (heart rate<50 beats/minute), nausea, vomiting.

DOI: 10.5281/zenodo.

Background: Sexuality is an important aspect of health which can impact the overall well-being of men and women. In spite of the high prevalence of sexual dysfunction it has received little attention from researches in India. Aims & objectives: To assess the socio-demographic variables and the prevalence of psychiatric comorbidity among male patients of sexual dysfunction and Dhat syndrome attending psychiatry OPD of a tertiary care general hospital. Methodology: prevalence of psychiatric comorbidity was assessed in 50 out patients of sexual dysfunction and Dhat syndrome with the help of instrument M.I.N.I. Results: 70% of patients with sexual dysfunction and Dhat syndrome has associated psychiatric comorbidity. Most common psychiatric comorbidity being major depressive episode followed by generalised anxiety disorder.

DOI: 10.5281/zenodo.

Background and Objective: Bronchiolitis is self-limiting in most children, and hyponatremia is one of the well-known complications of bronchiolitis and its presence at the time of admission is known to have an impact on the adverse outcome. To the best of our knowledge there has been no study has been done in the past in the Indian setting on the relationship between hyponatremia and the severity of bronchiolitis in children. Methods: The study was a prospective cohort study that was conducted for a time period of Two years on sixty children with diagnosis of bronchiolitis in admitted in PICU was based on NICE clinical criteria These two groups were compared for the outcome variables. Outcomes were use of mechanical ventilation and ICU length of stay (LOS). To examine the association of sodium status with outcomes, we fit logistic and linear regression models with propensity score adjustment. Conclusion: Our findings confirm in bronchiolitis children there is no significant association between the development of hyponatremia and severity of bronchiolitis. Further studies needed to validate about hyponatremia as a prognostic factor.

DOI: 10.5281/zenodo.

Background and Objectives: The term malnutrition refers to both undernutrition as well as overnutrition. Undernutrition is a condition in which there is inadequate consumption, poor absorption or excessive loss of nutrients. Overnutrition is caused by overindulgence or excessive intake of specific nutrients. By using WHO guideline, to identify the children with SAM from the patients admitted in department of Pediatrics, BMIMS Pawapuri. Method: This observational study will be carried out on admitted patients in upgraded department of Pediatrics, Pawapuri Nalanda. Conclusion: Prevalence of Malnutrition is almost similar in both the sexes with slight male dominance. Most of the malnourished child are in the age group of 6 to 12 months, and mean age of presentation was 20 months.

DOI: 10.5281/zenodo.

Background: Neonatal seizures are clinically significant because very few are idiopathic. Biochemical disturbances occur frequently in neonatal seizures either as an underlying cause or as associated abnormalities. In their presence it is difficult tocontrol seizures and there is a risk of further brain damage. Methodology: The present study included 110 neonates presenting with seizures admitted to NICU at BMIMS, Pawapuri.  Study duration of Two years. Detailed antenatal, natal and postnatal history were taken and examination of baby was done and HIE staged according to modified Sarnat’s staging. Relevant investigations including biochemical parameters were done and etiology of neonatal seizures and their associated biochemical abnormalities were diagnosed. Conclusion: Biochemical abnormalities are common in neonatal seizures. Isolated biochemical abnormalities without other co morbid states were seen in 13 (11.8%) cases. 33 (30%) cases of neonatal seizures with identifiable etiology had associated biochemical abnormalities.

DOI: 10.5281/zenodo.

Background: Thalassemia is a hereditary anaemia resulting from defect in haemoglobin production and the most common genetic disorders worldwide. The aim of this case control study was to know the growth patterns and thyroid dysfunction in beta thalassemia major patients. Materials and Methods: This study was conducted in the Department of Paediatrics, BMIMS Pawapuri, over a period of two years. The study included 50 homozygous thalassemia major patients, receiving regular blood transfusion and 50 normal children were taken as controls. Conclusion: Thalassemia major patients with iron overload had decreased weight for age, height for age and increased TSH suggestive of subclinical hypothyroidism. Awareness of these findings is helpful to avoid unnecessary evaluation in patients with beta thalassemia. Better evaluation of iron toxicity can protect patients from complications associated with treatment.

DOI: 10.5281/zenodo.

Background and Objectives: Hepatic encephalopathy is a complex neuropsychiatric syndrome characterised by disturbances in consciousness and behaviour, personality changes, (1) Alteration in the level of Serum Sodium, Potassium and Chloride in hepatic encephalopathy. (2) Correlation of these levels with severity of hepatic encephalopathy due to various causes. (3) The role of Serum Sodium, Potassium and Chloride as a predictor for grading of severity of hepatic encephalopathy. Study Design: Prospective observation study. Inclusion Criteria: All children with clinical and biochemical evidence of liver dysfunction having neuropsychiatric changes were included. Exclusion Criteria: Cases with meningioencephalitis and other cases of encephalopathy will be excluded. Upgraded Department of Paediatrics, BMIMS, Pawapuri. Study Group: All children with hepatic encephalopathy, they were admitted in paediatrics ward of BMIMS Pawapuri, Nalanda.

DOI: 10.5281/zenodo.

Background: CNS tuberculosis is the most devastating form of extra pulmonary tuberculosis in which TB meningitis is the most common form affecting 1-2 percent of untreated tuberculosis. Early treatment is critical to reduce TBM related mortality and morbidity. Diagnosing TBM based on smear microscopy has very low sensitivity and using CSF culture and sensitivity takes long time. Hence rapid and accurate detection methods are essential for initiation of early treatment especially in vulnerable pediatric age group. Methods: It is a hospital based observational study conducted in Department of Paediatrics BMIMS, Pawapuri. All children with clinically suspected tuberculous meningitis were enrolled into the study and underwent detailed history taking, clinical examination, blood investigation, CT scan brain and Lumbar Puncture. CSF samples were sent for CSF Xpert MTB/RIF. Conclusion: CSF genexpert was considered superior to smear for AFB in isolating TB bacilli in case of suspected TB meningitis. The sensitivity of CSF genexpert against clinical scoring was 46.15% and specificity was 100%.

DOI: 10.5281/zenodo.

Background: Effective surgical management is crucial for optimal outcomes in posterior malleolar fractures. This study compares the efficacy of lag screw versus buttress plate fixation techniques in treating these fractures. Aim and Objective: To compare the efficacy of lag screw versus buttress plate fixation in treating these fractures. Methods and Methods: In this prospective randomized controlled trial, 40 patients with posterior malleolar fractures were assigned to either lag screw fixation (n=20) or buttress plate fixation (n=20). Clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) scores, range of motion (ROM), and radiographic evaluations over a mean follow-up period of 38.2 months. Results: At 1 year, the AOFAS scores for the lag screw group averaged 94.1 ± 5.4, and for the buttress plate group, 93.8 ± 5.6. ROM improved to 60.3 ± 6.4 degrees in the lag screw group and 60.0 ± 6.6 degrees in the buttress plate group. Complete union was achieved in 19 patients in each group, with minor step-off discrepancies noted in one patient per group. Complication rates were low, with superficial infections occurring in 1 patient from the lag screw group and 2 from the buttress plate group. Conclusion: Lag screw and buttress plate fixations provide comparable and satisfactory outcomes for posterior malleolar fracture management. Both techniques are effective, allowing surgeons to choose based on specific fracture characteristics and personal expertise.

DOI: 10.5281/zenodo.

Background: Osteoporosis is a prevalent condition in the elderly, characterized by reduced bone mass and increased fracture risk. Fracture healing in osteoporotic patients is often delayed, posing significant clinical challenges. Teriparatide, a recombinant form of parathyroid hormone (PTH 1-34), has shown promise in enhancing bone regeneration and fracture healing. Aims and Objective: To evaluate the efficacy of teriparatide in fracture healing among osteoporotic patients. Materials and Methods: This prospective, observational study was conducted at Gandhi Medical College and Hamidia Hospital, Bhopal, from January 2021 to December 2023. A total of 150 osteoporotic patients with confirmed fractures were enrolled and treated with teriparatide (20 µg daily) for six months, along with standard fracture care. The primary outcome was the time to fracture healing, assessed through clinical and radiographic evaluations. Secondary outcomes included bone mineral density (BMD) changes and functional recovery, evaluated using SF-36 and WOMAC scores. Safety and tolerability were also monitored. Results: The mean time to fracture healing was significantly shorter in the teriparatide group (13.5 ± 2.1 weeks) compared to historical controls (18.7 ± 3.5 weeks, p < 0.001). BMD improved from a mean T-score of -2.8 ± 0.3 at baseline to -2.3 ± 0.4 at six months (p < 0.001). Functional outcome scores showed significant improvements in physical function and pain reduction. Teriparatide was well-tolerated, with minor adverse events, including transient hypercalcemia (5%), mild injection site reactions (3%), and mild dizziness (2%). Conclusions: Teriparatide significantly accelerates fracture healing in osteoporotic patients, improves BMD and functional recovery, and is well-tolerated. These findings suggest that teriparatide can be a valuable therapeutic option in the management of osteoporotic fractures, potentially improving patient outcomes and reducing healthcare costs. Further research is warranted to explore the long-term benefits and optimize the use of teriparatide across different fracture types and patient populations.

DOI: 10.5281/zenodo.

Objectives: Refractive error is related to anatomic and functional differences in the eye, particularly in axial length, lens thickness, and lens opalescence. Myopia progression is more commonly produced by the increase of AL than for changes in the other optical components. In fact, the measurement of AL has been considered the most accurate way to monitor myopia progression. The present study was to evaluate the refractory error and ocular biometry among young adults in Muzaffarpur, Bihar. Methods: An ophthalmological examination was conducted with the assessment of visual acuity, the measurement of static refraction with the use of an autorefractor under cycloplegia, with prior administration of 0.5% proparacaine, followed by one application of 1% cyclopentolate eye drops, and two applications of 1% tropicamide, one drop each, with 5-minute intervals between drops. Biomicroscopic examination of the anterior segment was performed using a slit lamp, tonometry, cover test, corneal topography, and optical biometry. Results: A total of 100 adults with age group 18-30 years were enrolled. The mean age was 22.56±3.23 years. 42(42%) participants were males and 58(58%) were females. Regarding refractive errors, 12(12%) were hyperopic, 32(32%) were emmetropic, 51(51%) were myopic and 5(5%) were high myopic. most of the patients of18(18%) emmetropia had no family history. Most of the patients of 25(25%) myopia had history of one parent. 5(5%) patients of myopia had both parent history. 5% patients had not known the causes of refractory error. Most of the 34(34%) patients had >0 D Spherical equivalent OD. 31(31%) patients had -2.50 to 0 D. 28(28%) patients had -5.50 to -2.50 spherical equivalent OD. Conclusions: Myopia is the most common refractory error in young adult. Anterior segment biometric components and axial length make the greatest contribution to spherical equivalent in hyperopia and high myopia.

DOI: 10.5281/zenodo.

Hypertensive disorders of pregnancy (HDP) significantly contribute to maternal and perinatal morbidity and mortality, especially in developing countries. This paper examines the effectiveness of second trimester uterine artery Doppler in predicting pre-eclampsia and fetal growth restriction (FGR). Doppler ultrasounds performed at 20-24 weeks measured parameters like peak systolic velocity (PSV), end-diastolic velocity (EDV), pulsatility index (PI), and resistive index (RI), along with early diastolic notching. Results showed that increased impedance to uterine artery flow (PI > 1.45 or RI > 0.58) and early diastolic notching are significant predictors of pre-eclampsia and FGR, with negative predictive values of 91% and 90%, respectively, and sensitivities of 85% for pre-eclampsia and 71% for FGR. This paper highlights the importance of early detection and intervention in high-risk pregnancies and provides a comprehensive summary of methodologies, findings, and future research directions to aid fellow researchers in this field.

DOI: 10.5281/zenodo.

Interstitial lung diseases (ILDs) are challenging to diagnose with traditional chest radiographs due to their low resolution and overlapping anatomical features. High-resolution computed tomography (HRCT) has transformed the diagnosis and characterization of ILDs. This study uses HRCT to evaluate pulmonary involvement in connective tissue diseases (CTDs) such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), systemic sclerosis, scleroderma, polymyositis, dermatomyositis, mixed connective tissue disease (MCTD), and undifferentiated connective tissue disease (UCTD). Significant patterns like non-specific interstitial pneumonia (NSIP) and usual interstitial pneumonia (UIP) are identified, with 42% of RA subjects and 54% of SLE subjects showing pulmonary involvement. Early detection of pulmonary abnormalities through HRCT can precede symptoms, aiding in better prognosis and treatment [2]. HRCT is essential for diagnosing, assessing disease severity, guiding biopsies, and monitoring antifibrotic treatment efficacy in ILDs associated with CTDs.

DOI: 10.5281/zenodo.

Introduction: Common bile duct (CBD) stone is a common issue in clinical practice, demanding swift diagnosis and treatment. Treatment options encompass open, endoscopic, and laparoscopic methods. CBD stones pose challenges for surgeons and gastroenterologists due to varying symptom severity. This study aimed to assess different treatment modalities for CBD stones in females and their effectiveness in terms of outcomes and complications. Materials and Methods: We conducted a prospective study involving 89 patients. Data collected included detailed patient history (age, gender, admission date), chief and associated complaints, past medical history, general and systemic examinations (particularly abdominal), laboratory investigations (if conducted), and special investigations such as X-ray, ultrasound, CT scan, MRCP, and ERCP. Complications were meticulously evaluated and monitored post-treatment. Patients were followed up monthly for six months after discharge to track recurrent attacks or new complications. Results: CBD stones predominantly affected females aged 55 to 64 years, presenting a range of symptoms from asymptomatic to severe complications like acute biliary pancreatitis and cholangitis. Pain, jaundice, and fever were common symptoms. Ultrasonography detected stones in about 40% of cases. ERCP was the primary extraction method, with open surgery used in failed cases. Open surgery showed slightly higher success rates than endoscopic procedures. Conclusion: Open surgery demonstrated greater success compared to endoscopic procedures, particularly in cases with large stone burdens causing lower CBD obstruction. Proper patient categorization, pre-operative evaluation, and skilled medical staff are critical for optimal treatment decisions.

DOI: 10.5281/zenodo.

Background and Objectives: Diabetes mellitus is a metabolic disorder characterized by increased blood sugar levels. It is of two types. Type two is very common, due to deficiency in secretion of insulin. That eventually affects derangement of carbohydrate, protein and lipid metabolism. On long standing, this metabolic derangement will affect vital organs like liver, kidney, brain etc. To study correlation analysis that determine strength and direction of relationship between indicator of DM (FBS and PPBS) and RFT (serum urea and serum creatinine) in Indian population. Methods: A retrospective study design was done in government hospital, Rajkot, Gujarat, India (study population).Total 1,45,369 patients in period of April 2023 to April 2024 included in this study .Data sources from the laboratory tests. The patients who were tested for RFT (serum urea and serum creatinine) and DM (Plasma FBS, Plasma PPBS) were included in this study. Results: A total of 1,45,369 cases were studied from April 2023 to April 2024 (1 year) of which 64% of males and 36% were females. Based on statically significant variables, multiple binary logistic using stepwise regression analysis was performed to determine that direct association of renal function test with diabetes mellitus. Conclusions: Long standing diabetes can affect multisystem like neuropathy, nephropathy. Therefore, regular monitoring of RFT is essential in diabetic patients.

DOI: 10.5281/zenodo.

Background: Polycystic ovary syndrome (PCOS) is defined as an ovarian dysfunction syndrome which affects the reproductive, endocrine and metabolic functions. Insulin resistance and hyperandrogenism is found to play a key role in the pathogenesis of polycystic ovarian syndrome. Objective: To compare the effects of N-acetyl cysteine with metformin on clinical profile in anovulatory infertile women with PCOS. Method: Study was performed as a randomized control trial on infertile anovulatory women with PCOS without additional endocrinopathy. Total 60 women were enrolled. In one group, oral NAC 600 mg, three times a day and in the other group, 500 mg oral metformin, three times a day were prescribed for 3 months. Menstrual pattern, ovulation and BMI were noted before and after completion of treatment along with the side effect profile of the drugs. Results: 28 women in metformin group and 29 in N-acetyl cysteine completed the study. A statistically significant decrease in BMI was noted in both the metformin and NAC groups (25.36±2.15 kg/m² vs. 24.34±2.14 kg/m² respectively) with a p value of 0.00 for each group. Both treatments led to significant improvement in menstrual pattern and ovulation. The efficacy of the two drugs was equal. The side effects on NAC was significantly less (p = 0.02) compared to metformin. Conclusion: Metformin and NAC appear to have equal effects on clinical profile in PCOS women. However NAC has better tolerability with fewer side effects.

DOI: 10.5281/zenodo.

Background: Study of respiratory functions of four groups of women: Nonpregnant, early pregnancy, singleton pregnancy at 36 weeks and twin/polyhydramnios at 36 weeks reveal that inspiratory capacity (IC), tidal volume (TV) and expiratory reserve volume (ERV) in different group pairing have statistically significant difference. This is very important during the assessment of pregnant mother suffering from respiratory or cardiopulmonary disorder. Objectives: This study aims to observe the additional demands placed on the maternal respiratory system in cases of advanced normal pregnancy or over distended uterus, like multifetal gestation and polyhydramnios, and whether the average Indian woman is able to cope with these respiratory changes. Methods: Around 80 women were divided into four equal groups which included non-pregnant controls, normal early pregnancy (< 20 weeks), and normal singleton pregnancy at 36 weeks and multifetal gestation/polyhydramnios, underwent spirometry for static lung volume measurement. The overall comparison was done by using the Kruskal-Wallis test whereas the individual comparison by Mann-Whitney tests. Final statistical computing was performed with SPSS statistical package. Results: The groups were comparable on the basis of age, height and hemoglobin levels. Comparisons of various groups show statistically significant difference in tidal volume, in spiratory capacity and expiratory reserve volume especially in advance pregnancy with control nonpregnant mothers without significant adverse effect on respiratory system. Conclusions: Results of the study indicate that though there are significant respiratory functional changes, healthy women, even having twin/polyhydramnios, can tolerate this well. But this knowledge is very important to assess and to formulate management of pregnant women with respiratory or cardiopulmonary compromise.

DOI: 10.5281/zenodo.

Objectives: To examine the prevalence of risk factors in patients suffering from uterine fibroid at Obstetrics and Gynaecology Department of SKMCH, Muzaffarpur, Bihar. Methods: A cross-sectional study carried out between January 2020 to December 2020 includes patients who were diagnosed with uterine fibroids. The position and number of the fibroids were counted and noted by the reports of Ultrasound examinations. Especially we assessed the prevalence of risk factors for uterine fibroids based on the questionnaire filled by the patients. The data were processed with the statistical program SPSS 25 and P value less than 0.05 were considered to be statically significant. Results: A total of 137 patients was studied, the majority of subjects were below the age group of 36-50 years (63.5%) followed by 21-35 years (24.08%) and 51-65 years (12.4%). The average age of the participants was 42.08 ± 8.89 years. BMI showed that women with 25 kg/m² to 29.9 kg/m² (54.74%) and ≥30 kg/m²(8.75%) experienced a higher prevalence of fibroids (χ2 =11.55, P =0.003) than women with 18.5 kg/m² to 24.9 kg/m² (36.49%). The average body mass index (BMI) of women with fibroids that were detected in our study was 27.5kg/m2. Other risk factors were not significantly linked with uterine fibroids. Conclusion: Fibroid prevalence had a significant correlation with age and BMI. Early detection and reduced body weight may bring down the occurrence of uterine fibroids.

DOI: 10.5281/zenodo.

Background: The primary treatment for acute myocardial infarction (AMI), which is a growing concern in developing countries, is thrombolysis. Patients with a poor prognosis are those who fail to achieve effective reperfusion, which occurs in 25–50% of cases. Since there are other options for reperfusion, it’s critical to recognize them. Aim of this study to failure of thrombolysis with streptokinase in acute myocardial infarction using E.C.G criteria. Methods: A prospective study of patients presenting with acute myocardial infarction in Department of Medicine, Darbhanga Medical College and Hospital, Laheriasarai, Bihar for a period of one year from September 2020 to August 2021. A total of 220 patients who presented with acute myocardial infarction were included in the study. Results: Out of 220 patients 193(87.7%) males and 27 (12.3%) females participated in the study. All the patients underwent thrombolysis with streptokinase. Out of 220 patients who were being thrombolysed with streptokinase, most of them (97; 41.1%) were in the age group of 56-65 years. Out of all the patients who underwent thrombolysis (n=220), thrombolytic failure was observed in 121 (55%) patients. Failure rate was significantly higher in the age group of 56-65 years (88; 72.7%). Significantly higher prevalence of thrombolytic failure with streptokinase was observed among diabetic patients (65.2%) as compared to non-diabetics (52.3%).

DOI: 10.5281/zenodo.

Background: Previously referred to as acute renal failure, acute kidney injury (AKI) is defined by an abrupt reduction of kidney function that causes the kidneys to retain waste products that are normally eliminated by the kidneys, including nitrogenous waste. This study aims to investigate the etiology, risk factors, clinical and laboratory characteristics, and outcome of patients who report with acute renal damage, fever, and jaundice. Methods: This prospective study was done on 100 patients presented with triad of fever, jaundice and acute kidney injury (AKI) in the Department of Medicine, Darbhanga Medical College and Hospital, Laheriasarai, Bihar from November 2020 to October 2021. Patients having temperature more than >100⁰ F, serum creatinine ≥1.3 mg/dL or a 50 % increase from baseline or a reduction in urine output (documented oliguria of <0.5 ml/kg/hr for >6 hours), serum bilirubin >1.8 mg/dL were included in the study. A detailed history, clinical examination and investigations were done to find the cause of these derangements and all the patients were managed accordingly. Results: A total 100 patients were included in study out of which 70% were males. Out of 100 patients, 50% were of septicemia, 34% were having malaria, 12% had acute pancreatitis and 4% patients were of dengue. Out of 50 septicemia patients, 35(70%) were male, out of which 11(31.42%) were of 56-65 years of age. Out of 17 deaths, 13(76%) were males. Among total death, 11(22%) were in septicemia followed by 5(14.70%) in malaria patients. Conclusion: Many infectious and non-infectious diseases like malaria, septicemia, acute pancreatitis, dengue fever etc. can present with fever, jaundice and deranged renal functions. This triad of presentation is associated with high morbidity and mortality and the advanced age, male gender presences of anemia were the risk factors for high mortality. AKI occurs most commonly in association with P. falciparum malaria. Early diagnosis and prompt management including dialysis can reduce mortality and expedite recovery of renal function.

DOI: 10.5281/zenodo.

Background: The ascitic fluid albumin concentration less the serum albumin concentration is known as the Serum-Ascites Albumin Gradient, or SAAG. An alternative, physiologically based criterion for classifying asci-tes has been proposed: SAAG. The aim of the present study was to distinguish between ascites and se-rum/ascites albumin gradient by utilizing biochemical parameters to compare the concepts of transudate and exudate. The purpose of the study was also to identify different ascites etiologies. Methods: This cross-sectional study was done among 60 patients with ascites in Darbhanga Medical College and Hospital, Laheriasarai, Bihar from December 2020 to November 2021. Ascitic fluid and blood samples were sent for various investigations depending on the presentation of the patient to hospital. Results: In our study Cirrhosis of liver was the most common cause of ascites (78%) followed by Tubercular peritonitis (8%) and alcohol was the commonest cause for cirrhosis of liver (85%) followed by Hepatitis B virus infection. Cirrhosis of liver showed high SAAG compared with tubercular peritonitis and malignant ascites which showed low SAAG. Among High SAAG patients 96% had portal hypertension. Transudative ascites observed in 72.5% of cirrhosis patients whereas tubercular peritonitis showed exudative type in 60% of cases. Conclusion: Cirrhosis liver was the most common cause of Ascites and alcohol was the commonest cause for cirrhosis. SAAG is superior to transudate exudate concept in differentiating the causes of ascites. High SAAG indicates presence of portal hypertension and low SAAG indicates absence of portal hypertension.

DOI: 10.5281/zenodo.

Background: Heart failure (HF) is a prevalent cardiovascular disease that has become more widespread in recent years. Its genesis involves multiple risk factors, which complicates its management and prevention. The purpose of this study was to evaluate the clinical profile of heart failure patients. Methods: This prospective observational study was undertaken among the patients admitted in the Medicine unit of DMCH, Laheriasarai, and Bihar from October 2020 to September 2021. Patients fulfilling European Society of Cardiology (ESC) criteria of HF were included in the study. Prevalence of congestive HF was estimated based on community study and hospital OPD. Results: Smoking, alcoholism, ischemic heart disease and hypertension were the leading risk factors in developing HF. Breathlessness (100%), swelling of the feet (92.3%), cough (57.7%) and palpitation (50%) were the most common symptoms observed in the patients. Oedema feet (100%), basal crepitations (80.3%), raised Jugular Venous Distention (JVD) (57.7%) and S3 (57.7%)were the leading signs in the patients. Chest X-ray (CXR) findings indicate that 76.9% of the patients reported with increased cardiothoracic ratio. Arrhythmias (predominantly AF-19.2%) and Left Ventricular Hypertrophy (LVH) accounted for 26.9% each. The prevalence of HF was estimated to be in between 0.51 to 27.27 respectively. Conclusion: Ischemic heart disease and hypertension were the leading risk factors apart from smoking and alcoholism and the management of comorbid conditions may have sizeable effect in the clinical management.

DOI: 10.5281/zenodo.

Background: The definition of chronic liver disease (CLD) is the persistent, long-term destruction and regeneration of the liver; as the disease progresses, cirrhosis and hepatic fibrosis (scarring) often develop. It seems sense that vitamin D deficiency would be prevalent in people with chronic liver disease (CLD) since the liver is involved in the synthesis of bile salts, vitamin D absorption, and 25-hydroxylation of vitamin D. Methods: The present hospital based observational comparative analysis was conducted in the Department of Medicine of DMCH, Laheriasarai, Bihar among a total of 60 participants. The minimum sample size required in each group was at 95% confidence interval and 80% power to verify the expected difference of 58.6% in proportion of cases with vitamin D deficiency in non-cholestatic chronic liver disease group with age and sex matched control group (hospital staff and attendants of patients) (76.5% vs. 17.96%) was 30 in each group. Results: 30 study participants were cases and 30 study participants were controls. Out of the total study participants 23(38.3%) were female and 37(61.7%) patients were male and the male to female sex ratio was 1.6 : 1. The mean age of 30 cases in our study was 39.1±8.69 years and the mean age of 30 controls was 38.4±8.02 years and no significant difference was observed. Mean serum Vitamin D3 was lower in CLD cases (23.4 ± 6.44 ng / L) as compared to controls (43.8 ± 5.18ng/L). This difference was statistically significant with a p-value <0.001. In univariate analysis in patients with non-cholestatic CLD, significant (P<0.05) positive correlations were found between serum level of vitamin D and serum bilirubin, serum albumin, platelet count, & haemoglobin. Also, there were significant (P<0.05) negative correlations between vitamin D concentration and serum bilirubin, INR & MELD score. No significant correlation was seen between vitamin D and age, serum level of PTH, calcium, phosphate, ALT, AST, ALP, urea, or creatinine. Conclusion: Vitamin D inadequacy is very common in non-cholestatic CLD patients and correlates with the severity of the disease. Therefore, were commend that clinical guidelines for managing non-cholestatic CLD should include the assessment of vitamin D status in all patients. For vitamin D assessment and replacement in the management of patients with non-cholestatic CLD further studies are required.

DOI: 10.5281/zenodo.

Background: In clinical practice, diagnosing Tubercular (TB) pleural effusion remains difficult since conventional diagnostic techniques are helpful but insufficiently sensitive and specific. Methods: This was a prospective observational study carried out at DMCH, Laheriasarai, Bihar with study population of 76 patients. Etiological diagnosis was based on clinical history with radiological imaging, biochemical and cytological examination of pleural fluid. Pleural fluid ADA was used as a biomarker for the diagnosis of tubercular pleural effusion. Results: The study included 76 patients with 69.7% (n=53) males and 30.3%(n=23) females. The mean age of patients was 48.97±17.03 years. Of 76 cases of pleural effusion, 62 were exudates and 14 transudates. Tuberculosis was the most common cause among exudates which accounted for 51.3% (n=39) of cases. The sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV), Accuracy of pleural fluid ADA in diagnosing tubercular pleural effusion was 92.3%, 97.3%, 97%, 92% and 94.7% respectively. Conclusion: Pleural fluid ADA can be one of the most reliable biomarkers for the diagnosis of TB pleural effusion considering its high sensitivity and specificity.

DOI: 10.5281/zenodo.

Background: Polycystic Ovarian Syndrome is the most common endocrine disorder of reproductive age. It has an unknown etiology and is related to overproduction of androgens and insulin resistance. Methods: This study was conducted in Sri Krishna Medical College & Hospital, Muzaffarpur over the period of 6 months. Total 100 PCOS patients were selected for study. Lifestyle modification, Yoga & Exercise was advised and changes noted after study. Results: Out of 100 PCOS cases 65 patients were obese having high BMI. 60% patients show menstrual cycle improvement. LH/FSH ratio improved in 35% cases and improved ovulatory cycles after physiotherapy in 50% cases. Conclusion: We can see from this study that just lifestyle modification makes a huge change in pathophysiology and symptoms of PCOS. So our first line therapy should be weight reduction and lifestyle modification rather than prescribing medicines.

DOI: 10.5281/zenodo.

Aim: To find the prevalence of anemia in pregnancy this needs admission for treatment of anemia and to overview the management of anemia in tertiary care center. Methods: It is a prospective study conducted at Sri Krishna Medical College & Hospital, Muzaffarpur, in Department of Obstetrics and Gynecology during May 2019 to October 2019 among antenatal women attending OPD. Women with anemia requiring admission for management of anemia included in our study. Results: In 6 months study period 3766 women attended antenatal OPD. Only 96(2.54%) women needed admission for anemia correction .Among 96 women,49(51%) managed with parenteral iron injection and 47(49%)women managed with blood transfusion. Conclusion: In our Institution, all antenatal women are provided with nutritional counselling and supplemented with Iron Folate and hence percentage of women requiring admission for treatment of anemia is less. Proper nutritional advice and Iron Folate supplementation during antenatal period reduce the need for admission for anemia correction.

DOI: 10.5281/zenodo.

Background: The incidence of Jaundice in pregnancy is 3% to 5%. The causes of jaundice in pregnancy can be coincidental liver disease, underlying chronic disease and condition related to pregnancy. Management of pregnant women with jaundice is very challenging because accurate diagnosis sometimes is very difficult and delay in management can be life threatening. Aim of this study to evaluate the etiology of the jaundice among pregnant women and their outcome. Methods: An observational study was done in Department of Obstetrics and Gynaecology at Sri Krishna Medical College & Hospital, Muzaffarpur, Bihar among pregnant women with jaundice who were admitted in the hospital. Results: A total of 43 pregnant women were admitted in hospital over the period of 4 months. 18 women were diagnosed as viral hepatitis. Ten women suffered from Intrahepatic cholestasis of pregnancy, 2 from obstructive jaundice, 10 from hypertensive disorder in pregnancy and rest of unknown etiology. 23 women (53.4%) had preterm delivery and 12 women delivered by LSCS. Three women (7.14%) had maternal mortality. All the three mortality belonged to hypertensive disorder in pregnancy and its associated complication. Conclusion: Main cause of maternal mortality in cases of jaundice in pregnancy was found to be hypertensive disorder in pregnancy and its sequel.

DOI: 10.5281/zenodo.

Background: The humerus bone is the long bone located in the upper arm. It extends from the shoulder joint to the elbow joint and is one of the major bones in the human skeleton. The humerus bone is responsible for providing structural support to the upper arm and facilitating movement of the arm. The aim of this study was to compare the outcomes between open reduction and internal fixation by locking compression plate (LCP) and closed reduction and internal fixation with anterograde interlocking nail (ILN) for the treatment of diaphyseal fractures of the humerus. Methods: This is a prospective comparative study, with diaphyseal fractures of the humerus treated by LCP in 30 patients and with ILN in 30 patients. Patients were followed up to 18 months. The clinical and radiographic outcomes were assessed in terms of union, complications, reoperation rate and functional outcome using the American shoulder and elbow surgeons’ score (ASES) and Stewart and Hundley’s criteria. Results: Union was achieved in 93.3% of patients in LCP group and 90% in ILN group. The mean blood loss in LCP group was 280±22.10 ml (160-400 ml) and in ILN group was 110±17.62 ml (70-150 ml) (p=0.001). The ASES score was 42.47±5.532 in LCP group and 40.93±6.330 in nailing group (p=0.320; p>0.05). Stewart Hundley criteria showed excellent and good results in 26/30 and 17/30 patients in LCP group and ILN group respectively (p=0.070; p>0.05). Complications and re-operation rate were higher in ILN group. Conclusion: Our study concludes that LCP can be considered a better surgical option for the management of diaphyseal fractures of the humerus as it had lower incidence of complications, less re-operation rate and better union rate. However, there is no difference between the two groups in terms of union time and functional out-come.

DOI: 10.5281/zenodo.

Introduction: Rupture of amniotic membranes before labor that occurs before 37 weeks of gestation is referred to as “Preterm Prelabor Rupture Of Membranes” (PROM). The most significant maternal consequence of PROM is intrauterine infection, the risk of which increases with the duration of membrane rupture. To reduce maternal and neonatal infections and gestational-age-dependent morbidity, a 7-day course of therapy of latency antibiotics with a combination of intravenous ampicillin and erythromycin followed by oral amoxicillin and erythromycin is recommended during expectant management of women with preterm PROM who are at less than 34 0/7 weeks of gestation. ACOG 2020 update states that replacing erythromycin with azithromycin in situations, where erythromycin is not available or not tolerated, and this substitution is a suitable alternative, secondary to its ease of administration, better side effect profile, and decreased cost. There are presently only a few prospective studies investigating the substitution of azithromycin for erythromycin in the setting of PROM. Aims and Objective: The goal of this study is to see if there is a difference between the antibiotic (azithromycin) compared to the antibiotic (erythromycin) in prolonging pregnancy in patients and the development of chorioamnionitis with Preterm Premature Rupture of Membranes (PPROM).  Materials and Methods: The study was carried out in the Department of Obstetrics and Gynecology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow after getting ethical clearance from the Institute’s Ethical Committee. It will be a single-center, prospective observational cohort study. Pregnant women between 24 0/7 to 36 0/7 weeks of gestation presenting with PPROM were included in the study. The Erythromycin group consisted of erythromycin 250 mg and ampicillin 2 g every 6 hours IV for 48 hours followed by amoxicillin 250 mg and erythromycin 333 mg every 8 hours PO for 5 days (7 Days total). The azithromycin group consisted of azithromycin 1 g PO once.  Patients were followed till delivery. Results: Three hundred ninety-four patients who met inclusion criteria were identified. 197 study participants received an erythromycin-based antibiotic regimen in the first half of the study and the remaining 197 received an Azithromycin-based regimen in the second half of the study. There was no statistical difference in the primary outcome of latency to delivery. Unadjusted median time from PPROM to delivery was 9 days for the azithromycin group and 7 days for erythromycin (P = .98).  The clinical rates of chorioamnionitis was seen in 50 pregnant women of Group 1 and 33 pregnant women of Group2 and this difference was statistically significant (pvalue=0.04). Conclusion: Azithromycin could be considered as an alternative to erythromycin in the expectant management of Preterm Premature Rupture of Membranes if erythromycin is unavailable or contraindicated.

DOI: 10.5281/zenodo.

Background: Healthcare workers (HCWs) are experiencing tremendous pressure from COVID-19 as compared to general population, especially those who might be in contact with confirmed or suspected cases. This cross- sectional study has been conducted for better understanding of psychological conditions of Health Care Workers during pandemic including individual and social perspectives of providing insight into possible individual, social and occupational approaches. Methods: A cross sectional study has been performed on healthcare workers working in a tertiary care institute of Jaipur. Results: Majority of the nurses (47.5%), lab technicians (32.35%) were suffering from insomnia. Anxiety was mostly seen among nurses (48.89%), doctors (22.22%), medical residents (20%) and lab technicians (8.89%).  The study detected depressive symptoms in 38.24% of healthcare workers. Conclusions: This study has shown burden of psychological problems among different healthcare workers during COVID-19 pandemic. The findings of this study will help to improve understanding of influence of pandemics on psychological health among healthcare workers and will suggest implementation of steps like psychological interventions and support for healthcare workers.

DOI: 10.5281/zenodo.

Background: The coronavirus belongs to the Coronaviridae family and is characterized by enveloped, positive-sense, single-stranded RNA structure. COVID-19 has been shown to exhibit greater disease severity in individuals with diabetes. In healthy individuals, circulating D-dimer levels remain low. Conversely, conditions marked by hypercoagulation and heightened fibrinolytic activity often result in elevated D-dimer levels. This study seeks to investigate and compare D-dimer levels among COVID-19 patients with diabetes and those without diabetes. Methods: This current research is designed as a prospective cohort study with a predetermined sample size of 60 participants. COVID-19 diagnosis was confirmed through either RT-PCR (Real Time Reverse Transcription Polymerase Chain Reaction) or RAT (Rapid Antigen Test). Participants with a prior medical history of diabetes and HbA1c levels exceeding 6.5 were included in the study. To assess variations among various groups, statistical comparisons were carried out employing the ANOVA test, and further examination of significant differences between pairs of means was conducted using Scheffe’s test. Results: One-third of cases (33.3%) were from the 55-64 years’ age group, followed by 45-54 (23.3%), and the least (3.3%) cases were from the 75-84 years’ age group. Random Blood Sugar (RBS) and mean D-dimer levels were 248.9±139.83 mg/dl and 878.62±860.74, respectively. In the present study, there was a statistically significant correlation of D-dimer with Random Blood sugar (spearman’s Rho coefficient-0.752), and a 43.6% change in D-dimer can be explained by the change in RBS. Conclusion: A significant increase in D-dimer levels is observed in patients with diabetes compared to those without the condition. This suggests that D-dimer could be a dependable indicator for assessing prognosis and predicting mortality outcomes.

DOI: 10.5281/zenodo.

Worldwide, scrub typhus poses a threat to 1 billion people. In the absence of appropriate antibiotic treatment, clinical symptoms vary from acute undifferentiated febrile illness to multiorgan failure. The case of scrub typhus was admitted and subjected to a detailed epidemiological and clinical investigation. History of having worked in a farm and itching over the left forearm was elicited. On admission the patient had a saturation of 92 % on BIPAP ventilation. Chest examination revealed reduced breath sounds in the right lower zone. Maculopapular rash on the face, trunk and extremities, tender hepatomegaly, splenomegaly; and lymphadenopathy were observed. Investigations revealed reduced haemoglobin, deranged renal and liver function tests and compensated metabolic acidosis. Weil-Felix test for antibody against OX-K was reactive with a titre of 1:640. Scrub typhus IgM ELISA was positive with a titre of 1:160. Blood culture revealed serratia growth. Radiology chest revealed bilateral pulmonary effusion; and right middle and lower zones consolidation. Based on the clinic-epidemiological and laboratory profile a preliminary diagnosis of scrub typhus with ARDS, sepsis and multi organ dysfunction syndrome was made. She was initially given Meropenem, doxycycline and artesunate with respiratory and ionotropic support. Later tigecycline, caspofungin were added in view of serratia related gram bacteremia and she was intubated in view of poor GCS. However, unfortunately on the second day she succumbed to her illness. Final diagnosis of Scrub Typhus induced severe ARDS with severe sepsis with septic shock was given.

DOI: 10.5281/zenodo.

Background and Objectives: Pneumonia causes at least 18% of all child deaths globally, in some countries up to a third. Biomarkers that indicate pneumonia severity and suggest appropriate treatment or supportive care may help lower mortality. The current best predictor of pneumonia mortality risk is arterial oxygen saturation, measured by pulse oximetry. Lactate is a product of anaerobic cellular metabolism. It is used as a marker of poor tissue oxygen delivery, and cell hypoxia to monitor critically ill children, patients with severe infections, low cardiac output and acute respiratory distress syndrome. There has been not much evaluation of its role in children with pneumonia. The objective is to study the association of elevated blood lactate levels in the outcome of children with pneumonia. Methods:  It is an explorative study with a total of 280 cases, aged between 2 months to 14 years admitted to BMIMS Pawapuri, hospital during the study period fulfilling the inclusion criteria were included in this study. Along with the demographic data and other investigations, using aseptic precautions 2 ml of venous blood was withdrawn and sent for lactate estimation. Conclusion:  The children who died had elevated lactate concentration, hypoxia, hypotension, prolonged CFT and other signs of shock. Serum lactate measured at the time of admission, age <1 yr; hypoxia; prolonged CFT; suboptimal, feeble or low volume peripheral pulses; shock; hypotension are other strong predictors of mortality. Used in conjugation with other known risk factors like young age and hypoxemia, lactate could play a role in identifying the sick children and in their management.

DOI: 10.5281/zenodo.

Background: Umbilical vein catheterisation is a common procedure performed in neonatal intensive care unitforthe management of pre-term and ill neonates. Although umbilical vein catheterisation is imperative for intensive neonatal care and their survival, its use has been associated with several complications. Infection related to the use of intravascular catheters including UVC may cause significant morbidity and mortality. Objectives: To find out the incidence of umbilical vein catheter related infections in neonates in our hospital and to identify commonest microorganisms causing catheter related infections and its sensitivity pattern to antibiotics. Methods: The study included 100 neonates admitted in BMIMS Pawapuri, Informed consent was obtained from the parents. Umbilical vein catheter was inserted on day 1 and catheter care done as per standard protocol. The neonate was assessed daily for clinical signs of sepsis and during catheter removal; catheter tip as well as blood from peripheral vein was sent for culture. Collected data was analysed using frequency, percentage and chi-square test. Results: The incidence of umbilical vein catheter related infection in our study was 1%. Umbilical vein catheter colonization was 37%; out of which 32.4% were terms and 67.6% pre terms. Escherichia Coli was responsible for catheter related sepsis which was sensitive to amikacin, piperacillin/ tazobactum, cefoperazone/ sulbactam, imipenem, meropenem, vancomycin, colistin and tigecycline. The mean duration of catheter placement in neonate UVC related sepsis was 20 days. Conclusion: The study concluded that the incidence of Umbilical Vein Catheter related infection was not significant in our NICU.

DOI: 10.5281/zenodo.

Background: The association of sub-normal vitamin-D levels with the lower respiratory tract infections (LRTI) in children has been a topic of interest in the recent literature. Vitamin-D insufficiency been explored as modifiable risk-factor in management of the pediatric recurrent respiratory tract infections. Methods: This cross-sectional study was carried-out on 100 pneumonia cases less than 15 years for the 18 months duration from July 2022 to December 2023. All children from 6 Months to 15 years of age reporting to the Hospital (OPD and IPD) with a clinical diagnosis of LRTI were included. Results: Based on severity of pneumonia the majority of the cases had mild pneumonia (46.0%) followed by moderate pneumonia (37.0%) and severe pneumonia (17.0%). The association between age and gender with severity of pneumonia was found insignificant (p>0.05). The vitamin-D level was significantly lower in severe pneumonia cases than in moderate and mild pneumonia (p<0.001). Therefore, the severity of vitamin-D deficiency correlates with the severity of pneumonia. Conclusion: Subclinical vitamin D deficiency is a significant risk factor for severe LRTI in Indian children of less than 15 years. There was a significant association between Vitamin-D levels and recurrent respiratory tract infections. Education regarding the importance and timing of sun exposure is necessary. Routine Vitamin D supplementation is recommended in children below 15 years.

DOI: 10.5281/zenodo.

Background: Epidermal cysts are benign mid/lower dermis or subcutaneous cystic lesion of hair-bearing skin commonly occurring on the scalp, face, neck, trunk, extremities and rarely on male and female external genitalia, palm, sole, fingers, and breast. Aims and Objectives: Aimed to explore the clinical and pathological features of epidermoid cysts, focusing on these less common presentations. Materials and Methods: This retrospective study was conducted at the Department of Surgery, Shri Jagannath Medical College and Hospital, Puri, Odisha, over a one-year period from January 2022 to December 2022. We analyzed the medical records of patients who presented with small, round bumps under the skin and who were subsequently treated surgically. Clinicopathological details were collected from patient files for this period, with emphasis placed on any unusual findings related to epidermoid cysts. Results: A total 135 cases of epidermoid cysts were included. The sex ratio was 1.4:1 for males to females. The age of the patients ranged from 2 years to 75 years with the mean age of 33.42 years and the median age of 30.5 years. The highest incidence was observed in the age group of 21–30 years 41 (30.4%) followed by age groups of 41–50 (26; 19.3%). The major locations of the cysts were the head and neck followed by trunk (Table 2). An epidermal punctum is a hallmark of the clinical diagnosis. In this study, one case of ECs in finger which was found to be very rare. Nine cases over the chest was associated with keloid and two cases was associated with lipoma. Conclusion: Epidermal cysts are common benign lesions of hair-bearing skin. An epidermal punctum is a hallmark of the clinical diagnosis; however, epidermal cysts can have unusual presentations. Early diagnosis and treatment are needed to avoid cosmetic damage, since epidermal cysts are mostly located in the head region.

DOI: 10.5281/zenodo.

Background: Surgical site infections (SSIs) are infections that occur within 30 days of surgery (or up to one year if implants are involved). These infections are a major concern, especially for complex surgeries, and are the third most common hospital-acquired infection. This study retrospectively examines factors that predict SSIs in patients who underwent surgery at a tertiary care hospital. Materials and Methods: This hospital based retrospective study was undertaken to examined the predictive risk factors for SSIs among patients admitted to the Department of General Surgery at Shri Jagannath Medical College and Hospital, Puri, Odisha, India, over a one-year period. Existing medical records of patients was reviewed to collect data on SSIs. Results: Maximum numbers of SSI cases were observed the age >60 years (55%).The duration of surgery (>2hrs) was associated with high number of SSI cases. Exploratory laparotomy (31%) was the procedure most commonly associated with SSI followed by appendectomy (27%). Conclusions: Present study found that, increasing age of the patient, contaminated wound, prolonged duration of surgery, absence of prophylactic antibiotics, use of drains and prolonged hospital stay are associated with increased incidence of SSI.

DOI: 10.5281/zenodo.

Background: Blunt abdominal trauma is a common presentation in emergency departments, necessitating accurate and timely assessment to guide appropriate management. The assessment of intra-abdominal injuries can now be aided by the use of the Blunt Abdominal Trauma Scoring System (BATSS). The purpose of this study is to evaluate BATSS’s clinical usefulness and ability to predict similar injuries. Methods: A single-center study was conducted on a sample of 285 patients presenting with blunt abdominal trauma. Patients were evaluated using the BATSS, with a cutoff score of 12 to categorize them into high or low-risk groups. The presence of intra-abdominal injuries was confirmed through computed tomography (CT) scans or laparotomy. Results: The study showed that BATSS has a high 89.7% sensitivity and 95.5% specificity for identifying intra-abdominal injuries. The most common organs damaged by blunt abdominal trauma were the spleen, liver, and jejunum; these injuries were primarily caused by road accidents. When the patients were first seen, a considerable percentage of them had symptoms like soreness, tachycardia, and stomach pain. Conclusion: The BATSS showed promising accuracy in identifying patients at high risk for intra-abdominal injuries, with a substantial number of cases requiring operative interventions. Further multicentric validation studies are warranted to confirm the efficacy of BATSS in clinical decision-making and its potential integration into trauma protocols for improved patient outcomes.

DOI: 10.5281/zenodo.

Background: Respiratory dynamics are significantly altered during laparoscopic surgeries. Anesthesiologists should be well versed with the benefits as well as limitations of positive end expiratory pressure (PEEP) during laparoscopy. They can then judiciously use the same in different patient populations. In this study we have compared the effects of ventilation with and without PEEP of 10 cm on blood gases, airway pressures and hemodynamic parameters during laparoscopy. Methods: 60 patients, from American Society of Anesthesiologists (ASA) physical status I and II, in the age group of 18 to 60, posted for laparoscopic cholecystectomy were enrolled. They were randomized into two groups of 30 each. Group P received PEEP of 10 cm during laparoscopy and group C did not receive any PEEP. The vital parameters, arterial blood gases, and airway pressures were compared in both groups. Results: The oxygenation, (PaO2/FiO2 ratio) was significantly higher in PEEP group (446.4±113.32 mm of Hg) as compared to the control group (404 ± 51.4 mm of Hg) after one hour of laparoscopy (P= 0.0037). The control group had higher arterial carbon dioxide tension (42.84 ± 2.38 mm of Hg) as compared to PEEP group (41.86 ± 2.33 mm of Hg), (P < 0.001). Both the findings suggest better ventilation perfusion matching in PEEP group. There was a no significant variation in mean arterial pressure and heart rate due to PEEP in our patient population. However the peak airway pressures were significantly higher in PEEP group. Conclusion: 10 cm of PEEP helped in better oxygenation with no significant hemodynamic alterations, in otherwise healthy patients undergoing laparoscopic cholecystectomy.

DOI: 10.5281/zenodo.

Background: Advent of Laparoscopy have benefitted patients in terms of lesser tissue damage, early ambulation, decreased duration of hospital stay and reduced analgesic needs. However capnoperitoneum and position of patient during laparoscopic procedure induces pathophysiological changes that may potentially complicate anesthetic management. Various pharmacological methods have been tried to overcome complications associated with pneumoperitoneum. One among those drugs is Clonidine, a centrally acting Alpha-2-adrenergic receptors agonist has sedative, anxiolytic, analgesic properties and stabilizes circulatory system. It diminishes stress response hence increases perioperative circulatory stability in patients undergoing laparoscopic surgeries. In addition, it increases cardiac baroreceptor reflex sensitivity in hypertensive individuals, and thus, stabilizes blood pressure by enhancing the role of changes in heart rate.  Aim of this study to efficacy and post-operative sedation in intravenous and intrathecal clonidine in patients undergoing laparoscopic assisted vaginal hysterectomy under general anesthesia. Methods: Patients were divided randomly into 2 groups (A group & B group) of 30 each. Patients assigned to group a, received 50 mcg of clonidine in 50ml of normal saline over 10 minutes 10 minutes before induction. Patients assigned to group B, received intrathecal clonidine 50 mcg in 1 ml normal saline in sitting position at L3-L4 interspace using 27G quincke’s spinal needle just before induction. Intraoperative monitoring included heart rate (HR), continuous electrocardiography, noninvasive systolic (SBP), diastolic (DBP), mean blood pressure (MBP), pulse oximetry (SpO2) and EtCO2. Systolic, diastolic, mean arterial blood pressures and heart rate were recorded at regular interval. Results: During capnoperitoneum, mean HR values, mean SBP values, mean DBP values, mean MAP values in (IT) group B were below the baseline and that in group A (IV) were near the baseline. Conclusion: Efficacy of Intrathecal route of clonidine administration during laparoscopic hysterectomy surgeries have better control of heart rate, mean systolic and diastolic blood pressure and mean arterial pressure is better during capnoperitoneum compared to intra venous clonidine. But post-operative sedation and adverse effects in both routes are statistically insignificant.

DOI: 10.5281/zenodo.

Background: As hypertensive disorders of pregnancy contribute significantly to maternal and neonatal mortality and morbidity, it is very essential to diagnose which cases will eventually have severe disease. Glycosylated fibronectin (GlyFn) is a protein involved in vessel remodelling and inflammation. It is a new biomarker to diagnose severe disease in new onset hypertension. The objective is to determine the sensitivity, specificity, positive predictive value and negative predictive value of GlyFn to predict the severity of disease in new onset hypertension in pregnancy from 24 weeks to term. Methods: The study was carried out in the Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar from April 2023 to December 2023. A total of 50 cases from 24 weeks to term with new onset hypertension were enrolled. The glycosylated fibronectin was estimated in their serum. Final analysis was done on 30 cases, of less than 37 weeks diagnosed as pre-eclampsia. Results: In 30 mothers with PE: 28 true positive, 2 false negative. TPR (true positive rate) or sensitivity = 28/30 = 93.33%; FNR (false negative rate) = 2/30 = 6.67%. Besides, all the high positive cases were associated with adverse maternal and fetal outcomes such as severe hypertension, thrombocytopenia, increased liver enzymes, increased creatinine, neurological complications, pulmonary edema, and low birth weight, prematurity, growth restriction and intrauterine death. Conclusion: All the high positive cases were associated with severe maternal and fetal adverse outcomes and therefore we recommend that cases with GlyFn level more than 600 μg/mL be considered for hospital admission and intensive maternal and fetal monitoring and termination accordingly.

DOI: 10.5281/zenodo.

Background: Intrahepatic cholestasis of pregnancy (IHCP) is a hepatic disorder associated specifically with pregnancy. It is found to affect both mother and fetus. It requires detailed clinical and biochemical evaluation for optimal feto-maternal outcome. Aim of this study to demographic profile, clinical features and obstetric outcome in patients with intrahepatic cholestasis of pregnancy and to assess correlation between serum bile acid levels and perinatal outcome. Methods: This was a prospective study conducted on 150 pregnant women with IHCP who delivered at Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar from April 2023 to December 2023. The relationship between serum bile acid levels and fetal complications was analysed with binary logistic regression method. Results: The incidence of IHCP at our centre was found to be 2.82%. We found that 59.94% patients had bile acid levels between 10-40 μmol/L, 36.6% patients bile acid levels between 41-100 μmol/L and 3.33% patients had bile acid levels >100 μmol/L. The correlation between serum bile acid levels with onset of labour and mode of delivery was not statistically significant (p-value 0.16 and 0.556 respectively). The correlation between serum bile acid levels with meconium stained liquor, NICU admission and prematurity was found to be statistically significant with p-value of <0.001, 0.007 and 0.018 respectively. Conclusion: Symptomatic women should be subjected to estimation of serum bile acid levels so that appropriate treatment and timely intervention can be done to optimize obstetric outcome.

DOI: 10.5281/zenodo.

Background: Interpregnancy interval (IPI) or birth to pregnancy interval is defined as time interval between live birth and beginning of following pregnancy. Interpregnancy interval has been shown to be an important prognostic marker for perinatal outcome. According to WHO at least 24 months of interpregnancy interval is optimal. This study was planned to correlate maternal and perinatal outcome with interpregnancy interval at SKMCH, Muzaffarpur, Bihar. Methods: This cross sectional observational study was conducted in department of obstetrics and gynecology, SKMCH, Muzaffarpur, Bihar. All pregnant women beyond period of viability, delivering at our centre, irrespective of live or stillborn were included in the study. Maternal and perinatal outcome of all the patients was observed. Results: 212 women were assessed in terms of interpregnancy interval and its correlation with maternal and perinatal outcome. Of these 212 women interval less than or equal to 24 months, 125 had interpregnancy interval >24 months. Proper antenatal registration (4 visits at least) was more in IPI more than 24 months group. Severe anemia and non-severe preeclampsia was found to be more in group with IPI ≤24 months than group IPI> 24 months. Perinatal outcome was found to be far better in group IPI> 24 months as compared to group with IPI ≤24 months in terms of perinatal mortality, preterm births, low birth weight and admission to neonatal unit /neonatal ICU. Conclusion: Our study concludes that there is a significant impact of interpregnancy interval on maternal and perinatal outcome which also signifies the importance of spacing and contraception. However this study being a small pilot study, further larger studies are required on this topic in future to consolidate the results.

DOI: 10.5281/zenodo.

Background: The rate of primary cesarean section (CS) is on the rising trend. More and more women report to ANC OPD with a history of previous cesarean delivery. Vaginal birth after a caesarean section can be an effective alternative to a cesarean section and decrease the complications associated with a repeat caesarean. Objectives: This study aims to determine the acceptability and outcome of TOLAC in women with one previous cesarean delivery. Methods: The prospective observational study was carried out in Department of Obstetrics and Gynaecology, Sri Krishna Medical College and Hospital, Muzaffarpur Bihar from October 2022 to March 2023. Sixty pregnant women with a history of one previous LSCS were enrolled in the study. Results: In the present study, a total of 60 cases with previous LSCS were included. 78.33% of cases had a successful TOLAC i.e vaginal birth after cesarean (VBAC) and 21.67% underwent a repeat emergency LSCS for failed TOLAC. Cervical dilatation of 4 cm and more at the time of admission was a significant factor for successful TOLAC. Having a previous vaginal birth also had a favourable prognosis in achieving a VBAC (89%). A birth weight of more than 3,000 gm was associated with a lower success rate of TOLAC. The incidence of scar dehiscence was 1.6% in the present study. There was no maternal or neonatal mortality. Conclusion: TOLAC in selected cases has great importance in the present era because of the rising rate of primary CS. With continuous efforts and proper antenatal counselling, TOLAC can be attempted with very low complication rates. This will further decrease the untoward complications associated with a repeat cesarean.

DOI: 10.5281/zenodo.

Background: The first trimester begins on the first day of your last period and lasts until the end of week 12. It is the most critical and tenuous period in human existence. We showed the utility of first trimester ultrasonography before 12 weeks of gestation. Ultrasonography has drastically changed validation and management of first trimester pregnancies. The purpose of this study was to evaluate the utility of first trimester ultrasound before 12 weeks of gestation in diagnosing and management of various conditions of pregnancy at an early stage. Methods: We conducted a retrospective data analysis on randomly selected 300 pregnant women (<12 weeks of gestation) at SKMCH, Muzaffarpur, Bihar from July 2022 to December 2022. These patients underwent first trimester ultrasonography (transvaginal/abdominal). Maternal age, parity, gestational age, and maternal gestational history were compared with ultrasonographic findings. Patients were divided into 11 groups based on ultrasonographic diagnoses. Results: We noted 71.3% patients to have single, viable, intrauterine pregnancies, while 28.7% had abnormal or complicated pregnancies with uterine anomalies, ovarian cysts, fibroids, or sub chorionic haematomas. Conclusion: The study emphasizes the fact that first trimester ultrasonography before 12 weeks of gestation is an important tool for predicting pregnancy outcomes, particularly with respect to detecting complicated or unviable pregnancies. It is a cheap and easily accessible imaging modality to be used during pregnancy. First trimester ultrasonography is helpful to date pregnancy, to define embryonic landmarks in developmental stages with reference to gestational age, early diagnosis of abortion, early detection of ectopic pregnancy, diagnose multifetal pregnancy for assessing chorionicity, detect pregnancy with fibroid, diagnose suspected uterine anomaly and detection of pre-eclampsia, IUGR babies with the help of uterine artery PI.

DOI: 10.5281/zenodo.

Background: Distal radius fractures are amongst the most common injuries seen in the emergency department. It is imperative to restore the anatomy as much as possible in order to restore wrist function. Identifying a frac-ture as ‘unstable’ is critical in predicting the final outcome of treatment. The present study compares two primary modalities of treatment: external fixation and volar plating in terms of the functional outcome post-surgery. Aim of the study was to compare the functional outcome of fixation of unstable distal radius fractures by external fixation to that of volar plating by the Disabilities of the Arm, Shoulder and Hand (DASH) scoring system and analysis of recovery of grip strength and range of motion. Settings and design: Hospital-based; randomized control trial. Methods: 80 patients presenting with unstable distal radius fractures were randomized into two groups of 40 each. One group received external fixation and the second received open reduction with volar plate fixation as the primary intervention. DASH scores were obtained and compared at specified time intervals following surgery. Results: The results of our study show a better improvement in the mean DASH scores at 3, 6 and 12 months in the volar plating group as compared to the external fixation group. Conclusions: Volar plating, with its definitive advantage of direct fracture visualization, has an overall better functional outcome with greater postoperative wrist motion and a lower incidence of complications.

DOI: 10.5281/zenodo.

Background: Fractures of the tibia remain a controversial subject despite advances in both non-operative and operative care. The goal in expert care is to realign the fracture, realign limb length, and early functional recov-ery. To analyze the short-term results of intramedullary interlocking nailing in the management of extra-articular distal tibial metaphyseal fractures done. Methods: This is a prospective comparative randomized study of 28 patients with distal tibial metaphyseal frac-tures in Department of Orthopaedics, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar with a fol-low-up ranging from August 2021 to November 2021 (4 months). Injury With more than 3 weeks, nonunion, and patient with multiple injuries or a history of previous knee or ankle pathology were not included as were patients who sustained high energy axial load injury-causing disruption or impaction of the ankle plafond. Results: The average distance between the distal tip of the nail and the articular surface of the plafond was 12 mm (range, 4 to 15 mm). Fibular plating was done in 10 patients. Two distal locking bolts were used in 26 patients; 2 patients had three distal locking bolts. Conclusions: Intramedullary nailing is a safe and effective technique for the treatment of extra-articular distal metaphyseal tibial fractures if careful preoperative planning is allied with the meticulous surgical technique.

DOI: 10.5281/zenodo.

Background: Fractures of the distal femur are complex injuries that pose a challenge to the orthopaedic surgeon. It constitutes about 6% of all femoral fractures. It usually occurs during high energy trauma in younger patients and frequently is associated with concomitant injuries. In contrast, elderly patients with severe osteopenia might sustain solitary distal femoral fractures from minor trauma such as a simple fall. Aim: The aim of the study is to analyse prospectively the results of Retrograde Supracondylar Intramedullary Nail in the management of Distal femoral & Supracondylar Fractures. Materials and Methods: This is a prospective study of 20 patients with supracondylar and distal femoral fractures treated with Retrograde Supracondylar nail at Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar from July 2020 to December 2021. Of the 20 patients, 11 cases were supracondylar fractures and 9 cases were distal femoral fractures. Results: In our study, 20 cases were treated by retrograde intramedullary supracondylar nail. Patients were followed up every 3 weeks till thereafter at 3 months, 5 months and 1 year. The functional outcomes were analyzed using Knee Rating System by the Hospital for Special Surgery. Of the forty cases, thirty eight were available for follow up. The functional outcome was good to excellent in 12 patients (63%), fair in 4 (21.0%) and poor in 3 patients (17.6%). Conclusion: Based on our study, we conclude that early surgical intervention and mobilization of patients will give better results. The retrograde intramedullary locked nail offers practical advantages of simple and efficient technique for patients with polytrauma, floating knee injuries and in elderly.

DOI: 10.5281/zenodo.

Background: The present study is an attempt to evaluate the results of locking compression plate for distal tibia in lower tibial fractures using open reduction internal fixation and minimally invasive plate osteosynthesis technique. Methods: Prospective and retrospective study was conduct on patients attending the outpatient department (OPD)/Emergency OPD in Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar during March 2019 to February 2020 with distal tibial fractures. The patients treated with locking compression plates using minimally invasive plate osteosynthesis (MIPO) or open reduction internal fixation (ORIF) are reviewed for inclusion and exclusion criteria. All data were collected and analyzed by Epi-info software. Results: Out of 52 patients, 48.4% patients undergo open reduction internal fixation had excellent results and 28.6% patients undergo surgery by MIPPO technique had excellent results. p value is 0.352 which is not signif-icant. Overall, 40.4% patients had excellent results. In our study, 32.6% patients having AO/OTA type A frac-tures had excellent score while type B and C had 1.9% excellent score. This is attributed to more comminution and involvement of ankle joint. Overall, 40.4% patients had excellent score. P value is 0.863 which is insignif-icant. Conclusions: We observed excellent/ good functional outcome in 65.3% of patients.

DOI: 10.5281/zenodo.

Background: Breastfeeding practices play an important role in reducing child mortality and morbidity. This study describes the breastfeeding practices. Methods: This observational prospective study was conducted on 500 newborns delivered at Department of JLNMCH Bhagalpur and outborn section of Department of Pediatrics, Jawaharlal Nehru Medical College & Hospital. Results: The effect of mother’s education on initiation of breastfeeding was found to be significant. The effect of higher family income on early initiation of breastfeeding was found statically significant. Conclusions: The study emphasizes the need for breastfeeding intervention programs especially for the mothers during antenatal and postnatal check-ups.

DOI: 10.5281/zenodo.

Background and Objective:  Iron deficiency anaemia is the most common type of anaemia. Pregnant women and infants are recognised as most vulnerable to Iron deficiency anaemia. Iron deficiency without anaemia may also adversely affect long term neurodevelopment and behaviour in infants which may be irreversible. Studies show that neonates of severe anaemic mothers tend to have low iron stores, retardation in growth and neurodevelopment. Comparison of the iron stores of neonates depicted by Cord serum Ferritin and haemoglobin levels and their anthropometric profile, is an important indicator of haematological status in newborns. These newborns were followed up at third and fourth month of life to further evaluate their Haemoglobin status and which in turn would pave the way to guidelines on iron therapy in these newborns. Materials and Methods: Our study was a Prospective Hospital based study conducted during the time period from September 2020 to July 20121 on 70 patients who satisfied the inclusion criteria and after taking an informed written consent.. Neonates were divided into three categories on basis of Hb of mother as per WHO classification. Cord blood sample is collected for complete hemogram and serum ferritin assay, anthropometric profile of these neonates weight ,head circumference, length were measured at birth, three months and at four months in whom supplementation was done as measured. Conclusion: If adequate therapy given at the right time during infancy ,then it is possible that even the children born to anaemic mothers with low haemoglobin and birth weight can catch up with the normal babies.

DOI: 10.5281/zenodo.

Background & Method: This Observational Study. study was conducted at Department of Pediatrics, at JLNMCH Bhagalpur. Study duration of Sep 2020 to July 2021. A detail history and clinical examination will be done and recorded on a proforma especially designed for the study. The etiology of the seizure was ascertained based on clinical data and relevant investigations. The neurological examination and seizure details were reviewed at discharge and once at 3 months follow up period. For those patients who did not come physically for follow up, a phone call was made to find the seizure outcome. Result: Out of 211 patients 144(68.2%) patient had excellent recovery whereas 35(16.6%) patients had partial recovery. Recovery was poor in 32(15.2%) patients. No association (P=0.063) was observed between recovery and type of seizures. Conclusion: Children with preexisting neurological deficits and those having etiologies known to have a poor prognosis had seizure recurrence on follow up at three months. Major cause of mortality in our study included severe CNS infection and hence the importance on prompt diagnosis and management for a better neurological outcome. The mortality amongst our study group was 12% and the most common cause being central nervous system infections.

DOI: 10.5281/zenodo.

Background: Most common type of anemia in developing countries is nutritional anemia. Nutritional anemia can be due to iron deficiency (most common cause), folic acid deficiency, and Vitamin B12 deficiency or may be combination of these. Other types include hemolytic anemia, which can be either congenital or acquired. In India the prevalence is about 51%. Methods: In our study of 100 patients admitted to the Paediatrics Department, at JLNMCH, Bhagalpur. the entire exclusion and inclusion criterion were studied. All the patients were subjected to a detailed history, physical examination and further investigation and management. All cases were examined in detail according to proforma, investigations, pathological examinations and other special tests were also done. Results: Pallor has been observed in 100% of patients. Fever was evident in 62% of patients followed by weakness in 77% of patients, cough in 34 %, diarrhea in 4%, breathlessness in 4% etc.73% patients were treated with oral medication while 9 % required oral injectables while remaining required mixed pattern therapy. We advised nutrition advisory / counseling for all our patients. Conclusions: In our study, severe anemia was found to be associated with morbidity and other complications. The main principles in management of iron deficiency anemia include investigation and elimination of the cause leading to iron deficiency, replacement of deficiency, improvement of nutrition and education of the patient and family.

DOI: 10.5281/zenodo.

Background: The association of sub-normal vitamin-D levels with the lower respiratory tract infections (LRTI) in children has been a topic of interest in the recent literature. Vitamin-D insufficiency been explored as modifiable risk-factor in management of the pediatric recurrent respiratory tract infections. Methods: This cross-sectional study was carried-out on 100 pneumonia cases less than 15 years for the 18 months duration from July 2022 to December 2023. All children from 6 Months to 15 years of age reporting to the Hospital (OPD and IPD) with a clinical diagnosis of LRTI were included. Results: Based on severity of pneumonia the majority of the cases had mild pneumonia (46.0%) followed by moderate pneumonia (37.0%) and severe pneumonia (17.0%). The association between age and gender with severity of pneumonia was found insignificant (p>0.05). The vitamin-D level was significantly lower in severe pneumonia cases than in moderate and mild pneumonia (p<0.001). Therefore, the severity of vitamin-D deficiency correlates with the severity of pneumonia. Conclusion: Subclinical vitamin D deficiency is a significant risk factor for severe LRTI in Indian children of less than 15 years. There was a significant association between Vitamin-D levels and recurrent respiratory tract infections. Education regarding the importance and timing of sun exposure is necessary. Routine Vitamin D supplementation is recommended in children below 15 years.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

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.

DOI: 10.5281/zenodo.

Introduction and Objective: A flat foot is a condition where the arch of the foot is reduced or absent, causing the entire bottom of the foot to touch the ground. The causes of flat feet differ among various age groups, requiring specific evaluations based on age. The objective of this study was to utilize the Plantar Arch Index (PAI) to assess the occurrence of pes planus among a group of young adults and to explore any potential connection between pes planus and obesity. This study involved 250 first-year medical students from Andhra Medical College, Visakhapatnam, during the academic year 2023-2024. It was a prospective, cross-sectional study. The PAI was calculated using Staheli’s method after obtaining ink footprints from the participants. An analysis was performed to assess the correlation between PAI and body mass index (BMI). Findings: Type III pes planus was found to have a prevalence of 8%, with a slightly higher occurrence in males. The PAI values varied from 0 to 1.720. There was no notable link discovered between obesity (as determined by BMI) and PAI in the age group under investigation. Conclusion: There is no notable link between being overweight and the development of flat feet in young adults aged 18-22 years. In this age group, the causes of pes planus can be varied and not necessarily related to body weight. The ink footprint method is a dependable and gentle technique for identifying flat feet in its early stages, similar to radiographic methods.

DOI: 10.5281/zenodo.

Background: Intestinal segment resection is one of the major surgical procedures performed in elective and emergency settings. There are various etiological factors contributing to the intestinal pathologies wherein the patient might present with intestinal obstruction or peritonitis. However, there are very few published articles describing the type of intestinal resection and correlating it with etiological factors and post-operative HPE. Therefore, our study aims to include the above criteria and its relation with southern India and how it differs from other parts of India and the rest of the world. Methods: We conducted a retrospective study of HPE reports of resected bowel segments which were collected from patient records who underwent intestinal resections. Data was subsequently analyzed, the factors beginning from the diagnosis to post-op recovery were evaluated. Results: Of the 97 patients included in the study 30 presented with AIO (Acute Intestinal Obstruction) followed by 23 with SAIO (Subacute Intestinal Obstruction) and 21 with peritonitis. During laparotomy, the most common finding was tumor followed by stricture and perforation. Ileum was the most common anatomical location of pathology as well as the cause of morbidity and mortality. Patients with ileostomy had the highest rate of mortality. Conclusion: The disease demographic is highly site and time-specific and surgeons should be ready to adapt and change their approach to management. In the setting of intestinal perforations, not all ileal perforations are due to typhoid and ileostomy doesn’t always save lives. The leading cause of non-adhesive intestinal obstruction is a tumor and a general surgeon should be in a position to do a right hemicolectomy or at least an ileocecal resection in the emergency setting followed by an anastomosis to expect a reasonably good outcome in the patient population presenting to the general surgery department.

DOI: 10.5281/zenodo.

Introduction: Carbapenem resistant Enterobacterales (CRE) is a rapidly unfolding concern in the realm of public health. Ceftazidime-Avibactam combination has excellent in vitro activity against Gram negative pathogens showing promising results with Aztreonam. Objective: To determine the phenotypic synergy of Ceftazidime-Avibactam with Aztreonam in Carbapenem resistant Enterobacterales. Methodology: 100 Carbapenem resistant Enterobacterales were included in the study and tested for Ceftazidime-Avibactam (CZA) sensitivity by Vitek2 using Critical Alert cards. Phenotypic synergy testing of CZA resistant isolates with Aztreonam (ATM) was done by Disc-E strip method. ATM discs were placed 15mm away from centre of CZA strip and incubated overnight at 37°C. Reduction in MIC of CZA by ≥3 folds and zone of inhibition around ATM >21mm was reported as synergy positive. Isolates were further tested for presence of genes coding for bla-NDM and bla-OXA-48 by conventional PCR. Results: 62/100 (62%) isolates were Klebsiella pneumoniae and 38/100 (38%) were Escherichia coli. 61/62 (98%) Klebsiella pneumoniae and 36/38 (94%) Escherichia coli isolates were synergy positive. 1 (2%) Klebsiella pneumoniae and 2 (6%) Escherichia coli were synergy negative. PCR identified bla-NDM gene in 46(46%), bla-OXA-48 in 21(21%), co-production of both in 27(27%) isolates. 6(6%) isolates were negative for both genes. Conclusion: Multidrug resistance is a threat to mankind and this combination of Ceftazidime-Avibactam with Aztreonam will help in combating this problem.

DOI: 10.5281/zenodo.

Introduction: Since the late 19th century ideal rate of the caesarean section is considered to be 10-15%. However, there has been a recent rapid surge in the number of caesarean sections being done in various medical care centres because of various reasons. To restrain this upward trend of caesarean section rates, an audit at each medical care centre is necessary. ROBSONS ten-group classification system is one of the more widely accepted methods. Aim: Analysis of caesarean section audit according to Robson criteria at tertiary health care centre. Objectives: 1. Identify and analyse the group of females which contribute most and least to overall caesarean section rate. 2. Assess the effectiveness of strategies or interventions targeted at optimising the role of caesarean section. Methods: A retrospective observational study was conducted in the Department of obstetrics, Government General Hospital attached to Rangaraya Medical College for a period of 12 months from January 2023 to December 2023. Results: During the course of this study, a total number of 2856 deliveries were recorded. Among them, 1682 (58.89%) were caesarean sections. The major cause for the caesarean section is found to be the Group 5 [multiparous with previous caesarean section, more than 37 weeks] of ROBSONS ten group classification system followed by Group 2 and 1. Caesarean section rate is much higher in primigravid as than in multigravidas in our institution. Conclusion: Induction of labour based on bishops score is best to reduce the caesarean section rate in group 2 patients. TOLACs have to be encouraged to reduce the caesarean section rate in group 5 patients.

DOI: 10.5281/zenodo.

Background: Anastomotic leak is one of the most common complications in the early postoperative phase following anastomosis, especially in those cases where anastomosis is done in emergency conditions. Aim and Objective: To determine the efficacy of conservative management with TPN in Cases of postoperative anastomotic leak. Methods: This is a prospective study of 30 cases with postoperative anastomotic leak admitted in the department of general surgery, king George hospital, Visakhapatnam over a period of 1 year from September 2022 to august 2023. Results:  25 cases (83.33%) showed spontaneous healing with conservative management by TPN.  1 case (3.33%) of high output anastomotic leak on pod-7, died on pod-11 after second surgery. 2 cases (6.66%) of anastomotic leak were managed with ostomies. Another 2 cases (6.66%) which were managed conservatively developed enterocutaneous fistulas in the follow up period. Conclusion: With the aforementioned results, we believe, in cases of anastomotic leak, Conservative management with total parenteral nutrition and nil per orals is the treatment of Choice.

DOI: 10.5281/zenodo.

Background: Anemia is a common entity in the developing world. In particular female gender is more of a sufferer owing to the indispensable physiological conditions like menstruation and child birth. According to data from the World Health Statistics, 40.1 % of pregnant women worldwide were anemic in 2016. In India, the prevalence of anemia in pregnant women aged 15-49 years has decreased from 57.9 % in the NFHS-3 (National Family Health Survey-2005-06) to 52.2 % in NFHS-5 (2019-21). Various studies have found a link between maternal anemia and negative pregnancy outcomes such as Low birth weight (LBW), preterm birth, Small-for-gestational-age (SGA), postpartum hemorrhage, and eclampsia. Aim:  To study the impact of maternal hemoglobin on cord blood hemoglobin of newborn and correlation between maternal and newborn iron levels. Methods: A cross sectional study conducted at a teaching hospital of Bihar, India for a period of one year. After ethical approval and obtained written consent from all participants, 200 mother-newborn pairs were enrolled in the study. Blood sample from mother was collected during routine investigation. Cord blood was collected after delivery of the newborn and also prior to expulsion of the placenta. Data was entered and analysed using statistical software Epi Info and Microsoft Excel. Results: The Mean age of mothers was – 27.80 years SD- 4.23, Range – 19-43 years. Majority of the mothers (63%) were multi gravida whereas only 37% mothers were primi gravida. The mean maternal hemoglobin level was 10.52±1.74, for anemic mother it was 9.18±1.34, and for non-anemic mothers it was 11.89±0.76. The mean serum iron in mothers was 108.06±37.19. 31.68% mothers had mild anemia, 58.42% mothers had moderate anemia whereas only 9.90% study mothers had severe anemia. The mean cord blood hemoglobin were 15.55±1.35 and mean cord blood iron level was 148.69, SD- 36.00. Mean cord hemoglobin between anemic and non-anemic mothers were compared and the difference between them was statistically significant with p<0.01. There was statistically significant difference between mean cord hemoglobin among anemic compared with mean cord hemoglobin of the non-anemic group. Conclusion: Iron deficiency in mothers may affect the haemoglobin and iron status of their babies. Timely intervention is needed to check this commonly prevalent problem.

DOI: 10.5281/zenodo.

Background: In the current research region, small bowel perforations are among the most frequent surgical abdominal emergencies seen. Their delayed manifestation presents a challenge for diagnosis and therapy. The current study was out to ascertain the etiological causes, clinical characteristics, age, sex, incidence, and different surgical techniques for small Bowel perforations and the associated setup problems. Methods: From October 2023 to January 2024, 100 cases were observed prospectively in a single educational institution as part of this investigation. Numerous pieces of information were examined, tallied, and assessed, including the patient’s presentation, age and sex incidence, etiologies, pathological aspects, morbidity, and mortality related to the cause and treatment. Through data analysis, frequent causes of small bowel perforations, the best modality for investigation and treatment, complications related to various management strategies, and potential preventative measures were examined. Findings: all small bowel perforations, duodenal perforations accounted for 68 % of cases. These were followed by ileal (23%) and jejunal (7%). Typhoid fever (47.8%) was the most common cause of ileal perforation, followed by TB (13%) and trauma (13%). Total death rate from minor bowel perforations was 15%, and the mortality rate from ileal perforation (39%) was higher than that from duodenal perforation (8.5%). Common side effects were wound infection, toxaemia, uraemia, hypotension, and respiratory issues; these were more frequently observed in ileal perforation cases. Conclusions: The study demonstrated that improved results in these instances were attained by efficient pre-surgical management, including sufficient fluid resuscitation, prompt operative intervention, and appropriate post-operative care. Hence, the best course of action for patients with small intestinal perforations is early identification and effective treatment.

DOI: 10.5281/zenodo.

Introduction: The standard test of real time (RT) PCR in the diagnosis of Coronavirus disease 19 (COVID-19) are reported based on the cycle threshold (Ct) value. The Ct value being inversely proportional to the viral load, limited studies have proved its relation to clinical severity. Aim: The study aimed at evaluating the correlation of Ct value with clinical severity for COVID-19 and its comparison of baseline characteristics with the two waves of the pandemic. Materials and Methods: The clinical parameters of all symptomatic COVID-19 patients positive by Truenat RT-PCR test and admitted to the hospital during the first and second waves were evaluated. Results: Among 183 patients, early testing with a mean duration of 3.6 days after onset of symptoms had higher viral load content when compared to testing at 4.6 days after onset of symptoms (p-0.003). There were no significant association observed between COVID severity, oxygen requirement, co-morbidities, outcome, wave and viral load. When compared with the two waves, a significant association was observed with age, symptom categories and presence of comorbidities. Conclusion: The Ct values of Truenat RT-PCR alone do not have a role in commenting the clinical severity among symptomatic COVID-19 patients. It can offer an opportunity to the clinicians to take extra precautions during the early stage of the disease to prevent favourable disease transmission. The first wave of COVID-19 being of longer duration, many older patients with comorbidities were infected when compared with the second wave.

DOI: 10.5281/zenodo.

Background: Abnormal uterine bleeding (AUB) can be defined as any abnormality in normal menstrual cycle. It creates emotional, physical and social discomfort to menstruating female. AUB is the commonest menstrual problem observed in perimenopausal age group. PALM–COEIN classification given by International Federation of Gynecology and Obstetrics (FIGO) as well as American College of Obstetricians and Gynecologists (ACOG) suggested currently used AUB classification system. Various diagnostic and therapeutic approaches are available to treat AUB. Material and Methods: Total 94 patients were enrolled in this study and compared their demography, different diagnostic methods used and results of medical as well as surgical treatment modalities. Results: Transvaginal ultrasonography (TVS) is a method of diagnosis to rule out endometrial and intrauterine abnormalities. However, Ultrasound allows examining endometrium, and its hyperplasia, polyp/ fibroid. If it is abnormal or inconclusive then further investigations may be needed. Medical treatment is the preferred choice but Hysterectomy is the definitive surgical treatment for AUB. Conclusion: TVS is the superior diagnostic method and hysterectomy is the definitive treatment for AUB.

DOI: 10.5281/zenodo.

Background: Chronic pancreatitis is characterized by progressive and irreversible damage of exocrine as well as endocrine functions of the gland that eventually results in significant impairment. Objective:  To study the outcome of optimum surgical management of chronic pancreatitis. Methods: A hospital based observational follow up study was undertaken among the patients attending surgical units of a tertiary care institute in Assam, who were diagnosed as chronic pancreatitis. Results: Total 50 patients presenting with symptoms of chronic pancreatitis, confirmed by radiological and laboratory investigation were included in the study. Most of the cases were 41-50 years (32%) of age, with a male, female ratio of 7:3. Pain abdomen was the main complaint of each patient (100%), followed by nausea and vomiting in 66% patients. Majority of the patients had epigastric tenderness (38%) followed by tenderness on left hypochondrium. Out of 50 patients, 29 patients treated conservatively and where 6 patients had aggravated symptoms after initial recovery. So, 27 patients required surgical interventions. A systematic follow up of all patients done upto 12 months. It was found that all patients undergoing surgery recovered from abdominal pain, irrespective of the type of surgical procedure. Conclusion: An integrated approach for correct diagnosis and planning early intervention is required for chronic pancreatitis.

DOI: 10.5281/zenodo.

Background: The abdominal emergency particularly those due to intestinal perforation has remained a great challenge to the surgeon from the time of immemorial. The fluctuating clinical course associating with its poor prognosis in these cases are due to late presentation because of poverty, illiteracy and ill planned management of local quacks. The intestinal perforation, a common occurrence this part of the country, is associated with peritonitis and requires emergency surgical management. The exact underlying cause of perforation is difficult to ascertain preoperative and even in post-operative in some cases. Taking all these factors into consideration, the present study is under taken to evaluate the different anatomical location of the perforation, age, sex, effect of seasonal variation and in end to assess to the different operative modalities of management for better outcome in these patients. Aim and Objective: The aim of this study is to observation and modalities of management of intestinal     perforation. The following parameters were evaluated for Intestinal perforation: 1. Patient selection. 2. Operative technique. 3. Complication, 4. Outcome. 5. Follow up. Patients and Methods: This study on aetiological observation on intestinal perforation and its management was carried out in M K C G Medical College hospital, Berhampur from January 2023 to December 2023. The patients who were admitted to the indoor surgical wards with the diagnosis of acute abdomen were taken as material and the detail clinical study, investigation as necessary, pre-operative and operative finding were recorded in a preformed proforma, after taking proper consent and those patients who came out to intestinal perforation were studied and the patient with gastric and duodenal perforation were excluded from the study. Results: In this study there were 450 cases of acute abdomen with different aetiology and out of all 380 cases underwent Laparotomy. 50were conservatively treated in standard method because they were not suitable or fit for operation. Out of these 50 patients 35 patients recovered and 15 patients expired. Another 20 patients left the hospital of their own accord. The incidence was higher during the rainy season. The commonest organism isolated in the peritoneal fluid was E.Coli 70%. In this study trauma was most common cause of intestinal perforation accounting for 40%. In 78% of cases ileostomy and simple closure of the perforation was done. In Laparotomy, free fluid in the peritoneum was seen in all cases and free gas in the peritoneum was seen in 46 cases (92%). All case of traumatic perforation was treated with simple closure. Conclusion: Intestinal perforation is one of the most dangerous abdominal catastrophes. It has delayed presentation and difficult pre-operative diagnosis. The post-operative period is usually stormy and full of complications with a high mortality. Hence, we conclude that after appropriate pre-operative resuscitation, all cases of acute abdomen with provisional diagnosis of intestinal perforation must be opened as early as possible to settle the diagnosis to prevent the continued pouring out of intestinal contents in the peritoneal cavity, to limit the septicaemia and to undergo appropriate surgical procedures so as to reduce the ultimate mortality and morbidity. The golden principles of these case of acute abdomen coming with severe toxaemia fall back it the aphorism. It is better to look and see then wait and see.

DOI: 10.5281/zenodo.

Background: Anogenital warts are predominantly attributed to human papillomavirus (HPV) infection, yet the influence of epigenetic factors, particularly DNA methylation, remains uncertain. Clarifying these relationships could enhance understanding of pathogenesis and potential oncogenic biomarkers. Aim: This cross-sectional study aims to explore the prevalence of HPV genotypes and assess DNA methylation patterns in patients diagnosed with anogenital warts in eastern India. Material and Methods: Patients aged 18 to 60 years, diagnosed with anogenital warts, were recruited from a tertiary care teaching hospital. Anogenital scrapings were subjected to RT-PCR for HPV genotyping and ELISA for DNA methylation analysis. Results: Among participants, 93% of anogenital warts showed no association with HPV, while 2% were linked to HPV 16 and 1% to HPV 18, with an equal gender distribution. However, no significant differences in DNA methylation patterns were observed between patients with anogenital warts and healthy controls. Conclusion: This cross-sectional investigation reveals a limited correlation between anogenital warts and HPV infection or DNA methylation in the studied population. Future longitudinal studies are warranted to explore additional factors influencing anogenital wart pathogenesis and identify potential biomarkers for oncogenic risk assessment.

DOI: 10.5281/zenodo.

Background:  Laparoscopic cholecystectomy is a standard treatment for patients with gallstones in the gallbladder. However, multiple risk factors affect the probability of conversion from laparoscopic cholecystectomy to open surgery. Aim: This study aimed to identify risk factors and circumstances that could lead to the conversion of laparoscopic cholecystectomy to open surgery. Laparoscopic cholecystectomy offers benefits like reduced hospitalization, reduced postoperative pain, accelerated recovery, and improved cosmetic outcomes. Understanding these factors is crucial for enhancing patient safety and preventing surgeons from being forced to switch to open surgery. Methods: A prospective cohort research was conducted on a sample of 300 patients who were admitted to the Department of General Surgery at Government Erode Medical College Hospital in Perundurai, Tamil Nadu. The study was conducted between August 2022 and December 2023. The study comprised a total of 5 out of 300 patients who were initially scheduled for laparoscopic cholecystectomy but had to undergo open cholecystectomy instead. The recorded and analyzed factors were the patient’s age and sex, presence of diabetes mellitus, previous episode of Acute Cholecystitis, Body Mass Index, existence of abdominal scar, total count, Ultrasonagram Abdomen findings of Gallbladder wall thickness, and presence of pericholecystic fluid. Results: Out of the 300 patients in our study, a total of 5 individuals (2%) underwent a conversion to open surgery. Observations have shown that several factors related to the patient and the disease is significant risk factors for converting laparoscopic cholecystectomy to open cholecystectomy. These factors include age over 50 years, male gender, presence of diabetes mellitus, obesity, previous abdominal surgeries, previous episode of acute cholecystitis, presence of acute cholecystitis, gallbladder wall thickness over 4mm, and presence of pericholecystic fluid. Conclusions: These risk variables aid in predicting the complexity of the treatment, enabling the surgeon to provide patients with more accurate information regarding the likelihood of needing to convert from laparoscopic to open cholecystectomy. Predictive risk assessments or nomograms are highly valuable tools for risk classification in clinical scenarios. By utilizing these predictive methods, doctors can enhance the quality of care by considering the established risk factors for the conversion, while patients can have a more comprehensive understanding of the potential hazards associated with their procedure.

DOI: 10.5281/zenodo.

Introduction: Lung cancer is one of the most frequent and severe malignancies in the world. It has a poor prognosis. The present study was done to study the clinical, radiological, and histological profiles of lung cancer patients. Materials and Methods: This cross-sectional descriptive research was conducted over a one-year period on 50 patients with primary lung cancer who were diagnosed radiologically and histopathologically and visited the Warangal hospital and diagnostic center. The clinicopathological, radiological, and Histopathological profile data were entered in a predesigned proforma. Results: The study involved 50 patients: 40 males and 10 females. Patients ranged in age from 40 to 85 years, with the majority being between the ages of 61 and 70. 36 male patients (72%) had a smoking history. Four of the 14 non-smokers were men, and ten were women. Bidi smokers accounted for 76% of all smokes. Cough was the most common clinical manifestation, affecting 47 patients (94%). The most prevalent chest radiographic characteristic was a mass lesion, which was identified in 50 individuals (100%). The most common histological kind of lung cancer was adeno carcinoma, which was detected in 31 cases (62%). Conclusion: Awareness of symptoms and related risk factors is critical for early diagnosis of lung cancer, reducing mortality and mobility. Patients with a history of smoking and persistent respiratory symptoms should be checked immediately for lung cancer.

DOI: 10.5281/zenodo.

Introduction: Total knee arthroplasty (TKA) is a common procedure for improving mobility and quality of life in patients with osteoarthritis. The present study was conducted to compare the efficacy of intra-articular infusion analgesia and epidural versus following total knee replacement. Materials and Methods: 60 patients were included in a randomized prospective study and distributed in 2 groups.  Patients in Group 1 received LIA and Group 2 EA. Patients were assessed for visual analogue score (VAS) for pain to determine the analgesic effect. Complications such as paraesthesia in the lower limbs, hypotension, urinary retention, and abdominal distension were recorded, and rehabilitation progress was recorded. Result: The pain was significantly more in EA group than in LIA group. With respect to complications, Patients with epidural infusion analgesia had a significantly higher complication rate in terms of hypotension (48% vs. 28%), paraesthesia in the lower extremities (44% vs. 12%,)  and higher abdominal distension rate (24% vs. 4%). Patients with intra-articular infusion analgesia were able to stand/ walk (2.02 vs. 3.01 days,) and climb stairs earlier (3.96 vs. 4.12 days,) which was significant. Conclusion: It was concluded that Intra-articular infusion analgesia was associated with less intensity of pain, fewer complications and earlier rehabilitation compared to epidural analgesia.

DOI: 10.5281/zenodo.

Background: An individual’s natural inclination towards the time of the day, when they prefer to sleep or to be active, can be known by their chronotype. It is important for the circadian rhythm and influences the physical and psychological well-being. Our study focuses on assessing the chronotype and its relationship with depressive symptoms and sleep quality in the undergraduate medical students. Methodology: It is a cross-sectional study, done in 290 students between 18-25 years of age, studying first and final year MBBS. They completed the Morningness-Eveningness Questionnaire (MEQ), Quick Inventory of Depressive symptomatology (QIDS) and Pittsburgh Sleep Quality Index(PSQI). Individual scores for each scale were taken and compared between both groups. The effect of chronotype and its association with depressive symptoms and sleep quality was assessed in both the groups. Results: Among first years, 11% had evening-chronotype, 28.7% -moderate, 25.4% -severe depression and 44.5% had significant sleep disturbances. Among final years, 11.8% had evening-chronotype, 34% -moderate, 22.3% -severe depression and 33.3% had significant sleep disturbances. There was a significant negative correlation between chronotype and sleep quality in both groups. No statistically significant difference was found between both groups. Conclusion: Our study showed that students with evening-chronotype had poorer sleep quality. Although students with evening chronotype scored higher on depressive scale, it was not statistically significant. A prospective study is necessary to understand the temporal relationship of chronotype with sleep and depressive symptoms.

DOI: 10.5281/zenodo.

Background and Objectives: This study aimed to compare the safety and efficacy of tenecteplase and alteplase as thrombolytic agents in the management of acute ischemic stroke in a single-center setting. Material and Methods: We conducted a retrospective comparative analytical study involving patients who presented to the emergency department of MGM Hospital with acute ischemic stroke and were Thrombolysed with either alteplase or tenecteplase between March 2021 and December 2022. Patients were divided into two groups: Group A (alteplase, n=25) and Group B (tenecteplase, n=25). Primary outcomes included the modified Rankin Scale (mRS) at 24 hours, 3 days, 7 days, and 28 days, as well as the NIH Stroke Scale (NIHSS) score at 24 hours. Secondary outcomes included ICU and hospital stay duration, and mortality. Results: The mean Glasgow Coma Scale (GCS) on admission was significantly lower in Group A (7.80 ± 3.81) compared to Group B (12.88 ± 1.94) (P<0.05). After 72 hours, Group A’s mean GCS remained lower (11.08 ± 4.54) compared to Group B (14.64 ± 1.11) (P<0.05). Group A had higher NIHSS scores on admission (16.04 ± 7.17) than Group B (11.16 ± 5.50) (P<0.05), and at 72 hours (11.24 ± 7.29 vs. 6.72 ± 4.87, P<0.05). mRS scores on admission were higher in Group A (3.76 ± 1.17) compared to Group B (2.88 ± 1.05) (P<0.05), and at 3 days (2.72 ± 1.31 vs. 1.96 ± 1.06, P<0.05), but not significantly different at 7 and 28 days. Group A had a significantly higher mean infarct volume compared to Group B (P<0.05). There were no significant differences in systolic and diastolic blood pressures, random blood sugar levels, ICU stays, and hospital stays. Conclusion: Tenecteplase demonstrated better early neurological improvement and lower infarct volumes compared to alteplase, despite similar long-term functional outcomes and safety profiles. These findings suggest that tenecteplase may be a viable alternative to alteplase for thrombolysis in acute ischemic stroke.

DOI: 10.5281/zenodo.

Background: Suprascapular nerve block (SSNB) is an effective method for the treatment of shoulder disorders. The present study was conducted to evaluate and compare the effectiveness of SSNB under ultrasonographic guidance with anatomical landmark-guided (LMG) technique in the treatment of adhesive capsulitis shoulder. Objectives: To evaluate and compare the clinical and functional outcomes of ultrasound (US)-guided versus landmark-guided SSNB for the treatment of adhesive capsulitis shoulder. Study design: Randomized, prospective analysis. Setting: Patients attending Opd and casualty of department of orthopaedics of GMCH. Materials and Methods: 500 patients with chronic shoulder pain and stiffness were enrolled. The patients were randomly allocated into 2 groups.250 patients received US-guided SSNB with 5 ml of 0.75% ropivacaine and 250 underwent landmark-guided SSNB with same drug . Initial examinations before injection, first week and first and third months post injection were recorded. Visual Analog Scale (VAS) pain intensity levels, shoulder functions based on the Shoulder Pain and Disability Index (SPADI) were evaluated. Results: Statistically significant recovery was observed in terms of VAS pain levels, SPADI from the first week after injection in both groups, but no significant difference was observed between the groups. Discussion: In our study the techniques of the SSNB, i.e., USG and LMG resulted in decreased pain score, improved range of motion, and decreased SPADI scores after 3 months of administration of block. However, when both the techniques were compared with each other the improvement in pain score and shoulder movement and decrease in SPADI scores were comparable. Conclusions: Our results indicate that US-guided SSNB does not potentially offer a significantly greater clinical improvement over landmark-guided SSNB in patients with adhesive capsulitis shoulder. However Further research is required to establish this hypothesis in clinical practice.

DOI: 10.5281/zenodo.